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Scalable Targeting of Social Protection: When Do Algorithms Out-Perform Surveys and Community Knowledge?
Full text linkInnovations in big data and algorithms are enabling new approaches to target interventions at scale. We compare the accuracy of three different systems for identifying the poor to receive benefit transfers — proxy means-testing, nominations from community members, and an algorithmic approach using machine learning to predict poverty using mobile phone usage behavior — and study how their cost-effectiveness varies with the scale and scope of the program. We collect mobile phone records from all major telecom operators in Bangladesh and conduct community-based wealth rankings and detailed consumption surveys of 5,000 households, to select the 22,000 poorest households for $300 transfers from 106,000 listed households. While proxy-means testing is most accurate, algorithmic targeting becomes more cost-effective for national-scale programs where large numbers of households have to be screened. We explore the external validity of these insights using survey data and mobile phone records data from Togo, and cross-country information on benefit transfer programs from the World Bank
Period Poverty And The Politics Of Refusal: Building Menstrual Equity Beyond The State Through Mutual Aid
Full text linkThis thesis examines period poverty as a consequence of systemic neglect, disproportionately affecting those made vulnerable by intersecting structures of racial, gendered, and economic injustice. Situating menstruation as a public health crisis shaped by policy failure, social stigma, and institutional disregard, this research critiques dominant legal and policy frameworks that approach menstrual equity through a limited scope that overlooks deeper structural inequalities rooted in race and class. This thesis explores how marginalized populations experience legal and welfare systems as sites of surveillance and moral judgment in the context of menstrual equity. Through seven semi-structured interviews with menstrual justice organizers, this study illustrates how these spaces function as holistic sites of resistance, rejecting stigma and reimaging health infrastructure in ways state programs have failed to do. Ultimately, this thesis calls for public health practitioners to recognize and defer to community expertise to address period poverty with a trust-centered approach. By foregrounding the lived experiences of grassroots organizers, I hope this work contributes to ongoing conversations in public health, reproductive justice, and menstrual equity to urge a reexamination of the state’s role in perpetuating and potentially redressing menstrual injustice
The Mortality Effects Of Daily Ambient Pm2.5 Concentrations By Urbanicity In North Carolina
Full text linkDaily ambient PM2.5 (particulate matter ≤ 2.5 µm) concentration poses substantial health risks. PM2.5 comes from various sources, leading to regional differences in concentrations. Urban areas generally experience higher PM2.5 concentrations compared to rural areas. However, urban-rural differences in the relationship between daily PM2.5 concentration and adverse health effects remain unclear. The mortality effects of daily PM2.5 concentration across all counties in North Carolina were analyzed both temporally and spatially over a five-year period (2015-2019). A two-stage time series analysis was conducted using a quasi-Poisson regression model with various lag structures to estimate the relative mortality risk for each county. A meta-analysis was then performed to pool these estimates. All analyses were stratified by urbanicity. Further analysis using the selected lag model included sensitivity and spatial analyses. For spatial analysis, both Global and Local Moran’s I statistics were calculated to determine spatial autocorrelation. For single-day lags, lag 0 and lag 1 showed statistically significant associations. A 10 μg/m³ increase in daily ambient PM2.5 concentration was associated with a relative risk (RR) of 1.02 (95% CI:1.00, 1.03) at lag 0 and 1.01 (95% CI: 1.00, 1.02) at lag 1. For cumulative-day lags, a 10 μg/m³ increase in PM2.5 was associated with significantly elevated relative risks of 1.02 (95% CI: 1.00, 1.03) at lag 0-1 (lag 0 to lag 1), 1.02 (95% CI: 1.00, 1.03) at lag 0-2 and lag 0-3, 1.02 (95% CI: 1.00, 1.04) at lag 0-4 and lag 0-5. Cumulative-day lags were significant for urban counties, while no significant associations were observed in rural counties. However, there was no statistically significant difference in the effect estimates between urban and rural counties. Spatial analysis showed no significant clustering of total mortality risk (Global Moran’s I = -0.06, p = 0.76); Local Moran’s I identified a few significant clusters including two hot and cold spots in southeastern urban counties. Sensitivity analysis confirmed model robustness, with consistent PM2.5 -mortality associations. Overall, this study found that daily ambient PM2.5 concentration is associated with an increased risk of mortality, particularly in urban areas with cumulative exposure. However, the differences between urban and rural areas were not statistically significant, and no clear spatial clustering of mortality risk was detected across North Carolina
Workplace Violence Involving Practitioners In Veterans Health Administration Emergency Departments: An Analysis Of Reports Submitted To The Vha Disruptive Behavior Reporting System, 2018-2023
Full text linkBackground: Published reports and survey data indicate that workplace violence (WPV) in emergency departments (EDs) is on the rise. The severity of WPV incidents and extent to which this trend affects staff differentially by role is less well characterized. This study analyzed workplace violence reports from a nationwide integrated health system to evaluate this observation. Methods: Reports submitted to the Veterans Health Administration (VHA) Disruptive Behavior Reporting System (DBRS) were analyzed. The sample included all reports from over 170 VHA emergency departments across the United States, spanning fiscal years 2018 to 2023. The association between the severity of outcomes and incident characteristics documented in each DBRS report, including shift, tour, type of behavior, relationship to alcohol or substance abuse, use of physical containment, and year the report was filed was evaluated. Outcomes for VHA staff experiencing violence, distinguishing between those in “practitioner” based roles (licensed professionals such as physicians, physician assistants, nurse practitioners, and other advanced practice providers) and those in “non-practitioner” roles (including nurses, medical assistants, and other clinical and administrative staff) were compared. Results: Shift and tour were not significantly associated with greater outcome severity. Incidents involving criminal intent, physically disruptive behavior, alcohol or substance abuse, and the need for physical containment were significantly associated with greater outcome severity across all roles. Conversely, verbally disruptive incidents were associated with less severe outcomes. The severity of outcomes in reports involving practitioners was comparable to those involving non-practitioners. While the proportion of incidents involving practitioners significantly increased over time, the proportion of incidents with severe outcomes remained stable. Conclusions: The experience of WPV within the VHA aligns with findings from other published studies. The findings of this study support the perception that WPV involving practitioners is increasing in frequency
Measuring Sexual Citizenship: Health, Rights, And Pleasure In The Wake Of National Level Policy Changes – Considering Namibia
Full text linkWhile public health evidence and rhetoric is frequently leveraged in scholarship and policy advocacy related to changes in law/policy targeting LGBTQ+ individuals, the existing public health body of evidence surrounding punitive and progressive policy shifts does not fully account for the interconnectedness of the law’s impacts on health, rights, pleasure, and belonging. To address this and pave the way for more representative research, the triangle of sexual citizenship framework links pleasure, rights, health, and sexual citizenship as key, connected components of research in this field. To account for hesitancy and confusion on how to integrate components of the triangle of sexual citizenship into health research, this thesis presents a scoping review and evaluation of public health methodologies and study designs based on their ability to address oft forgotten connections, represented by the triangle of sexual citizenship framework. Learnings from the scoping review and methods evaluations are applied to Namibia as a case study for future research recommendations in the face of anticipated changes to law/policy impacting LGBTQ+ individuals
Evaluating Clinical Outcomes And Cost-Effectiveness Of Aspirin And Clopidogrel Versus Factor Xa Inhibitors And Clopidogrel For Treatment Of Patients With Peripheral Arterial Disease After Lower Extremity Revascularization
Full text linkIntroduction and Objective: Antithrombotic treatment plays a critical role in managingperipheral arterial disease (PAD) and reducing the risk of major adverse limb events (MALE) and major adverse cardiovascular events (MACE) after revascularization. Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is the most commonly used regimen for medical management to prevent cardiovascular events following revascularization. Still, emerging studies suggest that dual antithrombotic pathway inhibition (DAPI), which combines a Factor Xa inhibitor with clopidogrel, may offer enhanced protection. This study evaluates the clinical outcomes and cost-effectiveness of DAPI compared to DAPT in patients undergoing lower extremity revascularization (LER).
Methods: A retrospective cohort analysis was conducted on patients who underwent open orendovascular LER at a tertiary healthcare institution. After applying a 4:1 propensity score matching (PSM), patient characteristics and outcomes of those discharged on DAPT and DAPI were compared. Cost-effectiveness was evaluated over a five-year horizon using modeled costs and quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) was calculated. The willingness-to-pay threshold (WTP) was set at 73,826 vs. 30,331 per QALY, indicating it is a cost-effective intervention compared to DAPT.
Conclusions: DAPI is associated with superior limb-related outcomes and represents a cost-effective alternative to DAPT for antithrombotic management post-revascularization
Association Between Primary Covid-19 Vaccine Type And Booster Uptake Among Incarcerated People In Connecticut: A Retrospective Cohort Study
No full textImportance: Booster doses of the COVID-19 vaccine are critical for maintaining protection against SARS-CoV-2, especially in high-risk settings such as correctional facilities. Understanding how initial vaccine type influences booster uptake can inform vaccination strategies in these and other underserved populations.Objective: To assess whether the type of COVID-19 vaccine received for the primary series—either viral vector (Janssen/Jcovden) or mRNA (Moderna/Spikevax or Pfizer-BioNTech/Comirnaty)—was associated with timing or likelihood of booster completion among incarcerated individuals. Design: Retrospective cohort study using survival analysis methods. The study period spanned from February 2, 2021, to May 31, 2023. Setting: Connecticut Department of Correction (DOC) facilities, including both jails and prisons. Participants: The study included 6,404 individuals who were incarcerated during the study period, completed a primary COVID-19 vaccine series (one dose of Janssen or two doses of Moderna or Pfizer-BioNTech), and became booster eligible while incarcerated. Individuals were excluded if vaccine manufacturer data were missing, if they received a booster before eligibility, or if they left DOC custody before becoming eligible or contributing follow-up time. Exposures: Primary COVID-19 vaccine type: Viral vector (Janssen/Jcovden) or mRNA (Moderna/Spikevax or Pfizer-BioNTech/Comirnaty) Main Outcomes and Measures: Time from booster eligibility to booster receipt. Cox proportional hazards models estimated the association between vaccine type and booster uptake, adjusted for age, gender, and race, and stratified by facility type and calendar month of booster eligibility. Results: Among the 6,404 included individuals, (median age at eligibility: 39 years), 891 received Janssen for their primary series, 4,997 received Moderna, and 516 received Pfizer. Overall, 3,538 individuals (55.2%) received a booster. Median time from primary vaccination completion to booster receipt was 113 days for Janssen recipients, 67 days for Pfizer recipients, and 63 days for Moderna recipients. Compared to Janssen recipients, the adjusted hazard of booster receipt was higher among mRNA (combined) recipients (aHR: 2.02; 95% CI: 1.63–2.50), as well as for Moderna recipients (aHR: 2.14; 95% CI: 1.72–2.66) and Pfizer recipients (aHR: 1.34; 95% CI: 1.03–1.75). Conclusions and Relevance: Primary vaccine type was strongly associated with the timing and likelihood of booster uptake in this incarcerated population. Perceptions shaped by early public health messaging—including concerns around safety and efficacy and the framing of Janssen as a single-dose vaccine—may have influenced future vaccination behavior. Public health campaigns should address concerns raised as new information on vaccine efficacy and safety emerges, which in turn may impact uptake of booster vaccination
Impact Of Maternal Chronic Diseases In Pregnancy On Duration Of Infant Intake Of Breastmilk In The Postpartum Period
Full text linkBackground: Chronic disease in pregnancy, including hypertensive disease, diabetes, and mental health disorders, is associated with adverse mother and infant health outcomes. Breastfeeding offers well-documented benefits, but currently, little evidence exists on how maternal chronic disease impacts the duration of breastfeeding postpartum, especially multiple chronic disease diagnoses. Objectives: To examine associations between maternal chronic disease and (1) duration of any breastmilk feeding through six months postpartum, (2) in-hospital infant feeding patterns, and (3) the impact of in-hospital breastmilk exposure on postpartum duration of breastmilk feeding among women with a chronic disease. Methods: This retrospective cohort study analyzed 1,294 maternal-infant records from full-term births at a single hospital (Sept 2021–Apr 2023), with pediatric and postpartum follow-up at a federally qualified health center. Infants with prolonged hospitalization (\u3e7 days), death before six months, or required parenteral nutrition were excluded. Cox proportional hazard and Poisson models were used to address the study aims, adjusting for confounders. Results: Any chronic disease (adj HR = 1.66, 95%CI [1.33-2.07]), hypertensive disease (HR = 1.34, 95%CI [1.08-1.67]), mental health disorder (HR = 1.70, 95% CI [1.39-2.08]), and multiple diagnoses (HR = 1.27, 95% CI [0.98-1.63]) were associated with earlier cessation of postpartum breastmilk feeding. These diagnoses were also associated with lower in-hospital breastmilk feeding rates (e.g., any chronic disease adj RR = 0.97, 95%CI [0.94-1.00]) and higher formula feeding. Exclusive breastfeeding at discharge was linked to prolonged breastmilk feeding postpartum in all groups except those with diabetes (e.g., any chronic disease adj HR = 0.48, 95%CI [0.36-0.64]). Conclusions: Maternal chronic disease was associated with a shorter duration of breastmilk feeding and reduced exclusive breastfeeding. In-hospital breastmilk exposure improved postpartum duration. Future research is needed to understand better the factors contributing to early cessation of breastfeeding in this population
Global Perspectives On 1,4-Dioxane: Environmental Persistence, Detection Strategies, And Policy Frameworks
Full text link1,4-Dioxane is a persistent environmental contaminant present in industrial activities, pharmaceutical manufacturing, and consumer items, particularly challenging to manage due to its high solubility in water and resistance to traditional water treatment processes. Although some countries have implemented stringent regulatory measures, there is a lack of consistent detection and remediation of 1,4-Dioxane in the environment, potentially leading to unregulated contamination in areas with insufficient monitoring capabilities.
In this literature review, studies that have already been published focusing on 1,4-dioxane pollution in China, South America (including Brazil, Argentina, and Peru), and Europe (Germany and the Netherlands) will be evaluated against relevant literature on the United States. This evaluation will encompass investigations of industrial emissions, remedial regulations, and detection capabilities in the 1.4-dioxane area to identify deficiencies in contamination control and to clarify the contamination risks posed by the industrial circumstances of each nation. Following a comparative analysis of the reviewed literature and relevant GIS mapping conducted on the subject, this review aims to elucidate successful remediation strategies and the necessity for standardized detection methods
Exploring The Chemistry Of Wildfire Smoke: Leveraging High-Resolution Mass Spectrometry Approaches To Detect Chemical Signatures
Full text linkBackground: Wildfire smoke is an increasingly important public health concern. While regulatory monitoring emphasizes fine particulate matter (PM2.5), wildfire smoke is composed of complex mixtures of volatile and semi-volatile organic compounds (VOCs and SVOCs), many of which are harmful to human health but are understudied.
Methods: Fresh Air Clips, passive chemical samplers, were deployed in Kamloops and Kelowna from March to September 2024 to measure VOC and SVOC concentrations before, during, and after the wildfire season. Chemical samples were analyzed using high-resolution mass spectrometry. PM2.5 concentrations, wildfire perimeters, wind direction and speed data, and HYSPLIT back-trajectories were integrated to classify wildfire smoke days and infer pollutant transport pathways and sources. Bayesian Profile Regression was applied to identify and characterize multi-pollutant exposure clusters.Results: PM2.5 and chemical concentrations peaked between mid-July and August, with Kamloops consistently recording higher levels than Kelowna. Bayesian clustering revealed four chemical profiles. Clusters 1 and 3 reflected background conditions in Kelowna and Kamloops, respectively. Cluster 2 captured wildfire smoke signatures rich in PAHs and phthalates, and Cluster 4 indicated a mixed source of wildfire and industrial pollutants, including di-n-butyl phthalate. Wind and trajectory analyses highlighted Canada-US cross-border transport.
Conclusion: Wildfire smoke contains a diverse mix of health-relevant pollutants, including plasticizers and PAHs, whose composition reflects both fuel type and transport dynamics. This study underscores the need for chemical-specific monitoring, transboundary air quality coordination, and targeted source attribution to inform public health responses during wildfire events