Search Results (25)

Understanding how vaccination-event characteristics relate to doses administered can inform public health delivery strategies. This study examined associations between modifiable characteristics of community-based COVID-19 vaccination events and doses administered per event. We conducted a retrospective analysis of 631 vaccination events coordinated by the Louisville Metro Department of Public Health and Wellness (LMPHW) in Jefferson County, Kentucky, between March 2021 and May 2022. The outcome was the number of COVID-19 vaccine doses administered per event. Multivariable regression models assessed associations between event characteristics and doses administered per event. Across all events, 27,767 COVID-19 vaccine doses were administered. Each additional hour of event duration was associated with 21.6% more doses administered per event (95% CI: 14.0–29.8%). Weekend events were associated with 87.8% more doses administered per event than weekday events (95% CI: 45.7–142.0%). Compared with government-hosted events, 44.7% more doses were administered at non-profit organizations, 110.0% more at business organizations, and 57.8% more at medical service providers. LMPHW-only events were associated with 198.4% more doses administered per event than partnered events (95% CI: 120.1–304.6%). Principal findings were generally consistent across sensitivity analyses. These findings may help inform planning of future community vaccination and other immunization initiatives. Full article

Background: Older adults (aged 65 and older) faced a disproportionate burden of mortality during the COVID-19 pandemic, yet substantial geographical and sociodemographic disparities in vaccine uptake persisted within this vulnerable population. Objective: To examine the temporal dynamics of COVID-19 vaccination rates among older adults and investigate the association between vaccination uptake and neighborhood-level social determinants of health (SDOHs), including disability and poverty. Methods: COVID-19 vaccination data for older adult residents in Jefferson County, Kentucky, were obtained from the Kentucky Immunization Registry (KYIR). ZIP-code-level vaccination rates were calculated at three time points: 28 February 2021 (Q1), 31 May 2021 (Q2), and 31 May 2022 (Q6). The rates were linked to 2021 American Community Survey (ACS) ZIP code-level estimates of disability, poverty, and household composition. Two-dose COVID-19 vaccination rates stratified by race, ethnicity, and geographic region were used as outcome measures. Pearson correlation coefficients, bivariate, and multivariate linear models were used to estimate the association between COVID-19 vaccination rates and the SDOHs at the ZIP code level. Results: Among the estimated 139,222 older adults, overall two-dose vaccination rates rose from 22.4% in Q1 to 77.5% by Q6. Significant regional disparities were observed early in the campaign, with Q1 rates ranging from 12.6% in the Southwest to 35.4% in the Inner East county regions. Bivariate analyses showed ZIP-code-level disability and poverty rates were negatively associated with ZIP-code-level vaccination uptake in Q1 (disability slope: −0.38; 95% CI, −0.63 to −0.13; poverty slope: −0.36; 95% CI, −0.65 to −0.07). By Q6, the negative association between disability and vaccination had weakened significantly and was no longer statistically significant, while the negative association between poverty rate and vaccination rate remained persistent across all time points. Conclusions: The disability-associated gaps in older adults’ vaccination rates were dynamic and narrowed over time, whereas the poverty-associated gaps remained persistent and static. The low uptake observed among Black and Hispanic older adults in historically underserved areas suggests that understanding the specific factors that most negatively associate with vaccination rates in these populations, such as specific disabilities, may mitigate structural barriers. Future public health interventions should prioritize socioeconomically disadvantaged neighborhoods and account for the evolving association of functional impairments and healthcare access. Full article

Background: Infectious diseases accounted for approximately 18.4% of global mortality in 2019. According to the World Health Organization (WHO), vaccines are available for about 30 potentially lethal diseases. Vaccination prevents substantial mortality and hospitalization. However, its ability to improve overall public health depends on equitable access across all populations, regardless of race, ethnicity, education, or socioeconomic status. Objectives: This study aims to examine how disparities in social determinants of health (SDOH) affect COVID-19 vaccination uptake across Jefferson County, Kentucky. Using ZIP code–level spatial mapping, this study investigates the intersection of SDOH, racial composition, and geographic characteristics to identify inequities and inform equitable interventions. Methods: Data from the Kentucky Immunization Registry (KYIR) were analyzed to assess two-dose COVID-19 vaccination rates at the ZIP code and regional levels in Jefferson County, Kentucky. Vaccination rates were stratified by race and ethnicity and linked with SDOH, including education, employment, insurance status, and income, obtained from the 2021 American Community Survey. Results: By May 2021, vaccination rates ranged from 25.9% in the West region to 57.0% in the Inner East region; by May 2022, these rates increased to 46.2% and 73.9%, respectively. White residents consistently had the highest two-dose vaccination rates (66.4% by May 2022), while Black and Hispanic residents had lower rates (45.7% and 43.9%, respectively). Vaccination rates were strongly correlated with SDOH, especially educational attainment, average family income, and employment rate, underscoring the role of socioeconomic inequities in vaccination disparities. Conclusions: Geographical and racial disparities emphasize the influence of social and economic inequality on vaccine uptake. Full article

This study presents a comprehensive framework for flood susceptibility mapping by integrating geospatial factors with both statistical and machine learning models. Thirteen Flood-related factors, including DEM, slope, TWI, NDVI, etc., are extracted as features of models, and historical flood data derived from Sentinel-1 SAR from 2018 to 2023 are used as the target variables of the models. These datasets are analyzed using a frequency-based statistical model and three machine learning models, including Random Forest, XGBoost, and CNN, to generate flood susceptibility maps. The performance of each model is evaluated through AUC; and SHAP scores are separately generated for Machine learning (ML) models to explain each feature contribution in the ML model. The generated susceptibility maps are validated by high-flood-risk locations monitored by flood sensors, BLE inundation models, and flood-prone areas suggested by the Local Community Task Force. The results indicate that the XGBoost model outperforms all other models, with an AUC of 0.92 and demonstrates the highest alignment with recommended high-flood-risk locations, while the frequency-based statistical model showed the weakest performance with an AUC of 0.65. SHAP value graphs highlight the elevation, slope, and TWI as the most influential features across all models. The susceptibility maps generated by the machine learning model show strong agreement with the BLE map and high-flood-risk areas identified by the local Community Task Force. Full article

Heart disease remains the leading cause of death in both the United States and globally. Urban heat is increasingly recognized as a significant public health challenge, particularly in its connection to cardiovascular conditions. This study, conducted in Jefferson County, Kentucky, examines the distribution of coronary heart disease rates and develops an urban heat risk index to examine underlying socioeconomic and environmental factors. We applied bivariate spatial association (Lee’s L), Global Moran’s I, and multiple linear regression methods to examine the relationships between key variables and assess model significance. Global Moran’s I revealed clustered distributions of both coronary heart disease rates and land surface temperature across census tracts. Bivariate spatial analysis identified clusters of high heart disease rates and temperatures within the West End, while clusters of contiguous suburban tracts exhibited lower heart disease rates and temperatures. Regression analyses yielded significant results for both the ordinary least squares (OLS) model and the spatial regression model; however, the spatial error model explained a greater proportion of the variation in coronary heart disease rates across tracts compared to the OLS model. This study offers new insights into spatial disparities in coronary heart disease rates and their associations with environmental risk factors including urban heat, underscoring the challenges faced by many urban communities. Full article

Background: While disparities in vaccine uptake have been well documented, few studies have evaluated the impact of local vaccine programs on COVID-19 outcomes, namely cases, hospitalizations, and deaths. Objectives: Evaluate the impact of COVID-19 vaccine doses coordinated by the Louisville Metro Department of Public Health and Wellness (LMPHW) on COVID-19 outcomes by race across ZIP codes from December 2020 to May 2022 in Jefferson County, Kentucky. Methods: Fixed-effects longitudinal models with ZIP codes as ecological time-series units were estimated to measure the association between COVID-19 vaccine doses and outcomes with time lags of one week, two weeks, three weeks, four weeks, and one month. Models were adjusted for time (week or month of the year) and its interaction with ZIP code. Results: In the one-week lag model, significant negative associations were observed between LMPHW-coordinated vaccine doses and COVID-19 outcomes, indicating reductions of 11.6 cases, 0.4 hospitalizations, and 0.3 deaths per 100 doses administered. Vaccine doses were consistently associated with fewer deaths among White residents across all lags, with an average reduction of 0.2 deaths per 100 doses. No significant associations were found for Black residents. Temporal trends also indicated declines in COVID-19 outcomes when LMPHW’s vaccine administration program peaked, between March and May 2021. Conclusions: Timely uptake of COVID-19 vaccines remains critical in avoiding severe outcomes, especially with emerging variants. Racial disparities in vaccine–outcome associations emphasize the potential need for equitable, community-driven vaccine campaigns to improve population health outcomes. Full article

Land managers across the United States (U.S.) are developing plans to mitigate climate change. Effective implementation and monitoring of these climate action plans require standardized methods and timely, accurate geospatial data at appropriate resolutions. Despite the abundance of geospatial and statistical data in the U.S., a significant gap remains in translating these data into actionable insights. To address this gap, we developed the Land Emissions and Removals Navigator (LEARN), an online tool that automates subnational greenhouse gas (GHG) inventories of forests and trees in nonforest lands using a standardized analytical framework consistent with national and international guidelines. LEARN integrates multiple datasets to calculate land cover and tree canopy changes, delineate areas of forest disturbance, and estimate carbon emissions and removals. To demonstrate the application of LEARN, this paper presents case studies in Jefferson County, Washington; Montgomery County, Maryland; and federally owned forests across the conterminous U.S. Our results highlight LEARN’s capacity to provide localized insights into carbon dynamics, enabling subnational entities to develop tailored climate strategies. By enhancing accessibility to standardized data, LEARN empowers community land managers to more effectively mitigate climate change. Future developments aim to expand LEARN’s scope to cover nonforest landscapes and incorporate additional decision-making functionalities. Full article

Accurate and timely flood mapping is critical for informing emergency response and risk mitigation during extreme weather events. This study presents a synthetic aperture radar (SAR)-based approach for rapid flood extent mapping using Sentinel-1 imagery, demonstrated for Tropical Storm Imelda (17–21 September 2019) in southeastern Texas. Dual-polarization Sentinel-1 SAR data (VH and VV) were processed by computing the VH/VV backscatter ratio, and the resulting ratio image was classified using a supervised Random Forest classifier to delineate water and land. All Sentinel-1 images underwent radiometric calibration, speckle noise filtering, and terrain correction to ensure precision in flood delineation. The Random Forest classifier achieved an overall flood mapping accuracy exceeding 94%, with Cohen’s kappa coefficients of approximately 0.75–0.80, demonstrating the approach’s reliability in distinguishing transient floodwaters from permanent water bodies. The spatial distribution of flooding was strongly influenced by topography and land cover. Analysis of Shuttle Radar Topography Mission (SRTM) digital elevation data revealed that low-lying, flat terrain was most vulnerable to inundation; correspondingly, the land cover types most affected were hay/pasture, cultivated land, and emergent wetlands. Additionally, urban areas with low-intensity development experienced extensive flooding, attributed to impervious surfaces exacerbating runoff. A strong, statistically significant correlation (R² = 0.87, p < 0.01) was observed between precipitation and flood extent, indicating that heavier rainfall led to greater inundation; accordingly, the areas with the highest rainfall totals (e.g., Jefferson and Chambers counties) experienced the most extensive flooding, as confirmed by SAR-based change detection. The proposed approach eliminates the need for manual threshold selection, thereby reducing misclassification errors due to speckle noise and land cover heterogeneity. Harnessing globally available Sentinel-1 data with near-real-time processing and a robust classifier, this approach provides a scalable solution for rapid flood monitoring. These findings underscore the potential of SAR-based flood mapping under adverse weather conditions, thereby contributing to improved disaster preparedness and resilience in flood-prone regions. Full article

Background/Objectives: The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus type-2 (SARS-CoV-2), has resulted in 777 million cases worldwide. Various vaccines have been approved to control the spread of COVID-19, with mRNA vaccines (Pfizer and Moderna) being widely used in the USA. We conducted a prospective longitudinal study to analyze the immune response elicited by two/three and four doses of monovalent mRNA vaccines in both vaccinated individuals and those who experienced breakthrough infections. Participants were stratified into different age groups: 18–40, 41–60, and over 60 years. Methods: We assessed cross-variant neutralization responses in two cohorts—Cohort I: n = 167 (serum), Cohort II: n = 92 (serum and nasal swab) samples—using infectious virus microneutralization assay (MN) and antibody (IgG or IgA) binding ELISA titers to the spike protein receptor binding domain (RBD). Samples were collected from the Louisville Metro–Jefferson County Co-Immunity Project, a federally funded, population-based study for the surveillance of SARS-CoV-2 in Jefferson County, Kentucky during 2020–2022, involving both health care workers and a local community. Results: Individuals who received two doses of the mRNA vaccine exhibited reduced neutralization against Beta, Delta, and Omicron BA.1 variants compared to wildtype Wuhan, with further decline observed six months post-booster vaccination. However, individuals who experienced natural COVID-19 infection (breakthrough) after receiving two vaccine doses showed enhanced neutralization and antibody responses, particularly against Omicron BA.1. Following the 3rd dose, antibodies and neutralization responses were restored. Among triple-vaccinated individuals, reduced neutralization was observed against Omicron variants BA.1, BA.5, and BA.2 compared to Wuhan. Neutralization responses were better against BA.2 variant compared to BA.1 and BA.5. However, individuals who received three doses of vaccine and experienced a breakthrough infection (n = 45) elicited significantly higher neutralizing antibodies responses against all Omicron subvariants compared to vaccinated individuals. Interestingly, nasal swab samples collected from volunteers with breakthrough infection showed significantly elevated spike-reactive mucosal IgA antibodies and enhanced cross neutralization against BA.1, BA.2, and BA.5 compared to individuals who received only three vaccine doses. Conclusions: mRNA vaccination elicits a strong systemic immune response by boosting serum neutralizing antibodies (NAb), although this protection wanes over time, allowing new variants to escape neutralization. Breakthrough individuals have extra enrichment in nasal NAb offering protection against emerging variants. This longitudinal immune profiling underscores the strengthening of pandemic preparedness and supports the development of durable mucosal vaccines against respiratory infectious disease. Full article

Adults face a higher risk of exposure to COVID-19 than older adults and children due to their labor force participation. This study investigated the uptake of the initial and second doses of the COVID-19 vaccine among adults, stratified by age, race, ethnicity, sex, and their combinations. Data from the Kentucky Immunization Registry were employed to evaluate temporal changes in COVID-19 vaccine uptake among adults in three age groups (college age: 18–24, prime working age: 25–44, and middle age: 45–64) in Jefferson County, Kentucky (2020 population: 782,969). The analysis explored trends by age, race, and ethnicity; intersections of age with race and ethnicity; and interactions of age–race and age–ethnicity with sex. By May 2022, the highest and lowest COVID-19 vaccination rates were observed among White and Black 45–64-year-old adults: 74.8% and 64.0%, respectively, for dose two. The highest and lowest two-dose vaccination rates at ages 25–44 and 18–24 were also among White and Black residents: 67.9% versus 46.0% and 55.2% versus 35.4%, respectively. Disparities in COVID-19 vaccination by race, ethnicity, sex, and their intersections remained evident during the study period. Efforts in vaccine distribution and promotional initiatives should focus on demographically appropriate strategies. Full article

Background: Although children can contract COVID-19, their typically lower immune reactivity appears to shield them from the intense hyperinflammatory response observed in other age groups, leading to milder disease symptoms. Nonetheless, children’s infection raises the possibility of unwanted transmission of the coronavirus to others, especially because most infected children are asymptomatic. Objectives: This study examines the uptake of the first and second doses of the COVID-19 vaccine among children by combinations of age, race, ethnicity, and sex. Methods: Data from the immunization registry were utilized to assess changes over time in COVID-19 vaccine uptake among children in Jefferson County, Kentucky’s most populous county. The analysis examined trends by age, race, ethnicity, and combinations of age-race, age-ethnicity, age-race-sex, and age-ethnicity-sex during the first six quarters of the COVID-19 vaccination rollout. Results: By May 2022, in 16–17-year-olds, the highest and lowest COVID-19 vaccination rates were observed among White and Black children (64.8% versus 41.2%, respectively, for dose two). The highest two-dose vaccination rate at ages 12–15 years was among Multiracial and White children (63.3% and 62.9%, respectively), the lowest among Black children (38.8%). The highest two-dose vaccination rate at ages 5–11 years was among children of Some Other Races, Asian, and White children (37.0%, 36.7%, and 35.5%, respectively), and the lowest among Black children (17.2%). Conclusions: Inequalities in COVID-19 vaccination based on race, ethnicity, and sex persisted throughout the study period. Efforts in vaccine distribution and promotional initiatives should focus on increasing vaccination rates among children from racial and ethnic minority groups and males. Full article

Although the literature provides valuable insight into tornado vulnerability and resilience, there are still research gaps in assessing tornadoes’ impact on communities and transportation infrastructure, especially in the wake of the rapidly changing frequency and strength of tornadoes due to climate change. In this study, we first investigated the relationship between tornado exposure and demographic-, socioeconomic-, and transportation-related factors in our study area, the state of Kentucky. Tornado exposures for each U.S. census block group (CBG) were calculated by utilizing spatial analysis methods such as kernel density estimation and zonal statistics. Tornadoes between 1950 and 2022 were utilized to calculate tornado density values as a surrogate variable for tornado exposure. Since tornado density varies over space, a multiscale geographically weighted regression model was employed to consider spatial heterogeneity over the study region rather than using global regression such as ordinary least squares (OLS). The findings indicated that tornado density varied over the study area. The southwest portion of Kentucky and Jefferson County, which has low residential density, showed high levels of tornado exposure. In addition, relationships between the selected factors and tornado exposure also changed over space. For example, transportation costs as a percentage of income for the regional typical household was found to be strongly associated with tornado exposure in southwest Kentucky, whereas areas close to Jefferson County indicated an opposite association. The second part of this study involves the quantification of the tornado impact on roadways by using two different methods, and results were mapped. Although in both methods the same regions were found to be impacted, the second method highlighted the central CBGs rather than the peripheries. Information gathered by such an investigation can assist authorities in identifying vulnerable regions from both transportation network and community perspectives. From tornado debris handling to community preparedness, this type of work has the potential to inform sustainability-focused plans and policies in the state of Kentucky. Full article

The fertility tracking of menstrual cycles during perimenopause with a quantitative hormone monitor is a novel undertaking. Women in regular menstrual cycles have been tracking their fertility using different biomarkers since the 1960′s. Presently, there are newer electronic hormonal devices used to track fertility that provide more exact and objective data to help delineate the fertile time frame of a woman’s cycle. These devices measure quantitative levels of estrogen, the luteinizing hormone, progesterone, and follicle-stimulating hormone, all of which occur at varying levels during the menstrual cycle. As women advance toward menopause, their cycles vary in length, and their hormones fluctuate. In this retrospective analysis, forty-two women aged 40 to 50 tracked their cycles over time, and eight of these forty-two women used the quantitative hormonal device. With the use of this device, the perimenopausal period has revealed distinct hormonal cycle characteristics that are unique to this group of women. It is the purpose of this paper to discuss these cycle’s characteristics during perimenopause, which were found with the use of the quantitative hormonal device. Full article

Despite entering an endemic phase, SARS-CoV-2 remains a significant burden to public health across the global community. Wastewater sampling has consistently proven utility to understanding SARS-CoV-2 prevalence trends and genetic variation as it represents a less biased assessment of the corresponding communities. Here, we report that ongoing monitoring of SARS-CoV-2 genetic variation in samples obtained from the wastewatersheds of the city of Louisville in Jefferson county Kentucky has revealed the periodic reemergence of the Delta strain in the presence of the presumed dominant Omicron strain. Unlike previous SARS-CoV-2 waves/emergence events, the Delta reemergence events were geographically restricted in the community and failed to spread into other areas as determined by wastewater analyses. Moreover, the reemergence of the Delta strain did not correlate with vaccination rates as communities with lower relative vaccination have been, to date, not affected. Importantly, Delta reemergence events correlate with increased public health burdens, as indicated by increased daily case rates and mortality relative to non-Delta wastewatershed communities. While the underlying reasons for the reemergence of the Delta variant remain unclear, these data reaffirm the ongoing importance of wastewater genomic analyses towards understanding SARS-CoV-2 as it enters the endemic phase. Full article

Background: The impact of chronic health conditions (CHCs) on serostatus post-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination is unknown. Methods: We assessed serostatus post-SARS-CoV-2 vaccination among fully vaccinated adult residents of Jefferson County, Kentucky, USA, from April 2021 to August 2021. Serostatus was determined by qualitative analysis of SARS-CoV-2-specific Spike IgG antibodies via enzyme-linked immunoassay (ELISA) in peripheral blood samples. Results: Of the 5178 fully vaccinated participants, 51 were seronegative and 5127 were seropositive. Chronic kidney disease (CKD) and autoimmune disease showed the highest association with negative serostatus in fully vaccinated individuals. The absence of any CHC was strongly associated with positive serostatus. The risk of negative serostatus increased as the total number of pre-existing CHCs increased. Similarly, the use of two or more CHC-related medications was associated with seronegative status. Conclusions: The presence of any CHC, especially CKD or autoimmune disease, increased the likelihood of seronegative status among individuals who were fully vaccinated to SAR-CoV-2. This risk increased with a concurrent increase in number of comorbidities, especially with multiple medications. The absence of any CHC was protective and increased the likelihood of a positive serological response. These results will help develop appropriate guidelines for booster doses and targeted vaccination programs. Full article