Heidi E Brown

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Courses

Scholarly Contributions

Chapters

• Smith, E. M., Lashway, S. G., Laukaitis, C. M., Brown, H. E., Lynch, C. F., & Dennis, L. K. (2022). Cancer. In Maxcy-Rosenau-Last Public Health and Preventive Medicine. New York: McGraw-Hill Medical.
• Garfin, G. M., Garfin, G. M., Gonzalez, P., Breshears, D. D., Brooks, K., Brown, H. E., Elias, E., Gunasekara, A., Huntly, N., Maldonado, J. K., Mantua, N. J., Margolis, H. G., Mcafee, S., Middleton, B. R., Udall, B., Huntly, N. J., Middleton, B. R., & Maldonado, J. K. (2018). Chapter 25 : Southwest. Impacts, Risks, and Adaptation in the United States: The Fourth National Climate Assessment, Volume II. In The Fourth National Climate Assessment, Volume II. U.S. Global Change Research Program. doi:10.7930/NCA4.2018.CH25
• Udall, B. H., Middleton, B. R., McAfee, S., Margolis, H. G., Mantua, N. J., Maldonado, J. K., Huntly, N., Gunasekara, A., Elias, E. H., Brooks, K. M., Brown, H. E., Breshears, D. D., Garfin, G. M., & Gonzalez, P. (2018). Southwest. In Impacts, Risks, and Adaptation in the United States: Fourth National Climate Assessment, Volume II(pp 1101–1184). Washington, DC: U.S. Global Change Research Program. doi:doi: 10.7930/NCA4.2018.CH25
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  Chapter 25 in the Fourth National Climate Assessment
• Ernst, K. C., Morin, C., & Brown, H. E. (2015). Extreme Weather Events and Vector-borne Diseases. In Public Health in Natural Disasters: Nutrition, Food, Remediation and Preparation. Wageningen Academic Publishers.
• Brown, H. E., Comrie, A. C., Tamerius, J., Khan, M., Tabor, J. A., & Galgiani, J. N. (2014). Climate, wind storms, and the risk of valley fever (coccidioidomycosis). In The Influence of Global Environmental Change on Infectious Disease Dynamics(pp Chapter A12). Washington, D.C.: The National Academies Press.
• Brown, H. E., Comrie, A. C., Drechsler, D., Barker, C. M., Basu, R., Brown, T., Gershunov, A., Reisen, W. K., & Ruddell, D. (2013). Health Effects of Climate Change in the Southwest. In Assessment of Climate Change in the Southwest United States: a Technical Report Prepared for the U.S. National Climate Assessment.(pp 312-339). Southwest Climate Alliance.
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  Review Editor: English, P. Health Effects of Climate Change in the Southwest. Chapter 15, in: Assessment of Climate Change in the Southwest United States: a Technical Report Prepared for the U.S. National Climate Assessment. A report by the Southwest Climate Alliance [Garfin, G., Jardine, A., Merideth, R., Black, M., and Overpeck, J. (eds.)]. 2013, Tucson, AZ: Southwest Climate Alliance.
• Liverman, D., Moser, S. C., Weiland, P. S., Dilling, L., Boykoff, M. T., Brown, H. E., Gordon, E. S., Greene, C., Holthaus, E., Niemeier, D. A., & others, . (2013). Climate choices for a sustainable Southwest. In Assessment of Climate Change in the Southwest United States(pp 405--435). Island Press/Center for Resource Economics.

Journals/Publications

• Brown, H. E., Keith, L., & Ahn, M. W. (2025). Rural heat health disparities: Evidence from the U.S. National Emergency Medical Services Information System (NEMSIS). The Journal of Climate Change and Health, 22(2025), 100432. doi:10.1016/j.joclim.2025.100432
• Austhof, E., Austhof, E., Brown, H., Brown, H., White, A., White, A., Jervis, R., Jervis, R., Weiss, J., Weiss, J., Davis, S., Davis, S., Shrum Davis, S., Shrum Davis, S., Moore, D., Moore, D., Pogreba-Brown, K., & Pogreba-Brown, K. (2024). Association between Precipitation Events, Drought, and Animal Operations with Campylobacter Infections in the Southwest United States, 2009–2021. Environmental Health Perspectives, 132(9). doi:10.1289/EHP14693
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  BACKGROUND: Weather variability is associated with enteric infections in people through a complex interaction of human, animal, and environmental factors. Although Campylobacter infections have been previously associated with precipitation and temperature, the association between precipitation and drought on campylobacteriosis has not been studied. OBJECTIVE: Using data from Arizona, Colorado, New Mexico, and counties in Utah, this ecological study aimed to assess the association between precipitation and the incidence of campylobacteriosis by county from 2009 to 2021 and to determine how this association is modified by prior drought level and animal operations. METHODS: We merged 38,782 cases of campylobacteriosis reported in 127 counties with total precipitation (in inches), temperature (in average degrees Fahrenheit), Palmer Drought Severity Index (PDSI, category), and animal census data (presence, density per square mile) by week from 2009 to 2021. Negative binomial generalized estimating equations adjusted for temperature with a 3-wk lag were used to explore the association between precipitation on campylobacteriosis with resulting incidence rate ratios (IRRs). Stratified analyses explored the association with precipitation following antecedent drought, presence of farm operations, and animal density. RESULTS: A 1-in (25:4 mm) increase in precipitation was associated with a 3% increase in campylobacteriosis reported 3 wks later (IRR = 1.03; 95% CI: 1.02, 1.04) after adjusting for average temperature and PDSI. Compared with normal conditions, there were significantly more cases when precipitation followed antecedent extremely wet (IRR = 1.15; 95% CI: 1.04, 1.26), very wet (IRR = 1.09; 95% CI: 1.01, 1.18), moderately wet (IRR = 1.06; 95% CI: 1.01, 1.12), moderate drought (IRR = 1.11; 95% CI: 1.07, 1.16), and severe drought (IRR = 1.06; 95% CI: 1.02, 1.11) conditions, whereas there were significantly fewer cases (IRR = 0.89; 95% CI: 0.85, 0.94) for antecedent extreme drought. Compared to counties with no animal opera-tions, counties with animal operations had significantly more cases following precipitation for every PDSI category except extreme drought. Counties with a higher density of beef cattle, goats for meat, chicken broilers, and chicken layers had significantly higher rates of campylobacteriosis following precipitation than those with no such operations, whereas those with dairy cattle and goats for milk, did not. DISCUSSION: In this majority arid and semiarid environment, precipitation following prior wet conditions and moderate and severe drought were significantly associated with increased rates of campylobacteriosis, and only in prior extreme drought did rates decrease. Where the precipitation fell made a difference; after precipitation, counties with farm operations had significantly more cases compared to counties without farm operations. Further work should assess individual-level risk factors within environmental exposure pathways for Campylobacter. https://doi.org/10.1289/EHP14693.
• Austhof, E., Brown, H. E., White, A. E., Jervis, R. H., Weiss, J., Shrum Davis, S., Moore, D., & Pogreba-Brown, K. (2024). Association between Precipitation Events, Drought, and Animal Operations with Infections in the Southwest United States, 2009-2021. Environmental Health Perspectives, 132(9), 97010.
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  Weather variability is associated with enteric infections in people through a complex interaction of human, animal, and environmental factors. Although infections have been previously associated with precipitation and temperature, the association between precipitation and drought on campylobacteriosis has not been studied.
• Austhof, E., Pogreba-Brown, K., White, A. E., Jervis, R. H., Weiss, J., Davis, S. S., Moore, D., & Brown, H. E. (2024). Association between precipitation events, drought, and animal operations with infections in the Southwest US, 2009-2021. One health (Amsterdam, Netherlands), 19, 100941.
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  Temperature and precipitation have previously been associated with infections. The association between salmonellosis and precipitation might be explained by antecedent drought conditions; however, few studies have explored this effect.
• Austhof, E., Pogreba-Brown, K., White, A., Jervis, R., Weiss, J., Davis, S., Moore, D., & Brown, H. (2024). Association between precipitation events, drought, and animal operations with Salmonella infections in the Southwest US, 2009–2021. One Health, 19. doi:10.1016/j.onehlt.2024.100941
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  Background: Temperature and precipitation have previously been associated with Salmonella infections. The association between salmonellosis and precipitation might be explained by antecedent drought conditions; however, few studies have explored this effect. Methods: Using an ecological study design with public health surveillance, meteorological (total precipitation [inches], temperature [average °F], Palmer Drought Severity Index [PDSI, category]), and livestock data we explored the association between precipitation and Salmonella infections reported in 127/141 counties from 2009 to 2021 in the Southwest, US and determined how this association was modified by antecedent drought. To explore the acute effect of precipitation on Salmonella infections we used negative binomial generalized estimating equations adjusted for temperature with a 2-week lag resulting in Incidence Rate Ratios (IRR). Stratified analyses were used to explore the effect of antecedent drought and type of animal density on this association. Results: A one inch increase in precipitation was associated with a 2 % increase in Salmonella infections reported two weeks later (IRR: 1.02, 95 % CI: 1.00, 1.04) after adjusting for average temperature and PDSI. Precipitation following moderate (IRR: 1.22, 95 % CI: 1.17, 1.28) and severe drought (IRR: 1.16, 95 % CI: 1.10, 1.22) was associated with a significant increase in cases, whereas in the most extreme drought conditions, cases were significantly decreased (IRR: 0.89, 95 % CI: 0.85, 0.94). Overall, more precipitation (above a 30-year normal, the 95th and 99th percentiles) were associated with greater increases in cases, with the highest increase following moderate and severe drought. Counties with a higher density of chicken and beef cattle were significantly associated with increased cases regardless of drought status, whereas dairy cattle, and cattle including calves had mixed results. Discussion: Our study suggests precipitation following prior dry conditions is associated with an increase in salmonellosis in the Southwest, US. Public health is likely to see an increase in salmonellosis with extreme precipitation events, especially in counties with a high density of chicken and beef cattle.
• Austhof, E., Warner, S., Helfrich, K., Pogreba-Brown, K., Brown, H. E., Klimentidis, Y. C., Scallan Walter, E., Jervis, R. H., & White, A. E. (2024). Exploring the association of weather variability on Campylobacter - A systematic review. Environmental research, 252(Pt 1), 118796.
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  Previous work has found climate change-induced weather variability is suspected to increase the transmission of enteric pathogens, including Campylobacter, a leading cause of bacterial gastroenteritis. While the relationship between extreme weather events and diarrheal diseases has been documented, the specific impact on Campylobacter infections remains underexplored.
• Brown, H. E., Begay, R. L., Sanderson, P. R., Chief, C., Lameman, B., & Harris, R. B. (2024). Healthcare access, attitudes and behaviours among Navajo adults during the COVID-19 pandemic: a cross-sectional study. BMJ public health, 2(1).
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  To assess factors associated with positive COVID-19 tests, perspectives on health-related care delivery during pandemic, and factors supporting resilience among members of the Navajo Nation.
• Watkins, L., Brown, H. E., Keith, L., Austhof, E., Lin, H., Chambers, S. N., Tabor, J., Gettel, A., & Guardaro, M. (2024). A Co-Produced Workflow for Addressing Inequities in Cooling Center Access. Community Science, 3(4), e2023CSJ000038.
• Watkins, L., Brown, H. E., Keith, L., Cox, H. L., Austhof, E., Chambers, S., Tabor, J., Gettel, A., & Guardaro, M. (2024). A co-produced workflow for addressing inequities in cooling center access.. Community Science, 3(4), e2023CSJ000038. doi:10.1029/2023CSJ000038
• Woodson, L. L., Garcia Saldivar, A., Brown, H. E., Magrath, P. A., Antunez de Mayolo, N., Pettygrove, S., Farland, L. V., Madhivanan, P., & Blas, M. M. (2024). The downstream effects of COVID-19 on adolescent girls in the Peruvian Amazon: qualitative findings on how the pandemic affected education and reproductive health. BMJ Global Health, 9(4).
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  Due to COVID-19, schools were closed to mitigate disease spread. Past studies have shown that disruptions in education have unintended consequences for adolescents, including increasing their risk of school dropout, exploitation, gender-based violence, pregnancy and early unions. In Peru, the government closed schools from March 2020 to March 2022, declaring a national emergency that affected an estimated 8 million children. These closures may have unintended consequences, including increased adolescent pregnancy, particularly in Peru's rural, largely indigenous regions. Loreto, located in the Peruvian Amazon, has one of the highest adolescent pregnancy rates in the country and poor maternal and child health outcomes. The underlying causes may not be fully understood as data are limited, especially as we transition out of the pandemic. This qualitative study investigated the downstream effects of COVID-19 on adolescent education and reproductive health in Loreto's districts of Nauta and Parinari. In-depth interviews (n=41) were conducted with adolescents and community leaders. These were held in June 2022, 3 months after the reinstitution of in-person classes throughout Peru. Focus group discussions (FGDs) were also completed with community health workers and educators from the same study area in October 2022 to supplement our findings (3 FGDs, n=15). We observed that the economic, educational and health effects of the COVID-19 pandemic contributed to reduced contraceptive use, and increased school abandonment, early unions and adolescent pregnancy. The interplay between adolescent pregnancy and both early unions and school abandonment was bidirectional, with each acting as both a cause and consequence of the other.
• Woodson, L. L., Garcia Saldivar, A., Brown, H. E., Magrath, P. A., Farland, L. V., Blas, M. M., & Madhivanan, P. (2024). 'You have a lot of mirrors': structural and socioecological factors impacting adolescent pregnancy and reproductive health in the Amazon basin, Peru, a qualitative study. Culture, health & sexuality, 1-17.
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  Loreto, in the Peruvian Amazon, has one of the highest adolescent pregnancy rates in the country. However, underlying causes of adolescent pregnancy are not fully understood as data are limited in Indigenous and remote Amazonian communities. This study investigated adolescent reproductive health within Loreto using an ecological systems framework. Forty-one semi-structured interviews were conducted in June 2022: community leaders ( = 12) and adolescent participants between 15 and 17 years of age (pregnant girls,  = 11; never pregnant girls,  = 9; and boys,  = 9). We also conducted focus group discussions with community health workers and educators in October 2022 (three focus groups,  = 15). Adolescent reproductive health is complex with multi-layered factors that put girls at higher risk of pregnancy. We found a paradoxical relationship between expected social and gender norms and individual desires. This research provides a contextual understanding of the lived experience of adolescents and young people in the Amazon region of Peru. Our findings suggest the need for greater exploration of the contradictory ideas surrounding adolescent pregnancy and female sexuality.
• Yang, H., Pan, F., Tong, D., Brown, H. E., & Liu, J. (2024). Measurement error tolerant Poisson regression for Valley Fever incidence prediction. IISE Transactions on Healthcare Systems Engineering, 14(4), 305-317.
• Austhof, E., Keith, L., Brown, H. E., & Chambers, S. (2023). Development of a Geographic Human Heat Balance Equation to Support Public Health Analyses: An Arizona Urban Sun Corridor application. Remote Sensing Applications: Society and Environment., 32(2023), 101009. doi:10.1016/j.rsase.2023.101009
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  Land surface temperature (LST) estimates often serve as urban heat islands maps and to infer human thermal comfort. Parallel to this, physiological heat balance calculations have been well documented to measure changes in body core temperature and measure risk of heat-related illness. However, there is a need for an improved spatially explicit method to assess human thermal comfort. Using spatial climate data measuring temperature, airflow, and humidity, we developed a geographic body heat storage (BHS) model based on heat exchange and evaporative heat loss from the human body. As proof of concept, we used heat-related illness emergency department visits in two Arizona metropolitan areas to demonstrate that BHS can improve LST's shortcomings, with its increased explanatory power of and linear fit to emergency records. The BHS model can support decision making for public health outcomes as heat risk increases with climate change and urban overheating to more closely approximate the human heat experience. BHS allows can be implemented in different climate regions and with investigations of additional physiological and community variables to better describe risk of heat-related illness.
• Bailey, K. S., Brown, H. E., Lekic, V., Pradeep, K., Merchant, J. L., & Harris, R. B. (2023). Helicobacter pylori treatment knowledge, access and barriers: A cross-sectional study. Helicobacter, 28(2), e12954.
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  Helicobacter pylori (Hp) is among the most common bacterial infections in the world and one of the most common infectious agents linked to malignancy, gastric cancer (GC). Within the US there is high disparity in the rates of Hp infection and associated diseases. Hp infection is treatable, and knowledge may influence screening and treatment seeking behaviors.
• Dennis, L. K., Brown, H. E., & Arrington, A. K. (2023). Comparison of Prognostic Factors for Merkel Cell Carcinoma, Mucosal Melanoma and Cutaneous Malignant Melanoma: Insights into Their Etiologies. Current oncology (Toronto, Ont.), 30(4), 3974-3988.
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  Little is known about the epidemiology of Merkel cell carcinoma (MCC) and mucosal melanoma (MM). Using the United States (US) National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program data, we compared MCC and MM with cutaneous malignant melanoma (CMM) with respect to incidence rates and prognostic factors to better understand disease etiologies. We describe the proportional incidences of the three cancers along with their survival rates based on 20 years of national data. The incidence rates in 2000-2019 were 203.7 per 1,000,000 people for CMM, 5.9 per 1,000,000 people for MCC and 0.1 per 1,000,000 people for MM. The rates of these cancers increased over time, with the rate of MM tripling between 2000-2009 and 2010-2019. The incidences of these cancers increased with age and rates were highest among non-Hispanic Whites. Fewer MCCs and MMS were diagnosed at the local stage compared with CMM. The cases in the 22 SEER registries in California were not proportional to the 2020 population census but instead were higher than expected for CMM and MCC and lower than expected for MM. Conversely, MM rates were higher than expected in Texas and New York. These analyses highlight similarities in the incidence rates of CMM and MCC-and differences between them and MM rates-by state. Understanding more about MCC and MM is important because of their higher potential for late diagnosis and metastasis, which lead to poor survival.
• Kamana, E., Bai, D., Brown, H. E., & Zhao, J. (2023). The malaria transmission in Anhui province China. Infectious Disease Modelling, 8(1), 1-10.
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  cases have opposite trends in Anhui China in the past decade. Long term and seasonal trends in the transmission rate of in Africa has been well studied, however that of transmitted by in China has not been investigated. There is a lot of work on the relationship between cases and climatic factors in China, with sometimes contradicting results. However, how climatic factors affect transmission rate of in China is unknown. We used Anhui province as an example to analyze the recent transmission dynamics where two types of malaria have been reported with differing etiologies. We examined breakpoints of the and malaria long term dynamics in the recent decade. For locally transmitted malaria, we analyzed the transmission rate and its seasonality using the combined human and mosquitos SIR-SI model with time-varied mosquito biting rate. We identified the effects of meteorological factors on the seasonality in transmission rate using a GAM model. For the imported malaria, we analyzed the potential reason for the observed increase in cases. The breakpoints of and dynamics happened in a same year, 2010. The seasonality in the transmission rate of malaria was high (42.4%) and was linearly associated with temperature and nonlinearly with rainfall. The abrupt increase in imported cases after the breakpoint was significantly related to the increased annual Chinese investment in Africa. Under the conditions of the existing vectors of malaria, long-term trends in climatic factors, and increasing trend in migration to/from endemic areas and imported malaria cases, we should be cautious of the possibility of the reestablishment of malaria in regions where it has been eliminated or the establishment of other vector-borne diseases.
• Monroy, F. P., Brown, H. E., Acevedo-Solis, C. M., Rodriguez-Galaviz, A., Dholakia, R., Pauli, L., & Harris, R. B. (2023). Antibiotic Resistance Rates for in Rural Arizona: A Molecular-Based Study. Microorganisms, 11(9).
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  () is a common bacterial infection linked to gastric malignancies. While infection and gastric cancer rates are decreasing, antibiotic resistance varies greatly by community. Little is known about resistance rates among rural Indigenous populations in the United States. From 2018 to 2021, 396 endoscopy patients were recruited from a Northern Arizona clinic, where community prevalence is near 60%. Gastric biopsy samples positive for ( = 67) were sequenced for clarithromycin- and metronidazole-associated mutations, 23S ribosomal RNA (23S), and oxygen-insensitive NADPH nitroreductase () regions. Medical record data were extracted for endoscopic findings and prior history. Data analysis was restricted to individuals with no history of infection. Of 49 individuals, representing 64 samples which amplified in the 23S region, a clarithromycin-associated mutation was present in 38.8%, with T2182C being the most common mutation at 90%. While the prevalence of metronidazole-resistance-associated mutations was higher at 93.9%, the mutations were more variable, with D95N being the most common followed by L62V. No statistically significant sex differences were observed for either antibiotic. Given the risk of treatment failure with antibiotic resistance, there is a need to consider resistance profile during treatment selection. The resistance rates in this population of American Indian patients undergoing endoscopy are similar to other high-risk populations. This is concerning given the high prevalence and low rates of resistance testing in clinical settings. The mutations reported are associated with antibiotic resistance, but clinical resistance must be confirmed.
• Sanderson, P. R., Monroy, F. P., Brown, H. E., & Harris, R. B. (2023). Abstract IA008: Weaving university and community-based partnership. Cancer Epidemiology, Biomarkers & Prevention, 32(12_Supplement), IA008-IA008. doi:10.1158/1538-7755.disp23-ia008
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  Abstract Introduction/Background Including Hypothesis/Objectives: University investigators affiliated with the Partnership for Native American Cancer Prevention (NACP) and Navajo Nation partners worked together with a goal to estimate the prevalence of Helicobacter pylori infection and its specific subtypes and factors associated with infection. Methods: This partnership required multiple strategies to promote awareness and individual participation in this study. The team started with tribal resolutions and communication network with local Chapter House officers, Community Health Representatives (CHRs), local Navajo translators, Diné Haatalii Association (Navajo Medicine Man), social network outreach, and community healthcare providers. Results: Our population-based study weaved together various networks with local leaders, social media, and the Navajo Healthy Stomach website. Participant follow-up after testing found that local hospitals were overwhelmed with requests for appointments and immediate treatment. Participants reported side-effects of prescribed medications. The Monroy lab revealed enough biopsies to test for Helicobacter pylori infection. Conclusions: Successful studies must utilize both Navajo Nation Human Research and Review Board approvals with university Institutional Review Boards (IRBs). Local, in-person, radio, and social media-based weaving of culturally sensitive communications develops strong partnerships between university and community-based local people, programs, and hospitals. Future Directions (Opportunities and Challenges): The team continues to study the role of Helicobacter pylori on the gastrointestinal microbiome in the development of gastric disease in infected Navajo patients. Further outreach is ongoing with local community and providers. Funding Support: Partnership for Native American Cancer Prevention, U54 NCI grant. Citation Format: Priscilla R. Sanderson, Fernando Monroy, Heidi Brown, Robin Harris. Weaving university and community-based partnership [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA008.
• Austhof, E., & Brown, H. E. (2022). Global Warming's Six MTurks: A Secondary Analysis of a US-Based Online Crowdsourcing Market. International journal of environmental research and public health, 19(14).
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  Using a global warming audience segmentation tool (Six Americas Super Short Survey (SASSY)) as a case study, we consider how public health can use consumer panels and online crowdsourcing markets (OCMs) in research. Through a secondary analysis, we aim to understand how consumer panels and OCMs are similar to or different from each other on demographics and global warming beliefs through SASSY, and how they compare to US Census estimates. With this information, researchers will understand public opinion of global warming in their sample, which is useful for many climate change initiatives. Neither the consumer panel (Ipsos) or OCM sample (MTurk) matched US estimates of population demographics. Both panels achieved similar SASSY segments, showing that even with diverse sampling frames, SASSY is a useful tool for understanding global warming sentiment. Compared to Ipsos, MTurk was younger (more Millennials and Generation X), had higher educational attainment, and lower income. Both panels were majority White, but Ipsos was more diverse than the unweighted MTurk. Ipsos had more respondents from the South whereas MTurk had more respondents from the West. Across the MTurk SASSY segment, there were no significant differences for the majority of demographic characteristics except for age; younger generations were more Alarmed or Concerned, and older generations were more Doubtful and Dismissive. Researchers interested in understanding their sample's opinions of global warming should use SASSY and consider oversampling in key demographic variables if they intend to achieve a nationally representative and diverse sample.
• Brown, H. E., Keith, L., Madera-Garcia, V., Taylor, A., Ramirez, N., & Ogata, I. (2022). Greening Up For Mosquitoes: A Comparison of Green Stormwater Infrastructure in a Semiarid Region. Journal of the American Mosquito Control Association, 38(2), 109-112.
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  Green stormwater infrastructure provides environmental, economic, and health benefits as a strategy for building resilience against climate change impacts. However, it may inadvertently increase vulnerability due to improper design and construction or lack of maintenance. We engaged city stakeholders and a diverse student group to investigate possible maladaptation. After rain events, student interns collected data at green stormwater infrastructure, identified in partnership with city stakeholders, for both water retention and mosquito larvae, if present. During the sampling period in 2018, 24 rain events occurred, with 28 sites visited 212 times including visits to basins (63%), curb cuts (34%), and a bioswale (2%). The largest basin consistently retained water (mean: 3.3 days, SD: 2.3 days) and was a positive site for Culex quinquefasciatus, a West Nile virus vector. We found that while basins can become mosquito breeding habitat, there was no evidence that curb cuts were collecting and retaining water long enough. As cities turn to green stormwater infrastructure to address climate change impacts of increasing drought, flooding, and extreme heat, these findings can help in the selection of appropriate infrastructure design typologies.
• Catalfamo, C. J., Brown, H. E., & Dennis, L. K. (2022). Evaluating the Strength of Association of Human Papillomavirus Infection With Penile Carcinoma: A Meta-Analysis. Sexually transmitted diseases, 49(5), 368-376.
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  Human papillomavirus (HPV) is a common sexually transmitted infection that is strongly associated with cervical cancer. A link to penile cancers has been suggested by case series. We sought to assess the strength of the association between HPV infection and penile cancer by meta-analysis.
• Moore, T. C., & Brown, H. E. (2022). Estimating Aedes aegypti (Diptera: Culicidae) Flight Distance: Meta-Data Analysis. Journal of Medical Entomology, 59(4), 1164-1170.
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  The yellow fever mosquito, Aedes aegypti, is a growing global concern. An ecological parameter necessary for vector control is the dispersal, or flight range, of mosquito vectors. Information on mosquito dispersal supports identifying optimal sampling and control strategies to limit the invasion of adult mosquitoes. Attempts around the world to understand the movement and flight range of Ae. aegypti have used a variety of techniques, but there has been little agreement regarding flight distances of Ae. aegypti, specifically the average linear distance Ae. aegypti travel in their natural environment. To generate a more robust estimate of Ae. aegypti flight distance, we conducted a meta-data analysis with the aims 1) to provide a flight distance measurement and 2) investigate how mosquito flight range can be affected by study design and climatic factors. Published studies were retrieved from public databases and reviewed for mean distance traveled (MDT) or maximum distance traveled measurements of Ae. aegypti. Linear regression was used to assess potential relationships between Ae. aegypti flight distance and factors pertaining to climate, degrees of urbanization, and study design. MDT estimates were pooled from 27 experiments to calculate a weighted MDT of 105.69 m. This study addresses the average flight distance of Ae. aegypti with the intention of informing vector control programs in Ae. aegypti prevalent regions of the world.
• Sheng, Z. Y., Li, M., Yang, R., Liu, Y. H., Yin, X. X., Mao, J. R., Brown, H. E., An, J., Zhou, H. N., & Wang, P. G. (2022). COVID-19 prevention measures reduce dengue spread in Yunnan Province, China, but do not reduce established outbreak. Emerging microbes & infections, 11(1), 240-249.
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  The COVID-19 pandemic and measures against it provided a unique opportunity to understand the transmission of other infectious diseases and to evaluate the efficacy of COVID-19 prevention measures on them. Here we show a dengue epidemic in Yunnan, China, during the pandemic of COVID-19 was dramatically reduced compared to non-pandemic years and, importantly, spread was confined to only one city, Ruili. Three key features characterized this dengue outbreak: (i) the urban-to-suburban spread was efficiently blocked; (ii) the scale of epidemic in urban region was less affected; (iii) co-circulation of multiple strains was attenuated. These results suggested that countermeasures taken during COVID-19 pandemic are efficient to prevent dengue transmission between cities and from urban to suburban, as well to reduce the co-circulation of multiple serotypes or genotypes. Nevertheless, as revealed by the spatial analysis, once the dengue outbreak was established, its distribution was very stable and resistant to measures against COVID-19, implying the possibility to develop a precise prediction method.
• Austhof, E., & Brown, H. E. (2021). Flexibility and partnerships perceived as supportive of dual hazard response: COVID-19 and heat related illness, Summer 2020. The Journal of Climate Change and Health, 4, 100068.
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  To understand how health departments implemented the response to the dual hazards of Heat Related Illness (HRI) and COVID-19 in Summer 2020.
• Brown, H. E., & Cox, J. (2021). Brown and Cox Respond to "Epidemiologic Methods in Epidemiology Education". American Journal of Epidemiology, 190(2), 317.
• Brown, H. E., & Cox, J. (2021). Improving Undergraduate Epidemiology Education: An Example Using Instructional Teams. American Journal of Epidemiology, 190(2), 305-312.
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  Epidemiology is a core component of the undergraduate public health curriculum and a critical component of a healthy community and a comprehensive education. Evidence-based, collaborative instructional practices improve student success, reach diverse student populations, and improve learning outcomes. Here we describe the pedagogical approach of an instructional team with which we observed an 18% greater learning gain (95% confidence interval: 6.5, 29.5; t = -3.08; P = 0.002), based on pre-/posttesting in a large (approximately 120 students) undergraduate course, than with the prior course offering. There were no differences in DEW rates (defined as receiving a grade of D (scoring 60%-69%) or E (scoring
• Brown, H. E., Sedda, L., Sumner, C., Stefanakos, E., Ruberto, I., & Roach, M. (2021). Understanding Mosquito Surveillance Data for Analytic Efforts: A Case Study. Journal of Medical Entomology, 58(4), 1619-1625.
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  Mosquito surveillance data can be used for predicting mosquito distribution and dynamics as they relate to human disease. Often these data are collected by independent agencies and aggregated to state and national level portals to characterize broad spatial and temporal dynamics. These larger repositories may also share the data for use in mosquito and/or disease prediction and forecasting models. Assumed, but not always confirmed, is consistency of data across agencies. Subtle differences in reporting may be important for development and the eventual interpretation of predictive models. Using mosquito vector surveillance data from Arizona as a case study, we found differences among agencies in how trapping practices were reported. Inconsistencies in reporting may interfere with quantitative comparisons if the user has only cursory familiarity with mosquito surveillance data. Some inconsistencies can be overcome if they are explicit in the metadata while others may yield biased estimates if they are not changed in how data are recorded. Sharing of metadata and collaboration between modelers and vector control agencies is necessary for improving the quality of the estimations. Efforts to improve sharing, displaying, and comparing vector data from multiple agencies are underway, but existing data must be used with caution.
• Bui, D. P., Chandran, S. S., Oren, E., Brown, H. E., Harris, R. B., Knight, G. M., & Grandjean, L. (2021). Community transmission of multidrug-resistant tuberculosis is associated with activity space overlap in Lima, Peru. BMC infectious diseases, 21(1), 275.
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  Transmission of multidrug-resistant tuberculosis (MDRTB) requires spatial proximity between infectious cases and susceptible persons. We assess activity space overlap among MDRTB cases and community controls to identify potential areas of transmission.
• Chakravarti, I., Miranda-Schaeubinger, M., Ruiz-Remigio, A., Briones-Garduño, C., Fernández-Figueroa, E. A., Villanueva-Cabello, C. C., Borge-Villareal, A., Bejar-Ramírez, Y., Pérez-González, A., Rivera-Benitez, C., Oren, E., Brown, H. E., Becker, I., & Gilman, R. H. (2022). Chagas Disease in Pregnant Women from Endemic Regions Attending the Hospital General de Mexico, Mexico City. Tropical Medicine and Infectious Disease, 7(1).
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  infection leads to Chagas disease (CD), a neglected tropical infection of significant public health importance in South and Central America and other, non-endemic, countries. Pregnant women and their children are of particular importance to screen as can be transmitted vertically. The objective of this study was to screen for infection among pregnant women from endemic areas seen at the Hospital General de Mexico for prenatal care, so that they and their children may be quickly connected to CD treatment. Pregnant women were recruited through the hospital prenatal clinic and screened for infection using a series of serological and molecular tests. Of 150 screened patients, mean age 26.8 (SD 6.4), 30 (20.0%) were positive by at least one diagnostic test. Of these, only nine (6%) were positive as determined by PCR. Diagnosis of chronic CD is difficult in endemic places like Mexico due to the limitations of current commercially available diagnostic tests. Further evaluation of diagnostic performance of various assays could improve current CD diagnostic algorithms and proper care management in these regions. Genetic variability in the parasite may also play a role in the differing assay performances seen in this study, and this may be a valuable avenue of further research.
• Harris, R. B., Brown, H. E., Begay, R. L., Sanderson, P. R., Chief, C., Monroy, F. P., & Oren, E. (2022). Prevalence and Risk Factors in Three Rural Indigenous Communities of Northern Arizona. International journal of environmental research and public health, 19(2).
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  () is one of the most common bacterial stomach infections and is implicated in a majority of non-cardia gastric cancer. While gastric cancer has decreased in the United States (US), the incidence in the Navajo Nation is nearly four times higher than surrounding Non-Hispanic White populations. Little is known about prevalence in this population or other Indigenous communities in the lower 48 states. In this cross-sectional study, 101 adults representing 73 households from three Navajo Nation chapter communities completed surveys and a urea breath test for active . Accounting for intrahousehold correlation, prevalence was 56.4% (95% CI, 45.4-66.8) and 72% of households had at least one infected person. The odds of having an active infection in households using unregulated water were 8.85 (95% CI, 1.50-53.38) that of the use of regulated water, and males had 3.26 (95% CI, 1.05-10.07) higher odds than female. The prevalence of in Navajo is similar to that seen in Alaska Natives. Further investigation into factors associated with prevention of infection is needed as well as understanding barriers to screening and treatment.
• Langston, M. E., Brown, H. E., Lynch, C. F., Roe, D. J., & Dennis, L. K. (2022). Ambient UVR and Environmental Arsenic Exposure in Relation to Cutaneous Melanoma in Iowa. International journal of environmental research and public health, 19(3).
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  Intermittent sun exposure is the major environmental risk factor for cutaneous melanoma (CM). Cumulative sun exposure and other environmental agents, such as environmental arsenic exposure, have not shown consistent associations. Ambient ultraviolet radiation (UVR) was used to measure individual total sun exposure as this is thought to be less prone to misclassification and recall bias. Data were analyzed from 1096 CM cases and 1033 controls in the Iowa Study of Skin Cancer and Its Causes, a population-based, case-control study. Self-reported residential histories were linked to satellite-derived ambient UVR, spatially derived environmental soil arsenic concentration, and drinking water arsenic concentrations. In men and women, ambient UVR during childhood and adolescence was not associated with CM but was positively associated during adulthood. Lifetime ambient UVR was positively associated with CM in men (OR for highest vs. lowest quartile: 6.09, 95% confidence interval (CI) 2.21-16.8), but this association was not as strong among women (OR for highest vs. lowest quartile: 2.15, 95% CI 0.84-5.54). No association was detected for environmental soil or drinking water arsenic concentrations and CM. Our findings suggest that lifetime and adulthood sun exposures may be important risk factors for CM.
• Tang, X., Sedda, L., & Brown, H. E. (2021). Predicting eastern equine encephalitis spread in North America: An ecological study. Current research in parasitology & vector-borne diseases, 1, 100064.
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  Eastern equine encephalitis (EEE) is a rare but lethal mosquito-borne zoonotic disease. Recent years have seen incursion into new areas of the USA, and in 2019 the highest number of human cases in decades. Due to the low detection rate of EEE, previous studies were unable to quantify large-scale and recent EEE ecological dynamics. We used Bayesian spatial generalized-linear mixed model to quantify the spatiotemporal dynamics of human EEE incidence in the northeastern USA. In addition, we assessed whether equine EEE incidence has predictive power for human cases, independently from other environmental variables. The predictors of the model were selected based on variable importance. Human incidence increased with temperature seasonality, but decreased with summer temperature, summer, fall, and winter precipitation. We also found EEE transmission in equines strongly associated with human infection (OR: 1.57; 95% CI: 1.52-1.60) and latitudes above 41.9°N after 2018. The study designed for sparse dataset described new and known relationships between human and animal EEE and environmental factors, including geographical directionality. Future models must include equine cases as a risk factor when predicting human EEE risks. Future work is still necessary to ascertain the establishment of EEE in northern latitudes and the robustness of the available data.
• Austhof, E., Berisha, V., McMahan, B., Owen, G., Keith, L., Roach, M., & Brown, H. E. (2020). Engaging public health stakeholders in climate and health adaptation. Atmosphere, 11(3), 265. doi:https://doi.org/10.3390/atmos11030265
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  Stakeholder participation at the intersection of climate and health is essential to assess and plan for the human health impacts of current and projected climate-sensitive hazards. Using the Maricopa County Department of Public Health (MCDPH) Coalition on Climate Change and Public Health workgroup and the Climate Assessment for the Southwest (CLIMAS) program as examples, this paper describes the important role of scientist–public health stakeholder collaboratives in addressing the public health impacts of climate-sensitive hazards. Using the MCDPH and CLIMAS stakeholder groups, stakeholder connections were mapped to show relationships between the organization types and connections between scientists and public health stakeholders. Stakeholders, defined as meeting attendees, were primarily individuals from academic institutions (n = 175), government agencies (n = 114), non-profits (n = 90), and health departments (n = 85). Engaging public health stakeholders in transdisciplinary regional climate initiatives and addressing gaps in their networks helped these programs to develop more collaborative projects over time.
• Baum, C., Soliman, A. S., Brown, H. E., Seifeldin, I. A., Ramadan, M., Lott, B., Nguyen, A., El-Ghawalby, A., & Hablas, A. (2020). Regional Variation of Pancreatic Cancer Incidence in the Nile Delta Region of Egypt over a Twelve-Year Period. Journal of Cancer Epidemiology, 2020, 6031708.
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  Pancreatic cancer is one of the deadliest forms of cancer, with incidence rates rising in many countries around the world. Geographic variation in pancreatic cancer incidence has not been studied extensively, especially in low- and middle-income countries. The aim of this study was to characterize the distribution of pancreatic cancer incidence in the central Nile Delta region of Egypt and to examine differences by urban and rural patient residence using the nation's only population-based cancer registry.
• Cook, A., Harris, R., Brown, H. E., & Bedrick, E. (2020). Geospatial characteristics of non-motor vehicle and assault-related trauma events in greater Phoenix, Arizona. Injury epidemiology, 7(1), 34.
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  Injury-causing events are not randomly distributed across a landscape, but how they are associated with the features and characteristics of the places where they occur in Arizona (AZ) remains understudied. Clustering of trauma events and associations with areal sociodemographic characteristics in the greater Phoenix (PHX), AZ region can promote understanding and inform efforts to ameliorate a leading cause of death and disability for Arizonans. The outcomes of interest are trauma events unrelated to motor vehicle crashes (MVC) and the subgroup of trauma events due to interpersonal assaults.
• Harris, R. B., Sanderson, P. R., Monroy, F. P., Mbegbu, M., Kyman, S., Jarrin, G., Harris, R. B., Chief, C., & Brown, H. E. (2020). Abstract PO-162: Helicobacter pylori in Native Americans in Northern Arizona. Cancer Epidemiology, Biomarkers & Prevention. doi:10.1158/1538-7755.disp20-po-162
• Harris, R. B., Sanderson, P. R., Oren, E., Monroy, F. P., Harris, R. B., Chief, C., Brown, H. E., & Begay, R. (2020). Abstract D109:Helicobacter pyloriinfections in Navajo communities of Northern Arizona. Cancer Epidemiology, Biomarkers & Prevention. doi:10.1158/1538-7755.disp19-d109
• Lega, J. C., Brown, H. E., & Barrera, R. (2020). A 70 percent reduction in mosquito populations does not require removal of 70 percent of mosquitoes. Journal of Medical Entomology, 57(5), 1668-1670.
• Zhu, G., Yuan, L., Xu, B., Xiao, X., Vandewoude, S., Shi, Z., Shi, X., Shi, J., Olival, K. J., Martinez-lopez, B., Lu, J., Liu, W., Liu, Q., Lips, K. R., Li, H., Grohn, Y. T., Getz, W. M., Evans, T. S., Escobar, L. E., , Civitello, D. J., et al. (2020). Synergistic China-US Ecological Research is Essential for Global Emerging Infectious Disease Preparedness.. EcoHealth, 17(1), 160-173. doi:10.1007/s10393-020-01471-2
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  The risk of a zoonotic pandemic disease threatens hundreds of millions of people. Emerging infectious diseases also threaten livestock and wildlife populations around the world and can lead to devastating economic damages. China and the USA-due to their unparalleled resources, widespread engagement in activities driving emerging infectious diseases and national as well as geopolitical imperatives to contribute to global health security-play an essential role in our understanding of pandemic threats. Critical to efforts to mitigate risk is building upon existing investments in global capacity to develop training and research focused on the ecological factors driving infectious disease spillover from animals to humans. International cooperation, particularly between China and the USA, is essential to fully engage the resources and scientific strengths necessary to add this ecological emphasis to the pandemic preparedness strategy. Here, we review the world's current state of emerging infectious disease preparedness, the ecological and evolutionary knowledge needed to anticipate disease emergence, the roles that China and the USA currently play as sources and solutions to mitigating risk, and the next steps needed to better protect the global community from zoonotic disease.
• Dennis, L. K., Brown, H. E., & Farland, L. V. (2019). DSM II Colormeter for measuring skin color: its usefulness and reliability of its measurement of melanin. J Dermatol Cosmet Treat, 1(1), 1-5.
• Florea, A., Brown, H. E., Harris, R. B., & Oren, E. (2019). Ethnic Disparities in Gastric Cancer Presentation and Screening Practice in the United States: Analysis of 1997-2010 Surveillance, Epidemiology, and End Results-Medicare Data. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 28(4), 659-665.
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  Chronic infection with () is the strongest risk factor for distal gastric cancer. Although gastric cancer incidence has decreased, variation by race and ethnicity is observed. This study describes gastric cancer presentation and screening services among Medicare patients by race/ethnicity, place of birth, and history of gastric cancer-related conditions.
• Harris, R. B., Roe, D. J., Oren, E., Knight, G. M., Harris, R. B., Grandjean, L., Gilman, R. H., Bui, D. P., & Brown, H. E. (2019). A Case-Control Study to Identify Community Venues Associated with Genetically-clustered, Multidrug-resistant Tuberculosis Disease in Lima, Peru.. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 68(9), 1547-1555. doi:10.1093/cid/ciy746
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  The majority of tuberculosis transmission occurs in community settings. Our primary aim in this study was to assess the association between exposure to community venues and multidrug-resistant (MDR) tuberculosis. Our secondary aim was to describe the social networks of MDR tuberculosis cases and controls..We recruited laboratory-confirmed MDR tuberculosis cases and community controls that were matched on age and sex. Whole-genome sequencing was used to identify genetically clustered cases. Venue tracing interviews (nonblinded) were conducted to enumerate community venues frequented by participants. Logistic regression was used to assess the association between MDR tuberculosis and person-time spent in community venues. A location-based social network was constructed, with respondents connected if they reported frequenting the same venue, and an exponential random graph model (ERGM) was fitted to model the network..We enrolled 59 cases and 65 controls. Participants reported 729 unique venues. The mean number of venues reported was similar in both groups (P = .92). Person-time in healthcare venues (adjusted odds ratio [aOR] = 1.67, P = .01), schools (aOR = 1.53, P < .01), and transportation venues (aOR = 1.25, P = .03) was associated with MDR tuberculosis. Healthcare venues, markets, cinemas, and transportation venues were commonly shared among clustered cases. The ERGM indicated significant community segregation between cases and controls. Case networks were more densely connected..Exposure to healthcare venues, schools, and transportation venues was associated with MDR tuberculosis. Intervention across the segregated network of case venues may be necessary to effectively stem transmission.
• Isoe, J., Koch, L. E., Isoe, Y. E., Rascón, A. A., Brown, H. E., Massani, B. B., & Miesfeld, R. L. (2019). Identification and characterization of a mosquito-specific eggshell organizing factor in Aedes aegypti mosquitoes. PLoS Biology, 17(1), e3000068.
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  Mosquito-borne diseases are responsible for several million human deaths annually around the world. One approach to controlling mosquito populations is to disrupt molecular processes or antagonize novel metabolic targets required for the production of viable eggs. To this end, we focused our efforts on identifying proteins required for completion of embryonic development that are mosquito selective and represent potential targets for vector control. We performed bioinformatic analyses to identify putative protein-coding sequences that are specific to mosquito genomes. Systematic RNA interference (RNAi) screening of 40 mosquito-specific genes was performed by injecting double-stranded RNA (dsRNA) into female Aedes aegypti mosquitoes. This experimental approach led to the identification of eggshell organizing factor 1 (EOF1, AAEL012336), which plays an essential role in the formation and melanization of the eggshell. Eggs deposited by EOF1-deficient mosquitoes have nonmelanized fragile eggshells, and all embryos are nonviable. Scanning electron microscopy (SEM) analysis identified that exochorionic eggshell structures are strongly affected in EOF1-deficient mosquitoes. EOF1 is a potential novel target, to our knowledge, for exploring the identification and development of mosquito-selective and biosafe small-molecule inhibitors.
• Luz, P., Brown, H. E., & Struchiner, C. (2019). Disgust as an emotional driver of vaccine attitudes and uptake? A mediation analysis. Epidemiology and Infection, 147(e182), 1-8.
• Oren, E., Pelley, E., Purve, J., Lauro, P. L., Dennis, L. K., & Brown, H. E. (2019). Emerging evidence for infectious causes of cancer in the United States.. Epidemiologic Reviews.
• Thompson, C., Saxberg, K., Lega, J. C., Tong, D., & Brown, H. E. (2019). A new gravity model for spatial interaction. Journal of Transport Geography, 79.
• Del Valle, S. Y., McMahon, B. H., Asher, J., Hatchett, R., Lega, J. C., Brown, H. E., Leany, M. E., Pantazis, Y., Roberts, D., Moore, S., Peterson, T., Escobar, L. E., Qiao, H., Hengartner, N. W., & Mukundan, H. (2018). Summary Results of the 2014-2015 DARPA Chikungunya Challenge. BMC Infectious Diseases, 18, 245. doi:http://dx.doi.org/10.1186/s12879-018-3124-7
• Langston, M. E., Dennis, L. K., Lynch, C. F., Roe, D., & Brown, H. E. (2017). Temporal Trends in Satellite-Derived Erythemal UVB and Implications for Ambient Sun Exposure Assessment. Int J Environ Res Public Health.
• Roach, M., Austhof, E., Berisha, V., Brown, H. E., Carr, D., Harlow-Smith, L., Hondula, D. M., & Snyder, K. (2018). Addendum to the Arizona Climate and Health Adaptation Plan. Report.
• Brown, H. E., Barrera, R., Comrie, A. C., & Lega, J. (2017). Effect of temperature thresholds on modeled Aedes aegypti (Diptera: Culicidae) population dynamics. Journal of Medical Entomology, 54(4), 869-877.
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  Dynamic simulation models provide vector abundance estimates using only meteorological data. However, model outcomes may heavily depend on the assumptions used to parameterize them. We conducted a sensitivity analysis for a model of Aedes aegypti (L.) abundance using weather data from two locations where this vector is established, La Margarita, Puerto Rico and Tucson, Arizona. We tested the effect of simplifying temperature-dependent development and mortality rates and of changing development and mortality thresholds as compared with baselines estimated using biophysical models. The simplified development and mortality rates had limited effect on abundance estimates in either location. However, in Tucson, where the vector is established but has not transmitted viruses, a difference of 5 °C resulted in populations either surviving or collapsing in the hot Arizona mid-summer, depending on the temperature thresholds. We find three important implications of the observed sensitivity to temperature thresholds. First, this analysis indicates the need for better estimates of the temperature tolerance thresholds to refine entomologic risk mapping for disease vectors. Second, our results highlight the importance of extreme temperatures on vector survival at the marginal areas of this vector's distribution. Finally, the model suggests that adaptation to warmer temperatures may shift regions of pathogen transmission.
• Brown, H. E., Cox, J., Comrie, A. C., & Barrera, R. (2017). Habitat and Density of Oviposition Opportunity Influences Aedes aegypti (Diptera: Culicidae) Flight Distance. Journal of Medical Entomology, 54(5), 1385-1389.
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  Understanding the dispersal of Aedes (aegypti (L.) Diptera: Culicidae) after consuming a potentially infectious bloodmeal is an important part of controlling the spread of the arboviruses it transmits. Because of the impact on abundance, removal of oviposition sites is a key component of vector control. However, source reduction around a case may encourage dispersal of potentially infected vectors. We compare the effect of oviposition site availability on Ae. aegypti dispersal behavior within 30-m linear cages in three model ecosystems at the University of Arizona's Biosphere 2 research facility. We found a significant interaction effect in which, when oviposition site density was sparse, dispersal was greater in the highly vegetated humid rainforest and limited in the low vegetation, arid desert model ecosystem. When oviposition site density was dense, no significant effect on dispersal was observed. These analyses support the idea that source reduction has an important influence on the distance that gravid, potentially infected, females will travel.
• Driscoll, L. J., Brown, H. E., Harris, R. B., & Oren, E. (2017). Population knowledge, attitude, and practice regarding Helicobacter pylori transmission and outcomes: A Literature Review. Frontiers in Public Health, 5, 144.
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  Helicobacter pylori infection is associated with the development of chronic gastritis, peptic ulcer disease, and gastric cancer. Current clinical recommendations are that H. pylori test-and-treat should be individualized based on comorbidities and patient preferences among populations at increased risk for certain morbidities. However, knowledge, attitudes and practices regarding H. pylori among potential patient populations are largely unknown.
• Heidi E, B., Wangshu, M., Mohammed, K., Clarisse, T., Jian, L., & Daoqin, T. (2017). Spatial scale in environmental risk mapping: A Valley fever case study. Journal of Public Health Research, 6(2), 886.
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  Valley fever is a fungal infection occurring in desert regions of the U.S. and Central and South America. Environmental risk mapping for this disease is hampered by challenges with detection, case reporting, and diagnostics as well as challenges common to spatial data handling.
• Lega, J., Brown, H. E., & Barrera, R. (2017). Aedes aegypti (Diptera: Culicidae) Abundance Model Improved With Relative Humidity and Precipitation-Driven Egg Hatching. Journal of Medical Entomology, 54(5), 1375-1384.
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  We propose an improved Aedes aegypti (L.) abundance model that takes into account the effect of relative humidity (RH) on adult survival, as well as rainfall-triggered egg hatching. The model uses temperature-dependent development rates described in the literature as well as documented estimates for mosquito survival in environments with high RH, and for egg desiccation. We show that combining the two additional components leads to better agreement with surveillance trap data and with dengue incidence reports in various municipalities of Puerto Rico than incorporating either alone or neither. Capitalizing on the positive association between disease incidence and vector abundance, this improved model is therefore useful to estimate incidence of Ae. aegypti-borne diseases in locations where the vector is abundant year-round.
• Luz, P. M., Johnson, R. E., & Brown, H. E. (2017). Workplace availability, risk group and perceived barriers predictive of 2016-17 influenza vaccine uptake in the United States: A cross-sectional study. Vaccine, 35(43), 5890-5896.
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  Seasonal influenza, though mostly self-limited in the healthy adult, may lead to severe disease and/or complications in subpopulations. Annual influenza vaccination is available in many countries with coverage goals rarely being met. We conducted a cross-sectional study of influenza vaccine uptake and explored socio-demographic, economic, and psychological factors that explained vaccine uptake.
• Murakami, T. T., Scranton, R., Brown, H. E., Harris, R. B., Chen, Z., Musuku, S., & Oren, E. (2017). Management of Helicobacter Pylori in the United States: Results from a national survey of gastroenterology physicians. Preventive Medicine, 100, 216-222.
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  We sought to determine current knowledge and practices among gastroenterology physicians and assess adherence to current guidelines for H. pylori management.
• Brown, H. E., Smith, C., & Lashway, S. (2016). Influence of the length of storage on Aedes aegypti (Diptera: Culicidae) egg viability. Journal of Medical Entomology.
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  Aedes aegypti (L.) is one of the most important arboviral vectors worldwide. Vector control is targeted at immature and adult stages; however, eggs are resistant to desiccation and may repopulate treated areas long after treatment ceases. We investigated the effect of age on Ae. aegypti egg hatching rates using newly colonized populations (F2) from an arid region. We found a strongly negative association where older eggs had lower hatch rates. The capacity of eggs to survive for long periods of time has implications on mosquito control. In addition, the accumulation of eggs in containers should be accounted for in abundance modeling efforts where populations may grow rapidly early in the season.
• Bui, D., Brown, H. E., Harris, R. B., & Oren, E. (2016). Serologic Evidence for Fecal-Oral Transmission of Helicobacter pylori. The American Journal of Tropical Medicine and Hygiene, 94(1), 82-8.
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  Helicobacter pylori infection is among the most prevalent infections in the world and a key cause of gastric diseases; however, its route of transmission remains unclear. This study aimed to assess the potential for fecal-oral transmission of H. pylori by leveraging its association with a disease with known etiology. Utilizing serology data from the National Health and Nutrition Examination Survey (NHANES 1999; N = 6,347), the association between H. pylori and hepatitis A virus (HAV), a sensitive indicator for fecal-oral exposure, was assessed. Survey-weighted kappa and multiple logistic regression were used to quantify the association between H. pylori and HAV after controlling for age, sex, race, poverty, birthplace, crowding, smoking, and alcohol use. Concordant serological results were found among 69.8% of participants (survey-weighted κ = 0.30, 95% confidence interval [CI] = 0.26, 0.35). The adjusted odds of H. pylori seropositivity were over two times higher after adjusting for confounders (odds ratio = 2.27, 95% CI = 1.79, 2.87). Results from this study suggest H. pylori and HAV infections are strongly associated. Since HAV is primarily transmitted through the fecal-oral route, fecal-oral transmission may be an important pathway for H. pylori spread.
• Haenchen, S., Hayden, M., Dickinson, K., Walker, K. R., Jacobs, E. T., Brown, H. E., Gunn, J., Kohler, L., & Ernst, K. C. (2015). Mosquito avoidance practices and knowledge of arboviral diseases in cities with differing recent history of disease. American Journal of Tropical Medicine and Hygiene.
• Hansen, V., Oren, E., Dennis, L. K., & Brown, H. E. (2016). Infectious Disease Mortality Trends in the United States, 1980-2014. JAMA, 316(20), 2149-2151.
• Lega, J. C., & Brown, H. E. (2016). Data-driven outbreak forecasting with a simple nonlinear growth model. Epidemics, 17, 19-26. doi:http://dx.doi.org/10.1016/j.epidem.2016.10.002
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  Recent events have thrown the spotlight on infectious disease outbreak response. We developed a data-driven method, EpiGro, which can be applied to cumulative case reports to estimate the order of magnitude of the duration, peak and ultimate size of an ongoing outbreak. It is based on a surprisingly simple mathematical property of many epidemiological data sets, does not require knowledge or estimation of disease transmission parameters, is robust to noise and to small data sets, and runs quickly due to its mathematical simplicity. Using data from historic and ongoing epidemics, we present the model. We also provide modeling considerations that justify this approach and discuss its limitations. In the absence of other information or in conjunction with other models, EpiGro may be useful to public health responders.
• Shelly, E. M., Acuna-Soto, R., Ernst, K. C., Sterling, C. R., & Brown, H. E. (2016). A Critical Assessment of Officially Reported Chagas Disease Surveillance Data in Mexico.. Public Health Reports, 131.
• Brown, H. E., Young, A., Lega, J., Andreadis, T. G., Schurich, J., & Comrie, A. (2015). Projection of Climate Change Influences on U.S. West Nile Virus Vectors. Earth Interactions, 19.
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  While estimates of the impact of climate change on health are necessary for health care planners and climate change policy makers, models to produce quantitative estimates remain scarce. We describe a freely available dynamic simulation model parameterized for three West Nile virus vectors, which provides an effective tool for studying vector-borne disease risk due to climate change. The Dynamic Mosquito Simulation Model is parameterized with species specific temperature-dependent development and mortality rates. Using downscaled daily weather data, we estimate mosquito population dynamics under current and projected future climate scenarios for multiple locations across the country. Trends in mosquito abundance were variable by location, however, an extension of the vector activity periods, and by extension disease risk, was almost uniformly observed. Importantly, mid-summer decreases in abundance may be off-set by shorter extrinsic incubation periods resulting in a greater proportion of infective mosquitoes. Quantitative descriptions of the effect of temperature on the virus and mosquito are critical to developing models of future disease risk.
• Clark, R., Taylor, A., Garcia, F., Krone, T., & Brown, H. E. (2015). Recognizing the Role of Skunks in Human and Animal Rabies Exposures in the Southwest. Vector borne and Zoonotic Diseases, 15(8), 494-501.
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  Rabies is arguably the most important viral zoonotic disease worldwide with an estimated 55,000 human deaths each year. Globally, dogs are the primary animals affected. In the United States, especially on the East Coast, raccoons and bats are the primary reservoir. However, in the southwestern United States, skunk and bat rabies play a large role. We describe the epidemiology and environmental risk factors associated with rabies in the US Southwest using exposure data for 2004-2012 from one Arizona county as a case study. Unlike other parts of the country, here bats and skunks are the most commonly collected positive animals (62% and 32%, respectively). Even though most of the positive animals were bats, human and domestic animal exposures were primarily a result of skunk interactions (58% and 50%, respectively). Consequently, the majority of exposures occur early in the year, January and February, when the majority of skunk pickups also occur. Using public health surveillance data, our study highlights the importance of recognizing the role of skunks in human and animal exposures in the southwestern United States. Consistent with a "One Health" approach, our data show how wildlife and domestic animal and human exposures are associated and informative to one another.
• Nsoesie, E. O., Ricketts, R. P., Brown, H. E., Fish, D., Durham, D. P., Ndeffo Mbah, M. L., Christian, T., Ahmed, S., Marcellin, C., Shelly, E., Owers, K., Wenzel, N., Galvani, A. P., & Brownstein, J. S. (2015). Spatial and temporal clustering of chikungunya virus transmission in Dominica. PLoS Neglected Tropical Diseases, 9(8), e0003977.
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  Using geo-referenced case data, we present spatial and spatio-temporal cluster analyses of the early spread of the 2013-2015 chikungunya virus (CHIKV) in Dominica, an island in the Caribbean. Spatial coordinates of the locations of the first 417 reported cases observed between December 15th, 2013 and March 11th, 2014, were captured using the Global Positioning System (GPS). We observed a preponderance of female cases, which has been reported for CHIKV outbreaks in other regions. We also noted statistically significant spatial and spatio-temporal clusters in highly populated areas and observed major clusters prior to implementation of intensive vector control programs suggesting early vector control measures, and education had an impact on the spread of the CHIKV epidemic in Dominica. A dynamical identification of clusters can lead to local assessment of risk and provide opportunities for targeted control efforts for nations experiencing CHIKV outbreaks.
• Reyes-Castro, P. A., Harris, R. B., Brown, H. E., Christopherson, G. L., & Ernst, K. C. (2017). Spatio-temporal and neighborhood characteristics of two dengue outbreaks in two arid cities of Mexico. Acta Tropica, 167, 174-182.
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  Little is currently known about the spatial-temporal dynamics of dengue epidemics in arid areas. This study assesses dengue outbreaks that occurred in two arid cities of Mexico, Hermosillo and Navojoa, located in northern state of Sonora. Laboratory confirmed dengue cases from Hermosillo (N=2730) and Navojoa (N=493) were geocoded by residence and assigned neighborhood-level characteristics from the 2010 Mexican census. Kernel density and Space-time cluster analysis was performed to detect high density areas and space-time clusters of dengue. Ordinary Least Square regression was used to assess the changing socioeconomic characteristics of cases over the course of the outbreaks. Both cities exhibited contiguous patterns of space-time clustering. Initial areas of dissemination were characterized in both cities by high population density, high percentage of occupied houses, and lack of healthcare. Future research and control efforts in these regions should consider these space-time and socioeconomic patterns.
• Sedda, L., Morley, D., & Brown, H. E. (2015). Characteristics of Wind-Infective Farms of the 2006 Bluetongue Serotype 8 Epidemic in Northern Europe. EcoHealth, 12(3), 461-7.
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  Bluetongue is a Culicoides-borne viral disease of livestock. In 2006, northern Europe experienced a major outbreak of this disease with devastating effects on the livestock industry. The outbreak quickly spread over the region, primarily affecting cattle and sheep. A previous analysis of the role of vector flight and wind in the spread of this virus across northern Europe indicated that infection at 1,326 (65%) of the reported infected farms could be traced back to just 599 (29%) farms (wind-infective farms). Rather than focusing on presence or absence of vectors or difference between infected and non-infected farms, we investigate the zoological and environmental characteristics of these 599 wind-infective farms (which can be thought of as super-spreaders) in order to characterize what makes them distinct from non-infective farms. Differences in temperature, precipitation, and the density of sheep at individual farms were identified between these two groups. These environmental and zoological factors are known to affect vector abundance and may have promoted bluetongue virus transmission. Identifying such ecological differences can help in the description and quantification of relative risk in affected areas.
• Harris, R. B., Scranton, R. A., Oren, E., Musuku, S., Murakami, T., Harris, R. B., Chen, Z., & Brown, H. E. (2014). A Survey of Screening and Treatment Practices for Helicobacter pylori in the United States: 144. The American Journal of Gastroenterology, 109, S45. doi:10.14309/00000434-201410002-00144
• Wang, D., Bowman, D. D., Brown, H. E., Harrington, L. C., Kaufman, P. E., McKay, T., Nelson, C. T., Sharp, J. L., & Lund, R. (2014). Factors influencing U.S. canine heartworm (Dirofilaria immitis) prevalence. Parasites & Vectors, 7, 264.
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  This paper examines the individual factors that influence prevalence rates of canine heartworm in the contiguous United States. A data set provided by the Companion Animal Parasite Council, which contains county-by-county results of over nine million heartworm tests conducted during 2011 and 2012, is analyzed for predictive structure. The goal is to identify the factors that are important in predicting high canine heartworm prevalence rates.
• Borchert, J. N., Eisen, R. J., Holmes, J. L., Atiku, L. A., Mpanga, J. T., Brown, H. E., Graham, C. B., Babi, N., Montenieri, J. A., Enscore, R. E., & others, . (2012). Evaluation and modification of off-host flea collection techniques used in northwest Uganda: laboratory and field studies. Journal of Medical Entomology, 49, 210--214.
• Brown, H. E., Harrington, L. C., Kaufman, P. E., McKay, T., Bowman, D. D., Nelson, C. T., Wang, D., & Lund, R. (2012). Key factors influencing canine heartworm, Dirofilaria immitis, in the United States. Parasites & Vectors, 5.
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  An examination of the Companion Animal Parasite Council's (CAPC) canine heartworm data to clarify the spatial prevalence of heartworm in the United States. Factors thought to influence the spatial risk of disease, as identified in a recent CAPC workshop, are discussed.
• Craciunescu, V., Brown, H., Comrie, A., Zelicoff, A., Ward, T., Ragain, R., Simpson, G., Stanhope10, W., Kass-Hout11, T., Scharl12, A., & others, . (2012). Information and decision support systems. Environmental Tracking for Public Health Surveillance, 11, 369.
• Sedda, L., Brown, H. E., Purse, B. V., Burgin, L., Gloster, J., & Rogers, D. J. (2012). A new algorithm quantifies the roles of wind and midge flight activity in the bluetongue epizootic in northwest Europe. Proceedings of the Royal Society of London B: Biological Sciences, rspb20112555.
• Brown, H. E., Doyle, M. S., Cox, J., Eisen, R. J., & Nasci, R. S. (2011). The effect of spatial and temporal subsetting on Culex tarsalis abundance models-a design for sensible reduction of vector surveillance. Journal of the American Mosquito Control Association, 27, 120--128.
• Brown, H. E., Levy, C. E., Enscore, R. E., Schriefer, M. E., DeLiberto, T. J., Gage, K. L., & Eisen, R. J. (2011). Annual seroprevalence of Yersinia pestis in coyotes as predictors of interannual variation in reports of human plague cases in Arizona, United States. Vector-Borne and Zoonotic Diseases, 11, 1439--1446.
• Brown, H. E., Yates, K. F., Dietrich, G., MacMillan, K., Graham, C. B., Reese, S. M., Helterbrand, W. S., Nicholson, W. L., Blount, K., Mead, P. S., & others, . (2011). An acarologic survey and Amblyomma americanum distribution map with implications for tularemia risk in Missouri. American Journal of Tropical Medicine and Hygiene, 84, 411--419.
• Cox, J., Brown, H. E., & Rico-Hesse, R. (2011). Variation in vector competence for dengue viruses does not depend on mosquito midgut binding affinity. PLoS Negl Trop Dis, 5, e1172.
• Brown, H. E., Ettestad, P., Reynolds, P. J., Brown, T. L., Hatton, E. S., Holmes, J. L., Glass, G. E., Gage, K. L., & Eisen, R. J. (2010). Climatic predictors of the intra-and inter-annual distributions of plague cases in New Mexico based on 29 years of animal-based surveillance data. American Journal of Tropical Medicine and Hygiene, 82, 95--102.
• Hartemink, N., Purse, B., Meiswinkel, R., Brown, H., De Koeijer, A., Elbers, A., Boender, G., Rogers, D., & Heesterbeek, J. (2009). Mapping the basic reproduction number (R 0) for vector-borne diseases: a case study on bluetongue virus. Epidemics, 1, 153--161.
• Brown, H. E., Childs, J. E., Diuk-Wasser, M. A., & Fish, D. (2008). Ecological factors associated with west nile virus transmission, northeastern United States. Emerging Infectious Diseases, 14(10), 1539-1545.
• Brown, H. E., Diuk-Wasser, M. A., Guan, Y., Caskey, S., & Fish, D. (2008). Comparison of three satellite sensors at three spatial scales to predict larval mosquito presence in Connecticut wetlands. Remote Sensing of Environment, 112(5), 2301-2308.
• Brown, H. E., Paladini, M., Cook, R. A., Kline, D., Barnard, D., & Fish, D. (2008). Effectiveness of mosquito traps in measuring species abundance and composition. Journal of Medical Entomology, 45(3), 517-521.
• Brown, H., Duik-Wasser, M., Andreadis, T., & Fish, D. (2008). Remotely-sensed vegetation indices identify mosquito clusters of West Nile virus vectors in an urban landscape in the northeastern United States. Vector-borne and Zoonotic Diseases, 8(2), 197-206.
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  Heterogeneity in urban landscapes can influence the effectiveness of mosquito-borne disease control. We used remotely sensed vegetation indices to discriminate among mosquito habitats within a densely populated urban environment in New Haven, CT. ASTER derived vegetation indices were identified for 16 sites where adult mosquitoes were trapped over the summer of 2004. Canonical correlation analysis showed a significant relationship between the environmental variables (normalized difference vegetation index, disease/water stress index and distance to water) and four local West Nile virus competent vectors (Cx. pipiens, Cx. restuans, Cx. salinarius, and Ae. vexans) (0.93, P = 0.03) explaining 86% of the variance in the environmental and mosquito measures. Sites were clustered based on these remotely sensed environmental variables. Three clusters were identified which provide insight into the distribution of West Nile virus vectors in an urban area. Identification of habitat differences of mosquitoes within the urban landscape has important implications for understanding West Nile virus transmission and for control of vector-competent mosquito species.
• Purse, B. V., Brown, H. E., Harrup, L., Mertens, P., & Rogers, D. J. (2008). Invasion of bluetongue and other orbivirus infections into Europe: the role of biological and climatic processes. Revue Scientifique et Technique-Office International des Epizooties, 27(2), 427-442.
• Diuk-Wasser, M. A., Brown, H. E., Andreadis, T. G., & Fish, D. (2006). Modeling the spatial distribution of mosquito vectors for West Nile virus in Connecticut, USA. Vector-borne and Zoonotic Diseases, 6(3), 283-295.
• Eden, G. F., Joseph, J. E., Brown, H. E., Brown, C. P., & Zeffiro, T. A. (1999). Utilizing hemodynamic delay and dispersion to detect fMRI signal change without auditory interference: The behavior interleaved gradients technique. Magnetic Resonance in Medicine, 41(1), 13-20.
• Zeffiro, T. A., Joseph, J. E., Eden, G. F., Brown, H. E., & Brown, C. P. (1998). fMRI acquisition without auditory interference: The "flatcar" design. NeuroImage, 7(4), S538. doi:10.1016/s1053-8119(18)31371-5
• Helmbrecht, G. D., Farhat, M. Y., Lochbaum, L., Brown, H. E., Yadgarova, K. T., Eglinton, G. S., & Ramwell, P. W. (1996). L-Arginine reverses the adverse pregnancy changes induced by nitric oxide synthase inhibition in the rat. American Journal of Obstetrics and Gynecology, 175(4), 800-805.

Proceedings Publications

• Roach, M., Owen, G., Mcmahan, B., Keith, L., Brown, H. E., Berisha, V., & Austhof, E. (2020). Participation and Engagement of Public Health Stakeholders in Climate and Health Adaptation. In Atmosphere, 11, 265.
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  Stakeholder participation at the intersection of climate and health is essential to assess and plan for the human health impacts of current and projected climate-sensitive hazards. Using the Maricopa County Department of Public Health (MCDPH) Coalition on Climate Change and Public Health workgroup and the Climate Assessment for the Southwest (CLIMAS) program as examples, this paper describes the important role of scientist–public health stakeholder collaboratives in addressing the public health impacts of climate-sensitive hazards. Using the MCDPH and CLIMAS stakeholder groups, stakeholder connections were mapped to show relationships between the organization types and connections between scientists and public health stakeholders. Stakeholders, defined as meeting attendees, were primarily individuals from academic institutions (n = 175), government agencies (n = 114), non-profits (n = 90), and health departments (n = 85). Engaging public health stakeholders in transdisciplinary regional climate initiatives and addressing gaps in their networks helped these programs to develop more collaborative projects over time.

Presentations

• Brown, H. E., Keith, L., Roach, M., Owen, G., McMahan, B., Berisha, V., & Austhof, E. (2019, December 13). Engaging public health stakeholders in climate change adaptation: Lessons learned from Maricopa County, AZ and the Climate Assessment for the Southwest. Fall Meeting 2019. San Francisco, California: American Geophysical Union.
• Beamer, P., O'Rourke, M. K., Guerra, S., Brown, H. E., Lopez-Galvez, N., & Lothrop, N. (2018, August). Escape to America: Adapting European Study for Cohorts for Air Pollution Effects (ESCAPE) Methods to the Desert Southwestern US. Joint meeting of the International Society of Exposure Science and the International Society of Environmental Epidemiology.
• Beamer, P., O'Rourke, M. K., Guerra, S., Furlong, M., Brown, H. E., Bell, M. L., & Lothrop, N. (2017, Fall). Modeling Historic Air Pollution Concentrations with Land Use Regression in Tucson, AZ. International Society of Exposure Science Conference. Research Triangle Park, NC.
• Lega, J. C., & Brown, H. E. (2015, May). Modeling the Spread of Chikungunya in the Caribbean and Central America. DARPA Chikungunya Challenge Finale. DARPA: DARPA.
• Lega, J. C., & Brown, H. E. (2015, October). Modeling the Spread of Chikungunya in the Caribbean and Central America. UA Microlunch SeriesUniversity of Arizona.

Poster Presentations

• Murakami, T., Scranton, R., Brown, H. E., Harris, R. B., Zhao, C., Musuku, S., & Oren, E. (2014, October). A Survey of Screening and Treatment Practices for Helicobacter pylori in the United States. American College of Gastroenterology.. Philadelphia, PA.
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  Murakami T, Scranton R, Brown H, Harris RB, Chen Z, Musuku S, Oren E. A Survey of Screening and Treatment Practices for Helicobacter pylori in the United States. Poster presentation at the American College of Gastroenterology 79th Annual Scientific Meeting, Philadelphia, PA, October 2014.

Case Studies

• Tabor, J., Schweers, N., Rabby, Q., Lega, J. C., Hondula, D., Clark, R., Brown, H. E., & Roach, M. (2017. Projections of Climate Impacts on Vector-Borne Diseases and Valley Fever in Arizona(p. 20).

Others

• Brown, H. E., Keith, M., Currans, K. M., Chambers, S., Austhof, E. C., & McCesney, C. R. (2023, Nov.). Cooling Center Walkshed & Transit Accessibility Analysis. A Report by the Building Resilience Against Climate Effects (BRACE) Team at the University of Arizona in Cooperation with the Pima County Health Department..
• Austhof, E., Keith, L., Brown, H. E., & Chambers, S. (2022, September). Summary of Body Heat Exposure Layer Development.
• Van Ohlen, K., Brown, H. E., Keith, L., Austhof, E., Watkins, L., & Chambers, S. (2022, August). Summary of Pima County Cooling Center Spatial Optimization. University of Arizona.