Kacey C Ernst

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Courses

Scholarly Contributions

Chapters

• Ernst, K. C., Morin, C., & Brown, H. E. (2014). Extreme Weather Events and Vector-borne Diseases. In Public Health in Natural Disasters: Nutrition, Food, Remediation and Preparation. Wageningen Academic Publishers.
• Ernst, K. C., Morin, C., Brown, H. E., 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.

Journals/Publications

• Iyengar, M. S., Merchant, N., Ernst, K., Rains, S., Arora, M., Ngaybe, M. G., & Gonzalez, M. (2024). Resilience Informatics for Public Health. Studies in health technology and informatics, 310, 1276-1280.
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  Resilience research is attracting increasing attention as stressors such as pandemics and climate change impact normal life worldwide. Informatics tools can play an important role in enhancing resilience of people, communities, and organizations. We present Resilience Informatics as a sub-discipline of resilience research and propose a conceptual framework for Resilience Informatics to aid in the development and effective deployment of informatics systems for resilience.
• Kimaru, L. J., Habila, M. A., Mantina, N. M., Madhivanan, P., Connick, E., Ernst, K., & Ehiri, J. (2024). Neighborhood characteristics and HIV treatment outcomes: A scoping review. PLOS global public health, 4(2), e0002870.
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  Recognizing challenges faced by people living with HIV is vital for improving their HIV treatment outcomes. While individual-level interventions play a crucial role, community factors can shape the impact of individual interventions on treatment outcomes. Understanding neighborhood characteristics' association with HIV treatment outcomes is crucial for optimizing effectiveness. This review aims to summarize the research scope on the association between neighborhood characteristics and HIV treatment outcomes. The databases PubMed, CINAHL (EBSCOhost), Embase (Elsevier), and PsychINFO (EBSCOhost) were searched from the start of each database to Nov 21, 2022. Screening was performed by three independent reviewers. Full-text publications of all study design meeting inclusion criteria were included in the review. There were no language or geographical limitations. Conference proceedings, abstract only, and opinion reports were excluded from the review. The search yielded 7,822 publications, 35 of which met the criteria for inclusion in the review. Studies assessed the relationship between neighborhood-level disadvantage (n = 24), composition and interaction (n = 17), social-economic status (n = 18), deprivation (n = 16), disorder (n = 8), and rural-urban status (n = 7) and HIV treatment outcomes. The relationship between all neighborhood characteristics and HIV treatment outcomes was not consistent across studies. Only 7 studies found deprivation had a negative association with HIV treatment outcomes; 6 found that areas with specific racial/ethnic densities were associated with poor HIV treatment outcomes, and 5 showed that disorder was associated with poor HIV treatment outcomes. Three studies showed that rural residence was associated with improved HIV treatment outcomes. There were inconsistent findings regarding the association between neighborhood characteristics and HIV treatment outcomes. While the impact of neighborhood characteristics on disease outcomes is highly recognized, there is a paucity of standardized definitions and metrics for community characteristics to support a robust assessment of this hypothesis. Comparative studies that define and assess how specific neighborhood indicators independently or jointly affect HIV treatment outcomes are highly needed.
• Madera-Garcia, V., Soto, J. R., Ellingson, K. D., Jacobs, E., Walker, K. R., & Ernst, K. C. (2024). Preferences and Demand for Mosquito Control among Dengue-Endemic Communities in Peñuelas, Puerto Rico: An Application of the Best-Worst Choice Model. The American journal of tropical medicine and hygiene, 110(3), 540-548.
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  Aedes aegypti is the primary vector of dengue virus and threatens 3.9 billion people living in many tropical and subtropical countries. Prevention and reduction of dengue and other Aedes-borne viruses, including Zika and chikungunya, requires control of mosquito populations. Community mobilization and input are essential components of vector control efforts. Many vector control campaigns do not engage communities prior to implementation, leading to program failure. Those that do often conduct basic knowledge, attitude, and practice surveys that are not designed to explicitly elicit preferences. Here, we applied a novel stated preference elicitation tool, best-worst choice, to understand preferences, willingness to participate, and willingness to pay for mosquito control in dengue-endemic communities of Peñuelas, Puerto Rico. Findings revealed that the community preferred mosquito control programs that are 1) applied at the neighborhood level, 2) implemented by the local government, and 3) focused specifically on reducing disease transmission (e.g., dengue) instead of mosquito nuisance. Programs targeting the reduction of disease transmission and higher educational level of participants increased willingness to participate. Participants were willing to pay an average of $72 annually to have a program targeting the reduction of diseases such as dengue. This study serves as a model to engage communities in the design of mosquito control programs and improve stakeholders' decision-making.
• Newman, E. A., Feng, X., Onland, J. D., Walker, K. R., Young, S., Smith, K., Townsend, J., Damian, D., & Ernst, K. (2024). Defining the roles of local precipitation and anthropogenic water sources in driving the abundance of Aedes aegypti, an emerging disease vector in urban, arid landscapes. Scientific reports, 14(1), 2058.
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  Understanding drivers of disease vectors' population dynamics is a pressing challenge. For short-lived organisms like mosquitoes, landscape-scale models must account for their highly local and rapid life cycles. Aedes aegypti, a vector of multiple emerging diseases, has become abundant in desert population centers where water from precipitation could be a limiting factor. To explain this apparent paradox, we examined Ae. aegypti abundances at > 660 trapping locations per year for 3 years in the urbanized Maricopa County (metropolitan Phoenix), Arizona, USA. We created daily precipitation layers from weather station data using a kriging algorithm, and connected localized daily precipitation to numbers of mosquitoes trapped at each location on subsequent days. Precipitation events occurring in either of two critical developmental periods for mosquitoes were correlated to suppressed subsequent adult female presence and abundance. LASSO models supported these analyses for female presence but not abundance. Precipitation may explain 72% of Ae. aegypti presence and 90% of abundance, with anthropogenic water sources supporting mosquitoes during long, precipitation-free periods. The method of using kriging and weather station data may be generally applicable to the study of various ecological processes and patterns, and lead to insights into microclimates associated with a variety of organisms' life cycles.
• Arora, M., Comrie, A. C., & Ernst, K. E. (2023). Assessing climate and health curriculum in graduate public health education in the United States. Frontiers in public health, 11, 1124379.
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  Climate change has been identified as both a challenge and an opportunity for public health. The onus to prepare the next generation of public health practitioners lies heavily on schools and programs of public health. This article (i) assesses the status of climate change and health curricula in accredited schools of public health in the United States and (ii) proposes strategies to better train professionals so they are more informed and prepared to mitigate, manage, and respond to the health impacts of climate change. Course offerings and syllabi listed in online course catalogs from 90 nationally accredited schools of public health were evaluated with the purpose of identifying the extent of climate change education in graduate programs. Only 44 public health institutions were found to offer a climate change related course at the graduate level of education. Of the 103 courses identified, approximately 50% ( = 46) are focused on this climate change and health. These courses cover a wide array of topics with an emphasis on conveying fundamental concepts. In-depth assessment revealed a need for integrating learning opportunities that build practical skills useful in a hands-on public health practice environment. This assessment indicates the limited availability of climate-health course offerings available to graduate students in accredited schools. The findings are used to propose an educational framework to integrate climate change into public health curricula. The proposed framework, while rooted in existing directives, adopts a tiered approach that can be readily applied by institutions training the next generation of public health leaders.
• Burger, J. R., Okie, J. G., Hatton, I., Weinberger, V. P., Shrestha, M., Liedtke, K. J., Be, T., Cruz, A. R., Feng, X., Hinojo-Hinojo, C., Kibria, A. S., Ernst, K. C., & Enquist, B. J. (2023). Global city densities: re-examining urban scaling theory.
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  Understanding scaling relations of social and environmental attributes ofurban systems is necessary for effectively managing cities. Urban scalingtheory (UST) has assumed that population density scales positively with citysize. We present a new global analysis using a publicly available database of933 cities from 38 countries. Our results showed that (18/38) 47% of countriesanalyzed supported increasing density scaling (pop ~ area) with exponents ~5/6as UST predicts. In contrast, 17 of 38 countries (~45%) exhibited densityscalings statistically indistinguishable from constant population densitiesacross cities of varying sizes. These results were generally consistent inyears spanning four decades from 1975 to 2015. Importantly, density varies byan order of magnitude between regions and countries and decreases in moredeveloped economies. Our results (i) point to how economic and regionaldifferences may affect the scaling of density with city size and (ii) show howunderstanding country- and region-specific strategies could inform effectivemanagement of urban systems for biodiversity, public health, conservation andresiliency from local to global scales.[Journal_ref: ]
• Chebet, J. J., McMahon, S. A., Tarumbiswa, T., Hlalele, H., Maponga, C., Mandara, E., Ernst, K., Alaofe, H., Baernighausen, T., Ehiri, J. E., Geldsetzer, P., & Nichter, M. (2023). Motivations for pre-exposure prophylaxis uptake and decline in an HIV-hyperendemic setting: findings from a qualitative implementation study in Lesotho. AIDS research and therapy, 20(1), 43.
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  Pre-Exposure Prophylaxis (PrEP) has demonstrated clinical efficacy in preventing HIV infection, yet its uptake remains low. This study, conducted in five PrEP implementing districts in Lesotho, examined factors motivating persons at risk of HIV infection to adopt or reject PrEP when offered freely.
• Coalson, J. E., Richard, D. M., Hayden, M. H., Townsend, J., Damian, D., Smith, K., Monaghan, A., & Ernst, K. C. (2023). Aedes aegypti abundance in urban neighborhoods of Maricopa County, Arizona, is linked to increasing socioeconomic status and tree cover. Parasites & vectors, 16(1), 351.
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  Understanding coupled human-environment factors which promote Aedes aegypti abundance is critical to preventing the spread of Zika, chikungunya, yellow fever and dengue viruses. High temperatures and aridity theoretically make arid lands inhospitable for Ae. aegypti mosquitoes, yet their populations are well established in many desert cities.
• Ernst, K. C., Walker, K. R., Castro-Luque, A. L., Schmidt, C., Joy, T. K., Brophy, M., Reyes-Castro, P., Díaz-Caravantes, R. E., Encinas, V. O., Aguilera, A., Gameros, M., Cuevas Ruiz, R. E., Hayden, M. H., Alvarez, G., Monaghan, A., Williamson, D., Arnbrister, J., Gutiérrez, E. J., Carrière, Y., & Riehle, M. A. (2023). Differences in Longevity and Temperature-Driven Extrinsic Incubation Period Correlate with Varying Dengue Risk in the Arizona-Sonora Desert Region. Viruses, 15(4).
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  Dengue transmission is determined by a complex set of interactions between the environment, mosquitoes, dengue viruses, and humans. Emergence in new geographic areas can be unpredictable, with some regions having established mosquito populations for decades without locally acquired transmission. Key factors such as mosquito longevity, temperature-driven extrinsic incubation period (EIP), and vector-human contact can strongly influence the potential for disease transmission. To assess how these factors interact at the edge of the geographical range of dengue virus transmission, we conducted mosquito sampling in multiple urban areas located throughout the Arizona-Sonora desert region during the summer rainy seasons from 2013 to 2015. Mosquito population age structure, reflecting mosquito survivorship, was measured using a combination of parity analysis and relative gene expression of an age-related gene, SCP-1. Bloodmeal analysis was conducted on field collected blood-fed mosquitoes. Site-specific temperature was used to estimate the EIP, and this predicted EIP combined with mosquito age were combined to estimate the abundance of "potential" vectors (i.e., mosquitoes old enough to survive the EIP). Comparisons were made across cities by month and year. The dengue endemic cities Hermosillo and Ciudad Obregon, both in the state of Sonora, Mexico, had higher abundance of potential vectors than non-endemic Nogales, Sonora, Mexico. Interestingly, Tucson, Arizona consistently had a higher estimated abundance of potential vectors than dengue endemic regions of Sonora, Mexico. There were no observed city-level differences in species composition of blood meals. Combined, these data offer insights into the critical factors required for dengue transmission at the ecological edge of the mosquito's range. However, further research is needed to integrate an understanding of how social and additional environmental factors constrain and enhance dengue transmission in emerging regions.
• Hawkes, B. A., Khan, S. M., Bell, M. L., Guernsey de Zapien, J., Ernst, K. C., & Ellingson, K. D. (2023). Healthcare System Distrust and Non-Prescription Antibiotic Use: A Cross-Sectional Survey of Adult Antibiotic Users. Antibiotics (Basel, Switzerland), 12(1).
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  Antibiotic resistance is a major public health concern driven by antibiotic overuse. Antibiotic stewardship programs are often limited to clinical settings and do little to address non-prescription antibiotic use in community settings. This study investigates the association between non-prescription antibiotic use and healthcare system distrust in the United States and Mexico. An online survey was deployed in the United States and Mexico with enhanced sampling through in-person recruiting in the border region. Non-prescription antibiotic use was defined as having bought or borrowed non-prescription oral or injectable antibiotics within the last 3 years. The survey included a previously validated 10-item scale to measure healthcare system distrust. Logistic regression was used to model the use of non-prescription antibiotics by the level of healthcare system distrust, adjusted for demographic characteristics and antibiotic knowledge. In total, 568 survey participants were included in the analysis, 48.6% of whom had used non-prescription oral or injectable antibiotics in the last 3 years. In the fully adjusted regression model, the odds of using non-prescription antibiotics were 3.2 (95% CI: 1.8, 6.1) times higher for those in the highest distrust quartile versus the lowest. These findings underscore the importance of community-based antibiotic stewardship and suggest that these programs are particularly critical for communities with high levels of healthcare system distrust.
• Jacobs, E. T., Catalfamo, C. J., Colombo, P. M., Khan, S. M., Austhof, E., Cordova-Marks, F., Ernst, K. C., Farland, L. V., & Pogreba-Brown, K. (2023). Pre-existing conditions associated with post-acute sequelae of COVID-19. Journal of autoimmunity, 135, 102991.
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  Post-acute sequelae of COVID-19 (PASC) are conditions that occur or remain at least 28 days after SARS-CoV-2 infection. While some risk factors for PASC have been identified, little is known about pre-existing conditions that render one susceptible to developing PASC. Data from participants (n = 1224) in a longitudinal COVID-19 cohort study in Arizona were used to investigate comorbid conditions associated with PASC. After adjustment of the models for age, BMI, gender, race, and smoking, the following pre-existing conditions were statistically significantly associated with the development of PASC: asthma (OR = 1.54; 95% CI = 1.10-2.15); chronic constipation (OR = 4.29; 95% CI = 1.15-16.00); reflux (OR = 1.54; 95% CI = 1.01-2.34); rheumatoid arthritis (OR = 3.69; 95%CI = 1.15-11.82); seasonal allergies (OR = 1.56; 95% CI = 1.22-1.98); and depression/anxiety (OR = 1.72; 95% CI = 1.17-2.52). When grouping conditions together, statistically significant associations with PASC were observed for respiratory (OR = 1.47; 95% CI = 1.06-2.14); gastrointestinal (OR = 1.62; 95% CI = 1.16-2.26), and autoimmune conditions (OR = 4.38; 95% CI = 1.59-12.06). After adjustment for severity of acute SARS-CoV-2 infection and depression/anxiety, seasonal allergies (OR = 1.48; 95% CI 1.15-1.91) and autoimmune disease (OR = 3.78; 95% CI - 1.31-10.91) remained significantly associated with risk for PASC. These findings indicate that numerous pre-existing conditions may be associated with an increased risk for the development of PASC. Patients with these conditions should consider taking extra steps to avoid infection.
• Jacobs, E. T., Cordova-Marks, F. M., Farland, L. V., Ernst, K. C., Andrews, J. G., Vu, S., Heslin, K. M., Catalfamo, C., Chen, Z., & Pogreba-Brown, K. (2023). Understanding low COVID-19 booster uptake among US adults. Vaccine, 41(42), 6221-6226.
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  Vaccinations against SARS-CoV-2 have consistently been shown to reduce the risk of severe COVID-19 disease. However, uptake of boosters has stalled in the United States at less than 20% of the eligible population. The objective of this study was to assess the reasons for not having obtained a bivalent booster within an existing COVID-19 cohort.
• Liu, R. W., Cheng, Y., Barbati, J. L., Rains, S. A., Crane, T. E., & Ernst, K. C. (2023). The Effectiveness of Social Norm Appeals on Promoting COVID-19 Prevention Behaviors: A Multistudy Examination. Health communication, 1-9.
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  Recent research shows social norm perceptions predict people's adherence to COVID-19 preventative health practices. Nonetheless, additional empirical studies are necessary to evaluate the effectiveness of different types of social norm messages on behavioral outcomes with experimental designs. Guided by the social norm literature and frameworks, the current research addresses this need by examining the effects of descriptive and injunctive norm appeals promoting the practice of social distancing and mask-wearing with both a controlled experiment and social media campaigns. Results from this multistudy investigation showed the effectiveness of descriptive and injunctive norm messages (v. no message exposure) in promoting focal behaviors and highlighted the superiority of injunctive norm appeals in promoting behavioral intentions and increasing social media engagement. Theoretical implications and recommendations for practice are discussed.
• Madera-Garcia, V., Coalson, J. E., Subelj, M., Bell, M. L., Hayden, M. H., Agawo, M., Munga, S., & Ernst, K. C. (2023). Self-Reported Symptoms at Last Febrile Illness as a Predictor of Treatment-Seeking in Western Kenya: A Cross-Sectional Study. The American journal of tropical medicine and hygiene, 108(1), 212-220.
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  Timely treatment-seeking behavior can reduce morbidity and mortality due to infectious diseases. Patterns of treatment-seeking behavior can differ by access to health care, and perceptions of disease severity and symptoms. We evaluated the association between self-reported symptoms at last illness and the level of treatment-seeking behaviors. We analyzed cross-sectional data from 1,037 participants from the lowlands and highlands of Western Kenya from 2015 using logistic regression models. There was considerable heterogeneity in the symptoms and treatment-seeking behaviors reported among individuals who were febrile at their last illness. A greater number of self-reported categories of symptoms tended to be associated with a higher likelihood of treatment-seeking in both sites. Participants were significantly more likely to seek treatment if they reported fever, aches, and digestive symptoms at last illness than just fever and aches or fever alone, but the frequency of treatment-seeking for fever in combination with aches and respiratory symptoms did not follow a consistent pattern. Among those who sought treatment, most used a formal source, but the patterns were inconsistent across sites and by the number of symptoms categories. Understanding the drivers of treatment-seeking behavior after febrile illness is important to control and treat infectious diseases in Kenya.
• Yeo, S., Park, Y., McClelland, D. J., Ehiri, J., Ernst, K., Magrath, P., & Alaofè, H. (2023). A scoping review of maternal health among resettled refugee women in the United States. Frontiers in public health, 11, 1157098.
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  Globally, refugee women continue to face higher maternity-related risks from preventable complications during pregnancy and childbirth, partly due to high health care costs, unfamiliarity with the healthcare system, language barriers, and discrimination. Nevertheless, there is still a paucity of literature that evaluates the available evidence in the US. This scoping review delineated the body of literature on maternal health among refugee women resettled in the US in order to identify knowledge gaps in the literature and highlight future research priorities and directions for maternal health promotion.
• Anderson, E. J., Coalson, J. E., Agawo, M., Munga, S., Hayden, M., Santos, E. M., Little, A. C., Tamari, N., & Ernst, K. (2022). Factors related to long-lasting insecticidal net (LLIN) use during travel in western Kenya: A descriptive analysis. Travel medicine and infectious disease, 47, 102291.
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  Overnight travel predicts increased likelihood of Plasmodium infection and may introduce parasite strains to new areas, but deviations from routine at-home use of long-lasting insecticidal nets (LLINs) during travel are not well studied.
• Anderson, E. J., Ernst, K., Garcia, D. O., Lopez, E., Pogreba Brown, K., Austhof, E., Carr McCuin, D., Hayden, M. H., & Koss, M. P. (2022). Knowledge of Sexual Transmission of Zika Virus Among Women Who Are Pregnant or Intend to Become Pregnant, Arizona, 2017. Public health reports (Washington, D.C. : 1974), 137(3), 488-497.
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  Levels of knowledge about the sexual transmission of Zika virus are consistently low in populations at risk of a mosquito-borne outbreak, including among women of childbearing age and women who are pregnant or intend to become pregnant. We investigated the effectiveness of sources of public health messaging about sexual transmission to women who are pregnant or intend to become pregnant in Arizona.
• Bandzuh, J. T., Ernst, K. C., Gunn, J. K., Pandarangga, S., Yowi, L. R., Hobgen, S., Cavanaugh, K. R., Kalaway, R. Y., Kalunga, N. R., Killa, M. F., Ara, U. H., Uejio, C. K., & Hayden, M. H. (2022). Knowledge, attitudes, and practices of Anopheles mosquito control through insecticide treated nets and community-based health programs to prevent malaria in East Sumba Island, Indonesia. PLOS global public health, 2(9), e0000241.
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  With an estimated 241 million human cases and 627,000 deaths in 2020, malaria remains a significant and ongoing global health challenge. This study employs a qualitative approach to investigate knowledge, attitudes, and practices surrounding mosquito control and prevention methods in East Sumba Regency, Indonesia. While malaria is under control in much of Indonesia, transmission in Sumba Island remains high, with incidence as high as 500 per 1000 population in some areas. A qualitative study was undertaken to explore use of insecticide treated nets, (ITNs), traditional Sumbanese mosquito control methods, and the role of women, integrated health service posts, (posyandu) and community-based health workers (kaders) in combatting malaria and controlling mosquitoes. Focus group discussions (n = 7) were conducted in East Sumba Island stratified by urban/rural location and level of malaria transmission. Key informant interviews (n = 14) were conducted with religious leaders, health workers, and women's group leaders. Results indicate that environmental conditions, such as high temperatures, were common deterrents to regular ITN use. Furthermore, our results suggest that community embedded health workers, kaders, and health service posts, posyandu, play an important role in information dissemination related to mosquitoes and mosquito-borne diseases as well as the distribution and use of ITNs in East Sumba Island. The role of the posyandu and kaders could be expanded to improve malaria prevention by integration with educational campaigns, aiding ITN distributions, and malaria diagnosis and treatment. This study is the first to examine mosquito-borne disease-related knowledge, attitudes, and practices in East Sumba Island, Indonesia. Results could improve mosquito control and malaria prevention by providing insights into local knowledge of Anopheles mosquitoes and malaria as well. Tailoring mosquito control and malaria prevention strategies around local knowledge and perceptions is likely to be more acceptable and sustainable.
• Colombo, P. M., Freylersythe, S., Sprinkle, M. M., Ernst, K. C., Yubeta, M., Barbati, J. L., Merchant, N., Iyengar, S., Crane, T. E., Oxnam, M., & Rains, S. A. (2022). Design and implementation of a health messaging protocol employed for use within a COVID-19 health dissemination platform. Frontiers in public health, 10, 942795.
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  AZCOVIDTXT, a bilingual, two-way information sharing platform was created in April of 2020 in response to rising COVID-19 cases in Arizona. The aim of this paper is to delineate the protocol and processes used to develop and disseminate health messaging to serve as guidance for other groups, universities, or public health programs in the implementation or enhancement of health communication services.
• Farland, L. V., Khan, S. M., Shilen, A., Heslin, K. M., Ishimwe, P., Allen, A. M., Herbst-Kralovetz, M. M., Mahnert, N. D., Pogreba-Brown, K., Ernst, K. C., & Jacobs, E. T. (2022). COVID-19 vaccination and changes in the menstrual cycle among vaccinated persons. Fertility and sterility.
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  To describe the characteristics of people who experience changes to their menstrual cycle after COVID-19 vaccination.
• Fernandez, M. P., Ernst, K. C., Bron, G. M., Berry, K., Diuk-Wasser, M. A., & Hayden, M. H. (2022). Outdoor Activity Associated with Higher Self-Reported Emotional Well-Being During COVID-19. EcoHealth, 19(2), 154-158.
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  Shifts in activity patterns during the COVID-19 pandemic might have impacted the benefits of outdoor activities for mental health. By leveraging an existing mobile application, we collected self-reported data on daily outdoor activities, emotional well-being, and the influence of COVID-19 on participant's outdoor activity levels during April-July 2020. Individuals reporting outdoor activities, in greenspaces or in their residence, had higher well-being scores and this effect increased with age. Self-reported impacts of COVID-19 on emotional well-being were associated with lower well-being scores. This work suggests that outdoor activities may have improved mental health during the COVID-19 pandemic.
• Gutiérrez, E. H., Riehle, M. A., Walker, K. R., Ernst, K. C., & Davidowitz, G. (2022). Using body size as an indicator for age structure in field populations of Aedes aegypti (Diptera: Culicidae). Parasites & vectors, 15(1), 483.
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  The Aedes aegypti mosquito is a vector of several viruses including dengue, chikungunya, zika, and yellow fever. Vector surveillance and control are the primary methods used for the control and prevention of disease transmission; however, public health institutions largely rely on measures of population abundance as a trigger for initiating control activities. Previous research found evidence that at the northern edge of Ae. aegypti's geographic range, survival, rather than abundance, is likely to be the factor limiting disease transmission. In this study, we sought to test the utility of using body size as an entomological index to surveil changes in the age structure of field-collected female Aedes aegypti.
• Habila, M. A., Valencia, D. Y., Khan, S. M., Heslin, K. M., Hoskinson, J., Ernst, K. C., Pogreba-Brown, K., Jacobs, E. T., Cordova-Marks, F. M., & Warholak, T. (2022). A Rasch analysis assessing the reliability and validity of the Arizona CoVHORT COVID-19 vaccine questionnaire. SSM - population health, 17, 101040.
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  Despite the widespread availability of COVID-19 vaccines in the United States, many that have chosen not to be vaccinated have done so because of vaccine hesitancy. This highlights the need for tools that accurately capture the knowledge, attitudes, and beliefs towards COVID-19 vaccines, and provide steps toward improving vaccine acceptance.
• Joshi, N., Lopus, S., Hannah, C., Ernst, K. C., Kilungo, A. P., Opiyo, R., Ngayu, M., Davies, J., & Evans, T. (2022). COVID-19 lockdowns: Employment and business disruptions, water access and hygiene practices in Nairobi's informal settlements. Social science & medicine (1982), 308, 115191.
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  Host to one billion people around the world, informal settlements are especially vulnerable to COVID-19 lockdown measures as they already lack basic services such as water, toilets, and secure housing. Additionally, many residents work in informal labor markets that have been affected by the lockdowns, resulting in further reductions in access to resources, including clean water. This study uses a cross-sectional design (n = 532) to examine the vulnerabilities of households to employment and business disruptions, water access and hygiene practices during the COVID-19 lockdowns between April and June 2020 in three informal settlements in Nairobi, Kenya. We used survey questions from the Household Water Insecurity Experience Scale (HWISE) to investigate the relationship between employment and business disruptions, water access, and hygiene practices (i.e., hand washing, body washing, clothes washing, and being able to use or drink clean water). Of the sampled households, 96% were forced to reduce work hours during the lockdowns, and these households had 92% lower odds of being able to afford water than households who did not experience a work hour reduction (OR = 0.08, p 
• Joy, T., Chen, M., Arnbrister, J., Williamson, D., Li, S., Nair, S., Brophy, M., Garcia, V. M., Walker, K., Ernst, K., Gouge, D. H., Carrière, Y., & Riehle, M. A. (2022). Assessing Near-Infrared Spectroscopy (NIRS) for Evaluation of Population Age Structure. Insects, 13(4).
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  Given that older (L.) mosquitoes typically pose the greatest risk of pathogen transmission, the capacity to age grade wild mosquito populations would be a valuable tool in monitoring the potential risk of arboviral transmission. Here, we compared the effectiveness of near-infrared spectroscopy (NIRS) to age grade field-collected with two alternative techniques-parity analysis and transcript abundance of the age-associated gene . Using lab-reared mosquitoes of known ages from three distinct populations maintained as adults under laboratory or semi-field conditions, we developed and validated four NIRS models for predicting the age of field-collected . To assess the accuracy of these models, female mosquitoes were collected from Maricopa County, AZ, during the 2017 and 2018 monsoon season, and a subset were age graded using the three different age-grading techniques. For both years, each of the four NIRS models consistently graded parous mosquitoes as significantly older than nulliparous mosquitoes. Furthermore, a significant positive linear association occurred between and NIRS age predictions in seven of the eight year/model combinations, although considerable variation in the predicted age of individual mosquitoes was observed. Our results suggest that although the NIRS models were not adequate in determining the age of individual field-collected mosquitoes, they have the potential to quickly and cost effectively track changes in the age structure of populations across locations and over time.
• Khan, S. M., Farland, L. V., Catalfamo, C. J., Austhof, E., Bell, M. L., Chen, Z., Cordova-Marks, F., Ernst, K. C., Garcia-Filion, P., Heslin, K. M., Hoskinson, J., Jehn, M. L., Joseph, E. C., Kelley, C. P., Klimentidis, Y., Russo Carroll, S., Kohler, L. N., Pogreba-Brown, K., & Jacobs, E. T. (2022). Elucidating symptoms of COVID-19 illness in the Arizona CoVHORT: a longitudinal cohort study. BMJ open, 12(1), e053403.
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  To elucidate the symptoms of laboratory-confirmed COVID-19 cases as compared with laboratory-confirmed negative individuals and to the untested general population among all participants who reported symptoms within a large prospective cohort study.
• Khan, S. M., Shilen, A., Heslin, K. M., Ishimwe, P., Allen, A. M., Jacobs, E. T., & Farland, L. V. (2022). SARS-CoV-2 infection and subsequent changes in the menstrual cycle among participants in the Arizona CoVHORT study. American journal of obstetrics and gynecology, 226(2), 270-273.
• Luzingu, J. K., Stroupe, N., Alaofe, H., Jacobs, E., & Ernst, K. (2022). Risk factors associated with under-five stunting, wasting, and underweight in four provinces of the Democratic Republic of Congo: analysis of the ASSP project baseline data. BMC public health, 22(1), 2422.
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  Determining the magnitude and risk factors of undernutrition in a country that has one of the highest prevalence of undernutrition in the world is paramount for developing contextual interventions.
• Wilson, A. M., Aviles, N., Petrie, J. I., Beamer, P. I., Szabo, Z., Xie, M., McIllece, J., Chen, Y., Son, Y. J., Halai, S., White, T., Ernst, K. C., & Masel, J. (2022). Quantifying SARS-CoV-2 Infection Risk Within the Google/Apple Exposure Notification Framework to Inform Quarantine Recommendations. Risk analysis : an official publication of the Society for Risk Analysis, 42(1), 162-176.
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  Most early Bluetooth-based exposure notification apps use three binary classifications to recommend quarantine following SARS-CoV-2 exposure: a window of infectiousness in the transmitter, ≥15 minutes duration, and Bluetooth attenuation below a threshold. However, Bluetooth attenuation is not a reliable measure of distance, and infection risk is not a binary function of distance, nor duration, nor timing. We model uncertainty in the shape and orientation of an exhaled virus-containing plume and in inhalation parameters, and measure uncertainty in distance as a function of Bluetooth attenuation. We calculate expected dose by combining this with estimated infectiousness based on timing relative to symptom onset. We calibrate an exponential dose-response curve based on infection probabilities of household contacts. The probability of current or future infectiousness, conditioned on how long postexposure an exposed individual has been symptom-free, decreases during quarantine, with shape determined by incubation periods, proportion of asymptomatic cases, and asymptomatic shedding durations. It can be adjusted for negative test results using Bayes' theorem. We capture a 10-fold range of risk using six infectiousness values, 11-fold range using three Bluetooth attenuation bins, ∼sixfold range from exposure duration given the 30 minute duration cap imposed by the Google/Apple v1.1, and ∼11-fold between the beginning and end of 14 day quarantine. Public health authorities can either set a threshold on initial infection risk to determine 14-day quarantine onset, or on the conditional probability of current and future infectiousness conditions to determine both quarantine and duration.
• Anderson, E., Koss, M., Castro Luque, A. L., Garcia, D., Lopez, E., & Ernst, K. (2021). WhatsApp-Based Focus Groups Among Mexican-Origin Women in Zika Risk Area: Feasibility, Acceptability, and Data Quality. JMIR formative research, 5(10), e20970.
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  Despite unprecedented advances in worldwide access to the internet via smartphones, barriers to engaging hard-to-reach populations remain in many methods of health research. A potential avenue for conducting qualitative research is via participatory web-based media, including the free, popular social platform WhatsApp. However, despite the clear advantages of engaging with participants over a well-established web-based platform, logistical challenges remain.
• Bell, M. L., Catalfamo, C. J., Farland, L. V., Ernst, K. C., Jacobs, E. T., Klimentidis, Y. C., Jehn, M., & Pogreba-Brown, K. (2021). Post-acute sequelae of COVID-19 in a non-hospitalized cohort: Results from the Arizona CoVHORT. PloS one, 16(8), e0254347.
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  Clinical presentation, outcomes, and duration of COVID-19 has ranged dramatically. While some individuals recover quickly, others suffer from persistent symptoms, collectively known as long COVID, or post-acute sequelae of SARS-CoV-2 (PASC). Most PASC research has focused on hospitalized COVID-19 patients with moderate to severe disease. We used data from a diverse population-based cohort of Arizonans to estimate prevalence of PASC, defined as experiencing at least one symptom 30 days or longer, and prevalence of individual symptoms. There were 303 non-hospitalized individuals with a positive lab-confirmed COVID-19 test who were followed for a median of 61 days (range 30-250). COVID-19 positive participants were mostly female (70%), non-Hispanic white (68%), and on average 44 years old. Prevalence of PASC at 30 days post-infection was 68.7% (95% confidence interval: 63.4, 73.9). The most common symptoms were fatigue (37.5%), shortness-of-breath (37.5%), brain fog (30.8%), and stress/anxiety (30.8%). The median number of symptoms was 3 (range 1-20). Amongst 157 participants with longer follow-up (≥60 days), PASC prevalence was 77.1%.
• Catalfamo, C. J., Heslin, K. M., Shilen, A., Khan, S. M., Hunsaker, J. R., Austhof, E., Barraza, L., Cordova-Marks, F. M., Farland, L. V., Garcia-Filion, P., Hoskinson, J., Jehn, M., Kohler, L. N., Lutrick, K., Harris, R. B., Chen, Z., Klimentidis, Y. C., Bell, M. L., Ernst, K. C., , Jacobs, E. T., et al. (2021). Design of the Arizona CoVHORT: A Population-Based COVID-19 Cohort. Frontiers in public health, 9, 620060.
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  This study is a prospective, population-based cohort of individuals with a history of SARS-CoV-2 infection and those without past infection through multiple recruitment sources. The main study goal is to track health status over time, within the diverse populations of Arizona and to identify the long-term consequences of COVID-19 on health and well-being. A total of 2,881 study participants (16.2% with a confirmed SARS-CoV-2 infection) have been enrolled as of December 22, 2020, with a target enrollment of 10,000 participants and a planned follow-up of at least 2 years. This manuscript describes a scalable study design that utilizes a wide range of recruitment sources, leveraging electronic data collection to capture and link longitudinal participant data on the current and emerging issues associated with the COVID-19 pandemic. The cohort is built within a collaborative infrastructure that includes new and established partnerships with multiple stakeholders, including the state's public universities, local health departments, tribes, and tribal organizations. Challenges remain for ensuring recruitment of diverse participants and participant retention, although the electronic data management system and timing of participant contact can help to mitigate these problems.
• Coalson, J. E., Anderson, E. J., Santos, E. M., Madera Garcia, V., Romine, J. K., Dominguez, B., Richard, D. M., Little, A. C., Hayden, M. H., & Ernst, K. C. (2021). The Complex Epidemiological Relationship between Flooding Events and Human Outbreaks of Mosquito-Borne Diseases: A Scoping Review. Environmental health perspectives, 129(9), 96002.
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  Climate change is expected to increase the frequency of flooding events. Although rainfall is highly correlated with mosquito-borne diseases (MBD) in humans, less research focuses on understanding the impact of flooding events on disease incidence. This lack of research presents a significant gap in climate change-driven disease forecasting.
• Coalson, J. E., Anderson, E. J., Santos, E. M., Madera Garcia, V., Romine, J. K., Luzingu, J. K., Dominguez, B., Richard, D. M., Little, A. C., Hayden, M. H., & Ernst, K. C. (2021). Erratum: "The Complex Epidemiologic Relationship between Flooding Events and Human Outbreaks of Mosquito-Borne Diseases: A Scoping Review". Environmental health perspectives, 129(12), 129001.
• Donzella, S. M., Kohler, L. N., Crane, T. E., Jacobs, E. T., Ernst, K. C., Bell, M. L., Catalfamo, C. J., Begay, R., Pogreba-Brown, K., & Farland, L. V. (2021). COVID-19 Infection, the COVID-19 Pandemic, and Changes in Sleep. Frontiers in public health, 9, 795320.
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  The objective of this study was to investigate the differences in sleep patterns among individuals with and without laboratory-confirmed SARS-CoV-2 infection. Laboratory-confirmed SARS-CoV-2 test results and self-reported measures recalling sleep habits prior to and during the pandemic were collected from May 2020 to March 2021 among 1,848 individuals in The Arizona CoVHORT Study. We used linear and logistic regression to model the association between test status, presentation of symptoms, and time since test result with sleep duration and trouble sleeping, respectively. Mixed models were used to investigate change in sleep duration prior to the pandemic compared to during the pandemic. Overall, 16.2% of the sample were SARS-CoV-2 positive, 64.3% were SARS-CoV-2 negative, and 19.5% were untested for SARS-CoV-2. Independent of SARS-CoV-2 infection status, all participants slept longer during the pandemic compared to pre-pandemic (Δ SARS-CoV-2 positive: 77.7 min, 95% CI 67.9, 87.5; Δ SARS-CoV-2 negative: 13.4 min, 95% CI 8.4, 18.3). However, SARS-CoV-2 positive participants slept 60.9 min longer (95% CI 49.1, 72.8) than SARS-CoV-2 negative participants in multivariable-adjusted models and had greater odds of trouble sleeping three or more times per week since the start of the pandemic (OR: 1.34 95% CI 1.02, 1.77) This greater odds of trouble sleeping persisted for participants who reported sleep habits > 30 days after their positive SARS-CoV-2 (OR: 2.11 95% CI 1.47, 3.03). Sleep patterns among non-hospitalized individuals with COVID-19 were altered following infection, regardless of the presentation of symptoms and time since infection.
• Feng, X., Merow, C., Liu, Z., Park, D. S., Roehrdanz, P. R., Maitner, B., Newman, E. A., Boyle, B. L., Lien, A., Burger, J. R., Pires, M. M., Brando, P. M., Bush, M. B., McMichael, C. N., Neves, D. M., Nikolopoulos, E. I., Saleska, S. R., Hannah, L., Breshears, D. D., , Evans, T. P., et al. (2021). How deregulation, drought and increasing fire impact Amazonian biodiversity. Nature, 597(7877), 516-521.
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  Biodiversity contributes to the ecological and climatic stability of the Amazon Basin, but is increasingly threatened by deforestation and fire. Here we quantify these impacts over the past two decades using remote-sensing estimates of fire and deforestation and comprehensive range estimates of 11,514 plant species and 3,079 vertebrate species in the Amazon. Deforestation has led to large amounts of habitat loss, and fires further exacerbate this already substantial impact on Amazonian biodiversity. Since 2001, 103,079-189,755 km of Amazon rainforest has been impacted by fires, potentially impacting the ranges of 77.3-85.2% of species that are listed as threatened in this region. The impacts of fire on the ranges of species in Amazonia could be as high as 64%, and greater impacts are typically associated with species that have restricted ranges. We find close associations between forest policy, fire-impacted forest area and their potential impacts on biodiversity. In Brazil, forest policies that were initiated in the mid-2000s corresponded to reduced rates of burning. However, relaxed enforcement of these policies in 2019 has seemingly begun to reverse this trend: approximately 4,253-10,343 km of forest has been impacted by fire, leading to some of the most severe potential impacts on biodiversity since 2009. These results highlight the critical role of policy enforcement in the preservation of biodiversity in the Amazon.
• Huete-Pérez, J. A., Ernst, K. C., Cabezas-Robelo, C., Páiz-Medina, L., Silva, S., & Huete, A. (2021). Prevalence and risk factors for SARS-CoV-2 infection in children with and without symptoms seeking care in Managua, Nicaragua: results of a cross-sectional survey. BMJ open, 11(9), e051836.
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  This study aimed to capture key epidemiological data on SARS-CoV-2 infection in Nicaraguan children (≤18 years) seeking medical care, between 6 October and 16 November 2020.
• López-Gálvez, N., Wagoner, R., Canales, R. A., Ernst, K., Burgess, J. L., de Zapien, J., Rosales, C., & Beamer, P. (2021). Longitudinal assessment of kidney function in migrant farm workers. Environmental research, 202, 111686.
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  Chronic kidney disease of unknown etiology (CKDu) is an epidemic that affects young agricultural workers in several warm regions of the world. However, there is a lack of monitoring of kidney issues in regions with extremely warm environments such as the Northwest of Mexico, a semi-arid region with a growing agricultural industry, where migrant and seasonal farm workers (MSFWs) travel to work in the fields. The objective of this study was to longitudinally assess kidney functioning of MSFWs in relation to pesticide exposure, heat stress and dehydration in a large-scale farm in Mexico. We enrolled 101 MSFWs, of whom 50 were randomly selected to work in an organic certified area and 51 were randomly selected to work in a conventional area. We also enrolled 50 office workers within the same region as a reference group. We collected urine and blood samples from all workers in addition to demographic, behavioral, and occupational characteristics. The physiological strain index (PSI) was used to estimate workers' heat strain. Sampling was conducted at pre-harvest (March) and late in the harvest (July). Linear mixed models were built with the estimated glomerular filtration rate (eGFR) as the dependent variable. We found a significant decrease in kidney function in MSFWs compared to office workers. By the late harvest, one MSFW developed kidney disease, two MSFWs suffered a kidney injury, and 14 MSFWs were at risk of a kidney injury. We found that the eGFR in MSFWs decreased significantly from pre-harvest (125 ± 13.0 mL/min/1.73 m) to late harvest (109 ± 13.6 mL/min/1.73 m) (p 
• Reyes-Castro, P. A., Ernst, K. C., Walker, K. R., Hayden, M. H., & Alvarez-Hernandez, G. (2021). Knowledge, Attitudes, and Practices Related to Rocky Mountain Spotted Fever in Hermosillo, México. The American journal of tropical medicine and hygiene, 104(1), 184-189.
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  Rocky Mountain spotted fever (RMSF) is a serious disease in northwest Mexico, particularly in low-income communities. This study aimed to evaluate RMSF-related knowledge, attitudes, and practices in an endemic urban area with a high burden of the disease. A cross-sectional study design using a non-probabilistic household survey was conducted with 400 residents in Hermosillo, Mexico. Primary themes assessed included dog and tick-related exposure, RMSF knowledge, healthcare-seeking behavior, sociodemographic data, and household information. The majority (59%) of those surveyed had heard about RMSF, although only 36% of RMSF-aware respondents knew any RMSF symptoms. Among RMSF-aware respondents, 26% did not know or were unsure of prevention strategies. Individuals in the low socioeconomic status (SES) stratum were less likely to have heard about RMSF (odds ratio [OR]: 0.39; 95% CI: 0.25-0.59), use dog collars or any other product to avoid ticks (OR: 0.40; 95% CI: 0.17-0.99), or check their dogs for ticks (OR: 0.25; 95% CI: 0.09-0.74). The likelihood of observing high numbers of free-roaming dogs in their neighborhood was four times higher in the low SES stratum (OR: 4.19; 95% CI: 2.10-8.38) than in the high SES stratum. These findings emphasize the need for an integrative community approach to improve early recognition of symptoms and knowledge of prevention strategies, particularly in low SES neighborhoods.
• Anderson, E. J., Ernst, K. C., Fernando Martins, F., da Silva Martins, C., & Koss, M. P. (2020). Women's Health Perceptions and Beliefs Related to Zika Virus Exposure during the 2016 Outbreak in Northern Brazil. The American journal of tropical medicine and hygiene.
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  During the 2016 Zika pandemic in Brazil, women's perceptions of infection risk, ability to adhere to Zika prevention strategies, or access to services following exposure were not emphasized in the public health response. Women in Fortaleza, Brazil, responded to a questionnaire on social factors related to perceived Zika risk and access to health care in June 2016. Data were coded using prespecified categories, and response frequency was reported. Of 37 respondents, most reported a lack of public services to support mosquito control ( = 19) or delayed access to reproductive health care ( = 14). Only 22% described specific maternal risks or fetal outcomes as a consequence of Zika infection. Respondents indicated an overall disconnect between public health efforts and women's perceptions of their reproductive control, including limited support concerning microcephaly in infants. Interventions targeting Zika may require a greater emphasis on strengthening health systems and infrastructure to realistically prevent transmission.
• Coalson, J. E., Santos, E. M., Little, A. C., Anderson, E. J., Stroupe, N., Agawo, M., Hayden, M., Munga, S., & Ernst, K. C. (2020). Insufficient Ratio of Long-Lasting Insecticidal Nets to Household Members Limited Universal Usage in Western Kenya: A 2015 Cross-Sectional Study. The American journal of tropical medicine and hygiene, 102(6), 1328-1342.
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  Universal "coverage" with long-lasting insecticidal nets (LLINs) is recommended for malaria control in endemic areas, but ownership does not ensure usage. We evaluated relationships between household-level ownership and individual-level usage in western Kenya in 2015. Low-prevalence highland (> 1,500 m) and highly endemic lowland (< 1,200 m) sites were surveyed from July to August 2015. Household members reported long-lasting insecticidal net ownership, use, and barriers to use. Net ownership was categorized as sufficient (≤ 2 people/net), insufficient (> 2 people/net), or none. Each LLIN was assumed to provide access to two people. We surveyed 574 lowland and 643 highland households, with 1,677 and 2,742 members, respectively. More than 98% of lowland households owned LLIN(s); 72.1% owned a sufficient number. Only 37.5% of highland households had sufficient nets. More people used LLINs than were estimated to have access in the lowlands (94.2% versus 85.3%), but proportions were similar in the highlands (54.3% versus 53.3%). Insufficient ownership was most common for larger households in both areas and strongly predicted LLIN usage. In households with insufficient nets, men, school-age children (aged 5-15 years), and nonnuclear family members were less likely to use LLINs; only relationship to the head of the household significantly predicted use in households with sufficient nets. Long-lasting insecticidal nets were widespread in western Kenya in 2015, but insufficient household ownership remained common in the epidemic highlands and in large households. Access seemed to be the primary driver of individual use. To interrupt transmission, LLIN campaigns should improve distribution to large households and promote use among men, school-age children, and nonnuclear family members.
• Comeau, G., Zinna, R. A., Scott, T., Ernst, K., Walker, K., Carrière, Y., & Riehle, M. A. (2020). Vertical Transmission of Zika Virus in Produces Potentially Infectious Progeny. The American journal of tropical medicine and hygiene, 103(2), 876-883.
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  Vertical transmission, or pathogen transfer from female to offspring, can facilitate the persistence of emerging arboviruses, such as Zika virus (ZIKV), through periods of low horizontal transmission or adverse environmental conditions. We aimed at determining the rate of vertical transmission for ZIKV in its principal vector, , and the vector competence of vertically infected progeny. females that consumed a blood meal provisioned with ZIKV were maintained under three temperature conditions (27°C, 30°C, and 33°C) following the infectious blood meal and allowed to complete three reproductive cycles. The overall vertical transmission rate was 6.5% (95% CI = 3.9-9.9). Vertical transmission of ZIKV was observed across all temperature conditions and virus detected in adult progeny up to 2 weeks postemergence. In total, 3.4% (95% CI = 1.6-6.2) of adult progeny produced saliva with ZIKV, indicating their vector competence. These results suggest the virus may be maintained in populations without a vertebrate host for short periods.
• Davidowitz, G., Riehle, M. A., Ernst, K. C., Walker, K. R., & Jeffrey Gutierrez, E. (2020). Size as a Proxy for Longevity in Aedes aegypti (Diptera: Culicidae) Mosquitoe. Journal of Medical Entomology, 57(4), 1228-1238. doi:10.1093/jme/tjaa055
• Davidowitz, G., Riehle, M. A., Ernst, K. C., Walker, K. R., & Jeffrey Gutierrez, E. (2020). Size as a Proxy for Longevity in Aedes aegypti (Diptera: Culicidae) Mosquitoe. Journal of Medical Entomology, 57, 1228-1238.
• Davidowitz, G., Riehle, M. A., Ernst, K. C., Walker, K. R., & Jeffrey Gutiérrez, E. (2020). Size as a Proxy for Longevity in Aedes aegypti (Diptera: Culicidae) Mosquitoes. Journal of Medical Entomology.
• Ernst, K. C., Ernst, K. C., Mukherjee, A., Mukherjee, A., Wilder, M. O., Wilder, M. O., Zuniga Teran, A. A., Zuniga Teran, A. A., Lemos, M. C., Lemos, M. C., Albrecht, T., Albrecht, T., Mayer, B. M., Mayer, B. M., Gerlak, A. K., Gerlak, A. K., Varady, R. G., & Varady, R. G. (2020). The exigencies of transboundary water security: Insights on community resilience. Current Opinion in Environmental Sustainability, 44, 74-84.
• Jeffrey Gutiérrez, E. H., Walker, K. R., Ernst, K. C., Riehle, M. A., & Davidowitz, G. (2020). Size as a Proxy for Survival in Aedes aegypti (Diptera: Culicidae) Mosquitoes. Journal of medical entomology, 57(4), 1228-1238.
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  The Aedes aegypti mosquito is the primary vector of dengue, yellow fever, chikungunya, and Zika viruses. Infection with the dengue virus alone occurs in an estimated 400 million people each year. Likelihood of infection with a virus transmitted by Ae. aegypti is most commonly attributed to abundance of the mosquito. However, the Arizona-Sonora desert region has abundant Ae. aegypti in most urban areas, yet local transmission of these arboviruses has not been reported in many of these cities. Previous work examined the role of differential Ae. aegypti longevity as a potential explanation for these discrepancies in transmission. To determine factors that were associated with Ae. aegypti longevity in the region, we collected eggs from ovitraps in Tucson, AZ and reared them under multiple experimental conditions in the laboratory to examine the relative impact of temperature and crowding during development, body size, fecundity, and relative humidity during the adult stage. Of the variables studied, we found that the combination of temperature during development, relative humidity, and body size produced the best model to explain variation in age at death. El mosquito Aedes aegypti es el vector primario de los virus de dengue, fiebre amarilla, chikungunya y Zika. Solamente las infecciones con los virus de dengue ocurren en aproximadamente 400 millones de personas cada año. La probabilidad de infección con un virus transmitido por Ae. aegypti es frecuentemente atribuido a la abundancia del mosquito. No obstante, la región del desierto de Arizona-Sonora tiene una abundancia de Ae. aegypti en la mayoría de las áreas urbanas, pero la transmisión local de estos arbovirus no ha sido reportada en muchas de estas ciudades. Trabajos previos han examinado el rol de las diferencias de longevidad en Ae. aegypti como explicación potencial por estas discrepancias en la transmisión. Para determinar que factores fueron asociados con longevidad en Ae. aegypti en la región, colectamos huevos de ovitrampas en Tucson, Arizona y los criamos debajo de múltiples condiciones experimentales en el laboratorio para examinar el impacto relativo de temperatura y competencia para nutrición durante desarrollo, tamaño del cuerpo, capacidad reproductiva, y humedad relativa durante adultez. De las variables estudiados, encontramos que la combinación de temperatura durante desarrollo, humedad relativa, y tamaño del cuerpo produjo el mejor modelo para explicar variación en edad al tiempo de la muerte.
• Lott, B. E., Trejo, M. J., Baum, C., McClelland, D. J., Adsul, P., Madhivanan, P., Carvajal, S., Ernst, K., & Ehiri, J. (2020). Interventions to increase uptake of cervical screening in sub-Saharan Africa: a scoping review using the integrated behavioral model. BMC public health, 20(1), 654.
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  Sub-Saharan Africa (SSA) experiences disproportionate burden of cervical cancer incidence and mortality due in part to low uptake of cervical screening, a strategy for prevention and down-staging of cervical cancer. This scoping review identifies studies of interventions to increase uptake of cervical screening among women in the region and uses the Integrated Behavioral Model (IBM) to describe how interventions might work.
• Park, D. S., Feng, X., Maitner, B. S., Ernst, K. C., & Enquist, B. J. (2020). Darwin's naturalization conundrum can be explained by spatial scale. Proceedings of the National Academy of Sciences of the United States of America, 117(20), 10904-10910.
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  Darwin proposed two seemingly contradictory hypotheses regarding factors influencing the outcome of biological invasions. He initially posited that nonnative species closely related to native species would be more likely to successfully establish, because they might share adaptations to the local environment (preadaptation hypothesis). However, based on observations that the majority of naturalized plant species in the United States belonged to nonnative genera, he concluded that the lack of competitive exclusion would facilitate the establishment of alien invaders phylogenetically distinct from the native flora (competition-relatedness hypothesis). To date, no consensus has been reached regarding these opposing hypotheses. Here, following Darwin, we use the flora of the United States to examine patterns of taxonomic and phylogenetic relatedness between native and nonnative taxa across thousands of nested locations ranging in size and extent, from local to regional scales. We find that the probability of observing the signature of environmental filtering over that of competition increases with spatial scale. Further, native and nonnative species tended to be less related in warm, humid environments. Our work provides an empirical assessment of the role of observation scale and climate in biological invasions and demonstrates that Darwin's two opposing hypotheses need not be mutually exclusive.
• Rains, S. A., Crane, T. E., Iyengar, S., Merchant, N., Oxnam, M., Sprinkle, M. M., & Ernst, K. C. (2020). Community-Level Health Promotion during a Pandemic: Key Considerations for Health Communication. Health communication, 35(14), 1747-1749.
• Riehle, M. A., Walker, K. R., Ernst, K. C., Carriere, Y., Zinna, R., & Comeau, G. (2020). Impact of Zika virus vertical transmission in the mosquito Aedes aegypti. American Journal of Tropical Medicine and Hygiene, 103(2), 876-883. doi:10.4269/ajtmh.19-0698
• Santos, E. M., Coalson, J. E., Munga, S., Agawo, M., Jacobs, E. T., Klimentidis, Y. C., Hayden, M. H., & Ernst, K. C. (2020). "After those nets are torn, most people use them for other purposes": an examination of alternative bed net use in western Kenya. Malaria journal, 19(1), 272.
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  Alternative long-lasting insecticidal net (LLIN) use for purposes other than sleeping protection from mosquitoes is widely debated as a limitation to successful malaria control efforts, yet rarely rigorously studied.
• Santos, E. M., McClelland, D. J., Shelly, C. E., Hansen, L., Jacobs, E. T., Klimentidis, Y. C., & Ernst, K. C. (2020). Malaria education interventions addressing bed net care and repair practices: a systematic review. Pathogens and global health, 114(1), 2-15.
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  Education intervention effectiveness to improve bed net care and repair knowledge or practices is unclear. To assess intervention effectiveness, we systematically reviewed eight peer-reviewed literature databases and 16 malaria organizations (PROSPERO protocol CRD42019123932) using pre-specified combinations of 'education intervention', 'mosquito net', and 'malaria' search terms. Data were abstracted for 29 of 43 studies meeting inclusion criteria, of which 16 studies included education as amain focus. Of these 16, there was evidence of intervention effectiveness among half of the studies, which reported improvements in knowledge or practices, while four had mixed results, and four had unclear results. Overall there is no clear conclusion regarding the effectiveness of education interventions to improve net care and repair, though some instructional methods suggest more success than others. Interventions used combinations of instructional methods; passive mass education (6), active mass education (12), and interpersonal methods (8). Interventions combining mass and interpersonal methods resulted in positive improvements (four positive, one mixed). We found no evidence that interventions grounded in health behavior theory achieved more positive results than those not grounded in theory, potentially because net care education was typically asecondary objective. Of 289 gray literature results, 286 (99%) were net distribution reports from Against Malaria Foundation describing 136 distributions; eighty of which (58.8%) mentioned no education related to net care and repair. We found lack of involvement of experts in education among included interventions. Involving trained instructors with expertise in education theory and instructional strategies may improve instruction quality to yield more effective interventions.
• Anderson, E. J., Krause, K. C., Meyer Krause, C., Welter, A., McClelland, D. J., Garcia, D. O., Ernst, K., Lopez, E. C., & Koss, M. P. (2019). Web-Based and mHealth Interventions for Intimate Partner Violence Victimization Prevention: A Systematic Review. Trauma, violence & abuse, 1524838019888889.
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  Mobile health (mHealth) technologies are increasingly used across health programming including intimate partner violence (IPV) prevention to optimize screening, educational outreach, and linkages to care via telehealth. We systematically evaluated current web-based and mHealth interventions, which include web- or mobile-based delivery methods for primary, secondary, and tertiary IPV victimization prevention. We searched MEDLINE/PubMed, Embase, CINAHL, PsycINFO, Open Grey, and Google Scholar for empirical studies published 1998-2019. Studies were included if they considered empirical data, participants in adult romantic relationships, IPV as a primary or secondary outcome, and an mHealth component. The Mixed Methods Appraisal Tool was used to record critical ratings of quality among studies selected for inclusion. We assessed variation in targeted populations, types of IPV addressed, and mHealth approaches used. Of 133 studies identified for full-text review, 31 were included. Computer-based screening with or without integrated education was the most common mHealth approach ( = 8, 26%), followed by safety decision aids ( = 7, 23%). Feasibility and acceptability were found to be generally high where assessed (23% of studies, = 7). There was limited evidence around whether mHealth interventions better addressed population needs compared to conventional interventions. mHealth tools for IPV prevention are especially acceptable in health-care settings, on mobile phone platforms, or when connecting victims to health care. Despite enthusiasm in pilot projects, evidence for efficacy compared to conventional IPV prevention approaches is limited. A major strength of mHealth IPV prevention programming is the ability to tailor interventions to individual victim needs without extensive human resource expenditure by providers.
• Asaolu, I., Nuño, V. L., Ernst, K., Taren, D., & Ehiri, J. (2019). Healthcare system indicators associated with modern contraceptive use in Ghana, Kenya, and Nigeria: evidence from the Performance Monitoring and Accountability 2020 data. Reproductive health, 16(1), 152.
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  Public health literature is replete with evidence on individual and interpersonal indicators of modern contraceptive use. There is, however, limited knowledge regarding healthcare system indicators of modern contraceptive use. This study assessed how the healthcare system influences use of modern contraceptive among women in Ghana, Kenya, and two large population states in Nigeria.
• Ehiri, J. E., Taren, D. L., Ernst, K. C., Nuno, V. L., & Asaolu, I. (2019). Healthcare System Indicators of Modern Contraceptive Use in Ghana, Kenya, and Nigeria: Evidence from the Performance Monitoring and Accountability 2020 Data. Reproductive Health, 16(152). doi:https://doi.org/10.1186/s12978-019-0816-4
• Ernst, K. C., Rosa, L., Joli, W., Amanda, O., Erika, B., & Pogreba Brown, K. M. (2019). Public Perceptions of Non-Pharmaceutical Interventions for Vectorborne and Respiratory Illnesses – A Statewide Survey in Arizona.. Epidemiology and Community Health. doi:https://journals.sagepub.com/doi/pdf/10.1177/1757913919886605
• Pogreba-Brown, K., Austhof, E., Okello, A., Weiss, J., Lira, R., & Ernst, K. (2019). Public perceptions of non-pharmaceutical interventions for influenza and mosquito-borne illnesses - a statewide survey in Arizona. Perspectives in public health, 1757913919886605.
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  We conducted a statewide online survey to understand public knowledge, attitudes, and practices (KAP) related to non-pharmaceutical interventions (NPIs) for mosquito-borne diseases and influenza in Arizona.
• Ruberto, I., Yaglom, H., Erhart, L. M., Plante, L., Weiss, J., Golenko, C., Casal, M., McCotter, O., Adams, L., Ernst, K., & Komatsu, K. (2019). Dengue Knowledge, Attitudes, and Practices Among Arizona Health Care Providers, 2014-2015. Vector borne and zoonotic diseases (Larchmont, N.Y.), 19(6), 434-440.
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  Detection of local dengue transmission requires an aware and engaged medical community, as health care providers are the front line of public health surveillance. To assess the knowledge, attitude, and practice about dengue, an online survey was distributed among Arizona health care providers during 2014 and 2015. The survey consisted of a total of 10 knowledge, attitude, and practice questions divided as follows: 5 knowledge questions, 2 attitude questions, and 3 practice questions. The link to the Qualtrics survey was distributed through the Arizona Health Alert Network to a total of 4582 e-mail addresses, of which 335 participants opened the survey, and 196 completed and submitted their responses. Less than half the respondents reported choosing the right dengue diagnostic test (40.4%) or understanding the epidemiology of dengue in Arizona (40.9%). Slightly more than half the respondents reported frequently asking for travel history (59%), and three-fourth of them would notify the local health department on suspicion of a dengue patient (76.1%). Survey score was associated with providers specialized in infectious diseases (1.88, 95% CI: 0.42-3.33,  = 0.01), medical doctors or doctors of osteopathic medicine (1.82, 95% CI: 0.98-2.65,  
• Santos, E. M., Coalson, J. E., Jacobs, E. T., Klimentidis, Y. C., Munga, S., Agawo, M., Anderson, E., Stroupe, N., & Ernst, K. C. (2019). Bed net care practices and associated factors in western Kenya. Malaria journal, 18(1), 274.
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  Insecticide-treated nets (ITNs) and long-lasting insecticidal nets (LLINs) are effective for malaria prevention and are designed to provide nearly 5 years of mosquito protection. However, many ITNs and LLINs become damaged and ineffective for mosquito bite prevention within 1 to 2 years in field conditions. Non-adherence to recommended bed net care and repair practices may partially explain this shortened net longevity.
• Alvarez-Hernandez, G., Ernst, K., Acuña-Melendrez, N. H., Vargas-Ortega, A. P., & Candia-Plata, M. D. (2018). Medical knowledge related to Rocky Mountain spotted fever in Sonora, Mexico. Transactions of the Royal Society of Tropical Medicine and Hygiene, 112(3), 109-114.
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  Rocky Mountain spotted fever (RMSF) is a tick-borne disease with a high case-fatality rate unless diagnosed promptly and treated timely with doxycycline. Physician knowledge about presentation and treatment can improve outcomes of RMSF in endemic regions, such as Sonora in northern Mexico, where RMSF has caused 1348 non-fatal cases and 247 deaths from 2003 to 2016.
• Asaolu, I. O., Alaofè, H., Gunn, J. K., Adu, A. K., Monroy, A. J., Ehiri, J. E., Hayden, M. H., & Ernst, K. C. (2018). Measuring Women's Empowerment in Sub-Saharan Africa: Exploratory and Confirmatory Factor Analyses of the Demographic and Health Surveys. Frontiers in psychology, 9, 994.
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  Women's status and empowerment influence health, nutrition, and socioeconomic status of women and their children. Despite its benefits, however, research on women's empowerment in Sub-Saharan Africa (SSA) is limited in scope and geography. Empowerment is variably defined and data for comparison across regions is often limited. The objective of the current study was to identify domains of empowerment from a widely available data source, Demographic and Health Surveys, across multiple regions in SSA. Demographic and Health Surveys from nineteen countries representing four African regions were used for the analysis. A total of 26 indicators across different dimensions (economic, socio-cultural, education, and health) were used to characterize women's empowerment. Pooled data from all countries were randomly divided into two datasets-one for exploratory factor analysis (EFA) and the other for Confirmatory Factor Analysis (CFA)-to verify the factor structure hypothesized during EFA. Four factors including attitudes toward violence, labor force participation, education, and access to healthcare were found to define women's empowerment in Central, Southern, and West Africa. However, in East Africa, only three factors were relevant: attitudes toward violence, access to healthcare ranking, and labor force participation. There was limited evidence to support household decision-making, life course, or legal status domains as components of women's empowerment. This foremost study advances scholarship on women's empowerment by providing a validated measure of women's empowerment for researchers and other stakeholders in health and development.
• Barnes, S. R., Wansaula, Z., Herrick, K., Oren, E., Ernst, K., Olsen, S. J., & Casal, M. G. (2018). Mortality estimates among adult patients with severe acute respiratory infections from two sentinel hospitals in southern Arizona, United States, 2010-2014. BMC infectious diseases, 18(1), 78.
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  From October 2010 through February 2016, Arizona conducted surveillance for severe acute respiratory infections (SARI) among adults hospitalized in the Arizona-Mexico border region. There are few accurate mortality estimates in SARI patients, particularly in adults ≥ 65 years old. The purpose of this study was to generate mortality estimates among SARI patients that include deaths occurring shortly after hospital discharge and identify risk factors for mortality.
• Ernst, K. C., Barrett, E., , A. t., Hoswell, E., & Hayden, M. H. (2018). Increasing women's engagement in vector control: a report from Accelerate To Equal project workshops. Malaria journal, 17(1), 326.
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  Workshops with academic, national and local government, and community stakeholders were held in Kenya (2017) and Indonesia (2018) to understand the role and perceptions of women in vector control and to identify strategies for accelerating involvement of women in sustained support for vector control interventions at multiple levels/sectors.
• Ernst, K. C., Comrie, A. C., & Morin, C. W. (2013). Climate and dengue transmission: evidence and implications. Environmental health perspectives, 121(11-12), 1264-72. doi:http://dx.doi.org/10.1289/ehp.1306556
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  Climate influences dengue ecology by affecting vector dynamics, agent development, and mosquito/human interactions. Although these relationships are known, the impact climate change will have on transmission is unclear. Climate-driven statistical and process-based models are being used to refine our knowledge of these relationships and predict the effects of projected climate change on dengue fever occurrence, but results have been inconsistent.
• Ernst, K. C., Ehiri, J. E., Hayden, M., Monroy, A., Adu, A., Gunn, J., Alaofe, H. S., Asaolu, I., Asaolu, I., Alaofe, H. S., Gunn, J., Adu, A., Monroy, A., Hayden, M., Ehiri, J. E., & Ernst, K. C. (2018). Measures of Women’s Empowerment in sub-Saharan Africa: an Exploratory Factor Analysis of the Demographic and Health Surveys.. The International Journal of Maternal and Child Health (MCH) and AIDS (IJMA).
• Gunn, J. K., Ernst, K. C., Center, K. E., Bischoff, K., Nuñez, A. V., Huynh, M., Okello, A., & Hayden, M. H. (2018). Current strategies and successes in engaging women in vector control: a systematic review. BMJ global health, 3(1), e000366.
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  Vector-borne diseases (VBDs) cause significant mortality and morbidity in low-income and middle-income countries and present a risk to high-income countries. Vector control programmes may confront social and cultural norms that impede their execution. Anecdotal evidence suggests that incorporating women in the design, delivery and adoption of health interventions increases acceptance and compliance. A better understanding of programmes that have attempted to increase women's involvement in vector control could help shape best practices. The objective of this systematic review was to assess and critically summarise evidence regarding the effectiveness of women participating in vector control.
• Hayden, M. H., Barrett, E., Bernard, G., Toko, E. N., Agawo, M., Okello, A. M., Gunn, J. K., & Ernst, K. C. (2018). Barriers and Opportunities to Advancing Women in Leadership Roles in Vector Control: Perspectives from a Stakeholder Survey. The American journal of tropical medicine and hygiene, 98(5), 1224-1227.
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  Increasing the active participation of professional women in vector control (VC) activities may help promote greater gender equity in the workplace and reduce the burden of vector-borne diseases. This stakeholder survey examined the current roles and perspective of professionals employed in the VC sector in Kenya, Indonesia, India, and other countries. The largest barriers that women face in pursuing leadership roles in the VC sector include lack of awareness of career opportunities, limitations based on cultural norms, and the belief that VC is men's work. These barriers could be addressed through improving education and recruitment campaigns, as well as supporting higher education and mentoring programs. Females were almost six times more likely to be encouraged to pursue leadership positions in their organization compared with male respondents (odds ratio = 5.9, > 0.03, 95% confidence interval: 1.19, 29.42). These findings suggest that once women are recruited into the VC workforce, they face minimal discrimination and have increased leadership opportunities.
• Hayden, M., Gunn, J., Barrette, E., & Ernst, K. C. (2018). Barriers and opportunities to advancing women in leadership roles in vector control: Perspectives from a stakeholder survey. American Journal of Tropical Medicine and Hygiene.
• Monaghan, A. J., Sampson, K. M., Steinhoff, D. F., Ernst, K. C., Ebi, K. L., Jones, B., & Hayden, M. H. (2018). The potential impacts of 21st century climatic and population changes on human exposure to the virus vector mosquito. Climatic change, 146(3-4), 487-500.
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  The mosquito transmits the viruses that cause dengue and chikungunya, two globally-important vector-borne diseases. We investigate how choosing alternate emissions and/or socioeconomic pathways may modulate future human exposure to . Occurrence patterns for for 2061-2080 are mapped globally using empirically downscaled air temperature and precipitation projections from the Community Earth System Model, for the Representative Concentration Pathway (RCP) 4.5 and 8.5 scenarios. Population growth is quantified using gridded global population projections consistent with two Shared Socioeconomic Pathways (SSPs), SSP3 and SSP5. Change scenarios are compared to a 1950-2000 reference period. A global land area of 56.9 M km is climatically suitable for during the reference period, and is projected to increase by 8% (RCP4.5) to 13% (RCP8.5) by 2061-2080. The annual average number of people exposed globally to for the reference period is 3794 M, a value projected to statistically significantly increase by 298-460 M (8-12%) by 2061-2080 if only climate change is considered, and by 4805-5084 M (127-134%) for SSP3 and 2232-2483 M (59-65%) for SSP5 considering both climate and population change (lower and upper values of each range represent RCP4.5 and RCP8.5 respectively). Thus, taking the lower-emissions RCP4.5 pathway instead of RCP8.5 may mitigate future human exposure to globally, but the effect of population growth on exposure will likely be larger. Regionally, Australia, Europe and North America are projected to have the largest percentage increases in human exposure to considering only climate change.
• Monaghan, A. J., Schmidt, C. A., Hayden, M. H., Smith, K. A., Reiskind, M. H., Cabell, R., & Ernst, K. C. (2018). A Simple Model to Predict the Potential Abundance of Mosquitoes One Month in Advance. The American journal of tropical medicine and hygiene.
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  The mosquito () (.) is the primary vector of dengue, chikungunya, and Zika viruses in the United States. Surveillance for adult is limited, hindering understanding of the mosquito's seasonal patterns and predictions of areas at elevated risk for autochthonous virus transmission. We developed a simple, intuitive empirical model that uses readily available temperature and humidity variables to predict environmental suitability for low, medium, or high potential abundance of adult in a given city 1 month in advance. Potential abundance was correctly predicted in 73% of months in arid Phoenix, AZ (over a 10-year period), and 63% of months in humid Miami, FL (over a 2-year period). The monthly model predictions can be updated daily, weekly, or monthly and thus may be applied to forecast suitable conditions for to inform vector-control activities and guide household-level actions to reduce mosquito habitat and human exposure.
• Pottinger, H. L., Jacobs, E. T., Haenchen, S. D., & Ernst, K. C. (2018). Parental attitudes and perceptions associated with childhood vaccine exemptions in high-exemption schools. PloS one, 13(6), e0198655.
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  Previous work demonstrates that individuals who obtain exemptions from school immunization requirements are geographically clustered, making regional differences in vaccination coverage a significant concern. Even where exemption levels are high, there are still parents that vaccinate. School-level assessments have determined that exemptors are more likely to attend wealthier schools with fewer minorities. Few studies have assessed divergent opinions within the context of a higher-exemption community to examine subtle differences in opinion surrounding vaccinations. Therefore, the objective of this work was to assess attitudes and perceptions towards vaccinations and compare them for exemptors and non-exemptors. We administered surveys to parents in high-exemption (>10%) elementary schools in Arizona during the 2012-13 school year. A total of 404 surveys were completed by parents among schools in Maricopa (n = 7) and Yavapai (n = 2) counties. Of these, 35% (n = 141) were exemptors and 65% (n = 261) were non-exemptors. Exemptors were more likely than non-exemptors to be concerned about serious side-effects (p
• Schmidt, C. A., Comeau, G., Monaghan, A. J., Williamson, D. J., & Ernst, K. C. (2018). Effects of desiccation stress on adult female longevity in Aedes aegypti and Ae. albopictus (Diptera: Culicidae): results of a systematic review and pooled survival analysis. Parasites & vectors, 11(1), 267.
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  Transmission dynamics of mosquito-borne viruses such as dengue, Zika and chikungunya are affected by the longevity of the adult female mosquito. Environmental conditions influence the survival of adult female Aedes mosquitoes, the primary vectors of these viruses. While the association of temperature with Aedes mortality has been relatively well-explored, the role of humidity is less established. The current study's goals were to compile knowledge of the influence of humidity on adult survival in the important vector species Aedes aegypti and Ae. albopictus, and to quantify this relationship while accounting for the modifying effect of temperature.
• Suppes, L. M., Ernst, K. C., Abrell, L., & Reynolds, K. A. (2018). Validation of Questionnaire Methods to Quantify Recreational Water Ingestion. International journal of environmental research and public health, 15(11).
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  Swimming pool water ingestion volumes are necessary for assessing infection risk from swimming. Pool water ingestion volumes can be estimated by questionnaire or measuring a chemical tracer in swimmer urine. Questionnaires are often preferred to the chemical tracer method because surveys are less time consuming, but no research exists validating questionnaires accurately quantify pool water ingestion volumes. The objective of this study was to explore if questionnaires are a reliable tool for collecting pool water ingestion volumes. A questionnaire was issued at four pool sites in Tucson, Arizona to 46 swimmers who also submitted a urine sample for analyzing cyanuric acid, a chemical tracer. Perceived ingestion volumes reported on the questionnaire were compared with pool water ingestion volumes, quantified by analyzing cyanuric acid in swimmer urine. Swimmers were asked if they swallowed (1) no water or only a few drops, (2) one to two mouthfuls, (3) three to five mouthfuls, or (4) six to eight mouthfuls. One mouthful is the equivalent of 27 mL of water. The majority (81%) of swimmers ingested 27 mL ("one mouthful") on the questionnaire. More than half (52%) of swimmers overestimated their ingestion volume. These findings suggest swimmers are over-estimating pool water ingestion because they perceive one mouthful is
• Walker, K. R., Williamson, D., Carrière, Y., Reyes-Castro, P. A., Haenchen, S., Hayden, M. H., Jeffrey Gutierrez, E., & Ernst, K. C. (2018). Socioeconomic and Human Behavioral Factors Associated With Aedes aegypti (Diptera: Culicidae) Immature Habitat in Tucson, AZ. Journal of medical entomology.
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  Aedes aegypti (L.; Diptera: Culicidae) has been established in the southwestern United States for several decades, but relationships between humans and mosquitoes in this arid region are not well-characterized. In August 2012, the outdoor premises of 355 houses within 20 neighborhoods in Tucson, Arizona were surveyed for containers that could provide larval habitat for Ae. aegypti mosquitoes. At the same time, a knowledge, attitudes and practices (KAP) questionnaire was administered to a resident of each house surveyed for immature mosquitoes. The KAP questionnaire assessed respondents' knowledge and concerns about vector-borne illnesses as well as practices they used to avoid mosquitoes. Of the houses surveyed, 91% had at least one container present, and 64% had at least one container with standing water. On average, each house had 2.2 containers with water at the time of the survey. The overall House Index (proportion of premises surveyed with at least one container with Ae. aegypti immatures present) was 13%. Based on questionnaire responses, there was a significant positive association between the number of residents in the home and the odds of finding Ae. aegypti positive containers on the premises, while household income showed a significant negative association. The reported frequency of checking for standing water was also significantly associated with the odds of finding immatures, although the nature of this association was ambiguous. Flower pots were the principal type of container with Ae. aegypti larvae. These findings show that larval habitat is widely available even in an arid environment and city with good housing and sanitation infrastructure.
• Donner, A., Belemvire, A., Johns, B., Mangam, K., Fiekowsky, E., Gunn, J., Hayden, M., & Ernst, K. (2017). Equal Opportunity, Equal Work: Increasing Women's Participation in the U.S. President's Malaria Initiative Africa Indoor Residual Spraying Project. Global health, science and practice, 5(4), 603-616.
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  One of the primary control measures for malaria transmission is indoor residual spraying (IRS). Historically, few women have worked in IRS programs, despite the income-generating potential. Increasing women's roles in IRS requires understanding the barriers to women's participation and implementing measures to address them. The U.S. President's Malaria Initiative (PMI) Africa Indoor Residual Spraying (AIRS) Project is the largest implementer of IRS globally. To address gender inequity in IRS operations, PMI AIRS assessed the barriers to the participation of women and developed and implemented policies to address these barriers.
• Duncan, J., Gordon-Johnson, K. A., Tulloch-Reid, M. K., Cunningham-Myrie, C., Ernst, K., McMorris, N., Grant, A., Graham, M., Chin, D., & Webster-Kerr, K. (2017). Chikungunya: important lessons from the Jamaican experience. Revista panamericana de salud publica = Pan American journal of public health, 41, e60.
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  To describe the clinical presentation of chikungunya virus (CHIKV) illness in adults during the 2014 outbreak in Jamaica and to determine the predictive value of the case definition.
• Ernst, K. C., Erly, S., Adusei, C., Bell, M. L., Kessie, D. K., Biritwum-Nyarko, A., & Ehiri, J. (2017). Reported bed net ownership and use in social contacts is associated with uptake of bed nets for malaria prevention in pregnant women in Ghana. Malaria journal, 16(1), 13.
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  Despite progress made in the last decades, malaria persists as a pressing health issue in sub-Saharan Africa. Pregnant women are particularly vulnerable to infection and serious health outcomes for themselves and their unborn child. Risk can be mitigated through appropriate use of control measures such as insecticide-treated bed nets. Although social networks can influence uptake of preventive strategies, the role of social influence on bed net ownership has not been explored. During an evaluation of a bed net distribution programme, the influence of non-health care advisors on ownership and use of bed nets by pregnant women in Kumasi, Ghana was examined.
• Ernst, K. C., Hayden, M., Walker, K. R., Diaz-Caravantes, R., Luque-Castro, A. L., & Castro-Reyes, P. (2016). Outdoor Spatial Spraying Against Dengue: A False Sense of Security Among Inhabitants of Hermosillo, Mexico.. PLoS Neglected Tropical Diseases.
• Ernst, K. C., Walker, K. R., Reyes-Castro, P., Joy, T. K., Castro-Luque, A. L., Diaz-Caravantes, R. E., Gameros, M., Haenchen, S., Hayden, M. H., Monaghan, A., Jeffrey-Guttierez, E., Carrière, Y., & Riehle, M. R. (2017). Aedes aegypti (Diptera: Culicidae) Longevity and Differential Emergence of Dengue Fever in Two Cities in Sonora, Mexico. Journal of medical entomology, 54(1), 204-211.
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  Dengue virus, primarily transmitted by the Aedes aegypti (L.) mosquito, has rapidly expanded in geographic extent over the past several decades. In some areas, however, dengue fever has not emerged despite established Ae. aegypti populations. The reasons for this are unclear and have sometimes been attributed to socio-economic differences. In 2013 we compared Ae. aegypti adult density and population age structure between two cities in Sonora, Mexico: Hermosillo, which has regular seasonal dengue virus transmission, and Nogales, which has minimal transmission. Larval and pupal abundance was greater in Nogales, and adult density was only higher in Hermosillo during September. Population age structure, however, was consistently older in Hermosillo. This difference in longevity may have been one factor that limited dengue virus transmission in Nogales in 2013, as a smaller proportion of Ae. aegypti females survived past the extrinsic incubation period.
• Gunn, J. K., Ehiri, J. E., Jacobs, E. T., Ernst, K. C., Pettygrove, S., Center, K. E., Osuji, A., Ogidi, A. G., Musei, N., Obiefune, M. C., Ezeanolue, C. O., & Ezeanolue, E. E. (2017). Prevalence of Caesarean sections in Enugu, southeast Nigeria: Analysis of data from the Healthy Beginning Initiative. PloS one, 12(3), e0174369.
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  In order to meet the Sustainable Development Goal to decrease maternal mortality, increased access to obstetric interventions such as Caesarean sections (CS) is of critical importance. As a result of women's limited access to routine and emergency obstetric services in Nigeria, the country is a major contributor to the global burden of maternal mortality. In this analysis, we aim to establish rates of CS and determine socioeconomic or medical risk factors associated with having a CS in Enugu, southeast Nigeria.
• Gunn, J., Ernst, K. C., Center, K., Biscoff, K., Nunez, A., Hyun, M., Okello, A., & Hayden, M. (2018). Current strategies and successes in engaging women in vector control: A systematic review. BMJ Global Health, 3(1).
• Lwin, M. O., Jayasundar, K., Sheldenkar, A., Wijayamuni, R., Wimalaratne, P., Ernst, K. C., & Foo, S. (2017). Lessons From the Implementation of Mo-Buzz, a Mobile Pandemic Surveillance System for Dengue. JMIR public health and surveillance, 3(4), e65.
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  Approximately 128 countries and 3.9 billion people are at risk of dengue infection. Incidence of dengue has increased over the past decades, becoming a growing public health concern for countries with populations that are increasingly susceptible to this vector-borne disease, such as Sri Lanka. Almost 55,150 dengue cases were reported in Sri Lanka in 2016, with more than 30.40% of cases (n=16,767) originating from Colombo, which struggles with an outdated manual paper-based dengue outbreak management system. Community education and outreach about dengue are also executed using paper-based media channels such as pamphlets and brochures. Yet, Sri Lanka is one of the countries with the most affordable rates of mobile services in the world, with penetration rates higher than most developing countries.
• Reyes-Castro, P. A., Castro-Luque, L., Díaz-Caravantes, R., Walker, K. R., Hayden, M. H., & Ernst, K. C. (2017). Outdoor spatial spraying against dengue: A false sense of security among inhabitants of Hermosillo, Mexico. PLoS neglected tropical diseases, 11(5), e0005611.
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  Government-administered adulticiding is frequently conducted in response to dengue transmission worldwide. Anecdotal evidence suggests that spraying may create a "false sense of security" for residents. Our objective was to determine if there was an association between residents' reporting outdoor spatial insecticide spraying as way to prevent dengue transmission and both their reported frequency of dengue prevention practices and household entomological indices in Hermosillo, Mexico.
• 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.
• Thomson, C. A., Jackson, R., Chou, Y., Hu, C., Ernst, K. C., Bea, J. W., Klimentidis, Y. C., & Chen, Z. (2017). Body mass index, waist circumference and mortality in a large mutiethnic postmenopausal cohort - Results from the Women's Health Initiative.. Journal of the American Geriatric Society.
• Valencia, C. I., Ernst, K., & Rosales, C. B. (2017). Tuberculosis Treatment Completion in a United States/Mexico Binational Context. Frontiers in public health, 5, 118.
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  Tuberculosis (TB) remains a salient public health issue along the U.S./Mexico border. This study seeks to identify the social and structural factors, which are associated with TB disease burden in the binational geographic region. Identification of barriers of treatment completion provides the necessary framework for developing evidence-based interventions that are culturally relevant and context specific for the U.S./Mexico border region.
• Beamer, P. I., Lothrop, N., Lu, Z., Ascher, R., Ernst, K., Stern, D. A., Billheimer, D., Wright, A. L., & Martinez, F. D. (2016). Spatial clusters of child lower respiratory illnesses associated with community-level risk factors. Pediatric pulmonology, 51(6), 633-42.
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  Identifying geographic areas with increased incidence of disease may elucidate community-level risk factors for intervention development. Lower respiratory illnesses (LRIs) are the leading cause of death in children and are associated with other morbidities. We assessed geographic clustering of LRIs and evaluated if these spatial patterns and associated risk factors differed by phenotype. Participants enrolled at birth in the Tucson Children's Respiratory Study were followed through age three for physician diagnosed LRIs. Spatial clustering analysis, based upon each participant's birth address, was performed for four LRI phenotypes. We conducted principal component analysis at the census tract level to generate indices for lower socioeconomic status (SES), poorer housing conditions, and increased air pollution. Enrollment addresses were mapped for 812 subjects, of whom 58.4%, 33.5%, 34.2%, and 23.4% had any LRI, a wheezing LRI, a viral LRI, and a respiratory syncytial virus (RSV) LRI, respectively. Patterns of spatial clustering and associated risk factors differed by LRI phenotype. Multivariable regression analyses showed that wheezing LRI clusters were associated with increased air pollution (OR = 1.18, P = 0.01). Being in a viral cluster was associated with poorer housing conditions (OR = 1.28, P = 0.01), while being in a RSV cluster was associated with increased air pollution (OR = 1.14, P = 0.006), poorer housing conditions (OR = 1.54, P = 0.003), and higher SES (OR = 0.77, P = 0.001). Our use of social and environmental indices allowed us to identify broad contextual factors that may contribute to increased incidence of LRIs in specific geographic regions. To reduce LRI incidence, multifaceted interventions should be developed at the community level. Pediatr Pulmonol. 2016;51:633-642. © 2015 Wiley Periodicals, Inc.
• Dickinson, K. L., Hayden, M. H., Haenchen, S., Monaghan, A. J., Walker, K. R., & Ernst, K. C. (2016). Willingness to Pay for Mosquito Control in Key West, Florida and Tucson, Arizona. The American journal of tropical medicine and hygiene, 94(4), 775-9.
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  Mosquito-borne illnesses like West Nile virus (WNV) and dengue are growing threats to the United States. Proactive mosquito control is one strategy to reduce the risk of disease transmission. In 2012, we measured the public's willingness to pay (WTP) for increased mosquito control in two cities: Key West, FL, where there have been recent dengue outbreaks, and Tucson, AZ, where dengue vectors are established and WNV has been circulating for over a decade. Nearly three quarters of respondents in both cities (74% in Tucson and 73% in Key West) would be willing to pay $25 or more annually toward an increase in publicly funded mosquito control efforts. WTP was positively associated with income (both cities), education (Key West), and perceived mosquito abundance (Tucson). Concerns about environmental impacts of mosquito control were associated with lower WTP in Key West. Expanded mosquito control efforts should incorporate public opinion as they respond to evolving disease risks.
• Dickinson, K., Hayden, M., Haenchen, S., Monaghan, A., Walker, K., & Ernst, K. C. (2016). Willingness to Pay for Mosquito Control in Key West, Florida, and Tucson, Arizona. American Journal of Tropical Medicine and Hygiene.
• Ernst, K. C., Hayden, M. H., Olsen, H., Cavanaugh, J. L., Ruberto, I., Agawo, M., & Munga, S. (2016). Comparing ownership and use of bed nets at two sites with differential malaria transmission in western Kenya. Malaria journal, 15, 217.
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  Challenges persist in ensuring access to and optimal use of long-lasting, insecticidal bed nets (LLINs). Factors associated with ownership and use may differ depending on the history of malaria and prevention control efforts in a specific region. Understanding how the cultural and social-environmental context of bed net use may differ between high- and low-risk regions is important when identifying solutions to improve uptake and appropriate use.
• Ernst, K. C., Shelly, E., Acuno-Soto, R., Sterling, C., & Brown, H. (2016). A critical assessment of Chagas Disease surveillance data utility and recommendations for improvement in Mexico. Public Health Reports, 131(1).
• Ernst, K. C., Walker, K. R., Reyes-Castro, P., Joy, T. K., Castro-Luque, A. L., Diaz-Caravantes, R., Gameros, M., Haenchen, S., Hayden, M., Monaghan, A., Jeffrey Guttierez, E., Carriere, Y., & Riehle, M. A. (2016). Aedes aegypti (Diptera: Culicidae) Longevity and Differential Emergence of Dengue Fever in Two Cities in Sonora, Mexico. Journal of Medical Entomology.
• Gunn, J., Ehiri, J., Jacobs, E., Ernst, K. C., Pettygrove, S., Kohler, L., Haenchen, S., Obiefune, M., Ezeanolu, C., Ogidi, A., & Ezeanolue, E. (2016). Population based prevalence of malaria among pregnant women in Enugu State, Nigeria: The HEalthy Beginnings Initiative. Malaria Journal.
• Haenchen, S. D., Hayden, M. H., Dickinson, K. L., Walker, K., Jacobs, E. E., Brown, H. E., Gunn, J. K., Kohler, L. N., & Ernst, K. C. (2016). Mosquito Avoidance Practices and Knowledge of Arboviral Diseases in Cities with Differing Recent History of Disease. The American journal of tropical medicine and hygiene, 95(4), 945-953.
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  As the range of dengue virus (DENV) transmission expands, an understanding of community uptake of prevention and control strategies is needed both in geographic areas where the virus has recently been circulating and in areas with the potential for DENV introduction. Personal protective behaviors such as the use of mosquito repellent to limit human-vector contact and the reduction of vector density through elimination of oviposition sites are the primary control methods for Aedes aegypti, the main vector of DENV. Here, we examined personal mosquito control measures taken by individuals in Key West, FL, in 2012, which had experienced a recent outbreak of DENV, and Tucson, AZ, which has a high potential for introduction but has not yet experienced autochthonous transmission. In both cities, there was a positive association between the numbers of mosquitoes noticed outdoors and the overall number of avoidance behaviors, use of repellent, and removal of standing water. Increased awareness and perceived risk of DENV were associated with increases in one of the most effective household prevention behaviors, removal of standing water, but only in Key West.
• Jones, J. M., Lopez, B., Adams, L., Gálvez, F. J., Núñez, A. S., Santillán, N. A., Plante, L., Hemme, R. R., Casal, M., Hunsperger, E. A., Muñoz-Jordan, J., Acevedo, V., Ernst, K., Hayden, M., Waterman, S., Gomez, D., Sharp, T. M., Komatsu, K. K., , D. I., , , A. D., et al. (2016). Binational Dengue Outbreak Along the United States-Mexico Border - Yuma County, Arizona, and Sonora, Mexico, 2014. MMWR. Morbidity and mortality weekly report, 65(19), 495-9.
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  Dengue is an acute febrile illness caused by any of four dengue virus types (DENV-1-4). DENVs are transmitted by mosquitos of the genus Aedes (1) and are endemic throughout the tropics (2). In 2010, an estimated 390 million DENV infections occurred worldwide (2). During 2007-2013, a total of three to 10 dengue cases were reported annually in Arizona and all were travel-associated. During September-December 2014, coincident with a dengue outbreak in Sonora, Mexico, 93 travel-associated dengue cases were reported in Arizona residents; 70 (75%) cases were among residents of Yuma County, which borders San Luis Río Colorado, Sonora, Mexico. San Luis Río Colorado reported its first case of locally acquired dengue in September 2014. To investigate the temporal relationship of the dengue outbreaks in Yuma County and San Luis Río Colorado and compare patient characteristics and signs and symptoms, passive surveillance data from both locations were analyzed. In addition, household-based cluster investigations were conducted near the residences of reported dengue cases in Yuma County to identify unreported cases and assess risk for local transmission. Surveillance data identified 52 locally acquired cases (21% hospitalized) in San Luis Río Colorado and 70 travel-associated cases (66% hospitalized) in Yuma County with illness onset during September-December 2014. Among 194 persons who participated in the cluster investigations in Yuma County, 152 (78%) traveled to Mexico at least monthly during the preceding 3 months. Four (2%) of 161 Yuma County residents who provided serum samples for diagnostic testing during cluster investigations had detectable DENV immunoglobulin M (IgM); one reported a recent febrile illness, and all four had traveled to Mexico during the preceding 3 months. Entomologic assessments among 105 households revealed 24 water containers per 100 houses colonized by Ae. aegypti. Frequent travel to Mexico and Ae. aegypti colonization indicate risk for local transmission of DENV in Yuma County. Public health officials in Sonora and Arizona should continue to collaborate on dengue surveillance and educate the public regarding mosquito abatement and avoidance practices. Clinicians evaluating patients from the U.S.-Mexico border region should consider dengue in patients with acute febrile illness and report suspected cases to public health authorities.
• Monaghan, A. J., Morin, C. W., Steinhoff, D. F., Wilhelmi, O., Hayden, M., Quattrochi, D. A., Reiskind, M., Lloyd, A. L., Smith, K., Schmidt, C. A., Scalf, P. E., & Ernst, K. (2016). On the Seasonal Occurrence and Abundance of the Zika Virus Vector Mosquito Aedes Aegypti in the Contiguous United States. PLoS currents, 8.
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  An ongoing Zika virus pandemic in Latin America and the Caribbean has raised concerns that travel-related introduction of Zika virus could initiate local transmission in the United States (U.S.) by its primary vector, the mosquito Aedes aegypti.
• Pogreba-Brown, K., Baker, A., Ernst, K., Stewart, J., Harris, R. B., & Weiss, J. (2016). Assessing risk factors of sporadic Campylobacter infection: a case-control study in Arizona. Epidemiology and infection, 144(4), 829-39.
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  Case-control studies of sporadic Campylobacter infections have predominately been conducted in non-Hispanic populations. In Arizona, rates of campylobacteriosis have been historically higher than the national average, with particularly high rates in Hispanics. In 2010, health departments and a state university collaborated to conduct a statewide case-control study to determine whether risk factors differ in an ethnically diverse region of the United States. Statistically significant risk factors in the final multivariate model were: eating cantaloupe [odds ratio (OR) 7·64], handling raw poultry (OR 4·88) and eating queso fresco (OR 7·11). In addition, compared to non-Hispanic/non-travellers, the highest risk group were Hispanic/non-travellers (OR 7·27), and Hispanic/travellers (OR 5·87, not significant). Results of this study suggest Hispanics have higher odds of disease, probably due to differential exposures. In addition to common risk factors, consumption of cantaloupe was identified as a significant risk factor. These results will inform public health officials of the varying risk factors for Campylobacter in this region.
• 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 (Washington, D.C. : 1974), 131(1), 59-66.
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  Chagas disease, a disease caused by Trypanosoma cruzi, disproportionately affects poor people throughout Latin America. In Mexico, assessments of officially reported burden have not been previously reported. To evaluate discontinuity between surveillance data and data from other sources, we used data from the Mexican Ministry of Health to describe the distribution of reported Chagas disease over time in Mexico and compare it with estimates from the literature.
• Arellano, C., Castro, L., Díaz-Caravantes, R. E., Ernst, K. C., Hayden, M., & Reyes-Castro, P. (2015). Knowledge and Beliefs about Dengue Transmission and Their Relationship with Prevention Practices in Hermosillo, Sonora. Frontiers in public health, 3, 142.
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  Dengue is an emerging threat in the U.S.-Mexico border region. Transmission has regularly occurred in Sonora, MX since 1982 but it was not until 2014 that cities directly on the Arizona-Sonora border had local transmission. One of the closest urban areas to have regular seasonal transmission is Hermosillo, SN, MX. Developing a better understanding of the knowledge and perceptions of dengue in close geographic proximity to the border can identify areas to target for prevention and control measures.
• Beamer, P., Beamer, P., Lothrop, N. Z., Lothrop, N. Z., Lu, Z., Lu, Z., Ascher, R., Ascher, R., Ernst, K. C., Ernst, K. C., Stern, D. A., Stern, D. A., Billheimer, D. D., Billheimer, D. D., Wright, A. L., Wright, A. L., Martinez, F. D., & Martinez, F. D. (2015). Spatial Clusters of Child Lower Respiratory Illnesses associated with Community-Level Risk Factors. Pediatric Pulmonology, DOI: 10.1002/ppul.23332.
• Beamer, P., Lothrop, N. Z., Lu, Z., Ascher, R., Ernst, K. C., Stern, D. A., Billheimer, D. D., Wright, A. L., & Martinez, F. D. (2014). Spatial Clusters of Child Lower Respiratory Illnesses associated with Community-Level Risk Factors. Pediatric Pulmonology.
• Ernst, K. C., Ernst, K. C., Haenchen, S., Haenchen, S., Dickinson, K., Dickinson, K., Doyle, M., Doyle, M., Walker, K. R., Walker, K. R., Monaghan, A., Monaghan, A., Hayden, M., & Hayden, M. (2015). Awareness and Support of Release of Genetically Modified “Sterile” Mosquitoes, Key West, Florida, USA. Emerging Infectious Diseases, 21(2).
• Ernst, K. C., Haenchen, S., Dickinson, K., Doyle, M. S., Walker, K., Monaghan, A. J., & Hayden, M. H. (2015). Awareness and support of release of genetically modified "sterile" mosquitoes, Key West, Florida, USA. Emerging infectious diseases, 21(2), 320-4.
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  After a dengue outbreak in Key West, Florida, during 2009-2010, authorities, considered conducting the first US release of male Aedes aegypti mosquitoes genetically modified to prevent reproduction. Despite outreach and media attention, only half of the community was aware of the proposal; half of those were supportive. Novel public health strategies require community engagement.
• Ernst, K. C., Haenchen, S., Dickinson, K., Walker, K., Doyle, M., & Hayden, M. (2014). Community awareness and support of the controversial release of OX513A Ae. aegypti in Key West, FL.. Emerging Infectious Disease.
• Gunn, J. K., Ehiri, J. E., Jacobs, E. T., Ernst, K. C., Pettygrove, S., Kohler, L. N., Haenchen, S. D., Obiefune, M. C., Ezeanolue, C. O., Ogidi, A. G., & Ezeanolue, E. E. (2015). Population-based prevalence of malaria among pregnant women in Enugu State, Nigeria: the Healthy Beginning Initiative. Malaria journal, 14, 438.
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  Malaria adversely affects pregnant women and their fetuses or neonates. Estimates of the malaria burden in pregnant women based on health facilities often do not present a true picture of the problem due to the low proportion of women delivering at these facilities in malaria-endemic regions.
• Hayden, M. H., Cavanaugh, J. L., Tittel, C., Butterworth, M., Haenchen, S., Dickinson, K., Monaghan, A. J., & Ernst, K. C. (2015). Post Outbreak Review: Dengue Preparedness and Response in Key West, Florida. The American journal of tropical medicine and hygiene, 93(2), 397-400.
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  Dengue is the most prevalent mosquito-borne viral infection. Recent outbreaks in the southern United States illustrate the risk of reemergence. The first autochthonous cases since 1934 in Key West, FL, occurred in 2009-2010. We conducted a survey in 2012 with decision makers instrumental to the control of the outbreak to 1) determine their awareness of the multiple strategies used to control the outbreak and 2) assess their perceptions of the relative effectiveness of these strategies. An online survey was delivered to a predefined list of decision makers from multiple sectors to better understand dengue preparedness and response. Thirty-six out of 45 surveys were returned for an 80% response rate. Results indicate the need to focus prevention strategies on educational campaigns designed to increase population awareness of transmission risk. Respondents remain concerned about future dengue transmission risk in Key West and lack of resources to respond.
• Morin, C. W., Monaghan, A. J., Hayden, M. H., Barrera, R., & Ernst, K. (2015). Meteorologically Driven Simulations of Dengue Epidemics in San Juan, PR. PLoS neglected tropical diseases, 9(8), e0004002.
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  Meteorological factors influence dengue virus ecology by modulating vector mosquito population dynamics, viral replication, and transmission. Dynamic modeling techniques can be used to examine how interactions among meteorological variables, vectors and the dengue virus influence transmission. We developed a dengue fever simulation model by coupling a dynamic simulation model for Aedes aegypti, the primary mosquito vector for dengue, with a basic epidemiological Susceptible-Exposed-Infectious-Recovered (SEIR) model. Employing a Monte Carlo approach, we simulated dengue transmission during the period of 2010-2013 in San Juan, PR, where dengue fever is endemic. The results of 9600 simulations using varied model parameters were evaluated by statistical comparison (r2) with surveillance data of dengue cases reported to the Centers for Disease Control and Prevention. To identify the most influential parameters associated with dengue virus transmission for each period the top 1% of best-fit model simulations were retained and compared. Using the top simulations, dengue cases were simulated well for 2010 (r2 = 0.90, p = 0.03), 2011 (r2 = 0.83, p = 0.05), and 2012 (r2 = 0.94, p = 0.01); however, simulations were weaker for 2013 (r2 = 0.25, p = 0.25) and the entire four-year period (r2 = 0.44, p = 0.002). Analysis of parameter values from retained simulations revealed that rain dependent container habitats were more prevalent in best-fitting simulations during the wetter 2010 and 2011 years, while human managed (i.e. manually filled) container habitats were more prevalent in best-fitting simulations during the drier 2012 and 2013 years. The simulations further indicate that rainfall strongly modulates the timing of dengue (e.g., epidemics occurred earlier during rainy years) while temperature modulates the annual number of dengue fever cases. Our results suggest that meteorological factors have a time-variable influence on dengue transmission relative to other important environmental and human factors.
• Pogreba Brown, K. M., Ernst, K. C., Woodson, L., & Harris, R. (2015). Determining Risk Factors of a Non-Point Source Outbreak of Campylobacter Cases Using Case-Case and Case-Control Studies.. Epidemiology Open Access.
• Suppes, L. M., Ernst, K. C., Abrell, L. M., Reynolds, K. A., Suppes, L. M., Ernst, K. C., Abrell, L. M., & Reynolds, K. A. (2015). Validation and Standardization of Swimming Exposure and Pool Operations Questionnaires. International Journal of Hygiene and Environmental Health..
• Suppes, L. M., Ernst, K. C., Abrell, L., & Reynolds, K. A. (2014). Validation and Standardization of Swimming Exposure and Pool Operations Questionnaires. International Journal of Environmental Research and Public Health.
• Alkoshi, S., Ernst, K., Maimaiti, N., & Dahlui, M. (2014). Rota Viral Infection: A Significant Disease Burden to Libya. IRANIAN JOURNAL OF PUBLIC HEALTH, 43(10), 1356-1363.
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  Background: Rotavirus is a common infection causing 450,000 deaths annually primarily in children 5 years and below. Despite the high burden of disease, little is known about the epidemiology of rotavirus in Libya. The aim of this study was to estimate the rotavirus disease burden among Libyan children.
• Alkoshi, S., Ernst, K., Maimaiti, N., & Dahlui, M. (2014). Rota Viral Infection: A Significant Disease Burden to Libya. Iranian journal of public health, 43(10), 1356-63.
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  Rotavirus is a common infection causing 450,000 deaths annually primarily in children 5 years and below. Despite the high burden of disease, little is known about the epidemiology of rotavirus in Libya. The aim of this study was to estimate the rotavirus disease burden among Libyan children.
• Ernst, K. C. (2014). Measles surveillance in Nigeria: enough information for policy making?. Transactions of the Royal Society of Tropical Medicine and Hygiene, 108(6), 311-2.
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  Data collected through routine surveillance of measles cases will ideally be used to make policy decisions for vaccination programs. Nigeria has recently implemented a passive surveillance system for measles. Results indicate increasing measles cases in Southwest Nigeria but this may or may not indicate a true increase in measles cases. Only very basic assessments of the logistics of the system have been conducted. Further investigations of the quality of the data and performance of reporting sites must be made to determine the reliability of information being generated by the surveillance system before conclusions can be drawn.
• Ernst, K. C., & Erhart, L. M. (2014). The role of ethnicity and travel on Hepatitis A vaccination coverage and disease incidence in Arizona at the United States-Mexico Border. Human vaccines & immunotherapeutics, 10(5), 1396-403.
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  Hepatitis A (HAV) incidence has decreased in the United States, yet regional disparities persist. The role of international travel has become increasingly important in HAV transmission. We compared the relative burden of HAV in border and non-border regions in Arizona and examined the role of travel in sustaining HAV transmission.
• Ernst, K. C., Pogreba-Brown, K., Rasmussen, L., & Erhart, L. M. (2014). The effect of policy changes on hepatitis A vaccine uptake in Arizona children, 1995-2008. Public health reports (Washington, D.C. : 1974), 126 Suppl 2.
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  In 1995, the first hepatitis A vaccines became available for use. At that time, Arizona had the highest hepatitis A incidence of all 50 states. During that same time period, the Arizona State Immunization Information System (ASIIS) was created to collect information on all immunizations given in the state. Four state-level hepatitis A vaccination policies were enacted according to Centers for Disease Control and Prevention recommendations and local initiatives from 1996 to 2005. Our primary objective was to assess the impact of these policies on vaccine uptake in children.
• Haenchen, S. D., Jacobs, E. T., Bratton, K. N., Carman, A. S., Oren, E., Pottinger, H. L., Regan, J. A., & Ernst, K. C. (2014). Perceptions of personal belief vaccine exemption policy: a survey of Arizona vaccine providers. Vaccine, 32(29), 3630-5.
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  As exemptions to school-entry requirements rise, vaccination rates in Arizona school children are approaching levels that may threaten public health. Understanding the interactions physicians have with vaccine-hesitant parents, as well as the opinions physicians hold regarding vaccination, exemption, and exemption policies, are critical to our understanding of, and ability to affect, vaccination exemption rates among children.
• Haenchen, S., Jacobs, B., Pottinger, H., Bratton, K., Carmen, A., Oren, E., Regan, J., & Ernst, K. C. (2014). Perceptions of Personal Belief Vaccine Exemption Policy: A Survey of Arizona Vaccine Providers. Vaccine, Under revision.
• Mugoya, G. C., & Ernst, K. (2014). Gender differences in HIV-related stigma in Kenya. AIDS care, 26(2).
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  Stigma associated with HIV/AIDS directly and indirectly drives HIV transmission. We examined how factors associated with HIV-related stigma differed by gender, using data from the 2008-2009 Kenya Demographic and Health Survey (KDHS). Descriptive, bivariate and multinomial logistic regression analyses were conducted on selected HIV-related stigma indicators for men and women. Bivariate analyses showed significant gender differences in the overall HIV Stigma index with a higher proportion of women than men presented at the highest stigma level (4.9% vs 2.7%, p < 0.01). Women were more likely to express higher stigmatic attitudes for all components of stigma measured than men. Multivariate analyses showed that HIV-related knowledge had significant inverse dose-response for both men and women. For instance, compared to women in the first HIV-related knowledge quartile, a 1 unit increase in HIV-related knowledge among women at the third HIV-related knowledge quartile was expected to lead to a 63.8% decrease in HIV-related stigma (95% CI [0.21, 0.63]) for women with high stigma, 57.8% decrease for similar women with medium stigma (95% CI [0.33, 0.55]) and 28.4% decrease for those with low stigma (95% CI [0.57, 0.90]). Acceptance with the statement "a husband is justified to hit or beat his wife if she refuses to have sex with him" was a significant risk factor for expression of stigmatising attitudes at all levels for women (High: OR = 1.49, 95% CI [1.02, 2.17]), Medium: OR = 1.47, 95% CI [1.18, 1.82], Low: OR = 1.38, 95% CI [1.10, 1.73]) and men at medium stigma (OR = 2.02, 95% CI [1.38, 2.95]). Other notable gender differences were found in employment, marital status, ethnicity, region of residence, wealth and media exposure. Our results showed that women in the general Kenyan population had higher stigmatic attitudes than men. This was associated with differences in risk factor profile and confirmed previous literature on complexity of social-cultural factors associated with HIV-related stigma.
• Mugoya, G. C., Witte, T. H., & Ernst, K. C. (2014). Sociocultural and Victimization Factors That Impact Attitudes Toward Intimate Partner Violence Among Kenyan Women. Journal of interpersonal violence.
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  This study investigates the association between acceptance of intimate partner violence (IPV) and reported IPV victimization among Kenyan women, taking into consideration select sociocultural factors that may also influence acceptance of IPV. Data from a nationally representative, cross-sectional, household survey conducted between November 2008 and February 2009 in Kenya were analyzed. Hierarchical multiple regression was conducted to estimate the effect of select sociodemographic characteristics and reported IPV victimization on acceptance of IPV. The results showed that while both sociodemographic characteristics and reported IPV victimization were significantly associated with IPV acceptance, sociocultural factors had a greater impact. Programs aimed at empowering women and culturally competent IPV prevention strategies may be the key elements to reducing IPV.
• Pogreba Brown, K. M., Ernst, K. C., Harris, R. B., Pogreba Brown, K. M., Ernst, K. C., & Harris, R. B. (2014). Case-case methods for studying enteric diseases: A review and approach for standardization.. OA Epidemiology, 18(2), 1-9.
• Pogreba-Brown, K., Ernst, K., & Harris, R. (2014). Teaching epidemiology concepts experientially: a "real" foodborne outbreak in the classroom. Public health reports (Washington, D.C. : 1974), 127(5).
• Ernst, K. C., Phillips, B. S., & Duncan, B. D. (2013). Slums are not places for children to live: vulnerabilities, health outcomes, and possible interventions. Advances in pediatrics, 60(1).
• Ernst, K., Birnbaum, M. S., Jacobs, E. T., Ralston-King, J., & Ernst, K. C. (2013). Correlates of high vaccination exemption rates among kindergartens. Vaccine, 31(5).
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  The present study was designed to characterize Arizona schools with high rates of permanent PBE among kindergartners, and to determine the degree to which they aggregate across the state.
• Erhart, L. M., & Ernst, K. C. (2012). The changing epidemiology of hepatitis A in Arizona following intensive immunization programs (1988-2007). Vaccine, 30(42).
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  Arizona had the highest hepatitis A incidence of any U.S. state during 1987-1997. In 1995, the first hepatitis A vaccines became available in the U.S. A series of hepatitis A vaccination policies and recommendations were implemented in 1996-2006. Our objective was to examine the shifting epidemiologic patterns in hepatitis A in Arizona from 1988 to 2007.
• Ernst, K. C., & Jacobs, E. T. (2012). Implications of philosophical and personal belief exemptions on re-emergence of vaccine-preventable disease: the role of spatial clustering in under-vaccination. Human vaccines & immunotherapeutics, 8(6).
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  Vaccine exemption policies vary by state, and it has been demonstrated that easier protocols for personal/philosophical belief exemptions are associated with lower vaccine coverage at the state level. However, this does not lead to ubiquitously lower immunization rates across the state, as shown by variability in county-level exemption rates. Rather, there is geographical clustering of areas which are then more vulnerable to outbreaks of vaccine-preventable diseases. Understanding both state and local patterns of vaccine exemptions and developing policies and public health interventions to increase coverage in high-risk areas is critical. At all levels of healthcare, efforts must be made to encourage vaccination education and legislation to protect the public's health.
• Joy, T. K., Jeffrey Gutierrez, E. H., Ernst, K., Walker, K. R., Carriere, Y., Torabi, M., & Riehle, M. A. (2012). Aging field collected Aedes aegypti to determine their capacity for dengue transmission in the southwestern United States. PloS one, 7(10).
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  Aedes aegypti, the primary vector of dengue virus, is well established throughout urban areas of the Southwestern US, including Tucson, AZ. Local transmission of the dengue virus, however, has not been reported in this area. Although many factors influence the distribution of the dengue virus, we hypothesize that one contributing factor is that the lifespan of female Ae. aegypti mosquitoes in the Southwestern US is too short for the virus to complete development and be transmitted to a new host. To test this we utilized two age grading techniques. First, we determined parity by analyzing ovarian tracheation and found that only 40% of Ae. aegypti females collected in Tucson, AZ were parous. The second technique determined transcript levels of an age-associated gene, Sarcoplasmic calcium-binding protein 1 (SCP-1). SCP-1 expression decreased in a predictable manner as the age of mosquitoes increased regardless of rearing conditions and reproductive status. We developed statistical models based on parity and SCP-1 expression to determine the age of individual, field collected mosquitoes within three age brackets: nonvectors (0-5 days post-emergence), unlikely vectors (6-14 days post-emergence), and potential vectors (15+ days post-emergence). The statistical models allowed us to accurately group individual wild mosquitoes into the three age brackets with high confidence. SCP-1 expression levels of individual, field collected mosquitoes were analyzed in conjunction with parity status. Based on SCP-1 transcript levels and parity data, 9% of collected mosquitoes survived more than 15 days post emergence.
• Rolfes, M. A., McCarra, M., Magak, N. G., Ernst, K. C., Dent, A. E., Lindblade, K. A., & John, C. C. (2012). Development of clinical immunity to malaria in highland areas of low and unstable transmission. The American journal of tropical medicine and hygiene, 87(5).
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  In highland areas of unstable, low malaria transmission, the extent to which immunity to uncomplicated malaria develops with age and intermittent parasite exposure has not been well characterized. We conducted active surveillance for clinical malaria during April 2003-March 2005 in two highland areas of western Kenya (Kapsisiywa and Kipsamoite). In both sites, annual malaria incidence was significantly lower in persons ≥ 15 years of age than in persons < 5 years of age (Kapsisiywa: incidence = 382.9 cases/1,000 persons among persons < 1-4 years of age versus 135.1 cases/1,000 persons among persons ≥ 15 years of age; Kipsamoite: incidence = 233.0 cases/1,000 persons in persons < 1-4 years of age versus 43.3 cases/1,000 persons in persons ≥ 15 years of age). In Kapsisiywa, among persons with malaria, parasite density and axillary body temperature were also significantly lower in persons ≥ 15 years of age than in persons < 5 years of age. Even in highland areas of unstable and low malaria transmission, age is associated with development of clinical immunity to malaria.
• Cohen, J. M., Ernst, K. C., Lindblade, K. A., Vulule, J. M., John, C. C., & Wilson, M. L. (2010). Local topographic wetness indices predict household malaria risk better than land-use and land-cover in the western Kenya highlands. Malaria journal, 9.
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  Identification of high-risk malaria foci can help enhance surveillance or control activities in regions where they are most needed. Associations between malaria risk and land-use/land-cover are well-recognized, but these environmental characteristics are closely interrelated with the land's topography (e.g., hills, valleys, elevation), which also influences malaria risk strongly. Parsing the individual contributions of land-cover/land-use variables to malaria risk requires examining these associations in the context of their topographic landscape. This study examined whether environmental factors like land-cover, land-use, and urban density improved malaria risk prediction based solely on the topographically-determined context, as measured by the topographic wetness index.
• Robinson, K. L., Ernst, K. C., Johnson, B. L., & Rosales, C. (2010). Health status of southern Arizona border counties: a Healthy Border 2010 midterm review. Revista panamericana de salud pública = Pan American journal of public health, 28(5).
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  The region on the United States (US) side of the US-Mexico border consists of 44 counties in four states; populations on both sides of the border have similar health problems. Healthy Border 2010: An Agenda for Improving Health on the US-Mexico Border (HB 2010) is a binational agenda of health promotion and disease prevention for individuals in the region. This study reports on the health status of the four southern Arizona border counties.
• Ernst, K. C., Lindblade, K. A., Koech, D., Sumba, P. O., Kuwuor, D. O., John, C. C., & Wilson, M. L. (2009). Environmental, socio-demographic and behavioural determinants of malaria risk in the western Kenyan highlands: a case-control study. Tropical medicine & international health : TM & IH, 14(10).
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  To identify risk factors for uncomplicated malaria in highland areas of East Africa at higher risk of malaria epidemics, in order to design appropriate interventions.
• Cohen, J. M., Ernst, K. C., Lindblade, K. A., Vulule, J. M., John, C. C., & Wilson, M. L. (2008). Topography-derived wetness indices are associated with household-level malaria risk in two communities in the western Kenyan highlands. Malaria journal, 7.
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  Transmission of Plasmodium falciparum generally decreases with increasing elevation, in part because lower temperature slows the development of both parasites and mosquitoes. However, other aspects of the terrain, such as the shape of the land, may affect habitat suitability for Anopheles breeding and thus risk of malaria transmission. Understanding these local topographic effects may permit prediction of regions at high risk of malaria within the highlands at small spatial scales.
• Menge, D. M., Ernst, K. C., Vulule, J. M., Zimmerman, P. A., Guo, H., & John, C. C. (2008). Microscopy underestimates the frequency of Plasmodium falciparum infection in symptomatic individuals in a low transmission highland area. The American journal of tropical medicine and hygiene, 79(2).
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  In an area with unstable malaria transmission, detection of Plasmodium falciparum infection in 379 symptomatic individuals was assessed by microscopy and three polymerase chain reaction (PCR) methodologies. P. falciparum infection was detected in 25% of patients by microscopy, 37% by nested PCR, 41% by merozoite surface protein-2 (MSP-2) PCR, and 45% by a ligase detection reaction-fluorescent microsphere assay (LDR-FMA). Of the 64 individuals who were LDR-FMA positive, microscopy negative and did not receive treatment, 8 (12.5%) had persistent symptoms and returned for treatment. Malaria attributable fraction (MAF) in symptomatic individuals was 14.6% by microscopy (95% confidence interval [CI] = 6.6-21.8%) and 28.2% by nested PCR (95% CI = 17.9-37.2%). In this highland area, P. falciparum infection in symptomatic individuals is detected more frequently by PCR than microscopy, and most frequently by LDR-FMA. P. falciparum infection appears to resolve without treatment in most LDR-FMA-positive, microscopy-negative individuals, but is persistent in a subset of these individuals and requires treatment.
• Ernst, K. C., Adoka, S. O., Kowuor, D. O., Wilson, M. L., & John, C. C. (2006). Malaria hotspot areas in a highland Kenya site are consistent in epidemic and non-epidemic years and are associated with ecological factors. Malaria journal, 5.
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  Malaria epidemics in highland areas of East Africa have caused considerable morbidity and mortality in the past two decades. Knowledge of "hotspot" areas of high malaria incidence would allow for focused preventive interventions in resource-poor areas, particularly if the hotspot areas can be discerned during non-epidemic periods and predicted by ecological factors.

Proceedings Publications

• Ernst, K. C. (2017, 06/2017). Building Communication Capacity to Counter Infectious Disease Threats: Proceedings of a Workshop. In National Academy of Science, National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Global Health; Forum on Microbial Threats. Washington (DC): National Academies Press (US); 2017 Jun 16..
• Schmidt, C., Phippard, A., Olsen, J., Wirt, K., Rivera, A., Crawley, A., Waterman, S., & Ernst, K. C. (2017, 06/2017). Kidenga: Public engagement for detection and prevention of Aedes-borne viral diseases. In Online Journal of Public Health Informatics, 9.

Presentations

• Ernst, K. C., Tamari, N., Li, Y., Pogreba Brown, K. M., Shilen, A., Orias, J., Elmer, C., Helming, B., Kaur, D., Beamer, P., & Ram, S. (2021). Deployment of the COVID-Watch exposure notification application in Arizona: acceptability, performance, and utility.. Council of State and Territorial Epidemiologists Virtual Conference.
• Teegerstrom, T., Ellsworth, P. C., Woolfolk, C. M., Weber, J. L., Nair, S., Ernst, K. C., Walker, K. R., Fournier, A. J., Gouge, D. H., & Li, S. (2021, October-November). Emergency Preparedness through Integrated Pest Management Education and Tribal Partnerships in Arizona. 2021 Entomological Society of America Annual Conference. October 31-November 3, 2021.
• Nair, S., Arnbrister, J., Li, S., Williamson, D., Ernst, K. C., Riehle, M. A., Gouge, D. H., & Walker, K. R. (2020, November). Impacts of ULV adulticiding on the vectorial capacity of the Zika vector, Aedes aegypti. 2020 Entomological Society of America Virtual Annual Meeting. November 11–25, 2020.
• Nair, S., Arnbrister, J., Li, S., Williamson, D., Ernst, K. C., Riehle, M. A., Gouge, D. H., & Walker, K. R. (2020, November). Impacts of ULV adulticiding on the vectorial capacity of the Zika vector, Aedes aegypti. 2020 Entomology Virtual Annual Meeting. November 11 – 25, 2020.
• Teegerstrom, T., Ellsworth, P. C., Ernst, K. C., Walker, K. R., Brophy, M., Reese, S., Dorame-Avalos, A., Nair, S., Fournier, A. J., Gouge, D. H., & Li, S. (2020, November). Public Health IPM Education – Honoring and empowering tribal nations and indigenous peoples. 2020 Entomology Society of America Virtual Annual Meeting. November 11 – 25, 2020.
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  1220 views. On-demand presentation available for 3068 meeting registrants.
• Teegerstrom, T., Teegerstrom, T., Ellsworth, P. C., Ellsworth, P. C., Ernst, K. C., Ernst, K. C., Walker, K. R., Walker, K. R., Brophy, M., Brophy, M., Reese, S., Reese, S., Dorame-Avalos, A., Dorame-Avalos, A., Nair, S., Nair, S., Fournier, A. J., Fournier, A. J., Gouge, D. H., , Gouge, D. H., et al. (2020, November). Public Health IPM Education – Honoring and empowering tribal nations and indigenous peoples. 2020 Entomological Society of America Virtual Annual Meeting. November 11–25, 2020.
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  1220 views. On-demand presentation available for 3068 meeting registrants.
• Ellsworth, P. C., Fournier, A. J., Teegerstrom, T., Rivadeneira, P., Ernst, K. C., Walker, K. R., Brophy, M., Reese, S., Dorame-Avalos, A., Nair, S., Gouge, D. H., & Li, S. (2019, August). Effective Partnerships in Public Health IPM Education in American Indian Communities. National Environmental Health Association Integrated Pest Management Solutions in Environmental Health Virtual Conference. Virtual Conference: National Environmental Health Association.
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  158 views. 106 NEHA CEUs
• Fournier, A. J., Ellsworth, P. C., Teegerstrom, T., Rivadeneira, P., Ernst, K. C., Walker, K. R., Brophy, M., Reese, S., Dorame-Avalos, A., Nair, S., Gouge, D. H., & Li, S. (2019, August). Effective Partnerships in Public Health IPM Education in American Indian Communities. National Environmental Health Association Integrated Pest Management Solutions in Environmental Health Virtual Conference. August 28-29, 2019. National Environmental Health Association.
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  158 participants. 106 NEHA CEUs.
• Fournier, A. J., Ellsworth, P. C., Teegerstrom, T., Rivadeneira, P., Ernst, K. C., Walker, K. R., Brophy, M., Reese, S., Dorame-Avalos, A., Nair, S., Gouge, D. H., & Li, S. (2019, October). Effective Partnerships in IPM Education in Indian Communities. Tribal/EPA Region 9 Conference. Maricopa, AZ 85138. October 22-24, 2019.
• Walker, K. R., Riehle, M. A., & Ernst, K. C. (2019, July). Unravelling the social and biological determinants of arboviral transmission in the Arizona-Sonora border region.. 8th International Symposium on Insect Molecular Biology. Sitges, Spain.
• Ernst, K. C., Ernst, K. C., Enquist, B. J., Enquist, B. J., Ferguson, D. B., Ferguson, D. B., Merideth, R., Merideth, R., Park, D. T., Park, D. T., Dang, T., Dang, T., Nuñez-Regueiro, M. M., Nuñez-Regueiro, M. M., Baldwin, E., Baldwin, E., Soto, J. R., Soto, J. R., Breshears, D. D., , Breshears, D. D., et al. (2018, June). Crops in a Changing World: Hidden Forest-Agriculture Teleconnections. 5th European Congress of Conservation Biology. Jyväskylä, Finland: European Congress of Conservation Biology.
• Ernst, K. C., Riehle, M. A., Walker, K. R., & Weitemier, T. D. (2018, October). Evidence and variation in nectar feeding from wild Aedes aegypti mosquitoes from an arid environment. Society of Vector Ecology. Yosemite, California.
• Ernst, K. C., Castro Luque, A. L., Walker, K. R., & Reyes Castro, P. (2017, Nov.). Datos de investigación y recomendaciones para la vigilancia y prevención del dengue.. Advisory meeting to the Secretaria de Salud, Estado de Sonora (Sonora State Health Department). Hermosillo, Sonora, Mexico: Foro Binacional, Estado de Sonora.
• Ernst, K. C., Castro Luque, A. L., Walker, K. R., & Reyes Castro, P. (2017, Nov.). On the edge: dengue and climate (in Spanish). Foro Binacional: Redes Regionales - Arizona, Sonora, California, Baja California. Hermosillo, Sonora, Mexico: Foro Binacional Redes Regionales - Arizona, Sonora, California, Baja California.
• Reyes Castro, P., Joy, T., Riehle, M. A., Ernst, K. C., & Walker, K. R. (2017, March). Ecology of Aedes aegypti and public perception of mosquitoes in the Arizona/Sonora border region. 2017 Arizona Vector Control Conference. Phoenix, AZ: Arizona Dept. of Health Services.
• Walker, K. R., Ernst, K. C., Castro-Reyes, P., & Riehle, M. A. (2016, October). Ecologia de Aedes aegypti y el Riesgo de Dengue en la Region de Arizona/Sonora [in Spanish]. Simposio Binacional: Exploracion de los Aspectos Ambientales y de Salud del Zika, Dengue Chikungunya y la Fiebre Manchada,. Nogales, Sonora: U.S. EPA.
• Walker, K. R., Joy, T. K., Ernst, K. C., Riehle, M. A., & Daniel, W. (2016, September). Understanding the Zika vector in the desert southwest.. Science Café –. Tucson, AZ: Southwest Environmental Health Sciences Center, University of Arizona.
• Walker, K. R., Joy, T. K., Ernst, K. C., Riehle, M. A., & Daniel, W. (2016, September). Understanding the Zika vector in the desert southwest.. Volunteer Leadership Engagement Day with the Wildcat for Life and National Leadership Councils. Tucson, AZ: University of Arizona.
• Walker, K. R., Rathman, R., Yaglom, H., Levy, C., Beal, B., Ernst, K. C., Casal, M., & Stokka, D. (2016, September). Enlisting citizen scientists for disease vector surveillance: The Great Arizona Mosquito Hunt.. International Congress of Entomology. Orlando, Florida,: International Congress of Entomology.
• Dickinson, K., Hayden, M., Haenchen, S., & Ernst, K. C. (2015, January). Willingness to pay for control of dengue - transmitting mosquitoes in Key West, FL. American Meteorological Society. Phoenix, AZ.
• Ernst, K. C. (2015, October 2015). Aedes distribution on the US border with Mexico/ Dengue risk perception a cross border perspective. American Society of Tropical Medicine and Hygiene. Philadelphia, PA.
• Ernst, K. C. (2015, October 2015). Climatic influences of Ae. aegypti dynamics and dengue transmission at the edge of its natural range. American Society of Tropical Medicine and Hygiene. Philadelphia, PA.
• Ernst, K. C., Bauman, A., & Taren, D. (2015, March 2015). Assessing community health: innovation in anthropometric tool for measuring height and length. CUGH Global Health. Boston, MA.
• Morin, C., Monaghan, A., Crosson, W., Quattrochi, D., Hayden, M., & Ernst, K. C. (2015, January). Assessing disparities of dengue virus transmission risk across the US Mexico border using a climate driven vector epidemiological model. American Meteorological Society. Phoenix, AZ.
• Ugwu, C., Ezeanolue, E., Ehiri, J., & Ernst, K. C. (2015, March 2015). Feasibility of using world health organization standard verbal autopsy to assess causes of neonatal and post-neonatal death in Enugu, Nigeria. CUGH Global Health Conference. Boston, MA.
• Walker, K. R., Ernst, K. C., Reyes-Castro, P., Castro, L., Diaz-Cervantes, R., Walker, K. R., Ernst, K. C., Reyes-Castro, P., Castro, L., & Diaz-Cervantes, R. (2015, August). Factores que influyen en el riesgo de dengue en la región Arizona-Sonora. Reunion sobre el control de enfermedades transmitido por insectos. Ciudad Obregon, Sonora, Mexico: Instituto Technologica de Sonor.
• Walker, K. R., Ernst, K. C., Walker, K. R., & Ernst, K. C. (2015, July). Factores que influyen en el riesgo de dengue en la región Arizona-Sonora (in Spanish). Meeting with Sonoran Health Dept. in Santa Ana, Sonora.
• Castro-Reyes, P., & Ernst, K. C. (2014, Fall 2015). Social and Environmental Factors of Dengue Fever in the Sonoran Desert of Mexico, 2006-2011. APHA Annual Meeting 2014. New Orleans, LA.
• Ernst, K. C., Beamer, P., Ernst, K. C., & Beamer, P. (2014, October). Relationship of mosquito density and particle loading from cooking fires in Kenya.”. International Society of Exposure Science.
• Ernst, K. C., Haenchen, S., Dickinson, K., Doyle, M., & Hayden, M. (2014, October). Community awareness and support of the controversial release of OX513A Aedes aegypti in Key West, FL. Presented at Fourth Pan-American Dengue Network Meeting..
• Ernst, K. C., Hayden, M., Riehle, M., Walker, K. R., & Riehle, M. A. (2014, August). Differential Emergence of Dengue in the Arizona-Sonora Desert Region: Understanding the Role of Social and Environmental Factors.”. International Society for Environmental Epidemiology.
• Ernst, K. C., Hayden, M., Walker, K. R., Castro, L., Diaz, R., Reyes-Castro, P., Monaghan, A., Haenchen, S., & Riehle, M. A. (2014, November). Diferencias en el riesgo del dengue a través del norte de México. Prevención de riesgos para la salud de las poblaciones vulnerables..
• Monaghan, A., Hayden, M., Steinhoff, D., Rodriguez, D., Ernst, K. C., Ernst, K., Eisen, L., S, L. F., & P, B. (2014, August). Disease Vector Mapping Via Environmental, Climatological and Sociological Factors. International Society for Environmental Epidemiology.
• Reyes-Castro, P., & Ernst, K. C. (2014, November). Social and Environmental Factors of Dengue Fever in the Sonoran Desert of Mexico, 2006-2011. American Public Health Association.
• Walker, K. R., & Ernst, K. C. (2014, Fall). Factores que influyen en el riesgo de dengue en la región Arizona-Sonora. Training event for nurses & hospital staff - Hospital General Nogales. Nogales, Sonora, Mexico: Hospital General Nogales.
• Ernst, K. C. (2013, June). Identifying community-based strategies to improve insecticide treated bednet use.. Grand Rounds. Kisumu, Kenya: Centers for Disease Control and Prevention.
• Ernst, K. C., Castro-Reyes, P., & Walker, K. (2013, May). Dengue in the Arizona-Sonora Border Region.. U.S. Public Health Service Scientific and Training Symposium..
• Ernst, K. C., Haenchen, S., Walker, K., Doyle, M., Dickinson, K., & Hayden, M. (2013, November). Comparing Social and Behavioral Factors Related to Dengue Transmission in Two U.S. Communities: One With and One Without a Recent Transmission. American Society of Tropical Medicine and Hygiene. Washington D.C..
• Reynolds, K. A., Suppes, L. M., Ernst, K. C., & Gerba, C. P. (2014, Spring). Aquatic Environmental Exposure and Operation Questionnaire Standardization and Validation. 5th International Conference Swimming Pool and Spa. Rome, Italy: National Swimming Pool Foundation (NSPF).
• Suppes, L. M., Reynolds, K. A., Ernst, K. C., & Gerba, C. P. (2013, January). Influence of Swimmer Activity and Behavior on Pool Water Ingestion. Arizona County Directors of Environmental Health Services Association. Laughlin, NV.

Poster Presentations

• Ellsworth, P. C., Teegerstrom, T., Ernst, K. C., Walker, K. R., Brophy, M., Reese, S., Dorame-Avalos, A., Nair, S., Fournier, A. J., Gouge, D. H., & Li, S. (2020, October). Honoring and Empowering Tribal Nations and Indigenous Peoples Through IPM Education and Emergency Preparedness. 2020 Arizona Cooperative Extension Virtual Conference. October 6-8, 2020.
• Ellsworth, P. C., Teegerstrom, T., Ernst, K. C., Walker, K. R., Brophy, M., Reese, S., Dorame-Avalos, A., Nair, S., Fournier, A. J., Gouge, D. H., Li, S., Ellsworth, P. C., Teegerstrom, T., Ernst, K. C., Walker, K. R., Brophy, M., Reese, S., Dorame-Avalos, A., Nair, S., , Fournier, A. J., et al. (2020, October 6-8). Honoring and Empowering Tribal Nations and Indigenous Peoples Through IPM Education and Emergency Preparedness. 2020 Arizona Cooperative Extension Virtual Conference. October 6-8, 2020.
• Walker, K. R., Carriere, Y., Gouge, D. H., Ernst, K. C., Joy, T., & Riehle, M. A. (2020, November). How old is that mosquito? Age grading Aedes aegypti in the desert Southwest.. ESA National Meeting. Virtual.
• Fournier, A. J., Ellsworth, P. C., Teegerstrom, T., Rivadeneira, P., Ernst, K. C., Walker, K. R., Brophy, M., Reese, S., Dorame-Avalos, A., Nair, S., Gouge, D. H., & Li, S. (2019, August). Public Health IPM Education in American Indian Communities. Arizona Cooperative Extension Conference. Tucson, AZ: UA Extension.
• Fournier, A. J., Fournier, A. J., Ellsworth, P. C., Ellsworth, P. C., Teegerstrom, T., Teegerstrom, T., Rivadeneira, P., Rivadeneira, P., Rivadeneira, P., Rivadeneira, P., Ernst, K. C., Ernst, K. C., Walker, K. R., Walker, K. R., Brophy, M., Brophy, M., Reese, S., Reese, S., Dorame-Avalos, A., , Dorame-Avalos, A., et al. (2019, 08-06-2019). Public Health IPM Education in American Indian Communities. 2019 Arizona Cooperative Extension Conference.
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  8/6/19. Li, S., Gouge, D.H., Nair, S., Dorame-Avalos, A., Reese, S.K., Brophy, M., Walker, K.C., Ernst, K.C., Rivadeneira, P., Teegerstrom, T., Ellsworth, P.C. and Fournier, A.J. (presented the poster). 2019. Public Health IPM Education in American Indian Communities. Poster presentation. 2019 Arizona Cooperative Extension Conference. Westin La Paloma Resort, 3800 E. Sunrise Dr., Tucson, AZ 85718. August 6-7, 2019.
• Li, S., Fournier, A. J., Gouge, D. H., Ellsworth, P. C., Nair, S., Teegerstrom, T., Dorame-Avalos, A., Rivadeneira, P., Reese, S. K., Ernst, K. C., Walker, K. R., Walker, K. R., Reese, S. K., Ernst, K. C., Dorame-Avalos, A., Rivadeneira, P., Teegerstrom, T., Nair, S., Ellsworth, P. C., , Gouge, D. H., et al. (2019, August). Public Health IPM Education in American Indian Communities. University of Arizona Cooperative Extension Annual In-Service Training. Tucson, Arizona.
• Ernst, K. C., Gouge, D. H., Riehle, M. A., & Walker, K. R. (2018, October). Impacts of ULV adulticiding on the vectorial capacity of the Zika Vector. Society of Vector Ecology. Yosemite, California.
• Joy, T., Walker, K. R., Ernst, K. C., & Riehle, M. A. (2018, October). Age grading individual field collected Aedes aeg ypti mosquitoes: qPCR versus near - infrared spectrophotometry (NIRS). Society of Vector Ecology. Yosemite, California.
• Koch, S., Harris, R. B., Jacobs, E. T., Ernst, K. C., Dennis, L. K., Koch, S., Harris, R. B., Jacobs, E. T., Ernst, K. C., & Dennis, L. K. (2016, October). Sun protection behavior and sunburns among Arizona adults. Joint IDEA-Keracon Conference [7th International Dermato-Epidemiology Association (IDEA) Congress and Keratinocyte Carcinoma Consortium (KeraCon). Aurora, CO: International Dermato-Epidemiology Association.
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  Koch S, Harris RB, Jacobs ET, Ernst KC, Dennis LK. Sun protection behavior and sunburns among Arizona adults. Poster presentation at Joint IDEA-Keracon Conference [7th International Dermato-Epidemiology Association (IDEA) Congress and Keratinocyte Carcinoma Consortium (KeraCon) . Aurora CO, September 2016
• Pogreba Brown, K. M., Ernst, K. C., Harris, R. B., Pogreba Brown, K. M., Ernst, K. C., & Harris, R. B. (2015, November). Determining Risk Factors of a Non-Point Source Outbreak of Campylobacter Cases Using Case-Case and Case-Control Studies. Campylobacter, Helicobbacter and Other Related Organisms International Conference. Rotorua, New Zealand.
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  This poster was accepted for the conference, but I was unable to attend due to medical reasons. Dr. Alexandra Armstrong, a colleague from CALS was able to present for me.
• Walker, K. R., Ernst, K. C., Joy, T., Reyes-Castro, P., Carriere, Y., Castro, L., Diaz-Cervantes, R., Gameros, M., Hayden, M., Monaghan, A., Haenchen, S., Guttierez-Jeffrey, E., Riehle, M. A., Walker, K. R., Ernst, K. C., Joy, T., Reyes-Castro, P., Carriere, Y., Castro, L., , Diaz-Cervantes, R., et al. (2015, September). Exploring differential emergence of dengue in two cities with established Aedes aegypti populations: A case study in Sonora, Mexico. 2015 Annual Meeting of the Society for Vector Ecology. Albuquerque, NM.
• Ernst, K. C., & Beamer, P. (2014, October). Relationship of mosquito density and particle loading from cooking fires in Kenya.”. International Society of Exposure Science.
• Ernst, K. C., Hayden, M., & Munga, S. (2013, November). Attitudes towards indoor residual spray - A comparison of areas with endemic and unstable transmission. American Society of Tropical Medicine and Hygiene. Washington D.C..
• Haenchen, S. D., Pottinger, H. L., Jacobs, E. T., Gast, P. B., & Ernst, K. C. (2013, March). Opinions of Arizona Physicians Regarding Childhood Immunizations. 2013 Public Health Research Poster Forum. Tucson, AZ: Mel & Enid Zuckerman College of Public Health.
• Haenchen, S., Hayden, M., Dickinson, K., & Ernst, K. C. (2013, September). Knowledge and Attitudes Towards Dengue and Their Effect on Mosquito Breeding-site Prevention Practices in Key West, FL.. Society of vector ecology. La Quinta, CA.
• Pottinger, H. L., Steven, H. D., Jacobs, E. T., & Ernst, K. C. (2013, March). Parental attitudes toward childhood immunization(s) in Arizona elementary schools. 2013 Public Health Research Poster Forum. Tucson, AZ: Mel & Enid Zuckerman College of Public Health.
• Pottinger, H. L., Haenchen, S. D., Jacobs, E. T., Gast, P. B., & Ernst, K. C. (2012, November). Parental attitudes toward childhood immunization(s) in Arizona elementary schools. 2012 Frontiers in Biomedical Research Poster Forum. Tucson, AZ: The University of Arizona College of Medicine.

Reviews

• Ernst, K., Morin, C. W., Comrie, A. C., & Ernst, K. C. (2013. Climate and Dengue Transmission: Evidence and Implications.
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  Climate influences dengue ecology by affecting vector dynamics, agent development, and mosquito/human interactions. While these relationships are known, the impact climate change will have on transmission is unclear. Climate-driven statistical and process-based models are being used to refine our knowledge of these relationships and predict the effects of projected climate change on dengue fever occurrence, but results have been inconsistent.

Others

• Walker, K. R., Nair, S., Stefanakos, E., Ernst, K. C., Huijben, S., Ruberto, I., Li, S., Paaijmans, K., Sumner, C., & Gouge, D. H. (2021, June). Developing the National Public Health Strategy for the Prevention and Control of Vector-Borne Diseases in Humans.. Department of Health and Human Services Request for Information.
• Ernst, K. C., & Pottinger, H. L. (2019, March). Why Some Parents Seek Vaccine Exemptions. Arizona Public Media. https://www.azpm.org/p/azillhome/2019/3/8/147544-why-some-parents-seek-vaccine-exemptions/