Author ORCID Identifier

https://orcid.org/0009-0002-2019-7405

Date Available

4-30-2025

Year of Publication

2025

Document Type

Graduate Capstone Project

Degree Name

Master of Public Health (M.P.H.)

College

Public Health

Department/School/Program

Public Health

Faculty

Steven Browning

Committee Member

Wayne Sanderson

Faculty

Jay Christian

Abstract

Congenital defects are a significant contributor to infant morbidity and mortality. The multifactorial etiology of such defects presents complex challenges for public health. This ecologic study investigates the association between environmental and behavioral exposures and congenital defects rates at the county level in Kentucky from 2010 to 2019. The Kentucky Department for Public Health, Office of Vital Statistics, provided all relevant defect data. County-level exposure data was collected from multiple sources.

Descriptive and geospatial analyses revealed substantial geographic variability, with notable high defect rates in northeastern Kentucky. Negative binomial regression models identified behavioral and socioeconomic factors to be the strongest predictors of increased risk of congenital defects. Unexpectedly, many environmental factors revealed an inverse association with defect rates.

Many limitations impact the generalizability of this study including the reliance on aggregate data, temporal imprecision, and exposure misclassification. Despite such limitations, the study highlights the potential importance of behavioral and socioeconomic determinant in shaping congenital defect rates. These findings point to a need for targeted public health strategies for improving maternal health behaviors in high-risk areas.

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