Prince Michael Amegbor

Prince M. Amegbor
Prince Michael Amegbor
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Assistant Professor of Global and Environmental Health

Professional overview

As a health geographer using big data and a multi-methods approach in his research on the environmental and social determinants of health, Dr. Prince Michael Amegbor is an assistant professor in the Department of Global and Environmental Health. He specializes in visualizing the geospatial distribution of risks and burdens on health that are associated with environmental exposures. He works to unravel how factors such as climate change, air pollution and other environmental exposures contribute to health inequalities, particularly in Sub-Saharan Africa and other geographic contexts (e.g., Denmark).

Prior to his appointment at GPH, Dr. Amegbor was a postdoctoral research fellow with the Big Data Centre for Environment and Health (BERTHA) and the Department of Environmental Science at Aarhus University (Denmark). He is also a guest researcher at Statistics Denmark and has worked as a co-task leader of two European Union Horizon 2020 Projects: REGREEN and ICARUS (Integrated Climate forcing and Air pollution Reduction in Urban Systems).

Dr. Amegbor has published dozens of articles in peer-reviewed scholarly journals including Scientific Report, Health & Place and Applied Geography. He earned his PhD in human geography from Queen’s University in Ontario, and holds an MPhil in development geography from the University of Oslo. He obtained his undergraduate degree in geography and resource development from the University of Ghana, Legon.

 

 

Below are links to the results from ICARUS – Favorite Location Study published in the Environment and Planning B: Urban Analytics and City Science journal:

Education

PhD, Department of Geography & Planning, Queen’s University, Kingston, Ontario
MPhil Developmental Geography, University of Oslo, Oslo, Norway
BA Geography & Resource Development, University of Ghana, Accra

Honors and awards

Principal's International Doctoral Award, Queen’s University (201520162017)
Quota Scheme Scholarship, Department of Sociology & Human Geography, University of Oslo (201220132014)

Areas of research and study

Aging and the Life Course
Alternative Medicine
Child Health
Complementary Medicine
Environmental Public Health Services
Immigrant Health
Public Health Policy
Social Determinants of Health
Socio-cultural Identities and Health Seeking Behaviors
Traditional Medicine
Urban Geography
Violence and Victimisation
Women's Health

Publications

Publications

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

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Publication year

2024

Journal title

The Lancet

Volume

403

Issue

10440

Page(s)

2100-2132
Abstract
Abstract
Background: Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. Methods: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model—a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates—with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality—which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. Findings: The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2–100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1–290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1–211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4–48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3–37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7–9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. Interpretation: Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. Funding: Bill & Melinda Gates Foundation.

Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

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Publication year

2024

Journal title

The Lancet

Volume

403

Issue

10440

Page(s)

2133-2161
Abstract
Abstract
Background: Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. Methods: The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. Findings: Global DALYs increased from 2·63 billion (95% UI 2·44–2·85) in 2010 to 2·88 billion (2·64–3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7–17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8–6·3) in 2020 and 7·2% (4·7–10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0–234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7–198·3]), neonatal disorders (186·3 million [162·3–214·9]), and stroke (160·4 million [148·0–171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3–51·7) and for diarrhoeal diseases decreased by 47·0% (39·9–52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54–1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5–9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0–19·8]), depressive disorders (16·4% [11·9–21·3]), and diabetes (14·0% [10·0–17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7–27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6–63·6) in 2010 to 62·2 years (59·4–64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6–2·9) between 2019 and 2021. Interpretation: Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. Funding: Bill & Melinda Gates Foundation.

Global, regional, and national incidence and mortality burden of non-COVID-19 lower respiratory infections and aetiologies, 1990–2021: a systematic analysis from the Global Burden of Disease Study 2021

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Publication year

2024

Journal title

The Lancet Infectious Diseases
Abstract
Abstract
Background: Lower respiratory infections (LRIs) are a major global contributor to morbidity and mortality. In 2020–21, non-pharmaceutical interventions associated with the COVID-19 pandemic reduced not only the transmission of SARS-CoV-2, but also the transmission of other LRI pathogens. Tracking LRI incidence and mortality, as well as the pathogens responsible, can guide health-system responses and funding priorities to reduce future burden. We present estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 of the burden of non-COVID-19 LRIs and corresponding aetiologies from 1990 to 2021, inclusive of pandemic effects on the incidence and mortality of select respiratory viruses, globally, regionally, and for 204 countries and territories. Methods: We estimated mortality, incidence, and aetiology attribution for LRI, defined by the GBD as pneumonia or bronchiolitis, not inclusive of COVID-19. We analysed 26 259 site-years of mortality data using the Cause of Death Ensemble model to estimate LRI mortality rates. We analysed all available age-specific and sex-specific data sources, including published literature identified by a systematic review, as well as household surveys, hospital admissions, health insurance claims, and LRI mortality estimates, to generate internally consistent estimates of incidence and prevalence using DisMod-MR 2.1. For aetiology estimation, we analysed multiple causes of death, vital registration, hospital discharge, microbial laboratory, and literature data using a network analysis model to produce the proportion of LRI deaths and episodes attributable to the following pathogens: Acinetobacter baumannii, Chlamydia spp, Enterobacter spp, Escherichia coli, fungi, group B streptococcus, Haemophilus influenzae, influenza viruses, Klebsiella pneumoniae, Legionella spp, Mycoplasma spp, polymicrobial infections, Pseudomonas aeruginosa, respiratory syncytial virus (RSV), Staphylococcus aureus, Streptococcus pneumoniae, and other viruses (ie, the aggregate of all viruses studied except influenza and RSV), as well as a residual category of other bacterial pathogens. Findings: Globally, in 2021, we estimated 344 million (95% uncertainty interval [UI] 325–364) incident episodes of LRI, or 4350 episodes (4120–4610) per 100 000 population, and 2·18 million deaths (1·98–2·36), or 27·7 deaths (25·1–29·9) per 100 000. 502 000 deaths (406 000–611 000) were in children younger than 5 years, among which 254 000 deaths (197 000–320 000) occurred in countries with a low Socio-demographic Index. Of the 18 modelled pathogen categories in 2021, S pneumoniae was responsible for the highest proportions of LRI episodes and deaths, with an estimated 97·9 million (92·1–104·0) episodes and 505 000 deaths (454 000–555 000) globally. The pathogens responsible for the second and third highest episode counts globally were other viral aetiologies (46·4 million [43·6–49·3] episodes) and Mycoplasma spp (25·3 million [23·5–27·2]), while those responsible for the second and third highest death counts were S aureus (424 000 [380 000–459 000]) and K pneumoniae (176 000 [158 000–194 000]). From 1990 to 2019, the global all-age non-COVID-19 LRI mortality rate declined by 41·7% (35·9–46·9), from 56·5 deaths (51·3–61·9) to 32·9 deaths (29·9–35·4) per 100 000. From 2019 to 2021, during the COVID-19 pandemic and implementation of associated non-pharmaceutical interventions, we estimated a 16·0% (13·1–18·6) decline in the global all-age non-COVID-19 LRI mortality rate, largely accounted for by a 71·8% (63·8–78·9) decline in the number of influenza deaths and a 66·7% (56·6–75·3) decline in the number of RSV deaths. Interpretation: Substantial progress has been made in reducing LRI mortality, but the burden remains high, especially in low-income and middle-income countries. During the COVID-19 pandemic, with its associated non-pharmaceutical interventions, global incident LRI cases and mortality attributable to influenza and RSV declined substantially. Expanding access to health-care services and vaccines, including S pneumoniae, H influenzae type B, and novel RSV vaccines, along with new low-cost interventions against S aureus, could mitigate the LRI burden and prevent transmission of LRI-causing pathogens. Funding: Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care (UK).

Modelling the spatial risk pattern of dementia in Denmark using residential location data: A registry-based national cohort

Amegbor, P. M., Sabel, C. E., Mortensen, L. H., & Mehta, A. J. (n.d.).

Publication year

2024

Journal title

Spatial and Spatio-temporal Epidemiology

Volume

49
Abstract
Abstract
Dementia is a major global public health concern that is increasingly leading to morbidity and mortality among older adults. While studies have focused on the risk factors and care provision, there is currently limited knowledge about the spatial risk pattern of the disease. In this study, we employ Bayesian spatial modelling with a stochastic partial differential equation (SPDE) approach to model the spatial risk using complete residential history data from the Danish population and health registers. The study cohort consisted of 1.6 million people aged 65 years and above from 2005 to 2018. The results of the spatial risk map indicate high-risk areas in Copenhagen, southern Jutland and Funen. Individual socioeconomic factors and population density reduce the intensity of high-risk patterns across Denmark. The findings of this study call for the critical examination of the contribution of place of residence in the susceptibility of the global ageing population to dementia.

Smoke exposure, hemoglobin levels and the prevalence of anemia: a cross-sectional study in urban informal settlement in Southern Ghana

Appiah-Dwomoh, C., Tettey, P., Akyeampong, E., Amegbor, P., Okello, G., Botwe, P. K., & Quansah, R. (n.d.).

Publication year

2024

Journal title

BMC public health

Volume

24

Issue

1
Abstract
Abstract
Background: In sub-Saharan African cities, more than half of the population lives in informal settlements. These settlements are close to smoky dumpsites, industrial plants, and polluted roads. Furthermore, polluting fuels remain their primary sources of energy for cooking and heating. Despite evidence linking smoke and its components to anaemia, none of these studies were conducted on populations living in urban informal settlements. This study investigated the risks of anemia/mean Haemoglobin (HB) levels in an informal settlement in Accra, Ghana. Exposure to smoke was examined across various sources, encompassing residences, neighborhoods, and workplaces. Methods: The study was a facility-based cross-sectional design among residents at Chorkor, an informal settlement in the Greater Accra region of Ghana. A questionnaire was administered at a community hospital during an interview to gather data on sources of smoke exposure in the household, in the neighbourhood, and in the workplace. A phlebotomist collected blood samples from the participants after the interview to assess their anaemia status. Results: The population (n = 320) had a high prevalence of anemia, with 49.1% of people fitting the WHO’s definition of anemia, while the average HB level was 12.6 ± 2.1 g/dL. Anemia was associated with the number of different types of waste burnt simultaneously [(1 or 2: prevalence ratio (PR): 95% confidence interval (CI), 1.14, 0.99–1.28: 3+: 1.16, 1.01–1.63, p-for-trend = 0.0082)], fuel stacking [(mixed stacking: 1.27, 1.07–1.20: dirty stacking:1.65, 1.19–2.25, p-for-trend = 0.0062)], and involvement in fish smoking (1.22, 0.99–1.06). However, the lower limit of the CIs for number of different forms of garbage burned simultaneously and engagement in fish smoking included unity. Reduced mean HB levels were associated with the number of different types of waste burnt simultaneously [(1 or 2: regression coefficient (β): 95% confidence interval (CI), -0.01, -0.97- -0.99: 3+: -0.14, -0.77- -0.05)], current smoker [(yes, almost daily: -1.40, -2.01- -0.79: yes, at least once a month: -1.14, -1.79- -0.48)], Second-Hand-Smoking (SHS) (yes, almost daily: -0.77, -1.30- -0.21), fuel stacking [(mixed stacking-0.93, -1.33–0.21: dirty stacking-1.04, -1.60- -0.48)], any smoke exposure indicator in the neighbourhood (-0.84, -1.43- -0.25), living close to a major road (-0.62, -1.09- -0.49), and fish smoking (-0.41,-0.93- -0.12). Conclusion: Although the cross-sectional design precludes causality, smoke exposure was associated with mean HB levels and anaemia among populations living in informal settlements.

Spatial modelling of psychosocial benefits of favourite places in Denmark: A tale of two cities

Amegbor, P. M., Dalgaard, R., Nainggolan, D., Jensen, A., Sabel, C. E., Panduro, T. E., Jensen, M. S., Dybdal, A. E., & Puig, M. (n.d.).

Publication year

2024

Journal title

Environment and Planning B: Urban Analytics and City Science
Abstract
Abstract
Living in urban areas is known to increase the risk of psychosocial disorders, including stress, depression, and anxiety. Existing studies suggest that experiential places, including places of interest or favourite places, can mitigate these negative effects on psychological and physical health often associated with urban living. This study aims to model the spatial patterns of the benefits derived from favourite locations in two cities in Denmark: an urban metropolitan area (the capital city) and a provincial commuter town. Additionally, it examines the influence of individual and household socioeconomic factors on the benefits derived from these favourite places. Employing an online Public Participatory Geographic Information System (PPGIS) approach, data on favourite locations, derived benefits, and socioeconomic characteristics of 1400 respondents were collected. Bayesian modelling with Stochastic Partial Differential Equations under the Integrated Nested Laplace Approximation framework (INLA-SPDE) was utilized to predict the spatial patterns of four types of benefits – restorative, physical activity, socializing, and cultural – associated with enjoying favourite places in the two municipalities. This geostatistical approach allows for the identification of specific locations within the cities with perceived benefits and areas lacking such benefits. The findings provide insights into potential inequalities in the spatial distribution of perceived benefits of favourite places in Copenhagen and Roskilde, thereby informing urban planning policies and programs aimed at addressing these disparities.

Assessing the association between overcrowding and human physiological stress response in different urban contexts: a case study in Salzburg, Austria

Zhang, Z., Měchurová, K., Resch, B., Amegbor, P., & Sabel, C. E. (n.d.).

Publication year

2023

Journal title

International Journal of Health Geographics

Volume

22

Issue

1
Abstract
Abstract
Overcrowding in densely populated urban areas is increasingly becoming an issue for mental health disorders. Yet, only few studies have examined the association between overcrowding in cities and physiological stress responses. Thus, this study employed wearable sensors (a wearable camera, an Empatica E4 wristband and a smartphone-based GPS) to assess the association between overcrowding and human physiological stress response in four types of urban contexts (green space, transit space, commercial space, and blue space). A case study with 26 participants was conducted in Salzburg, Austria. We used Mask R-CNN to detect elements related to overcrowding such as human crowds, sitting facilities, vehicles and bikes from first-person video data collected by wearable cameras, and calculated a change score (CS) to assess human physiological stress response based on galvanic skin response (GSR) and skin temperature from the physiological data collected by the wristband, then this study used statistical and spatial analysis to assess the association between the change score and the above elements. The results demonstrate the feasibility of using sensor-based measurement and quantitative analysis to investigate the relationship between human stress and overcrowding in relation to different urban elements. The findings of this study indicate the importance of considering human crowds, sitting facilities, vehicles and bikes to assess the impact of overcrowding on human stress at street level.

Early-life air pollution and green space exposures as determinants of stunting among children under age five in Sub-Saharan Africa

Amegbor, P. M., Sabel, C. E., Mortensen, L. H., Mehta, A. J., & Rosenberg, M. W. (n.d.).

Publication year

2023

Journal title

Journal of Exposure Science and Environmental Epidemiology
Abstract
Abstract
Background: Childhood malnutrition is a major public health issue in Sub-Saharan Africa (SSA) and 61.4 million children under the age of five years in the region are stunted. Although insight from existing studies suggests plausible pathways between ambient air pollution exposure and stunting, there are limited studies on the effect of different ambient air pollutants on stunting among children. Objective: Explore the effect of early-life environmental exposures on stunting among children under the age of five years. Methods: In this study, we used pooled health and population data from 33 countries in SSA between 2006 and 2019 and environmental data from the Atmospheric Composition Analysis Group and NASA’s GIOVANNI platform. We estimated the association between early-life environmental exposures and stunting in three exposure periods – in-utero (during pregnancy), post-utero (after pregnancy to current age) and cumulative (from pregnancy to current age), using Bayesian hierarchical modelling. We also visualise the likelihood of stunting among children based on their region of residence using Bayesian hierarchical modelling. Results: The findings show that 33.6% of sampled children were stunted. In-utero PM2.5 was associated with a higher likelihood of stunting (OR = 1.038, CrI = 1.002–1.075). Early-life exposures to nitrogen dioxide and sulphate were robustly associated with stunting among children. The findings also show spatial variation in a high and low likelihood of stunting based on a region of residence. Impact Statement: This study explores the effect of early-life environmental exposures on child growth or stunting among sub-Saharan African children. The study focuses on three exposure windows – pregnancy, after birth and cumulative exposure during pregnancy and after birth. The study also employs spatial analysis to assess the spatial burden of stunted growth in relation to environmental exposures and socioeconomic factors. The findings suggest major air pollutants are associated with stunted growth among children in sub-Saharan Africa.

Global Burden of Cardiovascular Diseases and Risks, 1990-2022

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Publication year

2023

Journal title

Journal of the American College of Cardiology

Volume

82

Issue

25

Page(s)

2350-2473

Spatiotemporal analysis of the effect of global development indicators on child mortality

Amegbor, P. M., & Addae, A. (n.d.).

Publication year

2023

Journal title

International Journal of Health Geographics

Volume

22

Issue

1
Abstract
Abstract
Background: Child mortality continue to be a major public health issue in most developing countries; albeit there has been a decline in global under-five deaths. The differences in child mortality can best be explained by socioeconomic and environmental inequalities among countries. In this study, we explore the effect of country-level development indicators on under-five mortality rates. Specifically, we examine potential spatio-temporal heterogeneity in the association between major world development indicators on under-five mortality, as well as, visualize the global differential time trend of under-five mortality rates. Methods: The data from 195 countries were curated from the World Bank’s World Development Indicators (WDI) spanning from 2000 to 2017 and national estimates for under-five mortality from the UN Inter-agency Group for Child Mortality Estimation (UN IGME).We built parametric and non-parametric Bayesian space-time interaction models to examine the effect of development indicators on under-five mortality rates. We also used employed Bayesian spatio-temporal varying coefficient models to assess the spatial and temporal variations in the effect of development indicators on under-five mortality rates. Results: In both parametric and non-parametric models, the results show indicators of good socioeconomic development were associated with a reduction in under-five mortality rates while poor indicators were associated with an increase in under-five mortality rates. For instance, the parametric model shows that gross domestic product (GDP) (β = − 1.26, [CI − 1.51; − 1.01]), current healthcare expenditure (β = − 0.40, [CI − 0.55; − 0.26]) and access to basic sanitation (β = − 0.03, [CI − 0.05; − 0.01]) were associated with a reduction under-five mortality. An increase in the proportion practising open defecation (β = 0.14, [CI 0.08; 0.20]) an increase under-five mortality rate. The result of the spatial components spatial variation in the effect of the development indicators on under-five mortality rates. The spatial patterns of the effect also change over time for some indicators, such as PM2.5. Conclusion: The findings show that the burden of under-five mortality rates was considerably higher among sub-Saharan African countries and some southern Asian countries. The findings also reveal the trend in reduction in the sub-Saharan African region has been slower than the global trend.

Assessing the association between urban features and human physiological stress response using wearable sensors in different urban contexts

Zhang, Z., Amegbor, P. M., Sigsgaard, T., & Sabel, C. E. (n.d.).

Publication year

2022

Journal title

Health and Place

Volume

78
Abstract
Abstract
Public open space (POS) plays a significant role in fostering human health and wellbeing in cities. A major limitation of current research on POS and health is that there is little attention on the role of various urban features on people's mental health, in different urban context. This study employed wearable sensors (a wearable camera, Empatica 4 wristband and a GPS device) to measure human physiological responses to urban indicators, objectively. To do this, we selected six kinds of public open space (water area, transit area, green area, commercial area, motor traffic area and mixed office and residential area) and recruited 86 participants for an experimental study. Next, we detected urban features by using Microsoft Cognitive Services (MCS) and calculated a change score to assess human physiological stress responses based on galvanic skin response (GSR) and skin temperature from the wristband. Lastly, we applied random effect model and geographically weighted regression analysis to examine the relationship between urban indicators and human physiological stress responses. The findings show that urban flow (vehicles, bikes and people), waterbodies, greenery and places to sit are associated with the changes of human physiological stress response. The findings indicate that the type of urban context may confound the effect of green and blue urban features; i.e., the effect on physiological stress response can be positive or negative depending on the context. The paper highlights the relevance of considering urban context in research on associations between urban features and stress response.

Early-life environmental exposures and anaemia among children under age five in Sub-Saharan Africa: An insight from the Demographic & Health Surveys

Amegbor, P. M. (n.d.).

Publication year

2022

Journal title

Science of the Total Environment

Volume

832
Abstract
Abstract
Background: Reports show that the majority (60%) of children under age five years in Sub-Saharan Africa are anaemic. Studies in the region have mainly focused on the effect of individual, maternal and household socioeconomic status on the prevalence of anaemia. Currently, there is limited understanding of the association between early-life environmental exposures and anaemia among children in Sub-Saharan Africa. Objective: The study examines the association between early-life environmental exposures and anaemia among children under five in Sub-Saharan Africa. Methods: The study used health and demographic data from the Demographic and Health Survey (DHS) program and environmental data from NASA's Geospatial Interactive Online Visualization ANd aNalysis Infrastructure (GIOVANNI) and Atmospheric Composition Analysis Group. Three exposure periods were defined for the study, namely: in-utero, post-utero and cumulative life exposures. Multilevel mixed-effect models were used to assess the associations between environmental exposures and anaemia in each exposure period. Results: The findings show that 63% of children in the study were anaemic. It also reveals that mean PM 2.5 exposure for in-utero (34.93 μgm−3), post-utero (35.23 μgm−3) and cumulative exposure (35.08 μgm−3) were seven times higher than the new air quality guideline WHO recommended. A 10 μgm−3 increase in in-utero, post-utero and cumulative PM 2.5 exposures was associated with 4% to 5% increase in the prevalence of anaemia among children. A 10ppbv increase in in-utero, post-utero and cumulative carbon monoxide exposures was associated with 1% increase in the prevalence of anaemia among children. The spatial risk distribution maps show that socioeconomic factors modify the spatial risk distribution pattern. Conclusion: The findings of the study suggest that early-life exposure to ambient air pollution is significantly associated with anaemia among children in Sub-Saharan Africa. Thus, policies aimed at addressing air quality should be incorporated into targeted interventions for anaemia among children in the region.

Effect of individual, household and regional socioeconomic factors and PM2.5 on anaemia: A cross-sectional study of sub-Saharan African countries

Amegbor, P. M., Borges, S. S., Pysklywec, A., & Sabel, C. E. (n.d.).

Publication year

2022

Journal title

Spatial and Spatio-temporal Epidemiology

Volume

40
Abstract
Abstract
There is limited knowledge on the effect of contextual and environmental factors on the risk of anaemia, as well as the spatial distribution of anaemia in the Sub-Saharan Africa region. In this study, we used multi-country data from the Demographic & Health survey (DHS) with 270,011 observations and PM2.5 data from NASA, applied to the spatial risk pattern of anaemia in the SSA region. The prevalence of anaemia amongst women (41%) was almost twice that of men (22%). A Bayesian hierarchical model showed that individual household, neighbourhood and regional socioeconomic factors were significantly associated with the likelihood of being anaemic. 1 μg/m3 increase in cumulative lifetime PM2.5 exposure accounted for 1% (β = 0.011, CI = 0.008 – 0.015) increase in the likelihood of being anaemic. The results suggest the need for a multidimensional approach to tackle anaemia in the Sub-Saharan African region and identify high-risk areas for target intervention policies or programs.

Health and socioeconomic risk factors for overnight admission among older adults in Ghana

Amegbor, P. M., & Rosenberg, M. W. (n.d.).

Publication year

2022

Journal title

Journal of Population Ageing

Volume

15

Issue

4

Page(s)

961-979
Abstract
Abstract
Ghana’s older adult population is growing significantly. However, there is limited knowledge or research on the effect of place, chronic health conditions, and socioeconomic status on the risk of overnight hospital admission or the frequency of hospitalisation among older adults in Ghana. Using the WHO SAGE (Wave 1) data, we examine the influence of place of residence, chronic health conditions, and socioeconomic status on overnight hospital admission, as well as, frequency of hospital admission among older adults in Ghana. Multivariate logistic regression and zero-inflated negative binomial regression models were used to study the influence of place, health conditions, and socioeconomic status on overnight hospital admission. The findings show that older adults with functional limitations and chronical health conditions were more likely to have experienced an overnight hospital admission. The expected number of overnight hospital admission was greater among chronically ill older adults than their healthy counterparts. However, the findings show that socioeconomically vulnerable older adults were less likely to have overnight hospital admission and they had lower admission rates. The presence of chronic health conditions is associated with overnight hospital admission, while poor socioeconomic status may imply underutilization or limited access to healthcare for the socioeconomically vulnerable.

Individual and contextual predictors of overweight or obesity among women in Uganda: a spatio-temporal perspective

Amegbor, P. M., Yankey, O., Davies, M., & Sabel, C. E. (n.d.).

Publication year

2022

Journal title

GeoJournal

Volume

87

Issue

5

Page(s)

3793-3813
Abstract
Abstract
Being overweight and obesity are emerging public health issues in sub-Saharan Africa. Currently, there is limited knowledge on the temporal trend of the effect of socioeconomic factors and air quality on being overweight or obesity. Using data from the Ugandan Demographic and Health Survey and NASA’s Socioeconomic Data and Applications Center (SEDAC), we examined the spatio-temporal effect of individual and contextual factors on overweight and obesity among women in Uganda using cross-sectional data on 15,655 women in Uganda. We employed multilevel mixed-effect analysis and Bayesian hierarchical spatial models to examine the effect of individual socioeconomic status, contextual socioeconomic factors and air quality on women’s risk of being overweight or obese as well as investigate spatial heterogeneity in the association. The prevalence of overweight/obesity for the study periods were 17.23% (2000/2001), 15.36% (2006), 19.36% (2011) and 21.93% (2016). The result from the multilevel analysis shows change in the directions of the association between individual factors (educational status and household wealth) and overweight or obese over the years. Women with secondary education were 1.514 times (p = 0.002) more likely to be overweight or obese in the 2000/2001 group but 0.655 times (p = 0.007) less likely to be overweight or obese in the 2016 group. It also reveals temporal consistency in the effect of the air pollutant PM2.5 on overweight or obese. The spatial models reveal spatial heterogeneity in the association between district-level factors and the proportion of overweight or obese women. The findings suggest improving women’s socioeconomic status and air quality could reduce the rising obesity epidemic in Ugandan women.

Assessing the current integration of multiple personalised wearable sensors for environment and health monitoring

Zhang, Z., Amegbor, P. M., & Sabel, C. E. (n.d.).

Publication year

2021

Journal title

Sensors

Volume

21

Issue

22
Abstract
Abstract
The ever-growing development of sensor technology brings new opportunities to investigate impacts of the outdoor environment on human health at the individual level. However, there is limited literature on the use of multiple personalized sensors in urban environments. This review paper focuses on examining how multiple personalized sensors have been integrated to enhance the monitoring of co-exposures and health effects in the city. Following PRISMA guidelines, two reviewers screened 4898 studies from Scopus, Web of Science, ProQuest, Embase, and PubMed databases published from January 2010 to April 2021. In this case, 39 articles met the eligibility criteria. The review begins by examining the characteristics of the reviewed papers to assess the current situation of integrating multiple sensors for health and environment monitoring. Two main challenges were identified from the quality assessment: choosing sensors and integrating data. Lastly, we propose a checklist with feasible measures to improve the integration of multiple sensors for future studies.

Determinants of the type of health care sought for symptoms of Acute respiratory infection in children: analysis of Ghana demographic and health surveys

Danquah, L., Amegbor, P. M., & Ayele, D. G. (n.d.).

Publication year

2021

Journal title

BMC Pediatrics

Volume

21

Issue

1
Abstract
Abstract
Background: Globally, acute respiratory infection (ARI) is a leading cause of infant and childhood morbidity and mortality. Currently, it is estimated that 50 million cases of childhood ARI are untreated. In this study, we identified determinants of the type of treatment sought for symptoms of childhood acute respiratory infection (ARI), including non-treatment, amongst a nationally representative sample of children under five years in Ghana. Methods: In total, 1 544 children were studied by a secondary analysis of pooled survey data from the 1993, 1998, 2003, 2008, and 2014 Ghana Demographic and Health Surveys (GDHS). Cross-tabulations, chi-square, multinomial logistic regression, and Bayesian hierarchical spatial logistic regression analyses were used to identify relationships between the type of treatment sought and maternal socio-economic and household characteristics. Results: Seeking medical care was significantly associated with child age (RRR= 1.928, 95 % CI 1.276 – 2.915), maternal employment status (RRR = 1.815, 95 % CI 1.202 – 2.740), maternal health insurance status, (RRR = 2.618, 95 % CI 1.801 – 3.989), children belonging to middle (RRR = 2.186, 95 % CI 1.473 – 3.243), richer (RRR = 1.908, 95 % CI 1.145 – 3.180) and richest households (RRR = 2.456, 95 % CI 1.363 – 4.424) and the 1998 survey period (RRR = 0.426, 95 % CI 0.240 – 7.58). Seeking self-care or visiting a traditional healer was significantly associated with maternal educational status (RRR = 0.000, 95 % CI 0.000 – 0.000), and the 1998 (RRR= 0.330, 95 % CI 0.142 – 0.765), 2003 (RRR= 0.195, 95 % CI 0.071 – 0.535), 2008 (RRR= 0.216, 95 % CI 0.068 – 0.685) and 2014 (RRR= 0.230, 95 % CI 0.081 – 0.657) GDHS periods. The probability that the odds ratio of using medical care exceeded 1 was higher for mothers/caregivers in the Western, Ashanti, Upper West, and Volta regions. Conclusions: Government policies that are aimed at encouraging medical care-seeking for children with ARI may yield positive results by focusing on improving maternal incomes, maternal NHIS enrolment, and maternal household characteristics. Improving maternal education could be a positive step towards addressing challenges with self-care or traditional healing amongst children with ARI.

Examining Spatial Variability in the Association Between Male Partner Alcohol Misuse and Intimate Partner Violence Against Women in Ghana: A GWR Analysis

Amegbor, P. M., Yankey, O., Rosenberg, M. W., & Sabel, C. E. (n.d.).

Publication year

2021

Journal title

Journal of Interpersonal Violence

Volume

36

Issue

23

Page(s)

NP12855-NP12874
Abstract
Abstract
Globally, it is estimated that about 30% of ever-partnered women have experienced some form of intimate partner violence (IPV)—physical assault, sexual assault, or emotional abuse. The prevalence of IPV in sub-Saharan Africa is considerably higher than the global estimate. In Ghana, it is estimated that 24% of women have experienced physical and/or sexual IPV in their lifetime. Studies point to the association between alcohol misuse by intimate male partners and violence against women. However, there has been no consideration for potential spatial variation or heterogeneity in this association. Using estimates from the 2008 Ghana Demographic and Health Survey Data, we employed geographically weighted regression (GWR) analysis to examine spatial variations in the relationship between male partner’s alcohol misuse and IPV among women in Ghana. We fitted three models to assess the relationship using a step-wise approach. The first model has alcohol misuse as the only predictor, whereas the second model included other male partner characteristics, such as post-secondary education and employment status. The final introduced female characteristics as additional covariates. The result of the GWR analysis shows that the effect of alcohol misuse on IPV is elevated in the south-western part of Ghana. The findings suggest the potential influence of place-based or contextual factors on the association between alcohol misuse and women’s exposure to IPV.

Social Frailty and Depression Among Older Adults in Ghana: Insights from the WHO SAGE Surveys

Amegbor, P. M., Kuuire, V. Z., Yawson, A. E., Rosenberg, M. W., & Sabel, C. E. (n.d.).

Publication year

2021

Journal title

Research on Aging

Volume

43

Issue

2

Page(s)

85-95
Abstract
Abstract
In this study, we examine the association between social frailty and depression among older adults in Ghana over time. We employed longitudinal data analysis to examine the association between social frailty, socioeconomic status and depression using data from the WHO-SAGE survey. Our descriptive and cross-tabulation analyses show that the prevalence of depression and social frailty among older adults decreased considerably in 2014/2015 compared to 2007/2008. The finding also reveals a huge reduction in social frailty among older adults in northern Ghana–the most deprived regions in Ghana–compared to those in southern Ghana. The multivariate panel data analysis reveals that depression was significantly associated with social isolation, financial needs, and physical needs. The findings suggest an over time decline in social frailty and depression among older adults, as well as, reduction in regional differences in social frailty and depression among older adults in Ghana.

The effect of sociodemographic factors on the risk of poor mental health in Akron (Ohio): A Bayesian hierarchical spatial analysis

Yankey, O., Amegbor, P. M., & Lee, J. (n.d.).

Publication year

2021

Journal title

Spatial and Spatio-temporal Epidemiology

Volume

38
Abstract
Abstract
We examined the association of sociodemographic factors on mental health risk within the city of Akron (Ohio). A Spatial Bayesian Hierarchical model was used in this study. We found that the risk of poor mental health was positively associated with the proportion of people lacking sufficient sleep (RR = 0.42, 95% CI:0.22-0.62), the percentage of people below poverty (RR = 0.12, 95% CI: 0.09, 0.16), and the percentage of married couples (RR = 0.02, 95% CI: -0.05, 0.08). On the contrary, the percentage of female population (RR = -0.06, 95% CI: -0.13, 0.01), the percentage of the black population (RR = -0.05, 95% CI: -0.08, -0.02), and the college-educated population (RR = -0.03, 95% CI: -0.09, 0.04) was negatively associated with the risk of poor mental health. We also found that the sociodemographic variables have spatially varying effects across different neighborhoods. Future studies will examine the joint spatial effect of poor mental health risk and suicide ideation in the study area.

The effect of socioeconomic and environmental factors on obesity: A spatial regression analysis

Yankey, O., Amegbor, P. M., & Essah, M. (n.d.).

Publication year

2021

Journal title

International Journal of Applied Geospatial Research

Volume

12

Issue

4

Page(s)

58-74
Abstract
Abstract
This paper examined the effect of socio-economic and environmental factors on obesity in Cleveland (Ohio) using an OLS model and three spatial regression models: spatial error model, spatial lag model, and a spatial error model with a spatially lagged response (SEMSLR). Comparative assessment of the models showed that the SEMSLR and the spatial error models were the best models. The spatial effect from the various spatial regression models was statistically significant, indicating an essential spatial interaction among neighboring geographic units and the need to account for spatial dependency in obesity research. The authors also found a statistically significant positive association between the percentage of families below poverty, Black population, and SNAP recipient with obesity rate. The percentage of college-educated had a statistically significant negative association with the obesity rate. The study shows that health outcomes such as obesity are not randomly distributed but are more clustered in deprived and marginalized neighborhoods.

Understanding unmet health-care need among older Ghanaians: A gendered analysis

Kuuire, V. Z., Tenkorang, E. Y., Amegbor, P. M., & Rosenberg, M. (n.d.).

Publication year

2021

Journal title

Ageing and Society

Volume

41

Issue

8

Page(s)

1748-1769
Abstract
Abstract
Health insurance schemes are important for bridging gaps in health-care needs between the rich and poor, especially in contexts where poverty is higher among seniors (persons aged 65 years and above). In this study we examined (a) gender-based predictors of unmet health-care need among seniors and (b) whether access was influenced by wealth status (measured by income quintiles). Gender-specific negative log-log regression models were fitted to data from the Study on Global Ageing and Health to examine associations between unmet health-care need and health insurance status controlling for theoretically relevant covariates. Insurance status was an important determinant of men and women's unmet health-care need but the relationship was moderated by income quintile for women and not men. While occupation was important for men, religion, marital status and income quintile were significantly associated with women's unmet health-care need. Based on the observed gender differences, we recommend the implementation of programmes aimed at improving the economic situation of older people, particularly women.

Urban Health and Wellbeing

Sabel, C. E., Amegbor, P. M., Zhang, Z., Chen, T. H. K., Poulsen, M. B., Hertel, O., Sigsgaard, T., Horsdal, H. T., Pedersen, C. B., & Khan, J. (n.d.). In Urban Book Series (1–).

Publication year

2021

Page(s)

259-280
Abstract
Abstract
This chapter explores how the Internet of Things and the utilization of cutting-edge information technology are shaping global research and discourse on the health and wellbeing of urban populations. The chapter begins with a review of smart cities and health and then delves into the types of data available to researchers. The chapter then discusses innovative methods and techniques, such as machine learning, personalized sensing, and tracking, that researchers use to examine the health and wellbeing of urban populations. The applications of these data, methods, and techniques are then illustrated taking examples from BERTHA (Big Data Centre for Environment and Health) based at Aarhus University, Denmark. The chapter concludes with a discussion on issues of ethics, privacy, and confidentiality surrounding the use of sensitive and personalized data and tracking or sensing individuals across time and urban space.

Variations in Emotional, Sexual, and Physical Intimate Partner Violence Among Women in Uganda: A Multilevel Analysis

Amegbor, P. M., & Pascoe, L. (n.d.).

Publication year

2021

Journal title

Journal of Interpersonal Violence

Volume

36

Issue

15

Page(s)

NP7868-NP7898
Abstract
Abstract
Evidence shows that a significant proportion of ever-partnered women suffer some form of intimate partner violence (IPV) perpetuated by male partners. The prevalence of IPV in sub-Saharan African countries is considerably higher than global estimates. Although existing studies show the effect of women’s and intimate male partner’s characteristics on IPV, knowledge on how these factors increase or reduce women’s risk to specific types of IPV is limited. Using the 2016 Ugandan Demographic and Health Survey (UDHS), we examine regional variations in women’s and intimate male partner’s characteristics and their effect on emotional, sexual, and physical violence perpetuated by men and experienced by women in Uganda. The result shows that women’s educational status is a significant predictor of all forms of IPV, whereas other characteristics, such as employment and housing ownership, have differential effects on specific types of IPV. Less educated women were more likely to experience emotional, sexual, and physical violence. Alcohol abuse was a significant determinant of men perpetuating all types of IPV; other male characteristics had differential effects on specific types of IPV. Male partners who abuse alcohol “often” and “sometimes” were more likely to commit acts of emotional, sexual, and physical violence against their female intimate partners. The findings also show that ~5%, ~8%, and ~2% of the variance in emotional, sexual, and physical violence (respectively; in the final models) are attributable to regional differences. The findings suggest the need for interventions aimed at increasing women’s access to higher education, working with men and boys to reduce the occurrence of alcohol abuse and address harmful constructions of masculinity, and promoting gender equality among men as well as women.

Determinants of Overnight Stay in Health Centres and Length of Admission: A Study of Canadian Seniors

Amegbor, P. M., Plumb, K. B., & Rosenberg, M. W. (n.d.).

Publication year

2020

Journal title

Canadian Journal on Aging

Volume

39

Issue

4

Page(s)

533-544
Abstract
Abstract
This study examines the influence of chronic health conditions and socio-economic status on overnight admission and length of stay among Canadian seniors. Incremental multivariate logistic and zero-inflated negative binomial regression models assessed the relationship between selected predictors, overnight admission, and duration of stay. The findings show that all chronic health conditions and socio-economic factors examined were significantly associated with overnight hospital admission. However, seniors with cardiovascular health conditions, the very old, and seniors living in lower-income households had a greater risk of longer stays. Canadian seniors diagnosed with hypertension, cancer, diabetes, and stroke had greater risk of longer overnight hospital stays. Seniors aged 75 to 79 years, 80 years or older, and those living in lower-income households (≤ $39,999) were more likely to have a longer overnight hospital stay. Findings suggest that improving seniors' health and socio-economic status may reduce the risk of overnight admission and longer stays of hospitalisation.

Contact

prince.amegbor@nyu.edu 708 Broadway New York, NY, 10003