Graduation Year


Document Type




Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Public Health

Major Professor

Etienne Pracht, Ph.D.

Co-Major Professor

Sandra Potthoff, Ph.D.

Committee Member

Barbara Orban, Ph.D.

Committee Member

Timothy Boaz, Ph.D.


environmental factors, health services research, mental health, public health


Behavioral health disorders are the leading cause of disability in the United States and are known to have multidimensional effect on wellbeing. Several environmental factors are known to impact behavioral health such as weather (i.e. heat) and access to natural environments (i.e. parks and beaches). The study goals were to identify contextual factors that increase the co-occurrence of heat-related illness and behavioral health disorders, illustrate the re-utilization patterns of these co-occurring cases in Florida emergency and inpatient settings, and explore the association between behavioral health disorders such as anxiety and depression, and natural environments such as parks and beaches. The study was conducted among all Florida residents for 2016-2018 and used Agency for Health Care Administration emergency and inpatient data. Regression modeling was used to predict hospital utilization. The results indicate that increases in outpatient services are associated with a significant decline in emergency and inpatient utilization for co-occurring heat-related illness and behavioral health disorders. Individuals with nicotine dependence, male gender, and uninsured status were found to be significantly more likely to revisit the ED or be readmitted to the hospital for another heat-related illness. Furthermore, availability of county parks was associated with a significant decline in anxiety and depression-related ED visits. Overall, the results presented indicate that uninsured white non-Hispanic middle-aged males are highly vulnerable and more likely to utilize hospitals in Florida for co-occurring HRI and BHDs. It is suggested that communities focus their resources on outpatient mental health care in order to improve continuity of care and reduce the costs of hospital utilization. In addition, there is a need for improved risk communication, education, and awareness, particularly for those at increased risk of a heat event. Lastly, parks need to be valued as a vital resource for community health, the environment, and social resilience. Policy makers, city planners, and public health practitioners must work together to ensure parks are equitably distributed in easily accessible areas and have an adequate variety of amenities to benefit residents. As climate change persists and temperatures continue to rise, it is important that we as a society strategize by identifying vulnerable populations and preparing adequate public health interventions that promote health and safety when enjoying the outdoors.