About

Alva O. Ferdinand, DrPH, JD, is the Director of the Southwest Rural Health Research Center and an Associate Professor in the School of Public Health at Texas A&M University. His educational background includes a JD from Michigan State University College of Law, a Master of Public Health, and a Doctor of Public Health in Health Care Organization and Policy from the University of Alabama at Birmingham. His research interests focus on the effectiveness of laws aimed at improving public health, regulation of health care delivery at the state and federal levels, health law and ethics, research integrity, and disparities in health outcomes. Ferdinand has contributed extensively to understanding public health law, health disparities, and rural health issues, with numerous publications addressing topics such as hospital mortality, health disparities in rural areas, telehealth regulations, and the impact of policies on health outcomes. His work emphasizes the importance of legal and policy frameworks in shaping health equity and access, particularly in rural and underserved populations.

Research topics

• Political Science
• Medicine
• Environmental health
• Computer Science
• Sociology
• Gerontology
• Library science
• Psychology
• Demography
• Socioeconomics
• Internal medicine
• Medical education
• Nursing
• Data science
• Pathology

Selected publications

• National Trends in the Potentially Preventable Hospitalization for Pediatric Asthma, 2016-2020

  2026-04-01

  reportOpen accessSenior author

  This policy brief analyzes national trends in potentially preventable hospitalizations for pediatric asthma among children aged 2-17 years in the United States from 2016 to 2020. Utilizing the National Inpatient Sample (NIS) data provided by the Healthcare Cost and Utilization Project (HCUP), the study examines annual changes in hospitalization rates, explores disparities by race/ethnicity and rural-urban classification, and assesses related hospital costs. The findings reveal a significant decline in potentially preventable pediatric asthma admissions, dropping from 89.6 per 100,000 children in 2016 to 68.4 in 2019, an average annual percentage change of -8.41%. The most substantial decreases were among children aged 5-9 years (-9.3%), those under 5 (-7.9%), and ages 15-17 (-6.3%), with comparable rates of decline between males and females. Black children experienced the highest rates of decline (-8.5%), followed by White (-7.4%) and Hispanic children (-6.0%); however, admission rates remained stable among other groups. Despite the decline, Black children continued to have admission rates about five times higher than those of White children. Geographically, admission rates for potentially preventable asthma hospitalizations were higher in urban areas, particularly in large central metropolitan counties, and lowest in non-core rural areas. Significant declines were found in micropolitan (-9.4%) and non-core (-9.2%) areas, indicating progress across urban-rural gradients. The brief also highlights the impact of the COVID-19 pandemic, with a dramatic 59.3% decrease in hospitalization rates for pediatric asthma from 2019 to 2020. While hospital admission costs generally increased by 5-7% nationally, non-core rural areas saw stable costs over time.

  PublisherOA PDFDOI

• Emergency Dental Care in the <scp>ACA</scp> Era: Rural–Urban Disparities and Their Association With State Medicaid Policy

  Journal of Public Health Dentistry · 2026-01-28

  articleOpen accessSenior author

  OBJECTIVES: Rural US populations face greater barriers to dental care than urban residents. This study examines emergency department (ED) visits for nontraumatic dental conditions (NTDCs) among adults, comparing rural and urban areas. It also explores how Medicaid expansion and varying state Medicaid dental policies influence the likelihood of NTDC-related ED visits. METHODS: We conducted a cross-sectional analysis using 2019 ED data from eight states. Descriptive statistics characterized NTDC-related ED visits by patient, visit, and county-level variables across four Medicaid policy groups. Chi-squared tests and T-tests assessed rural-urban differences in visit characteristics and payer mix. Logistic regression models estimated the likelihood of NTDC ED visits by rurality and payer type, adjusting for sociodemographic factors and stratified by Medicaid expansion and adult dental benefit status. RESULTS: Rural NTDC ED visits were shorter (2.5 h) and less costly ($1602) than urban visits (over 3 h, $2532). Analysis of rurality and payer mix revealed three key patterns: (i) rural residents consistently had higher visit rates than urban residents in three of the four groups; (ii) uninsured patients-both rural and urban-had the highest probability of NTDC ED visits in three of the four groups; and (iii) among Medicaid-covered visits, rural enrollees in non-expansion states without adult dental benefits had the highest likelihood of NTDC ED visits. CONCLUSIONS: This study highlights continued ED reliance for NTDCs 5 years post-ACA, driven by Medicaid policy and access gaps. Expanding rural oral healthcare remains vital for improving access, especially for the uninsured.

  PublisherOA PDFDOI

• Response to Letter on Exploring Neighborhood Opportunity as a Factor in Pediatric Asthma Visits to the Emergency Department

  Public Health Reports · 2026-01-08

  articleOpen accessSenior author
  PublisherOA PDFDOI

• Maternal Chronic Disease Prevention in Rural America: A Life Course Perspective

  Journal of Primary Care & Community Health · 2025-12-01

  articleOpen access

  PURPOSE: This commentary examines the complex maternal health landscape in rural America, highlighting the structural barriers to effective chronic disease management. We provide recommendations to center chronic disease management using a life course approach. CONCLUSIONS: Women in rural areas face significantly higher maternal mortality and morbidity rates than their urban counterparts, largely due to a disproportionate burden of chronic disease conditions such as gestational diabetes, preeclampsia, cardiomyopathy, and mental health disorders. These disparities are deeply rooted in the unequal distribution of systemic and structural determinants of health. We call for a system-level approach related to primary, secondary, and tertiary prevention efforts to improve maternal health in rural areas, based on the life course perspective.

  PublisherDOI

• Geographic and Demographic Differences in Studies of the Five Leading Causes of Death in the U.S.: Evidence from Peer-Reviewed Literature

  2025-12-08

  report1st authorCorresponding
  PublisherDOI

• Privacy-by-design: Case studies in interactive record linkage using a hybrid human-computer system

  International Journal of Medical Informatics · 2025-07-31 · 1 citations

  articleOpen access

  OBJECTIVE: High-quality patient matching from several sources without a common identifier (ID) requires interactive record linkage (RL) using a hybrid human-computer system. MiNDFIRL (MInimum Necessary Disclosure For Interactive Record Linkage) is a hybrid prototype software system that facilitates maximizing linkage accuracy while minimizing information disclosure. We present and evaluate MiNDFIRL using two real-world case studies. MATERIALS AND METHODS: Two user studies were conducted linking 10,000 data pairs from EHR data and 18,240 unique patient IDs from patient generated data. After automated RL, manual review was conducted by three teams of four reviewers (12 total) using MiNDFIRL to resolve potential matches that required human judgment. Reviews for matches were conducted independently and disagreements were resolved through consensus. The teams then participated in a group discussion about MiNDFIRL using a semi-structured interview format. RESULTS AND DISCUSSION: The best algorithm, Random Forest, found 388 and 539 matches each for EHR and patient generated data algorithmically, but also output an additional 303 and 187 potential pairs that required manual review. 232 and 84 more matches were confirmed manually from these uncertain pairs respectively. Among the full uncertain pairs, only 30% of available identifying information was needed in MiNDFIRL to separate out 77% (232/303) and 45% (84/187) true linkages respectively. When available, first names and emails were the most frequently used fields in making RL decisions. CONCLUSION: On-demand access and masking techniques along with risk quantification through a hybrid human-computer system can significantly reduce disclosure while still minimizing false positives and false negatives in real-world RL.

  PublisherDOI

• Assessing the Impact of Social Factors on Survival Among Infants Born with Transposition of the Great Arteries, Tetralogy of Fallot, and Diaphragmatic Hernia in Texas, 2011–2019

  Maternal and Child Health Journal · 2025-07-09

  article
  PublisherDOI

• Exploring Neighborhood Opportunity as a Factor in Pediatric Asthma Visits to the Emergency Department

  Public Health Reports · 2025-08-31 · 2 citations

  articleOpen accessSenior author

  OBJECTIVES: Despite growing interest in environmental and social determinants of health, few studies have explored how residential mobility influences respiratory health outcomes. We examined the relationship between levels of opportunity across education, health and environment, social and economic, and all domains in a child's neighborhood and the likelihood of emergency department (ED) visits for asthma and showed how moving from one neighborhood to another would affect the odds of visiting the ED for asthma. METHODS: In this cross-sectional study, we analyzed asthma-related ED visits among children aged 2 to 17 years in 9 US states (Arizona, Florida, Kentucky, Maryland, New Jersey, North Carolina, Oregon, Rhode Island, and Wisconsin) during 2016-2019. We used a multivariable logistic regression model to examine the relationship between the Child Opportunity Index (COI) and ED visits for asthma. We used a piecewise linear logit model to estimate the neighborhood's opportunity effect. RESULTS: < .001). In addition, moving from a low to a very low COI neighborhood significantly increased the probability of asthma-related ED visits among children aged 5 to 9 years (0.8 percentage points), Black children (0.4 percentage points), boys (0.7 percentage points), and those living in large metropolitan areas (0.6 percentage points). CONCLUSIONS: Our findings suggest that improvement in neighborhood opportunity may translate to better asthma-related health outcomes among children. Future research should continue to investigate the effects of neighborhood opportunity on other childhood conditions.

  PublisherOA PDFDOI

• Exploring Rurality and Racial/Ethnic Disparities in Texas Mortality: A Scoping Review of the Five Leading Causes of Death

  Journal of Racial and Ethnic Health Disparities · 2025-09-17

  reviewOpen accessSenior author

  OBJECTIVE: While the five leading causes of death in Texas mirror national trends, the unique racial/ethnic and geographical diversity of the state requires a focused analysis of mortality disparities. To address this gap, we conducted a scoping review of Texas-specific peer-reviewed studies on how race/ethnicity and rurality impact mortality from heart disease, cancer, unintentional injuries, stroke, and chronic lower respiratory diseases (CLRDs). METHODS: Using a scoping review methodology, we identified Texas-specific empirical articles examining the relationship between either rurality or race/ethnicity and the leading causes of death. We extracted and analyzed data from the included studies using a coding instrument specifically designed for this study. Descriptive synthesis summarized study trends, and multivariable logistic regression assessed overarching patterns. RESULTS: Our synthesis of the Texas-specific literature reveals that cancer was the focus of nearly half of the studies (49.4%), whereas rurality was seldom examined (4.2%). Multivariable logistic regression showed that studies on CLRDs were more likely to find higher mortality among Blacks (OR = 3.07) and Hispanics (OR = 4.24). For stroke, Hispanics were associated with increased mortality (OR = 2.49), while for unintentional injuries, the study found significantly higher mortality for Native Americans (OR = 8.72) and Blacks (OR = 2.76). CONCLUSIONS: Existing Texas-focused studies consistently link racial and ethnic minority status with higher mortality from the five leading causes of death. However, significant gaps remain, particularly concerning the intersection of race/ethnicity and rurality. Future Texas-based research should prioritize these intersectional factors to better understand and address persistent mortality disparities.

  PublisherOA PDFDOI

• Maternal Exposure to SSRIs or SNRIs and the Risk of Congenital Abnormalities in Offspring: A Systematic Review and Meta-Analysis

  SSRN Electronic Journal · 2024-01-01

  reviewOpen access
  PublisherDOI

Frequent coauthors

• Nir Menachemi

  Indiana University – Purdue University Indianapolis

  43 shared

• Jane N. Bolin

  Texas A&M University

  37 shared

• Valerie A. Yeager

  Indiana University – Purdue University Indianapolis

  30 shared

• Marvellous A. Akinlotan

  29 shared

• Timothy Callaghan

  Georgia State University

  23 shared

• TaShauna U. Goldsby

  19 shared

• Bryn Manzella

  18 shared

• Devon Taylor

  Duke University

  16 shared