About

Judy Y. Ou, PhD, MPH, is a faculty member at the Spencer Fox Eccles School of Medicine, where she is involved in research related to environmental health, cancer survivorship, and health disparities. Her academic background includes a BS from Brigham Young University, an MPH from Boston University School of Public Health, and a PhD from the same institution. She has completed postdoctoral training at the University of Utah School of Medicine, Huntsman Cancer Institute. Her research focuses on the impacts of environmental exposures such as air pollution and radon on health outcomes, particularly among pediatric, adolescent, and young adult cancer survivors. She investigates associations between ambient air pollution and healthcare visits, cardiovascular risks in cancer survivors, and the development of health education programs for underserved communities. Her work also explores sociodemographic factors influencing late effects in cancer survivors, healthcare utilization patterns, and the social and environmental determinants of health. Through her extensive publication record, she contributes to understanding how environmental and social factors influence cancer outcomes and survivorship, aiming to inform public health strategies and improve health equity.

Research topics

• Internal medicine
• Pediatrics
• Medicine
• Immunology
• Demography
• Gerontology
• Family medicine

Selected publications

• Associations between Ambient Air Pollution and Cardiovascular and Respiratory Healthcare Visits in Adolescent and Young Adult Cancer Survivors

  Cancer Epidemiology Biomarkers & Prevention · 2026-02-06

  articleOpen access

  BACKGROUND: Cancer therapies have well documented adverse effects on cardiovascular and respiratory health, which could increase cancer survivors' susceptibility to poor air quality. We describe the risk of cardiovascular and respiratory healthcare visits following acute air pollution exposures among adolescent and young adult (AYA) cancer survivors. METHODS: We identified all Utah AYAs diagnosed at 15 to 39 years of age with thyroid, melanoma, lymphoma, breast, or testicular cancer from 1998 to 2016 (N = 8,016). AYAs were linked by residential location to daily particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) for 2000 to 2016. Case cross-over models in a distributed lag nonlinear model framework estimated odds ratios (OR) and 95% confidence intervals (95% CI) for cardiovascular and respiratory healthcare visits (inpatient admissions and emergency department/urgent care visits) with exposure over the 6 days preceding an event, adjusting for temperature and relative humidity. RESULTS: A total of 3,143 AYAs (39%) experienced ≥1 respiratory/cardiovascular event. O3 was associated with cardiovascular events (ORlag4 = 1.08; 95% CI, 1.02-1.14, and ORlag5 = 1.05; 95% CI, 1.01-1.09), and NO2 was associated with respiratory events (ORlag1 = 1.05; 95% CI, 1.01-1.10). Breast cancer survivors showed an elevated risk for cardiovascular and respiratory visits; melanoma, lymphoma, and testis survivors displayed an increased risk for cardiovascular visits. CONCLUSIONS: O3 was linked with an elevated risk of cardiovascular events, whereas respiratory events were associated with NO2. Associations between air pollutants and healthcare visits varied by primary diagnosis site, indicating that susceptibility to air pollution could differ due to cancer-specific treatment factors. IMPACT: AYAs face an increased risk for cardiovascular and respiratory events with exposure to ambient air pollution and may benefit from interventions to reduce exposures.

  PublisherOA PDFDOI

• COVID-19–Related Employment Disruptions and Increased Financial Burden Among Survivors of Adolescent and Young Adult Cancer

  UNC Libraries · 2025-03-14

  articleOpen access

  <strong><em>Background:</em></strong> Financial burden is a major concern for survivors of adolescent and young adult (AYA) cancers. We identified if employment disruptions during the COVID-19 pandemic affected AYA survivors' financial burden. <strong><em>Methods:</em></strong> AYAs who were enrolled in a cancer patient navigation program were e-mailed a survey in fall 2020. Survey items included sociodemographics, employment disruption, and two measures of financial burden: COmprehensive Score for Financial Toxicity (COST) and material and behavioral financial hardship items (for any reason, COVID-19 induced, cancer induced). Financial burden outcomes were dichotomized at the median (COST&thinsp;=&thinsp;21; financial hardship&thinsp;=&thinsp;3). The association of employment disruptions and sociodemographics with financial burden was assessed using multivariable logistic regression models. <strong><em>Results:</em></strong> Reduced hours/job loss was reported by 24.0% of 341 participants. Survivors with a high school education or less (odds ratio [OR]: 2.70; 95% confidence interval [CI]: 1.21-6.03) or who had decreased hours or job loss (OR: 3.97; 95% CI: 2.01-7.84) had greater odds for high financial toxicity. Reduced hours/job loss was the only factor associated with high material and behavioral financial hardship for both any reason (OR: 2.75; 95% CI: 1.41-5.33) and owing to COVID-19 (OR: 4.98; 95% CI: 2.28-10.92). Cancer treatment since March 2020 was associated with cancer-induced high material and behavioral financial hardship (OR: 3.31; 95% CI: 1.96-5.58). <strong><em>Conclusion:</em></strong> Employment disruptions owing to the COVID-19 pandemic, lower education levels, and cancer treatment were associated with high financial burden among AYA cancer survivors. Our findings suggest the need for multilevel interventions to identify and address financial burden among vulnerable cancer survivors.

  PublisherDOI

• Financial burdens during the COVID-19 pandemic are related to disrupted healthcare utilization among survivors of adolescent and young adult cancers

  UNC Libraries · 2025-05-01

  articleOpen access
  PublisherDOI

• Development of a Navigator-Delivered Health Insurance Education Program for Hispanic and Latine Communities

  Health Education & Behavior · 2025-01-23 · 1 citations

  article

  Background Equitable access to health care services for Hispanic and Latine populations requires that systems go beyond working to increase enrollment in health insurance but also addressing health insurance literacy—the knowledge, ability, and confidence to find and use health insurance. Methods In collaboration with a local health policy organization, individual interviews were conducted with Hispanic and Latine community members. Group engagement sessions were conducted with key professionals. Interviews and engagement sessions focused on the adaptation of an existing health insurance education program (HIEP) to Spanish-speaking Hispanic and Latine individuals. An outline of the proposed HIEP content was provided prior to each interview or engagement session. Qualitative content was analyzed using an inductive thematic analysis guided by the intervention adaptation literature. Results A total of N = 20 professionals participated in an engagement session, while N = 21 community members took part in an interview. Professionals worked in both health care systems (55%) and community organizations (45%). Community members were on average 41 years of age ( SD = 13), 81% female, and 100% Hispanic or Latine. Qualitative analysis revealed that participants overwhelmingly supported the adaptation of the HIEP and approved of the proposed topics. Participants also provided recommendations to improve the intervention content and characteristics including a focus on controlling costs, tailoring to the population, ensuring accessibility of content, and specifics regarding the HIEP delivery and facilitator. Conclusions Overall participants were supportive of the proposed HIEP adaptation and provided a variety of recommendations. Health insurance literacy was perceived as an important next step to enrollment in health insurance.

  PublisherDOI

• Identifying Patterns of Late Effects With Latent Class Analysis Among Adolescent and Young Adult Thyroid Cancer Survivors in California and Utah

  Cancer Medicine · 2025-11-27

  articleOpen access1st authorCorresponding

  ABSTRACT Introduction Thyroid cancer is one of the most common cancers in adolescents and young adults (AYA, 15 to 39 years), with an excellent 5‐year survival of 98%. However, treatments for thyroid cancer such as radioactive iodine and thyroid hormone suppression may increase the risk for multiple late effects (LEs). We investigated the incidence of severe LE that clustered in AYA thyroid cancer survivors in a large population‐based cohort. Methods California and Utah Cancer Registry records identified AYAs diagnosed with first thyroid cancer during 2006–2018 linked to statewide hospitalization, ambulatory surgery, and emergency department data. Cohort entry began 2 years from diagnosis. Severe LE included cardiovascular, respiratory, renal, and liver diseases, diabetes, and second cancers. Cumulative incidence of each LE, accounting for the competing risk of death, was calculated. Latent class analysis (LCA) identified clustering of LE over the study period. The number of LE classes was identified by selecting models with the lowest likelihood‐ratio G 2 statistic, Akaike's Information Criterion, and Bayesian Information Criterion. Probabilities of each LE are presented in each class. Results Of 14,268 survivors, median follow‐up time was 7 years. The LCA model identified 3 classes: 88% with low LEs, 9% experiencing moderate LEs with elevated probability of diabetes, liver, and respiratory conditions, and the remaining 3% experiencing the highest probability of all LEs, including cardiovascular disease. Non‐Hispanic (nH)‐Black and Hispanic survivors, those on public insurance, residing in lower socioeconomic status neighborhoods, or diagnosed with distant stage disease experience greater odds of being in the moderate and cardiovascular classes. Conclusion While most survivors of AYA thyroid cancer have a low incidence of LEs, a small proportion have a high probability of multiple morbidities. Multidisciplinary survivorship care should include identifying and supporting thyroid cancer survivors at higher risk for developing multiple LEs through early screening.

  PublisherOA PDFDOI

• Air Pollution and Cardiovascular Risks in Testicular Cancer Survivors: An Exploratory Case-Crossover Study

  Journal of Adolescent and Young Adult Oncology · 2025-06-24 · 2 citations

  article1st authorCorresponding

  Objectives: Testicular cancer survivors can experience cardiovascular and respiratory complications due to cancer treatment. We assessed associations between nitrogen dioxide (NO 2 ) and ozone (O 3 ) air pollution and health care encounters among survivors of adolescent and young adult (AYA) testicular cancer. Methods: A total of 385 AYA testicular cancer survivors, diagnosed 2000–2016, with cardiovascular and/or respiratory health care encounters (emergency department/urgent care [ED/UC], inpatient) were identified using a statewide Utah-based resource. Continuous and dichotomous (≥moderate air quality index) exposure measures were included for NO 2 and O 3 for the 1–4 days (lag days) before events. A case-crossover framework using conditional logistic regression with robust standard errors computed the association of lag days 0–3 with cardiovascular or respiratory encounters and stratified by encounter type (ED/UC, inpatient). Models that were significant in the full cohort were also stratified on demographic and treatment factors. All models were controlled for temperature and humidity. Results: Survivors contributed 257 cardiovascular and 685 respiratory encounters. NO 2 ≥moderate on lag day 1 was associated with increased odds of any cardiovascular encounter (odds ratio [OR] = 1.97, 95% confidence interval [CI] = 1.08–3.59) and inpatient cardiovascular encounters in the full cohort (OR = 2.48, 95% CI = 1.21–5.10), survivors treated with radical orchiectomy and chemotherapy (OR = 3.00, 95% CI = 1.29–7.00), and Hispanic survivors (OR = 4.32, 95% CI = 1.18–15.85). O 3 ≥moderate on lag day 4 was associated with respiratory ED/UC encounters (OR = 1.34, 95% CI = 1.00–1.79) and O 3 on lag day 4 was associated with any cardiovascular encounter (OR = 1.02/parts per billion [ppb], 95% CI = 1.00–1.03) and inpatient cardiovascular encounters (OR = 1.03/ppb, 95% CI + 1.00–1.05). Conclusions: NO 2 and O 3 are associated with risk for health care encounters among testicular cancer survivors and could increase health disparities in survivorship.

  PublisherDOI

• Air pollution and breast cancer incidence in a United States-wide prospective cohort study: Examining sensitive periods of exposure

  Environment International · 2025-11-26

  articleOpen access

  • We examined timing of air pollution exposure in relation to breast cancer (BC) risk. • We found limited evidence of heightened risk during windows of susceptibility. • NO 2 was associated with increased risk across a 10-year exposure lag. • Risk of ER-negative BC was associated with PM 2.5 at an 11–13-year lag. Mounting evidence supports that air pollution is related to a higher breast cancer risk, yet the importance of exposure timing in this relationship remains unclear. In the Sister Study, a United States-wide prospective cohort (n = 50,884, 2003–2009), we estimated time-varying annual concentrations of nitrogen dioxide (NO 2 ) and fine particulate matter (PM 2.5 ) from 1990 to 2017 at residential addresses using validated spatiotemporal models. Self-reported breast cancer diagnoses were validated using medical records. We used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for breast cancer incidence in relation to air pollutant concentrations during predetermined windows of susceptibility. We also applied distributed lag non-linear models to estimate adjusted cumulative and lag-specific HRs and 95 % CIs for the association between air pollutants and breast cancer across a lag period of 0–15 years. We evaluated breast cancer overall and by estrogen receptor (ER) status and tumor extent [ductal carcinoma in situ (DCIS) versus invasive]. We found limited evidence that air pollutant exposure during the time of a woman’s first birth, most recent birth, or menopause transition was associated with heightened risk for breast cancer. When examining exposure flexibly over the long-term, a 10-ppb increase in NO 2 across lag years 1–11 significantly contributed to the risk of ER-positive (HR cumul = 1.14; 95 % CI: 1.03–1.27; n = 2619 cases) and DCIS (HR cumul = 1.27, 95 % CI: 1.04–1.54; n = 706 cases) breast cancer, whereas PM 2.5 experienced during lag years 11–13 was associated with ER-negative breast cancer (e.g., HR Lag12l = 1.36 per 10-µg/m 3 increase, 95 % CI: 1.02–1.81; n = 448 cases). We identified unique periods of susceptibility to NO 2 and PM 2.5 for breast cancer risk by ER status.

  PublisherDOI

• Identifying clustering in patterns of late effects among survivors of adolescent and young adult Hodgkin lymphoma

  JNCI Cancer Spectrum · 2025-09-27

  articleOpen access

  BACKGROUND: We examined late effects clustering among adolescent and young adult (AYA; age 15-39 years at diagnosis) Hodgkin lymphoma (HL) survivors and identified characteristics associated with each cluster. METHODS: We included AYAs with HL in 2006-2018 from the California and Utah Cancer Registries linked to statewide hospitalization, emergency department, and ambulatory surgery visit data. We identified severe late effects >2 years after cancer diagnosis in 9 late effects categories. Latent class analysis (LCA) was used to identify late effects clusters. Multinomial logistic regression models estimated adjusted associations of demographic and treatment characteristics with LCA late effect group. RESULTS: We identified 4635 AYA HL survivors with median follow-up of 8.2 years and 4 late effects groups: 77.1% had a low probability of any late effect (Low Morbidity), 12.8% had high probability of Thyroid disorders, 8.0% had high probability of Cardiovascular Disease (CVD), and 2.1% had high probability of Multiple Conditions (CVD, diabetes/pancreatic, thyroid, and renal diseases). Publicly insured AYAs were more likely than those with private insurance to be in the CVD (OR = 1.53, 95% CI = 1.18 to 1.98) and Multiple Conditions (OR = 2.17, 95% CI = 1.29 to 3.66) than the Low Morbidity group. AYAs with radiation were more likely to be in the Multiple Conditions (OR = 2.31, 95% CI = 1.41 to 3.78) and Thyroid (OR = 2.81, 95% CI = 2.20 to 3.58) groups. Hematopoietic cell transplantation was associated with Multiple Conditions (OR = 9.50, 95% CI = 5.82 to 15.50), CVD (OR = 3.82, 95% CI = 2.96 to 4.93), and Thyroid (OR = 2.86, 95% CI = 2.12 to 3.85) groups. CONCLUSIONS: While most AYA HL survivors were in the Low Morbidity group, those with public insurance or intense treatment may be at higher risk for multiple conditions.

  PublisherDOI

• Sociodemographic and Socioeconomic Factors Correlate with Late-Stage Pediatric Hodgkin Lymphoma and Rhabdomyosarcoma: A Report from the Children’s Oncology Group Registries

  Cancer Epidemiology Biomarkers & Prevention · 2024-07-31 · 4 citations

  articleOpen access1st authorCorresponding

  BACKGROUND: We examined the association between late-stage diagnosis and individual- and community-level sociodemographic and socioeconomic characteristics among patients with pediatric Hodgkin lymphoma and rhabdomyosarcoma (RMS). METHODS: We obtained Children's Oncology Group data from 1999 to 2021 including summary stage [local (L), regional (R), and distant (D)], tumor subtype, demographics, and ZIP Code at diagnosis. We linked ZIP Codes to county-level redlining scores (C, D = greatest redlining), the Child Opportunity Index, and measures of segregation (racial dissimilarity indices). Logistic regressions calculated odds ratios for late-stage diagnosis and by race within tumor subtype. RESULTS: In total, 5,956 patients with Hodgkin lymphoma and 2,800 patients with RMS were included. Late-stage diagnosis of Hodgkin lymphoma was correlated with Black race [ORDistant(D) vs. regional/local (R&L) = 1.38 (1.13-1.68)], being uninsured [ORD vs. R&L = 1.38 (1.09-1.75)], and subtype [nodular sclerosis vs. Other Hodgkin lymphoma: ORD vs. R&L = 1.64 (1.34-2.01), Untyped: ORD vs. R&L = 1.30 (1.04-1.63)]. Late-stage RMS was correlated with bilingual households [ORDistant/regional(D&R) vs. local(L) = 2.66 (1.03-6.91)] and tumor type [alveolar vs. embryonal ORD vs. R&L = 6.16 (5.00-7.58)]. Community-level factors associated with late-stage Hodgkin lymphoma were greater Black (OR80-100% = 1.83; 95% CI = 1.11-3.02) and Hispanic (OR60-79% = 1.30; 95% CI = 1.05-1.60) dissimilarity indices. Late-stage diagnosis for RMS was associated with more redlined census tracts within counties (OR = 1.54; 95% CI = 1.02-2.35) and low/very low Child Opportunity Index (OR = 1.21; 95% CI = 1.02-1.45). CONCLUSIONS: Novel markers of community deprivation, such as redlining and racial segregation, were correlated with cancer outcomes for children with Hodgkin lymphoma and RMS in this first disparities study using Children's Oncology Group registries. IMPACT: The interplay of multilevel risk factors provides important consideration for efforts to improve early detection of pediatric cancer diagnosis.

  PublisherOA PDFDOI

• Temporal associations between fine particulate matter exposure and breast cancer incidence in the Sister Study

  ISEE Conference Abstracts · 2024-07-31

  articleOpen access
  PublisherDOI

Frequent coauthors

• Anne C. Kirchhoff

  90 shared

• Heydon K. Kaddas

  58 shared

• Joemy M. Ramsay

  University of Utah

  55 shared

• Heidi A. Hanson

  University of Utah

  43 shared

• Echo L. Warner

  University of Utah

  41 shared

• Douglas Fair

  University of Utah

  39 shared

• Deanna Kepka

  37 shared

• Kellee Parker

  University of Utah

  22 shared

Labs

• Judy Y. Ou LabPI

Education

• B.S.

  Brigham Young University

• Other

  Brigham Young University

• Ph.D.

  Boston University School of Public Health

• Other

  University of Utah School of Medicine, Huntsman Cancer Institute