{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T03:52:01Z","timestamp":1782877921611,"version":"3.54.5"},"reference-count":43,"publisher":"IWA Publishing","issue":"6","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Louisville Metro Government"},{"name":"Owsley Brown II Family Foundation"}],"content-domain":{"domain":["iwaponline.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Overview graphic showing the community-level data inputs into the random forest model used to predict school attendance.<\/jats:p>\n                  <jats:p>Community-transmitted seasonal infectious diseases pose a significant challenge to school systems across the nation. School attendance is central to student learning progress and is a key public health indicator. We aimed to evaluate the incremental explanatory value of community-level seasonal influenza wastewater concentrations for estimating school absenteeism within the corresponding geographic sewershed in Louisville, Kentucky (USA). We used community wastewater seasonal influenza concentrations from a catchment area that geographically encompassed 51 public elementary, middle, and high schools. These data were compared with daily school-level attendance records provided by Jefferson County Public Schools for three academic years (2022\u20132025). Two random forest models were developed that incorporated community influenza A wastewater concentrations, environmental variables (e.g., rainfall and maximum temperature), school-level attendance, and total enrollment to predict attendance outcomes. Across the sewershed, the all-schools model (N = 51) performed well (training R2 = 0.94, testing R2 = 0.60, and MAE = 2.88); however, the high school-only model (N = 7) performed better (training R2 = 0.98, testing R2 = 0.86, and MAE = 3.22). Our findings present a preliminary approach for using wastewater-based epidemiology and machine learning to enhance early-warning capacity and inform health-supportive responses across educational settings.<\/jats:p>","DOI":"10.2166\/wh.2026.223","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T12:23:16Z","timestamp":1780402996000},"page":"773-783","update-policy":"https:\/\/doi.org\/10.2166\/iwapcrossmarkpolicypage","source":"Crossref","is-referenced-by-count":0,"title":["Community-level wastewater influenza concentrations and school attendance in Jefferson County, Kentucky (2022\u20132025)"],"prefix":"10.2166","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8029-2838","authenticated-orcid":false,"given":"Anna","family":"Dusterhoff","sequence":"first","affiliation":[{"name":"a Center for Healthy Air Water and Soil, Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0556-7260","authenticated-orcid":false,"given":"Lauren B.","family":"Anderson","sequence":"additional","affiliation":[{"name":"a Center for Healthy Air Water and Soil, Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8849-1390","authenticated-orcid":false,"given":"Rochelle H.","family":"Holm","sequence":"additional","affiliation":[{"name":"a Center for Healthy Air Water and Soil, Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7671-4742","authenticated-orcid":false,"given":"Emily","family":"Reece","sequence":"additional","affiliation":[{"name":"b Jefferson County Public Schools, 3301 Stober Road, Louisville, KY 40213, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6527-7957","authenticated-orcid":false,"given":"Eva","family":"Stone","sequence":"additional","affiliation":[{"name":"b Jefferson County Public Schools, 3301 Stober Road, Louisville, KY 40213, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2804-4294","authenticated-orcid":false,"given":"Ted","family":"Smith","sequence":"additional","affiliation":[{"name":"a Center for Healthy Air Water and Soil, Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, 302 E. Muhammad Ali Blvd., Louisville, KY 40202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"945","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"issue":"1","key":"key-10.2166\/wh.2026.223-1","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1186\/1471-2458-5-105","article-title":"Evaluation of school absenteeism data for early outbreak detection, New York City","volume":"5","author":"Besculides","year":"2005","journal-title":"BMC Public Health"},{"issue":"1","key":"key-10.2166\/wh.2026.223-2","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1038\/s41597-024-03969-8","article-title":"Human pathogen nucleic acids in wastewater solids from 191 wastewater treatment plants in the United States","volume":"11","author":"Boehm","year":"2024","journal-title":"Scientific Data"},{"issue":"1","key":"key-10.2166\/wh.2026.223-3","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1023\/A:1010933404324","article-title":"Random forests","volume":"45","author":"Breiman","year":"2001","journal-title":"Machine Learning"},{"issue":"6","key":"key-10.2166\/wh.2026.223-4","doi-asserted-by":"crossref","first-page":"e0270168","DOI":"10.1371\/journal.pone.0270168","article-title":"Monitoring occurrence of SARS-CoV-2 in school populations: a wastewater-based approach","volume":"17","author":"Castro-Gutierrez","year":"2022","journal-title":"PLoS One"},{"issue":"1","key":"key-10.2166\/wh.2026.223-5","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1007\/s11111-024-00448-5","article-title":"Temperature and school absences: evidence from England","volume":"46","author":"Conte Keivabu","year":"2024","journal-title":"Population and Environment"},{"issue":"9","key":"key-10.2166\/wh.2026.223-6","doi-asserted-by":"crossref","first-page":"e2126447","DOI":"10.1001\/jamanetworkopen.2021.26447","article-title":"Assessment of a program for SARS-CoV-2 screening and environmental monitoring in an urban public school district","volume":"4","author":"Crowe","year":"2021","journal-title":"JAMA Network Open"},{"issue":"9","key":"key-10.2166\/wh.2026.223-7","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1111\/josh.12929","article-title":"Using school climate to improve attendance and grades: understanding the importance of school satisfaction among middle and high school students","volume":"90","author":"Daily","year":"2020","journal-title":"Journal of School Health"},{"key":"key-10.2166\/wh.2026.223-8","doi-asserted-by":"crossref","first-page":"164519","DOI":"10.1016\/j.scitotenv.2023.164519","article-title":"Wastewater-based prediction of COVID-19 cases using a random forest algorithm with strain prevalence data: a case study of five municipalities in Latvia","volume":"891","author":"Dejus","year":"2023","journal-title":"Science of The Total Environment"},{"key":"key-10.2166\/wh.2026.223-9","doi-asserted-by":"crossref","first-page":"1141136","DOI":"10.3389\/fpubh.2023.1141136","article-title":"An alternative method for monitoring and interpreting influenza A in communities using wastewater surveillance","volume":"11","author":"de Melo","year":"2023","journal-title":"Frontiers in Public Health"},{"key":"key-10.2166\/wh.2026.223-10","volume-title":"Chronic Absenteeism Still a Struggle in 2024\u20132025 Selected Findings From the American School District Panel and the American Youth Panel","author":"Diliberti","year":"2025"},{"issue":"11","key":"key-10.2166\/wh.2026.223-11","doi-asserted-by":"crossref","first-page":"1899","DOI":"10.1021\/acsestwater.1c00434","article-title":"Nationwide trends in COVID-19 cases and SARS-CoV-2 RNA wastewater concentrations in the United States","volume":"2","author":"Duvallet","year":"2022","journal-title":"ACS ES&T Water"},{"key":"key-10.2166\/wh.2026.223-12","doi-asserted-by":"crossref","first-page":"100449","DOI":"10.1016\/j.lana.2023.100449","article-title":"Safer at school early alert: an observational study of wastewater and surface monitoring to detect COVID-19 in elementary schools","volume":"19","author":"Fielding-Miller","year":"2023","journal-title":"The Lancet Regional Health\u2013Americas"},{"issue":"2","key":"key-10.2166\/wh.2026.223-13","doi-asserted-by":"crossref","first-page":"315","DOI":"10.3102\/0002831220924037","article-title":"Can a positive school climate promote student attendance? 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