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Item Association Between Built Environment or Health Behavior and Good Health Status Using ACSM American Fitness Index® Data Between 2018 and 2022(2023-12) Seo, Bojung; Han, Jiali; Nan, Hongmei; Monahan, Patrick O.; Duszynski, Thomas J.The US cities still have room for improvement in residents’ health and there are significant differences in general health measures between the cities. High quality environment assets and personal healthier behaviors of residents were known as factors related to better health. Because both sufficient sleep and higher level of personal physical activity are well-known indicators to attain optimal health of individuals, city-level measures of resident health behaviors, such as sleep quantity, and environmental assets that support physical activity may jointly improve residents’ general health. Further, sufficient sleep may mediate the effect of activity-related environmental factors on general health. However, evidence regarding such associations at the city level is lacking. The American College of Sports Medicine (ACSM) American Fitness Index® (AFI) data currently provide both environment assets and health indicators for the 100 largest US cities. The aim of this research was to test the following three hypotheses using the 2018 to 2022 AFI data. First, the association between environment indicators of cities and good health status of residents was examined. Second, the association between personal health behaviors of residents and good health status was also examined. Lastly, the moderating or mediating effect of sleep on the association between significant environmental factors and good health status was examined. This study discovered that activity-related environment factors, such as availability of parks within a 10-minute walk, Walk Score®, Bike Score®, and adoption of Complete Streets policy, were significantly associated with the self-reported general health status of residents. This study also demonstrated all measured healthy behaviors including meeting physical activity guidelines, using active transport to work, sufficient intake of fruits and vegetables, sufficient sleep, and non-smoking were positively related to general health status of city residents. This study also identified the synergistic interaction between sufficient daily sleeping and environment factors related to the level of physical activity on residents’ good health status. Overall, these findings will provide evidence for better understanding the health-related unmet needs of residents in US cities, and also create valuable context and support for development and targeting of more efficacious public health interventions and messaging.Item Association of Health Status and Nicotine Consumption with SARS-CoV-2 positivity rates(BMC, 2021-10) Duszynski, Thomas J.; Fadel, William; Wools-Kaloustian, Kara K.; Dixon, Brian E.; Yiannoutsos, Constantin; Halverson, Paul K.; Menachemi, Nir; Epidemiology, School of Public HealthBACKGROUND: Much of what is known about COVID-19 risk factors comes from patients with serious symptoms who test positive. While risk factors for hospitalization or death include chronic conditions and smoking; less is known about how health status or nicotine consumption is associated with risk of SARS-CoV-2 infection among individuals who do not present clinically. METHODS: Two community-based population samples (including individuals randomly and nonrandomly selected for statewide testing, n = 8214) underwent SARS-CoV-2 testing in nonclinical settings. Each participant was tested for current (viral PCR) and past (antibody) infection in either April or June of 2020. Before testing, participants provided demographic information and self-reported health status and nicotine and tobacco behaviors (smoking, chewing, vaping/e-cigarettes). Using descriptive statistics and a bivariate logistic regression model, we examined the association between health status and use of tobacco or nicotine with SARS-CoV-2 positivity on either PCR or antibody tests. RESULTS: Compared to people with self-identified "excellent" or very good health status, those reporting "good" or "fair" health status had a higher risk of past or current infections. Positive smoking status was inversely associated with SARS-CoV-2 infection. Chewing tobacco was associated with infection and the use of vaping/e-cigarettes was not associated with infection. CONCLUSIONS: In a statewide, community-based population drawn for SARS-CoV-2 testing, we find that overall health status was associated with infection rates. Unlike in studies of COVID-19 patients, smoking status was inversely associated with SARS-CoV-2 positivity. More research is needed to further understand the nature of this relationship.Item Dashboards Are Trendy, Visible Components of Data Management in Public Health: Sustaining Their Use After the Pandemic Requires a Broader View(American Public Health Association, 2022) Dixon, Brian E.; Dearth, Shandy; Duszynski, Thomas J.; Grannis, Shaun J.; Epidemiology, School of Public HealthItem Epidemiological Analysis of SARS-CoV-2: Three Papers Examining Health Status, Response Bias, and Strategies for Engagment(2022-02) Duszynski, Thomas J.; Wessel, Jennifer; Dixon, Brian E.; Li, Xin; Menachemi, NirThe emergence of the global SARS-CoV-2 pandemic created tremendous impact on humanity beginning in late 2019. Public health researchers at Indiana University Richard M. Fairbanks School of Public Health responded by conducting research into the etiological profile of the virus, including a large Indiana state-wide population-based prevalence study in early 2020. Methods Data on demographics, tobacco use, health status, and reasons for participating in the population prevalence study were used to conduct three retrospective cross-sectional studies. The first study assessed the association of self-reported health and tobacco behaviors with COVID-19 infection (n=8,241). The second study used successive wave analysis to assess nonresponse bias (n=3,658). Finally, participants demographics were characterized by who responded to text, email, phone calls, or postcards and by the number of prompts needed to elicit participation (n= 3,658). Results The first study found self-identified health status of those reporting “poor, “fair” or good” had a higher risk of past or current infections compared to “very good” or “excellent” health status (P <0.02). Positive smoking status was inversely associated with SARS-CoV-2 infection (p <0.001). When assessing the sample for non-response bias (n=3,658), 40.9% responded in wave 1 of recruitment, 34.1% in wave 2 and 25.0% in wave 3 for an overall participation rate of 23.6%. There were no significant differences in response by waves and demographics, being recently exposed or reasons for participating. In the final study, compared to males, females made up 54.6% of the sample and responded at a higher rate to postcards (8.2% vs. 7.5%) and text/emails (28.1 vs. 24.6%, 2= 7.43, p 0.025); and responded at a higher percentage after 1 contact (21.4 vs. 17.9%, 2 = 7.6, p 0.023). Conclusion This research contributed to the scientific understanding of the etiological picture of SARS-CoV-2. Additionally, the current study used a novel method that public health practitioners can easily implement to detect non-response bias in primary data collection without advanced statistical methods. Finally, the current study allows researchers to focus not only on the modality of inviting participants, but the frequency of invitations needed to secure specific populations, reducing time and resources.Item Findings From a Scoping Review: Presumptive Treatment for Chlamydia trachomatis and Neisseria gonorrhoeae in the United States, 2006–2021(American Sexually Transmitted Diseases Association, 2023-04) Allen, Katie S.; Hinrichs, Rachel J.; Heumann, Christine L.; Titus, Melissa K.; Duszynski, Thomas J.; Valvi, Nimish R.; Wiensch, Ashley; Tao, Guoyu; Dixon, Brian E.Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are the 2 most common reported sexually transmitted infections in the United States. Current recommendations are to presumptively treat CT and/or GC in persons with symptoms or known contact. This review characterizes the literature around studies with presumptive treatment, including identifying rates of presumptive treatment and overtreatment and undertreatment rates. Of the 18 articles that met our inclusion criteria, 6 pertained to outpatient settings. In the outpatient setting, presumptive treatment rates, for both asymptomatic and symptomic patients, varied from 12% to 100%, and the percent positive of those presumptively treated ranged from 25% to 46%. Three studies also reported data on positive results in patients not presumptively treated, which ranged from 2% to 9%. Two studies reported median follow-up time for untreated, which was roughly 9 days. The remaining 12 articles pertained to the emergency setting where presumptive treatment rates, for both asymptomatic and symptomic patients, varied from 16% to 91%, the percent positive following presumptive treatment ranged from 14% to 59%. Positive results without presumptive treatment ranged from 4% to 52%. Two studies reported the percent positive without any treatment (6% and 32%, respectively) and one reported follow-up time for untreated infections (median, 4.8 days). Rates of presumptive treatment, as well as rates of overtreatment or undertreatment vary widely across studies and within care settings. Given the large variability in presumptive treatment, the focus on urban settings, and minimal focus on social determinants of health, additional studies are needed to guide treatment practices for CT and GC in outpatient and emergency settings.Item Findings From a Scoping Review: Presumptive Treatment for Chlamydiatrachomatis and Neisseria gonorrhoeae in the United States, 2006-2021(Wolters Kluwer, 2023) Allen, Katie S.; Hinrichs, Rachel; Heumann, Christine L.; Titus, Melissa K.; Duszynski, Thomas J.; Valvi, Nimish R.; Wiensch, Ashley; Tao, Guoyu; Dixon, Brian E.; University LibraryChlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) are the two most common reported sexually transmitted infections in the USA. Current recommendations are to presumptively treat CT and/or GC in persons with symptoms or known contact. This review characterizes the literature around studies with presumptive treatment, including identifying rates of presumptive treatment and over- and under-treatment rates. Of the 18 articles that met our inclusion criteria, six pertained to outpatient settings. In the outpatient setting, presumptive treatment rates, for both asymptomatic and symptomic patients, varied from 12% - 100%, and the percent positive of those presumptively treated ranged from 25% - 46%. Three studies also reported data on positive results in patients not presumptively treated, which ranged from 2% - 9%. Two studies reported median follow-up time for untreated, which was roughly nine days. The remaining 12 articles pertained to the emergency setting where presumptive treatment rates, for both asymptomatic and symptomic patients, varied from 16% - 91%, the percent positive following presumptive treatment ranged from 14% - 59%. Positive results without presumptive treatment ranged from 4% - 52%. Two studies reported the percent positive without any treatment (6% and 32% respectively) and one reported follow-up time for untreated infections (median: 4.8 days). Rates of presumptive treatment, as well as rates of over- or under- treatment vary widely across studies and within care settings. Given large variability in presumptive treatment, the focus on urban settings, and minimal focus on social determinants of health, additional studies are needed to guide treatment practices for CT and GC in outpatient and emergency settings.Item Mitigation of COVID-19 at the 2021 National Collegiate Athletic Association Men's Basketball Tournament(Springer, 2022-11-10) Dixon, Brian E.; Fadel, William F.; Duszynski, Thomas J.; Caine, Virgina A.; Meyer , Joeseph F.; Saysana , Michele; Epidemiology, Richard M. Fairbanks School of Public HealthBackground Data are lacking regarding the risk of viral SARS-CoV-2 transmission during a large indoor sporting event involving fans utilizing a controlled environment. We sought to describe case characteristics, mitigation protocols used, variants detected, and secondary infections detected during the 2021 National Collegiate Athletic Association (NCAA) Men’s Basketball Tournament involving collegiate athletes from across the U.S. Methods This retrospective cohort study used data collected from March 16 to April 3, 2021, as part of a closed environment which required daily reverse transcription-polymerase chain reaction (RT-PCR) testing, social distancing, universal masking, and limited contact between tiers of participants. Nearly 3000 players, staff, and vendors participated in indoor, unmasked activities that involved direct exposure between cases and noninfected individuals. The main outcome of interest was transmission of SARS-CoV-2 virus, as measured by the number of new infections and variant(s) detected among positive cases. Secondary infections were identified through contact tracing by public health officials. Results Out of 2660 participants, 15 individuals (0.56%) screened positive for SARS-CoV-2. Four cases involved players or officials, and all cases were detected before any individual played in or officiated a game. Secondary transmissions all occurred outside the controlled environment. Among those disqualified from the tournament (4 cases; 26.7%), all individuals tested positive for the Iota variant (B.1.526). All other cases involved the Alpha variant (B.1.1.7). Nearly all teams (N = 58; 85.3%) reported that some individuals had received at least one dose of a vaccine. Overall, 17.9% of participants either had at least one dose of the vaccine or possessed documented infection within 90 days of the tournament. Conclusion In this retrospective cohort study of the 2021 NCAA Men’s Basketball Tournament closed environment, only a few cases were detected, and they were discovered in advance of potential exposure. These findings support the U.S. Centers for Disease Control and Prevention (CDC) guidelines for large indoor sporting events during the COVID-19 pandemic.Item Population Point Prevalence of SARS-CoV-2 Infection Based on a Statewide Random Sample — Indiana, April 25–29, 2020(Department of Health and Human Services, Centers for Disease Control and Prevention, 2020-07-24) Menachemi, Nir; Yiannoutsos, Constantin T.; Dixon, Brian E.; Duszynski, Thomas J.; Fadel, William F.; Wools-Kaloustian, Kara K.; Needleman, Nadia Unruh; Box, Kristina; Caine, Virginia; Norwood, Connor; Weaver, Lindsay; Halverson, Paul K.; Health Policy and Management, School of Public HealthDuring April 25–29, 2020, Indiana conducted statewide random sample testing of persons aged ≥12 years to assess prevalence of active infection and presence of antibodies to SARS-CoV-2; additional nonrandom sampling was conducted in racial and ethnic minority communities to better understand the impact of the virus in certain racial and ethnic minority populations.Item Real-World Evidence Studies on the Association of Serum 25-Hydroxyvitamin D Levels with Pain Intensity and Opioid Use(2022-12) Choong, Casey Kar-chan; Han, Jiali; Dixon, Brian E.; Xu, Huiping; Duszynski, Thomas J.; Zhang, JianjunVitamin D deficiency has been linked to chronic pain and increased opioid use. Realworld data such as electronic medical records and administrative claim data contain large amounts of clinical data and present an opportunity to study the relationship of serum 25- hydroxyvitamin D [25(OH)D] with pain intensity and opioid use. The first study assessed the association between serum 25(OH)D) levels and pain intensity. Compared to patients with normal 25(OH)D levels, those who had insufficient or deficient levels were more likely to experience moderate or severe pain, with multivariable-adjusted odds ratios (95% confidence intervals) of 1.19 (1.05-1.36) and 1.51 (1.28-1.79), respectively. Similar findings were obtained using propensity scores in the matched analyses. In the second study, we investigated the association between serum 25(OH.)D levels and opioid use among opioid-naïve patients. We revealed that those who had insufficient or deficient levels of 25(OH)D were more likely to receive an opioid prescription, with multivariableadjusted odds ratios of 1.10 (1.02-1.17) and 1.18 (1.09-1.28), respectively, compared to patients with normal 25(OH)D levels. Vitamin D deficiency was also associated with a longer duration of opioid use. In the third study, we performed machine learning to identify patient characteristics associated with persistent moderate-to-severe pain (PMSP), explicitly investigating if low serum 25(OH)D levels were a risk factor for heightened pain intensity among obese patients. Low levels of 25(OH)D were consistently identified as a key predictor from a large number of candidate variables in the machine learning models. We detected a significant positive association between serum 25(OH)D levels and PMSP in the logistic regression analysis. Compared to patients with normal levels of 25(OH)D, those who had insufficient or deficient levels of 25(OH)D were more likely to report PMSP, with multivariable-adjusted OR (95% CIs) of 1.15 (1.10-1.21) and 1.28 (1.21-1.35) respectively. We replicated the findings in the first study in a different cohort that showed that low serum 25(OH)D levels might play a role in pain perception. This research contributes to an improved understanding of the role of vitamin D on pain, and opioid use. Individuals who experience pain and need opioid therapy may benefit from optimizing their serum 25(OH)D levels.Item Successive Wave Analysis to Assess Nonresponse Bias in a Statewide Random Sample Testing Study for SARS-CoV-2(Wolters Kluwer, 2022) Duszynski, Thomas J.; Fadel, William; Dixon, Brian E.; Yiannoutsos, Constantin; Halverson, Paul K.; Menachemi, Nir; Epidemiology, School of Public HealthIntroduction: Nonresponse bias occurs when participants in a study differ from eligible nonparticipants in ways that can distort study conclusions. The current study uses successive wave analysis, an established but underutilized approach, to assess nonresponse bias in a large-scale SARS-CoV-2 prevalence study. Such an approach makes use of reminders to induce participation among individuals. Based on the response continuum theory, those requiring several reminders to participate are more like nonrespondents than those who participate in a study upon first invitation, thus allowing for an examination of factors affecting participation. Methods: Study participants from the Indiana Population Prevalence SARS-CoV-2 Study were divided into 3 groups (eg, waves) based upon the number of reminders that were needed to induce participation. Independent variables were then used to determine whether key demographic characteristics as well as other variables hypothesized to influence study participation differed by wave using chi-square analyses. Specifically, we examined whether race, age, gender, education level, health status, tobacco behaviors, COVID-19-related symptoms, reasons for participating in the study, and SARS-CoV-2 positivity rates differed by wave. Results: Respondents included 3658 individuals, including 1495 in wave 1 (40.9%), 1246 in wave 2 (34.1%), and 917 in wave 3 (25%), for an overall participation rate of 23.6%. No significant differences in any examined variables were observed across waves, suggesting similar characteristics among those needing additional reminders compared with early participants. Conclusions: Using established techniques, we found no evidence of nonresponse bias in a random sample with a relatively low response rate. A hypothetical additional wave of participants would be unlikely to change original study conclusions. Successive wave analysis is an effective and easy tool that can allow public health researchers to assess, and possibly adjust for, nonresponse in any epidemiological survey that uses reminders to encourage participation.