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Item Cancer‐related knowledge, beliefs, and behaviors among Hispanic/Latino residents of Indiana(Wiley, 2023) Espinoza-Gutarra, Manuel R.; Rawl, Susan M.; Maupome, Gerardo; O'Leary, Heather A.; Valenzuela, Robin E.; Malloy, Caeli; Golzarri-Arroyo, Lilian; Parker, Erik; Haunert, Laura; Haggstrom, David A.Background: Cancer is the leading cause of death for Hispanics in the USA. Screening and prevention reduce cancer morbidity and mortality. Methods: This study administered a cross‐sectional web‐based survey to self‐identified Hispanic residents in the state of Indiana to assess their cancer‐related knowledge, beliefs, and behaviors, as well as to identify what factors might be associated with cancer screening and prevention. Chi‐square and Fisher's exact test were used to compare associations and logistic regression used to develop both univariate and multivariate regression models. Results: A total of 1520 surveys were completed, median age of respondents was 53, 52% identified as men, 50.9% completed the survey in Spanish, and 60.4% identified the USA as their country of birth. Most were not able to accurately identify ages to begin screening for breast, colorectal, or lung cancer, and there were significant differences in cancer knowledge by education level. US‐born individuals with higher income and education more often believed they were likely to develop cancer and worry about getting cancer. Sixty eight percent of respondents were up‐to‐date with colorectal, 44% with breast, and 61% with cervical cancer screening. Multivariate models showed that higher education, lack of fatalism, older age, lower household income, and unmarried status were associated with cervical cancer screening adherence. Conclusions: Among a Hispanic population in the state of Indiana, factors associated with cervical cancer screening adherence were similar to the general population, with the exceptions of income and marital status. Younger Hispanic individuals were more likely to be adherent with breast and colorectal cancer screening, and given the higher incidence of cancer among older individuals, these results should guide future research and targeted outreach.Item Cardiovascular disease in thymic cancer patients(Frontiers Media, 2024-09-10) Khemka, Abhishek; Clasen, Suparna C.; Loehrer, Patrick J.; Roberts, Anna R.; Golzarri-Arroyo, Lilian; Badve, Sunil S.; Raman, Subha V.; Hui, Siu L.; Schleyer, Titus K. L.; Medicine, School of MedicineIntroduction: Cancer patients may have increased risk for adverse cardiac events, but our understanding of cardiovascular risk in thymic cancer patients is not clear. We sought to characterize baseline cardiometabolic risk factors before thymic cancer diagnosis and the potential association between cancer treatment and subsequent cardiac events. Methods: This was a retrospective cohort study evaluating patients with thymic cancer from 2003 to 2020 compared to age- and sex-matched controls without cancer. Baseline cardiovascular risk factors, cancer characteristics, and incidence of cardiac events were collected from the health information exchange. Multivariable regression was used to examine the impact of cardiovascular risk factors and cancer therapies. Results: We compared 296 patients with pathology-confirmed thymic cancer to 2,960 noncancer controls. Prior to cancer diagnosis, thymic cancer patients (TCPs) had lower prevalence of hypertension, dyslipidemia, and diabetes mellitus and similar rates of obesity, tobacco use, and pre-existing cardiovascular disease (CVD) compared to controls. After diagnosis, high-risk TCPs (>2 cardiovascular risk factors or pre-existing CVD) had higher risk for cardiac events (HR 3.73, 95% CI 2.88-4.83, p < 0.001). In the first 3 years after diagnosis, TCPs had higher incidence of cardiac events (HR 1.38, 95% CI 1.01-1.87, p = 0.042). High-risk TCPs who received radiotherapy or chemotherapy had higher risk of cardiac events (HR 4.99, 95% CI 2.30-10.81, p < 0.001; HR 6.24, 95% CI 2.84-13.72, p < 0.001). Discussion/conclusion: Compared to noncancer controls, TCPs experienced more cardiac events when adjusted for risk factors. Patients with multiple cardiovascular risk factors receiving radiotherapy or chemotherapy had higher incidence of cardiac events.Item Changes in Penile-Vaginal Intercourse Frequency and Sexual Repertoire from 2009 to 2018: Findings from the National Survey of Sexual Health and Behavior(Springer, 2021-11) Herbenick, Debby; Rosenberg, Molly; Golzarri-Arroyo, Lilian; Fortenberry, J. Dennis; Fu, Tsung-chieh; Medicine, School of MedicineSolo and partnered sexual behaviors are relevant to health, well-being, and relationships. Recent research shows that sexual frequency has declined in the U.S. and in other countries; however, measurement has been imprecise. We used data from 14- to 49-year-old participants in the 2009 and 2018 waves of the National Survey of Sexual Health and Behavior (NSSHB), a confidential U.S. nationally representative survey that is conducted online. We aimed to: (1) assess changes in frequency of past-year penile-vaginal intercourse and (2) examine combinations of past-year sexual behaviors for each of the two waves. We hypothesized that we would observe lower frequency of penile-vaginal intercourse (PVI) from 2009 to 2018 and that we would observe greater engagement in sexual repertoires involving non-coital partnered behaviors (e.g., partnered masturbation, oral sex) in 2018 as compared to 2009. Participants were 4155 individuals from the 2009 NSSHB (Adolescents: 406 females, 414 males; Adults: 1591 women, 1744 men) and 4547 individuals from the 2018 NSSHB (Adolescents: 416 females, 411 males; Adults: 2007 women, 1713 men). Compared to adult participants in the 2009 NSSHB, adults in the 2018 NSSHB were significantly more likely to report no PVI in the prior year (28% in 2018 vs. 24% in 2009). A similar difference in proportions reporting no PVI in the prior year was observed among 14–17-year-old adolescents (89% in 2018 vs. 79% in 2009). Additionally, for both adolescents and adults, we observed decreases in all modes of partnered sex queried and, for adolescents, decreases in solo masturbation.Item COVID-19 Misinformation Prophylaxis: Protocol for a Randomized Trial of a Brief Informational Intervention(JMIR, 2020-12) Agley, Jon; Xiao, Yunyu; Thompson, Esi; Golzarri-Arroyo, Lilian; School of Social WorkBackground: As the COVID-19 pandemic continues to affect life in the United States, the important role of nonpharmaceutical preventive behaviors (such as wearing a face mask) in reducing the risk of infection has become clear. During the pandemic, researchers have observed the rapid proliferation of misinformed or inconsistent narratives about COVID-19. There is growing evidence that such misinformed narratives are associated with various forms of undesirable behavior (eg, burning down cell towers). Furthermore, individuals’ adherence to recommended COVID-19 preventive guidelines has been inconsistent, and such mandates have engendered opposition and controversy. Recent research suggests the possibility that trust in science and scientists may be an important thread to weave throughout these seemingly disparate components of the modern public health landscape. Thus, this paper describes the protocol for a randomized trial of a brief, digital intervention designed to increase trust in science. Objective: The objective of this study is to examine whether exposure to a curated infographic can increase trust in science, reduce the believability of misinformed narratives, and increase the likelihood to engage in preventive behaviors. Methods: This is a randomized, placebo-controlled, superiority trial comprising 2 parallel groups. A sample of 1000 adults aged ≥18 years who are representative of the population of the United States by gender, race and ethnicity, and age will be randomly assigned (via a 1:1 allocation) to an intervention or a placebo-control arm. The intervention will be a digital infographic with content based on principles of trust in science, developed by a health communications expert. The intervention will then be both pretested and pilot-tested to determine its viability. Study outcomes will include trust in science, a COVID-19 narrative belief latent profile membership, and the likelihood to engage in preventive behaviors, which will be controlled by 8 theoretically selected covariates. Results: This study was funded in August 2020, approved by the Indiana University Institutional Review Board on September 15, 2020, and prospectively registered with ClinicalTrials.gov. Conclusions: COVID-19 misinformation prophylaxis is crucial. This proposed experiment investigates the impact of a brief yet actionable intervention that can be easily disseminated to increase individuals’ trust in science, with the intention of affecting misinformation believability and, consequently, preventive behavioral intentions.Item Effect of the COVID-19 pandemic on colorectal cancer screening in two university-affiliated health care systems(Public Library of Science, 2025-01-06) Kumar, Vinod; Golzarri-Arroyo, Lilian; Roth, Sarah; Imperiale, Thomas F.; Medicine, School of MedicineObjectives: In two large university affiliated healthcare systems, we examined trends in colorectal cancer (CRC) screening both prior to and during the COVID-19 pandemic to compare the trends in non-invasive screening tests and colonoscopy. Materials and methods: In this retrospective time-trend analysis, we obtained the numbers of colonoscopies and non-invasive tests performed monthly during the pandemic and the year prior to it. We obtained colonoscopy data from five endoscopy units with the indication determined by dual independent review. Monthly numbers of completed fecal immunochemical (FIT) and FIT-DNA tests were obtained from the electronic medical records of both health systems. Trends in testing, numbers, and stage of incident CRCs diagnosed during the 30-month interval were examined using Poisson regression and logistic regression, respectively. Results: From January 2019 to June 2021, we identified 16,939 FIT tests, 2,942 FIT-DNA tests, and 38,332 colonoscopies from the two health systems, and 368 colorectal cancers (105 early stage, 263 advanced stage) from the private hospital system. Overall colonoscopy volume declined by 18.7% (from 16,483 to 13,393) in 2020 compared to 2019 in both health systems, returning to baseline in 2021. Non-invasive tests declined by 21.9% in 2020, but increased in 2021 due to greater use of FIT/DNA. Compared to 2019, incident CRCs declined in 2020 but rebounded in 2021, with no difference in early versus late-stage cancers. Conclusions: These trends in CRC screening tests may be useful for modeling the effects of the pandemic on the longer-term outcomes of CRC incidence and mortality.Item Effects of ACT Out! Social Issue Theater on Social-Emotional Competence and Bullying in Youth and Adolescents: Cluster Randomized Controlled Trial(JMIR Publications, 2021-01-06) Agley, Jon; Jun, Mikyoung; Eldridge, Lori; Agley, Daniel L.; Xiao, Yunyu; Sussman, Steve; Golzarri-Arroyo, Lilian; Dickinson, Stephanie L.; Jayawardene, Wasantha; Gassman, Ruth; School of Social WorkBackground: Schools increasingly prioritize social-emotional competence and bullying and cyberbullying prevention, so the development of novel, low-cost, and high-yield programs addressing these topics is important. Further, rigorous assessment of interventions prior to widespread dissemination is crucial. Objective: This study assesses the effectiveness and implementation fidelity of the ACT Out! Social Issue Theater program, a 1-hour psychodramatic intervention by professional actors; it also measures students' receptiveness to the intervention. Methods: This study is a 2-arm cluster randomized control trial with 1:1 allocation that randomized either to the ACT Out! intervention or control (treatment as usual) at the classroom level (n=76 classrooms in 12 schools across 5 counties in Indiana, comprised of 1571 students at pretest in fourth, seventh, and tenth grades). The primary outcomes were self-reported social-emotional competence, bullying perpetration, and bullying victimization; the secondary outcomes were receptiveness to the intervention, implementation fidelity (independent observer observation), and prespecified subanalyses of social-emotional competence for seventh- and tenth-grade students. All outcomes were collected at baseline and 2-week posttest, with planned 3-months posttest data collection prevented due to the COVID-19 pandemic. Results: Intervention fidelity was uniformly excellent (>96% adherence), and students were highly receptive to the program. However, trial results did not support the hypothesis that the intervention would increase participants' social-emotional competence. The intervention's impact on bullying was complicated to interpret and included some evidence of small interaction effects (reduced cyberbullying victimization and increased physical bullying perpetration). Additionally, pooled within-group reductions were also observed and discussed but were not appropriate for causal attribution. Conclusions: This study found no superiority for a 1-hour ACT Out! intervention compared to treatment as usual for social-emotional competence or offline bullying, but some evidence of a small effect for cyberbullying. On the basis of these results and the within-group effects, as a next step, we encourage research into whether the ACT Out! intervention may engender a bystander effect not amenable to randomization by classroom. Therefore, we recommend a larger trial of the ACT Out! intervention that focuses specifically on cyberbullying, measures bystander behavior, is randomized by school, and is controlled for extant bullying prevention efforts at each school.Item Efficacy of supplemental oxygen in reducing the need for laser or intravitreal bevacizumab in preterm infants with stage 2 retinopathy of prematurity(Springer Nature, 2024-05-24) Minturn, Robert; Hartigan, Kelly; Vegunta, Sravanthi; Boente, Charline; Golzarri-Arroyo, Lilian; Hynes, Elizabeth; Laughlin, Elleen; Haider, Kathryn; Kua, Kok Lim; Ophthalmology, School of MedicineBackground: Retinopathy of prematurity (ROP) is a disease that affects preterm infants born younger than 30 weeks of gestation. The pathophysiology of ROP involves an initial vaso-obliterative phase followed by vaso-proliferative phase that leads to disease progression. The use of supplemental oxygen during the vaso-proliferative phase of ROP has been associated with reduced disease progression, but how this impacts the need for ROP treatment is unclear. The goal of this study was to compare the rate of laser or intravitreal bevacizumab after implementation of a new supplemental oxygen therapy protocol in preterm infants with stage 2 ROP. Methods: This is a retrospective chart review of preterm infants diagnosed with stage 2 ROP at Riley Hospital for Children between 1/2017 and 12/2022. Patients diagnosed between 1/2017 and 6/2020 were classified as Cohort A, preprotocol implementation. Patients diagnosed from 8/2020 to 12/2022 were classified as Cohort B, postprotocol implementation. In Cohort A, oxygen saturation was kept at 91-95% through the entire hospitalization. In Cohort B, oxygen saturation was increased to 97-99% as soon as Stage 2 ROP was diagnosed. Statistical analyses were performed using chi-square and Student's T test, followed by multivariate analyses to determine the impact of the oxygen protocol on the need for ROP treatment. Results: A total of 211 patients were diagnosed with stage 2 ROP between 1/2017 and 12/2022. Of those patients, 122 were before protocol implementation therapy (Cohort A), and 89 were after implementation of supplemental oxygen protocol (Cohort B). Gestational age was slightly higher in Cohort B (Cohort A 25.3 ± 1.9, Cohort B 25.8 ± 1.84, p = 0.04). There was no difference in birth weight, NEC, BPD, or survival. Cohort B had lesser need for invasive mechanical ventilation and higher days on CPAP during hospitalization. Notably, Cohort A had 67 (55%) patients treated with laser photocoagulation or intravitreal bevacizumab versus 20 (22%) patients in Cohort B (OR 0.19, 0.08-0.40). Conclusion: The need for laser photocoagulation or intravitreal bevacizumab was significantly decreased in high-risk patients treated with the supplemental oxygen protocol. This result supports the idea that targeted supplemental oxygen therapy to keep saturations between 97 and 99% can reduce disease progression in infants with stage 2 ROP and potentially decrease the burden of additional procedures.Item Factors Associated with Reported Likelihood to Get Vaccinated for COVID-19 in a Nationally Representative US Survey(Elsevier, 2021-06) Agley, Jon; Xiao, Yunyu; Thompson, Esi E.; Golzarri-Arroyo, Lilian; School of Social WorkObjectives While general principles related to vaccination hesitancy have been well-researched, reports on reluctance to be vaccinated for COVID-19 in the US are somewhat surprising given the disease’s substantive disruption of everyday life. However, the landscape in which people are making COVID-19 vaccination decisions has recently evolved with releases of encouraging vaccine-related data and changes to official messaging about the virus. Therefore, this study sought to identify factors associated with reported likelihood to get vaccinated for COVID-19 among US adults in late January 2021. Study Design We used the Prolific online research panel to survey a nationally representative sample of 1,017 US adults. Methods Respondents were asked about their behavioral intentions toward COVID-19 vaccination, trust in science, perceptions related to COVID-19, and selected sociodemographic factors. We computed associations between those 11 independent variables and likelihood to get vaccinated for COVID-19 using multiple linear regression. Results Around 73.9% of respondents indicated at least some likelihood to get vaccinated for COVID-19. Trust in science and perceived seriousness of COVID-19 were positively associated, and identifying as Black or African American was negatively associated, with intention to get vaccinated. Other factors were moderately, weakly, or not at all associated with intention. Conclusions Building trust in science and truthfully emphasizing the seriousness of catching COVID-19 should be further researched for their potential to support campaigns to encourage COVID-19 vaccination. Data continue to suggest the importance of dialogue with Black communities about COVID-19 vaccination.Item From Model Organisms to Humans, the Opportunity for More Rigor in Methodologic and Statistical Analysis, Design, and Interpretation of Aging and Senescence Research(Oxford University Press, 2022) Chusyd, Daniella E.; Austad, Steven N.; Brown, Andrew W.; Chen, Xiwei; Dickinson, Stephanie L.; Ejima, Keisuke; Fluharty, David; Golzarri-Arroyo, Lilian; Holden, Richard; Jamshidi-Naeini, Yasaman; Landsittel, Doug; Lartey, Stella; Mannix, Edward; Vorland, Colby J.; Allison, David B.; Anatomy, Cell Biology and Physiology, School of MedicineThis review identifies frequent design and analysis errors in aging and senescence research and discusses best practices in study design, statistical methods, analyses, and interpretation. Recommendations are offered for how to avoid these problems. The following issues are addressed: (a) errors in randomization, (b) errors related to testing within-group instead of between-group differences, (c) failing to account for clustering, (d) failing to consider interference effects, (e) standardizing metrics of effect size, (f) maximum life-span testing, (g) testing for effects beyond the mean, (h) tests for power and sample size, (i) compression of morbidity versus survival curve squaring, and (j) other hot topics, including modeling high-dimensional data and complex relationships and assessing model assumptions and biases. We hope that bringing increased awareness of these topics to the scientific community will emphasize the importance of employing sound statistical practices in all aspects of aging and senescence research.Item Impact of the COVID-19 pandemic on adherence to diagnostic colonoscopy after a positive non-invasive screening test for colorectal cancer in two Indiana healthcare systems(Elsevier, 2024-11-26) Richter, Benjamin; Roth, Sarah M.; Golzarri-Arroyo, Lilian; Kumar, Vinod; Tuason, Rick; Imperiale, Thomas F.; Medicine, School of MedicineObjective: To describe trends in the use of non-invasive tests (NIST) and the interval between a positive NIST and diagnostic colonoscopy. Methods: Using a retrospective time-trend design, we examined medical records of patients within two large Indiana integrated healthcare systems who had a positive NIST between January 2019 and June 2021 and quantified the proportion of patients who had not completed colonoscopy within 60, 90, and 180 days to determine the interval between NIST result and diagnostic colonoscopy in days. Results: Of 1379 patients with positive NISTs, 930 (68 %) underwent diagnostic colonoscopy during the 30-month study timeframe. Median time to colonoscopy completion was significantly longer in 2020 compared to 2019 (50 vs. 37 days, p < 0.01) and 2021 (46 days, p = 0.06). The proportion of patients completing colonoscopy within 90 days of a positive FIT in 2019, 2020, and 2021 were 79 %, 83 %, and 72 %, respectively (p = 0.63), and were 86 %, 78 %, and 84 %, respectively, after positive FIT/DNA (p = 0.07). Median time to diagnostic colonoscopy completion was significantly longer in 2020, likely due to the COVID-19 pandemic. Conclusions: Studies of outcomes in those who declined or delayed colonoscopy in 2020 are needed to estimate the potential subsequent colorectal cancer disease burden.