Browsing by Author "Zollinger, Terrell"

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    Associations of Metabolic syndrome and C-reactive protein with Mortality from total cancer, obesity-linked cancers and Breast Cancer among Women in NHANES III
    (Wiley, 2018-08) Gathirua-Mwangi, Wambui G.; Song, Yiqing; Monahan, Patrick; Champion, Victoria L.; Zollinger, Terrell; Biostatistics, School of Public Health
    Although metabolic syndrome (MetS) is a prognostic factor for cancer occurrence, the association of MetS and cancer mortality remains unclear. The purpose of this study was to evaluate whether MetS, components of MetS and C-reactive protein (CRP) are associated with cancer mortality in women. A total of 400 cancer deaths, with 140 deaths from obesity-linked-cancers (OLCas), [breast (BCa), colorectal, pancreatic and endometrial], linked through the National Death Index, were identified from 10,104 eligible subjects aged ≥18 years. Cox proportional hazards regression was used to estimate multivariable-adjusted hazard ratios (HR) for cancer mortality. MetS was associated with increased deaths for total cancer [HR = 1.33, 95% confidence interval (CI) 1.04-1.70] and BCa [HR = 2.1, 95% CI, 1.09-4.11]. The risk of total cancer [HR = 1.7, 95% CI, 1.12-2.68], OLCas [HR = 2.1, 95% CI, 1.00-4.37] and BCa [HR = 3.8, 95% CI, 1.34-10.91] mortality was highest for women with all MetS components abnormal, compared to those without MetS. Linear associations of blood-pressure [HR = 2.5, 1.02-6.12, Quartile (Q) 4 vs Q1, p trend = 0.004] and blood-glucose [HR = 2.2, 1.04-4.60, Q4 vs. Q1, p trend = 0.04] with total-OLCas mortality were observed. A threefold increased risk of BCa mortality was observed for women with enlarged waist circumference, ≥100.9 cm, [HR = 3.5, 1.14-10.51, p trend = 0.008] and in those with increased blood glucose, ≥101 mg/dL, [HR = 3.2, 1.11-9.20, p trend = 0.03] compared to those in Q1. None of the components of MetS were associated with total-cancer mortality. CRP was not associated with cancer mortality. In conclusion, MetS is associated with total-cancer and breast-cancer mortality, with waist circumference, blood pressure and blood glucose as independent predictors of OLCas and BCa mortality.
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    Center for Urban Health: Enhancing the health of cities by focusing on communities and the environment
    (Office of the Vice Chancellor for Research, 2013-04-05) Filippelli, Gabriel; Johnson, Daniel P.; Wiehe, Sarah E.; Zollinger, Terrell
    Urban sustainability is a new philosophy of developing healthy, productive communities that (1) promote and use locally-produced foods and products, (2) ensure safe access to natural spaces, and (3) establish low-carbon transportation systems. Urban living is arguably the most sustainable form of community given the concentration of resources, protection of arable land, and vertical structure of housing. In fact, urbanization is becoming the global norm; the percentage of global population living in urban settings has increased from less than 30% in 1950 to 47% in 2000; the percentage of urban dwellers is expected to increase to 60% by 2025. The promise of a healthy and sustainable urban future is clouded, however, by the reality of environmental insults, economic disparities, and behavioral pressures that exist in modern cities. The challenge is not how to build a shiny carbon-neutral city from scratch, but rather how to transition our current urban state toward one that is healthier, has less environmental impact, and is more prepared to respond and adjust to variety of environmental, social, and health changes in the future. Several groups at IUPUI and in the community are collaborating to explore connections between environment, behavior, health, and climate as related to urban environments. These translational efforts are inter- and trans-disciplinary, as evidenced by earth scientists publishing with pediatricians, and geographers publishing with epidemiologists. These efforts are largely undertaken with a geospatial and geotemporal research template. This template allows environmental, health, and behavioral data to be collected individually but with reference to space and time, which become important metadata components for analysis. The Center for Urban Health promotes discovery by building research collaborations among Center Investigators, providing seed funds for new research areas, funding graduate fellowships, and sponsoring educational activities such as public lectures and a Visiting Scholars Program.
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    Dietary intake and urinary excretion of phytoestrogens in relation to cancer and cardiovascular disease
    (2014) Reger, Michael Kent; Zollinger, Terrell; Jones, Josette F.; Liu, Ziyue; Zhang, Jianjun
    Phytoestrogens that abound in soy products, legumes, and chickpeas can induce biologic responses in animals and humans due to structural similarity to 17β-estradiol. Although experimental studies suggest that phytoestrogen intake may alter the risk of cancer and cardiovascular disease, few epidemiologic studies have investigated this research question. This dissertation investigated the associations of intake of total and individual phytoestrogens and their urinary biomarkers with these chronic conditions using data previously collected from two US national cohort studies (NHANES and PLCO). Utilizing NHANES data with urinary phytoestrogen concentrations and follow-up mortality, Cox proportional hazards regression (HR; 95% CI) were performed to evaluate the association between total cancer, cardiovascular disease, and all-cause mortality and urinary phytoestrogens. After adjustment for confounders, it was found that higher concentrations of lignans were associated with a reduced risk of death from cardiovascular disease (0.48; 0.24-0.97), whereas higher concentrations of isoflavones (2.14; 1.03-4.47) and daidzein (2.05; 1.02-4.11) were associated with an increased risk. A reduction in all-cause mortality was observed for elevated concentrations of lignans (0.65; 0.43-0.96) and enterolactone (0.65; 0.44-0.97). Utilizing PLCO data and dietary phytoestrogens, Cox proportional hazards regression examined the associations between dietary phytoestrogens and the risk of prostate cancer incidence. After adjustment for confounders, a positive association was found between dietary intake of isoflavones (1.58; 1.11-2.24), genistein (1.42; 1.02-1.98), daidzein (1.62; 1.13-2.32), and glycitein (1.53; 1.09-2.15) and the risk of advanced prostate cancer. Conversely, an inverse association existed between dietary intake of genistein and the risk of non-advanced prostate cancer (0.88; 0.78-0.99) and total prostate cancer (0.90; 0.81-1.00). C-reactive protein (CRP) concentration levels rise in response to inflammation and higher levels are a risk factor for some cancers and cardiovascular disease reported in epidemiologic studies. Logistic regression performed on NHANES data evaluated the association between CRP and urinary phytoestrogen concentrations. Higher concentrations of total and individual phytoestrogens were associated with lower concentrations of CRP. In summary, dietary intake of some phytoestrogens significantly modulates prostate cancer risk and cardiovascular disease mortality. It is possible that these associations may be in part mediated through the influence of phytoestrogen intake on circulating levels of C-reactive protein.
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    Health Matters: Reframing Design in Community Health Interventions
    (Office of the Vice Chancellor for Research, 2014-04-11) Hong, Youngbok; Sanematsu, Helen; Cole, Lisa; Zollinger, Terrell
    Garden on the Go, a signature obesity prevention effort, is Indiana University Health's year round mobile produce delivery program, providing fresh, affordable produce to Indianapolis neighborhoods in need. As the mobile nature of the service is well aligned with context based approaches in Service Design, the design researchers perceived potentials to reconfigure the Garden on the Go service as well as to reframe a health care service model from institution to people based. In partnership with the Garden on the Go community outreach team and the Fairbanks School of Public Health at Indiana University, design researchers from Herron School of Art and Design initiated the "Health Matters" study in 2013. The ultimate objective of the study aims to define 1. How individuals in underserved communities define health and 2. How interventions should be created and deployed to provide appropriate programing that addresses community-centered needs. The project is currently at the recruitment stage, we expect to release final research outcomes in the fall of 2014. This presentation, specifically focusing on the interdisciplinary research process, will address the role of the design researcher/ service designer in interdisciplinary settings and discuss the methodology of intervention design from the disciplinary perspective
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    Joint models for longitudinal and survival data
    (2014-07-11) Yang, Lili; Gao, Sujuan; Yu, Menggang; Tu, Wanzhu; Callahan, Christopher M.; Zollinger, Terrell
    Epidemiologic and clinical studies routinely collect longitudinal measures of multiple outcomes. These longitudinal outcomes can be used to establish the temporal order of relevant biological processes and their association with the onset of clinical symptoms. In the first part of this thesis, we proposed to use bivariate change point models for two longitudinal outcomes with a focus on estimating the correlation between the two change points. We adopted a Bayesian approach for parameter estimation and inference. In the second part, we considered the situation when time-to-event outcome is also collected along with multiple longitudinal biomarkers measured until the occurrence of the event or censoring. Joint models for longitudinal and time-to-event data can be used to estimate the association between the characteristics of the longitudinal measures over time and survival time. We developed a maximum-likelihood method to joint model multiple longitudinal biomarkers and a time-to-event outcome. In addition, we focused on predicting conditional survival probabilities and evaluating the predictive accuracy of multiple longitudinal biomarkers in the joint modeling framework. We assessed the performance of the proposed methods in simulation studies and applied the new methods to data sets from two cohort studies.
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    Listening through seeing: Using design methods to learn about the health perceptions of Garden on the Go® customers
    (2014-04-11) Sanematsu, Helen; Hong, Youngbok; Cole, Lisa; Zollinger, Terrell
    The goal of this project is to apply an innovative approach to gathering beliefs and attitudes of an inner city population in a more valid and reliable way than traditional data collection methods. This community based research study will focus on dietary risk factors for obesity, diabetes type 2, and cardiovascular disease in underserved communities. Our study assesses what health means to the underserved Garden on the Go® clients and how they define a healthy diet. Garden on the Go®, a signature obesity prevention effort, is Indiana University Health’s year-round mobile produce delivery program providing fresh, affordable produce to Marion County neighborhoods in need. We build upon previous research conducted with Garden on the Go® to enhance the effectiveness of this intervention and provide valuable information that other groups may use to improve the impact of their efforts in meeting the health needs of similar communities.