IU Indianapolis ScholarWorks :: Browsing by Author "Zollinger, Terrell W."

Browsing by Author "Zollinger, Terrell W."

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Adult BMI change and risk of Breast Cancer: National Health and Nutrition Examination Survey (NHANES) 2005-2010
(Springer-Verlag, 2015-11) Gathirua-Mwangi, Wambui G.; Zollinger, Terrell W.; Murage, Mwangi J.; Pradhan, Kamnesh R.; Champion, Victoria L.; Department of Epidemiology, Richard M. Fairbanks School of Public Health
OBJECTIVE: Breast cancer is the second leading cause of cancer mortality among women in the developed world. This study assessed the association between occurrence of breast cancer and body mass index (BMI) change from age 25 to age closest to breast cancer diagnosis while exploring the modifying effects of demographic variables. METHODS: The National Health and Nutrition Examination Survey data were used. Women included were ≥50 years, not pregnant and without a diagnosis of any cancer but breast. The total sample included 2895 women (172 with breast cancer and 2723 controls with no breast cancer diagnosis). Multivariate logistic regression was used to estimate the OR and 95 % CIs and interaction evaluated by including an interaction term in the model. RESULTS: Women whose BMI increased from normal or overweight to obese compared to those who remained at a normal BMI were found to have a 2 times higher odds (OR = 2.1; 95 % CI 1.11-3.79) of developing breast cancer. No significant association was observed for women who increased to overweight. However, a more pronounced association was observed in non-Hispanic black women (OR = 6.6; 95 % CI 1.68-25.86) and a significant association observed when they increased from normal to overweight (OR = 4.2; 95 % CI 1.02-17.75). CONCLUSIONS: Becoming obese after age 25 is associated with increased risk of breast cancer in women over 50 years old, with non-Hispanic black women being at greatest risk.
Assessment of Risk Behaviors in Patients With Opioid Prescriptions: A Study of Indiana’s Inspect Data
(Wiley, 2017-12) Greene, Marion S.; Chambers, Robert Andrew; Yiannoutsos, Constantin T.; Wright, Eric R.; Steele, Gregory K.; Zollinger, Terrell W.; Health Policy and Management, School of Public Health
Background and Objectives Prescription Drug Monitoring Programs (PDMPs) can serve as screening tools and support the clinical decision‐making process in patients receiving opioids. The objective of the study was to utilize 2014 INSPECT (Indiana's PDMP) data to identify factors that increase patients’ likelihood to engage in opioid‐related risk behaviors. Methods Based on a literature review, four risk behaviors were identified: Receiving >90 morphine milligram equivalents (MME), having >4 opioid prescribers, obtaining opioids from >4 pharmacies, and concurrent use of opioids and benzodiazepines. Two binary logistic regression analyses (engaging in at least one risk behaviors; engaging in all four risk behaviors) and an ordinal regression analysis (engaging in 0–4 risk behaviors) were conducted to identify factors associated with these opioid‐related risk behaviors. Results Of the 1,538,120 unique opioid patients included in the study, 18.4% engaged in one, 5.3% in two, 1.6% in three, and .4% in all four risk behaviors. Depending on the model, prescribing a second monthly opioid increased patients’ odds to engage in risk behaviors by a factor of 10 or more and prescribing two or more benzodiazepines annually increased the odds at least 13‐fold. Conclusions and Scientific Significance About one‐fourth of all patients consuming opioids engaged in one or more risk behaviors; higher number of opioid prescriptions and addition of even a small number of benzodiazepine prescriptions dramatically increased these odds. PDMPs can be helpful in identifying opioid users at high‐risk for misuse. This information could be used to target efforts to reduce the prescription drug epidemic.
Association between Urinary Phytoestrogens and C-reactive Protein in the Continuous National Health and Nutrition Examination Survey
(Taylor & Francis, 2017) Reger, Michael K.; Zollinger, Terrell W.; Liu, Ziyue; Jones, Josette; Zhang, Jianjun; Epidemiology, School of Public Health
Objective: A reduced risk of some cancers and cardiovascular disease associated with phytoestrogen intake may be mediated through its effect on serum C-reactive protein (CRP; an inflammation biomarker). Therefore, this study examined the associations between urinary phytoestrogens and serum CRP. Methods: Urinary phytoestrogen and serum CRP data obtained from 6009 participants aged ≥ 40 years in the continuous National Health and Nutrition Examination Survey during 1999–2010 were analyzed. Results: After adjustment for confounders, urinary concentrations of total and all individual phytoestrogens were inversely associated with serum concentrations of CRP (all p < 0.004). The largest reductions in serum CRP (mg/L) per interquartile range increase in urinary phytoestrogens (ng/mL) were observed for total phytoestrogens (β = −0.18; 95% confidence interval [CI], −0.22, −0.15), total lignan (β = −0.15; 95% CI, −0.18, −0.12), and enterolactone (β = −0.15; 95% CI, −0.19, −0.12). A decreased risk of having high CRP concentrations (≥3.0 mg/L) for quartile 4 vs quartile 1 was also found for total phytoestrogens (OR = 0.63; 95% CI, 0.53, 0.73), total lignan (OR = 0.64; 95% CI, 0.54, 0.75), and enterolactone (OR = 0.59; 95% CI, 0.51, 0.69). Conclusion: Urinary total and individual phytoestrogens were significantly inversely associated with serum CRP in a nationally representative sample of the U.S. population.
Behavioral and Mental Health Professionals 2004 and 2006 Re-Licensure Survey Report
(2010-05) Zollinger, Terrell W.; Kochhar, Komal; West, Jessica M.; Varma, Ram A.
The Indiana State Department of Health (ISDH) and the Indiana Professional Licensing Agency (IPLA) collaborated in implementing the 2004 and 2006 Indiana mental health professional re-licensure surveys. All behavioral and mental health professionals who renewed their license electronically during the 2004 and 2006 re-licensure periods under the Behavioral Health and Human Services Licensing Board were asked to complete an electronic survey instrument. The results of the special Psychiatric/Mental Health Nurse Survey conducted in 2010 are also included in this report.
Changes in Adult BMI and Waist Circumference Are Associated with Increased Risk of Advanced Colorectal Neoplasia
(Springer, 2017-11) Gathirua-Mwangi, Wambui G.; Monahan, Patrick; Song, Yiqing; Zollinger, Terrell W.; Champion, Victoria L.; Stump, Timothy E.; Imperiale, Thomas F.; Epidemiology, School of Public Health
BACKGROUND: Waist circumference (WC) is a stronger predictor of colon cancer (CRC) risk than body mass index (BMI). However, how well change in either WC or BMI predicts risk of advanced colorectal neoplasia (AN) is unclear. AIMS: To determine the relationship between change in BMI and WC from early adulthood to later age and the risk of AN and which change measure is a stronger predictor. METHODS: In 4500 adults, ages 50-80, with no previous neoplasia and undergoing screening colonoscopy, BMI and WC at age 21 and at time of screening were reported. Changes in BMI and WC were defined using universal risk cutoffs. Known CRC risk factors were controlled in the logistic models. RESULTS: Overall, model statistics showed WC change (omnibus test χ 2 = 10.15, 2 DF, p value = 0.006) was a statistically stronger predictor of AN than BMI change (omnibus test χ 2 = 5.66, 5 DF, p value = 0.34). Independent of BMI change, participants who increased WC (OR 1.44; 95% CI 1.05-1.96) or maintained a high-risk WC (OR 2.50; 95% CI 1.38-4.53) at age 21 and at screening had an increased risk of AN compared to those with a low-risk WC. Study participants who were obese at age 21 and at screening had an increased risk of AN (OR 1.87; 95% CI 1.08-3.23) compared to those who maintained a healthy BMI. Maintaining an overweight BMI or increasing BMI was not associated with AN. CONCLUSIONS: Maintaining an unhealthy BMI and WC throughout adult life may increase risk of AN. WC change may be a better predictor of AN than BMI change.
A Community Needs Assessment of the Physical Activity and Food Environment in a Predominantly Hispanic U.S. City
(Springer, 2016-09) Lebron, Cynthia; Stoutenberg, Mark; Portacio, Francia; Zollinger, Terrell W.; Department of Epidemiology, Richard M. Fairbanks School of Public Health
Introduction: Hispanics suffer disproportionately compared with non-Hispanic Whites from health conditions that are affected by physical inactivity and poor dietary habits. Method: A needs assessment was conducted in Hialeah, Florida, the largest enclave of Cubans in the United States, to assess the perspectives of community stakeholders and members regarding the roles of physical activity and nutrition environments. Interviews were performed with community stakeholders (n = 21), and responses were grouped into major themes. Surveys were conducted with community members (n = 85). Descriptive analyses were used to categorize responses and potential differences across responses were explored. Results: Both community members and stakeholders reported that the local park system was a major asset to healthy living in Hialeah and agreed that traffic issues and a lack of walkability were major barriers to being physically active; however, there was variability in the response to the quality of the food environment. Conclusion: The perspectives of the community members and stakeholders will be valuable in highlighting pathways to enhancing the health and wellness of the residents of Hialeah.
Data Brief: Indiana Physician Assistants 2012
(2014-06) Banti, Sudha; Barclay, Jonathan; Sheff, Zachary T.; Allen, Deborah I.; Zollinger, Terrell W.
The physician assistant (PA) workforce in Indiana is growing quickly. Since 2004, the estimated number of non‐government − employed PAs actively working in Indiana has more than doubled, from less than 400 in 2004 to nearly 900 in 2012.
Dental Workforce Report of Indiana University School of Dentistry Graduates and Other Practicing Dentists in Indiana
(2014-05) Kochhar, Komal; Zollinger, Terrell W.; Saywell, Robert M. Jr; Buente, Bryce B.
All dentists who renewed their Indiana licenses on - line in 2010 or 2012 were asked to complete a voluntary survey instrument that ha d a 95.4% response rate 1 in 2010 and 80.7% response rate 2 in 2012. The purpose of this study was to describe the dental workforce in Indiana with a focus on comparing graduates from the Indiana University School of Dentistry (IUSD) to all other practicing ( n on - IUSD ) dentists in Indiana. Of primary interest is how well the graduates of IUSD are meeting the oral health needs of the population of the state, particularly in the rural and underserved areas. Using data from the Office of Alumni Relations at IUPUI, license numbers of IUSD alumni were matched to the license numbers of individuals in the 2010 or 2012 Indiana Dentist Licensure Survey datasets. Individuals whose license numbers matched with the alumni list were identified as “IUSD” graduates and those that did not match were identified as “non - IUSD” graduates. This report compares responses between 2,203 IUSD and 835 n on - IUSD graduates who renewed their licenses and completed the Indiana Dentist Licensure Surveys in 2010 or 2012, respectively. Lastly, most of the differences between groups were found to be statistically significant due to the large sample size of IUSD graduates compared to non - IUSD graduates. Thus, for the purposes of this report if the differences between groups were noted to be at least 10 percent they were considered remarkable and reported as such.
Dietary intake of isoflavones and coumestrol and the risk of prostate cancer in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial
(Wiley, 2018-02) Reger, Michael K.; Zollinger, Terrell W.; Liu, Ziyue; Jones, Josette F.; Zhang, Jianjun; Epidemiology, School of Public Health
Experimental studies have revealed that phytoestrogens may modulate the risk of certain sites of cancer due to their structural similarity to 17β‐estradiol. The present study investigates whether intake of these compounds may influence prostate cancer risk in human populations. During a median follow up of 11.5 years, 2,598 cases of prostate cancer (including 287 advanced cases) have been identified among 27,004 men in the intervention arm of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Dietary intake of phytoestrogens (excluding lignans) was assessed with a food frequency questionnaire. Cox proportional hazards regression analysis was performed to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for dietary isoflavones and coumestrol in relation to prostate cancer risk. After adjustment for confounders, an increased risk of advanced prostate cancer [HR (95% CI) for quintile (Q) 5 vs. Q1] was found for the dietary intake of total isoflavones [1.91 (1.25–2.92)], genistein [1.51 (1.02–2.22), daidzein [1.80 (1.18–2.75) and glycitein [1.67 (1.15–2.43)] (p‐trend for all associations ≤0.05). For example, HR (95% CI) for comparing the Q2, Q3, Q4 and Q5 with Q1 of daidzein intake was 1.45 (0.93–2.25), 1.65 (1.07–2.54), 1.73 (1.13–2.66) and 1.80 (1.18–2.75), respectively (p‐trend: 0.013). No statistically significant associations were observed between the intake of total isoflavones and individual phytoestrogens and non‐advanced and total prostate cancer after adjustment for confounders. This study revealed that dietary intake of isoflavones was associated with an elevated risk of advanced prostate cancer.
Differences in cervical cancer screening knowledge, practices, and beliefs: An examination of survey responses
(Elsevier, 2016-12-21) Kasting, Monica L.; Wilson, Shannon; Zollinger, Terrell W.; Dixon, Brian E.; Stupiansky, Nathan W.; Zimet, Gregory D.; Department of Epidemiology, Richard M. Fairbanks School of Public Health
Among the identified barriers to HPV vaccination is the concern that women may compensate for their reduced susceptibility to cervical cancers by reducing cervical cancer screening. This exploratory study examined the relationship between cervical cancer screening rates and HPV vaccination. We conducted a cross-sectional survey using a convenience sample of women aged 21-35 attending a local minority health fair in July 2015. Data were analyzed in 2015-2016. Outcomes assessed were: receiving a Pap test within the last three years, awareness and comfort with current Pap test recommendations, and knowledge regarding the purpose of a Pap test. A total of 291 women were included in the analyses. Mean age was 28.5 years and 62% were non-Hispanic black. 84% had received a Pap test in the last three years and 33% had received at least one HPV vaccine. Logistic regression results showed that women who had been vaccinated did not have lower odds of having a Pap test in the past three years (OR = 1.32; 95% CI = 0.66-2.65). In an adjusted regression model controlling for age and race, vaccinated women were significantly more likely to have had a Pap test (AOR = 3.06; 95% CI = 1.37-6.83). Yet only 26% of women knew the purpose of a Pap test and the proportion who answered correctly was higher among non-Hispanic white women. Women who have been vaccinated for HPV are more likely to have been screened for cervical cancer. These results suggest areas for more robust studies examining pro-health attitudes, behaviors, and communication regarding vaccination and preventive screening.

Browsing by Author "Zollinger, Terrell W."

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