Public Health Commons^™

A More Powerful Test For Three-Arm Non-Inferiority Via Risk Difference: Frequentist And Bayesian Approaches, Erina Paul, Ram C Tiwari, Shrabanti Chowdhury, Samiran Ghosh

Faculty, Staff and Student Publications

Necessity for finding improved intervention in many legacy therapeutic areas are of high priority. This has the potential to decrease the expense of medical care and poor outcomes for many patients. Typically, clinical efficacy is the primary evaluating criteria to measure any beneficial effect of a treatment. Albeit, there could be situations when several other factors (e.g. side-effects, cost-burden, less debilitating, less intensive, etc.) which can permit some slightly less efficacious treatment options favorable to a subgroup of patients. This often leads to non-inferiority (NI) testing. NI trials may or may not include a placebo arm due to ethical reasons. …

Genome-Wide Mendelian Randomization Identifies Putatively Causal Gut Microbiota For Multiple Peptic Ulcer Diseases, Jingwei Zhao, Yucheng Hou, Tianyi Xie, Yizhang Zhu, Xinyi Feng, Yong Zhang, Ziyi Yang, Wei Gong

Faculty, Staff and Student Publications

OBJECTIVE: The pathogenesis of peptic ulcer diseases (PUDs) involves multiple factors, and the contribution of gut microbiota to this process remains unclear. While previous studies have associated gut microbiota with peptic ulcers, the precise nature of the relationship, whether causal or influenced by biases, requires further elucidation.

DESIGN: The largest meta-analysis of genome-wide association studies was conducted by the MiBioGen consortium, which provided the summary statistics of gut microbiota for implementation in the Mendelian randomization (MR) analysis. Summary statistics for five types of PUDs were compiled using the FinnGen Consortium R8 release data. Various statistical techniques, including inverse variance weighting …

Regional Outbreak Of Multidrug-Resistant Klebsiella Pneumoniae Carbapenemase-Producing Pseudomonas Aeruginosa, Bekana K Tadese, Anna Nutt, Ifrah Chaudhary, Charlene Offiong, Charles Darkoh

Faculty, Staff and Student Publications

Klebsiella pneumoniae carbapenemase-producing P. aeruginosa (KPC-CRPA) are rare in the United States. An outbreak of KPC-CRPA was investigated in Texas using molecular and epidemiologic methods and 17 cases of KPC-CRPA were identified. The isolates were genetically related and harbored the emerging P. aeruginosa multilocus sequence type 235, the first in the United States.

Incidence Trends In Triple-Negative Breast Cancer Among Women In The United States From 2010 To 2019 By Race/Ethnicity, Age And Tumor Stage, Xianglin L Du, Zhuoyun Li

Faculty, Staff and Student Publications

There were substantial ethnic disparities in the incidence rates of triple-negative breast cancer, but few studies were conducted on the incidence trend of triple-negative breast cancer by race/ethnicity. This study aimed to address the longer trends in the incidence of triple-negative breast cancer by race/ethnicity in women from 2010 to 2019, examine the incidence trends by patient age, tumor stage and time periods, and explore the changing proportions of three component receptors over time for triple-negative breast cancer. Our study identified 573,168 women with incident breast cancer at age ≥20 years between 2010 and 2019 in 18 SEER (Surveillance, Epidemiology, …

Toward A More Comprehensive Understanding Of Organizational Influences On Implementation: The Organization Theory For Implementation Science Framework, Sarah A Birken, Cheyenne R Wagi, Alexandra G Peluso, Michelle C Kegler, Jure Baloh, Prajakta Adsul, Maria E Fernandez, Manal Masud, Terry T-K Huang, Matthew Lee, Mary Wangen, Per Nilsen, Miriam Bender, Mimi Choy-Brown, Grace Ryan, Aliza Randazzo, Linda K Ko

Faculty, Staff and Student Publications

INTRODUCTION: Implementation is influenced by factors beyond individual clinical settings. Nevertheless, implementation research often focuses on factors related to individual providers and practices, potentially due to limitations of available frameworks. Extant frameworks do not adequately capture the myriad organizational influences on implementation. Organization theories capture diverse organizational influences but remain underused in implementation science. to advance their use among implementation scientists, we distilled 70 constructs from nine organization theories identified in our previous work into theoretical domains in the Organization Theory for Implementation Science (OTIS) framework.

METHODS: The process of distilling organization theory constructs into domains involved concept mapping and …

Health-Related Quality Of Life And Recovery Capital Among Recovery Residents Taking Medication For Opioid Use Disorder In Texas, Elizabeth O Obekpa, Sheryl A Mccurdy, Vanessa Schick, Christine M Markham, Kathryn R Gallardo, Johnny Michael Wilkerson

Faculty, Staff and Student Publications

BACKGROUND: Recovery from opioid use disorder (OUD) includes improvements in health-related quality of life (HRQOL) and is supported by recovery capital (RC). Little is known about RC and HRQOL among recovery residents taking medication for OUD. We described HRQOL and RC and identified predictors of HRQOL.

METHODS: Project HOMES is an ongoing longitudinal study implemented in 14 recovery homes in Texas. This is a cross-sectional analysis of data from 358 participants' on HRQOL (five EQ-5D-5L dimensions-mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and RC (Assessment of Recovery Capital scores) collected from April 2021 to June 2023. Statistical analyses were conducted …

Observed And Perceived Benefits Of Providing Physical Activity Opportunities In Elementary Schools: A Qualitative Study, Timothy J Walker, Derek W Craig, Christopher D Pfledderer, Michael C Robertson, Paula Cuccaro, Keisey Fumero, John B Bartholomew

Faculty, Staff and Student Publications

INTRODUCTION: Schools play an important role in promoting physical activity for youth. However, school-based physical activity opportunities often compete with other academic priorities, limiting their implementation. The purpose of this study was to qualitatively explore elementary school teacher and staff perspectives on providing physical activity opportunities and how they impact students and learning.

METHODS: We partnered with a school district in Texas to conduct semi-structured individual interviews. We used a purposeful sampling approach to recruit elementary teachers and staff knowledgeable about the physical activity opportunities provided at their school. Interviews included questions about participant opinions of providing physical activity opportunities …

Elementary School Staff Perspectives On The Implementation Of Physical Activity Approaches In Practice: An Exploratory Sequential Mixed Methods Study, Timothy J Walker, Christopher D Pfledderer, Derek W Craig, Michael C Robertson, Natalia I Heredia, John B Bartholomew

Faculty, Staff and Student Publications

INTRODUCTION: A whole-of-school approach is best to promote physical activity before, during, and after school. However, multicomponent programming is often complex and difficult to deliver in school settings. There is a need to better understand how components of a whole-of-school approach are implemented in practice. The objectives of this mixed methods study were to: (1) qualitatively explore physical activity approaches and their implementation in elementary schools, (2) quantitatively assess implementation levels, and (3) examine associations between school-level physical activity promotion and academic ratings.

METHODS: We used an exploratory sequential mixed methods design. We conducted semi-structured qualitative interviews with elementary school …

Do Breast Cancer Survivors With A Recent History Of Clinical Depression Report Worse Experiences With Care? A Retrospective Cohort Study Using Seer-Cahps Data, Mariana Arevalo, Trevor A Pickering, Sally W Vernon, Kayo Fujimoto, Melissa F Peskin, Albert J Farias

Faculty, Staff and Student Publications

PURPOSE: We examined whether breast cancer survivors' experiences with care differed by a recent history of clinical depression, and whether associations differed by race/ethnicity.

METHODS: Using the Epidemiology and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) dataset, we analyzed records of breast cancer survivors who completed a survey at least 12 months after their cancer diagnosis. We assessed clinical depression 12 months prior to survey completion using Medicare claims. We used separate multivariable logistic regressions to examine the associations between depression and excellent (vs. less than excellent) ratings of experiences with care (i.e., doctor communication, getting needed care, …

Semiparametric Regression Modeling Of The Global Percentile Outcome, Xiangyu Liu, Jing Ning, Xuming He, Barbara C Tilley, Ruosha Li

Faculty, Staff and Student Publications

When no single outcome is sufficient to capture the multidimensional impairments of a disease, investigators often rely on multiple outcomes for comprehensive assessment of global disease status. Methods for assessing covariate effects on global disease status include the composite outcome and global test procedures. One global test procedure is the O'Brien's rank-sum test, which combines information from multiple outcomes using a global rank-sum score. However, existing methods for the global rank-sum do not lend themselves to regression modeling. We consider sensible regression strategies for the global percentile outcome (GPO), under the transformed linear model and the monotonic index model. Posing …

Biomimetic Copper-Doped Polypyrrole Nanoparticles For Enhanced Cancer Low-Temperature Photothermal Therapy, Hao Chen, Xi Luo, Wei Cai, Shile Wang, Jingfeng Xiang, Zeming Liu, Daoming Zhu

Faculty, Staff and Student Publications

INTRODUCTION: Photothermal therapy (PTT) has a significant potential for its application in precision tumour therapy. However, PTT-induced hyperthermia may damage healthy tissues and trigger the expression of heat shock proteins (HSPs), thereby compromising the long-term therapeutic efficacy of PTT.

METHODS: In this study, a biomimetic drug delivery system comprising CuP nanozymes as the inner core and platelet membrane (PM) as the outer shell was successfully developed for administering synergistic chemodynamic therapy and mild PTT. PM is encapsulated on CuP to form this biomimetic nanoparticle (PM-coated CuP nanoparticles, PC). PC possesses peroxidase (POD) activity, can facilitate the conversion of hydrogen peroxide …

The 18-Year Risk Of Cancer, Angioedema, Insomnia, Depression, And Erectile Dysfunction In Association With Antihypertensive Drugs: Post-Trial Analyses From Allhat-Medicare Linked Data, Xianglin L Du, Journey Martinez, Jose-Miguel Yamal, Lara M Simpson, Barry R Davis

Faculty, Staff and Student Publications

PURPOSE: This study aimed to determine the 18-year risk of cancer, angioedema, insomnia, depression, and erectile dysfunction in association with antihypertensive drug use.

METHODS: This is a post-trial passive follow-up study of Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants between 1994 and 1998 that was conducted by linking their follow-up data with Medicare claims data until 2017 of subjects who were free of outcomes at baseline on 1 January 1999. The main outcomes were the occurrence of cancer (among

RESULTS: The 18-year cumulative incidence rate of cancer other than non-melanoma skin cancer from Medicare inpatient claims …

Understanding The Implications Of Under-Reporting, Vaccine Efficiency And Social Behavior On The Post-Pandemic Spread Using Physics Informed Neural Networks: A Case Study Of China, Samiran Ghosh, Alonso Ogueda-Oliva, Aditi Ghosh, Malay Banerjee, Padmanabhan Seshaiyer

Faculty, Staff and Student Publications

In late 2019, the emergence of COVID-19 in Wuhan, China, led to the implementation of stringent measures forming the zero-COVID policy aimed at eliminating transmission. Zero-COVID policy basically aimed at completely eliminating the transmission of COVID-19. However, the relaxation of this policy in late 2022 reportedly resulted in a rapid surge of COVID-19 cases. The aim of this work is to investigate the factors contributing to this outbreak using a new SEIR-type epidemic model with time-dependent level of immunity. Our model incorporates a time-dependent level of immunity considering vaccine doses administered and time-post-vaccination dependent vaccine efficacy. We find that vaccine …

A Satellite-Driven Model To Estimate Long-Term Particulate Sulfate Levels And Attributable Mortality Burden In China, Xia Meng, Yun Hang, Xiuran Lin, Tiantian Li, Tijian Wang, Junji Cao, Qingyan Fu, Sagnik Dey, Kan Huang, Fengchao Liang, Haidong Kan, Xiaoming Shi, Yang Liu

Faculty, Staff and Student Publications

Ambient fine particulate matter (PM

Transcription Factor E2f1 Regulates The Expression Of Adrb2, Juan Du, Feifei Rui, Zhongfen Hao, Yun Hang, Jin Shu

Faculty, Staff and Student Publications

Adrenergic beta-2-receptor (ADRB2) is highly expressed in various tissue cells, affecting the susceptibility, development, and drug efficacy of diseases such as bronchial asthma and malignant tumor. However, the transcriptional regulatory mechanism of the human ADRB2 gene remains unclear. This study aimed to clarify whether E2F transcription factor 1 (E2F1) was involved in the transcriptional regulation of the human ADRB2 gene. First, the 5' flanking region of the human ADRB2 gene was cloned, and its activity was detected using A549 and BEAS-2B cells. Second, it was found that the overexpression of E2F1 could increase promoter activity by a dual-luciferase reporter gene …

Whole Genome Sequence Analysis Of Apparent Treatment Resistant Hypertension Status In Participants From The Trans-Omics For Precision Medicine Program, Nicole D Armstrong, Vinodh Srinivasasainagendra, Farah Ammous, Themistocles L Assimes, Amber L Beitelshees, Jennifer Brody, Brian E Cade, Yii-Der Ida Chen, Han Chen, Paul S De Vries, James S Floyd, Nora Franceschini, Xiuqing Guo, Jacklyn N Hellwege, John S House, Chii-Min Hwu, Sharon L R Kardia, Ethan M Lange, Leslie A Lange, Caitrin W Mcdonough, May E Montasser, Jeffrey R O'Connell, Megan M Shuey, Xiao Sun, Rikki M Tanner, Zhe Wang, Wei Zhao, April P Carson, Todd L Edwards, Tanika N Kelly, Eimear E Kenny, Charles Kooperberg, Ruth J F Loos, Alanna C Morrison, Alison Motsinger-Reif, Bruce M Psaty, Dabeeru C Rao, Susan Redline, Stephen S Rich, Jerome I Rotter, Jennifer A Smith, Albert V Smith, Marguerite R Irvin, Donna K Arnett

Faculty, Staff and Student Publications

Introduction: Apparent treatment-resistant hypertension (aTRH) is characterized by the use of four or more antihypertensive (AHT) classes to achieve blood pressure (BP) control. In the current study, we conducted single-variant and gene-based analyses of aTRH among individuals from 12 Trans-Omics for Precision Medicine cohorts with whole-genome sequencing data.

Methods: Cases were defined as individuals treated for hypertension (HTN) taking three different AHT classes, with average systolic BP ≥ 140 or diastolic BP ≥ 90 mmHg, or four or more medications regardless of BP (n = 1,705). A normotensive control group was defined as individuals with BP < 140/90 mmHg (n = 22,079), not on AHT medication. A second control group comprised individuals who were treatment responsive on one AHT medication with BP < 140/ 90 mmHg (n = 5,424). Logistic regression with kinship adjustment using the Scalable and Accurate Implementation of Generalized mixed models (SAIGE) was performed, adjusting for age, sex, and genetic ancestry. We assessed variants using SKAT-O in rare-variant analyses. Single-variant and gene-based tests were conducted in a pooled multi-ethnicity stratum, as well as self-reported ethnic/racial strata (European and African American).

Results: One variant in …

Fakestack: Hierarchical Tri-Bert-Cnn-Lstm Stacked Model For Effective Fake News Detection, Ashfia Jannat Keya, Hasibul Hossain Shajeeb, Md Saifur Rahman, M F Mridha

Faculty, Staff and Student Publications

False news articles pose a serious challenge in today's information landscape, impacting public opinion and decision-making. Efforts to counter this issue have led to research in deep learning and machine learning methods. However, a gap exists in effectively using contextual cues and skip connections within models, limiting the development of comprehensive detection systems that harness contextual information and vital data propagation. Thus, we propose a model of deep learning, FakeStack, in order to identify bogus news accurately. The model combines the power of pre-trained Bidirectional Encoder Representation of Transformers (BERT) embeddings with a deep Convolutional Neural Network (CNN) having skip …

Automated Type 2 Diabetes Case And Control Identification From The Mimic-Iv Database, Wanheng Zhang, Tru Cao

Faculty, Staff and Student Publications

Phenotyping for Type 2 Diabetes (T2DM) is needed due to the increasing demand for T2DM research on electronic health records (EHRs). eMERGE is a reliable and interpretable rule-based algorithm for the identification of T2DM cases and controls in EHRs. MIMIC-IV, an extension of MIMIC-III, contains more than 520,000 hospital admissions and has become a valuable EHR database for secondary medical research. However, there was no prior work to extract T2DM cases and controls from MIMIC-IV, which requires a comprehensive knowledge of the database. Our work provided insight into the structure and data elements in MIMIC-IV and adapted eMERGE to accomplish …

Age And Sex-Specific Stroke Epidemiology In Covid-19, Youngran Kim, Maria A Parekh, Xiaojin Li, Yan Huang, Guo-Qiang Zhang, Bharti Manwani

Faculty, Staff and Student Publications

BACKGROUND: COVID-19 has emerged as an independent risk factor for stroke. We aimed to determine age and sex-specific stroke incidence and risk factors with COVID-19 in the US using a large electronic health record (EHR) that included both inpatients and outpatients.

METHODS: A retrospective cohort study was conducted using individual-level data from Optum

RESULTS: Of 387,330 COVID-19 patients, 2,752 patients (0.71%, 95% CI 0.68-0.74) developed stroke during the 180-day follow-up, AIS in 0.65% (95% CI 0.62-0.67), and ICH in 0.11% (95% CI 0.10-0.12). Of strokes among COVID-19 patients, 57% occurred within 3 days. Advanced age was associated with a substantially …

Proteomic Analysis Of Diabetes Genetic Risk Scores Identifies Complement C2 And Neuropilin-2 As Predictors Of Type 2 Diabetes: The Atherosclerosis Risk In Communities (Aric) Study, Brian T Steffen, Weihong Tang, Pamela L Lutsey, Ryan T Demmer, Elizabeth Selvin, Kunihiro Matsushita, Alanna C Morrison, Weihua Guan, Mary R Rooney, Faye L Norby, Nathan Pankratz, David Couper, James S Pankow

Faculty, Staff and Student Publications

AIMS/HYPOTHESIS: Genetic predisposition to type 2 diabetes is well-established, and genetic risk scores (GRS) have been developed that capture heritable liabilities for type 2 diabetes phenotypes. However, the proteins through which these genetic variants influence risk have not been thoroughly investigated. This study aimed to identify proteins and pathways through which type 2 diabetes risk variants may influence pathophysiology.

METHODS: Using a proteomics data-driven approach in a discovery sample of 7241 White participants in the Atherosclerosis Risk in Communities Study (ARIC) cohort and a replication sample of 1674 Black ARIC participants, we interrogated plasma levels of 4870 proteins and four …

Effect Of "Maccog" Tcm Tea On Improving Glucolipid Metabolism And Gut Microbiota In Patients With Type 2 Diabetes In Community, Biyue Hu, Tongtong Yin, Jiajia Zhang, Minjing Liu, Hang Yun, Jian Wang, Renmei Guo, Jie Huang, Yixia Zhou, Hongyan Meng, Li Wang

Faculty, Staff and Student Publications

OBJECTIVES: This work aimed to observe the effect of consuming Chinese herb tea on glucolipid metabolism and gut microbiota in patients with type 2 diabetes mellitus (T2DM).

METHODS: Ninety patients with T2DM were recruited from a community and randomly divided into the control group (CG) and intervention group (IG). CG maintained conventional treatment and lifestyle, and IG accepted additional "maccog" traditional Chinese medicine (TCM) tea (mulberry leaf, radix astragali, corn stigma, cortex lycii, radix ophiopogonis, and gynostemma) for 12 weeks. Glucolipid metabolism, hepatorenal function, and gut microbiota were then measured.

RESULTS: After the intervention, the decreases in fasting plasma glucose …

Post-Acute Sequelae Of Covid-19 And Longitudinal Antibody Levels In A Community-Based Cohort, Noa Kopplin, Angie Garcia, Annika Reczek, Kate Wilkinson, Sruthi Yekkaluri, Caitlin C Murphy, Jasmin Tiro, Alagar R Muthukumar, Andrew Masica, Amit G Singal

Faculty, Staff and Student Publications

BACKGROUND: Coronavirus disease 2019 (COVID-19) infection invokes variable immune responses and poses a risk of post-acute sequelae SARS-CoV-2 infection (PASC) symptoms; however, most data on natural history are derived from patients with severe infection. Further data are needed among patients with mild infection, who comprise most cases.

METHODS: The Dallas Fort-Worth (DFW) COVID-19 Prevalence Study included 21,597 community-dwelling adults (ages 18-89) who underwent COVID-19 PCR and anti-nucleocapsid antibody testing between July 2020 and March 2021. We invited participants with positive COVID-19 results (cases) and a subset with negative results (controls), matched on age, sex, race/ethnicity, and ZIP code, to complete …

Do Breast Cancer Survivors With A Recent History Of Clinical Depression Report Worse Experiences With Care? A Retrospective Cohort Study Using Seer-Cahps Data, Mariana Arevalo, Trevor A Pickering, Sally W Vernon, Kayo Fujimoto, Melissa F Peskin, Albert J Farias

Faculty, Staff and Student Publications

PURPOSE: We examined whether breast cancer survivors' experiences with care differed by a recent history of clinical depression, and whether associations differed by race/ethnicity.

METHODS: Using the Epidemiology and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) dataset, we analyzed records of breast cancer survivors who completed a survey at least 12 months after their cancer diagnosis. We assessed clinical depression 12 months prior to survey completion using Medicare claims. We used separate multivariable logistic regressions to examine the associations between depression and excellent (vs. less than excellent) ratings of experiences with care (i.e., doctor communication, getting needed care, …

Application Of Implementation Mapping To Develop Strategies For Integrating The National Diabetes Prevention Program Into Primary Care Clinics, William B Perkison, Serena A Rodriguez, Fernanda Velasco-Huerta, Patenne D Mathews, Catherine Pulicken, Sidra S Beg, Natalia I Heredia, Pierre Fwelo, Grace E White, Belinda M Reininger, John W Mcwhorter, Roshanda Chenier, Maria E Fernandez

Faculty, Staff and Student Publications

BACKGROUND: Diabetes is considered one of the most prevalent and preventable chronic health conditions in the United States. Research has shown that evidence-based prevention measures and lifestyle changes can help lower the risk of developing diabetes. The National Diabetes Prevention Program (National DPP) is an evidence-based program recognized by the Centers for Disease Control and Prevention; it is designed to reduce diabetes risk through intensive group counseling in nutrition, physical activity, and behavioral management. Factors known to influence this program's implementation, especially in primary care settings, have included limited awareness of the program, lack of standard clinical processes to facilitate …

Understanding The Influence Of Atomizing Power On Electronic Cigarette Aerosol Size And Inhalation Dose Estimation, Jinho Lee, Wei-Chung Su, Inkyu Han

Faculty, Staff and Student Publications

Although many studies have estimated the inhalation dose of aerosols emitted from electronic cigarettes (e-cigs), the association between the atomizing power and inhalation dose of e-cig aerosols has not been fully examined. The aim of this study was to determine the mass and inhalation doses of e-cig aerosols and their association with the atomizing power of vaping devices. Size-segregated aerosol masses were collected using an 11-stage cascade impactor and the deposition dose in the human respiratory tract was estimated using the size-segregated aerosol mass. The results showed that an increase in atomizing power was positively associated with the amount of …

An Open-Source System For Efficient Clinical Trial Support: The Comet Study Experience, Jonathan Clutton, Robert Neal Montgomery, Dinesh Pal Mudaranthakam, Erin M Blocker, Ashley R Shaw, Amanda N Szabo Reed, Eric D Vidoni

Faculty, Staff and Student Publications

Exercise clinical trials are complex, logistically burdensome, and require a well-coordinated multi-disciplinary approach. Challenges include managing, curating, and reporting on many disparate information sources, while remaining responsive to a variety of stakeholders. The Combined Exercise Trial (COMET, NCT04848038) is a one-year comparison of three exercise modalities delivered in the community. Target enrollment is 280 individuals over 4 years. To support rigorous execution of COMET, the study team has developed a suite of scripts and dashboards to assist study stakeholders in each of their various functions. The result is a highly automated study system that preserves rigor, increases communication, and reduces …

Reimbursement For Hpv Vaccine Cost In The Private Sector: A Comparison Across Specialties, Yenan Zhu, Yueh-Yun Lin, Ruosha Li, Cara He, David R Lairson, Ashish A Deshmukh, Kalyani Sonawane

Faculty, Staff and Student Publications

The human papillomavirus (HPV) vaccine is the most expensive of all routinely recommended pediatric vaccines. Adequate cost reimbursement by 3rd-party payers is a critical enabling factor for clinicians to continue offering vaccines. This study found that net returns from HPV vaccine cost reimbursements are lowest for family physicians ($0.34/dose) and highest for pediatricians ($5.08/dose). Furthermore, a $1 increment in return was associated with an increase in HPV vaccine doses administered (highest for family physicians; 0.08% per dollar). Reimbursement for HPV vaccine costs by private payers is adequate; however, return margins are small for non-pediatric specialties.

Survival Of Cancer Survivors With A New Pancreatic Cancer Diagnosis, Sandi L Pruitt, Anna Tavakkoli, Hong Zhu, Daniel F Heitjan, David E Gerber, Amit G Singal, Ethan A Halm, Muhammad Shaalan Beg, Bhumika Maddineni, Ankit J Kansagra, Caitlin C Murphy

Faculty, Staff and Student Publications

BACKGROUND: Persons newly diagnosed with pancreas cancer and who have survived a previous cancer are often excluded from clinical trials, despite limited evidence about their prognosis. We examined the association between previous cancer and overall survival.

METHODS: This US population-based cohort study included older adults (aged ≥66 years) diagnosed with pancreas cancer between 2005 and 2015 in the linked Surveillance, Epidemiology, and End Results-Medicare data. We used Cox proportional hazards models to estimate stage-specific effects of previous cancer on overall survival, adjusting for sociodemographic, treatment, and tumor characteristics.

RESULTS: Of 32,783 patients, 18.7% were previously diagnosed with another cancer. The …

Designing And Pilot-Testing Smokefreesgm: A Text-Based Smoking Cessation Intervention For Sexual And Gender Minority Groups, Rebecca Klaff, Samuel Tundealao, Brittany Krenek, Irene Tamí-Maury

Faculty, Staff and Student Publications

BACKGROUND: Although the prevalence of smoking is significantly higher among sexual and gender minorities (SGM) than the general population, no text-based smoking cessation intervention has been specifically tailored to this group. The objective of this phase of our study was to develop SmokefreeSGM, an SGM-tailored text-based smoking cessation program, and pilot test its design to inform the refinement of the program.

METHODS: SmokefreeSGM was adapted from SmokefreeTXT, the National Cancer Institute's text-based smoking cessation program, to respond to the needs of SGM smokers. In addition to tailored text messages, SmokefreeSGM includes a new keyword, STRESS, to address the unique psychosocial …

Plasma Protein Biomarkers Of Healthy Dietary Patterns: Results From The Atherosclerosis Risk In Communities Study And The Framingham Heart Study, Shutong Du, Jingsha Chen, Hyunju Kim, Maura E Walker, Alice H Lichtenstein, Nilanjan Chatterjee, Peter Ganz, Bing Yu, Ramachandran S Vasan, Josef Coresh, Casey M Rebholz

Faculty, Staff and Student Publications

Background: Molecular mechanisms underlying the benefits of healthy dietary patterns are poorly understood. Identifying protein biomarkers of dietary patterns can contribute to characterizing biological pathways influenced by food intake.

Objectives: This study aimed to identify protein biomarkers associated with four indexes of healthy dietary patterns: Healthy Eating Index-2015 (HEI-2015); Alternative Healthy Eating Index-2010 (AHEI-2010); DASH diet; and alternate Mediterranean Diet (aMED).

Methods: Analyses were conducted on 10,490 Black and White men and women aged 49-73 y from the ARIC study at visit 3 (1993-1995). Dietary intake data were collected using a food frequency questionnaire, and plasma proteins were quantified using …