Epidemiology & Biostatistics Research Works

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Leveraging 13 million responses to the U.S. COVID-19 Trends and Impact Survey to examine vaccine hesitancy, vaccination, and mask wearing, January 2021-February 2022
(Springer Nature, 2022-10-13) Nguyen, Quynh C.; Yardi, Isha; Gutierrez, Francia Ximena Marin; Mane, Heran; Yue, Xiaohe
The urgency of the COVID-19 pandemic called upon the joint efforts from the scientific and private sectors to work together to track vaccine acceptance and prevention behaviors. Our study utilized individual responses to the Delphi Group at Carnegie Mellon University U.S. COVID-19 Trends and Impact Survey, in partnership with Facebook. We retrieved survey data from January 2021 to February 2022 (n = 13,426,245) to examine contextual and individual-level predictors of COVID-19 vaccine hesitancy, vaccination, and mask wearing in the United States. Adjusted logistic regression models were developed to examine individual and ZIP code predictors of COVID-19 vaccine hesitancy and vaccination status. Given the COVID-19 vaccine was rolled out in phases in the U.S. we conducted analyses stratified by time, January 2021-May 2021 (Time 1) and June 2021-February 2022 (Time 2). In January 2021 only 9% of U.S. Facebook respondents reported receiving the COVID-19 vaccine, and 45% were vaccine hesitant. By February 2022, 80% of U.S. Facebook respondents were vaccinated and only 18% were vaccine hesitant. Individuals who were older, held higher educational degrees, worked in white collar jobs, wore a mask most or all the time, and identified as white and Asian had higher COVID-19 vaccination rates and lower vaccine hesitancy across Time 1 and Time 2. Essential workers and blue-collar occupations had lower COVID vaccinations and higher vaccine hesitancy. By Time 2, all adults were eligible for the COVID-19 vaccine, but blacks and multiracial individuals had lower vaccination and higher vaccine hesitancy compared to whites. Those 55 years and older and females had higher odds of wearing masks most or all the time. Protective service, construction, and installation and repair occupations had lower odds of wearing masks. ZIP Code level percentage of the population with a bachelors’ which was associated with mask wearing, higher vaccination, and lower vaccine hesitancy. Associations found in earlier phases of the pandemic were generally found to also be present later in the pandemic, indicating stability in inequities. Additionally, inequities in these important outcomes suggests more work is needed to bridge gaps to ensure that the burden of COVID-19 risk does not disproportionately fall upon subgroups of the population.
Food insecurity among African Americans in the United States: A scoping review
(2022-09-12) Dennard, Elizabeth; Kristjansson, Elizabeth; Tchangalova, Nedelina; Totton, Sarah; Winham, Donna; O’Connor, Annette
In 2019, the estimated prevalence of food insecurity for Black non-Hispanic households was higher than the national average due to health disparities exacerbated by forms of racial discrimination. During the COVID-19 pandemic, Black households have experienced higher rates of food insecurity when compared to other populations in the United States. The primary objectives of this review were to identify which risk factors have been investigated for an association with food insecurity, describe how food insecurity is measured across studies that have evaluated this outcome among African Americans, and determine which dimensions of food security (food accessibility, availability, and utilization) are captured by risk factors studied by authors. Food insecurity related studies were identified through a search of Google Scholar, PubMed, CINAHL Plus, MEDLINE®, PsycINFO, Health Source: Nursing/Academic Edition, and Web of Science™ (Clarivate), on May 20, 2021. Eligible studies were primary research studies, with a concurrent comparison group, published in English between 1995 and 2021. Ninety-eight relevant studies were included for data charting with 37 unique measurement tools, 115 risk factors, and 93 possible consequences of food insecurity identified. Few studies examined factors linked to racial discrimination, behaviour, or risk factors that mapped to the food availability dimension of food security. Infrequently studied factors, such as lifetime racial discrimination, socioeconomic status (SES), and income insecurity need further investigation while frequently studied factors such as age, education, race/ethnicity, and gender need to be summarized using a systematic review approach so that risk factor impact can be better assessed. Risk factors linked to racial discrimination and food insecurity need to be better understood in order to minimize health disparities among African American adults during the COVID-19 pandemic and beyond.
Strategies to increase happiness and wellbeing among public health students, faculty and staff
(2022-07-01) Carter-Pokras, Olivia; Tchangalova, Nedelina; Puett, Robin
BACKGROUND: Public health schools equip students with skills to promote and protect health, however, little is known about what is provided to support physical, mental and social wellbeing in academic public health. AIMS: To identify programs, interventions, strategies, and tools in medical and academic settings that could be applicable to supporting mental health and wellbeing of public health professionals, students, staff and faculty. METHOD: In November 2019 (updated in January 2022), 13 databases were searched: PubMed, 10 EBSCO databases(e.g., Academic Search Ultimate, APA PsycINFO, CINAHL Plus, Education Source, ERIC, Health Source: Nursing/Academic Edition, MEDLINE, SocINDEX), ProQuest Dissertations & Theses Global, and Web of Science. Inclusion criteria were randomized controlled trials, group interventions to support mental health curriculum, online tools, strategies, techniques, and programs of mindfulness, anxiety, depression, stress/distress, or burnout. Studies were limited to English and from 1998 to January 3, 2022. Websites for U.S. Schools of Public Health were searched. RESULTS: Out of 19,527 articles, 6,752 duplicates were removed. Following abstract and title screening, full-text articles will be screened for eligibility. The main themes from included studies will be shared. Preliminary findings show examples of activities to support well-being of public health professional students, staff, and faculty (e.g., providing free access to meditation apps, funding a dedicated wellness coordinator within the School). CONCLUSIONS: The literature on strategies to increase happiness and wellbeing among public health students, faculty, and staff is scarce and efforts to support physical mental, and social wellbeing for this community should be evaluated, and findings shared.
Racial and Sex Differences between Urinary Phthalates and Metabolic Syndrome among U.S. Adults: NHANES 2005–2014
(MDPI, 2021-06-26) Ghosh, Rajrupa; Haque, Mefruz; Turner, Paul C.; Cruz-Cano, Raul; Dallal, Cher M.
Phthalates, plasticizers ubiquitous in household and personal care products, have been associated with metabolic disturbances. Despite the noted racial differences in phthalate exposure and the prevalence of metabolic syndrome (MetS), it remains unclear whether associations between phthalate metabolites and MetS vary by race and sex. A cross-sectional analysis was conducted among 10,017 adults from the National Health and Nutritional Examination Survey (2005–2014). Prevalence odds ratios (POR) and 95% confidence intervals (CIs) were estimated for the association between 11 urinary phthalate metabolites and MetS using weighted sex and race stratified multivariable logistic regression. Higher MCOP levels were significantly associated with increased odds of MetS among women but not men, and only remained significant among White women (POR Q4 vs. Q1 = 1.68, 95% CI: 1.24, 2.29; p-trend = 0.001). Similarly, the inverse association observed with MEHP among women, persisted among White women only (POR Q4 vs. Q1 = 0.53, 95% CI: 0.35, 0.80; p-trend = 0.003). However, SDEHP metabolites were associated with increased odds of MetS only among men, and this finding was limited to White men (POR Q4 vs. Q1 = 1.54, 95% CI: 1.01, 2.35; p-trend = 0.06). Among Black men, an inverse association was observed with higher MEP levels (POR Q4 vs. Q1 = 0.43, 95% CI: 0.24, 0.77; p-trend = 0.01). The findings suggest differential associations between phthalate metabolites and MetS by sex and race/ethnicity.
Vaginal cytokine profile and microbiota before and after lubricant use compared with condomless vaginal sex: a preliminary observational study
(Springer Nature, 2021-09-18) Tuddenham, Susan; Stennett, Christina A.; Cone, Richard A.; Ravel, Jacques; Macintyre, Andrew N.; Ghanem, Khalil G.; He, Xin; Brotman, Rebecca M.
Limited data suggest that personal lubricants may damage the vaginal mucosal epithelium, alter the vaginal microbiota, and increase inflammation. We compared vaginal cytokine profiles and microbiota before and after vaginal lubricant use and condomless vaginal sex. Reproductive-age women were recruited to a 10-week observational cohort study and were asked to self-collect vaginal samples and behavioral diaries daily. This nested case–control analysis utilized samples collected before and after self-reported condomless sexual activity with lubricants (22 case participants) and without lubricants (22 control participants). Controls were matched to cases on race/ethnicity. Microbiota composition was characterized by sequencing amplicons of the 16S rRNA gene V3–V4 regions. Cytokine concentrations were quantified using a magnetic bead 41-plex panel assay and read using a Bio-Plex 200 array reader. Wilcoxon signed-rank tests were used to assess baseline differences in vaginal cytokines between cases and controls as well as differences pre- and post-exposure. Linear mixed effects models were used to examine differences in relative post-to-pre change in each individual cytokine between matched cases and controls. Similar analyses were conducted for the microbiota data. Mean age was 29.8 years (SD 6.8), and 63.6% were African American. There were few statistically significant changes in cytokines or microbiota before and after exposure in cases or controls. In mixed-effects modeling, the mean relative post-to-pre change of cytokines was higher in cases vs. controls for macrophage derived chemokine (MDC) (p = 0.03). The microbiota data revealed no significant changes when measured by similarity scores, diversity indexes and descriptive community state types (CST) transition analyses. However, post sexual activity, the mean relative abundance of L. crispatus decreased for those who used lubricants (particularly those who were L. iners-dominated prior to exposure). Although there were overall few differences in the vaginal microbiota and cytokine profiles of lubricant users and controls before and after condomless vaginal sex, there was a trend toward decreases in relative abundance of L. crispatus following use of lubricant. Future larger studies that take into account osmolarity and composition of lubricants may provide additional insights.

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