Category: Statistics

Nicotine Tob Res. 2022 Sep 7:ntac209. doi: 10.1093/ntr/ntac209. Online ahead of print.

ABSTRACT

INTRODUCTION: E-cigarette advertising exposure is linked to e-cigarette initiation and use. Thus, monitoring trends in e-cigarette advertising practices is important to understand e-cigarette use patterns observed over recent years.

METHODS: E-cigarette advertising expenditures (January 2016-July 2021; Numerator Ad Intel) for 154 U.S. market areas were harmonized with U.S. Census sociodemographic data through Nielsen market area/zip code designations. Descriptive statistics and multivariable linear regressions were used to examine trends in e-cigarette advertising expenditures across media outlets and associations between sociodemographic characteristics and e-cigarette advertising over time.

RESULTS: E-cigarette advertising expenditures peaked in 2018/2019, followed by a sharp decline in 2020. Expenditures were concentrated primarily on print (58.9%), TV (20.6%) and radio (14.4%). Major print outlets were Sports Illustrated, Rolling Stone, and Star magazines. Top TV channels were AMC, Investigation Discovery, and TBS. TV advertisements were purchased commonly during popular movies/series (e.g., King of Queens, Everybody Loves Raymond, The Walking Dead). Higher expenditures were associated with U.S. market areas that had (a) a larger percentage of non-rural zip codes (radio), (b) smaller male populations (radio), and (c) larger White/Caucasian, Black/African American, American Indian/Alaska Native, Asian, and Other/Multiracial populations (radio, print, online display, online video).

CONCLUSIONS: E-cigarette companies advertised in print magazines geared toward males and youth/young adults, radio commercials focused in urban areas with smaller male populations, and nationwide TV commercials. Declines in e-cigarette advertising expenditures in 2020 demonstrate the potential impact that federal policies may have on protecting populations who are at higher risk for tobacco use from predatory advertising practices.

IMPLICATIONS: E-cigarette advertising exposure is associated with initiation and use of e-cigarettes. This study shows how e-cigarette marketing expenditures in the U.S. may have targeted specific consumers (e.g., youth/young adults) between 2016 and 2021. The precipitous drop in advertising expenditures across all outlets during early 2020 corresponds with the implementation of the Tobacco 21 federal policy, the federal enforcement policy to remove most unauthorized flavored e-cigarette cartridges from the U.S. market, preparations for FDA’s premarket review of e-cigarette products, and the decision by several TV broadcast companies to stop showing e-cigarette ads. The potential impact of federal policies may have far-reaching implications for protecting populations who are at high risk for tobacco use and its health consequences.

PMID:36070398 | DOI:10.1093/ntr/ntac209

PLoS Comput Biol. 2022 Sep 7;18(9):e1010430. doi: 10.1371/journal.pcbi.1010430. Online ahead of print.

ABSTRACT

Genetic risk for complex traits is strongly enriched in non-coding genomic regions involved in gene regulation, especially enhancers. However, we lack adequate tools to connect the characteristics of these disruptions to genetic risk. Here, we propose RWAS (Regulome Wide Association Study), a new application of the MAGMA software package to identify the characteristics of enhancers that contribute to genetic risk for disease. RWAS involves three steps: (i) assign genotyped SNPs to cell type- or tissue-specific regulatory features (e.g., enhancers); (ii) test associations of each regulatory feature with a trait of interest for which genome-wide association study (GWAS) summary statistics are available; (iii) perform enhancer-set enrichment analyses to identify quantitative or categorical features of regulatory elements that are associated with the trait. These steps are implemented as a novel application of MAGMA, a tool originally developed for gene-based GWAS analyses. Applying RWAS to interrogate genetic risk for schizophrenia, we discovered a class of risk-associated AT-rich enhancers that are active in the developing brain and harbor binding sites for multiple transcription factors with neurodevelopmental functions. RWAS utilizes open-source software, and we provide a comprehensive collection of annotations for tissue-specific enhancer locations and features, including their evolutionary conservation, AT content, and co-localization with binding sites for hundreds of TFs. RWAS will enable researchers to characterize properties of regulatory elements associated with any trait of interest for which GWAS summary statistics are available.

PMID:36070311 | DOI:10.1371/journal.pcbi.1010430

PLoS One. 2022 Sep 7;17(9):e0273078. doi: 10.1371/journal.pone.0273078. eCollection 2022.

ABSTRACT

A growing number of studies suggest that climate may impact the spread of COVID-19. This hypothesis is supported by data from similar viral contagions, such as SARS and the 1918 Flu Pandemic, and corroborated by US influenza data. However, the extent to which climate may affect COVID-19 transmission rates and help modeling COVID-19 risk is still not well understood. This study demonstrates that such an understanding is attainable through the development of regression models that verify how climate contributes to modeling COVID-19 transmission, and the use of feature importance techniques that assess the relative weight of meteorological variables compared to epidemiological, socioeconomic, environmental, and global health factors. The ensuing results show that meteorological factors play a key role in regression models of COVID-19 risk, with ultraviolet radiation (UV) as the main driver. These results are corroborated by statistical correlation analyses and a panel data fixed-effect model confirming that UV radiation coefficients are significantly negatively correlated with COVID-19 transmission rates.

PMID:36070304 | DOI:10.1371/journal.pone.0273078

PLoS One. 2022 Sep 7;17(9):e0273195. doi: 10.1371/journal.pone.0273195. eCollection 2022.

ABSTRACT

The selection of dialysate calcium concentration (D-Ca) is still controversial among chronic hemodialysis (HD) regimens. We examined the trajectories of CKD MBD parameters among the J-DAVID trial participants to see the effect of D-Ca and alfacalcidol. The trial was an open-label randomized clinical trial including 976 HD patients with intact PTH of 180 pg/mL or lower which compared the users of vitamin D receptor activator (oral alfacalcidol) and non-users over a median of 4 years. The main D-Ca used at baseline were 3.0 mEq/L in 70% and 2.5 mEq/L in 25%, respectively. The primary endpoint was the composite of fatal and non-fatal cardiovascular events and the secondary endpoint was all-cause mortality. Multivariable Cox proportional hazard regression analyses in which D-Ca was included as a possible effect modifier and serum laboratory data as time-varying covariates showed no significant effect modification for composite cardiovascular events or all-cause mortality. This post hoc analysis showed that the effects of alfacalcidol on cardiovascular outcomes were not significantly modified by D-Ca.

PMID:36070301 | DOI:10.1371/journal.pone.0273195

Int Forum Allergy Rhinol. 2022 Sep 7. doi: 10.1002/alr.23082. Online ahead of print.

ABSTRACT

BACKGROUND: Patients with limited health literacy tend to have worse medical outcomes, often due to decreased medication compliance or reduced capacity to self-manage disease. Health literacy can be assessed using validated tools such as the Brief health literacy screening tool (BRIEF). This study theorizes that lower health literacy is associated with worse sinonasal disease quality of life (QOL).

METHODS: A cohort of 187 patients at our clinic were routinely screened for health literacy and rhinosinusitis disability index (RSDI) scores. Health literacy is categorized into “Limited,” “Marginal,” and “Adequate.” The higher the RSDI, the worse the patient’s QOL. Patients were stratified into “New” and “Established” groups. Their demographic data and sinonasal disease-specific QOL were recorded. Statistical analysis was performed to assess the relationship between health literacy and Sinonasal Disease-specific QOL.

RESULTS: The cohort mean age was 50 years, and 56% were females. In “New” patients, “Limited” health literacy was associated with an increase in RSDI scores (p<0.0001).

CONCLUSION: This study demonstrates that patients with limited health literacy have a worse sinonasal disease-specific QOL. Therefore, rhinologists must be aware of this discrepancy and tailor their care appropriately to help patients with limited health literacy. This article is protected by copyright. All rights reserved.

PMID:36070205 | DOI:10.1002/alr.23082

J Gen Intern Med. 2022 Sep 7. doi: 10.1007/s11606-022-07774-0. Online ahead of print.

ABSTRACT

BACKGROUND: Patient agency in contraceptive decision-making is an essential component of reproductive autonomy.

OBJECTIVE: We aimed to develop a psychometrically robust measure of patient contraceptive agency in the clinic visit, as a measure does not yet exist.

DESIGN: For scale development, we generated and field tested 54 questionnaire items, grounded in qualitative research. We used item response theory-based methods to select and evaluate scale items for psychometric performance. We iteratively examined model fit, dimensionality, internal consistency, internal structure validity, and differential item functioning to arrive at a final scale.

PARTICIPANTS: A racially/ethnically diverse sample of 338 individuals, aged 15-34 years, receiving contraceptive care across nine California clinics in 2019-2020.

MAIN MEASURES: Contraceptive Agency Scale (CAS) of patient agency in preventive care.

KEY RESULTS: Participants were 20.5 mean years, with 36% identifying as Latinx, 26% White, 20% Black, 10% Asian/Native Hawaiian/Pacific Islander. Scale items covered the domains of freedom from coercion, non-judgmental care, and active decision-making, and loaded on to a single factor, with a Cronbach’s α of 0.80. Item responses fit a unidimensional partial credit item response model (weighted mean square statistic within 0.75-1.33 for each item), met criteria for internal structure validity, and showed no meaningful differential item functioning. Most participants expressed high agency in their contraceptive visit (mean score 9.6 out of 14). One-fifth, however, experienced low agency or coercion, with the provider wanting them to use a specific method or to make decisions for them. Agency scores were lowest among Asian/Native Hawaiian/Pacific Islander participants (adjusted coefficient: -1.5 [-2.9, -0.1] vs. White) and among those whose mothers had less than a high school education (adjusted coefficient; -2.1 [-3.3, -0.8] vs. college degree or more).

CONCLUSIONS: The Contraceptive Agency Scale can be used in research and clinical care to reinforce non-coercive service provision as a standard of care.

PMID:36070169 | DOI:10.1007/s11606-022-07774-0

Arch Osteoporos. 2022 Sep 7;17(1):120. doi: 10.1007/s11657-022-01158-x.

ABSTRACT

In this population-based, cross-sectional study, we investigated vertebral fracture (VF) prevalence among Chinese postmenopausal women. We found 14.7% of population had VFs, which increased with age. Age ≥ 65 years, hip fracture, and densitometric osteoporosis were significantly associated with VFs. The prevalence of osteoporosis was remarkably high.

PURPOSE: To investigate VF prevalence among Chinese postmenopausal women in this population-based, randomized-sampling, cross-sectional study.

METHODS: The investigator obtained lists of women from communities. Randomization was performed using SAS programming based on age group in each region. Postmenopausal women aged ≥ 50 years in the urban community were included. The investigator interviewed subjects to collect self-reported data and measured BMD. Spine radiographs were adjudicated by Genant’s semi-quantitative method. VFs were defined as fractures of at least one vertebra classified by Genant’s score 1-3 and were analyzed using descriptive statistics.

RESULTS: A total of 31,205 women listed for randomized sampling from 10 Tier-3 hospitals at 5 regions. Of 2634 women in the full analysis set, 14.7% (388/2634, 95% CI: 13.4, 17.1) had prevalent VFs. VF prevalence increased with age (Cochran-Armitage test p < 0.0001) and was significantly higher in women aged ≥ 65. VF prevalence did not differ between North (14.4%, 95% CI: 12.5, 16.4) and South China (15.1%, 95% CI: 13.3, 17.1). In women with no prior VFs, prevalent VFs were 12.4% (95% CI: 11.2, 13.7). Age ≥ 65 years (OR: 2.57, 95% CI: 1.91, 3.48), hip fracture (OR: 2.28, 95% CI: 1.09, 4.76), and densitometric osteoporosis (OR: 2.52, 95% CI: 1.96, 3.22) were significantly associated with prevalent VFs. Prevalence of osteoporosis was 32.9% measured by BMD and 40.8% using NOF/IOF clinical diagnosis criteria.

CONCLUSION: VFs are prevalent among Chinese postmenopausal women who were ≥ 50 years and community-dwelled. Osteoporosis prevalence is remarkable when fragile fractures were part of clinical diagnosis.

PMID:36070158 | DOI:10.1007/s11657-022-01158-x

Ergonomics. 2022 Sep 7:1-44. doi: 10.1080/00140139.2022.2122587. Online ahead of print.

ABSTRACT

The use of both hands is often required for force/torque exertions, particularly when using hand tools. This study investigated the effects of handle diameter (3-5 cm), between-handle distance (0.5-1.5 shoulder span (SS), workpiece orientation (horizontal/frontal), working height (shoulder/elbow/knuckle), and exertion direction (clockwise/counter-clockwise) on maximum two-handed torque strength, usability and comfort/discomfort while using T-shaped handles. Participant (n = 20) performed 36 experimental conditions. The handle diameter had no significant main effect on torque strength. The 3 cm diameter handle was associated with better usability and comfort compared to other options. Higher torque values were recorded with between-handle distance of 1.0 and 1.5 SS, in frontal plane, in shoulder and knuckle heights, and in counter-clockwise direction. The between-handle distance of 1.0 SS had better comfort and higher usability than other conditions. Interactions between the between-handle distance and working height, between-handle distance and workpiece orientation, and workpiece orientation and working height were also significant.

PMID:36069666 | DOI:10.1080/00140139.2022.2122587

Hum Vaccin Immunother. 2022 Sep 7:2114261. doi: 10.1080/21645515.2022.2114261. Online ahead of print.

ABSTRACT

Knowledge, attitudes, and beliefs are important antecedents to HPV vaccination, yet remain suboptimal among young gay, bisexual, and other men who have sex with men (YGBMSM). We report the effects of a theoretically-informed, web-based HPV vaccination intervention on these cognitive outcomes. From 2019-2021, we recruited a national sample of YGBMSM ages 18-25 in the United States who were unvaccinated against HPV (n = 1,227). Participants received either standard HPV vaccination information online (control) or population-targeted, individually-tailored content online (Outsmart HPV intervention). Mixed effects models determined if pre-post changes in cognitive outcomes differed between study groups. For five of seven knowledge items about HPV, there were larger pre-post increases among the intervention group than the control group in the percentage of participants who provided correct responses (all statistically significant at p = .05 after Holm’s correction). There were also larger pre-post improvements among the intervention group than the control group for most attitudes and beliefs examined, including response efficacy of HPV vaccine (pre-post increases in means: 0.57 vs. 0.38); self-efficacy for the HPV vaccination process (pre-post increases in means: 0.23 vs. 0.10); and intention to get HPV vaccine (pre-post increases in means: 0.70 vs. 0.28) (all statistically significant at p = .05 after Holm’s correction). Outsmart HPV is a promising tool for improving key cognitive antecedents to HPV vaccination among YGBMSM, supporting the use of theoretically-informed interventions to affect such outcomes. If efficacious in increasing HPV vaccine uptake in future analyses, this intervention could be utilized in clinical and other healthcare settings that provide services to YGBMSM.

PMID:36069662 | DOI:10.1080/21645515.2022.2114261

Health Policy Plan. 2022 Sep 7:czac075. doi: 10.1093/heapol/czac075. Online ahead of print.

ABSTRACT

The Revised National Community Health Services Policy (2016-2021) (RNCHSP) and its program implementation, the Liberian National Community Health Assistant Program (NCHAP), exhibit a critical gender imbalance among the Community Health Assistants (CHAs) as only 17% are women (MOH, 2016). This study was designed to assess the gender responsiveness of the RNCHSP and its program implementation in five counties across Liberia to identify opportunities to improve gender equity in the program. Using qualitative methods, 16 semi structured interviews were conducted with policymakers and 32 with CHAs, other members of the community health workforce and community members. The study found that despite the Government of Liberia’s intention to prioritise women in the recruitment and selection of CHAs, the planning and implementation of the RNCHSP were not gender responsive. While the role of community structures, such as Community Health Committees, in the nomination and selection of CHAs is central to community ownership of the program, unfavourable gender norms influenced women’s nomination to become CHAs. Cultural, social and religious perceptions and practices of gender created inequitable expectations that negatively influenced the recruitment of women CHAs. In particular, the education requirement for CHAs posed a significant barrier to women’s nomination and selection as CHAs, due to disparities in access to education for girls in Liberia. The inequitable gender balance of CHAs has impacted the accessibility, acceptability, and affordability of community healthcare services, particularly among women. Strengthening the gender responsiveness within the RNCHSP and its program implementation is key to fostering gender equity among the health workforce and strengthening a key pillar of the health system. Employing gender responsive policies and programs will likely increase the effectiveness of community healthcare services.

PMID:36069652 | DOI:10.1093/heapol/czac075