Kristen Malecki | University of Wisconsin-Madison (original) (raw)

Papers by Kristen Malecki

Journal of environmental health, 2007

Examining the relationship between health outcomes and environmental exposures requires summary m... more Examining the relationship between health outcomes and environmental exposures requires summary measures, or indicators. To advance the use of indicators, the Johns Hopkins Center for Excellence in Environmental Public Health Tracking piloted three pairs of indicators: 1) air toxics and leukemia in New Jersey, 2) mercury emissions and fish advisories in the United States, and 3) urban sprawl and obesity in New Jersey. These analyses illustrate the feasibility of creating environmental hazard, exposure, and health outcome indicators, examining their temporal and geographic trends, and identifying their temporal and geographic relationships. They also show the importance of including appropriate caveats with the findings. The authors' investigations demonstrate how existing environmental health data can be used to create meaningful indicator measures to further the understanding of environment-related diseases and to help prioritize and guide interventions. Indicators are the foun...

Journal of Clinical and Translational Science, 2020

Introduction: Urothelial carcinoma (UCC) develops in both humans and dogs and tracks to regions o... more Introduction: Urothelial carcinoma (UCC) develops in both humans and dogs and tracks to regions of high industrial activity. We hypothesize that dogs with UCC may act as sentinels for human urothelial carcinogen exposures. The aim of this pilot study was to determine whether healthy people and dogs in the same households share urinary exposures to potentially mutagenic chemical carcinogens. Methods: We measured urinary concentrations of acrolein (as its metabolite 3-HPMA), arsenic species, 4-aminobiphenyl, and 4-chlorophenol (a metabolite of the phenoxyherbicide 2,4-D) in healthy dogs and their owners. We assessed possible chemical sources through questionnaires and screened for urothelial DNA damage using the micronucleus assay. Results: Biomarkers of urinary exposure to acrolein, arsenic, and 4-chlorophenol were found in the urine of 42 pet dogs and 42 owners, with 4-aminobiphenyl detected sporadically. Creatinine-adjusted urinary chemical concentrations were significantly higher,...

Open Forum Infectious Diseases, 2019

Background There is little research on the relationship between diet and Clostridium difficile in... more Background There is little research on the relationship between diet and Clostridium difficile infection. Animal studies have shown potential benefits of dietary fiber in modulating C. difficile infection. Methods In 2016–2017, we carried out a microbiota study among adults in the Survey of the Health of Wisconsin, a population-based health survey collecting data on a wide range of health determinants and outcomes. We administered the Dietary History Questionnaire and asked about risk factors for C. difficile and collected fecal samples for 16S rRNA sequencing of gut microbiota and cultured for C. difficile. Dietary components were standardized to 1,000 kcal energy intake. Logistic regression was used to examine diet factors associated with C. difficile colonization. The quasi-conditional association test (QCAT) was performed to identify taxa that were significantly associated with fiber intake. Results In our general population sample of adults [(N = 238; 58% female; mean (range) a...

Gut Pathogens, 2021

Background New technologies like next-generation sequencing have led to a proliferation of studie... more Background New technologies like next-generation sequencing have led to a proliferation of studies investigating the role of the gut microbiome in human health, particularly population-based studies that rely upon participant self-collection of samples. However, the impact of methodological differences in sample shipping, storage, and processing are not well-characterized for these types of studies, especially when transit times may exceed 24 h. The aim of this study was to experimentally assess microbiota stability in stool samples stored at 4 °C for durations of 6, 24, 48, 72, and 96 h with no additives to better understand effects of variable shipping times in population-based studies. These data were compared to a baseline sample that was immediately stored at − 80 °C after stool production. Results Compared to the baseline sample, we found that the alpha-diversity metrics Shannon’s and Inverse Simpson’s had excellent intra-class correlations (ICC) for all storage durations. Cha...

ABSTRACTThere is an urgent need to track the early and ongoing impact of the COVID-19 pandemic on... more ABSTRACTThere is an urgent need to track the early and ongoing impact of the COVID-19 pandemic on population health from local to global scales. At the same time, there is an overall lack of U.S. state-specific surveillance data tracking social determinants of health (SDOH) and associations with population well-being, individual mitigation and coping strategies, family dynamics and other economic shocks of the pandemic in populations. Statewide data can offer important insights into how SDOH shape the long-term effects of COVID-19 in the population since implementation of many policies and programs varied widely early on in the pandemic. In May of 2020, the Survey of the Health of Wisconsin (SHOW) program launched a statewide online/phone survey of early and ongoing impacts of COVID-19 on health and well-being across diverse communities and families. The goal of this study is to provide descriptive data including perceived COVID-19 risks, access to and results of COVID-19 antigen te...

Background/Aim: Obesity may increase human sensitivity to environmental toxicants through multipl... more Background/Aim: Obesity may increase human sensitivity to environmental toxicants through multiple mechanisms including inflammation. Obesity has been shown to increase susceptibility of asthma sym...

Open Forum Infectious Diseases, 2017

Background. We hypothesized that in ventilated patients the composition and the temporal evolutio... more Background. We hypothesized that in ventilated patients the composition and the temporal evolution of the oropharyngeal microbiome may predict the development of ventilator-associated pneumonia (VAP). Methods. Prospective, observational single-center nested case-control study. Patients with acute critical illness and anticipated duration of mechanical ventilation >4 days were eligible. We took oropharyngeal swabs (and if available, tracheal secretions) on a daily basis, starting with the day of intubation. Microbiota were characterized with 16S rRNA pyrosequencing and compared between patients who developed VAP vs. controls. Results. Thirty patients met inclusion criteria and were enrolled, among which we selected 10 for microbiome evaluation. Five of them developed VAP. In three of those the causative pathogens were Enterobacteriaceae and in two Haemophilus influenzae (HI). The within diversity (= alpha) decreased significantly throughout the first five days in Enterobacteriaceae VAP patients (P = 0.002) but not in HI VAP patients (P = 0.6) when compared with no VAP (Figure 1). When comparing the oral microbiomes in individual patients between the initial sample and day 4, the in-between diversities (= β) were not different in patients with Enterobacteriaceae VAP, HI VAP or controls. Detection of Enterobacteriaceae in the oropharynx occurred on day two of follow-up and consisted of a single species in 2/3 patients (Figure 2). Conclusion. In patients who develop enterobacterial VAP the causative pathogen appears to gain access to the oropharynx early after starting ventilation and outgrow the commensal members of the microbiome. A decreased alpha diversity may contribute to the development of VAP pathogenesis, given that this was not witnessed in patients without VAP.

WMJ : official publication of the State Medical Society of Wisconsin, 2020

BACKGROUND The opioid epidemic is a national crisis. The objectives of this report were to descri... more BACKGROUND The opioid epidemic is a national crisis. The objectives of this report were to describe prescription opioid use in Wisconsin from 2008 through 2016 using unique populationrepresentative data and to assess which demographic, health, and behavioral health characteristics were related to past 30-day prescribed opioid use. METHODS Data were obtained from the Survey of the Health of Wisconsin (SHOW), a statewide representative sample of 4,487 adults. Prescription medication use was ascertained via in-person interviews that included an inventory of all prescription medications used by the respondent in the past 30 days. The data were weighted to represent the adult population of Wisconsin, aged 21 to 74. Chi-square, logistic regression, and descriptive statistics were used to analyze data. RESULTS From 2008 to 2016, 6.4% (95% CI, 5.5-7.3) of adults age 21 years or older reported using a prescribed opioid in the past 30 days. Hydrocodone was the most prescribed opioid class fol...

INTRODUCTION Radon is the second-leading cause of lung cancer in the United States, the leading c... more INTRODUCTION Radon is the second-leading cause of lung cancer in the United States, the leading cause of lung cancer in nonsmokers, and is estimated to cause 21,000 deaths every year. Radon is especially prevalent in the upper Midwest. This study aimed to assess radon testing and mitigation practices among residential homeowners, landlords, and school districts in Wisconsin. METHODS Two survey sample datasets were used to assess radon testing and mitigation in residential homes: the Survey of the Health of Wisconsin (SHOW) and Wisconsin Behavioral Risk Factor Surveillance System (BRFSS) survey. Wisconsin landlords and school administrators were surveyed to assess radon testing and mitigation in rental properties and schools, respectively. RESULTS Approximately 30% of Wisconsin homeowners (22.1% from SHOW and 39.9% from BRFSS) have tested their properties for radon. Similarly, 31.0% of Wisconsin landlords (40/129) and 35.1% of Wisconsin school districts (78/222) have tested their sch...

ABSTRACTPurposeThe Population-based Microbiome Research Core (PMRC) is an expandable and longitud... more ABSTRACTPurposeThe Population-based Microbiome Research Core (PMRC) is an expandable and longitudinal research core infrastructure to support the study of the human microbiome within the context of environmental, sociodemographic, and health factors. Broadly, the purpose of this infrastructure is to provide new insights into how human-environment interactions affect health through its influence on the composition and function of the microbiome. The PMRC was established as an ancillary study of the Survey of Health of Wisconsin (SHOW) and serves as a platform for ancillary studies, ongoing follow-up of the cohort, and expansion of the microbiome biorepository.ParticipantsThe study recruited adult participants who had previously participated in SHOW’s Wisconsin Microbiome Study (WMS). Over 59% of the eligible WMS participants agreed to provide a repeat stool sample and household samples including dust, high touch surface swabs and outside soil.Findings to datePMRC includes 323 individ...

Background: Groundwater contamination of private wells is widespread. Despite this, regulators in... more Background: Groundwater contamination of private wells is widespread. Despite this, regulators in Wisconsin and across the United States estimate only 10% of private well owners regularly test thei...

Antibody surveillance provides essential information for public health officials to work with com... more Antibody surveillance provides essential information for public health officials to work with communities to discuss the spread and impact of COVID-19. At the start of the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in the United States, diagnostic testing was limited with many asymptomatic and thus undetected cases. Irrespective of symptom severity, antibodies develop within two to three weeks after exposure and may persist 6 months or more.; Thus, antibody surveillance is an important tool for tracking trends in past infections across diverse populations. This study includes adults and children (≥12 years old) recruited from a statewide sample of past 2014-2020 Survey of the Health of Wisconsin (SHOW) participants. SHOW, an ongoing population-based health examination study including a randomly selected sample of households, partnered with the Wisconsin Department of Health Services and the Wisconsin State Laboratory of Hygiene to conduct longitudinal ...

The Lancet Global Health, 2021

Abstract Background The burning of fossil fuels, including coal, is the primary source of greenho... more Abstract Background The burning of fossil fuels, including coal, is the primary source of greenhouse gas emissions driving anthropogenic climate change and its associated health harms: heat-related illnesses, arboviral diseases, trauma from extreme weather events, allergies, and chronic disease exacerbations. Coal-fired power plants (CFPP) supply 23% of electricity in the USA and 42% for the state of Wisconsin. Air pollution from CFPP has been associated with respiratory diseases, cancers, cardiovascular and neurological disorders, especially for vulnerable populations. In this cross-sectional study, we aim to measure associations between respiratory diseases and residential proximity to CFPP. Methods We obtained cross-sectional, population-based health data for non-institutionalised, non-active-duty adults from the Survey of the Health of Wisconsin database from 2008 to 2013. Pulmonary function was measured by spirometry as a ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC). An average of three or more FEV1/FVC readings Findings We included data from 2327 adults aged 21–74 years in analysis. Adults living in close proximity to one of 11 CFPP had worse pulmonary function than did adults living more than 35 km away from CFPP with an odds ratio of 1·24 (95% CI 0·90–1·70). Although not statistically significant, trends suggest higher odds of obstructive pulmonary diseases in those living within 35 km of CFPP. Protective factors, in addition to distance, were higher education and younger age. Risk factors identified were older age and having a history of smoking. Although Black residents made up 4·8% of the total sample population, they accounted for 13·3% of people living within 35 km of CFPP. Similarly, Hispanic residents accounted for 4·8% of those living within 35 km of CFPP but only made up 2·8% of the sample population. Interpretation Wisconsin CFPP might be associated with worse pulmonary function in people living at or within 35km of their locations, with possible consequences related to costly inhaler medications, health-care visits, and hospitalisations. When linked with socioeconomic factors, and race and ethnicity, closing down CFPP should be considered when addressing health disparities and environmental injustices. Affordable, clean energy solutions are readily available and just transitions have recently been demonstrated in North America. As nations recover from COVID-19, there is a profound opportunity for leaders across sectors to build healthier communities and prioritise climate action for health. Funding Dr Elaine Kohler Summer Academy of Global Health Research and Wisconsin Partnership Program.

Environmental Research, 2020

Abstract Background Understanding the health effects of exposure to chemical mixtures is critical... more Abstract Background Understanding the health effects of exposure to chemical mixtures is critically important given the broad range of concurrent exposures throughout the life-course. While investigations of environmental chemicals and components of the human microbiome are becoming more common, few have examined associations with chemical mixtures. This study assesses the association between exposure to mixtures of 66 different environmental chemicals and nasal colonization of Staphylococcus aureus (SA) and methicillin resistant SA (MRSA). Methods Data came from the National Health and Nutrition Examination Survey (NHANES) 2001–2004. The analytical sample consists of 10,312 participants, age 6 years and older, subdivided into 8 groups with different chemical exposure mixtures. Within each of 6 chemical classes (metals, phthalates, polycyclic aromatic hydrocarbons (PAHs), polybrominated diphenyl ethers (PBDEs), polyfluorochemicals (PFCs), and phenols), weighted quantile sum (WQS) regression was used to analyze the joint association of the component compounds and nasal SA colonization. WQS was also used to assess the joint association of 3 chemical mixtures (metals, metal and PAHs, and metal and triclosan) and nasal MRSA colonization. All regression models were adjusted for confounders. Results The analytical sample was between ages 6–85, slightly more female, and predominantly non-smokers. Prevalence of SA carriage was 29.2%, and MRSA colonization prevalence was 1.2%. Within each chemical class, odds of SA colonization increased statistically significantly with exposure to mixtures of metals (OR = 1.11, 95% CI = 1.02–1.20), phthalates (OR = 1.09, 95% CI = 1.04–1.14), and phenols (OR = 1.08, 95% CI = 1.01–1.15). Exposure to a mixture of metals combined with PAHs was also associated with increased odds of MRSA carriage (OR = 1.38, 95% CI = 1.02–1.86). Conclusion Results indicate an association between multiple environmental chemical mixtures and SA colonization, including MRSA. These findings support the need for further analysis of associations between chemical mixtures and SA colonization, as well as other components of the human microbiome.

Open Forum Infectious Diseases, 2019

Background Little is known about the relationship between oral hygiene and multidrug-resistant or... more Background Little is known about the relationship between oral hygiene and multidrug-resistant organism in the mouth and gut. We aimed to assess the relationship of oral hygiene and diet with multidrug-resistant organism (MDRO) carriage in the oral cavity and gut. Methods Participants were adults over age 18 from the 2016–2017 Survey of the Health of Wisconsin (SHOW) and its ancillary Wisconsin Microbiome Study. SHOW surveys residents of Wisconsin, collecting health determinants including a food frequency questionnaire, oral health, as well as biologic specimens. MDROs were defined as the presence of methicillin-resistant Staphylococcus aureus, Vancomycin-resistant Enterococcus, and Fluoroquinolone-resistant Gram-negative bacteria identified via culture from saliva, oral swabs, and stool samples. Statistical analysis was performed in R v3.5.1. Univariate analyses were conducted for all variables in the data set. Any variable with a P-value < 0.2 in the univariate analysis was con...

Journal of Transport & Health, 2019

Background: The majority of commuting trips in the United States are taken by motor vehicle. Yet,... more Background: The majority of commuting trips in the United States are taken by motor vehicle. Yet, lack of regular physical activity has been identified as one of its most significant public health issues, and globally, risks due to physical inactivity are increasing. However, we believe current studies offer an unclear picture of the complex role of the environmental or psychological influences in active travel behavior across urbanicity classifications. Aims: To (1) determine an association between objective or subjective measures of the built environment and active transportation, and (2) characterize the associations within both urban and non-urban contexts among a statewide sample of 862 adults residing in Wisconsin. Methods: Multivariate logistic regression analysis of subjective data from the Survey of the Health of Wisconsin (SHOW) and data from the Wisconsin Assessment of the Social and Built Environment (WASABE), a direct observation audit tool, to test the impacts of subjective perceptions and objective built environment predictors on active transportation in both urban and rural contexts. Results: Males, non-married, physically active individuals, those living in urban areas and with higher education levels had greater odds of using active transportation. Bicycle friendliness (aOR = 2.43; 95% CI: 1.4-4.2) and presence of non-residential destinations (aOR = 1.03; 95% CI: 1.01-1.05) were the strongest objective predictors of active transportation overall. Subjective measures were especially predictive of active transportation in non-urban areas, specifically for participants identifying presence of trails (adjusted odds = 3.71; 95% CI: 1.5-9.2) and nonresidential destinations nearby (adjusted odds = 2.65; 95% CI: 0.99-7.06). Conclusions: Active transportation is associated with built environment characteristics and perceived environmental factors, but the specific predictors and strength of associations vary by context. Results suggest perceived bicycle friendliness may be important in urban areas and access to trails for walking and biking may provide important opportunities to promote active transportation in more suburban or rural areas.

Preventive Medicine Reports, 2019

Introduction: Despite the well-established benefits of physical activity (PA), a large portion of... more Introduction: Despite the well-established benefits of physical activity (PA), a large portion of U.S. adults are not meeting recommended health-based guidelines. Although PA occurs in several domains, population-based studies tend to focus on leisure-time PA, with few studies examining occupational activity (OA) level as a separate determinant of overall PA. Methods: Data were obtained from the 2014-2016 Survey of Health of Wisconsin (SHOW). Currently employed SHOW participants (n = 822) were categorized into OA level categories. Bivariate analyses and multinomial logistic regression analyses were used to identify predictors and to test associations between OA and odds of meeting total PA guidelines using both self-reported and accelerometer-based data. Results: Individuals with high OA level jobs tended to be males (p < 0.01), current smokers (p < 0.01), and have low education (p < 0.01). When measured by self-report, a greater proportion of individuals in high OA jobs (89%) met the physical activity guidelines compared to those in medium (78%) and low (76%) OA jobs (p = 0.01). Further, adjusted odds of doing some PA vs meeting PA guidelines were higher for low OA vs. high OA level (OR = 2.40, 95% CI 1.46-3.94, p < 0.01). This trend was not observed when PA was measured via accelerometer (OR = 1.00, 95% CI 0.62-1.60, p = 0.99). Conclusions: Correlations between low, intermediate, and high OA and levels of overall PA varied by measurement type. Further research is needed to improve PA measurements within subdomains such as OA and to examine the tradeoffs between OA and leisure-time PA and relationships with health.

Preventive Medicine Reports, 2019

There are known health disparities between lesbian, gay, bisexual and transgender (LGBT) people a... more There are known health disparities between lesbian, gay, bisexual and transgender (LGBT) people and non-LGBT people, but only in the past couple of decades have population-based health surveys in the United States included questions on sexual and gender identity. We aimed to better understand LGBT disparities in health, health care access and utilization, and quality of care. Data are from the Survey of the Health of Wisconsin (SHOW) from 2014 to 2016 (n = 1957). The analyses focused on comparing health care access and utilization, and quality of care between LGB and non-LGB people and transgender and cisgender people. 3.8% (n = 73) identified as lesbian, gay or bisexual, and 1.3% (n = 25) were transgender. LGB adults were 2.17 (95th CI: 1.07-4.4) times more likely to delay obtaining health care. Transgender adults were 2.76 (95th CI: 1.64-4.65) times more likely to report poor quality of care and 2.78 (95th CI: 1.10-7.10) unfair treatment when receiving medical care. The results show differences in health care access and utilization and quality of care, and they add to the growing body of literature that suggest that improved health care services for LGBT patients are needed to promote health equity for LGBT populations.

Sleep health, 2018

Adequate sleep duration and quality are protective against many adverse health outcomes. Many ind... more Adequate sleep duration and quality are protective against many adverse health outcomes. Many individual-level predictors of poor sleep have been examined, but few studies have examined neighborhood-level influences. Despite known associations between neighborhood green space and sleep influencing factors (eg, physical activity, mental health), few studies have examined green space and sleep's relationship. Furthermore, little work has examined the relationship between the magnitude and type of neighborhood sounds and sleep. We analyzed data from the Survey of the Health of Wisconsin database (n = 2712) for 2008-2013, a representative sample of Wisconsin residents ages 21-74. Outcomes included weekday and weekend sleep duration and self-rated sleep quality. Primary predictors were the proportion tree canopy (National Land Cover Database) and mean decibel levels of outdoor sound (US National Park Service) at the census block group level. Survey regression analysis was used to exa...

International Journal of Hygiene and Environmental Health, 2016

Fish are an important source of nutrients which may reduce risk of adverse health outcomes such a... more Fish are an important source of nutrients which may reduce risk of adverse health outcomes such as cardiovascular disease; however, fish may also contain significant amounts of environmental pollutants such as mercury, polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), and perfluorinated compounds (PFCs, also called perfluoroalkyl compounds), which confer increased risk for adverse health effects. The Wisconsin Departments of Health Services and Natural Resources developed a survey instrument, along with a strategy to collect human biological samples to assess the risks and benefits associated with long-term fish consumption among older male anglers in Wisconsin. The target population was men aged 50 years and older, who fish Wisconsin waters and live in the state of Wisconsin. Participants provided blood and hair samples and completed a detailed (paper) questionnaire, which included questions on basic demographics, health status, location of catch and species of fish caught/eaten, consumption of locally caught and commercially purchased fish, and awareness and source of information for local and statewide consumption guidelines. Biological samples were used to assess levels of PCBs, PBDEs, PFCs (blood), and mercury (hair and blood). Quantile regression analysis was used to investigate the associations between biomarker levels and self-reported consumption of fish from the Great Lakes and other areas of concern, other locally caught fish, and commercially purchased fish (meals per year). Respondents had a median age of 60.5 (interquartile range: 56, 67) years. The median fish consumption was 54.5 meals per year, with most fish meals coming from locally-caught fish. Participants had somewhat higher mercury levels compared with the US general population, while levels of other contaminants were similar or lower. Multivariate regression models showed that consumption of fish from the Great Lakes and areas of concern was associated with higher levels of each of the contaminants with the exception of PBDEs, as was consumption of locally caught fish from other water bodies. All commercial fish consumption was also associated with both hair and blood mercury. When looking at specific PCB, PBDE and PFC analytes, consumption of fish from the Great Lakes and areas of concern was associated with higher levels of each of the individual PCB congeners examined, as well as higher levels of all of

Journal of environmental health, 2007

Examining the relationship between health outcomes and environmental exposures requires summary m... more Examining the relationship between health outcomes and environmental exposures requires summary measures, or indicators. To advance the use of indicators, the Johns Hopkins Center for Excellence in Environmental Public Health Tracking piloted three pairs of indicators: 1) air toxics and leukemia in New Jersey, 2) mercury emissions and fish advisories in the United States, and 3) urban sprawl and obesity in New Jersey. These analyses illustrate the feasibility of creating environmental hazard, exposure, and health outcome indicators, examining their temporal and geographic trends, and identifying their temporal and geographic relationships. They also show the importance of including appropriate caveats with the findings. The authors' investigations demonstrate how existing environmental health data can be used to create meaningful indicator measures to further the understanding of environment-related diseases and to help prioritize and guide interventions. Indicators are the foun...

Journal of Clinical and Translational Science, 2020

Introduction: Urothelial carcinoma (UCC) develops in both humans and dogs and tracks to regions o... more Introduction: Urothelial carcinoma (UCC) develops in both humans and dogs and tracks to regions of high industrial activity. We hypothesize that dogs with UCC may act as sentinels for human urothelial carcinogen exposures. The aim of this pilot study was to determine whether healthy people and dogs in the same households share urinary exposures to potentially mutagenic chemical carcinogens. Methods: We measured urinary concentrations of acrolein (as its metabolite 3-HPMA), arsenic species, 4-aminobiphenyl, and 4-chlorophenol (a metabolite of the phenoxyherbicide 2,4-D) in healthy dogs and their owners. We assessed possible chemical sources through questionnaires and screened for urothelial DNA damage using the micronucleus assay. Results: Biomarkers of urinary exposure to acrolein, arsenic, and 4-chlorophenol were found in the urine of 42 pet dogs and 42 owners, with 4-aminobiphenyl detected sporadically. Creatinine-adjusted urinary chemical concentrations were significantly higher,...

Open Forum Infectious Diseases, 2019

Background There is little research on the relationship between diet and Clostridium difficile in... more Background There is little research on the relationship between diet and Clostridium difficile infection. Animal studies have shown potential benefits of dietary fiber in modulating C. difficile infection. Methods In 2016–2017, we carried out a microbiota study among adults in the Survey of the Health of Wisconsin, a population-based health survey collecting data on a wide range of health determinants and outcomes. We administered the Dietary History Questionnaire and asked about risk factors for C. difficile and collected fecal samples for 16S rRNA sequencing of gut microbiota and cultured for C. difficile. Dietary components were standardized to 1,000 kcal energy intake. Logistic regression was used to examine diet factors associated with C. difficile colonization. The quasi-conditional association test (QCAT) was performed to identify taxa that were significantly associated with fiber intake. Results In our general population sample of adults [(N = 238; 58% female; mean (range) a...

Gut Pathogens, 2021

Background New technologies like next-generation sequencing have led to a proliferation of studie... more Background New technologies like next-generation sequencing have led to a proliferation of studies investigating the role of the gut microbiome in human health, particularly population-based studies that rely upon participant self-collection of samples. However, the impact of methodological differences in sample shipping, storage, and processing are not well-characterized for these types of studies, especially when transit times may exceed 24 h. The aim of this study was to experimentally assess microbiota stability in stool samples stored at 4 °C for durations of 6, 24, 48, 72, and 96 h with no additives to better understand effects of variable shipping times in population-based studies. These data were compared to a baseline sample that was immediately stored at − 80 °C after stool production. Results Compared to the baseline sample, we found that the alpha-diversity metrics Shannon’s and Inverse Simpson’s had excellent intra-class correlations (ICC) for all storage durations. Cha...

ABSTRACTThere is an urgent need to track the early and ongoing impact of the COVID-19 pandemic on... more ABSTRACTThere is an urgent need to track the early and ongoing impact of the COVID-19 pandemic on population health from local to global scales. At the same time, there is an overall lack of U.S. state-specific surveillance data tracking social determinants of health (SDOH) and associations with population well-being, individual mitigation and coping strategies, family dynamics and other economic shocks of the pandemic in populations. Statewide data can offer important insights into how SDOH shape the long-term effects of COVID-19 in the population since implementation of many policies and programs varied widely early on in the pandemic. In May of 2020, the Survey of the Health of Wisconsin (SHOW) program launched a statewide online/phone survey of early and ongoing impacts of COVID-19 on health and well-being across diverse communities and families. The goal of this study is to provide descriptive data including perceived COVID-19 risks, access to and results of COVID-19 antigen te...

Background/Aim: Obesity may increase human sensitivity to environmental toxicants through multipl... more Background/Aim: Obesity may increase human sensitivity to environmental toxicants through multiple mechanisms including inflammation. Obesity has been shown to increase susceptibility of asthma sym...

Open Forum Infectious Diseases, 2017

Background. We hypothesized that in ventilated patients the composition and the temporal evolutio... more Background. We hypothesized that in ventilated patients the composition and the temporal evolution of the oropharyngeal microbiome may predict the development of ventilator-associated pneumonia (VAP). Methods. Prospective, observational single-center nested case-control study. Patients with acute critical illness and anticipated duration of mechanical ventilation >4 days were eligible. We took oropharyngeal swabs (and if available, tracheal secretions) on a daily basis, starting with the day of intubation. Microbiota were characterized with 16S rRNA pyrosequencing and compared between patients who developed VAP vs. controls. Results. Thirty patients met inclusion criteria and were enrolled, among which we selected 10 for microbiome evaluation. Five of them developed VAP. In three of those the causative pathogens were Enterobacteriaceae and in two Haemophilus influenzae (HI). The within diversity (= alpha) decreased significantly throughout the first five days in Enterobacteriaceae VAP patients (P = 0.002) but not in HI VAP patients (P = 0.6) when compared with no VAP (Figure 1). When comparing the oral microbiomes in individual patients between the initial sample and day 4, the in-between diversities (= β) were not different in patients with Enterobacteriaceae VAP, HI VAP or controls. Detection of Enterobacteriaceae in the oropharynx occurred on day two of follow-up and consisted of a single species in 2/3 patients (Figure 2). Conclusion. In patients who develop enterobacterial VAP the causative pathogen appears to gain access to the oropharynx early after starting ventilation and outgrow the commensal members of the microbiome. A decreased alpha diversity may contribute to the development of VAP pathogenesis, given that this was not witnessed in patients without VAP.

WMJ : official publication of the State Medical Society of Wisconsin, 2020

BACKGROUND The opioid epidemic is a national crisis. The objectives of this report were to descri... more BACKGROUND The opioid epidemic is a national crisis. The objectives of this report were to describe prescription opioid use in Wisconsin from 2008 through 2016 using unique populationrepresentative data and to assess which demographic, health, and behavioral health characteristics were related to past 30-day prescribed opioid use. METHODS Data were obtained from the Survey of the Health of Wisconsin (SHOW), a statewide representative sample of 4,487 adults. Prescription medication use was ascertained via in-person interviews that included an inventory of all prescription medications used by the respondent in the past 30 days. The data were weighted to represent the adult population of Wisconsin, aged 21 to 74. Chi-square, logistic regression, and descriptive statistics were used to analyze data. RESULTS From 2008 to 2016, 6.4% (95% CI, 5.5-7.3) of adults age 21 years or older reported using a prescribed opioid in the past 30 days. Hydrocodone was the most prescribed opioid class fol...

INTRODUCTION Radon is the second-leading cause of lung cancer in the United States, the leading c... more INTRODUCTION Radon is the second-leading cause of lung cancer in the United States, the leading cause of lung cancer in nonsmokers, and is estimated to cause 21,000 deaths every year. Radon is especially prevalent in the upper Midwest. This study aimed to assess radon testing and mitigation practices among residential homeowners, landlords, and school districts in Wisconsin. METHODS Two survey sample datasets were used to assess radon testing and mitigation in residential homes: the Survey of the Health of Wisconsin (SHOW) and Wisconsin Behavioral Risk Factor Surveillance System (BRFSS) survey. Wisconsin landlords and school administrators were surveyed to assess radon testing and mitigation in rental properties and schools, respectively. RESULTS Approximately 30% of Wisconsin homeowners (22.1% from SHOW and 39.9% from BRFSS) have tested their properties for radon. Similarly, 31.0% of Wisconsin landlords (40/129) and 35.1% of Wisconsin school districts (78/222) have tested their sch...

ABSTRACTPurposeThe Population-based Microbiome Research Core (PMRC) is an expandable and longitud... more ABSTRACTPurposeThe Population-based Microbiome Research Core (PMRC) is an expandable and longitudinal research core infrastructure to support the study of the human microbiome within the context of environmental, sociodemographic, and health factors. Broadly, the purpose of this infrastructure is to provide new insights into how human-environment interactions affect health through its influence on the composition and function of the microbiome. The PMRC was established as an ancillary study of the Survey of Health of Wisconsin (SHOW) and serves as a platform for ancillary studies, ongoing follow-up of the cohort, and expansion of the microbiome biorepository.ParticipantsThe study recruited adult participants who had previously participated in SHOW’s Wisconsin Microbiome Study (WMS). Over 59% of the eligible WMS participants agreed to provide a repeat stool sample and household samples including dust, high touch surface swabs and outside soil.Findings to datePMRC includes 323 individ...

Background: Groundwater contamination of private wells is widespread. Despite this, regulators in... more Background: Groundwater contamination of private wells is widespread. Despite this, regulators in Wisconsin and across the United States estimate only 10% of private well owners regularly test thei...

Antibody surveillance provides essential information for public health officials to work with com... more Antibody surveillance provides essential information for public health officials to work with communities to discuss the spread and impact of COVID-19. At the start of the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in the United States, diagnostic testing was limited with many asymptomatic and thus undetected cases. Irrespective of symptom severity, antibodies develop within two to three weeks after exposure and may persist 6 months or more.; Thus, antibody surveillance is an important tool for tracking trends in past infections across diverse populations. This study includes adults and children (≥12 years old) recruited from a statewide sample of past 2014-2020 Survey of the Health of Wisconsin (SHOW) participants. SHOW, an ongoing population-based health examination study including a randomly selected sample of households, partnered with the Wisconsin Department of Health Services and the Wisconsin State Laboratory of Hygiene to conduct longitudinal ...

The Lancet Global Health, 2021

Abstract Background The burning of fossil fuels, including coal, is the primary source of greenho... more Abstract Background The burning of fossil fuels, including coal, is the primary source of greenhouse gas emissions driving anthropogenic climate change and its associated health harms: heat-related illnesses, arboviral diseases, trauma from extreme weather events, allergies, and chronic disease exacerbations. Coal-fired power plants (CFPP) supply 23% of electricity in the USA and 42% for the state of Wisconsin. Air pollution from CFPP has been associated with respiratory diseases, cancers, cardiovascular and neurological disorders, especially for vulnerable populations. In this cross-sectional study, we aim to measure associations between respiratory diseases and residential proximity to CFPP. Methods We obtained cross-sectional, population-based health data for non-institutionalised, non-active-duty adults from the Survey of the Health of Wisconsin database from 2008 to 2013. Pulmonary function was measured by spirometry as a ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC). An average of three or more FEV1/FVC readings Findings We included data from 2327 adults aged 21–74 years in analysis. Adults living in close proximity to one of 11 CFPP had worse pulmonary function than did adults living more than 35 km away from CFPP with an odds ratio of 1·24 (95% CI 0·90–1·70). Although not statistically significant, trends suggest higher odds of obstructive pulmonary diseases in those living within 35 km of CFPP. Protective factors, in addition to distance, were higher education and younger age. Risk factors identified were older age and having a history of smoking. Although Black residents made up 4·8% of the total sample population, they accounted for 13·3% of people living within 35 km of CFPP. Similarly, Hispanic residents accounted for 4·8% of those living within 35 km of CFPP but only made up 2·8% of the sample population. Interpretation Wisconsin CFPP might be associated with worse pulmonary function in people living at or within 35km of their locations, with possible consequences related to costly inhaler medications, health-care visits, and hospitalisations. When linked with socioeconomic factors, and race and ethnicity, closing down CFPP should be considered when addressing health disparities and environmental injustices. Affordable, clean energy solutions are readily available and just transitions have recently been demonstrated in North America. As nations recover from COVID-19, there is a profound opportunity for leaders across sectors to build healthier communities and prioritise climate action for health. Funding Dr Elaine Kohler Summer Academy of Global Health Research and Wisconsin Partnership Program.

Environmental Research, 2020

Abstract Background Understanding the health effects of exposure to chemical mixtures is critical... more Abstract Background Understanding the health effects of exposure to chemical mixtures is critically important given the broad range of concurrent exposures throughout the life-course. While investigations of environmental chemicals and components of the human microbiome are becoming more common, few have examined associations with chemical mixtures. This study assesses the association between exposure to mixtures of 66 different environmental chemicals and nasal colonization of Staphylococcus aureus (SA) and methicillin resistant SA (MRSA). Methods Data came from the National Health and Nutrition Examination Survey (NHANES) 2001–2004. The analytical sample consists of 10,312 participants, age 6 years and older, subdivided into 8 groups with different chemical exposure mixtures. Within each of 6 chemical classes (metals, phthalates, polycyclic aromatic hydrocarbons (PAHs), polybrominated diphenyl ethers (PBDEs), polyfluorochemicals (PFCs), and phenols), weighted quantile sum (WQS) regression was used to analyze the joint association of the component compounds and nasal SA colonization. WQS was also used to assess the joint association of 3 chemical mixtures (metals, metal and PAHs, and metal and triclosan) and nasal MRSA colonization. All regression models were adjusted for confounders. Results The analytical sample was between ages 6–85, slightly more female, and predominantly non-smokers. Prevalence of SA carriage was 29.2%, and MRSA colonization prevalence was 1.2%. Within each chemical class, odds of SA colonization increased statistically significantly with exposure to mixtures of metals (OR = 1.11, 95% CI = 1.02–1.20), phthalates (OR = 1.09, 95% CI = 1.04–1.14), and phenols (OR = 1.08, 95% CI = 1.01–1.15). Exposure to a mixture of metals combined with PAHs was also associated with increased odds of MRSA carriage (OR = 1.38, 95% CI = 1.02–1.86). Conclusion Results indicate an association between multiple environmental chemical mixtures and SA colonization, including MRSA. These findings support the need for further analysis of associations between chemical mixtures and SA colonization, as well as other components of the human microbiome.

Open Forum Infectious Diseases, 2019

Background Little is known about the relationship between oral hygiene and multidrug-resistant or... more Background Little is known about the relationship between oral hygiene and multidrug-resistant organism in the mouth and gut. We aimed to assess the relationship of oral hygiene and diet with multidrug-resistant organism (MDRO) carriage in the oral cavity and gut. Methods Participants were adults over age 18 from the 2016–2017 Survey of the Health of Wisconsin (SHOW) and its ancillary Wisconsin Microbiome Study. SHOW surveys residents of Wisconsin, collecting health determinants including a food frequency questionnaire, oral health, as well as biologic specimens. MDROs were defined as the presence of methicillin-resistant Staphylococcus aureus, Vancomycin-resistant Enterococcus, and Fluoroquinolone-resistant Gram-negative bacteria identified via culture from saliva, oral swabs, and stool samples. Statistical analysis was performed in R v3.5.1. Univariate analyses were conducted for all variables in the data set. Any variable with a P-value < 0.2 in the univariate analysis was con...

Journal of Transport & Health, 2019

Background: The majority of commuting trips in the United States are taken by motor vehicle. Yet,... more Background: The majority of commuting trips in the United States are taken by motor vehicle. Yet, lack of regular physical activity has been identified as one of its most significant public health issues, and globally, risks due to physical inactivity are increasing. However, we believe current studies offer an unclear picture of the complex role of the environmental or psychological influences in active travel behavior across urbanicity classifications. Aims: To (1) determine an association between objective or subjective measures of the built environment and active transportation, and (2) characterize the associations within both urban and non-urban contexts among a statewide sample of 862 adults residing in Wisconsin. Methods: Multivariate logistic regression analysis of subjective data from the Survey of the Health of Wisconsin (SHOW) and data from the Wisconsin Assessment of the Social and Built Environment (WASABE), a direct observation audit tool, to test the impacts of subjective perceptions and objective built environment predictors on active transportation in both urban and rural contexts. Results: Males, non-married, physically active individuals, those living in urban areas and with higher education levels had greater odds of using active transportation. Bicycle friendliness (aOR = 2.43; 95% CI: 1.4-4.2) and presence of non-residential destinations (aOR = 1.03; 95% CI: 1.01-1.05) were the strongest objective predictors of active transportation overall. Subjective measures were especially predictive of active transportation in non-urban areas, specifically for participants identifying presence of trails (adjusted odds = 3.71; 95% CI: 1.5-9.2) and nonresidential destinations nearby (adjusted odds = 2.65; 95% CI: 0.99-7.06). Conclusions: Active transportation is associated with built environment characteristics and perceived environmental factors, but the specific predictors and strength of associations vary by context. Results suggest perceived bicycle friendliness may be important in urban areas and access to trails for walking and biking may provide important opportunities to promote active transportation in more suburban or rural areas.

Preventive Medicine Reports, 2019

Introduction: Despite the well-established benefits of physical activity (PA), a large portion of... more Introduction: Despite the well-established benefits of physical activity (PA), a large portion of U.S. adults are not meeting recommended health-based guidelines. Although PA occurs in several domains, population-based studies tend to focus on leisure-time PA, with few studies examining occupational activity (OA) level as a separate determinant of overall PA. Methods: Data were obtained from the 2014-2016 Survey of Health of Wisconsin (SHOW). Currently employed SHOW participants (n = 822) were categorized into OA level categories. Bivariate analyses and multinomial logistic regression analyses were used to identify predictors and to test associations between OA and odds of meeting total PA guidelines using both self-reported and accelerometer-based data. Results: Individuals with high OA level jobs tended to be males (p < 0.01), current smokers (p < 0.01), and have low education (p < 0.01). When measured by self-report, a greater proportion of individuals in high OA jobs (89%) met the physical activity guidelines compared to those in medium (78%) and low (76%) OA jobs (p = 0.01). Further, adjusted odds of doing some PA vs meeting PA guidelines were higher for low OA vs. high OA level (OR = 2.40, 95% CI 1.46-3.94, p < 0.01). This trend was not observed when PA was measured via accelerometer (OR = 1.00, 95% CI 0.62-1.60, p = 0.99). Conclusions: Correlations between low, intermediate, and high OA and levels of overall PA varied by measurement type. Further research is needed to improve PA measurements within subdomains such as OA and to examine the tradeoffs between OA and leisure-time PA and relationships with health.

Preventive Medicine Reports, 2019

There are known health disparities between lesbian, gay, bisexual and transgender (LGBT) people a... more There are known health disparities between lesbian, gay, bisexual and transgender (LGBT) people and non-LGBT people, but only in the past couple of decades have population-based health surveys in the United States included questions on sexual and gender identity. We aimed to better understand LGBT disparities in health, health care access and utilization, and quality of care. Data are from the Survey of the Health of Wisconsin (SHOW) from 2014 to 2016 (n = 1957). The analyses focused on comparing health care access and utilization, and quality of care between LGB and non-LGB people and transgender and cisgender people. 3.8% (n = 73) identified as lesbian, gay or bisexual, and 1.3% (n = 25) were transgender. LGB adults were 2.17 (95th CI: 1.07-4.4) times more likely to delay obtaining health care. Transgender adults were 2.76 (95th CI: 1.64-4.65) times more likely to report poor quality of care and 2.78 (95th CI: 1.10-7.10) unfair treatment when receiving medical care. The results show differences in health care access and utilization and quality of care, and they add to the growing body of literature that suggest that improved health care services for LGBT patients are needed to promote health equity for LGBT populations.

Sleep health, 2018

Adequate sleep duration and quality are protective against many adverse health outcomes. Many ind... more Adequate sleep duration and quality are protective against many adverse health outcomes. Many individual-level predictors of poor sleep have been examined, but few studies have examined neighborhood-level influences. Despite known associations between neighborhood green space and sleep influencing factors (eg, physical activity, mental health), few studies have examined green space and sleep's relationship. Furthermore, little work has examined the relationship between the magnitude and type of neighborhood sounds and sleep. We analyzed data from the Survey of the Health of Wisconsin database (n = 2712) for 2008-2013, a representative sample of Wisconsin residents ages 21-74. Outcomes included weekday and weekend sleep duration and self-rated sleep quality. Primary predictors were the proportion tree canopy (National Land Cover Database) and mean decibel levels of outdoor sound (US National Park Service) at the census block group level. Survey regression analysis was used to exa...

International Journal of Hygiene and Environmental Health, 2016

Fish are an important source of nutrients which may reduce risk of adverse health outcomes such a... more Fish are an important source of nutrients which may reduce risk of adverse health outcomes such as cardiovascular disease; however, fish may also contain significant amounts of environmental pollutants such as mercury, polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), and perfluorinated compounds (PFCs, also called perfluoroalkyl compounds), which confer increased risk for adverse health effects. The Wisconsin Departments of Health Services and Natural Resources developed a survey instrument, along with a strategy to collect human biological samples to assess the risks and benefits associated with long-term fish consumption among older male anglers in Wisconsin. The target population was men aged 50 years and older, who fish Wisconsin waters and live in the state of Wisconsin. Participants provided blood and hair samples and completed a detailed (paper) questionnaire, which included questions on basic demographics, health status, location of catch and species of fish caught/eaten, consumption of locally caught and commercially purchased fish, and awareness and source of information for local and statewide consumption guidelines. Biological samples were used to assess levels of PCBs, PBDEs, PFCs (blood), and mercury (hair and blood). Quantile regression analysis was used to investigate the associations between biomarker levels and self-reported consumption of fish from the Great Lakes and other areas of concern, other locally caught fish, and commercially purchased fish (meals per year). Respondents had a median age of 60.5 (interquartile range: 56, 67) years. The median fish consumption was 54.5 meals per year, with most fish meals coming from locally-caught fish. Participants had somewhat higher mercury levels compared with the US general population, while levels of other contaminants were similar or lower. Multivariate regression models showed that consumption of fish from the Great Lakes and areas of concern was associated with higher levels of each of the contaminants with the exception of PBDEs, as was consumption of locally caught fish from other water bodies. All commercial fish consumption was also associated with both hair and blood mercury. When looking at specific PCB, PBDE and PFC analytes, consumption of fish from the Great Lakes and areas of concern was associated with higher levels of each of the individual PCB congeners examined, as well as higher levels of all of