Rajesh Talluri

Background We examined the awareness, interest, and information sources relating to cannabis use for cancer management (including management of cancer symptoms and treatment‐related side effects) and determined factors associated with cancer survivors' awareness and interest in learning about cannabis use for cancer management. Methods This was a cross‐sectional study of adult cancer survivors (N = 1886) receiving treatment at a comprehensive cancer center. Weighted prevalence and multivariable logistic regression analyses were conducted. Results Among cancer survivors, 88% were aware and 60% were interested in learning about cannabis use for cancer management. Common sources of information to learn about cannabis use for cancer management were cancer doctors/nurses (82%), other patients with cancer (27%), websites/blogs (26%), marijuana stores (20%), and family/friends …

Mendelian randomization (MR) is an epidemiological framework using genetic variants as instrumental variables (IVs) to examine the causal effect of exposures on outcomes. Statistical methods based on unidirectional MR (UMR) are widely used to estimate the causal effects of exposures on outcomes in observational studies. To estimate the bidirectional causal effects between two phenotypes, investigators have naively applied UMR methods separately in each direction. However, bidirectional causal effects between two phenotypes create a feedback loop that biases the estimation when UMR methods are naively applied. To overcome this limitation, we proposed two novel approaches to estimate bidirectional causal effects using MR: BiRatio and BiLIML, which are extensions of the standard ratio, and limited information maximum likelihood (LIML) methods, respectively. We compared the performance of the two proposed methods with the naive application of UMR methods through extensive simulations of several scenarios involving varying numbers of strong and weak IVs. Our simulation results showed that when multiple strong IVs are used, the proposed methods provided accurate bidirectional causal effect estimation in terms of median absolute bias and relative median absolute bias. Furthermore, compared to the BiRatio method, the BiLIML method provided a more accurate estimation of causal effects when weak IVs were used. Therefore, based on our simulations, we concluded that the BiLIML should be used for bidirectional causal effect estimation. We applied the proposed methods to investigate the potential bidirectional …

BackgroundPlasma amyloid-β (Aβ) (Aβ42, Aβ40, and Aβ42/Aβ40), biomarkers of the Alzheimer’s form of dementia, are under consideration for clinical use. The associations of these peptides with circulating proteins may identify novel plasma biomarkers of dementia and inform peripheral factors influencing the levels of these peptides.MethodsWe analyzed the association of these 3 plasma Aβ measures with 4638 circulating proteins among a subset of the participants of the Atherosclerosis Risk in Communities (ARIC) study (midlife: n = 1955; late life: n = 2082), related the Aβ-associated proteins with incident dementia in the overall ARIC cohort (midlife: n = 11,069, late life: n = 4110) with external replication in the Age, Gene/Environment Susceptibility (AGES)–Reykjavik Study (n = 4973), estimated the proportion of Aβ variance explained, and conducted enrichment analyses to characterize the proteins associated …

Background Transplant recipients have a 2‐ to 4‐fold increased risk of developing malignancies over the general population. Cancer is the second most common cause of death for recipients. The magnitude of the risk depends on the cancer type and increases in viral‐related malignancies. Skin cancer is the most common. However, data in most cancer registries is limited to cutaneous melanomas, thereby limiting the epidemiologic examination of cancer risk in non‐melanoma skin cancer. Our goal was to evaluate post‐kidney transplant cancer cases and sites in our population to guide screening recommendations. Methods Between 2009 and 2015, a retrospective study of adult kidney recipients transplanted at East Carolina University was conducted. The first cancer diagnosis after transplant through February 18, 2020, was captured and analyzed. Patient demographics, cancer sites, and histological …

BackgroundThere is increasing discourse on the use of cannabis as a palliative for cancer/cancer-treatment-related symptoms. We described the prevalent reasons for use, perceived benefits, and awareness of health risks from cannabis use for cancer management among cancer survivors.MethodsCross-sectional survey of adult (≥ 18 years) cancer survivors from 41 US states receiving treatment at a comprehensive cancer center.ResultsOf 1,886 cancer survivors included, 17.4% were current users, 30.5% were former users, and 52.2% were never users of cannabis. Among survivors who currently or formerly used cannabis after their cancer diagnosis (n = 510), the reasons for cannabis use in cancer management were; sleep disturbance (60%), pain (51%), stress (44%), nausea (34%), and mood disorder/depression (32%). Also, about a fifth (91/510) of survivors used cannabis to treat their cancer. Across the …

Background In 2021, the U.S. Preventive Services Task Force (USPSTF) updated its recommendation to expand lung cancer screening (LCS) eligibility and mitigate disparities. Although this increased the number of non‐White individuals who are eligible for LCS, the update's impact on drivers of disparities is less clear. This analysis focuses on racial disparities among Black individuals because members of this group disproportionately share late‐stage lung cancer diagnoses, despite typically having a lower intensity smoking history compared to non‐Hispanic White individuals. Methods We used data from the National Health Interview Survey to examine the impact of the 2021 eligibility criteria on racial disparities by factors such as education, poverty, employment history, and insurance status. We also examined preventive care use and reasons for delaying medical care. Results When comparing Black …

Simple Summary There is a need for alternative and effective approaches to manage the cancer-related symptoms experienced by survivors. This cross-sectional study describes the current state of cannabis use and how cancer survivors use cannabis during their cancer management to alleviate their cancer-related symptoms including use pattern, product type, and mode of delivery of cannabis. Nearly half of the survivors had used cannabis at some point in their lifetime. Among survivors using cannabis, about half said their cannabis use had increased since cancer diagnosis. The most common types of cannabis products used were dry-leaf cannabis, cannabidiol (CBD) oil, and cannabis candy. Regarding the method of use, most survivors preferred to inhale or smoke cannabis rather than eat or drink it. The most common inhalational methods were rolled cannabis cigarettes, pipes, water pipes, vaporizers, and e-cigarette devices. The study highlights the importance of educating healthcare providers and survivors about cannabis use during cancer treatment. Abstract Despite growing interest in the use of cannabis for the treatment of cancer-related symptoms, there are limited studies that have assessed the use pattern, type, and mode of delivery of cannabis products used by cancer survivors. This study describes the current state of the use pattern, product type, and mode of delivery of cannabis used by cancer survivors. This was a cross-sectional study of cancer survivors from 41 U.S. states who received treatment at the largest NCI-designated comprehensive cancer center. The weighted prevalence of the …

OBJECTIVE:We sought to determine the clinical and histopathological factors associated with intestinal hemorrhage and its correlation with clinical outcomes in neonates with surgical necrotizing enterocolitis (NEC).METHODS:A retrospective study compared clinical and histopathology information in neonates following surgical NEC with severe hemorrhage and those with mild/moderate hemorrhagic lesions seen on resected intestine pathology.RESULTS:The infants with severe hemorrhage (Grade 3-4, 81/148, 54.7%) had significantly lower exposure to antenatal steroids (52.5% vs 76.9%; p= 0.004), had higher gestational age (28.5 weeks [7.14] vs. 26.58 [2.90]; p= 0.034), lost more bowel length (p= 0.045), had higher CRP levels at 2 weeks (p= 0.035), and had less intestinal failure ([30.3% vs 52.5%]; p= 0.014) than mild/moderate (Grade 0–2, 67/148, 45.2%) hemorrhage group. Those with severe hemorrhage …

Background Despite the known benefits of preventing human papillomavirus (HPV)–related cancers, HPV vaccine coverage is low in the United States. Grounded in Social Ecological theory, we assessed the macro-level (state) and meso-level (organization) factors associated with HPV vaccine initiation and up-to-date. Methods Data from 2020 National Immunization Survey-Teen were used to study a sample of 20 163 US adolescents (aged 13-17 years). The data were collected from each teen’s parents or guardians and health-care professionals. Weighted prevalence estimates were calculated, and multivariable regression analyses were conducted. Results The prevalence of HPV vaccine initiation was 75.1% and of remaining up-to-date was 58.6%. At the macro level, teens living in states with high and moderate religiosity had lower odds of HPV …

OBJECTIVE: We sought to investigate the clinical determinants of intestinal failure and death in preterm infants with surgical NEC.METHODS: Retrospective comparison of clinical information between Group A= intestinal failure (Parenteral nutrition (PN)> 90 days) and death and Group B= survivors and with PN dependence< 90 days in preterm infants with surgical NEC. RESULTS: Group A (n= 99/143) had a lower mean gestational age (26.4 weeks [SD3. 5] vs. 29.4 [SD 3.5]; p= 0.013), lower birth weight (873 gm [SD 427g] vs. 1425 gm [894g]; p=< 0.001), later age of NEC onset (22 days [SD20] vs. 16 days [SD 17]; p= 0.128), received surgery later (276 hours [SD 544] vs. 117 hours [SD 267]; p= 0.032), had cholestasis, received dopamine (80.6% vs. 58.5%; p= 0.010) more frequently and had longer postoperative ileus time (19.8 days [SD 15.4] vs. 11.8 days [SD 6.5]; p=< 0.001) and reached full feeds later (93 days …

BackgroundDespite the known benefits of preventing HPV-related cancers, HPV vaccine coverage is low in the United States. Grounded in Social Ecological theory, we assessed the macro-(state) and meso-level (organization) factors associated with HPV vaccine initiation and up to date (UTD).MethodsData from NIS-Teen 2020 was used to study a sample of 20,163 US adolescents (ages 13-17). The data was collected from the teen’s parents/guardians and their healthcare providers. Weighted prevalence estimates were calculated, and multivariable regression analyses were conducted.ResultsThe prevalence of HPV vaccine initiation was 75.1%, and UTD was 58.6%. At the macro-level, teens living in states with high and moderate religiosity had lower odds of HPV vaccine initiation (high religiosity AOR: 0.63 [95% CI: 0.50-0.78]; moderate religiosity (AOR: 0.68 [95% CI: 0.55-0.85]) and UTD (high religiosity AOR …

BackgroundMenthol cigarette use is associated with higher smoking initiation and reduced smoking cessation. We investigated sociodemographic differences in menthol and nonmenthol cigarette use in the United States.MethodsWe used the most recent available data from the May 2019 wave of the nationally-representative Tobacco Use Supplement to the Current Population Survey. The survey weights were used to estimate the national prevalence of individuals who currently smoke among individuals who use menthol and nonmenthol cigarettes. Survey-weighted logistic regression methods were used to estimate the association of menthol cigarette use with formerly smoking cigarettes and attempting to quit within the past 12 months while adjusting for several sociodemographic factors associated with smoking.ResultsThe prevalence of current smoking in individuals who ever smoked menthol cigarettes was …

The most important determinant of HPV vaccination uptake is healthcare provider recommendation, yet not all eligible patients receive HPV vaccination recommendations. We used data from the 2020 National Immunization Survey-Teen to determine individual, systemic, and state factors associated with provider recommendation of HPV vaccination. A total of 18,534 teens were included, with 81.4% receiving provider recommendations for HPV vaccination. HPV vaccination recommendation was higher among females compared to males (AOR: 1.57; 95% CI: 1.27–1.93), teens who received a well-child exam at 11 or 12 years compared to those who did not (AOR: 2.10; 95% CI: 1.61–2.74), and teens whose mothers had college, some college or at least a high school education compared to those with less than high school education. In addition to individual factors, provider recommendation of HPV vaccination was …

Background: Previous studies suggest poor pulmonary function is associated with increased burden of cerebral white matter hyperintensities and brain atrophy among elderly individuals, but the results are inconsistent. Objective: To study the cross-sectional associations of pulmonary function with structural brain variables. Methods: Data from six large community-based samples (N= 11,091) were analyzed. Spirometric measurements were standardized with respect to age, sex, height, and ethnicity using reference equations of the Global Lung Function Initiative. Associations of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and their ratio FEV1/FVC with brain volume, gray matter volume, hippocampal volume, and volume of white matter hyperintensities were investigated using multivariable linear regressions for each study separately and then combined using random-effect meta …

Amid subpar uptake of HPV vaccination in the United States, gender-generated disparities in HPV vaccination uptake have the potential to perpetuate existing disparities in HPV-associated cancers. Yet few studies have investigated the influence of parent–child gender on intentions to refuse HPV vaccination due to safety concerns/side effects. This study used nationally representative data, spanning 2010–2019, from the National Immunization Survey-Teen (NIS-Teen). NIS-Teen respondents are parents/guardians or primary caregivers of adolescents 13–17 years old living in the United States. Over the study period, intentions to refuse HPV vaccination due to safety concerns rose among all parent–child gender pairings but were highest among respondent mothers regarding their unvaccinated daughters. The results revealed a statistically significant increased likelihood of having intentions to refuse HPV …

This study estimates the out-of-pocket (OOP) expenditures for different cancer types among survivors with current versus no current cancer condition and across sex, which is understudied in the literature. This is a cross-sectional study of Medical Expenditure Panel Survey data for 2009–2018 where the primary outcome was the average per year OOP expenditure incurred by cancer survivors. Of 189,285 respondents, 15,010 (7.93%) were cancer survivors; among them, 46.28% had a current cancer condition. Average per year OOP expenditure for female survivors with a current condition of breast cancer ($1,730), lung cancer ($1,679), colon cancer ($1,595), melanoma ($1,783), non–Hodgkin lymphoma ($1,656), nonmelanoma/other skin cancer (NMSC, $2,118) and two or more cancers ($2,310) were significantly higher than that of women with no history of cancer ($853, all P < 0.05). Similarly, average per year …

Background: Gender-generated disparities in HPV vaccination uptake have the potential to further perpetuate existing disparities in HPV-associated cancers. This study examines the influence of parent-child gender on intent to not vaccinate against HPV due to safety/side effect concerns. Methods: Study data was from the National Immunization Survey-Teen (2010 - 2019). Weighted prevalence of intention to refuse HPV vaccination due to safety/side effect concerns were stratified by parent-child gender. Multivariable logistic regressions were used to examine for associations between intentions to refuse HPV vaccination due to safety concern/side effects and parent-child gender. Results: Over the study period, intentions to refuse HPV vaccination due to safety concerns rose among all parent-child gender pairings but was highest among respondent mothers when pertaining to their unvaccinated daughters. Results …

Introduction A data‐driven index of dementia risk based on magnetic resonance imaging (MRI), the Alzheimer's Disease Pattern Similarity (AD‐PS) score, was estimated for participants in the Atherosclerosis Risk in Communities (ARIC) study. Methods AD‐PS scores were generated for 839 cognitively non‐impaired individuals with a mean follow‐up of 4.86 years. The scores and a hypothesis‐driven volumetric measure based on several brain regions susceptible to AD were compared as predictors of incident cognitive impairment in different settings. Results Logistic regression analyses suggest the data‐driven AD‐PS scores to be more predictive of incident cognitive impairment than its counterpart. Both biomarkers were more predictive of incident cognitive impairment in participants who were White, female, and apolipoprotein E gene (APOE) ε4 carriers. Random forest analyses including predictors from …

BackgroundLittle is known regarding human immunodeficiency virus (HIV)/sexually transmitted infection (STI) testing preferences for location, staffing, and hours of operation among Young Black men who have sex with men (YBMSM) in the Southeastern United States, a population at high risk for HIV/STIs. We used a discrete choice experiment to explore these preferences.MethodsYoung Black men who have sex with men ages 16 to 35 years in Birmingham, AL and Jackson, MS completed online surveys evaluating their preferences (best/worst) for HIV/STI testing locations, staffing, hours, method of results notification, and cost. They also selected preferred combinations of these variables through choice tasks. Results were analyzed using joint best/worst and discrete choice experiment models.ResultsBetween June 2018 and December 2019, participants in Alabama (n= 54) and Mississippi (n= 159) completed …

Introduction Heated Tobacco Products (HTP) have the potential to attain high uptake in the US. The current study estimated the prevalence of awareness, prevalence of use and the factors associated with awareness of HTP among US adults. Methods This study included 3201 respondents from the Health Information National Trends Survey (HINTS) 5 Cycle 4 (2020). The prevalence of awareness of HTP and ever use of HTP among US adults were estimated. Multivariable logistic regression was conducted to identify the factors associated with awareness of HTP. Results About 15% of the adult US population were aware of HTP, while 2.2% had ever used HTP. Age between 35 and 49 years (aOR, 1.9; 95% CI, 1.3–2.9; p-value= 0.003), male sex (aOR, 1.7; 95% CI, 1.0–2.7; p-value= 0.04), lower income (0– 9,999)(aOR, 3.0; 95% CI, 1.3–6.9; p-value= 0.01), smoking on some days (aOR, 3.4; 95% CI, 1.2–9.4; p-value …