Publications by authors named "Andrew Brouwer"

Background: While water, sanitation, and hygiene (WASH) interventions can reduce diarrheal disease, many large-scale trials have not found the expected health gains for young children in low-resource settings. Evidence-based guidance is needed to improve interventions and remove barriers to diarrheal disease reduction.

Objectives: We aimed to estimate how sensitive WASH intervention effectiveness was to underlying contextual and intervention factors in the WASH Benefits (WASH-B) Bangladesh cluster-randomized controlled trial.

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Background: Given the many nicotine and tobacco products in use, studies of the interdependence of use patterns and transitions are needed.

Methods: Using Waves 1-4 of the PATH Study, we analyzed latent transitions among adults who ever regularly used nicotine or tobacco products at Wave 1 to identify latent use states (n = 12,358) and estimated one-wave transition probabilities. Multinomial logistic regression identified demographic factors associated with transitions.

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Journal peer review is a gatekeeper in the scientific process, determining which papers are published in academic journals. It also supports authors in improving their papers before they go to press. Training for early-career researchers on how to conduct a high-quality peer review is scarce, however, and there are concerns about the quality of peer review in the health sciences.

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  • Environmental enteropathy (EE) is a condition affecting children in low-resource settings due to exposure to enteric pathogens, and a new noninvasive breath test (C-SBT) to assess carbohydrate digestion was developed and validated.
  • The study aimed to link the C-SBT results to the lactulose/rhamnose ratio (LR) and identify their relationship with child growth, as well as investigate connections with socio-economic factors, dietary diversity, and other EE biomarkers.
  • Results indicated variability in C-SBT and LR measurements across different sites, with some associations found between child growth and test timing, but no significant links between C-SBT and LR or overall growth metrics were established.
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Self-sampling for primary HPV detection for cervical cancer screening is now FDA-approved. Many persons interested in cervical cancer screening are eager to opt out of the invasive speculum exam and opt into the self-sampling. There is no limitation on which persons can choose self-sampling.

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Introduction: This study examines the prospective association between financial strain and smoking cessation and smoking relapse among U.S. adults with established smoking.

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TheC-sucrose breath test (C-SBT) has been proposed to estimate sucrase-isomaltase (SIM) activity and is a promising test for SIM deficiency, which can cause gastrointestinal symptoms, and for intestinal mucosal damage caused by gut dysfunction or chemotherapy. We previously showed how various summary measures of theC-SBT breath curve reflect SIM inhibition. However, it is uncertain how the performance of these classifiers is affected by test duration.

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  • - STIs are increasingly affecting older age groups, highlighting a gap in research that has traditionally focused on younger populations and their risk behaviors.
  • - The study utilized multi-group latent class analysis to identify sexual activity and substance use behaviors, finding six overall profiles and five unique profiles in each of four age groups, suggesting complex relationships between age and STI risk factors.
  • - The research indicates that while behavior profiles are similar across age groups, the experience of belonging to these profiles differs significantly by age, suggesting that STI risk assessments should consider peer comparisons rather than general population norms.
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Introduction: The use of cigarettes and electronic nicotine delivery system (ENDS) has likely changed since 2019 with the rise of pods and disposables, the lung injuries outbreak, flavour bans, Tobacco 21 and the COVID-19 pandemic.

Methods: Using the Population Assessment of Tobacco and Health Study, we applied a multistate transition model to 28 061 adults in waves 4-5 (2017-2019) and 24 584 adults in waves 5-6 (2019-2021), estimating transition rates for initiation, cessation and switching products for each period overall and by age group.

Results: Cigarette initiation among adults who never used either product decreased from 2017-2019 to 2019-2021, but ENDS initiation did not significantly change.

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Occupational and residential segregation and other manifestations of social and economic inequity drive of racial and socioeconomic inequities in infection, severe disease, and death from a wide variety of infections including SARS-CoV-2, influenza, HIV, tuberculosis, and many others. Despite a deep and long-standing quantitative and qualitative literature on infectious disease inequity, mathematical models that give equally serious attention to the social and biological dynamics underlying infection inequity remain rare. In this paper, we develop a simple transmission model that accounts for the mechanistic relationship between residential segregation on inequity in infection outcomes.

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Purpose: Surveillance, Epidemiology, and End Results (SEER) cancer registries provides information about survival duration and cause of death for cancer patients. Baseline demographic and tumor characteristics such as age, sex, race, year of diagnosis, and tumor stage can inform the expected survival time of patients, but their associations with survival may not be constant over the post-diagnosis period.

Methods: Using SEER data, we examined if there were time-varying associations of patient and tumor characteristics on survival, and we assessed how these relationships differed across 14 cancer sites.

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Article Synopsis
  • Environmental enteric dysfunction (EED) affects children's growth by damaging intestinal function, with the C-sucrose breath test (C-SBT) proposed as a method to measure sucrase-isomaltase (SIM) activity, which may be impaired in EED.
  • A study was conducted using data from 16 adults receiving varying doses of Reducose to analyze the effectiveness of different classifiers in predicting SIM activity based on C-SBT results over various test durations.
  • Results showed that tests shorter than 2 hours were generally unreliable, with the cumulative percent dose recovered at 90 minutes (cPDR90) emerging as the most accurate classifier, but further research is needed to confirm these
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Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face numerous barriers to preventive care, including for cervical cancer screening. At-home human papillomavirus (HPV) testing may expand access to cervical cancer screening for TGD people AFAB. This study assessed the perceptions of TGD individuals AFAB who self-collected cervicovaginal and anal samples.

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The human papillomavirus (HPV) causes cervicovaginal, oral, and anogenital cancer, and cervical cancer screening options include HPV testing of a clinician-collected sample. Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face many barriers to preventive care, including cancer screening. Self-sampling options may increase access and participation in HPV testing and cancer screening.

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The human papillomavirus (HPV) carries a significant health risk for people with a cervix. Among transgender and nonbinary people, however, testing and treatment for HPV can pose difficulties, and even be traumatic at times. This current study is part of a larger mixed methods study conducted in Michigan in 2020, and it explores the experiences of transmasculine and nonbinary people with at-home self-swabbing HPV test kits and knowledge of HPV transmission/screenings.

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Background: Environmental enteric dysfunction (EED) causes malnutrition in children in low-resource settings. Stable-isotope breath tests have been proposed as noninvasive tests of altered nutrient metabolism and absorption in EED, but uncertainty over interpreting the breath curves has limited their use. The activity of sucrose-isomaltase, the glucosidase enzyme responsible for sucrose hydrolysis, may be reduced in EED.

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  • Diarrheal diseases significantly affect children in low-income countries, driven by enteropathogens from various transmission pathways, with contaminated chickens being a key concern.
  • The study aimed to analyze how different transmission pathways contribute to infections in Mozambique, and to assess the impact of reducing each pathway on human infection rates.
  • Simulation findings revealed that reducing foodborne transmission by 90% could substantially lower infection rates, emphasizing the need for targeted interventions in food safety, particularly concerning chicken contamination.
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Introduction: The use of cigarettes and electronic nicotine delivery system (ENDS) has likely changed since 2019 with the rise of pods and disposables, the outbreak of lung injuries related to vaping THC, flavor bans, and the COVID pandemic. We analyzed patterns of initiation, cessation, and transitions between cigarettes, ENDS, and dual use before and after 2019.

Methods: Using the Population Assessment of Tobacco and Health (PATH) Study, we applied a multistate transition model to 28,061 adults in Waves 4-5 (2017-19) and 24,751 adults in Waves 5-6 (2019-21), estimating transition rates for initiation, cessation, and switching products for each period overall and by age group.

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Article Synopsis
  • Transgender and gender diverse (TGD) individuals assigned female at birth (AFAB) often struggle to access preventive healthcare like HPV and cervical cancer screenings, highlighting the potential need for self-sampling options.
  • A study involving 101 TGD AFAB participants showed that most found cervicovaginal self-swabs comfortable and easy to use, with a high willingness to continue using them, while anal swabs were less comfortable but still deemed manageable by most.
  • Overall, the findings suggest that TGD AFAB individuals prefer self-sampling methods for HPV testing, indicating that such options could improve access to necessary healthcare for this population.
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Introduction: HPV causes oral, cervicovaginal, and anogenital cancer, and cervical cancer screening options include HPV testing of a physician-collected sample. Transgender and gender diverse (TGD) people assigned female at birth (AFAB) face discrimination and stigma in many healthcare settings; are believed to be a lower risk for cervical cancer by many physicians; are less likely to be up to date on preventive health care services such as pelvic health exams; and are more likely to have inadequate results from screening tests. Self-sampling options may increase access and participation in HPV testing and cancer screening.

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  • * This study provides longitudinal data on fecal shedding of SARS-CoV-2 RNA from 48 infected individuals, revealing that a significant number (77%) had positive samples over time, showcasing the variability in individual shedding patterns.
  • * The research also details the detection of fecal indicators like PMMoV RNA and crAssphage DNA, emphasizing their potential role in improving estimates of COVID-19 prevalence in wastewater, thus enhancing public health monitoring efforts.
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For vector-borne diseases the basic reproduction number [Formula: see text], a measure of a disease's epidemic potential, is highly temperature-dependent. Recent work characterizing these temperature dependencies has highlighted how climate change may impact geographic disease spread. We extend this prior work by examining how newly emerging diseases, like Zika, will be impacted by specific future climate change scenarios in four diverse regions of Brazil, a country that has been profoundly impacted by Zika.

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Background: A better understanding of sociodemographic transition patterns between single, dual and poly tobacco product use may help improve tobacco control policy interventions.

Methods: HRs of transition between never, non-current (no past 30-day use), cigarette, e-cigarette, other combustible, smokeless tobacco (SLT), dual and poly tobacco use states in adults were estimated for age, sex, race/ethnicity, education and income using a multistate model for waves 1-4 of the Population Assessment of Tobacco and Health study (2013-2017), a US-based cohort study, accounting for complex survey design.

Results: Sole cigarette and SLT use were persistent, with 77% and 78% of adults continuing use after one wave.

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Introduction: It is unknown how recent changes in the tobacco product marketplace have impacted transitions in cigarette and electronic nicotine delivery system (ENDS) use.

Methods: A multistate transition model was applied to 24 242 adults and 12 067 youth in waves 2-4 (2015-2017) and 28 061 adults and 12 538 youth in waves 4 and 5 (2017-2019) of the Population Assessment of Tobacco and Health Study. Transition rates for initiation, cessation and product transitions were estimated in multivariable models, accounting for gender, age group, race/ethnicity and daily versus non-daily product use.

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