Robin B Harris

Interests

Teaching

basic epidemiology, chronic disease epidemiology, incorporation of field work into course work

Research

cancer epidemiology with focus on skin cancers; cancer prevention and environmental health research in Native American populations; cancer registration

Courses

Scholarly Contributions

Journals/Publications

• Chief, C., Sanderson, P. R., Willeto, A. A., Yazzie, A., McKinley, A., Monroy, F. P., Harris, R. B., & Oren, E. (2022). "Nobody Is Talking About It": Diné (Navajo) Communities Speak About Stomach Cancer and Helicobacter pylori Infections. Journal of cancer education : the official journal of the American Association for Cancer Education, 37(1), 3-9.
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  Stomach cancer is the third leading cause of cancer death globally. Helicobacter pylori plays a role in the healthy human gut, but is also associated with multiple chronic diseases, including stomach cancer. Though H. pylori prevalence is declining in parts of the world, it remains high among certain populations. In Arizona, stomach cancer rates are 3-4 times higher among the Navajo Nation population as compared with the non-Hispanic white population. This pilot project assessed adult Diné (Navajo) individuals' understanding and awareness regarding H. pylori infection and stomach cancer. Focus groups were held in three Diné communities. Data were analyzed thematically using a multi-investigator consensus approach. Participants had limited knowledge of H. pylori infection and stomach cancer and perceived local medical providers as also having limited knowledge on these conditions. Participants described poor health care experiences, structural inequalities, and environmental concerns and associated these with H. pylori infection and stomach cancer. This study highlights the need for additional research and education on current knowledge and perceptions of stomach cancer and H. pylori infections in Navajo Nation.
• Harris, R. B., Brown, H. E., Begay, R. L., Sanderson, P. R., Chief, C., Monroy, F. P., & Oren, E. (2022). Prevalence and Risk Factors in Three Rural Indigenous Communities of Northern Arizona. International journal of environmental research and public health, 19(2).
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  () is one of the most common bacterial stomach infections and is implicated in a majority of non-cardia gastric cancer. While gastric cancer has decreased in the United States (US), the incidence in the Navajo Nation is nearly four times higher than surrounding Non-Hispanic White populations. Little is known about prevalence in this population or other Indigenous communities in the lower 48 states. In this cross-sectional study, 101 adults representing 73 households from three Navajo Nation chapter communities completed surveys and a urea breath test for active . Accounting for intrahousehold correlation, prevalence was 56.4% (95% CI, 45.4-66.8) and 72% of households had at least one infected person. The odds of having an active infection in households using unregulated water were 8.85 (95% CI, 1.50-53.38) that of the use of regulated water, and males had 3.26 (95% CI, 1.05-10.07) higher odds than female. The prevalence of in Navajo is similar to that seen in Alaska Natives. Further investigation into factors associated with prevention of infection is needed as well as understanding barriers to screening and treatment.
• Catalfamo, C. J., Heslin, K. M., Shilen, A., Khan, S. M., Hunsaker, J. R., Austhof, E., Barraza, L., Cordova-Marks, F. M., Farland, L. V., Garcia-Filion, P., Hoskinson, J., Jehn, M., Kohler, L. N., Lutrick, K., Harris, R. B., Chen, Z., Klimentidis, Y. C., Bell, M. L., Ernst, K. C., , Jacobs, E. T., et al. (2021). Design of the Arizona CoVHORT: A Population-Based COVID-19 Cohort. Frontiers in public health, 9, 620060.
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  This study is a prospective, population-based cohort of individuals with a history of SARS-CoV-2 infection and those without past infection through multiple recruitment sources. The main study goal is to track health status over time, within the diverse populations of Arizona and to identify the long-term consequences of COVID-19 on health and well-being. A total of 2,881 study participants (16.2% with a confirmed SARS-CoV-2 infection) have been enrolled as of December 22, 2020, with a target enrollment of 10,000 participants and a planned follow-up of at least 2 years. This manuscript describes a scalable study design that utilizes a wide range of recruitment sources, leveraging electronic data collection to capture and link longitudinal participant data on the current and emerging issues associated with the COVID-19 pandemic. The cohort is built within a collaborative infrastructure that includes new and established partnerships with multiple stakeholders, including the state's public universities, local health departments, tribes, and tribal organizations. Challenges remain for ensuring recruitment of diverse participants and participant retention, although the electronic data management system and timing of participant contact can help to mitigate these problems.
• Florea, A., Harris, R. B., Klimentidis, Y. C., Kohler, L. N., Jurutka, P. W., & Jacobs, E. T. (2021). Circulating Fibroblast Growth Factor-21 and Risk of Metachronous Colorectal Adenoma. Journal of gastrointestinal cancer, 52(3), 940-946.
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  Prior work has shown that higher circulating concentrations of fibroblast growth factor-21 (FGF-21) are associated with an increased likelihood of developing colorectal cancer. We conducted a prospective study to assess the relationship between circulating FGF-21 and odds of developing early neoplastic lesions in the colorectum.
• Florea, A., Jacobs, E. T., Harris, R. B., Klimentidis, Y. C., Thajudeen, B., & Kohler, L. N. (2021). Chronic kidney disease unawareness and determinants using 1999-2014 National Health and Nutrition Examination Survey Data. Journal of public health (Oxford, England).
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  Although chronic kidney disease (CKD) affects 15% of the United States (US) population,
• Hadeed, S. J., O'Rourke, M. K., Canales, R. A., Joshweseoma, L., Sehongva, G., Paukgana, M., Gonzalez-Figueroa, E., Alshammari, M., Burgess, J. L., & Harris, R. B. (2021). Household and behavioral determinants of indoor PM in a rural solid fuel burning Native American community. Indoor air, 31(6), 2008-2019.
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  Indoor and outdoor concentrations of PM were measured for 24 h during heating and non-heating seasons in a rural solid fuel burning Native American community. Household building characteristics were collected during the initial home sampling visit using technician walkthrough questionnaires, and behavioral factors were collected through questionnaires by interviewers. To identify seasonal behavioral factors and household characteristics associated with indoor PM , data were analyzed separately by heating and non-heating seasons using multivariable regression. Concentrations of PM were significantly higher during the heating season (indoor: 36.2 μg/m ; outdoor: 22.1 μg/m ) compared with the non-heating season (indoor: 14.6 μg/m ; outdoor: 9.3 μg/m ). Heating season indoor PM was strongly associated with heating fuel type, housing type, indoor pests, use of a climate control unit, number of interior doors, and indoor relative humidity. During the non-heating season, different behavioral and household characteristics were associated with indoor PM concentrations (indoor smoking and/or burning incense, opening doors and windows, area of surrounding environment, building size and height, and outdoor PM ). Homes heated with coal and/or wood, or a combination of coal and/or wood with electricity and/or natural gas had elevated indoor PM concentrations that exceeded both the EPA ambient standard (35 μg/m ) and the WHO guideline (25 μg/m ).
• Lashway, S. G., Harris, R. B., Farland, L. V., O'Rourke, M. K., & Dennis, L. K. (2021). Age and Cohort Trends of Malignant Melanoma in the United States. Cancers, 13(15).
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  The incidence of malignant melanoma in the United States is increasing, possibly due to changes in ultraviolet radiation (UVR) exposure due to lifestyle or increased awareness and diagnosis of melanoma. To determine if more recent birth cohorts experience higher rates of melanoma as they age, we examined age and birth cohort trends in the United States stratified by anatomic site and cancer type (in situ vs. malignant) of the melanoma diagnosed from 1975-2017. Poisson regression of cutaneous melanoma cases per population for 1975-2017 from the Surveillance, Epidemiology, and End Results (SEER) cancer registries was used to estimate age adjusted incidence for five-year birth cohorts restricted to Whites, ages 15-84. The rate of melanoma incidence across birth cohorts varies by anatomic site and sex. Melanomas at all anatomic sites continue to increase, except for head and neck melanomas in men. Much of the increase in malignant melanoma is driven by cases of thin (
• Batai, K., Sanderson, P. R., Hsu, C. H., Joshweseoma, L., Russell, D., Joshweseoma, L., Ojeda, J., Burhansstipanov, L., Brown, S. R., Ami, D., Saboda, K., & Harris, R. B. (2020). Factors Associated with Cancer Screening Among Hopi Men. Journal of cancer education : the official journal of the American Association for Cancer Education.
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  Cancer screening rates remain low among American Indian men, and cancer screening behaviors and barriers to cancer screening among American Indian men are not well understood. This study evaluated cancer screening behaviors in 102 Hopi men who were 50 years of age or older from the Hopi Survey of Cancer and Chronic Disease. Reported cancer screening frequencies were 15.7%, 45.1%, and 35.3% for fecal occult blood test (FOBT), colonoscopy, and prostate-specific antigen (PSA) test, respectively. Among men who reported having had a FOBT, 81.2% had the test more than 1 year ago. Among men who reported a colonoscopy, 60.8% had colonoscopy within the past 3 years. Similarly, among men who reported having had PSA, 72.3% had PSA within the past 3 years. "No one told me" was the most common answer for not undergoing FOBT (33.7%), colonoscopy (48.2%), and PSA (39.4%). Men who reported having had a PSA or digital rectal exam were three times as likely to also report having a FOBT or colonoscopy (odds ratio [OR] 3.19, 95% confidence interval [CI]: 1.21-8.46). Younger age (
• Cordova-Marks, F. M., Cunningham, J., Harris, R. B., Gerald, L., Norton, B., Mastergeorge, A., & Teufel-Shone, N. I. (2020). Resilience and Stress among Hopi Female Caregivers. American Indian and Alaska native mental health research (Online), 27(2), 76-89.
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  Resilience and stress are important factors in the caregiving experience, but research has yet to examine their association among American Indian (AI) caregivers. This study examines resilience and stress in a group of Hopi female caregivers. Data came from the Hopi Adult Caregiver Survey (2017), which conducted interviews with 44 Hopi women who were providing care without remuneration to an adult family member. Measures included the abbreviated Connor-Davidson Resilience Scale (CD-RISC-10), the Perceived Stress Scale (PSS-10), and questions about caregiver characteristics, care recipient characteristics, social support/ community support, and cultural factors. Stress and resilience were looked at above the median (higher stress or higher resilience) and below the median (lower stress or lower resilience). Caregivers who reported relatively lower resilience were more likely to report that they lived separately from their care recipients and that all Hopis are expected to be caregivers. Caregivers who reported relatively higher stress reported a higher total number of caregiver difficulties, a poorer self-perception of their own health, use of a traditional healer in the past 5 years, and that females are expected to be caregivers. A regression analysis adjusting for age, education, and employment status indicated that higher resilience among the caregivers was significantly associated with lower stress. In light of these findings, programs working with AI caregivers may wish to explore whether supporting the resilience of these caregivers is a means towards limiting their stress.
• Garrido, C. O., Coşkun, R. A., Lent, A. B., Calhoun, E., & Harris, R. B. (2020). Use of cervical cancer preventive services among US women aged 21-29: an assessment of the 2010 Affordable Care Act rollout through 2018. Cancer causes & control : CCC, 31(9), 839-850.
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  The 2010 Affordable Care Act (ACA) provided millions of people with health insurance coverage and facilitated routine cancer screening by requiring insurers to cover preventive services without cost-sharing. Despite greater access to affordable cancer screening, Pap testing has declined over time. The aim of this study is to assess participation in Pap test and HPV vaccination, and adherence to guidelines as outlined by the American Cancer Society (ACS) from the 2010 ACA provision eliminating cost-sharing for preventive services.
• Hadeed, S. J., O'Rourke, M. K., Burgess, J. L., Harris, R. B., & Canales, R. A. (2020). Imputation methods for addressing missing data in short-term monitoring of air pollutants. The Science of the total environment, 730, 139140.
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  Monitoring of environmental contaminants is a critical part of exposure sciences research and public health practice. Missing data are often encountered when performing short-term monitoring (
• Trejo, M. J., Lishimpi, K., Kalima, M., Mwaba, C. K., Banda, L., Chuba, A., Chama, E., Msadabwe, S. C., Bell, M. L., Harris, R. B., Jacobs, E., & Soliman, A. (2020). Effects of HIV status on non-metastatic cervical cancer progression among patients in Lusaka, Zambia. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, 30(5), 613-618.
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  Sub-Saharan Africa has the highest global incidence of cervical cancer. Cervical cancer is the most common cause of cancer morbidity and mortality among women in Zambia. HIV increases the risk for cervical cancer and with a national Zambian adult HIV prevalence of 16%, it is important to investigate the impact of HIV on the progression of cervical cancer. We measured differences in cervical cancer progression between HIV-positive and HIV-negative patients in Zambia.
• Kurzius-Spencer, M., da Silva, V., Huang, S., Hartz, V., Thomson, C. A., Hsu, C., Burgess, J. L., O'Rourke, M. K., & Harris, R. B. (2016). Modeling the relation of dietary arsenic intake (total and inorganic) and one-carbon metabolism on urinary arsenic methylation in a nationally representative population (NHANES 2003-04). Environmental Health Perspectives.
• Labiner, D. M., Harris, R. B., Chong, J. W., Malone, D. C., & Ip, Q. (2018). An update on the prevalence and incidence of epilepsy among older adults. Epilepsy Research, 139, 107-112.
• Labiner, D. M., Harris, R. B., Chong, J. W., Malone, D. C., & Ip, Q. (2018). Economic impact of epilepsy and the cost of nonadherence to antiepileptic drugs in older Medicare beneficiaries. Epilepsy & Behavior.
• Bui, D. P., Oren, E., Roe, D. J., Brown, H. E., Harris, R. B., Knight, G. M., Gilman, R. H., & Grandjean, L. (2018). A Case Control Study to Identify Community Venues Associated with Genetically Clustered Multidrug-Resistant Tuberculosis Disease in Lima, Peru. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.
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  The majority of tuberculosis transmission occurs in community settings. The primary aim of this study was to assess the association between exposure to community venues and multidrug-resistant tuberculosis (MDR-TB) disease. The secondary aim was to describe the social networks of MDR-TB cases and controls.
• Ip, Q., Malone, D. C., Chong, J., Harris, R. B., & Labiner, D. M. (2018). Economic impact of epilepsy and the cost of nonadherence to antiepileptic drugs in older Medicare beneficiaries. Epilepsy & behavior : E&B, 80, 208-214.
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  Epilepsy is most prevalent among older individuals, and its economic impact is substantial. The development of economic burden estimates that account for known confounders, and using percent incremental costs may provide meaningful comparison across time and different health systems. The first objective of the current study was to estimate the percent incremental healthcare costs and the odds ratio (OR) for inpatient utilization for older Medicare beneficiaries with epilepsy and without epilepsy. The second objective was to estimate the percent incremental healthcare costs and the OR for inpatient utilization associated with antiepileptic drug (AED) nonadherence among Medicare beneficiaries with epilepsy. The OR of inpatient utilization for cases compared with controls (i.e., non-cases) were 2.4 (95% CI 2.3 to 2.6, p-value
• Kohler, L. N., Harris, R. B., Oren, E., Roe, D. J., Lance, P., & Jacobs, E. T. (2018). Adherence to Nutrition and Physical Activity Cancer Prevention Guidelines and Development of Colorectal Adenoma. Nutrients, 10(8).
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  Adherence to the American Cancer Society's (ACS) Nutrition and Physical Activity Cancer Prevention Guidelines is associated with reductions in overall cancer incidence and mortality, including site-specific cancers such as colorectal cancer. We examined the relationship between baseline adherence to the ACS guidelines and (1) baseline adenoma characteristics and (2) odds of recurrent colorectal adenomas over 3 years of follow-up. Cross-sectional and prospective analyses with a pooled sample of participants from the Wheat Bran Fiber ( = 503) and Ursodeoxycholic Acid ( = 854) trials were performed. A cumulative adherence score was constructed using baseline self-reported data regarding body size, diet, physical activity and alcohol consumption. Multivariable logistic regression demonstrated significantly reduced odds of having three or more adenomas at baseline for moderately adherent (odds ratio [OR] = 0.67, 95% confidence intervals [CI]: 0.46⁻0.99) and highly adherent (OR = 0.50, 95% CI: 0.31⁻0.81) participants compared to low adherers (-trend = 0.005). Conversely, guideline adherence was not associated with development of recurrent colorectal adenoma (moderate adherence OR = 1.16, 95% CI: 0.85⁻1.59, high adherence OR = 1.23, 95% CI: 0.85⁻1.79).
• Driscoll, L. J., Brown, H. E., Harris, R. B., & Oren, E. (2017). Population Knowledge, Attitude, and Practice Regarding Transmission and Outcomes: A Literature Review. Frontiers in public health, 5, 144.
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  infection is associated with the development of chronic gastritis, peptic ulcer disease, and gastric cancer. Current clinical recommendations are that test-and-treat should be individualized based on comorbidities and patient preferences among populations at increased risk for certain morbidities. However, knowledge, attitudes and practices regarding among potential patient populations are largely unknown.
• Kohler, L. N., Hibler, E. A., Harris, R. B., Oren, E., Roe, D. J., Jurutka, P. W., & Jacobs, E. T. (2017). Greater Adherence to Cancer Prevention Guidelines Is Associated with Higher Circulating Concentrations of Vitamin D Metabolites in a Cross-Sectional Analysis of Pooled Participants from 2 Chemoprevention Trials. The Journal of nutrition.
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  Several lifestyle factors targeted by the American Cancer Society (ACS) Nutrition and Physical Activity Cancer Prevention Guidelines are also associated with circulating concentrations of vitamin D metabolites. This suggests that greater adherence to the ACS guidelines may be related to better vitamin D status.
• Kurzius-Spencer, M., da Silva, V., Thomson, C. A., Hartz, V., Hsu, C. H., Burgess, J. L., O'Rourke, M. K., & Harris, R. B. (2017). Nutrients in one-carbon metabolism and urinary arsenic methylation in the National Health and Nutrition Examination Survey (NHANES) 2003-2004. The Science of the total environment, 607-608, 381-390.
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  Exposure to inorganic arsenic (inAs), a potent toxicant, occurs primarily through ingestion of food and water. The efficiency with which it is methylated to mono and dimethyl arsenicals (MMA and DMA) affects toxicity. Folate, vitamins B12 and B6 are required for 1C metabolism, and studies have found that higher levels of these nutrients increase methylation capacity and are associated with protection against adverse health effects from inAs, especially in undernourished populations. Our aim was to determine whether 1C-related nutrients are associated with greater inAs methylation capacity in a general population sample with overall adequate nutrition and low levels of As exposure. Univariate and multivariable regression models were used to evaluate the relationship of dietary and blood nutrients to urinary As methylation in the National Health and Nutrition Examination Survey (NHANES) 2003-2004. Outcome variables were the percent of the sum of inAs and methylated As species (inAs+MMA+DMA) excreted as inAs, MMA, and DMA, and the ratio of MMA:DMA. In univariate models, dietary folate, vitamin B6 and protein intake were associated with lower urinary inAs% and greater DMA% in adults (≥18years), with similar trends in children (6-18). In adjusted models, vitamin B6 intake (p=0.011) and RBC folate (p=0.036) were associated with lower inAs%, while dietary vitamin B12 was associated with higher inAs% (p=0.002) and lower DMA% (p=0.030). Total plasma homocysteine was associated with higher MMA% (p=0.004) and lower DMA% (p=0.003), but not with inAs%; other blood nutrients showed no association with urinary As. Although effect size is small, these findings suggest that 1C nutrients can influence inAs methylation and potentially play an indirect role in reducing toxicity in a general population sample.
• Murakami, T. T., Scranton, R. A., Brown, H. E., Harris, R. B., Chen, Z., Musuku, S., & Oren, E. (2017). Management of Helicobacter Pylori in the United States: Results from a national survey of gastroenterology physicians. Preventive medicine, 100, 216-222.
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  We sought to determine current knowledge and practices among gastroenterology physicians and assess adherence to current guidelines for H. pylori management.
• Pogreba-Brown, K., Weiss, J., Briggs, G., Taylor, A., Schumacher, M., England, B., & Harris, R. B. (2017). Student outbreak response teams: lessons learned from a decade of collaboration. Public health, 149, 60-64.
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  Student response teams within colleges of public health effectively address important concerns for two stakeholders. For universities, students learn the fundamentals of field epidemiology and provide popular training and networking opportunities. For health departments, students serve as surge capacity as trained workforce available during outbreak investigations and potentially for routine tasks.
• Reyes-Castro, P. A., Harris, R. B., Brown, H. E., Christopherson, G. L., & Ernst, K. C. (2017). Spatio-temporal and neighborhood characteristics of two dengue outbreaks in two arid cities of Mexico. Acta tropica, 167, 174-182.
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  Little is currently known about the spatial-temporal dynamics of dengue epidemics in arid areas. This study assesses dengue outbreaks that occurred in two arid cities of Mexico, Hermosillo and Navojoa, located in northern state of Sonora. Laboratory confirmed dengue cases from Hermosillo (N=2730) and Navojoa (N=493) were geocoded by residence and assigned neighborhood-level characteristics from the 2010 Mexican census. Kernel density and Space-time cluster analysis was performed to detect high density areas and space-time clusters of dengue. Ordinary Least Square regression was used to assess the changing socioeconomic characteristics of cases over the course of the outbreaks. Both cities exhibited contiguous patterns of space-time clustering. Initial areas of dissemination were characterized in both cities by high population density, high percentage of occupied houses, and lack of healthcare. Future research and control efforts in these regions should consider these space-time and socioeconomic patterns.
• Bui, D., Brown, H. E., Harris, R. B., & Oren, E. (2016). Serologic Evidence for Fecal-Oral Transmission of Helicobacter pylori. The American journal of tropical medicine and hygiene, 94(1), 82-8.
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  Helicobacter pylori infection is among the most prevalent infections in the world and a key cause of gastric diseases; however, its route of transmission remains unclear. This study aimed to assess the potential for fecal-oral transmission of H. pylori by leveraging its association with a disease with known etiology. Utilizing serology data from the National Health and Nutrition Examination Survey (NHANES 1999; N = 6,347), the association between H. pylori and hepatitis A virus (HAV), a sensitive indicator for fecal-oral exposure, was assessed. Survey-weighted kappa and multiple logistic regression were used to quantify the association between H. pylori and HAV after controlling for age, sex, race, poverty, birthplace, crowding, smoking, and alcohol use. Concordant serological results were found among 69.8% of participants (survey-weighted κ = 0.30, 95% confidence interval [CI] = 0.26, 0.35). The adjusted odds of H. pylori seropositivity were over two times higher after adjusting for confounders (odds ratio = 2.27, 95% CI = 1.79, 2.87). Results from this study suggest H. pylori and HAV infections are strongly associated. Since HAV is primarily transmitted through the fecal-oral route, fecal-oral transmission may be an important pathway for H. pylori spread.
• Chongpison, Y., Hornbrook, M. C., Harris, R. B., Herrinton, L. J., Gerald, J. K., Grant, M., Bulkley, J. E., Wendel, C. S., & Krouse, R. S. (2016). Self-reported depression and perceived financial burden among long-term rectal cancer survivors. PSYCHO-ONCOLOGY, 25(11), 1350-1356.
• Cordova, F. M., Harris, R. B., Teufel-Shone, N. I., Nisson, P. L., Joshweseoma, L., Brown, S. R., Sanderson, P. R., Ami, D., Saboda, K., Mastergeorge, A. M., & Gerald, L. B. (2016). Caregiving on the Hopi Reservation: Findings from the 2012 Hopi Survey of Cancer and Chronic Disease. JOURNAL OF COMMUNITY HEALTH, 41(6), 1177-1186.
• Jacobs, E. T., Roe, D., Oren, E., Harris, R. B., Garcia, D. O., & Kohler, L. N. (2016). Adherence to Diet and Physical Activity Cancer Prevention Guidelines and Cancer Outcomes: A Systematic Review.. Cancer Epidemiology, Biomarkers & Prevention. doi:10.1158/1055-9965.EPI-16-0121
• Kohler, L. N., Garcia, D. O., Harris, R. B., Oren, E., Roe, D., & Jacobs, E. T. (2016). Adherence to Diet and Physical Activity Cancer Prevention Guidelines and Cancer Outcomes: A Systematic Review.. Cancer Epidemiology, Biomarkers & Prevention.
• Pogreba-Brown, K., Baker, A., Ernst, K., Stewart, J., Harris, R. B., & Weiss, J. (2016). Assessing risk factors of sporadic Campylobacter infection: a case-control study in Arizona. Epidemiology and infection, 144(4), 829-39.
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  Case-control studies of sporadic Campylobacter infections have predominately been conducted in non-Hispanic populations. In Arizona, rates of campylobacteriosis have been historically higher than the national average, with particularly high rates in Hispanics. In 2010, health departments and a state university collaborated to conduct a statewide case-control study to determine whether risk factors differ in an ethnically diverse region of the United States. Statistically significant risk factors in the final multivariate model were: eating cantaloupe [odds ratio (OR) 7·64], handling raw poultry (OR 4·88) and eating queso fresco (OR 7·11). In addition, compared to non-Hispanic/non-travellers, the highest risk group were Hispanic/non-travellers (OR 7·27), and Hispanic/travellers (OR 5·87, not significant). Results of this study suggest Hispanics have higher odds of disease, probably due to differential exposures. In addition to common risk factors, consumption of cantaloupe was identified as a significant risk factor. These results will inform public health officials of the varying risk factors for Campylobacter in this region.
• Poplin, G. S., Roe, D. J., Burgess, J. L., Peate, W. F., & Harris, R. B. (2016). Fire fit: assessing comprehensive fitness and injury risk in the fire service. International archives of occupational and environmental health, 89(2), 251-9.
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  This study sought to develop a comprehensive measure of fitness that is predictive of injury risk and can be used in the fire service to assess individual-level health and fit-for-duty status.
• Brown, S. R., Joshweseoma, L., Saboda, K., Sanderson, P., Ami, D., & Harris, R. B. (2015). Cancer Screening on the Hopi Reservation: A Model for success in a Native American Community. J Community Health, 40, 1165–1172.
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  Sylvia R. Brown, PhD, MPH1,2, Lori Joshweseoma, MPH3, Kathylynn Saboda, MS2, Priscilla Sanderson, PhD4, Delores Ami5, Robin Harris PhD, MPH1,2 CANCER SCREENING ON THE HOPI RESERVATION: A MODEL FOR SUCCESS IN A NATIVE AMERICAN COMMUNITY .
• Bui, D., Brown, H. E., Harris, R. B., & Oren, E. (2016). Serologic evidence for fecal-oral transmission of Helicobacter pylori. American Journal of Tropical Medicine and Hygiene.
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  In Press
• Davis, R., Loescher, L. J., Rogers, J., Spartonos, D., Snyder, A., Koch, S., & Harris, R. B. (2015). Evaluation of Project Students are Sun Safe (SASS): A University Student-Delivered Skin Cancer Prevention Program for Schools. Journal of cancer education : the official journal of the American Association for Cancer Education, 30(4), 736-742.
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  Skin cancer is the most common cancer in the USA and is increasing in children and young adults. Adolescents are an important target population for sun-safety interventions with ultraviolet radiation as the strongest risk factor for developing skin cancer. Schools are an ideal setting to intervene with adolescents. A novel Arizona skin cancer prevention in-class education-activity program, Project 'Students are Sun Safe' (SASS), was designed to be delivered by university students for middle school and high school students. Participant students completed the pre- and post-program tests and a satisfaction questionnaire; teachers completed reviews. The evaluation examined the program's influence on participants' sun-safety knowledge, perceptions, and behaviors; satisfaction with the program; and intent to change. After exposure to Project SASS, participants were more likely to perceive a high risk of skin cancer, report negative attitudes toward tanned skin, and answer knowledge-based questions correctly. There were minimal differences in self-reported sun-safety behaviors, though participants did report intent to change. Both participants and teachers were satisfied with the program. Project SASS appears to be an effective sun-safety program for middle school and high school students for knowledge and perceptions, and the results confirm that appropriately tailoring program components to the target population has strong potential to impact adolescent perceived susceptibility, knowledge, and behavioral intent. The strengths and weaknesses of Project SASS have many implications for public health practice, and Project SASS may hold promise to be a model for skin cancer prevention in adolescents.
• Harris, R. B. (2015). Relation of dietary inorganic arsenic to serum matrix metalloproteinase-9 (MMP-9) at different threshold concentrations of tap water arsenic. J Exposure Sci & Environ Epidemiol, [Epub ahead of print]. doi:10.1002/pon.3957
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  Kurzius-Spencer M. Harris RB. Hartz V. Roberge J. Huang S. Hsu CH. O'Rourke MK, Burgess JB. Relation of dietary inorganic arsenic to serum matrix metalloproteinase-9 (MMP-9) at different threshold concentrations of tap water arsenic. J Exposure Sci & Environ Epidemiol Accepted.
• Harris, R. B., Koch, S. M., Newton, C., Silvis, N. G., Curiel-Lewandroski, C., Giancola, J., Sagerman, P., Alder, S., Yee, G., & Flood, T. J. (2015). A public health partnership approach: Under-reporting of melanoma in Arizona and strategies for increasing reporting. Public Health Reports, 130, 737-744,.
• Kurzius-Spencer, M., Harris, R. B., Hartz, V., Roberge, J., Hsu, C., O'Rourke, M. K., & Burgess, J. L. (2015). Relation of dietary inorganic arsenic to serum matrix metalloproteinase-9 (MMP-9) at different threshold concentrations of tap water arsenic. Journal of exposure science & environmental epidemiology.
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  Arsenic (As) exposure is associated with cancer, lung and cardiovascular disease, yet the mechanisms involved are not clearly understood. Elevated matrix metalloproteinase-9 (MMP-9) levels are also associated with these diseases, as well as with exposure to water As. Our objective was to evaluate the effects of dietary components of inorganic As (iAs) intake on serum MMP-9 concentration at differing levels of tap water As. In a cross-sectional study of 214 adults, dietary iAs intake was estimated from 24-h dietary recall interviews using published iAs residue data; drinking and cooking water As intake from water samples and consumption data. Aggregate iAs intake (food plus water) was associated with elevated serum MMP-9 in mixed model regression, with and without adjustment for covariates. In models stratified by tap water As, aggregate intake was a significant positive predictor of serum MMP-9 in subjects exposed to water As≤10 μg/l. Inorganic As from food alone was associated with serum MMP-9 in subjects exposed to tap water As≤3 μg/l. Exposure to iAs from food and water combined, in areas where tap water As concentration is ≤10 μg/l, may contribute to As-induced changes in a biomarker associated with toxicity.Journal of Exposure Science and Environmental Epidemiology advance online publication, 21 January 2015; doi:10.1038/jes.2014.92.
• Hingle, M. D., Snyder, A. L., McKenzie, N. E., Thomson, C. A., Logan, R. A., Ellison, E. A., Koch, S. M., & Harris, R. B. (2014). Effects of a short messaging service-based skin cancer prevention campaign in adolescents. American journal of preventive medicine, 47(5), 617-23.
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  Skin cancer prevention emphasizes early adoption and practice of sun protection behaviors. Adolescence represents a high-risk period for ultraviolet radiation exposure, presenting an opportunity for intervention. The ubiquity of mobile phones among teens offers an engaging medium through which to communicate prevention messages.
• Kurzius-Spencer, M., Burgess, J. L., Harris, R. B., Hartz, V., Roberge, J., Huang, S., Hsu, C., & O'Rourke, M. K. (2014). Contribution of diet to aggregate arsenic exposures An analysis across populations. JOURNAL OF EXPOSURE SCIENCE AND ENVIRONMENTAL EPIDEMIOLOGY, 24(2), 156-162.
• Molmenti, C. L., Hibler, E. A., Ashbeck, E. L., Thomson, C. A., Garcia, D. O., Roe, D., Harris, R. B., Lance, P., Cisneroz, M., Martinez, M. E., Thompson, P. A., & Jacobs, E. T. (2014). Sedentary behavior is associated with colorectal adenoma recurrence in men. Cancer causes & control : CCC, 25(10), 1387-95.
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  The association between physical activity and colorectal adenoma is equivocal. This study was designed to assess the relationship between physical activity and colorectal adenoma recurrence.
• Poplin, G. S., Roe, D. J., Peate, W., Harris, R. B., & Burgess, J. L. (2014). The association of aerobic fitness with injuries in the fire service. American journal of epidemiology, 179(2).
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  The aim of the present study was to understand the risk of injury in relation to fitness in a retrospective occupational cohort of firefighters in Tucson, Arizona, from 2005 to 2009. Annual medical evaluations and injury surveillance data were linked to compare levels of aerobic fitness in injured employees with those in noninjured employees. The individual outcomes evaluated included all injuries, exercise-related injuries, and sprains and strains. Time-to-event analyses were conducted to determine the association between levels of fitness and injury likelihood. Fitness, defined by relative aerobic capacity (Vo2max), was associated with injury risk. Persons in the lowest fitness level category (Vo2max 48 mL/kg/minute). Those with a Vo2max between 43 and 48 mL/kg/minute were 1.38 times (95% confidence interval: 1.06, 1.78) more likely to incur injury. Hazard ratios were found to be greater for sprains and strains. Our results suggest that improving relative aerobic capacity by 1 metabolic equivalent of task (approximately 3.5 mL/kg/minute) reduces the risk of any injury by 14%. These findings illustrate the importance of fitness in reducing the risk of injury in physically demanding occupations, such as the fire service, and support the need to provide dedicated resources for structured fitness programming and the promotion of injury prevention strategies to people in those fields.
• Burgess, J. L., Harris, R. B., Hartz, V., Hsu, C., O'Rourke, M. K., & Kurzius-Spencer, M. (2013). Measured versus modeled dietary arsenic and relation to urinary arsenic excretion and total exposure. Journal of Exposure Science and Environmental Epidemiology, 23(4), 442-449.
• Burgess, J. L., Kurzius-Spencer, M., O'Rourke, M. K., Littau, S. R., Roberge, J., Meza-Montenegro, M. M., Gutiérrez-Millán, L. E., & Harris, R. B. (2013). Environmental arsenic exposure and serum matrix metalloproteinase-9. Journal of exposure science & environmental epidemiology, 23(2).
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  The objective of this study was to evaluate the relationship between environmental arsenic exposure and serum matrix metalloproteinase (MMP)-9, a biomarker associated with cardiovascular disease and cancer. In a cross-sectional study of residents of Arizona, USA (n=215) and Sonora, Mexico (n=163), drinking water was assayed for total arsenic, and daily drinking water arsenic intake was estimated. Urine was speciated for arsenic, and concentrations were adjusted for specific gravity. Serum was analyzed for MMP-9 using ELISA. Mixed model linear regression was used to assess the relation among drinking water arsenic concentration, drinking water arsenic intake, urinary arsenic sum of species (the sum of arsenite, arsenate, monomethylarsonic acid and dimethylarsinic acid), and MMP-9, controlling for autocorrelation within households. Drinking water arsenic concentration and intake were positively associated with MMP-9, both in crude analysis and after adjustment for gender, country/ethnicity, age, body mass index, current smoking, and diabetes. Urinary arsenic sum of species was positively associated with MMP-9 in multivariable analysis only. Using Akaike's Information Criterion, arsenic concentration in drinking water provided a better fitting model of MMP-9 than either urinary arsenic or drinking water arsenic intake. In conclusion, arsenic exposure evaluated using all three exposure metrics was positively associated with MMP-9.
• Chong, J., Hesdorffer, D. C., Thurman, D. J., Lopez, D., Harris, R. B., Hauser, W. A., Labiner, E. T., Velarde, A., & Labiner, D. M. (2013). The prevalence of epilepsy along the Arizona-Mexico border. EPILEPSY RESEARCH, 105(1-2), 206-215.
• Chong, J., Hesdorffer, D. C., Thurman, D. J., Lopez, D., Harris, R. B., Hauser, W. A., Labiner, E. T., Velarde, A., & Labiner, D. M. (2013). The prevalence of epilepsy along the Arizona-Mexico border. Epilepsy research, 105(1-2).
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  This study describes the epidemiology of epilepsy on the Arizona-Mexico border.
• Harris, R. B., Gutiérrez-Millán, L. E., Meza-Montenegro, M. M., Roberge, J. L., Littau, S. R., O'Rourke, M. K., Kurzius-Spencer, M., & Burgess, J. L. (2013). Environmental arsenic exposure and serum matrix metalloproteinase-9. Journal of Exposure Science and Environmental Epidemiology, 23(2), 163-169.
• Kurzius-Spencer, M., Burgess, J. L., Harris, R. B., Hartz, V., Roberge, J., Huang, S., Hsu, C., & O'Rourke, M. K. (2013). Contribution of diet to aggregate arsenic exposures-An analysis across populations. Journal of exposure science & environmental epidemiology.
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  The relative contribution of dietary arsenic (As) to aggregate daily exposure has not been well-characterized, especially in relation to the current EPA maximum contaminant level (MCL) of 10 p.p.b. for As in drinking water. Our objectives were to: (1) model exposure to inorganic and total As among non-seafood eaters using subject-specific data, (2) compare the contribution of food, drinking and cooking water to estimated aggregate exposure in households with variable background tap water As levels, and (3) describe the upper distribution of potential dose at different thresholds of tap water As. Dietary As intake was modeled in regional study populations and NHANES 2003-2004 using dietary records in conjunction with published food As residue data. Water As was measured in the regional studies. Among subjects exposed to tap water As >10 p.p.b., aggregate inorganic exposure was 24.5-26.1 μg/day, with approximately 30% of intake from food. Among subjects living in homes with tap water As ≤10, 5 or 3 p.p.b., aggregate inorganic As exposure was 8.6-11.8 μg/day, with 54-85% of intake from food. Median inorganic As potential dose was 0.42-0.50 μg/kg BW/day in subjects exposed to tap water As >10 p.p.b. and less than half that among subjects exposed to tap water As ≤10 p.p.b. The majority of inorganic and total As exposure is attributable to diet in subjects with tap water As
• Kurzius-Spencer, M., O'Rourke, M. K., Hsu, C., Hartz, V., Harris, R. B., & Burgess, J. L. (2013). Measured versus modeled dietary arsenic and relation to urinary arsenic excretion and total exposure. Journal of exposure science & environmental epidemiology, 23(4).
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  Chronic exposure to arsenic (As) in food and water is a significant public health problem. Person-specific aggregate exposure is difficult to collect and modeling based on limited food As residue databases is of uncertain reliability. Two cross-sectional population exposure studies, the National Human Exposure Assessment Survey-Arizona and Arizona Border Survey, had a combined total of 252 subjects with diet, water, and urinary As data. Total As was measured in 24-h duplicate diet samples and modeled using 24-h diet diaries in conjunction with several published food surveys of As. Two-stage regression was used to assess the effects of dietary As on urinary total As (uAs): (1) generalized linear mixed models of uAs above versus below the limit of detection (LOD); and (2) restricted models limited to those subjects with uAs>LOD, using bootstrap sampling and mixed models adjusted for age, sex, body mass index, ethnicity, current smoking, and As intake from drinking and cooking water. In restricted models, measured and modeled estimates were significant predictors of uAs. Modeled dietary As based on Total Diet Study mean residues greatly underestimated the dietary intake. In households with tap water As ≤10 p.p.b., over 93% of total arsenic exposure was attributable to diet.
• Pogreba-Brown, K., McKeown, K., Santana, S., Diggs, A., Stewart, J., & Harris, R. B. (2013). Public Health in the Field and the Emergency Operations Center: Methods for Implementing Real-Time Onsite Syndromic Surveillance at Large Public Events. DISASTER MEDICINE AND PUBLIC HEALTH PREPAREDNESS, 7(5), 467-474.
• Pogreba-Brown, K., McKeown, K., Santana, S., Diggs, A., Stewart, J., & Harris, R. B. (2013). Public health in the field and the emergency operations center: methods for implementing real-time onsite syndromic surveillance at large public events. Disaster medicine and public health preparedness, 7(5).
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  To develop an onsite syndromic surveillance system for the early detection of public health emergencies and outbreaks at large public events.
• Sardo, C. L., Kitzmiller, J. P., Apseloff, G., Harris, R. B., Roe, D. J., Stoner, G. D., & Jacobs, E. T. (2013). An Open-Label Randomized Crossover Trial of Lyophilized Black Raspberries on Postprandial Inflammation in Older Overweight Males: A Pilot Study. American journal of therapeutics.
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  This study was a 14-day, outpatient, open-label randomized crossover trial of lyophilized black raspberries (BRBs) in older overweight or obese males to determine whether BRB consumption affects postprandial inflammation associated with consumption of a high-fat high-calorie (HFHC) meal. Ten study participants consumed 45 g/d of lyophilized BRBs for 4 days, followed by a HFHC breakfast plus BRBs on day 6 or consumed the HFHC breakfast on day 6 without previous consumption of BRBs and then crossed over to the other treatment after a 2-day washout period. Blood samples were obtained before and 1, 2, 4, 8, and 12 hours after consumption of the HFHC breakfast. The primary study outcomes were changes in area under the concentration-time curve (AUC) for interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-α). The secondary outcomes were safety and tolerability of lyophilized BRB powder. The chronology and values of measured serum concentrations for IL-6, TNF-α, and CRP were consistent with those described previously by other investigators. The AUC of serum IL-6 was lowered significantly (P = 0.03, n = 10) with BRB consumption (34.3 ± 7.6 pg·mL·h compared with 42.4 ± 17.9 pg·mL·h for consumption of the HFHC meal alone). However, no significant differences (change in AUC) were calculated for serum CRP and TNF-α. The findings of this pilot study suggest that consumption of lyophilized BRBs may attenuate postprandial inflammation in overweight or obese males consuming a HFHC meal. Further investigation of BRBs is warranted to better elucidate their inflammomodulatory potential.
• Abalos, A. T., Harris, R. B., Nyitray, A. G., Mitchell, A., Thompson, P. A., Giuliano, A. R., & Garcia, F. (2012). Human Papillomavirus Type Distribution Among Heterosexual Couples. JOURNAL OF LOWER GENITAL TRACT DISEASE, 16(1), 10-15.
• Abalos, A. T., Harris, R. B., Nyitray, A. G., Mitchell, A., Thompson, P. A., Giuliano, A. R., & Garcia, F. (2012). Human papillomavirus type distribution among heterosexual couples. Journal of lower genital tract disease, 16(1).
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  To gain a better understanding of human papillomavirus (HPV) transmission dynamics between sexual partners, HPV-type-specific concordance was investigated.
• Hakim, I. A., Harris, R., Garland, L., Cordova, C. A., Mikhael, D. M., & Chow, H. S. (2012). Gender Difference in Systemic Oxidative Stress and Antioxidant Capacity in Current and Former Heavy Smokers. CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION, 21(12), 2193-2200.
• Hakim, I. A., Harris, R., Garland, L., Cordova, C. A., Mikhael, D. M., & Sherry Chow, H. (2012). Gender difference in systemic oxidative stress and antioxidant capacity in current and former heavy smokers. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 21(12).
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  Several studies suggested that women may be more susceptible to oxidative damage induced by cigarette smoking, but the role of smoking status and antioxidant capacity in gender difference in susceptibility to oxidative damage has not been well studied.
• Harris, J. M., & Harris, R. B. (2012). Rampage violence requires a new type of research. American journal of public health, 102(6).
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  Tragedies such as school shootings and the assault on Congresswoman Gabrielle Giffords share features that define them as acts of "rampage violence." These types of events can lead to despair about their inevitability and unpredictability. To understand and prevent rampage violence, we need to acknowledge that current discipline-based violence research is not well suited to this specific challenge. There are numerous important, unanswered research questions that can inform policies designed to prevent rampage violence. It is time to develop alternative research approaches to reduce the risk of rampage violence. Such approaches should incorporate transdisciplinary research models; flexible, outcomes-focused organizational structures similar to those used to investigate other catastrophic events; and an expanded inventory of analytic tools.
• Nuno, T., Gerald, J. K., Harris, R., Martinez, M. E., Estrada, A., & Garcia, F. (2012). Comparison of breast and cervical cancer screening utilization among rural and urban Hispanic and American Indian women in the Southwestern United States. CANCER CAUSES & CONTROL, 23(8), 1333-1341.
• Pogreba-Brown, K., Ernst, K., & Harris, R. (2012). On Academics TEACHING EPIDEMIOLOGY CONCEPTS EXPERIENTIALLY: A "REAL" FOODBORNE OUTBREAK IN THE CLASSROOM. PUBLIC HEALTH REPORTS, 127(5), 549-555.
• Pogreba-Brown, K., Ernst, K., & Harris, R. (2012). Teaching epidemiology concepts experientially: a "real" foodborne outbreak in the classroom. Public health reports (Washington, D.C. : 1974), 127(5).
• Poplin, G. S., Harris, R. B., Pollack, K. M., Peate, W. F., & Burgess, J. L. (2012). Beyond the fireground: injuries in the fire service. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention, 18(4).
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  Background Although firefighting and emergency medical services are high-risk professions, few studies have identified the aetiology of injury in the fire service beyond the fireground. Methods Data were collected for work-related injuries in a medium-sized metropolitan fire department. In a descriptive study, the factors explored included the nature of injury, agent, mechanism, body location, environment, abbreviated injury scale (AIS), functional capacity index (FCI) and lost time status. Results From 2004 to 2009, the annual injury incidence rate averaged 17.7 per 100 employees. One-third of all injuries (32.9%) resulted from physical exercise activities, while patient transport, training drills and fireground operations resulted in 16.9%, 11.1% and 10.2% of injuries, respectively. For all job operations, sprains and strains were the most prevalent type of injury (40.2-85.2%), followed by contusions and lacerations (7.7-26.1%). The third most common injury was related to the conventional hazards of the individual job operation. Most injuries (n=862, 95.6%) were minor in severity, while 4.3% of injuries were classified as having some impedance of normal function (FCI 3). Moderate injuries (AIS 2) were infrequent, but comprised a greater proportion of fireground injuries (8.7%) than the other activities (1.0-4.1%); however, lost time injuries were more frequent for patient transport (46.1%) than other operations (22.0-29.1%). Conclusions Physical exercise, patient transport and training activities were responsible for a greater percentage of injuries than fireground operations. Focused efforts to improve the characterisation of risks during these more diverse set of work processes should help guide the development of salient strategies for injury prevention.
• Roberge, J., O'Rourke, M. K., Meza-Montenegro, M. M., Gutiérrez-Millán, L. E., Burgess, J. L., & Harris, R. B. (2012). Binational arsenic exposure survey: methodology and estimated arsenic intake from drinking water and urinary arsenic concentrations. International journal of environmental research and public health, 9(4).
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  The Binational Arsenic Exposure Survey (BAsES) was designed to evaluate probable arsenic exposures in selected areas of southern Arizona and northern Mexico, two regions with known elevated levels of arsenic in groundwater reserves. This paper describes the methodology of BAsES and the relationship between estimated arsenic intake from beverages and arsenic output in urine. Households from eight communities were selected for their varying groundwater arsenic concentrations in Arizona, USA and Sonora, Mexico. Adults responded to questionnaires and provided dietary information. A first morning urine void and water from all household drinking sources were collected. Associations between urinary arsenic concentration (total, organic, inorganic) and estimated level of arsenic consumed from water and other beverages were evaluated through crude associations and by random effects models. Median estimated total arsenic intake from beverages among participants from Arizona communities ranged from 1.7 to 14.1 µg/day compared to 0.6 to 3.4 µg/day among those from Mexico communities. In contrast, median urinary inorganic arsenic concentrations were greatest among participants from Hermosillo, Mexico (6.2 µg/L) whereas a high of 2.0 µg/L was found among participants from Ajo, Arizona. Estimated arsenic intake from drinking water was associated with urinary total arsenic concentration (p < 0.001), urinary inorganic arsenic concentration (p < 0.001), and urinary sum of species (p < 0.001). Urinary arsenic concentrations increased between 7% and 12% for each one percent increase in arsenic consumed from drinking water. Variability in arsenic intake from beverages and urinary arsenic output yielded counter intuitive results. Estimated intake of arsenic from all beverages was greatest among Arizonans yet participants in Mexico had higher urinary total and inorganic arsenic concentrations. Other contributors to urinary arsenic concentrations should be evaluated.
• Burgess, J. L., Peate, W. F., Pollack, K. M., Harris, R. B., & Poplin, G. S. (2011). Beyond the fireground: Injuries in the fire service. Injury Prevention.
• Gomez-Rubio, P., Roberge, J., Arendell, L., Harris, R. B., O'Rourke, M. K., Chen, Z., Cantu-Soto, E., Meza-Montenegro, M. M., Billheimer, D., Lu, Z., & Klimecki, W. T. (2011). Association between body mass index and arsenic methylation efficiency in adult women from southwest U.S. and northwest Mexico. Toxicology and applied pharmacology, 252(2).
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  Human arsenic methylation efficiency has been consistently associated with arsenic-induced disease risk. Interindividual variation in arsenic methylation profiles is commonly observed in exposed populations, and great effort has been put into the study of potential determinants of this variability. Among the factors that have been evaluated, body mass index (BMI) has not been consistently associated with arsenic methylation efficiency; however, an underrepresentation of the upper BMI distribution was commonly observed in these studies. This study investigated potential factors contributing to variations in the metabolism of arsenic, with specific interest in the effect of BMI where more than half of the population was overweight or obese. We studied 624 adult women exposed to arsenic in drinking water from three independent populations. Multivariate regression models showed that higher BMI, arsenic (+3 oxidation state) methyltransferase (AS3MT) genetic variant 7388, and higher total urinary arsenic were significantly associated with low percentage of urinary arsenic excreted as monomethylarsonic acid (%uMMA) or high ratio between urinary dimethylarsinic acid and uMMA (uDMA/uMMA), while AS3MT genetic variant M287T was associated with high %uMMA and low uDMA/uMMA. The association between BMI and arsenic methylation efficiency was also evident in each of the three populations when studied separately. This strong association observed between high BMI and low %uMMA and high uDMA/uMMA underscores the importance of BMI as a potential arsenic-associated disease risk factor, and should be carefully considered in future studies associating human arsenic metabolism and toxicity.
• Loescher, L. J., Hibler, E., Hiscox, H., Hla, H., & Harris, R. B. (2011). Challenges of using the internet for behavioral research. Computers, informatics, nursing : CIN, 29(8).
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  Using the Internet in behavioral research remains a challenge. We developed a video intervention and conducted a pilot study that was designed to deliver and test the intervention via the Internet. One aim of this study was to evaluate the feasibility of using the Internet to both deliver the intervention and collect data from participants. This article summarizes procedures for delivering the intervention and survey via the Internet, obstacles encountered during delivery of the intervention and data collection, and lessons learned that can be applied to future research involving the Internet.
• Nuno, V. L., Zhang, Q., Harris, R. B., Wilkinson-Lee, A. M., & Wilhelm, M. S. (2011). Smoking susceptibility among students followed from grade six to eight. Addictive Behaviors, 36(12), 1261-1266. doi:10.1016/j.addbeh.2011.07.041
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  ;Your Role: I was involved in the synthesis of the paper and critical review.;Full Citation: Nuno, V.L., Zhang, Q., Harris, R.B., Wilkinson-Lee, A.M., & Wilhelm, M.S. (2011). Smoking susceptibility among students followed from grade six to eight. Addictive Behaviors, 36, 1261-1266. doi: 10.1016/j.addbeh.2011.07.041.;Collaborative with graduate student: Yes;Collaborative with faculty member at UA: Yes;Other collaborative: Yes;Specify other collaborative: A research specialist in Evaluation, Research and Development (ERAD);
• Nuño, T., Castle, P. E., Harris, R., Estrada, A., García, F., & , Y. P. (2011). Breast and cervical cancer screening utilization among Hispanic women living near the United States-Mexico border. Journal of women's health (2002), 20(5).
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  Hispanic women who reside in low-resource settings are especially at risk for nonparticipation in cancer screening programs. The purpose of this study was to assess characteristics that influence breast and cervical cancer screening among older Hispanic women living along the United States-Mexico border.
• Nuño, T., Martinez, M. E., Harris, R., & García, F. (2011). A Promotora-administered group education intervention to promote breast and cervical cancer screening in a rural community along the U.S.-Mexico border: a randomized controlled trial. Cancer causes & control : CCC, 22(3).
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  Breast cancer is the most common neoplasm among Hispanic women. Cervical cancer has a higher incidence and mortality among Hispanic women compared with non-Hispanic White women.
• Tabor, J. A., O'rourke, M. K., Lebowitz, M. D., & Harris, R. B. (2011). Landscape-epidemiological study design to investigate an environmentally based disease. Journal of exposure science & environmental epidemiology, 21(2).
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  Cost-effective approaches for identifying and enrolling subjects in community-based epidemiological studies face many challenges. Additional challenges arise when a neighborhood scale of analysis is required to distinguish between individual- and group-level risk factors with strong environmental determinants. A stratified, two-stage, cross-sectional, address-based telephone survey of Greater Tucson, Arizona, was conducted in 2002-2003. Subjects were recruited from direct marketing data at neighborhood resolution using a geographic information system (GIS). Three geomorphic strata were divided into two demographic units. Households were randomly selected within census block groups, selected using the probability proportional to size technique. Purchased direct marketing lists represented 45.2% of Census 2000 households in the surveyed block groups. Survey design effect (1.6) on coccidioidomycosis prevalence (88 per 100,000 per year) was substantially reduced in four of the six strata (0.3-0.9). Race-ethnicity was more robust than age and gender to compensate for significant selection bias using poststratification. Clustered, address-based telephone surveys provide a cost-effective, valid method for recruiting populations from address-based lists using a GIS to design surveys and population survey statistical methods for analysis. Landscape ecology provides effective methods for identifying scales of analysis and units for stratification that will improve sampling efficiency when environmental variables of interest are strong predictors.
• Clouser, M. C., Roe, D. J., Foote, J. A., Harris, R. B., & Alberts, D. S. (2010). Dose response of retinol and isotretinoin in the prevention of nonmelanoma skin cancer recurrence. Nutrition and cancer, 62(8), 1058-66.
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  Using data from a randomized, double blind, study of the efficacy of retinol or isotretinoin vs. placebo on recurrence of nonmelanoma skin cancer in high-risk subjects, a reanalysis of the original intent to treat analysis was performed in a dose-response format. Cox proportional hazards models describe the relationship between dose quartiles of isotretinoin and retinol use and time to first occurrence of squamous cell carcinoma (SCC) or basal cell carcinoma (BCC) in crude and adjusted models. Neither the isotretinoin nor retinol models showed any significance at any quartile for reduction in first BCC or SCC occurrence. Crude and adjusted retinol models show a statistically significant increase in risk of developing an SCC in the first quartile, whereas only the crude model shows a statistically significant increase in risk in the first quartile of the isotretinoin model. For retinol and SCC, hazard ratios (HRs) for the first quartile were as follows: HR = 2.92, 95% confidence interval (CI) = 1.67-5.10 crude; HR = 1.95, 95% CI = 1.00-3.80 adjusted. For isotretinoin and SCC, HRs for the first quartile were as follows: HR = 2.38, 95% CI = 1.35-4.19 crude; HR = 1.69, 95% CI = 0.87-3.31 adjusted. Test for trend was not significant in any of the models. These analyses confirm the results of the original intent to treat analyses and raise an interesting question related to the potential for increased risk for patients in the first quartile of retinol dose.
• Loescher, L. J., Hibler, E., Hiscox, H., Quale, L., & Harris, R. (2010). An Internet-delivered video intervention for skin self-examination by patients with melanoma. Archives of dermatology, 146(8), :922-3.
• Lu, B., Hagensee, M. E., Lee, J., Wu, Y., Stockwell, H. G., Nielson, C. M., Abrahamsen, M., Papenfuss, M., Harris, R. B., & Giuliano, A. R. (2010). Epidemiologic factors associated with seropositivity to human papillomavirus type 16 and 18 virus-like particles and risk of subsequent infection in men. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 19(2).
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  Our understanding of humoral response to human papillomavirus (HPV) infection has been mainly derived from studies in women. The role of serum antibodies in the natural history of HPV in men has yet to be investigated. Data from 285 male participants of a natural history study were used to determine the epidemiologic factors associated with HPV 16/18 seropositivity and explore the role of HPV 16 and 18 serum antibodies in subsequent HPV infections. Serum antibodies were detected by use of HPV 16- and 18 virus-like particles enzyme-linked immunoassay. Logistic regression and Generalized Estimating Equation was used for the evaluation of risk factors. The risk of subsequent HPV infection by baseline antibody status was assessed by incidence rate ratio and its confidence intervals. Men ages 36 to 44 years compared with men ages 18 to 25 years were four times more likely to be seropositive to HPV 16/18. In addition, being divorced, separated, or widowed; being a former smoker; and having sex with men was positively and independently associated with HPV 16/18 seropositivity. Our findings on the potential role of HPV 16 or 18 serum antibodies in subsequent infection were inconclusive. Large prospective studies are warranted to adequately address questions on the role of natural immunity in the natural history of HPV infections in men.
• Nielson, C. M., Harris, R. B., Nyitray, A. G., Dunne, E. F., Stone, K. M., & Giuliano, A. R. (2010). Consistent condom use is associated with lower prevalence of human papillomavirus infection in men. The Journal of infectious diseases, 202(3).
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  Reported associations between condom use and human papillomavirus (HPV) infection in men have been inconsistent.
• Nyitray, A. G., Harris, R. B., Abalos, A. T., Nielson, C. M., Papenfuss, M., & Giuliano, A. R. (2010). Test-retest reliability and predictors of unreliable reporting for a sexual behavior questionnaire for U.S. men. Archives of sexual behavior, 39(6).
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  Accurate knowledge about human sexual behaviors is important for increasing our understanding of human sexuality; however, there have been few studies assessing the reliability of sexual behavior questionnaires designed for community samples of adult men. A test-retest reliability study was conducted on a questionnaire completed by 334 men who had been recruited in Tucson, Arizona. Reliability coefficients and refusal rates were calculated for 39 non-sexual and sexual behavior questionnaire items. Predictors of unreliable reporting for lifetime number of female sexual partners were also assessed. Refusal rates were generally low, with slightly higher refusal rates for questions related to immigration, income, the frequency of sexual intercourse with women, lifetime number of female sexual partners, and the lifetime number of male anal sex partners. Kappa and intraclass correlation coefficients were substantial or almost perfect for all non-sexual and sexual behavior items. Reliability dropped somewhat, but was still substantial, for items that asked about household income and the men's knowledge of their sexual partners' health, including abnormal Pap tests and prior sexually transmitted diseases (STD). Age and lifetime number of female sexual partners were independent predictors of unreliable reporting while years of education was inversely associated with unreliable reporting. These findings among a community sample of adult men are consistent with other test-retest reliability studies with populations of women and adolescents.
• Pogreba-Brown, K., Harris, R. B., Stewart, J., Anderson, S., Erhart, L. M., & England, B. (2010). Outbreak investigation partnerships: utilizing a student response team in public health responses. Public health reports (Washington, D.C. : 1974), 125(6).
• Clouser, M. C., Roe, D. J., Foote, J. A., & Harris, R. B. (2009). Effect of non-steroidal anti-inflammatory drugs on non-melanoma skin cancer incidence in the SKICAP-AK trial. Pharmacoepidemiology and drug safety, 18(4).
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  Recent studies link the prostaglandin metabolic pathway to skin carcinogenesis expanding possibilities that cyclooxygenase (COX) inhibitors may be utilized in non-melanoma skin cancer (NMSC) chemoprevention. Using data from a study of the efficacy of retinol supplementation on incidence of NMSC, we sought to determine the role of non-steroidal anti-inflammatory drugs (NSAIDs) in NMSC development. Cox proportional hazards models describe the relationship between NSAID use and time to first squamous cell carcinoma (SCC) or basal cell carcinoma (BCC) among participants categorized by use pattern: continuous users (use for length of study duration), new users (use for less than study duration), and non-users. For SCC and BCC, there was a statistically significant protective effect for participants who reported use for less than the study duration (HR = 0.49, 95%CI 0.28-0.87 and HR = 0.43, 95%CI 0.25-0.73, respectively). Categorical examination of NSAIDs (aspirin (ASA) vs. non-ASA NSAIDs) showed significant effects for BCC among those using non-ASA NSAIDs for less than the study duration (HR = 0.33, 95%CI 0.13-0.80). For SCC and BCC, NSAID use of shorter duration and potentially more recent, was more protective than longer duration of use. These results are counter to the idea that longer duration of NSAID use is more protective. Additional investigations are needed into the role NSAIDs play in the chemoprevention of NMSC.
• Dunne, E. F., Nielson, C. M., Hagensee, M. E., Papenfuss, M. R., Harris, R. B., Herrel, N., Gourlie, J., Abrahamsen, M., Markowitz, L. E., & Giuliano, A. R. (2009). HPV 6/11, 16, 18 seroprevalence in men in two US cities. Sexually transmitted diseases, 36(11).
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  A vaccine to prevent human papillomavirus (HPV) 6, HPV 11, HPV 16, or HPV 18 and associated diseases is licensed for females, and it may be licensed for men in the future. There are limited data on HPV 6/11, 16, and/or 18 seroprevalence in men.
• Granado, N. S., Smith, T. C., Swanson, G. M., Harris, R. B., Shahar, E., Smith, B., Boyko, E. J., Wells, T. S., Ryan, M. A., & , M. C. (2009). Newly reported hypertension after military combat deployment in a large population-based study. Hypertension, 54(5).
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  High-stress situations, such as combat deployments, are a potential risk factor for hypertension. Although stress is postulated to increase blood pressure, the underlying role of stress on hypertension is not well established. We sought to determine the relations between combat deployment-induced stress and hypertension. The Millennium Cohort baseline questionnaire (2001-2003) was completed by 77,047 US active-duty and Reserve/National Guard members. Follow-up was completed by 55,021 responders approximately 3 years later (2004-2006). Multivariable logistic regression was used to estimate the 3-year risk of newly reported hypertension, adjusting for general and mental health, demographics, and occupational and behavioral characteristics. After applying exclusion criteria, our analyses included 36 061 service members. Subanalyses of deployers included 8829 participants. Newly reported hypertension was identified in 6.9% of the cohort between baseline and follow-up, many of whom had deployed on military operations in support of the conflicts in Iraq and Afghanistan. After adjusting, deployers who experienced no combat exposures were less likely to report hypertension than nondeployers (odds ratio: 0.77; 95% CI: 0.67 to 0.89). Among deployers, those reporting multiple combat exposures were 1.33 times more likely to report hypertension compared with noncombat deployers (95% CI: 1.07 to 1.65). Although military deployers, in general, had a lower incidence of hypertension than nondeployers, deployment with multiple stressful combat exposures appeared to be a unique risk factor for newly reported hypertension.
• Lu, B., Wu, Y., Nielson, C. M., Flores, R., Abrahamsen, M., Papenfuss, M., Harris, R. B., & Giuliano, A. R. (2009). Factors associated with acquisition and clearance of human papillomavirus infection in a cohort of US men: a prospective study. The Journal of infectious diseases, 199(3).
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  Our understanding of factors associated with acquisition and clearance of human papillomavirus (HPV) in men has been limited. This study sought to determine factors associated with those aspects of HPV infection in a cohort of US men.
• Nielson, C. M., Harris, R. B., Flores, R., Abrahamsen, M., Papenfuss, M. R., Dunne, E. F., Markowitz, L. E., & Giuliano, A. R. (2009). Multiple-type human papillomavirus infection in male anogenital sites: prevalence and associated factors. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 18(4).
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  Human papillomavirus (HPV) causes cervical cancer and is strongly associated with other anogenital cancers. Multiple-type HPV infection has been associated with lengthier infection and precancerous lesions. Little is known about multiple-type HPV prevalence and associated factors in men. We examined the prevalence of and risk factors for multiple-type HPV in primarily asymptomatic men. Detection of 37 HPV types in male anogenital epithelium and semen was completed in 463 men in two U.S. cities. The proportions of men with multiple HPV of any type and with multiple oncogenic or nononcogenic types were calculated. Factors associated with multiple HPV were evaluated using multinomial logistic regression. Overall, 22.9% of men had multiple-HPV, 8.6% of men had multiple oncogenic types, and 13.4% had multiple nononcogenic types. Greater proportions of samples at the shaft, glans/corona, and scrotum had multiple HPV types (18.7%, 12.8%, and 7.3%, respectively) than did other anogenital sites (all < or =2.8%). Factors independently associated with multiple-type HPV were Hispanic ethnicity [adjusted odds ratio (AOR), 2.45; 95% confidence interval (95% CI), 1.05-5.67], concurrent detection of genital warts (AOR, 10.40; 95% CI, 1.12-96.6), smoking > or =10 cigarettes/d (AOR, 3.00; 95% CI, 1.07-8.43), greater lifetime number of female sexual partners (AOR, 13.73 for > or =21 versus 1-5; 95% CI, 5.34-35.3), and condom use less than half the time (AOR, 2.03; 95% CI, 1.07-3.84). Detection of multiple HPV types in this study of primarily asymptomatic men was common, particularly at external genital sites. Lifetime number of female sex partners, condom use, and smoking were modifiable factors associated with multiple HPV.
• Burgess, J. L., Harris, R. B., Kurzius-Spencer, M., Bofinger, C. M., Ranger-Moore, J., Miller, H. B., Poplin, G. S., Burgess, J. L., Harris, R. B., Kurzius-Spencer, M., Bofinger, C. M., Ranger-Moore, J., Miller, H. B., & Poplin, G. S. (2008). International evaluation of injury rates in coal mining: A comparison of risk and compliance-based regulatory approaches. Safety Science, 46(8), 1196-1204.
• Flores, R., Abalos, A. T., Nielson, C. M., Abrahamsen, M., Harris, R. B., & Giuliano, A. R. (2008). Reliability of sample collection and laboratory testing for HPV detection in men. Journal of virological methods, 149(1).
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  Analysis of male HPV infection is hindered frequently by the lack of consistency in collection methods and sample adequacy for detection of HPV with molecular methods. Presented here are the reliability of sample collection of male anogenital skin exfoliated cells, as well as reliability of PCR-based HPV detection method and genotyping analysis. Concordance of HPV test for paired collected samples from different anatomical sites was determined. The highest agreement was observed for penile shaft with a kappa (kappa)=0.75 (95% CI: 0.63-0.86), followed by perianal area (kappa=0.68, 95% CI: 0.51-0.86); and lowest at the anal canal (kappa=0.55, 95% CI: 0.35-0.74) and scrotum (kappa=0.54, 95% CI: 0.40-0.69). The reliability of laboratory testing was highest for detection of oncogenic types (kappa=0.86, 95% CI: 0.71-1.00) and for multiple-type HPV infections (kappa=0.84, 95% CI: 0.72-0.95) compared to detection of non-oncogenic HPV types (kappa=0.64, 95% CI: 0.47-0.82) or single HPV-type detection (kappa=0.52, 95% CI: 0.32-0.72). In conclusion, the swab method used to obtain skin exfoliated cells is adequate for sample collection, and the specimens can be used reliably for molecular HPV testing.
• Flores, R., Lu, B., Beibei, L., Nielson, C., Abrahamsen, M., Wolf, K., Lee, J., Harris, R. B., & Giuliano, A. R. (2008). Correlates of human papillomavirus viral load with infection site in asymptomatic men. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 17(12).
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  Numerous studies have evaluated human papillomavirus (HPV) DNA load in women, especially HPV-16 viral load, and its role in cervical carcinogenicity. Few studies have examined HPV viral load in men, none among asymptomatic men. The aim of the current study is to quantify HPV-16 viral load in male anogenital specimens and to explore its correlates with anatomic sites. Two-hundred and ninety-four specimens from 42 men who tested positive for HPV-16 at one or more anatomic sites were evaluated. HPV DNA was detected with PGMY 09/11 primer and genotyped with reverse line blot assay followed by HPV-16 viral quantification using type-specific real-time PCR assay (TaqMan). The quantitative PCR assay showed a higher sensitivity in HPV-16 viral DNA detection compared with the reverse line blot assay. Viral load varied significantly by anatomic site (P = 0.019). Penile shaft specimens had significantly higher viral load than any other anatomic site evaluated except for the anal canal. HPV-16 viral load was positively correlated between proximal anatomic sites: perianal and anal canal (P = 0.003), perianal and scrotum (P = 0.011), scrotum and glans/corona (P = 0.045), and scrotum and penile shaft (P = 0.037). In conclusion, the penile shaft seemed to be the preferred site for HPV-16 viral replication. Viral load correlation between proximal sites suggested a possible autoinoculation in male HPV transmission.
• Giuliano, A. R., Lu, B., Nielson, C. M., Flores, R., Papenfuss, M. R., Lee, J., Abrahamsen, M., & Harris, R. B. (2008). Age-specific prevalence, incidence, and duration of human papillomavirus infections in a cohort of 290 US men. The Journal of infectious diseases, 198(6).
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  Human papillomavirus (HPV) infections cause disease in men and women, and male-to-female HPV transmission influences the risk of cancer in females. The purpose of the present study was to describe the overall and age-specific incidence and clearance of HPV infections in men.
• Hakim, I. A., Chow, H. S., & Harris, R. B. (2008). Green tea consumption is associated with decreased DNA damage among GSTM1-positive smokers regardless of their hOGG1 genotype. The Journal of nutrition, 138(8), 1567S-1571S..
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  The levels of tobacco-related DNA adducts in human tissues reflect a dynamic process that is dependent on the intensity and time of exposure to tobacco smoke, the metabolic balance between activation of detoxification mechanisms, and the removal of adducts by DNA repair and/or cell turnover. Urinary 8-hydroxydeoxyguanosine (8-OHdG) is probably 1 of the most abundant DNA lesions formed during oxidative stress and is proposed as a sensitive biomarker of the overall oxidative DNA damage and repair. We performed this study to determine whether there were differences in increased oxidative stress susceptibility to smoking within the combined GSTM1 and hOGG1 genotypes and the impact of green tea drinking on this. We completed a Phase II randomized, controlled, 3-arm tea intervention trial to study the effect of high consumption of decaffeinated green or black tea or water on urinary 8-OHdG among heavy smokers and to evaluate the roles of GSTM1 and hOGG1 genotypes as effect modifiers. Assessment of urinary 8-OHdG after adjustment for baseline measurements and other potential confounders revealed a significant effect of green tea consumption (P = 0.001). The change from baseline was significant in all GSTM1-positive smokers regardless of their hOGG1 genotype. Our data show that consumption of 4 cups (960 mL) of tea/d is a feasible and safe approach and was associated with a significant decrease in urinary 8-OHdG among green tea consumers. Our finding also suggests that green tea intervention might be effective in decreasing DNA damage in the subgroup of smokers who are GSTM1 positive regardless of their hOGG1 genotype.
• Nyitray, A., Nielson, C. M., Harris, R. B., Flores, R., Abrahamsen, M., Dunne, E. F., & Giuliano, A. R. (2008). Prevalence of and risk factors for anal human papillomavirus infection in heterosexual men. The Journal of infectious diseases, 197(12).
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  In US men, the incidence of anal cancer, the primary cause of which is human papillomavirus (HPV) infection, has increased almost 3-fold in 3 decades; however, little is known about the epidemiology of anal HPV infection, especially in heterosexual men. In 2 US cities, behavioral data and anal biological specimens were collected from 253 men who acknowledged having engaged in sexual intercourse with a woman during the preceding year. On the basis of DNA analysis, overall prevalence of anal HPV infection was found to be 24.8% in 222 men who acknowledged having had no prior sexual intercourse with men. Of the men with anal HPV infection, 33.3% had an oncogenic HPV type. Risk factors independently associated with anal HPV were lifetime number of female sex partners and frequency of sex with females during the preceding month. These results suggest that anal HPV infection may be common in heterosexual men.
• Wang, M., Skrepnek, G. H., Armstrong, E., Sherrill, D. L., Harris, R. B., Tsai, C., & Malone, D. C. (2008). Use of salmeterol with and without concurrent use of inhaled corticosteroids and the risk of asthma-related hospitalization among patients with asthma. Current medical research and opinion, 24(3).
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  Studies evaluating the safety of salmeterol are inconclusive, which might be the result from not taking into account the impact of concomitant inhaled corticosteroids (ICS).
• Giuliano, A. R., Nielson, C. M., Flores, R., Dunne, E. F., Abrahamsen, M., Papenfuss, M. R., Markowitz, L. E., Smith, D., & Harris, R. B. (2007). The optimal anatomic sites for sampling heterosexual men for human papillomavirus (HPV) detection: the HPV detection in men study. The Journal of infectious diseases, 196(8).
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  Background. Human papillomavirus (HPV) infection in men contributes to infection and cervical disease in women as well as to disease in men. This study aimed to determine the optimal anatomic site(s) for HPV detection in heterosexual men.Methods. A cross-sectional study of HPV infection was conducted in 463 men from 2003 to 2006. Urethral, glans penis/coronal sulcus, penile shaft/prepuce, scrotal, perianal, anal canal, semen, and urine samples were obtained. Samples were analyzed for sample adequacy and HPV DNA by polymerase chain reaction and genotyping. To determine the optimal sites for estimating HPV prevalence, site-specific prevalences were calculated and compared with the overall prevalence. Sites and combinations of sites were excluded until a recalculated prevalence was reduced by
• Keim, S. M., Mays, M. Z., Parks, B., Pytlak, E., Harris, R. M., & Kent, M. A. (2007). Heat fatalities in Pima County, Arizona. Health & place, 13(1).
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  The most common cause of heat fatalities is environmental exposure during heat waves. Deserts of the southwestern USA are known for temperatures that exceed 32 degrees C for 30 days or more; yet, heat-related fatalities are rare among residents of the region. We compiled data from the National Weather Service and the Office of the Medical Examiner in order to determine the relationship between temperature and occurrence of heat fatalities in Pima County, AZ. Logistic regression indicated that for each degree of increase in temperature (degrees C), there was a 35% increase in the odds of a heat fatality occurring (p
• Nielson, C. M., Flores, R., Harris, R. B., Abrahamsen, M., Papenfuss, M. R., Dunne, E. F., Markowitz, L. E., & Giuliano, A. R. (2007). Human papillomavirus prevalence and type distribution in male anogenital sites and semen. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 16(6).
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  Human papillomavirus (HPV) is sexually transmitted and causes cervical cancer. Although HPV can infect men and women, little is known about infection in men. Specifically, the prevalence of type-specific HPV infection and the distribution of infections by anogenital anatomic site in men are incompletely characterized.
• Nielson, C. M., Harris, R. B., Dunne, E. F., Abrahamsen, M., Papenfuss, M. R., Flores, R., Markowitz, L. E., & Giuliano, A. R. (2007). Risk factors for anogenital human papillomavirus infection in men. The Journal of infectious diseases, 196(8).
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  Human papillomavirus (HPV) is strongly associated with cervical and other anogenital cancers. Identification of risk factors for HPV infection in men may improve our understanding of HPV transmission and prevention.
• Clouser, M. C., Harris, R. B., Roe, D. J., Saboda, K., Ranger-Moore, J., Duckett, L., & Alberts, D. S. (2006). Risk group, skin lesion history, and sun sensitivity reliability in squamous cell skin cancer progression. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 15(11).
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  In studies of skin cancer, participants are often classified into risk groups based on self-reported history of sun exposure or skin characteristics. We sought to determine the reliability of self-reported skin characteristics among participants of a study to evaluate markers for nonmelanoma skin cancer (NMSC). Multiple questionnaires and screening protocols were administered over a 3-month period to individuals from three risk groups: existing sun damage on forearms but no visible actinic keratoses (n = 91), visible actinic keratoses (n = 38), and history of resected squamous cell skin cancer in the last 12 months (n = 35). We assessed consistency of risk group assignment between telephone screen and study dermatologist assignment, self-reported sun sensitivity (telephone recruitment form versus participant completed profile), and self-reported history of NMSC skin lesions (telephone recruitment form versus health history). There was substantial agreement between probable risk group and final assignment (kappa = 0.76; 95% confidence interval, 0.65-0.85) and agreement did not differ by gender. Agreement for self-reported sun sensitivity was moderate (kappa weighted = 0.46; 95% confidence interval, 0.36-0.56) with higher agreement for women. For self-reported NMSC lesion history between two interviews, 24 days apart, kappa estimates ranged from 0.66 to 0.78 and were higher for women than men. Overall, there was evidence for substantial reproducibility related to risk group assignment and self-reported history of NMSC, with self-reported sun sensitivity being less reliable. In all comparisons, women had higher kappa values than men. These results suggest that self-reported measures of skin cancer risk are reasonably reliable for use in screening subjects into studies.
• Keim, S. M., Mays, M. Z., Parks, B., Pytlak, E., Harris, R. M., & Kent, M. A. (2006). Estimating the incidence of heat-related deaths among immigrants in Pima County, Arizona. Journal of immigrant and minority health / Center for Minority Public Health, 8(2).
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  Widespread media reports have described an increase in heat-related deaths among illegal immigrant border crossers in Southern Arizona in recent years. We conducted a retrospective case series review of heat-related deaths reported by a large border county medical examiner office in an attempt to estimate the occurrence and distribution of these deaths for the years 1998-2003. United States Border Patrol apprehension data were also collected and used in the analysis to estimate the size of the population of border crossers. An increase in the total heat-related deaths has occurred since 1999 in Pima County Arizona and has continued to date. Precise estimates of rates are not possible but appear to have increased as well. Implications for understanding the complexity of researching this public health issue including the definition of cases and population at risk are discussed.
• Keim, S. M., Mays, M. Z., Williams, J. M., Serido, J., & Harris, R. B. (2006). Measuring wellness among resident physicians. Medical teacher, 28(4).
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  Requirements to include professionalism in residency curricula have generated a substantial body of literature concerning the environments that fail to nurture professionalism. Local and national surveys provide evidence that a high prevalence of depersonalization and emotional exhaustion exists among residents and that clinical practice is impaired as a result of these factors. A group of 34 residents from ten residency programmes participated in the psychometric testing of a resident wellness assessment instrument that can be rapidly administered, scored, and interpreted. The Brief Resident Wellness Profile is composed of a Mood faces graphical rating item and a six-question subscale. The six-item subscale had good reliability (alpha = 0.83; r = 0.84), convergent validity (r = 0.63), discriminant validity (r = -0.37), and concurrent validity ( p = 0.007). The Mood faces item had good convergent validity (r = 0.66), discriminant validity (r = -0.71), and concurrent validity ( p = 0.008). The Brief Resident Wellness Profile appears to be a reliable and valid instrument that measures residents' sense of professional accomplishment and mood and can be rapidly administered, scored, and interpreted.
• Loescher, L. J., Harris, R. B., Lim, K. H., & Su, Y. (2006). Thorough skin self-examination in patients with melanoma. Oncology nursing forum, 33(3).
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  To examine the feasibility of using Weinstock et al.'s thorough skin self-examination (TSSE) assessment in patients with melanoma, to describe TSSE characteristics of patients with melanoma, and to explore associations of personal and disease variables with TSSE.
• Harris, R. B., Foote, J. A., Hakim, I. A., Bronson, D. L., & Alberts, D. S. (2005). Fatty acid composition of red blood cell membranes and risk of squamous cell carcinoma of the skin. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 14(4).
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  Differential effects of fatty acids on carcinogenesis suggest that fatty acid composition is important in tumor development. Arachidonic acid and its metabolites elicit inflammation and promote tumor formation in mouse skin. Inhibitors of the arachidonic cascade inhibit tumor incidence. A population-based case control study in Southeastern Arizona tested the hypothesis that lower levels of arachidonic acid in RBC membranes were associated with decreased risk of skin squamous cell carcinoma (SCC; n = 335 SCC cases and 321 controls). Extracted and esterified RBC fatty acids were analyzed using capillary gas chromatography. Individual peaks for 14 fatty acids were measured as a percentage of total fatty acids. Logistic regression was used to estimate odds ratios (OR), adjusting for SCC risk factors (age, gender, actinic keratosis history, freckling, and tanning ability). Increased levels of arachidonic acid in RBC membranes were associated with increased risk of SCC [odds ratio (OR), 1.08 per mg/100 mL change; 95% confidence interval (95% CI), 1.02-1.15] and this association remained when controls with actinic keratosis precursor lesions were excluded. SCC risk was highest among the upper quartile of arachidonic acid (OR, 2.38; 95% CI, 1.37-4.12). In contrast, increasing proportions of palmitic acid (OR, 0.94; 95% CI, 0.89-1.00) and palmitoleicacid (OR, 0.49; 95% CI, 0.30-0.81) were associated with reduced SCC risk. More studies are needed to elucidate the function of RBC fatty acids so that recommendations can be made to alter the human diet for cancer prevention.
• Thomson, C. A., Harris, R. B., Craft, N. E., & Hakim, I. A. (2005). A cross-sectional analysis demonstrated the healthy volunteer effect in smokers. Journal of clinical epidemiology, 58(4).
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  This cross-sectional descriptive analysis sought to determine if a healthy volunteer effect can be demonstrated among smokers selected to participate in a dietary intervention trial.
• Hakim, I. A., Harris, R. B., Chow, H. S., Dean, M., Brown, S., & Ali, I. U. (2004). Effect of a 4-month tea intervention on oxidative DNA damage among heavy smokers: role of glutathione S-transferase genotypes. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.
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  Glutathione S-transferase (GST), a member of the phase II group of xenobiotic metabolizing enzymes, has been intensively studied at the levels of phenotype and genotype. The GST mu 1 (GSTM1) and GST theta 1 (GSTT1) genes have a null-allele variant in which the entire gene is absent. The null genotype for both enzymes has been associated with many different types of tumors. The aim of this study was to determine the possible differences in increased oxidative stress susceptibility to smoking within the GSTM1 and GSTT1 genotypes and the impact of high tea drinking on this. We designed a Phase II randomized, controlled, three-arm tea intervention trial to study the effect of high consumption (4 cups/day) of decaffeinated green or black tea, or water on oxidative DNA damage, as measured by urinary 8-hydroxydeoxyguanosine (8-OHdG), among heavy smokers over a 4-month period and to evaluate the roles of GSTM1 and GSTT1 genotypes as effect modifiers. A total of 133 heavy smokers (100 females and 33 males) completed the intervention. GSTM1 and GSTT1 genotype statuses were determined with a PCR-based approach. Multiple linear regression models were used to estimate the main effects and interaction effect of green and black tea consumption on creatinine-adjusted urinary 8-OHdG, with or without adjustment for potential confounders. Finally, we studied whether the effect of treatment varied by GSTM1 and GSTT1 status of the individual. Although there were no differences in urinary 8-OHdG between the groups at baseline, the between-group 8-OHdG levels at month 4 were statistically significant for GSTM1-positive smokers (P = 0.05) and GSTT1-positive smokers (P = 0.02). GSTM1-positive and GSTT1-positive smokers consuming green tea showed a decrease in urinary 8-OHdG levels after 4 months. Assessment of urinary 8-OHdG after adjustment for baseline measurements and other potential confounders revealed significant effect for green tea consumption (P = 0.001). The change from baseline was significant in both GSTM1-positive (t = -2.99; P = 0.006) and GSTT1-positive (P = 0.004) green tea groups, but not in the GSTM1-negative (P = 0.07) or GSTT1-negative (P = 0.909) green tea groups. Decaffeinated black tea consumption had no effect on urinary 8-OHdG levels among heavy smokers. Our data show that consumption of 4 cups of tea/day is a feasible and safe approach and is associated with a significant decrease in urinary 8-OHdG among green tea consumers after 4 months of consumption. This finding also suggests that green tea intervention may be effective in the subgroup of smokers who are GSTM1 and/or GSTT1 positive.
• Harris, R. B., & Alberts, D. S. (2004). Strategies for skin cancer prevention. International journal of dermatology, 43(4).
• Cussler, E. C., Lohman, T. G., Going, S. B., Houtkooper, L. B., Metcalfe, L. L., Flint-Wagner, H. G., Harris, R. B., & Teixeira, P. J. (2003). Weight lifted in strength training predicts bone change in postmenopausal women. Medicine and science in sports and exercise.
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  The aim of this study was to examine the relationship between weight lifted in 1 yr of progressive strength training and change in bone mineral density (BMD) in a group of calcium-replete, postmenopausal women.
• Hakim, I. A., Harris, R. B., Brown, S., Chow, H. S., Wiseman, S., Agarwal, S., & Talbot, W. (2003). Effect of increased tea consumption on oxidative DNA damage among smokers: a randomized controlled study. The Journal of nutrition.
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  Tea drinking has been associated with decreased occurrence of cancer and heart disease. One potential mechanism for these findings is the strong antioxidant effect of tea polyphenols. A phase II randomized controlled tea intervention trial was designed to study the effect of high consumption (4 cups/d) of decaffeinated green or black tea on oxidative DNA damage as measured by urinary 8-hydroxydeoxyguanosine (8-OHdG) among smokers over a 4-mo period. A total of 143 heavy smokers, aged 18-79 y, were randomized to drink either green or black tea or water. Levels of plasma and urinary catechins and urinary 8-OHdG were measured monthly. A total of 133 of 143 smokers completed the 4-mo intervention. Multiple linear regression models were used to estimate the main effects and interaction effect of green and black tea consumption on creatinine-adjusted urinary 8-OHdG, with or without adjustment for potential confounders. Plasma and urinary levels of catechins rose significantly in the green tea group compared with the other two groups. Assessment of urinary 8-OHdG after adjustment for baseline measurements and other potential confounders revealed a highly significant decrease in urinary 8-OHdG (-31%) after 4 mo of drinking decaffeinated green tea (P = 0.002). No change in urinary 8-OHdG was seen among smokers assigned to the black tea group. These data suggest that regular green tea drinking might protect smokers from oxidative damages and could reduce cancer risk or other diseases caused by free radicals associated with smoking.
• Harris, J. M., Novalis-Marine, C., & Harris, R. B. (2003). Women physicians are early adopters of on-line continuing medical education. The Journal of continuing education in the health professions, 23(4).
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  On-line continuing medical education (CME) provides advantages to physicians and to medical educators. Although practicing physicians increasingly use on-line CME to meet their educational needs, the overall use of on-line CME remains limited. There are few data to describe the physicians who use this new educational medium; yet, they clearly are the innovators and early adopters who will facilitate the growth of this educational technology. It would be useful to instructional designers and CME developers to better understand the characteristics of this influential group.
• Giuliano, A. R., Harris, R., Sedjo, R. L., Baldwin, S., Roe, D., Papenfuss, M. R., Abrahamsen, M., Inserra, P., Olvera, S., & Hatch, K. (2002). Incidence, prevalence, and clearance of type-specific human papillomavirus infections: The Young Women's Health Study. The Journal of infectious diseases, 186(4).
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  The natural history of type-specific human papillomavirus (HPV) infections was examined in a cohort of 331 women aged 18-35 years who self-referred for routine gynecological care. Participants underwent a gynecological examination at baseline and at approximately 4 and approximately 10 months after baseline. Cervical samples were collected for HPV testing and genotyping at each visit, as was information on reproductive, sexual, and medical histories. The rate of new HPV infections was 2.9% per month; the highest rates were observed for HPV types 16, 39, 84, and 51. Among women who tested negative for HPV at baseline, the cumulative probability of acquiring an oncogenic HPV strain during a 12-month follow-up period was 0.32, compared with 0.18 for nononcogenic strains. Women who had had >/=1 new male sex partner in the recent past were significantly more likely to acquire a new HPV infection (relative hazard, 2.39; 95% confidence interval, 1.20-4.76). The median time to clearance of infection was significantly longer for oncogenic strains (9.8 months) than for nononcogenic strains (4.3 months).
• Sedjo, R. L., Inserra, P., Abrahamsen, M., Harris, R. B., Roe, D. J., Baldwin, S., & Giuliano, A. R. (2002). Human papillomavirus persistence and nutrients involved in the methylation pathway among a cohort of young women. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 11(4).
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  Persistent oncogenic human papillomavirus (HPV) infection is associated with cervical dysplasia. Cofactors, such as nutrient status, may be required for the progression of HPV infection to neoplasia. HPV DNA methylation patterns in vitro have been shown to be associated with viral transcriptional activity. Folate, vitamin B12, vitamin B6, and methionine may function to prevent cervical cancer through their role in DNA methylation. This study was conducted to examine the relationship of dietary intake of folate, vitamin B12, vitamin B6, and methionine, as well as circulating levels of folate and vitamin B12 to HPV persistence. Oncogenic HPV status was determined at baseline and at approximately 3 and 9 months postbaseline. Multivariate logistic regression analysis was used to determine the adjusted odds ratios for persistent HPV infection associated with each tertile of individual nutrient among 201 women with a persistent or intermittent HPV infection. Circulating vitamin B12 levels were inversely associated with HPV persistence (P for trend, 0.037) after adjusting for age, age at first intercourse, marital status, cigarette smoking status, race, and body mass index. In addition, women with circulating levels in the highest tertile (>493.2 pg/ml) of vitamin B12 were less likely to have a persistent infection (adjusted odds ratio = 0.4; 95% confidence interval = 0.17-0.96). No significant associations were observed between HPV persistence and dietary intake of folate, vitamin B12, vitamin B6, or methionine from food alone or from food and supplements combined or from circulating folate. These data suggest a role for circulating vitamin B12 in early cervical carcinogenesis.
• Sedjo, R. L., Roe, D. J., Abrahamsen, M., Harris, R. B., Craft, N., Baldwin, S., & Giuliano, A. R. (2002). Vitamin A, carotenoids, and risk of persistent oncogenic human papillomavirus infection. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 11(9).
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  Oncogenic human papillomavirus (HPV) infection is the main etiologic factor for cervical neoplasia, although infection alone is insufficient to produce disease. Cofactors such as nutritional factors may be necessary for viral progression to neoplasia. Results from previous studies have suggested that higher dietary consumption and circulating levels of certain micronutrients may be protective against cervical neoplasia. This study evaluated the role of vitamin A and carotenoids on HPV persistence comparing women with intermittent and persistent infections. As determined by the Hybrid Capture II system, oncogenic HPV infections were assessed at baseline and at approximately 3 and 9 months postbaseline. Multivariate logistic regression analysis was used to determine the risk of persistent HPV infection associated with each tertile of dietary and circulating micronutrients. Higher levels of vegetable consumption were associated with a 54% decrease risk of HPV persistence (adjusted odds ratio, 0.46; 95% confidence interval, 0.21-0.97). Also, a 56% reduction in HPV persistence risk was observed in women with the highest plasma cis-lycopene concentrations compared with women with the lowest plasma cis-lycopene concentrations (adjusted odds ratio, 0.44; 95% confidence interval, 0.19-1.01). These data suggest that vegetable consumption and circulating cis-lycopene may be protective against HPV persistence.

Presentations

• O'Rourke, M. K., Hadeed, S. J., Honanie, G. S., Mahkewa, A., Paukgana, M., Kelley, C., Alshammari, M. A., Canales, R. A., & Harris, R. B. (2017, October). Assessing Indoor PM2.5 Concentrations in Households on the Hopi Reservation. International Society of Exposure Science. Research Triangle Park: International Society of Exposure Science.

Poster Presentations

• Florea, A., Kohler, L. N., Trejo, M. J., Jurutka, P., Klimentidis, Y. C., Harris, R. B., Lance, M. P., & Jacobs, E. T. (2020, March). Circulating Fibroblast Growth Factor-21 and Odds of Metachronous Colorectal Adenoma.. ASPO. Tucson, AZ.
• Bea, J. W., Dickeson, K., Harris, R. B., Ehiri, J. E., Lind, K. E., Yung, A., & Thomson, C. A. (2020, Fall). In-person versus virtual training for the next generation of U3 cancer prevention scientists.. University of Arizona Cancer Center Fall Retreat. Tucson, AZ.
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  Bea JW, Dickeson KM, Harris RB, Ehiri JE, Lind KE, Yung AK, Thomson CA. In-person versus virtual training for the next generation of U3 cancer prevention scientists. UACC Fall Retreat. (November 2020).
• Foote, J. A., Roe, D., Harris, R. B., Dennis, L. K., & Celaya, M. P. (2019, November). Prediction of Attrition From a Medical Weight Loss Intervention With Community Hospital Employees. Obesity Week 2019 - TOS.
• Harris, R. B., Sanderson, P. R., Begay, R., Chief, C., Monroy, F., Brown, H., & Oren, E. (2019, September 20-23). Harris RB, Sanderson PR, Begay R, Chief C, Monroy F, Brown HE, Oren E. Helicobacter pylori infections in Navajo communities of Northern Arizona. San Francisco CA.. The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved Conference. San Francisco: AACR.
• Thomson, C. A., Dickeson, K., Kohler, L. N., Garcia, D. O., Harris, R. B., & Ehiri, J. E. (2018, Fall). Abstract: STEP-Up for Cancer Prevention. UACC Scientific Retreat.
• Koch, S., Harris, R. B., Jacobs, E. T., Ernst, K. C., & Dennis, L. K. (2016, October). Sun protection behavior and sunburns among Arizona adults. Joint IDEA-Keracon Conference [7th International Dermato-Epidemiology Association (IDEA) Congress and Keratinocyte Carcinoma Consortium (KeraCon). Aurora, CO: International Dermato-Epidemiology Association.
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  Koch S, Harris RB, Jacobs ET, Ernst KC, Dennis LK. Sun protection behavior and sunburns among Arizona adults. Poster presentation at Joint IDEA-Keracon Conference [7th International Dermato-Epidemiology Association (IDEA) Congress and Keratinocyte Carcinoma Consortium (KeraCon) . Aurora CO, September 2016
• Pogreba Brown, K. M., Ernst, K. C., & Harris, R. B. (2015, November). Determining Risk Factors of a Non-Point Source Outbreak of Campylobacter Cases Using Case-Case and Case-Control Studies. Campylobacter, Helicobbacter and Other Related Organisms International Conference. Rotorua, New Zealand.
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  This poster was accepted for the conference, but I was unable to attend due to medical reasons. Dr. Alexandra Armstrong, a colleague from CALS was able to present for me.
• Chongpison, Y., Hornbrook, M. C., Harris, R. B., Herrinton, L. J., Gerald, J. K., Grant, M., Bulkley, J. E., Wendel, C. S., & Krouse, R. S. (2014, April). ‘Depression and Perceived Financial Burden among Long-Term Rectal Cancer Survivors. 2014 Health Maintenance Organization Research Network (HMORN) conference. Phoenix, AZ.
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  Yuda Chongpison, Mark C. Hornbrook,Robin B. Harris, Lisa J. Herrinton, Joe K. Gerald, Marcia Grant, Joanna E. Bulkley, Christopher S. Wendel, Robert S. Krouse. Depression and Perceived Financial Burden among Long-Term Rectal Cancer Survivors. Poster presentation to 2014 Health Maintenance Organization Research Network (HMORN) conference, Phoenix, AZ: April, 2014.
• Murakami, T., Scranton, R., Brown, H. E., Harris, R. B., Zhao, C., Musuku, S., & Oren, E. (2014, October). A Survey of Screening and Treatment Practices for Helicobacter pylori in the United States. American College of Gastroenterology.. Philadelphia, PA.
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  Murakami T, Scranton R, Brown H, Harris RB, Chen Z, Musuku S, Oren E. A Survey of Screening and Treatment Practices for Helicobacter pylori in the United States. Poster presentation at the American College of Gastroenterology 79th Annual Scientific Meeting, Philadelphia, PA, October 2014.
• Sardo, C. L., Thomson, C. A., Hibler, E. A., Harris, R. B., Roe, D. R., Greenlee, H., Lance, M. P., Thompson, P., & Jacobs, E. T. (2013, November). Berry consumption and colorectal adenoma recurrence: a pooled analysis. American Institute for Cancer Research. Washington, DC.