Survey of the Health of Wisconsin (SHOW)

Principal Investigator:   Ajay Sethi, Co-PI Nasia Safdar

Affiliation (Dept/Agency):  Population Health Sciences

This study had three aims. The first aim was to determine if Wisconsin residents with usual diets that are in high vs. low quartiles for total fiber and specific types of fiber have significantly more diverse gut microbiota compared to resident with low fiber diets. The second aim was to determine if Wisconsin residents whose usual diets are in high vs. low quartiles for total fiber and specific fiber types have significantly lower populations of gut-related multidrug resistant organisms (MDROs) compared to those with low fiber diets and characterize population groups at risk for the presence of MDROs. The third and final aim was to use a data reduction approach (partial least squares regression modeling) to evaluate dietary intake of specific foods to identify clusters of food associated with the highest gut microbial diversity and lowest MDROs in representative population groups of WI residents.

This study will lead to a greater knowledge of the relationship between fiber intake, microbiota diversity, and MDRO colonization. This will further our understanding of the effects dietary habits have on the acquisition of MDROs. As SHOW already collects data on various demographic and health factors, this information was available for use without using extra funding.

This study is unique in that it is the first to use statewide microbiome data in its analysis, making it a diverse sample population. It also uses a “novel interdisciplinary collaboration between clinician-scientists and scientists”.

Eligibility criteria: Since the WARRIOR participants are taken from the SHOW participants, the exclusion and inclusion criteria are the same. To be included, the participants must live in the selected household, be aged 18 or older, be mentally capable of giving written informed consent, and able to communicate answers to the interview questions. A potential participant is excluded if they are a resident of a nursing home, hospital, mental institution, penal institution, jail, halfway house, or if they are under the jurisdiction of the Department of Corrections, if they are a student not currently residing in the household selected, if they are full-time members of the armed forces or activated units of the National Guard who are stationed away and do not usually sleep at the selected household, if they are visiting the household, if they have two residences and spend the greater number of nights at the non-selected household, and individuals who have voluntarily disclosed a diagnosis of mental incapacity.

Recruitment: Follow-up of SHOW participants from a pool of 1,200 adults who had previously consented to participate in the SHOW. The 1,200 participants who had previously consented to participant in the SHOW were approached to also participate in this study. Participants were recruited from Brown, Chippewa, Eau Claire, Green Lake, Milwaukee, Outagamie, Waupaca, Waushara, and Winnebago Counties.

Study Completion: 700 of the 1,200 SHOW participants completed the study. SHOW received stool samples from 805 participants of which 105 were rejected, unusable, or otherwise removed.

The study leveraged SHOW’s: biorepository; field team resources, recruitment, and protocol development expertise, as well as entry, storage, cleaning, and analysis of data.

Data Collection: 

• Survey data was collected on paper.
• Stool samples were produced in the participant’s home, brought to an onsite appointment, and given to a field staff member.

 Microbiome samples collected for this study are available for use by investigators with SHOW’s biobank.

Principal Investigator: Janean Dilworth Bart, Co-PI Kristen Malecki

Affiliation (Dept/Agency): Department of Family Studies, UW School for Human Ecology

The CREATE study had three main aims. Aim one was to identify sources of chemical and non-chemical stress in preschool-aged children. This will be done by establishing a time-activity modeling protocol for assessing multiple personal exposures to indoor and outdoor fine particulate matter [PM_2.5] and noise among 60 3-4 years old children. The second aim is to develop an integrative child cumulative risk score to include chemical, non-chemical, and psychological stress. This includes factors such as household chaos, parenting quality, caregiver psychological distress, language environment quality, indoor and outdoor sources of PM_2.5, and noise. The final aim is to determine associations between cumulative risk, inflammation, and indicators of academic readiness (SR and language) among 3-4 years old children. The first hypothesis is that children facing an increased number of combined stressors from exposure to social and environmental risks will have lower academic readiness scores. The second hypothesis is that the unique profiles of aggregate chemical, nonchemical, and psychosocial domain scores will be associated with self-regulation (model I), and verbal ability (model II), and these relationships are partially mediated by inflammation.

Brain development occurs rapidly in early childhood, at a time of increased vulnerability to the negative effects of psychosocial and environmental stress, as well as exceptional receptivity to high-quality interventions. Despite the sensitivity of this time, there are few studies that examine how a child’s simultaneous exposure to psychosocial, chemical, and non-chemical stressors affect academic readiness (self-regulation and language deficits). Even fewer studies include biomarkers of stress and inflammation.

The CREATE study looked at the exposure to psychosocial, chemical, and non-chemical stressors in tandem with the biomarkers of stress and inflammation that will be assessed by urine cortisol, creatinine, norepinephrine, and epinephrine, IL-6, and CRP inflammatory markers.

Eligibility criteria: 3 or 4 years old child with a parent available to participate, English language proficiency of both parent and child.

Recruitment: This study recruited new, non-SHOW participants. N=60 was the original goal, 67 were recruited, and 26 children ultimately participated. Participants were recruited at various preschools in the Madison WI area.

The study leveraged SHOW’s: biorepository; field team resources and recruitment expertise, as well as entry, storage, cleaning, and analysis of data.

Data Collection: 

• Survey data was collected on paper, using Qualtrics. The online platform used to complete the CAFÉ questionnaire was Qualitrics, on a tablet provided by the field staff.
• Psychosocial stress was measured using the Home Observation for Measurement of the Environment (HOME) Inventory, Early Childhood Version, which was filled out by the field staff. Household chaos was measured with Chaos, Hubbub, and Order Scale, and Caregiver depression was identified using the Center for Epidemiological Studies-Depression Scale. Both were filled out by the caregiver.
• Two devices were used in this study. The Language Environment Analysis (LENA) system (worn as a shirt) recorded 16 hours of the child’s auditory environment and a small, personal monitoring device (worn as a backpack) measured air quality by estimating fine particulate matter.
• Urine samples were collected in the child’s home. Some participants also gave cheek swabs and hair samples.

This study culminated in this publication:

Investigating Cumulative Exposures among 3- to 4-Year-Old Children Using Wearable Ultrafine Particle Sensors and Language Environment Devices: A Pilot and Feasibility Study. Schultz et al. Int. J. Environ. Res. Public Health 2020, 17(14), 5259; http://doi.org/10.3390/ijerph17145259

Principal Investigator: Noelle LoConte

Affiliation (Dept/Agency): Wisconsin Cancer Collaborative

The purpose of this research is to learn about cancer survivor experiences, such as the quality of care and communication you received throughout treatment. We hope to use the information participants provide to better understand cancer patient and survivor needs.

This study aimed to learn more about the health, difficulties, and healthcare of cancer survivors

Eligibility criteria: prior participation in SHOW, self-disclosure of prior cancer diagnosis (cancer survivors)

Recruitment: Follow-up of prior SHOW participants via mail and email of survey. SHOW attempted to recruit N~600, N=306 completed the survey

The study leveraged SHOW’s: expertise in survey development, participant recruitment, data collection, and data cleaning.

This study was used to inform the survivorship chapter of the Wisconsin Cancer Plan 2020-2030 as well as an issue brief on the Financial Toxicity of Cancer.

Principal Investigator: Henry Anderson

Affiliation (Dept/Agency): Wisconsin Department of Health Services (DHS)

Preliminary data from a biomonitoring assessment by the DHS, in collaboration with ATSDR, showed that the Burmese population in Milwaukee had significantly higher levels of contaminants in their blood stream than both Asians in the NHANES and the NHANES study population in general. This is exceptionally dangerous, particularly for women of child-bearing age (WCBA). That is why this study aims to recruit immigrant WCBA of Hmong, Burmese, Chinese, and Filipino ethnicity.

By studying this population, the effects of fish consumption from polluted water ways can be analyzed in a subset of people that are especially vulnerable to adverse health outcomes.

Eligibility criteria: In order to be eligible for the study, participants must be at least 18 years old, must have lived in Milwaukee for the last 12 months, not be pregnant, have eaten at least one fish meal from the water bodies of concern, and be the first/only member of the household participating in the study.

Recruitment: SHOW assisted with the recruitment of the underrepresented Burmese population in Milwaukee. This was a separate population from the SHOW cohort. Participants were recruited by Respondent Driven Sampling (RDS). This was used rather than traditional sampling, as the Burmese population in Milwaukee is underrepresented and is difficult to get significant participation rates using traditional sampling methods.

The study leveraged SHOW’s: biorepository; field team resources, recruitment, protocol development, and collection (survey data, biospecimen, physical measurements) expertise; as well as entry, storage, and cleaning of data.

Post-award, SHOW assisted with recruitment and also provided data on blood contaminant levels from the state-wide population for the years 2014-2016 to serve as a baseline.

Data Collection: 

Survey data was collected on paper, then transcribed to an online form in REDCap. Urine, blood, and hair samples were collected, as well as physical measurements. This was done at the International Institute of Wisconsin.

This study culminated in the following publications:

Fish Consumption, Awareness of Fish Advisories, and Body Burden of Contaminants among the Milwaukee Urban Anglers: A Biomonitoring Study. He et al. Environ Res. 2021 Nov;202:111761. https://doi.org/10.1016/j.envres.2021.110906

Fish consumption, awareness of fish advisories, and body burden of contaminants among the Milwaukee urban anglers: A biomonitoring study. He et al. Journal of Toxicology and Environmental Health Sciences. 2022 Jul; 14(2), 20-35. https://doi.org/10.5897/JTEHS2022.0506

Principal Investigator: Ajay Sethi

Affiliation (Dept/Agency): UW Population Health Sciences

The purpose of PMRC was to create a platform, resource, and infrastructure for continued and future microbiome research. PMRC aimed to do this by following up 2016 WARRIOR participants and collecting repeat stool samples, as well first-time collection of environmental samples – soil from outside their home, swabs from high touch surfaces areas in their home, and dust from the living room.

Few microbiome studies have stool/gut microbiome on a diverse study sample such as SHOW – urban/rural, variability in demographics. Most are clinical or convenience samples near research institutions. Also, we are among the first to have environmental samples with rerepeat longitudinal stool – and stored for future analyses, could look at a number of relationships including pesticides, endotoxin, etc. in dust/soil and their relationship with the human microbiome.

Samples from this study are stored for in SHOW biorepository for investigators to use along with baseline WARRIOR health data to investigate all sorts of microbiome questions, including household and environmental connections.

Eligibility criteria: 

• Adults (>18 years old)
• Previous participation in SHOW Microbiome study (WARRIOR)
• Completed stool collection in previous SHOW Wisconsin Microbiome study

Recruitment: Participants were sent a mailed invitation, reminder postcard, and follow-up invite.  SHOW field staff continued recruitment at participants’ homes – at the door in person, and followed up via telephone if they were not able to reach the participant at home.

The study leveraged SHOW’s: biorepository; protocol and survey development; field team resources, such as recruitment, logistical, and collection (survey data, biospecimen, physical measurements) expertise; as well as entry, storage, and cleaning of data.

Data Collection: 

Survey data was collected on paper as well as online, REDcap was used on tablets in the field by interviewers, and paper surveys were used by participants.  Stool, soil, high-touch surface swabs, and dust were collected at participants’ homes throughout the 4 Wisconsin counties that had been invited to SHOW core in 2016/ WARRIOR – Brown, Eau Claire, Waushara, and Milwaukee counties.

This study culminated in the following publications:

The Population-based Microbiome Research Core: a longitudinal infrastructure for assessment of household microbiome and human health research. Schultz et al. MedRxiv pre-print. 2021 Nov. https://doi.org/10.1101/2021.11.22.21266369

Principal Investigator: Lisa Cadmus-Bertram

Affiliation (Dept/Agency): UW Department of Kinesiology

There were two aims for this study. The first aim was to identify and examine barriers to physical activity that rural women face by conducting focus groups comprised of rural women. This information will be used to shape future questionnaires about physical activity. The second aim was to identify physical activity needs, barriers, and attitudes rural women have via a mail-based survey.

Little is known about how to promote physical activity among rural populations best. This study began the development of a more comprehensive understanding of the physical activity levels and best promotional strategies to reach rural Wisconsin Women.

Eligibility criteria: 

• Identify as female
• Live in rural Wisconsin
• Be aged 18-74 years old
• Self-report doing 150 minutes/week of moderate-to-vigorous activity

Recruitment: Participants were recruited through mailings and phone calls to satisfy aim one. The women invited to explore aim two were invited by mailings only. The goal was to recruit 2 focus groups of 10 to 12 women each to participate, for a total of 20-24 participants.

The study leveraged SHOW’s: Field team resources, such as recruitment, logistical, and in-person interviewing expertise.

Data Collection: Survey data was collected on paper.

This study culminated in the following publications:

Understanding the physical activity needs and interests of inactive and active rural women: a cross-sectional study of barriers, opportunities, and intervention preferences. Cadmus-Bertram, L., Gorzelitz, J., Dorn, D., Malecki, K. Journal of Behavioral Medicine 2020 (43) 638–647. http://doi.org/10.1007/s10865-019-00070-z