All Publications

  • Characterization and regulation of microplastic pollution for protecting planetary and human health. Environmental pollution (Barking, Essex : 1987) Jung, Y. S., Sampath, V., Prunicki, M., Aguilera, J., Allen, H., LaBeaud, D., Veidis, E., Barry, M., Erny, B., Patel, L., Akdis, C., Akdis, M., Nadeau, K. 2022: 120442


    Microplastics are plastic particles <5 mm in diameter. Since the 1950s, there has been an exponential increase in the production of plastics. As of 2015, it is estimated that approximately 6300 million metric tons of plastic waste had been generated of which 79% has accumulated in landfills or the natural environment. Further, it is estimated that if current trends continue, roughly 12,000 million metric tons of plastic waste will accumulate by 2050. Plastics and microplastics are now found ubiquitously-in the air, water, and soil. Microplastics are small enough to enter the tissues of plants and animals and have been detected in human lungs, stools, placentas, and blood. Their presence in human tissues and the food chain is a cause for concern. While direct clinical evidence or epidemiological studies on the adverse effects of microplastic on human health are lacking, in vitro cellular and tissue studies and in vivo animal studies suggest potential adverse effects. With the ever-increasing presence of plastic waste in our environment, it is critical to understand their effects on our environment and on human health. The use of plastic additives, many of which have known toxic effects are also of concern. This review provides a brief overview of microplastics and the extent of the microplastic problem. There have been a few inroads in regulating plastics but currently these are insufficient to adequately mitigate plastic pollution. We also review recent advances in microplastic testing methodologies, which should support management and regulation of plastic wastes. Significant efforts to reduce, reuse, and recycle plastics are needed at the individual, community, national, and international levels to meet the challenge. In particular, significant reductions in plastic production must occur to curb the impacts of plastic on human and worldwide health, given the fact that plastic is not truly recyclable.

    View details for DOI 10.1016/j.envpol.2022.120442

    View details for PubMedID 36272609

  • A protocol to inject ocular drug implants into mouse eyes. STAR protocols Lin, C., Sun, Y. J., Lee, S. H., Mujica, E. M., Kunchur, C. R., Wu, M., Yang, J., Jung, Y. S., Chiang, B., Wang, S., Mahajan, V. B. 2022; 3 (1): 101143


    Ocular drug implants (ODIs) are beneficial for treating ocular diseases. However, the lack of a robust injection approach for small-eyed model organisms has been a major technical limitation in developing ODIs. Here, we present a cost-effective, minimally invasive protocol to deliver ODIs into the mouse vitreous called Mouse Implant Intravitreal Injection (MI3). MI3 provides two alternative surgical approaches (air-pressure or plunger) to deliver micro-scaled ODIs into milli-scaled eyes, and expands the preclinical platforms to determine ODIs' efficacy, toxicity, and pharmacokinetics. For complete details on the use and execution of this protocol, please refer to Sun etal. (2021).

    View details for DOI 10.1016/j.xpro.2022.101143

    View details for PubMedID 35141566

  • An intravitreal implant injection method for sustained drug delivery into mouse eyes. Cell reports methods Sun, Y. J., Lin, C., Wu, M., Lee, S. H., Yang, J., Kunchur, C. R., Mujica, E. M., Chiang, B., Jung, Y. S., Wang, S., Mahajan, V. B. 2021; 1 (8)


    Using small molecule drugs to treat eye diseases carries benefits of specificity, scalability, and transportability, but their efficacy is significantly limited by a fast intraocular clearance rate. Ocular drug implants (ODIs) present a compelling means for the slow and sustained release of small molecule drugs inside the eye. However, methods are needed to inject small molecule ODIs into animals with small eyes, such as mice, which are the primary genetic models for most human ocular diseases. Consequently, it has not been possible to fully investigate efficacy and ocular pharmacokinetics of ODIs. Here, we present a robust, cost-effective, and minimally invasive method called "mouse implant intravitreal injection" (MI3) to deliver ODIs into mouse eyes. This method will expand ODI research to cover the breadth of human eye diseases modeled in mice.

    View details for DOI 10.1016/j.crmeth.2021.100125

    View details for PubMedID 35128514

  • Cost-utility analysis of an integrated genetic/epigenetic test for assessing risk for coronary heart disease EPIGENOMICS Jung, Y., Frisvold, D., Dogan, T., Dogan, M., Philibert, R. 2021; 13 (07): 531-547


    Aim: New epigenetically based methods for assessing risk for coronary heart disease may be more sensitive but are generally more costly than current methods. To understand their potential impact on healthcare spending, we conducted a cost-utility analysis. Methods: We compared costs using the new Epi + Gen CHD™ test with those of existing tests using a cohort Markov simulation model. Results: We found that use of the new test was associated with both better survival and highly competitive negative incremental cost-effectiveness ratios ranging from -$42,000 to -$8000 per quality-adjusted life year for models with and without a secondary test. Conclusion: The new integrated genetic/epigenetic test will save money and lives under most real-world scenarios. Similar advantages may be seen for other epigenetic tests.

    View details for DOI 10.2217/epi-2021-0021

    View details for Web of Science ID 000621085600001

    View details for PubMedID 33625255

  • Implementation and outcome evaluation of a team nutrition intervention: increasing knowledge, attitudes, and preferences HEALTH EDUCATION RESEARCH Askelson, N. M., Brady, P., Ryan, G., Scheidel, C., Delger, P., Phuong Nguyen, Jung, Y. 2021; 36 (1): 75-86


    Low-income, rural children are at a greater risk for poor dietary intake. Schools offer a venue to deliver appropriate interventions. Our aim was to evaluate the implementation and effectiveness of Healthy Schools, Healthy Students (HSHS). We conducted a mixed-methods evaluation using a cluster-randomized trial design with 20 schools in a rural, Midwestern state. HSHS included education sessions, cafeteria coaching and taste testing. We interviewed implementers (n = 13) and nutrition educators (n = 8), conducted six focus groups with cafeteria coaches, and surveyed fourth graders (n = 1057) about their nutrition knowledge, attitudes toward and preferences for fruits and vegetables (F&V), F&V consumption and MyPlate awareness. We used multi-level linear models to estimate the intervention effect and qualitative data were coded. There were very few challenges to implementation. HSHS participation was positively associated with knowledge, attitudes toward F&V, preferences for vegetables from the taste tests, MyPlate awareness and vegetable consumption. HSHS was viewed as beneficial and easy to deliver, suggesting this type of intervention could be widely implemented. Improving knowledge and attitudes through nutrition education and preferences through taste testing have the potential to improve dietary intake among rural students. Low-cost nutrition interventions can be successfully implemented in rural elementary schools with positive outcomes.

    View details for DOI 10.1093/her/cyaa036

    View details for Web of Science ID 000732791400005

    View details for PubMedID 33221862

  • Implementation Matters: Lessons From Iowa Medicaid's Healthy Behaviors Program HEALTH AFFAIRS Askelson, N. M., Wright, B., Brady, P. J., Jung, Y., Momany, E. T., Mcinroy, B., Damiano, P. 2020; 39 (5): 884-891


    Iowa's Medicaid expansion includes the Healthy Behaviors Program (HBP), which incentivizes enrollees to receive a wellness exam and complete a health risk assessment annually to waive a monthly premium. We conducted a telephone survey with enrollees to examine their awareness and understanding of the HBP, and we then merged the survey data with claims data to examine factors associated with the completion of program requirements. As found in previous research, awareness of the HBP remains low, with approximately half of respondents unaware of the program or the premium requirement. Our results suggest that four years after the program was implemented, requirements are not being effectively communicated to enrollees. When designing and implementing such programs, policy makers should note that they are unlikely to succeed without consideration of how the program is structured and promoted. Limited program awareness is likely to result in low participation and consequences related to paying premiums or being disenrolled.

    View details for DOI 10.1377/hlthaff.2019.01302

    View details for Web of Science ID 000531051800021

    View details for PubMedID 32364850

  • Iowa's Medicaid Healthy Behaviors Program Associated With Reduced Hospital-Based Care But Higher Spending, 2012-17 HEALTH AFFAIRS Wright, B., Jung, Y., Askelson, N. M., Momany, E. T., Damiano, P. 2020; 39 (5): 876-883


    Health behavior incentive programs are increasingly common in Medicaid programs nationwide. Iowa's Healthy Behaviors Program (HBP) requires Medicaid expansion enrollees to complete an annual wellness exam and health risk assessment or pay monthly premiums to avoid disenrollment. The extent to which the program reduces the use of hospital-based care and lowers health care spending is unknown. Using data for 2012-17 from Medicaid and for 2014-17 from HBP, we evaluated changes in use and spending associated with HBP participation. Compared to nonparticipants, HBP participants were less likely to have an emergency department visit or be hospitalized (by 9.6 percentage points and 2.8 percentage points, respectively) but had higher total health care spending ($1,594). Meanwhile, Iowa's Medicaid expansion was associated with increased use and spending independent of HBP participation-that is, applying to both participants and nonparticipants. Overall, our findings suggest that the HBP was associated with substantial reductions in hospital-based care but increased health care spending.

    View details for DOI 10.1377/hlthaff.2019.01145

    View details for Web of Science ID 000531051800020

    View details for PubMedID 32364851

  • Visualizing Immunization Registry Data to Identify Places With Low Rates of HPV Vaccination Initiation in a Rural State PREVENTING CHRONIC DISEASE Askelson, N. M., Kim, S., Jung, Y., Adam, E. E., Ryan, G., Novak, N. L., Kintigh, B., Callaghan, D., Carrel, M. 2020; 17: E21

    View details for DOI 10.5888/pcd17.190350

    View details for Web of Science ID 000539222500001

    View details for PubMedID 32134718

    View details for PubMedCentralID PMC7085903

  • The impact of expanding Medicaid on health insurance coverage and labor market outcomes INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT Frisvold, D. E., Jung, Y. 2018; 18 (2): 99-121


    Expansions of public health insurance have the potential to reduce the uninsured rate, but also to reduce coverage through employer-sponsored insurance (ESI), reduce labor supply, and increase job mobility. In January 2014, twenty-five states expanded Medicaid as part of the Affordable Care Act to low-income parents and childless adults. Using data from the 2011-2015 March Current Population Survey Supplements, we compare the changes in insurance coverage and labor market outcomes over time of adults in states that expanded Medicaid and in states that did not. Our estimates suggest that the recent expansion significantly increased Medicaid coverage with little decrease in ESI. Overall, the expansion did not impact labor market outcomes, including labor force participation, employment, and hours worked.

    View details for DOI 10.1007/s10754-017-9226-8

    View details for Web of Science ID 000431886300001

    View details for PubMedID 28940021