Jens C Eickhoff

Iowa State University, Ames, Iowa, United States

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Publications (167)584.83 Total impact

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    ABSTRACT: To compare complex quantitative magnetic resonance imaging (MRI) with MR spectroscopy (MRS) for quantification of hepatic steatosis (HS) and determine clinically significant MRI-based thresholds of HS in female youths. This prospective, cross-sectional study was conducted in 132 healthy females (11-22 years, mean 13.3 ± 2). Proton density fat-fraction (PDFF) was measured using complex quantitative MRI and MRS. Body mass index (BMI), fasting labs [glucose, insulin, alanine aminotransferase (ALT), and other metabolic markers] were obtained. Outcomes were measured using regression analysis, Spearman-rank correlation, and receiver operator characteristics (ROC) analysis. HS was defined as MRI-PDFF >5.6 %. HS was detected by MRI-PDFF in 15 % of all subjects. Linear regression demonstrated excellent correlation and agreement [r(2) = 0.96, slope = 0.97 (95 %CI: 0.94-1.00), intercept = 0.78 % (95 %CI: 0.58-0.98 %)] between MRI-PDFF and MRS-PDFF. MRI-PDFF had a sensitivity of 100 % (95 %CI: 0.79-1.00), specificity of 96.6 % (95 %CI: 0.91-0.99), and a kappa index of 87 % (95 %CI: 0.75-0.99) for identifying HS. In overweight subjects with HS, MRI-PDFF correlated with ALT (r = 0.84, p < 0.0001) and insulin (r = 0.833, p < 0.001), but not with BMI or WC. ROC analysis ascertained an optimal MRI-PDFF threshold of 3.5 % for predicting metabolic syndrome (sensitivity = 76 %, specificity = 83 %). Complex quantitative MRI demonstrates strong correlation and agreement with MRS to quantify hepatic triglyceride content in adolescent girls and young women. A low PDFF threshold is predictive of metabolic syndrome in this population. • Confounder-corrected quantitative MRI (ccqMRI) effectively measures hepatic triglyceride content in adolescent girls. • MRS and ccqMRI strongly correlate in liver proton density fat-fraction (PDFF) detection. • A PDFF threshold of 3.5 % may be predictive of paediatric metabolic syndrome.
    European Radiology 04/2015; DOI:10.1007/s00330-015-3724-1 · 4.34 Impact Factor
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    ABSTRACT: Prostate cancer (PCa) in many patients remains indolent for the rest of their lives, but in some patients, it progresses to lethal metastatic disease. Gleason score is the current clinical method for PCa prognosis. It cannot reliably identify aggressive PCa, when GS is ≤ 7. It is shown that oxidative stress plays a key role in PCa progression. We have shown that in cultured human PCa cells, an activation of spermidine/spermine N(1) -acetyl transferase (SSAT; EC 2.3.1.57) enzyme initiates a polyamine oxidation pathway and generates copious amounts of reactive oxygen species in polyamine-rich PCa cells. We used RNA in situ hybridization and immunohistochemistry methods to detect SSAT mRNA and protein expression in two tissue microarrays (TMA) created from patient's prostate tissues. We analyzed 423 patient's prostate tissues in the two TMAs. Our data show that there is a significant increase in both SSAT mRNA and the enzyme protein in the PCa cells as compared to their benign counterpart. This increase is even more pronounced in metastatic PCa tissues as compared to the PCa localized in the prostate. In the prostatectomy tissues from early-stage patients, the SSAT protein level is also high in the tissues obtained from the patients who ultimately progress to advanced metastatic disease. Based on these results combined with published data from our and other laboratories, we propose an activation of an autocrine feed-forward loop of PCa cell proliferation in the absence of androgen as a possible mechanism of castrate-resistant prostate cancer growth. Prostate 9999: XX-XX, 2015. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    The Prostate 04/2015; DOI:10.1002/pros.22996 · 3.57 Impact Factor
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    ABSTRACT: Although fitness and obesity have been shown to be independent predictors of cardiometabolic disease risk in obese children, this interaction is not well defined in non-obese children. The purpose of this study was to define the relationships between peak aerobic capacity, body composition, and fasting insulin levels in non-obese middle school children. 148 middle school children (mean age 11.0 ± 2.1 years, 49% male) underwent determination of BMI z-score (BMIz), fasting glucose, fasting insulin (FI), body composition by DXA scan [lean body mass (LBM) and body fat percentage (BF%)], and peak oxygen uptake per kg of LBM (VO2peak). Univariate correlations and multivariate regression analysis were used to identify independent predictors of FI using age, sex, BF%, BMIz, and VO2peak. FI was significantly related to VO2peak (r=-0.37, p<0.001), BF% (r=0.27, p<0.001), and BMIz (r=0.33, p=0.002). After inclusion in the multivariate model, VO2peak (p=0.018) and BMIz (p=0.043) remained significant predictors of FI, while age (p=0.39), sex (p=0.49), and BF% (p=0.72) did not. Among non-obese middle school children, FI is independently related to aerobic fitness after accounting for age, sex, and body composition. Public health efforts to reduce cardiometabolic disease risk among all adolescents should include exercise programs to increase cardiovascular fitness.
    Pediatric exercise science 04/2015; DOI:10.1123/pes.2014-0098 · 1.61 Impact Factor
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    ABSTRACT: Vaccination coverage rates can be improved through the application of complete and accurate immunization information systems (IISs). Evaluate the completeness and accuracy of Wisconsin's IIS, the Wisconsin Immunization Registry (WIR). Cross-sectional evaluation, comparing vaccination medical records (MRs) from provider clinics with WIR records. Medical records of patients born during 2009 were randomly selected from 251 Wisconsin clinics associated with the Vaccines for Children Program. Completeness: percentage of patients with client records in the WIR, percentage of patients up-to-date (%UTD) with the 4:3:1:3:3:1:4 vaccination series, and percentage of patients' MR vaccinations matched by administration date (±10 days) and type to vaccinations documented in the WIR. Accuracy: percentages of matched vaccinations with the same administration date, same trade name (TN), and same lot number. Of the 1863 selected patient MRs, 98% (n = 1833) had WIR client records and 97% of their 30 899 vaccinations were documented in the WIR. The %UTD was 49.3% using the MR only, 76.5% using the WIR only, and 75.2% as estimated by the National Immunization Survey. Among matched vaccinations, 99% had the same administration date, 96% had the same TN, and 95% had the same lot number. Compared with patients from clinics that entered data into the WIR using data exchange from electronic health records, patients from clinics that entered data using the Web-based user interface were less likely to have client records in the WIR (odds ratio: 0.3; 95% confidence interval: 0.1-0.9) and less likely to have accurate TNs (odds ratio: 0.3; 95% confidence interval: 0.1-0.5). The WIR was complete and accurate among this sample of children born during 2009 and provided a vaccination coverage assessment similar to the National Immunization Survey. Our results provide support for the expectation that meaningful use and other initiatives that increase data exchange from electronic health records to IISs will improve IIS data quality.
    Journal of public health management and practice: JPHMP 01/2015; DOI:10.1097/PHH.0000000000000216 · 1.47 Impact Factor
  • M Bruce Edmonson, Jens C Eickhoff, Chong Zhang
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    ABSTRACT: To describe the clinical spectrum and frequency of acute care revisits after tonsillectomy in a population-based sample from a single state in the US. We used California state discharge databases from 2009 to 2011 to retrospectively identify retrospectively routine tonsillectomy discharges in residents <25 years of age and to establish record linkage to revisits within 30 days at ambulatory surgery, inpatient, and emergency department facilities statewide. Percentages and descriptive statistics were sample-weighted, and revisit rates were adjusted for demographic factors, expected payer, chronic conditions, surgical indication, facility type, and clustering. Records were available for 35 085 index tonsillectomies, most of which were performed at hospital-owned ambulatory and inpatient facilities. There were 4944 associated revisits: 3761 (75.9%) treat-and-release emergency room visits, 816 (17.1%) inpatient admissions, and 367 (7.0%) ambulatory surgery visits. Most revisits (3225 [67.7%]) were unrelated to bleeding; these typically occurred early (mode, day 2) and were commonly associated with diagnosis codes indicating pain, nausea/vomiting, or dehydration. Crude all-cause revisit and readmission rates were 10.5% and 2.1%, respectively. Adjusted all-cause revisit rates (range, 8.6%-24.5%) were lowest in young children, increased in adolescents, and peaked in young adults. Adjusted bleeding-related revisit rates increased abruptly in adolescents and reached 13.9% in males (6.8% in females, P < .001) ages 20-24 years. Acute care revisits after tonsillectomy performed at predominately hospital-owned facilities in California are common and strongly age-related. Most revisits are early treat-and-release outpatient encounters, and these are usually associated with potentially preventable problems such as pain, nausea and vomiting, and dehydration. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of Pediatrics 12/2014; DOI:10.1016/j.jpeds.2014.11.009 · 3.74 Impact Factor
  • Shannon M. Dean, Jens C. Eickhoff, Leigh Anne Bakel
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    ABSTRACT: Providers nationally have observed a decline in the quality of documentation after implementing electronic health records (EHRs). In this pilot study, we examined the effectiveness of an intervention bundle designed to improve resident progress notes written in an EHR and to establish the reliability of an audit tool used to evaluate notes. The bundle consisted of establishing note-writing guidelines, developing an aligned note template, and educating interns about the guidelines and using the template. Twenty-five progress notes written by pediatric interns before and after this intervention were examined using an audit tool. Reliability of the tool was evaluated using the intraclass correlation coefficient (ICC). The total score of the audit tool was summarized in terms of means and standard deviation. Individual item responses were summarized using percentages and compared between the pre- and postintervention assessment using the Fisher exact test. The ICC for the audit tool was 0.96 (95% confidence interval: 0.91–0.98). A significant improvement in the total note score and in questions related to note clutter was seen. No significant improvement was seen for questions related to copy-paste. The study suggests that an intervention bundle can lead to some improvements in note writing. Journal of Hospital Medicine 2014. © 2014 Society of Hospital Medicine
    Journal of Hospital Medicine 11/2014; 10(2). DOI:10.1002/jhm.2283 · 2.08 Impact Factor
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    ABSTRACT: Background RO4929097 is an oral inhibitor of γ -secretase that results in Notch signaling inhibition. Prior work has demonstrated that Notch signaling inhibition enhances chemotherapy sensitivity of cancer cells. This phase I study was conducted to determine maximum tolerated dose (MTD), toxicities and efficacy of RO4929097 and capecitabine in advanced solid tumors. Methods Patients with refractory solid tumors received capecitabine at a fixed dose of 1,000 mg/m(2) twice daily with escalating doses of RO4929097 on a 21-day cycle in a 3 + 3 design. Capecitabine was administered for 14 days and the RO49029097 once daily, 3 days per week, both for a 21 day cycle. Results Thirty patients were treated on six dose levels (20 to 150 mg). The maximally tolerated dose was not reached. One dose limiting toxicity was observed at each level 3 through 6 (hypophosphatemia, fatigue, and nausea/vomiting). Three confirmed partial responses were observed: two patients with fluoropyrimide-refractory colon cancer and one patient with cervical cancer. Autoinduction of RO4929097 was demonstrated with increasing dose levels and duration. Conclusions The recommended phase 2 dose is capecitabine 1,000 mg/m(2) orally twice daily on days 1 through 14 with RO4929097 20 mg orally once daily on days 1-3, 8-10 and 15-17 with a 21 day cycle. Clinical benefit was observed in cervical and colon cancer. Autoinduction of RO4929097 was seen both with increasing cycle number and increasing dose. Plasma concentrations of RO4929097 were above those needed for Notch inhibition.
    Investigational New Drugs 10/2014; 33(1). DOI:10.1007/s10637-014-0166-6 · 2.93 Impact Factor
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    ABSTRACT: PurposeRetreatment with bortezomib (B) is often considered for patients with relapsed multiple myeloma (MM), but this strategy is hindered by uncertainty of response and emergence of B-induced peripheral neuropathy (PN). We incorporated acetyl-l-carnitine (ALCAR) to prevent PN and allow for adequate dosing. We also investigated the correlation between B-inducible NF-κB activation and response to therapy.MethodsNineteen patients with relapsed/refractory MM received up to 8 cycles of intravenous bortezomib, doxorubicin and oral low-dose dexamethasone (BDD) to evaluate response and toxicity. Thirteen additional patients received prophylactic ALCAR (BDD-A). Patients receiving BDD-A were evaluated by FACT-GOG-TX, FACIT-Fatigue, Neuropathic Pain index (NPI) and Grooved Pegboard (GP) testing. Primary MM cells from 11 patients were tested for B-inducible NF-κB activation.ResultsSeventy-six percent of subjects were refractory to previous treatment, 39 % refractory to bortezomib. Median cycles received were 5. CR + PR for the entire group were 53 % and did not differ between groups. Incidence of ≥3 PN was 32 % in the BDD group versus 15 % in the BDD-A group (p = ns). Patient-reported fatigue and PN measured by FACT-GOG-TX increased throughout the treatment period in the BDD-A group, although time to complete GP testing declined. In a sub-study examining constitutive bortezomib-inducible NF-κB activity in primary subject-specific MM cells, the presence of NF-κB activation correlated with lower likelihood of response.ConclusionsAddition of ALCAR to BDD did not alter the incidence or severity of PN in relapsed MM patients receiving a B-based regimen. Bortezomib-inducible NF-κB activation in patient-derived primary MM cells may be associated with poorer response.
    Cancer Chemotherapy and Pharmacology 08/2014; 74(4). DOI:10.1007/s00280-014-2550-5 · 2.57 Impact Factor
  • The Journal of Infectious Diseases 08/2014; 211(3). DOI:10.1093/infdis/jiu478 · 5.78 Impact Factor
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    ABSTRACT: Yttrium 90-ibritumomab tiuxetan (90Y-IT) radioimmunotherapy has proved to be effective in relapsed follicular lymphoma (FL). We conducted a clinical trial in which 90Y-IT followed by maintenance rituximab (MR) was evaluated as initial therapy for high-tumor-burden FL.
    Clinical advances in hematology & oncology: H&O 08/2014; 12(8):509-15.
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    ABSTRACT: Pulmonary arterial hypertension (PAH) results in right ventricular (RV) dysfunction and failure. Paradoxically, women are more frequently diagnosed with PAH but have better RV systolic function and survival rates than men. The mechanisms by which sex differences alter PAH outcomes remain unknown. Here, we sought to study the role of estrogen in RV functional remodeling in response to PAH. The SU5416-Hypoxia (SuHx) mouse model of PAH was used. To study the role of estrogen, female mice were ovariectomized and then treated with estrogen or placebo. SuHx significantly increased RV afterload and resulted in RV hypertrophy. Estrogen treatment attenuated the increase in RV afterload compared to the untreated group (effective arterial elastance: 2.3±0.1 mmHg/µl vs. 3.2±0.3 mmHg/µl and this was linked to preserved pulmonary arterial compliance (compliance: 0.013±0.001 mm<2/sup>/mmHg vs. 0.010±0.001 mm<2/sub>/mmHg, P<0.05) and decreased distal muscularization. Despite lower RV afterload in the estrogen-treated SuHx group, RV contractility increased to a similar level as the placebo-treated SuHx group, suggesting an inotropic effect of estrogen on RV myocardium. Consequently, compared to the placebo-treated SuHx group, estrogen improved RV ejection fraction and cardiac output (EF: 57±2% vs. 44 ± 2% and CO: 9.7±0.4 ml/min vs. 7.6±0.6 ml/min; P<0.05). Our study demonstrates for the first time that estrogen protects RV function in the SuHx model of PAH in mice directly by stimulating RV contractility and indirectly by protecting against pulmonary vascular remodeling. These results underscore the therapeutic potential of estrogen in PAH.
    AJP Heart and Circulatory Physiology 06/2014; 307(3). DOI:10.1152/ajpheart.00758.2013 · 4.01 Impact Factor
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    ABSTRACT: Background. We estimated the vaccine effectiveness (VE) of tetanus-diphtheria-acellular pertussis vaccine (Tdap) for preventing pertussis among adolescents during a statewide outbreak of pertussis in Wisconsin during 2012. Methods. We used the population-based Wisconsin Immunization Registry (WIR) to construct a cohort of Wisconsin residents born during 1998-2000 and collect Tdap vaccination histories. Reports of laboratory-confirmed pertussis with onset during 2012 were matched to WIR clients. Incidence rate ratios (IRRs) of pertussis and Tdap VE estimates [(1 - IRR)*100%], by year of Tdap vaccine receipt and brand (Boostrix/Adacel), were estimated using Poisson regression. Results. Tdap VE decreased with increasing time since receipt, with VEs of 75.3% (95% confidence interval [CI], 55.2%-86.5%) for receipt during 2012, 68.2% (95% CI, 60.9%-74.1%) for receipt during 2011, 34.5% (95% CI, 19.9%-46.4%) for receipt during 2010, and 11.9% (95% CI, -11.1% to 30.1%) for receipt during 2009/2008; point estimates were higher among Boostrix recipients than among Adacel recipients. Among Tdap recipients, increasing time since receipt was associated with increased risk, and receipt of Boostrix (vs Adacel) was associated with decreased risk of pertussis (adjusted IRR, 0.62 [95% CI, .52-.74]). Conclusions. Our results demonstrate waning immunity following vaccination with either Tdap brand. Boostrix was more effective than Adacel in preventing pertussis in our cohort, but these findings may not be generalizable to adolescent cohorts that received different diphtheria-tetanus-acellular pertussis vaccines (DTaP) during childhood and should be further examined in studies that include childhood DTaP history.
    The Journal of Infectious Diseases 06/2014; 210(6). DOI:10.1093/infdis/jiu322 · 5.78 Impact Factor
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    ABSTRACT: Problematic Internet Use (PIU) is a growing health concern among adolescents and young adults. The purpose of this mixed-methods study was to develop and refine a theoretically-grounded and psychometrically-validated assessment instrument for PIU specifically tailored to adolescents and young adults. An item pool was developed using concept mapping and a review of the literature, and administered to 714 students from two universities between 18 and 25 years of age. Exploratory and confirmatory factor analyses were used in a development subsample (n = 500) to construct the scale. A cross-validation sample (n = 214) was used to confirm the scale’s reliability. The Problematic and Risky Internet Use Screening Scale (PRIUSS) is an 18-item scale with three subscales: Social Impairment, Emotional Impairment, and Risky/Impulsive Internet Use. Based on its strong theoretical foundation and promising psychometric performance, the PRIUSS may be a valuable tool for screening and prevention efforts in this population.
    Computers in Human Behavior 06/2014; 35:171–178. DOI:10.1016/j.chb.2014.01.035 · 2.27 Impact Factor
  • Michael J Rock, Linda Makholm, Jens Eickhoff
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    ABSTRACT: Background: Conventional methods of sweat testing are time consuming and have many steps that can and do lead to errors. This study compares conventional sweat testing to a new quantitative method, the CF Quantum (R) (CFQT) sweat test. This study tests the diagnostic accuracy and analytic validity of the CFQT. Methods: Previously diagnosed CF patients and patients who required a sweat test for clinical indications were invited to have the CFQT test performed. Both conventional sweat testing and the CFQT were performed bilaterally on the same day. Pairs of data from each test are plotted as a correlation graph and Bland-Altman plot. Sensitivity and specificity were calculated as well as the means and coefficient of variation by test and by extremity. After completing the study, subjects or their parents were asked for their preference of the CFQT and conventional sweat testing. Results: The correlation coefficient between the CFQT and conventional sweat testing was 0.98 (95% confidence interval: 0.97-0.99). The sensitivity and specificity of the CFQT in diagnosing CF was 100% (95% confidence interval: 94-100%) and 96% (95% confidence interval: 89-99%), respectively. In one center in this three center multicenter study, there were higher sweat chloride values in patients with CF and also more tests that were invalid due to discrepant values between the two extremities. The percentage of invalid tests was higher in the CFQT method (16.5%) compared to conventional sweat testing (3.8%) (p < 0.001). In the post-test questionnaire, 88% of subjects/parents preferred the CFQT test. Conclusions: The CFQT is a fast and simple method of quantitative sweat chloride determination. This technology requires further refinement to improve the analytic accuracy at higher sweat chloride values and to decrease the number of invalid tests.
    Journal of cystic fibrosis: official journal of the European Cystic Fibrosis Society 05/2014; 13(5). DOI:10.1016/j.jcf.2014.05.001 · 3.82 Impact Factor
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    ABSTRACT: Objective To develop a risk assessment model for early detection of hepatic steatosis using common anthropometric and metabolic markers. Study design This was a cross-sectional study of 134 adolescent and young adult females, age 11-22 years (mean 13.3 +/- 2 years) from a middle school and clinics in Madison, Wisconsin. The ethnic distribution was 27% Hispanic and 73% non-Hispanic; the racial distribution was 64% Caucasian, 31% African-American, and 5% Asian, Fasting glucose, fasting insulin, alanine aminotransferase (ALT), body mass index (BMI), waist circumference (WC), and other metabolic markers were assessed. Hepatic fat was quantified using magnetic resonance imaging proton density fat fraction (MR-PDFF). Hepatic steatosis was defined as MR-PDFF >5.5%. Outcome measures were sensitivity, specificity, and positive predictive value (PPV) of BMI, WC, ALT, fasting insulin, and ethnicity as predictors of hepatic steatosis, individually and combined, in a risk assessment model. Classification and regression tree methodology was used to construct a decision tree for predicting hepatic steatosis. Results MR-PDFF revealed hepatic steatosis in 16% of subjects (27% overweight, 3% nonoverweight). Hispanic ethnicity conferred an OR of 4.26 (95% CI, 1.65-11.04; P = .003) for hepatic steatosis. BMI and ALT did not independently predict hepatic steatosis. A BMI >85% combined with ALT >65 U/L had 9% sensitivity, 100% specificity, and 100% PPV. Lowering the ALT value to 24 U/L increased the sensitivity to 68%, but reduced the PPV to 47%. A risk assessment model incorporating fasting insulin, total cholesterol, WC, and ethnicity increased sensitivity to 64%, specificity to 99% and PPV to 93%. Conclusion A risk assessment model can increase specificity, sensitivity, and PPV for identifying the risk of hepatic steatosis and guide the efficient use of biopsy or imaging for early detection and intervention.
    Journal of Pediatrics 05/2014; 165(2). DOI:10.1016/j.jpeds.2014.04.019 · 3.74 Impact Factor
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    ABSTRACT: We have previously reported that a DNA vaccine encoding prostatic acid phosphatase (PAP) could elicit PAP-specific T cells in patients with early recurrent prostate cancer. In the current pilot trial we sought to evaluate whether prolonged immunization with regular booster immunizations, or "personalized" schedules of immunization determined using real-time immune monitoring, could elicit persistent, antigen-specific T cells, and whether treatment was associated with changes in PSA doubling time (PSA DT).
    Clinical Cancer Research 05/2014; 20(14). DOI:10.1158/1078-0432.CCR-14-0169 · 8.19 Impact Factor
  • Journal of Pediatric and Adolescent Gynecology 04/2014; 27(2):e44. DOI:10.1016/j.jpag.2014.01.050 · 1.81 Impact Factor
  • American journal of health-system pharmacy: AJHP: official journal of the American Society of Health-System Pharmacists 03/2014; 71(6):507-10. DOI:10.2146/ajhp130653 · 2.21 Impact Factor
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    ABSTRACT: Alcohol displays on Facebook are ever-present and can be socially desirable for college students. As problematic drinking is a concern for college students, this research sought to understand how different types of information on a Facebook page influence likelihood to drink. Telephone interviews were conducted with 338 incoming college freshmen from two large national universities. Data were obtained from a vignette prompt which presented a scenario in which a senior college student's Facebook profile displayed wall-posts, pictures, and status updates that were drinking-related or pro-social in nature. Participants were asked to report intention to drink alcohol with that student if together at a party. Findings supported the hypotheses: wall-posts were most influential (the stickiest), followed by pictures, followed by status updates. Findings provide additional empirical support for established online impression formation patterns, and additionally provide evidence that virtual cues are being ingrained as schema in interpersonal communication. These results are discussed in relation to the conception of "sticky cues" in impression formation.
    Bulletin of Science Technology &amp Society 02/2014; 34(1-2):13-20. DOI:10.1177/0270467614538002
  • Journal of Pain and Symptom Management 02/2014; 47(2):501-502. DOI:10.1016/j.jpainsymman.2013.12.177 · 2.74 Impact Factor

Publication Stats

3k Citations
584.83 Total Impact Points

Institutions

  • 2014
    • Iowa State University
      Ames, Iowa, United States
  • 2004–2014
    • University of Wisconsin–Madison
      • • Department of Biostatistics and Medical Informatics
      • • Department of Medicine
      Madison, Wisconsin, United States
  • 2009–2013
    • Colorado State University
      • • College of Veterinary Medicine and Biomedical Sciences
      • • Department of Statistics
      Fort Collins, Colorado, United States
  • 2011
    • University of Wisconsin - Stout
      Menominee, Wisconsin, United States
  • 2010
    • The American Board of Family Medicine
      Lexington, Kentucky, United States
    • The Children's Hospital of Philadelphia
      Filadelfia, Pennsylvania, United States
  • 2007
    • Klinikum Ludwigshafen
      Ludwigshafen, Rheinland-Pfalz, Germany