About

Melanie Bell, PhD, MS, is a Professor Emeritus in the Department of Epidemiology and Biostatistics at the Mel and Enid Zuckerman College of Public Health. Her research focus is on methods for handling missing data in intervention and cluster randomized trials, patient reported outcomes, and research methods evaluation. She is engaged in collaborative research in the fields of cancer, tobacco cessation, psycho-oncology, cardiovascular disease prevention, and health inequities. Her past collaborations include research in sexual health, physical activity, and nutrition. Dr. Bell has worked at the University of Sydney with a cancer trials group focusing on quality of life and other patient reported outcomes, where she also taught workshops on designing and analyzing quality of life trials, avoiding statistical errors, and designing intervention studies. Before that, she was a senior lecturer at the University of Otago in Dunedin, New Zealand. She earned her PhD in Biostatistics from the University of Colorado Health Sciences Center in 2002, an MS in Mathematics from Northern Arizona University in 1992, and an AB in Mathematics from Occidental College in Los Angeles in 1990.

Research topics

• Medicine
• Sociology
• Computer Science
• Internal medicine
• Geography
• Environmental health
• Family medicine
• Environmental planning
• Socioeconomics
• Statistics
• Mathematics
• Nursing
• Archaeology
• Data science
• Gerontology
• Pediatrics
• Ecology
• Environmental protection

Selected publications

• Infertility burden among women firefighters: a cross-sectional exploratory analysis

  Occupational and Environmental Medicine · 2025-07-31

  articleOpen access

  OBJECTIVES: Despite biological and environmental plausibility, risk factors for infertility have not yet been studied among female firefighters. In this exploratory analysis, we investigated the burden of infertility among a subset of US firefighters enrolled in the Health and Wellness of Women Firefighters Study. METHODS: Women firefighters enrolled in the study responded to surveys administered in 2017 and 2019, reporting on their work environment, reproductive health, infertility history and fertility treatment history among those with infertility. Demographics and reproductive history of firefighters were compared by reported history of infertility. Log binomial regression models were used to estimate the association between occupational factors and risk of infertility. RESULTS: Of the 562 firefighters in our analysis, 168 of these women (30%) reported a history of infertility. A longer length of employment as a firefighter was associated with a modest, but non-statistically significant, increased relative risk of experiencing infertility (1.39, 95% CI 0.86 to 2.24). CONCLUSIONS: This exploratory analysis highlights an opportunity to further examine infertility and impaired fertility among firefighters. Future studies may focus on comparing the burden of infertility in firefighters to the general population and evaluating the influence of additional occupational factors.

  PublisherOA PDFDOI

• Association of vaccine intention against COVID-19 using the 5C Scale and its constructs: a Pima County, Arizona cross-sectional survey

  PeerJ · 2024-12-06 · 3 citations

  articleOpen access

  Background: Vaccine hesitancy has been ranked as one of the top 10 threats to global health by the World Health Organization. The 5C model (Confidence, Calculation of risk, Complacency, Collective Responsibility, and Constraints) and an accompanying tool to measure vaccine hesitancy, summarize several significant explanatory variables, and move beyond the most common explanatory variable, Confidence. Methods: ., psychological factors that lead to) COVID-19 vaccination using the 5C Scale. Participants were recruited virtually for the survey using multiple recruitment methods. Unadjusted and adjusted hierarchical ordinal logistic regressions were conducted to determine if the 5C variables had an association with intention to vaccinate (or intent to vaccinate) against COVID-19. Results: Of the 1,823 participants who responded to the survey, 924 (76%) were included in the final analyses. Respondents were White (71%), non-Hispanic (59%), Female (68%), Liberal (37%) and Married (46%). The average age of the participants was 43.9 (±1.3) years. Based on the 5C Scale, Confidence (adjOR:3.64, CI [3.08-4.29]), Collective Responsibility (adjOR:1.94, CI [1.57-2.39]) and Complacency (adjOR:0.64, CI [0.51-0.80]) were significantly associated with intention to vaccinate against COVID-19. Conclusion: Three of the five 5C variables were associated with the intention to vaccinate, two positively and one negatively. A limitation of the study was that the sample was not weighted to be representative of Pima County. Future research should focus on determining which interventions can bolster Confidence and Collective Responsibility attitudes in communities, while dampening Complacency, to better promote vaccine uptake.

  PublisherOA PDFDOI

• Racial and Ethnic Underserved Populations Prescription Analgesic Use Before and After Lower Extremity Amputation in US Medicare

  Anesthesia & Analgesia · 2024-07-23

  article

  BACKGROUND: Racial disparities exist in access to health care and management of multiple health conditions including chronic pain; however, racial disparities in pre- and postoperative pain management in lower extremity amputation are not well-studied. Our objective was to examine the association between different racial and ethnic groups and prescription opioid and other analgesics use before and after lower extremity amputation. We hypothesize prescription opioid and other analgesic use among Black, Hispanic, and Native American US Medicare beneficiaries undergoing lower extremity amputations will be lower compared to White US Medicare beneficiaries. METHODS: This retrospective cohort study included a 5% national sample of all Medicare beneficiaries from 2011 to 2015 and 15% national sample of fee-for-service Medicare beneficiaries from 2016 to 2018 undergoing nontraumatic, lower extremity amputations. The exposure of interest was racial and ethnic group membership (ie, Black, Hispanic, Native American, White, and others-with others being the combination of the categories Asian and other) as provided in Medicare claims data. Using multivariable generalized estimating equations with a logistic link to account for repeated measurements over time, we estimated the odds of prescription opioid use within 6 months before and after lower extremity amputation across different racial and ethnic groups separately, adjusting for sociodemographic and health status factors (eg, Elixhauser index). Adjusted odds ratios (aORs) and 95% confidence intervals (95% CI) were reported. RESULTS: Among 16,068 eligible beneficiaries who underwent major and minor amputations (mean age = 65.1 ± 12.7 years; female = 36.1%), 10,107 (62.9%) were White, 3462 (21.5%) were Black, 1959 (12.2%) were Hispanic, 247 (1.5%) were Native American, and 151 (2.9%) were beneficiaries of other races. During the 6 months before lower extremity amputation, Hispanic beneficiaries (aOR, 0.71, 95% CI, 0.65-0.78) and beneficiaries of other races (aOR, 0.60, 95% CI, 0.47-0.76) had significantly lower odds of using prescription opioids compared to White beneficiaries. Similarly, Hispanic beneficiaries (aOR, 0.78, 95% CI, 0.71-0.84) and beneficiaries of other races (aOR, 0.63, 95% CI, 0.51-0.78) were associated with lower odds of opioid use in the 6 months after amputation compared to White beneficiaries. CONCLUSIONS: Among fee-for-service Medicare beneficiaries, Hispanic and other (eg, Asian) fee-for-service Medicare beneficiaries had lower odds of prescription opioid use than their White counterparts before and after nontraumatic, lower extremity amputations. Efforts to determine the underlying reasons are needed to ensure equitable health care access.

  PublisherDOI

• Anxiety, depression, and concentration in cancer survivors: National Health and Nutrition Examination Survey results

  Supportive Care in Cancer · 2023-04-15 · 32 citations

  articleOpen accessSenior author

  PURPOSE: We report on prevalence of anxiety, depression, and concentration difficulties and their associations in survivors of cancer in a nationally representative sample up to 25 years after diagnosis. METHODS: Using the National Health and Nutrition Examination Survey (NHANES) data from 2015 to 2018, participants between the ages of 18 and 79 self-reported on cancer history, symptoms of anxiety, depression, and difficulties with concentration. RESULTS: Of 10,337 participants, 691 (6.7%) reported a previous diagnosis of cancer; the median time since diagnosis was 8 years. Prevalence was similar between those with and without cancer for anxiety (45.8% versus 46.9%) and depression (19.7% versus 20.0%). Concentration difficulties were more common (11.3% versus 9.0%) for those with a history of cancer compared to those without (adjusted OR = 1.38, 95% CI: 1.00-1.90). Prevalence of mental health symptoms was not related to time since diagnosis. Anxiety and depression were highly correlated (r = 0.81, 95% CI: 0.74-0.86) and moderately correlated with difficulty with concentration (r = 0.52, 95%CI: 0.40-0.64 and r = 0.64, 95% CI: 0.53-0.74 respectively). CONCLUSIONS: Difficulty with concentration was more commonly reported by participants with than without a cancer history. Report of anxiety and depression was no different between participants with and without a history of cancer. Anxiety, depression, and difficulties with concentration were strongly related. Further research is needed to explore if there is a causal association, and if so, the direction of these correlations, so that interventions may be appropriately targeted.

  PublisherOA PDFDOI

• Does high family support protect against substance use in adolescents who perceive high disordered neighborhood stress, border community and immigration stress or normalization of drug trafficking at the US-Mexico border? Analysis of the BASUS survey

  Journal of Migration and Health · 2023-01-01 · 4 citations

  articleOpen accessSenior author

  Background: Adolescent substance use is a significant issue which occurs during a critical period of life of youth. Perceived stress is a risk factor for adolescent substance use, and life events such as low family support, and community and familial turmoil often lead to ongoing feelings of stress and uncertainty. Similarly, structural factors such as poverty, local neighborhood disinvestment and disrepair, and exposure to racism and discrimination are linked to feelings of stress. The US-Mexico border region is favorable for drug smuggling. Such a context exacerbates stressful life events during adolescence and increases the risk of adolescent substance use. This study aims to investigate the impact family support has on substance use in adolescents living on either side of the U.S./Mexico border who self-reported high perceptions of disordered neighborhood stress, border community and immigration stress, or normalization of drug trafficking. Methods: This study used data from the cross-sectional BASUS survey. Logistic regression was used to study the association between family support and past 30-day use of alcohol, tobacco, marijuana, and any substance in a sample restricted to students who self-reported high perceptions of disordered neighborhood stress, border community and immigration stress, or normalization of drug trafficking. Results: Participants with low family support were at higher risk of using any substance compared to participants with high family support (aOR= 1.58, 95% CI: 1.02; 2.45). Similar results were found for alcohol (aOR= 1.79, 95% CI: 1.13, 2.83). While the odds of using tobacco were higher for those with low social support as compared to participants with higher social support, this association was not statistically significant (aOR = 1.74, 95% CI: 0.93, 3.27). Conclusion: Prevention programs tailored to the U.S.-Mexico border region should emphasize strengthening family support as a preventive factor against adolescent substance use. Family support should be considered in school counseling assessments, healthcare screenings and other social services.

  PublisherDOI

• Studying full-shift inhalation exposures to volatile organic compounds (VOCs) among Latino workers in very small-sized beauty salons and auto repair shops

  Frontiers in Public Health · 2023-12-01 · 4 citations

  articleOpen access

  Background: One in every 200 US jobs is in a beauty salon or auto repair shop, where workers are regularly exposed to volatile organic compounds (VOCs) that may cause a range of short- and long-term health issues. In these shops, Latino workers are overrepresented and lack culturally and linguistically appropriate industrial hygiene resources. This leaves a gap in knowledge on inhalation exposures to VOCs in this hard-to-reach and ubiquitous worker population. Objective: Our goal was to recruit hard-to-reach, predominantly Spanish-speaking workers in beauty salons and auto repair shops and monitor total VOC inhalation exposures for over entire work shifts, with minimal impact on workers, clients, and business. Methods: We developed and refined measurement and exposure assessment methods for personal and area full-shift VOC inhalation exposures. Results: With minimal participant loss, we measured over 500 h of real-time, personal VOC exposures and recorded activities and other exposure factors for 47 participants, while also documenting chemical inventories and quantifying indoor area concentrations of specific VOCs among 10 auto repair shops and 10 beauty salons. Conclusion: Lessons learned from our study can assist future studies of inhalation exposures in other hard-to-reach occupational populations.

  PublisherOA PDFDOI

• Cooper [married name Alexander], Brigid Winifred Thérèse [Budge] (1913–1983), documentary film-maker

  Oxford Dictionary of National Biography · 2023-09-27

  reference-entry1st authorCorresponding
  PublisherDOI

• Healthcare System Distrust and Non-Prescription Antibiotic Use: A Cross-Sectional Survey of Adult Antibiotic Users

  Antibiotics · 2023-01-01 · 12 citations

  articleOpen access

  Antibiotic resistance is a major public health concern driven by antibiotic overuse. Antibiotic stewardship programs are often limited to clinical settings and do little to address non-prescription antibiotic use in community settings. This study investigates the association between non-prescription antibiotic use and healthcare system distrust in the United States and Mexico. An online survey was deployed in the United States and Mexico with enhanced sampling through in-person recruiting in the border region. Non-prescription antibiotic use was defined as having bought or borrowed non-prescription oral or injectable antibiotics within the last 3 years. The survey included a previously validated 10-item scale to measure healthcare system distrust. Logistic regression was used to model the use of non-prescription antibiotics by the level of healthcare system distrust, adjusted for demographic characteristics and antibiotic knowledge. In total, 568 survey participants were included in the analysis, 48.6% of whom had used non-prescription oral or injectable antibiotics in the last 3 years. In the fully adjusted regression model, the odds of using non-prescription antibiotics were 3.2 (95% CI: 1.8, 6.1) times higher for those in the highest distrust quartile versus the lowest. These findings underscore the importance of community-based antibiotic stewardship and suggest that these programs are particularly critical for communities with high levels of healthcare system distrust.

  PublisherOA PDFDOI

• Association of e-Cigarette Use and Postpartum Depression: Pregnancy Risk Assessment Monitoring System 2016–2019

  Journal of Women s Health · 2023-11-09 · 6 citations

  articleOpen access

  Background: Postpartum depression (PPD) is a prevalent public health concern. Combustible cigarette use is associated with increased risk of PPD. While electronic cigarette (e-cigarette) use during pregnancy is linked to increased risk of depressive symptoms during pregnancy, the relationship between e-cigarette use and PPD is not well understood. We sought to examine the association of e-cigarette use with PPD. Materials and Methods: Using Pregnancy Risk Assessment Monitoring System 2016–2019 data, unadjusted and adjusted logistic regression analyses for PPD were conducted via three analyses where e-cigarette use (any vs. none) was retrospectively self-reported (1) in past 2-year, (2) prepregnancy ( i.e. , 3 months before pregnancy), and (3) during pregnancy ( i.e. , last 3 months of pregnancy). We conducted an additional past 2-year e-cigarette use analysis excluding those who used combustible cigarette and/or hookah. Covariates included age, race, ethnicity, combustible cigarette, and/or hookah use, prenatal care during the last trimester, health insurance coverage during pregnancy, physical abuse during pregnancy, income, and survey type. Results: Only unadjusted odds ratios from past 2-year e-cigarette use (1.63, 95% confidence interval [CI]: 1.42–1.87) and past 2-year e-cigarette use excluding individuals with cigarette and/or hookah use (1.78, 95% CI: 1.30–2.38) were statistically associated with PPD. No adjusted analyses were statistically significant. Conclusion: Any e-cigarette use, as compared to no use, does not appear to be an independent risk factor of PPD, though it may be a useful clinical marker of increased risk of PPD. Future studies are warranted to advance our knowledge of impact of e-cigarette use on PPD.

  PublisherOA PDFDOI

• Comorbidities and perceived health status in persons with history of cancer in the US

  Research Square · 2022-05-09

  preprintOpen access

  Abstract Purpose: Comorbidities can further challenge prognosis and general wellbeing of cancer patients. This study aimed to assess the association between comorbidities and perceived health status (PHS) of United States persons with cancer. Methods: This retrospective study used 2019 Medical Expenditure Panel Survey (MEPS) data and included individuals who were alive throughout the year, aged 18 to 84 years, and had diagnosis for cancer. Using adjusted logistic regression models, we estimated the association of comorbidities (no, few[1/2], and more[3 or more] comorbidities) with PHS. Analyses accounted for the complex design of MEPS. Results: The dataset included 28,512 participants, 1,739 of which were eligible for the study. Of these, 11.16%(95%CI 9.64,12.59%); 41.73%(95%CI 39.21,43.96%) and 47.10%(95%CI 44.86,49.73%) reported having no, few, and more comorbidities, respectively. While breast(N = 356), prostate(N = 276) and melanoma(N = 273) were the most common cancers, hypertension(88.3%), hypercholesterolemia(49.5%) and arthritis(48%) were the most prevalent comorbidities. Adjusted logistic regression showed that, compared with those with no comorbidities, persons with few, and more comorbidities had 1.58(95%CI = 0.79,3.15) and 2.27(95%CI = 1.19,4.32) times greater odds of poor PHS. Younger or male patients, those with less formal education, low-income, pain, functional limitation or poor perception of mental health were more likely to regard their health as poor. Conclusion: About 88% of persons with history of cancer in US 18–84 years reported at least one comorbidity. Having more comorbidities, along with several other variables, was associated with poor PHS. Comorbidities management must be given special consideration to improve the prognosis and general wellbeing of persons with cancer.

  PublisherOA PDFDOI

Frequent coauthors

• Phyllis Butow

  University of Sydney

  63 shared

• Janette Vardy

  National Cancer Centre Japan

  44 shared

• Ming Sze

  30 shared

• David Goldstein

  Office of the Assistant Secretary for Health

  29 shared

• Madeleine King

  University of Sydney

  26 shared

• Lynley Aldridge

  Evolved Analytics (United States)

  24 shared

• Maurice Eisenbruch

  Australian Regenerative Medicine Institute

  22 shared

• Skye Dong

  Melanoma Institute Australia

  20 shared

Education

• PhD

  University of Colorado Denver

  2002

• MS, mathematics

  Northern Arizona University

  1990

• BA, mathematics

  Occidental College

  1988

Awards & honors

• Dean's Fund for Excellence
• Alumni Giving Circle
• 25th Anniversary Gala Sponsorship Opportunities
• Dean's Annual Fund Application
• Dean's Students Research Funds