Faculty Bibliography

INTRODUCTION/UNASSIGNED:Associations between unhealthy food environments and increased risk of diabetes or obesity have been studied extensively in urban areas but less so in rural areas. To address this gap, we performed a geographically detailed study of the rural food environment, summarizing and assessing various measures and identifying their association with a higher rate of diabetes and obesity. METHODS/UNASSIGNED:We surveyed 1,311 residents of Sullivan County, New York, collecting data on demographic characteristics and health status in January 2021. We assessed the food environment by cataloging restaurants and retail food stores and used least absolute shrinkage and selection operator (LASSO) regression to identify metrics strongly associated with diabetes and obesity (body mass index >30.0). We compared absolute proximity, density, relative proportions, and modified retail food environment index metrics. We applied fixed distance bands and nearest-neighbor approaches for proportions. RESULTS/UNASSIGNED:Older age (LASSO = +0.276), nearest-neighbor proportion of fast food restaurants (LASSO = +0.155), and low income (LASSO = +0.150) were associated with higher diabetes rates. Nearest-neighbor proportion (LASSO = +0.269), density per square mile of groceries/supermarkets (LASSO = +0.247), and Hispanic ethnicity (LASSO = +0.181) were the strongest predictors of obesity. Nearest-neighbor metrics helped with the problem of frequent zeros: the least skewed measures were fast food restaurants with 20 nearest neighbors (P = .37 for skewness) and counter-service restaurants with 20 nearest neighbors (P = .81). CONCLUSION/UNASSIGNED:Nearest-neighbor approaches were less skewed to other metrics based on fixed distance bands, proximity, and density. Food environment metrics must be fully described and validated, especially in rural environments, before they are applied in research on critical health outcomes.

INTRODUCTION/UNASSIGNED:For the public to adopt health promoting behaviors widely, there has to be sufficient trust in the institutions that disseminate information on protective behaviors. However, when members of the public lose trust in formal information sources, many seek information from informal information sources. Identifying trusted informal messengers is key to restore trust and effectively promote public health. METHODS/UNASSIGNED:We conducted repeat surveys with young adults and older adults living in New York City public housing to assess who they consider a trusted source of COVID-19 information, as well as their protective behavior practices across a period of five weeks. We then examined the association between trusted sources and participant behavior. RESULTS/UNASSIGNED:Participants in both age groups showed the highest trust in doctors or healthcare providers. Associations with protective behavior existed across multiple information sources, but strongest associations for both age groups were seen in relation to trusting one's faith leader for information. DISCUSSION/UNASSIGNED:Although other sources of information were more frequently cited as trustworthy by participants, trust in one's faith leader was the strongest predictor of protective behavior practices.

Long-acting injectable cabotegravir (LAI-CAB) is a novel HIV pre-exposure prophylaxis (PrEP) modality found to significantly lower HIV risk in key populations. EquiPrEP was an observational implementation science study to examine multilevel barriers and facilitators to LAI-CAB implementation among Black and/or Latine MSM, Black and/or Latine cisgender women, and transgender and nonbinary persons. This study took place at the Pride Health Center (PHC) at NYC Health+Hospitals (H+H)/Bellevue in New York City (February 2023-February 2025). Sociodemographic and health related social needs screening data were collected from EquiPrEP participants via a survey. We conducted in-depth interviews with study participants (N=26) and implementers (N=25) guided by The Consolidated Framework for Implementation Research 2.0. Descriptive statistics were used to assess sociodemographics for all EquiPrEP participants versus those recruited for in-depth interviews. Qualitative data was analyzed using thematic content analysis. Comparing all EquiPrEP participants (N=129) with the subgroup (N=26), the subgroup was older, with more Black cisgender MSM, and transgender women, a higher percentage ever on oral PrEP, and referred from an external clinic. Facilitators included open communication among staff, a patient-centered culture of care delivery and the EquiPrEP Navigator. Barriers included distance to clinical services, financial issues and insurance access. EquiPrEP is one of the first LAI-CAB implementation studies for HIV prevention to center equitable access for communities with the highest burden of HIV and elucidate implementation determinants to LAI-CAB. Findings may inform future implementation strategies seeking to incorporate equity as part of LAI-PrEP care.

BACKGROUND:Medication non-adherence contributes to the efficacy-effectiveness gap in real-world practice. Glucosuria, routinely measured on urinalysis, may serve as an objective proxy for assessing medication adherence to sodium-glucose cotransporter 2 (SGLT2) inhibitors, a class of medications that reduce the risks of kidney disease, heart failure, and mortality. METHODS:We leveraged two cohorts from the Optum Labs Data Warehouse real-world data (2014-2023): Cohort 1 included 3,987 patients with SGLT2 inhibitor pharmacy claims and a urinalysis performed both before and during active fill periods; cohort 2 included 45,711 patients prescribed SGLT2 inhibitors with urinalysis performed within 6 months after initiation. Glucosuria was defined as urine glucose 2+ or greater. Cohort 2 was followed for a mean of 3.3 years for all-cause mortality, heart failure hospitalization, end-stage kidney disease; fractures were used as a negative control outcome. RESULTS:In cohort 1, SGLT2 inhibitor use (vs. no use) was associated with 18.1-fold higher odds of glucosuria (95% CI, 16.4-20.0), adjusted for diabetes status. In cohort 2, 26,657 (58%) had glucosuria within 6 months of SGLT2 inhibitor initiation, suggesting adherence. After inverse probability of treatment weighting, glucosuria was associated with lower risks of all-cause mortality (HR, 0.78; 95% CI, 0.73-0.83), heart failure hospitalization (HR, 0.87; 95% CI, 0.78-0.98), and end-stage kidney disease (HR, 0.73; 95% CI, 0.58-0.91) compared to no glucosuria. No association was observed with fractures (HR, 1.00; 95% CI, 0.95-1.06). CONCLUSIONS:Glucosuria was associated with SGLT2 inhibitor adherence and, among patients prescribed SGLT2 inhibitors, is associated with reductions in risks of all-cause mortality, heart failure, and end-stage kidney disease.

BACKGROUND:The early stage of bipolar I disorder is considered a crucial period for improving long-term outcomes, yet evidence guiding treatment selection after a first manic episode is scarce. Using data from the BD-CAUSAL Collaboration, we aimed to emulate a pragmatic target trial among individuals aged 16 years or older presenting with a first manic episode with psychotic features. METHODS:For the target trial, individuals were eligible if they were aged 16 years or older, treated at a first-episode psychosis clinic with a diagnosis of bipolar I disorder between Jan 1, 2006, and Dec 31, 2021, with a manic episode (with or without mixed features) with psychotic symptoms based on DSM-5 criteria; not currently hospitalised; had no previous use of mood stabilisers or second-generation antipsychotics in the past 3 months; and had no history of severe side-effects. Treatment strategies compared were initiating mood stabiliser monotherapy, second-generation antipsychotic monotherapy, or combination therapy. Individuals are followed up for up to 2 years. We emulated the target trial using the BD-CAUSAL Collaboration database that includes participants from North America, Chile, and Spain, and is a subset of a large consortium of observational cohorts. Information on mood stabilisers and antipsychotic prescription was identified via data linkages with outpatient and hospitalisation databases. We assessed eligibility for each person-visit between Jan, 1, 2006, and Dec, 31, 2021, and assigned individuals to the treatment strategy that was compatible with their data. The main outcome was hospitalisation or an emergency department visit due to any psychiatry reason over 2 years. Intention-to-treat and per-protocol effects were estimated using pooled logistic regression adjusted for baseline and time-varying confounders. People with lived experience were not involved in the study design, analysis, or interpretation of findings. FINDINGS/RESULTS:Among 371 eligible individuals with bipolar I disorder (465 eligible treatment initiations), 141 (38%) were female, 230 (62%) were male, 216 (58%) were White, 155 (42%) were not White, and the median age was 22 years (IQR 19-25). Of 371 patients, 155 (42%) were hospitalised due to psychiatric reasons over a median of 19·8 months (IQR 16·1-24·0). The 2-year hospitalisation or emergency department visit risk was 42·3% (95% CI 32·5 to 61·1) for mood stabiliser monotherapy, 49·5% (42·4 to 60·6) for second-generation antipsychotic monotherapy, and 42·2% (33·3 to 52·5) for combination therapy. Compared with second-generation antipsychotic monotherapy, the risk was lower with mood stabiliser monotherapy (risk difference -7·3% [95% CI -15·8 to -1·4]; risk ratio 0·82 [0·63 to 0·97]) and combination therapy (-7·4% [-16·0 to -2·1]; 0·82 [0·63 to 0·91]). Risks were similar between mood stabiliser monotherapy and combination therapy. INTERPRETATION/CONCLUSIONS:Mood stabiliser-based strategies, alone or in combination, had a lower relapse risk than second-generation antipsychotic monotherapy in the continuation and maintenance treatment after a first episode of mania with psychotic symptoms. These findings would support prioritising mood stabilisers in early treatment and highlight the need for randomised trials for confirmation. FUNDING/BACKGROUND:ASISA and National Institute of Mental Health.

OBJECTIVES/UNASSIGNED:To develop and evaluate the Community Research Consulting Initiative (CRCI), a no-cost, student-led model designed to build bidirectional capacity between academic institutions and community-based organizations (CBOs) through research consulting and project-based assistance. STUDY DESIGN/UNASSIGNED:This formative program evaluation examined the feasibility, acceptability, and preliminary outcomes of CRCI, which includes virtual Office Hours for short-term research consultation and Project-Based Assistance (PBA) for longer-term collaborations. The goal was to support CBOs with technical research needs while providing academic trainees with real-world experience. METHODS/UNASSIGNED:Academic consultants (students, staff, faculty) were recruited through institutional listservs and outreach and completed an intake form outlining their expertise and learning goals. CBOs were engaged through Community Advisory Boards, faculty referrals, and existing networks. Consultants provided support via Zoom-based Office Hours and were matched with CBOs for PBA through a memorandum of understanding. Data collection included Zoom registration logs, post-session surveys, and follow-up communications. Quantitative data were analyzed descriptively, and qualitative feedback was reviewed thematically to inform implementation improvements. RESULTS/UNASSIGNED:Thirty-three consultants expressed interest; 21 participated in Office Hours or PBA projects, representing a range of NYU departments. Consultants sought practical experience applying academic skills in community settings. Fifty-one unique CBOs registered for 90 Office Hours slots, primarily serving racial/ethnic minority and at-risk populations in New York City. Grant writing and data analysis were the most frequently requested topics. Among 20 completed surveys, 95% of CBO respondents found sessions useful and relevant, citing take-home resources as especially beneficial. Six CBOs engaged in PBA projects involving survey design, data analysis, and program evaluation. Consultants appreciated the learning opportunity but highlighted challenges related to attendance, preparation time, and expectation setting. CONCLUSION/UNASSIGNED:CRCI demonstrates a feasible and replicable model for advancing equitable academic-community partnerships aligned with NIH priorities. The initiative supports community capacity building while fostering practical training for future leaders in community-engaged research. Broader implementation of CRCI-like models may enhance the sustainability and impact of academic-community collaborations.

Aside from specific occupational exposures, ingestion is believed to be the primary route of exposure to PFAS, a class of forever chemicals known for their ability to repel oil and water, reduce friction, and resist high temperatures. The goal was to explore the geographic distribution of PFAS water contamination versus human exposure and identify dietary factors that may explain high PFAS levels among rural residents. We performed PFAS analyses among 160 rural participants, who provided blood samples and survey responses in our chemical exposure cross-sectional study. We mapped the geographic distribution of PFAS contamination based on water testing versus human samples results. We also used health surveys and food frequency questionnaire data to identify factors associated with high PFAS levels. The geographic mismatch between the distribution of PFAS water contamination and human exposure highlights the need to assess other potential sources, which identified potential dietary sources of these chemical hazards.

INTRODUCTION/BACKGROUND:with dysglycemia, it remains unknown if reducing air pollution exposure through air filtration can affect improvements in glucose. This study aims to test the hypothesis that short-term, in-home air pollution reduction using high efficiency particulate air (HEPA) filtration will improve blood sugar in adults with prediabetes. METHODS AND ANALYSIS/METHODS:as the independent variable. ETHICS AND DISSEMINATION/BACKGROUND:This study has undergone peer review; and the work was supported by Grant 2023-0214 from the Doris Duke Foundation, who had no other role in study design or implementation. The study was registered in ClinicalTrials.gov (NCT05994937) prior to recruitment.

BACKGROUND:Environmental epidemiology studies increasingly integrate "big" geospatial and health data sets to examine associations between environmental factors and health outcomes. Using such data sets ─ and linking between them ─ presents a number of complexities with regard to study design and analytic approaches. These complexities are often magnified with the integration of additional contextual data representing other neighborhood characteristics including socioeconomic factors. Guidance regarding the design of environmental health studies that leverage "big" geospatial and health outcome data is limited and fragmented. OBJECTIVE:Drawing on methodological literature and case studies, this commentary outlines common challenges related to geospatial and health data linkages, posing a series of guiding questions and considerations for investigators conducting environmental health studies, particularly analyses with an etiological focus. DISCUSSION:Recommendations include: 1) using a target trial approach to guide causal analysis, 2) aligning measures with hypothesized causal mechanisms, 3) exploring opportunities to "groundtruth" and validate data, and 4) prioritizing interdisciplinary science. The goal of the commentary is to consolidate insights from multiple disciplines ─ including exposure science, epidemiology, and sociology ─ to provide a foundation for etiologic research focused on advancing environmental health for all populations.

The social environment refers to our interpersonal relations, workplaces, and neighborhoods, towns, or cities in which we live. A growing literature indicates that social environments are related to cognitive aging and risk of Alzheimer's disease and related dementias (AD/ADRD). Still, relatively little is known about how social-environmental exposures affect cognitive function over the life course and into older ages. Addressing this limitation, our paper outlines key features of the social environment and recommends priority areas of research on the social environment and cognitive aging. We divide our discussion into three subdomains: social connections, residential context, and work context. We then identify important gaps in the conceptual and empirical literature before outlining avenues for future research to strengthen our understanding of how social-environmental exposures over the life course link with cognitive function and AD/ADRD risk in late life.