Faculty Bibliography

INTRODUCTION/BACKGROUND:Identifying strategies to mitigate the effects of secondhand smoke exposure is crucial for public health. Thus, we estimated the effect of a 2018 federal smoke-free housing (SFH) policy on adverse birth outcomes among New York City (NYC) public-housing residents. METHODS:We obtained data on all live births to NYC residents in NYC from 2013 to 2022, using the borough-block-lot of the birthing person's address to identify births to public-housing residents. We then estimated the effect of the SFH policy on risk of preterm birth or low birth weight among births to NYC public-housing residents using a linear-probability difference-in-differences estimator, weighted by inverse probability weights to increase the plausibility of the parallel-trends assumption. RESULTS:Our sample included 44 455 births to public-housing residents and 803 648 births to non-public-housing residents. Difference-in-difference analyses suggested the SFH policy did not affect risk of preterm birth (risk difference (RD) per 100: 0.1; 95% CI -0.6 to 0.9) or low birth weight (RD per 100: 0.3, 95% CI -0.4 to 1.0). Event-study analyses supported these findings and lent credibility to the parallel-trends assumption. CONCLUSIONS:We estimated no initial effects of a federal SFH policy on risk of preterm birth or low birth weight among births to NYC public-housing residents.

OBJECTIVES/OBJECTIVE:Rural residents face unique challenges that contribute to poor diet quality and health. The objective of this study was to assess diet quality using the Alternative Healthy Eating Index (aHEI) among residents of a rural New York county with poor health outcomes, and identify geographic and individual-level factors associated with lower diet quality. DESIGN/METHODS:We performed a cross-sectional study using survey data and multivariable linear regression analyses, supplemented by geographic distribution assessment of aHEI scores. SETTING/METHODS:Sullivan County, New York, a rural county with poor health outcomes. PARTICIPANTS/METHODS:Households in Sullivan County who responded to a dietary and sociodemographic health survey in 2021-2022. OUTCOME MEASURES/METHODS:The primary outcome was the aHEI score and its dietary subscores. Secondary measures included sociodemographic characteristics, receipt of income assistance, financial hardship, food and housing insecurity, primary food store type, distance to food store and frequency of canned or plastic-wrapped food consumption. RESULTS:The overall survey response rate was 42.5%. The mean aHEI score was 56.5 (SD: 11.9), normally distributed across respondents. Lower aHEI scores were associated with not completing high school (10.0 points lower vs college graduates, p<0.01), reporting a disability (3.5 points lower, p<0.01), experiencing food insecurity (3.0 points lower, p<0.01) and frequent consumption of canned foods (6.2 points lower compared with those who never consumed canned foods, p<0.01). Geographic analysis revealed clustering of predictors but no substantial geographic clustering of aHEI scores. CONCLUSIONS:Poor diet quality in rural areas is associated with education level, disability, food insecurity and canned food consumption. These findings highlight potentially modifiable risk factors and support the need for targeted interventions to improve diet quality and reduce health disparities in rural populations.

BACKGROUND:Quality parks have the potential to promote well-being and health equity in urban communities through reduced stress, yet high-quality epidemiological evidence is limited. This quasi-experimental study measured associations between park renovation and changes in perceived stress among low-income adults in New York City. METHODS:Pre- and post-renovation data on the Perceived Stress Scale and park use from 162 adults living near (< 0.3 miles) 31 renovated parks and 151 adults living near 21 sociodemographically matched control parks were analyzed. Linear mixed-effects difference-in-difference (DID) regression measured the association between park renovation and change in perceived stress (post-pre) in the overall sample and stratified by baseline sociodemographics. Additional models explored the interaction of post-renovation park use frequency [high (≥ once/week), low (< once/week)] and intervention status on changes in perceived stress. RESULTS:Overall, changes in perceived stress were similar between intervention and control groups [DID = 0.28 (95% CI -1.48, 2.03)]. However, park renovation was associated with a significant decrease in perceived stress among divorced/separated/widowed participants [DID = -4.22 (95% CI -7.92, -0.53)] and middle-aged participants (35-49y) with high park use [DID = -4.46 (95% CI -8.28, -0.64)]. Among intervention but not control participants, those with high park use experienced a significantly larger decrease in perceived stress compared to those with low park use [DID = -2.92 (95% CI -5.36, -0.47)]. CONCLUSIONS:In one of the first and largest studies on park quality improvement and mental health, park renovation near one's home was associated with decreased perceived stress among divorced/separated/widowed adults and middle-aged frequent park users. Frequent users of renovated parks experienced a larger drop in perceived stress than infrequent users, suggesting that high-quality parks may be an important pre-condition to the benefits of frequent park use on stress reduction.

BACKGROUND:Incidence estimates of post-acute sequelae of SARS-CoV-2 infection, also known as long-COVID, have varied across studies and changed over time. We estimated long-COVID incidence among adult and pediatric populations in three nationwide research networks of electronic health records (EHR) participating in the RECOVER Initiative using different classification algorithms (computable phenotypes). METHODS:This EHR-based retrospective cohort study included adult and pediatric patients with documented acute SARS-CoV-2 infection and two control groups-- contemporary COVID-19 negative and historical patients (2019). We examined the proportion of individuals identified as having symptoms or conditions consistent with probable long-COVID within 30-180 days after COVID-19 infection (incidence proportion). Each network (the National COVID Cohort Collaborative (N3C), National Patient-Centered Clinical Research Network (PCORnet), and PEDSnet) implemented its own long-COVID definition. We introduced a harmonized definition for adults in a supplementary analysis. RESULTS:Overall, 4% of children and 10-26% of adults developed long-COVID, depending on computable phenotype used. Excess incidence among SARS-CoV-2 patients was 1.5% in children and ranged from 5-6% among adults, representing a lower-bound incidence estimation based on our control groups. Temporal patterns were consistent across networks, with peaks associated with introduction of new viral variants. CONCLUSION/CONCLUSIONS:Our findings indicate that preventing and mitigating long-COVID remains a public health priority. Examining temporal patterns and risk factors of long-COVID incidence informs our understanding of etiology and can improve prevention and management.

BackgroundCommunity health workers (CHW) can perform unique functions to facilitate the implementation of evidence-based interventions for infection-related cancer prevention and control, and alleviate minoritized and immigration-related disparities.PurposeWe describe the implementation evaluation of three CHW-delivered infection-related cancer programs focused on Asian American (AA) communities in New York City: 1) a H. pylori treatment adherence program for Chinese and Korean Americans; 2) a HPV screening program for Muslim Americans; and 3) a hepatitis B screening, linkage to care, and treatment program for AA and other priority communities.MethodsWe conducted semi-structured key informant interviews with multi-level stakeholders from the programs.ResultsLessons learned include the importance of: 1) sustaining engagement and buy-in from implementation partners; 2) prioritizing recipient- and deliverer-centeredness; 3) fostering program flexibility to accommodate multiple implementation settings and to meet dynamic community resources and priorities; and 4) understanding interoperability between the CHW-delivered intervention and the inner setting for effective program implementation.ConclusionsThese findings can inform other efforts to implement CHW-delivered community-clinical cancer programs for AA and other underserved communities to advance health equity.

Urban parks may promote health through physical activity, stress management, and social connectedness. However, poor-quality parks in disrepair are underutilized, limiting these benefits. This study evaluated the impact of a citywide park renovation program known as the Community Parks Initiative (CPI) on changes in park use patterns and park satisfaction among residents living in low-income New York City neighborhoods. Repeated cross-sectional surveys were administered to residents living near 31 parks undergoing CPI renovations (545 pre-renovation and 201 post-renovation respondents) and near 21 parks in socio-demographically matched control neighborhoods (345 pre-renovation and 129 post-renovation respondents). Surveys measured self-reported past-month park visits, typical park visit duration, and satisfaction with park quality and facilities. Using a difference-in-differences (DID) approach, generalized estimating equations were fit to compare changes over time in park use and satisfaction among residents living near parks receiving renovations compared to those living near control parks. Models were adjusted for age, body mass index, income, public housing, marital status, and children in household. Residents in neighborhoods receiving park renovations reported a larger increase in minutes spent at the park on weekdays [DID = 30.0 min (95% CI 10.3, 49.7)] and total minutes spent at the park in the last 30 days [DID = 466.3 min (95% CI 63.0, 869.6)] compared to controls. Residents of renovated park neighborhoods also reported larger increases in park satisfaction relative to residents of control neighborhoods, with the largest improvements in the percent of residents satisfied with overall park quality [DID = 38.4% (95% CI 25.2, 51.6)] and maintenance of grounds and facilities [DID = 40.9% (95% CI 27.7, 54.1)]. This study provides evidence that park renovations are an important urban planning strategy to support community health through increased park use and improved park perceptions.

BACKGROUND/UNASSIGNED:Environmental epidemiology studies increasingly integrate "big" geospatial and health datasets to examine associations between environmental factors and health outcomes. Using such datasets - 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/UNASSIGNED: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/UNASSIGNED: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. https://doi.org/10.1289/EHP15756.

BACKGROUND:We conducted a cost analysis of implementing a randomized controlled trial that proved the effectiveness of a community health worker (CHW) facilitated weight loss intervention among South Asian patients with prediabetes receiving care at primary care practices in New York City. South Asians have a high prevalence of diabetes, but no study to date has evaluated the cost of implementing an evidence-based lifestyle intervention in this population. Cost estimates are necessary for an intervention's adoption and scale-up. METHODS:The first wave of the intervention was implemented in-person, followed by two waves implemented remotely during the COVID-19 pandemic. We estimated the implementation, intervention, and adaptation costs and the costs by each wave of implementation, by applying the Gold et al.'s economic framework and ERIC discrete implementation strategy compilation Costs were calculated from the perspective of a health care payer, public health agency, or health care system. The CHW intervention included group education sessions over six months. For each wave, we separately estimated the total cost, cost per practice, and cost when implemented at only one practice. Using the Bureau of Labor Statistics salary estimates, we calculated the national average (mean salary) and lower (25th percentile salary) and upper (75th percentile salary) bounds. RESULTS:The average total 6-month implementation costs over 3 waves, each targeting seven practices was $215,420 (range: $158,620-$257,020). Program staff salaries comprised > 93% of total costs. Adaptation cost was nearly 1/3 of start-up costs. On average, implementation at one practice would cost twice as much as the per-practice costs when implemented simultaneously at seven practices in a wave, due to spread of start-up costs across multiple sites. CONCLUSIONS:Staff salaries comprise most of the budget to implement such an intervention. It is most efficient for an agency to implement this intervention across several practices simultaneously. Decision-makers will need to evaluate relative costs and effectiveness of other options to achieve weight loss in a minority community with constrained resources. CLINICALTRIALS:GOV: This study was registered on June 15, 2017 at  https://www. CLINICALTRIALS:gov as NCT03188094. https://clinicaltrials.gov/ct2/show/NCT03188094 .

OBJECTIVE:The Diabetes in Children, Adolescents, and Young Adults (DiCAYA) network seeks to create a nationwide electronic health record (EHR)-based diabetes surveillance system. This study aimed to develop a DiCAYA-wide EHR-based computable phenotype (CP) to identify prevalent cases of diabetes. RESEARCH DESIGN AND METHODS/METHODS:We conducted network-wide chart reviews of 2,134 youth (aged <18 years) and 2,466 young adults (aged 18 to <45 years) among people with possible diabetes. Within this population, we compared the performance of three alternative CPs, using diabetes diagnoses determined by chart review as the gold standard. CPs were evaluated based on their accuracy in identifying diabetes and its subtype. RESULTS:The final DiCAYA CP requires at least one diabetes diagnosis code from clinical encounters. Subsequently, diabetes type classification was based on the ratio of type 1 diabetes (T1D) or type 2 diabetes (T2D) diagnosis codes in the EHR. For both youth and young adults, the sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) in finding diabetes cases were >90%, except for the specificity and NPV in young adults, which were slightly lower at 83.8% and 80.6%, respectively. The final DiCAYA CP achieved >90% sensitivity, specificity, PPV, and NPV in classifying T1D, and demonstrated lower but robust performance in identifying T2D, consistently maintaining >80% across metrics. CONCLUSIONS:The DiCAYA CP effectively identifies overall diabetes and T1D in youth and young adults, though T2D misclassification in youth highlights areas for refinement. The simplicity of the DiCAYA CP enables broad deployment across diverse EHR systems for diabetes surveillance.