Faculty Bibliography

BACKGROUND/UNASSIGNED:Prediabetes is common in the United States, and adverse social determinants of health (SDOH) are known to undermine diabetes prevention efforts. Chinese Americans experience a disproportionately high prevalence of prediabetes, yet the SDOH profiles of this population remain understudied. OBJECTIVE/UNASSIGNED:This study assessed SDOH among Chinese Americans at risk for diabetes and examined the associations between sociodemographic characteristics and SDOH barriers. METHODS/UNASSIGNED:We conducted a cross-sectional analysis of baseline survey data from the Integrating Cultural Aspects into Diabetes Education (INCLUDE) study, a randomized controlled trial of a culturally and linguistically tailored mobile diabetes prevention intervention for Chinese Americans. Participants at risk for diabetes were enrolled between April 2023 and June 2024 in New York City (N=150). Measures included in the analyses were a 14-item SDOH scale (range 0-14, with higher scores indicating more barriers) and sociodemographic characteristics. Due to the small frequencies of high SDOH scores, we collapsed the outcome into 5 categories (0, 1, 2, 3, and 4-14) to improve model stability. We first used univariable logistic regression models to examine associations between each sociodemographic factor (age, sex, years of US residence, English proficiency, education, marital status, employment status, and annual household income) and the collapsed SDOH category, followed by a multivariable ordinal regression model including all sociodemographic variables. RESULTS/UNASSIGNED:A total of 150 participants had a mean age of 49.9 (SD 12.6) years. Most were female (n=124, 82.7%), born outside the United States (n=149, 99.3%), and reported speaking English less than very well (n=132, 88.0%). Among respondents to the SDOH items (n=149), the mean SDOH score was 2.4 (SD 2.3), and 81.9% (n=122) reported at least 1 SDOH barrier. The three most frequently reported barriers were (1) the need to improve English proficiency, reading skills, or educational attainment (n=77, 51.7%); (2) experiences of racial discrimination (n=49, 32.9%); and (3) adverse housing conditions (n=38, 25.5%). After collapsing the original SDOH score, 27 (18.2%) participants had a score of 0, 39 (26.2%) had a score of 1, 23 (15.4%) had a score of 2, 27 (18.2%) had a score of 3, and 33 (22.1%) had scores of 4 to 14. In the multivariable analysis, female sex (vs male) was associated with higher SDOH score categories (odds ratio 3.83, 95% CI 1.65-9.16; P=.002). CONCLUSIONS/UNASSIGNED:SDOH-related barriers were prevalent among Chinese Americans at risk for diabetes. Diabetes prevention efforts should incorporate routine SDOH screening and structured resource navigation or referral pathways, with particular attention to subgroups at higher risk, such as female individuals.

BACKGROUND/UNASSIGNED:It remains unclear whether individuals living in more walkable neighborhoods spend less time engaging in domain-specific sedentary behaviors, which vary by certain groups. Therefore, this study aimed to examine the associations between neighborhood walkability and total and domain-specific sedentary behavior, and to explore how this relationship varied by sociodemographic factors. METHODS/UNASSIGNED:Participants from AmeriSpeak who completed up to two activities completed over time in 24-hours in 2019 were included. Sedentary behavior outcomes (hours/day) included: (1) total sedentary behavior and (2) domain-specific sedentary behaviors (leisure, work, household, transport, personal, and other sedentary activities). Neighborhood walkability index was classified into four groups (least walkable [referent], below average, above average, and most walkable). Weighted generalized linear regression models were used to examine the associations, adjusting for covariates. Subsequently, such associations were stratified by sociodemographic factors. RESULTS/UNASSIGNED:Compared with the least walkable neighborhoods, below average, above average, and most walkable neighborhoods were positively associated with longer total sedentary behavior time (β = 0.53, 95% confidence interval [CI] = 0.06, 1.01; β = 0.78, 95% CI = 0.29, 1.27; and β = 1.40, 95% CI = 0.75, 2.05, respectively). For domain-specific sedentary behavior, neighborhoods with below average, above average, and most walkable neighborhoods were positively related to work sedentary behavior. However, neighborhood walkability was not related to other domain-specific sedentary behaviors. Lastly, adults aged 20-39 living in more walkable neighborhoods spent longer total sedentary behavior and work-related sedentary behavior. CONCLUSION/UNASSIGNED:Residents living in highly walkable neighborhoods engaged in more total sedentary behavior and work-related sedentary time. Future research should explore how neighborhood environments collectively influence sedentary behavior.

BACKGROUND:Chinese immigrants face numerous social determinants of health (SDOH) challenges that limit access to evidence-based diabetes self-management education and support programs (DSMES). To address these challenges, our team developed the LINK-IT intervention. This manuscript presents the study protocol for the LINK-IT trial. METHODS:The LINK-IT trial is a 12-month, 3-arm randomized controlled trial aiming to enroll 405 Chinese immigrants with T2D (HbA1c≥7%) from multiple community and clinical settings in New York City. A total of 405 participants will be randomly allocated to one of three groups (n = 135 per group): (1) video-based DSMES plus community health worker (CHW) support (VIDEO+CHW), (2) video-based DSMES only (VIDEO), or (3) wait-list control (CONTROL). The VIDEO+CHW group will receive 24 culturally and linguistically tailored DSMES videos (one per week for 24 weeks) delivered via text message links, along with biweekly (every other week) phone calls from trained CHWs to review video content, support goal setting, and address SDOH barriers. The VIDEO group will receive the same video intervention without CHW support. The CONTROL group will receive usual care and will be offered access to the videos upon study completion. The primary outcome is the change in HbA1c at 6 months. Secondary outcomes include changes in HbA1c at 12 months, self-efficacy for diabetes, dietary intake, physical activity, medication adherence and emotional support at 6 and 12 months. Data will be analyzed using an intention-to-treat approach with linear mixed-effects models. ETHICS AND DISSEMINATION/BACKGROUND:This study protocol has been approved by the Institutional Review Board of the NYU Grossman School of Medicine (S23-01274). All study procedures will adhere to the ethical principles outlined in the Declaration of Helsinki. Written or verbal informed consent will be obtained from all participants. Study results will be disseminated through peer-reviewed publications, presentations at scientific conferences, and community events. TRIAL REGISTRATION/BACKGROUND:The LINK-IT trial was registered on March 20, 2024, on ClinicalTrials.gov under the identifier NCT06319716; https://clinicaltrials.gov/study/NCT06319716.

BACKGROUND:Dietary self-monitoring is central to effective personalized nutrition, providing critical data to inform tailored feedback and support behavior change. OBJECTIVE:To examine the impact of dietary self-monitoring adherence and the indirect effect of personalized scores to predict postprandial glycemic response (PPGR) on weight loss. METHODS:Post-hoc analysis of the Personal Diet Study that investigated the impact of a machine algorithm-based diet that integrates clinical and microbiome features (Personalized) compared to a standard, low-fat diet (Standardized) on weight loss. All participants received behavioral counseling and were encouraged to self-monitor dietary intake via a smartphone app. Personalized received algorithm-based scores (1 to 5) on predicted PPGR to foods logged (PPGR score; 1-2 indicating optimal; 3-5 suboptimal). Dietary self-monitoring adherence was the percentage of days logging ≥50% of target calories, classified as high or low. PPGR score quality was calculated by the proportion of optimal predicted PPGR scores per day; defined as "high-PPGR quality" days when this exceeded the group average. Mediation analysis assessed whether PPGR quality mediated the relationship between dietary self-monitoring adherence and weight loss. RESULTS:Participants with high self-monitoring adherence lost an average of 4.2% of their baseline weight, compared to 1.9% among those with low adherence (p=0.016). High self-monitoring adherence was associated with a greater likelihood of achieving ≥5% weight loss (aOR=3.67, 95% CI: 1.63-8.50). Within Personalized, high PPGR quality mediated 53.4% of the total effect of self-monitoring adherence on weight loss (p<0.001). CONCLUSION/CONCLUSIONS:Consistent self-monitoring coupled with personalized feedback may significantly enhance weight loss in a precision nutrition approach. CLINICAL TRIAL REGISTRATION/BACKGROUND:NCT03336411.

BACKGROUND:Depression, a debilitating mental disorder, has become the leading cause of disability worldwide. A growing body of evidence supports the feasibility and effectiveness of multicomponent lifestyle medicine programs for the treatment of depression, including the recent novel multicomponent Traditional Chinese Medicine Lifestyle Medicine (TCMLM) program (Registered at ClinicalTrials.Gov with registration number: NCT05799586). However, little is known about participants' experiences and perceptions of the program and the aspects that require improvement. This study aimed to explore the experiences and perceptions of participants attending the multicomponent TCMLM program and practicing the related lifestyle behaviors. METHODS:In this descriptive qualitative study, purposeful sampling was used to recruit Hong Kong Chinese adults who had participated in the multicomponent TCMLM program between August 2023 and January 2024. Face-to-face focus-group interviews and semi-structured interviews were conducted with audio recording, transcribed verbatim, and analyzed using conventional content analysis. All interviews were performed in classrooms in a university in Hong Kong. RESULTS:A total of 31 multicomponent TCMLM program attendees aged 20 to 65 years participated in the qualitative interviews. The content analysis identified three themes and 12 subthemes, namely, Theme 1: multicomponent TCMLM program originally being comprehensive and special (e.g., TCMLM program content originally being not unitary, increasing the number of methods for dealing with depressive symptoms); Theme 2: multicomponent TCMLM program being far more beneficial than expected (e.g., promoting diet, exercises, daily routine and sleep management based on TCMLM, improving physical functional status, improving one's personality); and Theme 3: practicing multicomponent TCMLM program having challenges (e.g., unsuitable conditions hindering some TCMLM practices in community). CONCLUSIONS:This study provides fresh in-depth insights into the perceptions and experiences of Hong Kong Chinese adults with depression who attended the multicomponent TCMLM program and engaged in the related lifestyle behaviors. Meanwhile, the challenges encountered while attending the program and practicing the related behaviors offer valuable information for further optimization of the program and expanding its application in Hong Kong or other regions.

BACKGROUND:Immigrant populations face numerous barriers to accessing evidence-based diabetes interventions. Mobile health (mHealth) interventions are increasingly being used to support individuals in managing diabetes. This review aims to synthesize the available evidence on mHealth interventions specifically designed for immigrant populations with diabetes. METHODS:An integrative review was conducted following Whittemore and Knafl's methodology. Studies from the inception of PubMed, Web of Science, Cochrane Library, CINAHL Ultimate, Embase, and APA PsycInfo up to July 2024 were searched. The Mixed Methods Appraisal Tool was used to assess the quality of the included studies. A constant comparison strategy was employed for data analysis. RESULTS:A total of seven studies met the inclusion criteria for this review, including five randomized controlled trials (RCTs: two fully powered RCTs and three pilot RCTs) and two pre-post single-arm pilot studies. All studies were conducted in the United States. The mHealth interventions were tailored to Korean, Chinese, Marshallese, Latinx, and South Asian immigrants. The sample sizes varied from 17 to 250. Evidence from the included studies is primarily limited by statistical power due to their pilot designs and small sample sizes. Despite this limitation, all studies demonstrated high feasibility and acceptability of mHealth interventions for diabetes management among these immigrant groups. Participants also reported high levels of satisfaction with mHealth interventions. The included studies consistently reported significant improvements in a range of health, psychosocial, and behavioral outcomes within the intervention groups, including hemoglobin A1C levels, body weight, blood glucose, total cholesterol, triglycerides, low-/high-density lipoprotein levels, and blood pressure; and self-efficacy, mental health status, diabetes knowledge, and quality of life; as well as physical activity, self-management, and dietary behaviors. However, when compared to control groups, the reported effectiveness of mHealth interventions on these outcomes was inconsistent. CONCLUSIONS:This review demonstrates the feasibility and acceptability of mHealth interventions for diabetes management among within immigrant populations. The findings suggest that these interventions may serve as a viable strategy to improve health, psychosocial, and behavioral outcomes. Future RCTs with larger sample sizes are needed to provide more robust evidence of the effectiveness of mHealth interventions. Importantly, this review highlights the scarcity of mHealth-related studies focused on immigrant populations with diabetes and calls for more research to examine how to best support this underserved group.

BACKGROUND:levels. However, it remains unclear whether the CARE program also improves diabetes self-efficacy and psychosocial outcomes in the same study sample. OBJECTIVE:This is a secondary analysis to examine the potential efficacy of the CARE program on secondary outcomes, including diabetes self-efficacy, self-care activities, beliefs in diabetes self-care activities, and diabetes distress among Chinese Americans with T2D. METHODS:level of 7% or higher. Participants were recruited from various health care settings in New York City, including community health centers, private primary care providers, and NYU Langone Health and its affiliates, and were randomly assigned to either the CARE intervention group (n=30) or a waitlist control group (n=30). The intervention consisted of 2 culturally and linguistically tailored educational videos per week for 12 weeks, covering diabetes self-care topics such as healthy eating, physical activity, and medication adherence. These videos were delivered via the WeChat app. In addition, community health workers provided support calls to assist them in setting goals, problem-solving, and addressing social determinants of health barriers every 2 weeks. Secondary outcomes included patient self-reported diabetes self-efficacy, self-care activities, beliefs in diabetes self-care activities, and diabetes distress. Outcomes were assessed at baseline, 3 months, and 6 months. RESULTS:Participants had a mean age of 54.3 (SD 11.5) years and 62% (37/60) were male, 78% (47/60) were married, 58% (35/60) were employed, 70% (42/60) had a high school education or lower, and 88% (53/60) reported limited English proficiency. Intervention participants demonstrated statistically significant improvements in self-efficacy at 3 months (estimated difference in change: 8.47; 95% CI 2.44-14.5; adjusted P=.02), diabetes distress at 6 months (estimated difference in change: -0.43; 95% CI -0.71 to -0.15; adjusted P=.009), and adherence to a healthy diet at both 3 months (estimated difference in change: 1.61; 95% CI 0.46-2.75; adjusted P=.02) and 6 months (estimated difference in change: 1.64; 95% CI 0.48-2.81; adjusted P=.02). CONCLUSIONS:The culturally and linguistically tailored intervention showed promise in improving self-efficacy and diabetes self-care activities among Chinese Americans with T2D, warranting validation through a large-scale randomized controlled trial. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov NCT03557697; https://clinicaltrials.gov/study/NCT03557697.

PURPOSE/UNASSIGNED:Chinese Americans face disproportionately higher rates of Type 2 Diabetes (T2D) and co-occurring mental health challenges. Little is known about how they perceive mental health care during their journey with diabetes. This study aimed to provide an in-depth exploration of mental health care perceptions in this population. PATIENTS AND METHODS/UNASSIGNED:Two focus group discussions involving 12 participants were conducted in Mandarin. Participants were purposively sampled from a previous survey of Chinese immigrants with T2D who reported co-occurring mental health challenges and were recruited through referrals from primary care practices and community-based organizations in New York City. Data were analyzed using inductive content analysis. RESULTS/UNASSIGNED:The participants in this study ranged in age from 45 to 67 years. Most were female, married, and had low educational attainment (less than a college education) and low annual household incomes (less than USD $25,000). All participants were first-generation Chinese immigrants with limited English proficiency and had health insurance. HbA1c levels ranged from 6.5% to 12.6%. Depressive symptoms and elevated stress were the most commonly reported mental health issues in this sample. Data analysis revealed five categories related to participants' perceptions of mental health care: 1) interactions between mental health and T2D, 2) barriers to accessing mental health care, 3) facilitators of accessing mental health care, 4) coping strategies for mental health challenges, and 5) preferences for mental health services. CONCLUSION/UNASSIGNED:This study suggests the complex interactions between T2D and mental health issues among Chinese Americans. The findings indicate that seeking professional mental health services is uncommon among many individuals in this population and highlight several barriers and facilitators to access. The findings also suggest directions for future interventions to support mental health among Chinese Americans with T2D. Addressing mental health needs through effective interventions is essential for providing comprehensive care to this underserved population. Future research should explore the role of stigma in mental health-seeking behaviors, as well as design and assess the effectiveness of mental health interventions for Chinese Americans with T2D.

AIMS/OBJECTIVE:To characterize changes in continuous glucose monitoring (CGM)-derived time in tight range (TIR) measures in individuals with prediabetes or non-insulin-treated type 2 diabetes undergoing dietary weight loss intervention and to quantify the association between weight loss and TIR improvement. METHODS:) were analysed. The association between weight change and TIR change adjusted for demographic and clinical covariates was computed using linear regression. RESULTS:. There were no associations between weight loss and change in any overnight TIR measure. CONCLUSION/CONCLUSIONS:in individuals with prediabetes and non-insulin-treated type 2 diabetes undergoing dietary intervention. The daytime time in tight range measures can complement traditional markers like HbA1c, offering a more comprehensive view of glycaemic variations during dietary weight loss programmes for individuals with prediabetes and type 2 diabetes not on insulin.