Faculty Bibliography

PurposeTo estimate the effect of the culturally-adapted Greenlight intervention on parent activation and locus of control (LOC) among Chinese-American immigrant parents.DesignProspective, quasi-experimental study.SettingA New York City-based federally-qualified health center with a large patient population of low-income, ethnically Chinese immigrant individuals and families.Sample444 Immigrant Chinese-American parents of infants (267 cross-sectionally enrolled historical controls and 177 Greenlight recipients followed prospectively).InterventionA culturally-adapted version of Greenlight, a health literacy- and communication-informed early childhood obesity prevention intervention in primary care which promotes certain healthy infant feeding practices at 12 months in the present sample.MeasuresParent activation and LOC were measured at 6, 12, 24, and 36 month well child visits.AnalysisGeneralized estimating equations were used to examine the effects of the Greenlight intervention on the outcome measures.ResultsCompared to historical controls, parents receiving Greenlight were more likely to strongly agree with the activation statements: "I know how to prevent my child from becoming overweight" (adjusted odds ratio (aOR): 9.62 [4.70, 19.73]); "I have been able to help my child maintain recommended changes like eating right or exercising" (aOR: 6.42 [4.14, 9.97]); and "I am confident I can keep my child eating and exercising right, even when I am busy or stressed" (aOR: 8.44 [5.35, 13.31]). Greenlight recipients also demonstrated increased internal LOC (aOR: 2.02 [1.35, 3.03]) and decreased powerful others external LOC (aOR: 1.76 [1.23, 2.51]).ConclusionTo reduce disparities in child obesity, especially among immigrant families, interventions must also prioritize parent factors like parent activation and LOC to build upon their inherent assets and promote long-term change.

BACKGROUND:Early experiences shape how children understand food as part of their health, family, and culture. Pediatricians promote picture book reading to support developmental and relational health. We conducted a pediatric-informed content analysis of food and nutrition in US picture books. METHODS:Using an interdisciplinary content analysis framework, we assessed food and nutrition content within a representative sample of US picture books (N = 159). Coders documented the presence and types of food, mealtimes, and social drivers of nutritional health. We assessed interrater reliability and summarized food-related content within the context of how the book depicted the role and function of food. RESULTS:The κ agreement ranged from 78% to 99% (strong reliability). Most books depicted food in text (67%) or pictures (68%). Fruit (39%) was the most depicted food group, milk the most depicted beverage (15%), and sweet the most depicted flavor (33%). Among books that included meals, snacks were most common (57%), followed by dinner (41%). Characters ate with their families in over half (53%) of books that depicted meals. Food often symbolized a role beyond satiating hunger (eg, rewarding behavior, fostering connection). Specific roles were associated with a higher appearance of certain foods (eg, fruits with pleasure). CONCLUSIONS:Picture books, which frequently portray food and reliably capture children's interest, are helpful tools to engage children in conversations about the social, cultural, and nutritional functions of food. Our findings suggest that picture books are a commercial-free early literacy tool that can support integrated interventions addressing both nutritional and relational health.

PURPOSE/OBJECTIVE:Poverty is strongly associated with obesity, particularly among women. Positive childhood experiences (PCEs) may protect against obesity, but longitudinal studies are limited. We assessed: 1) the effects of PCEs at age 15 on obesity risk at age 22; and 2) whether these effects vary by exposure to extreme poverty in childhood. METHODS:We analyzed data of female participants in the Future of Families and Child Wellbeing Study, a national birth cohort oversampling socioeconomically disadvantaged groups. PCEs were assessed across three domains separately and cumulatively: maternal, neighborhood, and school support. Multivariable linear and logistic regression was adjusted for relevant sociodemographic characteristics. Stratified analyses and interaction terms were tested for moderation by extreme poverty exposure. RESULTS:The analytic sample included 1,339 female participants (49% Black; 18% primary caregivers without high school education; 67% exposed to extreme poverty in childhood). Higher maternal support (B = -.61, p = .04), neighborhood support (B = -.80, p = .02), and cumulative PCEs (-.68, p = .01) at age 15 were associated with lower body mass index at age 22. Higher neighborhood support (adjusted odds ratio = .81, p = .02) and cumulative PCEs (adjusted odds ratio = .87, p = .04) at age 15 were associated with lower odds of obesity at age 22. In moderation analyses, maternal support and cumulative support were only associated with lower body mass index among those never exposed to extreme poverty. DISCUSSION/CONCLUSIONS:PCEs during adolescence protect against obesity in early adulthood in an urban female cohort, but this protective effect is negated by exposure to extreme poverty. Further research should investigate the mechanisms underlying these associations and the potential impact of interventions aimed at strengthening PCEs and alleviating poverty.

Early-career hospitalists interested in research often face uncertainty when deciding whether to apply for grant funding. This article provides a practical guide to help early-career researchers navigate early decisions in the grant application process. We review key sources of grants (federal funding, foundations, professional societies, institutional, and commercial), as well as common types of grants (eg, pilot or seed grants, travel grants, career development awards, engagement or community partnership grants, independent research grants) that may be of interest to junior investigators. We take readers through the process of determining whether specific grants are the right fit, how to decide if they should apply, sources of grants, and how to find them. The article addresses the next steps after submission, including interpreting feedback, options for resubmission, or alternative approaches if funding is not secured. Overall, this guide aims to demystify the grant-writing process and support early-career hospitalist researchers in taking their first steps toward funded research. Several helpful tips are also provided. A future article will take readers through the process of writing components of individual grants.

Oxidative stress, an imbalance between reactive oxygen species and antioxidants, has been linked to impaired placental function and suboptimal fetal growth, yet trimester-specific associations remain poorly understood. We examined 561 mother-infant pairs from The Infant Development and Environmental Study (TIDES), measuring maternal urinary biomarkers of DNA oxidation (8- hydroxydeoxyguanosine (8-OHdG)), lipid peroxidation (malondialdehyde (MDA), and F2-isoprostanes), and protein oxidation (dityrosine (diY)) at first and second trimesters. Using generalized linear models, we examined prospective associations between oxidative stress and ultrasound-derived growth velocities. Early pregnancy oxidative stress biomarkers were persistently associated with reduced second and third trimester growth velocities. First trimester lipid peroxidation markers (8-PGF2α, 15-PGF2α, and 8,15-PGF2α) were associated with slower estimated fetal weight growth velocity in both second trimester (-0.81, -0.93, and -1.72 g/week per log-unit increase, respectively) and third trimester (-4.25, -5.60, and -6.74 g/week). Similarly, first trimester 8-OHdG and diY were associated with both second trimester (-1.31 and -1.17 g/week, respectively) and third trimester estimated fetal weight velocity (-8.01 and -6.75 g/week, respectively). Second trimester 8-OHdG and MDA were associated with slower third trimester estimated fetal weight velocity (-8.57 and -9.25 g/week, respectively). These results provide novel insights into trimester-specific associations between oxidative stress and fetal growth.

Environmental exposures can have adverse associations with perinatal health and birth outcomes. This study aimed to identify the overlap and association between urban areas of environmental risk and adverse perinatal health indicator hotspots in New York City. We examined 2101 census tracts representing 575,257 births from 2016 to 2020 recorded by the New York City Bureau of Vital Statistics looking at preterm birth, adolescent pregnancy, and pre-pregnancy obesity rates. The Getis-Ord Gi* statistic was used to identify geospatial hotspots of adverse indicators. We used multivariable logistic regression to assess associations between areas of environmental risk and odds of indicator hotspot status and Poisson regression to assess associations of hotspot overlap. Overall, 54.6% of environmental risk areas were hotspots for at least one adverse perinatal indicator, accounting for 63.7% of preterm birth hotspots, 93.7% of adolescent pregnancy hotspots, and 67.3% of pre-pregnancy obesity hotspots. Compared with non-risk areas, risk areas had greater odds of being a hotspot of preterm birth (aOR = 2.11; 95% CI 1.60-2.78), adolescent pregnancy (aOR = 32.8; 21.8-49.4), and pre-pregnancy obesity (aOR = 3.15; 2.56-3.87). Environmental risk areas were expected to have 3.36 times the number of overlapping hotspots after adjusting for parental birthplace and parity. The overlap between environmental risk areas and hotspots of adverse perinatal health indicators and the associations with individual indicators and overlapping hotspots suggest that environmental risk area designation may be a useful measure of perinatal health vulnerability for targeted community interventions.

OBJECTIVE:To examine if variation in session format and content of a prenatal obesity prevention program is associated with fruit and vegetable (FV) voucher redemption in Hispanic/Latino pregnant participants. METHODS:A secondary analysis of participants who received FV vouchers in a single-arm feasibility trial. We used linear regressions to assess associations between program session format (group vs individual) and FV voucher redemption rate, with session content (nutrition vs other lifestyle content [e.g., stress management or physical activity]) as a secondary predictor. RESULTS:Participants (n = 131) who attended a greater percentage of sessions in group format had increased voucher redemption rates (B = 0.37 [95% confidence interval, 0.05-0.70]. P = 0.03). Attending a higher percentage of group sessions with nutrition content rather than other lifestyle content was associated with a higher redemption rate (B = 0.19 [95% confidence interval, 0.002-0.38], P = 0.05). CONCLUSIONS AND IMPLICATIONS/CONCLUSIONS:Pairing FV voucher distribution with nutrition counseling delivered in a group format may increase utilization of FV vouchers.

OBJECTIVE:To explore attitudes and preferences related to remote nutrition education programming for Latino families in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and primary care. DESIGN/METHODS:Community-engaged, qualitative, thematic analysis of interviews and focus groups. SETTING/METHODS:Prenatal and pediatric primary care and WIC sites in Manhattan, Queens, and Nassau Counties, New York. PARTICIPANTS/METHODS:Four stakeholder groups: (1) past participants of a primary care-based obesity prevention program (Starting Early Program Prenatal) for Latino families that transitioned to remote delivery because of coronavirus disease 2019 (n = 40), (2) Latina WIC participants, including pregnant women and mothers of young children (n = 40), (3) Starting Early Program Prenatal staff (n = 6), and (4) WIC staff (n = 16). PHENOMENON OF INTEREST/METHODS:Attitudes and preferences related to in-person vs remote nutrition education programming. ANALYSIS/METHODS:Focus groups and interviews were audio-recorded, transcribed, and analyzed for emergent themes using reflexive thematic analysis. RESULTS:Four themes emerged: (1) valuing in-person social connection while recognizing barriers to in-person gathering, (2) navigating distraction-related barriers to remote engagement, (3) consistent content delivery but uncertain quality of remote programs, and (4) coronavirus disease 2019 pandemic-related contextual factors. CONCLUSIONS AND IMPLICATIONS/CONCLUSIONS:Future remote programs in WIC may benefit from incorporating opportunities for social interaction, explicit discussion of anticipated barriers, and strategies to overcome them.

OBJECTIVE:This study aimed to quantify associations between newborn social risk factors and high infant weight-for-length (WFL) at 6 months. METHODS:We conducted a longitudinal, observational study using electronic health record data among infants in New York City. We included newborns with a primary care screening questionnaire for social risk factors (food insecurity, housing instability, transportation problems, and utility hardship) measured using the Accountable Health Communities Screening Tool. We conducted regression analyses to assess associations between social risk factors and high WFL, or the 97.7th percentile at 6 months. Secondary analyses included additional single-time-point and longitudinal weight outcomes (continuous and dichotomous). RESULTS:Among 1876 newborns, 77.3% identified as Hispanic/Latino, almost all had Medicaid insurance (96.6%), 355 (23.3%) had food insecurity risk, 149 (7.9%) had housing instability, 132 (7.0%) had transportation problems, and 110 (5.9%) had utility hardship. Newborns with utility hardship had higher odds of high WFL in unadjusted (OR 3.0, 95% CI: 1.8-5.2) and adjusted models (aOR 3.1, 95% CI: 1.7-5.6) accounting for infant, parent, and social risk factors. CONCLUSIONS:Newborn utility hardship was associated with obesity risk at age 6 months. Interventions to address newborn social risk factors should examine the effectiveness of utility shutoff protection to reduce excess infant weight gain.

OBJECTIVE:To examine associations between oxidative stress and fetal weight across pregnancy. STUDY DESIGN/METHODS:Cohort study of pregnant participants from 2016-2021 in New York City with urinary lipid, protein, and DNA oxidative stress biomarkers (<18, 18-25, >25 weeks) and estimated fetal weight from ultrasound fetal biometry with the HadlockIII formula (20, 30, 36 weeks). RESULT/RESULTS:percentile. Oxidative stress biomarkers of protein damage were associated with larger estimated fetal weight at 20 (3.4 [95% CI: 1.2, 5.7]) and 36 weeks (16.5 [95% CI: 5.2, 27.8]). CONCLUSION/CONCLUSIONS:These findings advance our understanding of different oxidative stress pathways and their potential role in fetal growth.