Faculty Bibliography

OBJECTIVE:Type 2 diabetes mellitus (T2DM) affects millions of Americans, and prediabetes significantly increases progression to T2DM. Community Health Workers (CHWs) may help prevent diabetes through behavioral interventions, but their effectiveness in real-world settings remains uncertain. We evaluated whether a CHW intervention prevents incident T2DM among adults with prediabetes. RESEARCH DESIGN AND METHODS/METHODS:Pragmatic, cluster-randomized controlled trial in primary care clinics at the Veterans Affairs NY Harbor Healthcare System (Manhattan) and Bellevue Hospital, New York City. The study included adults aged 18-75 years with HbA1c 5.7-6.4% and no prior diabetes or use of diabetes medications other than metformin. Primary care teams were cluster-randomized to a 12-month CHW program-health action plans, motivational interviewing, health education, and community referrals-versus usual care. The primary outcome was incident diabetes during up to 6 months' follow-up after the 12-month intervention. Secondary outcomes were changes in HbA1c, weight, blood pressure, lipids, and health care utilization. RESULTS:Incident diabetes occurred in 5.9% of intervention patients versus 4.3% of controls (risk difference 1.6%; 95% CI -3.68% to 4.10%). No significant differences were observed in HbA1c, weight, blood pressure, or lipids. The intervention group had more primary care encounters (77.6% vs 62.5%) and emergency department encounters (35.0% vs 29.1%). CONCLUSIONS:In this pragmatic trial, a 12-month CHW program did not reduce incident diabetes among adults with prediabetes but was associated with greater health care engagement (more primary care visits). More intensive or standardized CHW models should be tested to determine whether increased engagement translates into long-term metabolic benefit. TRIAL REGISTRATION/BACKGROUND:The study protocol was registered at ClinicalTrials.gov (NCT03006666, 12/27/2016). https://clinicaltrials.gov/study/NCT03006666.

Rapid proliferation of digital technologies presents a paradox: expanding health access while introducing risks such as digital overload, privacy concerns, and negative mental health impacts. A conceptual and implementation gap remains in defining and optimizing wellbeing in a digital world, particularly because digital wellbeing refers both to interventions intentionally designed to promote health and to everyday digital environments that influence wellbeing indirectly. We convened a multidisciplinary think-tank of 24 scholars in May 2025 at New York University Florence, using a structured, mixed-format process to identify gaps and generate integrative concepts for advancing wellbeing within digital and hybrid care ecosystems. The group found that current digital health tools often fragment wellbeing into siloed biomedical paradigms and may be shaped by commercial incentives that favor engagement over flourishing. Consensus emerged that integrated wellbeing is a multidimensional construct spanning physical, mental, emotional, social, spiritual, and nourishment-related dimensions, supported by technologies only when they augment human relationships, context, and autonomy. Key themes included clearer conceptual boundaries; persistent gaps in design, safety, regulation, and health equity; human-centered frameworks that augment rather than replace human support; bridging digital tools with nourishment and nature-based practices; and personalizing strategies across the lifespan and across low- and high-resource settings.

DESCRIPTION/UNASSIGNED:A work group representing the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) prepared a new VA/DoD clinical practice guideline (CPG) for tobacco use treatment. This article provides a synopsis of the 2026 CPG, which addresses use of commercially available tobacco and nicotine products. METHODS/UNASSIGNED:A multidisciplinary work group developed 19 key questions on clinical topics of highest priority for the VA and DoD populations. Published literature from 1 January 2014 to 10 December 2024 was systematically reviewed using the PICOTS (population, intervention, comparator, outcomes, timing of outcomes measurement, and setting) framework. Recommendations were made by consensus and informed by evaluation using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method, which assesses quality of evidence and balances benefits and harms, patient preferences, and feasibility. The final document incorporated input from peer review by an external group of experts. RECOMMENDATIONS/UNASSIGNED:The 2026 guideline includes 32 recommendations across 10 topic areas. Key recommendations for increasing abstinence from combustible tobacco include recommending motivational interviewing to increase engagement in treatment of tobacco and nicotine use (strong) and use of U.S. Food and Drug Administration-approved pharmacotherapies (strong), with varenicline recommended over monotherapy with other agents (strong), combination nicotine replacement therapy ([NRT] for example, patch plus lozenge) recommended over NRT monotherapy (single agent) (strong), and extending use of bupropion sustained release beyond 12 weeks (weak). Other key recommendations include varenicline for increasing abstinence from smokeless tobacco (strong) and electronic nicotine delivery systems (weak) and use of NRT or varenicline to increase quit attempts and abstinence in patients not ready to quit in the next 30 days (weak).

PURPOSE/UNASSIGNED:Microhematuria may be a sign of underlying genitourinary pathology, but diagnoses of bladder cancer are rare among those who complete evaluations. This study determines the incidence of bladder cancer in a large cohort of patients with microhematuria, assesses the diagnostic potential of current guideline recommendations, and characterizes the relative risks of clinicodemographic factors to inform the need for microhematuria evaluation. MATERIALS AND METHODS/UNASSIGNED:microhematuria. The main outcome was a new bladder cancer diagnosis within 2 years of index urinalysis with microhematuria. Patients were stratified by American Urologic Association risk categories to compare guideline-based risk classification with model-based estimation. The Fine-Gray method was used to estimate adjusted associations between clinicodemographic characteristics and incident bladder cancer, accounting for the competing risk of death. RESULTS/UNASSIGNED:Among 267,133 patients with microhematuria, the two-year cumulative incidences of cystoscopy completion and a new bladder cancer diagnosis were 11.9% (95% CI 11.7, 12.0) and 1.5% (95% CI 1.4, 1.5), respectively. Older age, male sex, smoking history, and ≥25 RBC/hpf were associated with a new bladder cancer diagnosis when adjusted for competing risk of death. Performance of our bladder cancer prediction model was better (ROC AUC=0.63) than that of the current AUA guidelines (AUC=0.52, p<0.001) and allowed for further risk-estimation of patients designated "high risk" by AUA criteria. CONCLUSIONS/UNASSIGNED:Estimation of patient-level microhematuria-related bladder cancer risk is possible with readily available clinicodemographic factors. Current approaches lack nuance, particularly among "high risk" patients. Precision approaches that use relative risk-factor weights and/or novel diagnostic tools may improve individualized decision-making for evaluation.

BACKGROUND:There are limited studies on telehealth use patterns among patients with prostate cancer. OBJECTIVE:We assessed the patterns of delivery of care for prostate cancer management in the Veterans Health Administration (VHA). DESIGN/METHODS:A retrospective observational cohort study from January 2016 to February 2023. PARTICIPANTS/METHODS:Data were from the VHA's Corporate Data Warehouse (CDW). Veterans with a new diagnosis of prostate cancer were included in the study. Those who died within 1 year of diagnosis, had missing staging information, or had no prostate-specific antigen (PSA), biopsy, or treatment recorded within 2 years of initial diagnosis were excluded. MAIN MEASURES/METHODS:Veterans were categorized into watchful waiting, active surveillance, and active treatment management groups based on subsequent care received and categorized into National Comprehensive Cancer Network (NCCN) risk categories. We categorized outpatient urology or oncology visits as telephone-based, video-based, or in-person using administrative stop codes. We used logistic regression models to evaluate the characteristics associated with at least one video/virtual visit. KEY RESULTS/RESULTS:In total, 60,381 Veterans were included in the study (20.3% low risk, 49.8% intermediate risk, and 29.8% high risk). Even during the COVID-19 pandemic, less than 6% and 9% of Veterans had at least one urology or oncology video visit, respectively, in the first year after diagnosis across all management groups. In the regression model, Veterans aged 60 and older were less likely to have video visits for both urology and oncology. In contrast, living in urban areas, being diagnosed during the COVID-19 pandemic, and being in the intermediate NCCN risk group were associated with higher odds of having at least one video visit in both specialties. CONCLUSIONS:Despite improvements in telehealth use among Veterans with prostate cancer, telehealth utilization, particularly video visits, remains low, warranting attention from leadership and policymakers.

BACKGROUND/UNASSIGNED:Precision oncology (PO) improves and extends the lives of patients living with cancer, but multiple studies have documented its underuse in practice. Specifically, studies note a significant lack of PO use within the Veterans Affairs (VA) medical system. A paucity of implementation of PO in oncologic practice poses a significant barrier to providing the most up-to-date guideline-based care. OBJECTIVE/UNASSIGNED:While several studies have explored determinants of PO use, we sought to contribute to the body of knowledge by additionally focusing on the unique perspectives of patients, as well as conducting a comprehensive study within the VA medical system, the United States' largest single-payer health care system. We conducted interviews with both patients and providers at multiple VA sites to identify and characterize barriers and facilitators of PO use in clinical care. METHODS/UNASSIGNED:Using a qualitative descriptive approach, we conducted semistructured interviews with 17 patients with cancer and 16 oncology providers recruited from multiple VA sites. Cancer types included prostate, gastrointestinal, and lung. Data were analyzed via a team-based coding approach using directed content analysis. Data were coded and then aggregated into themes and mapped to the Theoretical Domains Framework (TDF) and Behavior Change Wheel sources of behavior (Capability, Opportunity, and Motivation) based on the consensus of the study team. RESULTS/UNASSIGNED:The patient sample consisted of 17 all-male veterans seen at VA oncology clinics in 2022. Participants predominantly self-identified as White (n=9, 52.9%) or Black (n=6, 35.3%), and the majority (n=11, 64.7%) held a high school degree or a higher level of education. The provider sample consisted of 16 physicians, all of whom held MD degrees and practiced oncology. The provider sample represented 6 states, was 50% (8/16) female, and participants averaged 14 years in their current position. The overarching theme was the "Precision Oncology Feedback Loop," which captured the essence of the complex processes involved in facilitating PO care in the VA system. The TDF and Behavior Change Wheel helped categorize findings to identify where issues in the feedback loop could facilitate or generate barriers to care. CONCLUSIONS/UNASSIGNED:Our findings expand on the current literature by highlighting both patient and provider experiences across key TDF domains (Environmental Context and Resources, Knowledge, Memory, and Attention). The conceptual model produced by the analysis illustrates the complexities associated with the implementation. Our findings support the design of multilevel interventions that target increased knowledge or education, improved workflow, and ease of communication to enhance PO delivery.

Chinese Americans who smoke have low use of nicotine replacement therapy (NRT). This study explored perceptions of NRT and decision-making around product choice among Chinese American smokers who received NRT. From September 2023 to January 2024, we conducted in-depth phone interviews with 20 participants recruited in New York City from a WeChat-based cessation pilot trial and a community-based cessation program, both providing free nicotine patches, gum, or lozenges. Participants (aged 26-72; 85% male; 60% current smoking) included 12 consistent NRT users (≥2 weeks), four trial users (<2 weeks), and four non-users. Five participants (25%) had never heard of NRT before program enrollment, and 14 (70%) had never used it previously. Consistent users generally viewed NRT as helpful in reducing cravings. Others reported barriers, including culturally rooted skepticism toward pharmacotherapy, preference for unassisted quitting, lack of readiness to quit, prior negative experiences, and unpleasant taste or side effects. Product choice was influenced by lay knowledge, ease of integrating NRT into daily routines, perceived effectiveness, and taste and side effects. Cessation programs addressing cultural beliefs, reframing willpower, engaging individuals not ready, and providing diverse NRT options with guidance on side effect management and routine integration may increase NRT use among this population.

OBJECTIVE:It is critical to understand the characteristics of people who use cannabis during pregnancy. We examined the prevalence and sociodemographic and clinical correlates of current, recent, former, and never cannabis use among pregnant individuals in the U.S. METHODS:We analyzed pooled data from 1,992 pregnant participants in the National Survey on Drug Use and Health (NSDUH) from 2021 to 2023. We used multinomial regression to identify correlates of cannabis use status (i.e., never use vs. current [past 30-day], recent [past 2-12-month], and former [nonuse in the past year], respectively). RESULTS:Overall, nearly 7% of pregnant participants reported current cannabis use. Among current users, 31% reported any doctor-recommended cannabis use in the past year and 52% bought their cannabis from a dispensary. Compared to never users, current cannabis use was more likely among those aged 18-25 (vs. 26+; Relative Risk Ratio [RRR] = 2.08, 95% CI: 1.04-4.18), unmarried (vs. married; RRR = 2.54, 95% CI: 1.05-6.14), with greater education (vs. < high school; RRR = 2.97, 95% CI: 1.42-6.23), past 30-day cigarette use (RRR = 2.57, 95% CI: 1.11-5.94), alcohol use (RRR = 7.24, 95% CI: 1.52-34.49), e-cigarette use (RRR = 4.92, 95% CI: 1.71-14.10), or serious psychological distress (RRR = 6.25, 95% CI: 2.46-15.85); current use was less likely among those perceiving some risk of weekly cannabis use (vs. no risk; RRR = 0.07, 95% CI: 0.03-0.14). Recent use (vs. never use) was less likely in states where cannabis was illegal (RRR = 0.45, 95% CI: 0.22-0.95). CONCLUSION/CONCLUSIONS:Cannabis use during pregnancy remains high among certain subgroups. Future research should develop tailored interventions targeting motivations of cannabis use during pregnancy, such as risk perceptions and polysubstance use, which negatively impact maternal and fetal health.

BACKGROUND:Little is known about the use of text messages to promote enrollment in smoking cessation treatment. RESEARCH QUESTION/OBJECTIVE:What is the impact of number of outreach messages and monetary incentives on enrollment in smoking cessation treatment among Latino adults? STUDY DESIGN AND METHODS/METHODS:This pragmatic randomized clinical trial used a 3x2 factorial design. The first factor, monetary incentives, consisted of three conditions: 1) receiving a small fixed amount ($5) when enrolling, 2) getting a chance to win a large amount ($200) when enrolling, and 3) no monetary incentive when enrolling. The second factor, number of cycles, consisted of two conditions: 1) one cycle of messages, and 2) four cycles of messages. Latino adults who smoke (n=2,826) were identified in electronic medical records. Participants were randomized in a 1:1:1 ratio to receive one of three monetary incentive conditions and in a 1:2 ratio to receive one or four cycles of messages. The main outcome was enrollment in a smoking cessation text messaging intervention. RESULTS:Enrollment rates ranged from 1.3% for the group that received no monetary incentive for enrollment and one cycle of messages to 5.4% for the group that received a fixed amount for enrollment and four cycles of messages. Receiving four cycles of messages was associated with a higher likelihood of enrollment compared to receiving one cycle of messages (OR 1.92 [95% CI, 1.22-3.01], p<0.01). Monetary incentives were not associated with enrollment. INTERPRETATION/CONCLUSIONS:Among Latino adults, enrollment in smoking cessation treatment increased significantly with increasing number of cycles. In contrast, monetary incentives did not increase enrollment. While modest, the 5.3% enrollment rate found among participants who received four cycles of messages and no monetary incentive can inform future population-level efforts to advance smoking cessation among Latino adults. CLINICAL TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov identifier: NCT05722132.