Faculty Bibliography

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: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: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.

BACKGROUND:Minoritized populations face many barriers to accessing evidence-based diabetes intervention. OBJECTIVES/OBJECTIVE:To evaluate the feasibility, acceptability, and potential efficacy of a social media-based intervention to improve glycemic control among Chinese Americans with type 2 diabetes. DESIGN/METHODS:A pilot randomized controlled trial (RCT) with 3-month and 6-month follow-ups. PARTICIPANTS/METHODS:Chinese Americans (n = 60, mean age 54.3 years old) with limited education (70.0% with high school or less) and low income (50.0% with annual household income < $25,000), and 88.3% have limited English proficiency. INTERVENTION/METHODS:Culturally and linguistically tailored diabetes videos (two videos/week for 12 weeks) delivered via social media and support calls from community health workers. MAIN MEASURES/METHODS:Primary outcomes include feasibility (video watch rate, biweekly call completion rate, and retention rates), acceptability (patient satisfaction), and HbA1c. Secondary health-related outcomes include body weight, BMI, physical activity, and dietary intake. Video watch rate and biweekly call completion rate were assessed at baseline and 3 months, while others were measured at baseline, 3 months, and 6 months. RESULTS:We observed high feasibility and acceptability of the intervention, with retention rates over 87%, an 89% video watch rate, 80% biweekly phone call completion, and a satisfaction rating of 9 out of 10. The intervention group showed a significantly greater increase in fruit intake compared to the control group (0.15 cups vs. - 0.44 cups, adj_p = 0.023) at 3 months. While no significant differences in other outcomes were observed between the groups, the intervention group showed significant improvements in key outcomes, including reduced HbA1c levels (- 1.08%, adj_p < 0.001), weight loss (- 5.15 lbs, adj_p = 0.004), lower BMI (- 0.83, adj_p = 0.023), and reduced starchy food intake (- 0.33 cups, adj_p = 0.033) at 6 months. CONCLUSIONS:The observed high feasibility and acceptability suggest the intervention's feasibility. However, due to the limited sample size, a larger-scale RCT is warranted to test the efficacy of the intervention. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov NCT03557697; https://clinicaltrials.gov/ct2/show/NCT03557697.

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.

OBJECTIVE:To examine the associations of deprived neighbourhoods with all-cause mortality and incident cardiovascular disease (CVD) and to investigate whether these associations were independently and concurrently stratified by sex and ethnicity. METHODS:Data came from the UK Biobank, a prospective cohort study of over 500 000 participants aged 22-69 across the UK between 2006 and 2010. The follow-up time was calculated from each participant's enrolment at baseline until the first occurrence of a diagnosis of each death, incident or the censor date (31 December 2020). All-cause mortality, incident total CVD, ischaemic heart disease (IHD) and cerebrovascular disease (CeVD) were the outcomes defined based on the International Classification of Diseases. Deprived neighbourhoods were categorised into four groups: least deprived (referent), somewhat deprived, deprived, and most deprived neighbourhoods. Cox proportional hazards models were used to examine associations of deprived neighbourhoods with each outcome. Analyses were stratified by sex and ethnicity separately and simultaneously. RESULTS:A total of 261 954 participants were included. Participants had a mean follow-up of 14.3 years for all-cause mortality (3 745 307 person-years, 9933 deaths) and 12.7 years for total CVD incidence (3 321 619 person-years, 64 748 events). Those in the most deprived neighbourhoods (compared with the least) had a 31%, 13%, 15% and 34% greater risk of all-cause mortality, incident total CVD, IHD and CeVD, respectively. Patterns of associations were somewhat similar by sex, yet varied by ethnicity. The overall results were consistent with the white cohort but not for the other cohorts. CONCLUSIONS:This study indicated that individuals living in highly deprived neighbourhoods may have an elevated risk of all-cause mortality and incident CVD, particularly among the white cohort but not other cohorts. Future research should focus on efforts to invest in deprived areas to alleviate the burden of all-cause mortality and CVD incidence.

AIMS/OBJECTIVE:This study tested direct and indirect associations between neighborhood social environments and type 2 diabetes (T2D), serially mediated via health-related (physical activity [PA], body mass index [BMI]), psychosocial factors, and inflammation. METHODS:Data came from the Midlife in the United States (MIDUS 3 [2013-2014] and MIDUS 3 Biomarker Project [2017-2022]; n = 518). T2D (yes/no) was based on the American Diabetes Association criteria. Perceived neighborhood social cohesion and safety were assessed separately (higher scores = more favorable neighborhoods). PA, BMI, perceived stress, depression, and c-reactive protein (CRP) were included as mediators in the associations between exposure and the outcome adjusting for covariates. RESULTS:Higher social cohesion was indirectly related to lower likelihood of T2D, serially mediated through PA, BMI, and CRP (odds ratio [OR] = 1.00 [95 % bias-corrected confidence interval [BC CI] = 0.99, 1.00]). Higher social cohesion and safety were indirectly associated with a lower likelihood of T2D, serially mediated via stress, depression, and CRP (Social cohesion: OR = 0.98 [95 % BC CI = 0.96, 1.00]; and safety: OR = 0.98 [95 % BC CI = 0.96, 1.00], all p < 0.05). CONCLUSIONS:This study may be the first to demonstrate underlying potential mechanisms through which socially cohesive and safe neighborhoods lower the risk of T2D. These pathways present potential targets for interventions to reduce the risk.

OBJECTIVE/UNASSIGNED:Despite persistent disparities in diabetes prevalence among racial and ethnic minorities, there remains a significant lack of understanding regarding the intersectionality of racial and ethnic groups and socioeconomic status (SES) with diabetes. METHODS/UNASSIGNED: = 30,754, mean age = 47.4) using cross-sectional survey cycles from 2007 to 2008 through 2017-2020. Diabetes status was self-reported by physician diagnosis. Sociodemographic factors included racial and ethnic groups and SES. Weighted Poisson models were used to examine the association of racial and ethnic groups and SES with diabetes, stratified by age groups (20-44, 45-64, 65-79), sex, and racial and ethnic groups for SES, separately. RESULTS/UNASSIGNED:Non-Hispanic Black, Hispanic, and other adults had a 47 %, 31 %, and 76 % higher prevalence of diabetes than non-Hispanic White adults, while adults from low and middle SES compared to high SES had a 37 % and 22 % higher prevalence of diabetes. Non-Hispanic Black, Hispanic, and other adults aged 45-64 years had a 45 %, 34 %, and 78 % higher prevalence of diabetes, and low and middle SES had a 57 % and 32 % higher prevalence of diabetes. Similar patterns were observed for adults aged 65-79. Males among non-Hispanic Black, Hispanic, and other adults and females from low and middle-SES families had a higher prevalence of diabetes. CONCLUSION/UNASSIGNED:Minority groups, middle and older-aged adults, males from minority groups, and females from low SES had a greater prevalence of diabetes. Effective interventions should prioritize tailoring efforts to specific minoritized and low SES groups to address diabetes disparities.