Faculty Bibliography

INTRODUCTION/UNASSIGNED:Poor dental health is linked to poor physical and mental health. This study was aimed to examine the characteristics of U.S. adults that are associated with having seen a dentist in the past year. METHODS/UNASSIGNED:A cross-section of adults aged 18-64 years (N=19,975) from the 2023 National Health Interview Survey was examined. Bivariate analyses examined the associations of sociodemographic and financial variables with recent dental visits in the last 12 months. Multinomial modeling was used to assess these variables to predict 3 outcomes of time since the last dental visit: in the last 12 months; over a year but <10 years; and over 10 years or never, which was the reference category. RESULTS/UNASSIGNED:In young and middle-aged adults, 4.8% of Americans, representing over 9 million people, had either never seen a dentist or not seen a dentist in 10 years or more. The likelihood of a dental visit in the last 12 months increased with education level (no high-school degree versus a graduate or professional degree [AOR=0.21, 95% CI=0.09, 0.50]) and income (income below the federal poverty line versus income in the highest quartile [AOR=0.20, 95% CI=0.11, 0.35]). Having dental coverage in a private plan or Medicaid, compared with having no coverage, predicted having a dental visit within the last 12 months in both multinomial and bivariate analyses. CONCLUSIONS/UNASSIGNED:Access to dental care in young and middle-aged adults is determined by financial ability. Increasing access to dental care could happen once the financial barriers to dental care are reduced, including increasing the age at which a young adult can be covered by a parent's plan and making dental coverage comparable with physical health coverage. Given the current data about the links between dental, mental, and physical health, parity for all care is warranted.

BACKGROUND:Glucagon-like peptide-1 (GLP-1) medications, recently introduced in the United States for treating type 2 diabetes and obesity, have sparked interest and discussion on social media. Social media has emerged as a prominent platform for the distribution of health information; its vast user base and accessibility make it a popular resource for individuals seeking medical advice. This study characterized GLP-1 medication-related content on Instagram about 3 critical areas of public health: women's health, access from nontraditional settings, and barriers to access. OBJECTIVE:This study aimed to perform passive content analysis in which information patterns would be observed from Instagram posts. METHODS:We examined 40 GLP-1 medication-related Instagram posts to develop a list of the most frequently used hashtags. In total, 10 "top posts" were collected for 7 days (July 11-17, 2023) for 11 study hashtags (eg, #Ozempic). Duplicates, deleted posts or accounts, non-English content, and unrelated posts were removed. Each post was reviewed by at least 2 coders. Coding discrepancies were resolved through discussion. RESULTS:The final sample included 239 posts. More than half of the posts (130/239, 54%) were from GLP-1 medication users. Raters perceived most users to be female (90/97, 92.8%); inferred that most used medications for weight loss (69/130, 53.1%); determined the most frequently noted health condition was polycystic ovarian syndrome (25/130, 19.2%); and judged posts to have positive sentiments about well-being (64/130, 49.2%) and toward the medications (100/130, 76.9%). About a quarter of the posts (55/239, 23%) offered services for obtaining GLP-1 medications; GLP-1 medications were perceived to be accessible via nontraditional health care settings (eg, medical spas) versus traditional settings (39/239,16.3% vs 12/239, 5%). Most users (78/97, 80.4%) were perceived to be White; barriers to access (ie, shortages, insurance, and cost) were infrequently mentioned (6/239, 2.5%; 3/239, 1.3%; and 1/239, 0.4%, respectively). CONCLUSIONS:Our findings highlight the perceived benefits of GLP-1 medications for women's health, the need to increase health literacy about where to safely access medications, and how additional attention is needed for equitable access to GLP-1 medications. The onus is on social media companies to promote content that is safe and for the health care system and its payers to address health care inequities for historically marginalized communities.

OBJECTIVE:This study examined racial and ethnic differences in percent total weight loss (%TWL) and glycemic improvement following sleeve gastrectomy (SG) and explored the role of socioeconomic and psychosocial factors in postsurgical outcomes. METHODS:This longitudinal study included patients who underwent SG between 2017 and 2020, with follow-up visits over 24 months. RESULTS:Non-Hispanic Black (NHB) participants had lower %TWL at 3, 12, and 24 months compared with Hispanic (H) and non-Hispanic White (NHW) participants. Fat mass index was initially lower in NHB, with smaller reductions over time and significant group differences persisting at 24 months. NHB participants had higher baseline fat-free mass index values; by 24 months, fat-free mass index values were lower in H participants. Hemoglobin A1c decreased across all groups but remained consistently higher in NHB and H compared with NHW at 24 months. NHB participants reported higher perceived discrimination, sleep disturbance, and perceived stress than H and NHW participants at all time points. Employment status predicted %TWL at 12 months. There was a significant interaction between race and ethnicity and employment status observed at 12 and 24 months, suggesting that employment-related disparities could impact surgical outcomes. CONCLUSIONS:NHB participants experienced less favorable outcomes following SG, emphasizing the need for tailored interventions addressing socioeconomic and psychosocial disparities.

PurposeTo evaluate the association between demographic characteristics and weight-loss in response to financial incentives designed using behavioral economics.DesignRetrospective analysis of randomized clinical trial (RCT).SettingFIReWoRk RCT (NCT03157713), which found that financial incentives were more effective than provision of weight-management resources only for weight-loss.Subjects668 adults with obesity (221 in resources-only group, 447 in incentive groups) living in low-income neighborhoods.MeasuresDemographic characteristics and weight-loss.AnalysisLinear mixed-effects models with interaction terms to examine effect of incentives on weight-loss in different demographic groups.ResultsMean age of participants was 47.69 years, 81.0% were women, 72.6% were Hispanic, and mean BMI was 37.95 kg/m². Financial incentives increased percent weight loss at 6 months (difference in percent weight loss between financial incentive and resources-only group = -2.41%; 95% CI -3.23% to -1.58%). In fully adjusted models, participants who were Black lost less weight than participants who were White (difference in percent weight loss = 2.12%; 95% CI 0.25% to 3.99%). Differences in percent weight loss by sex, age, education and neighborhood income were absent. Models that tested for interactions between group assignment and percent weight loss did not demonstrate evidence of a heterogenous effect of incentives in sociodemographic subgroups.ConclusionBlack participants in the FIReWoRk intervention lost less weight than White participants, but effectiveness of financial incentives generally did not vary significantly by sociodemographic characteristics. However, it remains important to evaluate potential impacts of financial incentive programs on health disparities.

Access to an academic clinical research center (CRC) in health professional shortage areas (HPSA) can help address healthcare disparities and increase research accessibility and enrollment. Here we describe the development of a community-centered CRC in the underserved area of Sunset Park, Brooklyn, New York, centered within a larger academic health network and the evaluation of its outcomes within the first two years. In addition to resources and space, establishment of the CRC required a culturally competent and multilingual team of healthcare professionals and researchers and buy-in from the community. Between 1/2022 and 12/2023, the CRC opened 21 new trials (10 interventional and 11 noninterventional) with greater than 500 participant visits that reflect the racial and ethnic diversity of the community. These participants represent 110 distinct zip codes; 76% of these zip codes are underserved and designated HPSA. 60% self-identified as non-White and 20% identified as Hispanic, with 12 other distinct ethnicities represented. 28% of participants speak 11 languages other than English. Community-based CRCs can be created with sustainable growth to align with the mission of the National Institutes of Health and U.S. Food and Drug Administration to meet the ever-growing clinical, social, and research needs of the communities they serve.

Heavy drinking is a major public health concern, particularly among young adults who often experience fear of being stigmatized when seeking help for alcohol-related problems. To address drinking concerns outside clinical settings, we tested the feasibility of a novel imagery-based behavior change strategy led by student lay interventionists in a college setting. Participants were adults recruited on a college campus and were randomized to either learn the four steps of WOOP (Wish, Outcome, Obstacle, and Plan) or to learn a format-matched Sham WOOP (Wish, Outcome, "Outcome," and Plan). Both WOOP and Sham WOOP interventions were taught by student lay interventionist. We found that the WOOP intervention group reported fewer heavy drinking days (≥ 5 drinks for men or ≥ 4 drinks for women, measured using the Alcohol Timeline Follow-Back Method) compared to the Sham group at the 1-month and 2-month follow-ups. WOOP, when taught by student lay interventionists in a single session, demonstrated the feasibility of reducing heavy drinking. WOOP shows promise as a low-cost and scalable intervention for reducing heavy drinking in nonclinical settings.