Faculty Bibliography

BACKGROUND:Adult females of reproductive age (18-44 years) with disabilities have higher rates of health-risk behaviors and chronic conditions compared to their counterparts without disabilities; however, there is limited examination of diet. OBJECTIVE:To examine associations of self-reported disability status with diet quality and diet-related factors. DESIGN/METHODS:Cross-sectional data were from the National Health and Nutrition Examination Surveys, 2013-2018. PARTICIPANTS/SETTING/METHODS:Adult females aged 18-44 years were included. Disability was defined as serious difficulty hearing, seeing, concentrating, walking, dressing, and/or running errands due to physical, mental, or emotional conditions. MAIN OUTCOME MEASURES/METHODS:The Healthy Eating Index (HEI)-2015 assessed diet quality. Diet-related factors included self-rated diet healthfulness, meal characteristics, food security, and food assistance programs. STATISTICAL ANALYSIS/METHODS:Multivariable linear regression estimated differences in HEI-2015 scores for a given day and multivariable Poisson regression estimated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) of diet-related factors by disability status. RESULTS:Of 3,579 adult females, 557 (16%) reported any disabilities, 207 (6%) of whom reported having two or more types of disabilities. Differences in mean HEI-2015 scores for a given day were one third to half of a point lower for fruits, total protein foods, and seafood/plant proteins among females with two or more types of disabilities compared to those without disabilities. Females with any disabilities were more likely to rate their diet as poor, have low food security, participate in food assistance programs, and consume frozen foods/pizza compared to those without disabilities (aPR ranged from 1.35 to 1.93); they were less likely to be the main food planner/preparer or shopper for their households. CONCLUSIONS:Some indicators of diet quality and diet-related factors differed between adult females with and without disabilities. Further investigation of dietary intakes and behaviors, as well as access to and availability of healthy foods, among females with disabilities is necessary.

Caring for individuals with autism spectrum disorder (ASD) can be complicated, especially when challenging behaviors are present. Providers may feel unprepared to work with these individuals because specialized training for medical and social service providers is limited. To increase access to specialized training, we modified an effective half-day ASD-Care Pathway training (Kuriakose et al. 2018) and disseminated it within five different settings. This short, focused training on strategies for preventing and reducing challenging behaviors of patients with ASD resulted in significant improvements in staff perceptions of challenging behaviors, increased comfort in working with the ASD population, and increased staff knowledge for evidence-informed practices. Implications, including the impact of sociodemographic characteristics on pre/post changes, and future directions are discussed.

Elevated exposure to multiple trace metals can be neurotoxic even at relatively low levels. These findings are primarily evident from adult occupational studies as well as in children exposed prenatally or in early childhood. Less research has focused on the neurodevelopmental impacts of exposure to metals among school-aged children. We examined associations between exposure to a mixture of four metals (arsenic, cadmium, manganese, lead) measured in hair and markers of cognition, attention, and behavior among 222 6-12 year old children who participated in a 2009-2010 neurodevelopmental follow-up to the C8 Health Project. Using quantile-based g-computation we estimated the adjusted overall metal mixture effect ψ (95 % CI) as the change in outcome per decile increase in all metals in the mixture. Hair metal levels varied by metal, with cadmium being lowest (median 0.007, interquartile range (IQR) 0.013 μg/g) and lead the highest concentration (median 0.152, IQR 0.252 μg/g). Children's cognitive skills and development, attention/impulsivity, and behavior were all close to standardized population means. Each decile increase in all metals was associated with a Full Scale IQ reduction of 1.01 points (95 % confidence interval (CI) -1.88, -0.15) and Verbal IQ reduction of 1.11 points (95 % CI -1.97, -0.25), adjusted for child age, sex, secondhand smoke exposure, HOME score, maternal education, maternal IQ, and examiner. Maternal report of ADHD-like behaviors and executive functioning also showed adverse associations with the metal mixture. Our findings suggest that similar to exposure during prenatal and early childhood periods, recent exposure to metals during middle childhood is associated with adverse neurodevelopmental consequences. Middle childhood may also be a developmental window of susceptibility to the negative consequences of exposure to environmental neurotoxicants.

BACKGROUND:The association between adversity and psychopathology in adolescents and adults is characterized by equifinality. These associations, however, have not been assessed during early childhood when psychopathology first emerges. Defining adversity using both dimensional and cumulative risk approaches, we examined whether specific types of adversity are differentially associated with psychopathology in preschool-aged children. METHODS:Measures of threat, deprivation, and total adversities (i.e., cumulative risk) were calculated based on parent-reported information for 755 2- to 5-year old children recruited from pediatric primary care clinics. Logistic regression was used to estimate cross-sectional associations between type of adversity and anxiety, depression, ADHD, and behavioral disorder diagnoses. RESULTS:Threat and cumulative risk exhibited independent associations with psychopathology. Threat was strongly related to behavioral disorders. Cumulative risk was consistently related to all psychopathologies. CONCLUSIONS:Using mutually adjusted models, we identified differential associations between threat and psychopathology outcomes in preschool-aged children. This selectivity may reflect different pathways through which adversity increases the risk for psychopathology during this developmentally important period. As has been observed at other ages, a cumulative risk approach also effectively identified the cumulative impact of all forms of adversity on most forms of psychopathology during early childhood.

This study examined product use among pregnant women and new mothers in New York City during the COVID-19 pandemic (July 2020-June 2021). Women reported use of personal care and household cleaning products within the previous month, changes in antibacterial product use, receipt of healthcare provider advice, and opinions on environmental chemicals (n = 320). On average, women used 15 personal care products and 7 household cleaning products. Non-Hispanic Black women used nearly two more personal care products; non-Hispanic Black women, those with a college degree, and essential workers used 1-3 more household cleaning products. Women who were Hispanic or reported their race and ethnicity as Other were two times more likely to use antibacterial personal care products. Non-Hispanic Black, Hispanic, and women who reported their race and ethnicity as Other were 1.5 times more likely to increase antibacterial product use during the pandemic. Nearly all women agreed that environmental chemicals pose health risks and are impossible to avoid, while less than one quarter received advice regarding product use. Product use is a modifiable source of chemical exposures. Results from this study suggest that women may have increased their product use during the pandemic. Healthcare providers may use the current focus on health hygiene to promote discussion and assessment of environmental chemical exposures with patients.

Background:Previous studies demonstrated that when the violence-exposed child becomes a mother and interacts with her own child during early sensitive periods for social-emotional development, she may have difficulties providing sensitive responsiveness to the child's emotional communication. Such difficulties place the child's development of emotional comprehension (EC) and related self-regulation at risk. The aim of this study was to examine how mothers' interpersonal violence-related posttraumatic disorder (IPV-PTSD) would affect their children's EC and their own ability to predict their children's EC. We also investigated how mothers' predictive ability would correlate with child psychopathology. Methods:Sixty-one mother-child dyads (36 with IPV-PTSD) participated in this study. Children's (mean age = 7.0 years, SD = 1.1) EC was assessed with the Test of Emotion Comprehension (child TEC) and their psychopathology as reported by the mother was assessed with the Child Behaviour Checklist (CBCL) and as evaluated by a clinician using selected modules of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Mothers were measured for IPV-PTSD with the Clinician Administered PTSD Scale (CAPS) and for their capacity to predict their child's emotional comprehension (mother-responding-as-child TEC; mTEC). Results:We found no significant between-group differences in children's level of EC. Maternal PTSD was associated with lower scores on the mTEC, however. Reduced maternal scores on the mTEC were significantly associated with maternal report of increased aggressive child behaviour and with depression symptoms on the K-SADS. Further, scores on the mTEC interacted with maternal report of child aggression on child oppositional defiant disorder (ODD) symptoms on the K-SADS. Conclusion:These findings support that improving maternal emotional comprehension may help reduce child risk for psychiatric morbidity in this population.

OBJECTIVE:This study aimed to characterize suicide risk screening results for youth in pediatric ambulatory subspecialty clinics. METHOD/METHODS:The Ask Suicide-Screening Questions was administered to patients ages 9-24 years in 12 subspecialty clinics to assess suicide risk, determined by suicide ideation/behavior. The SAMSHA-HRSA standard framework for integrated health was used to categorize each clinic's level of behavioral health integration. RESULTS:6365 patients completed 7440 suicide risk screens; 6.2% of patients screened positive at their initial screen and 4.1% at subsequent annual screens. There was no dose-response pattern between increasing level of integration and decreasing likelihood of a positive suicide screen. Youth identifying as gender expansive were 3.1 times (95% CI [2.0, 4.9]) more likely to screen positive as compared to cisgender youth, adjusted for age, gender, race/ethnicity, screen type, year, and clinic integration level. CONCLUSION/CONCLUSIONS:Results surrounding disparities in suicide risk based on gender identity underscore the importance of further investigating how to optimally identify and manage high-risk, often understudied youth at suicide risk.

BACKGROUND:Disability among women of reproductive age is common; many of these women desire children and do not have impaired fertility. OBJECTIVES/OBJECTIVE:To examine the epidemiological literature on perinatal health outcomes among women with physical disabilities. DATA SOURCES/METHODS:We searched Medline and CINAHL for articles published January 2009-April 2020 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. STUDY SELECTION AND DATA EXTRACTION/METHODS:Eligible studies were observational, quantitative, and reported on physical disabilities in association with prenatal, perinatal, postpartum, and/or infant health outcomes. We included studies that grouped physical and non-physical disabilities, such as surveys that queried only about general daily life limitations. We excluded case reports, descriptive studies without comparison groups, and studies conducted in low- or middle-income countries. Data extraction was done using predefined data fields. SYNTHESIS/RESULTS:All authors were involved in screening activities, data extraction, and/or quality assessment (rating and areas for bias). RESULTS:A total of 2650 articles were evaluated, of which sixteen met inclusion criteria (8 cross-sectional studies and 8 retrospective cohort studies). Assessments of disability status and perinatal outcomes widely varied across studies. Studies were rated as poor (n = 8) or fair quality (n = 8). Findings suggested that women with physical disabilities were at risk of several adverse outcomes, including caesarean delivery, infections, preterm complications, and maternal post-delivery hospitalisations, while their infants may be at risk of low birthweight and small-for-gestational age. Women classified as having complex/severe disabilities were often observed to be at higher risk of adverse outcomes compared to women with less severe disabilities. CONCLUSIONS:Research assessing how physical, functional, and medical restrictions influence health outcomes among women with physical disabilities, from preconception through postpartum, is limited. Longitudinal studies with comprehensive data collection that accurately identify women with physical disabilities are critical to understanding their reproductive health risks and outcomes.

Decline in cognitive functioning among rescue and recovery workers who responded in the aftermath of the September 11, 2001, World Trade Center (WTC) attacks is of emerging interest. Responders are vulnerable to cognitive decline from exposure to airborne toxins present at the WTC site, as well as from WTC-related mental and physical health conditions. To better understand the relationship between occupational WTC exposure, mental health, physical health and subjective cognitive functioning, we examined the mediating role of health status in the association between exposure and subjective cognitive concerns in a multi-site, longitudinal investigation of the WTC General Responder cohort (n = 16,380 responders; n = 58,575 visits) for the period 2002-2015. Through latent class analyses, we identified a four-level marker of cognitive concerns based on information from a Self-Administered Mental Health Questionnaire. Using generalized linear mixed models with random intercepts, we observed that a higher intensity WTC exposure composite was associated with greater cognitive concerns, and that this association was operating almost entirely through mental health comorbidities, not physical health comorbidities. In fully adjusted models, the inclusion of probable depression, anxiety, PTSD and use of psychotropic medications attenuated the association between highest WTC exposure and greatest cognitive concerns. Physical health did not appear to be on the pathway between WTC exposure and cognitive concerns. Understanding the underlying sources of cognitive concerns may help identify vulnerable members of the General Responder cohort and potentially aid clinical decision-making, such as treatment choice and enhanced screening options. Earlier diagnosis and symptom treatment may help preserve functional independence.