Faculty Bibliography

In spite of the many studies examining alcohol consumption, recent reviews have indicated that binge drinking has not been extensively studied. Furthermore, it is becoming increasingly clear that sleep is associated with many physiological functions and to drug addictions. The present study aimed to evaluate the relationship between alcohol binge drinking and insomnia in college students of health sciences. All first-year health sciences students (n=286) were evaluated in a cross-sectional study. Envelopes containing the Insomnia Severity Index (ISI), the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), and questions capturing sociodemographic data were distributed and collected in classes. It was found that most non-drinkers were female (70.6%), although there were no sex-related differences in the number of binge drinkers (more than 5 drinks on each occasion at least once a week), allowing statistical comparison. The Mann-Whitney U test indicated that the ISI scores were significantly greater in female than male binge drinkers (P=0.014). Moderate or severe insomnia was reported by 23% of the sample, with alcohol being the most frequently associated substance. A specialized intervention was suggested by ASSIST: brief for marijuana (19.2%) and tobacco (23.3%) use, and moderate (31.5%) or intensive (1.4%) for alcohol consumers. The data highlighted the need to pay attention to the habits of college students beyond obtaining scientific information. New data suggesting the influence of genetics on insomnia may be of importance when performing additional studies on the sex differences in alcohol binge drinking.

BACKGROUND AND OBJECTIVES/UNASSIGNED:The effect of the ambient environment, sound, light, and movement, on the nighttime rest-activity of patients hospitalized with moderate-severe traumatic brain injury (TBI) is poorly understood. The purpose of this study was to examine how sound, light, and movement in these patients' hospital rooms may contribute to nighttime awakenings. METHODS/UNASSIGNED:An observational design was used with 18 adult participants on a neuroscience step-down unit diagnosed with moderate-severe TBI. For up to five consecutive nights, actigraphy was used to capture nighttime awakenings while a custom-made multisensory device captured sound, light, and movement exposures in the participant's room. RESULTS/UNASSIGNED:< .05), but reductions in light did not. CONCLUSION/UNASSIGNED:The ambient environment seems to impede restful sleep in immediate post-injury phase of patients with moderate-severe TBI.

Introduction: Previous studies have linked sleep to risk of diabetes and obesity, at least partially via alterations in food intake. Diabetes and obesity are common among Hispanics/Latinos, and studies are needed to better clarify the role of sleep in health among this group. Utilizing the revised TFEQ-R-18, this study will examine whether eating behaviors such as cognitive restraint, emotional eating and uncontrolled eating are related to self-reported sleep experiences. Specifically, we hypothesized that poor eating habits would be associated with (1) more insomnia symptoms, (2) overall worse sleep quality, (3) increased daytime sleepiness, and (4) shorter sleep duration.Methods: Data were collected from N = 100 adults (age 18-60, 47% female) of Mexican descent in the city of Nogales, AZ (34% not born in the US). Surveys were presented in English or Spanish. Eating Patterns were assessed with the Three-Factor Eating Questionnaire (TFEQ), which resulted in a total score and subscales for "cognitive restraint," "uncontrolled eating," and "emotional eating." Insomnia was assessed with the use of the Insomnia Severity Index (ISI), Sleepiness with the use of the Epworth Sleepiness Scale (ESS), Sleep quality with the use of the Pittsburgh Sleep Quality Index (PSQI), and weekday and weekend sleep duration with the use of the Sleep Timing Questionnaire (STQ). Covariates included age, sex, Body Mass Index (BMI), education and immigrant status.Results: Overall TFEQ score (problematic eating) was positively associated with greater insomnia, poorer sleep quality, more sleepiness, and less weekend (but not weekday) sleep. Mean TFEQ score in the sample was 18.7 (range 0-51). In adjusted analyses, every point on the TFEQ was associated with 0.6 ISI points, 0.8 PSQI points, 0.5 ESS points, and 1.1 minutes of less weekend sleep duration. Regarding subscale scores, relationships were generally seenbetween sleep and emotional eating and unrestricted eating, and not cognitive restraint.Conclusions: Greater insomnia, poorer sleep quality, increased daytime sleepiness and decreased weekend sleep duration were associated with eating patterns at the US-Mexico border, particularly in the area of unrestricted eating and emotional eating. This suggests possible mechanisms linking sleep and obesity in Hispanic/Latinos.

We examined the relative contribution of pulmonary diseases (chronic obstructive pulmonary disease, asthma and sleep apnea) to mortality risks associated with Coronavirus Disease (COVID-19) independent of other medical conditions, health risks, and sociodemographic factors. Data were derived from a large US-based case series of patients with COVID-19, captured from a quaternary academic health network covering New York City and Long Island. From March 2 to May 24, 2020, 11,512 patients who were hospitalized were tested for COVID-19, with 4,446 (38.62%) receiving a positive diagnosis for COVID-19. Among those who tested positive, 959 (21.57%) died of COVID-19-related complications at the hospital. Multivariate-adjusted Cox proportional hazards modeling showed mortality risks were strongly associated with greater age (HR = 1.05; 95% CI: 1.04-1.05), ethnic minority (Asians, Non-Hispanic blacks, and Hispanics) (HR = 1.26; 95% CI, 1.10-1.44), low household income (HR = 1.29; 95% CI: 1.11, 1.49), and male sex (HR = 0.85; 95% CI: 0.74, 0.97). Higher mortality risks were also associated with a history of COPD (HR = 1.27; 95% CI: 1.02-1.58), obesity (HR = 1.19; 95% CI: 1.04-1.37), and peripheral artery disease (HR = 1.33; 95% CI: 1.05-1.69). Findings indicate patients with COPD had the highest odds of COVID-19 mortality compared with patients with pre-existing metabolic conditions, such as obesity, diabetes and hypertension. Sociodemographic factors including increased age, male sex, low household income, ethnic minority status were also independently associated with greater mortality risks.

(1) Background: Unhealthy sleep durations (short and long sleep) are associated with emotional distress (ED). Minority populations, specifically Blacks, are more burdened with unhealthy sleep durations and ED. The ameliorative effect of physical activity (PA) on ED and sleep duration may provide insight into how to reduce the burden among Blacks and other minorities. However, it is unclear whether PA attenuates the relationship between sleep and ED, and whether this relationship differs by race. (2) Methods: We analyzed data from the nationally representative 2005-2015 National Health Interview Survey (NHIS) dataset. ED, physical activity, and sleep duration were collected through self-reports. Regression analyses investigated the moderating effect of PA on the relationship between sleep and ED (adjusting for age, sex, BMI, and employment status) and stratified by race. (3) Results: We found that sleep duration was independently associated with ED. Physical activity moderated the relationship between sleep and ED, the full population, and Whites, but not Blacks. (4) Conclusion: PA moderated the relationship between short, average, or long sleep and ED, but in stratified analyses, this was only evident for Whites, suggesting Blacks received differing protective effects from physical activity. Further research should be performed to understand the connection of physical activity to sleep and mental health.

PURPOSE OF REVIEW/OBJECTIVE:The mental health toll on populations exposed to COVID-19 is alarming, and there is a need to address this with urgency. This current review provides insights on how individuals, communities, and specific populations, such as healthcare workers and patients are leveraging pre-COVID-19 and peri-COVID-19 factors to reinforce their psychological resilience during the global public health crisis. RECENT FINDINGS/RESULTS:Examination of the extant literature indicated that populations around the world rely often on support from their loved-ones, closed significant others, outdoor and physical activities, and spirituality to cope with the COVID-19-related distress. Increased sense of meaning/purpose since the COVID-19 pandemic was also reported. SUMMARY/CONCLUSIONS:A portion of publications provided intervention models to reinforce resilience among specific populations during the COVID-19 pandemic. Nevertheless, it is not convincing that some of these models can be applied universally. Additionally, it is important to note that in this category, translational data was scarce.

OBJECTIVES/OBJECTIVE:The objective of the present study is to identify which underlying beliefs about the impact of sleep on health may motivate change in sleep behavior. DESIGN/METHODS:A cross-sectional study conducted between 2012 and 2014. SETTING/METHODS:Data were from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study conducted in Philadelphia, PA, and its surrounding regions. PARTICIPANTS/METHODS:Participants consisted of N = 1007 community-dwelling adults age 22-60. MEASUREMENTS/METHODS:Respondents indicated behaviors they could improve on to facilitate sleep and their corresponding readiness to change. They were also asked items from the Sleep Practices and Attitudes Questionnaire (SPAQ) regarding the degree to which they agree with whether "not getting enough sleep" can impact a variety of health factors. RESULTS:In adjusted analyses, stage of change was associated with degree of agreement that insufficient sleep can cause sleepiness (odds ratio [OR] = 1.17, P = .035), weight gain (OR = 1.20, P < .0005), heart disease (OR = 1.21, P = .001), cholesterol (OR = 1.13, P = .047), hypertension (OR = 1.16, P = .014), moodiness (OR = 1.42, P < .0005), decreased energy (OR = 1.30, P = .002), absenteeism (OR = 1.13, P = .007), decreased performance (OR = 1.20, P = .003), concentration/memory problems (OR = 1.23, P = .004), diabetes (OR = 1.14, P = .042), and feeling tired (OR = 1.39, P < .0005). When sleep duration was added to the model, significant associations remained for all except cholesterol. When accounting for insomnia, significant associations were maintained for only weight, moodiness, performance, diabetes, and tiredness. CONCLUSIONS:Degree of belief that insufficient sleep can cause outcomes such as moodiness, occupational problems, and health problems may impact whether an individual is contemplating/attempting to change their sleep-related behaviors. Targeting these key messages about the associations between sleep health with moodiness and weight gain in informational material may enhance education/outreach efforts aimed at adults.

This study explored the divergence in population-level estimates of insufficient sleep (<6 h) by examining the explanatory role of race/ethnicity and contrasting values derived from logistic and Poisson regression modeling techniques. We utilized National Health and Nutrition Examination Survey data to test our hypotheses among 20-85 year-old non-Hispanic Black and non-Hispanic White adults. We estimated the odds ratios using the transformed logistic regression and Poisson regression with robust variance relative risk and 95% confidence intervals (CI) of insufficient sleep. Comparing non-Hispanic White (10176) with non-Hispanic Black (4888) adults (mean age: 50.61 ± 18.03 years, female: 50.8%), we observed that the proportion of insufficient sleepers among non-Hispanic Blacks (19.2-26.1%) was higher than among non-Hispanic Whites (8.9-13.7%) across all age groupings. The converted estimated relative risk ranged from 2.12 (95% CI: 1.59, 2.84) to 2.59 (95% CI: 1.92, 3.50), while the estimated relative risks derived directly from Poisson regression analysis ranged from 1.84 (95% CI: 1.49, 2.26) to 2.12 (95% CI: 1.64, 2.73). All analyses indicated a higher risk of insufficient sleep among non-Hispanic Blacks. However, the estimates derived from logistic regression modeling were considerably higher, suggesting the direct estimates of relative risk ascertained from Poisson regression modeling may be a preferred method for estimating population-level risk of insufficient sleep.

Importance/UNASSIGNED:Black and Hispanic populations have higher rates of coronavirus disease 2019 (COVID-19) hospitalization and mortality than White populations but lower in-hospital case-fatality rates. The extent to which neighborhood characteristics and comorbidity explain these disparities is unclear. Outcomes in Asian American populations have not been explored. Objective/UNASSIGNED:To compare COVID-19 outcomes based on race and ethnicity and assess the association of any disparities with comorbidity and neighborhood characteristics. Design, Setting, and Participants/UNASSIGNED:This retrospective cohort study was conducted within the New York University Langone Health system, which includes over 260 outpatient practices and 4 acute care hospitals. All patients within the system's integrated health record who were tested for severe acute respiratory syndrome coronavirus 2 between March 1, 2020, and April 8, 2020, were identified and followed up through May 13, 2020. Data were analyzed in June 2020. Among 11 547 patients tested, outcomes were compared by race and ethnicity and examined against differences by age, sex, body mass index, comorbidity, insurance type, and neighborhood socioeconomic status. Exposures/UNASSIGNED:Race and ethnicity categorized using self-reported electronic health record data (ie, non-Hispanic White, non-Hispanic Black, Hispanic, Asian, and multiracial/other patients). Main Outcomes and Measures/UNASSIGNED:The likelihood of receiving a positive test, hospitalization, and critical illness (defined as a composite of care in the intensive care unit, use of mechanical ventilation, discharge to hospice, or death). Results/UNASSIGNED:Among 9722 patients (mean [SD] age, 50.7 [17.5] years; 58.8% women), 4843 (49.8%) were positive for COVID-19; 2623 (54.2%) of those were admitted for hospitalization (1047 [39.9%] White, 375 [14.3%] Black, 715 [27.3%] Hispanic, 180 [6.9%] Asian, 207 [7.9%] multiracial/other). In fully adjusted models, Black patients (odds ratio [OR], 1.3; 95% CI, 1.2-1.6) and Hispanic patients (OR, 1.5; 95% CI, 1.3-1.7) were more likely than White patients to test positive. Among those who tested positive, odds of hospitalization were similar among White, Hispanic, and Black patients, but higher among Asian (OR, 1.6, 95% CI, 1.1-2.3) and multiracial patients (OR, 1.4; 95% CI, 1.0-1.9) compared with White patients. Among those hospitalized, Black patients were less likely than White patients to have severe illness (OR, 0.6; 95% CI, 0.4-0.8) and to die or be discharged to hospice (hazard ratio, 0.7; 95% CI, 0.6-0.9). Conclusions and Relevance/UNASSIGNED:In this cohort study of patients in a large health system in New York City, Black and Hispanic patients were more likely, and Asian patients less likely, than White patients to test positive; once hospitalized, Black patients were less likely than White patients to have critical illness or die after adjustment for comorbidity and neighborhood characteristics. This supports the assertion that existing structural determinants pervasive in Black and Hispanic communities may explain the disproportionately higher out-of-hospital deaths due to COVID-19 infections in these populations.

BACKGROUND:Social media platforms have created a new advertising frontier, yet little is known about the extent to which this interactive form of advertising shapes adolescents' online relationships with unhealthy food brands. OBJECTIVE:We aimed to understand the extent to which adolescents' preferences for Instagram food ads are shaped by the presence of comments and varying numbers of "likes." We hypothesized that adolescents would show the highest preferences for ads with more "likes" and comments. We predicted that these differences would be greater among adolescents who were "heavy social media users" (ie, >3 hours daily) vs "light social media users" (ie, <3 hours daily). METHODS:We recruited Black and non-Latinx White adolescents (aged 13-17 years; N=832) from Dynata, a firm that maintains online participant panels. Participants completed an online survey in which they were randomized to view and rate Instagram food ads that either did or did not show comments. Within each condition, adolescents were randomized to view 4 images that had high (>10,000), medium (1000-10,000), or low (<100) numbers of "likes." Adolescents reported ad preferences and willingness to engage with the brand. RESULTS:Adolescents rated ads with medium or high numbers of "likes" higher than ads with few "likes" (P=.001 and P=.002, respectively). Heavy social media users (>3 hours/day) were 6.366 times more willing to comment on ads compared to light users (P<.001). CONCLUSIONS:Adolescents interact with brands in ways that mimic interactions with friends on social media, which is concerning when brands promote unhealthy products. Adolescents also preferred ads with many "likes," demonstrating the power of social norms in shaping behavior. As proposed in 2019, the Children's Online Privacy and Protection Act should expand online advertising restrictions to include adolescents aged 12 to 16 years.