Faculty Bibliography

BACKGROUND:With increasing efforts to cultivate and foster a diverse physician workforce to improve the delivery of culturally responsive care, the accurate representation of Asian medical students continues to be obscured by aggregation of over 40 ethnic groups that are categorized as Asian race. OBJECTIVE:To describe representation of Asian ethnic groups among applicants and matriculants to US allopathic medical schools. DESIGN AND PARTICIPANTS: Cross-sectional study of applicant and matriculant data from 2020 to 2023, provided by the Association of American Medical Colleges, on self-reported Asian ethnic group and sex of medical school applicants and matriculants, compared with the American Community Survey population estimates of the typical medical school-aged population. MAIN MEASURES/METHODS:For each academic year, Asian ethnic group, and sex, the representation quotient (RQ), defined as the proportion of an ethnic group in the total population of medical school applicants or matriculants relative to the corresponding estimated proportion of that ethnic group in the US population, was calculated. We compared differences in applicant and matriculant RQs using t-tests for those with an RQ less than one. KEY RESULTS/RESULTS:Cambodian, Filipino, Indonesian, and Laotian applicants and matriculants were underrepresented in medicine with an RQ less than one. The RQ of Filipino females was lower than Filipino males among applicants and matriculants (p = 0.04 and 0.04, respectively). The RQ of Laotian and Filipino matriculants were lower than their respective applicant representation (p = 0.01 and 0.02, respectively). CONCLUSIONS:With disaggregated race and ethnicity data, we found significant variation in representation of Asian ethnic groups among medical school applicants and matriculants relative to the US population. Aggregating Asians into a single racial group conceals a more nuanced picture of representation in medicine, hindering efforts for a diverse workforce and improved patient care.

IMPORTANCE/UNASSIGNED:Membership in both the Alpha Omega Alpha (AOA) and Gold Humanism Honor Society (GHHS) is positively associated with career advancement. Prior studies have shown that Asian American medical students are less likely to be selected for these societies, but it is unknown whether representation among specific Asian American subgroups differ. OBJECTIVE/UNASSIGNED:To examine the association between AOA and GHHS membership and self-reported ethnicity among Asian American students at US doctor of medicine (MD)-granting medical schools. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This retrospective cross-sectional study analyzed deidentified data from the Association of American Medical Colleges, focusing on allopathic medical students graduating between 2018 and 2021. Data analysis was conducted from July 10, 2024, to January 26, 2026. EXPOSURE/UNASSIGNED:Self-reported race and Asian ethnicity. MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcome was AOA and GHHS membership at graduation. Multivariable logistic regression was performed, adjusting for Medical College Admission Test score, childhood income, sex, and sexual orientation, and clustered by medical school. RESULTS/UNASSIGNED:Among 55 632 graduating medical students, 28 127 (50.6%) self-identified as female and 10 867 (19.5%) as Asian American. AOA membership was reported by 10 126 students (18.2%), and GHHS membership was reported by 8623 students (15.5%). Bangladeshi (odds ratio [OR], 0.35; 95% CI, 0.20-0.61), Chinese (OR, 0.51; 95% CI, 0.44-0.58), Filipino (adjusted OR, 0.44; 95% CI, 0.29-0.65), Indian (OR, 0.56; 95% CI, 0.50-0.63), Japanese (OR, 0.48; 95% CI, 0.28-0.81), Korean (OR, 0.41; 95% CI, 0.33-0.51), Pakistani (OR, 0.46; 95% CI, 0.34-0.63), Taiwanese (OR, 0.38; 95% CI, 0.28-0.51), and Vietnamese (OR, 0.56; 95% CI, 0.45-0.71) students were less likely to be AOA members than White students. Chinese (OR, 0.67; 95% CI, 0.58-0.78), Korean (OR, 0.55; 95% CI, 0.43-0.69), and Taiwanese (OR, 0.67; 95% CI, 0.49-0.91) students were less likely to be GHHS members compared with White students. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This cross-sectional study of graduating medical students found widespread underrepresentation of most Asian American subgroups in AOA membership and for Chinese, Korean, and Taiwanese medical students in GHHS membership. This underscores the importance of disaggregating Asian American individuals in medicine to unmask disparities and provide opportunities to promote greater inclusion in medicine.

BACKGROUND:Chinese immigrants face numerous social determinants of health (SDOH) challenges that limit access to evidence-based diabetes self-management education and support programs (DSMES). To address these challenges, our team developed the LINK-IT intervention. This manuscript presents the study protocol for the LINK-IT trial. METHODS:The LINK-IT trial is a 12-month, 3-arm randomized controlled trial aiming to enroll 405 Chinese immigrants with T2D (HbA1c≥7%) from multiple community and clinical settings in New York City. A total of 405 participants will be randomly allocated to one of three groups (n = 135 per group): (1) video-based DSMES plus community health worker (CHW) support (VIDEO+CHW), (2) video-based DSMES only (VIDEO), or (3) wait-list control (CONTROL). The VIDEO+CHW group will receive 24 culturally and linguistically tailored DSMES videos (one per week for 24 weeks) delivered via text message links, along with biweekly (every other week) phone calls from trained CHWs to review video content, support goal setting, and address SDOH barriers. The VIDEO group will receive the same video intervention without CHW support. The CONTROL group will receive usual care and will be offered access to the videos upon study completion. The primary outcome is the change in HbA1c at 6 months. Secondary outcomes include changes in HbA1c at 12 months, self-efficacy for diabetes, dietary intake, physical activity, medication adherence and emotional support at 6 and 12 months. Data will be analyzed using an intention-to-treat approach with linear mixed-effects models. ETHICS AND DISSEMINATION/BACKGROUND:This study protocol has been approved by the Institutional Review Board of the NYU Grossman School of Medicine (S23-01274). All study procedures will adhere to the ethical principles outlined in the Declaration of Helsinki. Written or verbal informed consent will be obtained from all participants. Study results will be disseminated through peer-reviewed publications, presentations at scientific conferences, and community events. TRIAL REGISTRATION/BACKGROUND:The LINK-IT trial was registered on March 20, 2024, on ClinicalTrials.gov under the identifier NCT06319716; https://clinicaltrials.gov/study/NCT06319716.

Medical mistrust, clinical trial knowledge, and clinical trial risk impact research participation, yet are rarely studied among racial and ethnic groups. Data were from a cross-sectional survey (n = 1,794). Multinomial logistic regression models examined associations of medical mistrust, clinical trial knowledge, and clinical trial risk with willingness to participate in health research (Yes, No, Unsure) among Chinese, Korean, South Asian, Haitian, North American Latiné, South American Latiné, and Southwest Asian and North African (SWANA) NYC residents with one model per group. Overall, 46.0% of participants reported willingness to participate, ranging from 35.8% (Chinese participants) to 58.7% (South Asian participants). Increased mistrust was associated with less willingness among Chinese (OR: 1.06, 95%CI: 1.00, 1.12) and South American Latiné (OR: 1.15, 95%CI: 1.02, 1.30) participants; more willingness among Haitian participants (OR: 0.87, 95%CI: 0.81, 0.94); more uncertainty among Korean (OR: 1.13, 95%CI: 1.05, 1.22), South Asian (OR: 1.06 95%CI: 1.01, 1.12), and North American Latiné (OR: 1.18, 95%CI: 1.10, 1.28) participants; and less uncertainty among Haitian (OR: 0.91, 95%CI: 0.84, 0.99) and SWANA (OR: 0.91, 95%CI:0.86, 0.97) participants. Knowledge was associated with more willingness for Haitian participants (OR: 2.77, 95%CI: 1.15, 6.65), less willingness for Chinese participants (OR: 0.55, 95%CI: 0.34, 0.88), and more uncertainty among South Asian (OR: 2.09, 95%CI: 1.07, 4.07) and SWANA (OR: 2.71, 95%CI: 1.21, 6.03) participants. Some risk and more willingness were linked for South American Latiné participants (OR: 0.13, 95%CI: 0.02, 0.82). Associations varied by group. Studying multiple racial and ethnic groups advances equitable research representation.

BACKGROUND:New York City (NYC) Cancer Outreach Network in Neighborhoods for Equity and Community Translation (CONNECT) aims to address determinants of cancer screening and access disparities in low-income NYC neighborhoods with high cancer burden. OBJECTIVES/OBJECTIVE:NYC CONNECT community partners formed neighborhood action councils (NACs) and engaged in mixed-method formative research and an iterative consensus-building process to co-identify structural and social determinants of cancer screening. The NACs co-developed with health and academic partners community-level strategies to address structural determinants of health. The objective of this manuscript is to describe participatory processes to engage and support community partners in low-income and high poverty communities and the evaluation of their functioning within the context of a community-academic research partnership. METHODS:NYC CONNECT partnership development is informed by trauma-informed community building and community-based participatory research principles. Our mixed-methods partnership evaluation included surveys, qualitative interviews, and speaking time in meetings as a proxy for engagement. LESSONS LEARNED/CONCLUSIONS:Trauma-informed community building and community-based participatory research informed co-learning and consensus-building activities among the NACs. Identifying and prioritizing structural and social determinants of health strategies was a non-linear, iterative process that required multiple interactive activities (e.g., asset mapping, impact to effort matrix, and voting). CONCLUSION/CONCLUSIONS:Community engagement is a dynamic process that requires adapting to community partners' goals and sharing decision-making power.

Worldwide, over half of all individuals with dementia are undiagnosed. In the United States, racial, ethnic, and economic inequities mirror global findings, with higher rates of missed and delayed diagnosis and poorer diagnostic quality among minoritized and disadvantaged groups. For example, delayed diagnosis is more prevalent among people identifying as non-Hispanic Black or Latino than non-Hispanic White. Systematic efforts to improve detection can increase diagnosis rates; there is broad consensus that earlier detection and initiation of focused care and support services benefit both affected individuals and their loved ones. Systemic under-detection and its contributions to persistent population-level suffering underscore the importance of early detection of dementia as a key public health issue. Improving early detection calls for comprehensive, coordinated responses from local, regional, and national public health systems in partnership with health care delivery systems and community-based organizations. The Public Health Center of Excellence on Early Detection of Dementia (PHCOE on EDD), funded by the Centers for Disease Control and Prevention (CDC), is a national resource to promote understanding and implementation of evidence-based and evidence-informed public health strategy for early detection of dementia. We, together with the PHCOEs on Dementia Risk Reduction and Dementia Caregiving, and nearly four dozen state and local initiatives, seek to operationalize the priorities of the Building Our Largest Dementia Infrastructure for Alzheimer's Act and National Healthy Brain Initiative, established by federal legislation in 2018 and 2024. Our efforts support the CDC's mandate to build a national public health infrastructure for brain health and dementia.

INTRODUCTION/BACKGROUND:Chinese Americans are one of the fastest growing racial and ethnic groups and represent the largest subgroup of the Asian American population in the US and in New York City (NYC) where they number 573,528 in 2021. Despite their numbers, current pain perceptions, expectations, and attitudes of Chinese Americans remains poorly understood, especially as related to postoperative pain. OBJECTIVE:A better understanding of pain experience among Chinese American patients is needed to inform strategies on improving pain management satisfaction. METHODS:A total of 27 Chinese American postoperative patients from a NYC health system were recruited for face-to-face surveys and interviews with a trained bilingual and bicultural Community Health Worker. Questions from the Survey on Disparities in Quality of Healthcare and Kleinman's Explanatory Model of Illness were integrated into the survey and topic guide. Topics of discussion included satisfaction with healthcare and pain management during hospital stay and health beliefs and practices. RESULTS:More than half of participants experienced language challenges that made it difficult to communicate with healthcare staff. In general, high levels of satisfaction with pain management were reported; however, participants reported feeling less comfortable asking healthcare teams questions. Common themes across interviews included: (1) pain was an expected outcome of the procedure and was thus perceived as tolerable; (2) the wish to not be a burden to others; (3) concerns about side effects of pain medications; and (4) a cultural and language mismatch between healthcare teams and patients on words being used to elicit pain and discomfort. CONCLUSION/CONCLUSIONS:Our project findings can inform pain management strategies and tools to serve the Chinese American patient population.

Early childhood is a critical period for overall development and well-being, yet children from low-income and low-resourced families, such as Chinese American immigrant families, often have unmet mental health needs as they face additional barriers like limited English proficiency and health literacy. Cultural and linguistic adaptation is essential for equitable access to resources and care. Despite the need, early childhood mental health among Chinese American families remains significantly understudied. A digital mental health solution may pose greater access and convenience to address the mental health needs of this community. Thus, this study aims to collaboratively develop a web-based app called OurChild, which provides culturally and linguistically adapted early childhood mental health and development resources for Chinese American immigrant families in New York City. Using the Participatory Cultural Adaptation Framework for Implementation Research (PCAFIR), the project involves a multiphased participatory co-design process: 1. understanding community needs through formative research and engagement; 2. building a digital library with evidence-based and culturally tailored content; 3. designing a culturally tailored web-based app using a participatory approach; and 4. refining and validating the design through user testing. Informed by formative data from existing studies and programs; focus groups and interviews with community experts (n = 6) and parents (n = 11); user testing with parents (n = 11), and through an iterative re-design process, the app was designed to be user-friendly, culturally relevant, and evidence-based. This study described the co-design process and highlighted the lessons learned in developing culturally tailored digital health tools to promote digital health equity for underserved communities.