Faculty Bibliography

OBJECTIVE:We discuss implications of potential ascertainment biases for studies examining diabetes risk following SARS-CoV-2 infection using electronic health records (EHRs). We quantitatively explore sensitivity of results to misclassification of COVID-19 status using data from the U.S.-based Diabetes in Children, Adolescents and Young Adults (DiCAYA) Network on children (≤17 years) and young adults (18-44 years). MATERIALS AND METHODS/METHODS:In our retrospective case study from the DiCAYA Network, SARS-CoV-2 was identified using labs and diagnoses from June 1, 2020 to December 31, 2021. Patients were followed through December 31, 2022 for new diabetes diagnoses. Sites examined incident diabetes by COVID-19 status using Cox proportional hazards models. Results were pooled in meta-analyses. A bias analysis examined potential impact of COVID-19 misclassification scenarios on results, guided by hypotheses that sensitivity would be <50% and would be higher among those who developed diabetes. RESULTS:Prevalence of documented COVID-19 was low overall and variable across sites (children: 4.4%-7.7%, young adults: 6.2%-22.7%). Individuals with documented COVID-19 were at higher risk of incident diabetes compared to those with no documented infection, but results were heterogeneous across sites. Findings were highly sensitive to COVID-19 misclassification assumptions. Observed results could be biased away from the null under several differential misclassification scenarios. DISCUSSION/CONCLUSIONS:Although EHR-based documentation of COVID-19 was associated with incident diabetes, COVID-19 phenotypes likely had low sensitivity, with considerable variation across sites. Misclassification assumptions strongly impacted interpretation of results. CONCLUSION/CONCLUSIONS:Given the potential for low phenotype sensitivity and misclassification, caution is warranted when interpreting analyses of COVID-19 and incident diabetes using clinical or administrative databases.

This study investigates associations between the strength of local Tobacco Retail Licensing (TRL) laws and adult tobacco use patterns (i.e., cigarette, e-cigarette, and dual use), and differences by sociodemographic characteristics, using California as a case study. We merged data from the American Lung Association's (ALA) State of Tobacco Control Reports and the California Health Interview Survey (CHIS) from 2016 to 2022. We recoded the ALA local policy grades as strongest (highest grade) versus weaker (all other grades). Using quantitative methods, we estimated multilevel multinomial logistic regression models to examine the relationship between the strength of local TRL laws and cigarette and e-cigarette single and dual use among adults aged 25 and older, nesting by city/town. We also examined the potential for effect modification by including interaction terms for race and ethnicity, income, and education in separate models. Our results showed that no associations existed between stronger TRL grades and exclusive cigarette, e-cigarette or dual use in any of the models. Neither were there statistically significant interactions by race and ethnicity, income, or education. These null findings suggest that while TRL laws may potentially be useful to restrict adolescent access, local TRL strength may have few impacts on adult nicotine consumption.

PURPOSE/OBJECTIVE:Adolescents with internalizing mental health (IMH) symptoms are more likely to use nicotine/tobacco products; however, the association with gender identity remains unclear. We examined differences in the relationship between IMH symptoms and nicotine/tobacco use by gender identity. METHODS:= 28,959). Current nicotine/tobacco use was categorized as: (1) no use, (2) exclusive combustible product use, (3) exclusive noncombustible product use, and (4) use of both product types. Current depression and anxiety symptoms were aggregated into an IMH symptoms variable (yes/no). Gender identity was determined based on responses to questions regarding current gender identity and sex assigned at birth. Analyses examined differences in IMH symptoms and nicotine/tobacco use by gender identity and the potential moderating role of gender identity in the relation between IMH symptoms and nicotine/tobacco use. RESULTS:< 0.0001). CONCLUSION/CONCLUSIONS:This study revealed the importance of disaggregating GNC and transgender identities in research related to nicotine/tobacco use and mental health among adolescents.

We characterize within-city life expectancy gaps and their correlation with social and environmental characteristics in 948 US cities. Life expectancy estimates were drawn from the US Life Expectancy Estimation Program. City life expectancy gaps were calculated by subtracting the lowest tract-level life expectancy estimate from the highest for each city. Correlations were established using Spearman's correlation coefficient. The average city-level life expectancy gap in our sample was 11.8 years. Life expectancy gaps were larger in cities with lower average life expectancy and were evident across the USA. Life expectancy gaps of a decade were seen even in smaller cities and in high life expectancy cities. Life expectancy gaps were most strongly correlated with racialized residential segregation, children in poverty, and household income. Significant between-neighborhood gaps in life expectancy exist across US cities. Life expectancy gaps present a compelling target for establishing robust health equity goals.

INTRODUCTION/BACKGROUND:Tobacco smoke exposure (TSE) among individuals who do not smoke has declined in the USA, however, gaps remain in understanding how TSE patterns across indoor venues-including in homes, cars, workplaces, hospitality venues, and other areas-contribute to TSE disparities by income level. METHODS:We obtained data on adults (ages 18+, N=9909) and adolescents (ages 12-17, N=2065) who do not smoke from the National Health and Nutrition Examination Survey, 2013-2018. We examined the prevalence of self-reported, venue-specific TSE in each sample, stratified by poverty income ratio (PIR) quartile. We used linear regression models with a log-transformed outcome variable to explore associations between self-reported TSE and serum cotinine. We further explored the probability of detectable cotinine among individuals who reported no recent TSE, stratified by PIR. RESULTS:Self-reported TSE was highest in cars (prevalence=6.2% among adults, 14.2% among adolescents). TSE in own homes was the most strongly associated with differences in log cotinine levels (β for adults=1.92, 95% CI=1.52 to 2.31; β for adolescents=2.37 95% CI=2.07 to 2.66), and the association between home exposure and cotinine among adults was most pronounced in the lowest PIR quartile. There was an income gradient with regard to the probability of detectable cotinine among both adults and adolescents who did not report recent TSE. CONCLUSIONS:Homes and vehicles remain priority venues for addressing persistent TSE among individuals who do not smoke in the USA. TSE survey measures may have differential validity across population subgroups.

INTRODUCTION/BACKGROUND:Identifying strategies to mitigate the effects of secondhand smoke exposure is crucial for public health. Thus, we estimated the effect of a 2018 federal smoke-free housing (SFH) policy on adverse birth outcomes among New York City (NYC) public-housing residents. METHODS:We obtained data on all live births to NYC residents in NYC from 2013 to 2022, using the borough-block-lot of the birthing person's address to identify births to public-housing residents. We then estimated the effect of the SFH policy on risk of preterm birth or low birth weight among births to NYC public-housing residents using a linear-probability difference-in-differences estimator, weighted by inverse probability weights to increase the plausibility of the parallel-trends assumption. RESULTS:Our sample included 44 455 births to public-housing residents and 803 648 births to non-public-housing residents. Difference-in-difference analyses suggested the SFH policy did not affect risk of preterm birth (risk difference (RD) per 100: 0.1; 95% CI -0.6 to 0.9) or low birth weight (RD per 100: 0.3, 95% CI -0.4 to 1.0). Event-study analyses supported these findings and lent credibility to the parallel-trends assumption. CONCLUSIONS:We estimated no initial effects of a federal SFH policy on risk of preterm birth or low birth weight among births to NYC public-housing residents.

INTRODUCTION/BACKGROUND:Effective July 2018, the U.S. Department of Housing and Urban Development issued a rule requiring all public housing authorities to implement smoke-free housing (SFH) policies in their developments. We examined the differential impacts of SFH policy on hospitalizations for myocardial infarction (MI) and stroke among adults aged ≥50 years old living in New York City (NYC) Housing Authority (NYCHA) versus a matched-comparison population in NYC. AIMS AND METHODS/OBJECTIVE:We identified census block groups (CBGs) comprised solely of 100% NYCHA units (N = 160) and compared NYCHA CBGs to a selected subset of CBGs from all CBGs with no NYCHA units (N = 5646). We employed propensity score matching on distributions of key CBG-level sociodemographic and housing covariates. We constructed incident rates per 1000 persons by aggregating 3-month "quarterly" counts of New York State all-payer hospitalization data from October 2015 to December 2022 and dividing by the population aged ≥50 in selected CBGs, ascertained from 2016 American Community Survey 5-year estimates. We selected a difference-in-differences (DID) analytic approach to examine pre- and post-policy differences in incident hospitalizations between the intervention and matched-comparison groups. RESULTS:Matching results indicated a balanced match for all covariates, with standardized mean differences <0.10. In DID analyses, we observed small declines in both MI (DID = -0.26, p = .02) and stroke (DID = -0.28, p = .06) hospitalization rates for NYCHA CBGs compared to non-NYCHA CBGs from pre-to post-54 months' policy. CONCLUSIONS:SFH policies in NYC were associated with small reductions in CVD-related hospitalizations among older adults living in housing subject to the policy. IMPLICATIONS/CONCLUSIONS:Housing remains a key focal setting for interventions to reduce SHS exposure and associated morbidities. Ongoing monitoring is warranted to understand the long-term impacts of SFH policies in public housing developments.

BACKGROUND/UNASSIGNED:Environmental epidemiology studies increasingly integrate "big" geospatial and health datasets to examine associations between environmental factors and health outcomes. Using such datasets - and linking between them - presents a number of complexities with regard to study design and analytic approaches. These complexities are often magnified with the integration of additional contextual data representing other neighborhood characteristics, including socioeconomic factors. Guidance regarding the design of environmental health studies that leverage "big" geospatial and health outcome data is limited and fragmented. OBJECTIVE/UNASSIGNED:Drawing on methodological literature and case studies, this commentary outlines common challenges related to geospatial and health data linkages, posing a series of guiding questions and considerations for investigators conducting environmental health studies, particularly analyses with an etiological focus. DISCUSSION/UNASSIGNED:Recommendations include: 1) using a target trial approach to guide causal analysis, 2) aligning measures with hypothesized causal mechanisms, 3) exploring opportunities to "groundtruth" and validate data, and 4) prioritizing interdisciplinary science. The goal of the commentary is to consolidate insights from multiple disciplines - including exposure science, epidemiology, and sociology - to provide a foundation for etiologic research focused on advancing environmental health for all populations. https://doi.org/10.1289/EHP15756.

BACKGROUND:Disruption of ambulatory healthcare in New York City (NYC) during the COVID-19 pandemic was common, but the impact on the cardiometabolic health of vulnerable patient groups is unknown. Therefore, we estimated the effect of total care disruption (TCD) on blood pressure (BP) control among older NYC residents with hypertension and at least one other chronic condition, and examined whether neighborhood poverty moderated this impact. METHODS:From the INSIGHT Clinical Research Network, we identified NYC residents ≥50 years of age with hypertension and at least one other chronic condition. TCD was defined as no ambulatory or telehealth visit during the pandemic. We contrasted the change in prevalence of controlled BP (BP <140/90) before and after the pandemic among those with and without TCD via an inverse probability weighted (IPW) difference-in-difference regression model. RESULTS:Among 212,673 eligible individuals, mean age was 69.5 years (SD: 10.2 years) and 15.1% experienced TCD. BP control declined from 52.4% to 45.9% among those with TCD and from 53.6% to 48.9% among those without TCD. After IPW adjustment, a larger decline in BP control was noted among those with TCD (adjusted difference-in-difference = 1.13 percentage points (95% CI 0.32-1.94, p-value=0.0058)). There was no consistent difference in the relationship between TCD and post-pandemic BP control across neighborhood poverty levels. CONCLUSION/CONCLUSIONS:COVID-19-related TCD was associated with a modest decline in BP control among older adults with hypertension in NYC; this was not moderated by neighborhood poverty level.