Faculty Bibliography

Air pollution remains a leading cause of mortality. Few studies have leveraged residential relocation to examine impacts of intra-individual changes in PM2.5 exposure. As the largest integrated health system in the U.S., the Veterans Health Administration (VHA) is an ideal setting to examine relocation-induced changes in air pollution. We constructed a cohort of Veterans who relocated from one ZIP code to another between 2011 and 2017 (n = 762 905). We linked spatially averaged annual PM2.5 estimates to each person based on residential address. We examined relocation-induced PM2.5 changes and post-move mortality in discrete time models, accounting for individual- and area-level confounding variables. We estimated pooled odds ratios over 5 years of follow up and examined effect measure modification by age (<65, 65+), sex, and neighborhood-level poverty. The pooled OR associated with a 2 μg/m3 increase in PM2.5 levels between the origin and destination areas was 1.03 (95% CI = 1.01-1.03). Associations appeared more pronounced among older individuals when assessing potential additive effect measure modification. Examining intra-individual changes in PM2.5 exposure and subsequent health outcomes can elucidate potential impacts of air pollution and pollution reduction policies. Results suggest survival benefits associated with policies that continue to reduce PM2.5 levels.

Introduction Cordon-based congestion policies have demonstrated air quality and health benefits in cities outside the United States (U.S.), yet selecting comparison areas to evaluate these policies remains a methodological challenge. Using two pre-policy administrative health datasets, we examined the feasibility of constructing local, state, and regional counterfactual populations to inform an evaluation of child health impacts of the recently implemented New York City (NYC) congestion pricing policy, focusing on pediatric asthma emergency department visits. Methods Our study population included children aged 0-17 years. Using a difference-in-differences approach for repeated measures, we evaluated crude pre-policy pediatric asthma trends between the congestion relief zone (CRZ) and three comparison areas: (1) NYC neighborhoods outside the CRZ, (2) nine major New York State cities, and (3) dense, heavily trafficked Northeast regional U.S. cities. We compared this approach with a generalized synthetic control method (G-SCM). Results Crude pre-policy pediatric asthma trends were most parallel between the CRZ and the local NYC comparison zone. Socioeconomic, built environment, and environmental exposure covariates varied across comparison areas at baseline. G-SCM improved visual pre-policy trend alignment across all three comparison areas; however, placebo tests revealed statistically significant parallel trend violations persisted for non-local comparison areas. Conclusions Local comparison populations may offer the most representative counterfactual for evaluating NYC congestion pricing child health impacts. Residual parallel trend violations in non-local areas underscore the methodological challenges of counterfactual selection for geographically concentrated urban policies, highlighting the value of triangulating findings across comparison areas and analytic approaches in future post-implementation evaluations.

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.

Prior studies suggest that diabetes is associated with severe outcomes following COVID-19. However, most research has focused on early phases of the COVID-19 pandemic, and less is known about changing diabetes-associated risks over time. We constructed a retrospective cohort of U.S. Veterans with documented COVID-19 between March 2020 and August 2023 (N = 426,170). We used Poisson regression models to estimate relative risks of 60-day mortality following COVID-19 among Veterans with and without diabetes, incorporating demographic and clinical covariates, as well as weights to address unequal probabilities of selection into the sample. We then incorporated interaction terms representing six-month time windows and plotted predicted mortality risks over time. To contextualize risk estimates, we repeated the analysis among a cohort of Veterans without documented COVID-19. Diabetes was associated with overall higher risk of 60-day mortality following COVID-19 (RR = 1.21, 95% CI = 1.17-1.26). Mortality risks attenuated over time and converged with risks observed among Veterans without COVID-19 by March-August 2022. Results suggest that post-COVID-19 mortality risks associated with diabetes may have attenuated over time. Mechanisms underlying the attenuation of mortality risks were beyond the scope of the paper, however, future studies can potentially shed light on the contributions of population immunity (driven by previous infection or vaccination status), changing treatment patterns, and other factors to time-varying mortality risks following COVID-19 among individuals with diabetes.

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.