Faculty Bibliography

The COVID-19 pandemic exposed and exacerbated longstanding inefficiencies and deficiencies in chronic disease management and treatment in the United States, such as a fragmented healthcare experience and system, narrowly focused services, limited resources beyond office visits, expensive yet low quality care, and poor access to comprehensive prevention and non-pharmacological resources. It is feared that the addition of COVID-19 survivors to the pool of chronic disease patients will burden an already precarious healthcare system struggling to meet the needs of chronic disease patients. Digital health and telemedicine solutions, which exploded during the pandemic, may address many inefficiencies and deficiencies in chronic disease management, such as increasing access to care. However, these solutions are not panaceas as they are replete with several limitations, such as low uptake, poor engagement, and low long-term use. To fully optimize digital health and telemedicine solutions, we argue for the gamification of digital health and telemedicine solutions through a pantheoretical framework-one that uses personalized, contextualized, and behavioral science algorithms, data, evidence, and theories to ground treatments.

Objective/UNASSIGNED:Compared to European Americans, research indicates that African Americans have higher white matter hyperintensity (WMH) load; however, the clinical and biological bases underlying this higher burden are poorly understood. We hypothesize that obesity may explain differences in WMH between African and European Americans. Methods/UNASSIGNED:, and WMH load, captured by FLAIR images, as sum of deep and periventricular volumes, scored using the Fazekas scale (0-6), WMH≥4 considered high. Results/UNASSIGNED:=5.3, p=0.02). Conclusion/UNASSIGNED:Results denote that age predicted WMH among European Americans, while obesity predicted WMH among African Americans. Matched sample analyses indicate that obesity increases the odds of WMH, though more pronounced in African Americans. These findings suggest that obesity may explain the differential burden of white matter hyperintensity load, signifying public health and clinical importance.

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.

INTRODUCTION/BACKGROUND:System-level factors such as poor access to health services can help explain differential uptake in breast and cervical cancer screening between U.S.- and foreign-born women. However, few studies have explored the roles of family history and perceived risk of these cancers on screening rates. To address these gaps, this study investigates whether a family history of cancer, perceived risk, and system-level factors independently and additively predict differential screening rates of breast and cervical cancer between U.S.-born and foreign-born women living in the U.S. METHODS:Data were analyzed in 2019 from the 2015 National Health Interview Survey. Descriptive and multivariable logistic regression modeling was performed to test whether there were differences in breast and cervical cancer screening within and between the 2 groups and whether family history of cancer and perceived risk of breast cancer were predictors of uptake. RESULTS:The sample comprised women aged 21-74 years (n=14,047). The mean age of the sample was 45.5 (SD=14.8 years). The majority of the women were U.S.-born (77.5%). U.S.- and foreign-born women had more mammograms and Pap tests with a usual source of care (p<0.001) and insurance (p<0.001). Healthcare access and utilization factors were also predictive for both groups of women. Data analyses were conducted in 2019. CONCLUSIONS:These findings are consistent with previous work. Access and healthcare utilization were associated with screening uptake. However, differences in risk perception, family history of breast and cervical cancers, and screening uptake were found between U.S.- and foreign-born women.

Sleep disparities exist among Hispanics/Latinos, although little work has characterized individuals at the United States (US)-Mexico border, particularly as it relates to acculturation. This study examined the association of Anglo and Mexican acculturation to various facets of sleep health among those of Mexican descent at the US-Mexico border. Data were collected from N = 100 adults of Mexican descent in the city of Nogales, Arizona (AZ). Surveys were presented in English or Spanish. Acculturation was assessed with the Acculturation Scale for Mexican-Americans (ARSMA-II). Insomnia was assessed with the Insomnia Severity Index (ISI), sleepiness was assessed with the Epworth Sleepiness Scale (ESS), sleep apnea risk was assessed with the Multivariable Apnea Prediction (MAP) index, weekday and weekend sleep duration and efficiency were assessed with the Sleep Timing Questionnaire, sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), and sleep duration and sleep medication use were assessed with PSQI items. No associations were found between Mexican acculturation and any sleep outcomes in adjusted analyses. Anglo acculturation was associated with less weekend sleep duration and efficiency, worse insomnia severity and sleep quality, and more sleep apnea risk and sleep medication use. These results support the idea that sleep disparities may depend on the degree of acculturation, which should be considered in risk screening and interventions.

OBJECTIVE:To estimate the average incremental health care expenditures associated with habitual long and short duration of sleep as compared with healthy/average sleep duration. DATA SOURCE/METHODS:Medical Expenditure Panel Survey data (2012; N=6476) linked to the 2010-2011 National Health Interview Survey. STUDY DESIGN/METHODS:Annual differences in health care expenditures are estimated for habitual long and short duration sleepers as compared with average duration sleepers using 2-part logit generalized linear regression models. PRINCIPAL FINDINGS/RESULTS:Habitual short duration sleepers reported an additional $1400 in total unadjusted health care expenditures compared to people with average sleep duration (P<0.01). After adjusting for demographics, socioeconomic factors, and health behavior factors, this difference remained significant with an additional $1278 in total health care expenditures over average duration sleepers (P<0.05). Long duration sleepers reported even higher, $2994 additional health care expenditures over average duration sleepers. This difference in health care expenditures remained significantly high ($1500, P<0.01) in the adjusted model. Expenditure differences are more pronounced for inpatient hospitalization, office expenses, prescription expenses, and home health care expenditures. CONCLUSIONS:Habitual short and long sleep duration is associated with higher health care expenditures, which is consistent with the association between unhealthy sleep duration and poorer health outcomes.

PURPOSE OF REVIEW/OBJECTIVE:In this current review, we describe the benefits of community-based and "precision and personalized population health" (P3H) approaches to assessing and addressing sleep health problems and sleep-related cardiovascular diseases (CVD) among vulnerable populations such as racial/ethnic minorities, the elderly, and the socioeconomically disadvantaged. RECENT FINDINGS/RESULTS:Very few sleep health programs utilize a community-based or P3H approach, which may account for low estimates of sleep health problems, related CVD outcomes, and inadequate healthcare infrastructure to address sleep-related health outcomes at the community and population level. We describe community-based and P3H approaches and programs as solutions to accurately capture estimates of sleep health and reduce burden of sleep health problems and corollary CVD outcomes at the level of the community and population. Specifically, we describe seven critical steps needed to successfully implement a community-based and P3H approach to address sleep health problems. Community-based and P3H approaches are effective strategies to assessing and addressing sleep health problems and related health conditions.