Faculty Bibliography

Tobacco products, consisting of the highly addictive chemical, nicotine, are commonly used in the United States. Chronic nicotine use remains the leading cause of preventable disease and death in the United States. The vast majority of adults with nicotine addiction began using the substance during adolescence. Existing research suggests that adolescents experience increased susceptibility to nicotine addiction. Nicotine addiction or tobacco use disorder is characterized by clinically significant impairment and distress related to nicotine consumption (DSM-5). Individuals must have at least 2 of 11 symptoms during a 12 month period in order to meet diagnostic criteria.

IMPORTANCE:Although fluoride exposure at high levels during the perinatal period has been associated with socioemotional problems among children, there is limited evidence regarding potential associations at lower levels of fluoride exposure, particularly in the US. OBJECTIVE:To examine the association between prenatal exposure to public drinking water fluoride levels and children's socioemotional problems in a pooled US pediatric consortium. DESIGN, SETTING, AND PARTICIPANTS:This cohort study used observational pregnancy cohort data from January 1, 2005, to December 31, 2019, on children aged 1.5 to 17 years from the Environmental Influences on Child Health Outcomes (ECHO) Cohort, which took place at 20 prenatal pediatric cohort sites across 34 US states. Statistical analysis was conducted from December 2024 to December 2025. EXPOSURE:Area-level, time-weighted, mean fluoride concentrations in public water were estimated based on residential addresses during pregnancy. MAIN OUTCOMES AND MEASURES:Children's socioemotional problems were assessed using caregiver reports of internalizing and externalizing problems via the Child Behavior Checklist. Generalized estimating equation models evaluated the adjusted mean difference in T scores (1) across the range of exposure values in cubic spline models, (2) per 500.0-µg/L higher fluoride level in linear models, (3) across quartiles of exposure, and (4) at the US Public Health Services recommended cutoff (≤700.0 µg/L; 3998 less than the cutoff). RESULTS:The cohort comprised 5520 children (mean [SD] age, 5.8 [3.0] years; 2849 boys [51.6%]). The mean (SD) prenatal time-weighted water fluoride level was 407.9 (361.0) µg/L (range, <1.4-3272.5 µg/L). The adjusted mean difference in emotional and behavioral problem T scores per 500.0-μg/L higher exposure to prenatal public water fluoride was -0.15 (95% CI, -0.85 to 0.56) for internalizing problems and 0.06 (95% CI, -0.44 to 0.55) for externalizing problems, consistently showing no associations at the continuous level. However, some positive associations were observed only when using change point models for externalizing problems (adjusted mean difference, 1.59 [95% CI, 0.72-2.47] per 500.0-µg/L increase above the inflection point), and for some subgroups. CONCLUSIONS AND RELEVANCE:In this cohort study, prenatal exposure to fluoride levels in regulated public water was not associated with internalizing and externalizing problems among offspring. In change point models, positive associations were found for externalizing problems. The results contribute to growing evidence that could inform future policy decisions regarding fluoride in the US public water systems. Additional studies are needed to further investigate this association, especially examining other sources of fluoride that may have an association with children's emotional and behavioral problems.

ObjectiveThe prevalence of attention-deficit/hyperactivity disorder (ADHD) has risen in recent decades. The objective of this study was to identify trends in prevalence rates of ADHD medication use as well as any patterns of ADHD medication use among individuals aged up to 24 years in Quebec, Canada.MethodWe conducted a repeated cross-sectional study using medico-administrative data between the fiscal years 2000 to 2001 and 2022 to 2023. We estimated crude and age-adjusted prevalence rates along with their 99% confidence intervals according to sex, age (only for crude estimates), material and social deprivation, and ADHD medication type, namely stimulants (amphetamine-based and methylphenidate-based medications) and non stimulants (atomoxetine and guanfacine). We also analyzed prescribing by prescriber type.ResultsAmong the 4,771,183 individuals aged ≤24 years, 7.7% claimed ADHD medications. Age-adjusted prevalence of ADHD medication use increased from 2000 to 2001 (1.9%) until 2017 to 2018 (7.9%) and plateaued afterwards. The analysis highlighted not only variations in medication use over time but also by sex, with males more likely to be prescribed these medications than females. Family physicians have become the primary prescribers, overtaking pediatricians in recent years. Stimulant medications were the most common treatment throughout the study period, though we observed diversification in prescribed ADHD medication types across age groups.ConclusionsThis study emphasizes a significant increase in ADHD medication use from 2000 to 2018 and a stabilization in use afterwards. The expansion of diagnostic criteria in 2013 and heightened awareness may have narrowed the disparity between the condition's prevalence and its management and may explain the increase in use observed in earlier years and the stabilization observed over the more recent years. The disparities between males and females, as well as between age groups, highlight the need for continuous monitoring of prescribing trends and support targeted equity evaluations to inform service planning and improve access where needed.

PURPOSE/OBJECTIVE:Effective immunotherapy for mismatch repair proficient colorectal cancer (CRC) is lacking. We examined the safety and efficacy of the novel next-generation immune activator/Fc-enhanced CTLA-4 inhibitor botensilimab (BOT) plus PD-1 inhibitor balstilimab (BAL) in the neoadjuvant setting for patients with resectable CRC. PATIENTS AND METHODS/METHODS:Patients 18 years of age or older with non-metastatic CRC awaiting surgical resection were eligible. BOT/BAL was administered followed by surgical resection. In cohort A, patients received BOT 75 mg d1 and BAL 240 mg d1, 15; in cohorts B/C, patients received 2 additional BAL doses (d29, 43). The primary study objectives were safety, feasibility (based on surgery delay), and pathologic response. Exploratory analyses examined changes in the tumor microenvironment. RESULTS:Twenty-four eligible patients (26 tumors, n=22 pMMR; n=4 dMMR) were enrolled (two patients had synchronous primary tumors). Neoadjuvant BOT/BAL was safe and did not delay planned surgery in any patient. The major pathologic response rate was 41% (95% CI, 21%-64%) for pMMR, and 100% (95% CI, 40%-100%) for dMMR CRC. BOT/BAL was associated with significant anti-tumor effects in the tumor microenvironment, with an increase in the density and proportion of CD8+ T cells, a reduction in tumor infiltrating FOXP3+ Tregs, and evidence of increased immune cell-cell interaction in responding patients. CONCLUSIONS:These findings demonstrate safety, feasibility, and encouraging pathological responses for BOT/BAL in both non-metastatic pMMR and dMMR CRC. Tumor microenvironment remodeling suggests a robust anti-tumor immune response induced by immunotherapy. These data support the continued development of BOT/BAL in CRC.

PURPOSE/OBJECTIVE:performed with autistic youth with varying presentations. METHODS:administration and results were analyzed and compared across relevant clinical characteristics, including age, language level, and autism severity. RESULTS:results were highly correlated with existing measures, parent-child agreement was relatively low and variable across subgroups of autistic youth. CONCLUSIONS:adaptations are likely necessary to improve accessibility, linguistic clarity, and diagnostic specificity and will be important to promote scalable, equitable MH screening for autistic youth.

INTRODUCTION/BACKGROUND:Historical disparities in maternal and infant health, exacerbated over the COVID-19 pandemic, necessitate investment in a systematic and community-based approach to dyadic care. NewYork-Presbyterian sought to build an innovative, 2-generation program integrating obstetric, pediatric, behavioral health, and community services. METHOD/METHODS:This report outlines the development of the Maternal and Child Integrated Mental Health Program (MAC-IMP) from 2020 to 2024, utilizing the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, informed by deidentified patient data collected during this period. RESULTS:Through multidisciplinary collaboration, data and health record optimization, risk stratification, and comprehensive service alignment, an equitable and patient-centered model was developed. DISCUSSION/CONCLUSIONS:Lessons learned include methods for multisystem clinical and administrative coordination, communication, and community-partnership building. These lessons can be adapted for multispecialty health care systems across the country to build a more patient-centered, preventative, and holistic model of maternal and infant care. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

BACKGROUND:Autism is most often diagnosed after the age of 3, despite evidence that neurodevelopmental differences emerge within the first 2 years of life and that genetic and familial risk can be identified at birth. METHODS:Established in September 2022 (anticipated duration of 5-7 years), the Prospective Genetic Risk Evaluation and Assessment (PROGRESS) in Autism Center is an ongoing longitudinal cohort study designed to characterize early developmental trajectories associated with autism and evaluate the impact of providing genetic information to families. RESULTS:Infants who undergo genomic newborn screening and enroll in PROGRESS are followed from 3 to 24 months of age and categorized into three groups: identified genetic probability (IGP), familial likelihood without identified genetic probability (Baby Siblings), and no identified genetic probability (NGP). Assessments include electroencephalography, electrocardiography, auditory, eye tracking, developmental testing, caregiver-infant interaction, and caregiver-reported measures. Autism screening is conducted at 18 months, with comprehensive diagnostic evaluation at 24 months. Caregiver psychosocial experiences of receiving early genetic information are assessed through surveys and interviews. CONCLUSION/CONCLUSIONS:By integrating genomic probability with early neurobehavioral development and family experiences, PROGRESS provides a framework to inform ethical genomic screening, developmental monitoring, and timely access to early intervention supported by a family navigator. IMPACT/CONCLUSIONS:This study presents the rationale and methods of the ongoing Prospective Genetic Risk Evaluation and Assessment (PROGRESS) in Autism Center at Columbia University, which began in September 2022 (anticipated duration of 5-7 years). PROGRESS is a prospective longitudinal cohort assessing infants with identified genetic probability, familial likelihood, or no identified genetic probability for autism from 3 to 24 months of age. By linking early genetic probability with brain-behavioral trajectories, PROGRESS advances understanding of autism-related differences before clinical diagnosis and provides an empirically grounded foundation for ethical genomic newborn screening and optimized early developmental monitoring and intervention.

There is limited understanding of modifiable factors influencing health-related quality of life (HRQoL) among children living with type 1 diabetes (T1D). Executive function skills may be a relevant factor because they underpin the ability to successfully orchestrate T1D self-management. We examined the association between executive functioning and HRQoL among 10-17 year old children living with T1D for more than six months. Caregivers and children (n = 41) completed assessments to measure the child's executive function skills and child and caregiver HRQoL. Linear regression models estimated adjusted betas and 95% confidence intervals (CI) for associations between child executive functioning and child and caregiver HRQoL. In adjusted models, worse executive functioning skills were associated with worse HRQoL. This pattern was consistent across caregiver and child report of the child's executive functioning, caregiver and child report of the child's HRQoL, and caregiver report of their own HRQoL. Further investigation is needed to understand how executive functioning and HRQoL are related in this population, as well as whether educating families on the role of executive functioning in diabetes self-management could improve HRQoL within the family ecosystem.

More than 100 prediction models have been developed to support the diagnosis, prognosis, or treatment of ADHD, yet none has reached routine clinical practice. In this Personal View, we argue that an important reason for this implementation gap is the absence of clearly defined prediction-based decision rules-formalised mappings from a model's output to specific clinical actions. Most published models report discrimination metrics such as the area under the receiver-operating-characteristic curve, but do not specify what a clinician should do differently for a patient classified as at high risk versus low risk. Without this link to action, even an accurate model remains clinically inert. We describe how prediction-based decision rules, combined with target trial emulation of their clinical utility in large observational datasets, offer a feasible path forward. We illustrate the approach with two worked ADHD examples (treatment intensity guided by predicted persistence and medication selection guided by predicted treatment response) and propose four priorities to shift the field from model development towards decision-oriented evaluation and implementation.