Faculty Bibliography
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Department/Unit:Population Health
Total Results:
13489
Breast cancer in gene mutation carriers: Does family history matter?
BACKGROUND/OBJECTIVE/OBJECTIVE:As genetic testing becomes routine, more individuals carrying pathogenic variants in breast cancer susceptibility genes in the absence of suggestive family history have been identified. Mutations in BRCA 1, BRCA 2, ATM, CHEK2, and PALB2 account for approximately 7-10% of breast cancers. Our aim was to identify differences in demographic factors, tumor characteristics, and surgical treatment between mutation carriers with and without a reported first-degree affected relative. METHODS:We retrospectively reviewed our Institution's IRB approved breast cancer database to identify patients enrolled between 1/2010 and 8/2025 who tested positive for BRCA1, BRCA2, ATM, CHEK2, or PALB2. Patients with prior breast cancer were excluded. Demographic, clinical, tumor, and surgical data were collected. Continuous variables were compared using t-tests and categorical variables using chi-square tests. RESULTS:Among 199 mutation carriers with breast cancer, 128 (64%) reported no first-degree affected relative (N1D) and 71 (36%) did (Y1D). At diagnosis, N1D patients were younger (p=0.001), more often presented with a palpable mass (p=0.003) and had higher rates of neoadjuvant chemotherapy (NAC) (p= 0.023). Mutation distribution did not differ, nor did overall histology, although N1D patients trended to have more invasive disease. Surgery type did not differ between groups (p=0.607). 55% of N1D patients had an affected second-degree relative. CONCLUSION/CONCLUSIONS:N1D patients presented at a younger age and were more likely to have clinically apparent invasive disease, along with higher rates of NAC. These findings likely reflect differences in screening rather than more aggressive tumor biology, as receptor subtype, triple-negative rates, and tumor grade were comparable across groups. Despite these differences, surgical management was similar, suggesting that operative planning is influenced more by genetic risk rather than by family history alone. Many N1D patients had an affected second-degree relative, indicating the need for comprehensive evaluation of family history. These findings support expanding genetic testing beyond family-based criteria to better identify high-risk individuals.
PMID: 42998405
ISSN: 2210-7762
CID: 6075524
A Scalable Teacher Professional Development and Wellness Program in Primary Schools: A Cluster Randomized Clinical Trial
IMPORTANCE/UNASSIGNED:In Uganda and other low-income settings with prevalent mental health problems and limited resources, scalable professional development (PD) models are needed to strengthen teachers' capacity to apply evidence-based practices to support child mental health. OBJECTIVE/UNASSIGNED:To examine the short-term effectiveness of PD and PD with a teacher-wellness enhancement (PDT) compared with a control condition on teacher knowledge and use of evidence-based practices, teacher stress, and teacher stress management; implementation outcomes; and the differential outcomes between urban and rural primary schools in Uganda. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cluster randomized clinical trial was conducted in 47 urban and rural schools in Uganda between August 2021 and February 2025. Participating teachers in the schools were followed-up 24 months after the intervention, and the present trial focused on short-term teacher outcomes. Statistical analysis followed the intention-to-treat principle. INTERVENTIONS/UNASSIGNED:Schools and teachers were randomized to 1 of 3 conditions: PD, PDT, and control. The PD intervention (mWEL-PD or Mental Wellbeing and Empowering Lives of the School Community: Professional Development) consisted of 3 days of training and 8 one-hour coaching sessions in person for 2 to 3 months. The PDT intervention (mWEL-PD with a teacher-wellness enhancement) was provided as the PD program plus a 1-day workshop and 3 group support sessions. The control condition offered no intervention during year 1, but mental health knowledge and promotion materials and a 1-day teacher-wellness workshop were provided in year 2. MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcomes for PD and PDT groups were knowledge and use of evidence-based practices. Teachers completed 15 self-report measures assessing 4 key outcomes: knowledge of evidence-based practices, use of evidence-based practices, teacher stress, and teacher stress management. Implementation outcomes, self-assessed after completion of the intervention, included teacher engagement in the intervention, teacher perception of acceptability and usefulness of the content, and teacher perception of the competence of the program facilitators. RESULTS/UNASSIGNED:A total of 47 schools with 509 teachers (mean [SD] age, 40.60 [11.12] years; 368 females [72.3%]) were included in the analysis. Among the schools, 15 (31.9%) were randomly assigned to the control, 16 (34.0%) to the PD, and 16 (34.0%) to the PDT groups. Among teachers, 165 (32.4%) were randomly assigned to the control, 187 (36.7%) to the PD, and 157 (30.8%) to the PDT groups. Teacher attendance at training and coaching sessions and ratings of relevance and facilitator competence were high in both urban and rural contexts. Compared with teachers in the PD group, those in the PDT group were more likely to attend all training days offered (120 of 187 [64.1%] in the PD group vs 127 of 157 [80.9%] in the PDT group) and participated in more coaching sessions (mean [SD] number, 4.58 [2.91] vs 6.09 [2.28]). Compared with teachers in the control condition, teachers in the PDT condition benefited on all 4 key outcomes: increased knowledge (standardized mean difference [SMD], 0.57; 95% CI, 0.26-0.88) and use (SMD, 0.36; 95% CI, 0.01-0.71) of evidence-based practices, increased stress management (SMD, 0.50; 95% CI, 0.19-0.80), and decreased stress (SMD, -0.27; 95% CI, -0.54 to 0.01). Benefits of PD were limited to knowledge of evidence-based practices (SMD, 0.33; 95% CI, 0.03-0.62). CONCLUSIONS AND RELEVANCE/UNASSIGNED:This trial of a scalable teacher PD program delivered through existing educational infrastructure and resources demonstrates the program's feasibility, acceptability, and impact on self-reported teacher outcomes. The finding of short-term benefits for teacher practice and wellness suggests the potential of the PDT model for school-based mental health promotion. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT04383327.
PMCID:13744022
PMID: 42993547
ISSN: 2574-3805
CID: 6075504
Educating Pediatric Oncology Clinicians on Sexual Health Care for Adolescents and Young Adults With Cancer: Results From a Proof-of-Concept Study
PURPOSE/OBJECTIVE:This work reports on the proof-of-concept testing for a suite of educational modules designed to improve oncology clinician sexual health (SH) communication with adolescent and young adult (AYA) patients. METHODS:Pediatric oncology clinicians completed four interactive SH education modules. Intervention feasibility was evaluated through rates of intervention completion and study retention, with benchmarks of 60% and 70%, respectively. Acceptability and perceived usefulness were assessed through standardized self-report measures, using a benchmark of 70% of participants rating the intervention favorably. Pre- and postsurveys evaluated knowledge, attitudes and beliefs, SH communication practices, and perceived self-efficacy. Open-ended feedback and key takeaways from each module were analyzed qualitatively. RESULTS:A total of 45 clinicians enrolled, with 39 completing the intervention and study surveys. Completion and retention rates (86.6% and 100%, respectively) exceeded the preset feasibility benchmarks. Positive endorsement of self-report measures demonstrated acceptability (100%) and perceived usefulness (94.9%). Pre- and postintervention surveys signaled increases in clinician knowledge, beliefs, and self-efficacy. Key qualitative insights from participants were received pertaining to AYA concerns, needs, and preferences and clinician responsibilities. CONCLUSION/CONCLUSIONS:This innovative approach to clinician education on SH demonstrates potential to improve clinician knowledge and engagement in SH conversations with AYAs, a key first step in improving AYA SH during and after cancer. Next steps must focus on a larger trial to assess intervention effectiveness.
PMID: 42900854
ISSN: 2688-1535
CID: 6074870
Global Burden of Anorexia Nervosa and Bulimia Nervosa, 1990 to 2023, With Forecasts to 2050: A Global Burden of Disease Study 2023 Analysis
IMPORTANCE/UNASSIGNED:Eating disorders are a major cause of nonfatal mental health burden, yet global evidence on their long-term trends, geographic distribution, and future trajectories remains limited. OBJECTIVE/UNASSIGNED:To estimate the global, regional, and national prevalence and disability burden of anorexia nervosa and bulimia nervosa-and mortality attributable to anorexia nervosa-from 1990 to 2023, and to forecast prevalence to 2050. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:Using Global Burden of Disease (GBD) 2023 methods, data were synthesized from systematic literature reviews, population surveys, and vital registration systems. Estimates were produced for 204 countries and territories from 1990 to 2023, with forecasts through 2050. These data were analyzed from October 2025 to August 2026. EXPOSURE/UNASSIGNED:Anorexia nervosa or bulimia nervosa diagnosis. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Counts and age-standardized rates with 95% uncertainty intervals (UIs) for anorexia nervosa and bulimia nervosa prevalence, years lived with disability (YLDs), and disability-adjusted life-years (DALYs), and anorexia nervosa mortality, reported by age, sex, and location. RESULTS/UNASSIGNED:In 2023, an estimated 18.1 million people (95% UI, 13.9-24.0) globally were living with anorexia nervosa or bulimia nervosa, of whom 12.6 million (69.4%) were female, 5.5 million were male (30.6%), and 41.2% were aged 10 to 24 years. These cases accounted for 3.83 million DALYs (95% UI, 2.23-5.69). Since 1990, the global number of prevalent cases increased by 71.0%, while age-standardized prevalence and DALY rates rose by about 21%. Females experienced substantially higher prevalence and DALY rates than males. The highest age-standardized prevalence rates were observed in high-income regions, particularly Australasia and Western Europe, whereas the largest relative increases in age-standardized prevalence occurred in East Asia, South Asia, and Southeast Asia. Forecasts indicate continued increases in prevalent cases through 2050. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This GBD 2023 analysis found that anorexia nervosa and bulimia nervosa contribute substantially to global nonfatal health loss. These findings support the integration of eating disorders into mental health surveillance, prevention, and service planning worldwide.
PMCID:13717465
PMID: 42949727
ISSN: 2168-6238
CID: 6074830
Prenatal exposure to di(isononyl) cyclohexane-1,2-dicarboxylate and adverse birth outcomes in the USA: a prospective analysis of births in a large American birth cohort
BACKGROUND:A large body of evidence has documented the effects of ortho-phthalates, additives to soft plastic used in food packaging, on premature birth. Ortho-phthalates are increasingly replaced with alternatives including tere-phthalates and di(isononyl) cyclohexane-1,2-dicarboxylate (DINCH). A limited toxicological literature suggests that DINCH metabolites disrupt sex hormones and promote oxidant stress known to contribute to adverse birth outcomes, and epidemiologic studies have also been limited in sample size, inclusivity of different populations and measurements at different time points in pregnancy. METHODS:We leveraged a large American cohort comprised of mother-child dyads from twenty-two cohorts to assess associations of trimester-specific and pregnancy-wide DINCH metabolites with birth weight (BW) and gestational age (GA). FINDINGS/RESULTS:Average prenatal urinary DINCH was inversely associated with birth length, birthweight, and birthweight for gestational age z-scores, but not GA. A tenfold increase in the pregnancy-averaged DINCH metabolite cyclohexane-1,2-dicarboxylic acid-monocarboxy isooctyl ester (MCOCH) was associated with a decrease of 27.43 g (95%CI: -54.81, -0.04) in birthweight. Trimester-specific analyses revealed stronger associations for third trimester DINCH exposure with birth outcomes. INTERPRETATION/CONCLUSIONS:In a large American cohort representing a broad range of backgrounds, we identified an inverse association of DINCH with standardized measures of birth size, but not gestational age. Further studies should examine joint exposures to DINCH, tere- and orthophthalates, and repeated measures across pregnancy.
PMID: 42901092
ISSN: 1873-6750
CID: 6074873
Management of Patients with High-risk Localised, Locally Advanced, and Biochemically Recurrent Prostate Cancer: Report from the 2026 Advanced Prostate Cancer Consensus Conference
BACKGROUND:Innovations have improved outcomes in high-risk localised, locally advanced, and biochemically recurrent prostate cancer (PC), yet high-level evidence remains limited for many management decisions. The 2026 Advanced Prostate Cancer Consensus Conference (APCCC) surveyed an international panel on key clinical questions to complement evidence-based guidelines. OBJECTIVE:Here we present the voting results for the questions on high-risk localised, locally advanced, and biochemically recurrent PC from APCCC 2026. DESIGN, SETTING, AND PARTICIPANTS/METHODS:Before the conference, a multidisciplinary panel of 144 international PC experts used a modified Delphi process to develop 313 multiple-choice consensus questions, of which 134 covered high-risk localised and locally advanced PC, including prostate-specific antigen (PSA) persistence and PSA recurrence, and side effects of treatment. These questions were administered to the 133 voting panel members "panellists" via a web-based survey prior to the conference. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS/METHODS:Consensus was defined a priori as ≥75% agreement, with strong consensus defined as ≥90% agreement. Overall, consensus was reached for 44 of the 134 questions (32.8%), with seven questions reaching a strong consensus. Results and limitations The voting results show varying degrees of consensus, as discussed in this article and as detailed in the Supplementary Material. An interactive heat map for the questions can be found at https://apccc.org/APCCC2026-votings-localised-and-locally-advanced-prostate-cancer/. These findings do not include a formal literature review or meta-analysis. CONCLUSIONS:The voting results can help physicians and patients navigate controversial areas of clinical management for which evidence is scant or conflicting. The findings can also help funders and policymakers in prioritising areas for future research. Importantly, APCCC 2026 once again identified important gaps (areas of no consensus) that merit evaluation in specifically designed trials.
PMID: 42934071
ISSN: 1873-7560
CID: 6074731
State and Local Syringe Distribution Laws and the Presence of Syringe Services Programs
IMPORTANCE/UNASSIGNED:Syringe services programs (SSPs) are an evidence-based intervention to reduce bloodborne disease transmission and other risks related to injection drug use; however, SSP access is uneven. State and local syringe distribution laws may influence variation in the presence and number of SSPs across local jurisdictions. OBJECTIVE/UNASSIGNED:To assess the association between state and local syringe distribution laws and presence of publicly listed SSPs in a sample of US cities. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cross-sectional study linked state and local laws with information on publicly reported SSPs in 2024 for the largest US municipalities and census-designated places (localities). The outcomes of policy exposure in SSP presence and total number of SSP locations among localities with at least 1 SSP were estimated using a 2-part negative binomial hurdle model, adjusting for state and local policy and demographic and health characteristics. The study team collected the legal data from January 11, 2023, through May 7, 2024. EXPOSURE/UNASSIGNED:State and local syringe distribution policy environment as of December 31, 2022, categorized from most restrictive (state prohibition) to least restrictive (neither state nor locality prohibits syringe distribution). MAIN OUTCOMES AND MEASURES/UNASSIGNED:Publicly reported SSP presence (binary) and total count of SSP locations within each locality as of February 2024. RESULTS/UNASSIGNED:In this study using data from 482 US localities, there was at least 1 SSP in 181 (37.6%) localities. Localities with the least restrictive legal environment had increased odds of SSP presence (adjusted odds ratio, 16.3; 95% CI, 6.0-44.1) compared with those with the most restrictive legal environment. Among localities with 1 or more SSP, localities in the least restrictive legal environment or a legal environment that exempted SSPs from a syringe distribution prohibition had increased rates of SSPs, relative to the most restrictive legal environment (rate ratio for least restrictive policy environment, 2.7; 95% CI, 1.1-6.4; rate ratio for legal environment that exempts SSPs from prohibition, 2.4; 95% CI, 1.1-5.6). Overall, policies that exempted SSPs from syringe distribution prohibitions and those with no syringe distribution prohibitions had the highest estimated SSP counts (1.9 SSPs; 95% CI, 1.5-2.4; 1.5 SSPs; 95% CI, 1.1-1.9, respectively). CONCLUSIONS AND RELEVANCE/UNASSIGNED:This study found that state and local syringe distribution laws were associated with publicly listed SSP presence. Legal environments that prohibit or restrict syringe distribution may limit the presence and total number of SSPs, highlighting the role of policy context in shaping access to harm-reduction services.
PMCID:13695068
PMID: 42912382
ISSN: 2689-0186
CID: 6074918
Perinatal phthalate, paraben, and phenol exposure is associated with the neonatal metabolome measured in umbilical cord plasma
BACKGROUND:Perinatal exposure to phthalates, parabens, and phenols-common endocrine disrupting chemicals (EDCs)-has been associated with adverse health outcomes, but the underlying biological mechanisms remain unclear. This study aims to explore the associations between perinatal EDC exposure--individually and as a mixture--and the neonatal metabolome, which provides a readout of metabolic processes and the factors that impact them. METHODS:EDCs and the metabolome were characterized in umbilical cord blood plasma from 175 pregnant participants recruited through the Columbia Center for Children's Environmental Health. Nontargeted screening revealed 15 EDCs using gas chromatography coupled to high resolution mass spectrometry (HRMS) and 5835 metabolic features using liquid chromatography HRMS. Correlated features were grouped into 21 modules using weighted gene co-expression network analysis and into integrative networks using xMWAS. Linear regression and quantile g-computation were used to assess associations between EDC exposures and individual metabolic feature abundance and the modules. RESULTS:We observed 2208 metabolome-wide associations between individual metabolic features and EDCs modeled individually and one association with the EDC mixture. Eight EDCs were individually associated with 7 modules, and the EDC mixture was associated with 1 module. Pathway enrichment analyses revealed phenol and phthalate exposures were associated with fatty acid and energy metabolism. xMWAS networks demonstrated similar EDC-module and EDC-metabolic feature relationships. CONCLUSION/CONCLUSIONS:Perinatal EDC exposure, individually and as a mixture, is associated with individual metabolic features and metabolic networks measured in cord plasma. These results could offer insight into the biological processes underpinning relationships between perinatal EDC exposure and adverse health outcomes.
PMID: 42966289
ISSN: 1090-2414
CID: 6074826
A Research-Practice Partnership to Advance Equitable Early Childhood Outcomes Through District-Wide Scaling of a Family-Centered, Evidence-Based Preventive Intervention
Scaling evidence-based interventions (EBIs) in public education systems remains a persistent challenge in prevention science. Although many interventions demonstrate impact in efficacy trials, they are often underused or fail to achieve intended benefits when introduced in routine practice without sufficient implementation support. Research-practice partnerships (RPPs) offer a promising approach for bridging research, policy, and practice; however, few published examples describe how RPPs can support district-wide scale-up and sustainment of EBIs. This article describes an RPP formed to scale ParentCorps-a family-centered EBI developed through community-engaged research-within New York City's universal pre-kindergarten initiative, Pre-K for All. ParentCorps is designed to strengthen family-school partnerships and reduce racial and income disparities in children's educational and mental health outcomes. The partnership brought together the Center for Early Childhood Health and Development (the intervention developer), the NYC Public Schools Division of Early Childhood Education (the implementing system), and the Research Alliance for New York City Schools (a research intermediary). Guided by implementation science frameworks, partners co-designed a series of pragmatic, cluster randomized studies conducted under routine district conditions. We present findings from a pragmatic hybrid type 3 implementation-effectiveness trial that compares two levels of implementation support for ParentCorps. Primary outcomes included pre-K program family engagement practices, assessed using the district's annual system-wide survey; secondary outcomes included parent and child outcomes. We conclude by highlighting the RPP structures, processes, and design choices that enabled rigorous evaluation at scale and discussing implications for how RPPs can build implementation capacity to support district-wide scale-up and sustainment of family-centered EBIs in public education systems.
PMID: 42944833
ISSN: 1573-6695
CID: 6074749
Beyond documentation burden: clinician-reported workflow and cognitive changes associated with ambient documentation technology
OBJECTIVE/UNASSIGNED:To examine clinicians' experiences using ambient documentation technology (ADT) in ambulatory practice, with a focus on impacts on documentation workflows, perceived cognitive burden, and clinical reasoning. MATERIALS AND METHODS/UNASSIGNED:This survey study included clinicians participating in an ADT pilot at NYU Langone Health between March and December 2024. Clinicians completed a baseline survey before receiving access to ADT and a posttrial survey after use. Outcomes included self-reported changes in documentation time, workflow, communication, cognitive load, and clinical and diagnostic reasoning. RESULTS/UNASSIGNED:Eighty-four clinicians across multiple specialties participated. Most reported reduced documentation time (75 [89%]) and preferred editing ambient notes (65 [77%]). Many reported reduced cognitive load (49 [58%]), while fewer reported improvements in clinical (22 [26%]) or diagnostic reasoning (20 [24%]). Clinicians who viewed note writing as part of their reasoning process reported heterogeneous cognitive effects, whereas those who did not reported no perceived benefit. A subset reported workflow changes (26 [31%]) or changes in patient communication (22 [26%]) to integrate ADT. Concern about reliance on ADT was reported by 26 clinicians (31%). DISCUSSION/UNASSIGNED:Clinicians using ADT commonly reported efficiency gains and reduced cognitive burden, although reported cognitive effects varied across clinicians and practice contexts. CONCLUSION/UNASSIGNED:Clinicians reported reductions in documentation burden and changes in documentation workflows following ADT adoption, with heterogeneous perceived effects on clinical reasoning. Implementation should address both efficiency and changes to clinicians' cognitive and workflow practices.
PMCID:13694108
PMID: 42921637
ISSN: 2574-2531
CID: 6074940
