Faculty Bibliography

OBJECTIVES/OBJECTIVE:To study the impact of an educational intervention on obstetrician-gynecologist clinicians' knowledge of racial and ethnic disparities in the menopause experience. METHODS:Twenty-five obstetrician-gynecologist physicians (residents, fellows, and attendings) at an academic medical center in New York, NY, completed the Achieving Menopausal Health Equity Network course, a brief web-based intervention consisting of four modules delivered through narrated didactic videos and interactive tools, a 10-item pretest and posttest, and a course evaluation survey. The primary outcome was a change in knowledge scores after the completion of the educational intervention. Item analysis was also performed to assess item discrimination, item difficulty, and response frequency. Feedback on modules was obtained, and thematic analysis was performed. RESULTS:In this study, 25 participants completed the educational intervention. There was a statistically significant increase in mean test scores after participation (pretest mean score=7.1/10 vs. posttest mean score=8.1/10, P =0.0021). The following themes emerged in thematic analysis: knowledge building with potential for practical application for clinicians and non-clinicians, clarity and relevance, and opportunities for growth for future iterations of the modules. CONCLUSIONS:This brief, online educational curriculum focused on racial and ethnic disparities in menopause significantly improved the knowledge of obstetrician-gynecologist clinicians at various levels of training and provides a useful model for introducing more formal training on menopause medicine for obstetrician-gynecologist clinicians.

INTRODUCTION/BACKGROUND:Research has demonstrated that food insecurity during childhood is associated with worse physical and mental health in childhood. However, little is known about how food insecurity during childhood impacts health outcomes in young adulthood. METHODS:This study analyzed data from the Future of Families and Child Wellbeing Study (2024), a longitudinal birth cohort study of children born in 1998-2000. Childhood food insecurity trajectory groups from age 3 to 15 years were identified using group-based trajectory modeling. Associations between childhood food insecurity trajectory groups and young adult weight (BMI, overweight status, and obese status) and high self-reported health (good/excellent) at age 22 were modeled with multivariate linear and logistic regression. RESULTS:Three trajectories were identified among 4,296 participants: 66.9% were food secure, 7.5% were food insecure, and 25.6% transitioned from being food insecure-to-secure throughout childhood. In adjusted analyses, young adults assigned to the food insecure-to-secure trajectory group as children had higher BMI (B 0.82, 95% CI [0.07-1.58]) and higher odds of overweight status (OR 1.24, 95% CI [1.01-1.52]) than young adults assigned to the food secure trajectory group as children. Young adults in the food insecure trajectory group as children had lower odds of high self-reported health than those in the food secure trajectory group as children (OR 0.65, 95% CI [0.48-0.89]). CONCLUSIONS:Food insecurity in childhood is associated with high weight status and poor self-reported health in young adulthood. These findings highlight the importance of childhood food insecurity screening and interventions to promote health throughout the life course.

BACKGROUND:The Tobacco, Alcohol, Prescription Medication, and Other Substance (TAPS) tool is a screening and brief assessment instrument to identify unhealthy tobacco, alcohol, drug use, and prescription medication use in primary care patients. This secondary analysis compares the TAPS tool to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) for alcohol screening. METHODS:Adult primary care patients (1124 female, 874 male) completed the TAPS tool followed by AUDIT-C. Performance of each instrument was evaluated against a reference standard measure, the modified World Mental Health Composite International Diagnostic Interview, to identify problem use and alcohol use disorder (AUD). Area under the curve (AUC) appraised discrimination, and sensitivity and specificity were calculated for Youden optimal score thresholds. RESULTS:For identifying problem use: On the AUDIT-C, AUC was 0.90 (95% Confidence Interval: 0.86-0.92) for females and 0.91 (0.89-0.93) for males. Sensitivity and specificity for females were 0.89 (0.83-0.93) and 0.78 (0.75-0.80), respectively, and for males were 0.84 (0.79-0.88) and 0.82 (0.79-0.85). On the TAPS tool, AUC was 0.82 (0.79-0.86) for females and 0.81 (0.78-0.84) for males. Sensitivity and specificity for females were 0.78 (0.72-0.84) and 0.78 (0.75-0.81), respectively, and for males were 0.76 (0.71-0.81) and 0.76 (0.72-0.79). For AUD: On the AUDIT-C, AUC was 0.90 (0.88-0.93) for both females and males. Sensitivity and specificity for females were 0.83 (0.74-0.90) and 0.83 (0.80-0.85), respectively, while for males, they were 0.81 (0.74-0.87) and 0.84 (0.81-0.87). On the TAPS tool, AUC was 0.84 (0.80-0.89) for females and 0.82 (0.78-0.86) for males. Sensitivity and specificity for females were 0.73 (0.63-0.81) and 0.85 (0.83-0.88), respectively, while for males, they were 0.75 (0.68-0.81) and 0.84 (0.81-0.86). CONCLUSION/CONCLUSIONS:The AUDIT-C performed somewhat better than the TAPS tool for alcohol screening. However, the TAPS tool had an acceptable level of performance for alcohol screening and may be advantageous in practice settings seeking to identify alcohol and other substance use with a single instrument.

Poor cardiovascular health is strongly linked to increased risk of cognitive impairment and Alzheimer's disease and related dementias. This commentary discusses Yang and associates' work on the associations between cardiovascular health in middle age, as defined by Life Essential 8 scores, and later digital cognitive performance and incident Alzheimer's disease. We examine the strengths and weaknesses of their study within the broader research context. We emphasize the potential significance of sleep and stress the need for longitudinal studies incorporating robust neuropsychiatric methodologies, advanced neuroimaging techniques, and diverse participant samples to enhance the reliability and generalizability of results.

BACKGROUND:Ketamine-related poisonings and law enforcement seizures have been increasing in the United States, but population surveys suggest that recreational use has been rare with trends being relatively stable. This study aimed to estimate trends and correlates of use among nightclub attendees-a population known for high prevalence of party drug use. METHODS:Adults entering randomly selected nightclubs in New York City were surveyed in 2017 (n = 674), 2018 (n = 724), 2019 (n = 541), 2021 (n = 160), 2022 (n = 322), and 2024 (n = 911) (total N = 3332; 56.3 % male, 52.7 % age ≥26). Trends in lifetime, past-year, and past-month ketamine use were estimated using logistic regression, and correlates and trends in characteristics of people who used in the past month were also estimated. RESULTS:Between 2017 and 2024, lifetime ketamine use increased from 16.6 % to 22.7 % (a 36.7 % increase), past-year use increased from 7.4 % to 14.3 % (a 94.0 % increase), and past-month use increased from 3.1 % to 6.8 % (an 118.1 % increase, Ps<0.001). Past-month use particularly increased among those aged ≥26 (by 222.0 %), females (by 216.6 %), those with a college degree (by 161.0 %), and among people who identify as bisexual or "other" sexuality (by 445.0 %), and among those who used cocaine (by 213.8 %), ecstasy/MDMA (by 94.9 %), and/or LSD (238.2 %) in the past month (Ps<0.01). Identifying as gay/lesbian (aOR=2.03, 95 % CI: 1.19-3.48) and past-month use of cocaine (aOR=8.17, 95 % CI: 4.97-13.43) in particular were associated with increased odds for past-month use. CONCLUSIONS:Recreational ketamine use is increasing among this population so an increased focus on both prevention and harm reduction is needed.

Despite several randomized controlled trials demonstrating the benefits of combination therapies for metastatic hormone-sensitive prostate cancer (mHSPC), a significant treatment gap persists. This initiative by the Prostate Cancer Foundation (PCF) convened stakeholders from academia, community practices, industry, and patient advocacy groups to address critical challenges in mHSPC care. Expert discussions and a review of real-world evidence and meta-analyses informed the development of strategies to improve care delivery. Evaluation of the data from global registries, such as IRONMAN, and large community databases was used to assess treatment utilization patterns and disparities. Combination therapies with two agents-androgen deprivation therapy (ADT) plus an androgen receptor pathway inhibitor (ARPI)-or three agents-ADT + ARPI + docetaxel-demonstrate significant survival improvements while preserving quality of life for patients with mHSPC, yet adoption remains inconsistent. Of the eligible patients, 20%-60% remain undertreated, with geographic, financial, and systemic barriers contributing to inconsistencies in care. Younger, White, urban-dwelling patients with fewer comorbidities are more likely to receive combination treatment, highlighting disparities across populations. Meta-analyses identified a lack of standardization due to varying inclusion criteria and comparators across trials. Real-world evidence underscored disparities influenced by geographic location, practice type, and access to specialty care. Initiatives such as the PANTHER study highlight improved outcomes in Black patients treated with combination therapies, emphasizing the importance of including diverse populations in clinical trials. To bridge gaps in care, this initiative prioritizes awareness, standardization, and equitable access to evidence-based therapies. Proposed solutions include targeted knowledge dissemination strategies, development of educational resources, and advocacy for policy changes to promote guideline-concordant care. By leveraging collaborative efforts, organizations, including PCF, can contribute to enhancing survival outcomes and quality of life for all patients with mHSPC.

BACKGROUND/UNASSIGNED:Colorectal cancer screening can reduce colorectal cancer risk, yet many men are not up to date with screening guidelines. Although previous qualitative studies have suggested links among anti-gay prejudice, traditional masculine self-concept, racial identity, and colorectal cancer screening among men, scholars have yet to fully explore these associations using quantitative data. This study used a nationally representative sample of Black and White men in the United States to test these associations and examine the sociodemographic correlates. METHODS/UNASSIGNED:Using the National Opinion Research Center (NORC)/AmeriSpeak probability-based panel, we recruited a sample of Black and White men in the United States ages 45 to 74 years who had never been diagnosed with colorectal cancer (N = 909). Participants completed an online questionnaire measuring anti-gay prejudice, traditional masculine self-concept, sociodemographic variables, and screening-related outcomes (awareness of screening test options, screening intention, and adherence to screening recommendations). RESULTS/UNASSIGNED:Black participants reported higher levels of anti-gay prejudice and traditional masculine self-concept than White participants. Anti-gay prejudice was associated with lower awareness and lower screening intention. Black participants reported higher intention to follow screening recommendations but not higher odds of actual adherence than White participants. CONCLUSIONS/UNASSIGNED:Men with anti-gay prejudice are less likely to be aware of colorectal cancer screening test options and less likely to intend to engage in colorectal cancer screening. The results have implications for the design and development of future interventions aimed at increasing colorectal cancer screening rates. IMPACT/UNASSIGNED:Future studies could develop targeted interventions and observe subsequent changes or conduct longitudinal studies to further explore the role of anti-gay prejudice in colorectal cancer screening.

BACKGROUND:We sought to estimate the prevalence of synthetic cannabinoid use and characteristics of people who use in the US general population. METHODS:We compared the prevalence of past-year synthetic cannabinoid use in 2023 to 2021 among individuals ages ≥ 12 surveyed via the National Survey on Drug Use and Health (N = 173,808). We also compared prevalence according to demographic and drug use characteristics and delineated correlates of past-year use. RESULTS:Synthetic cannabinoid use increased from 0.17 % in 2021 to 0.26 % in 2023, a 50.0 % increase (p = .042) (0.25 % prevalence in 2021-2023 overall). The largest increases were among those aged ≥ 35 (by 255.3 %), those with an annual family income of < $20,000 (by 242.1 %), and those who used methamphetamine in the past year (by 184.6 %) (Ps < .05). In our final multivariable model, those with less than a high school diploma (aOR=2.20, 95 % CI: 1.12-4.32) and those with past-year cannabis use (aOR=13.55, 95 % CI: 8.36-21.95) and use disorder (aOR=26.03, 95 % CI: 17.70-38.29) were at higher odds for synthetic cannabinoid use, as were people with methamphetamine use (aOR=3.08, 95 % CI: 1.18-8.01) and use disorder (aOR=4.74, 95 % CI: 2.17-10.37), and prescription opioid misuse (aOR=1.75, 95 % CI: 1.05-2.93) and use disorder (aOR=3.22, 95 % CI: 1.78-5.82). CONCLUSION/CONCLUSIONS:Survey data suggest that synthetic cannabinoid use is rare but increasing, particularly among people of lower socioeconomic status and people who use other drugs. Cannabis use disorder in particular is associated with higher odds for use. Research is needed to determine if overreporting is occurring due to confusion with emerging cannabis products.