Faculty Bibliography

According to the family stress model (FSM), economic stressors undermine optimal child development through negative impacts on parent psychological well-being and family relationships, which in turn disrupt positive parenting. However, few studies have examined the role of interparental conflict among these pathways and the resilience factors that buffer the FSM processes. Understanding risk and resilience is especially relevant for families in Flint, MI, for whom poverty resulting from structural racism and chronic disinvestment has coincided with public health crises. Using 199 families from low socioeconomic backgrounds in an ongoing parenting intervention in Flint, this study examined whether parent psychological distress and interparental conflict mediated the association between economic pressure at baseline (around birth) and cognitive stimulation at 9 months, and whether parenting self-efficacy and social support moderated the sequential mediation. Data were collected through parent interviews at both time points. We found that the negative association between economic pressure at baseline and cognitive stimulation at 9 months was sequentially mediated by parent psychological distress and interparental conflict. Furthermore, this negative sequential mediation was reduced and became nonsignificant when parents reported higher levels of parenting self-efficacy and social support. These findings suggest that improving interparental relationships in addition to parent mental health may promote positive parenting in at-risk two-parent families and that strength-based interventions are needed to reinforce parenting self-efficacy and facilitate parents' social networks and connections with the community to foster positive parenting. Programs should address these issues during infancy to build a strong foundation for long-term healthy development. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Socioeconomic position (SEP) in childhood and beyond may influence the gut microbiome, with implications for disease risk. Studies evaluating the relationship between life-course SEP and the gut microbiome are sparse, particularly among Hispanic/Latino individuals, who have a high prevalence of low SEP. We use the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a population-based cohort study conducted in four field centers in the United States (U.S.), to evaluate the association between life-course SEP and gut microbiome composition. Life-course SEP indicators included parental education (proxy of childhood SEP), current SEP (n = 2174), and childhood (n = 988) and current economic hardship (n = 994). Shotgun sequencing was performed on stool samples. Analysis of Compositions of Microbiomes was used to identify associations of life-course SEP indicators with gut microbiome species and functions. Parental education and current SEP were associated with the overall gut microbiome composition; however, parental education and current education explained more the gut microbiome variance than the current SEP. A lower parental education and current SEP were associated with a lower abundance of species from genus Bacteroides. In stratified analysis by nativity, we found similar findings mainly among foreign-born participants. Early-life SEP may have long-term effects on gut microbiome composition underscoring another biological mechanism linking early childhood factors to adult disease.

OBJECTIVE/UNASSIGNED:Social support interventions may enhance access and use of evidence-based tobacco cessation treatments (EBCTs). We assessed the feasibility of a proactive social support intervention for Veterans who smoke. METHODS/UNASSIGNED:We used national Veterans Health Administration (VHA) data to identify Veterans who smoke cigarettes in the United States. We mailed invitation letters to a random national sample, followed by telephone outreach. Veteran-support person dyads were randomly assigned to intervention or control conditions. Support persons in the intervention group additionally received a 1-call coaching session. Assessments were conducted at baseline, 1-month, and 4-months post-randomization. Data collection occurred from March 2021 - August 2022. RESULTS/UNASSIGNED:A total of 27 dyads were randomized. Two-thirds of Veteran participants were women. Veteran follow-up survey response rates were 81.5 %. Intervention participants reported a higher rate of cessation medication use (57.1 % vs. 30.8 %), use of any EBCT (64.3 % vs. 38.5 %), and biochemically confirmed seven-day point-prevalence abstinence (14.3 % vs 7.7 %) than control participants. The proactive recruitment rate was 6 % for Veterans, 74 % for support persons, and a 93 % support person completion rate for the coaching call intervention. CONCLUSIONS/UNASSIGNED:Recruitment methods were feasible, especially for women Veterans. A proactive social support intervention shows promise for increasing Veteran utilization of EBCTs.

INTRODUCTION/BACKGROUND:Colorectal cancer (CRC) screening rates among patients receiving care at multiple federally qualified health care centers (FQHCs) in New York city are low. Proactive outreach through mailed fecal immunochemical tests (FIT), reminders and navigation are evidence based interventions to improve CRC screening rates but remain untested in this study population. OBJECTIVE:To evaluate the effectiveness, implementation, and cost-effectiveness of a multilevel proactive outreach strategy to improve CRC screening rates among underserved adults in Brooklyn, New York. METHODS:This is a randomized controlled trial across five FQHCs serving predominantly Black and low-income populations. Adults aged 45-75 who are overdue for CRC screening are randomized to usual care or a multi-level proactive intervention. The intervention includes mailed education and FIT kits, patient navigation, and support for colonoscopy scheduling and follow-up. The primary outcome is CRC screening completion (FIT or colonoscopy) within six months. Secondary outcomes include colonoscopy follow-up after a positive FIT, implementation barriers and facilitators, and cost-effectiveness. RESULTS:A total of 1379 participants have been enrolled through May 2025. DISCUSSION/CONCLUSIONS:This trial addresses a critical gap in CRC prevention by testing a scalable, multilevel outreach model tailored to underserved populations. Findings will inform future strategies to enhance screening rates while reducing screening disparities through sustainable FQHC-based programs.

BACKGROUND AND OBJECTIVE/OBJECTIVE:Prostate cancer (PC) is the second most common cancer and a leading cause of death among males. In this systematic review we evaluated cohort studies and randomized controlled trials (RCTs) on the relationship between dietary patterns and PC risk, progression, mortality, and biomarkers. METHODS:A systematic search of MEDLINE, Embase, and Cochrane Central was conducted through June 2024 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 63 studies (49 cohort studies, 14 RCTs reports) examining dietary patterns and PC outcomes were included. Study quality was assessed using Critical Appraisal Skills Programme checklists. KEY FINDINGS AND LIMITATIONS/UNASSIGNED:Among males without PC at baseline, plant-based and healthy dietary patterns (eg, higher Healthy Eating Index, lower dietary inflammatory and hyperinsulinemic scores) were generally associated with lower total PC risk. Among patients with PC, Mediterranean, plant-based, and low-inflammatory diets were more consistently linked to lower risk of progression and PC-specific mortality. RCTs testing various diet patterns showed mixed effects on prostate-specific antigen or tumor markers. Limitations include variations in diet definitions, outcomes, and follow-up duration, and residual confounding. CONCLUSIONS AND CLINICAL IMPLICATIONS/CONCLUSIONS:Healthy dietary patterns that support cardiometabolic health may also benefit PC prevention and management. While evidence appears stronger for diet in slowing PC progression after diagnosis, the impact of diet on reducing the risk of other PC outcomes should not be overlooked (eg, risk of developing PC or risk of PC death). Integrated strategies are needed to promote healthy eating, particularly for patients at risk of PC progression, as this population often has higher risk of cardiovascular disease and metabolic disorders such as diabetes.

BACKGROUND:The United States has one of the highest incarceration rates in the world. Prior incarceration is associated with adverse health effects. While the era of "mass incarceration" began in 1973, little work has focused on older adults, whose lives have spanned the five decades of mass incarceration. METHODS:We conducted a cross-sectional analysis using data on adults 50 or older from the nationally representative Family History of Incarceration Survey to test the independent association between prior incarceration and self-reported physical and mental health. In logistic regression models, we controlled for age, gender, race/ethnicity, education, income, employment, and marital status. We also tested for effect modification by race/ethnicity, gender, and time since last incarceration, as well as financial and social wellbeing. RESULTS:Among 1318 older adults, 21% had been incarcerated. Formerly incarcerated older adults were more likely to be men; non-Hispanic Black or "other" race/ethnicity; meet criteria for disability; be unmarried; and have lower income and education compared with those never incarcerated. In fully adjusted models, prior incarceration was independently associated with greater odds of reporting "fair" or "poor" physical health (aOR:1.88, 95% CI: 1.19-2.98; p = 0.007). Prior incarceration was associated with reporting "fair" or "poor" mental health after adjusting for demographic covariates (aOR: 2.12, 95% CI: 1.24-3.65; p = 0.006) but was nonsignificant after adding socioeconomic covariates. Length of time from last incarceration did not moderate the observed association, meaning that even those incarcerated > 10 years ago had poor self-reported health. Financial wellbeing moderated the association between incarceration and mental health. CONCLUSION/CONCLUSIONS:Prior incarceration is a social determinant of health for older adults, even those with distant incarceration history, and is strongly associated with current poverty and meeting criteria for disability. Further research is needed to understand the mechanisms of these associations and means to mitigate health harms associated with prior incarceration.

Cisgender women are underserved by current HIV prevention efforts, and substantial gender disparities persist in pre-exposure prophylaxis (PrEP) use. Recent diagnoses with a bacterial sexually transmitted infection (STI) are objective, readily available indicators of PrEP-eligibility that could be used to improve PrEP prescribing for cisgender women. To better understand missed opportunities for prescribing, we examined the prevalence and correlates of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) diagnoses among cisgender women seeking care at a New York City obstetrics and gynecology (Ob/Gyn) clinic, along with the number of PrEP prescriptions provided post-STI diagnosis. A cross-sectional, retrospective review of electronic health record data was conducted for all HIV-negative cisgender women tested for CT and/or NG at the clinic between September 1, 2021 and September 19, 2022. Counts and prevalence for CT and NG infection were calculated, and multivariable log-binomial regression was used to examine associated factors. Among 7593 cisgender women receiving CT/NG testing during the study period, 186 had ≥ 1 CT infection (prevalence: 2.45%) and 18 had ≥ 1 NG infection (prevalence: 0.24%). In a multivariable model, CT/NG infection was significantly associated with age, having Spanish as a primary language, and a marital status of divorced, widowed, or separated. No cisgender women who received CT or NG diagnoses were prescribed PrEP during the study period. These findings highlight how opportunities to prescribe PrEP to cisgender women continue to be missed, even with readily available indicators for PrEP eligibility. More effective strategies are needed to promote PrEP prescribing among diverse populations of cisgender women, particularly in Ob/Gyn settings.

BACKGROUND/UNASSIGNED:; environmental injustice) by racial/ethnic segregation (social injustice) on dementia diagnosis in ESKD. METHODS/UNASSIGNED:concentrations (annualized and matched to older adults' residential ZIP code at dialysis initiation) and by segregation scores (Theil's H method). FINDINGS/UNASSIGNED:and segregation. INTERPRETATION/UNASSIGNED:experienced an increased risk of dementia; this risk was particularly pronounced among individuals in high segregation and predominantly minority neighborhoods. Environmental and social injustices likely drive racial and ethnic disparities in dementia for older adults with ESKD, underscoring the need for interventions and policies to mitigate these injustices. FUNDING/UNASSIGNED:National Institutes of Health.

RATIONALE AND OBJECTIVES/OBJECTIVE:To evaluate the performance, stability, and decision-making behavior of large language models (LLMs) for title and abstract screening for radiology systematic reviews, with attention to prompt framing, confidence calibration, and model robustness under disagreement. MATERIALS AND METHODS/METHODS:We compared five LLMs (GPT-4o, GPT-4o mini, Gemini 1.5 Pro, Gemini 2.0 Flash, Llama 3.3 70B) on two imaging-focused systematic reviews (n = 5438 and n = 267 abstracts) using binary and ternary classification tasks, confidence scoring, and reclassification of true and synthetic disagreements. Disagreements were framed as either "LLM vs human" or "human vs human." We also piloted autonomous PubMed retrieval using OpenAI and Gemini Deep Research tools. RESULTS:LLMs achieved high specificity and variable sensitivity across reviews and tasks, with F1 scores ranging from 0.389 to 0.854. Ternary classification showed low abstention rates (<5%) and modest sensitivity gains. Confidence scores were significantly higher for correct predictions. In disagreement tasks, models more often selected the human label when disagreements were framed as "LLM vs human," consistent with authority bias. GPT-4o showed greater resistance to this effect, while others were more prone to defer to perceived human input. In the autonomous search task, OpenAI achieved moderate recall and high precision; Gemini's recall was poor but precision remained high. CONCLUSION/CONCLUSIONS:LLMs hold promise for systematic review screening tasks but require careful prompt design and circumspect human-in-the-loop oversight to ensure robust performance.

INTRODUCTION/BACKGROUND:Process evaluation provides insight into how interventions are delivered across varying contexts and why interventions work in some contexts and not in others. This manuscript outlines the protocol for a process evaluation embedded in a hybrid type 1 effectiveness-implementation randomised clinical trial of incremental-start haemodialysis (HD) versus conventional HD delivered to patients starting chronic dialysis (the TwoPlus Study). The trial will simultaneously assess the effectiveness of incremental-start HD in real-world settings and the implementation strategies needed to successfully integrate this intervention into routine practice. This manuscript describes the rationale and methods used to capture how incremental-start HD is implemented across settings and the factors influencing its implementation success or failure within this trial. METHODS AND ANALYSIS/METHODS:We will use the Consolidated Framework for Implementation Research (CFIR) and the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) frameworks to inform process evaluation. Mixed methods include surveys conducted with treating providers (physicians) and dialysis personnel (nurses and dialysis administrators); semi-structured interviews with patient participants, caregivers of patient participants, treating providers (physicians and advanced practice practitioners), dialysis personnel (nurses, dieticians and social workers); and focus group meetings with study investigators and stakeholder partners. Data will be collected on the following implementation determinants: (a) organisational readiness to change, intervention acceptability and appropriateness; (b) inner setting characteristics underlying barriers and facilitators to the adoption of HD intervention at the enrollment centres; (c) external factors that mediate implementation; (d) adoption; (e) reach; (f) fidelity, to assess adherence to serial timed urine collection and HD treatment schedule; and (g) sustainability, to assess barriers and facilitators to maintaining intervention. Qualitative and quantitative data will be analysed iteratively and triangulated following a convergent parallel and pragmatic approach. Mixed methods analysis will use qualitative data to lend insight to quantitative findings. Process evaluation is important to understand factors influencing trial outcomes and identify potential contextual barriers and facilitators for the potential implementation of incremental-start HD into usual workflows in varied outpatient dialysis clinics and clinical practices. The process evaluation will help interpret and contextualise the trial clinical outcomes' findings. ETHICS AND DISSEMINATION/BACKGROUND:The study protocol was approved by the Wake Forest University School of Medicine Institutional Review Board (IRB). Findings from this study will be disseminated through peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBER/BACKGROUND:NCT05828823.