Faculty Bibliography

Historically, recruiting research participants through social media facilitated access to people who use opioids, capturing a range of drug use behaviors. The current rapidly changing online landscape, however, casts doubt on social media's continued usefulness for study recruitment. In this viewpoint paper, we assessed social media recruitment for people who use opioids and described challenges and potential solutions for effective recruitment. As part of a study on barriers to harm reduction health services, we recruited people who use opioids in New York City to complete a REDCap (Research Electronic Data Capture; Vanderbilt University) internet-based survey using Meta (Facebook and Instagram), X (formerly known as Twitter), Reddit, and Discord. Eligible participants must have reported using opioids (heroin, prescription opioids, or fentanyl) for nonprescription purposes in the past 90 days and live or work in New York City. Data collection took place from August 2023 to November 2023. Including study purpose, compensation, and inclusion criteria caused Meta's social media platforms and X to flag our ads as "discriminatory" and "spreading false information." Listing incentives increased bot traffic across all platforms despite bot prevention activities (eg, reCAPTCHA and counting items in an image). We instituted a rigorous post hoc data cleaning protocol (eg, investigating duplicate IP addresses, participants reporting use of a fictitious drug, invalid ZIP codes, and improbable drug use behaviors) to identify bot submissions and repeat participants. Participants received a US $20 gift card if still deemed eligible after post hoc data inspection. There were 2560 submissions, 93.2% (n=2387) of which were determined to be from bots or malicious responders. Of these, 23.9% (n=571) showed evidence of a duplicate IP or email address, 45.9% (n=1095) reported consuming a fictitious drug, 15.8% (n=378) provided an invalid ZIP code, and 9.4% (n=225) reported improbable drug use behaviors. The majority of responses deemed legitimate (n=173) were collected from Meta (n=79, 45.7%) and Reddit (n=48, 27.8%). X's ads were the most expensive (US $1.96/click) and yielded the fewest participants (3 completed surveys). Social media recruitment of hidden populations is challenging but not impossible. Rigorous data collection protocols and post hoc data inspection are necessary to ensure the validity of findings. These methods may counter previous best practices for researching stigmatized behaviors.

BACKGROUND:Exposure to endocrine-disrupting chemicals such as bisphenols and phthalates might lead to adverse fertility and early pregnancy outcomes. METHODS:This study was embedded in the Generation R Next Study, a population-based cohort study from preconception onwards. Urinary phthalate and bisphenol concentrations were assessed in the preconception period (938 women), defined as the period in which couples were actively trying to conceive, and early pregnancy (1,366 women and 1,202 men, mean gestational age at sampling 8·6 weeks). Time to pregnancy and miscarriage were assessed using questionnaires and ultrasounds. Subfertility was defined as the inability to conceive within 12 months or need for assisted reproductive technologies. FINDINGS/RESULTS:Higher preconception urinary bisphenol S (BPS) and cyclohexane-1,2-dicarboxylic acid-monocarboxy isooctyl ester (mCOCH) concentrations in women were associated with longer time to pregnancy. Higher preconception mono-[(2-carboxymethyl)hexyl] phthalate, mono-2-ethyl-5-oxohexyl phthalate (mEOHP), mono-(7-carboxy-n-heptyl)phthalate (mCHpP), and mono benzyl phthalate (mBzBP) were associated with shorter time to pregnancy, and higher mono-2-ethyl-5-hydroxyhexyl phthalate (mEHHP), mEOHP, and mBzBP with lower odds of subfertility. In men, higher early pregnancy BPS, mCHpP, mono-4-methyl-7-hydroxyoctyl phthalate, mono-4-methyl-7-oxooctyl phthalate, and mono-ethyl phthalate were associated with shorter time to pregnancy or lower odds of subfertility. Higher preconception or early pregnancy BPS, phthalic acid, and mCHpP in women were associated with lower odds of miscarriage, whereas higher mono-carboxy-isoctyl phthalate, mCOCH, and mono-2-(propyl-6-carboxy-hexyl)-phthalate (cxmPHxP) with higher odds of miscarriage (all p-values <0·05). INTERPRETATION/CONCLUSIONS:Preconception and early pregnancy exposure to bisphenols and phthalates may affect couple fertility. Our results should be considered as hypothesis generating and replicated in future studies, possibly including repeated chemical measurements and mixture analysis.

BACKGROUND/UNASSIGNED:Nurses are one of the largest user groups of the electronic health record (EHR) system, relying on its tools to support patient care and nursing workflows. Recent studies suggested that the redesign of nursing documentation may reduce the time spent in the EHR system and improve nurse satisfaction. OBJECTIVE/UNASSIGNED:We aimed to assess nurses' perceptions of the redesigned EHR, evaluate the impact of documentation interventions, and identify future improvement needs. METHODS/UNASSIGNED:Guided by the American Nursing Informatics Association's Six Domains of Burden conceptual framework, this multimethod project combined both qualitative and quantitative approaches. Registered nurses across the academic health system were recruited via email invitations to participate in focus group discussions. The focus groups were conducted via a web conference and ranged from 60 to 90 minutes in duration. The focus group discussions were transcribed and analyzed through thematic analysis. The EHR vendor's time data were used to analyze nurses' time spent in documentation. RESULTS/UNASSIGNED:In total, 20 registered nurses participated in the focus group discussions, and 17 nurses completed the demographic survey; 88% (15/17) of participants had ≥3 years of EHR experience at the academic health system, and 53% (9/17) self-reported being competent in the EHR system. The following six themes emerged: positive feedback, usability and workflow opportunities, nuisance, training and education, communication, and time spent in the system. EHR vendor time data revealed that the time spent in flowsheets averaged 31.11% per 12-hour shift. CONCLUSIONS/UNASSIGNED:Overall, participants reported a positive experience and that the EHR supported patient care. There are opportunities to further reduce redundancies in documentation and implement programs that support continuous learning about EHR and health technology tools. Specific suggestions include optimizing the oral health assessment tool. Analyzing frontline nursing perspectives in the redesign of EHR workflows is imperative for identifying interventions that support nurses' satisfaction with the EHR.

INTRODUCTION/BACKGROUND:Transition-age (TA) adults, aged 18-25, have the highest prevalence of substance use disorder (SUD) among all age groups yet they are less likely to seek treatment and more likely to discontinue it than older adults, making them a high-priority treatment population. While structural barriers and varying expectations of recovery may affect treatment initiation, insights from providers working with TA adults can reveal what further impels and impedes treatment engagement. METHODS:We conducted two focus groups with 14 front-line treatment providers, representing urban and rural outpatient, residential, and inpatient SUD care settings across New York State. Providers were selected through stratified sampling using restricted-access treatment registry data. A semi-structured interview guide facilitated discussions, and transcripts were analyzed to identify key themes. RESULTS:Providers report that TA adults prefer briefer, innovative treatment approaches over traditional modalities like A.A./12-step recovery, driven by a desire to rebuild their lives through education and career. Post-pandemic social disruptions were cited as exacerbating engagement challenges and increasing the need for integrating mental health support. Providers highlighted the potential of technology to enhance treatment engagement, though expressed concerns regarding social isolation and the fraying of childhood safety nets and support systems (e.g., housing) undermining successful treatment outcomes and transitions to adulthood more broadly. CONCLUSIONS:Providers report and perceive various challenges-unmet mental health needs, social alienation, and housing insecurity-that impede TA adults from successful SUD treatment. Understanding providers' perceptions of the needs of young adults can inform patient and clinical decision-making, lead to the development of innovative treatment approaches tailored to TA adults and contribute to improved health outcomes over the life course.

BACKGROUND:New evidence has emerged that plastic polymers and their chemical additives, particularly di-2-ethylhexylphthalate (DEHP), contribute to cardiovascular disease (CVD). Phthalates are commonly used in the production of plastic materials and have been linked to increased oxidative stress, metabolic dysfunction, and cardiovascular disease. Estimates of phthalate-attributable cardiovascular mortality have been made for the US, but global estimates are needed to inform ongoing negotiations of a Global Plastics Treaty. METHODS:Cardiovascular mortality data from the Institute for Health Metrics and Evaluation (IHME) and regional DEHP exposure estimates from several sources were used to estimate burden. Hazard ratios of CV mortality were calculated using published exposure estimates, and country-level cardiovascular mortality rates were used to calculate excess deaths and years of life lost (YLL) due to DEHP exposure. FINDINGS/RESULTS:In 2018, an estimated 356,238 deaths globally were attributed to DEHP exposure, representing 13.497% of all cardiovascular deaths among individuals aged 55-64. Of these, 349,113 were attributed to the use of plastics. Geographic disparities were evident, with South Asia and the Middle East suffering the greatest percentage of cardiovascular deaths attributable to DEHP exposure (16.807%). The Middle East, South Asia, East Asia, and the Pacific accounted for the largest shares of DEHP-attributable CVD deaths (73.163%). Globally, DEHP resulted in 10.473 million YLL. INTERPRETATION/CONCLUSIONS:Plastics pose a significant risk to increased cardiovascular mortality, disproportionately impacting regions which have developing plastic production sectors. The findings underscore the need for urgent global and local regulatory interventions to kerb mortality from DEHP exposure. FUNDING/BACKGROUND:Bloomberg Philanthropies and the National Institutes of Health.

OBJECTIVE:Maternal vitamin D level is an important determinant of pregnancy and child health outcomes. Exposure to air pollution is suspected to increase the risk of vitamin D deficiency, but the evidence is scarce. We investigated the association between air pollution during pregnancy and maternal vitamin D levels. METHODS:A total of 15,935 pregnant women from 5 birth cohorts in Europe and U.S were included. Averaged concentrations of nitrogen oxides, fine and coarse particles, and composition of fine particles from conception until vitamin D measurement were estimated at participants' residential addresses using land-use regression or other spatiotemporal models. Cohorts measured vitamin D as 25(OH)D or 25(OH)D3 levels in serum or plasma at early or mid-pregnancy. We defined suboptimal vitamin D levels as levels below 20 ng/mL. We performed logistic regression models for each cohort to estimate the association between air pollution exposure and suboptimal vitamin D levels and pooled cohort-specific estimates in a random-effect meta-analysis. Models were adjusted for sociodemographic and lifestyle characteristics and month of conception. RESULTS:We found an association between PM2.5 and higher odds of suboptimal vitamin D levels (i.e., below 20 ng/mL) (odds ratio per 5 μg/m3 increase in PM2.5, 1.43 95%CI: 1.02, 1.99). There was no association between other air pollutant exposure and vitamin D levels. CONCLUSIONS:PM2.5 exposure might contribute to suboptimal levels of vitamin D in pregnancy. Reducing air pollution exposure should be a priority because vitamin D deficiency may adversely influence offspring development.

OBJECTIVE:This study aimed to identify facilitators and barriers among sexual and gender minority (SGM) individuals in receiving reproductive healthcare. METHODS:Participants were recruited through social media and university groups across the US. Inclusion criteria consisted of self-identified SGM community members; aged 18-40. This included: cisgender women whose sexual orientation included gay, lesbian, bisexual, and/or queer and / or individuals whose gender identity does not align with their sex assigned at birth; transgender men, non-binary people with a uterus, cisgender queen woman, and transgender woman. An initial codebook was developed utilizing inductive coding to identify key themes. RESULTS:A total of 9 focus groups were held with 67 people,5-10 people per group. Six themes were identified: 1) Barriers to high quality reproductive care, 2) Facilitators to high quality reproductive care, 3) Negative prior experiences, 4) Physical/logistical access to adequate care, 5) Emotions/trust in disclosing SGM status, and 6) Knowledge levels on SGM reproductive healthcare. CONCLUSION/CONCLUSIONS:Quality reproductive health care for SGM individuals is hindered by individual, clinician, and institutional factors. The factors include individual barriers of knowledge, distrust, and dysphoria; clinician barriers knowledge gaps or discomfort; and institutional factors of false advertising of LGBTQ+ friendly practices. PRACTICE IMPLICATIONS/CONCLUSIONS:This study impacts clinical practice through providing focused areas to better improve training and education for healthcare providers. Findings support improving clinical training on cultural humility, creating a welcoming environment, maintaining trust, and utilizing sensitive terminology.