Faculty Bibliography

BACKGROUND:Community-clinical linkage models (CCLM) display significant potential to address the unique, multi-level type 2 diabetes risk factors facing minoritized communities, such as South Asian Americans. However, there lacks a systematic, longitudinal evaluation of how such tailored CCLMs can be better implemented in dynamic, real-world settings. This study aims to leverage multi-partner insights, collected in real time, to explore the barriers and facilitators to implement a South Asian American diabetes management and prevention intervention (the DREAM intervention). METHODS:The DREAM intervention, a two-arm randomized controlled trial, was implemented from 2019-2022; partners involved in its implementation were interviewed annually to understand their experiences of the program. Implementation partners included community health workers (CHWs), participating healthcare providers, community advisory board (CAB) partners, and research staff. The interview guide and subsequent deductive qualitative analysis was informed by the Consolidated Framework for Implementation Research (CFIR). RESULTS:Overall, 78 interviews were conducted across four waves (2019-2022) with 5 research staff, 8 CHWs, 18 providers/clinic staff, and 12 CAB partners. CHWs adapted intervention characteristics by tailoring curriculum and implementation to patient needs, including personalized goal setting and shifting to remote delivery with COVID-19-related content. At the individual level, participants' occupations, family dynamics, and technological capacity shaped engagement, while changing social, financial, and health contexts over time required CHWs to continually adjust support. Within the inner setting, partner roles and resource availability fluctuated, yet structured and consistent meetings facilitated communication and problem-solving. Outer setting influences, including shifting government and universities policies and the COVID-19 pandemic, required repeated adaptations, while CAB partnerships expanded community connections and services over time. Process-related findings underscored the evolving role of CHWs and research staff in planning and fidelity, with training shifting toward peer mentorship to build capacity. CONCLUSION/CONCLUSIONS:Findings revealed the pivotal role of programmatic adaptability and robust partner engagement in navigating dynamic contexts to support the diabetes needs of minoritized communities. The real-time, longitudinal approach taken for data collection and analysis was crucial in understanding how intervention changes were implemented and experienced, providing a model for similar implementation assessments.

Household chaos has been shown to be an important predictor across multiple domains of children's development, with both direct associations and indirect associations through changes in parenting practices. Yet, little is known about these associations among immigrant families. Data from the Children, Community, and Caregivers (C3) Study of the larger Together Growing Strong place-based initiative among predominantly Chinese and Latine immigrant families in the Sunset Park neighborhood of Brooklyn, New York were used to examine cross-sectional associations between household chaos and child behavior and receptive vocabulary at child ages 4 and 6 (N = 187). The STROBE checklist for cross-sectional research was adhered to. Linear regression models were used to examine unique contributions of variables, as well as structural equation modeling to examine mediation through parenting stress. As a supplemental exploratory analysis, differences in associations between household chaos and child behavior and language by race/ethnicity were further examined. There were significant positive associations between household chaos and parental reports of children's problem behavior (β = 0.21, 95% CI [0.07-0.35]) and significant negative associations between household chaos and direct assessments of children's receptive vocabulary (β=-0.21, 95% CI [-0.37 - -0.04]). Further, there were indirect associations of household chaos through parenting stress for child problem behavior only (β = 0.11, 95% CI [0.05-0.17]). The results for the main linear regression models and mediation models were primarily driven by Chinese families. Implications for predictors of child development in immigrant populations and the enduring salience of household chaos are discussed.

OBJECTIVES/OBJECTIVE:People receiving medications for opioid use disorder often continue to experience opioid withdrawal, creating barriers to improved outcomes. Emerging evidence suggests the existence of distinct opioid withdrawal subtypes characterized by high and low levels of withdrawal severity, highlighting the need for personalized treatment approaches. To inform clinical practice, we identified subgroups of adults based on levels of opioid withdrawal over time during opioid use disorder (OUD) treatment. METHODS:We conducted a secondary analysis of the Clinical Trials Network (CTN-0051) Extended-Release Naltrexone versus Buprenorphine for Opioid Treatment trial using latent class growth analysis to identify subgroups of withdrawal. Four hundred and seventy-four participants in an OUD trial were randomized to receive extended-release naltrexone (XR-NTX) or sublingual buprenorphine-naloxone (BUP-NX). Withdrawal symptoms were measured using the Subjective Opiate Withdrawal Scale (SOWS) at 10 timepoints. We identified classes and compared their predictors of withdrawal and time to return to opioid use. RESULTS:Two distinct trajectories - low and high sustained opioid withdrawal - were identified in each treatment arm. Most participants were in the low withdrawal class (n = 176; 86 % XR-NTX and n = 241; 89 % BUP-NX) with fewer in the high sustained withdrawal class (n = 28; 14 % XR-NTX and n = 29; 11 % BUP-NX). Differences in lifetime history of anxiety and depression and in quality of life domains (mobility, usual activities, and pain/discomfort) were primarily observed among XR-NTX participants, with only one baseline mobility difference emerging between BUP-NX classes. In the XR-NTX arm, time to return to use was significantly shorter in the high sustained withdrawal class compared to the low withdrawal class, whereas BUP-NX classes did not differ on time to return to use. DISCUSSION AND CONCLUSIONS/CONCLUSIONS:Our findings demonstrate the existence of distinct high and low opioid withdrawal subtypes among individuals receiving XR-NTX and BUP-NX. These results underscore the importance of personalized withdrawal management strategies and highlight the need to consider individual withdrawal trajectories when optimizing treatments. Future research should focus on identifying predictors of withdrawal severity to improve clinical outcomes.

BACKGROUND:levels. However, it remains unclear whether the CARE program also improves diabetes self-efficacy and psychosocial outcomes in the same study sample. OBJECTIVE:This is a secondary analysis to examine the potential efficacy of the CARE program on secondary outcomes, including diabetes self-efficacy, self-care activities, beliefs in diabetes self-care activities, and diabetes distress among Chinese Americans with T2D. METHODS:level of 7% or higher. Participants were recruited from various health care settings in New York City, including community health centers, private primary care providers, and NYU Langone Health and its affiliates, and were randomly assigned to either the CARE intervention group (n=30) or a waitlist control group (n=30). The intervention consisted of 2 culturally and linguistically tailored educational videos per week for 12 weeks, covering diabetes self-care topics such as healthy eating, physical activity, and medication adherence. These videos were delivered via the WeChat app. In addition, community health workers provided support calls to assist them in setting goals, problem-solving, and addressing social determinants of health barriers every 2 weeks. Secondary outcomes included patient self-reported diabetes self-efficacy, self-care activities, beliefs in diabetes self-care activities, and diabetes distress. Outcomes were assessed at baseline, 3 months, and 6 months. RESULTS:Participants had a mean age of 54.3 (SD 11.5) years and 62% (37/60) were male, 78% (47/60) were married, 58% (35/60) were employed, 70% (42/60) had a high school education or lower, and 88% (53/60) reported limited English proficiency. Intervention participants demonstrated statistically significant improvements in self-efficacy at 3 months (estimated difference in change: 8.47; 95% CI 2.44-14.5; adjusted P=.02), diabetes distress at 6 months (estimated difference in change: -0.43; 95% CI -0.71 to -0.15; adjusted P=.009), and adherence to a healthy diet at both 3 months (estimated difference in change: 1.61; 95% CI 0.46-2.75; adjusted P=.02) and 6 months (estimated difference in change: 1.64; 95% CI 0.48-2.81; adjusted P=.02). CONCLUSIONS:The culturally and linguistically tailored intervention showed promise in improving self-efficacy and diabetes self-care activities among Chinese Americans with T2D, warranting validation through a large-scale randomized controlled trial. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov NCT03557697; https://clinicaltrials.gov/study/NCT03557697.

PURPOSE/OBJECTIVE:To evaluate the association of patient characteristics, community-level social determinants of health, and cyst risk categories with completion of follow-up recommendations for incidental Pancreatic Cystic Lesions (PCLs). METHODS:We retrospectively identified consecutive patients (2013-2023) whose MRI radiology reports described PCLs. A fine-tuned LLaMA-3.1 8B Instruct large language model was used to extract PCL features. Lesions were classified using the 2017 ACR white paper: Category 1 (low risk), Category 2 (worrisome features), or Category 3 (high-risk stigmata). We recorded demographics and follow-up imaging or endoscopic ultrasound dates. Community-level factors were characterized by the 2020 CDC Social Vulnerability Index (SVI), stratified into quartiles. The primary outcome, "inappropriate follow-up," combined late and no follow-up. Multivariable binomial regression was applied to evaluate associations with inappropriate follow-up. RESULTS:In 7,745 patients (mean age 66.3 years; 4,796 women), 92.9% (7,198/7,745) of cysts were Category 1, 6.4% (498/7,745) were Category 2, and 0.6% (49/7,745) were Category 3. Only 36.3% of patients completed appropriate follow-up, 12.1% were late, and 51.6% were lost to follow-up. Inappropriate follow-up was high in every cyst category: 64.2% in Category 1, 59.4% in Category 2 and 49.0% in Category 3. In multivariable analysis, non-English primary language (RR 1.08; 95% CI, 1.02-1.14) and residing in more vulnerable communities of the 3rd quartiles of the socioeconomic Social Vulnerability Index subcategory (RR 1.07; 95% CI, 1.02-1.12) were associated with inappropriate follow-up. Higher age-adjusted Charlson Comorbidity Index (CCI ≥ 4) (RR .84; 95% CI, .79-.88), CCI 2-3 (RR .84; 95% CI, .79-.88), and higher-risk cysts in patients under 65 years of age (RR .76; 95% CI, .65-.89) were associated with completed follow-up. CONCLUSION/CONCLUSIONS:Follow-up completion for incidental PCLs was low. Factors most consistently associated with follow-up completion were language barriers, residence in socioeconomically vulnerable communities, age-adjusted CCI and higher-risk features among those under 65 years.

Phenolic compounds may be harmful to the developing fetus, but many have not been studied in-depth for adverse childhood allergic and respiratory health effects. We hypothesized that higher levels of phenolic compounds in prenatal spot urine would be associated with greater odds of childhood atopic dermatitis, allergic rhinitis, and asthma, and that child sex may modify these associations. 3198 mother-child paired cases were enrolled from 16 cohorts in the U.S. ECHO consortium. Fifteen phenols (e.g. benzophenones, parabens, bisphenols, triclosans) were measured from mother's urine during pregnancy using a multi-class chemical panel. Childhood outcomes included parent-reported atopic dermatitis (1466 mother-child pairs) between ages 0-3 years, and allergic rhinitis (901 mother-child pairs) and asthma (1662 mother-child pairs) between ages 5-9 years. Prenatal parabens were associated with increased odds of atopic dermatitis (odds ratio (OR) 1.13, 95 % confidence intervals (CI) 1.02, 1.26). Benzophenones were associated with lower odds of asthma (OR 0.77, CI 0.66, 0.90). Compared to boys, girls demonstrated higher odds of parabens (1.21, CI 1.04, 1.42), benzophenones (1.18, CI 1.00, 1.38) and bisphenol S (1.21, CI 1.03, 1.43) being associated with atopic dermatitis, and of the benzophenones (1.46, CI 1.11, 1.93) being associated with allergic rhinitis. An association of benzophenones (0.66, CI 0.53, 0.83) with lower odds of asthma was stronger among boys. These findings suggest that prenatal paraben and other phenol exposures may adversely affect early-life allergic and respiratory outcomes, with sex-specific vulnerability. Novel, multi-modality approaches to reduce maternal phenol exposure during pregnancy are urgently needed to protect children's health.

BACKGROUND:Child and adolescent labor intensity, including the number of working hours and tasks performed, is both a cause and consequence of functional difficulties in children, particularly in low- and middle-income countries (LMICs) where the prevalence of these difficulties is not well understood. OBJECTIVE:This study aimed to determine the prevalence of functional difficulties among child laborers and explore the association between labor intensity and these difficulties. PARTICIPANTS AND SETTING/METHODS:We analyzed data from 344,721 children aged 5 to 17 years from recent Multiple Indicator Cluster Surveys conducted in 36 mostly LMICs. METHODS:Logistic regression models were used to estimate odds ratios for the association between child labor intensity and functional difficulties. RESULTS:The overall prevalence of functional difficulties was 18.1 % (95 % CI: 18.0-18.2), with notable country variations-ranging from 2.9 % in Belarus and Montenegro to 41.9 % in Roma Settlements, North Macedonia. Major risk factors for functional difficulties included living in urban areas, lower education, lower wealth, residing in West & Central Africa, performing income-related work, and engaging in tasks like carrying heavy loads or fetching water. Protective factors included younger age, fewer working hours, and residing in Europe & Central Asia. CONCLUSION/CONCLUSIONS:The study highlights that UNICEF's indicators of child labor intensity are closely associated with functional difficulties. Global strategies to reduce child labor should focus on improving child and caregiver education, early identification, and treatment of functional difficulties, with particular emphasis on LMICs.

BACKGROUND/OBJECTIVES/OBJECTIVE:Approximately half of male cancer survivors experience infertility following cancer treatment, which can lead to psychosocial distress. The aim of this study was to identify support needs and reflections on the decision-making process related to sperm banking among adolescent male cancer survivors and their caregivers at 1 year post-diagnosis. METHODS:As part of a randomized controlled trial testing a family-centered sperm banking decision-making intervention, males diagnosed with cancer (12-25 years old) and their caregivers completed semi-structured interviews 1 year post-diagnosis. Thematic analysis was conducted by three independent coders (κ = 0.80) and focused on two interview questions: (1) Is there anything you wish you would have known or done before making the [sperm banking] decision? and (2) What information or support do you think is needed regarding your/your son's future fertility goals? RESULTS:Qualitative interviews with adolescents (n = 20) and caregivers (n = 18) revealed three primary themes: (1) satisfaction with information received at diagnosis, but retrospective desire for more decision-making time; (2) current desire for additional fertility-related support; (3) potential need for future fertility-related support. CONCLUSION/CONCLUSIONS:Despite satisfaction with the oncofertility consultation at diagnosis, clinical teams should prioritize fertility education moving forward and allow additional time for sperm banking decision-making (when possible) at diagnosis. Counseling gaps can lead to uncertainty, unplanned pregnancies, and adverse mental health outcomes. Thus, it is important to revisit issues surrounding fertility and family planning after treatment, particularly among adolescents transitioning to adulthood.

BACKGROUND:The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) has supported clinical trials of substance use disorder (SUD) interventions for 25 years. This review describes the use of implementation outcomes across CTN trials, characterizes outcomes included, and identifies gaps and potential opportunities to strengthen implementation research within the CTN and the field of SUD treatment. METHODS:This systematic review included active or completed studies listed on the CTN Dissemination Library webpage as of August 18, 2021, and approved by the CTN for development by January 1, 2022. Study summaries and protocols were reviewed if they: 1) measured at least one implementation outcome and 2) examined a practice change, intervention, or process. Extracted data elements included trial design characteristics, implementation frameworks, and outcome assessment domains informed by the RE-AIM and Proctor Implementation Outcomes Frameworks. RESULTS:114 protocols were considered, 42 full-text protocols were screened, and 25 were included for data extraction. Start dates of trials spanned a 20-year period (2004-2024) with latter studies including more implementation outcomes. Fidelity (n = 29) and reach/penetration (n = 26) were the most included implementation outcomes. Equity was not identified in any protocols. Methods of defining, capturing, and evaluating outcomes data varied across trials and outcomes. CONCLUSION/CONCLUSIONS:The inclusion of implementation outcomes increased over time, perhaps reflecting a growing emphasis on implementation research. Incorporating measures of equity could advance knowledge about differential receipt or effectiveness of SUD interventions. Future research should seek to improve the consistency and comprehensiveness in descriptions of implementation science elements.