Faculty Bibliography
Searched for:
Department/Unit:Population Health
Total Results:
13489
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
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
Association of maternal adverse childhood experiences with inflammatory and growth factor pathway activity during pregnancy: a cross-sectional proteomics-based KEGG pathway analysis in the ECHO cohort
While maternal histories of adverse childhood experiences (ACEs) have been linked to altered immune signaling during pregnancy, the specific inflammatory pathways underlying these associations remain poorly characterized. We leveraged high-dimensional proteomics to examine associations between maternal ACEs and pregnancy-associated inflammatory signaling pathways defined by the Kyoto Encyclopedia of Genes and Genomes (KEGG) and tested whether these associations were moderated by neighborhood-level social vulnerability during pregnancy. Participants included pregnant individuals enrolled in the Environmental influences on Child Health Outcomes (ECHO) Cohort (N = 770). Circulating inflammatory proteins were assayed from maternal plasma using the Olink Target 96 Inflammation panel. Protein markers were mapped to Human Genome Organisation (HUGO) Gene Nomenclature Committee gene symbols and aggregated into KEGG pathway scores using curated definitions. Linear regression models evaluated associations between continuous maternal ACE scores and each pathway score. Following correction for multiple comparisons, higher maternal ACE exposure was associated with higher activity across 12 KEGG-annotated protein pathways, including AGE-RAGE, non-alcoholic fatty liver disease, chemokine, Th17 differentiation, HIF-1, cellular senescence, Rap1, NOD-like receptor signaling, transcriptional misregulation in cancer, and infection-related pathway signaling. Domain-specific analyses identified the most consistent associations for childhood household dysfunction. Neighborhood-level social vulnerability during pregnancy did not moderate ACE-inflammation associations but was independently associated with higher KSHV infection and NOD-like receptor signaling pathway scores. Together, these findings indicate that maternal ACEs and prenatal social vulnerability are independently associated with small, but directionally consistent, differences in overlapping inflammatory and growth-related protein signals during pregnancy.
PMID: 42957063
ISSN: 1090-2139
CID: 6074799
Lower airway microbiome transcriptional and metabolic activities influence responsiveness to immunotherapy in NSCLC
Immune checkpoint inhibitors (ICIs) have transformed the treatment of advanced non-small cell lung cancer (NSCLC), yet a large proportion of patients do not respond. The lung microbiome is a key modulator of antitumor immunity, however, the functional contribution of active microbial communities and their interaction with host transcriptional programs in shaping ICI outcomes remain poorly defined. Here, we prospectively analyzed bronchoalveolar lavage (BAL) samples from 71 NSCLC patients prior to ICI initiation. We profiled the microbiome and host transcriptome in the BAL to look for microbial and host signatures in the lower airways associated with treatment response. We found that enrichment of the lower airway microbiome with oral commensals was associated with disease progression and worse prognosis of patients treated with ICI. Metatranscriptomics-derived microbial clustering revealed distinct functional profiles. The microbial cluster enriched with oral commensals, which was only present among patients with poor response to ICI, had differential regulation of pathways involved in the metabolism of short-chain fatty acids, methane, and pyruvate. This cluster also correlated with host immune pathways including upregulation of interferon signaling, neutrophil degranulation, and mitophagy, all of which could contribute to the poor response to immunotherapy. In a preclinical murine model of lung cancer with dysbiosis, inoculating lung tumor-bearing mice with oral commensals increased intratumoral neutrophils and Th17 responses and impaired ICI efficacy. Our findings support the concept that microbial communities in the lower airways influence tumor-immune interactions via defined metabolic-immune axes.
PMID: 42905123
ISSN: 2326-6074
CID: 6074891
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
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
Qualitative study on barriers and facilitators to genetic testing in Hispanic patients with prostate cancer
BACKGROUND:Despite the importance of germline genetic evaluation in prostate cancer (PCa), fewer U.S. Hispanic patients receive it. METHODS:We conducted semi-structured in-depth interviews with U.S. Hispanic patients with PCa in English or Spanish on facilitators and barriers to germline genetic testing. RESULTS:Barriers and facilitators were multidimensional. Key facilitators include family benefit, actionability, trust in clinicians, bilingual educational materials and insurance coverage; whereas key barriers include confusion with other tests, fear of negative implications, low awareness and limited clinician-led counseling. CONCLUSIONS:Bilingual informational materials, public messaging, and greater clinician education are needed to promote equity in PCa genetic evaluation.
PMID: 42892630
ISSN: 1476-5608
CID: 6074840
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
Neurobehavioral dysregulation, depressive symptoms, and cognition in former American football players
Neurobehavioral dysregulation (NBD) is a core clinical feature of traumatic encephalopathy syndrome (TES), but its relationships with repetitive head impact (RHI) exposure, cognitive performance, and depressive symptoms remain unclear. This study examined clinical factors associated with NBD among former American football players with substantial RHI exposure. Cross-sectional baseline data were analyzed from 179 former American football players enrolled in the DIAGNOSE CTE Research Project, including 119 former professional and 60 former college players. NBD was assessed using measures of impulsivity, behavioral regulation, hostility, and emotional lability. Multivariate regression models evaluated associations of continuous NBD scores with depressive symptom dimensions, cognitive performance, playing level, and years of football participation, adjusting for demographic and clinical covariates. Secondary analyses evaluated dichotomized NBD outcomes using study-specific thresholds. Bonferroni-adjusted p-values were reported for multiple comparisons. Depressive symptoms demonstrated the most consistent associations with NBD. Greater neurovegetative depressive symptom burden was associated with greater impulsivity (estimate = 6.84; 95% CI = 4.45, 9.23; p-value < 0.0001), behavioral dysregulation (estimate = 11.63; 95% CI = 8.50, 14.76; p-value < 0.0001), hostility (estimate = 5.07; 95% CI = 2.32, 7.81; p-value = 0.0004), and emotional lability (estimate = 1.16; 95% CI = 0.12, 2.20; p-value = 0.0284). Greater agitated/reactive depressive symptom burden was associated with greater impulsivity (estimate = 3.42; 95% CI = 1.44, 5.41; p-value = 0.0008) and hostility (estimate = 5.11; 95% CI = 2.89, 7.32; p-value < 0.0001), while greater affective depressive symptom burden was associated with greater behavioral dysregulation (estimate = 3.09; 95% CI = 0.01, 6.18; p-value = 0.0494). Better verbal memory was associated with lower impulsivity (estimate = -2.02; 95% CI = -3.65, -0.40; p-value = 0.0149) and behavioral dysregulation (estimate = -2.64; 95% CI = -4.76, -0.52; p-value = 0.0150), while better executive speed was associated with lower behavioral dysregulation (estimate = -3.10; 95% CI = -5.11, -1.09; p-value = 0.0027). Years of football exposure was not independently associated with NBD outcomes. Among former American football players with substantial RHI exposure, depressive symptom burden was more consistently associated with NBD than football participation characteristics or cognitive performance. These findings support a heterogeneous clinical phenotype and underscore the importance of evaluating depressive symptoms when interpreting NBD in the context of TES.
PMCID:13709984
PMID: 42947748
ISSN: 1664-2295
CID: 6074762
