Faculty Bibliography

The neighborhood environment influences the amount of children's screen time, which in turn affects later development. Few studies have examined the potential for parent-child interventions to moderate such associations. This study examined the link between neighborhood disorder (observed and parent-reported) and infant screen time at 9 months, and whether the PlayReadVIP intervention attenuates this relation among Black/African-American and White families in Flint, MI. Three -hundred and ninety-nine families were included in analyses. Multigroup SEM path analyses indicated that observed neighborhood disorder predicted screen time for all participants (β=.19), but perceived neighborhood disorder was a significant -predictor of infant screen time only for the Control group (β=.11). Findings support the potential of early parent-child -programs to attenuate a range of risk factors for children's development.

Recreational ketamine use and related adverse outcomes have been increasing; however, correct diagnostic classification of quantitative oral fluid test results remains challenging, considering the potential for unintentional exposure to ketamine as an adulterant in other drugs. We surveyed and collected oral fluid from 1819 adults entering nightclubs and compared detection results with past 24-h self-reported ketamine use. Other drug use (based on detection and on self-reported past 24-h use) was considered a risk factor for unintentional ketamine exposure as an adulterant. Oral fluid specimens were analyzed via liquid chromatography quadrupole time-of-flight mass spectrometry. 10.8% of participants reported past 24-h ketamine use, 23.7% tested positive for ketamine (≥ 1 ng/mL), and 10.9% tested positive for norketamine (≥ 1 ng/mL). 46.0% tested positive for drugs other than ketamine, primarily cocaine. Among those testing positive for ketamine (n = 431), 41.5% reported past 24-h use. Among these cases, the optimal ketamine concentration cut-point for predicting self-report was ≥ 18 ng/mL. In analyses using the full sample (n = 1819) and a subsample with data on past 48-h use (n = 795), optimal cut-points were ≥ 2 ng/mL and ≥ 5 ng/mL, respectively. However, norketamine detection was the strongest predictor of self-reported use across the full sample and subsamples examined. Using self-report as the comparison, norketamine detection most accurately classified reported use; however, relying solely on higher concentration thresholds of ketamine or norketamine detection alone may lead to underdetection in some cases. Findings indicate the importance of carefully selected biological markers and thresholds when interpreting oral fluid results in settings where adulterant exposure is common.

INTRODUCTION/BACKGROUND:This study examines the association of HealthySteps - a two-generation, team-based pediatric primary care model - on preventive care and healthcare utilization for Medicaid-insured children and mothers, and differences across racial/ethnic groups. METHODS:This retrospective cohort study used linked HealthySteps and Medicaid claims data to compare 12-month outcomes for children receiving comprehensive services with a matched group of similar Medicaid-insured children and mothers. Data used in this study were collected from 2016-2021 and analyzed from 2022-2026. RESULTS:HealthySteps was associated with higher rates of any well-child visit (89.0% vs. 79.6%), attendance of 6+ well-child visits by 15 months of age (64.2% vs. 54.0%), continuity of care with the same provider (65.3% vs. 52.8%), developmental screening (37.9% vs. 26.9%), and Early Intervention (13.8% vs. 8.9%). HealthySteps was also associated with greater likelihood of an emergency department visit (43.9% vs. 38.7%), though not high ED usage (2+ visits). Compared with their counterparts, preventive care increases associated with HealthySteps were larger for Black, Hispanic, and, to a lesser extent, Asian children than for White non-Hispanic children. Among mothers, HealthySteps was associated with greater family planning services (35.8% vs. 31.6%), maternal depression screening (10.9% vs. 8.8%), postpartum care (29.5% vs. 24.6%), and ED visits (36.1% vs. 33.5%), as well as fewer lactation services (6.9% vs. 9.4%). CONCLUSIONS:Improvements in preventive care associated with HealthySteps represent meaningful clinical impact, as timely care in the first three years is crucial for healthy development. The larger gains among Black, Hispanic, and Asian children also highlight HealthySteps potential to mitigate persistent disparities in preventive care receipt.

OBJECTIVE:Cross-sectional analyses have demonstrated an association between lower social capital and higher food insecurity in families with children. This study examined the association between social capital in the newborn period and household food insecurity at child age two years in a diverse US sample. METHODS:This secondary analysis used survey data from 596 child-caregiver dyads enrolled at six US academic sites in Greenlight Plus, a childhood obesity prevention trial. Proportional odds regression models analyzed associations between two newborn-period social capital measures, caregiver social support and neighborhood social cohesion, and household food insecurity at child age two years, adjusted for newborn-period food insecurity and sociodemographic covariates. Additional models evaluated the interaction between the two social capital exposures. RESULTS:In adjusted analyses, a low caregiver social support score of 18 was associated with over three times the odds of higher food insecurity at child age two years, compared to a high score of 30 (aOR=3.23 with 95%CI=1.84-5.68). Low neighborhood social cohesion in the newborn period was not significantly associated with higher household food insecurity at child age two years, with similar odds for a low neighborhood social cohesion score of 10 compared to a high score of 20 (aOR= 1.24 with 95%CI=0.56-2.78). Results remained similar when both social capital exposures were included in the same model, and no significant interaction was detected. CONCLUSIONS:Caregiver social support in the newborn period may represent a modifiable protective factor against developing or worsening household food insecurity in families with young children.

Manufacturing and use of pharmaceuticals is responsible for nearly 20% of US health care's greenhouse gas footprint. As highly effective weight-loss medications such as incretin mimetics become widely prescribed, it is important to understand environmental implications. More than 33.5 million Americans have tried incretin mimetic medications (IMMs), and nearly 30 million are projected to be consistent users by 2030. This article examines the broader potential implications of glucagon-like peptide-1 and other IMMs on climate change. We conducted a preliminary and speculative carbon footprint of IMMs using a life cycle assessment approach. Our findings suggest widespread IMM use could reduce greenhouse gas emissions by decreasing caloric consumption, food production, and health care activities, leading to a maximum estimated reduction of 760 kg CO2e/person/year. This reduction would be greater than the environmental benefits of switching to electric vehicles or adopting a vegetarian diet. This study highlights the need for more research into potential environmental benefits of IMMs.

Tobacco smoking is critical risk factor for cardiovascular disease (CVD) and mortality, with epigenetics implicated as a key biological mechanism. Smoking disproportionately impacts CVD risk in women; however, limited research has examined smoking-associated DNA methylation (DNAm) changes in women. We measure whole blood DNAm (EPICv2) and self-reported smoking (three-category, pack-years, and years since cessation) via questionnaires in 6,005 Women's Health Initiative Memory Study participants. We perform epigenome-wide association studies and develop epigenetic predictors of each smoking phenotype, and compare DNAm and self-reported pack-years for CVD-related and all-cause mortality prediction. Here we find 20,388 FDR-significant sites related to current smoking, 2149 for former smoking, 14,709 for pack-years, and 753 for smoking cessation. The epigenetic predictors of smoking activity are highly correlated with their respective phenotypes and DNAm pack-years outperforms self-reported pack-years in mortality prediction. We report robust validation of previous findings, novel smoking associations in women, and introduce epigenetic predictors of smoking activity.

Uncomplicated Type B aortic dissection (uTBAD) treatment is changing, and the evidence driving this change is scarce. The decision to offer upfront thoracic endovascular aortic repair (TEVAR) or medical therapy varies significantly among providers, driven more by individual preference than scientific evidence. The IMPROVE-AD trial is a randomized, multidisciplinary, prospective, controlled, superiority trial designed to compare treatment efficacy; functional outcomes; quality of life; and costs in patients with uTBAD undergoing upfront TEVAR or medical therapy with selective TEVAR for deterioration during follow-up. In all, 60 clinical sites in the United States and Canada will enroll 1,100 patients with uTBAD, who are candidates for both treatment options and randomized in a 1:1 ratio. The primary efficacy endpoint of the trial is all-cause mortality and major aortic complications at 4 years. The IMPROVE-AD trial is the only ongoing North America-based large pragmatic trial comparing upfront TEVAR to medical therapy with selective TEVAR in patients with uTBAD. This landmark comparative effectiveness trial aims to provide Level I data to clarify the appropriate role for both treatment strategies and inform clinical practice.

INTRODUCTION/BACKGROUND:Puberty is a key transition point in adolescents' lives that plays a foundational role in shaping health behaviors and outcomes across one's life course. This period holds significant potential to empower adolescents and support autonomy in health and well-being, but limited puberty education curricula exist for early adolescents (age 8-14), and those that do exist vary in content. There is a paucity of evaluations of puberty competencies and limited consensus on what competencies should be measured to assess effectiveness or even how to measure these competencies. OBJECTIVE:The objective of this scoping review is to systematically map and characterize the outcomes, domains, and instruments used to evaluate puberty education curricula for early adolescents aged 8-14 years. In accordance with PRISMA-ScR and JBI scoping review guidance, this review does not synthesize effect sizes or assess intervention efficacy, but maps the breadth of evidence to identify conceptual gaps and inform future framework development. METHODS:The review protocol is registered with the Open Science Framework (OSF). We will search PubMed, CINAHL, PsycInfo, ERIC, Education Source, Scopus, Web of Science Core Collection, ProQuest Dissertations and Theses Global, and OpenAlex for relevant sources. Two reviewers will independently screen and extract studies that meet inclusion criteria using our data extraction tool. EXPECTED OUTPUTS/UNASSIGNED:Findings from the scoping review will be synthesized to create an overarching framework that can guide approaches to the development and evaluation of puberty curricula targeted to early adolescents. Focus group discussions with adolescents, parents, and school representatives will be conducted to assess the applicability and appropriateness of identified competencies and evaluation measures prior to broader dissemination. Insights from this scoping review will ultimately be used to inform the implementation and evaluation of puberty education.

Clinical equipoise-genuine uncertainty within the expert community regarding the relative merits of competing treatments-forms the ethical and scientific foundation of randomized controlled trials. The growing adoption of thoracic endovascular aortic repair (TEVAR) for uncomplicated type B aortic dissection (uTBAD) has increasingly challenged the principle of clinical equipoise in the treatment algorithm of uTBAD. Optimal medical therapy remains the accepted standard in the treatment of uTBAD. However, the expanding role of TEVAR has led some clinicians and institutions to view early intervention as beneficial, despite the lack of definitive comparative data. Randomized controlled trials, such as INSTEAD, INSTEAD-XL, and ADSORB, have demonstrated that TEVAR promotes false-lumen thrombosis and remodeling, but have not shown a clear survival benefit over optimal medical therapy. Retrospective studies frequently suggest favorable aortic remodeling and improved survival with TEVAR, yet these associative findings cannot establish causality and fall short of the evidentiary strength required to resolve treatment uncertainty. Contemporary guidelines reflect this ambiguity by endorsing aggressive medical therapy with selective TEVAR for anatomically high-risk patients. In the absence of definitive data, practice patterns have been shaped by institutional culture. Persistent uncertainties underscore the need for a definitive randomized trial. These unresolved questions underscore the persistence of clinical equipoise and the ethical necessity for a definitive randomized trial. Equipoise is challenged by institutional culture, specialty bias, referral patterns, patient expectations, and device marketing. Clinical equipoise in uTBAD will be resolved by adequately powered trials demonstrating improvement in patient-centered outcomes. Surrogate measures of aortic remodeling are insufficient.