Faculty Bibliography

OBJECTIVE:This study examines the development of active television (TV) watching behaviors across the first 2 years of life in a racially and ethnically diverse, low-income cohort and identifies caregiver and child predictors of early TV watching. METHODS:We used longitudinal data from infants enrolled in the active control group (N = 235; 39% Latino; 29% Black; 15% White) of Greenlight, a cluster randomized multisite trial to prevent childhood obesity. At preventive health visits from 2 months to 2 years, caregivers were asked: "How much time does [child's first name] spend watching television each day?" Proportional odds models and linear regression analyses were used to assess associations among TV introduction age, active TV watching amount at 2 years, and sociodemographic factors. RESULTS:Sixty-eight percent of children watched TV by 6 months, and 88% by 2 years. Age of TV introduction predicted amount of daily active TV watching at 2 years, with a mean time of 93 minutes if starting at 2 months; 64 minutes if starting at 4 or 6 months; and 42 minutes if starting after 6 months. Factors predicting earlier introduction included lower income, fewer children in household, care away from home, male sex, and non-Latino ethnicity of child. CONCLUSIONS:Many caregivers report that their infants actively watch TV in the first 6 months of life. Earlier TV watching is related to sociodemographic factors yet predicts more daily TV watching at 2 years even controlling those factors. Interventions to limit early TV watching should be initiated in infancy.

The Adverse Childhood Experiences (ACEs) framework has contributed to advances in developmental science by examining the interdependent and cumulative nature of adverse childhood environmental exposures on life trajectories. Missing from the ACEs framework, however, is the role of pervasive and systematic oppression that afflicts certain racialized groups and that leads to persistent threat and deprivation. In the case of children from immigrant parents, the consequence of a limited ACEs framework is that clinicians and researchers fail to address the psychological violence inflicted on children from increasingly restrictive immigration policies, ramped up immigration enforcement, and national anti-immigration rhetoric. Drawing on the literature with Latinx children, the objective of this conceptual article is to integrate the ecological model with the dimensional model of childhood adversity and psychopathology to highlight how direct experience of detention and deportation, threat of detention and deportation, and exposure to systemic marginalization and deprivation are adverse experiences for many Latinx children in immigrant families. This article highlights that to reduce bias and improve developmental science and practice with immigrants and with U.S.-born children of immigrants, there must be an inclusion of immigration-related threat and deprivation into the ACEs framework. We conclude with a practical and ethical discussion of screening and assessing ACEs in clinical and research settings, using an expanded ecological framework that includes immigration-related threat and deprivation.

BACKGROUND:Enhanced literacy and increased vocabulary related to Reach Out and Read (ROR) are well described. Less is known about clinicians' experience with the program. OBJECTIVE:Understand clinician experiences of implementing ROR. DESIGN/METHODS/METHODS:This study was a collaboration between ROR and the Academic Pediatric Association's Continuity Research Network. Participants completed an anonymous online survey to evaluate literacy promotion activities and training, and asked "What has been the most meaningful experience you have encountered with using ROR?" and "Is there anything else you would like to add?" Responses were evaluated by researchers and four themes were generated through discussion. All responses were then divided and coded by researchers working in pairs and then by all researchers until consensus was reached. Data were organized into themes. FINDINGS/RESULTS:Responses were provided by 592 (35%) participants. Qualitative analysis revealed benefits to participation in ROR within four themes: (1) Child/Family Impact (60%): "Seeing a child read for the first time" (2) Physician Impact (16%): "I... use the books... to connect with patients." (3) Impact on clinic practice (25%): "I... enjoy modeling for parents and use the books to assess... development" (4) Social Determinants of Health (2%): "The books... are an invaluable resource to our under-served population." CONCLUSION(S)/CONCLUSIONS:Clinicians who implement ROR report positive impact on patients, families, and their own satisfaction and methods in practice. Clinicians value that the program addresses social determinants of health and facilitates developmental surveillance. Further study is needed to understand how clinician's perspectives affect and are affected by their experiences.

OBJECTIVES:This study assessed the association of diabetes duration with incident heart failure (HF). BACKGROUND:Diabetes increases HF risk. However, the independent effect of diabetes duration on incident HF is unknown. METHODS: ≥7%), with tests for interaction. RESULTS:, women, and Blacks (all P interactions <0.05). CONCLUSIONS:Delaying diabetes onset may augment HF prevention efforts, and therapies to improve HF outcomes might target those with long diabetes duration.

This paper examines the political embeddedness of public-sector primary care in urban India. The low quality of urban healthcare in many low- and middle-income countries is well documented. But there is relatively little analysis showing how the politics of urban healthcare delivery contribute to quality shortfalls. This study integrates urban and political theory and draws on ethnographic fieldwork in municipal government-run primary care clinics in Pune, India. I conceptualize Pune's municipal doctors as street-level bureaucrats: frontline state agents charged with delivering public services, who regularly confront conflicts between their mandate and its realization in practice. I observe how the municipal doctors experience and respond to these conflicts; delineate the historical design of the municipal institutions in which they operate; and interview doctors, nurses, nonclinical staff, administrators, and elected officials, who collectively shape primary care delivery in municipal clinics. My findings show how the doctors' work is characterized by routine departures from public service ideals. The departures stem from local electoral politics (politicians' patronage and clientelistic relations with municipal employees and patients) and weak administrative capacity (misuse and incompetent planning of public resources). The doctors are compelled to follow extra-policy directives, meaning instructions that have little to do with healthcare goals and that emphasize the political utility rather than medical purpose of their work. In response, the doctors circumscribe their clinical practice. They aim, as one doctor put it, only to "ensure the ordinary," or to sustain a deficient status quo. In these conditions, improving quality of care requires not just behavioral interventions targeted at doctors. It requires normative, social, and organizational shifts in public service planning and delivery so that doctors are positioned - materially and affectively - to meet urban healthcare challenges in low-resource contexts.

OBJECTIVES/OBJECTIVE:Gullah African Americans are descendants of formerly enslaved Africans living in the Sea Islands along the coast of the southeastern U.S., from North Carolina to Florida. Their relatively high numbers and geographic isolation were conducive to the development and preservation of a unique culture that retains deep African features. Although historical evidence supports a West-Central African ancestry for the Gullah, linguistic and cultural evidence of a connection to Sierra Leone has led to the suggestion of this country/region as their ancestral home. This study sought to elucidate the genetic structure and ancestry of the Gullah. MATERIALS AND METHODS/METHODS:We leveraged whole-genome genotype data from Gullah, African Americans from Jackson, Mississippi, African populations from Sierra Leone, and population reference panels from Africa and Europe to infer population structure, ancestry proportions, and global estimates of admixture. RESULTS:Relative to non-Gullah African Americans from the Southeast US, the Gullah exhibited higher mean African ancestry, lower European admixture, a similarly small Native American contribution, and increased male-biased European admixture. A slightly tighter bottleneck in the Gullah 13 generations ago suggests a largely shared demographic history with non-Gullah African Americans. Despite a slightly higher relatedness to populations from Sierra Leone, our data demonstrate that the Gullah are genetically related to many West African populations. DISCUSSION/CONCLUSIONS:This study confirms that subtle differences in African American population structure exist at finer regional levels. Such observations can help to inform medical genetics research in African Americans, and guide the interpretation of genetic data used by African Americans seeking to explore ancestral identities.

OBJECTIVE:To describe attitudes, perceptions, and beliefs related to smoking and smoking cessation among survivors of genitourinary cancers using a theory-based framework. METHODS:We performed a cross-sectional analysis of Wave III of the PATH study, a prospective cohort survey study assessing tobacco-use patterns and attitudes among a representative population-based sample of US adults. All adult current smokers with a history of urologic cancer were included. Primary outcomes were mapped to components of the Theory of Planned Behavior (TPB) and included: attempts to quit, readiness to quit, plan to quit, being told to quit, peers views toward smoking, regret about smoking, the perceived relationship between smoking and cancer/overall health. Secondary outcomes include: time to first cigarette, utilization of smoking cessation aids. Population weighted percentages with 95% confidence intervals were estimated. RESULTS:Our cohort represents a population estimate of 461,182 adult current smokers with a history of genitourinary cancer. The majority of respondents (90%) perceived smoking to be harmful to one's health and 83% were regretful about having started smoking. An equal proportion of respondents indicated that they were "very ready to quit," "somewhat ready to quit," or "not ready to quit." Among all respondents, 73% had been told by a physician to quit in the past year but only 7% indicated that they had used prescription medication and only 21% had used nicotine replacement therapy to help with smoking cessation. CONCLUSION/CONCLUSIONS:There is significant variation in attitudes, behaviors, and perceptions related to smoking and smoking cessation among survivors of genitourinary malignancy. Patient-level smoking cessation interventions may need to be highly personalized for optimal success.

The genome-wide association study (GWAS) is a powerful means to study genetic determinants of disease traits and generate insights into disease pathophysiology. To date, few GWAS of circulating metabolite levels have been performed in African Americans with chronic kidney disease. Hypothesizing that novel genetic-metabolite associations may be identified in a unique population of African Americans with a lower glomerular filtration rate (GFR), we conducted a GWAS of 652 serum metabolites in 619 participants (mean measured glomerular filtration rate 45 mL/min/1.73m²) in the African American Study of Kidney Disease and Hypertension, a clinical trial of blood pressure lowering and antihypertensive medication in African Americans with chronic kidney disease. We identified 42 significant variant metabolite associations. Twenty associations had been previously identified in published GWAS, and eleven novel associations were replicated in a separate cohort of 818 African Americans with genetic and metabolomic data from the Atherosclerosis Risk in Communities Study. The replicated novel variant-metabolite associations comprised eight metabolites and eleven distinct genomic loci. Nine of the replicated associations represented clear enzyme-metabolite interactions, with high expression in the kidneys as well as the liver. Three loci (ACY1, ACY3, and NAT8) were associated with a common pool of metabolites, acetylated amino acids, but with different individual affinities. Thus, extensive metabolite profiling in an African American population with chronic kidney disease aided identification of novel genome-wide metabolite associations, providing clues about substrate specificity and the key roles of enzymes in modulating systemic levels of metabolites.