Faculty Bibliography

Growing evidence links prenatal air pollution with early behavioral outcomes, yet U.S. studies remain sparse. We analyzed data from 8370 mother-child dyads from 28 Environmental influences on Child Health Outcomes (ECHO) Cohort sites. Prenatal nitrogen dioxide (NO₂), fine particulate (PM_2.5), and ozone (O₃) levels were estimated using residential addresses. Caregiver-reported Child Behavior Checklist for ages 1.5-5 (CBCL/1.5-5) assessed internalizing and externalizing problems. Covariate-adjusted linear mixed-effects models estimated associations between pollutants and CBCL/1.5-5 T-scores. Child sex, socioeconomic neighborhood conditions, and prenatal depressive symptoms were evaluated as potential modifiers. Each interquartile range increase in pregnancy-average PM_2.5 was associated with higher externalizing (β_{externalizing} = 0.52, 95% confidence intervals: 0.15-0.90) and internalizing (β_{internalizing} = 0.45, 0.07-0.83) T-scores. Trimester-specific associations were observed: first-trimester PM_2.5 was associated with externalizing (β_{externalizing} = 0.39, 0.08-0.70) and second-trimester PM_2.5 with internalizing (β_{internalizing} = 0.32, 0.01-0.64) T-scores. Third-trimester NO₂ was linked to higher behavioral T-scores (β_{externalizing} = 0.52, 0.03-1.01; β_{internalizing} = 0.51, 0.00-1.01). Associations for O₃ were nonsignificant. Children from the lowest-opportunity neighborhoods exhibited stronger positive associations for NO₂. Males and children whose mothers reported lower prenatal depressive symptoms showed stronger inverse associations for O₃. Overall, prenatal PM_2.5 and NO₂ exposures may be associated with modest increases in early behavioral problems, potentially affecting many children given widespread exposure.

OBJECTIVE:To evaluate the association between severe perioperative surgical morbidity with cesarean delivery and postpartum readmission. METHODS:This was a retrospective cross-sectional study using linked birth certificate and maternal discharge data for patients who underwent cesarean delivery in any California hospital between October 2015 and October 2021. Severe perioperative surgical morbidity is an index characterized by severe surgical complications occurring during hospitalization for cesarean delivery, identified using International Classification of Diseases, Tenth Revision diagnosis and procedure codes for severe surgical complications. The primary outcome was all-cause postpartum readmission within 42 days after hospital discharge. Readmission rates were quantified for patients with and without severe perioperative surgical morbidity, and generalized estimating equations were used to estimate adjusted relative risks (aRRs), adjusted risk differences (aRD), and 95% CIs, accounting for patient- and hospital-level factors. In secondary analysis, the association was assessed separately for prelabor and intrapartum cesarean deliveries. RESULTS:The study population included women who had undergone 703,079 cesarean deliveries. The readmission rate was higher among those with severe perioperative surgical morbidity compared with those without severe perioperative surgical morbidity (469.4/10,000 [95% CI, 428.0-511.0] vs 165.3/10,000 [95% CI, 162.3-168.3]). Severe perioperative surgical morbidity was associated with a twofold increased risk of readmission (aRR 2.22; 95% CI, 2.00-2.46). The aRD for patients with severe perioperative surgical morbidity was an excess of two readmissions (2.5; 95% CI, 2.1-3.0/100 cesarean deliveries) compared with patients without severe perioperative surgical morbidity. Wound infection was the most common diagnosis at readmission among patients with severe perioperative surgical morbidity (77/10,000; 95% CI, 60.5-95.3). The risk of readmission was similar among patients with severe perioperative surgical morbidity and without severe perioperative surgical morbidity who underwent intrapartum cesarean delivery (aRR 2.35; 95% CI, 2.09-2.65) and prelabor cesarean delivery (aRR 2.03; 95% CI, 1.72-2.40). CONCLUSION/CONCLUSIONS:Nearly 1 in 20 patients undergoing cesarean delivery who experience severe perioperative surgical morbidity undergoes postpartum readmission, with a twofold increased readmission risk at 42 days after discharge. Patients with severe perioperative surgical morbidity may benefit from targeted follow-up to reduce postpartum admission.

BACKGROUND:Individuals are ubiquitously exposed to bisphenols and phthalates, common plasticizers that may affect neurodevelopment. We examined associations of prenatal and childhood bisphenol and phthalate exposure with internalizing and externalizing problems from early childhood through adolescence. METHODS:Within the Generation R study, prenatal urinary concentrations of bisphenol A (BPA) and phthalate metabolites were assessed in early, mid- and late pregnancy and in childhood at age 6 years. Pregnancy levels were averaged and used in analyses. Internalizing and externalizing problems were reported by parents at child age 3, 6, 10 and 14 years and by children at ages 10 and 14 years. Mother-child dyads with at least one prenatal exposure measure and one internalizing or externalizing problem score during follow-up were included (n = 1361). Among children with childhood exposure measures, n = 651 had at least one internalizing or externalizing problem score. Associations were examined using linear mixed models. Mixture analysis was performed for self-reported scores at age 14 with G-computation. FINDINGS/RESULTS: = 0.12, 95%CI: 0.04, 0.20). No associations with BPA were found. G-computation showed positive, but non-significant, associations for the same metabolites as in single chemical analyses. CONCLUSIONS:Associations of BPA and phthalate exposure with internalizing and externalizing problem scores in adolescents were largely null, associations with childhood phthalate exposure were less consistent and harder to interpret.

COP30 in Belém highlighted the urgent intersection of climate change, air pollution, and cardiovascular health. Climate hazards including heatwaves, floods, wildfires, and deteriorating air quality disproportionately affect vulnerable populations, exacerbating cardiovascular disease and straining fragile health systems. Air pollution, a major contributor to global CVD mortality, shares common sources with climate change, yet both act through distinct health pathways. Low- and middle-income countries face the greatest burden, reflecting inequities in social determinants, energy use, and urban infrastructure. The World Heart Federation emphasizes that climate action is cardiovascular action: reducing emissions, improving air quality, and building climate-resilient health systems are among the most effective preventive cardiology interventions. The Belém Health Action Plan provides a framework for integrating CVD into national climate strategies, strengthening health system preparedness, and fostering community resilience. Political leadership is critical to translate commitments into tangible health gains, as exemplified by successful urban interventions. Protecting hearts requires protecting the planet; coordinated climate-health action offers a pathway to healthier populations and sustainable societies.

BACKGROUND:Between 1979 and 2016, US overdose death rates rose in a smooth fashion, described by Jalal and Burke using an exponential growth curve that fit observed data nearly perfectly. Fluctuations above this curve have subsequently been seen during shocks related to drug supply and the COVID-19 pandemic. However, large-magnitude dips below the curve have never been demonstrated. Given that overdose mortality began sharply falling during 2023-2024, we assess updated overdose trends against the Jalal-Burke curve. METHODS:We examined US overdose deaths from the National Vital Statistics System between 1979-2024. We recreated the Jalal-Burke curve, fitting an exponential growth curve to overdose rates from 1979 to 2016, projected through 2024, with 95% confidence intervals. We also examined trends by specific substance involvement. RESULTS:After precipitously surpassing exponential growth predictions in 2020-2023, overdose deaths decreased sharply from approximately 32 per 100,000 in 2021-2023 to 23.7 in 2024, falling below the lower bound of the Jalal-Burke curve (24.1 per 100,000) for the first time since 2001. These decreases reflected declining illicit fentanyl-involved deaths, which fell to 14.25 per 100,000 in 2024; however, deaths involving stimulants without fentanyl, and those involving xylazine, represent an increasing share of deaths, rising to 5.64 and 1.89 per 100,000, respectively, in 2024. CONCLUSIONS:Rather than simply representing a return to the Jalal-Burke exponential growth curve, recent decreases in overdose deaths represent the first significant, large-magnitude deviation below exponential growth projections. This represents a very positive development; however, shifting challenges in the US drug crisis require a tailored response.

AIMS/HYPOTHESIS/OBJECTIVE:levels. METHODS:levels. We additionally assessed these staging schemas requiring an initial clinical score cutoff of ≥10% probability of developing diabetes in 10 years before proceeding to laboratory testing. We calculated baseline insulin responsiveness (insulin secretion-sensitivity index-2, ISSI-2) and the frequency of an estimated high risk of complications (Whitehall subphenotype clusters) across stages. We estimated relative risks of developing diabetes ascertained by self-report and glucose measurements after a 5.31 (0.44) year follow-up using robust Poisson regression with an offset for person-years. We calculated the prognostic properties of staging schemas in the prediction of diabetes. RESULTS:staging schemas were superior to the binary categorisation of prediabetes (intermediate hyperglycaemia). CONCLUSIONS/INTERPRETATION/CONCLUSIONS:schemas. Applying a predictive clinical score in staging reduced laboratory testing and false positives.

OBJECTIVES/OBJECTIVE:Fentanyl test strips (FTS) have the potential to moderate drug use behavior amidst an unregulated drug supply, yet are underutilized in medical settings. We aimed to describe emergency department (ED) FTS distribution across a large NYC health system and examine characteristics associated with clinicians' ordering FTS compared with the current standard-of-care, take-home naloxone (THN), to identify opportunities to optimize FTS distribution. METHODS:We conducted a retrospective review of THN and FTS provision across a large urban health system in its first year of FTS distribution. We evaluated the demographic and clinical characteristics of visits in which clinicians ordered FTS, compared with THN only. RESULTS:From July 20, 2022 to July 20, 2023, 237 (of 423) clinicians ordered THN for 1279 unique individuals in 1376 eligible visits (436 with FTS, 940 without). In pairwise analysis, FTS receipt was associated with being male, younger, non-White, lacking commercial insurance; substance-related or overdose-related visit chief complaint or diagnosis, attending physician, and patient-directed discharge ( P <0.05 for each). In multivariable regression, higher odds of FTS receipt were associated with male gender (OR=2.4; 95% CI=1.8-3.5), a substance-related chief complaint (OR=2.0; 95% CI=1.2-3.2) or visit diagnosis (OR=5.5; 95% CI=3.8-8.0), and overdose visit diagnosis (OR=1.7; 95% CI=1.1-2.8). Lower odds of FTS receipt were associated with older age (OR=0.98; 95% CI=0.97-0.99), noncommunity hospital sites (OR=0.71; 95% CI=0.60-0.83), and non-attending clinicians (OR=0.83; 95% CI=0.69-0.98). CONCLUSIONS:Integrating FTS into an existing ED THN program was feasible without disrupting clinical workflow. ED encounters where FTS were dispensed differed significantly from THN-only, revealing opportunities to optimize FTS ordering.

BACKGROUND:Best practices for engaging patients and the community in biomedical research evolved significantly in recent years. However, few focus on patient engagement in the design and implementation of a national study. OBJECTIVES/OBJECTIVE:To describe the initial engagement development and implementation; present findings from data collected during the first year; and discuss lessons learned. METHODS:Data were collected as part of continuous quality improvement efforts to assess and refine the engagement strategy. Fifty-two patient, caregiver, and community representatives were invited to complete a brief online survey about their experience participating in a national initiative. RESULTS:A framework for engagement was created and 35 representatives completed the survey (67% response rate). Representatives demonstrated awareness related to their roles and responsibilities. Seventy-six percent indicated that they felt comfortable expressing opinions and the decision-making process. CONCLUSIONS:The RECOVER initiative's approach promoted greater transparency and trust between researchers and the community, leading to more impactful engagement.

BACKGROUND:New York City (NYC) Cancer Outreach Network in Neighborhoods for Equity and Community Translation (CONNECT) aims to address determinants of cancer screening and access disparities in low-income NYC neighborhoods with high cancer burden. OBJECTIVES/OBJECTIVE:NYC CONNECT community partners formed neighborhood action councils (NACs) and engaged in mixed-method formative research and an iterative consensus-building process to co-identify structural and social determinants of cancer screening. The NACs co-developed with health and academic partners community-level strategies to address structural determinants of health. The objective of this manuscript is to describe participatory processes to engage and support community partners in low-income and high poverty communities and the evaluation of their functioning within the context of a community-academic research partnership. METHODS:NYC CONNECT partnership development is informed by trauma-informed community building and community-based participatory research principles. Our mixed-methods partnership evaluation included surveys, qualitative interviews, and speaking time in meetings as a proxy for engagement. LESSONS LEARNED/CONCLUSIONS:Trauma-informed community building and community-based participatory research informed co-learning and consensus-building activities among the NACs. Identifying and prioritizing structural and social determinants of health strategies was a non-linear, iterative process that required multiple interactive activities (e.g., asset mapping, impact to effort matrix, and voting). CONCLUSION/CONCLUSIONS:Community engagement is a dynamic process that requires adapting to community partners' goals and sharing decision-making power.