Faculty Bibliography

IMPORTANCE/UNASSIGNED:Colorectal cancer screening rates in the US remain suboptimal, particularly among low-income and minoritized populations, despite the availability of effective, low-cost options such as the fecal immunochemical test (FIT). Scalable outreach strategies are needed to improve uptake and reduce staff burden in safety-net settings. OBJECTIVE/UNASSIGNED:To evaluate whether a behavioral economics-informed, automated text messaging strategy was associated with increased FIT completion compared with nurse-led telephone call outreach. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This quality improvement randomized clinical trial was conducted from April 7 to June 24, 2025, at 8 Federally Qualified Health Centers (FQHCs) in Brooklyn, New York, within the Family Health Centers at NYU Langone. Participants included adults (aged ≥18 years) with a new FIT order who listed English, Spanish, or Chinese (Mandarin or Cantonese) as their preferred language and had not opted out of text messaging. INTERVENTION/UNASSIGNED:Patients were randomized 1:1 to receive either 3 automated, 1-way text message reminders on days 2, 5, and 8 (intervention) or a single nurse-led telephone call reminder on day 8 (usual care). MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcome was FIT completion within 21 days of the test order, assessed from the electronic health record. Secondary outcomes included completion at 7 and 14 days. FIT completion at 7, 14, and 21 days was compared between groups using χ2 tests. RESULTS/UNASSIGNED:Among 1275 eligible randomized participants, 649 were assigned to the text group (418 female participants [64.4%]; mean [SD] age, 56.4 [9.3] years) and 626 to the telephone group (398 female participants [63.6%]; mean [SD] age, 56.7 [9.6] years). FIT completion within 21 days was higher in the text group (382 of 649 participants [58.9%]) compared with the telephone group (312 of 626 participants [49.8%]) with an absolute difference of 9.0 percentage points (95% CI, 3.6-14.5 percentage points; P = .001). Post hoc analyses found no evidence of differential effectiveness by age, sex, race and ethnicity, or patient portal use. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this quality improvement randomized clinical trial, a behaviorally informed text messaging strategy was associated with significantly improved FIT completion compared with usual nurse-led telephone outreach. Automated messaging may offer a scalable, low-cost strategy to promote preventive care and reduce staff burden in underserved populations. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT06632054.

PURPOSE/OBJECTIVE:(REFLECT), a digital health application designed to provide education and decision support related to fertility, genetic risk, and future family building for AYAs with cancer. This study developed and pilot-tested REFLECT to support informed decision-making. METHODS:REFLECT was developed using evidence-based content and implemented on a web-based platform integrating multimedia education and decision support. Two iterative rounds of user testing were conducted with AYA survivors (ages 18-39) using a Learner Verification framework to assess comprehension, usability, relevance, and acceptability. Participant feedback informed iterative refinements. RESULTS:= 16) reported that REFLECT was engaging, easy to navigate, and relevant to fertility, genetics, and future family-building concerns. Iterative testing identified opportunities to improve navigation, accessibility, and content organization, which were addressed through refinement. Participants reported increased confidence in discussing fertility preservation and genetic risk with providers and emphasized the value of an integrated patient-centered tool, particularly at the time of diagnosis. CONCLUSION/CONCLUSIONS:This pilot demonstrates that REFLECT is feasible, acceptable, and usable among AYAs. By integrating fertility and genetic risk education with decision support in an accessible digital format, REFLECT addresses a critical gap in AYA oncology care. These findings support further evaluation in clinical settings.

OBJECTIVE:Little is known about patterns of anxiety and depressive symptoms (ADS) beginning in infancy, particularly in the U.S. It is also unclear how early harsh discipline predicts these symptoms over time. We aimed to describe longitudinal patterns of ADS from 18 months through 6 years of age and examine whether those patterns are associated with harsh discipline at 18 months. METHODS:We performed a secondary analysis of parent-child dyads in a study focused on early relational health and school readiness in low-income families in the U.S. We used group-based trajectory modeling to identify distinct patterns of ADS between 18 months and 6 years. Multinomial logistic regression was used to examine the relationship between harsh discipline (total, physical, and verbal) and trajectory group membership. RESULTS:We identified three ADS trajectories: low (29%), moderate (61%), and high (10%). Children who experienced more total harsh discipline were at greater risk of belonging to the moderate (relative risk ratio (RRR), 1.98; 95% CI, 1.19-3.32) and high groups (RRR, 2.76; 95% CI, 1.32-5.77) than the low group. After disaggregating harsh discipline into physical and verbal components and controlling for each other, harsh verbal discipline alone significantly predicted membership in the moderate group only (RRR, 1.62; 95% CI, 1.10-2.38). CONCLUSIONS:Approximately 10% of the sample developed persistent ADS starting in infancy with harsh discipline as a risk factor. Findings underscore the importance of addressing harsh discipline in early anticipatory guidance.

BACKGROUND:Social support is associated with improved prognosis and quality of life after a cancer diagnosis. However, less is known about patients' experiences with disclosing their diagnosis to access support. This study investigated diagnosis disclosure patterns and the illness experiences of patients with multiple myeloma and precursor plasma cell disorders. METHODS:A 34-question survey was distributed between April-November 2023 to patients with plasma cell disorders via HealthTree Foundation's Patient Portal. Deidentified survey responses were analyzed using summary statistics, Fisher's exact test for group comparisons, and qualitative coding of open-ended answers. RESULTS:Among 510 survey respondents, 98% shared their diagnosis. Of these (n = 501), most shared within a day or week (88%), primarily in person (86%), and most frequently with spouses/partners (81%) and friends (81%). Sharers reported improved coping (84%) and stronger relationships (55%), whereas nonsharers (n = 9) reported feeling more isolated (56%). The majority of sharers (87%) did not regret disclosing their diagnosis to anyone. Compared to patients with multiple myeloma (n = 328; 78%), patients with precursor disorders (n = 44; 56%) were less likely to report coping well with their diagnosis (P < .001). Overall, participants advised newly diagnosed patients to consider disclosure timing, prioritize sharing with close contacts, maintain privacy, and educate themselves before sharing. CONCLUSION/CONCLUSIONS:Patients considered diagnosis disclosure to be beneficial to their coping and relationships, and recommended considering various factors when disclosing, including timing, personal relationships, and privacy. Patients with precursor disorders were less likely to indicate they were coping well, suggesting that this group may benefit from additional support resources.

BACKGROUND:Hospital ownership type may influence acute cardiovascular disease disparities that persist across the U.S. We examined associations between hospital ownership type and in-hospital and readmission outcomes for STEMI hospitalizations. METHODS:We performed a retrospective cohort study of hospitalizations for STEMI using the National Readmissions Database (2016-2022). Hospitals were categorized as nonprofit, for-profit, or public. Outcomes included in-hospital mortality and 90-day readmission for acute coronary syndrome, heart failure, cardiovascular, and all causes. Associations were assessed using multivariable logistic and Cox proportional hazards regression, adjusting for patient, hospitalization, and hospital-level characteristics. RESULTS:Of 610,427 STEMI hospitalizations, 460,451 (75.4%) were at nonprofit, 88,965 (14.6%) at for-profit, and 61,011 (10.0%) at public hospitals. Compared with nonprofit hospitals, for-profit hospitals (aOR 1.09, 95% CI 1.05-1.13) and public hospitals (aOR 1.17, 95% CI 1.12-1.22) were each associated with higher odds of in-hospital mortality. For-profit hospitals were associated with higher risk of 90-day readmission for acute coronary syndrome (aHR 1.15, 95% CI 1.10-1.21), heart failure (aHR 1.08, 95% CI 1.03-1.13), cardiovascular (aHR 1.08, 95% CI 1.05-1.12), and all causes (aHR 1.13, 95% CI 1.10-1.16) relative to nonprofit hospitals. Public hospitals were associated with higher risk of 90-day readmission for heart failure (aHR 1.08, 95% CI 1.02-1.13) relative to nonprofit hospitals. CONCLUSIONS:For-profit and public hospitals were associated with higher in-hospital mortality and 90-day readmission for various causes compared with nonprofit hospitals. These findings suggest that hospital-level factors may contribute to disparities in STEMI outcomes and warrant further investigation.

INTRODUCTION/BACKGROUND:Repetitive head impacts (RHI) from contact sports may cause a unique pattern of white matter hyperintensities (WMH) on T2-weighted fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI), termed RHI-associated WMH (RHI-WMH). These lesions are punctate, circular, and located at the gray-white matter boundary, an area vulnerable to trauma-related damage. METHODS:We investigated the association of RHI with these lesions in two aging cohorts: (1) former American football players versus asymptomatic unexposed men and (2) individuals with RHI from various contact sports versus non-RHI participants. RHI-WMH were assessed using visual ratings and a novel automated quantification pipeline. RESULTS:Individuals with RHI had greater RHI-WMH by both detection methods in both cohorts. RHI-WMH were associated with plasma neurofilament light and p-tau231, and flortaucipir positron emission tomography (PET) uptake. DISCUSSION/CONCLUSIONS:RHI-WMH may represent a new supportive biomarker for the detection of RHI-related neuropathologies later in life.