Faculty Bibliography

PURPOSE/OBJECTIVE:To evaluate outcomes from the Trainers in Oncofertility Reproductive Communication and Health (TORCH) program, which trains Allied Health Professionals (AHPs) to become leaders in counseling AYA cancer patients on reproductive health. METHODS:ECHO-TORCH was developed for alumni of the Enriching Communication Skills for Health Professionals in Oncofertility (ECHO) program. It included web-based modules on evidence-based content, adult learning principles, and a simulation exercise for skill practice. Evaluation involved pre/post-tests, skills assessments during simulation via standardized learners (SLs) and faculty observers, and online focus groups. RESULTS:ECHO-TORCH learners (n = 10) showed improved knowledge, from 76% on pre-test to 86% on post-test (p < 0.01). Both SLs (86%) and faculty observers (90%) showed high likelihood of inviting learners back for future presentations. In online focus groups, participants described the modules as clear, relevant, and highly satisfying. Learners appreciated the opportunity for practice and structured review of the ECHO content. CONCLUSIONS:The ECHO-TORCH program improved AHPs' knowledge and skills in teaching reproductive health content to AYA cancer patients. The train-the-trainer model empowers AHPs to disseminate knowledge within their institutions, ultimately improving care quality and empowering AYA patients to make informed decisions about reproductive health. IMPLICATIONS FOR CANCER SURVIVORS/CONCLUSIONS:Continued development of professionals in reproductive healthcare will significantly enhance cancer survivors' quality of life by supporting informed decision-making regarding their reproductive health.

Sensory impairments are common with aging, but studies examining the relationships of these impairments with DNA methylation-based biomarkers of aging, strong predictors of morbidity and mortality, remain sparse. We investigated whether subjective measures of sensory impairment are associated with epigenetic age biomarkers. We conducted a cross-sectional analysis in a representative sample of 2344 U.S. adults from the 1999-2000 and 2001-2002 cycles of the National Health and Nutrition Examination Survey (NHANES). We examined the relationships of self-rated auditory and vision function with seven epigenetic aging biomarkers: HannumAge, HorvathAge, SkinBloodAge, PhenoAge, GrimAge2, DNA methylation telomere length, and DunedinPoAm. We adjusted for potential confounders including chronological age, other demographics, lifestyle factors, and general health. In adjusted survey-weighted models, self-reported deafness was associated with a significantly higher GrimAge2 (β = 4.19-years, 95% CI 2.29, 6.09, P = 0.004) and DunedinPoAm (β = 0.07, 95% CI 0.04, 0.09, P = 0.002) compared to good hearing. Deafness was also associated with significantly higher GrimAge2 estimates of TIMP1 (β = 459.51, 95% CI 287.00, 632.03 P = 0.002) and marginally higher estimated levels of ADM (β = 10.06, 95% CI 1.76, 18.36, P = 0.03), CRP (β = 0.34, 95% CI 0.11, 0.56, P = 0.01), and cigarette pack-years (β = 6.55, 95% CI 2.62, 10.47, P = 0.01). No associations were observed with self-rated vision. We describe associations of self-rated deafness with accelerated epigenetic aging, as measured by GrimAge2 and DunedinPoAm. These results provide a foundation for future research exploring epigenetic biomarkers as tools for predicting and understanding the biological processes underlying sensory impairments like deafness.

BACKGROUND:Few African studies have established links between climate shocks and mental health outcomes. This study examines the impact of climate change-related shocks on depressive symptoms and suicidal thoughts in a group of 14,801 female participants dependent on the informal agricultural sector. METHODS:Women living in informal settlements without running water or flushing toilets were classified as the treatment group, while rural women with basic amenities served as the control group. We applied a two-stage least-squares model to assess the effects of climate shocks-reduced rainfall, heat waves, and drought-on depression and suicidal ideation. FINDINGS/RESULTS:Climate shocks contribute towards a 10.8% [95% CI: 2.3%-17.7%] increase in depressive symptoms in the women from the informal settlement group versus the women from rural households. These increases in depressive symptoms have significant negative spillover effects on suicidal ideation in the woman living in informal settlements. Less rain was associated with 28.7% [95% CI: 22.5%-34.5%] higher suicidal ideation in the woman living in informal settlements. Heat waves increased suicidal ideation by 14.9% [95% CI: 7.6%-20.7%]. Drought caused a 36.7% [95% CI: 29.4%-41.1%] increase in suicidal ideation. The accumulative effects of climate change shocks and high food prices increased suicidal ideation by 48.3% [95% CI: 35.2%-54.9%]. INTERPRETATION/CONCLUSIONS:Climate change shocks worsen depression and consequently drive suicidal thoughts in women from informal settlements with varying intensity. Kenyan policymakers may need to prioritize the provision of mental health services in the aftermath of climate change-related shocks. FUNDING/BACKGROUND:This study was supported by the Canadian philanthropic foundation called the Waverley House. This funding is used to support all research projects of the Brain and Mind Institute, Aga Khan University.

INTRODUCTION/BACKGROUND:Spending on tobacco products may exacerbate health-related financial hardship experienced by low-income older adults. This study examined tobacco spending and the relationship between tobacco use and non-tobacco spending among low-income older adults in the U.S. METHODS:Using pooled 2021-2023 Consumer Expenditure Survey data, 1,983 single-person households (aged ≥65, with income <200% of the federal poverty level) were analyzed. Descriptive statistics summarized quarterly expenditures and budget shares for tobacco and non-tobacco goods. Generalized linear and fractional logit models compared non-tobacco expenditures and budget shares between people who use (versus do not use) tobacco, controlling for sociodemographic covariates. RESULTS:Overall, 10.6% of respondents reported tobacco spending. Respondents who used tobacco spent an average of $305.0 (SD = 303.4) per quarter on tobacco (7.8% of their total budget). Compared to respondents that did not use tobacco, respondents that used tobacco spent significantly more per quarter on alcohol ($54.8 vs. $22.0, P<0.001) and significantly less per quarter on food ($783.9 vs. $837.0, P<0.01), housing ($1,754.5 vs. $2,189.7, P<0.05), health care ($564.0 vs. $720.2, P<0.05), and clothing ($47.8 vs. $64.7, P<0.05). Similarly, respondents that used tobacco spent a significantly greater portion of their budget on alcohol (1.3% vs. 0.4%, P<0.001) and a significantly lower portion on food (19.6% vs. 19.7%, P<0.05), housing (38.8% vs. 43.4%, P<0.01), health care (14.7% vs. 16.8%, P<0.01), and other expenses (2.0% vs. 3.9%, P<0.01). CONCLUSIONS:Tobacco spending and its complementary alcohol spending may reduce low-income older adults' expenditures on food, housing and health care.

BACKGROUND:Eleven years have passed since the 2014 Flint water crisis (FWC), yet many voices still go unheard. There is limited evidence of the impact of the FWC on maternal health. This paper used a cross-sectional study design to survey 152 women enrolled in the Supporting Parents and Raising Resilient Kids (SPARRK) study in Flint, Michigan to examine racial differences in women's perceptions of their overall health pre- and post-FWC, perceived maternal health services, and explore the interaction of race and living in Flint on maternal morbidity. METHODS:Perceived maternal health was defined using the Centers for Disease Control and Prevention's 21 Severe Maternal Morbidity (SMM) diagnosis codes. SMM were obtained via questionnaire. Logistic regression analyses were performed to identify factors associated with SMM within two domains: (1) overall health pre- and post-FWC and (2) perceived maternal health care received during birth. RESULTS:There were 17 cases of SMM in which Black women accounted for 62.5% of these cases. Perceived quality of care was overall positive; yet, perceived overall health decreased post-FWC for all women. The odds of SMM were 6 times higher for those who had a college degree or higher. CONCLUSION/CONCLUSIONS:In the predominately Black city of Flint, race was not a significant factor in the perception of health and quality of care. Surprisingly, educational attainment was significantly associated with a 6-time increase in odds of experiencing an SMM. More research is needed to examine the association of patient-provider perception of quality care and education on maternal health outcomes.

Germline Testing (GT) for prostate cancer (PCA) is now central to PCA care and hereditary cancer assessment, with a rising role in PCA screening approaches. Guidelines have significantly expanded to include testing patients with metastatic PCA, advanced PCA or with high-risk features, and for males with or without PCA with a strong family cancer history to identify hereditary cancer syndromes for patients and their families. However, the expansion of GT has overwhelmed genetic counselling programs, necessitating the development and evaluation of alternate genetic delivery models. Furthermore, disparities in engagement in PCA GT are of major concern for impacting PCA-related and overall cancer-related outcomes for patients and their families. This review focuses on integrating PCA GT guidelines with implementation strategies and addressing PCA GT disparities to help inform current and future strategies to enhance the benefits of GT across populations.

There is extensive system-wide evidence of disparities in access to organ transplantation in the US based on race, ethnicity, and socioeconomic status. However, little information is available regarding care disparities among US organ procurement organizations (OPOs). Commissioned by the US Centers for Medicare and Medicaid Services (CMS), we studied racial/ethnic disparities in organ donation and transplantation across and within OPOs. Based on the 2020 CMS final rule, we calculated OPO donation and organ transplantation rates with 95% confidence intervals for racial (Black, White, and Asian American and Pacific Islander, AAPI) and ethnic (Hispanic and non-Hispanic) groups. OPOs were ranked with national rates as references and classified according to the CMS 3-tier system. Of the 58 OPOs, 8 and 4 had donation rates lower for Black and AAPI donors than for White donors; 21 and 18 had organ transplantation rates lower for Black and AAPI donors than for White donors; 1 and 1 had a donation rate or organ transplantation rate lower for Hispanic donors than for non-Hispanic donors. Significant racial/ethnic disparities in organ donation and transplantation exist among many OPOs, whereas the overall OPO performance is dominated by White and non-Hispanic donors. These disparities may be influenced by variations and structural barriers in resource access, donor identification, transplantation referral, and waitlisting processes-some of which lie partially outside the direct control of OPOs and disproportionately affect disadvantaged populations. Results support equitable organ donation and allocation through enhanced awareness of health care disparities, increased accountability of OPOs, and informed policies and interventions.

BACKGROUND/OBJECTIVES/OBJECTIVE:The Family-centered Adolescent Sperm banking values clarification Tool (FAST) was developed to facilitate sperm banking communication and decision-making pre-cancer treatment. The FAST was tested in a pilot parallel randomized controlled trial (Fertility Preservation Discussions And Decisions: "FP-DAD"-NCT04268004), aiming to (i) assess feasibility/acceptability of FP-DAD; and (ii) examine efficacy regarding banking attempts (yes/no) and decision quality. Differences in decision quality by banking attempt were explored. DESIGN/METHODS/METHODS:Males (12-25 years, new cancer diagnosis) and caregivers were randomized to standard of care (fertility consult) or FP-DAD (fertility consult + FAST + interventionist-led discussion). One month later, FP-DAD participants completed acceptability surveys. Both arms completed the Brief Subjective Decision Quality measure. Descriptive statistics, chi-square, and independent samples t-tests/mixed-models examined relationships between variables. RESULTS:Acceptability ratings of FP-DAD were high (88%-100%). Recruitment and participation challenges limited the final sample size (21 adolescents and 32 caregivers). Banking attempts (67% in standard of care vs. 82% in FP-DAD) did not differ by arm. While decision quality was not significantly different between groups, effect sizes were medium-large for four of six items for adolescents (d = 0.6 to -0.90) and two of six for caregivers (d = 0.36 to -0.78). Decision quality was significantly higher across several domains among those who banked. CONCLUSIONS:FP-DAD had high acceptability, though feasibility challenges (e.g., time contraints) limited full family participation. Findings showed limited efficacy, but effect sizes suggest this may be due to sample size. Relationships between banking attempts and decision quality emphasize banking benefits. Findings will inform adaptations to the FAST for clinical implementation.

BACKGROUND:Health status is closely linked to both healthcare access and utilization. While previous research has identified associations between health status and DNA methylation-based biomarkers of aging (epigenetic aging), studies exploring these relationships in the context of healthcare access and utilization remain limited. To address this gap, we analyzed cross-sectional associations in a representative sample of 2,343 U.S. adults from the 1999-2000 and 2001-2002 cycles of the National Health and Nutrition Examination Survey (NHANES). Our study examined the relationships of self-rated health status, healthcare access, and healthcare utilization with seven epigenetic aging biomarkers: HannumAge, HorvathAge, SkinBloodAge, PhenoAge, GrimAge2, DNAm Telomere Length (DNAmTL), and DunedinPoAm. RESULTS:After adjusting for chronological age, demographics, lifestyle factors, and health insurance, participants with good-excellent self-rated health had a 1.58-year lower PhenoAge (95% CI - 2.54, - 0.62 P = 0.006) and a 1.16-year lower GrimAge2 (95% CI - 1.80, - 0.53, P = 0.004) than participants with poor-fair health. Participants who reported having a routine place where they received healthcare had a lower GrimAge2 (β = - 1.44-years, 95% CI - 2.66, - 0.22, P = 0.03) than participants without a routine healthcare location. Participants with ≥ 10 healthcare visits in the prior year had a shorter DNAmTL (β = - 0.05-kb, 95% CI - 0.09, - 0.01, P = 0.02) than participants with < 10 visits. After including additional adjustments for estimated leukocyte proportions, participants who were hospitalized overnight in the prior year had a shorter DNAmTL (β = - 0.05-kb, 95% CI - 0.08, - 0.01, P = 0.02) than non-hospitalized individuals. CONCLUSIONS:Our findings reinforce previous reports linking better health status to lower epigenetic aging and provide new evidence of associations of epigenetic aging with measures of healthcare access and utilization. If validated, these findings suggest that epigenetic aging biomarkers may be useful in studying disease processes and assessing health outcomes related to access and utilization.