Faculty Bibliography

BACKGROUND:As new psychoactive substances (NPS) continue to emerge both in the US and globally, it is important to investigate characteristics of persons who use these substances. METHODS:Data on self-reported NPS use come from the National Drug Early Warning Rapid Street Reporting study, which uses a venue-intercept design to assess drug use and associated adverse effects among adults (≥18 years) in a given US city over a weekend period. Between January 2022 and November 2023, 6039 individuals were surveyed in person in 20 unique cities regarding prevalence and correlates of past 12-month NPS and other drug use. RESULTS:In the overall sample, 259 (4.3 %) individuals reported any past 12-month NPS use. Synthetic cannabinoids (n = 150, 2.5 %), novel opioids (n = 34, 0.6 %), and synthetic cathinones (n = 33, 0.6 %) were the most frequently reported NPS classes used. Those also reporting past 12-month common stimulant use (aOR=2.39, 95 % CI:1.68-3.39) and a higher number of common drugs used in the past 12 months (aOR=1.28, 95% CI:1.18-1.40) had higher odds of reporting any NPS use; those with a college education were found to have lower odds of reporting NPS use (aOR=0.46, 95% CI:0.28-0.78). CONCLUSIONS:While the self-reported use of individual classes of NPS was low relative to other drugs in this large, multi-city sample, NPS use was most common among those reporting polysubstance use. Those who used synthetic cannabinoids appeared to represent a distinct subgroup. Given the continued public health concern posed by NPS, surveys which systematically ask about specific NPS are increasingly needed.

PURPOSE/OBJECTIVE:This study evaluated how frequently patients with early onset colorectal cancer received fertility counseling and whether patient characteristics affected the likelihood of receiving such counseling. METHODS:We conducted a single-center retrospective review of all new patients seen by medical oncology for colorectal cancer who were age 55 years or younger for men and 50 years or younger for women. Associations between patient demographics and clinical characteristics with receipt of fertility counseling were explored using univariate analyses and multivariable logistical regression analyses. RESULTS:A total of 194 patients were included, of whom 15.5% received fertility counseling. Using multivariate analysis, we found that age < 40 (OR 15.587, p < 0.0001, 95% CI 4.841-50.191) and female sex (OR 3.979, p = 0.0292, 95% CI 1.150-13.770) were correlated with increased likelihood of fertility counseling. Patients living in areas of higher household income were more likely to receive fertility counseling, with a statistically significant difference between the 3rd and 1st quartiles of income (p = 0.0369, 95% CI 1.161-115.940). CONCLUSION/CONCLUSIONS:A majority of patients with EOCRC did not receive fertility counseling despite the known toxicities of CRC treatment modalities on fertility. Older age, male sex, and residence in areas of lower income were associated with decreased likelihood of receiving fertility counseling.

BACKGROUND:The number of pediatric ophthalmology and strabismus (PO&S) fellowship positions filled each year remains consistently lower compared with other subspecialities. It is unclear where along the recruitment pathway trainees interested in pediatrics decide to select other subspecialities. This study assesses for differences in the competitiveness of ophthalmology residency applicants based on interest in PO&S, which may impact their ability to matriculate into residency. METHODS:and Mann-Whitney U tests were used to compare categorical and continuous variables, respectively. RESULTS:Of the 631 applications reviewed, 125 (19.8%) of applicants stated a subspeciality interest. Among those who stated an interest, 34 (27.2%) were interested in PO&S. When compared to all other applicants (with or without a stated subspecialty interest), applicants interested in PO&S were more likely to be female (P < 0.001). No significant difference was found in academic, research, or extracurricular variables based on subspeciality interest in PO&S. The same was true when applicants interested in PO&S were compared to those interested in competitive subspecialities (cornea, glaucoma, retina, or oculoplastics). CONCLUSIONS:Applicants interested in PO&S were observed to be as competitive as other applicants. Among students who expressed a fellowship interest, there was a high proportion interested in pediatrics. Recruitment efforts can be targeted toward encouraging medical students interested in pediatrics to apply into ophthalmology.

IMPORTANCE/OBJECTIVE:Patients with poor glycaemic control have a high risk for major cardiovascular events. Improving glycaemic monitoring in patients with diabetes can improve morbidity and mortality. OBJECTIVE:To assess the effectiveness of a patient portal message in prompting patients with poorly controlled diabetes without a recent glycated haemoglobin (HbA1c) result to have their HbA1c repeated. DESIGN/METHODS:A pragmatic, randomised clinical trial. SETTING/METHODS:A large academic health system consisting of over 350 ambulatory practices. PARTICIPANTS/METHODS:Patients who had an HbA1c greater than 10% who had not had a repeat HbA1c in the prior 6 months. EXPOSURES/METHODS:A single electronic health record (EHR)-based patient portal message to prompt patients to have a repeat HbA1c test versus usual care. MAIN OUTCOMES/RESULTS:The primary outcome was a follow-up HbA1c test result within 90 days of randomisation. RESULTS:The study included 2573 patients with a mean (SD) HbA1c of 11.2%. Among 1317 patients in the intervention group, 24.2% had follow-up HbA1c tests completed within 90 days, versus 21.1% of 1256 patients in the control group (p=0.07). Patients in the intervention group were more likely to log into the patient portal within 60 days as compared with the control group (61.2% vs 52.3%, p<0.001). CONCLUSIONS:Among patients with poorly controlled diabetes and no recent HbA1c result, a brief patient portal message did not significantly increase follow-up testing but did increase patient engagement with the patient portal. Automated patient messages could be considered as a part of multipronged efforts to involve patients in their diabetes care.

INTRODUCTION/BACKGROUND:Research has demonstrated that food insecurity during childhood is associated with worse physical and mental health in childhood. However, little is known about how food insecurity during childhood impacts health outcomes in young adulthood. METHODS:This study analyzed data from the Future of Families and Child Wellbeing Study (2024), a longitudinal birth cohort study of children born in 1998-2000. Childhood food insecurity trajectory groups from age 3 to 15 years were identified using group-based trajectory modeling. Associations between childhood food insecurity trajectory groups and young adult weight (BMI, overweight status, and obese status) and high self-reported health (good/excellent) at age 22 were modeled with multivariate linear and logistic regression. RESULTS:Three trajectories were identified among 4,296 participants: 66.9% were food secure, 7.5% were food insecure, and 25.6% transitioned from being food insecure-to-secure throughout childhood. In adjusted analyses, young adults assigned to the food insecure-to-secure trajectory group as children had higher BMI (B 0.82, 95% CI [0.07-1.58]) and higher odds of overweight status (OR 1.24, 95% CI [1.01-1.52]) than young adults assigned to the food secure trajectory group as children. Young adults in the food insecure trajectory group as children had lower odds of high self-reported health than those in the food secure trajectory group as children (OR 0.65, 95% CI [0.48-0.89]). CONCLUSIONS:Food insecurity in childhood is associated with high weight status and poor self-reported health in young adulthood. These findings highlight the importance of childhood food insecurity screening and interventions to promote health throughout the life course.

BACKGROUND:The Tobacco, Alcohol, Prescription Medication, and Other Substance (TAPS) tool is a screening and brief assessment instrument to identify unhealthy tobacco, alcohol, drug use, and prescription medication use in primary care patients. This secondary analysis compares the TAPS tool to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) for alcohol screening. METHODS:Adult primary care patients (1124 female, 874 male) completed the TAPS tool followed by AUDIT-C. Performance of each instrument was evaluated against a reference standard measure, the modified World Mental Health Composite International Diagnostic Interview, to identify problem use and alcohol use disorder (AUD). Area under the curve (AUC) appraised discrimination, and sensitivity and specificity were calculated for Youden optimal score thresholds. RESULTS:For identifying problem use: On the AUDIT-C, AUC was 0.90 (95% Confidence Interval: 0.86-0.92) for females and 0.91 (0.89-0.93) for males. Sensitivity and specificity for females were 0.89 (0.83-0.93) and 0.78 (0.75-0.80), respectively, and for males were 0.84 (0.79-0.88) and 0.82 (0.79-0.85). On the TAPS tool, AUC was 0.82 (0.79-0.86) for females and 0.81 (0.78-0.84) for males. Sensitivity and specificity for females were 0.78 (0.72-0.84) and 0.78 (0.75-0.81), respectively, and for males were 0.76 (0.71-0.81) and 0.76 (0.72-0.79). For AUD: On the AUDIT-C, AUC was 0.90 (0.88-0.93) for both females and males. Sensitivity and specificity for females were 0.83 (0.74-0.90) and 0.83 (0.80-0.85), respectively, while for males, they were 0.81 (0.74-0.87) and 0.84 (0.81-0.87). On the TAPS tool, AUC was 0.84 (0.80-0.89) for females and 0.82 (0.78-0.86) for males. Sensitivity and specificity for females were 0.73 (0.63-0.81) and 0.85 (0.83-0.88), respectively, while for males, they were 0.75 (0.68-0.81) and 0.84 (0.81-0.86). CONCLUSION/CONCLUSIONS:The AUDIT-C performed somewhat better than the TAPS tool for alcohol screening. However, the TAPS tool had an acceptable level of performance for alcohol screening and may be advantageous in practice settings seeking to identify alcohol and other substance use with a single instrument.

BACKGROUND:Age-related hearing loss is common among older adults and may influence physical activity and sedentary behaviors, such as TV viewing. This study examined whether a hearing intervention could affect these behaviors over three years. METHODS:977 participants (mean age of 76.8, 53.5% female, 11.5% Black), recruited from the ARIC study (n=238) and de novo (n=739) with hearing loss (pure-tone average=39.4 dB), were randomized to a hearing intervention or a health education control group. Physical activity, leisurely walking, and TV viewing were interrogated at baseline and three-year follow-up. We used regression models adjusted for demographic and hearing loss severity to examine the impact of the intervention on the change in the frequency of engaging in these activities. RESULTS:At baseline, 57.6% of participants engaged in moderate-to-vigorous physical activity (MVPA), 29.1% in high-frequency leisurely walking, and 46.8% in high-frequency TV viewing. Over three years, MVPA decreased to 48.8%, while leisurely walking and TV viewing increased. After three years, the hearing intervention group had similar odds of engaging in MVPA (ratio of odds ratios [ROR] = 1.03, 95% confidence interval [CI]: 0.93 to 1.14), leisurely walking (ROR = 1.04, 95% CI: 0.93 to 1.17), and TV viewing (ROR = 0.95, 95% CI: 0.87 to 1.02) compared to the control group. Results were consistent across recruitment sources (ARIC and de novo). CONCLUSION/CONCLUSIONS:A hearing intervention did not significantly influence physical activity, walking, or TV viewing behaviors in older adults over three years. Additional strategies may be needed to change physical and sedentary behaviors in this population.

Poor cardiovascular health is strongly linked to increased risk of cognitive impairment and Alzheimer's disease and related dementias. This commentary discusses Yang and associates' work on the associations between cardiovascular health in middle age, as defined by Life Essential 8 scores, and later digital cognitive performance and incident Alzheimer's disease. We examine the strengths and weaknesses of their study within the broader research context. We emphasize the potential significance of sleep and stress the need for longitudinal studies incorporating robust neuropsychiatric methodologies, advanced neuroimaging techniques, and diverse participant samples to enhance the reliability and generalizability of results.

BACKGROUND:Ketamine-related poisonings and law enforcement seizures have been increasing in the United States, but population surveys suggest that recreational use has been rare with trends being relatively stable. This study aimed to estimate trends and correlates of use among nightclub attendees-a population known for high prevalence of party drug use. METHODS:Adults entering randomly selected nightclubs in New York City were surveyed in 2017 (n = 674), 2018 (n = 724), 2019 (n = 541), 2021 (n = 160), 2022 (n = 322), and 2024 (n = 911) (total N = 3332; 56.3 % male, 52.7 % age ≥26). Trends in lifetime, past-year, and past-month ketamine use were estimated using logistic regression, and correlates and trends in characteristics of people who used in the past month were also estimated. RESULTS:Between 2017 and 2024, lifetime ketamine use increased from 16.6 % to 22.7 % (a 36.7 % increase), past-year use increased from 7.4 % to 14.3 % (a 94.0 % increase), and past-month use increased from 3.1 % to 6.8 % (an 118.1 % increase, Ps<0.001). Past-month use particularly increased among those aged ≥26 (by 222.0 %), females (by 216.6 %), those with a college degree (by 161.0 %), and among people who identify as bisexual or "other" sexuality (by 445.0 %), and among those who used cocaine (by 213.8 %), ecstasy/MDMA (by 94.9 %), and/or LSD (238.2 %) in the past month (Ps<0.01). Identifying as gay/lesbian (aOR=2.03, 95 % CI: 1.19-3.48) and past-month use of cocaine (aOR=8.17, 95 % CI: 4.97-13.43) in particular were associated with increased odds for past-month use. CONCLUSIONS:Recreational ketamine use is increasing among this population so an increased focus on both prevention and harm reduction is needed.

Despite several randomized controlled trials demonstrating the benefits of combination therapies for metastatic hormone-sensitive prostate cancer (mHSPC), a significant treatment gap persists. This initiative by the Prostate Cancer Foundation (PCF) convened stakeholders from academia, community practices, industry, and patient advocacy groups to address critical challenges in mHSPC care. Expert discussions and a review of real-world evidence and meta-analyses informed the development of strategies to improve care delivery. Evaluation of the data from global registries, such as IRONMAN, and large community databases was used to assess treatment utilization patterns and disparities. Combination therapies with two agents-androgen deprivation therapy (ADT) plus an androgen receptor pathway inhibitor (ARPI)-or three agents-ADT + ARPI + docetaxel-demonstrate significant survival improvements while preserving quality of life for patients with mHSPC, yet adoption remains inconsistent. Of the eligible patients, 20%-60% remain undertreated, with geographic, financial, and systemic barriers contributing to inconsistencies in care. Younger, White, urban-dwelling patients with fewer comorbidities are more likely to receive combination treatment, highlighting disparities across populations. Meta-analyses identified a lack of standardization due to varying inclusion criteria and comparators across trials. Real-world evidence underscored disparities influenced by geographic location, practice type, and access to specialty care. Initiatives such as the PANTHER study highlight improved outcomes in Black patients treated with combination therapies, emphasizing the importance of including diverse populations in clinical trials. To bridge gaps in care, this initiative prioritizes awareness, standardization, and equitable access to evidence-based therapies. Proposed solutions include targeted knowledge dissemination strategies, development of educational resources, and advocacy for policy changes to promote guideline-concordant care. By leveraging collaborative efforts, organizations, including PCF, can contribute to enhancing survival outcomes and quality of life for all patients with mHSPC.