Faculty Bibliography

OBJECTIVES/OBJECTIVE:Self-report and biospecimen testing to assess drug exposure have limitations. Surface testing of personal objects (e.g., mobile phones) may provide complementary information about drug exposure, particularly when there is discordance between biospecimen results and self-report. We examined whether mobile phone swab testing, alongside self-report and oral fluid data, could provide information regarding drug exposure among nightlife attendees-a population with high prevalence of party drug use. We also examined whether detection could inform situations in which a drug is detected in oral fluid but not reportedly used. METHODS:In 2025, we assessed self-reported drug use and analyzed oral fluid and swabs of mobile phones from 127 adults attending nightclubs in New York City. We compared the prevalence of detection of cocaine, ketamine, 3,4-methylenedioxymethamphetamine (MDMA), and 4-methylmethcathinone (4-MMC) across the three modes of collection. RESULTS:Cocaine was detected on 26.8% of phones, followed by ketamine (22.0%), 4-MMC (3.1%), and MDMA (2.4%). When classifying phone detection, reported past-48-hour use and oral fluid detection of cocaine and ketamine demonstrated high specificity (0.85-0.91), but lower sensitivity (0.37-0.73). Among participants with oral fluid positivity after not reporting use, 33.3% and 17.1% of these discordant cases had ketamine and cocaine detected on their phones, respectively. CONCLUSIONS:Phone swab results often align with self-reported use and, less consistently with biologically confirmed exposure. However, drugs detected on phones may reflect less recent use or unintentional environmental sources contributing to oral fluid detection, supporting the role of phone swabbing as a complementary tool for detecting possible drug exposure.

OBJECTIVE:Supporting early relational health (ERH) positively affects lifelong health. We investigated perspectives of low-income parents of preterm children regarding child factors and parenting behaviors (defined as responsive parenting, structure/routines, and warm parent-child relationship) associated with ERH and factors associated with these behaviors. METHODS:We conducted in-depth, semi-structured interviews with low-income parents of children born preterm between Neonatal Intensive Care Unit (NICU) discharge and age 3 years. We examined perceptions of ERH and used the PRECEDE framework to identify predisposing, enabling, and reinforcing factors affecting parenting behaviors associated with ERH. We developed codes and themes iteratively using a deductive qualitative approach. RESULTS:We interviewed 22 parents of children born 24 to 34 weeks' gestation at 1 to 35 months corrected age. Regarding perspectives on ERH, parents shared that the NICU hospitalization heightens attention to children after discharge and that they feel an intense, sometimes overwhelming, bond with children born preterm. Parents both make accommodations for their preterm children and treat them the same as children born full term. Medical vulnerability affects how they spend time with their children. Regarding predisposing, enabling, and reinforcing factors of parenting behaviors associated with ERH, parents noted that developmental professionals can support relationships, that perceptions of preterm birth affect parents' relationships with their children, and that prior experience parenting preterm and full-term children affects confidence and knowledge of how to form relationships. CONCLUSION/CONCLUSIONS:Adaptation of existing ERH interventions should incorporate ways that NICU hospitalization and views of prematurity inform low-income parents' perceptions and use of parenting behaviors associated with ERH.

BackgroundPersons living with dementia (PLWD) and their care partners face unique challenges in participating in research studies. Community Engagement Studios (CES) provide a framework for researchers to work directly with community members, considered as Community Experts, who experience conditions under study to enhance research design, implementation, and dissemination.ObjectiveWe describe our experience conducting CES with PLWD and their care partners and lessons learned.MethodsPLWD and their care partners participated in three CES between July and December 2022; one in New Hampshire in English and two in New York, one of which was in Spanish. We followed the CES Toolkit guidance, which involves 1) inviting experts/stakeholders (PLWD and their care partners) to a consultative meeting, 2) preparing a presentation (interview guide) and facilitating the meeting, and 3) receiving and analyzing feedback from participants.Results12 community members (6 PLWD and 6 care partners) participated in our three studios. Three study design factors were identified during the CES: recruitment process (trust and communication with the research team), participants' autonomy, and trust and communication with clinicians. Spanish language community members raised similar issues to those in the English-speaking CES. However, Spanish language participants also noted the potential impact of interpreters during clinic visits.ConclusionsCES were feasible, informative, and well-received by PLWD and led to changes in our study design. We describe strategies for engaging care partners and PLWD, Community Experts, to elicit valid and valuable recommendations for making research studies more relevant and impactful.

BACKGROUND:In the US, 40 states and the District of Columbia (DC) have implemented medical cannabis legalization (MCL), while 24 states and DC have enacted some form of recreational cannabis legalization (RCL). We examined the association between cannabis legalization and law enforcement cannabis seizures to understand illegal drug market responses to increasing state cannabis legalization. METHODS:Data on law enforcement cannabis seizures came from the High Intensity Drug Trafficking Areas (HIDTA) program. We tested the association between state-level RCL and MCL adoption and annual changes in cannabis seizures aggregated by state-year from 2010 to 2023 using a series of Poisson regression models that controlled for time-varying state demographic and law enforcement variables in addition to state and year fixed effects. To account for potential lag time between MCL/RCL effective dates and policy impacts on seizures, we conducted additional analyses with 1-year MCL/RCL lags. RESULTS:Over the study period, there were 286,844 cannabis seizures by HIDTA-affiliated agencies, with 686 state-years of observation. In primary adjusted models, RCL adoption was associated with a significant decrease in cannabis seizures in MCL & RCL states versus MCL-only states, both immediately following RCL adoption (exp(β)=0.55, 95% CI: 0.54, 0.56) and one year after RCL went into effect (exp(β) for 1-year lag=0.62, 95% CI: 0.61, 0.64). CONCLUSIONS:The adoption of RCLs in US states, beyond only MCLs, may help to reduce the size of illegal cannabis markets, or there may be shifting law enforcement seizure priorities in those states.

BACKGROUND AND OBJECTIVES/OBJECTIVE:Plasma biomarkers such as phospho-tau species are increasingly used in clinical practice for the diagnosis of Alzheimer disease (AD). Phosphorylated-tau at threonine 181 (p-tau181) values also provide prognostic information about incident dementia. Cognitive status similarly conveys prognostic information, but the relationship between plasma biomarkers for AD and cognitive status requires clarification. METHODS:Participants from the Atherosclerosis Risk in Communities (ARIC) study who were adjudicated as free of dementia in 2011-2013 had plasma samples analyzed for p-tau181 and other biomarkers. Participants were surveilled for incident dementia through December 31, 2022. Cumulative incidence curves, Cox models, and Fine-Gray models were used to evaluate the independent and combined discriminatory accuracy of cognitive status and plasma biomarkers for incident dementia. RESULTS:The sample comprised 1,577 ARIC participants (age 76.5 years, 60% women, 73% White, 27% Black). The risk of incident dementia was higher in persons with a baseline status of mild cognitive impairment (covariate-adjusted hazard ratio [HR] 2.94, 95% CI 2.61-3.33) compared with those who were cognitively unimpaired independent of biomarker status. The risk of dementia was also higher in persons with more abnormal concentrations of p-tau181 and other biomarkers independent of cognitive status. When age, cognitive status, and p-tau181 were included in the same models, the risk was attenuated relative to models where only cognitive status or plasma biomarkers were included. For continuous p-tau181 concentrations, the covariate-adjusted HR without cognitive status was 1.45 (95% CI 1.36-1.54), but when cognitive status was included, the HR decreased to 1.37 (95% CI 1.29-1.46). Models showed that when combined with age, p-tau181 alone, cognitive status alone, or the combination of p-tau181 and cognitive status had similar discriminatory accuracy. DISCUSSION/CONCLUSIONS:Cognitive status and plasma biomarker concentrations convey independent but overlapping information about the risk of incident dementia. Although cognitive status and plasma p-tau181 have similar discriminatory accuracies, the far lower incidence rate of dementia in persons who are initially cognitively unimpaired highlights the importance of an accurate clinical diagnosis.

OBJECTIVE:We discuss implications of potential ascertainment biases for studies examining diabetes risk following SARS-CoV-2 infection using electronic health records (EHRs). We quantitatively explore sensitivity of results to misclassification of COVID-19 status using data from the U.S.-based Diabetes in Children, Adolescents and Young Adults (DiCAYA) Network on children (≤17 years) and young adults (18-44 years). MATERIALS AND METHODS/METHODS:In our retrospective case study from the DiCAYA Network, SARS-CoV-2 was identified using labs and diagnoses from June 1, 2020 to December 31, 2021. Patients were followed through December 31, 2022 for new diabetes diagnoses. Sites examined incident diabetes by COVID-19 status using Cox proportional hazards models. Results were pooled in meta-analyses. A bias analysis examined potential impact of COVID-19 misclassification scenarios on results, guided by hypotheses that sensitivity would be <50% and would be higher among those who developed diabetes. RESULTS:Prevalence of documented COVID-19 was low overall and variable across sites (children: 4.4%-7.7%, young adults: 6.2%-22.7%). Individuals with documented COVID-19 were at higher risk of incident diabetes compared to those with no documented infection, but results were heterogeneous across sites. Findings were highly sensitive to COVID-19 misclassification assumptions. Observed results could be biased away from the null under several differential misclassification scenarios. DISCUSSION/CONCLUSIONS:Although EHR-based documentation of COVID-19 was associated with incident diabetes, COVID-19 phenotypes likely had low sensitivity, with considerable variation across sites. Misclassification assumptions strongly impacted interpretation of results. CONCLUSION/CONCLUSIONS:Given the potential for low phenotype sensitivity and misclassification, caution is warranted when interpreting analyses of COVID-19 and incident diabetes using clinical or administrative databases.

BACKGROUND/UNASSIGNED:Clinical decision support (CDS) tools embedded in electronic health records in the form of integrated clinical prediction rules provide a potentially effective intervention to reduce inappropriate antibiotic prescribing for acute respiratory infections. However, their effectiveness has been limited by workflow barriers and low adoption by health care providers. Nurses are well positioned to implement evidence-based protocols using CDS tools. In a multicenter randomized controlled trial, a nurse-led implementation strategy for acute respiratory infection integrated clinical prediction rules was evaluated for use in primary care and urgent care settings. OBJECTIVE/UNASSIGNED:This study aimed to examine nurse and nurse leader perspectives on the sustainability of an electronic health record-integrated CDS tool for antibiotic stewardship and explored factors influencing its potential long-term integration into ambulatory nursing practice beyond the clinical trial. METHODS/UNASSIGNED:We interviewed 22 nurses and nurse leaders from 37 clinics across 3 academic medical centers that participated in the clinical trial. Two semistructured interview guides, one for nurses and one for nursing leadership, were developed to understand the barriers and facilitators to implementing a decision aid tool for nurses and to elicit challenges specific to nursing interactions with the CDS tool. Interviews were recorded and transcribed. Using thematic content analysis and iterative coding, our team collaboratively identified emerging themes related to sustainability and refined the results with consensus. RESULTS/UNASSIGNED:Five themes emerged: (1) importance of staffing stability and capacity, (2) impact of dedicated clinic resource availability, (3) variable nurse readiness with CDS-guided clinical care, (4) influence of openness to change and a nurse-supportive clinic culture, and (5) ongoing need for training and support. Specific recommendations for future actions were also noted. CONCLUSIONS/UNASSIGNED:Our findings revealed specific barriers and facilitators to the sustainability of a CDS tool from the nursing perspective that can inform further implementation of nurse-led delegation protocols in the ambulatory setting. Future solutions should consider mapping physical workflows, scheduling specific to nurse visits, continuing education, and treating cough and sore throat as 2 distinct processes.

Pregnant and birthing people with untreated substance use disorders (SUDs) face multiple risks of mortality and morbidity. Acute care settings (i.e., hospital inpatient, labor/delivery and emergency departments) are one opportunity to provide substance use services, but have had limited implementation. This scoping review synthesized studies that used an implementation science or quality improvement (QI) strategy to implement substance use services into acute care settings for pregnant or birthing people. Our aim was to 1) characterize the implemented strategies; 2) assess the inclusion of racial equity in study design and implementation; 3) summarize measures and outcomes used to evaluate implementation; and 4) identify reported barriers and facilitators to implementation. We searched MEDLINE (PubMed), CINAHL Complete (EBSCO), Scopus (Elsevier), and APA PsycINFO (Ovid) for published studies using keywords and structured vocabulary, and supplemented database searches with a grey literature search of conference proceedings. Two authors independently screened then extracted studies that met eligibility criteria. After removing 661 duplicates, we screened 1101 studies by title and abstract and excluded 1037. Thirty-six were excluded after full text review yielding 28 studies for extraction. Studies were observational (n = 20, 71%), QI (n = 7, 25%), and experimental (n = 1, 4%). Twenty (71%) focused on SUDs broadly; 8 (29%) targeted OUD. Five strategy types were identified: 1) education and learning collaboratives (n = 11, 39%); 2) clinical workflows and pathways (n = 7, 25%); 3) brief interventions (n = 2, 7%); 4) peer support (n = 4, 14%); and 5) structural changes (n = 4, 14%). Five studies (18%) considered racial and ethnic equity in design or implementation. Overall, studies highlight promising strategies to implement substance use services for pregnant and birthing people in acute care settings. However, many strategies were not rigorously evaluated and few considered racial and ethnic equity in design or implementation. Future research should focus on more rigorous evaluations of implementation strategies, measure downstream outcomes such as adoption and sustained use of substance use services, and apply a racial equity lens more explicitly.

OBJECTIVE:To examine if variation in session format and content of a prenatal obesity prevention program is associated with fruit and vegetable (FV) voucher redemption in Hispanic/Latino pregnant participants. METHODS:A secondary analysis of participants who received FV vouchers in a single-arm feasibility trial. We used linear regressions to assess associations between program session format (group vs individual) and FV voucher redemption rate, with session content (nutrition vs other lifestyle content [e.g., stress management or physical activity]) as a secondary predictor. RESULTS:Participants (n = 131) who attended a greater percentage of sessions in group format had increased voucher redemption rates (B = 0.37 [95% confidence interval, 0.05-0.70]. P = 0.03). Attending a higher percentage of group sessions with nutrition content rather than other lifestyle content was associated with a higher redemption rate (B = 0.19 [95% confidence interval, 0.002-0.38], P = 0.05). CONCLUSIONS AND IMPLICATIONS/CONCLUSIONS:Pairing FV voucher distribution with nutrition counseling delivered in a group format may increase utilization of FV vouchers.