Faculty Bibliography

Objectives/UNASSIGNED:Since the number of individuals who use substances in the United States has markedly increased every year, substance use is a significant public health concern. The current study examines the possible risk and protective factors associated with triple comorbid trajectories of longitudinal alcohol, tobacco, and cannabis use from age 14 to 36. Methods/UNASSIGNED:A community sample of 674 participants (53% African Americans and 47% Puerto Ricans; 60% females) were recruited from the Harlem Longitudinal Development Study. Multinomial logistic regression analyses were conducted to examine the associations between the risk (low self-control, peer drug use) and protective (parent-child attachment, family church attendance) factors at age 14 and membership in the triple trajectory groups derived from a multivariate growth mixture model. Results/UNASSIGNED:Low self-control and peer drug use were associated with an increased likelihood of being a member in the triple comorbid trajectory groups compared to the reference group (i.e., low alcohol, no tobacco, and no cannabis use). On the other hand, parent-child attachment and family church attendance were associated with a decreased likelihood of being a member in the triple comorbid trajectory groups compared to the reference group. Conclusions/UNASSIGNED:Treatment programs for adolescents who use substances may be more helpful if their parents and/or friends could also participate together with the adolescent, rather than only the adolescent participates in the treatment programs. Further research is needed to gain a greater understanding of the conceptual nature of the relationship between earlier risk and protective factors and later substance use patterns.

BACKGROUND:The relationship between worklife factors, clinician outcomes, and time pressure during office visits is unclear. OBJECTIVE:To quantify associations between time pressure, workplace characteristics ,and clinician outcomes. DESIGN:Prospective analysis of data from the Healthy Work Place randomized trial. PARTICIPANTS:168 physicians and advanced practice clinicians in 34 primary care practices in Upper Midwest and East Coast. MAIN MEASURES AND METHODS:Time pressure was present when clinicians needed more time than allotted to provide quality care. Other metrics included work control, work pace (calm to chaotic), organizational culture and clinician satisfaction, stress, burnout, and intent to leave the practice. Hierarchical analysis assessed relationships between time pressure, organizational characteristics, and clinician outcomes. Adjusted differences between clinicians with and without time pressure were expressed as effect sizes (ESs). KEY RESULTS:Sixty-seven percent of clinicians needed more time for new patients and 53% needed additional time for follow-up appointments. Time pressure in new patient visits was more prevalent in general internists than in family physicians (74% vs 55%, p < 0.05), women versus men (78% vs 55%, p < 0.01), and clinicians with larger numbers of complex psychosocial (81% vs 59%, p < 0.01) and Limited English Proficiency patients (95% vs 57%, p < 0.001). Time pressure in new patient visits was associated with lack of control, clinician stress, and intent to leave (ESs small to moderate, p < 0.05). Time pressure in follow-up visits was associated with chaotic workplaces and burnout (small to moderate ESs, p's < 0.05). Time pressure improved over time in workplaces with values alignment and an emphasis on quality. CONCLUSIONS:Time pressure, more common in women and general internists, was related to chaos, control and culture, and stress, burnout, and intent to leave. Future studies should evaluate these findings in larger and more geographically diverse samples.

OBJECTIVE:To study the associations between maternal polycystic ovary syndrome (PCOS) and hirsutism with offspring attention-deficit/hyperactivity disorder (ADHD), anxiety, conduct disorder, and behavioral problems. DESIGN/METHODS:Prospective birth cohort study. SETTING/METHODS:Not applicable. PATIENT(S)/METHODS:A total of 1,915 mother-child dyads. INTERVENTION(S)/METHODS:None. MAIN OUTCOME MEASURE(S)/METHODS:Maternal report of offspring ADHD, anxiety, or conduct disorder diagnosis at 7 to 8 years; emotional symptoms, behavioral problems (including peer relationship, conduct, hyperactivity/inattention), and prosocial problems measured with the Strengths and Difficulties Questionnaire (SDQ) at 7 years. RESULT(S)/RESULTS:Prevalence of PCOS and hirsutism were 12.0% and 3.9%; 84% of women with hirsutism had PCOS. After adjustment for sociodemographic covariates, prepregnancy body mass index, and parental history of affective disorders, children born to mothers with PCOS had higher risk of anxiety (adjusted risk ratio [aRR] 1.62; 95% confidence interval [CI], 1.02-2.57) and borderline emotional symptoms (aRR 1.66; 95% CI, 1.18-2.33) compared with children born to mothers without PCOS. The associations between maternal PCOS and offspring ADHD were positive but imprecise. Maternal hirsutism was related to a higher risk of children's ADHD (aRR 2.33; 95% CI, 1.28-4.24), conduct disorder (aRR 2.54; 95% CI 1.18-5.47), borderline emotional symptoms, peer relationship problems, and conduct problems (aRRs 2.61; 95% CI, 1.69-4.05; 1.92; 95% CI, 1.16-3.17; and 2.22; 95% CI, 1.30-3.79, respectively). CONCLUSION(S)/CONCLUSIONS:Maternal PCOS was associated with offspring anxiety, and hirsutism was related to other offspring behavioral problems. These findings should be interpreted with caution as replication is needed in prospective cohort studies that assess PCOS and hirsutism diagnoses using medical records.

BACKGROUND:Cardiorenal syndrome is a well known concept, bolstered by extensive investigations of CKD as a risk factor of cardiovascular disease. However, data on whether cardiovascular disease increases long-term risk of ESKD are sparse. METHODS:We assessed the association of incident hospitalization with major cardiovascular diseases (heart failure, atrial fibrillation, coronary heart disease, and stroke) with subsequent risk of ESKD among individuals enrolled in the Atherosclerosis Risk in Communities study; the analysis included 9047 individuals without prevalent cardiovascular disease at their fourth study visit. Each relevant incident cardiovascular disease event was entered into multivariable Cox proportional hazard models as a time-varying exposure to estimate hazard ratios. RESULTS:=559) and 210 cases of incident ESKD. The incidence of major cardiovascular disease was associated with increased risk of ESKD, with the highest risk for heart failure (hazard ratio, 11.40; 95% confidence interval, 8.38 to 15.50), followed by coronary heart disease, atrial fibrillation, and stroke. When we analyzed heart failure with preserved ejection fraction and heart failure with reduced ejection fraction separately, the risk was nominally higher for heart failure with preserved ejection fraction. CONCLUSIONS:Major incident cardiovascular disease events were associated with ESKD, independent of kidney risk factors. In particular, heart failure showed a very strong association with ESKD. Our findings highlight the importance of monitoring and managing kidney disease in patients with cardiovascular disease. The potentially distinct contribution to ESKD of heart failure with preserved versus reduced ejection fraction deserves future investigation.

Mining social media data for studying the human condition has created new and unique challenges. When analyzing social media data from marginalized communities, algorithms lack the ability to accurately interpret off-line context, which may lead to dangerous assumptions about and implications for marginalized communities. To combat this challenge, we hired formerly gang-involved young people as domain experts for contextualizing social media data in order to create inclusive, community-informed algorithms. Utilizing data from the Gang Intervention and Computer Science Project-a comprehensive analysis of Twitter data from gang-involved youth in Chicago-we describe the process of involving formerly gang-involved young people in developing a new part-of-speech tagger and content classifier for a prototype natural language processing system that detects aggression and loss in Twitter data. We argue that involving young people as domain experts leads to more robust understandings of context, including localized language, culture, and events. These insights could change how data scientists approach the development of corpora and algorithms that affect people in marginalized communities and who to involve in that process. We offer a contextually driven interdisciplinary approach between social work and data science that integrates domain insights into the training of qualitative annotators and the production of algorithms for positive social impact.

With the ubiquity of mobile devices, the availability of mobile health (mHealth) applications for cardiovascular disease (CVD) has markedly increased in recent years. Older adults represent a population with a high CVD burden and therefore have the potential to benefit considerably from interventions that utilize mHealth. Traditional facility-based cardiac rehabilitation represents one intervention that is currently underutilized for CVD patients and, because of the unique barriers that older adults face, represents an attractive target for mHealth interventions. Despite potential barriers to mHealth adoption in older populations, there is also evidence that older patients may be willing to adopt these technologies. In this review, we highlight the potential for mHealth uptake for older adults with CVD, with a particular focus on mHealth cardiac rehabilitation (mHealth-CR) and evidence being generated in this field.

Objectives: * Identify components of a new mode of palliative care delivery for the growing population of patients with advanced illness discharged from the ED. * Discuss success and challenges for the delivery of a nurse-led telephonic palliative care program. Original Research Background: The demand for palliative care has outstripped the supply of trained physicians. Nurse-led telephonic palliative care is a potential model to address the growing need for palliative care. Research Objectives:: * Describe the development of a novel nurse-led telephonic palliative care program for seriously ill patients who are discharged from the Emergency Department (ED). * Describe the program implementation. * Share preliminary operational and clinical outcomes.
Method(s): The nurse-led telephonic palliative care program is part of the EMPallA research study, a large Patient-Centered Outcomes Research Institute (PCORI)-funded randomized controlled trial comparing facilitated, outpatient specialty palliative care to nurse-led telephonic case management for seriously ill patients after an ED visit. Three palliative care certified nurses, under supervision of a Hospice and Palliative Medicine (HPM) physician, provided telephonic care to patients across seven states. Patients received weekly calls from the telephonic nurse for six months.
Result(s): Of the first 100 patients who completed the telephonic arm intervention, 78 patients (78%) were actively engaged, while 9 patients were lost to follow-up and 13 patients withdrew. Eighteen patients (18%) died during the intervention and, of those, 11 (61%) enrolled in hospice prior to death. The average caseload per nurse was 18 patients per week and an average of 10 calls were made to each patient over the six-month period. Telephonic nurses made a total of 206 outgoing calls or emails to the patient's care teams and received an average of 222 responses.
Conclusion(s): Preliminary results show that seriously ill patients and their caregivers are willing to engage with telephonic nurses. A majority of patients remained engaged throughout the six-month intervention, and nearly two-thirds of patients who died utilized hospice prior to death. Implications for Research, Policy or Practice: This model has the potential to augment traditional physician-led outpatient palliative care and may be preferable for many patients who have difficulty traveling to a clinic setting for palliative care.
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Objectives:The purpose of the present study was to examine associations between life stress and incarceration history in relation to sexual health risk practices among a sample of cisgender Black gay, bisexual and other men who have sex with men (MSM) in the Deep South. Methods: Using data from a sample of 355 cisgender Black MSM in Mississippi and Georgia, multivariable logistic regression analyses were conducted to examine associations between life stress and sexual risk practices. In addition, we assessed whether stress may interact with experiences of incarceration to influence sexual health risk practices. Results: After controlling for sociodemographic characteristics, stress was associated with some sexual risk practices (e.g. alcohol and drug use during sex and group sex). Further, when an interaction with incarceration was assessed, among participants who had been incarcerated, high compared with low levels of stress were associated with alcohol use during sex (adjusted odds ratio (aOR) 4.59, 95% confidence interval (CI) 2.11-9.99, P < 0.001), drug use during sex (aOR 3.92, 95% CI 1.79-8.60, P < 0.001), condomless sex with casual partners (aOR 2.83, 95% CI 1.31-6.12, P < 0.001), having six or more casual partners (aOR 2.77, 95% CI 1.09-7.06, P = 0.02) and participating in group sex (aOR 5.67, 95% CI 2.07-15.51, P < 0.001). Stress and incarceration produced a dose-response effect for each association; similar associations with stress were not observed among men who had not been incarcerated. Conclusions: Among people with experiences of incarceration, there are several possible ways our findings could be applied practically, including through safer sex and stress management interventions designed specifically for Black MSM following their release.

GOALS/BACKGROUND/OBJECTIVE:Patients who "no-show" for colonoscopy or present with poor bowel preparation waste endoscopic resources and do not receive adequate examinations for colorectal cancer (CRC) screening. Using the Health Belief Model, we modified an existing patient education pamphlet and evaluated its effect on nonattendance rates and bowel preparation quality. STUDY/METHODS:We implemented a color patient education pamphlet to target individual perceptions about CRC and changed bowel preparation instructions to include a low-residue diet instead of the previous clear liquid diet. We compared the nonattendance rate over a 2-month period before and after the introduction of the pamphlet, allowing for a washout period during which pamphlet use was inconsistent. We compared the Boston Bowel Preparation Scale (BBPS) in 100 consecutive patients who underwent colonoscopy during each of the 2 periods. RESULTS:Baseline characteristics between the 2 groups were similar, although patients who received the pamphlet were younger (P=0.03). The nonattendance rate was significantly lower in patients who received the pamphlet (13% vs. 21%, P=0.01). The percentage of patients with adequate bowel preparation increased from 82% to 86% after introduction of the pamphlet, although this was not statistically significant (P=0.44). The proportion of patients with a BBPS score of 9 was significantly higher in the pamphlet group (41% vs. 27%, P=0.03). There was no difference in adenoma and sessile serrated adenoma detection rates before and after pamphlet implementation. CONCLUSIONS:After implementing a theory-based patient education intervention with a low-residue diet, our absolute rate for colonoscopy nonattendance decreased by 8% and the proportion of patients with a BBPS score of 9 increased by 14%. The Health Belief Model appears to be a useful construct for CRC screening interventions.