Faculty Bibliography

BACKGROUND:Dietary self-monitoring is central to effective personalized nutrition, providing critical data to inform tailored feedback and support behavior change. OBJECTIVE:To examine the impact of dietary self-monitoring adherence and the indirect effect of personalized scores to predict postprandial glycemic response (PPGR) on weight loss. METHODS:Post-hoc analysis of the Personal Diet Study that investigated the impact of a machine algorithm-based diet that integrates clinical and microbiome features (Personalized) compared to a standard, low-fat diet (Standardized) on weight loss. All participants received behavioral counseling and were encouraged to self-monitor dietary intake via a smartphone app. Personalized received algorithm-based scores (1 to 5) on predicted PPGR to foods logged (PPGR score; 1-2 indicating optimal; 3-5 suboptimal). Dietary self-monitoring adherence was the percentage of days logging ≥50% of target calories, classified as high or low. PPGR score quality was calculated by the proportion of optimal predicted PPGR scores per day; defined as "high-PPGR quality" days when this exceeded the group average. Mediation analysis assessed whether PPGR quality mediated the relationship between dietary self-monitoring adherence and weight loss. RESULTS:Participants with high self-monitoring adherence lost an average of 4.2% of their baseline weight, compared to 1.9% among those with low adherence (p=0.016). High self-monitoring adherence was associated with a greater likelihood of achieving ≥5% weight loss (aOR=3.67, 95% CI: 1.63-8.50). Within Personalized, high PPGR quality mediated 53.4% of the total effect of self-monitoring adherence on weight loss (p<0.001). CONCLUSION/CONCLUSIONS:Consistent self-monitoring coupled with personalized feedback may significantly enhance weight loss in a precision nutrition approach. CLINICAL TRIAL REGISTRATION/BACKGROUND:NCT03336411.

OBJECTIVES/OBJECTIVE:Given the growing housing crisis, researchers increasingly point to housing as a possible risk factor for nursing home utilization, yet the exact pathways from housing to nursing home utilization are unclear. The purpose of this review is to describe how housing acts as a mechanism that influences nursing home utilization in the United States. DESIGN/METHODS:Integrative review. SETTING AND PARTICIPANTS/METHODS:Studies involving individuals at risk for long-term nursing home placement or residents at risk for continued nursing home use in the United States. METHODS:Five databases were searched in April 2024. Articles were included if they (1) operationalized housing pathways as factors in nursing home utilization, (2) focused on long-term nursing home utilization, (3) used data after 1999, and (4) were based in the United States. The quality of articles was assessed and constant-comparative approach guided data synthesis. RESULTS:Sixteen articles met inclusion criteria. Three themes were identified describing housing's influence on nursing home utilization: (1) Housing as Financial Asset vs Strain represents how housing operates as either a protective financial asset or a financial strain that can act as a risk factor for nursing home use; (2) (Mis)match Between Needs and Housing represents how evolving functional needs create misalignments with housing environments, potentially leading to nursing home use; (3) Compounding Systemic Inequities represents how socioeconomic disparities related to housing contribute to risk of nursing home utilization among marginalized communities. CONCLUSIONS AND IMPLICATIONS/CONCLUSIONS:This review provides evidence of the relationship between housing and nursing home utilization; however, because of a weak quality of evidence and limited methodologic diversity, more research is needed to strengthen the evidence base. Clinicians, researchers, and policy makers should still recognize the significance of the role housing plays in nursing home utilization and target policies and interventions toward improving housing conditions for older adults and people with disabilities.

BACKGROUND:Little is known about the use of text messages to promote enrollment in smoking cessation treatment. RESEARCH QUESTION/OBJECTIVE:What is the impact of number of outreach messages and monetary incentives on enrollment in smoking cessation treatment among Latino adults? STUDY DESIGN AND METHODS/METHODS:This pragmatic randomized clinical trial used a 3x2 factorial design. The first factor, monetary incentives, consisted of three conditions: 1) receiving a small fixed amount ($5) when enrolling, 2) getting a chance to win a large amount ($200) when enrolling, and 3) no monetary incentive when enrolling. The second factor, number of cycles, consisted of two conditions: 1) one cycle of messages, and 2) four cycles of messages. Latino adults who smoke (n=2,826) were identified in electronic medical records. Participants were randomized in a 1:1:1 ratio to receive one of three monetary incentive conditions and in a 1:2 ratio to receive one or four cycles of messages. The main outcome was enrollment in a smoking cessation text messaging intervention. RESULTS:Enrollment rates ranged from 1.3% for the group that received no monetary incentive for enrollment and one cycle of messages to 5.4% for the group that received a fixed amount for enrollment and four cycles of messages. Receiving four cycles of messages was associated with a higher likelihood of enrollment compared to receiving one cycle of messages (OR 1.92 [95% CI, 1.22-3.01], p<0.01). Monetary incentives were not associated with enrollment. INTERPRETATION/CONCLUSIONS:Among Latino adults, enrollment in smoking cessation treatment increased significantly with increasing number of cycles. In contrast, monetary incentives did not increase enrollment. While modest, the 5.3% enrollment rate found among participants who received four cycles of messages and no monetary incentive can inform future population-level efforts to advance smoking cessation among Latino adults. CLINICAL TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov identifier: NCT05722132.

BACKGROUND:To estimate biological age, we developed a proteomic aging clock in cancer-free participants (CaPAC) and examined its association with mortality in long-term cancer survivors (LTCS, >2 years between cancer diagnosis and blood collection) and cancer-free participants in the Atherosclerosis Risk in Communities (ARIC) and Multi-Ethnic Study of Atherosclerosis (MESA) studies. METHODS:ARIC measured 4712 proteins using SomaScan in plasma samples collected at 3 visits, including Visit 5 (2011-2013) from 806 LTCS and 3699 cancer-free participants, all aged 66-90. Among 2466 randomly selected cancer-free participants, we developed CaPAC using elastic net regression. Age acceleration was calculated as residuals of CaPAC regressed on chronological age (CaPACAccel). We used multivariable Cox proportional hazards regression to calculate hazard ratios (HRs) for the associations of CaPACAccel with all-cause and cancer mortality in LTCS and all-cause mortality in the remaining cancer-free participants. We replicated the analysis of all-cause mortality in MESA. RESULTS:In LCTS, CaPACAccel was associated with increased all-cause mortality in both ARIC (HR per 1 SD = 1.42, 95% confidence interval [CI] = 1.24 to 1.62; P < .001) and MESA (1.62, 1.12 to 2.33; P = .009). Also, in ARIC, CaPACAccel was associated with all-cause mortality in breast (1.54, 1.05 to 2.25; P = .028) and colorectal LTCS (1.96, 1.19 to 3.22; P = .008). Additionally, CaPACAccel was associated with cancer mortality in LTCS (1.34, 1.09 to 1.64; P = .005) in ARIC. In MESA, limited sample size precluded us from examining individual cancers and cause-specific mortality. In cancer-free participants, the associations of CaPACAccel with all-cause mortality were similar across studies. CONCLUSION/CONCLUSIONS:Proteomic aging clocks hold promise as a predictor of all-cause and cancer mortality in LTCS.

This manuscript explores the myriad ethical controversies associated with declaration of brain death/death by neurologic criteria (BD/DNC) during pregnancy raised by the case of Ms. Adriana Smith, a 30-year-old Georgia nurse, who came to international attention in May 2025. We will discuss: (1) the factors that may have impacted the decision not to perform neuroimaging when she first presented to medical attention; (2) the significance of identifying and deferring performance of futile interventions to decrease intracranial pressure relative to BD/DNC declaration; (3) the medical, ethical and legal complexities associated with BD/DNC declaration and continuation of maternal organ support in pregnancy; (4) the impact of continuing maternal organ support after BD/DNC declaration on the fetus, the family, Ms. Smith and the treatment team; and (5) the effects of media coverage of this case. This case's influence on future BD/DNC declarations during pregnancy, both in Georgia and elsewhere, remains to be seen.

Medical mistrust, clinical trial knowledge, and clinical trial risk impact research participation, yet are rarely studied among racial and ethnic groups. Data were from a cross-sectional survey (n = 1,794). Multinomial logistic regression models examined associations of medical mistrust, clinical trial knowledge, and clinical trial risk with willingness to participate in health research (Yes, No, Unsure) among Chinese, Korean, South Asian, Haitian, North American Latiné, South American Latiné, and Southwest Asian and North African (SWANA) NYC residents with one model per group. Overall, 46.0% of participants reported willingness to participate, ranging from 35.8% (Chinese participants) to 58.7% (South Asian participants). Increased mistrust was associated with less willingness among Chinese (OR: 1.06, 95%CI: 1.00, 1.12) and South American Latiné (OR: 1.15, 95%CI: 1.02, 1.30) participants; more willingness among Haitian participants (OR: 0.87, 95%CI: 0.81, 0.94); more uncertainty among Korean (OR: 1.13, 95%CI: 1.05, 1.22), South Asian (OR: 1.06 95%CI: 1.01, 1.12), and North American Latiné (OR: 1.18, 95%CI: 1.10, 1.28) participants; and less uncertainty among Haitian (OR: 0.91, 95%CI: 0.84, 0.99) and SWANA (OR: 0.91, 95%CI:0.86, 0.97) participants. Knowledge was associated with more willingness for Haitian participants (OR: 2.77, 95%CI: 1.15, 6.65), less willingness for Chinese participants (OR: 0.55, 95%CI: 0.34, 0.88), and more uncertainty among South Asian (OR: 2.09, 95%CI: 1.07, 4.07) and SWANA (OR: 2.71, 95%CI: 1.21, 6.03) participants. Some risk and more willingness were linked for South American Latiné participants (OR: 0.13, 95%CI: 0.02, 0.82). Associations varied by group. Studying multiple racial and ethnic groups advances equitable research representation.

PURPOSE/UNASSIGNED:Underutilization of genetic testing among Hispanic males results in higher rates of variants of uncertain significance (VUS). We examined the impact of VUS on decision making and behavioral intentions. METHODS/UNASSIGNED:We conducted a nationwide survey of 807 US Hispanic males aged ≥40 in English and Spanish on perspectives about genetic testing results. Logistic regression was used to examine predictors of worry and behavior change with a hypothetical VUS result. RESULTS/UNASSIGNED:Over half of Hispanic male participants would still participate in genetic testing with a 1 in 5 chance of VUS. However, 36% were at least somewhat likely to regret testing and 49.9% would worry about cancer risk with VUS results. In addition, 56.3% were somewhat or very likely to change behavior due to a VUS, such as getting checked by the doctor more often or telling family members to get checked. Younger age and college education were associated with more worry and intended behavior change. CONCLUSION/UNASSIGNED:Although many Hispanic males are interested in genetic testing despite the higher likelihood of VUS, potential consequences include decisional regret, anxiety, and even changes in behavior. Effective counseling and support are important for minoritized groups undergoing genetic evaluation to avoid the potential to exacerbate health disparities.