Faculty Bibliography

Aim and objective Injunctive norms about smoking, the perceived approval or acceptability of smoking from friends or wider peer group, have rarely been studied outside the Western world. We investigated injunctive norms and the associations with smoking susceptibility in adolescents in Hong Kong, where most adolescents are negative towards smoking. Methods In 2017/18, 7031 Secondary 1-5 (US grade 7-11) students (48.9% boys; mean age 14.3, SD 1.7) were surveyed.Students reported the perceived approval of smoking from good friends (disapprove/neutral/approve) and the perception of whether most secondary school students accepted smoking (no/yes). Smoking susceptibility referred to the lack of a firm intention not to smoke in the next 12 months, when good friends smoked in front, or when a good friend offered a cigarette. Logistic regression yielded adjusted odds ratios (AORs) of smoking susceptibility for injunctive norms in never smokers, adjusting for sociodemographic characteristics and school clustering effect. Results Overall, 1.3%, 21.1% and 77.5% of students perceived approval, neutral response and disapproval of smoking from good friends, respectively. Some (5.8%) perceived that most students accepted smoking. In never smokers (n=6472, 92.5%), compared with perceived disapproval from good friends, perceived neutral response (AOR 3.58, 95% CI 2.86-4.50) and approval (5.41, 2.93-9.97) were associated with smoking susceptibility. The perception that most students accepted smoking was also associated with smoking susceptibility (2.73, 2.02-3.71). Conclusions Injunctive norms were associated with smoking susceptibility in Hong Kong never smoking adolescents. Addressing misperceptions of others' approval or acceptability of smoking may help prevent adolescent smoking. Funding General Research Fund (17629016), Research Grants Council of Hong Kong Special Administrative Region, China

Background: Approximately 40% of metastatic cutaneous melanoma (CM) patients do not respond to the current immunotherapy (IT) regimens, pointing to other, yet unknown factors conferring IT resistance. In addition, > 60% of patients from single-line or combined treatment (COMBO) regimens present severe immune related adverse events (irAEs). In this study we have developed a novel genomic approach interrogating expression quantitative trait loci (eQTLs) to explore weather germline genetic variation can serve as novel personalized determinant of immunotherapy response and toxicity.
Method(s): By interrogating the genome wide expression data and SNP array datasets of healthy twin cohort (MuTHER), we have identified 85 eQTLs most significantly associated with the expression of 265 immune genes. Using the MassARRAY system, the 85 SNPs were genotyped in 138 anti-CTLA-4 treated patients, 87 PD-1 treated patients, and 69 patients from combined (COMBO) treatments, collected from multi-institutional collaborations. To test the association of SNPs with IT response and irAEs, logistic regression analyses were performed for each treatment group adjusting by demographic and clinical covariates.
Result(s): We found significant associations with COMBO IT resistance for and eQTL in IL10/IL19 (OR = 4.249, p = 0.0167), which we have recently identified for association with melanoma survival and which, interestingly, is an established locus associated with the risk of several autoimmune diseases. Additionally, we also identified eQTLs that are associated with IT sensitivity; IL1-beta with resistance to anti-CTLA-4 and SPI1 with resistance to anti-PD-1. Interestingly, genomic scan of 85 eQTLs has identified novel loci predictive of severe autoimmunity and site specific irAEs in patients treated with COMBO or single-line anti- CTLA4 IT.
Conclusion(s): In this study, we report that eQTLs from IL19/IL10 locus, previously shown to predict autoimmunity risk and CM survival, is also a surrogate marker of response to COMBO IT, indicating a strong relationship between interleukin pathways and tumor immunogenicity. Novel loci have been found as predictive markers for autoimmune toxicity, in patients treated with COMBO and anti-CTLA4 IT. This is a first evidence that immunomodulatory pathways modulated by germline genetic variation can impact susceptibility to irAEs as well as IT efficacy. Currently, a large scan is underway using genome-wide genetic screens to further test the functional validity of these findings in a large collaborative setting

BACKGROUND:Policy makers are considering changes to the Supplemental Nutrition Assistance Program (SNAP). Proposed changes include financially incentivizing the purchase of healthier foods and prohibiting the use of funds for purchasing foods high in added sugars. SNAP participant perspectives may be useful in understanding the consequences of these proposed changes. OBJECTIVE:To determine whether food restrictions and/or incentives are acceptable to food benefit program participants. DESIGN/METHODS:Data were collected as part of an experimental trial in which lower-income adults were randomly assigned to one of four financial food benefit conditions: (1) Incentive: 30% financial incentive on eligible fruits and vegetables purchased using food benefits; (2) Restriction: not allowed to buy sugar-sweetened beverages, sweet baked goods, or candies with food benefits; (3) Incentive plus Restriction; or (4) Control: no incentive/restriction. Participants completed closed- and open-ended questions about their perceptions on completion of the 12-week program. PARTICIPANTS/SETTING/METHODS:Adults eligible or nearly eligible for SNAP were recruited between 2013 and 2015 by means of events or flyers in the Minneapolis/St Paul, MN, metropolitan area. Of the 279 individuals who completed baseline measures, 265 completed follow-up measures and are included in these analyses. STATISTICAL ANALYSIS/METHODS:analyses were conducted to assess differences in program satisfaction. Responses to open-ended questions were qualitatively analyzed using principles of content analysis. RESULTS:There were no statistically significant or meaningful differences between experimental groups in satisfaction with the program elements evaluated in the study. Most participants in all conditions found the food program helpful in buying nutritious foods (94.1% to 98.5%) and in buying the kinds of foods they wanted (85.9% to 95.6%). Qualitative data suggested that most were supportive of restrictions, although a few were dissatisfied. Participants were uniformly supportive of incentives. CONCLUSIONS:Findings suggest a food benefit program that includes incentives for purchasing fruits and vegetables and/or restrictions on the use of program funds for purchasing foods high in added sugars appears to be acceptable to most participants.

Social media offers a unique window into attitudes like racism and homophobia, exposure to which are important, hard to measure and understudied social determinants of health. However, individual geo-located observations from social media are noisy and geographically inconsistent. Existing areas by which exposures are measured, like Zip codes, average over irrelevant administratively-defined boundaries. Hence, in order to enable studies of online social environmental measures like attitudes on social media and their possible relationship to health outcomes, first there is a need for a method to define the collective, underlying degree of social media attitudes by region. To address this, we create the Socio-spatial-Self organizing map, "SS-SOM" pipeline to best identify regions by their latent social attitude from Twitter posts. SS-SOMs use neural embedding for text-classification, and augment traditional SOMs to generate a controlled number of nonoverlapping, topologically-constrained and topically-similar clusters. We find that not only are SS-SOMs robust to missing data, the exposure of a cohort of men who are susceptible to multiple racism and homophobia-linked health outcomes, changes by up to 42% using SS-SOM measures as compared to using Zip code-based measures.

The aim of this study was to identify mathematical competencies in early childhood and cognitive correlates of those competencies in a prospective longitudinal sample of children (N=1292) in predominantly low-income and nonurban communities in the United States. General mental ability (IQ), processing speed, vocabulary, and the working memory, inhibitory control, and cognitive flexibility components of executive function (EF) were assessed when children were ages 4 and 5. Math ability was assessed prior to school entry using a norm-referenced assessment. Exploratory factor analysis indicated that items from the math assessment loaded onto factors representing conceptual and procedural skill. IQ, processing speed, vocabulary, and a unitary EF composite all related to both conceptual and procedural skill. When EF components were examined separately, however, only the inhibitory control aspect of EF was related to conceptual skill and only the working memory aspect of EF was related to procedural skill.

Concerns remain about the health of children conceived by infertility treatment. Studies to date have predominantly not identified substantial long-term health effects after accounting for plurality, which is reassuring given the increasing numbers of children conceived by infertility treatment worldwide. However, as technological advances in treatment arise, ongoing studies remain critical for monitoring health effects. To study whether the techniques used in infertility treatment cause health differences, however, remains challenging due to identification of an appropriate comparison group, heterogeneous treatment, and confounding by the underlying causes of infertility. In fact, the factors that are associated with underlying infertility, including parental obesity and other specific male and female factors, may be important independent factors to consider. This review will summarize key methodological considerations in studying children conceived by infertility treatment including the evidence of associations between underlying infertility factors and child health.

New York City (NYC) public hospitals recently mandated that all pregnant women be screened for depression, but no funds were allocated for screening or care coordination/treatment, and research suggests that unfunded mandates are not likely to be successful. To address this, we implemented an on-site depression prevention intervention (NYC ROSE) for positive depression screens among pregnant, mostly Black and Hispanic, lower-income women in one public hospital. In this paper, we used Aarons' implementation model to describe the successes and challenges of screening and intervention. Patient tracking sheets and electronic medical records were abstracted. Key informant interviews and an informal focus group were conducted, and staff observations were reviewed; common implementation themes were identified and fit into Aarons' model. We found that a lack of funding and staff training, which led to minimal psychoeducation for patients, were outer context factors that may have made depression screening difficult, screening results unreliable, and NYC ROSE enrollment challenging. Although leadership agreed to implement NYC ROSE, early involvement of all levels of staff and patients would have better informed important inner context factors, like workflow and logistical/practical challenges. There was also a mismatch between the treatment model and the population being served; patients often lived too far away to receive additional services on site, and economic issues were often a higher priority than mental health services. Screening and interventions for perinatal depression are essential for optimal family health, and a detailed, thoughtful and funded approach can help ensure effectiveness of such efforts.