Faculty Bibliography

BACKGROUND:Osteoporosis is a significant cause of morbidity and mortality in the aging population. Individuals with type 2 diabetes mellitus (T2D) typically have higher bone density yet also a higher rate of fractures. Blacks, meanwhile, have a lower incidence of osteoporosis compared to European Americans. Serum bicarbonate may be a risk factor for bone loss, but studies are conflicting, and little is known about this relationship in T2D or Blacks. METHODS:We examined the longitudinal relationship between serum bicarbonate and change in bone density in 300 participants with T2D in the African American-Diabetes Heart Study (AA-DHS). Serum bicarbonate was measured at baseline, and bone density was assessed using CT volumetric bone mineral density (vBMD) scans of the thoracic and lumbar vertebrae at baseline and after five years of follow-up. Multivariate linear regression models assessed associations between baseline serum bicarbonate and longitudinal change in vBMD, adjusted for multiple confounders. RESULTS:, p < 0.001), without a clear threshold effect or differences by sex. CONCLUSIONS:In this cohort of Blacks with T2D, higher baseline serum bicarbonate levels were associated with improved changes in bone density over time. Further studies are needed to determine if alkali supplementation would ameliorate loss of bone density in this population.

INTRODUCTION/BACKGROUND:Black sexually minoritized men and gender-expansive people (SGM), including transgender women, have higher levels of alcohol use and experience greater negative consequences from alcohol consumption than the general population. We investigated the role of multilevel factors contributing to alcohol use among these groups. METHODS:We analyzed data collected from HIV-negative participants in the Neighborhoods and Network (N2) cohort study in Chicago, IL (N = 138). Participants completed a social network inventory (November 2018-April 2019) and reported alcohol use (frequency, quantity, and frequency of binge drinking) during a quantitative assessment. We used stepwise negative binomial regression to identify associations with social network and individual-level alcohol use while controlling for sociodemographic variables. RESULTS: = 2.7), of whom 93% were Black and 78% were friends/family. Among the confidants, 30% drank alcohol at least several times per week. Identifying as Latine (RR = 2.21; 95% CI: 1.44-3.10), having a higher Generalized Anxiety Disorder-7 score (RR = 1.03; 95%CI: 1.00-1.05), living with a problem drinker during one's childhood (RR = 1.80; 95% CI: 1.39-2.34), and having a greater proportion of regular drinkers in one's social network (RR = 1.49; 95% CI: 1.02-2.17) were positively associated with alcohol use. CONCLUSION/CONCLUSIONS:Black SGM exposed to social network alcohol use during childhood and adulthood reported increased alcohol use. Interventions targeting Black SGM should address social norms around alcohol, intersectional discrimination, and mental health.

BACKGROUND:Maternal thyroid dysfunction and maternal depression during pregnancy may increase the risk of child behavioral and emotional problems. We sought to investigate the independent and interactive associations of these two risk factors with child behavior problems. METHODS:We combined data from four cohorts in the Environmental influences on Child Health Outcomes (ECHO) program (N = 949). Maternal thyroid function (thyroid-stimulating hormone [TSH], free thyroxine [fT4], thyroid peroxidase autoantibodies [TPO-Ab], fT4/TSH ratio) was measured predominantly during the first half of pregnancy. We harmonized maternal depression into a continuous measure of antepartum depressive symptomatology and a dichotomous measure reflecting (history of) clinical depression. Child internalizing and externalizing problems were harmonized to the T-score metric of the Child Behavior Checklist. We used multiple linear regression and random effects meta-analysis to assess the average relationship between each predictor and outcome, and the variability in these relationships across cohorts. RESULTS:Across cohorts, antepartum depressive symptomatology was positively associated with both internalizing (meta B = 2.879, 95 % CI 1.87-3.89, p < .001) and externalizing problems (meta B = 1.683, 95 % CI 0.67-2.69, p = .001). None of the indicators of maternal thyroid function was associated with child behavior problems across cohorts. TPO-Ab concentrations were positively associated with child externalizing problems only in offspring of depressed mothers (meta B = 3.063, 95 % CI 0.73-5.40, p = .010). CONCLUSIONS:This study supports the importance of maternal antepartum mental health for child behavior across diverse populations. However, we found little empirical evidence for an association between maternal thyroid function within the normal range during pregnancy and child behavioral problems.

PurposeTo examine multimorbidity prevalence by race/ethnicity and unique health disparities for Native Hawaiian and Other Pacific Islanders (NHPI).DesignCross-sectional study.SettingThis study uses combined data from the 2014 National Health Interview Survey (NHIS) and the 2014 NHPI-NHIS.Sample38,965 adults, including a representative sample of 2,026 NHPIs.MeasuresSelf-reported diagnoses of ten chronic conditions and race/ethnicity, including Non-Hispanic (NH) Whites, NH Blacks, NH Asians, NH NHPIs, Hispanics and NH Mixed Race. Covariates include age, sex, marital status, education, family income, and employment status.AnalysisWe used multinomial logistic regression models to evaluate the adjusted association between race/ethnicity and number of chronic conditions: none, 1, and ≥ 2 (multimorbidity).ResultsCompared to Whites, Asians and Hispanics (aRRR = 0.39, P < .001 and aRRR = 0.59, P < .001) had significantly lower odds of having multimorbidity relative to no chronic condition. In contrast, Black Americans and NHPIs (aRRR = 1.27, P < .001 and aRRR = 1.22, P < .05) had significantly higher odds of multimorbidity compared to Whites. Of note, NHPIs showed significantly higher odds of multimorbidity compared to Asians (aRRR = 3.07, P < .001).ConclusionOur findings highlight significantly higher risk of multimorbidity for NHPIs relative to Whites as well as Asians. This underscores the importance of disaggregating NHPI data from Asians as a whole. Future studies should incorporate additional social factors relevant to the NHPI community.

BACKGROUND:Hearing loss is prevalent in older adults and is associated with reduced daily physical activity, but whether hearing intervention attenuates declines in physical activity is unknown. We investigated the 3-year effect of a hearing intervention versus a health education control on accelerometer-measured physical activity in older adults with hearing loss. METHODS:This secondary analysis of the ACHIEVE randomized controlled trial included 977 adults aged 70-84 years with hearing loss. Participants were randomized to either a hearing intervention group or a health education control group. Physical activity was measured using wrist-worn accelerometers at baseline, 1, 2, and 3 years. Linear mixed models assessed the impact of the intervention on changes in total activity counts, active minutes per day, and activity fragmentation. RESULTS:Among 847 participants in the final analysis (mean age 76.2 years; 440 [52%] women; 87 [10%] Black; 5 [0.8%] Hispanic), total activity counts declined by 2.7% annually, and active minutes/day declined by 2.1% annually over 3 years in both intervention and control groups. Activity patterns also became more fragmented over time. No appreciable differences were observed between hearing intervention and health education control in the 3-year change in accelerometry-measured physical activity measures. CONCLUSIONS:Hearing intervention did not appreciably attenuate 3-year declines in physical activity compared to health education control in older adults with hearing loss. Alternative strategies beyond hearing treatment may be needed to enhance physical activity among older adults with hearing loss.

OBJECTIVE:Despite increasing incidence of genital gender-affirming surgery (GGAS), there is no systematic method of evaluating patient perspectives. The objective of this study is to elucidate transgender and non-binary patient perspectives on gender-affirming phalloplasty/metoidioplasty via structured focus groups and determine convergent themes as the first step towards the development of a GGAS patient-reported outcome measure. DESIGN/METHODS:We conducted a systematic qualitative study using a thematic content analysis of four focus groups from April 2021 to April 2022 comprising 8 patients undergoing phalloplasty/metoidioplasty and 10 patients post-phalloplasty/metoidioplasty. Focus groups were hosted virtually and recorded and transcribed. Discussions were guided by participant input and focused on goals, experiences, outcomes, satisfaction, and quality of life. SETTING/METHODS:This volunteer but purposive sample of patients was recruited directly in clinic, via email, and via social media at NYU Langone Health (primary site), Callen-Lorde Community Health Center (New York, New York, USA) and the San Francisco Community Health Center. PARTICIPANTS/METHODS:We conducted focus groups with 18 patients before/after undergoing gender-affirming phalloplasty/metoidioplasty. PRIMARY AND SECONDARY OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Transcripts were uploaded into ATLAS.ti, a qualitative data analysis software that facilitates coding for thematic content analysis. We performed deductive and inductive coding to identify the themes that were clustered into overarching domains. RESULTS:The mean duration of focus groups was 81.5 min. Seven themes and 19 subthemes were constructed. The major themes were (1) goals, expectations, and priorities before/after surgery; (2) sexual function; (3) urinary function; (4) peer support; (5) decision-making; (6) mental health and quality of life; and (7) gender dysphoria. Of the major themes, those determined before the study included themes 1-3 and 6-7. Limitations include small sample size and bias in patient selection. CONCLUSIONS:We conducted focus groups with 18 patients before/after undergoing gender-affirming phalloplasty/metoidioplasty. Mental health, quality of life, functional, and aesthetic outcomes are all critical to patients. Phalloplasty/metoidioplasty impact numerous aspects of patients' lives. Experiential components of the surgical process, mental health, and quality of life are important metrics to consider in addition to functional and aesthetic outcomes.

BACKGROUND/UNASSIGNED:Ecological momentary assessment (EMA) provides insight into the effectiveness and feasibility of smoking-related interventions. OBJECTIVE/UNASSIGNED:The objective of this paper was to assess adherence to an EMA protocol and compare EMA-derived responses with measures collected through multiple surveys. METHODS/UNASSIGNED:A subanalysis was conducted using data from a 12-week, open-label, and 2-arm pilot randomized clinical trial among adult smokers with chronic obstructive pulmonary disease, coronary artery disease, peripheral vascular disease, or asthma in the last 12 months (n=109). Participants were randomized to either electronic cigarette (EC) or nicotine replacement therapy (NRT) treatment arms. We compared EMA data collected through automated SMS text message prompts sent to participants 4 times daily for 12 weeks, including cigarettes smoked per day (CPD), craving, and satisfaction, to survey data collected at 12 weeks. Convergent validity between survey- and EMA-reported measures was evaluated using Pearson correlation and paired t tests. CPD was modeled using negative binomial regression. Relative rates (RRs) of reaching at least 50%, 75%, and 100% CPD reduction between two arms were calculated using both EMA and survey data. RESULTS/UNASSIGNED:The majority of participants were non-Hispanic White (63/109, 58%) and female (60/109, 55%), and had a median age of 60 (IQR 54-65) years. Among the 109 participants, 59.6% (n=65) were consistently adherent to the EMA protocol over the 12-week period. Median weekly EMA response rate remained high over the 12-week study period even though a modest decline was observed (week 1, 97.8% and week 12, 89.4%). The mean CPD declined significantly (week 1, mean 14.2, SD 9.9 and week 12, mean 4.6, SD 6.7; P<.001). EMA-derived and survey-based CPD measurements were positively correlated (r=0.73, 95% CI 0.6-0.82) as were measures of craving (r=0.38, 95% CI 0.17-0.56). No significant paired difference in CPD was observed between EMA measurements and surveys. A significant effect of time on CPD EMA data (incidence rate ratio [IRR] 1-week change 0.93; P<.01) and survey data was found (IRR 12-week change 0.36; P<.01). However, the treatment effect was not significant, which aligned with the RR results. An increase in the EC consumption was observed over time in the EC arm, with 12.1% (7/58) fully switched to EC (defined as CPD=0 and EC use>0) and 20.7% (12/58) mostly switched (defined as a reduction in CPD>75% and EC use>0) in week 12. CONCLUSIONS/UNASSIGNED:EMA is a suitable method to collect recall-based smoking-related data. Though results from mixed effect modeling and RR comparisons were similar using EMA or survey data, EMA provides unique advantages, namely greater granularity in the time and the capability to detect switching patterns in near real time. These findings provide the feasibility of using EMA in developing smoking cessation interventions in future tobacco harm reduction research.

OBJECTIVES/OBJECTIVE:We examined trends in the socioeconomic distribution of work schedules from 1990s to 2010s and how early adulthood disadvantages are associated work schedules over working age. METHODS:In a representative sample of U.S. workers(N = 3,328), we calculated recycled predictions of day, evening, night, and long shift prevalence associated with time-period. Logistic regression was used to analyze the association of non-day shifts with age and its variations by early adulthood disadvantage in U.S. baby boomers(N = 10,293). RESULTS:Between 1990s-2010s, evening shifts increased in adults without college education and night shifts increased in the lowest income quartile. Day shifts decreased in both groups. Being Black, not attending college, and poverty were associated with non-day shiftwork throughout working age. CONCLUSIONS:Evening and night shifts may have replaced day shifts in disadvantaged populations between 1990s-2010s. Early disadvantages may have sustained effects on work schedules.

INTRODUCTION/BACKGROUND:Despite the end of the federal COVID-19 public health emergency in May 2023, COVID-19 prevention remains a priority. This study investigates how public vaccination attitudes and perceived COVID-19 risks relate to vaccination status, aiming to identify factors associated with COVID-19 vaccination post-emergency. METHODS:An online survey was conducted from April to May 2023 among a non-representative, nationally-based sample of MTurk workers. The primary outcome was COVID-19 vaccination status. Variables examined included anti-vaccine attitudes, health status, COVID-19 experiences, and sociodemographic factors. We created a composite measure of anti-vaccine attitudes from 15 items with three levels. Bivariate tests of association and multivariable logistic regression were performed. RESULTS:A final sample of 989 adults were included in this analysis. In our multivariable model, individuals with higher anti-vaccine attitudes were less likely to be vaccinated against COVID-19 compared to those with low anti-vaccine attitudes (OR = 0.10, 95 % CI 0.04, 0.25). Those who identified as LGBQ+ (OR = 2.55, 95 % CI 1.32, 4.94), had chronic conditions (OR = 2.94, 95 % CI 1.43, 6.01) and had felt stigmatized from COVID-19 infections (OR = 3.33, 95 % CI 1.47, 7.58) were more likely to be vaccinated, even after adjusting for anti-vaccine attitudes. News source, perceived risk of contagion by contact, and long COVID-related factors were not significantly associated with vaccination status in the multivariable model. DISCUSSION/CONCLUSIONS:Our findings highlight the persistent relationship between anti-vaccine attitudes and vaccination status in the "post-pandemic" era. Beyond vaccine attitudes, sexual orientation, chronic conditions, and stigmatization experiences may influence perceived need for protection. Stigma can sometimes reinforce social norms driving vaccination, but this effect is nuanced, particularly with anti-vaccine attitudes. To promote vaccine uptake, interventions should prioritize community support, counter misinformation, and enhance vaccine literacy. Building trust among vulnerable populations is essential, rather than relying on public health messaging that may reinforce social stigma.