Faculty Bibliography

There is growing concern that exposure to per/polyfluoroalkyl substances (PFAS), persistent chemicals used widely to make consumer products water- or grease-proof, may alter immune function, leading to reduced vaccine response or greater susceptibility to infections. We investigated associations between two legacy PFAS (PFOA and PFOS) and infant cytokine levels measured in newborn dried bloodspots (NDBS) from a large population-based birth cohort in Upstate New York, to determine whether exposure to legacy PFAS is associated with variability in cytokine profiles in newborns. We performed adjusted mixed effects regressions for each cytokine against PFOS and PFOA followed by exploratory factor analysis (EFA) on specific cytokine subsets selected via the prior regressions. Among 3448 neonates (2280 singletons and 1168 twins), significant cytokines were dominated by cytokines negatively associated with the given PFAS. Adjusted single-pollutant models with continuous log-transformed PFOA showed significant negative associations with IL-16 (-0.07, 95% CI: -0.3, -0.1), IL-5 (-0.05, 95%CI: -0.09, -0.02), IL-6 (-0.06, 95%CI: -0.1, -0.02), 6-Ckine (0.06, 95% CI: -0.10, -0.02) and significant positive associations with IL-1α (0.066, 95%CI: 0.03, 0.11), MCP-1 (0.06, 95%CI: 0.03, 0.10). Estimates for PFOS were slightly larger than estimates for PFOA but only significant for 6-Ckine (-0.21, 95%CI: -0.09, -0.33) after correction for multiplicity. Our data consistently suggest that legacy PFAS exposures are associated with disrupted, typically reduced, cytokine levels in neonates, with PFOA exposure resulting in more significant differences in individual cytokines and cytokine groupings than PFOS. Regression by PFAS quartile shows evidence of nonlinear dose-response relationships for most cytokines and cytokine groupings.

BACKGROUND AND AIMS/OBJECTIVE:The association of physical activity (PA) with coronary artery calcification (CAC), one of the strongest predictors of cardiovascular disease, is unclear. Moreover, different domains of PA (e.g., exercise/sports vs. work) and extra-coronary calcification (ECC) have not been extensively studied. We comprehensively evaluated the association of PA with CAC and ECC. METHODS:We investigated 2025 ARIC participants (age 73-95 years) without coronary heart disease at visit 7 (2018-19). Mid-life total and domain-specific (sport, leisure, and work) PA scores were estimated using a modified Baecke questionnaire. We modeled the averaged PA scores at visit 1 (1987-89; age 44-65 years) and visit 3 (1993-95; age 49-70 years). We explored continuous CAC and ECC (log-transformed [Agatston score+1]) or the presence of any CAC and ECC (Agatston score >0 vs. 0) as dependent variables using multivariable linear regression and logistic regression models, as appropriate. RESULTS:Total PA scores showed a U-shaped association with both continuous and any vs. no CAC. Higher total PA scores were associated inversely with ECC and most pronounced for the descending aorta calcification. The associations were generally consistent across demographic subgroups. When specific PA domains were examined, higher sport and work PA scores were significantly associated with lower descending aorta calcification. CONCLUSIONS:Mid-life PA showed a U-shaped association with late-life CAC. Among ECC, the association of higher PA with lower calcification of the descending aorta was the most consistent. Our results further corroborate a complex interplay between PA and vascular health and unique pathological processes across different vascular beds.

PURPOSE/UNASSIGNED:We aimed to determine whether implementation of clinical decision support (CDS) tool integrated into the electronic health record of a multisite academic medical center increased the proportion of patients with AUA "high-risk" microscopic hematuria (MH) who receive guideline concordant evaluations. MATERIALS AND METHODS/UNASSIGNED:We conducted a two-arm cluster randomized quality improvement project in which 202 ambulatory sites from a large health system were randomized to either have their physicians receive at time of test results an automated CDS alert for patients with "high-risk" MH with associated recommendations for imaging and cystoscopy (intervention) or usual care (control). Primary outcome was met if a patient underwent both imaging and cystoscopy within 180 days from MH result. Secondary outcomes assessed individual completion of imaging, cystoscopy, or placement of imaging orders. RESULTS/UNASSIGNED:= .09). CONCLUSIONS/UNASSIGNED:Implementing an electronic health record-integrated CDS tool to promote evaluation of patients with high-risk MH did not lead to improvements in patient completion of a full guideline-concordant evaluation. The development of an algorithm to trigger a CDS alert was demonstrated to be feasible and effective. Further multilevel assessment of barriers to evaluation is necessary to continue to improve the approach to evaluating high-risk patients with MH.

This is an invitation letter for the principal investigators and cohort studies to join the Consortium on Thyroid and Pregnancy. The inclusion criteria are population-based cohorts with data on maternal thyroid function during pregnancy and any measurement of known groups of endocrine disrupting chemicals.

Heavy drinking is a major public health concern, particularly among young adults who often experience fear of being stigmatized when seeking help for alcohol-related problems. To address drinking concerns outside clinical settings, we tested the feasibility of a novel imagery-based behavior change strategy led by student lay interventionists in a college setting. Participants were adults recruited on a college campus and were randomized to either learn the four steps of WOOP (Wish, Outcome, Obstacle, and Plan) or to learn a format-matched Sham WOOP (Wish, Outcome, "Outcome," and Plan). Both WOOP and Sham WOOP interventions were taught by student lay interventionist. We found that the WOOP intervention group reported fewer heavy drinking days (≥ 5 drinks for men or ≥ 4 drinks for women, measured using the Alcohol Timeline Follow-Back Method) compared to the Sham group at the 1-month and 2-month follow-ups. WOOP, when taught by student lay interventionists in a single session, demonstrated the feasibility of reducing heavy drinking. WOOP shows promise as a low-cost and scalable intervention for reducing heavy drinking in nonclinical settings.

BACKGROUND:Online ordering in food pantries may support food security among adults with low socioeconomic status. PURPOSE/OBJECTIVE:Determine the impact of a transition from in-person ordering to online ordering on the food security status of food pantry clients. METHODS:For this quasi-experimental study, we recruited participants from Met Council's Kosher Food Network in New York City, including one pantry in Staten Island (intervention) and three pantries in the Bronx, Queens, and Brooklyn (comparison). The final sample included 114 and 90 adults in the intervention and comparison groups, respectively, at baseline (April-July 2023); and 77 and 58 adults in those groups during follow-up (October-December 2023). Using a six-item survey, we assessed food security status, where scores range from zero to six points and higher points indicate lower food security. Secondary outcomes included nutrition security status, fruit and vegetable intake, and pantry wait time. We used a difference-in-differences approach to assess differences in outcomes between conditions, including testing for differences by age (18-64 vs. ≥65 years). RESULTS:Food security scores decreased in the intervention and comparison groups over time, with no difference in the decrease between groups (P = .87). Yet, among younger adults in the intervention group, wait time decreased during follow-up, and increased in the comparison group (difference-in-differences = -12.1 minutes (95% CI: -21.9, -2.4); P = .02). We did not observe similar differences among older adults (P = .83), nor significant changes in other outcomes. CONCLUSIONS:The transition to online ordering did not influence food security status among food pantry clients but may help to save time, especially among younger adults. CLINICAL TRIALS REGISTRATION/BACKGROUND:NCT05752721.