Faculty Bibliography

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.

Prior studies assessing the impact of calorie labels in fast-food settings have relied on comparisons across local and state jurisdictions with and without labeling mandates; several well-designed studies indicate a small reduction of calories purchased as a result of the labels. This study exploits a staggered roll-out of calorie labels in California to study the same issue using a novel comparison of in-store purchases with calorie information and drive-through purchases without calorie information at the same locations. With this design, consumers in both the treatment and comparison groups have been subject to the same social signals associated with the policy change and may have been exposed to calorie information during prior purchases, narrowing the intervention under study to the impact of posted menu labels at the point of purchase. Transactions (N = 201,418,976) at 424 unique restaurants at a single fast-food chain were included and a difference-in-differences design was used to examine changes one and two years after the implementation of labels at in-store counters compared to baseline. Using this comparison of consumer purchases within the same jurisdictions, we found no meaningful impact of posted calorie labels at the point of purchase, suggesting that such labels did not induce behavioral change. Additional methods to strengthen the impact of labeling policies are worthy of further study.

Studies suggest that environmental disasters have a big impact on population health conditions including metabolic risk factors, such as obesity and hypertension. The World Trade Center (WTC) destruction from the 9/11 terrorist attack resulted in environmental exposures to community members (Survivors) with potential for metabolic effects. We now examine the impact of WTC exposure on Body Mass Index (BMI) using the data from 7136 adult participants enrolled in the WTC Environmental Health Center (EHC) from August 1, 2005, to December 31, 2022. We characterized WTC-related exposures by multiple approaches including acute dust-cloud exposure, occupational or residential exposures, and latent exposure patterns identified by synthesizing multiplex exposure questions using latent class analysis. Employing multivariable linear and quantile regressions for continuous BMI and ordered logistic regression for BMI categories, we found significant associations of BMI with WTC exposure categories or latent exposure patterns. For example, using exposure categories, compared to the group of local residents, local workers exhibited an average BMI increase of 1.71 kg/m² with 95% confidence intervals (CI) of (1.33, 2.09), the rescue/recovery group had an increase of 3.13 kg/m² (95% CI: 2.18, 4.08), the clean-up worker group had an increase of 0.75 kg/m² (95% CI: 0.09, 1.40), and the other mixer group had an increase of 1.01 kg/m² (95% CI: 0.43, 1.58). Furthermore, quantile regression analysis demonstrated that WTC exposures adversely affected the entire distribution of BMI in the WTC EHC Survivors, not merely the average. Our analysis also extended to blood pressure and hypertension, demonstrating statistically significant associations with WTC exposures. These outcomes highlight the intricate connection between WTC exposures and metabolic risk factors including BMI and blood pressure in the WTC Survivor population.

3,4-methylenedioxymethamphetamine (MDMA; commonly referred to as "ecstasy" or "molly") is a substituted amphetamine drug that is used recreationally for its acute psychoactive effects, including euphoria and increased energy, as well as prosocial effects such as increased empathy and feelings of closeness with others. Acute adverse effects can include hyperthermia, dehydration, bruxism, and diaphoresis. Post-intoxication phenomena may include insomnia, anhedonia, anxiety, depression, and memory impairment, which can persist for days following drug cessation. MDMA acts as a releasing agent for monoamine neurotransmitters, including dopamine (DA), norepinephrine (NE) and serotonin (5-HT), by interfering with vesicular storage and transporter function, thus increasing extracellular levels of DA, NE, and 5-HT. Medical intervention in response to adverse events is complicated by the fact that illicitly-acquired MDMA is frequently adulterated, contaminated, or outright replaced with other psychoactive drugs such as synthetic cathinones ("bath salts") or methamphetamine, often unknown to the person using the drug. This review provides background on the legal status of MDMA and its use patterns, including proposals for its use as an adjunct in psychotherapy. It also discusses the pharmacological properties, mental and physical health effects, and interactions of MDMA with other drugs, with special focus on harm reduction strategies. This information will help healthcare providers assess adverse health effects related to MDMA/ecstasy use in order to facilitate appropriate treatment strategies and improve patient outcomes.

Mobile health (mHealth) tools can be used to deliver nonpharmacologic therapies to patients with migraine. However, mHealth studies often report poor treatment adherence. Neuroscience Education Therapy (NET), behavioral economics, and Digital Navigators have the potential to increase treatment adherence and thereby improve remote migraine self-management. We conducted a 6-month prospective pilot randomized controlled trial testing if a multi-component package of behavioral interventions increased treatment adherence among patients using one of two different mHealth migraine self-management programs (low-intensity program consisting only of a headache diary versus high-intensity program consisting of a headache diary and behavioral exercises). Our outcomes were the number of diary entries and behavioral exercises completed/week captured via back-end analytics of the mHealth application. We also compared our adherence data at 90-days (a secondary endpoint to assess the durability of the effect) with adherence data from similar published studies without the adherence-enhancing package. We enrolled 26 participants (n = 15 low intensity group, n = 11 high-intensity group). During the 6-week intervention period, we had a median of 7 headache diary entries/week in both groups and a median of 6 days/week of behavioral exercises in the high-intensity group. The rate of adherence with the adherence-enhancing package included was 2.9-8x higher compared to the median rates of the behavioral exercises to historical controls. With use of NET, behavioral economics, and digital navigators, participants achieved higher levels of adherence to both self-management programs compared to prior remote migraine self-management studies. Therefore, these tools may be beneficial to improving adherence to migraine self-management programs.

PURPOSE/OBJECTIVE:Our goals were to: 1) examine the occurrence of behavioral and emotional symptoms in children on the autism spectrum in a large national sample, stratifying by sex, and 2) evaluate whether children with increased autism-related social communication deficits also experience more behavioral and emotional problems. METHODS: Participants (n = 7,998) were from 37 cohorts from the Environmental influences on Child Health Outcomes (ECHO) Program. Cross-sectional information on demographic factors, parent-report of an ASD diagnosis by clinician, Social Responsiveness Scale (SRS) scores, and Child Behavior Checklist (CBCL) scores were obtained for children aged 2.5-18 years by surveys. We examined mean differences in CBCL Total Problems and DSM-oriented subscale scores by autism diagnosis and by child sex. Analyses using logistic regression were conducted to examine whether autism was associated with higher CBCL scores. We further examined if these relationships differed by child age category (< 6 years, 6-11 years, 12 + years). The relationships between SRS score and CBCL total and subscale scores were examined using quantile regression models, with analyses adjusted for child sex and age. RESULTS: In ECHO, 553 youth were reported by a parent to have a clinician diagnosis of autism spectrum disorder (ASD) (432 [78%] boys and 121 [22%] girls). Youth on the spectrum had higher mean CBCL raw scores on Total Problems and all DSM-oriented subscales compared to those not on the spectrum (all p < 0.0001). Analyses adjusted for sex and stratified by age group indicated that higher odds of autism diagnosis were associated with total, depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD) scales in the top 30% of the CBCL score distribution. Autistic girls were more likely to have parent-reported depression and anxiety compared to autistic boys. In quantile regression analyses, we observed evidence of stronger associations between SRS and CBCL for those in higher quantiles of CBCL total problems scale score (beta representing 1-unit change in SRS associated with 1-unit increase in CBCL total problems scale score), among children in the 70-90th percentile (β = 1.60, p < 0.01), or top 10th percentile (β = 2.43, p < 0.01) of the CBCL total problems scale score distribution. Similar findings were seen for the DSM-oriented depression, anxiety, and ADHD subscales. CONCLUSION/CONCLUSIONS: Results from this large national sample suggest increased behavioral and emotional problems among autistic children compared to non-autistic children throughout early life. Among children on the spectrum this may warrant increased monitoring for co-occurring behavioral and emotional problems.

BACKGROUND:Children's social-emotional development and mental well-being are critical to adult mental health. However, little is known about the mechanisms or factors that contribute to poor child mental health in low- and middle-income countries. Given the lack of child mental health research to guide interventions or social-emotional learning programs and policy planning, the present study aimed to address these knowledge gaps by examining the psychopathology mechanism involved in the development of childhood mental health problems. METHODS:This cross-sectional study recruited parents (N = 393) whose children attended preschool to primary classes in the Arghakhanchi district of Nepal. Data were gathered through parent interviews. Structural Equation Modeling was used to examine the pathways of the mediational mechanism that examined the influence of parental well-being on parenting and children's mental health outcomes. RESULTS:Approximately 22% of the parents were at risk for moderate to severe mental health problems (anxiety: 24%, depression:19%). Parental mental health problems were higher in families who reported food insecurity, among female parents, less educated parents, and those who perceived themselves on a lower social ladder. Parental mental health, social support, and perceived class were associated with parent-child conflict. Greater parent-child conflict was associated with decreased social competence and increased anger, anxiety, and depression in children. CONCLUSION/CONCLUSIONS:The results partially support the mediational model that Nepali parents' well-being (especially in mental health symptoms, social support, and perception of family's social class domains) is associated with less optimal parenting and, in turn, greater child mental health problems and lower social competence. This study provides new evidence of cross-cultural consistency in child psychopathology and guides the development of evidence-based programs to prevent and promote mental health among Nepali children and families.

BACKGROUND:Exposure to polycyclic aromatic hydrocarbons (PAHs) during childhood has been associated with altered growth and adiposity in children. The effects of prenatal exposure to PAHs on developmental programming of growth and adiposity are still unknown. OBJECTIVE:To study the association of prenatal exposure to PAHs with early childhood growth and adiposity measures. METHODS:In NYU Children's Health and Environment Study (2016-2019), we studied 880 mother-child pairs for maternal urinary PAH metabolites in early, mid, and late pregnancy and measured child weight, length/height, triceps, and subscapular skinfold thicknesses at 1, 2, 3, and 4 years. We used linear mixed models to investigate associations between average pregnancy exposure to PAHs and the z-scores of child repeated measures. The models were adjusted for sociodemographic and health-related factors. RESULTS:Children prenatally exposed to higher levels of PAHs had greater weight and length/height z scores. We found an interaction with time-point of child assessment, showing stronger associations at later ages. For instance, PAH exposure was associated with higher weight z-scores at 3 years: coefficient per Ln-unit increase in 2-NAP=0.25 (95%CI: 0.13, 0.37), 2-PHEN=0.25 (95%CI: 0.11, 0.39), 1-PYR=0.13 (95%CI: 0.02, 0.24), and 4-PHEN=0.09 (95%CI: 0.02, 0.15). Higher concentrations of 2-NAP (coefficient=0.21, 95%CI: 0.11, 0.31), 2-PHEN (coefficient=0.24, 95%CI: 0.12, 0.35), 3-PHEN (coefficient=0.13, 95%CI: 0.02, 0.24]), 4-PHEN (coefficient=0.09, 95%CI: 0.04, 0.15), and 1-PYR (coefficient=0.11, 95%CI: 0.02, 0.21) were associated with higher weight z-score at 4 years. CONCLUSION/CONCLUSIONS:Prenatal PAH exposure may contribute to the developmental programming of growth in childhood.

IMPORTANCE/UNASSIGNED:Among older adults with ischemic heart disease, participation in traditional ambulatory cardiac rehabilitation (CR) remains low. While mobile health CR (mHealth-CR) provides a novel opportunity to deliver care, age-specific impairments to technology use may limit uptake, and efficacy data are currently lacking. OBJECTIVE/UNASSIGNED:To test whether mHealth-CR improves functional capacity in older adults. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:The RESILIENT phase 2, multicenter, randomized clinical trial recruited patients aged 65 years or older with ischemic heart disease (defined as a hospital visit for myocardial infarction or coronary revascularization) from 5 academic hospitals in New York, Connecticut, and Massachusetts between January 9, 2020, and April 22, 2024. INTERVENTION/UNASSIGNED:Participants were randomized 3:1 to mHealth-CR or usual care. mHealth-CR consisted of commercially available software delivered on a tablet computer, coupled with remote monitoring and weekly exercise therapist telephone calls, delivered over a 3-month duration. As RESILIENT was a trial conducted in a routine care setting to inform decision-making, participants in both arms were also allowed to receive traditional CR at their cardiologist's discretion. MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcome was change from baseline to 3 months in functional capacity, measured by 6-minute walk distance (6MWD). Secondary outcomes were health status (12-Item Short Form Health Survey [SF-12]), residual angina, and impairment in activities of daily living. RESULTS/UNASSIGNED:A total of 400 participants (median age, 71.0 years [range, 65.0-91.0 years]; 291 [72.8%] male) were randomized to mHealth-CR (n = 298) or usual care (n = 102) and included in the intention-to-treat analysis. Of those, 356 participants (89.0%) returned in person for 6MWD assessment at 3 months. For the primary outcome, there was no adjusted difference in 6MWD between participants receiving mHealth-CR vs usual care (15.6 m; 95% CI, -0.3 to 31.5 m; P = .06). Among subgroups, there was an improvement in 6MWD among women (36.6 m; 95% CI, 8.7-64.4 m). There were no differences in any secondary outcomes between groups (eg, adjusted difference in SF-12 physical component scores at 3 months: -1.9 points; 95% CI, -3.9 to 0.2 points). Based on inverse propensity score weighting, there was no effect of mHealth-CR on 6MWD among those who did not attend traditional CR (25.7 m; 95% CI, -8.7 to 60.2 m). CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this randomized clinical trial of mHealth-CR vs usual care, mHealth-CR did not significantly increase 6MWD or result in improvements in secondary outcomes. The findings suggest the older adult population may require more age-tailored mHealth strategies to effectively improve outcomes. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT03978130.