Faculty Bibliography

BACKGROUND:Midwakh smoking is the second most widely used form of smoking in the United Arab Emirates predominantly among adults. Despite high prevalence, there is a lack of scientific data on plasma nicotine after a single midwakh session and its effect on cardiopulmonary function. This study assessed the acute effects of midwakh smoking on plasma nicotine levels and cardiopulmonary function after a single session. METHODS:Among 211 midwakh smokers who visited the Sleep Disorders Specialized Clinic, 9 (nine) agreed to participate in the study. Blood samples were collected before and after smoking (5 min) to determine the nicotine and cotinine levels using mass spectroscopy. Anthropometric data, smoking details, physiological parameters, heart rate variability (HRV), spirometry, and forced oscillation technique were measured pre- and post-smoking. RESULTS:< 0.001, parameters pre- and postsmoking. CONCLUSION/CONCLUSIONS:This study involving a small sample demonstrates changes in blood nicotine and cotinine levels and differences in cardiopulmonary function among midwakh smokers; however, findings should be interpreted with caution due to limited generalizability.

BACKGROUND:Data on patient-centered outcomes of mobile health cardiac rehabilitation (mHealth-CR) for older adults with ischemic heart disease are limited. The RESILIENT (Rehabilitation at Home Using Mobile Health in Older Adults After Hospitalization for Ischemic Heart Disease) trial, the largest randomized study of mHealth-CR in this population, found no significant improvements in functional capacity, health status, angina, or disability compared with usual care. OBJECTIVES/OBJECTIVE:The purpose of this study was to evaluate whether mHealth-CR affects personalized goal attainment-a prespecified secondary endpoint of RESILIENT-using goal attainment scaling (GAS). METHODS:A total of 400 patients (≥65 years) with ischemic heart disease were randomized to mHealth-CR or usual care. Participants specified goals for CR at baseline using the five-category goal attainment scale: much-less-than-expected (-2), less-than-expected (-1), expected (0), better-than-expected (+1), and much-better-than-expected (+2). Goal attainment was assessed at 3 months. RESULTS:Of 400 patients (median age, 71.0 years [range 65.0-91.0]; 72.8% male; 65.2% prefrail/frail) randomized to mHealth-CR (n = 298) or usual care (n = 102), 353 (88.3%) completed GAS. Most goals addressed physical activity (54.0% mHealth-CR vs 59.0% usual care), health care behaviors (14.4% vs 11.9%), or symptom management (13.1% vs 9.0%). Rates of attaining or exceeding goals (GAS ≥0) were similar between groups (80.5% vs 77.6%; P = 0.492). However, in the intervention arm, there was a higher rate of exceeding expected level of goal attainment (GAS +1, +2) compared with usual care (52.6% vs 34.2%; P = 0.006). CONCLUSIONS:In a trial that did not demonstrate differences on traditional endpoints, those receiving mHealth-CR were more likely to exceed personalized CR goals. These findings suggest the intervention facilitated greater progress toward individualized goals and underscore the importance of patient-centered outcomes in CR.

BACKGROUND:Adolescents in low- and middle-income countries (LMICs) face significant mental health challenges, yet their perspectives are often underrepresented in the design of preventive strategies. Co-design approaches, such as human-centered design (HCD), offer a promising way to tailor interventions and implementation strategies to adolescents’ needs and local context. In LMICs, these methods require careful adaptation to address resource constraints, limited design literacy, and cultural norms. This study documents how HCD was adapted to engage adolescents in northern Ghana as co-designers of school-based mental health preventive strategies. METHODS:Guided by the first two phases of HCD, we conducted two workshops with 24 students from 12 public senior high schools in Tamale, Ghana. Workshop 1 (Inspiration) used structured, case-based discussions informed by the Consolidated Framework for Implementation Research (CFIR) to explore adolescents’ perspectives on mental health. Workshop 2 (Ideation) used interactive choice-based activities to elicit youth-generated strategies. To align with cognitive and sociocultural factors, we incorporated scaffolded facilitation, hands-on activities, and peer-led engagement. Qualitative data from facilitator notes, artifacts, and audio-confirmed summaries were synthesized using structured rapid qualitative analysis. RESULTS:Adolescents identified key mental health concerns, including stigma, peer and family influences, and fears about confidentiality. Gender-specific discussions revealed culturally rooted concerns, such as peer pressure and substance use among boys and limited support-seeking among girls. Adolescents prioritized five school strategies: teacher training, curricular integration, mentorship programs, activities that promote positive thinking and mindfulness, and entertainment-based mental health education. Youth demonstrated a conceptual shift from viewing mental health as an individual problem to a shared responsibility across schools and communities. Formation of an Adolescent Advisory Board reflected youth interest in sustained leadership and co-design. CONCLUSIONS:Contextualized co-design methods can meaningfully engage adolescents in LMIC settings and support the development of culturally grounded, feasible, and youth-prioritized mental health strategies. Structured facilitation enhances both the inclusivity and authenticity of adolescent engagement. This study contributes to implementation science by presenting a replicable co-design framework with policy relevance and providing a foundation for multilevel intervention development in resource-constrained educational systems. SUPPLEMENTARY INFORMATION:The online version contains supplementary material available at 10.1186/s12889-025-25012-0.

BACKGROUND:Prior studies have found racial and ethnic disparities in cancer screenings, yet smaller minority ethnic groups are often aggregated. METHODS:Data from the 2021-2022 Community Health Resources and Needs Assessment (Cancer CHRNA) and the 2017-2020 NYC Community Health Survey (CHS) examined the prevalence of breast, cervical, and colorectal cancer screenings among Eastern European, Afro-Caribbean, Latine, Chinese, Korean, South Asian, and Southwest Asian and North African (SWANA) groups in New York City. Multivariable logistic regression models estimated adjusted relative risks of cancer screening outcomes by group. RESULTS:Up-to-date mammogram screening was low (< 70%) among all groups except Afro-Caribbean in the Cancer CHRNA; and among South Asian, Chinese, and Eastern European groups in the CHS. In logistic regression, South Asian and SWANA groups were less likely to have received an up-to-date mammogram compared to the Afro-Caribbean group in the Cancer CHRNA; no group differences were found in the CHS. Up-to-date Pap screening was low (< 70%) among all groups except Latina in the Cancer CHRNA; and among South Asian and Chinese groups in the CHS. In logistic regression, all other groups were less likely to have received an up-to-date Pap test compared to the Latina group in the Cancer CHRNA; and Chinese and South Asian groups were less likely to have received an up-to-date Pap test compared to the Latina group in the CHS. Up-to-date colonoscopy screening was low (< 70%) among all groups in the Cancer CHRNA; and among SWANA, South Asian, Chinese, and Eastern European groups in the CHS. In logistic regression, all groups except Chinese were less likely to have received an up-to-date colonoscopy compared to the Eastern European group in the Cancer CHRNA; and the Chinese and SWANA groups were less likely to have received an up-to-date colonoscopy compared to the Afro-Caribbean group in the CHS. CONCLUSIONS:Disparities in cancer screenings differed by screening type and survey, with larger disparities found among groups in the Cancer CHRNA. System level efforts are needed to monitor cancer screening disparities by disaggregating diverse groups; culturally tailored strategies should be used to raise awareness to increase screening. CLINICAL TRIAL INFORMATION/BACKGROUND:Not applicable.

BACKGROUND:Pregnant and parenting women with substance use disorders (SUDs) face complex and overlapping challenges, including substance use, legal issues, housing instability, and trauma. Effective interorganizational collaboration is critical but often hindered by fragmented care and resource limitations. This study explores the key barriers and facilitators that impact collaborative efforts among healthcare providers, government agencies, and community organizations in addressing SUD among pregnant and parenting women. METHODS:This qualitative study was conducted in New York State between April 2022 and April 2023. The study focused on organizations that provide services to pregnant and parenting women with SUDs, including government agencies, SUD treatment centers, healthcare settings, and community-based care organizations. Semi-structured, one-on-one interviews were conducted with staff to explore how their organizations coordinate care. Thematic analysis was used to identify patterns related to interorganizational collaboration. Primary data were collected through interviews with 30 staff members across multiple stakeholder groups: child welfare services (n = 8), criminal legal agencies (n = 5), health agencies (n = 3), healthcare service settings (n = 4), SUD treatment programs (n = 6), and community-based organizations (n = 4). Interviews lasted approximately one hour and focused on organizational roles, referral processes, and coordination efforts in serving the target population. RESULTS:Collaborative care was primarily facilitated through referral networks, case management teams, and the presence of embedded healthcare professionals. However, these systems were frequently limited by fragmented communication, stigmatizing attitudes, and insufficient resources. Organizational facilitators included co-located healthcare staff within child welfare services and formalized partnerships across sectors. Key barriers included staffing shortages, burnout, and misalignment of organizational goals. At the individual level, collaboration often depended on informal relationships and staff-driven initiatives, though interdisciplinary knowledge gaps remained a significant challenge. CONCLUSIONS:Improving service coordination for pregnant and parenting women with SUDs will require stronger organizational infrastructure, investment in cross-sector communication strategies, and deliberate efforts to address stigma. Future research should explore models that support sustained, formalized interagency partnerships to enhance care integration.

INTRODUCTION/BACKGROUND:The Neighborhoods Study (TNS) is a novel investigation of adverse social exposome and brain health leveraging 22 Alzheimer's Disease Research Centers (ADRCs). TNS aims to understand if the adverse social exposures increase Alzheimer's disease and related dementias (ADRD) risk. METHODS:TNS uses innovative methods to determine lifetime addresses of living (n = ≈ 3116) and brain bank cohorts (n = ≈ 8637). Addresses are linked to time-concordant adverse social exposome using the Area Deprivation Index (ADI) and summarized over time. Brain health measures are provided by the National Alzheimer's Coordinating Center. RESULTS:We highlight a general overview and methodology of TNS. Data collection is ongoing; however, preliminary findings indicate that the adverse social exposome is related to ADRD biomarkers, neuropathology, and cognitive function. DISCUSSION/CONCLUSIONS:TNS is the largest study of adverse social exposome and ADRD, using the ADRC network to build robust scientific consortia. Its findings will inform ADRD interventions, precision medicine, and policy. HIGHLIGHTS/CONCLUSIONS:The Neighborhoods Study (TNS) investigates adverse social exposome and brain health. TNS is a collaboration among 22 Alzheimer's Disease Research Centers. TNS will give insight on environmental and exposomal factors which may be modifiable. Participant lifetime addresses are linked to temporal adverse social exposome metrics. This study's findings will inform precision approaches to mitigate dementia risk.

Adolescent mental health remains a critical yet under-prioritized issue in low- and middle-income countries (LMICs) like Kenya, where resource limitations, stigma, and systemic barriers hinder access to care. While policies and strategies such as Kenya's Mental Health Action Plan (2021-2025) exist on paper, their implementation is constrained by limited resources and a weak mental health service delivery infrastructure. This qualitative descriptive study examines the perspectives of mental health actors and youth advocates on the development and implementation of adolescent mental health policy in Kenya. Using a political economy analysis, we conducted 15 key informant interviews (KIIs) and analyzed observational field notes from a Google Jam board exercise to explore factors that enable or impede the prioritization of adolescent mental health policy and care. Thematic analysis was guided by Shiffman and Smith's policy framework, focusing on four domains: actor power, ideas, political context, and issue characteristics. Findings reveal significant barriers, including the exclusion of adolescents from decision-making, limited family involvement, weak policy formulation, and the destabilizing effects of government transitions. Stigma, poverty, and chronic underfunding further hinder progress, despite ongoing strategic efforts. Comparisons with other LMICs indicate that these challenges are widespread, underscoring the need for localized, inclusive, and well-coordinated approaches. Addressing these issues will require strong political commitment, increased youth-led advocacy, and sustained investment in mental health services. By prioritizing adolescent mental health, Kenya can move toward a more equitable and effective mental health system that supports the wellbeing of its youth.

BACKGROUND:Studies examining the association of chronic kidney disease (CKD) with cancer risk have demonstrated conflicting results. METHODS:This was an individual participant data meta-analysis including 54 international cohorts contributing to the CKD Prognosis Consortium. Included cohorts had data on albuminuria [urine albumin-to-creatinine ratio (ACR)], estimated glomerular filtration rate (eGFR), overall and site-specific cancer incidence, and established risk factors for cancer. Included participants were aged 18 years or older, without previous cancer or kidney failure. RESULTS:Among 1,319,308 individuals, the incidence rate of overall cancer was 17.3 per 1000 person-years. Higher ACR was positively associated with cancer risk [adjusted hazard ratio 1.08 (95% CI 1.06-1.10) per 8-fold increase in ACR]. No association of eGFR with overall cancer risk was seen. For site-specific cancers, lower eGFR was associated with urological cancer and multiple myeloma, whereas higher ACR was associated with many cancer types (kidney, head/neck, colorectal, liver, pancreas, bile duct, stomach, larynx, lung, hemolymphatic, leukaemia, and multiple myeloma). Results were similar in a 1-year landmark analysis. DISCUSSION/CONCLUSIONS:Albuminuria, but not necessarily eGFR, was independently associated with the subsequent risk of cancer. Our results warrant an investigation into mechanisms that explain the link between albuminuria and cancer.

OBJECTIVE:This study examines how social determinants of health (SDOH) influence mild cognitive impairment (MCI) and its progression to dementia across racial/ethnic groups, identifying disparities and key predictors using machine learning approaches. METHODS:We analyzed data from 83,180 participants aged 50+ in the All of Us Research Program (65,582 White, 6,207 Black, 4,170 Hispanic, 7,221 Other). The sample had mean ages ranging from 62.4 (Hispanic) to 68.1 (White) years, with significant gender disparities (70.9% Black females vs. 46.0% Other females). We developed machine learning classification models to predict MCI and its progression to dementia across the four racial/ethnic groups using 18 SDOH, along with key sociodemographic variables. We then applied SHapley Additive exPlanations (SHAP) to quantify each factor's contribution and interpret its risk and protective effects on individual predictions. RESULTS:MCI prevalence was comparable across groups (7.5%-8.0%), but progression to dementia varied (9.4% Black vs. 11.4% Other). Perceived stress was the strongest predictor of MCI across all groups, with SHAP values of 15.1% (White), 13.5% (Black), 17.4% (Other), and 19.3% (Hispanic). Predictors of progression to dementia varied by groups: perceived stress (7.0%) for Whites, instrumental social support (14.2%) for Hispanics, daily spiritual experience (34.0%) for Blacks, and everyday discrimination (11.2%) for other groups. DISCUSSION/CONCLUSIONS:The findings underscore the need for group-specific interventions addressing stress mitigation for MCI prevention and culturally-tailored support systems to delay dementia progression. This machine learning approach reveals complex SDOH interactions that traditional methods might overlook, particularly for racial/ethnic underrepresented populations.