Faculty Bibliography

Several decades of converging research in the fields of pediatrics, child development, and neuroscience demonstrate that the first years of life set the stage for children's school readiness and have lasting impacts on health, learning, and well-being across the lifespan. Early childhood is therefore an ideal time to deliver preventive interventions to reduce disparities in child development that emerge due to poverty, toxic stress, and other adversities. Early Relational Health (ERH), which includes parent-child interactions and relationships supports child development and can serve as a protective factor in the pathway between poverty/early stress and child outcomes. It is also the focus of recent policy statements and recommendations from key experts and leaders within the early childhood landscape. In the current paper, we describe interventions and strategies that use primary care alone or as a point of entry to other programs to promote ERH in order to enhance early child development. Primary care offers early contact and relationship building with families, provides near universal reach, and is low cost compared to other platforms, and layering and linking programs helps to address diverse family needs and preferences. We highlight challenges and bright spots in these endeavors and note the need for additional advocacy for the promotion of ERH that leverages a strong evidence base and converging policy recommendations.

BACKGROUND/UNASSIGNED:Myocardial infarction with nonobstructive coronary arteries (MINOCA) accounts for 6% to 15% of acute coronary syndromes and disproportionately affects women. Although coronary culprit lesions are present in 45% of patients with MINOCA, multivessel optical coherence tomography (OCT) is infrequently performed. We evaluated whether interventional cardiologists can identify coronary arteries with culprit lesions using invasive coronary angiography in women with MINOCA. METHODS/UNASSIGNED:Women with MINOCA who had a coronary culprit lesion identified by multivessel OCT were included. A core laboratory confirmed and localized OCT-defined culprit lesions using angiographic coregistration. Two interventional cardiologists blinded to OCT findings independently reviewed invasive coronary angiography, before and after review of ECG and transthoracic echocardiography, to identify the culprit artery. RESULTS/UNASSIGNED:=0.97). Culprit arteries were identified by at least 1 cardiologist in 87.5% of plaque rupture cases. Only 11% of circumflex lesions were identified. CONCLUSIONS/UNASSIGNED:Interventional cardiologists could not reliably identify culprit arteries using coronary angiography in women with MINOCA, even after ECG and transthoracic echocardiography review. Our findings suggest that invasive angiography alone should not guide vessel selection for intracoronary imaging and support multivessel imaging when evaluating MINOCA. REGISTRATION/UNASSIGNED:URL: https://www.clinicaltrials.gov; Unique identifier: NCT02905357.

BACKGROUND:Community-engaged dissemination and implementation research focuses on the implementation of evidence-based interventions within clinical or community-based settings. It uses community-engaged processes or partnerships. This includes (but is not limited to) community-based participatory research (CBPR). CBPR is an approach that centers actively engaging and collaboratively sharing power with community members, which can increase the value of studies for the communities being served and researchers. Community members include those who are most affected by the research (e.g. patients, citizens) and those most invested in the communities being researched (e.g. advocates, leaders). MAIN BODY/METHODS:Policy implementation research is the subfield of implementation science that aims to understand how policies are implemented and improve their implementation. Previous literature discusses policy co-design, defined as actively partnering with community members in the policy making process. In this article, we suggest ways to integrate CBPR methods within policy implementation research as well. We specifically discuss ways that community-members can be actively and substantively engaged in policy implementation in addition to policy making. CONCLUSION/CONCLUSIONS:Policy implementation research researchers who wish to approach their work through a CBPR lens would benefit from our overarching recommendation to meaningfully engage community members throughout the policy implementation research process including (i) building or maintaining meaningful partnerships, (ii) engaging in transparent and equitable resource sharing, cost charging, compensation, and incentives. (iii) co-designing/co-conceptualizing projects, (iv) co-refining the project and co-selecting strategies for project completion, (v) bi-directional learning and open channels of communication during the project period, and (vi) taking action on harmful or inequitable policy implementation research and results of research. We argue that if policies are causing harm or not reaching marginalized communities, researchers should alert policymakers, frontline staff, and community members to this information and actively assist in providing solutions to this issue. Ideally, the steps outlined in this article will enable researchers to directly uncover the presence of harm and/or lack of reach of policies and form the communication channels that would enable researchers to inform policymakers and community members.

OBJECTIVE/UNASSIGNED:Depressive and bipolar disorders commonly emerge during adolescence and are associated with disturbances in sleep, daily routines and social rhythms, as well as functional impairment. Social Rhythm Therapy (SRT) targets these processes. However, adult-derived rhythm protocols do not adequately reflect adolescents' school and family schedules, developmental autonomy, social and digital routines, or preferences regarding monitoring. Direct youth co-design is therefore needed to improve developmental fit, engagement and feasibility. We addressed this gap by co-designing the Social Therapy for Adolescent Rhythms in Depression (STAR-D), an adolescent-adapted SRT intervention, and evaluating its feasibility and acceptability within routine Child and Adolescent Mental Health Services (CAMHS). METHODS/UNASSIGNED:A two-phase mixed-methods feasibility design was used. Phase 1 involved co-production and intervention adaptation using questionnaire feedback from 10 adolescents, an in-depth interview with one Young People's Advisory Group representative, and feedback from six clinicians. TIDieR principles guided intervention description and adaptation. Phase 2 piloted STAR-D in adolescents receiving care in Lambeth CAMHS, London, UK. Feasibility was assessed through referral, uptake, retention and completion. Acceptability was assessed through qualitative feedback. Exploratory clinical outcomes were described using measures of functioning, depressive symptoms and manic symptoms. RESULTS/UNASSIGNED:Phase 1 feedback identified priorities for intervention adaptation, including accessible language, explicit links between routines and mood, personalised goals and flexible delivery. These findings informed an eight-session STAR-D protocol. In Phase 2, seven young people were referred, six accepted and started STAR-D, and five completed all eight sessions. Participants described the intervention as supportive, collaborative and accessible. However, they suggested simplifying daily monitoring to reduce burden. Quantitative completion and missingness data for monitoring forms were not prospectively collected. Exploratory clinical trajectories were variable. CONCLUSION/UNASSIGNED:STAR-D was feasible to deliver and acceptable to most participants in this small, uncontrolled, single-service pilot. The findings support further optimisation, particularly of routine monitoring, followed by a larger multicentre controlled mechanistic trial. Future work should test whether changes in sleep-wake regularity, daily routines and social rhythm stability mediate changes in mood and functioning, and should evaluate unipolar and bipolar presentations with sufficient diagnostic stratification.

Health literacy is a foundational component of providing accessible pediatric care, influencing whether families can understand, access, and use health information. As families increasingly rely on online health resources, health literacy skills applied to digital information, or e-health literacy, has become an evolving dimension of pediatric health literacy. The concept of health literacy extends beyond an individual's abilities, intersecting with the demands placed on individuals by healthcare systems. There is a growing focus on organizational health literacy (OHL), which reflects how effectively systems support equitable communication, but this remains infrequently assessed or implemented. Limited parent, child, and adolescent health literacy is common and disproportionately affects families with lower income, minoritized racial/ethnic backgrounds, lower educational attainment, and who use languages other than English for care. Limited health literacy has been associated with decreased disease-specific knowledge, suboptimal health behaviors, and worse clinical outcomes. Although health literacy-informed strategies can improve comprehension and outcomes, best practices, such as teach-back, remain underutilized across pediatric care settings. The rapid expansion of digital tools offers new opportunities to enhance health literacy-informed communication but also introduces challenges related to equity, accuracy, and safety. Advancing pediatric health literacy requires coordinated efforts: embedding health literacy principles into institutional and national policies, integrating universal health literacy precautions into clinical workflows, expanding clinician and patient health literacy education, and advancing health literacy-focused research, including on digital interventions and artificial intelligence (AI)-supported communication. Prioritizing these efforts is essential to creating health literate-systems that enable all families to access, understand and use health information.

BACKGROUND:Cannabis use among older adults has increased in recent years. Age-related physiological changes, socio-ecological factors, and medications may exacerbate potential adverse effects of cannabis and complicate the detection of cannabis use disorder (CUD) in older adults. However, current estimates of cannabis use are largely limited to national surveys, which may have age-related surveying challenges. METHODS:We conducted an intercept survey of 315 adults aged ≥ 65 in New York City, primarily in public parks and immediately outside older adult centers. The survey asked primarily about drug use with a focus on past-year cannabis use, reasons for use, adverse effects, and CUD. We examined reported cannabis use and delineated correlates of use and of having CUD. RESULTS:22.2% of participants (n = 70) reported past-year cannabis use, and among them, 11.1% (n = 35) reported past 24-h use. Older [adjusted odds ratio (aOR) = 0.90, 95% CI: 0.84-0.95] and female participants were at lower odds for use (aOR = 0.35, 95% CI: 0.17-0.73), and those who smoked cigarettes were at higher odds (aOR = 3.73, 95% CI: 1.65-8.48). Cannabis was most often used to get high (60.0%), relieve tension (55.7%), sleep (52.9%), or relieve chronic pain (30.0%). Dry mouth (41.4%) and drowsiness (18.6%) were the most reported adverse effects. Nearly a third (32.9%) who used cannabis had CUD, with 5.7% having severe CUD. CONCLUSIONS:Findings suggest that cannabis use among older adults may be more common and clinically significant than suggested by prior evidence. Improved screening, clinician education, and harm reduction strategies are needed to confront emerging risks in this population.

Kaplan-Meier analysis of time to first all-cause readmission over 12 months among older adults with ischemic heart disease randomized to 3 months of mobile health cardiac rehabilitation (mHealth-CR) or usual care. There was no significant difference in time to first readmission between groups (log-rank P = 0.26).

Global positioning system (GPS) data capture fine-scale spatial and temporal mobility, enabling more precise, individualized assessments of neighborhood exposures than residential address-based measures. Despite growing use, there is little consensus on how to define and quantify GPS-based exposures, highlighting the need for theory-informed approaches. This study demonstrates how GPS data can enhance neighborhood exposure assessment, address spatial misclassification, and inform future research on mobility and neighborhood environments. We integrated theoretical frameworks from psychology, sociology, and geography into GPS-based research using data from two cohort studies: the Neighborhoods and Networks (N2) Study and the Trying to Understand Relationships, Networks, and Neighborhoods among Trans Women of Color (TURNNT) Study. The final GPS analytic sample was 649 participants. We constructed GPS-based neighborhood exposure measures, including direct exposure to specific locations and neighborhood psychosocial exposures, and compared these metrics with conventional residential address-based measures. We also derived GPS-based mobility measures to characterize individual mobility patterns. GPS-based measures captured higher variability in neighborhood exposures compared with residential-based measures. GPS-derived mobility measures further characterized individual mobility patterns, providing additional context for understanding exposure beyond residential location. Accounting for spatial and temporal dimensions offers a robust foundation for future studies with more precise spatially relevant health interventions.

BACKGROUND:The early stage of bipolar I disorder is considered a crucial period for improving long-term outcomes, yet evidence guiding treatment selection after a first manic episode is scarce. Using data from the BD-CAUSAL Collaboration, we aimed to emulate a pragmatic target trial among individuals aged 16 years or older presenting with a first manic episode with psychotic features. METHODS:For the target trial, individuals were eligible if they were aged 16 years or older, treated at a first-episode psychosis clinic with a diagnosis of bipolar I disorder between Jan 1, 2006, and Dec 31, 2021, with a manic episode (with or without mixed features) with psychotic symptoms based on DSM-5 criteria; not currently hospitalised; had no previous use of mood stabilisers or second-generation antipsychotics in the past 3 months; and had no history of severe side-effects. Treatment strategies compared were initiating mood stabiliser monotherapy, second-generation antipsychotic monotherapy, or combination therapy. Individuals are followed up for up to 2 years. We emulated the target trial using the BD-CAUSAL Collaboration database that includes participants from North America, Chile, and Spain, and is a subset of a large consortium of observational cohorts. Information on mood stabilisers and antipsychotic prescription was identified via data linkages with outpatient and hospitalisation databases. We assessed eligibility for each person-visit between Jan, 1, 2006, and Dec, 31, 2021, and assigned individuals to the treatment strategy that was compatible with their data. The main outcome was hospitalisation or an emergency department visit due to any psychiatry reason over 2 years. Intention-to-treat and per-protocol effects were estimated using pooled logistic regression adjusted for baseline and time-varying confounders. People with lived experience were not involved in the study design, analysis, or interpretation of findings. FINDINGS/RESULTS:Among 371 eligible individuals with bipolar I disorder (465 eligible treatment initiations), 141 (38%) were female, 230 (62%) were male, 216 (58%) were White, 155 (42%) were not White, and the median age was 22 years (IQR 19-25). Of 371 patients, 155 (42%) were hospitalised due to psychiatric reasons over a median of 19·8 months (IQR 16·1-24·0). The 2-year hospitalisation or emergency department visit risk was 42·3% (95% CI 32·5 to 61·1) for mood stabiliser monotherapy, 49·5% (42·4 to 60·6) for second-generation antipsychotic monotherapy, and 42·2% (33·3 to 52·5) for combination therapy. Compared with second-generation antipsychotic monotherapy, the risk was lower with mood stabiliser monotherapy (risk difference -7·3% [95% CI -15·8 to -1·4]; risk ratio 0·82 [0·63 to 0·97]) and combination therapy (-7·4% [-16·0 to -2·1]; 0·82 [0·63 to 0·91]). Risks were similar between mood stabiliser monotherapy and combination therapy. INTERPRETATION/CONCLUSIONS:Mood stabiliser-based strategies, alone or in combination, had a lower relapse risk than second-generation antipsychotic monotherapy in the continuation and maintenance treatment after a first episode of mania with psychotic symptoms. These findings would support prioritising mood stabilisers in early treatment and highlight the need for randomised trials for confirmation. FUNDING/BACKGROUND:ASISA and National Institute of Mental Health.