Faculty Bibliography

Research shows that donor families report feeling abandoned, lacking social support, and receiving insufficient aftercare services. To meet the needs of these families, Taylor's Gift Foundation developed a free, virtual grief support program that pairs participating donor family members with Caring Guides trained in assertive community engagement and offers peer-facilitated support groups. Project Aim: The aim was to assess participant experiences with Taylor's Gift Foundation grief support program to understand its impact on grief symptoms, donor family access to grief support, and perceived social support. Design: Researchers conducted a qualitative evaluation using semi-structured interviews with 21 program participants. Results were analyzed using rapid qualitative analysis and descriptive statistics. Results: Eighteen (86%) participants worked with Caring Guides, 12 (57%) attended an average of 7 support groups, and 8 (39%) worked with Caring Guides and attended support groups. Eleven (52%) program participants reported difficulties accessing mental health services. Most program participants (86%) reported a decrease in grief intensity since enrolling in the program. Conclusion: Effective aftercare services were critical in helping donor families cope with, and adapt to, their loss. The Taylor's Gift Foundation grief support program helped donor family members access otherwise inaccessible grief support services and provided a valuable means of social support.

Mechanisms underlying the dynamic relationships of viral infections and neurodegeneration warrant examination. Using a community-based cohort of older adults, the current study characterized the neurocognitive (cognitive functioning, brain volumes, Alzheimer's disease positron emission tomography, and plasma biomarkers) and plasma proteomic (7268 proteins) profiles of four common coronavirus and six herpesvirus antibody titers. Genetic inference techniques demonstrated the associations between viral antibody titers and neurocognitive outcomes may be attributed to altered expression in a subset of mechanistically relevant proteins in plasma. One of these proteins, IGDCC4 (immunoglobulin superfamily deleted in colorectal cancer subclass member 4), was related to 20-year dementia risk, cognitive functioning, and amyloid-β positivity using data from two independent cohorts, while its plasma and intrathecal abundance were causally implicated in dementia risk and clinically relevant brain atrophy. Our findings illuminate the biological basis by which host immune responses to viruses may affect neurocognitive outcomes in older adults and identify IGDCC4 as an important molecular mediator of neurodegeneration.

Parental reflective functioning (PRF) refers to a parent's ability to understand their own and their child's mental states and connect them to behaviors. This longitudinal study evaluated (1) associations among prenatal PRF, using the Pregnancy Interview, demographics, prenatal maternal depressive symptoms, and maternal-fetal attachment and (2) whether prenatal PRF predicted parenting quality assessed during unstructured and challenging mother-child interaction tasks beyond infancy, after controlling for cumulative risk. Data were collected in an urban community sample of women in the midwestern US. Prenatal PRF was positively associated with maternal educational attainment and negatively associated with cumulative demographic risk, but not with depressive symptoms or maternal-fetal attachment. Controlling for cumulative risk, hierarchical regressions showed that prenatal PRF was the sole significant predictor of positive parenting at 36 months, observed during a challenging teaching task but not during free play. Prenatal PRF did not predict negative parenting. These patterns persisted when analyses were repeated within a subsample of Black mothers, with PRF again being the sole significant predictor of positive parenting. Further attention to cultural variations in PRF and parenting in future research is warranted.

Wildfires continue to increase in size, intensity, and duration. There is growing evidence that wildfire smoke adversely impacts clinical outcomes; however, few studies have assessed the impact of wildfires on household air quality and subclinical cardiovascular health indicators. We measured continuous indoor and outdoor fine particulate matter (PM_2.5) concentrations from July-October 2022 at 20 residences in the rural, mountainous state of Montana in the United States. We used a combination of satellite-derived smoke plume data from the National Oceanic and Atmospheric Administration's Hazard Mapping System and household-level daily mean PM_2.5 concentrations to classify wildfire-impacted days. One participant from each household self-reported in-home blood pressure (BP) on weekly electronic surveys. We used linear mixed-effects regression models to assess associations between air pollution exposures (PM_2.5 concentrations; number of wildfire-impacted days) and systolic BP (SBP) and diastolic BP (DBP). Models were adjusted for potential time-variant confounders including temperature, humidity, and self-reported exercise. Compared to survey periods with 0 wildfire days, SBP was 3.83 mmHg higher (95% Confidence Interval [95% CI]: 0.22, 7.44) and DBP was 2.36 mmHg higher (95% CI: -0.06, 4.78) during periods with 4+ wildfire days. Across the entire study period, a 10 µg m^-3 increase in indoor PM_2.5 was associated with 1.34 mmHg higher SBP (95%CI: 0.39, 2.29) and 0.71 mmHg higher DBP (95% CI: 0.07, 1.35). We observed that wildfire-impacted days and increasing household-level PM_2.5 concentrations are associated with higher in-home BP. Our results support growing literature which indicates that wildfires adversely impact subclinical cardiovascular health. Clinical and public health messaging should emphasize the cardiovascular health impacts of wildfire smoke and educate on exposure-reduction strategies such as indoor air filtration.

BACKGROUND:E-cigarettes may serve as a safer alternative to combustible cigarettes and may be more effective than currently available nicotine replacement therapy (NRT). Little is known about the perceptions of using e-cigarettes as part of a smoking treatment program. The objective of this study was to gain insight into patient-level factors to consider when developing smoking treatment programs that incorporate e-cigarettes. METHODS:Qualitative analysis of in-depth interviews with 14 participants enrolled in the e-cigarette treatment arm of a tobacco treatment intervention pilot randomized trial comparing the impact of behavioral counseling paired with e-cigarettes or NRT on smoking outcomes. Participants were prompted to share their experiences with the products and the study overall. Transcripts were coded according to the principles of framework analysis for applied research. Codes were organized into themes using the principles of grounded theory. RESULTS:Themes suggest that while there is an eagerness to try e-cigarettes as a new tool for smoking cessation, there is apprehension regarding what it means to "quit" if switching to e-cigarettes. Reflecting on the transitional purpose of e-cigarettes and potential health concerns associated with their use, many participants differentiated between the short-term goal to quit combustible cigarettes and the long-term goal to quit e-cigarettes. CONCLUSIONS:Including e-cigarettes as an option in smoking treatment regimens may be an opportunity to re-engage people who smoke who have tried and failed to quit with other forms of treatment. Participants found it challenging to establish what it means to quit cigarettes with e-cigarettes due to addiction and other health concerns. Clear guidelines are needed for integrating e-cigarettes into smoking cessation programs. TRIAL REGISTRATIONS/BACKGROUND:ClinicalTrials.gov Identifier: NCT04465318.

BACKGROUND:Hearing loss is highly prevalent among older adults and has been associated with an increased likelihood of falling. We aimed to examine the effect of a hearing intervention on falls over 3 years among older adults in a secondary analysis of the ACHIEVE study. METHODS:The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study was a 3-year, unmasked, randomised controlled trial of adults aged 70-84 years at enrolment with untreated hearing loss and without substantial cognitive impairment. Participants were recruited at four US community-based field sites from two study populations: (1) an ongoing observational study of cardiovascular health (Atherosclerosis Risk in Communities [ARIC] study), and (2) de novo from the community. Participants were randomly assigned (1:1) to a hearing intervention (audiological counselling and provision of hearing aids) or a health education control (didactic education and enrichment activities covering chronic disease prevention topics). A prespecified exploratory outcome was falls. Self-reported falls in the past 12 months were assessed at baseline and annually for 3 years, and analysed by intention to treat with covariate adjustment. The study was registered with ClinicalTrials.gov, NCT03243422, and is completed. FINDINGS/RESULTS:Between Nov 9, 2017, and Oct 25, 2019, 3004 individuals were screened for eligibility and 977 (238 [24%] from the ARIC study and 739 [76%] de novo) were randomly assigned, with 490 (50%) in the hearing intervention group and 487 (50%) in the health education control group. Overall mean age was 76·8 years (SD 4·0), 523 (54%) participants were female and 454 (46%) were male, and 112 (11%) were Black, 858 (88%) were White, and seven (1%) were other race. In adjusted analyses, the intervention group had a 27% reduction in the mean number of falls over 3 years compared with the control group (intervention group: 1·45 [95% CI 1·28 to 1·61]; control group: 1·98 [1·82 to 2·15]; mean difference: -0·54 [95% CI -0·77 to -0·31]). This 3-year effect of hearing intervention was consistent across both the ARIC and de novo study populations. INTERPRETATION/CONCLUSIONS:Hearing intervention versus a health education control was associated with a reduction in the mean number of falls over 3 years in older adults. Ongoing follow-up of ACHIEVE participants in a separate follow-up study (NCT05532657) will enable examination of the longer term effects of hearing intervention on falls. FUNDING/BACKGROUND:US National Institutes of Health.

OBJECTIVE:To compare anonymized and non-anonymized approaches for imputing race and ethnicity in descriptive studies of chronic disease burden using electronic health record (EHR)-based datasets. STUDY SETTING AND DESIGN/METHODS:In this New York City-based study, we first conducted simulation analyses under different missing data mechanisms to assess the performance of Bayesian Improved Surname Geocoding (BISG), single imputation using neighborhood majority information, random forest imputation, and multiple imputation with chained equations (MICE). Imputation performance was measured using sensitivity, precision, and overall accuracy; agreement with self-reported race and ethnicity was measured with Cohen's kappa (κ). We then applied these methods to impute race and ethnicity in two EHR-based data sources and compared chronic disease burden (95% CIs) by race and ethnicity across imputation approaches. DATA SOURCES AND ANALYTIC SAMPLE/UNASSIGNED:Our data sources included EHR data from NYU Langone Health and the INSIGHT Clinical Research Network from 3/6/2016 to 3/7/2020 extracted for a parent study on older adults in NYC with multiple chronic conditions. PRINCIPAL FINDINGS/RESULTS: = 0.33). When these methods were applied to the NYU and INSIGHT cohorts, however, racial and ethnic distributions and chronic disease burden were consistent across all imputation methods. Slight improvements in the precision of estimates were observed under all imputation approaches compared to a complete case analysis. CONCLUSIONS:BISG imputation may provide a more accurate racial and ethnic classification than single or multiple imputation using anonymized covariates, particularly if the missing data mechanism is MNAR. Descriptive studies of disease burden may not be sensitive to methods for imputing missing data.

BACKGROUND:While a growing body of scientific literature suggests that evidence-based interventions may improve health outcomes in diverse settings, little is known about the best strategies for large-scale implementation. In Africa, music-an important positive social determinant of health-leverages existing cultural values, which may effectively enhance the reach, uptake, and long-term sustainability of evidence-based interventions in the region. To understand how music interventions work, why they are effective, and with whom they resonate, this systematic review aims to evaluate the quality and empirical application of music as an implementation strategy for adopting evidence-based interventions in Africa using the RE-AIM framework as a guide. METHODS:A comprehensive librarian-assisted search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five major electronic databases, EBSCOhost, PubMed, Web of Science, Embase, and MEDLINE, were searched for empirical studies focused on using music as an implementation strategy to improve health outcomes in Africa. Two independent investigators extracted components of retrieved papers using the RE-AIM framework as a guide. RESULTS:From 981 citations, eight studies met the inclusion criteria, each reporting a unique music intervention. The interventions were conducted in West Africa (n = 3), South African regions (n = 4), and East Africa (n = 1) and included seven observational studies and one randomized controlled trial (RCT). Using the RE-AIM scoring criteria, we summarize the RE-AIM dimensions reported from selected studies - Adoption (72.5%) being the highest, followed by Reach (62.5%), Implementation (41.7%), and Efficacy/Effectiveness (20.0%). All eight studies (100%) described the intervention location, the expertise of delivery agents, the target population, and the participant characteristics. Moreover, our analysis highlighted the effectiveness of music interventions in enhancing health outcomes, particularly in improving knowledge and awareness (62.5%), facilitating behavioral change (50%), and promoting mental health (25%). CONCLUSION/CONCLUSIONS:Music interventions adapted to the sociocultural context in Africa have the potential to help prevent diseases, improve well-being, and enhance health outcomes. Our review emphasizes the importance of customizing music-based interventions to fit the cultural context, which can enhance the programs' effectiveness, acceptance, and sustainability. Clinical trials are necessary to confirm the efficacy of music interventions in specific medical conditions and from a public health promotion perspective.

BACKGROUND:Fetal growth is shaped by a complex interplay of parental traits, environmental exposures, nutritional intake, and genetic predispositions. In epidemiological research, birth weight is widely used as a proxy of impaired or favorable fetal growth; but it fails to provide a comprehensive measure, particularly if used alone. METHODS:In a cohort of 538 mother-fetal pairs from the New York University Children's Health and Environment Study (NYU CHES), we utilized multiple linear regression and structural equation modeling (SEM) to assess the influence of various determinants-maternal characteristics, chemical exposures, and dietary factors-on fetal growth. To comprehensively evaluate fetal growth, we employed the concept of latent variable Favorable Fetal Growth Conditions (FFGC), together with three observed outcomes: birth weight, birth length, and gestational age. RESULTS:Maternal characteristics such as height, BMI, race/ethnicity, and maternal alcohol intake were significantly associated with birth weight, birth length, and gestational age in both the linear regression and with FFGC in the SEM. However, SEM additionally revealed significant relationships that were not detected by linear regression. Specifically, di(2-ethylhexyl) phthalate (DEHP) latent factor showed a negative association with the FFGC (β=-0.16, 95% confidence interval (CI)=-0.27, -0.04). The diet latent variable positively impacted FFGC (β=0.15, 95% CI=0.04, 0.25), whereas total calorie intake exhibited a negative effect (β=-0.13, 95% CI=-0.22, -0.05). CONCLUSION/CONCLUSIONS:The SEM provided a thorough understanding of the multifaceted pathways through which multiple factors of chemical mixtures, diet intakes, and maternal characteristics affected fetal development, uncovering nuanced associations that were not apparent in direct effects models. Our findings highlight the intricate interplay of maternal characteristics, chemical exposures, and dietary factors in shaping fetal growth.