Faculty Bibliography

Background: Pregnancy is a crucial period to improve cardiovascular health (CVH) for mothers and their families. The current study emphasizes framework-guided factors that influence the adaptation of an evidence-based intervention (Parents as Teachers and Healthy Eating Active Living Taught at Home [PAT + HEALTH]) to support healthy gestational weight gain and postpartum weight management among pregnant women with obesity and their infants in Nigeria. Methods: From May to June 2023, 43 in-depth interviews were conducted with 11 parents, 15 community health extension workers (CHEWs)/health educators, and 17 policymakers/ healthcare supervisors in the Federal Capital Territory, Nigeria. Additionally, nine focus groups were conducted with 75 participants. Interviews were recorded, de-identified, and transcribed. The updated Consolidated Framework for Implementation Research (CFIR 2.0) informed the development of the interview guides and the thematic analysis. Transcripts were double-coded using Dedoose. Results: We identified assessing context, tailoring strategies, local attitudes, and sustainability as constructs to consider when adapting and implementing the PAT + HEALTH intervention successfully within the Nigerian primary care context. For example, policymakers and healthcare supervisors emphasized the feasibility of the intervention, including raising community awareness, planning for hard-to-reach areas, and ensuring supportive supervision of CHEWs delivering the intervention. Additional factors included customizing educational content and delivery methods to fit the cultural, socioeconomic, and environmental contexts of Nigerian families. CHEWs highlighted the importance of public education on locally available foods for better nutrition. Potential barriers to the PAT + HEALTH intervention included local attitudes influenced by sociocultural factors, such as food taboos, and structural factors, including limited financial support for the long-term sustainability of some components of the home visiting program. Conclusions: Building on these formative activities, the ENHANCE CVH trial will advance dissemination and implementation science by adapting, testing, and evaluating the effectiveness and implementation of the PAT + HEALTH intervention among pregnant women with obesity and their infants in Nigeria in a cluster randomized trial. Trial registration: ClinicalTrials.gov/NCT06773299, Registration Date: January 14, 2025.

BACKGROUND/UNASSIGNED:Weight bias is pervasive, occurs in a variety of contexts, and is associated with a range of suboptimal outcomes, including delays or avoidance in seeking health care, misdiagnosis, and denial of services. The aim of this study was to quantitatively describe the relationship between experiences of weight bias and eating behaviors of patients in a lifestyle medicine program and qualitatively describe healthcare providers' insights about weight bias. METHODS/UNASSIGNED:This study utilized an explanatory sequential design that drew on one-time survey data collected from 109 patients of a Plant-Based Lifestyle Medicine (PBLM) Program in New York City in 2019. Ordinary Least Squares and logistic regression models examined the association between weight bias and healthful plant-based eating and emotional eating after adjusting for sociodemographic characteristics. Qualitative data come from asynchronous interviews with five healthcare providers from the PBLM program completed in 2024 which were analyzed using rapid coding. RESULTS/UNASSIGNED:Survey participants were on average 53 years old, 67.0% female, 68.6% Black, Indigenous, and other people of color (BIPOC), and 56.2% reported experiencing weight bias. Weight bias was associated with 4.07 fewer points on the healthful plant-based eating measure (95%CI: 6.86, -1.27), and participants had 5.06 times the odds (95%CI: 1.76, 14.59) of emotional eating compared to those not reporting weight bias. Interview themes were: (1) Weight bias negatively influences patient lives, (2) Weight bias is negatively associated with patients' mental health, (3) Promising weight-inclusive approaches, and (4) Recommendations for providers to address weight bias. CONCLUSION/UNASSIGNED:Experiences of weight bias were associated with suboptimal eating behaviors and poor mental health. Providers observed their patients experience harm in connection with weight bias, suggested weight-inclusive approaches, and identified recommendations that would mitigate weight bias in healthcare environments including routinely screening for weight bias, training providers on weight inclusive care, incorporating mental health services into care teams, and creating size inclusive spaces. This study demonstrates that weight bias is linked to deleterious outcomes and the importance of weight-inclusive care delivery and environments.

BACKGROUND/UNASSIGNED:Weight bias is pervasive, occurs in a variety of contexts, and is associated with a range of suboptimal outcomes, including delays or avoidance in seeking health care, misdiagnosis, and denial of services. The aim of this study was to quantitatively describe the relationship between experiences of weight bias and eating behaviors of patients in a lifestyle medicine program and qualitatively describe healthcare providers' insights about weight bias. METHODS/UNASSIGNED:This study utilized an explanatory sequential design that drew on one-time survey data collected from 109 patients of a Plant-Based Lifestyle Medicine (PBLM) Program in New York City in 2019. Ordinary Least Squares and logistic regression models examined the association between weight bias and healthful plant-based eating and emotional eating after adjusting for sociodemographic characteristics. Qualitative data come from asynchronous interviews with five healthcare providers from the PBLM program completed in 2024 which were analyzed using rapid coding. RESULTS/UNASSIGNED:Survey participants were on average 53 years old, 67.0% female, 68.6% Black, Indigenous, and other people of color (BIPOC), and 56.2% reported experiencing weight bias. Weight bias was associated with 4.07 fewer points on the healthful plant-based eating measure (95%CI: 6.86, -1.27), and participants had 5.06 times the odds (95%CI: 1.76, 14.59) of emotional eating compared to those not reporting weight bias. Interview themes were: (1) Weight bias negatively influences patient lives, (2) Weight bias is negatively associated with patients' mental health, (3) Promising weight-inclusive approaches, and (4) Recommendations for providers to address weight bias. CONCLUSION/UNASSIGNED:Experiences of weight bias were associated with suboptimal eating behaviors and poor mental health. Providers observed their patients experience harm in connection with weight bias, suggested weight-inclusive approaches, and identified recommendations that would mitigate weight bias in healthcare environments including routinely screening for weight bias, training providers on weight inclusive care, incorporating mental health services into care teams, and creating size inclusive spaces. This study demonstrates that weight bias is linked to deleterious outcomes and the importance of weight-inclusive care delivery and environments.

BACKGROUND/UNASSIGNED:Effective management of alcohol withdrawal syndrome during hospitalization is paramount to patient safety and quality care. NYC Health + Hospitals initiated a quality improvement project to pilot an electronic health record (EHR) integrated, nurse-driven CIWA-Ar symptom-triggered protocol, including recommendations for medications for alcohol use disorder (MAUD), in medical and surgical units at 3 public hospitals. OBJECTIVE/UNASSIGNED:To describe implementation processes and to report related implementation outcomes (appropriateness, feasibility, and adoption) of the updated CIWA-Ar protocol in a safety net hospital setting. METHODS/UNASSIGNED:NYC Health + Hospitals implemented a standardized CIWA-Ar symptom-triggered, nurse-driven EHR protocol on March 15, 2022. The protocol included order sets, practice advisories, task lists, and reminders for assessments and orders. We measured nursing perspectives on feasibility and appropriateness at 6 months via a survey. We measured provider adoption as the proportion of admissions with a CIWA-Ar protocol ordered among admissions that triggered a recommendation, and MAUD use as the proportion of admissions with a MAUD order during hospitalization among all patients with a protocol ordered. RESULTS/UNASSIGNED:= .249). CONCLUSIONS/UNASSIGNED:The CIWA-Ar protocol was appropriate, feasible, and adopted at NYC public hospitals. Quality improvements to ensure protocol fidelity with benzodiazepine dosing and MAUD prescribing are needed.

BACKGROUND AND OBJECTIVES/OBJECTIVE:The link between repetitive head impact (RHI) exposure, later-life cognitive decline, and neurobehavioral dysregulation (NBD) is not well understood. Recent work has implicated inflammation and limbic dysfunction as relevant RHI correlates. Our goal was to integrate plasma and CSF inflammatory biomarkers, structural brain imaging, and clinical measures in former elite American football players to better understand reasons for RHI-related cognitive and neurobehavioral changes. METHODS: RESULTS: DISCUSSION/CONCLUSIONS:In former elite football players, elevated plasma and CSF inflammatory markers were associated with poorer limbic WM microstructure, which in turn related to worse cognition. Given the limbic system's role in cognition and behavior, inflammation may be a modifiable target for RHI-related neurodegeneration. Limitations include the cross-sectional design and limited generalizability to other contact sports, lower levels of play, female athletes, or other RHI sources.

BACKGROUND AND AIMS/OBJECTIVE:Nitazenes are a novel subclass of synthetic opioids that have been increasingly implicated in the United States (US) overdose crisis. Despite their growing presence in the illicit drug supply, national trends have not been systematically evaluated. This study aimed to describe temporal and geographic patterns in nitazene detections and assess substances co-involved in nitazene-positive biospecimens. DESIGN/METHODS:Cross-sectional study using forensic data from two national sources: the US Drug Enforcement Administration's National Forensic Laboratory Information System (NFLIS) and the Center for Forensic Science Research & Education's (CFSRE) NPS Discovery Program. SETTING AND CASES/METHODS:Nitazene detections in all 50 US states and the District of Columbia between 2019 and 2024. MEASUREMENTS/METHODS:We quantified annual nitazene detections overall and by individual nitazene analog, US Census region and state. Temporal trends were modeled using piecewise linear regression with a Poisson distribution and log link, nationally and by region. NPS Discovery data were used to characterize substances co-involved with nitazene-positive biospecimens. FINDINGS/RESULTS:Between 2019 and 2024, 7117 nitazene analog reports were submitted to NFLIS, increasing from 43 in 2019 to 1905 in 2024. Counts rose sharply from 2019 to 2021 [count ratio = 7.32; 95% confidence interval (CI) = 2.22-24.20] but did not increase statistically significantly from 2021 to 2024 (count ratio = 1.08; 95% CI = 1.00-1.17). Early detections were predominated by isotonitazene (97.7% of NFLIS nitazene reports in 2019) but later shifted toward metonitazene and protonitazene (29.5% and 30.1%, respectively, in 2024). NPS Discovery identified 361 nitazene-positive biospecimens, increasing from 11 in 2019 to 113 in 2024, with counts increasing by approximately 45% per year (count ratio = 1.45; 95% CI = 1.23-1.71). Nearly all nitazene-positive biospecimens (98.3%) had at least one co-detected substance, most commonly fentanyl (54.6%). CONCLUSIONS:Nitazene detections increased sharply across the United States between 2019 and 2024, with shifting patterns in the prevalence of individual nitazenes and extensive polysubstance involvement. These findings highlight the need to strengthen drug testing capacity, expand epidemiological surveillance and implement targeted public health interventions to mitigate harms associated with this emerging class of synthetic opioids.

Characterizing the relationship between DNA methylation and circulating proteins is critical to understanding the epigenetic regulation of the human plasma proteome. Here, we performed an epigenome-wide association study (EWAS) of 5,032 circulating proteins in 1,449 White and 315 Black participants from the Atherosclerosis Risk in Communities (ARIC) cohort. We identified 12,500 significant protein quantitative trait methylation (pQTM)-protein associations involving 1,647 proteins. Among 7,796 unique pQTMs, 14.7% were classified as cis-pQTMs, which were enriched for fundamental cellular processes, whereas trans-pQTMs were predominantly linked to immune-related functions. Trans-pQTMs also exhibited stronger associations with demographic, lifestyle, and clinical traits compared with cis-pQTMs. We identified proteins such as GM2A and EPHB6 whose expression appears to be strongly associated with DNA methylation, suggesting potential as targets for epigenetic-based therapeutic interventions. Together, these findings demonstrate the extensive impact of DNA methylation on the circulating proteome through cis- and trans-regulatory mechanisms and underscore the influence of population-level traits on epigenetic regulation. These findings highlight a broad impact of DNA methylation on circulating proteins through both cis- and trans-regulatory mechanisms and the roles of population-level phenotypes.

Evidence is inconsistent regarding which windows of PM_2.5 exposure are critical for adverse perinatal outcomes. We investigated associations between timing of gestational PM_2.5 exposure and perinatal outcomes. Participants included 19,108 mother-infant dyads from 51 sites of the Environmental influences on Child Health Outcomes (ECHO) cohort. Repeated measures of PM_2.5 exposure were included based on high-resolution spatiotemporal models for trimesters 1-3, early first trimester (≤14 days), and late first trimester (70-92 days). We estimated associations of PM_2.5 exposure (per 5 μg/m³ increase) and continuous outcomes (gestational age at birth [GA] and birthweight for gestational age z-scores [BWZs]) using generalized estimating equation (GEE) models for linear regression. Poisson regression via GEE was used to estimate risk ratios (RRs) of PM_2.5 exposure (per 5 μg/m³ increase) with binary outcomes (preterm birth [PTB], <37 completed weeks of gestation), and term small for gestational age [SGA], <10th percentile). We explored effect modification by participants' characteristics. In fully adjusted models, early 1st trimester PM_2.5 exposure was associated with lower BWZ (β = -0.03, 95 % CI -0.06, -0.001); association with term SGA was RR = 1.06, 95 % CI 0.99, 1.13. Results were mostly null for other windows of gestational exposure. When stratified by sex, early pregnancy PM_2.5 exposure and lower BWZ associations were observed among females, but not males. Suggestive evidence indicates that associations of PM_2.5 exposure with GA, PTB risk, and term SGA risk may vary by maternal race and ethnicity. Our results suggest that policies and practices that reduce the risks of PM_2.5 exposure, particularly in pre-conception and early pregnancy, may improve perinatal outcomes.