Faculty Bibliography

BACKGROUND:Positive psychology well-being constructs like flourishing are important predictors of health and quality of life. However, few studies have examined the association between flourishing and psychological distress (i.e., depression and anxiety). We investigated the association between flourishing and psychological distress symptoms among higher education students. METHODS:We analyzed cross-sectional survey data from 60,386 students aged 18-34 in the United States (Healthy Minds Study 2022-2023). Flourishing was measured using the Flourishing Scale, while symptoms of depression and anxiety were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scales, respectively. Associations between flourishing and psychological distress were examined using multiple logistic regression models, adjusting for age, gender identity, race/ethnicity, financial stress, and self-reported mental health treatment. RESULTS:Of the 60,386 participants included the mean age was 21.7 (SD = 3.6). Most participants were female (68.3 %) and White (55.6 %). Among individuals with significant symptoms of depression or anxiety, 13.7 % and 17.7 % were classified as flourishing (Flourishing Scale ≥48), respectively. Participants with significant symptoms of depression (OR: 0.23; CI: 0.22-0.25) or anxiety (OR: 0.56; CI: 0.54-0.59) were less likely to be classified as flourishing than those without significant symptoms. CONCLUSION/CONCLUSIONS:Flourishing is possible within psychological distress. These results suggest the importance of assessing both positive psychological well-being and psychological distress to understand student mental health. While reducing symptoms of psychological distress is crucial, enhancing positive psychological well-being should also be prioritized as part of mental health treatment.

Obesity has been associated with non-Hodgkin lymphoma (NHL), but the evidence is inconclusive. We examined the association between genetically determined adiposity and four common NHL subtypes: diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, chronic lymphocytic leukemia, and marginal zone lymphoma, using eight genome-wide association studies of European ancestry (N = 10,629 cases, 9505 controls) and constructing polygenic scores for body mass index (BMI), waist-to-hip ratio (WHR), and waist-to-hip ratio adjusted for BMI (WHRadjBMI). Higher genetically determined BMI was associated with an increased risk of DLBCL [odds ratio (OR) per standard deviation (SD) = 1.18, 95% confidence interval (95% CI): 1.05-1.33, p = .005]. This finding was consistent with Mendelian randomization analyses, which demonstrated a similar increased risk of DLBCL with higher genetically determined BMI (OR_{per SD} = 1.12, 95% CI: 1.02-1.23, p = .03). No significant associations were observed with other NHL subtypes. Our study demonstrates a positive link between a genetically determined BMI and an increased risk of DLBCL, providing additional support for increased adiposity as a risk factor for DLBCL.

IMPORTANCE/UNASSIGNED:Chronic exposure to arsenic in drinking water has been associated with increased chronic disease mortality. However, there is limited evidence on associations between reduced exposure and mortality risk. OBJECTIVE/UNASSIGNED:To examine whether reductions in arsenic exposure, measured using urinary arsenic levels, are associated with lower mortality from chronic diseases, including cancer and cardiovascular disease (CVD). DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:A prospective cohort of 11 746 adults was enrolled between 2000 and 2002 in Araihazar, Bangladesh, with levels of well-water arsenic ranging from less than 1 µg/L to 864 µg/L (mean, 102 µg/L), exceeding the Bangladesh standard of 50 µg/L. Arsenic levels declined over time as a result of community mitigation. Mortality was tracked through 2022. Analyses included 10 977 participants with calculable changes in urinary arsenic levels. EXPOSURES/UNASSIGNED:Urinary arsenic levels were measured up to 5 times per participant through 2018. Participants were categorized based on changes in urinary arsenic levels. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Adjusted hazard ratios (aHRs) and 95% CIs for mortality from chronic diseases, including cancer and CVD. RESULTS/UNASSIGNED:Among 10 977 participants (57% female; mean age, 37.0 [SD, 10.1] years), mean urinary arsenic levels declined from 283 (SD, 314) to 132 (SD, 161) µg/g creatinine from 2000 to 2018. Each IQR decrease in urinary arsenic (197 µg/g creatinine) was associated with 22% lower chronic disease mortality (aHR, 0.78 [95% CI, 0.75-0.82]), 20% lower cancer mortality (aHR, 0.80 [95% CI, 0.73-0.87]), and 23% lower CVD mortality (aHR, 0.77 [95% CI, 0.73-0.81]). Time-varying Cox and restricted cubic spline analyses showed larger reductions were associated with lower mortality, while increases were linked to higher risk. Compared with participants with consistently high urinary arsenic levels (above the baseline median of 199 µg/g creatinine [n = 1757]), those whose levels declined below the median (n = 3757) had lower mortality from chronic diseases (aHR, 0.46 [95% CI, 0.39-0.53]), including cancer (aHR, 0.51 [95% CI, 0.35-0.73]) and CVD (aHR, 0.43 [95% CI, 0.34-0.53]), similar to those consistently below the median (n = 4959) (aHR, 0.43-0.49). Findings were similar in propensity score-matched analyses. CONCLUSIONS AND RELEVANCE/UNASSIGNED:These findings support an association between reduced arsenic exposure and improved health outcomes in populations exposed to contaminated drinking water.

AIMS/HYPOTHESIS/OBJECTIVE:plus FPG. METHODS:, individually and in combination, for diagnosing diabetes. Random-effects meta-analyses were applied to pooled data to summarise the overall diagnostic accuracy across studies. RESULTS:, with pooled AUCs (95% CI) of 0.97 (0.96, 0.98) vs 0.85 (0.82, 0.88). CONCLUSIONS/INTERPRETATION/CONCLUSIONS:for diagnosing type 2 diabetes.

Cisgender women are underserved by current HIV prevention efforts, and substantial gender disparities persist in pre-exposure prophylaxis (PrEP) use. Recent diagnoses with a bacterial sexually transmitted infection (STI) are objective, readily available indicators of PrEP-eligibility that could be used to improve PrEP prescribing for cisgender women. To better understand missed opportunities for prescribing, we examined the prevalence and correlates of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) diagnoses among cisgender women seeking care at a New York City obstetrics and gynecology (Ob/Gyn) clinic, along with the number of PrEP prescriptions provided post-STI diagnosis. A cross-sectional, retrospective review of electronic health record data was conducted for all HIV-negative cisgender women tested for CT and/or NG at the clinic between September 1, 2021 and September 19, 2022. Counts and prevalence for CT and NG infection were calculated, and multivariable log-binomial regression was used to examine associated factors. Among 7593 cisgender women receiving CT/NG testing during the study period, 186 had ≥ 1 CT infection (prevalence: 2.45%) and 18 had ≥ 1 NG infection (prevalence: 0.24%). In a multivariable model, CT/NG infection was significantly associated with age, having Spanish as a primary language, and a marital status of divorced, widowed, or separated. No cisgender women who received CT or NG diagnoses were prescribed PrEP during the study period. These findings highlight how opportunities to prescribe PrEP to cisgender women continue to be missed, even with readily available indicators for PrEP eligibility. More effective strategies are needed to promote PrEP prescribing among diverse populations of cisgender women, particularly in Ob/Gyn settings.

Previous studies have developed proteomic aging clocks to estimate biological age and predict mortality and age-related diseases. However, these earlier clocks were based on cross-sectional data, capturing only the cumulative aging burden at a single time point but were unable to reflect the dynamic trajectory of biological aging over time. We constructed a longitudinal proteomic aging index (LPAI) using data from 4684 plasma proteins measured by the SomaScan 5K Array across three visits in the Atherosclerosis Risk in Communities (ARIC) study (ages 67-90 at last visit). Our two-step approach applied functional principal component analysis (FPCA) to capture protein-level change patterns over time, followed by elastic net penalized Cox regression for protein selection. LPAI was constructed in a randomly selected training set of ARIC participants (N = 2954), tested among the remaining ARIC participants (N = 1267), and validated externally in Multi-Ethnic Study of Atherosclerosis (MESA) participants (N = 3726, ages 53-94 at last exam). Using Cox proportional hazards model, higher LPAI was associated with increased all-cause mortality (HR = 2.50, 95% CI: [2.15, 2.92] per SD), CVD mortality (HR = 1.79, 95% CI: [1.34, 2.39] per SD), and cancer mortality (HR = 1.96, 95% CI: [1.45, 2.64] per SD) risk in ARIC, with statistically significant and directionally consistent associations also observed in MESA. Additionally, higher LPAI was associated with increased multimorbidity and frailty. This study demonstrates the feasibility of developing biological aging measures from longitudinal proteomics data and supports LPAI as a biomarker for aging-related health risks.

Fatty acids are involved in disease risk and aging processes. In the US National Health and Nutrition Examination Survey (1999-2002), we tested for associations of total, saturated (SFA), monounsaturated (MUFA), polyunsaturated (PUFA), and subtypes of dietary fatty acids with DNA methylation-based aging biomarkers, adjusting for age, BMI, total energy intake, and sociodemographic and behavioral factors (N = 2260). Higher SFA and MUFA were associated with greater GrimAge2, an aging biomarker of mortality; PUFA was associated with lower Horvath1, Hannum, and PhenoAge (p < 0.05). Omega-3 and the PUFA:SFA ratio were negatively associated with Horvath1, Hannum, Vidal-Bralo, and PhenoAge. Notably, a one-unit increase in PUFA:SFA was associated with 1.05 years lower PhenoAge (95% CI = -1.87, -0.22). We found consistent positive associations for SFA subtypes and negative associations for PUFA subtypes with epigenetic aging; associations of MUFA subtypes varied. Future studies, including randomized controlled trials, are needed to investigate causality and downstream clinical outcomes.

PURPOSE/OBJECTIVE:The National Academy of Science Engineering and Medicine (NASEM) developed items to collect sexual orientation and gender identity (SOGI) in healthcare settings to harmonize collection of these data and address disparities often experienced by sexual and gender minorities (SGM) (LGBTQAI+). This study tested wording of SOGI items among the SGM Community. METHODS:Individuals were recruited to participate in an interview about the NASEM SOGI items. Eligible participants identified as SGM, lived within the catchment area of an NYC academic medical center, had a history of cancer, or were caregivers of a person with cancer. Interviews were audio-recorded, transcribed, and qualitatively coded. RESULTS:Thirty-eight SGM individuals participated. The majority disliked the options for sexual orientation (SO) and gender identity (GI) but did find one they would choose. For SO, participants thought options like queer, pansexual, and asexual were missing, and for GI, participants said non-binary and transgender category (transgender man, transgender woman) were needed. Half said they had no concerns about disclosing SOGI information on medical intake forms and others reported preferring knowing why it was needed and who would have access. Several expressed worry about their safety upon disclosure of SOGI. Respondents cited being less likely to disclose SOGI if there was an offensive question on intake form (e.g., spouse instead of partner) or if there were no privacy assurances. Almost all expected reported SOGI to be reflected in their oncology healthcare. CONCLUSIONS:The NASEM questions need improvement. To improve trust and encourage disclosure, clinicians and clinics should improve the options for SOGI data collection and take steps to ensure privacy is addressed.