Publications

Risk of Cardiovascular Events During Delivery Hospitalization Among Pregnant Patients With Mental Health Conditions

Cardiovascular disease remains the leading cause of maternal mortality. Mental health disorders are risk factors for cardiovascular disease in nonpregnant populations, but their association with delivery outcomes is unknown

Journal of the American Heart Association

Feasibility and Impact of Local Retail Tobacco Policy in the United States: Views From Research and Practice.

Retail tobacco policymaking is increasing in the United States. Respondents were asked to give ratings on local policies. Licensing with fees received high ratings. This policy allows for self-funded enforcement of existing laws, and can be combined with other policies that address tobacco retail density, prices, and products.

Health Promotion Practice

Feasibility and Impact of Local Retail Tobacco Policy in the United States: Views From Research and Practice.

Retail tobacco policymaking is increasing in the United States. This is due, in part, to increased recognition that greater tobacco retail density is associated with higher commercial tobacco product use rates and contributes to health disparities. Tobacco control practitioners, researchers, and attorneys were asked their thoughts on the feasibility and impact of 10 retail tobacco policies at the local level in the US. Policies included, for example, capping the number of tobacco retail licenses in communities, setting minimum distance requirements between tobacco retail locations, and flavored tobacco product sales prohibitions. Respondents were asked to give ratings on six dimensions: overall effectiveness, legal feasibility, political feasibility, economic impact, equity impact, and ease of enforcement. Fifty-one professionals responded, and 40 of them had more than 5 years of experience in tobacco control work. Legal feasibility and equity impact were rated highest across policies, and political feasibility the lowest. Ending all tobacco sales received the lowest average ratings across dimensions of feasibility and impact. Establishing tobacco retail licensing programs with fees received the highest average ratings across dimensions of feasibility and impact. The high ratings for licensing with fees can help support localities considering implementing this foundational policy, which increases knowledge of the pervasiveness of tobacco retail locations, allows for self-funded enforcement of existing laws, and can be combined with other policies that address tobacco retail density, prices, and products. Researchers and practitioners alike can focus on identifying strategies to address the lack of local political will for certain tobacco retail policies.

Health promotion practice

Cooling down hotspots of retail tobacco products: addressing disparities in the built environment through policy.

Multiple disparities exist in the built environment for retail tobacco. Disproportionate concentrations of retail outlets result in variation in the availability of tobacco products, consumer access, and exposure to tobacco marketing. Neighborhoods with higher tobacco retail density have higher tobacco use than neighborhoods with lower density. Local policies focused on reducing tobacco retail concentration can address systematic disparities in the built environment. Using census-based synthetic populations for 30 US cities and retail tobacco location data, we simulated the disparity-reducing potential of three retail reduction policies: capping the number of available retail tobacco sales licenses, and minimum distance requirements between schools and retail locations and between retail locations themselves. Outcomes included retail concentration in density (stores/km2) and proximity for residents (km to nearest retail). We investigated differences across seven demographic and structural indicators in the tobacco retail environment including social, economic, and political dimensions. All the measures for retail concentration and demographic and structural context have considerable variation within and between cities. All three policies addressed disproportionate concentrations to varying degrees. The minimum distance requirements - 600m buffers around schools or retail locations - narrowed differences in the built environment for tobacco more so than halving the number of existing retail outlets through licensing caps. Policy effectiveness is context dependent. Buffer policies, for example, can be effective if retail locations are disproportionately concentrated near schools, near one another, or in low-income or racially/ethnically minoritized neighborhoods. Policy development should be informed not only by generalizable evidence but also by local data and familiarity with communities.

Health & place

The Health Consequences of Nonhealth Policies in a Time of Policy Disruption.

JAMA health forum

Physical Activity and Climate Change: A Content Analysis of National Adaptation Plans for Climate Adaptation for Low- and Middle-Income Countries.

Climate change and physical inactivity are significant health challenges. While physical activity's role in climate change mitigation is recognized, its contribution to climate change adaptation remains underexplored. This study aimed to identify physical activity in National Adaptation Plans (NAPs) for low- and middle-income countries and common sectors benefiting climate change adaptation and promoting physical activity.

Journal of physical activity & health

Results of an Outpatient Antibiotic Stewardship Survey in Missouri.

To understand the perceptions, knowledge, and opportunities to improve antibiotic prescribing practices among outpatient providers.

Missouri medicine

The relationships between cerebrospinal fluid neurofilament light chain and hippocampal atrophy with cognitive decline.

BackgroundIdentifying predictive biomarkers of cognitive decline is critical for timely intervention in early Alzheimer's disease and related dementia. Biomarkers such as cerebrospinal fluid (CSF) neurofilament light (NfL), and MRI-based hippocampal atrophy are potential indicators of neurodegeneration, but their long-term predictive value remains unclear.ObjectiveThis study examined 20-year longitudinal associations between CSF NfL, MRI-based hippocampal atrophy, and cognitive decline in cognitively normal older adults.MethodsA cohort of 279 cognitively normal adults aged ≥55 years was followed from 2003 to 2023 at the Knight ADRC. Participants underwent annual cognitive and neurological assessments, including Clinical Dementia Rating (CDR), CSF NfL quantification, and MRI-based hippocampal volumetry. Cognitive decline was defined as: (1) first progression (CDR ≥ 0.5) and (2) sustained progression (two consecutive CDRs ≥ 0.5). Analyses included Kaplan-Meier survival, Cox proportional hazards models, and linear mixed-effects (LME) models.ResultsParticipants had a mean age of 66.5 years (SD = 6.08); 58.4% were female. Mean follow-up was 11.41 years (SD = 3.5). First progression occurred in 71 participants (25.4%), and sustained progression in 35 (13%). Higher CSF NfL levels were associated with faster time to first (95% CI:0.2-1; p < 0.001) and sustained progression (95% CI:0.46-1; p = 0.008). Cox models showed increased risk of first progression (HR = 1.83; 95% CI: 1.11-3.01; p = 0.018) but not sustained (p = 0.093). LME models showed CSF NfL increase and hippocampal volume decline (p < 0.001) in both outcomes.ConclusionsCSF NfL is a strong predictor of cognitive decline and may serve as a screening biomarker for early dementia risk.

Journal of Alzheimer's disease : JAD

Feasibility and Efficacy of Decision Aids to Improve Decision-Making for Contralateral Prophylactic Mastectomy: A Systematic Review.

Rates of contralateral prophylactic mastectomy (CPM) for unilateral breast cancer have increased significantly. Decision aids (DAs) can support the shared decision-making process. This study systematically reviewed the literature to understand the feasibility and efficacy of using DAs to improve decision outcomes about CPM.

Annals of surgical oncology