2025 Chicagoland K Day

The interface between exposures in the environment and the human body is dynamic across life stages and time. Likewise, disease pathology can develop over decades of human life. Developmental origins of health and disease (DOHaD), previously termed the Barker Hypothesis, is studied across scientific disciplines to reveal preventative measures to reduce disease incidence in later life. Exposures to neurotoxicants occur across the life course and some chemicals are stored in the body for long periods of time, like elements in teeth, or like persistent organic pollutants (POPs) such as pesticides (e.g., DDT) or industrial chemicals (e.g., PCBs) in adipose tissue. Given the lack of preventative measures or effective treatments, there is a critical need for uncovering environmental influences of Alzheimer’s Disease at early stages of development. Measurement of these stored chemicals in the body can unlock decades of past exposure before signs of ADRD occur. Critically, environmental chemical body burdens are higher in racial ethnic minorities in the United States and also have higher risks of ADRD. More research is needed to understand relationships between neurotoxic environmental chemicals and neurological disease across the life course.

Black women with gestational diabetes mellitus (GDM) face a 2.4x higher risk of future cardiometabolic diseases compared to non-Hispanic White women, partly due to poorer dietary quality. Diet quality influences GDM risk by impacting gut microbiota composition and diversity, which affect bile acid metabolism, glucose homeostasis, and insulin sensitivity. Diet is a major modifiable risk factor for GDM that can be improved through lifestyle behavior change. However, behavioral lifestyle interventions designed to improve dietary quality, optimize glycemic control, and prevent GDM among pregnant Black women are scant and lack an exploration of diet-microbiota-host interactions in the context of maternal glycemic control. This project aims to refine and pilot test DASH for Us, a 12-week antenatal behavioral intervention using the DASH (Dietary Approaches to Stop Hypertension) diet to prevent GDM in Black women. This intervention is being co-develop with and for Black pregnant women using mixed-methodologies comprised of Intervention Mapping techniques and community-based research methods. Additionally, this study will explore intervention effects on clinical metabolic markers and diet-microbiota host interactions. Results from this novel and innovative study will provide a foundation for decreasing Black maternal health disparities for GDM through a culturally safe approach that targets diet-gut relationships.

Metastatic prostate cancer has a poor prognosis, with a 31% five-year relative survival. Amongst men with metastatic prostate cancer, improved overall survival from androgen deprivation therapy intensification with abiraterone acetate and apalutamide was established in three landmark randomized clinical trials: LATITUDE, TITAN, and SPARTAN. Despite the promising average treatment effects reported in these trials on overall survival, it is difficult to translate their results to individual-level clinical decision making due to the existence of heterogeneous treatment effects within the trial populations. Recent methodological advances in pharmacoepidemiology and statistics have detailed how to deliver predicted individualized treatment effects from randomized trials using counterfactual prediction models.  Methods: Data from the LATITUDE, TITAN, and SPARTAN trials will be used to characterize individual variability in the effectiveness of ADT intensification regimens. Predicated individualized treatment effects of ADT intensification will be estimated using the causal forest supervised machine learning algorithm. The predictive capabilities of the models will be internally validated using counterfactual decision curve analysis. Using the model output, we will develop a web-based application that allows one to generate predicted individualized treatment effects for these pivotal trials given a suite of patient characteristics.

This project sought to examine changes in healthcare encounters and identify risk factors associated with substance use among the pediatric population before, during, and after the COVID-19 pandemic.  Over 20 million healthcare encounters were examined among the pediatric population from 2017 through 2023.  We found that during the COVID-19 era, the proportion of encounters associated with substance use increased. Healthcare encounters attributed to substance use were more common in older youth, males, and those who were American Indian or Alaska Native. Additional disparities were associated with certain substances, indicating the need for tailored public health and clinical interventions. Although overall healthcare encounters dropped during the pandemic, the proportion of visits attributed to substance use increased significantly during that time. Of note, encounters attributed to marijuana use have remained elevated among youth. Unique risk factors may exist for healthcare encounters based on substance, warranting the need for additional research on these disparities.

Pediatric asthma health disparities are common. Schools often lack asthma diagnostic information and infrastructure to handle asthma symptoms.  Stock inhalers, undesignated rescue inhalers available to anyone in respiratory distress, are a solution.   Methods:   A stock inhaler programming pilot was conceptualized utilizing the Exploration, Preparation, Implementation and Sustainment framework, and then evaluated using the Reach Effectiveness Adoption, Implementation and Sustainment framework. Districts from high-asthma-burden counties were engaged through the statewide stock albuterol coalition and agreed to participate with a Letter of Support. Guided implementation was offered. Districts were required to complete training and report stock inhaler incidents. Pre/post implementation interviews and surveys were performed to assess acceptability, feasibility, fidelity to emergency protocols, satisfaction, and utilization. Descriptive statistics were calculated for surveys and utilization data. Abductive thematic data analysis was performed on interview transcripts.     Results:   Fourteen pilot schools from six districts enrolled 10,265 children, of which 23% identified as Black, 20% Hispanic/Latinx, 42% low-income, and 18% with a 504 or IEP. Twenty-eight stock inhaler events were documented, with 15 from the largest participating district. The majority of children (75%) using the stock inhaler had known asthma. Of the 24 events for which disposition was reported, 12 students returned to class (50%), 10 left school with a parent (42%), and only two were transported by emergency services  (8%). Pre- implementation interviews revealed that school nurses were concerned about family asthma education (76%) and staff training (29%), while 83% of district administrators discussed barriers to obtaining stock inhalers. Post implementation themes included “Stock Inhaler Program Experiences,” “Stock Inhaler Sustainability Barriers,” and “Stock Inhaler Sustainability Facilitators.” One interviewee described the program as ”  a sturdy safety net…  if you can’t breathe, nothing else matters.” All schools intended to continue stocking inhalers next year.   Conclusion:   Stock inhaler programming was well received and improved student outcomes. RESCUE-IL secured state funding in Illinois to expand stock inhaler programming to 80% of Illinois public schools. Multi-level programming implementation facilitated by community-engaged implementation science methodologies has the capacity to successfully transform health policy to impact.

Primary care-based interventions promoting responsive parenting have demonstrated potential for reducing inequities in early child development (ECD), yet research on the cultural adaptation of such interventions for Latine families is limited. Drawing on the Trial of Improved Practices (TIPs) methodology, we conducted formative research to enhance the acceptability and cultural appropriateness of an existing intervention, Sit Down & Play (SDP), for the Latine population. Parents (n=22) of children 2-24 months receiving well-child care at a Latine-serving FQHC in Chicago were involved in two study interactions. During the well-child visit, they received an age-appropriate SDP module with counseling about play-based learning, a simple toy, and a handout with recommended games. Follow-up phone interviews explored participants’ experiences implementing the recommendations and their opinions of SDP. Participants expressed overwhelmingly positive reactions to SDP but also identified several barriers to parent-child interactions, including time constraints, competing priorities, and perceptions of play as silly or inappropriate. Findings informed several intervention changes, such as emphasizing the value of play for just 5-10 minutes per day and replacing SDP handouts with a more accessible website. These results underscore the value of building on users’ experiences to tailor interventions to Latine’s families lived realities.

This career development proposal focuses on creating AIDx, an equitable, scalable Clinical Decision Support System (CDSS) to optimize vancomycin dosing in ICU patients. Through an observational study at three Chicago institutions, I will assess vancomycin target attainment across diverse groups, train advanced deep learning models, and validate AIDx recommendations against historical decisions. This KL2 award will support skill development in AI, clinical trials, and implementation science, enabling the successful design and translation of AIDx while fostering my growth as an independent translational informatics researcher.

Adolescents with a chronic medical condition (A-CMC) are more likely to misuse and initiate alcohol and other drugs (AOD) at younger ages compared to adolescents without CMCs. A-CMCs account for the majority of pediatric inpatient hospitalizations as A-CMCs are often admitted for an acute inpatient stay following an emergency department visit for an exacerbation of their disease. However, A-CMCs are not routinely screened for alcohol use in pediatric inpatient settings. Thus, the pediatric inpatient setting provides clinicians a critical, but missed, opportunity to universally screen for alcohol use among A-CMCs once medical concerns are stabilized. The current study addresses this gap in the care cascade by examining the workflow processes in an urban pediatric hospital’s inpatient units, adapting Screening, Brief Intervention, and Referral to Treatment (SBIRT) to the population and setting, and identifying SBIRT implementation strategies to pilot in a single arm hybrid type III effectiveness-implementation trial. This research is attained via three Specific Aims. In Aim 1, the candidate will observe inpatient workflows and collaborate with a Partner Steering Committee (PSC) composed of hospital staff (e.g., clinicians, administrators, information technology), A-CMCs, and parents to adapt SBIRT delivery and intervention components for the inpatient setting and population. Aim 2 will involve continued partnership with the PSC, to select, specify, and prioritize a set of SBIRT implementation strategies ideally suited for the inpatient setting and population. Aim 3 will consist of a single arm pilot hybrid type III effectiveness-implementation trial that simultaneously tests the set of implementation strategies selected in Aim 2 (primary outcome) and the SBIRT intervention adapted in Aim 1 (secondary outcome).

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