Abstract BackgroundNeighborhood revitalization is a process through which land use rezoning and capital investment can spur new resources, such as access to healthful food and amenities for physical activity. While revitalization efforts may promote cardiovascular health, their benefits may not be distributed equally across sociodemographic groups. ObjectiveThe objective of the study is to apply a socioecological framework that uses a multimethod approach incorporating quantitative data (longitudinal electronic health records and cross-sectional surveys) and qualitative data (longitudinal “walk-a-long” interviews) to examine the short-term effect of neighborhood land use rezoning and revitalization efforts on cardiovascular disease (CVD), CVD-related health behaviors, and access to and utilization of health care. System science methods, namely microsimulation modeling and system dynamics modeling, will be used to assess the long-term effects of land use rezoning policy and revitalization efforts on cardiovascular health and ways to sustain priority health equity goals in revitalized neighborhoods. MethodsWe leverage a land use rezoning initiative in the Bronx, New York, where a largely commercial area is being rezoned along with capital investments to expand healthful neighborhood resources. Using electronic health records from a single hospital system, we will follow cohorts of midlife and older adults (≥50 y) residing in both the rezoned area and a comparison area. We will assess clinically measured incident CVD and other CVD risk factors to evaluate changes in cardiovascular health over time. In parallel, we will conduct a cross-sectional survey and a purposive sampling of patients for in-person “walk-a-long” qualitative interviews to understand how residents perceive neighborhood access to healthful resources after land use rezoning. To estimate long-term effects, we will use a validated microsimulation model to project CVD outcomes and costs. Finally, we will use system dynamics modeling to integrate quantitative and qualitative findings to inform future revitalization and public health strategies. ResultsMidlife and older adult patients (N=10,813) in the intervention area and the comparison area will be followed for approximately 7 years following land use rezoning and revitalization efforts to compare CVD risk between neighborhoods. The cross-sectional survey (n=300) and qualitative assessment (n=36) will increase understanding of perceptions of access to healthful resources and related health behaviors among residents. Systems science approaches will estimate long-term CVD risk and related costs associated with revitalization efforts. An advisory committee of clinical and community stakeholders will assist in interpreting results and developing dissemination strategies for their constituents. This study was funded from January 2023 until December 2026. ConclusionsThis study uses a socioecological framework to provide a novel, transferable method for evaluating the impact of neighborhood revitalization efforts on cardiovascular health by combining methods to examine short- and long-term effects across individual, neighborhood, and structural (system) levels over time. Findings will inform policies aimed at reducing CVD through equitable urban revitalization.

BACKGROUND:Short-term air pollution exposure may exacerbate respiratory health outcomes in vulnerable populations, particularly those with pre-existing cardiovascular conditions. Given the persistent burden of COVID-19 pneumonia, there is a need to better understand how environmental exposures influence risk of COVID-19 pneumonia. OBJECTIVE:We aimed to explore whether associations between short-term particulate matter (PM2.5) exposure and COVID-19 pneumonia risk are stronger among those with pre-existing cardiovascular conditions. METHODS:We used NYC COVID-19 hospitalization records (March-December 2020; N = 15,361) and defined short-term PM2.5 as a 7-day residential ZIP Code average prior to and including hospitalization, using Environmental Protection Agency (EPA) Community Multiscale Air Quality (CMAQ) modeled data. Pre-existing cardiovascular conditions included 15 ICD-coded circulatory conditions (e.g. myocardial infarction, atrial fibrillation, ischemic heart disease). Modified Poisson regression estimated risks of acute respiratory distress syndrome, pneumonia, ventilation use, and dialysis use, and Cox hazards regression estimated COVID-19 fatality risk and length of stay, adjusting for age, sex, smoking status, and environmental vulnerability. Relative excess risks of interaction (RERI) estimated additive interaction between short-term PM2.5 exposure and cardiovascular conditions on risk of COVID-19 pneumonia during hospitalization. Targeted maximum likelihood estimation estimated average treatment effects (ATE) of short-term PM2.5 exposure on COVID-19 pneumonia, among those with and without cardiovascular conditions. RESULTS:Short-term PM2.5 and pre-existing cardiovascular conditions together increased pneumonia risk from July to December 2020. For example, joint exposure to an interquartile range increase in short-term PM2.5 and pre-existing myocardial infarction amplified pneumonia risk (RR:1.67; 95%CI:1.41,1.99), with smaller increases observed for PM2.5 alone (RR:1.03; 95%CI:0.95,1.12) or myocardial infarction alone (RR:1.34; 95%CI:1.14,1.58). Upper-quartile short-term PM2.5 increased pneumonia risk only among individuals with cardiovascular conditions (ATE:0.05, 95%CI:0.02,0.08). IMPACT:COVID-19 pneumonia drives substantial hospitalizations, but little is known about the link between environmental exposures and pneumonia. We aimed to examine whether short-term air pollution influences pneumonia risk, and if pre-existing cardiovascular conditions modify this link. We found that pre-existing cardiovascular conditions increase vulnerability to short-term air pollution, amplifying COVID-19 pneumonia risk during hospitalization. These study findings may help identify populations that may be more vulnerable to the effects of short-term air pollution exposure during future respiratory infectious disease outbreaks.

Neighborhood factors, encompassing social, built, and natural environments, may explain geographic differences in the impact of COVID-19 pandemic on populations. Data from pre-existing national, population-based cohorts could be leveraged to better understand how pre-existing conditions (both individual and neighborhood) contribute to risk factor development and disease progression. We catalogued spatial and neighborhood data in the Collaborative Cohort of Cohorts for COVID-19 Research (C4R), comprising 14 diverse US cohorts (>50,000 participants). The C4R sample is generally spatially and socially representative of the overall nation, with C4R's calculated spatial coverage representing 28% of US land area and 52% of the total US population. However, C4R (vs. non C4R) areas were more urban, wealthy, with more foreign-born residents, and less car-dependent with lower proportion employed and green. Twelve cohorts collected neighborhood characteristics - most commonly social environment data on neighborhood socioeconomic status- based on participants' addresses. The most common built environment measures were related to food access, followed by other destination-based measures such as walkability. Natural environment data were available in the fewest cohorts, with emphasis on air quality or greenspace. This work provides clarity on available neighborhood and spatial data and facilitates future harmonization of data from C4R cohorts. Ultimately, this may enable future longitudinal and comparative analyses of neighborhood influences on COVID-19.

Neighborhood-scale environmental factors, including disinvestment in infrastructure, may impact cardiometabolic disease risk. To our knowledge, no prior studies have investigated the association between neighborhood disinvestment and incident diabetes. We used a virtual street audit of Google Street View Imagery to generate a neighborhood disinvestment score for participants' residential addresses in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). An item response theory model was fit to indicators (litter, graffiti, under-maintained buildings, bars on windows, and abandoned buildings) to form a scale measuring a latent level of disinvestment. Ordinary kriging was used to estimate levels for each residential address within the HCHS/SOL census tracts via spatial interpolation. HCHS/SOL is a longitudinal cohort study of self-identified Hispanic/Latino adults in the Bronx, Chicago, Miami, and San Diego. Using covariate-adjusted and survey-weighted Poisson regression models with data from 9120 participants free of diabetes at baseline (2008-2011), we investigated the association between neighborhood disinvestment and incident diabetes at visit 2 (2014-2017). A sensitivity analysis included only those who did not move during the follow-up period. A one-standard deviation increase in neighborhood disinvestment score was associated with a 13% (95% CI, 1-23%) lower risk of incident diabetes when adjusting for age, sex, education, income, study center/heritage, years in the US, family history, and a neighborhood socioeconomic index. Our sensitivity analysis yielded qualitatively similar results with lower precision. Overall, our analysis does not support the hypothesis that neighborhood physical disinvestment is associated with incident type 2 diabetes in this Hispanic/Latino population.

Objective This qualitative study aims to explore the experiences and preferences of Hispanic men participating in the National Diabetes Prevention Program (NDPP), an intensive lifestyle change intervention that effectively reduces diabetes risk, considering Hispanic men experience diabetes disproportionately yet remain underrepresented in the NDPP.Design Individual semi-structured interviews were conducted over the phone in English or Spanish between June 2023 and February 2024. Transcripts were analysed using a framework analysis.Participants 17 Hispanic men engaged in the NDPP for ≥4 sessions. The majority were foreign-born (n=11) and self-identified as English proficient (n=11).Results Through three major themes, Hispanic men reflected on their experiences: (1) Going into the NDPP: despite not knowing what to expect from the NDPP, their fear of diabetes motivated them to enrol in the programme; (2) During the NDPP: they felt relief from gaining critical knowledge about diet, exercise and diabetes prevention; and finally (3) Impressions of the NDPP: they appreciated the NDPP’s informational resources, personalised coaching, group format and acknowledgement of traditional cultural diets and found men-only groups often offered additional emotional safety but had mixed feelings about the programme’s virtual format.Conclusions Findings suggest that Hispanic men appreciate the knowledge and skills attained from the NDPP and value its resources, group format, culturally-tailored content and gender-tailored structure. Recruitment efforts may benefit from emphasising how the programme reduces uncertainty about prediabetes and from more clearly conveying the structure of the programme. Strategies to improve sustained engagement should consider how to feasibly offer delivery formats that accommodate diverse preferences.

While awareness of the importance of social determinants of health (SDOH) has grown over the past 2 centuries, commensurate spending on social care programs has not. Building on the foundational works of Frederich Engels, Rudolf Virchow, W.E.B. Du Bois, and Salvadore Allende, the World Health Organization codified the SDOH framework in their Commission on Social Determinants of Health. Within this framework, important distinctions exist between the intermediary social causes of health and the distribution of these causes, which are driven by the larger structural determinants of health. A focus on the SDOH has recently gained traction within health systems through screening for health-related social needs (HRSNs). There is a strong evidence base supporting this work; however, large gaps remain in our understanding of the implementation challenges across complex health care delivery systems. While screening for and addressing HRSNs is a necessary step for health systems to address the intermediary social causes of health, upstream interventions requiring multi-sectoral policies and approaches are critical to reduce health inequities.

Background Cardiotoxicity in patients with cancer treated with anthracyclines is associated with increased morbidity and mortality. We aimed to examine the incidence of and risk factors for cardiotoxicity in a racially and ethnically diverse cohort with cancer treated with anthracyclines. Methods We included consecutive adult patients who underwent anthracycline‐based chemotherapy from 2016 to 2019 for any type of cancer. The end point was the development of cardiotoxicity (defined as clinical heart failure or drop in left ventricular ejection fraction ≥10% to ≤50%). Results A total of 743 individuals were included (28.0% Non‐Hispanic [NH] White, 30.5% NH Black, 38.5% Hispanic, 3.0% Asian). Hypertension, diabetes, hyperlipidemia, obesity, and low socioeconomic status were more common in NH Black and Hispanic individuals. During a median follow‐up of 21 months, 98 individuals (13.2%) developed cardiotoxicity. The incidence of cardiotoxicity was significantly higher in NH Black (16.3%), Hispanic (14.7%) and Asian (18.2%) individuals than in NH White (7.2%) individuals (P=0.024). After adjusting for cardiovascular risk factors, socioeconomic status score, anthracycline dose, baseline left ventricular ejection fraction, and cancer type, being NH Black (hazard ratio [HR], 2.62 [95% CI, 1.23–5.56]) or Hispanic (HR, 2.37 [95% CI, 1.11–5.07]) was independently associated with a higher risk of cardiotoxicity. NH Black and Hispanic individuals had a greater decline in left ventricular ejection fraction compared with NH White and Asian counterparts. The associations between baseline characteristics and incident cardiotoxicity were similar across different racial and ethnic groups. Conclusions In a large retrospective multiracial and ethnic cohort treated with anthracyclines, NH Black, Hispanic, and Asian individuals had an increased risk of cardiotoxicity compared with their NH White counterparts.

Introduction and Objective: Research on participation in the National Diabetes Prevention Program (DPP) primarily focuses on individual level factors such as demographics and health beliefs, while largely overlooking the impact of neighborhood context. We aim to examine neighborhood vulnerability as a factor influencing the likelihood of participation in a DPP intervention for men. Methods: The Area Deprivation Index (ADI) State Ranking is a validated census tract-based neighborhood level score reflecting a neighborhood’s socioeconomic disadvantage relative to others in the state. The men included in this study were recruited as part of the Power-Up virtual DPP trial for men, identified based on National DPP eligibility from the electronic health records of a large academic medical center and a network of small-to-medium independent primary care practices throughout New York City. Power-Up was a 12-month DPP weight loss trial delivered online between Oct 2021 - Aug 2024. Participation in Power-Up was defined by: enrollment - agreeing to participate in the trial, and engagement - attending 4+ DPP sessions vs. 0-3 DPP sessions. The association between ADI and both enrollment and engagement was examined using logistic regression, adjusting for age. Results: Of the 601 men consented to participate in Power-Up, 572 were eligible for this study based on a complete residential address. Eligible participants had a median age of 50 years (SD: 9 years) and median ADI of 5 (SD: 1 rank), ranging from 1 (least disadvantaged) to 9 (most disadvantaged). Of 295 enrolled men, 109 attended 4+ sessions. In the adjusted analysis, there were higher odds of enrollment (OR=1.14, 95% CI: 1.05-1.25), but not engagement (OR=1.02, 95% CI: 0.92-1.14), with increasing ADI. Conclusion: These findings suggest that while neighborhood disadvantage is associated with enrollment, other factors may be important for sustaining long term engagement. K. Diaz: None. J.S. Gonzalez: None. E. Chambers: None. National Institutes of Health (R01-DK121896)

Studies suggest ambient air pollution increases risk of individual-level adverse COVID-19 outcomes. Our review seeks to understand how air pollution influences adverse COVID-19 outcomes, by identifying how researchers accounted for cardiovascular morbidity, a predominant COVID-19 risk factor that is strongly linked to air pollution exposure. Our review primarily consisted of retrospective cohorts from the US and Europe, that examined both historical and short-term air pollution. Studies typically found that air pollution was associated with greater risk of individual-level adverse COVID-19 outcomes and adjusted for cardiovascular morbidities as confounders. Few hypothesized cardiovascular morbidity as a mediator or effect modifier in this relationship. Improved understanding of cardiovascular morbidity’s potential role as an effect modifier or mediator can help better explain the link between air pollution and COVID-19, in addition to identifying and assisting populations that may be at greater risk for adverse pandemic outcomes.

INTRODUCTION:Communities disproportionately burdened by adverse neighborhood-level social and structural factors may experience greater vulnerability to environmental exposures, contributing to health inequities, including adverse COVID-19. We assessed the effects of chronic air pollution on COVID-19 morbidities in NYC and examined whether these effects varied by neighborhood-level vulnerability. METHODS:We used NYC COVID-19 hospitalization records (3/1/2020-2/28/2021) and conducted analyses in the full sample and within hospital catchment. Chronic air pollution (particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon (BC), ozone (O3)) was assigned using residential ZIP Code (NYC Community Air Survey; 2009-2019). Modified Poisson regression estimated risk of acute respiratory distress syndrome (ARDS), pneumonia, ventilation, and dialysis, and Cox regression estimated risk of discharge, adjusting for age, sex, BMI, smoking, asthma, diabetes, and hypertension. We assessed effect modification by neighborhood-level environmental vulnerability index (NEVI) tertiles. RESULTS:From March to June 2020 (within hospital catchment), adjusted estimates generally suggest greater chronic NO2, PM2.5, and BC was associated with increased risk of ARDS, pneumonia, and dialysis, and not associated with discharge and ventilation; inverse estimates found for chronic O3. Relationships between air pollution and adverse COVID-19 were generally stronger among those with greater neighborhood environmental vulnerability. For example, chronic NO2 and pneumonia's relationship was stronger in individuals within higher NEVI tertiles (T1: aRR: 1.13, 95%CI: 1.02-1.25; T2: aRR: 2.11, 95%CI: 1.73-2.56; T3: aRR: 6.36, 95%CI: 4.71-8.60). DISCUSSION:Differences in neighborhood-level social and structural factors contribute to unequal health burdens associated with air pollution. Public health resources targeted toward neighborhoods with greater environmental vulnerability can encourage population-level pandemic preparedness.

PURPOSE:We evaluated associations among long-term air pollution exposure, neighborhood-level social and structural drivers of environmental vulnerability, and COVID-19 death during the first pandemic year in New York City (NYC). METHODS:We triangulated findings across statistical approaches susceptible to different biases: a hospital-based COVID-19 fatality analysis using Cox proportional hazard models and two ZIP code-level, city-wide excess all-cause mortality analyses using periodic and linear regression models. We estimated chronic fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) exposures as 11-year mean concentrations. Social and structural factors were integrated into a neighborhood environmental vulnerability index (NEVI), with higher scores indicating greater vulnerability. RESULTS:Cox models demonstrated PM2.5 (0.88 [0.84, 0.93]) and NO2 (0.84 [0.79, 0.89]) exposures were weakly and negatively associated, while O3 (1.06 [1.04, 1.08]) exposure was weakly and positively associated with COVID-19 fatality. Linear regression models showed similar PM2.5 (-0.64 [-0.87, -0.41]), NO2 (-0.53 [-0.71, -0.34]), and O3 (0.55 [0.39, 0.71]) associations with excess all-cause mortality. NEVI scores were strongly and positively associated with COVID-19 fatality and excess all-cause mortality across air pollutant concentrations. Periodic regression models showed the highest monthly excess all-cause mortality rates per 10,000 were observed in ZIP codes with low PM2.5 (40.54) and NO2 (33.99) with high NEVI scores and high O3 (32.39) with high NEVI scores. CONCLUSIONS:Inverse PM2.5, NO2, and COVID-19 death associations were unexpected, highlighting challenges in examining these associations in NYC. Future pandemic preparedness efforts should prioritize urban communities burdened by structurally rooted health vulnerabilities, even in areas with low air pollution exposure.

Background Black and Latino men are at increased risk for poor diabetes health outcomes but are underrepresented in lifestyle interventions for weight loss and diabetes prevention. Although relatively few men participate in the National Diabetes Prevention Program (NDPP), it remains the most widely available evidence-based approach to type 2 diabetes prevention in the United States. Thus, an NDPP tailored to Black and Latino men has the potential to address prior limitations of NDPP implementation and reduce gender, racial, and ethnic diabetes disparities. It also provides an opportunity to define a population for targeted outreach and evaluate the reach of our recruitment methods and interventions. Objective We tailored the US Centers for Disease Control and Prevention Prevent T2 curriculum for the NDPP for Black and Latino men, called Power-Up, and will evaluate its effects in comparison to standard mixed-gender NDPP groups via virtual delivery. The primary aim of the project is to assess the effect of Power-Up versus NDPP on weight loss among men with prediabetes. The secondary aim is to compare the engagement and retention of men with prediabetes in Power-Up versus NDPP. We will also examine the reach of our recruitment methods and engagement in our screening, consenting, and assessment procedures prior to the point of randomization. We hypothesized that men randomized to Power-Up would achieve greater percent weight loss from baseline at 16 weeks (end of Core sessions) and 1 year (end of Maintenance sessions) than men randomized to standard, mixed-gender NDPP. Power-Up is also expected to have better engagement and retention. Methods Using the electronic health record (EHR) systems of a large academic medical center and a network of small to medium independent primary care practices throughout New York City, we identified Black and Latino men who met eligibility criteria for NDPP and enrolled them in a randomized controlled trial in which they were assigned 1:1 to receive Power-Up or the standard, mixed-gender NDPP over 1 year via online videoconferencing. Coaches delivering these interventions were trained according to the standards for the NDPP. Power-Up will be delivered by men coaches. Weight will be collected with home-based electronic scales for primary outcome analyses. Engagement will be assessed by session attendance logs. Results We identified 11,052 men for outreach based on EHR data, successfully screened 26% of them, consented and enrolled 22% of these, and randomly assigned 48% of consented participants. Primary and secondary outcome analyses will be assessed among randomized men. Conclusions This study highlights the effort required to reach and engage Black and Latino men for virtually delivered diabetes prevention programs. Forthcoming trial results for weight loss and engagement will further inform efforts to address disparities in diabetes prevention through tailored programming for Black and Latino men. Trial Registration ClinicalTrials.gov NCT04104243; https://clinicaltrials.gov/study/NCT04104243 International Registered Report Identifier (IRRID) DERR1-10.2196/64405

The prevalence of type 2 diabetes is increasing among the Hispanic/Latino population. Type 2 diabetes incidence rates vary between neighborhoods, but no single aspect of the neighborhood environment is known to cause type 2 diabetes. Using data from the Hispanic Community Health Study/Study of Latinos cohort of 16,415 Hispanic/Latino adults in four major US cities, we conducted a neighborhood environment-wide association study to identify neighborhood measures or clusters of measures associated with diabetes incidence. Two-hundred and four neighborhood measures were calculated at the census tract level or within a 1-km buffer of participants' residential addresses. Independent covariate-adjusted and survey-weighted Poisson regressions were run for each neighborhood measure and incident diabetes. Principal component analysis of neighborhood measures was conducted to reduce dimensionality. No coherent pattern of neighborhood measures or principal component scores were associated with diabetes incidence within the cohort, though established individual-level risk factors such as age and family history were strongly associated with diabetes incidence. Results from our analysis did not indicate specific neighborhood measures, clusters, or patterns. Individual, rather than neighborhood, factors distinguish incident diabetes cases from non-cases.

Importance:Hispanic men experience higher rates of diabetes compared with non-Hispanic White men but remain underrepresented in preventive lifestyle interventions. Objective:To identify unique reasons for Hispanic men's low engagement in the National Diabetes Prevention Program (NDPP) compared with those with high engagement to inform strategies for improving participation. Design, Setting, and Participants:This qualitative study recruited Hispanic men aged 18 years and older and at risk for diabetes per electronic medical records from June 2023 to February 2024 from primary care sites affiliated with hospital-associated Montefiore Health Systems related to an ongoing clinical trial called Power Up. Patients were invited to participate in one-time phone interviews. Interviews were analyzed deductively, guided by behavior change frameworks. Exposure:Participant's level of engagement varied with representation balanced between those demonstrating low and high engagement in the NDPP (attendance at <4 and ≥4 sessions, respectively). Main Outcomes and Measures:Planned study outcomes included NDPP notable factors associated with low engagement. Results:Of 32 Hispanic men who completed interviews (20 patients [62.5%]aged >50 years), 15 had low engagement in the NDPP, 13 (87%) were not born in the US, 12 (80%) had limited English proficiency, and 8 (53%) did not complete high school. Three major themes and 11 subthemes emerged. Hispanic men with low engagement discussed limited awareness of their prediabetes diagnosis, lifestyle change self-sufficiency, and skepticism about their diabetes risk and the benefits of NDPP. Also mentioned were financial barriers, restricted access to the program, and the perceived negatives of participation outweighing potential benefits. Conclusions and Relevance:Addressing the unique barriers faced by Hispanic men in engaging with the NDPP is critical to reducing diabetes-related inequities and may require tackling knowledge gaps, financial barriers, and perceptions of program relevance before, during, and after enrollment. Future research should explore how to tailor recruitment strategies and program content to Hispanic men's specific identities, motivations, and challenges.

Objective: Examine the association of household ties with diabetes awareness and self-care behaviors among Hispanic/Latinos. Research Design and Methods: Data from the Hispanic Community Health Study/Study of Latinos were used (Visit 2; 2014-2017; n = 11,071). Household ties extended, and close), sex, and loneliness were used in a cluster analysis to derive the household clusters. Diabetes awareness and diabetes self-care behaviors (among the aware only) were the outcomes. Results: Clusters that emerged were: (1) Females who rarely feel lonely and who mostly live with close ties; (2) Males who rarely feel lonely and who mostly live close ties; (3) Males and females who feel lonely despite living with mostly close ties; (4) Males and females who feel lonely and mostly live alone or without familial ties. Cluster 4 had the highest proportion of diagnosed (27%) and undiagnosed diabetes (10%). In regression models, none of the clusters related to diabetes awareness. However, among the aware, glucose monitoring was only significantly higher among cluster 1 relative to cluster 4. Compared to cluster 4, all clusters were significantly more likely to know their HbA1c. Conclusions: Household tie clusters were related to diabetes self-care behavior but not awareness.

Introduction and Objective: Hispanic men have a relatively high prevalence of diabetes but relatively low rates of enrollment and engagement in preventive interventions like the NDPP. This qualitative study aimed to comprehensively explore influences unique to Hispanic men with low engagement in the NDPP, compared to those with high engagement, with the goal of informing strategies to improve their engagement in the program. Methods: Participants were self-identified Hispanic men, aged ≥18 years, at risk for diabetes per electronic medical records at an urban outpatient network, and invited to the NDPP. They completed individual audio-recorded interviews in English and Spanish. Using Nvivo, transcripts were analyzed deductively, informed by the Theoretical Domains Framework, to identify influences on engagement in the NDPP. Codes emerging uniquely among those with low engagement (attendance at <4 NDPP sessions) were identified through consensus. Results: Of 32 Hispanic men interviewed, 15 had low engagement in the NDPP. More of those with low engagement had limited English proficiency and did not complete high school. Three major themes delineated their Capacity, Motivations, and Opportunities for engaging with the NDPP. They expressed limited awareness of their prediabetes diagnosis, felt self-sufficient about enacting lifestyle change, and were skeptical about their diabetes risk and the utility of the NDPP. They also mentioned financial barriers and limited access to the program. Conclusion: Addressing the unique barriers faced by Hispanic men in engaging with the NDPP is critical to reducing diabetes-related inequities and may require tackling knowledge gaps, financial barriers, and perceptions of program relevance before, during, and after enrollment. Future research should explore how to tailor recruitment strategies and program content to Hispanic men’s specific identities, motivations, and challenges. C.J. Gonzalez: None. C.N. Perez-Mejia: None. N. Hernandez: None. H. Flaxman: None. C. Stephenson-Hunter: None. E.N. Gil: None. T. Formagini: None. E. Chambers: None. J.S. Gonzalez: None. Robert Wood Johnson Foundation (234326-01); UCSF Research in Implementation Science for Equity Subaward (R25HL126146 Subaward No 13969sc); National Heart, Lung, and Blood Institute (T32HL079891); National Institute of Diabetes and Digestive and Kidney Diseases (3R01DK121896); National Institute of Diabetes and Digestive and Kidney Diseases (3P30DK111022)

Google Street View’s historical imagery is a promising data source for measuring neighborhood conditions over time. However, images are not available for all years. To assess bias that may arise due to a mismatch between the year imagery is available and the year of researcher interest, we assessed prevalence of change in 20 commonly assessed built environment features between the oldest and newest available high-quality images (median difference 10.5 years, range from 2007 to 2023) on Street View at 2118 total locations in four US cities representing the Hispanic Community Health Study/Study of Latinos (New York City, Chicago, Miami, and San Diego). Seventeen (85

Introduction:Routine screening for health-related social needs (HRSNs) is inconsistent, creating disparities in who gets identified and supported. Transgender patients, already facing structural stigma, may be especially affected. Methods:We analyzed electronic health records from a large urban safety-net system (2018-2023). We identified 2639 transgender patients with at least one outpatient visit and created a ∼11:1 comparison cohort of 23 944 cisgender patients. Overall, 7.5% (n = 1997) completed a Social Needs Questionnaire (SNQ), including 1840 cisgender and 157 transgender patients. We compared screening rates using chi-square tests and assessed adjusted odds for HRSN with logistic regression. Results:Transgender patients were screened less often than cisgender patients (5.9% vs 7.7%, P = 0.001). Among those screened, they had more than twice the odds of housing instability, poor-quality housing, and healthcare costs. Odds for interpersonal violence were th3ree times higher. Findings were consistent in sensitivity analyses adjusting for age, insurance, and neighborhood. Conclusion:Transgender patients were underscreened yet faced greater HRSNs. Standardized screening and expanded supports are critical to support transgender communities.

Background Allostatic load (AL) is a measurement of physiological burden of chronic stress, operationalized using a composite score derived from biomarkers from multiple physiologic systems. The relationship between AL and anthracycline cardiotoxicity is unclear. Methods and Results We included consecutive adult patients who underwent anthracycline‐based chemotherapy from 2016 to 2019 for any type of cancer. Patients with preexisting heart failure and lack of AL score measures were excluded from the analysis. A composite AL score was calculated using 9 biomarkers tested before initiating chemotherapy. The end point was the development of cardiotoxicity (defined as clinical heart failure or drop in left ventricular ejection fraction≥10% to <50%). A total of 718 patients were included in the analysis (29% Non‐Hispanic White, 31% Non‐Hispanic Black, 40% Hispanic). The mean AL score was 2.4±1.4 and it was significantly higher in Non‐Hispanic Black and Hispanic patients compared with Non‐Hispanic White patients (2.5±1.3 in Non‐Hispanic Black versus 2.4±1.3 in Hispanic versus 2.1±1.5 in Non‐Hispanic White, P=0.031). In patients who developed cardiotoxicity, AL score was significantly higher than patients without cardiotoxicity (2.7±1.4 versus 2.3±1.3, P=0.006). AL score was independently associated with incident anthracycline cardiotoxicity after adjusting for race and ethnicity, age, sex, cardiovascular risk factors, anthracycline dose, baseline left ventricular ejection fraction, cancer type, and cancer metastasis (hazard ratio 1.20 per 1 AL score increase [95% CI, 1.02–1.43], P=0.033). AL score remained significantly associated with anthracycline cardiotoxicity after additional adjustment of social determinants of health. Conclusions AL score can be a potential important prognostic marker in the prediction of cardiotoxicity in patients with cancer undergoing cardiotoxic treatment independent of social determinants of health.