Tobacco use remains the leading preventable cause of cancer mortality worldwide, with marked disparities in cancer incidence and outcomes across racial and ethnic groups. This study investigates the genetic determinants of tobacco carcinogen metabolism among smokers, focusing on ancestry-informative markers (AIMs) near genes involved in metabolic activation (Phase I), detoxification (Phase II), and transport (Phase III) of tobacco-specific carcinogens. Using data from 274 smokers recruited in the United States and the Caribbean, we measured urinary NNAL (a metabolite of NNK) to classify metabolic phenotypes and performed genotyping with a customized array enriched for AIMs. Most participants (94%) were classified as poor metabolizers of NNAL, with a higher prevalence among Black/African American smokers. Multivariable analyses, after adjusting for age, sex, assay batch, and number of cigarettes smoked per day, identified 14 AIMs near Phase I, II, and III pathway genes significantly associated with NNAL metabolizer phenotype, with African ancestry alleles conferring increased odds of poor metabolism. Functional annotation revealed that most significant AIMs overlapped regulatory regions, and the CYP3A5 rs776746 variant demonstrated structural disruption likely to impair enzymatic activity. Majority of participants had high African ancestry and were poor NNAL metabolizers, consistent with the observed association between African ancestry and poor NNAL metabolism. These findings highlight the biological basis for tobacco-related cancer disparities and underscore the importance of integrating genetic ancestry and metabolic phenotyping in risk assessment and personalized prevention strategies for tobacco-associated cancers.

Abstract Introduction Bedsharing is common in the U.S., especially in toddlerhood. Few studies have examined bedsharing in socioeconomically disadvantaged families, where structural stressors such as housing instability or overcrowding may increase its likelihood. Although bedsharing has been linked to poor maternal and infant sleep, evidence in toddlerhood is limited. This study examined associations between (1) caregiver stress and bedsharing and (2) bedsharing and caregiver/toddler sleep health in socioeconomically disadvantaged households. Methods We enrolled 60 caregiver–toddler dyads eligible for federally funded programs (e.g., WIC, Medicaid). Using a micro-longitudinal design, caregivers and toddlers wore 24/7 actigraphy for two weeks to measure sleep duration, efficiency, and timing. Caregivers also completed daily electronic diaries reporting stressors (severity, management strategies, perceived effectiveness) and toddler sleep location. Generalized Linear Models using GEEs assessed associations between caregiver stress, toddler sleep location, and dyadic sleep, adjusting for demographics. Results Caregivers (90% mothers; 48% Black; 83% <$75k annual income) slept an average of 417.12 minutes/night (SD=76.88), with 83% sleep efficiency (SD=5.64) and an 11:15pm bedtime. Toddlers (57% male; mean age 2.36 years, SD=1.01) slept an average of 537.68 minutes/night (SD=87.47), with 88% sleep efficiency (SD=6.7), a 10:20pm bedtime, and 42% bedshared. One-quarter of caregivers reported family/parenting issues as their primary stressor, and 25% reported moderate-to-high daily stress. Up to 90% used healthy stress-management strategies (e.g., mindfulness, distraction), though 44% found them ineffective. Higher-income families (>$75k) were less likely to bedshare (OR=–2.47, p=0.003) compared to lower-income, and toddler males were more likely to bedshare (OR=2.40, p=0.003) compared to females. Experiencing mild, moderate, or high stress was associated with greater odds of bedsharing (OR=0.6–0.9, all p< 0.05) compared with no stress. Stress-management effectiveness was not associated with bedsharing. Nightly bedsharing was also not associated with caregiver or toddler sleep outcomes. Conclusion Caregiver stress was associated with increased odds of bedsharing, regardless of how effectively caregivers managed their stress. Bedsharing was not linked to caregiver or toddler sleep health. Future work should explore caregivers’ motivations for bedsharing in toddlerhood and contextual contributors such as limited living space and housing instability. Support (if any) Rockefeller University Heilbrunn Family Center for Research Nursing (#UL1TR001866); Institutional Development Award from NIH NIGMS (#U54-GM104941).

BACKGROUND & AIMS:Cardiovascular disease develops throughout life, with metabolic syndrome components increasing risk. Eating patterns - how long individuals eat during a 24-h period and the timing of caloric intake, particularly at night - may play critical roles in metabolic syndrome development. This study aimed to describe eating window length and night eating (% of calories consumed after 8pm or after dinner) and their associations with metabolic syndrome risk in emerging adults. Diet quality was assessed as a mediator between eating variables and metabolic syndrome risk. METHODS:National Health and Nutrition Examination Survey (NHANES) 2017-2020 pre-pandemic data were analyzed. Emerging adults (aged 18-29) with ≥1 day of dietary data who were not pregnant, taking metabolic-related medication, or with a history of metabolic disease were included. Multiple linear regression models stratified by sex assessed whether eating window length and night eating predicted metabolic syndrome risk z-score, controlling for demographic and lifestyle variables. RESULTS:Among 1478 emerging adults, mean eating window length was 10.9 ± 0.1 h and 34.7% of participants ate for ≥12 h. Median % of calories consumed after 8pm was 18.8% ± 0.8; 11.2% ate ≥25% of calories after dinner. In the fully adjusted model, longer eating windows were associated with lower metabolic syndrome risk in males (n = 181, β = -0.06, p = 0.0008). Males with longer eating windows started eating earlier (6:42am for>14hr eating window vs 2:24pm for<8hr) and had a higher Healthy Eating Index score (50.1 for>14hr eating window vs 40.8 for<8hr). However, diet quality was not a significant mediator. In females (n = 186 in the fully adjusted model), longer eating windows predicted lower metabolic syndrome risk in those who ate a greater proportion of calories after dinner (p = 0.008). CONCLUSIONS:Long eating windows with early start times were associated with better cardiometabolic health in emerging adult males. Eating window timing may be a consideration for metabolic syndrome risk.

BACKGROUND:Adults with intellectual disabilities (IDs), particularly those who reside in community living arrangements (CLAs), are at high risk for these chronic diseases. Sedentary behaviour (SB) is an emergent, independent risk factor for several chronic diseases including cardiovascular and metabolic conditions. SB may represent a potent behavioural target to mitigate chronic disease risk in adults with ID who live in CLAs. Limiting the development of interventions to address SB is a lack of understanding of device-estimated SB patterns. Also not clear are the individual-level determinants of SB in this high-risk group of CLA residents with ID. The current study sought to address these knowledge gaps. METHODS:A cross-sectional observational study design was used to characterize SB patterns and individual-level determinants of SB in adults with ID living in CLAs. Thirty-eight adults from 24 different CLAs wore activPAL devices for 1 week to enable device estimates of SB. activPAL data were processed, and the study outcomes of daily time spent in SB, SB bout lengths, sedentary breaks and prolonged SB were generated. Participants also completed an online survey to assess individual factors, which included demographics, independence, programming and health status. Univariate statistics were used to describe SB patterns and logistic regression models were used to ascertain the association between individual factors and SB variables. RESULTS:On average, the sample were aged 44.79 years (SD = 14.9), and 60.53% were male. The sample were highly sedentary: 47.37% engaged in prolonged SB, the daily average time in SB was 7.46 h (SD = 2.18), and an average of 32.4 daily SB bouts (95% CI = 28.9, 35.9) lasted 17.7 min (95% CI = 13.8, 21.7). Participants requiring more assistance with ADLs were more likely to have longer uninterrupted sedentary bouts (95% CI = 0.169, 1.721; β = 0.945; p = 0.018) and total daily duration of SB (95% CI = 4.58, 20.21; β = 12.394; p = 0.003). Those with less than a high school education had sedentary bouts that were ~15 min longer (95% CI = 3.21, 25.69; p = 0.013). CONCLUSIONS:Adults with ID living in CLAs spent almost 8 h of their waking day in SB. Those with lower levels of independence and education were more likely to have higher levels of SB. CLAs may represent a critical opportunity for targeted, place-based interventions to reduce time spent in SB.

Prediabetes is highly prevalent in the United States. The first-line evidence-based lifestyle intervention is the Diabetes Prevention Program (DPP). Yet, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) demonstrate significant efficacy for weight loss and glycemic control. As GLP-1 RAs gain clinical traction, there is a risk that pharmacotherapy may supplant rather than reinforce lifestyle change. Optimal prediabetes management requires integrated approaches in which glucagon-like peptide-1 receptor agonists use supports and sustain, rather than replace, DPP lifestyle modification. Nurse practitioners, as frontline providers, are positioned to lead comprehensive diabetes prevention through systematic DPP referrals, appropriate pharmacotherapy, patient education, and coordinated interdisciplinary care. (c) 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Background: Sleep disturbances are common in pregnancy and have negative implications for the health of the mother and offspring. We aimed to test the effect of prenatal exercise on sleep quantity and quality. Methods: This study was a retrospective, secondary analysis of pooled data from 2 blinded, prospective, randomized controlled trials (control n = 15; exercise n = 71). Sleep quality and quantity were assessed via self-report at 16 (baseline) and 36 weeks’ gestation in women assigned to exercise (aerobic, resistance, or combination) or an attention-control group. Sleep metrics were compared between exercise and control groups using independent-samples t tests. Tests for exercise mode and sleep characteristics were completed using mixed models, and the influence of exercise dose on sleep was assessed via Pearson correlations and independent-samples t tests. Results: Women exercised for an average of 21.8 weeks during pregnancy (range = 13–28 weeks). Exercising women slept 15–30 min longer per night than controls at 16 weeks’ ( P = 0.049) but not 36 weeks’ gestation (control 7.27 h, exercise 7.52 h; P = 0.26). Whereas the aerobic and resistance exercise groups showed an increased probability of reporting good sleep quality at 36 weeks ( P < .05), combination exercisers had no decrease in sleep quantity compared with decreases in the other groups ( P = 0.19). Conclusion: Whereas exercise benefits sleep quantity during pregnancy, our results show an exercise mode–dependent influence on sleep quantity and quality at 36 weeks’ gestation.

BACKGROUND:Adverse pregnancy outcomes (APOs) are associated with a higher risk of developing chronic hypertension. The objectives of this study were to determine whether patterns of perceived stress during and after pregnancy were associated with blood pressure and incident hypertension 2 to 7 years after delivery, and whether having an APO modified this association. METHODS:Analyses utilized data from the prospective nuMoM2b-HHS cohort (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be Heart Health Study). Perceived stress was assessed using the Perceived Stress Scale in the first and third trimester and 2 to 7 years after delivery. Latent class trajectory analysis characterized subgroups with similar patterns of perceived stress over time. APOs were abstracted from medical charts and included hypertensive disorders of pregnancy, preterm birth, small-for-gestational-age, and stillbirth. Multivariable regression models evaluated the independent effects of perceived stress on systolic and diastolic blood pressure and incident hypertension and 2 to 7 years after delivery. RESULTS:Three distinct stress trajectory groups emerged, delineated by persistently low, moderate, and high stress levels. No associations between stress trajectory group and blood pressure or incident hypertension were observed after adjustment for covariates. However, there was a significant interaction between stress trajectory group and APO on blood pressure (P for interaction=0.04). Stress trajectory group was associated with higher blood pressure only among those with APO (β=1.991±0.819 mm Hg; P=0.02) but not without APO (β=0.040±0.471 mm Hg, P=0.93). CONCLUSIONS:These findings suggest that elevated perceived stress may contribute to higher blood pressure, specifically among women who had an APO.

Time restricted eating (TRE) improves cardiometabolic (CM) health. However, TRE’s usefulness as a preventative intervention, particularly among women at risk for dysregulated eating is unknown. This single-arm study examined the impact of a 4-week TRE intervention on eating behaviors, body composition, and dietary intake in women at risk for dysregulated eating. 36 emerging adult women with eating windows ≥ 12 h and moderate–high dietary restraint completed 1 baseline week and 4 weeks of TRE (10 h eating window ending by 8 pm). Participants completed the Dutch Eating Behavior Questionnaire, 3-day food logs, anthropometric measurements, and DXA scans at baseline and post-intervention. Ecological momentary assessments (EMA) were administered 5x/day during baseline and weeks 1 and 4 of TRE to assess eating in the absence of hunger (EAH). Adherence with TRE and EMA was above 85

Sleep health disparities are well documented, whereas racial differences in treatment response to sleep interventions, are not. This single arm sleep intervention study explored treatment-response differences in sleep behaviors, quality of life, well-being, depressive symptoms, and daytime sleepiness between White and Underrepresented racial groups, as well as racial differences in pre-treatment sleep-relevant characteristics. Middle-aged adults at risk for the metabolic syndrome with short sleep duration (N = 41; 49

Chronotherapeutic approaches that optimize the timing of therapy to enhance efficacy and minimize side effects are becoming mainstream. The widespread adoption of chronotherapeutic approaches is hindered by the lack of accessible, valid tools to determine circadian time. Building on evidence that gene expression profiles predict circadian time, this pilot study assessed associations between circadian phase predictions from a single blood sample, actigraphy-estimated sleep, and chronotype in a real-world setting. Twelve adults (mean age 51 y, 8 women) reporting short sleep (<7 h/night) and at risk for metabolic syndrome participated. CD14+ monocytes were isolated from 20 ml blood samples, pelleted, and stored at -80°C before RNA sequencing. Sleep was monitored over two weeks using the ActiGraph GT9X-BT, and chronotype preference was assessed with the Composite Scale of Morningness. Spearman's correlations analyzed correlations between predicted dim light melatonin onset (DLMO), sleep, and chronotype preference. Moderate-to-strong association was found between gene expression-based DLMO predictions and sleep, supporting the utility of peripheral blood mononuclear cell gene expression profiles for estimating circadian phase. This approach shows promise for improving chronotherapy implementation in middle-aged adults with chronic health conditions and short sleep. This study was part of a larger study that was registered with Clinicaltrials.gov as NCT03596983.

Parenting toddlers is stressful and for caregivers experiencing low socioeconomic status (SES), stress can be exacerbated by insufficient resources. Cross-sectional examinations suggest that stressful life events and ineffective stress management relate to poor sleep. This evidence base fails to recognize that naturally occurring stressors, stress management and sleep are dynamic and are marked by fluctuations within-persons from one day to the next. Not known is the day-to-day experience of stress among toddler caregivers, and how daily stress management relates to caregiver sleep in low-SES family contexts. Therefore, this study aims to characterize the day-to-day experience and response to stressors in association with caregiver sleep health. We enrolled 60 caregiver-toddler dyads who were eligible for federally funded programs (e.g., WIC, Medicaid). Using a micro-longitudinal design, we used 24/7 actigraphy to measure caregiver sleep health (duration, efficiency, timing) over two-weeks. Concurrently, caregivers completed daily electronic diaries reporting experienced stressors, their severity, stress management strategies and their effectiveness. Generalized Linear Models utilizing GEEs quantified the associations between caregiver stress and sleep health. Caregivers (90% mothers, 48% Black, 25% < high school educated) slept on average 417.12 (SD=76.88) minutes/night, had 83% (SD=5.64) sleep efficiency and an 11:15 pm bedtime. One-quarter of caregivers reported family/parenting issues as their primary stressor, with up to 90% taking a healthy action against stress (e.g., mindfulness-based techniques, distraction), yet 44% reported healthy strategies as ineffective in managing their stress. Mixed model results showed that caregiver sleep efficiency varied by stress management effectiveness (p=0.009), ranging from a low of -0.4% decreased sleep efficiency (ineffective strategies) up to a high of 1.5% increased efficiency (very effective strategies). Similarly, on days when caregivers reported high strategy effectiveness, their sleep duration increased by 48-minutes (p=0.034). Our findings underscore the importance of perceived stress management effectiveness on sleep quality and quantity in low-SES contexts. Future work is needed to better understand how toddler caregivers are employing stress management strategies, and if targeting such strategies may positively affect caregiver sleep. Rockefeller University Heilbrunn Family Center for Research Nursing (#UL1 TR001866); Institutional Development Award (IDeA) from NIH NIGMS (#U54-GM104941; PI: Hicks)

Study Objectives:We tested associations between serum 25-hydroxyvitamin D concentration ([25(OH)D]) and device-estimated sleep metrics, including sleep duration, sleep efficiency, sleep duration regularity, sleep timing regularity, and sleep regularity index (SRI), in young and early middle-aged adults (18-45 years). We also assessed the mediating effect of nighttime melatonin (urinary 6-sulfatoxymelatonin (aMT6s) excretion) on these associations. Methods:Participants (n = 79) completed 14 days of wrist actigraphy. Fasted blood sampling was performed to quantify serum [25(OH)D]. First morning void was used to quantify overnight urinary aMT6s excretion, normalized to creatinine clearance. Associations between [25(OH)D] and sleep metrics were evaluated using linear regression (model 1). Separate models adjusted for age, sex, race, and body fat % (model 2), season of testing, caffeine consumption, and education level (model 3), and device-estimated moderate-to-vigorous physical activity (model 4; n = 68). Results:Serum [25(OH)D] was positively associated with sleep duration, sleep efficiency, and SRI, and negatively associated with sleep duration regularity, sleep onset timing regularity, and sleep midpoint timing regularity in model 1 (all p < .03) and model 4 (all p < .02). In model 2, serum [25(OH)D] remained significantly associated with sleep duration only (p = .036). In model 3, serum [25(OH)D] remained significantly associated with all sleep metrics (p < .02) except sleep duration regularity and SRI. Serum [25(OH)D] was not associated with aMT6s:creatinine, indicating no grounds for performing mediation analyses. Conclusions:Serum [25(OH)D] is independently associated with several sleep metrics in healthy adults. However, nighttime melatonin concentration did not mediate these associations, thus other mechanistic pathways must be considered.

Introduction: Heightened negative affective responsivity (NA-R) to daily stressors predicts increased cardiovascular disease (CVD)-related morbidity and mortality, but the mechanisms remain incompletely understood. Psychological stress arising from daily life is associated with greater ambulatory blood pressure variability (BPV)—a major contributor to excessive CVD risk. However, no studies have examined the link between NA-R to daily stressors and beat-to-beat BPV or explored potential underlying mechanisms. Hypothesis: We hypothesized that greater NA-R to daily stressors would be positively related to elevated beat-to-beat BPV. Given studies reporting a link between NA-R to daily stressors and chronic sympathetic overactivation, we further hypothesized that greater NA-R to daily stressors would be positively related to augmented beat-to-beat total peripheral resistance (TPR) variability. Methods: Daily stress processes and affective dynamics were assessed during routine everyday life (daily diary) for 8 consecutive days in 81 normotensive young adults (58 female; 22±5 yrs; 115±9/79±10 mmHg). On the last day of daily assessments, beat-to-beat BP (finger photoplethysmography) was measured during 20-min of supine rest. TPR and cardiac output (CO) were estimated using Modelflow. NA-R to daily stressors was operationalized as the intra-individual slope of the change in negative affect on stressor days compared to stressor-free days (multilevel modeling). Results: Negative affect was greater on stressor days compared to stressor-free days (0.7±0.4 vs. 0.4±0.4; p<0.01), providing evidence of NA-R to daily stressors. NA-R to daily stressors was positively related to BPV (e.g., mean arterial pressure coefficient of variation; b =4.1, SE=1.9; p=0.03) but was not related to either TPR ( b =1.3, SE=3.3; p=0.69) or CO variability ( b =1.5, SE=2.8; p=0.59). Conclusions: These data suggest that amplified NA-R to daily stressors may be associated with elevated beat-to-beat BPV, thereby potentially contributing to increased daily stress-related CVD risk.

Hypertension diagnosed via peripheral (brachial) blood pressure (pBP) is a strong independent predictor of overt cardiovascular disease (CVD). However, central (aortic) blood pressure (cBP), which is influenced by arterial stiffness, may be more strongly associated with CVD risk. Young Black women (BLW) demonstrate higher pBP than White women (WHW), but investigations of racial differences in central haemodynamics and arterial stiffness in young women are lacking. We assessed pBP, central haemodynamics and arterial stiffness in young, non‐hypertensive BLW and WHW. We hypothesized that pBP, central haemodynamics (cBP, augmentation pressure (AP), augmentation index normalized to a heart rate of 75 beats per minute (AIx75), arterial wave reflections), and arterial stiffness (carotid–femoral pulse wave velocity (cf‐PWV)) would be higher in BLW. Under standardized resting conditions, supine brachial pBP was measured, and central haemodynamics were estimated via pulse wave analysis using partial cuff inflation. cf‐PWV was assessed via simultaneous carotid artery applanation tonometry and partial cuff inflation over the femoral artery. Participants were young, apparently healthy women who self‐identified their race as Black (BLW: n = 44) or White (WHW: n = 40). Systolic pBP ( P = 0.04) and diastolic pBP ( P < 0.01) were higher among BLW. Systolic cBP ( P < 0.01), diastolic cBP ( P < 0.01), heart rate ( P < 0.001), AP ( P = 0.02), AIx75 ( P < 0.001), arterial wave reflection magnitude ( P = 0.40) and cf‐PWV ( P = 0.04) were all higher among BLW. Findings demonstrate elevations in pBP, central haemodynamics and arterial stiffness in young BLW versus WHW. Central haemodynamics and arterial stiffness may be promising targets in the early assessment of CVD risk in young BLW.