Resa M. Jones

Background: The use of glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) for obesity management has gained widespread popularity and media attention. However, little is known about patients' knowledge related to GLP‐1 RAs (e.g., prescribing indications, side effects), how patients currently learn and wish to learn about GLP‐1 RAs, and how GLP‐1 RA use may impact weight‐related behaviors and attitudes within households (e.g., food purchasing patterns). Objective: This study evaluated these questions among diverse adults recruited from a large, urban health system. Methods: Participants were recruited to complete a brief online questionnaire through flyers posted in several outpatient clinics within a large health system. Recruitment occurred from November 2024 to April 2025. Descriptive statistics were calculated. Results: Fifty‐two patients completed the questionnaire. Overall, 98% of participants had heard at least “a little” about GLP‐1 RAs. The conditions participants most commonly believed could benefit from use were obesity (88%), diabetes (75%), and high blood pressure (43%). The side effects they had heard most about were nausea/vomiting (71%), diarrhea (49%), and constipation (47%). Expected amount of weight loss and understanding of GLP‐1 RAs' mechanisms of action varied widely. The most common GLP‐1 RA information source was commercials/advertisements (73%); however, the most frequently preferred information source was healthcare professionals (87%). In exploratory analyses among patients with current or past GLP‐1 RA use and ≥ 1 other household member ( n = 12), 75% believed their use impacted adult household members' attention to weight, eating, or exercise; 50% believed GLP‐1 RA use impacted child/adolescents household members' attention to these matters; and 42% reported perceived weight loss among household adult(s). All GLP‐1 RA users reported changes in their household meal behaviors, and many reported shifts toward more healthful food purchases. Conclusion: These findings suggest that many patients understand the primary indications for GLP‐1 RAs for obesity and common side effects, while also highlighting opportunities for improved decision support. Additional research on a potential “ripple effect” within households using larger samples and more robust methods is warranted.

Purpose: Long COVID literature often describes new-onset symptoms or conditions following SARS-CoV-2 infection; however, Long COVID also encompasses the exacerbation of pre-existing conditions. We describe health conditions reportedly worsened by COVID-19 illness and associated concerns in U.S. adults. Methods: We collected longitudinal data from adults 18 years and older participating in the Track Post COVID-19 Conditions, an active Long COVID cohort surveillance project. Respondents completed surveys 3-, 6-, and 12- months after COVID-19 illness, beginning in July 2023. In each survey, respondents were asked whether they had any health conditions or concerns that were made worse by COVID-19. Those with an affirmative response were asked to specify the worsening condition(s) via free text. Some respondents used this free text to describe challenges or experiences related to their worsening conditions. This report categorizes and quantifies reported conditions and concerns by body system categories and qualitatively describes associated challenges and experiences using direct quotes from respondents’ free text responses. Results: Among 2,227 adults, 263 (11.8%) respondents reported at least one worsening condition or concern following COVID-19 illness. Of these, nearly 32% reported a worsening respiratory condition or concern. Adults with worsening pre-existing conditions reported challenges accessing adequate care, completing daily activities, and managing their symptoms following COVID-19. Discussion: While Long COVID literature often focuses on the development of new-onset long-term symptoms, more than 1 in 10 adults reported worsening of a pre-existing condition following COVID-19. Reported challenges with accessing care and daily activities highlight potential need for accommodations or support for adults with Long COVID.

Purpose: To examine reasons for not having sex and contraceptive knowledge disparities by sexual activity status among college students aged 18-24. Design: A cross-sectional survey assessing sexual activity status, reasons for not having sex, and contraceptive knowledge was conducted. Setting: Large urban university. Sample: The study included 700 college students (sexually active: n = 443; inactive: n = 76; never had sex: n = 181). Measures: Sexual activity status was self-reported, and contraceptive knowledge were measured using the Contraception Knowledge Assessment (score range: 0-25). Demographics included sex, race, education year, sexual orientation, and age. Analysis: Descriptive statistics and adjusted linear regression models were used to compare mean contraceptive knowledge scores between groups, controlling for demographic factors. Results: Among students, 26% never had sex, were primarily female (86%) and white (54%), and citied “not finding the right person” (65%) and religious or moral reasons (12%) as top reasons for not having sex. In adjusted analyses, sexually active students had higher contraceptive knowledge scores than peers who never had sex (14.3 vs 12.5). Conclusion: Students who never had sex had lower contraceptive knowledge, suggesting a need for informational sex preparedness. All students, regardless of activity status, need comprehensive sexual education to support informed decisions and safe sex practices.

Background: Despite strong evidence supporting cardiovascular and kidney benefits of sodium‐glucose co‐transporter‐2 inhibitors (SGLT2i) and glucagon‐like peptide‐1 receptor agonists (GLP‐1 RA) in patients with type 2 diabetes, prescribing rates remain suboptimal. The aim of this study was to assess clinicians' knowledge and comfort prescribing SGLT2i and GLP‐1 RA in clinical practice and factors influencing prescribing of these agents. Methods: This multi‐methods study used questionnaires to assess self‐reported knowledge and comfort prescribing SGLT2i and GLP‐1 RA, and semi‐structured interviews based on the Consolidated Framework for Implementation Research (CFIR) to assess factors affecting prescribing decisions among 21 clinicians (12 primary care physicians, 4 pharmacists, 5 nurse practitioners) at a large community‐based health system in Virginia. Questionnaire results were analyzed using descriptive statistics, and interviews used a two‐phase analytic approach combining inductive and deductive coding. Results: Clinicians self‐reported high knowledge (7.9/10) and comfort (8.1 and 8.4/10) prescribing SGLT2i and GLP‐1 RA but identified multiple implementation barriers. The most significant barriers were insurance coverage and out‐of‐pocket costs, with prior authorization requirements delaying therapy initiation. Medicare beneficiaries faced particularly challenging access due to coverage gaps and ineligibility for manufacturer assistance programs. Organizational factors, including high workload, limited appointment time, and the absence of automated patient identification systems, hindered consistent prescribing. Medication burden, side effects, and aversion to injectable medications emerged as patient‐related barriers. Facilitators included strong clinical evidence supporting these agents, organizational culture supportive of innovation, and access to pharmacist support. Conclusion: Despite high self‐reported knowledge and comfort prescribing SGLT2i and GLP‐1 RA, clinicians identified barriers to their use in clinical practice at the patient, clinician, organizational, and medication access levels. Future work should identify the best implementation strategies to address these barriers.

Background: This study examined risk factors for post-COVID respiratory infection using data from the Tracking the Burden , Distribution , Impact of Tracking Post-COVID-19 Conditions in Diverse Populations for Children , Adolescents , Adults (Track PCC) passive surveillance cohort. Methods: This retrospective study included adult Temple Health patients in Philadelphia, Pennsylvania with SARS-CoV-2 (COVID-19) infections from March 2020 to December 2022 and ≥ 90 days follow-up. COVID-19 infection was identified via laboratory testing, billing codes, or clinical documentation. The primary outcome was post-COVID respiratory infection identified by billing codes. Predictors included social, clinical, and COVID-related correlates. Adjusted logistic regression models were used on 17,539 complete cases and multiple imputed datasets ( n = 45,513) with SuperMICE. Results: In complete-case analysis, uninsured coverage, Alpha variant, total comorbidities, and hospitalization were associated with lower odds of respiratory post-COVID conditions (ORs: 0.02–0.99). Dual Medicare/Medicaid and current smokers, increased odds (ORs: 1.33–1.58). Imputed analyses showed consistent results with and additionally observed higher odds of respiratory infection among those with Medicaid and higher number of vaccinations, and lower odds among those of any non-white race, Hispanic ethnicity. Conclusions: Temple Track PCC findings identify high-risk populations and underscore the utility of advanced imputation in surveillance-based research.

Geographic and racial/ethnic disparities in cancer outcomes exist but are not fully explained. As neighborhood context significantly influences these disparities, understanding factors related to neighborhood disadvantage (ND), including historical and structural injustice, will identify key areas that could eliminate disparities. This study will address three important limitations to understanding the role of neighborhood factors on cancer outcomes, the: (1) timing of exposures during the life course, (2) identification of the most important ND variables, and (3) comprehensive assessment of several domains of neighborhood-based exposures. The neighborhood exposome comprises four domains over the life course: socioeconomic deprivation, racial segregation, environmental pollutants, and built environment. To elucidate the relationship between ND and cancer risk, we will use Virginia and Pennsylvania state cancer registry data, case and control residential histories, and data documenting multiple historical and current ND exposure indicators. The aims of this project are to determine the effects of different ND exposure domains for colorectal, lung, and female breast cancer incidence cumulatively over time using residential histories. The expected outcomes of this research will be (1) new methods for estimating ND effects over time and (2) identification of previously undetected historic ND exposures associated with significant cancer risk.

Background: Cancer is a complex set of diseases, and many have decades-long lag times between possible exposure and diagnosis. Environmental exposures, such as per- and poly-fluoroalkyl substances (PFAS) and area-level risk factors (e.g., socioeconomic variables), vary for people over time and space. Evidence suggests PFAS exposure is associated with several cancers; however, studies to date have various limitations. Few studies have used rigorous spatiotemporal approaches, and, to our knowledge, none have assessed cumulative exposures given residential histories or incorporated chemical mixture modeling. Thus, spatiotemporal analysis using advanced statistical approaches, accounting for spatially structured and unstructured heterogeneity in risk, can be a highly informative strategy for addressing the potential health effects of PFAS exposure. Methods: Using population-based incident cancer cases and cancer-free controls in a 12-county area of southeastern Pennsylvania, we will apply Bayesian spatiotemporal analysis methods using historically reconstructed PFAS-contaminated water exposure given residential histories, and other potential cancer determinants over time. Bayesian group index models enable assessment of various mixtures of highly correlated PFAS chemical exposures incorporating mobility/residential history, and contextual factors to determine the association of PFAS-related exposures and cancer incidence. Discussion: The purpose of this paper is to describe the Enhanced PFAS Spatial Analysis study rationale, study design, and methods.

Background: Track PCC includes five geographic surveillance sites to conduct standardized population-based surveillance to estimate and track Post-COVID Conditions (PCC) by age, sex, race/ethnicity, geographic area, severity of initial infection, and risk factors among persons with evidence of SARS-CoV-2 infection (based on the Council of State and Territorial Epidemiologist [CSTE] case definitions for confirmed cases or laboratory-confirmed evidence of infection). Methods: The study will estimate the incidence, prevalence, including temporal trends, and duration and severity of PCC symptoms, among children, adolescents, and adults. PCCs include a broad range of symptoms and conditions that continue or develop after acute SARS-CoV-2 infection or COVID-19 illness. Surveillance includes both passive and active components for diverse populations in Arizona, Indiana, and Utah as well as the Bronx Borough, NY, and part of Philadelphia County, PA. Passive surveillance will utilize electronic health records and health information exchanges within each site catchment area to longitudinally follow persons with COVID-19 to estimate PCC occurring at least 30 days after acute COVID-19 illness. Active surveillance will utilize self-report of PCCs from detailed surveys of persons ages 7 years and older with evidence of SARS-CoV-2 infection in the past 3 months. Respondents will complete follow-up surveys at 6-, 12- and 18-months post-infection. Discussion: These data can help identify which groups are most affected by PCC, and what health differences among demographic groups exist, as well as indicate potential barriers to care. These additional levels of granularity can inform public health action and help direct needed clinical care for patients.