The relationship of smoking and unhealthy alcohol use to HIV care retention and viral suppression: findings from a multi-site cohort study.

Objectives: Tobacco smoking and alcohol use may negatively influence HIV care, but associations have not been examined across cohorts.

Design: Multisite international collaboration of cohort studies.

Methods: People with HIV (PWH) were included from 11 cohorts; 5 North American and 6 Western European.

Incidence of Heart Failure in Asian American, Native Hawaiian, and Other Pacific Islander Populations.

Background: Asian American, Native Hawaiian, and Other Pacific Islander (AANHPI) persons comprise ∼10% of the U.S. population-24 million people-yet a significant gap exists in contemporary data on incident heart failure (HF).

Association between proximity to a lead releasing facility and cognition in diverse cohorts.

Background: While lead exposure is associated with poorer cognitive performance in children, the association with late life cognition in diverse cohorts is unknown.

Method: In two adult cohorts (Kaiser Health Aging and Diverse Life Experiences (KHANDLE, n=1,638), Study of Healthy Aging in African Americans (STAR, n=741)), we assessed residential proximity to lead releasing facilities, measured through the Toxics Release Inventory, for associations with domain-specific cognition, measured using the Spanish and English Neuropsychological Assessment Scales, two years later. Linear regression models were adjusted for age, sex, race/ethnicity (KHANDLE only), income, education, marital status, smoking status, and alcohol consumption.

A Healthcare System's Path to Carbon Neutrality: Addressing Climate Change and Role of the Health Care.

Introduction: Anthropogenic climate change, according to the WHO, results in approximately 150,000 deaths annually through mechanisms such as heat-related mortality, altered food production, and the spread of infectious diseases. With climate change predicted to cause over half a million climate-related deaths by 2050, healthcare systems, which contribute significantly to greenhouse gas emissions, must adopt roles in environmental stewardship.

Methods: This descriptive case study details how Kaiser Permanente, a large nonprofit organization, became the first carbon-neutral healthcare system in the country.

Associations Between Immigrant Status and Dietary Patterns in ENCLAVE, A Pooled, Observational Study of Women Diagnosed With Breast Cancer.

Background: Diet, critical to breast cancer (BC) survivorship, may change with immigration.

Objective: We examined associations between immigration factors and diet in a large, diverse population of BC survivors.

Methods: The Exploring Networks in a Cohort of Latina and Asian Emigrants, lifestyle, and Vital status (ENCLAVE) study included harmonized, pooled data from 4882 Asian, Hispanic, and non-Hispanic White (NHW) women from 3 Northern California cohorts of women diagnosed from 1996 to 2013 with invasive BC and who provided data on immigrant status and diet.

Association of Preconception and Prenatal Cannabis Use with Breastfeeding.

Introduction: Breastfeeding is recommended. It is unknown whether preconception or prenatal cannabis use are related to breastfeeding behaviors.

Methods: This population-based retrospective cohort study included 200,207 pregnancies in Northern California (2016-2022) with live births screened in early pregnancy for cannabis use.

Exposure to organophosphate ester flame retardants and plasticizers during pregnancy and autism-related outcomes in the ECHO Cohort.

Background: Organophosphate ester flame retardants and plasticizers (OPEs) have myriad uses in industry and consumer products. Increasing human exposure to OPEs has raised concerns about their potential effects on child neurodevelopment during pregnancy.

Objective: We investigated whether OPE urinary concentrations during pregnancy were associated with child autism-related outcomes.

Maternal Prenatal Cannabis Use and Major Structural Birth Defects.

Objective: We evaluated associations between prenatal cannabis use and major structural birth defects of the child.

Methods: This population-based retrospective cohort study comprised singleton births (January 2011-July 2020) universally screened for substance use at entrance to prenatal care. Prenatal cannabis use was defined as self-reported use or a positive toxicology test during pregnancy.

Developing and Validating Models to Predict Suboptimal Early Glycemic Control Among Individuals With Younger Onset Type 2 Diabetes.

Objective: Younger age at the time of type 2 diabetes onset increases individuals' future complication risk. Proactively identifying younger-onset individuals at increased risk of not achieving early glycemic goals can support targeted initial care.

Design And Methods: Individuals (ages 21-44) newly diagnosed with type 2 diabetes were identified and randomly assigned to training (70%) and validation (30%) datasets.

Associations of Local Cannabis Policy and Retail Availability in Northern California with Adverse Adolescent Mental Health Outcomes.

Background: Local policies prohibiting cannabis sales and lower cannabis retail availability are associated with a lower prevalence of adolescent cannabis use. In this study, we examined whether local prohibitions on cannabis retail and cannabis retailer proximity and density are associated with adverse cannabis-related mental health outcomes among adolescents.

Methods: Cross-sectional study of 95,645 Northern California adolescents aged 13-17 who completed a well-check questionnaire in 2021 during standard pediatric care.

Moving to greener neighborhoods and healthcare costs in Northern California.

Background: Environmental drivers of healthcare costs are mainly unknown. Studies that account for changes in longitudinal, within-individual changes accompanying changes in residential addresses have not been conducted. In the current study, we tested whether moving to a greener neighborhood was associated with decreases in healthcare costs and whether these associations vary by individual and neighborhood-level characteristics.

Nativity and Healthy Lifestyle Index in a Pooled Cohort of Female Breast Cancer Survivors from Northern California.

Background: In the United States, breast cancer is common in Asian, Hispanic, and non-Hispanic White (NHW) women, many of whom are immigrants. A healthy lifestyle is vital to survival, but it is unknown how lifestyle varies by nativity among survivors.

Methods: The study included 4,754 racially diverse, female breast cancer survivors from the Northern California, Exploring Networks in a Cohort of Latina and Asian Emigrants, Lifestyle, and Vital Status (ENCLAVE) study.

Patterns of substance use and associations with mental health and interpersonal violence among adolescents.

Objective: To identify patterns of adolescent substance use and associated behavioral health characteristics among adolescents.

Methods: We conducted a cross-sectional study of 167,504 adolescents aged 13-17 who were screened for substance use, mental health symptoms, and interpersonal violence during well-check visits in a large healthcare system in California from 2021 to 2022. We conducted latent class analysis to identify patterns of substance use from four substance use behaviors (past-year alcohol, cannabis, other substance, and close friends' use).

Early Pregnancy Blood Pressure Trajectories and Hypertension Years After Pregnancy.

Background: Hypertensive disorders of pregnancy (HDP) increase cardiovascular disease risk. Blood pressure (BP) trajectories ≤20 weeks' gestation predict HDP outcomes. We hypothesized that early-pregnancy BP patterns stratify risk of developing hypertension years after pregnancy.

Urinary concentrations of early and mid-pregnancy parabens and gestational diabetes: A nested case-control study within the PETALS cohort.

Parabens are widely used preservatives with endocrine-disrupting properties, but their role in glucose metabolism during pregnancy is unclear. This study examines prospective associations between urinary concentrations of four parabens in early and mid-pregnancy and gestational diabetes (GDM). A matched case-control study nested within a diverse longitudinal pregnancy cohort (PETALS) with universal GDM screening matched GDM cases to two controls (111 cases; 222 controls).

Frequency of Preconception and Prenatal Cannabis Use and Nausea and Vomiting in Pregnancy.

This cross-sectional study analyzed associations between preconception and prenatal cannabis use and first-trimester nausea and vomiting in pregnancy (NVP) using data from 356,343 pregnancies in a large health care system (2011-2022). Prevalence of preconception and prenatal cannabis use was 11.3% (2.

Early identification of weight loss trajectories in advanced cancer and associations with survival.

Consensus criteria to diagnose unintentional weight loss, a condition often termed cachexia that affects most patients with advanced cancer, are based on 6-month changes by which time intervention is often ineffective. Leveraging the large and diverse population in Kaiser Permanente Northern California's community oncology practice, we studied 8338 patients with advanced lung, pancreatic, or colorectal cancers. We calculated weekly weight change measurements from 2 months pre- to 6 months post-diagnosis to identify 4 weight change trajectories (Gain, Stable, Moderate Loss, and Severe Loss) and associated these trajectories with survival.

Alcohol, Cannabis, and nicotine use during early pregnancy and infant hearing loss.

Objective: To examine whether maternal prenatal alcohol, cannabis, or nicotine use was associated with offspring diagnoses of hearing loss during the first six months of life.

Methods: We conducted a population-based retrospective birth cohort study of infants (N = 297,147) born between 2011 and 2023 to pregnant individuals (N = 233,902) in Kaiser Permanente Northern California universally screened for any prenatal alcohol, cannabis, or nicotine use since pregnancy at entrance to prenatal care (at ∼8-10 weeks gestation). Offspring hearing loss was defined as ≥1 hearing loss diagnosis in the infant's electronic health record based on ICD codes.

Unraveling the genetic landscape of susceptibility to multiple primary cancers.

With advances in cancer screening and treatment, there is a growing population of cancer survivors who may develop subsequent primary cancers. While hereditary cancer syndromes account for only a portion of multiple cancer cases, we sought to explore the role of common genetic variation in susceptibility to multiple primary tumors. We conducted a cross-ancestry genome-wide association study (GWAS) and transcriptome-wide association study (TWAS) of 10,983 individuals with multiple primary cancers, 84,475 individuals with single cancer, and 420,944 cancer-free controls from two large-scale studies.

Wildfire Air Pollution and Rates of Cardiovascular Events and Mortality in Northern California in 2018.

Background: We examined the association between acute cardiovascular disease (CVD) events and wildfire air pollution in California in 2018.

Methods: The study included adult (≥18 years) members of Kaiser Permanente Northern California, an integrated health care system. Outcomes included CVD events (hospitalizations for acute myocardial infarction, heart failure, or stroke, and CVD death) and death from any cause.

Severe Maternal Morbidity Associated With Chronic Hypertension, Preeclampsia, and Gestational Hypertension.

Importance: Chronic hypertension and preeclampsia are leading risk enhancers for maternal-neonatal morbidity and mortality. Severe maternal morbidity (SMM) indicators include heart, kidney, and liver disease, but studies have not excluded patients with preexisting diseases that define SMM. Thus, SMM risks for uncomplicated chronic hypertension specific to preeclampsia remain unclear.

Early Postpartum Metabolic Heterogeneity Among Women Who Progressed to Type 2 Diabetes After Gestational Diabetes: A Prospective Cohort.

Aims: Gestational diabetes mellitus (GDM) poses a significant risk for developing type 2 diabetes mellitus (T2D) and exhibits heterogeneity. However, understanding the link between different types of post-GDM individuals without diabetes and their progression to T2D is crucial to advance personalised medicine approaches.

Materials And Methods: We employed a discovery-based unsupervised machine learning clustering method to generate clustering models for analysing metabolomics, clinical, and biochemical datasets.

Unraveling the genetic landscape of susceptibility to multiple primary cancers.

With advances in cancer screening and treatment, there is a growing population of cancer survivors who may develop subsequent primary cancers. While hereditary cancer syndromes account for only a portion of multiple cancer cases, we sought to explore the role of common genetic variation in susceptibility to multiple primary tumors. We conducted a cross-ancestry genome-wide association study (GWAS) and transcriptome-wide association study (TWAS) of 10,983 individuals with multiple primary cancers, 84,475 individuals with single cancer, and 420,944 cancer-free controls from two large-scale studies.

The association of maternal COVID-19-infection during pregnancy on the neonatal immune profile and associations with later diagnosis of neurodevelopmental disorders.

Despite the prevalence and significant concern of COVID-19 in maternal and offspring health, little is known about the impact of COVID-19 during pregnancy on newborn immunity and neurodevelopment. This study aimed to examine 1) the relationship between maternal COVID-19 during pregnancy and newborn immune profiles and investigate the 2) associations between specific newborn immune profiles and the risk of subsequent diagnosis of a neurodevelopmental disorder (NDD) among children with prenatal exposure to COVID-19. Newborn dried bloodspots (NBS) from 545 children born at Kaiser Permanente Northern California between January 2020 and September 2021 (460 [223 males, 237 females] to COVID-19-infected [COVID+] mothers; 85 [45 males, 40 females] to COVID-19-uninfected [COVID-] mothers) were used to profile newborn immune molecules via a 42-plex cytokine/chemokine assay.