David William Lounsbury

Albert Einstein College of Medicine | AECOM · Department of Epidemiology & Population Health

Purpose: We aimed to help community stakeholders develop a shared understanding of the opioid crisis through qualitative system dynamics (SD) modeling to inform local strategies for prevention and treatment. Methods: As part of the HEALing Communities Study-New York State, we used secondary qualitative data from community stakeholder interviews and...

Aims: To assess clinicians' self-reported knowledge of current policies in African oncology settings, of their personal communication practices around sharing bad news with patients, and to identify barriers to the sharing of serious news in these settings. Methods: A cross-sectional study of cancer care providers in African oncology settings (N...

Introduction: The use of digital technology in HIV-related interventions and implementation strategies is increasing. Whether the use of technology is to directly improve patient outcomes (ie, part of the intervention) or as part of the strategy to implement interventions has important implications. In this article, we present 5 case studies of pr...

Recent literature indicates that apathy is associated with poor cognitive and functional outcomes in older adults, including motoric cognitive risk syndrome (MCR), a predementia syndrome. However, the underlying biological pathway is unknown. The objectives of this study were to (1) examine the cross-sectional associations between inflammatory cyto...

HIV-outcome inequities remain prevalent in the U.S. Medical providers (MPs) are gatekeepers of PrEP, and understanding the dynamics of PrEP assessments is of major interest for public health. We analyzed data from Together 5000, an internet-based U.S. national cohort of sexual and gender minority (SGM) individuals aged 16-49 years and at risk for H...

Objectives. To create causal loop diagrams that characterize intersectional stigma experiences among Black, gay, bisexual, same gender–loving, and other men who have sex with men and to identify intervention targets to reduce stigma and increase testing and prevention access. Methods. Between January and July 2020, we conducted focus groups and in-...

The Ryan White CARE Act provides federal dollars supporting low income people living with HIV/AIDS (PLWH). Regional Ryan White Planning Councils (RWPC) are responsible for setting priorities and deciding CARE Act fund allocations, using local data to identify greatest need. However, RWPC are challenged with interpreting complex epidemiological, ser...

Despite the disproportionate burden of Alzheimer's disease in older adults of color, the scientific community continues to grapple with underrepresentation of racial and ethnic minorities in clinical research. Our Center of Excellence for Alzheimer's Disease (CEAD) collaborated with a local community partner to conduct community engagement (CE) stu...

Background The food system is a social determinant of health and leverage point for reducing diet-related racial inequities. Yet, food system interventions have not resulted in sustained improvement in dietary outcomes for underrepresented minorities living in neighborhoods with a history of disinvestment. Research is needed to illuminate the dynam...

BACKGROUND Background: Inclusion of social determinants of health is mandated for undergraduate medical education. However, little is known about how prepare pre-clinical students for “real world” screening and referrals to address social determinants of health. OBJECTIVE The pilot project objective was to evaluate the feasibility of using “real w...

Background: The inclusion of social determinants of health is mandated for undergraduate medical education. However, little is known about how to prepare preclinical students for real-world screening and referrals for addressing social determinants of health. Objective: This pilot project's objective was to evaluate the feasibility of using a re...

Access to fresh and healthy food within a neighborhood has been identified as a social mechanism contributing to community health. Grounded in the understanding that challenges related to equity within a food system are both structural and systemic, our research demonstrates how systems thinking can further understandings of food system complexity....

Background: The objective of this paper was to describe the role of dietary practices and physical activity in the interaction of the social determinants of non-communicable diseases (NCDs) in Nepal. Method: The study was a qualitative study design guided by systemic intervention methodology. Qualitative data were collected through key informant in...

Psychosocial health can influence the development and experience of several chronic diseases, and has been negatively affected for many individuals amid the COVID-19 global pandemic. To understand the impact of contemplative practices on emotional and mental health during COVID-19, the Stanford WELL for Life Study (US component), incorporated a ser...

Introduction Non-communicable diseases (NCDs) are a rapidly emerging global health challenge with multi-level determinants popularly known as social determinants. The objective of this paper is to describe the individual and community experiences of NCDs in the two case districts of Nepal from a social determinants of health perspective. Method Th...

The article “Participatory System Dynamics Modeling: Increasing Stakeholder Engagement and Precision to Improve Implementation Planning in Systems”, written by “Lindsey Zimmerman, David W. Lounsbury, Craig S. Rosen, Rachel Kimerling, Jodie A. Trafton, Steven E. Lindley”, was originally published Online First without Open Access. After publication i...

Community-driven responses are essential to ensure the adoption, reach and sustainability of evidence-based practices (EBPs) to prevent new cases of opioid use disorder (OUD) and reduce fatal and non-fatal overdoses. Most organizational approaches for selecting and implementing EBPs remain top-down and individually oriented without community engage...

Objective: To identify dietary patterns (DP) of children enrolled in the Family Weight Management Study (FWMS) and to examine relationship between the identified DP with demographics. Design: We performed a cross-sectional analysis of baseline data from 332 children (BMI ≥85th percentile for age and sex and 7–12 years old) who were enrolled in the...

Objective Physical activity (PA) during COVID-19 shelter-in-place (SIP) may offset stress. This study examined associations between PA, stress and stress management strategies during SIP. Design and main outcome measures Participants (N = 990) from a cohort of Northern California adults completed surveys during early SIP (3/23/20-4/2/20) and mid-S...

Apathy is a psychological syndrome characterized by lack of motivation, interest, flattening of affect and social withdrawal; which has been associated with cognitive and functional decline in community dwelling older adults. Many of these associations have been investigated using subscales of depression tools, with varying sensitivity and specific...

Background Opioid overdose deaths remain high in the U.S. Despite having effective interventions to prevent overdose deaths, there are numerous barriers that impede their adoption. The primary aim of the HEALing Communities Study (HCS) is to determine the impact of an intervention consisting of community-engaged, data-driven selection, and implemen...

This protocol describes the development, design, and calibration of a system dynamics (SD) model of the HIV Care Continuum (CC) in one geographic region. Community stakeholders can use this SD model to better understand structural and behavioral characteristics of the HIV CC system and to inform strategic planning to determine the most promising st...

Background: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The sy...

Background: Household air pollution (HAP) is a significant source of the global burden of disease. Our objective was to evaluate the association between environmental health literacy (EHL), a domain of health literacy (HL) that describes the ability to use environmental health information to reduce health risks, and symptoms associated with HAP....

The continuing HIV pandemic calls for broad, multi-sectoral responses that foster community control of local prevention and care services, with the goal of leveraging high quality treatment as a means of reducing HIV incidence. Service system improvements require stakeholder input from across the care continuum to identify gaps and to inform strate...

This protocol describes the development, design, and calibration of a system dynamics (SD) model of the HIV Care Continuum (CC) in one geographic region. Community stakeholders can use this SD model to better understand structural and behavioral characteristics of the HIV CC system and to inform strategic planning to determine the most promising st...

This protocol describes the development, design, and calibration of a system dynamics (SD) model of the HIV Care Continuum (CC) in one geographic region. Community stakeholders can use this SD model to better understand structural and behavioral characteristics of the HIV CC system and to inform strategic planning to determine the most promising st...

Background: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal contributing to rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health system. Systems approach has...

Background: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The sys...

Background: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The sys...

Background: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The sys...

System dynamics (SD) modeling is used to compare and contrast strategies for effective implementation of an evidence-based adolescent behavioral health treatment in primary care settings. With qualitative and quantitative data from an on-going cluster-randomized trial in 7 federally qualified health center sites, two implementation conditions were...

Objectives Music therapy has been shown to be effective for reducing anxiety and pain in people with a serious illness. Few studies have investigated the feasibility of integrating music therapy into general inpatient care of the seriously ill, including the care of diverse, multiethnic patients. This leaves a deficit in knowledge for intervention...

Objectives: Home environment may influence children's health behaviors associated with obesity. In this study, we examined home environment factors associated with diet and physical activity behaviors of overweight or obese youth. Methods: We analyzed baseline data from child and parent/caregiver dyads enrolled in an urban family weight management...

Objective The Patient-Reported Outcomes Measurement Information System (PROMIS®) Network has developed a comprehensive repository of electronic patient reported outcomes measures (ePROs) of major symptom domains that have been validated in cancer patients. Their use for patients with gynecologic cancer has been understudied. Our objective was to es...

Background: School health curricula should help students choose health goals related to the Dietary Guidelines (DG) recommendations addressing obesity. We aimed to identify characteristics associated with choice of DG recommendation items. Methods: In 12 HealthCorps affiliated high schools, students completed a 19-item web-based questionnaire that...

Background and context: In Nigeria, cancer leads to >72,000 deaths per annum (30,924 for male and 40,647 for female). This number is set to increase given that there are 102,000 new cases of cancer every year. The estimated incidence for prostate cancer is (12%) and estimated mortality prostate (13%). Prostate cancer is the third leading cancer dea...

Purpose: Health research in low- and middle-income countries can generate novel scientific knowledge and improve clinical care, fostering population health improvements to prevent premature death. Project management is a critical part of the success of this research, applying knowledge, skills, tools, and techniques to accomplish required goals. H...

Purpose: Cancer of the prostate (CaP) is the leading cancer among men in sub-Saharan Africa (SSA). A substantial proportion of these men with CaP are diagnosed at late (usually incurable) stages, yet little is known about the etiology of CaP in SSA. Methods: We established the Men of African Descent and Carcinoma of the Prostate Network, which i...

Correction: Following the publication of the original article [1], it was brought to our attention that author Judith Wylie-Rosett was erroneously included as Judith Wylie.

Background: Adolescent obesity is a major public health concern. Open to all high school students regardless of weight status, HealthCorps is a nationwide program offering a comprehensive high school-based participatory educational program to indirectly address obesity. We tested a hypothesis that the HealthCorps program would decrease BMI z-score...

This study evaluated the associations among perceived risk, perceived efficacy, and engagement in six cancer-related risk behaviors in a population-based Hispanic/Latino sample. Interviews were conducted with 5,313 Hispanic/Latino adults as part of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. Partic...

Achieving community-level goals to eliminate the HIV epidemic requires coordinated efforts through community consortia with a common purpose to examine and critique their own HIV testing and treatment (T&T) care system and build effective tools to guide their efforts to improve it. Participatory system dynamics (SD) modeling offers conceptual, meth...

Reduction of cancer-related disparities requires strategies that link medically underserved communities to preventive care. In this community-based participatory research project, a public library system brought together stakeholders to plan and undertake programs to address cancer screening and risk behavior. This study was implemented over 48 mon...

Background Prevalence of non-communicable diseases has been increasing at a greater pace in developing countries and, in particular, the South Asia region. Various behavioral, social and environmental factors present in this region perpetuate common metabolic risk factors of non-communicable diseases. This study will identify social determinants of...

While complex systems science approaches have been increasingly embraced within many scientific fields, in the social sciences the incorporation of these approaches has been sluggish. For Community Psychology, whose foci for research and action are inherently complex in nature, complex systems science provides a potent theoretical, conceptual, meth...

Objective Preterm birth is a leading cause of perinatal morbidity and mortality. Prevention strategies rarely focus on preconception care. We sought to create a preconception nomogram that identifies nonpregnant women at highest risk for preterm birth using the Pregnancy Risk Assessment Monitoring System (PRAMS) surveillance data. Methods We used P...

We describe a co-flow structure that models internal, goal-directed changes to an attribute (e.g., employee loyalty) of fundamental material (e.g., employees). This co-flow accommodates problems not adequately modeled with an existing, generic structure. Our structure builds on the co-flow proposed by Hines, which uses an information delay to model...

Implementation planning typically incorporates stakeholder input. Quality improvement efforts provide data-based feedback regarding progress. Participatory system dynamics modeling (PSD) triangulates stakeholder expertise, data and simulation of implementation plans prior to attempting change. Frontline staff in one VA outpatient mental health syst...

Background: Cancers constitute a significant public health problem in Nigeria. Breast, cervix and prostate cancers are leading causes of cancer-related deaths. Changing diets, lifestyles, HIV/AIDS and macro-structural factors contribute to cancer morbidity and mortality. Poor health information linking cancer risk to individual behaviors, environm...

Purpose: Lung cancer is the most common incident cancer worldwide, accounting for 13% of all cancers. With decreasing burden of infectious diseases and increasing life expectancy in Africa, this study sought to identify risk factors for lung cancer and suggest mitigation strategies for implementation. Methods: Lung cancer incidence rates for the di...

Women in the US continue to be affected by HIV through heterosexual contact. Sexual risk behaviors among women have been associated with a syndemic, or a mutually reinforcing set of conditions, including childhood sexual abuse (CSA), depression, substance use, violence, and financial hardship. Baseline data from a cohort of women with and at-risk f...

Background: HealthCorps provides school wellness programming using curricula to promote changes in nutrition, mental health, and physical activity behaviors. The research objective was to evaluate effects of implementing its curricula on nutrition, mental health, and physical activity knowledge and behavior. Methods: Pre- and postsurvey data wer...

Since 2012, US guidelines have recommended against prostate-specific antigen (PSA) screening for prostate cancer. However, evidence of screening benefit from the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening trial and the European Randomized Study of Screening for Prostate Cancer has been inconsistent, due partly to differences in...

Objective: This descriptive cross-sectional study assessed cancer patients' use of traditional healers, the association between delay in coming to this clinic and patients' use of traditional healers, reasons cancer patients use western medicine after trying traditional treatment and the cost of obtaining traditional treatment. Methods: Particip...

Syndemic risk is an ecological construct, defined by co-occurring interdependent socio-environmental, interpersonal and intrapersonal determinants. We posited syndemic risk to be a function of violence, substance use, perceived financial hardship, emotional distress and self-worth among women with and at-risk for HIV in an impoverished urban commun...

The home environment, which includes parenting practices, is an important setting in which children develop their health behaviors. We examined the role of parenting practices in the home environment among underserved youth. We examined baseline data of a family-focused pediatric obesity intervention. Parenting practices (monitoring, discipline, li...

Alcohol, tobacco, and other drug use remains highly prevalent among US adolescents and is a threat to their well-being and to the public health. Evidence from clinical trials and meta-analyses supports the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) for adolescents with substance misuse but primary care provider...

Men of African descent have the highest incidence and mortality rates of prostate cancer (PrCa) worldwide. Notably, PrCa is increasing in Africa with Nigerian men being mostly affected. Thus, it is important to understand risk factors for PrCa in Nigeria and build capacity for cancer research. The goals of this study were to determine the feasibili...

The current chapter applies a systems thinking approach to define and study the dynamics underlying increased rates of obesity in Low and Middle Income Countries (LMICs). Systems thinking and dynamics modeling belong to the rapidly evolving, interdisciplinary field of system science research. This field adds value to more traditional public health...

System dynamics (SD) modeling belongs to the rapidly evolving, interdisciplinary field of system science research. This field adds value to more traditional health research by contributing to the design and testing of complex integrated models of change, to examine health system performance and patient outcomes. Using selected milestones in HIV car...