About

Knashawn H. Morales is a Professor of Biostatistics and Epidemiology at the Hospital of the University of Pennsylvania and a Senior Scholar at the Center for Clinical Epidemiology and Biostatistics within the Perelman School of Medicine. He is also the Director of Statistics for the Master of Science in Health Policy Research program at the University of Pennsylvania. Dr. Morales holds a BA in Mathematics from Hampton University, an Sc.M. in Biostatistics from Harvard University, and an Sc.D. in Biostatistics from Harvard University. His research expertise is in biostatistics, with a focus on epidemiological methods and health data analysis. His work includes applications in risk assessment for environmental exposures, weight change patterns in different populations, behavioral interventions for health conditions such as asthma and insomnia, and social influences on health behaviors. Dr. Morales has contributed to numerous publications addressing diverse health issues, emphasizing the application of statistical methods to improve health outcomes and health disparities.

Research topics

• Medicine
• Internal medicine
• Psychiatry
• Psychology
• Family medicine

Selected publications

• Meal Timing Patterns and Associations with Fat Mass in Adolescents

  medRxiv · 2026-04-23

  articleOpen access

  Background: The timing of energy intake could be important in the development of obesity. However, most observational evidence stems from adults, anthropometric defined obesity outcomes, single meal timing phenotyping, and traditional regression modeling. Objective: We aimed to describe meal timing patterns in adolescents and determine if they associated with fat mass by modeling the median and all other percentiles of the frequency distribution. Methods: We analyzed data from the Sleep and Growth Study 2 (S-Grow2, N=286, 12-13y). Participants completed 3-day 24-hour dietary recalls and time stamped eating occasions were used to define 8 meal timing traits, with aide from self-reported wake and bed timing. Principal component analysis (PCA) identified multi-dimensional meal timing patterns. Fat mass index (FMI) was estimated using dual energy X-ray absorptiometry. Quantile regression assessed if there were associations between meal timing traits and FMI across the entire FMI frequency distribution. Results: The typical first and last eating occasions were 8:00am (40 minutes after waking) and 8:00pm (2.7 hours before sleep), respectively, thus the eating period typically lasted 11.5 hours per day. The typical eating period midpoint was 2:15pm, and the timing when 50% of energy intake was consumed typically occurred at 3:15pm. PCA revealed three meal timing patterns: 1) "Delayed Start, Condensed Eating Period" (43% of variance; shorter eating period and delayed timing of first eating); 2) "Late, Sleep Proximal Eating" (30% of variance; later timing of last eating and extended eating period), and 3) "Later Energy Intake" (10% of variance; delayed energy intake midpoint). Higher scores for the "Delayed Start, Condensed Eating Period" pattern associated with higher body mass index and FMI at the upper tails of their distributions. Conclusions: Distinct multidimensional meal timing patterns emerged in early adolescence, with the delayed start, condensed eating period pattern potentially associated with higher adiposity.

  PublisherOA PDFDOI

• HIV Prevention Continuum Outcomes Following Implementation of a Municipal HIV Self-Testing Program

  AIDS and Behavior · 2025-08-14 · 2 citations

  articleOpen access

  HIV self-testing (HIVST) must lead to engagement in the HIV status neutral continuum to maximize its benefits. The objective of this research was to determine the reach of a public health HIVST program, characterize the HIV prevention continuum following self-testing, and identify correlates associated with obtaining post-test care and discussing PrEP. We prospectively recruited individuals who obtained an HIVST through a municipal program in Philadelphia, a metropolitan area with high burden of HIV. We examined factors associated with seeing a provider after self-testing, and among those who saw a provider, factors associated with discussing PrEP. Between October 2022 and March 2024, 282 people met inclusion criteria. Men who have sex with men (MSM) comprised 28% of the study sample, 22% identified as Black cis-gender women, and 22% reported no prior HIV test. At one-month follow-up, 53% of respondents with HIV-negative/unknown status saw a provider, but less than a quarter of those discussed PrEP. Black individuals were more than twice as likely to see a provider compared with White individuals. Among those who saw a provider, MSM and Latinx/e individuals were more likely to discuss PrEP, while those assigned female at birth were less likely to discuss PrEP. Implementation of a municipal HIVST program can advance health equity by reaching priority populations, including previously untested persons. Although over half of participants saw a provider after self-testing, very few discussed or initiated PrEP. Interventions to promote linkage to care and PrEP uptake are needed to maximize the impact of HIVST.

  PublisherDOI

• ASSOCIATIONS OF DEPLOYMENT TO IRAQ OR AFGHANISTAN WITH NEW-ONSET ASTHMA AND UPPER RESPIRATORY DISEASES

  Annals of Allergy Asthma & Immunology · 2025-11-01

  article
  PublisherDOI

• Authors’ response

  Annals of Allergy Asthma & Immunology · 2025-06-01

  letter
  PublisherDOI

• 0538 A Randomized Controlled Trial of CBT-I in Veterans in Early Recovery from Alcohol Use Disorder

  SLEEP · 2025-05-01

  articleOpen access

  Abstract Introduction Although insomnia increases relapse risk in early recovery from Alcohol Use Disorder (AUD), no adequately powered clinical trial has evaluated the efficacy of Cognitive Behavioral Therapy for Insomnia (CBT-I) on either insomnia or alcohol outcomes in a largely African-American sample. Objectives: 1) To determine the efficacy of CBT-I for improving insomnia, alcohol-related outcomes, and daytime functioning at post-treatment and at 3- and 6-month follow-up; 2) Evaluate whether improvement in insomnia is associated with a reduction in alcohol-related outcomes post-treatment. Methods Design: A randomized, controlled clinical trial of CBT-I compared to Quasi-Desensitization therapy (QDT), conducted between 2015 and 2020, with assessments at baseline, end of treatment (8 weeks), and 3- and 6-month post-treatment (Clinicaltrials.gov # NCT01987089). Setting: Outpatient addiction psychiatry clinic at an urban VA Medical Center. Participants: 63 veterans (51.6±9.6 years, 58 men (92.1%), 52 African-Americans (82.54%) with insomnia and past-year AUD. Intervention(s): Eight weekly in-person sessions of either CBT-I (n=31) or QDT (n=32). Main Outcome(s) and Measure(s): Primary outcomes were the Insomnia Severity Index score (ISI), and Percent Days Abstinent (PDA, from the Timeline Follow Back interview). Secondary outcomes were sleep diary variables, drinks per day, percent non-heavy drinking days, Penn Alcohol Craving Scale score, and scores from the 12-item Short Form scale (SF-12), Beck Depression Inventory and Trait subscale from the State-Trait Anxiety Inventory. Results Post-treatment data were obtained from 88.9% of participants. Although CBT-I was efficacious in improving insomnia with effect sizes (E.S.) larger than the meta-analytic estimates, QDT was equally efficacious in improving insomnia (E.S.=-1.63 vs. -1.50), improving abstinence (E.S.=1.54 vs. 1.91) and next-day functioning (E.S.=-0.26 vs. -0.17). Across treatment groups, remission from insomnia was associated with a lower post-treatment alcohol craving score at 8 weeks (2.8, 95% CI=1.1, 4.4 vs. 9.5, 95% CI=6.1, 13.0 in non-responders), an effect that persisted for 6 months after treatment. Conclusion CBT-I and QDT are equally effective for treating insomnia during early recovery from AUD. Reduced alcohol craving may be a mechanism by which a remission from insomnia improves drinking outcomes. Support (if any) VA grant IK2CX000855 and 5I01CX001957 (SC) and NIH grants R01 AG041783 and R56 AG050620 (M.L.P.); R01 AA023192 and R01 AA021164 (H.R.K.).

  PublisherOA PDFDOI

• A Randomized Controlled Trial of Cognitive Behavioral Therapy for Insomnia During Early Recovery from Alcohol Use Disorder Among Veterans

  medRxiv · 2025-01-05 · 2 citations

  preprintOpen access

  Study Objectives: 1) To determine the efficacy of Cognitive Behavioral Therapy for Insomnia (CBT-I) for improving insomnia, alcohol-related outcomes, and daytime functioning at post-treatment and at 3- and 6-month follow-up, in a largely African American Veteran sample; 2) Evaluate whether improvement in insomnia is associated with a reduction in alcohol-related outcomes post-treatment. Methods: An RCT of CBT-I (n = 31) compared to Quasi-Desensitization therapy (QDT, n = 32), eight weekly in-person sessions, with assessments at baseline, end of treatment (8 weeks), and 3- and 6-months post-treatment. Primary outcomes were the Insomnia Severity Index (ISI) total score, and Percent Days Abstinent (PDA). Secondary outcomes were sleep diary variables, drinks per day, percentage non-heavy drinking days, Penn Alcohol Craving Scale, PCS and MCS scale (from the SF-12), BDI and STAI-Trait subscale total scores. Results: Post-treatment data were obtained from 88.9% of participants. Although CBT-I improved insomnia with effect sizes (E.S.) larger than the meta-analytic estimates, QDT was equally efficacious in improving insomnia (E.S. = -1.63 vs. -1.50), improving abstinence (E.S. = 1.54 vs. 1.91) and next-day functioning (E.S. = 0.26 vs. -0.17). Across treatment groups, remission from insomnia was associated with a lower post-treatment alcohol craving score (2.79, 95% CI 1.14, 4.44 vs. 9.51, 95% CI 6.06, 12.95 in non-responders), an effect that persisted for 6 months after treatment. Conclusions: CBT-I and QDT are equally effective for treating insomnia during early recovery from AUD. Reduced alcohol craving may be a mechanism by which a remission from insomnia improves drinking outcomes.

  PublisherOA PDFDOI

• 1162 Sleep Disturbance in Individuals with and Without Minor Memory Complaints

  SLEEP · 2025-05-01

  articleOpen access

  Abstract Introduction Prior research indicates that individuals with Mild Cognitive Impairment (MCI) or Alzheimer’s Disease (AD) exhibit higher-than-normal levels of sleep disturbance. Epidemiologic studies suggest that poor sleep may be a risk factor for the progression of Alzheimer’s Disease and Related Dementias (ADRD). Despite these findings, the literature is non-specific regarding the types of sleep disturbances that present in this population. We aimed to assess the various forms of sleep disturbance in individuals with and without minor memory complaints (MMC). Methods Data were obtained from an online sleep and health survey, with participants directed to the site via advertisements on platforms such as Facebook, Google, TV, and local newspapers. The survey includes sections on general sleep, health conditions, and chronic diseases, and takes approximately 20 minutes to complete. In 2024, three questions regarding memory function were added: (1) recent memory issues, (2) use of supplements or over-the-counter medications for memory, and (3) diagnosis or treatment for memory problems. Two groups were formed based on reported memory problems, distinguishing those with minor memory complaints (MMC) from those without. Analyses focused on sleep patterns (e.g., Time in Bed, Wake After Sleep Onset, Sleep Efficiency), insomnia severity, and frequency of sleep disorders. Bivariate contrasts were conducted with an alpha level set at p< 0.01. Results The sample included 308 participants (mean age 46.0 ± 12.9, 64% female, 14% non-white). Of these, 134 had MMC and 174 did not. The groups did not differ demographically, but those with MMC exhibited a subtle sleep phase delay (~30 minutes), increased insomnia severity (related to daytime function), and a higher frequency of parasomnic behaviors (e.g., nightmares). Conclusion Subjects with MMC demonstrated more severe sleep disturbance, particularly with phase delays and parasomnias. These findings suggest that sleep disturbance may occur early in cognitive decline and could serve as a potential early indicator of MCI. Given the connection between sleep and memory function, these results may offer insight into the pathophysiology of ADRD. Analyses are ongoing. Support (if any)

  PublisherOA PDFDOI

• 1348 Exploratory Analysis of Patient Opinions, Preferences, and Experiences with Insomnia Treatment

  SLEEP · 2025-05-01

  articleOpen access

  Abstract Introduction Little is known about patient beliefs and preferences regarding treatment approaches for insomnia. Understanding of such inclinations will allow clinicians to better address these perspectives, and in so doing improve treatment adherence. In the present study, patient beliefs about the relevance of evidence-based treatment and preferences for and experiences with over-the-counter (OTCs), prescriptive medications (RXs), and behavioral treatments (BTs), were surveyed. Methods Four items were added to the Penn Behavioral Sleep Medicine online screener (sleeplessinphilly.com), which profiles sleep and general health of individuals seeking to participate in research. Two questions asked about the importance of safety and effectiveness information for OTCs and RXs (on a 0-5 scale, 0=not important, 5=very important). One question asked respondents to rank which of the treatment approaches (OTCs, RXs, BTs) were most and least preferable. One question asked respondents to indicate which of these treatments they had tried, and in what order. Examples were given for each treatment (e.g., BT was parenthetically defined as “4-10 week cognitive behavioral therapy for insomnia”). Results 181 patients completed the survey (82.3% female, mean±SD age of 48.2±12.2 years). The mean Insomnia Severity Index (ISI) for the group was 16.8±5.1. Roughly 80% of respondents scored evidence and safety information as important (responses of 4 or 5) for both OTCs (82.3%, 4.3±1.2) and RXs (80.7%, 4.3±1.2). The most frequently preferred first, second, and third choices were BTs (45.9%), OTCs (43.6%), and RXs (50.3%), respectively. Despite this stated preference, 71.8% of respondents tried OTCs first, 33.7% tried RXs second and 8.3% tried BTs third. Overall, just 8.8% tried BTs first, and 25.4% ever tried BTs. Conclusion Survey findings highlight that patients consider information on safety and effectiveness of insomnia treatment as important (equally so for Rx and OTC treatments), that they prefer behavioral and OTC care as compared to prescriptive medications. Interestingly, although the most patients stated a preference for behavioral therapies first, most reported trying OTCs first and only 8.8% had tried BTs first. This likely reflects the limited availability of BTs, particularly compared to the ease at which patients can access OTC therapies. Support (if any)

  PublisherOA PDFDOI

• HIV Virologic Suppression and Mental Well-being in Adolescents and Young Adults Living with HIV

  International Journal of Maternal and Child Health and AIDS · 2025-05-09

  articleOpen access

  Background and Objective: Human Immunodeficiency Virus (HIV) care programs in resource-limited settings reserve counseling and referral for individuals with identified mental illness for those with HIV virological treatment failure (VTF). Adolescence is a period that may increase the likelihood of internalizing psychiatric disorders (IPDs). We assessed the relationship between HIV VTF and symptoms of IPDs among adolescents and young adults (AYA) living with HIV in Gaborone, Botswana. Methods: A cross-sectional study was conducted in Botswana from December 2018 to December 2019 among AYA living with HIV aged 12–24 years. Logistic regression analysis was used to examine relationships between age, sex, and HIV VTF (≥400 copies/mL) and clinically relevant IPD symptoms, namely, depression (Patient Health Questionnaire-9 score of ≥10) and anxiety (Generalized Anxiety Disorder-7 score of ≥10). Results: Of 553 participants, most were aged 16–19 years (53%) with an equal sex distribution; the minority had VTF using HIV viral load (VL) cutoff levels of ≥400 copies/mL (11%). Close to one-sixth (15%) had clinical depression symptoms; participants aged 16–19 years and 20–24 years were more likely to have clinically relevant depression symptoms when compared to participants who were aged 12–15 years (odds ratio [OR] 3.160, 95% confidence interval [CI] 1.094–9.123 and OR 4.748, 95% CI 1.624–13.877, p = 0.0117, for participants aged 15– 19 years and 20–24 years, respectively). Participants with clinically relevant anxiety symptoms (11%) or both clinically relevant anxiety and depression symptoms (8%) did not differ from those without these symptoms by age, gender, or VTF status. Similar results were observed using HIV VL cutoff levels of <1000 copies/mL. Conclusion and Global Health Implications: HIV VTF may be a poor proxy for mental well-being among AYAs receiving HIV. Universal screening should be considered for AYA receiving care for HIV.

  PublisherDOI

• Treatment of Insomnia with Zaleplon in HIV+ Significantly Improves Sleep and Depression

  Psychopharmacology Bulletin · 2025-08-12 · 6 citations

  articleOpen access

  More than 50% of individuals who are HIV positive report insomnia, which can reduce HIV treatment adherence, impair quality of life, and contribute to metabolic dysfunction. Major depressive disorder is also highly comorbid in this population, leading to further impairment. There is evidence that treating insomnia may improve not only sleep, but depression and metabolic function, as well. The present study aimed to examine the effects of pharmacotherapeutic treatment of insomnia on sleep, depression, and metabolic functioning in individuals with HIV. 20 individuals with asymptomatic seropositive HIV and comorbid insomnia and depression were administered zaleplon for 6 weeks. Insomnia severity was assessed using the Insomnia Severity Index and Epworth Sleepiness Scale, and depression severity was assessed using the Quick Inventory of Depression, both prior to treatment and 6 weeks post treatment. Metabolomic changes were assessed using a comprehensive platform measuring ~2000 lipid features and polar metabolites. Linear mixed effects models demonstrated that 6 weeks of treatment with zaleplon significantly improved symptoms of both insomnia and depression. Metabolomic analyses also demonstrated that changes in insomnia severity were associated with significant changes in key branched chain amino acid metabolites. Our results show that improvement in insomnia is associated with reduced depressive symptoms and beneficial metabolomic changes. Additionally, changes in key branched chain amino acid metabolites following treatment may serve as useful biomarkers of treatment response.

  PublisherOA PDFDOI

Recent grants

• NIH Grant K01MH073903

  NIH · $689k · 2012

• Developmental Core B

  NIH · $44.1M · 2013–2028

Frequent coauthors

• Darren R. Linkin

  Museum of Heilongjiang Province

  48 shared

• Lawrence Ward

  Bayhealth Foundation

  36 shared

• Mindy J. Perilla

  36 shared

• C. Victor Spain

  36 shared

• Hillary R. Bogner

  University of Pennsylvania Health System

  34 shared

• Michael L. Perlis

  University of Pennsylvania

  24 shared

• Ebbing Lautenbach

  23 shared

• Joseph J. Gallo

  Johns Hopkins University

  23 shared