SUMMER 2014 MAILMAN SCHOOL of PUBLIC HEALTH – COLUMBIA UNIVERSITY Sandro Galea, MD, Drph Gelman Professor and Chair Department of Epidemiology
Total Page：16
File Type：pdf, Size：1020Kb
The global burden of lung disease Living to 100 in a California town The gluten-free fad The statin controversy issue 5.02 FROM THE DEPARTMENT OF EPIDEMIOLOGY SUMMER 2014 MAILMAN SCHOOL OF PUBLIC HEALTH – COLUMBIA UNIVERSITY Sandro Galea, MD, DrPH Gelman Professor and Chair Department of Epidemiology EDITOR Barbara Aaron Administrative Director EDITOR / WRITER Elaine Meyer Associate Director of Communications CONTRIBUTING EDITORS Dana March, PhD Assistant Professor of Epidemiology Joshua Brooks Senior Health and Epidemiology Fellow CONTRIBUTING WRITERS Amina Foda Patches Magarro Catherine Richards, PhD Stephanie Shiau Christopher Tait Kaitlin Ugolik ASSOCIATE DESIGNER Kristen Byers Web Developer / Graphic Designer DESIGNER Jon Kalish ON THE COVER: The smoggy skyline of Beijing, China. A lone tree in the foreground in the shape of human lungs symbolizes the negative effect of air pollution on the public. Read more about how this and other factors can be addressed through a public health approach on page 10. CONTENTS 3 Publication highlights FEATURES 10 The global burden of lung disease 16 Place and health: into the blue zone 20 Does your brain really do better off grain? 24 Changing the statins quo 27 Symposium report: Encouraging urban health has multiple benefits 29 Grand rounds report: Sticks and bones may break my heart 30 In the news 33 Faculty publications DEPARTMENT OF EPIDEMIOLOGY 1 chair’s message Colleagues, The Institute of Medicine defines public health as “what we, as a society, do collectively to assure the conditions for people to be healthy.”1 Epidemiology, as the science of public health, then has a particular responsibility to provide data that can guide the improvement of those conditions. The summer issue of 2x2 synthesizes new research that is concerned with the creation of these conditions. We highlight articles that look at the relationship between lung disease and economic development, how place influences longevity, whether a gluten-free diet is really better for everybody, how new statin guidelines might change treatment for heart disease, and the inextricable link between urban planning and promoting health. These stories illustrate how epidemiological research examines the conditions that can improve population health on the broadest scale. I hope you find them interesting and informative. Warm regards, 1) Institute of Medicine. The Future of Public Health. National Academy Press; Washington, D.C.: 1988 2 publication highlights hey have been called “suicide who are either similar to the reader outbreaks,” “suicide epidemics,” (i.e., another teenager) or revered T or “copycat suicides”—when by him or her (e.g., a celebrity),” the multiple suicides occur in a commu- authors write. nity in a short period of time, usually The authors controlled the study among teenagers and young adults. so that nothing about the suicides Suicide clusters are somewhat of a they examined would have led to mystery: why does a suicide lead to varying coverage in the comparison an “outbreak” of many more in some groups—such as how graphic or public communities but not in others? a suicide was. To help answer that question, Although the study does not prove a group of researchers at Columbia causality, the authors suggest theo- University, led by Dr. Madelyn Gould, a ries for why media coverage could professor of epidemiology in psychiatry, influence suicides. Repeated coverage examined the influence of media cover- may normalize suicide in the eyes of age in the initiation of suicide clusters, young, vulnerable people, according in a study published in Lancet Psychia- to one theory, or it may “prime” latent try last month. Although research has thoughts in already suicidal youth, shown that press reports are associated according to another theory. with suicide spikes nationally, no study Media guidelines on how to cover had yet examined how they might influ- suicide, which have been published by ence suicide clusters. the World Health Organization, among Dr. Gould and her colleagues exam- other sources, can be helpful. ined the period between 1988-1996 “In light of the extensive use of looking at news reporting in various social media by teens, we hope our communites around the country in the current findings will stimulate research aftermath of the first suicide of a clus- on social media’s impact on suicidal ter. They compared this to coverage in behavior. We also would recommend Does news communities that saw just one suicide. that our suggestions for responsible They found that there were signifi- reporting about suicidal individuals be reporting cantly more news stories in cluster applied by all who generate suicide-re- communities than in isolated suicide lated stories via social media, which encourage communities, suggesting an associ- would include teens, as well as media ation between reporting on suicides professionals,” the authors say. suicide and suicide clusters. Newspapers in the cluster communities gave more Gould MS, Kleinman MH, Lake AM, Forman J, outbreaks? prominent and detailed coverage of Basset Midle J. (2014). Newspaper coverage suicidal individuals, such as front-page of suicide and initiation of suicide clusters in Study has implications for placement, photography, headlines teenagers in the USA, 1988-96: A retrospec- how media covers teen suicides containing the word “suicide,” specifi- tive, population-based, case-control study. cation of the method used, and a more Lancet Psychiatry. published online May 2, detailed description of the person and 2014, 7-16. the2x2project.org how he or she committed the act. the2x2project.org/media-suicide-clusters The researchers only observed the association in the coverage that focused on a suicidal individual—as related media coverage opposed to stories that covered sui- cide more generally. This “supports USA Today the theory that the media effect usat.ly/1iQsvqP operates through the mechanism of identification with a model…. [T]he Live Science models with the most effect are those bit.ly/1nR3C4M DEPARTMENT OF EPIDEMIOLOGY 3 PUBLICATION HIGHLIGHTS n states where they experience and whites is greater, health problems more systematic disadvantage are worse than in states where blacks Ithan whites, blacks have worse occupy a lower socioeconomic status cardiovascular health than they do but there is less inequality. in states where opportunity is more “While inequality does track with evenly distributed, according to a socioeconomics of U.S. states, there study published in the journal Social is considerable variation; for example, Science & Medicine. states like Maine and New York have While past research has looked higher rates of inequality than would at the effects of self-reported experi- be expected given their economic pro- ences of discrimination on health at an files,” says Dr. Keyes. individual level, this study is one of the As for whites, they reported better first to examine how unfair treatment cardiovascular health in states where at an institutional level contributes there was more structural racism. to health, according to the authors, “These results raise the provoca- Dr. Katherine Keyes, an assistant tive possibility that structural racism professor of epidemiology, Dr. Mark may not only harm the targets of Hatzenbuehler, assistant professor of stigma but also benefit those who sociomedical sciences, and Dr. Alicia wield the power to enact stigma and Lukachko, a postdoctoral alumna of discrimination,” write the authors of the Psychiatric Epidemiology Training the study. Program, all from Columbia Universi- Structural racism did not appear to ty’s Mailman School of Public Health. influence health when it came to job To determine what the researchers status. Black Americans in states with call “structural racism,” which they greater parity in terms of the relative define as “the systematic exclusion of percentage of blacks and whites in blacks from resources and mobility in high status executive or managerial society,” they looked at the percentage positions actually were at higher odds Racial inequality of blacks compared to the percentage of a heart attack than those in states of non-Hispanic whites in each of the with a greater disparity. and matters of 50 U.S. states on several measures: This is not the first time researchers holding a college degree, employ- have observed this. Epidemiologist the heart ment, incarceration, and participation Dr. Sherman James found that blacks in the state’s political system. in high status positions cope with Structural racism predicts worse Blacks were more likely to report structural racism like the pressure to cardiovascular health for blacks having had a heart attack in the past assimilate and defy negative racial year in states where there was greater stereotypes by putting forth extraor- inequality in the number of blacks dinary levels of effort, often at the versus whites employed, well edu- expense of their health. He called this cated, and politically represented. In phenomenon John Henryism, invoking states where the gulf between blacks an American folk figure who worked and whites in prison was larger, they himself to death while he was suc- were also more likely to have had a cessfully competing against a steam heart attack in the past year. Across powered machine. the United States, blacks are jailed “People with high levels of [John or put in prison from two to 14 times Henryism] and inadequate resources the2x2project.org more frequently than whites. have a much higher prevalence of Interestingly, the results indicate health disorders… because they drive 2x2.ph/racism-inequality-heart-health that structural race inequality plays a themselves toward reaching specific larger role than socioeconomic status goals at the expense of their health, in determining health outcomes. In often without realizing they are doing states where on average blacks occupy so,” says research that emerged from a higher socioeconomic status, but a 2006 symposium on the subject. the gap in opportunity between blacks “While many recognize that 4 SUMMER 2014 : ISSUE 5.02 A lithographic composite of thirteen scenes pertaining to African-American history c.1897.