VOLUME 4 • ISSUE 4 DECEMBER 2013

NEWS FROM THE DEPARTMENT OF EPIDEMIOLOGY MAILMAN SCHOOL OF PUBLIC HEALTH COLUMBIA UNIVERSITY 3 PUBLICATION HIGHLIGHTS 7 IN THE NEWS 8 LINES OF INQUIRY 12 TYPHOON HAIYAN 14 CUESS 19 CUEGR 20 PROFILES 25 BOOKS, BRIEF Patients with MENTIONS AND AWARDS ancient stomach 30 FACULTY ARTICLE bacteria less at BIBLIOGRAPHY risk for celiac disease

ndividuals whose stomachs do not contain colonies of bacteria known as Helicobacter pylori are at greater risk of celiac disease Ithan those who do have the bacteria, according to a new study lead authored by Dr. Benjamin Lebwohl, assistant professor of medicine and epidemiology, with co-author Dr. Andrew Rundle, associate professor of epidemiology, and other colleagues. Celiac disease is an immune-based dis- order in which the small intestine becomes damaged in reaction to the protein gluten, making it difficult to absorb nutrients. It can lead to uncomfortable and sometimes severe digestive problems, which is why patients with celiac disease are typically put on a diet free of foods with gluten, such as those made gastrointestinal endoscopy, a procedure that of wheat, barley, or rye. allows doctors to look at the inner lining Scientists are not yet sure why the disease of the stomach. H. pylori prevalence in the has risen four-fold in the US over the last stomach was significantly lower (4 percent) 50 years. One theory known as the “hygiene in patients with celiac disease than in those hypothesis” points to America’s fight against without (9 percent). bacteria, which has taken place around the “These results offer a potential explana- same period. tion for the unexplained rise in celiac disease In this fight, efforts to kill disease-causing in recent decades,” says Dr. Lebwohl. “As H. bacteria with antibiotics have also resulted in pylori colonization rates decline, perhaps reducing exposure to beneficial bacteria. This Scientists are we are witnessing a trade-off in the rise of may be the case for H. pylori, an ancient mi- autoimmune conditions.” crobe that survives in the acidic lining of the not yet sure why He and his colleagues recommend study stomach. Thirty years ago, scientists fingered of immune responses to gluten in order to H. pylori as the primary cause of gastritis and the disease has understand the mechanism by which H. pylori peptic ulcers, and as a result, many doctors may fend off celiac disease. started prescribing antibiotics to kill it. But risen four-fold in more recently H. pylori has been associated Lebwohl B, Blaser MJ, Ludvigsson JF, Green PH, Rundle A, with positive health traits, such as decreased the US over the Sonnenberg A, Genta RM. Decreased Risk of Celiac Disease in risk of allergic diseases like asthma and Patients With Helicobacter pylori Colonization. Am J Epidemiol. better hormonal appetite regulation. 2013 Oct 11. [Epub ahead of print] Drs. Lebwohl, Rundle, and their col- last 50 years. leagues compared results for 136 thousand patients nationwide who had an upper

IMAGE: AJ CANN 1 MESSAGE FROM THE CHAIR Dear colleagues,

Welcome to the December 2013 issue of Two by Two, the Epidemiology Department newsletter. There is as always much to report as we approach the end of a very busy fall semester. Our third master’s student day was once again a huge success, and the winners of the abstract and poster competitions are celebrated in these pages. In September, in conjunction with the annual United Nations General Assembly, we cosponsored with UNICEF Columbia University Epidemiology Scientific Symposium (CUESS), focused on Putting childhood disability on the map. Our second CUESS of the academic year, Philosophy and medicine: Explanation and prediction population health, was cosponsored with the International Philosophy of Medicine Roundtable, and brought together thought leaders from the realms of economics, political science, history, bioethics, and of course epidemiology to tackle some of the broadest philosophical questions that shape our scholarly lives. We cover a range of research findings in this issue, including Dr. Benjamin Lebwohl’s striking news about the beneficial role of a previously vilified bacterium. MPH 2014 trainee Ms. Stephanie Lucas reports from her practicum in the Philippines on the aftermath of Typhoon Haiyan. Our Lines of Inquiry article is a fascinating exploration of the forces that shape immunization rates, comparing two very different US cities. A final note: in keeping with our mission of extending the public health conversation, I invite you to join me on Twitter (@sandrogalea) as I share the best of the science that crosses my virtual desk each day.

Warm regards,

UPCOMING JANUARY—MARCH

FRIDAY, JANUARY 17 FACULTY MEETING All CUEGRs will be held on Wednesdays from 4-5:30pm WEDNESDAY, JANUARY 22 CUEGR: OLLI MIETTINEN, MD, PhD in the 8th floor auditorium. FRIDAY, JANUARY 24 DEPARTMENT SEMINAR: BENJAMIN LEBWOHL, MD, MS

FRIDAY, FEBRUARY 14 DEPARTMENT SEMINAR: KATHERINE KEYES, PhD All department seminars will be held on Fridays from 12-1:00pm WEDNESDAY, FEBRUARY 19 CUEGR: JANET RICH-EDWARDS, ScD, MPH in a to be determined location. FRIDAY, FEBRUARY 21 FACULTY MEETING

FRIDAY, MARCH 7 DEPARTMENT SEMINAR: PAM FACTOR-LITVAK, PhD All faculty meetings will be held in the 5th Floor Conference FRIDAY, MARCH 14 FACULTY MEETING Room, Room 532. WEDNESDAY, MARCH 26 CUEGR: DANIEL W. KING, PhD AND LYNDA A. KING, PhD

Follow us on Twitter twitter.com/cuepidemiology, and “like” us on Facebook facebook.com/cuepidemiology to Be sure to also check out our online keep up with the latest Department news and events. presence at the2x2project.org.

DECEMBER 2013 2 PUBLICATION HIGHLIGHTS

Results of many Researchers are not publishing in a timely fashion the results of the clinical trials that could help decision-making concerning treatments, often breaching a federal cancer drug trials law that makes it mandatory, according to a study conducted by Dr. Philippe Ravaud, senior lecturer in epidemiology at the Mailman School and professor of epidemiol- not made publicly ogy at Paris’s Descartes University. A 2007 amendment to the Food and Drug Administration Act requires that available randomized clinical trial results of FDA-approved drugs with at least one site in the US are posted to a government website called ClinicalTrials.gov within one year after researchers have measured the “primary outcome” of the last patient. Looking at nearly 650 randomized controlled trials assessing cancer drugs with at least one site in the US, Dr. Ravaud and his colleagues found that only 20 percent had reported results publicly on ClinicalTrials.gov or published in journals within that year. Three years later, nearly half were still not publicly available. The amendment was passed after revelations that trial results of an estimated 25 to 50 percent of FDA-approved drugs had not been published five years after the drug had been green-lighted. Trials with negative results were published much less often than those with positive results, according to past research. This “biases the literature,” say the study’s authors. “Under-reporting of trial results also contributes to the overall waste of research and breaches implied contracts with patients who agree to participate in these trials.”

Nguyen TA, Dechartres A, Belgherbi S, Ravaud P. Public availability of results of trials assessing cancer drugs in the United States. J Clin Oncol. 2013 Aug 20;31(24):2998-3003. doi: 10.1200/JCO.2012.46.9577. Epub 2013 Jul 22.

3 Sugary beverages are harmful for young children Two studies by faculty point to health risks for young children who regularly consume soda and other sugary beverages.

Soda-drinking children more likely to Sugary beverages linked to have behavioral problems childhood obesity

Children who drink soda are more likely to behave aggressively than Four and five-year-olds who drank one or more sugar- those who do not, according to a new study led by Dr. Shakira Suglia, sweetened beverages a day were more likely to be obese assistant professor of epidemiology. than those not consuming the beverages, according to a The researchers assessed survey data on behavior of 3,000 5-year- new study by Dr. Ryan Demmer, assistant professor of old children reported by their mothers in the Fragile Families and Child epidemiology, and colleagues. Wellbeing Study. They found that any amount of soda consumption was Analyzing body mass index (BMI) scores among 9,600 associated with aggression, withdrawal, and attention problems, even children, the researchers found that between the ages of after adjusting for sociodemographic factors, maternal depression, 2-4, children who drank sugary beverages had greater intimate partner violence, and paternal incarceration. Children who drank increases in BMI scores than those who didn’t consume the four or more soft drinks a day were more than two times as likely to drinks regularly after adjusting for several factors, includ- destroy others’ possessions, get into fights, physically attack people, and ing race, socioeconomic status, and mother’s BMI. have attention problems than children who did not consume soft drinks.` Earlier studies had found a link between sugar- “We found that the child’s aggressive behavior score increased with sweetened beverage consumption and weight among older every increase in soft drinks servings per day,” says Dr. Suglia. children, but this is one of the first to find a link among Read the news coverage: preschoolers. Regular drinkers of sugar-sweetened beverages like

■■ http://cbsn.ws/19dL3LO soda, sports drinks, and fruit drinks that are not 100 percent juice also drank less milk and were more likely to ■■ http://lat.ms/1aORawI watch more than two hours of television per day. “Policies that reduce the consumption of these bever- ■■ http://ti.me/16VXpvg ages in young children should be considered and scientifi- ■■ http://reut.rs/1cO3IWL cally tested as such steps may help mitigate a small but important contribution to the current epidemic of childhood Read the related 2x2 project article, “Kicking the Can: Examining obesity,” said Dr. Demmer. the link between soda consumption and violence in children” http://the2x2project.org/kicking-the-can DeBoer MD, Scharf RJ, Demmer RD. “Sugar-Sweetened Beverages and Weight Gain in 2- to 5-Year-Old Children,” Pediatrics. Pediatrics. 2013 Aug 5. [Epub ahead of print] Suglia SF, Solnick S, Hemenway D. Soft Drinks Consumption Is Associated with Behavior Problems in 5-Year-Olds. J Pediatr. 2013 Aug 19. doi:pii: S0022-3476(13)00736-1. 10.1016/j. jpeds.2013.06.023. [Epub ahead of print]

DECEMBER 2013 PHOTO: SHARON DRUMMOND 4 Women on contraceptives less likely to be depressed

Women on hormone-based contraceptives including the birth control pill were less likely to suffer from depression than other women, according to a new study by lead author Dr. Katherine Keyes, assistant professor of epidemiology; senior author Dr. Karestan Koenen, associate professor of epidemiology; Dr. Carolyn Westhoff, professor of epidemiol- ogy; and colleagues. “This counters somewhat some of the prevailing wisdom that hormone “A 5-year-old growing up today is living contraceptive use in general is associated Obesity-related in an environment where obesity is much with adverse mental health outcomes in more the norm than was the case for a women,” said Dr. Keyes. deaths more five-year-old a generation or two ago. Analyzing survey data on 6,654 sexually Drink sizes are bigger, clothes are bigger, active women between ages 25 to 34 over a common and greater numbers of a child’s peers 14-year period, the researchers found these are obese,” says co-author Dr. Bruce Link, women were 32 percent less likely than other than previous professor of epidemiology and sociomedi- women to have strong depressive symptoms cal sciences. “And once someone is obese, and 63 percent less likely to have attempted research it is very difficult to undo. So it stands to suicide in the past year. reason that we won’t see the worst of the An alternative explanation for these find- suggests epidemic until the current generation of ings could be that women who are depressed children grows old.” would choose not to use contraceptives or go A significantly greater number of people Read the news coverage: off of them, though the authors tried to control die from obesity-related causes than for many factors that are different between previously thought, according to a new the two groups being compared, such as age, ■■ http://nbcnews.to/17tKWiv study. High body mass accounted for 18 education level, and how regularly the women percent of deaths among black and white got medical checkups. Americans between 1986 and 2006, the Masters RK, Reither EN, Powers DA, Yang YC, Burger AE, While women have reported feeling study found. Previous research put that Link BG. The impact of obesity on US mortality levels: emotional and irritable on the pill, Dr. Keyes the importance of age and cohort factors in population number at 5 percent. estimates. Am J Public Health. 2013; 103(10):1895-901. notes that mood swings are substantially dif- “Past research in this area lumped doi: 10.2105/AJPH.2013.301379. ferent from depression and suicide attempts, together all Americans, but obesity though important to bring up with a doctor. prevalence and its effect on mortality Read the news coverage: differ substantially based on your race or ethnicity, how old you are, and when you ■■ http://on.today.com/19WySYb were born,” says Dr. Ryan Masters, lead author of the study and a Robert Wood ■■ http://bit.ly/1aOR6gs Johnson Health & Society Scholar. Contrary to what previous research Keyes KM, Cheslack-Postava K, Westhoff C, Heim CM, suggested, younger Americans who have Haloossim M, Walsh K, Koenen K. Association of Hormonal lived their whole lives during the obesity Contraceptive Use With Reduced Levels of Depressive epidemic, which began in the 1980s, are Symptoms: A National Study of Sexually Active Women in especially at risk. the United States. Am J Epidemiol. 2013 Sep 15. [Epub ahead of print]

5 Rates of tuberculosis (TB) and multidrug-resistant tuberculosis (MDR TB) are Rising rates of “extremely” high in Central Asian countries, threatening a “potentially devastating co-epidemic” if treatment and prevention services are not integrated and offered injection drug use, to a wider swath of the population, say Dr. Neil Schluger, professor at NYPH/ CUMC of epidemiology; Dr. Sandro Galea; and Ms. Sabrina Hermosilla, a doctoral HIV, and TB creating candidate in the department, in a paper for Drug and Alcohol Dependence. In the last 20 years, a rise in HIV rates in low and middle-income countries perfect storm in and the emergence of a strain of TB that is resistant to the drugs most used to treat it have posed significant challenges to the global effort against what is an Central Asia often lethal bacterial illness that typically infects the lungs. In Kazakhstan, Uzbekistan, Tajikistan, and Kyrgyzstan, HIV rates are rising because of an epidemic of injection drug use. Meanwhile, needle exchange programs that have been shown to reduce HIV transmission rates and treatment for HIV are available to only a small number of patients in the region. This has created a perfect storm, where untreated HIV-positive individuals are at greater risk of contracting TB because of their weakened immune systems. Treating patients with TB and HIV is a time-sensitive process that requires awareness and integration of health services. “Failure to integrate and improve health services for these important problems will lead to the creation of a spiral of increasing rates of tuberculosis and HIV infection, among people who use drugs, as inadequate treatment of any one of them will cause more transmission of TB and HIV,” write the authors. “Effective programs have been created in a number of regions around the world, and these models should be adopted in Central Asia.”

Schluger NW, El-Bassel N, Hermosilla S, Terlikbayeva A, Darisheva M, Aifah A, Galea S. Tuberculosis, drug use and HIV infection in Central Asia: An urgent need for attention. Drug Alcohol Depend. 2013 Aug 5. pii: S0376-8716(13)00277-9. doi: 10.1016/j.drugalcdep.2013.07.012. [Epub ahead of print]

DECEMBER 2013 PHOTO: URBAN SEED EDUCATION 6 IN THE NEWS

Risk of breast A large study looking at women on hormone replacement therapy (HRT) found that the risk of breast cancer may depend on body type, race, and ethnicity. While slim and normal-weight women with cancer varies for dense breast tissue had a significantly greater risk on HRT, women who were black or overweight women on HRT with less-dense breast tissue showed no increased risk. Women take replacement estrogen alone or with progestin during menopause to reduce symptoms such as hot flashes and night sweats, but a 2002 study found that HRT increased the risk of developing invasive breast cancer. “A lot of data now, both observational as well as clinical trials, have supported that certain sub- groups of women may not have an increased risk from hormone replacement therapy,” said Dr. Mary Beth Terry, professor of epidemiology, who wrote an editorial accompanying the study.

http://reut.rs/1c8LcHd

Shutdown Government In the midst of October’s federal government shutdown, Dr. Stephen Morse, professor of epidemiology at CUMC, joined WNYC’s Leonard Lopate to talk about whether efforts to contain a salmonella outbreak hampered in response from chicken produced by Foster Farms in California had been hampered. to salmonella outbreak “The shutdown certainly hasn’t helped, and it has reduced capabilities considerably. On the other hand, there is the possibility CDC for example can call people in for emergencies like this, so the gov- ernment has responded,” he said. “Although probably it could have responded more strongly without the shutdown, I think the miracle is that it was able to do it.” Dr. Morse also gave an interview to Discover Magazine about his efforts to expand the US Agency for International Development’s worldwide PREDICT project, which identifies emerging pandemic threats, to new countries.

http://wny.cc/1bAvfWx http://bit.ly/1dYL63f

Marijuana and other Use of marijuana and other drugs significantly increases a driver’s risk of being involved in a fatal crash, finds a case-control study published in Accident Analysis & Prevention by Dr. Guohua Li, Finster drugs increase driver’s Professor of Epidemiology and Anesthesiology and director of the Center for Injury Epidemiology, with fatal crash risk PhD candidate Ms. Joanne Brady that was covered in several media outlets. The study assessed fatal crash risks associated with different types of drugs detected in drivers, finding that drivers using de- pressants, such as prescription opioids, were nearly five times as likely as other drivers to be involved in such collisions. Stimulants, narcotics, and marijuana are also associated with significantly increased risks. Drivers who tested positive for both alcohol and drugs were 23 times as likely as those using neither alcohol nor drugs to be involved in fatal crashes. “While alcohol-impaired driving remains the greatest threat to traffic safety, these findings about drugged driving are particularly salient in light of the increases in the availability of prescription stimulants and opioids over the past decade,” said Dr. Li.

http://bit.ly/17PCTiS http://bit.ly/HQgc2i http://bit.ly/1eEtaht

Regular teeth brushing People who brush their teeth at least two minutes twice a day are less likely to develop heart disease or suffer a stroke, according to a study by Dr. Moïse Desvarieux, associate professor of epidemiol- may reduce risk of ogy, with Dr. Ryan Demmer and colleagues that was published in the Journal of the American Heart heart disease, stroke Association and covered in the media. The researchers found that atherosclerosis—when the arteries narrow through the build-up of calcium and fatty material—progressed in patients at the same time as clinical periodontal disease and bacterial build-up in the gums. “This is the most direct evidence yet that modifying the periodontal bacterial profile could play a role in preventing or slowing both [periodontal disease and atherosclerosis,” said Dr. Desvarieux.

http://dailym.ai/17PH9yY http://cbsloc.al/1cfZXEv

Intestine damage raises Intestinal damage makes it more likely that a person with celiac disease will develop lymphoma, according to a study co-authored by Dr. Benjamin Lebwohl that was reported on in the LA Times. lymphoma risk in celiac While it has been known that celiac disease puts one at higher risk of lymphoma, a cancer that patients, study begins in the immune system, this is the first study to find that intestinal healing reduces the risk, said Dr. Lebwohl. He said it was unclear why some people’s intestines heal while others do not.

http://lat.ms/1hAfpm3

7 LINES OF INQUIRY

THE LINES OF INQUIRY SERIES TACKLES TIMELY QUESTIONS IN PUBLIC HEALTH SCIENCE, HIGHLIGHTING OUR RESEARCH AND PROVIDING PERSPECTIVE ON OFTEN CONTROVERSIAL TOPICS.

A tale of two cities Ashland, Oregon and Houston, Texas, have both struggled to immunize their children against vaccines. That’s where the similarities end.

When in 1955 the polio vaccine was introduced of around 20,000, an annual Shakespeare Festival, a slew of vegetar- ian restaurants, and well-preserved historical structures. Ashland to the public, it was in such high demand that also has earned the title of “least vaccinated city in the US,” for the there was an immediate shortage.1 At the time sizable number of parents who refuse to vaccinate their children against diseases such as polio, measles, mumps, rubella, rotavirus, a polio epidemic was gripping the US. Hepatitis A and B, and influenza.2 Ashland’s vaccine “refusers” have drawn national attention, includ- 3 Considered the biggest public health problem in the nation, the viral ing a visit from the Centers for Disease Control and Prevention (CDC) illness affected 30,000 to 50,000 children per year in the early 1950s, in 2008 and a prominent role in a 2010 Frontline documentary called 4 spreading to towns with little warning and sometimes rendering an “the Vaccine War.” infected child paralyzed for life. In a show of mass solidarity that Ashland is not an anomaly. In the US today, there are many places mirrored the war effort, millions of Americans contributed money to like it: middle and upper-middle class suburban enclaves with a large the effort to find a vaccine. Just a few years after the vaccine became number of parents who refuse vaccines for their children. In fact, available, rates of polio had declined by 50 percent. By 1994, the virus was eradicated from the Western Hemisphere. To understand just how much the culture around vaccines has changed in certain parts of the country, one might visit Ashland, 2 “CDC to Investigate Ashland, OR: Least Vaccinated City in US.” Eco Child’s Play. 26 January 2009. http://ecochildsplay.com/2009/01/26/ Oregon, a picturesque mountain town with a well-educated population cdc-to-investigate-ashland-or-least-vaccinated-city-in-us

3 “Archive: The Immunization Safety Office Scientific Agenda.” CDC. 16 March 2011. http://www.cdc.gov/vaccinesafety/Activities/agenda-archive.html

1 “Who is responsible, and why, for the chaotic confusion over the polio inoculations?” 4 “Frontline: The Vaccine War.” PBS. 27 April 2010. http://www.pbs.org/wgbh/pages/ Harpers Magazine. frontline/vaccines

DECEMBER 2013 8 families who refuse to vaccinate are more likely Coming from behind: Vaccination rates in Houston in 1997 and 2012 to live in well-educated, higher income areas than 1997 2012 those who do not, according to research.5 “Its constituents are part of what you might call 100% ESTIMATED POLIO VACCINATION RATES ESTIMATED MMR VACCINATION RATES the suburban counterculture—parenthood and af- AMONG CHILDREN AGED 19-35 MONTHS AMONG CHILDREN AGED 19-35 MONTHS fluence mixed with creative aspirations, a crunchy- chewy lifestyle, and an inclination to question 95% authority,” says journalist Nina Shapiro in a 2011 article6 in the Seattle Weekly. CDC 2020 GOAL A contrasting story has taken place in Houston, where in the early 1990s, the vaccination coverage 90% rate was an abysmal 10 percent. In 1997, even as Houston started to improve, its coverage rates for children ages 19-35 months for the polio and the measles, mumps, rubella vaccine lagged 85% well behind the rest of the country and two other major cities, Chicago and New York, according to an analysis by Columbia Mailman School’s Global 80% Research Analytics for Population Health (GRAPH) project using CDC data. By 2012, Houston had shot well ahead. Today, Houston’s vaccine coverage is not drastically 75% better than Ashland’s. From 2009 to 2011 in Houston US CHICAGO NEW YORK HOUSTON US CHICAGO NEW YORK HOUSTON 68 percent of children ages 19 to 35 months had received all of the recommended vaccinations, while during the same period in Ashland 59 percent did. Data source: National Immunization survey administered by the Centers for Disease Control But Houston’s exemption rate is very low: for kin- and Prevention. 1997 and 2012 data. Extracted on November 3, 2013. http://www.cdc.gov/ vaccines/stats-surv/nis/default.html#nis dergartners in the 2012-13 school year it was 0.9 percent, according to the CDC.7 In Ashland, 28 percent of the town’s youth population has been exempted from at least some vaccines, according to the Oregon State Department of Health. Half of those children have not received a single vaccination, according to Rebekah Sherman, the coordinator and spokesperson for the Ashland Immunization Team. “Its constituents are part In the US, all children entering elementary school in the US are required to have a standard vaccination schedule. Parents who do of what you might call the not want their children vaccinated for some or all of the diseases can request a “personal belief exemption” from their school citing suburban counterculture— religious or philosophical reasons. Some states are more lenient about allowing personal belief exemptions than others. parenthood and affluence mixed Parents who refuse immunization for their children often argue that vaccines are full of toxins that pose health risks. One of the most with creative aspirations, a predominant fears among this group is that the MMR vaccination causes autism, a theory that was put forward by British researcher crunchy-chewy lifestyle, and an Andrew Wakefield in the late 1990s and early 2000s in two stud- ies that scientists later discovered were flawed8 and could not be inclination to question authority” replicated, as well as fraudulent9. Wakefield was barred from practicing medicine in Britain in 2010, yet an active anti-MMR vaccine movement has survived his infamy, in part because vaccine refusers are skeptical of the established science.

5 Wei F, Mullooly JP, Goodman M, McCarty MC, Hanson AM, Crane B, Nordin JD. Identification and characteristics of vaccine refusers. BMC Pediatr. 2009;9:18. doi: 10.1186/1471-2431-9- 18. http://www.biomedcentral.com/1471-2431/9/18

Smith PJ, Chu SY, Barker LE. Children who have received no vaccines: who are they and where do they live? Pediatrics. 2004;114(1):187-95. http://www.ncbi.nlm.nih.gov/pubmed/15231927

6 “The Anti-Vaccine Epidemic.” Seattle Weekly. 14 June 2011. http://www.seattleweekly. com/home/875619-129/story.html

7 “Vaccination Coverage Among Children in Kindergarten — United States, 2012–13 School Year.” CDC Morbidity and Mortality Weekly Report. 2 August 2013. http://www.cdc.gov/mmwr/ preview/mmwrhtml/mm6230a3.htm

8 “Autism and Andrew Wakefield.” American Academy of Pediatrics. 30 October 2013. http://www2.aap.org/immunization/families/autismwakefield.html

9 Editorial. Wakefield’s article linking MMR vaccine and autism was fraudulent. BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.c7452 Epub 6 January 2011. http://www.bmj.com/ content/342/bmj.c7452

PHOTO: JENNIFER P. 9 They often subscribe to a natural health lifestyle, believing that “[Vaccine exemption is] really not our issue. It’s encouraging exposure to certain illnesses like the measles and chicken pox is families to go to the locations where vaccines for children are better for their children than a vaccine. In Ashland, many parents take readily available, just getting them to come in to those locations, and their children to naturopaths who do not recommend vaccinations understanding that they don’t need insurance to come in, that they for children under two, the age which kids are most vulnerable to can come for free,” says Dr. Julie Boom, director of Texas Children’s preventable infectious disease, according to Sherman. Hospital’s Immunization Project. “It’s sort of the same difficulties of “Some of these normal viruses are part of the natural maturation any preventive care. It’s that same demographic that struggles with of the immune system,” herbalist and family physician Dr. Howard W. getting routine pediatric care. Immunizations are obviously one of the Morningstar told Ashland’s local paper,10 expressing a common view most important pieces of that.” among vaccine refusers. “I wonder if it is wise to try to stop every mild The “large Hispanic population and large African-American popula- childhood disease.” tion are not typically your exempters,” adds Dr. Boom. Sherman is not aware of any disease outbreak as a Vaccine outreach efforts in Ashland have been more difficult. result of Ashland’s high exemption rate, but she adds that the “We tried having parent meetings. People don’t want to be seen naturopaths in town do not always report if their patients have come down with a disease for which there is a vaccine. Two thousand miles away, in Houston, the If one child gets sick, an outbreak is picture is very different. In the fifth largest city in the US, medical professionals do not struggle preventable if most children nearby with the unvaccinated—children in places like Ashland whose parents refuse vaccines. They are vaccinated, because the disease struggle with the undervaccinated—economically disadvantaged minorities who do not get all is not likely to spread. This idea is recommend vaccinations because of barriers like cost or a low-resourced health system. known as herd immunity. Amidst a national measles outbreak, a 1992 CDC report11 showed that the proportion of the Houston’s children who were up-to-date on the recommended vaccine doses by their second birthday was a paltry 10 percent. talking about vaccinations. They don’t want to publicly grab informa- “It was really hurting Houston’s reputation to have such low tion. Two weeks ago at a school open house with the school nurse rates,” says Anna Dragsbaek, president and CEO of Immunization we had vaccination and head lice stuff out. Everyone came out and Partnership, an organization dedicated to raising vaccine awareness. grabbed the head lice information but nobody wants the vaccine “Texas has always been horrible, and Houston was the worst in information,” says Sherman. Texas,” says Kathy Barton, the chief of public affairs at Houston’s Sherman’s organization recently lost funding for a vaccine educa- Department of Health & Human Services. “When you’re at the bottom tion site they were working on. of the barrel, you look at what’s going on.” She worries that Ashland’s days are numbered, that one of its resi- A prideful city, various Houston hospital systems, nonprofits, dents could bring back a virus like the unvaccinated preteen children schools, clinics, and the department of health coordinated in order to who went to Kenya last summer when that nation was gripped by a raise the numbers, with funding from the federal government through polio outbreak or the school football team which visited Japan while the CDC’s Vaccine for Children program. there was a rubella outbreak. “Houston is a pretty good community for coming together. We’ve If one child gets sick, an outbreak is preventable if most children demonstrated it in lots of different ways. This is one of those episodes nearby are vaccinated, because the disease is not likely to spread. where it happened. We all love our hometown,” says Draegsbak. This idea is known as herd immunity. However, when a critical number Barton, Dragsbaek and other people involved in the immunization of people are not vaccinated against the illness, herd immunity goes effort say there were many changes. The department of health and down, and populations are much more vulnerable to an epidemic. Texas Children’s Hospital started a vaccination registry to consolidate Outbreaks have occurred in parts of the country with high and track every child’s immunization status. Organizations focused concentrations of “intentionally undervaccinated children,”12 including on boosting immunization services in clinics serving low-income a 2008 measles outbreak and a 2010 whooping cough outbreak13 in families. Two of the city’s large hospital corporations, Texas Children’s San Diego; a measles outbreak this year in a town near Fort Worth, and Baylor Medicine began a large education effort. Organizations like Texas,14 linked to an evangelical church; and another measles Dragsbaek’s came into local clinics to help them with a “reminder- recall program” that would contact families to tell them they needed to bring their children in for immunizations. Unlike Ashland, Houston did not have to struggle against a large and vocal population of vaccine refusers. 12 Sugerman DE, Barskey AE, Delea MG, Ortega-Sanchez IR, Bi D, Ralston KJ, Rota PA, Waters-Montijo K, Lebaron CW. “Measles outbreak in a highly vaccinated population, San Diego, 2008: role of the intentionally undervaccinated.” Pediatrics. 2010; 125(4):747-55. doi: 10 “Poxsicle Parties: Ashland parents hold ‘pox parties’ to give children natural 10.1542/peds.2009-1653. http://www.ncbi.nlm.nih.gov/pubmed/20308208 immunity from chicken pox; health officials say vaccine is safer, avoids suffering.” Ashland Daily Tidings. 13 February 2012. http://www.dailytidings.com/apps/pbcs.dll/ 13 “Vaccine refusal fuels whooping cough outbreaks, study finds.” NBC article?AID=/20120213/NEWS02/202130305 News Health. 30 September 2013. http://www.nbcnews.com/health/ vaccine-refusal-fuels-whooping-cough-outbreaks-study-finds-8C11301986 11 “Retrospective Assessment of Vaccination Coverage Among School-Aged Children -- Selected U.S. Cities, 1991.” CDC Morbidity and Mortality Weekly Report. 14 February 1992. 14 “Texas measles outbreak linked to church.” USA Today. 25 August 2013. http://www. http://www.cdc.gov/mmwr/preview/mmwrhtml/00016086.htm usatoday.com/story/news/nation/2013/08/23/texas-measles-outbreak/2693945

DECEMBER 2013 10 outbreak, this one in an Orthodox Jewish15 community in Brooklyn, New York. The principle behind mass vaccination mirrors liberal ideals about government: that individuals should sacrifice for the greater good, that we have a responsibility not just to ourselves and our immediate families but to our communities. Ironically, the liberal parents of Ashland and similar communities can sound like conservatives and libertarians when defending themselves. “It’s my responsibility as a parent to keep my child safe, I think, and I don’t think it’s your responsibility to take a vaccine because I might be at the same party with you and you might cough on her. Honestly. I think your job is to protect your own health,” says Jennifer Margulis, an Ashland parent featured in the “Vaccine Wars.”16 Sherman acknowledges the irony: “These are educated people. If you were to question any of these people about the science behind climate change, they would look at you like you were crazy.” They think “’because we wash our hands, because we eat organic foods, because all our friends’ children are happy, because they go to these Waldorf schools that are really environmentally conscious,’ that they’re protected. They have the sense that ‘I can control every encounter my child has.’ They don’t think about the fact that kids are leaving Ashland, going to places with outbreaks, and coming back,” says Sherman. Ironically the success of campaigns against polio and other nearly-eradicated diseases may have created a complacency out of which sprung up the anti- vaccine movement of today. People in the movement will often mention that the vaccines they are refusing for their kids are for diseases that we no longer have to worry about anyway—though this is only the case so long as enough of the population is vaccinated. “The period of time during which disease prevalence remains low enough to escape public notice corresponds to a spike of vaccine refusal as vaccine-pre- ventable diseases fall out of public notice and post-vaccine adverse events gain more attention,” says an article17 from June in the journal Biological Sciences by Drs. Diane Saint-Victor and Saad B. Omer at the Rollins School of Public Health at Emory University. In Ashland, Sherman says that the people she knows who get their children fully vaccinated “all know somebody that had polio or meningitis or pertussis and had some life-altering event because of those diseases.” This is true for Lorie Anderson, a mother in Ashland who has vaccinated her own children and who runs a blog called Thinking it Out,18 which covers the immunization controversy in her town from a pro-vaccination perspective. Says Anderson: “I guess if you go back into my personal history, I did have a grandmother who died early because of her polio injuries. And I remember see- ing images of iron lungs and just being terrified, and I remember being terrified of getting my first shot and meeting people in school who were refusing the first shot. But I also remember thinking ‘I’m a pioneer doing this.’”

15 “Notes from the Field: Measles Outbreak Among Members of a Religious Community — Brooklyn, New York, March–June 2013.” CDC Morbidity and Mortality Weekly Report. 13 September 2013. http://www.cdc. gov/mmwr/preview/mmwrhtml/mm6236a5.htm

16 “Frontline: The Vaccine War” Transcript. PBS. 27 April 2010. http://www.pbs.org/wgbh/pages/front- line/vaccines/etc/script.html

17 “Vaccine refusal and the endgame: walking the last mile first.” Saint-Victor DS, Omer SB. Philos Trans R Soc Lond B Biol Sci. 2013;368(1623):20120148. doi: 10.1098/rstb.2012.0148. http://rstb.royalsocietypub- lishing.org/content/368/1623/20120148.long

18 http://applyingcriticalanalysis.wordpress.com/immunize-ashland

ARCHIVAL PHOTO: NIH 11 From paradise

BEFORE: LAKE KAYANGAN to public health emergency

AFTER: TACLOBAN

Read the full article at MPH ’14 trainee Stephanie Lucas offers a view http://the2x2project.org/typhoon-haiyan from the Philippines post-Haiyan

The weekend before the typhoon hit, I was in Coron, a city in the province of Palawan, which people like to call the “last frontier of the Philippines.” I had spent the first two months of my global practicum Ms. Stephanie Lucas is doing a living in Palawan, so it was natural for me to trade the fast-paced three-month practicum in Manila life in my current residence, Manila, for a weekend in paradise. On with the International Organization a boat ride there, a friend and I toured numerous limestone islands, for Migration (IOM), one of the hiked trails to swim in the famous Lake Kayangan, and climbed up Mt. groups involved in the current relief Tapyas to view the large cross and gush at the view of Coron Town efforts in response to Typhoon during sunset. It was magical. All of these sites would be severely Haiyan. This is an excerpt of an devastated a mere four days after I left. article she wrote for the 2x2 project …I heard reports of the typhoon hitting Samar and Leyte early about her experience before, dur- Friday morning, but that was about the extent of the news. The ing, and after the typhoon. storm was ravaging through the Philippines, and it was set to be closer to metro Manila by nightfall. The dark and ominous sky, however, looked scarier than it actually was. We only had about an hour of light rain and some winds here. We were lucky: the typhoon nearly missed us entirely. That weekend, reports slowly started to surface about the

DECEMBER 2013 TOP PHOTO: STEPHANIE LUCAS 12 I was living in the Philippines. I was in Manila. People were still going to work and carrying on with their lives. I sympathized, but I did not fully get it.

damages: the Eastern Visayas region where the storm initially made coverage ends? Will funding and aid still continue? How do we rebuild landfall was particularly hard hit. Other areas like Central Visayas, whole cities and re-establish infrastructure once the rubble has been Southern Luzon, and Northern Palawan were also said to be affected. cleared? How do we ensure the continuity of care and access to care Luckily there were also places that were spared: friends I knew in for the massive amounts of displaced people? central Palawan said that they experienced heavy rains and wind, but I received a text today from my friend in Coron. While she is that all in all, the informal communities that they worked in were okay. physically well, she has many other issues to deal with. Currently she On Monday, stories started to circulate in the office. People with is homeless. Her house was completely destroyed in the storm. She family and friends in affected regions had much difficulty contacting doesn’t have any money or a means of making any. As an island guide, them. A surgeon from Samar sent word that his town was not okay. the storm has halted all tourism almost completely, leaving Coron’s He appealed to my coworker for help, telling how many people were major industry to rapidly deteriorate. And all of this stress may injured or missing and how many houses were flattened. unconsciously start to affect her mental health. But at that point, it was still difficult for me to fully comprehend the This is just one person in one town affected by Typhoon Haiyan. situation. What I saw on the news and the stories I heard impacted There are millions of others. me, but it wasn’t real yet. I was living in the Philippines. I was in …Typhoon Haiyan is not going to be the last disaster or crisis; we Manila. People were still going to work and carrying on with their need to continue thinking about these issues before the next one comes. lives. I sympathized, but I did not fully get it. I want to keep encouraging people to donate (http://redcross.org.ph) Then I received word from a friend I made in Coron. She reported or at the very least, keep the Philippines in your thoughts. While there is that many trees had fallen causing places like Lake Kayangan—where still so much to do, Filipinos will get past this crisis- especially with all I had been the weekend before—to be inaccessible. The large cross on the help and support they are currently receiving. Mt. Tapyas fell. More than 50 boats were destroyed. Many people were dead or missing. The devastation started to hit home. On Tuesday, I participated in a series of health cluster meetings at the Philippine Department of Health, and the details of the storm and its destruction became even more concrete. I never thought about what actually goes on behind the scenes of a humanitarian response until that moment. It helped me look beyond mere sympathy and real- ized that we, in being there, had the responsibility to do something. We discussed how to assess the situation, brought up current and potential challenges, and aimed to organize, prioritize, and coordinate response efforts. As someone who has no prior experience with disaster relief, I see now how difficult it can be for the people leading a response to weigh questions of necessity, efficiency, timeliness, and accuracy. With my epidemiology background, I am struck by the tension between collect- ing and analyzing data in a timely manner and simply acting with the information that you have. It takes collaboration with others, patience, and composure to make tough calls that will save lives and restore structure to a seemingly hopeless situation. It takes negotiating the differing priorities of individuals and groups in order to come up with a solid plan of action. It takes the ability to recognize and utilize the human rights framework in a situation that stripped individuals of that dignity. To put it simply, it takes finding creative short and long-term CORON AFTER THE TYPHOON solutions to both minor and major challenges. …The effects of catastrophes such as Typhoon Haiyan stretch way beyond the short-term relief needs. What will happen when the news

PHOTO: CORON MAYOR’S OFFICE 13 COLUMBIA UNIVERSITY EPIDEMIOLOGY The CUESS series brings the best minds in our field together for a full day of discussions on SCIENTIFIC SYMPOSIUM the most pressing health questions of our time. We encourage participants to follow our Twitter @cuepidemiology for coverage of the event and to tweet about it using the hashtag #CUESS. For more information about future CUESS events, visit http://cuess.org.

Putting childhood disability on the map Epidemiology and UNICEF join for symposium on historically challenging public health issue

s global officials gathered in New York City for the United developmental disabilities is that the more that’s our goal, the more Nations’ annual General Assembly meeting, the department we’ll be disappointed.” teamed up with the United Nations Children’s Fund, or Low and middle-income countries are in the midst of an “epidemio- AUNICEF, to host the first Columbia University Epidemiology logic transition” where reduced child mortality will lead to increases in Scientific Symposium (CUESS) of the fall 2013 school year, titled chronic conditions. “Putting childhood disability on the map.” “We need to think beyond just survival,” said Dr. Durkin. The symposium comes at a time of heightened attention to One key way to do that is to improve the way data about children and new partnerships in this area. The UN General Assembly and with disabilities is collected. Participants in a UNICEF-organized the World Assembly have passed resolutions calling for greater collaboration spoke about the importance of setting statistical and recognition and collaboration around developmental disabilities, and methodological standards at an international level in order to compare UNICEF’s “State of the World’s Children” report, published this year, different countries. made child disability a global priority. Heads of state met during the “We need to make sure that children with disability are visible in General Assembly to decide whether disability will be included in a research and statistics so that their needs can be met,” said Dr. Cappa. post-2015 global development agenda. Yet there are many significant challenges. Countries use different At the CUESS, national and international research, policy, and definitions between them, the quality of statistical data varies widely, government leaders addressed such topics as how to improve in many places there is too little research, and some disabilities simply inclusion of disabled children, challenges of collecting data in low and are not recognized at all. middle-income countries, and disability rights. Take depression: despite being the leading cause of disability The event was hosted by Dr. Leslie Davidson, professor of epide- globally and the leading cause of suicide, it is often ignored or belittled, miology, who specializes in maternal and child health, and Dr. Claudia said Dr. Cappa. Yet suicide—which often results from depression—is in- Cappa, a statistics and monitoring specialist in the division of policy creasingly a cause of death for youth, according to Dr. Christina Hoven, and practice at UNICEF. professor of epidemiology (in psychiatry) at Columbia, who investigates The underlying causes of developmental disabilities are myriad possible interventions that could be used to reduce suicide in schools. and can include genetic factors, nutritional deficiencies, infec- Despite a supposed commitment his home country of India had tions, trauma, toxic exposures, perinatal health, and poverty, said made to address childhood disabilities, Mr. Javad Abidi, founder of the Dr. Maureen Durkin, professor of population health sciences and National Disability Network, said that data is not being collected and it pediatrics at the University of Wisconsin-Madison. Yet, the majority of feels like people with disabilities “are invisible.” Ninety-eight percent disabilities are a result of unknown causes. of children with disabilities in India are not able to access any form of Progress in this area looks different than in many others, said Dr. education, according to Mr. Abidi. Durkin. Disability diagnoses have risen not because health is getting Today, the vast majority of research—more than 90 percent—occurs worse but because there have been global reductions in infant and in high-income countries, even though more children probably live in child mortality over the last 25 years. low and middle-income countries. This can be seen in autism, where “Typically our goal in public health is to eradicate the dis- there is a global disparity in the number of epidemiologically confirmed eases we’re trying to study,” said Dr. Durkin. “What I’ve learned in cases between high and low income countries, said Dr. Durkin.

DECEMBER 2013 14 DRS. LESLIE DAVIDSON, ZENA STEIN, AND MAUREEN DURKIN

Many of the data sources high-income countries use to estimate prevalence of disability are not available in low and middle income countries, including administrative records from schools and clinics, Although the registries, birth cohort studies, household censuses, and surveys. The “deprivations stem from and are perpetuated by children’s exclusion from statistics,” said Mr. Abid Aslma editor of UNICEF’s challenges are The State of the World’s Children. “We need data to expel ignorance about causes of disability.” But new efforts for data collection are underway, said UNICEF admittedly great, representatives. Dr. Michael Boivin, associate professor of neurology at Michigan State University, who conducts assessments of children with participants neuropsychological diseases in low-income countries in Africa said that the revolution in mobile network technology would usher in improved measurement tools. expressed With Dr. Davidson, and several other organizations present at the CUESS, UNICEF is working to provide guidelines to low and middle-income countries in their capacity to gather sound and optimism over relevant data, discuss conceptual and theoretical issues, and review methods that have been previously used to collect data, with particular attention to methods in low-resource settings. the growing “All countries in the world have collected data on disability,” said Dr. Cappa. “It’s not the lack of data: it’s the lack of quality data that is the real problem.” attention to child Although the challenges are admittedly great, participants expressed optimism over the growing attention to child disability. “There is a sort of a feeling of change, of excitement, that after disability. the many years people have been working in this area, there are some shifts,” said Dr. Davidson. “The shifts are kind of cataclysmic.” — Additional reporting by Chris Tait, MPH ‘14 Communication in Health and Epidemiology Fellow for the 2x2 project

15 Mental health as a global issue

ccording to recent estimates, mental disorders and At Columbia, GMHP offers many resources for Epidemiology faculty, substance abuse add up to almost a quarter of the global including connecting them to a network of other researchers, highlight- disease burden—more than any other cause.1 Yet, compared ing their research, and helping to recruit research assistants for studies. Ato other diseases, few resources are devoted to treating Students can do a global mental health-themed practicum working and preventing conditions like depression, anxiety, bipolar disorder, with GMHP and Dr. Anne Paxton, associate professor of epidemiology, autism, drug addiction, and schizophrenia. and head of the school-wide Global Health Certificate. This year GMHP In many, if not most cultures, the stigma surrounding mental placed two MPH students at WHO (see below). illness deters people from seeking help. Often when they do, they run GMHP also hosts regular symposia and other events, such as the up against difficulty finding good treatments. seminars held last spring that focused on the development of the “From within public health there has been a commitment to a International Classification of Diseases-11, and the NYC Forum on global understanding of health for decades, but mental health has Global Mental Health, and a monthly Columbia University Seminar on largely been in the shadows,” says Dr. Kathleen Pike, clinical professor Global Mental Health. The 2013-2014 program was launched with a of psychology and education (in Psychiatry and Epidemiology). “Mental talk by Robin Hammond, an award-winning photojournalist who spoke and behavioral disorders are the leading cause of disability globally, about his work documenting the plight of individuals with mental and mental health is the strongest predictor of well-being worldwide. illness in low-resourced communities in Sub-Saharan Africa. Mental illness is common, serious, and global—it can’t be left behind With funding from the inaugural round of President Lee Bollinger’s and it can’t be addressed later, after we deal with everything else Global Innovation Initiative, GMHP will also organize a series of meet- given that it impacts virtually everything else.” ings to address mental health priorities in various parts of the world. Dr. Pike is executive director and scientific co-director of the The first will take place in Amman, Jordan in 2014. Global Mental Health Program, or GMHP, a collaborative effort led by Students interested in learning more about global mental health are a partnership of investigators in the Departments of Epidemiology encouraged to register for the course Priorities in Global Mental Health, and Psychiatry. GMHP supports faculty and prepares trainees to which will be offered for the first time during the spring 2014 semester. advance the field of global mental health by building research ties and For more information, visit http://columbiagmhp.org or email Dr. establishing educational and training opportunities in low and middle- Pike at [email protected]. income countries to raise awareness and build capacity for prevention and treatment of mental illnesses. Dr. Pike and her fellow scientific co-directors Dr. Sandro Galea; Dr. Harold Pincus, professor of psychiatry and vice-chair for strategic initiatives in the Department of Psychiatry; and Dr. Ezra Susser, professor of epidemiology and psychiatry, all have a history of work- ing on mental health projects abroad. Several other Epidemiology faculty are involved including Drs. Lawrence Yang, Myrna Weissman, Francine Cournos, Christina Hoven, Magdalena Cerdá, Silvia Martins, and Richard Neugebauer. GMHP’s work takes place at a time of increased global attention to mental health. This year, the World Health Organization (WHO) released its first global mental health action plan, a historic commitment to improving mental health services and reducing suicide rates in nearly 200 member states. Dr. Pike attended its launch at WHO in Geneva. According to WHO, 75 to 85 percent of individuals with mental illness in low and middle income countries never receive treatment.2 Because most research on mental health and mental disorders comes from high-income countries, the need to build both research and clini- cal capacity in low-income communities is significant. To achieve this, GMHP is working with WHO to develop a global network of clinicians and clinical sites committed to research and training in mental health.

GMHP SEMINAR WITH DRS. MARIA ELENA MEDINA-MORA (INSTITUTO NACIONAL DE PSIQUIATRIA, MEXICO), DAVID STRAUSS (COLUMBIA PSYCHIATRY), MICHAEL FIRST (COLUMBIA), JEFFREY LIEBERMAN (COLUMBIA DEPARTMENT OF PSYCHIATRY), KATHLEEN PIKE, GEOFF REED (WHO), PRATAP SHARAN (ALL INDIA 1 Knox, Richard. “ Illicit Drugs And Mental Illness Take A Huge Global INSTITUTE OF MEDICAL SCIENCES, INDIA), EZRA SUSSER, HAROLD PINCUS, OYE Toll.” NPR. http://www.npr.org/blogs/health/2013/08/28/216524066/ GUREJE (UNIVERSITY OF IBADAN, NIGERIA) illicit-drugs-and-mental-illness-take-a-huge-global-toll

2 “WHO Mental Health Gap Action Programme (mhGAP)” http://www.who.int/ mental_health/mhgap/en

DECEMBER 2013 16 Two Epidemiology students did their practica through GMHP this year. Here they describe their experiences:

Leona Zahlan, Mala Dorrai, MPH ’14 MPH ’14

WHO ICD-10 Revision, WHO (Geneva, GMHP/AUB-MC Intern Switzerland) (Beirut, Lebanon) This summer I had the My interest in global honor of working with a public health originated team of three experts on while growing up in developing the monitor- Ghana, where I was able ing and evaluation to observe the drastic aspects of the WHO’s effects of HIV/AIDS and comprehensive mental the impact of stigma- health action plan tization on the mental (CMHAP) 2013-2020, a health of HIV positive commitment of all 194 women. While studying WHO member states to biological determi- bolster their national nants of health at the mental health systems University of Miami, I was surprised to observe similar issues of and reduce the global burden of mental disorders by updating heath disparities in the US as in Ghana. My interest in mental health policies and laws, providing more community-based mental health was reinforced while volunteering with AIDS Project Los Angeles. care, and strengthening mental health information systems. Six After that, I became involved in research on the spiritual coping global targets have been established in the CMHAP addressing key mechanisms of HIV positive individuals in South Florida. I decided to action areas of the plan including a 20 percent increase in service pursue a degree in public health at Mailman because of its excellent coverage for severe mental disorders and a 10 percent reduction in reputation and numerous opportunities to grow. suicide rate by the year 2020. Through Dr. Pike and GMHP, I was given the opportunity to work Our primary goal was to develop a list of indicators that would on field studies that will inform WHO ICD-11 for my practicum. My capture the global targets of CMHAP that member states would placement in Beirut, with trips to Mexico City and Geneva, focused report in an accurate and timely manner. on sexual health in the Arab Region, providing support to help those We were also responsible for developing a global monitoring countries reduce their disease burden. framework document to provide guidance, training and technical as- While attending WHO Final Project Protocol Meeting in Mexico City sistance to member states on capturing data using these indicators. in early July, I was fascinated to observe the number of stake- I also helped outline the monitoring framework document, con- holders involved in the process, including forensic psychiatrists, sisting of a section that provides an overview of current data collec- psychologists, reproductive health experts, sexologists, lawyers, and tion techniques and a section that provides data collection sources judges, and the amount of work and dedication required to modify, and strategies at the population, policy, facility, and individual level. create, and test the sexual health and sexual disorders proposals. We established screening criteria and created a scoring template Working with Dr. Brigitte Khoury at the American University of for the indicator review process. My supervisor and I facilitated four Beirut (AUB), I have been able to observe the importance of cultural meetings with a WHO mental health expert panel, and three rounds differences. Since there are few epidemiologists or public health of email consultations with mental health experts around the world, experts working with me on this project, it has been rewarding to be where the preliminary indicator list was reviewed, scored, and refined. able to provide an epidemiologic perspective and to apply some of I learned a great deal about the processes involved in the the skills I learned through my coursework at Mailman. monitoring and evaluation of a large-scale action plan and program. I am currently working on the preparations of WHO Stakeholder I also gained the skills needed to develop contextual framework, Meeting hosted by the Arab Regional Center in Beirut in late October conduct extensive literature reviews, and facilitate deliberations to initiate the field studies process. In early October, I will be travel- with world health leaders. This experience showed me the value of ling to WHO in Geneva to attend and assist with the Global Mental the work of international non-governmental organizations such as Health Forum, which is a World Mental Health Day event. WHO to prevent disease and to protect and promote the health of After I earn my MPH at Mailman, I plan to work in the field of individuals. I eagerly await the impact that the CMHAP makes on the global mental health and reproductive and sexual health before global burden of mental disorders over the next eight years. continuing towards a PhD. For more information on the ICD Revision: http://www.who.int/classifications/icd/revision/en

17 Conference addresses dearth of autism research in Latin America

ike many conferences, Latin America’s first-ever regional discuss the state of autism in Chile and strategies to implement new conference on autism spectrum disorders brought to- United Nations General Assembly and World Health Assembly resolu- gether scientists and clinicians to share knowledge. But what tions on autism. Lsurprised Dr. Daniel Pilowsky, assistant professor at CUMC of “Latin America is poised to be a leader in the global autism epidemiology and psychiatry, and chair of the event, was the number movement,” said Mr. Rosanoff after the meeting and conference. of non-practitioners from the region in attendance, including govern- “The activities happening on the ground in Argentina, Brazil, and ment representatives of Argentina, Brazil, and Chile, and a large group Chile—from services capacity building to awareness and legislation— of families with autistic children. will provide a framework for action in other countries in the region “It suggests that parents are very active in demanding services in and around the world.” these countries,” said Dr. Pilowsky. For Dr. Pilowsky, the most memorable moment of the conference While rates of autism diagnoses are believed to be rising in Latin was a 25-minute drama presentation by autistic children and their America, little data is available in the region, and many families dealing parents showing common challenges that these families must deal with autism have trouble finding treatment. Most autism research takes with. One presentation showed an autistic child having a severe tem- place in high-income countries in North America and Western Europe. per tantrum at a store and a parent struggling to figure out what to do. The purpose of the Conferencia Latino-Americana del Espectro “I was struck by the level of interest among parents and clinicians Autista, held September 10-11 in Santiago, Chile, at the Universidad in all three countries and especially by the fact that most of what has de Chile, was to encourage more research into autism in the region by been accomplished there is because parents have been pushing hard. creating partnerships with investigators in North America and Europe, It’s the pressure coming from below,” said Dr. Pilowsky. and to discuss strategies to further understanding of autism and im- He says the next step is to establish a joint effort between prove delivery of services to people with the disorder. The Department Columbia, Autism Speaks, and academic centers in the participating of Epidemiology co-sponsored the event with Austism Speaks, an Latin American countries, which he hopes will lead to more advanced advocacy organization, and RedeAmericas, a National Institute of training of clinicians and collaborative research. Mental Health (NIMH)-sponsored network for mental health research in Latin America whose principal investigators include Dr. Ezra For more on the conference, visit http:// Susser, professor of epidemiology and psychiatry, and Dr. Sandro autismspeaks.org/science/science-news/ Galea, and Dr. Pilowsky as a co-investigator. Representatives from autism-speaks-hails-first-latin-american-autism-conference NIMH and UNICEF also attended the event. Dr. Susser, Mr. Michael Rosanoff, a DrPH candidate and associ- For more on the meeting with Dr. Bachelet, visit ate director of public health research at Autism Speaks, and their http://autismspeaks.org/science/science-news/ colleagues also met with Chilean presidential candidate and former autism-speaks-receives-audience-michelle-bachelet president Dr. Michelle Bachelet at her campaign headquarters to

FROM LEFT: MICHAEL ROSANOFF, GRACIELA ROJAS (DIRECTOR OF THE SCHOOL OF MEDICINE AT LA UNIVERSIDAD DE CHILE), MICHELE BACHELET, EZRA SUSSER, ANDY SHIH (AUTISM SPEAKS SENIOR VICE PRESIDENT FOR SCIENTIFIC AFFAIRS), AND KATIE HILL (ASSOCIATE DIRECTOR OF MEDIA, BLJ WORLDWIDE)

DECEMBER 2013 PHOTO: US NATIONAL ARCHIVES 18 COLUMBIA UNIVERSITY EPIDEMIOLOGY GRAND ROUNDS

From power lines to cell phones: 25 years of research on nonionizing radiation and cancer

on-ionizing radiation from power lines, uncertainty, and the evidence stabilized to allow microwaves, and cell phones is unlike people to get on with their lives without concern.” many chemical exposures in that it Just as worries about the potential health Nhas never posed a known public health effects from power lines began to subside, threat. But interest groups, politicians, and some believed the emergence of cellular phone individuals have long worried that technology technology posed a new possible threat. that produces this kind of radiation increases the Studies in the 1990s began to look into risk of developing cancer. self-reported history of cell phone use and its At the first Columbia University Epidemiology association with brain tumors. Grand Rounds (CUEGR) of the academic year, Dr. Dr. Savitz reviewed the landmark Interphone David Savitz, a professor of epidemiology and Study, an international collaborative investiga- obstetrics and gynecology at Brown University, tion into the potential effects of cell phone spoke about how epidemiologic investigation use on the risk of brain tumors. Surprisingly, has informed policy debates around radiation, results suggested that cell phone users were where, like many new technologies, public at decreased risk of brain tumors compared to concern has been high despite much uncertainty non-users. Further research failed to find a link about health effects. between cell phone use and brain tumors, mak- At least 25 years of research has gone into ing it an increasingly doubtful hypothesis. this area, including Dr. Savitz’s own work. He Although researchers spent years failing to find described two long-running areas of investiga- evidence of cancer risk from non-ionizing radia- tion: magnetic fields emitted from power lines tion, Dr. Savitz said there is still value to this work. DR. SAVITZ and radiation from cell phones and cell towers. “Practicing epidemiology to make sure we Public concern in the 1980s and 1990s about haven’t missed something that’s unlikely to be power lines came out of increased awareness there can be informative in addressing a policy about environmental issues, particularly because concern where we just don’t want to make a the effect of radiation emission from power lines mistake,” he said. was not well understood. He also stressed the importance of com- The first epidemiologic study in this area, municating scientific information clearly to which looked into whether children with brain policymakers so they are equipped to address tumors and leukemia were more likely to live the uncertainty. And he advised epidemiologists near power lines, was widely criticized for its to be receptive to engaging with other disciplines unconventional methods and high potential for where epidemiology alone may not be enough to biased results. understand the whole story. Over the next two decades, research using He closed by encouraging trainees to learn new methods produced very little evidence to enough about areas outside of their immediate confirm fears that children exposed to high focus: “I think students should pick a territory levels of radiation from power lines were at that’s broad enough to be interesting, but to be increased risk. open-minded and recognize that as you get into “We moved rapidly from ignorance to more depth you are going to need collaborators.” sufficient clarity,” said Dr. Savitz, “We reduced —Chris Tait

19 FACULTY PROFILES Charles DiMaggio

While working as a physician whether the success has occurred in other cities and states around the nation. assistant in emergency In other research, he has found that children who are put under anesthesia are at medicine at Elmhurst Hospital greater risk of developmental and behav- in Queens, NY, Dr. Charles ioral disorders, although it is not clear if the relationship is causal. DiMaggio, now an associate He has also looked at the emergency re- professor of epidemiology, sponse to terrorist attacks as well as mental health treatment after such disasters and how observed that many of the those data can contribute to surveillance pro- grams that can monitor the behavioral health most terrible injuries he had effects of the disasters like the September 11, to treat were also the most 2001, attacks in New York City. As injury epidemiology has become an preventable. important research focus in the department, Dr. DiMaggio has played a significant role, “There was a time when in the summer serving as the research director at the Center months in New York City, we would routinely for Injury Epidemiology and Prevention, have cases where children fell out of apart- where he administers the center’s pilot ment windows. It was simply awful,” he says. grant program and coordinates the efforts of “Through the work of folks like Dr. Barbara co-investigators. He also meets frequently Barlow at Harlem Hospital and Columbia, with students who are interested in the field APPOINTMENTS there was a push to mandate window guards of injury epidemiology. AND PROMOTIONS in apartments with children. After that, we “I give thought to the kinds of issues facing gradually stopped seeing many of those injury epidemiology. Two that occur to me kinds of injuries. I felt an epidemiological are: first how we can inspire and most appro- FACULTY perspective and public health approach could priately prepare the next generation of injury help prevent some of that trauma.” researchers and practitioners, and second Marlyn Delva was appointed lecturer in the Although Dr. DiMaggio “caught the epi bug how we can best harness the potential of chronic disease epidemiology cluster early” while learning about John Snow in an new, large, and ubiquitous data sources to undergraduate course in public health at St. inform the evidence base to prevent and John’s University, he spent his first 20 years control injuries,” he says. after college as a physician assistant before Dr. DiMaggio has taught epidemiologic coming to the Department of Epidemiology research methods to the epidemiology for his graduate work. master’s students for over 10 years and Child pedestrian injuries, such as getting currently teaches statistical computing in R hit by a car, were “among the most objection- to doctoral students. able, and preventable, kinds of trauma we Apart from his academic interests, he likes routinely saw” in the emergency room. When traveling with family and playing the guitar. he began his graduate work, he decided he He plans to continue his focus on pediatric would research the epidemiology of such injury, saying that a common misconception injuries in New York City, supported by the about prevention efforts is that they prevent New York City Department of Transportation. “kids from being kids.” More recently, funded by the National “It’s not an either or choice. There are Institutes of Health and the Centers for public health interventions that ensure that. A Disease Control and Prevention, he and Dr. lot of parents think, ‘well I want to protect my Guohua Li, a frequent collaborator and cur- child so probably best if they stay very close rent head of the injury cluster and the Center to home,’ and a lot of kids do stay home and for Injury Epidemiology and Prevention, then they have other issues, like obesity or released a study that found Safe Routes they don’t interact with other kids,” he says. to School, a federal program that funds “Kids really can be allowed to be kids and can “traffic-calming measures” around schools, be allowed to be active and can be allowed to dramatically reduced injuries in New York run around and play and still be safe.” City. He and Dr. Li are currently looking at — Co-authored by Richa Singh, MPH ‘15

DECEMBER 2013 20 ALUMNA PROFILES Sandra Echeverria

Dr. Sandra Echeverria, To ensure that the project would have long- term policy implications, she designed an as- PhD ’06, an assistant sessment for local community groups and the professor of epidemiology mayor’s office in New Brunswick. The city is now considering adopting park programming at the Rutgers School of and working on an approach to addressing physical activity for the city’s youth. Public Health, is a social Dr. Echeverria’s work is a testament to the epidemiologist who studies diverse academic experience she had at the Mailman School. With an MPH in sociomedi- the social determinants cal sciences, she developed a strong founda- of cardiovascular health, tion in racial and ethnic health disparities and the role of social determinants in shaping focusing on health and the health of populations. After completing her MPH, Dr. Echeverria spent several years physical activity in Latino working on international public health at the communities. International Planned Parenthood Federation in the Western Hemisphere region. She traveled extensively to countries includ- In her research, Dr. Echeverria uses large- ing Bolivia, Argentina, Mexico, Guatemala, scale data or cohort studies to examine how Jamaica, St. Lucia, and Guyana. As a woman people’s level of physical activity and BMI are raised in an inner city in the US, she found associated with whether they are native or that travel allowed her “to see my humanity foreign-born, their neighborhood “built envi- in a different perspective” and identify “our ronment,” and their socioeconomic position. common humanity” across the globe. Yet, She is currently looking at racial and as she moved forward in her career, she ethnic disparities in physical activity of no longer wanted to be “shuttled in and out participants recruited at Columbia University of places,” working with communities at a and at the longitudinal relationship between snapshot moment. various modes of physical activity and BMI. Returning to the US, she decided to Dr. Echeverria uses traditional epidemio- pursue an epidemiology degree in order logic study designs for what she refers to as to build a strong methodological founda- her “nontraditional” epidemiologic work in tion, focus on refining her skills in study communities. Over the past few years, she design, and on crafting rigorous quantitative has dedicated a significant amount of time investigations. She recalls the encouraging to working with community groups in New and passionate research and mentorship Brunswick and Newark, NJ, on preventive of her PhD advisor, Dr. Ana Diez-Roux, and health initiatives for marginalized Latino and dissertation chair, Dr. Bruce Link. African-American populations. “I was exposed to people at the cutting Her purpose is not only to use the data edge of their field who remain a part of generated from these projects academi- my network and have been instrumental cally but also to create “tangible community in shaping my academic, professional and results” that provoke conversations and personal growth.” Among her fond memories efforts toward sustainable changes. She while studying at Mailman was going to is currently examining how neighborhood El Presidente, her favorite spot to eat in residents perceive the role of parks in Washington Heights, with fellow classmates promoting health, using their perspectives and professors. Today Dr. Echeverria lives to launch programs that increase park use. in New Jersey with her husband and two After finding that parents in an impoverished children, Camila and Adrian. and crime-ridden area were concerned about — Amina Foda, MPH ‘15 taking their children to parks because of safety issues, she worked with community partners to develop and evaluate the delivery of physical activity programs where the local police force would provide more active patrol during sessions.

21 STAFF PROFILES Bijal Shah

As senior cluster She came to the SCA job nearly one year ago. It is rare that any two days in this job administrator (SCA) for the are alike, she says, but a typical one might chronic disease epidemiology involve submitting a grant application, work- ing on a progress report, reviewing projects cluster, Bijal Shah is used to keep track of the budget, and answering questions from trainees and faculty. to switching between the “It is a pleasure working with Bijal. She is numerous and widely varied extremely smart, hard-working, and profes- sional. It is incredibly impressive to see how demands of her position. much she juggles. Our cluster is so lucky to work with her,” says Dr. Mary Beth Terry, the “Getting acclimated to our department’s fast- director of the chronic disease epidemiology paced environment is never easy for an SCA, cluster and a professor of epidemiology. but Bijal came to work for us at a particularly Bijal recently moved to Harlem from the busy time–-right in the middle of the January Upper East Side. She takes advantage of NIH cycle,” says department administrator many of New York City’s cultural offerings, Christina McCarthy, who manages the SCAs. “I including seeing her friends play jazz; going was so impressed with how quickly she was to events at Summer Stage, Lincoln Center, able to start working with the faculty and staff and the New York Philharmonic; visiting the and how committed she was, and is, to under- city’s art museums; and going to plays—she standing everything that is happening across recently saw Betrayal with Daniel Craig and every project in the cluster. She has become Rachel Weisz. such an integral part of the chronic team and “It’s great working here. Everyone’s really I think that the entire cluster is functioning nice. It makes it easier when things get more efficiently because of her efforts.” stressful” she says. Bijal was born in India but spent most of her life in California, studying history and digital arts at University of California-Irvine. She tried out journalism as an intern at KPCC, an NPR affiliate in Los Angeles, on the show “Airtalk with Larry Mantle” which covers cur- APPOINTMENTS rent events, politics, and news. She worked on a pilot show during the 2004 elections that included a memorable interview where she STAFF got to speak with the actor Paul Newman. “I had to ask him to speak up because he Jamil Alexis was Styl Perez was appointed Janine Rose was appointed was speaking too softly,” she says. “He was appointed as a technician as a research worker in as a project coordinator I in nice when I asked him about it.” A in the infectious disease the infectious disease the lifecourse epidemiology After NPR, she gained financial manage- epidemiology cluster. epidemiology cluster. cluster. ment experience as a project specialist at Melanie Caban was Charissa Pratt was Jennifer Sumner was Kaiser Permanente, working with architects appointed as a variable appointed as a project appointed as a project on financing for facilities and capital projects hours officer in the injury coordinator I in the lifecourse manager in the psych-neuro like building a new hospital or renovat- epidemiology cluster. epidemiology cluster. epidemiology cluster. ing a space. While at Kaiser, she became interested in working in education and took Sabrina Hermosilla Seth Prins was appointed Alejandro Vanegas was a position at the Southern California Institute was appointed as a data as a data specialist in the appointed as a project of Architecture as executive assistant to the analyst in the psych-neuro psych-neuro epidemiology coordinator in the chronic director of the school. epidemiology cluster. cluster. disease epidemiology cluster. Bijal eventually decided she wanted a Stephanie Kujawski Catherine Richards was change and made the cross-country move to was appointed as a data appointed as a program New York City. analyst in the psych-neuro manager in the psych-neuro “I had reached a point where I was like, epidemiology cluster. epidemiology cluster. it’s now or never.” After two months, she was hired to work at the Research Foundation Valerie McArdle was Andrew Ratanatharathorn for Mental Hygiene at the New York State appointed as associate was appointed as a data Psychiatric Institute in Dr. Deborah Hasin’s director for special analyst in the psych-neuro research group. programs. epidemiology cluster.

DECEMBER 2013 22 PROFILES

Master’s Student Day Trainee research highlighted in presentations and poster session

Are natural detoxifications safe and effective? This research and much more was on display at the third annual Epidemiology Master’s Student Day in October, where second year How can surveillance of food-borne illnesses be master’s students prepared a presentation or poster about their practicum work. The event was created to give master’s students an improved? Is there a connection between how experience similar to a professional conference and an opportunity teenage girls go through puberty and their risk to share their practicum work with faculty and other students in the department. Dr. Joyce Pressley, associate professor of epidemiology of breast cancer later in life? Are kids eating and health policy and management at CUMC and director of the department’s practicum-thesis program, is the central coordinator healthier after McDonald’s menu changes? Is of the event. there an association between video games and Prizes were awarded for best student abstracts and best poster in each cluster. The students who won for best abstract gave children’s thoughts of death and suicide? presentations, which are summarized below:

FIRST PRIZE SECOND PRIZE Psychiatric hospitalizations among children Prenatal maternal stress and risk of autism and youth in New York City spectrum disorder (ASD)

Raquel Duchen (Adviser: Dr. Cynthia Driver) Amrita R. Vavilikolanu Practicum site: New York City Department of (Adviser: Dr. Mady Horning) Health and Mental Hygiene (Epi Scholar) Practicum site: Center for Infection and Immunity at the Mailman School of Public Health Ms. Duchen was concerned with whether hospitalization of young people for mental or As rates of autism spectrum disorders (ASD) behavioral disorders could have been prevented have increased, there is growing interest in if the patient had earlier and better access to whether pre-birth conditions can predispose a health services. To investigate this, she looked at child to one of the disorders. The idea is that pre- the connection between neighborhood poverty natal exposure to environmental stressors could and hospitalization for individuals in New York be linked to adverse neurodevelopment. Ms. City under age 24 over the years 2000 to 2010. Vavilikolanu looked at the effects of a mother’s According to her research, one in 12 children stress response on the risk for an ASD. in New York City were hospitalized for psy- The study used the Autism Birth Cohort Study, chiatric conditions, and young people living in in which mothers were surveyed about stressors lower income neighborhoods who ostensibly during pregnancy such as physical or sexual had less access to mental health services were abuse, emotional loss, physical problems, or more likely to have been hospitalized than their work and financial stress. Mothers who dealt counterparts in more well-to-do neighborhoods. with any one of those stressors were significant- This suggests that many young people who were ly more likely to have a child with an ASD—but hospitalized did indeed lack access to other only a male child. Ms. Vavilikolanu concluded mental health services. that ASD is related to maternal anxiety and depression; however, the biological mechanism that could explain this is not known.

CONTINUED

23 PROFILES Master’s Student Day

DR. KATHERINE KEYES AND THOMAS VO

LEFT TO RIGHT: LINDSEY WAHLSTROM, DR. JOYCE PRESSLEY, AMRITA R. VAVILIKOLANU, AND RAQUEL DUCHEN

THIRD PRIZE POSTER PRIZE WINNERS Lifecourse Epidemiology: The impact of changing kids’ meal default items Mr. Thomas Vo for “Racial and Chronic disease epidemiology: at fast-food restaurants ethnic differernces in substance Ms. Sara Gelb for “Gender use across the life course: A Lindsey Wahlstrom (Adviser: Dr. Y. Claire Wang) differences in the association national study” (Department of Practicum site: Yale Rudd Center for Food Policy between depression, anxiety Epidemiology, Dr. Katherine Keyes) and Obesity (New Haven, Conn.) and type 2 diabetes mellitus” (Department of Epidemiology, Psychiatric/neuro epidemiology: Reacting to pressure from parents and members Dr. Ryan Demmer) Ms. Janice Okeke for “Genetic of the health and medical community, McDonalds testing preferences among in 2011 began offering healthy side items in Infectious disease epidemiology: individuals with epilepsy and its kids Happy Meals to replace or supplement Mr. Patrick Warren for “In vivo unaffected family members: French fries. Ms. Wahlstrom chose to investigate efficacy of artemether-lumefan- Impact of penetrance and clinical whether this move got parents and kids to trine, aremether-lumefantrine + utility” (Sergievsky Center and change their eating habits. primaine, and artesunate for the the Department of Epidemiology, Remarking that “as Americans we feel we treatment of P. vivax malaria: A Dr. Ruth Ottman) have the right to do whatever we want or die try- randomized open-label trial in ing,” Ms. Wahlstrom pointed out that McDonald’s Central Ethiopia (Earth Institute, Social epidemiology: Mr. John strategy represents a “libertarian paternalism.” Columbia University) Pamplin for “Perceived stress While the change came from above, parents could and hypertension among still opt to get their child a meal that did have Injury epidemiology: Hispanics in Northern Manhattan fries in addition to or instead of apple slices. Ms. Hajere Gatollari for (Mount Sinai School of Medicine) What she found is that most parents chose to “The impact of backseat seatbelt get their kids the “default” option, which serves laws and driver characteristics Drs. Grace Hillyer, Fran Cournos, apples slices with fries. She concluded that a on restraint status in rear-seated and L.H. Lumey reviewed restaurant’s decision to change its menu items teens involved in fatal motor abstracts and judged posters. can positively shape food choices. vehicle crashes” (Departments of Epidemiology and Health Policy and Management, Dr. Joyce Pressley)

DECEMBER 2013 24 NEW RELEASES

Launch of new journal Faculty release Exec MS trainee Injury Epidemiology new textbook on a re-releases textbook lifecourse approach Dr. Guohua Li, to mental disorders Dr. David S. Younger, a Finster Professor of trainee in the executive Epidemiology and Drs. Karestan Koenen, MS in epidemiology Anesthesiology and Sasha Rudenstine (a program, a 1981 gradu- director of the Center for post-doctoral fellow ate of the College of Injury Epidemiology, is in the department), Physicians and editor-in-chief of a new, Ezra Susser, and Surgeons, and an alumnus of the Neurological open-access journal Sandro Galea are authors of the textbook Institute, was honored at a gathering of the called Injury Epidemiology, which is published A Life Course Approach to Mental Disorders, Alumni Organization of Columbia University by Springer in partnership with Columbia published by Oxford University Press in in November, where he distributed copies of University. The mission of Injury Epidemiology October. The book reviews the methods and the third edition of his textbook called Motor is to advance the science and practice of injury synthesizes the existing knowledge about the Disorders, to medical students in the Class prevention and control through timely publica- life course epidemiology of mental disorders, of 2017. Dr. Younger is currently at New York tion and dissemination of peer-reviewed suggests a comprehensive overview about University as a practicing neurologist and a research. Other faculty from the department future directions for both the policy and trainee in the masters in public health in com- and the Injury Center are involved, includ- practice in mental health, and brings together munity and international health program. ing Dr. Barbara Barlow, special lecturer of researchers across the disparate disciplines of epidemiology and director of the Injury Free epidemiology, developmental psychopathology, Coalition for Kids, as honorary editor, and psychiatric genetics, and basic neuroscience. Dr. Charles Dimaggio, associate professor at CUMC of epidemiology, as associate editor. Drs. Magdalena Cerdá, Katherine Keyes, Thelma Mielenz, and Joyce Pressley serve on the editorial board, which includes over 40 accomplished injury epidemiologists across the world.

For more information, visit the journal’s website: http://www.injepijournal.com.

25 AWARDS

Dr. Bassett recognized by Public Health Dr. Cerdá receives Provost award Association of New York City Dr. Magdalena Cerdá, assistant professor The Public Health Association of New York of epidemiology, received funding from the City, one of the largest affiliates of the Provost’s Grant Program for Junior Faculty American Public Health Association, honored Who Contribute to the Diversity Goals of Dr. Mary Bassett, associate clinical professor the University, which provides awards of up of epidemiology, at its 2013 annual awards to $25,000 each to support new or ongo- ceremony for making outstanding contribu- ing research and scholarship. The award tions to improving the health of New Yorkers. will go toward Dr. Cerdá’s research into Dr. Bassett is program director of the African “Neighborhood interventions to reduce racial/ Health Initiative at the Doris Duke Charitable Foundation, an effort ethnic disparities in alcohol-related homicide.” that focuses on strengthening health systems in projects underway in Ghana, Mozambique, Rwanda, Tanzania, and Zambia.

Dr. El-Sadr appointed to NIH advisory board Dr. Lipkin appointed to NIH committee Dr. Wafaa El-Sadr, professor of epidemiol- Dr. W. Ian Lipkin, John Snow Professor of ogy and director of ICAP, was appointed by Epidemiology and director of the Center for Secretary of Health and Human Services Infection and Immunity, has been appointed Kathleen Sebelius to the Fogarty International to the advisory committee to the director Center, the international arm of the NIH. The of the NIH which makes recommendations Fogarty Center supports and facilitates global concerning program development, resource health research conducted by US and interna- allocation, NIH administrative regulation and tional investigators and builds partnerships policy, and other aspects of NIH policy. between health research institutions in the US and abroad. Fogarty’s advisory board is comprised of research- ers, policymakers, and others involved in global health.

Dr. Lovasi awarded Calderone prize Dr. Martins receives award from Dr. Gina Lovasi, assistant professor of President’s Global Innovation Fund epidemiology, has been awarded the Frank Dr. Silvia Martins, associate professor of A. Calderone Junior Faculty Prize, which epidemiology, was awarded a Columbia gives $25,000 to support her research efforts President’s Global Innovation Fund Research on the project “Neighborhood commercial Award to conduct research into further resources and sudden cardiac arrest.” The understanding the relationship between prize was established by the Calderone fam- exposure to trauma and urban violence ily in 1986 to honor Dr. Calderone’s distin- and adolescent comorbid psychopathology guished career and life-long commitment to in Brazil and Chile. Together with other the health of the public. Mailman faculty, Dr. Martins will establish and solidify collaboration between the department and university departments of psychiatry and preventive medicine in São Paulo, Rio de Janeiro, and Chile.

Doctoral alumna wins American College MPH alumnus wins infectious disease of Epidemiology prize surveillance award Dr. Bianca Malcolm, MPH ’13, was awarded Mr. Don Olson, MPH ‘05, has been honored first prize by the American College of with the International Society for Disease Epidemiology (ACE) in its student prize Surveillance’s (ISDS) 2013 first annual Rick paper competition for her manuscript “The Heffernan Award for Public Health Practice. spatiotemporal characteristics of seasonal The award was established to honor Dr. influenza in the United States, 1968-2008.” Rick Heffernan, an early leader in the field Dr. Stephen Morse, recommended Dr. of biosurveillance and founding member Malcolm for the award, which was presented and supporter of ISDS who passed away in at ACE’s annual meeting in Louisville, Kentucky. Dr. Malcolm is February 2013. According to ISDS the award is “in recognition of currently doing a postdoctoral fellowship at the National Center for [Don’s] outstanding contributions to the knowledge and practice of Health Statistics, a branch of the CDC, in Hyattsville, Md. biosurveillance. His leadership on the DiSTRIBuTE project solidified the ISD ‘community of practice,’ and helped establish the value of a surveillance system that spans jurisdictions.” Mr. Olson said that Dr. Heffernan was an important influence on his own work.

DECEMBER 2013 26 BRIEF MENTIONS MICHAEL MAZZANTI

Dr. Morabia speaks at epidemiology Dr. Koenen releases report on symposium Peace Corps progress in dealing Dr. Alfredo Morabia, professor of epidemiology, was the keynote with sexual harassment speaker at the First Cutter Symposium “Celebrating 100 years of epidemiology at the Harvard School of Public Health.” His talk Dr. Karestan Koenen is part of a group called First Response Action was called “100 years (and more) of epidemiology at Harvard: A (FRA), which released a report about the Peace Corps’ progress in methodological beacon for an adventurous discipline,” which offered implementing a law that is supposed to improve support for volunteers “a lively historical overview” of epidemiology at Harvard. For the talk, who report sexual assault. Giving the agency a C on a letter grade Dr. Morabia pored through library archives and interviewed more than scale, FRA said that although the Corps has made progress, there are 20 faculty members, former chairs, and others connected to Harvard’s still major gaps and that there has been an increase in victims who epidemiology department. reported sexual assault in recent years. For more on the talk, visit: http://hvrd.me/1auyT4V http://firstresponseaction.blogspot.com/2013/07/fra-releases- first-report-card.html

Dr. Cerdá gives Dr. Abrams plays birth to baby girl key role on WHO

Lucía Isabel, daughter of Dr. HIV treatment Magdalena Cerdá and her report husband Johnathan Jenkins, was born on September 8, 2013. Dr. Elaine Abrams, professor of epidemiology and senior research director at ICAP, played a key role in the development of the World Health Organization’s 2013 Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection. The guidelines focus on the continuum of HIV care – including existing recommendations and new developments in research and technology – and highlight the importance of a public health strategy in providing comprehensive and consistent HIV services.

27 Update for trainees who want to contribute to Epidemiology communications

The skill of communicating science to a broad public is increasingly central to the modern practice of epidemiology. The department has established a communication structure for this purpose and encourages our trainees to get involved.

@cuepidemiology Two by Two If you are interested in writing for The department encourages trainees the 2x2 project, please visit the site Follow us and stay up to date with what the to develop their communication skills to get familiar with its content, and department is up to #CUepidemiolgy by getting involved with Two by Two, read the submission guidelines at our quarterly publication. Two by Two http://the2x2project.org/submit. covers news from the department in Applications for the 2x2 project’s a journalistic style. Articles students Communication in Health and write for Two by Two include features Epidemiology Fellowship or “CHEF” about faculty, alumni, or students fellowship will be solicited this winter. in the department; chronicles of Learn more at the2x2project.org/ department-sponsored events such fellowships. as a CUESS or a CUEGR; features on collaborations or special initiatives Share your achievements between the department and other Many trainees are engaged in impor- groups; or a subject of your choos- tant and exciting research that can ing, such as your own research or a be shared in Two by Two. If you have professional experience. Writing for news such as publication of a paper, Two by Two is a great opportunity to an award, or a talk that you would like sharpen your public health communi- to share, please send to Ms. Meyer at cations skills and get experience with [email protected]. the journalistic form, particularly if you are interested in applying to be a Social media fellow on the 2x2 project. Follow the department on Twitter and Facebook for frequent updates on Responding to popular interest, the news, events, and other opportunities, department is requesting that any and join LinkedIn to keep in touch student who would like to write for with classmates and alumni. You can Two by Two send either a writing participate in social media by posting sample or a draft of a proposed your news on our Facebook wall or submission to Ms. Elaine Meyer, joining in live tweeting at department associate director of communications CUESS and CUEGR events using ([email protected]). The piece #CUESS and #CUEGR. should convey your ability to write about a subject for a lay audience; if it Twitter is already written, it need not be about twitter.com/cuepidemiology public health. If you wish to write for the next Two by Two, please send the Facebook sample by January 5. facebook.com/cuepidemiology

The 2x2 project LinkedIn Providing “health beyond the linkedin.com/company/ headlines,” the 2x2 project is a cuepidemiology department-sponsored site that deliv- ers public health news, analysis, and commentary, and trains future science communicators. The site disseminates epidemiologic and public health science insights to the greater public and engages readers in the health conversation.

28 USEFUL RESOURCES

Hiring staff: The 10 basic steps

The associate director for human resources and faculty affairs has primary responsibility for all human resources functions. However, particularly when we bring new people into the department as employees or visitors, other members of the chair’s office team play critical roles. SCAs must always confirm funding for any new hire or salary increase. The operations manager must be notified to assign office space and phone number, and the IT support specialist must ensure that a computer is set up, encrypted, and has internet access. In almost all cases, it is wise to contact your SCA as a first step in undertaking HR actions.

1 Principal investigator/supervisor checks in with 6 PI/supervisor reviews applicants, arranges and the department chair to confirm the availability of space documents interviews, identifies selectee, and notifies for new hire. Department chair alerts operations manager SCA and associate director of HR. to plan for space.

7 SCA works with IT support to specify hardware 2 Principal investigator/supervisor meets with and software purchases as needed. SCA and completes Hiring Form (Appendix E), providing information about proposed job title, position type, salary, space, and funding. 8 Associate director of HR collects interview documentation and selectee information, reconfirms salary and start date, and submits selectee to MSPH 3 SCA signs off to confirm funding, enters grant and HR for approval. project numbers, appends ARC statement and forwards Hiring Form to associate director of HR. 9 Once the selectee is approved, Associate director of HR sends formal offer letter and arranges with selectee 4 Associate director of HR iterates with PI/SCA to to complete HR paperwork and schedule orientation. develop job description and enters it in JAC. Associate director of HR prepares hiring documentation for department administrator (DA) signature and MSPH HR 10 Associate director of HR emails operations manager and Salary Review approval. and IT support to alert them of imminent hire. Operations manager and IT support finalize arrangements for office space, telephone, domain and Exchange accounts, and 5 Associate director of HR provides guest access hardware/software. to JAC system to allow PI/supervisor and SCA to review applicants.

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37 SUBMIT TO TWO BY TWO

If you have a study, news story, award, or other milestone you’d like to share in Two by Two, please email Elaine Meyer at [email protected] with your submission.

TWO BY TWO

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 WRITERS Amina Foda Richa Singh Christopher Tait

DESIGNER Jon Kalish