Low Levels of Good Cholesterol May Increase Risk of Alzheimer's

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VOLUME 2 • ISSUE 1 FEBRUARY 2011

NEWS FROM THE DEPARTMENT OF EPIDEMIOLOGY MAILMAN SCHOOL OF PUBLIC HEALTH COLUMBIA UNIVERSITY 2 UPCOMING 3 PUBLICATION HIGHLIGHTS 5 BRIEF MENTIONS 6 SUBMITTED GRANTS Innovation, Page 16 7 IN THE NEWS 8 FACULTY APPOINTMENT Low Levels of 9 PROFILES 13 GIANTS AMONG US Good Cholesterol 20 FACULTY ARTICLE May Increase Risk BIBLIOGRAPHY of Alzheimer’s

Low levels of high-density lipoproteins (HDL) may increase the risk of developing Alzheimer’s disease, according to a new study of elderly individuals senior authored by Dr. Jose Luchsinger, Associate Professor of Medicine and Epidemiology. Low levels of good cholesterol are very common in the U.S. and are a well-known risk factor for heart disease. But the relationship between HDL and Alzheimer’s had previously been unclear, with some studies finding a connection and others not. This new study provides a more complete picture of the relationship between HDL and Alzheimer’s because the researchers followed subjects for longer than past studies. They monitored 1,130 elderly northern Manhattan residents for an average of four years, finding that those with low HDL had a 40 percent higher rate of Alzheimer’s incidence. This illustration shows the damage caused by Alzehimer’s Disease: plaques, tangles, Unlike similar studies, this study includes and the loss of connection between neurons. a large number of African Americans and Hispanics, and its findings suggest that low HDL is linked to a high risk of Alzheimer’s in of the study suggest that researchers should focus specifically on many different ethnicities. HDL—as opposed to general cholesterol levels—as a predictor of Scientists still do not understand why dementia in the elderly. there is a link between HDL and Alzheimer’s, “Interventions that target HDL increase in the elderly may but the studies’ authors say that the two improve dementia risk,” he says. could be linked through stroke, since low About 5.3 million Americans have HDL raises the risk of stroke. Alzheimer’s disease, according to the Al- The other possibility is that HDL works About 5.3 million zheimer’s Association. It is the sixth leading by itself to clear amyloid proteins from the cause of death in the U.S. and has been on brain, or is a marker for other factors re- Americans have the rise in recent years: From 2000 to 2006, lated to amyloid clearance, such as insulin Alzheimer’s disease, deaths from the disease increased 46.1 per resistance. Amyloid proteins are associated cent, while other major causes of death with plaques, one of two abnormal struc- according to the like prostate cancer, breast cancer, heart tures that has been linked to Alzheimer’s. disease HIV-related illnesses, and stroke The other structures are called tangles. Alzheimer’s Association. saw a decline. Both are seen in the brain cells of those It is the sixth leading with the disease and are believed to hinder Reitz C, Tang MX, Schupf N, Manly JJ, Mayeux R, Luchsinger communication in the nerve center by cause of death in the U.S. JA. Association of higher levels of high-density lipoprotein damaging or killing cells. cholesterol in elderly individuals and lower risk of late-onset According to Dr. Luchsinger, the results Alzheimer disease. Arch Neurol. 2010 Dec; 67(12): 1491-7.

IMAGE COURTESY NATIONAL INSTITUTE ON AGING 1 MESSAGE FROM THE CHAIR

Dear colleagues,

Welcome to the February 2011 issue of Two by Two, the Epidemiology Department newsletter. This issue is dedicated to innovation in the Department. In fostering innovation, we seek to build interdisciplinary collaborations; contribute to the intellectual discussion in our field; and expand the scope of our teaching, research, and service activities. The three new initiatives featured in this newsletter exemplify those aims. The Epidemiology and Population Health Summer Institute at Columbia (EPIC) creates expanded learning opportunities for investigators and scholars from the health and social sciences, public health practitioners, clinicians, and industry professionals interested in population health research. EPIC features a full slate of week-long focused training courses in the month of June. Courses are developed and taught by Department faculty in collaboration with experts from across the Medical Center. The Epidemiology, Design, Guidance, and Expertise (EDGE) program aims to provide epidemiologic expertise to investigators across Columbia University whose research might benefit from rigorous epidemiologic input on the research design. The program seeks to build collaborations between the Epidemiology Department and investigators across the University during the design and planning phase of projects and grant proposals so as to improve the design of the project and thus its potential for success. The Global Mental Health Program (GMHP) is working to put global mental health squarely in the middle of the global health agenda at the School and the University, as well as in the broader global health conversation. It aims to promote innovative research, educate a new cohort of scholars and practitioners, and build capacity in research and intervention in low and middle income countries. The GMHP is a priority program of the Global Health Initiative (GHI) and works closely with leaders of the GHI to achieve its goals. Each of these three initiatives benefits from substantial guidance and infrastructure from the Chair’s office. In highlighting them, we hope to inspire members of the Epidemiology community to develop bold new ideas, and to demonstrate that the Chair’s office stands ready to provide support to assure their successful implementation. As a last note, in this newsletter we introduce a new feature, Giants Among Us. We aim on a regular basis to feature some of the senior faculty in the Department who have made seminal contributions to the field. We start by featuring Dr. Mervyn Sussser, former Chair of this Department and a true giant in epidemiology.

Warm regards, CLUSTER SEMINARS FEBRUARY — MARCH

SOCIAL EPIDEMIOLOGY Thursday, FEBRUARY 3 10:00-11:30 AM Thursday, FEBRUARY 17 12:30-2:00 Pm THURSDAY, MARCH 3 10:00-11:30 AM UPCOMING FEBRUARY — MARCH THURSDAY, MARCH 31 10:00-11:30 AM

PSYCH / NEURO EPIDEMIOLOGY Thursday, FEBRUARY 3 12:30-2:00 PM Friday, February 11, 2011 Department Seminar: Nicole Schupf, PhD, DrPH THURSDAY, MARCH 10 12:30-2:00 PM Tuesday, February 15, 2011 Special Lecture: Shakira Suglia, ScD LIFECOURSE EPIDEMIOLOGY Friday, February 18, 2011 Faculty Meeting TUESDAY, FEBRUARY 8 1:00-2:30 PM Tuesday, February 22, 2011 Special Lecture: Jennifer Smith TUESDAY, MARCH 8 1:00-2:30 PM Wednesday, February 23, 2011 CUEGR: Daniel M. Fox, PhD Wednesday, March 2, 2011 CUEGR: George Davey-Smith, MD, DsC EPIDEMIOLOGY INNOVATION Thursday, March 10, 2011 Special Lecture: Miguel Hernan WEDNESDAY, FEBRUARY 16 8:30-10:00 Am Friday, March 11, 2011 Department Seminar: Alfredo Morabia, MD, PhD WEDNESDAY, MARCH 16 8:30-10:00 Am Friday, March 25, 2011 Faculty Meeting CHRONIC DISEASE EPIDEMIOLOGY Friday, FEBRUARY 4 12:00-1:00 PM Friday, MARCH 4 12:00-1:00 PM

INFECTIOUS DISEASE EPIDEMIOLOGY

Friday, FEBRUARY 25 3:00-4:30 PM FEBRUARY 2011 INNOVATION FRIDAY, MARCH 25 3:00-4:30 PM 2 PUBLICATION HIGHLIGHTS

Nicotine dependence associated with personality disorders

A substantial percentage of adults who have personality disorders are addicted to smoking, according to a new study senior authored by Dr. Renee Goodwin, Associate Professor of Epide- miology. The study is the first to find a relationship between cigarette smoking and personality disorders. Using data from 43,083 adults in the U.S., the investigators found that the association between personality disorders and smoking var- ies by the specific disorder. Antisocial personality disorder was most strongly associated with nicotine dependency, the study found. “Personality disorders may increase vulner- ability to dependence on nicotine, and may impede efforts to quit,” says Dr. Goodwin. “This information may be useful in the development of more effective smoking cessation programs.”

Zvolensky MJ, Jenkins EF, Johnson KA, Goodwin RD. Personality disorders and cigarette smoking among adults in the United States. J Psychiatr Res. 2010 Dec 16. [Epub ahead of print]

HPV in female HIV patients tied to dysfunctioning mucosal immune system

It is established that Human papillomavirus (HPV) increases in prevalence among individuals with HIV. A new study senior authored by Dr. Louise Kuhn, Professor of Epidemiology (in the Gertrude H. Sergievsky Center), shows that a dysfunctioning mucosal immune system—the part of the immune system that provides protection to an organism’s mucous membranes—may influence HPV-related diseases. She and fellow researchers conducted a South African cervical cancer screening trial, in which 5,595 women 35–65 years of age were followed for 36 months. They found that detection of HPV infection increases rapidly within the first years after HIV seroconversion, suggesting HPV may be related to the dysfunctioning of the mucosal immune system. human papillomavirus is the most common sexually transmitted infection (STI). Wang C, Wright TC, Denny L, Kuhn L. Rapid rise in detection of Human Papillomavirus (HPV) Infection soon after incident HIV infection among South African women. J Infect Dis. 2011 Jan 7. [Epub ahead of print]

FEBRUARY 2011 INNOVATION HPV IMAGE BY AJ CANN 3 1 in 26 will develop epilepsy during lifetime

One in 26 people will develop epilepsy in their lifetime, according to a new study conducted by Dr. Dale Hesdorffer, Associate Professor of Clinical Epidemiology (in the Sergievsky Center), which was published in the January 4 issue of Neurology. The population-based study is the first to measure lifetime risk for epilepsy. Unlike previous studies, this one accounted for death, which prevented the overestimation of epilepsy risk. Dr. Hesdorffer and her colleagues looked at the medical records of residents of Rochester, Minn. from 1960-1979. They found that lifetime risk increased as people got older: at age 50, the risk was 1.6%, and at age 80, it was 3%. “This information can be used to better communicate risk of epilepsy to patients and to health care policy makers,” Dr. Hesdorffer says.

Hesdorffer DC, Logroscino G, Benn EK, Katri N, Cascino G, Hauser WA. Estimating risk for developing epilepsy: A population-based study in Rochester, Minnesota. Neurology. 2011 Jan 4;76(1):23-7

Over 3,000 9/11 survivors have long-term PTSD symptoms

Over 3,000 survivors of the September 11, 2001, World Trade Center attacks have long-term post-traumatic stress disorder (PTSD) symptoms, according to a new study senior authored by Dr. Sandro Galea, Gelman Professor and Chair of the Department of Epidemiology, in conjunction with the New York City Department of Health and Mental Hygiene and the federal Agency for Toxic Substances Disease Registry (ATSDR). A full 95.6% of the 3,271 people who evacuated the Twin Towers have experienced long-term PTSD symptoms, and 15% screened positive for the disorder two to three years after the disaster. The biggest predictors of PTSD were initiating evacuation late, being on a high floor in the towers, being caught in the dust cloud that resulted from the tower collapses, personally witnessing horror, and sustaining an injury.

Digrande L, Neria Y, Brackbill RM, Pulliam P, Galea S. Long-term Posttrau- matic Stress Symptoms Among 3,271 Civilian Survivors of the September 11, 2001, Terrorist Attacks on the World Trade Center. Am J Epidemiol. 2010 Dec 29. [Epub ahead of print]

FEBRUARY 2011 INNOVATION PHOTO BY U.S. Air Force/Denise Gould 4 BRIEF MENTIONS

APPA Annual Meeting in New York Series of Department-EHESP meetings Holiday Party 2010

The 101st Annual American In November, the Department hosted the On December 13, 2010, the Department PsychoPathological Association (APPA) first in a series of collaborative meet- hosted its yearly holiday party in the Hammer meeting will take place March 3-5 at the ings between faculty from the Mailman Building’s Riverview Lounge. The event Grand Hyatt New York. Among the speakers School and our French partners at Ecole brought together people from across the are Epidemiology faculty members Dr. des Hautes Etudes en Santé Publique who Department and the Mailman School to Patricia Cohen, Professor of Clinical are researching chronic diseases. Faculty celebrate the season and enjoy food, drinks, Epidemiology (in Psychiatry), and Dr. Sandro discussed, among other things, the “Spin” and socializing with one another. Galea, Gelman Professor and Chair of the project, which aims to identify and quantify Department. In addition, Dr. Cohen and Dr. bias in reporting on observational epide- Ezra Susser, Professor of Epidemiology miologic studies. The next meeting will take and Psychiatry, (currently President-elect place in March in Paris. of APPA) will be honored at the conference with special awards.

World AIDS Day

Dr. Wafaa El-Sadr, Professor of Epidemiology and Medicine and Director of the International Center for AIDS Care and Treatment Programs (ICAP), used the occasion of Worlds Aids Day 2010 to underscore that the U.S. still has far to go in the fight against HIV/AIDS. Dr. El-Sadr assembled a panel of experts in HIV prevention, infectious diseases, mental health, and policy who are on the frontline of fighting the epidemic in the U.S., for a discussion called “The HIV Epidemic in the United States: A Time for Action.” The event also served to launch an ICAP-sponsored issue of the Journal of Acquired Immuno- deficiency Syndrome dedicated to key challenges related to the U.S. HIV epidemic. In a year that was marked by incredible develop- ments in the testing of drugs that prevent HIV, and at a time when treatment is able to extend the lives of those infected longer than ever anticipated, there is the risk that the epidemic will recede from public consciousness, panelists warned. As Dr. El-Sadr put it, “AIDS in America is forgotten but not gone.”

FEBRUARY 2011 INNOVATION 5 AWARDS AND GRANTS Dr. Gina Lovasi awarded Active Living Research grant

Dr. Gina Lovasi, Assistant Professor of Epidemiology, was awarded an Dr. Lawrence Yang Active Living Research grant from the Robert Wood Johnson Founda- tion. She will conduct a quantitative meta-analysis and meta-regression receives two awards project on the relationship of the built environment with physical activity and obesity across multiple U.S. sites. Dr. Lawrence Yang, To a large extent the health relevant aspects of the built environ- Assistant Professor of ments, such as walkable urban form or the presence of large parks, Epidemiology, was are the unintended consequences of policies and actions designed for awarded the Council of the pursuit of other social and economic goals. The links between built National Psychologi- environment and physical activity have relevance to obesity and a range cal Associations for the of chronic disease outcomes, but studies to date have not provided a Advancement of Ethnic consistent, cohesive picture. Minority Interests’ Recent work by Dr. Lovasi in collaboration with the Built Environ- (CNPAAEMI) 2010 Henry ment and Health project, an interdisciplinary research program at Tomes Award for Sig- Columbia University, has highlighted the possibility that commonly nificant Contributions measured aspects of the built environment are modified by population to the Advancement of and area characteristics such as poverty. This project, an interdisciplin- Ethnic Minority Psychol- ary research program at Columbia University, represents an opportu- ogy by an Emerging nity to continue this line of investigation by seeking patterns across the Leader. The award was U.S. literature. given to Dr. Yang for his Dr. Lovasi’s project “uses meta-analytic methods to test hypotheses research into the stigma in China around schizophrenia about effect modification that go beyond what the individual studies were and how it impedes symptomatic and social recovery. assessing,” she says. This effort will be supported by an interdisciplinary He was also awarded a two-year $60,000 National research team that includes epidemiologist Dr. Andrew Rundle, as well Alliance for Research on Schizophrenia and Depression as Drs. Christopher Weiss and Michael Bader, sociologists at (NARSAD) grant for his project entitled “Stigma Associ- Columbia and University of Pennsylvania, respectively, and Dr. Malo ated with a High-Risk State for Psychosis among Adoles- André Hutson, an urban planner at the University of California-Berkeley. cents: Impacts on Identity and Recovery.” The principal goal of this prospective study is to systematically examine Lovasi GS, Hutson MA, Guerra M, Neckerman KM. Built environments and obesity in impacts of stigma of the new ‘high-risk’ for psychosis disadvantaged populations. Epidemiol Rev 2009; 31:7-20. designation on adolescent identity to optimize transition to adulthood. Lovasi GS, Neckerman KM, Quinn JW, Weiss CC, Rundle A. Effect of individual or neighborhood disadvantage on the association between neighborhood walkability and body mass index. Am J Public Health 2009; 99(2):279-84.

SUBMITTED GRANTS DEPARTMENT OF EPIDEMIOLOGY, JANUARY 2011

ASSISTANT PROFESSOR ASSOCIATE PROFESSOR PROFESSOR POSTDOC

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FEBRUARY 2011 INNOVATION 6 IN THE NEWS

Faculty’s hunger studies Science Watch profiles CAPRISA researchers featured in Nature Dean Linda Fried and featured in O Magazine her pioneering work with Dr. L.H. Lumey, Associate Clinical Professor Dr. Quarraisha Abdool Karim, Associate of Epidemiology, was featured in Nature’s healthy aging Professor of Clinical Epidemiology, and Dr. December 2010 issue, in an article about Salim S. Abdool Karim, Professor of Clinical epigenetic studies of people conceived Science Watch recently profiled the pioneer- Epidemiology, who were behind the ground- during periods of famine. Dr. Lumey is ing research on aging and frailty in older breaking study of HIV prevention vaginal gel, currently studying the impact of the Dutch adults of Dr. Linda Fried, Dean of the Mailman were featured in the November issue of O, Hongerwinter (hunger winter) of 1944-45, School of Public Health and Professor of The Oprah Magazine. The article discusses when parts of Holland were blocked by Epidemiology. Dr. Fried has dedicated 25 the results of the “CAPRISA 004 Trial” and WWII military action from receiving food years to the goal of keeping people healthy the hope it brought to the female partici- supplies. Dr. Lumey and other research- as they age, and her efforts have led to pants and to many women who are at-risk. ers discovered that the famine through a major advances in the field of geriatrics and Young women at the study site in Vulindlela, process called DNA methylation deactivated gerontology. Science Watch, a publication South Africa, have a high rate of HIV—by age the expression of certain genes associ- of Thomson Reuters, ranked her one of the 30, two-thirds of them have been infected— ated with human growth and development. most-cited researchers in the field over the and very limited prevention options in a Dr. Lumey is now looking at whether the last decade. culture where they often must exchange genomic methylation patterns of those In a Q and A with editors in the January sex for favors like taxi fare and food. These conceived during famine are at a variance 2011 issue, Dr. Fried talks about how she realities are what led the Karims to focus from their “unexposed” siblings. If so, this first became interested in studying geriat- on developing a vaginal gel that is capable might explain how changes in the early life rics, her hypothesis on the vicious cycle of of delivering antiretrovirals (ARV). The environment could play an important role in frailty and how to intervene and/or postpone response to the request for volunteers was the development of adult diseases. its consequences. Dr. Fried also addresses “overwhelming,” according to the O article. how contributing to society can make a “HIV is killing our friends and sisters. I difference in helping older people stay more wanted to help stop that,” said Duduzile physically, cognitively, and socially active. Ndlovu, a 27-year-old study participant. The gel has brought new hope in a community that had many reasons to despair. “It has the potential to alter the Dr. Ian Lipkin profiled in pandemic, and prevent more than 800,000 New York Times deaths in the next twenty years. And it gives control to those who need it most—women,” Dr. W. Ian Lipkin, the Director of the Center Faculty’s HPV study featured Dr. Quarraisha Abdool Karim says. for Infection & Immunity (CII) and the John on Reuters video Snow Professor of Epidemiology, was featured in an article in The New York Times A study led by Dr. Louise Kuhn, Profes- about his virus hunting operations at the CII. sor of Epidemiology (in the Gertrude H. Since the Center started in 2002, Dr. Lipkin Sergievsky Center), was featured in January and his team have discovered 400 viruses, in the Reuters Health Doctor’s Channel using a technique he developed that involves Daily Newscast. The results of the study identifying a virus by its genetic signature. show that a single test for high-risk human Dr. Lipkin used the method to identify West papillomavirus (HPV) infection followed by Nile virus in 1999 after studying the blood of cryotherapy is an effective method to reduce encephalitis patients in New York. It was the high-grade cervical cancer precursors in first time the deadly virus had been identi- HIV-infected women. fied in the Western Hemisphere. The video can be found here: http://thed- “If scientists are lucky, they’ll identify octorschannel.com/go/reuters/3627.html one novel virus in their whole life,” said Dr. Anthony S. Fauci, director of the National Kuhn L, Wang C, Tsai WY, Wright TC, Denny L. Efficacy of Institute of Allergy and Infectious Diseases, human papillomavirus-based screen-and-treat for cervical who is quoted in the article. “Lipkin really cancer prevention among HIV-infected women. AIDS. 2010 Oct 23;24(16):2553-61. stands out from the crowd.”

FEBRUARY 2011 INNOVATION 7 Faculty Member Named Dean of University of California, San Francisco School of Nursing

Dr. David Vlahov, PhD, Professor of Clinical Epidemiology, has been appointed as the new Dean of the University of California, San Francisco School of Nursing. As an epidemiologist, a nurse, and the first male dean of the school, he brings a unique background to the post.

lthough he will have to scale down his many tis carinii, a form of commitments in the epidemiology world, Dr. pneumonia that afflicts Vlahov will be promoting the discipline as Dean individuals with AIDS. A at the UCSF School of Nursing, as nurses are on As a PhD student at the front lines of public health initiatives. Hopkins during a time “Nurses make great epidemiologists. Having attended when scientists were births, visited homes, been at the bedside, seen and only beginning to realize that AIDS could become a major eased suffering, and comforted bereaved loved ones, public health issue, he began studying HIV infection in nurses understand what is behind the binary code. They injection drug users, setting up and upon graduation can visualize data in multiple dimensions,” he says. becoming Principal Investigator of ALIVE, a natural history Dr. Vlahov further points to three decades of studies study of street recruited out-of-treatment injection drug demonstrating the effectiveness of nurse practitioners in users in Baltimore. primary and chronic disease management, not to mention The study was instrumental in defining incidence and other areas of advanced practice. risk factors of HIV infection as well as the spectrum of With 30 million new people expected to come into the disease, rate of progression to AIDS, and survival. It also health care system because of the Patient Protection and helped encourage the Maryland State Legislature’s pas- Affordable Care Act, the system will need well-trained sage of a law permitting needle exchange programs. nurses and nurse practitioners if it is able to meet the When he came to New York City, Dr. Vlahov assumed goal of “health for all,” he says. the position of Director of the Center for Urban Epide- Dr. Vlahov has an accomplished background in urban miologic Studies, recently vacated by Dr. Ezra Susser. His epidemiology, not only here at the Mailman School of Public work over the next ten years focused on HIV and hepatitis Health, but also as Senior Vice President for Research and C infection among injection drug users, and an evalua- Director of the Center for Urban Epidemiologic Studies at tion of the New York Expanded Syringe Access Program the New York Academy of Medicine, where he has led stud- through pharmacies, a line of research expanded by Dr. ies in Harlem and the Bronx on racial and ethnic disparities Crystal Fuller. With Dr. Sandro Galea, he led the Center’s in health care treatment and how they can be addressed. response to the events of September 11, 2001, conducting He earned his BS and MS in nursing from University of landmark population based assessments and follow-ups Maryland and a PhD in epidemiology from Johns Hopkins to understand the mental health of New York City resi- University. Much of his research has been devoted to the dents after the terrorist attacks. study of urban health issues, including HIV. He remem- Dr. Vlahov will continue his active research career bers being a nurse in the mid-1980s, when the disease while he is Dean and also plans to continue as the editor was thought to be only the province of white gay men, of the Journal of Urban Health and to work with the Inter- and watching as doctors puzzled over how a black female national Society for Urban Health. injection drug user could have contracted Pneumocys-

FEBRUARY 2011 INNOVATION 8 FACULTY PROFILE CRYSTAL FULLER

Effective January 1, the Department became the official home for Crystal Fuller, PhD, MPH, Associate Professor of Clinical Epidemiology, and her research team.

lthough Dr. Fuller, has long been on purchase syringes in pharmacies through the faculty, she had previously divided the New York State Expanded Syringe Access her time between here and the New Program (ESAP). A York Academy of Medicine. The pharmacy interventions Dr. Fuller has In the time that she has been in the Depart- conducted have included increasing syringe ment, Dr. Fuller has made significant con- access for drug users, connecting drug users tributions to the rapidly growing literature in to medical care and social services, using phar- the area of drug abuse and related infectious macies as an HIV-testing venue and packaging diseases, namely HIV, Hepatitis, and sexually these services with other chronic disease pre- transmitted infections. vention services (i.e., blood pressure, glucose, As an infectious disease epidemiologist, her and cholesterol screening) to reduce HIV testing research has focused on HIV prevention and stigma, and most recently, using pharmacies structural interventions among drug users and to help drug users gain access to antiretroviral other marginalized populations in low-income, therapy to help prevent HIV acquisition. These urban communities. At the same time she has are based on the premise that intervention is expanded her body of work beyond infectious optimized through targeting the individual and disease epidemiology to include social epidemi- the social/structural environment. ology, particularly the study of racial disparities in urban areas of the U.S. For over 10 years, she has collaborated with community leaders and stakeholders in order to conduct community-based participatory research (CBPR) throughout New York City. She has directed large-scale public health program and policy evaluation studies aimed at reducing individual and community-wide disease rates, particularly within communities where racial disparities persist. She has carried out several pilot and large- scale structural interventions among black and Hispanic drug users and their social networks. Many of these studies reach out to drug users in HIV burdened neighborhoods when they

FEBRUARY 2011 INNOVATION 9 STAFF PROFILE THE RESEARCH TEAM OF DR. FULLER

Dr. Fuller’s 12-person research team—who often refer to themselves as a family—recently arrived at Columbia to carry out her studies on HIV/AIDS treatment intervention through pharmacy syringe purchases.

Back row: Mario Cruz (Technician B), Gregory Malave (Research Assistant), Preston Garnes (Technician B), Pedro Batista (Technician B) Middle row: Katherine Harriper- saud (Technician B), Alexis Rivera (Project Coordinator), Brittany Novak (Technician B) mong the group, there is a diverse range of experience Front row: Carolyn Hernandez (Project Coordinator), Alezandria Turner (Project Coordinator), Natalie Crawford (Project Coordinator), Jacey Hernandez (Technician A) in the public health field. Seated: Dr. Crystal FulleR Alexis Rivera, who was a student at Mailman, had A Dr. Fuller as her adviser and thesis reader, which she said was a perfect fit, since her areas of interest were racial/ethnic disparities in HIV/AIDS. Gregory Malave, a research assistant who has been with Dr. Fuller the longest—eight years—and is jokingly referred to as the father of the team, says that Dr. Fuller’s personal and professional support keeps everyone incredibly motivated. That degree of motivation is evident in their work. For example, in order to recruit pharmacies for the ESAP studies, their team trekked across every borough in New York, even during evening hours and on weekends, in order to find as many participants as they could. In total, they interviewed over 400 pharmacies and were able to select more than 90 for the study. The passion that team members feel for their work is reflected in the quality and integrity of what they do, says Natalie Crawford, project coordinator, who is also a doctoral student in the Department. “I think these things have greatly contributed to our ability to collect quality data and they have given me a personal sense of fulfillment in knowing that our studies are providing increased accessibility to health services through pharmacies in communities most at need,” Natalie says. Not only does the team work hard together, but they are friends outside of work, celebrating one another’s birthdays and other events. “We’re a great team. We all play off of each other well,” says Brittany Novak, who has worked with Dr. Fuller since 2008 and plans to go to medical school.

FEBRUARY 2011 INNOVATION 10 ALUMNUS PROFILE MICHAEL ROSANOFF

Michael Rosanoff, who is currently the Associate Director of Public Health Research and Scientific Review at Autism Speaks in New York, earned his MPH in Epidemiology from the Mailman School in 2007.

t Autism Speaks—the world’s larg- etiology, and potential treatment approaches, est autism science and awareness which made working at Autism Speaks a fitting organization—Michael’s epidemiology choice for Michael. A training has come directly into play. He Michael further says he owes much of his works on the organization’s etiology team, man- passion for his work to his cousin Paul who is ages its epidemiology and public heath research affected by autism, and to Paul’s family. program, and is part of a development team for Since joining Autism Speaks, Michael has the Global Autism Public Health Initiative. worked with several Department faculty, “Epidemiology has played a major role in including Dr. Ezra Susser, who is a member of raising awareness of autism in the U.S. and Autism Speaks Scientific Advisory Committee, around the world,” he says. “Today the preva- and Dr. Leslie Davidson, who is a co-investi- lence of autism in the U.S. is 1 in 110, much gator on a study co-funded by Autism Speaks, more common than most people ever imag- which involves surveying developmental dis- ined,” he said. abilities—including autism—among the Zulu Those figures have provided a platform for nation of Kwa-Zulu Natal. Autism Speaks’ advocacy of increased access to “I owe much of where I am today to my time autism services and additional research fund- spent at Mailman, as well as to the amazing ing from local and federal governments. support of my colleagues at Autism Speaks,” Michael originally became interested in Michael says. epidemiology as an undergraduate at Bingham- ton University, through studying psychobiol- ogy and working in a lab that was researching causes of stress. As a graduate student, Michael combined his interests in epidemiology and biological psychology to study complex diseases—those influenced by both genes and environment—and did a research practicum in the genetic epidemiology of epilepsy with Dr. Ruth Ottman. Epilepsy may in fact be closely related to autism in terms of neurobiology,

FEBRUARY 2011 INNOVATION 11 STUDENT PROFILES Four Epi students among seven winners of prize for injury prevention in Native Americans

On December 7, four Epidemiology students were awarded the 2010 Susan P. Baker Prize for Injury Prevention in Native Americans. Dr. Guohua Li handed out the Kristyn Bigback (far left), Charley Liu (third from left), Katherine Hensel (third from honors at a ceremony. right), Carla Foster (second from right)

ecognizing that injuries take a great toll on young Native Risk Behavior Surveillance System to analyze the association between Americans, each of the honorees will use the award to carry gender-based violence and suicidal ideation in youth, as suicide rates out a research project on injuries to Native Americans or among 15-24 year old Native Americans are more than double the rate Rother indigenous people of the U. S. or Canada. Their work for all U.S. races. Katherine also plans to look at substance abuse as a aims to be an impetus for policy or environmental changes that mediator for gender-based violence and suicidal ideation. benefit the population. MPH candidate Charley Liu, who was advised by Dr. Li, won the prize Kristyn Bigback, an MPH candidate, took first place, winning for his proposal to compare injury death rates between the U.S. and $2,000 for her proposal to use data from the Indian Health Service Canada using data from the Center for Disease Control’s web-based (IHS) 2003 Injury Focus report to look at the relationship between Injury Statistics Query and Reporting System and the First Nations, state Graduated Driver Licensing laws, tribal driver licensing laws, Inuit, and Aboriginal Health branch of Health Canada. and motor vehicle crash injury and death rates. She further plans to Dr. Baker, a Professor at the Johns Hopkins Bloomberg School compare the rates of motor vehicle hospitalizations reported by IHS of Public Health, established the awards after winning the Mailman to those reported by Healthcare Cost and Utilization Project HCUP School’s Frank A. Calderone Prize in Public Health In 2010. in order to determine the degree of underreporting of motor vehicle crashes by the tribes to the states. (Motor vehicle-related death rates of Native Americans are twice the rates for other Americans). Kristyn was advised by Dr. Joyce Pressley. Three other Epidemiology students won prizes of $500 each for their proposals. Carla Foster, an MPH candidate who was advised by Dr. Anne Paxton, won a prize for her proposal to assess moder- ate traumatic brain injury (MTBI) among Native American children. Specifically, she plans to evaluate its cause and determinants, and risk factors that determine outcome, in order to recommend prevention and intervention strategies. Katherine Hensel, a doctoral candidate who was advised by Dr. Les- lie Davidson, won the prize for her proposal to use data from the Youth

FEBRUARY 2011 INNOVATION 12 GIANTS AMONG US

MERVYN SUSSER

Mervyn Susser, MB, BCH, Sergievsky Professor of Epidemiology Emeritus, is one of the pioneers of epidemiology in the twentieth century. His emphasis on the relationship between society and disease is foundational to the discipline as it is practiced today. He has also consistently drawn attention to the interrelationships between health, disease, and social injustice.

hese are, however, only some of the ways in which he has Russian Empire—opened a clinic in the black township of Alexandra, shaped our field. His influence extends to the foundations Johannesburg, with a group of colleagues to provide medical care to of life course epidemiology, genetic epidemiology, epidemiol- non-whites at a time when they were largely ignored by the medical Togy of neurodevelopmental disorders, global health (later system. Though not formally trained in epidemiology, Drs. Susser including HIV/AIDS), and other areas. and Stein carried out one of the first studies of community health Dr. Susser was born in South Africa in 1921, the son of immi- in the developing world, published in 1955 in the Lancet, under the grants who left the Russian Empire because of persecution of the title, “Medical care in a South African township. “ During the same Jewish population. Those circumstances shaped his opposition period, working with Nelson Mandela and others, they became to racism in apartheid South Africa. In the early 1950s, he and his deeply involved in opposing the Afrikaner nationalist government wife and partner Dr. Zena Stein—also a child of Jews who fled the created in 1948.

FEBRUARY 2011 INNOVATION PHOTO BY Helene Kreniske 13 A brief stay in England for further study began decades of exile for Mervyn and Zena, following the arrest of politi- cal colleagues and friends in South Africa. With the help of the great epidemiologist, Jerry Morris, Drs. Susser and Stein were offered positions in the Department of Social For me, Causal and Preventive Medicine at the University of Manchester. Dr. Susser was also appointed Medical Officer for Mental Health in Salford, where Mervyn and Zena pioneered a Thinking in the Health transformation of mental health services, and established a psychiatric registry that they used to carry out the first Sciences indicated study of incidence of mental disorders in a large urban population, described in his book Community Psychiatry. how one pushes the In this period, they were prolific, inaugurating influential studies in several areas. An example is their investiga- understanding of social tion of the relationship between social environment and the cognitive development of children. “It is evident from this investigation,” Drs. Susser and Stein wrote, “...that factors in health beyond culture, social class and family function profoundly influence the diagnosis and management of the educationally whimsical speculation subnormal child.” That observation reflected Dr. Susser’s consistent emphasis on the role of the social environment —Dr. Bruce Link in the determination of diseases and disorders, in the treatment of diseases and disorders, and in social policy related to diseases and disorders. During this period he joined the anthropologist Dr. William Watson to write the classic textbook Sociology in Medicine, a landmark work which was one of the first to examine the relationships between historical and social context, social and family environment, and health across the lifecourse. In 1965, Dr. Susser was invited to chair the Division of Dear Zena and Mervyn, Epidemiology at the Columbia University School of Public Health. He “was faced with the challenge of articulat- ing to a skeptical faculty the need to make a transition As someone who became an octogenarian three years ago, to the ‘chronic disease’ era of epidemiology while at the I have great pleasure in saying ‘Welcome to the Club’. same time, retaining the insights about society and health Over the years, especially when we were in prison, we managed described in Sociology in Medicine,” (Davey Smith GM and to get trickles of information about you. It was always heartening Susser E, International Journal of Epidemiology, 2002). to know that, albeit under dierent circumstances and many To do this, he gave a series of lectures that became the miles from home, your commitments and active contribution basis of one of his most influential works, Causal Thinking to struggle for democracy remained undiminished. in the Health Sciences. “For me, Causal Thinking in the Health Sciences Although we are divided by a great distance today, please know indicated how one pushes the understanding of social that our thoughts and best wishes are with you, and with all the factors in health beyond whimsical speculation,” says friends who are joining you in the celebration. Dr. Bruce Link. The book “covers astonishing ground in unpacking the Hearty congratulations! essence of epidemiology; 25 years later people were still writing review articles about the book, which is quite re- markable in a rapidly developing discipline like epidemiol- Nelson Mandela ogy,” says Dr. Landon Myer. The book “given to me by a sociology professor became my inspiration to study epidemiology. It so influenced me that I still use parts of the text in advanced classes, “ says Dr. Pam Factor-Litvak. At Columbia, Dr. Susser also initiated groundbreaking studies in a remarkably wide range of areas. Especially noteworthy among the earlier studies was the landmark investigation of the Dutch Hunger Winter of 1944-45 led by him and Dr. Stein. The Dutch Hunger Winter resulted from LETTER FROM NELSON MANDELA ON THE OCCASION OF THE 80TH a Nazi blockade of Holland at the end of World War II. Drs. BIRTHDAYS OF DRS. SUSSER AND STEIN Susser and Stein rigorously tested the causal relationship

FEBRUARY 2011 INNOVATION 14 Dr. Susser’s colleagues are not only influenced by HIs work but between prenatal nutrition and child cognitive develop- credit it with shaping the discipline and their own careers ment by comparing Dutch men exposed and unexposed to famine at the age of 18 when they were seen for military induction. Ultimately the study showed that prenatal famine did not impact IQ at age 18 in a developed society. “One nugget in Sociology in Medicine frames my Although the finding was not what they and others had entire career. It reads as follows, ‘Societies in part create hoped for (they sought an empirical basis for providing the disease they experience and, further, they materially nutritional supplements to improve child development), shape the way diseases are to be experienced.’ As a social they always believed that it was essential to combine intellectual integrity and rigorous science with attempts epidemiologist my job is to understand the social ‘creating’ to improve public health. The negative finding proved and ‘shaping’ of population health and to effectively important in leading to the current deeper understanding communicate that understanding to others.” of how prenatal nutrition influences development. —Dr. Bruce Link Especially noteworthy in later years, after he had founded the Gertrude H. Sergievsky Center, was that “Mervyn put THINKING back into epidemiology and he when the HIV/AIDS epidemic broke out in New York City is thoroughly impatient with cookbook approaches that in the 1980s, he and Dr. Stein became absorbed by this undermine serious, incisive thinking.” public health tragedy. They were among a small group of —Dr. Louise Kuhn established chronic disease epidemiologists who worked to fight the epidemic at home. HIV/AIDS would soon draw his and Dr. Stein’s atten- “The totality of Mervyn’s work weaves a path tion back to their other home, South Africa, where, by the to understanding the underlying goals of epidemiology; late 1980s, the epidemic was seen as a potentially grave they are truly to have a macro to micro perspective on threat to the black population. They helped organize a health and disease, from the social environment 1990 conference of anti-apartheid health activists and to subcellular processes.” members of the African National Congress in Maputo, —Dr. Pam Factor-Litvak several weeks following Nelson Mandela’s release after 27 years of government confinement. That and other activities helped influence the newly formed democratic “To me, one of Dr. Susser’s most influential government in 1994 to make the first serious moves to works is Causal Thinking in the Health Sciences. address the epidemic. Its clarity and economy make it a timeless reference and a Around the same time, Dr. Susser and his son Dr. Ezra pleasure to read. Dr. Susser is a truly integrative thinker, Susser wrote a seminal piece called, “Choosing a Future a brilliant epidemiologist, and an extraordinary writer. for Epidemiology” in the American Journal of Public Health. In this slim volume, he demonstrates beautifully that This paper challenged epidemiologists to think out of the epidemiology is at once a science and an art.” black box, to re-think the social environment, and to re- —Dr. Dana March think pathways leading to disease causation. Moreover, many Department faculty are here because of him, including Dr. Salim Abdool Karim, a South African “Who could envision inverting the continental drift whose important work on AIDS stemmed from the influ- and reuniting Africa and South America? Sounds crazy, ence of Drs. Susser and Stein and who first came to but Mervyn did something similar when he began Columbia University in 1977 on a Rockefeller Fellowship to re-unify two drifting intellectual continents: sociology under Dr. Susser’s mentorship. and epidemiology. Sociologists dig into causal processes, Now in his ninth decade, Dr. Susser’s influence is still while epidemiologists are after distant, yet effective great. The year 2009 saw the publication of his and Dr. associations. With Causal Thinking in the Health Sciences, Stein’s book Eras in Epidemiology: The Evolution of Ideas, Mervyn began to enrich epidemiology with sociological which describes the historical evolution of epidemiology thought. This seminal attempt has imprinted the and, like so much of Dr. Susser’s work, will shape the field theory of confounding and interaction, still resonates for years to come. in the emerging interest for so-called causal References models, and is bound to have further

repercussions of geological magnitude.” Davey Smith GM and Susser E. Zena Stein, Mervyn Susser and epidemiology: —Dr. Alfredo Morabia observation, causation and action. International Journal of Epidemiology. 2002; Feb 31 (1): 34-37.

Abdool Karim SS, Abdool Karim Q. The evolving HIV epidemic in South Africa. International Journal of Epidemiology. 2002; Feb 31(1): 40-45.

Oppenheimer GM and Rosner D. Two lives, three legs, one journey: A retro- spective appreciation of Zena Stein and Mervyn Susser. International Journal of Epidemiology. 2002; Feb 31 (1): 34-37.

FEBRUARY 2011 INNOVATION 15 INNOVATION

The Department has been nurturing new initiatives that build on our strengths and capitalize on opportunities for growth. The three new initiatives featured on the following pages exemplify this.

GMHP

p. 17 p. 18 p. 19

→ The Epidemiology and Population → The Epidemiology, Design, → The Global Mental Health Program Health Summer Institute at Guidance, and Expertise (GMHP) is working to put global Columbia (EPIC) creates expanded (EDGE) program aims to provide mental health squarely in the learning opportunities for epidemiologic expertise to middle of the global health agenda investigators and scholars from the investigators across Columbia at the School and the University, as health and social sciences, public University whose work might well as in the broader global health health practitioners, clinicians, and benefit from rigorous epidemiologic conversation. industry professionals interested in input on design and analysis. population health research.

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Epidemiology and Population Health Summer Institute at Columbia (EPIC)

This summer, the Epidemiology Department will host the first annual Epidemiology and Population Health Summer Institute at Columbia University (EPIC), providing public health and other professionals and students a unique opportunity to learn population research skills they would not otherwise have the time or resources to acquire.

With the increasing popularity and relevance of epidemiology to a broad range of disciplines, EPIC fills an unmet demand for a learning institute in New York City. “EPIC will help enhance the Department’s visibility while also providing a valuable service to professionals interested in population-based research,” says Dr. Ryan Demmer, Assistant Profes- sor of Epidemiology, and the co-director of EPIC. Over 25 intensive week-long courses will be offered in topics such as Applied Epidemiologic Analysis Using SAS, Multi-Level Modeling, and Psychiatric Epidemiology. The courses are open to anyone, including students and professionals in the biological sciences, medicine, nursing, dentistry, public health, and social sciences. EPIC courses will be taught by experts both within the Department and outside who offer a com- prehensive set of population study design skills and expertise across all epidemiology sub-fields. “Planning for EPIC has given me the opportunity to connect with creative and experienced instructors, and I’ve found their enthusiasm for teaching contagious,” says Dr. Gina Lovasi, Assistant Professor of Epidemiology, and co-director of EPIC. For more information about EPIC, please go to http://cuepisummer.org

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Epidemiology, Design, Guidance, and Expertise (EDGE)

The newly-launched Epidemiology, Design, Guidance, and Expertise (EDGE) program is building collaborations across the University by providing the expertise of our Department to researchers who could benefit from rigorous epidemiologic input on design and analysis.

“The goal is to look outwards from the Department and seek opportunities to develop new trans- disciplinary research projects that can improve public health and clinical practice,” says Dr. Andrew Rundle, Associate Professor of Epidemiology, who is leading EDGE. Our faculty are trained in a core set of methods and theories that are critical to the successful conduct of a broad range of health studies. Faculty members work with outside investigators during the design and planning phase of projects and grant proposals to improve the project’s chance for success. EDGE is designed to foster lasting interdisciplinary collaborations rather than the provision of a finite service. Expertise provided by the Epidemiology faculty includes, but is not limited to:

■■ Study design and conduct

■■ Methodological development

■■ Questionnaire and scale development

■■ Assessment of bias, confounding, interaction, and mediation

■■ Causal inference

■■ Multi-level methodologies; linking data on neighborhood, individual, and molecular risk factors or phenomena

■■ Statistical analyses

■■ Large data set and secondary data set analyses (SEER-Medicare, Census, medical claims, digital medical record)

■■ Analysis of geospatial data

■■ Simulation and modeling analyses

Dr. Rundle will be leading an effort to reach out to the rest of the University community about EDGE in the coming months.

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Global Mental Health Program (GMHP)

Although mental health is central to the health of populations— with mental disorders being a leading cause of disability worldwide—it has been a low priority on the global health agenda and disproportionately few resources, both in research and in service provision, are dedicated to it.

The time has come for a public health institution with such a strong faculty in psychiatry to spot- light this issue, say the program’s organizers. “Global mental health is like the Cinderella of global health. Until now, it has been neglected, but it is beginning to flower, and in my view it is destined to become the most interesting area of all in GMHPglobal health,” says Dr. Ezra Susser, Professor of Epidemiology and Psychiatry, who runs the program, along with Dr. Sandro Galea, Gelman Professor and Chair of the Department of Epidemiology. Working to change the status quo, the Epidemiology Department’s new Global Mental Health Program (GMHP) is putting global mental health squarely in the middle of the global health agenda at the Mailman School, the University, and in the larger global conversation. The GMHP is a Priority Program of the Mailman School’s Global Health Initiative (GHI). GMHP “Global mental health is about taking on one of the most stigmatized forms of human suffering and overcoming the life and death consequences of ignoring it,” says Dr. Francine Cournos, who is also actively involved in the program. The GMHP partners on a variety of mental health initiatives with government, global agencies, and programs at Columbia and other universities that are engaged in global mental health. So far, it has collaborated with programs in the School of Social Work, the Institute for Social and Eco- nomic Research and Policy, the New York State Psychiatric Institute, and the Earth Institute. Its partnerships take on many forms, including hosting seminars, promoting interdisciplinary research and interventions, nurturing young scholars interested in global mental health, building capacity in global mental health research, and interventions in partner institutions in low and middle-income countries. In 2010 GMHP held four seminars on such varied subjects as preventing HIV in psychiatric patients in Brazil and whether global health can cross the “quality chasm.” There will be eight seminars held in 2011.

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TWO BY TWO

Sandro Galea, MD, DrPH Gelman Professor and Chair Department of Epidemiology

Editor Barbara Aaron Administrative Director

ASSOCIATE Editor Elaine Meyer Communications Coordinator

Designer Jon Kalish