Epidemiology 2016
FROM THE DEPARTMENT OF EPIDEMIOLOGY 2016 ANNUAL REPORT MAILMAN SCHOOL OF PUBLIC HEALTH – COLUMBIA UNIVERSITY Charles C. Branas, PhD Chair Department of Epidemiology
EDITOR Kathryn Gerlach Assistant Manager for Communications
CONTRIBUTING WRITERS Stephanie Berger Director of Communications for Media Relations, Mailman School of Public Health
Timothy S. Paul Associate Director for Editorial Communications, Mailman School of Public Health
DESIGNER Kristen Byers Web Developer / Graphic Designer table of contents
Research highlights Symposium report
4 Humans vs. the mosquito: An age-old battle 21 Injuries, including those caused by guns, are preventable 5 New evidence on why young women in South Africa are at high risk of HIV infection Epidemiology by the numbers 6 The curious link between family size and height 22 EPIC: Registration growth by year 7 Wage gap may help explain why more women are 23 Supporting student research anxious and depressed than men 24 Fall 2016 incoming students 8 What’s the right prescription to end the opioid epidemic? 24 Epidemiology graduates: Employment outcomes 9 Marijuana use disorder is on the rise nationally; 25 Epidemiology graduates: Work type few receive treatment
10 Low maternal thyroid hormone increases In the news schizophrenia risk for offspring 26 U.S. suicide rate at 30-year high 11 Pre-diabetes may damage heart 27 The opioid epidemic 12 Health goes downhill when older adults stop driving 28 Gun violence in America 13 9/11-related illness still common 29 Other clips 14 Fruits and vegetables may slow ALS
15 Cancer expert says public health and prevention Bibliography measures are key to defeating cancer 30 Faculty publications
Feature
16 The future of epidemiology
1 letter from the chair
Colleagues,
Welcome to Epidemiology 2016, the annual report for the Department of Epidemiology at the Columbia University Mailman School of Public Health.
Having only just begun my new role as department chair it seems fitting that, in learning the full extent of my new colleagues’ many impres- sive achievements, I use this opportunity to share these with you as part of our yearly snapshot of science, training, and translation in the Department.
For many years, I’ve reflected on the future of epidemiology as a front- line scientist—where we’ve been and where we should go, and I was greatly honored when Dr. Linda Fried, Mailman School Dean, invited me this past summer to share my thoughts on such a weighty topic.
Epidemiology is, and should be seen as, a world-class science that impacts the lives of real people, in ways we can all appreciate.
On page 16, I’ve elaborated on this in The Future of Epidemiology: World Class Science, Real World Impact, and it’s my hope that this principle will be one of the guideposts for the future of our Department. Dr. Guohua Li, to whom we owe a great debt for his stellar commitment as interim chair, wrote in last year’s annual report that the future of epidemiology seminar series would forge “a roadmap for ensuring our Department’s successful transition and continued growth in the years to come.” Indeed it has.
I am eager to start on this exciting journey, and am confident that the Department of Epidemiology will continue to reach ever more impressive heights with its world class science, its production of next- generation scientific leaders, and its use of epidemiology as a powerful force for change in the world.
Best regards for a great year,
Charles C. Branas, PhD
3 research highlight
here’s an old proverb: “If you think Controlling yellow fever: A victim you are too small to make a differ- of its own success ence, try spending the night with a T Immunization, paired with mosquito mosquito.” It’s an inspiring sentiment— control efforts, was so effective in the but of course the insects do far worse Western Hemisphere that yellow fever than ruin a single night’s sleep; they are was largely relegated to the history responsible for carrying and spreading books—a problem of the past. But some of the most lethal diseases in today, the world is seeing a resurgence human history. of yellow fever, and the other diseases “The Aedes aegypti mosquito is carried by the Aedes aegypti pose a notorious,” says Stephen Morse, pro- greater threat than ever. fessor of Epidemiology. “It carries a “In many parts of the world, the vac- family of viruses that have posed a cine is only made widely available when threat throughout history: yellow fever, you have an outbreak,” explains Morse. dengue, chikungunya, and—most “It’s been used not for prevention but recently—Zika.” Fortunately, humans do emergency response. have effective tools to fight the Aedes aegypti and all the diseases it carries. Simultaneous battles: Yellow fever and Zika A brief history of yellow fever Compounding this problem is Of all the viruses carried by the another virus carried by the Aedes Aedes aegypti, yellow fever has his- aegypti: Zika. Until very recently, Zika torically been considered the most was considered mild, especially when dangerous due to its high fatality rate. compared with the fatality rate of Originating from West Africa, yellow yellow fever. But recently, scientists fever made its way across the Atlantic confirmed the connection between the Ocean with the slave trade, spreading virus and very severe birth defects. The across the Caribbean and the tropical top Aedes aegypti experts and vaccine Humans vs. the regions of North and South America. companies are working now to rapidly Throughout early American history, develop a vaccine for Zika. mosquito: An there were several deadly outbreaks For many in public health, the best of yellow fever, the worst of which hit way to tackle Zika and yellow fever lies age-old battle Philadelphia in 1793, killing an esti- not in vaccines, but in stepping up mos- mated 5,000 people—about 10 percent quito control efforts. The Aedes aegypti of the city’s population. Yellow fever is highly adaptable to human beings: it also posed such a deadly threat that bites during the day, it can breed in the related media coverage the very first attempts to build the tiniest amounts of water, and will often Panama Canal failed. Around the turn stay in or near homes. After World War ABC News of the 20th century, scientists proved II, many countries in South and North abcn.ws/2bsFplg two important facts to help fight yellow America dedicated extensive, effec- fever: mosquitoes could spread human tive—and very expensive efforts—to The Atlantic diseases—and yellow fever was carried control the mosquito, including the theatln.tc/1Zgn2zz by the Aedes aegypti mosquito. spraying of pesticides like DDT. These discoveries led to a break- “Mosquito control was a victim of Huffington Post through: in 1936, Max Theiler—who was its own success,” says Morse. “The huff.to/1UpZF4b awarded the Nobel Prize for his work— mosquito problem wasn’t as glaring, created the yellow fever vaccine. “The so the efforts weren’t sustained—and New York Times development of the vaccine was really a the mosquitoes came back. That’s the nyti.ms/2cawvca remarkable tour de force,” says Morse. irony in today’s Zika outbreak: if it had “That’s what tamed yellow fever for happened fifty years ago, we would most of the wealthy world. It’s one of probably be better off. The virus likely the oldest vaccines, but today it remains wouldn’t have been able to establish one of the safest, most effective vac- itself in South America, because the cines we have.” mosquito had been largely controlled.”
4 2016 ANNUAL REPORT research highlight
vidence by the Centre for the “Reducing new HIV infections in AIDS Programme of Research young women is one of the greatest Ein South Africa (CAPRISA) challenges in southern Africa,” com- consortium of South African and North mented Dr. Abdool Karim. American researchers was presented The three studies provide scien- at the International AIDS 2016 tific evidence, using state-of-the-art Conference in Durban, shedding new research technologies, to guide tar- light on why young women in South geted HIV prevention interventions to Africa have high rates of HIV infection. break the cycle of HIV transmission Dr. Salim Abdool Karim, professor of and impact the course of HIV in South Epidemiology at Columbia University’s Africa and potentially in other high Mailman School of Public Health and burden settings. Since the Prevotella director of CAPRISA, led the research and Gardnerella bacteria raise the team. The Mailman School was also vaginal pH, a readily available, quick, among the North American institutions simple and cheap test can be used providing research support. to ascertain which women require In a study of 9,812 individuals, the treatment for bacterial vaginosis, an genetic code of HIV from each of 1,589 imbalance in the vaginal bacteria. Com- HIV-positive people was analyzed bined, these interventions could have a to better understand the relentless significant impact on the spread of HIV spread of HIV in a rural and urban in women in South Africa and beyond. community in South Africa. It revealed Dr Margaret Chan, Director-Gen- a “cycle of HIV transmission” driven eral, World Health Organization, by high rates of new HIV infections in commented that, “Young women in adolescent girls and young women Africa have missed out while others from men, on average 8 years older. have benefitted from global progress Many of these men were also partners against AIDS. The new studies point of similarly aged women who have HIV the way to HIV prevention oppor- New evidence prevalence rates exceeding 60%. tunities that can help rectify this A second study, led by Dr. Brent imbalance.” on why young Williams in the Center for Infection and “Reducing new HIV infections in Immunity at the Mailman School, dis- young women is one of PEPFAR’s high- women in South sected the vaginal microbiome of 119 est priorities”, said Dr. Deborah Birx, South African women. Women with United States Ambassador and Global Africa are at an overgrowth of Prevotella bivia had AIDS Coordinator. “The CAPRISA an almost 13 times higher chance of findings provide us with a greater high risk of HIV acquiring HIV than those at low levels understanding of how to protect young or absence of this vaginal bacterium. women. This new insight will allow infection In the third study, an analysis of us to move forward with a different 3,334 genital bacterial proteins from understanding of how best to protect 688 women showed that the three out women from HIV.” related media coverage of five women who had a “healthy” In most of southern and eastern lactobacillus dominant vagina showed Africa, HIV incidence in young women Science that tenofovir gel preexposure pro- (less than 25 years) continues to bit.ly/29T9YRh phylaxis was effective in preventing remain unacceptably high. About HIV, while the women who did not 380,000 new HIV infections occur in Science Daily have lactobacillus dominance, showed adolescent girls and young women bit.ly/2cmOCer little benefit from the gel. Follow up aged 16-24 years each year. These laboratory studies showed that Gard- young women experience HIV rates nerella vaginalis, which predominates several-fold higher than their male in the vagina when lactobacillus levels peers, making the reduction of infec- are low, absorbs tenofovir thereby tion rates among young women one reducing the availability of the drug to of the most crucial challenges in HIV prevent HIV infection. prevention in Africa.
DEPARTMENT OF EPIDEMIOLOGY 5 research highlight
f you find yourself staying in an old military recruits in the Netherlands, bed and breakfast in Holland, you age 18, from 1962–65. Because service Imay have to duck your head when was compulsory during this period, walking through the door and sleep the data is representative a broad with your feet hanging over the end of spectrum of socioeconomic and demo- the bed. This is because over the past graphic groups. 150 years, the average height of Dutch While family size has trended men has increased from about 5-foot-4 smaller since World War II, the to over 6 feet, and they are now among researchers say the shift happened the tallest people in the world. slowly enough that it wouldn’t skew There have been similar height the results. And while parents who increases in other European countries have larger families would have been and the United States. And while most aware that having more children of a person’s stature can be attributed means there is less to spend for each to genetics, some researchers estimate child, the researchers say it is unlikely that a fifth of height can be attributed that parents anticipated that this would to environmental factors like the avail- affect the height of their offspring and ability of food and social resources. adjusted their family size decisions With this knowledge, Laura Strad- accordingly. ford, MPH ‘15, examined data on While stunting can happen as the uniform measurements for Dutch mili- consequence of disease, poor health tary conscripts as part of her Mailman is far from the main determinant of School Epidemiology thesis and found height. For that reason, the findings that men with more siblings were shouldn’t be interpreted as meaning shorter than those born into smaller that larger families or shorter people families. Under the advisement of L.H. are less healthy, cautions Lumey, the Lumey, the results of her work were study’s senior author. recently published in the journal, The “At the population level,” he says, The curious link History of the Family. “height is a general indicator of how According to Stradford, the link equitable societal resources are between family between family size and height is spread across the socio-economic likely explained by what is known as strata. It is an important marker of size and height resource dilution. As families grow, socio-economic inequality.” And time parents have less to give to each child. and again, socio-economic status has “If you have a small family, maybe been shown to be one of the clearest you have more time to read to the chil- indicators of health. dren and to interact with them. Maybe An unanswered question is you have more money to buy food whether the connection between and medical care,” Stradford explains. family size and health also applies “Whether you’re rich or poor, if you’re to women vis-à-vis their sisters and from a larger family you’re likely to be their brothers. According to Lumey, a bit shorter.” one possibility would be to examine There was a difference of almost data from military recruits in Israel an inch between the height averages where everyone, men and women, are of families with one child compared to required to serve. nine or more, which was seen in both high and low socioeconomic statuses. Stradford, L, van Poppel, F, Lumey, LH. Can Recruits from relatively more affulent resource dilution explain differences in backgrounds were significantly taller. height by birth order and family size? A study The study finds new evidence that the of 389,287 male recruits in twentieth-cen- men were taller than their younger tury Netherlands. The history of the family: brothers—although the effect was less An international quarterly. 2016 Oct 17. doi: pronounced than family size. 10.1080/1081602X.2016.1230510 [Epub ahead The study used height and demo- of print] graphic information from 389,287 male
6 2016 ANNUAL REPORT research highlight
or every dollar an American included; the lower the income, the man makes, his equally qualified greater the risk. But according to Platt Ffemale counterpart makes just and his co-authors, the dispropor- 82 cents. According to a new study tionate rate of anxiety and depression by Mailman School researchers, the diagnoses in women is about more consequences of this wage gap extend than just material resources. For one, beyond the checking account: women women spend more time on domestic who earn less than their male peers roles than men, an added burden that are at greater risk for anxiety and can lead to anxiety and depression. On depression than those who are fairly top of that, there is an insidious psy- compensated. chological process that leads women Jonathan Platt, a PhD student in to blame themselves for different Epidemiology, and colleagues looked expections around their jobs and how at a survey of 22,581 working adult they’re compensated. Americans, finding that among women “If women internalize these neg- whose income was lower than their ative experiences as individual-level male counterparts, the odds of major issues, rather than the result of struc- depression were nearly two-and-a-half tural discrimination, they may be at times higher, and odds of anxiety were increased risk for depression and anxi- more than four times higher, than men ety disorders,” says Platt. matched for age, education, occupa- “Our findings suggest that pol- tion, family composition, and other icies must go beyond prohibiting factors. Yet when women’s income overt gender discrimination,” says was greater than their male coun- Katherine Keyes, assistant professor terparts, women’s odds for having of Epidemiology and senior author. anxiety or depression was nearly “While it is commonly believed that equivalent to men. gender differences in depression and Wage gap may It’s a startling fact: women in the anxiety are biologically rooted, these U.S. are nearly nearly twice as likely to results suggest that such differences help explain why have depression or anxiety than men. are much more socially constructed Past research looking to account for than previously thought, indicating more women this disparity explored factors like dif- that gender disparities in psychiatric ferences in sex hormones and coping disorders are malleable and arise from are anxious and mechanisms, but so far nothing has unfair treatment.” provided an adequate explanation. In Keyes notes that policies such as depressed than their new study published in Social paid parental leave, affordable child- Science & Medicine, the Mailman care, and flexible work schedules men researchers find that higher rates of may ameliorate some of this burden, these mental problems in women may although more research is necessary. in part be explained by lower pay. “Greater attention to the funda- “Our results show that some of mental mechanisms that perpetuate related media coverage the gender disparities in depression wage disparities is needed,” says and anxiety may be due to the effects Keyes, “not only because it is unjust, CBS News of structural gender inequality in the but so that we may understand and cbsn.ws/2czTr6I workforce and beyond,” says Platt, be able to intervene to reduce subse- first author of the paper. “The social quent health risks and disparities.” Fortune processes that sort women into cer- for.tn/1mN0sks tain jobs, compensate them less than Platt J, Prins S, Bates L, Keyes K. Unequal equivalent male counterparts, and depression for equal work? How the wage Science Daily create gender disparities in domestic gap explains gendered disparities in mood bit.ly/2cEjOFQ labor that have material and psychoso- disorders. Soc Sci Med. 2016 Jan;149:1-8. doi: cial consequences.” 10.1016/j.socscimed.2015.11.056. Epub 2015 Income is a strong predictor of Dec 8. PubMed PMID: 26689629; PubMed health outcomes, mental health Central PMCID: PMC4801117.
DEPARTMENT OF EPIDEMIOLOGY 7 research highlight
early 20,000 people died in the The worry is that as opioid prescrip- United States from prescription tions become harder to get, users Nopiate overdoses in 2014—more will switch to an illegal alternative. than three times the number in 2001. “Several studies have shown that In a March 29 speech at the National individuals with previous nonmedical Rx Drug Abuse and Heroin Summit, use of prescription opioids may be at President Obama compared the opiate greater risk of heroin use and heroin epidemic with the threat of terrorism, dependence,” notes Martins. and set aside $1.1 billion to combat the Opioid substitution, which took off problem. in 2008, has recently taken a turn for Earlier that month, the Centers the worse. Starting last year, Li says, a for Disease Control and Prevention new trend has emerged: heroin users published a proposed new guideline are increasingly switching to the much for prescription opioids. While it has more potent synthetic opioid Fentanyl, yet to be adopted, the Guideline for a development he calls “a formidable Prescribing Opioids for Chronic Pain, challenge.” United States, 2016 endorses the Ironically, loosening the rules on lowest dose for the shortest period of dispensing one kind of drug could rein time, excepting patients undergoing in dependence on its more dangerous cancer, palliative, and end-of-life care. cousins. Silvia Martins, associate professor of Prevention efforts continue to play a Epidemiology, notes that patients who crucial role. Compared to illegal drugs, take opioids for extended timeframes there is much less stigma around pre- risk becoming addicted to the drugs. scription opioids—and an exaggerated understanding of their safety. Many Legislation people continue to be unaware of the Guohua Li, former interim chair consequences of sharing pain medica- of Epidemiology, applauds ongoing, tions. According to Martins, education What’s the right informal efforts to stem the flow of to correct these misconceptions is espe- prescriptions as both sensible and cially needed for young adults, since prescription to necessary, but says, by themselves early use prescription opioids is associ- they aren’t enough. “Relying on ated with transition to heroin use. end the opioid changing physician behavior through While it is increasingly clear that training programs and clinical practice there is no easy single solution to epidemic? guidelines is not enough to effectively ending the opioid epidemic, Li and control the opioid overdose epidemic,” Martins are encouraged by policy he says. More important in Li’s view is momentum in Washington, includ- legislation and enforcement to restrict ing President Obama’s March 29 the manufacturing, marketing, and announcement and Senate bill that sale of opioids and other controlled passed earlier in the month which substances. provides money to states for addiction related media coverage Along these lines, the Federal Trade treatment, prevention and education. Authority is pushing generic drug In late April, a bipartisan panel in the New York Times makers to develop abuse-deterrent House of Representatives followed nyti.ms/2cggCnw opioids, formulated to make the pills suit with its own legislative package, harder to crush or dissolve into a form which includes money for prescription that can be sniffed or injected, although drug monitoring programs. drug makers have countered saying reformulating their product would be Kim JH, Santaella-Tenorio J, Mauro C, Wrobel prohibitively expensive. J, Cerdà M, Keyes KM, Hasin D, Martins SS, Li G. State Medical Marijuana Laws and Treatment and prevention the Prevalence of Opioids Detected Among Another approach to curbing the Fatally Injured Drivers. Am J Public Health. opioid epidemic emphasizes treatment 2016 Sep 15:e1-e6. [Epub ahead of print] for those already misusing the drugs. PubMed PMID: 27631755.
8 2016 ANNUAL REPORT research highlight
he percentage of Americans who of the disorder is rated as mild, mod- reported using marijuana in the erate, or severe depending on the Tpast year more than doubled number of symptoms. As the severity between 2001-2002 and 2012-2013, of marijuana use disorder increased, and the increase in marijuana use dis- so did associated disability levels and orders during that time was nearly as frequency of marijuana use. large, according to a new study in the Deborah Hasin, PhD, lead author American Journal of Psychiatry. The and professor of Epidemiology research also showed that 2.5 percent at Columbia’s Mailman School of of adults—nearly 6 million people— Public Health and in the Department experienced marijuana use disorder of Psychiatry at CUMC, was on the in the past year, while 6.3 percent had workgroup responsible for making the met the diagnostic criteria for the dis- changes in DSM-5 substance use diag- order at some point in their lives. nostic criteria, including marijuana use The collaborative study was carried disorders. In a study published last year, out by scientists at Columbia Universi- Dr. Hasin reported that three out of ten ty’s Mailman School of Public Health, marijuana users experienced marijuana Columbia University Medical Center, abuse or dependence in 2012–13. and the National Institute on Alcohol “An increasing number of Ameri- Abuse and Alcoholism (NIAAA), part can adults do not perceive marijuana of the National Institutes of Health. use as harmful,” said Hasin. “While The study also found that marijuana some can use marijuana without use disorder is often associated with harms, other users do experience neg- other substance use disorders, behav- ative consequences. ioral problems, and disability, and The researchers found that only goes largely untreated. about 7 percent of people with past- The data were collected in the year marijuana use disorder receive Marijuana use 2012-2013 wave of NIAAA’s National any marijuana-specific treatment, and Epidemiologic Survey on Alcohol and only about 14 percent of people with disorder is on the Related Conditions (NESARC), the lifetime marijuana use disorder receive largest ever conducted on the co-oc- treatment. rise nationally; currence of alcohol use, drug use, and “We feel strongly that more related psychiatric conditions. For this public education about the dangers Few receive study, over 36,000 U.S. adults were associated with marijuana use is interviewed about alcohol, drug, and imperative,” stated Hasin. “This is treatment related psychiatric conditions. The especially critical since we are learning data showed that marijuana use disor- more about public beliefs that mari- der is about twice as common among juana use is harmless.” men than women, that younger age The study was supported by the groups are much more likely to expe- National Institute on Alcohol Abuse rience the disorder than people age 45 and Alcoholism and the National Insti- related media coverage and over, and that those at the lowest tute on Drug Abuse (R01DA034244-01 income levels were at the highest risk. and F32DA0364431). The authors Science Daily This is the first national survey to report no conflicts of interest. bit.ly/2d2scPI use the diagnostic criteria from Diag- nostic and Statistical Manual of Mental Hasin DS, Kerridge BT, Saha TD, Huang The Guardian Disorders (DSM-5). In DSM-5, the old B, Pickering R, Smith SM, Jung J, Zhang bit.ly/2bLBZXO categories of marijuana dependence H, Grant BF. Prevalence and Correlates of and abuse are combined into a single DSM-5 Cannabis Use Disorder, 2012-2013: disorder. To be diagnosed with the Findings from the National Epidemiologic disorder, individuals must meet at Survey on Alcohol and Related Conditions-III. least two of 11 symptoms that assess Am J Psychiatry. 2016 Jun 1;173(6):588-99. craving, withdrawal, lack of control, doi: 10.1176/appi.ajp.2015.15070907. Epub and negative effects on personal and 2016 Mar 4. PubMed PMID: 26940807; professional responsibilities. Severity PubMed Central PMCID: PMC5026387.
DEPARTMENT OF EPIDEMIOLOGY 9 research highlight
study published in Biological literature on maternal hypothyrox- Psychiatry reveals a new link inemia during gestation altering Abetween low levels of the offspring brain development.” Dr. thyroid hormone thyroxine during Gyllenberg was a visiting scholar at pregnancy and risk of schizophrenia in Columbia University when much of the the offspring. research was conducted. Low levels of free thyroxine in Brown emphasized that “this work pregnant women, referred to as hypo- adds to a body of literature suggesting thyroxinemia, are associated with that maternal influences, both envi- abnormalities in cognitive develop- ronmental and genetic, contribute to ment similar to those in schizophrenia, the risk of schizophrenia. Although a neurodevelopmental disorder. replication in independent studies is Hypothyroxinemia is also associated required before firm conclusions can with preterm birth, a risk factor for be drawn, the study was based on schizophrenia. a national birth cohort with a large To determine if hypothyroxinemia sample size, increasing the plausibility is associated with schizophrenia, of the findings.” the study, led by senior author Alan This study did not address the Brown, MD, MPH, professor of Psy- cause of this association, but did chiatry Epidemiology at Columbia find that adjusting for preterm birth University’s Mailman School of Public lessened the association between Health, Columbia University Medical hypothyroxinemia and schizophrenia, Center, and the New York State Psy- suggesting that preterm birth may chiatric Institute, examined thyroxine mediate some of the increased risk. levels in archived serum samples The authors note in the paper from 1,010 mothers of children with that the finding may not be specific schizophrenia and 1,010 matched to schizophrenia, but could be a risk control mothers. The sera were col- factor for other neurodevelopmental Low maternal lected during the first and early second disorders as well, such as bipolar dis- trimesters of pregnancy as part of order, autism, and mental retardation. thyroid hormone the Finnish Maternity Cohort. Com- Dr. John Krystal, editor of Biolog- prehensive Finnish registries of the ical Psychiatry, thinks the association increases population and psychiatric diagnoses has clinical potential for reducing risk provided information on case status in the offspring of mothers with low schizophrenia (schizophrenia or control) among off- thyroxine levels. “This study identifies spring of mothers corresponding to a preventable potential contributor risk for offspring the prenatal serum samples. to the risk for schizophrenia. Mater- The authors found that 12 percent nal hypothyroidism can be easily of people with schizophrenia had a diagnosed and effectively treated,” mother with hypothyroxinemia, com- said Krystal, who is chairman of the pared with 9 percent of people without Department of Psychiatry at the Yale related media coverage schizophrenia. The finding was statis- University School of Medicine and tically significant. This suggests that chief of Psychiatry at Yale-New Haven PsychCentral children of mothers with hypothyroxin- Hospital. bit.ly/2d516un emia during pregnancy have increased odds of developing schizophrenia. Gyllenberg D, Sourander A, Surcel HM, Science Daily The association remained even after Hinkka-Yli-Salomäki S, McKeague IW, bit.ly/28NaCxP adjusting for variables strongly related Brown AS. Hypothyroxinemia During to schizophrenia such as maternal psy- Gestation and Offspring Schizophrenia in chiatric history and smoking. a National Birth Cohort. Biol Psychiatry. First author of the study Dr. David 2016 Jun 15;79(12):962-70. doi: 10.1016/j. Gyllenberg of the University of Turku, biopsych.2015.06.014. Epub 2015 Jun 19. thinks the importance of this paper is PubMed PMID: 26194598; PubMed Central that it “links the finding to an extensive PMCID: PMC4684794.
10 2016 ANNUAL REPORT research highlight
study of U.S. Hispanics with was defined as a fasting glucose read- diabetes mellitus showed a link ing of ≥126 mg/dL, and a HbA1c of ≥6.5 Abetween impaired glucose regu- percent. Prediabetes was prevalent lation and adverse measures of cardiac for 42 percent of the participants, and function and structure. Researchers diabetes mellitus was reported by 28 at Columbia University’s Mailman percent with 47 percent uncontrolled School of Public Health in collabora- and a HbA1c of ≥7.0 percent. tion with colleagues from Wake Forest “Whether aggressive glucose-low- Medical School and six other institu- ering therapy can prevent these tions extended previous knowledge cardiac alterations that lead to heart regarding the concept of diabetic car- failure remains unknown, but it sup- diomyopathy by also observing that ports the notion that HbA1c <7% may these relationships emerged early and be important for cardiac health,” said before the full onset of diabetes melli- Dr. Carlos J. Rodriguez, senior author tus. The findings are published online and PI of the ECHO-SOL. in the journal Circulation: Cardiovascu- These findings also raise the lar Imaging. possibility that primary prevention This is the first study to assess the efforts targeting insulin resistance and impact of diabetes mellitus on cardiac glucose homeostasis might also be geometry using several measures beneficial for optimal cardiac health and the first to report the association and heart failure prevention, although between insulin resistance and cardiac future studies are necessary. “If con- structure and function among a U.S. firmed, these results would have high sample population of Hispanics/Lati- public health importance given the fact nos not previously studied. that Hispanics have elevated rates of “Our findings inform and extend Type 2 diabetes compared to the U.S. the clinical concept of diabetic car- population overall. This is coupled with Pre-diabetes may diomyopathy—adverse changes in the fact that Hispanics are expected to cardiac structure and function com- account for 25 percent of the U.S. pop- damage heart monly observed among patients ulation by 2050,” noted Demmer. with diabetes mellitus in two ways,” The study was supported by said lead author Ryan Demmer, PhD, National Heart, Lung, and Blood Insti- assistant professor of Epidemiol- tute, National Institute on Deafness ogy at the Mailman School of Public and Other Communication Disorders, Health. “First, they confirm that dia- National Institute of Dental and Cra- betes mellitus—both controlled and niofacial Research, National Institute uncontrolled—is related to the worse of Diabetes and Digestive and Kidney measures of cardiac structure and Diseases, National Institute of Neu- function among Hispanics. Second, rological Disorders and Stroke, and they demonstrate that these rela- National Institutes of Health-Office of tionships emerge early in the natural Dietary Supplements. ECHO-SOL was related media coverage history of diabetogenesis and prior to supported by R01 HL104199 and R01 diabetes development.” DK102932. Medical Xpress Results were from the ECHO-SOL epi.is/2gCcYFG (Echocardiographic Study of U.S. Lati- Demmer RT, Allison MA, Cai J, Kaplan RC, nos) which examined chronic disease Desai AA, Hurwitz BE, Newman JC, Shah risk factors and related morbidity and SJ, Swett K, Talavera GA, Thai A, Young- mortality of 1,818 Hispanic/Latino men blood ME, Rodriguez CJ. Association of (43 percent) and women (57 percent) impaired glucose regulation and insulin 45 years of age and older. Participants resistance with cardiac structure and were recruited from the Bronx, New function: results from ECHO-SOL (Echocar- York; Chicago; Miami; and San Diego. diographic Study of Latinos). Circ Cardiovasc Glucose intolerance was defined Imaging. 2016;9:e005032. doi: 10.1161/ as having a prediabetes HbA1c of ≥5.7 CIRCIMAGING.116.005032. and <6.5 percent; diabetes mellitus
DEPARTMENT OF EPIDEMIOLOGY 11 research highlight
or older adults, driving a car is health after driving cessation appeared an important aspect of having greater in women than in men. Fcontrol over one’s life. While 81 Former drivers were also nearly percent of the 29.5 million U.S. adults five times as likely as current drivers aged 65 and over continue to hold to be admitted to a nursing home, a license and get behind the wheel, assisted living community, or retire- age-related declines in cognition and ment home, after adjusting for marital physical function make driving more status or co-residence. difficult, and many seniors reduce or “As older ex-drivers begin substi- eventually stop driving altogether. tuting outside activities with indoor Researchers at Columbia Universi- activities around the home, these ty’s Mailman School of Public Health activities may not be as beneficial to examined the health and well-being of physical functioning as working or vol- older adults after they stopped driving unteering on the outside,” said Thelma and found that their health worsened Mielenz, PhD, assistant professor of in a variety of ways. In particular, driv- Epidemiology at the Mailman School ing cessation nearly doubled the risk and co-author. “When the time comes of depressive symptoms, while also to stop driving, it is important to make contributing to diminished cognitive personalized plans to maintain mobil- abilities and physical functioning. Find- ity and social functions.” ings are published online in the Journal The researchers note that merely of the American Geriatrics Society. making alternative transportation “For many older adults, driving is available to older adults does not more than a privilege; it is instrumen- necessarily offset the adverse health tal to their daily living and is a strong effects of driving cessation. “What indicator of self-control, personal free- we need most of all are effective pro- dom, and independence,” said Guohua grams that can ensure and prolong an Health goes Li, MD, DrPH, Mailman School pro- older adult’s mobility, physical, and fessor of Epidemiology, the founding social functioning,” said Dr. Li. downhill when director of the Center for Injury Epide- Other study co-authors are Stan- miology and Prevention at Columbia, ford Chihuri, Charles J. DiMaggio, older adults stop and senior author. “Unfortunately, it is Columbia University’s Mailman School almost inevitable to face the decision of Public Health; Marian E. Betz, driving to stop driving during the process of Department of Emergency Medicine, aging as cognitive and physical func- University of Colorado School of Med- tions continue to decline.” icine; Carolyn DiGuiseppi, Colorado Dr. Li and a team of researchers School of Public Health; and Vanya reviewed and analyzed quantitative C. Jones, Johns Hopkins Bloomberg health-related data for drivers aged 55 School of Public Health. and older from 16 studies that met eli- The research was supported by gibility criteria and compared results the AAA Foundation for Traffic Safe- related media coverage with data from current drivers. The ty’s Longitudinal Research on Aging study updates and expands on earlier Drivers (LongROAD) Project and the PsychCentral findings with more than 10 additional National Center for Injury Prevention bit.ly/2cuysjJ years of empirical research. and Control, Centers for Disease Data showed that older adults Control and Prevention (Grant 1 R49 Science Daily experienced faster declines in cogni- CE002096). The authors report no con- bit.ly/2cDGbK7 tive function and physical health after flicts of interest. stopping driving. Driving cessation Reuters Health was also associated with a 51-percent Chihuri S, Mielenz TJ, DiMaggio CJ, Betz ME, reut.rs/1QDaP6A reduction in the size of social networks DiGuiseppi C, Jones VC, Li G. Driving Cessa- of friends and relatives—something tion and Health Outcomes in Older Adults. J the researchers say can constrain the Am Geriatr Soc. 2016 Feb;64(2):332-41. doi: social lives of seniors and their ability 10.1111/jgs.13931. Epub 2016 Jan 19. Review. to engage with others. Decline in social PubMed PMID: 26780879.
12 2016 ANNUAL REPORT research highlight
ignificant health problems Kills Landfill for processing as part continue to affect people of the recovery efforts and criminal Sexposed to hazards 15 years investigation. This mass of debris, after the collapse of the World Trade which ranged from tons of fine dust Center towers on September, 11, to twisted metal girders, was meticu- 2001. Steven Stellman, a professor lously examined for human remains of Epidemiology, is co-author of four that could aid identification of victims, new studies through the World Trade as well as personal effects of the thou- Center Health Registry that report sands who perished in the collapse of on outcomes, including cancer, acid the buildings. reflux, asthma, as well job loss and An estimated 15,000 workers car- early retirement. ried out these operations on Staten Led by scientists at the New York Island, yet little was known about their Department of Health and Mental specific tasks, exposures, and health Hygiene, the studies appear in a spe- outcomes until now. The new study cial 9/11-themed issue of the American finds that post-9/11-onset asthma was Journal of Industrial Medicine. associated with two separate exposure “A decade and a half after the measures: one representing a range terrorist attacks of September 11, we of potential dust and fume exposures, have the clearest picture yet on the and second, a more focused collection effects of the events on the health and of job tasks that included digging, wellbeing of those most affected,” loading, dumping, and welding or steel says Stellman, the former research cutting. director of the Registry. Jobs picture While the full extent of cancer risk to the affected population may not Ten years after the disaster, about be known for years, the new research seven percent of non-uniformed reveals that, as of 2011, rescue/recov- rescue and recovery workers left 9/11-related ery workers at the World Trade Center their jobs prematurely, about half site had an 11 percent greater overall through early retirement and half due illness still cancer risk compared to New York to health-related job loss. Among State norms. non-uniformed rescue/recovery work- common ers age 60 or younger who were still Acid reflux and PTSD working in 2008, those who endured Gastroesophageal reflux disease, the most serious 9/11-related health or GERD, is one of the most common burden were most likely to retire related media coverage health conditions reported among per- early before reaching the age of 60, sons exposed to the attacks, affecting and most likely to be unemployed for PsychCentral one in five Registry enrollees in the health reasons. bit.ly/2cUDkzu first two years after 9/11. In the new According to Stellman, the Registry, research, Stellman and his co-authors which opened in 2003 and has enrolled BrainBlogger find that half of those with early GERD 71,000 people, will continue monitor- bit.ly/2d4w42N symptoms continued to report per- ing for health changes. When it comes sistent symptoms ten years after 9/11, to chronic diseases, “much of the story and were more likely to report continu- is still to be written,” he says. ing symptoms if they both had asthma and PTSD during the first three years Li J, Brackbill RM, Liao TS, Qiao B, Cone JE, after 9/11. Farfel MR, Hadler JL, Kahn AR, Konty KJ, Stayner LT, Stellman SD. Ten-year cancer Staten Island exposures incidence in rescue/recovery workers and Between September, 2001 and July, civilians exposed to the September 11, 2001 2002, nearly two million tons of debris terrorist attacks on the World Trade Center. at the WTC site were dismantled and Am J Ind Med. 2016 Sep;59(9):709-21. doi: transported by truck and barges for 10.1002/ajim.22638. PubMed PMID: 27582473. transfer to the Staten Island Fresh
DEPARTMENT OF EPIDEMIOLOGY 13 research highlight
ew research at Columbia Univer- “The foods and nutrients that may sity’s Mailman School of Public help reduce the severity of ALS are NHealth reveals that foods like very similar to the recommendation to fruits and vegetables that are high in prevent many other chronic diseases,” antioxidant nutrients and carotenoids noted Dr. Nieves. are associated with better function in “Our cross-sectional study relied amyotrophic lateral sclerosis (ALS) on a food questionnaire and those patients around the time of diagno- may not always represent a true daily sis. This is among the first studies to diet,” cautioned Dr. Nieves. “However, evaluate diet in association with ALS those responsible for nutritional care function and the first to show that of the patient with ALS should con- healthy nutrients and antioxidants are sider promoting fruits and vegetables associated with better ALS function- since they are high in antioxidants and ing. The findings are published online carotenes. Future studies will look at in JAMA Neurology. follow-up data on both dietary intake ALS, also known as Lou Gehrig’s and progression of ALS.” Disease, is a severe neurodegener- Co-authors are Pam Factor-Litvak ative disorder that causes atrophy, of Columbia University’s Mailman paralysis, and eventually respiratory School of Public Health; Jonathan failure. Median survival for ALS Hupf, Jessica Singleton, Valerie Sharf, patients ranges from 20 to 48 months, and Hiroshi Mitsumoto, all of the although 10 percent to 20 percent of Department of Neurology, Columbia patients can live longer than 10 years. University; Chris Gennings, Icahn Jeri W. Nieves, PhD, associate School of Medicine at Mount Sinai; professor of Epidemiology, and co-au- Bjorn Oskarsson, University of Cali- thors examined the links between fornia–Davis, Sacramento; Fernandes nutritional intake and severity of Filho, University of Nebraska Medical Fruits and ALS for patients who had ALS symp- Center; Eric J. Sorenson, Mayo Clinic; toms for 18 months or less. The Emanuele D’Amico, Neurological vegetables may study, which relied on nutrient intake Institute, Catania, Italy; and Ray Goetz, reported using a food questionnaire, Department of Psychiatry, New York slow ALS followed 302 participants recruited at State Psychiatric Institute. 16 clinical centers throughout the U.S. The study was supported by the The researchers used a validated mea- National Institute of Environmental sure of ALS severity and respiratory Health Sciences, National Institutes function. of Health (Grant R01ES016348). The related media coverage “It appears that nutrition plays a journal article has additional funding role both in triggering the disease and sources and non-conflict of interest Nature World News why it progresses,” said Dr. Nieves. statements. epi.is/2fe99T9 “For this reason, ALS patients should eat foods high in antioxidants and Nieves JW, Gennings C, Factor-Litvak P, Neurology Advisor carotenes, as well as high fiber grains, Hupf J, Singleton J, Sharf V, Oskarsson B, epi.is/2gevGzh fish, and poultry.” Fernandes Filho JA, Sorenson EJ, D’Amico E, The researchers also found that Goetz R, Mitsumoto H. Association Between Science Daily milk and lunch meats were associated Dietary Intake and Function in Amyotrophic epi.is/2fUHFBv with lower measures of function, or Lateral Sclerosis. JAMA Neurology. 2016. more severe disease. Two different doi:10.1001/jamaneurol.2016.3401. statistical analyses by Dr. Nieves both indicate that diet may help minimize the severity of ALS and point to the role of oxidative stress in ALS severity.
14 2016 ANNUAL REPORT research highlight
s investment in research to develop new treatments the best approach Ito controlling cancer? Would empha- sizing prevention bring about more return on investment? Should we channel what we are learning about precision medicine and the genome into cancer prevention, not treatment alone? Many people believe that the time is right for another big push to defeat cancer, including President Obama, who called for a major cancer-fight- ing campaign in his final State of the Union address. But in the latest opinion piece, “Targeting the Cancer Moonshot” in JAMA Oncology, this kind of effort will never cure cancer without public health and prevention. While there have been some important and notable cures for certain types of cancer in the last half-century, Alfred I. Neugut, MD, PhD, Myron M. Studner Professor of Cancer Research and professor of Epidemiology at Columbia Universi- ty’s Mailman School of Public Health, and co-author Cary P. Gross, MD, Yale Cancer expert University School of Medicine, drive home the point that these cures are says public health responsible for only a small fraction of improvements in mortality. and prevention “The true successes of cancer have been made in prevention,” notes measures are Dr. Neugut, who is also professor of Medicine at the Herbert Irving Com- key to defeating prehensive Center at Columbia. “In particular, lung cancer rates have cancer plummeted in the U.S.—but from the decline in smoking rates. There are other cancer success stories as well— related media coverage from screening techniques for colon and cervical cancer to vaccines that Modern Healthcare will help wipe out the latter disease epi.is/2fxSF7B completely.”
Science Daily Neugut AI, Gross CP. Targeting the Cancer epi.is/2geAl4g Moonshot. JAMA Oncol. 2016 Apr;2(4):421-2. doi: 10.1001/jamaoncol.2016.0328. PubMed PMID: 26940477.
DEPARTMENT OF EPIDEMIOLOGY 15 feature
The future of epidemiology
World class science, real world impact
BY CHARLES C. BRANAS, PHD
16 2016 ANNUAL REPORT and monumental accomplishments, but The U.S. does storytelling and science his past July, I was at the same time, stop under-selling itself better than any other country. Hollywood honored to be invited as a science and downplaying its massive manages to export our stories to the world potential as an engine for change in the like no other country. And our research uni- by the Mailman School real world. Epidemiology is, and should be versities export our science like nowhere T seen as, a world-class science that impacts else. Scientists, including epidemiologists, of Public Health to speak on the lives of real people, in ways we can all enjoy a privileged position in U.S. soci- the future of epidemiology appreciate. ety. We earn decent salaries and we get and its place in science more This short statement encompasses to make our own way – there are no time a lot so let me unpack its three core cards to punch; we study questions that broadly. components: interest us, educate the next generation of scientists, and, for the most part, choose Needless to say, it was a tall order—the ■■ World class science how we will spend our days. field of epidemiology is a centuries-old ■■ Impacting the lives of real people Along with the many advantages we science and my contributions only a few ■■ Ways we can all appreciate have in our working lives, we as epidemi- decades. Reflecting on the experiences ologists also have certain responsibilities, that I have had, as well as those of my I recently read The Great American perhaps the most important of which is to colleagues in the many cities, towns, and University, a book by former Columbia conduct research that is new and cool. We countries within which we have worked, I University Provost Jonathan Cole. In it, he have a duty to be curious, imaginative, and thought carefully on where the field of epi- argues that our U.S. research universities skeptical. We also have a duty to do work demiology has been and perhaps where it are creative machines unlike any other in that ultimately impacts real people in posi- should go. history. They are central to our place in the tive ways. To paraphrase John F. Kennedy: In responding to a request for some sort world, intellectually as well as technolog- To those whom much is given, much is of vision for the field, I settled on a few core ically. I couldn’t agree more. I always tell expected in return. concepts that ultimately made me think epi- people that America has two great exports: demiology should build on its storied past storytellers and scientists.
DEPARTMENT OF EPIDEMIOLOGY 17 Has epidemiology lived up to this challenge?
The field has made some truly impres- sive contributions to humanity, including the eradication of smallpox, fluoridation of drinking water, improved motor vehicle safety, and recognition of tobacco as a health hazard. According to the CDC, the greatest public health achievements of the 20th century are built on epidemiology. Still, it was a list released by the National Academy of Sciences that dominated headlines in 2003. Based on media cover- age alone, it would seem that the greatest achievements of the 20th century are largely not built on epidemiology and that the moon.” An unfortunate statement, but while saving millions of lives, is not a tangi- innovations like electrification, automo- one that I would argue is perhaps a useful ble product like electricity and, by design, biles, and airplanes are more deserving of ground-truthing for the field. not easily noticed and often overlooked. recognition than inventions and programs Epidemiology is a world-class science, Epidemiologists have saved millions and emerging from the public health sciences but there are a few reasons why it is not millions of lives, and we’re not getting and epidemiology. always viewed as such. credit. Perhaps this is one reason why epide- I’ve often heard my colleagues complain To be considered a world class science, miology does not receive the same level about a scientific hierarchy, lamenting epidemiology must do a better job of tout- of attention as many other sciences. The the existence of a continuum where the ing accomplishments that would otherwise public impression of the field was sum- “harder sciences” (physical sciences) go unnoticed. marized years ago by a Washington Post outrank the “softer sciences” (social We could, of course, continue to march reporter who wrote, “epidemiology is, by sciences). on without concern for our place in the its very nature, much more inexact than I think we as epidemiologists are viewed pantheon of science. Doing so, however, the kind of science that puts people on by the public as perhaps “medium-soft,” would be a disservice to humanity. somewhere between biologists and Epidemiologists save lives. To insist that sociologists. And this view may be echoed epidemiology receive greater recognition among our scientific colleagues. At one is to insist that the world take advantage of the large research universities where I of the field’s unique and highly effective had the pleasure of working, a mantra that approaches for solving problems that touch I often heard was that, in the search for large groups of people. answers, there was a biologist who spoke Competing for financial resources to to a chemist, who spoke to a physicist, who fund our work is made easier if the public ‘Epidemiology is a spoke to God, and scientific truth somehow has even a basic idea what we do and, emerged. The implication of this, of course, more so, if policymakers see epidemiology world-class science, was that epidemiologists somehow had no as an important force for change. There is place in the chain of scientific evidence. great value to what we do and we must do but there are a few This is how the public and other a better job of broadcasting this fact. scientists see epidemiology. I believe the In addition to promoting specific reasons why it is not field has to contend with its image, which is epidemiological success stories and improving, but still needs work. breakthroughs, let’s remind the world that always viewed as The other major issue that stands in epidemiology is a fundamental science the way of epidemiology being viewed as with a centuries-old history, much the such.’ a world-class science is that prevention, same as the ‘hard sciences.’
18 2016 ANNUAL REPORT Whenever possible, epidemiologists should pursue ‘win-win’ science that produces knowledge while simultaneously helping communities in need.
Money tends to flow towards more our many strengths and highlights for it comes to choosing those that will have recognizable sciences. Perform a quick scientists outside epidemiology how we the highest impact we should be looking search on USAspending.gov and you’ll see uniquely contribute to the world. more to basic approaches that “make the that biology, chemistry, and physics, for And contribute we must. Epidemiology healthy choice the easy choice” and that example, receive four times more grants should be an applied science and a force affect more people for longer periods of and contracts than epidemiology. for change. We cannot simply study the time. A 2012 letter in the American Journal Even the term ‘hard’ science is mislead- distribution and determinants of health-re- of Public Health points this out and I often ing. Given the higher-order complexities lated states or events; we must use our like to quote it in support of the importance and challenges inherent in studying large knowledge to actually intervene on dis- of place: “if a brackish tidal pool is breed- groups of people, epidemiology and the eases and other health problems for the ing mosquitoes that serve as a vector for social sciences should more aptly be called betterment of humankind. malaria, the intervention of filling it in... the ‘really hard sciences.’ To paraphrase Dr. Inder M. Verma, may be far more likely to continue reducing So what else should we do as a field Editor-in-Chief for the Proceedings of the incidence of malaria five years after besides reminding others about epidemi- the National Academy of Sciences of the funding has run out than...expecting local ology’s centuries-old history and touting United States of America, we need to focus community members to continue regular the real world implications of our work? more on impact and less on impact factor. applications of larvicide.” We should also consider other actions like Most academics, especially those Place-based interventions often cost introducing epidemiology as an obligatory working at research universities, aspire less than programs aimed at changing peo- part of any general science curriculum at to publish frequently in top tier journals – ple’s behaviors and the benefits of these our universities. Teaching fundamental but this is not the only (or even the most interventions often appear to be more epidemiology to undergraduate students important) measure of success. sustainable over the long term. They can has been the joy of my teaching career, and Whenever possible, epidemiologists also address a wide range of public health ensuring the next generation of scientists should pursue ‘win-win’ science that pro- issues. Gun violence is one example of a has foundational knowledge about our field duces knowledge while simultaneously public health problem that is especially is critical to epidemiology’s reputation in helping communities in need. amenable to place-based interventions, the decades to come. Public health advocates, and I, of which I have focused on in my own epide- Additionally, we must embrace team sci- course, count us among them, seek to alter miologic research. ence. Fifteen years ago, ‘multidisciplinary’ one or more components in the epidemio- There are substantial political hurdles meant getting a cardiologist and a cardio- logic triad – acting on pathogens, people, to focusing on the users of firearms or the thoracic surgeon to work together. Since or places. To curtail malaria’s spread, for firearms themselves in working to reduce then, much has changed. As someone example, we can target the parasite itself, firearm violence. My research has shown who develops programs targeting multidi- the behaviors of the people who are at risk there’s another way to reduce gun-related mensional public health problems like gun for infection, or the swamp from which the injuries and deaths – changing places. violence, I’ve collaborated with researchers mosquitos that transmit malaria emerge in Making improvements to urban neighbor- from law and business schools, as well as the first place. hoods, such as fixing abandoned building city planners and engineers. Embracing Addressing “place” can often have and greening vacant land, is inexpensive, mixed methods, including approaches that the largest effects and the most lasting scalable, and highly effective in the fight are not traditionally associated with epi- impacts on health. As the CDC Director has against gun violence. Experimental and demiology, enriches our field. Sharing our noted, not all ideas to improve health will quasi-experimental studies we’ve com- expertise with other disciplines showcases have the same levels of success and when pleted have shown a significant drop of
DEPARTMENT OF EPIDEMIOLOGY 19 almost 40 percent in gun violence lasting that we may not have seen in just present- World-class science that impacts the for years after blighted urban places, like ing to our scientific colleagues. lives of real people, in ways we can all abandoned buildings and vacant lots, were As Atul Gawande has recently argued, appreciate—it’s a vision for the future of remediated. it is unnatural to think like a scientist. epidemiology that is hopefully intuitive to These sorts of place-based interven- We follow a purposefully dispassionate many of you, and one that we should dog- tions are also key examples of ‘win-win’ scientific method to minimize bias in our gedly embrace as a field and teach to our science, something on which epidemiology research. We ‘fail to disprove’ our hypoth- students. can more overtly begin to focus. That is, eses, and never ‘prove’ them since we our research to reduce gun violence not must remain open to new evidence. It’s only raised funds from the NIH and CDC to easy to forget that this is quite a departure References conduct field trials of urban blight remedia- from normal thinking. We must remind tion and produce new scientific knowledge, ourselves that nonscientists, including Branas CC, Kondo MC, Murphy SM, South EC, it also concurrently managed to repair, policymakers and members of the general Polsky D, MacDonald JM. Urban Blight Reme- clean, and green thousands of vacant public, will often be baffled by our refusal diation as a Cost-Beneficial Solution to Firearm and abandoned urban spaces in heavily as scientists to ‘take a side’ and that the Violence. Am J Public Health. 2016 Oct 13:e1-e7. under-resourced neighborhoods across very cornerstone of scientific discourse is multiple cities. dissent and constantly evolving findings. Branas CC, MacDonald JM. A simple strategy Our contributions to knowledge are thus Yes, it’s challenging to describe our to transform health, all over the place. J Public only useful to the extent that they impact findings in a way that nonscientists can Health Manag Pract. 2014;20:157–159. the lives of real people. But, again, what if understand, but communicating with a Card AJ. Sustainability of public health pro- the people (and policymakers) who would broader audience is critically important. It’s grams. Am J Public Health. 2012;102(5):776–777. most benefit from these great epidemio- enormously beneficial to get the media and logic actions remained unaware that they the public at-large behind our work. Cole JR. The great American university: Its rise to had ever been undertaken on their behalf? Talking with reporters about your preeminence, its indispensable national role, and This brings me to the last component in my research, providing compelling statements why it must be protected. New York: PublicAf- aspirational statement about the future of that convey its real-world implications, fairs, U.S.; September 1, 2007. epidemiology, the notion that the impacts and always exuding the enthusiasm that Frieden TR. A framework for public health action: we have should be packaged in “ways we motivated you to start your decades-long the health impact pyramid. Am J Public Health. can all appreciate.” research project in the first place, will 2010 Apr;100(4):590-5. In saying this, I do mean ‘all.’ This ensure that your scholarship does what it is includes fellow epidemiologists, other sci- intended to do: improve public health. Gawande A. The mistrust of science. New Yorker, entists, policymakers, and the public. The Take the time to really think about how June 10, 2016. more the world knows about our work, the to frame and deliver your message. When- Greatest Engineering Achievements of the 20th more grants we’ll receive to pursue our ever possible, use analogies to explain Century. National Academy of Engineering. http:// research goals, the greater the likelihood concepts—mitochondria are like factories— www.greatachievements.org/. Published 2003. that health-enhancing policies will emerge, and describe magnitude with comparisons Accessed November 09, 2016. and the better the chances that we’ll to familiar objects—enough hazardous improve the public’s health. waste to fill a hundred Olympic-sized swim- Ness RB, Bondy ML, Branas C, et al. Editorial. We need to be scientists first but to ming pools. A little imagery and social Annals of Epidemiology. 2003;13(9):597–598. reach those outside academia, we also math go a long way. doi:10.1016/j.annepidem.2003.09.001. need to be storytellers with clear, and com- Preparing a “three-minute thesis” to Thompson B. WashingtonPost.com: The Science pelling narratives that explain what we do. summarize your latest study results isn’t of Violence. Available at: http://www.washing- If you can convince the person sitting next dumbing-down your scholarship; it’s tonpost.com/wp-srv/national/longterm/trigger/ to you on the subway that your research making it accessible to those who can trigger6.htm. Accessed October 28, 2016. has merit, chances are you’re on to some- benefit from it. After all, isn’t that why we thing. And framing our science this way, so became epidemiologists? Verma I. Impact, not impact factor: Pro- that a reasonably educated non-scientist As epidemiologists we owe it to the ceedings of the National Academy of would say, “Wow, that’s really important!,” world to create the highest caliber science Sciences. 2015;112(26):7875-7876. doi:10.1073/ gives our scholarship the focus it needs and disseminate this science in ways that pnas.1509912112. and really helps to refine and clarify for will ensure it is understood and applied to ourselves mechanisms and applications significantly improve the public’s health.
20 2016 ANNUAL REPORT symposium report
Injuries, including those caused by guns, are preventable Conference discusses how to reduce avoidable harms
ate does not dictate when Injuries are “the leading cause of death and disability in children and young adults worldwide,” he said. or where injuries will And suicide is the world’s number-one cause of injury death. It’s much more occur. They’re predictable common than homicide, even when firearms enter the equation. Approximately F 10,000 Americans will be killed in gun murders this year—but twice as many will and preventable, according to die from suicide. Guohua Li, founding director of Mass shootings are especially rare—though that’s difficult to keep in mind while still reeling from the attack on an Orlando, FL nightclub that killed 49 the Center for Injury Epidemiol- people just days before the fourth annual meeting of the Center for Injury Epide- ogy and Prevention and former miology and Prevention took place. At the recent injury conference, keynote speaker David Hemenway, director interim chair of Epidemiology of the Harvard Injury Control Research Center, addressed the audience’s solemn who spoke at a recent injury mood directly in his talk, adding “We need much better data on gun violence.” Without good data, much of what we think we know about guns, suicide, and conference at Columbia’s Mail- murder could be wrong. Many people assume that those who want to kill them- man School of Public Health. selves will find a way—that their minds are made up and something as simple as not having the tools for their demise readily available couldn’t possibly affect the outcome. That assumption, Hemenway said, is misguided. The research shows that suicides rates fell significantly when pesticides were made less toxic in Sri Lanka, when the carbon monoxide levels in gas for stoves were lowered in the UK, and when armed forces throughout the world stopped allowing soldiers to take their guns home on weekends, said Hemenway at the conference. Gun ownership makes it easy to kill yourself—a gun in the home is associated with a suicide rate that is three times higher than average—and states with more guns have more suicides, he added. Contrary to popular thinking, suicides probably aren’t well planned and those who kill themselves likely wouldn’t have had the energy to overcome many obstacles, said Hemenway. When those who have attempted suicide are sur- veyed, nearly all report that they decided to kill themselves less than 10 minutes before acting. The good news is that if public health advocates can make the tools that people use to end their lives less available or less lethal, suicides will plummet. The bad news, of course, is that the feasibility of putting this plan into effect may be low—gun control, in particular is a hot button political issue. Hemenway did offer one simple, life-saving solution that can be enacted at the individual level: If someone you know seems sad, angry, or depressed, offer to ‘babysit’ his or her gun. Doing so, could prevent a suicide or murder. Another speaker at the event, Ted R. Miller, principal research scientist at the Pacific Institute for Research and Evaluation, said the average gun causes 695 dollars’ worth of injuries each year. All injuries combined cost the U.S. about $2.8 trillion annually, he added.
DEPARTMENT OF EPIDEMIOLOGY 21 epidemiology by the numbers
EPIC: Registration growth by year The Epidemiology and Population Health Summer Institute at Columbia University (EPIC) had its best year to date in 2016 with a 21.4 percent increase in registrations compared to the previous year. The number of students who enrolled in digital courses nearly tripled from 2015 to 2016.
Registration growth by year