Columbia Epidemiology 2017 Training tomorrow’s scientific leaders and promoting public health one discovery at a time FROM THE DEPARTMENT OF EPIDEMIOLOGY 2017 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 Editorial Director for Communications, Mailman School of Public Health DESIGNER Kristen Byers Web Developer / Graphic Designer table of contents Research highlights Our epidemiology graduates 4 What the hygiene hypothesis is telling us about 20 Employment outcomes early puberty 20 Increased earnings 5 Understanding breast density 21 Work type 6 Growing body of evidence supports use of mind-body therapies during breast cancer treatment 21 Job sources 7 Financial incentives enhance viral suppression among HIV-positive persons in the U.S. Most talked about research 23 January 8 Autism risk linked to fever during pregnancy 24 February 9 Bats are the major reservoir of coronaviruses worldwide 25 March 10 Mixing booze and pot is a serious threat to traffic 26 April safety 27 May 11 Individuals with autism at substantially heightened risk for injury death 28 June 12 Heroin use rises significantly among young whites 29 July 13 Half of adults with anxiety or depression report 30 August chronic pain 31 September 14 Chinese famine data show no long-term health effects except for schizophrenia 32 October 15 Researchers find link between food allergies and 33 November childhood anxiety 34 December 16 Losing train of thought? You may be having one drink too many Faculty awards 17 Scientists present evidence that racism and sexism fuel drug use 35 Select list of faculty accomplishments Bibliography 38 Faculty publications 1 letter from the chair Colleagues, My first year as head of Columbia’s Department of Epidemiology has been a whirlwind of activity, and it’s been my privilege getting to know such a creative, dedicated, and warm group of people. With their efforts, the department has achieved a great deal this past year — groundbreaking science covered by practically every major news outlet, a new team of superb staff, bringing in and graduating the best students in the world, and hiring seven truly remarkable junior faculty members. Our first departmental retreat this past summer was extremely well attended. Animated discussions at this retreat have produced tangible actions that the department has launched and will continue to launch these next few years. Our faculty continue to amaze with their productivity (nearly 1,000 articles in 2017 alone; see pp 38–65), garnering some of the most prestigious awards from our own university on up to the United Nations (see pp 35–37) while also training tomorrow’s public health leaders (see pp 20–21) and prompting global discussions on human health (see pp 22–34). This all speaks to our vision of world-class science with real-world impact. A productive, happy, and healthy year lies ahead. Warmest regards, Charles C. Branas, PhD 3 research highlight ccording to the hygiene hypoth- measures of molecular markers for esis, growing up in a home immune and hormone signaling in a Acleaned to contemporary stan- cohort of 37 girls ages 8 to 14 years. dards can increase a child’s risk for The Provost award allows Dr. McDonald developing allergies. Using Lysol and to scale up her study to over 150 girls other disinfectants kills microorganisms with assessments at several time that play a role in the development of points, where half of these girls are at an immune system that won’t overreact increased risk of breast cancer due to a when confronted with say pollen or family history of the disease. peanut butter. “We know the immune system com- Taking the hypothesis a step fur- municates with the endocrine system,” ther, Dr. Jasmine McDonald, assistant she says. “When your immune system professor of Epidemiology, is study- is kicking in, you don’t have the same ing whether a similar phenomenon is kind of hormonal response.” responsible for the increasing number Dr. McDonald expects to find that of girls who are experiencing an earlier girls who were exposed to more infec- age of puberty. tions during childhood experienced Over the last 50 years, the median puberty later than their counterparts age of puberty for girls in the United with fewer infections. States and other wealthy countries has “I’ve been looking at the girls who dropped where breast development is have not gone through breast devel- up to a year earlier, and some girls show opment, looking at immune markers signs of breast development as early as in blood taken at various time points, age 5. Not only is experiencing these asking the question of whether levels changes at a young age socially awk- of immune factors are associated with ward, it’s also linked to risk for breast pubertal timing,” she says. The study cancer, cardiovascular disease, and will also look for evidence of how and What the hygiene type 2 diabetes. when the immune system signals to the Explanations for earlier puberty in endocrine system to open the hormonal hypothesis is girls are varied: some suggest obesity floodgates for puberty. and endocrine-disrupting chemicals The first physical sign of puberty telling us about could be causal factors. There is also in girls, breast development, normally growing evidence that the immune precedes menarche. With age at early puberty system may play a role. menarche remaining relatively stable According to this theory, these infec- and breasts developing at an earlier tions activate a child’s immune system. age, this gap has widened. Because Once a girl’s immune system becomes puberty involves changes on the adapted to the pathogenic challenges cellular level, girls’ bodies may be more in her environment, resources can now vulnerable during this time to genetic be directed to the energy-intensive pro- mutations—a likely reason why earlier cess of puberty. On the other hand, in age at puberty increases a girl’s risk for more sterile environments, energy that later developing breast cancer. would otherwise be fighting infections Unlike girls, there is scant evidence may be directed to puberty sooner that boys are going through puberty rather than later. any younger than they ever have. One In her new study, funded through possible explanation, says Dr. McDon- a Columbia University Junior Faculty ald, is that our society holds girls to a Diversity Grant, Dr. McDonald is looking higher standard for cleanliness than behind the curtain at the biological boys, giving the former fewer opportu- underpinnings of this process using nities for microbial exposures. the New York site of the LEGACY Girls Cohort. The study is the first to look at multiple pubertal outcomes— breast development, pubic hair, and menarche—as well as prospective 4 2017 ANNUAL REPORT research highlight or many years, all women over the questions Dr. Tehranifar is seeking 40 were encouraged to receive to address in a new $2.78 million study Fannual mammograms. But over funded by the National Institutes of the last decade, this recommendation Health/National Institute on Minority has been modified with different expert Health and Health Disparities. groups and medical organizations Working with the Avon Foundation generating guidelines that differ in Breast Imaging Center here in the age of initiation and cessation of Washington Heights, her study will mammography as well as the intervals follow 1,000 women for a year after of screening. their mammograms, gauging what The latest complication to breast they know about breast density, how cancer screening is breast density. they feel about their screenings, how Researchers and radiologists have well they understand their results, and long observed that breasts fall on a if they are accessing any additional spectrum of breast density, from those medical services as a result of their composed largely of fatty tissue to mammogram reports. those with a greater share of dense, As she works to better understand fibroglandular tissue. National esti- patient comprehension of breast mates find that more than 40 percent of density, Dr. Tehranifar also sees an screened women between ages 40 and opportunity for breast density to be 74 years, or over 27 million American added into existing models that predict women, can have mammograms that risk of breast cancer. A number of these show dense breasts, as classified by risk models are used in clinical settings radiologists. and some are freely available online. As Dr. Parisa Tehranifar, assistant The vast majority of current risk models professor of Epidemiology, explains: such as the well-known Breast Cancer “Breast density is one of the strongest Risk Assessment or Gail Model cur- Understanding independent risk factors for breast rently do not include breast density in cancer. And large amount of dense their standard form. breast density breast tissue also interfere with detec- With a grant from the National tion, making it harder for mammograms Cancer Institute, Dr. Tehranifar and her to pick up tumors.” colleagues will also tap into a cohort of patients from the Sister Study, a ten- Breast density 101 for patients: Is year prospective study of more than it working? 50,000 women with sisters who have As a result of nationwide patient had breast cancer. They will collect advocacy, breast density has gained repeated mammograms for the Sis- greater public understanding. Twen- ters Study participants to determine ty-seven states now have breast density individual women’s changes in breast notification laws on the books –if a density over time and whether these woman is found to have dense breasts trajectories can improve breast cancer on her mammogram, she will be risk assessment.