Cardiovascular & Respiratory Disease
Epidemiologic Methods and Research Ethics
Reproductive, Perinatal and Pediatric
Social Determinants and Behavioral Research
Urinary System Research
Care Giving & Healthy Aging Research
Our research group is conducting epidemiologic studies on how psychosocial factors influence physical health and functioning in community-dwelling older adults, hip fracture patients, and adults at-risk of arthritis. Our work addresses two broad questions: How does care giving to an impaired friend or relative affect aging and health outcomes and how do positive affect and optimism influence functioning and physical health in elderly adults? Our caregiver research includes several NIH-funded prospective cohort studies on the health effects of caregiving, and the physiological pathways that may link caregiving stress to adverse health outcomes (i.e., higher mortality rates, poorer immune functioning) that have been observed in prior studies. Our findings from Caregiver SOF suggest that the relationship between caregiving, aging and health is more complex, and that older women may derive health benefits from caregiving. In the Health Pathways Study, we are utilizing biomarkers to uncover the physiological pathways that may link to metabolic syndrome and underlie the relationships between caregiving activities, caregiving-related stress, physiological functioning, and health outcomes. We are also conducting a randomized controlled trial of mindfulness-based stress reduction for caregivers, The Stress Reduction for Caregivers Study. Through the data we have collected from each of these studies, we are exploring the impact of positive affect and optimism on functional decline, stress, and other health outcomes in older adults. We are interested in how physiological mechanisms may mediate these relationships. Epidemiology faculty: Lisa Fredman.
Chicago Health and Aging Project
The Chicago Health and Aging Project (CHAP), which began in 1993, is a community-based study of aging set on the south side of Chicago and comprising more than 10,000 older adults, 60% of whom are African American. CHAP is perhaps best known for its source as an estimate of Alzheimer’s dementia prevalence in the US. Among the currently funded investigations set in CHAP are: studies of community exposure to noise and its relation to blood pressure and cognitive aging; a study of racial differences in cognitive aging; and a study of dementia trends. Work on the health effects of air pollution exposure in older adults is ongoing. Epidemiology faculty: Jennifer Weuve
The e-Cognitive Health Initiative (e-CHI)
The e-CHI seeks to create a comprehensive, open-access, high quality brain health data resource. Anchoring this research initiative is the Framingham Cognitive Aging Study program that boasts arguably the richest database of its kind, with up to 7 decades of prospective health and lifestyle measures, along with available genetic and other biomarkers to relate to brain health. The longitudinal assessment of brain health includes an extensive battery of neuropsychological testing, as well as neuroimaging via MRI. More recently, the assessment of cognitive performance has also included digital capture, starting with voice (2005) and extending to written performance (2011). Additional efforts are underway to expand the work beyond what is possible within the Framingham Cognitive Aging Study. The vision is to create a platform from which to validate new e-health measures against known gold standards, and then build and implement a scalable, e-digital health solution that integrates use of wearable/mobile and smart home technologies, collecting data continuously in real time and in natural settings—potentially transforming our understanding of how the brain ages. Central to achieving the goals of the e-CHI is the building of an ecosystem of multi-disciplinary, multi-sector collaborators that together can catalyze groundbreaking discoveries for cognitive impairment prevention, inform policies for reducing the economic cost and healthcare burden generally associated with progressive dementing disorders, such as Alzheimer’ disease, and identify determinants of sustained lifelong cognitive health. Epidemiology Faculty: Rhoda Au
Coronary Heart Disease in US Black Women
This is a recently funded study (K01) of selected adverse pregnancy outcomes, such as gestational diabetes and preeclampsia, as risk factors for coronary heart disease (CHD) in black women. An accumulating body of evidence on this topic exists in predominantly white populations, but there is a dearth of evidence among black populations, despite persistent racial disparities in CHD morbidity and mortality. Identifying risk factors for CHD during pregnancy can provide an early window of opportunity to identify women at high-risk of CHD and translate to improvements in prevention and intervention. The study will also address mediation by clinical risk factors for CHD, including chronic hypertension and diabetes, and modification by life course measures of individual-level and neighborhood-level social determinants of health. The study is being conducted within the Black Women’s Health Study at the Slone Epidemiology Center. Epidemiology faculty: Samantha Parker
Long-term follow-up of individuals exposed to diethylstilbestrol (DES)
This multi-center prospective cohort study follows over 10,000 mothers, daughters, sons and third generation granddaughters who were exposed to the pregnancy drug, DES. DES was originally used to prevent miscarriage and preterm birth between the early 1940’s and 1971. Not only was it not effective in preventing pregnancy problems, but it was also found cause a rare vaginal cancer and other health problems in the daughters who were exposed in utero. Participants in this study are being followed for breast and other cancers, as well as reproductive problems such as infertility and early menopause. Epidemiology faculty: Julie Palmer, Elizabeth Hatch, and Lauren Wise.
Health Advocates as a Vehicle to Improve Treatment for Smokers in Public Housing
Quitting smoking is the most important step that smokers can take to benefit their health. However, low-income smokers are less successful in quitting than higher-income smokers. If these socioeconomic disparities in smoking and smoking cessation rates persist, low-income smokers will bear an increasingly disparate burden of smoking-related morbidity and mortality. Therefore, interventions to improve the rate of smoking cessation among low-income smokers are urgently needed. Smoking cessation treatment programs such as telephone quitlines and clinic-based programs exist but are underutilized, particularly by low-income smokers. A group-randomized trial is being conducted among public housing residents to test whether the use of resident Community Health Advocates with special training in smoking cessation (Tobacco Treatment Advocates (TTAs) can improve (1) utilization of quitlines and clinic-based programs and (2) smoking cessation rates among smokers in public housing. Epidemiology faculty: Daniel Brooks.
The project described above is supported by the National Cancer Institute. To read more about this research project and other NCI funded tobacco control research, please visit www.cancercontrol.cancer.gov/tcrb .
Prostate Cancer Screening in Mexico
Effective cancer screening policy requires robust evidence of screening test efficacy as well as an understanding of healthcare capacity, and political and cultural factors. Through a collaboration with the Instituto Nacional de Salud Publica (Institute of Public Health) in Mexico, we conducted a pilot study of male teachers in Mexico. Our results indicated that prostate cancer screening with prostate specific antigen (PSA) was frequently occurring outside of national recommendations and among younger men. Our ongoing study will help us to understand the outcomes of opportunistic prostate cancer screening in Mexico and develop recommendations for screening policy. Epidemiology faculty: Jennifer Rider
The Detection and Outcomes of Prostate Cancer in HIV-infected Men
HIV-infected persons have a higher risk of a variety of malignancies due to immunospuppression or other mechanisms, and the cancer burden in HIV-infected populations is increasing as more effective HIV therapy extends life. However, HIV-infected men have consistently lower rates of prostate cancer than the general population. Funded by a pilot grant from BUSPH, we will compare data from HIV-infected and HIV-uninfected men to explore potential differences in prostate cancer detection with PSA according to HIV status, as well as characterize differences in tumor biology reflected in tumor mRNA expression. The results of this study will contribute to evidence-based screening and treatment recommendations for HIV-infected men. Epidemiology faculty: Jennifer Rider
Biomarkers of prostate cancer progression
There are few established risk factors for the development or the progression of prostate cancer, which limits efforts aimed at both prevention and therapy. Using cohorts from the U.S. and Sweden with long-term follow-up and archival tumor specimens, our ongoing work aims to use expression of mRNA and protein to provide clues into disease etiology and identify therapeutic targets. Some of these analyses investigate specific pathways, such as cholesterol metabolism, while other studies aim to relate lifestyle factors to biological changes in the prostate in order to clarify disease mechanism. Epidemiology faculty: Jennifer Rider
Effects of Endocrine Disrupting Chemicals (EDCs) on Fertility and Thyroid Hormones
With support from the National Toxicology Program, and grants from the Oak Foundation and NICHD, we are evaluating the association of several classes of EDCs, including phthalates, poly-flouro-alkyl substances, and phenols with fertility in our Danish and North American prospective cohorts of pregnancy planners. We have also measured over 130 chemicals in a sub-study of our Danish cohort to describe levels and patterns of co-exposure in this population (Rosofsky et al, 2017). With a pilot grant from BUSPH, we will be evaluating levels of EDCs during the preconception and pregnancy time periods with levels of maternal thyroid hormones. Epidemiology faculty: Elizabeth Hatch and Lauren Wise; Environmental Health faculty: Patricia Janulewicz
Validation of Portable Methods of Measuring Cumulative Exposures to Heavy Metals
Exposures to heavy metals at low levels over an extended period of time appear to be related to chronic disease health outcomes, such as cardiovascular and renal disease, later in life. A critical challenge to identifying these effects is the lack of practical measures that capture exposures over the long term. We are currently validating a portable x-ray fluorescence instrument for the purpose of in vivo quantification of lead in bone and both manganese and mercury in toenail. Such a device, if shown to be accurate and precise, could be used for large-scale studies in almost any setting, including people’s homes. Epidemiology faculty: Jennifer Weuve
Health Impacts of Exposure to PCE-Contaminated Drinking Water *completed*
We have conducted a series of studies to investigate the health impacts of exposure to tetrachloroethylene (PCE)-contaminated drinking water. These studies have been conducted among residents of the Cape Cod region of Massachusetts where thousands of residents were exposed to PCE during the 1960s-1990s when it leached into the drinking water from vinyl-lined water pipes. Our research has focused on whether PCE exposure during pregnancy may have increased the risk of pregnancy loss or having a child with birth defects and whether exposure to PCE has influenced the long-term health of PCE exposed children.
We have found that exposure to PCE-contaminated drinking water during pregnancy does not appear to increase the risk of pregnancy loss, low birth weight or prematurity. Nor does it seem to increase the risk of learning problems in exposed children. However, our findings suggest that PCE exposure during pregnancy may increase the risks of having a stillborn child or a child born with oral clefts and neural tube defects. They also suggest that there may be behavioral health consequences later in life, such as drug abuse and an increased risk of bipolar disorder and post-traumatic stress disorder. SPH Investigators: Ann Aschengrau, Lisa Gallagher, Patricia Janulewicz, Thomas Webster, David Ozonoff, Roberta White, Janice Weinberg, Michael Winter
SEE ALSO: Chicago Health and Aging Project—entry under “Aging Research” above.
Internet-based study of time to pregnancy and miscarriage
This NIH-funded prospective cohort study is recruiting Danish and North American women via the internet to study risk factors for delayed time to pregnancy and miscarriage. Over 14,000 women have enrolled so far and are being followed for up to twelve months or until they become pregnant. An additional 1,600 male partners have been enrolled to obtain male factor data. The primary risk factors of interest include dietary intake, medication use, environmental toxins, and male factors. We have published on caffeine and alcohol consumption, smoking, medication use, physical activity, depression and body mass index. The extensive system of medical registries in Denmark, including birth, medication, and medical registries allow for data linkage to assess the validity of the using the internet for epidemiologic research and to study other health outcomes. Birth registry linkage in selected US states and Canadian provinces is underway, permitting the assessment of adverse birth outcomes. Epidemiology faculty: Elizabeth Hatch, Lauren Wise, and Ken Rothman
A Conceptual Model for the Design and Interpretation of Biomarker Studies
Observational studies are often used to identify biomarkers that could stratify patients in terms of risk of cancer progression, and therefore inform subsequent management decisions. However, the selection of the appropriate patient populations for these studies, particularly with respect to whether patients have been treated or untreated, is not always tied to the specific clinical question of interest. We developed a framework for designing and interpreting biomarker studies of prostate cancer, the ABC Model of Prostate Cancer. Ongoing studies will use the ABC Model to evaluate existing prostate cancer biomarker signatures, some of which are now commercially available, to inform clinical application. Epidemiology faculty: Jennifer Rider
Methods for Analysis of Ecological Momentary Assessment Data
Craig Ross, in collaboration with researchers at Boston Children’s Hospital, has explored using ecological momentary assessment (EMA) methods to assess changes in affect surrounding the use of marijuana. Dr. Ross has developed methods to embed a case-crossover study design within the context of an EMA study. Epidemiology faculty: Craig Ross
Ethical Considerations for the collection of geographic data for HIV prevention research among persons who use drugs *completed*
The major goals of this project were to (1) describe the privacy and confidentiality concerns associated with different approaches used to collect geographic information in HIV-prevention and substance-use research on the risk environment and (2) assess how these concerns may influence the validity of participant responses. Epidemiology faculty: Abby Rudolph
The e-Cognitive Health Initiative (e-CHI)—entry under “Aging Research”
Boston University School of Public Health participates in TB research through two Federally-funded research networks, the Tuberculosis Trials Consortium (TBTC) and the Tuberculosis Epidemiologic Studies Consortium, both supported by the CDC. These consortia design and conduct clinical trials of new drugs and regimens for the treatment and prevention of TB and perform Epidemiologic studies of TB disease and Latent TB Infection (LTBI).
BUSPH is also performing the Opti-Q Study, a multicenter prospective clinical trial to determine optimal doses of levofloxacin for treatment of MDR-TB, with study sites in Peru and South Africa (funded by NIH and CDC). Through RePORT India, the Department is participating in an observational cohort study of TB in India, and through the TBRU, we are participating in a household contact study of TB transmission in South Africa (both funded by NIH). Additionally, we are participating in a cohort study of alcohol and TB in South Africa (funded by NIH). Lastly, we are part of consortia to perform cost-effectiveness studies of TB and HCV (funded by CDC), and cost-effectiveness of TB and HIV (funded by NIH). Epidemiology faculty: C. Robert Horsburgh Jr.
HIV and Substance Abuse Epidemiology among IDUs: Structural and Network Risk Factors
The major goal of this project is to better understand how network and spatial factors act independently and together to influence risk and health-seeking behaviors among HIV positive people who use drugs in Baltimore, Maryland. The findings from this proposal can be used to guide the development of multi-level interventions that integrate both structural ad network approaches to specifically target the needs of those most at risk. Epidemiology faculty: Abby Rudolph
Combining social network, spatial, and phylogenetic approaches to identify new HIV infections
HIV transmission rates are ~3.5 times higher among those who are HIV-infected but unaware of their status, compared to those who are aware, and innovative strategies are urgently needed to find HIV-infected individuals who are not yet linked to care and others who are at increased risk for acquiring HIV. Current strategies to identify new HIV infections use social network, spatial, and phylogenetic approaches, but combining these three approaches is rare. This project will develop new analytic methods to combine these three types of data and analyses will inform the development novel multi-level and targeted strategies to identify previously undiagnosed HIV infections and deliver prevention interventions to those most at risk for acquiring HIV. Epidemiology faculty: Abby Rudolph
ENHANCE: Evaluation of South Africa’s National Adherence Guidelines
To address high levels of loss to follow up from HIV care and treatment, South Africa intends to roll out a package of interventions as part of its National Adherence Guidelines. The package of interventions includes fast track initiation counseling for patients eligible for ART, enhanced adherence counseling for unstable patients, adherence clubs for stable patients, decentralized medication delivery for stable patients and early tracing of all patients who miss an appointment by two weeks. To evaluate the impact of this strategy, we will work with the National Department of Health in South Africa and the World Bank to assess the effectiveness of the five interventions in the minimum package. We will also estimate for each study site an overall “adherence guideline impact” to provide an indication of the effectiveness of the package as a whole. In addition, we will estimate the cost of each of the interventions compared to standard of care. Finally, we will describe the cascade of care for tuberculosis, hypertension, and diabetes, three other chronic diseases for which little information currently exists. To evaluate these interventions, we will work with the National Department of Health (which will implement the interventions) to randomize 24 clinics in 4 provinces 1:1 to receive the interventions or continue standard of care. All evaluations will use data routinely collected by the clinics, with no study interaction with subjects. A total of 6,680 patients will be enrolled and followed for up to 20 months to estimate short- and long-term outcomes. Epidemiology faculty: Matthew Fox
Anti-retroviral Treatment (ART) for HIV in Zambia and South Africa *concluded*
Zambia, Factors Influencing Enrollment in Treatment for HIV/AIDs: Despite Zambia’s rapid scale-up of antiretroviral therapy, the number of Zambians on ART is thought to be only about half to two-thirds of the number of those who are medically eligible. To identify barriers to and facilitators of ART-seeking among those medically eligible, a cross-sectional survey was conducted among 400 patients on ART (able to access care) and 400 patients accessing home-based care without ART (either not able, chose not, or poor access to care) in two rural and two urban sites in Zambia. Patients in home-based care for HIV/AIDS (who never initiated ART) perceived greater financial and logistical barriers to seeking HIV care and had more negative perceptions about the benefits of the treatment. Future efforts to expand access to antiretroviral care should consider ways to reduce these barriers in order to encourage more of those medically eligible for ART to initiate care.
South Africa, Use and Outcomes of Second-and-Third Line HIV Treatment: As South Africa continues its rapid expansion of access to first-line antiretroviral therapy (ART), more patients will need to be switched to second-line therapy as these first-line regimens fail, and eventually may need third-line treatment regimens. However, with little experience with second- and third-line treatments in resource-limited settings and their high costs, it is critical to evaluate whether these medications can be delivered effectively as part of a large-scale public health response to HIV. To date there have been only a limited number of such evaluations, as they require large databases to conduct a robust evaluation. To evaluate the need for and effectiveness of second- and third-line ART, we have analyzed data from several large clinical HIV treatment databases in South Africa, including the Themba Lethu Clinical HIV Cohort, the Right to Care Clinical Cohort and the IeDEA-SA cohort. Our findings show that most patients on second-line ART are alive, engaged in care and are achieving viral load suppression in the year after being switched. However, the need for both second- and third-line ART is increasing over time. These studies are among the first of their kind and suggest that these regimens can effectively be delivered to patients who fail first-line treatments in such settings but they come at an increased cost compared to first-line ART. Epidemiology faculty: Matthew Fox
Mental Health and Service Utilization among Reserve and National Guard Forces
The reliance on U.S. Reserve and National Guard forces has become greater than ever during the conflicts in Iraq and Afghanistan through Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. The purpose of this project is to assess mental health over time among a representative sample of Reserves and National Guard members within a causal framework that takes into account lifecourse experiences and circumstances together with combat history, other Reserve and National Guard experience (e.g. humanitarian activity), civilian traumatic event experiences, and genetic factors as determinants. The central goal is to identify modifiable factors that can foster resilience over time and hence may optimize mental health functioning and health behavior in these groups. This project is in collaboration with Uniformed Services University of the Health Sciences. Epidemiology faculty: Sandro Galea
Risk and Resilience Factors for Combat-Related Posttraumatic Psychopathology and Post Combat Adjustment: The Long-term Follow-Up Project of the Ohio Army National Guard Mental Health Initiative
This project is a 10-year longitudinal observational survey study of the relationships between pre-existing mental illness/substance use disorders, deployment to Operation Iraqi Freedom or Operation Enduring Freedom, post-deployment related mental health, and overall psychosocial adjustment of Ohio National Guard members. Information is collected through telephone interviews about military history, medical history, quality of life, and use of healthcare services in order to document the prevalence and correlates of mental illness and health service utilization among these forces, as well as trajectories of mental health over time. Other organizations involved in this project include Case Western Reserve University, University of Toledo, and University of Michigan. Epidemiology faculty: Sandro Galea
Hurricane Sandy Community Resilience Project
There is ample evidence that natural disaster experiences as well as characteristics of individuals shape postdisaster mental and behavioral health outcomes. Less is known about the characteristics of communities that promote postdisater resilience, and how community and individual characteristics work together to shape outcomes. Such information is crucial for community-level interventions that aim to promote recovery in the aftermath of disasters and mitigate risks of future disasters. The goal of this project is to assess community-level factors including economic development, information and communication, community competence, and social capital that promoted resilience in the aftermath of Hurricane Sandy so as to inform both ongoing recovery efforts and future disaster preparedness plans. Simulated agent-based models are built to demonstrate how manipulating key elements of community resilience may mitigate the consequences of disasters. Other organizations involved in this project include Montclair University and The Rand Corporation. Epidemiology faculty: Sandro Galea
The BWHS is the largest follow-up study of the health of African-American women yet conducted. The purpose is to identify and evaluate causes and preventives of cancers and other serious illnesses in African-American women. Among the diseases being studied are breast cancer, colon cancer, hypertension, type 2 diabetes, uterine fibroids, systemic lupus erythematosus, rheumatoid arthritis, and sarcoidosis. The study began in 1995, when 59,000 black women from all parts of the United States enrolled through postal questionnaires. The women provided demographic and health data on the 1995 baseline questionnaire, including information on weight, height, smoking, drinking, contraceptive use, use of other selected medications, illnesses, reproductive history, physical activity, diet, use of health care, and other factors. The participants are followed through biennial questionnaires to determine the occurrence of cancers and other illnesses and to update information on risk factors. Completion of follow-up questionnaires by members of the 1995 cohort has exceeded 80% in each cycle of follow-up. Information on outcomes is validated through medical record review. Validation studies of diet, anthropometric measures, and physical activity have been completed. In a genetic component, saliva samples have been obtained from participants; DNA from the samples will serve as a resource for testing hypotheses about gene-environment interactions. Epidemiology faculty: Lynn Rosenberg, Julie Palmer, Yvette Cozier, Lauren Wise, Patricia Coogan, and Edward Ruiz-Narvaez.
Coronary Heart Disease in US Black Women—entry under “Cardiovascular & Respiratory Research”
Chicago Health and Aging Project—entry under “Aging Research”
Boston Collaborative Drug Surveillance Program (BCDSP) continues its work in the area of pharmacoepidemiology and drug safety. We are conducting several studies on a diverse set of questions including continued research in the area of hormonal contraceptives in relation to risks of venous thromboembolism (VTE). We are also conducting studies on
- drugs to treat psoriasis and risk of infection
- maternal antidepressant drug use, depression and risk of autism in the offspring
- changes in MS outcomes following newer MS treatments, and
- iodine exposure in young children and risk of hypoglycemia.
We are also conducting research on
- quantifying the effects of quinolones on tendon rupture,
- the importance of idiopathic cases selection in drug safety studies, and
- comorbidities in patients with vasculitis
Epidemiology faculty: Susan Jick.
Our staff of approximately 100 includes specialists in epidemiology, adult and pediatric medicine, nursing, pharmacy, biostatistics, and computer science. Slone researchers use a variety of epidemiological tools, including case-control and follow-up studies, clinical trials, surveillance studies, risk management studies, and population-based surveys. Over the years, Slone investigators have been supported by grants and contracts from the National Institutes of Health (NIH), other government agencies, the pharmaceutical industry, and private foundations. Slone works in partnership with hundreds of hospitals and thousands of health care providers, both nationally and internationally. Epidemiology faculty: Patricia Coogan, Michael Corwin, Yvette Cozier, David Kaufman, Carol Louik, Allen Mitchell, Julie Palmer, Lynn Rosenberg, Edward Ruiz-Narvaez, Martha Werler, and Lauren Wise.
Best Treatment Practices in Opioid Dependent Pregnant Women & Their Infants
Opioid agonist therapy with methadone or buprenorphine improves pregnancy outcomes in opioid dependent women by preventing withdrawal and relapse with opioids. However, preventing maternal opioid relapse and withdrawal requires exposing the fetus to these potent therapies, which can cause neonatal opioid withdrawal (neonatal abstinence syndrome, NAS). Rising rates of opioid use in pregnant women and NAS in their neonates are major public health concerns. Investigators from the Departments of Epidemiology, Biostatistics, Internal Medicine, Obstetrics & Gynecology, and Pediatrics of Boston University Medical Campus have collaborated to establish a large prospective cohort of mother-neonate pairs. Data collection is ongoing with women enrolled in care at Boston Medical Center. For women in the study, we collect a large array of maternal medical information, pregnancy and delivery data, and neonatal outcome data. Epidemiology faculty: Martha Werler and Susan Brogly (Adjunct)
Long-term follow-up of individuals exposed to diethylstilbestrol (DES)
This multi-center prospective cohort study follows over 10,000 mothers, daughters, sons and third generation granddaughters who were exposed to the pregnancy drug, DES. DES was originally used to prevent miscarriage and preterm birth between the early 1940s and 1971. Not only was it not effective in preventing pregnancy problems, but it was also found cause a rare vaginal cancer and other health problems in the daughters who were exposed in utero. Participants in this study are being followed for breast and other cancers, as well as reproductive problems such as infertility and early menopause. Males are also being followed for cancer and cardiovascular disease. A sub-study is evaluating hormonal and epigenetic changes the daughters exposed in utero. Epidemiology faculty: Julie Palmer, Elizabeth Hatch, and Lauren Wise.
Risk factors for spina bifida in the era of folic acid fortification
When folic acid intake was established as a protective factor for the development of spinal defects in the mid-1990s, the US Public Health Service formally recommended that all women of childbearing age ingest 400 micrograms of folic acid daily. To help women achieve this, the cereal grain supply has been fortified with folic acid since 1998. Although the prevalence of spina bifida has dropped, an estimated 800 pregnancies are affected each year in the US to women who ingested at least the recommended amount of folic acid. Using data collected by the Slone Epidemiology Center Birth Defects Study, associations between spina bifida and maternal exposures and illnesses in pregnancy are evaluated according to level of folic acid intake. This CDC-sponsored project has identified found evidence of folic acid reducing increased risks of spina bifida associated with assisted reproductive technologies, fever, diabetes, use of nitrosatable medications, and use of opioids. Epidemiology faculty: Martha Werler
Hemifacial Microsomia: From Gestation to Young Adulthood
Hemifacial microsomia is a craniofacial malformation characterized by asymmetric development of the cheek, chin, mouth, ear, and/or eye. A first ever, large-scale, multi-center study of pregnancy risk factors for this birth defect was launched in 1997. Over 200 cases and 800 controls were enrolled from craniofacial centers across the US and Canada. Vasoactive exposures in pregnancy were observed to increase risk. Cases and controls were subsequently assessed at elementary-school ages and at adolescence for psycho-social and cognitive outcomes. Cases were identified as having more behavior problems and neurocognitive deficits than controls, but the majority of cases score in the normal range. Plans are underway to follow the cohort into young adulthood to identify predictors of resilience. Epidemiology faculty: Martha Werler
Prospective Studies of Uterine Fibroids in Black Women
Black Women’s Health Study (BWHS): Uterine fibroids are the primary indication for hysterectomy in the US. Black women are 2–3 times more likely to be diagnosed with uterine fibroids than white women, and they tend to have earlier onset and greater symptoms at the time of diagnosis. Established risk factors for fibroids do not fully explain this black-white discrepancy in rates. GENETICS STUDY: We have compared genetic loci of Black Women’s Health Study (BWHS) participants with and without fibroids in an attempt to identify genes potentially involved in the etiology of fibroids. A total of 2500 cases (fibroids) and 2500 controls (without fibroids) will be studied. Differences will also be examined according to age at onset and disease severity. The DNA for these analyses will be obtained from saliva samples that have been provided by BWHS participants. PSYCHOSOCIAL FACTORS: Recent evidence in white populations suggests that psychosocial stress can increase the risk of fibroids, possibly by causing chronic dysregulation of the hypothalamic-pituitary-adrenal axis and alterations in ovarian hormones that could affect fibroid risk. We have planned analyses of BWHS data to identify whether various psychosocial stressors—including adverse socioeconomic conditions across the lifespan, abuse victimization across the lifespan, depressive symptoms, and caregiver responsibilities—influence the risk of fibroids. SPH Faculty: Lauren Wise, Edward Ruiz-Narvaez, Julie Palmer, Lynn Rosenberg.
Study of Environment Lifestyle and Fibroids (SELF): Sex steroid hormones are involved in the pathogenesis of fibroids. Given that endocrine disrupting chemicals (EDCs) can alter the functioning of hormones, we will evaluate fibroid risk in relation to 3 classes of EDCs: phthalates, polychlorinated biphenyls (PCBs), and phenols. This study will use data and biospecimens from SELF, a NIEHS-funded prospective cohort study of 1,300 African American women aged 23-34 and free of fibroids at baseline (2010-2012). Questionnaire data were collected at baseline and subjects are being followed for 5 years. Every 20 months, blood and urine were collected, and ultrasounds were performed by trained sonographers to detect fibroids. Non-persistent chemicals (e.g., phthalates) will be measured at baseline, 20 months, and 40 months. Persistent chemicals (e.g., PCBs) will be measured at baseline only. This project has many strengths that overcome the limitations of prior studies: large sample size, prospective data collection, state-of-the-art EDC measurement, serial ultrasound screening for fibroids, analysis of repeated EDC measures, innovative statistical approaches for evaluating EDC mixtures, and control for multiple confounders. The study of African Americans, a high-risk population for EDC exposure and fibroids, will provide informative data on the effects of widespread pollutants on fibroids and seek explanations for the racial disparity in fibroid incidence. SPH Faculty: Epidemiology: Lauren Wise, Jennifer Weuve. Environmental Health: Michael McClean, Birgit Claus Henn.
Environmental Risk Factors for Birth Defects and Stillbirths
Our current research is examining environmental risk factors for three types of birth defects (oral clefts, neural tube defects and male genital defects) and stillbirths stemming from placental dysfunction. Environmental factors under investigation in this case-control study include PCE-contaminated drinking water, traffic related air pollution, and ambient temperature extremes. SPH Investigators: Ann Aschengrau, Lisa Gallagher, Patricia Fabian, Michael Winter
See also: Internet-based study of time to pregnancy—entry under “Epidemiologic Methods Research and Ethics”
Electronic Cigarette/Vaping Devices and Materials Used by Adults and Youth
Electronic cigarettes and vaping devices are cast as both the hero and the villain in public health. Some evidence suggests that these devices are helping adults quit traditional tobacco cigarettes. Other evidence suggests that youth are experimenting with these devices and questions are unanswered about whether such experimentation may lead to use of traditional tobacco cigarettes. Knowing the specific devices and materials used by youth and adults when vaping is a key to understanding of the potential risks and benefits. Funded by a pilot grant from the BU SPH, this study will develop methods for cataloguing the range of vaping devices and materials used by youth and adults. SPH Faculty: Craig Ross (Epidemiology), Michael Siegel and Bill DeJong (Community Health Sciences).
Youth Exposure to Alcohol Advertising and Underage Drinking
Alcohol is the most prevalent drug used by youth and is associated with sexual assault, unwanted pregnancies, sexually transmitted infections, unintentional injuries, vehicular crashes, violence, homicide, and suicide. Exposure to alcohol advertising is associated with initiation of alcohol use, drinking frequency and intensity, and drinking consequences. The Centers for Disease Control and Prevention has funded research to monitor the amount of exposure that youth receive to alcohol advertising and to recommend changes that will reduce youth exposure to alcohol advertising without affecting advertisers’ ability to reach legal-age adults. This work is conducted in collaboration with the Center on Alcohol Marketing and Youth at Johns Hopkins University. Epidemiology faculty: Craig Ross
Care Giving & Healthy Aging Project—entry under “Aging Research”
The e-Cognitive Health Initiative (e-CHI)—entry under “Aging Research”
Coronary Heart Disease in US Black Women—entry under “Cardiovascular & Respiratory Research”
Training Program in HIV and Substance Abuse Prevention Research Ethics—entry under “Epidemiologic Methods and Research Ethics”
HIV and Substance Abuse Epidemiology among IDUs—entry under “Infectious Disease Research”
Hurricane Sandy Community Resilience Project—entry under “Mental Health Research”
Chronic Kidney Disease of Unknown Etiology in Nicaragua
This project is attempting to determine the causes of an unexplained epidemic of chronic kidney disease (CKD) in western Nicaragua that has led to significant health, economic, and social strains. SPH has been working as part of a World Bank-organized mediation process that has brought together a Nicaraguan sugar company and a group of ex-workers and widows who have been affected by CKD to address these problems. A team of epidemiologists, environmental health faculty, and nephrologists is carrying out a number of activities intended to evaluate the potential causes of the excess of CKD in the area and whether work practices or chemicals used at the company is at least partly responsible for the occurrence of the disease. To date, two reports have been issued: (1) a review of the evidence available, proposed hypotheses, and recommendations for research activities; and (2) an evaluation of the current work practices at the company and a review of the literature on the renal effects of the agrichemicals that have been used. Potential causes being investigated include occupational, environmental, medical, and behavioral factors. Some of the activities planned or in process include a record-based retrospective cohort study, environmental sampling, blood and urine testing of 1200 current workers, a urinalysis study among adolescents, and kidney biopsies. Epidemiology Faculty: Daniel Brooks, Ann Aschengrau
The Prevention of Lower Urinary tract Symptoms (PLUS) Consortium
The PLUS Consortium will identify promising strategies for promoting bladder health and reducing lower urinary tract symptoms (LUTS) and conditions in women throughout the lifespan. Using both qualitative and quantitative research strategies, the Consortium will obtain information about girls and women in various age groups including prevalence and characteristics of those with no history of any LUTS, prevalence and characteristics of those with various LUTS, and potential protective and risk factors including such things as past or current health conditions, history of medical procedures, and toileting behaviors. Information to inform health promotion and prevention interventions will be obtained including knowledge, attitudes, beliefs, cultural norms, and environmental influences related to bladder health behaviors. The focus will be on obtaining the necessary information to plan for future prospective observational studies, and bladder health promotion educational efforts with the ultimate goal of reducing LUTS and their impact on overall health. Epidemiology Faculty: Bernard L Harlow