Research Areas.

• Methodology: Measurement, Recruitment, Sampling, Study Design, and Analyses
• Health Equity: Structural and Social Determinants of Health
• Environmental Determinants of Health
• Stress, Trauma, and Mental Health
• Infectious Disease Research
• Aging and Chronic Diseases Research
• Reproductive, Perinatal, Gynecologic, & Developmental Epi

Faculty active in this cluster: Alana Brennan, Ann Aschengrau, Anthony Rosellini, Avron Spiro, Bernard Harlow, Collette Ncube, Eleanor Murray, Jacob Bor, Jaimie Gradus, Jennifer Weuve,  Kenneth Rothman, Koichiro Shiba, Lauren Wise, Leonardo Martinez, Marcia Pescador Jimenez, Maria Glymour, Martha Werler, Mary Willis, Salma Abdalla,  Samantha Parker Kelleher,  Ziming Xuan

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Externally funded research within this cluster often has a strong applied bent, with a focus on solving methodologic problems in a specific area.  Examples include: 

• The Methods in Longitudinal research on Dementia (MELODEM) Initiative: an NIA-funded workshop grant providing a platform for developing and disseminating research methodologies for improved cognitive aging and dementia research. The workshop has also served as a venue to identify and support emerging scholars as they engage with dementia research. (PI: Weuve)
• Pregnancy Study Online (PRESTO): This extremely influential web-based North American cohort of pregnancy planners addresses key methodologic challenges in research on fertility, including misclassification, selection bias, and reverse causation. The cohort’s prospective design, cost-efficient web-based infrastructure for participant recruitment and follow-up, geographic and racial/ethnic heterogeneity make it a model for the future of cohort-based research. (PI: Wise)

Examples of recent published scholarship in this area include:

• Fox MP, MacLehose RF, Lash TL. SAS and R code for probabilistic quantitative bias analysis for misclassified binary variables and binary unmeasured confounders. Int J Epidemiol. 2023 Oct 05; 52(5):1624-1633. PMID: 37141446.
• Murray EJ, Carr KC. Measuring Racial Sentiment Using Social Media Is Harder Than It Seems. Epidemiology. 2024 Jan 01; 35(1):60-63. PMID: 37756311.
• Rosellini, A. J., & Brown, T. A. (2021). Developing and validating clinical questionnaires. Annual Review of Clinical Psychology, 17, 55-81.
• Jimenez MP, Aris IM, Rifas-Shiman S, Young J, Tiemeier H, Hivert MF, Oken E, James P. Early life exposure to greenness and executive function and behavior: An application of inverse probability weighting of marginal structural models. Environ Pollut. 2021 Dec 15; 291:118208. PMID: 34740291.
• Schwartz GL, Maria Glymour M. Bridging the Divide: Tackling Tensions Between Life-Course Epidemiology and Causal Inference. Annual Review of Developmental Psychology. 2023 Aug 24;5.
• Jiang T, Gradus JL, Rosellini AJ. Supervised machine learning: a brief primer. Behavior Therapy. 2020 Sep 1;51(5):675-87.
• Shiba K, Daoud A, Kino S, Nishi D, Kondo K, Kawachi I. Uncovering heterogeneous associations of disaster‐related traumatic experiences with subsequent mental health problems: A machine learning approach. Psychiatry and clinical neurosciences. 2022 Apr;76(4):97-105.

Projects include:

Internet-based study of time to pregnancy and miscarriage

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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.

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Faculty active in this cluster: Koichiro Shiba, Yvette Cozier, Jonathan Jay, Salma Abdalla, Collette Ncube, Leonardo Martinez, Daniel Brooks, Ziming Xuan, Jacob Bor, Lauren Wise, Rhoda Au, Emilia Benjamin, Jennifer Weuve, Amelia Wesselink, Samantha Parker Kelleher, Sandro Galea,  Marcia Pescador Jimenez, Mary Willis

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Externally funded research within this cluster includes:

• Understanding racial and ethnic disparities in preterm birth: a systems science approach. This research aims to address significant gaps in our understanding of how structural and intermediary determinants of health interact and function interdependently to generate and perpetuate racial/ethnic preterm birth disparities, as well as inform strategies to address these disparities. (PI: Ncube)
• Postpartum remote blood pressure monitoring program: study of reducing severe maternal morbidity among Black and Latina women by incorporating patient experiences and systems science. Cardiovascular complications are the leading cause of postpartum maternal morbidity and are more common among Black and Hispanic women compared to White women. The proposed project will evaluate an innovative postpartum blood pressure monitoring program aimed at improving blood pressure management, decreasing health emergencies, and reducing population rates of cardiovascular related severe maternal morbidity among women of color. (PI: Parker)
• An assessment of neighborhood and environmental determinants of subfertility in the Black Women’s Health Study. This study aims to assess the extent to which environmental and neighborhood-level exposures are related to time-to-pregnancy and infertility risk in Black women. This is the first study focused on structural determinants of infertility in Black women. (PI: Wesselink)

Examples of recent published scholarship in this area include:

• Martinez L, et al. Global, regional, and national estimates of tuberculosis incidence and case detection among incarcerated individuals from 2000 to 2019: a systematic analysis. The Lancet Public Health. 2023 Jul; 8(7):e511-e519.
• Nakagomi A, Tsuji T, Saito M, Ide K, Kondo K, Shiba K. Social isolation and subsequent health and well-being in older adults: A longitudinal outcome-wide analysis. Soc Sci Med. 2023 Jun; 327:115937. PMID: 37167920
• Matthay EC, Glymour MM. Causal inference challenges and new directions for epidemiologic research on the health effects of social policies. Current Epidemiology Reports. 2022 Mar;9(1):22-37.
• Willis MD, Orta OR Ncube C, Wesselink AK, Doan LN, Kirwa K, Boynton-Jarrett R, Hatch EE, Wise LA. Association between neighborhood disadvantage and fertility among pregnancy planners in the US. JAMA Netw Open. 2022 Jun; 5(6): e2218738. PMID: 35771576

Projects include:

Black Women’s Health Study (BWHS)

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SEE ALSO:

Coronary Heart Disease in US Black Women—entry under “Aging and Chronic Diseases Research”

Chicago Health and Aging Project—entry under “Aging and Chronic Diseases Research”

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Examples of externally funded scholarship in this domain include:

• Air Pollution And Noise Exposures In Relation To Dementia: From Brain Imaging Markers To Clinical Disease (PI: Weuve)
• A Preconception Cohort Study on Oil and Gas Development, Fertility, and Pregnancy (PI: Willis)
• A preconception cohort study of air pollution, fertility, and miscarriage (PI: Wise, Hatch)
• Chronic kidney diseases of uncertain etiology (CKDu) in agricultural communities (CURE) research consortium – Scientific and Data Coordinating Center (Subaward PI: Brooks)

Examples of recently published scholarship:

• Wesselink AK, Hystad P, Kirwa K, Kaufman JD, Willis MD, Wang TR, Szpiro AA, Levy JI, Savitz DA, Rothman KJ, Hatch EE, Wise LA. Air pollution and fecundability in a North American preconception cohort study. Environ Int. 2023 Nov; 181:108249. PMID: 37862861.
• Zhang B, Weuve J, Langa KM, D’Souza J, Szpiro A, Faul J, Mendes de Leon C, Gao J, Kaufman JD, Sheppard L, Lee J, Kobayashi LC, Hirth R, Adar SD. Comparison of Particulate Air Pollution From Different Emission Sources and Incident Dementia in the US. JAMA Intern Med. 2023 Oct 01; 183(10):1080-1089. PMID: 37578757.
• Willis MD, Buonocore JJ. Fossil Fuel Racism: The Ongoing Burden of Oil and Gas Development in the Shadows of Regulatory Inaction. Am J Public Health. 2023 Nov; 113(11):1176-1178. PMID: 37651657.
• Doran CR, Aschengrau A. Prenatal and early childhood exposure to tetrachloroethylene-contaminated drinking water and the risk of poor sleep quality during adulthood: a retrospective cohort study. Environ Health 2022, 21:15.
• Daneshvar DH, Nair E, Baucom Z, Rasch A, Abdolmohammadi B, Uretsky M, Saltiel N, Shah A, Jarnagin J, Baugh CM, Martin BM, Palmisano JN, Cherry JD, Alvarez VE, Huber BR, Weuve J, Nowinski CJ, Cantu RC, Zafonte RD, Dwyer B, Crary JF, Goldstein LE, Kowall NW, Katz DI, Stern RA, Tripodis Y, Stein TD, McClean M, Alosco ML, McKee AC, Mez J. Leveraging football accelerometer data to quantify associations between repetitive head impacts and chronic traumatic encephalopathy. Nature Communications 2023 Jun 20;14(1):3470. PMC10281995

Projects include:

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

Impact of Early Life Exposure to Environmental and Social Stressors

Tetrachloroethylene (PCE) is a solvent commonly used in metal degreasing, textile processing, and dry cleaning. Because it is often used in poorly controlled settings, it is a common ground water and Superfund site contaminant. Our prior research found that early life exposure to PCE-contaminated drinking water was associated with substance use during adolescence and adulthood. However, early life exposure to social stressors is widely thought to influence this behavior and so we are now conducting a retrospective cohort study to examine the combined impact of early life exposure to PCE-contaminated drinking water and social stressors on the subsequent occurrence of illicit drug use and unhealthy alcoholic beverage consumption. Epidemiology faculty: Ann Aschengrau

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Faculty active in this cluster: Jaimie Gradus, Jennifer Weuve, Maria Glymour, Marcia Pescador Jimenez, Salma Abdalla, Yvette Cozier, Koichiro Shiba, Ann Aschengrau, Avron Spiro, Bernard Harlow, Eleanor Murray

This research cluster includes both psychosocial exposures and psychiatric outcomes. The creation of the Center for Trauma and Mental Health crystallized the department’s strength in these areas. Our scholarship encompasses challenging conventional narrow definitions of trauma and mental health (i.e., extending beyond DSM/ICD diagnostic codes), understanding the myriad health effects of individual and mass trauma, and evaluating how social and psychosocial adversity, including exposure to racism and other stressors, influences mental and physical health outcomes. The department’s faculty use exceptional data sets and collaborative efforts to conduct work that would not otherwise be possible, such as understanding the health consequences of having a family member die by suicide.  

Examples of current externally funded scholarship in this domain include:

• Identifying Cardiotoxic Manifestations Of Posttraumatic Psychopathology: A Population-Based Longitudinal Investigation (PI: Gradus)
• Testing The Effectiveness Of An Evidence-Based Transdiagnostic Cognitive Behavioral Therapy Approach For Improving HIV Treatment Outcomes Among Violence-Affected And Virally Unsuppressed Women In South Africa (PI: Fox)
• Examining the Physical and Mental Health Outcomes of Suicide Loss (MPI: Rosellini/Gradus)
• Exposure to Suicide Among Post 9/11 Veterans: Prevalence, Correlates and Treatment Needs (Site PI: Gradus)
• Real-World Effectiveness of Long-Acting Injectable Versus Oral Naltrexone for Co-Occurring Posttraumatic Stress Disorder and Alcohol Use Disorder (Site PI: Gradus)
• Suicidal risk modification by statin prescriptions in US Veterans with common inflammation-mediated clinical conditions- a controlled, quasi- randomized epidemiological approach. (Site PI: Gradus)

Examples of recently published scholarship in this area (*Denotes work led by a trainee):

• Shiba K, Daoud A, Hikichi H, Yazawa A, Aida J, Kondo K, Kawachi I. Uncovering Heterogeneous Associations Between Disaster-Related Trauma and Subsequent Functional Limitations: A Machine-Learning Approach. Am J Epidemiol. 2023 Feb 01; 192(2):217-229. PMID: 36255224.
• *Yamin N, Brown TA, Rosellini AJ. Longitudinal associations of chronic health stress and COVID-19-related anxiety among outpatients with anxiety and mood disorders. Clin Psychol Psychother. 2023; 30(5):1020-1028. PMID: 37073862.
• Matthay EC, Smith ML, Glymour MM, White JS, Gradus JL. Opportunities and challenges in using instrumental variables to study causal effects in nonrandomized stress and trauma research. Psychological Trauma: Theory, Research, Practice, and Policy. 2023 Sep;15(6):917.
• Sabbath EL, Willis MD, Wesselink AK, Wang TR, McKinnon CJ, Hatch EE, Wise LA. Association between job control and time to pregnancy in a preconception cohort. Fertil Steril. 2023 Nov 28. PMID: 38036244.
• Gradus, J. L., Smith, M. L., Szentkúti, P., Rosellini, A. J., Horváth-Puhó, E., Lash, T. L., Galea, S., Schnurr, P. P., Sumner, J. A., Sørensen, H. T., (2023). Anti-hypertensive medications and PTSD incidence in a trauma cohort. Journal of Clinical Psychiatry, 84(5), 22m14767.
• *Smith, M. L., Seegulam, V., Szentkúti, P., Horváth-Puhó, E., Galea, S., Lash, T. L., Rosellini, A. J., Schnurr, P. P., Sørensen, H. T., Gradus, J. L. (2023). Risk of psychopathology following traumatic events among immigrants and native-born persons in Denmark. Social Psychiatry and Psychiatric Epidemiology, 58(9), 1305-1316.
• *Sampson, L., Gradus, J. L., Cabral, H. J., Rosellini, A. J., Fink, D. S., Cohen, G. H., Liberzon, I., Galea, S. (2023) Stressful life events and incident depression among U.S. military personnel. Social Psychiatry and Psychiatric Epidemiology, 58(7), 1009-1018.
• *Jiang, T., Nagy, D., Rosellini, A. J., Horváth-Puhó, E., Keyes, K. M., Lash, T. L., Galea, S., Sørensen, H. T., Gradus, J. L. (published online ahead of print; 2023). Prediction of suicide attempts among persons with depression: A population-based case cohort study. American Journal of Epidemiology. doi:10.1093/aje/kwad237
• Shiner, B., Park, J. A., Rozema, L., Hoyt, J. E., Watts, B. V., Gradus, J. L. (2023) Safety of Glecaprevir/Pibrentasvir for Hepatitis C in patients with posttraumatic stress disorder: A post-marketing surveillance study.  General Hospital Psychiatry, 84, 268-270.
• Aschengrau A, Winter M, Shea MG. Associations between resilience promotion factors during childhood and drug use disorder. Addiction Substance Abuse 2023, (2(1):1-9.

Projects include:

Examining the Physical and Mental Health Outcomes of Suicide Loss

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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

Hurricane Sandy Community Resilience Project

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Faculty active in this cluster: Alana Brennan, Benjamin Linas, Eleanor Murray, Jacob Bor, Leonardo Martinez, Maria Glymour,  Matthew Fox

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Examples of externally funded scholarship: 

• Testing The Effectiveness Of An Evidence-Based Transdiagnostic Cognitive Behavioral Therapy Approach For Improving HIV Treatment Outcomes Among Violence-Affected And Virally Unsuppressed Women In South Africa (MPI: Fox)
• Identifying Effective And Efficient Approaches To Tuberculosis Screening In Brazilian Prisons (PI: Martinez)
• DRAMATIC Phase 2 Duration Randomized MDR-TB Treatment Trial (MPI: Horsburgh)

Examples of recently published scholarship:

• Martinez L, Gray DM, Botha M, Nel M, Chaya S, Jacobs C, Workman L, Nicol MP, Zar HJ. The long-term impact of early-life tuberculosis disease on child health: a prospective birth cohort study. American Journal of Respiratory and Critical Care Medicine. 2023 Apr 15;207(8):1080-8.
• Aschmann HE, Riley AR, Chen R, Chen YH, Bibbins-Domingo K, Stokes AC, Glymour MM, Kiang MV. Dynamics of racial disparities in all-cause mortality during the COVID-19 pandemic. Proceedings of the National Academy of Sciences. 2022 Oct 4;119(40):e2210941119.
• Esra RT, Carstens J, Estill J, Stoch R, Le Roux S, Mabuto T, Eisenstein M, Keiser O, Maskew M, Fox MP, De Voux L, Sharpey-Schafer K. Historical visit attendance as predictor of treatment interruption in South African HIV patients: Extension of a validated machine learning model. PLOS Glob Public Health. 2023; 3(7):e0002105. PMID: 37467217.
• Shumba K, Bor J, Nattey C, Gareta D, Lauren E, Macleod W, Fox MP, Puren A, Mlisana K, Onoya D. Record linkage without patient identifiers: proof of concept using data from South Africa’s national HIV program. Res Sq. 2023 May 15. PMID: 37292689.
• Cowger TL, Murray EJ, Clarke J, Bassett MT, Ojikutu BO, Sánchez SM, Linos N, Hall KT. Lifting universal masking in schools—COVID-19 incidence among students and staff. New England Journal of Medicine. 2022 Nov 24;387(21):1935-46.

Projects include:

Tuberculosis

Boston University School of Public Health participates in TB research through four Federally-funded research networks, the Tuberculosis Trials Consortium (TBTC), the Tuberculosis Epidemiologic Studies Consortium, both supported by the CDC and the TB Research Unit (TBRU), and RePORT India, funded by NIH. 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 PREEMPT Study, a multicenter prospective observational cohort study to identify the causes of emergence of resistance during therapy for treatment of MDR-TB, with study sites in India and Brazil and South Africa (funded by NIH). Through RePORT India, the Department is participating in an observational cohort study of TB in India, and through TBRU, we are participating in a household contact study of TB transmission in South Africa. Additionally, we are performing two cohort studies of TB in South Africa focusing on the effects of alcohol and drug use on TB (funded by NIH). Lastly, we are performing cost-effectiveness studies of TB and HCV (funded by CDC), and mathematical modeling of TB transmission (funded by NIH).

BUSPH has also partnered with Boston Medical Center and Brown/Lifespan in the Providence/Boston Center for AIDS Research (CFAR, founded by NIH), with a Scientific Working Group that addresses TB/HIV co-infection. Epidemiology faculty: C. Robert Horsburgh Jr.

ENHANCE: Evaluation of South Africa’s National Adherence Guidelines

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Faculty Active in this Cluster: Marcia Pescador Jimenez, Jennifer Weuve, Mary Willis, Phillip Hwang, Emilia Benjamin, Rhoda Au, Daniel Brooks, Megan Healey, Alana Brennan, Avron Spiro, Koichiro Shiba, Salma Abdalla

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Examples of externally funded scholarship: 

• Building an unbiased pooled cohort for the study of lifecourse social and vascular determinants of Alzheimer’s Disease and Related Disorders (MPI: Glymour) 
• Air Pollution and Alzheimer’s Dementia: Neuropathologic and Olfactory Mechanisms in Multi-Ethnic Longitudinal Cohorts (MPI: Weuve)
• Neurodegenerative diseases and the role of green space: A deep learning assessment (PI: Jimenez)
• Physical activity over the adult life course and cognitive resilience to Alzheimer’s disease and related dementias (PI: Hwang)
• Social networks over the adult life course and cognitive resilience (PI: Hwang)
• Impact of midlife and late-life intake of flavonoid-rich fruits on dementia risk in the Framingham Heart Study (PI: Hwang)
• Early detection and monitoring of Alzheimer’s disease and related dementia using non-semantic linguistic and acoustic features of speech derived from hearing aids (Subaward PI: Hwang)
• Risk of cardiovascular disease following different manifestations of posttraumatic psychopathology in a trauma cohort (PI: Gradus)
• Role of genetic susceptibility in the Central American kidney disease epidemic (MPI: Brooks)
• Chronic kidney diseases of uncertain etiology (CKDu) in agricultural communities (CURE) research consortium – Scientific and Data Coordinating Center (Subaward PI: Brooks)

Examples of recently published scholarship:

• Hwang PH, Ang TFA, De Anda-Duran I, Liu X, Liu Y, Gurnani A, Mez J, Auerbach S, Joshi P, Yuan J, Devine S, Au R, Liu C. Examination of potentially modifiable dementia risk factors across the adult life course: The Framingham Heart Study. Alzheimers Dement. 2023 Jul; 19(7):2975-2983. PMID: 36656649.
• Hikichi H, Shiba K, Aida J, Kondo K, Kawachi I. Association between sense of coherence and health and well-being among older survivors of a natural disaster: a prospective outcome-wide study. Sci Rep. 2023 Sep 29; 13(1):16385. PMID: 37773258.
• Anyane-Yeboa A, Buadu MAE, Khalili H, Cozier YC. Epidemiology of Inflammatory Bowel Disease in a Cohort of US Black Women. Inflamm Bowel Dis. 2023 Oct 03; 29(10):1517-1523. PMID: 36946376.
• Delgado, IS, Outterson A, Ramesh V, Amador Sanchez AG, Boza AC, Lopez-Pilarte D, Amador Velázquez JJ, Friedman DJ, Brooks DR, Scammell MK, Wang C. Ethical considerations for genetic research in low-income countries: Perceptions of informed consent, data sharing, and expectations in Nicaragua. Eur J Hum Genet. Published online December 2023, https://doi.org/10.1038/s41431-023-01505-7.
• Wang J, Buto P, Ackley SF, Kobayashi LC, Graff RE, Zimmerman SC, Hayes-Larson E, Mayeda ER, Asiimwe SB, Calmasini C, Glymour MM. Association between cancer and dementia risk in the UK Biobank: evidence of diagnostic bias. European Journal of Epidemiology. 2023 Oct;38(10):1069-79.

Projects include:

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)

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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

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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 .

Boston Collaborative Drug Surveillance Program

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

1. Drugs to treat psoriasis and risk of infection
2. Maternal antidepressant drug use, depression and risk of autism in the offspring
3. Changes in MS outcomes following newer MS treatments, and
4. Iodine exposure in young children and risk of hypoglycemia.

We are also conducting research on

1. Quantifying the effects of quinolones on tendon rupture,
2. The importance of idiopathic cases selection in drug safety studies, and
3. Comorbidities in patients with vasculitis

Epidemiology faculty: Susan Jick.

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Faculty active in this cluster: Lauren Wise, Amelia Wesselink, Mary Willis, Collette Ncube, Martha Werler, Bernard Harlow, Eric Rubenstein, Ann Aschengrau, Kenneth Rothman

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Examples of externally funded scholarship in this domain include:

• An internet-based preconception cohort study in North America (PI: Wise)
• A Prospective Study Of Male Factors, Fertility, And Pregnancy Outcomes (Pi: Wise)
• Down Syndrome: Toward Optimal Trajectories And Health Equity Using Medicaid Analytic Extract (Ds-To-The-Max) (Pi: Rubenstein)
• A Prospective Study Of Heat Exposure And Miscarriage (PI: Wesselink)
• Early Life Course Of Children With Congenital Structural Heart Anomalies (PI: Werler)
• Impact of Postpartum Remote Blood Pressure Monitoring on Maternal Morbidity (Pi: Parker)
• An assessment of neighborhood and environmental risk factors for subfertility in the Black Women’s Health Study (PI: Wesselink)
• Environmental risk factors for uterine fibroids: a prospective ultrasound study (PI: Wise)

Examples of recently published scholarship:

• Wesselink AK, Hatch EE, Rothman KJ, Wang TR, Willis MD, Yland JJ, Crowe HM, Geller RJ, Willis SK, Perkins RB, Regan AK, Levinson J, Mikkelsen EM, Wise LA. A Prospective Cohort Study of COVID-19 Vaccination, SARS-CoV-2 Infection, and Fertility, Am J Epidemiol, 2022 Aug; 191(8), 1383–1395. 
• Rubenstein E, Tewolde S, Michals A, Fox M, Wang N. Prevalence of Autism Among Medicaid-Enrolled Adults. JAMA Psychiatry. 2023 Oct 04. PMID: 37792361.
• Willis MD, Harris L, Campbell EJ, Chaskes M, Sawyer E, Harleman M, Ritz B, Hill EL, Hystad P. A population-based cohort study of electronic tolling, traffic congestion, and adverse birth outcomes. Environ Int. 2023 Nov 27; 183:108355. PMID: 38056094.
• Geller RJ*, Wesselink AK, Koenig MR, Eisenberg ML, Tucker KL, Hatch EE, Wise LA. Association of male fatty acid intake with fecundability among couples planning pregnancy. 2023 Aug; Hum Reprod 38(8): 1601-1612.

Projects include:

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

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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

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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 “Methodology: Measurement, Recruitment, Sampling, Study Design, and Analyses”

Chronic Kidney Disease of Unknown Etiology in Nicaragua

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The Prevention of Lower Urinary tract Symptoms (PLUS) Consortium

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Immunological Predictors of Unexplained Vulvar Pain (Vulvodynia)

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