The Epidemiology faculty include: Ruth Etzel, D. Phuong (Phoenix) Do, Amy Kalkbrenner, Lorraine Halinka Malcoe, and Amanda Simanek. Learn more about featured research projects by Epidemiology faculty:

Air pollutants and autism: New pathways in analysis of windows of susceptibility
Amy Kalkbrenner, Marc Serre, Gayle Windham, Xuexia Wang, Julie Daniels
Environmental chemical exposures are suspected to contribute to autism, and one study has shown that living closer to freeways is associated with increasing autism risk. We will further understanding in this area by examining the association between 3traffic-related pollutants – course particulate matter, nitrogen dioxide, and ozone – with autism. This case-cohort design includes hundreds of children recognized to have autism in California and North Carolina by the autism surveillance program of the Centers for Disease Control and Prevention, combined with birth records representing the source population and air monitoring data. Notably, we will explore critical windows of susceptibility – exploring whether air pollutant exposures in early pregnancy, late pregnancy, or early childhood are more impactful.

Associations of neighborhood segregation with BMI and obesity in the Multi-ethnic Study of Atherosclerosis (MESA)
D. Phuong Do, Ana Diez Roux, Kiarri Kershaw, Mahasin Mujahid, Mercedes Carnethon
Racial/ethnic differences in obesity, an epidemic in the U.S., are only partially accounted for by individual-level socioeconomic status, suggesting that examination of the causes and correlates of overweight and obesity ought to include other factors patterned by race and ethnicity, including various features of the environments in which groups live. Using the longitudinal data from the Multi-ethnic Study of Atherosclerosis (MESA), this study investigates the association between local spatial measures of segregation and BMI and whether these associations differ between blacks, Hispanics, and whites. We also investigate whether specific physical and social features of neighborhoods (e.g., social cohesion, safety, food access) explain any associations found. Three- level hierarchal models with repeated measures nested within persons nested within neighborhoods are applied across multiple MESA sites, providing a detailed and comparative analysis of the relationship between local segregation and BMI across multiple cities in the U.S.

Inter- and transdiscplinary approaches for advancing social justice in mental health
Marina Morrow, Lorraine Halinka Malcoe
Mainstream approaches to mental health research, policy, and practice are limited by the heavy use of biomedical paradigms, individualistic psychiatric and pharmaceutical interventions, and intersecting medical/legal/criminal justice system responses that limit the autonomy of persons classified as mentally ill. This book project, Critical Inquiries: Theories and Methodologies for Social Justice in Mental Health (University of Toronto Press, 2015) builds on a burgeoning inter- and transdisciplinary scholarship of critical and intersectional approaches to mental health research and policy that center social justice ethics. Many book contributors are investigators with the Centre for the Study of Gender, Social Inequities and Mental Health housed at Simon Fraser University, Vancouver, BC. Authors demonstrate how mental health research, practice, policy, and state/medical system responses often reproduce social inequities, causing harm to individuals and communities. They offer alternative strategies designed to create individual, community, and societal-level responses that are socially just.

Intergenerational impact of maternal psychosocial stress on offspring mental health as mediated by maternal immune response to persistent pathogens in pregnancy
Amanda M. Simanek, Monica Uddin, Allison Aiello
Nearly one quarter of U.S. children will experience an anxiety disorder during adolescence. Studies suggest that maternal exposure to traumatic events during pregnancy may play a particularly important role in fetal programming of offspring mental health, warranting further investigation of the effect that the in utero milieu may have on the development of adverse mental health outcomes in children. Stress-mediated maternal immune activation against persistent pathogens during pregnancy resulting from traumatic event exposure may represent a novel biological mechanism whereby the detrimental effects of maternal psychosocial stress are transmitted to offspring in the form of childhood anxiety disorders. This project aims to examine the association between maternal experience of traumatic events directly before or during pregnancy, in utero exposure of offspring to elevated maternal immune response against several persistent pathogens (cytomegalovirus (CMV), herpes simplex virus (HSV)-1, and lifetime history of generalized anxiety disorder among female participants from the Detroit Neighborhood Health Study (DNHS) (R01 DA022720) and their children.

In utero and childhood tobacco exposures and autistic traits
Amy Kalkbrenner, Joe Braun, Kim Dietrich, Kimberly Yolton, John T. Bernert, Bruce Lanphear
Studies have yielded inconsistent results about whether maternal cigarette smoking in pregnancy is associated with autism in the child. We will address prior limitations in research on this topic using a normal pregnancy cohort from Cincinnati, Ohio. We will evaluate whether second-handsmoke in pregnancy, maternal smoking in pregnancy, and second-hand exposure to the child after birth, are associated with autistic traits, after adjusting for a comprehensive set of confounders. In this cohort, tobacco exposures were well-characterized with biomarkers and questionnaires, and the full spectrum of autistic-like behaviors and related social and communication impairments at ages 4 and 5 years was measured using standardized psychometric tools.

Perinatal exposure to hazardous air pollutants and associations with autism phenotype
Amy Kalkbrenner, Heather Volk, Gayle Windham, Nora Lee
Three studies in different populations have suggested that some hazardous air pollutants may be risk factors for autism. Specifically, methylene chloride and some metals and solvents have been implicated. This study will build upon prior research using a large national sample of children with autism and their families, the Autism Genetic Resource Exchange. After obtaining a residential history for children in these families, we will historically reconstruct exposures to over a hundred volatile organic compounds and metals, using a census-tract based model of the Environmental Protection Agency. Air pollutant concentrations will be evaluated with regard to not only the diagnosis of autism, but the continuous phenotype of autism symptoms.

Racial Disparities Project: Rethinking quantitative research on 'racial/ethnic' health inequalities
Lorraine Halinka Malcoe
For more than three centuries Western science has been part and parcel of societal conceptualizations and uses of ‘race’ and hierarchical racial classifications in Europe and in countries colonized and re-settled by Europeans, including Canada and the United States. In the past 25 years several systematic reviews have examined the uses, definitions, and concepts of race and ethnicity in epidemiologic and other health studies, demonstrating that most articles lacked a sound scientific basis for their use, e.g., in 1999, 75% of epidemiology articles failed to state how the variables were even measured. No systematic reviews have focused on race or ethnicity concepts in research that aims to understand health disparities. The Racial Disparities Project systematically identified all original research articles which studied explanations for ‘racial’/’ethnic’ health inequalities and were published during 2000-2009 in select high-impact epidemiology, public health, and medical sociology journals. The Project applies content analysis to assess framing of paper aims, race and ethnicity constructs, and selection of explanatory variables; it applies critical discourse analysis to examine how population scientists produce knowledge regarding race when studying causes of health differences among populations defined by race or ethnicity.

Social inequalities and toxic air pollution exposures in Milwaukee, WI
Amy Kalkbrenner, Lorraine Halinka Malcoe, D. Phuong Do, Brian Thayer
Air toxics – hundreds of airborne metals and volatile organic compounds – cause oxidative stress and systemic immune responses, biologic effects likely to underlie suboptimal birth outcomes such as infant mortality or preterm birth. Yet air toxics have been largely ignored by researchers studying these birth outcomes. This study will screen 187 toxic air pollutants from the EPA’s National-Scale Air Toxics Assessment and will lay the foundation for a full exploration of the intersection of air toxics and social inequalities in contributing to infant mortality and preterm birth. For this pilot study, the City of Milwaukee serves as the focal point - an ideal setting due to the City’s high degree of segregation, racial disparities in infant mortality, and large number of polluting sources. Levels, variations, and patterning of air toxics in Milwaukee by racial/ethnic and socioeconomic geographies will be identified. Illustrative maps will be produced to help communicate air pollutant “hotspots”, and importantly, identify and engage community partners for future collaborative research.

The Ties that Bind: Investigating the interconnections between metropolitan segregation, neighborhood context, and racial/ethnic health disparities
D. Phuong Do, Reanne Frank, John Iceland, Lorraine Halinka Malcoe
Though neighborhood conditions, such as poverty and disorder, are thought to be the primary means through which segregation affects health, we know very little about how segregation and neighborhoods interact together to influence the health. Are the effects of metropolitan segregation conditioned on neighborhood factors or are the effects uniform across all neighborhood types? Do the effects of neighborhood-level (local) segregation on health differ from the effects of metropolitan-level (metro) segregation? Using data from the National Health Interview Survey, this study comprehensively examines the interconnections between metropolitan segregation, neighborhood context, and individual health. We utilize spatial measures of metro and local segregation, account for neighborhood conditions, and apply three- level hierarchal models to asses how contextual factors at different levels interact to affect the health of blacks, Hispanics, and whites in the U.S. This fundamental determinants perspective underscores the potentially immense impact of housing policies, urban design, and the spatial allocation of resources and patterning of risk exposure in reducing racial health disparities.