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New
faculty appointments
THIS
FALL, the Rollins School of
Public Health (RSPH) welcomes new faculty members in several departments:
Susan Allen, professor of international health,
holds joint appointments in epidemiology and pathology. Previously,
she was an associate professor of epidemiology at the University
of Alabama at Birmingham (UAB), a core director and scientist at
UAB’s Center for AIDS Research (CFAR), and director of the
Africa program for the Fogarty AIDS International Training in Research
program.
An NIH-supported researcher, Allen
focuses on the behavioral, social, and biologic determinants of
heterosexual transmission of HIV in developing countries. Her current
projects include a family-planning promotion to prevent unplanned
pregnancies in HIV-infected couples in Zambia, couples HIV counseling
and testing in Rwanda and Zambia, and a pilot study to prepare for
the evaluation of HIV/AIDS vaccines in Rwanda.
Allen also actively collaborates with
her husband, Eric Hunter, professor of pathology and laboratory
medicine in Emory School of Medicine and a Georgia Research Alliance
Eminent Scholar. Both will serve as faculty of the Emory CFAR and
Emory Vaccine Center.
Joe Lipscomb,
professor of Health Policy and Management, is the former chief of
the Outcomes Research Branch of the Division of Cancer Control and
Population Sciences at the NIH. A Georgia Cancer Coalition scholar,
he serves as director of cancer economics and outcomes at the Emory
Center on Health Outcomes and Quality and holds a secondary appointment
at the Winship Cancer Institute.
Chensheng (Alex) Lu,
assistant professor of Environmental and Occupational Health (EOH),
is an expert in exposure assessment and biomarker development. His
recent work focuses on quantifying exposure to pesticides using
novel methods such as saliva analysis. He also is engaged in a longitudinal
approach of assessing aggregate exposure to pesticides in children
and a study of human exposure to pesticides due to variations of
dietary consumption patterns. His research takes him not only to
agricultural areas in the United States but also to Central America
and Southeast Asia, where he collaborates with local university
faculty members in conducting pesticide exposure assessment studies
in farm workers and their children.
Anne Riederer, senior
research associate in EOH, recently earned an ScD in environmental
health from Harvard School of Public Health, where she focused on
residential exposures to developmental toxins in the Philippines.
Her research looks for practical ways to mitigate environmental
risks in the developing world, with a special emphasis on water
pollution.
Jeremy Sarnat, assistant
professor, and Stephanie Ebelt, research assistant
professor, are joining the EOH faculty in January. A married couple,
they come to the RSPH from Harvard School of Public Health, where
Sarnat was a research fellow in exposure, epidemiology, and risk,
and Ebelt completed a thesis on the impact of air pollution on cardiovascular
health. Both hold an ScD in Environmental Health from Harvard. They
will join Paige Tolbert and other colleagues in a thriving RSPH
program on air pollution epidemiology.
Paul Terry is assistant
professor of epidemiology. His work focuses on the etiology of cancers
of the digestive tract and several hormone-mediated cancers. Terry
completed doctoral studies in epidemiology at Columbia University
and Karolinska Institute in Stockholm. He recently completed a fellowship
at the National Institute of Environmental Sciences.
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Prevention
Research Center targets cancer in South Georgia
THE CDC recently awarded the Rollins School of
Public Health a $3.8 million grant to establish a Prevention Research
Center (PRC) in partnership with Southwest Georgia Cancer Coalition
(SWGCC). The partners will work jointly in 33 counties in southwest
Georgia in an initiative designed to reduce high cancer rates. They
seek to
promote prevention behaviors, specifically targeting smoking and
nutrition issues, and creating a foundation for additional collaborations
in this medically underserved region.
This marks the first time Emory has
received a PRC award. It recognizes a growing cluster of talent
in applied public health research and training, including the arrival
of nationally known cancer researcher Karen Glanz—professor
of Behavioral Sciences and Health Education (BSHE) and a Georgia
Cancer Coalition (GCC) scholar—who will direct Emory’s
Prevention Research Center. The award also recognizes an increasing
emphasis at Emory on cancer control, including a push by the Winship
Cancer Institute (WCI) to be designated by NCI as Georgia’s
first comprehensive cancer center.
James Hotz, interim CEO of the Southwest
Georgia Cancer Coalition and community leader for the PRC, calls
the effort “a bold initiative to study the best methods to
control cancer in rural populations. All citizens in Georgia stand
to benefit from our research.”
Glanz and Michelle Kegler, associate
professor of BSHE and deputy director of the center, previously
participated in PRC activities at the University of Hawaii and the
University of Oklahoma. “I like the philosophy of the PRCs:
bringing the university and the community together,” says
Kegler. “After all, that’s a big part of what public
health is about.”
Not only will the center strengthen
a natural affiliation between the university and the community,
but also it is a way for faculty in many disciplines to get involved.
“We’ve developed a faculty network with talent from
across the university,” Glanz says, “along with a world-class
advisory group for the center.” Key leaders include WCI Director
Jonathan Simons; Otis Brawley, RSPH professor and associate director
of WCI; Jack Mandel, chair of the RSPH Department of Epidemiology
and director of WCI’s program in population sciences and cancer
control; and Jerome Yates, national vice president for research
at the American Cancer Society.
Each year, the PRC program gives participants
an opportunity to compete for additional funds through the Special
Interest Project, or SIP, initiative. In its first year, Emory’s
PRC has received $2.5 million in SIP funding. One award, led by
Glanz, supports a five-year role in the Cancer Prevention &
Control Research Network. The other, led by GCC scholar Kyle Steenland
in the Department of Environmental
and Occupational Health, supports a three-year study of quality
of life for men with localized prostate cancer.
The SWGCC, designated a Regional Program
of Excellence by the GCC, hopes to build its capacity to do research
locally as the main partner for the Emory PRC. It already marshals
the efforts of hospitals, medical clinics, churches, and colleges
in the region to control cancer. An affiliation with Emory brings
an opportunity for local residents to enroll in NCI trials at the
university. In addition to offering clinical advantages, the SWGCC
will gain support from experts in training, communications, and
evaluations of prevention programs.
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NCID
director joins Emory faculties
THIS
SPRING, James Hughes, director
of the National Center for Infectious Diseases (NCID) at CDC and
an Assistant Surgeon General in the U.S. Public Health Service,
will join Emory’s public health and medicine faculties. With
joint appointments as professor of international health and professor
of medicine, he will direct the Emory Center for Global Safe Water
and a new program in Global Infectious Diseases.
For Hughes, the move (literally down
the street) seems like a return to his roots. Hughes began his career
as an Epidemic Intelligence Service officer at CDC in 1973, working
on waterborne and foodborne diseases. His mentor then was Eugene
Gangarosa, the Emory professor emeritus
whose lifelong passion has been improving water safety around the
globe. Gangarosa encouraged Hughes to pursue international training
in waterborne diseases, and Hughes did so at the International Centre
for Diarrhoeal Disease Research in Bangladesh, where he focused
on cholera.
With a MD from Stanford, Hughes completed
a residency in internal medicine at the University of Washington
and a fellowship in infectious diseases at the University of Virginia,
after which he returned to CDC to work on water-related diseases.
Since then, his career has expanded to encompass all infectious
diseases. He directed CDC’s Hospital Infections Program from
1983–1988. In 1988, he became deputy director of NCID, and
he was named director in 1992.He has garnered many accolades along
the way: membership in the Institute of Medicine, fellowship in
the American Association for the Advancement of Science and the
American College of Physicians, and Distinguished and Meritorious
Service Medals and the Surgeon General’s Exemplary Service
Award from the U.S. Public Health Service.
During his tenure at CDC, he’s
dealt with the major infectious disease killers of the past decade:
HIV and AIDS, tuberculosis, malaria, acute lower respiratory infections
(including pneumonia), and diarrheal diseases. Together infectious
diseases are the second leading killer in the world after heart
disease. According to Hughes, they account for one-quarter to one-third
of all deaths each year, and are the leading cause of death in children
under 5. Many of these diseases also share a common characteristic:
a tendency to be resistant to treatment.
In fact, antimicrobial resistance,
along with the emergence and reemergence of infectious diseases,
is a main interest of Hughes. He has focused extensively on the
implementation and evaluation of policies and practices for preventing,
rapidly detecting, and responding to infectious agents as well as
assessing the political, economic, and social implications of disease
outbreaks.
With its huge impact on diarrheal
diseases, water is now back on Hughes’s mind as he contemplates
a strategy for leading the Center for Global Safe Water. He’ll
bring with him the lessons learned at NCID: resource mobilization,
communication, and partnership development.
“I’ve discovered how important
partnerships are in reaching across disciplines and geographic boundaries,”
Hughes says, “and at the Center for Global Safe Water, I’ll
be thinking how we can strategically strengthen existing partnerships
and develop new ones.”
The center already is structured
on this model with founding partners of Emory, CDC, CARE USA, and
Population Services International. Hughes wants to find areas where
these partners and others can add value to the program, including
marshaling international collaborations at the university in the
area of safe water, building on CDC’s international platforms,
and tapping the multidisciplinary talent and expertise at Emory
and beyond.
In transitioning from a government
to a university setting, Hughes says he’ll “have to
learn the ropes.” He has many former CDC colleagues who are
now Emory faculty to help him. “I plan to spend my first weeks
meeting people, talking, and listening,” he says. “What
I hear will shape what I’m thinking and planning.”
Hughes is particularly looking forward
to interacting with students. “At CDC, we are always interested
in training the next generation to take on the work we are doing,”
he says. At Emory he’ll serve as a mentor to that next generation,
much as Gangarosa did for him.
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New
Center for Infectious Disease Analysis
THIS FALL an interdisciplinary Center for Infectious
Disease Analysis opened at Emory. Housed in the Department of Biostatistics
at the Rollins School of Public Health, the center coordinates work
already under way on campus, in which biostatisticians apply statistical
modeling to some of today’s most challenging epidemics: smallpox,
cholera,
influenza, SARS.
Directed by Professor of Biostatistics
Elizabeth Halloran, the center will raise visibility for medically
and math-ematically linked research projects. One of its first research
projects—supported by a five-year, $3 million grant from the
National Institute of General Medical Sciences—is part of
a new NIH initiative known as MIDAS (models of infectious disease
agent study). MIDAS links four research groups to harness the nation’s
computing skills to enable better response to infectious disease
epidemics and bioterrorism.
In countries such as the United Kingdom,
when public health crises such as mad cow disease arise, government
has a group in place with which to consult. However, that hasn’t
been the case in the United States, where efforts have been fragmented,
says Halloran. MIDAS will develop a national capacity for such emergencies.
The first joint project of the MIDAS
teams is to model a disease outbreak in a hypothetical American
community and search for the best ways to control an epidemic. Ira
Longini, biostatistics professor and principal investigator of Emory’s
MIDAS effort, and colleagues will base their model on collaboration
with other MIDAS teams. The researchers are constructing models
of social networks to identify who contacts whom and where during
a given day.
“People are deterministic
beings,” says Longini. “They do the same thing every
day. They go to work, pick up their kids from child care, go to
the grocery, to the doctor’s office.” This predictability
enables modelers to base their work on a somewhat realistic scenario.
Empirical data also comes from epidemiologic studies of disease.
“If you’re going to model, you need epidemiologic studies
first,” says Halloran, “because if you don’t know
how efficacious the treatments are, your modeling is invalid. You
then need to follow up with community trials in the population against
which to check your model.”
The RSPH team will examine the effectiveness
of policies such as surveillance and containment, vaccination, medical
treatment, and closing of key institutions. They will adapt their
model for smallpox, SARS, pandemic flu, and other possible bioterrorist
agents or naturally occurring diseases.
The approach is not a new one for
Halloran and Longini, who are long-time collaborators. In April,
the American
Journal of Epidemiology published their research on containment
of pandemic influenza. The research team (also including RSPH biostatisticians
Azhar Nizam and Yang Yang) used a simulation model that includes
elements of chance and probability to determine the effectiveness
of antiviral treatment on an influenza pandemic or a bioterrorist
influenza-like attack.
The modeling revealed that if
no interventions were used in a similar pandemic, 33% of the population
would become ill, resulting in a death rate of 0.58 per 1,000 people.
However, in a strategy of targeted antiviral prophylaxis, given
within one day of identifying suspected flu cases and then subsequently
for up to eight weeks, only 2% would become ill, lowering the death
rate to 0.04 per 1,000 people. Eight weeks of antiviral prophylaxis
proved nearly as effective as vaccinating 80% of the population.
In addition to supporting research,
the new Center for Infectious Disease Analysis also encourages more
work in bioinformatics, vaccine development, and understanding transmission
of infectious diseases.
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Curbing
sexual risk-taking among teens
HIV
AMONG adolescents is a hidden
epidemic, according to researchers at the Rollins School of Public
Health. Two recent studies by faculty in the Department of Behavioral
Sciences and Health Education focus on ways to equip African-American
teenagers with the skills they need to prevent HIV.
Researchers Ralph DiClemente and Gina
Wingood have found that messages tailored to gender and culture
substantially reduce sexual risk behavior and enhance HIV prevention
behavior among this population. Although other studies have shown
a reduction in sexual risk behaviors in adolescents, this multi-university
effort is the first to show a substantial reduction in sexual risk
behaviors, including acquiring new male sex partners and enhanced
skills associated with HIV prevention behaviors among high-risk
African-American girls. The Journal of the American Medical Association
published the results in July.
Laura Salazar, RSPH research director
of a second study, has discovered a more positive self-concept helps
sexually active African-American girls refuse unwanted and unprotected
sex. In a study funded by the National Institute of Mental Health,
Salazar examined data from 335 sexually active African-American
teenage girls. The sample represented a broad cross-section of adolescents
residing in low-income neighborhoods, with data collected from two
adolescent medical clinics, four health department clinics, and
health classes in five high schools in Birmingham.
“With sexually active girls
we tend to focus mainly on condom use,” says Salazar, “but
it’s also important to look at the frequency with which these
girls refuse unwanted and unprotected sex and the factors that determine
the refusal. We found that having a positive total self-concept
had a large effect on the girls’ communication abilities with
their sex partners, which influenced the frequency of sex refusal.”
The study—published in Prevention
Science in September—also suggests that intervention
programs incorporate issues such as body image and self-esteem and
communication skills.
In DiClemente’s and Wingood’s
research, participants were randomly assigned to either an HIV intervention
group or a general health promotion group. The HIV intervention
consisted of four, 4-hour group sessions, emphasizing ethnic and
gender pride, HIV knowledge, communication, condom use skills, and
healthy relationships. The control group participated in sessions
that emphasized exercise and nutrition.
The researchers found that participants
in the HIV intervention group reported using condoms 75.3% of the
time during the 30 days preceding the six-month follow-up versus
58.2% for the control group. At the 12-month interval, HIV group
participants reported consistent condom use of 73.3% in the preceding
30 days versus 56.5% for the control group. In the six months preceding
both follow-ups, HIV group participants reported more consistent
condom use than the control group participants.
The girls in the HIV intervention
group were more likely to use a condom at last intercourse, less
likely to have a new vaginal sex partner in the past 30 days, have
better condom application skills, report a higher percentage of
instances of condom-protected intercourse, and report fewer instances
of unprotected intercourse. They also had a lower risk of Chlamydia
infections and new pregnancies.
Both research projects demonstrate
a similar conclusion: ethnic identity must be considered in designing
interventions to curb sexual risk-taking and prevent HIV in the
vulnerable population of African-American teens.
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