The Epidemiology faculty include: D. Phuong (Phoenix) Do, Keith Dookeran, Lorraine Halinka Malcoe, Amanda Simanek and Ellen Velie.

In Epidemiology, faculty research specializations are in the areas of social, community-based, life course and environmental epidemiology. Faculty have expertise in pediatric health, environmental health, infectious disease, aging, nutrition, cancer prevention, violence against women, mental health, structural determinants of health, and community-level interventions.

On-going research examines health inequities; lifecourse sociocultural and nutritional risk factors for breast cancer; links between psychosocial stress, immune function and chronic disease; social and environmental risk factors for immune dysfunction in aging populations; mass criminalization and community health; the misuse of race as a genetic construct in epidemiologic research; and methodologies for studying gender, race, and social class inequalities in health.

Epidemiology faculty have collaborated with foreign governments, Indigenous nations, community organizations, community-based researchers, and health justice activists to address children’s environmental health, women’s health, and community health. Students enrolled in the Epidemiology track of the MPH program will have opportunities to work with a wide array of organizations, such as the AIDS Resource Center of Wisconsin, Diverse & Resilient, and local health departments.

Overall, our program integrates themes of social justice theories, with rigorous epidemiologic methods, and community practice to prepare students to utilize the tools of epidemiology to study the distribution and determinants of health, and to advocate for social and health equity in their local communities and beyond. Learn more about featured research projects by Epidemiology faculty:

Life course socio-cultural and early life nutritional risk factors (e.g. diet and body size) and primarily breast cancer
Dr. Velie is currently leading a large population-based case-control study of breast cancer in young African American and White women from diverse socioeconomic backgrounds (information available at: www.ywhhs.org).
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.

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.

The Ties that Bind: Investigating the interconnections between metropolitan segregation, neighborhood context, and racial/ethnic health disparities

D. Phuong Do, Reanne Frank, John Iceland

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.

A marginal structural modeling strategy investigating short and long-term exposure to neighborhood poverty on BMI among U.S. black and white adults

D. Phuong (Phoenix) Do, Cheng Zheng

Estimating the causal impact of neighborhood effects from observational data has proven to be a challenge. Omission of relevant factors may lead to overestimating the effects of neighborhoods on health while inclusion of time-varying confounders that may also be mediators (e.g., income, labor force status) may lead to underestimation. Because policy inferences and anticipated impacts of interventions rely on estimates of causal versus associational connections, addressing these sources of bias are important to make appropriate policy recommendations. Using longitudinal data from the 1999 to 2013 years of the Panel Study of Income Dynamics, this study investigates the link between neighborhood poverty and body weight. We address the issue of possible downward bias due to adjusting for mediating factors by employing a marginal structural modeling strategy, which appropriately adjusts for simultaneous mediating and confounding factors. We then compare conventional naïve estimates to those recovered from marginal structural modeling. To address the issue of possible upward bias due to omitted variables, we conduct a sensitivity analysis to assess the robustness of results against unobserved confounding.

Associations of neighborhood segregation with BMI and obesity in the Multi-ethnic Study of Atherosclerosis (MESA)

D. Phuong (Phoenix) 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.