Symposia Session Abstracts

 

Plenary Session:  How Epidemiologists can Play a Greater Role in Environmental Decision-making: Comparing Apples to Apples

 Chair:   Heidi Erickson, PhD, MS, Chevron Energy Technology Company

Speakers:          Carol Burns, PhD, FACE, Burns Epidemiology Consulting

                        Judy Lakind, PhD, President of the LaKind Associates, LLC

                        Kyla Taylor, PhD, NIEHS

                        Hubert Vesper, PhD, CDC

 75 min:  5 min for session intro & speaker transitions/intros; 15 min per speaker; 10 min panel discussion

 Session Abstract:  The American College of Epidemiology is an organization of epidemiologists for epidemiologists.  Our research, however, relies increasingly on integrating other disciplines.  Furthermore, to enhance our findings for decision making our investigations are strongest when we collaborate.  This session features speakers from epidemiology, environmental science, medicine and exposure science.  

 Epidemiology data are increasingly being evaluated by risk assessors for potential use as the basis for setting regulations to protect human health.  The available data are of often of varying internal quality and generalizability and care must be taken in considering their utility in epidemiology studies and in risk assessment. With the focus on the use of environmental epidemiology data for this purpose, issues surrounding inter-study consistency and quality of the epidemiology data and the underlying exposure data are coming to the forefront.  These issues are often limiting factors in fully utilizing these data for public health protection; guidance for designing and evaluating these studies is available but requires discussion and further development.   

The session will focus on (i) the strengths and limitations of exposure data, (ii) the challenges associated with interpreting those data, (iii) instruments available for systematically examining the body of literature, and (iv) the importance of this kind of examination for understanding human exposures.  This overall topic is consequential as these kinds of data may be used to support policy decisions and regulatory actions in the US and internationally and it is only recently that approaches to fully examining the quality of this literature have become available.  The implications of the examples to be presented are applicable to epidemiology studies that rely upon environmental and biological samples to characterize exposure, and to all chemistries.
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Symposium Session sponsored by the Ethics Committee (Monday, September 25th, 2017, pm)
 
Title: Untangling the Ethical Intersection of Epidemiology, Human Subjects Research and Public Health
 
Co-Chairs: WayWay Hlaing and Jennifer Salerno
Moderator: Ken Goodman
 
                Epidemiologists are engaged in ethical and scientific decision-making at all levels of research and practice. There is often little discussion or guidance on the ethical reasoning required along the continuum of the professional practice of epidemiology, especially in diverse, non-traditional and specialized areas of epidemiology and public health practice. Ethical reasoning may play a role in a number of areas; from consideration of the study methods/design, data collection/analysis to program planning, evidence-based practice, knowledge translation, and communication of findings.  A number of high profile examples, mostly in the topic area of communicable diseases and emergency responses have highlighted the ethical principles of autonomy, informed consent and balancing the protection of individual harm versus benefit. While technology-driven molecular and genetic epidemiology have underscored the ethical principles of individual privacy and confidentiality. This session will focus on untangling the ethical intersection of epidemiology, human subjects research and public health, and will offer guidance to epidemiologists when challenged with ethical reasoning under conditions of uncertainty.
 
Speaker 1: Edward Peters, School of Public Health, Louisiana State University
Title: Overview of ethics and epidemiology
 
Speaker 2: Susan Pinney, University of Cincinnati Department of Environmental Health
Title: Very high biomarker levels in environmental epidemiology research: A void in guidance for investigators
 
Speaker 3: Stephanie Morain, Center for Medical Ethics and Health Policy, Baylor College of Medicine
Title: Interface of epidemiology, human subjects research, and public health interventions
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Refugee Health: Global and Domestic Perspectives

Organizer: Lorna Thorpe, PhD, MPH, FACE, NYU School of Medicine
Moderator: Olivia Carter-Pokras, MHS, PhD, FACE, University of Maryland

Speakers:

Heike Thiel de Bocanegra, MPH, PhD, University of California, San Francisco
J. David Ingleby, MA, PhD, University of Amsterdam
Sonita Singh, MPH, PhD, Tulane University School of Law

The cumulative total of persons forced to leave their country for fear of persecution or organized violence reached an unprecedented 24.5 million by the end of 2015. Receiving countries are challenged with providing equitable access to appropriate health services for these highly diverse newcomers. In this case study, we showcase the importance of translating epidemiology into policy to address the health needs of refugees by highlighting lessons learned from effective examples, as well as identifying important policy-relevant gaps in knowledge. We formed an international working group of epidemiologists and health services researchers to identify available literature on the intersection of epidemiology, policy, and refugee health. We created a synopsis of findings to best inform a recommendation for integration of policy and epidemiology to support refugee health in the US and other high-income receiving countries. Eight key areas were identified that guide the involvement of epidemiologists in addressing refugee health concerns. The complexity and uniqueness of refugee health issues, and the need to develop sustainable management information systems, require epidemiologists to expand their repertoire of skills to identify disease patterns among arriving refugees, monitor access to appropriately designed health services, address inequities, and communicate with policy makers and multidisciplinary teams.
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Advancing Risk Stratification for Precision Prevention: Methodologic, Clinical, and Ethical Considerations for Rare Diseases

Chair(s):
Jessica L. Petrick, PhD, MPH, National Cancer Institute, Division of Cancer Epidemiology and Genetics
Ronald C. Eldridge, PhD, MPH, National Cancer Institute, Division of Cancer Epidemiology and Genetics

Names/Affiliations of Speakers:
Speakers:
Nancy Cook, ScD, MS, Professor, Department of Epidemiology, Harvard School of Public Health, “Current methodological concepts in risk reclassification”.
Teri Manolio, MD, PhD, Director, Division of Genomic Medicine, National Human Genome Research Institute, “Risk Prediction in the Genomic Era”
Ashley I. Naimi, PhD, Department of Epidemiology, University of Pittsburgh, “Machine Learning for Risk Stratification of Rare Outcomes: Examples from Reproductive/Perinatal Epidemiology”
Steven Coughlin, PhD, MPH, Associate Professor, Augusta University, “The Relevance of Public Health Ethics to Rare Diseases”.

The National Institutes of Health is in the process of launching the Precision Medicine Initiative Cohort-Program, which aims to leverage large-scale data to determine the risk of multiple diseases based on environmental exposures, genetics, and biomarkers. Epidemiology has had some success in risk stratification for more common diseases, such as utilization of biomarkers for cardiovascular disease and screening for cervical and colorectal cancer. However, methods for stratifying risk of rarer disease are lacking, as we need sufficient sample sizes to produce and implement effective risk stratification algorithms. Thus, the focus of the proposed symposium is to describe how methods of risk stratification utilized for common diseases can additionally be applied to precision prevention of rare diseases. The speakers will cover the methodologic, clinical/applied, and ethical implications of risk stratification for rare outcomes. 
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Advancing Policy-Relevant Epidemiologic Research on the Social Determinants of Health

Chair: Daniel Kim, MD, DrPH, Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University

Speakers:
Katherine Theall, PhD, Tulane University School of Public Health, New Orleans, “Social Determinants of Health and Health Equity: Closing the Gap on Maternal and Child Health Disparities”
Kelli Komro, PhD, MPH, Rollins School of Public Health, Emory University, Atlanta, “Effects of State-Level Minimum Wage and EITC Policies on Infant Health Outcomes”
Daniel Kim, MD, DrPH, Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, “Novel Approaches to Estimating Impacts of State-Level Social Determinants on Adult Health”

Along with the theme for this year's ACE Annual Meeting, "The Methods of Translating and Disseminating Epidemiology into Public Health", the National Institutes of Health and Healthy People 2020 have called for research on the social determinants of health to help the nation achieve health equity and eliminate health disparities. Increasingly in recent years, calls have also been made for an epidemiology that is 'consequential' in nature—an epidemiology that is more directly linked to interventions or policies to address population health issues of concern. In this symposium, we present epidemiologic research on the estimated impacts of modifying key social and economic determinants of health that carry direct policy relevance. Professor Theall will present her work on the social and policy contexts impacting maternal and child health outcomes, including awareness and implementation of workplace policies, the role of state reproductive policy (e.g., sex education, Medicaid expansion, abortion policies) on adverse birth outcomes, and the impact of structural racism on infant mortality in the United States. Professor Komro will report her empirical findings from longitudinal evaluations of policies shaping family economic conditions [e.g., state minimum wage laws, state Earned Income Tax Credit (EITC) laws] on birth outcomes and infant mortality in the United States, that implement a difference-in-differences approach across all 50 states continuously from 1980 to present. Professor Kim will present his findings on the impacts of paid vacation leave on depression using fixed effects analysis, on U.S. state social spending (e.g., public welfare spending) and income inequality on adult mortality using instrumental variable analysis, and on the projected impacts of policies that modify current federal tax structures and income redistribution on mortality using microsimulation. These presentations will be followed by a Q&A panel discussion of next steps for the field. This symposium promises to highlight novel social epidemiologic research that will suggest new avenues for epidemiologists to perform policy-relevant translational research on the social determinants of health.
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Antimicrobial Resistance: Shaping Policy Solutions through Epidemiology

The rapid pace of emerging antimicrobial resistance (AR) is a major public health threat. Infections due to AR pathogens have increased significantly in recent years in both community and healthcare settings. AR is associated with worse clinical outcomes including increased mortality, as well as increased cost. In the United States, AR infections currently cost the health-care system more than $20 billion annually and result in 8 million additional hospital days. Finally, there is an increasing awareness that AR is a global problem, recognized as such recently by the United Nations and the World Health Organization. Existing efforts to combat AR have been unsuccessful in large part due to our limited understanding of the clinical and molecular epidemiology of AR pathogens. Expanding this scientific knowledge base is critical to better target effective treatment and preventions strategies. Specific problems include limited antimicrobial stewardship (particularly outside the acute care hospital setting), lack of understanding of regional spread of AR pathogens, limited focus on preventing colonization with AR organisms, inadequate rapid diagnostic capacity to guide treatment decisions, insufficient training and supervision of health personnel, and limited numbers of new investigators entering the field.

This plenary session would explore how epidemiology can be used to shape policy solutions to prevent healthcare associated infections, reduce the development of antimicrobial resistance, and improve treatment of resistant infections.

Speakers/Topics
Ebbing Lautenbach, MD, MPH, MSCE
University of Pennsylvania
“The Antimicrobial Resistance Crisis: Urgent Need for Action”
Note: this talk would focus on the current state of AR including describing the general epidemiology and impact of AR, recent trends in AR, and the globalization of AR”

Susan Huang, MD, MPH
University of California at Irvine
“Strategies to Curtail AR Healthcare Infections: Translating Data into Practice”
Note: this talk would focus on various epidemiologic studies that have assessed the impact of strategies designed to limit healthcare-associated infections. This could focus on multicenter studies that have assessed the impact of different strategies on reducing device-based infection as well as intervention to limit colonization with AR pathogen. The role of this work in driving hospital policies would also be addressed.

Mike Lin, MD, MS
Rush University
“Thinking Regionally: Novel Approaches to Tracking Spread of Antimicrobial Resistance”
Notes: this talk would focus on new approaches to tracking AR pathogens and patients colonized or infected with AR pathogens across clinical settings regionally. Dr. Lin oversees a novel academic/public health partnership with the state of Illinois to do just this. Implications of such programs for state and federal policy would be explored.
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