Re-thinking Alzheimer’s disease therapeutic targets using gene-based tests
Alzheimer’s disease (AD) is a devastating condition with no known cure. Existing drugs only alleviate symptoms. Given repeated and costly drug failures, CUNY SPH Professor Mary Schooling and colleagues assessed whether approved and investigational AD drugs are targeting products of genes strongly associated with AD and whether these genes are targeted by existing drugs for other indications which could be re-purposed.
Schooling and her team identified genes strongly associated with late-onset AD from the loci of genetic variants associated with AD at genome-wide-significance and from a gene-based test applied to the most extensively genotyped late-onset AD case (n = 17,008)-control (n = 37,154) study, the International Genomics of Alzheimer’s Project. They used three gene-to-drug cross-references, Kyoto Encyclopedia of Genes and Genomes, Drugbank and Drug Repurposing Hub, to identify genetically validated targets of AD drugs and any existing drugs or nutraceuticals targeting products of the genes strongly associated with late-onset AD.
A total of 67 autosomal genes were identified as strongly associated with late-onset AD. Existing approved or investigational AD drugs did not target products of any of these 67 genes. Drugs for other indications targeted 11 of these genes, including immunosuppressive disease-modifying anti-rheumatic drugs targeting PTK2B gene products.
The researchers found that approved and investigational AD drugs are not targeting products of genes strongly associated with late-onset AD. However, other drugs targeting products of these genes exist and could perhaps be re-purposing to combat late-onset AD after further scrutiny.
“This study shows the value of systematically searching bioinformatics resources to discover new leads concerning the prevention or treatment of complex diseases,” Schooling said.
Kwok, MK, Lin Lin, S, Schooling, MC. Re-thinking Alzheimer’s disease therapeutic targets using gene-based tests. EBioMedicine, Volume 0 , Issue 0.
Hazardous air quality in New York City nail salons
In 2016, New York State put forth regulations to improve indoor air quality in nail salons by requiring the business owners to install local exhaust ventilation systems. In advance of the full implementation of the rules by 2021, Brian Pavilonis, Assistant Professor at CUNY SPH, led a pilot study to establish reliable and usable baseline indoor air quality metrics to determine the feasibility and effectiveness of the requirement. The findings were published in The Journal of Occupational and Environmental Hygiene.
Pavilonis and his team measured carbon dioxide and total organic volatile compounds (TVOC) in ten nail salons in Manhattan, Queens, and the Bronx. Concentrations of TVOC varied between nail salons with an almost tenfold increase in concentrations observed in salons with poor ventilation.
“In order to reduce airborne concentrations of TVOC, nail salons need to continuously use their HVAC system and not recirculate air,” Pavilonis said.
Pavilonis B, Roelofs C, Blair C. J. Assessing Indoor Air Quality in New York City Nail Salons Occup Environ Hyg. 2018 Mar 1:1-23. doi: 10.1080/15459624.2018.1447117
Acceptability of a prophylactic vaginal ring as an HIV prevention method
Dana Watnick, a doctoral student at CUNY SPH, authored a study examining the use of pre-exposure prophylaxis in the form of a vaginal ring as an HIV prevention method for women.
Through a randomized placebo-controlled trial of a tenofovir disoproxil fumarate intravaginal ring, Watnick and colleagues assessed the acceptability of the product among its users through in-depth interviews with 18 women in New York City during and after 14 days of continuous use. The results were published in the journal AIDS and Behavior.
The women reported that the ring was comfortable with few side effects, regardless of whether they received the active ring or the placebo ring. However, interest in future use of the ring by this cohort was modest.
“Most women wouldn’t even consider ring use because they didn’t think they were at risk for HIV,” Watnick said.
Watnick’s findings suggest that future studies should continue to identify and address individual and relationship factors that influence acceptability, early in the product development process.
“In order to develop these rings so that that women might actually use them, it is crucial to understand what makes these rings acceptable or not to women,” Watnick concludes.
In April 2018, Watnick was awarded a $20,000 American Fellowship by the American Association of University Women (AAUW) to fund her dissertation work on the acceptability of a vaginal ring to prevent HIV and pregnancy.
Watnick D, Keller MJ, Stein K, Bauman LJ. Acceptability of a Tenofovir Disoproxil Fumarate Vaginal Ring for HIV Prevention Among Women in New York City, AIDS & Behavior (2018) 22: 421.
Improvements in fitness bring improvements in attendance among high-poverty NYC students
In high-poverty, urban school districts in the United States, only one in four youth ages 12-15 meet international physical activity recommendations. This raises concern given a well-established link between youth physical activity and health, and potential associations with school academics and attendance. One-fifth to one-third of students in high-poverty, urban school districts do not attend school regularly, missing around six school days per year.
In a study published in The Annals of Epidemiology, Dr. Emily D’Agostino, a CUNY SPH doctoral alum, and Dr. Katarzyna Wyka, Assistant Professor of Epidemiology and Biostatistics, observed six cohorts of New York City public school students from 2006 to 2012 to test the association of fitness changes and attendance across gender and poverty subgroups. The team found that, among girls attending schools in high poverty areas, greater improvements in fitness the year prior were associated with greater improvements in attendance. Girls with a large increase in fitness (greater than 20 percent) demonstrated 10.3 percent fewer days absent per year compared with those who had a large decrease in fitness.
“We hope that further research will examine the potential for school-based physical activity programs to improve attendance, particularly in high poverty neighborhoods,” D’Agostino said.
D’Agostino EM, Day SE, Konty KJ, Larkin M, Saha S, Wyka K. The association of fitness and school absenteeism across gender and poverty… Annals of Epidemiology Volume 28, Issue 3, March 2018.
“We’re on our own”: home health care workers report inadequate support from employers
Home health care work is not only physically demanding, but also emotionally taxing.
Home care workers do an enormous amount of emotional labor to keep clients feeling safe, calm and happy. This work can be rewarding but also very stressful. The stressful aspects often go unrecognized and are not necessarily reflected in job descriptions, training, or pay.
CUNY SPH researchers Emily Franzosa, a graduate of the doctoral program, and Assistant Professor Emma Tsui led a study examining home health workers’ perceptions of the emotional effects of caring work, how they cope and how they would like to be supported by their employers. The findings were published in The Gerontologist.
The health care aides responded that more connection with their supervisors and the care team, as well as structural supports like paid time off, more control over their schedules, and access to counseling and mental health benefits would help them better cope with job-related stress.
“Overwhelmingly, aides told us that they loved their jobs and their clients, but they needed more support,” Franzosa said. “If we’re going to retain a skilled, qualified workforce that can meet the needs of our aging population, we need to acknowledge aides’ emotional labor, and build that into the way we train workers and supervisors, design care plans, and pay for care.”
Franzosa E, Tsui EK, Baron S. “Who’s Caring for Us?”: Understanding and Addressing the Effects of Emotional Labor on Home Health Aides’ Well-being. Gerontologist. 2018 Aug 17. doi: 10.1093/geront/gny099.
Genetic determinants of telomere length in African American youth
Telomeres are DNA-protein structures that play a vital role in maintaining DNA stability and integrity. Telomere length (TL) is an important biomarker of aging and overall health, but has been mostly studied in adult populations of European or Asian ancestry. Previous studies identified 34 TL-associated genetic variants recently used as genetic proxies for TL.
CUNY SPH Professor Luisa N. Borrell was one of the senior authors of the first genome-wide association study of TL among African American youth, published in the journal Scientific Reports. The study notes that the lack of research on factors affecting TL in pediatric and non-European populations creates a knowledge gap in the scientific understanding of gene-environment interactions regulating telomeres.
Borrell and colleagues measured TL from whole blood samples of 492 healthy African American youth (between 8 and 20 years old) and were unable to replicate either the 34 reported genetic associations found in adults or the six genetic associations found in European children. The study also identified novel genetic associations with TL that have not been identified in previous studies. The findings suggest that genetic markers of TL are not generalizable across all populations.
“Our results underscore the importance of examining genetic associations with TL in diverse pediatric populations such as African Americans and call attention to include Hispanic pediatric populations, an admixture population when it comes to ancestry, in TL studies,” said Borrell.
Further telomere research is needed in pediatric populations from diverse ancestral backgrounds, Borrell said.
Zeiger AM, White M, Eng S, Oh SS, Witonsky J, Goddard PC, Contreras MG, Elhawary JR, Hu D, Mak ACY, Lee EY, Keys KL, Samedy LA, Risse-Adams O, Magaña J, Huntsman S, Salazar S, Davis A, Meade K, Brigino-Buenaventura E, LeNoir MA, Farber HJ, Bibbins-Domingo
Study finds family-cap policies are an ineffective approach to welfare reform
Federal welfare reform legislation enacted in 1996 was designed to discourage poor women from bearing children by allowing
a family-cap policy prohibiting the increase in cash assistance when a new child was born into a family. While there was some initial backlash claiming the legislation violated reproductive and human rights, in the ensuing two decades concerns about the policy have not been loudly raised.
A study co-led by CUNY SPH Associate Professor Diana Romero and Madina Agenor, Assistant Professor at Harvard University’s T.H. Chan School of Public Health, surveyed officials from the 24 states that implemented family-cap policies about their opinions on the policy’s status, implementation, effectiveness, benefits, and disadvantages. Their findings were published in the Journal of Poverty and Social Justice.
The study found that most officials feel the policy’s administrative burden and negative economic impact on poor families outweigh its potential benefits. Analysis of the interviews suggest that the inclusion of the family-cap policy among other welfare reforms was “more symbolic and punitive than substantive.” This study provides empirical support to criticisms of the family-cap policy that were raised shortly after the passage of the welfare reform legislation.
Romero, D., & Agénor, M. (2018). Twenty years post US welfare reform and state family caps aka child exclusion: An overdue assessment. Journal of Poverty and Social Justice, 26(2), 151-171.
Racial and gender discrimination among teens exposed to dating violence
Teen dating violence (TDV) is an urgent public health concern associated with a range of lasting mental, sexual, and behavioral health consequences. Studies have revealed high rates of dating violence and sexual coercion among youth of color, with several studies finding black female teens reporting the highest rates of victimization among all demographic groups.
Dr. Lynn Roberts, Assistant Professor of Community Health and Social Sciences, led a study examining the combined associations of racial and gender discrimination and TDV. The findings were published in the journal Ethnicity and Disease.
Roberts and her colleagues applied the Critical Race Theory framework, which asserts that racism is ubiquitous in the lives of people of color, and intersectionality, which recognizes that social identities are interdependent and mutually constitutive, to better understand the disparate impact of TDV on Black female teens.
The study suggests that adolescents reporting both racial and gender discrimination were 2.5 times more likely to experience dating violence than those who did not report racial and gender discrimination. The researchers recommend that future studies of TDV should examine the relationship between experienced racial and gender discrimination, while controlling for correlates at the individual and family levels, in order to understand and address the impact of TDV.
“I am hoping that our findings will open up more pathways for public health researchers and practitioners to consider and explore intersectionality, a central tenet of Critical Race Theory, in their research and interventions,” Roberts said.
Roberts, Lynn, Mahader Tamene, and Olivia R. Orta. The Intersectionality of Racial and Gender Discrimination among Teens Exposed to Dating Violence. Ethnicity & Disease, 2018. doi:https://doi.org/10.18865/ed.28.S1.253.
Neighborhood “greening” may lead to gentrification and displacement
Many post-industrial cities have areas of vacant and derelict land (VDL) which can have negative health and environmental impacts on nearby residents. VDL is located predominantly in poorer neighborhoods, posing a disproportionate risk upon these communities. Repurposing these areas into green spaces and community gardens may mitigate the risk of health and environmental hazards, but they may also result in unintended adverse impacts on the community, particularly displacement stemming from rises in property values due to new-found developer interest in the area.
Using Brooklyn, New York as a case study, CUNY SPH Associate Professor Andrew Maroko and Professor Juliana Maantay of Lehman College examined whether proximity to community gardens in less affluent neighborhoods is associated with an increased likelihood of gentrification. The results were published in the International Journal of Environmental Research and Public Health.
The researchers used Geographic Information Systems and two spatial methods to determine the potential impact of proximity to community gardens in lower-income areas. The researchers found that proximity to community gardens is associated with significant increases in per capita income over the five years study period, which is indicative of areas undergoing gentrification. This has implications for environmental justice because existing lower-income residents are likely to be displaced after their community is improved environmentally.
“We think community led responses to environmental equity issues are extremely important, and our concern is the possibility that the very things which a community can do to improve their local environment may ultimately contribute to their displacement from it,” said Maroko.
Juliana A. Maantay and Andrew R. Maroko, Brownfields to Greenfields: Environmental Justice Versus Environmental Gentrification. Int. J. Environ. Res. Public Health 2018, 15(10), 2233; doi:10.3390/ijerph15102233
The perception of PrEP as an excuse for promiscuity
Since the FDA approved the use of Pre-Exposure Prophylaxis (PrEP) in 2012 to reduce the risk of HIV infection in the event of exposure, the drug’s uptake among gay and bisexual men has been met with conflict, stemming from the perception that those who take the drug are promiscuous and engage in risky sexual behaviors.
A study co-authored by CUNY SPH Professor Christian Grov and Mark Pawson, doctoral candidate at the CUNY, sought to deconstruct the moral debate surrounding biomedical HIV prevention and the complex ways in which PrEP and PrEP users are defined within the gay and bisexual communities. The findings provided important insight into the norms and values that shape the perception of PrEP as being either a useful tool to prevent HIV or a harmful practice encouraging promiscuity and “irresponsible behaviors” among its users.
“Both perceived and experienced stigma of PrEP users are significant barriers to PrEP uptake,” Grov said. “Data show that the number of PrEP users has increased year-over-year since being approved, but uptake is still not commensurate with the need.”
The CDC recently estimated that as many as 1-in-4 gay and bisexual men would benefit significantly from the protection PrEP provides.
Pawson M, Grov C. ‘Its just an excuse to slut around’: Gay and Bisexual Mens’ Constructions of HIV Pre-exposure Prophylaxis (PrEP) as a Social Problem. Sociology of Health & Illness. 2018. doi:10.1111/1467-9566.12765.
Exploring the social epidemiology of the microbiome
The microbiome is emerging as a factor for many diseases for which there are known health disparities, pointing to the opportunity for investigation of this new area of biology in social and population health research. While recent research establishes the importance of the microbiome for human health, data on how the social environment shapes the microbiome is limited.
Jennifer Dowd, Associate Professor of Epidemiology and Biostatistics at CUNY SPH, and recent MPH graduate Audrey Renson published a paper describing potential mechanisms of the social epidemiology of the microbiome. The review appeared in the journal Current Epidemiology Reports.
In the paper, the researchers laid out the many factors that shape the microbiome in humans, such as social relationships, socioeconomic status, and health behaviors.
“While research in this area is still very new, we found evidence of the importance of early life exposures, psychosocial stress, and the built environment in influencing the microbiome,” said Dowd. “We argue that broader consideration of how the social environment shapes the microbiome over the life course is needed to understand variation in the microbiome and ultimately how to intervene on it.”
Dowd JB, Renson A. “Under the Skin” and into the Gut: Social Epidemiology of the Microbiome. Curr Epidemiol Rep. 2018;5(4):432-441.
