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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.


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.


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.


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.


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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