The genetic epidemiology program is focused on two major themes: (1) evaluating the role of genetic and environmental contributions in the etiology of chronic mental health and medical conditions and (2) translating the current understanding of the role of genetic and environmental influences on these outcomes into innovative approaches for enhancing the adoption of best practices in the community, clinical practice, and public health. The program maintains active collaborations with several organizations to accomplish these goals, including: the Virginia Institute for Psychiatric and Behavioral Genetics, the Center for Society and Health, and the Seventh District Health and Wellness Initiative of Richmond.
1- The Developmental Genetic Epidemiology of Smoking Behaviors.
The goal of this project is to improve understanding of the genetic and environmental contributions to the development of adolescent and young adult smoking behaviors using extended twin and family samples with previously collected longitudinal data across multiple countries of individuals. This effort represents smoking behavior (ie: initiation, progression, dependence and cessation) data from 16 different samples consisting of over 80,000 adolescent twin pairs. Results from this work are expected to refine future genetic association studies and public health approaches related to smoking behaviors (Hermine Maes, PI- 5R01DA025109).
2- The Seventh District Health and Wellness Survey.
The goal of this project is to develop a framework to maintain sustainable community-based public health research within a collaborative partnership (Seventh District Health and Wellness Initiative, HWI) between residents, elected officials, health care providers, and community organizations working to implement health strategies targeting in the East End. The genetic epidemiology group assists the HWI through its involvement with the Seventh District Health and Wellness Survey. This community-based participatory research project combines the strengths and interests of residents, community organizations, students, researchers to collect and analyze health-related data from east end residents using an online health survey. Preliminary goals include: (1) assessing the current state of health and access to health care in the east end of Richmond, (2) developing the foundation for long-term health-related collaborations in the east end, and (3) testing the feasibility of using an internet-based survey to complete this project. Secondary goals include: (1) developing resident capacity to conduct, analyze and disseminate results from epidemiological data and (2) assessing community readiness to receive genetic information in the form of family health history in a public health setting. Regular updates on this project can be found on the Seventh District Health and Wellness Survey Blog
3- The Relationship between New/Emerging Tobacco Use and Tobacco Use Beliefs Across the Lifespan.
The goal of this pilot study (Elizabeth Prom-Wormley, PI), funded by the VCU Center for the Study of Tobacco Products, is to estimate the associations between functional beliefs/opinions with single- and poly-tobacco use (defined as the use of more than one tobacco product simultaneously) in adults as well as adolescents. Analyses supporting study goals will be conducted using Wave 1 data from the Population Assessment of Tobacco and Health (PATH) sample; a longitudinal population-based study of 32,320 adult as well as 13,651 adolescents (ages 12-17) in the United States. Successful completion of this project is expected to produce results that will inform FDA marketing policies to protect the health of US population across all ages. Results will also develop future research in tobacco regulation as well as nicotine dependence.
4- Evaluating the Relationship between Alcohol Use Reduction and Smoking Cessation.
This project is part of an administrative diversity supplement to the parent grant “Gene-Environment Environment Interaction in Adolescent Alcohol Use” (R01AA015416, PI- Danielle Dick). The specific aims of the project are to: (1) Use twin data to characterize gene-environment processes influencing substance use and externalizing behavior in young adulthood; (2) Conduct a series of exploratory analyses aimed at understanding how gene-environment interaction effects identified in twin data can inform our understanding of GxE effects associated with measured genes via a genome-wide association study; and (3) Test the generalizability of identified GxE effects (both twin and molecular) in a second, independent sample (the Virginia Twin Study of Adolescent Behavioral Development, VTSABD), with phenotypic data collection across a parallel age range and GWAS data. The parent project uses previously collected data from ~5,500 individual twins ages 12-27 participating in the longitudinal, population-based Finnish twin study (FinnTwin12) and a second sample, the VTSABD, with data on ~2800 individual twins followed longitudinally, with substance use assessments during childhood/adolescence (8-16 years) and in the early 20s. The grant involves studying both latent genetic influences (as indexed via twin models) and specific measured genetic influences, through the analysis of GWAS data available on both samples.
Maternal and Child Health
The Maternal and Child Health epidemiology research program in the Division of Epidemiology is focused on improving the health and well-being of women, children and families. This research includes issues related to perinatal health, provision of comprehensive care to underserved pregnant women, infant development and school readiness, youth violence, sexual violence prevention, and assessment of women’s health status.
Current projects in this research area include:
- Postpartum Study (PI: Masho): This study compares the effectiveness of a shortened postpartum interval with the standard interval on the rates of postpartum visit attendance, contraceptive use, unintended pregnancy and Rapid Repeat of Pregnancy in predominantly underserved areas. Additionally, the study evaluates the cost-effectiveness of the different visit schedules. This study is a collaborative project between the VCU Institute for Women’s Health, Department of Obstetrics and Gynecology, Division of Epidemiology in the Department of Family Medicine and Population Health and University of Vermont. The study is financially supported through a federal grant awarded by the Agency for Healthcare Research and Quality (AHRQ).
- Virginia Strong Start (PI: Masho): The Strong Start Project compares the Centering Pregnancy prenatal care model with the usual prenatal care in reducing poor birth outcomes among Medicaid recipient high risk pregnant women. This multisite project is a collaborative effort with the Richmond Health District, Manassass Midwifery Women’s Health Center, Greater Prince William Community Health Center, VCU’s Obstetrics and Gynecology department and Shenandoah Women’s Healthcare. Partners include Virginia Chapter March of Dimes, Virginia Department of Medical Assistance Services (DMAS), Virginia Department of Health and the Centering Healthcare Institute (CHI). The project is funded through a federal grant awarded by the Centers for Medicare and Medicaid Services (CMS).
- Evaluation of the Healthy Start Initiative (PI: Masho): The goal of this project is to evaluate a comprehensive case management program designed to reduce perinatal disparity among at-risk and underserved African American women in Richmond, Virginia. The Healthy Start Evaluation Project is funded by the Maternal and Child Health Bureau, HRSA (HRSA) and contracted by the Richmond Social Services Department (RSS).
- Oral Probiotic Bacteria Supplementation to Reduce Harmful Inflammation and Attenuating Immune System Deterioration in HIV-infected Malian Women (Co-PI: Masho): This study assesses beneficial intestinal bacteria before and after probiotic administration in HIV infected women in Mali and the relation to immune system functioning. Intervention is performed in two clinics in Segou, Mali, serving 60,000 people. This is a collaborative study between researchers from the VCU Institute for Women's Health, VCU schools of Medicine, Nursing, and World Studies in the VCU College of Humanities and Sciences. Daniel Nixon, DO, PhD (Co-PI), director of the VCU HIV Center leads the scientific implementation of project and leads the partnership in Mali. The study is funded through the Grand Challenges Explorations Grant, awarded by the Bill and Melinda Gates Foundation.
- Women’s Stroke Prevention Initiative (Masho Co-I): This initiative focuses on examining the efficacy of electronic stroke screening and management tools in identifying and managing risk factors to stroke. The project aims to promote stroke prevention in women, with a focus on underserved populations. Dr. Masho serves as a Co-I, lead epidemiologist on the study. Warren Felton, M.D., professor of neurology and the medical director of the VCU Stroke Center, is the project’s principal investigator. Susan Kornstein, M.D., professor of psychiatry and obstetrics/gynecology and executive director of the Institute for Women’s Health, serves as the co-principal investigator. This study is a collaborative project between the VCU Institute of Women’s Health, the Departments of Neurology, Internal Medicine, and Family Medicine and Population Health. The Women’s Stroke Prevention Initiative is supported by a competitive grant from Pfizer.
- Healthy Families for Youth: A comprehensive community-level intervention to reduce youth violence (Masho Co-P): The goal of the proposed research is to implement and evaluate the impact of a comprehensive community-level youth violence prevention strategy that integrates the Communities That Care prevention system and the Walker Talker community outreach and capacity building approach (CTC PLUS) in three high-risk urban communities. The project will assess the impact of the intervention on: a) primary youth violence outcomes (e.g., homicides and intentional injuries); b) proximal outcomes including decreased neighborhood disorganization, increased numbers of youth served by high quality, evidence-based violence prevention programs, and decreased risk and increased protective and promotive factors associated with youth violence; and c) aspects of neighborhood and community readiness and capacity associated with youth violence prevention. Findings from this study will inform youth violence prevention strategies in other communities.
- Stress, social support and disparities in perinatal outcomes: an exploration of the influence of stress and social support on poor pregnancy outcomes and its role in perinatal disparities.
- Sexual and reproductive decision making: an exploration of social and environmental factors affecting decisions related to sexual and reproductive health and the contextual factors that influence a woman’s ability to control if and when to have children.
- Breastfeeding research: exploring factors influencing disparities in breastfeeding and factors affecting breastfeeding behaviors.
Traumatic Brain Injury
The Traumatic Brain Injury (TBI) research program in the Division of Epidemiology is primarily focused on advancing clinical research methods in search of effective treatment for patients with TBI. The activities include (I) research collaborations with the IMPACT investigators on (i) improving experimental study design in TBI research and (ii) understanding the impact of outcome misclassification in TBI clinical trials in order to develop new methods minimizing Glasgow Outcome misclassification in TBI clinical trials; (II) research collaborations with the Oslo University Hospital and Oslo University, Norway on (i) evaluating health and economic outcomes in TBI research, (ii) developing effective rehabilitation intervention programs for patients with moderate and severe TBI, and (iii) studying long-term outcomes following moderate and severe TBI. Several selected projects are briefly described below:
Minimizing outcome misclassification in TBI clinical trials: This work aims at understanding the impact of Glasgow Outcome misclassification through sensitivity analysis in order to develop, validate and implement an online outcome data collection tool that minimizes outcome misclassification in TBI clinical trials. This is a collaborative research effort with IMPACT investigators (International Mission for Prognosis and Analysis of Clinical Trials in TBI), and the project was funded by NIH and sponsored by BHR Pharma in later phase.
Cost analysis in TBI research: This work is to promote a standardized methodology to estimate health and economic outcomes for TBI research in general and to perform a cost-effectiveness analysis for a TBI rehabilitation program in particular. This is collaborative research with Dr. Nada Andelic and investigators from the Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Norway.
Developing effective rehabilitation intervention programs at post-acute phase following TBI: Two rehabilitation intervention studies were funded recently by the Norwegian Health Council. One intervention was designed to target at the community level, and the other was designed with combined cognitive and vocational intervention components for patients with TBI. This is collaborative research with the Department of Physical Medicine and Rehabilitation, Oslo University Hospital and Research Center and Rehabilitation Models and Services (CHARM) at Oslo University, Norway. I am a guest professor for the program of CHARM and PI via a subcontract.
Studying long-term outcomes following moderate and severe TBI: A couple of activities are ongoing to (1) understand the trajectories of long-term functional outcomes and (2) multi-dimensional outcomes following moderate and severe TBI. Again, this is a collaborative research effort with CHARM.
The social epidemiology research program in the Division of Epidemiology is grounded in fundamental cause and life-course theories, and is focused on empirically documenting associations between "upstream" social determinants and adverse health outcomes. This program of research lies at the intersection of civil rights and social justice and is focused on: (1) understanding race/ethnic and gender disparities in health; (2) identifying biologic, behavioral and psychosocial mechanisms of associations between social determinants and health disparities; (3) conducting within-group analyses and examining effect modification to identify high risk groups, as well as protective factors for adverse health outcomes; (4) identifying policy-amenable social determinants of health; and (5) designing intervention studies focused on modifiable social, psychosocial, biologic and behavioral risk factors.
The VCU Center on Society and Health is an academic research center that studies the health implications of social factors—such as education, income, neighborhood and community environmental conditions—and public policy. Its mission is to is to raise awareness about the importance of factors outside of health care that shape health outcomes and to explore ways to improve population health and wellbeing. The values the Center brings to this work include a commitment to equity--opening the doors of opportunity for all members of society--and to partnerships that work across sectors to help stakeholders discover aligned incentives and together achieve meaningful impact. The Center approaches this work by blending four ingredients for success: (1) user-oriented research—scientific scholarship directed at delivering actionable and policy-relevant findings and evidence sought by decision-makers; (2) policy outreach—active efforts to meet with decision-makers in all sectors to gain deep familiarity with the decision-making environment, priorities, and language; (3) stakeholder and community engagement—engaging with affected populations and other stakeholders with an intimate understanding of priorities, context, key questions, and feasible solutions; and (4) strategic communication—an organized effort to identify target audiences and prepare materials and media in a tailored format that is engaging and accessible to the audience. The Center pursues these goals through collaboration with scholars in different disciplines at VCU and other institutions, and by nurturing partnerships with community, government, and private-sector stakeholders.
The psychiatric epidemiology research program in the Division of Epidemiology is focused on examining the determinants of psychiatric and behavioral health conditions in the population and how those determinants change over the life span. This research aims to understand the interface between behavior and physiology to integrate social, psychological, and biological approaches to understanding mental health and illness over the life course. Active collaborations with the Virginia Institute for Psychiatric and Behavioral Genetics (VIPBG) and the University of Michigan Institute for Social Research (RCGD) and Center for Integrative Approaches to Health Disparities (CIAHD) contribute to this effort.
Current projects in this research area include
- Stress, Coping, and Mental Health Disparities: This project is a partnership with investigators at the University of Michigan CIAHD to examine the role of stress-coping behaviors on racial disparities in mental and physical health. Other studies in this vein include the Stress and Sugar Study, an ongoing pilot investigation of the role of stress reactivity and glucose metabolism among African Americans with pre-diabetes funded by the VCU Center for Clinical and Translational Research (CCTR). Dr. Jeanne Concha is expanding on this work to investigate how cultural factors influence the relationship between stress and diabetes risk.
- Depression, Inflammation, and Diabetes: Exploring Shared Etiopathology: This project leverages genetically-informed data (e.g., twin and family studies) to examine the interplay of genetic and environmental factors that contribute to the comorbidity between depression and type 2 diabetes. This work is supported by a grant from the National Institute of Mental Health (MH093642-A1). As part of this project we are examining the relationship between depressive symptoms and expression of immune-related genes in collaboration with Dr. Steve Cole at UCLA.
- Neighborhood context, depression, and type 2 diabetes: This project aims to understand how contextual environmental characteristics (e.g., neighborhood deprivation, social capital, walkability, access to goods and services) influences the risk of depression, type 2 diabetes, and their comorbidity. This work is a partnership with Dr. Kristina Sundquist of the Centre for Primary Care Research at Lund University in Malmo, Sweden, and is funded by the National Institute for Diabetes, Digestive, and Kidney Diseases (DK8356430-A1).
Other areas of research in this program include:
- Depression and Frailty in Later Life: An exploration of the interrelationship between depression and frailty among older adults originally sponsored by the VCU Building Interdisciplinary Research Careers in Women's Health (BIRCWH) Program. Work in this area is continuing through support by the National Institute of Aging (PI: Matthew Lohman). Related projects include investigations of the predictors and consequences of mobility for health and functioning in later life, a collaboration led by Dr. Moon Choi.
- Suicide Risk in Senior Living Facilities: Although older adults have the highest suicide risk, little is known about the epidemiology of suicide risk in senior living facilities (assisted living, nursing homes). This project uses data from the Virginia Violent Death Reporting System (VDRS), in partnership with the Virginia Office of the Chief Medical Examiner, to explore the incidence and risk factors for suicide among older adults in senior living communities.
The goal of this line of research is to inform interventions which reflect an integrative approach to health to effectively reduce the burden of mental disorders in mid and late-life.
Additional information on this research is posted at the website for the Group for Research on the Epidemiology of Mobility, Aging, and Psychiatry (GREMAP).