EP42 Live from the 2019 NYC Epidemiology Forum [Part 1]

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I AM GPH EP42 Live from the 2019 NYC Epidemiology Forum [Part 1]

EP42 Live from the 2019 NYC Epidemiology Forum [Part 1]

Chris Alexander: Hello and welcome to Part One of a special live edition of the I AM GPH podcast. I'm Chris Alexander, director of communications and promotion here at the College of Global Public Health and in this episode we get to hear from a variety of researchers who presented their work at the sixth annual New York City Epidemiology Forum held at the NYU School of Law. This annual event provides a forum for students and epidemiologists working in the New York City area to network, present their work and discuss opportunities for hopefully future collaborations. We learned about environmental pollution, the stigma of violence, sexual health, health data and analytics, cardiovascular disease, and so much more. So please enjoy this wide ranging selection of short interviews from the sixth annual New York City Epidemiology Forum. Can you start out by introducing yourself and tell us a little bit about the research that you're presenting here today?

Jimmy Ocrevus: My name is Jimmy Ocrevus. I am a data scientist at the Alzheimer's Disease Research Center at Icahn School of Medicine at Mount Sinai. The research that I'll be presenting here today is as follows. There is a wide range of research that shows that as a consequence of having to adapt to much more stressful environmental circumstances, low socioeconomic groups tend to experience much higher rates of disease mortality, biological dysregulation, and they tend to experience these at a much younger age than higher socioeconomic groups. Research also shows that biological dysregulation that is experienced by low SES groups also affects cognitive function. What I want to do in my research was to a: construct a measure of cumulative biological risk, the type of risk that is experienced in higher rates by low socioeconomic groups based on parameters for cardiovascular function, metabolic and immune system function. I wanted to test the hypothesis that this particular measure of cumulative biological dysregulation would mediate socioeconomic disparities and cognitive function in old age. That is the gist of what I did.

Chris Alexander: So why this topic of research? What drew you to go down this road?

Jimmy Ocrevus: There are several reasons. Socioeconomic disparities and health disparities in general are a major social problem. For example, the effect of dementia in our economy and on a person’s lives and families and economic output is substantial. Currently it is about a third of $1 trillion annually. That is a loss in economic productivity, a cost of treating people with dementia. We know from really well-conducted epidemiological studies that lower socioeconomic groups tend to have 2-3 higher odds of experiencing dementia. It's a debilitating disorder and being that this is something that we can control, there is no reason why we should be incurring the economic loss and personal loss that dementia and disorders of cognitive impairment in old age impact.

Chris Alexander: Can you share with us one of the biggest challenges you have faced or are facing with this research and how you're approaching it. Did you have a creative approach? How are you thinking through that challenge?

Jimmy Ocrevus: I've thought about this question. As with every other research study, there were methodological challenges and one of the challenges that was really interesting to me, that was a learning experience, was that because of the higher rates of mortality in lower socioeconomic groups, we have what's called a survivor bias, a survivor effect. By the time you study people who are in their seventies or eighties, which consisted as substantial part of the sample that I was studying, this is no longer a subset of the population that was relevant in mid life, in their forties or fifties, and it does have an effect on the effect sizes that I was studying from socioeconomic effect on biological dysregulation. The people I was looking at were slightly healthier individuals who were able to survive until that older age despite their adversity. That was one methodological issue that was a learning experience for me.

Chris Alexander: Thank you so much for sharing. Thanks for joining us.

Jimmy Ocrevus: Thanks.

Maria Miangel: I'm Maria MiAngel and I'm a doctor and an MPH candidate from NYU 2019. I presented research about gender differences in healthcare utilization, hypertension diagnosis and hypertension knowledge. The data used was from a survey done in an urban community in Eastern Ghana and the data set consisted of 118 participants who had uncontrolled blood pressure and that was defined by having a blood pressure over 140 over 90 at the time of the survey.

Chris Alexander: Why this topic? What drew you personally to look at this area and this research?

Maria Miangel: First of all, involving women in research is recent and I came across literature that said that men in urban Ghana, their blood pressure control was not as good as that of women. Given that and the fact that involving women in research is new and recent and people are starting to acknowledge the different social, cultural and biological processes and pathways and intermediaries in disease, I thought it would be interesting to know why men in Ghana were not getting a blood pressure control as good as women. I went out to find out if it was actually true and what exactly was involved in coming to that health outcome.

Chris Alexander: If you were to raise awareness about this issue, first of all, do you think that's important? And second of all, what would that look like? How would that happen to raise awareness about this issue?

Maria Miangel: If I were to raise awareness about this issue right now, I think the study I did is really quantitative research. It indicates that the numbers show there’s a problem in this area. Before I actually got to raise awareness, I would want to do qualitative research and a study to find out how and why and all the processes involved before I actually decide that this is how I want to raise awareness, because sometimes giving people information alone without understanding all these other social-cultural contexts does not make much of a difference. I would definitely want to do that first. I think it's definitely important to raise awareness, but after understanding everything involved and all the processes and the context and how to go about it.

Chris Alexander: Can you tell us about one challenge that you had while looking through this data and doing this research and how you approached that challenge? Did you take any creative steps or anything?

Maria Miangel: First of all, I was not on the ground collecting the data, so I just used the secondary data set and that comes with these issues because the dataset is not tailored to your research question. My data set had a bigger representation of women than men. It was about 80% women and 20% men. Because of that difference, it was hard to come up with statistically significant differences. At that point I decided to look at the differences in proportions instead of focusing on statistical significance. If I found more than 10% differences in proportions in the category, then I thought that that's definitely something you want to look at more in detail.

Chris Alexander: Are there any common myths or misunderstandings around this topic that the public may misinterpret or anything like that? Is there anything that you can shed light on for us?

Maria Miangel: I wouldn't say misinterpret or myths because I think a lot of focusing on Sub-Saharan Africa and low- and middle-income countries has been on infectious diseases and we are now seeing that cardiovascular disease and chronic conditions are becoming more common and a bigger cause of death in Sub-Saharan Africa because I think at the moment 80% of the deaths due to cardiovascular disease were in Africa. I would say that at the moment there's more focus on the communicable diseases because I guess it's easier to see differences when you actually do an intervention in infectious diseases. It's cheaper to invest in, it's not as hard as investing in, say, a noncommunicable disease like hypertension or CVD because I think it takes a while, it's a process and the impact is not as immediate and probably would not be as huge in the short run as you would get in an infectious disease. I would say that might be the problem, not so much a myth, but I guess these are biased to focus on infectious diseases when it comes to low- and middle-income countries.

Chris Alexander: Great. Thank you so much for sharing.

Maria Miangel: You're welcome

Ariadna Capasso: I'm Ariadna Capasso. I'm a second year PhD student in social behavioral sciences at the College of Global Public Health and today I'm going to be presenting on intimate partner violence in conflict affected areas of Ukraine, particularly Eastern Ukraine. This is from data. This is a collaboration with HealthRight International. That's an NGO affiliated with NYU. HealthRight runs a program where they have mobile teams that provide psychosocial support to survivors of gender based violence. I've taken some of this data. It's data from intake forms from women, 15 to 69 year old women, who survived gender based violence and are coming to seek support. Gender based violence includes violence that can be physical, sexual, psychological or economic coercion. It can be done by different perpetrators. It can be done by the intimate partner, so the woman's husband or boyfriend, or a relative or a stranger. Within this data set, which is all survivors of gender based violence in general, I've taken specifically women that are survivors of intimate partner violence, violence done by the partner. This is all data from the conflict in Eastern Ukraine started in 2014 and this is data that was collected between 2016 and 2017, so a few years after the conflict started but the conflict is ongoing. We wanted to look at what were the patterns of intimate partner violence within this population exposed to violence, basically in a humanitarian setting.

Chris Alexander: Why this topic? What drew you personally to this topic of research?

Ariadna Capasso: I've been an advocate for women's health for many years. Before joining NYU I was working at an NGO on sexual and reproductive health and women's health and rights. So this was a topic that was really close to my heart even before coming into NYU and starting this research. The opportunity presented itself to have this database that is very unique. We don't have a lot of data from conflict settings and specifically a lot of the research on gender based violence and conflict has looked at violence by strangers, with the idea that rape is a weapon of war, which it is. When we stopped looking at what's happening internally within their family when families are under strict stress or under economic instability, they have to move often, we have a lot of displaced people in this area of Ukraine, internally displaced people. It really was a unique data set to look at these patterns of what's happening internally within the family, in a conflict setting. I'm very drawn to this topic.

Chris Alexander: If we were to raise awareness around this issue, what would that look like? How would we do that? How would we achieve that goal?

Ariadna Capasso: I think raising awareness is really critical. Many women that experience violence by an intimate partner do not come forth in our data, on the population of women who are working with only 30% of the women are actually, based on research, we know that only about 30% of the women who experience violence by an intimate partner come forth to seek help. Depending on the culture it can be something that's stigmatized. In many cultures it’s seen that wife beating is okay, and so it is more common in cultures and in settings where this is the case. It's very important to raise awareness about this issue, to put forth more funding to research and also to treat and prevent gender based violence and this will be done through changing gender norms so that violence is not acceptable anymore.

Chris Alexander: Great. And lastly, can you tell us about one challenge that you faced while doing this research? What is that challenge and how did you approach it? What creative steps did you take to overcome those challenges?

Ariadna Capasso: So part of the data, we have both quantitative portions and qualitative portions where the women are describing the violence that happened to them, and some of this data was in Ukrainian. The whole idea of translating from Ukrainian into English so that the research team could understand that was a little bit challenging especially because you wanted to make sure that you're really... Translation is not a straight thing. There are a lot of things where it's very specific to words and whatnot and expressions are very specific to the area. I wanted to make sure that when we translated it, it really resonated with what the women were expressing. How we solved that was by going back to the team on the ground, by the people who are providing the services, and asking them to both help in the translation as well as to review the translations and also to provide context. Anytime we did any interpretation of the data, we would go back to the team on the ground and ask them to see if that made sense, if that's what they were seeing and also to provide context. One example for example is that many of the women who are displaced are reported that they had no children and we learned from our team on the ground that this could actually be due to under-reporting, displaced women because of how their status is and whatnot tend to not say that they have children. This is something that we learned and something that we incorporated into our limitations of our analysis. Making sure that whatever we say makes sense on the ground is a challenge, but it's also a great challenge to overcome.

Chris Alexander: Thank you so much for sharing.

Ariadna Capasso: You're welcome.

Simon Sand: My name is Simon Sand, I'm a second year PhD student here at the NYU College of Global Public Health and today the research I'm presenting is looking at the differences in domestic partner violence among sexual minority women and heterosexual women who use drugs in New York City. In that research, just to give some background on intimate partner violence, globally the estimates for prevalence of intimate partner violence at around 30% and then even within the United States, we see that there's around 32% prevalence of physical domestic violence, although other forms of domestic violence are much less. Some of the risk factors that have come out of that research has been looking at a sexual minority status as well as drug use associated with increases in domestic violence for those who use drugs as well as those who identify as lesbian or bisexual or gay. I wanted to take a look at that and see the connections between what that looks like within a sample that is predominantly drug using where all women are drug using. I use the Impact data set, which is actually from Dr. Ompad who is a professor at CGPH and using that dataset, I first just ran a unit variable, bi-variable and then my full model. What I found out was that initially when I just look at the plain old differences between domestic violence in those who are sexual minorities and those who are heterosexual, I see that there is a difference with sexual minorities having a higher prevalence of domestic violence, which is expected. That was something that I anticipate to see based on the research. When I adjusted for some sociodemographic characteristics as well as drug use, that difference was no longer significant. Although sexual minority women had a higher prevalence and a higher odds ratio when put in the full model, adjusting for everything, statistically we couldn't say it was significant. I was baffled by that because to me it seemed like all the research was really pointing towards figuring out or towards seeing that there will be a difference. I wondered why it was. One of the reasons why I'm guessing this is probably the case, was by looking at the prevalence of it in the overall sample that I had. As I mentioned, globally, and even a subsection of intimate partner violence nationally, estimates are around 30% or so and in my sample 65% of the women had experienced domestic violence. Given that the sample had already double the prevalence of domestic violence as compared to national/international standards, it kind of made it more difficult. I feel to parse out some of the differences that exist because the group as a whole is already much more vulnerable. However just statistical significance isn't everything that comes out of it. I was thinking what kind of implications does this actually have and it actually could have potential implications because if you think about in a primary care setting where a doctor is meeting with a woman who is a heavy drug users, the primary care physician may also want to see if the woman has been going through domestic violence as well given the high prevalence.

Chris Alexander: Sounds like a really important issue. If you were to raise awareness around this issue, what would that look like? How would that happen?

Simon Sand: In a lot of the conversations that happen about domestic violence, it's been very heterosexual focused and it's also, to some extent, been focused on gay men who have sex with men. Not much has been known about the domestic violence between women who have sex with women or sexual minority women. I think pretty much any sort of light that it gets is more than it has been getting in the past. Even being at this conference and being able to present it I think is giving it more light than it has been getting in the past. Hopefully presenting this as an issue, not just nationally but internationally, in any sort of platform gives us more awareness than it currently has.

Chris Alexander: Can you share with us one big challenge you faced and how you creatively took steps to overcome that challenge?

Simon Sand: Thinking about challenges, one challenge that I had and one that I kind of found a solution for, but wasn't happy about necessarily was in identifying these women as sexual minorities. Sexual minority is really broad and research has shown that there is a difference between if a woman identifies as bisexual and if a woman identifies as lesbian and the intimate partner violence that they face, with bisexuals actually having the highest rates of intimate partner violence. Given the limitations of my data, had I separated out lesbian women with bisexual women, my sample sizes just would not have worked and I would not have gotten the numbers that I needed to. That was the compromise I had to make with thinking creatively and thinking, well there are shared experiences between lesbian women, bisexual woman, and so grouping them together as sexual minorities instead of looking at them separately was like a challenge and looked at it in a different way of combining them together.

Chris Alexander: Cool. Well thank you so much for sharing and thanks for joining us.

Simon Sand: Thanks you so much for having me.