Faculty Bibliography

Rapid increases in e-cigarette use and potential exposure to harmful byproducts have shifted public health focus to e-cigarettes as a possible drug of abuse. Effective surveillance of use and prevalence would allow appropriate regulatory responses. An ideal surveillance system would collect usage data in real time, focus on populations of interest, include populations unable to take the survey, allow a breadth of questions to answer, and enable geo-location analysis. Social media streams may provide this ideal system. To realize this use case, a foundational question is whether we can detect e-cigarette use at all. This work reports two pilot tasks using text classification to identify automatically Tweets that indicate e-cigarette use and/or e-cigarette use for smoking cessation. We build and define both datasets and compare performance of 4 state of the art classifiers and a keyword search for each task. Our results demonstrate excellent classifier performance of up to 0.90 and 0.94 area under the curve in each category. These promising initial results form the foundation for further studies to realize the ideal surveillance solution.

Secure attachment in childhood and adolescence protects children from engagement in high risk behaviors and development of mental health problems over the life span. Poverty has been shown to create impoverishment in certain aspects of caregiving and correspondingly to compromise development of secure attachment in children. Nineteen children 8 to 14 years old from two schools in a middle income area and an urban informal settlement area of Nairobi were interviewed using an adapted Child Attachment Interview (CAI) protocol. CAI was developed to provide a glimpse into the 'meta-theories' children have about themselves, parents, parenting and their attachment ties with parents and extended family members. Narratives obtained with the CAI were analyzed using thematic analysis. Both Bowlby's idea of 'secure base' as well as Bronfrenbrenner's 'ecological niche' are used as reference points to situate child attachment and parenting practices in the larger Kenyan context. We found that with slight linguistic alterations CAI can be used to assess attachment security of Kenyan children in this particular age range. We also found that the narration ability in both groups of children was generally good such that formal coding was possible, despite cultural differences. Our analysis suggested differences in narrative quality across the children from middle class and lower socio-economic class schools on specific themes such as: sensitivity of parenting (main aspects of sensitivity were associated with disciplinary methods and child's access to education), birth order, parental emotional availability, and severity of inter-parental conflicts and child's level of exposure. The paper puts in context a few cultural practices such as greater household responsibility accorded to the eldest child and stern to harsh disciplinary methods adopted by parents in the Kenyan setting.

OBJECTIVE: To evaluate the acute impact of disasters on diabetic patients, we performed a geospatial analysis of emergency department (ED) use by New York City diabetic adults in the week after Hurricane Sandy. RESEARCH DESIGN AND METHODS: Using an all-payer claims database, we retrospectively analyzed the demographics, insurance status, and medical comorbidities of post-disaster ED patients with diabetes who lived in the most geographically vulnerable areas. We compared the patterns of ED use among diabetic adults in the first week after Hurricane Sandy's landfall to utilization before the disaster in 2012. RESULTS: In the highest level evacuation zone in New York City, postdisaster increases in ED visits for a primary or secondary diagnosis of diabetes were attributable to a significantly higher proportion of Medicare patients. Emergency visits for a primary diagnosis of diabetes had an increased frequency of certain comorbidities, including hypertension, recent procedure, and chronic skin ulcers. Patients with a history of diabetes visited EDs in increased numbers after Hurricane Sandy for a primary diagnosis of myocardial infarction, prescription refills, drug dependence, dialysis, among other conditions. CONCLUSIONS: We found that diabetic adults aged 65 years and older are especially at risk for requiring postdisaster emergency care compared to other vulnerable populations. Our findings also suggest that there is a need to support diabetic adults particularly in the week after a disaster by ensuring access to medications, aftercare for patients who had a recent procedure, and optimize their cardiovascular health to reduce the risk of heart attacks.

Introduction: Online drug markets and social media are facilitating the spread of information and sale of illicit substances. Online sites, such as Craigslist and Bluelight, underscore an emerging shift in contemporary drug consumerism. Case Descriptions: We report on two cases. Case 1 is a 42-year-old male with a history of heroin-use disorder, presented for an initial visit to an office-based buprenorphine program, and reported having acquired heroin from Craigslist. Despite several harrowing experiences, Craigslist remained Patient 1's primary method of purchasing heroin during a 14-month period. Craigslist ads also redirected the patient to the web site Bluelight, which facilitated access to updated information on open-air drug markets in New York City. Case 2 is a 23-year-old male, who was admitted to inpatient detoxification and utilized the site for the sale of heroin in order to fund his own use of heroin. He sold heroin via Craigslist for 1 year until his arrest, noting undeterred advertising and largely uncomplicated transactions. He secured largely professionals buyers that purchased a steady quantity of heroin over extended periods of time. Discussion: Online drug marketplaces offer platforms to extend public health surveillance, harm reduction, and treatment entry strategies for internet users with substance-use disorders.

BACKGROUND: Insomnia is increasingly recognized as a public health concern in modern society. Insomnia diagnoses appear to be increasing and are associated with poor health outcomes. They may cost $100 billion annually in health services. OBJECTIVE: Given the adverse consequences of insomnia such as cardiovascular disease, diabetes, and depression, the present study was designed to examine the relationship of the trajectories of earlier cigarette smoking and later insomnia. The ultimate goal is to reduce the prevalence of insomnia. METHODS: 674 participants (53% African Americans, 47% Puerto Ricans, 60% females) were surveyed at 6 points in time. We employed the growth mixture model to obtain the trajectories of cigarette smoking from age 14 to 32. We used logistic regression analyses to examine the associations between the trajectories of smoking and insomnia. RESULTS: Males were less likely to have insomnia than females (Adjusted odds ratio: AOR = 0.34, p < .05). A higher Bayesian posterior probability (BPP) for the chronic smoking trajectory group (AOR = 2.69, p < .05) and for the moderate smoking trajectory group (AOR = 5.33, p < .01) was associated with an increased likelihood of having insomnia at age 36 compared with the BPP of the no or low smoking trajectory group. CONCLUSIONS: Prevention and treatment programs for individuals who suffer from insomnia should be implemented in parallel with programs for smoking cessation. From a public health perspective, our longitudinal study that examined the association between earlier smoking trajectories and later insomnia suggests that treatments designed to reduce or cease smoking may lessen the occurrence of symptoms of insomnia.

BACKGROUND:Cardiovascular diseases are the leading cause of preventable morbidity and mortality in the USA. Medical schools must prepare trainees to address prevention, including improving ability in counseling patients to modify lifestyle risk factors. Most medical students do not receive significant training or clinical experience in preventive medicine until the clinical years of medical school. To enhance student education in disease prevention and lifestyle counseling, and simultaneously target cardiovascular disease prevention in high-risk Chicago neighborhoods, the Northwestern University Feinberg School of Medicine and Chicago Department of Public Health with support from the GE Foundation, developed the Keep Your Heart Healthy program. METHODS:Medical students participated in intensive faculty-led training. They subsequently screened local residents to identify and counsel for cardiovascular disease risk factors. Fifty-one predominantly preclinical medical students screened residents of the Humboldt Park and North Lawndale neighborhoods in Chicago, IL, at 31 screening events from August to December 2013. Fifty students (98% response rate) completed a survey assessing the educational value of various program components following the pilot. RESULTS:Of all respondents, 92% of students reported improved knowledge of cardiovascular disease prevention and 94% reported improved knowledge of vulnerable populations and health equity. The majority (88%) reported that their participation supplemented material they learned in the classroom. Eighty-six percent of students reported that their encounters with community participants were of educational value. Integration of this program into the medical school curriculum was supported by 68% of students. CONCLUSION/CONCLUSIONS:Keep Your Heart Healthy educates primarily preclinical medical students in cardiovascular disease prevention and prepares them to apply this knowledge for patient counseling. Results from student surveys demonstrate that this service-learning initiative enhances medical student knowledge in cardiovascular disease prevention, supplements classroom material, and provides students a valuable opportunity to apply interviewing and counseling skills in a real patient encounter.

Mucosal-associated invariant T cells (MAIT) are innate T cells restricted by major histocompatibility related molecule 1 (MR1) presenting riboflavin metabolite ligands derived from microbes. Specificity to riboflavin metabolites confers MAIT cells a broad array of host-protective activity against gram-negative and -positive bacteria, mycobacteria, and fungal pathogens. MAIT cells are present at low levels in the peripheral blood of neonates and gradually expand to relatively abundant levels during childhood. Despite no anti-viral activity, MAIT cells are depleted early and irreversibly in HIV infected adults. Such loss or impaired expansion of MAIT cells in HIV-positive children may render them more susceptible to common childhood illnesses and opportunistic infections. In this study we evaluated the frequency of MAIT cells in perinatally HIV-infected children, their response to antiretroviral treatment and their associations with HIV clinical status and related innate and adaptive immune cell subsets with potent antibacterial effector functions. We found HIV+ children between ages 3 to 18 years have significantly decreased CD8+ MAIT cell frequencies compared to uninfected healthy children. Remarkably, CD8 MAIT levels gradually increased with antiretroviral therapy, with greater recovery when treatment is initiated at a young age. Moreover, diminished CD8+ MAIT cell frequencies are associated with low CD4:CD8 ratios and elevated sCD14, suggesting a link with HIV disease progression. Last, CD8+ MAIT cell levels tightly correlate with other antibacterial and mucosa-protective immune subsets, namely, neutrophils, innate-like T cells, and Th17 and Th22 cells. Together these findings suggest that low frequencies of MAIT cells in HIV positive children are part of a concerted disruption to the innate and adaptive immune compartments specialized in sensing and responding to pathogenic or commensal bacteria.

Case-control design is widely used in epidemiology and other fields to identify factors associated with a disease. Data collected from existing case-control studies can also provide a cost-effective way to investigate the association of risk factors with secondary outcomes. When the secondary outcome is a continuous random variable, most of the existing methods focus on the statistical inference on the mean of the secondary outcome. In this paper, we propose a quantile-based approach to facilitating a comprehensive investigation of covariates' effects on multiple quantiles of the secondary outcome. We construct a new family of estimating equations combining observed and pseudo outcomes, which lead to consistent estimation of conditional quantiles using case-control data. Simulations are conducted to evaluate the performance of our proposed approach, and a case-control study on genetic association with asthma is used to demonstrate the method.

Background: Phosphodiesterase type 5 inhibitors are commonly used for management of erectile dysfunction after prostate cancer (CaP) treatment. Single-institution studies have reported conflicting data on PDE5i use and recurrence after radical prostatectomy (RP). We re-evaluated the association between PDE5i use after RP and RT with biochemical recurrence in a nationwide, population-based registry. Methods: We performed a nested case-control study using data from the National Prostate Cancer Register of Sweden (including >98% prostate cancer cases nationwide), linked to the national Prescribed Drug Register. Among men with localized CaP who underwent primary RT or RP from 20062007 with 5 years of follow-up, we identified those with biochemical recurrence (n=293 cases). For each case, we identified 20 controls who were recurrence-free at the event date of the index case, using incidence density sampling stratified by age and treatment (n=5,767 controls). Multivariable conditional logistic regression was used to examine the relationship between overall PDE5i use and cumulative pill number with biochemical recurrence. Results: Among men treated by RT, PDE5i were not associated with BCR (OR 0.97, 95% CI 0.48-1.94), adjusting for marital status, education, income, PSA, clinical stage, Gleason score, and proportion of positive biopsies. As shown in the table, PDE5i were not associated with biochemical recurrence after RP adjusting for clinical features (OR 0.79, 95% CI 0.60-1.05), or with additional adjustment for surgical pathology (OR 0.83, 95% CI 0.62-1.10). Men whose cumulative number of PDE5i pills was above the median had a slightly lower risk of biochemical recurrence in the clinical model, and no difference in risk of biochemical recurrence after adjustment for RP features. Conclusions: Our results from a population-based setting suggest against an increased risk of biochemical recurrence among men using PDE5i after CaP treatment. (Table Presented)