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Epidemiology

Perhaps there is a drug that can prolong your life. It’s called money

A wise man once said that “mo’ money, mo’ problems” (Wallace, 1997). However, despite increases in supposed problems, one of the major benefits is increased life expectancy.

New research published in JAMA last week examined how big a difference earning more money makes in life expectancy, as well as how this changes by geographic location across the United States. Researchers collected tax records from 1.4 billion individuals from 1999 to 2014 aged 40 to 76. Of these, around 4 million men died, compared to 2.7 million women (mortality rates of 596.3 and 375.1 per 100 000 respectively). They examined these data to look at what predicted life expectancy at age 40, after adjusting for race and ethnicity.

What makes New York different to other US cities? | Photo credit Kah-Wai Lin
What makes New York different to other US cities? | Photo credit Kah-Wai Lin (click for more)

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Tackling obesity needs all of us, not some of us

One of the most important issues facing public health today is obesity. Worldwide, approximately 30% of adults are obese,  and costs around $2 trillion annually. A health concern with complex determinants and many intertwined causes, there’s no single magic bullet solution to the rising prevalence of obesity. A new report by the McKinsey Global Institute studied 74 interventions to see what was effective. They studied 74 interventions that target obesity, which range from subsidizing school meals, adding calorie and nutrition labels, as well as restrictions on advertising high-calorie food and drinks.

The report covers areas one would expect, such as energy balance and changing dietary and physical activity behaviours. While these issues are important and do require study, the authors also looked at the environment and how that impacts obesity. There’s a lot of literature that shows that your environment plays a large role in obesity, and simply telling someone to “eat less and move more” is an ineffective strategy at best, and one that further stigmatizes at worst. It’s something we’ve discussed in relation to poverty, and illustrated with the retailer IKEA.

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Basic Income: A radical idea for eliminating poverty

The Watson Arts Centre in Dauphin, Manitoba (photo from Wikipedia)
The Watson Arts Centre in Dauphin, Manitoba (photo from Wikipedia)

I imagine most of my readers have never heard of Dauphin, Manitoba. A small, farming community in Canada, Dauphin is a town that was part of an experiment back in the 1970s. The “mincome” project was launched in 1974, and offered everyone a minimum income. Unfortunately, the project was shut down in 1979 with a change in the government, and so the effects weren’t long term enough. The purpose of the mincome project was to see what would happen if a “top up” was offered to everyone. Dr. Evelyn Forget has been studying records from those years, and following up on people to see how it impacted their life. Would people stop working? Would there be higher rates of employment? How would people respond?

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Why are middle-aged white Americans dying faster than others?

The best findings in science aren’t the ones that make you go “cool!”, they’re the ones that make you go “huh?”

A study in the Proceedings of the National Academy of Sciences reported a strange and unexpected finding. By looking at data from the CDC, researchers were able to evaluate mortality rates per 100,000 individuals, and compare this between ethnic groups. While there’s generally been a decrease in all-cause mortality, they found an increase in the mortality of middle-aged white non-Hispanic men and women in the US between 1999 and 2013 (solid red line below). This finding was unique to middle-aged White Americans – data from other countries also reported a drop in death rates.

So what makes White, middle-aged, non-Hispanic Whites unique?

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Hot time summer in the city (Legionnaires Disease)

1976 was a busy year in Philadelphia. They were holding the Bicentennial celebration, commemorating the two-hundredth anniversary of the Declaration of Independence. As part of the year-long festivities, the city had become a hub for events, hosting the championship game of the NCAA Final Four, as well as the all-star games for baseball, basketball and hockey. On the 4th of July, around 2 million people descended on the city for the celebrations, which featured a five hour parade with over 40,000 marchers and floats from every state. But it was to be a small, 2000 person event that would go down in history.

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Image courtesy Flickr user DaveZ

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If you play with scorpions, don’t be surprised when you get stung

When I was 6 or 7, my uncle gave me a book of Aesop’s Fables. I liked their imagery, and the idea of talking animals with anthropomorphized human traits appealed to my child sensibilities. Recent news about Turing Pharmaceuticals raising the price of Duraprim, a potentially life-saving drug, from a paltry $13.50 to an astonishing $750 brought one of these fables vividly back to mind: the story of the Scorpion and the Frog.

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Level up! Mr Epid is now Dr Epid!

My old lab got me a cake to celebrate!
My old lab got me a cake to celebrate!

I’m back! I took an extended hiatus from the blog while I finished up my PhD, but, at the end of March, I successfully defended my PhD, and after making the changes suggested by the examining committee I submitted in the middle of April and started working. Those of you following along on Twitter will recognize the change in my Twitter handle from @MrEpid to @DrEpid; those of you who know me in real life will have heard me go on about it for the last few months as I prepare. For those wondering, I will eventually change the URL of my blog as well so they all match 🙂

For those unaware of the process, the PhD defence is an oral exam. At Queen’s (the process may differ at other universities), you submit your thesis, and then have to wait (a minimum) of 25 business days for the exam. The exam consists of 4 examiners; an examiner external to your university, one external to your department, one from your department, and the final examiner is your department head (or a department head delegate). You also have a chair from another department from your institution, as well as your supervisors there. After you give a 15-20 minute presentation, the examiners ask their questions. Typically, there are two rounds of questions, after which you leave, and the examiners deliberate. You’re then called back in, and they let you know their decision, and any changes you have to make before submitting your final thesis. My examiners were amazing, and while the questions were tough, they were fair. I actually really enjoyed the discussion I had with my examiners during my defence, and they ranged from the details of my analysis, to the concept of “ethnic identity” and what it actually means in terms of my research.

I want to thank everyone for their support over the past 4 and a bit years. As per prior precedents (Janiszewski, 2010; Saunders, 2013), I will be copy-pasting the acknowledgements section from my thesis below. I’d also like to thank the PLOS Blogs network, especially Victoria Costello for giving me the opportunity to join the network, and Travis and Peter for their support and encouragement when I started blogging. In addition, thank you to my co-authors Beth and Lindsay here who picked up the slack when I took a hiatus this year to focus on finishing up.

Finally, a special thank you to all the readers of the blog. It’s been a privilege to write for you, and it means a lot when you tell me how much you enjoy my work. Thank you, and I’m looking forward to getting back into writing more regularly.

Acknowledgements

I would like to start by thanking my supervisors, Dr. Will Pickett and Dr. Ian Janssen. I am grateful to have had the opportunity to learn from you both, and appreciate your support through my PhD journey. Your honesty, integrity, and willingness to always provide me feedback and support was always appreciated. Will, I look forward to our teams meeting in the playoffs again (hopefully with better results for me this time!)

I would also like to thank those in the Department of Community Health and Epidemiology/Public Health Sciences and the Clinical Research Centre for their support, with a special thank you to Lee Watkins and Deb Emerton for their help. Thank you also to the Clinical Research Centre Student Group. Your antics, customized t-shirts, snack breaks, and random dance parties always kept me entertained, and it’s been a pleasure working with all of you. The Thought Tub is richer for having you.

This work would not have been possible without the financial support of Queen’s University, the Ministry of Colleges, Training and Universities Ontario Graduate Scholarship, and the Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Award.

I would also like to thank my friends and colleagues, especially Anne, Kim, Raymond, Sarah, Alison, Hidé and Marion who have been unwavering in their support over the years. I also owe a special debt of gratitude to Rim, Lydia, Liam, Hoefel, Brian and the Gong Show/Danger Zone family for ensuring that I always get some physical activity, and that yes, I do even lift.

Finally, thank you to my family. Your love, support, guidance, and willingness to listen to me at all times of the day have allowed me to complete this project. Thank you.

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Going to #CPHA2014

Toronto_at_Dusk_-a
The 2014 CPHA conference will be held in Toronto, ON | Picture courtesy Wikimedia
Commons

Next week, I (Atif) will be heading to the Canadian Public Health Association Conference, where I’ll be presenting at two different points.

I’ll be chairing a session titled “Youth Injury Prevention in Canada – Where should we direct our intervention resources.” It promises to be an interesting presentation, where we’ll be discussing injury in Canada, and where to start tackling the problem of injury. This session is scheduled for Wednesday, May 28th from 1:30pm – 3:00pm.

Injury represents one of the most important negative health outcomes experienced by young people in Canada today. Injuries inflict a large burden on children and adolescents and their
families and communities. Injury events are costly in so many ways, whether measured in premature mortality, or the pain, disability, lost productivity and emotional consequence of non-fatal events.

This panel will be made up of child injury researchers and advocates who will make their case for different forms of injury prevention intervention. At the end of this panel, delegates will: understand more about the burden of youth injury in Canada; be aware of at least four different avenues for injury prevention intervention (primordial intervention, context-level interventions, safe sport and peer-influence interventions); have identified the rationale, strengths and limitations of each intervention approach; and have learned more about ways to undertake and gain support for youth injury prevention (from the CPHA conference program).

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Click to go to the conference website

My second presentation is one of the studies from my PhD, titled “The influence of location of birth and ethnicity on BMI among Canadian youth.” This is a study that’s in press (woo!), and represents my own research focus. This one will be in the Kenora Room, on Thursday May 29th 2014, from 11:00am to 12:30pm.

Background:
Body mass indices (BMI) of youth change when they immigrate to a new country. This occurs by the adoption of new behaviors and skills, a process called acculturation.

Objectives:
We investigated whether differences existed in BMI by location of birth (Canadian vs foreign born) across 7 ethnic groups, both individually and together. We also examined whether time since immigration and health behaviors explained any observed BMI differences.

Methods:
Data sources were the Canadian Health Behaviour in School-Aged Children Study and the Canada Census of Population. Participants were youth in grades 6-10 (weighted n = 19,272). Sociodemographic characteristics, height, weight, and health behaviors were assessed by questionnaire. WHO growth references were used to determine BMI percentiles.

Results:
Foreign-born youth had lower BMI than peers born in Canada, a relationship that did not decrease with increased time since immigration. Similarly, East and South East Asian youth had lower BMI than Canadian host culture peers. Finally, Arab/West Asian and East Indian/South Asian youth born abroad had lower BMI than peers of the same ethnicity born in Canada. These differences remained after controlling for eating and physical activity behaviors.

Conclusions:
Location of birth and ethnicity were associated with BMI among Canadian youth both independently and together.

Implications:
Our findings stress the importance of considering both ethnicity and location of birth when designing and implementing interventions. While currently either one or the other is addressed, our study shows there is heterogeneity in BMI by specific ethnic groups depending on whether they were born in Canada or not.

As always I’ll be trying to livetweet the conference. I’ll be using the #CPHA2014 hashtag, so feel free to follow along online! As always, there are a wide range of presentations and workshops, so I’m excited to attend.

If you’re attending the conference, leave a comment with details of your own presentation so that other readers can attend your talks. And if you see me at the conference, be sure to say hi!

This was posted simultaneously on my blog PLOS Blogs Public Health Perspectives

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So you want to be an Epidemiologist…

Last week, my Gradifying co-author Amanda highlighted how her degree is structured. Today, I’ll be talking about the degrees offered by the Department of Public Health Sciences.

There are six factors that differentiate programs: the degree structure, courses, comps, research project requirements, teaching and timelines.

 

The degree itself

In my program, research projects are wildly different in terms of substantive research area, and students come in with very different backgrounds. My lab buddy in my Masters had a degree in engineering, I had a background in Psychology, another colleague had a degree in political science. With these different interests comes different theses. I’ve seen students do molecular projects that are most similar to biochem/bio projects, students who have either obtained or are in the process of obtaining their MD that are clinical in scope (note: clinical research projects are also performed by non-clinicians), and then there are projects like mine that draw heavily from psychology and sociology. The intricacies are driven by the interests of the student and the supervisor. There is also the Master’s of Public Health program that is a course-based, professional degree offered within the Department of Public Health Sciences.

 

Courses requirements

For the MSc in Epidemiology program, students have to take 4 core courses, and 3 elective courses. Usually, students will complete all but one elective in their first year, and will take one elective in their second year. Core courses include biostatistics and research methods, both of which become vital to your career as an epidemiologist. In addition to this, they are expected to complete a Masters Research Thesis.

The Masters of Public Health program is structured as a professional program where students get a broad background in public health. Students in this program take seven core courses and three electives, as well as a skills class (that I have guest lectured). Finally, they complete a 16 week practicum over the summer after their first year.

The PhD is completely different. We have one full-year seminar course, and one advanced biostatistics course. The course requirement is relatively light in that regard – if you want further, specific, training, you can seek that out yourself.

 

Comps

As I walk through the valley of the shadow of comps, I will fear no evil …

In the PhD Epi program, comps are scheduled to occur in the summer of your first year. They consist of a 4 hour open-book written exam that covers basic epidemiology principles. Following this, you are given a paper in your substantive area, and given two weeks to prepare two presentations. This forms the oral exam portion of the comps process, and is given to three professors in the department. For the first, the candidate is expected to present a 20 minute presentation where they summarize and critically evaluate the paper. Following this, they are asked questions about the paper and how the authors evaluated core epidemiology concepts. The second part of the exam requires the student to design and present an appropriate follow up study, addressing the shortcomings of the previous paper. The process takes between 90 minutes and 2.5 hours.

Typically, comps occur in late-June to early-July. The cohort of PhD students will typically study together from around April onwards, and there’s a certain solidarity that develops from going through this process together.

 

Research Project Requirements

For the MSc Epidemiology program, students are required to submit a 2 page outline of their project. Upon approval of the outline, they then prepare and submit a 20 page proposal. The proposal forms the basis of an open oral defence, where peers can ask questions. There is also a designated faculty member who acts as a reviewer for the project. Once the student passes their oral proposal defence, they can then continue with their project. Finally, they have a Masters thesis defence, where they present their work to an examining committee, consisting of 1) a professor external to the department, 2) one internal to the department, and 3) the department head (or someone in their stead).

The PhD in Epidemiology follows a very similar process, except everything is bigger. Students submit a 5-6 page outline, followed by a 20 page proposal of the project. Again, the proposal is followed by an oral exam, with two faculty members acting as reviewers as opposed to one in the Masters program. Once approval has been granted, the candidate now proceeds with their project, culminating in a PhD dissertation. This is defended to a committee consisting of a professor external to Queen’s in addition to the members of the Masters defence committee.

At both the outline and proposal stage, students are given feedback that they can consider with their supervisors as they move forward. Due to the variability in projects, there are no expectations around the number of manuscripts that you should produce, although I’ve seen Masters students produce 1-2 from their thesis work, and more if they did RA work. Doctoral candidates aim for 3-4 core manuscripts, and again, produce more if they work as an RA. These can be written while in the program, which results in a “manuscript-style” thesis (see mine here), or a “traditional” thesis, where, after defending, the student will prepare manuscripts for publication. My Masters was a manuscript based thesis, and my PhD will be as well, but this really varies on the project and whether this is feasible for you. My PhD fits nicely into four self-contained projects, and so publishing as I go was the best way to approach my PhD (you can read more about the first study from my PhD here, and the Queen’s press release here).

 

Teaching and Supervising

There’s no undergraduate program in epidemiology, and so teaching opportunities are limited. That being said, there are lots of opportunities to be a TA for graduate courses, and there are undergraduate courses that are offered. Many of the TA positions include opportunities to lecture and lead small group tutorials, which makes them a lot of fun and rewarding. Perhaps the most fun is the ability to really tailor your tutorials and classes to your own style and interests – I’ve taught several classes using data from the NHL to illustrate basic statistical concepts (what are the average number of goals scored, what’s the modal number of goals scored, why are they different).

 

Timelines

This is really left up to the student and supervisor – the department asks for progress reports by semester, but the onus is on the student and the supervisor to stick to the timelines set out in the proposal. I meet with my supervisors as required, and so we have gone 2-3 months without meeting in person if I’ve been working on a specific aspect of the project, and more often if I need feedback from them as I’m working through something. However, we touch base by email often, and this works well for us. Your mileage may vary – other students and supervisors work best with regularly scheduled meetings.

 

So while this is my experience in graduate school, I would suggest meeting with the department and potential supervisors if you are interested in joining the Department of Public Health Sciences. These are some of the core requirements and expectations, but these do change over time, and so if you’re finding this a year or more from now, be sure to check what the current requirements are.

 

This post was originally published on Gradifying

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