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Center for Studies in Demography and Ecology

Teaching war as a threat to public health: Hagopian and Kanter Discuss the UW Experience

CSDE Affiliate Dr. Amy Hagopian (Health Services and Global Health) and Dr. Evan Kanter authored an article in Medicine, Conflict, and Survival, titled “Teaching war as a threat to public health: the University of Washington experience“. Although war generates significant health harms directly and indirectly, and across generations, it is little studied in schools of public health as a preventable threat to health. The American Public Health Association and the Association of Schools and Programs of Public Health, among other professional organizations, have noted this gap and called for more attention to this determinant of health. Authors describe the University of Washington experience launching a well-subscribed and highly-rated 4-credit course in War & Health, designed to be taught simultaneously to undergraduate and graduate students from across the health sciences disciplines and for students in other arts and sciences tracks as well.

Guttmannova Examines High-risk Alcohol and Cannabis Use Amongst Young Adults

CSDE Affiliate Dr. Katarina Guttmannova (Psychiatry and Behavioral Science) and co-authors published their research in Addictive Behaviors, titled “Age-related patterns in high-risk alcohol and cannabis use and their associations with positive and negative affect in young adulthood“. Authors examined age-varying associations between young adult simultaneous alcohol and marijuana/cannabis use (SAM) and heavy episodic drinking (HED) and positive and negative affect to inform harm reduction efforts.

Young adults reporting past-year alcohol use (n = 556; ages 19–25) were recruited in a state where alcohol and nonmedical cannabis use was legal for those 21 +. Participants provided 24 repeated monthly assessments. Among those reporting past-month cannabis use on at least one survey, logistic time-varying effect models estimated (1) the age-varying prevalence of and associations between past-month SAM and HED and (2) age-varying unique associations of affect with SAM and HED.

There was a positive age-varying association between HED and SAM over time that was highest at age 19 (OR = 7.56), decreased until age 20.7 (OR = 3.39), increased until age 23.0 (OR = 4.85), and decreased until the association became non-significant by age 25. Negative affect was positively associated with SAM from ages 20.7 to 23.0, peaking at age 21.8 (OR = 1.36). Positive affect was positively associated with HED from ages 19.4 to 20.4 (peak OR = 1.25) and ages 22.5 to 24.5 (peak OR = 1.38). In contrast, positive affect was not uniquely associated with SAM nor negative affect with HED across ages 19–25.
While HED and SAM were positively associated throughout young adulthood and interventions could target them in tandem, their associations with affect suggest differential etiologic processes. Preventive intervention and harm reduction efforts should attend to psychological context in which these behaviors occur.

Cherkos, Kinuthia, Enquobahrie, and John-Stewart Compare the Impact of Material Breastfeeding and Education with In Utero HIV/ART Exposure on Infant Growth and Development

CSDE Affiliates Dr. Daniel Enquobahrie (Epidemiology), Dr. Grace John-Stewart (Global Health, Epidemiology, Medicine, and Pediatrics), and co-authors published their research in AIDS, titled “Maternal breastfeeding and education impact infant growth and development more than in utero HIV/ART exposure in context of universal ART: a prospective study”. This study was led by Dr. Ashenafi Cherkos as part of his PhD dissertation at UW, in addition to Dr. John Kinuthia (Global Health), who led the team in Kenya. Exposure to HIV and antiretroviral therapy (ART) in utero may influence infant growth and development. Most available evidence predates adoption of universal ART (Option B+ ART regimens). In a recent cohort, authors compared growth and development in HIV-exposed uninfected (HEU) to HIV-unexposed (HUU) infants. 

Their research design included a prospective cohort study: Data from Impact of Maternal HIV on Mycobacterium Tuberculosis Infection among Peripartum Women and their Infants (MiTIPS) in Western Kenya. Women were enrolled during pregnancy. Mother-infant pairs were followed until 24 months postpartum. Authors used multivariable linear mixed-effects models to compare growth rates (weight-for-age z-score [WAZ] and height-for-age z-score [HAZ]) and multivariable linear regression to compare overall development between HEU and HUU children. About 51.8% (184/355) of the infants were HEU, 3.9% low birthweight (<2.5 kg), and 8.5% preterm (<37 gestational weeks). During pregnancy, all mothers of HEU received ART; 67.9% started ART pre-pregnancy, and 87.3% received 3TC/FTC,TDF,EFV. In longitudinal analyses, HEU children did not differ significantly from HUU in growth or development (p > 0.05 for all). In the combined HEU/HUU cohort, higher maternal education was associated with significantly better growth and development: WAZ (β=0.18 [95% CI:0.01, 0.34]), HAZ (β=0.26 [95% CI:0.04, 0.48], and development (β=0.24 [95% CI:0.02, 0.46]). Breastfeeding was associated with significantly better HAZ (β=0.42 [95% CI:0.19, 0.66]) and development (β=0.31 [95% CI:0.08, 0.53]). HEU children in the setting of universal maternal ART had a similar growth trajectory and development to HUU children. Breastfeeding and maternal education improved children’s weight, height, and overall development irrespective of maternal HIV status.

Sepsis Treatment is the Focus of New Study by Fohner and Colleagues

CSDE Affiliate Dr. Alison Fohner (Epidemiology) and co-authors recently published their research in Critical Care Explorations, titled “Pharmacologic and Genetic Downregulation of Proprotein Convertase Subtilisin/Kexin Type 9 and Survival From Sepsis“. Circulating lipid and protein assemblies—lipoproteins play critical roles in clearing pathogens from the bloodstream. Authors investigated whether early inhibition of proprotein convertase subtilisin/kexin type 9 (PCSK9) may accelerate bloodstream clearance of immunogenic bacterial lipids and improve sepsis outcomes.

Their research design included genetic and clinical epidemiology, and experimental models. Nine human cohorts with sepsis (total n = 12,514) were assessed for an association between sepsis mortality and PCSK9 loss-of-function (LOF) variants. Across human cohort studies, the effect estimate for 28-day mortality after sepsis diagnosis associated with genetic PCSK9 LOF was odds ratio = 0.86 (95% CI, 0.67–1.10; p = 0.24). A significant association was present in antibiotic-treated patients. Sepsis therapies are urgently needed and further investigation into the role of PCSK9 in sepsis is needed.