Training of the next generation of biostatisticians: a call to action in the U.S

Two workshops (2001, 2003) were held by the National Institutes of Health (NIH) to examine the need to train more biostatisticians in the U.S. to meet the increasing opportunities in the biomedical research enterprise. The supply of new PhD graduates in biostatistics in the U.S. has been relatively steady for the past two decades while the demand has increased dramatically. These workshops concluded that a renewed effort must be made in the U.S., led in part by the NIH, to add to and expand the existing training programs to increase the supply. This article summarizes those two workshops and their recommendations. Some progress has been made through a new biostatistics training program with emphasis in bioinformatics sponsored by the National Institute of General Medical Sciences (NIGMS).     

The Africa Center for Biostatistical Excellence: a proposal for enhancing biostatistics capacity for sub‐Saharan Africa

Sub‐Saharan Africa has a shortage of well‐trained biomedical research methodologists, in particular, biostatisticians. In July 2014, a group of biostatisticians and researchers from the region attended a brainstorming workshop to identify ways in which to reduce the deficit in this critical skill. The workshop recognized that recommendations from previous workshops on building biostatistics capacity in sub‐Saharan Africa had not been implemented. The discussions culminated with a proposal to setup an Africa Center for Biostatistical Excellence, a collaborative effort across academic and researcher institutions within the region, as a vehicle for promoting biostatistics capacity building through specialized academic masters programs as well as regular workshops targeting researchers. Copyright © 2015 John Wiley & Sons, Ltd.     

Evaluation metrics for biostatistical and epidemiological collaborations

Increasing demands for evidence-based medicine and for the translation of biomedical research into individual and public health benefit have been accompanied by the proliferation of special units that offer expertise in biostatistics, epidemiology, and research design (BERD) within academic health centers. Objective metrics that can be used to evaluate, track, and improve the performance of these BERD units are critical to their successful establishment and sustainable future. To develop a set of reliable but versatile metrics that can be adapted easily to different environments and evolving needs, we consulted with members of BERD units from the consortium of academic health centers funded by the Clinical and Translational Science Award Program of the National Institutes of Health. Through a systematic process of consensus building and document drafting, we formulated metrics that covered the three identified domains of BERD practices: the development and maintenance of collaborations with clinical and translational science investigators, the application of BERD-related methods to clinical and translational research, and the discovery of novel BERD-related methodologies. In this article, we describe the set of metrics and advocate their use for evaluating BERD practices. The routine application, comparison of findings across diverse BERD units, and ongoing refinement of the metrics will identify trends, facilitate meaningful changes, and ultimately enhance the contribution of BERD activities to biomedical research.     

Continuing-education needs of public health educators: their perspectives.

The objective of the study described in this article was to determine the perceived continuing-education needs of employed public health educators. A three-wave mailing of a questionnaire was sent to a national sample of 500 public health educators who were asked to rate their preparation on 41 subcompetencies. Of 299 returned surveys (63%), 149 indicated that they were not currently practicing public health educators. Thus, analysis was based on 150 respondents. Six subcompetencies were perceived by 25% or more of the respondents as topics in which they needed more training. Health educators reported a need for continuing education, focused primarily on administration and evaluation of programs and applying appropriate research principles. Furthermore, the public health educators overwhelmingly preferred to attend a conference or workshop (85%) as their method of obtaining further continuing education. Health education programs and professional organizations need to take note of the identified continuing-education needs when developing future educational programs to adequately update health educators.     

Promotion of evidence-informed health policymaking in Nigeria: bridging the gap between researchers and policymakers

In Nigeria, the lack of adequate understanding of the complex nature of translating research into policy and the incompatibility existing between researchers and policymakers constitute a great challenge to evidence-informed policymaking. To address these challenges a one-day evidence-to-policy training workshop was organised for policymakers, researchers and other major stakeholders in the health sector in southeastern Nigeria. Of the 104 individuals invited to the workshop 87 (83.6%) attended. The workshop training sessions focused on capacity development for evidence-informed health policy-making and building effective linkages/partnerships. The post-workshop assessment indicated significant improvements in participants' knowledge, their understanding of the health policymaking process and the use of evidence compared to their pre-workshop status. Using a focus group discussion, major strategies identified by participants that can bridge the gap between health policymakers and researchers included: involving both parties in planning and execution of health research and health programmes; promoting dialogue between researchers and policymakers; institutionalising research grants and commissioning research in health ministries; and ensuring that researchers are made to focus on the core needs of policymakers. There is need for further discussion and debate on the researchers and policymakers partnership concept in low income settings.     

“Race” and “ethnicity” in biomedical research: How do scientists construct and explain differences in health?

Social and biomedical scientists, journal editors, and public health officials continue to debate the merits of the use of race and ethnicity in health-related research. As biomedical research focuses on issues of racial or ethnic health disparities, it remains unclear how biomedical scientists investigate race or ethnicity and health. This paper examines how biomedical researchers construct and analyze race or ethnicity in their studies and what conclusions they make about difference and health. Using content analysis of 204 biomedical research journal publications, which were supported by grants won from the National Cancer Institute of the National Institutes of Health in the USA, I demonstrate that although authors tended to see race or ethnicity as important and significant in their research, they rarely defined or operationalized the concepts adequately. Moreover, when presenting findings of racial or ethnic difference, authors generally did not provide explanations of the difference. I argue that this under-theorized and unspecified use of race or ethnicity and the biological conclusions drawn about health and difference have the potential to reify “race” and to limit our thinking about what these biomedical differences suggest about health disparities and inequalities in general.     

Neglected infectious diseases in Aboriginal communities: Haemophilus influenzae serotype a and Helicobacter pylori

This report describes proceedings of a workshop entitled “Neglected Infectious Diseases in Aboriginal Communities” which took place in Thunder Bay, Ontario, Canada, on October 12, 2011. This workshop was jointly organized by the National Research Council of Canada (NRC), the National Microbiology Laboratory (Public Health Agency of Canada) and Northern Ontario School of Medicine (NOSM) with participants from the Medical Sciences Division and Clinical Sciences Division of NOSM, NRC, National Microbiology Laboratory (NML), Public Health Laboratory (Thunder Bay), Thunder Bay District Health Unit, and Regional Health Survey at Chiefs of Ontario. The main purpose of the workshop was to summarize the current state of knowledge on two less publicized infectious disease agents afflicting Canadian Aboriginal communities: Haemophilus influenzae serotype a (Hia) and Helicobacter pylori. Another highlight of this workshop was the discussion on novel approaches for vaccination strategies in the control and prevention of such disease agents. In conclusion, a long-term collaborative research framework was established between NRC, NML and NOSM to develop carbohydrate-based vaccines against these pathogens that may benefit the health of Canadian Aboriginal peoples and other population groups at risk.     

Workgroup report: Indoor chemistry and health

Chemicals present in indoor air can react with one another, either in the gas phase or on surfaces, altering the concentrations of both reactants and products. Such chemistry is often the major source of free radicals and other short-lived reactive species in indoor environments. To what extent do the products of indoor chemistry affect human health? To address this question, the National Institute for Occupational Safety and Health sponsored a workshop titled "Indoor Chemistry and Health" on 12-15 July 2004 at the University of California-Santa Cruz. Approximately 70 experts from eight countries participated. Objectives included enhancing communications between researchers in indoor chemistry and health professionals, as well as defining a list of priority research needs related to the topic of the workshop. The ultimate challenges in this emerging field are defining exposures to the products of indoor chemistry and developing an understanding of the links between these exposures and various health outcomes. The workshop was a step toward meeting these challenges. This summary presents the issues discussed at the workshop and the priority research needs identified by the attendees.     

Peer Reviewed: Charting the Future of Community Health Promotion: Recommendations From the National Expert Panel on Community Health Promotion

In the decades since chronic illnesses replaced infectious diseases as the leading causes of death, public health researchers, particularly those in the field of health promotion and chronic disease prevention, have shifted their focus from the individual to the community in recognition that community-level changes will foster and sustain individual behavior change. The former emphasis on individual lifestyle change has been broadened to include social and environmental factors, often without increased resources. To find new ways to support community health promotion at the national level, the National Center for Chronic Disease Prevention and Health Promotion and the Division of Adult and Community Health invited an external panel of experts to participate in the National Expert Panel on Community Health Promotion. This article highlights the process through which the expert panel developed its eight recommendations. The recommendations include issues related to community-based participatory research and surveillance, training and capacity building, new approaches for health and wellness, and changes in federal investments. They illustrate the steps needed to broaden the traditional scope of public health and to advance a new vision for improving community health and wellness.     

Charting the future of community health promotion: recommendations from the National Expert Panel on Community Health Promotion

In the decades since chronic illnesses replaced infectious diseases as the leading causes of death, public health researchers, particularly those in the field of health promotion and chronic disease prevention, have shifted their focus from the individual to the community in recognition that community-level changes will foster and sustain individual behavior change. The former emphasis on individual lifestyle change has been broadened to include social and environmental factors, often without increased resources. To find new ways to support community health promotion at the national level, the National Center for Chronic Disease Prevention and Health Promotion and the Division of Adult and Community Health invited an external panel of experts to participate in the National Expert Panel on Community Health Promotion. This article highlights the process through which the expert panel developed its eight recommendations. The recommendations include issues related to community-based participatory research and surveillance, training and capacity building, new approaches for health and wellness, and changes in federal investments. They illustrate the steps needed to broaden the traditional scope of public health and to advance a new vision for improving community health and wellness.     

Building knowledge in literacy and health

Health and literacy share an interesting relationship. The complexities of the relationship between literacy and health need to be recognized by policy-makers and practitioners to dispel myths, reduce stigma attached to low literacy, and empower disadvantaged groups. As we engage in building knowledge in the field, there is a need for multi-sectoral collaboration, both quantitative and qualitative information, and more effective ways to communicate with and educate people with low literacy. At the Second Canadian Conference on Literacy and Health, research reported indicates that in terms of what we know, the field has focussed on: linking literacy and health; examining intervention programs; exploring e-health and rural health; evaluating programs; and empowering people. In exploring what we need to know, researchers at the conference identified the need to understand: the extent of literacy sensitivity among health care providers in diverse settings; the impact of using plain language and readability formulas; the effectiveness of approaches to instructing literacy; and the incorporation of health content and health literacy goals into literacy instruction. Further, we need to create accessible ways of sharing knowledge in the field to build and strengthen existing multi-sector partnerships within and between communities.     

Worksite health promotion programs in the U.S.: factors associated with availability and participation

PURPOSE: To examine how the availability of and participation in worksite health promotion programs varies as a function of individual (e.g., age), organizational (e.g., occupation), and health (e.g., high blood pressure) characteristics. Availability of worksite programs was also compared to that reported in two previous national surveys of private companies. DESIGN: Data analyzed were from the 1994 National Health Interview Survey (NHIS), a national cross-sectional probability sample of the U.S. civilian population. SUBJECTS: Five thousand two hundred nineteen NHIS respondents met the inclusion criteria of (1) being currently employed in a company of at least 50 employees, and (2) completing the NHIS section on worksite health promotion. MEASURES: Employees indicated the availability of, and their participation in, 33 different types of worksite programs. National Health Interview Survey data were also available regarding general health, blood pressure, body mass index, and medical conditions. RESULTS: Smoking cessation programs had the highest mean availability (43%), followed by health education programs (31%) and screening tests (31%). Overall, availability of worksite programs appeared comparable to that reported in a recent national survey. Participation ranged from 32% for health education programs to 5% for smoking cessation programs. Compared to availability, participation depended less on individual and organizational characteristics. Healthy employees were not consistently more likely to participate in worksite health promotion programs than nonhealthy employees. CONCLUSIONS: Although availability of worksite health promotion programs remains high, participation by employees in specific types of programs can vary widely. Attempts to increase participation should look beyond individual, health, and organizational variables, to specific features of the work environment that encourage involvement in health promotion activities.     

Human genetics, environment, and communities of color: ethical and social implications

A conference titled "Human Genetics, Environment, and Communities of Color: Ethical and Social Implications" and a workshop symposium titled "Human Genetics and Environmental Justice" were held by West Harlem Environmental Action, Inc., with cosponsorship by the National Institute of Environmental Health Sciences (NIEHS), the Community Outreach and Education Program of the NIEHS P30 Center for Environmental Health at the Mailman School of Public Health at Columbia University, New York, and the U.S. Environmental Protection Agency. The conference and symposium took place at Columbia University in New York City on 4-5 February 2002. Expert panels composed of public health practitioners, genetic researchers, ethicists, lawyers, social scientists, and community organizations were assembled to explore how genetic research will affect communities of color, specifically in environmental health research. The goal of the conference was to educate participants on the science and ethics of genetic research and to explore the potential benefits and pitfalls of genetic research vis-à-vis new trends in environmental health research, specifically with reference to communities of color. The goal of the symposium was to discuss the major perceptions and concerns for community-based environmental justice advocates and other communities of color regarding environmental health genetic research. The conference and symposium drew more than 300 participants and articulated important perspectives on the opportunities and challenges for environmental justice advocates and other communities of color posed by rapid advances in environmental health genetic research and toxicogenomics.     

Earlier detection of public health risks – Health policy lessons for better compliance with the International Health Regulations (IHR 2005): Insights from low-, mid- and high-income countries

The International Health Regulations (IHR 2005) require all Member States to build and maintain the capacities to prevent, detect and respond to public health emergencies. Early detection of public health risks is one of the core functions. In order to improve surveillance and detection, a better understanding of the health system conditions and their influencing factors are needed. The Israeli Ministry of Health/IHR National Focal Point held a workshop to elucidate health system conditions and their influencing factors that enable earlier detection. The workshop methodology employed a stepwise, small working group analysis approach to elucidate the conditions and their influencing factors affecting each stage of recognition, assessment, and reporting of infectious disease outbreaks, at the local, regional and national levels. In order to detect public health risks earlier, the detection process needs to be moved closer to the local communities and start with building capacity within communities. Building capacity and engaging with local and diverse communities requires significant changes in the governance approach and include information sharing, multi-sectoral communication and coordination across various levels before, during and after public health emergencies. Across the regions, low-, mid- and high-income countries seem to struggle more with governance and information sharing rather than with technical capacities and capabilities.     

An estimate of the need for environmental health academicians in the workforce

In July 1987, a workshop was held to evaluate the environmental health workforce. The workshop was sponsored by the Bureau of Health Professions. Health Resources and Services Administration of the Public Health Service. Participants were drawn from State and local agencies, Federal agencies, industry, and academia. Estimates of workforce needs were based on background information and informed consensus judgments of workshop participants. The final report of the workshop was published in January 1988. The authors synthesize some of the consensus judgements and review data from a position paper developed for the workshop. The supply, demand, and projected need for new academicians in environmental health on both graduate and undergraduate levels through 1992 are estimated. These estimates are based on the need for persons trained in the various environmental health subspecialties identified during the workshop. Outlined are the number and educational backgrounds of new faculty required. The types of new training programs that are required to meet the needs for environmental health specialists through 1992 are discussed.     

Development of adolescent self-report measures from the National Longitudinal Study of Adolescent Health.

PURPOSE: To present a set of multi-item indicators and associated reliability estimates derived from early research with survey data from adolescents participating in the National Longitudinal Study of Adolescent Health (Add Health). METHODS: Add Health provides information on the health and health-related behaviors of a nationally representative sample of U.S. adolescents, as well as on individual-level and contextual factors that either promote young peoples' health or increase their health risk. Specifically, the 135-page in-home adolescent survey instrument includes multiple items intended to measure individual-level and social-environmental constructs relevant to adolescent health and well-being. This article details the development of a set of multi-item scales and indices from Add Health in-home adolescent survey data. These steps include identification of inconsistent responders, use of a split-halves approach to measurement validation, and use of a deductive approach in the development of scales and item composites. RESULTS: Estimates of internal consistency reliability suggest that many of the multi-item measures have acceptable levels of internal consistency across grade, gender, and race/ethnic groups included in this nationally representative sample of adolescents. In addition, moderate to high bivariate correlations between selected measures provide initial evidence of underlying latent constructs. CONCLUSIONS: This article provides adolescent health researchers with a set of methodologic procedures and measures developed in early research on the Add Health core adolescent data set.     

An exploration of ethical issues in research in children's health and the environment

The consideration of ethical issues relating to pediatric environmental health is a recent phenomenon. Discussions of biomedical ethics, research on children, and environmental health research have a longer history. In the late 1990s, researchers at the Kennedy Krieger Institute in Baltimore, Maryland, undertook a study to compare the effectiveness of several methods of reducing lead risk in housing. In a preliminary finding in the case of Grimes v. Kennedy Krieger Institute, Inc., a Maryland court questioned the ethics of performing research on children when there is no prospect of direct benefit to those children and whether parents can consent to such research. This case dramatically raised the profile of ethical issues among the pediatric environmental health research community. To broaden the discussion of these issues and in response to the Kennedy-Krieger case, the Children's Environmental Health Network held a working meeting on 5 and 6 March 2004 to explore this topic. The articles in this mini-monograph were prepared by the authors as a result of the workshop and represent their opinions. This article is an introduction to the workshop and a summary of the articles to follow.     

Systematic overview of rural health research in Australia published in the serial literature

ABSTRACT: It is acknowledged that research outcomes need to be made available to other researchers, practitioners and consumers if the benefits of such research are to be disseminated as quickly as possible to other researchers and translated to influence practice and produce new products. If strategies are to be developed on future research directions, an analysis of current output will provide baseline data as well as a map for analysing gaps and overlaps in the research effort. This paper provides an overview of rural health research output in serial publications from 1990. It highlights the content of such literature, the relationship to the National Health Priority Areas and the types of research produced. The overview showed that there was a yearly increase in the absolute number of defined research articles produced over the period. There was also an increase in the relative number of rural health articles that could be defined as research articles (as opposed to commentary-type articles). Forty per cent of research articles are in the National Health Priority Areas and more than 30% address indigenous health specifically. Fifty per cent of articles address public health or health services issues. These data provide a general picture of the type and content of Australian rural health research that has been reported in the serial literature over the decade. This can be used to inform future strategies, provide the baseline for future targets, as well as giving a general picture of the gaps and overlaps from which more specific data can be compiled.     

Environmental air toxics: role in asthma occurrence?

The National Urban Air Toxics Research Center (NUATRC) hosted its first scientific workshop in 1994 that focused on possible relationships between air toxics and asthma. From that meeting came recommendations for future research including a need for more complete individual personal exposure assessments so that determinations of personal exposures to pollutants could be made. In the spring of 2001, NUATRC held a second such workshop to review progress made in this area during the intervening 7 years. Peer-reviewed articles from the workshop are published in this issue of (italic)Environmental Health Perspectives Supplements(/italic). As in 1994, academic, government, and industry scientists participated. Dave Guinnup of the Environmental Protection Agency discussed the nature of air toxics, their definition, and the basis for federal regulation. George Leikauf from the University of Cincinnati reviewed the 1994 workshop and subsequent research in this field. Current research funded by NUATRC that is addressing individual personal exposure was presented by Clifford Weisel (Environmental and Occupational Health Sciences Institute, University of Medicine and Dentistry of New Jersey), Patrick Kinney (Columbia University) and Candis Claiborn (Washington State University). David Corry from Baylor College of Medicine highlighted new insights into asthma pathogenesis while Stephen Redd from the Centers for Disease Control presented an overview of asthma epidemiology as well as the societal costs of the disease. Mary White (Agency for Toxic Substances and Disease Registry) discussed recent epidemiologic investigations by public health agencies into community concerns about asthma and hazardous air pollutants. David Peden (University of North Carolina) reviewed scientific studies into the links between asthma and air toxics as well as criteria air pollutants. In a session on occupational asthma, Lee Petsonk (National Institute for Occupational Safety and Health) discussed risk factors for work-related asthma, whereas Ralph Delfino (University of California, Irvine) addressed limitations of extrapolating from occupational asthma to asthma in the general population. These presentations were followed by panel discussions focusing on future research programs, both for NUATRC and similar research institutions. Recommendations for future research included improved assessments of personal exposure to air toxics as well as research focused on specific hazardous air pollutants. The latter recommendation was based on medical literature that suggests certain pollutants from the list of 188 air toxics are most likely to adversely affect respiratory health.     

Analysis of social epidemiology research on infectious diseases: historical patterns and future opportunities

BACKGROUND: Despite the many triumphs of biomedical research over infectious diseases, human pathogens continue to impact profoundly populations deprived of social resources. Correspondingly, health researchers have advocated a social determinants approach to the study and prevention of infectious diseases. However, it is unknown whether this call has resulted in an increase in the number of studies examining social determinants of infectious outcomes. METHODS: Research on social determinants of infectious diseases was systematically quantified by assessing temporal trends in the published literature using MEDLINE, PsycINFO and ISI Web of Science. RESULTS: Results of the literature review spanning 1966-2005 show that socially related citations increased an annual average of 180.3 for neuropsychiatric conditions, 81.9 for chronic conditions, 44.7 for sexually transmitted diseases and 18.9 for non-sexually transmitted infectious diseases (p<0.0001). Of the 279 publications found to employ the term "social epidemiology", 15 (5.4%) investigated infectious outcomes. CONCLUSIONS: The results of the literature review suggest a paucity of social research on infectious diseases. There is a need for increased dialogue and collaboration between infectious disease epidemiologists and social epidemiologists.