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The Future is Now

May 12, 2016

BIRCWH Scholars Move On and Move Science Forward

As a core mission, Women’s Health Research at Yale trains the next generation of researchers to continue the important work of determining the influence of sex and gender on health outcomes.

Judging by the accomplishments of the first five junior faculty graduating from our Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) Scholar Program funded by the National Institutes of Health, the next generation has arrived.

“Both during and since leaving the program over the last two years, these enthusiastic and dedicated faculty members have swiftly displayed an investigative talent that has advanced our knowledge of some of the most serious health conditions we face today,” said WHRY Director Carolyn M. Mazure, Ph.D. “Moreover, they are providing leadership in contemporary research with their focus on women’s health and sex differences.”

Over their three years in the program, the research accomplishments of the first five graduates were recognized through a total of 58 peer-reviewed scientific papers, of which 62 percent listed one of them as the first author. They gave 30 presentations at national scientific meetings. And all were awarded competitive grants to fund their work, including two as principal investigators.

“We could not be more proud of their progress nor more delighted to count them as valued colleagues,” Mazure said.

Dr. Megan Smith

Dr. Megan Smith, now among the tenure-track faculty of Yale’s Department of Psychiatry and the Child Study Center with a secondary appointment in the School of Public Health, created and built a unique neighborhood-based infrastructure for studying and responding to the health needs of the community.

As Director of the New Haven Mental Health Outreach for MotherS (MOMS) Partnership, Smith studies the needs of socially and economically disadvantaged pregnant and parenting women and then translates her research into public policy. She aims to redefine how communities can employ the latest proven findings to sustain and improve health and well-being.

“It’s been incredibly successful,” Smith said. “We have proven the effectiveness of our interventions and are now in a position to partner with state and federal agencies to expand our reach, help more people, and gather data on a wider scale.”

For example, a study led by Smith while a BIRCWH Scholar and published in 2013 showed that the stress associated with reduced resources such as the inability to pay for diapers led to depressive symptoms. High levels of stress and depression in parents can harm a child’s development, mental health, and school achievement, leading to problems that can last a lifetime. Smith pondered how to stop this cycle and decided to supply diapers to mothers as an incentive for seeking and receiving their own mental health care. She was able to empirically show that providing diapers increased the number of mothers receiving mental health care, which led to improvement in the quality of parenting and better outcomes for children.

Other innovations in her collaborative work with the community include a new pilot study to reduce postpartum smoking, using smartphone technology to assess smoking abstinence and provide monetary rewards for compliance.

“Similar contingency management programs using monetary rewards have proven effective when nothing else works to help people make better choices under difficult circumstances,” Mazure said. “In the end, these investments save money by improving or preventing conditions that can cause illness and increase the burden on the health care system.”

Smith expressed particular enthusiasm for a new effort in which MOMS is joining with the state and the White House Office of Social Innovation and Civic Participation to implement a pay-for-success model to study 2,500 families over five years with a focus on providing care that will curb maternal depression and achieve good outcomes for children.

Designed by Smith as a partnership with the state, philanthropic organizations, and private investors, collaborating banking institutions will finance specific health improvement programs and receive 5 percent returns for successful outcomes as measured by metrics such as children reading at grade level, increased school attendance, and reduced Medicaid spending for mothers and children.

“This is a well-researched technique, a sound evidenced-based practice that works to help people change their behavior,” Smith said. “We are providing needed support with contingencies designed to help people help their families.”

Dr. Tomoko Udo

During her BIRCWH training, Dr. Tomoko Udo honed her interest in sex differences in addictive behaviors as she pursued both human and animal model research and expanded her focus from smoking to other addictive behaviors, including alcohol abuse and overeating. Upon graduation from our program she was recruited to a tenure-track position as an Assistant Professor at The State University of New York at Albany in the Department of Health Policy, Management and Behavior.

Among her accomplishments, in 2014, Udo co-authored the first study of the general U.S. population to find that women experiencing stressful life events were more likely than men to have an increase in their body-mass-index (BMI), a measure of weight relative to height.

“Previous studies have shown a connection between stress and higher body weight that might be stronger in women than men,” Udo said. “But I wanted to know more about how stress affects changes in BMI and how this relationship might differ by gender.”

Udo and her co-authors found that women reported higher increases in BMI than men and that women but not men experienced BMI increases following stressful life events such as job changes, legal trouble, and the death of family or friends.

“Armed with this information, researchers can focus their attention on preventing weight gain in women by discovering the behavioral and physiological mechanisms that underlie these female-specific effects following stressful life events,” Udo said. “And health care providers can work to help their female patients reduce their stress to help avoid weight gain.”

After leaving the BIRCWH program, Udo was able to take with her a competitive grant — obtained in collaboration with her primary mentor, Dr. Sherry McKee — that focuses on the link between the appetite-regulating hormone ghrelin and alcohol craving and drinking.

“We are hard-wired to find food reinforcing to help perpetuate the survival of our species,” McKee said. “Substances such as alcohol hijack these reinforcement systems, and can lead to addiction. Understanding the interplay between systems that regulate eating and addiction can lead to new treatments for addiction.”

In the meantime, Udo continues to conduct research and write papers with colleagues at Yale. She remains committed to understanding the eating behaviors that may contribute to the obesity epidemic, in which more than one third of adults in the country are considered excessively overweight for their height.

“Unlike alcohol or smoking, with eating we cannot work toward abstinence as a strategy to control behavior,” Udo said. “Instead, we have to develop strategies that help us learn to make better food choices.”

Dr. Philip Smith

After demonstrating epidemiological research expertise as a BIRCWH Scholar examining differences between women and men in smoking behavior and cessation, Dr. Philip Smith was recruited by the City College of New York’s Sophie Davis School of Biomedical Education as a tenure-track Assistant Medical Professor in the school’s Department of Community Health and Social Medicine.

While at Yale, Smith conducted research on sex differences in a variety of different populations in relation to addictive behaviors and co-occurring conditions. These included the association of mental illness and cigarette smoking, excessive gambling and psychiatric disorders among Native Americans, and the impact of childhood abuse on smoking cessation.

In one study, published in 2014, Smith and his co-authors found that women who were physically or emotionally abused as children were more motivated to quit smoking but less likely to succeed, possibly because of serious psychological distress. The authors found that maltreatment in childhood and serious psychological distress did not affect smoking outcomes among the men they studied.

“People with a history of childhood maltreatment are more likely to smoke cigarettes than those who had no adversity in their past,” Smith said. “There is a growing body of evidence that associations between childhood maltreatment and adult substance use may be stronger in women than men. We need to better understand how this history of abuse and current stress affect smoking cessation to create better gender-sensitive treatments.”

Since joining CCNY in the fall, Smith has received a grant to study factors that influence how well different smoking cessation medications might work for different people, including a focus on gender differences.

In addition, he has applied for another grant to investigate the effectiveness of these medications in real-world settings as opposed to highly-controlled clinical trials, using statistical techniques to isolate cause and effect within observational data collected from The Population Assessment of Tobacco and Health, a three-year study following 46,000 people nationwide.

“People in clinical trials are being monitored and counseled,” Smith said. “Very often people with mental or physical illness are excluded. It’s unclear how results translate to real-world populations. With this large population of observational data, we can get a sense of how these medications are working for women and men in the real world.”

And like his work in the BIRCWH Program, the study would look at potential sex and gender differences.

“I can’t do research now and not think about gender differences and women’s health issues,” Smith said. “It’s just deeply ingrained in the fabric of who I am as a scientist.”

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Submitted by Carissa R Violante on May 12, 2016