The Division of Epidemiology in the Department of Environmental Medicine conducts research around several different themes:

• Cancer and biomarkers of environmental exposures or susceptibility
• Hormonal and genetic factors in cancer and cardiovascular disease
• HIV epidemiology and prevention program
• Occupational and environmental causes of asthma
• Health effects of ionizing radiation and other environmental exposures
• Health effects of the World Trade Center disaster

HIV Epidemiology And Prevention Program

• Genetic Resistance to HIV infection: Analysis of prospective cohort data showed that susceptibility to infection with R5 strains of HIV-1 infection was reduced by approximately 70% in persons with a single copy of the CCR5-_32 deletion mutation. Prior to this study, the heterozygous genotype, CCR5-_32/wild-type was known to slow progression of HIV-1 disease, but was thought to have no effect on susceptibility to infection.
• International Studies of HIV: Analysis of HIV-1-serostatus among 4,156 individuals residing in 53 rural villages in Cameroon revealed great heterogeneity in Village seroprevalences, ranging from 0% to 18.2%. Further epidemiologic analyses of HIV-1 in Cameroon including studies of viral diversity are underway with in collaboration with Drs. Phillipe Nyambi and Susan Zolla-Pazner.
• Acute HIV Infection: In a program project of the immunopathogenesis of acute and early HIV infection (Fred Valentine, MD, principal investigator), we will study specific questions related to the roles of dendritic cells, HIV-specific CD4 cells, and T cell hyperactivation in the first weeks and months of HIV infection. Identification of substantial numbers of acute or early HIV-1 infections should permit epidemiologic studies of the efficacy of early HIV risk reduction counseling and contact tracing.
Drug abuse, depression and Responses to HIV Counseling: We are screening and
• enrolling New York City men who have sex with men (MSM) at high risk of HIV infection in order to
  1. describe the distribution of psychopathologies among persons undergoing HIV testing and counseling, and
  2. test the hypotheses that high-risk, HIV-seronegative persons with mild-to-moderate depression will be more likely to adopt protective behavior changes when provided with pharmacotherapy for their depression than when treated with placebo.
  Longitudinal analyses of KaposiÕs sarcoma herpes virus among study participants also are being conducted with the assistance of Ornella Flore, Ph.D. (Department of Microbiology).
• Phase I, II and III clinical trials of preventive HIV vaccines: Since 1997, we have participated as a site in phase I, II and III HIV vaccine clinical trials conducted, respectively, in healthy low-risk volunteers, injection-drug users, and men who have sex with men. We expect to continue these activities until such time as an anti-HIV vaccine is proven efficacious.

Selected publications:
Marmor M, Krowka J, Goldberg JD. CD4+ T Cell Surface CCR5 Density and Virus Load in Persons Infected with Human Immunodeficiency Virus Type 1 (letter). J Infectious Diseases 2000; 182:1284-1285.

Marmor M, Sheppard HW, Donnell D, Bozeman S, Celum C, Buchbinder S, Koblin B, Seage GR III for the HIVNET Vaccine Preparedness Protocol Team. Both homozygous and heterozygous CCR5-D32 genotypes are associated with resistance to HIV infection. J Acquired Immune Deficiency Syndromes 2001;27(5):472-81.

Marmor M, Shore RE, Titus S, Chen X, Des Jarlais DC. Drug Injection Rates and Needle Exchange Use in New York City, 1991 Ð 96. J Urban Health 2000; 77:359-368.

Harro CD, Judson FN, Gorse, GJ, Mayer KH, Kostman JR, Brown SJ, Koblin B, Marmor M, Bartholow BN, Popovic V for the VAX004 Study Group. Recruitment and baseline epidemiologic profile of participants in the first phase 3 HIV vaccine efficacy trial. J Acquired Immune Deficiency Syndromes; in press.

Nyambi P, Zekeng L, Kenfack H, Tongo M, Nanfack A, Nkombe I, Ndonko I, Shang J, Burda S, Mbah H, Agyingi L, Zhong P, Nádas A, Zolla-Pazner S, Marmor M. Human immunodeficiency virus infection in rural villages of Cameroon. J Acquired Immune Deficiency Syndromes 2002; 31:506-513.

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Dr. Friedman-Jimenez is conducting a study of asthma and occupation among patients from a low-income urban population, including a substantial number of African-Americans and Hispanics. The purposes of the study are:

• To find what proportion of adult asthma is attributable to occupation, especially work in the garment industry, building cleaning or maintenance, and health care occupations
• To identify occupations and occupational factors that are associated with the aggravation of asthma symptoms when at work
• Provide insight into potential causes of the racial, ethnic, and socioeconomic disparities in asthma prevalence.

Dr. Friedman-Jimenez and El Puente, a community-based organization, are conducting a research-demonstration project to develop an environmental intervention that may reduce the prevalence and severity of asthma among people in Williamsburg, Brooklyn. The feasibility of the intervention is being tested in this initial project.

Selected Papers:
Friedman-Jiménez G, Beckett WS, Szeinuk J, Petsonk EL. Clinical evaluation, management and prevention of work-related asthma. American Journal of Industrial Medicine 37:121-141, 2000.

Moure-Eraso R, Friedman-Jiménez G. Occupational health among Hispanic (Latino) workers in the urban setting. Book chapter in ÒLatino Health in the U.S., Molina C, Aguirre-Molina M, eds. Jossey Bass Publishers, 2001.

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The NYU / Bellevue Occupational and Environmental Medicine Clinic, which is run by doctors in the Department of Environmental Medicine, is involved in funded projects that provide for medical screening and follow up of workers and volunteers involved in various aspects of the World Trade Center tragedy. Dr. Harrison, with the collaboration of Dr. Friedman-Jimenez, conducts these projects which are a combination of focused community service and environmental public health research.

World Trade Center (WTC) Worker and Volunteer Medical Screening Project: The purpose of this study is to establish a comprehensive medical screening program to characterize the health effects of the WTC disaster, and to provide medical assessments, diagnostic referrals and occupational health education for the workers exposed to hazards of the WTC tragedy. The research component will assess the prevalence of several diagnoses of interest, as well as key symptoms, physical examination findings, breathing test abnormalities, chest x-ray abnormalities, and blood tests including lead levels. Blood is being banked from a large sample of the most highly exposed participants for future laboratory analyses of biomarkers of environmental exposure. This is both a community service and a research project and involves collaboration between Mount Sinai Hospital and NYU / Bellevue.

WTC DAY Laborers Screening Programs: A grant from the September 11th Fund provides medical screening to day laborers who were involved in the clean-up of buildings around the WTC site. Participants in this program are mainly uninsured immigrant workers who cannot afford health care. Day laborers worked long hours cleaning apartments and offices around the WTC, usually without any health and safety training or the necessary protective equipment. They receive a comprehensive physical exam, routine blood work, pulmonary function test, and medical and exposure questionnaires, plus medical referrals as needed. This program ensures that they receive needed health monitoring.

Another grant from the Robin Hood Foundation expands the effort to monitor the health of day laborers involved in the WTC clean up. This program provides a mobile medical van to deliver clinical services to day laborers in their communities. Since many immigrant workers are reluctant to seek medical care in a large institution, going into the communities will provide medical care for a large group of people who would not otherwise receive it.

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Several key findings in our radiation studies are:

• A study of cataracts among Chernobyl clean-up workers showed that even low-to-moderate doses of radiation led to excesses of early-stage cataracts. Further follow-up will establish whether these become advanced cataracts. (Dr. Shore, and investigators from Columbia University and the Ukraine)
• A study of the health status of people who as children in the 1940's and 1950's received x-ray treatment for ringworm of the scalp (a fungal infection) showed small excesses of brain tumors and thyroid cancer, and a large excess of associated skin cancer. The excess was especially large among those who are more susceptible to sunlight-induced skin cancer (namely, those with light complexions), suggesting that sunlight exposure is a co-factor with x-rays. (Drs. Shore and Harley)
• An analysis of most of the worldwide major studies of radiation exposure and breast cancer, including two of our studies of x-ray treatments for medical conditions, showed that there is an apparently linear dose-response down to quite low doses, and that radiation to the breast before age 20 confers a relatively high risk for breast cancer, while radiation after age 40 confers little or no risk. (Dr. Shore and an international group of investigators)
• A study of 86,000 U.S. Navy nuclear submariners showed no clear association between cancer risk and radiation doses received aboard the submarines. There is a suggestion of an association between time aboard submarines and ischemic heart disease, possibly implicating air pollutants such as cigarette smoke in the submarine atmosphere. (Drs. Friedman-Jiménez, Shore and Kato (former Division member))

Several other studies are underway or have produced results of interest:

• A large case-control study found no association between the use of handheld cell phones and brain cancer. However, since cell phone use is fairly recent, additional studies should be conducted in a few years when more time has elapsed for the development of possible tumorigenic effects. (Dr. Shore and investigators from other institutions)
• A case-control study showed that non-Hodgkin's lymphoma (NHL) is associated with the use of nonsteroidal anti-inflammatory drugs (such as aspirin and ibuprofen) and with antibiotics. However, these findings require replication by other studies, especially those that can better rule out the possibility that the underlying conditions (for example, inflammation), rather than the medications, are associated with NHL. The study also found NHL to be associated with using certain household insecticides. (Drs. Shore, Koenig and Kato)
• Rates of osteoarthritis of the knee in China are among the highest in the world. A study is therefore being conducted in the Chinese-American community to try to investigate occupational factors associated with knee osteoarthritis and to study biomarkers of susceptibility to collagen- and bone degeneration. (Dr. Friedman-Jiménez)

Selected Papers:
Kato I, Koenig KL, Shore RE, Baptiste MS, Lillquist P, Frizzera G, Burke JS, Watanabe H. Use of anti-inflammatory and non-narcotic analgesic drugs and risk of non-HodgkinÕs lymphoma (NHL). Cancer Causes and Control 13:965-974, 2002. Kato I, Koenig KL, Baptiste M, Lillquist P, Frizzera G, Burke JS, Watanabe H, Shore RE. History of antibiotic use and risk of non-Hodgkin's lymphoma (NHL). International Journal of Cancer, 107:99-105, 2003.

Preston DL, Mattsson A, Holmberg E, Shore RE, Hildreth NG, Boice JD. Radiation effects on breast cancer risk: a pooled analysis of eight cohorts. Radiation Research 158:220-235, 2002.

Shore RE. Human evidence on the effects of in utero radiation exposure on neurological and mental processes. In: Biological Effects after Prenatal Irradiation. Oxford:Annals ICRP (International Commission on Radiological Protection), 2003, 33:103-124.

Shore RE, Moseson MM, Xue X, Tse Y, Harley N, Pasternack BS. Skin cancer following x-ray treatment for scalp ringworm. Radiation Research 157:410-418, 2002.

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