Past Research Projects
A Growing Repository
Below is a descriptive list of past research projects funded through CHW. They appear in alphabetical order by title. More information about current research conducted by CHW affiliates, including publications resulting from these projects, is available on their individual websites.
Find a research program or project:
- 2D and 3D Interfacing of Biomedical Devices for Ubiquitous, Customized Health Treatments
- Adversity and Resilience after Hurricane Katrina
- Applying Basic Bacteriology to the Global Health Challenges of Infectious Disease
- Center for Research on Experience and Wellbeing
- Ceramic Filters for Potable Water
- Characterizing the in vivo Plasmodium Metabolome
- College Education and Health
- Common Property Problems in Health
- Defining and overcoming the species barrier of Plasmodium falciparum blood stage infection
- Demanding the Right to Health in Courts: AIDS Treatment Access, Drug Markets, and Citizenship in Brazil Today
- Demography of Aging Center
- Differential Impacts of Environmental Policy on Infants in Poor and Minority Neighborhoods
- Digitization of vital statistics publications from early and mid-20th century America
- Dimensions of Subjective Well-Being: Aging, Religiosity, and Adaptation
- Economic Status, Public Policy and Child Neglect
- Endemic Fluorosis in Rural Villages of Northeastern India
- Expanding options for analyzing and summarizing hedonic wellbeing data from the Day Reconstruction Method
- From R&D to Patient Health: Studying the Orphan Drug Act
- Losing Hope, Losing Years: An Ethnographic Study of Declining Life Expectancies in White Rural America
- New Strategies to Detect and Prevent Tuberculosis
- Parental Resources and Child Wellbeing
- Provincializing Science: Mapping and Marketing Diversity from Lab to Legislature
- Quality of Health Care in India
- The Role of Humoral Immunity in Human Health: How Does Infection Susceptibility Relate to Autoimmune Susceptibility?
- Social Identity, Disease Risk Perception, and Policy Prioritization: Experimental Research on Race and HIV/AIDS in the United States
- South Africa: Poverty, Inequality and Health
- The Future of Global AIDS Treatment and the Social Determinants of Health
- The Integration of Chemistry and Biology to Seed a Next Generation of Malaria and Tuberculosis Therapeutics
- Udaipur Health Survey
- Using Vital Statistics Natality Data to Assess the Impact of Environmental Policy: The Examples of Superfund, the Toxic Release Inventory, and E-ZPass
- Who Governs the Microbe? Exploring the Emergence of Authority as Response to the Risk of Infectious Disease
2D and 3D Interfacing of Biomedical Devices for Ubiquitous, Customized Health Treatments
Mike McAlpine and colleagues focused on two major health thrust areas: 1) 2D biointerfaced graphene nanosensors for detection of infectious disease, and 2) 3D printing of implantable biomedical devices for treatment of peripheral neuropathies and nerve disorders, which are often due to infectious disease, HIV infections, nutritional deficiencies, and the use of neurotoxic antiretrovirals. For 1), direct 2D interfacing of nanosensors onto biomaterials could revolutionize health quality monitoring and adaptive threat detection. Graphene is capable of highly sensitive analyte detection, and we have shown that graphene nanosensors can be intimately biointerfaced onto the body, including teeth, skin and food. The result is a fully interfaced sensing platform which can be tuned to detect target infectious analytes, including wireless detection of bacteria at few-cell levels. For 2), the research team has developed 3D printed nerve conduits, or nerve guidance channels (NGCs), for complex peripheral nerve injuries. In order to achieve anatomically true and geometrically complex NGCs, they have developed a novel biofabrication platform which allows the NGC design to be matched to the actual patient anatomy via the use of 3D structured-light scanning (3DS)-based wound imaging and 3D printing (3DP)-based NGC assembly. This also addresses the significant problem of the lack of personalized conduits for peripheral nerve injuries. These studies point to a new model of healthcare, in which the manufacturing and interfacing of biomedical devices becomes ubiquitous.
Adversity and Resilience after Hurricane Katrina
Christina Paxson, with colleague Cecilia Rouse and collaborators at Harvard University, the University of Massachusetts-Boston and Washington State University, designed a survey to examine how a group of low-income parents from New Orleans - most of whom are single African American women - have coped with the effects of Hurricane Katrina. The 1,019 low-income parents in the sample are part of an intervention that was started before Hurricane Katrina; it provided members of a randomly-selected treatment group with tuition assistance and academic advising at local community colleges.
The original study provides pre-hurricane information on the health, social networks, and economic status of members of the treatment and control groups. Paxson and her group then conducted follow-up surveys and qualitative interviews 18 months and again four years after the hurricane. Their focus was on identifying factors that promoted resilience and heightened vulnerability within this group. They studied how pre-hurricane resources and capacities - defined to include mental and physical health, social networks, and economic resources - affect the ability to successfully adjust to a major life trauma. They also studied the factors that influenced a broad set of outcomes measured over a four-year period following the hurricane, including psychological distress, symptoms of post-traumatic stress disorder (PTSD), trauma exposure, and the re-establishment of social networks and resumption of employment and educational activities. They examined how the children in these families were coping with the effects of the hurricane. Finally, they examined whether those in the treatment group, who gained additional education prior to the hurricane, experienced better post-hurricane outcomes than those in the control group. This project was funded by the National Institutes of Health.
Applying Basic Bacteriology to the Global Health Challenges of Infectious Disease
The rise of antibiotic resistance in bacterial pathogens represents an escalating global health crisis. Gitai Zemer and his lab helped to tackle this problem by lending its expertise in bacterial cell biology for identifying new antibiotic drugs and drug targets. More specifically, the researchers used their understanding of a new set of essential bacterial proteins, the bacterial cytoskeleton, to discover both new families of proteins, essential for bacterial pathogenesis (candidate drug targets), and small molecules that perturb those proteins (candidate drugs). The group had already identified a small molecule that targets the essential bacterial actin-like cytoskeleton, which based on preliminary studies, could block the growth and virulence of a wide range of human pathogens. This project engaged a multidisciplinary group of scientists at the undergraduate, graduate, postdoc, and faculty levels and the researchers hope their efforts integrate with those of the greater Princeton community through new inter-disciplinary courses, seminar series, and interest groups. This project was funded by the Health Grand Challenge.
Center for Research on Experience and Wellbeing (completed pilot projects; all were funded by the National Institutes of Health)
“Understanding ‘life choices’: happiness or something else?” – Matt Adler (Duke University), Paul Dolan (London School of Economics) and Georgios Kavetsos (London School of Economics)
There has been increasing interest amongst academics and policymakers in using measures of subjective well-being (SWB) to monitor progress and evaluate policy across the world (Dolan and White, 2007; Stiglitz et al., 2009; Diener et al., 2010). The Office of National Statistics (ONS) in the U.K. has responsibility for measuring SWB in large general population samples, and the OECD and a panel convened by the National Academy of Science in the US are in the process of suggesting ways of measuring happiness for policymakers. At the same time, many organisations, such as Gallup, collect daily data on SWB around the world.
This presents a number of questions about precisely how happiness should be measured and what role the possible measures should play in judging how well life is going for people. There are many things that people may care about in their lives, such as income, health, relationships and the achievement of goals, and so we need to find out just how important SWB is to people when compared to directly to these other things. Remarkably little research has been conducted into eliciting such preferences and so this project seeks to fill this important gap in the evidence.
SSI will invite people to participate in the study and will do so according to pre-specified demographic criteria in order to achieve a representative sample of the population. This sampling strategy is expected to yield a socioeconomic distribution that is comparable to the general US population. The sample will be selected so that there is an equal number of males and females.
This protocol does not involve any special classes of subjects. Eligibility criteria are (1) no significant sight, hearing, or writing impairment, (2) English fluency. Participants will complete an online questionnaire. They will answer questions regarding the aspects of life that bring them happiness.
Verbal Interviewer and Respondent Behaviors that Predict Time Diary Quality: Lessons from the Panel Study of Income Dynamics PSID)
The purpose of this study by V. Freedman, F. Conrad, N. Schwarz, F. Stafford was to analyze verbal interviewer and respondent behaviors that occurred during the administration of the computer assisted time diary application in the PSID’s Disability and Use of Time supplement. Partial recordings of 95 diary interviews with married individuals ages 50 and older were transcribed and coded, using a scheme developed by the project team. Transcripts of the interviews yielded 21,685 "utterances," defined as a turn in the conversation about a given diary question, and 6015 "sequences," defined as the set of utterances about a question. Initial findings, presented at the PSID seminar series (Broome et al, 2011), are being finalized for submission to a peer-review journal.
Ceramic Filters for Potable Water
This research by Winston Soboyejo and Karen Malatesta built on an interdisciplinary project begun in the summer of 2008 that established a factory in Nigeria to produce ceramic water filters from locally available materials. The project was designed to improve the host community’s health and wealth by simultaneously protecting residents against water-borne disease and creating a new local enterprise. The second phase of research replicated the Nigerian prototype in Burkina Faso and Kenya, training personnel and equipping the factory to be supervised and operated by local staff, and investigating prospects for expansion to other settings using the franchise model. Public health studies in both new factory locations assessed the filters’ impact on local residents. Studies were also conducted to determine the mechanisms of microbe adsorption and the killing of bacteria by the colloidal silver coatings typically applied to the filter surfaces, and research objectives included the development and characterization novel adsorptive surfaces for the removal of nano-scale viruses and chemical contaminants in addition to bacteria. This project was funded by the Health Grand Challenge.
Characterizing the In Vivo Plasmodium Metabolome
Manuel Llinas and his team set out to understand the metabolic interaction between the malaria parasite, Plasmodium falciparum, and its human host during infection. One aspect of the study used mass spectrometry analysis on patient samples from endemic regions to catalogue the small molecule metabolite levels in infected and uninfected individuals. The methodology for this project was already well established in the lab, with the examination of in vitro cultures of infected red blood cells. One motivating factor for this project, therefore, was to extend this work to field samples from infected individuals, possibly providing valuable insight toward future therapies aimed at abrogating the severity of disease and ultimately curing people of it. Such research is ideal for international partnerships, as Princeton researchers provide the training for international personnel, who can then perform these experiments in established locations worldwide; as the technological investment is feasible; and the methodologies are easily transferable. This project was funded by the Health Grand Challenge.
College Education and Health
Christina Paxson, together with Cecilia Rouse and Adriana Lleras-Muney, studied the impact of education on health outcomes and behaviors among young adults. This work was done in collaboration with the Manpower Demonstration Research Corporation (MDRC). The study had added a health component to an assessment of a new and unique education intervention, the Opening Doors experiment. Opening Doors provided 4,400 economically disadvantaged young adults in a set of community colleges across the country with financial assistance, mentoring and curricular enhancements, all aimed at increasing levels of educational attainment. Approximately 3,600 controls did not receive program benefits but were followed over time. Randomization of individuals into treatment and control groups made it possible to identify the causal effects of educational attainment on health outcomes and behaviors. The study assessed how the intervention affects health and health behaviors in the short run; how initial health affects progression through college; and whether the intervention ameliorates adverse effects of initial health on educational attainment. This project was funded by the National Institutes of Health.
Common Property Problems in Health
This integrated research and teaching program was established by Simon Levin and Ramanan Laxminarayan in 2008 and examined the challenge of drug resistance within the broader context of common-property problems in infectious disease. Progress in creating policy solutions for dealing with drug resistance will depend on better understanding of the ecology of resistance as well as incentives for patients, physicians and health care facilities to make better use of antibiotics. Economic and social incentives and norms are important for determining how infection and drug resistance externalities are addressed in health care. The project’s overarching goal was to see how incentives and norms interact in the context of clinical practice.
In collaboration with the Centers for Disease Control and Prevention and other partners, researchers studied the epidemiology of antibiotic use in US hospitals. They tested the hypothesis that providing medical doctors with information on their own antibiotic prescribing practices and in relation to that of other physicians can change their prescribing behavior. This study helped to delineate the role of information in altering intrinsic motivation of healthcare providers, and it served a practical role in identifying the effectiveness of a feasible intervention to change antibiotic prescribing. This project was funded by the Health Grand Challenge.
Defining and overcoming the species barrier of Plasmodium falciparum blood stage infection
PI: Alexander Ploss, Princeton University
Annually, infectious diseases cause nearly one quarter of all human deaths worldwide. This large burden of mortality and morbidity is due to steady and significant background level of established infections, periodic emergence of new infectious diseases, and to sudden surges in infection of old established infections. Many pathogens exhibit very strong human tropism, meaning that only human tissues can be infected with these pathogens. This tropism poses unique challenges for studying host-pathogen interactions and for testing intervention strategies. Research in the Ploss Lab focuses on systematically identifying barriers preventing transmission of human hepatotropic pathogens to non-primate species, and translating our discoveries into devising experimental systems that will allow us to understand and dissect host responses to these diseases.
Parasites causing malaria in humans are a prime example of clinical highly relevant pathogens that infect only humans and some great apes. With particular focus on Plasmodium falciparum, the parasite species that is most virulent in humans, the goal is to establish proof-of-concept for overcoming genetically the barriers of interspecies transmission of plasmodial parasites to rodents. A mouse model with inbred susceptibility to P. falciparum infection would open unprecedented opportunities to study this important human pathogen. Furthermore, it could be used to assess the efficacy of novel drug and vaccine candidate.
Demanding the Right to Health in Courts: AIDS Treatment Access, Drug Markets, and Citizenship in Brazil Today
For this multi-site, interdisciplinary project, João Biehl and his Princeton students collaborated with local Brazilian university students studying social science, law, and medicine to understand the impact of judicial claims for access to high-cost pharmaceutical products in the Brazilian health care system. Biehl's research assumed a pedagogical approach to methodologically and analytically train a new generation of young scientists interested in public service.
Brazil has been an innovator and leader in the effort to universalize access to high-cost pharmaceutical products, particularly AIDS treatment. In 1996, it became the first developing country to make antiretroviral drugs (ARVs) universally available through its ailing public health care system. Following the ARV rollout, Brazilian courts began to see an increasing amount of private citizens prosecuting municipal and state offices to attain access to experimental and high-cost medications to treat all kinds of acute and chronic diseases. This growing demand for medicines raised a whole new set of challenges regarding the legal right to health and appropriate standards of care, while greatly straining public health budgets. The project focused on the southern state of Rio Grande do Sul, where the annual number of such cases had risen from a few hundred to more than ten thousand over a ten year period. Other regions experienced a similar pattern of growth.
Biehl considered several factors in studying the cause and effect of the judicialization of the right to health. He produced a database for a quantitative analysis of the phenomenon that revealed the demographic character of the patient/plaintiff population, the type and frequency of drugs requested, the pathological conditions involved, and the legal arguments employed. The phenomenon was studied from a qualitative perspective (literature review, archival research and semi-structured interviews), and included the role of public and private lawyers, the position and function of disease-specific nongovernmental organizations, the costs of the combined cases on legal systems, and the historical and political contexts of the legal arguments employed in these claims. Responses to important public health policy questions set forth in studying this phenomenon helped conceive responses to important public health policy questions, such as: what are appropriate standards of care, how can government costs be minimized, and how do pharmaceutical patents affect the accessibility of treatments?
The research also explored issues of health technology assessment and the production of scientific knowledge. For example, the reliability of clinical trials and the state’s ability to respond to contested medical claims.
Included in this study were interviews with professionals, in the state of Rio Grande do Sul, who dealt with the legal, medical and public health implications of this phenomenon, as well as the professional opinions of those involved in health technology assessment, intellectual property, and human rights in the cities of Rio de Janeiro, São Paulo, and Brasília.
The project was funded by the Ford Foundation.
Differential Impacts of Environmental Policy on Infants in Poor and Minority Neighborhoods
Janet Currie, PI
Where people live impacts the hazards they are exposed to. Minority and low income children may be disproportionately exposed to environmental pollution, and may be less able to deal with the consequences of these exposures. Exposure during the fetal period and in infancy may be particularly harmful, leading to lifelong consequences. Hence, policies to clean up pollution might be expected to have particular benefits for poor and minority infants.
This research, supported by funding from the MacArthur Foundation, considered several such policies including Superfund cleanups, changes in regulations covering the Toxic Release Inventory, and the introduction of the electronic toll collection systems on roadways. These initiatives represent differing approaches to the amelioration of environmental problems. The study asked whether vulnerable children suffer greater exposure, and whether vulnerable children are likely to benefit differentially from a given policy.
When measuring benefits, it is important to take account of potential effects through the housing market. When environmental policy is successful, it may increase housing costs and poor and minority children may be displaced. In this case, housing market effects could undo some of the positive effects of environmental cleanups for these children.
This research involved the statistical analyses of a unique longitudinal data base created from millions of U.S. birth records. This data base has large samples of African American, Asian American and Hispanic children. Less educated mothers, teen mothers, and mothers in high-poverty neighborhoods can also be identified.
The results of this study shed new light on the environmental justice literature by examining the extent to which environmental policies close gaps in exposures and outcomes between poor and minority infants and others, as well as on the extent to which these policies displace vulnerable mothers and infants from the newly improved neighborhoods. These research outcomes in turn show how spacial disparities in exposures arise, and how persistent they are likely to be. The ultimate goal of the research was to suggest policies to improve outcomes and minimize displacement. Since most neighborhood improvements can be expected to impact housing prices, the results are relevant to other place-based policies. The project was supported by funds from the MacArthur Foundation.
Digitization of vital statistics publications from early and mid-20th century America
PI: Ilyana Kuziemko, Princeton University
This seed grant will be used to digitize vital statistics birth and death records from the early 20th century US, which currently exist only in hard copy. The datasets that are created will have these statistics by locality (city, county or state, depending on the detail provided in a given year) and by race. The hope is that these data can be used by researchers to better understand state-to-state migration patterns during this period and black-white mortality (in particular infant mortality) differences by year and locality.
Dimensions of Subjective Well-Being: Aging, Religiosity, and Adaptation
PI: Angus Deaton, Princeton University
The project, funded in August 2011 by the National Institute on Aging, is directed by Angus Deaton, in collaboration with Arthur Stone (link is external), Distinguished Professor of Psychiatry and Psychology at Stony Brook University, and Nobel Laureate Daniel Kahneman, Professor Emeritus of Psychology and Public Policy at Princeton. The project will study the use of self-reports as measures of well-being, with a view to advancing the measurement of subjective well-being and to advancing the understanding of whether and how such measures can and should be used in policy. The analysis rests on the distinction between different concepts of “happiness.” One concept relates to hedonic well-being, the continuous flow of feelings that is experienced on a moment to moment basis. The other is an overall view of how life is going, which comes from a considered judgment. Accumulating evidence suggests that these two concepts capture different aspects of human well-being, and that they respond differently to different circumstances.
The project will explore this distinction using large new data sets for the United States and for more than 150 countries around the world. It will look at how the different measures of self-reported well-being are related to life circumstances, with a particular focus on age. There are several hypotheses in economics and psychology about how subjective well-being should change over the life-cycle, and these will organize the investigations.
Another major line of investigation is the role of religiosity in well-being; the research will seek to better understand both the determinants of religiosity—why people become more religious as they age, why women are more religious than men—as well as the benefits or costs of religion and whether they are or are not universal around the world. The final topic is the extent to which subjective well-being is relative: for example, whether well-being depends on a person’s own income, or instead on income relative to the income of others. One hypothesis is that the well-known phenomenon of adaptation can often be mistaken for relativity, and that this has important consequences for thinking about economic policy for the elderly, including such issues as the taxation of social security benefits or incentives for postponing retirement.
An overarching theme of the work is to understand whether self-reports of well-being can be defended as guides to policy, or whether the criticisms of them by some philosophers and economists are sufficient to rule them out. A better understanding of adaptation is also a key for this last endeavor.
Economic Status, Public Policy and Child Neglect
Christina Paxson engaged in research on the relationships between economic factors and child neglect. This work was done in collaboration with Jeanne Brooks-Gunn, Neil Guterman and Jane Waldfogel (at Columbia University) and former CHW-research fellow Lawrence Berger (University of Wisconsin-Madison). The research examined how parental resources—in the form of parental presence or absence, time, and money—influenced both physical and emotional neglect of pre-school children, and how recent changes in welfare policies influenced neglect. The study collected data on child neglect as part of the Fragile Families and Child Wellbeing Study, a birth cohort study directed by Sara McLahanan. The research was funded by a grant from the National Institute of Child Health and Development.
Endemic Fluorosis in Rural Villages of Northeastern India: Development of a Robust Water Treatment Technology, Field Implementation, and its Health Effects
Some 200 million people drink ground water containing flouride levels well above WHO guidelines. High fluoride levels in drinking water causes fluorosis, an incurable condition that deforms bones and damages teeth. Peter Jaffe set out to develop and deploy a simple and robust technology to remove fluoride from drinking water in impoverished villages in India, employing his research team's hypothesis that a hydroxyapatite-based filter is the simplest and most appropriate method of removing fluoride in this setting. Hydroxyapatite can be synthesized inexpensively from locally available materials. After completing laboratory studies of the filtration system, the team installed devices in two villages of approximately 200 people (nearly 100% of the population), who are severely afflicted with fluorosis. Performance optimization of such filters was an important aspect of this study.
By monitoring the fluorosis incidence as a function of age within years of this project, researchers can track new fluorosis cases to determine the project's success over just a few years in these two villages, illustrating how both the technological and strategic development of a project contributes to measurable health improvements. Such projects serve as an important model for necessary interdiciplinary collaboration, in this case, between the engineering and health sectors. This project was funded by the Health Grand Challenge.
Expanding options for analyzing and summarizing hedonic wellbeing data from the Day Reconstruction Method
Interest in the measurement of time-use and hedonic wellbeing (HWB) has risen substantially. One comprehensive method of evaluating time use and HWB is the Day Reconstruction Method (DRM) (Kahneman et al., 2004) . It combines elements of experience sampling and time diaries, and is designed specifically to facilitate accurate recall of daily HWB. The DRM asks respondents to reconstruct all episodes of the previous day, and to indicate the activities, social contexts, and HWB experiences for each episode. This way, a wealth of information about activities, the duration of those activities, and associated HWB is available for each individual.
The DRM provides important and novel opportunities for characterizing and comparing daily HWB between individuals, demographic subgroups, and across cultures. The fact that respondents provide ratings of experiences for multiple daily episodes allows for a much more fine grained understanding of HWB that cannot be achieved by traditional "global" wellbeing survey methods. However, to date, strategies for analyzing DRM data have not exploited the full potential of the method.
The purpose of this application, led by Stefan Schneider and Arthur Stone (USC), was to investigate several new approaches for analyzing and summarizing daily HWB based on multi-episode data from the DRM using state-of-the-art methods for the analysis of complex survey data. By applying these new approaches and examining their utility, the goal was to enrich the repertoire of available tools for understanding daily HWB from the DRM and similar data collection methods (for example, the Well Being Module of the American Time Use Survey). The application took advantage of several existing datasets that have used the DRM; no new data was collected. Drawing on several datasets was important to determine whether results obtained for one study replicated across studies.
From R&D to Patient Health: Studying the Orphan Drug Act
This project studied the mechanisms through which the Orphan Drug Act (ODA) benefits health and affects firm investment decisions. The Orphan Drug Act (ODA) was passed in 1983 to encourage R&D into drugs that treat rare diseases by providing incentives for R&D into rare disease drugs. Most significantly, it provides the sponsor of an orphan drug with marketing exclusivity, and a tax credit on its clinical trials expenses. Using a novel data set Wesley Yin collected on clinical trials of pharmaceutical and biotechnology firms, he estimated the impact of the ODA on clinical trials for rare disease drugs, and on final marketed products. To quantify these separate mechanisms, he distinguished between new drug development and marketing of existing products for orphan indications. R&D for new products leads to new drug innovations for patient consumption. Clinical trials for existing products benefits patients through information of new therapeutic uses, through tailoring dosages appropriate for the orphan population, and through expansion of insurance coverage for previously off-label drug use. The ODA's impact on each of these pathways was separately estimated. Finally, Wesley Yin studied the mechanism through which the incentives of the ODA affect firm investments. Stylized facts suggest that the incentives are not working through standard price and revenue mechanisms. Firm structure and financing constraints may be interacting with the incentives of the ODA. These interactions are important to understand, as the characteristics of a firm's capital structure will dictate the types of incentives best suited to promote rare disease drug development.
Losing Hope, Losing Years: An Ethnographic Study of Declining Life Expectancies in White Rural America
PI: Carolyn Rouse, Princeton University
Understanding declining life expectancies within certain white populations is important not simply because it represents a public health concern, but it also speaks to failures in social policy since the 1980s. This ethnographic research will focus on nine rural communities in a county in Northern California. The goal is to understand the loss of hope, the normalization of drug use and prison, and the lack of coherent political critiques focused around real policy reforms. In order to capture the relationship between political and social beliefs and declining life expectancy, Rouse will research family histories (genograms) with respect to jobs, income, health, religion, education, incarceration, and expectations for the future
New Strategies to Detect and Prevent Tuberculosis
This collaborative program, under the guidance of John Groves and Joshua Rabinowitz, aimed to discover and implement novel strategies for the detection and prevention of tuberculosis in humans. The program was built on discoveries in the Groves laboratories at Princeton that have elucidated pathways used by virulent mycobacteria to access the iron they need for propagation within human cells. The host-pathogen interaction for tuberculosis is extraordinarily complex since the bacterium exploits some aspects of normal cell function while inhibiting or deactivating others. However, little is known about the iron acquisition and transport pathways adapted by mycobacteria in vivo.
Fluorescence detection techniques were developed in the Groves laboratories that allowed direct observation of iron theft from the host cell by the invading bacterium. This project aimed to apply high-level mass spectrometric techniques developed in the Rabinowitz laboratory to monitor changes in metabolite profiles within human cells upon exposure to mycobacterial siderophores. Several past discoveries required researches to significantly modify the thoughts around iron acquisition by the pathogen. The basic premise of the project was that detection of siderophore production by the M. tuberculosis could be exploited as an early indication of infection. Further, the siderophore uptake pathway offers a new and highly specific avenue for drug delivery and therapy. This project was funded by the Health Grand Challenge.
Parental Resources and Child Wellbeing
This project, funded by the National Institutes of Health and led by Christina Paxson, studied how parental resources affect children’s wellbeing, as measured by children’s health status and their cognitive, social, and emotional development. The first aim of this project was to examine how three broadly defined aspects of parental resources — economic status, family structure, and parental health (both mental and physical) — are related to each other. The second was to study how parental resources affect the quality of parenting (discipline, warmth, supervision, and cognitive stimulation) and material resources (e.g., home learning materials, food security, neighborhood safety, and access to medical care) that children receive. Finally, the researchers examined how all of these “inputs,” in turn, affect children’s outcomes. A specific “case study” was on the determinants of childhood obesity, a preventable child health outcome that is the precursor of adult obesity. The study utilized newly collected data from the Fragile Families and Child Wellbeing Study, a survey that follows birth cohorts of 3,675 children born to unwed parents, and 1,125 children born to married parents, from twenty US cities in fifteen states, from birth to age four. A key advantage of this survey was that it tracks and collects information from fathers, including those who do not live with their children. Using the Fragile Families data, it was possible to study the role of fathers in children’s health and developmental outcomes. The project also used data from other surveys, including the Panel Study of Income Dynamics and the National Health Interview Survey. The results of this research provide valuable information on the determinants of children’s wellbeing, and the mechanisms through which parental resources affect children’s outcomes. Visit the project website.
Provincializing Science: Mapping and Marketing Diversity from Lab to Legislature
PI: Ruha Benjamin, Princeton University
In a project tentatively titled, Provincializing Science: Mapping and Marketing Diversity from Lab to Legislature, Ruha Benjamin asks how the field of human population genomics reflects, reinforces, and sometimes challenges socio-political classifications such as race, caste, and citizenship. Drawing upon in-depth interviews, participant observation, and a mixed archive of documents and media, she is examining how different national imaginaries shape the impact and meaning of this field in distinct ways, and increasingly through the idiom of ‘sovereignty’ in which governments claim to be the custodians of a population’s genetic inheritance. Ultimately, this project aims to further our understanding of how science and society are mutually constituted and how both are influenced by processes of globalization, nation-building, and ethnoracial stratification.
Quality of Health Care in India
Jeffrey Hammer has been developing methods of measuring the quality of health care in developing countries.
Defining "quality" of health care in economic research has always been problematic. For a long time it was identified with "presence of drugs or equipment" which has little to do with the quality in terms of accuracy and effectiveness of advice given at a clinic. This project was originated to make progress on this score using a variety of techniques using data collected on over 200 medical providers in Delhi chosen from a census of providers in areas of Delhi with an ongoing household survey. The providers were both public and private and within the private, spanned the range from highly trained doctors to people with no training at all.
The first technique was the use of "vignettes" or hypothetical cases presented to doctors by two interviewers, one playing the role of patient and the other a recorder (and course of answers to possible test results if called for by the medical provider). The second technique was simply to have an interviewer sit with a provider for the day, recording all visits (time spent, number of relevant questions asked, money paid, whether a diagnosis was given, medicines prescribed, etc.). This allowed for a variety of tests of quality of advice and the difference between what doctors say they would do and what they actually do. It also highlighted the deficiencies that poor people face in both public and private sectors.
Methods using Standardized Simulated Patients were developed and variants on all methods were adapted and used by a variety of researchers (See Health Affairs v. 26, no. 3, March 2007 Special Issue; Dehn, Reinikka and Svensson at World Bank website).
This project was done in conjunction with Jishnu Das at the World Bank and the Institute of Socio-Economic Research on Development and Democracy, Delhi.
The Role of Humoral Immunity in Human Health: How Does Infection Susceptibility Relate to Autoimmune Susceptibility?
Andrea Graham investigated how antibodies confer resistance against many infectious diseases and yet also cause autoimmunity when they attack host tissue or accrue at densities that damage blood-filtering organs. Despite the importance of these contrasting roles of antibody-mediated (humoral) immunity in human health, the relationship between infection susceptibility and autoimmune susceptibility remains unknown. We have taken a 2-pronged approach to investigate whether hosts experience a trade-off between infection and autoimmune susceptibilities. First, in a wild sheep “model system,” we found that parasite-reactive and self-reactive antibodies independently promote survival, via resistance to infection and maintenance of homeostasis, respectively, and independent of nutritional plane. Second, in elderly Taiwanese people, we measured self-reactive and herpes-specific antibodies and contracted a virology lab to measure influenza-specific antibodies. We will now test the hypothesis that, as in sheep, human predisposition to humoral autoimmunity may, prior to the onset of any autoimmune disease, be associated with enhanced resistance to infection.
Social Identity, Disease Risk Perception, and Policy Prioritization: Experimental Research on Race and HIV/AIDS in the United States
In this study, Evan Lieberman and Yarrow Dunham conducted a series of web-based survey experiments to investigate the implications of social identity theory for citizen risk perception and policy prioritization of a stigmatized condition. They hypothesized that race is likely to be an important heuristic for citizen risk assessment in the face of uncertainty. They also proposed that when primed to consider a disease as a stigmatized condition, members of stigmatized groups (such as Blacks in the U.S.) are more likely to downplay, or even deny, those risks in order to avoid the associated stigma or group shame. If the experimental results are consistent with the hypotheses, they may suggest that specific current practices of targeting African Americans as being most at risk for HIV and AIDS may yield unconsidered drawbacks. They also discussed additional hypotheses with respect to white Americans. This project was funded by the Program on U.S. Health Policy.
South Africa: Poverty, Inequality and Health
Anne Case and Angus Deaton, together with Alicia Menendez from the Harris School at the University of Chicago, conducted integrated health and economic surveys in South Africa, to investigate the links between health status and economic status. This work was done in collaboration with researchers from the Institute for Advanced Studies in Princeton and the University of Witwatersrand, and with WWS graduate and CHW visitor Ingrid le Roux of the Philani Nutrition Centers and Department of Health. The survey instruments collected data on a range of traditional and non-traditional measures of well-being, including income and consumption, measures of health status (including mental health), morbidity, crime, social connectedness, intrahousehold relationships, and direct hedonic measures of well-being. The surveys drew on recent work in economics, health, psychology, and anthropology to explore different kinds of welfare measures and the relationships between them. Their work in two South African field sites, Agincourt and Khayelitsha, was funded by the National Institutes of Health. Visit the project website.
The Future of Global AIDS Treatment and the Social Determinants of Health
Currently, many public- and private-sector initiatives are being launched worldwide, seeking to address HIV/AIDS therapeutically in places where treatments have been scarcely available. These initiatives raise a new set of national and global healthcare policy challenges regarding adequate drug delivery, sustainable treatment access, and the integration of treatment with primary care, food access and prevention. Broader questions arise as well: how can accountability of all sectors be assured? How do these trends affect health systems and the role of governments and their human rights obligations? How are other deadly diseases of poverty that have less political backing being dealt with? And, finally, what on-the-ground effects do these manifold issues have on the experience of living with HIV/AIDS and poverty?
This interdisciplinary and experience-based research and teaching project, initiated in March 2008 by João Biehl, used the Brazilian therapeutic response to AIDS and its repercussions through government, markets, health systems and civil society as an ethnographic baseline from which to gauge the aftermath of large-scale drug access programs. Focusing on Africa and Latin America and in partnership with local initiatives, the research team charted the emerging governmental, philanthropic, nongovernmental and industry networks developing around HIV/AIDS technology and delivery. The team also identified new challenges, limitations, and emergent forms of social mobilization and theorized the role of the social sciences in evidence-making and advocacy in global health. By using qualitative methodologies in harmony with more traditional quantitative ways of studying health interventions and outcomes, the project sought a people-centered approach to global health knowledge-making. This provided a much-needed window into the real-life outcomes of national, international, corporate, and institutional policies. This project was funded by the Health Grand Challenge.
The Integration of Chemistry and Biology to Seed a Next Generation of Malaria and Tuberculosis Therapeutics.
Professors Erik J. Sorensen and Dr. Joel S. Freundlich led a chemistry-driven effort to seed the discovery of novel antitubercular and antimalarial agents. Key to their effort was the development of a novel synthetic methodology to efficiently construct complex organic molecules, both natural products and their designed analogs that have the desired biological activity. Through extensivebiology-based collaborations at Princeton University and abroad, they detailed the in vitro and in vivo efficacy of these small molecules, and thoroughly examined their mechanism of action. The end result of this research should be both novel biological targets and facilely accessible small molecules that modulate them to achieve the desired antitubercular and/or antimalarial activity. This project was funded by the Health Grand Challenge.
Udaipur Health Survey
Angus Deaton, together with collaborators Abhijit Banerjee and Esther Duflo at MIT, Jishnu Das at the World Bank, and Seva Mandir in Udaipur, investigated health and economic status among rural households in the Udaipur district of Rajasthan in northwestern India. Members of around 1,000 households in 100 villages were surveyed, and asked about their economic activities, physical and mental health status, and experiences with healthcare. Complementary surveys collected information about village infrastructure and about the clinics and medical personnel that people use, including traditional healers. One aim of the study was to discover more about the quality of healthcare, how well it serves the people who use it, and the extent to which it contributes to health status. More broadly, the study aimed to improve understanding of the determinants of health, as well as the relationships between health and economic status, and how they work together to determine wellbeing. Visit the project website.
Using Vital Statistics Natality Data to Assess the Impact of Environmental Policy: The Examples of Superfund, the Toxic Release Inventory, and E-ZPass
Janet Currie led this study that investigated the extent to which geocoded Vital Statistics Natality data collected from birth certificates can be used to assess the impact of environmental policy changes. These records cover millions of births (in fact all births) over long periods of time. They include information about maternal background and birth outcomes as well as information about the precise residential location of mothers. Moreover, birth records can be linked to infant death records to yield large samples of infant deaths. Given residential addresses, it is possible to link mothers to information about nearby environmental hazards. It is also possible to link births to the same mother, so that the effect of changes in potential exposure can be assessed. The hypothesis investigated was that these large and comprehensive data sets can shed useful light on the effects of environmental policy. The specific policies investigated included cleanups of hazardous waste (Superfund) sites, changes in information about toxic releases as tracked in the Toxic Release Inventory, and the implementation of E-ZPass at toll plazas on busy roadways in New Jersey and Pennsylvania. The study was funded by the Environmental Protection Agency.
Who Governs the Microbe? Exploring the Emergence of Authority as Response to the Risk of Infectious Disease
Within any inhabited territory, people are vulnerable to various types of infections and the onset of disease and death. Any number of governing authorities -- ranging from local governments to international NGOs to traditional healers -- might allocate resources and energies to curb the spread of infectious disease, but across time, space, and infection type, these efforts vary widely. What explains who attempts to govern such problems? To what extent do different infections receive different responses, and why? What are the positive pressures that drive and what are the countervailing pressures that impede aggressive action?
This collaborative training and research project under Evan Lieberman, sought to answer such questions by gathering information about governance activities within particular well-defined localities. It aimed to shed light on theories of governance and government responsiveness, and on the politics of global public health as experienced at the local level; it also aimed to identify the links and gaps between scientific knowledge and the implementation of such knowledge at the local level. The project further searched for creative social and political strategies that have been used to induce the implementation of proven public health strategies. The research was based in localities in the Western Cape Province of South Africa initially, but extended to other regions and countries. This project was funded by the Health Grand Challenge.