2018 Annual Meeting

Applying Epidemiology Across the Lifespan to Improve Health Care,
Inform Health Policy and Enhance Population Health




Concurrent Session 1a

Location: University of Cincinnati, Medical Sciences Building (MSB), Kresge Auditorium

Biosocial Determinants of Obesity and Its Consequences Across the Lifecourse

Co-chairs: Bertha Hidalgo, PhD, Assistant Professor, Department of Epidemiology, Associate Scientist, Nutrition Obesity Research Center, Chair, Minority Affairs Committee, American College of Epidemiology, University of Alabama at Birmingham and Russell Kirby, PhD, MS, FACE, Distinguished University Professor and Marrell Endowed Chair, Department of Community and Family Health, College of Public Health, University of South Florida



Kaori Fujishiro, PhD, Senior Epidemiologist, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), “Investigating obesity risk among working-age adults: The role of job characteristics and what a life-course approach can illuminate”

Description: Work is relevant for many decades in adult life, during which major life events take place.  Using a life-course approach, this talk will discuss how work can contribute to obesity and also how it may facilitate obesity prevention.   

Abstract: A life-course approach—with its emphasis on human development as a life-long process, timing in life events, and human agency within social contexts—can provide unique insights into the social determinants of obesity.  The first part of the talk highlights findings from two studies using the Nurses’ Health Study II data. The first study showed that stress-related weight gain depended on baseline BMI: job stress may contribute to weight gain in the first place, but overweight and obesity may also make the person more vulnerable to job stress. The second study revealed that durations of working on rotating night shift before and during the 4-year study period had different associations with weight gain: previous shiftwork had a dose-response relationship with weight gain; concurrent shiftwork had an inversed-U shape.  The timing of first exposure along with life changes outside work may be important in middle-aged working women’s weight gain. The second half of the talk will focus on human agency in social contexts and the role of job quality in encouraging healthier behaviors. Obesity prevention efforts have aimed to increase knowledge (e.g., serious consequences of obesity) and to change environments (e.g., availability of healthy foods). For knowledge and environment to lead to actual action, self-efficacy (i.e., self-confidence in taking desired action) must be cultivated. A study using Gallup data suggested that certain work characteristics may help strengthen self-efficacy, which increases the chance of making healthier choices.  When researchers investigate either risk factors for obesity or facilitators of healthy behavior, they gain better understanding by incorporating the complexities of life as a process, the timing of life events, and the social contexts surrounding individuals.  

Brief Biography:

Kaori Fujishiro, PhD, is a social epidemiologist at the National Institute for Occupational Safety and Health (NIOSH).  Her research investigates health as a consequence of the dynamic interactions among individuals, their work environment, and their social contexts.  This perspective goes beyond the traditional exposures-disease framework and instead moves toward a complex systems approach. In her recent publications, Dr. Fujishiro argues that work plays an important role in creating and perpetuating health inequalities across racial/ethnic groups as well as socioeconomic positions.  


Sara Luckhaupt, MD, MPH, Commander, United States Public Health Service, Supervisory Medical Epidemiologist, National Institute for Occupational Safety and Health,“Biosocial Determinants of Obesity and Its Consequences Across the Lifecourse: Do Our Jobs Contribute?”

Description: The average employed adult spends up to one third of his or her waking hours working, and work can impact health in many different ways. Several recent cross-sectional studies performed by epidemiologists at the National Institute for Occupational Safety and Health (NIOSH) have illustrated associations between job characteristics and health outcomes that include obesity, other cardiovascular risk factors, and cardiovascular diseases.

Abstract: Both physical/chemical and psychosocial occupational factors have been linked to increased risk of cardiovascular disease. These factors might have both direct physiologic effects on cardiovascular health and indirect effects by influencing behavioral risk factors such as smoking and obesity. Some evidence indicates that workplace hazards such as job strain might pose more potent risk to workers in lower-income households, perhaps because of an interaction with adverse exposures in the community, combined with fewer health-enhancing opportunities (e.g., health care, a healthy diet, and exercise facilities). This presentation will summarize the results of multiple cross-sectional studies that have illustrated associations between job characteristics and obesity, other cardiovascular risk factors, and cardiovascular diseases. Data used in these studies come from the National Health Interview Survey (NHIS), the Behavioral Risk Factor Surveillance System (BRFSS), and the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. NHIS data suggest that: among all adult workers, working more than 40 hours per week, exposure to a hostile work environment, and employment in certain industries and occupations are significantly associated with an increased prevalence of obesity; and, among employed adults aged <55 years, working in service and blue collar occupations and certain industries are significantly associated with a history of coronary heart disease or stroke. BRFSS data from 21 States suggest that occupational group is significantly associated with both individual cardiovascular health metrics (CHMs) and the CHM summary score. Similarly, data from REGARDS show that the prevalence of optimal cardiovascular health among middle-aged and older workers in the U.S. varies considerably by occupation. Although these studies have several limitations, they all point to the need for future epidemiologic studies of obesity, other cardiovascular risk factors, and cardiovascular diseases to consider occupational risk factors along with other biosocial determinants of health.

Brief Biography:

CDR Sara Luckhaupt, MD, MPH, is a supervisory medical epidemiologist at the National Institute for Occupational Safety and Health (NIOSH, part of CDC).  She received a Medical Degree from the Ohio State University in 2002 and completed a preventive medicine residency at the University of Michigan in 2006, then joined the CDC/NIOSH and the Commissioned Corps as an Epidemic Intelligence Service Officer. She works on many national and international projects related to occupational safety and health, including serving as the project officer for occupational health supplements to the National Health Interview Survey in 2010 and 2015. She has also deployed in support of numerous public health emergencies, including the 2014-2015 Ebola epidemic in West Africa, the 2016-2017 Zika response in Puerto Rico, and Hurricanes Harvey and Maria in 2017.


Michele R. Forman, PhD, FACE, Distinguished Professor and Department Head, Department of Nutrition Science, College of Health and Human Science, Purdue Center for Cancer Research, Purdue University, “Life course of Preeclampsia:  Facing obesity and comorbidity in mothers and offspring”

Description: This presentation compares the health and development of a cohort of offspring with and without exposure to preeclampsia who were followed through the first 18 years and also addresses the long-term effects of preeclampsia on the index mother.  Repeated measures of growth and health illustrate the long-term effects of in utero exposures on mother-offspring dyads.

Abstract: Women who develop preeclampsia (PE), a comorbidity characterized by hypertension and proteinuria in pregnancy, are at increased risk of cardiovascular disease. Indeed the American Heart Association (AHA) Guidelines 2011 states that a pregnancy history of PE is an integral part of preventive cardiology assessments for women.  PE is diagnosed in 3-8% of pregnancies annually, is a disease of unknown etiology, and varies by severity and by gestation age at diagnosis. In a longitudinal nested case-control study within birth cohorts in Norway, we report that women diagnosed with PE in pregnancy are at higher risk for hypertension and for metabolic syndrome (higher glucose and insulin levels) 11 years postpartum than women not exposed to PE in pregnancy; but duration of lactation in the index pregnancy can modify this risk. Also women with PE exposure are at reduced risk of breast cancer than their non-PE peers. Importantly offspring of PE pregnancy have an almost double risk of stroke in adulthood with preclinical evidence apparent by childhood.  We report that offspring of PE pregnancy have elevated systolic blood pressure (SPB) in early adolescence (aged 11 y), and higher body mass index compared to age-sex matched peers unexposed to PE in utero. Girls of PE pregnancies delay breast development but have accelerated pubic hair development compared to girls without PE exposure. Thus the life course of mother-offspring dyads with exposure to PE is dramatically different than comparable dyads without exposure. These differences reveal a profile of pathways and perils to chronic disease prevention that is triggered by PE.

Brief Biography:

Michele R. Forman, PhD, FACE, has a career focuses on nutritional epidemiology and clinical nutrition research across the globe with an emphasis on early life exposures and risk for chronic disease as well as the role of nutrition in growth and health across the life course.  As her research foci have shifted from low birth-weight to chronic disease, the still point of the compass has remained fixed; she examines the developmental origins of disease. Much of her research is designed either as a longitudinal prospective cohort study that spans the peri-conceptional period through adulthood or dietary interventions in the free-living state or under controlled feeding conditions or randomized clinical trials. Her laboratory addresses nutritional assessment of individuals from infancy through adulthood; and tests dietary interventions amongst high risk groups such as chronic renal disease patients.  She has over 180 peer reviewed publications, numerous invited presentations nationally and internationally, is on many institutional committees, advisory boards. She has mentored over 80 postdoctoral fellows, graduate and undergraduate students.

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