Epidemiology's New Breed

In her recent survey of low-income women in Baltimore who suffered physical and sexual abuse, Patricia O'Campo, PhD '89, and her colleagues were dismayed to find that although 22 percent of women had wanted help from professional service agencies, only 14 percent actually received any support from them.

Published in the February issue of Patient Education and Counseling, the study of 340 women living in Baltimore underscores not only the dearth of services for women in abusive relationships but also the importance of education and job training that will enable these women to become economically independent.

O'Campo, an associate professor of Population and Family Health Sciences, has coupled a longstanding passion for the challenges faced by low-income women with an interest in new epidemiological methodology. She counts herself one of a new breed of social epidemiologists who in the 1990s began to look beyond individual demographic data to see if the characteristics of a neighborhood contributed significantly to the health outcomes of its residents.

Old-school epidemiologists were initially skeptical. Take, for example, her 1995 study that examined the factors involved in women bearing low-birthweight babies. Conventional wisdom held that individual characteristics of the mother — such as education, in-come level, and her willingness to seek prenatal care — were most important in determining whether she would have a low-birthweight baby. O'Campo's study showed, however, that the risk depends as much on where a mother lives as it does on her eating habits and use of prenatal care. That is, getting early prenatal care and eating all the right foods do not necessarily reduce a mother's risk, if she also happens to live in a census tract where crime and unemployment are high, homeowners are few, and per capita income is low. (O'Campo won't hazard a guess as to why this is the case, but she hopes her future studies will determine the reason.) 

Because the 1995 study considered data on neighborhoods as well as on mothers, it generated some initial resistance. "In fact, the manuscript got stuck in the journal's review process for two years before it was finally accepted," remembers O'Campo.

O'Campo, whose current prospective study will extend over the next four years, is quick to acknowledge that an individual's behavior can affect his or her health. "But if we base our policy recommendations and intervention strategies entirely on individual-level data," she says, "we may be overemphasizing changing individual behaviors while ignoring the even greater results to be gained by improving neighborhood conditions."