Frontline Research, Real Progress

Constructing a Harm Reduction Program 

When a group of Vermont construction leaders approached Stephanie Busch in the spring of 2023 about getting naloxone onto their job sites, she saw an opportunity to do more than distribute emergency overdose kits.

“They came to us saying, ‘Our industry is dying,’” recalls Busch, MPH ’24, Injury Prevention program director with the Vermont Department of Health. And the data backed them up. Construction workers accounted for nearly a quarter of overdose deaths in 2021, according to Vermont’s Social Autopsy Report, which documents how Vermonters who died of overdose interacted with health care and state systems and identifies intervention opportunities.

What began as a request for naloxone turned into a sweeping harm reduction initiative. Busch worked closely with the Vermont chapter of the Association of General Contractors to develop trainings that went beyond emergency response, addressing the broader context of “diseases of despair”—overdose, substance use disorder, and suicidality.

“It’s not just about having Narcan,” Busch explains. “It’s about recognizing when someone is struggling and knowing how to help.”

The program now provides onsite first aid kits with naloxone, mental health resources, and smaller take-home packs that that workers can discreetly take home—an acknowledgement that most overdoses occur in private residences. Crucially, the kits were quickly put to use: On at least one job site, workers saved a colleague’s life using Narcan from a kit that hadn’t even been unpacked yet.

Busch also helped launch a series of trainings for construction company owners and their safety leads, reframing overdose response as a workplace safety issue. To reach workers beyond the job site, the program introduced tools like the Man Therapy campaign, which speaks directly to men in high-risk industries who may shy away from seeking help for mental health problems.

“We want to save lives,” she says. “And that means looking at the whole picture.”

Abortion Bans in the Real World 

As abortion restrictions spread across the U.S. following the 2022 Dobbs decision, researchers Suzanne Bell and Alison Gemmill set out to quantify the real-world impact on mothers and infants.

What they found revealed stark inequities in who bears the heaviest burden when abortion access is restricted.

Through an analysis of birth‑ and death-certificate data from all 50 states and Washington, D.C., including 14 states with complete or six-week abortion bans, the team estimated that there were more than 22,000 additional births and 478 excess infant deaths through the end of 2023—a 5.6% increase in infant mortality—that would likely not have occurred otherwise.

“The sharpest increases in births were among people already facing the steepest barriers to care,” says Bell, PhD ’18, an associate professor in Population, Family and Reproductive Health (PFRH). These included low-income populations, Medicaid recipients, and communities of color—groups that already experience higher rates of poor maternal and infant health outcomes.

The spike in infant mortality wasn’t limited to congenital anomalies, such as anencephaly or severe heart-lung malfunctions, that prior to Dobbs might have been detected during a pregnancy which was subsequently terminated. While those deaths rose by 11%, non-congenital deaths—linked to factors like pregnancy complications, limited prenatal care, and social stressors—also increased by 4%, according to the April 15 study published in JAMA.

“Unwanted or unintended pregnancies can be pretty consequential for the mom and the family after birth,” says Gemmill, PhD, MPH, MA, an associate professor in PFRH. “And the states imposing these bans already had much worse maternal and infant health outcomes—even before Dobbs.”

Now, the team is examining maternal mortality and severe maternal morbidity. What’s already clear, however, is that post-Dobbs laws are forcing people to carry pregnancies under conditions linked to poorer outcomes, and without added postnatal social supports like consistent paid leave and robust postpartum care, say Bell and Gemmill.

The consequences, they say, could echo for generations.

A Rolling Lab Captures Chemical Exposures

When the Philadelphia Energy Solutions oil refinery exploded in 2019, it exposed a blind spot in community health safeguards: There were virtually no pollution monitoring stations within a couple miles of the complex, leaving residents in the dark about what they were breathing.

That failure helped launch a new kind of research partnership between environmental engineer Peter DeCarlo and risk scientist Keeve Nachman. With support from Bloomberg Philanthropies, they set out to measure and interpret chemical exposures in “fenceline” communities, residential areas directly adjacent to industrial facilities.

The team deployed a mobile laboratory, essentially a truck outfitted with advanced atmospheric chemistry instruments, and drove loops in an industrialized 8–10-mile stretch along the Delaware River. Unlike conventional regulatory monitors, which are sparse and stationary, the rolling lab collected air samples every second—capturing fine-grained shifts in chemical concentrations.

But measuring pollutants was only half the battle. Nachman’s team reported in the March 24 Environmental Health Perspectives that they developed a “multi-effects toxicity database” to assess how each chemical affects not just a single target human organ, but all 13 major systems in the body.

“When you’re exposed to one chemical, it doesn’t just go to one part of your body,” says Nachman, PhD ’06, MHS ’01, the Robert S. Lawrence Professor of Environmental Health and Engineering. “If we don’t account for all the places these chemicals travel, we miss the full picture of risk.”

The results were striking. While conventional monitoring methods suggested negligible health risks in these communities, the expanded approach identified significant risks to five different organ systems—elevating the odds of problems like kidney damage, memory loss, aggravated asthma, thyroid disorders, and other inflammatory illnesses.

“Communities who live in the shadow of these industries have long been told there’s no health effect,” says DeCarlo, PhD, associate professor in Environmental Health and Engineering. “Now, we have evidence that aligns with their lived experience.”

Toward Precision Psychiatry 

Roughly 58 million Americans—about 1 in 5— will experience a mood disorder such as depression or bipolar disorder at some point in life. But no two cases look exactly the same.

“Some people have a single episode and recover. Others struggle with severe, recurring symptoms that disrupt every part of life”—cycling through medications and therapies over years to find what works, says Peter Zandi, PhD ’01, MPH ’97, MHS ’00, a psychiatric epidemiologist in the School of Medicine with appointments in Mental Health and Epidemiology at the Bloomberg School.

Zandi and his team want to change that by identifying more precise patterns—subtypes of mood disorders that could help predict the most effective individual treatments.

To do that, his group is gathering a massive volume of real-world data. At the core is electronic health record data from more than 200,000 Hopkins patients treated for mood disorders since 2013. It includes diagnoses, prescriptions, lab results, and new additions like standardized symptom surveys from clinic visits. The team is also using large language models to pull useful details—like past stressors or medication history—from clinicians’ notes.

Housed in a secure cloud environment, the data allows researchers to trace the arc of a patient’s symptoms and treatments over time, and let predictive algorithms suggest the most promising next step in care. Over the next five years, the team hopes to layer in other data—from genetics and brain imaging to wearables and smartphone use—to better understand how people function outside the clinic.

Combining these data streams might show how genetic markers and sleep patterns could guide depression treatment—steering a first-time patient toward psychotherapy, while recommending innovative treatments like accelerated intermittent theta-burst stimulation, a noninvasive brain stimulation technique, for those with more severe recurring episodes.

“How can we figure out the underlying heterogeneity of illness,” asks Zandi, “and provide the right sort of intervention to the right individuals at the right time?”

A Chink in Malaria’s Armor 

For malaria parasites to infect a human, they first have to survive the journey through a mosquito’s gut. George Dimopoulos, PhD, MBA, and his team at the Johns Hopkins Malaria Research Institute are working to stop them there.

The group recently discovered that a protein-folding system in mosquitoes—known as the prefoldin–chaperonin complex—plays a critical role in the parasite’s survival, as published March 6 in Nature Microbiology. This system helps the mosquito form key structural components in the midgut, including the basal lamina, in which the parasite embeds itself to hide from the mosquito’s immune defenses.

“When you disrupt this protein-folding machine, the parasite can no longer hide,” says Dimopoulos. “At the same time, the mosquito’s gut lining breaks down, and bacteria leak out into the body causing a lethal infection. This also primes the mosquito’s immune response, which targets the exposed parasite.”

The result is a double blow: the parasite’s ability to survive is blocked, and in lab tests up to 60% of the mosquitoes died from bacterial infection. But what makes the discovery even more powerful is how it might be scaled.

Dimopoulos envisions two practical applications. One involves vaccines that prompt humans—or even livestock—to produce those antibodies in their bloodstream. When a mosquito bites a vaccinated host, it ingests the antibodies, which then disrupt its internal protein-folding system, exposing the parasite to the primed immune system and triggering the lethal bacterial infection. The other is based on artificial nectar stations laced with the antibody-mimicking molecules that target the protein-folding system when mosquitoes feed on it.

What's particularly promising is that the approach works against multiple malaria species—including Plasmodium falciparum and P. vivax—and across different mosquito vectors, offering protection that conventional methods can't match.

“This complex exists in all mosquito species,” Dimopoulos notes. “It’s a pan-antimalarial control method that blocks the parasite and also kills the mosquito.”