Our success as researchers is measured by our ability to translate our findings, according to the often-used phrase, from bench to bedside.  In other words, if we can apply our basic science findings to clinical care, we have the ability to impact countless lives.  This pipeline is a national priority, and in fact, many Academic Medical Centers have established programs to facilitate rapid clinical translation.  However, equally as important, and perhaps less appreciated is the need to translate basic science findings into relevant policies that protect and influence the general public.

Reproductive science and medicine are greatly impacted by the environment. Trends in reproductive health demonstrate that reproductive function has declined since the mid-20^th century in certain populations and locations [1].  Coincident with this decline in reproductive function is the large and ever-increasing number of natural and synthetic chemicals to which humans are exposed [2, 3].  Basic, clinical, and epidemiological research has demonstrated that exposure to certain compounds and contaminants, such as Endocrine Disrupting Chemicals (EDC), can have negative impacts on reproductive health. These compounds interfere with the production, transport, activity, and metabolism of natural hormones in the body. As we, as basic scientists and clinical researchers, understand the mechanisms by which these environmental exposures to such compounds affect developmental, reproductive, and neuroendocrine functions, we must also be able to inform and educate the implications of these specific reproductive health findings to the decision makers in Washington, DC.  The question is: How?

In  2010, the Program on Reproductive Health and the Environment at the University of California, San Francisco developed the Reach the Decision Makers Fellowship with the exact intent of providing interested individuals and teams with the resources to advance science-based policy solutions.  Specifically the Reach Program serves to provide individuals with a distinct interest in reproductive health and the environment, with mechanisms to interact with the United States Environmental Protection Agency (US-EPA).  Over the past two years, the Reach program directed by Tracey Woodruff, PhD, MPH, an esteemed leader in the field, has trained over 75 individuals nationwide based on the principles of participatory democracy, social justice, and taking action to prevent harm (for more recent news about the Reach Program, check out the following blog written for the Physicians for Social Responsibility).

Table 1. Our interdisciplinary team

To take advantage of this unique program, we assembled an interdisciplinary team of six individuals committed to reproductive health and the environment (Table 1).  Our team is comprised of professionals from academia, health care, government, and the community, and collectively we have experience in research, policy, advocacy, teaching, and communication (Table 2).   Prior to joining the Reach Program, our team has worked together at Northwestern University and Northwestern Memorial Hospital in various settings including the Women’s Health Research Institute, the laboratory of Teresa K. Woodruff, PhD, the Oncofertility Consortium, the National Physicians Cooperative, the Oncofertility Saturday Academy, and the proposed Northwestern University Superfund Research Center in Reproductive Health Hazards. We joined the Reach Program with the goal of ensuring that the manner in which the US-EPA evaluates reproductive health and toxicity is in line with the current state of scientific knowledge.

Table 2. Team backgrounds

As Reach Program fellows, we have participated in a rigorous training program to define a reasonable “ask” in relation to our goal, to perform research on the topic, and to learn how to identify the key decision makers within the US-EPA who will listen to our request and affect change.   Over the past six months, we have engaged in a first trip to Washington, DC where we attended presentations from policy experts regarding the US-EPA hazard evaluation procedures and how scientists can inform the agency on emerging research regarding the effects of environmental toxins on reproductive health. Meetings at the US-EPA gave the team a greater understanding of the overall institution and current initiatives of the agency. We have also participated in nine webinars covering topics spanning from the effects of environmental toxins on reproductive health to identifying policies and policy makers at the US-EPA.

We also developed our policy project by systematically gaining an understanding of the US-EPA as an agency and the documents and guidelines that inform its staff. Members of the US-EPA helped us identify a principle document in reproductive health and the environment, the Guidelines for Reproductive Toxicity Risk Assessment. This document was written in 1996 and has not been revised since that time so our group decided to focus on some of the significant opportunities to improve upon the guidelines. Since 1996, the state of reproductive research has advanced and we identified three specific areas of research that could be prioritized during the updating of the Guidelines for Reproductive Toxicity Risk Assessment, as follows:

• While the Guidelines acknowledged the importance of non-reproductive consequences of an impaired reproductive system, such as osteoporosis and increased risk of stroke, they did not include these outcomes as endpoint measures for further research study.
• Model organisms are necessary for advancing research in reproductive and environmental health. In the Guidelines, the authors state that effects seen in one organism may be assumed to occur in another. While this is meant to be protective for unstudied species, it is also true that certain species are ideal to investigate different aspects of science and health. Thus, we encourage the study of multiple model organisms in reproductive health and the environment.
• Research advances over the past decade have shown that significant sex differences are seen in the way males and females respond to different drugs and environmental toxins. This warrants the need to include both sexes in reproductive research, a consideration that could strengthen the updated Guidelines.

Our team developed these ideas into a position statement to inform US-EPA staff and interested parties of the need to advance reproductive health and the environment. This project culminates tomorrow, Thursday, October 18, 2012 when the team will fly to Washington, D.C. to meet with Nica Louie (Environmental Health Scientist at the National Center for Environmental Research), Brenda Foos (Director, Regulatory Support and Science Policy Division, Office of Children's Health Protection), and Daniel Axelrad (Environmental Scientist, Office of Policy) at the US-EPA. We hope to gain a greater understanding of the procedures of the agency at these meetings and advocate for the need to update Guidelines for Reproductive Toxicity Risk Assessment.

Virginia Neale, the Associate Director of Government Relations for Northwestern University, will also join the team and bring her expertise in bridging academia and the government to the project. Neale also facilitated a meeting between team members and legislative assistants to the House of Representatives congresswoman Jan Schakowsky (D-IL), who resides over Northwestern University’s Evanston campus. As congressional requests to the US-EPA are often needed to gather teams of experts and update guidelines, we will ask Schakowsky’s office to make such a request to gather the National Academy of Sciences and revise the Guidelines for Reproductive Toxicity Risk Assessment.

The work done this week, and over the past six months, by this interdisciplinary group, will build the foundation for the team to continue communicating evidence-based reproductive health findings to the policy makers in Washington D.C. who have the ability to affect change on a federal level. The relationships we develop this week will be fostered in the coming months and years to ensure that reproductive health is promoted at the highest level within the EPA and advocate that US-EPA guidelines are updated to include the most recent advances in reproductive research

This blog was Contributed by Francesca Elizabeth Duncan, PhD and Kate Waimey Timmerman, PhD    Read more about the team here in a Northwestern University press release.

1.         Woodruff, T.J., J. Schwartz, and L.C. Giudice, Research agenda for environmental reproductive health in the 21st century. Journal of epidemiology and community health, 2010. 64(4): p. 307-10.

2.         Sutton, P., L.C. Giudice, and T.J. Woodruff, Reproductive environmental health. Current opinion in obstetrics & gynecology, 2010. 22(6): p. 517-24.

3.         Woodruff, T.J., et al., Proceedings of the Summit on Environmental Challenges to Reproductive Health and Fertility: executive summary. Fertility and sterility, 2008. 89(2 Suppl): p. e1-e20.

Each year the Kaiser Family Foundation and the National Women’s Law Center release a Women’s Access To Care: State By State Analysis. This report highlights many of the key issues pertaining to women’s health and health policy. Given the vast amount of decision-making and funding that take place at the state level, this analysis is a yearly must read.

Here are the highlights for 2012:

General Notes of Importance

• A total of 13 states have Offices of Women’s Health that develop agendas on women’s health issues and provide policy guidance to the governor’s office, state legislature and the state department of health.
• Few states require special training and service protocols for health care providers and law enforcement personnel that serve victims of violence. Most states do, however, have laws prohibiting discrimination against victims of violence seeking health insurance.
• Women now account for 30% of new HIV infections in the United States. To prevent vertical transmission of HIV, the majority of states have implemented the Centers for Disease Control and Prevention’s 1995 guidelines for HIV testing of pregnant women, which call for voluntary testing for all pregnant women.

Private Insurance Coverage

• Most states mandate that insurers cover some screening tests important to women’s health. 49 states and DC have mammography mandates, while only 25 states and DC have cervical cancer screening mandates.
• Some states have taken major steps in increasing access to reproductive health care for women by mandating insurance coverage for key services. Half the states have adopted contraceptive coverage mandates, which require insurers to cover contraceptives to the same extent as other prescription medications, although 14 states include an exemption for employers and/or insurers with moral or religious objections to contraception.
• About two-thirds of states have addressed mental health parity in an attempt to increase access to mental health services. Access to mental health care is particularly important for women, who are twice as likely as men to suffer from certain mental health conditions.

Medicaid

• Most states have made significant expansions in Medicaid eligibility. Women comprise the majority of adult Medicaid recipients and nearly one in five women ages 18 to 64 living below 200% of the federal poverty level are enrolled in Medicaid.
• States have taken steps to expand Medicaid coverage and income protections for low-income seniors and people with disabilities. Medicaid is an important source of coverage for low-income seniors (who disproportionately tend to be women) and people with disabilities.

Guest Author:   Nicole Fisher

In a study recently published by the International Journal of Eating Disorders, women in their early 50’s (midlife) show more symptoms of disordered eating and concerns over their weight and shape than women in their late adulthood (mid 50’s and over).  The concerns are comparable to those expressed only in young women.

Hoping to better understand the weight and shape concerns of women over the age of 50, researchers gathered data from this population through an online survey.  Clinical studies have shown an occurrence of late-onset eating disorders and an increase in inpatient admissions for women over the age 35.  Reports show that there are three ways the disorders appear: a chronic presentation of an earlier-onset eating disorder that the patient never fully recovered from, a relapse of a disorder that the patient has previously experienced, or the late-onset of a disorder without having previously experienced it.

According to separate population-based studies, while the majority of women with eating disorders over 40 did not present with late-onset eating disorders, 69% of the cases studied in women over 50 concluded that the disorder was late-onset.  So at this age, many women are dealing with a new disorder that may negatively impact their lives.

Studies have found that body dissatisfaction remains somewhat stable throughout the lifetime, with surges among younger women and midlife women.  Higher incidence of reported body dissatisfaction occurs among midlife women with a higher BMI.  Physiologically, the BMI of a woman typically
increases during midlife, levels off and then decreases around the age of 60 (among other bodily changes).  Interestingly, areas of dissatisfaction in younger women seem to remain the same into adulthood even with a changing body and changing fat distribution.

The study (published by the International Journal of Eating Disorders) found that 71.2% of women were attempting to lose weight at the time of the survey with 35.6% spending at least half of their time dieting in the last five years.  Overall, 41.2% checked their body size/shape at least daily and 40% weighed themselves at least a couple of times per week.  Vomiting (1.2%), laxatives (2.2%), diuretics (2.5%), diet pills (7.5%) and excessive exercise (6.8%) were the behaviors women reportedly used to control their weight within the last five years.

61.8% said their concerns occasionally or often negatively affected their lives and 79.1% said their weight/shape had either a moderate or even the most important role in how they perceive themselves.  63.9% reported thoughts about their weight daily or more.  Most women had no history of eating disorders (59%); however, 13.3% of those sampled said they currently showed eating disorder symptoms while 27.7% had in the past.

The researchers concluded that younger midlife women showed more disordered eating/weight concerns. A possible explanation in the discrepancy of rates of disorders and concerns among younger midlife women relative to late adulthood is the cohort effect, in which these midlife women may have been exposed to different, and perhaps a greater amount of, socio-cultural pressures than those in later adulthood.  Another explanation may be that body health and function becomes more important than physical appearance in late adulthood.  Also, midlife women may be experiencing symptoms of menopause that prompts an increase in fat and how it is distributed, compounded by a decreased metabolism that may put them at risk for disorders.

Sources:

http://onlinelibrary.wiley.com/doi/10.1002/eat.22030/full