Population Health Gets a Signal Boost

No one uses landlines anymore. Nowadays we carry communication in our pockets, ready for instant access. Nowhere is this truer than Africa. In South Africa, for example, the Pew Research Center found that 94 percent of those surveyed, did not have a working phone line in their homes, while 89 percent owned a cell phone, equaling the portion with cells in the United States.

The proliferation of cell phones and other mobile technologies around the world allows people to connect across geographic and socioeconomic boundaries. Researchers at the Mailman School are taking advantage of this fact to reach populations who were previously difficult to reach.

Andrea Howard, an associate professor of Epidemiology and unit director at ICAP, has partnered with The Employment Bureau of Africa (TEBA) to develop a system to text migrant miners who live in Lesotho to combat the tuberculosis epidemic there.

Miners often sign one-year contracts to work in South Africa and only return home once a month to collect their deferred pay.  “Because of the nature of their work, these individuals are hard to monitor,” said Howard, “but we noticed that everyone has cell phones.”

The system reminds miners to adhere to their treatments while tracking their disease progression. In the first nine months of the program, more than 51,000 people were screened for TB, with 166 diagnosed cases.

Looking to target low-income residents of Northern Manhattan, Melissa Stockwell, associate professor of Pediatrics and Population and Family Health, set up a surveillance study to track respiratory infections by checking in with subjects through text messages and sending a researcher to catalogue their symptoms if they reported feeling sick. Her goal was to find a way to connect with populations who are less likely to seek primary care for their illnesses.

Preliminary analyses indicate that of those people reporting respiratory symptoms, only 25 percent see physicians of their own accord. Stockwell's cell phones reach the other 75 percent who might never step into a doctor’s office.

“If someone is conducting respiratory infection surveillance using only data from medically-attended illnesses, they are not getting the whole picture of disease burden,” Stockwell said. “Many people do not seek care, and there are differences in care-seeking based on socio-demographic characteristics.”

Teenagers are notoriously hard to track, especially when studies rely on accurate and timely reporting from subjects. Jasmine McDonald and Lauren Houghton, research scientists in Epidemiology, are meeting the adolescents on their level by partnering with the people behind the Clue period tracker app on a pilot study to collect data on the flow cycle of pubescent girls.

“This is a time-old thing that women have done, but it used to just be done with a calendar and pen and paper. Girls don’t do that anymore,” Houghton said. The app fills in this gap, gathering relevant data using a technology that meshes with today's teens.

“When you’re working with any population, it is important to touch them on their level,” added McDonald. “Mobile technologies are going to have to be utilized more often in order to keep them engaged and present.”

Researchers know that diseases like cancer and a host of other chronic diseases are associated with the period cycle, but the information is difficult to parse. When dealing with multifactorial interactions, such as effects of hormones, accurate reporting is crucial.

“Now we’re actually collecting real-time information,” said McDonald. Mobile technology makes data collection easy. Study participants always have the app on hand to report on their day-to-day experience. “We don’t have to rely on their recall,” she said.

The research pilot has taught Houghton and McDonald to move fast to take advantage of new technology. And, they’re adapting their research to the population’s habits rather than asking the subjects to come to them and submit their data.

“Instead of asking them to come into our world, we’re going into theirs and just asking for permission to be there,” said Houghton.