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Epidemiology Branch Fellow Wins Poster Session Award

By Eddy Ball
May 2007

Martha Montgomery
IRTA Fellow Martha Montgomery is weighing her options for the future. "I'm leaning toward an M.D.," she said. "You can do research with an M.D., but you can't do clinical practice with a Ph.D." (Photo courtesy of Steve McCaw)

Freya Kamel
Staff Scientist Freya Kamel. "Freya's been an incredible help," Montgomery said. "I really feel that she has my interests in mind." (Photo courtesy of Steve McCaw)

Research Fellow Martha Montgomery won a top prize in poster session competition at the Eighth Annual Women's Health Research Day(http://www.cwhr.unc.edu/genPage/index.pl?pgid=180 Exit NIEHS held April 3 and 4 at the Friday Center in Chapel Hill. Montgomery received the Judge's Award recognizing an emerging or unfunded area of women's health research, an honor that carried with it a $1,000 cash prize.

Montgomery was lead author on a study titled "Pesticide Use and Age-related Macular Degeneration in Female Spouses of Pesticide Applicators." The study grew out of earlier work performed by several of her co-authors in Phase One of the Agricultural Health Study (AHS)(http://www.aghealth.org/ Exit NIEHS, which enrolled a cohort of 52,395 pesticide applicators and 32,347 of their spouses from 1993 to 1997.

In her prize-winning study, Montgomery looked at macular degeneration among 23,000 women in the cohort of spouses, using updated information from Phase Two of the study. She and her colleagues plan a follow-up study to validate the participants' self-reported macular degeneration with medical records and collect saliva samples that can be used in gene expression studies.

In planning and conducting the study, Montgomery collaborated with her mentor in the Epidemiology Branch, Staff Scientist Freya Kamel, Ph.D. The two have worked closely together since Montgomery began her tenure as a Post-baccalaureate Intramural Research Training Award (IRTA) Fellow in June 2006.

Along with Kamel, Montgomery collaborated with five other scientists at NIEHS and the National Cancer Institute (NCI) who have been involved in the AHS. They included Staff Scientist Jane Hoppin, Sc.D., Biostatician David Umbach, Ph.D., NCI Senior Investigators Michael Alavanja, Dr.P.H., and Aaron Blair, Ph.D., and Branch Chief Dale Sandler, Ph.D.

"It's been great," Montgomery said of her experience with colleagues in the Epidemiology Branch. "I'm getting more experience in how to think about designing a study. I'll also be getting experience in data collection, the field aspect of epidemiology. That's a valuable experience that I might not have been able to get elsewhere."

The 24-year-old fellow holds a Bachelor of Arts in Chemistry from Carleton College and a Master of Health Science in International Health-Disease Prevention and Control from the Johns Hopkins School of Public Health. In addition to her prize-winning poster presentation, she displayed her work at the February meeting of the AHS National Advisory Panel.

She has also taken course work at UNC-CH while at NIEHS and attended Institute lectures that address epidemiological issues or appeal to more general audiences, such as talks in the Frontiers in Environmental Sciences series. In what spare time she has, Montgomery is completing two papers as lead author on her master's work in southern India and as second author on iron absorption in Peruvian infants.

Montgomery expects to stay at the Institute for another two or three years and add several publications to her CV before deciding on the next step in her career. She is considering pursuing a Ph.D. in epidemiology or an M.D. with a concentration in epidemiology and public health.

Strongly influenced by her earlier public health work in Ghana, Thailand and India, Montgomery is leaning toward a career with an international health organization, such as the World Health Organization, UNICEF or Médecins Sans Frontières/ Doctors Without Borders. "There are a number of other global health organizations," Montgomery noted. "But some have political biases that I would have to consider and decide whether I agree with them or not."

Abstract

Montgomery MP, Hoppin JA, Umbach DM, Alavanja MC, Blair A, Sandler DP, Kamel F. Pesticide use and age-related macular degeneration in female spouses of pesticide applicators.

BACKGROUND. Age-related macular degeneration (AMD) is the leading cause of blindness in white populations in industrialized countries, and women may have a higher risk of AMD than men. Previous cross-sectional analyses in a study of a large agricultural cohort found that prevalent retinal or macular degeneration was consistently associated with fungicide use among both licensed pesticide applicators and their wives.

OBJECTIVE. Estimate the risk of incident retinal degeneration (IRD) associated with the use of pesticides and other farm-related activities among farm women.

METHODS. We investigated wives of pesticide applicators in the Agricultural Health Study, a prospective cohort study involving 23,000 women from North Carolina and Iowa. Diagnosis of retinal or macular degeneration was self-reported in a self-administered questionnaire completed at enrollment and in a five year follow-up telephone interview. Details of lifetime use of pesticides and participation in farm-related activities were reported at enrollment. We used logistic regression analysis controlling for age, state, and years of smoking.

RESULTS. A total of 207 women reported a physician's diagnosis of retinal or macular degeneration since enrollment, and 23,030 women served as controls. Ever use of fungicides was weakly associated with IRD (odds ratio (OR) 1.5, 95% confidence interval [0.9 - 2.7]). Three other functional groups (herbicides, insecticides, and fumigants) and three insecticide classes (organochlorines, organophosphates, and carbamates) were not associated with IRD. The association with fungicides was stronger in North Carolina (OR 2.2 [1.1 - 4.7]) than in Iowa (OR 1.0 [0.4 - 2.4]). Of the specific fungicides, women who had used captan had more than double the odds of IRD (OR 2.3 [1.2 - 4.4]) of women who had not.

CONCLUSIONS. Our results extend findings from previous studies indicating that fungicide use is associated with retinal degeneration. Although the etiology of AMD is not well understood, inflammation, which may occur as a consequence of exposure to fungicides, is believed to play an important role. The next step is to evaluate self-reported diagnosis of retinal or macular degeneration using medical records to identify cases with confirmed AMD or other forms of macular degeneration.



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