Epidemiology Faculty and Staff

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Carol R. Hogue  

Updated: 09/28/2014    [update]
Professor (Graduate Faculty)

Jules and Deen Terry Professor of Maternal and Child Health
Professor of Epidemiology
Director, Women's and Children's Center


Department of:
Epidemiology

1518 Clifton Rd NE
Room 3005
Atlanta, GA 30322
carol.hogue@emory.edu
tel: (404) 727-8095
fax: 404-727-8737

AB, 1966, William Jewel College
MPH, 1971, University of North Carolina
PhD, 1973, University of North Carolina
 
Additional Appointment(s):
Sociology, Emory College, Jointly Appointed
Pediatrics, School of Medicine, Jointly Appointed
Behaviorial Science and Health Education, Jointly Appointed
 
Courses Taught:
EPI 596: Foundations in Maternal and Child Health
 
Career Overview:
Dr. Hogue was appointed Professor of Epidemiology and Jules & Uldeen Terry Professor of Maternal and Child Health at the Rollins School of Public Health of Emory University in 1992. For a decade before that, she was at the federal Centers for Disease Control, Division of Reproductive Health, where she was chief of the Pregnancy Epidemiology Branch (1982-88) and then Director of the Division (1988-1992). Prior to her government service, she was on the Biometry faculty of Arkansas medical school (1977-82) and the Biostatistics faculty of UNC-CH School of Public Health (1974-77). While at CDC, Dr. Hogue initiated many of the current CDC reproductive health programs, including the Pregnancy Risk Assessment Monitoring System (PRAMS), the National Pregnancy Mortality Surveillance System, and the National Infant Mortality Surveillance (NIMS) project that initiated the national and state-level development and use of linked birth and death records. In addition, Dr. Hogue led the first research on maternal morbidities that was the precursor to the current safe motherhood initiative, and the initial innovative research on racial disparities in preterm delivery that found that college-educated African American women have a three-fold risk of very preterm delivery, when compared to college-educated White women. This discovery has triggered further research into biological, biosocial, and environmental causes of this as-yet unexplained excess risk. Her ongoing research interests include the long-term effects of induced abortion, epidemiology of preterm delivery, and the impact of pregnancy complications on minority health. She has published broadly in maternal health, including studies of ectopic pregnancy, stillbirth, unintended pregnancy, contraceptive failure, and reproductive cancers. She has a long-standing interest in environmental impacts on reproductive health. With Carole Kimmel and others, she published a study in 1984 on the reliability of experimental studies for predicting hazards to human development.  Her subsequent research has focused on the effects of risk factors such as smoking, obesity and environmental stress on reproductive health. She is lead editor of the book, Minority Health in America (Johns Hopkins U. Press, 2000) and of a 2001 supplement to the journal Paediatric and Perinatal Epidemiology, entitled "New Perspectives on the Stubborn Challenge of Preterm Birth.” Currently she is PI of the Emory Center in the NICHD-funded Stillbirth Collaborative Research Network as well as PI of the Emory National Children’s Study Center for Wave 2.  She is also leading intervention research into reducing obesity among African American women healthcare workers, funded by an RO1 grant from CDC and a CSREES grant from USDA. Among her many honors, Dr. Hogue served as President of the Society for Epidemiologic Research (1988-89), served on the Institute of Medicine Committee on Unintended Pregnancy (1993-1995), was Chair of the Regional Advisory Panel for the Americas of the World Health Organization Human Reproduction Programme (1997-99), President of the American College of Epidemiology (2002-4), Senior Fellow of the Emory Center for the Study of Law and Religion (2001-6), and received the MCH Coalition’s National Effective Practice Award in 2002. 
 
Selected Research Projects:

For currently funded projects, please see Dr. Hogue's CV.  One research interest is summarized below.

Lynn and Carol Hogue, “Anthony Comstock: A Religious Fundamentalist's Negative Impact on Reproductive Health,” in Religion as a Social Determinant of Public Health, Ellen L. Idler ed. (Oxford University Press, 2014) examines two interrelated issues in public health law -- the destructive effects of religious fundamentalism when it is harnessed with the coercive power of the state, and the deconstruction of the Comstockian project by the evolution of constitutional doctrine.

Religious fundamentalism promotes an anachronistic, anti-intellectual and anti-scientific bias by militantly asserting a crabbed view of family relations -- particularly views regarding gender, sex roles, the nurturing and educating of children and human sexuality activity.  Anthony Comstock, a 19th century fundamentalist, mounted a religious crusade ostensibly to protect children, which harnessed the federal power to regulate the mail to suppress the circulation of information about sex and human sexuality.  For Comstock, any information about human anatomy that included the sex organs would serve as an inducement to immorality, a vicious progression from masturbation to promiscuous non-marital sex, to the demand for and use of contraceptives to avoid pregnancy, and either to abortion or the “burden” of bastards and resultant social opprobrium.

 

Comstockery, as the movement became known, “had profound implications for human reproduction and reproductive health in the United States.  There are three necessary conditions for effective family planning:  the will to control fertility, appropriate contraceptive technology to avoid conception, and information about how to access and use that technology.” (p. 160) In the 19th century all three of these conditions came together; the will to limit family size, already present as couples sensed the value of fewer children, information about how to limit births published by medical professionals for lay readers, and technological innovations that made contraceptives, particularly condoms, widely available.  Comstock’s project struck a disastrous blow to fertility control by making it impossible to mail information about sex and birth control as well as contraceptives and abortifacients.  The negative public health impact of Comstockery was clear:

 

“For nearly a century, public health investigators have known that maternal and infant mortality is higher when childbearing begins at too early an age or continues when the mother is older or physically impaired.  For even the healthiest women, pregnancies occurring in rapid succession are more likely to end poorly for the mother and baby than are pregnancies spaced two to three years apart.  Family planning, then, has a tremendous positive impact on individual and public health.”  It saves lives by avoiding an estimated 1.2 million infant deaths annually. (p. 168)

 

A difficult, slow-moving, piecemeal judicial process eventually resulted in the emergence of a robust doctrine of privacy, the creation of a First Amendment doctrine that protected information about sex, family planning and abortion by preventing the government from classifying any information about sex and human reproduction as obscene.  This process ultimately brought about the constitutional deconstruction of the legal framework supporting Comstock’s fundamentalist religious project.

 

Abortion remains as a vestigial remnant of Comstockianism.  The relative safety of legal abortion for women (legal abortion is safer for women than carrying a pregnancy to term and risking death from childbirth) led the Supreme Court to decide in Roe v. Wade (1973) that women had a constitutional right to make decisions about their health, even extending to decisions about whether or not to bear a child.  Studies show that the Roe decision did not increase the number of abortions, but merely substituted safe for unsafe abortions.  This had substantial public health benefits.  For example, it is estimated that in 1960, one in five pregnancies were terminated by unsafe, illegal abortions resulting in as many as five thousand women’s deaths annually in the U.S.  By contrast, only twelve maternal deaths attributed to abortion were reported in the U.S. in 2008. 

 

Although Comstockery was largely deconstructed over the last half of the 20th century, it has enjoyed a 21st century revival, for example, in the efforts of neo-Comstockians to limit access to Plan B One-Step, as a nonprescription morning-after contraceptive pill available to all women and girls without age restriction.  Plan B is a safe and effective contraceptive pill that prevents conception if taken within 72 hours after sexual intercourse.  The limit on access, pursued by religiously driven fundamentalists in the FDA appointed during the administration of President George W. Bush, was ultimately struck down.  The Plan B episode demonstrates the continuing danger to public health posed by the unholy alliance of government regulation with those who view sex “through the lens of fundamentalist religious presuppositions [divorcing] human reproduction from science.”  “In today’s global village, 220 million women seek contraceptive services that they cannot obtain due in large measure to the ongoing, corrosive influence of religious fundamentalism on unwilling non-adherents through state coercion.” (p. 170)

 

 

 

 
Selected Publications:

Risk factors for spontaneous and provider-initiated preterm delivery in high and low Human Development Index countries: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health.
BJOG
, 121: Suppl 1:101-9, 2014.
http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12631/a...
 
Kramer MR, Hogue CJ, Dunlop AL
Measuring women's cumulative neighborhood deprivation exposure using longitudinally linked vital records: A tool for life course MCH Research.
Matern Child Health Journal
, 18(2): 478-87, 2014.
http://www.ncbi.nlm.nih.gov/pubmed/23430295
 

Association between stillbirth and illicit drug use and smoking during pregnancy.
Varner MW1, Silver RM, Rowland Hogue CJ, Willinger M, Parker CB, Thorsten VR, Goldenberg RL, Saade GR, Dudley DJ, Coustan D, Stoll B, Bukowski R, Koch MA, Conway D, Pinar H, Reddy UM; Eunice Kennedy Shriver National Institute of Child Health and Human Development Stillbirth Collaborative Research Network.
, 123(1): 113-25, 2014.
PMID: 24463671 [PubMed - indexed for MEDLINE] PMCID...
 
Williams BL, Dunlop AL, Kramer M, Dever BV, Hogue C, Jain L.
Perinatal Origins of First-Grade Academic Failure: Role of Prematurity and Maternal Factors
Pediatrics
, 131: 1-8, 2013.
www.pediatrics.org/cgi/doi/10.1542/peds.2012-1408
 
Hogue CJR, Parker CB, Willinger M, Temple JR, Bann CM, Silver RM, Dudley DJ, Koch MA, Coustan DR, Stoll BJ, Reddy UM, Varner MW, Saade GR, Conway D, Goldenberg RL, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Stillbirth Collaborative Research Network Writing Group
A population-based case-control study of stillbirth: The relationship of significant life events to the racial disparity for African Americans
Am J Epidemiol
, 15;177(8): 755-67, 2013.
http://aje.oxfordjournals.org/content/177/8/755.long
 
Other affiliations and Activities:
NIH COMMITTEES
 
Special Emphasis Panel, Global Network for Women’s and Children’s Health, National Institute of Child Health and Human Development, June 12, 2006
 
Ad Hoc Review Committee on Fetal Effects on Adult Chronic Diseases, National Institutes of Health, 2001
 
Subcommittee on Clinic Investigators, Peer Review Oversight Group, National Institutes of Health, 1997-1998
 
Environmental Health Study Section, National Institute of Environmental Health Sciences, 1993-1997
 
Epidemiology and Disease Control Study Section, National Institutes of Health, 1982-1986
ADVISORY COMMITTEES
·        Steering Committee, WHO Multicountry Study on Maternal and Perinatal Health, 2008-2010
·        March of Dimes National Organization, Perinatal Advisory Committee, 2002 - present
·        World Health Organization, Human Reproduction Programme, Subcommittee for the Americas, Resources for Research, 1991-1996; Chair, Regional Advisory Panel (Americas Region), 1997-1999; Ad Hoc Member, Scientific and Technical Advisory Group, 1998-2000.    
·        Latin American Perinatal Center, Montevideo, Uruguay, 1997-present
·        Junior League of Atlanta, Community Advisory Board, 1998-present
·        UNICEF Child Survival Awards Committee, 1994-present
·        Institute of Medicine Committee on Unintended Pregnancy, 1993-1996
·        Department of Maternal and Child Health, University of South Florida, 1993-2005
·        Department of Maternal and Child Health University, of Alabama at Birmingham, 1993-1999
·        Low Birthweight PORT, University of Alabama at Birmingham, 1993-1998
·        MedTech Program, Morehouse School of Medicine, 1991 - 1997
·        Toward Improved Outcome of Pregnancy, 1989-1992
·        Expert Panel on Content of Prenatal Care, 1985-1990
MEMBERSHIPS IN PROFESSIONAL ORGANIZATIONS
 
·        American College of Epidemiology (elected fellow, 1983). Membership Committee, 1996-2000. Board of Directors, 1999-2004; president-elect, 2001; president, 2002; past President 2003; past past President 2004.
·        American Epidemiological Society (1985)
·        American Public Health Association (1974). First Program Chair, Population Section, 1978.
·        Association of Teachers of Maternal and Child Health (1992).
·        Delta Omega, Theta Chapter (1975)
·        International Epidemiological Association (1977)
·        MCH Council, Association of Schools of Public Health (appointed to represent the Rollins School of Public Health, 1998). Elected Chair, 1999-2001.
·        Planned Parenthood Federation of America (1984)
·        Population Association of America (1979)
·        Society for Epidemiologic Research (1979). Executive Committee, 1978-81. President (elect, president, past, and past past), 1987-1990; Senior Faculty, 1998.
 
Curriculum Vitae
 
Link to this page: http://www.sph.emory.edu/faculty/CHOGUE