Scoliosis (1990-). Target community: orthopedic surgeons, pediatricians. With my colleagues, I conducted the first large, long-term, follow-up study of adolescent idiopathic scoliosis in order to determine the natural history of the disease. For this research, we were awarded the Russel Hibbs award (1993) from the Scoliosis Research Society. The findings of the study have shown that these individuals need to be followed as they experience serious back pain. Based on this cohort, we also conducted a study to estimate the excess numbers of cancers attributable to diagnostic ionizing radiation for scoliosis. This study has shown that doses and numbers of cancers can be reduced substantially using alternate methods of radiography, and these are being adapted world-wide. We have also shown that AIS subjects may be subject to late reproductive problems due to early, low dose radiation exposure, although these results still need to be corroborated. 

Municipal solid waste sites (1994-). Target community: sanitary engineers, municipal officials, public health, epidemiologists, general public. Through a series of studies around a large municipal solid waste site in Montreal, I and my colleagues have found excesses in reproductive outcomes and cancer among persons living near the site. Given the toxic substances generated at such sites, into both air and water, these studies, among the few published to date, suggest that these sites may cause serious effects in persons living nearby, implying that these sites should not be located in populous areas and their emissions must be controlled. 

Breast cancer (1995-). Target community: cancer researchers, women, public health officials. Since 1995, I have been conducting a large population-based case-control study of postmenopausal breast cancer. I and France Labreche have published two influential papers that have led to much more interest in the possible relationship between breast cancer and occupational exposures. We have reviewed the state of the art showing that little research in occupational breast cancer has been conducted. In another article, we hypothesized that exposure to organic solvents may be cause breast cancer. As a result of these articles, there is a renewed interest in this research, and a series of new studies have been started. I am collaborating with Professor John Vena in Buffalo, NY, on a new study of female breast cancer in western New York State. Results from my study in Montreal will be published shortly.  

Air pollution (1995-). Target community: environmental health researchers, regulators. In 1995, I and my colleagues launched a novel study of particulate air pollution in Montreal. This study was intended to identify subgroups of the general population susceptible to the effects of ambient air pollution. Numerous studies around the world have shown important increases in the daily number of deaths when levels of air pollution increase, yet no one has been able to identify who may be at risk. My study uses an unusual approach whereby we use medicare's administrative databases to identify health conditions of persons before they die. With this, we conducted analyses to determine which groups showed associations between daily mortality and levels of air pollution. We have indeed identified a number of subgroups that are susceptible. These results are used by national governments around the world in promulgating ambient air quality standards. These findings have led to the development of a panel study of congestive heart failure patients and how air pollution and weather affects clinical signs and symptoms. In another study, my collaborators and I won a competition to reanalyze the Harvard Six-cities Cohort Study and the American Cancer Society Cohort Study. These two studies have shown increased levels of mortality with level of fine particles and are a principal basis for setting ambient air quality standards. The reanalysis has validated the original findings, showed the results are robust to different assumptions about exposure, statistical models, measurement errors, and the like.

Smoking and back pain (1997-). Target community-health professionals; employers; workers' compensation. Adding to the litany of adverse health effects caused by cigarette smoking is back pain. While a number of studies have reported this association, a further in-depth analysis of my scoliosis study showed conclusively that there is a strong association between back pain and cigarette smoking that is not confounded by occupation or other factors. Our study showed a dose-response relationship not only between the prevalence of back pain but with intensity and frequency. Our results have thus corroborated the earlier findings and suggest that the association may be causal.