My research is in four related areas: HIV prevention and treatment; health of women; health effects of traumatic stress over the life course; and health effects of compassionate/altruistic love. All of these areas of research overlap in domains of mind-body interactions and health, social epidemiology, pathophysiology and biology of aging, and statistics.

Mind/Body Interaction and Health Research

Over the last 25 years, my research has integrated reproductive and social epidemiology, developmental psychology, and epidemiologic methods with community-based public health practice. Major measurement development work includes research on life course exposure measurements of interpersonal and structural violence exposure, including neighborhood safety, police-related homicide of young Black men, economic composition and racial disparities in homicide victimization, and multiple studies of geospatial socioeconomic small-area interactions with respect to violence, depression, and HIV infection (Zierler, AJPH 2000; Pearlman PubPolRpt, 2003; Gjelsvik et al; J Urban Hlth 2004); development of measures of life course violence victimization (Wise et al, Zierler, The Lancet 1991;), and dimensions of spirituality and health effects (Zierler and Stein, Fetzer presentation, Chicago 2003).

"Compassionate love as a mediator of stress responses among HIV infected people (18+ years) and their families" (PI; Fetzer Institute; 2001-2004): Phase I of this project is measurement of spiritual dimensions using previously validated questions supplemented with qualitative interviews on spirituality, religiosity, love, and social responsibility. Our hypothesis is that compassionate love promotes physical well-being both proactively and reactively through spiritual interactions with physiologic regulation of stress. Preliminary data suggest that people with HIV infection who report selfless caring for others at least everyday had more than a three-fold increase in odds of CD4> 350 relative to people reporting compassionate loving less often. As well, risk of depression was over 7 times greater among people reporting less than daily compassionate love.

"Societal factors, stress hormones, and preterm birth", Co-investigator, Subcontract from HPHC, March of Dimes 20-FY03-0699 (Rich-Edwards, PI): The aims of this study are to test the extent to which: 1) maternal experiences of racism or violence in childhood and adulthood are associated with the risk of preterm birth; 2) second trimester levels of CRH are associated with risk of preterm birth; and 3) Corticotropin-releasing hormone (CRH) levels are associated with maternal experiences of racism or violence. Enduring social and psychological stress may raise the risk of preterm delivery by raising levels of placental CRH. Women who have been the targets of racism or personal violence may be at particularly high risk of preterm delivery. Dr. Rich-Edwards and her team have begun to examine these questions among women enrolled in Project Viva, a Boston-based longitudinal study of 6,000 pregnant women and their children. My role has been development and analysis of measures of violence and threats of violence over the life course of pregnant women in relation to maternal, cord blood, and newborn CRH levels.

"Life course of violence victimization and ovarian aging" (S Zierler, PI, NIH-NIMH 1R01 MH 57735, 9/1/1998-5/31/2001): The goals of this project were to investigate physiologic effects of sexual and physical violence as cumulative stressors on occurrence of menstrual disorders and rate of decline in ovarian aging, as measured by serum levels of follicle stimulating hormone (FSH) and estradiol (E2), which respectively rise and fall with onset of menopause. Overall, women who experienced abuse during childhood or adolescence relative to never abused women had a slight positive association with high FSH. However, a positive association with high FSH was not observed among women whose first abuse occurred during adulthood. We also reported early perimenopause to be associated with social and economic deprivation in childhood (ref.), and in another article, that early abuse was associated with greater risk of adult depression (Wise et al). Three articles on long-term effects of violence and social class on depression risk and perimenopausal onset have been published. Longitudinal data analysis did not support the baseline findings of early onset of perimenopause except among depressed women. Our studies have contributed to measurement discussions (laboratory levels and self-reports) and hypotheses regarding embodiment of early violence victimization as a cause of premature ovarian aging.

Other research on social inequalities in health include studies of protection laws of discrimination against sexual minorities and teenage suicide; neighborhood housing and environmental conditions and asthma risk; neighborhood, race/ethnicity, and overweight/obese prevalence; and pre-natal HIV testing in relation to race/ethnicity.

9/1/2001-8/31/2005 Fetzer Foundation
"Compassionate love in relation to HIV well-being"
Principal Investigator, 20% effort, $89,000

10/1/1998-2/280/2004 March of Dimes (Subcontract from Harvard-Pilgrim Health Care)
"Societal factors, stress hormones and preterm birth"
Co-investigator, 5% effort, $10,000

9/1/2002-8/31/2004 R01- NIDA
"Racial disparities in access to HIV prevention strategies"
Co-investigator, 20% effort, $750,000

6/1/1999-5/31/2002 R01-NIH/NIMH
"Epidemiology of ovarian function in relation to violence"
Principal Investigator, 15% effort, $700,000

7/1/1999-6/30/2002 NIH/NIA
"Racial disparities in medication use in US nursing homes"
Co-investigator, 10% effort

9/30/1998-1/31/2001 NIH/NICHD (Subcontract from Harvard University – R01NIH-NICHD)
"Area-based socioeconomic measures for health data"
Principal Investigator

3/1/1999-2/28/2001 AHCPR/AHRQ
"Socioeconomic deprivation and outpatient health care use"
Principal Investigator, $75,000

COMPLETED BEFORE 2000:

1997-1998 AHCPR
"Racial disparities in US Nursing Home Care"
Principal Investigator, $79,000

1994-1999 AHCPR (subcontract from RAND Corporation)
"HIV Care Utilization Study (HCSUS)"
Investigator

1996-1998 Massachusetts Dept. of Public Health
"Social deprivation and AIDS incidence in Massachusetts"
Principal Investigator, $20,000

1993-1998 Centers for Disease Control
"Natural History of HIV in Women" (HERS)
Investigator (awarded to Charles Carpenter, M.D., The Miriam Hospital)

1995-1996 RI Department of Health
"Violence Against Women Prevention Project"
Consultant

1995-1997 NIH-NICHD
"Cervicovaginal inflammation and infection and HIV load"
Consultant (awarded to Kenneth Mayer, M.D., Memorial Hospital of RI)

1987-1992 National Institute of Allergy and Infectious Diseases, NIH
Department of Community Health, Brown University/Memorial Hospital
"Heterosexual HIV Transmission in Greater Providence"
Co-principal Investigator

1991-1993 Department of Child Psychiatry, Rhode Island Hospital (NHLBI)
"Epidemiology of symptom perception of asthma in children"
Investigator

1987-1990 National Institute of Child Health and Development, NIH
Department of Community Health, Brown University
"Preterm and small for gestational age at delivery across generations"
Project Director/Investigator

1985-1987 US Environmental Protection Agency
Department of Epidemiology, Harvard School of Public Health
"Spontaneous Abortion and Water Toxicity"
Principal Investigator

1985-1987 US Environmental Protection Agency
Division of Health Statistics and Research, Massachusetts Department of Public Health
"Cancer Mortality and Chlorinated Drinking Water"
Principal Investigator

1984-1986 US Environmental Protection Agency
Department of Epidemiology, Harvard School of Public Health
"Congenital Heart Disease and Water Toxicity"
Principal Investigator

Pearlman D, Zierler S, Meersman S, Kim HK, Viner-Brown S, Caron C. Race disparities in childhood asthma: Does where you live matter? JNMA. 98;239-247, 2006

Dore D, Zierler S.Over-Reliance on Patient Information Sheets, American Journal of Medicine, in press, 2006

Dore D., Zierler S.Over-Reliance on Patient Information Sheets; The Americal Journal of Medicine, in press, 2006.

Synergistic Effects in Children Amara E. Ezeamama, Stephen T. McGarvey, Luz P. Acosta, Sally Zierler, Daria L. Manalo, Hai-Wei Wu, Jonathan D. Kurtis, Vincent Mor, Remigio M. Olveda, Jennifer F. Friedman PLoS Negl Trop Dis. 2008 June; 2(6): e245. Published online 2008 June 4. doi: 10.1371/journal.pntd.0000245

Schuster, MA, Collins R, Cunningham, WE, Morton SC, Zierler S, Wong M, Tu W, Kanouse DE, Perceptions of Discrimination in Clinical Care in a National Sample of Adults Receiving HIV Care, J General Internal Medicine, in press, 2005.

JE. Allsworth*, ,S Zierler , K L. Lapane, N Krieger, JW Hogan, BL. Harlow, A longitudinal study of the inception of perimenopause in relation to lifetime history of sexual or physical violence, Journal of Epidemiology and Community Health, in press, 2005.

Pearlman D, Auerbach A, Zierler S, McGuire J. Prenatal HIV testing in relation to health care delivery system and race/ethnicity, in press, J Natl Med Association, 2005

A Gjelsvik*, S Zierler, J Blume. Homicide risk across race and class: A small-area analysis in Rhode Island and Massachusetts, 2004, in press, J Urban Health.

N Krieger, S Zierler, P Waterman, et al. Neighborhood Measures for Health Research. In: Neighborhoods and Health. Editors: I Kawachi and L Berkman, Oxford University Press, 2003.

Eisenman DP, Cunningham WE, Zierler S, Nakazono TT, Shapiro MF; HCSUS Consortium. Effect of violence on utilization of services and access to care in persons with HIV.J Gen Intern Med. 2003 Feb;18(2):125-7.

D Pearlman, S Zierler, A Gjelsvik*, W Verhoek-Oftedahl. Neighborhood and racial position in relation to domestic violence: A contextual analysis. Public Health Reports, Jan-Feb;118(1):44-58. 2003.

L Wise*, N Krieger, S Zierler, B Harlow. Lifetime Socioeconomic position in relation to onset of perimenopause. J Epidemiol Comm Hlth. 2002 Nov;56(11):851-60

W Jesdale*, S Zierler. Adolescent suicide rates and state-level civil rights protection of sexual minority status. J Gay and Lesbian Human Rights, vol. 6:61-69, 2002.

58. Zierler S. Violence and HIV: strategies for primary and secondary prevention. Focus. 2001 May;16(6):1-4.

56. L Wise*, S Zierler, N Krieger, B Harlow. Adult onset of major depressive disorder in relation to childhood and adolescent violence victimization. The Lancet, 2001 Sep 15;358(9285):881-7

J Rich-Edwards, N Krieger, J Majzoub, S Zierler, E Lieberman, M Gillman Maternal experiences of racism and violence as predictors of preterm birth: rationale and study design. Paediatric and Perinatal Epidemiology 2001.

55. J Allsworth* S Zierler, N Krieger, B Harlow. Ovarian function in late reproductive years in relation to lifetime experiences of sexual and physical abuse. Epidemiology. 2001 Nov;12(6):676-81

57. Krieger N, Waterman P, Lemieux K, Zierler S, Hogan JW. On the wrong side of the tracts? Evaluating the accuracy of geocoding in public health research.Am J Public Health. 2001 Jul;91(7):1114-6.

S Zierler, N Krieger. Social Inequalities and HIV infection in Women. In: AIDS: Lessons from the frontline. Kenneth Mayer (editor). APHA, 2000 (revision and update of reference 40).

52. S. Zierler, W. E. Cunningham, R. Andersen, M. F. Shapiro, S. A. Bozzette, T. Nakazono, S. C. Morton, S. Crystal, Michael Stein, B. Turner and P. A.S. Clair. Violence Victimizatin after HIV Infection in a U.S. Probability Sample of Persons in HIV Primary Care. AJPH;2000; 90:208-215.

49. W. E. Cunningham, R. M. Andersen, M. H. Katz, M. D. Stein, B. J. Turner, SCrystal, S. Zierler, K. Kuromiya, S. C. Morton, P. S. Clair, S. A. Bozzette, M. F. Shapiro and the HCSUS Consortium. The Impact of Competing Subsistence Needs and Barriers on Access to Medical Care for Persons with HIV Receiving Care in the United States. Med Care, 2000.

48. M. Stein, S. Crystal, W. E. Cunningham, A. Ananthanarayanan, R. M. Andersen, B. J. Turner, S. Zierler, S. Morton, M. H. Katz, S. A. Bozzette, M. F. Shapiro, M. A. Schuster and the HCSUS Consortium. Delays in Seeking HIV Care Due to Competing Caregiver Responsibilities. Amer J Pub Hlth 2000;90:1138-1140.

50. M. Katz, W. E. Cunningham, V. Mor, R. M. Andersen, T. Kellogg, S. Zierler, S. C. Crystal, M. D. Stein, K. Cylar, S. A. Bozzette and M. F. Shapiro. Prevalence and Predictors of Unmet Need for Supportive Services among HIV-infected Persons: Impact of Case Management. Med Care,2000.

A. Bozzette, T. Nakazono, Sally Morton, S. Crystal, P. S. Clair, M. Stein, S. Zierler and for the HCSUS Consortium. Delayed Medical Care after Diagnosis in a U.S. National Probability Sample of HIV-Infected Persons in Care. Arch Int Med. 2000.

53. S Zierler, N Krieger, Y Tang, W Coady, E Seigfried, A DeMaria, J Auerbach. Economic Deprivation in relation to AIDS Incidence in Massachusetts. Amer J Pub Hlth. 2000;90:1064-1073.

S Zierler. Activism and academia. In: Service Learning in Women's Studies. K Heffernan (editor). AAHE. Washington D.C. 2000.

46. Zierler S. Mayer K, Moore J, Stein M, Schoenbaum E, Schuman P, Rompalo A. Sexual practices in a cohort of HIV positive and negative US women. JAMWA. 1999

47. De Groot AS, Stevens J, Leibel S, Pratt L, Zierler S. Setting the standard for care: HIV risk exposures and clinical manifestations of HIV in incarcerated Massachusetts women. New England J Criminal Civil Confinement. 1998;24:353-83.

44. M Klebanoff, BS Zemel, S Buka, S Zierler. Long term follow-up of participants in the collaborative perinatal project: Tracking the next generation. J Perinatal Epidemiology. 1998.

43. D Vlahov, D Wientge, J Moore, C Flynn, P Schuman, E Schoenbaum, S Zierler. Violence against women with or at risk for HIV infection. AIDS and Behavior 1998;2:53-60.

45. Zierler S. Efficacy versus impact of HIV therapy. Editorial. Epidemiology, 9:590-3, 1998.

42. G O'Brien*, MD Stein, S Zierler, M Shapiro, P O'Sullican, R Woolard. Persons who use the emergency department as their regular source of care: Associated factors beyond the lack of health insurance. Annals of Emergency Med 1997; 30:286-291.

41. JY Kim*, J Rich, S Zierler, K Lourie, K Vigilante, L Normandie, M Snead, J Renzi, D Bury-Maynard, P Loberti, R Richman, TP Flanigan. Successful community follow-up and reduced recidivism in HIV positive women prisoners. Journal of Correctional Health, 1997.

39. S Zierler and N Krieger. Reframing women's risk: Social inequalities and HIV infection. Annual Reviews of Public Health. 18:401-36,1997.

38. J Moore, D Warren, S Zierler, P Schuman, L Solomon, E Schoenbaum, M Kennedy. Characteristics of HIV infected lesbians and bisexual women in four urban centers. Women's Health: Research on Gender, Behavior, and Policy. 2: 49-60, 1997.

40. N Krieger and S Zierler. The need for epidemiologic theory. Epidemiology. 8:22-214, March, 1997.

S Zierler. Hitting hard: HIV and violence. In: Gender Politics of HIV. J Manlowe and NGoldstein, editors. NYU Press. 1997

37. S Zierler, B Witbeck, K Mayer. Sexual violence, women and HIV infection. Amer JPrev Med. 12:304-10, 1996

36. N Krieger and S Zierler. Accounting for Health of Women. Current Issues in Public Health 1: 251-256, 1996. Also reprinted in: Radical Community Medicine. 7, 1997

34. AS De Groot, S Zierler, J Stevens, D Dean, G Cram, E Andujar, J Baggett, C Johnsen, T Flanigan, Rochelle G. Sheib. HIV Risk Behaviors and Clinical Manifestations of HIV in Incarcerated Women in Massachusetts. J Women's Health, 1996

32. N Krieger, S Zierler. What explains the public's health?-A call for epidemiologic theory. Epidemiology 7: 107-109, 1996.

35. EP Larrat*, S Zierler, K Mayer. Cocaine use and HIV disease progression among heterosexuals. Pharmacoepidemiology and Drug Safety. 5:229-236, 1996

S Zierler. Care of the lesbian and gay patient. In: Practical Guide to Ambulatory Care. Mosby Publishers. St. Louis. T Wachtel and M Stein, Eds., 1995, 2nd edition 1999.

33. J Stevens*, S Zierler, D Deane, A Goodman, B Chalfen, A De Groot. Prevalence of prior sexual abuse and HIV risk-taking behavior in incarcerated women in Massachusetts. J Correctional Health Care 2: 137-149, 1995.

31. K Lapane*, S Zierler, T Lasater, M Stein, M Barbour, A Hume. Is a history of depression associated with an increased risk of infertility in women? Psychosomatic Medicine. 57:509-513 1995.

29. L Norton, J Peipert, S Zierler, B Lima, L Hume. Battering in Pregnancy: An Assessment of Two Screening Methods. Obst. Gyn. 85: 321-5, 1995.

30. K Lapane*, S Zierler, T Lasater, M Barbour, R Carleton, A Hume. Is the use of psychotropic drugs associated with increased risk of ischemic heart disease? Epidemiology 6:376-81, 1995.

S Zierler. Domestic violence. In: Practical Guide to Ambulatory Care. Mosby Publishers. St. Louis. T Wachtel and M Stein, Eds., 1995,2nd edition 1999.

28. S Zierler. Women, Sex and HIV. Editorial. Epidemiology. 5:565-7, 1994.

27. P Larrat*, S Zierler, K Mayer. Cocaine use and heterosexual exposure to HIV. Epidemiology, 5:398-403; 1994.

26. P Larrat*, S Zierler, K Mayer. Cocaine and HIV: A relational model. J Addiction, Sept. 1993.

23. A Aschengrau, S Zierler, A Cohen. Quality of community drinking water and the risk of late adverse pregnancy outcomes. Arch Environ Health. 1993.

25. S Zierler. Drinking water and reproductive health. Epidemiology, 3:77-78. 1992.

24. JD Piette*, O Intrator, S Zierler, V Mor, M Stein. An exploratory analysis of survival with AIDS using a nonparametric tree-structured approach. Epidemiology, 3:2310-18, 1992.

L Newman and S Zierler. Acceptability of HIV Behavioral Interventions: Ethnographic and Epidemiologic Approaches. Research Issues in Human Behavior and Sexually Transmitted Diseases in the AIDS Era. Edited by JN Wasserheit. ,1991.

22. S Zierler, L Feingold, D Laufer, P Velentgas, I Kantrowitz-Gordon, K Mayer. Adult survivors of childhood sexual abuse and subsequent risk of HIV infection. Am J Pub Hlth, 81: 572-575. 1991.

21. S Zierler, D Laufer, L Feingold, I Kantrowitz, K Mayer. Heterosexual HIV infection in Rhode Island: The New England Behavioral Health Study R.I. Medical J ,73:285-92, 1990.

20. P Velentgas*, C Bynum*, S Zierler. The buddy volunteer commitment in AIDS care. Amer J Pub Hlth, 80:1378-80, 1990.

18. CL Brosius, JW Newburger, JC Burns, P Hojanowski-Diaz, S Zierler, DYM Leung. Increased prevalence of atopic dermatitis in Kawasaki Disease. J Ped Infect Dis. 1990

Zierler S. Methodologic issues in epidemiologic studies of drug teratogens.In Reproductive and Perinatal Epidemiology, M. Kiely, editor, CRC Press, November, 1990.

19. A Aschengrau, S Zierler, A Cohen. Quality of community drinking water and the risk of spontaneous abortion. Arch Environ Hlth 1989; 44:283-290.

17. S Zierler, L Feingold, RA Danley, G Craun. A case-control study of bladder cancer in Massachusetts among populations receiving chlorinated and chloraminated drinking water. Arch Environ Health,43:195-200, 1988.

15. S Zierler. Causes of retinopathy of prematurity: An epidemiologic perspective. In: Retinopathy of Prematurity: Problem and Challenge, March of Dimes Birth Defects Original Article Series, 1988.

14. S Zierler, M Theodore, A Cohen, KJ Rothman. Quality of maternal drinking water and congenital heart disease. International J of Epidemiology. 17:589-94, 1988 .

Proceedings of the Sixth Conference on Water Chlorination, Oak Ridge, Tennessee, 1987.

13. WP Kanto, R Wilson, GL Breart, S Zierler, DM Purohit, GJ Peckham, RC Ellison. Perinatal events and necrotizing enterocolitis in premature infants. Amer J Dis Children, 141:167-9, 1987.

12. MD Cunningham, RC Ellison, S Zierler, WP Kanto, OS Miettinen, AS Nadas. Perinatal Risk Assessment for Patent Ductus Arteriosus in Premature Infants. Obstetrics and Gynecology, 68:41-44, 1986

9. S Zierler, D Purohit. Prenatal antihistamine and retrolental fibroplasia. American J Epidemiology 123:192-196, 1986.

8. E Walsh, RC Ellison, S Zierler, OS Miettinen. ECG findings at one year follow-up of very low birthweight babies. Pediatrics 77:353-356, 1986.

10. S Zierler, KJ Rothman. Maternal use of BendectinR and other drugs in early pregnancy and congenital heart disease. New Eng J Med 313:347-52, 1985.

7. D Purohit, RC Ellison, S Zierler, OS Miettinen, AS Nadas. Non-oxygen determinants of retrolental fibroplasia. Pediatrics September, 1985.

4. S Zierler. Maternal drugs and congenital heart disease. Obstetrics and Gynecology 65:155-165, 1985.

11. S Zierler, RA Danley, L Feingold. Chlorination in drinking water and cancer mortality. Proceedings of the US Environmental Protection Agency, Symposium on Health Effects of Water Disinfectants, August 27-29, 1985. in Environmental Health Perspectives, November, 1986.

6. G Peckham, RC Ellison, OS Miettinen, E Kraybill, Gersony, S Zierler, AS Nadas. Clinical course to one year of age of premature infants with patent ductus arteriosus: Results of a multicenter randomized trial of Indomethacin. J Pediatrics 105:285-91, 1984.

5. H. Wagner, RC Ellison, S Zierler, P Lang, DM Purohit, et al. Surgical closure of patent ductus arteriosus in 268 preterm infants. Journal of Thoracic and Cardiac Surgery 87:870-876, June, 1984.

3. RS Stern, S Zierler, JA Parrish. Methotrexate used for psoriasis and the risk of noncutaneous or cutaneous malignancy. Cancer 50:869-872, 1982.

2. RS Stern, S Zierler, JA Parrish. Psoriasis and the risk of cancer. Journal of Investigative Dermatology 78:147-149, 1982.

1. RS Stern, S Zierler, JA Parrish. Skin carcinoma in patients with psoriasis treated with tropical tar and artificial ultraviolet radiation. Lancet i: 732-735, 1980.

1980-1981 National Research Service Award Training Grant
1981-1984 Exxon Corporation Fellowship Program in Epidemiology
1984 Biomedical Research Support Grant, Harvard University
1985 Society for Epidemiologic Research Student Prize, "Maternal use of BendectinR and other drugs in early pregnancy and congenital heart disease"
1988 Brown University Women in Medicine, Mary Putnam-Jacobi Award in Teaching
1991-1992 Coolidge Fellow: Convenor, Faculty Discussion Groups on Challenge of Faith in the Academy, Pew Charitable Trust
1992 Coolidge Fellow, Episcopal Divinity School, Cambridge, Massachusetts
1992 Honorary Masters of Arts Degree ad eundum, Brown University
1994-1995 Fellowship in Health and Social Justice, Cambridge, Massachusetts
1996- 2001 Board of Directors, Thai Youth AIDS Prevention Project
1997 Rhode Island Campus Compact Community Service Award for Faculty Partnership
1999-2001 Board of Directors, National Women's Health Network
1998-2002 Founding Board of Directors, Occupational and Environmental Health Center of Rhode Island
2002 Extraordinary Woman Award, Rhode Island, Community Service Award
2003 Community partnership award: Rhode Island AIDS Prevention Strategic Planning Task Force
2004-2005 Brown University Award for Teaching Excellence in the Life Sciences
2006 Brown University Graduate School Teaching Service Award

Current
American Public Health Association
Association for Religious and Intellectual Life

Past
WHO Advisory Panel: Women, Violence, and HIV Infection, Geneva, Switzerland
Visiting Scholar in Epidemiology, Francois Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health
Fellow, Institute for Health and Social Justice, Cambridge, Massachusetts
Fellow, Dept. of Social Medicine, Harvard Medical School, Boston, MA

Social inequalities and health; Health and human rights; Critical epidemiology; Methods in epidemiologic research; Health of women.