Q&A with Annette Adams, Incoming President of the American College of Epidemiology: On Finding Your Professional Home

Annette Adams is a research scientist at Kaiser Permanente Southern California (KPSC), leading research on osteoporosis and atypical femoral fractures (AFFs). AFFs are rare but serious, unusual thigh bone fractures that are associated with long-term osteoporosis drug treatments.

Dr. Adams is an alumna of the University of Washington Department of Epidemiology’s (UW Epi) PhD program, where she found her groove in injury epidemiology, after working in emergency medicine as a research associate and training at the Harborview Injury Prevention & Research Center (HIPRC).

In addition to her impressive work and research on AFFs and other areas of injury epidemiology, Dr. Adams was recently named President Elect of the American College of Epidemiology (ACE) in October 2023, and will become President of the organization in September 2024. ACE is a professional membership organization dedicated to education and advocacy for epidemiologists in their efforts to promote public health. Adams sees her roles as President Elect, and upcoming term as President of ACE, as great ways to give back to an organization that has been meaningful to her, and support others at various stages of their careers.

In this Q&A, Adams describes her circuitous path to pursue a career in epidemiology, her research and professional activities, and shares advice for epidemiology students.

Tell me a little bit about your background and what drew you to epidemiology?

It’s kind of a long and winding road. After initially getting a master’s degree in counseling psychology from Lewis & Clark College, my first career was as a crisis team supervisor at the local mental health crisis line in Portland, Oregon. After doing that for about 10 years, I started to burn out and began looking for something else. I knew I still wanted to be in a health-oriented field, so I started doing some research.

My mom had been a clinical microbiologist, so I obliquely knew about public health from her. This was also around the time when The Hot Zone was the ‘it’ book. After reading it, I remember thinking, “Oh, epidemiology! That sounds really cool.” Long story short, I ended up pursuing a master’s in public health at Oregon Health & Science University (OHSU) in Portland. During my program, I took a job as a research associate (RA) with the Department of Emergency Medicine at OHSU. Through that research group, I got exposed to the broad field of emergency medicine, working with infectious disease doctors, trauma surgeons, and emergency physicians, and seeing how research can be done in those different areas.

I left that job to pursue my doctorate in epidemiology at the University of Washington (UW). I started at the UW thinking that I wanted to be an infectious disease epidemiologist. For several reasons, including influence from my emergency medicine colleagues, my interests drifted into injury epidemiology. While I was at UW, I did my RA-ship at the HIPRC with Fred Rivara, and then ended up doing my dissertation on fracture injuries in older adults with Melissa Schiff. Since then, I have continued to focus on osteoporosis fracture injuries and older adults. So, it took me 10 years after my undergrad to figure out what I wanted to be when I grew up. And now I can’t imagine there’s anything else I would rather be doing.

You were recently selected for the President Elect/President positions for the American College of Epidemiology (ACE) – congratulations! Could you share a little bit about ACE and these roles?

The American College of Epidemiology (ACE) is a professional organization for epidemiologists. It’s oriented towards providing professional advocacy and support for working epidemiologists, and resources to enhance the practice of epidemiology. I joined ACE as a trainee, as a doctoral student in 2006, and I was elected to be a representative to ACE’s Board of Directors. That was a terrific experience because I got to meet more senior people in the field and have a say in the direction of the college. I’ve since served on several different ACE committees, including the admissions, education, and policy committees, and had a hand in planning three or four annual meetings.

ACE is special to me because it’s become my professional home. So, I’m super excited to be able to continue to serve the college as President Elect. My role is kind of like president in training, as now I’m at the right hand of the current president and helping to support her initiatives for the over the course of the next year. And then I’ll assume the role of President for a one-year term.

At what stage of their careers do people typically get involved in ACE?

People can get involved in ACE at any stage of their career. Our membership tends to be more senior, so, we’re trying to encourage trainees to consider joining ACE earlier in their career, and to become actively involved and engaged in committee work. ACE is a volunteer-run organization and we’re going to need a good pipeline of future leaders to continue to guide the organization.

We’re a credential based organization. So, there’s an admissions committee who reviews credentials and makes admissions decisions based on that. Our membership is very diverse in terms of the kinds of settings in which people work, so you can talk to people who are in traditional academia, working in industry, as consultants, or working in local, state or federal public health agencies. There’s always the opportunity for making those connections that could lead to a new job opportunity.

It sounds like you’ve had a very interesting career path, can you share more about what you’re working on now and anything you’re particularly excited about?

Before starting at KPSC, I had been working on a large osteoporosis cohort study. One of the orthopedic surgeons that I began working with upon starting here at KPSC, was on the forefront of identifying these rare fractures of the femur, now called atypical femoral fractures (AFFs). I was able to partner with him and provide the methodologic expertise to look at these things from a research perspective. That doctor has since retired, and I’ve assumed the mantle of local research expert on these fractures.

I’m currently one of three PIs on an NIH-funded project studying these fractures in three large cohorts in collaboration with investigators from UCSF, Sweden, and Denmark. AFFs are very rare, about 100 times rarer than the typical hip fracture. Because KPSC has about 4.7 million diverse members, I have been able to assemble one of the largest cohorts in the world of people with these fractures, leveraging our robust and detailed electronic health records, which I can use to support research.

The work on AFFs strikes me as important because even though these fractures are rare, they’ve been a bit sensationalized. Over the last 10 years or so, people with low bone mass or osteoporosis have been choosing not to start treatment because AFFs are strongly associated with long-term treatment with the medications that are known to prevent hip fractures. As a result, we’re now seeing an increase in preventable hip fracture occurrence. So, we’re trying to convey that there still is benefit for these treatments and exploring treatment options to minimize these concerns.

What suggestions might you have for incoming students or current students who are thinking of pursuing a career in epidemiology?

Well, the first advice I’d have is to join ACE – there’s my unabashed plug. But seriously, in addition to organizations like ACE, I encourage folks to take different approaches and talk with other epidemiologists and explore different career settings. UW Epi is a very traditional, mature, academic-oriented program, and there’s nothing wrong with that. But that’s not the only pathway and that may not be the right fit for some people. I encourage folks to use all experiences to inform their learning, talk to people, and explore alternatives. If you have even an inkling that maybe a different setting might be a better place as you launch your career, there’s no harm in exploring. It costs you a little time and effort, but you may find the professional home that’s best for you.

It’s also important to establish some habits about being good to yourself. I was fortunate to have mentors who modeled the importance of work-life balance. It’s so easy, especially as a doctoral student or early in your career, to get so focused on work. Realistically, there’s always more work than you could do, and sometimes the smartest thing is to take a break for a while and recharge your batteries. You’ll come back and do better quality work. Don’t wait until you’re sick or burned out. Take care of yourself because you need your mind and your body to support you throughout your career.

Is there anything else that you want to share?

I’m also super grateful for the training I received and connections I made at the UW in the epidemiology department. When I talk with colleagues and collaborators who trained elsewhere, I am increasingly appreciative of how UW hit what I consider the sweet spot between being an academically rigorous challenging program while also treating graduate students well. They want you to be successful and there’s plenty of support. No doctoral program is perfect, but the UW Epi program was the perfect one for me.