History
Washington County’s leadership role in health studies pre-dates the Center as we know it today. When the Johns Hopkins Bloomberg School of Public Health was established in 1916 as the School of Hygiene and Public Health, field training was an essential component of training for public health students. Washington County was selected as a training site, presumably because it was unique in having two public health nurses supported by a voluntary association. In 1921, the Washington County Health Demonstration started. One of the most famous studies was the series of Hagerstown Morbidity Surveys, the first truly representative community health surveys, which set the stage for the National Health Interview Surveys of today, including the national health and nutrition examination surveys (NHANES). Other pioneering research studies were studies on child growth and dental caries in the 1930s. In 1957, the National Cancer Institute established the Environmental Cancer Field Research Project in a building adjacent to the health department. The County Health Officer had noticed what seemed to be considerable variation in cancer deaths within the county, and a major survey of cancers among past and present residents was made. However, when, after several years of data collection, none of the expected associations of cancers with geography developed, the National Cancer Institute decided to terminate the study and the building sat idle. In 1962 Dr. George Comstock, with a long history of directing community projects and a liking for the geography of Washington County, joined the Johns Hopkins faculty. On December 12, 1962, the Johns Hopkins Training Center for Public Health Research was established.
Early support of the Center came from a contract with the National Cancer Institute to conduct a private health census of the county to collect personal and housing information that would allow completion of the study of geographic and residential distribution of cancer cases. This 1963 census was the basis for a series of health studies for many years and continues to be today. A follow-up private health census was conducted in 1975. There are currently two research units associated with the Center: The Health Monitoring Unit and The Surveillance and Disease Prevention Unit, located in Hagerstown. This unit was founded in 1986, and it is the basis of operations for the Atherosclerosis Risk in Communities (ARIC) study. ARIC includes both a linked cohort study and heart disease surveillance program for the county. The ARIC Washington County Field Center is one of the four collaborative sites studying cardiovascular risk factors among persons 45 to 64 years of age. ARIC was followed by the Cardiovascular Health Study (CHS), which was limited to persons over the age of 65 years. Participation remains over 90 percent in the ARIC Study after more than 20 years of follow-up.
The CLUE studies were conducted in 1974 and 1989. The name of the cohorts were adopted from the campaign slogans Gives us a Clue to Cancer and Heart Disease. Initiated under the direction of Dr. George Comstock, they became known as CLUE I and CLUE II. Volunteer participants were recruited across the county and surrounding communities. In 1974 approximately 26,000 participants enrolled from May to November. In 1989, approximately 33,000 individuals took part. In 1974 blood samples were processed and stored as serum. In 1989 plasma and buffy coat were stored from the blood samples, and toenail samples were also collected. Beginning in 1996 the CLUE II cohort was expanded to include active follow-up with periodic mailing of health questionnaires. Questionnaires have been mailed to participants every two to three years. Over 8,000 of the participants in CLUE I also participated in CLUE II (this subcohort has been called the Odyssey Cohort). The CLUE studies have contributed to the understanding of cancer as well as other chronic diseases and are an integral member of the Cohort Consortium of the National Cancer Institute.
In 1989 Kathy Helzlsouer, MD, MHS joined the faculty of what was then called the Training Center for Public Health Research. The Center was renamed George W. Comstock Center for Public Health Research and Prevention to honor the long-standing contributions of Dr. Comstock to the development of the community-based center. Dr. Helzlsouer became the director of the Center in 2003 and stepped down as director in 2007. She is currently director of the Prevention and Research Center at Mercy Medical Center and continues as adjunct professor in the Department of Epidemiology and as a collaborator with the CLUE investigators.
Currently the Health Monitoring unit is engaged in studies using the CLUE information to evaluate cancer-related biomarkers, and to study how naturally-occurring genetic variations relate to health outcomes. This information will be the basis for health recommendations for modifying lifestyles, such that behaviors can work better with our genetic makeup, in order to promote health.
Historically and currently, Comstock Center collaborates with the Washington County Health Department on issues involving community health and program planning. In 2003 it implemented a survey of the health of residents of the county to identify the most pressing health needs. In 2002 an evaluation of the Health Department’s “Stop Smoking for Life Program,” which focused on the impact of nicotine patches on smoking cessation, resulted in a publication in the Journal of Addictive Diseases. In 1993 an assessment of the public health needs of African Americans in the Jonathan Street area of Hagerstown was conducted. The Center also collaborates with the Washington County Hospital, and in 2007 it conducted an evaluation of the heart failure monitoring program. The Center continues to collaborate with the Health Department on a variety of public health issues.
In October 2008, Josef Coresh, MD, PhD, was nominated as the director of the Center to lead the transition into innovative studies building on the rich history of research and collaboration. The Comstock Center organizational structure was revised. Increased collaboration between the two units and with local public health and medical organizations is leading to exciting opportunities in diabetes control and obesity treatment. New projects are being developed in the vascular basis of dementia, gout, and aging, as well as genomics to provide the basis for individualized medicine and early disease prevention.
In 2011, the ARIC study restarted its clinic visits. Visit 5 included approximately 6,500 participants across four sites with valuable data about cardiac function, cognitive function, and hearing loss among other components of the exam. ARIC visit 6 (2016 - 2017), visit 7 (2018 - 2019), visit 8 (2020 - 2021, conducted remotely during the COVID pandemic), and visit 9 (2022) added data on the evolution of health and how it is linked to behaviors and biologic measures over the past thirty years. ARIC Visit 10 is ongoing and expected to be completed in autumn of 2023. The center completed a clinical trial in 2016 - 2019, The STURDY study, which examined whether different doses of vitamin D could prevent falls. An additional clinical trial, The ACHIEVE study, is examining two different programs for protecting cognitive function among older adults with hearing loss. In 2017 the center celebrated the ARIC 30-year anniversary.
In summary, Washington County remains an outstanding place to conduct health studies. It has a state-of-the-art hospital and medical community. Most importantly, the population has a high interest in health research and willingness to participate in projects that will benefit the advancement of medical knowledge in order to improve the health of society as a whole.
Coffman Research Center 50th Anniversary and Original Dedication Brochure