Redefining what it means to grow old
Aging well looks different around the world. In Tobago and in veterans' clinics at home, Pitt Public Health researchers are learning how prevention and perseverance shape a healthier future.
Decades of Discovery: The Tobago Health Study
By Clare Collins
The Tobago Health Study was born from a chance encounter. In the late 1990s, University of Pittsburgh Epidemiologist Ronald LaPorte, PhD, (1949-2021) met Trinidadian physician Alan Leslie Patrick, MBBS, MD (1940-2017) at a medical conference, and their conversation sparked a study of prostate cancer among men of African ancestry led by Pitt epidemiologist Clareann Bunker, PhD, (1939-2024). Nearly 30 years later, the project has expanded to include women and a broad range of health issues, becoming one of the Caribbean's leading studies of aging.
Beginning with a narrow focus on prostate cancer, the study recruited men ages 40 and older. But as participants returned year after year and stayed involved for decades, the scope expanded. Women joined in 2019 and, today, with 80% retention rates among surviving participants, the project has become a broad resource for understanding health and aging.
 | "It's remarkable to see how it has transformed,"says Iva Miljkovic, MD, PhD, professor and vice chair for research, Department of Epidemiology. "When we talk about it now, it's not just a prostate cancer study. It's a study of aging." |
That shift has allowed researchers to explore new questions. "As the cohort aged, so did the questions we could ask," explains Caterina Rosano, MD, MPH, professor of epidemiology and associate director for clinical translation at the joint Pitt-UPMC Aging Institute. "We now have this incredible opportunity to understand not just prostate cancer, but how conditions like diabetes, hypertension and obesity influence again and risk for dementia."
Miljkovic says the study's longevity is only possible because of the community's involvement. "Everybody knows about the study—they call it the Pitt study," she explains. "People are very loyal. They come back year after year and bring their family members. They're proud to be part of it. People will say, 'Oh, my father was in the study, my uncle, my brother."
The research findings reflect that commitment. Past studies led by Joseph Zmuda, PhD, associate professor of epidemiology and of human genetics, found Tobagonian men to have lower rates of osteoporosis compared with men of European ancestry, confirming long-held assumptions about bone health. Studies of muscle quality have shown that fat infiltration in muscle, more than muscle mass itself, predicts mobility decline, diabetes and even mortality. Most recently, researchers have begun investigating cognition.
"Obesity, hypertension and diabetes—conditions on the rise across the Caribbean—are also major risk factors for dementia," Rosano says. "Yet we know very little about cognition in the region. Tobago gives us a unique chance to close that gap."
Miljkovic stresses that giving back to the community has always been a priority. "We don't just collect data and leave," she says. "We go into communities, share what we're learning and talk about prevention. That's why people continue to trust us."
Looking ahead, researchers hope to expand the work to other Caribbean islands to better understand how ethnicity and environment shape aging. But the Tobago Health Study remains unique as a project that began with a serendipitous meetings and, by lasting, grew into a window on the aging process.
"You don't often get to see a study evolve like this," Miljkovic reflects. "Because it lasted, it became something bigger than anyone imagined—a gift for science and for Tobago."
Raising the Cap
By Calvin Dziewulski
"A key part of aging well is preventing diseases before they start," says Soumik Purkayastha, PhD, MS, MStat, who joined the School of Public Health's Department of Biostatistics and Health Data Science last year as an assistant professor after earning his PhD from the University of Michigan. Working closely with the Veteran's Administration (VA) Pittsburgh Healthcare System's Center for Healthcare Evaluation, Research and Promotion, Purkayastha is focused on protecting the long-term health of veterans.
"We often think about things like cardiac and cerebral health, but what if we could prevent a cancer that tends to strike later in life? My collaborators over at the VA and our own School of Medicine are now exploring a new way to do just that for our nation's veterans."
The target is a type of throat cancer caused by the human papillomavirus (HPV). While HPV is widely known for causing cervical and other cancers, HPV-related oropharyngeal cancer is becoming more frequent—especially among veterans. Unlike most HPV-linked cancers, it often doesn't appear until middle age—15 to 20 years after infection—making it a unique challenge for healthy aging.
Currently, the HPV vaccine is recommended only through age 26. But given the elevated and delayed risk among veterans, Purkayastha and his team are studying the potential value of extending the recommendation to older individuals.
 | "This new study will investigate the potential public health benefit and cost-effectiveness of extending the universal HPV vaccination age cap for veterans to enable access at later stages of their lives,"Purkayastha explains. |
By rethinking prevention strategies for this group, the research aims to give veterans a better shot at living healthier, longer lives.