About

Chanelle J Howe is a Professor of Epidemiology in the Department of Epidemiology within the Brown University School of Public Health. She holds an appointment with Brown's Center for Epidemiologic Research, is a member of the Providence/Boston Center for AIDS Research, and is a faculty associate with Brown's Population Studies and Training Center. Her academic background includes an MPH in Epidemiology from Columbia University Mailman School of Public Health, a PhD in Epidemiology, and an MHS in Biostatistics from Johns Hopkins Bloomberg School of Public Health. She completed postdoctoral training in the Department of Epidemiology at the University of North Carolina Gillings School of Global Public Health. Dr. Howe's research interests encompass methods, infectious diseases, health disparities, and the health effects of social and economic policies.

Research topics

• Computer Science
• Medicine
• Artificial Intelligence
• Statistics
• Psychology
• Social psychology
• Econometrics
• Pathology
• Environmental health
• Mathematics

Selected publications

• Examining Associations between COVID-19 Distress, Multilevel Resilience, and HIV Viral Suppression among African American/Black Adults in the Southeastern United States

  Journal of Health Care for the Poor and Underserved · 2026-02-01

  articleSenior author

  Abstract: The COVID-19 pandemic may have exacerbated HIV viral suppression disparities between African American/Black and White people living with HIV in the United States. Although COVID-19 disrupted HIV care and caused distress, multilevel resilience resources may have mitigated the impact of COVID-19 distress on HIV viral suppression. We used prospective observational data on 124 African American/Black adults from two clinical cohorts in the Southeastern United States and modified Poisson regression to examine whether an intervention that reduced COVID-19 distress and enhanced multilevel resilience resources would have more effectively improved HIV viral suppression had such a dual intervention been implemented in the real-world during the COVID-19 pandemic. This examination did not yield strong evidence that a real-world dual intervention would have more effectively improved HIV viral suppression on the additive scale during the pandemic among study participants. Larger future studies that minimize systematic sources of bias are needed.

  PublisherDOI

• The Evolution of Selection Bias in the Recent Epidemiologic Literature—A Selective Overview

  UNC Libraries · 2026-04-25

  articleOpen access1st authorCorresponding

  Selection bias has long been central in methodological discussions across epidemiology and other fields. In epidemiology, the concept of selection bias has been continually evolving over time. In this issue of the Journal, Mathur and Shpitser (Am J Epidemiol. Am J Epidemiol. 2025;194(1):267–277) present simple graphical rules for using a Single World Intervention Graph (SWIG) to assess the presence of selection bias when estimating treatment effects in both the general population and a selected sample. Notably, the authors examine the setting in which the treatment affects selection, an issue not well-addressed in the existing literature on selection bias. To place the work by Mathur and Shpitser in context, we review the evolution of the concept of selection bias in epidemiology, with a primary focus on the developments in the last 20-30 years since the introduction of causal directed acyclic graphs (DAGs) to epidemiologic research.

  PublisherDOI

• Prompt and Intensive Antiviral Chemoprophylaxis in Nursing Home Influenza Outbreaks

  JAMA Internal Medicine · 2026-03-30

  articleOpen access

  Importance: Influenza outbreaks in nursing homes (NHs) can cause high morbidity and mortality. Antiviral chemoprophylaxis with oseltamivir is recommended, yet optimal implementation strategies remain unclear. Objective: To examine whether initiating antiviral chemoprophylaxis for 70% or more of eligible NH residents within 2 days of influenza outbreak detection is associated with lower all-cause mortality and hospitalization at 14 and 30 days. Design, Setting, and Participants: Retrospective cohort study using a sequential cluster-randomized target trial emulation and randomize-censor-weight approach for influenza outbreaks (September 1, 2018-May 31, 2022) in 12 US NH corporations. Eligibility criteria were age 18 years or older, present on the outbreak-detection day, no antiviral use in the preceding 7 days, no influenza in the past 14 days, and complete baseline data. Residents were followed up until hospitalization or death, an NH discharge to a nonacute-care location, or the end of follow-up. Data were analyzed from February 2023 to January 2026. Exposures: Intensive antiviral chemoprophylaxis with oseltamivir (≥70% of eligible residents within 2 days of outbreak detection) or nonintensive antiviral chemoprophylaxis (0% to <70% of eligible residents). Main Outcomes and Measures: Outcomes were all-cause death and hospitalizations within 14 and 30 days of outbreak detection. Discrete-time hazard models with pooled logistic regression were applied to estimate weighted risks, risk differences (RDs), and risk ratios (RRs). Results: Among 404 outbreaks in 318 NHs, 35 086 resident-trial observations (29 683 residents; median age 78 [IQR, 68- 86] years; 60% women; 81% White; 76% vaccinated) met eligibility criteria. Intensive oseltamivir prophylaxis was randomized to 17 155 observations; 17 931 were randomized to nonintensive care. At 14 days, intensive prophylaxis vs nonintensive yielded an RD of -0.06% (95% CI, -0.73% to 0.93%) and an RR of 0.96 (95% CI, 0.56-1.57) for death, and an RD of -0.96% (95% CI, -1.78% to -0.19%) and an RR of 0.79 (95% CI, 0.64-0.96) for hospitalization. At 30 days, the hospitalization differences persisted but were less precise and there continued to be no difference in death. Conclusions and Relevance: Study results suggest that clinicians should initiate antiviral chemoprophylaxis for at least 70% of eligible NH residents within 2 days of outbreak detection to lower risk of hospitalization.

  PublisherDOI

• Practice-Level Severity Case Mix and Treatment Patterns for Premenopausal Noncancerous Hysterectomy

  Journal of Women s Health · 2025-07-17

  articleOpen access

  Background: Hysterectomy for noncancerous conditions is a patient-preference-sensitive procedure. Therefore, gynecological practices may provide hysterectomy at varying levels of symptom severity. We assess whether practice-level severity case mix associates with segregation of patients by race and ethnicity or insurance status. Methods: In this case series, we analyzed electronic health records of 1,590 noncancerous hysterectomy patients across 20 clinical practices within a large health care system in the U.S. South (2014–2017). By abstracting 12-month presurgical medical notes, we developed severity scores for bleeding, pain, and bulk symptoms. The practice-level severity case mix measure distinguished six practices where ≥18% of patients had below median scores for bleeding, pain, and bulk. Log-binomial models estimated prevalence ratios (PRs) for severity case mix by race and ethnicity and insurance, adjusting for age, body mass index, gynecological conditions, previous abdominal surgeries, and prior uterine sparing treatments. Results: Patients at practices with lower severity case mix differed in surgical indications, had fewer uterine-sparing treatments before undergoing hysterectomy, and were largely (96%) privately insured. Compared to White patients, Hispanic patients underwent hysterectomy less frequently at lower severity practices (PR: 0.52 [0.33–0.82]) while Black patients showed no difference based on the point estimate (PR: 1.00 [0.87–1.14]). Publicly-insured and uninsured patients were less likely than privately-insured patients to receive hysterectomy at lower severity practices (PR: 0.13 [0.05–0.36] and PR: 0.28 [0.12–0.68], respectively). Conclusions: Publicly insured and uninsured patients receiving hysterectomy—including nearly all Hispanic patients—were concentrated in practices with a higher symptom severity case mix.

  PublisherOA PDFDOI

• Defining methodologic and other core competencies for PhD-level training in epidemiology

  American Journal of Epidemiology · 2025-04-07

  article

  In this manuscript, we present the results of a series of workshops convened in conjunction with the 2023 Society for Epidemiologic Research annual meeting. The overall objective of the workshops was to develop a set of core competencies for PhD students in epidemiology. The topics presented in the list of competencies are organized using a framework similar to many graduate programs in epidemiology, proceeding from basic to advanced topics. Given the breadth of substantive topics in the fields of epidemiology and public health, this list of competencies focuses on methodologic topics that are relevant to all students, regardless of research interest. The final topic lists were developed based on discussions including a large and diverse group of epidemiologists with different areas of expertise. By creating this resource, we aim to facilitate training of future generations of epidemiologists.

  PublisherDOI

• Exacerbation of racial disparities in COVID-19 outcomes by Alzheimer’s disease and related dementias among nursing home residents

  American Journal of Epidemiology · 2025-01-30

  articleOpen accessSenior author

  The COVID-19 pandemic has disproportionately impacted Black nursing home (NH) residents. Alzheimer's disease and related dementias (ADRDs) may exacerbate disparities, but little empirical evidence exists on the degree to which race and ADRDs intersect to impact COVID-19-related outcomes. We conducted a cohort study (April-December 2020) leveraging electronic health records from 12 US NH corporations. We used the parametric g-formula to obtain standardized estimates of incident COVID-19 infection and 30-day COVID-19-associated hospitalization or death by race, both overall and within strata of ADRD status. The cohort comprised 127 913 resident-episodes, including 15 379 incident COVID-19 infections, 1522 deaths, and 2548 hospitalizations. Black residents were more likely than White residents to experience incident COVID-19 and subsequent hospitalization, but not more likely to subsequently die. Disparities in hospitalization and a combined endpoint of hospitalization or death were more pronounced among residents with ADRDs compared to residents without ADRDs. These results suggest the presence of disparities in COVID-19 outcomes by race and provide evidence that ADRD status may exacerbate racial disparities in COVID-19 outcomes among nursing home residents. Our findings offer valuable insights for current and future preparedness efforts in NHs in the United States and countries with similarly underresourced long-term care settings. This article is part of a Special Collection on Methods in Social Epidemiology.

  PublisherOA PDFDOI

• Developing inclusive, antiracist approaches to public health research: Guidelines for action

  Journal of public health research · 2025-10-01

  articleOpen access

  The pervasive influence of racism confers on all public health researchers-even those for whom health disparities research is not their focus-a social responsibility to conduct research that is antiracist (i.e. to adopt research approaches that actively oppose racism and promote equity). This manuscript reviews the relevant literature and provides guidance for conducting antiracist public health research specifically for researchers for whom health disparities research is not a focus of their work. Drawing on Critical Race Theory, we propose a preliminary framework for conducting antiracist research in the form of five overarching guidelines, which were developed in the United States based on the American experience, but can be tailored/adapted to country-specific/cultural contexts: I. Frame race as a social (not a biological) construct; II. Actively solicit input and participation from individuals who are racial and ethnic minorities; III. Choose terminology carefully and be mindful of its implications; IV. Incorporate measures of contextual factors that may influence health-related behaviors and outcomes; and V. Be intentional with choices of theoretical frameworks, study design, and analytic approaches. We summarize relevant literature and provide recommendations and key references for how to follow each guideline. We also discuss how research that does not attend to these guidelines unintentionally supports racist structures and provide examples of how each guideline applies to research on the 2019 Coronavirus pandemic. Following the guidelines in this manuscript, though not exhaustive, will allow researchers to contribute to an antiracist public health agenda in pursuit of health equity regardless of content focus.

  PublisherDOI

• A spatially dynamic agent-based model for assessing the effect of gentrification-induced migration and HIV transmission among heterosexual African American/Black women

  Annals of Epidemiology · 2025-08-19

  articleOpen access
  PublisherOA PDFDOI

• Association between pre-pandemic wealth and material hardships during the COVID-19 pandemic: how racial and ethnic wealth inequities shape household vulnerability to national crises

  Health Affairs Scholar · 2025-04-09

  articleOpen access

  The COVID-19 pandemic was characterized by large racial and ethnic inequities in acute material hardships. Pre-pandemic economic conditions, including household wealth, may have contributed to these disparities. We used longitudinal data from the Understanding America Study surveys to (1) describe racial and ethnic differences in pre-pandemic household wealth; and to (2) evaluate the association between pre-pandemic household wealth and acute material hardships during the pandemic. We found large racial and ethnic inequities in pre-pandemic wealth, with 48.3% of non-Hispanic White households reporting wealth greater than $100,000, compared to 16.4% and 29.8% for non-Hispanic Black and Hispanic/Latino households, respectively. Adjusted Poisson regression models clustered by household revealed that, during the pandemic, households with less than $100,000 in pre-pandemic wealth had 1.7-3.0 times higher prevalence of food insufficiency and 1.4-2.0 times higher prevalence of housing insecurity compared with households with more than $100,000 in pre-pandemic wealth. Wealth inequities, which are racially patterned in the United States, shape vulnerability to material hardships such as food insufficiency and housing insecurity during economic crises.

  PublisherOA PDFDOI

• The Target Study: A Conceptual Model and Framework for Measuring Disparity

  Sociological Methods & Research · 2025-04-22 · 4 citations

  articleOpen accessSenior author

  We present a conceptual model to measure disparity-the target study-where social groups may be similarly situated (i.e., balanced) on allowable covariates. Our model, based on a sampling design, does not intervene to assign social group membership or alter allowable covariates. To address non-random sample selection, we extend our model to generalize or transport disparity or to assess disparity after an intervention on eligibility-related variables that eliminates forms of collider-stratification. To avoid bias from differential timing of enrollment, we aggregate time-specific study results by balancing calendar time of enrollment across social groups. To provide a framework for emulating our model, we discuss study designs, data structures, and G-computation and weighting estimators. We compare our sampling-based model to prominent decomposition-based models used in healthcare and algorithmic fairness. We provide R code for all estimators and apply our methods to measure health system disparities in hypertension control using electronic medical records.

  PublisherOA PDFDOI

Recent grants

• NIH Grant K22AI095021

  NIH · $261k · 2014

• The role of resilience in addressing racial disparities in adverse HIV-related outcomes

  NIH · $3.1M · 2017–2024

• NIH Grant F31DA022114

  NIH · $122k · 2009

• NIH Grant R56AI12083001A1

  NIH · $467k · 2019

• Impact of multilevel risk and resilience factors on cardiovascular health in racially/ethnically diverse men and women

  NIH · $1.5M · 2018–2023

Frequent coauthors

• Akilah Dulin‐Keita

  Brown University

  58 shared

• Katina Robison

  John Brown University

  55 shared

• Kyle Wohlrab

  Brown University

  53 shared

• Vivian W. Sung

  Brown University

  53 shared

• Christine Luis

  John Brown University

  52 shared

• Elizabeth Lokich

  52 shared

• Paul DiSilvestro

  Providence College

  51 shared

• Christina Raker

  Rhode Island Hospital

  43 shared

Education

• Ph.D., Epidemiology

  Johns Hopkins Bloomberg School of Public Health

• Other, Biostatistics

  Johns Hopkins Bloomberg School of Public Health

• Other, Epidemiology

  Columbia University Mailman School of Public Health

• Other, Epidemiology

  University of North Carolina Gillings School of Global Public Health