The Survey of the Health of Wisconsin (SHOW) Program: An infrastructure for Advancing Population Health Sciences in the 21st Century

PurposeThe Survey of the Health of Wisconsin (SHOW) was established in 2008 by the University of Wisconsin (UW) School of Medicine and Public Health (SMPH) within the Department of Population Health Sciences with the goals of 1) providing a timely and accurate picture of the health of the state residents; and 2) serving as an agile resource infrastructure for ancillary studies. Today SHOW continues to serve as a vital population health research infrastructure supporting studies examining interactions of multiple social determinants of health in the prevalence and etiology of multiple chronic diseases across the life-course. Detailed questionnaire, physical exam and wearable data combined with an extensive biorepository supports translational and multi-omics research to better understand how life experiences and exposures contribute to health disparities and aging processes in a diverse urban and rural population. ParticipantsSHOW currently includes 5,846 adult and 980 minor participants recruited between 2008-2019 in four primary waves. WAVE I (2008-2013) includes annual statewide representative samples of 3,380 adults ages 21 to 74 years. WAVE II (2014-2016) is a triannual statewide sample of 1957 adults age 18 years and over, and 645 children residing in 10 randomly selected counties. WAVE III (2017) consists of follow-up of 725 adults from the WAVE I and baseline interviews of 222 children in selected households. WAVES II and III include stool samples collected as part of an ancillary study in a subset of 784 individuals. WAVE IV includes geographically focused samples recruited from Milwaukee county, WI, focusing on recruitment of traditionally under-represented populations in biomedical research including African Americans and Hispanics. The WAVE IV samples consist of 517 adults and 113 children. Findings to DateThe ongoing cohort is geographically, racially and metabolically diverse. The core study provides applied public health practitioners data for monitoring population health and policy development. Blood, urine and DNA, along with questionnaire data, were collected in all WAVES. WAVES II - IV include accelerometry-based physical activity and sleep, and expanded biomarkers to whole blood RNA collection with ancillary support of microbiome samples in a subset. Over 59 publications have been written and cover a broad range of topics including the impacts of altered metabolic health on chronic disease prevalence, urban and rural disparities in food security and cardio-metabolic disease, differential impacts of smoking on gene expression among obese and non-obese and lead exposures associate with increased multi-drug resistance and altered gut dysbiosis. Future PlansThe SHOW cohort is available for continued longitudinal follow-up including biospecimen collection for advancing novel biomarker and microbiome research. During the 2020 COVID-19 pandemic, SHOW is maintaining the cohort through web-based surveys of health impacts and conducting serological antibody testing among WAVE II and WAVE IV participants. The biorepository includes over 210,000 DNA, plasma, serum, urine, whole blood DNA, whole blood RNA and stool for future unspecified research. Data are available upon request. Article SummaryO_ST_ABSStrengths and limitationsC_ST_ABSO_LIThe Survey of the Health of Wisconsin (SHOW) is an infrastructure to advance population health sciences including biological sample collection and broader data on individual and neighborhood social and environmental determinants of health. C_LIO_LIThe extensive data from diverse urban and rural populations offers a unique study sample to compare how gradients of socio-economics shape health determinants in different contexts. C_LIO_LIThe objective health data supports novel interdisciplinary research initiatives and is especially suited for research in causes and consequences of environmental exposures (physical, chemical, social) across the life course on metabolic health, immunity, and aging related conditions including cardiovascular disease. C_LIO_LIThe extensive biorepository supports novel omics research into common biological mechanisms underlying numerous complex chronic conditions including inflammation, oxidative stress, metabolomics, and epigenetic modulation. C_LIO_LIAncillary studies, such as the Wisconsin Microbiome Study, have expanded the utility of the study to examine human susceptibility to environmental exposures and opportunities for investigations of the role of microbiome in health and disease. C_LIO_LILong-standing partnerships and recent participation among traditionally under-represented populations in biomedical research offer numerous opportunities to support community-driven health equity work. C_LIO_LINo biological samples were collected among children. C_LIO_LIThe statewide sampling frame may limit generalizability to other regions in the United States. C_LI