Ohio State College of Public Health Spring Magazine 2016 by OSUPublicHealth

Global Significance. Local Impact.

OHIO STATE

SPRING 2016

COLLEGE OF PUBLIC HEALTH

IN THIS ISSUE

Addiction Endgame Burden of Tobacco Use Preschoolers Who Eat Veggies Just as Likely to Eat Junk Workplace Intervention for Diabetes Prevention Tales from a Quarintine Station

The Ohio State University College of Public Health

TABLE OF CONTENTS MESSAGE FROM THE DEAN

COVER STORY Addiction Endgame The 21 Trend Practice What You Research

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F E AT U R E S Preschoolers Who Eat Veggies Just as Likely to Eat Junk Workplace Intervention for Diabetes Prevention NEWS Research and News Briefs Culminating Project Results in Grant Passion: the Heart of Your Career 2015-16 College of Public Health General Scholarship Recipients Health Services Management and Policy Alumni Society Awards Class Notes Tales from a Quarantine Station

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Editorial Staff Tessie Pollock, Director of External Relations Colleen Herr, Communications Coordinator Alex Plaster, Communications Student Intern Steve Barrish, Alumni Affairs and Outreach Coordinator Misti Crane, University Communications K2Studios, LLC, Lisa Klancher Photo Credits Administration William J. Martin II, MD Dean for the College of Public Health Michael Bisesi, PhD Senior Associate Dean for Academic Affairs Christopher Weghorst, PhD Associate Dean for Research Pamela Salsberry, PhD Associate Dean for Outreach and Engagement Ann Florentine Assistant Dean for Finance and Administration Qinghua Sun, MD, PhD Assistant Dean for Global Public Health Division Chairs Biostatistics: Rodney Sturdivant, PhD (Interim) Environmental Health Sciences: Michael Bisesi, PhD (Interim) Epidemiology: Phyllis Pirie, PhD (Interim) Health Behavior and Health Promotion: Phyllis Pirie, PhD Health Services Management and Policy: Thomas Wickizer, PhD

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Message

from the Dean In my time as a physician and pulmonologist I have come to the conclusion that in the 20th century there have been two public health interventions which are so broad and so critically important, they have changed lives beyond the scale of any other campaign. The first is vaccine use and the second is tobacco cessation. The global burden of tobacco use and second-hand smoke is clear. Tobacco use is the largest preventable cause of death worldwide. It is estimated that more than 6 million people die every year from tobacco use, and that this growing toll will lead to more than a billion deaths in the 21st Century.1 In Ohio, 23.3 percent of adults (over 2 million) are current smokers. Of these people, about 1.6 million smoke every day.2,3 Health care costs directly associated with smoking have been estimated to total $5.64 billion annually in Ohio alone. Of this number, $1.4 billion is covered by the state Medicaid program.4 What is remarkable about tobacco is the impact on public policy. When people recognized the threat of exposure to environmental and second-hand smoke and the impact it had on their health and the health of their children, it drove public policy in the United States. Tobacco-free environments started with airlines and restaurants then migrated to public buildings. Now we even have tobacco-free standards for outdoor spaces, like the model policy here at The Ohio State University. These changes have been a powerful drive to de-normalize tobacco use; to help people on a daily basis decide that they donâ&#x20AC;&#x2122;t want to be a smoker anymore. We are changing the culture of tobacco use.

The global burden of tobacco use and second-hand smoke is clear. Tobacco use is the largest preventable cause of death worldwide.

The College of Public Health at Ohio State has the good fortune to have a national leader in tobacco research. Mary Ellen Wewers, PhD, and the entire Center of Excellence in Regulatory Tobacco Science (CERTS) team are championing a new generation of scientists focused on tobacco regulation. I am proud of their accomplishments over these past two and a half years and I look forward to even more outstanding and impactful work over the next few years. 1. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006; 2. Centers for Disease Control and Prevention, Behavior Risk Factor Surveillance System, Year 2012. William J. Martin II, MD Dean and Professor College of Public Health

3. U.S. Census Bureau, Statistical Abstract of the United States: 2012 (131st Edition) Washington, DC, 2011. 4. The Toll of Tobacco in Ohio, Tobacco Free Kids, 2014.

ENDGAME There’s a science behind tobacco addiction and a psychology to the marketing. For decades tobacco companies have been leaps and bounds in front of evidence-based regulation, but now the FDA and researchers at Ohio State are leveling the playing field, even as new products come into play. In the 50 years since the US Surgeon General issued the landmark report on the adverse health consequences of smoking and tobacco, public health has fought feverishly to go beyond preaching the benefits of being a quitter; to find the reasons the body

and the mind start – and don’t want to stop – using tobacco. The work continues every day in the College of Public Health (CPH) and by its researchers embedded in diverse communities across the state.

The death toll attributable to tobacco is staggering. “Tobacco consumption continues to be the number one cause of premature disability and death in the U.S.,” said Mary Ellen Wewers, PhD, professor emerita in the CPH Division of Health Behavior and Health Promotion. “The death toll attributable to tobacco is staggering.” Wewers co-leads The Ohio State University Center of Excellence in Regulatory Tobacco Science (OSU-CERTS) with oncologist Peter Shields of Ohio State’s Comprehensive Cancer Center. The two serve as co-principal investigators for the $18.7 million federal grant which funds the Center and its tobacco research. “We are composed of faculty members, staff and students who approach the burden of tobacco from multiple perspectives. We rely on epidemiological research, studies of human behavior surrounding nicotine dependence, investigations of environmental exposures that include active and passive smoking, health policy research regarding the regulation of tobacco products and sophisticated data analytic approaches that assist in understanding the impact of tobacco,” said Wewers.

GAME CHANGER In June 2009, President Barack Obama signed into law the Family Smoking Prevention and Tobacco Control Act granting the U.S. Food and Drug Administration (FDA) authority to regulate tobacco products. Along with the authority came huge opportunity- a chance to use the same science and psychology that tobacco companies had used for years to create a demand for their products to instead develop evidence-based policy recommendations to regulate tobacco. The National Institutes of Health (NIH) and the FDA then teamed up to establish 14 Tobacco Centers of Regulatory Science across the country to ensure tobacco regulations are based on sound and relevant scientific evidence. “FDA’s and NIH’s tobacco regulatory science initiative is an ideal setting to demonstrate the importance of bridging the gap between science and law,” said Micah Berman, JD, assistant professor of health services management and policy.

FAMILY SMOKING PREVENTION AND TOBACCO CONTROL ACT The act gives the FDA power to: l Require tobacco companies to submit ingredients lists for any product sold or imported to the United States l Require tobacco companies to make public the nicotine content of their products, to adopt standards of nicotine content and to reduce or eliminate other harmful substances present in their products l Enlarge warnings on tobacco packaging l Prohibit the use of any health-related claims, including use of the terms “mild” and “light,” without prior review and authorization by the FDA l Create a Tobacco Products Scientific Advisory Committee to help inform the FDA on issues

According to Berman, it is critical for attorneys and scientists to work together from the beginning of the process. That ensures research that could impact policy is conducted with regulatory structure and relevant legal doctrines in mind. Berman and co-author2 Annice Kim point to the example of tobacco marketing in stores where products are sold, the point-of-sale (POS). Because tobacco companies spend almost their entire marketing budget at the POS (about 95 percent), making imposing evidence-based restrictions on tobacco promotions could discourage use. However, if the research is not conducted without anticipating legal challenges in the real world, the implemented change could quickly go away (e.g. as the result of a lawsuit from tobacco companies claiming their First Amendment rights were violated).

one in five

current cigarette smokers use e-cigarettes

SELLER’S MARKET NO MORE Other important POS research conducted through CERTS focuses on who is being targeted. Postdoctoral researcher Megan Roberts, PhD recently led a study looking at how tobacco marketing outside of stores differs based on community-level demographics in Ohio (such as population density, economic-disadvantage, and race/ethnicity). She and her colleagues found that promotions for e-cigarettes and advertising for menthol cigarettes, cigarillos and cigars were more prevalent in communities with a higher percentage of African-Americans. Cigarillo advertising was more likely in high-disadvantage Columbus communities. Furthermore, a greater variety of products were advertised outside retailers in high-disadvantage, African-American communities in Columbus. “These findings suggest the tobacco industry is engaging in differential marketing at the retail point-of-sale, which disproportionately targets urban, high-disadvantage and African American communities,” said Roberts. “We believe our results point to a need for policies that will help improve equity and reduce health disparities.” Addressing disparities is a huge part of the tobacco research at OSU-CERTS and across the country. Regulation can impact communities differently, and often times policy is not a one-size-fits all. “When we initially discussed the OSU-CERTS 4

products, including little cigars, hookah and electronic cigarettes, in both urban and rural areas.”

A NEW PLAYBOOK

Tobacco advertising markets electronic cigarettes with “Helps You Quit” ads proposal nearly four years ago, it was clear to all of us that we needed to study tobacco use behaviors in both rural and urban regions,” said Amy Ferketich, PhD, professor of epidemiology at CPH. “The Buckeye Teen Health Study, a project in OSU-CERTS I work on, is focused, is focused on examining the influences of advertising and marketing on initiation of tobacco products, as well as transition to regular use, among adolescent males. For regulatory purposes, it is important to know if there are differences in exposures to advertising and marketing, as well as use of products, based on place of residence. Our research will answer novel questions related to use of alternative tobacco

In addition to differences in health outcomes across subgroups of the population, researchers also face the challenge of keeping up with a quicklychanging market. Cigarette smoking continues to decline while smokeless tobacco (ST) use is becoming more common, and trends indicate heightened concurrent use of cigarettes and ST, referred to as dual use. Among that trend: e-cigarettes. Smokers are even using e-cigarettes as a cessation aid, despite uncertainty about their efficacy. A recent Ohio State study1 found that among adult Appalachian smokers enrolled in a tobacco cessation treatment program, those that used e-cigarettes post-treatment were less likely to have quit smoking 12 months following the treatment program. “The study supports the growing findings that electronic cigarette use decreases the likelihood that a smoker will successfully quit. Despite such findings, approximately one in five current cigarette smokers use e-cigarettes,” said Elana Curry, an undergraduate public health student at Ohio State who analyzed data collected during the study and has submitted the results for publication. Her advisor is Mary Ellen Wewers. OSU-CERTS has successfully been awarded several pilot projects in addition

We are fortunate to have assembled a strong team of investigators who energize each other and are dedicated to stopping the tobacco epidemic in our lifetime. to the original four projects funded through NIH. In addition, OSU-CERTS was awarded a supplemental award for a project called “Tailoring and interactivity website features and their impacts on smoker’s knowledge.” To test this concept, an interdisciplinary team of researchers will work to test if websites with interactive and tailored features will help consumers better understand the list of harmful ingredients. The FDA has identified 93 harmful or potentially harmful ingredients that can come from cigarettes and secondhand smoke. However, many of those ingredients have long, complicated, scientific names unfamiliar to most consumers. In addition to providing easy-to-understand content for the website, researchers will also use eye-tracking technology to determine which information and aspects consumers pay attention to most frequently. “Our study aims to better understand the best practices for teaching consumers about technical health information online,” said Liz Klein, PhD,

associate professor of health behavior and health promotion. “The ultimate goal is for improved consumer comprehension and the ability to make more well-informed health decisions.” The supplemental research project began in September 2015 and will run for 12 months. To perform the research for this project, the team includes research expertise in tobacco control, epidemiology, health communications, biomedical informatics and biostatistics. The landscape of tobacco control changes rapidly,” said Wewers. “Our pilot projects have allowed us the flexibility to study topics ranging from the marketing of new tobacco products on social media to the emergence of e-cigarettes and how these products change the oral microbiome, human lung tissue, as well as the adolescent brain after viewing flavored tobacco product advertisements. We are fortunate to have assembled a strong team of investigators who energize each other and are dedicated to stopping the tobacco epidemic in our lifetime.”

The 21 Trend The FDA has identified 93 harmful or potentially harmful ingredients that can come from cigarettes and secondhand smoke.

Last spring, “Running the Numbers” a white paper addressing raising the minimum tobacco sales age to 21 debuted from Ohio State authors, Micah Berman, JD; Rob Crane, MD and Natalie Hemmerich, JD. In the months that followed, five cities in Ohio passed Tobacco 21 ordinances (Bexley, Cleveland, Grandview Heights, New Albany, Upper Arlington). As of December 2015, 107 cities in 9 states, and the entire state of Hawaii, have increased the legal minimum age for tobacco purchase to 21. Across Massachusetts, 80 cities passed Tobacco 21 ordinances. Hawaii is the first Tobacco 21 state. Information from tobacco21.org. 5

CERTS PROJECTS P R OJEC T 1

Tobacco Marketing and Youth Initiation P R OJEC T 2

Biomarkers in Adolescents P R OJEC T 3

Diversity of Tobacco Products P R OJEC T 4

Maximizing Health Risk Understanding P I LOTS

Maximizing Health Risk Understanding: Appalachian Sample Effects of ENDS on the Oral Microbiome Online E-Cigarette Advertising Study Functional Neuroimaging Effects of E-cigarettes on Lungs Read more about each CERTS project, the research team and funding at cph.osu.edu/certs

ARTICLES AND ABSTRACTS 1. Association between Electronic Cigarette Use and 12-month Tobacco Abstinence among Adult Appalachian Smokers Enrolled in a Tobacco Cessation Trial E. Curry, J. Nemeth PhD, A. Wermert MPH, N. Hood PhD, S. Conroy MS, Amy Ferketich PhD, Abigail Shoben PhD and M.E. Wewers PhD. The Ohio State University College of Public Health. 2. Bridging the gap between science and law: the example of tobacco regulatory science. Berman M.L., Kim A.E. J Law Med Ethics. 2015 Spring; 43 Suppl 1:95-8. 3. Point-of-Sale Tobacco Marketing in Rural and Urban Ohio: Could the New Landscape of Tobacco Products Widen Inequalities? Roberts, M.E., Berman, M.L., Slater, M.D., Hinton, A., Ferketich, A.K. Prev Med. 2015 Dec; 81:232-5. What predicts early smoking milestones? Roberts M.E., Colby S.M., Jackson K.M. J Stud Alcohol Drugs. 2015 Mar;76(2):256-66. With Others or Alone? Adolescent Individual Differences in the Context of Smoking Lapses. Roberts M.E., Bidwell L.C., Colby S.M., Gwaltney C.J. Health Psychol. 2015 Feb 9. Adolescent social networks: general and smoking-specific characteristics associated with smoking. Roberts M.E., Nargiso J.E., Gaitonde L.B., Stanton C.A., Colby S.M. J Stud Alcohol Drugs. 2015 Mar;76(2):247-55. Does Size Impact Attention and Recall of Graphic Health Warnings? Klein E.G,, Shoben A.B,, Krygowski S., Ferketich A,K, Berman M.L., Peters E., Rao U., Wewers M.E. Tobacco Regulatory Science. 2015 1(2):175-185. A Content Analysis of Electronic Cigarette Portrayal in Newspapers. Yates, K., Friedman, K., Slater, M., Berman, M.L., Paskett, E., Ferketich, A. Tobacco Regulatory Science. 2015 1(1), 94-102. Validation of a respiratory symptom questionnaire in adolescent smokers. Cassidy, R.N., Roberts, M.E., Colby, S.M. Tobacco Regulatory Science. 2015 1(2), 121-128. Providing a Science Base for the Evaluation of Tobacco Products. Berman M.L,, Connolly G,, Cummings K.M., Djordjevic M.V., Hatsukami D.K., Henningfield J.E., Myers M., O’Connor R.J., Parascandola M,, Rees V,, Rice J.M., Shields P.G. Tobacco Regulatory Science. 2015 Apr;1(1):76-93. Review of the Literature on Prevalence of Gender Differences and Intersections with Other Vulnerabilities to Tobacco Use in the United States, 2004-2014. Higgins, S.T., Kurti, A.N., Redner, R., White, T.J., Gaalema, D.E., Roberts, M.E., Doogan, N.J., Tidey, J.W., Miller, M.E., Stanton, C.A, Henningfield, J.E., Atwood, G. A. Prev Med. 2015 Jun 26.

The research reported in this publication is supported by NIH and FDA Center for Tobacco Products (CTP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration. 6

Practice What You Research The Ohio State University has adopted a tobaccofree policy that supports a healthy environment for all members of the Buckeye Nation. The use of all types of tobacco products is prohibited in all university buildings and on all university-owned properties, including parking lots, garages and all outside areas. Many of Ohio State’s peer institutions also made this move – The Universities of Florida, Michigan, Maryland, Penn State and Minnesota are among those. However, Ohio State continues to be a model for institutions who are adopting their own tobacco-free policies (in Ohio and beyond). Because Ohio State removed exemptions last year (including the Schottenstein Center), the University now meets the stringent requirements to be listed by the American Nonsmokers’ Rights Foundation (ANRF). The U.S. Department of Health and Human Services (HHS) created the Tobacco-Free College Campus Initiative to promote and support the adoption and implementation of tobacco-free policies at universities, colleges, and other institutions of higher learning across the United States. Ohio State already earned their Silver Award and is currently under review for the Platinum Plus Campus Award, the highest recognition by the organization.

Learn more at tobaccofree.osu.edu.

Preschoolers Who Eat Veggies Just as Likely to Eat Junk Public health experts have long expected that kids who eat more carrots and apples are less likely to eat a lot of candy and fries, but new research is calling that into question.

Preschoolers from low-income neighborhoods in Columbus who ate fruits and vegetables and drank milk many times every day were just as likely to eat foods high in sugar, salt and fat as those who rarely ate healthy foods, found a research team led by Sarah Anderson, associate professor of epidemiology at Ohio State’s College of Public Health. “We assumed that children who ate a lot of healthy foods would also be children who did not eat a lot of unhealthy foods,” Anderson said. “I just thought that was the way the world was and it turned out not to be the case.” When she and her colleagues looked for connections, studying their data in multiple ways, they found zero link. It’s too soon to call for policy changes based on this work alone, the researchers said. A larger national study is underway. But if replicated on a larger scale, the surprising discovery could

lead to the reframing of conversations about how to improve children’s diets and lower rates of childhood obesity, the researchers said. Instead of assuming a strategically located farmer’s market, for instance, will by default mean kids in the neighborhood eat less food high in fat, sugar and salt, policy makers might want to also consider emphasizing the downsides of those choices. “This suggests that we have to have two conversations,” said co-author Phyllis Pirie, professor of health behavior and health promotion at Ohio State.

“There has been a kind of assumption that if you encourage people to adopt healthy eating that it naturally leads to a decline in unhealthy eating,” Pirie said. “Efforts to lower childhood obesity rates often focus on adding ‘good’ foods, rather than on avoiding ‘bad’ foods,” she said. Trained interviewers met with parents or guardians of 357 children 2 to 5 years old and asked them to recall how often

Parents of 357 children 2 to 5 years old recalled how often the children ate certain foods in the past week.

1/2 ate fruit two or more times a day 1/3 had vegetables multiple times a day Most drank milk at least once a day 29% had not eaten fast food

the children ate certain foods in the past week. About 60 percent of the children were black and almost all were Medicaid recipients. Almost half were not in child care – a higher percentage than in the general U.S. population. The research team asked them about the children’s diets and categorized foods and drinks into healthy and unhealthy categories. Healthy choices included fruits, vegetables and milk. Unhealthy choices included sweetened drinks, fast food, sweets and salty snacks. Regardless of age, there was no evidence kids who frequently ate fruits, vegetables and drank milk were any less likely to partake in the unhealthy foods. The study appeared in the December 2015 issue of the Maternal and Child Health Journal. Anderson and her colleagues were surprised to find that this conventional 8

assumption had not been well tested and didn’t hold up in this study. This research doesn’t mean parents and policy makers should give up efforts to increase intake of more nutritious foods, she said. But it does challenge the idea that good automatically replaces bad. Anderson compared the discovery to previous research showing that a person can at once be both very active and highly sedentary. Just because you run marathons on the weekend doesn’t mean that you don’t sit in a desk chair most of your waking hours during the work week. About half the children in the study ate fruit two or more times a day. Some rarely ate vegetables, but more than a third had them multiple times a day. Most of the children drank milk at least once a day. In the week prior to the interview with a parent or guardian,

only a third of the children did not drink sugar-sweetened beverages including soda pop and 29 percent had not eaten fast food. The study was conducted in 2012 and 2013 as part of a larger project supported by the Centers for Disease Control and Prevention. A larger-scale study looking at how this plays out in a more-diverse group of children throughout the U.S. is underway. Other Ohio State researchers who worked on the study were Gail Kaye, assistant professor of clinical public health; Rebecca Andridge, assistant professor of biostatistics; Carol Smathers, assistant professor of health behavior and health promotion; and Juan Peng, biostatistician.

WORKPLACE INTERVENTION FOR DIABETES PREVENTION A recent Ohio State Study shows the workplace can provide an ideal setting for identifying employees with prediabetes and reduce the risk for diabetes through effective wellness programs. The study, published in a Centers for Disease Control and Prevention journal, found that employees enrolled in a workplace intervention program as a group lost more weight than employees who received only written health guidelines for diabetes prevention. The College of Public Health’s faculty emeritus, Raj Nagaraja, PhD, served as biostatistician on the NIH grant which funded the study. The study used data collected from a pretest-posttest control group made up of individuals with prediabetes from a university workplace. The group was divided into two groups; one received a 16 week lifestyle intervention and one, the control group, received usual care from their health care provider and were given a booklet describing strategies for self-regulated weight loss. Participants in the intervention group met for 60 minutes a week. Dietitians trained in intervention implementation served as lifestyle coaches for the group. Participants were encouraged to set small goals each week and engaged in group discussion to foster skill development and social support. There was an average weight loss of 5.5 percent in participants who took part in more group discussion sessions and who carefully monitored their food and physical activity whereas there was hardly any weight reduction in the control group. This is important because weight loss is the primary way to prevent type 2 diabetes from developing.

This was one of few studies to evaluate the impact of a lifestyle intervention designed for employees with prediabetes delivered at the worksite. “This was one of few studies to evaluate the impact of a lifestyle intervention designed for employees with prediabetes delivered at the worksite. Few worksite programs are designed to address the needs of people with prediabetes; most are general wellness programs. We found that it is feasible to offer an effective lifestyle intervention at the worksite,” says Carla Miller, who is the lead author of the study and a professor of human nutrition at The Ohio State University. Read the full article in the Centers for Disease Control journal, Preventing Chronic Disease.

ENVIRONMENTAL HEALTH SCIENCES In utero B(a)P Exposure Induces Behavioral Learning Deficits Darryl B. Hood, PhD, associate professor of environmental health sciences, along with researchers from both Meharry Medical College and Auburn University, recently discovered that children’s ability to learn may be negatively affected by the environment as early as in utero. Hood and colleagues found that when rats are exposed to Benzo(a)pyrene (B(a)P) in the environment while still in utero produces deficits in spatial discrimination reversals in the offspring during late adolescence. They chose to measure spatial discrimination reversal procedure because it reflects the brain’s ability to learn. Overall, they found that exposure to environmental contamination while in utero can produce long lasting negative effects on circuits of neurons that impact behavioral learning. B(a)P is a member of a class of compounds known as polycyclic aromatic hydrocarbons (PAHs). PAHs are primarily by-products of incomplete combustion. These combustion sources are numerous, including natural sources such as wildfires, industrial processes, transportation, energy production and use, food preparation, smoking tobacco and disposal activities such as open trash burning.

BIOSTATISTICS New RO1 Supports Development of Better Patient Outcome Analysis Method Bo Lu, associate professor of biostatistics, recently received an R01 award from the Agency for Healthcare Research and Quality (AHRQ) for a project titled “Causal inference for treatment effect using observational healthcare data with unequal sampling weights.” Lu is teaming up with Huiyun Xiang, MD, MPH, PhD, and professor of medicine from Nationwide Children’s Hospital to develop a new method that can help healthcare leaders determine if their policies and practices are really improving outcomes.

The proposed study will achieve four specific aims: (1) Develop a potentialoutcome-based theoretical framework to streamline causal inference in complex surveys. (2) Develop both propensity score and survey design adjusted estimators, including weighted, stratified and matched estimators. (3) Conduct extensive simulation studies to evaluate the performance of various estimators under different practical scenarios and develop a statistical software package for practitioners. (4) Apply the proposed methodology to a real survey for comparative trauma care research. This study is expected to fill a critical gap in healthcare policy and treatment effect evaluation research by extending the commonly used propensity score adjustment for non-survey data to complex sampling designs. Findings of this study will help promote AHRQ’s mission to produce more accurate evidence for health care program evaluation and to improve the current practice of comparative health outcome research.

EPIDEMIOLOGY Vitamin D and Brain Tumor Risk Three Division of Epidemiology graduate students are co-first authors on a study of vitamin D blood levels and the risk of brain tumors. Their study of 1,704 serum samples, collected on average 15 years before brain tumor diagnosis and stored in the Janus Serum Bank in Oslo, Norway, suggests that vitamin D reduces brain tumor risk in older men. There was no evidence of a similar effect among older women or younger men or women. Co-author, Randall Harris, PhD, professor of epidemiology at Ohio State, is an expert on the role of anti-inflammatory medication and cancer prevention. Harris notes that vitamin D has antiinflammatory effects. Brain tumors progress by suppressing anti-tumor immunity, thus vitamin D’s immuneregulatory role may account for the non-significant positive association between vitamin D blood levels and brain tumors observed among younger men and women. This study was the first to examine the association between vitamin D and brain tumor risk. Future research will attempt replication of the findings and examine the vitamin D- brain tumor association by pre-diagnostic hormone levels and brain tumor type.

HEALTH SERVICES MANAGEMENT AND POLICY

GLOBAL HEALTH Ten Steps to Successful Breastfeeding in DR Congo A United States initiative to increase breastfeeding rates could have universal impact. Marcel Yotebieng, assistant professor in Ohio State’s College of Public Health Division of Epidemiology, recently led a trial of Ten Steps to Successful Breastfeeding in the Democratic Republic of the Congo.

Academy of Management Honors CPH Professor

HEALTH BEHAVIOR AND HEALTH PROMOTION Learning from Service College of Public Health graduate students have the opportunity to take a class, Public Health in Action, where they step outside the classroom and experience firsthand the public health struggles facing the community.

Researchers believe that increasing exclusive breastfeeding for children in the region could have a significant impact on their health through age 5. Implementation of the Ten Steps to Successful Breastfeeding, the key component of the UNICEF/WHO Baby-Friendly Hospital Initiative (BFHI) has been the main strategy to improve breastfeeding practices worldwide. However, successful implementation of BFHI is challenging in many resource-poor countries because the final step calls for the “establishment of breastfeeding support groups and referring mothers to them on discharge from a hospital or clinic.” In this study, researchers assessed a short-cut implementation without step ten. The paper states that a large-scale implementation of steps one through nine could possibly help reduce mortality in children younger than five years. Additionally, results show that the training provided for the health professionals in steps one through nine was associated not only with a rise in “optimum breastfeeding,” but also a significant reduction of diarrhea in infants. Although there is already a great number of women who breastfeed in the area, the Ten Steps resulted in more children who were exclusive breastfeeding at 6 months of age.

In addition to in-class experience, students are required to complete 40 hours of field work at Neighborhood Food Services, Inc. (NSI) in Weinland Park which provides food services and material assistance to those in need. Students work with NSI director, Martin Butler, who trains, manages and assigns tasks to the student workers. “We want students to come in and see the difference that we are making at the edge of poverty, help us ‘hold the line’ and then graduate and continue to make changes that will ultimately help everyone. This approach brings the reality of what is read or discussed in class into sharper focus, because the students get to see it being lived out,” said Butler.

Multiple honors have been bestowed on College of Public Health professor Brian Hilligoss. The Health Care Management (HCM) Division of the Academy of Management recognized Hilligoss’s paper, which he presented at this year’s Academy of Management Annual meeting, with the “Best Theory to Practice” award. Hilligoss’s paper titled, “Aligning for Accountable Care: Strategic Practices for Change in Accountable Care Organizations?” was recognized by the HCM Review. This is not the first time his work has been recognized by HCM. In 2013 Hilligoss was recognized by HCM for HCM Division Outstanding Paper Based on a Dissertation. He was also elected academic-at-large by the HCM Division of the Academy Management. As an elected academic-atlarge, Hilligoss is now a part of the HCM leadership team. The purpose of this leadership team “is to provide a forum for the presentation of research and to provide an opportunity for interaction among professionals with interests in research and practice of management in the health services industry.” HCM is a global enterprise that promotes the use of technology in the health care landscape as a way to maintain and transform relationships not only between doctors and patients but also between professionals across the greater health care field.

Culminating Project Results in Grant A $35,000 grant was recently awarded to the Moms2B program by the Columbus Medical Association Foundation as a result of a culminating project completed by Masters of Public Health student, Anne Taylor, MD. Taylor’s interest in working with Moms2B, an organization focused on serving expectant mothers in high-risk communities, began when Dr. Patricia Gabbe, founder of Moms2B, spoke to one of her classes about Ohio’s high infant mortality rate and the newly-established Moms2B program. “Dr. Pat touched my heart and inspired me to get involved with the organization,” said Taylor. “My children and I began picking up food donated by the MidOhio Food Bank and packing it up for the moms and their families.” When the time came for Taylor to do her culminating project, she asked Gabbe and other program leaders what she could do to help. Brandy Warne, a mental health social worker at Moms2B indicated that moms in the program still struggle with their emotional health and wellbeing.

Mental health has long been overlooked as a factor in overall wellness of a pregnant woman... “While we provided weekly mental health education and support, we still had moms requesting additional support, but only 20 percent would follow through with individual counseling with outside agencies,” said Warne. “A lot of the moms reported feeling uncomfortable with counselors because of bad prior experiences or feeling that they couldn’t trust another agency like they trusted Moms2B.” 12

As a result, Taylor wrote a grant for her culminating project to provide focused, individual counseling and group therapy for the mothers with the hope of reducing their levels of anger and anxiety in order to improve their overall health and pregnancy. Following the counseling provided by Moms2B, they will then be referred to longer term assistance focused specifically on their individual stressors.

“Mental health has long been overlooked as a factor in overall wellness of a pregnant woman, and only recently has it obtained some recognition of the important role it plays in both maternal and fetal health,” said Taylor. By providing counseling resources, mothers are more likely to experience a healthy pregnancy and full term delivery of a healthy child.

PASSION: the Heart of Your Career Matthew Ritchey, PT, DPT, OCS, MPH, is a Senior Epidemiologist with CDC’s Division for Heart Disease and Stroke Prevention. Dr. Ritchey’s research focus is on national-level cardiovascular health projects, including Million Hearts®. He previously worked with CDC’s Division of Population Health on efforts to build sustainable capacity for chronic disease and injury epidemiology within the Indiana State Department of Health. Prior to that, he served as a field-based epidemiologist in CDC’s Epidemic Intelligence Service fellowship, where he led multiple state and local acute and chronic disease surveillance and disease outbreak management activities. He received a Master of Public Health degree from The Ohio State University in 2007. The College of Public Health grad shares a key takeaway of the CDC’s Million Hearts initiative:

Why is the Million Hearts® initiative so important for our country’s health? Heart disease and stroke are the first and fifth leading causes of death in the United States. Million Hearts® brings together key partners who are needed to improve population health and implement proven, effective, and inexpensive interventions that decrease the burden of cardiovascular disease. This five-year initiative set an ambitious goal of preventing 1 million heart attacks, strokes, and other related events by 2017. It’s linking traditional public health with the health care sector. We can see where the synergy exists. We’re coming together and informing this collaboration which can save lives.

What’s the most important takeaway from Million Hearts to improve our health? We all need to focus on the ABCS of heart health. Aspirin: use when appropriate. Blood pressure control: only about half of Americans who have hypertension have their blood pressure controlled. Cholesterol management. Smoking cessation: tobacco use is a big risk factor for developing cardiovascular disease.

How did Ohio State prepare you for your career? My experience in the College of Public Health Program for Experienced Professionals (PEP) was wonderful. The flexibility

of the program allowed me to keep my career at Cincinnati Children’s Hospital Medical Center and come to Columbus to do coursework over long weekends. Within my cohort, we had many people with considerable public health experience, or people like me, with clinical experience. It resulted in rich discussions in class. We were able to hear and understand different perspectives, and that’s valuable when you move outside the classroom into your work life.

What advice do you have for students and other young alumni? Make sure you take some time to be introspective. You need to understand where your passion lies. In public health there are lots of opportunities to figure out where that passion will best serve: whether it’s at the grassroots, state or national level. Take full advantage of opportunities to explore working in each of those types of environments. If you do, it will be personally enriching and make you a better overall public health professional. As your career progresses, you will find that those prior experiences, even if they aren’t directly related to the role you are currently working in, will provide you with the diversity of skills and knowledge needed to best address any public health problem you are presented with.

How’s life down south at CDC headquarters?

Even though I live in Georgia--SEC country--I’m still a Buckeye. If you yell O-H around Atlanta you can usually get an I-O!

CONGRATULATIONS

to the 2015-16 College of Public Health General Scholarship Recipients Tonni Blount

Master of Public Health, Health Behavior and Health Promotion specialization Tonni is expected to graduate in the spring of 2016. After graduation she would like to become a community health educator. She especially wants to work with the African American community to find solutions to reduce the disparity in infant mortality.

“Receiving this scholarship is an honor. It not only helps me financially, but will also contribute to my ability to focus on my studies and gain the skills to help others.” Melody Maxwell

Master of Public Health, Veterinary Public Health specialization Melody completed a number of internships with the US Department of Agriculture, Food and Drug Administration, and Centers for Disease Control. She also was awarded a Boren Fellowship with PANAFTOSA (PAHO/WHO) in Brazil. After her expected graduation in the summer of 2016, Melody would like to continue to work internationally as a veterinary public health professional.

“This scholarship means a chance to seek my dreams with a smaller loan burden at the end. While I appreciate the scholarship and opportunities now, the ability to continue to sustain a good life once I begin repaying my loans is equally as important.” Amanda Smith

Master of Public Health, Veterinary Public Health specialization Amanda has both domestic and international volunteer experience having participated in service trips to Thailand and Costa Rica as well as volunteering locally with the Franklin County Medical Reserve Corps. After her expected graduation in the spring of 2016, Amanda would like to gain work experience in the field of veterinary public health prior to pursuing a PhD in epidemiology with a specialization in zoonotic diseases.

“Obtaining a scholarship from the College of Public Health is not only allowing me to meet my ultimate goals faster, but is helping me to help others.”

Barret Zimmermann

Master of Health Administration + Master of Public Health, Health Behavior and Health Promotion specialization Barret is working towards a dual Masters of Health Administration and Public Health. Her volunteer experiences include direct outreach to sex workers in Washington, D.C. and work with the AIDS Resource Center in Columbus. Barret expects to graduate in the spring of 2017 and has interest in working for a Federally Qualified Health Center or large health system where she hopes to embed health promotion practices within the health care delivery system.

“This is the ideal setting to continue my commitment to, and enrich my passion for, health promotion and health care, while granting me the opportunity to wholeheartedly pursue a career merging the two fields. Without the scholarship support I have received through the College of Public Health, I may not have been able to pursue both degrees.” 14

Kate Friedman

Bachelor of Science in Public Health, Sociology specialization Kate has a broad spectrum of service learning experience. She’s mentored at-risk elementary school kids, interned at University Hospitals in Cleveland and at OSU’s Center of Excellence in Regulatory Tobacco Science through their summer undergraduate internship program. Kate expects to graduate in the spring of 2017 and aspires to pursue a Master of Science in Public Health degree.

“I am so honored to receive this scholarship. With this generous gift I will be able to finish college with fewer loans, allowing me to donate more of my time and resources to helping to make a positive impact through my work in public health. I have learned so much and had such an amazing time at Ohio State and this scholarship is a reminder of how many people have helped me get to where I am now.”

“I’m honored to be receiving this scholarship. It will help me to continue to follow my dreams and to finish my undergraduate degree. Paying for college is a daunting task, but scholarships such as this help significantly!”

Rachel Hardin Bachelor of Science in Public Health, Sociology specialization Rachel has worked with organizations such as Buckeyes for Public Health and Buck-I-SERV to promote men’s and women’s health, reproductive health and safe living conditions on campus and across the country. She has also coordinated volunteers and led projects for the Appalachia Service Project working towards improved safety and living conditions for residents in impoverished areas of Central Appalachia. After graduation this spring in 2016, Rachel would like to start her career with a local health department or non-profit organization.

Celia Wright Bachelor of Science in Public Health, Sociology specialization Celia served as the President of Undergraduate Student Government from 2014-2015, during which she worked to address many public health concerns (campus sexual assault, affordable and healthy meal plans, campus bike share, and the Mirror Lake Jump). She also completed a student internship with the Office of Government Affairs and a two-year fellowship with the Pure Water Access Project. Celia graduated in winter 2015 with the BSPH degree and minors in Spanish and International Studies. She hopes to pursue a Master of Science in Public Health.

“I am incredibly thankful for the scholarship, since it assists the financially difficult academic route that I wish to pursue…I am both encouraged and grateful for the scholarship and will use the moral and financial boon to continue working wholeheartedly to fully realize the goals and dreams that I have set.” Alex Northrop Bachelor of Science in Public Health, Environmental Public Health specialization Alex has interned with the Cuyahoga County Board of Health in the environmental division conducting beach monitoring and testing for E. coli. Alex is minoring in international studies and has an interest in pursuing an MD and MPH after completing his undergraduate degree which is expected in the spring of 2018.

HSMPAS Banquet On November 6, 2016, Health Services Management and Policy Alumni Society honored outstanding individuals who have made significant impact on the program and society. Congratulations to the following 2015 award recipients:

ALAN BRASS DISTINGUISHED ALUMNI ACHIEVEMENT AWARD Kevin Johnson ‘90 ALUMNI SOCIETY SERVICE AWARD Janet Porter ‘77 CHAMPION OF DIVERSITY AWARD Fred Hobby HSMP STAFF AWARD Naomi Adaniya ‘15 HONORARY ALUMNI AWARD Marti Taylor PROGRAM SERVICE AWARD Tammie Hayes ‘94 YOUNG ALUMNI SERVICE AWARD Ali Ristas ‘13 YOUNG ALUMNI ACHIEVEMENT AWARD Lisa Sloane ‘07

Congratulations also to Avery Schumacher, recipient of the Bernard J. Lachner Scholarship in Health Services Administration. To learn more about this important scholarship fund, please visit cph.osu.edu/giving (search fund #603890). 16

Faculty Tenure and Promotion

MHA Student Success at Case Competition Four Masters in Health Administration students finished in second place at the 2015 National Association Health Services Executives (NAHSE) Case Competition in New Orleans. This marks the third time in four years that the program’s team has placed second at the competition. The team was comprised of Anton Johnson, Chris Kvale, Philip Weiss and Karan Rai. Alum and former Case Competition team member, Brandon Buchanan, MHA ’14 coached the team and MHA program director, Julie Robbins, served as faculty advisor. Ohio State students beat out 23 teams from around the country and were edged out only by a very strong team from the University of Michigan. The competition consisted of three rounds beginning with 25 teams and narrowing down to 10 and finally 5. The teams were judged by senior health system leaders from around the country. Each team had only three weeks to prepare for the complex case in which they were asked to make recommendations for Kaiser Permanente Georgia’s strategy for improving financial position and services to members in the Atlanta market. Our students recommended strategies for improving member access to services, enhancing care coordination for the highest utilizers and incentivizing in-network utilization. The team was fortunate to have support and encouragement of NAHSE Case Competition committee members Tamara Austin, MHA ’04, recipient of the 2015 Everett V. Fox Legend Award as well as Jessica Jolly, MHA ’13 and Isaac Aziramubera, MHA ’14, both previous Case Competition finalists. In addition to finishing in second place in the competition, Ohio State also received the “School Spirit” award for their active social media support during the event.

Liz Klein, PhD, MPH was awarded tenure and promoted to Associate Professor.

ClassNotes

Amber Vasquez, MHA ’15 is now an officer in the Epidemic Intelligence Service of the Center for Disease Control in Atlanta, Georgia. She is serving at the National Center for Emerging and Zoonotic Infectious Diseases. Erin Shaffer, MHA ’10 has moved from South Florida to Chicago to join the University of Chicago Medicine Heart and Vascular Center as executive director after five years with the Cleveland Clinic Foundation. Beth Walker MPH ’02 was recognized as one of “130 Women Hospital and Health System Leaders to Know in 2015” in Becker’s Hospital Review. Beth has been chief operating officer of Ochsner Medical Center in New Orleans since February 2013. She first joined the system in 2002 and has served in a variety of positions, including vice president of operations for women’s and children’s services.

If you have news to share, please contact Steve Barrish, alumni affairs and outreach coordinator at Barrish.2@osu.edu or 614-292-0297.

Tales from a

QUARANTINE STATION Jalisa Herron, MPH ’15 Bachelor of Science in Microbiology Masters of Public Health at The Ohio State University

Public Health is a very broad, all-encompassing field, which can pose a challenge to students choosing which public health path to take. Luckily, there are many current students, recent graduates and alumni who are eager to share their experiences to help others. Jalisa Herron, MPH ’15 tells about her unique job and how she got there. Herron earned both her Bachelor of Science in Microbiology and Masters of Public Health at The Ohio State University. Herron currently works at a quarantine station for the Centers for Disease Control and Prevention in Detroit. There she screens incoming immigrants’ medical health records watching for any public health concerns before they enter the United States. At the top of the list are Tuberculosis, Small Pox, Yellow Fever, Ebola, Cholera and many more. Other aspects of her job include working closely with Customs and Border Protection to monitor biohazard imports and illness response.

Herron’s experience in the Public Health Association Program (PHAP) led her to her current career at the quarantine station. During that time, WHO declared the West Africa Ebola Outbreak a Public Health Emergency of International Concern and there was a high demand for people at the main screening centers in the United States. Fellows were called to backfill the positions at the non-screening stations to ensure continued surveillance for other public health concerns. Shortly after her fellowship ended, she applied for a job at the quarantine station. Herron talks about her experiences.

“I thought ‘oh my goodness, this is the best opportunity that could happen.’” Weren’t you scared during the Ebola break out? I was not at all. I thought ‘oh my goodness this is the best opportunity that could happen. I am a recent graduate and I have the opportunity to help and assist during this outbreak of unfathomable magnitude that has never happened before.’ I knew that they had personal protective equipment (PPE), and as long as I was smart about what I was doing and I followed protocol, I would be fine. It definitely helps to think of the end goal, and that is to protect the public’s health. You can’t think about catching a cold every day because you’re around all of these germs. You go to work thinking, ‘I’m going to help protect thousands, if not millions of lives by making sure that we are not exposing these people to the diseases that are being brought over from other countries.’

What are some bizarre or interesting instances that you’ve dealt with? Before I came here, I hadn’t heard of a (body) cavity search. At some point, because we are federal officers here, if say someone is a female that needs to have a cavity search done, then I would be called into the room if no other female customs officers were there to make sure the female does not feel violated. Well, they’ve found drugs and all kinds of things in people. People will have to go in for chest x-rays… it is pretty bad. Another time there was an individual who is actually a researcher—a researcher at a very well-known institution. They had been caught several times bringing in biological substances and not declaring them to federal officers. Bringing in samples is fine as long as they are properly documented and do not pose a threat to the public’s health. But this person was bringing them in and hiding them. Sometimes they would hide them in their shoes. This last time, they took a book, and cut out the pages and put the samples in there. It almost had gone through without being detected but one of the officers was just having a really good day and said ‘I’m going to look through the book,’ and found the substances in there. He got a hefty fine, probably around $10,000.

Do you have any advice to students in the public health field? Don’t make yourself follow a certain path. Don’t write out ‘this is what I have to do and I have to do it at this time.’ You definitely want to have goals, because it’s something that will keep you trying to increase your knowledge and to be a better person. But allow yourself to go off the path a little bit. For example, say you want to do epidemiology, don’t be afraid to try health promotion. If you see an opportunity, don’t turn it down just because that’s not what you set yourself out to do. Be open to different opportunities that you otherwise wouldn’t have gone after.

The Ohio State University College of Public Health National Public Health Week

Schedule of Events... Monday, April 4: • Public Health Trivia Night and canned food drive kickoff • Capture images of ways Ohio is helping to address the need for reliable access to a sufficient quantity of affordable, nutritious food and homelessness in the Diversity in Public Health Photo Contest. Tuesday, April 5 • Farm to Table luncheon featuring local food vendors and a presentation on quality food sourcing.

April 4-10, 2016

Thursday, April 7: • Tobacco Lecture featuring Matthew L. Myers, president of the Campaign for Tobacco-Free Kids.

For more information please visit go.osu.edu/NPHWOhioState #NPHWOSU

Friday, April 8: • Diversity in Public Health Photo Contest Reception will be held and contest winners will be announced. Saturday, April 9 • Diversity in Public Health Summit featuring speakers discussing the topic of homelessness.

For details and registration information visit go.osu.edu/NPHW. 20

Diversity in Public Health Summit Homelessness: Giving a Voice to an Underserved Population

Saturday, April 9 • 9 a.m. -3 p.m. • The Ohio State University Biomedical Research Tower

KEYNOTE SPEAKER Robert E. Fullilove, EdD Columbia University Medical Center

PLENARY SPEAKER Gregory L. Hall, MD Ohio Commission on Minority Health

The Summit will feature concurrent breakout sessions on: Homelessness and Poverty Healthcare for the Homeless

REGISTER ONLINE AT GO.OSU.EDU/DIVERSITY-SUMMIT2016 For additional information contact MPHSAPresented at mphsaboard@gmail.com or visit mphsaosu.weebly.com by

Presented by: In association with:

This event is being held as a part of the Ohio State University College of Public Health, National Public Health Week celebration. for details visit go.osu.edu/NPHW.

College of Public Health The Ohio State University 250 Cunz Hall 1841 Neil Ave. Columbus, OH 43210

Please join us for the 17th annual

SUMMER PROGRAM in Population Health

June 20 - 24, 2016 Featuring: week-long, 2 and 3 day courses For more information please visit go.osu.edu/summerprogram or call 614-292-2291

The 2016 Summer Program in Population Health presented by the Ohio State University College of Public Health with the support of the Ohio Colleges of Medicine Government Resource Center.