Continuum, Spring 2018

Continuum Magazine of the Brown University School of Public Health • Winter 2018

2 Building trust takes time. Researchers in the Brown University School of Public Health take a long-term approach.

Letter from the Dean When there are clearly so many health problems facing the United States, why should we invest in the health of people across the globe?

First, a core value of the Brown University School of Public Health is advancing health as a right for all, with a special emphasis on vulnerable and marginalized population groups. There is also an obvious ethical component to meeting needs that many of us take for granted in the U.S.—clean drinking water, basic sanitation, and basic nutrition. No one wants to see children dying from diseases that are easily cured with medication, and we feel a moral duty to make a difference to populations with the fewest resources. However, there are also broader, global considerations of our international public health work.

Diseases do not recognize political boundaries. The West Nile Virus, Zika, and the various strains of bird flu are but a few recent examples of viruses that rapidly spread across the world. Our health is clearly linked to the health of others. Our increasingly interconnected world means that not only our health, but also our security, can be impacted by disease outbreaks across the globe. HIV is an example of a disease with profound implications for economies in affected regions.

Another global challenge is not just the spread of disease but also the spread of the Western diet. Characterized by overconsumption of refined sugars, salt, and saturated fat, our fast-food lifestyle has spread across the world, endangering the health and well-being of populations as diabetes, hypertension, and obesity begin to dominate the globe.

Professor Stephen McGarvey’s work highlights this problem and shines some light on the causes of obesity, and on opportunities for tackling this global epidemic.

Learn more about Dean Marcus in our In Profile feature on page 10.

As you will read in this issue of Continuum, faculty and students in the School of Public Health are dedicated to improving the health of populations, not just in Providence, but across the globe. We are motivated by a deep understanding of the interconnected nature of our world and our social consciousness to address the needs of the most vulnerable.

Sincerely, Bess H. Marcus, Ph.D. Dean, School of Public Health

©2018 Brown University

On the Cover: Kaitlin Goodman in Khayelitsha township outside of Cape Town with the women’s group Iliso Lamakhosikazi, with whom she held focus groups for her MPH thesis research on the lived experiences and health literacy of women with obesity-related chronic disease in low-resource settings.

In This Issue Highlights

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FEATURE:

The Trust Network

When it comes to establishing a network of trust, Brown researchers know that community building is essential. Discover current global research projects and Brown’s ongoing global collaborations.

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IN PROFILE:

Leading the Way

Introducing Bess Marcus, the new dean of the Brown University School of Public Health. Dean Marcus gets personal about public health and discusses the larger public health problems currently facing the world.

Departments

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LEARN BY DOING:

Out of the Classroom and Into the Field

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It takes a special type of student to become involved in global public health.

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Faculty Profile Professor Stephen McGarvey has dedicated his career to the Samoan people.

New Faculty Faculty Honors

HEALTH IMPACT:

Women Empowering Women: Maternova A women’s health solutions company revolutionizing access to trusted innovations.

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In The News

Class Notes Alumni Profile Andri Chybisov, MPH ’17 is engaged in development of the global cancer fight.

When it comes to establishing a network of trust, Brown researchers know that community building is essential.

By Laura Kallio Joyce

Photo by: Andrew Naysmith

Caroline Kuo, assistant professor of behavioral and social sciences (far right) with team members filming a documentary on research findings about family dynamics of HIV in rural KwaZulu-Natal Province, South Africa.

So-called “helicopter research,” “parachute research,” or “drive-by research” occurs when researchers drop in to communities, and then quickly leave. Members of already marginalized communities can be made to feel used, intimidated, and even suspicious of researchers’ goals. Investigators in the Brown University School of Public Health take a different approach. They know that when community members are engaged in the process, researchers not only gain their trust, but are able to gain deeper understanding of prevailing

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health behaviors and formulate more nuanced approaches to improving them.

Making long-lasting commitments to the communities in which they work is a hallmark of the global health researchers in the School of Public Health. Their work is collaborative by nature and often community-based, relying on the buy-in and input of community members. While it often takes years to build community trust and understanding, partnered approaches can lead to innovative

research. One example is Caroline Kuo’s project applying a resilienceoriented, family-based approach to preventing HIV among South African adolescents. Professor Stephen McGarvey is an example of a faculty member who has dedicated his career to a particular people. What he has learned benefits the Samoan people directly, while it informs our larger understanding of obesity trends around the world.

Here are snapshots of some of the current global research projects now underway.

Family in rural Honduras taught to use their ceramic water filter by Matthew Maleck, MD, MPH ’16.

Access to safe drinking water remains a challenge for millions.

What happens if you pay members of populations at very high risk of contracting or spreading HIV to engage in risk-reducing behavior?

Professor Omar GalĂĄrraga explores the potential effectiveness of economic incentives, and other behavioral economics innovations, to prevent and treat HIV and other chronic conditions in Mexico City.

His findings suggest that incentives can reduce risky sexual behavior and improve rates of engagement with healthcare services.

What are the factors that prevent Brazilian youth from accessing antiretroviral therapy, the medication that controls HIV? Professor Matthew Mimiaga is conducting formative research with community advisory board

members, key informants, and HIV infected adolescents in Rio de Janeiro, Brazil to inform a behavioral intervention for improving adherence to antiretroviral therapy among this population. The resulting counseling- and technologybased HIV medication adherence intervention package will address inequalities among diverse ethnicities, sexual and gender minorities, and classes by addressing the structural (e.g., transportation to clinic visits, perceived healthcare discrimination) and individuallevel (e.g., social support, psychosocial problems) barriers to adherence faced by many adolescents in this setting.

Professor Mimiaga is also engaged in a social network-based intervention to promote PrEP adherence among transgender women at risk for HIV infection in Lima, Peru. PrEP (Pre-exposure prophylaxis) is a highly effective daily medication that lowers the chance of HIV infection.

In addition to daily PrEP, the intervention includes individual counseling, group workshops, and social network interactions. Once the intervention is developed, a pilot test will be conducted by randomizing social network-based clusters of transgender women.

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Professor Simin Liu’s research responds to the emerging health threats from the vast environmental pollution and deterioration in China. He is building a prenatal cohort study and a birth cohort study in Wuhan, China, to test the “fetal origin” hypothesis for human diseases. The fetal origin hypothesis suggests that human diseases start in utero, because fetuses are most sensitive to environmental exposures. He aims to follow women and their children from prenatal to postnatal, and to investigate factors related to pregnancy outcomes, birth outcomes, and health outcomes of children later in life.

Professor Liu also studies the environmental exposures of workers in China. His cohort study of the Kailuan Coal Industry in Hebei, China includes 100,000 coal miners and has followed the subjects every two years to study coal miners’ health from occupational exposure to coal dust. The Jingchuan Metal Exposure Cohort Study in Gansu, China, involves 50,000 workers exposed to nickel, copper, cobalt, zinc and other heavy metals. The study has followed the subjects every two years by interviewing and collecting blood samples to study the effect of heavy metal exposure on human health, including incidence of cancer, cardiovascular disease, and metabolic disease.

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Two Public Health students are examining the burden of behavioral and psychological health problems that contribute to morbidity and mortality in South Korea. Doctoral student Harold Lee is studying the socioeconomic disparities associated with physical activity, while master’s student Yoojin Cha is examining the prevalence and intersections of mental health, alcohol, and smoking. They are analyzing the Korean National Health and Nutrition Examination Survey, a national representative study of adults in South Korea.

Transmission of HIV through sex has been rising exponentially in China. Professor Don Operario is engaged in a trial that uses mobile health (mHealth) approaches to promote HIV self-testing with highrisk men in China. Using WeChat, the most popular social networking app in China, his team developed an mHealth intervention that supports high-risk HIV uninfected men in administering HIV self-testing, interpreting results, engaging in regular repeat testing, and reducing risk behavior. This is the first known attempt to develop a combination approach to HIV self-testing (HST) that leverages advances in mobile technology as a platform for repeat testing and motivating behavior change. The findings will support future testing of the effectiveness of a combined HST plus app-based messaging intervention on sexual risk behavior and HIV retesting.

Ukraine has the second-largest HIV epidemic in Eastern Europe and Central Asia.

Brown University Ukraine Collaboration HIV/AIDS is a crisis in Ukraine. Many of the infected are young adults, who, over the next ten years, will become ill with AIDS and TB, placing tremendous stress on Ukraine’s already strained healthcare system. The Brown University Ukraine Collaboration, now in its sixth year, is a joint venture between the Brown University Center for AIDS Research and HIV health and service providers in Ukraine through the support of the Elena Pinchuk ANTIAIDS Foundation.

Led at Brown by Professor Timothy Flanigan, the program aims to foster effective educational collaborations in the areas of public health with emphasis on improved care and prevention of diseases that impact marginalized communities, particularly HIV, TB, and hepatitis C.

South Africa suffers the world’s largest HIV epidemic. Professor Caroline Kuo is taking a resilienceoriented approach to preventing adolescent HIV/STI infection and depression. Her international team will examine the efficacy of a familybased preventive intervention for adolescents and their caregivers.

In 2010, 30.2% of all pregnant women in South Africa who attended public sector health-care facilities were infected with HIV. Healthy Moms, Healthy Families is a longitudinal qualitative study

by Professor Jennifer Pellowski that aims to develop and test a bio-behavioral intervention that capitalizes on the transition into motherhood to bolster self-care behaviors and increase HIV treatment adherence among pregnant and postpartum women in Cape Town, South Africa.

Professors Abigail Harrison and Caroline Kuo are researching the health needs of the first generation of adolescents living with HIV in

South Africa as they transition to adulthood. Their study is focused on this high-priority population’s social and reproductive health needs, as well as the barriers and facilitators to adherence for anti-retroviral therapy, and the development of innovative interventions to promote a healthenabling environment.

of the global population of people living with HIV reside in South Africa.

Migration, Urbanization and Health in a Transition Setting is a study led by Professors Mark Lurie and Stephen McGarvey that examines the contemporary health transition in South Africa to better understand, at the individual level, how a complex pattern of migration and urbanization helps drive the health transition in these settings. The study devotes particular attention to how

The NAMBARI Program: Moi/Brown Partnership for Biostatistical Training in HIV The NAMBARI program responds to the critical need for capacity building in biostatistics and other quantitative sciences to support the enormous volume of HIV and health-related research taking place at Moi University, in Eldoret, Kenya.

Expert statistical analysis is fundamental to generating high-quality research that informs evidence-based practices used to combat HIV. The NAMBARI program addresses the need for more highly trained Kenyan biostatisticians by expanding research and curricular capacity in biostatistics and advanced quantitative methods at Moi University, laying the foundation for development and ongoing training of a sustainable critical mass of faculty and staff scientists in this field. NAMBARI also provides graduate-level training in biostatistics at Brown University to highly qualified Kenyan candidates from Moi University, along with workshops and faculty development in Kenya. The program is led

by Principal Investigator Professor Joseph Hogan at Brown.

migration and urbanization help determine both risk factors for health conditions, as well as access to care and treatment.

There were 62,000 new HIV infections in Kenya in 2016.

Professor Don Operario is examining the co-occurrence of HIV risk, mental health, and alcohol use among men who have sex with men in coastal Kenya. His goal is to develop interventions using mobile health approaches to improve access to health promotion counseling and support for this population.

of global AIDS deaths occur in South Africa.

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Ghana has done well reacting to the HIV epidemic, increasing awareness and services, but many populations remain vulnerable.

Professor Omar GalĂĄrraga is engaged in a collaborative project with the Komfo Anoyke Teaching Hospital and Adolescent HIV Clinic in Kumasi, Ghana, to test the preliminary efficacy and feasibility of group-based conditional economic incentives to increase adherence to antiretroviral therapy among adolescents living with HIV.

reduction in new HIV cases in South Africa since 2010.

SASH: The South African Social Science and HIV Programme A joint project of the University of Cape Town, South Africa, and Brown University, SASH is led by Professor Mark Lurie at Brown. The program enhances infrastructure and research investments at the University of Cape Town’s School of Public Health and Family Medicine.

Key to these efforts are the training and mentoring of SASH fellows, young South African leaders who are learning to apply social science methods to better understand the HIV epidemic in subSaharan Africa. These investments will develop a new generation of rigorously trained HIV social scientists to address research questions of social science and public health importance, and to foster a culture of excellence in social science research on HIV/AIDS.

decrease in AIDS-related deaths in South Africa since 2010.

Professor Stephen McGarvey has spent decades studying obesity in Samoans.

His latest project is an investigation of the physiologic and behavioral pathways that may underlie the relationships of a newly found gene variant with adiposity and type 2 diabetes in Samoans. At the same time, his team is using whole genome sequence data to conduct whole genome-wide association studies of adiposity and related metabolic phenotypes in Samoans.

Learn more about Professor McGarvey’s work on p. 17.

of the population of American Samoa is overweight.

University of the Philippines The Philippines is experiencing one of the fastest growing HIV epidemics in the world, yet the country lacks the research infrastructure to mobilize a strong evidence-based response. Brown is helping to build capacity for HIV behavioral-social science research in the Philippines by training HIV scientists who can respond to the epidemic. The project supports students from the Philippines in master’s and doctoral training at the Brown University School of Public Health. Specific training will focus on HIV prevention and treatment in key populations, such as sexual and gender minorities. Brown will also host visiting scientists and postdoctoral fellows from the University of the Philippines as well as hosting annual workshops in Manila to build a curricular infrastructure related to HIV behavioral-social science research.

This project is led by principal investigator Professor Don Operario with support from the Fogarty International Center of the National Institutes of Health. brownpublichealthmagazine.com

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In Profile LEADING THE WAY: Bess H. Marcus, Ph.D. Bess Marcus wants to help people make healthy choices.

With a rabbi father and a social worker mother, helpers and healers were very much a part of Bess Marcus’s growing up. The Marcus family was all about helping relationships—in the family, and in the community. Her father’s heart disease was another important part of her growing up.

“I was always trying to get him into stress management programs,” Marcus said. “After his second heart attack, he called me excitedly: ‘Guess what? Now I can take that stress management class you wanted me to take.’ And I thought: Why, after you’ve had two heart attacks, does our system then say you’re worthy of this program?”

She understood the insurer’s perspective, but saw early on that what was good for the insurer wasn’t necessarily good for the population. “That was pivotal for me. We had to be thinking about the good of the population.”

Marcus’s interest in exercise started when she was an undergraduate at Washington University in St. Louis.

She conducted a senior honors project examining the differences between girls and boys in terms of their stress, mood, body image, and self-esteem.

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“I found the boys were much more confident, and had higher selfesteem and better mood than the girls,” Marcus said, “and, that for both boys and girls, if they participated in sports or exercise, their self-esteem was higher.”

Marcus continued investigating exercise during her graduate studies at Auburn University.

“I started running exercise programs for students who weren’t exercising,” she said, “and I measured their body image and their self-esteem and their mood, and I found very strong relationships. If they were exercising, they were happier and had more energy and they liked themselves, and yet, they didn’t stick with it.”

In her doctoral work she studied adherence. Why is it that people don’t stick with exercise?

“I found it a conundrum,” Marcus said, “this drug of exercise. If people take it, they say all of these great things about it, yet they don’t keep taking it.” She tried different strategies to increase adherence and found that some strategies worked better than others. In 1988, after an internship at the VA hospital in Atlanta, Marcus came to Brown for a postdoctoral fellowship in behavioral medicine, a field that integrates psychology and medicine.

By Laura Kallio Joyce

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Things to Know About Bess

THE LAST BOOK YOU READ? Americanah, by Chimamanda Ngozi Adichie PERSONAL EXERCISE ROUTINE? Find a way to be active every day IMPORTANT EMERGING AREAS OF PUBLIC HEALTH? The environment, mindfulness and gun violence

“

I see my job as taking the areas that we’re great in, and making sure those areas stay strong.

And the areas that we’re good at, nurturing them to be great.

”

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PATH TO BROWN 1988

Arrives at Brown as a postdoctoral scholar after earning master’s and doctoral degrees in clinical psychology from Auburn University

1991

Becomes a Brown faculty member, rising to the rank of professor of psychiatry and human behavior in 2000

2004

Named director of the Centers for Behavioral and Preventive Medicine at The Miriam Hospital

2011

Appointed chair of the Department of Family Medicine and Public Health at the University of California San Diego

2014

UCSD appointes Marcus as the School of Medicine’s inaugural senior associate dean for public health

2017

Serves on the executive committee for the Development of a National Strategic Plan for Physical Activity and on the board of directors for the National Physical Activity Plan Alliance

2017

Named second dean of the Brown University School of Public Health

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“When I came to The Miriam Hospital,” Marcus said, “the faculty were doing mostly tobacco research.

I started sitting at the meetings, with all of these addiction researchers, and they talked about why the smoking cessation programs were not going that well.” Patients described not having much energy, having high levels of stress and bad moods, being afraid they would gain weight if they quit smoking, or actually gaining weight when they quit smoking.

“I remember sitting at this meeting, and here I am, a young post doc, and I got the courage to say: ‘You know, there’s this thing called exercise, and it would do all of the things that you’re talking about. And there is no downside, there’re no side effects.’” She got the support to write her first grant, and subsequently found that people who started to exercise while in a smoking cessation treatment program were twice as likely to quit smoking and gained half as much weight.

Marcus continued her work in Rhode Island for the next 20 years, researching physical activity behavior, developing interventions to promote physical activity, and studying whether physical activity can help people quit smoking and maintain abstinence. By 2011, she was a professor of psychiatry and human behavior at Brown and director of the Centers for Behavioral and Preventive Medicine at The Miriam Hospital, and had published over 150 journal articles and authored three books.

As her research grew more focused on Latino populations and took a

technology turn, she wanted to do a sabbatical in San Diego to work with its large Latino community and be nearer the technology sector.

When the opportunity arose to become chair of the Department of Family Medicine and Public Health at the University of California San Diego, Marcus took the job, remaining an adjunct professor at Brown to facilitate her ongoing collaborations. UC San Diego appointed her the School of Medicine’s inaugural senior associate dean for public health in 2014. As dean, Marcus created the Institute for Public Health, promoted public health research and education activities across campus, and supervised the medical school’s public health degree offerings. She oversaw the establishment of a bachelor of science in public health, the first undergraduate degree offered by the School of Medicine, a doctoral program in biostatistics, and a new master of public health program. Under her leadership, the department’s research portfolio and faculty grew exponentially.

In January of 2017, after the sixth person mentioned the open deanship at what was now the Brown University School of Public Health, Marcus said, “All right, I have to take a look at this position. It was really the only position I would have left San Diego for. I loved San Diego and I loved my job there.”

Since arriving in November, Marcus has been learning more about the larger Brown community while getting to reknow the School. “Certainly our number of students has grown, and that’s super exciting to see,” she said, “and our new

Dean Marcus was part of a delegation from California, who attended the Pontifical Academy of Sciences and the Pontifical Academy of Social Sciences Conference, Health of People, Health of Planet and our Responsibility: Climate Change, Air Pollution and Health

California Vatican meeting participants, left to right: Dr. Michael Pratt, Gov. Jerry Brown, Dr. Veerabhadran Ramanathan, Congressman Scott Peters, Dr. Bess Marcus, Dr. Wael Al-Delaimy, and Dr. Fonna Forman

areas, like the Mindfulness Center and environmental health. I see my job as taking the areas that we’re great in, and making sure those areas stay strong. And the areas that we’re good at, nurturing them to be great. And then coming up with new emerging areas that we want to be known for.”

As Marcus recognizes the School’s opportunities and challenges, she keeps in mind the larger public health problems currently facing the U.S. “Tobacco use, poor eating, and poor exercise are contributing to

more than 50 percent of premature mortality, never mind lack of quality of life,” she said. “That’s a huge opportunity for us. I think the biggest challenge for public health is, how do we make the healthy choice the easy choice? How do we make it so that fruits and vegetables are inexpensive and easily available?

As long as brownies and cookies are cheap and ubiquitous, we have an uphill battle. How do we meet people where they are, and help to nudge them along? Making the healthy choice the easy choice is something that we need to embrace at a variety of levels.” brownpublichealthmagazine.com

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LEARN BY DOING

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OUT OF THE CLASSROOM AND INTO THE FIELD

By Meghan Gonsalves, ScM ’18

Global fieldwork requires getting out of one’s physical, psychological, and cultural comfort zones and being immersed in challenging and sometimes dangerous environments.

In an ever-changing world of increasing climate change, unprecedented natural disasters, uncertain healthcare policies, and growing disease epidemics, the need for global communication and partnership is greater than ever. The field of global public health is dedicated to improving health and reducing health inequalities in populations around the world. Graduate students at the Brown University School of Public Health are contributing to the growth and success of this field by tackling pressing issues both inside and outside the classroom.

Associate Dean for Academic Affairs and Professor of Behavioral and Social Sciences Don Operario, Ph.D., believes in the importance of global public health study. “We are living in an incredibly interconnected world,” he said. “The health of human populations across the globe is more intertwined and interdependent than ever. As students and scholars of global public health, we have an ethical responsibility to work collaboratively and in partnership with colleagues throughout the world, and to put our methodological and analytic skills to good use in order to address globalsocial inequities in health and to improve health for all.”

Arjee Restar, MPH, and Ashley Perez, Sc.M. ’17 are doing just that. They’re working in areas where HIV is rising in vulnerable communities, with limited infrastructure to address the needs of those communities. Restar, a second year doctoral student in behavioral and social health sciences, works in the Philippines, which according to

Operario, “is experiencing one of the fastest growing HIV epidemics in the world.” Because the epidemic there is so new, Restar is laying a foundation for the development of basic HIV prevention, testing, and treatment interventions for young gay men and transgender people. Due to stigma, these groups are highly underserved in public health and clinical settings, so Restar’s work has both public health and social advocacy components.

Perez, a Public Health alumna who completed a master’s in behavioral and social health sciences in 2017, conducts HIV research in China. “Her work takes place in a setting with relatively better HIV prevention and treatment infrastructure overall,” Operario said, “but where attention to gay men has been limited due to stigma and political will.” Perez is working to develop mobile health applications to promote HIV testing and prevention that she hopes will lead to sustainable public health solutions within this social and cultural context.

Restar’s project, based in metropolitan Manila, qualitatively examines the context of how socio-ecological factors affect uptake and adherence of HIV-related services among gay and transgender youths and young adults. She is also examining the challenges and strengths of delivering these services among providers and organizations dedicated to serving these populations. Some examples of HIV-related services examined were condoms, HIV testing and counseling, pre- and post-exposure prophylaxes (PrEP and PEP), anti-retroviral therapy (ART), and hormone brownpublichealthmagazine.com

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LEARN BY DOING

During her first trip to China, Ashley Perez, ScM ’17, worked on a mobile health project using WeChat.

replacement therapy (HRT). Her project was funded by Brown’s Minority Health and Health Disparities International Research Training (MHIRT) Program, part of the Global Health Initiative.

Philippines, are often stigmatized and seen as ‘not a priority’ in society, particularly from providers’ point-ofview. It is my goal to change that.”

Perez’s work in Hefei, China, in collaboration with Anhui Medical University, is a mobile health project that aims to increase utilization of oral HIV self-testing among men who have sex with men. For the project, called WeTest, she used WeChat, a popular smartphone application in China, to deliver risk reduction messages to participants.

To prepare for the last phase of WeTest, Perez traveled to China with Operario for 10 days to study procedures, data management, and survey development. While in China, Perez gave instructional presentations on conducting qualitative data analysis and on using a qualitative analysis software called MAXQDA.

“On an academic level, this project is important to me because it is the first independent project that I’m spearheading,” Restar said. “My experiences launching a study in an international setting will help me to define and recognize my abilities and skills as a research investigator, as well as acknowledge areas for improvement. On a social level, this project is important to me because transgender youths and young adults are often uncentered and not included in many HIV reduction programs. This has many implications, including driving transgender communities further underground and away from public health care, leaving them to fend for themselves. Transgender “This was my first trip to China,” communities, particularly in a Perez said, “and WeTest is the highly religious environment like the first intervention project that I’ve 16

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worked on, so it’s been an incredibly enriching experience, especially since it’s so hands on. I’ve worked on other research projects, but this project has shown me the true meaning of teamwork. There are many members of the research team,” she said, “all with different strengths and different project roles, and each of them is critical to making the project come to fruition.”

Perez’s interest in sexual and gender minority health drew her to this research project. “We hope this study will ultimately increase HIV testing rates,” she said. “The findings could offer insight on strategies to increase self-testing utilization, not only in China, but in other settings as well.”

Operario, a mentor to both young researchers, acknowledged that “it takes a special type of student to become involved in global public health. This is not glamorous work,” he said. “The appeal of international travel gets old fast.

This work requires getting out of one’s physical, psychological, and cultural comfort zones and being immersed in challenging and sometimes dangerous environments, in order to collect data or implement research projects.

Brown students who do this work are not looking for quick fixes or easy solutions to global public health problems,” he said, “but they see their skills contributing incrementally and collaboratively to new knowledge that, over time, can yield improvements to community and population health.”

Faculty In Focus Faculty Profile

Stephen McGarvey, Ph.D., MPH Mentoring global health leaders and teaching “​Burden of Disease in Developing Countries” since 1993.

By Meghan Gonsalves, ScM ’18

TELL US ABOUT YOUR EARLY CAREER AND ABOUT THE EVOLUTION OF YOUR INTEREST IN GLOBAL HEALTH, SPECIFICALLY YOUR INTEREST AND EXPERIENCE IN SAMOA AND AMERICAN SAMOA. My training is in biological anthropology, so my first master’s and my Ph.D. are in that field. During that time, I became less interested in understanding human biology, and more interested in studying the environmental, evolutionary, and genetic forces that underlie health and well-being. So I began to read about public health and epidemiology, and became interested in a newly developing field called international health. It was concerned with the sociocultural and biological basis of health in developing countries.

During the fourth year of my Ph.D. program, I went to Hawaii to study Samoan migrant populations living on the island of Oahu. While there, I analyzed what happens to the biology and overall health of this population when they change their way of life very rapidly. After I finished my Ph.D., I completed my MPH in epidemiology, and have been studying people in

independent Samoa and in the U.S. territory of American Samoa continuously since that time.

WHAT DO YOU THINK HAS BEEN YOUR MOST IMPACTFUL OR SIGNIFICANT FINDING? Throughout my career, I’ve been trying to measure and document what we have come to call the “nutrition transition” in the Samoan and American Samoan populations.

The “nutrition transition,” also known as the modernization or Westernization of the diet, means that people are eating more processed foods with more sugar, sodium, and fats in them, and as a result are consuming fewer of the healthy micronutrients that our bodies need.

This has been a theme throughout my career, but we recently published a major paper in Nature Genetics on a novel genetic variant in Samoans that we found that had never been reported before and had never been found to be related to obesity before. This gene variant is positively associated with obesity, but negatively associated with diabetes. This is very interesting

because we usually find that obesity and Type 2 diabetes are positively correlated with one another. We think this gene confers some relative protection against Type 2 diabetes, and contributes, along with other things like diet, to increased levels of body mass index or obesity. This is interesting partially because of its novelty, for this gene is not found in any other populations. As a result, we have several new NIH grants that are going to help us unpack how this gene interacts with different biological pathways and diet and physical activity.

Our current grant focuses extensively on the physiological and biological mechanisms that underlie the relationship between obesity and diabetes of this new gene we found.

We are out in Samoa right now collecting intensive phenotyping data on body composition, specifically looking at glucose and insulin responses under changes. We are also measuring eating habits and levels of physical activity to try to understand the potential metabolic pathways associated with this

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FACULTY IN FOCUS

Expanding Our Talent Behavioral and Social Sciences

Brown’s School of Public Health welcomes exciting new faculty in 2017-2018.

Hector Lopez-Vergara, Ph.D. Assistant Professor of Behavioral & Social Sciences

Jasjit Singh Ahluwalia, M.D., MPH, M.S. Professor of Behavioral & Social Sciences

Jennifer Pellowski, Ph.D. Assistant Professor of Behavioral & Social Sciences

Biostatistics

Matthew Meisel, Ph.D. Assistant Professor of Behavioral & Social Sciences

Health Services, Policy, and Practice

Lorin Crawford, Ph.D. Assistant Professor of Biostatistics

Stavroula Chrysanthopoulou, Ph.D. Assistant Professor of Biostatistics

Jon Steingrimsson, Ph.D. Assistant Professor of Biostatistics

Stefan Gravenstein, M.D., MPH Professor of Medicine and Health Services, Policy and Practice

Emmanuelle Belanger, Ph.D. Assistant Professor of Health Services, Policy and Practice

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Andrew Zullo, PharmD, Sc.M., Ph.D. Assistant Professor of Health Services, Policy and Practice

Eric Jutkowitz, Ph.D. Assistant Professor of Health Services, Policy and Practice

Faculty Profile Stephen McGarvey, Ph.D., MPH

“

Director of the International Health Institute Professor of Epidemiology, Professor of Anthropology

gene. In order to design potential interventions, or even discover a helpful drug that targets these pathways, we have to know the gene’s mechanisms. This pathway could be shared by many other humans, so by learning more about it, we could have the potential to impact health all over the globe.

TELL US ABOUT YOUR TEACHING EXPERIENCE HERE AT THE SCHOOL OF PUBLIC HEALTH. Before there was the School of Public Health, and before there was a program in public health, I taught a course called “The Burden of Disease in Developing Countries,” and I’m still teaching it now. It involves a variety of guest lecturers who come in and present on their specialties, whether it’s schistosomiasis, HIV, or humanitarian emergencies, such as refugee health. Students from all different disciplines, programs, and departments take it. It’s a course that gets good evaluations and students learn a lot, and we definitely make them work hard.

better explain the relationship between the way the world is ordered politically and the subsequent role that has in the production of social, economic, and health inequalities.

One important theme in my course is the role of conceptions of human rights and the human right to health.

Students at Brown are eager to hear about this and we try to present high quality scholarship about these issues. It becomes more than their commitment to social change and social justice, and grows into learning how to create change by understanding the peer-reviewed published literature that suggests the best way to think about these things.

WHAT HAS BEEN THE HISTORY OF STUDYING GLOBAL HEALTH AT THE SCHOOL OF PUBLIC HEALTH AND BROWN? I’ve been at Brown since 1985, and when I began, global health was called international health. Brown

It becomes more than their commitment to social change and social justice, and grows into learning how to create change.

”

has always had a good record of global health being studied in different disciplines around the University and it’s still that way. In fact, the community of people in global health has representatives from departments such as engineering and economics. Even though we may have disciplinary differences, we can create a shared trust and intellectual vision in global health that will help us to reduce health inequalities wherever we find them. While reviewing the new Global Public Health master’s program, the higher administrative committees at Brown reminded us to keep these conversations and connections alive so that this interdisciplinary degree not only reflects the faculty in the School of Public Health, but also the scholarly pursuits of people in other departments. We hope this program attracts people with many different backgrounds as well.

WHY IS IT IMPORTANT TO TEACH UNDERGRADUATE AND GRADUATE STUDENTS ABOUT GLOBAL HEALTH? I think that this age of students, especially at Brown, is more aware of the world than my generation was at that age, simply because of the reach of the global news media ultimately making them more mindful of health inequalities. Health inequalities have always been with us on a national and global scale, and the focus on them is very appealing to students.

We need to educate people about the level of these conditions and

Research assistant Abigail Wetzel and Professor Stephen McGarvey, poised to open the new lab at the Samoan Ministry of Health.

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FACULTY IN FOCUS

Faculty Honors The latest School of Public Health faculty awards and recognition

Linda Resnik, Ph.D., Department of Health Services, Policy and Practice 2017 Paul B. Magnuson Award

Akilah Dulin Keita, Ph.D., Department of Behavioral and Social Sciences The Marie O. Weil Outstanding Scholarship Award

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The Magnuson Award for Outstanding Achievement in Rehabilitation Research and Development is the highest honor for Department of Veterans Affairs rehabilitation investigators. It recognizes Resnik’s work with advanced upper limb prostheses, on veterans’ rehabilitation and community integration, and her leadership of the VA/Department of Defense Collaboration Guidebook for Healthcare Research.

This award recognizes outstanding scholarship published in the Journal of Community Practice.

Articles are reviewed and selected by a committee comprised of ACOSA scholars based on contribution to the field, scholarly approach, and promotion of macro practice values.

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Jennifer Nazareno, Ph.D. Brown University Presidential Diversity Postdoctoral Fellow

Chris Schmid, Ph.D., Department of Biostatistics President of the Society for Research Synthesis Methodology

Nazareno was named Presidential Diversity Postdoctoral Fellow in the School of Public Health and the Jonathan M. Nelson Center for Entrepreneurship.

Her research centers on the impacts of economic globalization on the organizational structure of the U.S. long-term care and mental health care systems. Nazareno will teach the course “Intersectionality and Health Inequities” in spring 2018.

Professor Schmid was elected president of the Society for Research Synthesis Methodology, a cross-disciplinary society that supports and promotes the development and use of innovative and robust methods of research synthesis.

Nicole AlexanderScott, M.D., MPH, Department of Health Services, Policy and Practice; Department of Pediatrics President-elect of the Association of State and Territorial Health Officials (ASTHO)

Joseph Braun, Ph.D., Department of Epidemiology Collaborative on Health and the Environment: 20 Pioneers under 40 in Environmental Public Health

ASTHO members are the chief health officials in each U.S. state. The organization develops and guides public health policy in state-based public health practice with the ultimate goal of improving the nation’s health. AlexanderScott will spend a year working with the current president to help steer the organization before assuming that role in September 2018.

The Collaborative on Health and the Environment, a nonprofit dedicated to educating people on how the environment impacts human health and well-being, recognized individuals whose work promises to drive environmental health science and advocacy in new directions. Braun researches whether environmental chemical exposures adversely affect infant and child health.

Six Brown faculty members were honored with inaugural Brown Research Achievement Awards, presented by the University’s Office of the Vice President for Research. Two of the awards went to School of Public Health faculty for their work on early life and the end of life: Vincent Mor, Ph.D., Department of Health Services, Policy, and Practice

Joseph Braun, Ph.D., Department of Epidemiology Brown University Early Career Research Achievement Award

Brown University Distinguished Research Achievement Award The Distinguished Research Achievement Award honors faculty members with exceptional records of nationally acclaimed research throughout their careers at Brown. Mor was cited for his sustained success over decades in advancing research on how the delivery of health care affects the well-being of frail and chronically ill people, particularly the elderly. He was also cited for his leadership in building an outstanding public health research program at Brown.

Medeva Ghee, Ph.D., Department of Behavioral and Social Sciences INSIGHT into Diversity’s 2017 Leaders in STEM

Ghee, executive director of the Leadership Alliance, a Brown-based consortium that supports scholars from historically underrepresented groups pursuing careers in science, technology, engineering and math, was recognized for motivating and encouraging the next generation of young people to pursue STEM education and careers.

Josiah Rich, M.D., MPH, Department of Medicine, Department of Epidemiology 2017 Charles “Bud” Kahn, M.D. Lifetime Leadership Award

Braun was highlighted for building a strong research program that has documented many important associations between prenatal and early life exposures to industrial toxicants, such as PFOA, and specific effects on human health including childhood adiposity and early termination of breastfeeding.

He was also cited for providing excellent research mentorship.

An infectious disease specialist, Rich is also the director and cofounder of the Center for Prisoner Health and Human Rights and a leader in efforts to combat opioid abuse. Joseph Garland, who nominated Rich for The Miriam Hospital award, noted his work providing care to prisoners saying he “has become a national leader in inmate health.”

Constantine Gatsonis, Ph.D., Department of Biostatistics 2018 Marvin Zelen Leadership Award in Statistical Science

The Harvard T.H. Chan School of Public Health’s Zelen Leadership Award recognizes an individual who has greatly impacted the theory and practice of statistical science, contributing to the creation of an environment in which statistical science and its applications have flourished.

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Health Impact Women Empowering Women: Maternova The world’s first global marketplace for lifesaving innovations | maternova.net Maternova, Inc. is a trusted resource for cutting-edge medical innovations in newborn, obstetrics and reproductive health. The company researches, reviews and sells proven obstetric and newborn technologies to private hospitals, governments, ministries of health, NGOs and healthcare professionals around the world. The womanowned, women’s health solutions company has a network of over 30,000 clinicians, midwives, and thought leaders as part of its sphere of influence. Maternova is a social enterprise that is mission driven, delivering products in a socially conscious way. The idea for the company originated when cofounders Meg Wirth and Allyson Cote recognized a gap in efficient technology transfer services for maternal and child health. Wirth noted that many organizations provide clinical or policy-related services and universities and startups create helpful biomedical technologies. However there have been few linkages between the two entities. Wirth and Cote knew more lives could be saved with a dedicated, trusted, efficient, commercialization platform.

According to Wirth, the three biggest threats to pregnant mothers around the world, including the United States, are postpartum hemorrhaging, eclampsia, and sepsis (with anemia and malnutrition underlying all three causes). In many developing countries there is 22

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Life-saving devices: one death caused by postpartum hemorrhage every four minutes.

Often women die while in transit to a hospital. But what if you could stabilize the woman until she reaches help? This is the idea behind the company’s top selling item, the Non-Pneumatic Anti-Shock Garment (NASG), an external pressure suit (with an embedded hard sphere over the uterus), used

health commodities marketing.

The whole approach of Maternova to pool in both large and smallscale manufacturers of medical innovations for newborn, obstetrics and reproductive health on an online platform is a new direction in the business-to-business model.

Tuladhar went on to say that “in addition to getting the opportunity to actually design a study to test

“The work is very gratifying and heart wrenching all at the same time. Students are very hands-on here at Maternova. It’s not a theoretical internship” —Meg Wirth, co-founder to stabilize a woman experiencing bleeding after delivering a baby.

This anti-shock garment has been proven in clinical trials to help stop hemorrhage and reverse shock in women while in transport in an ambulance or while awaiting blood transfusion at a hospital.

As a local company with a global reach, Maternova has hosted several Brown University Public Health students, such as Nirdesh Tuladhar, MPH ’15 and Hugo Petitjean, MPH ’17, for their internships.

At Maternova students have the opportunity to manage projects, create media strategies and outreach, vet new supplies, and create tracking processes. Tuladhar said “Maternova was a perfect match considering my prior applied experience and interest in working in global health and

a new rapid diagnostic testing (RDT) kit, Maternova opened me to the world of startups, social entrepreneurship and social media marketing. The internship at Maternova also allowed me to complement new skills I was learning at the School of Public Health, such as designing health interventions, epidemiology and applied methodologies of research design. If you are creative, innovative, business orientated and can think of out-of-thebox solutions for maternal and child health programs globally, Maternova is the place for you.

Founders, Meg Wirth and Allyson Cote, are wonderful people to work with and are excellent mentors. Their mission and passion to uplift women’s health globally is inspiring.”

- Karen Scanlan

Incublanket by Warmilu The Incublanket can be used for infant transport, in place of an incubator or as a supplement to Kangaroo Mother Care.

Non-Pneumatic AntiShock Garment (NASG) NASG is an external pressure suit used to stabilize a woman experiencing bleeding after delivery of a baby.

ThermoSpot The ultra simple, low-cost device adheres to the skin and indicates infant hypothermia or a fever by a change of color.

In the News Assessing and Addressing RI’s West African Immigrant Community

Akosua Boadiwaa Adu-Boahene dedicated her MPH master’s thesis work at Brown to understanding her community’s health needs.

In 2011, the medical research assistant and phlebotomist moved to Rhode Island from Kentucky to earn a master’s degree in public health at Brown University. The move brought the young Ghana native into Providence County’s community of more than 13,000 fellow immigrants from subSaharan Africa.

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Before enrolling at Brown, AduBoahene spent more than two years working at Women & Infants Hospital. Her experience as a health care worker and an immigrant, combined with what she often observed among her friends and neighbors at the Empowerment Temple of the International Central Gospel Church in Pawtucket, made it apparent that for many people, moving from West Africa to New England brings significant barriers to accessing health care.

With the encouragement of her

pastor, she helped to organize church health ministry programs, such as quarterly health fairs with screenings and educational events. She resolved to start a more permanent clinic in Pawtucket and, as a student at Brown, dedicated her thesis work to conducting a health needs assessment within the community.

A summary of her results was published in the Rhode Island Medical Journal. The paper provides a rare quantitative and qualitative

assessment of health and health access in a sampling of Rhode Island’s large African immigrant community. A common theme in the data is that, despite a prevalence of developing chronic health problems, many immigrants don’t seek, and don’t know how to seek, care.

“When we emigrate to the U.S., we have little background knowledge of preventive medicine,” Adu-Boahene said. “But there are real needs. Even if we do seek care, we have limited information on how to access the U.S. healthcare system.”

permanent residents. Three out of four participants had health insurance.

many immigrants don’t seek the preventive care that could prevent or address some chronic ailments.

Even though nearly half reported a chronic health problem, the group was somewhat disconnected from routine care. The sample revealed a variety of chronic ailments.

Topping the list were joint and back pain, high blood pressure, diabetes and being overweight. They also reported high levels of stress.

According to co-author Dr. Kwame Dapaah-Afriyie, clinical associate professor of medicine at the Warren Alpert Medical School, “this was seen in part as a function of unfamiliarity with preventive care and of concern about cost.”

An estimated 13,100 immigrants from sub-Saharan Africa live in Providence County.

Adu-Boahene recruited and surveyed 101 immigrants from Ghana, Liberia and Nigeria to amass quantitative data, and also interviewed a clinical pharmacist, five local physicians and three clergy members who serve the community to gain a deeper, more qualitative understanding than numbers alone can produce.

“The culture shock is huge,” AduBoahene said. “It’s fast-paced over Adu-Boahene’s sample consisted of here, but we’re so laid back where a young (75 percent under age 44) we come from. And we are very and well-educated (83 percent with communal — in the U.S., it’s ‘each at least some college) population man for himself.’” with a high rate of employment (90 percent). More than half had The interviews with doctors and become either U.S. citizens or pastors backed up the insight that

Since members of the community aren’t rushing to the clinic, AduBoahene has brought it to them.

Since graduating from Brown in May 2016, she’s realized her vision of establishing the WTL Health Clinic, Inc., a free clinic initiative in Pawtucket (WTL stands for “The Way, The Truth and The Life”).

The clinic offers free primary care services every Saturday and holds health seminars on Sundays focused on diabetes, heart health, and other chronic health challenges identified

by Adu-Boahene’s health needs assessment.

Having documented her community’s needs as a student, Adu-Boahene is now working to meet them.

- David Orenstein

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IN THE NEWS

In the Samoan Language “Olaga” Means Life The Obesity, Lifestyle and Genetic Adaptations (OLaGA) lab, led by Stephen McGarvey, professor of epidemiology, and Nicola Hawley, assistant professor of chronic disease epidemiology at the Yale University School of Public Health, is a unique new research laboratory at Samoa’s Ministry of Health.

Lab researchers will conduct three studies at three distinct stages of life — birth, childhood and adulthood — to understand and address the nation’s unusually high rates of obesity.

He noted that the lab includes the first dual-energy X-ray absorptiometry scanner in the Pacific islands. The instrument precisely measures body composition, including fat, lean mass and bone. McGarvey said the scanner, funded by the U.S. National Institutes of Health, will play a role in all three studies.

The team is particularly interested in better understanding the role of a rare genetic variant they discovered last year that appears to contribute to a higher risk of obesity but a lower risk of diabetes.

Samoa’s prime minister, Tuilaepa Lupesoliai Neioti Aiono Sailele Malielegaoi, formally opened the lab “We do not yet know how this at a November launch ceremony. gene influences basic biological mechanisms and thus how it “Non-communicable diseases (NCDs) stemming from obesity — diabetes, cardiovascular disease, kidney disease and cancer — are not only a threat and a cost to individual health, but to Samoa’s long-term economic and social development,” the prime minister said. “This collaboration, between our ministries and two outstanding universities in the U.S.A. allows Samoa to be at the forefront of the primary research needed to drive our NCD prevention and treatment agenda.”

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influences overweight and diabetes,” McGarvey said. “The new research taking place in this laboratory should provide greater biological understanding of how this gene affects NCDs. We are also taking the opportunity to use some of the research equipment for studies of children and infants so we can try to understand how early in life health indicators change that might help partly predict later NCD risk.”

When the research is complete, the equipment, including the scanner, will be donated to the Ministry of Health. As part of the project, the team will train local health workers to use it.

- David Orenstein

Daily Calcium Intake Varies Widely Around the World According to a new systematic review of research data published in the journal Osteoporosis International, there are many areas of the world with risk to bone health. Study lead author Ethan Balk, associate professor at Brown’s Center for Evidence Synthesis in Health, explained that outside of North America and most of Europe, particularly Northern Europe, there is lower intake than there should be for good bone health.

“In many parts of the world,” Balk said, “the low average calcium intake may be putting most people at increased risk of fractures and osteoporosis.”

Balk and his co-authors, including several at the International Osteoporosis Foundation, scoured the research literature and other data sources for studies that reported national averages of daily calcium intake among adults around the world. Ultimately they found useful information pertaining to 74 countries.

there were enough data to produce a global map illustrating some notable regional trends. Southern and Eastern Asia had the world’s lowest average intakes — often less than 400 mg a day — while only Northern European countries registered intakes of greater than 1,000 mg a day.

Countries in South America and Africa mostly had average intakes The studies varied widely in how in the middle, between about recent they were, how nationally 400 and 700 mg a day. National representative they were, and by recommendations for the ideal their sample size, Balk and his colevel of calcium intake vary around authors acknowledged. Nevertheless, the world, Balk said, but in most

countries average intake is lower than recommended.

The paper’s authors wrote that they hope the data will help to promote increased calcium consumption, particularly in the Asia-Pacific region and in places where it hasn’t been documented.

“This work draws attention to regions where calcium intake needs to be assessed and where measures to increase calcium intake are likely to have skeletal benefits,” they wrote.

- David Orenstein

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Alumni Spotlight Class Notes Read up on the latest from friends and alumni.

Meredith Bergey, Ph.D., Sc.M., MPH ’06 After completing her MPH in 2006, Meredith worked as an epidemiologist at the Rhode Island Department of Health and as a biostatistician at the University of Pennsylvania. Bergey later pursued a joint doctorate in sociology and social policy (focusing on health) from Brandeis University and the Heller School for Social Management and Policy, where she was an Andrew W. Mellon Dissertation Fellow. Bergey went on to teach at the University of Virginia where she partnered with undergraduate students and clinicians to create a Health Leads-inspired program to address social determinants of health for vulnerable populations.

Students Joey Michel, Harrison Boyce, Lauren Greenwood, and Matthew Salit (nephew of the MPH program’s own Joann Barao!) did an incredible

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job of getting the program, Health Bridge, up and running to serve patients in and around the Charlottesville area.

After completing two years at UVA, Bergey is excited to have returned home to Pennsylvania to join the faculty at Villanova University’s Department of Sociology and Criminology as an assistant professor. Her current research focuses on social determinants and experiences of health. She continues to write about these and other healthrelated topics in articles and chapters. Bergey and her colleagues recently published a book entitled Global Perspectives on ADHD: Social Dimensions of Diagnosis and Treatment in 16 Countries (Johns Hopkins University Press).

Nathaniel E. Lepp, M.D., MPH ’06 Nathaniel is now chief resident in family medicine at Natividad Medical Center in Salinas, California. He is a leader in one of the original full-spectrum family medicine residencies in rural California. He delivers babies and practices inpatient medicine in addition to serving as primary care

physician for a panel of underserved patients. He lives in Monterey, CA, with his wife, Stephanie, and baby daughter, Anik.

Jeffrey F. Peipert, M.D., Ph.D. Epidemiology ’07 Jeffrey began his job as the Clarence E. Ehrlich Professor and Chair of the Department of OB/GYN at Indiana University School of Medicine 18 months ago. His areas of interest include contraception and family planning.

Recently, he delivered the Guyer Lectureship at the University of Rochester. At the Guyer lectureship, he discussed the Contraceptive CHOICE Project that has been publicized in the news and during the recent national debate.

Bunna Kim, M.D., MPH ’08 Bunna works for the National Center for HIV/ AIDS Dermatology and STD (NCHADS) as Head of Planning, Monitoring and Reporting. In this

role he develops activity plans and monitors HIV program implementation at all levels. He collaborates with surveillance units to conduct HIV surveys and research, and with NGOs to provide HIV prevention programs for key populations.

He also develops an annual comprehensive report of HIV program implementation.

Monique J. Brown, Ph.D., MPH ‘09 As a Research Assistant Professor in the College of Behavioral and Community Sciences at the University of South Florida, Monique continues to conduct research examining socialbehavioral influences affecting health outcomes among people living with HIV. Her most recent article entitled “Perceived intentional transmission, sustained viral suppression and psychosocial outcomes among men who have sex with men living with HIV” is

currently in press in Sexually Transmitted Infections. One of her previous publications entitled “Association between adverse childhood experiences and diagnosis of cancer” was in the top 25% of most cited articles in PLoS One. More recently, Monique served as a panelist for the National HIV Testing Day panel at Synergy Health Centers and the 5508 Coworking Collaboration Exchange in Tampa, Florida, and was interviewed for a radio talk show “Is HIV/AIDS a Civil Rights Issue?” on Cole and the Cure, WTMP 1150 AM. Monique also completed the 2-year Cyber Mentors program, organized by the American Psychological Association and funded by the National Institute of Mental Health, which provides training and mentorship in HIV/AIDS and health disparities research and grant writing to junior researchers. She was also recently awarded a travel scholarship to attend the HIV and Aging Conference and Mentorship Program in November 2017 at Emory University.

Adrian A. Salmon, M.D., MBA, MPH ’10 A year after he graduated from the Public Health

program, Adrian decided to return to his home country, Ecuador. There, he served as a physician, applying what he learned at Brown in the public health arena.

As a part of the Ecuadorian government medical team, Adrian became actively involved in controlling outbreaks in remote areas and developing medical protocols for the first EMS911 (emergency medical system). Currently, he is in the process of establishing a private Internal medicine/Sleep medicine/ Telemedicine practice in Florida. In the near future, he plans to explore low-cost or non-profit applications of telemedicine outside the US. Kelsey Collins, Sc.M. Behavioral and Social Sciences Intervention ’14 Kelsey is currently in her last year of medical school at Columbia University College of Physicians and Surgeons and is in the process of applying for residency in psychiatry.

Throughout medical school, she has been involved in reproductive health advocacy and harm reduction work, and has consequently developed clinical, research, and advocacy interests in women’s mental health and

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ALUMNI SPOTLIGHT

Want to be included in the next issue of Continuum?

Let us know all about your latest accomplishments, accolades and promotions! E-mail us today at public_health@brown.edu.

community psychiatry. Her primary research interests are reproductive health behaviors and reproductive rights of women with mental illness. She looks forward to a career in which she can utilize her BSSI training to maximize reproductive choice and improve reproductive health outcomes among this underserved, stigmatized population.

Sarah Goddard, BA Community Health ’14 Sarah is pursuing a dual master’s in International Affairs and Public Health at Columbia University’s School of International and Public Affairs and Mailman School of Public Health. Her academic focus is on health and sustainable international development, particularly in urban contexts. After graduating from Brown, Sarah served with AmeriCorps in Springfield, MA on a community health and development project focused on public safety and noncommunicable diseases through the national BUILD Health initiative. During the summer 2017 she interned at the United Nations Development Programme in the HIV, Health and Development group in New York City. She is currently providing research support to faculty in Sociomedical

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Sciences on menstrual hygiene management and the Sustainable Development Goals (SDGs), and she is part of a capstone providing recommendations to a foundation in Bogota, Colombia on measuring progress toward the SDGs at the city level.

Madeline Benz, Sc.M. Behavioral and Social Sciences Intervention ’15 Madeline is currently in her second year of the Clinical Psychology Ph.D. program at Clark University in Worcester, Massachusetts.

Clinically, her cohort has been completing cognitive and personality assessments with children, as well as individual psychotherapy with adults.

In the research domain, she is collecting data for a project examining the compound impact of substance use and gender/ sexual minority stigma on help-seeking behaviors and intentions. Additionally, this past year she published a paper in Substance Use and Misuse entitled, “Offcampus residence as a risk

factor for alcohol misuse among college students.”

This publication was a collaborative effort with her mentors and colleagues at the Center for Alcohol and Addiction Studies at Brown.

Elizabeth Kinnard, Sc.M. Behavioral and Social Sciences Intervention ’15 Elizabeth is currently a Project Coordinator in the Department of Sociomedical Sciences at Columbia University’s Mailman School of Public Health, under the mentorship of Drs. Morgan Philbin and Lisa Metsch. She works on three primary projects: a NIDA-funded K01 examining the relationship between state-level policies and HIV-related risk behaviors among sexual minority youth; a Women’s Interagency HIV Study (WIHS) on biobehavioral HIV prevention and treatment modalities; and an Adolescent Trials Network (ATN) study on transition from adolescent to adult HIV care. Elizabeth is currently applying for Ph.D. programs in

Epidemiology and hopes to begin her doctoral studies in the fall of 2018.

Her research interests include substance use and addiction, drug policy, infectious diseases, stigma, and criminalization.

Mya Roberson, BA Public Health ’16 Mya is currently a second year Epidemiology doctoral student in the UNC-Chapel Hill Gillings School of Global Health. This past fall, she presented in Atlanta at the American Association for Cancer Research (AACR) Science for Cancer Health Disparities Conference.

At this conference, she presented an abstract entitled “Premenopausal Gynecologic Surgery and Breast Cancer Mortality in the Carolina Breast Cancer Study” and won an AACR Scholar-in-Training Travel Award for her abstract.

Recently it has been announced that she has been selected as a Robert Wood Johnson Foundation Health Policy Research Scholar.

Make your impact on the world!

Introducing the NEW Global Public Health Master’s Program

Learn public health by doing public health 8-week international field work experience Student-centered learning

To learn more, visit brown.edu/publichealth

12 courses Brown’s intellectual independence Join our community of scholars brownpublichealthmagazine.com

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ALUMNI SPOTLIGHT

Maximizing Good in the Global Cancer Fight

Andri Chybisov MPH ’17 TELL US ABOUT YOUR CURRENT ROLE AT THE AMERICAN CANCER SOCIETY? In developed countries, a cancer fight means hope. In low- and middleincome countries, it almost inevitably means pain, suffering, and death.

Three days after graduating with my MPH from Brown, I started work as the program manager for Global Capacity Development and Patient Support at the American Cancer Society. We support 59 cancerfocused civil society organizations in Kenya and Uganda. The goal is to create a critical mass of NGOs that can successfully work with their governments in fighting cancer and meeting the overwhelming demand for quality prevention and care that the over-strained health systems are unable to meet. We make small, but strategic, investments in the countries we work with to help change this situation through improved advocacy, planning, data use for decision making, and increased transparency.

YOU BECAME INVOLVED WITH THE PEACE CORPS IN UKRAINE IN 2005. TELL US ABOUT THE WORK YOU DID AND WHY IT WAS IMPORTANT TO YOU. Before coming to Brown in 2015, I worked for U.S. Peace Corps/ Ukraine for almost 10 years, where I managed the agency’s PEPFARfunded HIV Program. I started in an administrative capacity, but soon I found that many health inequalities stem from stigma and discrimination.

We decided to build our program around fighting stigma aimed at vulnerable populations and educating health professionals. Eventually, I came to realize that, in order to 32

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effectively manage health programs, I needed to improve my public health research skills – and that’s why I went back to graduate school.

WHAT ARE THE MAJOR BARRIERS YOU FACE WHEN ATTEMPTING TO SOLVE HEALTHCARE ISSUES WITHIN YOUR ROLE? ARE THEY POLICY ORIENTED? SOCIAL? RESOURCE?

By Karen Scanlan

system. This is a prime example of successful cooperation between the government and international donors, led by patient activists. This is what we are now trying to achieve in the cancer space.

HOW DID BROWN PREPARE YOU TO TACKLE CONTEMPORARY ISSUES IN GLOBAL PUBLIC HEALTH?

Not a day goes by without my From my experience in Ukraine and recalling something from my in Africa, lack of health awareness, coursework or research at Brown. severe underfunding of health Two years ago, I was examining programs, and corruption are some the phenomenon of epidemiologic of the major barriers to health. In the transition as part of Dr. McGarvey’s global context, one cannot assume “Burden of Disease in Developing that governments will always act with Countries” course; and today, I the best interests of their population support programs in countries which in mind, so engaging a multitude of are increasingly suffering from nonstakeholders, including state servants, communicable diseases, such as civil society, private entities, and cancer, in addition to the “traditional” international organizations is critical burdens of malaria, HIV/AIDS, and to the success of a large-scale other infectious diseases. Brown health intervention. taught me to look at the distribution of disease through the lens of social The experience of All-Ukrainian determinants of health, and I help Network of People Living with HIV/ our participating organizations to AIDS is a great example of success. be more effective and efficient in When the Network was created addressing those determinants and in 2000, HIV treatment was not eliminating disparities in access to available in the country, health quality health care. workers would loudly announce patients’ HIV test results in crowded clinic hallways, pregnant HIVpositive mothers were advised to get abortions, and getting HIV meant slowly dying in shame. Today, the Network is a major watchdog for Ukraine’s health, an indispensable stakeholder working hand-in-hand with (and holding accountable) the Ministry of Health in launching the first major health reform aimed at turning the outdated, inefficient Soviet-era health care system into a modern public health

Brown taught me to collect, analyze, and use data, and to share it with partners. I am now using those skills to develop a data management plan for our program, to engage partners in meaningful conversations about the purpose of quality data collection, and to address research fatigue in communities where participants have been studied, observed, measured, and stratified without much visible benefit to those communities. The discussions we had at Brown on

“

While at Brown, I realized that the maximum good for the maximum number of people should not be achieved at the expense of minority populations.

“

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ALUMNI SPOTLIGHT

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global health research ethics and community engagement are now very real in my daily job.

While at Brown, I realized that the maximum good for the maximum number of people should not be achieved at the expense of minority populations. Thanks to Dr. Operario’s LGBT Health class and his excellent mentorship, I always keep gender aspects of health in mind when designing programs or analyzing results.

My studies at Brown were sponsored by the Brown University-Ukraine Collaboration, a global health research group led by Dr. Tim Flanigan that does extensive research with the Ukraine medical community and civil society. I contributed to the Collaboration by working with an LGBT organization to help them evaluate an innovative HIV testing intervention in Ukraine. I found that

Internet-based interventions have great potential for bringing highly stigmatized populations into the cascade of HIV prevention, care, and treatment, but only if those services are organized with adequate standards of confidentiality. I still work with the group on crafting funding proposals and helping them to scale up their interventions.

WHAT IS YOUR ADVICE FOR STUDENTS IN THE PROGRAM NOW ON HOW TO PREPARE FOR A CAREER IN PUBLIC HEALTH? I cannot overstate how important practical experience is for your academic success, but even more so, for your future career. Any internship experience, paid or not, any class project experience, may be used to improve and showcase your professional skills. My month-long academic internship turned into a job offer after graduation.

“

“

The discussions we had at Brown on global health research ethics and community engagement are now very real in my daily job.

Another thing you’ve heard dozens of times: Your quantitative skills are important. My goal at Brown was to learn biostatistics to the extent that I would not fail the finals. I succeeded, but in the process, I learned to appreciate the tables in academic papers – those that used to scare me into reading just the conclusion section. Now, even though I am not a data analyst, I use those skills daily, and provide feedback on our partners’ data analysis and presentation.

Finally, be attentive to your resume and cover letters. In my current position, I’m surprised how many capable candidates make formatting errors or forget to craft their cover letters to the position they are applying for, or fail to follow up with a thank-you note. Those three little steps do not always go without saying – so make sure you follow those!

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Continuum Magazine of the Brown University School of Public Health

Winter 2018

Editors

Karen Scanlan Laura Kallio Joyce

Designed and Produced By

Brown University Office of University Communications

Contributors

Meghan Gonsalves, Sc.M. ’18 David Orenstein

We love feedback!

Please send your suggestions to public_health@brown.edu.

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Continuum / Winter 2018

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121 South Main Street Providence, RI 02912, USA P: 1.401.863.3375 F: 1.401.863.3713 public_health@brown.edu

TODAY’S STUDENTS / TOMORROW’S HEALTH LEADERS Sylvia Shangani was the first girl from her Kenyan village to attend a national secondary school.

She went on to Moi University, where she studied Public Health, and then came to Brown to pursue a master’s degree.

Sylvia is now completing her doctoral studies, working toward a Ph.D. in Behavioral and Social Health Sciences in the School of Public Health. She plans to use the training she’s received to develop effective interventions in the global fight against HIV/AIDS. Your support of the School of Public Health helps students like Sylvia pursue their dreams while improving health worldwide.

Make your gift today at gifts.brown.edu Questions? Email rebekah_mckinney@brown.edu

SYLVIA SHANGANI Sc.M. ’14,PH.D. ’19 BEHAVIORAL AND SOCIAL HEALTH SCIENCES