Volume 1 / Spring 2015
Education / p. 06
research / p. 12
• Seed to plate • MD/MPH • A world of opportunity
• Searching for answers about Alzheimer’s • The tween brain on video games
practice / p. 20
• Brownsville, Texas: award-winning city • Combating childhood obesity
Pioneers
new faculty / p. 30 • Learn more about the exciting new additions to our team.
The University of Texas School of Public Health
DALLAS EL PASO AUSTIN
HOUSTON
SAN ANTONIO
Working to improve the state of health in texas
BROWNSVILLE Houston | Austin | Brownsville | Dallas | El Paso | San Antonio
Giuseppe N. Colasurdo, M.D. President, The University of Texas Health Science Center at Houston (UTHealth) Osama I. Mikhail, Ph.D. Interim Dean, The University of Texas School of Public Health; Senior Vice President for Strategic Planning, UTHealth Hector Balcazar, Ph.D. Regional Dean, El Paso Regional Campus L. Kay Bartholomew, Ed.D. Associate Dean, Academic Affairs Eric Boerwinkle, Ph.D. Department Chair, Epidemiology, Human Genetics and Environmental Sciences Margaret O. Caughy, Sc.D. Interim Regional Dean, Dallas Regional Campus Linda Lloyd, Ph.D. Associate Dean, Public Health Practice Joseph McCormick, M.D. Regional Dean, Brownsville Regional Campus Laura Mitchell, Ph.D. Associate Dean, Research Robert Morgan, Ph.D. Department Chair, Management, Policy and Community Health Cheryl L. Perry, Ph.D. Regional Dean, Austin Regional Campus Debra Ryan, M.Ed. Associate Dean, Management Mary Ann Smith, Ph.D. Associate Dean, Student Affairs Barbara Tilley, Ph.D. Department Chair, Biostatistics Melissa Valerio, Ph.D. Regional Dean, San Antonio Regional Campus Sally W. Vernon, Ph.D. Department Chair, Health Promotion and Behavioral Sciences Erin Meade Director of Development
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Welcome
Public Health: Social Justice in Action How would you define public health? I had the good fortune of graduating from two fine schools of public health. There is no question that the experience and knowledge gained at these schools changed my life forever. Yet, had I been required to define public health at either of my commencement ceremonies, there might have been a fair amount of stammering and hesitation on my part. Yes, I knew the official definition of public health, “The science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals.” While this definition was factually accurate, it was far more challenging to communicate on an emotional level — one might even say on a spiritual level — what public health was all about.
Raymond S. Greenberg, M.D., Ph.D. joined The University of Texas System as executive vice chancellor for Health Affairs on September 9, 2013. He is responsible for the six UT System health institutions.
Capturing the true essence of public health first arose as a personal challenge when I became the founding dean of the Rollins School of Public Health at Emory University. After a few months as dean I had a breakthrough when I began characterizing public health efforts in terms of the concept of social justice. Our core purpose — whether as epidemiologists, biostatisticians, management experts, behavioral or environmental scientists — was to empower people to reach their full potential. One cannot have a truly just society if some people, by virtue of their place within it, suffer disproportionate burdens of disease and illness. Our task as public health professionals was and is to level the playing field: to address those factors that leave many people with disadvantaged health status, and as a result, impede their ability to compete and succeed within society. Now I have the pleasure of working with the top school of public health in Texas — The University of Texas School of Public Health. I can see that the school’s leadership, faculty, staff, students and alumni take the task of promoting public health — as I defined it those many years ago — very seriously. Inside this inaugural issue of Pioneers, you’ll find compelling examples of how the school is improving our health and our lives: from unlocking the genetic mysteries of Alzheimer’s disease to combating childhood obesity. The school’s focus on excellence in education, research and practice in the community is making a remarkable difference in our home state and beyond. We can all admit that there is a lot of room for improvement in how health and health care are distributed in this country, and Texas is certainly no exception to that rule. The question is: what are we going to do about it? The School of Public Health is investing in proven programs and new initiatives that make a tangible impact on the health of people around the world. Supporting the school’s efforts are an incredibly diverse faculty and student body at six campuses across Texas — all eager to advance the cause of public health, and work toward a brighter future. But individuals can also make a difference in the perception of public health and its support in the community. My challenge to you is to become an example to others — arouse and stir your friends and neighbors to action. Remember that public health is not just a profession — it is a calling. You have the opportunity to be a champion for social justice. The future of the world depends upon it.
in this issue P. 08
Campus news / p. 04 Education / p. 06 Seed to plate / P. 06 In demand: MD/MPH / P. 08 A world of opportunity / P. 10
Research / p. 12
P. 06 P. 10
Searching for answers about Alzheimer’s / P. 12 The tween brain on video games / P. 14 Bringing clinical trials to life / P. 15 Claims data yields new research projects / P. 16 Research highlights / P. 17
P. 12
Practice / p. 20
P. 14
Brownsville, Texas: award-winning city / P. 20 Combating childhood obesity / P. 22 Improving safety for Bangladeshi garment and textile workers / P. 26
addressing Ebola / p. 28 Welcome New Faculty / p. 30 game changers / p. 31
P. 20
P. 22
Editor
The University of Texas School of Public Health has six campuses across Texas: Houston as well as Austin, Brownsville, Dallas, El Paso and San Antonio. The School of Public Health works to improve the state of public health in Texas every day. The main campus, located in the heart of Houston’s Texas Medical Center, offers students unmatched opportunities for research and employment. Each of the regional campuses has its own faculty and research specialties. Students can attend class at any of the six campuses via Interactive Television (ITV). The School of Public Health is one of six schools at UTHealth, the most comprehensive academic health system in The University of Texas System and the U.S. Gulf Coast region. In addition to the School of Public Health, UTHealth is home to schools of biomedical informatics, biomedical sciences, dentistry, medicine and nursing. It also includes a psychiatric hospital, numerous institutes and centers, a growing network of clinics and outreach programs in education and care throughout the region. The School of Public Health is accredited by the Council on Education for Public Health (CEPH) and the university is accredited by the Southern Association of Colleges and Schools (SACS).
Shannon Neufeld
contributors
Anissa Anderson Orr Brooks Ballard John Evans Shannon Neufeld Hannah Rhodes
Office of Development
Erin Meade, Director of Development Olivia Koshy, Development Specialist Send your news or comments to: pioneers@uth.tmc.edu
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campus news Each of our six campuses is strategically placed across the state to meet the public health education, research and practice needs of our diverse populations. Here is a closer look at what has been happening on our campuses:
san antonio
el paso
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Melissa Valerio, Ph.D., M.P.H. named regional dean, after serving as interim dean following the retirement of Sharon Cooper, Ph.D.
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Hector Balcazar, Ph.D., regional dean
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136 students enrolled in the fall of 2014 (96 graduate M.P.H. and doctoral; 40 M.D./M.P.H.)
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33 students enrolled in fall of 2014
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As part of his sabbatical in Mexico City, Balcazar helped implement a community health worker program in Mexico to promote healthy eating and active living as a means of preventing cardiovascular disease and diabetes.
Kristina Walker Whitworth, Ph.D. awarded an R03 by the National Institute of Environmental Health Sciences (NIEHS) to fund research on the effects of fracking on perinatal health.
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150 promotoras (members of the community) attended health worker training at the Annual Meeting of the Paso del Norte Red De Promotora Network, facilitated by El Paso Regional Campus.
David Douphrate, Ph.D. received two awards from the National Institute for Occupational Safety and Health (NIOSH) to investigate improving safety in logging operations and a one-year Occupational Safety & Health Administration (OSHA) Susan Harwood Targeted Topic Training Grant focusing on safety training in large-herd dairy workers using a mobile-learning platform.
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$1.6 million in research awards for faculty in 2014*
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Kristina Mena, Ph.D., participated in a national advisory panel to oversee the development of a direct potable reuse system in El Paso, which will provide an example for others nationally and internationally.
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The campus is collaborating with the newly created Institute for Healthy Living to develop innovative community health worker projects in the U.S.-Mexico border.
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$609,000 in research awards for faculty in 2014*
brownsville •
Joseph M. McCormick, M.D., regional dean
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28 students enrolled in fall of 2014
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29 students enrolled in new collaborative program with UTHealth School of Biomedical Informatics, creating a health informatics work force for the Lower Rio Grande Valley area of South Texas
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Offering new degree programs including: A 4+1 B.S./M.P.H. program with The University of Brownsville (to become University of Texas Rio Grande Valley in 2015); and an M.D./M.P.H. program with University of Texas Rio Grande Valley School of Medicine for 2016.
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Participating in Project DOC, a newly-initiated UT System program using big data and cutting edge technology to address obesity and diabetes in the Rio Grande Valley.
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The City of Brownsville in collaboration with the School of Public Health was awarded Robert Wood Johnson Culture of Health Award for 2014.
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$3 million in research awards for faculty in 2014*
dallas •
Margaret Caughy, Ph.D., professor of Health Promotion and Behavioral Sciences, named interim regional dean beginning in January 2015, following the retirement of Raul Caetano, M.D., Ph.D.
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65 students in fall of 2014; 14 students enrolled in M.D./M.P.H. program, launched in 2013
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The Maternal and Child Health training program, led by Caughy, was recently approved for an additional five years of funding, totaling nearly $900,000.
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Bijal Balasubramanian, Ph.D., assistant professor of epidemiology, received the School of Public Health’s 2014 Front of the Envelope (FOTE) award, given to projects that have the potential to change research paradigms, for her proposal, “Systems Science Methodology to Study Complex Cancer Survivorship Care.”
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8 newly funded grants in 2014.
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$1.6 million in research awards for faculty in 2014*
Houston •
Osama Mikhail, Ph.D. named interim dean, following the stepping down of Dean Roberta Ness, M.D. National search underway for new dean
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829 students
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New awards include a $1.6 million Department of Homeland Security Emergency Preparedness and Response grant to Susan Day, Ph.D. to test the effectiveness of an Internet and mobile-based health and wellness program for firefighters, and a $2 million Texas Department of Insurance (TDI) grant to promote health care price transparency and increase health literacy around prices. Lee Revere, Ph.D. is lead investigator for the TDI project.
austin
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Cheryl L. Perry, Ph.D., regional dean
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181 students enrolled at the Austin Regional Campus in the fall of 2014.
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$4.5 million grant to renew funding for the Michael & Susan Dell Center for Healthy Living.
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New 7,600 square foot research offices located in downtown Austin, just one block from the regional campus.
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Offering new degree programs including: New 4+1 B.S./M.P.H. program with The University of Texas at Austin, planned M.D./M.P.H. degree for 2016, in partnership with the new Dell Medical School at The University of Texas at Austin.
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$13.4 million in research awards for faculty in 2014*
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The School of Public Health raised funds to add new components to its Dietetic Internship Program. New developments include a culinary center, holistic garden, and simulation and assessment skills center.
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The George McMillan Center for Healthcare Management acquired claims data from Blue Cross Blue Shield of Texas, Truven Health Marketscan Database, Texas Medicaid, Medicare, Urgent Care Clinic Data and now allows controlled access to qualified researchers.
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Offering new 4+1 B.S./M.P.H. program with the University of Houston
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$37 million in research awards for faculty in 2014*
* 2013/2014 fiscal year (Sept. 1, 2013-Aug. 31, 2014)
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education
from
seed plate
The United States has been facing an obesity epidemic for more than a decade. The statistics are staggering: according to the Centers for Disease Control, 69 percent of American adults are overweight, including those who are obese (obesity adds up to 35 percent of adults). Children between ages six and 19 are facing obesity numbers of about 18 percent.
Taking these numbers into consideration, it is important to note that the key to health has a lot to do with what one puts into the body. The Dietetic Internship Program at The University of Texas School of Public Health is focusing on whole foods and community education, acting as a nutrition hub to help Texans understand the importance of good nutrition. Some new developments are underway as the school raises funds for new state-of-the-art-facilities: a culinary center, holistic garden, and simulation and assessment skills center. The internship program is part of the Michael & Susan Dell Center for Healthy Living on the school’s Austin Regional Campus, though the internship program and these upcoming developments are based in Houston.
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The Culinary Center rendering
to
The culinary center will be available to students in the Dietetic Internship Program for education and research. The culinary center will enable faculty members to teach a structured curriculum of healthy cooking techniques. Nutrition classes will be available with a focus on medical nutrition therapy. Students in the internship program will lead classes on disease-specific diets (e.g. for diabetes and heart disease). Culinary center courses will be open to patients from UT Physicians clinics and other health care facilities, and will serve as a training kitchen for school educators throughout the region.
The holistic garden, located just outside the school’s back door, will be available to School of Public Health students as well as the community, allowing for a focus on seed-to-plate nutrition. The garden will be designed by a holistic garden architect and feature fruits and vegetables maintained by a dietetic internship garden club. Produce harvested from the garden will be prepared in the culinary center, providing a sustainable seed-to-plate model for interns.
The simulation and assessment skills center will provide a high-tech setting for students to build skills in nutrition care, recognizing the signs of malnutrition and inflammation, and responding to obesity, diabetes, cardiovascular disease and other medical conditions. These subjects will be addressed through a range of lectures and hands-on demonstrations to actively engage participation and improve learning while faculty observe and offer guidance. Laura S. Moore, M.Ed., R.D., L.D., and Jeanne E. Piga-Plunkett, M.S., R.D., L.D. are co-directors of the Dietetic Internship Program. Moore says the culinary center, garden and skills center are not only a draw for the school’s students, but also for establishing partnerships with other institutions.
“We envision our resources as a training ground, boot-camp type of environment for the Texas Medical Center,” says Moore. “Our medical-nutrition therapy classroom will
education / from seed to plate offer adult and pediatric nutrition-focused physical assessment courses. They’re designed either for dietetic internship students or even medical students, which will be great.” Moore says the new culinary center will be an opportunity to offer healthy cooking classes, nutrition education to students and the community. “We’ll also be coordinating the garden and the culinary center, so the harvest from the garden will be presented in the center’s kitchen,” says Moore. Faculty TRASH RECEPTACLE
members of the program are working on building courses around the garden and the culinary center, and educational classes for local school teachers will be offered in a “train the trainer” environment. “We’re hoping the garden and culinary center will be complete by late 2015 — that’s our goal right now,” says Moore. This university and community volunteer collaborative initiative was launched by Moore and her husband, Don Sanders, with a generous PLANTED ARCH PEDESTRIAN LIGHTING
BENCH
EXISTING TREES
GARDEN PLANTER W/ 18” GABION WALL
$650,000 gift. UTHealth and the School of Public Health also provided funding for the project. Generosity from the School of Public Health Advisory Council chair, Sue H. Smith, will help meet the ongoing needs of this project, ensuring it has ever-renewing resources to change lives. As the nutrition hub for the Texas Medical Center, the School of Public Health has just recently established a nutrition concentration. Students studying health promotion and epidemiology are likely candidates for the new concentration.
FRUIT TREES TABLES+SEATING GARDEN PLANTER W/ 32” GABION WALL
>> Program faculty
DECOMPOSED GRANITE 12” CONCRETE MOW STRIP
members
R. Sue Day, Ph.D. Associate Professor of Epidemiology. Deanna M. Hoelscher, Ph.D., R.D., L.D. John P. McGovern Professor in Health Promotion, Director of the Michael & Susan Dell Center for Healthy Living at The University of Texas School of Public Health Austin Regional Campus.
4’ GREENSCREEN WALL
Garden rendering
Laura S. Moore, M.Ed., R.D., L.D. Co-Director of the Dietetic Internship Program.
4’ GREENSCREEN WALL BENCH
TRASH RECEPTACLE
Jeanne Piga-Plunkett, M.S., R.D., L.D. Co-Director of the Dietetic Internship Program.
EDIBLE SHRUBS PEDESTRIAN LIGHTING PLANTED ARCH UTHSC EDIBLE GARDEN ILLUSTRATIVE PLAN
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About the Dietetic Internship Program Students enrolled in the Dietetic Internship Program are enrolled in the School of Public Health’s Master of Public Health degree program. Upon completion of the internship (which requires 1,270 hours during a two-year period — far more than a usual practicum), students are able to take the registered dietitian examination given by the Academy of Nutrition and Dietetics. Currently the program accepts nine students each year, and plans to double that in the future. The program includes coursework in the fall and summer, with supervised practice in the spring including a five-week rotation in a community environment such as a wellness program, the WIC program, UTHealth, UT Physicians, the City of Houston, the HE/AL program (Healthy Eating Active Living) or the School of Public Health’s Brighter Bites program at the Houston Food Bank.
After the five-week rotation, students move into a hospital food-service rotation, followed by a four-week school foodservice rotation. Students typically do hospital rotations at major hospitals in Houston such as The University of Texas MD Anderson Cancer Center, Memorial Hermann, Texas Children’s Hospital, North Cypress Medical Center, Houston Methodist, and more. For the school rotations, student work in all the major Houston-area independent school districts. In the summer, students complete one week of seminars for diabetes followed by a five-week seminar touching on all areas of diabetes. This prepares students for diabetes camp at Camp Rainbow or Texas Lion’s Camp. Students work for a week with children who have type 1 diabetes and their siblings.
Shreela Sharma, Ph.D., R.D., L.D. associate Professor of Epidemiology, Assistant Director of the Dietetic Internship Program. Read more about the faculty members on at http://go.uth.edu/DIfaculty
During the following spring, students in the program complete 11 weeks of clinical work and four weeks of specialty work. Clinical takes them through all the departments of a hospital such as pulmonary, cardiac, renal, pediatrics, “It’s quite an intense rotation,” says Moore. “They are shadowing dietitians, but they’re actually making the assessments,” much like a doctor completing a residency, says Moore. During the specialty training, students choose to work in one of those departments, learning about dietetics on a more detailed level for that area of health care. After students complete their competencies, they take the registered dietitian exam and are ready to work as entry level dietitians.
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Photo by Nash Baker
education
in demand
Academic affairs staff Sam Neher (left) and Sylvia Salas (center) helped student Jacob Gross (right) custom-design a degree that reflected his interests.
M.D./M.P.H. degree appeals to doctors pursuing diverse specialties It’s Match Day, the established rite of passage when medical school students learn where they will be completing their residency. On this anxiety and joy filled occasion, School of Public Health student Jacob Gross crosses his fingers for his pick of programs, and lets out a whoop of excitement and relief when he reads the results. He’s headed to the University of Washington in Seattle for a residency in anesthesiology — a specialty not typically associated with public health. “People think that the M.P.H. chiefly goes with primary care specialties,” says Gross, who will graduate with a dual degree in medicine and public health from UTHealth Medical School and the School of Public Health. “But I believe it provides valuable experience in research and public health, including principles in epidemiology and biostatistics that are
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important if you plan to pursue evidencedbased medicine in your career.”
Growing demand for M.D./M.P.H. Increasingly, students like Gross see the M.P.H. as a natural complement to their medical school education, no matter what field of medicine they plan to pursue after graduation. Recent news stories — from the rollout and implementation of the Affordable Care Act to the Ebola crisis — underscore the mounting significance of public health education for physicians. Alumni from the School of Public Health’s M.D./M.P.H. programs have gone into a wide range of medical specialties including surgery, ophthalmology, otolaryngology, psychiatry and urology. “The M.D./M.P.H. program is the most popular M.P.H. dual-degree program in the nation,” says Sam Neher, a program manager
with the School of Public Health’s Office of Academic Affairs, adding that M.D./M.P.H. students account for more than 20 percent of the school’s student population. “What we hear from students in the M.D./M.P.H. degree program, regardless of their stage, is the difference the M.P.H. makes in how they see patients. The M.P.H. allows students to think of patients as more than just individuals, but also as part of a population.” The School of Public Health laid the groundwork for its M.D./M.P.H. programs in the 1990s through collaboration with UTHealth Medical School, and launched its first official M.D./M.P.H. program in 2007, a partnership between The University of Texas School of Public Health San Antonio Regional Campus and UT School of Medicine at San Antonio. Since then, the school has teamed up with Baylor College of Medicine, UTHealth Medical School,
education / in demand
“I don’t think it matters which field of medicine you pursue. The M.D./M.P.H. gives you a broader picture of the health care system and how the patient sitting in front of us fits into that. I think it makes you a better physician.” - Eric Crowell, M.D./M.P.H. student
Texas Tech University Health Sciences Center Paul L. Foster School of Medicine and UT Southwestern School of Medicine, graduating a total of 104 students. “Our MD/MPH programs are customized to meet the unique curricula and objectives of our medical school partners,” says L. Kay Bartholomew, Ed.D., M.P.H., associate dean for Academic Affairs. “No two are the same.” The school will expand its M.D./M.P.H. program once again in 2016, partnering with two planned Texas medical schools: Dell Medical School at The University of Texas at Austin and The University of Texas Rio Grande Valley School of Medicine, continuing its mission to provide MD/MPH programs for all medical schools in The University of Texas system.
Dual degree broadens perspective While medical school education is clinically based and targets individual patients, the public health side of the dual degree broadens a student’s perspective by focusing on five core disciplines: biostatistics, epidemiology, environmental health, health promotion and behavioral sciences, and management, policy and community health. The M.P.H. degree program also teaches students how to conduct research and write in a scientific way, says Sylvia Salas, M.P.H., executive director of the Office of Academic Affairs and assistant dean of academic administration. “Alumni often tell us that the program helps them thoroughly understand research literature, which is invaluable for patient care. For example, when deciding what medication to give to their patients, they can determine whether the supporting research was done well.” Overall, the program’s well-balanced curriculum teaches students how patient health is linked to community health. The M.P.H. “opens the door for students to go into research or academic medicine, and prepares them to be leaders within their fields,” Salas adds.
Further enriching their academic experience, M.D./M.P.H. students attend class and collaborate with other students diverse in age, background and previous education, including currently practicing professionals as well as students working in the field. Shared credit courses let students graduate in four or five years, depending on where they complete their dual degree, saving valuable time and money. Adding to the program’s flexibility, students can take select M.P.H. classes online. Academic Affairs works closely with students to tailor the program to meet their interests and educational goals, and to keep them on track.
Program meets diverse interests
>> Leading the way The University of Texas School of Public Health M.D./M.P.H. students are following their passion for public health, and winning national recognition for their efforts. In 2014, M.D./M.P.H. students Steven Blake Baker, Chetna Pande and Andy Billnitzer received the Center for Disease Control and Prevention (CDC) 2014 Excellence in Public Health award from the United States Public Health Service for their innovative work on integrating public health in clinical settings.
Chetna Pande and Andy Billnitzer
In Gross’ case, Academic Affairs staff helped him design a degree that included a wide variety of public health courses, heavy on health care management, policy and research, but also representing other core disciplines. “I wanted a solid foundation in public health that would be applicable in any field,” says Gross, who is completing his M.D./M.P.H. in five years, having spent his third year focused on public health. “Academic Affairs was great about helping me arrange my schedule so that I could fit everything into one year.” Eric Crowell, M.D., M.P.H., an alumnus with the program at UTHealth Medical School and a current ophthalmology resident, was interested in health care policy, so he was steered toward an M.P.H. degree in Management, Policy and Community Health. Crowell says his education has prepared him well for a career in academic medicine and will help him follow his passion for health care advocacy. “In the future, my M.P.H. will help me analyze policy and give me insight on how policy affects my patients, which will enable me to better advocate for them,” he says. “I don’t think it matters which field of medicine you pursue. The M.D./M.P.H. gives you a broader picture of the health care system and how the patient sitting in front of us fits into that. I think it makes you a better physician.”
Steven Blake Baker
Beverly Patuwo
Beverly Patuwo, a fourth-year medical student at Baylor College of Medicine in Houston earning her Master of Public Health degree in the Department of Health Promotion and Behavioral Sciences, was selected as the District VII representative for the American Academy of Pediatrics section on Medical Students, Residents and Fellowship Trainees.
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education
A world of opportunity Beyond the books, lecture halls and papers to be written — there’s a world of public health waiting to be discovered. If you’re a Master of Public Health student at The University of Texas School of Public Health, that world is right at your doorstep. With its main campus located in the heart of the Texas Medical Center, the world’s largest medical complex, and five regional campuses throughout Texas, the School of Public Health offers students a dynamic environment from which to launch their discovery. Before graduating, each M.P.H. student completes a practicum: 180 hours of hands-on experience in a community setting. Akin to a medical-school residency, the practicum is an essential part of a student’s public health education, says Linda Lloyd, Ph.D., associate dean in the School of Public Health’s Office of Public Health Practice. “That real world experience is so important because the Master of Public Health is a practice-oriented degree,” Lloyd says. “The practicum allows students to test the waters
Assessing water quality in Galveston
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before deciding what direction they want to take with their careers.” M.P.H. students typically finish their practicum after they have completed the five core courses required for an M.P.H. and are encouraged to complete at least 12 hours per week onsite. Lloyd calls the experience a “winwin, not only for our students, but for the community.” Community partners benefit from students’ passion for public health and their extensive classroom knowledge of public health practice and research. Students gain the opportunity to try something new, or apply their skills in a different setting. To broaden her community experience, M.P.H. student Margaret Raber, a graduate of Le Cordon Bleu London and a former writer for Wine Spectator magazine, chose a practicum with the Michael & Susan Dell Center for Healthy Living’s Brighter Bites program. Raber is helping teach low-income families how to select healthy foods and cook healthy meals.
Learning how to protect worker health
“I wanted some wider community experience, and the practicum gave me the opportunity to branch out,” says Raber, adding that the Brighter Bites’ focus on community-based research enriches her public health skillset, and gives her valuable insight for planning her doctorate. “It was a great experience that really informs a lot of what I hope to do in the future.” At the conclusion of their practicum, students detail their experiences in e-magazines, which are posted on the Office of Public Health Practice’s website. Below, we’ve excerpted some recent e-magazines that highlight the diversity of practicum experiences at the School of Public Health.
Learning how to protect worker health
Mark Lies, an M.P.H. student of environmental and occupational health sciences, spent his summer practicum at Baker Hughes Incorporated, an oilfield services company headquartered in Houston.
M.P.H. student Margaret Raber teaches low-income families with the Brighter Bites program how to select healthy foods and cook healthy meals.
Expanding parenting programs
education / a world of opportunity
During his practicum, he monitored workers in Texas and Pennsylvania for exposure to air contaminants and excess noise. Lies says his practicum taught him the processes involved in field monitoring, and helped him evaluate whether or not he wanted to pursue a career in industrial hygiene. “The practicum was very well organized and exposed me to almost every aspect of what my career as a beginning, practicing industrial hygienist will involve.”
Assessing water quality in Galveston bay As a water quality intern with the Galveston Bay Foundation, Tanu Uppal collected and analyzed water samples from two marinas in Clear Lake (located near Galveston Bay, south of Houston), to assess the overall health of the water. The water quality data she collected will support regulatory agencies that monitor the health of Texas watersheds. “I remember as a teenager complaining to my parents, ‘I don’t want to go to Galveston beach. It’s dirty,’” says Uppal, who is earning her M.P.H. in environmental and occupational health sciences. Through her practicum, Uppal gained an appreciation of the unique beauty of Galveston Bay, as well as a desire to address the environmental factors threatening it. “These issues are solvable if we work to find answers and educate others about what we have found, so that future generations will regard the bay as something of which to be proud — not embarrassed.”
Expanding parenting programs During her summer practicum at Children at Risk’s Center for Parenting and Family Well-Being, Hannah Vardy helped evaluate the results of Triple P (Positive Parenting Program), finding that the program helped increase parenting knowledge and skills and decreased child behavior problems. Vardy, an M.P.H. student in the Department of Management, Policy and Community Health, also researched and drafted bills concerning the expansion of parent education in Houston and Texas, furthering her interest in policy work and policy analysis. “And because Children at Risk collaborates with many different organizations around Houston, I gained invaluable experience about interacting with other organizations and individuals working in the field.” she says.
“That real world experience is so important because the Master of Public Health is a practice-oriented degree,” Lloyd says. “The practicum allows students to test the waters before deciding what direction they want to take with their careers.”
>> New academic programs B.S./M.P.H. (4 + 1) Programs
Students in The University of Texas School of Public Health’s new 4 + 1 Bachelor of Science/ Master of Public Health (B.S./M.P.H.) program earn a bachelor’s degree in a variety of fields with a focus on public health and complete a B.S./M.P.H. in approximately five academic years rather than the traditional six years (four undergraduate and two graduate). Current partners include The University of Texas at Brownsville, The University of Texas at Austin and the University of Houston. Four other programs are in development state-wide.
Rice University Internship Programs
The Rice University-The University of Texas School of Public Health, Health, Humanism and Society Scholars Partnership program (HHASS) identifies School of Public Health faculty and administrators interested in mentoring Rice students majoring in Humanities or Social Sciences. The program allows Rice undergraduate students to earn course credit and receive valuable experience by assisting faculty and administrative members with their research or formal scholarship projects. Once accepted, students choose one specific research internship project with a year-long time span. (Program description provided by Rice University.)
Leadership Rice Mentorship Experience
This summer internship program for Rice University undergraduates matches students from all disciplines with mentors in public, private and non-profit organizations. In the summer of 2015, the School of Public Health will begin working with Rice to provide two to three selected Rice undergraduates with a research, practice and educational experience that focuses on leadership and professional development.
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research
Searching for answers about
Eric Boerwinkle, Ph.D., Human Genetics Center director
Alzheimer’s
They are the human miracles among us: the elderly grandmother next door who regales you with stories of her youth; the gregarious senior gentleman at church who always remembers you by name; your constantly texting and tweeting great aunt. They may be elderly and have a host of health problems, but their minds remain razor-sharp. Somehow, despite having risk factors for Alzheimer’s, or even a family history of the disease, these elderly individuals resist its torturous decline in memory and intellectual abilities. What makes them exceptional? Why are they protected from Alzheimer’s while others are not? That’s what researchers in the Human Genetics Center at The University of Texas School of Public Health are working hard to discover as a participating center in the National Institutes of Health (NIH) Alzheimer’s Disease Sequencing Project. Launched in 2012, the joint project with the National Institute on Aging and the National Human Genome Research Institute aims to advance understanding of the genetics of Alzheimer’s. As many as five million Americans age 65 and older are estimated to have the disease, and that number is only expected to increase. “Alzheimer’s is devastating, and it is growing in frequency as baby boomers age and we live longer lives,” says Eric Boerwinkle, Ph.D., director of the Human Genetics Center and one of the leaders of the project. “We desperately need effective treatments and preventive strategies.” Boerwinkle is also chair of the School of Public Health’s Department of Epidemiology, Human Genetics and Environmental Sciences.
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research / searching for answers about alzheimer’s
Making sense of big data Human Genetics Center researchers are analyzing the DNA of more than 11,000 study volunteers — 6,000 with Alzheimer’s and 5,000 without. The DNA data comes from flagship genome sequencing centers across the nation including the Human Genome Sequencing Center at Baylor College of Medicine in the Texas Medical Center, which is a frequent collaborator with the Human Genetics Center. NIH grants totaling $3.9 million fund Boerwinkle for a four-year study to investigate patterns in human DNA that either raise or lower the risk for Alzheimer’s. Analyzing such vast amounts of data (there are 3 BILLION letters in each genome) is an enormous undertaking, but one that the Human Genetics Center, with its extensive analytical expertise and sophisticated bioinformatics and computational tools, has ample experience handling. The Alzheimer’s Disease Sequencing Project comes close on the heels of the Human Genetics Center’s participation in the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Project, a collaboration between Baylor College of Medicine’s Human Genome Sequencing Center, DNAnexus, and Amazon Web Services that enabled what is believed to be the largest genomic analysis project to have ever taken place in “the cloud”— a network of remote servers hosted on the Internet and used to store, manage and process data. As part of their work, Human Genetics Center researchers analyzed the sequenced DNA of more than 14,000 individuals and identified a gene, PCSK9, that when “knocked out” or inhibited, lowers blood cholesterol levels and protects people from heart disease. The discovery led drug companies to develop PCSK9 inhibitors as a treatment for high cholesterol.
targeting Alzheimer’s Using this same approach, Human Genetics Center researchers are scanning each genome in the study sample for differences that may lead to clues about protection from Alzheimer’s and new drugs to lower the risk or treat the disease. “We are looking at the entirety of the genome, not the 2 percent that
Photos by Nash Baker
The Human Genetics Center, with its extensive analytical expertise and sophisticated bioinformatics and computational tools, has ample experience analyzing vast amounts of genetic data. From left to right: Center researchers Susan Rossi, Megan Grove and Genesis Williams.
we understand, but the 98 percent that we don’t,” Boerwinkle explains, comparing the targeting of specific areas of the genome to “looking for your keys under the street lights, when they were really lost in your back yard.” Casting a wide net is important, Boerwinkle adds, because more than just one gene or mutation protects people from Alzheimer’s. And because Alzheimer’s is so common and has so few treatments, scientists don’t need to find all the mutations or genes related to it, just those that provide insight on the disease’s biology and processes and can lead to novel therapies. “We don’t need a home run,” he explains. “We just need a series of solid base hits.”
“A major step forward” Identifying genes associated with Alzheimer’s would be a major step forward, in understanding the disease, agrees Myriam Fornage, Ph.D., a professor of molecular medicine and human genetics at The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases at UTHealth. Fornage is also a lead researcher on the Alzheimer’s Disease Project. She has devoted much of her career to studying neurological diseases. Most recently, she and her research team at the Institute for
Molecular Medicine analyzed the sequenced genetic data and brain scans of 2,500 people with traits related to Alzheimer’s. They found a correlation between Alzheimer’s traits, such as white matter lesions and smaller than normal brain volume, and genes related to high blood pressure. These findings, together with gene variants revealed through the Alzheimer’s Disease Sequencing Project, will hopefully create a more complete picture of how the disease progresses, Fornage says. “We’ll see if those genes show up in our research with the Alzheimer’s Disease Project,” she explains. “Will we find mostly genetic variants for neurodegenerative disease or vascular disease, or will we find a mixture of both? What we find out will help pave the way for potential new treatments for Alzheimer’s. Positively identifying those genes is the first step toward achieving that goal.”
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research
the tween brain on
video games Some tweens play violent video games to relieve boredom or boost their mood, but such attempts at catharsis may do more harm than good. Playing violent video games for a substantial amount of time each day is associated with increased symptoms of depression, according to research from the Center for Health Promotion and Prevention Research at The University of Texas School of Public Health. Susan Tortolero Emery, Ph.D.
“Previous studies have examined how aggression relates to video games, but this is the first to examine the relationship between daily violent video game exposure and depression,” says Susan Tortolero Emery, Ph.D., principal investigator and director of the Center for Health Promotion and Prevention Research. “We know that witnessing violence in real life is associated with mental health problems, and thought that the same might be true with video games. The brain doesn’t always distinguish between what we see on a screen and what happens in real life.”
In the study, published in the September 2014 issue of Cyberpsychology, Behavior and Social Networking, preadolescent youth who played violent video games for more than two hours a day had significantly more symptoms of depression than those who did not. This was especially true for males in the group — close to 16 percent played violent video games for more than two hours a day. Among African American males, that rate rose to 19 percent. The study assessed symptoms of depression as lack of pleasure, lack of interest in activities, concentration difficulties, low energy, low self-worth and having suicidal thoughts over the past year.
Researchers examined 5,147 fifth-grade students in three major cities, including Houston, as part of a longitudinal study called Healthy Passages, which followed study participants from fifth to tenth grade. In this racially and ethnically diverse group, students self-reported how often they played video games and how violent each video game was over a year-long period. The association between playing violent video games and depression was consistent across all racial and ethnic groups. Tortolero Emery, also a professor in the Department of Health Promotion and Behavioral Sciences at the School of Public Health, says it is important to investigate the now “ubiquitous behavior” of playing video games, adding that an estimated 97 percent of young people play them. “And while there are pro-social video games that have positive effects, we need to understand the negative effects as well.” Tortolero Emery and her colleagues at the Center for Health Promotion and Prevention Research are currently analyzing data from the Healthy Passages study to determine whether children exposed to violent video games in the fifth grade go on to be diagnosed with depression in the 10th grade. She expects to publish the results in the near future. Until then, findings from the most recently published study underscore the importance of helping children develop a wide range of interests. “Parents ask me if they should take away their kids’ video games,” Tortolero Emery says. “But based on our research, which found that playing video games for two hours or more was related to depression, I recommend limiting the amount of time kids spend playing video games, instead of banning video games completely. Kids need to maintain their connection with their peers. Involving your kids in a variety of activities limits their screen time automatically.”
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Bringing clinical trials
The center’s work has led to crucial insights into health issues impacting millions of Americans, including heart disease, diabetes and sickle cell anemia. Notably, the center’s landmark study of blood pressure medications, which was first published in 2002 and generated many subsequent articles, continues to change how physicians treat hypertension. More than 42,000 people participated in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), which found that diuretics or water pills matched or outperformed higher priced medications. “Our goal is to identify important public health problems and then design and coordinate clinical trials that help lead to novel discoveries,” says Barry Davis, M.D., Ph.D., center director and a professor of biostatistics. Future collaborations promise more breakthroughs, he adds. Here are some of the important public health questions the center is investigating:
Are there better ways to prevent strokes in children with sickle cell anemia? To find out, the center’s TWITCH (TransCranial Doppler With Transfusions Changing to Hydroxyurea) study investigated hydroxyurea therapy as a treatment for the disease — a serious genetic disorder that causes normal red blood cells to sickle or become crescent-shaped. The abnormallyshaped cells block blood flow to the blood
Start Study design, implementation, and oversight of study protocol and procedures
to life Photo by Nash Baker
Since its inception in 1971, the Coordinating Center for Clinical Trials at The University of Texas School of Public Health has led more than 20 nationwide clinical trials to success. Researchers and health care organizations across the country rely on the center’s staff to provide and coordinate the science, operations, procedures and activities necessary to run a large-scale randomized controlled clinical trial — a time-consuming and often complicated process.
Staff with the Coordinating Center for Clinical Trials have led more than 20 nationwide clinical trials to success.
vessels of limbs and organs, causing pain and organ damage. Researchers discovered that hydroxyurea therapy, which causes the body to make normal shaped red blood cells, offered a safe and effective disease management of sickle cell anemia and reduced the risk of stroke, prompting early termination of the trial sponsored by the National Heart, Lung and Blood Institute. This finding provides clinicians with more treatment options for reducing stroke risk in children with sickle cell disease.
What works best to control diabetes? Doctors often prescribe insulin therapy to improve glucose control in patients with type 2 diabetes. But keeping glucose levels steady can be a challenge, with too much insulin causing hypoglycemia and weight gain. The FLAT-SUGAR (FLuctuATion reduction with inSUlin and Glp-1 Added togetheR) study compares variation in blood glucose readings of study subjects who take insulin and those who take a GLP-1 agonist. The study’s goal is to determine which therapy does the best job in reducing variability in glucose levels. The study involves 102 diabetic patients in 12 centers across the United States.
$231 million Project management, data and safety monitoring, and quality assurance
Can stem cell therapy improve heart disease? As the data coordinating center for the Cardiovascular Cell Therapy Research Network (CCTRN), the Coordinating Center for Clinical Trials is investigating stem cell therapy for the treatment of heart disease and peripheral arterial disease. The center is collaborating with the CCTRN on several phase II clinical trials, sponsored by the National Heart, Lung and Blood Institute, which will potentially lead to more effective treatments for patients with cardiovascular disease.
How do we boost minority participation in clinical trials? The center is testing a recruitment intervention (RECRUIT), sponsored by a $3.5 million grant from the National Institute on Minority Health and Health Disparities, to address the problem of low minority recruitment in clinical trials. The approach targets multisite trials conducted at specialty clinics in academic centers, and focuses on improving health care quality and methods used to help minority patients navigate the health care system.
(total funding since 1971)
Contracting of services for trial (core lab analysis, meeting organization, training)
Regulatory guidance (compliance and clinical monitoring)
finish Statistical analysis, interpretation, publication management and dissemination of results
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research
>> Payment Systems
Overview
Truven Health Marketscan Database -- Private-sector health data from approximately 350 payers -- Data for 2011 – 2013 -- Approximately 50 million enrollees nationwide; 4.6 million in Texas
Texas Medicaid
-- Data for 2008 – 2012 -- Approximately 7.8 million unique enrollees -- 4 million enrollees are 18 years and younger
Medicare
-- Data for 2010 – 2013 -- Approximately 5 million enrollees in Texas -- Approximately 2.5 million sample from nationwide enrollees -- Includes the Minimum Dataset (MDS) data for Long Term Care or Skilled Nursing Facility individuals
Urgent Care Clinic Data -- Data for 2013 – 2014
-- Covers over 38,000 visits and 36,000 persons
Forthcoming Datasets
-- UT Physician Billing Data -- 2013 Texas Medicaid
claims data yields new research projects Four years after its launch, the Blue Cross Blue Shield of Texas (BCBSTX) Payment Systems and Policies Research Program has spawned more than 30 projects using the program’s claims data on more than 10 million enrollees. The program, funded in 2011 by a $1.5 million gift from BCBSTX and housed in the George McMillan Fleming Center for Healthcare Management at The University of Texas School of Public Health, offers qualified researchers and students controlled access to a vast body of claims data, starting in 2008 and updated annually. Researchers in the program work to foster research and inform the public, academia and other constituents about health care costs and utilization with the goal of improving efficiency and controlling health care costs in Texas.
“The data is unique, because it allows the researcher to follow a member’s historical access to health care services,” says Cecilia M. Ganduglia-Cazaban, Dr.P.H., BCBSTX program principal investigator and assistant professor of Management, Policy and Community Health.
One of the program’s first studies published last year in Health Services Research, provided key insights into the factors driving private health care spending compared to Medicare in Texas. The study authors, including Luisa Franzini, Ph.D., professor emeritus in the Department of Management, Policy and Community Health and Osama Mikhail, Ph.D., interim dean for the School of Public Health, found that prices and volume affected health care spending differently depending on the type of health service and payer. They concluded that strategies for managing spending may need specific tailoring. The BCBSTX dataset is one of several the Fleming Center holds. In total, its health care claims datasets provide access to information on more than 50 million patients. All information is housed on protected severs to ensure privacy. Data is available for collaborative projects in academic and public policy research, but not for commercial or competitive purposes.
Trudy Millard Krause, Dr.P.H. (left), and Lee Revere, Ph.D. (right), project co-directors. Revere is also director of the Fleming Center.
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Osama Mikhail, Ph.D.
Institutions collaborating with School of Public Health faculty using Fleming Center claims data include Georgetown University, Dartmouth College, John Hopkins University and The University of Texas MD Anderson Cancer Center. Contact: To request access to BCBSTX data, please contact Cecelia M. Ganduglia-Cazaban at Cecilia.M.GandugliaCazaban@uth.tmc.edu.
Cecilia M. Ganduglia-Cazaban, Dr.P.H.
research highlights Project investigates hearing loss in military Investigators with the San Antonio Regional Campus are conducting groundbreaking research into hearing loss and auditory injuries in the military, as part of the three-year Department of Defense Epidemiologic and Economic Study. The multidisciplinary team has analyzed more than 20 million military health records from a five-year-period, uncovering incidences of hearing injuries and hearing loss in 3 percent of the military’s 1.3 million active service members — an estimated 39,000 persons. Most cases were linked to sensorineural hearing loss (damage to the inner ear, or to the nerve pathways from the inner ear to the brain) and tinnitus. Jose Betancourt, Dr.P.H.
Hasanat Alamgir, Ph.D.
David Gimeno, Ph.D.
Hearing loss significantly affects the quality of life in the military, say the researchers, and the resulting economic burden can be substantial — costing the Department of Defense more than an estimated $60 million in outpatient health care expenditures between 2007 and 2012. More research will reveal the full effect of noise-related injuries on individual military service members. The $1.2 million project is a collaboration between the Department of Defense Hearing Center of Excellence and The Geneva Foundation. Principal investigators are Jose Betancourt, Dr.P.H., associate professor of Management, Policy and Community Health; and Hasanat Alamgir, Ph.D., and David Gimeno, Ph.D., both associate professors of Epidemiology, Human Genetics and Environmental Sciences. The investigators hope to expand the project to include veterans, with plans to continue conducting research that informs best practices for military hearing health programs.
Dallas researchers investigate smoking’s impact on homeless and poor
Michael Businelle, Ph.D.
Darla Kendzor, Ph.D.
A team of The University of Texas School of Public Health Dallas Regional Campus researchers led by Michael Businelle, Ph.D., and Darla Kendzor, Ph.D., assistant professors of health promotion and behavioral sciences, are investigating the impact of smoking on the homeless and poor — a population that continues to smoke despite overall declines in smoking in the United States. Their study in the American Journal of Public Health found that quitting smoking is more difficult for homeless people. Subsequent research studies discovered that instituting a partial smoking ban at a homeless shelter led to less exposure to cigarette smoke, and that offering small financial incentives doubled smoking cessation rates among socioeconomically disadvantaged smokers enrolled in a smoking cessation program at a Dallas safety net hospital. “Understanding the hurdles socioeconomic disadvantaged people face when quitting smoking will allow us to design smoking cessation interventions specifically for them,” Businelle says.
Online program targets firefighter obesity
R. Sue Day, Ph.D.
The University of Texas School of Public Health has been awarded a $1.5 million grant from the Federal Emergency Management Agency (FEMA) to test the effectiveness of an Internet and mobile-based health and wellness program intended to improve volunteer firefighters’ nutrition and fitness and reduce their risk of obesity and cardiovascular disease. The program was designed by a volunteer firefighter and is built around the firefighters’ lifestyle. “Volunteer firefighters comprise the majority of the U.S. fire service, yet they are harder to reach than career firefighters for health interventions because they have full-time jobs, fire service training requirements and on-call duties,” says R. Sue Day, Ph.D., the study’s principal investigator and associate professor in the Department of Epidemiology, Human Genetics and Environmental Sciences at the School of Public Health.
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research highlights
179 million cases of acute diarrhea in US each year, most preventable
Herbert L. DuPont, M.D. published an article in the New England Journal of Medicine on his conclusion that of the approximately 179 million cases of acute diarrhea that occur each year, most are entirely preventable. DuPont is the director of the Center for Infectious Diseases at The University of Texas School of Public Health.
Herbert L. DuPont, M.D.
Awards fund research on HPV vaccination, breast and cervical cancer screening
Maria Fernandez, Ph.D.
Maria Fernandez, Ph.D., associate professor in the Department of Health Promotion and Behavioral Sciences is leading research on cancer prevention. Recent projects include an effort to increase HPV vaccination among Hispanic adolescents, funded by a $1.4 million research grant from the Cancer Prevention and Research Institute of Texas (CPRIT); an initiative to increase breast and cervical cancer screening through education and outreach among lowincome underinsured women in El Paso, funded by a $2 million Cancer Prevention and Control Research grant; and a study to evaluate an intervention to increase HPV vaccination among the patients of a Federally Qualified Health Center in Houston. Fernandez is also collaborating with the University of Puerto Rico Cancer Center to develop and evaluate a colorectal cancer screening intervention to be implemented in Federally Qualified Health Centers in Puerto Rico.
Researchers map Houston diabetes rates
Stephen Linder, Ph.D.
Stephen Linder, Ph.D. is leading research efforts for Cities Changing Diabetes — a global effort to fight diabetes in metropolitan areas. Houston is the first city in the United States to join the three-year project. Linder, professor and associate director of the Institute for Health Policy at the School of Public Health, and his team of researchers are mapping key factors that account for disparities in the prevalence of diabetes across Harris County, using data from the Health of Houston Survey 2010. They will examine the role of social determinants, in addition to the well-known behavioral risk factors for type 2 diabetes, including physical inactivity and excess body weight. “The richness of the data we have on the county will permit us to consider social and neighborhood factors that play a role before diabetes develops, so that we can design better strategies, not just to manage the disease, but to prevent it,” says Linder about the project.
$20 million Award Launches tobacco regulatory science center The School of Public Health received $20 million in funding from the United States Food and Drug Administration (FDA) and the National Institutes of Health (NIH) as part of an ongoing interagency partnership. The University of Texas School of Public Health Austin Regional Campus was one of 14 Tobacco Centers of Regulatory Science (TCORS) that received a total of up to $53 million for tobacco-related research in fiscal year 2013. Cheryl L. Perry, Ph.D., is principal investigator, director of the center and regional dean of the campus. Cheryl L. Perry, Ph.D.
Study finds mental health care lacking in state and federal prisons
Jennifer Reingle, Ph.D.
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A significant portion of state and federal prisoners are not receiving treatment for mental health conditions, according to a study published in American Journal of Public Health by Jennifer Reingle, Ph.D., principal investigator and assistant professor in the Department of Epidemiology, Human Genetics and Environmental Sciences at The University of Texas School of Public Health Dallas Regional Campus. The study found that at the time of prison admission, 18 percent of each sample was taking medication for a mental health condition, but only 52 percent of that subset of the population in federal prisons and 42 percent in state prisons received medication during their sentence. “Individuals with untreated mental health conditions may be at higher risk for correctional rehabilitation treatment failure and future recidivism after release from prison,” Reingle says.
research highlights
Investigating food deserts in Texas
Jennifer Salinas, Ph.D.
New research from Jennifer Salinas, Ph.D., assistant professor of epidemiology, human genetics and environmental sciences at The University of Texas School of Public Health Brownsville Regional Campus, finds that much of Texas qualifies as a food desert, an area where access to healthy foods is difficult. Salinas and her research team rated every census tract in the state of Texas, from 0 (unhealthy areas with limited access to fruits and vegetables) to 100 (healthy). “What we found was that the major metro areas of the state — Austin, Dallas, Corpus Christi and Houston — had a higher concentration of lower scores, which was indicative of food deserts. We found slightly higher healthy numbers in the border metro areas of El Paso, Laredo, Brownsville and McAllen.” The study, published in the May 2014 issue of the International Journal of Environmental Research and Public Health, provides insight into how food availability operates in rural versus urban settings, and informs the design of public health prevention programs targeting food access.
Center expands projects focusing on sex education, teen pregnancy With funding from the U.S. Department of Health and Human Services’ Office of Adolescent Health, the Center for Health Promotion and Prevention Research (CHPPR), directed by Susan Tortolero Emery, Ph.D., has disseminated It’s Your Game…Keep It Real! (IYG) to 100 middle schools. IYG is a classroom- and computer-based sexual health education program grounded in theory and developed to prevent teen pregnancy and sexually transmitted infections including HIV. Rigorous evaluation has shown that IYG significantly delays sexual initiation among adolescents.
Susan Tortolero Emery, Ph.D.
CHPPR has also launched the We Can Do More (WCDM) campaign, a community-wide initiative to prevent teen pregnancy in Sunnyside, an economically disadvantaged Houston community with exceedingly high teen birth rates. CHPPR researchers and staff are attacking the problem from all angles — conducting community research, opening two school-based clinics, implementing middle school and high school sexual health education programs, hosting youth and adult workshops, and developing partnerships with schools, churches, and community-based organizations. A comprehensive communications strategy using billboards, fact sheets, and social media ties campaign elements together in order to impact attitudes and behaviors related to healthy relationships and teen pregnancy in Sunnyside.
Examining the growing problem of climate change, heat and health
Kai Zhang, Ph.D.
Learning more about the factors that contribute to heat-related health effects — from humidity to the heat index — is the focus of research by Kai Zhang, Ph.D., an assistant professor of epidemiology, human genetics and environmental sciences research. In a study published in the journal Environmental Research, Zhang and his colleagues ranked weather variables linked to heat-related deaths in Chicago, Detroit, Philadelphia and Phoenix, finding that apparent temperature — how warm or cool our bodies perceive the air to be — was the most important predictor of heat-related mortality, with absolute humidity — the total amount of water vapor in the air — a close second. The researchers are also studying the accuracy of heat wave and health warning systems and their relationship to heat-related deaths. “Because of climate change, heat waves are projected to occur more frequently, more intensely and to last longer,” Zhang says. “To help prevent heat-related deaths, we will need to identify which variables most predict health outcomes from heat exposure.”
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Practice
Brownsville, Texas:
award-winning The City of Brownsville and the School of Public Health are working together to make Brownsville a healthier place.
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Practice / brownsville, texas: an award-winning city
School of Public Health key partner in improving community health The University of Texas School of Public Health continues to garner national recognition for improving community health in the growing border city of Brownsville. Last June, the Robert Wood Johnson Foundation awarded Brownsville its prestigious Culture of Health Prize, and the National Civic League named it a 2014 “All-America City.” Both organizations credited the Brownsville Regional Campus for making the city a healthier place to live. The City of Brownsville and the Brownsville Regional Campus are working together to address obesity, chronic illness, physical inactivity, poor nutrition choices and the need for safe routes to school and walkable communities. With Regional Dean Joseph McCormick at its helm, the school implemented the Coordinated Approach To Child Health (CATCH) school nutrition and physical activity program and contributed to the creation of the city’s Community Advisory Board, which helped establish the Brownsville Farmer’s Market, city-wide fitness competitions and community gardens.
Brownsville Regional Dean Joseph McCormick, M.D.
“For the last 10 years, the School of Public Health has partnered with the Community Advisory Board, comprised of over 200 organizations and individuals from around the Rio Grande Valley, to improve health through research, implementation of evidence-based programs, mass media strategies, and policy and environmental Belinda Reininger, Dr.PH. change initiatives. The united, collaborative and evidencebased approach has created lasting change,” says Belinda Reininger, Dr.PH., associate professor of health promotion and behavioral sciences at the Brownsville Regional Campus.
city
Initiatives such as Tu Salud ¡Sí Cuenta! (Your Health Matters!), a community-wide campaign to address chronic disease prevention that includes mass media and free exercise and nutrition classes, and the help of bilingual community health workers, are essential to help uninsured and chronically ill residents live healthier lifestyles, Reininger says. The city has also implemented a comprehensive smoke-free ordinance, a Complete Streets Resolution and a Master Hike and Bike Plan. Activities such as CycloBia, in which thousands of residents walk, run, cycle and enjoy outdoor activities in traffic-free streets, and The Challenge, a city-wide, friendly weight-loss contest, have successfully promoted active lifestyles and demonstrate the strength of community partnerships in action. “Over the past several years, we have taken concrete steps toward improving our community and the lives of our citizens. It would not have been possible without the commitment of all parties involved,” says Arturo Rodriguez, Brownsville’s public health department director and an alumnus of the School of Public Health. “With the support of the Robert Wood Johnson Foundation, Brownsville will be able to sustain its efforts toward becoming a healthier and more vibrant city.” Brownsville was one of only six cities in the nation selected for the RWJF award, and one of 10 cities named an “All-America City,” by the National Civic League. The RWJF Culture of Health Prize honors communities harnessing the collective power of leaders, partners, and stakeholders to help residents live healthier lives. The city received a cash prize of $25,000 in recognition of its commitment to building a culture of health. The National Civic League’s “All-America City” award is given annually to cities focused on creating healthy communities.
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Practice
Combating
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Practice / combating childhood obesity
childhood obesity Stunning data released in 2014 showing a steep 48 percent decline in preschooler obesity has researchers feeling cautiously optimistic. The data, published in the Journal of the American Medical Association, follows a general national decline in childhood obesity over the past two decades. But individual states like Texas are seeing more modest reductions in childhood obesity or are simply holding steady. “To those of us in the field [of obesity research], any decline in the childhood obesity rate is good news,” says Steven Kelder, Ph.D., M.P.H., co-director of the Michael & Susan Dell Center for Healthy Living and professor of epidemiology for The University of Texas School of Public Health Austin Regional Campus. “But we still have a very large obesity problem we need to continue to address.” How large? Consider the statistics: Texas has the tenth highest rate of obesity among adolescents at 19.1 percent. Nearly a quarter of fourth-grade children are obese. And recent data doesn’t show a significant decrease in childhood obesity in Texas, possibly due to the recession and a lack of financial support for childhood obesity interventions. But there’s also good news. “In areas where we are able to implement obesity prevention school-based interventions and have community support, we have seen significant decreases in childhood obesity,” adds Deanna Hoelscher, Ph.D., Michael & Susan Dell Center for Healthy Living director and John P. McGovern Professor of health promotion at The University of Texas School of Public Health Austin Regional Campus.
Stephen Kelder, Ph.D. and Deanna Hoelscher, Ph.D., co-directors of the Michael & Susan Dell Center for Healthy Living.
“In areas where we are able to implement obesity prevention school-based interventions and have community support, we have seen significant decreases in childhood obesity.”
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Practice / combating childhood obesity
Since founding the Center for Healthy Living in 2006, Hoelscher and Kelder have gathered a wealth of information on what works best in the fight against childhood obesity. Here are some proven strategies they use in the ongoing battle:
Targeting schools One of the center’s most successful school obesity interventions is CATCH, or Coordinated Approach To Child Health, which provides in-depth materials about nutrition and physical activity to classroom teachers, child nutrition services staff, physical educators and families. The program has been proven to reverse childhood obesity in El Paso and Austin schools (a 2010 study found that childhood obesity in low-income Travis County schools was decreased by 8.3 percent), and has been adopted by more than 8,500 schools in the United States and abroad. Kelder says the program’s focus on energy balance (balancing the amount of food consumed with enough exercise to burn off excess calories) is the key to the program’s success, together with family involvement.
Repeatedly introducing healthy foods A child may need to sample a new food as many as 15 times before becoming used to the taste. To make that first bite happen, the center’s Brighter Bites program provides fresh fruit and vegetables to low-income
families in areas identified as food deserts. The 16-week program, in collaboration with the Houston Food Bank, gives families 50 servings of produce a week combined with nutrition education. Teaching kids to grow their own fruit and vegetables also increases exposure to healthy foods, and makes children more likely to eat them. Texas Grow! Eat! Go!, in collaboration with Texas Agrilife Extension Service and
child obesity in Texas The Michael & Susan Dell Center for Healthy Living developed the School Physical Activity and Nutrition project (SPAN), a unique study that monitors trends in the body mass index of school-age children in Texas in grades four, eight and 11 and identifies factors that may underlie obesity. Here are some striking results from the 2009-2011 study:
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Texas A&M University, is teaching kids at 32 CATCH elementary schools in Texas how to become master gardeners. Nearly a quarter of boys in the program and 13 percent of girls transitioned from an unhealthy weight to a healthy weight by the end of the pilot project.
Inspiring kids to move more CATCH also teaches kids how to reduce sedentary behavior, screen time, and
Practice / combating childhood obesity
engineer physical activity into their daily lives. The program encourages schools to form wellness teams and look for opportunities for more physical activity, such as classroom activity breaks and open gym times before and after school.
Involving the entire community “For programs to work, we need other organizations supporting and assisting our schools in encouraging healthy dietary habits and activities that encourage physical activity,” Kelder says, giving the example of the Texas Childhood Obesity Research Demonstration (CORD), a CDC-funded program that connects the dots between families, pediatricians, schools and local youth organizations. Families in the program can take educational classes about cooking, healthy eating and physical activity and participate in sports teams at their local YMCA.
More work to do
Above and left: the CATCH program provides schools with in-depth materials about nutrition and physical activity, and has been proven to reverse childhood obesity.
While progress continues in reducing childhood obesity, more work remains. Kelder compares the fight against obesity to public health campaigns aimed at smoking. “It is going to take some big societal changes to eliminate the problem of childhood obesity,” he says. “I am pleased that we are leveling off, but we still need to pay attention to childhood obesity, and focus our attention on reducing it.” (adapted from a HealthLeader article)
About the Michael & Susan Dell Center for Healthy Living Founded in 2006 Located at Austin Regional Campus (ARC) Cheryl L. Perry, Ph.D., ARC regional dean
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Practice
Improving safety
for Bangladeshi garment and textile workers
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Practice / improving safety
Left: Alamgir speaks to Bangladeshi rug factory workers about safety and visits a garment factory in Dhaka, Bangladesh, to see what progress is being made toward improving unsafe working conditions (right).
As a native of Bangladesh and an expert in occupational health, Hasanat Alamgir, Ph.D., associate professor in the Department of Epidemiology, Human Genetics and Environmental Sciences at the School of Public Health San Antonio Regional Campus, is working to improve the unsafe working conditions of garment workers in his homeland, the site of catastrophic factory fires and building collapses in 2012 and 2013. Alamgir visits Bangladesh often to see what progress is being made toward improving safety and has traveled the globe to share his insight and expertise at industry meetings and international conferences. “You can’t have improvements in factory safety without educating and empowering workers,” said Alamgir, speaking at the 2014 Alliance for Bangladesh Worker Safety Workshop chaired by former U.S. Senators George Mitchell and Olympia Snowe. The Alliance is a group of 26 global apparel companies, retailers and brands joined together to help improve worker safety in Bangladeshi garment factories. With support from the Alliance, Alamgir is working with Lung-Chang Chien, Dr.P.H., associate professor in the Department of Biostatistics at the School of Public Health, to assess fire safety training for garment workers in Bangladesh. The need for basic fire safety is urgent. A baseline study Alamgir helped conduct found that only 39 percent of workers could correctly identify what to do in case of emergency and only 2 percent could identify five common fire hazards. Alamgir will also collaborate with and mentor a team of faculty and graduate students at Dhaka University in Bangladesh to expand local research into worker safety. “Western companies and consumers have an obligation to remove barriers to workplace safety,” he says.
“Western companies and consumers have an obligation to remove the barriers to workplace safety.”
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special section
addressing
ebola Photo by Frederick A. Murphy, CDC - Nat. Center for Infectious Diseases; Special Pathogens Branch
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When the Ebola outbreak in West Africa developed into an international crisis, School of Public Health disease experts sprang into action — fighting misinformation, educating the public and officials on treatment and prevention, and advocating for better public health resources to respond to disease outbreaks.
special section / addressing ebola
The outbreak begins The school’s experts began tracking the disease early in the current outbreak and advised UT Physicians clinics in Houston, emphasizing the importance of taking a travel history from patients. Then on Sept. 30, 2014 Thomas Eric Duncan, a Liberian man visiting Dallas, was confirmed to be the first patient in the United States diagnosed with Ebola. Fear and panic about the spread of the disease quickly intensified. “We in public health want to try and keep unreasonable fears to a minimum, and to inform people about the real dangers,” counseled noted epidemiologist and Ebola expert Joseph McCormick, M.D., regional dean of The University of Texas School of Public Health Brownsville Regional Campus, in a live Houston Chronicle online chat in October. At the height of the crisis, nearly 2,000 news reports quoted School of Public Health faculty members, underscoring the tremendous grip the disease had on the public’s imagination.
Advising Preparation, not panic In November 2014, McCormick counseled Texas Governor Rick Perry’s Texas Task Force on Infectious Disease Preparedness and Response, stressing the need for hospitals to be prepared to identify and manage potential Ebola patients until they could be diagnosed and moved to regional facilities. He also advised using copious chlorine disinfection, particularly on the hands of medical staff and on spills in the ward, and recommended that health care workers wear the same personal protective equipment used by Doctors Without Borders, which covers every inch of the body and face for optimal protection against the virus. McCormick emphasized the need to focus efforts on fighting the epidemic in West Africa and quelling panic in the United States.
Don’t forget the Flu Catherine Troisi, Ph.D., an associate professor in the Department of Management, Policy and Community Health and the Department of Epidemiology, Human Genetics, and Environmental Sciences at the School of Public Health, also called for calm and the need to devote public health resources to prepare for other viruses like influenza, which have the potential to cause a pandemic (the 2014-2015 flu outbreak reached epidemic levels). “Ebola virus is a major concern for
the affected countries, and the fear and loss of life are devastating on a humanitarian level. But we do not have to spread fear of the virus to the United States or other resourcerich countries,” she said in her commentary to the Houston Chronicle, later giving similar testimony to the House Homeland Security Committee Field Meeting on Ebola and the Texas Task Force on Infectious Disease Preparedness and Response. As the crisis continued to unfold, Robert Emery, Dr.P.H., vice president of safety, health, environment & risk management at UTHealth and a professor of occupational health, educated the public on the nutsand-bolts of disease transmission, and in numerous media interviews, demonstrated precautions and personal protective equipment needed to safeguard health care workers against Ebola.
Continuing the fight Now months after the initial outbreak, School of Public Health faculty members continue to address the crisis — here and abroad. Emery, as a member of the Texas Task Force on Infectious Disease Preparedness and Response’s educational working group, is helping to gather and disseminate educational resources on Ebola and other infectious diseases. McCormick, Troisi and Susan Fisher-Hoch, M.D., a professor of epidemiology, frequently give talks to faculty members, students and community groups about Ebola and disease outbreaks, and are called upon for their insight into the disease. McCormick is also working with a journalist in Sierra Leone to provide much needed supplies to people in isolated areas of that country not reached by already established relief efforts.
UTHealth Safety Specialist, Brett Haltiwanger, Ph.D., CBSP, demonstrates precautions and personal protective equipment needed to safeguard health care workers against Ebola
McCormick sees such efforts as steps in the right direction. But while hope exists in the midst of the Ebola crisis — experimental drugs have shown some success at treating Ebola and a vaccine is on the horizon — much work remains to contain the outbreak. “The countries affected by the Ebola virus epidemic cannot manage this catastrophe alone, but will require sustained assistance from health professionals at all levels to treat patients and prevent continued spread of disease,” he says. “We all have a role to play by helping where we can and continuing to educate our public that we can manage the disease in the United States and will not experience an epidemic in this country.”
>> The Virus Hunters Joseph McCormick, M.D., regional dean of the The University of Texas School of Public Health Brownsville Regional Campus, is one of the nation’s foremost experts on Ebola, having diagnosed and treated patients during Ebola’s initial outbreaks in the 1970s in the Congo and later in Sudan. He and his wife, Susan Fisher-Hoch, M.D., detailed their experiences fighting the disease in their book Level 4: Virus Hunters of the CDC. Fisher-Hoch received the Légion d’Honneur, (the order is the highest decoration in France and was established by Napoleon Bonaparte in 1802), for the design, construction and commissioning of the Biosafety Level 4 laboratory in Lyon, France, where much of the work on the current Ebola epidemic is now being carried out. The couple has studied the virus for many years — focusing on understanding its pathophysiology and investigating potential vaccine.
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New faculty
1. Folefac Atem, Ph.D. Assistant Professor, Biostatistics, Dallas Regional Campus 2. Frank Bandiera, Ph.D. Assistant Professor, Epidemiology, Human Genetics & Environmental Sciences, Dallas Regional Campus 3. MeLisa Creamer, Ph.D. Faculty Associate, Health Promotion and Behavioral Sciences, Austin Regional Campus 4. Casey Durand, Ph.D. Assistant Professor, Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living
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5. Paula Stigler Granados, Ph.D. Assistant Professor, Management, Policy and Community Health, San Antonio Regional Campus 6. Eric Jones, Ph.D. Assistant Professor, Epidemiology, Human Genetics and Environmental Sciences, El Paso Regional Campus 7. Goo Jun, Ph.D. Epidemiology, Human Genetics and Environmental Sciences 8. Ruosha Li, Ph.D. Assistant Professor, Biostatistics 9. L. Renee Lowe Lecturer, Management, Policy and Community Health 10. Florence McKelvey Lecturer, Management, Policy and Community Health 11. Cecilia Montano Faculty Associate, Health Promotion and Behavioral Sciences 12. Luis Leon Novelo, Ph.D. Assistant Professor, Biostatistics 13. Jeanne Piga-Plunkett, M.S., R.D., L.D. Dietetic Specialist, Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living 14. Ellerie Weber, Ph.D. Assistant Professor, Management, Policy and Community Health 15. Rebecca Wells, Ph.D. Professor, Management, Policy and Community Health
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game changers Grant targets childhood obesity
The Michael & Susan Dell Foundation recently renewed its funding of the Center for Healthy Living with a grant of more than $4.5 million, a testament to the foundation’s confidence in the center’s work and their shared goal of reducing childhood obesity. “This type of public-private partnership really works, and our relationship is a good example of that,” says Aliya Hussaini, M.D., health lead for the Michael & Susan Dell Foundation. “And it goes both ways. While we provide funding for them, they provide us with incredibly useful research and information which helps us do our jobs better.” Michael and Susan Dell
From the Michael & Susan Dell Foundation’s perspective, their funding is a successful investment in public health; over the last four years, every dollar the Michael & Susan Dell Foundation gave to the Center for Healthy Living brought in $15 in grants and contracts for research and community programs (read more in “Combating childhood obesity” on page 22). That has enabled the center to reach roughly 444,000 children and families, and likely millions more through its advocacy, published work and public reports. “There is nothing more important than giving your children the gift of wellness,” says Susan Dell, co-founder of the Michael & Susan Dell Foundation, “and the Center for Healthy Living helps us contribute to that here in Central Texas.”
gift transforms nutrition education
Thanks to a $650,000 gift from Don Sanders and his wife Laura Moore, R.D., L.D., the School of Public Health is enhancing its Dietetic Internship Program with a culinary center, holistic garden and simulation and assessment skills center. Led by registered dietitians and School of Public Health faculty members Moore and Jeanne Piga-Plunkett, M.S., R.D., L.D., the Dietetic Internship Program will be one of only nine Master of Public Health programs in the nation with a central mission to educate and train future health leaders to address preventive nutritional health initiatives (read more about the project in “From seed to plate” on page 6).
Don Sanders and Laura Moore
This university and community volunteer collaborative initiative was launched by Moore and her husband, Don Sanders, with a generous $650,000 gift. UTHealth and the School of Public Health also provided funding for the project. Generosity from the School of Public Health Advisory Council chair, Sue H. Smith, will help meet the ongoing needs of this project, ensuring it has ever-renewing resources to change lives.
The school relies on both current use and endowed support to improve the state of health in Texas. For more information on these projects and other giving opportunities, contact Erin Meade, director of development, The University of Texas School of Public Health, 713-500-9059 or Erin.Meade@uth.tmc.edu. You may also visit our giving page online at http://sph.uth.edu/giving-to-sph/.
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