Advances U Takes Lead in Bird Flu Fight • page 7
from the University of Minnesota School of Public Health
American Indian Health SPH Partners with Communities on Research, Education, and Outreach
TOBACCO’S ROLE IN DNA DAMAGE MAKING OUR FOOD SUPPLY SAFER CAN MEDITATION CURE INSOMNIA? MEET THE NEW ALUMNI BOARD
FROM THE DEAN Dear Friends,
Photo: Richard Anderson
The cover photo for this edition of Advances really caught my eye. There’s something about happy, healthy-looking children that warms the heart of any school of public health dean. What’s even better is that these girls and their classmates are first-graders participating in Bright Start, one of our school’s obesity prevention research projects. They live on the Pine Ridge reservation in southwestern South Dakota. The students are pictured during one of the class walks they take several times each week as part of the project. This is one of the many ways our school is linked with American Indian tribes throughout the region. Our partnerships have been in place for decades in some instances, span research and education, and share the common goal of working to promote health among one of the most at-risk populations among us. Our work with this culturally rich community is featured in the cover story, which begins on page 2. What’s more, our American Indian students and alumni are among our brightest stars. Please take a moment to read the alumni profiles on page 17. While you’re on the alumni page, take note of the newly elected School of Public Health Alumni Society Board. Members come from a variety of leadership positions across the United States. They share the common goal of wanting to engage with a school that has played a part in helping them to reach great professional heights. I am grateful for the role they will serve in helping to shape a program that will benefit SPH alumni all over the world. And finally, a big thank you to all alumni and community partners who participated in the year-long accreditation process, which culminated recently with a site visit by a team from the Council on Education for Public Health (CEPH). Accreditation is critical to the status of our school and we couldn’t receive this important designation without you. Yours in health,
John R. Finnegan, Jr., Ph.D. Dean and Professor Assistant Vice President for Public Health
SCHOOL OF PUBLIC HEALTH LEADERSHIP
John R. Finnegan, Jr. Dean
John Connett Head, Division of Biostatistics
Editor Diana Harvey
Judith Garrard Senior Associate Dean for Research and Academic Affairs
Bernard Harlow Head, Division of Epidemiology and Community Health
Managing Editor Kristin Stouffer
Debra Olson Associate Dean for Public Health Practice Education
Ira Moscovice Interim Head, Division of Health Policy and Management
Contributing Writers Meredith McNab Toya Stewart
William Riley Associate Dean for Student Affairs
William Toscano Head, Division of Environmental Health Sciences
Art Direction Todd Spichke Riverbrand Design
Diana Harvey Assistant Dean for External Affairs
Contents Table of
School of Public Health faculty, staff, and students are
partnering with American Indian communities on public
health issues such as obesity prevention, tobacco control, disaster preparedness, access to care, and more.
Startling findings on hospice care, tobacco control and human
rights, the two faces of pandemic risk communication, and more.
Preeminent epidemiologist speaks at the SPH, website profiles â€œMedical Marco Polos,â€? SPH welcomes Iceland delegation, and more.
Hearst scholarship supports student's focus on injury prevention, and 3M supports infectious disease prevention.
Students lend a helping hammer to Habitat for Humanity, and two SPH students are appointed Presidential Management Fellows.
Alumni society board bios, and star alumni profiles.
AMERICAN INDIAN HEALTH SPH Partners with Communities on Research, Education, and Outreach
“Let us put our minds together and see what life we can make for our children.” Ask members of Bright Start to describe their program and chances are you will hear this quote from the famous Lakota leader Sitting Bull. Bright Start, or Ohiyu lyojanjan in Lakota, is a partnership of the School of Public Health and the Lakota people of the Sioux Nation of the Pine Ridge reservation in South Dakota. The two groups are working together on a school-based program to reduce obesity and diabetes in young children. Bright Start builds on Pathways, the first large-scale, school-based obesity prevention program conducted in the United States. Pathways ran from 1993 to 2000 and included third to fifth graders from 41 schools and seven American Indian nations. True to its name, Pathways forged the strong ties between the Pine Ridge community and SPH that led to Bright Start, which focuses on 500 kindergarten and first-grade children in 14 Pine Ridge schools. “Schools are the best place for change,” says SPH professor Mary Story, lead investigator of Bright Start. “Breakfast and lunch are served at school, there’s an opportunity for physical education, and you can connect to parents through teachers and administrators.”
Wayne Fox performs a hoop dance at the opening of the Public Health Institute, an annual three-week event from the SPH. Hoop dancing is a rare tradition passed from generation to generation in some American Indian cultures. The red, white, black, and yellow of Fox's 28 hoops represent different races. When the dance is performed, the hoops create patterns and shapes that form images of nature. 2
University of Minnesota School of Public Health
While diabetes has reached epidemic proportions in the general population, its rates are even higher among American Indians. Experts say American Indians are twice as likely to have diabetes as their white counterparts. They are also almost twice as likely to die from diabetes as non-Hispanic whites. Research has shown that 43 percent of American Indian five-year-olds in South Dakota are already overweight. That’s why Bright Start aims to instill healthy habits at a young age.
F E AT U R E S TO RY Collaboration and sustainability are key components of the program. “We are guests on the reservation,” says Story. “We have the research expertise, but our staff who live on the reservation know what approaches work best. We rely on them for that insight.” Bright Start has worked to improve school meals by increasing fruit and vegetable offerings. It has increased physical activity to 60 minutes a day through short “action breaks” in the classroom, active recess on the playground, and a walking program. And it has involved parents through “family night” events centered on fun activities that promote healthy eating and physical activity.
Indians. She found that Minnesota faces significantly greater disparities of infant mortality between whites and American Indians than the national average. And while national data suggests that disparities in prenatal care are narrowing, Johnson’s work with state data shows otherwise. Here, Minnesota has some of the worst disparities in the entire nation. “Clearly, Minnesota has the infrastructure to deliver effective health care, but it’s not equally available to everyone,” she says.
The child-centered values of the Lakota tribe are the foundation for strong parental participation of the program. More than 72 percent of Bright Start families attended a recent family night event—and many of them had to drive close to an hour to get there. “The parents and grandparents are truly concerned and always ask what they can do to help their children,” says Bright Start project director Mary Smyth. “Their support is really impressive.” Smyth, too, has logged some serious mileage in the name of Bright Start. Since April 2006, she has made the drive from Minneapolis to South Dakota to spend close to 100 days in the Pine Ridge area, working with staff members, schools, and families. “We are all working on this together,” she explains. Bonnie Holy Rock echoes those sentiments. An Oglala Lakota member, she is Bright Start’s field site coordinator and one of eight staff members from Pine Ridge who works on the project. Her connection to the SPH spans a dozen years and dates back to the Pathways project. Holy Rock credits the “positive collaborative efforts” of Pine Ridge and the University and points to the importance of “employing field staff from the area who know the schools, families, and communities.”
Methodological Issues Pamela Jo Johnson is a research associate in the school’s State Health Access Data Assistance Center (SHADAC). She studies the methodological issues behind health disparities research—what data is used, whether it is accurate, and how it influences our assumptions of the health of certain populations. Johnson has compared national and state data on infant mortality and prenatal care rates among American
Bright Start kids are all smiles.
While local data is generally more relevant than national averages, Johnson’s work highlights a challenge researchers face when studying minority populations locally: sometimes there isn’t enough data to draw on for accurate findings. She found that even when combining three years of data, only 13 states and two counties (and not one U.S. city) had large enough American Indian populations to render accurate rates of infant mortality and prenatal care. Researchers need to be aware of these shortcomings when citing national data, she says. Johnson hopes her work can highlight the disconnect between national and local rates and draw attention to health needs at the state and local level. “The big picture isn’t always our picture [in Minnesota],” she says. “The lesson is that we need to look in our own backyard to know what’s really going on.” (continued on page 4) 3
Marie Quasius, a dual degree student in the SPH and Law School, interned with MDH to research the interface between Superfund regulations and tribal law as it relates to clean-up of the Cass Lake Superfund site. Over the past year, McGovern, Stedman-Smith, and SPH faculty members Bruce Alexander and Tim Church have worked with the Mdewakanton Dakota Sioux Indians of Prairie Island, Minn. Prairie Island is the site of a nuclear power plant, nuclear waste storage facility, and a network of high voltage power lines. Tribal council members approached University faculty to request a study investigating the health effects of living near these facilities.
Prairie Island is the site of a nuclear power plant and massive network of power lines. (continued from page 3)
Environmental Justice Environmental justice has been a growing area of interest for SPH professor Pat McGovern. Along with colleagues in the Minnesota Department of Health (MDH), she has worked with members of the Leech Lake Band of Ojibwe from Cass Lake, Minn. Cass Lake has been on the EPA’s list of Superfund sites since 1984, and recent tests still show several contamination “hot spots” of dioxin in residential areas. Exposure to harmful agents is compounded by the tribe’s culture of subsistence fishing, hunting, and gardening. McGovern and several students have worked with MDH’s Division of Environmental Health, Site Assessment, and Consultation Unit and the Leech Lake Band on a variety of public health projects. Doctoral student Maggie StedmanSmith provided educational materials about environmental exposures for the band at a Powwow. Wendy Kvale, a dual degree student in the SPH and School of Nursing, interned with the Leech Lake Band’s health division and their public health nurses to provide continuing education and conduct a needs assessment to identify public health priorities. Kvale, who also works as an MDH public health nursing consultant for the Bemidji area, will continue her partnership with the band to assist them in working on identified priorities. 4
University of Minnesota School of Public Health
The SPH team analyzed previous studies of communities who live near nuclear plants and power lines. The researchers also conducted focus groups with tribal elders, adults, and youth to hear about their health and safety concerns. Said one woman in a focus group: “[What] worries me . . .is that I want my child to grow up here knowing the culture, the heritage, being around the people . . .[but] am I putting my children’s health in jeopardy so they can know their ways, their traditions, their culture?” While some tribal members expressed concerns over cancer and other diseases associated with nuclear power, more spoke about worries over potential terrorist attack of the plant and a lack of disaster preparedness. “The nuclear power plant is number one on the [nation’s] terrorist attack list and [the Department of] Homeland Security refuses to do anything about it,” said a tribal elder in a focus group. “We could lose this place in the blink of an eye.”
Star Student Work SPH student Katie Gruner recently won the Wisconsin Public Health Association’s New Public Health Worker Award in recognition of her work with American Indian communities in northeastern Wisconsin. Gruner helped to create the Off-Reservation Native American Wellness Initiative with the American Indian Center of the Fox Valley. Gruner and colleagues from the center worked with tribal health administrators of three nations: Oneida, Mohican (Stockbridge-Munsee Band), and Menominee. The goal was to improve community understanding of each tribe’s health insurance programs. The U.S. Indian Health Service has taken interest in the initiative and is scheduled to meet with its administrators.
As a possible next step, the SPH team has offered the services of the school’s disaster preparedness training experts. McGovern says discovering this critical area of concern highlights the importance of asking the community to determine how they want the research partnership to evolve. “This is the benefit of community participatory research,” says McGovern. “In this case, we learned that tribal members wanted the focus to be more on disaster preparedness.”
Health Care Access SPH associate professors Kathleen Thiede Call and Donna McAlpine are working to understand the factors that contribute to health disparities in Minnesota. Call directed a study funded by the Minnesota Department of Human Services to illustrate the barriers to care faced by adults and children in public health care programs. From that study, Call and colleagues created a special report of the barriers to care faced by American Indians enrolled in Minnesota Health Care Programs (MHCP) such as Medicaid and MinnesotaCare. The report was funded by the Medica Foundation, the grant-making sister organization to Medica Health Plans, a Minnesota-based nonprofit HMO. The researchers surveyed 560 American Indian enrollees on the problems they experience when trying to get health care. They looked at discrimination, financial barriers, clinic hours, transportation, family and work responsibilities, trust in providers, and language and cultural issues. The researchers found that American Indians were more likely than other MHCP enrollees to cite work and family responsibilities as a problem when trying to access heath care. Trustworthiness of doctors in general appeared to be a greater barrier for American Indian children than other MHCP children. And American Indian parents were three times more likely to lack trust in their child’s doctor than MHCP parents overall. In what she refers to as an effort to “move beyond the data to make change” Call, McAlpine, and their community partners have convened a series of forums. The forums include members of the Latino, American Indian, Hmong, Somali, and African American coummunities, as well as members of more than a dozen health institutions. Funded by the Media Foundation and UCare of Minnesota, the forums offer a place for community members and health care professionals to work together on recommendations for reducing barriers to care. The “Working Together to Achieve Results” forums take place at the Powderhorn Phillips Cultural Wellness Center in Minneapolis.
American Indian community members who have participated in the forums have proposed that health organizations work with the Bureau of Indian Affairs to improve access to services among those living away from a reservation and in the city who currently cannot afford care. They have called for improvements in communication about insurance coverage — which providers accept insurance and what is covered. Community members have said that the burden of time and energy needed to get this information is especially difficult for elders, who are more likely to give up and go without services. They have also asked providers for support to increase access to elders who can teach on the traditional ways of health care, including good nutrition and cooking with herbs.
SPH students who have worked on the American Indian Community Tobacco Project (from left): Lannesse Baker, Turtle Mountain Band of Chippewa Indians; Isaiah Brokenleg, Rosebud Sioux Nation; and Melissa Boney, Bois Forte Band of Chippewa Indians.
Tobacco Control It’s well known that American Indians in some parts of the country use tobacco more than other ethnic and racial groups. This is especially true in Minnesota, where about 60 percent of American Indians smoke, a rate far higher than American Indians nationally. But little is known about why the rates are so high or what can be done to address them. Most tobacco prevention research of the past has failed to build on the strengths of American Indian culture or to truly partner with community members. Previous interventions have also failed to acknowledge the sacred use of tobacco in Indian culture, and instead have deemed all tobacco use as “bad.” (continued on page 6) 5
led to mistrust of outsiders among the American Indian community. “The old saying is that we’ve been researched to death,” he says. “I’d like to add to that [saying] that we want to be researched back to life.” “This [research] model is helpful in eliminating that mistrust,” says Isaiah Brokenleg, one of three current SPH students to work on AICTP. Securing funding so that SPH students can work on AICTP has been a key development for Forster and SPH program coordinator Kris Rhodes, an Anishinabe member who earned an M.P.H. from the school in 2000. “It’s been beneficial to see my work benefiting the community,” says Brokenleg. “But [working on AICTP] has also been my saving grace in some ways. It’s kept me connected to the Indian community while in school.”
Resources for Education and Training American Indian Community Tobacco Project members (from left) Kris Rhodes, Jean Forster, and Lana WhiteKing dance to an honoring song for people who have quit smoking. The dance was part of the Ain Dah Yung Powwow in St. Paul, Minn. (continued from page 5)
The American Indian Community Tobacco Project (AICTP) was founded in 2001 to create a reality-based research model that involves the Twin Cities American Indian community. The AICTP is co-led by SPH professor Jean Forster and John Poupart, president of the St. Paul-based American Indian Policy Center. AICTP is funded by ClearWay Minnesota, a nonprofit group that funds tobacco research around the state. The AICTP steering council is made up of American Indian community members who have final authority on all aspects of the research. The steering council is charged with developing intervention strategies that take advantage of the traditional strengths of American Indian culture. Their strategies address the spiritual use of tobacco, the importance of children in the community, the widespread acknowledgement of the tobacco problem, and a strong belief in the community’s role to serve its people. “This is reality-based research that’s culturally appropriate. It involves [American Indians] from the first stages to the outcomes,” says Poupart, a member of the Anishinabe tribe. “We have ownership in the process and product.” Poupart has seen his fair share of the kind of research that 6
University of Minnesota School of Public Health
• For the third time, SPH alumnus and former director of the U.S. Indian Health Service (IHS) Michael Trujillo, at right, taught at the school’s annual Public Health Institute. His course provides an overview of the IHS and explores the diversity among the 570 federally recognized tribes it serves. • The school’s Centers for Public Health Education and Outreach (CPHEO) has partnered with tribal nations around the region on hands-on training for front-line emergency workers. CPHEO has provided Incident Command System (ICS) courses for the Leech Lake Band of Ojibwe and the White Earth Band of Ojibwe. The center has also provided customized training for several tribal entities, including volunteer fire departments around the state. Most recently, CPHEO participated in a statewide tribal preparedness conference. • CPHEO has developed an online course called “What is Public Health” that can be used by tribal colleges across the region. The Woodlands Wisdom Confederation and regional tribal members partnered with CPHEO on course content, which includes case studies on obesity, diabetes, and emergency preparedness.
EPIDEMIOLOGY AND COMMUNITY HEALTH
New Center Takes Leading Role in Avian Flu Fight The University of Minnesota will receive $22.5 million over the next seven years to track avian influenza and create strategies for preventing pandemic influenza. The University is one of six sites across the nation, selected by the National Institute of Allergy and Infectious Diseases (NIAID), for the new Centers of Excellence for Influenza Research and Surveillance. “We’ll be keeping our finger on the pulse of avian influenza,” says SPH professor Marguerite Pappaioanou, principal investigator. “This center establishes the University as an important player in the race to find a vaccine to protect against pandemic influenza.” Pappaioanou, colleagues in the College of Veterinary Medicine (CVM), and U.S. and international partners will conduct animal flu surveillance in multiple countries and states. The center will monitor wild birds in U.S. wetlands, identify low pathologic influenza strains in Minnesota poultry, characterize swine viruses in pigs from Minnesota to North Carolina, and conduct surveillance in live bird markets in the Midwest and Northeast. Chulalongkorn University in Thailand will conduct avian influenza surveillance of people, poultry, pigs, dogs, cats, and wild birds in rural Thailand. The Wildlife Conservation Society will conduct surveillance in Vietnamese waterfowl, wild birds in Laos, and commercial poultry in other Asian countries. Advisors to the center include SPH professor Michael Osterholm, CVM professor David Halvorson, and School of Medicine professor Vivek Kapur. Diagnostic testing and virus characterization in the United States will occur at CVM’s Veterinary Diagnostic Laboratory and the University’s Advanced Genomic Center.
Experts Discuss Agriculture Policy’s Role in the Obesity Epidemic Leading national experts on child obesity, nutrition, public health, and agriculture recently met for a first-of-a-kind meeting to discuss the impact of federal food and agriculture policy on obesity in American youth. Until now, public health voices have been largely absent in the debate over agriculture policy. In order to improve healthy eating and reduce obesity and other chronic diseases, agriculture policies need to be aligned with public health goals. SPH professor Mary Story was one of the key organizers behind the invitation-only meeting, held at the historic Wingspread Conference Center in Racine, Wisc. She joined 40 experts to discuss issues related to U.S. agriculture and food policy. Participants also explored the ways in which federal policy could advance the health and well-being of Americans. Story directs the Robert Wood Johnson Foundation’s Healthy Eating Research Program at the University of Minnesota, which co-sponsored the meeting along with the Institute for Agriculture and Trade Policy and the W.K. Kellogg Foundation. “Federal food and farm policies are so expansive, encompassing so many parts of the food system—from production, to marketing, to school foods—that they can no longer be ignored in serious public health discussions,” says Story. Given that Congress is reauthorizing the Farm Bill, this is a crucial time for the public health community to find its collective voice and identify opportunities for conducting research that will inform and enrich policy decisions. “This was a landmark meeting,” says Story. “We took initial steps toward a dialogue and developing policy options to help reverse the nation’s childhood obesity epidemic and benefit the population at large.”
ENVIRONMENTAL HEALTH SCIENCES
Improving the Safety of our Food Supply
The Role of DNA Repair in Cancer Cigarette smoking is the leading cause of cancer. While 90 percent of lung cancer patients are smokers, less than 20 percent of smokers get cancer. These estimates have led scientists to the theory that genes play an important role in lung cancer susceptibility. SPH professor Lisa Peterson is working to understand the link between DNA and cancer by studying two important tobacco carcinogens known as NNK and NNN. She and Li Li, a postdoctoral researcher, are conducting this work in a lab at the University of Minnesota Cancer Center. To trigger cancer, NNK and NNN must be converted in the body to compounds that are capable of damaging DNA. If the body does not repair this damage, the DNA undergoes gene mutation. An accumulation of these mutated genes leads to cancer. Therefore, DNA repair protects the body from cancer. Peterson and Li are studying one type of DNA damage caused by NNK and NNN. They are working to define the different pathways by which this DNA damage is repaired. These repair pathways occur in all humans, but genetic variation means that the DNA of some individuals is repaired better than in others. “Our overall goal is to explain why some people are more susceptible to cancer than others,” says Peterson. “Not smoking is the best prevention. But in the future, you might be able to tell people that they’re more at risk for cancer because their body is not efficient at repairing DNA damage. We could target those people for preventive therapy.” 8
University of Minnesota School of Public Health
From E. coli in fresh-bagged spinach, to Salmonella in peanut butter, the past year has brought an unprecedented array of major foodborne disease outbreaks. SPH professor Craig Hedberg is working to improve the way the public health system detects and responds to these outbreaks. Hedberg recently led the Enteric Diseases Investigation Timeline Study (EDITS), a groundbreaking effort to determine how long it takes for the public health system to identify and investigate individual cases and outbreaks of foodborne disease. Food production and public health both involve complex systems. The farm-to-table supply chain for a simple meal may be more complex than the supply chain that built a car. Improving the foodborne disease surveillance of the nation means improving the surveillance systems of 50 states and more than 3,000 local health departments. EDITS found that it takes 2-3 weeks for public health laboratories to identify an outbreak. But it also showed that even small improvements in response could significantly limit disease. For example, in the case of the E. coli outbreak caused by spinach, it took a month from when the contamination occurred until there was an intervention. A year before that incident there was an outbreak traced to bagged lettuce that was detected in Minnesota. It took 23 days from point of contamination to detection. The difference in response time between the two outbreaks translates to a significant difference in how many people fell ill. “When you consider the volume of nationally distributed products, you can see how a week’s time can help prevent potentially thousands of individuals from getting sick,” explains Hedberg.
PUBLIC HEALTH EDUCATION AND OUTREACH
Experts Give Insight to Global Tobacco Control Peter Sandman
The Two Faces of Pandemic Risk Communication Officials face a more difficult task of convincing the public to prepare for pandemic influenza than they did a year ago, says preeminent risk communication consultant Peter Sandman. He spoke recently at the invitation of the School of Public Health Center for Public Health Preparedness. Sandman is the creator of the “Risk = Hazard + Outrage” formula. The formula contends that the public is most concerned about the low “hazard” risks that are least likely to harm them. Conversely, they are not as concerned about high hazard risks such as smoking and driving. The job of a risk communicator is to gauge the public’s level of concern, or “outrage,” along with hazard, and then act accordingly. With pandemic flu, officials must alert people now and help them cope when it happens. Once a pandemic hits, outrage will be high. “We must have a stand-by crisis communication plan,” said Sandman. “We don’t know how fast a pandemic will hit us. . . .If we do have a severe [pandemic], we don’t know how fast we will have to act.” Right now we are in a “precaution advocacy” stage where officials must convince the public that a pandemic is still likely. Sandman said that a critical “teachable moment” was lost during the brief period when the public was interested in bird flu. Officials made the mistake of focusing on the birds and not on the real threat: the flu mutating to a strain that would kill humans. “We’re only going to get a few, if any, teachable moments before the next pandemic comes,” said Sandman. “So we must use them wisely.” 9
Photo: Tim Rummelhoff
If we are to combat global tobacco use, we must see the issue through the lens of human rights, said experts in health and law at a recent School of Public Health Roundtable. Each year the SPH hosts roundtables that address pressing issues in public health. SPH professor Harry Lando opened the roundtable by discussing how the burden of tobacco is moving to the developing world. According to World Bank statistics, by 2020, seven of every 10 people killed by smoking will be in low- and middle-income nations. Carolyn Dresler, formerly of the International Agency for Research on Cancer, spoke on the “inherent interrelated and interdependent nature” of human rights and health. To illustrate the connection between a right to health and a right to information, she cited a study that finds 69 percent of smoking men in China to be unaware of tobacco dangers. “You must address the social issues [in this case, access to information] if you want to claim physical and mental health,” she said. Benjamin Mason Meier, of Columbia University, spoke on the World Health Organization’s Framework Convention Tobacco Control (FCTC) as a model for strategically addressing the problem. “Through the FCTC, the World Health Organization has showed that it possesses the capacity to develop mechanisms of international collaboration and cooperation to challenge the globalization of disease through international law,” said Meier. The roundtable concluded with a question and answer session of the two keynote speakers and an expert panel. To view video of SPH Roundtables via the Web, go to http://cpheo.sph.umn.edu/cpheo/events/roundtable.
Can Meditation Fight Insomnia? University researchers are launching a pilot study to determine whether Mindfulness Meditation can be used to treat chronic insomnia. The study comes at a time of rising insomnia rates and few treatment options other than prescription drugs. The work is funded by an Academic Health Center (AHC) Faculty Research Grant. Cynthia Gross, a professor in the College of Pharmacy, is the primary investigator and SPH associate professor Melanie Wall serves as the biostatistician. The team also includes researchers from nursing, economics, engineering, and medicine. For the study, 40 participants will keep a sleep diary and wear a wrist device that measures sleep patterns. Half of the group will be trained in Mindfulness Meditation, and the other half will use a common sleep drug. The goal of this pilot study is to determine the feasibility of designing a large full-scale randomized trial. An important part of Wall’s job is to estimate “statistical power,” based on the variability of the findings. The variability will be affected by how well participants comply with the study and how widely sleep patterns differ among participants. The more variability, the more participants would be needed for a full-scale trial. Less variability would mean fewer participants. “Before beginning a large study, you have to scientifically justify your sample size,” explains Wall. If successful, the researchers would be among the first to conduct a major trial of non-drug treatment for insomnia— a condition that has become a major public health issue. “Taking pills to sleep. . .is not a healthy lifestyle, and it’s become so common,” says Gross. “It’s a bad message to be giving kids, if not everyone else.” 10
University of Minnesota School of Public Health
Rural America Lacks Access to Hospice Care Some 332,000 Americans live in rural areas not served by home-based hospice. The finding comes from the first study to examine rates of U.S. hospice service at the ZIP-code level. SPH professor Bradley Carlin designed the statistical model of the study. He is an expert in using statistical tools to make sense of geographically referenced data. SPH associate professor Beth Virnig served as principal investigator. Along with former SPH doctoral student Haijun Ma, Carlin used Medicare enrollment data to estimate ZIP-code-level service areas for hospice care. One of the challenges was dealing with the small number of hospice users in rural areas—the sparse data could easily lead to false conclusions. So Carlin used a “spatial smoothing” approach that accounted for patterns of hospice availability in adjacent ZIP codes. “The method allowed us to avoid overestimating the lack of service in low-population ZIP codes that have few in-hospice deaths,” explains Carlin. The researchers found that access to hospice care greatly depends on proximity to an urban area. Nearly 99 percent of metropolitan ZIP codes are served by hospice. But the researchers estimate that 2,900 ZIP codes in the United States are not serviced by hospice. These rural areas make up for 7 percent of the annual deaths among the Medicare beneficiaries studied. This means that each year more than 15,000 Medicare users die without the opportunity to receive home-based hospice care. The researchers hope these findings can be used to amend hospice reimbursement policies that currently favor large hospices over smaller, rural hospices. “Change to the payment rules is key to providing hospice care for both urban and rural populations,” says Carlin.
HEALTH POLICY AND MANAGEMENT
State Senator Appointed SPH Fellow
SPH to Evaluate State Health Reform The School of Public Health has launched a new Robert Wood Johnson Foundation National Program Office to support the evaluation of state health reform efforts nationwide. Developed in response to increased state activity to improve health care access, the State Health Access Reform Evaluation (SHARE) project will develop a coordinated approach for the evaluation of state health care reform initiatives being implemented nationwide. SHARE will coordinate state evaluation efforts, identify and fill gaps in research, and synthesize and release findings to assist policymakers interested in health reform. The project will provide evidenced-based research to state and national policymakers on factors that contribute to successful health care reform initiatives. SHARE’s research will identify best practices that lead to increased access to quality care. “States are our laboratories for experimenting with different health reform strategies,” says SHARE director Lynn Blewett, SPH associate professor. “SHARE will be able to assess the effectiveness of state initiatives and inform the policy debate about universal health coverage and ways to get there.” SHARE will award $7 million in grant funding to researchers evaluating state reform over a period of four years. The project is a national program of the Robert Wood Johnson Foundation, with direction by the State Health Access Data Assistance Center (SHADAC) at the School of Public Health. For more information about SHARE, go to www.statereformevaluation.org.
Former Minnesota Senator Sheila Kiscaden has been appointed a senior fellow by the School of Public Health’s Division of Health Policy and Management. Sheila Kiscaden Kiscaden is a fourterm state senator from District 30, which includes Rochester, Minn. and neighboring areas. She was first elected to the Senate in 1992 and served as a Republican for 10 years, until local Republicans refused to endorse her in 2002. She ran as an Independence Party candidate but still caucused with the Republicans until they publicly separated from her. She was then invited to join the Minnesota DFL caucus. Her most recent term in the State Senate ended in January 2007. It was SPH associate professor Lynn Blewett’s health policy work with the state that helped forge the connection between the senator and school. Kiscaden has also worked with SPH professor Bryan Dowd, who provided information for some of the health reform bills she sponsored while in office. Kiscaden focused on health care throughout her legislative career. She recently brought that experience to SPH students when she taught State Health Policy and Politics. In addition to an impressive list of guest speakers, Kiscaden arranged for students to visit the state capitol to meet with staffers, lobbyists, and freshman legislators. Nitika Malik is a research fellow for the State Health Access Data Assistance Center (SHADAC), a state-level health policy analysis group in the SPH. She says Kiscaden’s class offered a real-world perspective to policymaking and the rare opportunity to hear from a legislator who has worked within more than one party. “Her experience shows that you can work across the aisle and get things done,” says Malik.
SPH Dean John Finnegan signs a memorandum of agreement with School of Nursing Dean Connie Delaney (center) and Faculty of Nursing Dean Erla Kolbrun Svavarsdottir, University of Iceland.
Iceland Delegation Visits SPH Henry Blackburn, at right, travels to Ancona, Italy, with Margaret and Ancel Keys for the Seven Countries Study, 1963.
Telling Tales of Heart Disease
University of Minnesota School of Public Health
Photo: Tim Rummelhoff
Heart attack and stroke were long considered an inevitable part of aging. But by the late 1940s, a group of pioneering scientists set out to understand the devastating cardiovascular disease (CVD) epidemic. They boldly went beyond their laboratories and clinics, traveling the world in search of the societal origins of the disease. In that search the field of CVD epidemiology was born. SPH professor emeritus Henry Blackburn tells this story in a collection of letters, journals, photographs, and interviews available for the first time at www.epi.umn.edu/cvdepi. A companion book, Preventing Heart Attack and Stroke: A History of Cardiovascular Disease Epidemiology, is in process with Oxford University Press. In undertaking the mammoth history project, Blackburn believed it was time to look back. “We’re just two generations removed from the origins of CVD epidemiology,” he says. “As pioneering investigators rapidly leave the scene, it seems more urgent to tell their stories and share their legacy.” Blackburn tells the tales of “Medical Marco Polos,” who were the first scientists to link lifestyle and heart health. Included is the University of Minnesota’s own Ancel Keys, who traveled to Europe, Africa, and Asia to systematically study the diets and customs of different cultures. Blackburn collaborated with Keys for 50 years as SPH faculty and in the years beyond Key’s retirement in 1972. Blackburn still draws from the example set by Keys and other groundbreaking CVD investigators. But, more importantly, he believes these scientists can serve as an inspiration beyond their field: “They show us the importance of leaving comfortable surroundings, of challenging yourself, and of searching for answers in diverse places.”
Recently the SPH and School of Nursing welcomed a delegation of faculty from the University of Iceland (U of I) and Iceland’s Landspitali National Hospital for a day-long symposium on research areas in which the two universities might collaborate. As part of the event, a memorandum of agreement was signed between the University of Minnesota Academic Health Center (AHC) and the U of I to facilitate teaching and research partnerships. The University of Minnesota and the U of I have enjoyed a 25-year formal relationship that has included numerous student exchanges and faculty research collaborations. That relationship forms the basis for the new AHC partnership with the U of I in a variety of areas including informatics, public health, genetic epidemiology, clinical education, and more. In addition to the symposium, the visitors from Iceland participated in meetings with Fairview Health Services officials and representatives of the Mayo/University partnership. The latter included a tour of the Mayo Clinic, a roundtable discussion about the importance of partnerships between universities and private-sector leaders, and a visit to the home of a Mayo physician who is a native of Iceland. The visit from the Iceland delegation came between two visits by officials of the University of Minnesota to Iceland. Last fall, SPH Dean John Finnegan, School of Nursing Dean Connie Delaney, and other faculty met with their counterparts at the University of Iceland. And just a few weeks ago, University President Robert Bruininks led a delegation of faculty and staff on a visit that marked the 25th anniversary of the relationship between the two universities.
SCHOOL NEWS SPH Faculty Take Top Awards John Connett has received the SPH’s highest teaching honor, the Leonard M. Schuman Award for Excellence in Teaching, in recognition of his extraordinary impact on students. He was nominated for his remarkable student evaluations and for his outstanding availability to mentor students. Connett chooses to teach a full course load, in addition to his role as head of the Division of Biostatistics. Rosalie Kane has received the University of Minnesota
Mervyn Susser with a portrait of Gaylord Anderson.
Photo: Tim Rummelhoff
Preeminent Epidemiologist Speaks at the SPH Preeminent epidemiologist Mervyn Susser recently delivered the 2007 Gaylord Anderson Lecture at the School of Public Health. Susser is Sergievsky Professor of Epidemiology Emeritus at Columbia University’s Mailman School of Public Health. Susser began his career in community health care in South Africa. Years later, in 1978, he founded the Columbia University’s Gertrude H. Sergievsky Center, which focuses on neurologic, psychiatric, and developmental epidemiology. He served as the editor of the American Journal of Public Health from 1992 to 1998. Together with his foremost collaborator and wife, Zena Stein, in 1999, he served as the joint director of the Africa Centre for Population and Reproductive Health Research in South Africa. Susser is known for his work on the philosophy and goals of epidemiology, and for his active involvement in human rights. Susser is currently at work on a book on eras in epidemiology. His lecture at the SPH focused on the work of Joseph Goldberger and Edgar Sydenstricker, who conducted some of the earliest and most influential research on nutrition and public health. “This is the work of scientists who reached into my own time, if not the time of everyone else,” said Susser. While on campus, Susser and Stein also met informally with faculty and students of the school’s Division of Epidemiology and Community Health. The Gaylord Anderson Lecture is named for the founding dean of the SPH. Known as “Mr. Public Health,” Anderson served as dean for 32 years until retiring in 1970. To listen to the 2007 Gaylord Anderson Lecture on your computer or to download it to your iPod or other MP3 player, go to blog.lib.umn.edu/sphpod/sphpod.
Distinguished Women Scholars Award for Humanities, Social Sciences, and Arts. She was recognized for her work in improving long-term care and support services for elderly people worldwide. Kane is a prominent voice in the movement to dramatically transform nursing homes, and is one of the first researchers to show that housing can be mixed with services to better serve older people.
Charles Oberg has received the Charles N. Hewitt Creative Teaching Award, which recognizes SPH faculty who have made an outstanding contribution in special areas of public health education. He teaches courses in children’s health and rights. A student describes his classroom as an “exciting and fun environment that fosters critical thinking, challenges students, and caters to all learning styles.”
Michael Osterholm has received the Commissioner’s Special Citation award from the Food and Drug Administration. He is being honored “for continued excellence in promoting food safety and food defense to ensure the safety of the American public.” He received the award along with University colleagues Frank Busta and Shaun Kennedy.
James Rothenberger has received the University of Minnesota Outstanding Community Service Award. He was recognized for his work with chemical dependency prevention and treatment programs for adolescents and for his involvement with the Midwest AIDS Training and Education Center. Each year, Rothenberger reaches more than 4,000 students in an online course that he designed. The course is regarded for innovatively teaching students the dangers of drug and alcohol abuse.
Scholarship Supports SPH Student’s Injury Prevention Work Photo: Scott Streble
Quintin Williams is an expert on work. At 20-something, Williams has held more jobs than he can remember. But there’s one job he’ll never forget: the industrial battery factory in Chicago where he suffered serious burns in an explosion of molten lead. Now, with support from a William Randolph Hearst Foundation scholarship, Williams is pursuing a doctoral degree in occupational injury prevention in the School of Public Health that will make him an expert on safe working conditions. “My youth has been work, work, work, and pay the bills,” says Williams, who holds a B.S. in mechanical and industrial engineering. The first in his family to attend college, Williams has been on his own since he was a teenager in Chicago, sometimes working as many as four jobs to pay for school and make ends meet. “I worked two jobs, four jobs, whatever it took,” says Williams. “I had a full-time job during the day, a part-time job in the evening, and two janitorial accounts on the weekend.” Thanks to the Hearst scholarship, which covers his tuition, living expenses, and health insurance, Williams can finally concentrate on his studies without the distractions of a job. “The scholarship takes a huge burden off; I can focus entirely on school,” says Williams, who aspires to work for the National Institute for Occupational Safety and Health and teach at a university.
University of Minnesota School of Public Health
Williams is one of two SPH students currently receiving a Hearst scholarship from a $200,000 endowed fund established by the foundation in December 2002. The scholarship supports students from underrepresented populations who plan to do public health work in the United States. By 2008, the fund will provide larger scholarships for three SPH students every year, thanks to another $200,000 gift from the foundation last year. “I couldn’t be more gratified that the Hearst Foundation has made this commitment to our school and our students,” says SPH Dean John Finnegan. “With this support, we can help launch the careers of students like Quintin who have tremendous potential to improve public health in our country.” Though happily unemployed, Williams is still hard at work. In addition to taking classes, he’s developing his Ph.D. proposal—a study of farm-related injuries to children. As an intern for the past two summers, he created an emergency response plan for the deaf and hard of hearing, and worked on a study assessing the safeguards in machine shops. With a fellow graduate student, he volunteers as a mentor to 14 students from St. Paul’s Johnson High School. “We have to come up with the subject matter that will help them develop their career focus,” explains Williams. “It’s a wonderful feeling to see these young minds maturing. A lot of people helped me along the way, and I want to give back.” Reprinted with permission from the Winter 2007 edition of Giving Matters, a publication of the Minnesota Medical Foundation.
Web Extra! Quintin Williams is the latest SPH student to be featured in the school's My Life video podcast series. Check it out at www.sph.umn.edu/sphere.
3M Supports Infectious Disease Prevention Minnesota-based 3M Company and 3M Foundation have together pledged $1.2 million to advance the work of the Center for Infectious Disease Research and Policy (CIDRAP). SPH professor Michael Osterholm directs CIDRAP. The organizations were among the first to support CIDRAP’s mission to prevent illness and death caused by infectious disease. Additional support from 3M Company and 3M Foundation includes gifts totaling $62,000 for several other health-related programs at the SPH.
Alissa Van Wie and Amanda Woodfield
SPH Students Appointed Presidential Management Fellows Two School of Public Health students have been appointed Presidential Management Fellows (PMFs). Alissa Van Wie and Amanda Woodfield, both students in the Public Health Administration and Policy program, will begin the two-year fellowships in Washington, D.C. this summer. The purpose of the PMF program is to attract outstanding students from a variety of academic disciplines to federal service. This is the first time an SPH student has received the prestigious fellowship. While 3,800 students applied for PMFs, just 790 of them were deemed eligible. Van Wie will work as a budget analyst for the Food and Drug Administration. She will be responsible for the budget of one of the FDA’s six centers. “Working in a budget position will give me great insight to the policy process,” says Van Wie. “All policy relies on the successful implementation of a budget.” Becoming a PMF has been a goal of Woodfield’s since high school when she learned about the program as an intern at the U.S. Department of Health and Human Services. Woodfield will soon head to the National Cancer Institute, where she will rotate throughout various positions based on her interests. “I’m hoping to gain a deeper understanding of the different components of cancer control,” she says. As PMFs both Van Wie and Woodfield will receive a budget to attend conferences and trainings, and they will have the opportunity to spend a few months working at a nonprofit agency or on Capitol Hill. And, most importantly, they will most likely be offered a job at the conclusion of their fellowship. Traditionally, PMFs are non-competitively hired by their agency.
SPH students build beds for Camp Hope.
Students Lend a Hand to New Orleans Relief Efforts Students in the school’s Master of Healthcare Administration (MHA) program recently joined hospital executives from throughout the country to support Habitat for Humanity operations in New Orleans. The students arrived two days prior to the American College of Healthcare Executives (ACHE) Annual Congress so they could participate in the Habitat for Humanity event. The students who volunteered were Jerry Birk, Tara Boedeker, Hashir Hamza, Alicia Judkins, Juliet Nguyen, Aaron Patnode, and Jeff Skwarek. The group joined with other ACHE attendees to build 150 bunk beds for Camp Hope, the primary operations center for Habitat for Humanity efforts in the area. Camp Hope was once the site of a high school but flood waters damaged the building. It now serves as a warehouse for housing materials and as the lodging site for volunteers who come from throughout the country. Prior to having the bunk beds, volunteers were forced to sleep side by side on concrete floors. The idea of giving back to the community is a “natural fit” for MHA students like Birk. “There’s a clear relationship between healthcare administration and serving the community,” he says. “We’re looking for ways to develop experiences beyond the classroom that serve society.”
Cynthia Kenyon (M.P.H. ’99) is a senior epidemiologist with the Minnesota Department of Health. Her duties include statewide disease surveillance and overseeing projects directed by the Centers for Disease Control and Prevention.
Cecilia Amor Kramer (M.P.H. ’90) has more than 15 years of experience in communications and fund development. She is currently director of development for the Cancer Research Center of Hawaii.
An Liu (M.S. ’02) founded A&L Consulting, where he serves as principal statistician and president. A&L specializes in designing and analyzing clinical trial research data for biomedical sciences.
Richard Person (M.P.H. ’83) is a program administrator
Photo: Tim Rummelhoff
The SPH Alumni Society Board covenes for the first time. Front row, from left: Linda Olson Keller, Gizaw Tsehai, Brenna Vuong, Cynthia Kenyon, Mary Kay Hunt, Brigid Riley. Back row: Judy Beniak, Richard Person, James Anderson, Amos Deinard, Mary Sheehan, An Liu. Not pictured: Cecilia Amor Kramer, Michael Trujillo, Gita Uppal.
SPH Alumni Board Convenes The newly re-established SPH Alumni Society Board recently met for the first time. The board will lead initiatives to provided lifelong learning opportunities for SPH alumni. Board members are diverse in graduation years and expertise:
James Anderson (M.H.A. ’68) is a senior executive with 39 years of health administration leadership experience. He is currently the chief administrative officer for Mayo Clinic Arizona.
Judy Beniak (M.P.H. ’81) has extensive experience in public health administration. She currently directs the Health Careers Center for the University of Minnesota Academic Health Center. Amos Deinard (M.P.H. ’85) is an associate professor in the Department of Pediatrics at the University of Minnesota Medical School. He is also an adjunct faculty member of the Maternal and Child Health program in the SPH.
Mary Kay Hunt (M.P.H. ’83) is a consultant for the DanaFarber Cancer Institute and Harvard School of Public Health. Her international experience includes teaching in Bahrain and working at the World Health Organization.
Linda Olson Keller (M.S. ’79) is a public health nurse with experience as a consultant, evaluator, professor, and staff nurse. She recently accepted a position as senior research scientist in the University’s School of Nursing. 16
University of Minnesota School of Public Health
for the Saint Paul Department of Public Works. He oversees waste management and recycling and public rightof-way issues.
Brigid Riley (M.P.H. ’88) is the executive director of the Minnesota Organization on Adolescent Pregnancy, Prevention, and Parenting. She previously worked as a health promotion specialist for Hennepin County and the City of Bloomington.
Mary Sheehan (M.P.H. ’84) is health and human services director for Chisago County in Minnesota. She has previously worked as an epidemiologist, public health nurse, and administrator of programs in food safety and tobacco control. Michael Trujillo (M.P.H. ’84) is a faculty member of the University of Mexico, where he directs a minority and community programs outreach center. He previously served as director of the U.S. Indian Health Service.
Gizaw Tsehai (M.P.H. ’06) is a consultant to the Midwest Training and Education Center and a coach for leadership fellows at Clearway Minnesota. From 1983 to 1991 he served as Minister of Health of Ethiopia.
Gita Uppal (M.P.H. ’99) is a senior health policy analyst with the Office of the Secretary of Defense. She has also worked in the United Nations in Rome and Albania and in the U.S. Senate.
Brenna Vuong (M.P.H. ’04) is a clinical therapeutics program director for Hennepin County Medical Center in Minneapolis. She also serves on the Policy and Advocacy Committee for the Minnesota Public Health Association.
American Indian Alumnae Stay Connected to Their Communities
Jennifer Irving grew up in the town of Pine Ridge, located in the poorest county in South Dakota. As a member of the Oglala Lakota Sioux Tribe, she was raised in a culture that emphasizes compassion and generosity. Public health, she says, fits right into her traditional beliefs. “I’ve always felt pulled to health,” says Irving, who graduated with an M.P.H. in 2005 from the Community Health
Education program. Irving works as a data manager for a project funded by the Centers for Disease Control and Prevention called the South Dakota Tribal Pregnancy Risk Assessment Monitoring System. The program collects information on prenatal care, chemical use, maternal mental health, support systems, and a variety of other topics. One project goal is to improve the health of American Indians by reporting back to South Dakota tribes, a tribal member’s specific perinatal health needs. That way, tribes can address issues and tailor interventions specific to their own community’s needs. “The whole reason I went into public health was to work with American Indian people,” Irving says. Amy DeLong has long known that she wanted to work with her own community, the Ho-Chunk Nation in Wisconsin. DeLong, who graduated with an M.P.H. in 2003 from the Maternal and Child Health program, is getting to do just that through her work as a family physician at the tribal clinic, House of Wellness. DeLong is one of four medical staffers Amy DeLong at the clinic, which serves thousands of community members annually. “When I chose medicine I knew I wanted to be in Indian health,” says DeLong, who received her M.D. in 1998. “My tribe paid for my medical education and this is my payback to them, but it’s also what I wanted to do.” DeLong said she plans to continue her work at her tribe’s clinic until she retires.
ALUMNI NEWS Tiffany Beckman, a member of the Leech Lake Band of Ojibwe, has the distinction of being the first American Indian endocrinologist in the country. Beckman currently works in the University’s weight management clinic and serves as a consultant for the Shakopee Mdewakanton Sioux. At the University she draws on her knowledge of both western and traditional medicine Tiffany Beckman to help people fight obesity. “Part of traditional medicine is using intuition with the skill set you’ve acquired in western medicine,” she says. Beckman uses a healing method she calls, “wind, water, wound, walking.” She asks patients to examine their current behaviors, pause, breathe deeply, and bring in the wind. She encourages them to drink water when they think about eating, to walk in nature, and to have a period of reflection. “I’m doing what I was designed to do by [my] culture and the Creator,” she says. “It’s inherently what I’m supposed to do.” Beckman earned an M.P.H. in 2003 from the Maternal and Child Health Program. Jessica White Plume knows from personal experience that her work at North Dakota’s Center for Health Promotion and Prevention Research matters. White Plume, a member of the Oglala Lakota Tribe in Pine Ridge, is a 2005 graduate of the Executive Program in Public Health Practice. The center she works for helps prevent obesity and tobacco Jessica White Plume use in children and adolescents. Her work includes a school-based obesity prevention program and analysis of the environmental influences of childhood obesity such as the cost and availability of healthy foods. White Plume’s work, which takes her to each reservation in the state, is designed to focus on small towns and rural communities. “Researchers and policymakers are recognizing that we have to change policies and the food environment if we want to make a real difference in the rates of obesity we see in children,” she says. White Plume is also a consultant for the SPH’s Bright Start program, which aims to reduce obesity in first-graders at 14 tribal schools in South Dakota. (For more on Bright Start, see page 2.) 17
Upcoming Events SPH Reunion in Boston The SPH is hosting an alumni reunion in conjunction with the 40th Annual Meeting of the Society for Epidemiologic Research (SER). June 21, 7:00-9:00 p.m. The Boston Park Plaza Hotel and Towers
NOTES FROM THE FIELD
Maternal and Child Health Summer Institute July 24-25 Hubert H. Humphrey Conference Center
SPH Day at the Minnesota State Fair August 28, 9:00 a.m.-9:00 p.m. U of M Building, Fairgrounds
SPH Community Partners Event September 20, 5:30-7:30 p.m. McNamara Alumni Center More information on these and other events can be found at www.sph.umn.edu.
Mentors Needed! The SPH Mentor Program is recruiting mentors for the 2007-2008 school year and alumni are invited to participate. The commitment is one to two hours per month from November to May. More information and application at www.sph.umn.edu/mentor.
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