Advances - Spring/Summer 2012

advances Spring/Summer 2012

f r om the Un iversi ty o f M i n n eso ta S c h o o l o f P u bl i c H e a lt h

> In Pursuit of la Pura Vida > Eating Smart at School > Reducing Risk for Farm Kids > Driving After Combat Duty

Supporting the Agricultural Life SPH faculty tend to the concerns of workers and their families

School of Public Health Leadership

Debra Olson Associate Dean for Education William Riley Associate Dean for Strategic Partnerships and Relations Beth Virnig Associate Dean for Research Mary Ellen Nerney Assistant Dean for Education Operations

contents

Bradley Carlin Head, Division of Biostatistics Bernard Harlow Head, Division of Epidemiology and Community Health Rose Jones Senior Director, Advancement and External Relations

Dear Friends, By the summer of 1862, the American Civil War had fully engulfed the nation. President Abraham Lincoln and the U.S. Congress were not at all confident that peace would prevail. Yet both already were focusing on a better future. In July, Congress approved, and Lincoln signed into law, federal legislation called the Morrill Act creating the land-grant university. Its mission was to build the future by serving the people in education, research, and public engagement. Minnesota was among the first states to benefit.

Ira Moscovice Head, Division of Health Policy and Management William Toscano Head, Division of Environmental Health Sciences Joe Weisenburger Chief Administrative Officer/Chief Financial Officer

advances Executive Editor Rose Jones Editor Kristin Stouffer Managing Editor Martha Coventry

This year, the University of Minnesota commemorates the 150th anniversary of the Morrill Act with the theme “For the Common Good,” a phrase that is also a powerful reminder of the purpose and commitment of the School of Public Health. As we mark this milestone, it seems right to highlight a critical aspect of our work rooted in the original land-grant legislation but not always associated with public health— agriculture. From farm and food safety to rural health care to national food policy, the expansive reach of public health touches nearly every quarter of agriculture.

As you’ll see from the stories in this issue, interdisciplinary partnerships are vital to our efforts. The diverse research of the Upper Midwest Agricultural Safety and Health Center (page 2), the local–to-global reach of the new Food Policy Research Center (page 15), and the groundbreaking work of the school’s first holder of the Leon S. Robertson Professorship in Injury Prevention, Susan Gerberich (page 13), all rely on essential alliances for their success.

Contributing Writers Beth Dooley Nicole Endres Mark Engebretson Susan Maas

The cross-pollination of careers also reflects natural ties between public health and agriculture. “Hands in the Dirt” on pages 8-9 and “From Seeds to Savoring” on page 7 feature very different ways SPH graduates and students are staying connected to the soil.

Art Direction Cate Hubbard Design cat7hubb@gmail.com

To further our focus on the common good and our stewardship of the environment, we have upgraded the type of paper used in Advances. The new stock consists of 55 percent recycled paper with 30 percent post-consumer material. The paper is also ECF certified, meaning that no chlorine was used in the bleaching process.

Advances is published by the University of Minnesota School of Public Health. To submit comments, update your address, or request alternative formats email sphnews@umn.edu.

Yours in health,

Printed on recycled and recyclable paper made with at least 55 percent recycled paper and at least 30 percent postconsumer material.

Certified elemental chlorine free (ECF).

John R. Finnegan, Jr., PhD Assistant Vice President for Public Health Dean and Professor © Regents of the University of Minnesota. All rights reserved. The University of Minnesota is an equal opportunity educator and employer.

cover photo by dean Riggott, Photos above left to right: Paula Keller, Keith Weller, Laurie Schneider

Mary Story Senior Associate Dean for Academic and Student Affairs

from the dean

Photo by richard anderson

John Finnegan Dean

Spring/Summer 2012

Features

Departments

2 Supporting the Agricultural Life

10 Findings

Through attention to injury and disease prevention, and quality care, SPH faculty tend to the health and welfare of farming and ranching families.

5 Farm Bill Primer

What’s in the 1,000 page—and growing—2012 Farm Bill that can shape what and how we eat, as well as make or break agricultural endeavors?

6 Farm-to-school

By connecting area producers with their local schools, SPH alum Stephanie Heim helps introduce a generation of school children to real food.

7 From Seeds to Savoring

Recent Public Health Nutrition graduate Molly Turnquist is devoted to showing people the pleasure—and health—that comes with good food grown and shared.

Meds for asthmatic kids when costs rise; reducing cancer disparities; heath insurance gaps for reproductive-aged women; “natural” food: healthy or hype; and more.

14 school News

MHA alum Bill Kreykes is indefatigable SPH booster; new Food Policy Research Center brings unique collaborative perspective.

16 alumni News

Call for mentors; class notes; Gaylord Anderson Award nominations; and more.

8 Hands In the Dirt

Connecting public health with growing nutritious food is a natural step for three SPH grads.

13 Staying Safe in the Country

SPH professor Susan Gerberich began the landmark Rural Regional Injury Study to explore the risks of a rural life, especially for children. Recently, she was named the first recipient of the Leon S. Robertson Professorship in Injury Prevention.

advances.umn.edu/s12 1

E. coli 157 is not just a problem of cattle in large feedlots. It’s found in cows in small organic dairy farms as well.

– Craig hedBerg Extension, and Minnesota Department of Health to explore foodborne illness outbreaks and to work with farmers on prevention.

“This multidisciplinary group is important for extending the reach of our efforts and maintaining relationships with food pro­ducers,” says Hedberg. “In a state like Minnesota, where we have this very intense and rich animal agriculture system side-by-side with fresh fruit and vegetable production, there is tremendous potential for contamination.”

According to Hedberg, E. coli 157 is not just a problem of cattle in large feedlots. It’s found in cows on small organic dairy farms as well.

“Family farms aren’t necessarily safer when it comes to this organism and its potential to contaminate [fruits and vegetables],” says Hedberg. “Small producers are trying their best to produce wholesome and quality products and are eager to address whatever may threaten that effort. We need to reach out more to them so they understand where the hazards might be and what steps they could take to prevent contamination.

Supporting the

Day-to-day risks

Agricultural Life

SPH faculty tend to the concerns of workers and their families

2 University of Minnesota School of Public Health

they, themselves, most susceptible to? If they do get injured, can they get quality health care? And what will happen to them as they age?

Minnesota agriculture produces $3 billion each year worth of commodity crops—corn, soybeans, sugar beets, and small grains— but more and more small farmers are growing produce and raising fruit for direct consumption. In our state, as everywhere, that food is vulnerable to contamination, often before it’s harvested.

“Increasingly, we’re seeing E. coli 157 and Salmonella in fresh produce, and those bacteria can be traced directly back to the production source,” says Craig Hedberg, an epidemiologist and professor in the Division of Environmental Health Sciences.

Hedberg and his colleagues work with other SPH faculty and members of the College of Veterinary Medicine, CFANS (College of Food, Agriculture, and Natural Resource Sciences), University

TOP Photo by Darin Back

Safe at the source

Photo by Dean Riggott

T

he rural life is not a particularly easy one. Neighbors may be few and far between; emergency rooms, grocery stores, and schools, a long drive. And if you make your living off the land, you are extraordinarily susceptible to the weather, not to mention the markets.

Yet about 18 percent of the state’s people live outside metropolitan areas, drawn to the country for its promise of self-reliance, a slower pace of life, and the opportunity to farm or ranch. Agriculture makes up 20 percent of Minnesota’s economy and producing food for our state and beyond can be a family tradition or a new and growing passion for young people eager to work the land.

If you start exploring the range of expertise at the School of Public Health, you’ll find a surprising number of faculty who tackle the practical, yet critical concerns of farmers: How do they know that the food they produce is safe for their customers? Are their animals protected from disease? What injuries and illnesses are

“Agriculture work is recognized as one of the more dangerous jobs,” says Bruce Alexander, professor in environmental health sciences. “It puts people in close proximity to animals, machinery, dusts, gases, and chemicals.”

Alexander heads up the Upper Midwest Agricultural Safety and Health (UMASH) center whose mission is to reduce the burden of illness and injury in agricultural workers and their families. Established in September 2011, it’s one of nine regional Centers of Excellence in Agricultural Disease and Injury Research, Education, and Prevention funded by the National Institute for Occupational Safety and Health (NIOSH).

“UMASH builds a partnership with the School of Public Health, College of Veterinary Medicine, Minnesota Department of Health, and the National Farm Medicine Center at the Marshfield Clinic,” says Alexander. “This partnership brings a unique interdisciplinary approach to agricultural health and safety.”

UMASH’s focus is animal agriculture, and it takes a One Health approach, a global concept that stresses the inextricable connection among animals, people, and the environment when it comes to health. UMASH is concerned with zoonotic diseases—those that pass from animals to humans—and is exploring the possibility that antibiotic resistant organisms may be affecting agricultural workers.

The center is also examining, through a series of studies, how different means of dairy and pork production—from intensive methods to more traditional practices—influence injury or illness

advances.umn.edu/s12 3

A Farm Bill Primer On June 21, the U.S. Senate passed the Agriculture Reform, Food, and Jobs Act of 2012, better known as the Farm Bill. In the process, it trimmed nearly $24 billion off the $500 billion (over five years) legislation.

The bill has several more hurdles to clear—including the House—before Congress may or may not sign it into law sometime before September 30, when the 2008 bill expires.

A new Farm Bill has been passed every five to seven years since the first one was introduced in 1933. Our country was deep in the Great Depression then, the price farmers could get for their crops was near zero, and our topsoil was literally blowing away. That bill, called the Agricultural Adjustment Act, was crafted to regulate crop supply and demand, and it introduced subsidies to keep farmers afloat.

“ When you put farmers’ natural stoicism together with the lack of, or inadequate, insurance coverage, they may delay going to see a doctor.“ – I RA MOSCOVICE

When people on farms do get injured, where do they go? What kind of care do they receive? And how do they pay for it? The Rural Health Research Center has been asking questions like these for 20 years as it confronts the challenges of rural health care. For farmers who work for small operations or themselves, center director Ira Moscovice cites two particular concerns: lack of insurance coverage and quality of care.

“Due to a variety of factors, people in rural areas are more likely to have preexisting conditions, and they’re more likely to have chronic illnesses,” says Moscovice, health policy and management professor.

Both things make it more expensive to get private insurance coverage.

And farming is considered a high-risk occupation, which also drives up premiums. Being uninsured or underinsured has a serious impact on seeking care.

“When you put farmers’ natural stoicism together with the lack of, or inadequate, insurance coverage, they may delay going to see a doctor,” Moscovice says. “Early cancer diagnosis data, for example, show that people are 2.5 times more likely to delay going to see a

4 University of Minnesota School of Public Health

Using its influence wisely Farm Bills reflect current concerns and are always controversial. The most publicized issues in 2012 have been reducing funding for nutrition programs and increasing funding for commodity crop insurance, which some view as a windfall for insurance companies at taxpayer expense.

Reflecting our country’s growing attention to the obesity epidemic, the support given to “specialty crops”—fruits and vegetables—versus commodity or row crops has also received increased scrutiny this year.

Commodity crops—notably corn and soybeans—are the principal ingredients in processed foods and provide feed for the meat industry.

Decreasing support for these crops while increasing funding for specialty crops has the potential to overhaul the American diet. However sensible that shift may seem to some people, it would be a major threat to Farm Bill tradition and it could take decades to achieve.

Although it represents only 2 percent of the federal budget, the modern Farm Bill has an outsized influence on what we eat, the health of our environment (it sets conservation policy for nearly 40 percent of U.S. land), biofuels development, the farming community’s financial wellbeing, and the availability of food for vulnerable Americans. It stands as one of two pieces of legislation, along with the Affordable Care Act, that touches nearly every person in the country.

doctor if they don’t have insurance. We want access to appropriate medical services for everyone in the United States.”

The federally funded Rural Health Research Center is one of six in the United States. Each was asked to choose a major theme, and the University center chose to study the quality of rural health care, an issue that has been largely ignored.

“For many people living in rural communities, if they had a local doctor or a small group of doctors, that was [considered] a success,” says Moscovice. “Very few researchers have been interested in what was actually going on in rural health care and the quality of services people were receiving.”

The center has been working to develop relevant quality measures to monitor and evaluate rural health care and to make sure the quality issue is on the table as future health care reform and policy changes occur. These efforts are being helped along by the government’s focus on quality care nationwide.

“Recently, necessary services that lead to good patient outcomes have been what payers (insurance companies or the government) want to support,” Moscovice says. “This shift creates incentives for providers to focus on quality. We want to make sure our rural communities don’t get left behind.”

Learn more about: • Upper Midwest Agricultural Safety and Health (UMASH) center at umash.umn.edu • Rural Health Research Center at rhrc.umn.edu

Photo by Keith Weller

Getting good care

Like Farm Bills of the past, the 2012 legislation is broken up into individual title areas and numbered, for a total of 12 titles this year.

Conservation is Title II; Trade, which includes food aid to foreign countries, is Title III; and Energy is Title IX. The two that get the biggest portion of support are Nutrition (Title IV), at 80 percent, and Commodities (Title I), at 12 percent.

That a bill with the word “farm” in its name benefits urban populations as well as rural comes as a surprise to most people. The bulk of nutrition title money supports SNAP, the Supplemental Nutrition Assistance Program, formerly known as the Food Stamps Program. SNAP serves more than 46 million people each month, one in seven Americans. The rest of the nutrition funding is distributed to various programs addressing healthy foods, including some supporting school meals.

Photo by Dean Riggott

in workers and their families. Once risk factors are identified, targeted prevention methods can be put in place. These methods, like agriculture itself, must change to meet current needs and demographics.

“The shift to larger operations has changed the workforce, which is increasingly made up of new immigrants, thus disease and injury prevention must consider language, literacy, and culture in a way it hasn’t before,” says Alexander.

Not just for rural America

The Senate voted to maintain 2008 funding of $150 million for the Fresh Fruit and Vegetable Program that gives more than 3 million school children a fresh fruit or vegetable snack every day. A Department of Defense program that allows schools to use their commodity dollar allo­ cations on fresh produce was also fully funded at $50 million each year.

advances.umn.edu/s12 5

From seeds to savoring

Real food for real kids With Farm-to-School, local farmers and local schools join forces to help children eat better

Molly Turnquist finds pleasure and meaning in food’s timeless cycle

One aspect of Farm-to-School is the opportunity kids have to grow and harvest their own food in schoolyard gardens, like these students do at Meadowbrook Elementary School in Hopkins, Minn.

6 University of Minnesota School of Public Health

SPH professor Mary Story appears in the tpt documentary “Farm to School: Growing Our Future” at www.advances.umn. edu/s12/farmtoschool.

Photo by Darin Back

balanced meals. SPH public health nutrition alum Stephanie Heim is a Farm-to-School educator at University of Minnesota Extension. The University helps lead Farm-to-School in Minnesota with partners that include the Institute for Agriculture and Trade Policy (IATP) and the Minnesota departments of health, agriculture, and education.

According to IATP data, Minnesota schools bought $1.3 million of locally farmed or raised foods in 2011. Normally, farmers receive an average of 15 cents on every dollar consumers spend on food.

With Farm-to-School, the profit margin is considerably higher. And that money has a multiplier effect.

“These farmers spend that money at the local hardware store, the gas station, etc.,” says Heim. “Last year, Minnesota

Photo by Laurie Schneider

“A

s parents, we try to prepare decent meals, limit how much junk food our kids eat, and ensure they have a reasonably balanced diet,” said First Lady Michelle Obama in January. “And when we’re putting in all that effort, the last thing we want is for our hard work to be undone each day in the school cafeteria.”

With her remarks, Mrs. Obama was introducing new standards for school meals that are part of the Healthy, Hunger-Free Kids Act. These requirements demand more fresh, minimally processed food—the kind cafeterias used make, the kind that comes right off the farm.

Getting that food to school children is one of the goals of Farm-to-School, a nationwide effort that connects area producers with school districts to offer children locally grown, nutritionally

public schools served 788,000 meals every day during the school year. If only 5 or 10 percent of the money spent on those meals stays in the Minnesota economy, it will have a major impact.”

Turning to local sources of food rather than ordering all food from a prime vendor makes things a little more difficult for schools, and kitchen staff can be faced with muddy potatoes and dozens of ears of corn to shuck. But the payback comes with the chance to cook real food, build community, and improve children’s health.

“Schools and farmers have to put in a lot of extra effort in the beginning just to make [Farm-to-School] work,” says Heim.

“But once they get the relationships going, the advantages make it worthwhile.”

The schools can be steady, consistent customers, Heim explains, and often make good use of products that farmers can’t sell as easily to the general public, like ground dark turkey meat to make chili or sloppy joes, or smaller apples that are just right for school lunches. Sometimes schools talk to farmers in February to help them choose what to plant that will be ready to harvest and serve in September and October.

In the United States, one out of every three children is overweight or obese.

Turning around this epidemic depends in large part on a whole generation developing a healthier relationship to food. Farm-to-School is ready, willing, and able to help make that happen.

A strawberry—sun-ripened and field picked— flavored Molly Turnquist’s future. “Sweet, tart, and floral, I remember thinking,” she says. “I wanted everyone to taste how good a fresh strawberry can be.” That experience is the reason Turnquist earned a degree in dietetics and nutrition from Concordia College, Moorhead, Minn., then entered the Public Health Nutrition program at SPH. The time she spent the following summer on a tiny organic farm in Costa Rica confirmed her desire to pursue a career in food and health. “We worked hard in the fields then relaxed, cooked the food we’d harvested, and dined together,” says Turnquist. “I’ve adopted their motto, ‘Pura Vida’ or pure life.”

Her master’s project was an internship with Renewing the Countryside (RTC), a non-profit organization engaged in local food issues. She helped create a survey to gauge public perception of sustainably raised local food and then administered it at the RTC booth at the Minnesota State Fair. “We found the two key concerns were the price of local food and fair wages for farmers,” Turnquist says.

Following graduation, Turnquist will do her clinical rotation at St. Luke’s Hospital in Duluth.

“The food service has a rooftop garden, and most of the hospital’s food is sourced locally,” she says.

Turnquist credits SPH faculty for helping her secure this placement. “All of my professors know me well.

I didn’t expect [this benefit] at a big university.”

Turnquist spent a week last summer on Prairie Horizon Farm, near Starbuck, Minn., working with Mary Jo Forbord, a registered dietician and grass-fed beef and soybean farmer. Forbord works with the University of Minnesota, Morris, Healthy Eating Initiative to improve the food environment on campus. “We planted a Native American garden with traditional plants and helped organize feasts from the gardens that focused on local and heritage foods,” Turnquist says.

Forbord is converting former dairy buildings into a learning center where students can study dietetics and nutrition in relation to the food system. “That’s my dream,” says Turnquist. “I hope to create a teaching farm and agri-tourism business where everyone can learn about the cycle of food—from cultivating and harvesting to cooking and sitting down to dine together. We’ll plant fields of strawberries.”

12 University of Minnesota School of Public Health

advances.umn.edu/s12 7

Diamond A. Farm near St. Cloud, with guidance from her 91-yearold father. She’s selling the farm’s string green beans, seed corn, and soybean crop in domestic and international markets.

“Public health planning takes a long view, as does farming,” says Ayers. “Our farm has been in the family since 1876. My grandparents and father were Dust Bowl survivors and determined to preserve this land. They planted trees to hold soil and prevent water run-off; we use no-till practices to prevent erosion, and we are big supporters of the Conservation Reserve Program.”

In her daily decisions, Ayers draws on public health training.

“The rules of nature apply to human health and soil health,” she says. “Understanding human biology, disease prevention, and health promotion are akin to fungus prevention and crop rotation that enhance fertility; soil sampling is like blood or tissue testing. Having worked in occupational health, I am concerned with issues of air quality, noise, hazardous chemicals, and heavy equipment,” she continues.

“I worry about irrigation wheels that may trap a child or clothing that could get caught in machinery. [Our family] works hard to protect the land and the people on it.”

An intrepid traveler, Ayers has served as a member of an International Professional Exchange in Brazil and a Rotary International project in Peru. She also provided polio vaccinations in northern India with the World Health Organization. Currently on the Carver County Health Partnership Board of Directors, she formerly served on the Department of Labor and Industry Medical Services Advisory Board. Though each day brings challenges (figuring out a tractor malfunction, cleaning up after a hail storm) Ayers is sure that her public health training is serving her well.

Patricia Ohmans

Lure of the soil

Hands in the dirt

Peter Seim worked his way into an MPH from the ground up, literally.

A farmer from 1996 through 2006 with a BS in soil science from the University of Minnesota, Seim entered the MPH Environmental Health Program “interested in policy issues and the science of growing healthy food,” he says. In 1998, Seim founded Garden Farme, a permaculture, community-supported agriculture (CSA) farm on an historic 25-acre parcel in Minnesota’s Ramsey County. In the CSA model, “sharers” pay in advance for a season’s worth of harvest, delivered weekly. “I’ve witnessed what happens to people when they get good food and what happens to the land when it’s farmed organically,” says Seim. Using permaculture methods that replicate the natural system of soil health through mulching, composting, and perennial and companion planting, Seim helped restore the neglected landscape.

The farm’s members pitched in to weed, harvest, and share potluck dinners. “We built a community around healthy food,” he says.

Seim is finalizing his MPH thesis topic related to soil health and food. Meanwhile, he’s digging into a friend’s start up urban farm.

“This work is contagious,” he says.

The job of growing public health

8 University of Minnesota School of Public Health

a larger meeting at the local library and expected a few neighbors,” Ohmans says. “But more than 100 people showed up.”

Actual farm work won’t begin for 18 months while funds are being raised. In the meantime, Ohmans, through the organization she coordinates, Frogtown Gardens, is supporting gardens and community farms with a newsletter, events, and Frogtown Cooks!, a YouTube series with neighborhood cooks showing how to put fresh food to good use. “Every household in Frogtown could save over $500 a year with a vegetable garden,” she says.

Finding her way home “Public health is community health and family farming is about serving the community,” notes former health care executive Lynn Ayers, who holds an MPH in Occupational and Environmental Health Nursing and a pediatric nurse practitioner (PNP) degree.

Once director of business health at Ridgeview Medical Center in Waconia, Minn., Ayers now manages her family’s 1,200-acre

Photos by paula keller

“I

f public health’s mission is the greatest good for the greatest number, then helping people grow healthy food is a perfect career,” says Patricia Ohmans, MPH and Bush Foundation Fellow. Lately, the idea of working the land is drawing some SPH grads and students into farming.

The founder of Health Advocates, a public health consulting group, Ohmans is now drawing on her experience as a master gardener and community organizer to spearhead the development of Frogtown Park and Farm, a demonstration farm, park, and nature sanctuary on 13 vacant acres formerly owned by the Amherst Wilder Foundation in one of the Twin Cities’ most ethnically and racially diverse neighborhoods. This oasis will provide a beautiful antidote to many of the challenges faced by Frogtown’s low-income residents who live just a stone’s throw from downtown St. Paul.

Frogtown Park and Farm was conceived over dinner by Ohmans, along with friends and neighbors Tony Schmitz, Seitu Jones, and Soyini Guyton. Its plans sketched on a paper napkin. “We organized

Lynn Ayers

Just enter Frogtown Cooks! in the search bar on youtube.com to watch a grassroots, potentially game-changing effort to help people eat better.

Peter Seim

advances.umn.edu/s12 9

findings

To better understand why some ethnic and racial groups have higher rates of cancer than others, the National Cancer Institute has awarded a $2.2 million training grant to SPH and the University of Minnesota Medical School.

The grant will help researchers develop intervention strategies to reduce cancer disparities. SPH professor Jean Forster discusses the work at advances.umn.edu/ s12/disparities.

Minnesota’s uninsured rate remains high The economy is recovering, but the percentage of Minnesotans without health insurance remains as high now as it did two years ago when the recession officially ended. That’s according to findings from the Minnesota Department of Health and SPH. “The rate of uninsurance for the state as a whole is 9 percent, where it’s twice that for African Americans, almost twice that for American Indians, and it’s 26 percent among the Hispanic/Latino population in the state,” explains SPH associate professor Kathleen Call.

“So, that’s a significantly higher rate than is true for the state as a whole. The good news is that uninsurance hasn’t been increasing. But the bad news is, there’s still quite a disparity.”

Learn about other study findings, including why young adults made gains in securing insurance, at advances.umn.edu/s12/uninsured.

Taxing pop to fight obesity “The example of cigarette taxes gives me a lot of confidence that a pop tax would be a good idea,” says SPH heath economist Roger Feldman.

Learn more at advances.umn. edu/s12/pop.

Be in the know Keep up with the latest SPH news. Check out updates and subscribe to Public Health Moment, our weekly podcast, at advances.umn.edu.

10 University of Minnesota School of Public Health

Asthmatic kids get fewer meds when costs rise As health plans shift higher costs to patients, more schoolaged children go without needed asthma medicines and wind up in the hospital, finds research led

by SPH assistant professor Pinar Karaca-Mandic. The study, published in the Journal of the American Medical Association, is one of the first to show the impact of higher out-of-pocket costs on children’s health.

“These children aren’t getting the medicine they need, which can spell serious long-term trouble for them,” says KaracaMandic. “The results signal one of the true impacts of rising insurance costs.”

Karaca-Mandic discusses the study at advances.umn.edu/ s12/asthma.

Combat vets on U.S. roads U.S. soldiers are trained to drive defensively and aggressively in combat zones to evade enemy fire and avoid roadway explosives. But after returning home, some veterans find it difficult to adjust to normal driving behavior, resulting in higher accident rates. Their unpredictable driving likely is due to combat training, but might also be caused by traumatic brain injury. University researchers are teaming up on a national study that will attempt to uncover why so many veterans are driving erratically. Learn more about the work at advances.umn.edu/s12/vets.

9

%

African Americans 18% American Indians ~18% Hispanic/Latino 26%

Organic, natural, gluten-free, and whole-grain options are booming in grocery stores, but shoppers may not be getting their money’s worth if they don’t know the ins and outs of the food trend known as “whole health solutions.” “A lot of food manufacturers capitalize on ‘trigger terms’ to push consumers toward products they believe are better for them,” says SPH nutrition expert Lisa Harnack. Learn more at advances.umn.edu/s12/foodtrends.

Quarter of reproductive-age women lack access to insurance

“ When it comes to health, we are all in this together,” said Reed Tuckson in his address to the 2012 graduating class of the School of Public Health. Tuckson, who is executive vice president and chief of medical affairs of UnitedHealth Group, called on the students to make “profound, innovative, multisector, scalable, and sustainable” change in health care.

He challenged the group to engage populations “beyond the few and privileged” and to be accountable for quality and cost. “Has there ever been a more exciting time for your profession?” he asked. “Has the work of public health ever been so central to the health of our nation?” Watch Tuckson’s address, see photos from the ceremony, and post congratulations to graduates at advances.umn.edu/s12/grad.

TEDxUMN SPH experts Nick Kelley and Deb Swackhamer spoke at TEDxUMN 2012: At the Heart of Discovery. The event aimed to “tell the story of a future or the world due to the actions, ideas, and dreams of our fellow University members.” Kelley presented “Rethinking Influenza Vaccines” and Swackhamer discussed “Water Quality and Future Generations: What You Need to Know.” The event sold out, but you can watch online at advances.umn.edu/s12/tedx.

Organic and natural foods: What’s healthy, what’s hype?

Grad recap

Photo by Eric Miller

$2.2 million grant aims to reduce cancer disparities

“ Has the work of public health ever been so central to the health of our nation?”

One fourth of all reproductive-aged women are at risk of being uninsured or having gaps in their health insurance coverage, according to SPH research. The study also finds that private health insurance coverage has decreased among pregnant women, while more are relying on state Medicaid programs. “[Our study] raises concerns about access to pre-natal and pre-conception care, which impacts birth outcomes and child health and wellbeing, as well,” says SPH assistant professor Katy Kozhimannil, who led the research. She says that while Medicaid programs are doing a “fairly good job” of covering pregnant women, her analysis found that 10 percent of pregnant women reported having no health insurance.

Learn more, including how health reform will increase coverage but may limit access, at advances.umn.edu/s12/access.

My Life The latest installment of the My Life video series features Linda Kahn, an SPH student pursuing a certificate in public health core concepts. Kahn hopes to apply her skills to create policies that help disadvantaged communities.

Tune in at advances.umn.edu/s12/kahn.

advances.umn.edu/s12 11

Gerberich named first holder of Robertson Professorship

S

Staying safe in the country

– Leon robertson

SPH professor Susan Gerberich studies rural injuries and their consequences

Prevention and Control, and the Occupational Injury Prevention Research Training Program. She has conducted studies on a wide range of injuries—from brain and spinal cord injuries on the football field to injuries resulting from occupational violence against nurses and teachers.

Together, she and Robertson studied fatal farm vehicle crashes on public roads.

Today, Gerberich and her colleagues

12 University of Minnesota School of Public Health

F

Photo by Dean Riggott

Top: Susan Gerberich Bottom: Leon and Nancy Robertson

are completing their Regional Rural Injury Study III, which examined the long-term consequences of children’s injuries— incurred while doing farm chores and otherwise—on farm and ranch operations.

“I certainly admire her work,” says Leon Robertson. “My wife and I are quite delighted that Susan will be the first occupant of the professorship.”

A great complement to the Robertson Professorship is the Nancy A. Robertson Endowed Fellowship in Injury Prevention, which supports graduate student training.

The SPH’s injury prevention graduate training program, which Gerberich established in the early 1980s, is one of the nation’s first.

“You need a professor, and you need a student to have a program,” Leon Robertson says.

Gerberich says she is thrilled by the visibility the Robertson Professorship will bring to SPH and the University.

“Leon has been a major leader in the field,” she says. “To be really successful in public health, you have to be a risk taker.

And he is.”

But Gerberich is most excited about the stability the professorship brings to the injury prevention program.

“This really establishes a long-term resource for support of faculty members,” she says. “I want to see the whole field of injury prevention continue in this school.

This [professorship] can certainly be key to that, and I’m extremely grateful.”

Photo of susan gerberich bY Tim Rummelhoff

usan Goodwin Gerberich first met Leon Robertson as a student in a summer course on injury epidemiology he co-taught at the Uni­­ versi­t y of Minnesota School of Public Health in the 1970s and 1980s.

“The message was, ‘injuries are not accidents,’” Gerberich recalls. That message stunned her—and piqued her interest in injury prevention.

After earning her PhD, Gerberich co-taught that summer epidemiology course with Robertson and, for years after that, he was her mentor. Robertson, who is now retired, spent most of his career as a transportation injury epidemiology researcher at the Insurance Institute for Highway Safety and at Yale University.

He also taught at Wake Forest and Harvard universities.

“I consider him a friend and colleague at this point,” Gerberich says.

So it’s a special honor for Gerberich to be named the first holder of the Leon S. Robertson Professorship in Injury Prevention, pledged by Robertson and his wife, Nancy Robertson, in 1997. While initially they planned to make it an estate gift, the couple fulfilled their $500,000 pledge early to make the professorship a reality today.

“I thought that I would get it done before I’m gone, so I could see the fruits,” Leon Robertson says.

An endowed position such as the Robertson Professorship provides a steady income to be used at the holder’s discretion. It can provide the startup dollars needed to explore a new idea or the flexibility to bridge gaps in funding from other sources like the National Institute for Occupational Safety and Health.

Gerberich has had a fruitful career already. She directs the Midwest Center for Occupational Health and Safety and co-directs the Regional Injury Prevention Research Center, the Center for Violence

“ I certainly admire her work. My wife and I are quite delighted that Susan will be the first occupant of the professorship.”

arming and ranching have always been dangerous businesses, with agricultural workers experiencing death from injury nine times more than people in all other occupations combined.

What’s more, agricultural families often live at the workplace, making children and adults susceptible to hazards every day, and not just 9-5.

In 1990, SPH environmental epidemi­ ology professor Susan Gerberich began the first regional exploration of injuries to all household residents of agricultural operations, which was also the first with a concentration on risks to children and young adults up to 19 years old.

She co-directs the Regional Injury Pre­vention Research Center and is the initial recipient of the Leon S. Robertson Professorship in Injury Prevention (see page 12).

Using new research methodologies, Gerberich and her colleagues looked at agricultural households in Minnesota, Wisconsin, North Dakota, South Dakota, and Nebraska. Data from their groundbreaking Rural Regional Injury Study (RRIS)—now in its third phase—has provided the country’s most comprehensive and detailed information on agricultural and other rural injuries, including their physical, social, and psychological consequences as well as their long-term impact on productivity and quality of life.

According to statistics from the

National Safety Council and Human Rights Watch, child agricultural workers comprise only 8 percent of children who work in the United States, yet account for 40 percent of work-related fatalities among minors. They estimate that 100,000 children incur agriculture-related injuries each year in the United States.

Gerberich is in tune with farming and ranching cultures and the necessity of everyone in the family to pitch in to keep things running. Chores, beginning with the easiest and least dangerous for young children, are a fact of life on an agricultural operation.

“These families are very close,” she says.

“They’ve identified responsibilities within the family of what they have to do to maintain productivity. Children as well as adults and older adults are out there working.”

Given that reality, how can farm and ranch families keep their children safer?

Gerberich believes strongly that “injuries [in any environment] are preventable with few limitations.” But to forge preventive measures, risks and consequences need to be identified, as do the best ways to introduce changes without threatening traditional family life.

“One of the worst things is to tell a farm or ranch family that they can’t have their kids working,” says Gerberich. “But I have seen a shift to some degree as families rethink the age at which a child should be doing a certain task. We still see the same injuries, but things have improved.”

Select findings from two years of data from the Regional Rural Injury Study • Hours count—While rates of agriculturalrelated injuries to children and youth and adults were different, the rates were similar when hours worked were considered.

• Most dangerous—Primary sources of agricultural activity-related injuries to children and youth and adults, respectively, were: –a nimals (32-41% and 32-37%) – f alls (31-32% and 23-24%) – l arge machinery/equipment (12-14% and 19%) • Added risks—When it comes to agricultural activity-related injuries, children and youth 20 years of age and younger faced increased risks from: perating or riding in or on a motor –o vehicle; – r iding on or operating a tractor; –o perating large or small equipment; and –w orking with various types of animals (horses, sheep, beef cattle) • Consequences—Although only a small proportion of injured people required hospitalization, the consequences of their injuries from agricultural, as well as other activities, were significant. At least: – 87% required health care; – 75% were restricted from regular activities for a minimum of 4 hours; – 29% were restricted for 7 days or more; and – both agricultural and non-agricultural activity-related injuries involved lost agricultural work time

advances.umn.edu/s12 13

school news The importance of keeping in touch MHA alum Bill Kreykes strengthens ties to support students

G

rowing up the youngest of eight children in rural Iowa, Bill Kreykes “never had any expectation” of going to college. The idea of attending lab tech school in the Twin Cities seemed a big enough leap.

“My dad gave me a ride to Minneapolis and $50,” Kreykes recalls. That led to his first job, in the obstetrics lab at the University of Minnesota, where Edgar Makowski soon became Kreykes’ mentor. One of Makowski’s patients was married to James Hamilton, founder and chair of the School of Public Health’s program in what was then called Hospital Administration; the two men encouraged Kreykes to apply for the program.

He did, of course, and Kreykes credits the education he received there —and his longtime MHA Alumni Associ­ation/Foundation involvement—with the professional achievements that followed. For almost four decades, Kreykes led hospitals and academic health centers – Bill Kreykes in various places around the country, from Minnesota to Tennessee to Rhode Island. Today he chairs a board-level MHA endowment committee and touts the world-class Master of Healthcare Administration program at every opportunity.

One of his longstanding career passions, multidisciplinary collaboration, has also been a hallmark of his service to the program. To cultivate the kind of cross-disciplinary thinking that enriched his approach to leadership, he and his wife established – dan zismer a scholarship for MHA students who participate in the CLARION program, which offers interprofessional experiences for students in all health sciences schools at the University to promote safe and high quality care for patients.

Kreykes remains grateful for the stipend he received while earning his MHA. “I learned, as a student, the value of financial support,” he says. That’s why one of his goals is to secure some form of scholarship support for every student in the MHA program by 2020.

In turn, he hopes that students will feel inspired—as he has—to stay connected after graduation. Kreykes is effusive about the ad­van­tages he’s realized through his Min­nesota MHA affiliation. “I’ve appreciated the educational pro­­grams, the collegiality,” he says, as well as the invaluable networking opportunities.

“Every job [I held] came about almost directly because of alumni interaction,” Kreykes continues. “Jim Hamilton really instilled in us the importance of the [MHA] alumni association.” Kreykes took that to heart, and within a decade of graduation he was serving as association president.

He encourages today’s students to forge the same strong connection, and to that end, he helped create a student advisory group to work with the alumni board.

Kreykes’s generosity is a matter of record—he’s been key in raising over $4 million to help fund scholarships and future endowed chairs and professorships— while his skilled advocacy has yielded immeasurable benefits, says MHA program director Dan Zismer. “Bill embodies the spirit of a dedicated alumnus. His dedication and follow-through are [unimpeachable],” Zismer says. “When he tells you he’s going to do something, he does it.”

For Kreykes, giving back is a labor of love: “My ability to have a successful career and to enjoy financial security is a direct result of my education. I see a need, and I’m willing to dip into my resources to help meet it. It makes me feel good. And I’m not hesitant to reach out [and ask others to contribute too]. I’m a firm, solid believer in the program. If fewer of my friends return my calls, so be it,” he laughs. “I’ll make that second or third call.”

“ My ability to have a successful career and to enjoy financial security is a direct result of my education.”

“ Bill embodies the spirit of a dedicated alumnus.

His dedication and follow-through are [unimpeachable].”

12 University of Minnesota School of Public Health 14

U launches Food Policy Research Center

T

he simple fact is that everyone eats. The more complicated reality is that what we is eat is shaped by political, technical, environmental, economic, and cultural forces we can’t control or sometimes even understand.

A new USDA-funded initiative at the University of Minnesota is one of five centers nationwide that will contribute novel perspectives on the policies that shape our food supply. Out of that elite group, the University of Minnesota Food Policy Research Center (FPRC) is the only one to bring together experts from such a wide range of disciplines.

The aim is to arm lawmakers and consumers with scientifically sound information about how we raise, grow, process, package, distribute, and prepare what we eat. Nutrition, food safety, and sustainability are guiding principles.

Holistic view The FPRC is made up of four main partnering units: the School of Public Health, College of Veterinary Medicine, Humphrey School of Public Affairs, and College of Food, Agricultural, and Natural Resource Sciences. In addition to this core, the center will pull together some 20 more units from across the University.

“The scope of our collaborators is a unique strength,” says Will Hueston, a University faculty member and food safety expert who heads up FPRC. “Public health is the unifying theme for this comprehensive, collaborative approach.”

A seemingly simple message about nutrition—for instance, the call to eat more fruits and vegetables—can put strain on other facets of the food supply chain, such as the safeguards to protect consumers from E. coli and other contaminants.

Considering these sorts of potential conflicts is key to compre­ hensive policy analysis.

“We need to be looking at these issues from all angles, with a population-based perspective,” explains Hueston. “How do we

feed the world in a way that provides optimal nutrition while expanding safety?”

Leveraging expertise, training leaders Rather than build a center from the ground up, FPRC will leverage existing expertise. The result will be a virtual hub, where overhead is exchanged for a robust network. This means the center can be up and running quickly and provide more analyses for every dollar invested.

It also means more benefits for students. Sustainability is a key concept, not just in terms of food policy but also in training emerging leaders. The center will invite students across its four main units to participate in the policy analysis process, and it will offer educational opportunities to enhance multidisciplinary perspectives early in careers.

First steps, full spectrum In the coming two years, FPRC leaders will select several policies to analyze. They will work to communicate results broadly, from decision makers at the Capitol to those in the kitchen.

While policies surrounding food are diverse, the group will choose issues that are timely and have an impact on human, animal, and environmental health. Every analysis will also aim to consider all possible angles when asking who might benefit and who might not.

“There is no absolutely right or wrong policy—it depends on whether you’re viewing an issue from an economic, environmental, technological, or other perspective,” says Hueston. “Our job will be to provide scientific information to help others recognize tradeoffs and make informed decisions.”

Will Hueston discusses the challenges of safely and nutritiously feeding a growing world at advances.umn.edu/s12/fprc.

Policies-a-plenty Here are just some of the many possible issues the Food Policy Research Center could consider for analysis:

• Irradiation. How much science is sufficient? Should irradiation be required for high-risk foods?

• Food packaging. Should it be bio­de­ gradable? Tamper-proof? Who pays?

• Humanitarianism. Does sending food to nations in need undercut their local economy?

• Production. How should issues surround­ ing safety, nutrition, environ­ment, ethics, and the economy be considered when evaluating food production systems?

• Labeling. How should we define “organic” and “natural”? How much information should be listed on the label?

• Nanotechnology. Should nano particles be used in crops to better track foodborne disease and our global food supply?

advances.umn.edu/s12 15

alumni news

Class notes

Nicholas Kelley (MS ’08, PhD ’11) has been named a fellow in the Emerging Leaders in Biosecurity initiative at the Center for Biosecurity at the University of Pittsburgh Medical Center.

The fellowship is designed to identify and develop the next generation of leaders working to protect populations against biological agents. Kelley is a research associate for the BioWatch program and is a preparedness program coordinator at the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota. Watch a video profile of Kelley at advances.umn.edu/ s12/kelley.

Jennifer Kret (MPH ’12) has been awarded a CDC/CSTE Applied Epidemiology Fellowship through the Council of State and Territorial Epidemiologists and the Centers for Disease Control and Prevention. She will spend two years at the District of Columbia Department of Health.

for Disease Control and Prevention. The 2012 class of EIS officers consists of 83 professionals selected for two-year training to apply public health in field investigations. Stahre will be stationed at the Washington State Department of Health.

Emily Matson (MPH ’10) has been named 2011 Advisor of the Year by the Bacchus Network, a collegiate initiative of some 900 campuses focused on student health. Matson is the course coordinator for “Alcohol and College Life,” offered by SPH’s Rothenberger Institute.

Dorothy Woodin (MPH ’55) died March 29 at age 89. For many years, she served as director of public health nursing for the State of Kansas, a position appoint­ed by the governor.

In recognition of her contributions, the Kansas Board of Public Health annually selects an exemplary public health nurse as a Dorothy Woodin Award recipient.

David Pitts (MHA ’69) received an honorary Doctor of Civil Law from Sewanee: University of the South. He was recognized for his leadership in health care and the Episcopal church.

Pitts is chairman and CEO of Pitts Management Associates and the President of Health Insights Foundation.

Lisa Pogoff (MPH ’85) has been elected to a three-year term on the board of directors of Rimon: The Minnesota Jewish Arts Council.

Mandy Stahre (PhD ’12) has been selected to join the Epidemic Intel­ ligence Service (EIS) at the Centers

Share your news Submit your own class note or read about classmates at advances.umn. edu/s12/classnotes.

Call for Gaylord Anderson Award nominations

Welcome aboard!

The SPH Alumni Society Board welcomes six new members.

They will serve three-year terms to promote partnerships between the SPH and alumni.

Imee Cambronero (MPH ’09) Jerry Campbell (MHA ’76) Kathleen Harriman (PhD ’04) Carrie Klumb (MPH ’10)

Melissa Bachman Ugland (MPH ’98) wrote a report for the United Way of Greater Milwaukee: “If Truth Be Told: A Five-Year Progress Report on Ending Milwaukee’s Teen Pregnancy Crisis.” The report can be found at advances.umn.edu/s12/unitedway.

Anne Kollmeyer (MPH ’84) Susan Wyatt (MPH student) Thank you to outgoing board members Joy Ahern (MPH ’07), Dawn Bazarko (MPH ’03), Judy Beniak (MPH ’82), Cynthia Kenyon (MPH ’03), Meghan Mason (MPH ’10), Richard Person (MPH ’83), and Gita Uppal (MPH ’99).

16 University of Minnesota School of Public Health

The SPH Alumni Society Board is accepting nominations for the 2012 Gaylord W. Anderson Leadership Award. The award, named for SPH’s first director and founding dean, will be presented to an outstanding alum who is (or has been) engaged in public health and embodies the qualities of visionary leader, teacher, collaborator, and public health ambassador. Nominations accepted until July 31.

Learn more and download an application at advances.umn.edu/s12/gaylord.

Paul Aasen (MS ’86) Christine Hoang (MPH ’08) Elizabeth Hutchinson (MPH ’09) Allison Hawley March (MPH ’09) Sheila Moroney (MPH ’09) Heather Palenschat (MPH ’09) Rachel Isaksson Vogel (MS ’08)

SPH delegation strengthens partnership with the University of the West Indies

Walk & Talk: SPH explores the future of public health Thursday, Sept. 13, 6:30 p.m., Weisman Art Museum Photo credits: Tim Rummelhoff (Lester Breslow); Dylan Zhang (Nicholas Kelley); Paula Keller (Mandy Stahre)

Lester Breslow (MPH ’41) died April 9 at age 97.

Breslow was a visionary public health pioneer whose career included leadership posts at the Minnesota Department of Health, California State Department of Public Health, and University of California at Los Angeles (UCLA). He served as dean of the UCLA School of Public Health from 1972 to 1980. Breslow remained connected to SPH throughout his career.

In 1988, he and his wife, Devra, created the Lester Breslow Scholarship Fund.

Read more about Breslow’s contributions at advances.umn.edu/s12/breslow.

Congratulations to the following SPH alumni who have been inducted to the Pi Chapter of the Delta Omega Honorary Society in Public Health.

Save the date for Walk & Talk, the first event in a series discussing the challenges and opportunities public health will face in the coming years. The event will begin with a tour of the Weisman Art Museum and conclude with an expert discussion. This is a great opportunity for networking.

To receive more information about this and other events, sign up for the monthly SPH newsletter, Alumni E-News, at advances.umn.edu/s12/connect.

Give and gain: Be an SPH mentor Serve in the SPH mentor program and tap into a large professional network while helping to develop the next generation of public health leaders.

Mentors and students are matched based on interests and expertise.

The pairs decide how often to connect.

The school also hosts events and activities throughout the academic year.

To indicate interest, send your name to SPHmentor@umn.edu.

Mentors, save the date for the 2012 Mentor Program Kickoff, Friday, Oct. 19, 8-9:30 a.m., at McNamara Alumni Center.

An SPH delegation recently traveled to Jamaica to sign a formal agreement with health leaders of the University of the West Indies (UWI). The delegation included Deborah Lasher (MPH ’98) and Angie Lillehei (MPH’ 85), dean John Finnegan, student Remi Douah, assistant professor Paul Allwood, (MPH ’95, PhD ’04) and staff member Liz Stadther.

The group met with officials of the UWI and Ministry of Health, as well as other leaders, regarding efforts to more closely track renal health in the area through expansion of the Jamaican renal disease database and to create periodic reports. Allan Collins of the U.S. Renal Data System and U of M Medical School joined them.

Thanks to the alumni and friends who have served for at least 10 years in the mentor program.

Karen Adamson (MPH ’00) Carol Berg Janny Brust (MPH ’87) Gail Gentling (MPH ’86) Sarah Kogut Ann O’Fallon Patricia Ohmans (MPH ’91) Christopher Reif (MPH ’84) Ellie Zuehlke (MPH ’99)

SPH alumni society president Deborah Lasher and dean John Finnegan (center) sign a formal partnership with the University of the West Indies, establishing the two schools’ intentions to explore opportunities for partnerships in education and research.

Professors Everard Barton and Denise Eldemire-Shearer represented UWI.

advances.umn.edu/s12 17

Nonprofit U.S. Postage PAID Twin Cities, MN Permit No. 90155

420 Delaware Street SE Minneapolis, MN 55455 www.sph.umn.edu

Photo by Eric Miller

our graduates are changing the world.

Congratulations to the 2012 graduating class of the University of Minnesota School of Public Health. We are proud of you.

Š 2012 Regents of the University of Minnesota.

All rights reserved.