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ADVA N C E S T H E M A G A Z I N E O F T H E U N I V E R S I T Y O F M I N N E S O TA S C H O O L O F P U B L I C H E A LT H

Still smoking Despite public health efforts, smoking continues to be the leading cause of preventable deaths in the U.S.

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Alumna creates public health programming for Somali community

SPH students partner with MDH to investigate foodborne disease outbreaks

Summer 2017


Join the Movement Toward a Healthier Future For nearly 75 years, the University of Minnesota School of Public Health has been a leader in public health education and research.

Your Calling Students come from different backgrounds — medical doctors, mid-career professionals, new college graduates, etc. — but all come to us with the same passion for social change and vision to make the world a healthier place. At Minnesota, we give students the freedom to explore the complex and far-reaching field of public health and provide the comprehensive support, skills, and training required to create large-scale change.

Define Your Future Through four distinct degree types and numerous program, dual-degree and certificate offerings, you will have the foundation you need to: – Begin your career – Pivot to new career possibilities, or – Advance your leadership skills in health care and public health

Degree Programs – Master of Health Administration (MHA) – Master of Public Health (MPH) – Master of Science (MS) – Doctor of Philosophy (PhD) Executive & Distance Options Flexible course and program offerings allow working professionals to pursue a diegree that compliments career goals and fits into a busy schedule. Learn more: sph.umn.edu


co nte nts summer 2017

From the Dean 2 John Finnegan shares how public health can unite us Findings 3 New research and insights from School of Public Health experts Still Smoking 6 Despite public health efforts, smoking continues to be the leading cause of preventable death in the U.S. Advocating for her People 10 Alumna creates public health programs for Somali community From New Grad to CEO in Two Years 13 Alumnus named CEO of Indiana Medical Center

investigating food outbreaks 14 The Minnesota Department of Health’s Team D — made up in large part by SPH students — investigates foodborne disease outbreaks Detecting Infectious Diseases 16 Regents Professor Michael Osterholm shares need-to-know information about the latest outbreaks Celebrating Alumni Achievements 18 Honoring the 2017 Alumni Award Winners, including the first Outstanding Mentor of the Year A voice for women and children 19 Maternal and child health expert Wendy Hellerstedt retires Remembering Robert Kane 20

School of Public Health Leadership John R. Finnegan, Jr. Dean Beth Virnig Senior Associate Dean for Academic Affairs & Research

Timothy Beebe Head, Division of Health Policy and Management Bradley Carlin Head, Division of Biostatistics

Kristin Anderson Associate Dean for Learning Systems & Student Affairs

Dianne Neumark-Sztainer Head, Division of Epidemiology and Community Health

Bruce Alexander Head, Division of Environmental Health Sciences

Joe Weisenburger Chief Administrative Officer/ Chief Financial Officer

Advances Staff Louis Clark Chief Development Officer

Editor Sarah Haugen

Heidi Mastrud Director, Alumni Relations

Contributing Writers Elizabeth Foy Larsen Sarah Haugen Charlie Plain Stephanie Soucheray

Martha Coventry Director, Communications

Marketing Director Sarah Bjorkman Design Brian Donahue, bedesign, inc.

Advances is printed on Rolland Enviro 100, a 100 percent recycled paper. Our printer, Bolger Printing of Minneapolis, is FSC ® certified.


F ro m th e D ean to fact, reason, and compassion as it is now. Yet, I’m heartened by the voice of public health, which asks every day, “How can we come together to make this a better, stronger, healthier nation than anyone could have imagined more than 241 years ago?” Public health listens, thinks, and speaks through the research, learning, and engagement it conducts with its partners. As you read this issue of Advances, keep in mind the vital importance of public health and its need for independent scientific inquiry, a pursuit that would not be possible without the investment of federal dollars. To paraphrase the chairman of the House Appropriations Labor-HHS subcommittee, Tom Cole (R-Okla), public health is every bit as important in defending the lives of Americans as the Pentagon — in some ways, more so. All schools of public health and, indeed, every U.S. research university, depend on federal dollars to fuel their essential work. Please continue to support the search for life-changing discoveries for populations, communities, and individuals. This work is an important pathway to fulfilling the right of all people to live a healthy life. Yours in health,

John R. Finnegan, Jr., PhD Dean and Professor

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ike you, I have witnessed some really divisive times in my life: the “Cold War” and the specter of nuclear conflict; the Cuban Missile Crisis; the Civil Rights movement’s overturning of “Jim Crow” and riots over the treatment of African-Americans; the rise of the feminist and GLBT movements; the Vietnam War; Watergate; and so much more. I learned early that politics was a continuing, sometimes angry, conflict over human rights shaped by strongly held values and beliefs. Opposing values, differing cultures, and conflicting opinions have always been a part of our nation’s history. Today, we are passing through yet another time when there seems no possibility for common ground on even the simplest things. I cannot recall politics ever being as coarse, dogmatic, give-no-quarter, take-no-prisoners, and as blind and deaf

John R. Finnegan, Jr., PhD Dean and Professor

Editor’s Note: Notice something different? We’ve redesigned Advances to align with our school’s new look and feel. Our brand drives us forward by combining our history, strengths, personality, and values to convey the unique benefits we bring to public health education and research. Through our flagship publication, we are able to share with you how our faculty, staff, students, and alumni live our school’s values. We had many collaborators on this redesign and I want to thank our generous community for its willingness to help make Advances the best it can be. I welcome your thoughts at sphnews@umn.edu. Thank you, Sarah Haugen Editor, Advances

Photogr aph by mark brown

“All schools of public health and, indeed, every U.S. research university, depend on federal dollars to fuel their essential work.”


findings

Opioid Use During Pregnancy

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on-medical use of opioids has skyrocketed. To further undertand the epidemic, SPH Associate Professor and maternal health policy expert Katy Kozhimannil is researching how opioid use affects reproductive-age women, pregnant women, and infants. She found that 1.5 million reproductive-age women and 50,000 pregnant women across the U.S. reported using prescription opioids for non-medical purposes in the past year. And nearly half of these pregnant women got opioids from their doctor. A second study found that women who use opioids for non-medical purposes

during pregnancy also are more likely to use other substances (such as alcohol or marijuana) and have higher chances of reporting symptoms of depression or anxiety. A third paper found that this increase in non-medical opioid use during pregnancy has also led to a increase in U.S. babies born with Neonatal Abstinence Syndrome, or opioid withdrawal. From 2003–2014, the number of babies born with opioid withdrawal grew four times in urban areas and seven-fold in rural areas. “Every infant who is withdrawing has a mom who was exposed to opioids and, possibly, didn’t have access to the treatment and support she needed,” says

Kozhimannil. “The challenge is that pregnant women can’t just stop taking opioids — both because of their dependence, but also because without opioids, a baby could withdraw in utero and possibly die.” The ultimate goal is prevention. “Early recognition of non-medical opioid use can allow for tapering off the drug prior to planned pregnancies. When detected during pregnancy, opioid dependence can be appropriately treated to reduce its pregnancy-related health risks,” says Kozhimannil. “This research emphasizes the importance of targeted detection and treatment efforts that address a woman’s full range of needs.”

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Findings REDUCE CANCER RISK WITH ASPIRIN “Aspirin is very inexpensive and could be a very cost-effective way to reduce the burden of cancer in the elderly.” –Professor Kristin Anderson, who found that taking aspirin can lead to reductions in cancer anywhere from 5 to 15 percent. Talk to your health care provider about taking a daily aspirin. Learn more: z.umn.edu/aspirincancer

Helping People on Food Benefit Programs Eat Healthier

discrimination and diabetes Discrimination can have a negative impact on health outcomes and now research from post-doctoral fellow Kara Whitaker has found that those who experience discrimination are more likely to get type 2 diabetes. Whitaker examined two types of discrimination — “major” experiences, such as being treated unfairly by the police, and “everyday” discrimination, described as day-today unfair treatment. Those who experienced two or more major acts of discrimination had a 34 percent increased risk of developing diabetes over nine years of follow-up, compared to those who reported everyday discrimination or no major experiences. Given her findings, Whitaker suggests an important intervention: “Clinicians should ask patients about their experiences with discrimination as an additional method to identify individuals who may be at risk for developing type 2 diabetes.” Learn more: z.umn.edu/discrminiationdiabetes

ageism at work linked to depression “Women who felt like their age was the factor that kept them from getting a promotion, or forced them into retiring early, experienced depressive symptoms as a result of that.” –Associate Professor Tetyana Shippee, whose research explored how women experience age discrimination at work. Learn more: z.umn.edu/agedisrimination

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When policies for food benefit programs such as SNAP offered a 30 percent discount on fruits and vegetables and prohibited the purchase of sugary foods, participants ate less sugar and consumed more produce over the course of a year. –According to research from Professors Lisa Harnack and Michael Oakes, published in JAMA Internal Medicine Learn more: z.umn.edu/snapchoices


Cycling Saves Lives and Money in MN Minnesota’s investment in bike riding infrastructure is paying off, according to a study by Professor Mark Pereira and the Minnesota Department of Transportation. “The more cycling people do — whether it’s recreational riding or commuting — the fewer cardiovascular risk factors, like obesity and high cholesterol, they have.” This reduction in risk saves Minnesota $100-$500 million annually and prevents 12-61 deaths per year. Learn more: dot.state.mn.us/bike/ research/economic-health-impact.html

fake health news “News stories [often] exaggerate or emphasize the potential benefits of [a health intervention] while minimizing or ignoring the potential harms or costs. People are harmed by inaccurate, imbalanced, and incomplete messages about health care.” –Adjunct Associate Professor Gary Schwitzer, publisher of HealthNewsReview.org Learn more: z.umn.edu/newsharms

Improving chronic disease care Managing a chronic disease can lead to hard decisions and treatment often ignores the patient’s desires. But a study from Assistant Professor Nathan Shippee finds that a LifeCourse model can lead to better care and outcomes. LifeCourse is a team-based approach in which nurses, social workers, and others work with a care guide who serves as the patient’s point of contact. “This allows patients to articulate their questions, concerns, and goals,” says Shippee. The researchers found that patients using LifeCourse could communicate better and felt their wishes and goals were central in planning their treatment. Learn more: z.umn.edu/lifecoursecare

Chemical Exposure During the Deepwater Horizon Oil Spill When the Deepwater Horizon drilling rig exploded and sank in the Gulf of Mexico in 2010, more than 50,000 clean-up workers responded to the disaster. But estimating their exposure to chemicals from the spill has been difficult — mainly because the air samplers worn by workers couldn’t detect some chemicals and because measurements for particular chemicals were not available across the variety of work environments, such as numerous states and ecosystems. To fill the knowledge gap, biostatistics PhD student Carrie Groth created a new statistical method to calculate the workers’ chemical exposures. Her method can help esimate chemicals that were likely present and could have potential health effects, but were at levels too low to be detected by previous methods. “This new approach allows environmental health scientists and industrial hygienists to work with multiple-chemical scenarios in a new way to more accurately account for levels that are too low for detection with current technology.” Learn more: z.umn.edu/deepwaterhorizon

The Deepwater Horizon Disaster Affected 1,100 Miles of Coastline SPH.UMN.EDU

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Still Smoking Despite public health efforts, smoking continues to be the leading cause of preventable deaths in the U.S. By Elizabeth Foy Larsen / Photographs by Mark Brown

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any Americans don’t need to watch reruns of Mad Men to recall a time when airplanes had smoking “sections,” cigarettes were advertised on billboards and available for purchase at vending machines, and lighting up was such a mainstay of the bar scene that the smell of smoke clung to your clothes for days. In the mid-20th century, about half of all Americans smoked. But those numbers began to change after the 1964 Surgeon General’s Report linked smoking to cancer. The downward trend continued after successful national lawsuits against the tobacco companies, including Minnesota’s State of Minnesota v. Philip Morris, an unprecedented $6.6 billion win in 1998 that alleged tobacco companies were hiding the hazards of smoking and targeting children as new customers. The suit relied on the research and testimony of SPH researchers and generates $200 million annually — forever —for public health efforts across the state. By 2005, 20 percent of the U.S. population smoked. In 2015, that number was down to 15 percent. But smoking in 2017 is still the leading cause of preventable disease and death in the United States. It’s a significant risk factor for cardiovascular disease, cancer, respiratory diseases, and diabetes — chronic diseases that are responsible for 1-in-5 deaths each year. About 50 percent of all U.S. adults have a chronic disease today, and that number is forecasted to increase to around 65 percent by 2030. These sobering statistics drive School of Public Health faculty to investigate the social determinants of smoking, to increase what we know about emerging types of tobacco use, and to lead education efforts to prevent smoking.

Evidence for Quitting While health experts agree that quitting smoking is the single best thing you can do for your health, a recent SPH study found that smoking leaves an imprint on our genes — even for people who had quit smoking decades ago. “When we engage in certain health risk behaviors, it’s common to tell ourselves that we can always quit and there

won’t be long-lasting effects,” says genomics researcher and Professor Ellen Demerath, who was an author on the study. “While it’s true that our research showed former smokers had a more normal epigenetic profile than current smokers, the fact is there were still shadows on their genes that didn’t go away, even 30 years later.” That’s not to suggest that quitting smoking doesn’t have very tangible health benefits. The risk of having an abdominal aortic aneurysm drops when smokers quit, according to a 2016 study by cardiovascular health researcher and Associate Professor Weihong Tang. Her research found that while middle-aged smokers had a roughly 1-in-9 chance of developing an abdominal aortic aneurysm in their lifetime, that risk declined by 29 percent for the people who quit smoking during the course of the study. And longer-term quitters — those who had been former smokers for 25 years or more — had an even lower risk.

Tobacco and Cultural Norms When it comes to quitting smoking, social and cultural factors can make that exceptionally difficult, especially for U.S. veterans, blue collar workers, and American Indians. “There’s a lot of socializing in the military that occurs around smoking, which makes quitting hard — if you take a smoking break, you can hang out with your friends,” says Assistant Professor Rachel Widome, who investigates social determinants of health, including smoking use and cessation amongst veterans of

conducted a study in small manufacturing companies in five counties in the Minneapolis/St. Paul area that assessed a work safety/health promotion program to motivate smokers to use smoking cessation resources already available to them through their health insurance. Low-cost interventions like these can be a win-win for employees and companies, “because employees who smoke are sick more often and increase the cost of health insurance and other costs borne by the company,” Hennrikus says. In Minnesota’s American Indian reservations, smoking rates can be as high as 60 percent. Emerita Professor Jean Forster — who has worked on tobacco interventions for 30 years and was instrumental in the 1990, first-of-its-kind legislation that banned cigarette vending machines in public places — is now exploring community tobacco policies on reservations. She regularly works with the American Indian Cancer Foundation — directed by Kristine Rhodes, MPH ’00 — to better understand the complexities of cultural and tribal regulations and to forge collaborative solutions. “Reservation residents have strong feelings about outsiders leading change and tobacco has deep cultural significance,” says Forster.

Global Advocates “Today, more Americans are ex-smokers than current smokers and that is a great victory,” says tobacco policy researcher and Professor Harry Lando. But he is far less encouraged by increasing smoking in many low- and middle-income countries. Lando, who was an editor of the

“Globally, the tobacco industry is the biggest threat in decreasing and preventing tobacco use.” Monique Muggli, MPH ’99, associate legal director for the Campaign for Tobacco-Free Kids

the wars in Iraq and Afghanistan. After military discharge, vets take their smoking habit with them. Smoking cessation researcher and Associate Professor Deborah Hennrikus

Surgeon General’s Report on Smoking and Health in 1988, has now shifted his anti-tobacco work to developing countries — including Indonesia, a so-called “smoker’s paradise” where 70 percent of men SPH.UMN.EDU

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Public Health Milestones reduce Smoking Since State of Minnesota v. Philip Morris in 1998, a number of public health-led initiatives have contributed to national changes in tobacco use and policy 1999 All tobacco-related billboard advertisements in the U.S. are banned. 2000 Smoking is banned on all international flights departing from or arriving into the United States. 2005 The World Health Organization’s Framework Convention on Tobacco Control treaty calls on all 177 participating countries to enact proven measures to reduce tobacco use and exposure to secondhand smoke, including comprehensive smoke-free laws, higher tobacco taxes, strong health warnings, and bans on tobacco marketing. 8

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2006 “The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General” details the harmful effects of secondhand smoke and declares there is no “safe” secondhand smoke exposure. 2007 The Motion Picture Association of America begins to factor tobacco use in parental guidance ratings of films. 2009 The Family Smoking Prevention and Tobacco Control Act gives the FDA the authority to regulate the manufacturing, marketing, and selling of tobacco products to protect public health. The FDA

Center for Tobacco Products is formed and subsequently bans most flavored cigarettes and misleading cigarette labels such as “light” and “low-tar.” 2014 CVS Caremark announces that it will stop selling cigarettes and other tobacco products at its more than 7,600 CVS pharmacy stores across the United States. 2015 The U.S. Department of Housing and Urban Development requires all public housing agencies to implement smokefree policies for all residential units and common areas.

timeline sources: robert wood johnson foundation, american lung association

Associate Professor Irina Stepanov works with research associate Vipin Jain to determine chemicals found in cigarettes and smokeless tobacco.


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smoke. “One billion deaths from smoking are projected across the world in the 21st century,” says Lando. “That’s mostly in low- and middle-income countries. If we could bend that curve by even 10 percent, we can have an incredible public health impact.” But it’s a big challenge, says Monique Muggli, MPH ’99, associate legal director for the Campaign for Tobacco-Free Kids. “Globally, the tobacco industry is the biggest threat in decreasing and preventing tobacco use. It has exported its play book from the United States and other high-income countries to emerging economies in order to recruit young tobacco users and influence governments.” Lando has successfully lobbied the World Conference on Tobacco or Health to hold more of their conferences in the developing world. He wants the problem

“One billion deaths from smoking are projected across the world in the 21st Century.” School of Public Health Professor Harry Lando

to be witnessed first-hand by political leaders, who generally don’t see smoking as a high priority when compared to other public health challenges, including lack of access to clean water. Ultimately, Lando sees smoking as a human rights issue — it denies people the right to enjoy sound health and to live in a healthy environment that’s free from secondhand smoke, which accounts for an estimated 600,000 deaths around the globe every year.

Elizabeth Foy Larsen is a freelancer writer based in Minneapolis

E-cigarettes and Smokeless Tobacco: The Next Unknown Public Health Frontier Cigarette smoking rates are down across the United States, so tobacco companies are finding new and increasingly popular ways to market their product. “The use of other tobacco products, including e-cigarettes, is picking up,” says Assistant Professor Rachel Widome. “We don’t know yet if these alternatives are healthier, or if users, especially teenagers, will eventually switch to cigarette smoking.”

Is Vapor Safer?

According to a report in December 2016 from the United States Surgeon General, electronic cigarettes — which turn nicotine into inhalable vapor — are gaining popularity with young people. The 2016 Minnesota Student Survey (MSS) showed that nearly 20 percent of 11th grade students reported using e-cigarettes in the past 30 days, while only 8 percent smoked cigarettes. Recent research, published in Pediatrics, says that this spike in e-cigarette use has been powered by flavors that taste like gummy bears and bubble gum. While adults aren’t using e-cigarettes in such high numbers, a survey published in the International Journal of Environmental Research and Public Health found that 30 percent of surveyed current and former adult users turned to e-cigarettes to cut back on or quit smoking cigarettes. While tobacco companies like to market the idea that these products are safer than traditional cigarettes, there have been no definitive answers and the rise in usage is of great concern to public health professionals. The Surgeon General’s report, for example, cites studies in animals that suggest that e-cigarettes can harm developing brains of teenagers.

Chewing Chemicals

And it’s not just e-cigarettes that are gaining popularity. Today, 6.7 percent of American males use smokeless tobacco, up from 4 percent in 2000, according to the Centers for Disease Control and Prevention. While smokeless (chewing) tobacco is associated with lower risk of disease than cigarettes, its use is not risk free. For instance, N’-nitrosonornicotine (NNN), a chemical found in smokeless tobacco, can cause oral cancer and some smokeless users are exposed to high levels of this chemical from their favorite smokeless tobacco brand. SPH faculty Irina Stepanov and Silvia Balbo have contributed to understanding these risks by conducting studies in tobacco products, tobacco users, and laboratory animals. “When people buy smokeless tobacco products, they don’t really know what is in the product and if it contains cancer causing chemicals,” says Stepanov. That means that consumers can be unknowingly endangering their health. “We can’t yet predict who is at higher risk to develop cancer from smokeless tobacco use and how much exposure it will take for someone to end up with cancer,” says Stepanov. “The main message from a public health standpoint has to be to not use any tobacco products.” SPH.UMN.EDU

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Advocating for Her People amira adawe creates public health programs for the Somali community

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hen Amira Adawe, MPH ’15, immigrated from Somalia to Minnesota in 2000, she brought with her a life-long interest in serving her community through public health. “I’ve been interested in public health since I was a child,” says Adawe. “My mother was a nurse-midwife and the head of the maternal and child health bureau in Somalia. I grew up hearing her talk about immunizations, family planning, and child health.” In Minnesota, Adawe’s desire to support her Twin Cities Somali community grew. Her devotion led her to choose the School of Public Health, both for its great reputation and ideal location. “It’s one of the top public health schools in the country and going here meant I could earn my MPH degree while still working in Minnesota and helping the Somali community,” says Adawe, who enrolled in the Public Health Practice MPH program to focus on policy and maternal and child health.

somali health needs Minnesota is home to the nation’s largest Somali community. Many Somalis choose Minnesota because of its numerous refugee resettlement and social support organizations or to be reunited with family members who settled here before them. Somali refugees often suffer from a range of illnesses, including nutrition10

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al deficiencies, intestinal diseases and depression, and are unaccustomed to the concepts and practices of preventative medicine. As a result, many health issues threaten the community. While in school, Adawe identified and addressed a number of issues threatening the health of Somalis, including the use of dangerous skin-lightening creams by many Somali and African women. “These women inherited the belief from the colonization of Africa that the lighter you are, the better,” says Adawe. “In Africa, having lighter skin means economic mobility, plus men are attracted to lighter-skinned women. Using the creams has become popular — including among some of my own relatives and friends.” During a class on chemical exposure, Adawe learned through a literature review that the skin-lightening products often contain hydroquinone, which can cause birth defects if used by pregnant women. The internationally produced creams are for sale in the Twin Cities and Adawe became concerned that they could harbor other toxic chemicals and poison people here. Adawe voiced her concerns to Ramsey county officials and received their support to gather cream samples and have them analyzed for dangerous ingredients. The results were troubling: 11 of the 27 samples had extremely high levels of mercury, which is widely known to cause significant neurological damage in mothers and babies. “When the products we tested showed

Opposite: Amira Adawe, MPH ’15, at the Oxford Community Center in St. Paul, Minn., where she started a swimming program for Somali and Muslim women and children.

Photograph by mark brown

By Charlie Plain


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high levels of mercury, agencies including the Minnesota Department Health (MDH), the Minnesota Pollution Control Agency, and the Food and Drug Administration (FDA) got involved,” says Adawe. The FDA found that a single local seller was supplying the Twin Cities stores with the creams. It then issued a consumer warning stating that infants and small children might be exposed to mercury through parents who use the products. Adawe also worked with MDH to launch a biomonitoring study with HealthPartners and other organizations to screen some Hmong, Latina, Somali, and White women receiving prenatal care in Minneapolis and St. Paul for mercury, as well as lead and cadmium exposure.

learning to swim Another issue Adawe saw among Somalis in Minnesota was an alarming amount of drownings. Due to cultural and Islamic religious beliefs that require women to be fully clothed in public and avoid swimming with men, many women simply never swim and cannot teach water safety skills to their children. “A lot of Somali kids don’t know how 12

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to swim and they won’t learn anywhere else because of the lack of swimming lessons in schools,” says Adawe. In an effort to change this, Adawe formed a unique partnership between the City of St. Paul’s Police and Parks and Recreation departments, and local mosques. Together, they created a female-only swim program where Somali and Muslim women and girls get exclusive use of St. Paul’s Oxford Community Center pool, and staff it with female lifeguards and instructors. The St. Paul Police provide free transportation from the mosques to the pool. “The program gives me somewhere I can exercise and feel the freedom of swimming in whatever I want to wear,” says participant and mother-of-two Amina Aden. “It also gives my kids the opportunity to learn to swim, which is a life skill that will help keep Somali kids from drowning.”

influencing policy Toxic skin creams and drownings are just two of the many public health problems facing Minnesota’s immigrants. Today, Adawe is working to address many more as a legislative liaison for MDH. “The work

I do on a daily basis has an impact on the entire state,” says Adawe, who helps develop public health proposals and explains them to legislators. “Policies can make huge changes in public health.” Even with her successes, Adawe knows it’s going to take more than just herself to tackle the public health issues facing Minnesota immigrant communities. To attract more Somali-Americans to public health, she informally mentors high school and college students to spark their interest. “I do a lot of health education in the community,” says Adawe. “I try to guide students interested in public health based on their concerns and interests, and help them find opportunities, like internships with county health departments.” Adawe has also been consulting with educators about creating formal pathways for Somali students to enter public health graduate programs, and later, move into the workforce. For Adawe, public health is an area where the opportunity to do good abounds. “If you’re excited about solving problems and you have the right tools, it’s endless what you can do in public health.”

Photograph by MARK BROWN

Adawe (left) with Amina Aden, who participates in the female-only swimming program with her two children.


From New Grad to CEO in Two Years Brent Parsons Named CEO of Bluffton Regional Medical Center in Indiana

Photograph courtesy of brent parsons

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fter graduating with a finance degree from Brigham Young University, Brent Parsons (MHA ’15) worked in patient billing at Intermountain Healthcare in Salt Lake City. But he needed more. “I didn’t feel like I was close enough to the patients and truly making a difference in the care they received.” He set his sights on health care administration and enrolled in the School of Public Health’s Master of Healthcare Administration (MHA) program. “I looked at the program’s graduates and saw that I could have a national network to call on later in life,” says Parsons. Now, two years later, he’s making a difference for patients as CEO of Bluffton Regional Medical Center in Indiana. Days after graduating in spring 2015, Parsons went to work for Lutheran Hospital, the flagship hospital of the Lutheran Health Network in Indiana. There, he was put on high profile projects and moved quickly from administrative specialist to assistant CEO. After a year, he was hand-picked to serve as interim CEO of Lutheran Health Network’s Bluffton Regional Medical Center in Bluffton, a rural Indiana town of about 10,000. In January 2017, he was named the permanent CEO of the 79-bed hospital. In the role, he’s influencing patient care in the ways he wanted. “In administration you have the ability to make large-scale change. I can help implement policies and processes that can have a positive impact on the quality of care patients receive and

road to ceo May 2015 Graduates with a Master of Healthcare Administration degree from the UMN School of Public Health

June 2015 Becomes administrative specialist at Lutheran Hospital, part of the Lutheran Health Network in Indiana

February 2016 Named assistant chief executive officer of Lutheran Hospital

“I can help implement policies and processes that have a positive impact on the quality of care patients receive.”

August 2016 Named interim CEO of Bluffton Regional Medical Center

January 2017 Named permanent CEO of Bluffton Regional Medical Center

Brent Parsons, MHA ’15

also the satisfaction of our employees and physicians,” says Parsons. “The hospital is such a vital and emotional part of a community and it’s an honor to be entrusted with the care of our community,” he says.

To see more recent news about School of Public Health alumni, visit sphalumni.umn.edu/ alumninews.

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Investigating food Outbreaks By Stephanie Soucheray

Every year, Minnesota experiences more than 40 foodborne disease outbreaks. The summer months see scores of Salmonella cases or E. coli poisoning, while winter brings norovirus infections by the droves. The Minnesota Department of Health (MDH) is continuously collecting information on potential foodborne illness outbreaks via routine surveillance, or when a patient, provider, or institution reports a suspected outbreak. Investigating the source of those outbreaks takes hundreds of hours, many of which are conducted by Team D (“D” for diarrhea), a group in MDH’s Foodborne Diseases Unit made up in large part by School of Public Health students. Team D students are hired to investigate, document, and track outbreaks of foodborne diseases in the state. The program was founded by SPH professor and foodborne disease expert Craig Hedberg in 1996 and has continued to evolve under the direction of Carlota Medus, MPH ’99, PhD ’05, and Kirk Smith for the past 21 years. 14

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Team D students work in MDH’s Foodborne Diseases Unit, made up of SPH alumni. Left to right: Marijke Decuir (MPH ’15), Amy Saupe (MPH ’16), Aaron Beczkiewicz, Dana Eikmeier (MPH ’13), Tess Peterson, Carlota Medus (MPH ’99, PhD ’05), Luke Magnuson, and Sean Buuck.

Identifying an Outbreak “This is the true epidemiology experience,” says Medus, supervisor of the Foodborne Diseases Unit at MDH. “As part of Team D, you learn everything to do during an outbreak at the state level, and get a complete picture of what happens when you detect an outbreak.” Currently, all of the Foodborne Disease Unit epidemiologists, including Medus, are SPH alumni, and were part of Team D as students before getting hired by MDH. “Team D helps with every step of the investigation,” says Medus. Initially, a Team D worker will call a patient and take a detailed epidemiological history of their food intake and possible exposures. “They’ll ask about everything that happened in the seven days before symptoms began,” says Medus. And, Medus says, Team D members often break open a case. “Since the students are the ones on the phone with patients, they’re often the first to notice if a certain restaurant has been mentioned more than once.”

Amy Saupe (MPH ’16) analyzes data from a recent outbreak

Unique Experience Having the chance to solve the mystery of an outbreak is what attracted Krista Bryz-Gornia to Team D. The first-year epidemiology MPH student heard about the program during a student fair before she started in SPH and knew she wanted to be a part of the team. “I love that we get to see an outbreak or a case from beginning to end. It’s exciting to talk to other student workers when there’s an outbreak and say, ‘Did your patient eat at this restaurant?’ ‘Did they have this symptom?’” As a fluent Spanish speaker, Bryz-Gornia has conducted bilingual interviews and says MDH has been flexible in letting her balance work and school. Team D staff members work about 20 hours a week from 9 a.m. to 8:30 p.m., often contacting patients in the evening to get information about their illness and symptoms. “Team D has been a perfect complement to my public health education,”

Bryz-Gornia says. In addition to MDH, the program’s alumni work across the country in such institutions as the U.S. Department of Agriculture and the CDC. Andrew Beron, MPH ’14, was a Team D member and is now an epidemiologist for the U.S. Virgin Islands Department of Health on the island of St. Croix, where he helps perform Zika surveillance. Beron says his time at Team D was helpful in preparing him for a career in the field. “Team D is something students at other schools of public health don’t get,” says Beron. “It helped me build so much confidence as an investigator.”

Minnesota Leads the Way That confidence is what sets Minnesota’s SPH apart from other institutions. “By the mid-1990s it became clear that foodborne infections weren’t going away,” says Hedberg. “What we wanted to do with foodborne disease surveillance was create a student worker team that could participate in surveillance and do routine interviews with individual cases, then the students have both practical experience and the opportunity to work with data they’ve collected.” Hedberg says other state departments of health and even the CDC have taken note of Team D’s efficiency. “We developed the model, and others have tried to replicate it,” says Hedberg. “The partnership between the SPH and MDH is still one of the biggest draws to our school for students who want to work in epidemiology.”

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Detecting Infectious Diseases When it comes to need-to-know information on infectious diseases — think Zika, Ebola, and Measles — SPH Regents Professor Michael Osterholm leads the conversation

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chool of Public Health Regents Professor Michael Osterholm (MS, ’77, MPH, ’78, PhD, ’80) often says it’s not if infectious disease crises will occur, it’s just a matter of when. “There has never been a time in history when the challenges to controlling and preventing the global spread of infectious disease has ever been this daunting,” says Osterholm, an expert on the epidemiology of infectious diseases and director of the University of Minnesota Center for Infectious Disease Research and Policy (CIDRAP). While the world becomes more interconnected, infectious diseases like Zika, Ebola, and measels become real public health threats. But according to Osterholm, influenza — what he calls the “king of infectious diseases” — has the power to kill many millions of our population in a short period of time.

we don’t, then we become an accomplice to the morbidity and mortality they cause,” he says. “We need a new generation of public health experts who can effectively address these issues in ways we’re not addressing with them now.” Here, Osterholm talks about his drive to educate people about infectious diseases and explains what Americans need to do to be prepared for these emerging threats. What intrigues you about infectious disease epidemiology work?

Being a disease detective is very gratifying. But it’s also very sobering at the same time. These are real people dying from diseases that in many instances could have and should have been prevented. This work allows you to solve mysteries and implement positive change for large segments of the world’s population.

“There has never been a time in history when the challenges to controlling an preventing the global spread of infectious disease has ever been this daunting.” Regents Professor Michael Osterholm (MS ’77, MPH ’78, PhD ’80)

But his latest book hopes to help in our fight against these epidemics. In “Deadliest Enemy: Our War Against Killer Germs,” Osterholm lays out a “Battle Plan for Survival” with a nine-point plan on how we can keep ourselves safer from these emerging threats. He hopes this book not only informs, but also inspires people to commit to public health action and work. “If we know how to greatly reduce the risk of these public health problems and 16

Advances summer 2017

Why is “Deadliest Enemy” needed now?

This book is part history, part current affairs, and part blueprint for the future. We are facing so many challenges right now — from a potential looming influenza pandemic to the inevitable tsunami impact of antibiotic resistance to bioterrorism. And we have no clear international governance structure for how we are going to deal with these issues. I also want to show the

younger generation what kind of world they’re inheriting from us baby boomers and why they need to engage in this issue now for their own survival. What are some of the biggest challenges we face in preventing infectious diseases?

The World Health Organization is woefully underscaled and unprepared due to a lack of financial support and adequate governance authority. And early messaging from our current administration suggests that issues related to public and infectious diseases may not be top priorities on their agenda. Your biggest concern is pandemic influenza. So this is more than encouraging people to get their annual flu shot?

While the seasonal flu does kill anywhere from 3,000 to 49,000 people every year in the U.S. — typically on the lower end of that range — pandemic influenza can cause a worldwide outbreak of a new strain of influenza virus that spreads easily because most people don’t have previous immunity. When it comes to pandemic influenza, at this time, all bets are off for having an effective vaccine for most of the world. We desperately need a Manhattan-like project to develop and manufacture a game-changing influenza vaccine. This would have worldwide implications that even exceeds the incredible achievement of eradicating smallpox. So who is responsible for making changes?

Everyone. But the U.S. government has to play a key role. We don’t want to be unprepared. But the investment isn’t there. Last


year, the world spent about $35 million on researching influenza vaccines. Meanwhile, we spent over $1 billion on HIV vaccine research. That’s not to take away from HIV vaccine research as we should support it at this level. But, it shows you how we lack an international priority for addressing influenza.

sota. It’s people in the early to prime years of their lives. We’re trying to give people good deaths, which come after a long and fulfilled life. That’s all I hope to do. If public health is about foreseeing issues and connecting the dots, why didn’t we see things like Ebola and Zika coming?

How can people be part of the change?

What role does CIDRAP play?

Public health was asleep at the wheel. We need to train a generation of people so that this doesn’t happen anymore. We can’t be afraid to be in front of it. We have the same opportunities to do in public health what meteorologists do — to see what’s coming and help people prepare. I had talked for some time before 2014 about how the epidemiology of Ebola in Africa was going to

The best thing people can do is become informed and stay current. The more aware you are of the issues, the more you will want to change them. And I challenge baby boomers to step up. My generation, the baby boomers, have screwed up this planet so much more than any previous generations — we owe it to our kids and grandkids to leave them something better.

Policy without science is usually ineffective because it is poorly informed, and science without policy doesn’t do much. So CIDRAP brings the two together to represent the public’s interest. We work at the government and organization levels, and create plans and blueprints that people can follow to make real change.

change with the urbanization of Africa. We shouldn’t have been surprised to see what happened in West Africa. I lectured about the coming of Zika to the Americas more than 18 months before Brazil reported its first cases.

Your philosophy is that public health is not about preventing deaths, but it’s about preventing bad deaths. How does this relate to infectious diseases?

Photograph by stuart isett

Remember, we’re all going to die. If we eliminate the current top ten causes of death, we’ll have ten new top causes. I’m quite certain that many of those causes will not be any better than the top ten causes of death we have now. But, people who die of infectious diseases far too often die bad deaths. It’s infants who die of diarrheal disease in Africa or a 23-year-old who is pregnant and dies of influenza in Minne-

“Deadliest Enemy” is available now on Amazon.

Michael Osterholm led many investigations of infectious disease outbreaks of international importance during his 15 years as state epidemiologist at the Minnesota Department of Health. After 9/11, he served as special adviser to former DHHS Secretary Tommy Thompson on issues regarding public health preparedness. He is an elected member of the National Academy of Medicine and the

Council on Foreign Relations and is a frequent consultant to the World Health Organization, the National Institutes of Health, the Food and Drug Administration, the Department of Defense, and the Centers for Disease Control and Prevention. His previous book, “Living Terrors: What America Needs to Know to Survive the Coming Bioterrorist Catastrophe” was a New York Times best-seller.

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2017 Alumni Awards

Janny Brust Honored for Mentoring Students

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Advances summer 2017

Meet the 2017 Alumni Award Winners Gaylord Anderson Leadership Award Martin LaVenture (MPH ’78) has spent more than 40 years working in public health and public health informatics. He leads the Minnesota Department of Health’s e-Health Initiative, a collaboration that began in 2004 to encourage health information technology use in Minnesota. Alumni Award of Merit Sharon Buhr (MPH ’80) began North Dakota’s Young People’s Healthy Heart Program 35 years ago to encourage heart-healthy behavior change. She designed lesson plans and interactive aids that are now used by school districts in North Dakota. Outstanding Mentor Award Janny Brust (MPH ’87) Alumni Innovator Award In 2012, Carolyn Porta (MPH ’97; MS ’00) helped start the One Health Student Club at the University of Rwanda, which aims to prevent disease outbreaks through multidisciplinary partnerships and now has more than 500 members. As an associate professor and director of global health at the University of Minnesota School of Nursing, Porta continues to mentor and collaborate with the club. Emerging Leader Award As head of the Minnesota Department of Agriculture’s response to food- and feed-related disease outbreaks and contaminations, Carrie Rigdon (PhD ’07) connects people to information. She supervises investigations and creates training activities for employees and outreach activities that educate the public.

Photographs courtesy of carrie rigdon, carolyn porta, sharon buhr, and martin l aventure. janny brust photo by mark brown

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n 1995, Janny Brust (MPH ’87) was one of the first people to volunteer for the School of Public Health’s newly created mentor program. “I wish there had been something like the mentor program when I was in graduate school, so I was excited to connect with students and stay tied to the University of Minnesota,” says Brust. Since then, she’s mentored roughly 30 students. “Public health is collaborative, so students need to understand different perspectives and they can get that through mentoring,” says Brust, who encourages her mentees to join the Minnesota Public Health Association, has served on student’s master’s project committees, and invites her mentees to attend meetings with other public health professionals. “I always try to keep the student’s needs in the forefront and want to be part of their journey,” she says. Brust herself has benefited from mentors throughout her career, which includes roles as epidemiologist at the Minneapolis Department of Health and vice president of public health at Allina. “I always appreciated the time that my mentors took and the intellectual energy they brought with their guidance,” she says. “I’ve always wanted to pay that back, and be able to guide students.” Now retired as director of medical policy and community affairs for the Minnesota Council of Health Plans, Brust says the program keeps her tied to the public health community. “I get to build relationships and benefit from mutual learning. I might know something from the practice side; the students help me learn about it from an academic perspective.” In May 2017, Brust was honored with the School of Public Health’s first Outstanding Mentor Award at the school’s annual Celebration of Giving & 2017 Alumni Awards. “I’m shocked and very touched to have been nominated,” she says.


A Voice for Women and Children Maternal and Child Health Advocate and Pioneer Wendy Hellerstedt Retires

Photograph by thomas ryan

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t the School of Public Health, I found an institution that wasn’t afraid of hard questions,” says SPH Associate Professor Wendy Hellerstedt, a national leader in maternal and child health research and training for more than 30 years. “In academia, we can answer those questions,” says Hellerstedt, who asked those hard questions herself and changed how we think about maternal health. As an SPH Epidemiology PhD student, her dissertation changed how people thought out teen pregnancies early in her career. Her research found that when teen mothers have multiple children, these children have a higher risk for infant mortality. In adults, mothers on their second birth have generally healthy births. As an SPH faculty member, she helped guide knowledge for obese pregnant women. In the mid-1990s, it was recommended that obese women should not gain weight during pregnancy. But Hellerstedt found that if women did not gain weight, their infants were small for gestational age. The finding was controversial. “I remember going to a medical association and presenting this data and being booed,” says Hellerstedt. A first generation high school and college graduate, Hellerstedt didn’t aim for a career in academia — what she calls a “world of ideas.” But, in the 1980s, she was introduced to then-SPH Assistant Professor Robert Jeffrey, who encouraged Hellerstedt to study epidemiology. She earned her PhD and has been with the school ever since. “I kind of blindly followed his advice and will forever be indebted to him because he taught me to ask innovative questions and introduced me to a life devoted to research.” In her time at SPH, Hellerstedt was chair of the Maternal and Child Health pro-

gram, which is one of the oldest in the country. She created the program’s epidemiology track as well as its online program. “Minnesota has always been progressive in how we define maternal and child health. Our focus is on vulnerable populations, those who experience social marginalization,” says Hellerstedt, who has mentored hundreds of students. “This creates students and an alumni population that has deep concerns about social justice.” “Wendy helped me see the issues I was passionate about through a public health lens,” says maternal child health alumna Rebecca Shlafer Nealy (MPH ’15), an assistant professor in the UMN Department of Pediatrics and Adolescent Health who researches the health of incarcerated women. “Wendy provided me with opportunities for collaboration, leadership, and scholarship. Plus, she’s smart, down to earth, honest, and funny.” Hellerstedt has always just wanted to pass it on. “In public health we think about how we can do the most good, and as a teacher I can do the most good by disseminating knowledge,” says Hellerstedt, who wants to explore a “second career” in climate change in retirement. “Our best product is our graduates, they’re the ones who will change public health.”

“Wendy provided me with opportunities for collaboration, leadership, and scholarship. Plus, she’s smart, down to earth, honest, and funny.” Rebecca Shlafer Nealy (MPH ’15), assistant professor in the University of Minnesota Department of Pediatrics and Adolescent Health

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Advances - Summer 2017  
Advances - Summer 2017  

Advances, a twice-yearly print publication, showcases the range of discoveries and expertise from School of Public Health faculty and resear...

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