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

Temple Public Health

FALL 2019

Temple Made Healthier College of Public Health students work to promote health and well-being on campus PG 26

Groundbreaking research into complex transplants

Collaborating outside the Collaborative

College conducts three studies with $4 million in funding from the Department of Defense PG 18

Collaborative on Community Inclusion partners with organizations to advocate for people with serious mental illnesses PG 20

The entrance to the new Charles Library.

DEAN’S NOTE

Temple Public Health As a nation, we are confronted with rising healthcare costs and declining life expectancy. Health disparities are driven by many factors, among them implicit and explicit bias, lack of access to basic human needs such as healthy foods and housing, poor access to health services, and communities that suffer from violence and the ravages of the opioid epidemic. Far too often, an individual’s zip code indicates their destiny. These are complex problems with complex solutions that no individual field can solve alone. This is why our college trains future leaders in more than 40 programs that embrace not only the traditional public health disciplines of epidemiology, health policy, and social and behavioral sciences but also nursing, social work, kinesiology, speech and language pathology and the rehabilitative sciences. Together we can make a collective difference in understanding the genesis of health, disease and the most effective ways to deliver healthcare services. To help us realize this goal, the college will soon be embarking on its first-ever capital campaign; a key component of this campaign includes funds to create a new home in a fully renovated Paley Hall, the former site of Temple’s library and a space that resides in the heart of the campus. Our college is spread across 13 buildings on campus, with no central space of our own—bringing every unit together under one roof will be transformative. It will advance our model of interprofessional education, increase opportunities for collaborative research and practice, and make it easier for us to host symposia and other key events. Three pillars will support our campaign:

D E AN

Laura A. Siminoff, PhD E XE C UT I VE E D I TO R

Lisa Litzinger-Drayton M AN AGI N G E D I TO R

Christopher Sarachilli D E SI GN M AN AGE R

Abby Musial ASSI STAN T E D I TO R

Caitlin McHale PHOTO GR APHE R

Andrew Thayer C O N T R I B UT I N G W R I T E R S

Rjaa Ahmed Tara W. Merrigan Alexis Rogers Donald Steinberg SE N I O R ASSO C I ATE D I R E C TO R , D E VE LO PM E N T

Natasha de Luna natasha.deluna@temple.edu

• Accelerate solutions through a modern interprofessional home for the college • Recruit and retain world-class faculty • Prepare and equip future health leaders In this magazine, you will find stories that show how our college is already achieving our goals. Through an interprofessional lens, we are working to improve the health of both populations and individuals, generate new knowledge with immediate applications, and prepare future leaders who are well-equipped to collaborate on novel solutions. This last pillar is exemplified in our cover story (page 26), which details the many ways our students are improving health and well-being right here on campus. Students and researchers in the college were instrumental in establishing a tobacco-free campus. A new Social Service Annex, in which students offer peer support for issues such as housing and food insecurity and general stress, has been established. And elsewhere in the college, students gain firsthand experience treating patients in our pro bono physical therapy and speech-language-hearing clinics. Reading about the work of these students, I am reminded of the college’s new vision—solving health’s complexities for a better tomorrow. Together, I am confident we will get there.

Laura A. Siminoff Dean Laura H. Carnell Professor of Public Health

Temple University’s College of Public Health is one of the largest and most diverse colleges of its kind in the country, incorporating healthcare and health services disciplines as well as traditional public health programs. The college is home to the Departments of Communication Sciences and Disorders, Epidemiology and Biostatistics, Health and Rehabilitation Sciences, Health Services Administration and Policy, Kinesiology, Nursing, and Social and Behavioral Sciences, as well as the School of Social Work. Across our 20 disciplines and more than 40 academic programs, we are working to serve our students and our community. Together, we are redefining what it means to be leaders in public health.

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S TAT E O F R E S E A R C H This has been another year of great success for research in the College of Public Health. We received 47 new grants, totaling almost $8 million in new funding for our research. The average award per project is approximately $650,000, a substantial amount that allows our investigators to support their research teams and graduate students as they engage in research that directly impacts the health and well-being of our local and global communities. The National Institutes of Health (NIH) is one of the major funding sources for our research—and it’s worth noting that receiving an NIH grant is a prestigious accomplishment. Much of the college’s research in the areas of HIV/AIDS, cancer, substance abuse, smoking cessation and obesity comes from the NIH. In the past year, several faculty members received NIH awards, including Donna Coffman and Brandie Taylor (Department of Epidemiology and Biostatistics) and Edwin Maas and Jamie Reilly (Department of Communication Sciences and Disorders). Mark Salzer (Department of Social and Behavioral Sciences) also received an additional five years of funding to support the Temple University Collaborative on Community Inclusion, which does groundbreaking work to support community participation of individuals with mental illness. Faculty across the college also had great success with high-profile awards from foundations and other funding sources. Rebecca Alper (Department of Communication Sciences and Disorders) was awarded a major grant from the William Penn Foundation to expand an early language intervention for children living in underserved areas that can be delivered by their primary caregivers. Beth Pfeiffer (Department of Health and Rehabilitation Sciences) received a grant from the Administration for Community Living to enhance community participation through the greater use of public transportation by adults with autism spectrum disorders. As discussed on page 18, a team of researchers in the college has secured over $4 million in grants from the Department of Defense in the past 18 months to study the psychosocial functioning of military combat veterans who may be eligible for face or hand transplants. This fascinating line of research will teach us important things about the challenges of living with significant disability and the resiliency that some individuals show in response to those challenges. Updating the College of Public Health family on the scholarship of our faculty and students is one of my favorite aspects of my role as associate dean for research. To obtain real-time updates on our successes throughout the year, subscribe to the college’s newsletter, The Common Good, at cph.temple.edu/newsletter, or contact me directly at dsarwer@temple.edu. David B. Sarwer Associate Dean for Research Professor, Department of Social and Behavioral Sciences Director, Center for Obesity Research and Education davidbsarwer

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Contents 5 College News Updates from the College of Public Health

9 Solutions Grants and new projects

13 Impact Publications and findings

18 Groundbreaking research into complex transplants College conducts three studies with $4 million in funding from the Department of Defense

20 Collaborating outside the Collaborative Collaborative on Community Inclusion partners with organizations to advocate for people with serious mental illnesses

24 Public Health in Focus Portraits from the College of Public Health

26 Temple made healthier College of Public Health students work to improve health and wellness on campus (and beyond)

30 Global Community News from around the world

34 Alumni Spotlights Highlights from our graduates

TempleCPH temple_cph TempleCPH

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IN THE NEWS “For younger populations, there’s literature that suggests they don’t want to admit they have a chronic disease that they have to manage for the rest of their lives.” Gabriel Tajeu, assistant professor of health services administration and policy, on his research finding low medication adherence in younger patients with high blood pressure. HealthDay

“It’s not that bariatric surgery seems to be compromising healthy marriages, but rather it seems like it’s helping people get out of unhealthy relationships.” David Sarwer, associate dean for research, on the rate of divorce after bariatric surgery. The Guardian

“Our goal is to become a hub of comprehensive services that will be of value to the community, promoting health as well as treating illness.” Laura A. Siminoff, dean of the College of Public Health, on the opening of the Vaux Community Health Center. The Philadelphia Inquirer

“A lot of teens are now growing up with this idea that using e-cigarettes is a safer alternative, and we know from the evidence being generated in the scientific community that that’s not the case.” Jennifer Ibrahim, associate dean for academic affairs, on Temple’s new tobacco-free policy. WHYY

“As more millennials choose to live in Philadelphia, they wind up raising all rents. That affects older residents on fixed incomes.” Philip McCallion, director of the School of Social Work, on poverty among older citizens. The Philadelphia Inquirer

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COLLEGE NE WS

COLLABORATIVE ON COMMUNITY INCLUSION RE-FUNDED THROUGH $4.375 MILLION GRANT

Temple University goes tobacco free On July 1, 2019, Temple University implemented a new tobaccofree policy, based on recommendations from Dean Laura A. Siminoff and the Presidential Smokefree Campus Task Force. In addition to prohibiting smoking and tobacco products (including e-cigarettes and vapes) from buildings, parking lots and public spaces in and near campus, the new policy promotes resources to help students, faculty and staff quit using cigarettes or tobacco. The Task Force was commissioned in 2017 thanks to a grant from the American Cancer Society (ACS). An interdisciplinary group of faculty, students and staff from across Temple, the group surveyed the campus community on behaviors and perceptions about smoking on campus. They asked students and employees about their awareness of current campus policies; if, where and how they smoked; and the degree to which they felt that smoking was a problem on campus. The Task Force crafted a number of recommendations leading to the tobacco-free policy. They also stressed the importance of offering smoking cessation support alongside prohibiting tobacco use. “It’s not a matter of punishment,” said Jennifer Ibrahim, associate dean for academic affairs, who received the grant from the ACS. “We’re trying to prevent people from starting to smoke and offering support for individuals who are addicted to tobacco. The intent of the policy change is to create a healthier environment for our students, staff and faculty, as well as our North Philadelphia neighbors.”

Learn more about the college’s efforts to create a healthier campus in the cover story on page 26.

The Temple University Collaborative on Community Inclusion has received $4.375 million in funding from the National Institute on Disability, Independent Living, and Rehabilitation Research for an additional five years as a rehabilitation research and training center on independent living and community participation of individuals with serious mental illness. This marks the fourth such grant for the Collaborative. Housed in the College of Public Health, the Collaborative on Community Inclusion partners with individuals who live with serious mental illness (SMI), as well as with policymakers and care providers to offer opportunities for people with SMI to become active members of their communities. Collaborative members research a variety of subjects, from postwar mental health services in Bosnia and Herzegovina to peer support groups for young adults with early signs of psychosis and using public transportation to foster community participation. In its 15 years, the Collaborative has created more than 130 toolkits, manuals and resources for researchers, policymakers, consumers and healthcare providers on the subject of community inclusion and mental health. Researchers in the Collaborative have published nearly 450 peer-reviewed publications, and the Collaborative’s research has been cited more than 10,000 times.

The Collaborative’s Brandon Snead works with participants in a biking program.

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With ACS Working Group, Sarwer pushes back against bariatric bias Studies continue to establish the medical benefits of bariatric surgery: Beyond helping persons with clinically severe obesity look and feel better, bariatric procedures can result in lowered risk of obesity-linked issues including Type 2 diabetes, hypertension, heart problems and premature death. But because bariatric surgery may still be considered cosmetic, despite its medical benefits, “bariatric surgeons are often marginalized by the surgical community,” says David Sarwer, associate dean for research and director of the Center for Obesity Research and Education. Sarwer is part of an American College of Surgeons working group aiming to change perceptions about the procedure and improve the image of bariatric surgery within the medical community. Throughout 2019, the group has been publishing monthly papers in the Bulletin of the American College of Surgeons with the goal of highlighting the latest advances in the field for the wider surgical community and changing perceptions about the procedures. Sarwer is the only psychologist selected to join the ACS’s bariatric panel. “It’s really a strong statement that the thought leaders in the bariatric world recognize the importance of psychosocial and behavioral issues in patients and the important role they play in long-term success,” he says.

A nursing student reads to children in the community library.

Community library breaks fundraising goal A community library created by the Department of Nursing in partnership with Open Door Ministries in North Philadelphia raised $7,380 through Temple’s 15th OwlCrowd, the university’s crowdfunding program, far surpassing its $5,000 goal. The library opened last year, providing books to children at Webster Elementary, a school in the Kensington neighborhood whose students previously went without convenient access to a library. Over a period of about six weeks, Temple students cleaned and decorated the space, built shelves and other fixtures, and collected more than 6,000 books. The additional funds will cover repairs in the community center; provide additional carpeting, shelving, tables and seating areas; and purchase books that are more culturally diverse and representative. According to Rodney Timmons, a pastor at Open Door Ministries, the space could ultimately be used as a center to offer an abundance of services: the library, after-school programs and tutoring, physical activities and sports in the building’s gymnasium, and even skills and job training for parents in computer labs. The work is part of the nursing program’s “Community Home” curriculum, in which BSN students are immersed in a Philadelphia neighborhood beginning in their sophomore year. In addition to opening the library, the students assigned to this community teach health classes at Webster every Monday and assist with a soup kitchen through Open Door Ministries; on Wednesdays, a second group of students teaches health classes and is working with the church to build a community garden.

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BEDORE NAMED ASHA FELLOW Lisa Bedore, chair of the Department of Communication Sciences and Disorders, has been named a Fellow of the American SpeechLanguage-Hearing Association (ASHA). Among the highest honors in the organization, the status of Fellow recognizes achievement in the field of speech-language-hearing and is given to those whose contributions “are significant and would be so regarded within and beyond one’s community or state.” The status is retained for life and bestowed upon only a small percentage of the overall membership. A respected researcher of developmental language disorders among Spanish-English bilingual children, Bedore directs the HABLA (Human Abilities in Bilingual Language Acquisition) Lab at Temple University. Her research expertise is in morphology and phonology in Spanish-English bilingual children with language impairments. She is nationally recognized for her work in developing instruments to detect language disorders in bilingual children, and her research has been funded through the National Institutes of Health for over 20 years; she also has served as project director or co-director on multiple grants from the Department of Education.

Shawn Jackson with a young patient at the Vaux Community Health Center.

Vaux opens to serve North Philadelphia community The College of Public Health opened the Vaux Community Health Center, a nurse-managed primary care clinic, on Sept. 3, 2019, in the Sharswood/Blumberg neighborhood of North Philadelphia. Vaux is a community-based health center that focuses on the health and well-being of the whole person, offering comprehensive services for all ages including health screenings, acute and chronic disease management, health education and health promotion programs, care coordination, and preventive services that meet the unique needs of the local community. The health center is led by an experienced team of registered nurses that include Sofia Carreno, nurse manager, and Shawn Jackson, Sue Gresko and Deborah Moss-Gail, certified registered nurse practitioners with expertise in family health and pediatrics. Vaux is part of a communitywide effort known as the Sharswood/ Blumberg Neighborhood Transformation Plan, led by the Philadelphia Housing Authority with funding from the U.S. Department of Housing and Urban Development. In addition to the health center, the effort includes improvements to education, commercial activity, public safety, workforce training and residential units. “We are excited to be part of a neighborhood effort to improve the health and well-being of residents and the overall health and vitality of the community,” said Marti Kubik, professor of nursing and executive director of the health center. “I believe our mission says it all: ‘To partner with the residents of the Sharswood/Blumberg neighborhood to provide quality healthcare that supports personal health, family health and the health of the community.’”

Lisa Bedore.

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M A R T I N N A M E D Laura H. Carnell Professor Nadine Martin was one of only three faculty members across Temple this year to be honored with the title of Laura H. Carnell Professor, which recognizes faculty for outstanding scholarship and contributions to their fields through teaching, creative work and research. The award is named for Temple’s first dean, Laura Carnell. Martin has decades of experience as a researcher, educator and leader in the field of communication sciences and disorders. She heads the Aphasia Rehabilitation Research Laboratory, where she studies the relationship between verbal short-term memory and word processing disorders. Martin also is founder and director of the Eleanor M. Saffran Center for Cognitive Neuroscience. “It is a great honor to receive the Laura H. Carnell Professorship, and I am grateful for this recognition of my research in language disorders associated with stroke and aphasia,” said Martin. “I am committed to engaging students in research and fostering their interest in academic and clinical-research careers. The importance of translating basic research to clinical practice cannot be overstated. Thus, it is vital that students of clinical sciences develop a strong foundation in the research that informs clinical practice. I will continue to infuse the spirit of this mission in my teaching, research and scholarly work.”

Nadine Martin.

C O L L E G E TO S T U DY P FA S C O N TA M I N AT I O N I N LO C A L C O M M U N I T I E S The College of Public Health will examine possible associations between PFAS-contaminated drinking water and cancer as part of a federally funded multisite health study to understand the health effects of exposure to PFAS chemicals in drinking water. Temple’s study of PFAS and cancer expands upon its participation in a broader study that is in collaboration with the Pennsylvania Department of Health and RTI International and focused in Bucks and Montgomery Counties. This work is part of a national effort by the Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry. The federal agencies are providing an initial $1 million per year to each of seven U.S. sites. The total funding for the five-year Pennsylvania project is expected to be $5 million. Temple’s extension of the study is designed to look specifically at cancer, piggybacking on data collected in the core study and obtaining new information from sources like the Pennsylvania Cancer Registry. Temple originally budgeted $1.28 million to conduct this work. Resa Jones, chair of the Department of Epidemiology and Biostatistics, says: “Rigorous studies, like what we’ve proposed, hopefully will advance what’s known and provide a better understanding of how PFAS-contaminated drinking water could be impacting health.” Resa Jones.

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SOLUTIONS

Testing treatments for childhood apraxia of speech Childhood apraxia of speech (CAS) is a pediatric speech disorder that makes it difficult for kids to intelligibly speak the words they want to say. It’s a motor disorder, where speech muscles aren’t weak or paralyzed, but the brain can’t properly guide their movements to produce clear speech.

One-on-one therapy can help, and it’s useful to begin early. Edwin Maas, assistant professor of communication sciences and disorders and co-director of the Speech, Language, and Brain Laboratory (known as the SLAB Lab), has been awarded a fiveyear, $2.16 million grant from the National Institute on Deafness and Other Communication Disorders to test different ways of treating the disorder. The study will enroll groups of children under age 10 in intensive summer camps for the next three summers. The day camps, which will give children with CAS different kinds of one-on-one training with speechlanguage pathology graduate students under supervision of experienced speech-language pathologists, are aimed at discovering which therapy techniques are most effective at treating CAS. Each of the three summer sessions will enroll a different set of children and test different ways to use 16 hours of training. “The goal,” says Maas, “is really to help speechlanguage pathologists make better clinical decisions and ultimately make a difference in people’s lives.” CAS is believed to affect 40,000 to 160,000 children under age 10 in the United States. Its causes aren’t fully understood, and it can be confusing to diagnose because symptoms such as delayed speech can be associated with other conditions. CAS may limit one’s ability to participate fully in school, social activities and ultimately employment. It can also affect literacy, as learning to write in an alphabetic language like English is connected to the sounds of speech. Interventions to help children with CAS speak more intelligibly have potentially lifechanging consequences, but CAS is challenging to treat and hasn’t been widely studied. “There are other speech disorders that respond more quickly to treatment. Apraxia tends to take a lot longer to make the same kinds of gains,” Maas says. Maas’s study will use variations of an approach called integral stimulation, which encourages children

to look at, listen to and try to imitate a therapist pronouncing target phrases. Researchers in the study will look at whether simple or complex words work better in training and compare real words versus madeup words. They will also examine whether sessions packed closely together or spread out are more effective. Children’s speech accuracy in response to the training will be scored by researchers after the treatment and also recorded so that another set of listeners, recruited from the general public, will be able to evaluate the intelligibility of the speech. Control groups will allow comparison of each approach versus no treatment (children who receive no treatment during the first half of each summer camp will switch and receive training in the second half ), and each year’s findings will inform the next year’s study setup. “What we’re trying to do is find ways to get the most out of the limited sessions a therapist may have,” Maas says. “We’re saying, ‘If you get 16 hours, what gets you the biggest bang for your buck?’”

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Uncovering the origins of preeclampsia Preeclampsia, a syndrome that can affect pregnant women, has been called mysterious in both popular and scientific literature. It is characterized by high blood pressure and, often, protein in the urine. Symptoms vary, ranging from headaches to seizures and life-threatening complications. What causes preeclampsia is not well understood, so there isn’t a way to determine who will develop it. The only established treatment is clinically induced delivery, which sometimes leads to premature birth. Preeclampsia occurs in an estimated five to eight percent of all pregnancies. “Currently, there’s no clinically useful way to predict which women will develop preeclampsia,” says Brandie DePaoli Taylor, associate professor of epidemiology and biostatistics. Hoping to discover new connections that could shine some light on preeclampsia’s origins and inform future research or treatment, Taylor is leading a new fiveyear study funded by the National Institutes of Health. The study will include hundreds of women with and without preeclampsia and will analyze blood samples taken early in pregnancy. The researchers will look for biological markers in the blood that might correlate with cases of preeclampsia as well as severe symptoms. “There’s still a lot we don’t understand about the syndrome,” Taylor says. “There’s no clinical test that tells physicians which women have the highest chance of developing preeclampsia, and, of those women, which will require early intervention to avoid progression to the most severe preeclampsia-related outcomes.” The study will work with pregnancy data and biological samples taken as part of a multi-year national study called Screening for Obstetric and Pregnancy Endpoints, or SCOPE. More than 5,000 women participated in the recent study, whose purpose was to identify predictors of preeclampsia and prematurity while creating a large bank of data and biological specimens. Taylor’s team is exploring whether elevated levels of syncytiotrophoblast extracellular vesicles (STBEVs)—microvesicles shed from the outer layer of the placenta into the maternal bloodstream—are associated with increased risk of preeclampsia. “We hypothesize that STBEVs may be triggering an innate immune response early in pregnancy that could result in the development of preeclampsia,” Taylor says. In their analysis, the researchers will compare biomarkers between 280 women within the SCOPE

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study who experienced preeclampsia with 560 women who did not. Researchers at the University of Pittsburgh, a partner in the Temple study, will analyze the blood samples of those subjects, and Taylor’s team will crunch the numbers. Preeclampsia is currently diagnosed after 20 weeks of pregnancy if physicians detect new high blood pressure readings and protein in urine or evidence of organ dysfunction. SCOPE blood samples were taken as early as 16-18 weeks, so the researchers will be able to measure biological markers before preeclampsia is diagnosed. Knowing whether biological pathways are altered prior to disease diagnosis could help researchers better understand the origins of preeclampsia. That could eventually improve clinical management and influence early-delivery decisions, Taylor says. Currently, in certain situations, there are women with preeclampsia who are induced for delivery early who might not have progressed to severe disease, and that puts the baby at risk, she says. There may also be women who are not induced and progress to severe symptoms that can lead to various morbidities or even maternal death. The overall goal of the grant, Taylor says, is to find a better way to describe the disease and the forms it takes—to unravel some of the mystery and rethink what preeclampsia is. “We will combine the biological data with the existing clinical data to see if we can develop an algorithm that can help identify subtypes of the syndrome and perhaps in the future provide enough knowledge to redefine the syndrome,” she says.

FAT H E R H O O D R E S E A R C H A N D P R AC T I C E N E T W O R K AWA R D S 1 1 P R O G R A M S According to 2016 U.S. Census Bureau data, 23 percent of U.S. children under the age of 18 live in single-mother households. In these instances, nonresidential fathers can play an important role in a child’s life, influencing academic achievement, lowering rates of aggression and delinquency and improving overall well-being. But there are relatively few support programs for this type of father, says Jay Fagan, professor in the School of Social Work. Fagan co-directs the Fatherhood Research and Practice Network (FRPN) with Jessica Pearson, director of the Center for Policy Research, a nonprofit research and evaluation firm that seeks to improve the lives of children and their families. Funded by the U.S. Department of Health and Human Services, the FRPN provides funding for projects around the country in an effort to conduct research on fatherhood, disseminate findings and promote the use of research-based practices by fatherhood programs. Earlier this year, the FRPN announced programs in 11 states that will receive $10,000 mini grants to improve fatherhood programs. The awards will help to support strategic planning efforts, interagency convenings and data collection activities for projects that improve fatherhood involvement and community-based fatherhood programs. “Few states have engaged in systematic planning to implement services to low-income, nonresidential fathers,” says Fagan. “As a result, services to fathers are often fragmented and sometimes not available at all to families most in need of those services. These new state policy grants will enable more systematic planning of these services to meet the needs of the most vulnerable fathers and families.”

Can monetary incentives encourage breastfeeding? Research shows that breastfeeding through the first six months of a child’s life can have key health benefits for infants, such as reduced risk of obesity and Type 2 diabetes, as well as for mothers, such as a lesser likelihood of high blood pressure and breast cancer. Yet, while breastfeeding rates have risen steadily in recent years, mothers who live in poverty or lack a college education are still less likely to breastfeed their infant through their child’s first six months as compared to higher-income, college-educated mothers. A similar phenomenon is seen with race: African American and Hispanic mothers are less likely to breastfeed than white mothers. Through a five-year, $2 million grant from the National Institutes of Health, Professor of Social and Behavioral Sciences Bradley Collins and Lewis Katz School of Medicine Associate Professor Gail Herrine will examine whether a monetary incentive can encourage

breastfeeding. The project will be spearheaded by principal investigator Yukiko Washio, a researcher in the Substance Use, Gender, and Applied Research unit at RTI International, a nonprofit research institute. Building from a successful pilot project that saw breastfeeding rates increase, the project will test a behavioral intervention among African American and Hispanic mothers in Delaware and Pennsylvania who receive support from Women, Infants and Children (WIC) programs. Women will be randomized to either a control group that receives standard WIC counselor advice, support and resources to facilitate breastfeeding, or an experimental group that receives the same WIC services plus a monthly monetary incentive (known in the study as Breastfeeding Onset and Onward with Support Tools, or “BOOST”) to mothers for continuing to breastfeed their infants.

The smaller pilot study, Collins said, suggested that a monetary incentive could drastically improve breastfeeding rates among low-income mothers. The researchers hope that this larger study will provide firm evidence that a financial incentive can tip the scales toward higher levels of breastfeeding among mothers who face both economic and cultural barriers, such as the difficulty to keep breastfeeding after returning to work or the misconception that formula milk makes infants healthier. “In the pilot, the results showed a pretty dramatic, positive effect,” Collins says. “To test the BOOST intervention in a full-scale trial could show not only the potential efficacy of this intervention, which could improve maternal and child health, but also bolster evidence supporting its potential sustainability.”

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The how and why of exercise It’s well known that exercise can improve a person’s health: weight management, mood improvement and heart disease prevention are common outcomes for regular exercise. But though these effects are documented, scientists don’t know how and why regular exercise can produce all of these outcomes, especially heart disease prevention.

In an effort to better understand exercise and heart disease prevention on a molecular level, postdoctoral fellow Junchul Shin is embarking on a research project with funding from the American Heart Association (AHA). Shin is a third-year fellow in the Cardiovascular Genomics Laboratory, led by Kinesiology Associate Professor Joon Young Park. He plans to examine the molecular mechanism through which blood vessels form new capillaries, a process known as vascular formation. Shin will test whether low levels of oxygen after exercise induce the blood vessel molecules to form new capillaries, since people who exercise regularly have been shown to have a greater density of capillaries. “If there’s a density of capillary, there are greater health benefits,” says Shin. “We know that vessels are made through exercise. Researchers believe that density is related to hypertension, and increased density might decrease blood pressure.” The specific vascular molecules targeted in Shin’s study are HIF 1 alpha (short for “hypoxia-inducible factor 1”) and PHD2 (“prolyl hydroxylase domain 2”). Using an animal model involving mice, Shin will test if HIF 1 alpha activates and triggers blood vessel growth when PHD2 is dormant. Shin believes that PHD2’s inactivation is key to vascular formation, since it is known that PHD2 becomes dormant when the body is in a low-oxygen state—which

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is believed to be a common, temporary effect of exercise. “Using an animal model, we will collect blood pressure measurements from mice in which PHD2 is blocked in skeletal muscles,” says Shin. The experimental group’s blood pressure rates will then be compared to a control group’s rates. Exercise science and its underlying biological mechanisms have long been a major research interest for Shin. In 2016 he joined Park’s lab, housed in the Lewis Katz School of Medicine, to further his research in exercise physiology as it relates to cardiovascular health. “During my third year in university, I took a course and realized how important exercise is to health,” says Shin. “Exercise is a good strategy for some patients to improve their health, but it would be better to know how it delivers those benefits.”

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P O O R H E A LT H I N S U R A N C E C O V E R AG E A L I K E LY B A R R I E R TO E F F E C T I V E O B E S I T Y T R E AT M E N T One out of every three American adults has obesity, defined as a Body Mass Index (BMI) greater than 30, and about one in 13 adults has extreme obesity—a BMI of 40 or greater. And yet, only one percent of the patients eligible for bariatric surgery, considered to be the most effective treatment for obesity, actually undergo the surgery. Prior research has explored sociocultural factors that could contribute to this underutilization, but according to a review authored by Hamlet Gasoyan, a doctoral student in the Department of Health Services Administration and Policy, limited financial means or poor health insurance coverage are likely considerable barriers to receiving this life-changing surgery. In a literature review on bariatric surgery and insurance coverage, published in Surgery for Obesity and Related Diseases, Gasoyan and co-authors found that for one specific subpopulation—individuals with extreme obesity and Type 2 diabetes—access to bariatric surgery would be greatly increased if patient copays were eliminated and insurance companies’ financial standing would not be affected in the long term. “If cost-sharing was reduced from six percent to zero percent, utilization would increase,” says Gasoyan, whose review states that 35 percent of patients eligible for bariatric surgery did not have insurance or were underinsured. According to his calculations, eliminating copayments would result in a 17 percent increase in the number of individuals with extreme obesity and Type 2 diabetes who receive bariatric surgery. Gasoyan’s proposal is inspired by Value-Based Insurance Design (V-BID), in which insurance coverage and patient out-of-pocket costs are determined based on the value of a given treatment. In V-BID programs, patients are encouraged to utilize services that will have long-term, beneficial effects via minimal costsharing requirements. This inverts the traditional insurance payment structure: insurers pay more up front but less as time goes on, since individuals covered by their plans are healthier in the long run. Thus far, value-based insurance approaches have been applied primarily to lower-cost

Hamlet Gasoyan.

treatments, like daily medications, rather than more costly treatments like bariatric surgery. According to co-author David Sarwer, associate dean for research and director of the Center for Obesity Research and Education, bariatric surgery may be a good candidate for a value-based insurance approach. “Over the last several years, there is growing evidence demonstrating that the weight losses seen with bariatric surgery, typically one-third of a person’s body weight, are associated with significant improvements in morbidity and mortality,” says Sarwer. “In addition, other studies have suggested that the costs associated with the surgery are recovered in healthcare savings within three to five years for most people.” Sarwer notes, though, that further studies showing bariatric surgery’s effectiveness in the long term would be necessary before suggesting insurers should adopt a V-BID approach for the treatment.

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Pro-white bias found in non-medical healthcare staff

Appointments with a medical provider entail more than just interaction with the doctor. There are check-ins with reception, a pre-screening with a nurse and a follow-up with the office’s front desk after speaking with the doctor. While researchers have studied how physicians’ racial biases affect the experience of minority patients, little attention has been paid to how healthcare staff’s biases might affect patients. In a study published in the Journal of the National Medical Association, Assistant Professor of Health Services Administration and Policy Gabriel Tajeu found that healthcare staff showed greater pro-white bias than doctors and registered nurses. In the study, participants—doctors, registered nurses and staff—were asked to take the Implicit Association Test and Modern Racism Scale, tests administered by computer that measure implicit and explicit bias. In the implicit bias test, white participants (both MD/RN and staff) exhibited a bias score significantly higher than other participants. In addition, among white study participants, white staff (non-MD/RN) had higher levels of pro-white implicit bias compared to white MD/RN staff. The study found little difference between MD/RN and staff results for the explicit bias test. In recent years, especially since the 2001 publication of a landmark report entitled “Crossing the Quality Chasm,” researchers have increasingly considered how sociocultural factors might affect medical treatment. One 2007 study found that, when physicians were presented with a clinical vignette describing symptoms of heart attack, the greater a physician’s pro-white implicit bias, the less likely they were to recommend administering black patients with an effective, commonly used treatment. “The encounter with the front desk staff member who is scheduling you may influence various aspects of the rest of the healthcare experience, but that hasn’t been examined yet,” says Tajeu. “The next step would be to examine the potential effects of experiencing racism in the first interaction with a staff member.” While cultural competency training among nurses and doctors has become common, Tajeu says it is only a start. “In this study, we are saying that staff are a population that should not be overlooked when it comes to these trainings.”

In an initial meeting, it can be difficult for oncologists to discern how much patients and their families know about cancer. Professor of Epidemiology and Biostatistics Levent Dumenci and his co-investigators created a cancer health literacy test to help oncologists and other healthcare providers understand their patients’ level of cancer health literacy in 2014. After conducting further research, Dumenci and his colleagues recently found that the same test can be used to successfully gauge the cancer health literacy of an individual without cancer. Researchers administered the Cancer Health Literacy Test on a hand-held touch-screen device to individuals from various backgrounds. The research team, which included Dean Laura A. Siminoff, found that the 30-question test (known as CHLT-30) could predict an individual’s understanding of cancer with a high degree of reliability, regardless of demographic differences. “We thought the CHLT-30 could be used on populations without cancer,” said Dumenci. “What we found was those with cancer would score higher on the scale than people without cancer, due to exposure to language around cancer during treatment after a cancer diagnosis.” The Cancer Health Literacy Test also comes in a stripped-down six-question version that helps oncologists identify patients with limited cancer health literacy more quickly. Responses to the six questions, taken from the 30-question test, determine the likelihood that a given patient has either limited or adequate literacy. “No matter how good a clinician you are, how good an analysis you can make, if the patient doesn’t take medications, doesn’t understand information and doesn’t show up to an appointment, that has a major impact on health outcomes,” says Dumenci. “Understanding patient cancer health literacy levels can help make sure efforts and expenses aren’t in vain.” The Cancer Health Literacy Test is available for free to providers and researchers. Since its introduction in 2014, the test has been translated into Spanish, and Dumenci and his colleagues are currently overseeing the translation of the test into Mandarin Chinese. They hope to develop a mobile application that administers the test in the future.

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Cancer health literacy test effective with wider population

Social relationships could be key to overdose prevention in rural areas

As the opioid epidemic has widened, some of the most heavily impacted areas have been in rural Appalachia, a region of the country stretching from parts of New York to northern Alabama and Georgia. Opioid use in this region has grown disproportionately, driven in part by the higher prevalence of people using prescription opioids non-medically, the transition from prescription opioids to heroin, and the more recent increased availability of fentanyl. This has presented a potentially overwhelming public health challenge in rural areas, where facilities offering treatment for substance use disorders and mental health may be few and far between. Abby Rudolph, associate professor in the Department of Epidemiology and Biostatistics, has begun exploring how the methods that have previously been used to understand the epidemiology of HIV and prevent ongoing transmission could be applied to understand the opioid crisis and prevent future fatalities in rural settings. Her new study recently was published in the Journal of Urban Health. Her analysis, done in conjunction with researchers from the University of Kentucky, focuses on identifying individuals in an affected community who might be best positioned to intervene in life-threatening situations. The paper aimed to identify persons who use drugs who are more likely to witness an overdose in the future. Training these individuals to administer life-saving naloxone and rescue breathing to overdose victims could prevent fatal overdoses. These well-connected peers also can train others to be ready to respond. “Most overdose prevention programs target people who are likely to experience an overdose themselves, but you can’t give yourself naloxone,” Rudolph says. “We’re trying to change the framework for overdose prevention.

By capitalizing on social relationships and using peer-based trainings to increase the number of people who are trained in overdose prevention, we can ensure that more people feel able to respond in an emergency.” Often it’s someone at the scene of an overdose—rather than emergency help called via 911—who is able to deliver treatment most quickly. By targeting “likely bystanders,” people who spend time in the proximity of at-risk individuals, “we drastically increase our chances of having somebody in the area who can respond,” she says. These bystanders often are friends or family members. The study is built around a survey that asked 503 people who use drugs in rural eastern Kentucky about their own risk behaviors and their connections to others. The targeted region is an epicenter for prescription opioid use and overdose. From the self-reported connections, the larger study was able to construct the connections between all individuals in the sample. Using concepts from infectious disease literature, Rudolph’s paper discusses the concept of “herd immunity”—a threshold reached when a critical portion of the population becomes immune to a disease. If the disease in this case is a fatal overdose, training in overdose prevention can function like a vaccine, helping to prevent future fatal overdoses. Here, social connections can help to mitigate potentially fatal events. One key in dispersed rural settings is having people train others who can’t access in-person training sessions, Rudolph says. “We can give marginalized members of the population prosocial roles—training their peers in overdose prevention. Over time, you can expect to see a reduction in risk behaviors and fatal overdoses.”

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Phone intervention may reduce tobacco exposure in children

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While tobacco rates continue to drop—according to the CDC, 14 percent of adults nationwide smoke—rates in low-income and minority groups are often higher than 25 percent. The health implications carry through to the home: Within these demographics, more than 50 percent of children are exposed to secondhand smoke. That exposure can lead to ear and respiratory infections, as well as chronic problems, such as asthma. One effective way to lower exposure to secondhand smoke is affordable, replicable and already in most parents’ pockets. In an NIH-funded study published in The International Journal of Environmental Research and Public Health, Stephen Lepore, director of the Social and Behavioral Health Interventions Laboratory, and Bradley Collins, director of the Health Behavior Research Clinic, found that parents who used their Kids Safe and Smokefree (KiSS) intervention were nearly 2.5 times more likely to quit smoking than those in the control group. (Donna Coffman, assistant professor of epidemiology and biostatistics, is a co-author.) Researchers partnered with pediatricians serving low-income neighborhoods and used the “Ask, Advise, Refer” (AAR) model, where physicians ask patients about tobacco use, advise that they should quit and refer them to services that can help them do so. Participants—who were largely female, African American and below the poverty level—were randomly placed into two groups: the intervention group that received AAR and counseling and a control group that received AAR and regular nutrition education. Those in the KiSS intervention group received literature and individual telephone counseling sessions over 12 weeks that included tools and resources to help them eliminate secondhand smoke exposure for their children. At 12 months, researchers found that those who received the KiSS phone interventions were 2.47 times more likely to quit smoking than those in the control. In addition, children of parents in both groups demonstrated lower levels of exposure to secondhand smoke at 12 months than they did before their parents started the intervention, suggesting that the discussion with the pediatrician alone was enough for a parent to limit their child’s exposure to tobacco. The latter finding was particularly surprising, says Lepore, as previous studies suggested that the clinic-level intervention (that is, the discussions with the pediatrician) wouldn’t have much effect. According to Lepore, a difference in societal attitudes over time could account for the strong influence of the pediatrician, both as parents become more aware of the dangers of secondhand exposure and as smoking drops in popularity. In addition, because prompts to discuss secondhand smoke were embedded in electronic health records, pediatricians may have been more likely to discuss the topic during clinic visits. One challenge that researchers face for future interventions is what’s known as thirdhand smoke: the residual contamination that resides on carpets, walls and other surfaces, sometimes for long after a smoker has been in the area. Given the propensity for crawling on the floor and hand-to-mouth behaviors, children can be particularly susceptible. And, although smoking use is increasingly stigmatized in public places, tobacco products are still heavily advertised and marketed, especially toward those living in low-income areas. Despite these challenges, interventions such as KiSS are a promising step toward eliminating tobacco exposure. And, since KiSS incorporates alreadyavailable (and free) smoking quitlines into the telephone counseling, it’s easily reproducible at a larger scale. “These results suggest that the pediatrician’s advice is highly motivating to the parent,” said Lepore. “We should integrate these kinds of interventions into pediatric practice—they are effective, relatively easy to implement and scalable.”

Snacking differences found across gender and race

The Dietary Guidelines for Americans (DGA) recommend that children eat nutrientdense snacks throughout the day to meet their nutritional needs. But are teens snacking in ways that lead to better health—or unwanted weight? A new study led by College of Public Health researchers and published in Nutrients has found that adolescents with normal weight had fewer snacks daily and smaller snacks per occasion (i.e., fewer calories per snack) than teens classified as overweight or obese. Other findings from the study include that teens with overweight and obesity are consuming more added sugar, saturated fat and sodium from snacks compared to normal weight teens; boys are consuming more snacks per day compared to girls; and African American teens are consuming more frequent and more energy dense snacks compared to their white peers. “There is an extensive literature that looks at how high-fat, high-sugar foods are disproportionately marketed to racial and ethnic minority kids, especially teens,” says lead author Gina Tripicchio, assistant professor in the Department of Social and Behavioral Sciences and researcher in the Center for Obesity Research and Education (CORE). “What we show here is that they’re also disproportionately consuming these foods as snacks.” Overall, the data suggests that targeting snacking frequency and size is a potential way to reduce teen obesity and obesity-related diseases. “Despite how common snacking has become, there’s really not a lot of literature that uses rigorous methodology to look at snacking,” says Tripicchio. “We know adolescents have more autonomy than younger children, and

they’re establishing eating behaviors that can impact lifelong health. We wanted to look at snacking as a potentially important eating behavior and its association with weight status.” To conduct this study, Tripicchio and her team, including Jennifer Fisher, professor in the Department of Social and Behavioral Sciences and associate director of CORE, dug into 11 years of data from the National Health and Nutrition Examination Survey (NHANES). NHANES is a nationally representative survey collected annually in the U.S., gathering a range of health information, including dietary intake and demographic data from about 5,000 people of all ages across the country. Tripicchio’s group examined information from adolescents ages 12 to 19, including demographic information, height and weight, and self-reported snacking behavior. Most importantly, says Tripicchio, the study used multiple definitions of snacking in order to better describe the relationship between snacking and weight status. “Snacking” for this study included food and beverages consumed between meals, as well as extended consumption occasions where “you open a bag of chips, and you’re eating it over the course of a few hours,” she explains. Tripicchio says she hopes these results will spur further study and perhaps eventually a new look at official guidelines. As a next step, she and her team will be investigating the impact of snacking on diet quality and how snack patterns contribute to meeting or exceeding the DGA.

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Groundbreaking research into complex transplants College conducts three studies with $4 million in funding from the Department of Defense

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A soldier injured in combat receives new hands in a groundbreaking transplant procedure. A severe burn victim gets a new face that once belonged to someone else. These patients get restored physical appearance, the chance to regain lost functionality, and new reason to hope. In recent years, vascularized composite allotransplantation (VCA) procedures have advanced slowly but steadily. Since the earliest efforts about two decades ago, roughly 200 procedures have been performed worldwide, restoring limbs, faces and genitals to people who have sustained catastrophic injuries. The procedures are more complex than solid organ transplants, involving multiple tissues such as muscle, nerve, bone and skin. These pioneering transplants pull together medical specialists in new ways, and the emerging field has inspired a multidisciplinary approach in the College of Public Health. With grants from the Department of Defense totaling approximately $4 million, the college is conducting three studies that unite its expertise in traditional organ donation and the role of body image in patients’ quality of life. Laura A. Siminoff, dean of the College of Public Health, brings extensive experience in organ transplantation and donation issues. “We have looked at why people donate, why they don’t donate, and how we can improve the process,” says Siminoff, one of the lead investigators on the studies. “Many of the same issues apply here, but this is the next frontier.”

She is joined by fellow college investigators David Sarwer, associate dean for research, who brings decades of work examining reconstructive surgery and other appearance issues in the psychosocial health of patients; and Heather Gardiner, associate professor in the Department of Social and Behavioral Sciences and director of the Health Disparities Research Lab, who has studied organ and tissue donation issues with an emphasis on donor decision-making and information needs. Siminoff and Gardiner are working on two studies. One will gain feedback from military veterans and families to improve education about and readiness for VCA procedures. “What do we need to convey to people, so they can make a really informed decision about whether or not they really want to undergo this procedure?” Siminoff says. “What are their expectations? What type of result would make it worth their while? It’s not a passive process to get one of these grafts. You need to take care of it, you need to be actively engaged in it, and your family does, too.” Another study will work toward building a training program for organ procurement organizations, which have just begun to formulate best practices for asking families of deceased patients, on short notice, to donate loved ones’ visible body parts. “Requests for VCA donations are rare and new territory for both the individuals making the requests and for the families being asked to donate,” Gardiner says. “This study is focused on educating requesters in organ procurement organizations about VCA and ensuring that families have the information they need to make an informed decision.” On a technical level, donors need to match not only in blood and tissue type but in age and skin tone. But it’s a new kind of request in other ways. “This is so personal. We don’t visualize our relatives and think about their kidneys; we think about their face and hands,” Siminoff says. The lengthy, costly VCA operations aren’t for everyone. For arm transplants, bones, arteries and veins must be reattached. An operation can take 16 hours. Then, the body naturally works to reject the transplanted body part, so the immunosuppressive drug regimen is heavy. “You’re trading one set of medical issues for another,” Siminoff says. Recovery may involve six hours a day in therapy for years. Nerves regrow in a new limb about one inch per month. The recovery can be so physically and psychologically arduous that recipients in a few cases have wished to reverse the procedure, Sarwer says, and physical appearance issues create another important part of the decision-making process for recipients.

“It’s often a combination of functional and aesthetic reasons,” Sarwer says. “The way that we look plays an important part in our day-to-day social functioning.” Sarwer’s study, in collaboration with Siminoff, will assess the psychosocial burden experienced by military veterans whose service-related injuries have resulted in extreme disfigurement to the face/head and/ or hands/arms. His study will include interviews with 60 male and female military veterans who have suffered significant injuries to the head and neck and/or upper limbs and are potentially eligible for a VCA procedure. “There are a lot of very complex issues when you think about individual patients,” Sarwer notes. Soldiers may have suffered traumatic brain injuries, or they may be coping with PTSD or other psychological issues that can add challenges to long-term recovery in VCA procedures. Ultimately, the researchers say, a better way to identify candidates with the most promising outcomes might make it more likely that the Departments of Defense or Veterans Affairs will pay for such procedures. Working with military trauma groups and VCA programs, Sarwer’s team plans to produce guidelines for patient selection that will aid in clinical management of VCA candidates for years to come. “There’s no consensus in the field yet on what makes an appropriate candidate,” Sarwer says. “So we’re going to work with other professionals in the field to come together and make recommendations on what we need to be thinking about, not only for the individual who’s a candidate for VCA, but the role of a parent or caregiver, and the role of the other members of the medical team. The goal is to make the most informed decisions that lead to the best outcomes.”

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The Collaborativeâ€™s Brandon Snead works with participants in a biking program.

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C O L L A B O R AT I N G O U T S I D E T H E C O L L A B O R AT I V E Collaborative on Community Inclusion partners with organizations to advocate for people with serious mental illnesses Ten years ago, Christine Simiriglia launched the nonprofit Pathways to Housing to tackle the problem of chronic homelessness among adults with severe mental illness with unconventional strategies. She had worked for homelessness service providers for nearly two decades, but she wasn’t convinced that standard practices and processes were the most effective model for reducing homelessness long-term. Simiriglia decided that Pathways would reverse the usual model. Typically, homelessness services organizations offer independent housing to participants only after they have undergone months of evaluation to assess their “readiness.” Instead, Pathways participants are placed in a private apartment, in a neighborhood of their choice, almost immediately. “I came from the traditional system, where we think with all our education we can tell who’s going to make it in housing and who won’t,” said Simiriglia. “What I’ve learned is we don’t know a thing about who’s housing-ready.” Simiriglia also decided that Pathways would focus on making a concerted effort to improve participants’ quality of life beyond providing material basics. To help guide this new focus, Simiriglia reached out to Temple University’s Collaborative on Community Inclusion. In many ways, a partnership between the two organizations was a natural fit. Like Pathways’ housing-first model, the Collaborative’s approach to community inclusion stresses participants’ capacity to succeed and recover independently—a capacity that is far greater than conventional clinical wisdom suggests. Collaborative Director Mark Salzer offered Pathways a new framework that has transformed the way its staff views, encourages and assesses participants’ recovery. The Collaborative’s framework promotes opportunities for adults with severe mental illnesses, such as schizophrenia and bipolar disorder, to live in the community like anyone else, taking part in activities—like work, school, dating, leisure and parenting—that provide physical, cognitive and mental health benefits. Today, Pathways participants are forming new bonds with peers, both at Pathways and in their neighborhoods. About 80 percent of the organization’s 400 participants are in the process of preparing for employment. “Our message is very hopeful and positive: that people with serious mental illnesses, who are about four or five percent of the U.S. population, can live good lives,” explains Salzer.

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Collaborative Director Mark Salzer leads a training on community inclusion.

Founded in 2003 after receiving a grant from the federal Administration for Community Living’s National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), the Collaborative is powered by a dozen research investigators and a number of research assistants and staff specialists. Together, they’ve published more than 450 peer-reviewed publications that explore community inclusion for people with severe mental illnesses from a variety of angles. Early Collaborative research included studies on how peer support can help people achieve their community inclusion goals. Other research assessed how the environment in which people live affects participation. In the 15 years since the Collaborative was first funded, the published research of its investigators has been cited more than 10,000 times.

At the heart of the Collaborative are 11 principles for community inclusion that provide the foundation for the group’s approach (see sidebar). These principles lay out not only how providers should optimize community inclusion efforts, but also how a person with a severe mental illness should be viewed by providers. One of the Collaborative’s most significant departures from mainstream approaches to mental health is its emphasis that people with severe mental illnesses have far greater capacity for living than providers might expect. While research is a central mission of the Collaborative, training practitioners and consulting with policymakers, both in the U.S. and abroad, also comprises a large portion of their work—Salzer and his associates have delivered more than 600 presentations and trainings in over 20 countries. One of the Collaborative’s recent contributions is inclusion of certified peer specialists—those who once lived with similar mental health issues as those they support. Peers perform a number of roles: Some act as case managers, wellness coaches or educators, and research shows that peer support can facilitate a person’s recovery. At Pathways to Housing, peer specialists trained in the principles of community inclusion play an important role in helping formerly homeless individuals resume everyday life and manage severe mental illnesses, said community inclusion manager Rob Wetherington. Prior to starting a working relationship with the Collaborative five years ago, Pathways would occasionally organize events in which participants went bowling or out to dinner or to Alcoholics Anonymous meetings. Now that Pathways incorporates

I N T E R D I S C I P L I N A R Y C O L L A B O R AT I O N S Gretchen Snethen trains a peer specialist.

In addition to working with external agencies, the Collaborative often partners with researchers across disciplines. As part of the I-CAN project (Independence through Community Access and Navigation), which helps people identify community recreational and leisure activities they enjoy, Collaborative Associate Director Gretchen Snethen partnered with Assistant Professor of Physical Therapy Shivayogi Hiremath to study new methods of tracking activity. Together, the researchers set up a test equipping adults with schizophrenia with Fitbit-like wrist-worn activity trackers as well as a mobile phone location-tracking app. Participants carried the gear and generated data for one week to establish a baseline, then underwent a six-month intervention encouraging them to get into the community. Afterward, they were equipped with the technology again for another week, to measure the difference. Researchers in the Collaborative are currently digging into the data, hoping to learn whether the program measurably increased participants’ “community space”—the number of locations they visited—and boosted their activity levels. “We know environmental factors influence physical activity, and that becomes a potential opportunity to intervene,” Snethen says. In a potential future application, location data from a patient’s mobile phone could inform discussions with clinicians or even trigger what’s called Just-in-time Adaptive Intervention, an immediate response such as nudge by text message to get moving. 22 TEMPLE PUBLIC HE ALTH

Collaborative approaches and peer specialists, participants are forming friendships with and are receiving support from each other. Wetherington described how one participant was struggling with an abusive relationship after her partner was released from jail. “For the first time, she had someone to talk to about the relationship—and it was another program participant. She said, ‘I was in a domestic violence situation. I told the Pathways team, and they helped me file for a protection of abuse.’” A few years ago, in Raleigh, N.C., staff at the Alliance of Disability Advocates were having a difficult time helping participants in recovery find work. This was especially true for those who had recently spent time in a group home or psychiatric hospital, for whom resuming daily routines could seem like too overwhelming a task. Then the Alliance’s executive director at the time, Dave Wickstrom, met Salzer at the Collaborative’s 2017 Summer Institute and began implementing their strategies in his organization. In a short time, they began noticing improvements in the lives of participants. “What changed were the questions we asked,” says Wickstrom. “We used to ask participants, ‘What are your goals?’ Now we ask more pointed questions like: ‘Do you like to go to the park? Do you like to go to church?’” He says that asking these more targeted questions yielded results almost immediately. Wickstrom recalled the story of one Alliance participant who was struggling to get out of bed most days but began playing basketball at a local gym a few times a week after an Alliance community specialist encouraged him to resume the one-time hobby. “One of the guys who also was playing at the gym was a hiring manager at the local Lowe’s and offered him a job,” Wickstrom says. “The job was initially for three to eight hours a week. After a few weeks of working, he increased his hours to 15 to 20 hours a week.” The participant is doing much better, he said, because the community inclusion specialist was more interested in getting him involved in his community than in finding him a job. “The kind of research we’ve tried to focus on challenges people to think about this population in a different way,” says Salzer. “We look at topics that are under-studied, like dating, parenting, attending college, and interacting with the larger environment for people with a severe mental illness. Our research directly counters the narrative that people with severe mental illnesses cannot or should not do these things. Instead, our research indicates that they not only can do these things, but that it is critical to their health, and that prejudice and discrimination, poverty and access to resources are likely major reasons why they are not participating fully in the community.”

S TA R T I N G W I T H F U N DA M E N TA L S The Collaborative’s approach to community inclusion depends upon 11 fundamental principles intended to guide policies, programs and practices: 1 Community inclusion is important 2 Community inclusion applies to everyone who experiences a disability 3 Community inclusion requires seeing ‘the person,’ not ‘the patient’ 4 Self-determination and dignity of risk are central to community inclusion 5 Community inclusion should embrace multiple domains of mainstream life 6 Community inclusion focuses on participation that occurs more like everyone else 7 Community inclusion is strengthened through emerging support technologies, the natural supports of families and friends, and the engagement of peer supports 8 Providing support to family and other natural supports promotes community inclusion 9 Environmental barriers to community inclusion must be identified and addressed 10 Community inclusion initiatives for individuals with disabilities maximize the use of mainstream community resources 11 Community inclusion requires establishing welcoming communities

Learn more about the fundamentals and explore more than 100 toolkits, manuals and resources provided by the Collaborative at TUCollaborative.org.

A student captures images of activities on campus for a Collaborative research project.

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Public Health in Focus Each week in 2019, the College of Public Health is highlighting students, alumni, researchers and others in our community—some have spent years in the field while others are just starting their public health journey, but all are united by their commitment to building a better, healthier world.

Maila Turay

R E C E N T B AC H E LO R O F S C I E N C E I N N U R S I N G G R A D UAT E

I’ve talked to ICU nurses who say, ‘You’re not going to feel comfortable for the first year of your profession,’ and that’s just a testament to how much there is to learn in a hospital. I think that’s a good thing—you can go to school for four years, but sometimes you grow the most when you’re under pressure. That’s how I work best.

Fatema Ibrahim

D I S A B I L I T Y A DVO C AT E

My younger sister has a disability—what’s next for her after high school? Services are expensive, hard to access and have a number of eligibility requirements. So I’m working on a project about developmental disabilities and postsecondary education opportunities. What’s the problem, what’s the issue, how can we advocate for a better system?

Shivayogi Hiremath A S S I S TA N T P R O F E S S O R O F P H YS I C A L T H E R A P Y My dream research scenario is to develop technologies that eventually go into the market and are easily accessible to people with disabilities. Hopefully these technologies can improve their quality of life and health outcomes: they can participate more in the community, participate in their friend groups, get a good education and get employment, just like everyone else.

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Michelle Ferguson

I M M I G R A N T E D U C AT I O N S P E C I A L I S T

I work on a team that helps refugees settle in their first 90 days in the United States—teaching ESL classes, facilitating youth programs, helping them adapt to a new culture. Taking classes at the College of Public Health, you’re reminded of the community health perspective in everything that you do. Health doesn’t just mean illness and medicine, but also overall well-being, and I’m glad I’m able to bring that perspective to my work.

Helen Clay Gallagher A S S O C I AT E AT H L E T I C T R A I N E R F O R WO M E N ’ S V O L L E Y B A L L A N D R O W I N G In sports medicine, we’re always ready to find the next best thing that’s going to get athletes back faster—safe, but faster. It’s a never-ending field of learning and trying new things and improving, and so the clinical doctorate really is forcing me to take into account that there is ever-changing evidence out there and to not get stuck in my ways.

Innocent Tumwebaze

P O S T D O C TO R A L R E S E A R C H F E L LO W

We only have close to 10 percent of the 1.5 million residents of Kampala, Uganda, connected to the sewer network. Much of our waste water isn’t sufficiently treated, so the goal of our project is for sanitation stakeholders to implement evidence-based planning processes. We’re trying to take knowledge that’s often only shared in journals and put it into practice—simplifying it, making it more relevant to the people in charge.

C HE C K OUT MO RE P O RTRAITS AT C P H .E X P O S URE .C O CPH.TEMPLE.EDU

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T E M P L E M A D E H E A LT H I E R College of Public Health students work to improve health and wellness on campus (and beyond).

University life throws a lot at a student: the pressure of exams, a greater need for time-management skills, learning to live independently for the first time. Stressors like these can make it difficult for students to thrive. The College of Public Health has several new initiatives aimed at providing support to help students deal with issues like these and to keep Temple’s campus—and the surrounding community—healthier. The college’s newly opened Social Service Annex (SS Annex) was designed as a center where students can simply drop in for informal counseling or advice, a snack or a nap. Students don’t need an appointment, and there’s no paperwork involved. For students facing food insecurity, the SS Annex has a lounge where they can grab coffee or a muffin at no charge, perhaps while running between a job and a class. In a quiet space called the “Zen Den,” where overhead fluorescent bulbs are turned off in favor of gentle string lighting and an oversized floor lamp with a rice-paper shade, students can decompress, meditate or nap. “You can’t do homework in the Zen Den,” says Valarie Clemmons, SS Annex’s founding director. “And you can’t talk on your cell phone.” In addition to informal counseling, the SS Annex offers referrals to support programs available both on and off campus when needed. There’s a dedicated space for discussions that students may want to have in private with social work students who are volunteering or interning. Licensed social workers are also available, but students sometimes find it less intimidating to talk with a peer. “Having peers available to students creates a different energy,” says Oneita DeBrady, a

master of social work student who works in the SS Annex. “It’s not like walking into a clinic or a community program where there might be a stigma. It’s just coming in to talk to people. Many of us who work there have had similar experiences already, so we’re able to share how we handled our challenges.” DeBrady has also helped set up focus groups for students covering life-management issues. In advising students who may have issues with housing, food and financial insecurity, she says she has learned that real assistance often requires more than just handing out a list of resources. “When you connect people with resources, sometimes the resources can fall through,” DeBrady says. “You need to develop a solid action plan with them, so they know exactly what’s next on the list of things to do.” Philip McCallion, director of the School of Social Work, says that while there are great resources available at Temple University for when people are in crisis, “we wanted to do something preventive, to promote selfcare. Dean Siminoff and I both saw challenges mounting for some of our students, and we wanted to help.” The student body’s response has demonstrated the need for such services: The SS Annex opened its doors in January, and by the end of the spring semester, it had connected with approximately 1,200 undergraduate and graduate students.

The “Zen Den” in the Social Service Annex.

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TO B AC C O F R E E T E M P L E For generations, college students have dealt with peer pressure to smoke—and in fact, tobacco is still the leading cause of preventable death in the U.S. Nowadays, marketers are pushing ads to college students promoting vape products as safer and better tasting alternatives. Several studies show that e-cigarette use is rising quickly among high school and college students. New and far less studied than regular cigarettes, these products create nicotine dependence and have caused lethal lung illnesses. In an effort to make Temple’s campus a healthier place for students, faculty, staff and the community, Jennifer Ibrahim, associate dean for academic affairs, secured an American Cancer Society grant to assess tobacco use on campus and research smokefree programs at other schools. She and Dean Laura A. Siminoff assembled and led a task force of faculty members with expertise in tobacco and smoking cessation and brought in student interns to help with research: they observed smoking on campus, surveyed students and employees, and contacted other schools about their smokefree programs. Their task force report found, among other things, that about two-thirds of employees reported being exposed to secondhand smoke on campus, and 87 percent felt it was bad for their health. Student feedback was similar. These findings convinced university leadership to implement a new campuswide tobacco-free policy, which became effective July 1. “Our leadership made a commitment to go tobaccofree, not just smokefree, so that includes vaping,” Ibrahim says. Campus police spotting violations now hand

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out cards, which explain the policy and list resources available to students who need help quitting. “We’re going for compassionate enforcement.” Kristin Chalupa, who earned her bachelor of science in public health in May and is now pursuing her master of public health at Temple, worked as an intern on the tobacco project and is continuing as a research assistant. She helped conduct the campus tobacco-use research that went into the Task Force report, watched the policy proposal work its way through university approvals, and then went to work educating the campus about the new rules, via social media and other avenues. “It definitely has helped me become more confident in my planning and implementation skills,” Chalupa says. “The work to understand the wants and needs of the Temple community—it’s a community-needs assessment. You learn to work with a lot of individuals, and I think that will help me throughout my career.”

Clinical services on campus and beyond Every year, CPH nursing students get hands-on experience administering seasonal flu shots. And when the mumps scare hit last spring, these students were able to work in a truly acute situation, helping faculty members and clinicians to deliver hundreds of free MMR vaccines to Temple students, faculty and staff. Nursing students also pursue clinical work in Temple’s surrounding neighborhoods. As part of the Community Home curriculum, undergraduate nursing students are immersed in a Philadelphia neighborhood health facility or community organization beginning in their sophomore year, in order to experience firsthand what nursing in a community setting is like. “Community Home is focused on relationshipbuilding, trust and understanding that develops over time and in a real-world setting,” says Marti Kubik, professor of nursing. “Balancing undergraduate clinicals between hospital and community settings helps students recognize the value of both and understand the connection between a hospitalization for poor diabetes management and the lack of affordable, healthy food options in the neighborhood, for instance.” Students who study communication sciences and disorders have the opportunity to work at Temple’s SpeechLanguage-Hearing Center, which has been a regional resource for decades, providing a vast range of therapy to clients who range from toddlers to the elderly. The center, located in Weiss Hall, buzzes with activity “almost all the time,” serving 70 to 100 people a week, including students as well as people from the local community, says Beth Levine, director of clinical education and clinical services. Clients include children with language disorders, adults who have suffered strokes and traumatic brain injuries, and individuals with autism. There’s a stuttering clinic

and a program where transgender individuals can get help modifying their voices to match their gender identity. This summer, as part of a research study, a summer camp explored therapies for children with apraxia of speech. It’s a service to the community that also provides invaluable education for students who are learning how to become professionals in the field, preparing them for placements in schools and hospitals. “Without it, they really don’t have the skills to be able to make the most of what’s happening out in the world,” Levine said. On Temple’s Health Sciences Center Campus, physical therapy students staff the pro bono North Broad Physical Therapy Center. They meet a dire community need. Many patients treated at the North Broad facility may be uninsured or may have insurance but can’t afford their copays, says Mary Sinnott, professor of instruction and director of pro bono services in the Department of Health and Rehabilitation Sciences. All the therapy provided by the center is free. “Students completely run the clinic. They do the scheduling, daily operations, outcome measures, community outreach,” says Sinnott, “They learn how to run a business. They’re learning how to behave as professionals.” In this way, the connection between the College of Public Health, the campus community and the local community is symbiotic. The university benefits from an inhouse resource to stay as healthy as it can be. And students attain real-world experience putting interventions— many that they design themselves—into practice. “We’re not just teaching in the classroom. We’re trying to translate it out into the community,” Ibrahim says. “And in doing that, we’re setting the tone for our students to recognize where there is the most need.”

A nursing student administers a flu shot on campus.

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GLOB AL COMMUNIT Y

Q & A with Sheku Sillah

Sheku Sillah.

What first brought you to Philadelphia? When Sheku Sillah started his nursing career, he always hoped to one day return to his home country of Sierra Leone, which—when he left the country at the age of 10—had an average life expectancy around 35. As a doctor of nursing practice student, Sillah fulfilled that dream, traveling to Freetown, Sierra Leone, on a trip to deliver medical supplies and evaluate the state of healthcare in the West African country. Since then, he has returned on multiple occasions alongside other Temple students.

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I was born in Sierra Leone. My father was already living here in the United States, but my parents wanted me to get a basic education in Sierra Leone before we’d come here, in order to learn in our own culture. But then civil war broke out in 1991, and when it reached our city in 1997 we needed to leave—they were killing people, and there were rebels everywhere. So we went to Guinea, and my dad met us there and brought us to the United States. I’ve been living in Philadelphia ever since.

How did you become interested in nursing? My older brother is a nurse and has always been a good mentor for me, so he is one of the reasons. We always wanted to do something in healthcare, because the system where we’re from is one of the worst in the world. When you see what you left behind, you want to gain enough education to go back and help. I see how healthcare facilities in the U.S. compare to thirdworld or developing countries, and there are so many disparities; but, then again, healthcare providers here can also learn from those situations. I would like to help bring students from the U.S. to see healthcare systems in those other countries and gain a different perspective on healthcare, to see something that’s not within the norms of what they see here.

How has your experience been so far? Temple’s DNP program has been really great so far. They work so closely with underserved communities in Philadelphia, and that aligns closely with what I would like to pursue once I graduate. The neighborhood we’re in—it’s very much an impoverished neighborhood. So, I enjoy being at a place like Temple, where you are doing everything you can to help push back against this healthcare disparity.

Where do you envision yourself after you complete your degree? At first, I would like to stay in the U.S., working in an underserved community and mastering my field. But eventually, I want to do something internationally. I’ve been doing a lot of international work now, as a student. I’ve been going back to Sierra Leone; I collect books and medical equipment from hospitals and coworkers and we go back and donate to hospitals, nursing schools and medical schools over there.

What did you learn from that trip? What are some of the challenges facing Sierra Leone? I’ve seen some of the most devastating things that you can see, as far as lack of resources. As a nurse, you are aware of all the resources that you have: you know what you have in your facility and you know what you need. And when you go somewhere that doesn’t have these things, you immediately notice it. I’ll give you an example. We went to a facility in Sierra Leone, and the head nurse told us she has one stethoscope, one blood pressure machine, and she takes it from unit to unit to check patients’ blood pressure. You would never do that here, because cross-contamination is a major issue. There are things that, when you see them, you’re immediately aware that they in no way should be accepted. Healthcare—and I mean just a basic form of healthcare— should be a human right. I’ll continue to do what I can in my own small part to make whatever difference I can make, and hopefully somebody else will pick it up, keep the ball rolling, and eventually the playing field will be more level. I think that if the younger people over there can get the opportunity that we have here—if they have the opportunity to become doctors, to become engineers, to make the changes needed—I think they’ll have the ability to compete on the world stage. Photos courtesy of Sheku Sillah.

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Student returns home to study perceptions of menstrual hygiene When conducting a study in any community, it’s important for researchers to be mindful of that community’s history, language, religious customs and social norms. When conducting research internationally, the need for this understanding becomes even more crucial as the cultural differences expand.

For her research, public health student Tanya Dhingra already has a close understanding of that context: In the summer of 2018, she returned to her home country of India, where she lived before coming to Temple, and examined perceptions of menstrual hygiene and the quality of menstrual education for adolescent girls. Her background has helped her to connect with the participants, she said, which proved crucial for discussions around such a sensitive topic. The project builds on Dhingra’s experience with the nonprofit Child Rights and You, where she organized workshops for adolescent girls in India that provided information on menstruation and menstrual hygiene. After the internship, she became interested in further exploring the topic. Dhingra applied for and received funding through the Diamond Research Scholar Program to continue her work, mentored by Heather Murphy, assistant professor in the Department of Epidemiology and Biostatistics. She conducted the research in New Delhi over the span of 10 weeks. The study focused on a Muslim and Hindu community within the same neighborhood, where she surveyed the quality and prevalence of toilets in schools and homes. Dhingra noted that not all homes in these communities were equipped with latrines, and people sometimes have to walk more than 10 minutes to nearby facilities, which can be dangerous at night. Dhingra also interviewed adolescent girls and their mothers about menstrual health, including their cultural or religious beliefs and experience with sexual health education. She found that females are often treated differently during menstruation: They can be forced to sleep outside of the house, made to only eat food that is cooked separately, forbidden from touching the food of others, and barred from going into temples. Dhingra also examined differences in education between the two communities. In the Muslim community, she learned that girls were provided

textbooks that contain detailed information and descriptions about menstruation, the reproductive system, premenstrual syndrome and consent. Dhingra found that girls attending public schools in the Hindu community, however, were sheltered from these topics and did not discuss menstruation. One of Dhingra’s goals is to foster the belief that periods are a normal part of biology and development of all girls to communities that often do not hold that belief. “I am not going to drive religion out of their lives or make it the bad guy in this situation,” said Dhingra. “I want them to know that this is a biological process ... that it’s a good thing, not a bad thing.” Dhingra hopes her research can lead to positive impacts in the ways that adolescent girls in these communities see menstrual health—and their own bodies. “I feel like I’m just going there as, for many of them, something like an elder sister—somebody who can talk to them, who looks like them, who speaks the same language as them, and genuinely is compassionate and wants them to know that they are whole, full human beings,” she said.

Tanya Dhingra, front, third from left, with community members in New Delhi.

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Students from Vita-Salute San Raffaele University learn principles of recreational therapy at Camp Dynamo.

RECREATIONAL THERAPY WITH AN INTERNATIONAL PERSPECTIVE This summer, recreational therapy (RT) students and faculty traveled to Italy for two new programs: a partnership with Milan’s Vita-Salute San Raffaele University and a study abroad course in Rome. Alexis McKenney, director of the RT program, and Gena Vargas, RT graduate program coordinator, assembled a concentrated twoweek RT course for San Raffaele students, which helped students earn the school’s first-ever master’s degrees in recreational therapy. “These were all professionals coming back to get their master’s in RT. We had physical therapists, occupational therapists. Early childhood education. We had a nurse,” said McKenney. “The students had been taking psychiatry and other classes, but they never had studied recreational therapy. Our role was to hit the whole module of recreational therapy.” The instructors taught the program at a location about 170 miles south of Milan at a recreational camp for children with serious illnesses called Camp Dynamo, a bucolic campus set within a World Wildlife Fund reserve. Students in the master’s program didn’t work directly with the children who were at the camp but were able to use recreational facilities

there to learn about treatments like “adventure therapy” to supplement their classroom lessons. “The San Raffaele students were very interested in the ‘why’ of what we do, the philosophical underpinnings,” said McKenney. “They were very bright and motivated. It was hard to end classes. They were so engaged and interested. We never once talked about a grade. How liberating is that!” Though language was occasionally a barrier, McKenney thinks the program was a big success. “They got it. They wrapped their brains around this idea of how important recreation is in our lives and how useful it can be to help people,” she said. McKenney also taught a study abroad course in Rome that provided an international perspective on living with disability. The streets of Rome became a working classroom for the fourweek course, as students pushed one another in wheelchairs through Italy’s capital, learning how to better understand and care for people with disabilities. They conducted disability simulations like navigating the city wearing goggles that emulated vision impairment and examined the individual, social and environmental structures (family, school, government, community) that can shape the identity of persons with various types of disability. “It’s using the city as our laboratory and classroom,” said McKenney.

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ALUMNI SPOTLIGHT S

Taylor Matsinger.

Joining the ranks Like many physical therapists, Taylor Matsinger ’19 developed an interest in the field after an injury. In her freshman year of high school, she had two knee surgeries—and being in that environment, she says, gave her an appreciation for the restorative power of exercise. “I love helping others, and, as an athlete, I also can’t live without physical activity and exercise,” said Matsinger. “Physical therapy bridges my two greatest passions together, allowing me to impart the joy of recovery that I felt after getting injured myself.” Now, Matsinger is bringing that passion to the U.S. Army as one of a select group of individuals accepted to serve as a “direct accession” Army physical therapist—that is, one who is a civilian or veteran who hasn’t gone through the standard Army-Baylor DPT program, which trains the majority of the military’s physical therapists.

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Matsinger said she’s long had an interest in military physical therapy, but her time at Temple solidified her desire to work for the U.S. Army. As a student, she worked with William Egan, associate professor of instruction in physical therapy, to provide pro bono therapy to ROTC cadets. In addition, she treated patients at a Veterans Affairs hospital in California as part of her clinical fieldwork. Becoming an Army physical therapist includes a rigorous training regimen. Since she was accepted while still a student, Matsinger first needed to pass her licensing exam before commissioning. Then comes Officer Candidate School and Basic Officer Leaders Course for officer training, followed by medical officer training. After completing the trainings, Matsinger will be stationed and begin working. “Physical therapy in the military is different because you’re not only treating patients but are also required to serve as an officer in a chain of command, directing people beneath you—it’s like having two jobs at the same time,” Matsinger said. “The nature of PT practice in the military is also highly specialized, mostly comprising of outpatient and musculoskeletal therapy with a massive emphasis on injury prevention through periodic conditioning and constant training to enhance troop readiness.”

A safe haven for Camden youth In Camden, N.J., 2012 was a difficult year. Notably, the city faced a record number of homicides—69 in total—placing it among the top U.S. cities in terms of murder per capita. At the time, Tim Gallagher ’16 was working at Guadalupe Family Services, a social service agency in North Camden. In his role, Gallagher saw the dangers present for children in the city, both from their often violent environment and their lack of academic opportunity. He and his coworkers started Camden Adolescents Striving for Achievement (CASA), a program that provides help for at-risk youth through counseling, academic tutoring, trauma relief resources and leadership courses to help them attend college and pursue careers in law, medicine and business. “Every kid should know that they’re

worthy of a bright future,” said Gallagher. “No matter where they’re growing up, no matter where they live, no matter what, they should have the same opportunity to succeed.” In CASA’s inaugural class, about 10 students met for an afternoon each week; since then, the class size has grown to more than 100 students meeting five times a week. Students take part in trips and workshops, hear from guest speakers, perform community service, and do other activities that promote academic success or positive social interaction. Since 2012, crime rates in Camden have improved. At CASA, the impact on student success has been staggering. According to Gallagher, 100 percent of CASA participants graduate high school, nearly double the rate in Camden, and all of the students who attend college continue after their first year. To aid in college retention, CASA has also started a group for its graduates to stay connected while in college. One reason for the program’s success is its emphasis on the needs of the community, something Gallagher says was a focus of his social work education. “Everything about Temple was community-focused,” he said. “We were told to get out in the community, do a community study, and make sure that we’re meeting the needs of the community we’re working with. Temple really instilled in me the idea that you should look at what the community needs, not what you’re assuming they need. I’ve taken many of those lessons back to CASA.”

Tim Gallagher plays a game with students from Camden Adolescents Striving for Achievement.

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A lifetime of supporting nurses

David Devereaux. Photo courtesy of Villa Healthcare.

David Devereaux ’86 remembers his first visit to a nursing home. It was in the mid1960s, when he was 4 years old. His mother, a registered nurse, worked the 3-to-11 p.m. shift at a nursing home in Scranton, Pa., and it was the first of many days he spent hanging around the facility. As his mother continued moving up in her career, Devereaux started one of his own. In 1978, he got a job as a housekeeper in a nursing home—and he hasn’t left them since. Devereaux is now chief operating officer at Villa Healthcare, managing more than 20 centers throughout the Midwest. Like in much of the healthcare industry, he has seen technology bring rapid advancements in the way nursing home facilities operate since his first days in the field. However, Devereaux says the biggest change has taken place in the level of care offered by these facilities. When he started, most patients and residents were 65 or older. Now, care has expanded to include young people in need of assistance, and older patients are typically in their 80s. “We take care of people at both ends of the spectrum, the young and the old. The level of service that we have to provide for people is on par with what hospitals delivered back in the ’80s, ’90s, or as recently as 10 years ago,” he says.

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What has stayed constant is Devereaux’s passion for improving the quality of care and achieving excellence in an industry that isn’t always at the forefront of the public consciousness—as well as his admiration for his patients, stemming from his days of listening to stories from veterans of World War I or people whose parents or grandparents were familiar with the Civil War. “You begin to learn history through the stories of other people,” he said. “Whether it’s the people you take care of or the people you work with ... it’s extraordinarily interesting.” Devereaux is a graduate of the Fox School of Business, but his career path led him to develop a strong relationship with the College of Public Health. He served on the Board of Visitors for eight years; he was named chair in 2010 and appointed emeritus status in 2014. As chair, he established the Visionary Research Fund, providing students in the college with opportunities to work together with faculty on research that builds knowledge about the health and well-being of people and their communities. Devereaux’s most lasting legacy in the college, though, is the David R. Devereaux Chair in Nursing, the college’s first privately endowed faculty position, which he established in 2006. Devereaux Chairs include the inaugural recipient, Francis Ward, and Marti Kubik, who was instrumental in implementing the nursing program’s groundbreaking Community Home curriculum and creating the Vaux Community Health Center in North Philadelphia. For Devereaux, it’s a way to honor his mother’s 50-year career in nursing and to support the future of the field he’s been around since he was a child. “Being part of the college’s growth—seeing the incredible students, world-class faculty and leadership, and commitment to the community of North Philadelphia—has been a life-changing experience,” said Devereaux. “The ability to make a gift, to be a part of something that is growing every day, has been a whole lot of fun.”

Solving healthâ€™s complexities for a better tomorrow.

YOUR SUPPOR T IS V ITAL TO OUR S T UDENT Sâ€™ FU T URE S A gift to the College of Public Health provides essential resources for scholarships, student emergency support, new educational technology and more. That means our students will have the tools they need today in order to become the health leaders of tomorrow. To explore your giving options, contact Natasha de Luna, senior associate director of development, at natasha.deluna@temple.edu or 215-204-8624.

Or, make your gift at C P H . T E M P L E . E D U / G I V I NG .