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 2020
Our New Normal How the college took action against an unprecedented pandemic PG 24
Social Work and Social Justice
The role of the social worker in a society seeking change PG 12
The Time for Telehealth
For clinical fields, the switch to online healthcare presents many challenges —and opportunities PG 28
What’s Left Behind
Researchers and activists stand up for a community hurt by harmful substances in the water supply PG 32
The COVID-19 testing site at Temple’s Aramark Student Training and Recreation (STAR) Complex.
DEAN’S NOTE
At this time last year, I had no idea that the United States would soon face the greatest public health crisis in its history. Across the country, we see the same stories repeated. States and municipalities are experiencing record-breaking numbers of new infections from COVID-19. Numbers improve for a few weeks, restrictions are loosened and infections spike again in what software engineer Tomás Pueyo rightly termed as the “hammer and the dance.” Lives are risked in the name of politics, while the social safety net fails to support the millions who have been impacted by the pandemic. Day after day, we are painfully reminded of our healthcare system’s inefficiencies and inequities. Meanwhile, we repeatedly see the effects of centuries of unjust treatment of Black communities in the United States. The deaths of George Floyd and Breonna Taylor, among countless others, and continued institutional violence aimed at Black individuals are deeply disturbing. The impact of racism reaches across all facets of our country, and our healthcare system is no exception. For many, it is a time of uncertainty and fear—and these feelings are entirely justified. But this is also a time where there are opportunities for great change. Now more than ever, our fields are of vital importance: The public health sciences are at the forefront of managing the epidemic, and our social workers and clinical fields are critical to helping the public manage the extreme dislocations this crisis has brought to many. In this magazine, you will learn how the college responded in a time of crisis: how our
Temple Public Health classrooms pivoted to online education and hybrid models (page 26); how we established a contact tracing certificate program that supports the containment efforts of the Commonwealth of Pennsylvania and became one of the leading programs in the nation (page 27); how our researchers quickly began studies to help us better understand COVID19’s spread (page 27); how our students and faculty volunteered on the front lines (page 24); and how our generous community of donors rallied to support students affected by the pandemic’s financial impact (page 37). Perhaps even more impressive are the ways in which our college continued its work addressing myriad other health challenges, many of which have only been exacerbated by the pandemic. Over the past year, our faculty have been working hand-in-hand with community organizers to examine the prevalence and effects of harmful substances in our drinking water (page 32); shaping the future of telehealth (page 28); and rethinking our role in combating racial injustice (page 12). Each year, as I reflect on the work of our college, I am filled with pride. But after such a trying year—one that has stripped bare the many structural weaknesses in our healthcare system—I am particularly honored to have the privilege of serving as dean. Our students have shown incredible resilience in their ability to adapt to this unprecedented situation, and our faculty have responded with flexibility and compassion. With this next generation of health leaders, we are in good hands. As we adjust to this new normal, I urge us all to remain vigilant and continue practicing the four pillars of public health: wearing masks, social distancing, hand washing and health monitoring. As public health institutions, it is our duty to serve as a model for our students and our communities. The decisions we make over the coming months must be weighted in the interests of safety and health above all else.
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 AGER
Abby Musial ASSI STAN T E D I TO R
Caitlin McHale PHOTO GR APHE R
Andrew Thayer WR I T E R
Don Steinberg C HI E F D E VE LO P M E NT O F F I C E R
Natasha de Luna natasha.deluna@temple.edu B OAR D O F VI SI TO R S
Mary E. Ammon, MSW Christopher M. Barnett, JD David R. Devereaux, MBA** Barbara B. Ernico, MEd Thomas Gordon, MBA Lovell Harmon, MS, MBA Veronica Hill-Milbourne, BSN, MS, JD* John J. Kirby, OTR, MBA Doranne Lackman, PT Brian W. Lindberg, BSW, MMH Barbara P. Mastriano, PhD Ravi Rajan, MD R. Christopher Raphaely, Esq. Ellen Schwartz, MA Matthew Shelak, MBA Pamela Tyranski, BSN, MBA Susan Wayne, MSW * Chair ** Emeritus
Contact us
In good health,
Bell Building (Tech Center), 3rd Floor 1101 W. Montgomery Ave. Philadelphia, PA 19122 215-204-5200
Laura A. Siminoff Dean Laura H. Carnell Professor of Public Health
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S TAT E O F R E S E A R C H The research programs in our college are remarkably diverse. While some of our faculty and students use large data sets to look at the prevention and treatment of disease, most of the college’s research involves in-person contact with individuals, families and groups. When the coronavirus pandemic hit, our faculty and students were forced to quickly figure out how to continue their work while dealing with stay-at-home orders, social distancing, mask wearing and a campus that is largely studentfree, as well as personal responsibilities related to child and elder care, home schooling and supporting family-run businesses. Though there has been a great deal of talk in academic circles worldwide about how the coronavirus pandemic has impacted research productivity, I’m thrilled to share that our college has not missed a beat: From March through August, our researchers submitted approximately 10 percent more grant applications for extramural funding as compared to the same period in 2019. Some successes are particularly noteworthy. Drs. Sarah Bass and Heather Gardiner (Social and Behavioral Sciences) and Dr. Elizabeth Pfeiffer (Health and Rehabilitation Sciences) received additional research funding to explore how COVID-19 has impacted their areas of interest. Dr. Pfeiffer also was among the many students and faculty who contributed their time and effort to support those affected by COVID-19 (page 24). As a college, we have used our expertise to educate the public about the pandemic. Dean Siminoff was joined by Drs. Bass (Social and Behavioral Sciences), Graciela Jaschek, Krys Johnson and Heather Murphy (Epidemiology and Biostatistics) on a series of webinars updating viewers about the pandemic. Our faculty also became regular contributors to local and national news outlets, sharing their knowledge with the general public. Other members of the faculty published papers about the role of mask wearing and social distancing. Several of these projects are highlighted in the pages that follow. Despite the challenges we faced, it has been an eventful year for the college. With the exceptional work of the college’s IT team, we hosted over 120 student-led projects via Zoom for our Research and Evidence-based Practice Day. That same week, we published the first issue of CommonHealth, the college’s new e-journal, led by an editorial board of faculty and graduate students, as well as the exceptional work of Managing Editor Jacque Spitzer. In addition, our early career faculty continued to enjoy great success, as Drs. Krista Schroeder (Nursing), Brittany Schuler (Social Work) and Gabriel Tajeu (Health Services Administration and Policy) all received early career development awards from the National Institutes of Health. These accomplishments strengthen the foundation of our entire research enterprise and serve as morale boosters in a time when we all need some good news. I celebrated the end of my fifth year as associate dean for research in September. One of my favorite parts of my role is learning about the incredible diversity of exceptional work that is done by our faculty and students. I admire their drive and passion for producing high-quality scholarship to improve the lives of the citizens in our region and around the world. I could not be more proud to call them colleagues and share their accomplishments of the past year with you. David B. Sarwer Associate Dean for Research Professor, Department of Social and Behavioral Sciences Director, Center for Obesity Research and Education
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Contents 4 College News Updates from the College of Public Health
8 Solutions Grants and new projects
12 Social Work and Social Justice The role of the social worker in a society seeking change
14 Impact Publications and findings
20 Global Reach News from around the world
24 Our New Normal How the college took action against an unprecedented pandemic
28 The Time for Telehealth
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For clinical fields, the switch to online healthcare presents many challenges—and opportunities
32 What’s Left Behind Researchers and activists stand up for a community hurt by harmful substances in the water supply
36 Alumni News Highlights from our graduates
38 The Final Word
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Q&A with Judy Faulkner, CEO of Epic
TempleCPH temple_cph TempleCPH
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IN THE NEWS “As a researcher and a scientist, I’m driven by evidence, and so it is disappointing to see that science is sometimes being disregarded.” Resa M. Jones, chair of the Department of Epidemiology and Biostatistics, on the role politics has played in the government’s response to COVID-19. KYW Newsradio
“While these long-term effects have not yet been studied, there is plenty of evidence that indicates that vaping is not safe.” Laura A. Siminoff, dean of the College of Public Health, and Bradley Collins, professor of social and behavioral sciences, in an op-ed calling for a ban on vaping products. The Philadelphia Inquirer
“...simply drinking water to ‘rinse’ your digestive tract will not prevent you from being infected or from getting sick.” Krys Johnson, assistant professor of instruction in the Department of Epidemiology and Biostatistics, debunking myths about COVID-19 shared on social media. Factcheck.org
“For people who might be self-conscious or concerned about how they look in a mask when they go in the public, we now have evidence that says, in reality, people are going to see you as more attractive.” David Sarwer, associate dean for research, on his study finding that wearing a mask made people more attractive to observers. (Read more on page 27.) CBS3
“What’s happening in the surrounding community impacts the level of risk in the school.” Aimee Palumbo, assistant professor of instruction in the Department of Epidemiology and Biostatistics, on safely navigating social interactions as some children return to in-person schooling. The Philadelphia Inquirer
“This is a precarious time for higher education, and science-based solutions are needed.” Jeni Stolow, assistant professor of instruction in the Department of Social and Behavioral Sciences, in an op-ed arguing that universities shouldn’t rely on student contracts to keep campuses safe from COVID-19. Inside Higher Ed
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COLLEGE NE WS
MY LENS PROJECT SHARES STORIES ABOUT THE OPIOID CRISIS
College publishes first issue of ‘CommonHealth’ In April, the College of Public Health published the inaugural issue of CommonHealth, a new academic journal presenting peerreviewed articles from both the Temple University community and outside contributors. The premiere issue included articles from faculty in the Departments of Social and Behavioral Sciences, Kinesiology, and Health and Rehabilitation Sciences. “CommonHealth has tremendous potential to highlight the research and scholarship of our students and faculty not only to our on-campus community, but also to our alumni as well as the citizens of the region and our public health colleagues around the country and world,” said David B. Sarwer, associate dean for research. The journal is managed by the college’s graduate students, who take on all aspects of production, from soliciting and editing articles to publication and promotion. Molly Beiting, a PhD candidate in the Department of Communication Sciences and Disorders, and Hamlet Gasoyan, a PhD candidate in the Department of Health Services Administration and Policy, serve as co-editors-in-chief. “Health-focused research is critical to improving the health and well-being of Americans and key to improving the U.S. healthcare system and, importantly, the public health infrastructure,” said Laura A. Siminoff, dean of the College of Public Health. Authors from Temple University and the public health community at large are invited to submit original research, research commentary, clinical innovation and practice, teaching innovation and practice, community connection articles and multimedia for consideration.
The College of Public Health has launched an opioid education program funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency of the U.S. Department of Health and Human Services. Deirdre Dingman, assistant professor of social and behavioral sciences, and Marsha Zibalese-Crawford, associate professor of social work, have been working with faculty, staff and students on My Lens, a project that aims to reduce stigma associated with substance use and encourage better care. My Lens began with on-campus presentations. Attendees were shown how to recognize overdose symptoms and administer the overdose reversal medication Narcan (naloxone). The project also included an inventory of treatment and recovery resources available to students, including Tuttleman Counseling Services. An upcoming third component, Art for Change, will recruit students to create artwork that expresses their experiences with the opioid epidemic. “The number one underlying goal for all of this is reducing the stigma associated with substance use,” Dingman says. “The words we use to describe people who have a substance use disorder can be stigmatizing and keep people from reaching out for treatment.”
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MLK DAY TEACH-IN TO EXPLORE INTERSECTION OF RACE, POVERTY AND POLICY
Contact tracing certificate supports local efforts against COVID-19 The College of Public Health quickly responded to the need for contact tracers by launching a selfguided certificate course early this summer. Using a curriculum developed by Temple faculty and materials from the Centers for Disease Control and Prevention, the course covers all aspects of contact tracing, from understanding COVID transmission and testing to skills needed in making effective telephone calls. The course is open to anyone with an interest in contact tracing, from entry-level community volunteers to trained public health professionals, epidemiologists and healthcare providers. After completing this program, participants will be able to transition into the jurisdiction-specific protocol training required by local/state public health departments and call contacts. Those interested in enrolling in the course can sign up at cph.temple.edu/contact-tracing. Read more about the contact tracing course and the college’s response to the pandemic on page 24.
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The College of Public Health has received a grant from the Council on Social Work Education (CSWE) to facilitate a collegewide “teach-in” event on Martin Luther King Jr. Day in 2021. Faculty, staff, students and community members will be invited for discussions that focus on policy-level interventions that address the effects of the intersection of race and poverty. The grant also funds development of a webpage focused on these issues with corresponding resources and information. An interdisciplinary team of people representing social work, public health, athletic training, epidemiology and biostatistics, nursing, kinesiology, pharmacy, communication sciences and disorders, and health and rehabilitation sciences will collectively build a program for the day, including potential guest speakers and desired webpage content, concentrating on ways that social workers and public health professionals can influence and understand the social policies that affect their work. The CSWE’s overall goal in the grant program is to promote policy-level interventions to address the significant and growing inequality in the United States. “Our entire college focuses on how to protect and improve the health of the population. This is about being more upstream,” explained Jennifer Ibrahim, associate dean for academic affairs and associate professor in the Department of Health Services Administration and Policy. “So instead of having individuals focus on the patients before them, this is getting folks to be empowered to think about the policies that are driving things like structural racism and structural sexism. How can we help to address those issues? In disciplines like social work and public health, this is more second nature to them. But it’s a really nice opportunity for those students and faculty to help bring along other faculty in our college.” Social workers, nurses, athletic trainers, physical therapists, speech therapists and other public health professionals on the front lines see the effects of larger policies on individual lives, such as lack of health insurance, access to healthy food or jobs that pay a living wage. This event aims to bring the college’s professions together to discuss how these experiences can be used to communicate the need for structural changes. The relationships developed during the teach-in will inform the college’s participation in Social Work Month (March), National Public Health Week (April) and the co-hosting of Campaign School for Social Workers in Philadelphia in 2021. More information will be available on the college website as the event approaches.
Welcoming new chairs and senior leadership The College of Public Health has added new senior leadership to its faculty, welcoming new chairs in the Department of Kinesiology and Department of Health Services Administration and Policy, as well as an associate dean for clinical affairs and interprofessional education, a position new to the college. “We are tremendously fortunate to have attracted a stellar group of new colleagues who are joining us this summer and fall,” said Laura A. Siminoff, dean of the College of Public Health. Susan VonNessen-Scanlin, associate dean for clinical affairs and interprofessional education: VonNessen-Scanlin brings more than 30 years of experience in healthcare, having served at premier academic medical centers and children’s hospitals overseeing transformation initiatives, population health programs and other efforts to improve operations and patient care. She is a nationally certified pediatric nurse practitioner who has spent much of her clinical career caring for children with lung disease, such as urban asthma. Huanmei Wu, chair of health services administration and policy and assistant dean for global engagement: Wu has extensive experience in faculty and student recruitment and academic program development and an accomplished history as a bioinformatics researcher. Wu’s focus has been on translating heterogeneous data into intelligence for improved healthcare and creative clinical applications through data management, integration, analysis, modeling and prediction. Mark Stoutenberg, chair of kinesiology: An exercise physiologist, Stoutenberg joins Temple from the University of Tennessee at Chattanooga, where he was the inaugural director of an MPH program focused on chronic disease prevention and control. While at UTC, he helped launch a campuswide program to connect students, staff and faculty efforts with community organizations. His research has expanded from a focus on exercise to an implementation of science frameworks.
COLLEGE MAKES AN IMPACT AT 2019 APHA ANNUAL MEETING
The American Public Health Association (APHA) held its annual meeting in Philadelphia last fall, and the College of Public Health impressed attendees with a substantial presence. Visitors were welcomed to Philadelphia at a College of Public Health-sponsored reception at Reading Terminal Market, faculty and students took part in more than 40 presentations throughout the conference, and the college took home the blue ribbon for “Best Booth.” Sessions included a presentation on Temple’s transition to a tobacco-free university by Jennifer Ibrahim, associate dean for academic affairs, and students Cassidy Tarullo, Courtney Cunningham, Kirstin Chalupa, Pharah Morgan and Tirzah Sheppard. From the Center for Obesity Research and Education (CORE), Associate Dean for Research David Sarwer and faculty members Gina Tripicchio and Jennifer Orlet Fisher shared findings about nutrition, obesity and oral health from their collaborations with the Kornberg School of Dentistry. Bradley Collins and Stephen Lepore from the Department of Social and Behavioral Sciences shared their findings on smoking cessation interventions and efforts to keep children free from secondhand tobacco smoke. Members of Temple’s Collaborative on Community Inclusion delivered presentations on the role of community participation in the health of adults with serious mental illness, and Beth Pfeiffer, who has extensive work in transportation access for individuals on the autism spectrum, described a travel training program for individuals with intellectual disabilities. Doctoral fellow and PhD student Hamlet Gasoyan was awarded for his presentation on the “Impact of Insurance Plan Design on Bariatric Surgery Utilization.”
Grad programs soar in U.S. News & World Report Three College of Public Health programs climbed the rankings in the 2021 Best Graduate Schools rankings published by U.S. News & World Report. The Speech, Language and Hearing Science program ranked 25th, in the top 10 percent of programs in the nation. The Occupational Therapy program climbed to 23rd and is among the top 15 percent of programs nationwide. The Doctor of Physical Therapy program climbed 15 places to rank 38th in the nation. Programs are scored based on peer assessment surveys sent to deans, other administrators and faculty members at accredited degree programs and schools.
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SOLUTIONS
Nurturing better nutrition Jennifer Orlet Fisher, professor of social and behavioral sciences, will develop scientific guidelines to encourage healthy eating behaviors for children as co-chair of the national Healthy Eating Research (HER) panel, a program of the Robert Wood Johnson Foundation. Combating childhood obesity is an objective of the HER panel, “but our primary goal is to focus on what we know about developing healthy eating behaviors,” said Fisher, who has researched family contributions to the development of children’s eating behaviors as director of the Family Eating Laboratory at Temple’s Center for Obesity Research and Education. “In contrast to dietary guidelines, which focus on food and nutrient intakes, these guidelines will focus on the ‘how-tos’ of feeding children to promote healthy behaviors,” Fisher said. “Parents have an idea of what a healthy diet looks like, but how do you nurture those habits? How do you get kids to eat vegetables? And like vegetables?” The HER panel will pull together the growing body of literature on children’s eating behaviors to develop evidence-based technical recommendations for Jennifer Orlet Fisher. children ages 2 to 8, which the foundation hopes to publish in early 2021. “The research we’re looking at is akin to nutritional psychology,” Fisher explained. For example, what is the impact of pressuring children to eat certain foods versus letting children make their own choices? The panel will explore ways to educate parents about feeding strategies, including recommendations for setting up healthy home food environments across socioeconomic levels. “One thing that’s important for food acceptance is to give kids repeated experiences with new foods— and it can take anywhere from five to 15 exposures for kids to accept a new food. One of the panelists brought up the important point that for families with low resources and those who experience food insecurity, it is going to be a challenge to watch food go to waste if kids are not quite there accepting a new food. These kinds of conversations are critical from moving from the science to recommendations that are useful to parents.”
IMPROVING DATA COLLECTION THROUGH MOBILE TECHNOLOGY
Are there better ways to evaluate how prescribed therapies are working while patients are living their everyday lives, when doctors aren’t there to check? New answers may come from the digital devices we carry and wear, says Donna Coffman, a biostatistician in the College of Public Health. Coffman is leading a National Cancer Institute-funded study of smoking cessation treatments as a way to develop models that could help researchers improve patient responses to all sorts of ongoing therapies, from managing addictive behaviors to compliance with medication-taking. “We now have all these devices, from mobile phones to wearables, and they can collect a lot of data,” she says. “In the old days, you’d say to a smoker who’s trying to quit, ‘how have your withdrawal symptoms been over the last six months?’ Now you can send little surveys
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multiple times per day. That allows us to look at very fine-grain associations between, for example, withdrawal symptoms and relapse.” It’s called ecological momentary assessment (EMA), which measures how people are doing (the assessment) at points in time (the momentary) while they are out in the world (the ecological). By providing real-time glimpses of patient behavior and feelings, EMA can help researchers and clinicians understand how medicine and other treatments are working. That can foster development of new therapies, interventions and modifications of ongoing treatments, like sending a message to someone’s phone in moments when they are likely to relapse. It falls on biostatisticians like Coffman to create mathematical models to help researchers work with this new flood of data, using it to establish meaningful associations
and develop responses. In her smoking cessation study, patients trying to quit were given either nicotine patches, the medication varenicline (brand name Chantix) or a combination therapy including the patch plus optional nicotine lozenges. Each participant was sent a mini-questionnaire at three different moments during the day, asking them to rate the level of their cravings and mood and indicate whether they had smoked or been exposed to triggers like drinking alcohol. The frequent digital check-ins enable analysis of not only each treatment’s effectiveness but also how its effectiveness changes over time. Other wearable devices such as heart rate monitors and pedometers could increasingly become part of data gathering in consenting patients to make health interventions more timely and effective, Coffman says.
Exploring the link between adversity and obesity Obesity is an American epidemic, affecting approximately 40 percent of U.S. adults and 18.5 percent of children and adolescents. It is linked to health conditions including heart disease, stroke, Type 2 diabetes and certain types of cancer, some of the leading causes of preventable, premature death. Studies have established that a mix of risk factors, including heredity and environment, can influence weight status, and obesity’s prevalence is higher in certain low income populations. But there’s more to learn about the role of environmental factors, including adverse childhood experiences (ACEs), on obesity-linked health issues. A new study from Brittany Schuler, assistant professor in the School of Social Work, will explore how different types of childhood adversity connect to these risks. The results could provide a foundation for more specific interventions to promote child and long-term health. “We hope to dive deeper into this area around early childhood experiences that may play a role in the development of longer-term chronic illness,” Schuler said. “We know connections exist, but we don’t really know how to intervene yet, and we don’t know a whole lot about the mechanisms between them. So this is starting to piece together that part of the puzzle.” The multiyear study, funded by the National Institute on Minority Health and Health Disparities, will work with a North Philadelphia office of the Supplemental Nutrition Program for Women, Infants and Children (WIC) as its community partner. Through focus group conversations, the study will gather information about family experiences with adversity when children are very young, before age 3, as well as information about the quality of children’s diets and trends in their body mass index (BMI) as they move into mid- and late-childhood (ages 5 to 9). The mixed methods study also will incorporate a national data set representative of high-risk families. Expanding the way adversity is conceptualized and measured is an essential step in understanding how each dimension of adversity may differently predict poor diet quality and obesity risk among high-risk populations, Schuler said. This study may tease out whether traditionally defined forms of adversity (unexpected events that harm or threaten to harm child well-being such as maltreatment and violence exposure) differ from or worsen the effects of situations like deprivation, poverty or food insecurity.
“There are a lot of ways to experience adversity,” which is disproportionately prevalent among lowincome populations, Schuler explained. “It could come from exposure to trauma or violence. It can come from severe economic hardship or from racial or ethnic injustice. And depending on the support you have in your environment, depending on the other risk factors, depending on you as a person, that can mean many different things. The idea of this project is to dissect that a little bit and look at different dimensions of adversity that may affect obesity-related health outcomes.” Understanding more about these dimensions can inform future pediatric obesity interventions for those disproportionately exposed to adverse environments, Schuler said. Her focus as a social worker has been on exploring sustainable behavioral interventions that reduce early-life nutritional disparities and prevent subsequent chronic illness in high-risk communities. If environmental factors contributing to obesity risk can be identified, she said, “we could start plugging into prevention interventions, to sort of nip this in the bud before risks of excess weight and chronic illness set in.”
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What makes the perfect swear word? The way we might impulsively blurt out a profanity, in response to anger or surprise or hitting a thumb with a hammer, suggests curse words might have a special place in our brains, accessed a little bit differently than ordinary language.
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The study of taboo words has been a little bit taboo itself. But there is legitimate academic and health rationale for studying profane language, says Professor Jamie Reilly, who directs the Concepts and Cognition Lab in the College of Public Health. “I’ve seen lots of patients clinically who curse after they’ve had brain injuries,” Reilly says. “It just kind of comes out, and they really don’t want it to come out. Often they’ll say something harsh and then start crying and apologizing. There’s no treatment for it.” So Reilly and his team have been conducting serious research on explicit language. With “Building the perfect curse word: A psycholinguistic investigation of the form and meaning of taboo words,” published in Psychonomic Bulletin & Review, Reilly’s team has produced an R-rated report containing language too explicit to be spoken on network television, at least without frequent bleeps. They also have pioneered research in the emergent phenomenon of compound swear words, which creatively connect time-tested profanities with inoffensive words (-bucket, -wad, -monkey) to create noveland sometimes amusing expletives. Their goal is to better understand how our minds process bad words, as a step toward helping people control unwanted behavior. There’s much that researchers still don’t know. “It seems like cursing language may be coded differently by the brain,” says Peter Twigg, a graduate student and research technician in the lab. “You see
in traumatic brain injury or aphasia, people may have these outbursts of cursing language that is preserved, while other parts of their vocabularies are lost.” Are curse words stored in a way that lets them emerge like involuntary knee-jerk reactions? Does inappropriate language have the same “stop switch” that motor behaviors have, such as reacting with violence? It’s probably not the same for all brain disorders. “In traumatic brain injury, there may be little difference between a punch and a curse,” Reilly says. “Whereas stroke patients aren’t going to punch you, but maybe they can’t stop cursing.” Reilly’s research team began with psycholinguistics: what characteristics of a word make us think it’s bad? Building from existing lists of taboo American English words and adding others—1,194 in all, including non-offensive control words—his team of grad students and research technicians first graded words based on their meanings and sounds. Did the words describe bodily parts or functions? Were they male- or female-oriented? They obtained “valence” (whether a word connotes a positive or negative idea) and “arousal” (“how much of a jolt it gives you”) ratings for the words from existing psycholinguistic databases. They scored word lengths to investigate whether the “four-letter word” aphorism holds up. They rated words on concentration of stop consonants (t, d, b, p, g and k), which sound more blunt. These factors all were potential “predictors of tabooness.” They enlisted 190 participants to rate each word on how taboo it seemed. Then, the researchers correlated the tabooness ratings with the word characteristics. Analysis revealed that words with high arousal and negative valence scored high on the taboo-meter. Other predictors of tabooness were gender-specificity, body parts and body acts. The lone, purely linguistic element predicting tabooness was obstruence, the presence of consonants. Word length seemed irrelevant; the old “four-letter-word” idea collapsed, in part because the test included longer, compound bad words. What makes one common noun a better swear word sweetener than another? “You’ll hear things like ‘ass clown,’ which works as an insult. But something like ‘ass sink’ doesn’t,” says Alexandra Kelly, a research technician on the team. Some neo-profanities concatenate a known swear word with a trochee, a two-syllable word that stresses the first syllable (blank-blanker). But short words with potentially organic interpretations also seem to work (-sack, -rod, -stick). Receptacles appeared to be effective. “If you can put something in something, people think that’s a good compound, like -hat, -hole, -bucket,” Reilly explains.
The researchers categorized the meanings and phonetic characteristics of about 500 common nouns. They eliminated words already used in well-known profanities (e.g., -hat, -hole) in favor of neutral words like balloon, baby and tool. Outside participants then rated how effectively they felt each of the words might combine into a taboo curse word. Shorter words with more stop consonants emerged as the best candidates for compound cuss-word creation, including -sack, -trash, -pig, -rod and -mouth. Can this off-color research really lead to medical advances? “For people who experience debilitating social consequences of uncontrolled taboo word usage, algorithmic prediction of tabooness may hold promise for tailoring intervention,” according to Reilly’s paper. Reilly and colleagues are investigating cursing behaviors in various neurological disorders. The brain appears to have a complex set of “brakes” that stop us from executing imagined thoughts or movements. When these brakes are damaged, uncontrolled cursing can sometimes result, he says. Members of the lab are investigating whether the application of a low voltage current placed over the scalp can help people to reduce cursing behaviors. As for the promise of “Building the perfect curse word,” Reilly’s lab has yet to devise a formula for generating the ultimate profanity. The regression analyses that his team performed can help predict whether a given word might be considered taboo, but there’s no algorithm yet for creating the golden cuss. Though Reilly admits he has some personal favorites.
Jamie Reilly.
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Ashley Stewart.
Social Work and Social Justice
“Every day I’m waking up to new opportunities to have conversations that I would have had to pry doors open to have before.”
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For Ashley Stewart, assistant professor of instruction and MSW online program coordinator in the School of Social Work, the profession of social work is in a moment of unprecedented opportunity. She teaches and writes about issues such as race-based traumatic stress and identity-based oppression, and she tells her students that social work is all about social change. The upheavals over equal justice that the nation has been experiencing this year have brought to the forefront conversations about long-standing, racially oppressive social structures and institutions. Social work can be part of that change and must adapt to the need for new perspectives, says Stewart. She feels that the pandemic has played a role in society’s readiness for change—its norm-altering effect has spurred people to rethink societal conventions, the institutions where they work, the value of fellow citizens and their own abilities to make a difference. We spoke with her about how social work can engage in these conversations and the challenges ahead.
How does the current moment lend itself to change in a way that might not have been possible before?
Whether it’s with the individual or with the system, one of our roles is to find the strength or the avenues for change, so that the need for a social worker is no longer present.
Ashley Stewart: We’ve experienced issues around racism before. It’s nothing new. Now every day I’m waking up to new opportunities to have conversations that I would have had to pry doors open to have before. I am receiving requests to talk about issues that were once very difficult to bring up. And not just talk about it, but how do we move past the way we have typically responded? We’re really talking about culture shift now and no longer talking about just information.
How can social work itself adapt in this moment?
That change in mindset and action has flowed from the sustained protests over George Floyd and Breonna Taylor, but you think the pandemic also has contributed to this moment? AS: It is unique that we are experiencing this pandemic at the same time that there’s this upsurge in engagement and activism. People have been protesting, marching and engaging in activism for decades. Something has happened that I feel is different. With people not being able to navigate through life the same way as usual, many are seeing the world in a new way. The issues are harder to minimize and dissociate from. I don’t want to attribute people’s involvement merely to not having anything else to do. However, I believe the numbers we have seen in protests in part are because people have been actually sitting with the realities of racism, maybe for one of the first times in their lives, and felt really compelled to do something.
How do you regard social work as social change? It can be hard enough for social workers to help people manage day to day. AS: It’s social change to be mindful of and honor the intricacies of people’s lived realities, to unapologetically commit to social justice. So that families can be reunified, so that children can be placed safely, so that individuals can have healthy coping mechanisms to deal with their past traumas. Social workers may highlight people’s strengths, support the family, and get them adequate resources, so they can be supported when the practitioner leaves. That’s change.
AS: Social workers can apply anti-oppressive and traumainformed practices to all areas of the profession. In a clinical environment, or in community-based and advocacy initiatives, understanding intersecting layers of oppression within people’s lives can transform the ways we show up and provide support. In order to address issues, we must first acknowledge them. We have an opportunity to support healing in profoundly new ways. It starts with realizing that folks aren’t needing us to speak for them, instead acknowledging that folks aren’t being listened to and asking the critical question of ‘why?’ and getting to the root of the systemic issues suppressing liberation.
What might be a real-world example of that? AS: For example, a social work practitioner could be providing one-on-one counseling or helping someone through a particular issue. That person could say “I feel like people are always following me and looking at me. I feel really self-conscious.” They’re describing experiences that might align with anxiety or some aspects of hypervigilance. A clinician who hasn’t assessed bias—say this person is a person of color—might try to deal with the anxiety, address the “perception” that people are following you. But some folks really are being hyper-surveilled in their communities or when they’re out shopping. That might be actual. So we can create the space to talk all we want, but you want to have that critical awareness to say, “This might not just be an irrational thought. This is rooted in facts and experiences.” And then you can begin to talk with the person about the particular stresses that climate may create for them.
There is a role for bigger-picture work like advocating for policy shift, organizational structural change, community organizing. Within our code of ethics, a value is social justice. Within our ethical principles is the value of service. And within all of our core competencies as a profession, engagement with social systems to create systemic structural change has always been part of the profession.
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Vaccine marketing mischaracterized the risks of HPV
When it hit the market in 2006, the vaccine against human papillomavirus was marketed to parents of girls as a way to prevent cervical cancer. But the marketing ignored a population of people who could benefit from it: boys and men, particularly gay men, who are at risk of other preventable types of cancer that HPV can lead to, such as penile, anal and oral cancers. In fact, around 38 percent of diagnosed cancers attributable to HPV occurred in males, according to the CDC. In a study published in Vaccine, Christopher Wheldon, assistant professor of social and behavioral sciences, dug into national health survey data to quantify HPV vaccine awareness among American adults ages 27 to 45. Among his findings: most adults who were aware of HPV didn’t know it could cause cancers other than cervical cancer. “We have a vaccine that can protect against these other cancers, but most people still think it’s just a cervical cancer vaccine,” says Wheldon, whose research focuses on cancer education and care for underserved and vulnerable populations. For years, girl-centered marketing for the vaccine skirted around an uncomfortable yet important fact: HPV spreads as the most common sexually transmitted infection. “Parents were very uncomfortable with the idea of vaccinating their kids against an STI. So what they did instead was frame it as a cervical cancer prevention,” Wheldon explains. Recent advertising for Gardasil 9, a new version of the vaccine protecting against nine types of HPV, features boys as well as girls. Still, Wheldon’s work suggests that underserved populations can be left behind medically by marketing decisions. “For gay and bisexual men, I think that’s really important,” he says. “They’re not going to get cervical cancer, but they’re much more likely to get anal cancer, and for the most part they’re not aware there’s a vaccine that can actually prevent the majority of cases of it.”
Caregivers who spend a significant amount of time caring for family members who are elderly, ill or living with disability often neglect their own health. And although it’s been demonstrated that regular exercise can improve health and relieve stress, depression and fatigue, caregivers often don’t take time to keep themselves fit. “Caregivers may feel guilty about going out, and that can increase their stress,” says Daniel Rosney, assistant professor of instruction in kinesiology. He has been researching exercise, using home video game systems, as a way to keep caregivers healthy. (This fall, he is exploring other approaches to caregiver health as guest editor of “Caring for Caregivers During the COVID-19 Pandemic,” an upcoming special issue of the Journal of Primary Care & Community Health.) He feels the gaming approach to fitness could be especially beneficial to caregivers who provide demanding in-home care to patients with dementia. These caregivers experience high stress and elevated rates of morbidity and mortality. “I thought, if this can be used in a clinical setting, and caregivers are growing in numbers as baby boomers age and need to be cared for, this could be helpful for family caregivers as well,” says Rosney. He and a co-researcher recruited a group of sedentary adults and tested them for balance, endurance and cardiovascular fitness before and after an eight-week regimen of activities using a “virtual personal trainer” using Wii Fit training software for the Nintendo Wii. The group showed improvement in cardiovascular endurance, balance and lower extremity functional fitness over that period. Throughout testing, participants also completed surveys to self-report their feelings of stress and burden. And their levels of cortisol production, a biomarker of stress, were measured via saliva and hair samples. Analysis showed that the exercise gaming regimen helped in these stress measures, suggesting the intervention could be helpful to stressed caregivers who find it hard to make time for themselves.
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Exercise video games may reduce caregivers’ stress
Black adults under 65 twice as likely to die from cardiovascular disease
Black adults under age 65 have more than twice the risk of dying from cardiovascular disease (CVD) as white adults under 65, according to a new study led by Gabriel Tajeu, assistant professor of health services administration and policy. In a study published in the May 2020 issue of the American Journal of Public Health, Tajeu and the research team found that socioeconomic status and cardiovascular disease risk factor differences between Black and white adults overwhelmingly account for the disparity. “We know that race is associated with an increased risk of cardiovascular disease, but very little of the difference in health outcomes between white and Black adults can be attributed to genetic factors,” says Tajeu. Race, he writes, citing Harvard sociologist David Williams, is a social construct more than a biological category. He worked with co-authors from Weill Cornell Medical College and the University of Alabama at Birmingham, whose multiyear Reasons for Geographic and Racial Differences in Strokes (REGARDS) study provided the core data for the research. That study, which was national but focused on stroke incidence in the southeastern U.S., collected information from more than 30,000 participants on health factors including cholesterol, body mass index, diabetes, cigarette smoking, depression, stress and medication use, as well as demographics such as race, sex, education, income and health insurance status. “We compared Blacks and whites who live in the same geographical region—not necessarily in the same circumstances—who are the same sex and same age. And that’s when we observed that the risk of CVD mortality was over twice as high for Blacks, compared to whites, who are younger than 65,” Tajeu says.
When the authors compared Black and white participants with similar socioeconomic status and health risk factors, the disparity in CVD mortality almost disappeared. Data analysis revealed the disparity was largely due to differing socioeconomic status of Black and white participants. According to Tajeu, the findings build on a model from Williams, who suggested that historical, political and legal structures in the U.S. have led to racial differences in socioeconomic status. “In the Williams model, lower socioeconomic status leads to things like limited health insurance and disruption of the nuclear family. Those lead to underlying clinical risk factors like hypertension, which lead ultimately to disparities in health outcomes like heart attacks and strokes,” Tajeu explains. “The findings of our study provide more evidence of the power of the Williams model to conceptualize health disparities.” The study’s findings also point to immediate and longer-term needs, Tajeu concludes. “In the short and medium term, preventing the development of cardiovascular disease risk factors equitably is necessary,” he says. “We need to make sure there are targeted interventions for cardiovascular disease risk factors, focusing on prevention and treatment. Longer term, in the ideal scenario, the social determinants of health would be the same between Blacks and whites. That’s what we should strive for. It’s the most critical long-term intervention that federal policymakers can engage in.”
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Thomas helps develop substance use interventions for those with early psychosis
Substance use is a major problem among young people who are experiencing early psychosis, but there’s been little guidance to help healthcare professionals work with patients who are dealing with these issues together. Now, Elizabeth Thomas, an assistant professor in the Department of Social and Behavioral Sciences, has shared her expertise by co-authoring a new government-published guidebook on the subject. The Substance Abuse and Mental Health Services Administration (SAMHSA) has made First-Episode Psychosis and Co-Occurring Substance Use Disorders available for download to healthcare providers. Thomas co-authored the guide with Melanie Bennett of the University of Maryland School of Medicine and members of SAMHSA and Westat, with input from a national panel of experts. “It’s geared towards mental health clinicians who work with individuals with early psychosis, in what are called coordinated specialty care programs,” said Thomas, whose work in the Temple University Collaborative on Community Inclusion has focused on psychiatric rehabilitation and early intervention in psychosis. “To date, there has not been a strong understanding of how to treat substance use disorders within the context of early psychosis, which speaks to the importance of this guidebook.” Psychosis refers to a condition that makes it difficult for an individual to differentiate what is and isn’t real, as the new guidebook explains. People may perceive things that others do not or hold strong beliefs about things that aren’t true. Symptoms most commonly arise between ages 16
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and 30. Early or first-episode psychosis describes the period of up to five years after the onset of symptoms. Widely ranging estimates say anywhere from 13 to 51 percent of young people who have first-episode psychosis have a substance use disorder at the start of treatment for psychosis. Pulling from dozens of studies, Thomas and Bennett highlight specific interventions used to treat substance use among individuals with early psychosis to examine their strengths and weaknesses. They highlight common elements that seem to work, make recommendations and offer advice for implementing best practices based on real-world examples. Many interventions, for example, include a relapse prevention component, talking to people about how to deal with triggers and high-risk situations to avoid relapse of substance use. A main theme of the guide is the benefit of coordinated specialty care programs where “everyone working with the young person is part of the same team,” Thomas says. “One of the interesting things we found is that a lot of people will reduce or stop using substances after coming to a coordinated specialty care program, in which substance use is discussed as a part of recovery, but may not necessarily be the focal point,” Thomas says. “About 50 percent of people will reduce or stop using substances just from receiving care for early psychosis. And then some people may need more concentrated focus on addressing substance use.” The guidebook, as well as future research, will support programs in better meeting the needs of individuals with early psychosis who have persistent substance use issues.
Investigations in father-perpetrated maltreatment
Maltreatment of children deeply impacts a child’s life and often tears families apart. Julia Kobulsky, assistant professor in the School of Social Work, has been studying the ways in which authorities deal with fathers after child maltreatment incidents, hoping to discover what approaches might work best in minimizing recurrence of maltreatment. “We’re trying to get fathers more involved in child welfare and include them more as an important resource for kids. Historically, it hasn’t been done,” Kobulsky says. Kobulsky’s research has uncovered disparities in how situations involving fathers, particularly those in underrepresented populations, have been handled. Along with Rachel Wildfeuer, a Temple doctoral student in sociology, she examined outcomes of maltreatment cases reported to Child Protective Services (CPS) systems in the United States. Their research, funded and published by the Fatherhood Research and Practice Network (an organization co-directed by School of Social Work professor Jay Fagan), suggests that although child maltreatment by fathers was associated with less severe physical abuse behavior than maltreatment involving mothers, cases involving fathers are more likely to lead to criminal investigations. “There are stereotypes,” Kobulsky says. “In the context of child maltreatment, there’s a concern fathers are more dangerous.” It may be the absence of effective interventions that contribute to the criminal justice system getting involved, due to a lack of viable alternatives, Kobulsky says. There has been relatively limited work exploring what kinds of programs help fathers with parenting skills, particularly fathers in lowincome families and underrepresented populations, she says. Traditionally, the CPS system has been geared toward mothers, and caregiving has been seen as part of a woman’s role. Culturally, this is starting to change, but services and systems are slower to catch up, she says. Other factors may also be at play, Kobulsky suggests. Case workers often are female and may be more likely to feel like they need protection when interviewing a father. “Maybe they’re more likely to ask law enforcement to accompany them for their own safety. And then it has an unintended consequence,” she says. Training to address bias or help caseworkers engage fathers could be part of the solution. Even if separation from a maltreating father is called for to protect a child, interventions should address the father’s behavior to prevent the future victimization of another child or intimate partner, the study concludes. “Child protective services need to ensure the best interests of the child,” Kobulsky says. “Sometimes child removal or criminal justice intervention is the best option and is necessary to ensure child safety. But placing children into out-of-home foster care has consequences, too. Removal can be traumatizing. In lower-risk cases, appropriate services for fathers may successfully prevent harm and preserve family relationships.” Kobulsky and Wildfeuer are pursuing the next phase of this research. Preliminary findings suggest that race may play a factor in whether fatherperpetrated maltreatment leads to certain outcomes—for example, when both mother and father perpetrated maltreatment, odds of criminal charges tended to be highest when the father was Black.
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Phone calls, pediatric visits could lower secondhand smoke exposure
Secondhand tobacco smoke is no longer an issue in many public places, but it remains a health threat for children whose parents smoke at home. Tobacco smoke exposure (TSE) is a major cause of preventable disease in children, from sudden infant death syndrome and respiratory diseases to illnesses later in life. Across multiple studies, lower income and education have been observed as high barriers to maternal smoking cessation. Children in those homes are more vulnerable to the health effects of TSE. College of Public Health researchers have been testing interventions that appear to make a difference. Approaches involving telephone consultations with smoking mothers in lowincome homes not only helped them measurably lower their children’s smoke exposure, but they also led to efforts to reduce or quit their smoking entirely, even if they hadn’t intended to quit when they started treatment. “Parents are really receptive to trying to protect their kids,” says Bradley Collins, professor and director of the Health Behavior Research Clinic and principal investigator of the studies, which were funded by the National Cancer Institute. “Our approach seems to work for this high risk, underserved population, where you don’t jump right into quitting. It focuses on child exposure and builds on changes smoking parents make at home. As they master protecting their child, we encourage effort toward quitting smoking.” One study found that Collins’ Family Rules for Establishing Smokefree Homes intervention, or FRESH, was effective in both reducing longterm child exposure to secondhand smoke and increasing mothers’ odds of quitting smoking 12 months after the end of treatment. He developed FRESH, he says, because standard smoking cessation interventions were not effective in lowincome populations. Smoking mothers who participated in the study signed behavioral contracts and discussed treatment goals with family members. Then they received two home visits (pre-COVID) and phone calls designed to keep them motivated and help
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them devise strategies to overcome household challenges in keeping tobacco smoke away from their children. “We might start with ‘can you make their bedrooms smoke free? Can you make the kitchen smoke free?’,” Collins explains. “What about now smoking everything outside, and not letting anybody who visits smoke indoors? You start small and build on it—moving toward quitting, which is the ultimate goal of child protection from tobacco smoke.” Results of the FRESH study, published in the American Journal of Preventive Medicine, showed that children under 4 years old had lower levels of cotinine—a chemical biomarker of tobacco smoke exposure—than standard control group children even 12 months after the 16-week treatment had ended. And FRESH mothers maintained significantly greater odds of quitting between the end of the 16 weeks and the following 12 months. “Focusing on child health was a hook, getting low-income, distressed smokers that might not otherwise consider quitting smoking involved in a process to make gradual changes,” Collins says. A second project, titled Kids Safe and Smokefree, or KiSS, added a pediatrician’s office component. Collins and Stephen Lepore, chair of the Department of Social and Behavioral Sciences and director of the Social and Behavioral Health Interventions Laboratory, trained pediatric care providers at the Temple Health, St. Christopher’s Hospital for Children and Children’s Hospital of Philadelphia systems. They found that improving parents’ confidence in being able to shelter children from secondhand smoke—their selfefficacy—reduced the exposure. “We believe this could be a model for a national intervention,” Collins says. “State quitlines could coordinate child TSE reduction messaging and referrals links with pediatric providers, and low-income parents would be able to receive telephone-based counseling that boosts their confidence in keeping their children safe and healthy as they prepare to quit smoking.”
Social networks impact odds of stopping injection drug use
People with a history of injection drug use were found to have better odds of stopping injection when their social networks included more people who don’t inject, according to new research from Abby Rudolph, associate professor of epidemiology and biostatistics. The findings, published in the journal Addiction, are part of ongoing research that Rudolph and colleagues have been conducting to examine the social context of opioid use in rural Eastern Kentucky, a region hit hard by the opioid crisis and hepatitis C. In her work, Rudolph uses social network analyses to understand connections between an individual’s behaviors and the behaviors (both actual and perceived) of their social contacts, ultimately leading to ideas for effective health interventions. This study uses data from a long-term project called Social Networks among Appalachian People (SNAP), in which hundreds of people have been interviewed about their drug use and the people in their social networks. For people who inject drugs, many contacts in their networks are others who have a history of using injected drugs. “Injection drug use is a social behavior,” Rudolph says. In another study, it was found that those with a network member who stopped injecting were more likely to stop injecting over the following six-month period. The influence was stronger for certain members of a person’s social circle, particularly family members and those providing social support. The study suggested that treatment approaches that consider familialism and social support may be more effective. The new study looks at changes in people’s injection status, and the composition of their social networks, over multiple six-month intervals. It finds that for each additional network member who does not inject drugs, the odds of recent and sustained injection cessation increase. “If the number of people that you know who inject diminishes over time, then you may be more likely to stop injecting as there become fewer people in your network to inject with,” Rudolph says. Social networks are fluid, and cessation attempts can be as well, so research like this is challenging. The goal is to understand social network effects on drug use patterns and use that knowledge to identify opportunities to minimize risk. Interconnected social networks, with people influencing one another, by nature can have a multiplying effect. “If someone is able to stop injecting, they could be one of the disruptors in the network,” Rudolph says. “If key members of the network stop injecting, this behavior change could cascade through the network.”
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Research on sickle cell in Saudi Arabia earns alumnus national recognition Mohammed Alhajji’s doctoral research has won him two national awards, returned him to his native Saudi Arabia to continue his work and led him to become, he thinks, “the first PhD student ever to defend their dissertation in a hallway in an empty building.”
Alhajji, who graduated in spring 2020 with a PhD in social and behavioral sciences, studied premed in the United States before switching to public health, and his PhD research combines his biomedical training with interests in policy and behavioral health. It presents an intervention to reduce the incidence of sickle cell disease in Saudi Arabia, where it’s one of the most common genetic disorders. A child can develop the disease only if both parents carry the abnormal recessive gene, but many people don’t know if they do. Traditions of arranged and intrafamily marriages create the risk of pairing relatives such as cousins who may both carry the gene. A 2005 law required premarital screening to receive a marriage license, Alhajji says, “but the timing of the screening is way too late in the process. You could be dating for years and have all the arrangements set up, and then right before your wedding you get a screening. Some people just ignore the results.” Earlier screening would make age-old marriage traditions safer. In 2019 he returned to his home municipality of Alahsa to conduct focus groups and collect data from parents and high school students, measuring their openness to screening children as teenagers. “There was huge support for it,” he says. He hopes the findings can inform government policy. This research earned him the Student Award from the American Public Health Association (APHA) Genomics Forum, and it was named best student abstract by the Society of Behavioral Health. He was scheduled to defend his dissertation on March 30, by which time the university had shut down due to the COVID-19 pandemic. His plan to speak via video from home went afoul when his apartment’s internet connection failed, so he scrambled to
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Temple’s campus, “going from door to door, begging security guards to let me in to defend my dissertation,” he says. He got into the Science Education and Research Center, plugged in his laptop in a hallway and completed the final step toward his degree. Alhajji posted a video of that presentation online, as part of his other life as a social media personality: He has hundreds of thousands of followers on Twitter, YouTube and other platforms for videos in which he explains public health issues, in Arabic, for viewers back home. “It’s like a reality TV show, a lens for people 7,000 miles away to observe my PhD life in the U.S., my life in Philly.” He recently moved back to Saudi Arabia, where he has built enough of a following to sometimes get recognized. “They call me Dr. Mohammed,” he says.
Mohammed Alhajji.
Armenian students brush their teeth in a brushadrome. Photo credit: Children of Armenia Fund.
FINDING SUCCESS IN A DENTAL CARE PROGRAM IN ARMENIA Before Hamlet Gasoyan joined the College of Public Health as a doctoral student, he was a practicing dentist. Though his doctoral research focused on insurance benefit design and the benefits of bariatric surgery, he didn’t leave dental health behind. Gasoyan documented the benefits of a program that delivers dental care to rural villages of his native Armenia. His analysis determined that the program, which helps elementary school children develop the habit of brushing their teeth regularly, reduced the prevalence of cavities by 30 percent, making a significant health impact on children whose homes often don’t have running water. The results offered evidence that in some environments, a low-tech, inexpensive intervention can make a big difference. “There’s abundant research that connects dental health to serious health problems, nutrition and even performance in school,” said Gasoyan. “If you have a toothache, it’s harder to pay attention in class.” The dental care program began in 2013, when pediatric dentist Denise Klatchoian brought the idea of school-based toothbrushing stations to the nonprofit Children of Armenia Fund.
Along with Robert Bagramian, an alumnus of the Maurice H. Kornberg School of Dentistry at Temple, they set up colorful toothbrushing rooms called “brushadromes” adjacent to cafeterias in 14 schools in nine Armenian villages. Children ages 6 to 11 were given their own brushes and fluoride toothpaste and instructed on proper technique. After lunches, a nurse or teacher would lead them in brushing sessions designed to be effective and fun. Gasoyan, a visiting scientist at Yerevan State Medical University, worked with Yerevan student Armen Safaryan to measure the results as part of Safaryan’s master’s project. Safaryan performed dental exams on children in two randomly selected villages where the program was implemented to see whether incidence of cavities had changed since 2013. Gasoyan helped interpret the data and published the results with coauthors in Frontiers in Public Health. The success of the program in Armenia offers a lesson in public health more broadly, Gasoyan feels. It shows that a lowcost intervention, with limited resources, can produce results in a rural setting where people don’t have much access to specialized care. “Programs like this that work on prevention rather than treatment are the future of public health, and the simplicity is the most attractive part,” he says. “We often think of innovation as complex or resource-heavy or technology-related. But innovation can be simple and cheap.”
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For her upcoming book, Marsha Zibalese-Crawford (opposite page, at right) shared lessons from work with Bedouin communities in the Negev desert in Israel (below and on opposite page). Photo credits: Marsha Zibalese-Crawford.
Built from insights gathered around the world, new book shares lessons in improving human services Marsha Zibalese-Crawford is an associate professor of social work in the College of Public Health, but the stamps in her passport and her frequent flyer mileage might make her seem more like a global diplomat.
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Her work to strengthen human services agencies has taken her from Philadelphia to places as varied as the Israeli desert and the streets of Hong Kong; her research has taken her to Poland, the Czech Republic and BosniaHerzegovina. Now, she is putting her decades of globetrotting into a forthcoming book for Temple’s North Broad Press. The book, The Role of Combined Action in Enhancing Organizations’ Sustainability, will be built around examples of Zibalese-Crawford’s and other contributors’ collaborations with agencies globally to improve their sustainability and effectiveness. Its target readers are leaders of nongovernmental organizations (NGOs) and other agencies, as well as public policymakers and students. “The idea is to be very practical, not scholarly treatises,” she says. The book will focus on the importance of government and private partnerships that can extend an agency’s
influence and further its goals. “It examines innovative ways agencies can partner with one another to make a more lasting positive impact on community health.” Zibalese-Crawford does hands-on fieldwork known as community-based participatory research (CBPR). She spends time with organizations where they work and live, talking to leaders and members to understand their vision, strengths and challenges. She helps them identify goals and next steps for sustainability. She also guides them toward promising partnerships and strategies for appealing to funding sources. It’s all about “capacity building”—their ability to grow and remain vital. “So there’s a vision for the organization,” she says. “They learn about evaluation, how to collect data, analyze and disseminate information using multiple types of media. They learn about budgeting, fundraising and accountability, all these tools to support their efforts moving forward.” Zibalese-Crawford has spent many years working with U.S.-based nonprofit organizations and city governments to help maximize the impact of their services to at-risk communities. In 2012, she received a U.S. Department of State grant to work overseas with 27 Israeli and Palestinian agencies. The missions of those NGO participants ranged from curtailing human trafficking to increasing the arts in education. She visited them all to get a sense of how they operated, with an eye on sustainability and capacity building. She provided each organization an assessment report, and they worked on creating strategic plans to present to funding sources and potential partners. A 2013 grant from the Netherlands’ Cordaid Foundation allowed Zibalese-Crawford to deepen the work she’d begun with one particular group, Sidreh, a nonprofit whose mission is to support Palestinian-Bedouin women in Israel’s Negev region. Around 190,000 Palestinian-Arab Bedouins, who are citizens of Israel, live in unstable conditions in the region. Many are in villages unrecognized by the government that don’t have reliable infrastructure like electricity and transportation. Bedouin women are further constrained by patriarchal social norms.
Zibalese-Crawford led an effort to interview 100 women to discover their challenges and needs. With her guidance, Sidreh gained outside funding to enhance programs that taught women to read and write Arabic and Hebrew. Through another funding partner, Sidreh created an agricultural gardening program and financial literacy workshops. One key to success that her book will highlight is the need to continually seek suitable partners. Inter-organizational relationships can be fruitful but challenging, ZibaleseCrawford says. NGOs may have similar roles and sometimes compete for resources. “There’s always that element of asking: ‘Do we cooperate? Do we compete? How can we coalesce? What does that look like?’” she says. Thanks to a grant from North Broad Press, her book will be available digitally for free when it is published in 2021.
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OUR NEW NORMAL
The college’s wide-ranging response to COVID-19
In less than a year, the COVID-19 pandemic forever transformed the ways we study, teach and practice public health. Its medical and social challenges have yet to be resolved, while its financial and economic burden will be felt for years to come. In the face of such an unprecedented situation, the field of public health has taken on a new importance in the public consciousness. The College of Public Health responded swiftly on multiple fronts. Researchers worked to better understand the epidemiology and social impact of COVID. Students and faculty across the college’s departments volunteered in food distribution, COVID testing and information-sharing projects. Faculty experts created videos to inform audiences on proper precautions, share updates on the status of the pandemic and dispel myths pervading social media. The college created a course in contact tracing, available to the public, to assist the efforts of the Commonwealth of Pennsylvania. From the first weeks of the pandemic through an uncertain summer and fall, the college has demonstrated that the role of a vital public health institution is not only to teach and study but also to engage and act.
The college’s annual Research and Evidencebased Practice Day successfully goes virtual, with research presentations and discussions from more than 100 students across the college. Students, faculty and staff in the college volunteer their time and services on the front lines. Social work student Rachel Dettrey hand-delivers food across the city; faculty and students in the Department of Health and Rehabilitation Sciences assemble donations of more than 500 books,
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In response to the coronavirus outbreak, the college launches a COVID-19 resource page and a series of video panel discussions to provide the community with information and updates on COVID-19. The videos feature Dean Laura A. Siminoff and faculty experts Krys Johnson, Graciela Jaschek, Heather Murphy and Sarah Bass.
The college honors 790 undergraduate and 386 graduate students in a socially distanced graduation celebration (read more on page 36).
Faculty begin contributing their expertise to a range of media, including appearances in The Philadelphia Inquirer and Philadelphia Magazine; radio interviews on WHYY and KYW; television news appearances on local affiliates; and quotes on sites such as The Science Times, Technical.ly Philly, Marketwatch, LiveScience and Factcheck.org.
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Dean Siminoff and Assistant Professor Krys Johnson pen an op-ed in The Philadelphia Inquirer arguing for state officials to better enforce stay-at-home orders and share coronavirus data with the academic research community.
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The student response to supporting the fight against COVID continues: master of public health student Maya Shenoy creates the Voice Over Virus project, an online platform for sharing COVID stories; Nichola St. James, an athletic training doctoral student, screens patients and essential workers at care facilities and other locations; Cynthia Nieves, a doctor of nursing practice student, creates an educational Spanish-language video about COVID-19 safety for the local Telemundo TV affiliate.
magazines, games, puzzles and art supplies for quarantined COVID-19 patients at Temple Hospital; and Alyson Chambers, a senior public health major, assists at the public testing site at Citizens Bank Park. The Temple University Collaborative on Community Inclusion, whose research and programming depends on community activities for people with serious mental illness, hosts webinars and assembles an online resource guide to help service providers stay connected during the pandemic.
Gina Tripicchio, left, packs sports equipment for middle-school students for Game On Philly.
Alyson Chambers works at a public testing site in Philadelphia.
The Game On Philly program, a collaboration between Temple, the Philadelphia Youth Sports Collaborative, Eat Right Philly and the School District of Philadelphia, launches as a virtual program, delivering free sports equipment, healthy foods and online fitness coaching to Philadelphia middle school students.
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JUNE Responding to the pressing need to contain COVID-19 as facilities reopen, CPH begins offering a certificate program in contact tracing. (See next page.) The college launches “Beyond the Biology,” a series of webinars covering issues related to the pandemic, its impact on vulnerable populations and its implications for healthcare delivery. Faculty experts and alumni panelists discuss subjects such as racial and ethnic health disparities, the effects of the pandemic on older Americans and the impact on people with developmental disabilities.
FALL 2020 The college enters the fall semester through mostly remote education; adaptations help essential classes—those where educational objectives can’t be fully met online—to safely blend in-person instruction with stay-home lectures. (See next page.)
Athletic training student Nichola St. James screens patients and essential workers.
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A hybrid approach to essential classes Human Dynamics in Occupational Therapy, a first-year graduate course, demonstrated how essential classes can safely provide hands-on training for students in clinical disciplines. Students wore surgical masks and plastic face shields and spread out across four classrooms to avoid crowding together. “Splitting 60 students into the four rooms allows us to practice social distancing and keep to all of the guidelines the university has set for room capacities,” says Kimberly Gargin, interim program director for occupational therapy, who teaches the course. Students logged in via video conference for six weekly lecture hours. But hands-on training remains a vital part of what occupational therapists need. In person, students learned about working with clients on transfers from one position to another, actions like wheelchair transfers, toilet transfers and bed mobility. They practiced taking vital signs such as blood pressure, heart rate and respiratory rate. Students worked in pairs, with the same partners rather than a mixture of classmates, to minimize contact between students. “The students need to learn the correct biomechanics, so that they’re not injuring themselves when they start working with patients. We really need to be there to demonstrate, ‘this is how you bend your knees and not your back, and you lift here on the patient, and you have them put their hands here, and you set up everything this way,’” Gargin says. Whenever they came within six feet of one another, they made sure their shields were in place. Wearing protective equipment while working with clients may be part of real-life work, so it’s useful training. The online lectures were live and interactive, not prerecorded, so students can ask questions as in a physical class. Guest lecturers have joined to share perspectives, and students have occasionally split into breakout groups that allow them to collaborate and meet classmates. “I think it opens more minds than probably were open to online learning before,” Gargin says. “And it shows we can be smart about hands-on training where it’s really needed.”
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Contact tracing with an interdisciplinary lens Over the summer, the college launched a certificate course in contact tracing, a key containment strategy for COVID-19. The 10-hour course, quickly developed to combat the potential rise in cases as states reopen restaurants and businesses, is designed to prepare students to immediately begin training and working with the Pennsylvania Department of Health and other state and local health authorities. “We saw there was going to be an unprecedented need for contact tracers in order to open safely,” said Resa M. Jones, chair of the Department of Epidemiology and Biostatistics, who led course development. “And we knew that the college is uniquely prepared to deliver the multidisciplinary training that contact tracers need.” The Public Health Contact Tracing
course, offered for free to students and to the general public as a continuing education class, brings together instruction from CPH experts in epidemiology and biostatistics, social work and nursing. It incorporates training created by the Centers for Disease Control and Prevention (CDC), the Association of State and Territorial Health Officials (ASTHO) and the National Coalition of STD Directors (NCSD). The self-guided online course covers everything from the basics of epidemiology to the human factors in making phone calls to people who might not be happy to be receiving a coldcall about their exposure to a disease. Over the course of a dozen short modules, students receive selfpaced instruction in the details of epidemiology, the biology of COVID-19, ethics and privacy issues, health equity
and disparities and interpersonal skills that are useful in contacting people about their COVID-19 exposure. Students also make a practice phone call to put their training to the test. By mid-summer, 600 people had registered for the contact tracing course. They included Temple students from a range of fields and others from across the country, from as far as California and Colorado, Jones said. “The students we’ve trained come from public health or social work, from education, liberal arts, podiatry and the College of Science and Technology. It’s really cross-cutting,” she said. “We’ve even had quite a few people who aren’t students. We make it available to anybody who really would like to do it, because there’s such a great need.”
EARLY IN S I GH TS I N TO T H E PAN DE MI C Do you look more beautiful wearing a mask? In an article published in Plastic and Reconstructive Surgery—Global Open, David Sarwer, associate dean for research and director of the Center for Obesity Research and Education, shared results of a study suggesting an added benefit to mask wearing. Photographs of 60 faces, with and without surgical-style masks, were rated on attractiveness. All of the faces judged to be “unattractive” were rated higher after application of a mask, compared to approximately 70 percent of those judged to be “average.” Even in those already deemed “attractive,” application of masks increased attractiveness ratings.
How COVID impacts those with substance use disorder Sarah Bauerle Bass, associate professor of social and behavioral sciences and director of the Risk Communication Laboratory, received a grant from the National Institutes of Health to study the pandemic’s impact on people with substance use disorder and the facilities that serve them. Bass will explore how people with substance use disorder
learn about COVID and perceive its risk, and will employ perceptual mapping, a methodology aimed at tailoring health messages. “If you are unstably housed, maybe you’re not sitting watching the news at night,” she says. “We want to understand how best to communicate around COVID protections, to make it more salient for their situation.”
Early data on visits to public spaces In an article published in Preventing Chronic Disease, Associate Professor of Epidemiology and Biostatistics Abby Rudolph, with researchers from Temple’s College of Liberal Arts, found that decreases in visits to locations such as stores and workplaces correlated with a reduced rate of new COVID-19 cases reported in the same counties 11 days later, putting data from the pandemic’s early months behind the wisdom of minimizing public gatherings to curtail the spread of COVID-19. By examining countyby-county data across the U.S., the study also suggests a reason why, early in the outbreak, Americans in rural environments may have had different perceptions of the threat the virus presented than those in urban areas.
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T H E T I M E F O R T E L E H E A LT H Katie Reeb checks in for her weekly speech therapy session to work on her stuttering. She launches Zoom on her computer screen, and four video boxes pop open.
For Reeb’s clinician Missy Wells, a Temple master’s student in speech, language and hearing science, the session is another opportunity to improve her clinical skills with a client and gain experience working in telepractice, a method of health service delivery that wasn’t part of her original training plan but is destined to become a much bigger part of the public health landscape. Normally this meeting would be in a room at the Speech-Language-Hearing Center in Weiss Hall on Temple’s campus. Reeb and Wells began working there months earlier and got through an evaluation and two formal sessions before the clinic was closed for social distancing amid the COVID-19 pandemic. Over the internet, Wells and Reeb run through exercises and words. Reeb is a PhD student in physiology and pharmacology at nearby Drexel University, and one of her goals is to approach saying words she might avoid for fear of stuttering in research presentations, lab meetings and class discussions. She experiments by saying “glutamate” and “dopamine” and “physiology,” learning to work through them with less struggle and tension if she happens to stutter on them. From a third box on the screen, Kim Sabourin watches. Sabourin, a clinical instructor and supervisor in the College of Public Health’s Department of Communication Sciences and Disorders, helps Temple students learn to become clinicians. She observes as they work with clients and offers guidance as needed. Sabourin types suggestions unobtrusively as chat messages during the session and activates her microphone a few times to provide guidance.
Another student, Emily Pfoutz, watches too, preparing to take over as Reeb’s clinician in the next academic period. “It’s actually quite similar to what we would have been practicing in person,” Reeb says after the session. Wells agrees. “It doesn’t feel much different, besides the fact that you can see my bedroom behind me a little,” she says. Speech clients are doing more of their own work remotely, so online sessions resemble the environments they face every day. “With Katie being a PhD student, her classes and lab meetings are now all online. So where we might have worked through a presentation in the clinic that she would then give in-person, now we can practice a talk that she is going to go and give via Zoom. This kind of practice feels especially important with fluency disorders, where talking on the phone and public speaking can be daunting,” Wells explains. Much of stuttering treatment is conducted via conversation, so it’s one of the easier therapies to transition from in-person to remote. But telehealth
Kim Sabourin, bottom, observes a clinical session between Emily Pfoutz, top-left, and Katie Reeb, top-right.
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A physical therapy telehealth session, observed by Scott Burns, top-right.
is exploding across the spectrum of public health and healthcare. Delivering care via video is being done out of necessity amid the COVID-19 pandemic that has people staying home, but it is likely to become part of every clinician’s toolkit in the days ahead. “It’s not perfect for everyone,” Sabourin says. “But it makes treatment accessible to many more people—people who have limited mobility, who live in rural areas. People may want to find a stuttering specialist and there isn’t one in their area. I see so many advantages.” With a bigger future in store for telepractice, students across the College of Public Health are getting on-the-job training in a valuable skill. In occupational therapy, students performing field placements in medical and hospital settings as part of their degree requirements in the spring had those 12-week assignments interrupted by COVID. “Most of the students were at week nine when they were interrupted,” says Erica Pugh, assistant professor and academic fieldwork coordinator for Temple’s occupational therapy program. “We were able to create a three-week online fieldwork with local shelters for students impacted by closures of their original sites.” Students gained telehealth experience contacting coordinators at the shelters to conduct needs assessments via phone and Zoom conversations. Then they developed educational and other developmentally appropriate activities for children in the shelters. Entering the fall semester, easing of COVID-related restrictions has allowed some students to return to valuable on-site fieldwork assignments. But telehealth training will remain a vital and complementary piece of public health education. Scott Burns, director of the doctor of physical therapy program, thinks experience working with clients remotely through the college will be invaluable to his PT students. “I just met with some of the students that are going to be helping me with it. And I told them, I think this is going to be a part of your entry-level expectation when you go to apply for a job,” he says.
Leading the conversation Interest in telehealth, including how to do it, what works and what is permissible, has surged, says Cynthia Abbott-Gaffney, an assistant professor of instruction in the occupational therapy program in the Department of Health and Rehabilitation Sciences. She has been busy leading webinars about telehealth in occupational therapy. “For two years I was studying telehealth, and no one seemed to be interested,” she says. “Then in March I posted on Facebook about one of these webinars, and I woke up in the morning and I had 679 hits.” Her webinars now have reached professionals in 28 countries. As it becomes mainstream, telemedicine is moving away from any sense that it’s an inferior alternative to meeting in person.
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“There are probably people in the field who always thought that, but there also are people who have been doing this well for many years and have been saying this is not bargainbasement,” says Beth Levine, director of clinical education and clinical services in the Communication Sciences and Disorders Department. “This is therapy. It’s done just as well. And I think now’s the time that we’re all going to find that out.” A national survey of consumers in March, by Sage Growth Partners and Black Book Market Research, found that 25 percent of respondents had used telehealth previously, but 59 percent said they were more likely to use telehealth services now, and 36 percent would switch their physician in order to have access to virtual care. Teladoc Health, a public
company that connects patients with doctors via phone or video, nearly doubled its volume with 2 million appointments in the first quarter of 2020. As healthcare facilities have reopened, the percentage of visits done via telehealth has fallen, but the total remains substantially above pre-pandemic levels, according to Epic Health Research. One advantage that practitioners are discovering is that telehealth makes it easier for many people to attend their sessions—especially for those who may not have been able to access health resources due to other time commitments, like working fulltime or raising a family. Not needing to travel to receive health services may make great sense for senior citizens, who face increased risk from COVID. Therapists have noticed better
attendance at group speech therapy sessions when they’re done online. “For some people, it’s a struggle to get here,” Levine says. “Our clients in the Greater Philadelphia area might take two buses and a train. I think that this is going to change it. They’ll come in for their initial consult or evaluation, and then, if it’s appropriate, telehealth might be here to stay for us.” Seeing a healthcare provider from home means patients need access to technology instead of transportation. Temple’s clinics often serve populations at lower levels of income, so that access isn’t always a given. “We recommend using a technology checklist to find out what’s available to the family,” says
Abbott-Gaffney. “Some families have only a cell phone available. If it’s a smartphone, we can still make a lot of things work, because there’s video and audio. You really steer your session towards what a client is going to be able to do using the technology available.” Delivering care remotely also requires clinicians to make adjustments. In speech therapy, working on strategies for breath support can be more challenging remotely than in person, Sabourin says. Student clinicians and their clients may need to learn how to share computer screens to replace therapy cards used in an office setting. Working with young children remotely brings its own challenges. Clinicians
typically ask that parents be in the room to keep a child on task, and that can make the parent more involved in the session than usual. In physical therapy, practitioners lose the ability to make handson assessments to gauge patient progress. “I can’t say, ‘Push against me so I can get a gauge of how strong you are’,” Burns says. Instead, physical therapists need to rely on observation and pay close attention to patients’ own assessments. “You have to get a little bit more creative. You say: ‘I’m now going to have you stand up and move. Get in and out of a chair a couple times. How hard is it? How effortful is it?’”
PA RT O F T HE I R E VE RYDAY LI VE S The expansion of telehealth has been eased by the loosening of some restrictions, at least temporarily, when COVID-19 was declared a national public health emergency. But many requirements remain strict, as licensing organizations want to ensure that quality of care is maintained and accrediting bodies want to be sure students receive worthy training. In addition, while some insurance companies are becoming more flexible about reimbursement for telehealth services, their guidelines still can be complex to navigate. “It all starts with the really important regulatory, licensing and reimbursement guidelines,” says Abbott-Gaffney. “That’s like the first 20 minutes of a 90-minute webinar. There’s a lot to figure out.” The privacy requirement of HIPAA (the Health Insurance Portability and Accountability Act) requires special attention during online care delivery. Recording of sessions isn’t permitted, so clinicians must use a version of Zoom with its recording function disabled. But faculty also use Zoom to teach and record their classes. So the College of Public Health’s IT staff, working with Temple’s Information Technology Services, developed a method allowing clinicians to keep both secure and regular Zoom accounts under a single login and toggle between them as needed. The accrediting body for speech pathology instruction, the Council for Clinical Certification in Audiology and SpeechLanguage Pathology, requires that faculty supervisors of clinical sessions by students must be present 100 percent of the time. Ordinarily at the Speech-Language-Hearing facility, a faculty observer might have sessions happening in two or three rooms simultaneously and split time looking in on each. The online supervision requirement is more demanding of faculty, but there are payoffs. “I feel like I’ve been better as a supervisor because I can give input immediately and send private messages,” Sabourin says. Because student clinicians working with a particular client may change as semesters turn, Sabourin feels that her presence throughout all the sessions provides clients with continuity of care, which is especially helpful with children and parents. “I’m seeing more advantages than disadvantages.” Missy Wells, the master’s student Sabourin was observing, sees another benefit. People everywhere are spending more of their time on video calls, which means doing healthcare sessions online can be more integrated into their routines and potentially more effective. “They aren’t coming to a clinic to learn techniques and approaches in one context, and then having to generalize them outwards, but rather working directly within their own environment and on their own schedule,” she says. “It feels easier for clients to incorporate learned strategies into their everyday lives, because we now exist there too.”
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What’s Left Behind When she was growing up in the 1970s near the Naval Air Warfare Center in Warminster, Pa., Hope Grosse used to run to the wire fence, with other neighborhood kids, to watch Navy firefighters run through weekly training drills. “They would douse the shell of a plane with gasoline and light it on fire, and the firefighters would put the fire out,” Grosse remembers. The white foam firefighters sprayed from hoses did the job. It was thrilling and, it was later discovered, life-threatening to the nearby community. The foam contained man-made chemicals known as perfluoroalkyl and polyfluoroalkyl substances, or PFAS, which have been associated with a growing list of illnesses like ulcerative colitis, thyroid disease, pregnancy-induced pre-eclampsia, decreased vaccine response in children and testicular and kidney cancers. Links to other health conditions are suspected but not officially established. The chemicals contaminated the water that area families drank, cooked with and bathed in. Grosse was diagnosed with stage four cancer at age 25. Her father died of cancer. So did a neighbor. So did the family’s dogs. Grosse’s sister has autoimmune disease and other health issues. She wasn’t alone in wanting to know more. Joanne Stanton also grew up in Warminster, between the naval facility and the Willow Grove base in Horsham, Pa., before moving out of the area. In 1991, her six-year-old son was diagnosed with a brain tumor. “There were three of us that grew up on the same street in Warminster. We all moved away, and we each had children with cancerous brain tumors,” says Stanton, who is a graduate of the College of Public Health. The military bases used many substances suspected as hazardous. They were declared federal Superfund cleanup sites, and Environmental Protection Agency tests in 2014 showed areas around them to be contaminated with PFAS. By then, lawsuits over PFAS contamination from DuPont’s production of Teflon in West Virginia were bringing the issue into the public eye. Stanton and Grosse, who had attended grade school and high school together, reconnected
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over their quest to seek better answers about the chemical contamination and its effects. They worried about their old neighborhood and knew it was much more than just a local issue. Together, they started the Buxmont Coalition for Safer Water with goals of increasing public awareness of water contaminants and pushing for restrictions on PFAS in drinking water and consumer products. “As a parent, you go to the kitchen sink and turn on your faucet and assume that somewhere along the way your water has been tested, and it’s safe to drink. Unfortunately, with PFAS and other unregulated contaminants, that is not always the case,” Stanton says. PFAS have been detected in public and private water supplies in 49 states. They have been used for decades in nonstick cookware, stain-resistant fabrics, military tanks and industrial products. “It’s in makeup and diapers and carpets. It’s in our clothing. It’s in our food,” Grosse says. There are more than 4,000 different PFAS compounds. Due to their chemical structure—strong fluorine-carbon bonds designed to keep materials durable—they don’t biodegrade quickly in the environment, and they are believed to remain in the body for years. “They call them ‘forever chemicals’ for a reason,” Grosse says.
Firefighting foam is one product known to contain harmful PFAS chemicals.
As part of her induction into Temple’s Gallery of Success, Joanne Stanton leads a discussion about her work with the Buxmont Coalition for Safer Water.
Finding the ‘forever chemicals’ In 2018, Stanton visited Temple for her induction into the alumni Gallery of Success. After the ceremony, she met Resa M. Jones, chair of the Department of Epidemiology and Biostatistics— with a common interest in PFAS, they began brainstorming ways to join their efforts. Now, Jones and Temple epidemiologists are leading a study, with RTI International, the Pennsylvania Department of Health and Brown University, to study health outcomes among people who were unknowingly exposed to PFAS-contaminated drinking water in Pennsylvania, perhaps for decades. Grosse and Stanton, armed with years of research on the complexities of PFAS chemistry and the bureaucracy of government regulation, are consulting on the research and assisting with community engagement. “This is contamination that’s been happening in communities since the 1950s. They didn’t really learn about it until 2014,” says Jones, a co-investigator in the Pennsylvania site study along with Robin Taylor Wilson, CPH associate professor of epidemiology and biostatistics, and David Savitz, a professor of epidemiology at Brown. Principal investigators are Linda Brown, an epidemiologist at RTI International, and Sharon Watkins, Pennsylvania’s state epidemiologist. Pennsylvania is one of seven sites across the country where the federal Agency for Toxic
Substances and Disease Registry (ATSDR), part of the Centers for Disease Control and Prevention, is funding research as part of a nationwide study. The Pennsylvania area to be examined, with $1 million per year in funding for five years, includes the Warminster, Horsham and Warrington areas in Bucks and Montgomery Counties. The Pennsylvania site study is planning for its recruitment phase in late 2020. Area water samples have already been collected, Jones says. Researchers plan to enroll 1,000 adults and 300 children who have been exposed to PFAS living near military bases (people exposed on the job are not part of the study). Participants will give blood and urine samples and share their medical histories. “We’ll be looking not only at PFAS concentration in the blood but also other biomarkers,” Jones says. Health measurements taken will include thyroid hormone levels, liver function, hypertension, cholesterol and infertility. Children will be given behavioral assessment tests such as memory games and puzzles. Participants will receive individual test results with their PFAS levels, which they can share with healthcare providers (and information about PFAS will be made available to physicians). The researchers plan to use models to estimate individual residents’ lifetime exposure to PFAS through drinking water.
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The research team will screen participants for eligibility this year and begin data collection in 2021. They plan to report data by 2024. Temple’s Jones and Wilson, along with Grosse, Stanton and Watkins, are looking to raise separate funding to study cancer links. “We know the community is very interested in the possible association of PFAS and cancer,” Jones says. In a separate study, funded by the California-based nonprofit The Water Foundation, Jones and the Buxmont Coalition helped organize meetings with residents around the two military bases outside Philadelphia. Residents in the Bucks and Montgomery county areas affected by PFAS-contaminated water attended focus groups to discuss the real-life psychological and economic impacts they have endured. “Residents aren’t burdened only with health-related problems due to PFAS exposure. They also experience financial and psychological implications, such as higher water bills, concerns about decreased home values, inability to cover medical expenses, and fear of the future health implications for themselves and their children—born and unborn,” Jones points out. Resa M. Jones speaks at a press conference announcing the Pennsylvania component of the multi-site study.
EV ID ENC E M E E TS A DVOCACY In July, at the first of several public information meetings on the federally funded Pennsylvania site study, more than 150 area residents joined online to see a presentation from the project team and ask questions. The Q&A period filled 90 minutes of the two-hour meeting. Residents asked about eligibility to participate and other topics, including possible links between PFAS and COVID-19 severity, as PFAS may affect immune response. Data from the Pennsylvania portion of the study will be combined with the six other sites that received research funding—in California, Colorado, Massachusetts, Michigan, New Jersey and New York—as well as prior data from a New Hampshire study, with the goal of understanding more about connections between PFAS exposure and health outcomes. “It’s going to start building the foundation for other health studies,“ Grosse says. It also may add ammunition as public health advocates battle for stricter regulations: Currently, there is no federal legal limit on PFAS use or the chemicals’ presence in drinking water. The EPA has a non-enforceable health advisory limit (HAL) of 70 parts per trillion for two forms of PFAS that were involved in the
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Teflon case, but “we have science showing us that much lower levels are associated with cancer,” Grosse says. “Joanne and I are fighting for state and federal drinking water regulations for PFAS, so there is an enforceable maximum contaminant level. And we want to get PFAS deemed a hazardous substance under CERCLA (the federal Superfund act) so money is available for its environmental cleanup. These two things alone are like climbing Mount Everest.” The work to bring about change has been slow but increasingly steady. Spurred by the initial EPA advisories, Warminster began closing some of its wells in 2013 and began buying clean water from a neighboring town. The Navy has funded a portion of the filtration systems required to bring Warminster’s own well water to acceptable levels for PFAS. Stanton and Grosse feel they are only at the beginning of a long-overdue remedy. They hope the multi-site study will raise national awareness of the PFAS problem, lead to further investigation and inspire more serious public and private protection of a vital natural resource. “I hope it increases awareness of how important clean water sources are,” Stanton says, “and how vulnerable we are.”
A roadside scene in Montgomery County, Pa.
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CLASS OF 2020 HONORED AT ONLINE CELEBRATION With students distanced to limit the spread of the COVID-19 pandemic, the College of Public Health honored 790 undergraduate and 386 graduate students in the Class of 2020 for their accomplishments in receiving new degrees in a virtual celebration held in May. “Instead of gathering in the Liacouras Center surrounded by about 7,000 people, we’re scattered around the country and the world watching this together,” said Dean Laura A. Siminoff in her opening remarks. In an online video, Siminoff and other speakers congratulated graduates and stressed the heightened value of public health education amid the pandemic. Students’ names were called individually in a virtual procession. Faculty members added video messages to applaud students. Thousands of graduates, family members, friends and teachers watched from their homes. “We are heading into the unknown together,” said Siminoff. “Many of you will immediately take your place in the healthcare workforce. Some of you already have. Whatever you do, I know that you will harness your talent, energy and dedication to make our society a much better place.” Keynote speaker Judy Faulkner, CEO and founder of healthcare technology pioneer Epic Systems, encouraged graduates to be “accidental
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tourists on the river of life,” following their passions as they put their public health education to work. “This commencement marks the time for wings, to take off and fly your best,” she said. “It might feel like a strange time to celebrate…Yet it’s also a time of hope, as we all come together to face this challenge. As public health emergencies continue, your role will be increasingly important. You are joining the fight to keep people well, to protect the health of our world and to save lives.” Veronica Hill-Milbourne, chair of the College of Public Health Board of Visitors, emphasized the vital roles graduates will play as public health professionals. “It’s important for you to understand that as healthcare providers, we don’t run from the fire, we run towards the fire,” she said. “Regardless of the uncertainty that lies in each and every one of our paths, our resiliency and ability to continue to march forward is astounding,” said student speaker Hannah McKinney, who received her bachelor of science in public health. McKinney noted that public health is determined by the welfare of those who are least insured and least protected, by “the floor, not the ceiling… As public health professionals, how do we go about raising this floor?” she asked in her speech. “The college has set us up to address this question, and so much more. We have the ability to create a healthier, stronger, more educated society.”
Emergency Aid Fund provides lifeline to students affected by COVID-19 While the economic impact of the coronavirus Public Health’s Board of Visitors to assist students
pandemic has led to a radical rethinking of the way we live and work, it has also created widespread job layoffs, furloughs and an uncertain outlook for the United States’ economic future. College of Public Health students and their parents have been affected in multiple ways. Many are facing new job insecurity, loss of income or reductions of hours. International students who rely on on-campus employment were unable to seek employment elsewhere. Students who are parents were left to care for children who otherwise would have been in school or in a childcare facility, impacting the number of hours they could work. Alumni, donors and friends of the College of Public Health have generously supported these students through the Student Emergency Aid Fund, which was established in 2016 by the College of
with extreme emergency situations that could result in impeding students’ ability to progress in their studies. From March to September, the college received more than 90 emergency applications related to COVID-19 and has awarded over $22,000 to 45 students. This emergency funding is a vital lifeline for our students, assisting with the cost of food, rent, utilities, medical bills and educational necessities as classes pivoted to online instruction. “Receiving aid from the student emergency fund has helped replace my income from working at Shriners Hospital for Children,” said exercise and sport science student Ryan Paul, whose parents’ finances were also impacted by the pandemic. “This fund has tremendously helped keep me afloat and helped me to finish my semester strong.”
Alumni honored in Temple’s Gallery of Success
Terri Lipman, left.
Paolo del Vecchio.
College of Public Health alumna Terri Lipman and School of Social Work alumnus Paolo del Vecchio were inducted into Temple’s Gallery of Success, which honors alumni who have used their experience at Temple to make an impact in their field. Lipman is a pediatric nurse researcher, educator and practitioner who has dedicated her career to developing strategies to address the disparities in diagnosis, treatment and outcomes of childhood obesity and diabetes. She developed the Community Champions Program to provide opportunities for nursing students to address social determinants of health through community collaboration and created the intergenerational Dance for Health program to increase access to physical activity for over 800 vulnerable children and their families. A nationally recognized expert in pediatric diabetes, she has authored more than 150 scientific publications and is a fellow in the Center for Public Health Initiatives, the Leonard Davis Institute at the University of Pennsylvania and the American Academy of Nursing. Lipman also maintains a clinical practice at Children’s Hospital of Philadelphia. Del Vecchio is a behavioral health expert and national leader with more than 40 years of experience in the profession. He is director of the Office of Management, Technology and Operations at the Substance Abuse and Mental Health Services Administration (SAMHSA). Previously, del Vecchio served as director of SAMHSA’s Center for Mental Health Services, providing executive leadership for federal efforts to improve the nation’s mental health service systems. In this role, he managed the federal and state mental health block grant program and directed a range of programs and activities. Before joining SAMHSA, he worked for the Philadelphia Office of Mental Health in policy formulation and the planning of a comprehensive system of community-based mental health services addressing homelessness, HIV/AIDS and many other issues.
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THE FIN AL WORD
Left: Judy Faulkner, Founder and CEO of Epic. Right, top to bottom: Nicky Quick, Clinical Informatics at Epic; Jackie Gerhart, Director of Physician Engagement at Epic.
Talking healthcare tech with Epic’s public health leaders Judy Faulkner, founder and CEO of Epic, delivered the keynote address at the College of Public Health’s virtual celebration of the Class of 2020 in May. Faulkner grew her company from its beginnings in clinical databases to the nation’s leading provider of integrated healthcare software—all without ever taking the company public. The company has gone on to introduce a number of health technology firsts, including the first successful graphical user interfacebased electronic medical record (EMR), the first integrated patient portal and the first comprehensive health record (CHR) integrating healthcare, mental health, social care, specialty pharmacy, genomics, dental, payers, retail medicine and workplace health. Epic is frequently named overall best software suite by healthcare organizations. We spoke with Faulkner and two of Epic’s public health leaders, Clinical Informatics Physician Nicky Quick and Director of Physician Engagement Jackie Gerhart, about the future of healthcare data, emerging healthcare technologies and more. It has been edited for length.
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As someone who pioneered database technology, why did you choose to stick with a specialization in healthcare data? How has that shaped the direction of your company and your career? Judy Faulkner: I like the saying “Health IT is more complex than rocket science.” It’s challenging, interesting, constantly changing and incredibly meaningful. It’s full of caring, compassionate people trying to make the world a better place. Sticking with health IT was simple because no other area attracted me. Since I was a techie, and not a finance person, I concentrated on writing software that would help health systems and patients, and paid little attention to the money side. That focus helped us be successful.
Many students enter public health fields for altruistic reasons, and they look to the public sector for work. Is there a place for people who want to make a difference in private enterprise? Nicky Quick: Yes, absolutely. It’s important for people with knowledge and experience in public health to work with private enterprises because both sectors are concerned about population and community health. Having a public health background in a private company helps inform this shared goal. For example, private companies like Epic have worked on something called electronic case reporting, which automates communication between healthcare organizations and public health authorities. Public health knowledge helps shape these projects to benefit our communities.
Where do you foresee the greatest opportunities in the public health space in the coming years? NQ: One of the exciting fronts we’re seeing is moving care upstream in a patient’s life for truly preventive care. For example, can we reduce childhood obesity and as a result, reduce chronic disease later in life? Health systems now have tools to move toward targeted, proactive
outreach to at-risk communities and individuals for care that integrates medical needs with behavioral health, social work and community support. Addressing health disparities and ensuring equitable healthcare is one of the biggest challenges and opportunities of our time.
How do you think the rise of telemedicine will impact the skillset that future healthcare practitioners will need? Jackie Gerhart: One benefit of telehealth is that clinicians can better understand their patients’ lives. For example, clinicians might meet a patient’s dog or child, they might see if there is mold on the wall that could be contributing to the patient’s asthma, or they might see rugs on an elderly patient’s floor that she might slip on. Practitioners of the future will need to be cognizant of these new opportunities to provide better care. However, they will also need to be more attuned to subtle cues. For example, it’s harder to notice a tear in a patient’s eye or the rhythmic tapping of his foot due to anxiety.
Is there a risk that emerging healthcare technology helps wealthier populations but leaves lower-income populations further behind? What steps can we take to minimize this gap? JG: Yes, there is a serious risk that lower-income populations won’t be able to keep up with emerging healthcare technology. They may not have access to smartphones that would allow them to communicate with their physicians, see their medical information and participate in their care. Some health systems have found creative ways to help their lower-income populations. MetroHealth in Cleveland has a mobile clinic that provides flu shots and other preventive care in lower-income neighborhoods. In the process, patients are given the opportunity to sign up for Epic’s MyChart portal, which they can access from their own smartphones or community resources like public libraries.
A Volunteers in Medicine clinic in Bend, Oregon, provides free care to uninsured patients, many of whom don’t have internet access. Patients come into the clinic where there’s reliable internet and have a video visit with a provider and an interpreter, who are both at home. The Guthrie Clinic serves many elderly patients living in rural areas who don’t have the technological literacy to navigate telehealth on their own. Clinic staff call patients before their visits and walk them through setting up all the technology, and then call them again half an hour before their appointment to make sure everything is set.
In this time of pandemic, tracking the spread of a disease is more important than ever. That requires information systems, your area of specialty. How is Epic playing a role in the battle against COVID-19? JG: Epic staff developed hundreds of new features—46 percent more than an entire typical software release—to help combat COVID-19. Our software for telehealth, infection control, remote monitoring, PPE tracking and more is available at no cost to our customers during the pandemic. We installed our software at thousands of drive-thru test sites across the U.S. and helped create 92,000 beds in hospitals and at alternate care facilities like Temple’s Liacouras Center, New York’s Javits Center, Chicago’s McCormick Place and the USNS Comfort. Epic helped more than 200 healthcare organizations start using telehealth and remotely trained 5,000 clinicians. Within the first few weeks of the pandemic, Epic created Pulse Central, a near real-time analytics platform that aggregates de-identified data from 1,200 hospitals using Epic across the U.S. The data is summarized into dozens of COVID-19 metrics that are shared with public health agencies.
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Y OUR SUP P OR T IS V I TAL T O OUR S T UDEN T S ’ FU T UR E S The College of Public Health is preparing the next generation of researchers, practitioners and clinicians to solve health’s complexities for a better tomorrow. Our thriving and diverse community is guided by a commitment to social justice and the belief that health is a human right.
Backed by the generosity of several donors, Temple’s College of Public Health is announcing a $200,000 matching gift challenge. Inspired by the college’s extraordinary commitment to education, research and community impact, this challenge provides a limited-time opportunity for Temple alumni, parents and friends to change lives today and in the future through public health. When you make a gift of $10,000 or more to support scholarships for College of Public Health students, we will direct a matching gift of 10% of your gift’s value (up to $10,000) to either the College of Public Health General Scholarship Fund or a newly established named fund for general unrestricted scholarship support. Gifts may be made with an outright contribution or pledged over a period of several years. Matching dollars may not be directed to the principal balance of a named endowed fund but may be allocated to a corresponding spend account for current use. Over the last year, College of Public Health students, faculty and staff have personified Temple’s motto of “Perseverance Conquers.” We could not be prouder of the resilience and commitment shown as we transitioned to online learning this past semester in response to the COVID-19 pandemic. We are also grateful to our friends and alumni, many of whom have reached out to us during these uncertain times wanting to know how they can help. We understand that right now, balancing family and philanthropy can be difficult; that’s why we are excited to announce this opportunity to make a difference. Scholarships and graduate fellowships relieve students of having to obtain employment while pursuing a rigorous degree program and lessen their financial strain following graduation, making a career in health more accessible. Supporting the college’s students through scholarships and graduate fellowships offers a long-term return on investment as these dedicated individuals enjoy impactful careers in public health, clinical healthcare professions and social justice. Act soon to become a partner in fueling the careers of some of the most important professionals in our communities and our world. Matching funds are limited and available on a first-come, first-served basis, so be sure to notify us of your gift before they run out. You can make a difference by investing in a student who will go on to improve the lives of hundreds, if not thousands, of people for generations to come. To learn more about the match challenge and to explore your giving options, contact Natasha de Luna, chief development officer, at 215-694-9964 or natasha.deluna@temple.edu.
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Take the Next Step I N Y OU R C A R E ER The College of Public Health now offers the following graduate degrees fully online: Master of Public Health Master of Social Work MS in Health Informatics MS in Recreational Therapy Clinical Doctorate in Occupational Therapy Doctor of Athletic Training L E A R N M OR E AT C P H . T EMP L E. EDU /ONL INE