InSight Fall 2019

THE UNIVERSITY OF IOWA COLLEGE OF PUBLIC HEALTH

INSIGHT

Targeting New Health Challenges

Fall 2 019

FROM THE DEAN

Public health is not a passive profession—it’s constantly on the move, planning for, responding to, and assessing needs and measuring outcomes for communities and populations living complex and diverse lives. In our ever-changing world, new health challenges are constantly arising, along with old ones that reemerge or stubbornly persist.

This issue of InSight explores several timely issues— farmers’ stress and suicide risk, the health of refugee and immigrant populations, and vaping—that illustrate how closely public health is interwoven with current events. For example, recent extreme weather events and global economic policies have placed added strain on American farmers, a group with suicide rates consistently above those of the general population. Changes in technology such as the newest generation of e-cigarettes are associated with alarming health impacts. The U.S. Surgeon General has called the use of e-cigarettes by young people an epidemic, and an outbreak of severe lung illnesses and deaths linked to vaping is under investigation by the CDC. In such an interconnected world, it’s important for students to broaden their horizons and cultural understanding. You’ll meet two of our students who earned scholarships to study abroad and learn how these experiential learning opportunities strengthened their leadership, research, and problem-solving skills.

Finally, in July this year the College of Public Health marked its 20th anniversary. We’ve grown remarkably in the two decades since our founding, and we’re proud of the many milestones and accomplishments we’ve made in teaching, research, and community service. I’d like to express special thanks to our alumni and friends— your support and involvement are an integral part of our success. The best is yet to come!

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The New Farm Crisis

The college is working with numerous partners to provide resources that address farmers’ stress and suicide risk.

InSight is published twice a year for alumni and friends of the University of Iowa College of Public Health.

Director of Communications and External Relations Dan McMillan daniel-mcmillan@uiowa.edu Editor Debra Venzke Designer Leigh Bradford Marketing and Community Outreach Coordinator Mitch Overton Alumni and Constituent Relations Coordinator Tara McKee Webmaster Patrick Riepe Creative Media Specialist Katy Stites Correspondence, including requests to be added to or removed from the mailing list, should be directed to: Debra Venzke University of Iowa College of Public Health 145 N. Riverside Dr. 100 College of Public Health Bldg., Rm S173 Iowa City, Iowa 52242-2007 debra-venzke@uiowa.edu

Visit our website cph.uiowa.edu

Edith Parker

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Borders, Barriers, and Birth Outcomes

Maternal health sends a strong signal about the well-being of immigrant and refugee populations.

The Rise–and Risks–of Vaping Rising e-cigarette use among teens and a spate of vaping-related illnesses is prompting additional research.

Q & A: Peeling Back the Layers of Banana Production CPH student Madison Stewart traveled to Costa Rica to study pesticides used in banana production.

16 CELEBRATING 20 YEARS

The College of Public Health marked its 20th anniversary in July 2019.

18 HAPPENINGS

News and research findings.

24 CLASS NOTES

Alumni news and notes.

25 GALLERY

A study abroad trip to Denmark opens new perspectives for student Paige Grissinger.

26 SPARK

Alumna Kim Magee reaches new heights in ballooning.

The University of Iowa prohibits discrimination in employment, educational programs, and activities on the basis of race, creed, color, religion, national origin, age, sex, pregnancy, disability, genetic information, status as a U.S. veteran, service in the U.S. military, sexual orientation, gender identity, associational preferences, or any other classification that deprives the person of consideration as an individual.

The university also affirms its commitment to providing equal opportunities and equal access to university facilities. For additional information on nondiscrimination policies, contact the Director, Office of Equal Opportunity and Diversity, the University of Iowa, 202 Jessup Hall, Iowa City, IA, 52242-1316, 319-335-0705 (voice), 319-335-0697 (TDD), diversity@uiowa.edu. W41104 /12-2019

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THE NEW FARM CRISIS

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The College of Public Health is working with numerous partners to provide resources that address farmers’ stress and suicide risk.

BY DEBRA VENZKE

I

owa native and third-generation farmer David Weaver didn’t always work the land.

Before returning to his family’s farm in 2006, he attended college, taught English in Japan, earned a master’s degree, and worked as a college librarian.

He currently partners with his dad and a neighbor to farm nearly 2,000 acres in Boone and Greene counties in central Iowa, mainly raising corn and soybeans. He lives with his wife and daughter on the same acreage where his grandparents once lived.

Weaver was drawn back to farming in part because of the community, he says, but also because “the lifestyle and ability to be your own boss was appealing to me. I really enjoy the responsibility of making decisions on the farm. It’s rewarding to be able to look back after a day of work and feel good about what you’ve accomplished.”

A Perfect Storm But along with the rewards of farming come many stressors—bad weather, low commodity prices, financial worries, long hours, and social isolation can all contribute to feeling overwhelmed.

While some of these pressures are part of the business, recent events such as record flooding and trade wars have created additional strain, notes Brandi Janssen, director of Iowa’s Center for Agricultural Safety and Health (I-CASH) and CPH clinical assistant professor.

“This year has been a perfect storm of really challenging weather and of a particularly unstable political and economic system” that have led to reduced prices and a loss of markets, Janssen says.

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Rural Resources

When asked if she’s hearing more about stress and mental health being a concern in agricultural communities, Janssen answers without hesitation: “Definitely.”

“To some extent, there are similarities to the farm crisis of the 1980s,” she continues. “What is new is the way organizations are responding and trying to be proactive in a way that they were not during the 80s. That, to me, feels like a significant difference.”

Recognizing the Crisis The severity of the current crisis came home for Weaver several years ago when a farmer who lived nearby took his own life. That event “opened my eyes to the fact that it can happen to anyone, anywhere,” Weaver says.

Studies have found that suicide rates in rural areas are higher than in urban settings, a gap that has steadily increased over the past decade.

Additionally, farmers have been identified as a high-risk population, with suicide rates consistently above those of the general population.

“The people most at risk of suicide tend to be middle-aged white men, which dovetails with the demographics of farmers,” Janssen notes. “Farmers 4 INSIGHT FALL 2019

also have access to harm—the vast majority of farmer suicides are with firearms.”

Rural residents face a number of barriers to accessing mental health care, including a lack of providers, insufficient insurance coverage, stigma, and a culture of solving things on their own.

“Farmers are used to being independent and in control of things, so it can be challenging for them to ask for help,” Janssen says.

In October 2019, U.S. Sens. Chuck Grassley (R-Iowa) and Jon Tester (D-Mont.) introduced the Seeding Rural Resilience Act, which aims to curb the rising rate of farmer suicides in America.

“Farmers are increasingly feeling the pain of sinking commodity prices, devastating natural disasters, and ongoing trade disruptions,” Grassley stated in a press release. “That, coupled with the largely solitary nature of farming, has led more and more family farmers to desperation and feelings of hopelessness. This should not be the case. This bill continues important efforts to raise awareness about this issue and provide the assistance necessary to encourage farmers and their families during difficult times.”

I-CASH and the Great Plains Center for Agricultural Heath (GPCAH), directed

by CPH professor T. Renée Anthony, are working together, with producers, and with numerous partners around the state and region to provide resources and facilitate connections that address farmers’ stress and suicide risk.

I-CASH has produced and distributed a number of resources, including a brochure that compiles statewide crisis and suicide prevention hotlines; information about QPR, a short training program that teaches community members how to recognize the warning signs of suicide and refer someone to help; and a video on suicide prevention in rural Iowa.

This spring, I-CASH and GPCAH co-sponsored the Rural Mental Health Roundtable for Iowa stakeholders.

Partners included the Iowa Department of Agriculture and Land Stewardship, CommUnity Crisis Services, and representatives from producer groups, Iowa State University Extension, and mental health service providers. Participants discussed on-farm stressors and options for training community members in QPR and Mental Health First Aid. They also recommended developing a “pocket card” listing signs of stress and referral resources that field agents can hand out to farmers who might be struggling, which I-CASH then created.

A pilot grant from GPCAH helped fund TransFARMation, a podcast and radio program produced by the Minnesota Department of Agriculture and the Red River Farm Network focusing on on-farm stressors. The podcasts have reached at least 35,000 listeners and thousands more have heard the radio broadcasts.

“We are tremendously concerned about the mounting levels of stress

“We need to encourage farmers to talk about stresses and remove the stigma and expectations of conquering problems alone."

in agriculture,” says grant recipient Meg Moynihan from the Minnesota Department of Agriculture. “Our project shares stories of ways farmers experience and cope with financial, emotional, mental, and other stresses.

Listeners find out they’re not alone and learn about resources that could help.”

GPCAH also promoted National Mental Health Awareness month in May, and in August hosted a session on agricultural stressors and mental health concerns in farming communities.

The session was attended by the public as well as staff and volunteers from CommUnity Crisis Services, which helps operate many mental health hotlines in Iowa and nationally.

Informing mental health providers about agriculture can help close an important knowledge gap, Janssen says.

“Most people know very little about farming, even if they’re from a rural area,” Janssen notes. She cites a recent presentation she conducted for mental health providers in Poweshiek County, Iowa. “They said, this is work we don’t know a lot about. They know it’s not 9 to 5, but they don’t really know what type of work farmers do. They’re not familiar with the financial aspects of farming, from how farm programs work to the level of debt that is present in farming, to how astonishingly expensive the equipment is.”

The more providers know about farming, the better they can understand and advise clients who work in agriculture.

Stay Connected Farmers pour their hearts and souls into their work, often carrying on a generations-long legacy. The pressures of mounting debt, unpredictable weather, and low prices while struggling to hold on to the family land can be crushing.

“Farming is a cultural identity, it’s not just a job,” Janssen says.

“You don’t want to be the one to lose the family farm.”

Experts urge anyone experiencing distress or suicidal thoughts to talk to someone—a friend, family member, clergy member, health provider—or to contact one of the many crisis hotlines available 24/7 by call, chat, or text.

The headline on the resource card handed out to farmers reads You Are Not Alone—Stay Connected, a message Anthony wants to emphasize.

“We need to encourage farmers to talk about stresses and remove the stigma and expectations of conquering problems alone,” she says. “Help and support are available.”

Farm Stress Resources

https://icash.public-health.uiowa.edu/farm-stress-resources/

Mental Health Month Materials

https://gpcah.public-health.uiowa.edu/mental-health-awareness-resource/ David Weaver returned to help work his family's farm in 2006.

Podcast

www.rrfn.com/transfarmation/

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Borders, Barriers, and Birth Outcomes Maternal health sends a strong signal about the well-being of immigrant and refugee populations.

By Jennifer New

A

mong the factors that contribute to a positive pregnancy and delivery are access to health care, clear communication between a mother and her medical providers, and a relative lack of stress. For immigrant and refugee mothers, even those who are living in seemingly stable areas, none of these factors are certain or predictable.

Several UI College of Public Health faculty members and graduate students are trying to change this through studying and working with immigrant and refugee populations.

Their research is shedding light on the needs of Iowa’s changing population.

New Populations and Health Disparities According to the American Immigration Council, in 2015, 4.8% of Iowa’s population was born in another country.

These numbers reflect sizable populations who have immigrated to Iowa from Mexico, Central America, Asia, Africa, and Europe, as well as refugees fleeing conflict and violence. Iowa’s labor force is comprised of 5.8% of people born outside the U.S., and the number of English language learners in Iowa public schools has increased dramatically in the last two decades.

What researchers are finding, however, are groups of people whose health does not reflect the level of medical care to which most Iowans have access. At University of Iowa Hospitals and Clinics (UIHC), the discrepancy was particularly evident in the obstetrics outcomes of mothers from the local Congolese population.

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Gudino stresses it is important for health care providers to learn the complex ways in which immigrant and refugee communities care for each other and promote health.

William Story, CPH assistant professor of community and behavioral health, routinely works in sub-Saharan Africa and South Asia to improve access to health care for mothers and children.

When he learned about the issues being faced by Congolese women right in his backyard, he saw it as an opportunity to bring his expertise to his own community.

Creating the Congolese Health Partnership At the end of 2016, Story and a small team launched a crowdsource fundraiser via the University of Iowa’s first “Gold Rush” campaign. They raised more than $10,000 to launch the Congolese Health Partnership (CHP). Their first act was to create a community advisory board and learn more about the Congolese community’s barriers to health care.

“We trained the board members in community-based participatory research,” says Story, “including how to conduct interviews about the needs of the community.”

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Meeting at the Broadway Neighborhood Center in southeast Iowa City, they completed eight focus groups in Swahili and Lingala, the two languages most commonly spoken by the Congolese community.

CHP has since offered multiple educational sessions about child birth in the U.S., prenatal care, and health insurance. Now co-chaired by a health care provider and a member of the local Congolese community, CHP also hosts sessions in which Congolese speakers give context about health and cultural practices from the Democratic Republic of Congo.

Navigating the Health Care System Alka Walter, a UIHC family practice physician and current CHP co-chair, is motivated by the limitations she experiences in the outpatient clinic setting, in which she only has 30 or 40 minutes with a patient—not enough time, she says, when translation of both language and cultural practices are necessary.

Another issue, Walter adds, can occur during labor and delivery when patient consent is needed for procedures like

C-sections or assisted deliveries. The community education sessions provide information about these situations in a non-medical and relaxed setting.

The exact numbers of the Congolese population in the greater Iowa City area are unknown, but some CHP community members estimate it to be around 3,000. Walter notes that this includes people who have applied for asylum, having escaped genocide on the eastern border of their home country, and others who come via a green card lottery system and chose Iowa because of friends and relatives who are already here, as well as the area’s reputation for good schools and work.

However they arrive, most of these newcomers need help navigating the complexities of the American insurance and Medicaid systems, which are major parts of CHP’s work.

The Effects of Immigration Raids Maternal health can be a strong indication of the well-being of a community.

Just as poor obstetric outcomes notified providers in Iowa City of issues facing

Congolese women, so have birth outcomes provided researchers a measure of the effects of Immigration and Customs Enforcement raids on largely rural Latino communities in the U.S. Nicole Novak, a research scientist in the College of Public Health, studies physiological markers of stress, such as the stress hormone cortisol, in U.S.-born and immigrant Latina/os.

She used vital records data to study the birth outcomes of more than 25,000 women who had been pregnant during the 2008 immigration raid in Postville, Iowa, in which 389 workers were detained, the single largest raid on an American workplace at that time.

Supporting the growing evidence about the stress effects of chaotic and traumatic events, Novak and her fellow researchers found no change in pre-term births or birth weights among White moms, but saw an effect for Latinas—whether they were directly involved in the raid or not.

“At a population level, when you see those jumps in adverse birth outcomes,

you know there was a lot of stress in the population,” explains Novak.

“For example, low birth weight and pre-term birth can increase after earthquakes and mass violence.

We know that stress is a risk factor for poor health outcomes. Early birth and low birth weights put a child at risk for multiple developmental issues, such as cognitive and emotional or behavioral development.”

It is important, Novak believes, to remember the effects of immigration policy beyond the border. Currently, she and her collaborator William Lopez, clinical assistant professor in the University of Michigan’s School of Public Health, are partnering with six communities where 30 or more people have been arrested in worksite immigration raids in 2018, including Mt. Pleasant, Iowa.

Novak describes these events as very chaotic, with a lot of similarities to the confusion and distress experienced by those in natural disasters.

She and Lopez have found a pattern of who shows up immediately after a raid: “It’s almost always faith communities, teachers—because raids occur so often when kids are in school, so teachers are almost necessarily involved—lawyers, and Latino/ Hispanic civic groups and advocates,” says Novak. With only one exception, those who noticeably are not among the first responders are local health professionals. In thinking about these raids as a humanitarian, disaster response, Novak hopes to inform the response of health care workers.

Strengths and Challenges The CDC has identified health disparities as a major challenge to the nation’s well-being. One College of Public Health graduate student working with Novak, Juan Gudino, says, “The training in stress biomarkers has helped me understand the cumulative things in your life that shape you.

They’re not as obvious as exposure to a pathogen, but if you are activated and can’t calm yourself down, it really creates wear and tear on your system.”

Echoing sentiments expressed by members of the CHP, Gudino stresses it is important for health care providers to learn the complex ways in which immigrant and refugee communities care for each other and promote health.

Recognizing the positives, such as strong systems of interpersonal support and faith-based traditions, is just as vital as understanding the challenges.

“I’m interested in how people share knowledge to navigate new and unknown systems,” says Gudino, adding that we must recognize how this occurs against the backdrop of immigrants and refugees maintaining and being buoyed by their existing social and cultural practices.

Like Gudino, recent graduate Monisa Saravanan has an interest in global health, which she now realizes she might be able to meet much closer to home. Currently a first-year medical school student, Saravanan worked with Story during her time in the MPH program. “I now see that there are plenty of immigrants in the U.S. who need just as much help and have similar challenges to accessing health care as international populations,” she says.

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THE RISE– AND RISKS– OF VAPING The college is raising awareness of and increasing research into the health hazards of e-cigarettes.

BY DEBRA VENZKE

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inked to an outbreak of severe lung injuries and more than 45 deaths—and declared an epidemic among youth by the U.S. Surgeon General—the use of e-cigarettes and vaping devices

is clouded with troubling questions about safety.

Originally marketed as an alternative for conventional cigarettes, e-cigarettes entered the U.S. market around 2007. The battery-powered devices heat a liquid—typically containing nicotine, flavoring chemicals, and other additives—and produce an aerosol that users inhale and exhale.

In the last two years, e-cigarette use has skyrocketed among youth.

In 2018, CDC and FDA data showed that more than 3.6 million U.S. youth, including 1 in 5 high school students and 1 in 20 middle school students, had vaped in the past month.

E-cigarettes have evolved into sleek (and easy to conceal) designs that often resemble USB flash drives or pens. Vaping liquid or “e-juice” is available in dozens of kid-friendly flavors like strawberry, mango, and mint.

Users often mistakenly think that e-cigarettes create a harmless water vapor. In reality, the vapor contains harmful substances including nicotine, cancer-causing chemicals, volatile organic compounds, heavy metals, and ultrafine particles. Some vaping products contain THC, the psychoactive ingredient in marijuana, which has been linked to most of the reported lung injury cases.

Raising Awareness Well before the first death associated with vaping hit the news, the lack of public awareness around the detrimental health effects of e-cigarettes struck a note with Vickie Miene, interim director of the Iowa Institute of Public Health Research and Policy (IIPHRP) based in the College of Public Health.

She began talking with other colleagues to gauge their interest in the topic of vaping. Finding a receptive audience, Miene soon had a list of national experts recommended to her, and plans for a series of community presentations and activities began to take shape. Collaborating with a diverse set of campus and community partners, the IIPHRP developed the series “Vaping: The New Look of Nicotine Addiction.”

“It grew out of these grassroots conversations,” Miene says about the programs. “The goal of the series is to raise awareness about what is known about the health effects of vaping. We also need more research to fully understand the health impact of e-cigarettes.”

One of the first activities was a “speed networking” event held in collaboration with the UI Research Development Office that brought together investigators from across campus who are interested or involved in e-cigarette and/or vaping research. The event was so successful, Miene says, that the IIPHRP plans to fund an interdisciplinary research group called a collaboratory focused on vaping and e-cigarettes next year.

During the fall, two public lectures and panel discussions about vaping drew large crowds of parents, school representatives, policymakers, and community members. Additional presentations are in development for spring 2020.

A Surge in Vaping The startling rise in e-cigarette use among U.S. middle school and high school students between 2017 and 2018 prompted Wei Bao, CPH assistant professor of epidemiology, and colleagues to take a closer look at e-cigarette use among U.S. adults during the same time period.

In a previous study, Bao and colleagues found that from 2014 to 2016, the number of adults who tried e-cigarettes increased. However, during the same time, the number of people who said they currently use e-cigarettes “every day”

or “some days” decreased. The trends may suggest that some individuals are trying but not continuing use of e-cigarettes, Bao notes.

In the new analysis, the researchers found that the decline in current e-cigarette use among adults continued to 2017 but was reversed between 2017 and 2018. A significant increase in current e-cigarette use between 2017 and 2018 occurred among young adults aged 18 to 24 years old, but no such increase occurred in middle-aged or older adults.

The alarming increase in vaping among young people “may be at least partly attributable to the recent popularity of pod-based e-cigarettes, such as the Juul brand,” Bao and his coauthors wrote in their research letter published in JAMA Internal Medicine. They continue, “The marketing and sales of e-cigarettes have changed sharply; Juul sales have surged since its introduction in 2015, with the brand capturing the greatest market share by 2017. With a discreet design and abundant types of flavors, Juul e-cigarettes are appealing to young people but also concerning because of their high nicotine content.”

A single prefilled liquid nicotine Juul cartridge, or pod, contains as much nicotine as a pack of cigarettes.

No Safe Tobacco A single prefilled liquid nicotine Juul cartridge, or pod, contains as much nicotine as a pack of cigarettes. Nicotine is highly addictive and can harm adolescent brain development, which continues into the early to mid-20s, the CDC cautions. Young people who use e-cigarettes may be more likely to go on to use regular cigarettes.

As for traditional cigarette smokers, there is mixed evidence that e-cigarettes may be effective for helping smokers quit in some specific cases. The long-term health impacts of using e-cigarettes to try to quit are largely unknown, and the devices are not approved by the FDA as a smoking cessation aid.

“The only way to assure that you are not at risk while the investigation continues is to consider refraining from use of all e-cigarette, or vaping, products,” the CDC advises.

The agency further adds, “There is no safe tobacco product.

All tobacco products, including e-cigarettes, carry a risk.”

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PEELING BACK THE LAYERS OF BANANA PRODUCTION Madison Stewart, a second-year MS student in occupational and environmental health, spent two weeks in Costa Rica in May 2019 researching the production of one of her favorite foods—bananas. Specifically, she was interested in the occupational health impacts of pesticides used on the fruit.

Her trip was made possible through a grant from the Pulitzer Center Reporting Fellowship, which offers students a unique opportunity to further their understanding of a global health topic of their choice and develop high-level communications skills to publicize the significance of the issue to general audiences.

Although Stewart had traveled internationally before, she had never done so with an academic focus. It also was her first time traveling abroad on her own. She recently answered a few questions about her trip and reporting project.

What inspired you to apply for the Pulitzer reporting fellowship?

I’ve always wanted to go on a travel abroad trip, but never had the opportunity before starting my master’s program.

My original undergrad major was English, and I had the intention of becoming a journalist. However, I later changed my major to environmental science because I enjoyed it much more. When I saw the Pulitzer fellowship, I thought it would be the perfect opportunity to combine two of my favorite subjects.

Can you describe your reporting project – what you were investigating, how you got interested in the subject, and how you made contacts for the story?

My project was on pesticide application on banana plantations. I learned in a class years ago that bananas were extremely difficult to grow and had already gone commercially

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Madison Stewart (pictured far left) photographed the stages of banana production.

extinct once before. From my agricultural safety and health classes, I knew pesticide handling and application was also a critical public health topic. Combining the two seemed very intuitive, and when I dived into the research I found that it was a huge occupational health issue. I’m also a person who eats a banana every day and wanted to better understand my impact as a consumer on occupational health.

Making contacts for the story consisted of research, research, and more research. I contacted the principal investigators (PIs) of the research studies I found and crossed my fingers and hoped I got a response. Diane Rohlman, a professor in my department, actually knew one of the PIs and helped connect us, which was extraordinarily helpful. The PI, Dr. Berna van Wendel de Joode, was actually one of the most informative interview participants I had.

I also reached out to NGOs, non-profits, commercial plantations, etc. I ended up touring multiple commercial plantations while I was there and interviewing their managers. They walked me through the entire production process and showed me how they were protecting worker health.

What did you discover while working on the project?

The problems of pesticide over-application were much more broad than the research showed. In a way, I believe seeing the problem firsthand helped me to better understand its depth. There are so many facets to the issue and there are no simple solutions.

Insecticidal bags are tied around the plants to keep bugs off the bananas and are put on as soon as the fruit begins to form. The insecticide within the bags is known to aerosolize and travel quite a distance, posing an inhalation hazard for both workers and the public.

However, two of the plantations I visited were doing their best to produce bananas sustainably and in a way that was safe for workers. The ingenuity of the banana industry was pretty amazing. Each plantation had its own laboratory 13 INSIGHT FALL 2019

where they researched new ways to combat pests. One had started growing their own microorganisms to inject into the leaves to prevent fungal disease and reduce fungicide application. With this method, they had actually reduced their volume of fungicide application by 30 percent.

Was there a language barrier for you, and if so, how did you work around that?

Yes, there was quite a language barrier. I studied Spanish for over 10 years in school, but hadn’t used it in about two years, so I was rusty. I practiced on an app each night the semester before I left, but I found being fully immersed in Spanish once I got there to be the most helpful. Most of my vocabulary came back within a few days so I was able to shop, ask for directions, and order food. However, for the interviews, most were in English because my interview participants were perfectly fluent.

For one last-minute interview, I had to find a translator because no one on the plantation spoke English. I asked the manager at my hotel if they could recommend any employees and I would compensate them for a day of interviewing. She recommended a really great man named David who helped me out a lot. We rented a car and toured the plantation together while he did his best to interpret. I gave him all of the background info on my project so he was able to ask a lot of his own informed questions as well.

Fun side story: David and I actually tried to go tour the plantation after a heavy rain. We had to leave at 4 a.m. to make it there on time, and the maps app took us on a back road through the jungle. The road was gravel and my rental

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car was pretty tiny and didn’t have a lot of horsepower.

As you could expect after a heavy rain, we got stuck in the mud in complete darkness, no cell reception, and in the jungle. It was pretty terrifying!

A farmer came by on an ATV and helped us get out of the mud (you could tell he was pretty used to such things).

However, I couldn’t understand any of the Spanish he was using! I was so lucky to have David there because unfortunately in high school Spanish, they don’t teach you the directions for getting a car out of the mud. We had to reschedule the tour for the next day.

What form did your final project take?

My final project consisted of a video, written article, and a slide show. The article has been accepted for publication in Johns Hopkins Bloomberg School of Public Health’s Global Health Now.

How will this experience help you as you continue on in your education and career?

This project was an incredible experience! Traveling abroad alone was an opportunity for self-discovery and conquering fears. I grew a lot both as an individual and as a researcher/ student. I definitely enjoyed the more hands-on approach of working in the field and gathering one-on-one interview data.

As of now, I’m currently implementing what I learned about interviewing in the methods section of my master’s thesis.

I’m very grateful to the Pulitzer Center and the college’s Global Public Health Initiative for granting me this experience.

Majors: Public Health and International Relations Involvement: University of Iowa Student Government; College of Public Health Diversity, Equity, and Inclusion Committee; Iowa Agni A Capella; 24:7 Campus Ministry Scholarship: College of Public Health Dean’s Scholar

GIVE A STUDENT ACCESS TO IOWA

Highly engaged students like Anna exemplify the deep commitment to community service that is a hallmark of public health. You can bring Iowa’s top-quality public health education within reach for other outstanding students by supporting scholarships in the College of Public Health.

Learn more by contacting College of Public Health Director of Development Madelynn Krall at madelynn.krall@foriowa.org or 319-467-3645, or you can make a gift online.

givetoiowa.org/2020PQ99 15 INSIGHT FALL 2019

Celebrating 20 Years

Thank you to our alumni, friends, and public health community!

In the 20 years since its founding on July 1, 1999, the College of Public Health has steadily developed into one of the nation’s premier schools of public health. With its roots originating in the former Department of Preventive Medicine and Environmental Health and Graduate Program in Hospital and Health Administration, the college continues to build on these rich traditions while forging new paths in public health teaching, research, and service.

“I’m extremely proud of our faculty, staff, students, and alumni who have made the college so successful in its first two decades,” says Edith Parker, dean of the college. “I look forward to our strong future knowing that we have such collaborative, talented, and dedicated people who are passionate about improving the well-being of Iowans and communities around the world.”

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A Few Facts:

top 20

The CPH is ranked among the public health schools and programs by U.S. News and World Report.

2,605 degrees and certificates from

The college granted December 1999 to June 2019.

$762 million

CPH researchers have brought in in external research funding as principal investigators between July 1, 1999 and June 30, 2019.

20

interdisciplinary centers The college is home to that engage in a diverse range of activities and research.

12 of our centers are funded through highly-competitive federal agency grants (NIH, CDC, HRSA, SAMHSA).

The UI College of Public Health is Iowa’s accredited school of public health.

In August 2019,

only

543 students were enrolled in the college.

first

The undergraduate students to earn their bachelor’s degrees from the College of Public Health will graduate in December 2019.

14,600

More than individuals participated in CPH continuing education programs in FY19.

Since 1999, the College of Public Health has received

5,500

private philanthropic more than gifts to support programs and infrastructure.

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HAPPENINGS

Rising Breast Cancer Incidence among Young Women New research from the College of Public Health documents important differences in breast cancer incidence and survival based on cancer subtype among young women.

Led by Paul Romitti, professor of epidemiology, the study found certain subtypes—particularly hormone receptorpositive (HR-positive) high-grade cancer—are increasing and associated with reduced 10-year survival among young women. HR-positive cancer contains proteins that allow estrogen and progesterone hormones to attach, fueling cancer growth. High-grade compared to low-grade cancer cells tend to grow and spread more quickly.

Romitti notes the research has important clinical implications. Younger women more frequently experience care delays due to a variety of circumstances, such as lack of screening and less access to care. In addition, younger women’s dense breast tissue makes radiographic detection of cancer more difficult. As a result, their cancer may be diagnosed at a later stage. Most current breast cancer screening guidelines recommend starting mammography screening at age 40 or 50 for women with average breast cancer risk.

“We hope these findings will guide further evaluation of preventive, diagnostic, and therapeutic strategies for breast cancer among premenopausal women,” Romitti says.

The study was published in the Journal of the National Cancer Institute Cancer Spectrum. In addition to Romitti, other University of Iowa investigators include Anthony Rhoads, Elizabeth Pinkerton, Mary Schroeder, Kristin Conway, Jacob Oleson, and Charles Lynch. The research team also included Lacey McNally from Wake Forest University and William Hundley from Virginia Commonwealth University.

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CURBING OPIOID USE University of Iowa pain researchers are part of a major national initiative that aims to improve treatments for chronic pain, curb the rates of opioid use disorder and overdose, and achieve long-term recovery from opioid addiction.

Kathleen Sluka, professor of physical therapy and rehabilitation science, has received two grants totaling almost $13 million through the National Institutes of Health Helping to End Addiction Long-term (HEAL) Initiative, designed to improve prevention and treatment strategies for opioid misuse and addiction and enhance pain management.

Christopher Coffey, professor of biostatistics and director of the Clinical Trials Statistical and Data Management Center, will collaborate with Sluka and other UI colleagues on a four-year, $6.5 million award from the National Institute of Neurological Disorders and Stroke to establish a Clinical Coordinating Center for the Acute to Chronic Pain Signatures (A2CPS) Program.

The consortium’s goals are to identify biomarkers and biosignatures—patterns of biomarkers—that can predict whether a person is susceptible or resilient to the development of chronic pain following acute pain. The hope is that being able to identify people at risk of transitioning to chronic pain could improve the management of acute pain by personalizing treatment, reducing reliance on opioids, and identifying new therapeutic targets.

Alcohol Recovery Outside of Treatment College of Public Health researchers have been awarded a $2.27 million grant from the National Institute on Alcohol Abuse and Alcoholism to study adults with alcohol use disorder (AUD) who achieve remission without obtaining professional treatment.

Paul Gilbert, assistant professor of community and behavioral health, is the principal investigator on the study. Anne Helene Skinstad, clinical professor of community and behavioral health, and Grant Brown, assistant professor of biostatistics, are co-investigators.

According to the project summary, less than one-quarter of adults with AUD ever obtain treatment, but the majority will achieve remission at some point. Untreated recovery has been long recognized but is poorly understood.

The study will investigate how people define recovery when they don’t seek treatment, the behavior change strategies leading to resolution of a drinking problem without treatment, and how untreated recovery may vary by gender and race/ethnicity.

The long-term goal of the research is to expand the repertoire of responses to problem drinking.

The findings may be used to develop and test novel low-threshold interventions to promote recovery among people who are unable or unwilling to seek specialty treatment services.

Improving Maternal Health Care in Iowa University of Iowa maternal health experts, in partnership with the Iowa Department of Public Health (IDPH), have received a five-year, $10 million grant from the Health Resources & Services Administration to improve maternal health outcomes in the state.

Iowa is one of nine states to receive a State Maternal Health Innovation Program grant. The award will be used to create and implement innovative strategies to address disparities in maternal health and improve maternal health outcomes, with a particular emphasis on preventing and reducing maternal death and severe maternal illness.

Stephen Hunter, professor of obstetrics and gynecology, is

the principal investigator and Kelli Ryckman, associate professor of epidemiology, is a co-investigator. The team includes UI faculty in the Departments of Obstetrics and Gynecology and Epidemiology, and IDPH staff.

The aims of the grant including addressing the shortages of qualified obstetrical providers across the state; creating new systems for delivering quality care to make access less of an issue, including expanding telehealth services; improving education of providers delivering prenatal care; and helping local hospitals be better prepared and equipped to provide obstetric and prenatal care.

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HAPPENINGS

Using Chocolate to Investigate Overeating Adaeze Enekwechi Honored with UI Distinguished Alumni Award The University of Iowa named College of Public Health alumna Adaeze Enekwechi (07PhD in health services and policy) a recipient of its 2019 Distinguished Alumni Award in the Recent Graduate category.

She and other award recipients were recognized at a ceremony and reception on Oct. 18.

A health care executive who served in the White House during the Obama administration, Enekwechi is widely admired for tackling complex policy challenges and studying how the health system can work for everyone, particularly vulnerable populations.

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The taste perceptions that influence which foods we choose to eat and how much of those foods we consume may be significantly different in obese people, according to a study by a University of Iowa research team.

The study, published in the Journal of the Academy of Nutrition and Dietetics, found that when people were asked to eat pieces of chocolate and rate the taste of each piece on a scale from 0 to 10, people who were obese—having a body mass index (BMI) of 30 or higher—rated each piece higher than people who were overweight (BMI of 25 to 29) or normal weight (BMI lower than 25).

While previous studies of this kind have relied on studying participants who eat an entire meal or a large quantity of one particular type of food and reporting levels of satisfaction before and after consumption, the UI team borrowed the concept of diminishing marginal utility from economics in an attempt to gauge whether quantifying satisfaction from food in a more granular fashion can be helpful in explaining what drives a person’s decision to stop or continue eating.

“Diminishing marginal utility applies to any kind of consumption, not just food,” says Aaron C. Miller, CPH assistant professor of epidemiology. “The more you consume something, the less you like it or the less pleasure you get from it. But that has never really been studied in food in the continuous time frame we used.”

“If our findings are generalizable to other foods, they may help inform future interventions,” says Linnea Polgreen, associate professor in the College of Pharmacy. “Strategies aimed at reducing obesity may need to account for differences in the perceived taste.”

JANICE ELLIG HOSTS SCHOLARSHIP RECIPIENTS IN NEW YORK Continuing her legacy of student mentorship and advocacy for women leaders in the workplace, University of Iowa alumna Janice Ellig welcomed 17 graduates of the UI Department of Health Management and Policy to New York City in August for a weekend of networking, career guidance, and social interaction.

The guests of honor were all recipients of a scholarship Ellig established 20 years ago in memory of her sister. The Adrienne Astolfi Eddins’ Health Management Scholarship is awarded each fall to an entering female student in the College of Public Health’s Master of Health Administration program.

Ellig is chief executive officer of the Ellig Group, a leading firm in the executive search field whose practice focuses on identifying, recruiting, developing, and onboarding more diverse executive talent for senior-level appointments.

Electronic Health Records and Team Communication A research team led by Xi Zhu, CPH associate professor of health management and policy, will study patterns of information sharing among health care professionals in electronic health records (EHR) systems.

The project, funded by the Agency for Healthcare Research and Quality, will examine EHR-based communication in virtual care teams and the relationship between EHR communication networks and quality of care.

“Today’s health care professionals often work as virtual care teams— a variety of practitioners providing care to the same patients, but working at different times and locations—all connected through the EHR,” says Zhu. “Yet, it’s not clear how the EHR is impacting communication and teamwork among them and how those factors might affect the quality of care that patients receive.”

The project will seek to develop methods for measuring the communication that takes place within EHR networks, and then examine associations between EHR communication and patient outcomes, such as hospital re-admissions, emergency department visits, and mortality.

Other members of the research team include Daniel Sewell, CPH assistant professor of biostatistics, as well as investigators at Virginia Commonwealth University and University of California–Davis.

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HAPPENINGS Preventing Falls Researchers from the University of Iowa have received a $3 million grant from the Centers for Disease Control and Prevention to conduct a four-year study examining falls of elderly people. The study’s co-principal investigators are Carri Casteel, College of Public Health associate professor, and Korey Kennelty, College of Pharmacy assistant professor.

“Falls are a leading cause of unintentional injury among older adults,” says Kennelty. “Certain medications, including many that affect the central nervous system, increase the risk of an older adult experiencing a fall. We know these high-risk medications should be discontinued in our older patients, but how to do it is unclear. Our study will address that.”

The team is conducting a pilot study that will focus on 50 older adult patients (65 years and older) from two rural medical clinics in Iowa. The pilot will test study workflows and processes, including the effectiveness of documents used to educate and inform medical professionals and study patients.

Medications of particular interest are those that research has shown place older adults at more risk for falls. These medications include opioids, benzodiazepines, and anticholinergics (e.g., antihistamines). A second prong of the study will track automobile accidents of study participants.

RESEARCHERS WARN OF EXTREME HEAT Just weeks after July 2019 became the hottest month in 140 years of record keeping, science faculty and researchers from Iowa colleges and universities have endorsed the ninth annual Iowa Climate Statement 2019: Dangerous Heat Events to Become More Frequent and Severe.

The statement, signed by a number of CPH faculty members, warns of sobering extreme heat projections for the region. Based on the most up-todate scientific sources, the statement makes clear the urgency of preparing for dangerously hot summers in coming decades.

“Heat is the leading cause of weather-related deaths in the U.S.,” says Peter Thorne, CPH professor and head of occupational and environmental health. “Iowans that work outside will need to take special precautions.”

Highlights from the statement include: • By midcentury, temperatures in Iowa will exceed 90 degrees F 67 days per year, compared to a 23-day average in recent decades.

• By midcentury, the average daily high temperature for each year’s hottest five-day period will be 98 degrees, compared to 92 degrees in recent decades.

• Once per decade, five-year average high temperature will be 105 degrees.

• Confined livestock are at increased risk for death and widespread productivity losses.

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CDC Funds New Statewide Biomonitoring Program A new project led by the Iowa State Hygienic Lab will analyze the presence of environmental hazards in well water and households across the state. The award, which includes $728,016 in funding for the first year of the project, is one of six projects funded by the Centers for Disease Control and Prevention for statewide biomonitoring programs.

Biomonitoring is the direct measurement of environmental chemicals in people’s blood and urine, indicating the amount of chemical that actually enters the body from all environmental sources. Iowa’s new biomonitoring program will examine three hazard categories: naturally occurring contaminants, agricultural chemicals, and industrial chemicals.

“Biomonitoring data can inform important public health decisions,” says Susie Dai, environmental lab director at the State Hygienic Lab. “By launching a new statewide biomonitoring program, we will be better positioned to access exposures of concern in Iowa communities and identify at-risk populations.”

“The expanded biomonitoring program in Iowa will enable the State Hygienic Laboratory and the local public health departments to provide accurate and high-quality data that can inform state and local decision-makers,” adds Michael Pentella, director of the State Hygienic Laboratory.

“The funds will also be used to provide important training to laboratory staff members and local public health professionals.”

The project is a collaboration between the State Hygienic Lab with the Iowa Department of Public Health, the University of Iowa Hospitals and Clinics, University of Iowa College of Public Health, Center for Health Effects of Environmental Contamination, Iowa Poison Center, Iowa Criminal Investigation Lab, and ten local health departments.

Waist Size Often a Forgotten Health Factor A University of Iowa study finds that some people considered to be a normal weight could unknowingly be at high risk for obesityrelated health issues.

The study, published in the Journal of the American Medical Association’s JAMA Network Open, finds that a subgroup of people who are considered to be normal weight as measured by body mass index (BMI) could actually be at high risk for death because of their waist size.

Wei Bao, CPH assistant professor of epidemiology, says that according to current clinical guidelines, physicians need rely only on BMI to determine obesity-related health risk. This leaves people who are actually in a high-risk group because of other risk factors, such as percentage of body fat, thinking they’re healthy.

“The results suggest we should encourage physicians to look not only at body weight but also body shape when assessing a patient’s health risks,” says Bao. The study used data from the Women’s Health Initiative.

Bao and his team linked mortality rates to the respondents’ BMI as well as their central obesity, which is the excess accumulation of fat around a person’s midsection. Central obesity has been linked to an array of health problems and is measured by waist circumference.

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CLASS NOTES KATHLEEN M. ANDRUCH (17MPH) is a city research scientist for the New York City Department of Health and Mental Hygiene’s Public Health Laboratory.

PAUL KING (83MA) is president and CEO of Lucile Packard Children’s Hospital Stanford and Stanford Children’s Health in Stanford, California.

KAITLIN BOYLE (12MHA) is a market manager at HCA Healthcare Physician Services Group in Denver, Colorado.

DAVID NELSON (17MHA) is chief of staff at UnityPoint Health in Des Moines, Iowa.

SIERRA BURRELL (18MPH) is the USDA Animal and Plant Health Inspection Service Veterinary Services One Health Liaison to the Centers for Disease Control and Prevention.

KELLEY DONHAM (70MS) was awarded the 2019 Karl F. Meyer– James H. Steele Gold-Headed Cane Award at the American Veterinary Epidemiology Society meeting.

T.K. EVERETT (14MHA) is director, national accounts, at naviHealth in Atlanta, Georgia.

ROBERTO FERNANDEZ (07MPH) is a physician at St. Luke’s Regional Cancer Center in Duluth, Minnesota.

ADAM HEADLEY (09MHA) is director of finance at Intermountain Healthcare in Salt Lake City, Utah.

MEGAN HICKS (05 Certificate) joined the FDA Center for Tobacco Products as a public health analyst in 2019.

JANELLE JACOBSON (05MPH) is an assistant professor, Department of Public Health and Human Performance, and coordinator of the MS degree program in community health at the State University of New York at Potsdam in Potsdam, New York.

JANET KANG (13MHA) is a senior consultant at Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma, and Texas in Chicago, Illinois.

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CORMAC T. O’SULLIVAN (08PhD) received the 2019 Program Director of the Year Award from the American Association of Nurse Anesthetists for making a significant contribution to the educational process of student nurse anesthetists. He currently serves as associate clinical professor and director of the DNP Anesthesia Nursing Program at the University of Iowa College of Nursing in Iowa City, Iowa.

MORGAN PRICE (15MS) is a human factors design engineer at Apple in San Francisco, California.

SAMANTHA REED (10MHA) is system administrator, Orthopedics & Neurosciences, at Memorial Health System in Springfield, Illinois.

DOMINICA REHBEIN (14MPH, 14MHA) is group practice director, Department of Orthopedics, at Henry Ford Health System in Detroit, Michigan.

BRIAN RICHARDSON (15MHA) is managing director, Operations Support Services, at Kaiser Permanente in San Bernardino, California.

JAMISON ROBINETT (19MHA) is an administrative resident at HCA Mountain Division in Salt Lake City, Utah.

AMY SCHUMACHER (17PhD, 13MS) is a health scientist at the Centers for Disease Control and Prevention in Atlanta, Georgia.

CASSANDRA SPRACKLEN (14PhD, 11MS) is an assistant professor at the University of Massachusetts Amherst in Amherst, Massachusetts.

KATE SWANIC (16MHA) is the manager of clinical performance at Optum in Denver, Colorado.

TUAMAMI TAMINI (13MS) is the manager of IT project management at Exact Sciences in Madison, Wisconsin.

MINDI TENNAPEL (15PhD, 10MS) is an executive officer 2 - research, director of the Statistical Analysis Center at the Iowa Department of Human Rights in Des Moines, Iowa.

KELLI TODD (12MPH) has been named president and CEO of the Iowa Chiropractic Society in Des Moines, Iowa.

LEAH WENTWORTH (16PhD) is the director of student wellness for the State University of New York (SUNY) System in Albany, New York.

■ IN MEMORY ALLEN HICKS (55MA), a pioneer in the health care industry and former CEO of six hospital systems, passed away on July 25, 2019.

COL. WILLIAM O. VOGEL, USAF (Ret), (51BA, 57MA), of San Ramon, California, died Oct. 16, 2019.

SHARE YOUR NEWS Have you started a new job, received an honor or award, or achieved a noteworthy milestone or accomplishment? Share your professional news and updates with fellow College of Public Health alumni! Submit your news to tara-mckee@uiowa.edu with Class Notes in the subject line.

Be sure to include your year of graduation, department or program, and contact information so we can follow up with any questions.

GALLERY

A Small Town World-Traveler

Paige Grissinger, a third-year public health major and aerospace studies minor from Savanna, Illinois, was awarded a competitive Benjamin A. Gilman International Scholarship, sponsored by the U.S. Department of State.

She used her scholarship to study this fall in Denmark.

Why did you decide to study in Denmark?

I’m studying in Denmark because it’s the happiest place on earth! I hope to grasp an understanding of their culture and grow as an individual and leader. Being from a very small town, I did not ever envision myself as a world traveler, but now that it’s happening it feels surreal. I intend to learn as much as I can while in Copenhagen.

How do you envision this experience impacting your future/career?

I hope that the skills I learn abroad will make me a better leader in the Air Force ROTC program here at the University of Iowa, and eventually as an Air Force officer. Understanding other cultures will make me a better public health professional.

Why is studying abroad important to you?

I look forward to studying abroad and experiencing a culture different from my own. It’s important that I do this because my career could take me anywhere, and I’d like to experience international travel for the first time on my own terms before the military. This will allow me to grow as an individual and see new perspectives.

Text and photo courtesy of UI International Programs.

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145 N. Riverside Dr. 100 College of Public Health Bldg., Room S173 Iowa City, Iowa 52242-2007

SPARK

UP, UP, AND AWAY

Kim Magee is shown piloting a “cloud hopper” in January 2019. She reached an altitude of 10,243 feet and flew 62.1 miles in frigid temperatures, breaking previous records.

Not many people would feel at ease soaring 10,000 feet above the earth tethered to a balloon, but for pilot and CPH biostatistics alumna Kim Magee (15MS), the sky is practically a second home.

Throughout the year, she and her husband travel from their home in Swisher, Iowa, to ballooning events. While some flights are just for fun, others are competitive. Magee has achieved six world records and nine national records for flights in smaller, single-passenger balloons specially designed to attain altitude and distance.

Magee continues to seek out new flying challenges. In addition to her license to fly lighter-than-air aircraft, she recently earned a license to pilot single-engine airplanes.

“I like to push myself to see how much better I can be, and see how much more I can learn,” she says. “Ballooning has taken my husband and me all over the world.”

But Iowa remains a favorite place to fly. “People are super friendly,” she says. “It’s a lot of fun being a balloonist in Iowa.”

Watch Kim take flight: www.youtube.com/user/uiowapublichealth