The University of Iowa College of Public Health
FALL 2021
FROM THE
DEAN
Looking back at the past year filled with ups and downs, most of us are still figuring out the new normal. COVID-19 still overshadows much of our hybrid/virtual/in-person lives, but expanded eligibility for vaccinations and boosters, new treatments, and increased understanding of the virus are reasons to be hopeful. Throughout the pandemic, many professions have been working tirelessly to keep our families, workplaces, and communities safe, but I’d like to specifically recognize the dedication and courage of the public health workforce. Local public health workers have put in long hours, fought misinformation, and endured angry comments or even threats as they perform their jobs. This stress has taken its toll over time, with many practitioners experiencing burn out or leaving the workforce. In this issue, we explore the importance of supporting the mental health and well-being of the “invisible frontline” of public health workers, and what resources are needed—from budgets and staffing to time off—to help workers recover and thrive. We also examine the serious problem of health misinformation and efforts to help social media platforms, organizations, and individuals evaluate credible sources of information. We have an insightful Q&A with Professor Peter Thorne about climate change and the role of the EPA, a profile of alumna Elizabeth O’Neal and her research that blends injury prevention and developmental psychology, and a look at our three NIOSH-funded centers that are dedicated to protecting worker health and safety.
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
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 S257 Iowa City, Iowa 52242-2007 debra-venzke@uiowa.edu Visit our website cph.uiowa.edu
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Looking ahead, the University of Iowa will celebrate its 175th anniversary in 2022, with special events and activities planned throughout the academic year. Founded on Feb. 25, 1847, the UI is the oldest and largest university in the state. Faculty, staff, students, alumni, and friends can stay informed about the anniversary by checking 175.uiowa.edu, which will be updated with more information and events as they become available. I hope you all can take time this holiday season to relax, restore, and renew your energy, and I look forward to another exciting and productive year.
Edith Parker
FALL 2021 INSIGHT
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 Institutional Equity, the University of Iowa, 202 Jessup Hall, Iowa City, IA 52242-1316, 319335-0705, oie-ui@uiowa.edu. WW001331/12-2021
CONTENTS
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12 2 BURNED OUT The stresses of the pandemic have increased the mental health needs of the public health workforce.
6 MANAGING MISINFORMATION The alarming uptick in health misinformation is a “serious threat to public health,” says the U.S. Surgeon General, but there are steps to counter the problem.
10 THE ROAD TO INJURY PREVENTION Postdoctoral research fellow Elizabeth O’Neal’s selfdescribed “nontraditional route” to injury prevention blends developmental psychology and public health.
12 Q&A: THE CHALLENGES OF CLIMATE CHANGE Professor Peter Thorne discusses climate change, the role of the EPA Science Advisory Board, and actions to reduce global warming.
2 18 HAPPENINGS News and research findings. 24 CLASS NOTES Alumni news and notes. 26 SPARK The college celebrated a sunny Homecoming.
16 SUPPORTING SAFER WORKPLACES Three CPH centers funded by NIOSH provide research and education to protect worker health and safety.
COVER ART: ANTONIO RODRIGUEZ/STOCK.ADOBE.COM
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BURNED OUT The stresses of the pandemic have increased the mental health needs of the public health workforce. BY DEBRA VENZKE
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THE COVID-19 PANDEMIC
has been detrimental to many people’s mental health, with the stresses on workers in health care, education, and other essential services frequently highlighted. Less often, however, has attention been focused on the mental health needs of the public health workforce that has been in the trenches 24/7 since the beginning of the pandemic. Public health is the “invisible frontline,” says Lina Tucker Reinders, executive director of the Iowa Public Health Association. She compares the nonstop demands of the pandemic to a blizzard. “There’s overtime for the road crew, long hours, and it’s stressful—that’s been the pandemic for local public health for more than 19 months,” she says. “They’ve had no time off, they haven’t seen their families and friends.” On top of their other duties, public health workers have to stay up to date with changing guidance about the virus and regularly answer questions from the media and the public, Tucker Reinders says. Many staffers also have had to deal with threats and verbal abuse. “They’re getting calls, sometimes from people with basic questions, other times those calls are angry and vitriolic,” she says. And there’s never a break; they might get peppered with questions or remarks from neighbors while out grocery shopping. “Everyone knows you work in public health in a small community,” she says. Danielle Pettit-Majewski (10MPH), director of Johnson County Public Health in Iowa City, Iowa, is bluntly honest about the effect of pandemic stress on the workforce. “Public health workers are burned out,” she says. “I know I myself struggled with PTSD, anxiety, and memory loss during my response to
the pandemic. I’ve heard from other colleagues that they have considered leaving public health or retiring early. It’s been absolutely exhausting and we’ve never been given the kudos our colleagues in health care have, despite all of our efforts.” ADDRESSING WORKFORCE NEEDS
Pettit-Majewski is not alone in her experience. A report published in the CDC’s Morbidity and Mortality Weekly Report (MMWR) in July 2021 revealed that among 26,174 state, tribal, local, and territorial public health workers surveyed in MarchApril 2021, 53% reported symptoms of at least one mental health condition in the past two weeks. Respondents reported depression (32%), anxiety (30.3%), PTSD (36.8%), or suicidal ideation (8.4%). Symptoms were more prevalent among those who were unable to take time off or worked 41 or more hours per week. The survey found that prevalences of symptoms of depression and anxiety among public health workers were similar to those in previous reports among health care workers; however, prevalence of PTSD symptoms among public health workers was 10% to 20% higher than that previously reported among health care workers, frontline personnel, and the general public. “When we saw that report and from what we were hearing anecdotally, we had to pick up the mantle and address this,” says Tucker Reinders. The survey “really started to shed light on just how important this was,” adds Laurie Walkner,
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co-coordinator of the Midwestern Public Health Training Center (MPHTC) and interim director of the Institute for Public Health Practice at the University of Iowa College of Public Health. “No one really delved into the needs of the public health workforce until the survey results were published in MMWR in summer.” In response, the IPHA and MPHTC organized a workshop addressing the topic. Held on Aug. 24, 2021, the workshop was geared toward leaders of public health departments with the purpose of normalizing and validating conversations around employee burnout and mental health, as well as developing skills and tools to foster healing. The in-person workshop was held in Des Moines with attendance capped at about 24 participants to maintain social distancing. “We had some good conversations and presentations on burnout recognition and acknowledging and talking about how to have these conversations with staff members,” says Walkner. “In the afternoon session, we could really focus on what was going on in the health departments. What were people doing? How did they start these conversations? What are ways that we can support each other in this?” FATIGUE AND FINDING BALANCE
As part of the workshop, both Pettit-Majewski and Brad Brake, director of Harrison County Home & Public Health in western Iowa, shared insights about their own personal and professional experiences. “As someone who lives with mental illness, pandemic or no pandemic, I have had to be extremely proactive and flexible with my own mental health,” says Brake. “This has entailed increasing to weekly therapy appointments and more frequent medication checkups with my physician. I’ve had to lean heavily on my colleagues and staff for support these last few years in order to keep focus on making sure we are doing everything possible to slow COVID transmission in the community. “As for what I am seeing from employees and colleagues—fatigue,” he continues. “Fatigue of the pandemic. Fatigue from lack of supports. Fatigue
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from having to carry on with the ‘typical’ duties in tandem with the pandemic response. Fatigue of fighting misinformation and all of the local vitriol that can come with that. It’s more than understandable that we are seeing a mass exodus of public health workers either through retirement or through other opportunities. This fatigue is leading to depression, anxiety, PTSD, and apathy. We, as a state, need to be more proactive in how we are taking care of the workforce.” Tucker Reinders and Walkner say they have received positive feedback and evaluations of the workshop. The event “was so beneficial that we’re bringing in some of the same speakers to present to our staff during a retreat,” adds Pettit-Majewski. “I’ve also had lots of conversations with my staff about finding balance and ensuring they take time to recover when they’re not at work.” Brake is also supporting his staff in as many ways as possible. “You name it—I’m trying it,” he says, ticking off approaches such as relaxing the office dress code, increasing flexibility with weekly work schedules, adding staff to cover additional hours as needed, and holding an all-staff “mental health retreat” day to focus on burnout prevention and self-care practices. He also has staff complete burnout assessments and talk to him if their score hits a certain threshold. Brake stresses the importance of taking vacation and mental health time. “The pandemic will be here. Take the time you need to recharge.” THREATS TO PUBLIC HEALTH
The MMWR report provided a much-needed sliver of insight into the challenges and exhaustion facing the public health workforce as the pandemic drags on. Making the situation even more discouraging is the hostile reaction to public health measures by segments of the public. In the MMWR survey, respondents reported receiving job-related threats because of work (11.8%), and feeling bullied, threatened, or harassed because of work (23.4%). In October 2021, the National Association of County and City Health Officials (NACCHO) wrote to the U.S. Attorney General strongly urging the Justice Department to include public health department
AT LEAST 300 PUBLIC HEALTH DEPARTMENT LEADERS HAVE LEFT THEIR POSTS SINCE THE PANDEMIC BEGAN, IMPACTING 20% OF AMERICANS.
officials and staff in a federal effort to protect school-related personnel from the increased risk in harassment, intimidation, and threats of violence. The letter states: “While the pandemic has brought greater appreciation by many to the importance of public health and the people who work in the field, too many health department leaders and their staff have experienced threats to their jobs, their safety, and their family members. These threats have come from community members, organized (and armed) anti-government militias, and politicians. … These threats have taken a toll: at least 300 public health department leaders have left their posts since the pandemic began, impacting 20% of Americans.” An October 2021 New York Times article dug into the issues posing a crisis to the U.S. public health system, including loss of staff, an increase in laws limiting state and local health powers, lack of community support, and concerns about funding levels. The authors concluded that their “review of hundreds of health departments in all 50 states indicates that local public health across the country is less equipped to confront a pandemic now than it was at the beginning of 2020.” Tucker Reinders echoes the concerns about budget and staffing, citing a report by the de Beaumont Foundation and Public Health National Center for Innovation. The report estimates that
state and local public health departments need nearly 80,000 more full-time equivalent positions just to meet basic health requirements. She advocates for an increase in unrestricted resources dedicated to public health departments to hire staff and provide relief to overworked staff. “We need resources for people to access mental health care,” she adds, noting that she’d also like to replicate the mental health workshop and offer it around the state. REMAINING RESILIENT
Even in the current challenging climate, most public health workers remain committed to their mission. “Despite the fact that we’re in year two of a pandemic, now is an incredibly exciting time to be in public health,” says Pettit-Majewski. While public health has long been “discussing among ourselves how social determinants of health and health inequities lead to adverse health outcomes, the pandemic has given everyone in the world a front row seat to how that looks in real life,” she says. “Now is a time to use our advocacy skills and plan for how we can implement public health practices that will close those gaps and make our communities more resilient in the next disaster.”
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Managing Misinformation The alarming uptick in health misinformation is a “serious threat to public health,” says the U.S. Surgeon General, but there are steps to counter the problem. BY DEBRA VENZKE
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LIKE MOST PUBLIC HEALTH PRACTITIONERS, Robert Niezgoda has encountered a variety of myths and
conspiracy theories about health issues throughout his career. Currently a doctoral student in epidemiology in the University of Iowa College of Public Health, Niezgoda previously served as the director and emergency response planner for Taney County Health Department in Missouri. “The current situation with COVID-19 vaccine misinformation reminds me of what occurred during the 2009-2010 H1N1 pandemic,” he recalls. “Misinformation was circulating regarding the vaccine as the mass vaccination efforts started. Many of the misinformation talking points were similar to what we’ve been hearing today—the vaccine wasn’t tested; manufacturing was rushed; the vaccine contained monkey blood, microchips, and so on.” There were also rumors about “military quarantine of entire cities or that there would be vaccination requirements to drive from one region of the country to the next,” he says. “This created a lot of difficulties with mass vaccination.” Even without a pandemic to navigate, it can be challenging to sort through the deluge of health messages received from social media, television, friends and family, and hundreds of other sources. While much of this information is credible, a significant portion is inaccurate at best, and dangerous at worst. Misinformation isn’t a new phenomenon, but with the growth of the internet and social media, it can be amplified and spread more rapidly than ever before, easily leaping beyond geographic boundaries. The current alarming explosion of misinformation around COVID-19 prompted the U.S. Surgeon General to issue an advisory in July 2021, which warned: “Health misinformation is a serious threat to public health. It can cause confusion, sow mistrust, harm people’s health, and undermine public health efforts. Limiting the spread of health misinformation is a moral and civic imperative that will require a wholeof-society effort.” DISINFORMATION AND MISINFORMATION
The advisory defines misinformation as “information that is false, inaccurate, or misleading according to the best available evidence at the time.” Related but distinct is disinformation, defined as “misinformation spread intentionally to serve a malicious purpose, such as to trick people into believing something for financial gain or political advantage.”
While medical treatments, vaccines, climate change, and diet/nutrition are some the many subjects that have been saturated with both disinformation and misinformation over the years, the tobacco industry is one of the most notorious offenders of using disinformation for financial gain. In addition to using unsubstantiated claims and misleading language in its advertising, Big Tobacco has flat out lied to the public. “The tobacco industry knew that nicotine was addictive, and they testified in Congress in 1994 that it was not,” says Shannon Lea Watkins, CPH assistant professor of community and behavioral health, who studies tobacco and e-cigarette use. She and other researchers are looking at what type of tobacco and e-cigarette messages are being spread on social media. “Increasingly, pro-tobacco content is not coming directly from the industry, but it’s coming from influencers and peer-to-peer communication,” she says. Watkins is currently working with a team of students on several papers that examine how e-cigarettes are discussed in social media. One paper is looking at changes in e-cigarette use and perceptions around the beginning of the COVID pandemic when it was unclear if vaping increased the risk or severity of the disease. “In an information vacuum where there’s no clear messaging from public health and it’s too early to have empirical evidence yet, [social media] becomes a discussion platform where people are trying to process and understand what’s true,” Watkins says. “A lot of untruths are discussed there.” INSIGHT FALL 2021
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Few social media platforms attempt to differentiate between credible and non-credible sources of health information, leaving consumers to make their own judgments.
THE ROLE OF SOCIAL MEDIA
Nearly 3 out of 4 Americans search online for health and medical information, and 82 percent of the U.S. population had a social networking profile in 2021. However, few social media platforms attempt to differentiate between credible and non-credible sources of health information, leaving consumers to make their own judgments. Misinformation can proliferate in part because we tend to surround ourselves with like-minded people online and in real life, creating an “echo chamber” that reflects and reinforces our own viewpoints and beliefs. Additionally, social media algorithms serve up similar content based on what we’ve previously viewed or shared, creating “reinforcement loops” of information. Misinformation also frequently has a powerful emotional component. As the Surgeon General’s advisory explains, misinformation “is often framed in a sensational and emotional manner that can connect viscerally, distort memory, align with cognitive biases, and heighten psychological responses such as anxiety. People can feel a sense of urgency to react to and share emotionally charged misinformation with others, enabling it to spread quickly and go viral.” IDENTIFYING CREDIBLE SOURCES
While individuals are responsible for what they view and post, there’s a growing call for social media platforms to take additional steps to counter misinformation. In early 2021, the National Academy 8
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of Medicine (NAM), with funding from YouTube, convened an independent advisory committee that focused on developing a set of principles for identifying credible sources of health information in social media. Sue Curry, College of Public emeritus dean and distinguished professor of health management and policy, was a member of the independent advisory committee that authored the resulting NAM Perspectives discussion paper published in summer 2021. Social media platforms “have an important opportunity—and a growing responsibility—to intervene, not only to counteract harmful trends, but also to enhance consumers’ access and exposure to high-quality, science-based health information,” the authors write. The paper focuses specifically on the evaluation of sources of health information, rather than content. The authors propose that a credible source of health information should meet three foundational principles: it should 1) provide information that is consistent with the best scientific evidence available at the time, 2) be objective, and 3) be transparent and accountable. Although the paper is geared toward informing the policies of social media platforms, organizations that share health information through social media as well as members of the public can also benefit from the guidance.
The paper also addresses the need for additional strategies to supplement source evaluation, including content assessment, management of misinformation, health literacy, and other ethical and public health considerations. Sifting through the complex interplay of these dynamics posed a daunting task for the authors. “The most challenging aspect was knowing that principles and attributes for credible sources is necessary but not sufficient for addressing health misinformation in social media,” says Curry. “Identifying credible sources is just a first step and needs to be augmented by ensuring that the content or health information itself is based on sound evidence.” Although it’s difficult to distill the paper into one main takeaway, “Given the focus on sources, I’d say a key message is ‘consider the source’ when presented with health information,” Curry advises. “Trustworthy sources share science-based information without financial incentives and with transparency about where the evidence comes from.” INCREASING UNDERSTANDING
Efforts to slow the spread of COVID-19 have been hampered by widespread misinformation about public health measures such as vaccination and masking. Not only are hospitals and health systems strained by the consequences of pandemic misinformation, but so are family and community relationships. “Unfortunately, we are now in a most undesirable situation where an extreme level of mistrust and disrespect exists such that even the most basic communication is problematic,” says Niezgoda. “It can be difficult to have conversations with family and friends who might not share your values or trust in science,” says Natoshia Askelson, associate professor of community and behavioral health. She studies health communication and behavior change and has worked on several projects addressing vaccine hesitancy. “It is important to recognize their concerns and try to understand what might be influencing their hesitancy—is it a concern about safety, or a distrust in science or the government, or a belief in a myth about COVID-19? Trying to figure out what is driving the hesitancy can point to what they might need to hear to change their
opinion. It is possible to move people who are vaccine hesitant to a place of more confidence and intention to get the vaccine.” Many people who share misinformation aren’t purposely trying to misinform, the Surgeon General’s advisory points out. Instead, they may be raising a concern, making sense of conflicting information, or seeking answers to honest questions. “We need to try to respectfully understand those who are being influenced by these messages,” adds Niezgoda. Ridiculing or ostracizing people, especially if it’s done by community leaders and elected officials, “will only create more divisiveness while strengthening beliefs in the misinformation,” he cautions. “If we increase our understanding of one another, we’ll be better able to develop respectful and effective communication strategies.” In today’s hyper-connected and polarized environment, it can feel like an uphill battle to counter falsehoods and conspiracies about health and other topics. But we can all take a few simple steps to avoid spreading misinformation. Before hitting that send or retweet button, verify the accuracy of information by checking with trustworthy and credible sources, and, perhaps most importantly, follow a simple rule: If you’re not sure, don’t share.
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The Road to Injury Prevention
Postdoctoral research fellow Elizabeth O’Neal’s (16MPH) self-described “nontraditional route” to injury prevention blends developmental psychology and public health. Parents are an important source of education and guidance as children learn to navigate the world independently. Elizabeth O’Neal researches the role that parents play in teaching kids about safe behavior, whether it’s crossing streets, driving a car, or assessing other potentially dangerous situations. O’Neal is currently a postdoctoral research fellow in the Department of Psychological and Brain Sciences, the Injury Prevention Research Center in the College of Public Health, and the National Advanced Driving Simulator at the University of Iowa. She uses virtual environments to study these parent-child interactions with the goal of developing interventions to prevent childhood injuries.
Exploring New Avenues O’Neal completed a PhD in developmental psychology in 2018 and an MPH in 2016 at Iowa. “I had a nontraditional route to get here,” says O’Neal, who earned a BA in communications with an emphasis in public relations at Mississippi State University. Following graduation, she worked in sales, then opened a small business in Birmingham, 10 FALL 2021 INSIGHT
Alabama, with her brother. Unfortunately, she says, “The timing was not good.” After a promising first year, the 2008 economic crisis hit and they were forced to close the business. “I started exploring new avenues,” she says. “I enjoyed the business world but didn’t love it, and decided I wanted to go back to school and pursue a degree in psychology.” While completing a post-baccalaureate program at the University of Alabama at Birmingham, she volunteered at a lab that conducted injury prevention studies. The experience sparked her interest in research. “We were using virtual environments to train children to safely cross streets, which is why I ended up applying to the developmental psychology program at Iowa,” O’Neal says. “Professors Jodie Plumert and Joe Kearney had a very sophisticated virtual environment.” Once she was at Iowa, O’Neal connected with the Injury Prevention Research Center and started attending the center’s informal networking meetings. She soon realized that psychology and public health often approach the same problems in injury
tenure-track or equivalent faculty positions. Professors Corinne Peek-Asa and Jodie Plumert are O’Neal’s primary and secondary mentors, respectively.
Safer Teen Drivers
PHOTOS BY TOM LANGDON AND JUSTIN TORNER
prevention, “but we talk about them very differently,” she says. Attending the IPRC meetings and taking several injury prevention courses cemented her decision to pursue an MPH along with her doctoral degree.
Making a Difference O’Neal enjoyed research, but “I didn’t want to do research just for discovery’s sake,” she says. “I really wanted it to have an impact and make a difference. Injury prevention felt like a field in which I could do that. The work I was doing at UAB made that really clear to me. We can develop behavioral interventions that change injury risk in childhood.” O’Neal’s research has included using developmental science and the Hank Virtual Environments Lab (pictured above) to safely study children’s roadcrossing behaviors and parent conversations with their children around road safety. She also worked with the IPRC during her graduate studies on two school bus crash projects, and her doctoral dissertation focused on parent-child interactions related to pedestrian safety among children with and without ADHD. In 2021, O’Neal was awarded a prestigious K99/R00 Pathway to Independence Award from the National Institute of Child Health and Human Development. The award helps outstanding postdoctoral researchers complete needed mentored training and transition in a timely manner to independent,
The purpose of O’Neal’s project is to study the impact of parental instruction and teen drivers’ ability to identify and respond to potential road hazards. The first phase of research currently underway is examining and describing parent-teen conversations about hazard identification and mitigation. The second and third phases will develop and then test an intervention that teaches parents to better communicate with their teens about identifying potential hazards on the roadway. “As part of my postdoc, I was evaluating novice teen driver training programs that were meant to teach teens to anticipate potential hazards on the roadway,” O’Neal explains. “This is something that novice teen drivers aren’t very good at. During the learner phase of licensure, there are almost no crashes with teens behind the wheel. What we see as soon as teens are driving without supervision, that crash rate spikes really high, and it starts to slowly come down over the first 18 months of licensure. So there’s some sort of disconnection between what’s happening while kids are learning to drive, and then what they’re learning from experience.” There isn’t much research on this topic, O’Neal says, but a few studies show that parents don’t engage in a lot of conversation around teaching kids to anticipate what’s going to happen next. “We found from our pedestrian work that when parents do that, behavior is better,” she says. “I want to create a parent-focused intervention that helps teens acquire this skill during the learner phase of licensure.” During the third phase, the study will bring in teens to drive in the National Advanced Driving Simulator and look at differences between groups who receive the intervention and those who don’t. Although the research project is still in its early stages, the work so far is promising. “Anecdotally, we’re seeing parents give their kids lots of great information [about identifying potential hazards],” O’Neal says. “It tells us parents can do this, they just need the right tools.” INSIGHT FALL 2021 11
PHOTO BY K AT Y STITES
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THE CHALLENGES OF CLIMATE CHANGE
BY DAN MCMILLAN
In August 2021, Peter Thorne, professor and head of occupational and environmental health, was named to the Science Advisory Board (SAB) of the U.S. Environmental Protection Agency (EPA). He previously served on the SAB from 2011-2017 and served as its chair from 2015-2017. The board provides scientific expertise and recommendations for environmental quality standards and other policies intended to protect public health and the environment. Thorne recently answered questions about climate change, the role of the SAB, and what actions are needed to reduce global warming. The environmental agenda today is heavily focused on concerns about Earth’s changing climate. What role does the EPA have in developing science related to climate change and advancing initiatives to address the health effects of a warming climate? The Supreme Court ruled in Massachusetts vs. EPA that the EPA has the authority under the Clean Air Act to regulate greenhouse gas emissions because they “cause or contribute” to global warming and “may reasonably be anticipated to endanger public health.” EPA has a major role to play in efforts to reduce emissions. Unbiased, sound science is the foundation of EPA regulations and the Science Advisory Board exists to ensure that EPA is applying the most cutting-edge science in all its decision making.
As the United States transitions from a fossil fuelbased electricity and transportation infrastructure to renewable energy systems, we will see significant health benefits associated with reduced air pollution. Many EPA regulations require an integrated science assessment, cost-benefit analysis, and extensive review. The future health benefits of actions to mitigate climate change are complex to quantify. The EPA relies on peer-reviewed science, its own experts, and its advisory boards in formulating and evaluating this rule making.
At the EPA, where does climate change rank among the many priorities before the agency and the SAB? Two broad areas have risen to the top and really emanate from President Biden’s campaign promises. The first is programs and policies to mitigate greenhouse gas emissions and to prepare for the impacts of climate change. The second is delivering environmental justice to ensure that low-income people and people of color will no longer bear the heavy burden of exposures to environmental toxicants. These two areas are related because environmental justice includes climate justice. We know that people of low socioeconomic status already suffer from climate change more than those with greater means. Another major effort is to restore the scientific integrity of the EPA which suffered from undue political influence during the last administration.
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Evidence continues to mount that a warming climate adversely impacts human health across a wide spectrum. A recent study co-authored by Iowa researchers, for instance, found that drought conditions were a major contributor to increased stress among Midwest farmers. What other areas of health are environmental researchers looking at through the lens of climate change? The evidence of global warming and anthropogenic (human-caused) climate change is overwhelming and irrefutable. There are eight major impacts of climate change on the health of the public. These are extreme heat events, more frequent and severe weather disasters, increased air pollution, increased vector-borne infectious diseases, expanding respiratory allergy, rising sea levels, impaired water quality, and environmental degradation leading to forced migration and civil conflict.
Despite widespread scientific agreement that the Earth is getting hotter, that human activity is the primary cause of this warming, and that our planet and its residents face dire consequences without immediate action to avert further warming, political and economic leaders have struggled to adopt policies to combat climate change. What more can scientists and the public health community do to influence policymakers to make the changes needed to avoid worst-case outcomes? Scientists, the public health community, and health care professionals need to step up and inform the public and their patients that climate change is an existential threat to humankind and is the grandest challenge of the 21st century. People need to vote for candidates who understand this and have concrete plans to address climate change. We should preferentially support companies that are working to develop clean energy, e-vehicles, and green technology. Folks can easily lower their own carbon footprint and encourage others to do the same. Actions such as adopting active commuting,
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making our homes more energy efficient, reducing our consumption of beef, rejecting fast fashion, and reducing air travel can make a difference.
As someone who studies this area extensively, what policies do you think would get us the most “bang for the buck” when it comes to reducing carbon emissions? Should we ban internal combustion engines? Plant a billion trees? Paint every roof white? Tax carbon? All of the above or something else? If we are to hold global warming to a 2°C (3.2°F) increase over pre-industrial conditions, we need to make dramatic and immediate reductions in greenhouse gas emissions. The U.S. has the highest per capita carbon footprint of the major countries of the world and has the second highest total carbon emissions after China. Of course, China has 3.7 times the population of the U.S. We need to move quickly away from fossil fuels to renewables. We need to rebuild our infrastructure to be much more energy efficient. We can do those things you mentioned such as plant trees and make roofs more reflective, but we also need to recover wasted energy from our electricity generation and industrial sector. Two-thirds of the energy we generate is wasted and the technology exists to recover much of this. If we were to adopt a carbon tax and incentivize innovation, that would help propel us to the new technologies. We could retire our antiquated coal-fired power plants and grow green energy at a much faster rate.
The SAB has been a subject of controversy in recent years. In 2017, former EPA Administrator Scott Pruitt removed several academic scientists from the SAB and the agency’s other advisory boards. This year, EPA Administrator Michael Regan announced a “reset,” removing more than 45 members of the agency’s advisory boards, including some whose terms were not yet expired. To what extent do you feel the SAB has been “politicized”? How are political crosswinds impacting the work of the board and of EPA?
The Science Advisory Board and the Clean Air Scientific Advisory Committee are established by statute. What Mr. Pruitt did was unprecedented. Several federal judges ruled that the procedures he and his successor, Andrew Wheeler, used to disqualify academic scientists from science advisory boards and committees violated the Federal Advisory Committees Act. So current EPA Administrator Regan really needed to reconstitute these committees to correct this abuse and comply with the law. I think the EPA has returned to procedures that have been followed by Democrats and most Republicans since its inception in 1970. It is never smooth sailing for a regulatory agency but the seas have certainly calmed. The reset SAB has 47 outstanding scientists who have complied with all ethics and disclosure rules and are now doing the job of evaluating the science that drives EPA actions.
The city of Seville in Spain recently announced that it would begin naming and ranking heat waves, much like forecasters do for hurricanes, as a way to call attention to the health risks of extreme heat. Is this a gimmick? What do you think of this and other novel approaches to raise awareness about the dangers of climate change? Are there other steps leaders are talking about—or should be taking—to create urgency around climate action? It is important to track these climate exacerbated extreme events as they become more frequent and more severe. In the U.S. we have witnessed a steady increase in annual billion-dollar disasters. We name these—some are hurricanes like Katrina and Sandy and some are wildfires like the 2018 Camp Fire and the 2021 Dixie Fire. Similarly, it makes sense to name extreme heat events and track their impacts. The estimated death toll from the 2003 European heat wave was 70,000 people, so we do need to raise awareness of these events and understand that they are arising because of anthropogenic global warming.
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Supporting Safer Workplaces Three CPH centers funded by NIOSH provide research and education to protect worker health and safety. BY JENNIFER NEW
THE COVID-19 pandemic has made many people more aware of and appreciative for the professionals who research and protect workplace safety. Their expertise on everything from ventilation and how aerosols spread to best practices for managing remote workers has been critical to the operation of airlines, hospitals, schools, restaurants, fitness centers, office buildings, and every other manner of public interaction. Many who work in this area have the National Institute for Occupational Safety and Health (NIOSH) to thank for either their degree or their research funding. Take Justin Newnum, for example. Throughout the past year and a half, the University of Iowa occupational safety specialist has been busy developing methods to protect the university’s essential workers and keep critical health clinics open. 16 FALL 2021 INSIGHT
In 2010, he earned an MS degree from the UI College of Public Health’s Industrial Hygiene Program, based in the Department of Occupational and Environmental Health. It was not a degree or professional path he had anticipated; however, following an undergraduate degree in environmental science, he learned about graduate school opportunities with funding provided by NIOSH. The area appealed to Newnum for personal reasons: his grandfather died as the result of asbestos exposure as a shipyard worker. A full-ride scholarship from the UI’s NIOSH-funded Heartland Center for Occupational Safety and Health sealed the deal and brought him to Iowa, where he still lives, now sharing his expertise as a UI employee. Patrick O’Shaughnessy, professor of occupational and environmental health, directs the Heartland Center and the training grant
that funded Newnum’s graduate education. O’Shaughnessy notes that the UI is the only institution in the country that is home to three NIOSH-funded centers, which brings particular advantage and distinction to the campus and state. “These centers are massively advantageous to the university,” he says. “They help us maintain research and funding, perform outreach and continued education, and train professionals needed by our state and region.” FIFTY YEARS OF GREATER SAFETY
Currently celebrating its 50th year, NIOSH is an agency of the Centers for Disease Control and Prevention. It was created by the Occupational Health and Safety Act (OSH Act) of 1970 to provide independent, objective research concerning worker well-being and to translate it into practice. The act also established the Occupational Safety and Health
Administration (OSHA), responsible for making and enforcing new regulations to protect workers who had previously been viewed all too frequently as expendable. Prior to OSHA, there was little safety regulation in the workplace. Exposure to chemicals, dangerous machinery, loud noises, and other hazards routinely harmed and even killed American workers. As OSHA provided for greater oversight of workplaces, NIOSH was formed to deepen research about workplace hazards. Today, the three NIOSH-funded centers at the UI provide a triad of service to Iowa and the Midwest region: § The Heartland Center for Occupational Health and Safety is one of 18 centers training future workplace health professionals like Newnum and providing continuing education for current practitioners. § The Great Plains Center for Agricultural Health, directed by Renée Anthony, professor of occupational and environmental health, is one of 11 centers conducting research and providing outreach to prevent agricultural illness and injury.
advocates. Around a third of the students trained in the UI’s occupational health and safety programs remain in the state after graduation, protecting workers throughout Iowa. The UI centers serve Federal Region 7, which includes Iowa, Nebraska, Missouri, and Kansas. To address worker protection needs throughout this area, these centers conduct research to answer questions about protecting both rural and agricultural workers across the region. IMPACT ON WORKPLACES
Workers in every occupation, whether they are teachers, health care workers, farmers, or meatpacking processors, have all benefited from the highly trained professionals and researchers produced by the UI College of Public Health. These researchers are on the forefront of looking toward current and emerging hazards.
How Americans work and what they do are changing rapidly. The manufacturing jobs with high levels of injury that led to greater workplace protections over the past century are being replaced by service and technology-rich sectors. These occupations may not have the same kind of dangers as an assembly line, but all work has inherent threats. The COVID pandemic exposed the mental health toll that remote work can sometimes take on unsupported workers. The shadow of the opioid crisis continues to hang over the construction industry. Workers throughout the agricultural sector face elevated safety risks as production equipment and operating costs grow. “How do we safeguard workers in the future?” asks Rohlman. It’s a question that is as pertinent today as when NIOSH was formed a half century ago. Read more about the centers’ work at bit.ly/3hG0f2u.
§ The Healthier Workforce Center of the Midwest, directed by Diane Rohlman, professor and Endowed Chair in Rural Safety and Health, is one of 10 centers conducting research and outreach to address worker well-being. These centers perform research on issues that face workers across multiple industries and they disseminate their research findings to employees, employers, and a variety of health and safety INSIGHT FALL 2021 17
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New Center Addresses Trauma and Resiliency in Native American Children and Families College of Public Health researchers have been awarded a $3 million grant over five years by the Substance Abuse and Mental Health Services Administration to establish and support a new center, the National American Indian and Alaska Native Trauma and Service Adaptation Center (TSA). The goals of the TSA are to increase the national infrastructure and workforce capacity to prevent, reduce, and treat trauma as well as to increase wellness and resilience among American Indian and Alaska Native children, adolescents, and their families. The TSA will be housed within the Native Center for Behavioral Health, which is a research center in the Department of Community and Behavioral Health at the UI College of Public Health committed to developing programs to support the behavioral health workforce in Native American and Alaska Native communities across the country. “Importantly, our efforts will not endorse the inevitability of adverse outcomes,” says Anne Helene Skinstad, director of the Native Center for Behavioral Health and the program director for the new center. “The center will prioritize identification and dissemination of programs and approaches that seize the opportunities presented in early childhood and adolescence as an optimal time for prevention and intervention to mitigate trauma and promote resilience.”
Campaign Encourages COVID-19 Vaccinations in Iowa Communities The University of Iowa Prevention Research Center for Rural Health (UI PRC), Iowa Public Health Association, and Iowa Immunizes have collaborated on a new “mini-campaign” to increase COVID-19 vaccinations. The campaign was developed in response to the rise of the Delta variant that is making some unvaccinated people reconsider vaccination against the virus. The campaign was created by a team at the UI College of Public Health that specializes in health communication for behavior change. It was informed by conversations with local public health leaders, youth-serving organizations, small businesses, faith leaders, and other community representatives. The messages and images, like the one above, were also tested with a review panel that included members from Iowa communities. “The campaign is not intended to move hesitant folks, but motivate those that ‘just haven’t gotten around’ to getting the vaccine,” says Natoshia Askelson, deputy director and co-principal investigator of the UI PRC. The messages have been placed in movie theaters, paid social media, newspapers, and free papers in Iowa micropolitan areas—urban areas with a population of at least 10,000 but fewer than 50,000 people. The UI PRC is also freely sharing the campaign materials via social media and with community partners in micropolitan areas.
Healthier Workforce Center of the Midwest Awarded Renewed Funding The Healthier Workforce Center of the Midwest, based in the University of Iowa College of Public Health, has received renewed funding from the National Institute for Occupational Safety and Health (NIOSH) to continue researching the evolving connections between work and health. The federal grant is expected to total more than $6 million over five years. Directed by Diane Rohlman, professor of occupational and environmental health, the center focuses not only on changes at the individual worker level, but also policies and programs to change work climate and culture. The Healthier Workforce Center addresses emerging issues and high-risk, high-need populations in employers of all sizes in the predominately rural Federal Region VII (Iowa, Kansas, Nebraska, and Missouri). It is one of 10 NIOSH-funded Centers of Excellence for Total Worker Health. The Total Worker Health® approach collectively addresses workplace hazards to create a safer and healthier workplace and reduces the impact of injury and illness on businesses and communities. The center is a regional collaboration among the University of Iowa, Washington University in St. Louis, the University of Kansas Medical Center, WorkWell Kansas, and two NIOSH Total Worker Health Affiliates: the Nebraska Safety Council and the St. Louis Area Business Health Coalition. INSIGHT FALL 2021 19
Rural Americans Are Dying of COVID at Higher Rates than Their Urban Counterparts Rural Americans are dying of COVID-19 at higher rates than their urban counterparts—a divide that health experts say is likely to widen as access to medical care shrinks for a population that tends to be older, sicker, heavier, poorer, and less vaccinated. While the initial surge of COVID-19 deaths skipped over much of rural America, where roughly 15% of Americans live, nonmetropolitan mortality rates quickly started to outpace those of metropolitan areas as the virus spread nationwide before vaccinations became available, according to a report from the RUPRI Center for Rural Health Policy Analysis. Keith Mueller, director of the center, and Fred Ullrich, research analyst with the center, co-author the regularly updated report. The earliest surge in the pandemic (spring 2020) largely took place in metropolitan areas (both incidence and mortality), according to the report. The second surge (summer 2020) saw increases in incidence and mortality in both metropolitan and nonmetropolitan areas. However, it was at that time that nonmetropolitan incidence and mortality
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rates surpassed those in metropolitan areas. Both rates were higher in nonmetropolitan areas during the third surge until its peak in January 2021. Following that peak, metropolitan and nonmetropolitan rates declined in similar fashion with incidence rates (for both geographies) levelling off in the spring and then declining until July 2021. At that time incidence rates started rising sharply with mortality rates following suit in August. Although that surge appears to have peaked in late September, incidence and mortality rates remain much higher in nonmetropolitan counties than those in metropolitan counties, according the report published Nov. 1, 2021. Hospital closures and shortages of health care providers may contribute to the high mortality rates from COVID-19 in rural areas. “We know that around the country since 2010, over 130 rural hospitals have closed,” Mueller told the Daily Iowan. “In many places, that was the cornerstone of care in the community.” The latest report can be found at https://rupri. public-health.uiowa.edu/.
HAPPENINGS IOWA RESEARCH TEAM LAUNCHES HEALTH EQUITY PROJECTS
GPCAH Launches New FarmSafe Podcast The Great Plains Center for Agricultural Health has launched a new podcast, FarmSafe. During each episode, agricultural workers and public health experts share firsthand stories and real-life tips for making safer and healthier decisions while on the farm. Topics have included a series on ATV safety and the importance of sleep. Find the podcast episodes at https://gpcah.publichealth.uiowa.edu/ farmsafe/.
Martha Carvour, assistant professor of infectious diseases in the University of Iowa Carver College of Medicine, has received a three-year, $758,000 grant from the UI’s Strategic Initiatives Fund (UISIF) to begin a series of campus- and community-wide projects aimed at improving equity in health science and practice (E-HSP). Funds in the UISIF are generated from the publicprivate partnership Iowa established in 2019 and are to be used for goals aligned with the institution’s strategic plan, which includes diversity, equity, and inclusion, as well as engagement. In addition to Carvour, the E-HSP will be led by Ebonee Johnson, assistant professor in the College of Public Health, and Kimberly Dukes, research assistant professor in general internal medicine. The E-HSP project aims to alleviate longstanding imbalances in health care affecting patients who identify as members of a minoritized racial or ethnic group and/or who live in rural settings. The researchers initially will focus in part on interventions for people with COVID-19 and diabetes, two diseases that have disproportionately affected minoritized groups. The team will also establish structures and methodology—such as a reliance on community partnerships—that can be replicated in future projects.
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Study Examines Rural Cancer Control Plans to Address Disparities A study from researchers at the University of Iowa College of Public Health and the Arnold School of Public Health at the University of South Carolina (UofSC) found that only about one-third of U.S. states, territories, and tribal organizations have made plans to address rural cancer mortality disparities through their required comprehensive cancer control plans. In 2019, the National Advisory Committee on Rural Health and Social Services released a set of recommendations on rural cancer control that included a recommendation to address these disparities and provide rural-specific strategies as part of their comprehensive cancer control planning. However, there was not any baseline data on whether these plans already included this data. This new study sought to provide a baseline assessment of rural inclusion in these plans. The analysis and paper were led by Sydney Evans, an MPH student at the University of Iowa, and Cathryn Murphy, an undergraduate student at the University of South Carolina. Jan Eberth at UofSC and Natoshia Askelson and Whitney Zahnd at Iowa were also involved in the study. The team reviewed the Comprehensive Cancer Control Plans for all U.S. states, territories, and tribal organizations to see if they included rural-specific data, like cancer rates, or developed rural-specific goals, objectives, or strategies. The research team found that about two-thirds of these groups considered “rural” in their plans and only about one-third of plans included a rural-specific strategy. “As rural populations have higher cancer mortality rates, higher incidence rates for some of the more preventable cancers, and lower cancer screening rates, it is important that they are appropriately considered,” Zahnd says. “Our study helps provide information on how these plans include rural as one way of using research to facilitate public health changes.”
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The research team found that about two-thirds of these groups considered “rural” in their plans and only about one-third of plans included a ruralspecific strategy.
HAPPENINGS SURVEY HIGHLIGHTS PANDEMIC’S IMPACT IN IOWA’S SMALL TOWNS
The pandemic has taken a steep toll on mental health in many of Iowa’s rural communities, according to survey data gathered by an Iowa State University rural sociologist and University of Iowa researchers. The pandemic strained the mental health and personal relationships of many rural Iowans, while residents in larger towns tended to report physical health and economic challenges with greater frequency, according to the survey data collected between December 2020 and February 2021. The results illustrate how the pandemic impacted communities in different ways and can inform how public policies are constructed to address these challenges, said David Peters, professor of sociology at Iowa State University who led the survey effort. Nicole Novak, research assistant professor of community and behavioral health at the University of Iowa College of Public Health, and Mark Berg, associate professor of sociology at the University of Iowa, also contributed to the project. The survey asked respondents in 73 Iowa communities to evaluate how the pandemic has affected various aspects of their lives, including their physical and mental health as well as their financial situation. The survey found respondents in the smallest towns were more likely to report worsening mental health and relationships as a result of the pandemic than they were to report worsening physical health. Economic impacts were relatively less widespread in the smallest communities, according to the survey. In larger communities and in towns with meatpacking facilities, however, more respondents said their physical health and economic situation took a toll as a result of the pandemic. The results, including an overall report and statistics for individual communities, are available at https:// smalltowns.soc.iastate.edu/covid19/.
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CLASS NOTES Jessica Aguilar (08MHA), senior executive director of Women’s, Children’s and Cancer, Sanford Health, Sioux Falls, South Dakota, received the Early Careerist Healthcare Executive Award from the Regent for South Dakota.
Janet Benton (08MHA) is the chief operating officer at Twin Cities Orthopedics in Minneapolis, Minnesota. Kirsten Beyer (05MPH) has been named Milwaukee Business Journal’s 2021 Researcher of the Year. Beyer is an associate professor, Division of Epidemiology, Institute for Health and Equity, and director of the doctorate program in public and community health at the Medical College of Wisconsin in Milwaukee, Wisconsin. Corey Boles (19PhD) has been named to the advisory board of the Integrated Bioscience and Built Environment Consortium (IBEC). Boles is a senior health scientist with Cardno ChemRisk in Blue Ash, Ohio. Isabella Brauhn Kendall (20MPH) is the university prevention education coordinator at the Rape Victim Advocacy Program at the University of Iowa in Iowa City, Iowa. Jaime Butler-Dawson (15PhD) is an assistant professor at the Colorado School of Public Health in Aurora, Colorado. Olivia Denkinger (21BA) is manager of poverty and child health initiatives at American Academy of Pediatrics Arizona Chapter in Phoenix, Arizona. Amani Dewan (21BA) is a public health advisor with the Centers for Disease Control and Prevention’s Public Health Associate Program stationed in Mentor, Ohio.
Kevin Esch (10MPH) has been appointed senior director of safety, toxicology, and metabolism in veterinary medicine research and development at Zoetis in Kalamazoo, Michigan. Erin Ellisa Folker (11MHA) is clinical director at Family Medicine of Mount Pleasant P.C. in Mt. Pleasant, Iowa. Denyse Gipple (08MPH) is director of safety and clinical outcomes at Washington County Hospital and Clinics in Washington, Iowa. Marta Hemmingson-Van Beek (03MPH) is the executive medical director for main campus ambulatory clinics at University of Iowa Hospitals and Clinics in Iowa City, Iowa. Anna Herring-VanRyswyk (05MS) is an HL7 ELR program manager at North Carolina Department of Health and Human Services, Division of Public Health, in Raleigh, North Carolina. Leighton Hill (21MPH, 20BS) is an STD epidemiologist at Washington State Department of Health in Olympia, Washington. Hana Hinkle (09MPH) has been named the interim director and department head of the University of Illinois College of Medicine Rockford’s National Center for Rural Health Professions in Rockford, Illinois. Emily Houston (21MPH, 20BA) has been named director of Washington County Public Health in Washington, Iowa. Sarah Kersten (21MPH) is a research associate at Gretchen Swanson Center for Nutrition in Denver, Colorado.
Oluoma Obi (21BA) is a research assistant, Department of Population Health, at University of Kansas Medical Center in Kansas City, Kansas. Brian Pavilonis (12PhD) is an associate professor at CUNY School of Public Health in New York, New York. Mehwish Qasim (18PhD) is director of research at UnitedHealth Group in Aurora, Illinois. Kelli Todd (12MPH) is ACO director of government programs at UnityPoint Health in Des Moines, Iowa. Caitlyn Tolentino (21BA) is an advocacy and planning coordinator at AgeGuide in Chicago, Illinois. Priyanka Vakkalanka (21PhD) is an assistant research scientist, Department of Emergency Medicine, at the University of Iowa in Iowa City, Iowa. Kaley Wilkinson (05MHA) is vice president of sales at Everside Health in Minneapolis, Minnesota. Austin Wu (21MPH, 20BA) is a research assistant at the University of British Columbia in Vancouver, British Columbia, Canada. Jingyang Zhang (12PHD, 08MS) is the statistical science associate director at AstraZeneca in San Francisco, California. Brooke Zibell (21BS) is a research associate at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.
Ellie Keuter (19MHA) is a senior consultant, analysis and planning, at Brigham and Women’s Hospital in Brookline, Massachusetts.
IN MEMORY Thomas Barker (63PhD, 60MA) of Midlothian, Virginia, on May 28, 2021. Dorothy Copony (47MS) of Charlottesville, Virginia, on July 23, 2021. Wayne Henry (55MA) of East Bridgewater, Massachusetts, on Oct. 2, 2021. Kathleen McKeen of Iowa City, Iowa, on Oct. 1, 2021. James D. M. Russell (61MA) of Fort Pierre, South Dakota, on July 22, 2021. Richard Thompson (68PhD, 65MA) of Palm Coast, Florida, on Oct. 6, 2021. 24 24 FALL 2021 INSIGHT
MARISA KALLEM Alvarado, Texas Master of Science Candidate in Biostatistics Activities and Honors: Biostatistics Student Organization Vice President; College of Public Health Graduate Student Association Vice President; Iowa Summer Institute in Biostatistics Alumna; American Statistical Association; Hispanic Scholarship Fund Scholar; McNair Scholars Program Scholarship: College of Public Health Diversity, Equity & Inclusion Scholarship
GIVE A STUDENT ACCESS TO IOWA
Outstanding students like Marisa illustrate the optimism and determination that fuel public health during this challenging time. You can bring Iowa’s top-quality public health education within reach for other exceptional 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/2022PQ98 INSIGHT FALL 2021 25
145 N. Riverside Dr. 100 College of Public Health Bldg., Room S257 Iowa City, Iowa 52242-2007
SPARK The college celebrated a sunny University of Iowa Homecoming with food trucks and music on the patio of the College of Public Health Building. The October event brought together students, faculty, staff, alumni, and friends before the Hawkeye football game against Purdue. Even though the Hawks lost, the day was a win for fun and fellowship. (From left) CPH students Kailey Mulligan and Reyna Hernandez enjoyed homecoming with friend and Iowa alumna Jolie Erbacher. 26 FALL 2021 INSIGHT
