InSight Spring 2021

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The University of Iowa College of Public Health

SPRING 2021

How has the pandemic affected our eating and drinking habits and health?


FROM THE

DEAN

As the U.S. emerges from the pandemic, many of us are taking stock of what we experienced individually and collectively, and what comes next. It’s a strange time that mixes grief, joy, uncertainty, relief, and change. It’s a lot to process, and there’s much work left to do globally in the battle against COVID-19. This issue of InSight might best be summarized as looking at different facets of change. Our lead story examines how our eating and drinking habits changed during the pandemic. Another story shows how a research project cleverly changed course and partnered with a local farm-based school to help pilot test GPS equipment. The college’s 2021 Business Leadership Network Community Grant Program is helping to spur positive change in five Iowa communities. Area organizations received grant awards of up to $3,000 to support public health-related initiatives and projects in their communities, including one that will bolster mental health services in southeast Iowa. You may also notice that the magazine has undergone some design changes as we incorporate the University of Iowa’s new brand identity (check out our newly revamped web site, too). You’ll also learn about the latest “Cancer in Iowa” report that details the unacceptably high burden of cancer in the state’s Black population, a generous gift from Linda and Dale Baker that supports global public health initiatives and other opportunities, what some of our recent alumni are up to, and more.

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 S257 Iowa City, Iowa 52242-2007 debra-venzke@uiowa.edu Visit our website cph.uiowa.edu

Follow us

As this issue goes to press, the White House has announced that as part of its ongoing COVID-19 response efforts, the Biden-Harris Administration will invest $7.4 billion from the American Rescue Plan to recruit and hire public health workers to respond to the pandemic and prepare for future public health challenges. This is certainly exciting news, and we in the college will watch developments closely. We’re proud to train students who become part of an essential public health workforce that is so vital to the public’s safety and well-being. I wish you all a wonderful and healthy summer.

Edith Parker

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. W46771/6-2021


CONTENTS

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6 2 FOOD, ALCOHOL & THE PANDEMIC How has the pandemic affected our eating and drinking habits and health?

6 ANIMAL TRACKERS School kids and farm animals are helping researchers test GPS tracking methods as part of a larger global health project.

10 CANCER REPORT HIGHLIGHTS RACIAL DISPARITIES Iowa’s Black population bears a high burden of cancer.

12 SUPPORTING A HEALTHIER IOWA The BLN Community Grant Program helps fund mental health services and other public health projects around the state.

14 Q&A WITH ALEJANDRA ESCOTO (19MPH) 16 NEW GIFT ENRICHES PUBLIC HEALTH

12 18 HAPPENINGS News and research findings. 24 CLASS NOTES Alumni news and notes. 25 PROFILE Eric Kontowicz (20PhD) studies the health impacts of floods. 26 SPARK

A generous gift from Dale and Linda Baker supports numerous opportunities in the college.

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Food, Alcohol &the Pandemic

How has the pandemic affected our eating and drinking habits and health? BY DEBRA VENZKE

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The pandemic

has disrupted almost every aspect of everyday life, including how we eat and drink. Many people are coping with stress and isolation by turning to comfort foods and alcohol. For others, the economic fallout makes it a struggle to put meals on the table. College of Public Health researchers are looking at how profound changes to our food systems and daily habits have affected people’s health and well-being.

PANDEMIC POUNDS

Stress-snacking, Zoom happy hours, and reduced physical activity have added up to extra pounds— the so-called quarantine 15—for many of us. Staying at home so much means “we’re closer to food all the time,” notes Linda Snetselaar, professor and chair of preventive nutrition education in the Department of Epidemiology. Working remotely and binging Netflix often means sitting in a single spot and getting less exercise than is typically built into a day. “Burning calories is not happening,” Snetselaar says. In a survey of U.S. adults conducted in February 2021 by the American Psychological Association, a majority (61%) reported experiencing undesired weight changes since the start of the pandemic, with more than 42% saying they gained more weight than they intended. Of this group, adults reported gaining an average of 29 pounds (with a median gain of 15 pounds), and 1 in 10 said they gained more than 50 pounds. Overweight or obesity can have serious health consequences, including a higher risk for severe illness from COVID-19, type 2 diabetes, coronary heart disease, and stroke. One positive change brought about by the pandemic is that people are cooking at home more. “People who eat at home tend to eat a more healthy diet,” Snetselaar says. “Plus there’s more time to sit down and eat as a family and socialize.”

Adults reported gaining an average of 29 pounds (with a median gain of 15 pounds), and 1 in 10 said they gained more than 50 pounds.

FOOD INSECURITY

As COVID-19 spread across the United States in early 2020, millions of people lost their jobs or had their hours reduced, driving up unemployment and poverty. Feeding America, the largest hunger-relief organization in the United States, reports that before the start of the pandemic, the overall food insecurity rate had reached its lowest point since it began to be measured in the 1990s. The pandemic quickly overturned those improvements. The organization estimates that 45 million people, including 15 million children, may have experienced food insecurity in 2020. Patrick Brady, a doctoral candidate in community and behavioral health, recently completed a project with the Iowa Department of Public Health and the Iowa Food Bank Association to evaluate how the COVID-19 pandemic has impacted older Iowans’ ability to obtain food and to develop recommendations to better meet the needs of food-insecure older Iowans. Although the results of the project won’t be published until this summer, Brady says that, in general, “those who were already vulnerable were impacted more” by the pandemic. INSIGHT SPRING 2021

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Brady says a key policy that helped lessen the impact of the pandemic on food insecurity was the substantial increase in Supplemental Nutrition Assistance Program benefits, which also allowed some food-insecure Iowans to obtain a more healthful and varied diet. Another important resource has been food banks. “They play a huge role in making sure food needs are met,” Brady says. Food banks are thinking creatively about how to serve people with transportation barriers or special health needs. Snetselaar is working with food pantries in Johnson County, Iowa, on a proposal that would deliver boxes of healthy foods to people in need, along with access to an app to help track how healthy their diet is. She’s also working with colleauges in obstetrics on an idea to write a prescription for a box of healthy food at a local food pantry for people who have diabetes and are pregnant.

SCHOOL MEAL CHALLENGES

During a normal school year, 22 million kids nationwide depend on the National School Lunch Program for free and reduced-price meals. COVID-19 threw K-12 schools and meal programs into chaos. “The pandemic has dramatically changed school nutrition,” says Natoshia Askelson, assistant professor of community and behavioral health. Among the biggest changes were the federal requirements for school meals. “Previously, they were under the Healthy Hunger-Free Kids Act,” Askelson explains. “Now, for emergency purposes, they’re under the Summer Food Service Program. It’s less restrictive, which makes it easier for food service directors to meet the criteria and still get food out the door.” Nutrition directors also had to plan around fluctuations in student numbers as community positivity rates and attendance policies rapidly shifted. “Are students going to be in person, online, or hybrid? What’s happening next week?” Askelson says about the constant changes. “Food service directors usually have a cycle menu that’s six weeks, so how do you buy food or budget for the unknown?” To add to the budgeting woes, supplies like food service gloves increased in price, as did costs for 4

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“We have emerging evidence that drinking has gone up in the U.S. and Iowa.” “all the individual food packaging, extra sneeze guards, and plexiglass,” Askelson notes. To ease the financial burden on families, the U.S. Department of Agriculture extended flexibilities to allow free meals to continue to be available to all children, regardless of household income, throughout the entire 2020-2021 school year. “There’s lots of concern about what that particular issue will mean in the fall if it doesn’t continue, and all of a sudden parents have to start paying again,” Askelson says. With so many unknowns, nutrition directors are facing tough challenges as they look toward the next school year, but Askelson has confidence in them. “I think school nutrition directors are some of the heroes of the pandemic,” she says. “They were able to pivot, even when schools were shut down last March. They’ve always been concerned about


the most vulnerable kids and if kids are getting enough to eat. I’m so impressed by them and appreciative of their efforts.”

ALCOHOL CONSUMPTION

Alcohol researchers expected that drinking would increase during the pandemic, and they were right. “We have emerging evidence that drinking has gone up in the U.S. and Iowa,” says Paul Gilbert, assistant professor of community and behavioral health. “Drinking is a really common coping response to stressors. We have evidence that after disasters or catastrophic events, drinking increases. We see this pattern over and over again,” he says. “Iowa also had the derecho in August 2020, which was another stressor that may push drinking up.” Iowa saw an increase in alcohol sales starting in April 2020. By the end of the year, sales records were shattered. The Iowa Alcoholic Beverages Division (ABD) announced that liquor sales for December 2020 reached $42.8 million, making it the highest grossing month for liquor sales in Iowa ABD history. “Sales data doesn’t always tell us what people are doing,” Gilbert cautions. “They may be stocking up, for example. But three national surveys have been conducted, each showing drinking increases among those who already drink, and an increase in binge drinking.” The surveys revealed that lockdowns are associated with heavy drinking and that some groups may be more likely to drink heavily. One national survey found greater increases in drinking among women, Black respondents, and people with children in the household. As drinking increases, so do problems related to drinking. To reduce the risk of alcohol-related harms, the 2020-2025 Dietary Guidelines for Americans recommends limiting intake to two drinks a day for men and one drink a day for women. Above that amount is considered hazardous or risky drinking. Binge drinking is defined as five or more drinks in one occasion for men, and four or more for women.

An additional concern is the effect of drinking on risk of COVID. “Alcohol also weakens our immune system, so it’s plausible that it could increase our susceptibility to and severity of COVID infection,” Gilbert says. Recently there has been growing interest in moderated drinking. “Dry January” is a movement that encourages people to take a break from alcohol for a month after the holidays. Gilbert says the concept received a lot of attention this year. “It’s an opportunity to reflect on the role of alcohol in your life and assess whether you need help,” he says. By putting a pause on drinking, “you might notice how quickly you feel better, sleep better, and maybe lose a little weight,” Gilbert says.

LOOKING AHEAD

As we begin to emerge from the pandemic, what’s on the horizon for eating and drinking habits? “The immediate concern is what will happen in two or three years if people don’t return to lower, prepandemic levels of drinking, and what’s in the near future in terms of services for people who need help with problems that started during the pandemic,” says Gilbert. Brady points out that there has been “a huge increase in recognition of food insecurity as an issue.” Feeding America projects that 42 million Americans may experience food insecurity in 2021. It also notes that significant racial disparities in food insecurity that existed before COVID-19 remain in the wake of the pandemic. “Food insecurity is not going away with stimulus money or once everyone is vaccinated,” Brady says. “We need a much more comprehensive approach.” On a positive note, Snetselaar urges people to contemplate how the pandemic may have improved some of their eating habits. “Was there more time for food preparation and eating in a calmer and less hurried manner? How can we hang on to the things that are good for us?”

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Animal Trackers School kids and farm animals are helping researchers test GPS tracking methods as part of a larger global health project. BY DEBRA VENZKE PHOTOS BY K ATY STITES

W.C. Fields famously said “Never work with children or animals,” but College of Public Health researchers are bucking that advice by enlisting kids and farm animals to help develop one piece of a larger global public health project. The project, called PATHOME, is studying infectious disease transmission, specifically the pathogens that cause diarrhea and malnutrition, in urban Kenya. Co-principal investigators Kelly Baker, assistant professor of occupational and environmental health, and Dan Sewell, assistant professor of biostatistics, received a $2.5 million grant from the Fogarty International Center, part of the U.S. National Institutes of Health, to conduct the study over five years. “Animals can be carriers of the same pathogens that cause disease in humans,” says Baker. “One of our research questions is to try to understand the role of animals in infection of children in these cities and neighborhoods in Kenya.”

A UNIQUE NICHE The project involves geotracking freeroaming domestic animals and collecting spatial data to see where there could be points of animal-to-human transmission. It involves harnessing a small GPS tracker onto animals such as chickens, goats, sheep, cats, and dogs that are commonly found in low-income urban neighborhoods of Kenya. While geotracking is fairly common in the veterinary and wildlife research fields, it’s not often used in urban infectious disease research. “We’re tracking a unique niche of animals,” says Baker. “We’re trying to understand animal movement in crowded, population-dense urban areas.” The task isn’t something the research team has ever done before, Baker adds. “We haven’t found any studies that geotracked animals in urban environments, so we’re developing protocols ahead of time for implementation of this piece of the study.”

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A CREATIVE PARTNERSHIP The COVID-19 pandemic added another twist. “Back when we wrote this grant (before the pandemic), we anticipated being able to go to Kenya to test out some of these protocols ourselves, but we’ve had to pivot and be innovative in how we solve some of our method development and piloting needs,” Baker explains. That’s where the kids come in. Baker contacted a friend, Brydie Criswell, who directs a private school called The Good Earth Nature School in eastern Iowa, to pilot test the animal geotracking protocols and equipment. Through this experience, the young students are introduced to the concept of the scientific method. “The school is based on a farm, so they have chickens, goats, dogs, and cats,” Baker says. “The interaction with animals is part of what the kids learn. In talking with Brydie, we decided this would be a fun opportunity to do a K-12 STEM partnership exercise.” Members of the research team have met with the students via Zoom, and the students have helped brainstorm potential problems (Will the goats eat the harnesses and trackers?) and develop research questions. “We talked about how scientists form a hypothesis that is testable, then come up with an idea to test that hypothesis,” Baker says. The students, who range in age from 5 to 12, are helping to answer questions such as which harnesses are the easiest to fit to animals, which stay on best, what types of geotracking units work best, and if the GPS signal might be lost when an animal goes into a barn or coop. The project is following animal research protocols to ensure that the animals aren’t distressed or harmed. HELPING PEOPLE AROUND THE WORLD Bisola Osinuga, a PhD candidate in occupational and environmental health, serves as the project manager for the 8

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PATHOME study. Her responsibilities include identifying animal geotracking technologies suitable for the project and helping to develop and refine the protocols for both the geospatial monitoring and behavioral assessment tools. She’s visited with The Good Earth students via Zoom.

“I like to think that doing one small thing will help a bunch of people,” says student Elianna Nelson.

“I participated in some of their class sections, explaining why we are doing this project and sharing my experiences about growing up in Nigeria,” Osinuga says. “They had some fun questions for me, trying to understand what that looks like. I think sharing my experiences made them realize the stark contrast between living in Iowa and living in rural sub-Saharan Africa. It also motivated them to be more invested in the project, because they believe they are helping someone and making the world a better place through this project.” The students echo that sentiment. “I like to think that doing one small thing will help a bunch of people,” says student Elianna Nelson. “I feel good that I have accomplished something that will change someone’s life.” “I like that we get to help people all around the world,” adds Violet Criswell. The students also enjoy the project’s science aspects. “I like the challenge of using the tracker,” says Gabe Steburg. “I liked collecting the data,” says Nasya Cannon. The experience is providing Osinuga with valuable career experience. “I’m learning how to communicate the important aspects of research projects succinctly and intelligently,” she says. “I’m also learning how to deal with people on different parts of the planet, time management, research development and organization, teasing out likely problems one can experience in the field before actually starting a research project, and the power of collaboration in multidisciplinary research.” She’s been impressed by the students. “To be honest, working with them reminded me about the open innocence, passion, and enthusiasm of young children,” she says. She adds that she was “surprised to learn how resourceful they are in coming up with solutions when we are having troubleshooting problems. They never give up.”

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‘Cancer in Iowa’ Report Highlights Racial Disparities Iowa’s Black population bears a high burden of cancer. BY TOM SNEE

AFRICAN AMERICANS in Iowa are being diagnosed

with cancer and dying from it at higher rates than any other group in the state. According to the 2021 Cancer in Iowa report issued by the State Health Registry of Iowa, the age-adjusted cancer mortality rate for Black Iowans is more than 25% greater than it is for white Iowans. Report co-author Mary Charlton, associate professor of epidemiology in the College of Public Health, says that while the overall number of Black people in Iowa who get cancer is relatively low, this reflects the younger age distribution of Black people living in the state. When the numbers are adjusted for age, Black Iowans are more apt to get cancer when they’re younger, whereas white people are more likely to get it when they’re older. Charlton says Iowa’s Black population had the highest cancer incidence rates of all racial and ethnic groups for the ages of 50 to 79, whereas white Iowans had the highest incidence rate of those older than 80.

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“When examining rates by age at diagnosis, we found that in the 60to 69-year-old age group the Black population had an age-adjusted new case rate that was 33% higher than the white population,” she says. “The cancer incidence rates became more similar in the older age groups. This shows how cancer impacts the Black population in Iowa at younger ages.” Charlton says circumstances created by structural racism are largely responsible for the disparity. Black people have less access to health care, lower representation in clinical trials, more mistrust in the health care system, and may have historically received lower quality health care, resulting in increased mortality from diseases including cancer, heart disease, and diabetes.

CANCER, AGE & RACE Cancer is striking Iowa’s Black population at a much younger age compared to the white population.

74.8

years the life expectancy of the Black population in Iowa VS.

79.3

years the life expectancy of the white population in Iowa

The state’s Black population

has the highest cancer incidence rates of all racial/ethnic groups for those ages 50-79 years, whereas Iowa’s white population has the highest rate among those 80 and older.

George Weiner, director of the University of Iowa’s Holden Comprehensive Cancer Center, agrees those risk factors are responsible for much of the unacceptably high burden of cancer in the state’s African American community.

Black males have experienced the

“Some African Americans in Iowa suffer from lack of access to quality health care, cancer screening, or healthy diets while having increased rates of obesity and tobacco use,” says Weiner. “The result is an increased burden of cancer.”

Iowa’s Hispanic population

Weiner says research into the causes of, and new treatments for, cancer remains vital, but so is being sure all Iowans benefit from what we already know. “The causes of these disparities are deeply ingrained in our society, and it will take significant effort at many levels over a long period of time to address them,” he says. “If we are able to do so successfully, it will benefit all Iowans.”

greatest decrease in cancer mortality over the past few decades rates compared to all other racial/ethnic groups in Iowa.

has the lowest cancer incidence rates across all age groups.

Aside from suicide and liver disease, Iowa’s Black population has the highest mortality rate in every single major cause of death, including cancer.

SOME GOOD NEWS

Cancer mortality rates are declining for each racial/ethnic group, and the difference is narrowing between Iowa’s Black and white populations. Find the full 2021 Cancer in Iowa report at shri.public-health.uiowa.edu INSIGHT SPRING 2021 11


Supporting a Healthier Iowa THE BLN COMMUNITY GRANT PROGRAM HELPS FUND MENTAL HEALTH SERVICES AND OTHER PUBLIC HEALTH PROJECTS AROUND THE STATE.

IN A TYPICAL YEAR, about one in five Iowans, or around

600,000 people, are affected by a mental health challenge. With the stressors of the COVID-19 pandemic, the estimates are now closer to one in four Iowans, according to NAMI (National Alliance on Mental Illness) Iowa. NAMI Iowa also notes the state’s critical lack of mental health providers and services. Reports show 89 of Iowa’s 99 counties are federally designated as Mental Health Professional Shortage Areas by the Health Resources and Services Administration. MENTAL HEALTH NEEDS

The NAMI Southeast Iowa affiliate based in West Burlington addresses mental health needs in its region. To help meet an increasing demand for services, the organization applied for and received funding from the College of Public Health’s Business Leadership Network (BLN) 2021 Community Grant Program. The affiliate serves the Iowa counties of Des Moines, Henry, Jefferson, Keokuk, Lee, Louisa, Van Buren, and Washington. Much of this area is rural, where accessing quality mental health care can be difficult.

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“The pandemic has caused an increase in anxiety, depression, and suicide. Many people have a poor understanding of what mental illness is and how to cope with it, whether in a loved one or themselves,” wrote Terri Elliott, chair of NAMI Southeast Iowa, in the grant application letter. The organization will use the grant to conduct evidence-based mental health education classes in each of the eight counties it serves. “The purpose of these classes will be to help reduce stigma and increase knowledge and coping skills related to mental illness,” Elliott wrote.

IMPROVING QUALITY OF LIFE

The courses can also improve participants’ adherence to treatment and quality of life, Elliott added. “Ultimately, we hope that these classes reduce the number of people who feel alone as they cope with mental health conditions. It should help reduce suicide rates and reduce rates of hospitalization for mental health conditions.” The classes will be led by volunteers who have received NAMI training. The classes are free for participants, and the BLN Community Grant funds will cover the cost of advertising, student manuals, and teaching materials.


counseling organizations, public health departments, city councils, and individual businesses in order to sustain the program and expand other offerings. In addition to NAMI Southeast Iowa, the BLN’s Community Grant Program funded four other Iowa community organizations in 2021. The organizations received grant awards of up to $3,000 to support public health-related initiatives and projects in their communities. The projects run from March 1 to December 31, 2021. Funding for the BLN Community Grant Program is provided by the Iowa Farm Bureau Federation. The grant program also requires recipients to secure an equal cash or in-kind match from other community organizations or businesses.

ULTIMATELY, WE HOPE THAT THESE CLASSES REDUCE THE NUMBER OF PEOPLE WHO FEEL ALONE AS THEY COPE WITH MENTAL HEALTH CONDITIONS. NAMI Southeast Iowa is collaborating with First United Methodist Church in Burlington, Iowa, on the mental health education project, and plans to partner with other churches,

The additional 2021 BLN Community Grant Program projects and locations are: BUILDING BRIDGES – BURLINGTON

The Getting Ahead Workshop project will provide an 18-week workshop to help families and individuals living in poverty develop resources and a support system to help them succeed in their work and personal lives. The program focuses on strengthening skills in 11 areas: financial, emotional, language, mental/cognitive, social capital/ connections, physical, spiritual, motivation, integrity, relationships, and knowledge of hidden social rules.

CEDAR/JONES EARLY CHILDHOOD IOWA – ANAMOSA

The Jones County Story Walk project aims to promote early literacy while children and families engage in educational and physical activities. A children’s book will be installed and displayed pageby-page on posts along a park path in Jones County. Walking the path, children and their families can read the story and participate in related activities listed on each page. A variety of books will be interchanged on a regular basis. SOUTH CENTRAL IOWA COMMUNITY ACTION PROGRAM-PARENTS AS TEACHERS – CHARITON

The CPR and First Aid project will provide education and training to parents and caregivers to increase knowledge on how to take action in an emergency situation. A staff member will obtain CPR and basic First Aid instructor certification to provide free or low-cost trainings to low-income families enrolled in the Parents as Teachers program, area childcare providers, and other community partners. VINTON/SHELLSBURG COMMUNITY SCHOOL DISTRICT – VINTON

The Student Leadership Project seeks to combat negative consequences such as substance use, mental illness, and risk of suicide for students who have faced Adverse Childhood Experiences (ACEs). The project will provide students with resources and opportunities to develop leadership skills to reduce the effects of ACEs so that they can make a positive impact in their own school, community, and lives.

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Alejandra Escoto (19MPH) is a program coordinator for the Division of Child and Community Health at the University of Iowa. In this role, she develops and implements Title V programming aimed at improving the health of Iowa’s children and youth with special health care needs. She recently answered a few questions about her path to public health and current job.

SEEING HEALTH THROUGH A COMMUNITY LENS What made you choose a career in public health? When I was an undergraduate student at Iowa, a friend shared a cool research opportunity that they were a part of. I reached out to Dr. Daniel-Ulloa at the College of Public Health (now at the University of Washington) and began working with him on various research projects. Through these research opportunities, I fell in love with public health and the thought processes behind looking at health through a community lens. These experiences during my undergraduate career pushed me to pursue my MPH with an emphasis in community and behavioral health. I continued working on a variety of research projects during this time. Shortly after graduation, I started in my current position.

What does a typical day look like in your current job? Every day is a bit different, but I typically have meetings with my team to discuss collaboration on the various projects we’re working on. I also sometimes consult with our regional centers across the state about care coordination workflows. I also work with the Title V program manager to write, edit, and manage data for Iowa’s annual Title V block grant application and needs assessment.

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What excites you about your job? Developing and implementing family-centered care for children and youth with special health care needs is very exciting to me. This is a unique population that I feel is often overlooked in the greater public health world, probably due to its need for direct clinical services. Thinking about the systems of care that impact this population uses my public health education and allows me to learn more about how the public health and medical worlds coincide. I feel like I’m always learning something new in my job, and I love producing creative solutions to reach program objectives.

How did your University of Iowa public health education help in your career? My public health education gave me the framework to think about problems with a systems-level lens. Understanding all the factors that impact health has been important in developing effective programming. I’m also grateful to my mentors throughout my graduate school education that

helped develop me as a researcher. This is a unique skill set that I bring to public health practice, and I’ve found that I’m able to transfer these research skills to more practical experiences.

What other activities are you involved in? I recently helped develop the Division of Child and Community Health’s Health Equity Committee. This was an exciting project to be a part of, and it allowed me to utilize my experiences with health equity-related work and community engagement within my current position.

What advice do you have for students thinking about pursuing a degree in public health? A piece of advice that I have is to not be afraid of trying new things. The opportunities that I had outside of the classroom allowed me to grow as a public health professional and gave me a lot of the transferable skills needed to become a public health practitioner.

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New Gift Enriches Global Connections and Public Health A GENEROUS GIFT FROM DALE AND LINDA BAKER SUPPORTS NUMEROUS OPPORTUNITIES IN THE COLLEGE.

THE COVID-19 PANDEMIC REVEALED how quickly a

The gift also will provide supplemental funding to aid graduate and undergraduate student success. These funds support collegiate priorities of diversity, equity, and inclusion and experiential learning by offering scholarships and awards to students with demonstrated need and merit. The Bakers’ previous gifts to the college also have helped aid student support and educational innovation, health sciences research collaboration, entrepreneurship, and community outreach and engagement.

The Baker’s generous gift to the College of Public Health in 2020 will allow continued funding for the college’s Global Public Health Program initially created through their previous giving. This gift will enable the college to ensure ongoing support of student and faculty travel expenses as well as programmatic development that allows engagement with global public health issues in the classroom, across campus, and internationally.

“We’re so grateful for Dale and Linda’s continuing support of the college,” says Edith Parker, dean of the College of Public Health. “Their gifts have provided so many opportunities and support for our students and faculty, and have particularly made a tremendous impact on our global health collaborations, training, and research.”

health crisis can span the world, underlining the need for a well-trained public health workforce with a global skill set. Thanks to a recent gift from Dale and Linda Baker, College of Public Health students and faculty will benefit from a variety of global public health experiences and other valuable opportunities. In addition to the College of Public Health, the Bakers also supported 10 other areas at the University of Iowa.

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Students, faculty, and staff also expressed their thanks and highlighted how their work and studies have benefitted from the Bakers’ support.


THANK YOU SO MUCH for the many ways

you have supported our college through the years. As a member of our Global Public Health Committee, I am aware of so many students and faculty who have benefitted from travel awards sponsored by your generous donations. As an example, these funds allowed me to bring eight public health students to Xicotepec, Mexico, in 2019 for outreach activities at a number of schools and orphanages there. Such experiential trips help students and faculty get excellent experience in how to engage diverse communities to address public health issues, benefitting community members, as well as visiting students and faculty. Jeff Dawson, Associate Dean for Faculty Affairs and Professor of Biostatistics

YOUR SUPPORT has allowed me to establish Linda and Dale Baker show their Iowa spirit during homecoming.

THANK YOU for giving me the gift of a global public

health experience. My time studying abroad continues to benefit me today, leaving me with additional insight to bring into the classroom, experiences and new skills that make me a competitive applicant, and a broader worldview. Your gift has undoubtedly made me a much better student and future public health professional, and I am forever thankful for that. Julia Reichart, Undergraduate Student

I AM GENUINELY THANKFUL to Linda and Dale

Baker for providing the support of my attendance at the Academy Health meeting. Presenting my work and attending the meeting has allowed me to learn from others interested in rural health. It was an experience that has enriched my knowledge and inspired me with new research ideas.

stronger relationships with colleagues in Argentina to protect the health and safety of farmers, a population that is at risk worldwide. The ability to travel to Argentina and to host our colleagues here in Iowa creates a sense of shared responsibility to help foster global solutions to address agricultural safety and health. Thank you! Diane Rohlman, Professor and Endowed Chair in Rural Safety and Health, Department of Occupational and Environmental Health

WITH YOUR GENEROUS GIFT, the IIPHRP’s

Policy Fellowship program has supported numerous faculty projects that have meaningfully changed public health policies. Our Collaboratory program has resulted in new research partnerships along with additional grants, philanthropy, and increased visibility for our college and university. These and other opportunities have enabled faculty to accomplish new goals and have allowed students to be part of cutting-edge public health research and translating that research into action. Vickie Miene, Interim Director, Iowa Institute of Public Health Research and Policy

Muska Nataliansyah, PhD Candidate and Graduate Research Assistant, Department of Health Management and Policy INSIGHT SPRING 2021 17


HAPPENINGS

COLLEGE NAMES OUTSTANDING ALUMNI AWARD RECIPIENTS The University of Iowa College of Public Health has named Dwight Ferguson and Shenghui Tang the recipients of its 2021 Outstanding Alumni Awards.

Ferguson received a Master of Science degree in epidemiology in 2006 and a doctoral degree in occupational and environmental health in 2012. He currently serves in the U.S. Public Health Service as an emergency management specialist within the Office of the Assistant Secretary for Preparedness and Response in the Department of Health and Human Services. In this role, he plans for and coordinates the response for federal emergencies. Tang received a Master of Science degree in 1995 and a doctoral degree in 1999, both in in biostatistics. He currently serves as director of the Division of Biometrics V at the Center for Drug Evaluation and Research in the U.S. Food and Drug Administration. In this position, he focuses on the development and regulatory evaluation of cancer treatment drugs. The award recognizes College of Public Health alumni who have made distinguished contributions to the field of public health and demonstrated a strong interest and commitment to the mission, vision, and values of the college. The recipients will be honored at an event this fall.

Agriculture Workers More Likely to Have Dementia

Using data from the Health and Retirement Study (1998-2014), CPH researchers explored whether rates of dementia and cognitive decline were different in older adults who had worked long-term in agriculture. Investigators found that those who identified as having long-term occupations in the agriculture, fishing, and forestry sectors had 46% greater odds of having dementia than those who did not. The study can help researchers develop effective interventions to protect older farmers. “This study is both timely and relevant because farmers routinely work beyond standard retirement age, making them vulnerable to occupational injury. Additionally, a dementia diagnosis among farmers may be missed or delayed for a variety of reasons, causing even greater safety concerns,” says corresponding author Kanika Arora, assistant professor of health management and policy. While researchers could not attribute the association to hearing impairment or depression—factors independently associated with both agriculture and dementia—the effect of pesticide exposure among agricultural workers may warrant further study.

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of the Framingham Study, a landmark project begun in 1948 that investigated the causes and risk factors of cardiovascular disease by studying adults in Framingham, Massachusetts. Lauer’s plan was a Framingham-style study that tested children for various risk factors for cardiovascular disease and then followed them into adulthood to see if those factors manifested as cardiovascular disease as adults. He chose Muscatine in southeast Iowa because it was easily accessible from Iowa City and because the school district had a stable enrollment with students he could track from start to finish.

Muscatine Heart Study Still Ticking

Launched in 1970, the Muscatine Heart Study is one of the largest and longestrunning investigations of cardiovascular disease ever undertaken by the University of Iowa. “It was important because it found hereditary influences on the development of heart disease and risk factors that could be found as early as childhood,” says Hal Schrott, College of Public Health professor emeritus of epidemiology. He was involved with the study from 1973 until his retirement in 2003. The study was the brainchild of Ronald Lauer, a professor of pediatrics in the Carver College of Medicine who specialized in cardiology. He and his colleagues were inspired to follow up the findings

Trudy Burns, professor emerita of epidemiology in the College of Public Health who took over as lead investigator when Lauer retired in 2005, says the study made numerous key discoveries about childhood cardiovascular health. The most important was that the cardiovascular disease factors identified in adults in the Framingham Study also are seen in childhood, and what happens when you’re a child has an impact on your adult health. Elevated levels of cholesterol, body mass index, blood pressure, and smoking increase the risk of disease as adults. The project has so far led to more than 100 publications in research journals from Iowa faculty. The study is now in a new phase that will recruit 3,700 of the childhood participants from the 1970s for a full clinical exam to see how their health is progressing as they pass from middle to older age. Researchers hope to start that five-year investigation along with additional studies in July 2021.

THE UNIVERSITY OF IOWA COLLEGE OF PUBLIC HEALTH IS THE #20 SCHOOL OF PUBLC HEALTH

20

TOP NATIONAL RANKING

in the nation, according to the latest rankings from U.S. News & World Report. Among publicly supported schools, the college ranks #10.

Although they were not ranked for the 2022 issue of America’s Best Graduate Schools, the College of Public Health’s Department of Health Management and Policy is most recently ranked at #8 among health care management programs, and its Department of Biostatistics is ranked #55 among all statistics programs. Biostatistics is ranked #20 among all biostatistics departments, and #9 among those at publicly supported universities.

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RACIAL DISPARITIES IN PEDESTRIAN INJURIES A research study reveals that pedestrian injuries are worse for most minorities in the U.S. compared to whites, a racial disparity that points to inequities in access to safe transportation. “Basically in every indicator we looked at, we saw worse outcomes, particularly among Black, Hispanic, and multiracial groups,” says Cara Hamann, clinical assistant professor of epidemiology, who was the principal investigator on the study. Hamann and colleagues Corinne PeekAsa, professor of occupational and environmental health, and Brandon Butcher (20PhD), then a doctoral student in biostatistics, analyzed data on mortality rates and hospitalization rates from 2009 to 2016 to determine the frequency, severity, and cost of pedestrian-related injury hospitalizations by race and ethnicity. Multiracial, Black, and Hispanic groups had worse outcomes in most areas compared with whites by a significant margin. Only one group, Asian/Pacific Islanders, had better outcomes than whites in some areas.

New Toolkit for Global Birth Defects Surveillance

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“Hospital admission rates were almost two times higher for people who were multiracial or other ethnic groups, including Native Americans, compared to whites,” Peek-Asa says. “The hospitalization rates are about 20% higher among Blacks compared to whites. And, we also found that lengths of stay longer than one week were a lot higher for every race and ethnic group than white.” While racial disparities are documented in many areas of public health, this is the first study that lays out evidence of the burden of pedestrian injury hospitalizations by race. One cause is systemic—people of different races are likely to experience differences in their built environment and access to safe transportation. “We’re providing evidence to show that this really is a problem, and that’s the first step in addressing a public health issue. We have to identify it, and then we can move on to trying to intervene and prevent and identify avenues to do that,” Hamann says.

In his role as executive committee chair for the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR), Paul Romitti, professor of epidemiology, recently participated in a World Health Organization (WHO) webinar to release a new global resource to support population-based surveillance programs for birth defects. “Birth Defects Surveillance: A Manual for Program Managers” is a collaborative effort between the WHO, ICBDSR, the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention, and the March of Dimes. The manual is intended “to serve as a tool for the development, implementation and ongoing improvement of a congenital anomalies surveillance program, particularly for countries with limited resources,” according to the WHO.


Face Mask Study Ranks among the Most Shared Research Articles A College of Public Health study examining how community policies mandating face masks mitigate the spread of COVID-19 ranks among the most shared and mentioned research articles ever tracked by the data science company Altmetric. The study, “Community Use of Face Masks and COVID-19: Evidence from a Natural Experiment of State Mandates in the U.S.,” was authored by George Wehby, professor of health management and policy, and research associate Wei Lyu. It appeared in the June 2020 issue of the journal Health Affairs. According to data compiled by Altmetric, the face mask study surpassed an attention score of 10,000, which indicates the quality and quantity of online engagement with this research across various platforms, including social media, research blogs, public policy documents, and news articles. Compared to more than 17 million other research outputs tracked by the company, Lyu and Wehby’s study ranks in the top 100 of all research ever tracked.

HAPPENINGS Finding the Best Treatments for a Rare Form of Cancer

A newly funded research study in the UI College of Public Health aims to determine the optimal sequencing of treatments for people with neuroendocrine tumors, a rare form of cancer.

$5 million three-year study

The , will be led by Michael O’Rorke, assistant professor of epidemiology, and will enroll approximately patients from participating research centers throughout the United States. The project is funded by the Patient-Centered Outcomes Research Institute (PCORI), a nonprofit organization established by Congress.

3,000

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Neuroendocrine tumors (NETs) are a group of cancers that occur most frequently in the gastrointestinal tract, pancreas, and lungs. NETs are typically slow growing with vague signs and varied symptoms, which often leads to diagnostic delays and disease spread. Patients with NETs frequently experience a prolonged clinical course, significant symptom burdens, and a confusing array of therapeutic options, including biologic therapies, radiation, and chemotherapy. The study, which will follow patients for up to five years to track their outcomes, aims to partner with patients in an approach known as comparative effectiveness research (CER), a type of research that looks at which care options work, for whom, and under which circumstances. “This large CER study leveraging data from electronic medical records, chart abstractions, and patient reported outcomes will go some way to defining the risks and benefits of the different therapeutic options currently available—findings which will be of benefit to patients and their caregivers, clinicians, and other stakeholders involved in their care,” says O’Rorke.

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Regional Alliance Addresses Mental Health in the Workplace The Healthier Workforce Center of the Midwest, directed by Diane Rohlman, recently entered into an Alliance Agreement with the Occupational Safety and Health Administration’s (OSHA) Federal Region VII to address behavioral health, which includes mental health and substance use, in the workplace. “Mental health is a personal issue, a family issue, a societal issue, and a work issue,” says Rohlman, professor of occupational and environmental health. “That’s why mental health needs to be part of the safety conversation in U.S. workplaces.” The agreement establishes a collaborative relationship to provide employers and the public with information and training resources that will help protect workers by reducing and preventing

exposure to workplace hazards and addressing behavioral health issues. The agreement with OSHA, Rohlman says, stemmed from her work as a policy fellow in the CPH’s Iowa Institute of Public Health Research and Policy, which focused on developing workplace mental health policies for rural employers. “The COVID-19 pandemic has had a major impact on the way people live and work. This has led to greater mental health challenges for workers in all industries,” says Rohlman. “Our new partnership with OSHA will expand the work of the Healthier Workforce Center to promote safety, health, and well-being—which will benefit both the workers and the employers.”

PROJECT AIMS TO REDUCE HIV STIGMA IN WESTERN KENYA Will Story, assistant professor of community and behavioral health in the UI College of Public Health, and Nema Aluku, research associate at Tangaza University College in Nairobi, Kenya, recently received a National Institutes of Health grant to study HIV stigma among adolescents in western Kenya. “Adolescents, especially girls, are vulnerable to HIV in Kenya, where stigma and discrimination present an important challenge to HIV prevention. Understanding the complex relationship between social relationships, religious beliefs, and gender norms is critical to developing culturally appropriate interventions to reduce stigma among adolescents, but rarely studied in this population,” Story explains. “This project will identify potential pathways to reduce HIV-related stigma and increase HIV-preventive behaviors among adolescents in western Kenya, while building the research capacity of two Kenyan institutions—Tangaza University College in Nairobi and Gynocare Women’s and Fistula Hospital in Eldoret.”

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HAPPENINGS

Health Benefits Associated with Eating Plant Protein Postmenopausal women who ate high levels of plant protein had lower risks of premature death, cardiovascular disease death, and dementia-related death compared with women who ate less plant protein, according to new research led by Wei Bao, assistant professor of epidemiology. Researchers noted the levels and types of protein women reported consuming, then divided them into groups to compare who ate the least and who ate the most of each protein. Among the study’s key findings: § Compared to postmenopausal women who had the least amount of plant protein intake, those with the highest amount of plant protein intake had a 9% lower risk of death from all causes, a 12% lower risk of death from cardiovascular disease, and a 21% lower risk of dementia-related death. § Higher consumption of processed red meat was associated with a 20% higher risk of dying from dementia. § Substitution of 5% energy of animal protein with plant protein was associated with a 14% lower risk of deaths from all causes, a 22% lower risk of deaths from cardiovascular disease, and a 19% lower risk of deaths from dementia. “Our findings support the need to consider dietary protein sources in future dietary guidelines,” says Bao. “Current dietary guidelines mainly focus on the total amount of protein, and our findings show that there may be different health influences associated with different types of protein foods.” The study, published in the Journal of the American Heart Association, included University of Iowa investigators Yangbo Sun, Buyun Liu, Linda Snetselaar, and Robert Wallace.

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CLASS NOTES Rik Baier (82MA) is CEO of Barrington Orthopedic Specialists in Schaumburg, Illinois, and serves as CEO for the Schaumburg Surgery Center, which supports the practice.

Andy Barth (06MHA) has been named president and CEO of HSHS Sacred Heart Hospital in Eau Claire, Wisconsin. Quinton Behlers (17MPH) is a clinical pharmacist, Adult Intensive Care at Nebraska Medicine in Elkhorn, Nebraska. Emma Cole (19MPH) is a health policy analyst with LMI, a consultancy in Tysons, Virginia. Eliza Daly (20MPH) is a state coordinator, Behavioral Risk Factor Surveillance System, at the Iowa Department of Public Health in Des Moines, Iowa. Dwight Ferguson (12PhD, 06MS) is an emergency management specialist - Region VII at the Office of Emergency Management and Medical Operations, Office of the Principal Deputy Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services in Kansas City, Missouri.

Brenda (Saldivar) Granillo (02MS) is an associate research social scientist with the Southwest Institute for Research on Women at the University of Arizona in Tucson and is also founder and owner of EP Elite Consulting. Hunter Harig (13MPH) is a senior program officer at Johns Hopkins Center for Communication Programs in Detroit, Michigan. Kylie Henkels (20BA) is a quality improvement specialist at Medical Associates Clinic & Health Plans in Dubuque, Iowa. Clint Hugie (15MHA) is a system risk manager at Intermountain Healthcare in Salt Lake City, Utah. Alexandra Lackos-Schoming (11MHA) is an assistant administrator, University of Pittsburgh Physicians, Department of Obstetrics, Gynecology and Women’s Health at University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania. Jessica Larson (14MHA, 14MPH) is a business operations coordinator, Virginia Premier Government Programs at Sentara in Poquoson, Virginia.

Alexis Finer (19MS) is a research analyst at HCA Healthcare in Nashville, Tennessee.

Andrea Lenartz (20MPH, 17CER) is a CSTE applied epidemiology fellow at Maine Center for Disease Control and Prevention in Portland, Maine.

Jenna Gibbs (08MPH) is director of operations for the Ag Health and Safety Alliance in Iowa City, Iowa.

John Massimilla (80MA) is president of WellSpan Chambersburg Hospital in Chambersburg, Pennsylvania.

Mollie Giller (11MPH) is director of programs and supportive services at Polk County Housing Trust Fund in Des Moines, Iowa.

Daniel T. Meyer (85MA) has been elected as chair of the board of directors for the Wisconsin Hospital Association for 2020-2021. Meyer serves as president of Aurora BayCare Medical Center in Green Bay, Wisconsin.

Dexter Golinghorst (20MHA, 16CER) is an associate at McDermott Will & Emery in Chicago, Illinois.

Mikaela Mikkelsen (19BS, 20MPH) is an epidemiologist at DuPage County Health Department in Oak Park, Illinois.

Nicole Nichols (20BA) is an access counselor lead at Brave Health in Charlotte, North Carolina. Hua Ou (12MS) is an investigator and statistician at National Institute on Deafness and Other Communication Disorders (NIDCD) in Bethesda, Maryland. Rebecca Ritter (15MS) is a data manager 2 at DLH Corporation in Durham, North Carolina. Steve Slessor (08MHA) has been named chief administrative officer at Winneshiek Medical Center in Decorah, Iowa. Blake Smith (16MPH) is a geospatial systems specialist at U.S. Forest Service in New Bern, North Carolina. David Stark (96MA) has been named Business Record’s 2021 Forty Under 40 Alumnus of the Year. Stark was honored 20 years ago and is currently president and CEO of UnityPoint Health-Des Moines, Iowa. Nicole Therrien (19MPH) is a pharmacist consultant at ASRT, Inc in Atlanta, Georgia. Scott Vial (02MS) is deputy for trategy and quality at U.S. Army Public Health Center in Bel Air, Maryland. Joshua Viggers (15MHA) is program manager, Virtual Health at CommonSpirit Health in Tacoma, Washington. Leah Wentworth (16PhD) is a senior manager at the National Alliance on Mental Illness (NAMI) national office and is based in Albany, New York. Rachel Whitesitt (20MPH) is a pharmacist at University of Wisconsin/ Streu’s Pharmacy in Green Bay, Wisconsin.

IN MEMORY Larry Anderson (67MA) of Battle Creek, Michigan, on October 21, 2020. G. T. Dunlop Ecker (64MA) of Hollywood, Maryland, on April 19, 2021. Richard Green (61MA) of Champaign, Illinois, on March 4, 2021. Helen Hageboeck (78PhD) of Moline, Illinois, on Oct. 31, 2020. James Helzer (66MA) of Modesto, California, on Dec. 2, 2020. Gary Hessel (63MA) of Monroe, Wisconsin, on May 4, 2021. Carl Lippert (71MA) of Tumwater, Washington, on Dec. 8, 2020. Donald Ourth (69PhD) of Millington, Tennessee, on Nov. 17, 2020. Merrill Overturf (70PhD) of Galveston, Texas, in December 2020. Donald Van Hulzen (59MA) of Iowa City, Iowa, on Dec. 7, 2020. 24 SPRING SPRING2021 2021 INSIGHT INSIGHT 24


PROFILE COLLABORATING ON FLOODS AND FLU RESEARCH BY TOM SNEE

ERIC KONTOWICZ (20PHD) wrote his doctoral

dissertation thanks to help from all over the University of Iowa campus. The dissertation from the recent graduate in epidemiology looks at how climate change will affect influenza rates in animals and people, and in particular the impact that flooding has on flu infections in human populations. “Floods are not good for our health in many ways, and I wanted to know if that makes us more susceptible to the flu,” says Kontowicz. “Especially in Iowa, with floods becoming more frequent, how does that influence flu infections?” So Kontowicz set to work gathering data and finding experts from across campus to help him interpret all of it. He worked with his adviser, Professor of Epidemiology Christine Petersen, and faculty in the college’s Department of Occupational and Environmental Health. With university help, he gathered flu test results from the State Hygienic Lab, stream gauge data from the United States Geological Survey, census data from the U.S. Department of the Census, and weather station data from the National Oceanic and Atmospheric Administration. He worked with experts in the Iowa Flood Center in IIHR—Hydroscience and Engineering and the Department of Geographical and Sustainable Sciences to learn more about flooding impacts and atmospheric data. Statisticians in the College of Public Health’s Department of Biostatistics helped him build a model to make sense of it all.

“Collaboration is a wonderful thing,” Kontowicz says. His study found that populations exposed to flooded environments are at risk of experiencing a 1% rise in influenza diagnoses for each day they are flooded. He says that’s likely because the flooding increases production of molds and allergens that can compromise the lungs’ immune system. “This is important to know because we can target resources to those areas where there was flooding to protect those populations who might be compromised,” he says. “For instance, we can urge populations who have been in flooded areas to get their flu shots in the fall.” Kontowicz is currently working in several roles, including teaching as an adjunct faculty member in the CPH Department of Epidemiology. He’s also a postdoctoral researcher at the UI Center for Emerging Infectious Diseases, where he’s continuing work from his dissertation in addition to providing statistical and study design aide for research projects. Finally, he’s working remotely as an epidemiologist at US Biologic based in Memphis, Tennessee, where he helps develop, validate, and expand a predictive analytic toolset called ZooHUB. “The focus of this research is to develop accurate predictions for infection rates in ticks and mosquitoes to help guide and target backyard intervention and control efforts,” Kontowicz explains.

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145 N. Riverside Dr. 100 College of Public Health Bldg., Room S257 Iowa City, Iowa 52242-2007

SPARK

WITH THE PRICK OF A NEEDLE, feelings of relief, hope, and unexpected emotion welled up in many of us. Receiving a COVID-19 vaccine makes it safer to see the people we’ve missed and resume activities that bring us joy. University of Iowa Student Health held a vaccine clinic for students in April 2021. Over two days, nearly 2,000 students received the first dose of the PfizerBioNTech vaccine. A second clinic was held in May. Although there’s still much work to do fighting the pandemic here and around the world, thanks the efforts of health providers, pharmacists, and public health practitioners, the summer is looking brighter. PHOTO BY TIM SCHOON

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