InSight Spring 2023

Marking 50 years of the Iowa Cancer Registry

SPRING 2023

DEAN FROM THE

One of the most exciting aspects of public health is how very broad it is. You want to concentrate on rural health policy? You can do that. Adolescent health? Absolutely! Biostatistics, water quality, or diabetes? Yes, yes, and yes. There’s always a place for you in public health. This issue of InSight is a perfect example of how big the public health tent is. We start off with a story about the Iowa Cancer Registry and its 50 years of tracking cancer cases, survival rates, and deaths from cancer in the state. This valuable resource of high-quality data is used to inform cancer research, prevention, and treatment in Iowa and beyond.

Next, we look at the many ways that public health contributes to the area of oral health. Several of our faculty and students are involved in research on oral cancer prevention, access to dental care, children’s dental health, and the genetics of cleft lip and cleft palate. Another story highlights a program that delivers health equity training to health department employees in Iowa. The goal of the program is to deepen participants’ understanding of health equity principles so that they can better serve their communities and help dismantle inequities.

You’ll also meet a recent alumna who’s blending her interests in human health and the environment into her professional and volunteer work, as well as learn about a current student who’s dedicated to increasing access to affordable housing.

As we focus on our own careers and specialties, we can sometimes forget how expansive the scope of public health is. Despite the diversity of our job titles and backgrounds, we’re united in our efforts to prevent illness and injury and promote health and wellness.

I hope you enjoy reading about some of the amazing discoveries, activities, and accomplishments happening within our college, and I wish you a happy and healthy summer!

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 Joey Loboda

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

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. W O10686/5 - 2023

CONTENTS

2 QUICK TAKES

4 DATA

FOR DECADES

For half a century, the Iowa Cancer Registry has had a profound impact on research, prevention, screening, and treatment.

8 DENTAL

HEALTH IS PUBLIC HEALTH

Good oral health requires a multidisciplinary approach, including public health expertise in policy, access to care, disease prevention, and more.

12 BUILDING HEALTH EQUITY

A new training program provides health department employees with an understanding of health equity principles to support communities and address inequities.

16 SUPPORTING ENVIRONMENTAL AND HUMAN HEALTH

Audrey Tran Lam (17MPH) dedicates her work to improving the health of people and the natural environment.

18 HAPPENINGS

News and research findings.

24 CLASS NOTES

Alumni news and notes.

25 GALLERY

PhD candidate Jessica Andino (16MPH) works to increase access to safe and affordable housing.

26 SPARK

QUICK TAKES

Ellen Harris delivers keynote at HEAL Summit

Supporting Science

To celebrate National Public Health Week, students painted a banner in support of vaccines. The banner was a collaborative effort with Iowa Immunizes, a coalition committed to educating and protecting the health of all Iowans and their communities through vaccination of children and adults.

#17 BEST SCHOOL/ PROGRAM OF PUBLIC HEALTH IN THE NATION

Ellen W. Harris, DrPH, executive director of the Institute for Food & Development Policy, better known as Food First, was the keynote speaker for the seventh annual Science of Health Equity Summit hosted by the college’s Health Equity Advancement Lab (HEAL). Dr. Harris highlighted her extensive experience in food systems, nutrition, and agriculture.

Quoted

U2G Program Adds New Partner

Luther College and the University of Iowa College of Public Health have partnered to create an undergraduateto-graduate degree (U2G) program in public health. Students who take advantage of this program will be able to earn a bachelor’s degree plus a master’s degree in public health in five years.

“

The evidence is quite striking that people who report high levels of discrimination across a broad range of outcomes have worse physical and mental health. … So it says to all of us in society, in our communities, that we can be agents promoting life, or we can be agents promoting illness and death, just by how we relate to each other on a day-to-day basis. How we treat each other matters profoundly.

- Dr. David R. Williams, professor at the Harvard T.H. Chan School of Public Health and the 2022 University of Iowa College of Public Health Hansen Award recipient, on the CPH student-run podcast From the Front Row.

PUBLIC HEALTH DAY ON THE HILL

In February, College of Public Health students visited the State Capitol in Des Moines where they had the opportunity to speak with legislators about public health issues and gain real-world experience with advocacy.

1 in 3

University of Iowa undergraduate students participate in research.

As an undergraduate public health student, Makayla Morales was part of a team that conducted research on e-cigarettes and social media that led to a published paper.

DATA DECADES FOR

For 50 years, the Iowa Cancer Registry has served the state of Iowa as the trusted source for high-quality cancer data. The registry, housed at the University of Iowa, has been tracking cancer cases, survival rates, and deaths from cancer in the state since 1973.

BY RICHARD C. LEWIS

The wealth of data has enabled researchers to learn that Iowa, for example, has the second-highest cancer incidence rate in the United States and the highest incidence rate of head and neck cancer in the country. Such knowledge triggers resources—money, research, and doctors—to focus on how to prevent and better treat cancer.

It’s also unearthed geographical variation with cancer across Iowa, empowering county or regional hospitals to pivot care and support services to match patients’ greatest needs. More broadly, the Iowa Cancer Registry’s work has served as the standard-bearer for cancer information in the Midwest, and the data have been integral to supplying national analyses

For half a century, the Iowa Cancer Registry has had a profound impact on research, prevention, screening, and treatment.

such as the Agricultural Health Study, a 30-year (and ongoing), comprehensive look at cancer and other health factors affecting farmers.

It’s that kind of information, painstakingly collected over decades, that prompts prevention, screening, and treatment. Those collective efforts yield successes: Iowans have greater awareness about the risks of getting cancer, they’re getting earlier screening, and their survival rates have increased across the board.

“The Iowa Cancer Registry is a unique asset to Iowans, to health care and public health providers across the state, as well as to researchers worldwide,” says Mary Charlton, the registry’s director and associate professor of epidemiology in the UI College of Public Health. “This rich resource is changing the way we identify, diagnose, and treat cancer, and how

1983

1973 1993 2003 2013 2023

we care for and support the ever-growing population of those who have survived a cancer diagnosis.”

CANCER DATA FOR THE HEARTLAND

The Iowa Cancer Registry (ICR) was one of nine original members of the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program, and the only cancer data-collection center in the Midwest. As such, the information it collected about cancer in Iowa stood for years as the lone marker in the region for charting the disease.

“We were the only registry within the Heartland contributing our data since 1973, and that’s been our modus operandi ever since,” says Charles Lynch, who led the ICR from 1990 to 2020.

The ICR employed dedicated teams of professionals who fanned out to hospitals and pathology labs in every county, seeking paper records for each person who had been diagnosed with cancer. Staff made connections with cancer centers outside the state, such as the Mayo Clinic, to ensure the registry was collecting the most complete data it could on Iowans with cancer.

“We had to establish relations with hospitals in Iowa and surrounding states to detect all Iowans newly diagnosed with cancer,” Lynch recalls.

The collection challenge eased somewhat when the state legislature voted in 1982 to require cancer cases to be reported to the ICR.

Yet data are useful only if fully and accurately collected, and trends can be deciphered only after some passage of time. The year after Lynch took charge of the ICR, he directed staff to compile an annual report of cancer’s presence in Iowa.

“The idea was to put together something in a language that a citizen of Iowa could understand,” Lynch says.

The ICR has produced annual reports ever since. They include county-specific estimates for new cancer cases and cancer death projections, the most prevalent types of cancer in Iowa, cancer survivor statistics in each county, and cancer trends in the state.

“We spend a lot of time and effort collecting cancer data, developing reports and analyses to help hospitals across Iowa improve their care or their processes, and understand patient needs and services in that area,” Charlton says. “That exchange empowers hospitals and their communities to make improvements where they’re most needed.”

Those efforts have revealed telling trends about cancer in Iowa. Some are positive: The number of cancer survivors is rising, led by breast-cancer patients. Lung cancer cases have declined markedly, as fewer people smoke.

Others are concerning. Iowa has the secondhighest cancer incidence rate in the nation and is the only state where cancer incidence rates are increasing. It also ranks second in cancer incidence rates and third for cancer mortality rates in the Black population.

“We wouldn’t know that, or we wouldn’t be able to look at disparities like that, if we didn’t have really good data being collected by the registry,” Charlton says.

REGISTRY PARTNERSHIPS

In Carroll, Iowa, registry personnel are working closely with St. Anthony Regional Hospital, among other rural hospitals throughout Iowa, to help it win accreditation with the American College of Surgeons’ Commission on Cancer.

Through a five-year National Institutes of Health grant, Charlton and her team are helping St. Anthony undergo a full-scale review of its cancer care and its support services for cancer patients. These measures include core cancer services, such as radiation, and vital supplemental services, such as psychosocial, transportation, mental health, nutrition, genetic counseling, navigation, and palliative care. Each requires specific standards to be met, and the ICR staff is helping St. Anthony establish how to meet each standard and collect the data needed to track progress toward fulfilling those standards.

Lori Pietig, director of cancer services at St. Anthony Regional Hospital, says the accreditation would solidify the hospital’s cancer services and ensure it is meeting high-quality standards in

This rich resource is changing the way we identify, diagnose, and treat cancer, and how we care for and support the ever-growing population of those who have survived a cancer diagnosis.

“ ”

care. “If we are able to check the boxes needed for accreditation and have that stamp of approval, we can be looked at as a partner and that we’ve got resources here in west-central Iowa to take care of our patients,” Pietig says.

“You can’t put a value on the partnership,” she adds. “Data is key to growth and success. If you don’t have the data sets and the information, you don’t know where you’re really lacking. To do that, you must have information that is accurate, that is timely, and that you can trust. That’s what the Iowa Cancer Registry does well.”

NATIONAL AND GLOBAL IMPACT

The ICR’s data have contributed to numerous national cancer studies, enabling federal agencies such as the National Institutes of Health, the Environmental Protection Agency, the Centers for Disease Control and Prevention, the Department of Agriculture, and others to devote resources where the need is greatest.

One example is ICR’s leadership on radon, the naturally occurring, radioactive gas that can permeate residential homes and is the leading cause of lung cancer among nonsmokers. Radon is prevalent in some geographic areas in Iowa, so the ICR in 1993 began the Iowa Radon Lung Cancer Study examining residential radon exposure in the state. The data from that study were pooled with studies in the U.S., Canada, and Europe—and eventually made its way to the World Health Organization, which created a handbook on how countries should handle residential radon.

Looking ahead, the ICR aims to leverage advances in data collection, such as with electronic pathology (ePath), that can allow cases to be entered almost as soon as a new cancer has been diagnosed.

“We want to continue to collect really high-quality data in the most efficient way possible because the National Cancer Institute wants the most timely statistics,” Charlton says. “So, a big challenge moving forward is quickly obtaining crucial information, such as cancer site and cancer stage, that can provide accurate, timely information about the cancer burden in Iowa and nationally.”

Highlights from the 2023 Cancer in Iowa report include:

The Iowa Cancer Registry now RECORDS ALMOST TWICE AS MANY CANCER CASES than when the registry began in 1973.

IOWA HAS THE SECOND HIGHEST INCIDENCE RATE FOR CANCER IN THE U.S. and is the only state with an increasing rate of cancer.

IOWA RANKS FIRST AMONG ALL 50 STATES for rates of new cases of oral cavity and pharyngeal cancer, and it is in the top five for leukemia and melanoma.

CANCER MORTALITY RATES HAVE DECREASED OVER TIME, likely due to decreased smoking, available screenings, and advances in treatment.

SURVIVAL RATES HAVE ALSO IMPROVED since the 1970s, with more than 164,000 cancer survivors currently living in Iowa.

View

Dental Health Is Public Health

Good oral health requires a multidisciplinary approach, including public health expertise in policy, access to care, disease prevention, and more.

BY DEBRA VENZKE

You may not think of your toothbrush

as a powerful disease-fighting tool, but oral health has a significant impact on health and quality of life. It affects the ability to speak, eat, and smile, and it influences social interactions, work, and school performance. Poor oral health is also linked to numerous diseases, including diabetes, cardiovascular disease, some cancers, and adverse pregnancy outcomes.

Unfortunately, millions of Americans experience pain and disability from cavities, gum disease, and other conditions. Some 34 million school hours are lost each year because of emergency dental care, and over $45 billion in U.S. productivity is lost annually due to untreated dental disease, according to the Centers for Disease Control and Prevention (CDC). While dentistry and public health are traditionally viewed as separate fields, they often intersect in support of oral health. Community water fluoridation, reduction of tobacco and alcohol use, improved nutrition, and cancer screenings are some of the many ways that public health and dental health work together. Several investigators in the College of Public Health conduct research on oral health topics such as access to care, cancer prevention, and children’s dental health.

DENTAL HEALTH AND SCHOOLING

Cavities are the most common chronic disease of childhood in the United States. Research shows that children from low-income families are twice as likely to have cavities as children from higher-income households, and young children with public insurance also have higher rates of dental problems and unmet dental needs than those with private insurance.

George Wehby, professor and John W. Colloton Chair of Health Management and Policy, conducted a study that examined the association between oral health during the first five years of life and subsequent academic achievement for low-income children in Iowa. The study used a unique populationbased linkage between Medicaid claims data, birth certificates, and standardized test scores from grades 2-11.

The results showed that children who received comprehensive dental exams and minor dental treatments (such as fillings) during the first five years of life had higher reading and math scores, while children who received major dental treatments (such as a crown or tooth extraction) had lower reading and math scores.

These results suggest that “minor treatments prevented dental issues from deteriorating into more severe problems later in life, and that comprehensive dental exams were also beneficial,” Wehby explains. In contrast, the major treatments serve as markers for more severe dental problems that may disrupt children’s attention, sleep, and learning.

The findings support the importance of addressing barriers to dental care and promoting oral health in early childhood and suggest that the disproportionally high rates of unmet oral health needs among low-income children are associated with income gaps in academic achievement.

BARRIERS TO CARE

Barriers to accessing dental care include lack of time, information, and transportation, but the two primary barriers are affordability and insurance, Wehby says.

More than 84 million Americans with limited income rely on Medicaid for health coverage. With the passage of the 2010 Affordable Care Act (ACA), many people became newly eligible for medical and dental coverage in states that adopted Medicaid expansions.

But Medicaid is complicated: States are required to provide dental benefits to children covered by Medicaid and the Children’s Health Insurance Program. However, the federal government does not require Medicaid plans to cover adult dental services.

“It’s really up to states, and states vary dramatically in what dental services they cover under Medicaid for adults,” Wehby notes. Some states offer extensive benefits, others offer limited benefits, and others offer emergency-only or no benefits for adults.

Another difficulty is “finding dentists who accept Medicaid coverage and are willing to provide services,” Wehby says. “There are also geographic barriers—there are shortage areas for access and availability of dental care.”

Shortage areas are not exclusively a rural issue, he adds. “Even in urban areas, finding a dentist that accepts Medicaid patients might not be as easy as one would think.”

REDUCING DISPARITIES

Racial and ethnic inequities in accessing dental care have persisted for decades. Wehby and his colleagues Wei Lyu and Dan Shane conducted a study to see if recent ACA Medicaid expansions that included coverage of dental services for adults affected racial and ethnic disparities in dental services use.

While no decline in disparities was seen in states with less generous dental benefits, “We found that Medicaid expansion with extensive adult dental benefits has increased dental services use, particularly for Hispanic adults and non-Hispanic Black adults, and reduced racial and ethnic disparities in use,” the authors noted in their paper published in Health Affairs

However, the researchers found that utilization rates remained low across all groups during the study period, regardless of expansion status or the generosity of dental benefits.

“Even with improvements in coverage and narrowing of disparities in accessing care, more actions are needed to further reduce access barriers for all,” the authors concluded.

CANCER PREVENTION

Oral health involves more than teeth and gums. “It means being free of chronic oral-facial pain conditions, oral and pharyngeal (throat) cancers, oral soft tissue lesions, birth defects such as cleft lip and palate, and scores of other diseases and disorders that affect the oral, dental, and craniofacial tissues,” notes the 2000 Surgeon General’s Report on Oral Health in America.

Iowa has the unwelcome distinction of ranking first among all 50 states for rates of new cases of oral cavity and pharyngeal cancer, according to the 2023 Cancer in Iowa report produced by the Iowa Cancer Registry.

Cancers in the back of the throat (oropharynx) traditionally have been caused by tobacco and alcohol, but recent studies show that human papillomavirus (HPV)-associated oropharyngeal cancer rates are increasing. Up to 70% of oropharyngeal cancers may be caused by HPV, according to the CDC.

The HPV vaccine, recommended for children at ages 11-12, is safe and effective in protecting against HPV and the cancers it causes. However, HPV vaccination rates remain below the Healthy People 2030 goal of 80% coverage.

Natoshia Askelson, associate professor of community and behavioral health, is part of a research team that conducted a study showing that dental providers are willing to be partners in HPV vaccine promotion. The team used data from the study to develop a series of continuing education trainings for dental providers. The training covers HPV basics, the vaccine and its connection to oral health, and how to recommend the vaccine.

“The goal of the intervention is to train dentists and dental hygienists so that they can make a strong recommendation for the HPV vaccine to the parents of the [adolescent] patients that they see,” says Askelson. “We know a recommendation is more effective when coming from a health care provider.”

Working with colleagues from the University of Iowa College of Dentistry, the team has delivered the training to dental providers at Federally Qualified Health Centers in Iowa and to an oral health coalition in western Iowa.

The team plans to pilot the training in a study to see whether dental providers ultimately make strong recommendations for the HPV vaccine and if parents follow through and get their kids vaccinated.

The investigators are also working on a similar project with ENT (ear, nose, and throat) specialists.

“We hope to develop an intervention that would help ENTs in the community know how best they can support the uptake of the HPV vaccine,” says Askelson.

UNDERSTANDING OROFACIAL CLEFTS

Cleft lip and cleft palate are among the most common birth defects globally. They occur when facial structures that are developing in an unborn baby don’t close completely and are thought to be caused by an interaction of genetic and environmental factors.

“Orofacial clefts cause significant medical, psychological, educational, and financial problems,” says Azeez Alade, a PhD student in epidemiology whose research focuses on identifying the genetic and genomic causes of orofacial clefts. “There is a critical need to identify effective interventions, which will require more in-depth knowledge of the underlying genetics. The knowledge gained from our study will facilitate risk prediction, genetic counseling, and, ultimately, prevention.”

Tabitha Peter, a PhD student in biostatistics, is also applying her skills to better understand orofacial clefts. “For my dissertation, I’m studying families and how genetic markers impact physical traits for people in those families,” she says. “My work includes collaborating with other students from my department in writing code for a computing tool. This tool (an R package) is designed to analyze associations between multiple genetic markers and a physical trait. A novel feature of this tool is in its method for analyzing data from studies of related individuals. A specific application of this tool will be to a data set that describes families impacted by cleft lip/cleft palate.”

Supporting good oral health requires a multidisciplinary approach, and public health has a wide array of expertise to tackle policy, disparities, genetics, disease, and more. As former U.S. Surgeon General David Satcher said more than 20 years ago, “You cannot be healthy without oral health.”

Iowa has the unwelcome distinction of ranking first among all 50 states for rates of new cases of oral cavity and pharyngeal cancer, according to the 2023 Cancer in Iowa report produced by the Iowa Cancer Registry.

BUILDING HEALTH EQUITY

BY DEBRA VENZKE

initiatives, strategies, and goals. To give a few national examples, Healthy People 2030 identifies achieving health equity as one of its overarching goals. The American Public Health Association lists creating health equity as a guiding priority and core value. The CDC has launched an agency-wide strategy to integrate health equity into the fabric of its work at all levels, and many state and local public health departments are following suit.

But what, exactly, does health equity mean?

While there are a number of definitions that share similarities, the Iowa Department of Health and Human Services (IDHHS) defines health equity as “the attainment of the highest possible level of health for all people. It means achieving the environmental, social, economic, and other conditions in which all people have the opportunity

“Health equity” is a phrase that’s increasingly woven into public health

A new training program provides health department employees with an understanding of health equity principles to support communities and address inequities.

to attain their highest possible level of health. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequities, historical and contemporary injustices, and the elimination of health and health care disparities.”

A FOUNDATIONAL UNDERSTANDING

Because individuals’ familiarity with health equity varies within every health department and agency, trainings can help strengthen employees’ knowledge of health equity principles. One such program, the Building Health Equity (BHE) Training Program, provides health

department employees in Iowa with a foundational understanding of health equity issues, causes, and outcomes, as well as the tools to connect this knowledge to personal and professional situations.

The program consists of six asynchronous modules and four live discussion sessions, and is led by a team of public health practitioners, faculty, staff, and students from the Institute for Public Health Practice at the University of Iowa College of Public Health. The project is supported by IDHHS through funds provided by the American Rescue Plan Act of 2021.

This training is important because, as the BHE Training Program web site explains, “Racism, ableism, classism, and other forms of oppression, bias, or discrimination against certain groups or populations contribute to health disparities and other disproportionate negative outcomes in those affected. We must work to acknowledge our own experiences and biases to better understand the role each of us has in promoting equity in our work as public health professionals.

“Additionally, it is imperative that we recognize the historical and current systems that contribute

to these disparities so we can work to dismantle them to better the health and well-being of all members of the communities we serve.”

The trainings involve individual work and selfreflection as well as facilitated group conversations, some of which can be sensitive or difficult. Establishing boundaries of respect and confidentiality are important to the process.

“It’s two basic principles combined together,” says Laurie Walkner, one of the facilitators and interim director of the Institute for Public Health Practice, about the training. “It’s people doing inside work for their own health equity journey, and it’s how people translate that at work into the practices, partnerships, and policies they’re involved in.”

The training is about participants’ personal growth and learning and “how to make it apply to their everyday life, but also within their work that they do for the health department and the community and clients they interact with,” adds Tricia Kitzmann, who s erves as a training facilitator and program coordinator.

NEW PERSPECTIVES

As of spring 2023, the Building Health Equity Training Program has been delivered to the public health departments in Black Hawk and Linn Counties and is underway at Johnson County Public Health.

Jared Parmater completed the training in his role as environmental health program manager for Black Hawk County Public Health. He says the training provided a “slow and consistent build towards understanding the basic tenets of health equity.”

“It’s given me a better perspective on the cause of a lot of the issues that we encounter in our work and the importance of understanding the history behind equity,” Parmater says.

He adds that learning about and practicing health equity “is a process, particularly for those professionals that might not have a traditional public health background,” he says. “Give yourself grace and time to work through everything and understand that there will be difficulties and that that’s ok.”

Anne Harris Carter joined Linn County Public Health in April 2022 as the department’s first-ever health equity program manager. One of her initial projects was working with the BHE Training Program team to deliver the training.

“I was excited to come alongside the

College of Public Health team to customize and refine the workshop content, help develop group activities to complement the curriculum, and co-facilitate every session,” Carter says. “I’m also new to public health, having spent my career up to this point in the corporate sector. The series was structured in a way that allowed our entire department to learn together, regardless of our level of familiarity with health equity.”

HEALTH EQUITY IN EVERY COMMUNITY

The Building Health Equity team also produces a webinar series for public health practitioners that focuses on health equity issues. Topics have included environmental justice, food access, disabilities, the LGBTQ+ community, rural health, mental health, and more. The webinars are archived as videos and turned into podcasts for listening on the go.

“We get positive feedback from folks that it’s been beneficial, that this is good information. They like the tools and links that are shared,” says Kitzmann. Although the webinars are geared for Iowa, she notes that they’ve had participants from across the U.S. and Canada.

The team emphasizes that health equity isn’t an issue only for cities or metropolitan areas, but that it affects communities of all sizes.

“Ageism, poverty, and disabilities are issues that every community is challenged with,” Walkner says. “We try to stress the positive impact of health equity on community. Everybody benefits from a healthy society. There is diversity within every community, some of which isn’t visible. It may not be race or ethnicity, but there are diverse needs.”

“The mental health webinar was popular because the size of your community doesn’t matter,” Kitzmann cites as an example. “One in five people will experience a mental health condition in a given year, so it’s a common concern and people see that it’s applicable to their community.”

By addressing topics that some communities might not discuss often, “it’s giving public health workers those small but mighty steps to move [health equity] forward,” Walkner says. “I think that’s the key takeaway. We want to make sure that participants are able to take what we’ve talked about and start thinking about it,

implementing it, whether they’re already in the process or are just beginning.”

Some of the ways Carter and her colleauges at Linn County Public Health are putting health equity principles into action include conducting a “roadshow” to present highlights from the Community Health Improvement Plan (CHIP), including development of the plan, opportunities to

support implementation, and ways to engage.

“The goal is to prioritize relationship-building to expand the diversity—visible and invisible— of organizations and individuals who serve as co-creators for the 2025-2027 CHIP,” Carter explains. “We also have cross-sector efforts, such as the Alliance for Equitable Housing and examining the Linn County Board of Health position statement on Racism as a Public Health Crisis.”

MAKING TRANSFORMATIVE CHANGE

For Carter, “The BHE training series provided a tremendous foundation for me, and I’m grateful to continue learning and growing with my colleagues.”

Walkner echoes the idea that pursuing health equity is a continuous process. “One key message is that health equity is a lifelong journey, and that it’s important in both our professional and personal lives. To make transformative change, we have to start within ourselves and build out.”

“It’s not just one thing—whether we’re talking racism, sexism, ageism—it’s multifaceted, and there are multiple layers of issues that we’re trying to address,” says Kitzmann. “All of that, in some shape or form, is going to impact your health and well-being. If we want to have a healthy community, if we want to impact the next generation, we have to address inequities.”

The series was structured in a way that allowed our entire department to learn together, regardless of our level of familiarity with health equity.

“ ”

Supporting ENVIRONMENTAL and HUMAN HEALTH

Alumna Audrey Tran Lam (17MPH in occupational and environmental health) is an environmental health program manager with the Center for Energy & Environmental Education (CEEE) at the University of Northern Iowa. Originally from Vinton, Iowa, Tran Lam has also earned a Certificate in Plant-Based Nutrition from eCornell and a Graduate Certificate in Food Systems, the Environment, and Public Health from Johns Hopkins Bloomberg School of Public Health. She answered some questions about her career path, the power of volunteering, and environmental stewardship.

What led you to public health?

Funnily enough, I didn’t know what public health was until the summer of 2014. I was serving as an AmeriCorps volunteer in Cedar Rapids to make homes more energy efficient. During my service, I also worked on an organic vegetable farm for four seasons. It was there that I started really understanding the complex, interlocking web that connects food, food access, nutrition security, land use, agriculture, chemical fate and exposure, climate change, and human health. I saw the nexus of all these issues as being “public health,” and wanted to spend my life working to make the system more sustainable. So, I started at the College of Public Health in 2015!

PHOTO BY JOEY LOBODA

Tell us more about your work with the CEEE. My work spans two topics that I hold very dear: people and the natural environment. The two cannot be separated and are constantly influencing each other. Instead of just working to fix environmental problems or focusing strictly on topics of human health, I’m interested in where these topics bleed into each other. I hold a deep, deep love for Iowa, so the way that I think about the relationship between people and land is in a very Midwestern context.

I focus most of my time at the CEEE on two statewide environmental health programs—Good Neighbor Iowa and Farming for Public Health. Both aim to increase awareness about how practices we don’t think twice about impact human health in surprising ways. For example, many people don’t realize that many chemicals that we use in everyday life—pesticides, cosmetics, etc.—are derived from fossil fuels and can have many harmful impacts to health, especially that of children and pregnant women. Similarly, we don’t put together that agriculture, especially as currently practiced in the Midwest, has many negative downstream impacts to environmental and human health. How can we think about these problems in a way that encompasses the whole system to improve both our environment and human health?

You’re also involved with several nonprofits, including serving as current president of the Iowa Rural Health Association. What do you hope to focus on in this role?

I’m interested in highlighting how rural health encompasses more than the very real and immediate need of access to quality health care; it also includes environmental issues like poor water quality, vulnerability to floods, pesticide drift, lack of economic opportunity, and more.

My roles on the boards of the Heartland Health Research Alliance, the Pesticide Action Network, and the Plant Based Food Institute are not only ways that I can develop and deepen my understanding of how successful organizations function, but also support important work by passionate people.

What excites you most about your professional and volunteer work?

The people, most definitely! I have developed meaningful relationships with some of the most incredible, dedicated individuals who have chosen to spend their time making Iowa (and the world) a better place. I’ve learned so much from each of them. I also hope to one day gain enough experience to provide the guidance and mentorship that I’ve received to others.

What are three things that Iowans can do to help support or improve environmental health?

My first tip would be to eliminate the cosmetic use of pesticides in your home and lawn. We’re learning a lot about how chronic, low-doses of pesticides negatively impact human health, especially in-utero and in early life. Second, be aware of the chemicals in cleaning and personal care products; lots of everyday products contain endocrine-disrupting chemicals. Finally, eat more locally and mostly plants! Upwards of 86% of food that Iowans eat comes from outside of Iowa. Cultivation, processing, and transportation can impact the footprint of your food, and supporting biodiverse farming systems within the state improves environmental health and rural livelihoods.

What advice do you have for students who are interested in environmental issues and careers?

Public and environmental health are such diverse and vibrant fields. In his book,  Sicker, Fatter, Poorer, Dr. Leonardo Trasande remarks that “Public Health is a team sport.” I use that line all the time—there are so many different roles to play in the myriad of systems that intersect and interlock. My advice is to follow the thing that pulls you. For me, it was environmental exposures to chemicals, food systems, and climate change. I really believe that there is a place for you in the public health ecosystem to do whatever it is that you love.

Second, boundaries are important. That being said, say “yes” to opportunities as they come your way!

Volunteer to take notes at a meeting or to facilitate it! Volunteer to review abstracts for APHA! Little things build up your experience over time and signals to your colleagues that you’ll be there when they need you.

HAPPENINGS

The College of Public Health has named Carla Britton and Kelsey Feller the recipients of its 2023 Outstanding Alumni Awards.

Britton (above, left) received a Master of Science degree in epidemiology in 2006 and a doctoral degree in epidemiology in 2010, both from the University of Iowa College of Public Health, and a MS degree in environmental and public health from the University of Wisconsin. She is currently lead epidemiologist at the Alaska Native Tribal Health Consortium’s Alaska Native Epidemiology Center.

Feller (above, right) received a Master of Public Health degree in 2015 in community and behavioral health. She is the data sharing, privacy, and open records bureau chief in the Division of Public Health at the Iowa Department of Health and Human Services.

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.

A PARKINSON’S BIOMARKER BREAKTHROUGH

U.S. researchers recently announced that they have developed a new test that could help diagnose Parkinson’s disease before symptoms show. Their findings were published in the May 2023 issue of The Lancet Neurology journal.

The research from the Parkinson’s Progression Markers Initiative, a biomarker study sponsored by The Michael J. Fox Foundation for Parkinson’s Research ,  confirms the most significant breakthrough yet in the search for a Parkinson’s biomarker: a biological test for Parkinson’s disease that demonstrates high diagnostic accuracy, differentiates molecular subtypes, and detects disease in individuals before cardinal movement symptoms arise.

The Clinical Trials Statistical & Data Management Center (CTSDMC), based in the Department of Biostatistics in the UI College of Public Health, serves as both the statistics core and data management core for the research project. CTSDMC staff member and biostatistics doctoral student David-Erick LaFontant (13MS) led the analyses for the paper, and several other members of the CTSDMC contributed to the paper.

Petersen Named the Edwin B. Green Chair in Public Health

Christine Petersen, professor of epidemiology and director of the Center for Emerging Infectious Diseases in the College of Public Health, has been named the Edwin B. Green Chair in Public Health. Petersen will hold the endowed chair for a five-year term, which may be renewed. Petersen also was named the 2023 Scholar of the Year by the UI Office of the Vice President for Research. Petersen is internationally known for her work on the recognition and prevention of zoonotic diseases. Her work has focused particularly on visceral leishmaniasis, a tropical parasitic disease that kills 20,000–40,000 people every year, and tickborne diseases, particularly Lyme disease. In addition, she collaboratively works on malaria, Brucella canis, influenza, and other diseases.

IN MEMORY: Richard and Barbara Hansen

The College of Public Health was deeply saddened to learn of the passing of Barbara and Richard Hansen of Iowa City, Iowa, on March 20, 2023, and May 27, 2023, respectively. The Hansens were longtime supporters of the college and the University of Iowa. Prior to his retirement, Richard Hansen was founder, partner, and director of Hansen Lind Meyer, Inc., a leading health care architectural firm. Barbara Hansen was active in numerous educational and volunteer programs she established and nurtured. The Hansens were the first Founding Partners of the College of Public Health and, in 2001, established the Richard and Barbara Hansen Leadership Award and Distinguished Lectureship in the college. This award honors persons who have demonstrated exemplary leadership in the public health field and brings them to the University of Iowa campus for interaction with students, faculty, and public health professionals. The College of Public Health is forever grateful for their vision, trust, and generous support.

Innovative Mental Health Awareness Training

Gerta Bardhoshi, College of Education associate professor of counselor education, Ebonee Johnson, College of Public Health assistant professor of community and behavioral health, and Kari Vogelgesang, College of Education clinical associate professor, were awarded a grant to launch Project PEARLS (Prepare, Engage, Assess, Respond, Link, Sustain), a new mental health awareness training curriculum in the Iowa City community.

“There is a huge mental health awareness training need for community stakeholders,” says Johnson. “Through Project PEARLS, we will create that space to build self-efficacy and confidence in not only broaching youth mental health issues but also in making the appropriate referrals.”

Funded by a $500,000 grant from the Substance, Abuse, and Mental Health Services Administration , Project PEARLS will focus on nine schools—six elementary schools, one junior high school, and two high schools—with high rates of racial/ethnic minority students and free and reduced lunch recipients. More than 700 school personnel, onethird of all Iowa City Community School District (ICCSD) employees, are identified to receive training over four years.

“Anyone that is working in a school building—whether you are a teacher, school counselor, bus driver, cafeteria worker, or custodian—will be able to receive training,” says Bardhoshi, one of the project’s co-directors.

The evidence-based curriculum includes mental health literacy and recognition, intervention and crisis de-escalation best practices, strategies for self-care, and opportunities to practice and reflect. The initial phase rolled out to K-12 educators and school staff in April 2023, with key personnel first receiving a pilot training to better refine the curriculum. Phase two will include parents, and phase three will integrate key community stakeholders.

Since each group uniquely interacts with students and needs different skills to recognize and intervene, each training will be customized.

“We all have a role to play to improve the health and well-being of K-12 students,” says Johnson. “Oftentimes, we just need to be the bridge to other forms of support. This training will help each person figure out how they can be a connector in their role.”

BUILDING TRUST BETWEEN RESEARCHERS AND INDIGENOUS COMMUNITIES

The National American Indian & Alaska Native Prevention Technology Transfer Center has produced a new guide for researchers and Indigenous communities to help them understand some of the complexities they may encounter and elements they must consider when approaching research with Native populations. The guide, Research at the Speed of Trust, is intended to help researchers and the Indigenous communities they work with to avoid common pitfalls, improve their relationships, and strengthen the value of their research efforts. View the guide at https://bit.ly/3MA3 atm

Studying Climate Change and Lung Health

A new NIH-funded grant will offer University of Iowa trainees the opportunity to conduct research in the intersection of climate change and lung health. David Stoltz, professor and director of the Division of Pulmonary, Critical Care, and Occupational Health in the Carver College of Medicine, will serve as co-PI on this new T32 grant with Peter Thorne, professor of occupational and environmental health in the College of Public Health and a University of Iowa Distinguished Chair. Thorne also directs the CPH Nexus Collaboratory on Climate Change and Health.

The five-year, $2.13 million award from the National Heart, Lung, and Blood Institute will support research trainees from a variety of disciplines, including postdoctoral research fellows as well as PhD students in programs such as occupational and environmental health, epidemiology, human toxicology, and the Medical Scientist Training Program.

“Climate change is an existential threat to humankind and is the grandest challenge of the 21st century,” Thorne says. “This training grant represents another step toward our goal of equipping all students, and especially future health professionals, with the knowledge about the profound impacts of climate change.”

Public Health Heroes

The University of Iowa College of Public Health honored three Iowa public health leaders whose work is helping to promote better health, prevent disease, and build stronger communities throughout the state.

The 2023 Iowa Public Health Heroes Awards were presented to (from left) Joy Harris, director of education services for Iowa’s Public Health Accreditation Board; Peter Teahen, funeral director, author, mental health professional, and traumatologist from Cedar Rapids; and Michelle Lewis, health promotions and planning coordinator for the Siouxland District Health Department.

The award recipients were honored during a reception and awards ceremony at the Public Health Conference of Iowa in Ames.

CAVANAUGH RECEIVES 2023 REGENTS AWARD FOR FACULTY EXCELLENCE

Joseph Cavanaugh, professor and head of the Department of Biostatistics in the College of Public Health, is one of six outstanding University of Iowa faculty members selected by the Board of Regents, State of Iowa, to be honored for their extraordinary contributions and sustained record of excellence in teaching, scholarship, and service. The recipients will be honored at an awards celebration during the June 2023 Board of Regents meeting on the UI campus.

Mueller Honored for Publicly Engaged Research

Keith Mueller, Gerhard Hartman Professor in the Department of Health Management and Policy in the College of Public Health, received the 2023 Distinguished Achievement in Publicly Engaged Research Award from the UI Office of the Vice President for Research. The award recognizes an individual faculty member who has put addressing public needs and direct engagement with the public, in the service of improving quality of life through research, at the forefront of their academic activities.

Novak, Pacheco Selected as RWJF Interdisciplinary Research Leaders

University of Iowa professors Nicole Novak and Julianna Pacheco have been selected to participate in a Robert Wood Johnson Foundation (RWJF) leadership program that connects community researchers from across the country.

Novak, a research assistant professor in the Department of Community and Behavioral Health in the College of Public Health, and Pacheco, an associate professor of political science in the College of Liberal Arts and Sciences, were selected to a team of Interdisciplinary Research Leaders (IRL) that supports and expands action-oriented and communityengaged research to create healthier communities. The goal of the IRL is to train leaders who conduct and apply highquality and equity-focused research that drives improvements in community health.

Novak and Pacheco’s three-person team also includes Nicholas Salazar, president of the League of Latin American Citizens (LULAC). The trio will work with community members to explore how voter suppression bills affect voting, civic engagement, and health equity for Latino communities in Iowa. Research results will inform local efforts to promote inclusive communities with equitable political power and voice.

“We know that civic engagement and political incorporation are critical foundations to healthy, inclusive communities,” says Novak. “We want our research to make a real difference for Iowa communities, and there is no better way to have an impact than to work with people who are already fighting for change. LULAC has worked for decades to promote voter rights and inclusive communities, and together we will conduct rigorous research to bolster their efforts.”

CLASS NOTES

Amani (Dewan) Alam (21BA) is a community health planner and CHAT team coordinator at Franklin County Public Health in Columbus, Ohio.

Brianne Bakken (17MHA) received the 2023 American Pharmacists Association Wiederholt Prize for Best Published Paper for Economic, Social, and Administrative Sciences.

Hind Baydoun (09PhD) recently joined the Veterans Health Administration as a health science specialist with the National Center on Homelessness Among Veterans in Washington, DC.

Libby Beaman (21BS) is an associate account manager at Smith & Nephew in Chicago, Illinois.

Anna Kate (Kollasch) Bush (20MHA) is a manager of physician practice at Allina Health–New Ulm Medical Center in New Ulm, Minnesota.

Liz (Stepniak) Connellan (10MPH) is the director of population health research operations, Institute for Population and Precision Health, at the University of Chicago in Chicago, Illinois.

J. Alton Croker III (21PhD) will join the faculty in the Department of Health Services and Policy Management in the Arnold School of Public Health at the University of South Carolina in Columbia, South Carolina.

Daniel Davis (01MHA) is vice president at Elevance Health in Huntley, Illinois.

Robyn Espinosa (22PhD) is an epidemiologist at Peers & Partners in Atlanta, Georgia.

IN MEMORY

Claire Fleming (18MHA) is an implementation manager at Xealth in Seattle, Washington.

Caitlin (Lueck) Hard (15MPH) is an associate general manager at Aspire Health, Inc. in Mendota Heights, Minnesota.

Emma Herbach (22PhD) is an assistant scientist at Sylvester Comprehensive Cancer Center, Office of Community Outreach and Engagement, at the University of Miami in Miami, Florida.

Rebecca Hertges (22MS, 20BS) is a safety engineer CaptiveAire Systems in West Union, Iowa.

Marvin Holmes-Leopold (14MPH) is a payroll manager at Lutheran Social Service of Minnesota in St. Paul, Minnesota.

Nan Hu (14MS) is a senior principal statistical scientist at Genentech in San Francisco, California.

Steven Johnson (16MHA) is a senior consultant, performance management, at Trinity Health in Kansas City, Missouri.

Allison Ludwig (08MHA, 08MPH) is a principal at The MITRE Corporation in New York, New York.

Jennifer McDougle (21MPH) presented her work at the World Organization for Animal Health Global Conference on Emergency Management in Paris, France, in April 2023.

Emma Meador (22MPH, 21BS) is a cancer research data analyst at Mid-Atlantic Permanente Medical Group, Kaiser Permanente, in Rockville, Maryland.

Tyler Peterson (13MHA) is associate vice president, data operations, at Vizient, Inc. in Chicago, Illinois.

Rachel Quinn (21MS, 21CER) is a disease prevention specialist at Johnson County Public Health in Iowa City, Iowa.

Dominica Rehbein (14MHA, 14MPH) is a clinic manager, Family Medicine, University of Iowa Hospitals and Clinics, in Iowa City, Iowa.

Jamison Robinett (19MHA) is chief operating officer at HCA Florida Palms West Hospital in Loxahatchee Groves, Florida.

Jim Skogsbergh (82MA) received the 2023 Distinguished Service Award from the American Hospital Association. He is co-CEO of Advocate Health, the fifth largest not-for-profit, integrated health system in the U.S.

Jenni Talbott (04MHA) is the chief operating officer for McFarland Clinic PC in central Iowa.

Rebecca Villa (22MPH, 22CER) has been accepted into the University of Washington’s PhD program in pathobiology beginning in fall 2023, where she will conduct infectious disease research.

Leah Wentworth (16PhD) is the director of research, support, and education at the National Alliance on Mental Illness (NAMI) in Altamont, New York.

Haley Wilson (22MPH) is a public health systems analyst at Johnson County Public Health in Iowa City, Iowa.

May 8,

April 15, 2023.

Feb. 5,

Kelly Durian (95MA) of Iowa City, Iowa, on Jan. 9. 2023. Kenneth Etcheson (55MA) of Canton, Illinois, on April 7, 2023. Bushra Ibnauf Sulieman (06MS) of Khartoum, Sudan, on April 25, 2023. Barbara (Swain) Johnson (77MA) of Jefferson, Wisconsin, on March 6, 2022. Ralph Kessel (74MS) of Des Moines, Iowa, on Nov. 19, 2022. Jeanie (Beatty) Kirk (01MPH) of Saint Charles, Missouri, on

2022. A aron Liberman (68MA, 74PhD) of Orlando, Florida, on

2023. Bradley Randles (09MPH) of Martinez, California, on

Charles Ruehle (73MS) of Deale, Maryland, on Feb. 9, 2022. Susan (Burton) Sandra (93MS) of North Liberty, Iowa, on Nov. 13, 2022. Leslie Scarborough (63MS) of Stone Mountain, Georgia, on Nov. 19, 2022. Guy Thomas (82MA) of Parker, Colorado, on Aug. 13, 2022. William Yates (86MS) of Tulsa, Oklahoma, on Jan. 19, 2023.

Increasing Access to Affordable Housing

PhD candidate and alumna Jessica Andino (16MPH) studies the connection between housing and health. Research shows that households experiencing housing cost burden (spending more than 30% of income on rent, mortgage, and other housing needs) have increased stress and related mental health problems, and an increased risk of disease.

Her dissertation examines the impact of a specific type of affordable housing—manufactured home communities—on low-income residents’ well-being.

“Manufactured home communities are unique, affordable neighborhoods that may be a solution to the affordable housing crisis,” she says. “By investigating the health of individuals in manufactured home communities, I’m not only able to fill the gap in academic literature, but also can assist the affected communities in order to achieve future health equity.”

Andino extends her scholarly interests into community action. She serves as the executive director of the Johnson County (Iowa) Affordable Housing Coalition, whose mission is to increase access to affordable housing for low-income people through advocacy, education, and partnerships.

She also has dedicated countless hours to area volunteer organizations, including the Human Rights Commission for the City of Iowa City, Center for Worker Justice of Eastern Iowa, Open Heartland, and the Housing Trust Fund of Johnson County.

“Previously serving as the chair of the Human Rights Commission for the City of Iowa City allowed me to see first-hand the urgency and necessity for all individuals to have a right to safe, stable, and affordable housing,” Andino says. “It’s unjust to not have safe and affordable housing options in our community.

“Many Johnson County households cannot afford a decent, stable place to live,” she continues. “There are entire sectors without homes that can be rented or bought at reasonable prices. There are neighborhoods that lack important resources, such as access to good jobs, safe and well-maintained public spaces, and integrated schools. People with lower and moderate incomes are most disadvantaged by our housing system and the resources they cannot obtain. Given the current trends, the problem is growing more significant as rents and home prices steadily rise while incomes stay the same.”

In recognition of her work, Andino received the 2023 Sprince Zwerling Award for Social Justice. This award is given to a distinguished, well-deserving graduate student in the Department of Community and Behavioral Health who is pursuing an interest in addressing health disparities and alleviating social injustice.

Andino’s career goals include continuing her position at the Johnson County Affordable Housing Coalition and furthering her research and teaching on housing issues as a faculty member.

“My education at the University of Iowa College of Public Health and in-depth community involvement have provided a strong foundation for fighting against social injustices in a professional capacity,” Andino says. “Making a meaningful impact on my community is a priority and passion of mine.”

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

Summer in Iowa City has a pace all its own. From colorful festivals and live music to great restaurants and sunset strolls by the river, our town shines in the warm months.

PHOTO BY JUSTIN TORNER