FROM THE DEAN
People who reside in rural areas enjoy many benefits, but they face more challenges accessing health care than their urban counterparts. Long travel times, transportation difficulties, and shortages of physicians, dentists, and mental health professionals are just a few of the barriers t o accessing care. Rural areas also have more uninsured residents, lower incomes, and greater risk of injury-related death compared to urban areas.
At the College of Public Health, many of our researchers are examining how to improve the health and safety of rural communities. In February of this year, the college held the Rural Health Summit, which provided an opportunity to showcase the rural health research and initiatives conducted by faculty, staff, and students, as well as centers and programs.
In this issue, we highlight a few of these projects, including a study examining how proximity to concentrated animal feeding operations (CAFOs) might increase the risk of exposure to antimicrobial-resistant genes, a project that is using cutting-edge models and simulations to improve stroke triage in rural areas, and a training resource that addresses the unique safety and cultural concerns of farm families caring for a loved one with dementia.
We also feature the Cancer in Iowa: 99 Counties Project, an effort led by the Iowa Cancer Registry and University of Iowa College of Public Health, in collaboration with the Iowa Cancer Consortium, University of Iowa Holden Comprehensive Cancer Center, and Iowa Rural Health Association, to present county-specific cancer information and address community concerns in each of Iowa’s 99 counties.
We’re also proud to share some of our recent research findings, honors, and awards, and are delighted to mark the Department of Health Management and Policy’s 75th anniversary as a graduate health studies program at the University of Iowa.
It’s always exciting to let our alumni and friends know about the important work being conducted in the college. And while the field of public health is facing serious challenges, navigating these experiences also encourages us to adapt and reaffirm our dedication to our mission: to promote health and to prevent injury and illness through commitment to education and training, excellence in research, innovation in policy development, and devotion to public health practice.
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Edith Parker
Iowa Public Health Magazine is published annually for alumni and friends of the University of Iowa College of Public Health.
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The college’s longstanding commitment to protecting the health of rural communities continues with innovative research, training, policy analysis, and community engagement.
8 USING DATA TO FIGHT AGAINST CANCER
A public health team from the University of Iowa is collaborating with partners across the state to share county-specific cancer data with residents in each of Iowa’s 99 counties.
Iowa researchers are studying how to make roads and traffic safer for all ages.
Funding will continue to support a maternal and child health training program based in the college.
A recent study found no statistically significant positive associations between influenza vaccination and selected birth defects.
Abigail Tompkins (17MS) shares details about her work in industrial hygiene that takes place both high above and deep below ground.
Doctoral student Rebeca Galindo is helping to develop rapid testing to identify
QUICK TAKES
The college’s Department of Biostatistics was pleased to host another great group of students at the 2025 Iowa Summer Institute in Biostatistics! The seven-week program provides biostatistical research education and applied research opportunities to undergraduates.
The College of Public Health and its Business Leadership Network (BLN) awarded funding to five Iowa community organizations in Mason City, Hiawatha, Marshalltown, Burlington, and Fort Dodge through the BLN’s 2025 Community Grant Program. The grant awards of up to $3,000 support public health-related initiatives and projects in the communities. The grant program requires recipients to secure an equal cash or in-kind match from other community organizations or businesses. Funding for the Community Grant Program is provided by the Iowa Farm Bureau Federation.
The Journal of Rural Health (JRH) Editorial Board selected its 2025 Article of the Year, “Nursing home closures and access to post-acute care and long-term care services in rural areas,” authored by CPH researchers Hari Sharma, Redwan Bin Abdul Baten (now at University of North Carolina at Charlotte), Fred Ullrich, A. Clint MacKinney, and Keith Mueller.
DID YOU KNOW?
This year, the Department of Health Management and Policy is marking its 75th anniversary as a graduate health studies program at the University of Iowa. Read more about the department’s history and special anniversary events at cph.uiowa.edu/hmp75/
Ala na Knudson, director of the NORC Walsh Center for Rural Health Analysis, delivered the keynote lecture, “The Heart of Community: Rural Public Health Then, Now, and Tomorrow,” at the college’s Rural Health Summit held this spring.
Alana Knudson, left, with Dean Edith Parker
98% of our students are employed or pursuing further education within six months of graduation.
A group of University of Iowa students led by Nichole Nidey and Jonathan Platt, assistant professors of epidemiology, traveled to Costa Rica this past summer to participate in the Maternal and Migrant Health in Rural Communities program sponsored by the College of Public Health.
Close to Home: Rural Health Research in Iowa
Iowa is a predominantly rural state, and health issues that affect rural communities have been a longstanding priority for the University of Iowa College of Public Health. As the home to centers and programs such as the Rural Policy Research Institute (RUPRI), Prevention Research Center for Rural Health, Iowa’s Center for Agricultural Safety and Health, Great Plains Center for Agricultural Health, and Heartland Center for Occupational Health and Safety, the college has become a national hub for cutting-edge rural health research, training, policy analysis, and community engagement.
This work took center stage during the inaugural Rural Health Summit held at the College of Public Health in February 2025. Designed to showcase the wide variety of rural health topics the college addresses, the summit brought together faculty, students, post-docs, and staff. The summit included a poster session, table displays, and short “lightning talks” that provided an overview of research and projects. The event was anchored by keynote speaker Alana Knudson, a leading national voice in rural health research and capacity development.
The following stories highlight a sample of the innovative projects directed or co-led by researchers in the College of Public Health that continue the long tradition of excellence in rural health.
INVESTIGATING RURAL EXPOSURE TO ‘SUPERBUGS’
In the heart of Iowa’s agricultural landscape, a new study is examining an invisible threat within rural homes. Kathryn Dalton, assistant professor of occupational and environmental health, is investigating how proximity to concentrated animal feeding operations (CAFOs) might increase the risk of exposure to antimicrobial-resistant genes—a finding that could reshape how we understand occupational health in farming communities.
Dalton’s research shows that homes located closer to CAFOs are more likely to harbor antimicrobial resistance (AMR) genes, including genes associated with multi-drug resistance.
“My work on antimicrobial resistance in Iowa farmers is still ongoing,” Dalton says. “But we already see that agricultural workers living closer to CAFOs have higher odds of having AMR genes present in their homes. That’s important because the home can be a reservoir for these genes, potentially leading to infections in both workers and their families.”
Dalton’s interest in rural health is personal. She grew up in an agricultural community and worked as a veterinarian before shifting to public health. That path shaped her understanding of how animal husbandry practices might contribute to the presence
of resistant genes in the environment. While previous studies have linked CAFOs to resistant pathogens in soil and water, Dalton’s approach is novel—she is examining the broader microbial community within homes, known as the resistome.
“I was surprised to find such a strong association between proximity to CAFOs and the presence of AMR genes in homes,” Dalton says. “Especially that we saw this pattern extending up to 10 kilometers away. That goes well beyond the 2- to 5-kilometer radius most previous studies have focused on.”
For Dalton, the implications go beyond academic discovery. The research raises practical concerns for the health and safety of agricultural families.
“If more AMR genes are found in homes near CAFOs, extending good biosecurity and hygiene practices to the home—like removing work clothes and shoes before entering, and enhanced cleaning— could help reduce exposure,” she explains.
However, Dalton says there is still a need for more information about how AMR genes are transmitted from CAFOs to homes, such as whether they are carried by workers or spread through the environment.
“We also lack understanding of how the presence of AMR genes in the home translates to actual risk of infection in people,” she says. “The causal link between environmental exposure of AMR genes and resistant infections in individuals is not clear cut, and this has altered how I communicate the risk to the public and helped to direct future research.”
Dalton is now expanding the study to explore infection rates and environmental transmission routes in rural communities. “If we can track other reservoirs of AMR genes and see a pattern in resistant infections,” she says, “we’ll be better equipped to design interventions that protect farmers and their families.”
DEVELOPING SMARTER STROKE ROUTING FOR RURAL EMS SYSTEMS
When an emergency medical technician makes a split-second decision about where to transport a stroke patient, the consequences can be profound—especially in rural areas where distance to the right facility may mean the difference between life-altering treatment and missed opportunity.
Grant Brown, associate professor of biostatistics, is part of a team working to transform how those decisions are made, using cutting-edge models, national simulations, and a promising mobile app that could one day guide ambulance routing in real time.
The project builds on an important insight: strokes vary significantly in their type and required treatment. Large vessel occlusion (LVO) ischemic, non-LVO ischemic, and hemorrhagic strokes—as well as conditions that mimic strokes—all demand different interventions, often with competing timesensitive windows. Yet in the field, EMS workers can’t distinguish between them definitively without medical imaging.
“Stroke is a somewhat unique condition,” Brown explains. “There are multiple underlying subtypes that we can’t precisely identify in a triage setting. Our goal is to come up with an approach that is more sensitive, is grounded explicitly in a decision model, and takes into account the full context of a particular patient.”
Brown credits his collaborators, Nicholas Mohr and Santiago Ortega-Gutiérrez, both physicians at
University of Iowa Health Care, with sparking the idea for the project. “They knew it should be possible to improve on the current state of stroke triage, and we’ve worked together to find a strategy to do that,” he says. “That’s one of the exciting things about biostatistics—we get to work with renowned experts from a variety of fields.”
The research unfolds across three phases. First, the team developed predictive models based on clinical trial data to estimate the likelihood of each stroke type. They then ran nationwide simulations, mapping stroke incidents and modeling driving times to compare triage strategies. The final component is a mobile application designed to suggest an optimal hospital destination tailored to each patient’s situation. Although the app is not yet approved for clinical use, the team is actively testing it in simulated environments with EMS partners.
While the model is national in scope, its relevance is particularly acute in rural states like Iowa. “People are simply farther away from hospitals generally, and from comprehensive stroke centers specifically,” Brown says. “States like Iowa stand to benefit the most from these kinds of decision tools, because the transport decisions are so much more consequential.”
The road from simulation to clinical deployment is long, and Brown acknowledges the hurdles ahead. “We’re currently evaluating what will be required to take the next step,” he says. That includes trial designs, regulatory approvals, funding sources, and identifying sites for future studies.
While there is still much work to be done, Brown and his colleagues remain focused on proving that when it comes to stroke care, smarter decisions at the point of triage could change everything.
HELPING FARM FAMILIES MANAGE DEMENTIA CARE
Providing care for a parent or spouse with dementia is a demanding job, and it can be especially challenging for rural residents who are juggling both caregiving and farm work.
A new training resource that addresses the unique safety and cultural concerns of farm families caring for a loved one with dementia is being tested by researchers in the Midwest. The project, funded by a grant from the National Institute for Occupational Safety and Health, is co-led by Kanika Arora, associate professor of health management and policy at the University of Iowa, and Julie Bobitt, assistant professor of medicine at the University of Illinois Chicago.
Dementia is an overall term used to describe a decline in mental ability that interferes with daily life. Dementia isn’t a normal part of aging; instead, it’s a progressive brain disease that affects memory, reasoning, judgment, and behavior. Alzheimer’s disease is the most common type of dementia and affects an estimated 6.7 million U.S. adults.
An earlier study led by Arora found that long-term agricultural workers had 46% greater odds of developing dementia than non-agricultural workers. Potential risk factors for dementia include midlife hearing loss, loneliness, social isolation, pesticide exposure, and traumatic brain injury.
“Not only do older farmers have a higher risk of dementia, but dementia actually leads to a lot of safety issues,” Arora says. Farming is one of the most dangerous occupations, and farm environments pose numerous hazards, including machinery, livestock, and firearms. A missed or delayed dementia diagnosis could lead to greater safety concerns, Arora adds.
Stigma and a deep-rooted culture of self-reliance often prevent open discussions and requests for support, compounding the stress of caregiving in areas with limited resources.
Bobitt and Arora found that while there are resources that focus on agricultural safety or general dementia caregiving, none are tailored to the needs of agricultural families. “So that’s where the idea came from, that we need to have something that addresses the specific issues of farm families coping with dementia,” Arora explains.
To craft the training, researchers assembled a community advisory board with expertise in
Farming is one of the most dangerous occupations, and farm environments pose numerous hazards, including machinery, livestock, and firearms. A missed or delayed dementia diagnosis could lead to greater safety concerns.
Kanika Arora, associate professor of health management and policy at the University of Iowa ” “
agriculture, health care, education, and rural advocacy. Interviews with farm families helped shape the content.
The four-part program explores dementia basics, progression and safety concerns, communication strategies, and caregiver resources. If the training is shown to be effective, the program potentially could be expanded to other states through the Extension System.
“I’m hearing that providers want to know more about why this is an important issue for farmers, why early detection is even more important in this case, and how to address some of the safety issues when they speak to a farm family who has a family member with dementia,” Arora says. “I think that could be another part of the future of this project.”
Using Data to Fight Against Cancer
A public health team from the University of Iowa is collaborating with partners across the state to share county-specific cancer data with residents in each of Iowa’s 99 counties.
BY SARA EPSTEIN MONINGER
A U.S. News & World Report article in 2023 sounded the alarm for residents of a rural county in northwest Iowa. Palo Alto County, the report stated, had the secondhighest rate of newly diagnosed cancers in the country—and the highest in Iowa.
Seeking answers, Sarah Strohman, the county’s director of community health, hospice, and public health, turned to experts at the University of Iowa College of Public Health for guidance.
“We’ve always acknowledged that we live in an area that is a little more prone to cancer, but we didn’t realize how different we were from other areas,” Strohman
says. “When it became a national headline, it understandably scared people.”
Mary Charlton, director of the Iowa Cancer Registry and UI professor of epidemiology, agreed to prepare a report about cancer incidence in the county and present it to the community. That data, Strohman says, opened eyes.
“We learned that we are ranked most highly in lung cancer, and that gave us something to work with,” Strohman says. “Since lung cancer is frequently caused by smoking and radon, we secured some funding for prevention education. Having this data made us feel we could actually do
something. Before that report, cancer seemed too big to take on.”
When the report was presented to the community in November 2024, some 150 people showed up in person and another 50 attended virtually. The audience, Strohman says, ranged from police officers and members of the county’s boards of supervisors and health
to cancer survivors and a high school biology class—and they were engaged.
“I think people wanted to place the blame on agriculture and have that be the reason for high cancer incidence. While that could be a component, the fact that a person smoked for years during college is not insignificant,” says Strohman, noting that the county’s population of 8,996 includes a high number of smokers and people who are less active. “Cancer isn’t caused by just one thing, and everybody needs to take responsibility on some level and make healthier lifestyle choices.”
The turnout in Palo Alto County, coupled with the fact that Iowa has the second-highest rate of cancer incidence in the country, led to a new public health initiative spearheaded by Charlton called “Cancer in Iowa: 99 Counties Project.” The UI College of Public Health and the Iowa Cancer Consortium, in collaboration with UI Health Care Holden Comprehensive Cancer Center and the Iowa Rural Health Association, plan to share similar countyspecific cancer reports in each of the state’s 99 counties.
As of October 2025, the team has visited with residents in 38 of Iowa’s counties. Charlton says she and her team start the conversation with what she calls “level setting”—defining key terms, explaining the role of the Iowa Cancer Registry, and emphasizing that no one thing causes cancer. Then they walk through the data: the county’s most diagnosed new cancers and their risk factors, how those numbers compare to
the state and the nation, and what screening tests are available for those cancers and how county usage of those tests compares with other counties. They conclude by sharing statewide resources, including at the University of Iowa, and taking questions. The presentations are published online as they become available.
“If one of the top cancers is breast cancer, for example, we talk about mammography and share what their county’s breast cancer screening rate is compared to other areas and whether that is statistically significant,” says Charlton, who also is president of the Iowa Cancer Consortium. “Then we share risk factors for breast cancer and let them know that if you catch it early, your five-year survival rate is nearly 100%. If you catch it late, the five-year survival is more like 60%.”
Charlton says the hope is that the data empowers residents to make healthier choices, seek cancer screening tests, and press legislators for policy change and research funding.
“These presentations are meant to be a conversation opener and to give people some ideas about things to target in their community for reducing cancer risk. We reiterate that we hope this isn’t the last time we talk with them,” she says. “There are proven ways to prevent cancer and find it early. You can avoid risk factors and get screened. We have a lot of resources to help fight cancer, and policy changes at the local and state levels, such as taxes on tobacco, have a huge impact. We urge them to communicate their concerns with their state
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Mary Charlton presenting data at Bremer County (opposite page) and Johnson County.
We learned that we are ranked most highly in lung cancer, and that gave us something to work with,” Strohman says. “Since lung cancer is frequently caused by smoking and radon, we secured some funding for prevention education. Having this data made us feel we could actually do something. Before that report, cancer seemed too big to take on.
(Continued from previous page)
representatives and local policymakers and to let us know how we can help.”
One outcome of the conversation in Palo Alto County, where residents expressed concern about pesticides and radon, is that Mark Vander Weg, head of the UI Department of Community and Behavioral Health, added the community as a site in his multipronged study of lung cancer.
Charlton says the 99 Counties Project is an example of how the University of Iowa partners with state organizations to improve the health of Iowans.
“We don’t do our research in an ivory tower—we care about Iowans across the state and want to use our data and our expertise to help promote meaningful change and be a resource for them,” she says. “I personally invite state representatives and state senators to be part of these conversations, hoping to demonstrate to them that the University of Iowa is getting outside of Iowa City and working to improve the health of our state.”
In Palo Alto County, momentum in the cancer fight is palpable, Strohman says. County health officials have revised their community health improvement plan to include goals related to cancer, invited a representative from the agricultural industry to attend their meetings, prepared educational materials about well water testing to share with real estate agents, and applied for— and received—a grant from a local gaming corporation to provide free radon test kits to every household in the county.
“I feel like we are going to see some positive changes,” she says, “and although we’re focusing now on lung cancer, we aren’t forgetting that we still have breast cancer, skin cancer, colon cancer, and other cancers.”
Learn more about the 99 Counties Project at https://shri.public-health.uiowa.edu/ cancer-data/
Cancer in Iowa: 99 Counties Project Frequently Asked Questions
The Cancer in Iowa: 99 Counties Project aims to address community-specific cancer issues in all of Iowa’s counties. The following questions are a sample of queries that have come directly from participants of the county presentation discussions.
What is the role of the Iowa Cancer Registry?
The Iowa Cancer Registry (ICR) is a population-based cancer registry, meaning it collects cancer data, which is a reportable disease, on all Iowa residents. The ICR has been a member of National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program since its inception in 1973. SEER provides national populationbased statistics on the number of cancer cases and mortality rates. Along with the National Cancer Institute, ICR is funded by the University of Iowa and the State of Iowa.
Information we collect includes new cancer cases, stage at diagnosis, treatment, survival, cancer deaths, and demographics (e.g., sex at birth, race/ethnicity, age at diagnosis, etc.). Information we do not collect: environmental exposures, health behaviors (e.g., smoking, drinking, etc.), height and weight, and family history.
The most recent data presented is only from 2021. Is there a way to speed up data collection so we can have more timely information?
While more timely information is something the SEER program is working on, cancer data collection still takes time.
We collect over 200 variables on every person with cancer across the multitude of cancer types, and that data needs to be verified for quality. However, we are working with major health systems in Iowa to implement electronic pathology records, so every time they call something cancer, it sends us an electronic, automated message.
Does the ICR collect information on environmental factors? If not, why?
The Iowa Cancer Registry, as well as all other populationbased cancer registries, does not collect environmental factors or exposure information. The ICR is funded in part by the National Cancer Institute. We have the public health authority from the state of Iowa to collect data on cancer, and we are only funded to collect those variables on cancer.
The Iowa Cancer Registry only collects data found within a person’s medical records.
However, the Iowa Cancer Registry participates in the Agricultural Health Study. In this large prospective cohort study, 89,000 pesticide applicators and their spouses from Iowa and North Carolina have participated. The goal of this study is to learn about how agriculture, lifestyle, and genetic factors affect the health of farming populations.
How do folks begin to talk with legislators about their concerns, and how do they get involved in the legislative process?
The Iowa Cancer Consortium (ICC) is a great place to start. While the ICC does not lobby for legislation, many of their partners do. The ICC has a policy work group, which convenes people who are active in policy, and are also advocates themselves, and interested in becoming active at the state and federal level. This would be a great opportunity to listen and hear what different groups are working on and which group you might want to connect with. To join the policy work group and/or receive information, you can become a member of the Iowa Cancer Consortium.
To learn more, go to: canceriowa. org/membership/
The American Cancer Society Cancer Action Network is another cancer advocacy organization, and you can sign up for action alerts: www.fightcancer.org/
Write to your state senators and representatives and let them know your concerns about your community.
IMPROVING ROAD & STREET SAFETY
Iowa researchers are studying how to make roads and traffic safer for all ages.
Whether we’re crossing a street as a pedestrian, riding a bike, or driving a vehicle, navigating traffic can be complex. Researchers in the College of Public Health are studying different aspects of road safety and how to prevent injuries throughout the lifespan, including two recent studies that examine road crossing in childhood and driving in older adulthood.
PARENT-CHILD INTERACTIONS IN ROAD CROSSING
Crossing a road is a common challenge faced by adults and children alike. It’s a routine activity, but one that must be learned and practiced. Getting it right is a matter of life and death.
Despite the critical role that parents play in teaching kids how to safely cross roads, almost nothing is known about how parents and children interact when approaching this crucial task. A University of Iowa (UI) research study aims to shed light on parent-child road crossing behaviors and, ultimately, to help lead to changes that reduce motor vehicle collisions with pedestrians, a major cause of childhood death and disability.
The National Science Foundation grant was awarded to UI faculty researchers Jodie Plumert (PI), professor in the Department of Psychological and Brain Sciences, Elizabeth O’Neal (Co-PI), assistant professor in the Department of Community and Behavioral Health, and Joseph Kearney (Co-PI), professor emeritus in the Department of Computer Science.
COMMON ROAD-CROSSING HAZARDS
The study focuses on parents and their children, aged 6 to 8 years old, as they tackle two common road-crossing hazards: deciding whether an approaching vehicle intends to yield and deciding when to cross a stream of continuous traffic. The research is conducted in a virtual environment at the UI’s Hank Virtual Environments Laboratory in the Department of Computer Science, as well as in naturalistic environments.
“The goal of this project is to better understand how individual differences in parents’ risk-taking impacts children’s injury risk when crossing roads with traffic,” explains O’Neal. “We’ll first observe how parents cross roads on their own, without any children present, to assess their level of risk tolerance. Next, we’ll observe parents and children crossing together to see how the parent’s approach to crossing roads on their own impacts the way they teach their child to cross roads. Finally, we’ll assess how children’s experiences during joint road crossing with a parent impact their independent road-crossing behaviors.”
The individual road-crossing observations will be conducted in a virtual environment, says O’Neal, but recently developed wearable instrumentation will be used by the researchers to record parent-child interactions in real-world road crossing situations as well.
“Venturing from the laboratory to the natural environment will enrich our understanding of how parents approach teaching children complex, everyday skills, and allow us to determine the extent to which behavior in the laboratory corresponds to that in the natural environment,” says O’Neal.
OLDER DRIVERS AND LICENSING RENEWAL
Driving helps keep older adults connected to services and their communities. However, driving abilities can be affected by age-related declines in vision and cognitive functions, such as reasoning and memory. Motor vehicle crashes are the second leading cause of injury death (after falls) among adults ages 65 and older in the U.S.
In the U.S., states have a process to evaluate drivers who may no longer be fit to drive, called driver license review. A recent UI study, published in Injury Epidemiology and led by Cara Hamann, associate professor of epidemiology, examined the effects of driver license renewal policies on motor vehicle crashes and injuries among older drivers in 13 states over two decades.
The study found that states generally moved towards loosening licensing policies for older drivers. Policies investigated included renewal period, in-person renewal frequency (versus online), vision testing, knowledge testing, on-road drive testing, and mandatory physician reporting related to fitness to drive. Longer renewal periods and/or less frequent
in-person renewal were associated with increased crash and injury rates for older drivers.
Police-reported crash data, state license renewal policy data, and demographic data (years 2000-2019) were analyzed from 13 Mountain West and Midwest states, including Iowa. The study population included over 19 million drivers aged 40 and older who were involved in motor vehicle crashes.
ASSESSING FITNESS-TO-DRIVE
Hamann said it is not clear why states may be loosening driving license renewal restrictions, but doing so is likely aligned with customer (driver) demand, especially related to having more options to renew online versus in-person.
The study found limited evidence about how well knowledge, vision, and driving tests reduced crashes and injuries among older adults because these tests varied little between the states in this study.
Losing driving privileges too soon or when unwarranted causes premature driving cessation, Hamann said, which can be better avoided by having policies that assess a driver’s abilities.
“Assessing fitness-to-drive rather than using age cut-offs is ideal because age itself is not a good indicator of driving performance,” she says. “Age cut points may be too early for some drivers, but too late for others.”
This article contains contributions from the UI Injury Prevention Research Center.
Strengthening Maternal and Child Health in Iowa
The college has received funding to continue a maternal and child health training program.
Poor maternal and child health outcomes continue to increase in Iowa, and there is a growing and urgent need for a well-trained maternal and child (MCH) workforce. To help address this issue, the Health Resources and Services Administration (HRSA) awarded the College of Public Health funding to continue to expand and strengthen its maternal and child health curriculum.
The award, called the Maternal and Child Health Public Health Catalyst Program, will provide $135,000 each year for five years. The award will be used to build on the college’s MCH Training Program established in 2020 with a previous cycle of HRSA funding.
Led by William Story, associate professor of community and behavioral health, the program’s goals for the next five years are to:
recruit and train a diverse student body with an interest in MCH;
expand course offerings and create an MCH certificate focused on developing MCH leadership competencies and providing experiential learning opportunities;
continue to engage students interested in MCH by growing the MCH Student Interest Group;
provide faculty development opportunities for early- and mid-career faculty; and
enhance partnerships with state and local public health, Title V agencies, and community partners, with attention to organizations serving rural communities.
“We are thrilled to have the opportunity to continue to support our students through this new training grant,” Story says. “Whether it’s through our popular MCH scholars program, our new MCH certificate, or our vibrant MCH Student Interest Group, students who come to the University of Iowa to study MCH will leave with the knowledge and skills to make a difference in the lives of children and their families in Iowa and across the Midwest.”
Other core faculty members involved with the program include Nichole Nidey and Jonathan Platt, assistant professors of epidemiology.
Research Reaffirms Safety of Influenza Vaccination in Pregnancy
AUniversity of Iowa research study examining possible associations between maternal influenza vaccination and a host of major structural birth defects reaffirms the safety of the vaccination during early pregnancy.
The study, led by Paul Romitti, University of Iowa Distinguished Chair, professor of epidemiology, and director of the Iowa Registry for Congenital and Inherited Disorders, analyzed data from the U.S. Birth Defects Study to Evaluate Pregnancy exposureS (BD-STEPS), which is funded by the U.S. Centers for Disease Control and Prevention. The research, published in the June 20, 2025, issue of the journal Vaccine, focused on deliveries in the years 2014-2019 to examine early pregnancy influenza vaccine uptake and risk prior to the COVID-19 pandemic.
The investigators assessed mothers’ influenza vaccination status during early pregnancy for several birth defects, including central nervous system, craniofacial, ear, gastrointestinal, heart, limb, and musculoskeletal defects. The study sample included over 4200 mothers.
The findings showed no statistically significant positive associations between influenza vaccination and the selected birth defects, according to Romitti.
“These results reinforce the safety of influenza vaccination during pregnancy, which is a key strategy
for reducing health threats that influenza infections can pose to pregnant women and their newborns,” Romitti says.
The authors acknowledged that concern about potential risk to fetal safety is a barrier to maternal vaccination, noting that despite global and U.S. health recommendations for influenza vaccination during pregnancy, only around 60% of pregnant women typically receive the seasonal vaccine.
“To maintain public confidence in vaccine safety and optimize maternal and fetal health outcomes, it is important to continue to evaluate the safety of maternal vaccinations using well-characterized, population-based datasets encompassing children with and without major birth defects,” according to the report.
Romitti also noted that components of the influenza vaccine may change from one year to another, requiring ongoing evaluation of the safety of seasonal vaccinations.
The current study extends the research group’s previous work that examined risk for over 30 major structural birth defects among births 2006-2011, which also supported the safety of maternal influenza vaccination.
Digging into Workplace Safety
Abigail Tompkins graduated from the University of Iowa in 2017 with an MS degree in industrial hygiene (IH). Since then, she has earned the qualifications of Certified Industrial Hygienist and Certified Safety Professional and has served in an IH role in a variety of industries. She recently shared some details about her current work that takes place both high above and deep below ground.
Where do you currently work?
I work in Golden, Colorado, where the mountains are high (our site is at 11,000 feet), the air is crisp, and the molybdenum runs deep.
What is your current job title and employer?
I’m the senior supervisor of industrial hygiene at Climax Molybdenum Henderson Mine and Mill, a Freeport-McMoRan company. I lead IH programs for underground metal mining and milling operations— think 3,000 feet underground, hard hats, headlamps, and a whole lot of air sampling.
So... what is molybdenum and what is it used for, anyway?
Great question! Molybdenum is a powerhouse metal used in everything from stainless steel and aerospace parts to oil and gas pipelines, electronics, and even medical equipment. It strengthens steel, resists corrosion, and handles extreme heat—making it essential for things like spacecraft components, automotive parts, and high-performance tools. The metal we mine here in Colorado might just be in your kitchen appliances, your car, or even orbiting Earth.
Tell us about the type of work you do, or what a typical day is like.
My days are a mix of underground adventure and above-ground strategy. I oversee exposure assessments, update safety protocols, and collaborate with teams across operations, maintenance, and environmental compliance. Whether I’m mentoring a new IH tech or
implementing controls for silica and welding fumes, there’s never a dull moment. And yes, I’ve calibrated more air sampling pumps than I can count.
What do you find most rewarding about your work?
It’s incredibly rewarding to know that my work helps people stay healthy, not just today, but for the long haul. Industrial hygiene is often invisible when it’s working well, but that’s the beauty of it. We’re the quiet force behind safer workplaces.
What made you choose a career in industrial hygiene, or how did you find yourself on this career path?
Funnily enough, I originally wanted to be a nurse. But the more I learned, the more I realized I wanted to prevent injuries and illnesses, not just treat them after the fact. Industrial hygiene gave me that opportunity. Since then, my IH career has taken me from manufacturing plants at Altria to serving as the Radiation and Laser Safety Officer for over 50 R&D labs. I’ve supported satellite builds at Lockheed Martin Space, managed radiation safety for an irradiator, and even worked at a Department of Energy site in Ohio focused on decontaminating an old uranium enrichment site. Eventually, I found my way underground—and I’ve been loving the challenge ever since.
HAPPENINGS
2025Outstanding AlumniAwardsRecipients
The College of Public Health has named James Skogsbergh and Robsan Halkeno Tura the recipients of its 2025 Outstanding Alumni Awards.
Jim Skogsbergh received a Master of Arts degree in hospital and health administration in 1982 from the University of Iowa College of Public Health. He also has a Fellow of the American College of Healthcare Executives certification He spent more than 16 years at the helm of Advocate Health Care, including four years leading Advocate Aurora Health, then serving as CEO of Advocate Health, which was created in 2022 through the merger of Advocate Aurora and Atrium Health. He also served as chair of the Board of Directors of the American Hospital Association. Skogsbergh retired in 2024.
Robsan Halkeno Tura received a doctoral degree in community and behavioral health in 2021 from the University of Iowa College of Public Health, a Master of Arts degree in public health education from the University of Northern Iowa, and a Master of Public Health degree in nutrition from Liberty University. He is also a certified health education specialist. Currently he serves as assistant commissioner of health for the Health Improvement Bureau at the Minnesota Department of Health where he oversees the Divisions of Health Promotion and Chronic Disease, Injury Prevention and Mental Health, and Child and Family Health.
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 and vision of the college. The recipients were honored at events this fall.
JAMIESON PRESENTS HOSPITAL AND HEALTH SYSTEMS LEADERSHIP LECTURE
Denise Jamieson , MD, MPH, Vice President for Medical Affairs and the Tyrone D. Artz Dean, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Health Care, delivered the College of Public Health’s inaugural Hospital and Health Systems Leadership Lecture on Feb. 19, 2025.
Jamieson’s lecture, “Leading UI Health Care: Perspectives from a Career at the Intersection of Public Health and Clinical Medicine,” marked the launch of an exciting new annual lecture series created through the generosity of alumni and supporters of the UI College of Public Health. The series honors the vital role of hospitals and health systems in protecting and improving population health.
Lehmler Honored with 2025 Regents Award for Faculty Excellence
The Iowa Board of Regents selected six outstanding University of Iowa faculty members, including Hans-Joachim Lehmler, College of Public Health associate dean for research and professor of occupational and environmental health, to be honored for their extraordinary contributions and sustained record of excellence in teaching, scholarship, and service.
Lehmler has made world-renowned contributions to environmental health through his pioneering research on the toxicology of polychlorinated biphenyls (PCBs) and other environmental contaminants. He leads a highly productive chemical toxicology laboratory and has secured substantial extramural funding.
In addition to his research, Lehmler has demonstrated excellence in teaching and mentoring, advising numerous PhD students and postdoctoral fellows who have gone on to successful careers. He also serves as director of the Environmental Health Sciences Research Center and deputy director of the Iowa Superfund Research Program.
STUDY FINDS TELEMENTAL HEALTH SERVICES BOOST MENTAL HEALTH VISIT RATES IN FQHCS
Astudy from College of Public Health researchers highlights the positive impact of telemental health services (TMHS) on mental health care utilization in Federally Qualified Health Centers (FQHCs), particularly in rural and low-income communities. Mental health issues disproportionately affect these populations, where access to care is often limited. The study, which analyzed data from 9,540 FQHC-year reports spanning 2016 to 2022, found that FQHCs offering TMHS saw a 4% increase in mental health visits compared to those without TMHS.
Centers serving higher proportions of Medicaidinsured and low-income individuals saw even greater increases in mental health visit rates. Notably, FQHCs that adopted TMHS during the COVID-19 pandemic experienced a 5% increase in mental
Natural disasters such as hurricanes and tropical storms are increasing in frequency and severity due to global climate change. A new study by University of Iowa researchers evaluated whether exposure to hurricanes is associated with adverse mental health outcomes among U.S. veterans. The study was published online Jan. 17, 2025, in JAMA Network Open.
The investigators evaluated data from nearly 1.8 million U.S.
health visits, with urban centers benefiting more significantly than rural ones.
According to Khyathi Gadag, a recent PhD graduate in health management and policy and lead author of the study, the research provides crucial evidence that telemental health services can bridge gaps in mental health care, particularly for low-income and Medicaid-insured populations served by FQHCs.
“By demonstrating increased utilization of mental health services in FQHCs that offered the telemental health services, our findings reinforce the need for sustained telehealth policies that support equitable access,” Gadag says. “However, the disparities between rural and urban FQHCs highlight the ongoing need for targeted strategies to ensure all communities can benefit from these advancements.”
Kanika Arora, associate professor, and Whitney Zahnd, assistant professor, both in the Department of Health Management and Policy, are co-authors of the study.
Iowa Researchers Examine Association of Hurricanes with Veterans’ Mental Health
veterans enrolled in Veteran Health Administration (VHA) primary care with home addresses in regions that were affected by Hurricanes Sandy or Harvey. The research team looked at subsequent mental health visits among the veterans, adjusting for numerous demographic and neighborhood characteristics.
The findings showed that veterans’ exposure to Hurricanes Sandy or Harvey was not associated with increased acute care mental health visits up to four years after the hurricanes. However, increasing neighborhood disadvantage, which includes factors such as income, education, employment, and housing quality,
was strongly associated with adverse mental health outcomes.
“Our results suggest that neighborhood characteristics, rather than exposure to a hurricane, are the dominant determinants of mental health outcomes among veterans,” the authors wrote in the paper.
The study also illustrates the importance of considering preexisting regional differences when assessing the associations of hurricanes and other disasters with mental health outcomes, the authors noted.
The research team included Caryn Yip, Peter Kaboli, Michael Jones, Margaret Carrel, and Peter Thorne.
HAPPENINGS
Karen Hammar Named Director of the Master of Health Administration Program
Karen Hammar, MHA, MOT, OTR/L, FACHE, has been named clinical assistant professor and director of the college’s Master of Health Administration (MHA) Program, effective July 1, 2025.
Hammar previously served as director of the Center for Disabilities and Development at University of Iowa Health Care, where she oversaw several key programs, including clinical services, the University Center for Excellence in Developmental Disabilities, and the Iowa Leadership Education in Neurodevelopmental and Related Disabilities program. She also served as administrator for the Hawkeye Intellectual and Developmental Disabilities Research Center.
Former MHA Program Director Kristin Wilson, clinical associate professor of health management and policy, accepted a new faculty role at another institution. Ken Anderson, clinical professor and director of the Executive MHA track, will continue in his current role.
A Fellow of the American College of Healthcare Executives, Hammar brings extensive experience in health care leadership and over a decade of clinical practice as an occupational therapist. Her expertise includes patient- and family-centered, interdisciplinary care across the care continuum, with a focus on systems integration.
“She has been a valued member of our department as an adjunct assistant professor, contributing to student learning, professional development, and programmatic advancement,” said George Wehby, professor, John W. Colloton Chair, and head of health management and policy, in announcing the new appointment. “We look forward to working with Ms. Hammar in this expanded role within our department, where she will continue to build upon the excellent work done by Dr. Wilson and other department members.”
Zahnd to Lead Collaboratory Focused on Rural Cancer Survivorship Research
Whitney Zahnd , assistant professor of health management and policy, has been selected by the college’s Institute for Public Health Practice, Research and Policy to establish a new collaboratory dedicated to advancing rural cancer survivorship research.
A collaboratory is a creative group process designed to solve complex problems and connect collaborators from different backgrounds and disciplines to expand the scope, scale, and impact of critical public health research.
Zahnd’s interdisciplinary team will focus on rural cancer survivorship research. Iowa has the second highest rate of new cancers among all states, and is one of only two states with an increasing incidence rate. However, more Iowans are surviving cancer, with an estimated 46.6% of survivors residing in rural counties. Providing care in rural areas can be challenging when effective or promising interventions exist but are not available. An implementation science approach, focused on identifying barriers to implementing evidence-based interventions and the strategies to overcome those barriers, is critical to bringing comprehensive survivorship care to rural areas.
“We hope to establish a strong community-researcher network for initiating and sustaining rural cancer survivorship implementation science research,” says Zahnd. “Ultimately, this will contribute to improved cancer survivorship care and support for rural cancer survivors and their caregivers in Iowa and beyond.”
Bannur Receives Stanley Award for International Research
Shruthi Bannur, a PhD student in community and behavioral health, was awarded a 2025 Stanley Award for International Research. Bannur will travel to India for her project, “Understanding Tobacco Use and Oral Health Implications Among Women in Peri-Urban Areas of Bangalore: A Qualitative Study.”
“I will examine perceptions, motivations, and patterns of individual nicotine and tobacco product (NTP) use and exposure to secondhand smoke and its perceived impact on oral health among women in peri-urban regions,” Bannur says. “This award will lay the groundwork for my dissertation by supporting preliminary research and building collaborations with researchers and community partners in Bangalore and will contribute to my long-term goal of improving oral health outcomes for disadvantaged populations by leveraging tools of interdisciplinary and community-based research.”
HAPPENINGS
Romitti Named 2025 UI Distinguished Chair
Paul Romitti , professor of epidemiology in the College of Public Health, was named a recipient of the 2025 University of Iowa Distinguished Chair. Romitti is a world-renowned scholar in surveillance and interdisciplinary research of congenital and inherited disorders.
The UI Distinguished Chair, one of the most prestigious honors granted to faculty members at Iowa, is given to those who are known nationally and globally for their scholarly work and who have made significant contributions to the university, state of Iowa, and beyond.
Study Links Gut Microbiome Composition and Food Insecurity to Risk of Cognitive Impairment in Adults
Anew study has found a compelling link between the composition of the gut microbiome and the risk of cognitive impairment (RCI) in adults, underscoring the complex role that both biology and social determinants—such as food insecurity—play in brain health. This is the first epidemiologic study to assess the modifying role that food insecurity may play on the relationship between the gut microbiome and RCI. Published in NPJ Aging, this study investigated the role of food insecurity as an effect modifier between specific groups of microbes in the gut microbiome and RCI. The research shows that adults with lower microbial diversity and specific imbalances in gut bacteria were significantly more likely to experience cognitive impairment. The analysis also found that food insecurity—limited or uncertain access to adequate food—was independently associated with both poorer gut health and diminished cognitive performance.
“Food insecurity is consistently linked to adverse health outcomes such as poorer overall health and adverse neurological health outcomes. Understanding how gut health and social conditions interact gives us a fuller picture of what puts people at risk for cognitive decline,” said Shoshannah Eggers, CPH assistant professor of epidemiology and corresponding author on this study. Eggers began working on this study while a postdoctoral fellow at the Icahn School of Medicine at Mount Sinai.
The study, which was supported by grant funding from the National Institute of Environmental Health Sciences, calls for more integrated public health approaches that address both nutritional access and gut health. It also opens the door for future interventions combining dietary support and microbiome-targeted therapies to reduce the risk of dementia, particularly in vulnerable populations.
CLASS NOTES
Gabrielle Abouassaly (19MPH, 21MHA) is head of operations, Health Services Division at Sanford Health in Bismarck, North Dakota.
Dianna Appelgate (05MS) is an infection preventionist and epidemiologist at California Pacific Medical Center in San Francisco, California.
Yajaira Bolaños Flores (23MPH) is a senior clinical research coordinator at UChicago Medicine in Chicago, Illinois.
Caroline Carney (99MS) is chief executive officer of Magellan Health in Phoenix, Arizona.
Yiyi Chen (05MS, 08PhD) is director of biostatistics at Pfizer in Lake Oswego, Oregon.
Matthew Dubberke (22BS) is a security and compliance analyst at RedSail Technologies in Pleasant Hill, Iowa.
Katie Dunbar (12MPH) is a physician and co-founder at Prairie Rose Family Medicine in Coralville, Iowa.
Keegan First (24BA, 25MPH) is a safety specialist at PB Leiner in West Branch, Iowa.
Amber Hawkins (22BS, 24MPH) is a research project coordinator at University of Chicago in Chicago, Illinois.
Madison (Kerkove) Heilskov (21BA) is an outreach coordinator at Polk County Health Department in Des Moines, Iowa.
IN MEMORY
Chelsea Hicks (17MPH, 21PhD) is an educator consultant at the Hazardous Waste Management Program in King County in Seattle, Washington.
Lubna Hossain (21BS) is a data analyst at Michigan Medicine in Ann Arbor, Michigan.
Latoya Houskin-Lewis (18MHA) is a clinical integration program manager at Molina Healthcare and founder and CEO at Mahogany Doula Services LLC in Des Moines, Iowa.
Ashley Longnecker (19MHA) is a senior business analyst at Allina Health in Verona, Wisconsin.
Quincy Markham (22MHA, 23MPH) is clinic manager at Froedtert Hospital in Milwaukee, Wisconsin.
Megan McCabe (24PhD) is an assistant professor of biostatistics at the University of Alabama at Birmingham School of Public Health in Birmingham, Alabama.
Khusbu Patel (18MHA) is manager of clinical technology services at Optum in Washington, District of Columbia.
Abhismitha Ramesh (24PhD) is a data analyst at UCLA Health in Anaheim, California.
Chip Rank (18MHA) is system director, Canning Thoracic Institute at Northwestern Medicine in Chicago, Illinois.
M onika Reddy Bhuma (19MPH) is a dentist at Carus Dental in Austin, Texas.
Anna C. Reisetter (21PhD) is a senior bioinformatics scientist at Xaira Therapeutics in San Francisco, California.
Noah Segal (20MPH) is a senior project manager at Fred Hutch in Seattle, Washington.
Erblin Shehu (23MS) is an assistant professor of healthcare management at State University of New York Cortland in Cortland, New York.
Austin Smith (23BA, 24MPH) is program director, student threat assessment at University of Tennessee in Knoxville, Tennessee.
Scott Turner (97MA) is chief operational officer at Children’s Healthcare of Atlanta in Atlanta, Georgia.
Samantha Wittrock (16MPH) is manager of program innovation a nd continuing education at Northwestern Health Sciences University in Bloomington, Minnesota.
Meg (Duffy) Zacks (11MPH, 11MHA) is senior vice president and chief strategy officer at Saint Francis Health System in Tulsa, Oklahoma.
Jingyang Zhang (08MS, 12PhD) is director of biostatistics at Day One Biopharmaceuticals in Brisbane, California.
William Blessing (69MA) of Spring Lake, Michigan, on Oct. 12, 2024. Walter Burnett (64MA, 65PhD) of Cockeysville, Maryland, on June 1, 2025. Charles Denniston (65MA) of Williamsburg, Iowa, on Sept. 11, 2024. Mary Corita Heid (70MA) of Mason City, Iowa, on May 28, 2025. Roger Lacock (64MA) of Mount Pleasant, Wisconsin, on Feb. 18, 2025. Robert Larson (59MA) of Quogue, New York, on July 6, 2025. E. Thomas Lietzke (61MA) of Saint Paul, Minnesota, on Sept. 3, 2024. Paul Pomrehn (79MS) of Iowa City, Iowa, on Sept. 6, 2025. John Staley (74PhD) of Iowa City, Iowa, on Sept. 30, 2024. Robert Tujetsch (59MA) of Munster, Indiana, on Aug. 4, 2025.
ANTIBIOTIC RESISTANCE POSES A SERIOUS threat to the ability to manage and treat bacterial diseases. “Antibiotic resistance among strains of Salmonella and Campylobacter is on the rise,” says Rebeca Galindo, a doctoral student in epidemiology.
Salmonella and Campylobacter are two common bacterial pathogens that cause diarrheal disease. “Worldwide, one in nine children die of diarrheal diseases every year,” Galindo says, “and 1.7 billion children are diagnosed with diarrheal diseases every year.”
According to the Centers for Disease Control and Prevention, diarrheal disease is the second leading cause of death among children under the age of five.
Galindo is a graduate research assistant at the State Hygienic Laboratory (SHL) at the University of Iowa under the direction of Michael Pentella, director of the SHL and clinical professor of epidemiology. Galindo is part of a research project developing a rapid diagnostic test to accelerate identifying antibiotic resistance in Salmonella and Campylobacter.
“Currently, testing to determine if antibiotics can be used to treat these specific pathogens can take a minimum of three to four days for Salmonella and six to eight days for Campylobacter, but it can sometimes take longer,” Galindo describes. “I am working on research that takes that testing time down to under an hour.”
Being able to rapidly and efficiently identify antibiotic resistance in these bacterial pathogens
Rebecca Galindo: Developing rapid testing to identify antibiotic resistance
would allow medical practitioners to provide their patients with effective treatment.
“This new test will quickly provide results to the health care provider and to the patient, which will help them determine the appropriate course of treatment,” Pentella explains. “This rapid testing also provides the added benefit that a quick diagnosis can help prevent others from acquiring the infection from the patient.”
Galindo never had doubts about what career path she wanted to pursue. “I’ve known I wanted to be an infectious disease epidemiologist since I was 12,” she says.
Even though Iowa was far from Galindo’s home state of Texas, the university offered other perks. “I always joke that I came to watch Caitlin Clark play her senior year of basketball.”
Basketball aside, Galindo describes the impact of the interdisciplinary research opportunities within the College of Public Health (CPH). “I think that the College of Public Health models what public health should be in the real world, and that is inherently interdisciplinary and collaborative,” she says.
In the future, Galindo hopes to take her array of knowledge and apply it to working on various infectious diseases. “I love the idea of working in a hospital and taking care of the health of the hospital through studying bacteria and viruses,” she says.
Story by Lauren Linder, UI Graduate College research assistant. Photo by Cale Stelken, UI Graduate College
145 N. Riverside Dr.
100 College of Public Health Bldg., Room S171
Iowa City, Iowa 52242-2007
SPARK
Every fall, our incoming graduate students volunteer with area nonprofit organizations for a Day of Service. Students donate their time and build connections with each other and the community, putting their commitment to public health engagement into action.
PHOTO BY JOEY LOBODA