Advances – Summer 2015 by publichealthmn

Advances FROM THE UNIVERSITY OF MINNESOTA SCHOOL OF PUBLIC HEALTH

EBOLA

SPH helps put out the fire Making sense of health news Helping launch MN cannabis program Understanding the human-animal bond Studying health risks for taconite workers

FALL 2015

School of Public Health Leadership Dear Friends,

Beth Virnig Senior Associate Dean for Academic Affairs & Research Kristin Anderson Associate Dean for Learning Systems & Student Affairs Debra Olson Associate Dean for Global Health Bruce Alexander Head, Division of Environmental Health Sciences Bradley Carlin Head, Division of Biostatistics

Dianne NeumarkSztainer Interim Head, Division of Epidemiology and Community Health Ira Moscovice Head, Division of Health Policy and Management Joe Weisenburger Chief Administrative Officer/Chief Financial Officer Louis Clark Director of Development Martha Coventry Director, Communications

Advances Editor Sarah Howard Contributing Writers Tara Anderson Martha Coventry Sarah Howard Charlie Plain Mona Rath Art Direction Cate Hubbard Design cat7hubb@gmail.com Advances is published by the University of Minnesota School of Public Health. To submit comments, update your address, or request alternative formats email sphnews@umn.edu. Printed on recycled and recyclable paper made in Minnesota with at least 10 percent postconsumer material.

FROM THE

Fall semester is underway at the School of Public Health. Dusk descends earlier, the air brisks up in the evening, and 350 new, excited, and curious SPH students enliven our classrooms and programs. We are happy to have every one of them. Our school experienced tremendous research advances in the past year and a unique opportunity to help contain an epidemic before it spread DEAN unchecked in West Africa and perhaps beyond.

In March 2014, Ebola jumped the confines of a rural village and moved relentlessly through Guinea, Liberia, and Sierra Leone. This issue’s cover story tells how professors Jim Neaton, Mike Osterholm, and their colleagues used their expertise to break new ground in treating and preventing Ebola, and to focus attention on the lack of public health infrastructure and global policy. Both Jim and Mike had other major successes and recognitions this past year. Jim’s multi-year study of HIV drug regimes found that people with HIV should be put on antiretrovirals as soon as they learn they are infected, a discovery that will change treatment protocols around the world. Mike was named the first McKnight Presidential Endowed Chair in Public Health and, in June, became our first Regents Professor, the University’s highest faculty honor. We are tremendously proud of them both. In this issue you’ll also read that Rachel Widome’s research found that nearly twice as many veterans are food insecure than people in the general U.S. population; mothers in poorer health are less likely to breastfeed, according to research by Katy Kozhimannil; and middle-age Americans drastically underestimate the long-term care they’ll need as they age, as Carrie Henning-Smith found. Two of our alumni, Michele Larson and Tom Arneson, are heading up Minnesota’s medicinal cannabis program and are introducing a study to determine dose and effect correlations. Read about their efforts on page 12, and learn how cannabis works in the body. Students remain the backbone of our school and we want to give them the best possible experience as they explore, consider, choose, and attend SPH. To serve them better, we have redesigned our website — sph.umn.edu — to meet their needs at every step of that process and to offer a welcoming front door to SPH. Please take a look. The year ahead promises new collaborations, a focus on population and community health in our own backyard, and growing collaborations around the world. Thanks for your continuing support! Yours in health,

b University of Minnesota School of Public Health

John R. Finnegan, Jr., PhD Assistant Vice President for Public Health Dean and Professor

PHOTO BY RICHARD ANDERSON

John Finnegan Dean

Contents

FALL 2015

Features FEATURES 4 Putting Out the Fire As the Ebola virus ravaged West Africa, SPH faculty members helped to find a vaccine and educate the world.

8 Pet Projects The Center to Study Human Animal Relationships and Environments restarts with a new leader and vision.

9 Taconite Dust Raises Health Concerns in MN An SPH study sheds light on the health risks posed to taconite workers in northern Minnesota.

10 Two Birds, One Stone Internationally acclaimed website HealthNewsReview.org gets new funding — and a new home at SPH.

12 Legal Aid Two SPH alumni lead Minnesota’s new cannabis program for the chronically ill.

14 Field Notes A new website showcases the beginnings of cardiovascular epidemiology research.

Departments DEPARTMENTS 2

Findings

COVER ILLUSTRATION BY LINCOLN AGNEW

New and innovative research from SPH faculty and researchers.

School News The MHA program’s problem-solving method withstands the test of time; SPH alumni visit India.

Class Notes

Visit sph.umn.edu to check out our new website!

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FINDINGS

Kids exposed to more fat shaming comments on TV than adults We like to think of children’s television as typically humorous and harmless, but research shows this isn’t always so. A study from SPH’s Marla Eisenberg analyzed the content of more than 30 children’s shows and found that half of them contained at least one weight-stigmatizing, or “fat shaming,” comment. In comparison, only eight percent of general audience shows included such comments. The analysis also showed male characters were much more likely to make the comments, and the remarks were just as often directed at normal weight women as overweight women. The current results reflect a society that is overly critical about body shape and size, particularly for females and even those of healthy weight. For the full study, visit z.umn.edu/fatshamingstudy

FOOD INSECURITY IN VETERANS Nearly twice as many veterans are food insecure than people in the general U.S. population.

veterans

general population According to a study by SPH assistant professor Rachel Widome. For the full study, visit z.umn.edu/ veteranfoodinsecurity

Sarah Gollust receives $764,000 grant from American Cancer Society Assistant professor and McKnight Land-Grant Professor Sarah Gollust received a four-year grant from the American Cancer Society to investigate the effects of media messages on attitudes about cancer prevention and successful strategies for countering potentially misleading information.

More effective alcohol policies ignored while less effective passed into law Policymakers are significantly more likely to adopt ineffective alcohol policies than they are to adopt effective ones, reports an SPH study. Research led by professor Toben Nelson tracked 29 different state alcohol control policies from 1999 through 2011. The study found that none of the policies rated to be the most effective for reducing excessive drinking were either adopted or strengthened during the study period. During that same period, the study noted an increase in adoption of policies that were comparatively less effective, or that targeted only youth drinking or impaired driving. For the full study, visit z.umn.edu/alcoholpolicy

Women with PTSD more likely to meet criteria for food addiction Post-traumatic stress disorder is a mental illness that can wreak havoc on a person’s life, and in the case of women, make them twice as likely to exhibit food addiction. “Although food addiction is not considered a psychiatric diagnosis, the concept may be helpful in identifying a reliance on food to cope with psychological distress,” says Susan Mason, SPH researcher and the study’s author. More than half of the women in the study reported having a trauma experience and 66 percent of those said it resulted in at least one lifetime PTSD symptom. The study also determined that food addiction was present in six percent of women with no trauma and PTSD symptoms, and increased to 18 percent for those with six to seven reported symptoms. For the full study, visit z.umn.edu/PTSDfoodaddiction

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Future health care needs underestimated by most An SPH study published in Health Affairs found that middle-aged Americans have unrealistic expectations when it comes to their long-term care as they age — 60 percent think they are unlikely to need care, while in reality only 30 percent will not need care. According to lead author and SPH researcher Carrie Henning-Smith, it is important to think about long-term needs while you’re young and healthy. “The public needs to be aware that most people will need care and there’s a need to plan ahead,” she says. This lack of planning can lead to a strain on families. The study also found that nearly 75 percent of respondents expect family to provide future care and only one in 10 expect to use home health care agency or assisted living. For the full study, visit z.umn.edu/careexpectations

More research-based evidence needed in Minnesota legislative discussions about childhood obesity It’s said the facts speak for themselves, but when it comes to childhood obesity research, it appears Minnesota legislators aren’t listening. That’s the finding from an SPH study that shows research-based evidence is cited in only 41 percent of formal U.S. legislative discussions regarding childhood obesityrelated bills. “Research evidence regarding obesity costs, causes, consequences, and the impact of potential policies could be of great value for policy decisions,” says lead author and assistant professor Sarah Gollust. Gollust and her colleagues now plan to take this information and use it to help create approaches for getting the best research to policymakers in a timeframe and format they find useful. For the full study, visit z.umn.edu/obesitylegislation

Mothers in poorer health are less likely to breastfeed A maternal health study shows one-third of women entering pregnancy suffer from diabetes, hypertension, or obesity and are subsequently 30 percent less likely to breastfeed successfully. “This is troubling because the families with social and medical risk factors are often those who stand to gain the most benefits from breastfeeding,” says lead author and SPH assistant professor Katy Kozhimannil. The study reports one key factor in this issue is that women with complex pregnancies were less likely to receive recommended hospital-based breastfeeding support. “It’s important to stress that supportive hospital practices like showing mothers how to breastfeed, rooming-in, refraining from pacifiers, and not routinely providing free formula improves breastfeeding rates among new mothers,” says Kozhimannil. For the full study, visit z.umn.edu/breastfeedingstudy

Drop in adolescent antidepressant use after FDA warnings resulted in negative effects FDA warnings are meant to protect Americans from the ill effects of products we use. However, in the case of a notice regarding increased suicide risk among adolescents using antidepressants, the advisory seems to have produced another cascade of problems. Research from SPH assistant professor Ezra Golberstein shows the 2003–2004 FDA antidepressant warning actually resulted in a spike in lower grade point average, substance abuse, and delinquent behavior among adolescents. The sharp increase of these issues appears to be linked to the fact that following the FDA’s warning, many adolescents who were exclusively using medication to treat depression stopped taking the drugs. In addition, those youths didn’t seek alternative treatment, such as psychotherapy. The net result seems to be fewer adolescents were being treated for depression by any approach, and therefore, experienced more behavior problems. For the full study, visit z.umn.edu/FDAstudy

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Putting out the fire SPH TAKES ON THE EBOLA EPIDEMIC By Martha Coventry

n March 23, 2014, the World Health Organization confirmed an Ebola outbreak in Guinea. It was the first occurrence of the disease in West Africa and it involved the Zaire strain, the most deadly. Although Ebola terrifies our popular imagination, outbreaks of the disease are relatively rare. Until 2014, approximately 2,400 people in Africa had been infected with the virus since it was first isolated in 1976. According to Michael Osterholm, SPH professor and McKnight Presidential Endowed Chair in Public Health, Ebola had “hardly pinged the human species” before this recent epidemic. Fifteen months after the outbreak was reported, more than 11,000 people had died of Ebola, including some 500 health care workers. As the Ebola virus spread through Liberia, Guinea, and Sierra Leone in what Osterholm calls a “fireworks pattern” — sparks fly off that catch and flare — School of Public Health faculty and staff have used their expertise to help keep the epidemic from becoming a conflagration.

SENEGAL GAMBIA

BAMAKO

GUINEABISSAU GUINEA Conakry

SIERRA LEONE

Monrovia

COTE D’IVOIRE LIBERIA

Yamoussoukro

SPREADING THE WORD Osterholm is director of the University of Minnesota’s Center for Infectious Disease Research and Policy, or CIDRAP, one of the top sources in the world for breaking news on infectious diseases. While at the Minnesota Department of Health in 1981, he was among the first to recognize HIV/AIDS as an epidemic. As the late spring and summer of 2014 progressed, he saw Ebola’s shadow lengthening and a disaster taking shape for West Africa. In an effort to prevent this, Osterholm spoke anywhere and anytime. He saw every engagement — “Just tell me where to go, and I’ll be there,” he told his colleagues — as an opportunity to convey the facts about the epidemic, its threats, and the

MINNESOTA ON THE GROUND In August, when the number of Ebola cases was climbing steeply, Liberia’s minister for health and social welfare, Walter Gwenigale, wrote a letter to Sylvia Burwell, U.S. Secretary of Health and Human Services. Gwenigale asked if there was a way that the United States could work with his ministry on new approaches to treatment and prevention of Ebola. Burwell said yes and the two countries created PREVAIL (Partnership for Research on Ebola Virus in Liberia). Burwell assigned Cliff Lane, NIH’s Deputy Director for Clinical Research and Special Projects, as the U.S. principal investigator for the collaboration. Its first project was an Ebola vaccine trial, called PREVAIL I, based in Monrovia, Liberia. It would use two vaccines in a randomized, double-blind, placebo-controlled study to determine if a single dose of an experimental vaccine would protect against Ebola. “I started to think about a team for this project and, of course, I’m going to go for a dream team,” says Lane. Lane wanted SPH’s Jim Neaton on that team. Neaton, a biostatistics professor, runs some of the largest HIV/AIDS treatment trials in the world and has a reputation for building strong, collaborative groups. Lane has worked with him for 20 years “There’s nobody better than Jim at the

vital role African health workers were playing. He warned against complacency. In a July 29, 2014, opinion piece in the Washington Post, Osterholm urged faster, better coordinated, and smarter action from the global public health community and called for more resources and medical help on the ground. “We are at a critical point, and the response by the international community and the affected countries will determine if this outbreak is just a chapter in the region’s story — or a dramatic and dangerous shift in West Africa’s future,” he wrote. On August 8, WHO declared the epidemic “a public health emergency of international concern,” a move that would draw intense criticism six months later as being too little, too late.

science and operations of clinical research,” says Lane. “He brings those two things together in away that optimizes the chances for success. And that is what’s so incredibly special about him. And he has a phenomenal group at Minnesota.” Neaton joined the team and knew he needed to get the vaccine trial up and running as soon as possible. He asked his long-time operations manager Gregg Larson to come out of retirement to set up logistics. “I had a night to think about Jim’s offer, and two weeks later I was in Monrovia,” says Larson.

FINDING HOME BASE In Monrovia, Larson worked closely with NIH and the U.S. Embassy to find a place for the study headquarters. The location needed three critical assets: security, internet access, and reliable electricity — the vaccines had to be kept at -86 C (nearly -123 F) until thawed for use. Only the U.S. Embassy’s generators could provide uninterrupted power for the freezers, so Larson set about renovating space at the Embassy. Next, he worked with NIH to determine suitable clinical sites. He jumped into the task as diplomat, fixer, problem-solver, and construction manager, running into intricate bureaucracy and political infighting along the way.

Monrovia once had the best teaching hospital in Africa, but poverty and two successive civil wars had compromised all health care facilities. Neaton, Larson, and NIH staff visited facilities with their Liberian colleagues and finally settled on Redemption Hospital, a small institution in a part of Monrovia that was particularly hard hit by the epidemic. It was the best location to initiate vaccinations and establish a laboratory. Following that decision, NIH spent considerable funds renovating the space.

STUDY UNDERWAY The trial began on February 2, 2015, with an initial plan of enrolling 600 participants. It was to be a Phase 2 trial to gather more data on the vaccines’ safety, immunogenicity — whether they will provoke an immune response — and ability to protect against Ebola. Phase 3 would be the next step. The first task for trial participants was a clinic visit, where health care workers looked for specific symptoms and collected blood. Then they received one of the two vaccines or a placebo from a syringe whose label had first been scanned and the code matched to the participant. Every morning, two U.S. pharmacists and four Liberian pharmacists prepared the syringes. Each syringe got a coded

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label corresponding to the vaccine or placebo. They worked fast — the vaccines thawed in about 20 minutes, only held their potency in the syringes for 8 hours, and a driver had to travel about 40 minutes to Redemption to deliver the day’s supply. The volunteers returned to the clinic after one week and after one month for an assessment of adverse effects and additional lab work. Liberian and American trial personnel, with the essential aid of local community workers, continually monitored the participants. “There are no house addresses in Monrovia, so we needed the help of people intimate with the neighborhoods,” says Neaton. “Community workers followed up with participants. They went to their homes to check on them, called them to see if they were feeling OK, and helped them get to the clinic for lab work. They were critical to our efforts.” At the end of each day in Monrovia, all the collected data, which included lab results to assess if the vaccine was safe and

produced an immune response, were transmitted to Minnesota. Neaton’s team at the University immediately checked the information and entered it into databases the same day. In a double-blind study — where neither the participant nor the researcher knows who is receiving what treatment — someone has to be “unblinded.” If safety concerns arise, it’s crucial to be able to identify who received what drug or intervention. For this study, three of Neaton’s colleagues had that information: assistant professor Julian Wolfson, associate professor Birgit Grund, and research fellow Gregg Grandits. “We crunched the data as it came in from Monrovia,” says Wolfson. “Our principal task was to produce two reports — one open and one closed — every two weeks.” The open report went to Neaton and the protocol leadership and contained general information on the conduct of the study, but no data by treatment group. The 50-page-plus closed report went only to the Data and Safety

Monitoring Board (DSMB), the watchdog group for the study. It included summary data by treatment group so the DSMB could ensure that the trial was on track, following protocol, and safe for study participants.

TEAMING UP As Neaton and his group were managing the vaccine trial, Osterholm and the CIDRAP team were hard at work at one of the things they do best — deliberating a sticky problem and arriving at something no one has done or seen before. Osterholm realized that since 1976, the world had spent too little time and money developing Ebola vaccines and he was concerned that the disease could become a persistent, endemic threat. He wanted a roadmap to fast track Ebola vaccines that work. “We needed to institutionalize an approach to anticipate Ebola outbreaks rather than just respond,” Osterholm says. “If you’re only responding, you’re too late.” Osterholm contacted Jeremy Farrar,

Michael Osterholm, School of Public Health professor and infectious disease expert, has maintained that “the more we learn about Ebola, the more we realize we don’t know.” It is well documented that Ebola can pass from person to person when bodily fluids — blood, urine, saliva, sweat, semen, feces, vomit, and breast milk — from an infected person come into contact with the mucous membranes of a healthy person or enters his or her body through a break in the skin. But in a 2015 paper, “Transmission of Ebola Viruses: What We Know and What We Do Not Know,” Osterholm and 15 international Ebola experts introduced for the first time the real possibility that the virus can be transmitted through the air. “In all likelihood, this is already occurring in the patient setting,” says Osterholm, though it is hard to document. If a caregiver is close enough to an Ebola patient to be infected by minute airborne particles, the caregiver could also have been infected through more normal means. Careful scientific studies of Ebola transmission have been few. Currently, no one believes that the Ebola virus is highly

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Michael Osterholm, table center in blue tie, spoke at Johns Hopkins University’s Dean Symposium on October 20, 2014, on the scope and challenges of the then-current Ebola epidemic.

contagious as an airborne pathogen, but that could change as the virus evolves. The paper concludes on a cautionary note: “The West Africa Ebola epidemic surprised even the most astute infectious disease experts in the global public health community; we should not assume that Ebola viruses are not capable of surprising us again at some point in the future.”

LARRY CANNER, COURTESY OF JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH

Breathing in the virus

fellow infectious disease expert and director of the Wellcome Trust, a global charitable foundation second only to the Gates Foundation in money given for health support and healthrelated research. Osterholm and Farrar called on 26 international leaders in public health, medicine, bioethics, humanitarian relief, and pharmaceutical manufacturing to establish a “Team B” — a set of fresh eyes that could envision a new, coordinated, and fast path to effective and safe Ebola vaccines. “If we had been looking at Ebola four years ago with the creative imagination this group provides, think where we’d be now,” says Osterholm. With great organizational support from CIDRAP, Team B released “Recommendations for Accelerating the Development of Ebola Vaccines” on February 17. The comprehensive report covers funding, research development, vaccine efficacy, licensure, manufacturing, distribution, vaccine safety and administration, and ethics — all the critical issues that can be stumbling blocks in the way of an effective vaccine. The report — the first of its kind not sponsored by the government — also calls for putting African stakeholders in the forefront of decisions affecting the well being of their own people hit by an epidemic. “Our Team B efforts represent the first time that an independent group of scientists have played such a key role in helping define the characteristics and develop a roadmap for a successful Ebola vaccine,” says Osterholm. WHO has asked to use the Team B target product profile, which provides optimal criteria for Ebola vaccines in epidemic or endemic settings.

CHANGING DIRECTION The one certainty about this epidemic is that things will change unexpectedly. Neaton’s vaccine study did not go as planned, and for a good reason. Incidences of Ebola in Liberia dropped

drastically and the last person known to have Ebola in that country died on March 27, 2015 (as of June 1, 2015). Without an active spread of disease, there is no way to test the true effectiveness of a vaccine in a Phase 3 trial. The PREVAIL 1 study had to shift gears. “When it became clear that it wouldn’t be feasible to do Phase 3 in Liberia, we continued enrolling in Phase 2 to gather as much information as we could,” says Wolfson. “We had pretty low enrollment of female volunteers, so we decided to increase the number of women and enroll beyond the original 600 volunteers to 1,500 total.” Those volunteers will now be followed for 12 months with lab work including immune response tests at 6 and 12 months. This way, says Wolfson, “we can learn more about the durability of the vaccine. Will immunity be maintained or will it decline?” Phase 3, which was intended to be a study of nearly 30,000 people, needs to find a new home in West Africa.

USING WHAT’S THERE With the infrastructure created in Monrovia for the vaccine trial, the U.S./Liberian partnership plans to conduct an observational study of those who survive Ebola. “What’s clear is that there are a number of conditions that follow Ebola infection that are poorly understood and that probably are a significant cause of morbidity and perhaps even mortality in the survivors,” says Lane. Neaton, again, will manage this study as well as a randomized control trial of the Ebola treatment drug, ZMapp.

KEEPING AN EYE OUT The current Ebola epidemic may be fading from West Africa, but as Osterholm says, the disease is now on the continent “in a new way.” Forty years ago, Ebola was confined to isolated rural villages where the likelihood of it spreading to the rest of the world was virtually zero. But with Africa’s burgeoning populations and the ease

Jim Neaton in Monrovia at one of the handwashing stations that were outside every public building during the Ebola epidemic.

and frequency with which people travel within and among countries, the Ebola model has changed. The quickly growing megacities of Africa have millions of people living in desperate conditions with no adequate health care services or public health infrastructure. When it comes to an Ebola epidemic, “these cities are open gas cans just waiting for someone to throw a match in,” says Osterholm. New knowledge about Ebola transmission and containment, more trained medical and public health personnel, and greater education about the virus may create firewalls, but to truly protect a population and confine the disease, the world needs a quickly deployable Ebola vaccine. “The thing that we all worry about is that this [epidemic] was the first shot across the bow,” says Osterholm. “We may win battles against Ebola, but we will never win the war without an effective vaccine.”

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“Companion and agricultural animals are a big part of our environment,” she says. “We need to understand if animals provide a preventive health aspect for people and also determine if we benefit animals.” Schreiner also imagines CENSHARE offering guidance to others interested in conducting studies of their own. The center could operate as a hub of sorts to connect researchers with resources and bring them together through workshops and conferences.

CENSHARE returns with a new focus on animal-human interaction research By Charlie Plain

etting a dog or cat can be soothing, but is it possible that the company of animals can actually contribute to our good health? School of Public Health professor Pam Schreiner suspects there’s a connection. “The purr of a cat is at the same frequency as the ultrasound used to heal human bones,” says Schreiner, a cardiovascular epidemiologist and an avid pet lover. Schreiner is also the new director of CENSHARE — the Center to Study Human Animal Relationships and Environments — a renowned and recently revived SPH unit with a strong history serving the community and a new focus on researching the

health advantages of being around animals. “Animal-human interactions have a lot of benefits, we just need to understand them by asking the right questions and designing solid research studies,” says Schreiner.

VISIONARY INVESTIGATION CENSHARE was co-founded in 1981 by dog trainer Ruth Foster and internationally known veterinarian and SPH professor Robert “RK” Anderson. In pet culture, the duo is famous for developing the Gentle Leader dog harness. Anderson, who died in 2012, was an expert in animal behavior and psychology, infectious disease research, and veterinary public health.

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During CENSHARE’s first iteration, it focused primarily on helping people understand pet behavior problems and working with local therapy and service animal organizations. “RK was visionary,” says Schreiner. “After he died, people assumed CENSHARE died, too.” In this new era for the center, Schreiner hopes to build on the center’s reputation and also expand it. “I plan to grow it into an active research center, with graduate students and scientists who are all interested in the human-animal bond,” she says. Schreiner wants to take a truly scientific look at how animal-human interactions influence groups who have regular contact with animals, like farmers and pet owners.

THE NEW GUARD Shreiner has already made strides in reestablishing CENSHARE’s presence by relaunching its website and collaborating with the Center for Spirituality and Healing to examine current coursework for training in human-animal interaction research. CENSHARE has been funded for its first study under Shreiner’s leadership. In August, Schreiner began collecting data, biological samples, and interviews from rural and urban pet owners and farmers at Minnesota’s ultimate nexus of animal and human mingling, the State Fair. “The whole spectrum of how animals, humans, and the environment come together is an infinite source of study,” says Schreiner. “The sky’s the limit in terms of what we can try.” Visit censhare.umn.edu for more information.

PHOTO BY PAULA KELLER

Pet Projects

Taconite Dust Raises Health Risks in MN Miners

PHOTO BY ERLEND BJØRTVED

he final report on a School of Public Health study investigating the health of Minnesota’s taconite industry workers shows an association between mining dust exposure and cases of a rare cancer and it urges increased body monitoring and disease prevention initiatives for employees. The “Minnesota Taconite Workers Health Study” was headed by Dean John Finnegan and principal investigator Jeffrey Mandel. “Mining is of great importance to the people of Minnesota and to our state’s economy,” says Finnegan. “The state invested significant funds and time into the study and we felt it was important to indicate follow-up activities in order to continue to improve the health and safety of all miners moving forward.” The study launched in 2008 at the request of the state legislature after the Department of Health detected an unusually high number of cases of mesothelioma, a rare cancer of the lung lining, in Minnesota taconite workers. To address the concern, the study examined three questions to assess the occupational health risks to taconite workers and to search for a link in the mesothelioma cases: Is working in the taconite industry associated with mesothelioma and/or with other respiratory or non-respiratory diseases? The study found taconite workers had higher than expected death rates from three diseases when compared to the general Minnesota population: mesothelioma, lung cancer, and heart disease. In instances of lung cancer and heart disease, working in the mining industry was not believed to be the prominent cause of the illnesses. What factors, particularly dust from taconite operations, are associated with mesothelioma and other respiratory diseases? Researchers found that the length of time people worked in the industry was specifically linked to higher levels of mesothelioma. Pinpointing it more, exposure

to a fiber-like mineral — referred to as elongate mineral particle (EMP) — was linked to mesothelioma. The investigators determined EMP exposure could be from either dust generated in mining and processing, or from its most widely known source, commercial asbestos exposure. As a result, workers with above-average exposure to dust containing EMPs were twice as likely to develop mesothelioma as workers with belowaverage exposures. Are workers at risk for common dust-related lung diseases and are their spouses at risk for the same diseases due to their partners working in the industry? A health screening of current and former taconite workers and their spouses was conducted in 2010–11. The results revealed X-ray evidence of dustrelated scarring of the lung and lung lining (pleura) in workers. Once again, there was evidence of a link between EMP exposure in workers and observed scarring of the lung pleura. Spouses of taconite workers, however, showed lower instances of lung scarring comparable to what’s been reported for the broader general public. Read the full report at z.umn.edu/taconitestudy

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Two Birds, One Stone New funding revives internationally acclaimed website

2015

2015 marked the start of a new year as well as a fresh start for HealthNewsReview.org (HNR), the award-winning website that helps consumers make heads or tails of health news. The site, created by School of Public Health adjunct associate professor and former CNN medical correspondent Gary Schwitzer, ran for seven years until funding dried up in 2013. But now, a two-year, $1.3 million grant from the Laura and John Arnold Foundation has allowed the site to re-start and re-think its efforts, as well as fund the new Center for Media Communication & Health, headed by Schwitzer and located in the School of Public Health.

STARTING OUT HealthNewsReview.org launched in 2006 as a resource to help improve public discourse on health with funding from the Informed Medical Decisions Foundation. A team of 30-plus reviewers — who range from academics to medical professionals to journalists to women with

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breast cancer — regularly reviewed health care stories that appeared in one of 20 top news organizations. Reviews ran on HealthNewsReview. org, which consistently garners a quarter million unique site visits a year. By 2013, the group had reviewed 1,889 stories. Plus, HNR’s 10 criteria for judging stories became a gold standard for health reporters that Paul Raeburn of the Knight Science Journalism Tracker at MIT said “ought to be printed on wallet cards for reporters … to remind them what questions to ask.” When financial support for HNR stopped, Schwitzer continued to run the Health News Watchdog blog that resides within the broader site, but being the blog’s sole author — as well as continuing to speak nationally and fundraise — left him worn out.

TURNING POINT In May 2014, Schwitzer was invited to speak at a national medical conference in Australia. As he got on the plane, “I thought, this might be the end,” he recalls of HNR’s future. On his overseas flight, he read

PHOTO BY PAULA KELLER

By Sarah Howard

an article about Stanford’s Meta-Research Innovation Center (or METRICS), funded by the Laura and John Arnold Foundation (LJAF). For years, Schwitzer had admired the work of John Ioannidis, the cofounder of METRICS, which aims to improve the quality of scientific research. “I thought what I was doing regarding media messages was somewhat similar to what METRICS was doing in the health research world — so maybe Health News Review had a chance to get funded,” says Schwitzer. His enthusiasm cooled when Schwitzer discovered that the Foundation did not accept unsolicited proposals. But Stuart Buck, vice president of research integrity for LJAF, had his eye on HNR and a month later, when Schwitzer returned stateside from Australia, he had a message waiting for him from Buck simply asking, “What would you do if you had funding?” Now, that simple question is being answered.

VERSION TWO In early January 2015, HealthNewsReview.org began regularly publishing systematic, criteria-driven health news reviews, longtime HNR reviewer Kevin Lomangino became managing editor of the site, and HNR now lives at the School of Public Health in the newly created Center for Media Communication & Health. With Lomangino on board, Schwitzer can focus on continuing the Health News Watchdog blog as well as bringing his nationally recognized health reporting workshop around the country. “Nobody who covers health care news rolls out of bed and says ‘How can I screw up today?’” Schwitzer says of training reporters. “You don’t know you’re causing harm if you don’t know what you don’t know. We’re trying to offer positive, constructive outreach.” On April 16, 2015 (nine years to the day since the original site launched), a re-designed and expanded HealthNewsReview.org website launched with a fresh look and a new addition: the review of health care-related news releases. “A lot of health news is based off of these releases,” says Schwitzer. “It’s time for us to hold them to the same standards as health stories.” Days after news broke of HNR’s new funding, The BMJ (formerly British Medical Journal) published a study examining the association between health-related science news and press releases. The study found that 40 percent of press releases contained exaggerated evidence and one-third contained exaggerated causal claims. Most importantly — and possibly most obviously — the study found that when press releases contained exaggerated information, it was more likely that the news would, too. Another change for HNR is adding School of Public Health graduate student and patient perspectives to reviews. “I want to have as many voices in this dialogue as we can,” says Schwitzer. “I’m excited to involve graduate students because they can take lessons learned through this site and start to become disciples of effective communication around the country as they move into their careers.” “This is a true public service,” School of Public Health Dean John Finnegan says of HealthNewsReview.org and the Center for Media Communication & Health. “The center will allow us to involve School of Public Health faculty and graduate students in the continuing conversation about effective health communication.”

“You don’t know you’re causing harm if you don’t know what you don’t know. We’re trying to offer positive, constructive outreach.”

Red Flags If you’re not one of the A-list reviewers on HealthNewsReview.org, how can you know if news stories are misleading or inaccurate? Schwitzer weighs in on what you should look out for and what should make you think twice about health claims. • If it sounds too good to be true, in health care, it almost always is. • If you see a health care claim that only discusses the potential benefits, proceed with caution. “If harms are not discussed, it’s an incomplete discussion,” says Schwitzer. • If costs are not discussed. “70 percent of the 1,889 stories we reviewed did not adequately discuss cost,” says Schwitzer. “Media and journalists don’t help the picture if they don’t include the staggering costs related to health care.” • If you ever hear someone talk about a “simple” test, “run for the hills,” says Schwitzer. “There is no such thing as a simple test. Our decision to get screening tests should be among the most complex decisions because depending on what happens as a result, you may kick-off a cascade of issues.” When it comes to tests, Schwitzer says, people are largely uninformed and often have unbalanced discussions with their doctors where benefits are exaggerated and harms are ignored. • In health care, more is not always better. And newer is not always better.

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Legal Aid State cannabis program to help chronically ill By Charlie Plain

A PUBLIC HEALTH ISSUE Larson, who directs the MDH initiative and oversees everything from creating educational campaigns to establishing rules for drug manufacturing, is doing the work because cannabis has the potential to help those who need it the most. “At the end of the day, I’m doing it to help people with health conditions have a better quality of life, in a safe way,” she says. MDH estimates 5,000 people will enroll in the program during the first year.

“[Legalizing medical cannabis] is a public health issue because we have a fairly large population of people with chronic diseases and compromised lifestyles who, until now, couldn’t obtain a drug that may alleviate their symptoms,” says Larson.

SAFETY FIRST The law permits patients who are physiciancertified in nine illnesses — such as ALS, epilepsy, or cancer — to receive up to a 30-day supply of medical cannabis. The medication will be precisely formulated with active ingredients and produced as capsules, drops, or an inhalable vapor. The manufacturers will then directly sell the medi– cation at a set price from storefronts staffed by

How Cannabis Works in the Body People have used marijuana for thousands of years for medical purposes, and it was physician prescribed as recently as the early 1900s in the United States. How and why marijuana works is not fully understood, but current research is beginning to change that. Here’s what we know: The effectiveness of marijuana — or cannabis — as a drug seems to hinge on dozens of chemicals in the cannabis plant called phytocannabinoids. Phytocannabinoids are found inside trichomes, sticky, hair-like follicles that cover the leaves. The oily phytocannabinoids provide a toxic shield against hungry omnivores and serve as part of the plant’s cleansing system. The most widely understood phyto– cannabinoid — tetrahydrocannabinol 12 University of Minnesota School of Public Health

(THC) — is known for what it does for people. First isolated by researchers in 1964, THC has been long known as the “gets you high” component in marijuana. In 1988, researchers found a cannabinoid receptor in the brain that’s highly sensitive to THC. Called CB1, the receptor is the pathway through which THC enters our system and interacts with our minds and bodies. That discovery was a breakthrough, but it pointed the way to something even more significant. The presence of a receptor for a particular chemical that comes from outside the body implies the body itself is producing a substance similar to the chemical or there would be no purpose for the receptors. So if our brain is already wired to respond to plant cannabinoids, then it must mean our body is making and using cannabinoids of its own. And it is.

These body-produced cannabinoids are called endocannabinoids — endo meaning “within” — and their discovery led to finding a complex system of endocannabinoid receptors in the brain, nerves, GI system, and immune system. “We now know that we have this amazing thing called the endocannabinoid system,” says Arneson. “Endocannabinoids seem to have important purposes in appetite regulation, alertness and sleep, pain, and stimulation, among other functions.” Discerning just how the system works is leading to more discoveries, including finding another type of cannabinoid receptor nnamed CB2; identifying the first endocannabinoid, anandamide; and identifying other molecules that serve endocannabinoid functions. –CP

PHOTO BY PAULA KELLER

n July 1, Minnesota opened its doors to a state-monitored program legalizing the sale of medicinal cannabis. Proponents of the program say the medication safely and reliably offers relief to thousands of Minnesotans suffering from some of the most disabling medical conditions. Opponents fear the health and security risks, calling cannabis “the most dangerous illegal drug in our nation.” Leading the program are Michele Larson and Tom Arneson, two School of Public Health graduates working at the Minnesota Department of Health (MDH). Unlike other states where marijuana is legal, Minnesota is adopting a pharmaceutical model for its program that authorizes two statewide companies to produce and sell cannabis-based medications under strict guidelines. Patients in the program must participate in a registry and study aimed at increasing the limited understanding of medical cannabis effectiveness and side effects.

Tom Arneson and Michele Larson of the Minnesota Department of Health.

will gather information on individual cannabis use, dosages and patient experiences and side-effects. Much of the data will be collected during consultations with pharmacists at the point of sale and through patient self-reporting. “We’ll have much more definitive information on the exposure and effectiveness of cannabis because patients will be asked questions just days and weeks after they’ve used it,” says Arneson.

UNDERSTANDING DIFFERENCES

expertly trained pharmacists. “Our number one priority right now is ensuring patient safety and that we’re getting carefully formulated medical cannabis products into the hands of the people who qualify for it,” says Larson. Arneson will lead research aimed at adding to what we know about the safety and effectiveness of medical cannabis. He has an upcoming observational study of participants. “Most states aren’t following what patients enrolled in their programs are taking and what affect cannabis has on their health — that’s what our program intends to do,” says Arneson. Through a patient health data registry, Arneson

GRAPHIC ADAPTED FROM THE-HUMAN-SOLUTION.ORG

Cannabinoids

Along with recent research into cannabis and the body’s endocannabinoid system (see below), exploration of how cannabis-derived drugs work in respect to differences among bodies is crucial. “Even though everyone has the same endocannabinoid system, we seem to uniquely respond to drug compounds,” says Arneson. Early research and anecdotal evidence has already shown that therapeutic dosage levels vary among individuals and that side effects appear at both higher doses and when there’s quick escalation of the amount of medication used. Arneson says an important factor in understanding how individual patients might respond to a drug is knowing how the delivery method changes its efficacy. Medical cannabis can be taken in various ways — such as inhaled, swallowed or placed under the tongue — and the way the body absorbs it and puts it into the bloodstream could easily have an impact on how well it works. Many major questions remain and there are countless studies still to be run before the use of medical cannabis is as understood and common–place as other drugs. Nevertheless, one thing about marijuana is certain: science is quickly making up for lost time to unlock the secrets of this ancient and historically helpful plant.

CB1 receptors are primarily found in the brain and central nervous system, and to a lesser extent in other tissues.

CB2 receptors are mostly in the peripheral organs, especially cells associated with the immune system.

CB1

CB2

Receptors are found on cell surfaces

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Field Notes A new tool traces the history of how we look at heart disease

nce upon a time, we believed that only men died of heart attacks and that smoking, diet, and exercise had little impact on heart health. But toward the middle of the 20th century, large-scale trends in heart disease began to surface that challenged those views. Data suggested that deaths from heart attacks in Europe fell during World War II and spiked upward afterwards. Stories circulated about countries, like Japan and Greece, with almost no heart disease. And Finland claimed the highest heart attack rates in the world. Many believed that culture was a major influence on heart disease risk and frequency. Others thought that what we ate and how we lived played a significant role. Some believed that heart health was related to populations and their culture, not just to individuals and their heredity. To explore these intriguing possibilities, a new field of systematic study emerged — cardiovascular disease epidemiology — and the Seven Countries Study was one of its seminal investigations. Begun in 1958 with School of Public Health’s Ancel Keys leading an international team of collaborators, the study examined the relationship between contrasting eating patterns and heart disease

People Oral histories bring to life cardiovascular epidemiologists like Elizabeth Barrett-Connor, who relates being told by the dean of the University of California Medical School at San Diego that she would “never get tenure because all I did was count people.” Multimedia Rare footage shows Ancel Keys and Paul Dudley White examining village men in Italy and Crete in 1957 as they begin to study the role of eating patterns vis-à-vis heart disease rates among and within traditional cultures.

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rates among entire populations of men in the United States, Finland, the Netherlands, Japan, Greece, Italy, and Yugoslavia. Among its findings was a correlation between what we habitually eat and heart disease, and from that link, bolstered by School of Public Health laboratory studies, came the now popular Mediterranean Diet, which encourages a diet of plant-based foods. SPH Professor Emeritus Henry Blackburn was a principal investigator on the Seven Countries Study and has recently spear– headed a website that traces the early history of cardiovascular epidemiology and research in heart attack prevention. Through rare videos, photographs, interviews, personal essays about adventures in the field, and the explication of questions and study methods, the site conveys the energy and excitement behind the then-new discipline. Visit the site at www.epi.umn.edu/cvdepi and look for some of the riches highlighted below. Blackburn welcomes comments, corrections, and active participation in the site. You can contact him at black002@umn.edu.

The Research A synopsis of the British Doctors Study, which explored the mortality of doctors in relation to their smoking habits, shows why it is a classic in epidemiology and one of the icons of prospective cohort studies. Essays Blackburn writes about how American jazz brought together Soviet / Western factions at a delicate moment in the deliberations of the International Society of Cardiology on the Dalmatian Coast of Yugoslavia, 1963.

SCHOOL NEWS

Alumni drive MHA Problem Solving Method

SPH Alumni Take Service Trip to India

n January 2015, a group of SPH alumni, their families, and SPH friends traveled to India as part of an inaugural international group travel experience available through the School of Public Health. Open to all SPH alumni, the trip was originated by the SPH Alumni Society Board of Directors to give an experience of public health around the world. To get a first-hand look at public health in action, SPH partnered with a Minnesota nonprofit organization Pathways to Children, which provides educational volunteer experiences around the world and that planned the trip’s details and excursions. The two-week trip took the group of 18 to Kolkata, then on to Varanasi, and up to Dehli with a day trip to visit Agra and the Taj Mahal. A day-to-day account of the adventures and photos is available at umnsphalumni. blogspot.com. Travelers included: Jim Anderson, MHA ’68, and Bobbi Anderson; Tara Anderson; Javon Bea, MHA ’78, Vita Bea, and Theresa Bea; Melinda Bemis, MHA ’10; Sonia Gockley, MPH ’13, and Jeanne Gockley; Gopal Khanna; Deb Lasher, MPH ’98; Angie Lillehei, MPH ’85 and Haley Lillehei; Deb Moses, MPH ’90; Grace and Ralph Strangis; Wanda Webb, MHA ’02, and Jack Webb; and Beth Virnig, MPH ’89, PhD ’93, and Jonathan Levy. If you are interested in traveling with the SPH Alumni Society as more trips are planned, contact Tara Anderson, Director of Alumni Relations, at tlanders@umn.edu or 612-626-5536.

ince the master of healthcare administration’s inception in 1946, “The Minnesota Way” of problem-solving has been the signature of the degree, teaching a discipline of critical thinking and skillful presentation through a 14-step process. Taught by a cadre of faculty and alumni volunteers, full-time and Executive MHA students take courses throughout their studies that engage the problem-solving Jason Battaglia, Sumukh Sathnur and Philip Konkol method. Often alumni are able to identify present management recommendations at the University of Minnesota Masonic Children’s Hospital. one another in the workplace because of Their faculty advisor is Cari Worner ‘00. a shared way of thinking and vocabulary around problem solving. MHA founder James A. Hamilton developed the method and it includes the following steps: • Interpret results of comparisons by • Define the problem by apprehending the real issues of the situation and stating seeking the real reasons for variance. • Develop temporary conclusions. the problem precisely. • Consider various solutions; choose • Budget the time as well as the effort the best, not the first acceptable. available and necessary to arrive at • Take a fresh look at the approach to an acceptable solution. • List the areas necessary for consideration the problem and the selected solution. • Develop a plan of accomplishing to determine the best solution. the solution. • List the elements to be measured • Determine recommendations, and the best means of measurement. which invite action. • Plan, make contact, collect, and • Prepare and present a report to classify data. those who make the final decision. • Make comparisons with others, • Implement the action to carry with existing standards, or with out the selected solution. past experience.

Today, two alumni — Greg Hart, MHA ’76, and Justine Mishek, MHA ’02 — provide leadership for three problem-solving courses. “It has withstood the test of time,” Hart says of the method. “The success of the courses would not be possible without the time and commitment of alumni in decades past, and that remains true today.” “It’s an invaluable tool,” says Cari Worner, MHA ’00, president of Fairview laboratory service, and problem-solving faculty adviser for six years. “The experience helps alumni stay connected to the Cari Worner, ‘00 program and allows students to establish relationships with alumni.” This year, more than 45 MHA alumni volunteered as preceptors and faculty advisers.

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CLASS NOTES Kelsey Avery, MPH ‘14 (public health administration & policy), has a Presidential Management Fellowship for 2014-15, working as a social science analyst in the Office of Health Policy, Division of Health Care Access and Coverage Policy, HHS, Office of the Assistant Secretary for Planning and Evaluation (ASPE). Ken Bence, MHA ‘92, was given the 2015 Albert Justus Award for Distinguished Service in the field of public health in the state of Minnesota by the Minnesota Public Health Association. Bence is director of public health at Medica. Claude Betene a Dooko, MPH ‘13 (epidemiology), joined the United States Air Force as a public health officer in Florida in June 2015. Adam Berry, MHA ‘02, was named to the final found of 40-under-40 honorees by the Minneapolis/St. Paul Business Journal. Adam currently serves as CEO of Summit Orthopedics. Michel Boudreaux, PhD ‘14 (health services, research, policy & administration), won honorable mention in the John Heinz Dissertation Award for his dissertation “The Long-Term Effects of Exposure to Medicaid in Early Childhood.”

veterinarian to win the Siehl Prize for Excellence in Agriculture from the University of Minnesota College of Food, Agriculture and Natural Resource Sciences. Diesch is a professor emeritus at the University’s College of Medicine and the School of Public Health. Anne Dwyer, MPH ‘13 (public health administration & policy), joined the U.S. Senate Finance Committee as a staffer after a year in the David A. Winston Health Policy Fellowship in Washington, D.C. Dwyer is also a 2013 JD graduate of the University of Minnesota. Mary Beth Eldredge, MHA ‘87, received a master in healthcare delivery service from the Tuck School of Business and the Geisel School of Medicine at Dartmouth College. In November 2014, she was re-elected as board chair for the New Hampshire Health Information Organization. Gary L. Filerman, MHA ‘61, PhD ‘70, has been elected to the board of the Accreditation Council on Continuing Medical Education (ACCME) for a three-year term. Jamal Ghani, MHA ‘96, was named executive vice president and system chief operating officer for Kaleida Health in Buffalo, NY, after serving as chief executive administrative officer at the Cleveland Clinic Florida.

Rocklon “Rocky” Chapin, MHA ‘78, was named president and CEO of the Benedictine Health System in Duluth, Minn. Chapin joined the Benedictine Health System in January 2013 and has served as senior vice president, business development and strategic planning.

Michael “Mick” Gibbs, MHA ‘00, was named president of Rapid City Regional Hospital and its clinics in Rapid City, SD, on February 5, 2015. Prior to returning to RCRH, Mick was vice president at Sanford Health in Fargo, ND.

Stanley Diesch, MPH ‘63 (veterinary public health), recently became only the third

John Glaser, MS ‘82, PhD ‘84 (biometry & health information systems), was named senior vice

16 University of Minnesota School of Public Health

president at Cerner Corporation. He previously served as CEO of Siemens Health Services, which merged with Cerner. Scott Goodspeed, MHA ‘80, was named principal at Stroudwater Associates, and is founder and president of Winning-Healthcare™ in North Hampton, NH. He previously was vice president at iVantage Health Analytics. Michelle Heavens, MHA ‘04, has been named the new Ascension Health President and CEO Fellow. A member of Care Excellence leadership since 2007, Heavens has had a major role in Ascension Health’s successes in improving patient safety and quality. Andrew Huff, PhD ‘14 (environmental health), is investigator on a $4.6 million grant from the Defense Threat Reduction Agency awarded to EcoHealth Alliance, where he is a senior research scientist. The grant continues the development of the Global Rapid Identification Tool System, which monitors early-warning signals for possible infectious disease outbreaks. Ramatoulie Jallow, MPH ‘13 (community health education), is a Global Health Corps Fellow, serving as a research analyst for the Elizabeth Glaser Pediatric AIDS Foundation in Rwanda. Kimberly Johnson, MPH ‘04, PhD ‘07 (epidemiology), assistant professor at the Brown School, Washington University in St. Louis, has been honored by the National Cancer Institute for a paper she co-authored about genetic mutations that increase the risk of ovarian cancer. Amer Kaissi, PhD ‘03 (health services research, policy &

administration), professor of health care administration at Trinity University, has been named the 2015 recipient of the Dr. and Mrs. Z.T. Scott Family Fellowship in recognition of his outstanding abilities as a teacher and mentor. Barbara Knust, MPH ‘08 (veterinary public health), was named the 2014 Salmon Award Winner, presented by the National Association of Federal Veterinarians. William W. Latimer, MPH ‘00 (epidemiology), was named Dean of Lehman College’s New School of Health Sciences, Human Services, and Nursing in September 2014. Lehman College is part of the City University of New York. Stephen LeMaster, MPH ‘08 (environmental health), passed the three-part board certification examination given by the American Board of Toxicology in October 2013 and is a Diplomat of the American Board of Toxicology (DABT). Steve Lepinski, MHA ‘85, was named to Minnesota Business Magazine’s The (Real) Power 50 in 2014. Lepinski has served as the executive director of the Washburn Center for Children for more than three decades. Angie Lillehei, MPH ‘85 (public health nursing), earned a PhD in nursing from the University of Minnesota in 2014 with a minor in integrative therapies and healing practices. YangYa Lim, MHA ‘04, was appointed CEO for Fukui Kosei Hospital Group in Fukui, Japan. Emily Matson, MPH ‘10 (community health education), was awarded first place in the

Professional Practice poster category at the 2015 American College Health Association Annual Meeting. Her poster addressed the evaluation of the Rothenberger Institute’s undergraduate course, PubH 1004: Sexuality Matters. Scott Mortensen, MHA ‘09, was named CEO/administrator of Utah’s Orem Community Hospital, one of Intermountain Healthcare’s 23 hospitals. Previously, he was assistant administrator for American Fork Hospital in Utah, and worked for the Mayo Clinic, UnitedHealth Group, and the Cleveland Clinic.

(environmental health and epidemiology), SPH professor and director of the Center for Infectious Disease Research and Policy, has been honored with the University of Minnesota Regents Professorship, the University’s highest faculty honor. Alison Page, MHA ‘96, became president of the University of Minnesota Alumni Association Board of Directors in April 2015. She currently serves as CEO of Baldwin Area Medical Center in Baldwin, Wisc.

Aaron Patnode, MHA ‘09, was named executive director of Cover Oregon, the state’s Brock Nelson, MHA ‘76, online marketplace for health received Minnesota Business insurance. He was also named Magazine’s 2014 Leaders in Health Care Lifetime Achievement 1 of 17 Oregon business people to watch in 2015. Award. Nelson recently retired as president and CEO of Regions Robert Portwood, MHA ‘11, Hospital in St. Paul, Minn. and has received the American College was one of three individuals of Healthcare Executives (ACHE) selected for this award from Regent’s Early Career Executive Minnesota’s health care industry. Award. Portwood is director of operations at Siteman Cancer Nancy Omondi, MS ‘07 Center, Barnes-Jewish Hospital (health services research, policy in St. Louis, Mo. & administration), has been appointed program manager of Jeremy Price, MHA ‘03, research operations at the Mayo joined ProHealth Medical Group Clinic Robert D. and Patricia E. Kern Center for Science of Health as its executive vice president in Care Delivery in Rochester, Minn. Waukesha, Wisc. Britta Orr, MPH ‘11 (public health administration & policy), joined Blue Cross Blue Shield of Minnesota in November 2014 as a senior policy consultant to serve as the principle policy adviser for legislative, regulatory, and public policy initiatives impacting Medicare, Medicaid, and government programs. Orr previously served as executive director of the Local Public Health Association of Minnesota. Michael Osterholm, MS ‘78, MPH ‘80, PhD ‘80

Krystal Rampalli, MPH ‘13 (environmental health), was selected as an ASPPH/CDC Allan Rosenfield Global Health Fellow. She is one of 11 fellows who will engage in an intensive one-year assignment at the Centers for Disease Control and Prevention, within the Center for Global Health. She will be based in Zambia. Megan Remark, MHA ‘91, was named the new president and CEO of Regions Hospital in St. Paul, Minn.

Alicen Spaulding, PhD ‘13 (epidemiology), served as a coauthor on “International Study Demonstrates Benefits of Early HIV Treatment” with Anthony Fauci, MD, that was published in the Huffington Post “Healthy Living” section on May 28, 2015. Spaulding is an epidemiologist and NIH Presidential Management Fellow on rotation in the NIAID Immediate Office of the Director. Jennifer Schultz, PhD ‘01 (health services research, policy, & administration), won the seat for the Minnesota House of Representatives in Duluth, Minn., district 7A. She is a professor of economics and director of the health care management program in the Labovitz School of Business and Economics at the University of Minnesota-Duluth. Tricia Todd, MPH ‘94 (public health administration), assistant director at the University of Minnesota’s Health Careers Center, was the inaugural recipient of UMN’s C. Eugene Allen Award for Innovative International Initiatives for her work in ethical decision making with pre-health students completing study abroad experiences. Stephanie Triplett, MHA ‘09, was named vice president of operations (assistant director) at the W.G. (Bill) Hefner VA Medical Center in Salisbury, NC. Margaret “Peg” Van Bree, MHA ‘86, was appointed president of Rhode Island Hospital and Hasbro Children’s Hospital, effective January 5. Van Bree most recently served as CEO of St. Luke’s Medical Center in Houston.

ALUMNI IN MEMORIAM: 2014–15 Robert Angus, MPH ‘67 (veterinary public health) Robert S. Banks, Ph.D., MPH ‘79 (environmental health) Don C. Black, MHA ‘77 Kathleen G. Bodding, MPH ‘78 (maternal & child health) Arlene P. Bowles, MPH ‘44 (public health nursing) Marjorie Clos, MPH ‘58 (community health education) Dudley Conner, MPH ‘61 (environmental health) Margaret H. Crittenden, MS ‘56 (biostatistics) Komel Crowley, MPH ‘12 (public health nutrition) Janet D. Edwards, MS ‘80 (public health nursing) Elbert “Gil” E. Gilbertson, MHA ‘57 Patricia Glasrud, MPH ‘82 (dental public health) Vernon L. Harris, MHA ‘52 William J. Hartung, MHA ‘59 Garth E. Hinderman, MHA ‘64 Bernard Hoogenboom, MS ‘83 (environmental health) Kjeld O. Husebye, MPH ‘69 (health services administration) George O. Johnson, MHA ‘63 James K. Knoble Jr., MHA ‘63 Chantelle C. Kurtz, MPH ‘13 (public health nutrition) Anna B. Lawler, MPH ‘79 (epidemiology) Ann M. Lundvall, MPH ‘00 (environmental health) Larry L. Lloyd, MPH ‘68 (environmental health) Charles E. McJilton III, MS ‘65 (environmental health) Paul E. Mullen, MHA ‘61 Courtland E. Newman, MHA ‘72 Thomas N. Norris, MPH ‘83 (maternal & child health) Marion J. Owen, MPH ‘65 (public health nursing) Sharon E. Quast, MPH ‘76 (public health nursing) Dean K. Roe, MHA ‘57 John R. Roos, MPH ‘85 (health education) Robert M. Schwartzman, MPH ‘58 (veterinary public health) Kenneth T. Swanson, MHA ‘60 Kenneth W. Torbert, MHA ‘72 Daniel J. Werner, MHA ‘81 Howard M. Winholtz, MHA ‘51 sph.umn.edu 17

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The University of Minnesota School of Public Health turns every $1 OF STATE FUNDING INTO $13 to create healthier communities.

The School of Public Health is working to create a bright future for our state. We’re helping farmers prevent injuries and aiding veterans who struggle with food access because of limited finances. We’re striving to make mining safer and environmentally sustainable throughout northern Minnesota. Our work serves the things that make Minnesota proud— our healthy citizens and thriving communities.

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