Advances – Spring 2006

Advances Taking Aim at Tobacco Use in India • page 9

SPRING

2006

from the University of Minnesota School of Public Health

INFECTIOUS DISEASE: SPH Experts Fight Old Enemies and New Threats

CURBING COLON CANCER

Genes Unlock Asthma Mysteries LATE BASEBALL GREAT SUPPORTS STUDENTS

Live, from the SPH, It s Today s Lecture

FROM THE DEAN Dear Friends,

Photo: Richard Anderson

For the majority of the 20th century, infectious disease became something of a sleeping giant. Deaths from infectious disease declined, largely as a result of improved public health measures. However, the sleeping giant awoke toward the end of the century, and the world saw an increase in deaths from infectious disease, largely due to AIDS and influenza. Concerns about infectious disease have mounted with the emergence of new diseases, and with the threat of an influenza pandemic.

Beginning on page 2, you can read about how SPH faculty members are working on many fronts with colleagues around the world to combat the threat of infectious disease.

The adoption of the latest learning technologies has long been a priority for our School, and I am thrilled to report we now have our own Podcast channel. It is a valuable new learning tool and a vehicle for delivering vital SPH information to a larger audience.

Our current programming consists of audio recordings from recent high-profile public lectures at the school. Anyone with an Internet connection and speakers can access the channel’s content. And those with a portable listening device (iPod or other MP3 player) can download the files and listen at their leisure. Simply log onto the SPH web site (www.sph.umn.edu) and click on “SPH Podcasts” at the top of the page.

We come to the end of the 2005-2006 school year with a great deal of satisfaction at having shepherded the largest number of students in our School’s history through an academic year. I have had the opportunity to round out my executive team with the addition of a new dean for student affairs and a new head of the division of epidemiology and community health. We also are experiencing great anticipation for the future. There is significant change underway at the University of Minnesota as we attempt to elevate ourselves to one of the top three research universities in the world. The School of Public Health is poised to assist greatly in that effort. I will keep you updated on that progress in future issues of Advances.

Yours in health,

John Finnegan Assistant Vice President for Public Health Dean and Professor

SCHOOL OF PUBLIC HEALTH LEADERSHIP

Advances

John R. Finnegan, Jr. Dean

John Connett Head, Division of Biostatistics

Editor Diana Harvey

Judith Garrard Senior Associate Dean for Research and Academic Affairs

Bernard Harlow Head, Division of Epidemiology and Community Health

Managing Editor Kristin Stouffer

Debra Olson Associate Dean for Public Health Practice Education

Ira Moscovice Interim Head, Division of Health Policy and Management

Contributing Writers Adam Buhr Catherine Jacobs Theresa Olsen

William Riley Associate Dean for Student Affairs

William Toscano Head, Division of Environmental Health Sciences

Art Direction Todd Spichke Riverbrand Design

Contents Table of

Advances

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SPRING 2006

Feature: Infectious Disease

Old enemies lurk and new threats emerge: SPH experts attack infectious disease globally through research, education and public outreach.

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Division News

Rising rates of uninsured, stroke-fighting veggies, genomics and public health, new student affairs dean, and more

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Student News

A memorable commencement ceremony featuring the U.S. Surgeon General, and more

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School News

SPH Film Festival Recap, lecturer highlights health care challenges in India, and the SPH joins a national conversation on health care

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Alumni News

Upcoming events, the new Alumni Network, and Class Notes

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Philanthropy

Scholarship recipients and donors honored at annual event

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INFECTIOUS DISEASE: Protecting Health in an Era of Globalization

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University of Minnesota School of Public Health

F E AT U R E S TO RY In an age of ever-expanding air travel and international trade, infectious agents cross borders every moment of every day.

Invisible microbes are carried on millions of people, animals, and insects. They’re contained in shipments of the food we eat and the products we use. Their global travel time over the past century has gone from months to weeks. Now it takes mere hours for an infectious disease to circle the globe. It’s a startling reality Centers for Disease Control and Prevention (CDC) director Julie Gerberding has coined “the new normal.”

We may see malaria, tuberculosis, pneumonia, and measles as illnesses of the past. But worldwide, more than 90 percent of deaths from infectious diseases are caused by only a handful of diseases, including these “old” threats. In developing countries they continue to kill at an alarming rate, striking mostly children and young adults. The World Health Organization estimates that every three seconds a young child dies—in most cases from an infectious disease.

We’re not safe in the developed world either. Widespread outbreaks of emerging infectious diseases like SARS, West Nile virus, and most recently, avian influenza, loom large.

Left unchecked, today’s emerging infectious diseases can spread to become the pandemics of tomorrow. Think of this: 30 years ago HIV/AIDS was contained to a remote part of Africa. Today it is one of the world’s top killers with 40 million people living with the disease and no end in sight.

School of Public Health faculty members have long understood that these diseases need to be addressed at the global level. They’re working at home and around the world to confront infectious disease head-on and at all levels, from microbial surveillance to vaccinations and treatment to disaster response and public preparedness.

CIDRAP: Information to Action The University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP) works to translate scientific information to real-world action. CIDRAP’s director is SPH professor Michael Osterholm, one of the word’s most renowned experts in infectious disease epidemiology. Through its Web site (www.cidrap.umn.edu) the center provides an Internetbased “living textbook” of the latest information on bioterrorism, food safety, and infectious diseases. In the past year, the CIDRAP Web site was credited with having the most accurate accounting of H5N1 avian flu cases—surpassing the accuracy of the World Health Organization’s Web site.

CIDRAP staff work with University of Minnesota leadership and international, national, and state public health agencies to advise them on pandemic influenza preparedness. The center has led tabletop exercises and provided state and local health departments with a list of preparedness objectives.

Recently, CIDRAP hosted an online teleconference to help other large universities best serve their communities in the face of an influenza outbreak. Twelve major universities participated, as well as CDC representatives. “CIDRAP has become an important resource to government and private industry, as they increasingly focus on the issue of a potential pandemic,” says Jill DeBoer, CIDRAP associate director, who also heads the University’s emergency preparedness program.

“We’re able to synthesize the latest information to help communities plan strategically.”

HIV/AIDS Epidemiology professor Alan Lifson is working with the government of Guyana and other collaborators to scale up that country’s HIV/AIDS care and treatment. As one of the poorest countries in the Caribbean, Guyana has limited resources to fight HIV/AIDS, which has become the leading cause of death for 25 to 44-year-olds. Lifson is partnering with Guyana’s Ministry of Health, the International Training and Education Center on HIV, the CDC, and other partners to train health care workers on the most effective way to treat the disease.

He’s also partnering with medical and other professional schools in Guyana to develop curricula on the subject.

Lifson says one of the biggest challenges to health care workers is the complicated and ever-changing nature of HIV/AIDS treatment. Training is needed to address effective ways of treatment, so the most useful drugs are used, side effects are minimized, and patients don’t develop resistance to the drugs. “This field moves so quickly, we need to help our partners be up-to-date,” he says. But most important to Lifson is developing a program that lasts.

“It’s really important to build something sustainable,” he says.

“We want to do this in a way that builds infrastructure and that develops local people who can become experts themselves.”

SPH professor of biostatistics James Neaton is known internationally for his work conducting large randomized clinical trials on HIV/AIDS. Through the School’s Coordinating Centers for Biometric Research (CCBR), he leads a team focused on determining the most effective ways of treating (continued on next page)

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FEATURE STORY

Photos courtesy of Aaron Norman Aaron Norman

SPH Student Learns to Expect the Unexpected Students engaged in public health work abroad usually encounter their fair share of surprises. Second-year epidemiology major Aaron Norman’s experience doing HIV/AIDS prevention last year in Russia was no different.

He didn’t expect the celebrity reception he received from the Russians he met, simply by virtue of the fact that he was an American. And he certainly didn’t anticipate being a dinner guest at the elegant residence of the U.S. Ambassador to Russia. But what Norman found most troubling and surprising was young Russians’ apathy about simple HIV/AIDS prevention practices.

Norman and his colleagues spent several weeks working for Population Services International, as part of a USAID-funded program called the U.S.-Russia Volunteer Initiative. They went to the places that often serve as ground zero for HIV transmission among young Russians: the noisy, smoky, alcohol-infused nightclubs of Samara, a metropolitan area in southeastern Russia with a population of three million.

There, as Norman handed out condoms and prevention information, he learned the damage the prospect of a bleak future can do to young lives: it causes them to be reckless and unconcerned about protecting themselves from a deadly disease. Drug use, highly associated with the 4

University of Minnesota School of Public Health

incidence of HIV, is also a major problem Norman encountered.

Preventing the use of heroin, marijuana, and ecstasy, became a cornerstone of Norman’s health promotion efforts.

“I felt like the information I had was not only potentially life-saving, but also a ticket out of a hard life,” says Norman. “Their general lack of interest was an important, though difficult, lesson.”

Norman returned to the SPH to complete the remaining coursework for his M.P.H. Now, armed with a degree and educated about the realities of frontline public health work, he looks forward to returning to the Euroasia region to continue working in health promotion and epidemiology.

“Russia’s future is truly on a precipice at the moment, and the HIV/AIDS problem is adding a huge weight to their burdens,” says Norman. (continued from page 3) the disease. He and his colleagues have conducted the two largest HIV treatment trials done to date. Researchers are following more than 10,000 people in 33 countries in randomized studies designed and coordinated by CCBR staff.

Antiretroviral therapies for HIV/AIDS are costly and complicated—huge barriers for those seeking treatment in the developing world where the disease has reached epidemic levels. Neaton’s team is studying antiretroviral drug-sparing strategies and novel treatments to improve the health of those living with HIV/AIDS. Findings from several completed trials have already made a large impact on HIV care.

Ongoing trials—known by acronyms like SMART, ESPRIT, SILCAAT, and the latest, STALWART—also aim to curb the toxicity of the drugs and potential resistance to treatment.

From the foundation of these trials and the international partnerships that launched them, Neaton hopes to build on a global research strategy to treat HIV/AIDS. He recently submitted a proposal to the National Institutes of Health to establish a global collaborative network to conduct research at some 400 sites in 37 countries.

Pandemic Influenza In the past 30 years, Michael Osterholm’s public health work has dealt with some grim subjects—the emergence of HIV/AIDS, SARS, bioterrorism, 9/11. These though, he says, pale in comparison to a potential outbreak of influenza.

“There is nothing in my career that has disturbed me more than the issue of pandemic influenza,” he says. “It’s not a matter of if it is going to happen but when.”

Osterholm has been repeating that mantra during countless print and television appearances, including CNN, Oprah, and Nightline. He’s been telling it to high-ranking federal officials and business leaders. He’s written about it in influential journals like Nature, the New England Journal of Medicine, and Foreign Affairs. His efforts all center on one mission: to ramp up our preparedness. Despite the flurry of media coverage, government discussions, and rise in public awareness, he believes we remain sorely unprepared for what’s to come.

Central to Osterholm’s call for pandemic planning is a “just-in-time” economy that has left us with no surge capacity of the supplies—surgical gloves, IV bags, ventilators— needed to control this infectious and deadly disease. He also points out that the raw materials for 80 percent of U.S. pharmaceutical products come from other countries. If international borders are closed in an attempt to manage the pandemic, drug supplies will be severely limited.

Osterholm has called for government at every level to create an operational blueprint for the best way to get through one to two years of the pandemic, including a plan for staffing hospitals and vaccinating health care workers. “I think the U.S. has made some gains in overall preparedness. But with our complicated supply-chain issues, we have a long way to (continued on next page)

Businesses Must Prepare for Flu Pandemic CIDRAP partnered with the U.S. Chamber of Commerce to host the first-of-its kind national summit to prepare businesses for a flu pandemic. More than 300 people representing 200 companies, 38 states, and a combined annual revenue of $3 trillion attended the two-day summit. Speakers included Ted Koppel, Tommy Thompson, and U.S. Secretary of Health and Human Services Michael Leavitt.

An informal electronic poll of attendees underscored the need to plan; only 18 percent of those businesses said their companies have a response plan for a global pandemic.

“Anything we say before a pandemic sounds alarmist.

Anything we say afterward is inadequate,” says Leavitt. “The reality is [a pandemic] will happen at some point in time.”

Discussions focused on how to deal with a “just-in-time” economy that would mean no surge capacity of the critical supplies needed in a pandemic like medicine and masks.

Other potential problems include the breakdown of supply chains, collapse of Internet servers, and worker absentee rates as high as 30 percent.

CIDRAP developed take-away materials, including a 10point checklist for business continuity planning. Attendees met in sector-specific breakout sessions to begin designing plans based on their unique needs.

“Hope and despair are not strategies. And we can’t sit here and say ‘woe is me.’ Comprehensive and serious planning is not optional,” says CIDRAP director Michael Osterholm.

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Photo: Tim Rummelhoff

Pandemics, like hurricanes or earthquakes, are inevitable forces of nature. Ten influenza pandemics have circled the world in the past 300 years, and three in the past century.

The most devastating hit in 1918, infecting about a third of the world’s population and killing an estimated 50 to 100 million. It’s very possible that the next culprit for the next pandemic will be H5N1, the avian flu virus that since 2003 has killed more than 100 people worldwide, with most of those transmissions going from bird to human.

Health experts have warned that the virus could mutate into a form easily transmitted among people, creating a strain capable of killing millions. Most frightening: while the 1918 virus killed just 2 percent of its victims, H5N1 has killed more than half of the people it has infected.

Michael Leavitt

FEATURE STORY (continued from page 5) go,” says Osterholm. “We need detailed plans at every societal level, in private and public sectors. General statements of action will be meaningless in the face of a pandemic.”

When news of avian influenza first started making headlines, virtually all of the coverage focused on how Asia would have to deal with a potential outbreak. But Marguerite Pappaioanou, an SPH professor with expertise in emerging zoonotic infectious diseases, knew the virus could very easily spread to other parts of the world. And she knew something had to be done about it.

Pappaioanou, with co-investigators Sagar Goyal in the College of Veterinary Medicine, and Bill Stauffer in the School of Medicine, has received funding from the U.S. Agency for International Development to establish a laboratory-based influenza surveillance program in Tanzania. The country’s massive population of migratory birds and borders with several other sub-Saharan countries make it a target for a potential outbreak. University of Minnesota investigators will assist Tanzania’s Animal Disease Research Institute (ADRI) in the Ministry of Livestock Development to establish a capacity to test for influenza viruses. Laboratory-based surveillance will begin in a sentinel hospital-based system, as well as in Tanzania’s backyard poultry, swine, and wild birds. In addition to early detection efforts aimed at the H5N1 strain, yearly flu viruses will also be monitored. Right now, there is little to no information on influenza’s impact on human and animal health in sub-Saharan Africa. “People in Africa coming to a clinic with a fever and cough frequently are presumptively diagnosed with malaria or pneumonia, when it could be influenza,” says Pappaioanou.

Over the next year, Pappaioanou and colleagues will move beyond Tanzanian borders to build capacity for laboratorybased influenza surveillance in East Africa. She’s working to strengthen the relationship between the ADRI laboratory in Tanzania and the International Emerging Infections Program with the Kenyan Medical Research Institute and CDC in Nairobi, Kenya. With recent news of the first bird flu cases hitting Africa, Pappaioanou and colleagues are striving to have their work give Tanzania a “head start in early detection and response.”

The Human-Animal Connection It only takes a quick glance at today’s emerging infectious diseases to realize that most exist in the interface of 6

University of Minnesota School of Public Health

human and animal populations. For SPH adjunct professor Will Hueston that fact means educators must train a new type of public health professional. To that end, he directs the School’s dual program in veterinary medicine and public health (D.V.M./M.P.H). “These emerging diseases are the norm, not the exception,” he says. “We need a workforce that will be prepared, not surprised, when a diseases hits.”

Hueston, who directs the Center for Animal Health and Food Safety at the College of Veterinary Medicine, is also committed to educating those currently in the field. Every month he convenes a group of communicators from state agencies to talk about animal and human health issues.

The goal is to share information and make sure public messages about emerging diseases are clear and consistent across disciplines and fields.

As a professor in the SPH and Department of Veterinary and Biomedical Sciences, Randall Singer’s research focuses on infectious diseases in animals and humans. For the past three years, he has led an ecological study in southern Chile to determine how environmental factors are affecting the water quality of a system of rivers. His team is looking at how wastewater treatment plants, population density, runoff from the land, and hospital waste may be contributing to antibiotic resistance in the people who live there. “We’re finding that human wastewater treatment and hospital effluent are the biggest factors so far,” he says.

“Organisms we’ve found downstream resemble most closely what’s coming out of treatment plants and hospitals.”

Completing the environmental circle of “cause-and-affect”, the study is also looking at rates of E. coli and other waterborne and foodborne illnesses reported by patients in the hospitals. “Are these infections more resistant because of the environment,” asks Singer. “And how do patterns of resistance differ throughout the region?”

Singer’s team—which has included five SPH students who have each spent months in Chile analyzing environmental samples—is working closely with the Chilean health department and veterinary school. The aim is to offer guidance on how to manage the environment to improve public health.

Singer believes the lessons learned should be seen through a global lens—both because environmental challenges to water safety are applicable to other countries, and counties around the world like ours import Chilean seafood and produce.

‘The implications certainly are global,” he says. “There’s no such thing as an isolated environment.”

BIOSTATISTICS

There’s a Method to the Madness

Looking for the Genetic Link SPH researchers are speeding up the effort to find new asthma treatments. Assistant professor of biostatistics, Cavan Reilly, is examining data in search of a genetic link to the respiratory disease. The initial findings look promising.

“We were able to track down a gene that shows strong evidence for being associated with asthma,” says Reilly.

The discovery involved a dusty data set and an innovative approach. More than 15 years ago, researchers gathered information from 27 families that had at least two members with asthma. They collected DNA samples and measured more than 80 variables relating to health history and demographic information. Using the usual statistical techniques, other researchers found no correlation between specific genes and traits or behaviors within families. About three years ago, Reilly began analyzing the data using methodology he developed. “It is based on this idea that the genetic causes of asthma differed across the families,” he says.

Reilly’s approach is novel and apparently effective. His underlying mission is not unique, and the condition is not uncommon. Asthma is a widespread public health problem.

According to the Centers for Disease Control, 20 million Americans suffer from the condition. Environmental factors can trigger an attack. A lot of studies are trying to find the genes that make a person susceptible to the disease. “We are finding them. That’s the starting point. But there are probably dozens involved,” says Reilly. “If we can figure out the genetic basis for this disease, we can eventually find better treatments and improve a lot of lives.”

Normally SPH Biostatistics Professor Brad Carlin is deep into his work analyzing county-level breast cancer rates or trying to determine Medicare hospice service boundary areas.

But, he says, “Even statisticians have a guilty pleasure.”

His is the annual March Madness office pool.

March Madness is the 63-game tournament that concludes the men’s college basketball season. Only the Super Bowl tops this tournament as the most wagered event in the U.S. There’s a recognizable hum in offices every March as people scramble to predict the winners of the tournament.

This feat is nearly impossible says Carlin, since the event can result in roughly 9.2 quintillion possible outcomes.

But that doesn’t stop these enthusiasts from trying. And while normally Carlin is cited as an oft-published author of articles in scholarly journals, at this time of year, media outlets from the New York Times to MSNBC call him for basketball picking strategies.

The object of these pools is to predict winners of as many games as possible, with points awarded for each correct pick.

Some pools also award bonus points for other actions, such as correctly picking the upsets. With all these variables, how do players strategize?

“It was a good year to be ‘contrarian,’” says Carlin about this year’s tournament, in which the University of Florida Gators defeated the UCLA Bruins in the final. Players using this strategy avoid the most heavily favored teams (this year, Duke and Connecticut) and instead build their picks around the next tier of solid-but-not-so-great teams.

By avoiding the best teams, your expected point total is slightly lower. But if you guess correctly, you are likely to share the winnings with fewer opponents, thus increasing your expected payoff, he says.

Carlin co-authored the paper “How to Play Office Pools If You Must” with David Breiter, a biostatistics M.S. student at the time, and he recently finished another paper on the contrarian approach with Jarad Niemi, a 2005 biostatistics M.S. graduate. Applying some basic statistical concepts to the tournament is “a fun way to get some students a little more involved,” though he is quick to add that these students tend to be men. “I try not to overuse sports examples in class, since many students probably feel they hear more than enough sports analogies already,” Carlin says. “But it can help students who are already thinking about these problems learn many basic concepts in statistics and probability.”

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EPIDEMIOLOGY AND COMMUNITY HEALTH

Online Course Gives Campuses a Tool to Combat Drinking

SPH Professor Pushes for Produce Promotion In the January 28 issue of The Lancet, SPH assistant professor Lyn Steffen offered insight into current knowledge of fruit and vegetable intake. She urges partnerships to be formed between academia, state and local government, industry, and media to promote healthy food choices.

Since the creation of the 5-A-Day for Better Health program in 1991, the percentage of U.S. adults eating five or more daily servings of produce has only risen from 19 percent to 23 percent.

Unlike the whole grain industry, there is little money available in the fruit and vegetable coalition to support healthful eating campaigns. “And that’s a problem,” she says.

“Eating fruit and vegetables is healthful,” she says. “For a 2,000 calorie diet, a person should eat 4-5 servings of vegetables and 4-5 servings of fruit each day.”

According to her research, it is likely that the combination of nutrients and other food components in produce provide greater health benefits than the individual nutrient alone.

These foods are rich in vitamin C, folate, potassium, dietary fiber, and many other beneficial substances. “Low intake of fruit and vegetables is a major modifiable risk factor contributing to high blood pressure and stroke; stroke ranking third in the U.S. for mortality,” says Steffen.

She says because food habits develop in childhood, we as a society must provide the structure and means for children to develop healthy eating habits that they can sustain into adulthood.

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University of Minnesota School of Public Health

There’s quite a buzz about this course – no pun intended.

As part of a comprehensive effort to combat unsafe drinking, Minnesota State University – Moorhead (MSUM) recently announced they will be the first MNSCU campus in the state requiring incoming freshmen to take a course on alcohol.

Alcohol and College Life is a one-credit online course developed by James Rothenberger, Morse Alumni Distinguished Teaching Instructor of Public Health, and Tayne DeNeui, a University of Minnesota graduate.

Rothenberger says the goal of the course is bigger than just teaching about alcohol. It’s designed to give new students insight into the rewards and pressures of freshman year, particularly around the subjects of socialization, new friends, parties, and drinking.

According to Rothenberger, “We have three goals. The first is to reinforce those students who do not drink, offering options for dealing with a friend that shouldn’t drive or a roommate who comes home drunk. The second is to teach skills that minimize problems for those students who do drink; and the third is to expose the many myths students have about alcohol. For example, many students feel that it is good to pass out while drinking because the body no longer absorbs alcohol.”

While no single course will change the alcohol-related death rate, a course combined with other prevention efforts should slowly change the drinking culture of a college campus. Experts estimate that there are 1,700 alcoholrelated college student deaths per year.

The University selected MSUM to be the pilot for the four-year MNSCU campuses in the state. Since the course was developed in the fall of 2002, nearly 2,500 students have voluntarily registered for the course at the University’s Twin Cities, Crookston, and Duluth campuses, where it is not mandatory.

“It’s an incredibly good project,” says Susanne Williams, who chairs the MSUM President’s Task Force on Student Alcohol Misuse. “It’s not preachy or dull. It’s realistic, practical and fun, and includes text, video and audio lessons that students can do on their computers at their own pace or even download on their MP3 players.”

EPIDEMIOLOGY AND COMMUNITY HEALTH

Magnesium-Rich Diet Might Curb Colon Cancer Risk

Study Finds Unexpected Smoking Rates in Indian Youth

Colorectal cancer is the second leading cause of cancerrelated deaths in the United States. New evidence suggests that a diet high in magnesium may reduce the occurrence of colon cancer in women, according to research led by School of Public Health epidemiology professor Aaron Folsom.

“Foods high in magnesium, such as vegetables, grains, and fruit, are already considered useful for reducing colon cancer risk because of their high fiber and antioxidant content,” says Folsom. However, national health surveys report that many adults do not meet the Recommended Dietary Allowance (RDA) for this mineral.

It is not clear why magnesium may be beneficial for fighting colon cancer, but researchers suggest it contributes to reductions in insulin resistance, oxidative stress and cell proliferation.

As part of the large Iowa Women’s Health Study, Folsom and SPH colleagues assessed the women’s magnesium intake in 1986 and cancer incidence over a 17-year period. The American Journal of Epidemiology reported the inverse association they observed.

“If other observational studies reveal the same results, a clinical trial would be necessary to determine if it is magnesium specifically, and not other aspects of the diet, that offers the benefit,” says Folsom.

As the U.S. makes strides in battling the tobacco epidemic, it appears that the new front in tobacco prevention is shifting to developing countries such as India. In a new study of more than 11,000 adolescents in Delhi and Chennai, SPH professor Cheryl Perry, assistant professor Melissa Stigler, and colleagues from India reached an unexpected and alarming conclusion. Sixth-grade students were, overall, two to four times more likely to use tobacco than eighth-grade students.

Typically, increased age has been tied to greater tobacco use among youth. But Perry’s findings show the opposite.

Sixth graders in urban India were consistently using tobacco at significant rates -- in each city, in government schools, for both sexes, and among psychosocial factors, such as intentions to use in the future and susceptibility to use.

“Changes in the prevalence of adolescent tobacco use are important to monitor since increased use by young people might be a precursor to increased rates in the population,” says Perry in the February 18, 2006 issue of The Lancet.

This could signal a wave of increased tobacco use in India, says Perry, and it warrants confirmation and early intervention.

Although India is a leader in global tobacco control, the tobacco industry has also developed messages to counteract the effects of policy changes there. With greater exposure to media from other countries and images on the Internet, Indian youth may be hit with more pro-tobacco messages and images.

“Since early use of tobacco predicts greater likelihood of addiction, longer lifetime use, and higher rates of lung cancer, these findings are important to public health,” says Perry.

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ENVIRONMENTAL HEALTH SCIENCES

Smog hangs over Santiago, Chile, South America

SPH Professor Receives Opportunity to Research in Chile With every breath of air, we take in more than life-giving oxygen. At the same time, we breathe in particles that at high levels can negatively impact health. Researchers like SPH professor John Adgate are striving to understand the relationship between air pollution and illness. Adgate was awarded a Fulbright Scholar Program grant to assist colleagues in Santiago, Chile as they explore the relation between air pollution exposure and health outcomes.

“It’s a compelling public health issue because air pollution levels are quite high in Santiago,” says Adgate, who will relocate there in August.

He will develop air pollution exposure profiles for specific locations and socioeconomic groups in Santiago. Adgate would also like to spend time researching pesticide use to address concerns in Chile and the U.S. about chemicals that end up in food.

Additionally, this grant will enable Adgate to teach two graduate level courses during the time he’s there. As chair of the MPH program in environmental health, his knowledge of curriculum development will also benefit the newly created Master’s in Epidemiology at the Pontificia Universidad Catolica de Chile.

The U.S. State Department sponsors the Fulbright Program, which sends 800 U.S. faculty and professionals abroad each year.

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University of Minnesota School of Public Health

Lisa Brosseau’s Efforts Applauded with Alice Hamilton Award “It doesn’t surprise me that Lisa Brosseau has been honored with the Alice Hamilton Award,” says Ian Greaves, environmental health sciences professor. “She has the characteristics of Hamilton -Lisa Brosseau she is courageous, forthright and a prominent woman in the field of industrial hygiene.”

The American Industrial Hygiene Association (AIHA) honored SPH professor Lisa Brosseau with the 2005 Alice Hamilton Award. This award recognizes outstanding women for their achievements and contributions to the field of occupational hygiene.

Brosseau has been an active member of the American Conference of Governmental Industrial Hygienists (ACGIH) for nearly 13 years, during which she marked two important “firsts.” For the past six years, she served as the first woman to chair the Threshold Limit Values for Chemical Substances Committee. Established in 1941, this group investigates and annually recommends occupational exposure guidelines for chemical substances, which ACGIH publishes worldwide. Today’s list includes information on 642 chemical substances. Additionally, Brosseau is one of the first industrial hygienists to chair this committee, which is also made up of toxicologists, physicians, and epidemiologists.

Brosseau says she enjoys helping people through science.

Her dedication to occupational health resembles Hamilton, who was a crusader for improving workplace safety in the first half of the 20th century. Occupational medicine was not a specialty at that time, but Hamilton had a strong social agenda. She became the first woman faculty member at Harvard and is considered the founder of occupational medicine in the U.S. Hamilton made connections between poor working conditions and illness, and she led the cause to establish regulations to protect employee health, says Brosseau. “So she’s always been my hero.”

HEALTH POLICY AND MANAGEMENT

Riley Named Associate Dean

An SPH survey finds that more Minnesota children lack health insurance.

SPH Survey: More than 7 Percent of Minnesotans Lack Health Insurance A School of Public Health survey finds that a higher percentage of Minnesotans lack health insurance--about 7.4 percent in 2004, up from the 5.7 percent reported in 2001. This rise comes after years of declining and stable state insurance rates.

The SPH’s State Health Access Data Assistance Center (SHADAC) and the Minnesota Department of Health recently released the information as part of a collaborative report. Roughly 375,000 Minnesotans were uninsured in 2004, an increase of 94,000 over the 2001 rates.

The growth of uninsured Minnesotans is driven by a drop in the number of people covered by employer-based insurance.

The increase is also due to a shift in Minnesota’s income distribution and a growing Latino population that is hit particularly hard by the changes in coverage.

Low-income families and children saw significant decreases in coverage. Uninsurance rates among family incomes below the poverty level grew from 14 percent in 2001 to just over 20 percent in 2004. Children under the age of 5 saw an increase in the rate of uninsurance, from 3.9 percent in 2001 to almost 7 percent in 2004.

“Despite having one of the nation’s lowest uninsurance rates, the rates are climbing for the first time in years and big gaps exist in who is covered,” says Kathleen Thiede Call, SPH associate professor and one of the lead researchers on the survey. “Subpopulations based on income, race, ethnicity and age show an alarming and growing disparity in access to health insurance coverage.”

The full report is available at www.sph.umn.edu/shadac.

Associate professor Bill Riley was named SPH Associate Dean for Student Affairs earlier this spring, following professor Mary Story’s resignation of that position to devote more time to her extensive research portfolio.

“Bill brings to this position strong dedication and commitment to our students, excellent Bill Riley organizational and management skills, and a wealth of experience in the public and private sectors,” commented SPH Dean John Finnegan on the occasion of Riley’s appointment.

Riley received his Ph.D. in hospital and healthcare administration from the SPH and went on to serve as president of St. Paul, Minn.-based Aspen Medical Group, and president and CEO of Pacific Medical Care in Seattle. He returned to the SPH as a faculty member in 2001.

Division Receives Multi-Year MRAD Contract The Centers for Medicare and Medicaid Services (CMS) has awarded a Multiple Research and Demonstrations (MRAD) contract to the Division of Health Policy and Management.

CMS, a unit within the U.S. Department of Health and Human Services, will award 10 such multi-year contracts nationally. The MRAD brings with it the authority to spend up to $75 million for research and demonstrations to improve the Medicare and Medicaid programs.

SPH professor Bryan Dowd will be the primary investigator for Minnesota. The University of Minnesota-MRAD consortium consists of Emory University, Simmons College, the University of Maryland at Baltimore, Boston University, the Boston Veteran’s Administration, and numerous other research and consulting firms nationwide.

“This is a very significant award that places Minnesota among the top health policy centers. It is especially important as we embark on new Medicare initiatives such as the drug benefit that began earlier this year,” says SPH professor Roger Feldman, a national expert on health insurance.

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PUBLIC HEALTH EDUCATION AND OUTREACH

Event Highlights Genomics and Public Health Tie Simone French

Photo: Tim Rummelhoff

Minneapolis Communities Face Lack of Healthy Food Options University researchers and community leaders discussed how to improve the healthy food choices in low-income Minneapolis neighborhoods at a recent symposium drawing more than a hundred people.

SPH professor Simone French outlined some of the barriers communities of color and low-income families face when accessing healthy foods. Research has shown that the ratio of supermarkets in predominantly white neighborhoods is around one to 4,000 residents, while in African-American neighborhoods it is one supermarket to 23,000 residents.

Added to the problem is that healthy foods are often priced higher in low-income neighborhoods. Excess weight gain has been found among children who live in neighborhoods where fruit and vegetable prices are higher.

Ephraim Leibtag, an economist for the U.S. Department of Agriculture, noted the “Wal-Mart” effect on food choices.

Since 1998, grocery purchases at non-traditional food retailers have doubled from 20 to 40 percent. Leibtag said this means lower prices—about 20 percent lower—but only for those consumers who have a choice of where to shop.

Local ownership is part of the solution according to Angela Dawson, project director for the Northside Food Project in Minneapolis. Her own experiences growing up in a Minneapolis neighborhood with little access to healthy foods prompted her to get involved. She’s currently working with the city to establish a co-op that would serve 12 neighborhoods in need.

Dawson’s colleague Bernadette Longo summed up the issue well. “Access to healthy foods is a right we all take for granted,” she said. “But for the 68,000 people in North Minneapolis that isn’t so.”

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University of Minnesota School of Public Health

The title of the most recent SPH Roundtable -- “From the Human Genome Through Health Disparities to Public Health” -- may have seemed curiously broad, but those who attended the event were treated to an eye-opening presentation on the issues from Georgia Dunston, the founding director of the National Human Genome Center at Howard University.

Dunston, who has been called a passionate researcher-advocate, is internationally known for her study of the implications of the Human Genome Project on minority health issues, and in the larger context of all populations.

“We have begun a knowledge revolution with the sequencing of the human genome, the impact of which will move medicine to public health,” says Dunston.

While the new knowledge opens possibilities such as data mining for specific disease-related genomic activity, Dunston worries that genomics has the potential for being imposed on certain community groups. She argues that community-based participatory research must be the model for achieving the goals of Healthy People 2010.

This notion was echoed by Toby Citrin, of the University of Michigan School of Public Health: “Communities need to be at the table as research is designed, implemented, and reported.” Citrin was among a panel of SPH faculty members and other experts from the field of health disparities who grappled with these and other issues following Dunston’s remarks. SPH professor William Toscano argues that the teaching of genomics must be integrated into all the health disciplines, and it is particularly important to demonstrate the link between science and public health practice.

To hear audio of Dunston’s presentation, visit www.sph.umn.edu and click on “School of Public Health Podcasts” in the upper left-hand corner of the page.

The Roundtable was co-sponsored by the SPH’s Midwest Center for Life-Long-Learning and the Minnesota Department of Health Genomics Project.

STUDENT NEWS

Vice Admiral Richard H. Carmona

Surgeon General to Graduates: The World Needs You Photo: Bill Alkofer

Vice Admiral Richard Carmona, the 17th Surgeon General of the United States, says we as a country have mastered acute care, but haven’t begun to embrace prevention, wellness and public health in a way that will allow us to deal with the disease and economic burden facing us.

Delivering the keynote address before a near-capacity crowd at the 2006 School of Public Health Commencement Ceremony at the Ted Mann Concert Hall, Carmona said, “The current path we’re on is an unsustainable one.

Prevention is the only answer.” He said he began to consider a career in public health because as a trauma surgeon, nearly every case he saw was in some way preventable.

Carmona told the 162 graduates that the currency needed for changing the world is health diplomacy. “The world needs you today more than ever,” Carmona told the graduates.

“You have the currency to change the world. You can export health for peace and stability.”

Carmona traveled an unlikely route to the role of Surgeon General. He grew up in Harlem, was homeless for parts of his childhood, dropped out of high school, and “ran the streets” as a teenager. While he went on to a decorated military career, graduated at the top of his class in medical school and later earned a master’s in public health, Carmona says his childhood experiences shaped his role as Surgeon General more than any academic credential.

Later, Carmona spoke about the importance of viewing health from a worldwide perspective. “Global health is public health,” he said, offering a preview of a soon-to-bereleased Surgeon General’s report on global health.

Listen to Surgeon General Carmona’s commencement address at www.sph.umn.edu; click on “School of Public Health Podcasts.”

Kirby Puckett’s Generosity Lives on at the SPH The late baseball great Kirby Puckett not only left his mark on the pages of sports history, he made an unforgettable impression on two SPH students.

Susan Nwoke and Sara Hollie are recipients of a scholarship established at the University of Minnesota by the Hall of Famer. The Puckett Scholars Program provides educational opportunity to minority students, offering freshmen $4,000 a year for up to five years and an annual merit award of up to $2,000 for maintaining a high GPA. After earning their bachelor’s degrees with financial assistance from the former Minnesota Twin, both women pursued MPH degrees at the SPH. “As an undergraduate, the scholarship alleviated my financial concerns so I could focus on my studies,” says Nwoke. “It put graduate school within reach.”

Puckett’s gift not only provoked deep gratitude, his influence helped the women succeed. “The scholarship gave me the confidence to be where I am today,” says Hollie. She graduated from the SPH in May. “He pushed us to be better people both in school and in our communities.”

The Puckett Scholars Program has helped 45 students attend the University of Minnesota. The baseball legend’s gift will continue to grant opportunity to promising young students.

“Kirby always said you can fulfill your dreams if you work hard enough and believe in yourself. I live by this everyday,” says Hollie.

Kirby Puckett died at age 45 in March after suffering a massive stroke.

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SCHOOL NEWS

Delta Omega Inductees Are Recognized Earlier this spring, a group of SPH students, faculty members and alumni were inducted into the Pi Chapter of Delta Omega, the honorary society for graduate studies in public health.

Established in 1924, Delta Omega membership reflects the dedication to quality in the field of public health and to the protection and advancement of the health of all people.

Election to Delta Omega is based on outstanding performance – scholarship in students, teaching and research in faculty members, and community service in alumni.

Faculty Members

The newest members of the Pi Chapter of Delta Omega are: Bernard Harlow, Ph.D., M.P.H. Na Li, Ph.D. Alan Lifson, M.D., M.P.H. William Riley, Ph.D. Matt Simcik, Ph.D.

Alumni

University of Minnesota Marks NPHW with Film Festival The University of Minnesota School of Public Health National Public Health Week (NPHW) Film Festival drew a highly supportive audience of more than 325 people. The festival reached a broad audience this year – from high school, undergraduate and graduate students across the Twin Cities metro area, to practicing professionals and interested community members. The two highest attended evenings were the Infectious Diseases films, with 75 attendees, and Sex Ed. films, drawing more than 100 filmgoers.

More than 20 community partner co-sponsor organizations helped promote and staff the week-long event.

Compliments of the festival’s co-sponsors, one attendee won a $50 gift card to the University of Minnesota’s Bookstores. Another won a free one-year membership to the Minnesota Public Health Association.

More information about the National Public Health Week Film Festival at the University of Minnesota School of Public Health, visit: www.sph.umn.edu/filmfestival.

Thanks to all film festival volunteers for another successful annual event.

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University of Minnesota School of Public Health

Gail Gentling, M.P.H., Community Health Education Michelle Hanson, M.P.H., Epidemiology Carolyn Harley, Ph.D., Health Services Research, Policy and Administration Scott Harpin, M.S., M.P.H., Maternal and Child Health David Hillman, M.S., Biostatistics Robert Skoglund, M.S., Ph.D., Environmental Health Lori Roth Yousey, M.P.H., Public Health Nutrition

Students

Amanda Blasiak, M.S., Environmental Health Tricia Carmody, M.S., Environmental Health Heather Carrie Fragodt Case, D.V.M., M.P.H., Public Health Practice Michelle Flatt, M.P.H., Public Health Nutrition Shannon Flood, Ph.D., Health Services Research, Policy and Administration Ramona Johnson, M.S., Environmental Health Karen Kaphingst, M.P.H., Community Health Education Richard Lussky, M.D., M.P.H., Maternal and Child Health Sean Phelan, M.P.H., Epidemiology Diana Plumer, M.P.H., Public Health Administration and Policy Shweta Sharma, M.S., Biostatistics Guanghua Xiao, M.S., Ph.D., Biostatistics

SPH Joins National Conversation on Health Care

Dr. N.K. Ganguly with SPH Dean John Finnegan next to a portrait of Gaylord Anderson.

Lecture Offered Insights Into India Photos: Tim Rummelhoff

The Gaylord Anderson Lecture, named for the School of Public Health’s founding dean, is an opportunity to hear from nationally and internationally renowned health leaders.

The 2006 Gaylord Anderson Lecture was no exception.

This year’s speaker was Dr. N.K. Ganguly, director general of the Indian Council of Medical Research (ICMR), a New Delhi-based organization that is approximately equivalent to the U.S. National Institutes of Health (NIH).

Dr. Ganguly gave a broad overview of India’s health care challenges and ways that some of them are being addressed.

India has a lower life expectancy and a much higher disease burden that many other countries in the world. Despite the fact that the Indian economy is booming in many sectors, he attributed the country’s relatively poor health status to unequal wealth distribution: “Social class is a determinant of health and disease,” he said. He offered the example of southern Indian states’ well-developed infrastructure and higher rates of education as contributing factors to better health status of residents there.

He also commented about the lack of a coordinated public health emphasis in India and that country’s paltry spending on health, which is 8 percent of GDP compared to 16 percent in the U.S. “Despite the immense challenges India is facing in terms of public health, I am amazed and impressed at the creativity health officials at all levels are using to address them,” said John R. Finnegan, SPH Dean.

Dr. Ganguly spent a great deal of his time meeting individually with numerous SPH and Medical School faculty members who are conducting research in India.

Listen to Dr. Ganguly’s lecture at www.sph.umn.edu and click on “School of Public Health Podcasts” in the upper left-hand corner. His PowerPoint slide presentation is available there as well.

Fueled by frustration about the faults in the U.S. health care system, an overflow crowd participated recently in a national conversation on health care. The University of Minnesota was one of 22 university-based sites around the country to be linked via satellite to the University of Michigan, where the lead discussion was moderated by CNN reporter Tony Collings.

Participants deliberated four questions related to how health benefits should be delivered and financed, and what Americans would be willing to sacrifice in order to ensure affordable, high quality coverage for all.

Among the attendees in Minnesota were students in nursing, medicine, pharmacy and public health, a small business owner, a health actuary, a pharmacist, professors, an epilepsy patient, and a self-described health freedom advocate. Attendees played an active role in the discussion.

Minnesota panelists included SPH professors Roger Feldman, Susan Foote and Ira Moscovice, and the head of the University’s department of family medicine and community health, Macaran Baird. During the deliberations, comments were e-mailed from the 22 sites to the University of Michigan.

Then, when the cameras went back on in Michigan after each of the four questions, the panelists there grappled with issues put forth from locations around the country.

An attendee comments on the state of the U.S. health care system.

“The event was truly a national conversation,” says Judy Garrard, SPH senior associate dean, who served as moderator for the Minnesota event. “Many issues were discussed, and thanks to technology, we were able to interact with others across the country to begin crafting solutions.”

The Minnesota crowd seemed to favor a single-payer approach and agreed that Minnesota may be in a position to implement it given the overall good health of the population and low rates of uninsured.

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ALUMNI NEWS Mona Bormet (M.P.H. ‘05) is a health policy fellow in the office of Congresswoman Lois Capps (DCA) at the Asian Pacific American Institute for Congressional Studies (APAICS).

Programs. Suarez-Torres directs Minnesota Studies in International Development in Ecuador. He was nominated for his commitment to social justice work in Ecuadorian communities.

Perry A. Witkin (M.H.A. ‘81) has been elected to the Board of Directors of The American Refugee Committee International.

Networking Has Never Been Easier

Lt. Colonel Edward P. Horvath, above, (M.P.H. ‘73) was recently called to active duty serving the U.S. Army in Iraq. He is Deputy Commander and Chief of Clinical Services for the 344th Combat Support Hospital at Camp Bucca, located south of Basrah. During his current deployment, he has also been at Abu Ghraib prison hospital caring for both detainees and coalition forces. In his civilian life, Lt. Colonel Horvath is a staff physician in primary care at the Department of Veterans Affairs Medical Center in Cleveland, Ohio.

Pat Koppa (M.P.H. ‘79) has been active in the start-up of a new national non-profit organization known as the National Alliance for Thrombosis and Thrombophilia (NATT). The mission of NATT is to prevent venous blood clots, deep vein thrombosis (DVT) and pulmonary edema, and to ensure that Americans receive early diagnosis, optimal treatment and quality support. Visit www.nattinfo.org for more information.

Maureen F. Morrell (M.P.H. ‘76) co-authored the book “Parenting Across the Autism Spectrum: Unexpected Lessons We Have Learned.”

Rebecca Sanchez (M.P.H. ‘05) is a quality improvement specialist/dietitian for West Side Community Health Services.

She works between the East Side Family Clinic and La Clinica in St. Paul as the Diabetes Collaborative Team Leader.

Mary Sheehan (M.P.H. ‘84) has accepted the position as director of health and human services for Chisago County, Minn. For the past 22 years, she has worked at the Minnesota Department of Health.

Jose Suarez-Torres (Ph.D. ‘84) has been awarded the prestigious Distinguished Leadership Award for Internationals given by the University of Minnesota Office of International 16 16

University of Minnesota School of Public Health

Are you an SPH alum looking for a quick, easy way to network with School of Public Health students and other alumni? Now the information is at your fingertips - whenever you need it.

The online SPH Alumni Network helps you make connections and share your career experience with current and prospective students and other alumni. If you are relocating but aren’t familiar with the new city, log on to see if an alum lives there. Or if you want to assist students with career development, join the network.

Just follow two simple steps: 1.Go to www.sph.umn.edu/alumni/network/home.html and click the link to the Alumni Network Form. Type in your interests and you’ll be a new a resource for other alumni and students.

2.Use the Alumni Network Directory! Log in anytime to search for contacts around the world.

“The SPH Alumni Network is another important way we are hoping to build meaningful ties with our alumni,” says Michelle Lian-Anderson, associate director of alumni relations.

Join Us in Seattle at the Second American Congress of Epidemiology Friday, June 23, 7 p.m., Westin Seattle Hotel, Room Cascade 1C Take a break from the conference at the SPH Alumni and Friends Reception. Your host for this informal gathering will be Bernard Harlow, the new head for the Division of Epidemiology and Community Health. Sumptuous hors d’oeuvres and refreshments will be served. We hope to see you there!

Get Together - With SPH At the Fair!

Thursday, Aug. 24 Stop by the School of Public Health booth at the Minnesota State Fair. We’ll be in the U of M building on Dan Patch Avenue. Learn from interactive displays about infectious diseases, nutrition and environmental health.

Take a minute to tell us what the School means to you.

We’ll be recording thoughts of SPH alumni, and we’d love to hear from you.

PHILANTHROPY

Donors Frederick and Mary Rose Goetz with recipients of the Cecilia Goetz Memorial Scholarship in Public Health. From left to right are Elizabeth Scherman, Jose Suarez, and Azza Zarroug.

Photos: Eric Miller

2006 Scholarship Reception Honors Donors and Students The School of Public Health held its annual Scholarship Reception recently. The event honors student scholarship and award recipients for their achievements and thanks donors for their generosity. The school is fortunate to receive these gifts from friends, alumni, and past and present faculty members. Donors who attend the reception have an opportunity to meet the recipients of their scholarships.

Stories of accomplishment and challenge emanated from every table at the reception. One such table featured three recipients of the Cecilia Goetz Memorial Scholarship in Public Health, established in 1998 by Frederick and Mary Rose Goetz and awarded to students pursuing international public health, focusing on maternal and child health issues.

Students receiving this scholarship will be conducting international field experiences this summer in Damascus, Syria; Asamankese, Ghana; and Geneva, Switzerland, working directly with organizations such as the World Health Organization and SOS Children’s Villages.

Support for scholarships continues to grow, as SPH donors endowed six new scholarships during the last year, and all of the new endowed scholarships have their awards matched by University scholarship matching programs. Donor-endowed scholarships allow the school to attract and support top students in public health. For more information about endowed scholarship opportunities, please call Adam Buhr at (612)626-2391.

Devra and Lester Breslow visit with Kristin Nichol, Breslow Scholar 1988 - 1989. Dr. Nichol serves as chief of medicine for the Minneapolis Veterans Affairs Medical Center and is a professor of medicine at the University.

Lester Breslow Returns to the School of Public Health Since 1988, the School of Public Health has awarded 41 Lester Breslow Scholarships to public health students demonstrating excellence in health promotion and disease prevention. Recently, 12 past recipients gathered to show their appreciation and meet the donors who endowed the scholarship: Lester and Devra Breslow.

Lester Breslow, M.D., M.P.H., is a remarkable alumnus of the School of Public Health, with more than 65 years of accomplishments in the field of public health. He did pioneering work in chronic disease epidemiology and forged the initial link between health behaviors and quality of life.

After earning three degrees at the University and holding many roles in the field of public health, Dr. Breslow served as dean of the UCLA School of Public Health for eight years.

During the celebratory luncheon, the Breslow Scholars took turns describing their work in public health. Breslow commented that he was thrilled to see such a breadth of experience and was impressed by the excellence exhibited by these scholars, three of whom are current SPH faculty members. Former colleagues and friends also attended to honor Dr. Breslow’s distinguished career. The School of Public Health salutes Dr. Breslow’s accomplishments and the generosity that he and Devra have shown to the institution and its students.

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Get a free copy of “Milestones in Public Health” Milestones in Public Health, published by Pfizer’s U.S. Public Health Group and sourced in part from the CDC, is available to anyone with an interest in some of the most important public health achievements of the last century.

Books can be ordered at www.pfizerpublichealth.com.

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NOTES FROM THE FIELD

SPH Students Practice Public Health at Home and Abroad

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