Advances - Summer 2007

Advances Laurie Garrett on Global Health • page 13

SUMMER

2007

from the University of Minnesota School of Public Health

WRITING THE BOOK ON CLEAN WATER CANCER ON THE IRON RANGE ‘SHOULDER TAPPING’ FOR ILLEGAL BOOZE DISASTER IN FRANKLIN COUNTY

FROM THE DEAN Dear Friends,

Photo: Richard Anderson

Each summer, Advances allows us to tag along with our students engaged in public health fieldwork required for their degrees. This is an important student learning experience wherein they begin to apply and integrate their public health training with people’s real-world public health needs. And it has truly become a global experience for many of our students.

This year, students collected passport stamps in India, Mali, Tanzania, Vietnam, Kenya, Rwanda, Japan, and Switzerland. Their rich experiences are featured in our cover story that begins on page 2. We hope this will whet your appetite for more stories about students’ hands-on public health experiences, whether here at home or on the far side of the world.

One thing emerges from our students’ experiences: despite cultural and political differences, people around the world have much in common when it comes to public health. You can read about all of this in our students’ own words in their online journals, which can be found at www.sph.umn.edu.

As part of this year’s field experience issue, we invited students to submit photos for use with the story and on the magazine’s cover. The photos bring the words to life vividly. The cover photo comes from Amenah Babar. The M.P.H. student is in Mali, working with a team of researchers on clinical trials aimed at discovering a vaccine for malaria. This year, malaria will strike up to a half billion people. At least a million will die, most of them under age five, the vast majority living in Africa. The children pictured are from the village of Bancoumana, one of the vaccine trial sites. And they are the reason Amenah is in Africa this summer.

The message conveyed by these stories and photos is that public health is global, with all its challenges and implications. Our students know this, and that’s why they are seeking ever more opportunities for global health study. This is why philanthropic support for their work has become a pressing need of ours. They want to play a real part in changing the world—we shouldn’t let the price of a plane ticket stand in the way.

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

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

William Riley Associate Dean for Student Affairs

William Toscano Head, Division of Environmental Health Sciences

Diana Harvey Assistant Dean for External Affairs

Contributing Writer Nicole Endres Art Direction Todd Spichke Riverbrand Design

Contents Table of

Advances

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Feature: Notes from the Field

SPH students hit the road for their international field

SUMMER 2007

experiences. Find out how their hands-on work is helping to make the world a healthier place.

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Division News

Cancer’s earliest stages, computers curb drug errors, why kicking the habit is complicated, and more.

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12

School News

Famed journalist Laurie Garrett speaks at commencement, faculty awarded for career excellence, U renews partnership with University of Iceland, and more.

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Philanthropy

Family connections bring new scholarships for the school’s program in Community Health Education.

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Student News

Student leader speaks at commencement, and environmental health student analyzes air quality of a Minneapolis tunnel.

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Alumni News

Alumni board update, class notes, medical mission to Malawi, and more.

15 Correction: In the winter 2007 issue of Advances members of a research team featured on page 6 were listed incorrectly. The correct members are SPH faculty William Toscano and Bruce Alexander, research associates Sara Axtell and Kathy Koehler Raleigh, pediatrics assistant professor Anne Kelly, and Lea Foushee, co-founder of the North American Water Office.

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Once again, graduate education is going global at the University of Minnesota School of Public Health. It happens every summer when SPH students embark on international field experiences. Putting classroom smarts to use on real-world projects is key to the experience. But so is working in teams, with different cultures, and in unfamiliar settings.

This summer finds more than a dozen students on five continents. They’re grappling with pressing public health challenges like infectious disease, environmental pollutants, and health disparities. While the experience is s s u c exposing them to the daily workings y dis ere the nity. ing, wh r as a commu t e e m of global health, it’s also teaching the roup rk toge experience.

-help g o lf w e s o t a is or the students about themselves in ways ather f her field he idea omen g nd finance. T gs as part of w n ia d course could. They’re discovering hidden that no classroom In ha etin of healt ended the me issues t t strengths, enriched worldviews, expanded career options, Proue a Mandi and fresh ideas of what public health means to them. Here’s the latest news from some of our SPH students abroad.

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University of Minnesota School of Public Health

F E AT U R E S TO RY

Katie Gruner ca ptures a mother and child as they village of Getam line up at a clin ook, Tanzania. ic in the The clinic offers for children. Ba a monthly care bies are weighe program d and the inform growth chart. ation is noted on their

Asia Schelomo Marmor is working in Japan with the Nagasaki Association for Hibakusha’s Medical Care and the University of Nagasaki. He is conducting research on survivors of the World War II atomic bombs with the hope of caring for those who have been exposed to radiation in Japan and beyond. Marmor says the experience is showing him the most important aspect of an epidemiological study: the human element. “Meeting and interacting with survivors is teaching me to never let my research and study stand in the way of respecting human dignity,” says the public WEB EXTRA health administration and policy student. “Our research numbers represent people who suffered from the horrific tragedies of war.”

A

Get more online!

WEB EXTRA

SPH students are blogging from abroad.

Check out their travel tales, photos, and videos at ww.sph.umn.edu.

Air quality in Vietnam is the focus of Jooyeon Hwang’s work with the country’s National Institute of Agricultural Planning and Projection. Hwang chose the field experience because it fits with her area of study, and for the timeliness of the project. Since joining the World Trade Organization earlier this year, the Vietnamese government has been charged with ramping up environmental policies.

Currently, there are no governmental limits on emissions from Vietnam’s 20 million motorcycles. Hwang is collecting air samples in rural areas and in Hanoi and Ho Chi Minh City.

“An inspiring experience” is how Kaajal Singh refers to her time in Bangalore, India. She’s there with Ankur Sharma, a fellow student in the Master of Healthcare Administration program. The two are meeting with senior administrators of numerous hospitals and health care organizations. “We spent time understanding the pressures that health care organizations face in a developing country and how globalization is changing the face of health care in India,” says Singh. Those changes are evident in the telemedicine lab at Narayana Hrudayalaya Hospital. The lab partners with the Indian Space Agency to reach Indians in rural villages.

The hospital trains health care workers in the villages and provides them with telemedicine equipment, including electrocardiogram (ECG) machines. Hospital doctors are able to read the ECGs via the Web and determine the next steps for the rural patient. If a patient needs to be further evaluated, the hospital arranges for transportation to the hospital. continued on page 4

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FEATURE STORY

Neeta Shanbhag is in Delhi with the organization HRIDAYSHAN, where she’s charged with helping to mobilize students of 300 schools and 10 colleges with the primary aim of tobacco control. India has some of the world’s highest rates of tobacco use and some of the world’s youngest smokers.

Shanbhag is partnering with schools to form action groups centered on students, parents, teachers, and communities.

The project also sets policies for smoke-free schools and offers community-based strategies to enforce India’s national tobacco control act of 2003. HRIDAY-SHAN works in collaboration with the World Health Organization and the Indian Ministry of Health and Family Welfare.

Europe

bar of nah Ba e m A s ay less,” s is price y p p a h rt d’s hea s a chil e k a m “What in Mali. e her tim

continued from page 3

Mandi Proue’s field experience is solidifying her ideas about the type of job she wants to pursue after graduation, and it’s providing her with options of doing that work globally.

Proue is working with Action, Research, and Training for Health, an NGO in the Indian state of Rajasthan. The maternal and child health major is helping to improve the continuum of care of women and children from pre-conception, pregnancy, childbirth, and infancy. The rural area where she’s working in southern Rajasthan is characterized with low literacy and health care rates and high maternal mortality. “Seeing the huge challenges faced by the country very well could have turned me into a pessimist, where I found it hard to feel like any change was possible,” says Proue. “Yet, instead it has reiterated the importance of thinking optimistically, setting public health priorities and goals high, and doing your best to reach them, even if it takes time.”

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University of Minnesota School of Public Health

John Amuasi is in Geneva, Switzerland working with Drugs for Neglected Diseases initiative (DNDi), the first not-forprofit organization committed to fighting the most neglected diseases of the developing world. Before coming to the SPH, Amuasi witnessed the devastating effects of these diseases while working as a doctor in Ghana. This summer at DNDi, Amuasi prepared a paper on behalf of the executive director on one of the organization’s 22 projects. The paper is slated to be published in the journal Global Forum for Health Research. Amuasi has also conducted interviews with various partners in Geneva, Paris, and Rio de Janeiro via conference call, and synthesized the information for a manual on best practices in a public-private partnership.

“One important lesson I have learned is that regarding international health issues, things are not as simple as they initially appear, and strategic lobbying is an integral part of the system,” says Amuasi.

Africa The peaceful streets and green hills of Rwanda’s capital city Kigali make it difficult for Erin Galegher to imagine the genocide that began there 13 years ago. She’s learning how the country is working to address issues of torture and organized violence through her work at FACT-Rwanda.

Established in 1999, the NGO marks a partnership among human rights activists, lawyers, physicians, and medical students of the National University of Rwanda. FACT works to prevent violence and advocate for victims of torture. “My time in Rwanda has reminded me how humbling this part of the world can be,” says Galegher. “Traveling has always shown me what I am capable of, and it creates a state of clear-mindedness for me to think. I am not always happy, nor am I always sad. But I am always thinking.”

Memories of studying there as an undergraduate came alive as Katie Gruner stepped off the plane in the Tanzania. She returned to work with Minnesota International Health Volunteers (MIHV) on maternal and child health projects. The community health education major is in the northern town of Karatu, home to 4,000 people and the only paved road in the district. The maternal mortality rate in Tanzania is one of the highest in the world. MIHV is working to change that statistic by training birth attendants, providing emergency assistance to pregnant women, and creating support groups for mothers that encourage healthy choices. Gruner’s experience has shown her that “there is no cookie-cutter method” for developing, implementing, or evaluating public health programs. “While Americans live so much in the future that they do not appreciate the present, Tanzanians live so much in the present that they do not consider the future,” says Gruner. “Can we find something in between?”

Omar Fernandes has also returned to Africa, the continent his family called home for most of his childhood. A true world citizen, Fernandes has also lived in India, the United Arab Emirates, Saudi Arabia, St. Lucia, and the United States. This summer he brings his global view to Nairobi, Kenya, where he is working with the Nonviolent Peaceforce (NP), an international organization that partners with local groups to protect human rights and deter violence.

Fernandes received a Walter H. Judd Fellowship from the University of Minnesota to organize NP’s international assembly, set to take place in Nairobi this fall. His work with NP goes back to 2005, when he planned the organization’s first youth leadership conference on nonviolence in Minneapolis. These experiences are contributing to his goal to work in the field of refugee health. “My ideal position out of graduate school would be to work as a humanitarian aid worker for an international health organization in a conflictridden country in Africa,” says Fernandes. continued on page 6

Jooyeon Hw ang stands on a “pedes motorcycles trian road” in Vietnam in Hanoi. In has skyrocke the last dec ted from 4 ade, the nu million to 2 mber of 0 million.

Omar Fernandes, center , has fun with friends in Nairobi, Kenya.

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FEATURE STORY

kusha, a h a hiba it ic w r o the atom o Marm rvivors of asaki.

Schelom u s r fo rd wo Nag Japanese nursing home in a t a , b m bo

Self portrait in Tanzania: Katie Grune take a break r and neighb from playing or boys soccer to ga ther for a ph oto.

On the west side of the continent in Mali, Amenah Babar is working in the Malaria Vaccine Development Branch (MVDB) of the National Institutes of Health. Experts estimate that Malaria kills 3,000 children each day in sub-Saharan Africa.

MVDB has already developed several vaccines that are undergoing clinical trials in several sites in Mali. Babar’s primary role involves evaluating and developing databases for clinical electronic case reporting forms (eCRFs) for these clinical trials. She also trains researchers and data entry

personnel collaborating with MVDB on how to develop eCRFs and how to navigate a Web-based database called OpenClinica.

“One of the most important lessons I will take with me throughout my studies is that epidemiology is not just some numbers we manipulate to examine theories or prove points in a paper,” says Babar. “Living in Mali outside the laboratory, witnessing the lives of the children that will be affected, seeing the hope mixed with suffering, has brought the real meaning of these numbers to life.”

Closer to Home

Lauren Gilchrist is getting an introduction to the Minnesota legislature through her work with the Children’s Defense Fund.

This year, close to one hundred SPH students are working stateside for their field experience. Here are just a few of their projects.

Jason Crawford is working at Veterinary Diagnostic Services, a division of the New Mexico Department of Agriculture.

Beth Dammann is planning a health fair for employees and families of Minnesota-based 3M Company.

Alina Evans is collecting data on reindeer herd health in Wales, Alaska. (pictured below)

Kathleen Hoss is working on sustainable agriculture with the Land Stewardship Project in St. Paul, Minn.

William Lanier is learning about foodborne disease detection at the CDC in Atlanta.

Kerri-Elizabeth Sawyer is working with the Institute for Agriculture and Trade Policy (IATP) in Minneapolis. IATP advocates for fair global trade policies.

Robyn Scherber is the project coordinator for two smoking cessation studies at the University of Minnesota.

Christopher Tate is helping to develop pandemic preparedness guidelines with the Minnesota Department of Health.

Elizabeth VanDyk is contributing to infection control initiatives at Bronson Methodist Hospital in Kalamazoo, Mich.

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University of Minnesota School of Public Health

Why Groups Matter: Social Epidemiology The very first epidemiologists considered the social forces behind health. For instance, they understood that if you were poor, you were more likely to be exposed to diseases like cholera. But the dawn of germ theory in the 1820s pulled epidemiologists to the microscope and away from looking at how social context affects individual health.

In the past decade, a growing number of epidemiologists have called for a return to considering how social interactions —norms, laws, institutions, conventions, and conditions— affect the health of populations. With a new book, Methods in Social Epidemiology, SPH associate professor J. Michael Oakes offers a resource for those interested in this emerging field.

Oakes and co-editor Jay Kaufman, University of North Carolina at Chapel Hill, recruited original work from all-star experts in the field. The collection marks the first methods book on social epidemiology. It’s a greatly needed resource, says Oakes.

“People working in this new field haven’t paid enough attention to scientific rigor and to the challenges that social scientists have struggled with for a century,” he says.

“These issues have been largely ignored.”

At the surface, it may seem obvious to say that socioeconomic position affects health. But scientifically analyzing the issue brings complex challenges. How does one measure race, poverty, or segregation? How does one statistically compare the differences among neighborhoods? How does one account for differences that affect health?

Social epidemiology aims for a more comprehensive approach than the traditional “genes and germs” framework, says Oakes. He calls on a famous fictional castaway to illustrate his point.

“Epidemiologists have seen people’s health as the result of mother nature, island weather, and bacteria—but not other people,” he says. “This isn’t what the original epidemiologists or current social epidemiologists think. We’re trying to get past the epidemiology of Robinson Crusoe.”

EPIDEMIOLOGY AND COMMUNITY HEALTH

Young Men More Likely to Buy Alcohol for Underage Drinkers An SPH study finds that nearly 20 percent of young men are willing to buy alcohol for underage drinkers when approached outside a store.

In contrast, only 8 percent of the general population agreed to purchase alcohol when “shoulder-tapped” outside of a convenience or liquor store.

The study is the first of its kind to examine the effectiveness of the shoulder-tapping strategy, asking adults to buy youth alcohol as they enter stores. Most underage drinkers obtain alcohol from social sources—individuals who illegally provide alcohol to youth—as opposed to commercial sources.

“The small percentage of the general population that agreed to purchase alcohol when approached is encouraging,” says SPH associate professor Traci Toomey, lead author of the study. “However, the percentage of males willing to buy alcohol was much higher and more concerning.”

For the study, Toomey and colleagues recruited five people who were older than 21 but appeared to be 18 to 20 years old. The recruits approached adults as they entered 219 convenience or liquor stores in the Twin Cities metro area and asked if the customers would buy them a six-pack of beer.

The study also found that adults approached at a city store rather than a suburban one were nine times more likely to make the purchase.

“Examining the social sources of alcohol to underage drinkers allows us to identify effective interventions,” says Toomey. “This study is a first step, but more research WEB EXTRA WEB EXTRA needs to be done on all social sources and possible community efforts to stop adults from providing alcohol WEB EXTRA to underage drinkers.”

To hear a Public Health Moment on this study, go WEB EXTRA to http://blog.lib.umn.edu/sphpod/moment/.

WEB EXTRA 7

ENVIRONMENTAL HEALTH SCIENCES

MDH Commissioner Dianne Mandernach, MDH’s Alan Bender, and SPH’s Jeffrey Mandel and John Finnegan testify.

Photo: Larry Sillanpa, Duluth Labor World

SPH Takes Over Iron Range Cancer Study The School of Public Health will take over management of cancer studies among taconite workers in Minnesota’s Iron Range. The Minnesota Department of Health (MDH) had been planning the research, but the state agency came under fire for keeping quiet about deaths among Iron Range residents from a rare form of cancer called mesothelioma.

SPH Dean John Finnegan and faculty members Ian Greaves and Jeffrey Mandel recently testified at two legislative hearings, one of which was held on the Iron Range and was attended by more than 200 miners and community members. The researchers outlined their plans for leading a study of mesothelioma.

“We know some things. We suspect a lot of things,” said Finnegan. “This particular issue arising at this particular time provides us with the opportunity to increase our understanding of mining health issues.”

The University pledged to pay for the research until the legislature provides funding and to offer advice to mine workers on how to reduce risks.

Mandel said he was willing to start working with the MDH immediately to find answers. He explained that it would take six months to a year to conduct a comprehensive assessment of taconite dust and a total of three to five years to conduct a case-control study of mesothelioma and assess causes of death. A third study would examine lung health of current and former miners.

“This will be a laborious process because of the size of the study group, gathering work histories, and assessing exposures,” said Mandel. He also called for participation from the United Steelworkers union and mining companies.

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University of Minnesota School of Public Health

Taking a Closer Look at Cancer Cancer often isn’t detected until it has progressed to late stages, making it difficult to treat. With the goal of improving cancer prevention, SPH associate professor Betsy Wattenberg is working to understand the very earliest stages of the disease — namely what happens to cells when cancer strikes.

In her lab, Wattenberg and colleagues are studying the changes in cells that lead to cancer. Cells are normally highly regulated and in constant communication with each other through a network of “switches.” When cancer develops, that high level of communication is disrupted and switches within the cells are turned permanently on or off. “These switches act like brakes or accelerators in a car,” explains Wattenberg.

Wattenberg is studying a switch called Ras, which is defective in 30 percent of human cancers, including those of the lung, colon, and pancreas. Ras is a powerful switch because it is so far “upstream” in the complex cell pathway of communication. Scientists had assumed that when Ras is damaged, it causes a chain reaction that permanently turns on other switches downstream in the pathway.

But Wattenberg’s team discovered that this isn’t the case.

When Ras is damaged, the cell tries to readjust itself by producing a protein called a phosphatase that turns off the switches that have been turned on. Wattenberg says that this discovery may explain why these cells don’t develop into cancerous tumors. “If Ras is broken, it doesn’t necessarily lead to cancer,” says Wattenberg. “The cell tries to adapt to behave as normally as possible.”

While the Ras-damaged cells don’t always lead to cancer, they are vulnerable. “Future prevention strategies might focus on how to help these vulnerable cells,” says Wattenberg.

PUBLIC HEALTH EDUCATION AND OUTREACH

‘Disastrous’ Learning An F4 tornado and flash floods have hit. The massive storm has left in its wake blocked roads, power failures, an overturned tanker carrying toxic chemicals, and unconfirmed deaths. Will you make the right decisions to protect the community’s health in this time of emergency?

That’s the scenario behind Disaster in Franklin County, a new public health simulation from the SPH’s Center for Public Health Preparedness (CPHP). The simulation offers a way for public health professionals to apply their skills to an interactive reality-based Muin Khoury speaks at the SPH. emergency scenario. The simulation will also be used to evaluate course content of the school’s certificate program and The population-based approach of public health genomics M.P.H. focus in bioterrorism and provides the best strategy to translate scientific discovery to emergency readiness, offered in improvements in health, according to Muin Khoury, director the Public Health Practice major. of the CDC’s National Office of Public Health Genomics.

Learners make decisions on Khoury spoke for the final installment of the 2006-07 behalf of a public health nurse, an environmental health SPH Roundtable Series, “International Health Issues and specialist, and a county public health director. By dealing Human Rights.” The roundtables offer a venue to discuss with the emergency from different perspectives, players timely public health issues. gain a deeper understanding of the complex issues at hand.

Khoury says we need to move beyond the nature/nurture “It’s important to cross-train,” says SPH debate when discussing disease. “Genes or the environment? assistant education specialist Amy It’s both. This is an obsolete question,” he said. “We Scheller. “In emergencies, public know that all human disease is the result of genes and health workers often take on the environment.” expanded responsibilities.”

While many experts see schisms among the cultures of To make the training relevant, basic science, medicine, and public health, Khoury sees the SPH team worked with an opportunity—and public health genomics is key. Right now advisory board of public health genomics is “lost in translation,” he said. Scientific disprofessionals from Minnesota and North coveries aren’t translating to improvements in population Dakota. The end product is one that health. While there have been breakthrough discoveries in focuses on risk communication, food safety, identifying the gene variance behind disease, “the question mental health issues, and incident command systems. is what do we do with the genes when we find them?”

The advisory board members also said they wanted the The best way to bridge the gap between discovery and training to address not just the immediate response of delivery, Khoury says, is to take a population-based approach emergency workers but also the more long-term response to genomics. He outlined four focus areas to follow: preefforts. “The simulation follows a scenario for weeks, not vention, public health science, knowledge integration, WEB EXTRA WEB EXTRA just days,” says Debra Olson, CPHP primary investigator. “It and real-world health outcomes. “The population health focuses on what public health does down the road from the approach provides the best strategy for the appropriate WEB EXTRA time of a disaster.” application of genomics in health practice in the 21st Disaster in Franklin Country is available at no cost at century,” he said.

WEB EXTRA WEB EXTRA http://cpheo.sph.umn.edu/umncphp/franklincounty.

Khoury’s presentation was preceded by a tribute to Rachel Carson, who would have turned 100 this year.

Carson is best known for her 1962 landmark book on the dangers of DDT, Silent Spring.

To view this presentation, go to WEB EXTRA http://cpheo.sph.umn.edu/cpheo/events/roundtable.

Genomics and Public Health

Photo: Tim Rummelhoff

EB EXTRA

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BIOSTATISTICS

New Findings on Smoking Reduction and Smoking Compensation

U Embarks on National Study of Bone Cancer in Children University of Minnesota researchers have received a $1.7 million grant from the National Cancer Institute to lead the largest study to date on the causes of pediatric osteosarcoma.

Osteosarcoma, which affects the long bones of the arm or leg, is the most common type of bone cancer in U.S. children. Each year about 400 children are diagnosed with the disease.

Medical School pediatrician Logan Spector is head of the four-year study. SPH biostatistician Tracy Bergemann will direct the statistical aspects. She will analyze the DNA of 500 children with osteosarcoma and their parents. The aim is to identify the genes related to bone growth to determine if they have a role in causing the cancer.

For each of the 1,500 sets of DNA, Bergemann will analyze 250 genotypes in conjunction with three different lifestyle variables: diet, physical activity, and sun exposure. She will also study how the genes interact with each other. Because cancer is a complex disease, it is most likely caused by genes that interact with other genes at the cellular level.

Bergemann’s previous work has led to a method on how to pinpoint genes that interact with others. She’s discovered that the closer together two genes are on the chromosome, the more likely they are to be inherited through generations—and the less likely they are to interact in tandem with other genes.

Bergemann won’t know how many of the 250 genotypes she selects will prove to be factors in osteosarcoma until she receives the study data. “Will it be two genes, will it be eight, we don’t know,” she says. In the meantime, she’s designing statistical models to single out the genes that are most likely to be culprits.

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University of Minnesota School of Public Health

Heavy smokers who cut down on cigarettes take in more toxins than light smokers, even when the number of cigarettes smoked per day is identical. The finding comes from the University of Minnesota Transdisciplinary Tobacco Use Research Center (TTURC).

TTURC researchers measured the levels of a specific tobacco carcinogen called NNAL in smokers who were part of smoking reduction programs. As TTURC design and study analysis director, SPH professor Chap Le served as the study’s lead biostatistician.

The researchers selected 62 participants in two smoking reduction programs. The light smokers averaged 6 cigarettes a day. The heavy smokers started the study averaging 26 cigarettes a day, and then after six months reduced intake to 5 cigarettes a day. After the reduction by the heavy smokers, the two groups were matched to form clusters with the same number of cigarettes smoked per day. In each cluster, researchers found that the average level of the NNAL carcinogen in the heavy smokers was more than twice that of the light smokers.

Why the difference? Researchers point to “smoking compensation”—the act of inhaling longer and deeper, which has been known to increase exposure to carcinogens.

Smokers trying to cut back often compensate in this way to satisfy their urge to smoke more.

A breakthrough for Le and the research team was the idea of a “matched design” (matching the reduced heavy smokers to the light smokers) to arrive at more accurate measures of smoking compensation. The study design also revealed that the greater the reduction in smoking, the greater the amount of compensation.

The results suggest that heavy smokers who cut down still face harmful exposures to cancer-causing toxins. Likewise, no research has indicated whether there exists a “safe” level of reduction. There remains only one known way to lower the risks involved with cigarettes: Stop smoking completely.

HEALTH POLICY AND MANAGEMENT

Rural EDs Face Staffing Challenges As the gap between supply and demand continues to grow for emergency department (ED) physicians, rural hospitals must focus on continuing education to ensure quality of ED care.

The finding comes from the Rural Health Research Center (RHRC), which surveyed a national sample of rural hospitals on ED staffing challenges and quality of care. RHRC deputy director Michelle Casey authored the study report, along with SPH professors Ira Moscovice and Doug Wholey.

“It’s not realistic to expect an increase in the number of board-certified emergency medicine physicians in rural areas anytime in the near future,” says Casey. She points to a national shortage of ED doctors, a lack of emergency medicine residency programs in rural states, and the lowpatient volume of rural EDs. The study found that rural hospitals are using a variety of arrangements to staff their EDs, including combinations of physicians on their own medical staff, physician assistants and nurse practitioners, and contracts with emergency physician management groups and individual physicians.

The staffing also varies significantly by hospital characteristics including ownership type, region, and size.

The researchers suggest that rural EDs ramp up continuing education for these staff members. Training should focus on the technical skills needed to provide ED care and the ability to work well in teams with nurses and other hospital staff.

Survey results indicate that rural hospitals may need to add training in the areas of care for children and trauma patients.

“Staffing EDs is just one of the challenges faced by rural hospitals,” says Moscovice. “As rural emergency departments continue to rely on a variety of staff members, it’s critical that those members receive the training they need to deliver effective care.”

Computerized Doctor’s Orders Reduce Medication Errors U.S. hospitals that switched to a computerized physician order entry system (CPOE) saw a 66 percent drop in prescription errors, according to a new review of studies.

SPH researchers reviewed 12 studies conducted between 1990 and 2005 that compared the error rates associated with handwritten and computerized medication orders made by hospital physicians. The review was recently published in the journal Health Services Research.

Nearly 25 percent of all hospital patients experience medication errors, a rate that has skyrocketed from 5 percent in 1992. Each year, more than one-half million patients sustain injuries or die in hospitals from adverse events, costing up to $5.6 million per hospital.

“Patient safety is society’s ultimate goal,” says SPH research associate Tatyana Shamliyan, lead review author.

“Evidence from these studies shows that computerized systems can reduce mistakes, but unfortunately only a small proportion of hospitals have implemented these systems. There is a lot of work to be done.”

Medication errors—which include prescribing the wrong drug, ordering an inaccurate dosage, or administering a drug at the wrong time—dropped by as much as 66 percent in hospitals with computerized systems. Physician ordering and transcription errors account for more than 60 percent of medication errors.

“Medication errors are a central aspect of improving hospital safety. CPOE can help that process,” says SPH professor Robert Kane, review co-author. “Hospitals would be shortsighted not to use it.”

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SCHOOL NEWS SPH Faculty Awarded for Career Excellence SPH professor Mary Story has been named to the Academy for Excellence in Health Research.

The academy serves as the highest recognition of research among faculty of the University of Minnesota Academic Health Center (AHC).

Story is an internationally noted authority on obesity prevention and adolescent nutrition. She is principal investigator for numerMary Story ous studies in this area, among them a five-year $16 million Robert Wood Johnson Foundation initiative called Healthy Eating Research. She is one of the founding directors of the University of Minnesota Obesity Prevention Center, which includes 55 University faculty, spanning 26 different schools and colleges, as well as several community partners. Since 2005, she has served on the Institute of Medicine’s Food and Nutrition Board, where she helps to set nutrition standards for food in schools.

SPH professor Deborah Swackhamer has received the Harvey G. Rogers Environmental Health Leadership Award from the Minnesota Public Health Association.

Swackhamer’s research concerns compounds like PCBs, dioxins, and pesticides. She has studied how these agents affect the Great Lakes and their coastal zones. She is co-director of the Deborah Swackhamer University of Minnesota Water Resources Center and interim director of the Institute on the Environment, the University’s most comprehensive and ambitious environmentally focused endeavor to date. At the institute, Swackhamer will head a new 50-year conservation plan for the State of Minnesota, funded by the LegislativeCitizen Commission on Minnesota Resources. Governor Tim Pawlenty also recently appointed Swackhamer to serve on the Clean Water Council.

Partnering on Animal and Human Health The School of Public Health participated in the first joint symposium of the Association of American Veterinary Medical Colleges (AAVMC) and the Association of Schools of Public Health (ASPH): “Partnerships for Preparedness: Future Directions for Schools of Public Health and Colleges of Veterinary Medicine.” The symposium focused on how these two fields can partner on research, education, policy, and workforce training.

The SPH has been a national leader in this area, and the school’s faculty were well represented at the meeting.

Debra Olson and Will Hueston made presentations on the school’s joint M.P.H./D.V.M. program—the first of its kind nationally. Marguerite Pappaioanou discussed career pathways for veterinarians in the public health workforce. In a separate session, she presented an overview of a multidisciplinary framework for training on avian influenza preparedness. SPH Dean John Finnegan participated in a discussion on future directions of the field.

“You only have to look at today’s headlines to see how the interrelation of animal and human health is shaping our world—whether it be food safety, infectious disease, or emergency preparedness,” Finnegan says. “As these issues continue to become more pressing and complex, it’s critical that professionals in public health and veterinary medicine work together to address them.”

The symposium featured keynote addresses from former and acting U.S. Surgeon Generals David Satcher and Kenneth Moritsugu, respectively, and Lonnie King, director of the CDC’s National Center for Zoonotic, Vector-Borne, and Enteric Diseases.

Symposium presentations can be downloaded from WEB EXTRA www.asph.org/document.cfm?page=1005.

WEB EXTRA WEB EXTRA

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University of Minnesota School of Public Health

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SCHOOL NEWS

Laurie Garrett takes the stage at SPH commencement.

SPH Commencement ’07: Garrett on Global Health Global health is experiencing unprecedented advances and crippling challenges, says award-winning journalist Laurie Garrett.

She delivered the 2007 School of Public Health commencement address to an audience at the University of Minnesota’s historic Northrop Memorial Auditorium.

Garrett is the only writer to have been awarded all three of the Big “Ps” of journalism: the Peabody, Polk, and Pulitzer.

She is the best-selling author of The Coming Plague: Newly Emerging Diseases in a World Out of Balance. And she is a senior fellow for global health at the Council on Foreign Relations.

Noting a profound sense of charity, $18 billion on the global health table, and plummeting rates of HIV/AIDS, Garrett spoke of the developed world’s unprecedented “health generosity.”

“But let’s be clear, money alone solves nothing,” she said.

The world is also desperately short of health professionals, she said. As the wealthy world continues to age, the disparity of workers in developing and developed nations will only get worse. She cited Ghana as an example. Right now, there are 2,500 doctors in Ghana—barely enough to serve the population.

But New York City alone has 600 licensed Ghanese doctors.

“Gaps like these will soon become catastrophic,” she said.

“Welcome to the trenches,” Garrett half joked to the 189 graduates. She then concluded with the following advice: “Fight well, show courage, learn politics, and become guiding lights of good governance.”

U President Robert Bruininks renews an agreement with University of Iceland Rector Kristín Ingólfsdóttir.

U Renews Partnership with University of Iceland SPH Dean John Finnegan was part of a University of Minnesota delegation led by President Robert Bruininks to the University of Iceland this past spring. The visit marked the 25th anniversary of a cooperative agreement between the two universities. In renewing the agreement, there was emphasis placed on increased collaboration in the health sciences, particularly public health and nursing. The U of M delegation included Senior Vice President for Health Sciences Frank Cerra and School of Nursing Dean Connie Delaney. A highlight of the visit came when the University awarded an honorary doctor of laws degree to Iceland Prime Minister Geir Haarde, a Minnesota alumnus who took a master’s degree in economics in the late 1970s.

With a population of about 300,000 on an island the size of Ohio, Iceland has a robust economy, culture, and influence on the world that reaches far beyond a small place. The University of Iceland sees its own future as importantly linked to health sciences research and education. It has made important investments in health informatics, for example, and seeks to develop public health research and training. To accomplish its goals, the University of Iceland regards collaborative relationships such as its agreement with Minnesota as key. This agreement will provide SPH faculty and students with additional opportunities in research and education in a global setting.

One of the first collaborative efforts will be for the SPH to assist the University of Iceland in establishing a center for public health. A return visit in early September by SPH faculty will help move that effort forward.

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PHILANTHROPY

Peggie and Aldo Notarianni

Family connections encourage gift for CHE program scholarship Peggie Toomey Notarianni has always had an interest in promoting health. After graduating from the University of Minnesota’s dental hygiene program in 1950, the Minneapolis native moved to Denver to work in private practice and then in a program to teach nutrition and proper tooth-brushing techniques to schoolchildren. She spent an additional 25 years volunteering for Kids in Need of Dentistry, a program that provides low-cost dental care to children in low-income families.

Several years later, Peggie and her husband, Aldo Notarianni, learned about the work Traci Toomey was doing in the School of Public Health’s Division of Epidemiology and Community Health. Peggie was especially interested in the division’s Community Health Education (CHE) program, for which Toomey is the major chair.

“I like that idea—getting out into the community and promoting healthful behavior,” Peggie says. “Being that I was a dental hygienist, it rang a bell with me. It’s a need that I see in our society.”

After learning more about the program, the Notariannis decided to make a $50,000 bequest to fund a scholarship for students in the CHE program.

“Bequests such as this are key to building our students’ futures in public health,” says SPH Dean John Finnegan.

“We compete with many schools that have excellent community health education programs, and a gift like this 14

University of Minnesota School of Public Health

will provide us with a little more leverage to bring the best and the brightest students to Minnesota.”

The Notariannis first learned about the CHE program and Toomey’s work through Toomey’s father, who is one of Peggie’s cousins.

“Traci sounded so much like our eldest daughter, Elissa,” Peggie says. “Their paths in life were so similar.”

Elissa (Notarianni) Rivers also had an interest in health, following her mother’s footsteps to the University of Minnesota and earning a doctorate in anatomy. She was a cancer researcher and teacher before she died of breast cancer in 1997.

The Notariannis contacted Traci Toomey to learn more about her work. In the process, they became more aware of the need to educate people to take care of their own health and made a planned gift for a scholarship for CHE students, called the Aldo G. and Peggie Toomey Notarianni Scholarship.

The Notariannis are making a similar scholarship gift to the University of Minnesota School of Dentistry’s Dental Hygiene Program. They’ve also established scholarship funds in Elissa’s memory at both Regis University and Red Rocks Community College in Denver, where Elissa taught before her death.

“Aldo and our four children received scholarships to go to college based on their academics,” Peggie says. “We’re very grateful, and now it is payback time for all that has been given to our family by earlier benefactors.”

The Notariannis also chose to fund a scholarship because of rising tuition costs. Aldo, who is retired after a 53-year career in law, remembers paying $650—total—for his college education in the 1940s. Peggie remembers paying $150 per year at the University.

“Now it’s so different,” says Peggie. “Aldo and I have been so blessed in our early life. We’re trying to help other students have what we had.”

Use Your IRA as Never Before For a limited time, individuals age 701/2 or older can use their individual retirement account (IRA) to make an immediate gift to support the School of Public Health through the Minnesota Medical Foundation. Now until the end of the year, you can make a charitable contribution of up to $100,000 without adverse tax consequences. Specific rules apply. For more information, call Adam Buhr at 612-626-2391.

STUDENT NEWS

J. Girard Griggs works with air sampling equipment in a University of Minnesota lab.

Denise Feda: SPH Student Leader

Student Takes on Lowry Tunnel Air Quality

At the SPH commencement ceremony this spring, Denise Feda delivered a speech to fellow graduates about the personal rewards of completing a graduate degree at the School of Public Health.

Feda, who is putting the finishing touches on her dissertation, will soon experience the great reward of adding “Ph.D.” to her name. In her years at the SPH, the environmental health sciences student has served as president of the SPH Student Senate, been recognized for her leadership, and helped conduct a first-of-a-kind study on violence against educators.

As student senate president, Feda worked to expand student involvement and to create a diversity representative position on the senate. The new position led to the first Taste Diversity event. “The idea is that food and cooking are the glue that brings individuals of diverse backgrounds together to discuss cultural differences and their impact on public heath,” says Feda.

Earlier this year Feda became one of 12 graduate students to be honored with the University of Minnesota President’s Student Leadership and Service Award. The award is given to just one-half of one percent of the student body. Feda was recognized for her senate service, as well as for her roles as campus liaison for the American Public Health Association and vice president of internal relations for the Council of Graduate Students.

For her studies, Feda is working with SPH professor Susan Gerberich on novel research examining the factors that lead to violence against educators. “It’s an important but often overlooked perspective,” says Feda, who adds that most research has been limited to student-on-student violence. “The findings offer a new piece to the puzzle on policies that are effective in curbing school violence.”

While the interest of most Minnesotans is glued to the area where the I-35W bridge collapsed a few weeks ago, J. Girard Griggs is concerned about what’s happening just down the road from there. His focus? The I-94 Lowry Tunnel, one of the most heavily traveled freeway segments in the state.

Griggs, an environmental health sciences student and mechanical engineer, is launching a study to analyze the tunnel’s air quality. He plans to share his findings with the Minnesota Department of Transportation, the agency responsible for monitoring the tunnel.

When the Lowry Tunnel was built in the 1970s, carbon monoxide (CO) emissions were a top concern. Engineers equipped the tunnel with CO sensors and massive fans that turn on if levels reach dangerous levels. But the equipment monitors CO levels only—failing to account for a host of other pollutants emitted by vehicles.

Griggs will study levels of these other pollutants, including BTEX compounds, which are known to have major effects on the central nervous system. He’s sampling air at peak rush hours, when traffic often comes to a standstill in the quarter-mile tunnel.

“Additional air quality rules haven’t been applied here.

Tunnels aren’t typically classified as confined spaces,” says Griggs. “But at times they present inhalation hazards similar to confined spaces.”

Since this is the first comprehensive study of its kind, Griggs isn’t sure what he will find. But he believes the tunnel workers and thousands of commuters should know more about what they’re being exposed to daily. “Good news or bad, the information should be out there,” he says.

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Photo: Paul Bernhardt

Photo: Tim Rummelhoff

Denise Feda delivers the student address at SPH commencement.

ALUMNI NEWS

Class Notes Mark Eustis (M.H.A. ’79) has been named president and CEO of Fairview Health Services, the largest U.S. nonprofit health system. He leaves Ascension Health in St. Louis, Mo., where he was president of Regional Ministry Operations.

Cindy Kallstrom (M.P.H. ’90) is health promotion manager at UCare Minnesota, the fourth largest health plan in the state, exclusively serving members with government payors such as Medicaid and Medicare. Kallstrom heads a team of five people, with program oversight ranging from car seats to senior fitness.

Alumni Board Update The newly re-established SPH Alumni Society Board recently met for the second time to discuss goals for the coming year. Here are some highlights from the meeting: • The board will hold the first annual meeting for all SPH alumni in spring of 2008. If you would like to volunteer to be on the planning committee for the annual meeting, please email SPHnews@umn.edu. More details about the meeting will appear in future issues of Advances.

• The SPH mentor program is one of the largest and best among public health schools nationwide. The board will work to bolster the program by recruiting new alumni to mentor.

If you are interested in mentoring for the coming academic year, learn more at www.sph.umn.edu/alumni/mentor.

Gretchen Musicant (M.P.H. ’86) has received the Paul and Sheila Wellstone Public Health Achievement Award from the Minnesota Public Health Association. As Minneapolis health commissioner, Musicant has worked to create a public health focus on youth violence. The award recognizes her for her public health leadership and work as an advocate for the urban poor, uninsured, and disadvantaged.

Huy Pham (M.P.H. ’96) has accepted a position with Save the Children U.S. as the director for the Vietnam program.

He leaves his position of eight years as director of international programs with Minneapolis-based American Refugee Committee International. Save the Children U.S., part of the Save the Children International Alliance, is a nonprofit organization working in more than 35 nations.

Debra Yerike (M.P.H. ’97) earned an M.D. from St. Matthew’s University School of Medicine, located in the Cayman Islands.

• The board will work in an advocacy role for the school and for public heath issues. Potential advocacy initiatives WEB EXTRA would be writing op-ed pieces for local newspapers, working with community partners, and interacting with the state legislature.

• The board will work to support student scholarships. The goal will be increasing scholarship dollars so more SPH students can benefit.

WEB EXTRA

Connect to the SPH!

The school wants to hear from you. If you WEB EXTRA have news for a future issue of Advances, please send it to SPHnews@umn.edu.

The Alumni Network is a great way to connect to current

WEB EXTRA WEB EXTRA SPH students and fellow alumni. Learn more at

• The board will attend a retreat this fall to discuss alumni programming priorities and goals in more detail.

If you have ideas for alumni board initiatives, please send them to Michelle Lian-Anderson, director of alumni relations and special events, at liana001@umn.edu or 612-626-5536.

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University of Minnesota School of Public Health

www.sph.umn.edu/alumni.

ALUMNI NEWS

Alicia Liesener stands next to a goat corral at a “field day,” where community members view demonstrations on agriculture, nutrition, and health.

Medical Mission to Malawi In May of 2004 Alicia Liesener was busy completing her master’s thesis at the SPH. A month later, she was spending her days on the roads of Malawi in a Land Cruiser filled with medical supplies.

Now three years later, Liesener is back from the African country where she worked as a public health administrator for Central Africa Medical Mission. The organization has a 45-year history in Malawi and Zambia.

A desire to work with underserved populations and an interest in African cultures led the epidemiology graduate to the position. Liesener was in charge of a mobile clinic that served five rural villages surrounding Malawi’s capital, Lilongwe. Her staff included an American nurse and eight African medical personnel.

Established in 1970, the clinic offers programs in child health, HIV/AIDS prevention, agriculture, and nutrition. It also provides formula for orphaned infants, and—a program that Liesener started last year—assistance for mothers of twins and triplets. “Mortality rates for those groups are high,” explains Liesener. “We had the freedom to do something about it right away.”

Liesener is grateful for the breadth of public health education she received at the SPH. “I’m glad that as an epidemiology student you’re required to take classes in health administration and other areas,” she says. “That knowledge was useful when dealing with human resources and management issues.”

Liesener is interviewing for her next public health position with an outlook shaped by Africa. “It’s amazing how much can be done with very few resources” she says. “In Malawi, I learned to be creative with what we had. I think that’s a good perspective to bring to public health.”

It’s no exaggeration to say that the health of thousands of people worldwide can be traced back to one book.

Written in plain language —and reflected in its title, Water Well Manual—the instructional book was geared to the average person.

What was simple by design Ulric Gibson became revolutionary in impact. Thanks to the book, for the first time families in developing countries could build their own source of clean drinking water. It became a key to both health and self-sufficiency.

The primary author of the book is Ulric Gibson. Born and raised in Guyana, he came to the University of Minnesota, where he received an M.S. in public health engineering and a Ph.D. in environmental health engineering and water resources.

While Gibson was at the SPH as an assistant professor and doctoral candidate, the school was commissioned by the U.S. Agency for International Development to write a manual on water wells. SPH faculty member Rexford Singer was instrumental in getting the contract and is the book’s second author. Published in 1969, the manual remained a bestseller for years and is still regarded as an important resource in the developing world.

From there, Gibson went on to an illustrious career, which included a post at the American Public Health Association and consulting work with the Pan American Health Organization and World Health Organization. His water quality projects took him to places such as Guyana, the Caribbean, Argentina, Columbia, Israel, the Gambia, Senegal, Liberia, Russia, and the Ukraine.

Gibson retired in the late 1990s but his Water Well Manual continues to sell. More than a pioneer in water quality, Gibson was an early leader in global public health.

“International work gave me the opportunity to use my expertise for the betterment of people around the world,” he says. “And it gave me a much broader perspective.”

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Photo: Priscilla Nealy

SPH Alumnus Wrote the Book on Clean Water

MPHA Turns 100!

Minnesota Public Health Association Centennial Celebration Gala Keynote address from Will Steger, polar explorer October 25, 5:30-9:00 p.m.

University of Minnesota McNamara Alumni Center More information and registration available in September at www.mpha.net.

NEXT ISSUE: 2006-07 ANNUAL REPORT

Limit consumption of local fish.

Fishing is a favorite Minnesota pastime, yet we are warned to limit our consumption of local fish because of toxic chemicals. These contaminants get into lakes and rivers and accumulate up the food chain until they reach significant levels in fish, says Deborah Swackhamer, SPH professor and interim director of the Institute on the Environment.

Is it safe to eat fish from local lakes?

PCBs, mercury, and substances from household products can mimic estrogen. Exposures to these chemicals can harm children and fetuses, so mothers and women of childbearing age are urged not to eat local fish frequently.

Swackhamer is working on a model to predict how new chemicals behave in the Great Lakes, and whether they will accumulate up the food chain. To best protect our waters, she believes it’s critical to stop bioaccumulative chemicals from entering commerce in the first place.

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