Advances - Winter 2007 by publichealthmn

Advances Meeting Madeleine Albright • page 13

WINTER

2007

from the University of Minnesota School of Public Health

Chronic Disease The Next Generation of Prevention Research SCALE STEPPING BAD FOR TEENS LOCAL WELL WATER CONTAMINATED GUM DISEASE AND PRETERM BIRTH FIGHTING PESTICIDES WITH PHOTOS

FROM THE DEAN Photo: Richard Anderson

Dear Friends, Anyone who works in the field of chronic disease prevention in our School of Public Health stands “on the shoulders of giants” such as Ancel Keys and Leonard Schuman. Keys, a physiologist, left an indelible mark on the field as his research made enormous advances in cardiovascular disease prevention. Schuman, a physician and epidemiologist, was one of the few to work across the fields of chronic and infectious disease. He will forever be remembered for his work on the famous 1964 Surgeon General’s Report on Smoking. An exciting part of my job as dean is watching our faculty members follow in the footsteps of Keys, Schuman, and so many others. Today’s faculty continue to move the field forward in new and important ways. Our cover story focuses on these advances in chronic disease prevention, especially in the areas of heart disease, diabetes, and cancer. It is remarkable work of which I daresay Drs. Keys and Schuman would be proud. I am delighted to be embarking on a new program to engage the immensely talented and connected corps of SPH alumni. As I write this, a steering committee of alumni is reviewing a stack of applications for seats on the new SPH Alumni Society Board. That board will help to harness the incredible momentum we are experiencing as a school and lead new alumni efforts in public health advocacy, scholarship philanthropy, and counsel on our educational programming. (See story on page 17.) This year also marks the 100th anniversary of the Minnesota Public Health Association (MPHA), an important ally of the SPH, and an organization that has been behind many of our state’s most important public health advances over the last century. Their centennial year brings with it numerous celebratory events. See www.mpha.net for more information. Happy birthday, MPHA! Finally, please continue to pay us virtual visits at www.sph.umn.edu, where you’ll find a wealth of new features that I guarantee you will find interesting as well as surprisingly flashy, for public health. Yours in health,

John R. Finnegan, Jr. 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

Contributing Writers Nicole Endres Toya Stewart

William Riley Associate Dean for Student Affairs

William Toscano Head, Division of Environmental Health Sciences

Art Direction Todd Spichke Riverbrand Design

Diana Harvey Assistant Dean for External Affairs

Contents Table of

Advances

Feature

Despite years of research and a wealth of related information,

WINTER 2007

chronic disease remains the world's top killer. The SPH

has built a strong reputation of addressing chronic disease in groundbreaking ways that have led to major advances in prevention. That work continues today.

Division News

Americans make modest improvements in diet, biostatistics course beamed to Mayo Clinic, seven steps to emergency preparedness, and more

Student News

Students attend a national summit on pandemic planning in Florida, while students back home push for a smoke-free Minnesota

School News

New Mayo Professors named, â&#x20AC;&#x153;must seeâ&#x20AC;? films at upcoming festival, and more

Philanthropy

SPH professor honored with new scholarships, and public health pioneer leaves lasting legacy

Alumni News

Alumni society board update, CEO alumnus wins Baldrige

award, and more

CHRONIC DISEASE

The Next Generation of Prevention Research

University of Minnesota School of Public Health

F E AT U R E S TO RY While we have made great strides in health, chronic diseases—such as heart disease, cancer, and diabetes— remain the leading cause of death worldwide. In the United States, these diseases account for 7 of every 10 deaths and affect the quality of life of 90 million Americans. According to the World Health Organization (WHO), chronic disease is responsible for 60 percent of all deaths worldwide, and 80 percent of those deaths occur in low- and middle-income countries. Although chronic diseases are among the most common and costly health problems, they are also among the most preventable. The major risk factors for chronic disease are an unhealthy diet, physical inactivity, and tobacco use. If these risk factors were eliminated, at least 80 percent of heart disease, stroke, and type 2 diabetes would be prevented, and 40 percent of cancer would be prevented, according to the WHO.

Building on Tradition Experts at the University of Minnesota School of Public Health are building on a rich tradition of innovative, populationfocused research aimed at reducing chronic disease. SPH founding faculty member Ancel Keys was one of the first researchers ever to link behavior and diet to heart health. That work landed him on the cover of Time magazine in 1961. Emeritus professor Henry Blackburn, who studied under Keys, directed the first and formative years of the school’s Division of Epidemiology. The division quickly made a name for itself for conducting pioneering work in cardiovascular disease prevention. Today, the SPH is known for leading some of the world’s largest and longestrunning epidemiologic studies that have been critical in identifying key risk factors for heart disease, cancer, and other chronic culprits. The Iowa Women’s Health Study is one such project. Led by SPH professor Aaron Folsom, the study started in 1986 with a cohort of 41,836 postmenopausal women aged 55-69. The study goals are to determine how body fat distribution, diet, and other lifestyle factors predict cancer in older women. The research has led to more than 200 published articles. Just a few recent findings indicate the spectrum of information to come out of this one study: hormone replacement therapy does not increase risk of leukemia; magnesium can reduce risk of colon cancer; and, prevention of weight gain before

menopause reduces risk of postmenopausal breast cancer. While the findings are vast in scope, the foundation of the Iowa Women’s Health Study is that it seeks to understand what leads to cancers and therefore how to prevent them. The project plays a key role in identifying risks of cancer in older women.

Genetic Clues Genetic research is fast becoming the next frontier for chronic disease prevention. SPH associate professor James Pankow works in the area of molecular and genetic epidemiology to determine the causes of type 2 diabetes and cardiovascular disease. One of his current projects analyzes biomarkers and proteins in the blood of a group of adults, some who have developed diabetes over the course of the study. Pankow and colleagues are able to analyze blood samples taken before the study participants developed diabetes, which helps the researchers to pinpoint the proteins that may lead to disease. His team found proteins related to inflammation in the blood of participants who later developed diabetes. The discovery lends support to a growing hypothesis that links inflammation to diabetes. The researchers also found lower levels of the protein adiponectin, which is produced by fat cells and released into the blood. As body weight goes up, adiponectin levels go down. The protein plays a key role in suppressing metabolic processes that lead to type 2 diabetes. The adiponectin findings strengthen the connection between obesity and diabetes. “It’s unclear why obesity puts you at risk for diabetes,” says Pankow. “This protein might help to explain that link.” SPH faculty in the Division of Biostatistics have been teaming up with colleagues across the University to discover the genes behind a host of chronic diseases. SPH assistant professor Tracy Bergemann is working with colleagues in the Medical School on a first-of-a-kind study on osteosarcoma, the most common type of bone cancer. The research team has singled out 30 genes related to bone growth, and Bergemann is using complex statistical models to determine which of them are significant in their connection to osteosarcoma. SPH assistant professor Cavan Reilly has searched for the genetic basis of asthma by analyzing DNA samples from 27 families who each have at least two asthmatic members. Using a statistical model he designed, Reilly has been able to track down a gene that shows strong associations to asthma. 3

FEATURE STORY

biphenyls). These chemical substances, which typically accumulate up the food chain, may be linked to cancer and other chronic conditions. SPH associate professor Jeff Mandel is investigating the relationship between POPs and diabetes mellitus. Previous studies have indicated the link, but haven’t demonstrated whether the relationship is cause and effect or simply coincidental. But some studies have shown that higher exposure to POPs leads to more severe diabetes. “That’s the intrigue,” says Mandel. He thinks one of the next steps should be to look at POPs in relationship to a lab assessment of the metabolic changes of diabetes in an effort to better understand the biologic impact that these pollutants may have.

Environmental Culprits How the environment interacts with genes to lead to chronic disease is the focus of research from faculty in the school’s Division of Environmental Health Sciences (EnHS). “We believe in the ‘envirome,’” says EnHS head William Toscano. The concept behind the envirome is that whatever is not genetic is environmental. The envirome includes socioeconomic status, behavior, lifestyle, nutrition, pollutant chemicals, environmental toxicants, and how individuals interact with each other. Much of this envirome-focused work investigates the effects of POPs (Persistent Organic Pollutants). Two wellknown POPs are dioxins and PCBs (polychlorinated 4

University of Minnesota School of Public Health

Over the past 20 years, rates of asthma have skyrocketed, but researchers still aren’t sure why. SPH associate professor John Adgate is working with teachers in the Minneapolis public school system on the Home Allergen Reduction Study. The teachers have acted as liaisons between the researchers and the children’s families. Many of the families in the study live in older homes and rental properties, where mold and other contaminants are a concern. “One of the places where we are most exposed to pollutants is in our own homes,” says Adgate. “The levels of certain pollutants are, in some cases, higher in your house than they are elsewhere.” Home pollutants are associated with asthma but the nature of the association is, according to Adgate, “one of the unsettled questions related to the great asthma epidemic that we’re going through now.”

behavior and reducing costs in health care delivery. The researchers plan to develop a model that would predict the effectiveness of specific strategies for controlling blood pressure, managing osteoporosis, and addressing other chronic diseases. While it may seem like common sense that too much fast food is bad for you, there has been surprisingly little scientific evidence linking fast food diets to health status. In the first comprehensive, long-term study of its kind, SPH associate professor Mark Pereira has linked fast food consumption to type 2 diabetes. Researchers tracked the dietary habits of (continued on page 6)

New Methods SPH professor Brad Carlin is leading an innovative approach to research in which statistical tools are applied to geographically referenced data. The results are “disease maps” that can clarify underlying spatial patterns in disease—a vital tool in planning future public health interventions. Carlin was called in to refine the numbers of people at risk for radon exposure in a project conducted by the Centers for Disease Control and Prevention. The CDC was trying to estimate the number of deaths attributable to lung cancer in families living near a uranium recycling plant in southwestern Ohio. It was easy to determine which people had been exposed to harmful levels of radon some 25 years ago, but it became much more difficult to determine whether that exposure had led to lung cancer. “We were able to find improved risk estimates but could not get reliable death data,” explains Carlin. “So there was an important piece of the puzzle missing.” A legal case between a local citizen’s group and the federal agency charged with cleaning up the plant was eventually settled out of court. SPH professor Robert Kane, Minnesota Chair in Long-Term Care and Aging, is heading up a collaboration between the Division of Health Policy and Management (HPM) and the Division of Epidemiology and Community Health (EpiCH). HPM faculty include Rosalie Kane and Karen Kuntz. EpiCH faculty include Deborah Hennrikus, Rhonda Jones-Webb, and Kim Robien. The group’s aim is to develop chronic disease prevention strategies that are effective in changing individual

A Chronic Burden on Health Care As our population grows, so does the cost of treating its chronic conditions. SPH associate professor Susan Bartlett Foote is an expert in health care policy. She weighs the personal pros and financial cons of this reality. “A small percentage of Medicare beneficiaries—those over 65 years old— account for most of the spending in the program,” says Foote. “Many of these seniors have chronic diseases.” Technological innovation in pharmaceuticals and medical devices means many once fatal illnesses have become chronic diseases with lifelong management. “As Americans are living longer, many have improved quality of life despite dealing with one or more chronic diseases,” says Foote. “This means increased expenditures as well.” Making drugs more affordable is key to addressing the skyrocketing cost of caring for chronic diseases, says SPH professor Robert Kane. “Changes in the drug industry are tied to chronic disease care,” says Kane. “We are shifting into a world of lifelong drug takers. This is changing the whole nature of medical care.” 5

FEATURE STORY (continued from page 5)

more than 3,000 young people for 15 years. They found that those who ate at fast food restaurants at least twice a week or more and further increased their fast food over time gained about 10 pounds more than those who ate fast food less than once a week and further decreased their fast food over time. They also found that frequent fast food consumption doubled one’s increase of a pre-diabetes condition known as insulin resistance. On the heels of these findings Pereira set out on a pilot study to determine the effects of fast food consumption in the short term. He tracked 15 obese adults for three months. For the first month, the participants ate their usual diet and gained about one third of a pound on average. For the second month, participants ate at restaurants twice a day and gained about two thirds of a pound. For the third month, the group was supplied with groceries that fell within dietary guidelines. They ate every meal at home and gained no weight. Pereira is using the findings to apply for funding to follow 360 people for a year. The study would compare two strategies: counseling frequent restaurant-diners on how to order healthy options and counseling people who would eat only at home. The researchers would also track risk factors for diabetes and heart disease. The project is one of the first to address both the issues of individual responsibility and environmental pressure that surround the obesity crisis. “Most of the emphasis in research has been on the individual,” says Pereira. “But there’s a tremendous amount of environmental pressure, with portion sizes and choices at restaurants.”

New Populations As the burden of chronic disease moves to developing countries, SPH experts are forging international partnerships in an effort to improve health. The SPH has signed an agreement with the Indian Council of Medical Research (the equivalent of our National Institutes of Health) to partner on translational and clinical research. The partners are designing a study that will compare bariatric surgery and diet and lifestyle changes as approaches to deal with obesity and type 2 diabetes. The trial includes the University of Minnesota and three clinical sites in India. SPH professor John Connett is the lead biostatistician on the project and will be responsible for collecting and analyzing all data associated with the study.

University of Minnesota School of Public Health

SPH professor Gurumurthy Ramachandran is in the fifth year of investigating how air quality in India affects the lung health of women and children. Identifying the causes of chronic respiratory illnesses in India isn’t difficult. Poorly ventilated homes are filled with dirty fuels for heating and cooking. An explosive growth in industry and streets jammed with vehicles contribute to outdoor air pollution. But alarmingly little research has been done to address the problem. By providing scientifically sound data on exposure and lung health, Ramachandran hopes policies might be crafted that would improve air quality in developing countries like India. SPH researchers are partnering with community members to reduce exposure to contaminants found in local fish for Minnesota’s Dakota and Ojibwe populations. Many of the fish that these populations eat more than once a week are contaminated with mercury, dioxin, and PCBs. Dioxin and PCBs are known to cause cancer. The project team includes environmental health faculty Bruce Alexander, Pat McGovern, and William Toscano, research associate Sara Axtell, pediatrics assistant professor Anne Kelly, and community partner Lea Foushee, co-founder of the North American Water Office. Foushee has put together materials on which Minnesota fish are safe and unsafe to eat, how to clean fish to reduce exposures, and why pregnant women and small children are especially sensitive to exposure. The hope is to distribute the materials to tribal members so that they can reduce their exposure to the contaminants.

HEALTH POLICY AND MANAGEMENT

Capitol Forum Convenes in D.C.

SPH Wins 2 of 9 National ‘Investment’ Grants School of Public Health researchers have been awarded 2 of 9 grants on strategies aimed at improving the U.S. public health system. The University of Minnesota was the only school to win two such grants. The Public Health Systems Research (PHSR) foundation awarded the grants. The PHSR is a group within the Robert Wood Johnson Foundation (RWJF), which will invest close to $1.4 million in this year’s awards. SPH associate professor William Riley will develop and implement a pilot program to expand the use of continuous quality improvement measures in public health agencies. He will lead a collaboration of the University of Minnesota’s Academic Health Center and public health practitioners. Riley is one of the first researchers to apply continuous quality improvement measures to public health. SPH professor Douglas Wholey will look into the relationship between public health outcomes and public health system structures in rural communities. He will focus on rural communities because he says they face a scarcity of resources that makes it critical for public and private resources to be integrated. “These grants present opportunities to identify successes in public health, understand why they are succeeding, and apply that knowledge broadly,” says James Marks, RWJF senior vice president and director of the health group. “We are pleased to support these investigators and look forward to their contributions to the field of public health.”

A veritable “Who’s Who” in U.S. health policy participated in the recent Capitol Forum, sponsored by the SPH-based Medical Technology Leadership Forum (MTLF). MTLF convenes the Capitol Forum each year in Susan Bartlett Foote speaks at the Washington, D.C., just Capitol Forum after the U.S. president delivers his budget proposal to Congress. Participants in the Capitol Forum examine the president’s budget and discuss its implications for health care financing and medical technology. This year, attendees also discussed the health policy impact of the 2006 elections and the shift in party leadership in Congress. Outside the glare of the Washington press corps, the invitation-only meeting led to a fruitful discussion among senior lawmakers engaged in health policy and finance, health industry representatives, leaders of health policy think tanks, and heads of U.S. government agencies. Participants discussed health care pricing, medical technology, health care quality, transparency, research, and the role of the consumer in health care decision making. Susan Bartlett Foote, SPH associate professor and director of MTLF, says the annual Capitol Forum allows MTLF participants, including health professionals, academics, bioengineers, medical device firms, and consumer groups, to dialogue with a small group of key leaders in the public and private sectors about important policy issues of the day. “The players are leaders in their fields, the presentations are informative, and the ensuing discussions are candid and engaging,” says Foote. “In the end, I believe the Capitol Forum gatherings have the ability to inform and advance the debate on critical health care financing issues facing our country.” The 2007 MTLF Capitol Forum Report is available as a free download at www.MTLF.org.

EPIDEMIOLOGY AND COMMUNITY HEALTH

More Weighing May Mean More Troubles For Teens Teenage girls who frequently weigh themselves are more likely to binge eat and resort to unhealthy dieting measures, according to new research from SPH professor Dianne Neumark-Sztainer. A study published in a recent issue of the Journal of Adolescent Health found frequent selfweighing in teenage females did not help with better weight management. And the most frequent scale-steppers were more likely to skip meals, use diet pills or laxatives, smoke to lose weight, and binge eat. “As a society, so much attention is given to weight and staying within a specific number range to maintain a healthy lifestyle,” says Neumark-Sztainer, lead author of the study. “Our research shows that encouraging teens to focus on weight as a number is not helpful. In fact, it could be harmful.” The study, Project EAT: Eating Among Teens, tracked 2,500 Minnesota adolescents over a five-year period. The teens took two surveys, one in 1999 and another in 2004, to determine if those who reported frequent self-weighing were at an increased risk for obesity and eating disorders. In addition to being associated with unhealthy eating behaviors, there was no evidence that self-weighing helped with weight management. In fact, younger girls who weighed themselves more frequently had the highest weight gains over time. “We should tread cautiously before recommending that teens weigh themselves frequently when trying to manage weight,” says Neumark-Sztainer. “Self-weighing may be helpful to adults, but in adolescents it may not be the best option.” Neumark-Sztainer is author of the book, ‘I’m Like So Fat!’: Helping Your Teen Make Healthy Choices About Eating and Exercise in a Weight Obsessed World.

University of Minnesota School of Public Health

Spare-Time Activities Counter Workplace Idleness Daily activities outside of work may make up for sedentary hours in the office, new School of Public Health research finds. Researchers report that Minneapolis-St. Paul residents are expending significantly more energy through leisure activities than they were five years ago. As much as 70 percent of energy expended was on “personal lifestyle activities” that ranged from gardening and housework to biking and running. That’s good news, considering the same study found that the percentage of Twin Cities residents who sit for the majority of their work day increased from 57 percent to 71 percent since 1980. “Physical activity has decreased over the past 20 years in the work place, which makes it difficult for people to meet daily exercise recommendations,” says SPH assistant professor Lyn Steffen, lead researcher of the study. “But people can help fill the gap by participating in activities that are part of a daily routine, like walking their dog, playing with their kids, doing yardwork, and cleaning.” In the study’s most recent survey, only 20 percent of women and 30 percent of men were meeting the one hour of daily physical activity recommended by the Institute of Medicine. While the total hours spent exercising increased from 1980 to 2000, people still are not exercising enough, says Steffen. Even simple things, like taking the stairs, parking the car away from the building, and walking briskly are sources of physical activity, Steffen says. “Reengineering our culture and environment to include more opportunities for physical activity would go a long way to making our daily routines healthier.”

EPIDEMIOLOGY AND COMMUNITY HEALTH

Lung Function Linked to Stroke Risk People with poor lung function face an increased risk of stroke, even if they have never smoked or experienced respiratory problems. But the link may only hold true for white populations, not African Americans. SPH professor Aaron Folsom and colleagues were among the first to examine the tie between lung function and stroke incidence in African Americans. For 13 years, they followed nearly 14,000 adults, about a quarter of whom were African American. In that time 472 of the participants had strokes. Folsom’s team found that chances of a stroke went up as lung function went down. The relationship weakened once other risk factors—such as smoking, diabetes, and cholesterol levels—were taken into account. But the link remained statistically significant for white participants. Those with the lowest lung function had a 59 percent higher risk of stroke than those with the highest lung function. Researchers found the link even for white adults who had never smoked or experienced respiratory symptoms. But this was not the case for African-American participants. The results for African Americans may be explained by chance, says Folsom, because of the relatively small numbers of African Americans in the study, or because lung function measurements may have been less reliable in the AfricanAmerican group. The findings appear in a recent issue of the medical journal Chest. The findings do, however, support previous research linking lower lung function to stroke in white populations, even when taking into account other risk factors.

Americans Take Moderate Steps to Heart-Healthy Diet The quality of people’s diets designed to prevent coronary heart disease has “moderately improved” over the last two decades, but the trend may not be continuing, according to research from SPH associate professor Lisa Harnack. Harnack and colleagues analyzed data from more than 11,000 adults who took part in the Minnesota Heart Survey to measure whether their eating habits met dietary guidelines set by the American Heart Association. The researchers found that between 1980 and 2002, participants ate more fruits and vegetables, total grain and whole grain, and less total fat, saturated fat, trans fat, and cholesterol. They also drank less alcohol. The improvements in diet paralleled declining rates of heart disease and death, “suggesting that public health efforts to improve the population diet for coronary heart disease prevention may be yielding health benefits,” the researchers report in the Journal of the American Dietetic Association. However, Harnack’s team also found continuing “areas of concern” for three areas. Energy balance (consuming more calories than burned) and sodium intake worsened. And fish consumption remained below recommended levels. Another “worrisome finding,” Harnack says, “is that overall improvements in diet appear to have leveled off during the last five-year period we studied, after consistent progress between 1980-82 and 1995-97.” “We observed a reversal of some favorable trends, with saturated fat and cholesterol increasing in the latest survey period,” she says. “The rising popularity of low-carbohydrate diets such as the Atkins diet may have contributed to these unfavorable trends.”

ENVIRONMENTAL HEALTH SCIENCES

Concerns Deepen Over Tainted Water

Using Photography to Fight Pesticides

For more than two years, the Minnesota Pollution Control Agency (MPCA) has been scrambling to deal with groundwater pollution from 3M compounds called perfluorochemicals (PFCs). The likely sources are three Twin Cities landfills that 3M used to dispose PFC waste from 1956 to 1974. A recent discovery of contaminated wells has intensified concerns about the safety of drinking water. At one time the company used PFCs to make ScotchGard and other 3M products. Studies have shown that some of the chemicals are toxic to laboratory animals. Still, the pollution isn’t high enough to legally require 3M to remove the contaminated soil. SPH associate professor Matt Simcik, who studies PFCs, says the levels found in an Oakdale, Minn., dump are among the highest he has seen. He has been talking with the MCPA on how to deal with the contaminants. The usual route for PFCs is to accumulate through the food chain until concentrations reach significant levels. This route recently prompted Minnesota officials to limit consuming certain types of fish in the Mississippi River. But Simcik calls this latest discovery “a whole new route of contamination.” “These chemicals don’t stick to soils, so you can’t easily remove them from groundwater,” he says. Two other methods often used to remove chemicals from groundwater —aerating or injecting a retarding substance into the subsurface—also are unlikely candidates to stop the PFCs. So for now 3M is arming households with carbon filters. Simcik says it’s a good temporary solution but more bad news is likely on the way: “Based on the levels we’re finding now, I think we’re going to discover even more contamination.”

SPH associate professor Pat McGovern and doctoral student Maggie Stedman-Smith are collaborating with the University’s Regional Sustainable Development Partnerships program on an innovative way to assess pesticide exposure in Minnesota’s Red River Valley. The Red River Valley in northwest Minnesota is a major wheat, sugar beet, and potato-growing region. It also contains some of the country’s highest levels of pesticides. Recent research that included the valley showed death rates from birth defects among male infants born in “high wheat producing” counties was more than twice as high as in “low wheat producing” counties. While the study’s design limits the ability to draw cause and effect relationships on an individual level, the findings warrant further research. Home gardens, lawns, and indoor pest control are other sources of pesticide exposure in the valley. The University team will work with three communities: immigrant families from Somalia, women and children in the federal WIC program, and the White Earth Band of Chippewa. The researchers are using a method called photovoice in which community members are given cameras and asked to take photos that show their families’ exposure to pesticides. Photovoice has been successful with populations that rely on oral storytelling over written communication. The photos will be compiled in an exhibit for local government, health care providers, and tribal councils. Blue Cross and Blue Shield is funding the one-year planning grant. The hope is that it will lead to more projects in which these populations can identify and curb pesticide exposure. “The notion is to build confidence in the community and let them tell their own stories,” says McGovern.

University of Minnesota School of Public Health

PUBLIC HEALTH EDUCATION AND OUTREACH

Genomics Featured in Upcoming Institute This year’s Public Health Institute will feature courses and events on the science and politics of genomics. Most of the benefits regarding genomics have centered on how individual patients may be affected. There is, however, another important aspect of genomic science that has the potential to powerfully affect the health of populations. This emerging field of public health genomics examines the impact of genes and their interaction with behavior, diet, and the environment on the population’s health. Offered through the School of Public Health, the Public Health Institute is an annual three-week offering that allows students to design their own course of study. The institute draws participants from throughout the country. Courses, field trips, and lectures are organized around 11 different focus areas. This year, the institute will run May 21-June 8 on the University of Minnesota campus. The genomics courses are the result of a collaboration between SPH professor William Toscano and Kristin Peterson Oehlke, coordinator of the Genetics Project at the Minnesota Department of Health. The two are serving as lead faculty for the classes. Courses will also feature guest lecturers. Vilmunder Gudnason, University of Iceland, will speak on how the virtually homogenous population of his country has helped to offer insight into the area of cardiovascular genetics. Muin Khoury, director of the National Office of Public Health Genomics at the CDC, will discuss his views on the field. More on the institute can be found at www.cpheo.sph.umn.edu/institute.

U Offers Tools for Personal Emergency Planning For the first time, University experts are offering free online tools to help individuals and families plan for potential disease outbreaks and natural or man-made disasters. The materials are designed so that individuals can tailor plans to their own unique needs. The tools are part of a larger curriculum to teach trainers to conduct preparedness workshops in their communities. The curriculum comes from MERET (Minnesota Emergency Readiness Education and Training), a joint initiative of the School of Public Health and the School of Nursing. Last fall, 115 trainers completed training, and they are now holding workshops around the state. “The success of any emergency preparedness plan—for counties, states, or countries—depends in large part on how prepared its residents are,” says Andrea Hickle, MERET coordinator. “We hope these tools can help to establish a foundation of preparedness among households.” Users are guided through seven steps to becoming prepared. The first is developing a plan to communicate with family and friends. “A Day in My Life” inventory helps identify must-have supplies. For short- and long-term emergencies, users can access a checklist of supplies and tips on how to assemble and inventory items so they don’t expire. The same steps apply to “Go Kits,” which consist of items people could grab quickly for three days away from home. To develop the materials, MERET worked with University colleagues in the Academic Health Center Office of Emergency Response and the Department of Emergency Management. The Minnesota Department of Health also contributed. To access the tools, go to www.sph.umn.edu/preparedness. 11

BIOSTATISTICS

Treating Gum Disease Does Not Lower Risk of Preterm Birth Pregnant women who receive nonsurgical treatment for periodontal disease do not lower their risk of delivering a premature or low-birthweight baby. The results come from the largest clinical trial to date evaluating whether treating periodontal disease during pregnancy reduces the risk of early delivery. Observational studies have suggested that gum disease might be a risk factor of preterm birth. The theory is that bacteria associated with periodontal disease spread to the womb to induce preterm delivery, or that the body’s response to periodontal bacteria indirectly induces preterm delivery. Bryan Michalowicz, a periodontology professor at the University of Minnesota’s School of Dentistry, led the study. SPH associate professor Jim Hodges directed the study’s coordinating center and was second author on the findings, published recently in the New England Journal of Medicine. Researchers enrolled 823 pregnant women with periodontal disease from four U.S. centers: Hennepin County Medical Center in Minneapolis; University of Kentucky in Lexington, Ky.; University of Mississippi-Jackson Medical Mall in Jackson, Miss.; and Harlem Hospital-Columbia University in New York City. These centers generally provide prenatal care to low-income, underserved women of all races— a group recognized as being at high risk for early delivery.

SPH Partners with Mayo Clinic on Clinical Trials Course The tool behind the School of Public Health’s latest partnership with the Mayo Clinic is television. For the first time, staffers in the division of biostatistics at the Mayo Clinic can take an SPH course in clinical trials through interactive television (ITV). The ITV course lets Mayo students in Rochester, Minn., tune into a live broadcast for twice-weekly classes. SPH professor James Neaton, an expert in conducting large national and international clinical trials, is the instructor. The ITV technology allows both Neaton and the Mayo students to see each other and converse. The six Rochester-based students can also interact with the 70 other students in the Twin Cities campus classroom.

University of Minnesota School of Public Health

Researchers found no significant differences in preterm birth rates or birth weight between participants who received periodontal treatment and those who did not. However, periodontal treatment was safe and did improve periodontal disease. An “intriguing but inconclusive” finding, according to Hodges, is that women who received periodontal therapy experienced fewer miscarriages than the women who were not treated. Future studies will help determine if this link is significant.

Faculty in the division of biostatistics partnered with Dan Sargent on the offering. Sargent, professor of biostatistics at Mayo and director of statistics at the Mayo Clinic Cancer Center, earned an M.S. and Ph.D. from the SPH. He also serves as an associate academic advisor for his alma mater. “This partnership gives our staff access to a world-class curriculum, with all the conveniences of distance learning,” he says. The partners are hoping this first course offering will strengthen and expand the existing research collaborations between the two organizations. The ultimate goal is to offer M.S. and Ph.D. biostatistics degree programs to Mayo Clinic employees. “This is an exciting first step in what we hope will be a long and fruitful partnership,” says John Connett, head of the SPH division of biostatistics. “Working collaboratively on research and educational programs is key to training the growing data-based health care workforce.”

Students Lobby for a SmokeFree State

SPH students and alumni meet with Sen. Lawrence Pogemiller, back row, center.

Madeleine Albright, center, with SPH students and professor Michael Osterholm, at right.

SPH Students Attend Pandemic Flu Summit Eighteen SPH students took part in the recent Business Preparedness for Pandemic Influenza second national summit in Orlando, Fla. The invitation to join the gathering of leaders came from their professor Michael Osterholm. Osterholm’s Center for Infectious Disease Research and Policy (CIDRAP) delivered some big names at the summit. Margaret Chan, director-general of the World Health Organization, spoke in a videotaped message on the inherent global nature of pan flu. CDC director Julie Gerberding challenged businesses to stay focused on the “marathon” of preparing. Former U.S. secretary of state Madeleine Albright called the summit “a true national service.” In a meeting with the students before her keynote address, Albright encouraged the group to consider new career options. “If ever there was an issue that is transnational and global, it’s public health,” she said. “Think about a career in diplomacy—we need experts.” The students witnessed corporate executives debating pandemic issues rarely talked about in classrooms. How would businesses deliver masks, drugs, and food? What if half of the workforce fell ill? Would the Internet function? The summit underscored an important lesson: Tomorrow’s public health leaders need to understand the private sector, and the private sector looks to public health on issues of preparedness. “Public health can be an important player at the national and international level,” said Osterholm. “It’s about understanding consequential public health. It’s not enough to learn it, to preach it. You must practice it.” To read a student blog of the summit, go to http://blog.lib.umn.edu/sphpod/panflu/.

Photo: Tim Rummelhoff

School of Public Health students recently joined 800 fellow Minnesotans to rally for statewide smoke-free legislation. The students, along with SPH faculty and alumni, gathered at the Minnesota Capitol to meet with legislators on the issue. The students told lawmakers about a recent poll that finds 69 percent of Minnesotans in support of comprehensive smoke-free legislation. But they also shared personal stories on why the issue is important for them. Amanda Woodfield said she was at the capitol for her grandfather. Although he never smoked, he worked with smokers in a Pittsburgh area post office. When he died of lung cancer, Woodfield was inspired to act. The public health administration and policy student works on Quit and Win, a program that helps college students to stop smoking. Woodfield and other SPH students met with Sen. Lawrence Pogemiller and Rep. Phyllis Kahn. Both legislators are optimistic about passing a statewide bill in the 2007 session. Kahn was chief author of the pioneering Minnesota Clean Indoor Air Act of 1975. When Minnesota became the first state to pass the indoor air act, it was thought to be a leader in protecting people from secondhand smoke. Today, more than 20 other states have passed statewide smoke-free laws while Minnesota has failed to do so. Fourteen organizations sponsored Smoke Free Minnesota Day at the Capitol, including the School of Public Health. SPH Dean John Finnegan served as master of ceremonies for a pre-Capitol gathering.

STUDENT NEWS

SCHOOL NEWS SPH Gears Up for Film Festival

University of Minnesota School of Public Health

Harry Lando

Lando Awarded for Global Engagement Professor Harry Lando has received the Award for Global Engagement from the University of Minnesota. Lando is one of the world’s preeminent researchers in the area of tobacco use prevention and control. The diseases associated with tobacco use are now shifting to developing countries. According to World Bank statistics, by 2020 seven of every 10 people killed by smoking will be in developing countries, those with the fewest resources for tobacco control. This is where Lando has chosen to make his mark. “If we can reduce this projected toll by even 10 percent, the savings in lives, in suffering, and in economic loss will be immense,” he says. Among his work is a $1.8 million National Institutes of Health grant to conduct smoking cessation research and training in India and Indonesia. Lando has also brought leadership—including a term as president—to the Society for Research on Nicotine and Tobacco (SRNT), the only international organization solely developed to do research in tobacco prevention and control. His work with SRNT has helped elevate current membership to 1,200 researchers representing upwards of 50 countries. Much of his focus is on mentoring junior scientists and scholars. With a goal of reducing the global tobacco death rate by 10 percent over the next 20 years, Lando is working tirelessly to unite various constituencies from around the world. “We need to get away from our parochial turf issues to help make a difference,” he says. “I honestly believe that for the first time in my 30 years as a researcher we are in a unique position to make it happen.”

Photo: Tim Rummelhoff

It promises to be provocative, educational, and entertaining. Sound interesting? If so, join the School of Public Health as it celebrates National Public Health Week with a host of compelling films and engaging discussions that are sure to stimulate. The third annual National Public Health Week film festival begins Monday, April 2, and goes through Friday, April 6. Activities will begin at 5:30 p.m. and take place on campus in the newly remodeled Mayo Memorial Auditorium. Each night a different theme will be presented on topics that include aging, immigrant health, AIDS/HIV, climate change, and sex education. Experts will participate in panel discussions, as well as answer questions about the films and subject matter—audience interaction is encouraged. Some of the films that will be screened include An Inconvenient Truth, the Oscar-winning documentary featuring former vice president Al Gore’s quest to halt global warming; The Split Horn: Life of a Hmong Shaman in America; State of Denial, a film about AIDS/HIV set in South Africa; Living Old, a look at chronic illness in America; and a series of short sex education films. The sex ed films date back to the 1950s and move up to current times with Think MTV: Campus Guide to Safer Sex and Abstinence Comes to Albuquerque. The film festival is free and open to the public. For more information about the festival, including directions to the theater and the themes for each night, visit www.sph.umn.edu/ filmfestevents.

SCHOOL NEWS

David Jacobs and Susan Goodwin Gerberich Photo: Tim Rummelhoff

Dean Names Mayo Professors School of Public Health Dean John Finnegan has named Susan Goodwin Gerberich and David Jacobs Mayo Professors of Public Health, the school’s highest recognition of its faculty members. Made possible by the estates of Charles and William Mayo, the Mayo Professor of Public Health designation dates back to the foundation of the school in 1944. Gerberich is best known for helping to found the field of injury prevention research. She is the director of the Regional Injury Prevention Research Center and the Center for Violence Prevention and Control at the University of Minnesota and serves as a consultant to the National Institute of Occupational Safety and Health. She is the author of three books and more than 100 peer-reviewed journal articles. Jacobs is a noted epidemiologist who specializes in cardiovascular disease prevention research. Most recently his research has centered on the health benefits of whole grains. He is a fellow in the American College of Nutrition and the American Heart Association’s Council on Epidemiology and Prevention. He serves on the editorial boards of the British Journal of Nutrition, Clinical Chemistry, and Preventive Medicine. He has authored close to 500 peer-reviewed articles, book chapters, and editorials. “Sue Gerberich and David Jacobs have developed exactly the kind of careers that the Mayo Professorship seeks to honor,” says Finnegan. “Their research programs are well articulated, sustained, and far-reaching in their impact on health. They are known nationally and globally for their work, and they serve as exemplars for all of us.”

Web Extras: Get More from the SPH Online! SPH Research Brief www.sph.umn.edu/brief SPH experts share their latest research findings in this monthly online publication.

SPH Podcasts www.sph.umn.edu/podcast • Public Health Moment Tune into regular 90-second health segments featuring SPH faculty. Recent segments feature patient safety, cervical cancer, and teen diet dangers. • Public Lectures Choose from public health presentations by leading experts. Hear what Minnesota Gov. Tim Pawlenty had to say at the Midwest States Health Reform Summit. • My Life See what life is like for a SPH student in these short video segments. New installment just posted!

SPH Blogs www.sph.umn.edu/sphere Students blog about studying public health at the University of Minnesota, attending a pandemic flu summit in Florida, and working abroad for summer field experiences.

PHILANTHROPY Legacy of Ruth Stief Supports Program She Founded

University of Minnesota School of Public Health

Robert Veninga speaks to 150 colleagues, friends, and family at a reception commemorating his career.

SPH Professor Honored with Scholarship Fund Robert Veninga came to the School of Public Health as an instructor in 1969. Throughout the next 37 years, he served the school in various roles, including professor, division head, program director, and associate dean. Now, as he retires from an accomplished career, a colleague has inspired Veninga to step into yet a new role: philanthropist. SPH alumna Janet Porter (Ph.D. ’93) and her husband James O’Sullivan made a generous gift to establish the Robert and Karen Veninga Scholarship Fund. The Veningas soon followed with a significant contribution. And, in just two months, more than 70 alumni and friends have contributed. The fund will have its annual awards to international M.P.H. students doubled by the University’s scholarship match program. “These gifts pay tribute to Bob and Karen and their lifelong commitment to the University and the school,” says Porter. Veninga is best known for his work in organizational leadership. But being a mentor has always been at the heart of his career. Karen Veninga, an SPH graduate (M.P.H. ’76), worked for more than 25 years in health care. “As I cross paths with our alumni, there is one professor whose name is invoked with great fondness again and again, and that is Bob Veninga,” says SPH Dean John Finnegan. “With this gift, he continues to inspire and strengthen our school.” If you have an interest in supporting this new scholarship, please call Adam Buhr at 612-626-2391 for more information.

Photo: Tim Rummelhoff

Gutsy. Ahead of her time. Pioneering. That’s how colleagues describe Ruth Stief, founder of the public health nutrition program—one of the country’s first—in 1963. Generous comes up often, too. Stief, who recently died at age 94, directed the SPH public health nutrition program for 13 years. She also supported the program by establishing the Ruth E. Stief Public Health Nutrition Fund in 1985. She contributed $130,000 to the endowed fund during her lifetime and another $700,000 through her estate after death. Her gift will support faculty research and program development, and Ruth Stief with impact doubled by the University’s President’s Scholarship Match, the Ruth E. Stief Scholarship Fund will provide full support for five new students each year. “Ruth was always generous with her time and money,” says SPH professor Mary Story, a friend of Stief’s since the early 1980s. “It showed her firm belief in the program.” When Stief established the program, nutrition wasn’t widely viewed as a public health issue, says SPH instructor Bea Krinke. “Ruth pioneered a new way of looking at how to be a nutritionist, how to think about people’s eating habits and health.” Krinke and Story regularly visited Stief after she retired in 1976 and moved to Winona, Minn., her childhood home. “Ruth loved a good story,” says Krinke. “She wanted to stay informed. It was that spirit of engagement that made her such a leader.” To honor Stief, the public health nutrition program each year gives a star student a leadership award in her name. Exemplary. Stief remains the model. “In a sense, Ruth is leading us still with her generous estate gift,” says SPH Dean John Finnegan. “Her legacy will help build a better world.”

ALUMNI NEWS Alumni Society Board Planning Underway The School of Public Health is engaging with its vast alumni network by re-establishing the Alumni Society Board. A steering committee of alumni came together last fall and has been working to update the SPH Alumni Society constitution and bylaws, in preparation for assembling the board. Nominations to the board were sought over the last few months, and the steering committee is in the process of reviewing the nominations and naming board members. The board will consist of 15 members, representing a diversity of graduation years and programs. The first board meeting will be held in April. SPH Dean John Finnegan has charged the board to develop programming to provide value and lifelong learning opportunities to SPH alumni. Areas of focus for the new board will be public health advocacy, philanthropy to support scholarships, and advising on educational programming. “I am delighted to see alumni coming together with such great energy on behalf of the School of Public Health,” says Finnegan. “I think the SPH has a great deal to offer alumni and similarly our alumni are of great importance to the school.” Andrew Nelson, executive director of the Minnesota-based HealthPartners Research Foundation and vice president of HealthPartners, received a master’s in public health administration from the SPH in 1987. He is a member of the steering committee. “I don’t think there has ever been a better time to be engaged with the School of Public Health, given the significance of the field of public health and the prominence of the school,” says Nelson. “We need the collective leadership of our public health alumni to pave the way through changes in these next few years.”

Stay Connected! Do you have news to share—maybe about a new job, award, or other accomplishment? If you have news that you’d like to appear in a future issue of Advances, send it to SPHnews@umn.edu.

Premier Wins Malcolm Baldrige National Quality Award The Premier Inc. health care alliance is the only U.S. service company to win the 2006 Malcolm Baldrige National Quality Award (MBNQA). With this Richard Norling award, Richard Norling becomes the second SPH Master in Healthcare Administration (M.H.A.) alumnus to win the prestigious honor. Each year, the U.S. Commerce Department recognizes up to three organizations in each of the following categories: education, health care, manufacturing, service, and small business. The award is traditionally presented by the president of the United States. “This award is a tribute not only to our employees, but also to the commitment of our member hospitals across the nation,” says Norling, president and CEO of Premier Inc. “These farsighted community hospitals created Premier as a way to work together to continuously improve patient outcomes while safely reducing the cost of care. “Our staff deserves tremendous recognition for their dedication to this effort and their embrace of the principles of continuous improvement embodied by the Baldrige criteria.” Premier is one of the nation’s largest health care alliances, jointly owned as a shared resource by approximately 200 not-for-profit hospitals and health systems. They operate or are affiliated with about 1,500 hospitals and hundreds of other care sites. Norling joined Premier in September 1997, initially as chief operating officer. Before that, he was president and chief executive officer of Fairview Health Services, which serves the people of Minnesota through an integrated system of hospitals, clinics, and other service sites. He earned an M.H.A. from the University of Minnesota in 1975.

Would you like to connect to current SPH students and fellow alumni? Check out the Alumni Network at www.sph.umn.edu/alumni. 17

Upcoming Events Health Disparities Work Group Forum Relevant Risk, Revolution, and Revisiting Rose: Causes of Population Levels and Social Inequalities in Health March 23, 9:30 a.m.-noon Coffman Memorial Union Theater

National Public Health Week Film Festival April 2-6. Screenings begin at 5:30 p.m. Mayo Memorial Auditorium (See page 14 for more information.)

SPH Roundtable Series Human Rights, the Burden of Disease, and International Tobacco Control April 27, 8:30 a.m.-noon Humphrey Institute

MPHA Birthday Celebrating 100 Years of the Minnesota Public Health Association April 4, 2:30-4:30 p.m. Various sites around Minnesota See www.mpha.net for party locations and program details.

Community Action Forum Healthy Kids in Healthy Places May 9, 8:30 a.m.-4 p.m. Continuing Education Conference Center

SPH Commencement May 14, 5 p.m. Northrop Memorial Auditorium

Public Health Institute May 21-June 8 University of Minnesota, Twin Cities campus More information on these and other SPH events can be found at www.sph.umn.edu/news.

Public Health Discoveries . . . Delivered to You To stay current on the latest research findings from public health experts, sign up for Research Brief, a monthly electronic publication from the School of Public Health. www.sph.umn.edu/brief

Gaylord Anderson Lecture Mervyn Susser, Sergievsky Professor of Epidemiology Emeritus, Columbia University April 26, 4 p.m. Mayo Memorial Auditorium

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