Advances - Spring 2008

Advances Breakfast Keeps Teens Lean • page 7

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from the University of Minnesota School of Public Health

PRODUCTIVITY TO IMPACT

How the SPH became one of the most productive schools of public health in the country —and why it matters to you.

BATTLING BIRD FLU IN THAILAND PUBLIC HEALTH’S WORKFORCE SHORTAGE TRACKING TOXINS IN LOCAL LAKE MALARIA’S DEVASTATING AFTERMATH

FROM THE DEAN Dear Friends,

Photo: Richard Anderson

While it’s generally true that numbers don’t lie, it is also often the case that they don’t tell the whole story. I have seen some impressive numbers come across my desk in recent weeks, numbers that show the School of Public Health rising to new heights in terms of research productivity. What the numbers don’t necessarily tell though is the story of how our research affects communities and improves the lives of people. That is what we have tried to do with this issue’s cover story, “Productivity to Impact.” I hope as alumni, friends, and supporters of the SPH, you will join us in celebrating our success.

Some examples of this impact include promoting adolescent health, unlocking the mysteries of diabetes, working to understand how elements in the environment affect our health, and fighting the scourge of infectious disease around the world. Those stories are featured throughout this issue of Advances and represent our continuing commitment to improve public health.

While an April snowstorm threatened to interfere with our first-ever Alumni and Friends Scholarship Gala, you will see by the photos on page 17 that more than 200 of us enjoyed ourselves in spite of it. In the process, we reconnected with friends and continued the momentum of re-engaging our school with alumni at home and around the world. Read a recap of the evening and the rest of the jam-packed series of events held during National Public Health Week on pages 12, 14, and 17.

As we come to the end of spring semester and look toward our May 19 commencement, I would like to offer congratulations to our graduating students, thanks to our outstanding faculty and community partners who help make our education program one of the best in the country, and warm wishes to all of you for a relaxing summer.

Yours in health,

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

François Sainfort 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

Joe Weisenburger Chief Administrative Officer/ Chief Financial Officer

Contributing Writers Nicole Endres Toya Stewart Art Direction Todd Spichke Riverbrand Design

Contents Table of

Advances

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Feature: Productivity To Impact

The numbers are impressive. But it’s the community benefit behind the numbers that really matters. Find out how the

SPRING 2008

school’s high level of productivity has led to big-time breakthroughs in improving health.

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Division News

Western diet linked to metabolic syndrome, why so few

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veterans seek help for post-traumatic stress disorder, the hidden danger of flourescent bulbs, and more.

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School News

The dean speaks on public health’s workforce shortage, teens take top prize in filmmaking contest, SPH experts meet with bird flu partners in Thailand, and more.

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Student News

Three SPH students become CDC fellows, and the school

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awards top honors at the first-ever Research Day.

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Philanthropy

A woman’s love for animals inspires gift to an SPH center.

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Alumni News

Highlights from National Public Health Week, Epi grad pursues

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pharmacy path, alumni events hit the road, and more.

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PRODUCTIVITY TO

IMPACT

How the SPH became one of the most productive schools of public health in the country—and why it matters to you.

The University of Minnesota School of Public Health broke one of its own records in 2007. It rose to third place among all schools of public health in National Institutes of Health (NIH) grants, behind only Johns Hopkins and Harvard. The SPH’s annual sponsored project productivity is now $92 million.

Not bad for a school that has only about 25 to 50 percent of the faculty complement respectively of the top two schools.

The SPH also ranks first in average award amount from the NIH among the nation’s 40 accredited schools of public health. With an average award of $1.3 million, the SPH is ahead of its nearest competing school of public health by more than double and with fewer faculty members than many other top-producing schools.

At home, the SPH’s extramural research productivity puts it second at the University of Minnesota, behind only the Medical School, but also tops in per faculty member amount of grants and contracts.

And it makes for a sound investment. For every dollar the SPH receives from the State of Minnesota, the school generates nearly $10 in sponsored research—essentially new dollars brought to the state.

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University of Minnesota School of Public Health

F E AT U R E S TO RY The SPH is #1 in a ranking of NIH awards for public U.S. schools of public health. The SPH is #3 for all public health schools in the nation.

• NIH awards to the SPH in 2007: $59,592,119 • In the past two years the SPH moved from 5th to 3rd place

The SPH is #1 in a ranking of average NIH awards to U.S.

#1 in the Country The SPH is #1 in a ranking of grant funds per faculty member of all U.S. schools of public health. This makes the SPH the most productive public health school in the nation.

• Average 2007 award per faculty member: $447, 513

“If we were a business focused on the bottom line only, we could end this discussion now and simply celebrate our productivity,” says SPH dean John Finnegan. “But we are part of a public research land-grant university. We are in the business to improve people’s lives, a privilege provided and supported by the people of Minnesota and the United States. We search for knowledge, discover it, learn it, teach it, and transform it to make a difference in people’s lives.”

While the dollar amounts are impressive, it’s the impact of those dollars that really matters. Among other things, it helps make it possible to train the next generation of public health professionals and scientists with state-of-the-art tools and best practices. With the student body more than doubling since 2004, the school is certainly doing its share to train leaders in public health—a field facing a serious workforce shortage. But impact lies importantly in how faculty-led research makes a difference in people’s health.

This work by SPH faculty has led to advances in how we treat and prevent some of today’s most devastating health conditions like AIDS, cancer, and cardiovascular disease.

It has grappled with America’s biggest health care challenges, including how to address the growing number of those who lack health insurance, how to cope with an aging society, and how to prepare for an influenza pandemic. And it has set a multidisciplinary example of how to collaboratively tackle complex issues such as obesity, environmental pollutants, and infectious disease.

SPH’s productivity and impact are part of the school’s collective culture of engaging senior and junior faculty.

Senior faculty have long tutored and nurtured younger faculty as mentors and leaders of research groups.

“This part of our culture is important because it is where you learn the art of creating a research program and also

schools of public health.

• Number of NIH awards to the SPH in 2007: 44 • Average amount of those awards: $1.3 million —an amount that is more than double the second ranked school sources: Association of Schools of Public Health and www.nih.gov

the art of grantsmanship. You don’t often learn those things in professional or graduate training, but here you definitely have opportunities to learn from experienced senior faculty.

We are doing this sort of mentoring better all the time,” says Finnegan. He also notes that faculty mentor programs are now required in the school.

SPH experts are also committed to sharing their expertise with the public through media outreach. A day rarely goes by where faculty members aren’t featured in print, radio, and television news—whether it be to report their own research findings or to offer a scientific opinion on a hot issue. “Talking with the media is one of the most direct ways we as public health researchers can get our knowledge out and help communities live healthier lives,” says Finnegan.

While there are too many renowned senior faculty leaders across the SPH to capture here, a few of them took time to reflect on their greatest contributions, the collaborations they lead, and how they’re helping to shape the future of their field.

Cardiovascular Epidemiology SPH professor Aaron Folsom is an international expert on the risk factors for cardiovascular disease, and he’s one of the field’s most influential thinkers. According to the Web of Science database, his work has been cited more than 13,600 times in published research.

Through large, observational studies—some going on for more than 25 years—Folsom has shown that cardiovascular disease and diabetes are linked to an excess of hip or abdominal body fat distribution in women. He’s also helped identify why U.S. death rates from coronary heart disease and stroke have declined, shedding light on which prevention techniques have worked.

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FEATURE STORY

#1 at the U of M The SPH is #1 in a ranking of total average awards to U of M units, colleges, and schools. The SPH is #2 at the University in overall extramural research funding.

• Average award amount in 2007: $408,921 —an amount that is more than double the Medical School, the second ranked U of M unit The SPH is #1 in a ranking of success rates of garnering sponsored projects at the U of M • The SPH is awarded 79% of all awards it applies for—10% more than the average U of M success rate source: www.oar.umn.edu/trends

A strength of these long-term, large studies is that they can test the effectiveness of preventive medical technologies as those technologies evolve. For example, CT scans to assess coronary artery calcium didn’t exist when some of the studies began. But as that technology became more common, Folsom’s team was able to show that CT scans do play an important role in predicting heart disease.

“New techniques will continue to come along, and they will need to be evaluated,” says Folsom, who sees genomics and proteomics as the next step. With stored blood samples from thousands of study participants, the researchers have again adapted their work for the emerging field of DNA study.

Global HIV Trials In leading the world’s largest HIV clinical trials, SPH professor James Neaton has helped to make significant improvements in the way the disease is studied and treated.

These large randomized trials have led to changes in treatment that have meant an improved quality of life—and longer lives—for countless people worldwide.

Neaton credits this success to an ever-growing global collaboration of HIV researchers. Led by Neaton and known as INSIGHT, the group is set to launch a new trial on early 4

University of Minnesota School of Public Health

treatment for HIV that will involve 4,000 patients from 30 countries. Five pharmaceutical companies have agreed to provide drugs and several governments are sponsoring the work, including Germany and France.

INSIGHT’s trials have had major support from the U.S. government as well. In 2007, Neaton ranked fifth of all individuals in the U.S. conducting research under the NIH. That funding accounts for 10 percent of all NIH funding at the University of Minnesota.

One of INSIGHT’s greatest breakthroughs came from the SMART trial. The study showed that the risk of organ disease and cancer is greater among those not treated for HIV than those who receive drug treatment. The findings had an immediate impact—clinical practice guidelines changed within a month. “The SMART trial was totally unpredicted, and it changed the way we think about HIV treatment,” says Neaton. “What we thought were complications of treatment appear in part to be complications of HIV.”

Closing Health Coverage Gaps Since opening its doors in 2000, the State Health Access Data Assistance Center (SHADAC) has contributed to increases in health coverage and access throughout the country by helping policymakers better understand the factors that leave people without health insurance.

Led by SPH associate professor Lynn Blewett, along with SPH faculty members Kathleen Thiede Call and Michael Davern, SHADAC has implemented innovative methods to help bridge the gap between health care coverage data and policy, and helped ensure that information and communication span the sometimes-wide chasm between states and the federal government.

SHADAC has had a major impact on how analysts, policymakers, and others think about and measure the 47 million Americans who lack health care coverage. The center has been instrumental in helping decision-makers understand how estimates of the number of uninsured kids affect the allocation of federal funding to states for children’s health insurance programs. SHADAC has also developed the Coordinated State Coverage Survey that is being used by 20 states to understand the unique characteristics of the uninsured.

SHADAC has elevated the role of states and state-level research in the national discussion of health reform, a trend that Blewett sees continuing. “If and when we get to universal coverage, states will be ready to implement national policy,” she says. “I hope to be involved in representing state needs in national discussions of health reform.”

Protecting Our Waters For the past 20 years, SPH associate professor Deborah Swackhamer has studied how toxic chemicals affect our waters and our health. She has examined how chemicals behave in lakes, soil, and air and how humans are exposed to these toxic substances.

Her work has been key in helping Minnesota officials set limits on local fish consumption. These advised limits play an important role in protecting the health of Minnesotans, especially pregnant women and children, who are most vulnerable to the contaminants found in river and lake fish.

As interim director of the Institute on the Environment, Swackhamer is leading the University of Minnesota’s most comprehensive and ambitious environmentally focused endeavor to date. The institute brings together the vast collection of University environmental experts, helping to trigger even greater discoveries.

As water continues to become a more precious resource, Swackhamer believes that her expertise can best be used to guide decision-makers in creating laws that would protect the environment and the population. “Good science is the basis for good policy,” she says. “And a healthy environment is critical to human health. You can’t have one without the other.”

Project EAT Not long ago, the study of eating disorders was limited to the area of psychiatry, not public health. And preventing eating disorders was typically seen as a separate practice from preventing obesity. These models held true until the work of SPH professor Dianne Neumark-Sztainer.

Sound Investment For every dollar the State of Minnesota invests in the SPH, the school generates nearly $10 in sponsored research. source: U of M

With Project EAT (Eating Among Teens) Neumark-Sztainer was able to change the landscape of her field and produce a series of highly influential findings on the many factors that affect eating patterns, self esteem, and weight issues among adolescents. More than a hundred published papers have come from the research.

Project EAT’s landmark findings have shown the benefits of consistent family meals, the prevalence of steroid use among teens, and the dangers of weight-based teasing.

Neumark-Sztainer is committed to reaching the public with her expertise. She and colleagues have appeared in hundreds of print, radio, and television outlets discussing Project EAT. In 2005 Neumark-Sztainer completed “I’m, Like, SO Fat!” Helping Your Teen Make Healthy Choices About Eating and Exercise in a Weight-Obsessed World.

The book translates the science behind her research for parents of teens. “Parents really struggle with what kinds of messages to give kids,” she says. “There’s so much interest in this area.”

Transforming Long-Term Care

Tremendous Growth SPH sponsored revenue has increased by 55% since 2006.

• 2006 revenue: $66,023,330 • 2008 projected revenue: $102,261252

Faculty ranks have increased by 37% since 2004.

• From 95 faculty members to 130 in 2008

Student ranks have grown by 218% since 2004.

• From 615 students to 1,343 in 2007 source: SPH

SPH professor Robert Kane is a top authority on aging and long-term care who has written more than 30 books and 300 articles on the subject. Together with his wife, SPH professor Rosalie Kane, he has made countless contributions in improving quality of care, and has led advances in demonstrating the effectiveness of a quality-based payment system for long-term care facilities.

“But my epiphany came when I had to organize care for my mother,” says Kane. Despite more than 30 years of professional expertise and a long list of personal contacts with experts around the country, he couldn’t get the system to work right in an effort to care for his mother. So he and his sister wrote It Shouldn’t Be This Way: The Failure of LongTerm Care, a book for the millions of families navigating the confusing maze of long-term care. Kane also founded 5

FEATURE STORY

Innovations in Prevention Professionals with Personal Experience in Chronic Care, a national advocacy and awareness organization now 800 members strong.

Kane recently developed two online tools designed to help the public. With the State of Minnesota, he created the Nursing Home Report Card, a ranking system that helps people choose care based on their unique needs and motivates improvements among low-scoring facilities. He also served as the scientific expert for the Vitality Compass, which predicts one’s life expectancy based on current lifestyle habits and coaches individuals on how to live healthier and longer.

Fighting Obesity on All Fronts In the midst of America’s obesity epidemic, SPH researchers have made important strides in providing scientific evidence on what factors help people to make healthier choices about eating and physical activity. Their work has centered on school and worksite food environments, access to healthy food in low-income communities, portion sizes, and the influence of food pricing.

“Taking a wide-ranging, multidisciplinary approach is key,” says SPH professor Robert Jeffery who heads up the University of Minnesota Obesity Prevention Center (OPC) with co-directors and SPH professors Mary Story and Simone French. Since it began in 2004, the OPC has attracted more than $75 million in sponsored research for 30 projects.

More than 50 University faculty members from close to 30 different schools and colleges are OPC members. Beyond the health sciences, fields represented include psychology, sociology, anthropology, and civil engineering.

“Nobody can do this work alone,” says Story, a national expert on child and adolescent nutrition. “The school has been able to show how effective this multidisciplinary model can be.” Story directs the national program office for Healthy Eating Research, a Robert Wood Johnson Foundation-funded project that is setting a national agenda on preventing childhood obesity through environmental and policy approaches. She has also been involved with innovative NIH studies in which researchers partner closely with American Indian nations to reduce obesity and diabetes in children. “We’ve been able to achieve our accomplishments because of our partners and collaborations,” says Story.

A lot of what we know about heart disease can be traced back to the work of pioneering cardiovascular disease investigators like SPH professor Russell Luepker. But perhaps as significant as Luepker’s contributions to heart health are the surveillance and prevention methods he helped introduce.

The Minnesota Heart Survey demonstrates this “double impact” well. Launched in 1980, the project marks the largest community-based surveillance study ever granted in the state. It has played a major role in understanding the trends behind and risk factors for heart disease.

From the foundation of studies like these, SPH researchers have built a reputation on how to create successful prevention techniques in other areas such as tobacco use among youth. “The strategy used to be to tell teens they’d get cancer as adults,” says Luepker. “But that had no relevance for kids, who live in the short term.” So the researchers instead focused on social factors like friends and the school environment. Says Luepker, “we were early thinkers in these strategies, which are now widely accepted.”

“We’ve been fortunate to define the public health field, rather than waiting for others to identify the issues. That’s what being a leader in the field means.”

Prolific Research SPH faculty have authored some 3,600 publications since 1975.

• 1980-1989: 383 pubs.

• 1990-1999: 1,310 pubs.

• 2000-2008: 1,860 pubs.

Twenty of the school’s most productive faculty members have authored more than 2,000 publications and have been cited in other scholarly publications more than 65,000 times.

Faculty publications have more than doubled from 2000 to 2007.

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University of Minnesota School of Public Health

source: Web of Science

Diet Soda, Meat, and Fried Foods Linked to Metabolic Syndrome School of Public Health researchers have found a new reason to cut back on diet soda, meat, and fried foods. They all appear to raise the risk of metabolic syndrome, a condition that leads to diabetes and heart disease.

Metabolic syndrome develops when a person has three or more of the following risk factors: elevated blood pressure, abdominal obesity, and abnormal levels of triglycerides, blood sugar, and cholesterol.

The study was led by SPH associate professor Lyn Steffen, and doctoral student Pam Lutsey served as the first author.

The researchers followed the eating habits of close to 10,000 people. After tracking the group for nine years, they concluded that consuming two portions of meat a day increased the risk for metabolic syndrome by 26 percent, one daily can of diet soda increased risk by 34 percent, and fried foods by 25 percent.

Why diet soda proved to be a culprit is not yet known.

Steffen says it could be an ingredient in the soda, or it could be the lifestyle of the consumer. “Those who drink diet soda may overcompensate their consumption of other non-healthy foods,” she explains.

Dairy products, by contrast, appeared to offer some protection against metabolic syndrome. Three low-fat servings a day lowered risk by 13 percent.

Steffen says the typical western diet, which is heavy on red or processed meat and low on fish, fruit, vegetables, and whole-grains, isn’t doing Americans much good. “You don’t have to completely avoid certain foods and beverages,” she says. “But it’s important to eat a variety of foods in moderation.”

To hear a Public Health Moment about this study, WEB EXTRA go to www.sph.umn.edu/moment/.

WEB EXTRA

WEB EXTRA

EPIDEMIOLOGY AND COMMUNITY HEALTH

Teens Who Eat Breakfast Are Healthier Teenagers who regularly eat breakfast tend to weigh less, exercise more, and eat a more healthful diet than their breakfast-skipping peers, finds new research from the School of Public Health.

The study, part of Project EAT (Eating Among Teens), involved more than 2,200 Twin Cities adolescents who were tracked for five years. Findings were published in the journal Pediatrics.

The more regularly the teens ate breakfast, the lower their body mass index (BMI). (BMI is a measure of weight in relation to height.) Breakfast-skippers weighed an average of five pounds more than their peers who ate the meal every day.

“It’s interesting to note that the kids who ate breakfast daily had a much better diet and were more physically active,” says SPH associate professor Mark Pereira, one of the study’s authors. “While they ate more calories, they did more to burn them off, and that may be because those who ate breakfast didn’t feel so lethargic.”

About 25 percent of the group studied regularly missed breakfast, with young women skipping a morning meal the most. This trend comes at a time when obesity rates for teens have nearly tripled.

“Although adolescents may think that skipping breakfast seems like a good way to save on calories, findings suggest the opposite,” says SPH professor Dianne Neumark-Sztainer, lead investigator for Project EAT. “Eating a healthy breakfast may help adolescents avoid overeating later in the day and disrupt unhealthy eating patterns, such as not eating early in the day and eating a lot late in the evening.”

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BIOSTATISTICS

U Launches Study of Cerebral Malaria in Uganda

Study Aims to Increase PTSD Treatment Among Veterans

Malaria is the leading cause of death for children in subSaharan Africa. But for children who survive the disease, it can be the cause of devastating brain injury. While close to an estimated one-quarter of young malaria survivors develop cognitive deficits, the factors that lead to this damage are not well understood.

University of Minnesota researchers are teaming up with investigators at Mulago Hospital in Kampala, Uganda to better understand cerebral malaria, a type of malaria in which red blood cells obstruct blood vessels in the brain.

Global pediatrics associate professor John Chandy is leading the study, which includes SPH biostatisticians John Connett and Baolin Wu. The researchers will track the health and development of 200 children with cerebral malaria and compare them to 200 counterparts without malaria. The aim is to assess the frequency of cognitive impairment and what factors—genetic and immunologic—lead to it.

The project poses a challenge to the biostatisticians, who must determine how to design a study that measures cognitive ability. “Learning abilities are somewhat subjective,” says Wu. “It’s hard to have an underlying truth to them.”

Wu says a strength of the study is its comprehensive follow-up. Children will be tracked at 6, 12, and 24-month intervals with ophthalmologic exams, EEG and CT scans, and cognitive and neurological assessments.

While in its early stages, the researchers hope their work will be the first step in developing interventions that could potentially prevent brain injury for hundreds of thousands of children in sub-Saharan Africa.

While 30 percent of combat veterans develop post-traumatic stress disorder (PTSD), only a little more than half receive any treatment. Of those who do seek counseling or medication, many drop out after just a few appointments or prescriptions.

This means in a time when more and more veterans are diagnosed with PTSD very few receive adequate treatment for the disorder.

SPH associate professor Jim Hodges is working with colleagues at the Minneapolis Veterans Administration (VA) Medical Center to better understand why so many veterans do not start or persist with treatment. In studying the factors associated with successful and unsuccessful treatment, the team hopes to identify targeted changes in care that would improve treatment rates.

The team includes VA psychologist Michele Spoont and systems analyst Sean Nugent. The researchers plan to follow 5,000 veterans within two weeks after PTSD diagnoses and again at six months. In addition to gathering socioeconomic information like race, ethnicity, and education, vets will be asked about their views on antidepressants, counseling, and other health beliefs.

“People have broadly different ideas about what causes their PTSD and whether they can do anything about it,” says Hodges. “It’s been established that in other health conditions, these beliefs affect rates of treatment.”

A great asset to the researchers is the robust data the VA routinely collects on its patients—much more than most other health care systems. This means researchers will be able to learn about even the patients who don’t return study questionnaires. “We can learn more about non-respondents than in any other health care context,” says Hodges.

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University of Minnesota School of Public Health

ENVIRONMENTAL HEALTH SCIENCES

Most Fluorescent Bulb Shipping Containers Fail to Contain Mercury Vapor Every day, American businesses ship millions of used fluorescent bulbs for recycling. When the bulbs break in transit, they release poisonous mercury vapor. While mercury vapor can cause harm to workers and the environment, the Environmental Protection Agency (EPA) has not established regulations to prevent its release during shipment.

Enter VaporLok Products, a Minnesota-based company that created a shipping container designed to contain mercury vapor. Company leaders approached SPH researchers to test the effectiveness of their product, along with four other commercially marketed bulb recycling containers.

SPH associate professor Lisa Brosseau led the study team, which included Tracy Glenz, a master’s student in industrial hygiene and Richard Hoffbeck, a statistician. The team built

VaporLok shipping containers

a test chamber to measure mercury vapor released from broken bulbs packaged in the five different containers.

The team found that VaporLok was the only container tested where chamber concentrations were significantly less than federal or state occupational exposure limits for mercury vapor. They credit this to the container’s specially designed foil bag and a second internal cardboard box. The research team concluded that most currently marketed containers do not prevent the release of mercury vapor and do not effectively protect workers or the environment.

Brosseau is hoping the findings can be used to improve EPA or other federal regulations. VaporLok Products is planning to partner with Brosseau’s team again to test a recycling container for compact fluorescent bulbs used in household fixtures.

“It was tremendous to work with the [School of Public Health] researchers,” says Mark Stennes, of the VaporLok team. “The study dramatically increased our knowledge.”

Matt Simcik and a fellow SPH researcher on a water-sampling expedition in northern Minnesota.

SPH Leads Large-Scale Study of 3M Chemicals in Residential Lake In the first study of its kind locally, SPH researchers are analyzing perfluorochemical (PFC) levels of a St. Paul suburban lake. Twin Cities-based 3M once used the toxic chemicals to make water- and stain-resistant products like Scotchguard.

The research team, led by SPH associate professor Matt Simcik, is targeting Lake Johanna, located in a residential area miles from a 3M production plant that for years manufactured and disposed of PFCs. Despite the distance, the lake contains high enough PFC levels that officials have had to issue fish consumption advisories.

The lake also contains unusual PFC concentrations in its fish species. Namely, fish that are lower in the food chain like bass, bluegill, and crappie have higher PFC levels than the predatory fish farther up the chain.

Beginning this summer, Simcik’s team will conduct a comprehensive sampling of the lake’s “food web” to get a clearer picture of how the chemicals behave and accumulate.

The researchers will collect soil, sediment, and plant life, as well as the full range of animal species, including insects, fish, snails, and crayfish. Findings are expected to roll out next spring.

Right now the researchers don’t know what’s behind the elevated levels or the differences among fish species in this lake or others with similar characteristics. But a comprehensive analysis such as this is an important first step in getting answers. “There are a number of possible sources and scientific explanations,” says Simcik. “With this study we can start to rule out possibilities and build a better idea of how perfluorochemicals behave, spread, and accumulate in the aquatic food web.”

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HEALTH POLICY AND MANAGEMENT

Muscle Training Beats Meds in Treating Incontinence School of Public Health researchers have found that pelvic floor muscle training, also known as Kegel exercises, are the most effective way to address urinary incontinence in women.

The researchers also found that several other remedies, including drugs and devices, were inconsistent, ineffective, or actually increased rates of incontinence. Findings are based on a review of nearly 100 randomized trials published from 1990 to 2007.

“Buried in the bad news of widespread use of many products that don’t work is some very good news,” says SPH professor and study author Robert Kane. “Pelvic floor muscle training is two to three times more effective than most drugs or devices used to treat incontinence.”

Kegel exercises appear to be effective across all age ranges, regardless of whether women develop incontinence while pregnant or when they get older. Kane says the only drawback to the exercises is that they typically need to be performed for several months.

“The good news is it’s fairly cheap to do. The bad news is you have to do it and keep doing it,” he explains. “And you probably need to do these exercises for several months in order to be effective. And then you may have to do them again from time to time.”

SPH research associate Tatyana Shamliyan served as the WEB EXTRA study’s senior author. Findings appear in the journal Annals of Internal Medicine.

Minnesota Rates of Uninsurance Hold Steady

A new survey from the School of Public Health and the Minnesota Department of Health (MDH) says the percentage of Minnesotans without health insurance is holding steady at less than 8 percent. The rate has remained stable since 2004, following a rise in rates between 2001 and 2004.

In a telephone survey of more than 9,700 Minnesotans, researchers found that about 7.2 percent of Minnesotans didn’t have health insurance in 2007. That’s just under 375,000 people. National surveys, although not directly comparable to this study, show that Minnesota has the lowest uninsurance rate in the nation.

The researchers estimate that 4.8 million Minnesotans got health insurance through an employer, government program, or with a policy they purchased themselves.

“It’s good to see that insurance coverage rates have stabilized in recent years,” says SPH associate professor Kathleen Thiede Call, who led the school’s survey team. “However, it’s important to remember that while Minnesota has a low rate of uninsurance, the state continues to have large disparities in coverage by race and ethnicity.”

In 2007, the uninsurance rates for African-American, American-Indian, and Latino Minnesotans were up to three times higher than the rate for the white population.

The MDH and SPH have conducted Minnesota Health WEB EXTRA Access surveys together since 2001. Statewide surveys were conducted prior to that in 1990, 1995 and 1999. Survey data WEB EXTRA is used to inform Minnesota state health policy.

A 2007 survey fact sheet can be found at WEB EXTRA WEB EXTRA www.shadac.org.

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University of Minnesota School of Public Health

Join the Public Health Institute Participants from around the world can design their own educational experience at the University of Minnesota Public Health Institute, May 27-June 13. The institute provides those new to public health, or those who have been working in the field for years, with the opportunity to immerse themselves in a chosen field of study for a single day or three weeks.

The 2008 institute offers 53 courses that reflect the diversity of public health, organized around 10 concentration areas: • Applied Biostatistics and Research Methods • Culturally Responsive Public Health Practice • Environmental Health Sciences • Food Protection • Global Health • Infectious Disease Epidemiology • Public Health Leadership • Public Health Nursing Practice • Public Health Preparedness, Response, and Recovery • Women and Child Health and Nutrition This year’s field trips will bring students to various industry sites to give them an insider’s view of global food systems

Global Health Institute in Iceland a Success

PUBLIC HEALTH EDUCATION AND OUTREACH in poultry and dairy, as well as an up-close look at protecting the water supply. A community-immersion field trip will focus on the health of African Americans. As in years past, the institute will also feature free lectures on timely issues

from local and national public health leaders.

The institute is presented by the School of Public Health, School of Nursing, and College of Veterinary Medicine. For more information, including a full list of courses, see http://cpheo.sph.umn.edu/institute.

Promoting Healthy Living in Communities of Color

Photo: John Finnegan

The University of Minnesota and The latest SPH Roundtable, University of Iceland brought “Mobilizing Communities of Color together interdisciplinary teams to Promote Healthy Living and of faculty to present the Global Eating,” drew an audience of Health Institute. Held in April at researchers, community leaders, the University of Iceland in and public health practitioners.

Antronette Yancey discussed Reykjavik, the institute drew severcutting-edge strategies and pracal dozen students from both unitical tools that can be used by versities. community-based organizations The weeklong offering of coursto promote healthy living. Yancey es and presentations began at is a professor at the UCLA the home of Iceland’s president, School of Public Health. Other Ólafur Grímsson, who delivered an An SPH student takes in speakers included SPH professor address on climate change.

Mary Story, an expert on Iceland’s famous geysers.

Institute classes covered a range child nutrition, and SPH associate professor Rhonda Jonesof topics such as global health challenges, geothermal Webb, whose research focuses on health disparities. The energy, and informatics. Field trips included a visit to a roundtable was an effort of the SPH Health Disparities WEB EXTRA WEB EXTRA geothermal power plant, Iceland’s famed geysers, and the Work Group. steamy waters of the Blue Lagoon.

To watch a video of the presentation, go to The global institute is a collaboration of the SPH, School WEB EXTRA http://cpheo.sph.umn.edu/cpheo/events/roundtable. of Nursing, and College of Veterinary Medicine and an effort of the newly formed SPH Global Outreach team. WEB EXTRA WEB EXTRA

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SCHOOL NEWS

Photo: Karina Milosovich

Tricia Peterson, Sadie Haddow, and Emily Sylvestre collect their winnings.

U Flu Experts Meet with Peers in Thailand

School Awards Winners in PSA Contest

A team from the Minnesota Center of Excellence for Influenza Research and Surveillance (MCEIRS) recently met with colleagues at Chulalongkorn University in Bangkok, Thailand.

The partners are working to ramp up avian influenza surveillance and control in Southeast Asia.

The Thailand connection is just one within a large global network forged by MCEIRS since it launched a year ago.

Funded by the National Institutes of Health, the Minnesota center’s goal is to enhance understanding of how avian influenza viruses evolve, adapt, and spread among animal populations and from animals to humans. MCEIRS is part of the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP).

During the January visit, the MCEIRS team toured surveillance areas throughout Nakorn Pathom province, the site of three of Thailand’s five H5N1 outbreaks. They visited with local families who tend to chickens and ducks and saw surveillance efforts that include pigs, dogs, cats, open-billed storks, and local waterbirds.

During the visit, Thailand’s Department of Livestock Development (DLD) confirmed two H5N1 outbreaks. The Minnesota group was able to see firsthand how their Thai colleagues responded. Chulalongkorn’s team collaborated with the DLD to conduct an outbreak investigation, collect samples from poultry and other animals near the affected flocks, and monitor for potential human cases.

MCEIRS director Michael Osterholm says the visit underscores the need for public health to be globally oriented.

“These international partnerships are a two-way street,” says the SPH professor. “We’re assisting Thailand in the surveillance and control of avian influenza, but in the process we’re also learning a great deal about global health.”

Three Twin Cities teens took home first prize in the School of Public Health’s second annual “It’s Global” Public Service Announcement (PSA) contest. The contest allows amateur and professional filmmakers to showcase their work while making a 30-second statement on a public health topic.

Tricia Peterson, 14, Emily Sylvestre, 14, and Sadie Haddow, 13, heard about the contest through Haddow’s neighbor and SPH alumnus Jim Winkle (M.P.H. ’07). The trio—who have a production company, PB and J—put their heads together and came up with the winning entry, “Alone,” which addresses depression among teens. They won a cash prize of $500.

“We have a friend who is struggling with depression, so it made it more personal,” says Sylvestre, who wrote original music for their entry.

The girls collaborated on the script, but left the acting up to Peterson, because according to Sylvestre, “she’s the best actress of all of us.” Haddow served as director and camera operator. The young friends say they’ve created other short films, mostly horror flicks screened for family and friends, but are now planning to consider other genres.

More than 50 PSAs were entered in this year’s contest, and the top three earned prizes. Entries were screened during the school’s fourth annual National Public Health Week film festival, which set an attendance record of 430 people during the four-night run.

The top three winning entries can be viewed at WEB EXTRA www.sph.umn.edu/psa/.

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University of Minnesota School of Public Health

WEB EXTRA

For more on National Public Health Week, see page 17.

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Photo: Paula Keller

Photo taken by an MCEIRS staff member during a family farm visit in rural Thailand where scenes like this are common.

SCHOOL NEWS School Offers New Crop of Online Features The SPH’s Web site continues to offer a wealth of videos, podcasts, and blogs on timely pubic health issues. Check out the latest offerings:

Nation Faces Public Health Worker Shortage While high-profile events like the I-35W bridge collapse in Minneapolis or last summer’s flooding in southern Minnesota highlight the importance of public health professionals, all of us are affected in more ways than we can imagine by the public health profession every single day. Safe drinking water, vaccination programs, disease surveillance, and school nutrition programs are but a few of the hundreds of ways public health contributes to our quality of life.

Currently a public health worker shortage threatens the infrastructure in place to keep us healthy and safe. SPH dean John Finnegan joined his counterparts from schools of public health from around the country in Washington, D.C., recently to discuss the issue, which is approaching crisis proportions.

In a first-of-its-kind assessment, the Association of Schools of Public Health (ASPH) estimates that Minnesota’s projected public health workforce will fall short by 59 percent of what the state needs by the year 2020. Nationwide, ASPH estimates a shortage of a quarter of a million public health workers by 2020.

To address these shortages, ASPH is calling for increased federal investment in public health education and training.

“Tackling the health implications of tobacco use, heart disease, and obesity—not to mention the threat of globally spreading infectious diseases—depends entirely on the availability of a well-trained public health workforce,” says Finnegan. “Unless we act now to recruit and train a significant WEB EXTRA WEB EXTRA number of public health professionals, we will soon be ill-equipped to identify looming public health crises and EXTRA respondWEB decisively.”

Listen to John Finnegan discuss the workforce Minnesota Public Radio’s WEB EXTRA shortage WEBon EXTRA “Midmorning” program: http://minnesota.publicradio.org/radio/programs/ midmorning/index.php?date=03-03-2008.

• In Research Brief videos SPH faculty members discuss the methods of and findings generated by select research projects.

The latest videos focus on why the blood donor pool is shrinking and the need to improve airborne infection isolation rooms in hospitals. www.sph.umn.edu/brief/videos • A new “My Life” video profiles SPH student Katie Seitz, who works as an officer with the University of Minnesota Police Department while completing a public health certificate in core concepts. www.sph.umn.edu/sphere/katie • The blog Public Health Scene offers a roundup of SPH discoveries in the news and a forum to discuss hot public health issues. www.sph.umn.edu/scene • Public Health Moment gives a 30-second take on current public health issues. Recent audio segments discuss the danger of TV in teen bedrooms, how diabetes can lead to cancer, and why Minnesota has the healthiest hearts in the nation. www.sph.umn.edu/moment • Tanzania, Ecuador, and Bangladesh are just some of the destinations for SPH students heading out on summer field experiences. Read about their adventures and see their photos in the 2008 edition of the Notes from the Field blog. www.sph.umn.edu/notes08

SPH Faculty Guidebooks Available Get the latest guidebook on SPH faculty expertise. The resource tool offers an index of public health topics and listings for each faculty member.

To request a free guide, send an email to SPHnews@umn.edu.

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STUDENT NEWS Photo: Mikki Harris

Kristina McElroy, Megin Nichols, and Kis Robertson

Three SPH Students Awarded CDC Fellowships Three SPH students will soon join the ranks of the nation’s most prestigious disease-fighting unit: the Epidemic Intelligence Service (EIS).

As part of the Centers for Disease Control and Prevention (CDC), EIS officers have played a pivotal role in combating major epidemics over the past 50 years. The two-year postgraduate program is highly competitive with some 300 applicants a year.

This year, 11 officers with Doctor of Veterinary Medicine (D.V.M.) degrees will join the EIS. Of that group, three will be students from the SPH’s Public Health Practice major.

Designed for veterinary medicine students, medical students, and working professionals, the program offers online courses that count toward a Master of Public Health (M.P.H.).

Megin Nichols is finishing up her D.V.M. at Colorado State University. Her research focuses on avian influenza and other zoonotic diseases.

Kis Robertson began working toward an M.P.H. after graduating from Tuskegee University with a D.V.M. She completed her final master’s project while working at the Food Safety and Inspection Service of the U.S. Department of Agriculture.

Kristina McElroy became a resident at the University of Minnesota’s Center for Animal Health and Food Safety after several years of clinical practice and a D.V.M. from the University of Missouri. A member of the Army Reserve, her residency was interrupted when she was called to Germany to replace troops sent to Iraq.

Eighty EIS officers, who start work in July, are assigned to posts at CDC headquarters in Atlanta or to state and local health departments throughout the country. Recent EIS investigations have addressed polio eradication, bioterrorism preparedness, and control of West Nile virus.

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University of Minnesota School of Public Health

Research Day Celebrates Student Work Eight blue ribbons were awarded to SPH students at the school’s first-ever annual Research Day. For the event, held in conjunction with National Public Health Week, students were invited to create a poster outlining the research project of their choice. Awards were given for outstanding posters in three categories.

Student Choice (judged by a panel of four) Mary Forte, Ph.D. student in Health Services Research, Policy and Administration Helen Parsons, M.P.H. student in Public Health Administration and Policy Karen Soderberg, M.S. student in Health Services Research, Policy and Administration

Faculty and Alumni Choice (judged by a panel of seven) Gretchen Cutler, Ph.D. student in Epidemiology Jooyeon Hwang, M.S. student in Environmental Health Kristen Tharaldson, M.P.H. student in Community Health Education

Delta Omega, Pi Chapter (judged by two SPH professors who are members of the Delta Omega honor society) Amenah Babar, M.P.H. student in Epidemiology Mary Forte, Ph.D. student in Health Services Research, Policy and Administration The Delta Omega winners received $500 to cover the expense of attending a national scientific meeting of their choice. All other winners received a $50 gift certificate to the University of Minnesota bookstore. Twenty-four SPH students participated in Research Day, and more than 100 people attended the event.

“This is the first time the school has hosted Research Day, and it was a great success,” says Judy Garrard, senior associate dean for research and academic affairs. “The posters showcased the breadth of public health research, and the event celebrated the fine work of our students.”

Photo: Paula Keller

Research Day winners gather with SPH dean John Finnegan.

PHILANTHROPY

Kay Quam and Cami

Woman’s Love for Animals Inspires Gift to CENSHARE After a long day at work, Kay Quam came home to find that her pets had done a little redecorating.

“I’m surveying the handiwork of one of my new little kitties,” Quam says. “She’s taken it upon herself to remove all the dead leaves from one of my plants.”

Quam has been a “cat person” for as long as she can remember. She adopted her two young cats, Randi and Keise, from a local Humane Society just weeks ago, but her love for the feline species dates way back. In one photograph of her at 18 months old, she’s holding a stuffed animal cat.

And having grown up on a farm, Quam was used to dogs and barn cats running around the place.

“I didn’t know what it was like to have an indoor cat until I was adult,” she says, but she’s had them, loved them, and cared for them ever since.

Quam recently decided that it was time she made an estate plan. Her philanthropic interests have always included animal welfare and rescue groups, but she also wanted her bequest to address a more fundamental problem: Why are shelters filled with so many unwanted animals, especially cats?

“I tend to be a strategic person, so I was looking for approaches that could have what I call an ‘upstream effect,’” says Quam, who is a management consultant on organizational design and infrastructure in the Washington, D.C., area.

Through an Internet search, Quam found the Center to Study Human Animal Relationships and Environments (CENSHARE), housed in the University of Minnesota’s School of Public Health. CENSHARE’s members work to gather, share, and apply knowledge about the relationship between humans and animals to improve quality of life for all.

Since it was established in 1981, CENSHARE has become a national leader in promoting health and quality of life for people and animals by conducting behavior research, providing educational opportunities, and creating a forum to develop public policy.

After Quam learned more about the center, she spoke with CENSHARE cofounder and director R. K. Anderson about what could be done through research to strengthen the human-feline bond. She liked what she heard.

In November, Quam made a $150,000 bequest to the center. She also has made annual gifts to the center for the last two years.

“We are grateful for gifts such as Ms. Quam’s that help support CENSHARE’s mission to acquire new knowledge to improve human-animal relationships and strengthen the human-animal bond,” says Anderson, an SPH professor emeritus.

Quam lived in the Twin Cities area for 21 years, spending part of that time as a graduate student in microbial genetics at the University of Minnesota. Even without that connection, Quam says she would have chosen to support CENSHARE. “It just simply was the best fit for what I was looking to do,” she says.

To learn how you can make a gift to CENSHARE, contact Adam Buhr at 612-626-2391 or a.buhr@mmf.umn.edu.

Scholarship Gala Brings New Funds to the SPH The School of Public Health and the SPH Alumni Society Board would like to thank everyone who supported the 2008 Alumni and Friends Scholarship Gala on April 10. Thank you to event sponsors the Medtronic Foundation and Mayo Clinic, as well as table sponsors and guests. You have made significant commitments to build the SPH Alumni Scholarship Endowment. Look for these fundraising details in the next issue of Advances.

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ALUMNI NEWS Photo: Tim Rummelhoff

Megan Harkness-Madole

A Public Health Approach to Pharmacy In Megan Harkness-Madole’s ideal career, she would be a pharmacist who never dispenses a drug. She credits this nontraditional take on the profession to her public health background.

“I’m completely fascinated by the integration of pharmacy into the health care system,” says the 2004 epidemiology graduate. “More than just in a retail setting, a pharmacist should be viewed as part of a health care team, working with physicians and patients directly.”

Harkness-Madole is learning about this emerging philosophy as a first-year doctoral student at the University of Minnesota’s College of Pharmacy. She’s also learning the value of her M.P.H. degree. “I think it makes all the health disciplines stronger when we can talk the language of the professionals we interact with,” she explains.

While Harkness-Madole sees her job options as “limitless,” she would most like to work as part of a medical team that specializes in chronic disease care. Her role would be to talk with patients about the complex medications they’re taking—what the benefits and side effects are, whether the patient feels the medications are working, and why the meds were prescribed in the first place.

“Someone like that would have made such a difference in my mother’s experience,” says Harkness-Madole. While an SPH student, her mother was diagnosed with and died from colon cancer. Despite her family’s history of working in the field of pharmacy, the lack of communication regarding her mother’s chemotherapy often caused anxiety and doubt.

“You could say I’m still looking for some way to save my mother,” says Harkness-Madole of her career aspirations.

“If I have the knowledge to help, then maybe I can save someone else’s mother some of the pain and confusion.”

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University of Minnesota School of Public Health

Alumni Events Hit the Road This winter, two School of Public Health alumni events happened far from the cold tundra of Minnesota. The gatherings —one in Florida and one in Arizona—mark a new era of “on the road” alumni engagements that the school plans to increase in the years to come.

Naples, Fla. was the site of Minne-College, which offered a series of lively discussions from a variety of University of Minnesota faculty. SPH professor and environmental expert Deborah Swackhamer presented “A Thirst for Tomorrow: The Future of Minnesota’s Waters.”

More than 20 SPH-affiliated individuals traveled to Tempe, Ariz. for Winter College. The gathering featured speakers from the SPH and Arizona State University’s W.P. Carey School of Business. SPH professor Jon Christianson presented “Designing and Reacting to Pay for Performance in Health Care: What the Research Tells Us.” SPH Alumni Society Board member Jim Anderson (M.H.A. ’68), who is on the leadership team at the Mayo Clinic-Scottsdale, proposed the event to increase networking opportunities for alumni.

Alumni Gather at Winter College

Richard Norling (M.H.A.’75), William Kreykes (M.H.A. ’66), and Stanley Nelson (M.H.A. ’50)

John Marnell (M.H.A. ’66) and David Patton (M.H.A. ’66)

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SPH Alumni Celebrate National Public Health Week

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The school invited alumni to celebrate National Public Health Week at a series of reunionthemed events. The April 10 events included a roundtable discussion hosted by the SPH Alumni Society Board, a social hour, and the first-ever Alumni and Friends Scholarship Gala.

4) Michelle Ferrari (M.P.H. ’01), Cynthia Kenyon (M.P.H. ’99), and Anne McGeary Snowden (M.P.H. ’01) 5) Xin Ye (M.S. ’04), Dongfeng Qi (M.S. ’03), Yanping Chang (M.S. ’04), and SPH associate professor Melanie Wall 6) Richard Carmona shared the perspective he gained as the 17th Surgeon General of the United States at the Alumni and Friends Scholarship Gala. Proceeds from the gala will be used to create new SPH student scholarships. Carmona also received an honorary doctor of laws, the highest award conferred by the University of Minnesota.

2) At the gala, Ulric Gibson (M.S. ’62, Ph.D. ’70) received the Outstanding Achievement Award, the University of Minnesota’s highest alumni honor. He was recognized for his lifetime work in bringing sources of clean water to comWEB EXTRA(left) WEB EXTRA munities around the world. SPH Dean John Finnegan 7) Roger Banks, Brigid Riley (M.P.H. ’98), and Donna Anderson and Frank Cerra, (right) senior vice president for health sci(M.P.H. ’71) ences, presented the award.

WEB EXTRA 3) Nila Gouldin (M.P.H. ’03) and Ulric Gibson WEB EXTRA

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To view a video recap of National Public Health Week events, go to www.sph.umn.edu/nphw.

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Photos: Paula Keller

1) SPH Alumni Society Board member Michael Trujillo (M.P.H. ’84) facilitated a group discussion on science vs. ideology at the board’s meeting and reunion kickoff. Trujillo is executive director of program development and community outreach for the Translational Genomics Research Institute in Phoenix, Ariz. He previously served as director of the U.S. Indian Health Service.

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Upcoming Events

Next Issue: Notes from the Field

Industrial Hygiene Program Alumni and Friends Reception

SPH Students Report on their International Field Experiences

Tuesday, June 3, 5-7 p.m.

The Local, 931 Nicollet Mall, Minneapolis www.the-local.com Environmental Health Sciences professors Gurumurthy Ramachandran, Peter Raynor, and Lisa Brosseau invite all alumni and friends of the Industrial Hygiene Program to a reception, held in conjunction with the annual American Industrial Hygiene Conference and Exposition to take place in Minneapolis. The reception site is walking distance from the conference. Appetizers will be served, cash bar available.

Questions? Send an e-mail to SPHnews@umn.edu.

The SPH will be hosting an alumni reunion in conjunction with the 41st Annual Society for Epidemiologic Research (SER) meeting in Chicago.

Thursday, June 26, 7 p.m.

Hyatt Regency Chicago on the Riverwalk Wright Room 151 East Wacker Drive, Chicago

Sign up for SPH Alumni E-News Learn about alumni events, read alumni stories, and register to win SPH gear in this quarterly electronic newsletter. www.sph.umn.edu/engage

Students will be blogging from abroad at www.sph.umn.edu/notes08/.

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