Advances - Summer 2010

advances Summer 2010

f r o m t h e U n i v e r s i t y o f M i n n e s o ta S c h o o l o f P u b l i c H e a lt h

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notes

field from the

SPH students report on their global field experiences

from the dean School of Public Health Leadership

Judith Garrard Senior Associate Dean for Research and Academic Affairs Debra Olson Associate Dean for Education William Riley Associate Dean for Strategic Partnerships and Relations Mary Story Associate Dean for Student Life and Leadership Diana Harvey Assistant Dean for External Affairs

Bradley Carlin Head, Division of Biostatistics Bernard Harlow Head, Division of Epidemiology and Community Health Ira Moscovice Head, Division of Health Policy and Management William Toscano Head, Division of Environmental Health Sciences Joe Weisenburger Chief Administrative Officer/Chief Financial Officer

advances Editor Diana Harvey Managing Editor Kristin Stouffer Contributing Writer Mark Engebretson Art Direction Cate Hubbard Design cat7hubb@gmail.com Advances is published four times a year by the University of Minnesota School of Public Health.

To submit comments, update your address, or request alternative formats email sphnews@umn.edu.

Printed on recycled and recyclable paper made in Minnesota with at least 10 percent postconsumer material.

Dear Friends, The summer issue of Advances is always my favorite, featuring tales of students putting classroom smarts to work across the globe in a grand effort to advance public health. Each year we invite students to submit their favorite field experience photographs for inclusion in the magazine. This year’s cover photo was taken by Whitney Hogan, who spent the summer working with the Uganda Village Project (UVP) in the remote village of Buwaiswa. On the other side of the camera is Edisa, a widow raising five boys all under the age of 12. When she’s not cooking for UVP volunteers, she serves on safe water and sanitation initiatives for the village. Edisa is one of the vital community liaisons our students partner with to accomplish their work in meaningful ways.

The students’ interest in working outside the United States is reflective of the increasingly global nature of public health. Population growth, travel and trade, and the fact that disease knows no boundaries make public health issues ever more urgent. Of course, students are not the only ones engaged globally. See page 8 for a foldout map that shows some of the spots around the world where SPH faculty members are working with colleagues on research and education projects.

I recently spent a week in Kampala, Uganda, visiting with deans from seven schools of public health that form the “Health Alliance” in central and east Africa. While I was there, I formalized the expansion of a relationship between the University of Minnesota and Makerere University to include all of the health sciences. This memorandum of understanding opens the way to greater collaboration between faculty of our school and academic health center and Makerere, which is one of Africa’s finest schools. You can read about our most recent work with Makerere University on page 15.

Here in Minnesota, I am delighted to welcome the incoming class of SPH students. They come from all over the country and world and share a passion for improving health. We continue to attract record numbers. Currently, our student body totals 1,189, making it the third largest of the 45 accredited schools of public health in the country. Learning about our incoming students’ life experiences and future plans makes me confident that our world is in good hands.

Yours in health,

© Regents of the University of Minnesota. All rights reserved. The University of Minnesota is an equal opportunity educator and employer.

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

Photo by richard anderson

John Finnegan Dean

Summer 2010

contents

Features

Departments

2 Notes from the Field

12 Research News

From tiny villages to regional hospitals to WHO headquarters, SPH students are working abroad on five continents, taking on public health’s greatest challenges.

Diabetes linked to colon cancer; higher costs hinder access to critical drugs; big news on tanning risks; and more.

7 Work on the Wild Side

14 School News

Moose and wolves and bears, oh my!

A Fulbright fellowship brings Alina Evans to Norway, where the SPH alum is beginning a promising career in conservation medicine.

Global institute in Uganda kicks off worldwide training program; SPH taps into unprecedented international network; improving hospital safety in Jamaica; and more.

8 Thinking Locally, Acting Globally Take a round-the-world tour of the latest work by SPH faculty members.

18 Alumni News Celebrating milestones with SPH mentors; and class notes.

1

notes

field from the

SPH students report on their global field experiences

2 University of Minnesota School of Public Health

M

More than 20 students from the University of Minnesota School of Public Health are work­­ing abroad this summer on their field experience, the hands-on component of several SPH academic programs. While their projects and settings vary dramatically, the overarching goal is the same: promote health and improve lives. Much of this work is done in collaboration with non-governmental organizations and locally based groups that help the students connect to the communities they’re serving.

For some students, it’s the first time they’re putting academic concepts to use in real-world settings—often with the challenge of limited resources, language barriers, and cultural differences. For all, it’s an experience that is exposing them to enriched worldviews, expanded career options, the benefits of teamwork, and fresh ideas about the daily workings of global health.

Central America Operating out of the town of Jaltenango, nestled high in the Sierra Madre Mountains of Chiapas, Mexico, Amanda Eastwood is meeting with hundreds of women in coffee-producing communities to discuss the cervical cancer screening and treatment available to them through the nonprofit Grounds for Health. In an interesting twist of fate, Eastwood is working with the cooperative that supplies coffee for her employer, Café Imports. “How beautiful and humbling for me to have direct contact with the farmers who have taken part in providing me with a job and living wage over the last four years,” says Eastwood. “What a tremendous privilege to give back in such a direct and tangible way.”

Africa Eme Unanaowo finds herself in Xai-Xai, Mozambique, an area with daunting realities: HIV/AIDS rates hover around 21 percent; maternal mortality is high; and the Ministry of Health relies on outside sources for 80 percent of its budget. Working with Pathfinder International, Unanaowo is evaluating a program for doctors that aims to increase maternal and child health services in Gaza Province. While the work is challenging, Unanaowo loves the warmth and friendliness of Mozambique.

She would like to return to the country and work directly with communities.

“I hope to begin a doula course this fall,” she says. “As I look at the women and children here, I am inspired to help make delivery easier for both.”

Peace House Secondary School in Arusha, Tanzania is where Samuel Lee and Melanie Plucinski are developing curricula on entrepreneurship and nutrition. Operated by an Eden Prairie, Minn.-based foundation, the school for AIDS orphans and other vulnerable children trains future business leaders.

The SPH students are working with their Tanzanian counterparts to start a business that produces sustainable, nutritious foods. Lee’s participation in a social ventures competition earlier this year—which resulted in a twoweek visit to India to launch a business addressing water needs—helped prepare him for the crunch of quickly developing a business oversees. Plucinski says the experience has made her “more comfortable with uncertainty.” Lee says the uncertainty allows him to take more cues from the students, who have learned to be entrepreneurial out of economic necessity. (Lee recalls one young man who made and sold jewelry to help pay for his school fees, as well as those of his younger brothers.) “The effort and dedication the students put into their work rivals any co-worker or boss I have ever worked with,” says Lee. “This kind of education is impossible to gain in the classroom,” says Brittani

Schmidt of her work in Kenya with the Centers for Disease Control and Prevention (CDC). The CDC, in collabor­ ation with other agencies including the Kenyan Ministry of Health, is taking real-time data collection to the next level by using GPS and PDA devices to survey on malaria prevention. Schmidt, who helped train the surveyors on how to use the PDAs (Personal Digital Assistants), counts learning about the logistics of international project planning as her greatest accomplishment abroad. “The expertise, cooperation, and professionalism of all participating agencies made the survey successful,” she says. “It was inspiring to see so many groups with different goals and varying backgrounds adeptly work toward a common goal.”

(Opposite) Whitney Hogan (second from right), fellow Uganda Village Project interns, and young friends gather at the construction site of a new shallow well. (Above) Amazing views are one of the perks of Amanda Eastwood’s work in Chiapas, Mexico.

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notes from the field

(Top) Amber Koskey delivers a cleanburning cooking stove to a family in Uganda. (Middle) Melanie Plucinski and Samuel Lee lead a class at Peace House Secondary School in Tanzania. (Bottom) Dawn Sibanda works with Henri, lead pharmacy technician, to improve oper­­ations at St. Albert’s Mission Hospital in Zimbabwe. (Opposite) Robyn Browning, behind the camera, hikes with her Haitian host brother as he takes the family donkey to fetch a day’s supply of water.

Jeremy Johnson is combining his knowledge of public health with what he’s learned as a University of Minnesota Medical School student at Mseleni Hospital in South Africa. While the lack of medical supplies—everything from gloves and needles to ventilators—makes clinical care difficult, he’s found that community connections can go a long way toward improving health. One such instance was creating protocol for HIV/TB patient tracking and follow-up. The hospital had recommendations but first needed to address the concerns of its eight satellite clinics.

“This experience taught me so much,” says Johnson. “We can have great ideas and use existing successful interventions, but without buy-in from local leaders, community involvement in the decision process, and systems-based approaches, the best ideas will never materialize into action.”

Mulago Hospital in Kampala, Uganda, is where Kristin Finn is conducting data entry and analysis for HIV and cryptococcal meningitis studies. Learning new statistical software, finding missing lab tests, and deciphering handwritten doctor’s notes are just some of the on-the-job challenges.

Despite this, she has already presented physicians with some preliminary data.

She’s also been able to shadow them while they round the hospital, giving her a firsthand account of the patients that make up the statistics. Outside of work, Finn has rafted over Bujagali Falls (near the area where the Nile flows out of Lake Victoria), tracked chimps through the rainforest, and visited a rhino sanctuary. She’s also grown fond of her daily trek to the hospital. “I walk through this little neighborhood of mud and thatch-covered huts and the people there always say ‘Hi’ to me as I pass by,” she says. “There is one couple who tries to teach me Luganda every time I pass and offers me tea and chapati in the morning.”

“We have no running water, no electric­ ity, but in exchange we are living in a community that is incredibly welcoming,” says Whitney Hogan of the remote Buwaiswa Village, home to about 350 households.

She and Megan Slaughter are there with

4 University of Minnesota School of Public Health

the Uganda Village Project (UVP), kicking off several initiatives, including testing 150 adults for HIV, deworming nearly 800 children, coordinating the commissioning of a well, and forming a women’s insurance and savings group—all in the course of nine weeks. The UVP assembled a Village Health Team that will sustain the initiatives. The tight-knit group of women villagers that Hogan and Slaughter consulted was key to getting the projects going. They also met with the head woman of the village to ask for her help. Ironically, while women have public power, many lack it in their own homes. A meeting about reproductive health revealed that many women are afraid to use family planning methods out of fear of being physically harmed by their husbands.

Dawn Sibanda traveled home to complete her field experience. The native of Zimbabwe used her knowledge as a Mayo Clinic pharmacist to improve the operations of the pharmacy in St. Albert’s Mission Hospital, the first rural hospital in Zimbabwe to offer antiretroviral drugs for pregnant women to prevent mother-to-child transmission of HIV. Sibanda’s experience has reminded her of those who have dedicated their lives to improving health in her home country.

“There is certainly value in being educated outside the country and taking lessons back home,” she says. “But I was reminded that there are those who have chosen to stay and work with that they have. Their experience and dedication is unparalleled.”

Europe Michael Harvey is among is the first researchers to conduct a cost analysis of violent crime in Glasgow, Scotland. The city is statistically one of the most violent in the world and has been dubbed the “Murder Capital of Western Europe.” Harvey is working with colleagues at St. Andrews University to determine the societal costs of homicide, with the goal of later performing a benefit-side analysis of prevention. Harvey says he’s pleased with how well his education is translating to action: “I was thrown into a brand new study, working together with two doctors,

5

notes from the field Other SPH Students Abroad Anna Michael is in Costa Rica and Nicaragua providing veterinary care, including spaying and neutering, for pets of low-income families. Michael, who is also pursing a doctorate in veterinary medicine, plans to return for future service work.

Robyn Browning and Laurie Lucachick are working with No Time For Poverty (NTFP) in Port Salut, Haiti, conducting outreach on maternal health, nutrition, sanitation, and family planning in surrounding villages. The work is in conjunction with a children’s clinic being built

by NTFP. Katarina Grande and Amber Koskey are in Uganda partnering with the University of Minnesota group of Engineers Without Borders to educate on respiratory health and bolster community support for cooking stoves that burn fuel more efficiently and cleanly than tradi­tional stoves.

Meg Tabaka is part of a study to improve care for patients at Mulago Hospital in Kampala, Uganda. The goal is to create tools to help patients understand and seek treatment for meningitis.

Patrick Mustain is in Pajule, Uganda, home to the Acholi, an ethnic group that up until recently had been in the crossfire of a brutal civil war. He is working with Peace Together Uganda, an organization aimed at lifting people out of poverty.

and I was not only able to keep up but also set the pace at points.”

Kara Durski is working to prevent one of the world’s oldest known diseases during her time at the World Health Organization in Geneva, Switzerland. She’s writing field guidelines to help African clinicians and health officials control plague. The guidelines cover the management of individual cases, outbreak response, and vector and rodent surveillance.

“The coursework I have taken has been invaluable,” says Durski, noting that she draws on her knowledge of infectious disease transmission, project planning, and clinical guidelines. The work has solidified her career plans to work at the intersection of human health and zoonotic disease.

Mangalick Charity Hospital in Agra, India, is the focus of Joshua Gramling’s work.

After assessing various hospital hazards, Gramling decided to devise a plan to reduce injuries from sharps—instruments such as needles, syringes, and razorblades—the primary cause of occupational exposure to bloodborne infections. While he used his education to conduct site walkthroughs, literature reviews, and occupational interviews, Gramling had to dig deeper to confront his greatest challenge: getting hospital administrators to recognize the problem, especially when Indian occupational laws for hospital workers are not well enforced. Says Gramling, “I have had some success with this through a whole lot of perseverance.”

Asia Spencer Rudolf and Hannes Skillingstad are at the Beijing Royal Integrative Medicine Hospital, which blends traditional Chinese medicine with Westernized evidencebased medicine in a modern facility. The students are responsible for analyzing an organizational challenge and presenting recommendations to hospital leadership.

Rudolph is investigating how to create a payment system for international patients, key to the hospital’s mission to become a global leader in integrative medicine.

Skillingstad is charged with reducing the wait time for patients. The students have also presented on the American health care system to administrators, who in turn treated them to some traditional Chinese medicine: cupping or bá guan for Rudolf and acupuncture for Skillingstad. Learning from another culture was eye-opening for the students. “Just because we do something a certain way in the U.S. doesn’t mean it’s the right way,” says Rudolph.

Improving safety for staff at Shanti

Kristin Paulson is in Kathmandu researching NGOs that provide care to communities in Nepal. She is working with Kalika Community Hospital, run by the U.S.-based Mountain Fund, which provides health care to more than 40,000 rural Nepalese.

6 University of Minnesota School of Public Health

More adventures, photos, and videos await at the Notes from the Field Blog. www.sph.umn.edu/notes10

(Top) Hannes Skillingstad explores Beijing, China. (Bottom) Joshua Gramling and Chandra Shakar, a housekeeper at Shanti Mangalick Charity Hospital in Agra, India.

Work on the wild side Alina Evans investigates the health of Scandinavian wildlife.

Photo by Jon Martin Arnemo

Imagine sleeping in a cave for six months. Now imagine what you’d feel like waking up. In this environment, the human body would experience a combination of nasty conditions— osteoporosis, muscle atrophy, blood clots, kidney failure, and bedsores, not to mention the infectious diseases one might catch. But bears don’t suffer from any of these ailments.

This mystery of nature has prompted a team of scientists to get up close and personal with brown bears across Norway and Sweden. It’s the first time the species has ever been captured during hibernation and anesthetized. What they learn may lead to discoveries about improving human health.

Alina Evans (MPH ’07) is part of this pioneering group. She recently wrapped up a year as a Fulbright fellow and is starting two more years of study with funding from the Morris Animal Foundation. When Evans isn’t snowmobiling or helicoptering out to bear dens, the veterinarian—she earned a DVM from the U of M—works with caribou, reindeer, moose, red deer, wolves, beavers, and seals.

Volunteering at a musk oxen and caribou research station in her home state of Alaska got Evans thinking that she wanted to seek a career in conservation medicine, a discipline that focuses on the intersection of environmental, human, and animal health. Having a physician mother with an MPH degree also helped steer her to the crosscutting field.

Evans hopes to return to Alaska one day to work in wildlife management. Right now, she’s content to stay in Scandinavia. Intermediate goals include pursuing a PhD from Hedmark University College, with a focus on the hibernation physiology of brown bears.

“It’s an exciting group to work with,” says Evans of the mentors she chose as part of her Fulbright fellowship and other team members, which include cardiologists, park rangers, field biologists, veterinarians, and ecologists. “Coming from a public health background not only qualifies you to work on interdisciplinary projects, but it helps you appreciate all the different perspectives that people bring to the team.”

See a photo gallery of Alina Evans capturing wildlife in Scandinavia. www.sph.umn.edu/evans

7

Thinking Locally, Acting Globally When in the early 1950s health pioneer Ancel Keys hopped on a plane to investigate a colleague’s claim that heart attacks were uncommon in Italy, he had no idea he was laying the found­ ation for the global research agenda integral to the University of Minnesota School of Public Health.

That visit to Naples led to the Seven Countries Study, a landmark of science that looks at the interplay of diet and risk of heart attack. SPH professor emeritus Henry Blackburn traveled with Keys in those early days of the study. Today, Blackburn is con­ tinuing that line of research with collaborators in Minne­sota, Rome, and the Netherlands. He is one of many SPH experts who are working beyond borders to address the public health challenges that seem to become more complex with each passing year.

Never before in the history of the school has there been such active engagement in global work. SPH faculty members are partnering with colleagues on six continents, in hundreds of countries.

While unprecedented, it should perhaps be expected. As we have seen over and over again and with increasing frequency, disease knows no boundaries.

Simply put, public health is global health.

8 University of Minnesota School of Public Health

global work of sph faculty members

Rosalie Kane is working with the Canadian Patient Safety Institute and counterparts in Manitoba and Ontario on methods to maintain freedom for long-term care residents while ensuring safety. She is also on a University of Albertabased advisory board focused on transferring research to long-term care settings.

multi-site projects James Neaton leads INSIGHT, the world’s largest collaboration of HIV researchers.

INSIGHT directs a network of 400 sites in 37 countries and has enrolled more than 10,000 people in clinical trials aimed at improving HIV treatment.

Michael Osterholm directs the Minne­ sota Center of Excellence for Influenza Research and Surveillance (MCEIRS), which sponsors initiatives aimed at enhancing understanding of the diversity, reassortment, and transmission of influenza viruses, including the 2009 pandemic H1N1 virus.

Lisa Harnack leads the Nutrition Coordinating Center, which licenses its software to researchers at the Technological Educational Institution of Thessaloniki, Laval University, Chinese University of Hong Kong, Sao Paulo University, and University of Brasilia.

Debra Olson is leading a team of SPH experts who serve on RESPOND, one of five national projects charged with improving response to zoonotic disease outbreaks in developing countries. The work will take place in sites throughout South America, Asia, and Africa.

9 University of Minnesota School of Public Health

Paul Allwood is working with the Organization for Strategic Development in Jamaica to research the causes of leptospirosis and on initiatives aimed at curbing youth violence.

Harry Lando serves on the organizing committee for the Third Latin American and Caribbean Conference on Tobacco or Health to be held in either Peru or Colombia in 2011.

Claudia Muñoz-Zanzi is leading a study on leptospirosis, several studies on human toxo­ plasmosis, and community educational programs on preventing zoonotic infections in Chile.

She is also teaching an online course for Austral University in Valdivia.

James Jaranson serves on an advisory group for the International Rehabilitation Council for Torture Victims in Copenhagen, Denmark.

Douglas Wholey is partnering with the University of Manchester in England to study primary care for patients with multiple chronic conditions.

Roger Feldman is a visiting professor at the Universidad Carlos III, in Madrid, Spain, where he is collaborating on health econ­omics research.

William Riley is working with No Time for Poverty in Haiti on projects to rebuild and ramp up the country’s public health infrastructure in the wake of the January 2010 earthquake.

Claudia Muñoz-Zanzi is researching toxoplasmosis with the International Society for Infectious Diseases in collab­ oration with the University of Cape Coast in Ghana.

Alan Hirsch is evaluating methods to prevent leg amputations among people with peripheral artery disease in Bern, Switzerland.

Michael Osterholm chairs the Council on Pandemics for the World Economic Forum in Geneva, Switzerland.

Alan Lifson is conducting community-based research to improve retention in medical care for people living with HIV/AIDS in Ethiopia.

Project Eat (Eating Among Teens), led by Dianne NeumarkSztainer, is being replicated by a research team in Brazil.

James Neaton is working with the South African National Defense Force to curb rates of HIV among military staff and their families. The partnership also trains South African researchers to conduct clinical trials.

Several SPH faculty members are teaching courses on global health for a public health institute on the campus of Makerere University in Kampala, Uganda (see page 15).

William Toscano and Gurumurthy Ramachandran are working with the government of Georgia on a study of manganese and arsenic exposure.

U experts, including William Riley, are on an international team charged with restoring the blood banking and supply system in Afghanistan.

The SPH is part of University of Minnesota partnership with the Indian Council of Medical Research in New Delhi, India.

Simon Rosser is consulting on the first program to prevent HIV among homosexual men in Tanzania.

W te en an at of M

Bruce Alexander serves on the board of the U’s Whole Village Project, which works with people in rural Tanzanian villages to improve health and sustain natural resources.

Jeff Mandel, Bruce Alexander, and Gurumurthy Ramachandran are partnering with colleagues in India on interventions to assess and curb exposures to asbestos.

Harry Lando is the inter­national co-chair of the Scientific Program Committee for the 15th World Conference on Tobacco or Health to be held in Singapore in 2012.

Jian-Min Yuan is collaborating with the Shanghai Cancer Institute in China and the National University of Singapore on two large popu­lation-based studies examining environmental exposure and genetic changes in the etiology of cancer.

William Toscano and Chisato Mori are contributing to sustainable health science projects at Chiba University in Japan. The work curbs exposures to chemicals used in building materials.

Robert Kane and Rosalie Kane are advisers to the geriatrics program at Chung Shan Medical University in Taiwan.

Harry Lando is working to promote tobacco control among teachers in Bihar, India, a poor state that has very high rates of tobacco use.

Mark Pereira is leading a five-year study to examine genetic and lifestyle predictors of type 2 diabetes in Chinese adults living in Singapore. He’s pursuing funding for similar research in India, Columbia, and Brazil.

illustration by Celia Johnson

William Toscano eaches courses on nvironmental health nd global health t the Tata Institute f Social Science in Mumbai, India.

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research news

U to investigate why African American smokers more likely to get lung cancer Tobacco researchers at the University of Minnesota are teaming up with research­ers at the University of Southern California and the University of Hawaii to determine why African Americans and Native Hawaiians are far more susceptible to getting lung cancer from cigarette smoking than other ethnic and racial groups.

The University of Minnesota Masonic Cancer Center’s Stephen Hecht will lead the five-year, $10.7 million National Cancer Institute-funded study. SPH professor and Cancer Center member Lisa Peterson is part of the research team.

She is an expert in the chemical process by which tobacco carcinogens affect DNA. This new study picks up on previous research that finds African American and Native Hawaiian smokers have the highest risk of getting smoking-related lung cancer, compared to other racial and ethnic groups. The study also found that individuals in these two groups were more likely to get lung cancer even when they smoked less than their racial and ethnic counterparts.

“Those findings imply that African American and Native Hawaiian smokers metabolize nicotine and tobacco carcinogens differently than whites, Japanese Americans, and Latinos,” Hecht says. “Our new study will aim to find out why this appears to be the case.”

Fast food chains cut trans fats Major fast food chains have significantly decreased trans fats in their cooking oils, finds new research from the SPH’s Nutrition Coordinating Center.

Using the center’s proprietary database—which catalogs the nutrients of more than 18,000 foods—researchers looked at trans fat and saturated fat levels in french fries from five major fast food chains: McDonald’s, Burger King, Wendy’s, Jack in the Box, and Dairy Queen.

They found that McDonald’s, Burger King, and Wendy’s decreased the trans and saturated fatty acid composition of fries between 1997 and 2008. While the remaining two restaurants didn’t show a decrease during the time period studied, current nutrition information shows that they have cut down on trans and saturated fats since 2008.

“While it took time for fast food chains to decrease trans fats in their foods, I’m pleased to see that they have done it,” says SPH associate professor Lisa

12 University of Minnesota School of Public Health

Harnack, who heads up the Nutrition Coordinating Center. “I’m also pleased to see that they haven’t raised levels of saturated fats to replace trans fats.”

The findings suggest that restaurant chains may be responsive to health concerns. That’s good news, as Americans on average get about 10 percent of their calories from fast food.

“But moderation is still key when considering fast food,” says Harnack.

“Calories and sodium are high and portion sizes are often too large.”

Diabetes in older women linked to colon cancer Older women with diabetes are more than twice as likely to develop colorectal cancer, according to a Mayo Clinic and University of Minnesota study.

To make the connection, researchers examined data from 37,695 participants of the Iowa Women’s Health Study, which enrolled participants ages 55-69 in 1986 and is ongoing. In that time, 1,200 women developed colorectal cancer. Tumor tissue was analyzed from 550 of those subjects and comparisons were made between those with and without a prior history of colorectal cancer.

“Our findings provide further evidence that diabetes is a risk factor for colorectal cancer,” says SPH professor Kristin Anderson, one of the study’s researchers.

A growing body of science has indentified diabetes as a colon cancer risk factor, but the mech­ anisms aren’t completely understood. Anderson says these results provide scientists with more evidence to explore and potentially more tools to prevent colon cancer.

Higher co-pays limit access to arthritis drugs Biotech drugs used to treat people suffering from rheumatoid arthritis cost as much as 10 times more than conventional medicine. But often they are also more effective.

A new study finds that arthritis sufferers are less likely to use these more powerful drugs if their health insurance requires higher out-of-pocket costs to purchase them.

“Our work shows that out-of-pocket cost is a concern in the decision to initiate these drugs,” says SPH assistant Pinar KaracaMandic. “If higher cost-sharing forces people away from effective therapy, patients could end up with more complications and, potentially, higher medical costs.”

Karaca-Mandic says that health insurance providers need to establish more flexible guidelines so those who would benefit from the drugs can afford them.

“It’s important to target those most at risk,” she says. “Once you identify those in real need, increasing patients’ out-of-pocket costs makes little sense.”

Tanning beds raise risk of melanoma Last year, the International Agency for Research on Cancer added indoor tanning to its list of carcinogens. But the agency—part of the World Health Organization—relied on evidence that showed only a weak association between tanning beds and melanoma. Now, for the first time, a study from the University of Minnesota School of Public Health offers a definitive link between indoor tanning and melanoma.

Research led by SPH associate professor DeAnn Lazovich finds that people who use any type of tanning device for any length of time are 74 percent more likely to develop melanoma. Frequent users—defined at more than 100 sessions, 50-plus hours, or more than 10 years—have 2.5 to 3 times the risk of the rare but deadly skin cancer, and the risk increases with use.

“We found that it didn’t matter the type of tanning device used; there was no safe tanning device,” Lazovich says. “We also found—and this is new data—that the risk of getting melanoma is associated more with how much a person tans and not the age at which a person starts using tanning devices.”

Lazovich’s team surveyed 1,167 Minnesotans who were diagnosed with melanoma between the ages of 25 and 59 and 1,101 who were without cancer.

Unlike many previous studies, the researchers ac­count­ed for other risk factors, such as sun exposure, age, and skin type.

The findings could play a significant role in the Food and Drug Adminis­ tration’s pending decision on whether to ramp up regulation of tanning salons.

“Ultraviolet radiation, whether it comes from the sun or from indoor tanning, is not safe,” says Lazovich.

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school news SPH receives Global Spotlight awards

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wo SPH faculty members and one student have received Global Spotlight awards from the University of Minnesota Office of International Programs (OIP). The OIP’s global spotlight is a biennial focus on a region of the world and a pressing global issue. The latest focus is on Africa and the issue is water in the world.

SPH professor Alan Lifson leads one of four projects to receive a major international research grant. The funding will help move his work forward in rural Ethiopia to bolster patient retention in HIV therapy. It’s estimated that at least a quarter of all Ethiopian HIV patients die due to lack of followup care in the first year of diagnosis. Others return only after their illness has become so advanced that immune system reconstitution is impossible.

Lifson’s preliminary evaluations in Ethiopia have found that three interventions would help retention: increasing community-based support workers, offering nutritional counseling, and linking HIV-positive people to peer support groups.

SPH assistant professor Paul Allwood is one of nine investigators to receive an international collaborative seed grant, which supports semester- to yearlong projects that partner with at least one scholar from outside the United States. Allwood will study the prevalence and molecular characterization of cryptospordia, giardia, and leptospira, disease-causing agents that often contaminate water in developing countries. Allwood will work with colleagues at the University of the West Indies.

Ethiopia Kenya

West Indies

Farhiya Farah, a PhD student in environmental health, is one of 10 doctoral students to receive an international pre-dissertation and small grants award. Farah, a native of Somalia, will develop a social network model for foodborne disease surveillance in Kenya. She plans to work with vendors to improve the safety of street foods there.

Eunice Abiemo has received an International Peace Scholarship from the Philanthropic Educational Organization (PEO). The scholarship is for female international students pursuing graduate study in the United States or Canada.

Abiemo will use the scholarship funds to support her master’s work in the public health nutrition program. She came to the SPH after earning an undergraduate degree in her home country of Ghana. Abiemo, who interned at the World Health Organization last summer, is in the planning stages of her master’s project. It will focus on policies and community intervention programs to improve nutrition for mothers and children.

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illustrations by Celia Johnson

Student receives International Peace Scholarship

An orphaned elephant dangerously mixes with villagers. Insert: Karin Hamilton

Minnesota Public Health Institute Going Strong A little closer to home, the SPH recently wrapped up its annual summer Public Health Institute.

The three-week event, now in its ninth year, draws participants from through­­out world to the U’s Twin Cities campus.

Institute Stats-at-a-Glance

Photos by Mark Engebretson

SPH holds global institute in Uganda Learning how to work together under a “One Health” multidisciplinary umbrella to quickly identify and respond to emerging animal-to-human diseases was the focus of the most recent Global Health Institute, held Aug. 1 to 13 in Kampala, Uganda. Twelve University of Minnesota students from the schools of public health, nursing, and veterinary medicine joined 65 students from seven East African countries at the institute, sponsored, in part, by the U of M. “We had many participatory exercises, so we were able to interact with nurses, doctors, veterinarians, and public health students and professionals from many East African countries,” says Karin Hamilton, a veterinarian and SPH student. “Hearing about their experiences and their knowledge was great.”

During the institute, students traveled to rural Uganda to visit Queen Elizabeth National Park, a health center, and a fishing village on Lake George—where they witnessed an orphaned elephant mixing with villagers. The situation puts the villagers in danger of being trampled by an unpredictable wild animal, says institute faculty member Dominic Travis, an associate professor of veterinary medicine at the U of M. More appropriate to the topic of emerging diseases, he says, was the sight of water buffalo and hippos “literally almost sitting on the fishing canoes. This proximity creates an opportunity for things to interact and cause the spread of disease.”

Says Hamilton: “Seeing it in person, with cattle, goats, an elephant, people, hippos in the water—everything in close quarters—seeing how those interactions happen really makes a big difference [in helping to understand animal and human health].”

U of M faculty involved in the institute were John Connett, Joän Patterson, and Beth Virnig (SPH); Will Hueston, Travis, and Katherine Waters (College of Veterinary Med­­­i­­­cine); and Linda Halçon (School of Nursing). SPH associate dean Debra Olson led the effort.

• 41 courses • 10 new courses • 283 students • 18 participating U.S. states • 20 participating countries • 54 faculty • 43 guest speakers • 8 concentration areas – Culturally responsive public health practice – Environmental health sciences – Global health – Food protection – Infectious disease epidemiology – Public health leadership and management – Public health preparedness, response, and recovery – Women and child health and nutrition

Go in-depth with insti­tute courses that tackle obesity from a teen’s view and those that teach critical communication skills through live mock interviews. www.sph.umn.edu/screentime www.sph.umn.edu/commskills

Watch highlights of the institute at: www.sph.umn.edu/ghi.

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school news

SPH’s centers for education and outreach celebrate 10 years When the school’s Centers for Public Health Education and Outreach (CPHEO) opened for business 10 years ago, it Anniversary was faced with responding to the unprecedented needs of a post 9/11 world.

CPHEO—with a mission to educate professionals and encourage lifelong learning—not only met those needs but anticipated many of the emerging issues of the past decade—from preventing the spread of pandemic influenza to protecting our global food systems to addressing the growing influence of genomics.

Throughout it all, CPHEO has partnered with the practice community with the aim of providing training that is tailored to the needs of the workforce.

“The CPHEO model was ahead of its time in many ways,” says SPH dean John Finnegan. “The emphasis on workforce development, the global partnerships, the educational technology—CPHEO was one of the first centers of its kind to embrace these aspects of education and use them to move the field forward.”

10 Year

5 facts 10years

U team introduces new hygiene technology to Jamaican health officials Demand for beds at Jamaica’s largest hospital is always high. Each month some 5,500 people go through Kingston Public Hospital’s emergency department, and the intensive care unit also sees big patient loads. The heavy traffic has caused an upsurge in antibioticresistant diseases, including the highly dangerous and hard-to-control MRSA infection. Added to the problem is that the hospital, like many in the developing world, faces a chronic shortage of resources.

SPH assistant professor Paul Allwood recently met with staff at Kingston Public Hospital to introduce a new method of monitoring hygiene known as ATP Bioluminescence. He was joined by SPH student Annette Cunningham and Andrew Streifel, a specialist at the U’s Department of Environmental Health and Safety (where Allwood is an assistant director).

The presentation was part of an annual conference sponsored by the Organization for Strategic Development in Jamaica. Allwood, a native of Jamaica, has worked with the nonprofit group on several health initiatives.

At the conference, the trio demonstrated an ATP tool, which can rapidly detect the presence of soils, including microorganisms, on surfaces. The technology could substantially improve protocols to maintain the cleanliness of surfaces such as countertops, bed rails, and keyboards. Courtesy of 3M, the team donated an ATP wand to the hospital.

Allwood is hopeful that after awareness comes support.

“The hospital staff were very receptive to improving infection control practices, but this is going to take a sustained effort,” he says. “The next step will be to secure funding through a government agency or nonprofit group.”

about CPHEO’s first

1 2

Funding for major grants is more than $2.7 million.

In the past five years, online and face-to- face courses have reached participants in 101 countries.

3 4

In the last decade, some 35,000 people have participated in face-to-face courses.

From 2006 to 2009, enrollment for online courses grew to an all-time high of 6,521 students (an increase of 2,980 percent).

Course offerings grew from 2 to 80 (an increase of 3,950 percent).

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In the past five years, nearly 24,000 users have created accounts to participate in online learning opportunities.

From right, Paul Allwood, Annette Cunningham, and Andrew Streifel (fourth from right) meet with staff at Kingston Public Hospital.

16 University of Minnesota School of Public Health

SPH research cited in national HIV strategy When the White House unveiled its first-ever national HIV/AIDS strategy in July—a plan that aims to reduce the number of new cases by 25 percent in the next five years—the focus was not on developing new drugs.

Rather, much of the strategy is dedicated to preventing the disease, especially among populations that have persistently high infection rates, such as gay and bisexual men and African Americans.

Over the years, the federal government has spent tens of billions of dollars to develop and administer new drugs for HIV patients. But the number of new annual HIV infections has remained virtually unchanged for a decade.

An estimated 1.1 million Americans are living with HIV, with 56,000 new infections annually.

“The plan is far too long in coming, but I’m pleased to see that the country has finally established a formal coordinated set of principles and goals around HIV prevention and care,” says Keith Horvath, SPH assistant professor.

“ The plan is far too long in coming, but I’m pleased to see that the country has finally established a formal coordinated set of principles and goals around HIV prevention.”

Keith Horvath

Horvath’s study showing that HIV-specific laws do not deter high-risk sexual behavior among homosexual men was cited in the report outlining the national strategy. His work was among the first to examine whether state laws that criminalize HIV transmission influence the attitudes and sexual behavior of gay men.

While the study finds the laws to be ineffective in preventing risk-taking behavior among HIV-positive and negative men, Horvath stresses that there remains a lot to learn on whether the laws impede HIV prevention by discouraging people from seeking out testing and accessing the appropriate care. His next step is to investigate if and how HIV-specific laws act as a barrier for HIV testing and care. It’s an area of study that could benefit from the new national strategy, which highlights the need to steer federal funding toward prevention efforts.

U launches master’s in international development The first cohort of students has been admitted to the University of Minnesota’s Master of Development Practice (MDP). The Minnesota MDP is one of only seven in the country and will include courses taught by SPH faculty.

The MDP emphasizes hands-on field experiences to integrate policy analysis, health, natural sciences, and interdisciplinary research methods. The program is jointly administered by the Humphrey Institute and Interdisciplinary Center for the Study of Global Change. It spans several academic units across the University.

“When the announcement came through that the MDP would be offered here at the University of Minnesota, there was a lot of excitement among our faculty in the School of Public Health,” says SPH professor William Toscano. “The focus on health through an interdisciplinary lens complements the work we’ve been doing in the school for some time now.”

In 2009, the John D. and Catherine T. MacArthur Foundation committed $15 million to create MDP programs at 15 univer­ sities worldwide over the next three years. Collectively, the first 10 Universities—which are also in Ireland, India, Australia, China, Senegal, Botswana, and Nigeria—will produce some 250 MDP graduates by 2012, with a total of 750 students enrolled.

The latest round of schools added to the global MDP network are based in Bangladesh, Costa Rica, Sri Lanka, and Canada.

“By working with part­ ners in this network, we can have a much higher impact on complex global challenges than we would acting alone,” says Toscano. “This is a new era of global research, education, and outreach.”

William Toscano discusses the promise of the MDP degree program. www.sph.umn. edu/mdp

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alumni news

When Carol Berg, Patricia Ohmans (MPH ’91), and Ellie Zuehlke (MPH ’99) are in the room, so is 30 years of mentoring experience.

This year, the three women celebrate a decade of serving in the SPH’s mentor program, the largest public health mentoring program of its kind nationally. While they each pursued vastly different careers—Zuehlke works for the large health system Allina Hospitals and Clinics; Ohmans is the founder of Heath Advocates, a small consulting group; and Berg has a post with the nonprofit health plan UCare—they share a commitment to helping public health’s latest recruits find their own path of success.

Perhaps it’s no surprise that they all enjoy learning from the students they mentor— it’s part of what’s kept them in the program for so long. Ohmans appreciates the worldview of international students, who have come from Romania, Yemen, and Brazil, among other places. Zuehlke likes hearing about facets of public health that would otherwise be foreign to her. And Berg finds value in the perspective that, as she says, “someone with fresh eyes” brings to the field.

When asked for advice on mentoring, they each sketch out an easygoing yet structured relationship. “Don’t feel like you have to convey the wisdom of the ages,” says Ohmans. “It’s the personal connection that matters.”

Says Berg, “Make sure to work out specific goals at the beginning of your relationship—what your mentee wants to learn. But be open to incorporating new goals along the way.” Zuehlke agrees: “I like to look back at our objectives half way through the year and ask ‘Are we meeting our goals? Do we need new goals?’”

While the women have been successful in their own careers, Zuehlke says mentoring isn’t just for the young or those new to the field. In fact, she counts Berg and Ohmans among her own mentors. “I’ve looked to them for advice over the years,” she says.

“I always try to have mentors in my life.”

Sign up to mentor at www.sph.umn.edu/alumni/mentor.

Supermentors Patricia Ohmans, Ellie Zuehlke, and Carol Berg

18 University of Minnesota School of Public Health

“ Make sure to work out specific goals at the beginning of your relationship—what your mentee wants to learn. But be open to incorp­orating new goals along the way.”

Carol Berg The five plus club Thanks to the mentors who have served for five or more years.

David Abrams Karen Compton Adamson (MPH ’00) Jill Briggs (MPH ’99) Janette Brust (MPH ’87) Jeffrey Budd (MS ’77, PhD ’81) Neil Carlson (MS ’88) Kathy Chinn Richard Danila (PhD ’89) Heather Day (MPH ’02) Erica Fishman (MPH ’91) Christine Follett (MPH ’96) Rob Fulton Gail Gentling (MPH ’86) Stefan Gildemeister Gary Greenfield Julia Halberg (MPH ’83) Penny Hatcher Deborah Hendricks Karen Holtmeier (MPH ’88) Jay Jaffee Sarah Kogut Ting Kong (MS ’95) Christopher LeClair Todd Monson (MPH ’79) Ann O’Fallon Michael Olesen Lisa Pogoff (MPH ’85) Christopher Reif (MPH ’84) Deborah Sodt (MPH ’90) Gretchen Taylor (MPH ’84) Lisa Turnham (MPH ’03)

Photo by tim rummelhoff

A decade of mentoring brings rewards

Class notes Jeanne Ayers (MPH ’85) received the Josie R. Johnson Human Rights and Social Justice Award in recognition of her work as director of nursing and preventive services at Boynton Health Service, founder of Boynton’s occupational health and safety program, and advocate for health equity.

John Dao (MHA ’00) was elected to the partnership of Wipfli, a consulting firm with 14 offices in Wisconsin and Minnesota. Prior to joining Wipfli, he served as a manager for Partners Healthcare Consulting, Inc.

County Department of Health and Human Services in Maryland. Her most recent position was program administrator for the Office of Health Promotion and Prevention.

assistant professor in environmental and occupational health sciences at the University of Illinois at Chicago School of Public Health.

Michael Trujillo (MPH ’84) was named associate dean of the Office of Out­ reach and Multicultural Affairs for the University of Arizona College of Medicine-Phoenix in partnership with Arizona State University.

Nicholette Zeliadt (PhD ’10) was awarded a mass media fellowship from the American Association for the Advancement of Science. She is working for Scientific American Magazine and blogging about her experience at www.sph.umn.edu/aaas.

Quintin Williams (PhD ’08) is a research

Share your news at SPHnews@umn.edu.

Gary Gackstetter (PhD ’92) was appointed acting director of the CDC’s National Institute for Occupa­ tional Safety and Health. He is an infectious disease epidemiologist with 26 years of service as an Air Force Public Health Officer.

Anil Mangla (MPH ’08) was named director of the Infectious Disease and Immunization Program at the University of Georgia.

Photo by tim rummelhoff

Robert Norton (MHA ’76) was elected to the board of directors for Blue Cross and Blue Shield of Rhode Island. He is president and CEO of North Shore Medical Center in Salem, Mass.

Kay Schwebke (MPH ’95) won the Gold Award from the American Society of Healthcare Publication Editors for “The Vietnam Women’s Memorial: Better Late Than Never,” an article she wrote for the American Journal of Nursing. She is medical director of the Co-infection Clinic at Hennepin County Medical Center.

Lenora Sherard (MPH ‘75) retired after 22 years with the Montgomery

Judith Beniak (MPH ’82), Linda Olson Keller (MS ’80), both pictured, Linda Halçon (MPH ’86, PhD ‘98), Carol O’Boyle (MS ’92, PhD ’98), and Cheryl Robertson (MPH ’88) were among 14 University of Minnesota School of Nursing (SoN) distinguished faculty alumni members honored as part of the SoN’s centennial celebration.

Join the UMAA Become a member of the University of Minnesota Alumni Association and a portion of your membership dues will go directly toward the SPH alumni society (enter promo code NP4PB). Membership brings discounts on a variety of goods and services. Learn more at www.minnesotaalumni.org.

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Non-profit U.S. Postage PAID Permit No. 155 Minneapolis, MN

420 Delaware Street SE Minneapolis, MN 55455 www.sph.umn.edu

Is heart health connected to brain health?

SPH experts have found that poor cardiovascular health in middle age can lead to cognitive decline later in life. The researchers will learn more about this link through a new $26 million study focused on risk factors for Alzheimer’s disease and other forms of dementia. The work will answer questions about how and why the brain ages. Most importantly, it could lead to new ways to prevent and treat dementia.

Upcoming Events SPH assistant professor Jean Abraham discusses health care reform.

Sept. 16, 7 p.m., Mendota Heights City Hall Oct. 5, 7 p.m., Boutwell’s Landing in Oak Park Heights Presented by the University of Minnesota Alumni Association.

Javon Bea (MHA ‘78), president and CEO of Mercy Health System, delivers the James A. Hamilton Lecture.

Sept. 20, 5 p.m., Campus Club, Coffman Memorial Union Imee Cambronero (MPH ‘09) presents her documentary “Family Planning in India: North v. South.”

Sept. 23, 5:30 p.m., reception 6 p.m. film screening and Q&A Mayo Memorial Building 3-100 Register by Sept. 15: www.sph.umn.edu/documentary SPH book club discussions (live and via telephone) Sept. 25, 11 a.m., “Outbreak”

by Robin Cook Nov. 20, 11 a.m., “A Working Stiff’s Manifesto: A Memoir of Thirty Jobs I Quit, Nine That Fired Me, and Three I Can’t Remember” by Iain Levison

BYOB—“bring your own bike”—and ride in the SPH’s bike brigade for the U of M’s homecoming parade.

Oct. 1, 5 p.m., decorate your bike happy hour 7 p.m. parade George Halvorson, chair­man and CEO of Kaiser Permanente, leads an SPH Roundtable on health sector leadership in times of change and economic challenge.

Nov. 5, 9 a.m., Coffman Memorial Union Theater SPH alumni and friends reception at the annual meeting of the American Public Health Association Nov. 8, 6:30 p.m., Limelight Supper Club, Denver, Colo.

The SPH will not have a booth at the annual meeting.

Sign up for event notices, including alumni reunions, at www.sph. umn.edu/alumni/involved.

Event details at www.sph.umn.edu/events.