Advances - Fall 2016

Advances FROM THE UNIVERSITY OF MINNESOTA SCHOOL OF PUBLIC HEALTH

FALL 2016

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DON’T SHOOT How a public health approach can solve one of our country’s biggest problems

School of Public Health Leadership Dear Friends,

Beth Virnig Senior Associate Dean for Academic Affairs & Research Kristin Anderson Associate Dean for Learning Systems & Student Affairs Bruce Alexander Head, Division of Environmental Health Sciences Timothy Beebe Head, Division of Health Policy and Management Bradley Carlin Head, Division of Biostatistics

Dianne NeumarkSztainer Head, Division of Epidemiology and Community Health Tara Anderson Director, Alumni Relations and Annual Giving Louis Clark Director, Development Martha Coventry Director, Communications Susan Rafferty Chief of Staff Joe Weisenburger Chief Administrative Officer/Chief Financial Officer

Advances Editor Sarah Howard Contributing Writers Sarah Howard Meghan Laffen Heidi Mastrud Charlie Plain Art Direction Cate Hubbard Design cat7hubb@gmail.com Advances is published 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.

Now that one of the most polarizing presidential elections in our history is over, how will the public’s health fare in the coming administration?

Too many presidential administrations have FROM THE DEAN focused on illness at the individual level rather than population-level community strategies toward better health. Certainly this has improved some under the Affordable Care Act, along with efforts to create a culture of health by the Robert Wood Johnson Foundation and many others. But the U.S. still spends the overwhelming majority of our $3 trillion annual health care dollars — a higher amount per capita than any other nation — on expensive and unsustainable downstream care while an infinitesimal amount goes to upstream public health approaches.

The outcomes? We reap what we sow: our average lifespan has stagnated and our nation’s health is poorer than that of most developed nations.

The Association of Schools and Programs of Public Health (ASPPH) has tasked the new administration to make public health a priority by advancing research, training, and on-the-ground actions to protect and promote health for all. Specific goals include: • Ensuring that every American has the opportunity for a healthy life. This includes initiatives to prevent disease, injury, and disability; to prioritize quality, affordable health care; and to eliminate health inequities.

• Educating the next generation of skilled public health professionals. We need a workforce prepared to provide leadership. We need more support for education, more effective training, and educational opportunities for students to explore public health as early as grade school.

• Increasing investment in public health research. Our national agencies, such as the National Institutes of Health and the CDC, need to be able to support science and research in prevention and population health. We also need to focus on broader population health strategies in sectors such as urban planning, housing, environmental protection, and agriculture.

Public health must tackle another enormous issue: firearm violence and injury.

Too many headline-making tragedies lead us in sadness to ask yet again, “What can we do to stop this?” In our story on page 6, “Don’t Shoot,” we lay out how a public health approach can help prevent gun deaths, especially suicides and homicides.

As anti-violence activist Sarah Brady once said: “We are not for disarming people.

When you have an epidemic, it’s a public health issue, a safety issue.”

Yours in health,

John R. Finnegan, Jr., PhD Dean and Professor P.S. November 17 is Give to the Max Day! You can give to the University of Minnesota School of Public Health at crowdfund.umn.edu/GTMDSPH.

© Regents of the University of Minnesota.

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

PHOTO BY MARK BROWN

John R. Finnegan, Jr. Dean

Contents

Features FEATURES 6 Don’t Shoot

Gun deaths are preventable. So how can a public health approach solve one of our nation’s most contentious issues?

10 There’s an App for That SPH faculty, students, and alumni use app and text technology to change public health interventions.

FALL 2016

DEPARTMENTS 2 Findings New and innovative research from SPH faculty and researchers.

5 SPH faculty research around Minnesota

14 Alumni News Recap of Eat, Learn, Gather and SPH Celebration of Giving and 2016 Alumni Awards 15 Note from the Alumni Board

16 Class Notes 17 Donor Spotlights

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FINDINGS

Opioid prescribing common at hospital discharge An estimated 40 people die every day from overdoses of opioids, drugs that include pain killers such as Vicodin, oxycodone, and morphine.

The troubling high numbers of opioid-related deaths have prompted questions about how users obtain these drugs. A study from Associate Professor Pinar Karaca-Mandic points to one factor — Medicare beneficiaries who had no opioid use prior to hospitalization are commonly prescribed the drugs at hospital discharge.

Research has shown that even short-term opioid prescriptions can lead to long-term use.

“One of the more glaring and possibly problematic findings was that nearly 40 percent of patients with a new opioid prescription refilled the prescription 90 days after their discharge, suggesting long-term use,” says Karaca-Mandic.

Hospitals vary in their post-discharge opioid prescribing and that concerns Karaca-Mandic. She suggests that current hospital incentives to promote adequate pain control could be coupled with new measures to target and promote appropriate opioid use.

Protecting babies and children from harmful chemicals Associate Professor Ruby Nguyen is studying chemicals found in common products and how they can alter hormone-related levels in expectant mothers and affect their child’s development.

“We are looking at subtle differences in hormone levels that would change population norms,” says Nguyen. “Our work will bring together biological outcomes and typical education outcomes including IQ and learning disabilities, to see if there is a correlation between them.”

Nguyen is specifically studying phthalates, an endocrinedisrupting chemical found in hundreds of consumer products such as plastics, canned foods, and shampoos. So far, her research shows the higher the phthalate levels in mothers, the more hormonerelated differences seen in their children, particularly boys. These differences are thought to later affect everything from genderrelated play to biological outcomes like blood pressure, which additional studies will measure.

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40%

of patients

who are prescribed an opioid upon hospital discharge refill the prescription 90 days later, suggesting long-term use.

“Overservice” of alcohol still a major problem at bars and restaurants The U.S. has failed to reduce the likelihood of illegal alcohol sales to obviously intoxicated patrons in bars and restaurants according to a new study by Professor Traci Toomey.

The practice, known as “overservice,” is illegal in most states and can lead to fatal car crashes, violence, and other dangerous events.

“We were surprised that the likelihood was similar to the rates found in similar studies done in the 1990s,” says Toomey.

“We had thought that progress might have been made.”

In particular, the study found that corporate-owned establishments had 3.6 greater odds of selling alcohol to a pseudo-intoxicated buyer compared to an independently owned bar or restaurant.

To combat overservice, Toomey suggests implementing both effective training in responsible service of alcohol and increasing enforcement of laws prohibiting sales to intoxicated patrons.

Adolescent snacking likely contributes to poor diet, but is not related to being overweight Adolescents typically consume a total of four snacks a day and have more than two servings of energydense foods — like chips and candy — on a given day. Overall, snacking is associated with a higher daily consumption of calories, sugar-sweetened beverages, and fast-food, and a lower intake of fruits and vegetables. However, a new study by researcher Nicole Larson found that although snacking among U.S. adolescents is a risk factor for poor diet, it is not consistently related to being overweight. Given that snacking is a normal part of an adolescent’s day, she recommends trying to encourage them to snack on healthier food and drinks.

Thirty percent of antibiotic prescribing unnecessary Assistant Professor Eva Enns has discovered that an estimated 30 percent of outpatient antibiotic prescribing in the U.S. in 2010-2011 was unnecessary.

Enns and her collaborators used survey data, clinical guidelines, and geographic data to analyze the nearly 262 million total outpatient antibiotic prescriptions filled throughout the year.

Enns says eliminating unnecessary antibiotic prescribing is necessary to reduce the growth of antibioticresistant infections.

“Antibiotic resistance is an inevitable consequence of both appropriate and inappropriate antibiotic use,” says Enns.

“The key is to conserve antibiotics for the cases in which they are truly needed.”

The results of Enn’s research offers a baseline against which the nation can mark progress in reducing inappropriate prescriptions, and her analysis framework can be used to monitor how prescribing changes in future years.

Soda tax messaging has an impact on its effectiveness To reduce the consumption of sugar-sweetened beverages, policymakers have been talking about a “soda tax,” or a surcharge on sugary drinks.

Research led by Associate Professor Sarah Gollust set out to determine if how the potential price change is framed would affect how consumers responded.

Gollust found that justifying a tax by saying it will help reduce obesity, offset chronic health care costs, or protect children reduced people’s intentions of saying they would buy soda, compared to a message that simply explained that the cost of soda was going up.

In addition, justifying a tax for obesity prevention contributed to unfavorable perceptions of soda companies, but only among young people who did not regularly consume soda.

“The message that policymakers and advocates attach to a soda tax — why it is important, what the tax will accomplish — matters, since this language can influence consumers regardless of whether the tax actually gets adopted.”

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FINDINGS

Efforts to increase HPV vaccination are urgently needed in U.S. adolescent populations The use of the human papillomavirus (HPV) vaccine remains low in U.S. adolescents, with only 35 percent of females and 10 percent of males receiving at least one of the recommended three doses of the vaccine, according to a new study by Assistant Professor Nicole Basta.

“In the U.S., the HPV vaccines have been recommended for girls since 2006 and boys since 2009. However, vaccine uptake has been disappointingly low and far from the U.S. Department of Health and Human Services’ Healthy People 2020 target of 80 percent coverage,” says Basta.

The study recommends that all health care providers encourage adolescents to get the vaccinations and that current efforts to improve HPV vaccine uptake could be enhanced by defining target groups at greatest risk of failing to receive the vaccine.

THE HPV VACCINE HOW MANY ARE VACCINATED?

80%

Caregivers foster academic success among African-American youth Research by student Ashley Chesmore shows academic success of African-American youth is associated with their access to resources for resilience, like an emotionally supportive caregiver. That association was stronger among boys than among girls.

“A positive caregiver-child relationship may be especially important for boys’ academic performance,” says Chesmore.

Chesmore’s study also found that youth with greater perceived social support had less school misbehavior.

“It may also be beneficial to provide schoolbased mental health services for children and their families in order to strengthen adaptive coping strategies in the presence of stressors,” says Chesmore.

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FEMALES

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2016: WHERE WE ARE

FEMALES

MALES

2020: WHERE WE WANT TO BE

Around the State The work of School of Public Health faculty in local communities made positive change for Minnesotans in 2016. Here’s a small sample of what we’ve been up to.

Jean Abraham and Russell Luepker, as well as the Medical School’s Alan Hirsch, lead the statewide “Ask About Aspirin” campaign. Sanford Health, whose Minnesota hub is in Bemidji, has joined the initiative, which encourages men and women ages 50–69 to ask their health care professional if they should take a daily low-dose aspirin to decrease their risk of heart attack and stroke.

ILLUSTRATION BY STEVE STANKIEWICZ

Patricia McGovern, Donna McAlpine, and PhD student Jennifer Saunders are exploring worker health and resilience in Kandiyohi County during the 2015 outbreak of Highly Pathogenic Avian Influenza (HPAI), which resulted in the loss of more than 48 million birds.

The Minnesota Midwest AIDS Training and Education Center team (led by co-PIs Sarah Rybicki and Alan Lifson) works with organizations serving American Indian tribes in northern Minnesota and the Dakotas to provide training, technical assistance, and capacity building for health care providers and community members to reduce the burden of HIV, hepatitis C, sexually transmitted infections, TB, injection drug use, opioid use, and human trafficking.

Patricia McGovern, Lisa Harnack, Irina Stepanov, and PhD student Shannon Sullivan are examining exposure to naturally occurring manganese in well water among pregnant women and infants in select Minnesota communities.

Exposure to elevated levels of manganese in drinking water while pregnant may be associated with subtle, adverse neurodevelopmental effects in infants and children.

Linda Frizzell submitted a report to the National Rural Health Association that outlined health equity issues in Minnesota’s federally recognized American Indian tribes and included recommendations for Congress to improve the health status of American Indians and Alaska Natives.

An ecohealth study in the Grand Portage Indian Reservation is tapping the complexity science modeling expertise of Matteo Convertino. The project is assessing the health threat from pollutants in the environment and in the fished, hunted, and gathered food reservation residents eat.

John Finnegan, Peter Raynor, and Jeff Mandel found that taconite workers experience higher death rates from mesothelioma, lung cancer, and heart disease. In addition, their study found that the longer people worked in taconite mines, the higher their risk of mesothelioma.

Jennifer Linde addressed nutrition, stress, and health disparities in partnership with the Kwanzaa Community Church community in North Minneapolis. The work led to significant reductions in waist circumference and increased fruit intake in study participants, as well as improved attitudes toward physical activity.

Bruce Alexander, Peter Raynor, and Jeff Bender are looking at occupational hazards for pork producers by evaluating how different practices by hog farmers could have an impact on potentially hazardous airborne exposures and injury risks.

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DON’T SHOOT How a public health approach can solve one of our country’s biggest problems

BY SARAH HOWARD

It’s no longer debatable: Gun violence is a problem.

While we remain shocked by high-profile mass shootings fueled by hate and terrorism, data shows that these account for less than one percent of violence using firearms. Day-to-day, the majority of firearm deaths are suicides, followed by homicides.

So how do we begin to tackle this enormous issue, wrapped up in politics and emotion? Many experts agree that the way to reduce firearm-related injury and death requires a public health approach, which has been effective in previous challenges like vehicle safety, and tobacco and alcohol use.

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public health approach focuses on what really matters: keeping citizens safe and healthy. “The public health approach is about preventing people from being killed or hurt by guns,” says John Finnegan, School of Public Health dean and professor. “We look at the problem through multiple interventions — education, technology, and policy — as many paths leading to a solution. I know that some people are deeply afraid that this includes taking away people’s guns, but that’s not what we’re about. For us, it’s about realistic ways to reduce the carnage.”

“The public health point of view is all about making what is healthiest for the community and the individual easy,” says Nancy Nord Bence, executive director of gun violence prevention nonprofit Protect Minnesota. “Instead of focusing on each particular shooter, public health looks at the larger population and asks, ‘How can we make gun ownership safer?’”

says David Hemenway, professor at the T.H. Chan School of Public Health at Harvard University and a national expert on gun violence, who spoke at the School of Public Health in June 2016 as part of the school’s Gaylord Anderson Memorial Lecture.

“Suicide is a split-second impulse decision and every step we can put in a person’s way, the higher the likelihood that they will never die of suicide,” says Nord Bence. “[Removing guns from the reach of a suicidal person] is like taking away someone’s car keys who is drunk,” says SPH Professor and injury prevention expert Bruce Alexander.

But the connection between guns and suicide is often not made. SPH Professor Sue Gerberich, injury epidemiologist and co-director of the Center for Violence Prevention and Control, says there is pressure on the press not to report gun-related suicides for fear of copycats. Family may also be reluctant to talk about a loved one’s suicide.

HOMICIDES SELF-INFLICTED INJURY In 2015, there were 65 homicides in Minneapolis and St. Paul. Of those, 49 involved a gun.

The number one cause of death by guns is self-inflicted.

“The majority of homicides are between people that are Nationwide, 60 percent of gun deaths are from known to each other,” suicides, that number rises to 82 percent in says Alexander.

Minnesota and is the eighth leading “Mass shootings cause of death in our state. and hate crimes “As a means of suicide, firearms are account for a very, sadly successful,” says Finnegan.

“INSTEAD OF FOCUSING ON EACH small fraction While suicide is up among all age PARTICULAR SHOOTER, PUBLIC of gun violence.” groups, suicide prevention is often HEALTH LOOKS AT THE LARGER Nord Bence only geared toward youth. Youth POPULATION AND ASKS, argues that suicides have increased 10 percent homicides have since 2000, but among working-age ‘HOW CAN WE been portrayed as a adults, suicide is up by 44 percent.

MAKE GUN “black-on-black” problem, but gun violence Among the elderly, it’s up 30 percent.

OWNERSHIP cannot be ignored in white communities.

“84 “We are preventing suicides, but we SAFER?’” percent of white people killed in homicides are need to prevent more,” says Jon killed by other white people. Add that to the Roesler, MS ’87, head of the fact that white people kill themselves much Minnesota Department of Health’s more frequently than black people do, and you Violent Data Reporting System. can see that gun violence is really, statistically, a “We need to target all age groups, white problem in Minnesota.” not just youth, with suicide Communities around the United States are prevention methods.” experimenting with various methods to prevent Many argue that most suicides homicides. The most successful model to date is called Cure could be prevented by a very simple Violence (CV), which creates individual and community-level act. “If you feel someone may be change in communities where young people carry a gun. suicidal, the best thing you can The CV model focuses on high-risk individuals, but also do is make sure they don’t have simultaneously instills conflict resolution and anti-violence guns in the house, even if [guns norms throughout the community. The program, which are removed] just for a short while”

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“We started to see the role of firearms in injury-related deaths and we started to see the real story of gun violence through this data,” says Roesler.

But to reduce the number of violent deaths nationwide, there was a need for more comprehensive data. In 2002, the CDC provided funding for the National Violent Death Reporting System (NVDRS), a state-based surveillance system that gathers information about violent deaths. It does not fund research on the data, only the PAINTING THE PICTURE data collection itself. NVDRS links detailed information from death certificates, police In 1995, then-Minnesota Governor Arne reports, coroner reports, and crime labs Carlson declared gun violence a public in an effort to find out why the deaths health issue. At the time, Minneapolis THAT ARE FROM occurred. The information is added to was dubbed “Murderapolis” and an anonymous national database. experienced 100 homicides in one year, Slowly states were added to the NVDRS, which is about how many homicides the and, in 2015, Minnesota joined the system entire state has now, with a 20 percent and the Minnesota Violent Death Reporting System larger population.

(MN-VDRS) was created and housed within the Minnesota To understand the impact of violence on the health care Department of Health’s Injury and Violence Prevention Unit. system, Twin Cities hospitals began coding injury-related Headed by Roesler, MN-VDRS goes a step beyond what’s deaths to identify if the cause was a motor vehicle accident, available on the death certificate. For example, the death a fall, self-inflicted, a gunshot wound, or something else. includes outreach workers and violence interrupters, has been implemented in Chicago, Baltimore, Phoenix, Brooklyn, and Pittsburgh.

While the program has had mixed success and further work is needed, “programs like this have shown us that using public health methods can have an impact on hate and can work to change norms,” says Finnegan. “Every act of violence prevented could be a life saved.”

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Where is the Research?

While the United States struggles to be proactive in curbing gun violence, research on the problem has been stymied for the past 20 years by a so-called “funding ban” on the Centers for Disease Control and Prevention (CDC) to study gun violence.

In 1996, Arkansas Representative Jay Dickey, with support and lobbying from the National Rifle Association, inserted a rider into a federal spending bill that stipulated that no CDC funds “may be used to advocate or promote gun control.” The bill passed, rider intact.

Congress also went on to cut $2.6 million from the CDC’s overall budget — the exact amount the CDC had invested in firearm injury research.

Together, these actions were enough to discourage gun violence research.

“Unfortunately, there are economics that drive research and you go where the work and funding is,” says SPH Associate Professor Toben Nelson, who

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began his career in injury prevention and now studies alcohol and obesity.

“Gun violence is a topic of interest for me, but it became clear early in my career that gun violence was not going to get a lot of support from federal agencies,” says Nelson.

“There was money for injury prevention more broadly, but any time guns were involved in the mix, there was hesitation from funders and fellow researchers to collaborate.”

After the 2012 shooting of 20 schoolchildren and six adults at Sandy Hook Elementary, President Obama issued an executive order instructing the CDC to “conduct or sponsor research into the causes of gun violence and the ways to prevent it.” Since then, the NIH has funded three studies related to firearm injury and the National Institute of Justice has awarded $2 million in funding for firearms-related research.

But the vague language of Dickey’s rider remains in place, and the CDC

is nervous to study gun violence.

Especially as funding requests continue to be thwarted. President Obama asked for $10 million in funding for the CDC’s gun violence research, and in both 2012 and 2013, the request was blocked by Congress.

“Congress is ignoring a major public health issue,” says SPH Professor Bruce Alexander. “Data tells us about gun-related deaths, but what about injuries from firearms that don’t result in death? We have no basic information to even start a reasonable conversation leading to wiser policies. Instead, the issue is just polarized.”

While research is stalled, Jon Roesler, MS ’87, head of the Minnesota Department of Health’s Violent Data Reporting System, says public health can still play a role. “As the congressional ban still prohibits the CDC from funding research on gun violence, there is clearly a role for public health surveillance to help us understand trends to inform policy.”

certificate may say “death by firearm,” but Roesler’s team will identify the caliber of the gun and who made the fatal shot.

Roesler says Minnesota has approximately 40,000 deaths per year, with about 1,000 of those meeting the NVDRS criteria, meaning the death is considered violent. Of those 1,000 deaths, 70 percent are suicides, 20 percent are homicides, and the rest are undetermined, as of now.

“To prevent gun violence, we need to have better surveillance to fully understand the big picture,” says Roesler. “NVDRS came in part because our society was concerned about gun violence, and from our data, for example, we can see we’re becoming more suicidal in Minnesota.” We must now, Roesler says, use the data to add vital information to policy debates.

lead to future interventions.

In spring 2016, SPH student group Active Response Coalition for Public Health hosted a panel to talk about gun violence titled, “Gun Violence and Public Health: The Challenges of Prevention and Promotion.” Organized by students, the panel featured high profile community members as well as a keynote from Minnesota Congressman Keith Ellison.

“I was so impressed that the students wanted to take on this tough issue,” says Finnegan, who moderated the discussion.

“The event was the first of many gun violence discussions we want to have IN MINNEAPOLIS here at SPH and they started a really IN 2015 THAT INVOLVED important conversation.”

In addition to events like these, students take courses that dive into injury THE NEXT GENERATION prevention and gun violence, as well as Because of the complicated nature of gun violence research, health disparities. “These students have seen the effects of gun many current public health practitioners haven’t had the violence and they want to change its course,” says Finnegan. opportunity to study gun violence (see “Where is the “It’s these students, who are well-suited through their Research?” sidebar). This creates opportunities for current education and their willingness to save lives, that are wellpublic health students to explore these issues and potentially positioned to solve this crisis for our country.”

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What You Can Do You may feel powerless in the face of today’s gun violence epidemic. But there are steps you can take to help make a difference.

Prevent Gun-Related Incidents and Deaths If you own a gun, lock it up and store ammo away from the gun.

The majority of unintentional gun deaths happen in the home. It’s wellknown that a gun in your home is more likely to kill or hurt someone in your own family than an intruder. “We have to change the idea that owning a gun makes you safer,” says Nancy Nord Bence, executive director of Protect Minnesota.

When it comes to protecting your children, Nord Bence has an easy, but potentially awkward recommendation.

“If your child is going to a friend’s house, ask the parent if there is an unlocked gun in the house,” she says.

“It’s a hard thing to do, but if we could get 10 percent of parents to ask that question, we could start changing the way people view the responsibility of owning a gun.”

Turn in Guns Anonymous gun buyback programs have been overwhelmingly popular throughout the country. In summer 2016, a gun buyback program in Minneapolis offered Visa gift cards for those turning in guns and had to shut down nearly six hours early due to overwhelming demand. But these programs can be open to criticism, as there is little research to prove their effectiveness.

Regardless, says SPH Dean John Finnegan, encouraging gun buyback programs “could be a great option to get guns off the streets.”

Influence Policy A number of organizations are currently focusing their efforts on policies that help prevent gun violence, such as requiring background checks for people buying guns, 40 percent of which are purchased in the U.S. without a background check; creating gun violence protection orders so family members and police can get firearms out of the hands of people with signs of dangerous mental illness; and prohibiting those on the No-Fly List from being able to purchase guns.

“Get educated about your state and national officials,” says Nord Bence. “Find out where they stand on these issues and connect with them.”

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There’s an App for That Public health researchers and practitioners use app and text technology to change interventions and influence populations.

By Sarah Howard

Two-thirds of Americans own a smartphone and, for many, that phone is a main entry point into the online world.

But what’s redefined the smartphone experience is the application, or “app,”a self-contained software that fills a particular purpose for users, such as buying a car or tracking daily food intake.

A recent Nielsen report says that the average smartphone user has more than 25 apps on their phone.

For those in public health, apps are a tool that can have a large reach and change behavior.

“Everybody is used to carrying around a cell phone,” says SPH Assistant Professor Julian Wolfson, who is using apps to measure daily activity and behaviors. “And they’re convenient for researchers

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to gather data. You’re not intruding on what the user is doing and aren’t asking them to report information, like tracking their steps.”

“Smartphones are far more accessible, affordable, and portable than a desktop computer or laptop,” says SPH Associate Professor Keith Horvath, who is using app technology to connect HIV-positive men with public health messaging.

Smartphone use is consistent among black, white, and Hispanic groups. “When you look at smartphone ownership, the disparities between racial and ethnic groups disappear,” says Horvath.

Reasons like this have inspired SPH faculty, students, and alumni to make smartphones a key player in public health intervention strategies.

PODCASTS GIVE PATIENTS AND EXPERTS A VOICE Adjunct Associate Professor Gary Schwitzer is on a mission to bring truth to health news.

In 2006, he launched HealthNewsReview.org, which quickly gained attention as a leading source to help consumers understand the validity of health news stories.

The website grew in August 2015 to include the “Health News Watchdog” podcast with funds from the National Institute for Health Care Management Foundation.

The podcast, with titles like “A pat on the back to Vox for excellent reporting on melatonin” and “Medicating kids with ADHD keeps them safer? Not so fast, Wall Street Journal,” connects clinicians, researchers, and journalists to analyze the validity and accuracy of health news.

In addition to interviewing top names in research and health journalism, Schwitzer’s podcasts also allow patients to have a voice. “I’m most proud of the patient interviews, where they share examples of media messages that have misled them or their loved ones,” says Schwitzer. Those patient podcasts have so far covered glioblastoma (brain cancer), migraines, and breast cancer.

With about 500 listeners per episode, Schwitzer has found podcasts to be a great and innovative way to spread the mission of HealthNewsReview.org, which is housed in the School of Public Health’s Center for Media Communication & Health.

“I know that the media doesn’t roll out of bed in the morning and say, ‘How can I mislead people today?’ But it needs to hear from those most likely to be harmed — real people, real patients — that true harm does occur when media messengers disseminate inaccurate, imbalanced, incomplete messages about health care,” he says.

Listen to archived episodes and subscribe to the podcast at HealthNewsReview.org’s website

Continue the conversation by giving to the Health News Review Fund at give.umn.edu/giveto/sph

TAKING ON LANGUAGE BARRIERS IN FOOD-SERVICE PREP In Minneapolis alone, there are 63 Somali food establishments. But many of these restaurants employ limited English-speaking immigrants, and employees are accustomed to different food preparation methods. “People prefer to cook outside in Somalia, but here they cook inside with the windows closed,” says Farhiya Farah, MPH ’06, a Somali immigrant, former Minneapolis food inspector, and founder of GlobeGlow, a Minneapolis-based consulting and research firm serving ethnic businesses.

To address possible food safety issues as immigrants adapt to American cooking methods, Farah is developing an app with SPH Professor Craig Hedberg, one of the nation’s foodborne disease experts. “We want to help people in the Somali and other immigrant groups get a better understanding of food safety and the Minnesota Food Code,” says Hedberg.

The app prototype is available in English and Somali and uses video and interactive features to describe food safety practices and to train people on the Minnesota Food Code. The app is based on existing training materials developed in English for those interested in becoming certified food managers. To pass the certification, a person must be familiar with several hundred state regulations.

“If we can demonstrate improved compliance with the Minnesota Food Code by Somali food establishments using the app, we can translate the prototype into other languages,” says Farah, whose company is helping develop the app.

“Our goal is to have everyone in the restaurant industry understand safe food-handling practices,” says Hedberg.

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HELPING THOSE WORKING IN CRISIS For practitioners working in traumatic situations, conditions are often high-stress and looking after oneself can be forgotten. To help this group, the School of Public Health developed the Psychological First Aid (PFA) Tutorial, an app that serves as a resource for first responders, health care providers, volunteers, students, and others during and after a traumatic event, natural disaster, public health emergency, act of terrorism, or personal crisis.

The app aims to provide support, reduce stress, and assist in a healthy recovery. The app’s creators knew that mobile-based training would be vital for this group because in emergency situations, communication is often disrupted due to lost electricity and damaged infrastructure.

The app, which has been downloaded by nearly 14,000 people since its release in 2012, features scenarios where users are put into high-stress situations and asked how they would act. Through these scenarios, users can learn best practices during traumatic incidents so they can take care of themselves better in the next situation.

The PFA Tutorial app is free and available for Android and iPhone.

REACHING PEOPLE LIVING WITH HIV THROUGH APPS In America, 1.2 million people are living with HIV and one in eight don’t know it. Of new diagnoses, 67 percent occur among gay and bisexual men, according to the CDC. SPH Associate Professor Keith Horvath is leading several studies that leverage smartphone apps for HIV prevention and treatment.

“Status Update Project” is an app that encourages gay, bisexual, and other men who have sex with men (MSM) to regularly get tests for HIV. Although in early stages of development, Horvath is optimistic about the ability to reach a large part of the population through app technology. “You can reach a lot more people than with inperson interventions and you can target that reach more effectively,” says Horvath.

Among people living with HIV, sticking

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to life-saving antiretroviral therapy (ART) medication regimens is difficult. In an effort to increase ART medication adherence, Horvath is leading two technology-based projects.

“Thrive with Me,” is a large-scale study targeting HIV-positive MSM in New York City. This mobile-enabled website allows users to exchange messages, get tailored information about living with HIV, track their medications and moods, and receive virtual badges for participating. The website stems from a 2009 prototype, but was completely rebuilt in this study to prioritize mobile display. “We knew we needed to focus on mobile,” says Horvath. “If people were going to use this, we knew they would only use it on their phone.”

The second is an app prototype for HIVpositive MSM who also use substances.

“APP+” includes daily ART and HIV-related information, the ability to self-monitor medication adherence, and a “choose your own adventure”-type feature that engages users to follow a fictional character through choices around HIV health.

“We wanted to create something men could engage with in the comfort of their own homes,” says Horvath.

For Horvath, he hopes these apps allow more people to have ownership over their disease. “Men with HIV don’t want to spend all of their time in a doctor’s office,” he says.

“They want to manage their HIV and get on with their lives.”

The LGBT Health Research Fund helps fund projects affecting the LGBT community.

Contribute at give.umn.edu/giveto/SPHLGBT

PHOTO BY INNOVATIONS FOR POVERTY ACTION

TEXTING TO PREVENT BIRTH-RELATED DEATHS IN UGANDA Maternal and child health MPH student Sonja Ausen-Anifrani knew that Uganda has one of the highest maternal mortality rates in East Africa. So she is working to develop SMS Maama, a text messaging service that contacts expectant mothers in Uganda with health information and health screening questions with the hopes of decreasing health complications and increasing contact with the health provider.

“Initial research shows that texting educational platforms have been really effective in helping more women have healthy, full-term births and creating greater levels of engagement in their healthcare, so we wanted to explore that further,” says Ausen-Anifrani, who is developing the service with three other students across U of M programs.

A woman registers for the free service and SMS Mamma sends out weekly

informational messages that are relevant to the woman’s pregnancy gestational age and include information about nutrition, her HIV status, hygiene, labor and delivery, and development of the fetus.

The system takes things one step farther by routinely sending users interactive messages that probe for symptoms of

possible complications, like preeclampsia and gestational diabetes. The network alerts the mother’s midwife if the mother indicates signs of a potentially serious health condition.

Ausen-Anifrani and her colleagues have partnered with a Ugandan gynecologist and midwives and received a $5,000 fellowship from the U’s Acara Challenge and a matching fellowship from D-Prize, a social venture competition targeting poverty problems. They began piloting SMS Maama in summer 2016.

“Having local buy-in has been so important,” says Ausen-Anifrani. “These health care workers are selling the program to their patients and have been reviewing our texts to make sure we’re using the right language and are being culturally appropriate. That’s been a huge help.”

Contribute to SPH’s Uganda Health Research Project at give.umn.edu/giveto/ UgandaSPH

TRACKING DAILY ACTIVITY TO UNDERSTAND MOVEMENT Tracking daily activity relies on self monitoring and reporting, which can be time-consuming and inaccurate. To take the person out of the equation, SPH Assistant Professor Julian Wolfson, along with colleagues at the U of M’s Humphrey School of Public Affairs and Carlson School of Management, has developed a daily activity tracking app focused on how people move throughout their day. “We wanted to create a technology that would collect all of the information, without requiring the user to tell us everything,” says Wolfson.

The app relies on the GPS and accelerometer found in a user’s smartphone to track everyday movements, such as if a person uses the bus or car to get to work.

As a statistician, Wolfson was in charge of creating models to make sense of the phone’s data. “We need to translate the raw signal from the phone to discern whether you’re in the car, or in the bus, or walking. Are you at work or home? When did you leave a

location? All of that involves analysis based on sensor data that comes into the phone,” he says.

The app’s ability to track movement patterns had a strong tie to health research for Wolfson because it becomes possible to connect movement to health outcomes.

“We haven’t had much success in designing behavioral interventions that work well,” says Wolfson. “One of the potential reasons is that we don’t deliver these interventions in context. You can tell someone to get exercise, but that doesn’t translate to the moment where they are making a decision.”

The app is now being used in data collection for a study with SPH Professor Mark Pereira, who is researching the effectiveness of sit-stand desks. “We’re using the app to see if a sit-stand desk really makes a person more active,” says Wolfson.

Wolfson sees an opportunity for widespread use of the app. “There is an

increasing interest in self quantification,” he says. “People are interested in tracking their lives.”

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ALUMNI NEWS

2016 COMMUNITY PARTNER AWARD WINNERS Our community partners mentor students, work with our faculty, and help us take on public health issues.

STAR Award Susan Abderholden, MPH ‘80, NAMI Minnesota James V. Baker, MD, MS ‘07, Hennepin County Medical Center Debra Thingstad Boe, MPH ‘06, Dakota County Public Health Department James L. Craig, MD, Family and Preventive Medicine Services, Inc. Erin Huppert, Allina Health Tracy Keibler, ApparentPlan David F. Neitzel, MS ‘90, Minnesota Department of Health Dawn Simonson, Metropolitan Area Agency on Aging Agency Award Southside Community Health Services Organization Award Clear Channel Outdoor Global Partner Award Centre for Public Health, Tata Institute of Social Sciences in Mumbai, India

YOU’RE INVITED! UPCOMING EVENTS Nov. 17: Alumni Leadership Forum: The Future of Public Health at the Local Level Feb. 16: Alumni Leadership Forum: The Future of Public Health at the Global level April 20: Delta Omega Induction Ceremony May 4: Celebration of Giving and 2017 Alumni Awards June 2: Eat, Learn, Gather For event details and to register for an event, visit sphalumni.umn.edu.

14 University of Minnesota School of Public Health

Eat, Learn, Gather E at, Learn, Gather, the School’s annual day of learning for alumni, was held on Friday, June 3, 2016, at Coffman Memorial Union. More than 170 School of Public Health alumni, students, and members from the larger University and public health communities attended to learn about current trends and research in public health.

David Hemenway, from T.H. Chan Harvard School of Public Health, gave the Gaylord Anderson Memorial Lecture. Hemenway, an internationally recognized scholar on gun violence, spoke about how gun-related injuries could be prevented through a public health approach, which focuses on gun safety and policy. He also emphasized the importance for research to help advance knowledge on the controversial topic.

The day also offered learning sessions on a variety of topics, including programmatic approaches to reducing gun violence; mental health in children and teens; public health implications of paid parental leave in Minnesota; and water and public health.

The event concluded with a reception at the Campus Club where attendees sampled water from across Minnesota from Water Bar, a collaborative public art project that aims to educate people on the importance of sustainability, water pollution, and environmental injustice. For more information on the event speakers and to view recorded sessions from the day, visit sphalumni.umn.edu/elg.

Eat, Learn, Gather is organized by the Alumni Engagement Committee, a standing committee of the SPH Alumni Society Board of Directors. If you’re interested in joining the committee and assisting with planning social and educational events for alumni, email sph-alum@umn.edu.

Above: David Hemenway, Thomas Kottke, and Richard Carlbom speak on the Programmatic Approaches to Reducing Gun Violence panel.

FROM THE ALUMNI BOARD Whether you recently graduated from SPH or are no longer a “new” graduate, I’d like to welcome you to the SPH Alumni Society, of which we are all a part. The SPH Alumni Board of Directors is excited about our programs and upcoming events for the year and we hope that you will join us.

Please check sphalumni.umn.edu for more details on how you can attend an event in your area.

If you are interested in getting involved with the SPH Alumni Society, join one of our committees comprised of board members and volunteers. You can help with alumni and volunteer events, alumni recognition, or student engagement and support including the SPH Mentor Program.

Learn more and volunteer at sphalumni.umn.edu/volunteer.

Our SPH has alumni from diverse backgrounds doing public health work in a large variety of settings. We want to capture all the great work our alumni are doing and are striving to build a strong alumni community. We hope to see you at one of our events or committees in the coming year!

SPH Celebration of Giving and 2016 Alumni Awards O n May 5, 2016, nearly 225 School of Public Health alumni, students, staff, faculty, and friends filled McNamara Alumni Center to celebrate the School’s generous donors and honor six alumni award recipients.

University President Eric Kaler presented the Outstanding Achievement Award, the University’s highest alumni honor, to Brian J. Osberg, MPH ’86 for his dedication and work as an active alumnus of the School of Public Health and of the University.

The evening also included the presentation of the 2016 SPH Alumni Awards: • Gaylord Anderson Leadership Award | Robert W. Blum, PhD ’78, MPH ’77 • Alumni Award of Merit | Monique E. Muggli, MPH ’99 • Alumni Innovator Award | Erin J. Erickson, MPH ’10 • Emerging Leader Award | Lauren D. Gilchrist, MPH ’08 and Brian P. Hobbs, PhD ’10, MS ’07 Patrick Williams, an MPH Public Health Informatics student, shared his perspective on giving and the impact student scholarships have made on his education. Attendees heard live music from Homeward Bound, led

by SPH Professor Brad Carlin. To view photos and video from the event and to learn more about the recipients, visit sphalumni.umn.edu/awards.

Cheers, Carrie Klumb, MPH ’10 Alumni Board President PS: Support continuing SPH students by donating to the SPH Alumni Scholarship at sphalumni.umn.edu/give.

2016 Alumni Award recipients Brian Hobbs, Lauren Gilchrist, Monique Muggli, Erin Erickson, and Robert Blum

facebook.com/sphalumni twitter.com/umnsphalumni linkedin.com/groups/94877

Help us recognize our SPH alumni for their many public health contributions and achievements. Nominations for the 2017 SPH Alumni Awards are due January 15 and can be submitted at sphalumni.umn.edu. Awards will be presented at the Celebration of Giving & 2017 Alumni Awards on May 4, 2017, at McNamara Alumni Center.

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CLASS NOTES

James Anderson, MHA ’68, received the Distinguished Citizen Award from Macalester College. The Distinguished Citizen Award recognizes alumni who have exercised leadership in civic, social, religious, and professional activities.

Peter Ashbrook, MS ’76 (environmental health), was awarded the Honorary Life Award by the The Campus Safety Health and Environmental Management Association.

Jeremy Bradshaw, MHA ‘03, was named chief executive officer at Desert Springs Hospital in Las Vegas. Bradshaw served as chief operating officer of Desert Springs Hospital since May 2014.

Kevin Brooks, MHA ’05, was named to Utah Valley 360’s “40 under 40” list for his work as administrator of Utah Valley Hospital, Utah.

Heidi DeBeck, MPH ’12 (environmental health), was recognized by the Federal Executive Board of Minnesota as a Civil Servant of the Year, 2016.

Karen Hamre, PhD ’15 (epidemiology), joined the Centers for Disease Control and Prevention in Atlanta to work on Malaria Zero, the malaria elimination campaign in Haiti and the Dominican Republic.

Rachel Hardeman, PhD ’14 (health services research policy & administration), MPH ’11 (public health administration), joined the advisory board of Square Roots, a mission-driven company focused on defining and empowering healthy births.

She is also a new faculty member in the Health Policy and Management division of the School of Public Health.

Robert Holt, MHA ’97, retired from his position at the Austin Medical Center in Austin, Minn.

Sayeed Ikramuddin, MHA ’15, was named a “Top Doctor” in 2016 by Mpls.

St.Paul Magazine.

Abraham Jacob, MHA ’12, was named a “Top Doctor” in 2016 by Mpls.St.Paul Magazine.

Lauren Gilchrist, MPH ’08 (maternal and child health), was awarded the 2016 Advocate Award from the Planned Parenthood Action Fund. She has also been appointed by Governor Mark Dayton to serve on the MNsure board. Her term will expire May 5, 2020.

Chris Laszcz-David, MS ’73 (environmental health), was appointed to the Board of Scientific Counsellors, National Institute for Occupational Safety & Health, Centers for Disease Control and Prevention.

Her term begins January 1, 2017, and runs through December 31, 2019.

Gilbert Gonzales, PhD ’15 (health services research policy & administration), and Carrie Henning-Smith, PhD ’15 (health services research policy & administration), co-authored an article published in JAMA Internal Medicine that compared health and health risk factors between lesbian, gay and bisexual adults and heterosexual adults in the United States.

Meng-Chih Lee, MPH ’87 (public health administration), was awarded the National Health Medal from the Taiwan government.

Norm Gruber, MHA ’68, retired on July 1, 2016, from OHSU Partners in Salem, Ore.

16 University of Minnesota School of Public Health

Vladimir Makatsaria, MHA ’96, was appointed to the role of chairman, Johnson & Johnson China in March 2016.

Craig Marks, MHA ’86, was appointed CEO at PMH Medical Center in Prosser, Wash.

Nancy Morris Giunta, MHA ’92, retired from her position as executive director of the Women’s Medical & Diagnosis Center at the University of Florida.

Tom Parker, MHA ’90, was appointed CEO of Snoqualmie Valley Hospital in Snoqualmie, Wash.

William Petasnick, MHA ’70, received the American Hospital Association’s highest honor, the Distinguished Service Award, at a ceremony on May 2 in Washington, D.C. Petasnick is president and CEO emeritus of Froedtert Health in Milwaukee.

Mack Ruffin, MPH ’89 (epidemiology), joined Penn State Health Milton S. Hershey Medical Center on September 1, 2016, as the new chairman of the department of family and community medicine.

Benjamin Smalley, MHA ’11, was named the new administrator at Bear River Valley Hospital, Intermountain Healthcare, Utah, in March 2016.

Brian Sinotte, MHA ’04, was appointed to serve as chief executive officer for UP Health System-Marquette, effective August 2016.

Ben Wade, MHA ’12, was named one of the “Forty Under 40” by North Bay Business Journal for 2016. Wade is the director of the oncology service l∏ine at St. Joseph Health in Santa Rosa, Calif.

David Ziolkowski, MHA ’96, was named CEO of Person Memorial Hospital in Roxboro, N.C., in August 2016.

HAVE AN UPDATE YOU’D LIKE TO SHARE? Visit sphalumni.umn.edu/ quickupdate to fill us in!

DONOR SPOTLIGHTS GENELL KNATTERUD & JEAN ROBERTS: GIFTS TO SUPPORT BIOSTATISTICS EDUCATION Genell Knatterud, PhD ’63, and Jean Roberts, MS ’53, both made provisions in their estates that will benefit biostatistics students for years to come.

Roberts, who died in 2013, was a statistician for the National Center for Health Statistics. Her estate gift established the Jean Roberts Biostatistics Fellowship to provide graduate fellowship support for students training in biostatistics, specifically those focusing on training in public health and medical statistics with a cross disciplinary public health focus.

Knatterud was one of the country’s leading practitioners and advocates for clinical trials. She led statistical centers for several groundbreaking trials, served on Federal Advisory Committees and on advisory boards for highly significant trials, and chaired the boards of Maryland Medical Research Institute and Clinical Trials & Surveys Corporation. Upon her death in 2015, a gift from her estate went to further Knatterud’s passion for training the next generation of biostatisticians by establishing the Biostatistics Clinical Trials Fund to train students who want to become clinical trialists.

GEARY OLSEN PAYING IT FORWARD Geary Olsen, PhD ’85, MPH ’81, honored his former academic adviser through a gift to the Jack Mandel Scholarship, a fund that supports students with an interest in the field of occupational and environmental epidemiology.

“Jack’s philosophy was that it was important for students in a PhD program to be fully engaged in their research,” says Olsen. “But it has become much harder to fund research now.”

“My skills and my career grew because of SPH. People who are blessed to have that opportunity should give back as their career advances,” Olsen says. “I can’t give to Jack what he gave to me. But I can pass that on to others through gifts to the University. This is my recognition of the people who helped me.”

ALUMNI IN MEMORIAM: 2016 Ivan Anderson MHA ’53 Jonathan D. Bailey MS ’93 (biostatistics) Harry Baxter MHA ’76 Jack Brondum PhD ’95 (environmental health)

Ruby M. Jermstad BS ’57 (public health nursing) Donald L. Larimore MHA ’85 Joyce E. Lindgren MPH ’85 (maternal & child health) John W. Luebs MHA ’60

Vernon L. Buffong MPH ’82 (dental public health)

Catherine P. Majek MPH ’81 (public health nutrition)

Desmond H. Byrne MHA ’76

Robert S. Miller MPH ’53 (environmental health)

Gretchen S. Dale MPH ’91 (public health nutrition) Wayne W. Daley MPH ’67 (environmental health) Herbert L. Fromm MHA ’57 Gordon J. Girtz MPH ’93 (public health administration), MS ‘83 (environmental health) Eugene Horton MPH ’87 (public health administration) Keith E. Ingbritsen MHA ’59 Gerald A. Jacobson MPH ’60 (veterinary public health)

Herluf V. Olsen, Jr. MHA ’52 Martin J. Reape III PhD ’82, MPH ’73 (environmental health), MS ‘79 (epidemiology) Rexford D. Singer MS ’60 (environmental health) William A. Smoger MPH ’92 (public health administration) Reginald A. Spindler MHA ’58 Dean Emeritus Lee D. Stauffer MPH ’56 (environmental health)

sph.umn.edu 17

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