HAPPENINGS

News and research findings from the University of Iowa College of Public Health

College Names Outstanding Alumni Award Recipients

The University of Iowa College of Public Health has named Dwight Ferguson and Shenghui Tang the recipients of its 2021 Outstanding Alumni Awards.

Ferguson received a Master of Science degree in epidemiology in 2006 and a doctoral degree in occupational and environmental health in 2012. He currently serves in the U.S. Public Health Service as an emergency management specialist within the Office of the Assistant Secretary for Preparedness and Response in the Department of Health and Human Services. In this role, he plans for and coordinates the response for federal emergencies.

Tang received a Master of Science degree in 1995 and a doctoral degree in 1999, both in in biostatistics. He currently serves as director of the Division of Biometrics V at the Center for Drug Evaluation and Research in the U.S. Food and Drug Administration. In this position, he focuses on the development and regulatory evaluation of cancer treatment drugs.

The award recognizes College of Public Health alumni who have made distinguished contributions to the field of public health and demonstrated a strong interest and commitment to the mission, vision, and values of the college. The recipients will be honored at an event this fall.

Agriculture Workers More Likely to Have Dementia

Using data from the Health and Retirement Study (1998-2014), CPH researchers explored whether rates of dementia and cognitive decline were different in older adults who had worked long-term in agriculture.

Investigators found that those who identified as having long-term occupations in the agriculture, fishing, and forestry sectors had 46% greater odds of having dementia than those who did not. The study can help researchers develop effective interventions to protect older farmers.

“This study is both timely and relevant because farmers routinely work beyond standard retirement age, making them vulnerable to occupational injury. Additionally, a dementia diagnosis among farmers may be missed or delayed for a variety of reasons, causing even greater safety concerns,” says corresponding author Kanika Arora, assistant professor of health management and policy.

While researchers could not attribute the association to hearing impairment or depression—factors independently associated with both agriculture and dementia—the effect of pesticide exposure among agricultural workers may warrant further study.

Muscatine Heart Study Still Ticking

Launched in 1970, the Muscatine Heart Study is one of the largest and longest-running investigations of cardiovascular disease ever undertaken by the University of Iowa.

“It was important because it found hereditary influences on the development of heart disease and risk factors that could be found as early as childhood,” says Hal Schrott, College of Public Health professor emeritus of epidemiology. He was involved with the study from 1973 until his retirement in 2003.

The study was the brainchild of Ronald Lauer, a professor of pediatrics in the Carver College of Medicine who specialized in cardiology. He and his colleagues were inspired to follow up the findings of the Framingham Study, a landmark project begun in 1948 that investigated the causes and risk factors of cardiovascular disease by studying adults in Framingham, Massachusetts.

Lauer’s plan was a Framingham-style study that tested children for various risk factors for cardiovascular disease and then followed them into adulthood to see if those factors manifested as cardiovascular disease as adults. He chose Muscatine in southeast Iowa because it was easily accessible from Iowa City and because the school district had a stable enrollment with students he could track from start to finish.

Trudy Burns, professor emerita of epidemiology in the College of Public Health who took over as lead Muscatine investigator when Lauer retired in 2005, says the study Heart Study made numerous key discoveries about childhood cardiovascular health. The most important was that the cardiovascular disease factors identified in adults in the Framingham Study also are seen in childhood, and what happens when you’re a child has an impact on your adult health. Elevated levels of cholesterol, body mass index, blood pressure, and smoking increase the risk of disease as adults.

The project has so far led to more than 100 publications in research journals from Iowa faculty. The study is now in a new phase that will recruit 3,700 of the childhood participants from the 1970s for a full clinical exam to see how their health is progressing as they pass from middle to older age. Researchers hope to start that five-year investigation along with additional studies in July 2021.

Top 20 National Ranking

The University of Iowa College of Public Health is the #20 school of public health in the nation, according to the latest rankings from U.S. News & World Report. Among publicly supported schools, the college ranks #10.

Although they were not ranked for the 2022 issue of America’s Best Graduate Schools, the College of Public Health’s Department of Health Management and Policy is most recently ranked at #8 among health care management programs, and its Department of Biostatistics is ranked #55 among all statistics programs. Biostatistics is ranked #20 among all biostatistics departments, and #9 among those at publicly supported universities.

Racial Disparities in Pedestrian Injuries

A research study reveals that pedestrian injuries are worse for most minorities in the U.S. compared to whites, a racial disparity that points to inequities in access to safe transportation.

“Basically in every indicator we looked at, we saw worse outcomes, particularly among Black, Hispanic, and multiracial groups,” says Cara Hamann, clinical assistant professor of epidemiology, who was the principal investigator on the study.

Hamann and colleagues Corinne Peek-Asa, professor of occupational and environmental health, and Brandon Butcher (20PhD), then a doctoral student in biostatistics, analyzed data on mortality rates and hospitalization rates from 2009 to 2016 to determine the frequency, severity, and cost of pedestrian-related injury hospitalizations by race and ethnicity. Multiracial, Black, and Hispanic groups had worse outcomes in most areas compared with whites by a significant margin. Only one group, Asian/Pacific Islanders, had better outcomes than whites in some areas.

“Hospital admission rates were almost two times higher for people who were multiracial or other ethnic groups, including Native Americans, compared to whites,” Peek-Asa says. “The hospitalization rates are about 20% higher among Blacks compared to whites. And, we also found that lengths of stay longer than one week were a lot higher for every race and ethnic group than white.”

While racial disparities are documented in many areas of public health, this is the first study that lays out evidence of the burden of pedestrian injury hospitalizations by race. One cause is systemic—people of different races are likely to experience differences in their built environment and access to safe transportation.

“We’re providing evidence to show that this really is a problem, and that’s the first step in addressing a public health issue. We have to identify it, and then we can move on to trying to intervene and prevent and identify avenues to do that,” Hamann says.

New Toolkit for Global Birth Defects Surveillance

In his role as executive committee chair for the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR), Paul Romitti, professor of epidemiology, recently participated in a World Health Organization (WHO) webinar to release a new global resource to support population-based surveillance programs for birth defects. “Birth Defects Surveillance: A Manual for Program Managers” is a collaborative effort between the WHO, ICBDSR, the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention, and the March of Dimes.

The manual is intended “to serve as a tool for the development, implementation and ongoing improvement of a congenital anomalies surveillance program, particularly for countries with limited resources,” according to the WHO.

Face Mask Study Ranks among the Most Shared Research Articles

A College of Public Health study examining how community policies mandating face masks mitigate the spread of COVID-19 ranks among the most shared and mentioned research articles ever tracked by the data science company Altmetric.

The study, “Community Use of Face Masks and COVID-19: Evidence from a Natural Experiment of State Mandates in the U.S.,” was authored by George Wehby, professor of health management and policy, and research associate Wei Lyu. It appeared in the June 2020 issue of the journal Health Affairs.

According to data compiled by Altmetric, the face mask study surpassed an attention score of 10,000, which indicates the quality and quantity of online engagement with this research across various platforms, including social media, research blogs, public policy documents, and news articles. Compared to more than 17 million other research outputs tracked by the company, Lyu and Wehby’s study ranks in the top 100 of all research ever tracked.

Finding the Best Treatments for a Rare Form of Cancer

A newly funded research study in the UI College of Public Health aims to determine the optimal sequencing of treatments for people with neuroendocrine tumors, a rare form of cancer.

The $5 million, three-year study will be led by Michael O’Rorke, assistant professor of epidemiology, and will enroll approximately 3,000 patients from 14 participating research centers throughout the United States. The project is funded by the Patient-Centered Outcomes Research Institute (PCORI), a nonprofit organization established by Congress.

Neuroendocrine tumors (NETs) are a group of cancers that occur most frequently in the gastrointestinal tract, pancreas, and lungs. NETs are typically slow growing with vague signs and varied symptoms, which often leads to diagnostic delays and disease spread. Patients with NETs frequently experience a prolonged clinical course, significant symptom burdens, and a confusing array of therapeutic options, including biologic therapies, radiation, and chemotherapy.

The study, which will follow patients for up to five years to track their outcomes, aims to partner with patients in an approach known as comparative effectiveness research (CER), a type of research that looks at which care options work, for whom, and under which circumstances.

“This large CER study leveraging data from electronic medical records, chart abstractions, and patient reported outcomes will go some way to defining the risks and benefits of the different therapeutic options currently available—findings which will be of benefit to patients and their caregivers, clinicians, and other stakeholders involved in their care,” says O’Rorke.

Regional Alliance Addresses Mental Health in the Workplace

The Healthier Workforce Center of the Midwest, directed by Diane Rohlman, recently entered into an Alliance Agreement with the Occupational Safety and Health Administration’s (OSHA) Federal Region VII to address behavioral health, which includes mental health and substance use, in the workplace.

“Mental health is a personal issue, a family issue, a societal issue, and a work issue,” says Rohlman, professor of occupational and environmental health. “That’s why mental health needs to be part of the safety conversation in U.S. workplaces.”

The agreement establishes a collaborative relationship to provide employers and the public with information and training resources that will help protect workers by reducing and preventing exposure to workplace hazards and addressing behavioral health issues.

The agreement with OSHA, Rohlman says, stemmed from her work as a policy fellow in the CPH’s Iowa Institute of Public Health Research and Policy, which focused on developing workplace mental health policies for rural employers.

“The COVID-19 pandemic has had a major impact on the way people live and work. This has led to greater mental health challenges for workers in all industries,” says Rohlman. “Our new partnership with OSHA will expand the work of the Healthier Workforce Center to promote safety, health, and well-being—which will benefit both the workers and the employers.”

Project Aims to Reduce HIV Stigma in Western Kenya

Will Story, assistant professor of community and behavioral health in the UI College of Public Health, and Nema Aluku, research associate at Tangaza University College in Nairobi, Kenya, recently received a National Institutes of Health grant to study HIV stigma among adolescents in western Kenya.

This project will identify potential pathways to reduce HIV-related stigma and increase HIV-preventive behaviors among adolescents in western Kenya.

“Adolescents, especially girls, are vulnerable to HIV in Kenya, where stigma and discrimination present an important challenge to HIV prevention. Understanding the complex relationship between social relationships, religious beliefs, and gender norms is critical to developing culturally appropriate interventions to reduce stigma among adolescents, but rarely studied in this population,” Story explains. “This project will identify potential pathways to reduce HIV-related stigma and increase HIV-preventive behaviors among adolescents in western Kenya, while building the research capacity of two Kenyan institutions—Tangaza University College in Nairobi and Gynocare Women’s and Fistula Hospital in Eldoret.”

Health Benefits Associated with Eating Plant Protein

Postmenopausal women who ate high levels of plant protein had lower risks of premature death, cardiovascular disease death, and dementia-related death compared with women who ate less plant protein, according to new research led by Wei Bao, assistant professor of epidemiology.

Researchers noted the levels and types of protein women reported consuming, then divided them into groups to compare who ate the least and who ate the most of each protein.

Among the study’s key findings:

- Compared to postmenopausal women who had the least amount of plant protein intake, those with the highest amount of plant protein intake had a 9% lower risk of death from all causes, a 12% lower risk of death from cardiovascular disease, and a 21% lower risk of dementia-related death.

- Higher consumption of processed red meat was associated with a 20% higher risk of dying from dementia.

- Substitution of 5% energy of animal protein with plant protein was associated with a 14% lower risk of deaths from all causes, a 22% lower risk of deaths from cardiovascular disease, and a 19% lower risk of deaths from dementia.

“Our findings support the need to consider dietary protein sources in future dietary guidelines,” says Bao. “Current dietary guidelines mainly focus on the total amount of protein, and our findings show that there may be different health influences associated with different types of protein foods.”

The study, published in the Journal of the American Heart Association, included University of Iowa investigators Yangbo Sun, Buyun Liu, Linda Snetselaar, and Robert Wallace.