CAROLINA
PUBLIC HEALTH
Gillings School of Global Public Health | The University of North Carolina at Chapel Hill
FALL 2016 · VOLUME 2 · NUMBER 10
INNOVATION + DISCOVERY
Health behavior students Liz Chen and Cristina Leos designed an app
to help middle-school kids learn about reproductive health.
Donald A. Holzworth, MS
Chair
Executive in Residence
Gillings School of Global Public Health
James H. Rosen, MBA, MSPH
Public Health Foundation Board
Liaison to Advisory Council
President and Chief Executive Officer
Artizan Biosciences
Marcia A. Angle, MD, MPH
Public Health Physician (Retired)
Durham, N.C.
William K. Atkinson, PhD, MPH
Former President and Chief
Executive Officer
WakeMed
Gail H. Cassell, PhD, DSc (Hon.)
Vice President, Scientific Affairs
(Retired)
Distinguished Lilly Research Scholar
for Infectious Diseases
Eli Lilly and Co.
Michael J. Cucchiara
Consultant/Entrepreneur
Chapel Hill, N.C.
Leah Devlin, DDS, MPH
Gillings Professor of the Practice
Research and Innovation Solutions
Gillings School of Global Public Health
Jeffrey P. Engel, MD
Executive Director
Council of State and Territorial
Epidemiologists
Ken Eudy
Chief Executive Officer
Capstrat
James R. Hendricks Jr., MS
Vice President, Environment,
Health and Safety (Retired)
Duke Energy
Michael E. Kafrissen, MD, MSPH
Research Scientist
Massachusetts Institute of Technology
John McConnell
Chief Executive Officer
McConnell Golf
Jesse Milan Jr., JD
Interim President and
Chief Executive Officer
AIDS United
James P. O’Connell, PhD, MPH
Chief Executive Officer (Retired)
Acea Biosciences Inc.
Jane Smith Patterson
President
Jane Patterson & Associates
Pamela J. Pure
Chief Executive Officer
HealthMEDX
Maura Smith Rampolla, MPH
Co-founder and Director
The Mark and Maura Rampolla
Foundation
William G. Ross Jr., JD
Visiting Professor and Attorney
Chapel Hill, N.C.
Virginia B. Sall
Co-founder and Director
Sall Family Foundation
Markus Wilhelm
Chief Executive Officer
Strata Solar LLC
Louise Winstanly, LLB, MSB
Attorney and Medical Ethicist
Chapel Hill, N.C.
MEMBERS EMERITI
Nancy A. Dreyer, PhD, MPH
Global Chief of Scientific Affairs
Senior Vice President
Quintiles Outcome
Carmen Hooker Odom, MS
Former President
Milbank Memorial Fund
James H. Rosen, MBA, MSPH
Chair
President and Chief Executive Officer
Artizan Biosciences
Celette Sugg Skinner, PhD
Vice Chair
Professor and Interim Chair
Department of Clinical Sciences
Associate Director for Cancer Control
and Population Sciences
Harold C. Simmons Comprehensive
Cancer Center
University of Texas Southwestern
Medical Center
Paula Brown Stafford, MPH
Immediate Past Chair
President, Clinical
Development (Retired)
Quintiles
Barbara K. Rimer, DrPH
Executive Vice Chair
Ex Officio
Dean and Alumni
Distinguished Professor
Gillings School of Global Public Health
Crystal Hinson Miller, MA, CFRE
Executive Director/Secretary
Ex Officio
Associate Dean for Advancement
Gillings School of Global Public Health
Katie Thornsvard, MAC, CPA
Treasurer
Ex Officio
Assistant Dean for Finance
and Business
Gillings School of Global Public Health
Todd A. Jones, BSPH, JD
Alumni Association President-elect
Ex Officio
Attorney at Law
Anderson Jones PLLC
Antonio S. Braithwaite, DDS, MPH, PA
Diplomate of the American Board of
Pediatric Dentistry
Sanford Pediatric Dentistry
P. LaMont Bryant, PhD, RAC
Senior Director
McNeil Regulatory Affairs
Johnson & Johnson
Paul Casey
Former Vice President and Global
Head, Cardiac Safety Services
Quintiles
Stacy-Ann Christian, JD, MPH
President/Managing Director
JamCAN Home Care Limited
David Dodson, MDiv, MPPM
President
MDC Incorporated
Fred Hargett, MAC
Chief Financial Officer
Novant Health
Elaine B. Hoffman, PhD
Statistical Scientist Director
Pharmaceutical Product Development
Nancy McGee, JD, MPH, DrPH
Executive Vice President
Avalere Health
Mark H. Merrill, MSPH
President and Chief Executive Officer
Valley Health System
Stephen A. Morse, MSPH, PhD
Associate Director for
Environmental Microbiology (Retired)
National Center for Emerging and
Zoonotic Infectious Diseases
Centers for Disease Control
and Prevention
Jean G. Orelien, DrPH, MStat
Chief Executive Officer
SciMetrika LLC
Adam S. Parker, PhD
Chief U.S. Equity Strategist
Morgan Stanley
Laura Helms Reece, DrPH
Chief Executive Officer
Rho
Jacqueline Sergent, MPH, RD, LDN
Health Promotion Coordinator/
Health Education Supervisor (Retired)
Granville-Vance (N.C.) District
Health Department
Gregory Strayhorn, MD, PhD
Professor and Director of Research
Department of Family Medicine
Morehouse School of Medicine
Edgar G. Villanueva, MHA, FACHE
Owner/Principal
Leverage Philanthropic Partners
Alice D. White, PhD
Vice President (Retired)
Worldwide Epidemiology Department
GlaxoSmithKline
Chen-yu Yen, PhD, PE
President and Chief Executive Officer
TerraSure Development LLC
Vice President, Gannett Fleming Inc.
Senior Vice President, Gannett Fleming
Sustainable Ventures Corp.
Public Health Foundation Incorporated BOARD OF DIRECTORS
UNC Gillings School of Global Public Health ADVISORY COUNCIL
TABLE
of
CONTENTS
20
11 33
DEAN
Barbara K. Rimer, DrPH
COMMUNICATIONS DIRECTOR
David Pesci
EDITOR
Linda Kastleman
ASSOCIATE DEAN FOR
ADVANCEMENT
Crystal Hinson Miller
DESIGN AND PRODUCTION
UNC Creative
CONTRIBUTING WRITERS
Jamie Bartram, Linda Kastleman, Michele Lynn, David Pesci, Jennie Saia, James Schnabel
and Amy Strong
Send correspondence to Editor, Carolina Public Health, Gillings School of Global Public Health,
Campus Box 7400, Chapel Hill, NC 27599-7400, or email sphcomm@listserv.unc.edu.
SUBSCRIBE TO CAROLINA PUBLIC HEALTH sph.unc.edu/cph
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Carolina Public Health (ISSN 1938-2790) is published twice yearly by the UNC Gillings School of
Global Public Health, 135 Dauer Dr., Campus Box 7400, University of North Carolina at Chapel Hill,
Chapel Hill, NC 27599-7400.
Vol. 2, No. 10, Fall 2016
From the dean 2
Thoughts on innovation leadership 4
Well served? 11
Collaborative lab environment leads to
major weapon in Zika fight 15
The Measurement, Learning
& Evaluation Project 20
Pictures speak louder than words —
at least on cigarette packs 27
Student case studies dramatically improve
real-world hospital policy 30
Cystic fibrosis screening for newborns
transforms young lives 33
Trajectories 37
Marcia Angle, MD, MPH 58
Honor Roll of Donors 60
Annual Fund: 100 stories and counting 68
Paula Brown Stafford 54
Dennis Gillings speaks at
2016 commencement 55
A conversation with Dr. Amanda Adler 56
Awards & Recognitions 51
The great unsweetening 23
Jacqueline MacDonald Gibson investigates inequities
in drinking water quality in Wake County
Detailed and accurate data allow researchers to
avoid 'one-size-fits-all' solutions
Mexico's beverage tax moves the country toward health
Young alumni prove themselves as public health leaders
School News 46
A mother-daughter gift helps improve the
lives of children everywhere
Keep your standards high — and then go for it!
Our distinguished alumna—
Q & A with Tim Mukoda 69
And the winner is...
An innovative sex ed app! 7
from
THE DEAN
Greetings to our readers—
2 | C A R O L I N A P U B L I C H E A LT H
of public health provide great return on investment. I
am proud that faculty members in every Gillings School
department have contributed to policy over the years—
from the environment to insurance coverage, from the
use of taxes to reduce consumption of sugary beverages
to tobacco regulation, to neonatal screening and more.
There are no guarantees, but without research
that meets the highest scientifi c standards, chances
for good policy making are diminished. Developing
policy is a long process requiring a lot of evidence—
and persistence.
Research on neonatal screening for cystic fi brosis,
begun nearly 20 years ago by Dr. Michael Kosorok,
W.R. Kenan Jr. Distinguished Professor of biostatistics,
and colleagues resulted in a 2004 Centers for Disease
Control and Prevention recommendation that states
Presidential campaigns spark national conversations
about important issues, the role of government and
the future of our democracy. The campaign that ended
Nov. 8, 2016, certainly ignited conversations — and not
all of them were civil or grounded in fact.
Nevertheless, democracy proved stronger than the
intense feelings created by the campaign. In many
conversations about the election, I was relieved that
most people understood how important it is to exercise
one’s right and responsibility to participate in the
process, culminating in the act of voting.
After all these years, I still treasure the right to vote
and always get to early voting the fi rst or second day.
In the last election, a lot of statements were made about
important issues such as immigration, inequality and
the cost of health care. Not enough of substance was
said about these and other topics, such as responsible
gun control. They all are public health issues, with
critical policy implications. Now, it is time to move on,
regardless of how we feel about the outcome, and work
to achieve improvements in the public's health.
Data from well-designed research are an essential
foundation for good policy. This issue of Carolina
Public Health features faculty and student researchers
whose work yields data upon which policy makers rely
when making decisions to improve health, save lives
and protect the environment at local, state, national
and global levels.
Providing data, evidence and proven programs that
contribute to policy development is a way that schools
Photo by Brian Strickland
Dean Barbara K. Rimer
begin screenings. North Carolina and Texas – the last states
to implement screening – did not begin until 2009. Still,
Kosorok considers himself fortunate to have seen policy
change where many who do excellent research do not.
“Since you don’t have control over these things as
a scientist, it’s important to keep doing the good
research that is essential to making informed
decisions,” he emphasized.
This “good research” is a common denominator in
the successes of faculty members including Drs. Ralph
Baric, Noel Brewer, Jacqueline MacDonald Gibson,
Barry Popkin and Ilene Speizer. Students featured in this
issue have learned their lessons well and are on the way
to being formidable contributors to good health policy.
All have compelling and inspiring stories in this issue,
marked by their curiosity, collaborations, perseverance
and dedication to conducting rigorous high-quality
research as free from bias as can be designed.
When it comes to having an impact upon policy, the
stakes are high. In just these few examples, success
ultimately means signifi cant reductions of deaths due to
smoking and obesity, fewer illnesses due to contaminated
well-water and unprotected sex, fewer pregnancies
affected adversely by the Zika virus, and safer hospitals
for newborns and other patients.
The dedication of our faculty, students, alumni and
staff in tackling complex problems and the inequities that
often underlie them – and the commitment of those who
support their research – should give us hope for the future
of our nation and world, far beyond the next four years.
Warmest regards,
FA L L 2 0 1 6 | 3
LEADERSHIP
THOUGHTS ON
ith this issue of , we introduce a recurring
feature on innovation that will highlight projects by Gillings School
faculty and staff members and students. By exploring the process
through which a public health need is identifi ed and met, we hope to
illuminate the journey – from fi rst creative spark, to earnest inquiry and
collaboration, to the data-driven implementation of a program or system.
Cristina Leos, Elizabeth Chen and Vichi Jagannathan
Photo courtesy of Innovation Next
This issue features the student team of Liz Chen and Cristina Leos
(both health behavior doctoral students at the Gillings School) and
their colleague Vichi Jagannathan, Master of Business Administration
candidate at Yale University’s School of Management. (See page 7.)
The three women, who recognized the need for more effective
reproductive health education for young adolescents, won $405,000
to develop an app for middle-school students, through which the
students can obtain information and support about sexual and
reproductive issues.
As a preamble to the fi rst innovation article, we invited Jamie
Bartram, PhD, to share some thoughts about the importance of
leadership in innovation, using examples from The Water Institute at
UNC, which is based in the Gillings School. Bartram is Don and Jennifer
Holzworth Distinguished Professor of environmental sciences and
engineering and director of The Water Institute.
A DISCUSSION WITH
4 | C A R O L I N A P U B L I C H E A LT H
Innovation in devices
Chitosan is extracted easily from discarded
crustacean shells. The substance combines
characteristics attractive for water treatment; it
is highly absorptive, nontoxic, biodegradable, abundant and
cheap! Its potential is vast – for treatment of small volumes
of water in underserved households, through dispensing
units; for in situ treatment in wells; and potentially for
industrial-scale treatment plants.
Postdoctoral fellow Lydia Abebe, PhD, is leading
innovation to employ chitosan for water safety, work that
is supported by a Gillings Innovation Lab [sph.unc.edu/
research/gil]. Abebe has determined which doses of chitosan
are effective, and she is beginning to develop prototypes.
Along the way, she has benefi ted from a UNC CUBE social
innovation venture [tinyurl.com/unc-social-innovation] to
explore routes to commercialization and entrepreneurship.
innovation in methods
Continuous quality improvement (CQI) has
had dramatic and well-documented impacts in
the auto and health-care industries, delivering
improvements in quality and effi ciency. CQI had not been
applied to drinking water supply, however, despite the
FA L L 2 0 1 6 | 5
Look up “innovation” in a dictionary,
and you may be in for a surprise. It is
“the act or process of introducing new
ideas, devices or methods” — a far wider
defi nition than the usual focus on new
gizmos and services. The word also
refers to “changing something,” as well as
making something new.
Innovations matter in public
health. They fi ll gaps in our arsenals,
offer improved alternatives, and
increase impact and effi ciency of our
interventions.
Seven years ago, as we conceived The
Water Institute at UNC, we wanted its
focus to be on innovative, visionary
approaches that transform the water and
sanitation landscape. Since then, we
have led innovations across the spectrum
of devices, ideas and methods, and have
aimed both to adapt existing options and
bring forward entirely new ones.
6 | C A R O L I N A P U B L I C H E A LT H
At right: Elizabeth Chen (left) and Cristina Leos, health
behavior doctoral students, won a total of $405,000 to
develop ‘Real Talk,’ an app that helps young adolescents
learn about sexual and reproductive health. Their award
was the only one given to a student group and is the
largest ever made to a student group at UNC-Chapel Hill.
fact that high water-system failure rates have adverse
consequences for health and the economy.
Across sub-Saharan Africa, at any given time, one-third
of village handpumps are not functioning.
Contamination of small water systems is frequent, in
developed and developing countries alike. Our team,
led by project manager Kaida Liang, MPH, works with
large implementing agencies, including World Vision,
to reform how projects are evaluated – aiming to move
from conventional assessment (a pass or fail at the end
of a project, after as much as three to fi ve years) to fast-er
learning and improvement cycles of one year or less.
In Ghana, one cycle of improvement alone doubled
the proportion of households with safe water, and a sec-ond
cycle with similar potential is already in hand. De-livering
these changes increases impact and effi ciency,
but if we’re to have innovation in “methods,” there must
be widespread adoption. Therefore, we are collaborat-ing
with other partners to apply CQI in water programs
in 10 countries and intend to see the idea adopted as
global policy.
innovation in ideas
Despite advances in medicine, safe health
care is compromised by poor environmen-tal
conditions in health-care facilities. The
Water Institute’s strategic plan identifi ed health-care
settings as a key opportunity for exerting infl uence.
We set out to establish the idea of improving this
situation as an opportunity for both the health-care
and water and sanitation sectors. We published an
“opinion piece” to initiate discussion, analyzed moni-toring
potential and prepared a fi rst-of-its-kind review
of surveys of health-care facilities.
That review documented that 40 percent of 66,000
health facilities in 54 low- and middle-income coun-tries
did not have safe water. One-third were with-out
soap for handwashing, and 20 percent lacked a
toilet. Our work contributed to the inclusion of these
issues in international policy – as a global action plan
for the World Health Organization and in monitoring
of the U.N.’s Sustainable Development Goals. Our
compelling evidence is driving additional partners
to contribute, and our “innovation in ideas” is now
focused on ensuring that this is seen as an opportunity
for health-care providers to reduce costs and impacts
of health-care-acquired infection and confront the
challenge of antimicrobial resistance.
leading the way
Leadership in innovation means embracing
the breadth of that concept and applying
it appropriately. New and adapted devices
are needed for some challenges, such as water treat-ment.
For other purposes, new perspectives and new
thinking are required – sometimes including naming
the proverbial elephant in the room. Often, tools and
methods already proven in other applications can be
transferred, adapted and applied to great benefi t. To
innovate is to characterize, understand and tackle prob-lems
– and in so doing, to deliver impact and effi ciency
that improves lives and livelihoods.
— Dr. Jamie Bartram
FA L L 2 0 1 6 | 7 Photo by Brian Strickland
AND THE WINNER IS...
8 | C A R O L I N A P U B L I C H E A LT H
(Top) Abigail Roberts and Demonte Edwards compare
their impressions of the Real Talk app (shown below).
uring spring and summer 2016,
two Gillings School doctoral
students, Elizabeth Chen and
Cristina Leos, along with a Yale
colleague, Vichi Jagannathan,
set themselves an ambitious goal – to talk to more
than 150 middle-school students about sexuality, self-image,
changing bodies and relationships with peers.
You know – the easy stuff.
“We had no idea if the students would talk to us,”
says Chen. “We were strangers, after all. But they
were completely willing to be open with us about
everything.”
The team obtained permissions from the students
and their parents, and then conducted several months
of interviews with students. What they learned laid
the groundwork for “Real Talk,” a sex-ed app that
teaches kids about sexuality through storytelling.
The idea originated four years earlier, when Liz
Chen began teaching science at a rural eastern North
Carolina high school, through the Teach For America
program. Vichi Jagannathan, a fellow Princeton
alumna, coincidentally was teaching in the adjacent
classroom. During their time at the high school, they
saw many of their students struggling to cope with
unplanned pregnancies.
After teaching, Jagannathan entered the Yale
University School of Management, and Chen came
to study health behavior at the UNC Gillings School
– but they stayed in touch. After Chen met Cristina
Leos, also in health behavior, the three women
decided to join forces to transform health education
for underserved middle-school students.
The idea for the “Real Talk” app began in 2016
when Chen, Leos and Jagannathan entered the
Innovation Next competition, which challenges
innovators across the country to fi nd technology
solutions that will redefi ne sex education for the
21st century.
“The three of us already had been communicating
regularly about developing online sex-ed content,”
says Jagannathan. “It seemed this program could take
our idea to a different level.”
D
Photos by Brian Strickland
Photo by Brian Strickland
FA L L 2 0 1 6 | 9
Innovation Next awardees Cristina Leos (standing) and Liz Chen (in red) meet with middle-school students to review
a prototype of their app, Real Talk. Left to right are Abigail Roberts, Shamion Nelson, Leos, Desinea Watson, Chen and
Demonte Edwards.
As one of the ten fi nalists in the competition, the
team received $80,000 in development funds and the
opportunity to collaborate with IDEO, one of the world’s
premier innovation and design fi rms. IDEO’s “design
thinking” methodology, which puts people’s needs at the
heart of every design decision, was perfectly in line with
the team’s vision for their app.
They set to work interviewing middle-school students
and quickly made a discovery. Students are engaged by
sex education when it is told in the form of stories from
their peers, but much less interested when faced with
a didactic curriculum involving diagrams of body parts
and multiple-choice quizzes.
They also learned that middle school students,
whether in rural eastern North Carolina or urban west
Texas, all seemed to share a secret language of emojis (in
which eggplants and peaches represent body parts) and
neologisms (“cringey” was a favorite word to describe
all manner of awkwardness). The students were eager
to offer opinions on everything from font sizes to text
colors to their preferences for buttons versus swiping.
“Every single design decision we made was informed
by conversations with the students,” says Jagannathan.
“Everything in this app is grounded in something a
student told us.”
Chen and Leos also relied on their public health research
to inform certain aspects of the app’s development.
“We know that teen brains have a hard time retrieving
factual information in the heat of the moment,” Leos says.
“But when they’re at that moment of making a decision,
especially with their peers, they can retrieve stories.”
In August 2016, “Real Talk” received an additional
$325,000 award from Innovation Next to make the
app a reality. Chen, Leos and Jagannathan were the
only student group that won. Their award is the largest
award ever made to a student or student group at The
University of North Carolina at Chapel Hill.
“I was gobsmacked,” says Julie MacMillan, MPH,
managing director of Research and Innovation
Solutions at the Gillings School. “I was surprised at
the generosity of the cash, but not at all surprised that
our students were doing that caliber of good thinking
about problems. They are really exceptional inventors
and creative thinkers.”
The app isn’t intended to replace traditional sex
education in schools, but it will provide a much-needed
supplement to the standard curriculum.
“Teens love their phones,” says Chen, “but they
don’t necessarily want to feel like they’re being
taught something.”
With “Real Talk,” middle-school students can engage
with sex-ed content in a way that feels much more like
a conversation with a friend than would a facts-only
pamphlet from the doctor’s offi ce. At the same time,
the content is 100 percent curated and aligned with
national sexual education standards.
“We’re stealthy that way,” says Chen.
The “Real Talk” app is scheduled to be released in
early 2018.
– Amy Strong
10 | C A R O L I N A P U B L I C H E A LT H
Photo by Brian Strickland
FA L L 2 0 1 6 | 11
Well seRved?
Jacqueline MacDonald Gibson investigates
inequities in drinking water quality in Wake County
Photo by Brian Strickland
Dr. Jackie MacDonald Gibson
In 2014, when residents of Flint, Mich., began to
worry about brown water pouring from their taps,
Jacqueline MacDonald Gibson, PhD, already was
investigating inequities in water quality in North
Carolina.
Unlike Flint, N.C.’s Wake County has well-managed
municipal water systems, but some African-American
neighborhoods completely lack access to the grid.
Due to a historic exclusion from municipal water
lines, which dates back to the Jim Crow era, these
communities have depended upon private wells
for drinking water. Because the neighborhoods are
within urban areas, surrounded by mostly-white
neighborhoods that do have municipal water access,
MacDonald Gibson refers to them as “doughnut holes.”
MacDonald Gibson, associate professor of
environmental sciences and engineering in UNC’s
Gillings School of Global Public Health, was alerted
in 2012 by the North Carolina State Health Director
that some urban N.C. neighborhoods were without
municipal water access. Because Wake County's data
collection systems are advanced, MacDonald Gibson
selected that county for a pilot study and began
combing through tax records to identify locations of
doughnut-hole neighborhoods.
“Many underserved communities are afraid to make
themselves known,” she explains.
“Often, they also lack access to
municipal sewer lines and
fear their properties could be
condemned if public health
offi cials discover failing or
inadequate septic systems in
their yards.”
With the neighborhoods identifi ed,
MacDonald Gibson determined
whether exclusion from
municipal water service
increased residents’ exposure
to water contaminants.
(As well users, they are not
protected by the federal Safe
Drinking Water Act.)
She began to answer that question by analyzing
emergency department visits across the state. Her
fi ndings showed that individuals relying upon private
wells are more likely to visit an emergency room for
acute gastrointestinal illness than are individuals from
households with public water system connections.
For her latest research, published in November in
the American Journal of Public Health, she returned
to the underserved communities she had identifi ed in
Wake County and surveyed their water quality directly.
Laboratory testing revealed that residents in these
doughnut-hole neighborhoods are exposed to notably
higher quantities of microbial contaminants, including
bacteria associated with human fecal waste.
Nearly 30 percent of 171 private well water samples
tested positive for coliform bacteria, and more than 6
percent tested positive for E. coli. In samples from the
municipal system, results for both contaminants were
only a fraction of 1 percent.
Based on these fi ndings, MacDonald Gibson
estimates that more than one-fi fth of the underserved
communities’ 114 annual emergency department visits
for acute gastrointestinal illness could be prevented if
municipal water service were extended.
“From an infectious disease risk standpoint, these
communities would be much better off if they had
a connection to municipal water service,” she says.
“Ultimately, the important policy question is who
should bear the fi nancial cost.”
6%
30%
12 | C A R O L I N A P U B L I C H E A LT H
Photo by Brian Strickland
Clockwise from top: Frank Stillo, environmental
sciences and engineering doctoral student (left) and
Dr. Jackie MacDonald Gibson (right) visit the home
of Crystal Middleton to discuss procedures for testing
Middleton's well water; Samples of water are taken from
faucets in the home; Until results are back, Middleton
uses filtered water.
FA L L 2 0 1 6 | 13
Photo by Brian Strickland
MacDonald Gibson’s analysis of emergency department visits linked to well-water contaminants was published
online in May 2016 by Environmental Health Perspectives. See tinyurl.com/EHP-June2016. Partial funding for the
work on that study was provided by the Robert Wood Johnson Foundation (RWFJ).
Her fi ndings on inequities in municipal water access in Wake County, (published) online Nov. 17 in the American
Journal of Health, were supported by a grant from RWJF and a UNC IBM Junior Faculty Development Award.
Too often, vulnerable communities avoid announcing
themselves, for fear their properties will be condemned if
health officials discover inadequate water or septic systems.
14 | C A R O L I N A P U B L I C H E A LT H
As MacDonald Gibson continues her quest to
reduce inequities in drinking water quality, she plans
to follow up in the same neighborhoods to determine
whether residents also are being exposed to elevated
levels of lead and other metals in their well water.
Meanwhile, she aims to raise public awareness
about why some households are offered city water
while others are not.
“Racial inequity is certainly at play here,” she says.
“Members of these predominantly African-American
communities live with a higher risk of drinking
contaminated water. In neighborhoods that also have
lower incomes, residents are less able to take actions
to reduce their risk, such as installing home water
treatment systems.”
In 2008, the N.C. General Assembly passed a law
requiring testing of all new wells constructed after
July of that year. However, the law does not cover
wells built before July 1, 2008, nor does it require or
provide resources for the continuous monitoring of
any well. Wake County resident Alicia Jones collects water samples
from her kitchen faucet.
MacDonald Gibson’s study results suggest that the lack of support for private well owners to test and
maintain their wells will continue to leave underserved communities at increased health risk, compared to
adjacent neighborhoods.
As her research has progressed from a theoretical question to the identifi cation of a very real problem,
MacDonald Gibson moves toward closing the loop between research and policy change. Ultimately, she hopes
that her fi ndings will help achieve one of the charges in the Gillings School’s mission – to eliminate health
inequities across North Carolina and around the world.
– Jennie Saia
Photo by Brian Strickland
FA L L 2 0 1 6 | 15
TO MAJOR
Collaborative lab
environment leads
WEAPON
IN
It was nearly
impossible to look at
any news source in
the fi rst eight months
of 2016 without
coming across one
single word, over and
over again.
ZIKA.
osquito-borne, rapidly spreading, with
horrible potential impact upon pregnant
women and their unborn children, Zika had no
preventive vaccine, no treatment, no cure.
Hope arrived earlier this year, thanks to a team
led by Ralph Baric, PhD, professor of epidemiology
at the University of North Carolina’s Gillings
School of Global Public Health. The Baric team
conducted research that showed how antibodies
from patients who survived Dengue fever can be
used to fi ght the Zika virus now. That could open
the door to develop a Zika therapeutic treatment in
the not-too-distant future.
The research was published July 19 in mBio, the
journal of the American Society for Microbiology.
This rapid breakthrough came together as a
direct result of the way Baric manages his lab,
including the cultivation of innovation and inquiry by
students and staff members in his group.
“Dr. Baric encourages us to stretch ourselves
mentally and get outside our intellectual comfort
zones,” says Jessica Plante, PhD, a postdoctoral fellow
in the Baric lab and co-fi rst author of the study.
Zika virus has been known since 1947 but was
rarely studied, as human disease cases and outbreaks
were rare. Then, something changed. First seen in
an outbreak in Micronesia in 2007, Zika made its
presence known throughout the world after surfacing
in Brazil in late 2015, causing widespread concern,
especially for the 2016 Olympics.
Outbreaks have been reported since in 46 countries.
The virus is associated with severe neurological birth
defects and fetal loss in pregnant women and the onset
of Guillain-Barre syndrome in some adults.
Dr. Ralph Baric (above) and his team showed how
antibodies from Dengue fever survivors can be used
to fight Zika.
16 | C A R O L I N A P U B L I C H E A LT H
Photo by Linda Kastleman
As news spread about the virus, Plante and her fellow
researchers became intrigued. Zika is a fl avivirus,
similar to viruses that cause Dengue fever, West Nile
fever and yellow fever, all of which have been studied
extensively by the Baric lab and its collaborators.
“Several of us knew that our lab and the virology
research community at UNC were in a uniquely strong
position to address it,” she says.
Plante discussed the outbreak with her colleague,
Jesica Swanstrom, BS, who then approached Baric with
an idea.
“I asked him whether I could do a preliminary
experiment based on a hypothesis constructed from the
literature,” says Swanstrom, who works as a research
specialist in the Baric lab. “That fi rst assay yielded some
interesting results, so Jessica Plante and I sat down
together and designed some follow-up experiments that
we wanted to perform.”
The work they would be undertaking was highly
complex. In people who have contracted Dengue
virus, antibodies generated by the body in response
to serial infections may be protective or, under some
circumstances, actually may promote more severe
disease symptoms.
“We wanted to know how these pre-existing
Dengue antibodies in the human population were likely
to interact with the Zika virus,” Swanstrom says. “Would
it protect people from infection, do nothing or exacerbate
the condition?”
Conducting such a large-scale analysis at the cellular
level presented a unique challenge. Then again, the
Baric lab had a unique advantage – they had developed a
proprietary reverse genetics system for Dengue virus that
permitted such novel investigations.
Plante and Swanstrom designed experiments testing
various monoclonal Dengue antibodies. After several
sample runs, one antibody kept appearing as effective –
EDE 1. Not only could it protect multiple cell types from
infection in the lab, it also could do so in mice.
“We double- and triple-checked everything very
carefully,” Baric says. “Each time, the same outcome
occurred. The antibody derived from Dengue survivors,
EDE 1, neutralized the Zika virus in cell cultures, creating
a protective effect. A therapeutic treatment using these
Dr. Ralph Baric (left) chats with research team members Dr. Jessica Plante (center) and Jesica Swanstrom.
FA L L 2 0 1 6 | 17
Photo by Linda Kastleman
18 | C A R O L I N A P U B L I C H E A LT H
Zika can be passed
from a pregnant woman
to her fetus.
Infection during pregnancy
can cause certain serious
birth defects.
Zika is spread mostly by the
bite of an infected Aedes mos-quito.
It is also spread through
sex and blood tranfusions.
Mosquitoes that can
carry Zika are found in
some areas of the U.S.
Because the mosquitoes that
spread Zika virus are found
throughout the tropics,
outbreaks likely will continue.
At present, there is no
vaccine or treatment
for Zika.
antibodies would protect pregnant women and others
from contracting the Zika virus if they came in contact
with it.”
It was well into 2016 before the team confi rmed
their fi ndings – just as the media and public health
warnings were becoming more pervasive. Olympics
events were only a few months away, and mosquitoes
carrying the disease had been found throughout South
and Central America, the Caribbean and parts of the
southern United States.
The fi nding is potentially a major advance for
the prevention and treatment of Zika. Therapeutic
antibodies generated from people infected with
Dengue would be less likely to cause complications
in patients infected with either virus. The treatment
would not create a lifelong immunity but would be an
effective short-term tool to prevent infections from the
current strains of the Zika virus during an outbreak.
“[The potential value of our work] added a sense of
urgency to what we were doing and caused us to be
specifi c when writing the paper,” Plante says. “There
were a lot of late nights and weekends, but I am proud
that, at every step, we were appropriately cautious and
precise.”
The resulting paper, “Dengue Virus Envelope Dimer
Epitope Monoclonal Antibodies Isolated from Dengue
Patients Are Protective against Zika Virus,” was
published in the July/August issue of mBio, with Plante
and Swanstrom as co-fi rst authors. (See tinyurl.com/
mbio-zika.)
The paper generated extensive media coverage and
much discussion in the research community. Still, Baric
took care that the results were not misinterpreted.
“Our fi ndings did not mean that all Dengue survivors
have protection against Zika,” Baric says. “In fact, we
found only a small percentage of those people will have Images courtesy of Centers for Disease Control and Prevention
FA L L 2 0 1 6 | 19
DR. JESSICA DR. RALPH BARIC PLANTE JESICA SWANSTROM
Dr. Baric has created an
environment in which each
team member is encouraged
to try to incorporate genetics,
immunology, virology and
bioinformatics into our projects to
develop more complete explanations for
our observations. —jesica swanstrom
developed antibodies that have potential to protect
against both viruses. However, this particular class
of human monoclonal antibodies from a few DENV-infected
individuals are potentially therapeutic and
can prevent Zika virus infection.”
Baric adds that additional testing will be required to
further refi ne any treatment, such that it can combat
the inevitable mutations of the Zika virus that will
develop as more outbreaks occur.
“Follow-up studies with EDE1 and Zika in mouse
models are a priority,” Plante says. “It still needs to
be determined exactly how much EDE1 antibody is
necessary for protection and whether the antibody still
protects if it is administered after infection.”
Plante adds that other topics to explore include
whether EDE1 is safe to administer during pregnancy
and whether EDE1 can prevent Zika-associated
birth defects.
Swanstrom adds that the discoveries would not have
been possible if not for Baric’s leadership and the culture
he curated in his lab.
“Dr. Baric is incredibly receptive to ideas for
experiments and projects,” she says. “He has created an
environment in which each team member is encouraged
to try to incorporate genetics, immunology, virology
and bioinformatics into our projects to develop more
complete explanations for our observations.”
Thanks to Baric, Swanstrom says, the team is
working on a variety of projects, all of which make for
interesting science.
—David Pesci
Detailed and accurate data allow researchers to
avoid ‘one-size-fits-all’ solutions
The
MEASUREMENT,
LEARNING &
EVALUATION PROJECT
20 | C A R O L I N A P U B L I C H E A LT H
Women in a self-help group
in Agra, India, discuss health issues.
Photo © 2012 Urban Health Initiative
alf of the world’s population
lives in cities, and the number of
impoverished people living in cities
is growing exponentially. Of the many critical health
services needed by the urban poor, one is often overlooked –
family planning services.
Early in this decade, the Bill & Melinda Gates Foundation
recognized these disparities in reproductive health services
and decided to act.
“We realized that a lot of focus was on rural communities
and women in villages and that the urban poor were being
neglected,” says Lester Coutinho, deputy director of the
Family Planning Program at the Gates Foundation. “We
decided to try to solve this problem and made a large
investment in four countries, focusing on urban areas.”
The Gates Foundation funded the Urban Reproductive
Health (RH) Initiative, aimed at improving the health of
the urban poor in India, Kenya, Nigeria and Senegal. The
foundation also invested more than $22 million in The
Measurement, Learning & Evaluation (MLE) Project, the
evaluation component of the Urban RH Initiative, run by
UNC's Carolina Population Center. The goal of the MLE
project is to promote evidence-based decision making in
the design of integrated family planning and reproductive
health interventions for the Urban RH Initiative.
“The main objective of the MLE Project is to obtain
rigorous findings about the initiative,” says Ilene Speizer,
PhD, co-principal investigator and technical deputy
"director of MLE and research professor in the UNC
Gillings School of Global Public Health’s Department of
Maternal and Child Health.
Speizer has helped lead evaluations in the four targeted
countries and demonstrated increases in the use of modern
family planning in each country.
“Our second goal is to build the capacity of these
programs to use data to inform policies and programs,”
Speizer says. “We also want to share lessons on family
planning across the partnership and throughout the world.”
Coutinho says the investment was worthwhile, as the data
show dramatic results, particularly with the “poorest of the
poor,” the people whom the project wanted to help.
“We knew that if we wanted to help shape the thinking of
the broader community around integrated family planning
streamlined the program to six activities, including work-ing
with religious leaders to encourage family planning use.
“In our initial results, we found that working with reli-gious
leaders had no effect on women’s attitudes about
and use of family planning,” says Speizer. “Program leaders
were considering dropping the religious leader component
of the program, but we said, ‘Let’s look at men.’ We found
that religious leaders were clearly important influencers on
men, and so that component of the program remained.”
Similarly, the Nigerian Urban Reproductive Health
Initiative used the MLE four-year longitudinal study data
to create and refine its multifocal activities.
Dr. Mojisola Odeku, project director, says that using two
levels of data, which offer both population traits and indi-vidual
observations, allowed her project to build programs
and reproductive health interventions,” Coutinho explains,
“it wouldn't be enough to say, ‘We know this program
works because our partners have told us so.’ If we wanted to
convince the rest of the world that these programs worked,
we would need data to prove it.”
The most fascinating aspect of the findings, aside from
proving that the programs were successful, was that the
data pinpointed the program elements having the most
impact in sub-populations of the community.
“We couldn't explain which segments of the population
were better suited to the different solutions being tested,”
he says.
That was true in Senegal, where the program initiated 19
activities. After evaluating midterm data, the researchers
The lives of women
can be improved if
they have access to accurate
information and their concerns
are addressed through
[tailored interventions]."
– Dr. Mojisola Odeku
FA L L 2 0 1 6 | 21
(L-R): A couple in Uttar Pradesh, India, followed family
planning messages about healthy spacing of pregnancies
(photo ©2010 by M. Hussain/FHI 360); A woman in Nairobi,
Kenya, undergoes a procedure to insert an implant that
provides birth control for up to five years (photo ©2012 by
Tobin Jones, Tupange); A mother enjoys quiet time with her
newborn after a successful delivery (contributed photo).
that resulted in a higher demand for family planning ser-vices.
They also were able to strengthen supply-side activi-ties
to improve the quality of service.
“This project was created so that baseline data informed
program design, midterm data could be used to modify the
programs and scale up programs in new cities, and end-line
data are being used in our country and other countries, as
we expand,” says Odeku.
Based on MLE results, the Gates Foundation is expand-ing
activities in other urban areas within the four program
countries – and in additional countries – through a new
effort called The Challenge Initiative.
Speizer says that she and her research team have made
important contributions to the body of knowledge about
reproductive health services for the urban poor. MLE’s
data is having an impact on how family planning can be
adopted postpartum, the role played by gender relations on
family planning use, the barriers put in place by health care
providers to prevent some women from obtaining family
planning services, access to reproductive health services by
adolescent men and women, and other areas of reproductive
health and maternal and child health.
Ilene Speizer, PhD
In September 2016, Speizer
was selected as one of six
scholars who will spend up to
one full academic year at RTI International,
developing strategic research projects. Speizer
works with Wendee Wechsberg, PhD, director
of the RTI Global Gender Center, to pursue a
National Institutes of Health grant for health
interventions for young women who engage in
transactional sex in Pretoria, South Africa. RTI
began hosting its University Scholars program
in the 2014-2015 academic year.
“An important message from these data is that the
lives of women can be improved if they have access to
accurate information and their concerns are addressed
through different models of intervention,” says Odeku.
“Every city in which we’ve worked has its own unique
qualities, and the data revealed those nuances to us. The
data helped us to avoid ‘one-size-fits-all’ solutions and
allowed us, based on the findings, to adapt to each spe-cific
environment.”
Ω Michele Lynn
22 | C A R O L I N A P U B L I C H E A LT H
MEXICO’S BEVERAGE
TAX MOVES THE
COUNTRY TOWARD HEALTH
FA L L 2 0 1 6 | 23
FIVE YEARS AGO, MEXICO LED THE WORLD IN PER-CAPITA
CONSUMPTION OF COCA-COLA AND OTHER SUGAR-SWEETENED
BEVERAGES. NOW, ITS CONSUMPTION RATE IS STAGNANT — EVEN AS
RATES IN MOST OTHER DEVELOPING COUNTRIES KEEP SOARING.
hat explains this sudden shift toward
health? Many say it is the result of a tax –
a 10 percent excise tax on sugar-sweetened
beverages (SSBs) – which became law in Mexico
in January 2014. That the tax became policy owes
much to the work of Barry M. Popkin, PhD, W.R.
Kenan Jr. Distinguished Professor of nutrition
and director of UNC’s Global Food Research
Program, and to his collaboration with the Mexican
National Institute of Public Health (INSP) and key
nongovernmental organizations.
In 2006, Mexican minister of health José Ángel
Córdova, undersecretary of health Mauricio Hernández
and INSP nutrition expert Juan Rivera, PhD, invited
Popkin to Mexico City to discuss ways to combat
the country’s epidemic of obesity and related Type
2 diabetes. The statistics were astounding. Since
2000, the prevalence of diabetes in the country had
doubled, and about one third of 5- to 11-year-olds were
overweight or obese.
Epidemiologists already had linked obesity to sugary
sodas and other empty-calorie drinks, the consumption
W
24 | C A R O L I N A P U B L I C H E A LT H
Dr. Barry Popkin Dr. Shu Wen Ng
Photo by Linda Kastleman
Photo by Jennie Saia
FA L L 2 0 1 6 | 25
Read more in this Philadelphia Inquirer article: tinyurl.com/inquirer-sugartax.
MEXICO'S SUCCESSFUL SODA TAX HAS INSPIRED A
GLOBAL AWAKENING AMONG POLICY MAKERS ABOUT THE
PUBLIC HEALTH COSTS OF LOW-NUTRITION FOODS.
of which was skyrocketing in Mexico. Rivera and
Hernández wanted to do something to curb the
country’s addiction to these drinks.
Popkin helped set up a Mexican beverage guidance
panel – a team of eminent academics to advise on the
public health aspects of common beverages – such
as the one he had established in the United States in
2005. (See tinyurl.com/US-beverage-panel.) That
panel then published a report summarizing the state of
the science regarding the impact of SSBs upon health.
“We used that document to create awareness and
public debate and attempted to create a consensus
among Mexican academics,” Popkin says. “That was a
major step before the government pushed to establish
an SSB tax.”
The push met with resistance. Coca-Cola and other
soda companies held long-standing influence in
Mexican policy-making circles; the previous Mexican
president, Vicente Fox, once had been chief of Coca-
Cola Mexico. However, in late 2013, a 10 percent
SSB tax – negotiated from the 20 percent originally
proposed – was at last signed into law, becoming
effective in January 2014.
What was the result? During the first year of the tax,
the rate at which Mexicans purchased taxed SSBs began
to decline sharply, reaching a 12 percent reduction
(22 mL fewer per person, per day) by December, and
averaging a 6 percent drop in purchases over the entire
year. Low-income Mexicans, who would be expected
to be more sensitive to price increases, reduced their
purchases the most, by 9 percent over the year, and in
that sense, received the greatest benefit. Meanwhile,
purchases of untaxed beverages, such as water, rose by
comparison.
The study, published in BMJ in January 2016 as the
first of many planned evaluations of the tax’s impact, was
co-authored by M. Arantxa Colchero, PhD, researcher
at Mexico’s National Institute of Public Health; Rivera,
her colleague at the INSP; Shu Wen Ng, PhD, research
associate professor of nutrition at the Gillings School;
and Popkin.
The apparent success in Mexico has helped inspire a
global awakening among policy makers about the public
health costs of sugary, low-nutrition drinks and foods.
Chile began applying its own countrywide 8 percent SSB
tax in 2015. Popkin expects South Africa to follow with
a 20 percent tax in 2017, along with Colombia, whose
government has been consulting him for two years.
Popkin says that his team is now working at the
ministerial level with about a half-dozen other
governments to help them implement sugary drink taxes
and related policies, and he himself is directly aiding
several more.
“We’re very much in the center of this issue,” he says.
Oddly enough, one of the countries in which the SSB-tax
movement has been slow to gain traction is the
U.S., where “Big Soda” interests typically condemn such
efforts as “grocery taxes.” Prior to fall 2016, only two U.S.
cities, Berkeley and Philadelphia, had managed to pass
local SSB taxes. A study by Popkin, Ng and colleagues,
Dr. Barry Popkin (at right, holding child) visits with a family in their home in Chiapas, Mexico.
26 | C A R O L I N A P U B L I C H E A LT H
evaluating Berkeley’s tax, likely will be published next
year and could help encourage other cities to follow suit.
Certainly, the movement is still alive in America. “Five
local governments passed sugary drink taxes during
November elections – Boulder, Oakland, San Francisco,
Albany, Calif., and Cook County, Ill.,” says Ng.
Of course, sugary drinks are not the only dietary
contributors to obesity. One of the next frontiers for
Ng, Popkin and their colleagues are taxes aimed at junk
food; such a tax was imposed in Mexico at the same time
as the SSB tax. The UNC and INSP teams jointly are
studying its impact on spending and health.
“These types of policies have been talked about for a
long time, but there’s growing momentum for them now,
and I think they’re really going to make a difference,”
Ng says.
– James Schnabel
The estimated annual medical cost of obesity in the U.S.
was $147 billion in 2008; the medical costs for people
who were obese in 2008 were $1,429 higher than those
of normal weight.
PEOPLE LIVING WITH
DIABETES WORLDWIDE
2016
387 MILLION
2035
MORE THAN HALF BILLION
Contributed photo
with a four-week clinical trial involving more than
2,000 smokers. They found statistically significant
reductions in smoking behaviors among smokers
whose cigarette packs had graphic images, compared
to smokers whose packs did not. Exposure to
pictorial warnings resulted in smokers’ being more
likely to attempt to quit (40 percent vs. 34 percent)
– and more likely to succeed in quitting (5.7 percent
vs. 3.8 percent), compared to those seeing text-only
warning labels. The study was published in June
2016 in JAMA Internal Medicine.
“Our trial directly answers the court’s concerns
by providing strong evidence that pictorial health
warnings reduce smoking,” says Brewer.
igarette packaging has been a policy battleground
ever since Congress enacted its first warning-label
law in 1965. In recent years, researchers at
the UNC Gillings School of Global Public Health have
been in the thick of that battle.
In 2012, when a federal judge rejected the U.S.
Food and Drug Administration’s proposed new
pictorial warnings on cigarette packs – which
graphically depict blackened lungs and other
frightening health consequences of smoking (see
page 28) – he noted the lack of scientific evidence
that such pictorial warnings reduce smoking.
Noel Brewer, PhD, professor of health behavior,
and colleagues at the Gillings School responded
Drs. Kurt Ribisl (left) and Noel Brewer
FA L L 2 0 1 6 | 27
Photo by Linda Kastleman
28 | C A R O L I N A P U B L I C H E A LT H
Although the First Amendment and other issues
make it harder for the government to require
graphic warnings on cigarette packs in the U.S.,
at least 77 other countries already require such
warnings. In Thailand, for example, pictorial
warning labels have appeared on cigarette packs
since 2005, and now cover 85 percent of the
front of every cigarette pack and 90 percent of
the back (see the Canadian Cancer Society’s 2014
international status report at tinyurl.com/2014-
global-smoking-report).
Brewer and his colleagues have concluded from
systematic reviews and meta-analyses of studies
in those countries that pictorial warning labels are
indeed working – and are working better than
text warnings.
“The findings from our reviews of scientific
studies are broadly consistent with what we
found in the clinical trial,” Brewer says. “By some
estimates, pictorial warnings immediately reduce
smoking by five percent, which is a big deal.”
“We think the case is closed – pictorial is superior
to text,” says Kurt M. Ribisl, PhD, a professor
of health behavior who is a former member of
the FDA’s Tobacco Products Scientific Advisory
— Dr. Noel Brewer
Committee and co-author of several of the pictorial
warning studies.
The FDA is expected to issue a new set of
proposed pictorial warning labels within the next
year or two. If the tobacco companies sue again,
the recent clinical trial findings by Brewer, Ribisl
and colleagues could be an important factor in
withstanding the challenge.
“The UNC team has provided key evidence that
will inform the policy debate,” says Ribisl.
Gillings School researchers have been active in
shaping another new – and perhaps harder-to-challenge
– anti-tobacco strategy, enabled by the
same 2009 legislation that mandated cigarette
pack pictorial warnings. In that law, Congress
also gave the FDA leeway to require disclosure on
cigarette packs – most likely on the sides – of some
of the more harmful chemicals in tobacco smoke.
“People, including smokers, are largely unaware
of the chemicals in cigarette smoke, but they’re
interested in learning about them,” says Marcella
H. Boynton, PhD, research assistant professor of
health behavior, summing up a national survey
that she and her colleagues, including Ribisl and
Brewer, published in BMC Public Health in
June 2016.
That finding will help maintain pressure on the
FDA to issue a new rule in this area, but it is not
yet clear how best to present such information
on the side of a cigarette pack. Cigarette smoke
contains thousands of distinct chemicals, of which
more than 100 – including arsenic, benzene,
cadmium, and polonium 210 – are established
toxins and/or carcinogens. Which ones should be
Graphic pictorial labels such as these resulted in smokers' being more likely to quit smoking.
FA L L 2 0 1 6 | 29
highlighted and how their health impacts should be
explained are issues yet to be resolved.
“Which constituent message best discourages
smoking?” asks Boynton. “Saying that a toxin in
cigarette smoke causes bladder cancer, or that
it’s found in rat poison? These are the kinds of
questions we’re wrestling with.”
One concern is that cigarette companies could
use constituent messages to imply that some
cigarettes are relatively harmless – as they formerly
did with the now-banned “low tar” designation.
“We don’t want consumers to look at the label
and decide, ‘Oh, this has less arsenic; it must be
safer,’” Boynton says.
What is needed, she adds, is a systematic
approach to understanding which types of
constituent-related messages are most efficient at
conveying health risks.
“That’s what our work is now mostly focused on,”
she says.
Given clear health risks associated with smoking,
it might seem odd that governments do not ban
cigarettes. As Ribisl points out, however, making
cigarettes illegal would criminalize the behavior
of more than 40 million tobacco users in the U.S.
and encourage a vast black market. Thus, the fight
against tobacco remains largely a fight to coax
smokers away from their health hazard of choice –
and doing that with product packaging remains
a favored strategy.
“A pack-a-day smoker gets 20 impressions of label
messages per day, which is 7,300 impressions a year,”
says Ribisl. “The cigarette package is an extremely
low-cost and effective venue for discouraging
tobacco use.”
Good news came on Oct. 4, 2016, in the form of
eight anti-tobacco groups’ suing to force the FDA
to require graphic cigarette package warnings,
as mandated by law. (For more information, see
tinyurl.com/FDA-tobacco-suit).
“Our findings will help change national policy,”
Brewer says. “Now the FDA can require graphic
warnings and successfully defend that action in
court. Implementing graphic warnings will save
hundreds of thousands of lives.”
—James Schnabel
Dr. Marcy Boynton
— Dr. Kurt Ribisl
Photo by Jennie Saia
30 | C A R O L I N A P U B L I C H E A LT H
REAL-WORLD
HOSPITAL POLICY
S TUD ENT CA S E S TUD I E S
DRAMAT I CA L LY I M P R OV E
Photo by Brian Strickland
FA L L 2 0 1 6 | 31
SStudents in the Gillings
School’s executive
Master of Healthcare
Administration degree
program not only gain
knowledge and experience
from their studies – they also
have an impact on policy.
In Healthcare Quality and InformationManagement,”
a second-year course in the joint MPH/MHA program,
student teams engage in performance improvement
projects in which they analyze real-life problems faced
by UNC Health Care and provide recommendations to
the project sponsors.
Well-written case studies provide opportunities for
insight into real-life problems and are a great way to
teach a group of students,” says Larry Mandelkehr,
MBA, one of the class instructors. With a case
study, there is a solution guide and discussion points.
These projects go one step beyond because there is
no known right answer. There isn't anything better
for students than working with a real-life situation
and realizing that the recommendation they make
perhaps will have direct impact on the care we
provide or the safety of the environment.”
Mandelkehr, adjunct instructor of health policy and
management at the UNC Gillings School of Global
Public Health and Professor of the Practice at UNC’s
Kenan-Flagler Business School, is also director of
performance improvement at UNC Hospitals.
In spring 2014, Mandelkehr's students made a
signifi cant contribution to the safety of newborns at
UNC Hospitals when they examined the hospital’s
“code pink” plan. The plan outlines the steps to take
if a newborn is removed from the nursery without
authorization.
After presentation of the students’ projects and
outcomes, the hospital's board of trustees changed
Franklin Farmer, Larry
Mandelkehr and Bill Gentry
(l-r) pose outside the
UNC Children's Hospital.
Mandelkehr and Farmer teach
executive master's students
how to evaluate health
challenges and institute
policy changes. Gentry
directs the executive master's
programs.
Photo by Brian Strickland
32 | C A R O L I N A P U B L I C H E A LT H
the “code pink” policy to refl ect the student’s
recommendations, resulting in a decrease in the alert
time from 10 minutes to 100 seconds.
“This is such an absolutely dramatic result that you
don’t need a statistical analysis to know that this team
of students had an impact,” says Franklin Farmer,
MBA, associate chair for administration in UNC’s
Department of Emergency Medicine, who began
co-teaching the class with Mandelkehr last year. “The
‘before’ and ‘after’ numbers speak for themselves.”
Alyssa Mansfi eld Damon, PhD, MHA, MPH,
assistant professor of health policy and management
at the Gillings School, was a student in the cohort that
evaluated the code pink project.
“Class members had incredible diversity in our
backgrounds and experiences, and we were able to
pull together different strengths to accomplish work
that I'm really proud of,” she says. “Our experience
shows that you don't need to have years of experience
or be an executive to make impactful changes or
improve policy.”
In spring 2016, the class examined UNC Hospitals’
“active shooter” plan. Eric Horowitz, MD, MHA,
RD, a neonatologist at
Boston's North Shore
Medical Center, was
among the students
who recommended
improvements for
communications and
suggested a safer model
for transferring patients
from the emergency
department to the
operating rooms.
“Every small group
within our class
believed they had
looked at things from
every possible angle,
yet every group saw
something in the other
presentations that they
hadn’t thought about
– things that would have made their own proposals
and the overall presentation stronger,” says Horowitz.
We learned the value of different perspectives and
experiences and benefi ted from being in an academic
environment that was connected to reality.”
Farmer says that the hospital benefi ts as well.
“Having fresh sets of eyes that don’t use the same
paradigms as those of us who have worked in the fi eld
for a long time means that the students come up with
solutions and approaches that we wouldn’t,” he says.
“What we like to do in the program is support
Dean [Barbara K.] Rimer’s mission of having
faculty members ensure that teaching and research
lead to practice,” says Bill Gentry, MPA, director of
health policy and management’s executive master’s
programs and the Community Preparedness and
Disaster Management Certifi cate Program. “Our
executive program students already have work
experience, so we want to leverage that experience
by offering them academic projects that actually can
benefi t public health.”
—Michele Lynn
Students in the Healthcare Quality and Information Management course improved policies
that will keep patients and staff members safe at UNC Health Care. Left to right are
Franklin Farmer and Larry Mandelkehr, course instructors; Bill Gentry, director of the HPM
executive master's programs; and former students Kara Lingley-Brown and Paul Marini.
Photo by Brian Strickland
FA L L 2 0 1 6 | 33
As a young professor at the University of Wisconsin at Madison,
Michael R. Kosorok, PhD, completed research that has had an impact upon
the life of every baby born in the United States over the past decade.
Cystic fibrosis
screening for
newborns
YOUNG LIIVES
TRANSFORMS
ow the W.R. Kenan Jr. Distinguished
Professor of biostatistics at the UNC Gillings
School of Global Public Health, Kosorok
was the second lead author on “Nutritional Benefi ts
of Neonatal Screening for Cystic Fibrosis,” published
Oct. 2, 1997, in The New England Journal of Medicine.
The paper played a key role in the Centers for Disease
Control and Prevention’s 2004 recommendation that
states institute newborn screening for cystic fi brosis
(CF), a progressive, genetic disease which is the second
most common life-shortening, childhood-onset,
inherited disorder in the United States.
In November 2003, the CDC and the Cystic Fibrosis
Foundation co-sponsored a workshop to review benefi ts
and risks associated with newborn screening for CF.
“The written minutes from the workshop
make it clear that our paper was the key
piece of evidence that pushed people
over the edge to decide that
screening would be benefi cial,”
says Kosorok. “Other
evidence was important,
but our paper was
particularly infl uential
because we were the
only research group
that used a controlled randomized trial which met the
highest scientifi c standard.”
Kosorok and his colleagues demonstrated that
newborn screening for CF led to long-term benefi ts –
such as improved growth and, in one study, cognitive
development – as a result of early nutritional treatment.
George Retsch-Bogart, MD, professor in the UNC
School of Medicine and co-director of the UNC Cystic
Fibrosis Therapeutics Development Center, says that
Dr. Michael Kosorok (this page) meets with
the Stone family, whose children benefited
from his research. At far right is Dr. George
Retsch-Bogart, a pediatric pulmonologist
who treats children with cystic fibrosis.
N
34 | C A R O L I N A P U B L I C H E A LT H
identifying children with CF before they become
symptomatic has had a profound impact on the lives of
these patients and their families.
“Although parents are anxious when we give them
a post-screening diagnosis,” Retsch-Bogart says, “the
screening prevents them from visiting doctor after
doctor, wondering what's wrong with
their baby.”
Newborn screening in the United States leads to a
diagnosis of CF a median of one year earlier than does
symptomatic detection.
“We are able to get the identifi ed children into state-of-
the-art care centers where we see them a minimum
of every two months for the fi rst year of life and then
every three months thereafter,” says Retsch-
Bogart. “This allows us to make sure
Photo by Brian Strickland
FA L L 2 0 1 6 | 35
36 | C A R O L I N A P U B L I C H E A LT H
Drs. Michael Kosorok (left) and George Retsch-Bogart
review data on cystic fibrosis screening.
“But in the last fi ve to seven years, we have new
therapies being scaled down from adults to children.
We have breakthrough therapies for the fundamental
defect, and there are now studies underway in children
from early infancy to age two with a drug that targets
the underlying cause of CF produced by mutations of
the CF gene. As we get more of these therapies, we can
start children, immediately after the diagnosis, on a
therapy that is as close to a cure as we can imagine at
this time.”
Kosorok is gratifi ed that his work has led to policy
change throughout the country but says his primary
goal is to produce quality research.
“I was very fortunate because many people do
excellent research but don't see policy change,” he says.
“Since you don't have control over these things as a
scientist, it's important to keep doing the good research
that is essential to making informed decisions.”
—Michele Lynn
Although parents are
anxious when we give
them a post-screening
diagnosis, the screening
prevents them from
visiting doctor after
doctor, wondering
what's wrong with
their baby."
– DR. GEORGE RETSCH-BOGART
these children have the best nutrition possible while
monitoring and treating respiratory problems.”
Retsch-Bogart was a key player in infl uencing the
North Carolina Department of Health and Human
Services (DHHS) to add CF screening to its newborn
testing panel. In 2005, a multidisciplinary group of
health professionals approached the North Carolina
Newborn Screening Advisory Committee, which makes
recommendations to DHHS, to request the addition of
the CF test.
“In 2008, budget approval was received for a little
more than $1 million for the state to purchase testing
equipment, hire personnel and make sure there was
space in the state laboratory,” says Retsch-Bogart.
Newborn screening for CF began in North Carolina
on April 13, 2009, nearly 12 years after the publication
of Kosorok's paper.
“Even if you have all the resources at your fi ngertips,
there has to be a will among policy makers to make a
change,” says Kosorok.
Since its implementation, the screening test in North
Carolina has identifi ed between 30 and 34 newborns
with CF each year. Retsch-Bogart says that the few
diagnoses missed by the test are identifi ed through
clinical symptoms.
“In the past, people dragged their feet on newborn
screening for CF because there was no cure,” he says. Photo by Brian Strickland
Profi les by Jennie Saia and Linda Kastleman
Young alumni from all eight academic units at the UNC
Gillings School of Global Public Health prove themselves
as local and global public health leaders
FA L L 2 0 1 6 | 37
38 | C A R O L I N A P U B L I C H E A LT H
He might have been a psychologist or a
mathematician – but a chance encounter
on a golf course brought Abram Graham
to the Gillings School’s Department of Biostatistics.
In 2010, Professor Emeritus Lawrence Kupper, PhD,
was enjoying his fi rst day of retirement with a round
of golf at a local course. Graham, a club employee and
rising junior, was deciding on a major.
“Why not biostatistics?” Kupper asked.
“Dr. Kupper described a blend of mathematics and
problem solving (both of which I love), applied in a
discipline that would allow me to make a difference in
people’s lives,” Graham says.
Kupper emailed Jane Monaco, PhD, clinical associ-ate
professor and director of the biostatistics under-graduate
program.
“Talking to Dr. Monaco gave me the fi nal nudge to ap-ply
for the program,” Graham says. “She was an excellent
teacher and continues to be an important mentor.”
Those two years were only the beginning.
A native Chapel Hillian, Graham hadn’t considered
living or working abroad until his girlfriend (now fi an-cée)
suggested that they both study abroad as graduate
students. While earning a master’s degree in biosta-tistics
at the University of Reading, England, he was
surprised to learn that Quintiles – founded by the same
Dennis Gillings, PhD, CBE, whose generous gift, with
Joan Gillings, had resulted in the renaming of UNC’s
public health school – also had an offi ce in Reading.
After an internship at Quintiles in Research Triangle
Park, N.C., Graham worked in the Reading offi ce.
There, one of his projects was to provide statistics
for a cancer drug that proved successful. The oppor-tunity
allowed him an important perspective.
“I realized I was working with more than numbers on
a computer screen,” he says. “These are real people who
need a life-saving drug.”
Graham said a Gillings School bachelor's degree
gave him the tools to build a rewarding career.
“My degree taught me that I can help cure diseases
by using statistics,” he says. “I attended a top-rated
public health school and a biostatistics program where
I was able to develop real-world experience. This has
helped me land a job with a company that cares, as I
do, about improving people’s health.”
Abram Graham poses outside the Quintiles building
in Reading, England.
Abram Graham
􀇖􍘁􀇏􌼁􀇉􌤁􀇅􌔁􀇄􌐁􀇗􍜁􀇄􌐁􀇏􌼁􀇅􌔁􀇄􌐁􀇏􌼁􀇕􍔁􀇅􌔁
􀇃􌌁􀇅􌔁􀇏􌼁􀇊􌨁􀇑􍄠 􀇖􍘁􀇏􌼁􀇉􌤁􀇅􌔁􀇄􌐁􀇗􍜁􀇄􌐁􀇏􌼁􀇅􌔁􀇄􌐁􀇏􌼁􀇕􍔁􀇅􌔠 􀇄􌐁􀇉􌤠 􀇐􍀁􀇓􍌁􀇌􌰁􀇈􌠠 􀇕􍔁􀇃􌌁􀇆􌘁􀇓􍌠 􀇔􍐁􀇏􌼁􀇅􌔁􀇓􍌁􀇗􍜁􀇅􌔁􀇓􍌁􀇅􌕃
Contributed photo
FA L L 2 0 1 6 | 39
Brooke Hoots, PhD, has wanted to be a dis-ease
detective since she was in high school.
That was when she fi rst learned about the
Epidemic Intelligence Service (EIS) program, man-aged
by the Centers for Disease Control and Preven-tion
(CDC). With Rene Russo’s character in the movie
“Outbreak” in mind, Hoots came to the UNC Gillings
School to gain a strong methodological foundation in
epidemiology.
“I should mention that I’m very grateful to the
Gillings School students who did EIS work before me,”
she says. “They impressed the program offi ce so much
that EIS stayed excited to see applicants from UNC’s
Department of Epidemiology.”
Hoots graduated in 2011 and served as an EIS offi cer
until 2013. After her fellowship ended, she accepted a
position working on National HIV Behavioral Sur-veillance
(NHBS) in the CDC’s Division of HIV/AIDS
Prevention. In that role, she has access to large national
datasets and regularly interacts with leading experts in
the fi elds of surveillance and outbreak response.
“Our group operates the only ongoing surveillance
system that provides data on three populations at high
risk for HIV — men who have sex with men, people who
inject drugs and high-risk heterosexuals,” Hoots explains.
A health worker takes Dr. Brooke Hoots' temperature
before she enters a hotel in Monrovia. Elevated fever
may be an indicator of an infectious disease, such
as Ebola.
“Our group operates the
only ongoing surveillance
system that provides data
on three populations at
high risk of HIV.”
􀇔􍐁􀇆􌘮. 􀇖􍘁􀇆􌘁􀇉􌤁􀇉􌤁􀇍􌴁􀇓􍌠 􀇐􍀁􀇉􌤁􀇉􌤁􀇄􌐁􀇅􌕂
Brooke Hoots
􀇓􍌁􀇈􌠁􀇏􌼁􀇔􍐁􀇓􍌁􀇋􌬁􀇏􌼁􀇉􌤁􀇌􌰁􀇉􌤁􀇑􍄁􀆿􋼁
􀇕􍔁􀇉􌤁􀇋􌬁􀇖􍘁􀇗􍜁􀇄􌐁􀇄􌐁􀇏􌼁􀇊􌨁􀇑􍄠 􀇐􍀁􀇏􌼁􀇂􌈠 􀇗􍜁􀇅􌔠 􀇗􍜁􀇊􌨠 􀇓􍌁􀇈􌠁􀇏􌼁􀇔􍐁􀇓􍌁􀇋􌬁􀇏􌼁􀇉􌤁􀇌􌰁􀇉􌤁􀇑􍄁􀇏􌼁􀇅􌔁􀇄􌐠 􀇁􌄁􀇏􌼁􀇄􌐁􀇐􍀠 􀇄􌐁􀇐􍀁􀇓􍌠 􀇕􍔁􀇔􍐁􀇕􍔜
“As a senior epidemiologist, I analyze and publish a lot of
our data and assist others with their analyses.”
Because of her EIS training, she often deploys to assist
with outbreaks. In the past few years, she fl ew to Liberia
twice to help with the Ebola response and also traveled
to southern Indiana to serve as the data management
leader during an outbreak of HIV.
When she is at home in Atlanta, Hoots joins her long-standing
trivia team, which meets weekly at a local bar.
“We were EIS classmates together,” she says. “The
players rotate often because we all travel for work, but
the team has met almost every Thursday for the past
fi ve years.”
Contributed photo
40 | C A R O L I N A P U B L I C H E A LT H
A native of Japan, Dr. Hajime Kanamori
earned a certifi cate in fi eld epidemiology at
the Gillings School in 2011 and graduated
with a master’s degree in public health leadership in
2012. While a student, he found himself unexpectedly
treating survivors of a 9.0-magnitude earthquake and
subsequent tsunami in Japan’s Miyagi Prefecture. He
shared that experience in the fall 2012 issue of Caro-lina
Public Health (see tinyurl.com/cph-kanamori).
These days, Kanamori lives in Chapel Hill with his
family (he’s proud to share that his son was born at
UNC Hospitals) and works as a postdoctoral fellow in
the Division of Infectious Diseases at UNC’s School of
Medicine. There, he collaborates with mentors David
Weber, MD, MPH, professor of epidemiology, and Bill
Rutala, PhD, MPH, a Gillings School alumnus, to learn
about advanced molecular techniques for studying and
combating drug-resistant organisms.
“Antibiotic-resistant bacteria are a key cause of infec-tions
and outbreaks in health-care settings around the
world,” Kanamori says. “We urgently need to establish
prevention strategies against these pathogens.”
As Kanamori expands his research in the fi eld
of hospital epidemiology and infection control, he
has implemented the relatively new technology of
whole-genome sequencing to investigate new methods
for combatting infections in health-care facilities.
He recently conducted epidemiological studies on
infections linked to occupational blood and body fl uid
exposures among health-care personnel. He also has re-viewed
outbreaks of waterborne infections in health-care
settings and identifi ed prevention strategies and control
measures for each affected water source. This research
revealed surprising locations for bacteria incubation,
such as no-touch electronic water faucets in bathrooms
and decorative wall-mounted fountains in hallways.
When asked what comes next, Kanamori responds
with one simple, powerful goal.
“I want to advance the fi eld of infection control
based on solid scientifi c evidence,” he says.
Dr. Hajime Kanamori takes part in International
Infection Prevention Week at UNC Hospitals.
Dr. Kanamori (center) poses with his mentors at the
UNC School of Medicine - Dr. David Weber (left) and
Dr. Bill Rutala.
Hajime Kanamori
􀇈􌠁􀇃􌌁􀇖􍘁􀇌􌰁􀇏􌼁􀇕􍔠 􀇐􍀁􀇓􍌁􀇗􍜁􀇌􌰁􀇄􌐁􀇐􍀠 􀇌􌰁􀇓􍌁􀇗􍜁􀇔􍐁􀇓􍌁􀇆􌘁􀇅􌔁􀇐􍀁􀇏􌼁􀇈􌠠 􀇈􌠁􀇆􌘁􀇉􌤁􀇑􍄁􀇆􌘁􀇗􍜁􀇋􌬁
􀇍􌴁􀇓􍌁􀇓􍌁􀇈􌠁􀇏􌼁􀇊􌨁􀇑􍄠 􀇃􌌁􀇅􌔠 􀇅􌔁􀇗􍜁􀇒􍈁􀇓􍌠 􀇒􍈁􀇆􌘁􀇉􌤁􀇋􌬠 􀇏􌼁􀇊􌨁􀇒􍈁􀇓􍌁􀇕􍔁􀇄􌐁􀇏􌼁􀇉􌤁􀇃􌌁􀇅􌔠 􀇔􍐁􀇏􌼁􀇅􌔁􀇓􍌁􀇗􍜁􀇅􌔁􀇓􍌁􀇅􌕃
Contributed photos
FA L L 2 0 1 6 | 41
Since earning a doctor-ate
in health behavior
at the Gillings School
in 2013, Derrick Matthews has
led the life of an academic. That
often involves, he says with a
wry smile, “being hunched over
a computer.”
Staying focused on his
research has been benefi cial,
though.
After taking a position as
a postdoctoral scholar at the
University of Pittsburgh, he was
invited in 2015 to join the fac-ulty
as a tenure-track assistant
professor in the Department of
Infectious Diseases and Microbiology.
As a postdoc – in the Department of Behavioral and
Community Health Sciences – he worked on a train-ing
grant focused on HIV disparities among men who
have sex with men (MSM). Specifi cally, his research
involves black MSM, a group in which health disparity
is the result of a host of social factors, including reduced
access to health care and chronic exposure to racial and
sexual-orientation discrimination.
The primary study in which he has been involved is
Promoting Our Worth, Equality and Resilience (POW-ER).
To collect data for that study, he attends black
pride events, where he administers a health question-naire
to attendees. He also works with local agencies to
obtain HIV testing for black MSM.
“This feet-on-the-ground effort has allowed us to gen-erate
the largest serial cross-sectional sample of black
MSM in the U.S.,” Matthews says. “There are a number
of important questions we didn’t previously have data
for because our sample sizes were so small. For in-stance,
although many HIV-positive black MSM are not
receiving health care, some are – and they’re doing well
and adhering to their medication regimens. We want to
learn more about these two groups and determine what
we can do within the community and the health-care
system to get care for everyone.”
In summer 2016, during the third year of POWER’s
data collection, Matthews was able to collect blood
from study participants. Only a few drops can help the
research team examine HIV-relevant biomarkers, such
as viral suppression.
“Improving the lives of black MSM is both a personal
and professional passion,” Matthews says. “The great
research training I received at the Gillings School fueled
that passion. Having a strong foundation allowed me
to get to work right away addressing one of the most
extreme health disparities we have in the U.S.”
Derrick Matthews (far left) takes a break with members of his POWER
team while conducting surveys and providing HIV testing at a July 2016
event in Detroit.
Derrick Matthews
􀇐􍀁􀇓􍌁􀇗􍜁􀇌􌰁􀇄􌐁􀇐􍀠 􀇖􍘁􀇓􍌁􀇐􍀁􀇗􍜁􀇂􌈁􀇏􌼁􀇉􌤁􀇆􌘁
􀇏􌼁􀇋􌬁􀇈􌠁􀇆􌘁􀇉􌤁􀇂􌈁􀇏􌼁􀇊􌨁􀇑􍄠 􀇄􌐁􀇐􍀁􀇓􍌠 􀇌􌰁􀇏􌼁􀇂􌈁􀇓􍌁􀇅􌔠 􀇉􌤁􀇒􍈠 􀇖􍘁􀇌􌰁􀇗􍜁􀇕􍔁􀇍􌴠 􀇋􌬁􀇅􌔁􀇋􌭃
Contributed photo
42 | C A R O L I N A P U B L I C H E A LT H
Even when Katie Donohue McMillan was in
middle school, she was excited by decon-structing
problems and fi nding solutions.
That passion made her an amazing participant in
Odyssey of the Mind (odysseyofthemind.com), an in-ternational
educational program that provides creative
problem-solving opportunities for students from kin-dergarten
through college.
As a grown-up, she still is challenged by puzzles.
Now, as the innovation portfolio manager at Duke
Health, she works on solving health-care and public
health problems through the creative use of technology.
McMillan became involved in the mHealth move-ment
in 2009 when innovators fi rst considered using
text messages or apps as a way to improve health. After
earning a master's degree at the Gillings School in
2013, she began working at Smashing Boxes, a software
development start-up in Durham, N.C.
“I had learned about how to plan mHealth programs
and develop content,” she says, “but I wanted a better
understanding of what happened under the hood—how
much it costs to create apps, what to consider for an
optimal user experience, and how to market and launch
the product. If no one is using your app or service, you
haven’t made any change.”
After three years at Smashing Boxes, where she
worked to develop more than 20 health-related apps,
McMillan came to Duke to help accelerate their health
technology strategy.
Katie McMillan experiments with the Microsoft
Hololens while brainstorming ways to use
augmented reality in health care.
“In less than 10 years, apps have moved from being
experimental to being standard business practice. It's
amazing how far we've come.”
􀇍􌴁􀇗􍜁􀇄􌐁􀇏􌼁􀇓􍌠 􀇋􌬁􀇕􍔁􀇋􌬁􀇏􌼁􀇌􌰁􀇌􌰁􀇗􍜁􀇊􌩋
Katie McMillan
􀇋􌬁􀇗􍜁􀇄􌐁􀇓􍌁􀇆􌘁􀇊􌨁􀇗􍜁􀇌􌰠 􀇗􍜁􀇊􌨁􀇔􍐠 􀇕􍔁􀇐􍀁􀇏􌼁􀇌􌰁􀇔􍐠 􀇐􍀁􀇓􍌁􀇗􍜁􀇌􌰁􀇄􌐁􀇐􍀁
􀇅􌔁􀇉􌤁􀇌􌰁􀇂􌈁􀇏􌼁􀇊􌨁􀇑􍄠 􀇈􌠁􀇃􌌁􀇖􍘁􀇌􌰁􀇏􌼁􀇕􍔠 􀇐􍀁􀇓􍌁􀇗􍜁􀇌􌰁􀇄􌐁􀇐􍀠 􀇈􌠁􀇆􌘁􀇉􌤁􀇖􍘁􀇌􌰁􀇓􍌁􀇋􌬁􀇅􌔠 􀇄􌐁􀇐􍀁􀇆􌘁􀇉􌤁􀇃􌌁􀇑􍄁􀇐􍀠 􀇄􌐁􀇓􍌁􀇕􍔁􀇐􍀁􀇊􌨁􀇉􌤁􀇌􌰁􀇉􌤁􀇑􍄁􀆿􋼜
“In less than 10 years, apps have moved from being
experimental to being standard business practice,” she
says. “Now, we are studying how to gather better data from
wearables, Bluetooth-connected devices and apps directly
pulling from electronic health records – all of which will
inform and improve patient care. It’s amazing how far
we’ve come.”
After earning her master's, McMillan married fellow alumnus
Daniel McMillan, MD, MPH.
Contributed photo
FA L L 2 0 1 6 | 43
Sara Benjamin Neelon, PhD, MPH, RD, is
a lover of all things British. Naturally, she
was thrilled when – met with her husband’s
reluctance to relocate overseas in 2011 – the University
of Cambridge created an Honorary Senior Visiting Fel-lowship
that allows her to spend 20 percent of her time
in England. Every May and October, she visits to exam-ine
population-level infl uences on dietary behaviors.
During the rest of the year, she works as an associate
professor at Johns Hopkins University’s Bloomberg
School of Public Health. Stateside, she studies policy
and environmental approaches to obesity prevention
in children and helps doctoral students in her scientifi c
writing class prepare their fi rst manuscripts for publi-cation.
“Although much of my work is based in the United
States, I also run studies in Mexico, Kenya and – of
course – England,” Benjamin Neelon says. “The best
part about my research is the opportunity to travel to
so many interesting places around the world.”
Benjamin Neelon earned master’s and doctoral de-grees
from the Department of Nutrition at the Gillings
School. After completing her studies in 2006, she ac-cepted
a two-year postdoctoral fellowship at Harvard
Medical School. From 2009 to 2015, she conducted
research and taught global nutrition classes at Duke
University, and most recently moved to Baltimore to
join the faculty at the Bloomberg School. In October
2016, she was named director of the Lerner Center for
Public Health Promotion at Johns Hopkins.
In addition to her current roles as researcher, educa-tor
and administrator, Benjamin Neelon also is com-pleting
a Juris Doctor degree. She hopes studying law
will make her even more competitive when it comes to
obtaining funding for her research on obesity policy.
Throughout her travels and career achievements,
Benjamin Neelon has an exceptional reminder of her
time at the Gillings School. She met her husband,
Brian Neelon (PhD, 2005), when she was a nutrition
student and he was pursuing a degree in biostatistics.
“My adviser Dianne Ward hired him as a study stat-istician
while he was a UNC Gillings student,” she says.
“We extended our gratitude to Dianne with a gift at
our wedding!”
Dianne Stanton Ward, EdD, is professor of nutrition at
the Gillings School.
“The best part about my
research is the opportunity
to travel to so many
interesting places
around the world.”
􀇔􍐁􀇆􌘮. 􀇅􌔁􀇗􍜁􀇆􌘁􀇗􍜠 􀇖􍘁􀇓􍌁􀇊􌨁􀇎􌸁􀇗􍜁􀇋􌬁􀇏􌼁􀇊􌨠 􀇊􌨁􀇓􍌁􀇓􍌁􀇌􌰁􀇉􌤁􀇊􌩓
Sara Benjamin Neelon takes a break in the garden
outside her University of Cambridge offi ce.
Sara Benjamin Neelon
􀇊􌨁􀇃􌌁􀇄􌐁􀇆􌘁􀇏􌼁􀇄􌐁􀇏􌼁􀇉􌤁􀇊􌨁
􀇐􍀁􀇓􍌁􀇌􌰁􀇈􌠁􀇏􌼁􀇊􌨁􀇑􍄠 􀇈􌠁􀇆􌘁􀇓􍌁􀇂􌈁􀇓􍌁􀇊􌨁􀇄􌐠 􀇕􍔁􀇐􍀁􀇏􌼁􀇌􌰁􀇔􍐁􀇐􍀁􀇉􌤁􀇉􌤁􀇔􍐠 􀇉􌤁􀇖􍘁􀇓􍌁􀇅􌔁􀇏􌼁􀇄􌐁􀆿􋼠 􀇁􌄁􀇉􌤁􀇆􌘁􀇌􌰁􀇔􍐁􀇁􌄁􀇏􌼁􀇔􍐁􀇓􍍃
Contributed photo
44 | C A R O L I N A P U B L I C H E A LT H
Vann R. Newkirk II
􀇐􍀁􀇓􍌁􀇗􍜁􀇌􌰁􀇄􌐁􀇐􍀠 􀇈􌠁􀇉􌤁􀇌􌰁􀇏􌼁􀇕􍔁􀆿􋼠 􀇗􍜁􀇊􌨁􀇔􍐠 􀇋􌬁􀇗􍜁􀇊􌨁􀇗􍜁􀇑􍄁􀇓􍌁􀇋􌬁􀇓􍌁􀇊􌨁􀇄􌐁
􀇗􍜠 􀇂􌈁􀇉􌤁􀇏􌼁􀇕􍔁􀇓􍌠 􀇒􍈁􀇉􌤁􀇆􌘠 􀇄􌐁􀇐􍀁􀇓􍌠 􀇃􌌁􀇊􌨁􀇔􍐁􀇓􍌁􀇆􌘁􀇅􌔁􀇓􍌁􀇆􌘁􀇂􌈁􀇓􍌁􀇔􍐜
“Ialready have my dream job,” says Vann
Newkirk, a health policy writer at The
Atlantic. “Everything else is just gravy.”
His pleasure at having had good fortune, however,
reveals little about Newkirk’s serious and grounded
approach to work and life.
Just after completing his Master of Science in Public
Health degree at the Gillings School in 2012, Newkirk
landed a job at the Kaiser Family Foundation, where he
worked as a policy analyst. In that role, he developed
expertise in using quantitative data analysis programs.
He also wrote and presented reports, often about under-served
communities’ barriers to health care.
“The research skills I acquired at the Gillings School
were vital to my success at that job,” he says. “Statistics
programs I used in conducting research, learning how
to write about health policy and making effective class
presentations – all those skills helped me translate my
own quantitative studies into widely-read deliverables
at Kaiser.”
While at Kaiser, he began to write freelance articles
that refl ected his thinking about issues at the intersec-tion
of people and policy – criminal justice, for instance,
and civil rights. Before long, he was offered a job at Daily
Kos, a liberal blog, where he wrote about the Flint, Mich.,
water crisis and other environmental justice issues.
Those articles caught the eye of folks at The Atlantic,
who invited him on board to talk about health reform.
Newkirk credits Gillings School opportunities and
mentors with keeping him grounded during his quick
rise in the world of health-policy writing.
“The Gillings Merit Scholarship was vital,” he says.
“Because I don’t have the burden of paying back student
loans, I can take risks and follow stories that will advance
our understanding of health policy issues. Good people,
like my adviser Chris Shea, were always there for me.
Tom Ricketts pushed me to be a responsible and ethical
researcher. Jeffrey Simms also has been a mentor in my
life, and I always look forward to reunions with him.”
Newkirk says the stories that interest him most
are from people we rarely hear from – the vulnerable
and underserved. He writes about big-picture health
reform, but he wants specifi cally to tell the story of kids
in Alabama who are poisoned by lead paint, Puerto
Ricans who suffer from environmental injustice, dis-abled
patients who can pay for treatments, thanks to
the Affordable Care Act, and a Latina home health aide
trying to survive on minimum wage.
“The guiding principle in my life is to help people
when, where and how I can,” Newkirk says. “Right
now, that involves my telling stories that spotlight
things we’d rather forget. Public health is central to
that principle and is perhaps the purest policy expres-sion
of it. Our duty as humans should be to ensure the
basic welfare and well-being of other humans, and I
will continue writing about and being involved in that
goal as long as there are people who could benefi t from
my speaking out. My interest in health disparities is
the reason I get out of bed in the morning – because
I believe my work can help make the world more
equitable and fair.”
Vann Newkirk is a health policy writer at The Atlantic.
Contributed photo
FA L L 2 0 1 6 | 45
Alison P. Sanders, PhD, is on a mission to
make sure public health researchers also are
skilled communicators.
Sanders, who graduated from the Gillings School in
2013 with a doctoral degree in environmental sciences and
engineering and a minor in epidemiology, has co-authored
numerous research articles on maternal and fetal exposure
to toxic metals. Her work has linked this type of exposure
with birth defects and preterm birth, which are leading
causes of infant mortality in the United States.
“My research investigates the molecular changes and
subsequent health effects caused by developmental
exposure in human populations,” she explains. “These
fi ndings have important implications for public health
and potentially could impact our everyday decisions.”
Sanders’ dedication to excellence in research goes
beyond her own areas of expertise. She is a passionate
advocate for science education and believes academics
should be able to communicate effectively in a wide
range of settings. The ability to bridge research and
communication, she says, is “a skill that is lacking in
the professional development of many scientists.”
After graduation, Sanders became a postdoctoral
fellow in environmental medicine and public health at
the Icahn School of Medicine at Mount Sinai (ISMMS).
Prior to moving to New York City, she also applied to vol-unteer
as a science education fellow with the New York
Academy of Sciences.
Now, she co-directs the graduate-level toxicology
course in ISMMS’ Master of Public Health program
and teaches an after-school environmental health and
nutrition program to fourth- and fi fth-grade students in
East Harlem.
“This was a natural transition between outreach
projects I had enjoyed at the UNC Superfund Re-search
Program and my new life in New York,” Sanders
says. “I saw an opportunity to promote public health,
Dr. Alison Sanders directs a postdoctoral commu-nications
training program at Mount Sinai's Icahn
School of Medicine.
Alison P. Sanders
􀇓􍌁􀇊􌨁􀇂􌈁􀇏􌼁􀇆􌘁􀇉􌤁􀇊􌨁􀇋􌬁􀇓􍌁􀇊􌨁􀇄􌐁􀇗􍜁􀇌􌰠 􀇅􌔁􀇕􍔁􀇏􌼁􀇓􍌁􀇊􌨁􀇕􍔁􀇓􍌁􀇅􌔠 􀇗􍜁􀇊􌨁􀇔􍐠 􀇓􍌁􀇊􌨁􀇑􍄁􀇏􌼁􀇊􌨁􀇓􍌁􀇓􍌁􀇆􌘁􀇏􌼁􀇊􌨁􀇑􍄁
􀇋􌬁􀇗􍜁􀇍􌴁􀇏􌼁􀇊􌨁􀇑􍄠 􀇅􌔁􀇕􍔁􀇏􌼁􀇓􍌁􀇊􌨁􀇕􍔁􀇓􍌠 􀇕􍔁􀇉􌤁􀇋􌬁􀇋􌬁􀇃􌌁􀇊􌨁􀇏􌼁􀇕􍔁􀇗􍜁􀇄􌐁􀇏􌼁􀇉􌤁􀇊􌨠 􀇋􌬁􀇉􌤁􀇆􌘁􀇓􍌠 􀇓􍌁􀇒􍈁􀇒􍈁􀇓􍌁􀇕􍔁􀇄􌐁􀇏􌼁􀇂􌈁􀇓􍍷
work with kids, gain professional experience and
acclimate to the city. It was a win-win that’s been
truly rewarding.”
Inspired by her eager-to-learn students and the
dearth of teaching opportunities at private research
hospitals like ISMMS, Sanders crafted the Future Lead-ers
in Science Education and Communication Training
Program. Her proposal, one of seven selected for fund-ing
by the Burroughs Wellcome Fund in 2015, was the
only submission led by a postdoctoral fellow.
Sanders now directs of the Icahn School’s fi rst-ever
formal teaching training program for postdoctoral fel-lows,
which cultivates principles of teaching and science
communication through in-class training and applied
experiences. Her program has trained more than 25
fellows, all of whom gained hands-on experience in
Sanders’ fi fth-grade classroom before moving on to
graduate-level teaching.
“In this fi rst year, 20 percent of the program’s trainees
have earned promotions or transitioned to new careers
in teaching and communication-related fi elds,” says
Sanders. “As we often say, ‘If you can explain science to
a fi fth-grader, you can explain it to anyone.’”
Contributed photo
46 | C A R O L I N A P U B L I C H E A LT H
Selected Publications
CANCER
Stacie Dusetzina, PhD, assistant
professor of pharmaceutical
outcomes and policy in the UNC
Eshelman School of Pharmacy
and of HPM at the Gillings School,
has written extensively about the
price of and access to cancer drugs.
In an April 28 article in JAMA
Oncology, she found that oral cancer
drugs introduced in 2014 were six
times more expensive than those
introduced in 2000. Dusetzina
presented her research in June to
the President’s Cancer Panel (which
is chaired by Dean Barbara K.
Rimer). In a May 16 article in The
Oncologist, Dusetzina found that a
drug that offered people with liver
cancer a longer life was less effective
in Medicare patients, who likely
had more extensive cancer. In an
Oct. 3 article in Journal of Clinical
Oncology, she and lead author Aaron
Winn, HPM doctoral student,
reported that out-of-pocket costs for
some cancer patients with Medicare
delayed treatment with drugs that
improved survivorship dramatically.
Time interval to starting drug
treatment was shorter for patients
who had subsidies to help cover
drug costs.
Research led by Melissa Troester,
PhD, associate professor of EPI,
published May 4 in npj Breast
Cancer, a Nature partner journal,
identifi ed a particular gene
expression pattern in normal-appearing
breast tissue around
tumors that was linked to lower
10-year survival rates for women
with estrogen receptor-positive
breast cancer. About 70 percent
of breast cancers are estrogen
receptor-positive.
✪ Christine Rini, PhD, research
associate professor, and Yael Symes,
MSPH, doctoral student, both in
HB, found that cancer survivors
with negative attitudes about social
support may have lower quality
of life. Patients in the study who
preferred not to use their social
resources tended to expect low
levels of support and to experience
support as negative. Their study
was published in the June Annals of
Behavioral Medicine.
May - November 2016
SCHOOL NEWS
Read more at sph.unc.edu/news.
Student-led publications are marked with ✪.
Dr. Anne Meyer Dr. Andrew Olshan
Dr. Melissa Troester Aaron Winn
Dr. Stacie Dusetzina
Dr. Bryce Reeve
BIOS
EPI
ESE
HB
HPM
MCH
NUTR
PHLP
Biostatistics
Epidemiology
Environmental Sciences
and Engineering
Health Behavior
Health Policy and Management
Maternal and Child Health
Nutrition
Public Health Leadership Program
KEY TO DEPARTMENTS
Dr. Christine Rini
Dr. Noel Brewer
Dr. Barry Popkin
FA L L 2 0 1 6 | 47
Anne Marie Meyer, PhD, research
assistant professor of EPI, and
Ethan Basch, MD, MSc, professor
of HPM, led a study, published
June 28 in Cancer, reporting
that adults with acute myeloid
leukemia (AML) treated in-hospital
with chemotherapy had a higher
statistical risk of dying from the
disease if they lived in northeastern
N.C., in an area between Wilson
and Roanoke Rapids. No clear
reason for the inequities was
determined, but researchers
thought factors might include less
robust medical infrastructure and
fewer physicians, who were less
experienced in this complex but
urgent diagnosis.
✪ An analysis of the quality of life
of 2,100 breast cancer survivors
in N.C. found differences in how
black and white women functioned
and felt, spiritually and physically,
during treatment and two years
later. Overall, black women
reported better spiritual well-being,
and white women better physical
or functional well-being, both at
diagnosis and throughout the study
period. However, two years out,
more black women reported feeling
better physically, narrowing the
Dr. Leslie Lytle Dr. Lindsey Taillie Dr. Deborah Tate
inequity and suggesting that their
experiences with the health-care
system may have had positive impact
upon their overall health. Published
in the September Breast Cancer
Research and Treatment, the work
was co-authored by Laura Pinheiro,
HPM doctoral candidate, Andrew
Olshan, PhD, Barbara Sorenson
Hulka Distinguished Professor in
Cancer Epidemiology and EPI chair,
Bryce Reeve, PhD, HPM professor,
and others.
A national survey found that parents
were more likely to agree that laws
requiring students to be vaccinated
against HPV for school entry are a
“good idea” when there is an opt-out
clause. Noel Brewer, PhD, professor
of HB, is senior author of the
study, published Aug. 19 in Cancer,
Epidemiology, Biomarkers and
Prevention (CEB&P). Brewer also
worked with lead author Teri Malo,
PhD, postdoctoral fellow at UNC
Lineberger, to fi nd that 65 percent of
parents surveyed would be motivated
to obtain the HPV vaccination for
their children if a physician said, ‘I
strongly believe in the importance
of this cancer-preventing vaccine for
[your child’s name].’ Findings were
published in CEB&P on Sept. 30.
OBESITY
Deborah Tate, PhD, professor of
HB and NUTR, co-authored a JAMA
Internal Medicine study, published
online May 2, fi nding that two
specifi c diet and exercise strategies
prevented weight gain and obesity
among young adults. These included
a daily ‘small changes’ approach and
a periodic ‘large changes’ approach.
Her team found that making a big
change in diet and exercise at the
start of a weight loss program was
slightly more effective at sustaining
weight loss.
Lindsey Smith Taillie, PhD,
research assistant professor
of NUTR, and Barry Popkin,
PhD, W.R. Kenan Distinguished
Professor of NUTR, co-authored
a study of Mexico’s ‘junk food tax,’
fi nding that purchases of taxed
food items declined by more than 5
percent during the fi rst year the tax
was implemented. The study was
published July 5 in PLOS Medicine.
A technology-based intervention
to prevent weight gain among
young adults in community college
effectively reduced consumption
of fast food and improved overall
weight-related behavioral patterns.
Leslie Lytle, PhD, professor and
chair of HB, published fi ndings
June 7 in Preventive Medicine.
48 | C A R O L I N A P U B L I C H E A LT H
ENVIRONMENT
✪ Hang Nguyen, MS, ESE doctoral
student, is fi rst author of a study that
tested a new methodology to examine
the genomic response of lung cells to
real-world mixtures of air pollutants.
Many gases transform after being
released into the atmosphere, and fully
understanding health risks of exposure
requires the study of complex mixtures
of fresh and oxidized gases that cannot
be replicated in the lab. Nguyen's
work was published online Feb. 18 in
Environmental Health Insights.
Stephanie Engel, PhD, associate
professor of EPI, is a member of
Project TENDR, a group of leading
scientists, medical experts and
children’s health advocates who agree
that there is a link between exposures
to toxic chemicals and children’s risks
for neurodevelopmental disorders.
The group’s statement was published
July 1 in Environmental Health
Perspectives.
Dr. Jianwen Cai Dr. Edwin Fisher
Dr. Dilshad Dr. Nora Franceschini Jaff Dr. Lewis Margolis Dr. Kavita Ongechi
Dr. David Couper Dr. Stephanie Engel
CHRONIC DISEASES
In a May 12 article in The New
England Journal of Medicine,
David Couper, PhD, BIOS clinical
professor, found that about half of
smokers have respiratory symptoms
similar to those for chronic
obstructive pulmonary disease
(COPD) -- despite having had tests
that show normal lung function.
The results prompted researchers to
question whether the defi nition of
COPD should include people with
these symptoms.
✪ A systematic review published
in the July American Journal of
Public Health showed that peer
support is an effective strategy for
helping people not easily reached by
conventional prevention and health-care
initiatives. Rebecca Sokol, HB
doctoral student, and Edwin Fisher,
PhD, professor and global director of
Peers for Progress, were co-authors.
GLOBAL HEALTH
Dilshad Jaff, MD, MPH, alumnus
and research adviser in the Gillings
Global Gateway®, Kavita Singh
Ongechi, PhD, research associate
professor of MCH, and Lewis
Margolis, MD, MPH, associate
professor of MCH, co-authored an
article examining the complex and
disturbing pattern of health-care
professionals being targeted in
war zones. The commentary was
published online July 4 in Medicine,
Confl ict and Survival.
A large international collaboration,
led by Nora Franceschini, MD,
MPH, research associate professor
of EPI, and Jianwen Cai, PhD,
Cary C. Boshamer Distinguished
Professor and interim chair of BIOS,
marks the fi rst study of kidney
function involving individuals from
four continents. Published Sept.
1 in American Journal of Human
Genetics, the study reported 20
genetic regions that affect kidney
function and are common across all
ethnic ancestries. A second article,
published Sept. 20 in the Journal of
the American Society of Nephrology,
found that genetic variations specifi c
to African ancestry may increase
kidney disease risk in Hispanic and
Latino populations.
FA L L 2 0 1 6 | 49
Selected Grants
Dr. Michael Kosorok Dr. Dorothy Cilenti Dr. Joseph Ibrahim Dr. David Margolis Dr. Jason Surratt Dr. Barbara Turpin
NATIONAL INSTITUTES
OF HEALTH (NIH)
The NIH and U.S. Department
of Health and Human Services
awarded a $97,956 supplemental
‘Big Data to Knowledge’ (BD2K)
grant to UNC to train 20 predoctoral
students in datacentric, biomedical
science issues. Michael Kosorok,
PhD, W.R. Kenan Distinguished
Professor of BIOS, is co-principal
investigator. Program leaders aim
to prepare trainees to have a career-long
relationship with Big Data,
such that they develop new or apply
current methodologies in a number
of settings.
The National Cancer Institute
renewed grant funding for the
Gillings School’s genomics and
cancer research training program.
Joseph Ibrahim, PhD, Alumni
Distinguished Professor of BIOS and
principal investigator for the training
program, leads 2016-2017 doctoral
student trainees Paloma Hauser,
Ruth Huh, Sean McCabe, Douglas
Wilson and Laura Zhou.
as receiving $58,946,358 in NIH
funding, with 79 total awards.
OTHER FEDERAL AGENCIES
Barbara Turpin, PhD, ESE
professor and chair, will work with
Jason Surratt, PhD, associate
professor of ESE, as investigators
on a three-year, $592,448 grant
from the National Oceanic and
Atmospheric Association. The grant
supports their study of the impact
of biomass burning on air quality
and climate change.
Dorothy Cilenti, DrPH, clinical
assistant professor of MCH and
director of the National Maternal
and Child Health Workforce
Development Center, was awarded
a one-year, $1.74 million cooperative
agreement by the U.S. Division of
Workforce Development to support
workforce development for state
maternal and child health program
leaders and staff members.
The UNC Injury Prevention Research
Center was awarded a four-year,
$1.79 million grant from the Centers
The UNC-based Collaboratory of
AIDS Researchers for Eradication
(CARE) will receive nearly $23
million from NIH over fi ve years
to continue research on their
innovative ‘kick and kill’ strategy
for eradicating HIV. David Margolis,
MD, EPI professor at the Gillings
School and professor in the UNC
School of Medicine, is CARE’s
principal investigator.
Andrew Nobel, PhD, BIOS
professor, and Fred Wright, PhD,
adjunct BIOS professor, are principal
investigators for a three-year, $1.2
million National Human Genome
Research Institute grant to address
statistical challenges that arise in
the analysis of next-generation
expression quantitative trait loci
(eQTL) studies. In such studies, the
goal is to identify and quantify how
known genetic variants regulate gene
expression across multiple tissues.
In fi scal year 2015, the Gillings
School was the top public school
of public health in terms of NIH
funding for the third consecutive
year. NIH data listed the School
Dr. Greg Allgood Dr. Jamie Bartram Dr. Jennifer Smith
for Disease Control and Prevention
to examine the impact of a rape-prevention
education program
called ‘Wise Guys: The Next Level.’
Beth Moracco, PhD, research
associate professor of HB, will co-lead
the evaluation.
The World Health Organization
Collaborating Center for
Research Evidence for Sexual and
Reproductive Health, based in MCH,
was awarded a multimillion-dollar,
up-to-four-year grant from the U.S.
Department of Health and Human
Services for work in implementation
science. The Collaborating Center
and JSI Research and Training
Institute Inc. jointly will serve as
the new Family Planning National
Training Center for Service Delivery
Improvement. The Collaborating
Center’s subcontract award is for
about $1.5 million per year to fund
the new family planning center’s
implementation and improvement
activities and assure that its activities
are based upon the best science.
Herbert Peterson, MD, W.R.
Kenan Jr. Distinguished Professor
of MCH and director of the WHO
Collaborating Center, will chair
the new Family Planning Center’s
leadership council.
50 | C A R O L I N A P U B L I C H E A LT H
Dr. Beth Moracco Dr. Herbert Peterson
GATES FOUNDATION
Jennifer Smith, PhD, associate
professor of EPI and director of the
Cervical Cancer-Free Coalition at
the Gillings School, is a principal
investigator for a Grand Challenges
Explorations Grant, an initiative
funded by the Bill & Melinda Gates
Foundation. Smith’s $100,000
grant will allow her to work with
researchers at Duke University
and in Brazil to determine the
effectiveness of a urine-based,
cervical cancer screening tool.
OTHER SOURCES
A six-year, $2.9M grant from World
Vision to The Water Institute at
UNC creates a partnership to
improve water, sanitation and
hygiene interventions in several low-and
middle-income countries, with
the goal of solving the global water
and sanitation crises by 2030. Jamie
Bartram, PhD, Water Institute
director, leads the work at the
Institute. Greg Allgood, PhD,
ESE alumnus, is World Vision’s
vice president.
Emma Allott, PhD, research assistant
professor of NUTR, received the
Professor John Fitzpatrick Research
Fellowship, a three-year grant award
valued at $228,000 to investigate the
role of cholesterol in prostate cancer.
The N.C. Institute for Public Health
was awarded a $192,265 grant from the
Kate B. Reynolds Charitable Trust. The
funding will enable N.C.’s Edgecombe
and Nash counties to use data analysis
and visualization to enhance public
health programs, reduce duplicate
efforts and more effi ciently serve their
populations. Amy Belfl ower Thomas,
MHA, MSPH, will administer the two-year
grant.
@UNCpublichealth
Dr. Carolyn Halpern
Dr. Victor Schoenbach
May - November 2016
AWARDS &
RECOGNITIONS
Read more at sph.unc.edu/news.
INTERNATIONAL
Barry Popkin, PhD, W.R. Kenan
Jr. Distinguished Professor of
NUTR, received the World Obesity
Federation’s 2016 Population
Science and Public Health Award
and presented a plenary talk at
the Federation’s 13th International
Congress on Obesity, held in
Vancouver, B.C., on May 4.
Wizdom Powell, PhD, associate
professor of HB, was awarded
a residency at the Rockefeller
Foundation’s Bellagio Center, in
Bellagio, Italy, to further research
about gendered health inequities
among boys and men of color.
She also was one of 21 health-care
professionals chosen for the two-year
Aspen Institute Health Innovator
Fellowship. In September, Powell
was named research associate
professor of social medicine and
associate director of the UNC
Department of Social Medicine’s
Center for Health Equity Research.
Andrew Olshan, PhD, Barbara
Sorenson Hulka Distinguished
Professor in Cancer Epidemiology
and EPI chair, was elected president
of the Society for Epidemiologic
Research (SER). SER is the oldest
and largest general epidemiology
society in North America.
Xianming Tan, PhD, research
associate professor of BIOS, received
the Statistical Society of Canada’s
Canadian Journal of Statistics
Award for a paper published online
in the journal Oct. 20, 2015.
NATIONAL
Mark Sobsey, PhD, Kenan
Distinguished Professor of ESE,
was awarded the National Water
Research Institute’s prestigious
Athalie Richardson Irvine Clarke
Prize for excellence in water
research.
Penny Gordon-Larsen, PhD,
NUTR professor, was selected to
chair the National Institutes of
Health’s Kidney, Nutrition, Obesity
and Diabetes study section.
BIOS
EPI
ESE
HB
HPM
MCH
NUTR
PHLP
Biostatistics
Epidemiology
Environmental Sciences
and Engineering
Health Behavior
Health Policy and Management
Maternal and Child Health
Nutrition
Public Health Leadership Program
KEY TO DEPARTMENTS
Dr. Brian Pence Dr. Wizdom Powell Dr. Mark Sobsey
Dr. Eugenia Eng Dr. Mark Holmes
FA L L 2 0 1 6 | 51
Dr. P. Gordon-Larsen
Victor Schoenbach, PhD, associate
professor of EPI, won the Abraham
Lilienfeld Award, given by the
American Public Health Association’s
epidemiology section, for excellence in
teaching epidemiology over the course
of a career.
May Chen, MSPH, doctoral student,
is one of 22 U.S. students named
as Point Foundation Scholars. The
Foundation is the largest scholarship-granting
organization for LGBTQ
students. Chen’s research examines
the causes and consequences of
interpersonal violence, with a focus on
developing prevention programs for
vulnerable youth.
UNC-CHAPEL HILL
Alexandra Lightfoot, EdD, research
assistant professor of HB, is one of
10 UNC faculty members selected
for the sixth class of Thorp Faculty
Engaged Scholars. Lightfoot, who
uses a community-based participatory
research approach to address health
inequities in N.C. communities, will
use the two-year award to collaborate
on research about adolescents and
racial inequities.
Mark Holmes, PhD, associate
professor and associate chair for
research in HPM, was named director
of UNC’s Cecil G. Sheps Center for
Health Services Research, one of the
oldest and largest academic health
services research centers in the U.S.
52 | C A R O L I N A P U B L I C H E A LT H
GILLINGS SCHOOL
Barbara Turpin, PhD, professor of
ESE, was named ESE chair, effective
Sept. 1.
Jianwen Cai, PhD, professor of
BIOS, became interim chair of the
department in May, as Michael
Kosorok, PhD, W.R. Kenan Jr.
Distinguished Professor and
chair, began a one-year leave to
accelerate his research.
Catherine Sullivan, MPH, RD,
LDN, was named director of the
Gillings School’s Carolina Global
Breastfeeding Institute in October,
succeeding founding director, the late
Dr. Miriam Labbok. Sullivan also was
elected in July to the board of the U.S.
Breastfeeding Committee.
Ding-Geng (Din) Chen, PhD,
clinical professor of BIOS at the
Gillings School and Wallace H. Kuralt
Distinguished Professor in the UNC
School of Social Work, was named
a fellow of the American Statistical
Association. No more than one-third
of 1 percent of the ASA membership
may be designated as fellows.
Courtney Luecking, NUTR doctoral
student, won the North Carolina
Dietetics Association’s (NCDA)
Emerging Dietetic Leader Award for
2015-2016.
Sixteen students were selected as
2016-2017 recipients of Gillings Merit
Scholarships or Gillings Dissertation
Awards. They are Herodes
Guzman, Audra Reiter, Erin
Frey, DVM, and Christina Palazzo
(PHLP); Marwa Elnagheeb and
Alexandria Sanchez (MCH);
Christine Walsh and Blythe
Rhodes (HB); Cassandra Johnson,
MSPH, Deanne ‘Rose’ Ewald and
Yiqing Wang (NUTR); Corinne
Wiesner (ESE); Jennifer Stutsman
(HPM); Sydney Jones and Rae
Anne Martinez (EPI); and Gilson
Honvoh (BIOS).
Carolyn Halpern, PhD, professor
and chair of MCH, and Brian
Pence, PhD, associate professor
of EPI, were honored for their
teaching and mentorship at
the Gillings School’s May 7
commencement. Halpern was
presented with the John E. Larsh
Award for Mentorship, and Pence
received the McGavran Award for
Excellence in Teaching.
Eugenia Eng, DrPH, alumna and
HB professor, accepted the Edward
Kidder Graham Faculty Service
Award, which recognizes a faculty
member's outstanding service to the
University, state and nation, during
University Day ceremonies on Oct.
11. A trailblazer in community-engaged
scholarship, Eng refi ned
the innovative lay health adviser
intervention model, an approach that
builds on the social support function
of social networks in communities.
in MEMORIAM
FA L L 2 0 1 6 | 53
Miriam Harriet Labbok, MD, MPH, IBCLC, staunch crusader
for the health of women and infants and longtime advocate for
the health benefi ts of breastfeeding, passed away on Aug. 13 after
a courageous battle with cancer. From 2006 to 2016, she was
Professor of the Practice of MCH and founding director of the
Gillings School’s Carolina Global Breastfeeding Institute.
“Miriam was a tireless advocate for women’s, children’s and
families’ health – here and the world over,” said Herbert Peterson,
MD, W.R. Kenan Distinguished Professor of MCH, and of
obstetrics and gynecology in the UNC School of Medicine. “Her
commitment to breastfeeding was unsurpassed, as was her
devotion to those we serve.”
Steven Bennett Wing, PhD, activist for environmental justice and
advocate for human rights, mentor and friend to many, died Nov. 9,
of cancer. He was 64. An associate professor of EPI, he joined the
Gillings School faculty in 1985 after completing his doctorate at UNC.
His long list of honors refl ected the social causes for which he worked
so diligently and his devotion to teaching and mentoring students.
“Steve was a hero to many in the Gillings School and the broader
world of environmental scientists, advocates, activists, policy makers
and community members in N.C. and beyond,” said Andrew Olshan,
PhD, Barbara S. Hulka Distinguished Professor and chair of the
School’s EPI department. “He will be remembered for his unyielding
commitment to social justice and for his kindness and caring nature
with everyone.”
Harrison C. Spencer, MD, MPH, president and chief executive offi cer of the Association of Schools and Programs of
Public Health, died Aug. 10, a victim of violence. He was 71.
“Harrison was an ardent champion of public health — and all of us in the profession,” said Barbara K. Rimer, DrPH,
dean of the Gillings School. “A highly accomplished physician and epidemiologist who led two schools of public health
before taking the leadership role at ASPPH, he navigated the challenges of bringing the schools and programs of public
health together — a brilliant move.”
Saye Baawo, MD, MSPH, alumnus and assistant minister for curative services in Liberia’s Ministry of Health and
Social Welfare, died June 17 at age 50, of cancer. Baawo generously offered his time and energy as a mentor in the
Gillings Global Gateway®.
Dr. Miriam Labbok
Dr. Steven Wing
Photo by Donn Young Photo by Brian Strickland
U.S. President James K. Polk. Thirteen Pulitzer Prize
winners, numerous lawyers, statesmen, artists. Journalists
David Brinkley, Charles Kuralt and Stuart Scott. Actors
Andy Griffi th and Billy Crudup. Michael Jordan.
Paula Brown Stafford, MPH, is in good company
among the best of The University of North Carolina at
Chapel Hill’s successful alumni. UNC made it offi cial on
Oct. 11, the day before the university’s 223rd birthday,
by presenting Stafford with its University Distinguished
Alumna award.
“It is a tremendous honor to be recognized by UNC in
this way,” Brown Stafford says. “I am a Tar Heel born, a Tar
Heel bred, and a Tar Heel for life!”
Stafford, who earned Bachelor of Science in Public
Health and Master of Public Health degrees in
biostatistics from UNC’s Gillings School of Global Public
Health, is former president of clinical development at
Quintiles, a Fortune 500 company that is the world’s
largest provider of biopharmaceutical development and
commercial outsourcing services. She lends support to the
Gillings School in several capacities, including serving as
an adjunct professor, member and past president of the
School’s Public Health Foundation board, and loyal
donor and friend.
When Stafford joined Quintiles in 1985, she was only
the 23rd employee of the fl edgling company, which now
has more than 36,000 employees conducting business
in 100 countries. During her 30-year career there, she
was involved directly in the development and regulatory
approval of hundreds of life-changing drug therapies for
patients in North Carolina and throughout the world.
Personally, one of the most important was her fi rst
beginning-to-end clinical trial, in which she oversaw
the development of a diabetes drug that allowed her
grandmother to live well into her 90s by managing the
chronic disease. More than 30 million adults in the U.S.
are affected with diabetes.
As a recognized leader in biopharmaceutical
development, she was invited in 2014 to provide
expert testimony to a Congressional committee about
modernizing clinical trials. She spoke of three key areas of
drug development – patients, pathways and processes –
and the need to accelerate the delivery of therapies
to patients.
“Modernizing clinical trials is critical,” she said in
the testimony, “if we are to meet the goals we share of
delivering medicines faster and at less cost to patients
who need them.”
Since her retirement from Quintiles in 2015, Stafford
provides leadership consulting services to various
organizations, serves on the board of Health Decisions, a
Durham, N.C.-based contract research organization, and
enjoys the company of husband Greg and their two
grown children.
“My degrees from the Gillings School provided me with
the education and experience to be a partner in bringing
new medicines to markets around the world, improving
and saving lives,” she says. “I have been blessed with
wonderful professors, colleagues and family who have
supported me along the way.”
Paula Brown Stafford
Our distinguished alumna —
Alumni, share your success stories! Email us at
sphalumniandfriends@unc.edu.
Paula Brown Staff ord
54 | C A R O L I N A P U B L I C H E A LT H
Contributed photo
Your challenge [as public health
graduates] will be to make public
health the management leader
by using evidence to establish
health policy and decision making
for consequential problems,
nationally and globally, and also
at state and local levels. Let us
change the public discourse
on health care from a political
blame-game to an evidence-based
discussion about what works.
Thank you,
Dr. Gillings, for
an inspiring
commencement
address! "
— Dennis Gillings, PhD, CBE
May 7, 2016
FA L L 2 0 1 6 | 55
Photos by Brian Strickland
56 | C A R O L I N A P U B L I C H E A LT H
Gillings School alumna Amanda Adler,
MD, PhD, is chair of a multidisciplinary
technology appraisal committee at the
National Institute for Health Excellence
(NICE) in London and consultant physician
at Addenbrooke’s Hospital in Cambridge
(U.K.). Adler spoke recently with Crystal
Hinson Miller, MA, CFRE, associate dean
for advancement at the Gillings School.
Crystal Miller (CM):
Tell us about your journey from California to
Chapel Hill to the United Kingdom. You keep
traveling eastward!
Amanda Adler (AA):
I was born and raised in Santa Monica, a product of
the public schools there, which are excellent. When I
was seven, my father, who was working in the movie
industry, announced the family was moving to Tokyo
for a year – so I’ve been even farther east! That year
was formative in my life. It was then I decided I
wanted an international career.
As I grew older, I focused on international health as
a career path. I studied economics as an undergraduate
because of an internship at the World Health Organiza-tion’s
water sanitation and supply department. I came
to appreciate that health resources were limited and had
to be used wisely. After the internship, I came back to
the University of California and earned a degree in eco-nomics,
already knowing I wanted to go both to medical
school and public health school.
People in Santa Monica were skeptical that I would
be admitted to UNC, but I persisted. I learned about
the MD/PhD program, and that’s what I knew I wanted.
Since I’d always loved learning about epidemics, I knew
epidemiology would be the thing for me.
Getting to the U.K. was a serendipitous journey. After my
internship and residency at the University of Washington
at Seattle and a fellowship at the Fred Hutchinson Cancer
Research Institute, I went to Britain, single and eager, and
physically carried my CV to Oxford. It worked. They asked
me to interview the next day, and the following week, I was
a faculty member.
I was attracted to the British style of research. In the
U.K., as you know, people pay for health care through
their taxes, and they’re very keen on paying only for
things that work. The chronic disease clinical trials were
pragmatic, addressing both simple and very important
questions. For instance, in Type 2 diabetes, does lowering
blood sugar lower risk for problems related to diabetes?
I was hired as the epidemiologist for that trial (the U.K.
Prospective Diabetes Study), and essentially, I think I’ve
decided to stay, particularly since I met my husband here.
A Conversation
with Dr. Amanda Adler
Keep your standards high – and then go for it!
Dr. Amanda Adler
Contributed photo
FA L L 2 0 1 6 | 57
CM:
What do you remember about your time at UNC’s School
of Public Health? How did your epidemiology training
help you solve real-world problems?
AA:
I remember that it was rigorous. Very high standards.
Knowing now what the British educational system is
like, I appreciate that I was able to take classes at UNC.
A British doctorate doesn’t require any coursework; one
just takes off and does a project on one’s own. Now, I
appreciate having studied subjects that I wouldn’t have
necessarily chosen for myself – such as biostatistics. It’s
unbelievably important in all my work.
My current role at the National Institute for Health
Excellence (NICE) certainly contributes to public
health by bringing together medicine and epidemiology.
Britain has generous, if limited, funding for health, and
health care is free. The government has the motivation
and moral responsibility to spend its health-care tax
money wisely. We look at new drugs, new technologies
and new educational systems, and we evaluate how
likely they are to help the population and what the costs
are. We look not just at the price of drugs, but the costs
over a lifetime that might result as a consequence of
adopting a new drug into the health-care system.
That is one example of applying what I learned
at UNC. Another is the notion that conducting very
practical clinical trials can translate to patient benefi t.
CM:
While you were at UNC, did you take advantage of any
opportunities unique to the public health school?
AA:
I was awarded a scholarship for the MD/PhD program.
That certainly inspired me to train longer than I might
have. It also meant I was essentially debt-free when
I graduated, which allowed me to take advantage of
opportunities I couldn’t have otherwise. I was aware that it
was a gift to have the Research Triangle Park nearby, with
agencies such as the National Institute of Environmental
Health Sciences (NIEHS) and companies such as
Quintiles and GSK. Being trained in medicine, I was able
to connect with other physicians who were interested
in clinical epidemiology, which led to some wonderful
discussions. The proximity of UNC’s medical school to the
public health school shouldn’t be underestimated, either.
That physical closeness facilitates great collaborations.
CM:
What advice would you give current students at the
Gillings School?
AA:
• Change can occur in public health; always be open-minded
to the change you can bring about.
• Don’t hold yourself back. If you aspire for things, the
worst that can happen is that you won’t get them –
that’s still much better than not having tried.
• Always ask the ‘so what?’ questions for projects you
take on. Will the answers contribute to bettering
society and bettering yourself, in terms of return on
investment of time and energy? Keep your standards
high – and then go for it!
• Share the spotlight! Always give your colleagues credit
on joint projects.
Don’t hold yourself back. If you aspire for things, the worst that
can happen is that you won’t get them – that’s still much better
than not having tried.
— Dr. Amanda Adler
"
Adler earned a medical degree at UNC in 1988 and a doctorate in epidemiology in 1992. She enjoys tennis and
swimming, opera and travel, and is inspired by her 94-year-old parents.
58 | C A R O L I N A P U B L I C H E A LT H
Her mother’s career – as a pediatrician, toxicologist,
nephrologist and national expert on heavy metals and
other toxins – was an inspiration to Marcia Angle.
Not only was her mom, Dr. Carol Remmer Angle, a
successful scientist in an era when women rarely were
– but she chose to focus her knowledge and experience
upon solving problems that particularly affected
children and their families.
Marcia Angle became a physician, too. As a young
practitioner wanting to refi ne her work with children and
families, she enrolled at UNC-Chapel Hill for a Master of
Public Health degree in maternal and child health. That
training made a remarkable difference in her life.
“It opened the doors to my 20-year career in global
health [at IntraHealth] and to my responsibilities as
medical director at the Orange County (N.C.) Health
Department,” she says.
Years later, in 2003, Marcia and her mother decided
to establish a lasting tribute to her mother's career,
which had inspired Marcia's own life. The tribute took
the form of a professorship at her alma mater – the
Carol Remmer Angle Distinguished Professorship of
Children’s Environmental Health at the UNC Gillings
School of Global Public Health.
“Children, especially young ones, are particularly
vulnerable to environmental toxins because their
neurologic and metabolic systems are still developing,”
Marcia Angle says. “That’s why we wanted to support
research in this area. Recent studies suggest that
antenatal environmental exposures can trigger
potentially harmful changes in fetal cells, which even
can be passed on generationally. Because we are all
ingesting, breathing and even bathing our infants in
‘chemical soup,’ we are obligated to examine which
Marcia Angle, MD, MPH –
A mother-daughter gift helps improve the lives of children everywhere
(Left): Dr. Amy Herring is the second recipient of the Carol Remmer Angle Distinguished Professorship. (Right): Dr. Carol Angle
(left) and Dr. Marcia Angle (right) established the professorship.
Photo by Tom Fuldner
Contributed photo
FA L L 2 0 1 6 | 59
toxins cause particular diseases – an inquiry that will
benefi t children and public health, in general.”
Two Gillings School faculty members have held the
Angle professorship – Jonathan Kotch, MD, MPH,
professor emeritus and former chair of maternal and
child health (see tinyurl.com/kotch-named-angle-prof)
and, beginning in 2015, Amy Herring, ScD, professor
and associate chair of biostatistics at the School.
Kotch, who joined the UNC public health faculty
in 1978, has a long histor