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FAL L 2 0 1 0 VOLUME 1 · NUMBER 9 Jack E. Wilson, PE, MSENV President Member of the Board of Directors TEC Inc. Delton Atkinson, MPH, MPH, PMP Vice President Deputy Director Division of Vital Statistics National Center for Health Statistics Centers for Disease Control and Prevention Barbara K. Rimer, DrPH Executive Vice President Ex Officio Dean Alumni Distinguished Professor UNC Gillings School of Global Public Health Peggy Dean Glenn Executive Director/Secretary Ex Officio Associate Dean for External Affairs UNC Gillings School of Global Public Health Charlotte Nuñez-Wolff, EdD Treasurer Ex Officio Associate Dean for Business and Finance UNC Gillings School of Global Public Health Julie MacMillan, MPH Member Ex Officio Interim Senior Associate Dean UNC Gillings School of Global Public Health David J. Ballard, MD, MSPH, PhD, FACP Senior Vice President and Chief Quality Officer Baylor Health Care System Executive Director and BHCS Endowed Chair Institute for Health Care Research and Improvement Andrea Bazán, MPH, MSW President Triangle Community Foundation Fred T. Brown Jr., MPH, FACHE Group Senior Vice President Eastern Division Carolinas HealthCare System Kelly B. Browning, MA Executive Vice President American Institute for Cancer Research P. LaMont Bryant, PhD, RAC Manager, Regulatory Affairs Ethicon Endo-Surgery/Johnson & Johnson Cynthia H. Cassell, PhD Health Scientist, Epidemiology Team Birth Defects Branch Division of Birth Defects and Developmental Disabilities National Center for Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Deniese M. Chaney, MPH Partner Accenture Health and Life Sciences Stacy-Ann Christian, JD, MPH Senior Director Research Administration New York City Health and Hospital Corp. Michael (Trey) A. Crabb III, MHA, MBA President Health Strategy Partners LLC Leah Devlin, DDS, MPH Gillings Visiting Professor UNC Gillings School of Global Public Health Cynthia J. Girman, DrPH Senior Director, Department of Epidemiology Merck Research Laboratories Sandra W. Green, MBA, MHA, BSPH President East Coast Customer Management Group MedAssets Inc. C. David Hardison, PhD Corporate Vice President, Life Sciences Science Applications International Corp. Deborah Parham Hopson, PhD, RN Assistant Surgeon General Associate Administrator HIV/AIDS Bureau Health Resources and Services Administration Joan C. Huntley, PhD, MPH Adjunct Professor of Epidemiology UNC Gillings School of Global Public Health Joseph F. John, MHA, FACHE Administrator Clinical Operations The Emory Clinic Inc. Mark H. Merrill, MSPH President and Chief Executive Officer Valley Health System Stephen A. Morse, MSPH, PhD Associate Director for Environmental Microbiology National Center for the Prevention, Detection and Control of Infectious Diseases Centers for Disease Control and Prevention Douglas M. Owen, PE, BCEE Vice President Malcolm Pirnie Inc. Jonathan J. Pullin, MS President and Chief Executive Officer The Environmental Group of the Carolinas Inc. Roy J. Ramthun, MSPH President HSA Consulting Services LLC Laura Helms Reece, DrPH Chief Operating Officer Rho James Rosen, MBA, MSPH Partner Intersouth Partners Jacqueline vdH Sergent, MPH, RD, LDN Health Promotion Coordinator/ Health Education Supervisor Granville-Vance (N.C.) District Health Department Ilene C. Siegler, PhD, MPH Professor of Medical Psychology Duke University Jeffrey B. Smith, MHA, CPA Partner Ernst & Young LLP Paula Brown Stafford, MPH Executive Vice President Integrated Clinical Services Quintiles John C. Triplett, MD, MPH Regional Medical Officer Bethesda, Md. G. Robert Weedon, DVM, MPH Veterinary Outreach Coordinator Alliance for Rabies Control Adjunct Faculty UNC-Wilmington Veterinarian New Hanover Co. (N.C.) Board of Health Alice D. White, PhD Vice President 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 Joan H. Gillings CHAIR, ADVANCEMENT Donald A. Holzworth, MS Chair Chairman Futures Group International James Rosen, MBA, MSPH Public Health Foundation Board Liaison to Advisory Council Partner Intersouth Partners Marcia A. Angle, MD, MPH Adjunct Professor Nicholas School of the Environment Duke University William K. Atkinson, PhD, MPH President and Chief Executive Officer WakeMed Joseph Carsanaro, MBA, MSEE General Manager Pinehurst Advisors LLC Gail H. Cassell, PhD, DSc (hon) Vice President, Scientific Affairs Distinguished Lilly Research Scholar for Infectious Diseases Eli Lilly and Co. Willard Cates Jr., MD, MPH President, Research Family Health International Keith Crisco, MBA Secretary of Commerce State of North Carolina Ken Eudy Chief Executive Officer Capstrat Robert J. Greczyn Jr., MPH CEO Emeritus BlueCross and BlueShield of N.C. Gillings Visiting Professor UNC Gillings School of Global Public Health James R. Hendricks Jr., MS Vice President, Environment, Health and Safety (Retired) Duke Energy J. Douglas Holladay, MDiv Chairman and Chief Executive Officer PathNorth A. Dennis McBride, MD, MPH Health Director City of Milford (Conn.) John McConnell Chief Executive Officer McConnell Golf Jesse Milan Jr., JD Vice President and Director Community Health Systems Altarum Institute Guy Miller, MD, PhD Chairman and Chief Executive Officer Edison Pharmaceuticals Inc. James Patrick O’Connell, PhD, MPH Chief Executive Officer Acea Biosciences Inc. Jane Smith Patterson Executive Director The e-NC Authority Virginia B. Sall Co-founder and Director Sall Family Foundation Charles A. Sanders, MD Chairman and Chief Executive Officer (Retired) Glaxo Inc. Paul M. Wiles, MHA President and Chief Executive Officer Novant Health Inc. Markus Wilhelm Chief Executive Officer Strata Solar LLC Derek Winstanly, MBChB Executive Vice President Strategic Business Partnerships and Customer Relationships Quintiles Louise Winstanly, LLB, MSB Attorney and Medical Ethicist Chapel Hill, N.C. Lloyd M. Yates, MBA President and Chief Executive Officer Progress Energy MEMBERS EMERITI Nancy A. Dreyer, PhD, MPH Chief of Scientific Affairs OUTCOME Carmen Hooker Odom, MS President Milbank Memorial Fund UNC Gillings School of Global Public Health ADVISORY COUNCIL C A R O L I N A P U B L I C H E A L T H | 1 contents fall 2010 3 FROM THE DEAN’S DESK Let’s get moving! 4 FIT AND HEALTHY FOR A LIFETIME UNC public health faculty, students and alumni discover ways to trim down the obesity epidemic. 6 A HEALTHY START TO LIFE For 30 years, the number of overweight children has crept higher. Establishing good health habits early can reverse this trend and help children lead healthy lives. 9 NAP SACC – HELPING CHILD CARE CENTERS IMPROVE PRESCHOOLERS’ HEALTH This NIH-funded intervention helps child care centers in North Carolina boost food quality and improve opportunities for physical activity for preschoolers. 10 ADOLESCENCE – A TIME TO GROW UP FIT FOR LIFE Adolescence is a time of dramatic physical and emotional changes. It’s also a time when many young people gain weight as their exercise levels and appetites change. 13 EAT YOUR FRUITS AND VEGETABLES – MANGA COMICS GET THE MESSAGE ACROSS TO KIDS Alumna May May Leung uses Japanese comic art to promote positive health behaviors in youth. 14 FAT GENES School researchers identify the genes that affect body weight. 15 LIVING HEALTHY – HOW ADULTS CAN MAINTAIN OR LOSE WEIGHT As we ‘settle down,’ adults are at risk for weight gain and illness, including cardiovascular disease and diabetes. 17 IS PERCEIVED RACISM A RISK FACTOR FOR OBESITY? Dr. Anissa Vines suggests that an emotional response to racism is stress, which increases belly fat. 18 FOR WEIGHT LOSS, WORKING TOGETHER IS OFTEN THE BEST APPROACH Researchers engage churches, community groups and others in programs to improve health and avoid obesity-related illness. features & news continued 8 6 15 10 18 4 2 | FA L L 2 0 1 0 THE WORLD IS FAT Across North Carolina and around the world, we investigate why obesity rates have ballooned, how the phenomenon affects health and what to do about it. 21 ACTIVE LIVING BY DESIGN With an initial Robert Wood Johnson Foundation investment in 2001, ALBD began working within communities to solve infrastructure challenges around physical activity and healthy eating. 25 SCHOOL NEWS 28 AWARDS AND RECOGNITIONS 31 HONOR ROLL 33 ROSENAU SOCIETY 34 DR. MICHAEL KAFRISSEN 37 MATHILE INSTITUTE 38 BILL AND ROSA SMALL 39 MABEL JOHANSSON 41 CHILDFUND INTERNATIONAL 42 ANNUAL FUND SCHOLARS 44 THE COCA-COLA COMPANY contents, continued 31 fall 2010 DEAN Barbara K. Rimer, DrPH DIRECTOR OF COMMUNICATIONS MANAGING EDITOR Ramona DuBose EDITOR Linda Kastleman ASSOCIATE DEAN FOR EXTERNAL AFFAIRS Peggy Dean Glenn DESIGN AND PRODUCTION Amanda Zettervall UNC Design Services CONTRIBUTING WRITERS Ramona DuBose, Whitney L.J. Howell, Linda Kastleman, Kathleen Kearns, Michele Lynn, Chris Perry, Susan Shackelford, Angela Spivey, Bobbi Wallace COVER ILLUSTRATION John Roman Articles appearing in Carolina Public Health may be reprinted with permission from the editor. Send correspondence to Editor, Carolina Public Health, Gillings School of Global Public Health, Campus Box 7400, Chapel Hill, NC 27599-7400, or e-mail sphcomm@listserv.unc.edu. SUBSCRIBE TO CAROLINA PUBLIC HEALTH www.sph.unc.edu/cph 18,000 copies of this document were printed at a cost of $17,021.35 or $0.95 per copy. 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. 1, No. 9, Fall 2010. our donors gatefold 25 gatefold HONOR ROLL SCHOOL NEWS C A R O L I N A P U B L I C H E A L T H | 3 In 1980, about 15 percent of Americans were obese; today, about 34 percent are, and another third are overweight. Since 1980, the proportion of children ages 2 to 19 who are obese has tripled. How did we gain all this weight? Our genes did not change that fast! Most experts agree that there are several key reasons: we are eating about 300 more calories every day than we did in 1985, our portion sizes have increased dramatically, we’re drinking more sugary drinks, and the majority of us are getting less exercise. Most children no longer have regular gym classes, and they are more likely to be on computers and smart phones after school than outside playing. Many neighborhoods lack safe places to walk. Sixty percent of adults don’t get enough exercise to achieve health benefits. The tab for our extra pounds is at least $147 billion a year. Obese people spend 43 percent more on health care costs than do healthy-weight people. As you will read in this issue, faculty members in our Department of Nutrition and across the School have made fundamental contributions to under-standing the science of nutrition, determining why some people are more prone to gaining weight than others, explaining the worldwide distribution of obesity and its predictors, and developing, testing and disseminating evidence-based interventions and policies to reduce obesity and prevent weight gain in a variety of populations in the U.S. and elsewhere. As with other health problems, some minorities and disadvantaged populations bear a disproportionate share of the burden. Nutrition research must be done in labs, clin-ics, communities and workplaces, with individuals and in larger units. It is a complex problem with no “magic bullet” solution. As we have learned from the smoking arena, it won’t be sufficient to inter-vene only with individuals. Policies should require physical education in schools and limit sugary drinks. Worksite cafeterias should charge more for less healthy than healthy foods. Health plans should provide incentives for healthy weight and exercise. And that’s just a beginning. At the School, we’ve taken steps beyond our outstanding research, such as trying to increase the choices of healthier foods in our café, serving healthier foods at events, buying local foods wher-ever possible and reducing portion sizes. Ultimately, we’re also role models for one another and the larger community. We should more actively encourage our faculty, staff and students to exercise and eat healthily, and reach out to the community around us. We imagine a time when our grounds could be turned into great walking trails with water sculptures and informative trail markers, and we could become not just a center for knowledge dis-covery and dissemination but a center for activity. Let’s get moving! Let’s Get Moving! Obesity is a major economic and health threat in North Carolina, the U.S. and around the world. The fact that obesity is spreading in an almost epidemic manner means that some countries still could intervene before it is too late – just as some countries woke up to the potential for intervention on tobacco, before high smoking rates had overtaken their populations. We are at an important tipping point on obesity, both in the U.S. and globally. Dr. Barbara K. Rimer from the Dean’s desk PHOTO BY L ISA MARIE ALBERT We are at an important tipping point on obesity, both in the U.S. and globally. 4 | F A L L 2 0 1 0 Fit and healthy for a lifetime Her mother cringes, hearing echoes of the taunts from her own childhood. She wants to spare her daughter the low energy and poor self-esteem that she endures as an obese adult. Even more, she doesn’t want her daughter to face the same high risk of disease. But her mind races to statistics she’s read, compiled by the Robert Wood Johnson Foundation (www.rwjf.org) and the Trust for America’s Health (http://healthyamericans. org). In 2010, more than 25 percent of adults in 38 states are obese. (Just 10 years ago, no state had an obesity rate above 20 percent.) More than 12 million American children, ages 10 to 17, are obese. Her crisis – her daughter’s crisis – has become epidemic. These days, many agents – from First Lady Michelle Obama to the Centers for Disease Control and Prevention, from insurance companies to school nutrition counselors – seek ways to control the crisis. Mrs. Obama’s initiative, “Let’s Move” (www.letsmove.gov), has the audacious goal of solving the obesity epidemic in one generation. “[Obesity] is a major public health threat right now,” she said, announcing the program, “so just imag-ine what we’re going to be facing in 20 or 30 years if we don’t get on this issue.” The American Institute for Cancer Research (AICR) reports that excess body fat causes approximately 103,000 cases of cancer in the United States every year. “Many people are aware of the role of obesity when it comes to increasing the risk of cardiovascular disease and type 2 diabetes,” says Kelly B. Browning, AICR executive vice presi-dent and member of the School’s Public Health Foundation board of directors, “and we at AICR want to make sure people know that excess body fat also increases the risk for cancer.” For more than three decades, the UNC Gillings School of Global Public Health has been a recognized world leader in discover-ing evidence-based, creative and sustain-able ways to prevent obesity and to help people lose weight. Mrs. Obama cited UNC’s NAP SACC program (see page 9), aimed at improving nutrition and increasing exercise in child care centers throughout North Caro-lina, as an example of a creative, successful intervention. “We have a world that consumes more satu-rated fat and more meat and dairy products than we could have imagined 10 to 20 years ago,” says Barry Popkin, PhD, Carla Smith Chamblee Distinguished Professor of Global Nutrition at UNC Gillings School of Global Public Health. “Even in developing countries now, there are more obese people than there are hungry people.” Popkin is one of several School researchers advocating for policy changes at local, state, national and international levels that would help modify behavior, including a call for higher taxes on sugar-sweetened beverages to discourage people from drinking them. Maintaining healthy weight is not only about “looking good.” It’s about feeling good A 10-year-old girl runs into her house in tears. During her first day of fifth grade at a new school, children made fun of her weight. At recess, nobody chose her for their soccer team, saying she ran too slowly to keep up. Some boys called her names. Mommy, she cries, am I always going to be fat? UNC public health faculty, students and alumni discover ways to trim down the obesity epidemic F E AT U R E S A N D N EWS Kelly Browning Dr. Barry Popkin – having energy to enjoy life and minimiz-ing disease risks that strain the health care system and slow productivity. Faculty members and students in UNC’s renowned nutrition department – based in the public health and medical schools – are finding solutions. For example, nutrition professor Melinda Beck, PhD, uses mouse models to explain the link between obesity and higher mortality rates from influenza. Professor Rosalind Coleman, MD, stud-ies hepatic insulin resistance and inborn errors of carbohydrate and lipid metabolism. Researchers including Kari North, PhD, asso-ciate professor of epidemiology, and Daniel Pomp, MD, professor of genetics, nutrition, and cell and molecular physiology, look at genetic factors that may contribute to obesity and related diseases. Other researchers, including Peggy Bent-ley, PhD, nutrition professor and the School’s associate dean for global health, Miriam Labbok, MD, Professor of the Practice of maternal and child health and director of the School’s Carolina Global Breastfeeding Institute, and Elizabeth Mayer-Davis, PhD, nutrition professor and vice president of the American Diabetes Association, search for critical information about what and how we feed infants and young children. Nutri-tion professor Dianne Stanton Ward, EdD, explores ways to increase activity and healthy eating for children in child care settings. June Stevens, PhD, nutrition chair, and associate professors Penny Gordon-Larsen, PhD, Deborah Tate, PhD, and others, find interventions to help adolescents lose weight or avoid gaining extra pounds. Tate’s creative approaches include text messaging, active video gaming and nutrition counseling to help during this critical period of development. Recent alumna May May Leung, PhD, used manga comics (Japanese comic art) to pro-mote positive health behaviors in youth. (See page 13.) Other approaches are aimed at adults. Tate and associate professor Laura Lin-nan, ScD, assess the usefulness of work-place- centered weight loss programs. Professors Alice Ammer-man, DrPH, and Marci Campbell, PhD, teach communities about the benefits of eating fresh fruits and vegetables. Epide-miology professor Marilee Gammon, PhD, examines the connection between weight and exercise, and the impact both have upon multiple diseases, including cancer, diabetes, heart disease and stroke. Oth-ers, including Anissa Vines, PhD, research assistant professor of epidemiology, search for causes of racial disparities in obesity and related diseases. Their research is conducted across North Carolina in towns such as Kinston, Hills-borough, Clinton and Greensboro. The search for answers extends throughout the world, with research projects in China, India, Mex-ico, Philippines and the Arctic Circle. This issue of Carolina Public Health describes only some of the obesity-related work in which faculty members and students are involved. “Obesity is a preventable cause of disease and death that has a huge impact on quality of life and health care costs,” says nutrition chair Stevens, AICR/WCRF Distinguished Professor of nutrition and epidemiology. “It is important that we train the next gen-eration of students to build on what we are now discovering about obesity in order to create new solutions. There are so few indi-viduals trained to understand the biologic, behavioral and population sciences needed to effectively combat the obesity epidemic. The School’s approaches address health and nutrition at all stages of people’s lives.” To educate doctors about nutrition-related disease, Steve Zeisel, MD, PhD, Kenan Dis-tinguished Professor of nutrition at the School and director of the Nutrition Research Institute in Kannapolis, N.C., has developed a groundbreaking Nutrition in Medicine course for medical students and practic-ing physicians. (See www.med.unc.edu/nutr/ nim.) The online materials, made avail-able free to medical students, are used by more than 100 U.S. medical and osteopathic schools and by more than 50 international institutions. Also available is a new online training program, Nutrition Education for Practicing Physicians (NEPP), funded by the National Cancer Institute. “We have scientific evidence explaining the role of nutrition in preventing and man-aging most of the leading causes of death in the U.S.,” says Zeisel. “Physicians are uniquely positioned to emphasize to patients the importance of nutrition in prevent-ing and managing chronic disease. How-ever, physicians must be prepared to give specific advice about nutrition to patients.” Maybe one day, when the 10-year-old is grown and has a child of her own, new preven-tion strategies, combined with better under-standing of nutrition, genetics and behavior management, will reduce the chances that she and her child will face the dangers of obe-sity. With effort, they will be part of a more energetic, healthier world. –Ramona DuBose C A R O L I N A P U B L I C H E A L T H | 5 Dr. June Stevens Dr. Steve Zeisel 6 | F A L L 2 0 1 0 F E AT U R E S A N D N EWS Establishing good health habits early can reverse this trend and help children have healthy lives. The UNC Gillings School of Global Public Health leads the fight against the obesity epidemic and promotes healthy behaviors locally, nationally and globally. “Combating obesity is a key strategic area for the School,” says Peggy Bentley, PhD, nutrition professor and the School’s associ-ate dean for global health. “UNC is playing a major role in obesity research. We have faculty and graduate student expertise from the molecular level through epidemiology, economics, interventions and policy.” You are what your mother eats Society’s advice to expectant mothers his-torically has been to “eat for two.” However, contemporary research shows that eating unhealthy, high-calorie foods during preg-nancy can put children at risk for weight struggles and health complications before they are born. For 15 years, Anna Maria Siega-Riz, PhD, RD, nutrition and epidemiology professor and associate dean for academic affairs at the School, has analyzed prenatal nutrition data to determine which health habits give children the best start in life. “Pregnancy is a happy moment in life, but it’s also when women are most concerned about the health of their child,” she says. “If they have bad health habits, many women are more likely to modify their behavior, at least in the short term.” Although most women know to limit weight gain during pregnancy, 60 percent still gain more weight than they should, based on Institute of Medicine recom-mendations. (Siega-Riz was a member of the prestigious IOM panel that developed those guidelines, available at http://tinyurl. com/iom-guidelines.) Fewer than 25 percent receive guidance from their doctors about physical activity. Making and maintaining behavioral changes is difficult unless women have positive, consistent support. Siega-Riz’s team uses the Internet, pod-casts, chat rooms and cell phones to provide health information and online support for pregnant women. One podcast includes a skit in which four women, all at different parent-hood stages, advise an expectant mom about choosing nutritious foods. Women with healthy habits may avoid having a baby who is too large for gestational age (often leading to C-section births), pre-vent shoulder dystocia for the baby during birth, and limit the child’s risk for developing diabetes and obesity. “Women who aren’t eating right or exer-cising need assistance,” Siega-Riz says. “We must help them find balance and give them all the support they require.” Choosing healthful foods during preg-nancy could reduce the burden of chronic diseases later in life, says Mihai Niculescu, MD, PhD, nutrition assistant professor. Whether the “fat gene” exists is debatable (see page 14), but Niculescu’s epigenetic work – research that determines how outside A healthy start to life For 30 years, the number of overweight children has crept higher and higher. In 2008, the Centers for Disease Control and Prevention reported 10 percent of children ages 2 to 5 had an unhealthy body mass index. Those children have a 70 percent chance of being overweight or obese adults. Dr. Meghan Slining Dr. Margaret Bentley Dr. Cindy Bulik Dr. Miriam Labbok Dr. Mihai Niculescu Dr. Anna Maria Siega-Riz C A R O L I N A P U B L I C H E A L T H | 7 influences alter our DNA – shows that high-fat diets and maternal obesity in mice alter DNA, shutting down some genes and accel-erating others. Developmental brain delays in offspring are the result. When maternal obesity exists, the neu-rons in mouse fetal brains at 17 days of pregnancy appear less developed, according to Niculescu’s observations. The implications are worrisome, he says, because the effects are evident after three or four generations. “This may have profound consequences for an offspring’s life, including his or her mental development and ability to learn,” he says. “A high-fat, less nutritious diet can also create food preferences in unborn offspring that lead them to choose unhealthy foods later in life.” Open the hangar – here comes the airplane! Parental influence over children’s nutrition doesn’t end at birth, but little research exists on what increases obesity risk in children under two. In 2002, Associate Dean Bent-ley became a pioneer in this area when she launched “Infant Care, Feeding and Risk of Obesity,” a study of strategies used by first-time African-American mothers to feed their 3-month to 18-month-old children. With National Institutes of Health fund-ing, Bentley recruited 217 mother-child pairs in North Carolina through the Women, Infants and Children program and vid-eotaped them at three-month intervals to identify feeding styles. She and her team identified five styles: controlling, laissez-faire, responsive, pressuring and restrictive. Responsive mothers, she says, are “perfect moms” who pay close attention to and cor-rectly interpret child cues of hunger and satiety. They are very engaged during feeding and may provide verbal and physical encour-agement and help, when needed. Other styles pressure or even force children to eat when they reject food or overly restrict the qual-ity and quantity of what children eat, often because the mother is concerned about her child becoming fat. “Many factors play a role in how we feed infants. However, we believe that it is not just what children are fed, but also how they are fed that makes a difference in the child’s acceptance of food and perhaps in later food preferences and health outcomes,” Bentley says. “Understanding the role these styles 8 Women who choose healthful foods during pregnancy may reduce their own risk of chronic diseases later in life and improve their children���s ability to learn. Pregnancy is a happy moment in life, but it’s also when women are most concerned about the health of their child. If they have bad health habits, many women are more likely to modify their behavior, at least in the short term. F E AT U R E S A N D N EWS 8 | F A L L 2 0 1 0 play in growth and development outcomes is a big part of what drives our childhood obesity study.” Meghan Slining, PhD, nutrition assis-tant professor, analyzed data from Bentley’s study while she was a UNC doctoral student. Overweight infants – those who measured greater than the 90th percentile for weight versus length – were nearly twice as likely as normal-weight infants to have delayed motor development, Slining found. “While baby fat may be cute,” Slining says, “it increases the chance that a child could become an overweight adult. We also have seen more immediate consequences to extra pudginess. These children have lower gross motor development.” (See a video about Slining’s research at http://tinyurl.com/ slining-baby_fat.) Add a mother with an eating disorder to the mix, and feeding a child becomes even more complex. Jordan Distinguished Professor of Eating Disorders Cynthia Bulik, PhD, used data from the Norwegian Mother and Child Cohort Study, which followed more than 100,000 Norwegian mothers, some of whom had anorexia or bulimia nervosa or binge eating disorder, to deter-mine how they fed their children. Bulik followed the mothers from 17 weeks’ gestation through their chil-dren’s eighth birthdays. Although some moth-ers with eating disorders experienced a reprieve from their conditions during pregnancy, this was not universally the case. In fact, a surprising number of women developed binge eating disorder during pregnancy. Eating disorders during pregnancy expose babies to erratic eating, Bulik says. “The impact of roller-coaster caloric intake certainly affects growth and development,” Bulik says. “It could also affect obesity and diabetes risk, as well as the weight trajectory for later in life.” Mothers with eating disorders also aban-doned breastfeeding earlier than did healthy mothers, Bulik says. After giving birth, women with eating disorders often feel they no longer “have a reason to be overweight” and choose not to consume adequate calories to support breastfeeding. Bulik’s study also shows that, as these children grow, they are more likely to develop eating problems, such as having stomach aches, vomiting without cause or not enjoy-ing food. According to Miriam Labbok, MD, Pro-fessor of the Practice of maternal and child health and director of the School’s Carolina Global Breastfeeding Institute, a breastfeed-ing baby will “stop when full,” but bottle feeding can overpower a baby’s ability to recognize satiety. When a parent insists that the baby empty the bottle, the child learns the habit of overeating, Labbok says. Addi-tionally, breastfed babies are exposed to the tastes of foods eaten by their mothers. For a formula-fed child, food flavors are new and strange, which could cause the child to be a picky eater. Employing research to instill good eating habits early is paramount to changing the course of human health, Bentley says. “It’s harder to intervene and prevent nutri-tion problems when a child is older. They have preferences and eating patterns that make changes more complicated and dif-ficult,” she says. “But, with the research ongoing at the School, we know we’re leading a positive trajectory of implementing healthy habits early.” –Whitney L.J. Howell The impact of roller-coaster caloric intake certainly affects growth and development. It could also affect obesity and diabetes risk, as well as the weight trajectory for later in life. Karina Agopian, research assistant at UNC’s Nutrition Research Institute in Kannapolis, works with a toddler to determine what and how much the child has eaten. Research shows that early eating habits influence later food preferences and health outcomes. PHOTO BY CHAD W. MITCHELL C A R O L I N A P U B L I C H E A L T H | 9 WHAT WOULD HAPPEN IF CHILDREN IN CHILD CARE WERE SERVED GREEN BEANS INSTEAD OF FRENCH FRIES – OR TOOK A NATURE WALK INSTEAD OF SITTING IN A CIRCLE INSIDE? Then perhaps 26 percent of them wouldn’t be overweight, as they are now, reasons UNC Gillings School of Global Public Health nutrition professor Dianne Ward, EdD. These and other tactics are par t of an intervention Ward developed called Nutrition and Physical Activity Self Assessment for Child Care (NAP SACC) to help child care centers in Nor th Carolina boost their food quality, improve physical activities of fered and augment staf f-child interac-tions for children ages 2 through 5. “Child care center resources are of ten limited, and they don’t have a lot of leeway to spend time and money on making changes,” Ward says. “This intervention is designed to be used by the motivated, savvy child care provider to institute changes.” NAP SACC is a free, five-step intervention funded by the National Institutes of Health. It also has been recognized and recommended by the White House Task Force on Child-hood Obesity, led by First Lady Michelle Obama (www. letsmove.gov) and is par t of Nor th Carolina’s “Eat Smar t, Move More” initiative (www.eatsmartmovemorenc.com). Centers conduct a 15-par t self-assessment and select three or four areas for improvement. A NAP SACC consult-ant conducts workshops to guide the facility staf f through changes and is available for follow-up assistance as centers make alterations. A second assessment helps centers deter-mine whether they’ve been successful and prompts them to choose additional areas for improvement. To access the NAP SACC intervention online, visit www.napsacc.org. –Whitney L.J. Howell Dr. Dianne Ward Helping child care centers improve preschoolers’ health Go outside every day, without exception. T I P PHOTO BY JENNY SANDUM PHOTO BY LINDA KASTLEMAN Three-year-old Emily Sandum enjoys a daily visit to the playground. 10 | F A L L 2 0 1 0 “It’s essential to understand that adoles-cence is a crucial period for weight gain,” says Penny Gordon-Larsen, PhD, UNC nutrition associate professor. In her wide-ranging research on adolescent obesity, Gordon-Larsen has studied a representative group of Americans, starting in their teens and following them through their early 30s. In 1996, 13.3 percent of adolescents were obese; by 2008, obesity prevalence had increased to 36.1 percent. Ninety percent of the adolescents obese in 1996 remained obese in 2008. “With the vast majority of obese adoles-cents staying that way into adulthood, it is critical that we develop programs to prevent the problem in adolescence,” says Gordon- Larsen. “If we can interrupt that trajectory, we will save money later in terms of car-diovascular and other health risks, and we will help these young people have healthier and longer lives.” Gordon-Larsen is one of many UNC Gillings School of Global Public Health faculty members who have long been com-mitted to addressing the youth obesity epi-demic. June Stevens, PhD, nutrition profes-sor and department chair, was the principal investigator for “Trial of Activity in Adoles-cent Girls,” a pioneering National Institutes of Health-funded study. Known as TAAG, it explored ways to increase physical activ-ity among sixth-grade girls between 2003 and 2006. The program continues to serve as a model for communities throughout the country. “Get 60,” another innovative program, was a partnership between UNC’s pub-lic health school and athletics department and The Gatorade Company. Designed to Adolescence A time to grow up fit for life Adolescence is a time of dramatic physical and emotional upheaval. It’s also a time when many young people gain weight as their exercise levels and appetites change. Leave off the TV during meals. T I P Dr. Penny Gordon-Larsen leverage student athletes’ influence as role models, the program brought UNC athletes to local schools to encourage the children to be active 60 minutes each day. The program, now replicated in other parts of the coun-try, provides materials to teachers, parents and student athletes describing how to help young people become more physically active. Nutrition professor Dianne Ward, EdD, led the development of the program. Quantifying the impact of school physical education (PE) programs on physical activ-ity patterns was a key part of research by Gordon-Larsen, along with Barry Popkin, PhD, and Robert G. McMurray, PhD, both UNC nutrition professors. They found that students participating in daily PE classes were twice as likely to be physically active than students who were not enrolled in any school PE. Their study offered empirical data used to support passage of the national Physical Education for Progress Act. PEP, as it was called, was passed in 2000 to provide expanded physical education programs for students in kindergarten through grade 12. As the fight against ado-lescent obesity continues, UNC researchers turn to newer technologies to help reduce and prevent weight gain. For her doctoral dis-sertation, Elizabeth Lyons, PhD, and her adviser, Deb-orah Tate, PhD, associate professor of health behavior and health education and of nutrition, conducted a Robert Wood Johnson Foundation-funded study of video games played by 18- to 35- year olds. The results can be extrapolated to younger teens. “The study’s premise was not only to determine how much energy people can expend playing different types of video games, but also to consider how much they enjoyed different types of games,” says Tate. “The games that use the most energy expenditure may not be the ones that people like playing the most.” “People don’t have to be playing the most active games to achieve some benefit in terms of a public health impact,” Lyons adds, “if they are replacing their TV time with some-thing that is even slightly more active.” School researchers are not focused only on exercise as a means of addressing the issue of weight. Noel Kulik, another doctoral student of Tate’s, focuses her dissertation research 8 C A R O L I N A P U B L I C H E A L T H | 11 PHOTO BY KRIS HOYT (Right) Adolescents don’t have to play the most active games to achieve health benefits – as long as they replace TV time with something more active. (Below) Brothers Isaiah and Joe King select fruit for an afternoon snack. The boys participated in research conducted by Dr. May May Leung (see page 13). It’s essential to understand that adolescence is a crucial period for weight gain. 12 | F A L L 2 0 1 0 F E AT U R E S A N D N EWS on adolescent social support for weight loss. Tate has led a variety of studies with ado-lescents, including “enerG,” which used the Internet to help adolescent girls lose weight. While the researchers found that adding the Internet was not beneficial to adolescents, they realized that the intensive face-to-face program they developed as a control arm of the study was very effective. The SNAP (Study of Novel Approaches to Prevention) program – led by UNC principal investigator Tate and currently recruiting people ages 18 to 35 – aims for weight gain prevention through early adulthood. (See www.snapstudy.org.) Even if young people emerge from adolescence at normal weight, research shows that the aver-age weight gain for Ameri-cans in the years between age 18 and 35 is 30 pounds. Under the direction of Dr. June Stevens, Dan Taber, PhD, conducted disserta-tion research at UNC that examined whether ado-lescent weight gain can be influenced by public policy. Taber studied the association between soda consumption and Body Mass Index (BMI) in adolescents in states that changed their policies to restrict junk food in schools. He also mea-sured differences across racial and ethnic groups. The study suggests that changes in state policies restricting junk food in schools can reduce soda consumption among ado-lescents, particularly non-Hispanic blacks, but there was no impact on BMI percentile. Taber says the findings support a need for comprehensive policy change – in and out-side of schools. He says additional research is needed to evaluate the impact of compre-hensive policy change on obesity. As Stevens notes, “This may be the first time ever that the next generation of children will have a shorter life span than their parents, on average, and that change would be driven by obesity. Obesity is an extremely important public health problem that should have a simple solution: children need to eat healthier diets and be more active. But it’s actually quite complicated and challenging to make that happen. It needs to happen not just in a few individuals, but in the entire population of children in our country, because while not all children are obese, all children need to eat healthy diets and be physically active.” –Michele Lynn The Body Mass Index (BMI) is a measure that determines percentage of body fat based on a relationship of weight to height. A person is considered “overweight” if his or her BMI is between 25 and 29.9, and “obese” if the BMI is 30 or above. There are many BMI calculators available online,* but here’s one way to determine it: • A = Your body weight divided by your height • B = ‘A’ divided by your height • BMI = B x 703 Therefore a person who weighs 140 pounds and is 5’5” (65”) tall has a BMI of 23.2: • 140/65 = 2.15 • 2.15/65 = 0.033 • 0.033 x 703 = 23.199 A more informal way of calculation suggests that someone is “overweight” if he is 10 per-cent above healthy weight for his height, and “obese” if 30 percent above healthy weight. *For example, see http://tinyurl.com/bmi-at-cdc. BODY MASS INDEX (BMI) Try to eat two meals together at home each day. T I P This may be the first time ever that the next generation of children will have a shorter life span than their parents, on average, and that change would be driven by obesity. C A R O L I N A P U B L I C H E A L T H | 13 “Eat your fruits and vegetables” Dominating book sales in China and pump-ing nearly $100 million into the U.S. comic book industry, the popular Japanese comic art known as manga could have potential to pro-mote behavior change in youth, Leung says. “Often, interventions don’t properly engage or maintain the interest of the intended population,” she says, “so I looked for a model already successful at engaging my target population.” Leung evaluated manga comics and con-ducted research with preteens in four North Carolina counties. She asked the youths what they liked about manga and how they felt about specific health concepts. She then collaborated with local artist Kris Hoyt to create and test a manga comic called “Zen Aku: Fight for Your Right to Fruit.” “The characters are drawn in a simplified manner, allowing more people to identify with them, which could create a greater level of audience involvement,” Leung says. “And because manga comics are sold as entertain-ment, readers may be more likely to be per-suaded by the story’s health messages.” Leung’s research, which has been submit-ted for publication, showed that young people who read the manga comic significantly increased their beliefs in the importance of fruit intake when compared to a group that was given the same information in a nutri-tion newsletter. Alice Ammerman, DrPH, RD, Leung’s adviser, agrees that the results are promis-ing, as increased belief in the importance of fruit intake may result in changing behavior to consume more fruit. Now a tenure-track assistant professor at The City University of New York School of Public Health at Hunter College, Leung envisions taking that next step with future research and plans to extend her experiment to other populations. –Chris Perry Getting preteens to eat healthy foods and increase their physical activity can be a daunting task in today’s fast-food, multimedia world, but nutrition researcher and School alumna May May Leung, PhD, RD, has developed an innovative strategy to capture their attention – manga comics. Manga comics get the message across to kids Dr. May May Leung used manga comics, a popular Japanese comic art form, to encourage preteens to make healthy food choices. PHOTO BY KRIS HOYT ILLUSTRATION BY KRIS HOYT 14 | F A L L 2 0 1 0 F E AT U R E S A N D N EWS Dr. Kari North Dr. Rosalind Coleman Dr. Terry Combs Dr. Daniel Pomp Fat Genes • Kari North, PhD, epidemiology asso-ciate professor, studies risk factors for cardiovascular disease – and obesity is a big one. She and colleague Keri Monda, PhD, proposed a potential location for a gene that controls waist circumference. “Then we realized we needed a lot more samples to discover more loci,” North says. Through a project called GIANT, which has 125,000 participants, they have identified 18 new genetic markers associ-ated with obesity-related traits. “It helps us understand on a molecular level how individuals become obese,” North says. Now her team is working on how these genes interact with environmental factors including gender and physical activity. • Rosalind Coleman, MD, nutrition profes-sor, uses “knockout mice,” each of which lacks a specific enzyme and so a specific genetic function, to identify precise roles of enzymes that metabolize fatty acids. People who are obese or insulin resistant frequently have fatty livers, but the team found that mice lacking one particular enzyme had less fat in their livers, even when the mice were obese. Another group of mice that lacked a different enzyme – the one that activates most of the fatty acids in fat tissue – got fatter, not thinner. The surprising discoveries will lead to more nuanced understanding of the role these enzymes play in human obesity, insulin resistance, diabetes and heart disease. • The more weight a person gains, the more insulin resistant he or she will be. As insulin resistance rises, so does glucose level, which increases the likelihood of diabetes. Insulin normally controls the liver’s glucose production, but the liver of someone with high insulin resistance keeps producing glucose even when it shouldn’t. “We’re asking why the liver is not turning off when glucose is coming in from the gastro-intestinal tract,” says Terry Combs, PhD, nutrition assistant professor, whose team recently identified in mice a gene they believe plays a critical role in the process. “What insulin does is turn on the expression of this gene,” he says, explaining that when the gene is on, the liver turns off glucose production. Now Combs’ lab is working to discover whether the same genetic mechanism occurs in people. • Daniel Pomp, PhD, professor of genetics, nutrition, and cell and molecular physiol-ogy at Carolina Center for Genome Sci-ences, wondered why some people run marathons while others lie around on the couch. Using specially bred mice, he and his team are looking for the genes associ-ated with a predisposition to exercise, a trait that can prevent or control obesity. “There is not one single exercise gene or one obesity gene,” he says. “There are maybe 50, each with a relatively small impact.” His lab’s findings may help humans maintain a healthy weight, but it won’t be a magic bullet. “We know how much a person exercises is 30 to 40 percent influenced by genes,” Pomp says. “But we don’t want people to use [their genetic makeup] as an excuse. The information is meant to make you work harder if you’re predisposed not to exercise much.” –Kathleen Kearns Can we blame extra pounds on our genes? Several researchers at UNC Gillings School of Global Public Health are identifying which genes may have an impact on body weight and investigating precisely how that impact occurs. Eat five servings of fruits and vegetables daily. T I P PHOTOS BY LINDA KASTLEMAN Penny Gordon-Larsen, PhD, nutrition asso-ciate professor and fellow at UNC’s Carolina Population Center, and nutrition doctoral student Natalie The have shown that it’s not just older, married adults who are at risk of gaining weight. It’s young adults, too, par-ticularly if they are married or living with their romantic partners. Young heterosexual couples who live together are at more than twice the risk for becoming obese than are their dating peers, their research shows. Gordon-Larsen and The are the first to study this age group using a national sample. Drawing conclusions from the National Longitudinal Study of Adolescent Health, nicknamed “Add Health,” they released their findings in April 2009 in the journal Obesity. “At baseline, when we started our analysis (during the early- to mid-1990s), study par-ticipants were adolescents between 12 and 20 years old,” The says. “Then we followed them into adulthood, when they were 18 to 27 years of age.” Add Health also recruited the adolescents’ romantic partners to participate in the adult phase of study. The study didn’t address why obesity risk was higher in this group, but data implica-tions were clear. “When you establish a shared household with a romantic partner, you need to think of ways each partner can support the other to create a healthy environment – healthier foods in the house, working out together and supporting each other in terms of physical activity in general,” Gordon-Larsen says. A healthy, supportive environment on the job also is important. Laura Linnan, ScD, and Deborah Tate, PhD, associate professors of health behavior and health education, have shown the value of workplace weight-loss programs. In a “WAY to Health” study with employ-ees at 17 community colleges in North Caro-lina, nearly 20 percent of the subjects lost five percent or more of their body weight with minimum intervention over 12 months — a significant result. Most of the individuals who lost five per-cent of their weight fell into two groups – one that received a Web-based weight-loss pro-gram or one that received the Web program and cash incentives for weight loss. “Losing even five percent of baseline body weight (roughly 10 pounds for the average participant in this study) is important from a public health point of view because the participants begin to experience positive health benefits,” Linnan says of the study, which was funded by the Centers for Disease Control and Prevention. Living Healthy As young people grow up and settle into their adult lives, many are at greater risk for diabetes, heart disease, cancer and other chronic diseases if they become overweight or obese. Researchers at UNC Gillings School of Global Public Health want to know how adults can manage their weight and stay healthy. How adults can maintain or lose weight C A R O L I N A P U B L I C H E A LT H | 15 Young heterosexual couples who live together double their risk for becoming obese, as compared to their dating peers. 16 | F A L L 2 0 1 0 But the researchers, whose results are slated for publication in late 2010, still recog-nize that only about a fifth of the participants achieved the five percent loss over a year. “It told us that if people are motivated and get a self-directed program such as this, they can be successful, but the results are modest,” Tate says. Adds Linnan, “The Web-based weight-loss program is an important option we need to make available to those who are interested in it, but there is no magic bullet. We need other options to support healthy choices. This is not about how motivated people are. It’s more than that. It’s about creating condi-tions where motivated people can make good choices and have options that work for them.” Linnan and Tate were surprised that par-ticipants who received the Web/cash com-bination didn’t perform much better than those who only received the Web program. “They did a little better, but the results were not statistically significant,” Linnan says. She and Tate hope to shine more light on the role of cash incentives in 2011 when they release results from a second study, funded by the National Heart, Lung, and Blood Institute, which tests the inde-pendent effects of the Web-based program and cash incentives. Data from the sec-ond study come from nearly 1,000 employ-ees at 12 universities and community col-leges across North Carolina. One of four study groups received “cash only,” based on their percentage of weight loss over an 18-month study. The other three groups received a Web-based program only, the Web program and cash, or “usual care” (the control group). This study’s results are expected to draw national attention as it is the first large study of “cash only” incentives since the 1980s, Tate says. In other research related to adults and weight, Kimberly Truesdale, PhD, nutrition research assistant professor, has gleaned sig-nificant findings from the large longitudinal study known as “ARIC,” or Atherosclerosis Risk in Communities. The study focused on four U.S. communities and included both white and African-American respondents. Truesdale found no disparities between the two races in her most recent results, pub-lished online in January 2009 in Interna-tional Journal of Obesity. Looking at adults ages 45 to 64 and how their health is affected by excess weight over time, Truesdale discovered that simply maintaining weight brings benefits. “Weight loss is something a lot of adults can’t achieve,” she says. “We found that if people maintain Dr. Deborah Tate Dr. Laura Linnan Dr. Kim Truesdale Research assistants with “Way to Health,” a workplace weight loss program, interview a study participant. When you establish a shared household with a romantic partner, you need to think of ways each partner can support the other to create a healthy environment – healthier foods in the house, working out together and supporting each other in terms of physical activity in general. PHOTO COURTESY OF UNC CENTER FOR HEALTH PROMOTION AND DISEASE PREVENTION C A R O L I N A P U B L I C H E A L T H | 17 their weight (±3 percent), they still have some health improvements in total cholesterol, LDL cholesterol and diastolic blood pressure, regardless of weight status.” Truesdale also found that people who lose a significant amount of weight (≥5 percent) reap long-term benefits associated with their lighter physique. “We wondered, if you had been heavier in the past, do you pay the con-sequences of that for the rest of your life?” she asks. The answer, based on some important criteria, was no. “People who were heavier in the past – their blood pressure, lipids and glucose levels were slightly better or about the same as someone who always had been the lighter weight,” Truesdale says, noting that she didn���t look at hard outcomes like heart attacks. Carmen Samuel-Hodge, PhD, another nutrition research assistant professor, is test-ing a weight-loss intervention program tar-geted to low-income women who, as a group, have the highest rates of being overweight or obese. The intervention focuses on helping par-ticipants gain awareness of how their behavior contributes to weight gain. “Once they know what they are doing, they can start figuring out how to change,” Samuel-Hodge says. “A lot of the sessions were about problem solving. The participants were the ones who solved their own problems.” (For more on Samuel- Hodge’s study, see page 22.) — Susan Shackelford Is perceived racism a risk factor for obesity? “Right now, the literature is not at all consis-tent on the question of whether exposure to racism increases obesity risk,” says Anissa I. Vines, PhD, epidemiology research assistant professor at UNC Gillings School of Global Public Health. Vines co-authored a study published in American Journal of Epidemiology (March 2008), which found that higher levels of perceived racial discrimination might be protective against hypertension. She also was lead author for a study that found a rela-tionship between a larger waist-to-hip ratio and daily life stress and passive emotional responses to racism but could not support the hypothesis that racism, a chronic stressor, was associated with increased abdominal fat (American Journal of Public Health, March 2007). “Other researchers have shown a positive association between racism-related variables and obesity,” Vines says. Vines continues to explore some of these associations with the help of a questionnaire – the telephone-administered perceived racism scale – which she developed in collaboration with clinical psychologist Maya McNeilly, who designed the original perceived racism scale. “I am beginning to explore what it really means when an African-American person reports limited or no experiences of racism,” Vines says. “Maybe being able to acknowl-edge and report racism provides a protective psychological effect.” Vines also is examining early life expo-sures to stress and perceived racism. “We don’t know very much about how per-ceived racism acts as a stressor,” Vines says. “Multiple stressors can be in play at any given time. How one perceives those stressors, and how those stressors interact with other social and environmental factors, are important to explore.” –Angela Spivey Does perceived racism contribute to higher rates of obesity among African-Americans? The question is complicated. Dr. Anissa Vines PHOTO BY LINDA KASTLEMAN Maintaining a healthy weight throughout middle age may result in lower blood pressure and cholesterol levels. For weight loss, working together is often the best approach Researchers at UNC Gillings School of Global Public Health have found that, for many, community support helps make those behaviors stick. The School has a long history of cre-ating, testing and implementing programs designed to engage groups of people to work together to improve their health. One long-running effort based at the UNC Center for Health Promotion and Disease Prevention and led by a School researcher – HOPE (Health, Opportunities, Partnerships, Empowerment) Works – brought together low-income women in several rural counties in eastern North Carolina to form “Hope Circles” to support each other in healthier habits. Researchers reported that women who participated in the circles for six months lost an average of 4.5 pounds and also increased their physical activity significantly. Women in control groups didn’t lose weight. UNC nutrition professor Marci Campbell, PhD, who led the effort, now studies the same intervention over a longer time period. Campbell’s project, Seeds of HOPE, centers the support circles around churches or other formal groups, as her initial study found these settings more effective than informal meetings in private homes. Findings by Campbell and colleagues appear in Journal of Women’s Health (October 2007). Feedback from the communities involved in HOPE Works has led researchers to focus on improving economic as well as physical health. “People were saying you can’t tackle obe-sity if women don’t have jobs or education, The prescription for losing excess weight and avoiding heart disease and diabetes sounds simple – eat less in general, eat more fruits and vegetables, and move more. The hard part is helping real people fit those changes into their lives. 18 | F A L L 2 0 1 0 The Active Living by Design (ALBD) grantee in Columbia, Mo., has worked hard to mobilize the community to bike more often. Here, several families enjoy a crisp fall morning. Read more about ALBD on page 21. PHOTO COURTESY OF ACTIVE LIVING BY DESIGN Dr. Marci Campbell C A R O L I N A P U B L I C H E A L T H | 19 because they don’t have hope for the future. People will improve their health as part of an effort to improve their lives,” Campbell says. She and colleagues helped launch a model business, Threads of HOPE NC Inc., in Salemburg, a small town in Sampson County, N.C. The business provides women with management experience and draws on the sewing skills some had developed when the textile industry was vital in the eastern part of the state. Participants make custom tote bags from organic cotton and have filled orders for clients including the 2009 National Conference on Chronic Disease Prevention and Control. Input from HOPE Works participants also led to HOPE Accounts, which com-bines HOPE circles with a matched savings program to help women meet a goal such as going back to school or starting a small business. That project is funded by a grant from the American Recovery and Reinvest-ment Act. Listening to people in communities we serve is crucial if we are to solve complex health problems such as obesity, says Leah Devlin, DDS, MPH, former North Carolina state health director and a Gillings Visiting Professor of health policy and management at the School. “The problems we face in North Caro-lina are complex and multifactorial, and they require creative solutions that engage all types of expertise that we have in the public health school. But those solutions also must include the will and desires of the community,” Devlin says. “We have to listen to communities to understand what they see as priorities and what ideas they have for solutions that will help us be more successful together.” Campbell and Marlyn Allicock, PhD, research assis-tant professor of nutrition, also are applying strategies proven to help people eat more fruits and vegetables to an intervention in which military veterans are trained to counsel each other. They use motivational interviewing, which focuses on reflective listening and positive affirmations rather than on persuasion or advice giving. Those strategies were shown to help veterans eat more fruits and vegetables than did the stan-dard Veterans Affairs weight-management program, in a pilot study published in the May–June 2010 issue of Preventive Medicine. “We found that, due to other clini-cal responsibilities and time constraints, nurses are not necessarily the best people to do the counseling,” Allicock says. So she, Campbell and colleagues developed manuals and DVDs that train veterans to conduct the motivational interviewing for other veterans. The researchers currently are evaluating that intervention. The problems we face in North Carolina are complex and multifactorial, and they require creative solutions that engage all types of expertise that we have in the public health school. But those solutions also must include the will and desires of the community. Dr. Marlyn Allicock Production manager Mae Tuggle assembles a Threads of Hope tote bag. The organic cotton bags were sold last year at The Regulator Bookshop in Durham, N.C. PHOTOS BY SALLI BENEDICT F E AT U R E S A ND N EWS Active Living by Design (ALBD), founded in 2001 by the Robert Wood Johnson Foun-dation, works with communities to build environments for active living and healthy eating. (The program is featured on page 21.) ALBD staff members provide technical assistance to towns that have received grants from “Fit Community,” an initiative of the N.C. Health and Wellness Trust Fund. “Our role is to help communities identify those resources that are going to help make their project successful, not just over the course of the grant period, but beyond,” says Joanne Lee, a program officer with Active Living by Design. For example, Lee worked with a commu-nity in Black Mountain, N.C., which planted gardens connected by walking trails. “They were able to get a permanent position estab-lished that included in its duties managing the gardens,” Lee says. “We also worked with the community to help establish a nonprofit coalition to generate funding.” Another community intervention is led by Carmen Samuel-Hodge, PhD, research assis-tant professor of nutrition. Samuel-Hodge is testing a modified group weight-loss inter-vention to determine whether it is effective for low-income women when administered by county health department staff members rather than research team staff members. For example, to accommodate some women’s low literacy skills, she had them break into groups and choose a designated person to do any required writing. A prelimi-nary analysis of her ongoing study in six North Carolina counties found that 40 percent of the women lost 5 percent or more of their body weight, a clinically significant amount. “This was a better result than other studies targeting low-income populations have gotten,” Samuel-Hodge says. “A key element was the women helping each other,” she says. “A lot of the sessions were about problem solving, and the women solved their own problems. These were not teaching sessions. If the interventionist did more than 50 percent of the talking in a ses-sion, it was considered ineffective. The goal is for interventionists to guide the discussion. A lot of times the women are learning from each other. One person will come in and say, ‘I had a wonderful week, and here’s what I did.’” Finding ways that people in communities can work together to get healthy is becoming ever more important as public health officials try to fight obesity with fewer resources. For example, Samuel-Hodge points outs that in July 2011, the North Carolina State Health Plan, through its Comprehensive Wellness Initiative, will begin requiring members with a body mass index above 40 to enroll in weight-loss programs or pay higher insurance co-pays. But how many state employees can afford the hundreds of dollars that private weight-loss programs may cost? Can com-munities provide other options that cost less but are still effective? “We are finding that they can,” Samuel- Hodge says. –Angela Spivey The School also collaborates with towns and communities to develop programs for healthy living. 20 | FA L L 2 0 1 0 Threads of HOPE NC Inc. www.threadsofhopenc.org Seeds of HOPE http://tinyurl.com/hpdp-seeds-of-hope Weight Wise Works at Health Departments http://tinyurl.com/hpdp-weightwise Active Living by Design www.activelivingbydesign.org Websites for further information: In Santa Ana, Calif., the Healthy Eating by Design program provides opportunities for healthier eating to families in an urban Latino neighborhood. Here, a child hones his skills in the community garden. PHOTO COURTESY OF ACTIVE LIVING BY DESIGN Active Living by Design partners in Louisville, Ky., transformed a once-barren patch of land into a safe and fertile garden space. The garden became a community gathering place, where children learn about growing and eating healthy foods. But now, thanks to a Fit Community grant administered by UNC Gillings School of Global Public Health’s Active Living By Design (ALBD), the Yancey County com-munity is turning the tide. Using the $60,000 grant as seed money, the community partnership, known as “Healthy Yancey,” renovated a previously closed gymnasium, bought park playground equipment for young children, added a side-walk to connect a local swimming pool to Ray-Cort Park and hired a director to oversee the projects. The technical assistance Healthy Yancey received from ALBD was as critical as the seed money. “The five Ps they stress – Preparation, Promotion, Programs, Policy and Physical Projects – helped us tremendously,” says Kin-nane, who wrote the grant application. “They make you think things through. Because of that, I feel like we’ve been successful.” Although there is no hard data yet on youth weight loss or maintenance, it appears Healthy Yancey is making a difference. “Changes like this take a long time; the prob-lem is so multifactorial,” says Kinnane, direc-tor of the Toe River Health District, which covers Yancey, Avery and Mitchell counties. “I believe our community is more fit. Our gym is busy all the time; the park is busy, too. All of these things are helping.” Funded by the North Carolina Health and Wellness Trust Fund, Fit Community is one of many grant programs administered by ALBD, an organization based in the School’s North Carolina Institute for Public Health. What all ALBD programs have in common is a focus on supporting com-munity partnerships to create environ-ments that foster good health. “We are taking public health to the streets,” says ALBD director of communications Mark Dessauer. ALBD was one of the first organizations in the country to zero in on the importance of the built environment and its potential impact on health. “Our relationship with the Robert Wood Johnson Foundation and the focus of our first initiative together was inno-vative,” says ALBD director Sarah Strunk, MHA. “We were early adopters that helped communities translate a growing area of research into practice. We looked at how In the mid-2000s, Lynda Kinnane – and others in the beautiful mountain town of Burnsville, N.C. – had a major concern. “We were seeing a lot of children who were overweight,” Kinnane recalls. Active Living By Design Sarah Strunk 8 We wanted neighborhood groups to determine what their communities needed and to work with others to make it happen. … With a small amount of money, these partner-ships can accomplish something significant. PHOTO COURTESY OF ACTIVE LIVING BY DESIGN C A R O L I N A P U B L I C H E A L T H | 21 F E AT U R E S A N D N EWS 22 | F A L L 2 0 1 0 The World is Fat* Across North Carolina and around the world, researchers from UNC Gillings School of Global Public Health are investigating why obesity rates have ballooned, how this phenomenon affects health and what to do about it. Research synopses reported by Kathleen Kearns *Our article uses the title of a popular treatise by Dr. Barry Popkin, The World is Fat: The Fads, Trends, Policies and Products That Are Fattening the Human Race (New York, Penguin Books, 2008). For more information, see http://tinyurl.com/theworldisfat. C A R O L I N A P U B L I C H E A L T H | 23 The School conducts research, provides public service and par ticipates in engaged scholarship in all 100 Nor th Carolina counties. 29.4 percentage of Nor th Carolina adults who are obese 10of 11 states with highest rates of diabetes and hyper tension are in the South 38states in the U.S. with adult obesit y rates above 25 percent in 2010 12 million obese children in the U.S. 0states with adult obesity rate above 20 percent in 1991 56percent of voters who think preventing childhood obesity will save taxpayers money in the long run 8states with obesity rates above 20 percent among 10- to 17-year-olds (N.C. is not among them.) 41.1 percentage of African-Americans in Nor th Carolina who are obese 20states with nutritional standards for school meals (N.C. is among them.) 73percent of voters who say preventing childhood obesity is an impor tant priority for government f e at u r e s a n d n ews National chair for the SEARCH for Diabetes in Youth study, nutrition professor Elizabeth Mayer-Davis, PhD, leads the first long-term evaluation to track trends and incidence rates for all types of diabetes among young people from major racial and ethnic groups in the U.S. The large, multicenter study collects information about who gets diabetes and what kind, what care they receive and how the disease and its complications af fect their daily lives. Among the study questions: Why is type 2 diabetes rising so rapidly among adolescents, par ticularly minority adolescents? And does obesit y – not previously linked with type 1 diabetes – accelerate that form of the disease? While those in the U.S. who identify themselves as Hispanic die less often from heart disease than non-Hispanics, they have higher rates of obesity and diabe-tes. Lisa LaVange, PhD, biostatistics Professor of the Practice, leads the Hispanic Community Health Study, a comprehensive, nationwide assessment of how adapting to the U.S. environment and culture af fects the health of 16,000 Hispanic adults with family roots in Mexico, Cuba, Puer to Rico, the Dominican Republic, Central America and South America. Barry Popkin, PhD, Carla Smith Chamblee Distinguished Professor of Global Nutrition, has served on the Mexican Ministry of Health’s National Beverage Panel and has written three papers with the Instituto Nacional de Salud Publico related to beverage intake among Mexican children. He conducts studies in China, Russia, Brazil, Mexico and the United Arab Emirates to examine factors underlying dietary and physical activity pat terns and their ef fects on health. In Egypt, Iran, Mexico, Brazil, South Africa, Thailand, China, Chile, India and Indonesia, Popkin studies the relationship of massive shif ts in diet, activity and obesity to noncommunicable diseases. Penny Gordon-Larsen, PhD, nutrition associate professor, and Kari North, PhD, epidemiology associate professor, are working together to understand how genetic and environmental risk factors interact to influence weight gain as teens become young adults. They have shown that this developmental period is one of par ticular risk for weight gain. Understanding how genes and environ-ment interact can bet ter inform obesity prevention and treatment by tailoring such interventions to individuals who might benefit most. For a more comprehensive look at where in the world we are making a difference, see our interactive map at www.sph.unc.edu/globalhealth. Nutrition professor Peggy Bentley, PhD, conducts research on infant and young child nutrition in a number of countries, including Honduras, Malawi and India. Musk ox, caribou and other traditional foods of the Cana-dian Arctic have high nutritional value. But as the Inuvialuit of Nunavut have moved away from physically active ances-tral ways and started eating more processed, store-bought foods, their rates of obesity and other ills have climbed. Sangita Sharma, PhD, former UNC nutrition associate professor, now at University of Alber ta (Canada), worked with local groups to develop the Healthy Foods Nor th intervention program. Af ter collecting baseline health data, the team promoted vigorous traditional activities and nutritious foods that are both af fordable and culturally acceptable. Women who are obese when they are diagnosed with breast cancer have a greater risk of dying from the disease, Re-becca Cleveland, PhD, nutrition research as-sistant professor, has found. She has identified genes associated with breast cancer, obesity and diabetes and is now working to understand the connections among them. Her working hypotheses – that many of the genes associated with high levels of insulin also are associated with breast cancer and that breast cancer outcomes are worse for women with diabetes – drive her investigations of genes related to insulin resistance, estrogen and other factors. Cleveland’s findings are based on data collected by epidemiology professor Marilie Gammon, PhD, through Gammon’s Long Island Breast Cancer Study. (See www.sph.unc.edu/cph/ long_island_breast_cancer.) The Healthy Weight Commitment is a voluntary food indus-try effort, linked with First Lady Michelle Obama’s child-hood obesity initiative, to reduce obesity by changing what Americans eat. Nutrition professor Barry Popkin, PhD, leads a UNC-based team evaluating the impact of the Com-mitment’s attempt to remove 1.5 trillion calories a year from the U.S. marketplace by 2015. The independent team will track whether the calorie reductions result in American children and adoles-cents taking in significantly fewer calories each day. The evaluators will look par ticularly closely at whether the overall diet of 2- to 18-year-olds improves and at whether they take in less solid fats and added sugars. A 40-year-old journal article on Chinese Restaurant Syndrome grabbed the attention of nutrition associate professor Ka He, MD, ScD, when he read that study animals given monosodium glutamate (MSG) weighed more than the con-trol group. Intrigued, He examined data from both a small study and the large China Health and Nutrition Survey and discovered that humans’ MSG intake also is related to weight gain. Now, he is testing his theory that MSG causes resistance to leptin, the hormone that regulates energy balance. He is planning an intervention study to determine whether MSG intake can cause obesity. Having led two large national trials examining obesity and physical activity in children and adolescents, June Stevens, PhD, professor and chair of the nutrition de-partment, continues her research on obesity in differ-ent populations. She has found links between mental exhaustion, obesity and hear t at tacks among African-American and white men and women. Other studies showed that the ef fects of obesity on the risk of diabetes and hyper tension in Chinese may be even greater than in blacks and whites. Recent work by Stevens and Kimberly Truesdale, PhD, nutrition research assistant professor, showed that af ter losing weight, previously obese individuals enjoy a lowered risk of hear t disease similar to those who were never obese. Their innovative studies are the first to show that, similar to the lowered risk of lung cancer in people who quit smoking, the ef fects of obesity on hear t disease appear to be reversed by weight loss and maintenance of a healthy weight. Adults who lose weight and be-come normal weight have about the same risk of hear t disease as people who were never obese. Stevens also conducts research comparing body mass index and rates of diabetes and other conditions among African-Americans, whites and Chinese. That project is suppor ted by a supplement to the UNC Nutri-tion and Obesity Research Center, one of 12 national centers of research funded by the National Institutes of Health. Steven Zeisel, MD, PhD, Kenan Distinguished Professor of nutrition and director of the N.C. Nutrition Research Institute, is the Center’s principal investigator. In Mexico, Miroslav Styblo, associate professor, studies which arsenic exposure may induce and examines effects of diet on the metabolism of arsenic. his National Institutes of Health-funded been conducted in Bangladesh and Alice Ammerman, DrPH, RD, nutrition professor and director of UNC’s Center for Health Promotion and Disease Prevention, directs a Gillings Innovation Lab investigating – among other things – whether children eat more fruits and vegetables when their parents buy locally grown food. Using data from the Nor th Carolina Child Health Assessment and Monitoring Program, the team has found the answer may be yes. Teaching children where their food comes from and eating more meals at home also may af fect how likely children are to eat healthy food. In Nor th Carolina, it appears that families who are Hispanic and/or of lower socioeconomic status may be just as likely to buy local food as wealthier whites. Spurred by the World Health Organization, food companies worldwide are placing a uni-versal logo on food and beverage packages to help consumers make healthier choices. Barry Popkin, PhD, Carla Smith Chamblee Distinguished Professor of Global Nutrition, works with an international board of scientists to ensure the logo goes on products that really do promote health. The Choices International Foundation Programme aims to reduce diseases related to obesity by raising consumer awareness and by encourag-ing companies to market products that meet evidence-based benchmarks for trans fats, saturated fats, salt, sugar and – in most locations – fiber and energy intake. For more than 20 years, the China Health and Nutrition Survey has monitored the diet and body composition of 19,000 people in nine Chinese provinces. During that time, economic and social changes have altered what Chinese people eat and how much they move. Obesity in China has risen dramatically. Numer-ous School faculty researchers – among them Linda Adair, PhD; Margaret E. Bentley, PhD; Shufa Du, MD, PhD; Penny Gordon-Larsen, PhD, and study principal investigator Barry Popkin, PhD – track the changes. The information they gather helps Chinese of ficials identify and respond to the public health challenges that result. Since 1983, the Cebu [Philippines] Longitudinal Health and Nutrition Survey has followed a cohort of 3,000 women and their children. Origi-nally focused on maternal and infant health, the study – now led by nutrition professor Linda Adair, PhD – tracks a range of ma-ternal and child health issues, including a significant rise in obesity that parallels Cebu’s rapid growth and economic development. “There’s a clear trend from underweight to overweight and to hyper tension and dia-betes,” says Adair. Unlike in the United States, women from Cebu’s wealthier fami-lies tend to gain more weight. Poorer women and those with physically demanding jobs gain less. PhD, nutrition studies mechanisms by induce diabetes diet and obesity arsenic. Research for funded work also has and Taiwan. 24 | F A L L 2 0 1 0 F E AT U R E S A N D N EWS we could increase physical activity through community design.” With an initial foundation investment of $15.5 million in 2001, ALBD selected part-nerships of key players within communities to solve infrastructure challenges around physical activity and, later, healthy eating. “We wanted neighborhood and grassroots groups determining what their communities needed and working with others, including local government entities such as public health, transportation, and parks and recre-ation, to make it happen,” Dessauer says. The approach struck a chord. “We expected 300 to 350 to apply, but we had 966. The response broke all foundation records,” he says. The first 25 community grantees received technical assistance and $40,000 annually for five years. The money seeded partner-ships that leveraged nearly $260 million in additional community investments. “The lesson we learned was that with a small amount of money, these partnerships can accomplish something significant,” Des-sauer says. “It gave them an opportunity to pause and think about community health and how they could work together.” With such success, the N.C. Health and Wellness Trust Fund, Kellogg Foundation, Blue Cross Blue Shield of Minnesota and other groups soon engaged ALBD to work with their grants programs. In 2008, the Robert Wood Johnson Foun-dation made an even bigger commitment to ALBD, asking it to lead the new $33 million Healthy Kids, Healthy Communities pro-gram – the foundation’s largest investment in community-based change related to child-hood obesity, Dessauer says. Among the 50 Healthy Kids, Healthy Communities grants made so far, one for $400,000 in Baldwin Park, Calif., continues to fuel a childhood obesity fight launched more than a decade ago. The largely Latino suburb of Los Angeles has seen children lose weight and increase test scores as the community has instituted salad bars and mandatory physical education levels in schools, increased fresh produce in stores, banned drive-through windows at new fast-food restaurants and launched a website called www.werefedup.com, created by and targeted to young people. The grant is helping the partnership implement “People on the Move,” focused on decreasing unhealthy food marketing and advertising, increasing access to healthy foods in corner groceries near schools and boosting “walkability” and green space in the downtown area. In Somerville, Mass., ALBD also is advanc-ing a longtime initiative. Since the early 2000s, “Shape up Somerville” has spurred new parks, walking paths, recreational facilities, community gardens, low-fat menu options at restaurants and education of parents about healthy eating. A $400,000 Healthy Kids, Healthy Com-munities’ commitment is helping the town make changes in public policy to sustain health over time – a major ALBD emphasis. “To truly reverse the epidemic of childhood obesity, we need to address policies, environ-ments and systems, not just individual behav-ior,” says ALBD director Strunk. “This means working to create community-level changes that can be sustained for generations to come.” –Susan Shackelford Active Living by Design fosters community-led change by working with local and national partners to build a culture of active living and healthy eating. Above, elementary students in Seattle enjoy a snack provided by the local Healthy Eating by Design program. Below, South Bronx (N.Y.) youth celebrate their borough’s newest park. The ALBD grantee engaged local young people to clean up trash in the park and make landscaping changes. To truly reverse the epidemic of childhood obesity, we need to address policies, environments and systems, not just individual behavior. PHOTOS COURTESY OF ACTIVE LIVING BY DESIGN School reaccredited by CEPH for maximum period, seven years the unc gillings school of global public health was reac-credited in June by the Council on Education for Public Health (CEPH) for seven years, the maximum period of renewal. Leading the school’s accreditation team were Peggy Leatt, PhD, associate dean for academic affairs and chair of the Department of Health Policy and Management; Anita Farel, DrPH, associate chair for graduate studies in the Department of Maternal and Child Health; Laurel Files, PhD, associate chair of the Department of Health Policy and Management; Felicia Mebane, PhD, assistant dean for students; and Dave Potenziani, PhD, former senior associate dean. SCHOOL NEWS For more information on these topics and other news, please see www.sph.unc.edu/news_events. unc gil l ings school of globa l publ ic hea lth vangie a. foshee, phd, professor of health behavior and health education, has received a grant of nearly $1.2 million from the U.S. Centers for Disease Control and Prevention to evaluate a program aiming to prevent psychological, physical and sexual dating abuse by adolescents who have been exposed to domestic violence. “Moms and Teens for Safe Dates” was developed by Foshee and health behavior and health education colleagues, Professor Susan Ennett, PhD, and Beth Moracco, PhD, and James Michael Bowling, PhD, both research associate professors, with funding from the National Institute of Justice. Mothers who have left an abusive partner obtain pre-vention information through the program and participate in interactive activities with their 12- to 15-year-old adolescents who were exposed to the abuse. Adolescents exposed to domestic violence are at increased risk for being abused by and abusing the people they date. Foshee receives award to study prevention of dating violence C A R O L I N A P U B L I C H E A L T H | 25 Dr. Vangie Foshee thomas ricketts, phd, professor of health policy and management, is one of 15 national experts appointed to the new National Health Care Workforce Commission. The Commission is an independent body that advises Congress and the administration on health workforce policy. “This commission gives us the opportunity to develop new ways to modernize our workforce to meet the challenges of increasing access and quality of health care while we control costs,” Ricketts said. “We need to examine how we prepare and deploy our doctors, nurses, dentists, pharmacists and the many other health care practitioners to meet the nation’s future health care needs. In many ways, we have been trying to run a system for the 21st century with 20th century approaches.” Ricketts also serves as deputy director for policy analysis at UNC’s Cecil G. Sheps Center for Health Services Research and is co-director of American College of Surgeons Health Policy Research Institute. He is a Gillings Visiting Professor with Ecole des Hautes Etudes en Sante Publique in France. Ricketts named to national Health Care Workforce Commission Dr. Thomas Ricketts march ��� september 2010 although april’s bp oil spill in the Gulf of Mexico did not affect the North Carolina coast, it provided opportunity to evaluate local, state and federal readiness. More than 130 participants at the School’s July 29 “One Health” forum interacted with state and federal partners who described how to train and use volunteers and identi-fied areas requiring additional planning. Bill Gentry, director of health policy and management certificate programs, arranged and led the forum. Read more at www.sph. unc.edu/oilspill. School sponsors oil spill forum 26 | F A L L 2 0 1 0 S C H O O L N EWS Maternal and Child Health offers online degree the school’s maternal and child health department will offer an online master’s degree program in spring 2011 to comple-ment its established residential training programs. The degree will increase working professionals’ access to graduate education focused on improving the health of women, children and families. Developed with support from the U.S. Health Resources and Services Administra-tion’s Bureau of Maternal and Child Health, the new curriculum builds upon an online certifi-cate (MCH Ole!) introduced earlier this year. rebecca fry, phd, assistant professor of environmental sciences and engineering, has received two prestigious awards recognizing her potential to make substantial contributions throughout her career. The honors include the Outstanding New Environmental Scientist (ONES) Award, presented by the National Institutes of Health’s National Institute of Environmental Health Sciences (NIEHS), and selection as a PopTech Science and Public Leadership Fellow. Fry’s ONES award includes a $2.2 million grant to study health effects of prenatal arsenic exposure in newborns in Gomez Palacio, Mexico. PopTech, a global community of interdisciplinary leaders, each year selects young scientists who work in critical public health areas and provides them with advanced leadership and com-munications training. Fry also has received support from the University Cancer Research Fund and a Gillings Innovation Lab (see page 28). two school researchers received a five-year, $2.2 million grant to study how pregnancy and obesity may promote susceptibility to an aggressive subtype of breast cancer more prevalent in young, African-American women. Melissa Troester, PhD, assistant professor of epidemiology, and Liza Makowski, PhD, assistant professor of nutrition, are principal inves-tigators for the National Institute of Environmental Health Sciences’ Breast Cancer and Environmental Research Program. heather mun-roe- blum, phd, principal and vice-chancellor of McGill University in Mon-treal, gave the keynote address at UNC’s Uni-versity Day celebra-tion Oct. 12. The text of the presentation is available at http://tinyurl.com/munroe-blum. Munroe-Blum received a doctorate with dis-tinction in epidemiology from UNC in 1983. Researchers to study pregnancy, obesity, breast cancer disparities Munroe-Blum speaks at University Day event ESE’s Fry honored as ‘outstanding young researcher’ Dr. Melissa Troester (left), Dr. Liza Makowski Dr. Munroe-Blum the water institute at unc (http:// waterinstitute.unc.edu), housed in UNC Gill-ings School of Global Public Health, was launched Oct. 25 during UNC’s conference, “Water and Health: Where Science Meets Policy.” The conference, co-sponsored by the new institute and the UNC Institute for the Environment, attracted more than 350 attendees. Experts from more than 50 countries provided a wide range of per-spectives on drink-ing water, sanitation, hygiene and water resources. UNC has longstanding expertise in the areas of water, policy and health, with many faculty members engaged in associated research and recognized as international leaders. The Water Institute was established by the School to leverage this broad, interdis-ciplinary experience. “The Water Institute at UNC brings together individuals and institutions from diverse disciplines and empowers them to work together to tackle critical global issues in water and health,” says Jamie Bartram, PhD, Institute director and professor of envi-ronmental sciences and engineering. Water Institute at UNC launched in October Dr. Jamie Bartram Dr. Rebecca Fry PHOTO BY DIANNE SHAW C A R O L I N A P U B L I C H E A L T H | 27 unc-chapel hill has been named coordinating center for a National Institutes of Health-funded study to examine ways to curtail the nation’s childhood obesity epidemic. June Stevens, PhD, AICR/ WCRF Distinguished Professor of nutrition and epidemiology and chair of the nutrition department, is principal investigator for the center. The NIH’s $49.5 million Childhood Obesity Prevention and Treat-ment Research (COPTR) program is among the first long-term obesity prevention and treatment research studies in children. COPTR will test methods for preventing excessive weight gain in non-overweight and moderately overweight youth, and methods for reducing weight in obese and severely obese youth. Stevens also was a featured speaker at the 2010 American Institute of Cancer Research (AICR) Conference on Food, Nutrition, Physical Activity and Cancer, Oct. 21–22, in Washington, D.C. Nutrition’s Stevens coordinates national study of ways to prevent, treat childhood obesity kelly b. browning, member and for-mer president of the School’s Public Health Foundation board, and alumnus Richard Vinroot Jr., MD, MPH, will serve four-year terms on the 160-member UNC Board of Visitors, which assists the Chancellor and trustees in activities that help advance the University. Browning, Vinroot elected to UNC Board of Visitors Dr. June Stevens Kelly Browning Dr. Rich Vinroot Jr. a new unc study that follows patients with lung cancer is one of the first to suggest why patients choose not to have life-preserv-ing lung surgery and why such surgery is sought less often by blacks. Samuel Cykert, MD, associate professor in the UNC School of Medicine, is lead author of the American Cancer Society-funded study, published in the June 16 issue of the Journal of the American Medical Association. Study authors from UNC Gillings School of Global Public Health include Peggye Dil-worth- Anderson, PhD, professor of health pol-icy and management, and Lloyd J. Edwards, PhD, associate professor of biostatistics. Cykert says explanations for differences in surgical rates for blacks may include black patients’ perception of poor doctor-patient communication. Black patients also were less likely to have primary care providers who could help them reconsider a decision about surgery. UNC study helps explain why black patients with lung cancer have surgery less often than whites Physicians can improve children’s oral health school researchers have provided the first national data on the effectiveness of dental referrals by physicians. Heather Beil, MPH, doctoral student, and Gary Rozier, DDS, MPH, professor, both in the School’s Department of Health Policy and Manage-ment, co-authored the study, published in the August issue of the journal Pediatrics. Researchers sam-pled children to determine whether a medi-cal health care provider had recommended that a child be seen by a dentist and whether the child actually had a dental visit. The most significant finding was in the group of two- to five-year-olds. Of the 47 percent of the group advised to have a dental check-up, 39 percent did. Dr. Gary Rozier For more information about these and other events, contact Jerry Salak at (919) 843-0661 or jerry.salak@unc.edu. Feb. 18 – Lecture by Isabel Wilkerson, author of The Warmth of Other Suns: The Epic Story of America’s Great Migration Feb. 24 – Minority Student Caucus Alumni Reception Feb. 25 – Minority Health Conference (www.minority.unc.edu) March 31 – Foard Lecture (www.sph.unc.edu/foard) Speaker: Richard A. Vinroot Jr., MD, MPH Coming soon! F E AT U R E S A N D N EWS FACULTY Sobsey invited to NASA��s first LAUNCH event Mark Sobsey, PhD, Kenan Distinguished Professor of environmental sciences and engineering, was one of 10 innovators chosen to participate in NASA’s inaugural LAUNCH event, held March 16–18, at the Kennedy Space Center in Florida. Sobsey presented his proposal for simple, accessible and affordable tests to assess water quality and safety. Sen selected for prestigious Wilks Medal Pranab K. Sen, PhD, Cary C. Boshamer Distinguished Professor of biostatistics, was selected as the 2010 recipient of the American Statistical Association’s S.S. Wilks Medal, one of the most prestigious awards in the field. His research, pub-lished over the course of 50 years, has influ-enced generations of statisticians. Sen, a member of the UNC biostatistics faculty since 1967, is the first from the department to receive the medal. Gillings Innovation Labs awarded The School funded four new Gillings Innova-tion Laboratories last spring. Awardees, all assistant professors, include: • Eric Donaldson, PhD, epidemiology; • Rebecca Fry, PhD, environmental sciences and engineering; • Suzanne Maman, PhD, health behavior and health education; and • Jill Stewart, PhD, environmental sciences and engineering. Read more about the Gillings Innovation Lab Awards at www.sph.unc.edu/accelerate. Randolph reappointed to national board Susan Randolph, MSN, RN, was reappointed to the National Advisory Committee on Occu-pational Safety and Health (NACOSH). Randolph is clinical assistant professor in the Public Health Leadership Program. Swenberg honored with Greenberg Award James A. Swenberg, DVM, PhD, Kenan Dis-tinguished Professor of environmental sci-ences and engineering, received the School’s Bernard G. Greenberg Alumni Endowment Award for excellence in teaching, research and service. Director of the UNC Cur-riculum in Toxicology, Swenberg studies AWAR DS & R ECOGNITIONS unc gil l ings school of globa l publ ic hea lth march – september 2010 Read more at www.sph.unc.edu/recognitions_and_awards. Dr. Mark Sobsey Dr. Eric Donaldson Dr. Suzanne Maman Dr. Jill Stewart Dr. Rebecca Fry Dr. Pranab Sen Susan Randolph 28 | F A L L 2 0 1 0 C A R O L I N A P U B L I C H E A LT H | 29 the mechanisms of carcinogenesis, with an emphasis on the role of DNA damage and repair. He has mentored more than 40 gradu-ate students during his two decades at UNC. The award was presented at the School’s 2010 Foard Lecture in April. LaVange reappointed to health commission Lisa M. LaVange, PhD, was reappointed to the N.C. Health and Wellness Trust Fund Commission. LaVange is Professor of the Practice of bio-statistics and director of the Collaborative Studies Coordinating Center. The com-mission works to improve North Carolin-ians’ health by establishing partnerships to address access, prevention, education and research issues. Herring, Preisser, Zhou elected as ASA fellows Three UNC biostatis-tics faculty members have been elected as fellows of the Ameri-can Statistical Asso-ciation. They are Amy Herring, ScD, associate professor; John Pre-isser Jr., PhD, research professor; and Haibo Zhou, PhD, professor. Popkin awarded honor by Britain’s Nutrition Society Barry Popkin, PhD, Carla Smith Chamblee Distinguished Professor of Global Nutrition, is the 2010 recipient of the United Kingdom Nutrition Society’s Rank Prize, the soci-ety’s highest honor. He accepted the award in June 2010 in Edinburgh, Scotland. Popkin’s Nutrition Society Lecture was titled, “Contemporary Nutritional Transi-tion: Determinants of Diet and its Impact on Body Composition.” Zelman, Herring honored for teaching, mentoring Two prestigious fac-ulty awards were pre-sented at the School’s 70th commencement ceremony last spring. William Zelman, PhD, professor of health policy and management, received the John E. Larsh Jr. Award for Mentorship, and Amy Herring, ScD, associate professor of biostatistics, received the McGavran Award for Excellence in Teaching. Gentry awarded Moldova medal Bill Gentry, lecturer in health policy and management and director of the Com-munity Preparedness and Disaster Man-agement program, received Moldova’s “Honorary Rescuer” medal in May 2010. Gentry has a long history of emergency pre-paredness and response efforts in the country. Gordon-Larsen receives Obesity Society award Penny Gordon- Larsen, PhD, associate professor of nutrition, has won The Obesity Society’s 2010 Lilly Scientific Achieve-ment Award. Gordon- Larsen accepted the award, funded by the Eli Lilly Pharmaceuti-cal Co., at the Society’s October conference in San Diego. Peterson presented with prestigious Allan Rosenfield Award Herbert B. Peterson, MD, Kenan Distin-guished Professor and chair of the Depart-ment of Maternal and Child Health, received the 2010 Allan Rosenfield Award for Life-time Contributions to International Family Planning. The award is presented annually by the Society of Fam-ily Planning (SFP). Peterson, also pro-fessor of obstetrics and gynecology in the UNC School of Medi-cine, is known inter-nationally for his work in women’s reproduc-tive health, epidemiology, health policy and evidence-based decision-making. Dr. James Swenberg (left), Dr. Mike Aitken Dr. John Preisser Dr. Barry Popkin Dr. Halbo Zhou Dr. Lisa LaVange Dr. Amy Herring Bill Gentry Dr. William Zelman Dr. Penny Gordon-Larsen Dr. Herbert Peterson PHOTO BY TOM FULDNER 30 | FA L L 2 0 1 0 Halpern honored for leadership, teaching Carolyn Halpern, PhD, associate profes-sor of maternal and child health, received the national Associa-tion of Teachers of Maternal and Child Health’s 2010 Loretta P. Lacey Maternal and Child Health Aca-demic Leadership Award. STAFF Cilenti leads NC Healthy Start, receives women’s health award Dorothy Cilenti, DrPH, deputy direc-tor of the School’s N.C. Institute for Public Health, was appointed chair of the N.C. Healthy Start Foundation��s board of directors in July. She has served on the Healthy Start board since 2007. Cilenti also received a $305,000 grant from the U.S. Health Resources and Services Administration’s Maternal and Child Health Bureau. The project, Women’s Integrated Systems for Health (WISH) Distance Learning Initiative, will address the need to better inte-grate public health and mental health systems to improve women’s health. Stevens honored for local health efforts Rachel Stevens, EdD, RN, received the 2010 President’s Award from the National Association of Local Boards of Health (NALBOH) in August in recognition of her service. Stevens was deputy director of the School’s N.C. Institute for Public Health and clinical instructor of public health nursing before retiring in 2003. Perry receives Staff Excellence Award Chris Perry, assistant director of School communications, was selected for the School’s 2010 Staff Excellence Award, which acknowledges excel-lent attitude, leader-ship and initiative. Perry is credited with “beyond-the-call ” efforts on the School’s website content, including a recent major redesign of the site. STUDENTS Public health students recognized for work benefiting North Carolina UNC Gillings School of Global Public Health students won four of 16 Impact Awards, presented by UNC’s Graduate School in spring 2010 to recognize student research that benefits North Carolina citi-zens. The awards, sponsored by the Graduate Education Advancement Board, were given last spring to: • Jennifer Gierisch, PhD, health behavior and health education alumna; • Maiysha D. Jones, environmental sciences and engineering doctoral student; • Kathryn Remmes Martin, PhD, health behavior and health education alumna; and • Stephen Richardson, environmental sci-ences and engineering doctoral student. Read more at http://tinyurl.com/nc-impact. Two inaugural Gillings Dissertation Awards presented Stephen Richardson (environmental sciences and engineering) and Natalie The (nutrition) received Gillings Awards in spring 2010 for their research, respectively, on solutions to soil contamination and the associations among weight, diabetes and physical activity across race and ethnicity in the United States. Three students win Fulbright awards Jacqueline S. Knee, MSPH, and Bachelor of Science in Public Health alumnae Melissa Asmar and Erin Shigekawa were selected to receive Fulbright public health scholarships. Knee is examining sanitary conditions of stored rainwater in Thailand; Asmar con-ducts research on nutritional changes in the national diet in Germany; and Shigekawa studies chronic kidney disease in Taiwan. ALUMNI Brostrom selected for Barr Award Richard Brostrom, MD, MSPH, received the 2010 Harriet Hylton Barr Distinguished Alumnus Award for his achievements and contributions to the field of public health. Brostrom, medical director of the Division of Public Health for the U.S. Common-wealth of the Northern Mariana Islands, is also medical director of the common-wealth’s programs in tuberculosis control, public health bioterrorism preparedness and tobacco control. His award was announced at the School’s 2010 Foard Lecture. Dr. Dorothy Cilenti Dr. Rachel Stevens Chris Perry Maiysha Jones Dr. Carolyn Halpern Stephen Richardson Natalie The AWARDS A N D R ECOGNI T I O N S C A R O L I N A P U B L I C H E A L T H | 31 DONOR S $1,000,000 to $5,000,000 Anonymous GlaxoSmithKline Robert Wood Johnson Foundation sanofi-aventis $500,000 to $999,999 Anonymous Columbia University John D. & Catherine T. MacArthur Foundation Merck & Company John & Virginia Sall $250,000 to $499,999 Avon Foundation Boston University The Duke Endowment Estate of Mabel Smith Johanssen Government of Nunavut University of Bristol University of California – San Francisco Water Research Foundation $100,000 to $249,999 American Diabetes Association American Heart Association Anonymous Association of Schools of Public Health Centers for Disease Control Foundation The COPD Foundation Edward A. & Joanne Dauer Dauer Family Foundation Duke University Elizabeth Glaser Pediatric AIDS Foundation EngenderHealth Golden Leaf Foundation King Abdullah University Science & Tech Penn State University Pfizer Inc. San Diego State University Research Foundation UNICEF The Wistar Institute W. K. Kellogg Foundation $50,000 to $99,999 Alaska Native Health Consortium American Institute for Cancer Research Bryson Foundation Vaughn & Nancy Bryson Children’s Hospital of Philadelphia Coca-Cola Company Exxon Mobil Corporation International Agency Research on Cancer Makhteshim-Agan of North America Inc. Medical University of South Carolina Mount Sinai School of Medicine NARSAD Novartis University of Massachusetts University of Nevada Reno University of Virginia WaterAid $25,000 to $49,999 Abbott Diabetes Care Inc. Anonymous (2) Brigham and Women’s Hospital Fred Hutchinson Cancer Research Center International Association of Plumbing and Mechanical Officials International Water Association Michael E. Kafrissen Methanol Foundation Susanne Moulton & Thomas Wong Orica Watercare Inc. Otsuka Maryland Medicinal Lab Inc. Research Triangle Institute Schering-Plough Research Institute Schwarz BioSciences Inc. Pranab and Gauri Sen Tellus Educational Foundation Inc. Theratechnologies Inc. University of Georgia University of Texas – Houston Wake Forest University School of Medicine Washington University – St. Louis Derek & Louise Winstanly $10,000 to $24,999 Abbott Laboratories Amgen Inc. Anonymous (3) Marcia Angle & Mark Trustin Astellas Pharma US Inc. AstraZeneca Pharmaceuticals LP – US Edward Carroll Bryant “YOUR GIFTS ARE INVESTMENTS, AND WE THANK YOU FOR EVERY ONE OF THEM. The return on your investment is far more than the gratitude of public health researchers, teachers and students, though you have that in abundance. Your return is your gift’s impact – discoveries made, students trained, faculty recruited and retained, publications made possible, clinics supported, lives touched and the pub-lic’s health transformed. Your gift – your investment – has made a difference in the protection of the world’s health and America’s future. We are grateful to you and all our partners as we work together to engineer clean water, prevent obesity, cancer and other diseases, eliminate health disparities, and lower health care costs.” – D E A N B A R B A R A K . R I M E R JULY 1, 2009 – JUNE 30, 2010 of Donors and Partners HONOR ROL L Gi l l i n g s S c h o o l o f Gl o b a l Pu b l i c He a l t h 32 | F A L L 2 0 1 0 DONOR S Canadian Institute for Advanced Research Celgene Corporation Deniese May Chaney Dainippon Sumitomo Pharma America Inc. Nancy Ann Dreyer Eisai Research Institute Florida State University Forest Laboratories Inc. George & Bodil Gellman The Gellman Foundation Dennis B. Gillings Sandra Bartholomew Greene Donald & Jennifer Holzworth Peter Bert Imrey InterMune Inc. Esther Maria John JVC Enterprises Momentum Research MPEX Pharmaceuticals Inc. James E. Nix NSF International Orexigen Therapeutics Inc. Quintiles Barbara K. Rimer & Bernard Glassman Benedict & Philomena Satia Schwab Fund for Charitable Giving Sigma-Tau Pharmaceuticals Inc. Synteract Inc. Triangle Community Foundation University of Arkansas University of Florida Research Foundation University of Minnesota University of Wisconsin – Madison XenoPort Inc. Arnold & Maryanne Zaks $5,000 to $9,999 Sheryl Wallin Abrahams in memory of Linda Southern Anonymous (2) Anonymous in honor of James Imhotep Irving H. Michael & Barbara Arrighi Bergen County (N.J.) United Way The Boston Foundation Deshpande Foundation Leah McCall Devlin in honor of parents Fred & Pearle McCall Cynthia Girman Peggy & Cam Glenn Ellen Diane Habermacher Johns Hopkins University Gary & Carolyn J. Koch Stephen Allen Morse Douglas M. Owen Karl E. Peace Greg & Paula Brown Stafford William & Michele A. Sollecito David Marc Turner Jack Eugene Wilson Brian A. Zaks Jason Zaks $2,500 to $4,999 Accenture Foundation Inc. Anonymous Delton Atkinson David J. Ballard & Michela Caruso in memory of Harry Guess Howard J. Dunn Susan T. Ennett & Wayne E. Pein Fidelity Charitable Gift Fund Bob & Kristen Greczyn Paula Billingsley Harrison Waldo B. Harshberger Ronald W. Helms Joan Cornoni Huntley John P. McConnell Foundation Hong Li John & Kit McConnell Felicia Mebane David & Julie Potenziani Rebecca Raymond & Michael Stangl Rho James & Jennifer Rosen SAS Institute Inc. Anna Pittman & James Simpson Schenck IV Ilene C. Siegler & Charles D. Edelman Allen & Susan Willey Spalt Maura Ellen Stokes Lydia Lansangan Tiosejo in honor of Dr. Norman F. Weatherly Ronald & Ann Wooten $1,000 to $2,499 Accenture Foundation Inc. Michael Aitken & Betsy Rudolph American College of Epidemiology Lynda Anderson & J. Kenneth Conover Anonymous Association of N.C. Boards of Health Edward L. Baker Jeffrey Propes Baker Kathleen D. Barboriak Frank H. Barr Sterling Wilson Bell Deborah Bender & John Curry Peggy Bentley Mark Dean Beuhler Michael N. Boyd Antonio Braithwaite Fred & Laura Brown Jianwen Cai & Haibo Zhou Joseph & Jenifer Carson Ward Cates in honor of Barbara K. Rimer Ching Kuang Chen Terri Colangelo Ralph & Joann C. Cook in memory of Al Tyroler Georgia G. dela Cruz Chester W. Douglass Ramona & Alan DuBose Todd Alexander Durham Jo Anne & Shelley Earp Kenneth L. Eudy Jr. in honor of Dave Potenziani MaryAnn Cross Farthing Edwin B. Fisher Lyne Gamble & Kathryn Yandell Richard Gargagliano & Joan Hedgecock in memory of Diane Hedgecock Jay Marshall Goldring Sherri Lynn Green Andrea & Michael Griffin Jim & Barbara Grizzle in memory of Bradley Wells Priscilla Alden Guild C. David & Lucy S. Hardison James R. Hendricks Hendricks Consulting LLC Suzanne Havala Hobbs Deborah Parham Hopson Amelia Horne Sallie Craig Huber Joseph G. Ibrahim Inspire Pharmaceuticals Inc. International Lactation Consultant Association Mary Ellen James Raymond James Charitable Endowment Fund Young-Ho Khang in memory of H.A. Tyroler James D. Kinard Bill Kingsbury Lynn Koss Knauff Michael & Pamela Kosorok Kubwater Resources Inc. Miriam Labbok Kenneth Ladrach Don & Marie Lauria Lisa Morrissey LaVange in honor of Gary Koch Peggy Leatt & George Pink Danyu Lin Douglas S. Lloyd Julie MacMillan Sandy Martin & Larry Kupper Theresa A. Martino Danita McAllister A. Dennis McBride James A. & Mary L. Merchant Mark H. Merrill Wilbur & Virginia Milhous Robert C. Millikan Bill & Susan Milner Mona Marie Moon Alan Coningsby Moore Sarah Taylor Morrow Dara Lee Murphy The National Christian Foundation Jeanenne Little Nelson Sharon Nicholson-Harrell Charlotte & Miguel Nuñez-Wolff Jeffrey Oberhaus & Brent Wishart James P. O’Connell Andrew Olshan & Linda Levitch Phillip & Rachel Olsson Leonard Oppenheimer John E. Paul Herbert B. Peterson Alan & Linda Rimer Rotary Club of Chapel Hill R. Gary & Jeanette Rozier John & Kelly Russell Patricia D. Saddier Linda M. & Brian O. Sanders Sanford Pediatric Dentistry Helen C. Schaefer James K. Schaefer Jacqueline van der Horst Sergent Ruth Ann Shults Anna Maria Siega-Riz Gladys Siegel in memory of Earl Siegel Brian Springer Paul Edward Stang State Employees’ Combined Campaign David Steffen & Jill Kerr June Stevens in memory of Jessie A. Satia Joel & Donna Storrow Rosalind Thomas & David Strogatz in honor of Linda Cook Chirayath M. Suchindran Mary Charles Suther Mary S. Thompson Russell Barner Toal John Chester Triplett Douglas Blair Tully William J. Tyroler UNC Student Activities Fund Office Bobbi Wallace Dianne Stanton Ward G. Robert Weedon Alice D. White Paul & Janet Wiles David Winterle & Carey Dawson in memory of Leonard Dawson Kuan-Mu Yao Chen-Yu Yen $500 to $999 Stella Adamu Jerrold M. Alyea American Legacy Foundation Anonymous (3) Anonymous in honor of Linda Cook Gordon Berry in memory of Katherine Wildman William Cudd Blackwelder Michael Austin Boyd Douglas Donaldson Bradham Lynda Bryant-Comstock James Paul Bulman Jennifer Carr in memory of Mary Rose Tully David A. Charnes David Erwin Cooper Deborah Lee Covington Carol Jane Dabbs Dannon Institute Keith Allen Demke Janice M. Dodds Estate of Dorothy Fay Dunn C A R O L I N A P U B L I C H E A L T H | 33 DONOR S Stephen John Dunn George Roy Elmore Jr. Experience Inc. Mary Beth Fasano Lynn Schueler Fitzgerald Joyce M. Gallimore Stuart Gansky Jerry Gray Gentry Michael Craig Griffiths Anders W. Hall in memory of Frances Hall Healthsouth Men’s Clinic Inc. Gerardo & Jo Eaddy Heiss Robert Lee Hines David Lee Hlavac Omar Hopkins & Teresa Savarino Jonathan V. James Nalin Johri Thomas V. Jones Juhaeri Juhaeri Jane Kingsbury Warren Kingsbury Michael & Marilyn Knowles Margaret Edith Layne Mazie Jones Levenson Marcia Joanne Levenstein Catherine Rowland Liemohn Robert Martin David & Gladys McNelis William Clarence Miller Timothy James Mukoda N.C. Citizens for Public Health Zoe Henderson Parker Stephen Praissman Paul Joseph Rathouz in honor of Lawrence Kupper Thomas Cleveland Ricketts III Rachel F. Robbins Mark Graham Rodin Joan Siefert Rose Michael Gerard Schell Robert E. Silverman Philip C. Singer Ellison & Electa Smith C. Jean Spratt Rachel Humphries Stevens Jeanine Hamlin Stice Tamaurus Jerome Sutton John Henry Sweitzer Myduc L. Ta David & Jeanie Taylor in memory of Professor David Fraser Richard & Vanessa Thorsten Fredrick Seymour Whaley Jun-Guo Zhao & Yu Lou President’s Circle ($5,000–$25,000) Marcia Angle & Mark Trustin Anonymous Deniese May Chaney George & Bodil Gellman Peggy & Cam Glenn Donald & Jennifer Holzworth Esther Maria John Michael E. Kafrissen Gary G. & Carolyn J. Koch James E. Nix Barbara K. Rimer & Bernard Glassman John & Virginia Sall William A. & Michele A. Sollecito Derek & Louise Winstanly Chancellor’s Circle ($2,000–$4,999) Sheryl Wallin Abrahams in memory of Linda Southern Michael D. Aitken & Betsy Rudolph Sterling Wilson Bell Fred & Laura Brown Leah McCall Devlin Bob & Kristen Greczyn Andrea & Michael Griffin Paula Billingsley Harrison Joan Cornoni Huntley James D. Kinard Peggy Leatt & George Pink Hong Li Julie MacMillan John & Kit McConnell Felicia Mebane Dara Lee Murphy Charlotte & Miguel Nuñez-Wolff Douglas M. Owen David & Julie Potenziani Rebecca Raymond & Michael Stangl James & Jennifer Rosen Linda M. & Brian O. Sanders Anna Pittman & James Simpson Schenck IV Ilene C. Siegler & Charles D. Edelman Allen & Susan Willey Spalt Joel & Donna Storrow Lydia Lansangan Tiosejo in honor of Dr. Norman F. Weatherly Jack Eugene Wilson Ronald & Ann Wooten Kuan-Mu Yao Dean’s Circle ($1,000–$1,999) Lynda Anderson & J. Kenneth Conover H. Michael & Barbara Arrighi Edward L. Baker David J. Ballard & Michela Caruso in memory of Harry Guess Kathleen D. Barboriak Frank H. Barr Deborah Bender & John Curry Peggy Bentley Antonio Braithwaite Jianwen Cai & Haibo Zhou Joseph D. & Jennifer Carson Ward Cates in honor of Barbara K. Rimer Ching Kuang Chen Ralph R. & Joann C. Cook in memory of Al Tyroler Ramona & Alan DuBose Jo Anne & Shelley Earp Susan T. Ennett & Wayne E. Pein Kenneth L. Eudy, Jr. in honor of Dave Potenziani Edwin B. Fisher Lyne Gamble & Kathryn Yandell Jay Marshall Goldring Priscilla Alden Guild C. David & Lucy S. Hardison James R. Hendricks Suzanne Havala Hobbs Deborah Parham Hopson Amelia Horne Sallie Craig Huber Joseph G. Ibrahim Michael & Pamela Kosorok Miriam Labbok Kenneth S. Ladrach Lisa Morrissey LaVange in honor of Gary Koch Danyu Lin Douglas S. Lloyd Sandy Martin & Larry Kupper Theresa A. Martino Danita McAllister A. Dennis McBride James A. & Mary L. Merchant Mark H. Merrill Wilbur & Virginia Milhous Robert C. Millikan Bill & Susan Milner Mona Marie Moon Sarah Taylor Morrow Jeanenne Little Nelson Sharon Nicholson-Harrell Jeffrey Oberhaus & Brent Wishart James P. O’Connell Andrew Olshan & Linda Levitch John E. Paul Herbert B. Peterson John & Kelly Russell Patricia D. Saddier James K. Schaefer Jacqueline van der Horst Sergent Ruth Ann Shults Brian Springer Paul Edward Stang David Steffen & Jill Kerr June Stevens Mary Charles Suther Russell Barner Toal John Chester Triplett Bobbi Wallace Dianne Stanton Ward G. Robert Weedon Alice D. White Paul & Janet Wiles THE ROSENAU SOCIETY IS NAMED IN HONOR OF MILTON J. ROSENAU, THE FIRST DEAN OF THE SCHOOL OF PUBLIC HEALTH. MEMBERSHIP IN THE ROSENAU SOCIETY IS LIMITED TO BENEFACTORS MAKING A MINIMUM UNRESTRICTED CONTRIBUTION OF $1000 TO EITHER THE UNC GILLINGS SCHOOL OF GLOBAL PUBLIC HEALTH OR ONE OF ITS DEPARTMENTS. MEMBERSHIP MUST BE RENEWED ON AN ANNUAL BASIS. Rosenau Society Membership July 1, 2009–June 30, 2010 34 | F A L L 2 0 1 0 DONOR S $250 to $499 Omid & Julie Ahdieh Anonymous Mary Susan Anthony John Anton & Renee Schwalberg Stephen Charles Ayala Patricia Michel Backus Harriet Hylton Barr Eileen Danielle Barrett Edmund Gerald Barron Sheri Ruth Bates Stephen & Elaine Berman Lynn W. Blanchard Jo Ellen Brandmeyer Carolina Trust Robert & Helen Clawson Coastal Community Foundation of S.C. Francoise Marie Cornet Katherine Elizabeth Crosson Thomas Lawrence Crowe E. Stewart Crumpler Pedro & Carol Cuatrecasas Ronnie McConnell Davis Clifford Earl Decker Jr. Pamela France DeLargy David Louis Dodson Leroy & Kay Doughty Tom & Jenifer Faulkner Richard & Karen Fields Laurel Ann Files David Bernard Fischer Barbara J. Fleck Hilton Thomas Goulson Gretchen Groebel Kerry Brent Hafner Carolyn Cantlay Hart Richard John Heggen W. Howard Holsenbeck Essam Ibrahim in memory of Laurel Zaks Barbara Anne Israel in honor of Linda Cook W. Joe Jacumin Harvey Edward Jeffries James Joseph Jetter Baxter Lee Jones Michelle Crozier Kegler Oliver & Maighread Kelly Amy Hyonju Kim John & Judy Klaas Jacquelyn Hoffman Koehler in memory of Rebecca James Baker Michele Cherry Larson Peter Lauria & Kathleen Sheehan Sheri Johnson Lawrence David Ernest Layland Joseph Gilbert Louis Lee Kelvin K. Lee Wilbert Liou-Lang Lee James Robert Leserman Mike Kafrissen and Bert Peterson have been friends and colleagues for more than a quarter-century. As obstetrics and gynecology physi-cians, members of the U.S. Centers for Disease Control and Prevention’s Epidemic Intelligence Service and faculty members at UNC Gillings School of Global Public Health, they have worked in concert to improve the health of women and children around the world. Kafrissen, School alumnus, research scientist at Massachusetts Institute of Technology, Chief Scientific Officer for Johnson & Johnson’s North American Pharmaceutical Company, and adjunct professor of maternal and child health at UNC, says UNC-Chapel Hill has been instrumental in his career path. “During a recent visit to the campus, I felt led to increase my involvement with our school,” Kafrissen says. “I was moved by my conversations with Bert [Herbert Peterson, MD, Kenan Distinguished Professor and chair of the School’s Department of Maternal and Child Health] and his passion for and optimism about the current effort to reduce maternal mortality.” As a result of those conversations – and subsequent ones with Dean Barbara K. Rimer and UNC Chancellor Holden Thorp – Kafrissen presented the School with a generous gift, which was matched 2-to-1 by his former employer, Johnson & Johnson. The funding helps support Peterson’s efforts as director of the UNC-based World Health Organization (WHO) Collaborating Center for Research Evidence in Sexual and Reproductive Health. The Center helps WHO and other leading United Nations health agencies as they develop and implement science-driven solutions for preventing mater-nal deaths in the 25 countries in which most such deaths occur. “Mike has helped us immensely,” Peterson says. “His wisdom and expertise have been absolutely invaluable, and his generous gift is key in getting this important work off the ground.” – Linda Kastleman Michael Kafrissen, MD: Giving back to support a cause I believe in Dr. Michael Kafrissen Dr. Bert Peterson holding Nikhil Gomez PHOTO BY ANU MANCHIKANTI GOMEZ C A R O L I N A P U B L I C H E A L T H | 35 DONOR S Juliana Meimei Ma Allen Martin Mabry Craig Stephen Maughan William Sheffield McCoy The MidSouth Lactation Consultants Association Beverly Mirman Philip Keith Mitchell Hannah Yang Moore Hal Morgenstern John Bertrand Mulligan Jr. Mary Margaret H. Mundt J. Richard Navarre & Melissa McPheeters Jacob Alan Neufeld Raymond Joseph Nierstedt Julie Truax Nunez Donald & Mary Oberlin Timothy Wade Okabayashi Richard Davis Olin Richard Jay Osborne Jane Therese Osterhaus Anne Townsend Overman Ruth Woodenberg Patterson in memory of Jessie Satia Brian E. Pedersen Jamie Perin Helen Peters David Edward Pinsky Lewis William Pollack Barry Michael Popkin in memory of Jessie Satia Lanny & Cleta Puckett Xiang Qin Irving & Joan Rimer Susan Wenger Robbins in honor of Miriam Labbok Charles Eric Rodes Ruth Rothman in honor of Miriam Labbok Eris Hamrick Russell William & Donna Rutala Susan Marie Sanders Victor & Marion Schoenbach Chuan-Feng Shih Mary Kate Shirah in honor of Linda Cook Linda Simoni-Wastila William Thomas Small Jr. Fraser B. Smith Jeffrey Boyd Smith Amy Kathryn Spangler in memory of Mary Rose Tully Scott & Ann Stoioff Anne Nelson Stokley Susan E. Strunk Lisa Ann Sutherland James & Sandra Swenberg Robert Charles Sykes J. Chi-Chung Tang Gabriel Kodzo Tanson M.J. Territo Willem A. Van Eck Wanda Kay Wilkins Deborah Marie Winn Richard Vance Wolfenden Beverly Ann Young $100 to $249 Rashmi Agarwal Daniel & Kathryn Ahlport Alan & Barbara Alexander Jean Elizabeth Alexander M. Taylor Alexander Jr. William & Mary Allshouse Amgen Foundation Terry P. Anderson Anonymous (4) Lenore Arab Nikita Arya Annella Jean Auer Carolann Dineen Augustine A. John Bailer & Jennifer Faris-Bailer Samuel J. Barone E. Byrd Barr C. W. Bartholomai Valentine R. Bauer Melinda A. Beck Bruce Anthony Behringer Ronald Benson & Nellie Hansen Carl Levon Biggs Richard E. Bilsborrow Elizabeth Hardaway Birkenbeuel Michelle Jones Blackmon Aaron Earl Blair J
Object Description
Description
Title | Carolina public health |
Date | 2010 |
Description | Volume 1, Number 9 (Fall 2010) |
Digital Characteristics-A | 23320 KB; 52 p. |
Digital Format | application/pdf |
Full Text | FAL L 2 0 1 0 VOLUME 1 · NUMBER 9 Jack E. Wilson, PE, MSENV President Member of the Board of Directors TEC Inc. Delton Atkinson, MPH, MPH, PMP Vice President Deputy Director Division of Vital Statistics National Center for Health Statistics Centers for Disease Control and Prevention Barbara K. Rimer, DrPH Executive Vice President Ex Officio Dean Alumni Distinguished Professor UNC Gillings School of Global Public Health Peggy Dean Glenn Executive Director/Secretary Ex Officio Associate Dean for External Affairs UNC Gillings School of Global Public Health Charlotte Nuñez-Wolff, EdD Treasurer Ex Officio Associate Dean for Business and Finance UNC Gillings School of Global Public Health Julie MacMillan, MPH Member Ex Officio Interim Senior Associate Dean UNC Gillings School of Global Public Health David J. Ballard, MD, MSPH, PhD, FACP Senior Vice President and Chief Quality Officer Baylor Health Care System Executive Director and BHCS Endowed Chair Institute for Health Care Research and Improvement Andrea Bazán, MPH, MSW President Triangle Community Foundation Fred T. Brown Jr., MPH, FACHE Group Senior Vice President Eastern Division Carolinas HealthCare System Kelly B. Browning, MA Executive Vice President American Institute for Cancer Research P. LaMont Bryant, PhD, RAC Manager, Regulatory Affairs Ethicon Endo-Surgery/Johnson & Johnson Cynthia H. Cassell, PhD Health Scientist, Epidemiology Team Birth Defects Branch Division of Birth Defects and Developmental Disabilities National Center for Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Deniese M. Chaney, MPH Partner Accenture Health and Life Sciences Stacy-Ann Christian, JD, MPH Senior Director Research Administration New York City Health and Hospital Corp. Michael (Trey) A. Crabb III, MHA, MBA President Health Strategy Partners LLC Leah Devlin, DDS, MPH Gillings Visiting Professor UNC Gillings School of Global Public Health Cynthia J. Girman, DrPH Senior Director, Department of Epidemiology Merck Research Laboratories Sandra W. Green, MBA, MHA, BSPH President East Coast Customer Management Group MedAssets Inc. C. David Hardison, PhD Corporate Vice President, Life Sciences Science Applications International Corp. Deborah Parham Hopson, PhD, RN Assistant Surgeon General Associate Administrator HIV/AIDS Bureau Health Resources and Services Administration Joan C. Huntley, PhD, MPH Adjunct Professor of Epidemiology UNC Gillings School of Global Public Health Joseph F. John, MHA, FACHE Administrator Clinical Operations The Emory Clinic Inc. Mark H. Merrill, MSPH President and Chief Executive Officer Valley Health System Stephen A. Morse, MSPH, PhD Associate Director for Environmental Microbiology National Center for the Prevention, Detection and Control of Infectious Diseases Centers for Disease Control and Prevention Douglas M. Owen, PE, BCEE Vice President Malcolm Pirnie Inc. Jonathan J. Pullin, MS President and Chief Executive Officer The Environmental Group of the Carolinas Inc. Roy J. Ramthun, MSPH President HSA Consulting Services LLC Laura Helms Reece, DrPH Chief Operating Officer Rho James Rosen, MBA, MSPH Partner Intersouth Partners Jacqueline vdH Sergent, MPH, RD, LDN Health Promotion Coordinator/ Health Education Supervisor Granville-Vance (N.C.) District Health Department Ilene C. Siegler, PhD, MPH Professor of Medical Psychology Duke University Jeffrey B. Smith, MHA, CPA Partner Ernst & Young LLP Paula Brown Stafford, MPH Executive Vice President Integrated Clinical Services Quintiles John C. Triplett, MD, MPH Regional Medical Officer Bethesda, Md. G. Robert Weedon, DVM, MPH Veterinary Outreach Coordinator Alliance for Rabies Control Adjunct Faculty UNC-Wilmington Veterinarian New Hanover Co. (N.C.) Board of Health Alice D. White, PhD Vice President 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 Joan H. Gillings CHAIR, ADVANCEMENT Donald A. Holzworth, MS Chair Chairman Futures Group International James Rosen, MBA, MSPH Public Health Foundation Board Liaison to Advisory Council Partner Intersouth Partners Marcia A. Angle, MD, MPH Adjunct Professor Nicholas School of the Environment Duke University William K. Atkinson, PhD, MPH President and Chief Executive Officer WakeMed Joseph Carsanaro, MBA, MSEE General Manager Pinehurst Advisors LLC Gail H. Cassell, PhD, DSc (hon) Vice President, Scientific Affairs Distinguished Lilly Research Scholar for Infectious Diseases Eli Lilly and Co. Willard Cates Jr., MD, MPH President, Research Family Health International Keith Crisco, MBA Secretary of Commerce State of North Carolina Ken Eudy Chief Executive Officer Capstrat Robert J. Greczyn Jr., MPH CEO Emeritus BlueCross and BlueShield of N.C. Gillings Visiting Professor UNC Gillings School of Global Public Health James R. Hendricks Jr., MS Vice President, Environment, Health and Safety (Retired) Duke Energy J. Douglas Holladay, MDiv Chairman and Chief Executive Officer PathNorth A. Dennis McBride, MD, MPH Health Director City of Milford (Conn.) John McConnell Chief Executive Officer McConnell Golf Jesse Milan Jr., JD Vice President and Director Community Health Systems Altarum Institute Guy Miller, MD, PhD Chairman and Chief Executive Officer Edison Pharmaceuticals Inc. James Patrick O’Connell, PhD, MPH Chief Executive Officer Acea Biosciences Inc. Jane Smith Patterson Executive Director The e-NC Authority Virginia B. Sall Co-founder and Director Sall Family Foundation Charles A. Sanders, MD Chairman and Chief Executive Officer (Retired) Glaxo Inc. Paul M. Wiles, MHA President and Chief Executive Officer Novant Health Inc. Markus Wilhelm Chief Executive Officer Strata Solar LLC Derek Winstanly, MBChB Executive Vice President Strategic Business Partnerships and Customer Relationships Quintiles Louise Winstanly, LLB, MSB Attorney and Medical Ethicist Chapel Hill, N.C. Lloyd M. Yates, MBA President and Chief Executive Officer Progress Energy MEMBERS EMERITI Nancy A. Dreyer, PhD, MPH Chief of Scientific Affairs OUTCOME Carmen Hooker Odom, MS President Milbank Memorial Fund UNC Gillings School of Global Public Health ADVISORY COUNCIL C A R O L I N A P U B L I C H E A L T H | 1 contents fall 2010 3 FROM THE DEAN’S DESK Let’s get moving! 4 FIT AND HEALTHY FOR A LIFETIME UNC public health faculty, students and alumni discover ways to trim down the obesity epidemic. 6 A HEALTHY START TO LIFE For 30 years, the number of overweight children has crept higher. Establishing good health habits early can reverse this trend and help children lead healthy lives. 9 NAP SACC – HELPING CHILD CARE CENTERS IMPROVE PRESCHOOLERS’ HEALTH This NIH-funded intervention helps child care centers in North Carolina boost food quality and improve opportunities for physical activity for preschoolers. 10 ADOLESCENCE – A TIME TO GROW UP FIT FOR LIFE Adolescence is a time of dramatic physical and emotional changes. It’s also a time when many young people gain weight as their exercise levels and appetites change. 13 EAT YOUR FRUITS AND VEGETABLES – MANGA COMICS GET THE MESSAGE ACROSS TO KIDS Alumna May May Leung uses Japanese comic art to promote positive health behaviors in youth. 14 FAT GENES School researchers identify the genes that affect body weight. 15 LIVING HEALTHY – HOW ADULTS CAN MAINTAIN OR LOSE WEIGHT As we ‘settle down,’ adults are at risk for weight gain and illness, including cardiovascular disease and diabetes. 17 IS PERCEIVED RACISM A RISK FACTOR FOR OBESITY? Dr. Anissa Vines suggests that an emotional response to racism is stress, which increases belly fat. 18 FOR WEIGHT LOSS, WORKING TOGETHER IS OFTEN THE BEST APPROACH Researchers engage churches, community groups and others in programs to improve health and avoid obesity-related illness. features & news continued 8 6 15 10 18 4 2 | FA L L 2 0 1 0 THE WORLD IS FAT Across North Carolina and around the world, we investigate why obesity rates have ballooned, how the phenomenon affects health and what to do about it. 21 ACTIVE LIVING BY DESIGN With an initial Robert Wood Johnson Foundation investment in 2001, ALBD began working within communities to solve infrastructure challenges around physical activity and healthy eating. 25 SCHOOL NEWS 28 AWARDS AND RECOGNITIONS 31 HONOR ROLL 33 ROSENAU SOCIETY 34 DR. MICHAEL KAFRISSEN 37 MATHILE INSTITUTE 38 BILL AND ROSA SMALL 39 MABEL JOHANSSON 41 CHILDFUND INTERNATIONAL 42 ANNUAL FUND SCHOLARS 44 THE COCA-COLA COMPANY contents, continued 31 fall 2010 DEAN Barbara K. Rimer, DrPH DIRECTOR OF COMMUNICATIONS MANAGING EDITOR Ramona DuBose EDITOR Linda Kastleman ASSOCIATE DEAN FOR EXTERNAL AFFAIRS Peggy Dean Glenn DESIGN AND PRODUCTION Amanda Zettervall UNC Design Services CONTRIBUTING WRITERS Ramona DuBose, Whitney L.J. Howell, Linda Kastleman, Kathleen Kearns, Michele Lynn, Chris Perry, Susan Shackelford, Angela Spivey, Bobbi Wallace COVER ILLUSTRATION John Roman Articles appearing in Carolina Public Health may be reprinted with permission from the editor. Send correspondence to Editor, Carolina Public Health, Gillings School of Global Public Health, Campus Box 7400, Chapel Hill, NC 27599-7400, or e-mail sphcomm@listserv.unc.edu. SUBSCRIBE TO CAROLINA PUBLIC HEALTH www.sph.unc.edu/cph 18,000 copies of this document were printed at a cost of $17,021.35 or $0.95 per copy. 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. 1, No. 9, Fall 2010. our donors gatefold 25 gatefold HONOR ROLL SCHOOL NEWS C A R O L I N A P U B L I C H E A L T H | 3 In 1980, about 15 percent of Americans were obese; today, about 34 percent are, and another third are overweight. Since 1980, the proportion of children ages 2 to 19 who are obese has tripled. How did we gain all this weight? Our genes did not change that fast! Most experts agree that there are several key reasons: we are eating about 300 more calories every day than we did in 1985, our portion sizes have increased dramatically, we’re drinking more sugary drinks, and the majority of us are getting less exercise. Most children no longer have regular gym classes, and they are more likely to be on computers and smart phones after school than outside playing. Many neighborhoods lack safe places to walk. Sixty percent of adults don’t get enough exercise to achieve health benefits. The tab for our extra pounds is at least $147 billion a year. Obese people spend 43 percent more on health care costs than do healthy-weight people. As you will read in this issue, faculty members in our Department of Nutrition and across the School have made fundamental contributions to under-standing the science of nutrition, determining why some people are more prone to gaining weight than others, explaining the worldwide distribution of obesity and its predictors, and developing, testing and disseminating evidence-based interventions and policies to reduce obesity and prevent weight gain in a variety of populations in the U.S. and elsewhere. As with other health problems, some minorities and disadvantaged populations bear a disproportionate share of the burden. Nutrition research must be done in labs, clin-ics, communities and workplaces, with individuals and in larger units. It is a complex problem with no “magic bullet” solution. As we have learned from the smoking arena, it won’t be sufficient to inter-vene only with individuals. Policies should require physical education in schools and limit sugary drinks. Worksite cafeterias should charge more for less healthy than healthy foods. Health plans should provide incentives for healthy weight and exercise. And that’s just a beginning. At the School, we’ve taken steps beyond our outstanding research, such as trying to increase the choices of healthier foods in our café, serving healthier foods at events, buying local foods wher-ever possible and reducing portion sizes. Ultimately, we’re also role models for one another and the larger community. We should more actively encourage our faculty, staff and students to exercise and eat healthily, and reach out to the community around us. We imagine a time when our grounds could be turned into great walking trails with water sculptures and informative trail markers, and we could become not just a center for knowledge dis-covery and dissemination but a center for activity. Let’s get moving! Let’s Get Moving! Obesity is a major economic and health threat in North Carolina, the U.S. and around the world. The fact that obesity is spreading in an almost epidemic manner means that some countries still could intervene before it is too late – just as some countries woke up to the potential for intervention on tobacco, before high smoking rates had overtaken their populations. We are at an important tipping point on obesity, both in the U.S. and globally. Dr. Barbara K. Rimer from the Dean’s desk PHOTO BY L ISA MARIE ALBERT We are at an important tipping point on obesity, both in the U.S. and globally. 4 | F A L L 2 0 1 0 Fit and healthy for a lifetime Her mother cringes, hearing echoes of the taunts from her own childhood. She wants to spare her daughter the low energy and poor self-esteem that she endures as an obese adult. Even more, she doesn’t want her daughter to face the same high risk of disease. But her mind races to statistics she’s read, compiled by the Robert Wood Johnson Foundation (www.rwjf.org) and the Trust for America’s Health (http://healthyamericans. org). In 2010, more than 25 percent of adults in 38 states are obese. (Just 10 years ago, no state had an obesity rate above 20 percent.) More than 12 million American children, ages 10 to 17, are obese. Her crisis – her daughter’s crisis – has become epidemic. These days, many agents – from First Lady Michelle Obama to the Centers for Disease Control and Prevention, from insurance companies to school nutrition counselors – seek ways to control the crisis. Mrs. Obama’s initiative, “Let’s Move” (www.letsmove.gov), has the audacious goal of solving the obesity epidemic in one generation. “[Obesity] is a major public health threat right now,” she said, announcing the program, “so just imag-ine what we’re going to be facing in 20 or 30 years if we don’t get on this issue.” The American Institute for Cancer Research (AICR) reports that excess body fat causes approximately 103,000 cases of cancer in the United States every year. “Many people are aware of the role of obesity when it comes to increasing the risk of cardiovascular disease and type 2 diabetes,” says Kelly B. Browning, AICR executive vice presi-dent and member of the School’s Public Health Foundation board of directors, “and we at AICR want to make sure people know that excess body fat also increases the risk for cancer.” For more than three decades, the UNC Gillings School of Global Public Health has been a recognized world leader in discover-ing evidence-based, creative and sustain-able ways to prevent obesity and to help people lose weight. Mrs. Obama cited UNC’s NAP SACC program (see page 9), aimed at improving nutrition and increasing exercise in child care centers throughout North Caro-lina, as an example of a creative, successful intervention. “We have a world that consumes more satu-rated fat and more meat and dairy products than we could have imagined 10 to 20 years ago,” says Barry Popkin, PhD, Carla Smith Chamblee Distinguished Professor of Global Nutrition at UNC Gillings School of Global Public Health. “Even in developing countries now, there are more obese people than there are hungry people.” Popkin is one of several School researchers advocating for policy changes at local, state, national and international levels that would help modify behavior, including a call for higher taxes on sugar-sweetened beverages to discourage people from drinking them. Maintaining healthy weight is not only about “looking good.” It’s about feeling good A 10-year-old girl runs into her house in tears. During her first day of fifth grade at a new school, children made fun of her weight. At recess, nobody chose her for their soccer team, saying she ran too slowly to keep up. Some boys called her names. Mommy, she cries, am I always going to be fat? UNC public health faculty, students and alumni discover ways to trim down the obesity epidemic F E AT U R E S A N D N EWS Kelly Browning Dr. Barry Popkin – having energy to enjoy life and minimiz-ing disease risks that strain the health care system and slow productivity. Faculty members and students in UNC’s renowned nutrition department – based in the public health and medical schools – are finding solutions. For example, nutrition professor Melinda Beck, PhD, uses mouse models to explain the link between obesity and higher mortality rates from influenza. Professor Rosalind Coleman, MD, stud-ies hepatic insulin resistance and inborn errors of carbohydrate and lipid metabolism. Researchers including Kari North, PhD, asso-ciate professor of epidemiology, and Daniel Pomp, MD, professor of genetics, nutrition, and cell and molecular physiology, look at genetic factors that may contribute to obesity and related diseases. Other researchers, including Peggy Bent-ley, PhD, nutrition professor and the School’s associate dean for global health, Miriam Labbok, MD, Professor of the Practice of maternal and child health and director of the School’s Carolina Global Breastfeeding Institute, and Elizabeth Mayer-Davis, PhD, nutrition professor and vice president of the American Diabetes Association, search for critical information about what and how we feed infants and young children. Nutri-tion professor Dianne Stanton Ward, EdD, explores ways to increase activity and healthy eating for children in child care settings. June Stevens, PhD, nutrition chair, and associate professors Penny Gordon-Larsen, PhD, Deborah Tate, PhD, and others, find interventions to help adolescents lose weight or avoid gaining extra pounds. Tate’s creative approaches include text messaging, active video gaming and nutrition counseling to help during this critical period of development. Recent alumna May May Leung, PhD, used manga comics (Japanese comic art) to pro-mote positive health behaviors in youth. (See page 13.) Other approaches are aimed at adults. Tate and associate professor Laura Lin-nan, ScD, assess the usefulness of work-place- centered weight loss programs. Professors Alice Ammer-man, DrPH, and Marci Campbell, PhD, teach communities about the benefits of eating fresh fruits and vegetables. Epide-miology professor Marilee Gammon, PhD, examines the connection between weight and exercise, and the impact both have upon multiple diseases, including cancer, diabetes, heart disease and stroke. Oth-ers, including Anissa Vines, PhD, research assistant professor of epidemiology, search for causes of racial disparities in obesity and related diseases. Their research is conducted across North Carolina in towns such as Kinston, Hills-borough, Clinton and Greensboro. The search for answers extends throughout the world, with research projects in China, India, Mex-ico, Philippines and the Arctic Circle. This issue of Carolina Public Health describes only some of the obesity-related work in which faculty members and students are involved. “Obesity is a preventable cause of disease and death that has a huge impact on quality of life and health care costs,” says nutrition chair Stevens, AICR/WCRF Distinguished Professor of nutrition and epidemiology. “It is important that we train the next gen-eration of students to build on what we are now discovering about obesity in order to create new solutions. There are so few indi-viduals trained to understand the biologic, behavioral and population sciences needed to effectively combat the obesity epidemic. The School’s approaches address health and nutrition at all stages of people’s lives.” To educate doctors about nutrition-related disease, Steve Zeisel, MD, PhD, Kenan Dis-tinguished Professor of nutrition at the School and director of the Nutrition Research Institute in Kannapolis, N.C., has developed a groundbreaking Nutrition in Medicine course for medical students and practic-ing physicians. (See www.med.unc.edu/nutr/ nim.) The online materials, made avail-able free to medical students, are used by more than 100 U.S. medical and osteopathic schools and by more than 50 international institutions. Also available is a new online training program, Nutrition Education for Practicing Physicians (NEPP), funded by the National Cancer Institute. “We have scientific evidence explaining the role of nutrition in preventing and man-aging most of the leading causes of death in the U.S.,” says Zeisel. “Physicians are uniquely positioned to emphasize to patients the importance of nutrition in prevent-ing and managing chronic disease. How-ever, physicians must be prepared to give specific advice about nutrition to patients.” Maybe one day, when the 10-year-old is grown and has a child of her own, new preven-tion strategies, combined with better under-standing of nutrition, genetics and behavior management, will reduce the chances that she and her child will face the dangers of obe-sity. With effort, they will be part of a more energetic, healthier world. –Ramona DuBose C A R O L I N A P U B L I C H E A L T H | 5 Dr. June Stevens Dr. Steve Zeisel 6 | F A L L 2 0 1 0 F E AT U R E S A N D N EWS Establishing good health habits early can reverse this trend and help children have healthy lives. The UNC Gillings School of Global Public Health leads the fight against the obesity epidemic and promotes healthy behaviors locally, nationally and globally. “Combating obesity is a key strategic area for the School,” says Peggy Bentley, PhD, nutrition professor and the School’s associ-ate dean for global health. “UNC is playing a major role in obesity research. We have faculty and graduate student expertise from the molecular level through epidemiology, economics, interventions and policy.” You are what your mother eats Society’s advice to expectant mothers his-torically has been to “eat for two.” However, contemporary research shows that eating unhealthy, high-calorie foods during preg-nancy can put children at risk for weight struggles and health complications before they are born. For 15 years, Anna Maria Siega-Riz, PhD, RD, nutrition and epidemiology professor and associate dean for academic affairs at the School, has analyzed prenatal nutrition data to determine which health habits give children the best start in life. “Pregnancy is a happy moment in life, but it’s also when women are most concerned about the health of their child,” she says. “If they have bad health habits, many women are more likely to modify their behavior, at least in the short term.” Although most women know to limit weight gain during pregnancy, 60 percent still gain more weight than they should, based on Institute of Medicine recom-mendations. (Siega-Riz was a member of the prestigious IOM panel that developed those guidelines, available at http://tinyurl. com/iom-guidelines.) Fewer than 25 percent receive guidance from their doctors about physical activity. Making and maintaining behavioral changes is difficult unless women have positive, consistent support. Siega-Riz’s team uses the Internet, pod-casts, chat rooms and cell phones to provide health information and online support for pregnant women. One podcast includes a skit in which four women, all at different parent-hood stages, advise an expectant mom about choosing nutritious foods. Women with healthy habits may avoid having a baby who is too large for gestational age (often leading to C-section births), pre-vent shoulder dystocia for the baby during birth, and limit the child’s risk for developing diabetes and obesity. “Women who aren’t eating right or exer-cising need assistance,” Siega-Riz says. “We must help them find balance and give them all the support they require.” Choosing healthful foods during preg-nancy could reduce the burden of chronic diseases later in life, says Mihai Niculescu, MD, PhD, nutrition assistant professor. Whether the “fat gene” exists is debatable (see page 14), but Niculescu’s epigenetic work – research that determines how outside A healthy start to life For 30 years, the number of overweight children has crept higher and higher. In 2008, the Centers for Disease Control and Prevention reported 10 percent of children ages 2 to 5 had an unhealthy body mass index. Those children have a 70 percent chance of being overweight or obese adults. Dr. Meghan Slining Dr. Margaret Bentley Dr. Cindy Bulik Dr. Miriam Labbok Dr. Mihai Niculescu Dr. Anna Maria Siega-Riz C A R O L I N A P U B L I C H E A L T H | 7 influences alter our DNA – shows that high-fat diets and maternal obesity in mice alter DNA, shutting down some genes and accel-erating others. Developmental brain delays in offspring are the result. When maternal obesity exists, the neu-rons in mouse fetal brains at 17 days of pregnancy appear less developed, according to Niculescu’s observations. The implications are worrisome, he says, because the effects are evident after three or four generations. “This may have profound consequences for an offspring’s life, including his or her mental development and ability to learn,” he says. “A high-fat, less nutritious diet can also create food preferences in unborn offspring that lead them to choose unhealthy foods later in life.” Open the hangar – here comes the airplane! Parental influence over children’s nutrition doesn’t end at birth, but little research exists on what increases obesity risk in children under two. In 2002, Associate Dean Bent-ley became a pioneer in this area when she launched “Infant Care, Feeding and Risk of Obesity,” a study of strategies used by first-time African-American mothers to feed their 3-month to 18-month-old children. With National Institutes of Health fund-ing, Bentley recruited 217 mother-child pairs in North Carolina through the Women, Infants and Children program and vid-eotaped them at three-month intervals to identify feeding styles. She and her team identified five styles: controlling, laissez-faire, responsive, pressuring and restrictive. Responsive mothers, she says, are “perfect moms” who pay close attention to and cor-rectly interpret child cues of hunger and satiety. They are very engaged during feeding and may provide verbal and physical encour-agement and help, when needed. Other styles pressure or even force children to eat when they reject food or overly restrict the qual-ity and quantity of what children eat, often because the mother is concerned about her child becoming fat. “Many factors play a role in how we feed infants. However, we believe that it is not just what children are fed, but also how they are fed that makes a difference in the child’s acceptance of food and perhaps in later food preferences and health outcomes,” Bentley says. “Understanding the role these styles 8 Women who choose healthful foods during pregnancy may reduce their own risk of chronic diseases later in life and improve their children���s ability to learn. Pregnancy is a happy moment in life, but it’s also when women are most concerned about the health of their child. If they have bad health habits, many women are more likely to modify their behavior, at least in the short term. F E AT U R E S A N D N EWS 8 | F A L L 2 0 1 0 play in growth and development outcomes is a big part of what drives our childhood obesity study.” Meghan Slining, PhD, nutrition assis-tant professor, analyzed data from Bentley’s study while she was a UNC doctoral student. Overweight infants – those who measured greater than the 90th percentile for weight versus length – were nearly twice as likely as normal-weight infants to have delayed motor development, Slining found. “While baby fat may be cute,” Slining says, “it increases the chance that a child could become an overweight adult. We also have seen more immediate consequences to extra pudginess. These children have lower gross motor development.” (See a video about Slining’s research at http://tinyurl.com/ slining-baby_fat.) Add a mother with an eating disorder to the mix, and feeding a child becomes even more complex. Jordan Distinguished Professor of Eating Disorders Cynthia Bulik, PhD, used data from the Norwegian Mother and Child Cohort Study, which followed more than 100,000 Norwegian mothers, some of whom had anorexia or bulimia nervosa or binge eating disorder, to deter-mine how they fed their children. Bulik followed the mothers from 17 weeks’ gestation through their chil-dren’s eighth birthdays. Although some moth-ers with eating disorders experienced a reprieve from their conditions during pregnancy, this was not universally the case. In fact, a surprising number of women developed binge eating disorder during pregnancy. Eating disorders during pregnancy expose babies to erratic eating, Bulik says. “The impact of roller-coaster caloric intake certainly affects growth and development,” Bulik says. “It could also affect obesity and diabetes risk, as well as the weight trajectory for later in life.” Mothers with eating disorders also aban-doned breastfeeding earlier than did healthy mothers, Bulik says. After giving birth, women with eating disorders often feel they no longer “have a reason to be overweight” and choose not to consume adequate calories to support breastfeeding. Bulik’s study also shows that, as these children grow, they are more likely to develop eating problems, such as having stomach aches, vomiting without cause or not enjoy-ing food. According to Miriam Labbok, MD, Pro-fessor of the Practice of maternal and child health and director of the School’s Carolina Global Breastfeeding Institute, a breastfeed-ing baby will “stop when full,” but bottle feeding can overpower a baby’s ability to recognize satiety. When a parent insists that the baby empty the bottle, the child learns the habit of overeating, Labbok says. Addi-tionally, breastfed babies are exposed to the tastes of foods eaten by their mothers. For a formula-fed child, food flavors are new and strange, which could cause the child to be a picky eater. Employing research to instill good eating habits early is paramount to changing the course of human health, Bentley says. “It’s harder to intervene and prevent nutri-tion problems when a child is older. They have preferences and eating patterns that make changes more complicated and dif-ficult,” she says. “But, with the research ongoing at the School, we know we’re leading a positive trajectory of implementing healthy habits early.” –Whitney L.J. Howell The impact of roller-coaster caloric intake certainly affects growth and development. It could also affect obesity and diabetes risk, as well as the weight trajectory for later in life. Karina Agopian, research assistant at UNC’s Nutrition Research Institute in Kannapolis, works with a toddler to determine what and how much the child has eaten. Research shows that early eating habits influence later food preferences and health outcomes. PHOTO BY CHAD W. MITCHELL C A R O L I N A P U B L I C H E A L T H | 9 WHAT WOULD HAPPEN IF CHILDREN IN CHILD CARE WERE SERVED GREEN BEANS INSTEAD OF FRENCH FRIES – OR TOOK A NATURE WALK INSTEAD OF SITTING IN A CIRCLE INSIDE? Then perhaps 26 percent of them wouldn’t be overweight, as they are now, reasons UNC Gillings School of Global Public Health nutrition professor Dianne Ward, EdD. These and other tactics are par t of an intervention Ward developed called Nutrition and Physical Activity Self Assessment for Child Care (NAP SACC) to help child care centers in Nor th Carolina boost their food quality, improve physical activities of fered and augment staf f-child interac-tions for children ages 2 through 5. “Child care center resources are of ten limited, and they don’t have a lot of leeway to spend time and money on making changes,” Ward says. “This intervention is designed to be used by the motivated, savvy child care provider to institute changes.” NAP SACC is a free, five-step intervention funded by the National Institutes of Health. It also has been recognized and recommended by the White House Task Force on Child-hood Obesity, led by First Lady Michelle Obama (www. letsmove.gov) and is par t of Nor th Carolina’s “Eat Smar t, Move More” initiative (www.eatsmartmovemorenc.com). Centers conduct a 15-par t self-assessment and select three or four areas for improvement. A NAP SACC consult-ant conducts workshops to guide the facility staf f through changes and is available for follow-up assistance as centers make alterations. A second assessment helps centers deter-mine whether they’ve been successful and prompts them to choose additional areas for improvement. To access the NAP SACC intervention online, visit www.napsacc.org. –Whitney L.J. Howell Dr. Dianne Ward Helping child care centers improve preschoolers’ health Go outside every day, without exception. T I P PHOTO BY JENNY SANDUM PHOTO BY LINDA KASTLEMAN Three-year-old Emily Sandum enjoys a daily visit to the playground. 10 | F A L L 2 0 1 0 “It’s essential to understand that adoles-cence is a crucial period for weight gain,” says Penny Gordon-Larsen, PhD, UNC nutrition associate professor. In her wide-ranging research on adolescent obesity, Gordon-Larsen has studied a representative group of Americans, starting in their teens and following them through their early 30s. In 1996, 13.3 percent of adolescents were obese; by 2008, obesity prevalence had increased to 36.1 percent. Ninety percent of the adolescents obese in 1996 remained obese in 2008. “With the vast majority of obese adoles-cents staying that way into adulthood, it is critical that we develop programs to prevent the problem in adolescence,” says Gordon- Larsen. “If we can interrupt that trajectory, we will save money later in terms of car-diovascular and other health risks, and we will help these young people have healthier and longer lives.” Gordon-Larsen is one of many UNC Gillings School of Global Public Health faculty members who have long been com-mitted to addressing the youth obesity epi-demic. June Stevens, PhD, nutrition profes-sor and department chair, was the principal investigator for “Trial of Activity in Adoles-cent Girls,” a pioneering National Institutes of Health-funded study. Known as TAAG, it explored ways to increase physical activ-ity among sixth-grade girls between 2003 and 2006. The program continues to serve as a model for communities throughout the country. “Get 60,” another innovative program, was a partnership between UNC’s pub-lic health school and athletics department and The Gatorade Company. Designed to Adolescence A time to grow up fit for life Adolescence is a time of dramatic physical and emotional upheaval. It’s also a time when many young people gain weight as their exercise levels and appetites change. Leave off the TV during meals. T I P Dr. Penny Gordon-Larsen leverage student athletes’ influence as role models, the program brought UNC athletes to local schools to encourage the children to be active 60 minutes each day. The program, now replicated in other parts of the coun-try, provides materials to teachers, parents and student athletes describing how to help young people become more physically active. Nutrition professor Dianne Ward, EdD, led the development of the program. Quantifying the impact of school physical education (PE) programs on physical activ-ity patterns was a key part of research by Gordon-Larsen, along with Barry Popkin, PhD, and Robert G. McMurray, PhD, both UNC nutrition professors. They found that students participating in daily PE classes were twice as likely to be physically active than students who were not enrolled in any school PE. Their study offered empirical data used to support passage of the national Physical Education for Progress Act. PEP, as it was called, was passed in 2000 to provide expanded physical education programs for students in kindergarten through grade 12. As the fight against ado-lescent obesity continues, UNC researchers turn to newer technologies to help reduce and prevent weight gain. For her doctoral dis-sertation, Elizabeth Lyons, PhD, and her adviser, Deb-orah Tate, PhD, associate professor of health behavior and health education and of nutrition, conducted a Robert Wood Johnson Foundation-funded study of video games played by 18- to 35- year olds. The results can be extrapolated to younger teens. “The study’s premise was not only to determine how much energy people can expend playing different types of video games, but also to consider how much they enjoyed different types of games,” says Tate. “The games that use the most energy expenditure may not be the ones that people like playing the most.” “People don’t have to be playing the most active games to achieve some benefit in terms of a public health impact,” Lyons adds, “if they are replacing their TV time with some-thing that is even slightly more active.” School researchers are not focused only on exercise as a means of addressing the issue of weight. Noel Kulik, another doctoral student of Tate’s, focuses her dissertation research 8 C A R O L I N A P U B L I C H E A L T H | 11 PHOTO BY KRIS HOYT (Right) Adolescents don’t have to play the most active games to achieve health benefits – as long as they replace TV time with something more active. (Below) Brothers Isaiah and Joe King select fruit for an afternoon snack. The boys participated in research conducted by Dr. May May Leung (see page 13). It’s essential to understand that adolescence is a crucial period for weight gain. 12 | F A L L 2 0 1 0 F E AT U R E S A N D N EWS on adolescent social support for weight loss. Tate has led a variety of studies with ado-lescents, including “enerG,” which used the Internet to help adolescent girls lose weight. While the researchers found that adding the Internet was not beneficial to adolescents, they realized that the intensive face-to-face program they developed as a control arm of the study was very effective. The SNAP (Study of Novel Approaches to Prevention) program – led by UNC principal investigator Tate and currently recruiting people ages 18 to 35 – aims for weight gain prevention through early adulthood. (See www.snapstudy.org.) Even if young people emerge from adolescence at normal weight, research shows that the aver-age weight gain for Ameri-cans in the years between age 18 and 35 is 30 pounds. Under the direction of Dr. June Stevens, Dan Taber, PhD, conducted disserta-tion research at UNC that examined whether ado-lescent weight gain can be influenced by public policy. Taber studied the association between soda consumption and Body Mass Index (BMI) in adolescents in states that changed their policies to restrict junk food in schools. He also mea-sured differences across racial and ethnic groups. The study suggests that changes in state policies restricting junk food in schools can reduce soda consumption among ado-lescents, particularly non-Hispanic blacks, but there was no impact on BMI percentile. Taber says the findings support a need for comprehensive policy change – in and out-side of schools. He says additional research is needed to evaluate the impact of compre-hensive policy change on obesity. As Stevens notes, “This may be the first time ever that the next generation of children will have a shorter life span than their parents, on average, and that change would be driven by obesity. Obesity is an extremely important public health problem that should have a simple solution: children need to eat healthier diets and be more active. But it’s actually quite complicated and challenging to make that happen. It needs to happen not just in a few individuals, but in the entire population of children in our country, because while not all children are obese, all children need to eat healthy diets and be physically active.” –Michele Lynn The Body Mass Index (BMI) is a measure that determines percentage of body fat based on a relationship of weight to height. A person is considered “overweight” if his or her BMI is between 25 and 29.9, and “obese” if the BMI is 30 or above. There are many BMI calculators available online,* but here’s one way to determine it: • A = Your body weight divided by your height • B = ‘A’ divided by your height • BMI = B x 703 Therefore a person who weighs 140 pounds and is 5’5” (65”) tall has a BMI of 23.2: • 140/65 = 2.15 • 2.15/65 = 0.033 • 0.033 x 703 = 23.199 A more informal way of calculation suggests that someone is “overweight” if he is 10 per-cent above healthy weight for his height, and “obese” if 30 percent above healthy weight. *For example, see http://tinyurl.com/bmi-at-cdc. BODY MASS INDEX (BMI) Try to eat two meals together at home each day. T I P This may be the first time ever that the next generation of children will have a shorter life span than their parents, on average, and that change would be driven by obesity. C A R O L I N A P U B L I C H E A L T H | 13 “Eat your fruits and vegetables” Dominating book sales in China and pump-ing nearly $100 million into the U.S. comic book industry, the popular Japanese comic art known as manga could have potential to pro-mote behavior change in youth, Leung says. “Often, interventions don’t properly engage or maintain the interest of the intended population,” she says, “so I looked for a model already successful at engaging my target population.” Leung evaluated manga comics and con-ducted research with preteens in four North Carolina counties. She asked the youths what they liked about manga and how they felt about specific health concepts. She then collaborated with local artist Kris Hoyt to create and test a manga comic called “Zen Aku: Fight for Your Right to Fruit.” “The characters are drawn in a simplified manner, allowing more people to identify with them, which could create a greater level of audience involvement,” Leung says. “And because manga comics are sold as entertain-ment, readers may be more likely to be per-suaded by the story’s health messages.” Leung’s research, which has been submit-ted for publication, showed that young people who read the manga comic significantly increased their beliefs in the importance of fruit intake when compared to a group that was given the same information in a nutri-tion newsletter. Alice Ammerman, DrPH, RD, Leung’s adviser, agrees that the results are promis-ing, as increased belief in the importance of fruit intake may result in changing behavior to consume more fruit. Now a tenure-track assistant professor at The City University of New York School of Public Health at Hunter College, Leung envisions taking that next step with future research and plans to extend her experiment to other populations. –Chris Perry Getting preteens to eat healthy foods and increase their physical activity can be a daunting task in today’s fast-food, multimedia world, but nutrition researcher and School alumna May May Leung, PhD, RD, has developed an innovative strategy to capture their attention – manga comics. Manga comics get the message across to kids Dr. May May Leung used manga comics, a popular Japanese comic art form, to encourage preteens to make healthy food choices. PHOTO BY KRIS HOYT ILLUSTRATION BY KRIS HOYT 14 | F A L L 2 0 1 0 F E AT U R E S A N D N EWS Dr. Kari North Dr. Rosalind Coleman Dr. Terry Combs Dr. Daniel Pomp Fat Genes • Kari North, PhD, epidemiology asso-ciate professor, studies risk factors for cardiovascular disease – and obesity is a big one. She and colleague Keri Monda, PhD, proposed a potential location for a gene that controls waist circumference. “Then we realized we needed a lot more samples to discover more loci,” North says. Through a project called GIANT, which has 125,000 participants, they have identified 18 new genetic markers associ-ated with obesity-related traits. “It helps us understand on a molecular level how individuals become obese,” North says. Now her team is working on how these genes interact with environmental factors including gender and physical activity. • Rosalind Coleman, MD, nutrition profes-sor, uses “knockout mice,” each of which lacks a specific enzyme and so a specific genetic function, to identify precise roles of enzymes that metabolize fatty acids. People who are obese or insulin resistant frequently have fatty livers, but the team found that mice lacking one particular enzyme had less fat in their livers, even when the mice were obese. Another group of mice that lacked a different enzyme – the one that activates most of the fatty acids in fat tissue – got fatter, not thinner. The surprising discoveries will lead to more nuanced understanding of the role these enzymes play in human obesity, insulin resistance, diabetes and heart disease. • The more weight a person gains, the more insulin resistant he or she will be. As insulin resistance rises, so does glucose level, which increases the likelihood of diabetes. Insulin normally controls the liver’s glucose production, but the liver of someone with high insulin resistance keeps producing glucose even when it shouldn’t. “We’re asking why the liver is not turning off when glucose is coming in from the gastro-intestinal tract,” says Terry Combs, PhD, nutrition assistant professor, whose team recently identified in mice a gene they believe plays a critical role in the process. “What insulin does is turn on the expression of this gene,” he says, explaining that when the gene is on, the liver turns off glucose production. Now Combs’ lab is working to discover whether the same genetic mechanism occurs in people. • Daniel Pomp, PhD, professor of genetics, nutrition, and cell and molecular physiol-ogy at Carolina Center for Genome Sci-ences, wondered why some people run marathons while others lie around on the couch. Using specially bred mice, he and his team are looking for the genes associ-ated with a predisposition to exercise, a trait that can prevent or control obesity. “There is not one single exercise gene or one obesity gene,” he says. “There are maybe 50, each with a relatively small impact.” His lab’s findings may help humans maintain a healthy weight, but it won’t be a magic bullet. “We know how much a person exercises is 30 to 40 percent influenced by genes,” Pomp says. “But we don’t want people to use [their genetic makeup] as an excuse. The information is meant to make you work harder if you’re predisposed not to exercise much.” –Kathleen Kearns Can we blame extra pounds on our genes? Several researchers at UNC Gillings School of Global Public Health are identifying which genes may have an impact on body weight and investigating precisely how that impact occurs. Eat five servings of fruits and vegetables daily. T I P PHOTOS BY LINDA KASTLEMAN Penny Gordon-Larsen, PhD, nutrition asso-ciate professor and fellow at UNC’s Carolina Population Center, and nutrition doctoral student Natalie The have shown that it’s not just older, married adults who are at risk of gaining weight. It’s young adults, too, par-ticularly if they are married or living with their romantic partners. Young heterosexual couples who live together are at more than twice the risk for becoming obese than are their dating peers, their research shows. Gordon-Larsen and The are the first to study this age group using a national sample. Drawing conclusions from the National Longitudinal Study of Adolescent Health, nicknamed “Add Health,” they released their findings in April 2009 in the journal Obesity. “At baseline, when we started our analysis (during the early- to mid-1990s), study par-ticipants were adolescents between 12 and 20 years old,” The says. “Then we followed them into adulthood, when they were 18 to 27 years of age.” Add Health also recruited the adolescents’ romantic partners to participate in the adult phase of study. The study didn’t address why obesity risk was higher in this group, but data implica-tions were clear. “When you establish a shared household with a romantic partner, you need to think of ways each partner can support the other to create a healthy environment – healthier foods in the house, working out together and supporting each other in terms of physical activity in general,” Gordon-Larsen says. A healthy, supportive environment on the job also is important. Laura Linnan, ScD, and Deborah Tate, PhD, associate professors of health behavior and health education, have shown the value of workplace weight-loss programs. In a “WAY to Health” study with employ-ees at 17 community colleges in North Caro-lina, nearly 20 percent of the subjects lost five percent or more of their body weight with minimum intervention over 12 months — a significant result. Most of the individuals who lost five per-cent of their weight fell into two groups – one that received a Web-based weight-loss pro-gram or one that received the Web program and cash incentives for weight loss. “Losing even five percent of baseline body weight (roughly 10 pounds for the average participant in this study) is important from a public health point of view because the participants begin to experience positive health benefits,” Linnan says of the study, which was funded by the Centers for Disease Control and Prevention. Living Healthy As young people grow up and settle into their adult lives, many are at greater risk for diabetes, heart disease, cancer and other chronic diseases if they become overweight or obese. Researchers at UNC Gillings School of Global Public Health want to know how adults can manage their weight and stay healthy. How adults can maintain or lose weight C A R O L I N A P U B L I C H E A LT H | 15 Young heterosexual couples who live together double their risk for becoming obese, as compared to their dating peers. 16 | F A L L 2 0 1 0 But the researchers, whose results are slated for publication in late 2010, still recog-nize that only about a fifth of the participants achieved the five percent loss over a year. “It told us that if people are motivated and get a self-directed program such as this, they can be successful, but the results are modest,” Tate says. Adds Linnan, “The Web-based weight-loss program is an important option we need to make available to those who are interested in it, but there is no magic bullet. We need other options to support healthy choices. This is not about how motivated people are. It’s more than that. It’s about creating condi-tions where motivated people can make good choices and have options that work for them.” Linnan and Tate were surprised that par-ticipants who received the Web/cash com-bination didn’t perform much better than those who only received the Web program. “They did a little better, but the results were not statistically significant,” Linnan says. She and Tate hope to shine more light on the role of cash incentives in 2011 when they release results from a second study, funded by the National Heart, Lung, and Blood Institute, which tests the inde-pendent effects of the Web-based program and cash incentives. Data from the sec-ond study come from nearly 1,000 employ-ees at 12 universities and community col-leges across North Carolina. One of four study groups received “cash only,” based on their percentage of weight loss over an 18-month study. The other three groups received a Web-based program only, the Web program and cash, or “usual care” (the control group). This study’s results are expected to draw national attention as it is the first large study of “cash only” incentives since the 1980s, Tate says. In other research related to adults and weight, Kimberly Truesdale, PhD, nutrition research assistant professor, has gleaned sig-nificant findings from the large longitudinal study known as “ARIC,” or Atherosclerosis Risk in Communities. The study focused on four U.S. communities and included both white and African-American respondents. Truesdale found no disparities between the two races in her most recent results, pub-lished online in January 2009 in Interna-tional Journal of Obesity. Looking at adults ages 45 to 64 and how their health is affected by excess weight over time, Truesdale discovered that simply maintaining weight brings benefits. “Weight loss is something a lot of adults can’t achieve,” she says. “We found that if people maintain Dr. Deborah Tate Dr. Laura Linnan Dr. Kim Truesdale Research assistants with “Way to Health,” a workplace weight loss program, interview a study participant. When you establish a shared household with a romantic partner, you need to think of ways each partner can support the other to create a healthy environment – healthier foods in the house, working out together and supporting each other in terms of physical activity in general. PHOTO COURTESY OF UNC CENTER FOR HEALTH PROMOTION AND DISEASE PREVENTION C A R O L I N A P U B L I C H E A L T H | 17 their weight (±3 percent), they still have some health improvements in total cholesterol, LDL cholesterol and diastolic blood pressure, regardless of weight status.” Truesdale also found that people who lose a significant amount of weight (≥5 percent) reap long-term benefits associated with their lighter physique. “We wondered, if you had been heavier in the past, do you pay the con-sequences of that for the rest of your life?” she asks. The answer, based on some important criteria, was no. “People who were heavier in the past – their blood pressure, lipids and glucose levels were slightly better or about the same as someone who always had been the lighter weight,” Truesdale says, noting that she didn���t look at hard outcomes like heart attacks. Carmen Samuel-Hodge, PhD, another nutrition research assistant professor, is test-ing a weight-loss intervention program tar-geted to low-income women who, as a group, have the highest rates of being overweight or obese. The intervention focuses on helping par-ticipants gain awareness of how their behavior contributes to weight gain. “Once they know what they are doing, they can start figuring out how to change,” Samuel-Hodge says. “A lot of the sessions were about problem solving. The participants were the ones who solved their own problems.” (For more on Samuel- Hodge’s study, see page 22.) — Susan Shackelford Is perceived racism a risk factor for obesity? “Right now, the literature is not at all consis-tent on the question of whether exposure to racism increases obesity risk,” says Anissa I. Vines, PhD, epidemiology research assistant professor at UNC Gillings School of Global Public Health. Vines co-authored a study published in American Journal of Epidemiology (March 2008), which found that higher levels of perceived racial discrimination might be protective against hypertension. She also was lead author for a study that found a rela-tionship between a larger waist-to-hip ratio and daily life stress and passive emotional responses to racism but could not support the hypothesis that racism, a chronic stressor, was associated with increased abdominal fat (American Journal of Public Health, March 2007). “Other researchers have shown a positive association between racism-related variables and obesity,” Vines says. Vines continues to explore some of these associations with the help of a questionnaire – the telephone-administered perceived racism scale – which she developed in collaboration with clinical psychologist Maya McNeilly, who designed the original perceived racism scale. “I am beginning to explore what it really means when an African-American person reports limited or no experiences of racism,” Vines says. “Maybe being able to acknowl-edge and report racism provides a protective psychological effect.” Vines also is examining early life expo-sures to stress and perceived racism. “We don’t know very much about how per-ceived racism acts as a stressor,” Vines says. “Multiple stressors can be in play at any given time. How one perceives those stressors, and how those stressors interact with other social and environmental factors, are important to explore.” –Angela Spivey Does perceived racism contribute to higher rates of obesity among African-Americans? The question is complicated. Dr. Anissa Vines PHOTO BY LINDA KASTLEMAN Maintaining a healthy weight throughout middle age may result in lower blood pressure and cholesterol levels. For weight loss, working together is often the best approach Researchers at UNC Gillings School of Global Public Health have found that, for many, community support helps make those behaviors stick. The School has a long history of cre-ating, testing and implementing programs designed to engage groups of people to work together to improve their health. One long-running effort based at the UNC Center for Health Promotion and Disease Prevention and led by a School researcher – HOPE (Health, Opportunities, Partnerships, Empowerment) Works – brought together low-income women in several rural counties in eastern North Carolina to form “Hope Circles” to support each other in healthier habits. Researchers reported that women who participated in the circles for six months lost an average of 4.5 pounds and also increased their physical activity significantly. Women in control groups didn’t lose weight. UNC nutrition professor Marci Campbell, PhD, who led the effort, now studies the same intervention over a longer time period. Campbell’s project, Seeds of HOPE, centers the support circles around churches or other formal groups, as her initial study found these settings more effective than informal meetings in private homes. Findings by Campbell and colleagues appear in Journal of Women’s Health (October 2007). Feedback from the communities involved in HOPE Works has led researchers to focus on improving economic as well as physical health. “People were saying you can’t tackle obe-sity if women don’t have jobs or education, The prescription for losing excess weight and avoiding heart disease and diabetes sounds simple – eat less in general, eat more fruits and vegetables, and move more. The hard part is helping real people fit those changes into their lives. 18 | F A L L 2 0 1 0 The Active Living by Design (ALBD) grantee in Columbia, Mo., has worked hard to mobilize the community to bike more often. Here, several families enjoy a crisp fall morning. Read more about ALBD on page 21. PHOTO COURTESY OF ACTIVE LIVING BY DESIGN Dr. Marci Campbell C A R O L I N A P U B L I C H E A L T H | 19 because they don’t have hope for the future. People will improve their health as part of an effort to improve their lives,” Campbell says. She and colleagues helped launch a model business, Threads of HOPE NC Inc., in Salemburg, a small town in Sampson County, N.C. The business provides women with management experience and draws on the sewing skills some had developed when the textile industry was vital in the eastern part of the state. Participants make custom tote bags from organic cotton and have filled orders for clients including the 2009 National Conference on Chronic Disease Prevention and Control. Input from HOPE Works participants also led to HOPE Accounts, which com-bines HOPE circles with a matched savings program to help women meet a goal such as going back to school or starting a small business. That project is funded by a grant from the American Recovery and Reinvest-ment Act. Listening to people in communities we serve is crucial if we are to solve complex health problems such as obesity, says Leah Devlin, DDS, MPH, former North Carolina state health director and a Gillings Visiting Professor of health policy and management at the School. “The problems we face in North Caro-lina are complex and multifactorial, and they require creative solutions that engage all types of expertise that we have in the public health school. But those solutions also must include the will and desires of the community,” Devlin says. “We have to listen to communities to understand what they see as priorities and what ideas they have for solutions that will help us be more successful together.” Campbell and Marlyn Allicock, PhD, research assis-tant professor of nutrition, also are applying strategies proven to help people eat more fruits and vegetables to an intervention in which military veterans are trained to counsel each other. They use motivational interviewing, which focuses on reflective listening and positive affirmations rather than on persuasion or advice giving. Those strategies were shown to help veterans eat more fruits and vegetables than did the stan-dard Veterans Affairs weight-management program, in a pilot study published in the May–June 2010 issue of Preventive Medicine. “We found that, due to other clini-cal responsibilities and time constraints, nurses are not necessarily the best people to do the counseling,” Allicock says. So she, Campbell and colleagues developed manuals and DVDs that train veterans to conduct the motivational interviewing for other veterans. The researchers currently are evaluating that intervention. The problems we face in North Carolina are complex and multifactorial, and they require creative solutions that engage all types of expertise that we have in the public health school. But those solutions also must include the will and desires of the community. Dr. Marlyn Allicock Production manager Mae Tuggle assembles a Threads of Hope tote bag. The organic cotton bags were sold last year at The Regulator Bookshop in Durham, N.C. PHOTOS BY SALLI BENEDICT F E AT U R E S A ND N EWS Active Living by Design (ALBD), founded in 2001 by the Robert Wood Johnson Foun-dation, works with communities to build environments for active living and healthy eating. (The program is featured on page 21.) ALBD staff members provide technical assistance to towns that have received grants from “Fit Community,” an initiative of the N.C. Health and Wellness Trust Fund. “Our role is to help communities identify those resources that are going to help make their project successful, not just over the course of the grant period, but beyond,” says Joanne Lee, a program officer with Active Living by Design. For example, Lee worked with a commu-nity in Black Mountain, N.C., which planted gardens connected by walking trails. “They were able to get a permanent position estab-lished that included in its duties managing the gardens,” Lee says. “We also worked with the community to help establish a nonprofit coalition to generate funding.” Another community intervention is led by Carmen Samuel-Hodge, PhD, research assis-tant professor of nutrition. Samuel-Hodge is testing a modified group weight-loss inter-vention to determine whether it is effective for low-income women when administered by county health department staff members rather than research team staff members. For example, to accommodate some women’s low literacy skills, she had them break into groups and choose a designated person to do any required writing. A prelimi-nary analysis of her ongoing study in six North Carolina counties found that 40 percent of the women lost 5 percent or more of their body weight, a clinically significant amount. “This was a better result than other studies targeting low-income populations have gotten,” Samuel-Hodge says. “A key element was the women helping each other,” she says. “A lot of the sessions were about problem solving, and the women solved their own problems. These were not teaching sessions. If the interventionist did more than 50 percent of the talking in a ses-sion, it was considered ineffective. The goal is for interventionists to guide the discussion. A lot of times the women are learning from each other. One person will come in and say, ‘I had a wonderful week, and here’s what I did.’” Finding ways that people in communities can work together to get healthy is becoming ever more important as public health officials try to fight obesity with fewer resources. For example, Samuel-Hodge points outs that in July 2011, the North Carolina State Health Plan, through its Comprehensive Wellness Initiative, will begin requiring members with a body mass index above 40 to enroll in weight-loss programs or pay higher insurance co-pays. But how many state employees can afford the hundreds of dollars that private weight-loss programs may cost? Can com-munities provide other options that cost less but are still effective? “We are finding that they can,” Samuel- Hodge says. –Angela Spivey The School also collaborates with towns and communities to develop programs for healthy living. 20 | FA L L 2 0 1 0 Threads of HOPE NC Inc. www.threadsofhopenc.org Seeds of HOPE http://tinyurl.com/hpdp-seeds-of-hope Weight Wise Works at Health Departments http://tinyurl.com/hpdp-weightwise Active Living by Design www.activelivingbydesign.org Websites for further information: In Santa Ana, Calif., the Healthy Eating by Design program provides opportunities for healthier eating to families in an urban Latino neighborhood. Here, a child hones his skills in the community garden. PHOTO COURTESY OF ACTIVE LIVING BY DESIGN Active Living by Design partners in Louisville, Ky., transformed a once-barren patch of land into a safe and fertile garden space. The garden became a community gathering place, where children learn about growing and eating healthy foods. But now, thanks to a Fit Community grant administered by UNC Gillings School of Global Public Health’s Active Living By Design (ALBD), the Yancey County com-munity is turning the tide. Using the $60,000 grant as seed money, the community partnership, known as “Healthy Yancey,” renovated a previously closed gymnasium, bought park playground equipment for young children, added a side-walk to connect a local swimming pool to Ray-Cort Park and hired a director to oversee the projects. The technical assistance Healthy Yancey received from ALBD was as critical as the seed money. “The five Ps they stress – Preparation, Promotion, Programs, Policy and Physical Projects – helped us tremendously,” says Kin-nane, who wrote the grant application. “They make you think things through. Because of that, I feel like we’ve been successful.” Although there is no hard data yet on youth weight loss or maintenance, it appears Healthy Yancey is making a difference. “Changes like this take a long time; the prob-lem is so multifactorial,” says Kinnane, direc-tor of the Toe River Health District, which covers Yancey, Avery and Mitchell counties. “I believe our community is more fit. Our gym is busy all the time; the park is busy, too. All of these things are helping.” Funded by the North Carolina Health and Wellness Trust Fund, Fit Community is one of many grant programs administered by ALBD, an organization based in the School’s North Carolina Institute for Public Health. What all ALBD programs have in common is a focus on supporting com-munity partnerships to create environ-ments that foster good health. “We are taking public health to the streets,” says ALBD director of communications Mark Dessauer. ALBD was one of the first organizations in the country to zero in on the importance of the built environment and its potential impact on health. “Our relationship with the Robert Wood Johnson Foundation and the focus of our first initiative together was inno-vative,” says ALBD director Sarah Strunk, MHA. “We were early adopters that helped communities translate a growing area of research into practice. We looked at how In the mid-2000s, Lynda Kinnane – and others in the beautiful mountain town of Burnsville, N.C. – had a major concern. “We were seeing a lot of children who were overweight,” Kinnane recalls. Active Living By Design Sarah Strunk 8 We wanted neighborhood groups to determine what their communities needed and to work with others to make it happen. … With a small amount of money, these partner-ships can accomplish something significant. PHOTO COURTESY OF ACTIVE LIVING BY DESIGN C A R O L I N A P U B L I C H E A L T H | 21 F E AT U R E S A N D N EWS 22 | F A L L 2 0 1 0 The World is Fat* Across North Carolina and around the world, researchers from UNC Gillings School of Global Public Health are investigating why obesity rates have ballooned, how this phenomenon affects health and what to do about it. Research synopses reported by Kathleen Kearns *Our article uses the title of a popular treatise by Dr. Barry Popkin, The World is Fat: The Fads, Trends, Policies and Products That Are Fattening the Human Race (New York, Penguin Books, 2008). For more information, see http://tinyurl.com/theworldisfat. C A R O L I N A P U B L I C H E A L T H | 23 The School conducts research, provides public service and par ticipates in engaged scholarship in all 100 Nor th Carolina counties. 29.4 percentage of Nor th Carolina adults who are obese 10of 11 states with highest rates of diabetes and hyper tension are in the South 38states in the U.S. with adult obesit y rates above 25 percent in 2010 12 million obese children in the U.S. 0states with adult obesity rate above 20 percent in 1991 56percent of voters who think preventing childhood obesity will save taxpayers money in the long run 8states with obesity rates above 20 percent among 10- to 17-year-olds (N.C. is not among them.) 41.1 percentage of African-Americans in Nor th Carolina who are obese 20states with nutritional standards for school meals (N.C. is among them.) 73percent of voters who say preventing childhood obesity is an impor tant priority for government f e at u r e s a n d n ews National chair for the SEARCH for Diabetes in Youth study, nutrition professor Elizabeth Mayer-Davis, PhD, leads the first long-term evaluation to track trends and incidence rates for all types of diabetes among young people from major racial and ethnic groups in the U.S. The large, multicenter study collects information about who gets diabetes and what kind, what care they receive and how the disease and its complications af fect their daily lives. Among the study questions: Why is type 2 diabetes rising so rapidly among adolescents, par ticularly minority adolescents? And does obesit y – not previously linked with type 1 diabetes – accelerate that form of the disease? While those in the U.S. who identify themselves as Hispanic die less often from heart disease than non-Hispanics, they have higher rates of obesity and diabe-tes. Lisa LaVange, PhD, biostatistics Professor of the Practice, leads the Hispanic Community Health Study, a comprehensive, nationwide assessment of how adapting to the U.S. environment and culture af fects the health of 16,000 Hispanic adults with family roots in Mexico, Cuba, Puer to Rico, the Dominican Republic, Central America and South America. Barry Popkin, PhD, Carla Smith Chamblee Distinguished Professor of Global Nutrition, has served on the Mexican Ministry of Health’s National Beverage Panel and has written three papers with the Instituto Nacional de Salud Publico related to beverage intake among Mexican children. He conducts studies in China, Russia, Brazil, Mexico and the United Arab Emirates to examine factors underlying dietary and physical activity pat terns and their ef fects on health. In Egypt, Iran, Mexico, Brazil, South Africa, Thailand, China, Chile, India and Indonesia, Popkin studies the relationship of massive shif ts in diet, activity and obesity to noncommunicable diseases. Penny Gordon-Larsen, PhD, nutrition associate professor, and Kari North, PhD, epidemiology associate professor, are working together to understand how genetic and environmental risk factors interact to influence weight gain as teens become young adults. They have shown that this developmental period is one of par ticular risk for weight gain. Understanding how genes and environ-ment interact can bet ter inform obesity prevention and treatment by tailoring such interventions to individuals who might benefit most. For a more comprehensive look at where in the world we are making a difference, see our interactive map at www.sph.unc.edu/globalhealth. Nutrition professor Peggy Bentley, PhD, conducts research on infant and young child nutrition in a number of countries, including Honduras, Malawi and India. Musk ox, caribou and other traditional foods of the Cana-dian Arctic have high nutritional value. But as the Inuvialuit of Nunavut have moved away from physically active ances-tral ways and started eating more processed, store-bought foods, their rates of obesity and other ills have climbed. Sangita Sharma, PhD, former UNC nutrition associate professor, now at University of Alber ta (Canada), worked with local groups to develop the Healthy Foods Nor th intervention program. Af ter collecting baseline health data, the team promoted vigorous traditional activities and nutritious foods that are both af fordable and culturally acceptable. Women who are obese when they are diagnosed with breast cancer have a greater risk of dying from the disease, Re-becca Cleveland, PhD, nutrition research as-sistant professor, has found. She has identified genes associated with breast cancer, obesity and diabetes and is now working to understand the connections among them. Her working hypotheses – that many of the genes associated with high levels of insulin also are associated with breast cancer and that breast cancer outcomes are worse for women with diabetes – drive her investigations of genes related to insulin resistance, estrogen and other factors. Cleveland’s findings are based on data collected by epidemiology professor Marilie Gammon, PhD, through Gammon’s Long Island Breast Cancer Study. (See www.sph.unc.edu/cph/ long_island_breast_cancer.) The Healthy Weight Commitment is a voluntary food indus-try effort, linked with First Lady Michelle Obama’s child-hood obesity initiative, to reduce obesity by changing what Americans eat. Nutrition professor Barry Popkin, PhD, leads a UNC-based team evaluating the impact of the Com-mitment’s attempt to remove 1.5 trillion calories a year from the U.S. marketplace by 2015. The independent team will track whether the calorie reductions result in American children and adoles-cents taking in significantly fewer calories each day. The evaluators will look par ticularly closely at whether the overall diet of 2- to 18-year-olds improves and at whether they take in less solid fats and added sugars. A 40-year-old journal article on Chinese Restaurant Syndrome grabbed the attention of nutrition associate professor Ka He, MD, ScD, when he read that study animals given monosodium glutamate (MSG) weighed more than the con-trol group. Intrigued, He examined data from both a small study and the large China Health and Nutrition Survey and discovered that humans’ MSG intake also is related to weight gain. Now, he is testing his theory that MSG causes resistance to leptin, the hormone that regulates energy balance. He is planning an intervention study to determine whether MSG intake can cause obesity. Having led two large national trials examining obesity and physical activity in children and adolescents, June Stevens, PhD, professor and chair of the nutrition de-partment, continues her research on obesity in differ-ent populations. She has found links between mental exhaustion, obesity and hear t at tacks among African-American and white men and women. Other studies showed that the ef fects of obesity on the risk of diabetes and hyper tension in Chinese may be even greater than in blacks and whites. Recent work by Stevens and Kimberly Truesdale, PhD, nutrition research assistant professor, showed that af ter losing weight, previously obese individuals enjoy a lowered risk of hear t disease similar to those who were never obese. Their innovative studies are the first to show that, similar to the lowered risk of lung cancer in people who quit smoking, the ef fects of obesity on hear t disease appear to be reversed by weight loss and maintenance of a healthy weight. Adults who lose weight and be-come normal weight have about the same risk of hear t disease as people who were never obese. Stevens also conducts research comparing body mass index and rates of diabetes and other conditions among African-Americans, whites and Chinese. That project is suppor ted by a supplement to the UNC Nutri-tion and Obesity Research Center, one of 12 national centers of research funded by the National Institutes of Health. Steven Zeisel, MD, PhD, Kenan Distinguished Professor of nutrition and director of the N.C. Nutrition Research Institute, is the Center’s principal investigator. In Mexico, Miroslav Styblo, associate professor, studies which arsenic exposure may induce and examines effects of diet on the metabolism of arsenic. his National Institutes of Health-funded been conducted in Bangladesh and Alice Ammerman, DrPH, RD, nutrition professor and director of UNC’s Center for Health Promotion and Disease Prevention, directs a Gillings Innovation Lab investigating – among other things – whether children eat more fruits and vegetables when their parents buy locally grown food. Using data from the Nor th Carolina Child Health Assessment and Monitoring Program, the team has found the answer may be yes. Teaching children where their food comes from and eating more meals at home also may af fect how likely children are to eat healthy food. In Nor th Carolina, it appears that families who are Hispanic and/or of lower socioeconomic status may be just as likely to buy local food as wealthier whites. Spurred by the World Health Organization, food companies worldwide are placing a uni-versal logo on food and beverage packages to help consumers make healthier choices. Barry Popkin, PhD, Carla Smith Chamblee Distinguished Professor of Global Nutrition, works with an international board of scientists to ensure the logo goes on products that really do promote health. The Choices International Foundation Programme aims to reduce diseases related to obesity by raising consumer awareness and by encourag-ing companies to market products that meet evidence-based benchmarks for trans fats, saturated fats, salt, sugar and – in most locations – fiber and energy intake. For more than 20 years, the China Health and Nutrition Survey has monitored the diet and body composition of 19,000 people in nine Chinese provinces. During that time, economic and social changes have altered what Chinese people eat and how much they move. Obesity in China has risen dramatically. Numer-ous School faculty researchers – among them Linda Adair, PhD; Margaret E. Bentley, PhD; Shufa Du, MD, PhD; Penny Gordon-Larsen, PhD, and study principal investigator Barry Popkin, PhD – track the changes. The information they gather helps Chinese of ficials identify and respond to the public health challenges that result. Since 1983, the Cebu [Philippines] Longitudinal Health and Nutrition Survey has followed a cohort of 3,000 women and their children. Origi-nally focused on maternal and infant health, the study – now led by nutrition professor Linda Adair, PhD – tracks a range of ma-ternal and child health issues, including a significant rise in obesity that parallels Cebu’s rapid growth and economic development. “There’s a clear trend from underweight to overweight and to hyper tension and dia-betes,” says Adair. Unlike in the United States, women from Cebu’s wealthier fami-lies tend to gain more weight. Poorer women and those with physically demanding jobs gain less. PhD, nutrition studies mechanisms by induce diabetes diet and obesity arsenic. Research for funded work also has and Taiwan. 24 | F A L L 2 0 1 0 F E AT U R E S A N D N EWS we could increase physical activity through community design.” With an initial foundation investment of $15.5 million in 2001, ALBD selected part-nerships of key players within communities to solve infrastructure challenges around physical activity and, later, healthy eating. “We wanted neighborhood and grassroots groups determining what their communities needed and working with others, including local government entities such as public health, transportation, and parks and recre-ation, to make it happen,” Dessauer says. The approach struck a chord. “We expected 300 to 350 to apply, but we had 966. The response broke all foundation records,” he says. The first 25 community grantees received technical assistance and $40,000 annually for five years. The money seeded partner-ships that leveraged nearly $260 million in additional community investments. “The lesson we learned was that with a small amount of money, these partnerships can accomplish something significant,” Des-sauer says. “It gave them an opportunity to pause and think about community health and how they could work together.” With such success, the N.C. Health and Wellness Trust Fund, Kellogg Foundation, Blue Cross Blue Shield of Minnesota and other groups soon engaged ALBD to work with their grants programs. In 2008, the Robert Wood Johnson Foun-dation made an even bigger commitment to ALBD, asking it to lead the new $33 million Healthy Kids, Healthy Communities pro-gram – the foundation’s largest investment in community-based change related to child-hood obesity, Dessauer says. Among the 50 Healthy Kids, Healthy Communities grants made so far, one for $400,000 in Baldwin Park, Calif., continues to fuel a childhood obesity fight launched more than a decade ago. The largely Latino suburb of Los Angeles has seen children lose weight and increase test scores as the community has instituted salad bars and mandatory physical education levels in schools, increased fresh produce in stores, banned drive-through windows at new fast-food restaurants and launched a website called www.werefedup.com, created by and targeted to young people. The grant is helping the partnership implement “People on the Move,” focused on decreasing unhealthy food marketing and advertising, increasing access to healthy foods in corner groceries near schools and boosting “walkability” and green space in the downtown area. In Somerville, Mass., ALBD also is advanc-ing a longtime initiative. Since the early 2000s, “Shape up Somerville” has spurred new parks, walking paths, recreational facilities, community gardens, low-fat menu options at restaurants and education of parents about healthy eating. A $400,000 Healthy Kids, Healthy Com-munities’ commitment is helping the town make changes in public policy to sustain health over time – a major ALBD emphasis. “To truly reverse the epidemic of childhood obesity, we need to address policies, environ-ments and systems, not just individual behav-ior,” says ALBD director Strunk. “This means working to create community-level changes that can be sustained for generations to come.” –Susan Shackelford Active Living by Design fosters community-led change by working with local and national partners to build a culture of active living and healthy eating. Above, elementary students in Seattle enjoy a snack provided by the local Healthy Eating by Design program. Below, South Bronx (N.Y.) youth celebrate their borough’s newest park. The ALBD grantee engaged local young people to clean up trash in the park and make landscaping changes. To truly reverse the epidemic of childhood obesity, we need to address policies, environments and systems, not just individual behavior. PHOTOS COURTESY OF ACTIVE LIVING BY DESIGN School reaccredited by CEPH for maximum period, seven years the unc gillings school of global public health was reac-credited in June by the Council on Education for Public Health (CEPH) for seven years, the maximum period of renewal. Leading the school’s accreditation team were Peggy Leatt, PhD, associate dean for academic affairs and chair of the Department of Health Policy and Management; Anita Farel, DrPH, associate chair for graduate studies in the Department of Maternal and Child Health; Laurel Files, PhD, associate chair of the Department of Health Policy and Management; Felicia Mebane, PhD, assistant dean for students; and Dave Potenziani, PhD, former senior associate dean. SCHOOL NEWS For more information on these topics and other news, please see www.sph.unc.edu/news_events. unc gil l ings school of globa l publ ic hea lth vangie a. foshee, phd, professor of health behavior and health education, has received a grant of nearly $1.2 million from the U.S. Centers for Disease Control and Prevention to evaluate a program aiming to prevent psychological, physical and sexual dating abuse by adolescents who have been exposed to domestic violence. “Moms and Teens for Safe Dates” was developed by Foshee and health behavior and health education colleagues, Professor Susan Ennett, PhD, and Beth Moracco, PhD, and James Michael Bowling, PhD, both research associate professors, with funding from the National Institute of Justice. Mothers who have left an abusive partner obtain pre-vention information through the program and participate in interactive activities with their 12- to 15-year-old adolescents who were exposed to the abuse. Adolescents exposed to domestic violence are at increased risk for being abused by and abusing the people they date. Foshee receives award to study prevention of dating violence C A R O L I N A P U B L I C H E A L T H | 25 Dr. Vangie Foshee thomas ricketts, phd, professor of health policy and management, is one of 15 national experts appointed to the new National Health Care Workforce Commission. The Commission is an independent body that advises Congress and the administration on health workforce policy. “This commission gives us the opportunity to develop new ways to modernize our workforce to meet the challenges of increasing access and quality of health care while we control costs,” Ricketts said. “We need to examine how we prepare and deploy our doctors, nurses, dentists, pharmacists and the many other health care practitioners to meet the nation’s future health care needs. In many ways, we have been trying to run a system for the 21st century with 20th century approaches.” Ricketts also serves as deputy director for policy analysis at UNC’s Cecil G. Sheps Center for Health Services Research and is co-director of American College of Surgeons Health Policy Research Institute. He is a Gillings Visiting Professor with Ecole des Hautes Etudes en Sante Publique in France. Ricketts named to national Health Care Workforce Commission Dr. Thomas Ricketts march ��� september 2010 although april’s bp oil spill in the Gulf of Mexico did not affect the North Carolina coast, it provided opportunity to evaluate local, state and federal readiness. More than 130 participants at the School’s July 29 “One Health” forum interacted with state and federal partners who described how to train and use volunteers and identi-fied areas requiring additional planning. Bill Gentry, director of health policy and management certificate programs, arranged and led the forum. Read more at www.sph. unc.edu/oilspill. School sponsors oil spill forum 26 | F A L L 2 0 1 0 S C H O O L N EWS Maternal and Child Health offers online degree the school’s maternal and child health department will offer an online master’s degree program in spring 2011 to comple-ment its established residential training programs. The degree will increase working professionals’ access to graduate education focused on improving the health of women, children and families. Developed with support from the U.S. Health Resources and Services Administra-tion’s Bureau of Maternal and Child Health, the new curriculum builds upon an online certifi-cate (MCH Ole!) introduced earlier this year. rebecca fry, phd, assistant professor of environmental sciences and engineering, has received two prestigious awards recognizing her potential to make substantial contributions throughout her career. The honors include the Outstanding New Environmental Scientist (ONES) Award, presented by the National Institutes of Health’s National Institute of Environmental Health Sciences (NIEHS), and selection as a PopTech Science and Public Leadership Fellow. Fry’s ONES award includes a $2.2 million grant to study health effects of prenatal arsenic exposure in newborns in Gomez Palacio, Mexico. PopTech, a global community of interdisciplinary leaders, each year selects young scientists who work in critical public health areas and provides them with advanced leadership and com-munications training. Fry also has received support from the University Cancer Research Fund and a Gillings Innovation Lab (see page 28). two school researchers received a five-year, $2.2 million grant to study how pregnancy and obesity may promote susceptibility to an aggressive subtype of breast cancer more prevalent in young, African-American women. Melissa Troester, PhD, assistant professor of epidemiology, and Liza Makowski, PhD, assistant professor of nutrition, are principal inves-tigators for the National Institute of Environmental Health Sciences’ Breast Cancer and Environmental Research Program. heather mun-roe- blum, phd, principal and vice-chancellor of McGill University in Mon-treal, gave the keynote address at UNC’s Uni-versity Day celebra-tion Oct. 12. The text of the presentation is available at http://tinyurl.com/munroe-blum. Munroe-Blum received a doctorate with dis-tinction in epidemiology from UNC in 1983. Researchers to study pregnancy, obesity, breast cancer disparities Munroe-Blum speaks at University Day event ESE’s Fry honored as ‘outstanding young researcher’ Dr. Melissa Troester (left), Dr. Liza Makowski Dr. Munroe-Blum the water institute at unc (http:// waterinstitute.unc.edu), housed in UNC Gill-ings School of Global Public Health, was launched Oct. 25 during UNC’s conference, “Water and Health: Where Science Meets Policy.” The conference, co-sponsored by the new institute and the UNC Institute for the Environment, attracted more than 350 attendees. Experts from more than 50 countries provided a wide range of per-spectives on drink-ing water, sanitation, hygiene and water resources. UNC has longstanding expertise in the areas of water, policy and health, with many faculty members engaged in associated research and recognized as international leaders. The Water Institute was established by the School to leverage this broad, interdis-ciplinary experience. “The Water Institute at UNC brings together individuals and institutions from diverse disciplines and empowers them to work together to tackle critical global issues in water and health,” says Jamie Bartram, PhD, Institute director and professor of envi-ronmental sciences and engineering. Water Institute at UNC launched in October Dr. Jamie Bartram Dr. Rebecca Fry PHOTO BY DIANNE SHAW C A R O L I N A P U B L I C H E A L T H | 27 unc-chapel hill has been named coordinating center for a National Institutes of Health-funded study to examine ways to curtail the nation’s childhood obesity epidemic. June Stevens, PhD, AICR/ WCRF Distinguished Professor of nutrition and epidemiology and chair of the nutrition department, is principal investigator for the center. The NIH’s $49.5 million Childhood Obesity Prevention and Treat-ment Research (COPTR) program is among the first long-term obesity prevention and treatment research studies in children. COPTR will test methods for preventing excessive weight gain in non-overweight and moderately overweight youth, and methods for reducing weight in obese and severely obese youth. Stevens also was a featured speaker at the 2010 American Institute of Cancer Research (AICR) Conference on Food, Nutrition, Physical Activity and Cancer, Oct. 21–22, in Washington, D.C. Nutrition’s Stevens coordinates national study of ways to prevent, treat childhood obesity kelly b. browning, member and for-mer president of the School’s Public Health Foundation board, and alumnus Richard Vinroot Jr., MD, MPH, will serve four-year terms on the 160-member UNC Board of Visitors, which assists the Chancellor and trustees in activities that help advance the University. Browning, Vinroot elected to UNC Board of Visitors Dr. June Stevens Kelly Browning Dr. Rich Vinroot Jr. a new unc study that follows patients with lung cancer is one of the first to suggest why patients choose not to have life-preserv-ing lung surgery and why such surgery is sought less often by blacks. Samuel Cykert, MD, associate professor in the UNC School of Medicine, is lead author of the American Cancer Society-funded study, published in the June 16 issue of the Journal of the American Medical Association. Study authors from UNC Gillings School of Global Public Health include Peggye Dil-worth- Anderson, PhD, professor of health pol-icy and management, and Lloyd J. Edwards, PhD, associate professor of biostatistics. Cykert says explanations for differences in surgical rates for blacks may include black patients’ perception of poor doctor-patient communication. Black patients also were less likely to have primary care providers who could help them reconsider a decision about surgery. UNC study helps explain why black patients with lung cancer have surgery less often than whites Physicians can improve children’s oral health school researchers have provided the first national data on the effectiveness of dental referrals by physicians. Heather Beil, MPH, doctoral student, and Gary Rozier, DDS, MPH, professor, both in the School’s Department of Health Policy and Manage-ment, co-authored the study, published in the August issue of the journal Pediatrics. Researchers sam-pled children to determine whether a medi-cal health care provider had recommended that a child be seen by a dentist and whether the child actually had a dental visit. The most significant finding was in the group of two- to five-year-olds. Of the 47 percent of the group advised to have a dental check-up, 39 percent did. Dr. Gary Rozier For more information about these and other events, contact Jerry Salak at (919) 843-0661 or jerry.salak@unc.edu. Feb. 18 – Lecture by Isabel Wilkerson, author of The Warmth of Other Suns: The Epic Story of America’s Great Migration Feb. 24 – Minority Student Caucus Alumni Reception Feb. 25 – Minority Health Conference (www.minority.unc.edu) March 31 – Foard Lecture (www.sph.unc.edu/foard) Speaker: Richard A. Vinroot Jr., MD, MPH Coming soon! F E AT U R E S A N D N EWS FACULTY Sobsey invited to NASA��s first LAUNCH event Mark Sobsey, PhD, Kenan Distinguished Professor of environmental sciences and engineering, was one of 10 innovators chosen to participate in NASA’s inaugural LAUNCH event, held March 16–18, at the Kennedy Space Center in Florida. Sobsey presented his proposal for simple, accessible and affordable tests to assess water quality and safety. Sen selected for prestigious Wilks Medal Pranab K. Sen, PhD, Cary C. Boshamer Distinguished Professor of biostatistics, was selected as the 2010 recipient of the American Statistical Association’s S.S. Wilks Medal, one of the most prestigious awards in the field. His research, pub-lished over the course of 50 years, has influ-enced generations of statisticians. Sen, a member of the UNC biostatistics faculty since 1967, is the first from the department to receive the medal. Gillings Innovation Labs awarded The School funded four new Gillings Innova-tion Laboratories last spring. Awardees, all assistant professors, include: • Eric Donaldson, PhD, epidemiology; • Rebecca Fry, PhD, environmental sciences and engineering; • Suzanne Maman, PhD, health behavior and health education; and • Jill Stewart, PhD, environmental sciences and engineering. Read more about the Gillings Innovation Lab Awards at www.sph.unc.edu/accelerate. Randolph reappointed to national board Susan Randolph, MSN, RN, was reappointed to the National Advisory Committee on Occu-pational Safety and Health (NACOSH). Randolph is clinical assistant professor in the Public Health Leadership Program. Swenberg honored with Greenberg Award James A. Swenberg, DVM, PhD, Kenan Dis-tinguished Professor of environmental sci-ences and engineering, received the School’s Bernard G. Greenberg Alumni Endowment Award for excellence in teaching, research and service. Director of the UNC Cur-riculum in Toxicology, Swenberg studies AWAR DS & R ECOGNITIONS unc gil l ings school of globa l publ ic hea lth march – september 2010 Read more at www.sph.unc.edu/recognitions_and_awards. Dr. Mark Sobsey Dr. Eric Donaldson Dr. Suzanne Maman Dr. Jill Stewart Dr. Rebecca Fry Dr. Pranab Sen Susan Randolph 28 | F A L L 2 0 1 0 C A R O L I N A P U B L I C H E A LT H | 29 the mechanisms of carcinogenesis, with an emphasis on the role of DNA damage and repair. He has mentored more than 40 gradu-ate students during his two decades at UNC. The award was presented at the School’s 2010 Foard Lecture in April. LaVange reappointed to health commission Lisa M. LaVange, PhD, was reappointed to the N.C. Health and Wellness Trust Fund Commission. LaVange is Professor of the Practice of bio-statistics and director of the Collaborative Studies Coordinating Center. The com-mission works to improve North Carolin-ians’ health by establishing partnerships to address access, prevention, education and research issues. Herring, Preisser, Zhou elected as ASA fellows Three UNC biostatis-tics faculty members have been elected as fellows of the Ameri-can Statistical Asso-ciation. They are Amy Herring, ScD, associate professor; John Pre-isser Jr., PhD, research professor; and Haibo Zhou, PhD, professor. Popkin awarded honor by Britain’s Nutrition Society Barry Popkin, PhD, Carla Smith Chamblee Distinguished Professor of Global Nutrition, is the 2010 recipient of the United Kingdom Nutrition Society’s Rank Prize, the soci-ety’s highest honor. He accepted the award in June 2010 in Edinburgh, Scotland. Popkin’s Nutrition Society Lecture was titled, “Contemporary Nutritional Transi-tion: Determinants of Diet and its Impact on Body Composition.” Zelman, Herring honored for teaching, mentoring Two prestigious fac-ulty awards were pre-sented at the School’s 70th commencement ceremony last spring. William Zelman, PhD, professor of health policy and management, received the John E. Larsh Jr. Award for Mentorship, and Amy Herring, ScD, associate professor of biostatistics, received the McGavran Award for Excellence in Teaching. Gentry awarded Moldova medal Bill Gentry, lecturer in health policy and management and director of the Com-munity Preparedness and Disaster Man-agement program, received Moldova’s “Honorary Rescuer” medal in May 2010. Gentry has a long history of emergency pre-paredness and response efforts in the country. Gordon-Larsen receives Obesity Society award Penny Gordon- Larsen, PhD, associate professor of nutrition, has won The Obesity Society’s 2010 Lilly Scientific Achieve-ment Award. Gordon- Larsen accepted the award, funded by the Eli Lilly Pharmaceuti-cal Co., at the Society’s October conference in San Diego. Peterson presented with prestigious Allan Rosenfield Award Herbert B. Peterson, MD, Kenan Distin-guished Professor and chair of the Depart-ment of Maternal and Child Health, received the 2010 Allan Rosenfield Award for Life-time Contributions to International Family Planning. The award is presented annually by the Society of Fam-ily Planning (SFP). Peterson, also pro-fessor of obstetrics and gynecology in the UNC School of Medi-cine, is known inter-nationally for his work in women’s reproduc-tive health, epidemiology, health policy and evidence-based decision-making. Dr. James Swenberg (left), Dr. Mike Aitken Dr. John Preisser Dr. Barry Popkin Dr. Halbo Zhou Dr. Lisa LaVange Dr. Amy Herring Bill Gentry Dr. William Zelman Dr. Penny Gordon-Larsen Dr. Herbert Peterson PHOTO BY TOM FULDNER 30 | FA L L 2 0 1 0 Halpern honored for leadership, teaching Carolyn Halpern, PhD, associate profes-sor of maternal and child health, received the national Associa-tion of Teachers of Maternal and Child Health’s 2010 Loretta P. Lacey Maternal and Child Health Aca-demic Leadership Award. STAFF Cilenti leads NC Healthy Start, receives women’s health award Dorothy Cilenti, DrPH, deputy direc-tor of the School’s N.C. Institute for Public Health, was appointed chair of the N.C. Healthy Start Foundation��s board of directors in July. She has served on the Healthy Start board since 2007. Cilenti also received a $305,000 grant from the U.S. Health Resources and Services Administration’s Maternal and Child Health Bureau. The project, Women’s Integrated Systems for Health (WISH) Distance Learning Initiative, will address the need to better inte-grate public health and mental health systems to improve women’s health. Stevens honored for local health efforts Rachel Stevens, EdD, RN, received the 2010 President’s Award from the National Association of Local Boards of Health (NALBOH) in August in recognition of her service. Stevens was deputy director of the School’s N.C. Institute for Public Health and clinical instructor of public health nursing before retiring in 2003. Perry receives Staff Excellence Award Chris Perry, assistant director of School communications, was selected for the School’s 2010 Staff Excellence Award, which acknowledges excel-lent attitude, leader-ship and initiative. Perry is credited with “beyond-the-call ” efforts on the School’s website content, including a recent major redesign of the site. STUDENTS Public health students recognized for work benefiting North Carolina UNC Gillings School of Global Public Health students won four of 16 Impact Awards, presented by UNC’s Graduate School in spring 2010 to recognize student research that benefits North Carolina citi-zens. The awards, sponsored by the Graduate Education Advancement Board, were given last spring to: • Jennifer Gierisch, PhD, health behavior and health education alumna; • Maiysha D. Jones, environmental sciences and engineering doctoral student; • Kathryn Remmes Martin, PhD, health behavior and health education alumna; and • Stephen Richardson, environmental sci-ences and engineering doctoral student. Read more at http://tinyurl.com/nc-impact. Two inaugural Gillings Dissertation Awards presented Stephen Richardson (environmental sciences and engineering) and Natalie The (nutrition) received Gillings Awards in spring 2010 for their research, respectively, on solutions to soil contamination and the associations among weight, diabetes and physical activity across race and ethnicity in the United States. Three students win Fulbright awards Jacqueline S. Knee, MSPH, and Bachelor of Science in Public Health alumnae Melissa Asmar and Erin Shigekawa were selected to receive Fulbright public health scholarships. Knee is examining sanitary conditions of stored rainwater in Thailand; Asmar con-ducts research on nutritional changes in the national diet in Germany; and Shigekawa studies chronic kidney disease in Taiwan. ALUMNI Brostrom selected for Barr Award Richard Brostrom, MD, MSPH, received the 2010 Harriet Hylton Barr Distinguished Alumnus Award for his achievements and contributions to the field of public health. Brostrom, medical director of the Division of Public Health for the U.S. Common-wealth of the Northern Mariana Islands, is also medical director of the common-wealth’s programs in tuberculosis control, public health bioterrorism preparedness and tobacco control. His award was announced at the School’s 2010 Foard Lecture. Dr. Dorothy Cilenti Dr. Rachel Stevens Chris Perry Maiysha Jones Dr. Carolyn Halpern Stephen Richardson Natalie The AWARDS A N D R ECOGNI T I O N S C A R O L I N A P U B L I C H E A L T H | 31 DONOR S $1,000,000 to $5,000,000 Anonymous GlaxoSmithKline Robert Wood Johnson Foundation sanofi-aventis $500,000 to $999,999 Anonymous Columbia University John D. & Catherine T. MacArthur Foundation Merck & Company John & Virginia Sall $250,000 to $499,999 Avon Foundation Boston University The Duke Endowment Estate of Mabel Smith Johanssen Government of Nunavut University of Bristol University of California – San Francisco Water Research Foundation $100,000 to $249,999 American Diabetes Association American Heart Association Anonymous Association of Schools of Public Health Centers for Disease Control Foundation The COPD Foundation Edward A. & Joanne Dauer Dauer Family Foundation Duke University Elizabeth Glaser Pediatric AIDS Foundation EngenderHealth Golden Leaf Foundation King Abdullah University Science & Tech Penn State University Pfizer Inc. San Diego State University Research Foundation UNICEF The Wistar Institute W. K. Kellogg Foundation $50,000 to $99,999 Alaska Native Health Consortium American Institute for Cancer Research Bryson Foundation Vaughn & Nancy Bryson Children’s Hospital of Philadelphia Coca-Cola Company Exxon Mobil Corporation International Agency Research on Cancer Makhteshim-Agan of North America Inc. Medical University of South Carolina Mount Sinai School of Medicine NARSAD Novartis University of Massachusetts University of Nevada Reno University of Virginia WaterAid $25,000 to $49,999 Abbott Diabetes Care Inc. Anonymous (2) Brigham and Women’s Hospital Fred Hutchinson Cancer Research Center International Association of Plumbing and Mechanical Officials International Water Association Michael E. Kafrissen Methanol Foundation Susanne Moulton & Thomas Wong Orica Watercare Inc. Otsuka Maryland Medicinal Lab Inc. Research Triangle Institute Schering-Plough Research Institute Schwarz BioSciences Inc. Pranab and Gauri Sen Tellus Educational Foundation Inc. Theratechnologies Inc. University of Georgia University of Texas – Houston Wake Forest University School of Medicine Washington University – St. Louis Derek & Louise Winstanly $10,000 to $24,999 Abbott Laboratories Amgen Inc. Anonymous (3) Marcia Angle & Mark Trustin Astellas Pharma US Inc. AstraZeneca Pharmaceuticals LP – US Edward Carroll Bryant “YOUR GIFTS ARE INVESTMENTS, AND WE THANK YOU FOR EVERY ONE OF THEM. The return on your investment is far more than the gratitude of public health researchers, teachers and students, though you have that in abundance. Your return is your gift’s impact – discoveries made, students trained, faculty recruited and retained, publications made possible, clinics supported, lives touched and the pub-lic’s health transformed. Your gift – your investment – has made a difference in the protection of the world’s health and America’s future. We are grateful to you and all our partners as we work together to engineer clean water, prevent obesity, cancer and other diseases, eliminate health disparities, and lower health care costs.” – D E A N B A R B A R A K . R I M E R JULY 1, 2009 – JUNE 30, 2010 of Donors and Partners HONOR ROL L Gi l l i n g s S c h o o l o f Gl o b a l Pu b l i c He a l t h 32 | F A L L 2 0 1 0 DONOR S Canadian Institute for Advanced Research Celgene Corporation Deniese May Chaney Dainippon Sumitomo Pharma America Inc. Nancy Ann Dreyer Eisai Research Institute Florida State University Forest Laboratories Inc. George & Bodil Gellman The Gellman Foundation Dennis B. Gillings Sandra Bartholomew Greene Donald & Jennifer Holzworth Peter Bert Imrey InterMune Inc. Esther Maria John JVC Enterprises Momentum Research MPEX Pharmaceuticals Inc. James E. Nix NSF International Orexigen Therapeutics Inc. Quintiles Barbara K. Rimer & Bernard Glassman Benedict & Philomena Satia Schwab Fund for Charitable Giving Sigma-Tau Pharmaceuticals Inc. Synteract Inc. Triangle Community Foundation University of Arkansas University of Florida Research Foundation University of Minnesota University of Wisconsin – Madison XenoPort Inc. Arnold & Maryanne Zaks $5,000 to $9,999 Sheryl Wallin Abrahams in memory of Linda Southern Anonymous (2) Anonymous in honor of James Imhotep Irving H. Michael & Barbara Arrighi Bergen County (N.J.) United Way The Boston Foundation Deshpande Foundation Leah McCall Devlin in honor of parents Fred & Pearle McCall Cynthia Girman Peggy & Cam Glenn Ellen Diane Habermacher Johns Hopkins University Gary & Carolyn J. Koch Stephen Allen Morse Douglas M. Owen Karl E. Peace Greg & Paula Brown Stafford William & Michele A. Sollecito David Marc Turner Jack Eugene Wilson Brian A. Zaks Jason Zaks $2,500 to $4,999 Accenture Foundation Inc. Anonymous Delton Atkinson David J. Ballard & Michela Caruso in memory of Harry Guess Howard J. Dunn Susan T. Ennett & Wayne E. Pein Fidelity Charitable Gift Fund Bob & Kristen Greczyn Paula Billingsley Harrison Waldo B. Harshberger Ronald W. Helms Joan Cornoni Huntley John P. McConnell Foundation Hong Li John & Kit McConnell Felicia Mebane David & Julie Potenziani Rebecca Raymond & Michael Stangl Rho James & Jennifer Rosen SAS Institute Inc. Anna Pittman & James Simpson Schenck IV Ilene C. Siegler & Charles D. Edelman Allen & Susan Willey Spalt Maura Ellen Stokes Lydia Lansangan Tiosejo in honor of Dr. Norman F. Weatherly Ronald & Ann Wooten $1,000 to $2,499 Accenture Foundation Inc. Michael Aitken & Betsy Rudolph American College of Epidemiology Lynda Anderson & J. Kenneth Conover Anonymous Association of N.C. Boards of Health Edward L. Baker Jeffrey Propes Baker Kathleen D. Barboriak Frank H. Barr Sterling Wilson Bell Deborah Bender & John Curry Peggy Bentley Mark Dean Beuhler Michael N. Boyd Antonio Braithwaite Fred & Laura Brown Jianwen Cai & Haibo Zhou Joseph & Jenifer Carson Ward Cates in honor of Barbara K. Rimer Ching Kuang Chen Terri Colangelo Ralph & Joann C. Cook in memory of Al Tyroler Georgia G. dela Cruz Chester W. Douglass Ramona & Alan DuBose Todd Alexander Durham Jo Anne & Shelley Earp Kenneth L. Eudy Jr. in honor of Dave Potenziani MaryAnn Cross Farthing Edwin B. Fisher Lyne Gamble & Kathryn Yandell Richard Gargagliano & Joan Hedgecock in memory of Diane Hedgecock Jay Marshall Goldring Sherri Lynn Green Andrea & Michael Griffin Jim & Barbara Grizzle in memory of Bradley Wells Priscilla Alden Guild C. David & Lucy S. Hardison James R. Hendricks Hendricks Consulting LLC Suzanne Havala Hobbs Deborah Parham Hopson Amelia Horne Sallie Craig Huber Joseph G. Ibrahim Inspire Pharmaceuticals Inc. International Lactation Consultant Association Mary Ellen James Raymond James Charitable Endowment Fund Young-Ho Khang in memory of H.A. Tyroler James D. Kinard Bill Kingsbury Lynn Koss Knauff Michael & Pamela Kosorok Kubwater Resources Inc. Miriam Labbok Kenneth Ladrach Don & Marie Lauria Lisa Morrissey LaVange in honor of Gary Koch Peggy Leatt & George Pink Danyu Lin Douglas S. Lloyd Julie MacMillan Sandy Martin & Larry Kupper Theresa A. Martino Danita McAllister A. Dennis McBride James A. & Mary L. Merchant Mark H. Merrill Wilbur & Virginia Milhous Robert C. Millikan Bill & Susan Milner Mona Marie Moon Alan Coningsby Moore Sarah Taylor Morrow Dara Lee Murphy The National Christian Foundation Jeanenne Little Nelson Sharon Nicholson-Harrell Charlotte & Miguel Nuñez-Wolff Jeffrey Oberhaus & Brent Wishart James P. O’Connell Andrew Olshan & Linda Levitch Phillip & Rachel Olsson Leonard Oppenheimer John E. Paul Herbert B. Peterson Alan & Linda Rimer Rotary Club of Chapel Hill R. Gary & Jeanette Rozier John & Kelly Russell Patricia D. Saddier Linda M. & Brian O. Sanders Sanford Pediatric Dentistry Helen C. Schaefer James K. Schaefer Jacqueline van der Horst Sergent Ruth Ann Shults Anna Maria Siega-Riz Gladys Siegel in memory of Earl Siegel Brian Springer Paul Edward Stang State Employees’ Combined Campaign David Steffen & Jill Kerr June Stevens in memory of Jessie A. Satia Joel & Donna Storrow Rosalind Thomas & David Strogatz in honor of Linda Cook Chirayath M. Suchindran Mary Charles Suther Mary S. Thompson Russell Barner Toal John Chester Triplett Douglas Blair Tully William J. Tyroler UNC Student Activities Fund Office Bobbi Wallace Dianne Stanton Ward G. Robert Weedon Alice D. White Paul & Janet Wiles David Winterle & Carey Dawson in memory of Leonard Dawson Kuan-Mu Yao Chen-Yu Yen $500 to $999 Stella Adamu Jerrold M. Alyea American Legacy Foundation Anonymous (3) Anonymous in honor of Linda Cook Gordon Berry in memory of Katherine Wildman William Cudd Blackwelder Michael Austin Boyd Douglas Donaldson Bradham Lynda Bryant-Comstock James Paul Bulman Jennifer Carr in memory of Mary Rose Tully David A. Charnes David Erwin Cooper Deborah Lee Covington Carol Jane Dabbs Dannon Institute Keith Allen Demke Janice M. Dodds Estate of Dorothy Fay Dunn C A R O L I N A P U B L I C H E A L T H | 33 DONOR S Stephen John Dunn George Roy Elmore Jr. Experience Inc. Mary Beth Fasano Lynn Schueler Fitzgerald Joyce M. Gallimore Stuart Gansky Jerry Gray Gentry Michael Craig Griffiths Anders W. Hall in memory of Frances Hall Healthsouth Men’s Clinic Inc. Gerardo & Jo Eaddy Heiss Robert Lee Hines David Lee Hlavac Omar Hopkins & Teresa Savarino Jonathan V. James Nalin Johri Thomas V. Jones Juhaeri Juhaeri Jane Kingsbury Warren Kingsbury Michael & Marilyn Knowles Margaret Edith Layne Mazie Jones Levenson Marcia Joanne Levenstein Catherine Rowland Liemohn Robert Martin David & Gladys McNelis William Clarence Miller Timothy James Mukoda N.C. Citizens for Public Health Zoe Henderson Parker Stephen Praissman Paul Joseph Rathouz in honor of Lawrence Kupper Thomas Cleveland Ricketts III Rachel F. Robbins Mark Graham Rodin Joan Siefert Rose Michael Gerard Schell Robert E. Silverman Philip C. Singer Ellison & Electa Smith C. Jean Spratt Rachel Humphries Stevens Jeanine Hamlin Stice Tamaurus Jerome Sutton John Henry Sweitzer Myduc L. Ta David & Jeanie Taylor in memory of Professor David Fraser Richard & Vanessa Thorsten Fredrick Seymour Whaley Jun-Guo Zhao & Yu Lou President’s Circle ($5,000–$25,000) Marcia Angle & Mark Trustin Anonymous Deniese May Chaney George & Bodil Gellman Peggy & Cam Glenn Donald & Jennifer Holzworth Esther Maria John Michael E. Kafrissen Gary G. & Carolyn J. Koch James E. Nix Barbara K. Rimer & Bernard Glassman John & Virginia Sall William A. & Michele A. Sollecito Derek & Louise Winstanly Chancellor’s Circle ($2,000–$4,999) Sheryl Wallin Abrahams in memory of Linda Southern Michael D. Aitken & Betsy Rudolph Sterling Wilson Bell Fred & Laura Brown Leah McCall Devlin Bob & Kristen Greczyn Andrea & Michael Griffin Paula Billingsley Harrison Joan Cornoni Huntley James D. Kinard Peggy Leatt & George Pink Hong Li Julie MacMillan John & Kit McConnell Felicia Mebane Dara Lee Murphy Charlotte & Miguel Nuñez-Wolff Douglas M. Owen David & Julie Potenziani Rebecca Raymond & Michael Stangl James & Jennifer Rosen Linda M. & Brian O. Sanders Anna Pittman & James Simpson Schenck IV Ilene C. Siegler & Charles D. Edelman Allen & Susan Willey Spalt Joel & Donna Storrow Lydia Lansangan Tiosejo in honor of Dr. Norman F. Weatherly Jack Eugene Wilson Ronald & Ann Wooten Kuan-Mu Yao Dean’s Circle ($1,000–$1,999) Lynda Anderson & J. Kenneth Conover H. Michael & Barbara Arrighi Edward L. Baker David J. Ballard & Michela Caruso in memory of Harry Guess Kathleen D. Barboriak Frank H. Barr Deborah Bender & John Curry Peggy Bentley Antonio Braithwaite Jianwen Cai & Haibo Zhou Joseph D. & Jennifer Carson Ward Cates in honor of Barbara K. Rimer Ching Kuang Chen Ralph R. & Joann C. Cook in memory of Al Tyroler Ramona & Alan DuBose Jo Anne & Shelley Earp Susan T. Ennett & Wayne E. Pein Kenneth L. Eudy, Jr. in honor of Dave Potenziani Edwin B. Fisher Lyne Gamble & Kathryn Yandell Jay Marshall Goldring Priscilla Alden Guild C. David & Lucy S. Hardison James R. Hendricks Suzanne Havala Hobbs Deborah Parham Hopson Amelia Horne Sallie Craig Huber Joseph G. Ibrahim Michael & Pamela Kosorok Miriam Labbok Kenneth S. Ladrach Lisa Morrissey LaVange in honor of Gary Koch Danyu Lin Douglas S. Lloyd Sandy Martin & Larry Kupper Theresa A. Martino Danita McAllister A. Dennis McBride James A. & Mary L. Merchant Mark H. Merrill Wilbur & Virginia Milhous Robert C. Millikan Bill & Susan Milner Mona Marie Moon Sarah Taylor Morrow Jeanenne Little Nelson Sharon Nicholson-Harrell Jeffrey Oberhaus & Brent Wishart James P. O’Connell Andrew Olshan & Linda Levitch John E. Paul Herbert B. Peterson John & Kelly Russell Patricia D. Saddier James K. Schaefer Jacqueline van der Horst Sergent Ruth Ann Shults Brian Springer Paul Edward Stang David Steffen & Jill Kerr June Stevens Mary Charles Suther Russell Barner Toal John Chester Triplett Bobbi Wallace Dianne Stanton Ward G. Robert Weedon Alice D. White Paul & Janet Wiles THE ROSENAU SOCIETY IS NAMED IN HONOR OF MILTON J. ROSENAU, THE FIRST DEAN OF THE SCHOOL OF PUBLIC HEALTH. MEMBERSHIP IN THE ROSENAU SOCIETY IS LIMITED TO BENEFACTORS MAKING A MINIMUM UNRESTRICTED CONTRIBUTION OF $1000 TO EITHER THE UNC GILLINGS SCHOOL OF GLOBAL PUBLIC HEALTH OR ONE OF ITS DEPARTMENTS. MEMBERSHIP MUST BE RENEWED ON AN ANNUAL BASIS. Rosenau Society Membership July 1, 2009–June 30, 2010 34 | F A L L 2 0 1 0 DONOR S $250 to $499 Omid & Julie Ahdieh Anonymous Mary Susan Anthony John Anton & Renee Schwalberg Stephen Charles Ayala Patricia Michel Backus Harriet Hylton Barr Eileen Danielle Barrett Edmund Gerald Barron Sheri Ruth Bates Stephen & Elaine Berman Lynn W. Blanchard Jo Ellen Brandmeyer Carolina Trust Robert & Helen Clawson Coastal Community Foundation of S.C. Francoise Marie Cornet Katherine Elizabeth Crosson Thomas Lawrence Crowe E. Stewart Crumpler Pedro & Carol Cuatrecasas Ronnie McConnell Davis Clifford Earl Decker Jr. Pamela France DeLargy David Louis Dodson Leroy & Kay Doughty Tom & Jenifer Faulkner Richard & Karen Fields Laurel Ann Files David Bernard Fischer Barbara J. Fleck Hilton Thomas Goulson Gretchen Groebel Kerry Brent Hafner Carolyn Cantlay Hart Richard John Heggen W. Howard Holsenbeck Essam Ibrahim in memory of Laurel Zaks Barbara Anne Israel in honor of Linda Cook W. Joe Jacumin Harvey Edward Jeffries James Joseph Jetter Baxter Lee Jones Michelle Crozier Kegler Oliver & Maighread Kelly Amy Hyonju Kim John & Judy Klaas Jacquelyn Hoffman Koehler in memory of Rebecca James Baker Michele Cherry Larson Peter Lauria & Kathleen Sheehan Sheri Johnson Lawrence David Ernest Layland Joseph Gilbert Louis Lee Kelvin K. Lee Wilbert Liou-Lang Lee James Robert Leserman Mike Kafrissen and Bert Peterson have been friends and colleagues for more than a quarter-century. As obstetrics and gynecology physi-cians, members of the U.S. Centers for Disease Control and Prevention’s Epidemic Intelligence Service and faculty members at UNC Gillings School of Global Public Health, they have worked in concert to improve the health of women and children around the world. Kafrissen, School alumnus, research scientist at Massachusetts Institute of Technology, Chief Scientific Officer for Johnson & Johnson’s North American Pharmaceutical Company, and adjunct professor of maternal and child health at UNC, says UNC-Chapel Hill has been instrumental in his career path. “During a recent visit to the campus, I felt led to increase my involvement with our school,” Kafrissen says. “I was moved by my conversations with Bert [Herbert Peterson, MD, Kenan Distinguished Professor and chair of the School’s Department of Maternal and Child Health] and his passion for and optimism about the current effort to reduce maternal mortality.” As a result of those conversations – and subsequent ones with Dean Barbara K. Rimer and UNC Chancellor Holden Thorp – Kafrissen presented the School with a generous gift, which was matched 2-to-1 by his former employer, Johnson & Johnson. The funding helps support Peterson’s efforts as director of the UNC-based World Health Organization (WHO) Collaborating Center for Research Evidence in Sexual and Reproductive Health. The Center helps WHO and other leading United Nations health agencies as they develop and implement science-driven solutions for preventing mater-nal deaths in the 25 countries in which most such deaths occur. “Mike has helped us immensely,” Peterson says. “His wisdom and expertise have been absolutely invaluable, and his generous gift is key in getting this important work off the ground.” – Linda Kastleman Michael Kafrissen, MD: Giving back to support a cause I believe in Dr. Michael Kafrissen Dr. Bert Peterson holding Nikhil Gomez PHOTO BY ANU MANCHIKANTI GOMEZ C A R O L I N A P U B L I C H E A L T H | 35 DONOR S Juliana Meimei Ma Allen Martin Mabry Craig Stephen Maughan William Sheffield McCoy The MidSouth Lactation Consultants Association Beverly Mirman Philip Keith Mitchell Hannah Yang Moore Hal Morgenstern John Bertrand Mulligan Jr. Mary Margaret H. Mundt J. Richard Navarre & Melissa McPheeters Jacob Alan Neufeld Raymond Joseph Nierstedt Julie Truax Nunez Donald & Mary Oberlin Timothy Wade Okabayashi Richard Davis Olin Richard Jay Osborne Jane Therese Osterhaus Anne Townsend Overman Ruth Woodenberg Patterson in memory of Jessie Satia Brian E. Pedersen Jamie Perin Helen Peters David Edward Pinsky Lewis William Pollack Barry Michael Popkin in memory of Jessie Satia Lanny & Cleta Puckett Xiang Qin Irving & Joan Rimer Susan Wenger Robbins in honor of Miriam Labbok Charles Eric Rodes Ruth Rothman in honor of Miriam Labbok Eris Hamrick Russell William & Donna Rutala Susan Marie Sanders Victor & Marion Schoenbach Chuan-Feng Shih Mary Kate Shirah in honor of Linda Cook Linda Simoni-Wastila William Thomas Small Jr. Fraser B. Smith Jeffrey Boyd Smith Amy Kathryn Spangler in memory of Mary Rose Tully Scott & Ann Stoioff Anne Nelson Stokley Susan E. Strunk Lisa Ann Sutherland James & Sandra Swenberg Robert Charles Sykes J. Chi-Chung Tang Gabriel Kodzo Tanson M.J. Territo Willem A. Van Eck Wanda Kay Wilkins Deborah Marie Winn Richard Vance Wolfenden Beverly Ann Young $100 to $249 Rashmi Agarwal Daniel & Kathryn Ahlport Alan & Barbara Alexander Jean Elizabeth Alexander M. Taylor Alexander Jr. William & Mary Allshouse Amgen Foundation Terry P. Anderson Anonymous (4) Lenore Arab Nikita Arya Annella Jean Auer Carolann Dineen Augustine A. John Bailer & Jennifer Faris-Bailer Samuel J. Barone E. Byrd Barr C. W. Bartholomai Valentine R. Bauer Melinda A. Beck Bruce Anthony Behringer Ronald Benson & Nellie Hansen Carl Levon Biggs Richard E. Bilsborrow Elizabeth Hardaway Birkenbeuel Michelle Jones Blackmon Aaron Earl Blair J |
OCLC number | 235237567 |