First published on June 1, 2015 in observance of the COPH’s 30^th anniversary celebration.

It was the evening of May 2.  There was a slight chill in the air as fans gathered in Traditions Hall anxiously awaiting the event of the century.

No, not the Mayweather vs. Pacquiao fight.  The other event ….

The USF College of Public Health’s Inaugural Alumni Awards Ceremony.

More than 180 supporters of the college traveled from as far as Indonesia to celebrate 28 Bulls with significant impact in public health.  From research to practice to policy to teaching, the awardees have done it all and are doing it exceedingly well.

COPH 2015 alumni awardees

The celebration began with a cocktail reception at 6 p.m., followed by dinner and the ceremony.  The dynamic Dr. Joette Giovinco served as mistress of ceremony for the evening.  She’s the first physician to complete the COPH’s occupational medicine residency program, but is probably best known as Dr. Joe, the medical reporter for Fox News in Tampa.

Dr. Joe shared stories and relics from her days as a graduate student in 1988.  She even dusted off some vintage overhead sheets and her carousel replete with slides!

“We were so fortunate 30 years ago that visionary leaders like Sam Bell and Dr. Robert Hamlin believed that Florida deserved to have a school of public health and created the foundation for the first one in the state at the University of South Florida,” said Dr. Donna J. Petersen, COPH dean and senior associate vice president of USF Health.

“It is only fitting on the occasion of our 30^th anniversary that we recognize some of those alumni who, through their commitment to their profession, improve the health of communities around the world and reflect back so positively on our College of Public Health.”

Nominations were accepted through January.  A selection committee comprised of retired and current faculty, staff, alumni, students and community partners in public health had the arduous task of reviewing dozens of nomination packets.

Each alumni awardee received a stunning silver bull engraved with his or her name.

After dinner, Peggy Defay shared her experiences as a public health graduate student.

“As a first generation immigrant from Haiti,” she said, “higher education in any capacity is a priority for me.”

“I discovered my passion for public health through my experience as a Peace Corps volunteer in Namibia.  Through this experience, I gained a better understanding of health issues at the grassroots level.  Being a volunteer in the Peace Corps helped me understand some of my weaknesses and the need to continue training in this field.”

“The past seven years have taken me to various corners of the world where I have been privileged to meet, live and be empowered by many people.  The last two years at the University of South Florida are no exception to that.  And, I can now say that I have once again lived and worked among amazing people!”

Then, it was time for the main event—presentation of the COPH Class of 2015 alumni awardees.  Each alumni award recipient was recognized during the ceremony, and all are listed here.  A few of their stories are included for those who weren’t present to hear them all on May 2.

Tabia Henry Akintobi, PhD, MPH
Director, Prevention Research Center
Director, Evaluation and Institutional Assessment
Associate Professor, Department of Community Health and Preventive Medicine
Associate Dean, Community Health
Morehouse School of Medicine
Atlanta, Ga.

“As a graduate student, I had the opportunity not just to learn how to conduct research, but how to lead it in partnership with experts who cared,” Dr. Tabia Akintobi said.  “They recognized the importance of students as significant contributors to their research as reflected in the number of co-authored papers and abstracts I had under my belt prior to graduation.”

“Among the wonderful colleagues, mentors and leaders I met during my tenure was the love of my life, professional confidante and partner in good Dr. Adebayo Akindele Akintobi [former student and husband].”

Abdel A. Alli, PhD, MPH
Assistant Professor
Department of Physiology
Emory University School of Medicine
Atlanta, Ga.

Philip T. Amuso, PhD, MS
Consultant
Clinical Laboratory Medicine and Public Health Preparedness

Retired Director
Bureau of Laboratories
Florida Department of Health
Tampa, Fla.

Roy W. Beck, MD, PhD
Executive Director
Jaeb Center for Health Research
Tampa, Fla.

Sherri Berger, MSPH
Chief Operating Officer
Centers for Disease Control and Prevention
Atlanta, Ga.

“My undergraduate degree was in political science, and I didn’t know exactly what to do with it after graduation,” Sherri Berger said.

Sherri Berger and son Jacob.

“Listening to my mother’s advice to ‘get more education,’ I did what other college kids do, and I followed my boyfriend to Tampa, where he had a job offer.  I was hoping to get a master’s degree in hospital administration.  However, in my first semester at the COPH, I fell in love with epidemiology.”

Arlene Calvo, PhD, MPH
Research Assistant Professor
Depts. of Community and Family Health & Global Health
USF College of Public Health
City of Knowledge, Panama

James R. Chastain, Jr., PhD, PE, MPH
President
Chastain-Skillman, Inc.
Tampa, Fla.

“Having an undergraduate and graduate degrees in engineering, I found public health a perfect complement to that training,” Dr. James Chastain said.  “While engineering is much more design and nuts-and-bolts execution-oriented, public health was more about the personal impacts and generally a systems-oriented and advocacy approach.  There certainly was a great overlap, but even the way that I had to study was different.  Public health provided fresh perspectives to design problems, and I enjoyed expanding my horizons with my studies.  In a word, public health tended to address the “why” questions, and engineering focused on the “how” questions.  I’ve found that very helpful in my practice.”

The Chastain Family celebrated James accomplishments. James is pictured far left.

“The COPH also was quite progressive at the time in terms of scheduling courses that allowed working professionals to take the courses while working at the same time.”

Chastain managed a company and family with three children while earning his degree.

“The time pressures were intense,” he said, “and would not have been possible without a very understanding and supportive wife.”

Stephen R. Cole, PhD, MPH
Professor of Epidemiology
Gillings School of Global Public Health
University of North Carolina at Chapel Hill
Chapel Hill, N.C.

Martha L. Daviglus, MD, PhD
Associate Vice Chancellor for Research
Professor of Medicine
Director of the Institute for Minority Health Research
University of Illinois at Chicago
Chicago, Ill.

Hanifa M. Denny, PhD, MPH, BSPH
Dean
College of Public Health
Diponegoro University
Semarang, Indonesia

“One day, we were brought to new [medical] student orientation session.  After touring a hospital ward, I was not able to eat or sleep for some days due to seeing a diabetic patient with a severe wound,” Dr. Hanifa Denny recalled.

“I asked one professor if there is a program within the college of medicine without a requirement to visit patients in a hospital ward.  I also said that I wanted to help people to live in a healthy lifestyle without necessarily suffering from sickness.  I wanted to make people healthy and able to work without a fear of being sick.  The professor explained public health and how the science would meet my expectation.  After my second year of college, I fell in love with occupational and environmental health.”

Scott Dotson, PhD, MSC, CIH
Lead Health Scientist – Senior Team Coordinator
Education and Information Division
National Institute for Occupational Safety and Health
Centers for Disease Control and Prevention
Cincinnati, Ohio

Anthony Escobio, MPH, FHFMA, CHAM
Vice President
Patient Financial Services
Tampa General Hospital
Tampa, Fla.

“I wanted to be an MD.  I took a few of the pre-med “weed out” courses as an undergraduate and did not do very well,” Anthony Escobio recalled. “I had an entry-level job at St. Joseph’s Hospital in 1990, and this is where I learned that there were many more opportunities in health care that did not involve practicing medicine.”

The Escobios couldn’t be more proud of Anthony (back row, second from right).

One of the more “interesting” events from Escobio’s COPH days involves a class with Dr. Alan Sear.

“I left a management position at University Community Hospital to be a senior analyst at Tampa General Hospital,” Escobio said.  “TGH was having a host of financial challenges at the time, and the leadership was being ridiculed in the press on a weekly basis.  One of my professors, Alan Sear, spent an entire lecture discussing the poor decisions that leadership at TGH was making.  I sat slouched in my chair knowing that I had just taken a job to be an analyst for these very leaders.  All I could think to myself was ‘what have I done?’  Little did I know that I would be at the center of one of the biggest hospital turnarounds in the country for this period of time.”

Ligia María Cruz Espinoza, MD, PhD, MPH
Associate Research Scientist
International Vaccine Institute
Leon, Nicaragua

Kathryn J. Gillette, MHA, FACHE
Market President and Chief Operating Officer
Bayfront Health-St. Petersburg
St. Petersburg, Fla.

Jan J. Gorrie, JD, MPH
Managing Partner
Ballard Partners
Tampa, Fla.

Richard T. Hartman, PhD, MS, CSP, CIH
Chief Health Strategist
PSI Inc.
Alexandria, Va.

Xiomara Zulay Hewitt, MPH
Director
Infection Prevention and Control
Adventist Health System
Altamonte Springs, Fla.

Winifred M. Holland, MPH, MA, LMHC
Administrator-Health Officer
Florida Department of Health in Clay County
Green Cove Springs, Fla.

Carol Ann Jenkins, MPH, FACHE
Director, Accreditation and Survey Readiness
All Children’s Hospital Inc.
St. Petersburg, Fla.

Claudia X. Aguado Loi, PhD, MPH, CHES
Research Assistant Professor
Department of Community and Family Health
USF College of Public Health
Tampa, Fla.

Christine McGuire-Wolfe, PhD, MPH, CPH
Firefighter/Paramedic and Infection Control Officer
Pasco County Fire Rescue

Adjunct Faculty
Department of Global Health
USF College of Public Health
Tampa, Fla.

Maj. (Dr.) James McKnight
Force Health Protection Officer
U.S. Central Command
Serving in Jordan

Maj. James McKnight’s children accepted his award since he is serving in Jordan.

Rachel Nuzum, MPH
Vice President
Federal and State Health Policy
The Commonwealth Fund
Washington, D.C.

Claudine M. Samanic, PhD, MSPH
Commander
U.S. Public Health Service Commissioned Corps

Environmental Health Scientist
Agency for Toxic Substances and Disease Research Region 5
Division of Community Health Investigations
Centers for Disease Control and Prevention
Chicago, Ill.

“Since 1999, when I graduated, I’ve been impressed with the expansion and creation of new institutes and centers, the college’s increasing role in global health, and announcements of various faculty accomplishments and impact,” said Dr. Claudine Samanic.  “It was humbling to be in the room with so many accomplished fellow COPH alumni.”

Angelia Sanders, MPH
Associate Director
Trachoma Control Program
The Carter Center
Atlanta, Ga.

Natalia Vargas, MPH
Public Health Analyst
Health Resources and Services Administration
U.S. Department of Health and Human Services
Rockville, Md.

Angelica C. Williams, MPH
Disease Intervention Specialist
Florida Department of Health in Broward County
Pembroke Pines, Fla.

Lauren B. Zapata, PhD, MSPH
Commander
U.S. Public Health Service Commissioned Corps

Senior Research Scientist
Division of Reproductive Health
Centers for Disease Control and Prevention
Atlanta, Ga.

COPH Deans, from left: Drs. Peter Levin, Donna Petersen (current) and Charles Mahan.

Without question, the night was all about the alumni awardees, but there were a few other show-stoppers in the room. Namely, COPH Deans Drs. Peter Levin, Donna Petersen, and Charles Mahan (above) and COPH alumnus and USF Board Trustee Scott Hopes (below left).

USF Trustee Scott Hopes (on left) with Lesley and Rick Bateman.  Lesley was the college’s first public affairs and development officer.

Founded in July 1984, the USF College of Public Health is wrapping up a yearlong celebration of educating and training public health professionals.  Some of the 30^th anniversary year highlights include

• regional events in Orlando, New Orleans, Chicago, and Washington, D.C.
• the Dean’s Lecture Series featuring alumni like Drs. Richard Hartman, Charlan Kroelinger and Hana Osman.
• community building activities like a tailgate and USF football game, fall networking social during homecoming, Super Bowl party and spring BBQ.
• Team #USFCOPHRocks with more than 50 public health Bulls participating in the Gasparilla Distance Classic.
• raising almost $70,000 in new commitments to student scholarships in the college.

“We are proud of the work we have done building on a solid foundation and creating an outstanding school of public health—one that just recently jumped in national rankings from 21 to 16,” Petersen said.  “In addition to our great champions and the consistent high performance of our faculty and staff, the reputation we have earned is due in no small measure to the incredible contributions of our alumni.”

The alumni awards ceremony was made possible with support from the COPH, as well as corporate sponsors USF Health and Bayfront Health-St. Petersburg, and individual sponsors Drs. Jay Wolfson and Phillip and Jean Amuso.

It takes a village to raise a family AND host an amazing alumni awards ceremony.  Salute!

Alumni awardee Dr. Abdel A. Alli (second from right) enjoyed the festivities with his family, as well as nominator and faculty mentor Dr. Donna Haiduven (center) and her husband, Michael Gronquist (far right).

Alumni awardee Dr. Arlene Calvo shares a special moment with fellow alumnus Dr. Clement Gwede.

Go, Bulls!

“I applaud the College of Public Health for recognizing alumni who not only have tremendous accomplishments, but who have made a difference in the lives of so many,” said Bill McCausland, executive director of the USF Alumni Association.

Story by Natalie D. Preston, College of Public Health.  Photos by Ashley Grant and Humberto Lopez Castillo.

Related media:
Alumni Awards photo gallery on Facebook

The post Our past is our future: College recognizes distinguished alumni appeared first on College of Public Health News.

First published on April 6, 2015 in observance of the COPH’s 30^th anniversary celebration.

Dr. Karen Liller has been a child and adolescent injury prevention researcher for a quarter of a century.  A professor in the USF College of Public Health’s Department of Community and Family Health and a member of the Florida Injury Prevention Advisory Group, she worked with a Tampa General program called More Health in the mid-1990s to help evaluate its health education programs.  One of those programs promoted bicycle helmets for children.

Dr. Karen Liller

“I evaluated their program, and I started observational studies of children’s bicycle helmet use in Hillsborough County,” Liller said.  “I was monitoring this because, as part of the Injury Group, I knew this bill had been denied two times before.  We were all part of the advocacy efforts with Tallahassee between the state of Florida program, More Health and the college to get this passed.”

A natural proponent of requiring kids to wear helmets when they rode their bikes, Liller had her interest piqued.  From casual observation alone, she surmised that few were.  Determined to put scientifically collected numbers to the problem, she and a cadre of her graduate students set about the task of collecting data.

From low expectations to high hopes, then action

“I was focused on unintentional injuries in children,” she said.  “Nationally, this was a huge issue.  I had some colleagues at Harborview Injury Prevention Program in the state of  Washington, and they were some of the early leaders nationally in helmet use.  So I naturally got very, very interested and started looking, started conducting observational studies, because I didn’t know:  What is the helmet use rate? “I developed and performed community observations,” she said.  “I would hire my grad assistants, and they would stand on corners doing observational surveys of kids in helmets.  We mapped out the whole county, and I had them on streets everywhere.  We had a whole protocol of where we wanted to be, because we wanted to capture observational surveys in many different places – in community sites, in schools, not near schools, etc., so we had a good idea of what was going on in Hillsborough County.”

As low as Liller’s expectations were, reality turned out to be even worse.

“I can tell you, it was pitifully low,” she said.  “For children under 16, it was about three percent.”

Liller set out on a concentrated campaign to get a helmet law passed.  It already had languished and died in two previous legislative sessions, and she was determined to make the third try count.

“I did many radio spots and TV spots and Good Morning Whomever promoting bicycle helmets as the law was working its way through the legislature,” she recalled.

“I wanted to get ahold of it,” she said, “because I knew this was a national issue, and I knew states were starting to pass laws.  Florida is a tough state to get a law passed for children’s injury prevention.  In fact, we just got the booster seat law done.  We were one of the last states to do that.  I knew it was going to be a battle.  So, I knew I’d better get started early.” Liller learned through focus groups that legislators weren’t the only people she needed to convince.  Some parents didn’t want a law telling them to put helmets on their kids’ heads.  After all, bicycle shops already were selling more helmets.  McDonald’s was giving out helmet discount coupons and safe rider certificates.  Why should there be a legal mandate?

“My answer to them was, ‘Do you have a driver’s license?  Yes?  Well, the government told you to do that.’

“It always surprised me when parents would argue with me on this issue.  The famous one for me was, ‘I rode a bike all the time when I was a kid, and I never got a head injury.’  I’d say, ‘When was that?  Where was that?’  And it would be some idyllic little community in some other state, and I’d say, ‘Try riding a bike in Tampa now, and get back to me on that.  The world has changed.  The roads have changed.  The danger level has changed.”

Clearly, the law’s chief proponent had taken on a daunting task, but being part of the state’s first college of public health had its rewards.  Dr. Charles Mahan, state health director under Gov. Lawton Chiles, was a valuable ally.  COPH was still the only school of public health in Florida, and COPH professors were trekking all the way to Tallahassee to teach weekly classes at the state health department office.  Through the department’s close working relationship with COPH, Mahan already had known Liller and had been supportive of her efforts.

Dr. Charles Mahan

“We knew that Karen was really focused on getting a child helmet law through, and certainly, we were very much in favor of that,” said Mahan, who was COPH dean by the time the measure was in its third incarnation.  Mahan had known Chiles since well before the latter began his two terms as governor.

When Mahan was a medical student at the University of Florida, Chiles became interested in his work on infant mortality.  Personal and professional bonds soon followed.

“When he was a senator, I would go around the country and hold hearings with him,” Mahan recalled.  “He would do all the talking, but I would help him figure out what to say, depending on what the issue was.”

Mahan knew the governor well enough to know he was predisposed to children’s health issues.

“Any issue related to children was something that Gov. and Mrs. Chiles were supportive of,” Mahan said.  “Anything that needed his support on children’s issues for safety or survival or whatever, he would tell the staff – me and everyone else – to make sure that it got supported.” With the encouragement of a popular governor, the proposal was gaining momentum.  The awareness raised by the news of the pending legislation helped engender educational outreaches that helped the ball roll faster.

“Betty Castor, who became president of USF, was head of education at the time,” Mahan said, “and the school systems jumped right in with educational efforts.”

Those collective efforts eventually generated the irresistible momentum that carried the measure over the finish line.

“With Charlie’s support and the governor’s, on the third attempt, it was successful,” Liller said.  “And I testified and did a variety of things locally, as well, for the bill.  A colleague of mine also did a cost-effectiveness study, and he also testified with that in Tallahassee.  I think it was a combination of all of these things.  We kept sending the legislators our research findings, and with all the backing, eventually, in 1996, the bill passed.”

A victory not etched in stone

“Bike helmets are an investment we should make to ensure our children’s health and safety,” Chiles declared as he signed the bill onto law.

The measure became effective on Jan. 1, 1997, and for the next 12 months, it was easy for anyone to live with.  A violator would receive a warning and a bicycle safety brochure.  As of Jan. 1, 1998, however, that brochure was delivered with a $17 citation.  It was a light fine as fines go, and even it could be circumvented.

“After the first year, you could get a fine if the child was riding, was under the age of 16 and didn’t have a helmet on,” Liller said, “but you could get around that if you could show evidence of a bicycle helmet.”

That, of course, was only when the law was enforced, which, according to Liller, wasn’t – and still isn’t – very often.

“Police are very reluctant,” she said.  “I talk to them about how many tickets they’ve given, and usually the answer is ‘none,’ at least in Hillsborough County.  They’re very reluctant to stop a child on a bike.”

Nonetheless, she said, by 1998, helmet use had risen exponentially, to 67 percent in Hillsborough County.  So even without much enforcement, the law was accomplishing its purpose.

“I think the law has been great,” Liller said.  “We did an analysis of its efficacy.  We did show that helmet use has gone up, and we showed that injuries have gone down.  And that was great.  That was the intent of the law.  Injury prevention does its best, many times, when there’s a policy change or a legislative change, because it just reaches more people.”

Mahan agreed. “Having it as law is a big awareness raiser,” he said.  “It gets all over the papers and the news again and again.  The legislature is considering this measure.  That’s news.  The legislature passed it today.  That’s news.  The governor signed it into law.  That’s news again.  It went into effect today, so that’s news, too.

“For the majority of parents, who care so much about their kids, just the awareness-raising and then seeing other kids out there with their helmets on helped, but it took time.  As with any legislation, it takes about three years to get a good idea through.  It’s very hard to take a new idea on regulation to the legislature.”

“It was a very exciting time,” Liller said, “because, the first couple of times, I would go to the injury meetings, we’d work on the language of the law, and it just kept getting defeated.  The first year we did it, I think we just put it out there and said, ‘Let’s just see how it goes.’  The second year, we didn’t have the information about the penalty.  I still don’t like the penalty.  I don’t to this day.  But it was a really exciting process, and I’m so glad I was part of it.”

Still, Liller knows that no law is etched in stone.  The state threw a scare into helmet proponents and safety advocates in general when it partially repealed its motorcycle helmet law by limiting the requirement to riders under 21. “We were very afraid that they were going to repeal the bicycle helmet law, too, but so far, so good,” Liller said.  “They haven’t touched that law.  I think that’s because it’s for children.  I think if we would have had that helmet law for all ages, we would have been in trouble.”

“When I was at the state health office,” Mahan said, “the helmet law was a big plus, but at the same time, we lost the motorcycle helmet law, and that’s had tremendous consequences.”

The work continues

“We want it to become a norm,” Liller said of bicycle helmet use.  “We want it to be that, when these children have children, there won’t be any question when you get on a bike.  And we’re starting to see that.”

Mahan concurred.  He said he and his wife live two blocks from an elementary school, and the progress is easily visible.

“A lot of the kids are riding their bikes to school,” he said, “and every one of them has a helmet on.”

Work since the law’s passage has been geared toward bicycle helmet give-away programs.

“If you don’t have a helmet, we can find you one,” Liller said.  “We can find a program – Safe Kids, Tampa General, we can find somewhere to get you a helmet.”

Liller’s work on the law continues to influence safety initiatives.

“Our work has been in world publications about helmet use, about laws, about how it’s done,” she said.  “The Robert Wood Johnson Foundation wants to know about strategies, and it seems that the strategies that were developed in the ’90s – people are still really interested in those.  We were always pleased that our work is often cited as an example, even though many years have passed.”

Liller said she also is gratified to see the lasting validation of her and her colleagues’ methodology.

“It’s interesting that the work that we did is still being used.  If you run a program, you do some observational surveys.  You look at that helmet use on those kids.  You don’t just ask them.  You actually watch them.”

In the intervening years, Liller’s focus has shifted to high school sports injuries, but she remains committed to the legislation she helped to bring about, and she remains engaged with it, most recently as a content reviewer for the Robert Wood Johnson Foundation and the Wisconsin Population Health Institute for strategies they want to propose for child safety seats – and yes, bicycle helmets. Her message for the naysayers remains the same.

“We’re not telling children they can’t ride bikes,” she said.  “We’re not telling children they can’t have fun or anything else we were accused of so often.  Basically, it’s just taking necessary precautions.  There’s been some literature that says we should let kids take more risks.  We don’t want to stop anyone from taking risks or having fun or getting exercise.  We just don’t want a child to die from a perfectly preventable head injury.  We’re smarter now.”

Story by David Brothers, College of Public Health.  Photos courtesy of the National Highway Traffic Safety Association, Helmets On Heads, County Mayo and other sources.

The post COPH helped drive state’s bicycle helmet law appeared first on College of Public Health News.

First published on July 13, 2015 in observance of the COPH’s 30^th anniversary celebration.

Jodi Ray is a bundle of energy when she talks about the project that has become her life’s work, Florida Covering Kids and Families, which is a part of the Lawton and Rhea Chiles Center for Healthy Mothers and Babies.

The founding program director was Mary Figg, a state representative for Hillsborough County.  After a year or two of preliminary maneuvers, the initiative began formally in 1999.  Figg had enlisted Ray, who has a master’s degree in mass communications, the year before to be program coordinator and handle all things media, including assisting her with crafting the successful request for that all-important initial grant.

“My job was to manage a multimedia campaign.  I’ve done a lot of mass communications on this job,” she said.  “In fact, I’d say I do more of that than anything else.”

The project was funded its first seven years by the Robert Wood Johnson Foundation to do outreach enrollment of children eligible for the Children’s Health Insurance Program and Medicaid.  During that time, a staff of two more than doubled to five by 2006, then, when that funding ended, was cut all too literally in half, reduced to a project director, a coordinator and a half-time assistant: essentially, a staff of 2-1/2.  Fortunately, they had a dedicated network behind them.

Jodi Ray

“We have a state coalition,” Ray said, “a large collaboration of partners from around the state and local coalitions in almost every community in the state.  We came together and said, ‘Our mission is to get uninsured into coverage.’”

The coalition was initially mandated by the RWJF grant, Ray said.  It remains active today and includes some of its original members.  No question, it answered a critical need in 2006, when half the staff was asked to keep up with an exponential work-load increase created three years earlier.

Crying on the phone

“In 2003,” she explained, “the state ended all outreach efforts for CHIP.  So they literally boxed everything up and sent it to me.  They gave me their contact lists and all of their partnerships and said, ‘Could you please take this on?’  Now granted, there were no financial resources with that at the time.”

“The state also closed enrollment for CHIP in Florida for 18 months.  As a result of that, we lost over 300,000 kids in the Florida KidCare program.  In one month alone, we lost 40,000 kids.

“There was no statewide outreach initiative except us,” she said, “me and my other 1-1/2 people.  The number of calls I got was unbelievable.  People were calling and crying.  It was terrible.”

That situation started Ray on an 18-month crusade, talking to newspaper editorial boards, legislators, community leaders, almost anyone who would listen.

Committed to moving forward, she and the coalition began implementing a plan that was as innovative as it was aggressive:  Sign up as many kids as possible to a waiting list.  When the list reached 120,000, the New York Times took notice and gave the state a boatload of blistering press.  Not long after, the governor issued an executive order to enroll all the kids on the list, and open enrollment returned permanently four months later.

In 2007, a new governor, Charlie Crist, declared the uninsured rate among children appalling.  He brought the state agencies together, Ray said, and told them to figure out how to make it better, and fast.

“One of the things they did was decide to give us some resources,” Ray said.

A state contract and marketing materials soon followed, along with help from state agency staffs on routine but time-consuming matters like mailing.  Growth was back, and with it, ramped-up after-school activities and more engagement with local businesses.

The results since have ranged from impressive to remarkable.  Since the first open enrollment period began on Oct. 1, 2013, the project has gained national media coverage for enrolling about 2.5 million previously uninsured Floridians, twice the expectation.

“We expanded to focus on all the newly eligible uninsured to help them get into whatever coverage options are available,” Ray said, “whether under the Affordable Care Act in the marketplace or Medicaid or CHIP.  One way or another, we were going to help people who didn’t have coverage get health insurance so they could get access to health care services.

“Health care services are important, and having preventive care, all those things.  We talk about all those things being necessary, but you’re not getting in the door unless you have health insurance.  So that’s what we focus on: the first step, getting people in the door.”

That may be the focus, but there’s plenty more to do.

“We also do one-on-one application,” she said.  “We have consumers that actually sit down with us and do enrollment.  We do everything that involves connecting people to health coverage.

“We even do some health literacy.  How do you use health insurance?  How do you make an appointment to see a doctor?  For many of the uninsured, these are not obvious.”

“We work with all the agencies on both the state and federal levels that are involved in implementing health coverage, and we get out there and shake the bushes.”

Media and more

As much effort as is spent on finding the uninsured, many do find FCKF first, Ray said.

“We get cold calls for everything,” she said.  “I used to wonder sometimes how people find us, but I don’t wonder that anymore.  All you have to do is help somebody.  Then that person gives your number to somebody else.  We get a lot of calls by word of mouth.  We helped someone at some point, and even years later, we get a call from that person’s family member or friend who needs help.”

“The things that consumers come in here and tell you are unbelievable, sometimes heartbreaking.  That’s the other thing that’s really tough,” she said.  “I’ve gotten calls that have made me literally get up and walk around the building a few times because the stories are terrible: the family living in a car; the kid who’s got some kind of horrible heart condition; the mother who had CHIP coverage, but something went wrong with her renewal, it got dropped, it’s Christmastime and she has no money because the asthma medication she had to pick up for her son cost $400.”

While grants provide the funding, the University of South Florida and College of Public Health make it work, Ray said.

“Our work has been very well supported by both the College of Public Health and the University.  I say this out loud every day:  I don’t think anybody doing this work could be in a better place.  I don’t think there’s any way Dr. Petersen could support our work any more than she does.  We get so much support from one end of this university to the other, and we worked with everybody through open enrollment.”

Student Health Services, the libraries, the Morsani College of Medicine and the Marshall Center were regular haunts, as were the St. Petersburg and Sarasota-Manatee campuses.

From the beginning, Ray, who became director upon Figg’s retirement in 2003, has been the media go-to person from the beginning, and that responsibility has grown as exponentially as the project itself.

“We do four press conferences a year.  I spend a ridiculous amount of time talking to reporters.  Just in the first open enrollment period alone, I probably did 80 or 90 interviews with reporters from one end of the country to the other.”

The result was major articles in The New Yorker, the New York Times and the Los Angeles Times, to name a few, as well as pieces widely disseminated by the Associated Press and Reuters, as well as personal visits from two national health secretaries.

Ray on Capitol Hill in a nationally televised discussion.

“During the first open enrollment period, we had the second-largest grant in the country,” Ray said.  “That, in itself, drew attention, and [U.S. Health and Human Services Secretary Kathleen Sebelius] came here, herself, and awarded the grant.  She came to the college, and that’s how I found out we’d gotten the grant.”

It’s little wonder, then, that what began with two people 17 years ago keeps a dozen in the USF office busy with training, policy work, education, outreach, grant-writing, communications, etc.  It’s an office full of multi-taskers, Ray said.

“We all do all of it,” she said.

Given the complexities of health insurance laws and regulations, not to mention a new set of rules for navigators, just keeping up is a task unto itself.

“We do have to make it a point to stay informed.  We’re constantly on webinars and trainings, reading policies and reading new rules.  We have our hands in a lot of different elements of public health, just because we have to.”

The toughest part of the job, she said, is not being able to help everyone.

“We still have a gap of folks who are not going to qualify for coverage they can afford because the state has not expanded Medicaid coverage,” she said.  “I’d like to see us be able to enroll everyone who has no access to health coverage.  I’d like to see that in less than five years, quite frankly.  I would hate for that to be a five-year goal.”

Ray makes it obvious that what she and her colleagues do at Florida Covering Kids and Families is what keeps her pumped with energy.

“It’s all very exciting,” she said.  “We’re right there at the front end of this, and that, in and of itself, is exhilarating.  I feel good about what we’ve been able to accomplish, so it’s all been worth the time and effort – and the stress and the exhaustion – because it’s paid off.  We’re actually having an impact, and people see it.”

Every flight needs a navigator

The federal navigator initiative aimed at getting people into the new health insurance marketplace has been a major focus of their work the past two years, as well as a major hallmark of their success.

“The navigators are tied specifically to the federal marketplace.” Ray explained, “Some states are not participating in the federal marketplace, but Florida happens to be one of those states that is.”

The federal program provides outreach enrollment funds.  The first funding opportunities began in 2013, Ray said, and her office applied for USF to get an award that would cover the state.  She and her team did all the grant writing.

“We had already been doing this work on the ground across the state to enroll kids in CHIP and Medicaid,” Ray said, “and many of the partners around the state had come to a consensus that it made perfect sense for us to be the applicant for this grant and take the lead.  So, what we did was look at the model that was already working and find a way to expand on that.”

The result was a $4.2-million award in 2013 to cover 64 of the state’s 67 counties, the exceptions being Broward, Miami-Dade and Monroe, which submitted their own applications separately.

“The second year,” Ray said, “we went back to those partners again and asked them if they would like to join us for the 2014 application.  They said yes the second time around, so the second time around, we covered all 67 counties in Florida.”

The second award was worth $5.3-million.  Ray’s group had secured million-dollar grants for their Children’s Health Insurance Program enrollments, but those, which  had been their largest to date, are easily dwarfed by the Navigator grants.

Most of the funds are vested in the people who get the job done, Ray said.

“A lot of people.  I’m a big believer that priority number one should be the human resource.  The folks on the ground.  The folks who are out there doing the education, the communication, the one-on-one application assistants, the people who know the processes.  We know from our history of doing this and tons of research that these are the folks who keep people from getting lost along the way through the process.”

In one regard, Ray said, the Navigator’s work has only begun with the enrollment stage.

“They help people navigate the enrollment process and get to the point where they can be enrolled and covered, and they’re also key to helping people appropriately use health insurance,” she said.  “We want folks not just to get in, but we want them to keep their coverage and to use their coverage properly.

“When you’re connecting people to health care coverage for the first time, these are not innately understood concepts.  Insurance is actually a pretty complicated idea, and if you’ve never used it, you really can get overwhelmed.  If you have it and you’re not using it, then the tendency to understand its value can be diminished.  The Navigators and the Florida KidCare application assisters on the ground are essential for that piece of it.  It’s not just about filling out the forms.”

The numbers tell just how busy those people on the ground have been.

“The first year, the projected enrollment for the federal health insurance marketplaces in Florida was around 450,000, give or take,” Ray said.  “We ended up enrolling – with all partners across the state, not just the USF partners – almost a million.  We doubled the projections, basically.

“The second year, the last number I saw was about 1.6 million, but that didn’t include the last month, the limited special enrollment period for people who got hit with the tax penalties.”

As impressive as those figures are, their national rank may be more so, especially given California’s stand as by far the most populous state of the union.

“The first year, every month, we came in second in the country to California,” Ray said.  “This year, our enrollment here in Florida was higher than enrollment in any other state in the country.  It’s a pretty successful initiative in Florida.”

That seems understated, especially considering that it was the work of about 90 Navigators the first enrollment period and around 150 the second round.  Ray was quick to note, however, that Navigators weren’t the only people involved.

“There are more resources that go into managing this than just the enrollment folks,” she said.  “We have IT people involved, we have human resource people involved, we have grant administrators involved.  It’s an undertaking, for sure.  It’s all a team effort.”

A niche in the state’s public health

The stakes, along with the numbers, will be higher for the third round, since the funding will be for three years.  Ray is undaunted by the change and, in fact, favors it.  For one thing, it will provide greater continuity in enrollment services, she said.

“We won’t have the start-up delays that come with a grant ending,” she explained, “and then waiting for another grant to come in.”

Given the early success but also knowing the nature of the funding world, Ray is cautiously optimistic about future Navigator grants.

“We’re keeping our fingers crossed,” she said.  “I feel like we’ve done a good job.  I think our outcomes have been really high.  Our partners at the federal level seem very pleased with the work that we’re doing.

“Florida certainly has been a shining star all the way through this.  Not because I was optimistic, but because I believed we were doing the right thing and that we knew what we were doing, I’m not surprised.  Because we didn’t go into this making up a plan of action.  We went into it with a sense of how it can be done, what the best practices were.  We had learned our lessons along the way.  We didn’t have to reinvent the wheel to do this.  All our collaborative partners made a big difference, too.

“I feel pretty good going into years three through five.  It’s going to be harder going into these years, because we’ve enrolled so many of the low-hanging fruit, so we really have to hone in on who we’re missing and whatever we need to do to make sure we’re not leaving people behind.

“This is our niche for the state of Florida in public health.  Whether it’s obesity or diabetes or getting cancer screenings, it’s very difficult for people to do anything about those things we talk about in public health if they don’t have health insurance.  So, I think we’re doing something valuable in contributing that first step to addressing some of these important public health issues that are so important.”

Story by David Brothers, College of Public Health.  Graphics courtesy of Florida Covering Kids and Families, CSPAN and Jodi Ray.

The post Kids and Families, navigator grants hallmarks of college’s state and national presence appeared first on College of Public Health News.

First published on June 4, 2015 in observance of the COPH’s 30^th anniversary celebration.

It was January 1998, and the Florida Board of Regents had just promoted one of USF’s fledgling entities to major status with sublimely understated efficiency.

Following authorizations for a BS in dance education, a degree of undetermined level in occupational therapy and an MS in physical therapy, it was the last of four single-sentence items in the typically dry language of officialdom, replete with redundancy and excessive capitalization, on a State University System memo to Dr. Thomas Tighe, then USF provost: “Established the Type I Lawton and Rhea Chiles Center for Healthy Mothers and Babies as a Type I Center (sic).”

The rationale for the Center’s status elevation cited the state’s “tremendous progress in improving the health status of pregnant women and infants, largely through the leadership of Gov. and Mrs. Chiles and Charles Mahan,” who was then USF College of Public Health dean.  Marked improvement in the state’s infant mortality rate was among the leading factors, along with the Center’s performance the previous two years as a Type IV center.

Mahan had envisioned a research, program and policy institute for maternal and infant health as early as 1988, according to the Center’s official timeline.  The Center’s originally intended location was the University of Florida, Mahan said, but that was before the state had established its first college of public health at USF.  By the time the Center was created a few years later, USF, with the only COPH in the state, had become the obvious location, and Mahan had been named COPH dean.

Charles Mahan, MD, former USF College of Public Health dean

“Gov. and Mrs. Chiles had a lot of allegiance to the University of Florida, where they met and where he got his law degree,” Mahan said.  “I was state health officer on loan from the medical school at Florida, and I was supposed to go back there, and the Chiles Center was supposed to be there.”

But having served in the same administration, Mahan was friends with Betty Castor, who had been state secretary of education under Chiles and had since become president of USF.  Mahan said she called him and personally asked him to be the dean of COPH.  He accepted, and the first “steal” from the University of Florida only naturally led to the second.

USF was the better location for the Chiles Center, Castor told the governor, as it had the only college of public health and was headed by a dean who had served him as state health officer.  It also had a Healthy Beginnings program in place that arguably was already doing some of the work the Chiles Center would do.

Dr. Betty Castor, former USF president and Florida secretary of education.  To her left is her husband, former Florida state Rep. Samuel P. Bell III.

The Florida Healthy Start Program had been created by the legislature in 1991, under the urging of Chiles, and from its inception, had included a Healthy Beginnings Program at USF.  So when Mahan was appointed COPH dean in February 1995, he was at the right place at the right time to begin realization of his vision.  A year later, the Board of Regents established the Center, and Mahan served as its founding director in addition to his duties as COPH dean.

A $2-million federal grant followed in 1997 that was specifically aimed at reducing infant mortality in Hillsborough County.  In December of that year, a gala event at Busch Gardens honored the governor and his wife and formally launched the Center.  Additional state funding came in 1998 for construction of a building and a $600,000 annual operating budget.

Former Florida first lady Rhea Chiles (third from right) and her and the late governor’s daughter, also named Rhea (fourth from right), and son Ed (center) at the Chiles Center’s groundbreaking ceremony.

“President Castor invited Gov. and Mrs. Chiles down to USF, and we toured the campus and got them to put their names on the Chiles Center,” Mahan recalled.  “And then, Gov. Chiles was great about taking me to Washington and meeting all the senators who were his friends and raising money for the building.”

That journey for federal support brought home another $800,000 for the building.  The governor and first lady then spearheaded a series of fundraisers in Daytona Beach, Lakeland, Pensacola, Tallahassee and West Palm Beach.

“The Center was originally housed in office space near Tampa International Airport on Mariner Drive,” recalled Dr. Linda A. Detman, research associate for the Center.  “I believe that was from 1996 to 1998.  The Center’s first on-campus location was in FMHI, what is now labeled on maps as the College of Behavioral & Community Sciences building.  We also had a pair of temporary trailers for added office space between FMHI and the Westside Conference Center.”

Gov. Lawton Chiles (right) and daughter Rhea with Dr. Harold Varmus, then director of the National Institutes of Health, at the dedication of Lawton Chiles House (not related to the Chiles Center).

The Center’s impressive home since 2001 puts plenty of inspiration on display for visitors and staff alike:  A photo gallery of Gov. and Mrs. Chiles, including framed moments with presidents Clinton, Carter and Bush the first; a replica of the governor’s Tallahassee conference room for his use whenever he visited; even a bronzed pair of “Walkin’ Lawton’s” famous shoes.

After all, inspiration is what it’s all about.  Over the years, the Chiles Center’s health care initiatives have racked up impressive victories, to say the least.

“At the Chiles Center, Florida Covering Kids and Families and its collaborators across the state exceeded the federal goal for Florida in enrolling people for health care coverage in the federal health insurance marketplaces,” said Dr. William M. Sappenfield, Chiles Center director and Department of Community and Family Health chair and professor.  “During the first open enrollment, about 500,000 more individuals enrolled over the initial target and reached more than 1.6 million after the second enrollment period.  Moreover, because of the success of projects like this, Florida now enrolls more people through this important health insurance program than any other state.”

William M. Sappenfield, MD, MPH, director of the Chiles Center

Sappenfield also points to one of the Center’s most recent projects, the Florida Perinatal Quality Collaborative, which has radically reduced elective early deliveries (before 39 weeks of gestation).

“Babies electively delivered before 39 weeks are at higher risk of poor outcomes, including respiratory troubles and difficulties feeding, and are at higher risk of learning, behavioral and school-related problems in childhood,” explained Detman, who oversees the project.

“It continues to make a measurable difference in the quality of health care that mothers and babies are receiving,” Sappenfield said, “through improving newborn health care at birth and reducing death and morbidity to obstetric hemorrhage.”

Another recent Chiles Center project is the Obstetric Hemorrhage Initiative begun in October 2013 with 31 Florida and four North Carolina hospitals.  The participating Florida hospitals represent more than one-forth of the state’s delivery hospitals and nearly two-thirds of all births statewide, Detman said, adding that maternal deaths from postpartum hemorrhage are the leading cause of maternal mortality in the state.

Linda Detman, PhD, program manager for the Chiles Center’s Florida Perinatal Quality Collaborative

“We are fortunate to have the enthusiasm and dedication of perinatal professionals across the state who want to be engaged in improving outcomes for mothers and infants, and we plan to grow in the number of hospitals actively engaged in one or more of our projects,” she said.

Though funding issues put an end to the Center’s branch office in Tallahassee years ago, the original main office – now an imposing office building – on the USF Tampa campus continues to thrive and achieve.

“As was initially dreamed, the Chiles Center continues to improve the health and health care of women, children and families in Florida,” Sappenfield said.  “We will continue to build upon and expand these successful collaborations to succeed in our mission of improving their health and health care.”

Gov. Chiles visits COPH and its dean, Dr. Charles Mahan, in 1995.

“We worked with Gov. and Mrs. Chiles for many years to devise and implement programs and ideas to improve the pregnancy outcomes for women and babies,” Mahan said.  “The LRCC is designed to carry out these efforts and continue to design and improve new ones for future generations.”

Story by David Brothers, College of Public Health.

The post Chiles Center promotes health for all women and babies appeared first on College of Public Health News.

First published on June 1, 2015 in observance of the COPH’s 30^th anniversary celebration.

Dr. Carol Bryant was on the ground floor of the USF College of Public Health’s social marketing program when the social marketing field was in its infancy.  She credits Dr. Stan Graven, chair of the Department of Community and Family Health at the time, for the idea of a social marketing conference.

“He asked me to start a conference,” Bryant said.  “He said, ‘I think the field of social marketing has enough popularity and potential.  We need a conference on it.’”

Dr. Carol Bryant

Bryant, now USF Distinguished Health Professor in Community and Family Health, believes Graven’s own conference had convinced him of the viability of conferences in general, and specifically their ability to facilitate broad networking among stakeholders in any given field.

“It’s had a really major impact on his field,” Bryant said of what has become known as the Gravens conference, “so he could see that a conference in social marketing might be able to do the same thing.  He realized that a national conference could bring people together, disseminate the ideas, make a significant contribution to the public health community, and probably be good for branding USF.”

Bryant assented despite never having done anything of the kind or having any real idea of how to go about it.

She enlisted the help of Judy Sommers, who was at that time in charge of organizing COPH events.  She traveled to the nation’s capital to consult with two people at CDC who were well known in social marketing to ask whom to invite to speak.  She even began to think that putting a conference together might not be so difficult, after all.

“We had a really dynamic lineup of all the really active social marketers in the United States,” she said.  “We paid them all for their travel and a pretty good honorarium to come.  We promoted the conference, and we had 71 people.”

So far, so good.  There was just one problem.

“Forty or 50 of them were speakers,” she recalled, “so we lost a bundle of money.”

Bryant concluded then that the inaugural social marketing conference would also be the last, but she had a believer in Graven.

“Stan had the vision and courage to say, ‘Nope, we’re going to do it again.  Only this time, we’re not going to lose money, so let’s see how we can cut back on the budget and do better promotion.’”

Flanked by a cadre of congratulatory colleagues, Bryant (center) received a special recognition they presented her at the 2014 Social Marketing Conference.

The result was a second conference that turned the tide.  Smaller honoraria and fewer speakers fixed the early financial faux pas, along with the discovery within a few years that the honoraria could be dropped altogether.  There was enough interest in social marketing and enough respect for the conference that speakers would pay their own way to take part, and holding it at a beachfront resort didn’t hurt.

“Stan was absolutely right,” Bryant said.  “The conference would take the approach of social marketing and disseminate it in a way we couldn’t just through publications and my flying around and talking about it.”

Still, she said, social marketing’s early days at USF were lean at best.

“The early days were real tough financially,” she said.  “I was pretty terrified, actually, about how to do something like this.  Fortunately, we had good people – first Judy Sommers and then Ginger Phillips, and now Bobbi Rose – to do all the conference planning, but I didn’t realize I could just sit back and let them do that.  In the first years, I felt like, ‘Oh, my gosh, I have to learn how to do this.’”

In those early years, the Social Marketing Conference, the first of its kind anywhere, was pretty much the extent of social marketing, said Bryant, who also co-directs the Florida Prevention Research Center, a CDC-funded entity that develops and evaluates a community-based approach to social marketing.

“We did not have what we came to call the training academy yet, or the field school,” she said.  “I think I was teaching an Introduction to Social Marketing course at that time.”

Persistence pays

Bryant’s long-time social marketing partner is also her long-time partner in the bigger sense, her husband, James Lindenberger, director and faculty administrator of the Social Marketing Group.  When social marketing was launched at COPH, Lindenberger was not yet at USF, but was nonetheless a major catalyst in the start of social marketing at the university.  Together, he and Bryant founded Best Start Social Marketing, a nonprofit marketing agency with an innately symbiotic relationship with social marketing at USF.  Lindenberger was its executive director for its first 15 years.  He also is founder and former publisher of Social Marketing Quarterly, the first peer-reviewed journal dedicated to social marketing.

James Lindenberger

“Much of the work that we did, whether at our agency or at USF, was really done collaboratively between the two,” Lindenberger recalled.  While agreeing that the Social Marketing Conference drove at least the USF entry into the field, and probably more, he shared Bryant’s recollection of a shaky start.

“It was the first conference we’d ever put on,” he said.  “We didn’t know what we were doing, exactly, but we did have a lot of people who were instrumental in the field of social marketing, which was still a very young discipline.  We had a lot of what we thought were the important folks in the field do the presentations.”

One of those people, Lindenberger said, was Alan Andreasen, now a marketing professor at Georgetown University and executive director of the Social Marketing Institute.

“We asked him to be the closing speaker and add an exclamation point to the conference,” Lindenberger said.  “So, after a day-and-a-half of presentations, Alan got up and said, ‘Well, I want to tell you all that none of you know what social marketing is.  You’re completely wrong.’  He then proceeded to spend about 35 or 40 minutes telling us how much we had messed up.”

Lindenberger and Bryant at the recent COPH Alumni Awards

Bryant and Lindenberger laughed heartily as they recalled the incident, but said they were far from finding it amusing at the time.

“We were furious.  You left the room,” Lindenberger said, nodding to Bryant, who agreed.

“I got up,” she said, “and was just pacing in the hallway thinking, ‘I can’t take this.’”

“We were really furious,” Lindenberger continued, “because this is a guy who was really important, and a lot of people looked to him, and we wanted him to come in and say, ‘Bless you.  Thank you for doing this.  Nobody else has done it before.  We appreciate it.’  Instead, he got up and basically said, ‘You idiots.’

“After a few weeks of us getting through this, it dawned on us that he was right.  His concern was that we had had almost all communications presentations.  Almost everything we talked about was promotion.  He said, ‘That’s not what we’re about.  We aren’t advertisers, we’re marketers, and marketers do a complete and holistic look at solving problems and apply those different variables to the solutions.’”

What resulted, Lindenberger said, was a dramatic redesign of the conference for the following year.

Holding a conference at a seaside resort is a good thing, as the faces of Social Marketing Conference attendees show.

“It’s been interesting,” Bryant noted.  “That mistake was made by almost everyone we invited.  They showed off all their promotional materials and were very proud to do so, and we still have trouble with trying to make sure people don’t do that, and that our audience understands that it isn’t just advertising.

“It’s very humbling that people can sit there for two days having us tell them that maybe 20 times and still try to hire us to do TV ads.  I think it’s because most people think marketing is advertising.  It’s a hard misunderstanding to correct.”

In fact, both said the term “social marketing” has long been problematic.  Technology, it might seem, is doing all it can to keep it that way.

“It’s interesting,” Bryant said.  “It’s changed from ‘Don’t call it that, because marketing is evil’ or ‘Don’t call it social marketing, because that’s social engineering.’  Now, it’s a different debate.”

“A lot of the debate,” Lindenberger said, “seems to be rooted in younger folks coming into the field who do want to be social marketers, but when they present themselves as social marketers to their peers, their bosses or their clients, those people misinterpret that to mean social media and social media marketing.  Their concern is that it’s diminishing their ability to have an impact and also diminishing their ability to have a successful career.”

“For many of us who are kind of the old guard on this,” he continued, “our belief is there’s just so much brand equity built into it.  There’s a huge array of publications and organizations and conferences that are built around social marketing.  We would have another 30 years of building the brand up.”

“But we already have lost a lot of brand equity,” Bryant countered.  “If you Google ‘social marketing,’ you’ll get social media, even social media marketing conferences.  It is a real problem.

“In the U.S. public health system, and certainly within anthropology, it was seen as advertising and manipulation,” added Bryant, an anthropologist by training.  “I had anthropology friends who just thought I had gone totally to the dark side, but public health had a real misunderstanding about it, too, until people like Marsha Walker in Texas got it right and funded a really successful program.  That program was so successful that soon, the other agencies were asking us to do projects for them.  So, as they saw it work in this country, people in public health went, ‘Wait a minute.  Whatever it’s called, this might work for us.”

“I think what happened here at USF is a very significant part of why the discipline grew as rapidly and as successfully as it did,” Lindenberger said.  “A national program that we did out of USF and Best Start was the national breastfeeding promotion campaign for the Department of Agriculture.  That became their national brand.  It’s been used in every state in the country, is still being used, and that really brought social marketing to the foreground in Washington in a way domestically that it had never been before.”

Throw me a line

That early show of strength by the program also was a very early sign of things to come for the field, “upstream” social marketing, an approach that wouldn’t have a name for many years.

“Downstream is basically going to the individual or small group to influence their behaviors to be more positive in a particular issue, health issue or whatever it may be,” Lindenberger explained.  “Upstream is trying to look at the environment, decision-makers and the other factors that actually create a situation in which people can make change more effectively and more usefully.”

“All these people are drowning in the river downstream,” Bryant offered by way of the prevailing example in the field.  “So, you throw them educational pamphlets on how to swim or pull them out one at a time.  But upstream says, ‘No, let’s find out where they’re coming from.  Is there a bridge that’s broken?  Is something giving way?  Let’s go up there and keep them getting into the river in the beginning, instead of one by one educating them on how to survive.’  It’s a powerful metaphor, and it is catching on.”

Lindenberger noted that early applications of upstream social marketing significantly predate the metaphor.  While the national breastfeeding campaign was being developed in 1989, he said, Bryant and a pair of colleagues went to Capitol Hill and lobbied Congress for funding.

Social marketing at work at the Social Marketing Conference

“It had never been done before,” Lindenberger said, “and after that lobbying effort, $8-million was set aside specifically for breastfeeding promotion and management to be dispersed throughout the country in the WIC program.  That was upstream.  The very first project we ever did was as upstream as it gets.”

Bryant credits Andreasen for helping to widely disseminate the metaphoric term – source unknown – that has become a directional imperative for social marketing over the past decade, as well as numerous others for driving it forward.

“Many speakers at our conference, Bill Smith and Gerard Hastings from Scotland, especially, brought that metaphor alive for us and nudged us to go more upstream,” Bryant said, “and then our critics like Larry Wallach were saying the same thing,” which was that the downstream approach was blaming the victims, chiding them for not knowing how to swim well enough to save themselves.

“All those forces came together at the same time, and public health had the same realization.  We said, ‘Wait a minute.  We’d be really stupid to keep going downstream.  Let’s come up with a model that takes social marketing upstream,’ so that’s what we’ve done for the last 10 years – develop the model and test it out, and now, we’re training people in it.

“I’m hoping it will really take off.  It is more difficult to get funding, but it is more sustainable, too.”

This year, social marketing at USF COPH added to its impressive list of accolades the nation’s first MPH with a social marketing concentration.  Last year, the program celebrated the revision and re-launch of its social marketing training web site in conjunction with the Florida Prevention Research Center.  There is excitement over the field’s burgeoning relationships with other disciplines, namely engineering (humanitarian engineers) and a long-standing but still growing symbiosis with anthropology.  There also is that strengthening upstream trend.

Which way do we go?

But with all its successes, expansion, diversification and partnering, social marketing nonetheless remains a relatively new field in a time when a digital communications explosion can threaten to turn almost anything into a shape-shifter.  While few would argue that 44 successful years likely points toward anything less than a positive future, identifying potential threats can hardly be seen as unwise.

So, just where is social marketing headed?  In arguably its adolescence, what will it look like fully grown?  Who better to ask than two people who have nurtured it from infancy?

“I see a lot of dangers ahead,” Bryant said, “the big one being the brand equity diminishing because of confusion with social media marketing, and I’m not sure where I stand on the argument.  But I’m at this point kind of leaning toward maybe we do change our name, or do a qualification to it, ‘social marketing for behavior change,’ or something like that to help clarify that we’re not social media.

“Like anything, it peaks and then it falls,” she said, “and I resisted doing an MPH in social marketing, because I was afraid it was just an approach and its popularity might wane, and people with that degree – other people wouldn’t even know what they did.  I think those are some dangers that are real, but there are now so many people active in the field around the world.  We have two list serves, two journals, two conferences, and we’re thousands strong instead of just a hundred, so I think those fears are probably not warranted.”

“I agree with that,” Lindenberger offered.  “They’re not warranted.  We differ over the name issue and social media marketing.  I’m fairly comfortable with the fact that people sometimes get confused, and we can help them learn more about it if we have the chance to engage them.  And I also don’t really care.  I think we and other social marketers continue to do what we do, and if we do it well, if we produce the product successfully and deliver something to their audiences that they really need and want that will help them accomplish their own missions, then we’re fine.”

After discussing the future they anticipate for social marketing, it was time to consider the one they’d like to see.

A student poster presentation at the conference

“Something I think will happen – we’re already seeing it – that I would like more of is social marketing moving out of public health,” Bryant said.  “I think our conference taught people in public health how to apply social marketing.  Only more recently have we attracted people from other fields and changed our name from Social Marketing in Public Health to just Social Marketing Conference.

“It since then has also taken off in environmental protection.  A man named Doug McKenzie Moore, who’s a good trainer and has a wonderful web site and a list serve, has really spread it around the world for people who are working in recycling and all kinds of things.  We’re working with Qatar now to do the same thing in transportation.  Some social marketers want to see it in finance helping people to manage their finances better.

“So, what I’m hoping happens is it really does move out of just public health applications, because it could work so well in other arenas.  Healthy People 2020 has a set of objectives related to social marketing, and they want to see, by 2020, more health departments using social marketing.  I’d like to see state health departments really use it.  And the other set of objectives in Healthy People 2020 is that all schools of public health will offer at least a course in social marketing.”

“I’d like to see it be a degree program in a lot of universities around the country,” Lindenberger said.  “I think that would be a way for this to really take off – that people see it as a legitimate credential that helps them get jobs and provides them with tools to be able to influence positive change.”

Story by David Brothers, College of Public Health.

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First published on October 20, 2014 in observance of the COPH’s 30^th anniversary celebration.

October is Domestic Violence Awareness Month.

Like many entities directed at the greater public good, the USF College of Public Health’s Harrell Center was the product of a private philanthropist’s gift. James Harrell and his family wanted to do something to help eliminate family violence, and they acted on that desire. The result was a 1997 endowment that set the stage for what has become an international force.

“The intent of the Harrell family was to provide a center that would focus on family violence,” affirmed Dr. Martha Coulter, the center’s founding director, “but they were particularly interested in looking at the prevention of family violence, as well as research that would be directly applicable to prevention and intervention.

“So the mission of the Harrell Center, really, is to be an intermediary between research and practice, to do research that is focused on family violence intervention and prevention across the lifespan.

“The grant was an endowment, so the funding is very limited, because it’s just the interest on the endowment. Now, most of the income is from other grants and contracts,” Coulter said, “but what the Harrell endowment did was provide the base for doing that kind of research.”

Brick sponsored by the Harrell Center in remembrance of James Harrell after his death in 2007.

One of three faculty members at the center full-time, Coulter, whose doctorate is in maternal and child health, teaches three courses: Family and Community Violence, Child Maltreatment, and Child Health, in addition to coordinating the maternal and child health academic concentration at COPH.

“In the very beginning, there was only the grant and the establishment of the center conceptually,” she said. “Over the years, we’ve developed.”

That development recently necessitated alignment into three divisions.

“The specific divisions – the redesigning of the organizational chart – has really been something that I’ve done this year,” Coulter said. “Before that, over the years, we’ve just developed these different projects and all worked together, but it looked like now we were at a place where we really needed to have a little bit more separate organization and to develop some strategic goals and objectives in each of those content areas.”

The result is a children’s services division directed by Dr. Lianne Estefan, an intimate partner violence division directed by Coulter, and an elder mistreatment division directed by Dr. Carla Vandeweerd. Dr. Karen Liller recently joined the center as a regular collaborator focusing her attention on the overlap between child maltreatment and unintentional injury, Coulter said, and “usually about 10” graduate students round out her staff. A community advisory board is among the center’s numerous external extensions.

“The children’s section has been very involved in looking at issues regarding the prevention of violence in the community,” Coulter explained, “and the center has developed a virtual research institute with one of the community agencies, Champions for Children, which is a multi-program unit, so that we can do research that is truly collaborative. We’ve worked very consistently with them over the years.”

Graphic that Harrell Center graduate assistant Natasha Hojati created for the Center’s Facebook page.

Coulter said that much of what her intimate partner violence section does involves the courts, so much so that she has become a regular consultant for the courts and has undertaken the task of evaluating the effectiveness of their intervention programs for batterers. Developing and continually improving guidelines for batterer intervention and responses to the needs of victims have been major off-shoot projects.

Among the section’s more significant research findings is that female batterers are falling through the cracks. While the county’s intervention for male batterers has been “very effective,” Coulter said, it has largely failed to successfully intervene with female batterers, who comprise about 15 percent of all convicted batterers in Hillsborough County.

“The clinical providers of these programs,” she said, “have been saying for a long time that they didn’t think the state-mandated curriculum for men was really the right curriculum to use for women.”

Among many leaders and dignitaries who have visited the Harrell Center over the years was then-Attorney General Janet Reno, who attended an elder abuse conference sponsored by the Center in 2001. The attorney general is pictured above with students Seraphine Pitt (left) and Carol Williams, and below with Dr. Coulter.

The elder mistreatment division concentrates on elders with dementia and the kinds of violence against them, which is, Coulter said, “fairly common, unfortunately, from both spousal caretakers and children taking care of elderly parents. The dynamics of this are very different from other sorts of domestic violence and really have a lot to do with people not understanding how to help people who have dementia.”

Coulter said she considers a new project in the division to be particularly tantalizing and potentially groundbreaking.

Called the Senior Surfers Project, Coulter said it looks at the rapidly expanding but little-known phenomenon of women over 50 seeking relationships online and getting responses from people who wind up physically, emotionally or financially harming them.

All previous research on Internet connections leading to violent encounters has been on adolescents, she said, so Senior Surfers is another project aiming to keep potentially overlooked victims out of the cracks – in this case, the cracks that open at the nexus of society and technology.

Dr. Coulter chats with Judge Dennis Alvarez (left) and James Harrell at a 1997 function.

With so much involvement in the local community, including working closely with the Spring and, until its recent demise thanks to funding shortfalls, the Family Justice Center, the Harrell Center’s global impact might be surprising to some, but global involvement has proven beneficial on numerous fronts.

Dr. Pnina S. Klein, a clinical and developmental psychologist and professor of education at Bar-Ilan University in Israel, recently led a Mediational Intervention for Sensitizing Caregivers workshop on campus to promote cognitive functioning and attachment by improving parent-caregiver interactions with infants and young children.

Attendees included community professionals, physicians and COPH students, faculty and staff.  Dr. Robert Nelson, a joint professor in COPH and the Morsani College of Medicine, sponsored attendance by a visiting group of physicians and clinicians from Ecuador.

“It’s been used all over the world,” Coulter said of MISC. “The outcomes internationally of this program have shown that it’s very effective in strengthening attachment and reducing child maltreatment, so we brought Dr. Klein here from Israel this year to do a training for community people and staff here, as well as faculty and students.”

Dr. Martha Coulter, Harrell Center founding director (right in both photos), in Ecuador in 2007.

Elsewhere on the international front, Coulter is working with the medical school in Panama to begin collecting information and developing guidelines for Panamanian health providers to improve their responses to intimate partner violence. She’s also working in Quito, Ecuador, to develop a program that will provide fundamental intervention services for indigenous populations.

Children in a remote Himalayan village in India read books sent to them by the Harrell Center.

Coulter went to India in 2012 with a group that collected data on maternal/child health and family violence among the 26 indigenous tribes in the Himalayas as a response to one tribal leader’s interest in addressing those issues. Progress has been slow, she said, because the tribes are not formally centralized in any way, and the terrain is difficult and isolating. The center recently collected books to send to children there. A librarian navigates dirt paths on a bicycle to deliver them.

Not surprisingly, Coulter’s five-year vision for the Harrell Center is about more expansion, mostly ideological, and lots of it.

“I would like to expand our depth in looking at female offenders and the way the courts respond to them,” she said.

“We’ve applied for some grants to look with a lot more depth at issues related to fathers. This is an area that has been somewhat neglected and needs a lot of attention. What are the ways that we can help fathers from the very beginning develop the kinds of skills that will be more nurturing and less likely to produce problems?

“As far as the center itself,” she said, “I think the area that we really need to expand the most is our capacity for doing community training and education and technical assistance.”

“I’d also like to see us focus on more primary intervention in a public health direction.   A lot of what we’ve done has been secondary response intervention, but I would like to see us working with primary situations – families, parent-child relationships.”

Coulter said an example of the center’s involvement in this area is its participation in the Hillsborough County Violence Prevention Collaborative, a plan for reducing violence throughout the county.

Community events also make Coulter’s expansion list. Recent ones have included fundraisers with artists and bands, and even a biker run.

“I would like to see us expand these community events, because they have been very helpful. The center doesn’t have much funding,” she said, “and the funding that we get is almost always research funding, so if we want to do things that are outside the research arena, we have to raise the money ourselves.”

Story by David Brothers, College of Public Health. Photos courtesy of Dr. Martha Coulter, Eric Younghans, Dr. Robert Nelson, USF Health and the Harrell Center.

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World Salt Awareness Week is March 4-10

It is well-established that too much salt can have negative health effects, including high blood pressure and kidney problems. However, the average American consumes 1.5 times the recommended amount of sodium each day.

“Too much dietary salt is a major cause of high blood pressure, which is a leading risk for disability worldwide,” said Mahmooda Khaliq Pasha, PhD, MHS, CPH, assistant professor of social marketing and community and family health and at the USF College of Public Health.

The international public health community has shown great concern regarding this problem and efforts to reduce sodium consumption through policy change, health education and promotion and community-led interventions have been increasing in number and scope, according to Pasha. 

The WHO Collaborating Center on Social Marketing and Social Change (WHO CC) at USF, led by Pasha, has been engaged with public health professionals in Central and South America to build their capacity  to apply social marketing to the public health issue of reducing salt intake.

Pasha is the principal investigator for the International Development Research Centre (IDRC) funded project evaluating the use of social marketing to reduce salt intake in four countries–Brazil, Peru, Costa Rica and Paraguay.

The IDRC project is conducted in partnership with the Costa Rican Institute of Research and Teaching in Health and Nutrition (INCIENSA) and Pan American Health Organization (PAHO).

Pasha and her colleagues have been providing training and technical assistance in social marketing to core research teams in these four countries, consisting of representatives from the ministries of health, as well as those from the nonprofit sector and academic institutions.

The teams met in San Jose, Costa Rica in February to take the next steps in their research efforts.  

“We brainstormed an evidence-based strategy to tackle the problem of sodium consumption both at a regional and country level,” Pasha said. “In this second workshop, we took the time to synthesize the research findings from the four countries and start the process of developing a region-wide strategy on the reduction of salt within the household.”

Pasha and her team, including COPH doctoral student and WHO CC team member Silvia Sommariva, guided researchers from the participating countries in translating their findings on why individuals, particularly mothers and fathers, are resistant to reducing sodium consumption and which values and benefits could be leveraged to promote behavior change.

Creative professionals from each country were also invited to participate in the workshop and transform those insights into actionable creative strategies and communication materials.

“It was inspiring seeing how research findings from the different country reports could be transformed into action to reduce salt consumption in Central and Latin America.” Sommariva said. “The public health professionals that received training in social marketing were very motivated to use this approach to tackle an issue they have been dedicating their professional life to. We hope this is just the beginning for them and that they will be able to pilot the communication materials in their countries soon. It goes to show the importance of integrating research and practice in public health.”

Pasha and her team will review and finalize the materials created during the workshop. By May of this year, USF will present a regional communication plan that includes rolling out the umbrella creative concepts into multiple channels.  This plan will be adapted and implemented by partners in Central and South America.

Related media:

Reducir el consumo de sal, uno de los principales retos en las Américas

(Reducing salt consumption, one of the main challenges in the Americas)

Story by Silvia Sommariva and Anna Mayor, USF College of Public Health

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“Coming from Malawi where access to quality health care, or even just information, is beyond the reach of many is what fuels my passion for public health,” said USF College of Public Health alumna Elizabeth Mkutumula.

At only 37-years-old, she said she’s seen too many people die from preventable causes.

“I hear too many stories of premature preventable deaths of young men and women at the prime of their lives and I don’t want to feel helpless,” she said. “I ask,‘What can I do as a public health professional to stop this?’”

Born in Malawi the middle of five children, Mkutumula originally had aspirations of becoming a medical doctor, but she decided on public health after she says she wanted to make a bigger impact.

USF College of Public Health alumna Elizabeth Mkutumula donates blood at a community event in Malawi. (Photo courtesy of Elizabeth Mkutumula)

“Malawi, like many resource poor countries, has an inadequate number of medical doctors to serve the population,” she said. “I reasoned that I could save more lives by practicing prevention—public health—than medicine and reduce the need for the services of scarce doctors.”

After graduating high school she moved to Mobile, Ala. and completed an assistant program for a physical therapy in 2005 from Bishop State Community College before joining USF.

“I transferred to USF as an undergrad and just fell in love with it,” she said.

After earning her bachelor’s degree in biology in 2011 from USF, she earned a master’s degree in maternal and child health from the USF COPH.

“I loved the passion, the care, the campus, my lecturers, my courses, and the assistance I received from the international student office” she said. “Graduating while maintaining duties of a full-time mom, a full-time wife, and a full-time employee is something I wouldn’t have managed if it wasn’t for all my wonderful and helpful professors and classmates.”

Mkutumula and her daughter post with Rocky after the graduation celebration held at the USF College of Public Health. (Photo courtesy of Elizabeth Mkutumula)

She started her master’s program at eight months pregnant, but said the supportive environment of the COPH was key to her success.

“I had to juggle motherhood, work and school. However, the support that I received from my classmates and professors and the whole COPH culture made it possible to graduate successfully,” she said.

She’s now moved back to Malawi and works as a research assistant at the Malawi Liverpool WellcomeTust in Blantyre, where she interacts daily with the community and assists with clinical and community research projects.

“The organization is one of the premier research centers in Malawi that conducts research in communities, public hospitals and health care centers,” she said. “It does a great job of engaging the public.”

She also volunteers with No Woman Should Die Giving Birth (NWSDGB), an organization whose mission is to reduce maternal deaths in Malawi.

“In my spare time, I tutor students in my neighborhood and incorporate disease prevention education in all sessions. I provide transportation and sometimes accompany low income women in my area to family planning clinics for contraceptives and cervical cancer screenings,” she said.

Mkutumula said the wife of the vice president of Malawi attended a health care fair she helped NWSDGB organize and mentioned how amazed she was to see different maternal health organizations coming together.

Mkutumula speaking with the vice president’s wife, Mary Chilima, at the Maternal Health Fair held in June in Lilongwe, Malawi. (Photo courtesy of Elizabeth Mkutumula)

“A lot of women came and had access to free contraceptives, got screened for cervical cancer, had blood pressure checks and accessed information on prevention of maternal deaths and chronic diseases,” she said. “We also surpassed our target of units of blood collected.”

Mkutumula has even assisted a woman give birth to a baby on the side of the road and advocated for the woman after the baby passed away due to poor and delayed follow-up care.

“I comforted the woman and fought on her behalf until the head of department and the nurses admitted their fault and apologized to the woman and her family, a rarity in the Malawian health care system,” she said.

Mkutumula is passionate about making an impact in maternal health and said she plans to spend her public health career focused on making lives better for all Malawians.

“It makes me cry when I see and hear of young women and babies—regardless of socioeconomic status—dying in child birth from preventable causes’ that even a resource poor country like Malawi can manage,” she said. “I want to make an impact in emphasizing the need to put in place systems that do not rely too much on a handful of individuals to work.”

She also expressed an interest to collaborate with future USF COPH students interested in doing work in Malawi on topics including: prevention of maternal deaths, breastfeeding promotion and environmentally friendly diaper use and disposal.

“Malawi lacks resources, but I believe the bigger problem is poor resource management due to broken systems,” she said.

Alumni Fast Five

What did you dream of becoming when you were younger?
A doctor.

 Where could we find you on the weekend?
On the streets of Limbe (Blantyre Malawi).

What was the last book you read?
“The Diary of a Wimpy Kid: Cabin Fever” by Jeff Kinney.

 What superpower would you like to have?
Compassion giver (making people compassionate).

What is your all-time favorite movie?
“A Love Song for Bobby Long.”

Story by Anna Mayor, USF College of Public Health

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Rachel Logan, a USF College of Public Health doctoral student in community and family health, has been awarded an Emerging Scholars in Family Planning grant.

The grant is funded by the Society of Family Planning Research Fund and the Society of Family Planning. It is open to those in graduate-level programs who focus on research that advances access to safe abortion or the prevention of unintended pregnancy in the United States.

Logan was given the maximum award—$7,500—to help further her research examining the family planning care black women between the ages of 18-29 receive in the Southeast United States.

“I am interested in the experiences these women have when they go to clinical settings for birth control,” Logan said. “I want to see how they perceive their experiences with their provider and whether the entanglement of social and personal identities, things like race, age and social status, influence their perceptions of care.”

Doctoral student Rachel Logan. (Photo courtesy of Logan)

Logan decided to focus on young black women because it’s a demographic with a high unintended pregnancy rate and inconsistent contraceptive use.

“Providers have a critical role in women’s access to the most effective forms of contraception, particularly hormonal methods,” Logan noted. “I want to know more about what young black women experience since their rate of unintended pregnancy is disproportionately high when compared to women of other ages and races.”

Logan, who received her undergraduate degree in biochemistry from Virginia Tech and her MPH from George Mason University, hopes her research can help enhance patient experiences and patient-provider communication.

“I think public health has to be a part of leading research that encompasses all aspects of health care delivery, including non-disease and condition outcomes,” Logan commented.  “The research I want to do, and the research that I think is critical to the field of public health, is not always the research that is funded. The Society of Family Planning is committed to supporting researchers who are addressing issues of health equity in all facets of sexual and reproductive care.”

Included in the $7,500 award is membership to the Society of Family Planning, complimentary hotel and travel to its annual meeting, coverage of the processing fees associated with open-access publishing and admittance to a career-development workshop.

After graduation, Logan intends to work in a position that combines research, policy and practice to address health equity.

“This award,” Logan said, “is enabling me to do the research I want to do and is creating opportunities for me to continue it into the future. Besides increasing our understanding of patient experience, I hope my work will give black women and their diversity representation in public health research.”

Story by Donna Campisano, USF College of Public Health

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Increase your ROI with a degree in public health.

Register today for the September 13 public health graduate fair!

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