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.

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The Florida Perinatal Quality Collaborative (FPQC), housed within USF’s College of Public Health (COPH), has one mission: to give Florida’s mothers, infants and families the best health outcomes possible via perinatal care that’s respectful, equitable, high quality and evidence based.

The FPQC partners with perinatal-related organizations, individuals, health professionals, advocates, policymakers, hospitals and payers (FPQC stakeholders) from around the state. The collaborative aims to develop health care quality improvement initiatives and data-driven best practices that ultimately promote the health and health care of mothers, infants and families.

A collaborative takes off

The FPQC was born in 2010.

“The need to focus on maternal and infant quality improvement issues was identified as a major issue in Florida when I worked for the Florida Department of Health (FDOH) as the state maternal and child health epidemiologist,” explained Dr. William Sappenfield, the FPQC’s current executive director. “As part of the multi-state envisioning and implementation process, we had to put together our Florida leadership team. I recruited Dr. John Curran [a now-retired neonatologist and former associate vice president for USF Health] to lead the Florida group of state partners.  As a group, we quickly recognized the need to create the Florida Perinatal Quality Collaborative, and the FPQC was established at the USF Chiles Center in 2010.”

The Chiles Center, also part of the COPH, is a multidisciplinary, community-engaged collective that promotes optimal health and health care for mothers and babies around the time of birth.

Curran was named the founding director while Sappenfield lent a supportive leadership role from his position with the FDOH. Upon arrival at USF as a COPH professor, Sappenfield became co-director. When Curran retired in 2017, Sappenfield took over at the helm of the FPQC.

“It takes more than a leader, it takes a team”

Over the last 13 years, the FPQC has developed a number of initiatives, resources and training modules to help ensure moms and their babies have the best shot at a healthy life. Some of them include:

• Postpartum Access & Continuity of Care (PACC) Initiative. Noting that as many as 40 percent of moms do not see a health care provider for postpartum care, the PACC Initiative works with women, health care providers and hospitals to provide a continuum of after-delivery care to prevent pregnancy-related deaths.

• PAIRED. This initiative works to better how families with babies in the neonatal intensive care unit (NICU) engage and communicate with staff about the care of their infant.

• Levels of Maternal Care. This program is designed to promote Florida maternity hospitals’ participation in a verification program that aims to ensure mothers are cared for at hospitals that have the expertise, equipment and resources to appropriately treat their maternal needs, thereby reducing maternal morbidity and mortality.

“The FPQC has created a strong collaborative organization that works with all major state agencies and organizations,” Sappenfield noted. “Other organizations and individuals want to work with us because of our success. In 13 years, the FPQC has gone from working with six hospitals to all 105 Florida maternity hospitals. It takes more than a leader,” he added, “it takes a great team to do this quality of work, and the FPQC has been blessed with a highly capable one. Moreover, the FPQC has provided a great learning experience for many students as graduate assistants and volunteers who have helped develop data measures, reporting systems and quality initiatives, conduct surveys, evaluate initiatives and more.”

What’s next?

While Sappenfield will be retiring later this year, the FPQC will continue to trailblaze on behalf of moms and their babies.

“It is the improvement in maternal and infant health outcomes that I am most proud of,” Sappenfield said. “The FPQC is well positioned, resourced, led and staffed to continue to make a measurable difference in the health and health care of moms and babies for years to come.”

Story by Donna Campisano, USF College of Public Health

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Dawn Hunter’s first exposure to public health came when she worked as a research assistant in the Advanced Biosensors Laboratory at USF’s Center for Biological Defense.

“We developed and tested rapid-detection methods for food and waterborne pathogens,” said Hunter, who holds two bachelor’s degrees—one in English literature from Princeton and the other in microbiology from USF. “It was my first introduction into the intersection of law and science.”

Hunter decided to explore that intersection further, enrolling in a new-at-the-time JD/MPH dual program the USF College of Public Health (COPH) had with Stetson University College of Law. Hunter graduated the COPH in 2011 with an MPH in global communicable disease and Stetson in 2012 with a JD.

“Today, I’m most interested in how law shapes our physical, social and economic well-being,” Hunter said. “The public’s health depends on a legal infrastructure that ensures people have access to the resources and opportunities to thrive. Law is behind every single public health achievement in the 20^th century.”

Getting another two degrees under her belt wasn’t easy for Hunter. She worked nights and went to school by day while also doing volunteer work.

“I don’t know how I ran on such little sleep,” she recounted. “I remember sometimes taking naps in my car in the parking lot, and I think many of my classmates remember me for always having a Red Bull in my hand. I remember my time at the COPH fondly and any struggles were far outweighed by how proud I was when I completed my degree.”

When Hunter thinks of her career, she thinks of it in three distinct phases—her time working in child protective services (Hunter was a foster care case manager), her time at the Advanced Biosensors Lab and her time working as a public health law fellow at the New Mexico Department of Health and the years since.

“I consider all my experience public health career experience,” Hunter said. “The needs that families and children have in the foster care system are what we now talk about as the social determinants of health. I appreciate that I had first-hand experience with the challenges families and children face as well as their strength and resilience. It has really informed how I think about my role as a lawyer and how to best serve my community. And my time as a research assistant was directly related to public health, being affiliated with the College of Public Health and doing work in partnership with agencies like the Florida Department of Health in Hillsborough.”

Hunter is currently the director of the Network for Public Health Law, Southeastern Region. She and her team provide nonpartisan legal assistance and resources, collaborating with a broad set of partners, to expand and advance legal and policy solutions to advance public health.

“I really love and appreciate that I am in a position where all of my previous experiences in life come into play,” Hunter commented. “Every day, my work reflects experiences I have had, people I have met and things I have learned. I suppose that what I love most is that I am constantly learning and growing and I appreciate that I’m in a job that gives me the space to do that.”

Hunter credits her COPH training with teaching her the value of partnerships.

“Everyone hates group projects, but some of my greatest successes have come through collaborative work,” Hunter said. “I have taken with me the experience of working together in teams to address a public health issue. This is and has been a core part of my work. I hope that I can model for people who work for me everything that I have admired about people I have worked for. I think part of building and sustaining the public health workforce is recognizing where we can do better, as leaders and managers, and build positive workplace experiences for our teams.”

Alumni Fast Five

What did you dream of becoming when you were young?

A neurosurgeon.

Where can we find you on the weekend?

Taking a long walk in a city or county park. My favorite spots are Crescent and Sawgrass Lakes.

What is the last book you read?

“Finding Me,” by Viola Davis.

What superpower would you like to have?

To heal people from physical and emotional pain.

What is your all-time favorite movie?

“Braveheart.”

To view the awards ceremony, click here.

Story by Donna Campisano, USF College of Public Health

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USF College of Public Health’s associate professor Dr. Cheryl Vamos, along with Dr. Jill McCracken, a gender and sexuality expert in USF’s College of Arts and Sciences, are co-principal investigators of the Choosing Myself grant exploring teen pregnancy prevention among justice-involved and marginalized youth.

The two-year, nearly $800,000 grant from the U.S. Department of Health and Human Services, will consist of three phases of programming and evaluation and ultimately reach 200 justice-involved youth (ages 13-18), both in/out of residential facilities across Florida and Georgia. The program and evaluation, Vamos said, will be participant-centered, with all activities being informed by the community. The project is being conducted in partnership with Allies for Healing, a nonprofit organization established to develop, deliver and evaluate sexual reproductive health education programming.

“As with many significant public health issues, including issues related to sexual and reproductive health, often the needs of those who may be at greatest risk or who may experience challenges accessing information and services are not taken into account,” Vamos said. “Justice-involved and other marginalized youth (e.g., LGBTQ+, Dis/ability and BIPOC individuals) are at a greater risk of sexual violence, sexually transmitted infections (STIs), and teen pregnancy than their peers. This program acknowledges systems of oppression (e.g., racism, misogyny, homophobia, transphobia, and ableism) and social determinants of health (e.g., housing, food) that influence a youth’s decision-making. These lived experiences and structural factors often place justice-involved youth at greater risk and are not usually considered in standard programming.”

The research will be conducted with an interdisciplinary group of researchers, a youth advisory board (to help improve the program’s content and delivery) and community partners.

“We hope that our study will provide evidence of the following,” Vamos said. “First, that a co-created, trauma-informed sexual and reproductive health program can be developed to be participant-centered, appropriate and reflective of justice-involved youths’ lived experiences.

Secondly, that the program is acceptable and feasible. And lastly, that any potential barriers and facilitators are identified by stakeholders (youth participants, program facilitators, community partners) so that these can be addressed in future iterations of the program.”

Vamos, who also directs the college’s Center of Excellence in Maternal and Child Health Education, Science and Practice, noted that preliminary impact data suggests promise of the program’s effectiveness. She hopes the Choosing Myself program will better inform teen pregnancy prevention curriculums in the future.

“Ultimately, we hope that this research will provide evidence of short- (e.g., knowledge, self-efficacy and behavioral skills) and intermediate- (decrease nonconsensual and physically/psychological violent sex, correct/consistent condom/contraceptive use, increase access to sexual healthcare) term outcomes. This contributes to the ultimate goal of reducing unintended pregnancy, STIs and sexual violence.”

Story by Donna Campisano, USF College of Public Health

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September is National Childhood Obesity Awareness Month

Dr. Acadia Buro, a recent USF College of Public Health PhD graduate, will present research on obesity in adolescents at the upcoming American Public Health Association (APHA) annual meeting. The APHA meeting will be held Oct. 24-27 in Denver. 

Buro will present two posters, “Obesity and Comorbidities Among Adolescents with Autism Spectrum Disorder” and “Obesity and Comorbidities in Adolescents Aged 10-17.” The research was funded through a grant from the Health Resources and Services Maternal and Child Health Bureau. The COPH’s Dr. Russell Kirby is the grant’s principal investigator. Other faculty involved with the project are Drs. Abraham Salinas (co-principal investigator), Jennifer Marshall (co-investigator) as well as Heewon Gray (Buro’s major professor).

Using 2017-2018 data from the National Survey of Children’s Health, Buro looked at 27,328 adolescents, 911 of whom had autism spectrum disorder (ASD). Buro found that the prevalence of obesity was 15.3 percent overall, but higher among those with ASD, learning disabilities, epilepsy/seizure disorder, depression and anxiety. Interestingly, those with ADHD, cerebral palsy and Tourette Syndrome (a neurological disorder characterized by sudden repetitive movements and sounds) did not have an increased risk of obesity. 

In her poster that looked specifically at obesity in adolescents with ASD, Buro found that roughly 25 percent of 10-to-17-year-olds on the autism spectrum were obese. 

“There are many behavioral and environmental obesity risk factors among youth with ASD, including unhealthy eating behaviors, sedentary behavior, sleep disturbances, social and behavioral impairments, and environmental challenges,” Buro said. “In particular, youth with ASD may exhibit food selectivity, or consumption of a very narrow range of foods, and an increased preference for energy-dense foods, such as highly processed foods.”

While many of the adolescents with ASD that Buro studied had co-occurring conditions, such as learning disabilities, developmental delays, speech problems, depression, anxiety and Tourette Syndrome, only some—depression and anxiety, in particular—seemed to be associated with a greater risk of obesity.

“We can’t say whether depression and anxiety increase the risk of obesity or vice versa, since the data are cross-sectional, but previous studies have found bidirectional associations between depression and obesity in adolescents with ASD,” Buro explained. “Reduced physical activity, overeating, psychosocial stress and social environmental factors could all play a role.”

So how can the problem of obesity in adolescents with and without ASD be countered? According to Buro, who is now an applied postdoctoral fellow in behavioral oncology at Moffitt Cancer Center, it will take more research—especially research exploring the association between obesity and co-occurring conditions—and interventions.

“The findings of these analyses highlight an increased need for obesity-prevention measures, including lifestyle behavior interventions, among adolescents with ASD, learning disabilities, epilepsy or seizure disorder, and depression,” Buro said.  “Among adolescents with ASD specifically, the findings indicate a need for interventions addressing mental health and lifestyle behaviors, including eating, physical activity, and sleep behaviors.” 

Story by Donna Campisano, USF College of Public Health

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August is National Immunization Awareness Month

What’s another casualty of life during a pandemic? Childhood immunizations. 

According to the Centers for Disease and Prevention (CDC), as parents put off well visits and preventive care amidst stay-at-home orders and lockdowns, the rates of nearly all childhood vaccinations have declined. The CDC reports that all noninfluenza vaccines administered to children 18 years or younger declined 21.5 percent between January-April 2020 and the same period in 2018 and 2019.

And that’s a troubling trend, especially in light of a pandemic, when it’s more important than ever to reduce the impact of preventable diseases and ease the drain on an already-strained health care system. 

There’s also the fact that infections can weaken the immune system, making it more likely other, sometimes nastier germs will take hold and wreak their havoc.

“We know that measles infection, for example, depresses the immune system for a while and can leave a child vulnerable [to COVID-19 and other germs],” said Dr. Jill Roberts, a USF College of Public Health (COPH) assistant professor and infectious disease expert. “Fortunately, most children are vaccinated against measles. A more pressing concern is influenza. A co-infection of both influenza and COVID-19 could be extremely dangerous as both kill by lung infection and septic shock.  It is exceedingly important that children and adults are vaccinated for influenza in the coming year.”

The CDC has set up guidelines for the administration of vaccines at places like pharmacies, satellite clinics and drive-up locations, and the Trump administration has recently announced that pharmacists nationwide could administer scheduled vaccinations (including the flu shot) to children as young as three. 

In an effort to get kids back on appropriate vaccination schedules, Roberts says that many pediatricians are reaching out to their patients. 

“A significant number of pediatricians are working actively to close the vaccination gap that’s occurred due to COVID fears, and they should continue to do so,” commented Roberts. “Most doctors’ offices are taking extreme precautions, and to date there have been no [COVID-19] cases reportedly linked to going to the doctor.”

Story by Donna Campisano, USF College of Public Health

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USF College of Public Health students in the International Health Service Collaborative (IHSC), an interdisciplinary mix of USF Health students, faculty and professionals who work to promote health in underserved communities abroad, spent their annual week-long service trip in Jamaica this March.  

This was the first time the group volunteered in Jamaica thanks to the efforts of co-president Natalie Dehaney, a USF College of Pharmacy student from Jamaica, who worked with her father to find clinic space and make arrangements for the group to conduct community health events.

USF COPH graduate student Juliana Azeredo, a first year student in the MPH program with a concentration in public health education, said COPH students worked with other health students to educate both adults and children on a range of health topics.

The group spent some time at a local school in the Rosemount community educating children on oral health and proper hand washing activities.

“Through interactive, child-based activities, the children were able to learn about oral and hand hygiene, nutrition and vector control. We were even able to show them how to represent the USF Bulls,” Azeredo said.

Students also spent time at a local clinic to address health needs of adults, from reviewing their medical history to discussing ways to improve and protect their overall health, according to Azeredo.

When patients would arrive, some students assessed overall health and others would conduct educational trainings ranging from nutrition to preventing pregnancy.

“There was a collaboration of efforts. COPH students helped with triage and physical therapy students helped with public health efforts,” she said. “Everyone had the chance to work together and acquire new skills.”

Azeredo said she joined IHSC because of her desire to help abroad.  

“Without leaving the U.S., it is not possible to fully grasp what the needs are and what is going on in the rest of the world. You must see it and live it, even if just for a week,” she said. “I will always remember the smile on peoples’ faces when they put on a pair of donated glasses and were able to see clearly. It was especially touching when the person receiving a pair of glasses was in their later stages of life and had been living so long without good vision. They would walk around the rest of the day with their new glasses.”

For IHSC co-president Katelyn Henderson, an MPH student focusing on a concentration in epidemiology and global communicable disease and a certificate in infection control, the trip was a hands-on learning experience in cultural competence.

“Learning and applying this aspect of our curriculum to this trip was very beneficial in understanding and helping this community,” she said.

She said the group worked quickly to make adjustments to meet the needs of the community as they visited the clinic.

“Since we are an interdisciplinary organization, we all had the opportunity to see the different sides of the health field and come together as one for the good of the patients,” she said.

Henderson said individuals who visited the clinic left a lasting impact on her.

“Per Jamaican law, patients under 16 could not be seen by a physician without an adult present. Two 15-year-old girls came to our clinic and waited for a long time before we realized they were not of age to be seen by our doctors. They then explained to me that their mom was at work and could not come to the clinic with them,” she said. “They also told me that their father had passed away so they needed to be seen without a parent present. With the permission of a local physician, we were able to give the girls a vision test and get them prescription eye glasses, which was what was most important to them. Their situation was difficult and eye-opening, but it gave me confidence that we were really making a difference for the people of the Rosemount community.” 

Henderson said one of the main goals of this trip was to help the community more than they have ever done during past IHSC trips.

“Continuing to grow the public health aspect of our organization was something that was very important to me, and I feel that we achieved my goal in that,” she said.

For more information on joining IHSC, visit their website. To view more photos of the trip to Jamaica, visit the COPH’s official Instagram page and look for posts shared by Azeredo and Henderson during their takeover of the account.

Story by Anna Mayor, USF College of Public Health

The post USF Health students work together to address health needs in Jamaica appeared first on College of Public Health News.

The USF Maternal and Child Health Student Organization (MCHSO) will hold its 10th annual symposium on Friday, March 1, at the USF College of Public Health (COPH).

The MCHSO is a forum for students interested in maternal and child health to interact and engage in service and learning opportunities related to the well-being of women and children. It is open to all USF students, regardless of major or graduate/undergraduate status.

This year’s symposium is entitled “Reframing Adolescent Health: How Changing Social Norms Can Build a Healthier Future.”

“We will have sessions on LGBTQ+ health, sexual and reproductive health, suicide prevention and human trafficking,” said Rumour Piepenbrink, an MCHSO research and education chair and first-year MPH student concentrating in both epidemiology and maternal and child health. “We’ll also have breakout sessions on skill building and transitioning from adolescent to adult health care.”

Speakers—who were chosen because of their expertise in adolescent health, says Piepenbrink—will include:

• Dr. Michelle Forcier, a Providence, RI, pediatrician specializing in adolescent medicine
• Dr. Diane Straub, a USF Health pediatrician whose research focuses on the transition of youth with special health care needs to adult health care
•  Dr. Dae Sheridan, a licensed mental health counselor and board-certified clinical sexologist

The symposium will be held from 9 a.m. to 4 p.m. and is open to all USF students, faculty, staff and the public. The event is free. For more information, click here.

Story by Donna Campisano, USF College of Public Health

The post Save the date: This year’s MCHSO symposium will address adolescent health appeared first on College of Public Health News.

Health professionals can agree, breastmilk is magical.

Its numerous benefits—protecting against ear infections, lowering risk of diabetes, decreasing childhood obesity, improving the health of the mother postpartum, the list goes on—are all backed by the World Health Organization and the American Academy of Pediatrics.

The U.S. Surgeon General’s Call to Action to Support Breastfeeding identified childcare providers as “essential in supporting mothers” to continue breastfeeding after returning to work and urged states to adopt national standards.

Yet, when mothers return to work and place their baby in childcare, they face barriers to continue breastfeeding, according to USF College of Public Health’s Dr. Stephanie Marhefka, associate professor of community and family health.

In “’Why do we need a policy?’ Administrators’ perceptions on breastfeeding-friendly childcare,” published in Public Health Nutrition, she explored Florida-based childcare center administrators’ perceptions on breastfeeding and their perceptions of the barriers to implement programs that encourage mothers to continue.

(Photo source: Google images)

Marhefka and her team spoke with 28 childcare administrators of licensed child care centers across Hillsborough and Pinellas counties about the Florida Breastfeeding Friendly Childcare Initiative (FL-BFCCI)—a program established by the Florida Department of Health Office of the Child Care Food Program in 2012 to support Florida’s breastfeeding law.

To become designated breastfeeding friendly, centers must complete a self-assessment consisting of six yes or no statements and submit a copy of their center’s breastfeeding policy. Requirements include things such as feeding infants on cue and having a staff trained on preparation and storage of breast milk.

“Basically, the center has to be an environment that welcomes breastfeeding,” Marhefka said. “They must provide a quiet, comfortable place that mothers can feed their babies or express breastmilk and they have to have written materials and a policy that reinforces the idea that breastfeeding is welcome.”

There are currently 284 centers out of 6,798 child care centers in Florida with this designation.

However, Marhefka found that of those centers they interviewed, none carried the special designation.

She found that administrators were unaware of the FL-BFCCI and did not perceive the need for their centers to pursue the designation.

Only six centers thought designation should be their highest priority, despite 23 of the centers indicating that implementing the BFCCI requirements would be manageable.

“One of the things we found was that they didn’t think this would be a big priority of their centers,” she said.

Administrators often said their centers were already breastfeeding friendly, yet did not fully understand the reasons for the FL-BFCCI or what it means to be breastfeeding friendly, according to Marhefka.

“Some even said they ‘already do all this,’ but then also said moms can just ‘turn and face the wall,’ [to breastfeed],” she said. “There seems to be some attempts to try to accommodate this idea of being breastfeeding friendly, but not really understanding the spirit of what being breastfeeding friendly really is—to create a space where not only is breastfeeding welcome, but its considered completely normal. That sense of normalcy was really missing from the narratives from these administrators.”

Its these perceptions of acceptance versus the ideal level of acceptance—and the stigma surrounding breastfeeding—that can impede a mother’s ability to continue breastfeeding her child successfully once the baby enters childcare, Marhefka said.

(Photo source: iStock)

“I really believe that childcare workers have the potential to be public health liaisons to help moms who are trying to breastfeed to be successful in these environments or they could discourage moms from doing it, so if we could use policy and regulation as technical assistance and other support, I think we can get to the place where these childcare workers are infant feeding champions,” she said.

Marhefka also said the goal is not to create more stigma toward mothers who are formula feeding either.

“We’re trying to create a situation where everyone can feel the benefits of both,” she said.

While programs like the FL-BFCCI and an optional designation are a good first step, Marhefka said, we are in a need of a cultural shift.

“We need our licensing and regulation to not only require that these environments are breastfeeding friendly, but also some kind of quality assurance that they really are environments where breastfeeding is accepted as normal, healthy behavior,” she said.

Marhefka, who’s passion for researching this topic stemmed from the discrimination she faced as a breastfeeding mother with children in childcare, said she plans to speak with parents next.

“I was committed to breastfeeding for a year for my children,” she said. “That’s not the case for many moms and if you don’t have the conviction, you might just give up.”

***

Marhefka, S. L., Sharma, V., Schafer, E. J., Turner, D., Falope, O., Louis-Jacques, A., Wachira, M. M., Livingston, T., Roig-Romero, R.M. (2018). ‘Why do we need a policy?’ Administrators’ perceptions on breast-feeding-friendly childcare. Public Health Nutrition, 1-11. doi:10.1017/S1368980018002914

Story by Anna Mayor, USF College of Public Health

The post Childcare centers lack ‘breastfeeding friendliness’ appeared first on College of Public Health News.

For the second year now, the Annual Chiles Lecture and Symposium put a spotlight on how the USF College of Public Health is promoting the health and well-being of women, children, families and communities.

The 2018 Annual Chiles Symposium took place at the USF College of Public Health this year. (Photo by Ellen Kent)

The COPH’s Chiles Center aims to promote the optimal health using a multi-pronged approach: research, applying evidence-based practices, delivering education and guiding change through service and partnership.

And this year’s 2018 Annual Chiles Lecture and Symposium on April 6 highlighted the ways faculty, staff and students are doing just that.

“Starting last year, the Chiles Symposium provides Chiles Center faculty, students and staff the opportunity to showcase and discuss the breadth and depth of their research and research to practice for women, children and families,” said Dr. William Sappenfield, professor of community and family health and director of the Chiles Center. “It is a great forum given the large number of active members including our new undergraduates as part of the MCH Pipeline program. This year’s presentations and posters were outstanding.”

The Charles S. Mahan, M.D. Award for Best Student MCH Paper was also presented to doctoral student Silvia Sommariva. This award recognizes the best paper authored by a College of Public Health student on maternal and child health by providing a $500 award.

Dr. Russell Kirby presented the Charles Mahan MCH Best Student Paper Award to doctoral student Silvia Sommariva. (Photo by Dr. Jennifer Marshall)

Her paper, “Spreading the (Fake) News: Exploring Health Messages on Social Media and the Implications for Health Professionals Using a Case Study,” was just accepted for publication by the American Journal of Health Education.

“Winning the C.S. Mahan MCH Best Student Paper Award was indeed a great honor and I am very thankful to the committee for choosing this study on the role of ‘fake news’ in health education practice using Zika Virus as a case example,” she said. “This recognition definitely motivated me to continue this line of research. I would like to also thank my co-authors for their support and work on this paper.”

Co-authors on her paper are Dr. Cheryl Vamos, Alexios Mantzarlis, Lillie Uyên-Loan Đào, and Dinorah Martinez Tyson.

Other topics presented this year included:

Florida Health Babies: This is how “we” do it
Barr, A. Best, and C. Parvanta

Baby’s Best Sleep
Fross, A. McMahon, D. Rojas, V. Ciceron, E. Campos, T. Obioha, and J. Marshall

Supplementation and weaning at 1-month post-partum due to perceived milk insufficiency: risk factors for WIC participants
Roig-Romero, E. Schafter, A. Barr, W. Wang, T. Livingston, M. Wachira, and S. Marhefka

NAS and Future Research to Practice Opportunities
Kirby, J.P. Tanner, J. Salemi, D. Sampat, J. Marshall, T. Foti, C. Reid, and W.M. Sappenfield

Florida Early Childhood Comprehensive Systems (ECCS) Impact Project: Evaluation Strategies for Place-Based Initiatives to Improve Child Development
Delva, C. Ade, C. Geffrard, T. Bello, C. Apollon, E. Dias, and J. Marshall

Dietary intakes, mealtime behaviors and nutritional challenges of children with autism spectrum disorder in Florida
Webber, H. Gray, C. Robinson, B. Anuforo, and S. Sinha

 FL-CKF Strategic Outreach Tactics During Special Enrollment Period
Parrillo, K. Roders Turner, S. Vazquez

Following presentations and awards, all attending guests and speakers were invited to view research posters, network with potential colleagues, and meet the authors.

COPH student Laura Perkins shares her research findings during the poster presentation portion of the event. (Photo by Ellen Kent)

Dr. Paula Braveman, a leading national expert on health equity and professor of family community medicine at the University of California San Francisco, closed the event with a keynote discussion.

She discussed barriers to achieving optimal health faced by low-income, minority and disadvantaged populations in her address, “To Achieve Health Equity We Must Go (Even Farther) Upstream.”

While medical care is a vital component to health, Braveman discussed the need for improved living conditions, better wages, and educational attainment to improve health.

“As income goes up, health improves,” Braveman said. “Wealth of parents affects educational attainment and occupations of children.”

Paula Braveman, MD, MPH. (Photo by Ellen Kent)

Braveman discussed how education is linked to the ability to cope and respond to stress, and how stress impacts health equity as well.

She closed her talk with the urgency to examine health equity through addressing social determinants of health, including reducing poverty, segregation (which leads to areas with poorer schools), discrimination, and investing in healthier homes, neighbors, schools and workplaces.

“Chronic stress is toxic and impacts chronic disease in adulthood,” she said. “We must engage in advocacy to change what’s happening upstream.”

Related media:
Album by Ellen Kent.

Story by Anna Mayor, USF College of Public Health

The post Annual Chiles Symposium showcases efforts to improve community health appeared first on College of Public Health News.