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 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.

The post Pioneers of social marketing discuss its founding and its future appeared first on College of Public Health News.

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.

The post Harrell Center a local and international force in violence prevention 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.”

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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.

The USF Office of Graduate Studies presented its 10^th Annual Graduate Research Symposium on March 21 at the Marshall Student Center.

The event, sponsored by the Graduate and Professional Student Counsel and Research One, showcased graduate students across all disciplines. This year, 17 USF College of Public Health students participated.

The Graduate Research Symposium took place in the Marshall Student Center and included students from all disciplines across campus. (Photo by Caitlin Keough)

MPH student Katherine Lesser’s research, “Eliminating the Strain: Examining Immunization Policies at Accredited Florida Postsecondary Institutions” examined the discrepancies in immunization requirements for students at universities and colleges in Florida.

“I wanted to see if any of the Florida colleges had any of the same immunization policies,” she said.

Lesser, specializing in epidemiology and global communicable diseases, examined some of Florida’s laws stating that individuals at post-secondary institutes with on campus dwellings need to be vaccinated against meningococcal, meningitis, and hepatitis B unless they opt-out with a waiver.

“I thought that was interesting because another Florida statute for students entering daycare through post-secondary education, including childcare, daycare, pre-k and k-12 vaccines, require much more than meningitis and hepatitis B,” Lesser said.

Katherine Lesser. (Photo by Caitlin Keough)

Lesser segmented the universities and colleges in Florida by accreditation, looking specifically at those accredited by the Southern Association of Colleges and Schools Commission on Colleges, and split them even further between public and private institutions.

She conducted research of each institution’s vaccine requirements for incoming students.

“Most had immunizations forms, the only ones I found that didn’t were seminary schools,” Lesser said.

She found that Florida college systems had vaccination requirements, but that they were very specific to those in the health science professions.

“There is a lot of variation that exists between the schools,” Lesser said. “Not one institution has the same as the other, which I find very concerning especially because these are all highly contagious diseases that can be prevented by vaccines.”

She also found that the 12 Florida State University System institutions required hepatitis and meningitis by law, and that four required a TB screening for international students where TB is endemic.

“I suggest that the state of Florida create a cohesive immunization sheet that is used throughout all colleges and universities. From what I understand, no one institution has the same as the other and that is a huge issue,” Lesser said.

Vaccination is Lesser’s public health passion and in February, she, along with other classmates, went to Washington, D.C. to speak with Florida’s congressional members and senators regarding the need for continued funding and global support for the UN Foundation’s, Shot@Life, an organization advocating for childhood vaccines worldwide.

“Vaccines are such a vital part of public health, everyone should get them and support them,” Lesser said. “I want people to understand them, especially since they are like a ‘best buy’ of public health, as The Bill and Melinda Gates Foundation describes them. Most are affordable and with vaccines we’ve made so much progress, for example, Polio is only endemic in three countries. So, it’s clear that vaccines do so much good for the world and it’s an incredibly important topic.”

For environmental and occupational health graduate student Carli, her research, “USF Health Faculty & Staff Health & Well-being Assessment: Highlighting The Current” was driven by a personal experience.

“Occupational health and safety is my passion,” Carli said. “I have three years of experience working as a physician in my home country [Indonesia] where my best friend’s father developed thyroid cancer because of working in a fertilizer factory. Within two years of his retirement date, he found out he had cancer. He assessed that many of colleagues had the same issue. Occupational related diseases always happen near retirement, but after you end up with the issue there is not much that can be done because it’s already late.”

She decided to assess the health and wellness of USF Health’s faculty and staff.

“University workers don’t realize it, but they are workers too,” she said. “The University is a workplace and the federal government’s OSHA department says that it is an obligation for the employer to take care of the health and wellness of the employees.”

Using the CDC’s worksite questionnaire of 90 questions, Carli assessed the health and wellness of the workers and found that, overall, USF Health is taking strides in addressing employee wellness.

“Most of the workers of USF Health are entering their later years of life and are over age 50,” she said.

The four common complaints noted by USF Health employees were: hypertension, hypercholesterolemia, hyperglycemia—high blood glucose, and musculoskeletal issues.

Carli. (Photo by Caitlin Keough)

Carli assessed that staff also stressed the desire to have classes on physical activity, healthy eating, and ergonomics.

“This is the one department that allows its workers to access the recreation center at the WELL. In other departments at USF employees must pay to utilize the recreation center, but at USF Health it’s accessed for free. I really appreciate that USF Health thinks about the health and wellness of the workers,” she said.

She said she found that USF Health has done a great job addressing those desires and hopes the same wellness efforts will be offered to employees across campus.

“I hope that later USF as a whole will provide the opportunity its staff and faculty to use the gym,” she said.

(Photo by Caitlin Keough)

The complete list of College of Public Health participants include:

Student Affairs and Student Success

Taylor Grimm
Success and Wellness Coaching: Holistic wellness approach to student success

Environmental and Occupational Health

Carli
USF Health Faculty & Staff Health & Well-being Assessment: Highlighting The Current

Community and Family Health

Melody Chavez-Robben
Quality of Life among Hispanic Cancer Survivors

Alexis Barr
Promoting and Supporting Breastfeeding in the Hospital: Factors Associated with Exclusive Breastfeeding at One Month among WIC Participants

Janelle Barrera Ikan
School-level Factors Associated with Obesity: A Systematic Review of Longitudinal Observational Studies

Tara Foti
Quality of Life is Associated With Glucose Control Trends Among Diabetic REMEDIES4D Trial Participants: A Secondary Data Analysis

Lydia Mezenghie
Colorectal Cancer Screening among African Americans

Chinyere Reid
Improving Florida’s Birth Certificate Accuracy: A Pilot Initiative

Acadia Webber
Food, Nutrients, and Diet Quality in Children with Autism Spectrum Disorder in Florida

Global Health

Celina Flocks Monaghan
Navigating New Routes: Assessing Barriers to Medical Care in Congolese Refugee Populations of Tampa, Florida

Siriuk Changrob
Association of Immunologic Memory to Polymorphic Haplotypes of Plasmodium vivax Duffy Binding Protein in Low Malaria Transmission Area of Thailand

Muhammad Khalid
Heterologous expression and purification of Plasmodium falciparum protein kinase ABCk2 (PfABCk2) as a potential drug target

Asmita Mhaskar
Homeopathy: What are patients saying?

James Muncy
Perceptions of Zika Virus Among USF Students

Epidemiology and Global Health

Katherine Lesser
Eliminating the Strain: Examining Immunization Policies at Accredited Florida Postsecondary Institutions

Epidemiology and Biostatistics

Linh Duong
Assessing Hepatitis C Screening Completion Rates Using Electronic Medical Records from the USF Health System in Tampa, Florida

Mitra Kothari
Trends in the Prevalence of Hypertension Among Those Who Have Diabetes in U.S. Adults: An NHANES Data Analysis

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Photo album by Ellen Kent

Story by Anna Mayor, USF College of Public Health

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Each year the USF College of Public Health joins the country in celebrating National Public Health Week, held this year April 2-8.

One of the highlights of the USF COPH observance is the presentation of the COPH Outstanding Alumni Awards, given to alumni who demonstrate—as judged by their former professors and current colleagues—exceptional dedication and improvement to public health. This year Candace Webb, who earned her MPH in maternal and child health in 2006, was one of two graduates honored with the award at a presentation held at the COPH in the Samuel P. Bell, III Auditorium on April 4.

“Public health is a great home for all my interests,” said Webb, who is a senior state health policy analyst at the Georgetown University Health Policy Institute’s Center for Children and Families in Washington, D.C.

Candace Webb, MPH, accepting her award. (From left) Dr. Ellen Daley, Webb, Dr. Donna Petersen. Photo by Torie Doll)

Webb works with state advocates to advance the health and well-being of low-income children and families. She’s currently anchoring the 18-state network of child and family health advocacy organizations funded by the David and Lucile Packard Foundation’s Insuring America’s Children: States Leading the Way initiative. In this role, she serves as the primary liaison with state-based health policy organizations engaged in efforts to advance and protect health coverage for vulnerable children and families at both the federal and state level—through building policy and communications capacity, leadership development and implementing innovative access solutions for children and families.

Candace Webb, MPH, attending a Georgetown University Center for Children and Families’ event. (Photo courtesy of Candace Webb)

“Public health work is intellectually stimulating and meaningful, and you can always bring it back to social justice,” commented Webb, a Tampa native. “So many disciplines come to bear when you’re advocating for social justice and health care. I love that I get to do that.”

A career in public health wasn’t on Webb’s radar until she experienced a family tragedy.

When Webb was 18 and a freshman at the University of Florida studying premed, her mother died of complications from HIV, a condition Webb had no idea her mother was battling.

“My mother was a single mom who at the time of her death was waiting for her employer health coverage to kick in with her new job,” said Webb. “Her death made me acutely aware of the barriers people face getting health care. Sadly, it doesn’t have to be this way.”

After graduating from UF in 2004 with a degree in health science education, Webb became a certified health education specialist and enrolled at the USF COPH. Webb said she chose the COPH because of its “solid reputation,” but wound up staying because of “the relationships I formed with amazing faculty, staff and students—relationships I have maintained to this day. I was fortunate to be around professors who were not only incredible academicians, but who also had practical experience in the field that they brought into the classroom.”

(From left) Webb near the U.S. Capitol with COPH’s Dr. Ellen Daley, Webb family friend Krystle Starvis and COPH’s Dr. Kay Perrin. “The COPH has been such a big cheerleader for me. I always felt supported there,” said Webb, who calls Daley and Perrin some of her “mentors and friends.” (Photo courtesy of Webb)

One of Webb’s academic highlights was partnering with Dr. Ellen Daley, associate dean of research and practice in community and family health, other COPH faculty and Moffitt Cancer Center on research regarding the psychosocial impact of HPV diagnoses. This graduate research assistantship paid 75 percent of Webb’s tuition and gave her an hourly wage.

“It afforded me an opportunity to form strong relationships and collaborate on research with faculty, staff and peers,” said Webb, who had some of the research published in peer-reviewed journals. “The assistantship was a huge support for me, and I am extremely grateful.”

Webb has received numerous accolades and awards and has held an impressive array of jobs advocating for the health needs of the underserved. She worked in education and training at the AIDS Alliance for Children, Youth, and Families; was a scientific program analyst at the National Institute on Drug Abuse (part of the National Institutes of Health); and has been both a health analyst and supervisory public health analyst in the U.S. Department of Health and Human Services (HHS).

Webb at work on Capitol Hill. “Knowing the work I do has an impact on securing and safeguarding the health and well-being of others fills me with a sense of personal satisfaction.” (Photo courtesy of Candace Webb)

To date, Webb says her proudest career accomplishment has been securing and completing a competitive 11-month leadership development program for mid-level federal government leaders run by the Health Resources and Services Administration, part of the HHS Department. This while working her full-time job as a project officer with the federal Ryan White HIV/AIDS Program.

“COPH helped me channel my idealism in a really good way,” said Webb in accepting her award.

Webb’s next career move is to keep doing what she does best: learning and serving.
“I’ll continue to serve and apply my talents to those who need them the most. I also want to add more tools to my public health professional tool box and am exploring doctoral programs. I love being a part of something that’s bigger than I am.”

Alumni Fast Five
What did you dream of becoming when you were young?
A physician or medical geneticist.

Where would we find you on the weekend?
At a worship service, enjoying one of the D.C. metro area’s brunch options, relaxing at a dinner party with friends, taking in a show at the Kennedy Center, going to the Smithsonian’s National Museum of African American History and Culture, which is amazing!

What is the last book you read?
I recently re-read “Tuesdays with Morrie,” by Mitch Albom.

What superpower would you like to have?
To be a super linguist.

What is your all-time favorite movie?
“Outbreak” and “Up.”

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Healthy Bites

Story by Donna Campisano, USF College of Public Health

The post Candace Webb honored with 2018 Outstanding Alumni Award appeared first on College of Public Health News.

March is Colorectal Cancer Awareness Month

Colon cancer is the second deadliest cancer in the U.S. for cancers that affect both men and women, but early detection is key to prevention, according to Dr. Claudia Parvanta, director of the Florida Prevention Research Center (FPRC) at the USF College of Public Health.

The FPRC, a member of the CDC’s Centers for Excellence in Prevention Research, aims to increase colorectal cancer screening across the state of Florida to reach 80 percent by 2018.

Using the social marketing technique of community-based prevention marketing for social change as their framework, they’re focusing intervention efforts among two groups: insured individuals who are 50 years or older and individuals who have access to primary care, but are underinsured or have no insurance.

FPRC team members at a wellness fair hosted at Moffitt Cancer Center promoting colorectal cancer screening. From left: Manuel Mayor, intervention program manager and COPH alumnus, Aldenise Ewing, graduate assistant and COPH doctoral student, Laura Okoli, graduate assistant and COPH master’s student, and Dr. Claudia Parvanta, director of the FPRC. (Photo courtesy of FPRC)

“Colorectal cancer is one of the most preventable cancers when detected early and screening when recommended is imperative,” said Manuel Mayor, intervention program manager and COPH alumnus.

Mayor said the intervention has been designed as a two-tiered approached in order to reach the groups designated.

They’ve partnered with the Florida Health Care Coalition, a collaborative of more than 4,000 employers in the state of Florida, as well as True Health, a federally qualified health center (FQHC) provider with eight clinic sites in the Orlando area.

As the intervention program manager, Mayor coordinates with both the employer and FQHC sides of the project. He interacts with wellness coordinators and community leaders on ways to promote colorectal cancer screening.

“This is public health in action,” Mayor said.

He said they’ve established relationships with employers in Orlando, West Palm Beach and Miami, and the number of sites are growing.

Manuel Mayor (far right), intervention program manager, meeting with Miami Dade College wellness coordinators, one of the established intervention sites for increasing colorectal cancer screening. (Photo courtesy of Manuel Mayor)

Dr. Dina Martinez-Tyson, assistant professor of community and family health, has been with the project since the early planning stages and oversees the employer side of the intervention.

“I’ve learned how important employers are as stakeholders in our health care as well as the role they play in what your insurance covers and the benefits employees receive,” she said. “Our goal is to give the employers the resources and tools they can select from to promote colorectal cancer screening at their work sites and continue to use in the future.”

Mayor and other FPRC members work with the wellness coordinator of each organization to promote colorectal cancer screenings through tabling at health-related events and dissemination of intervention materials including flyers, brochures, newsletters, and one-page info sheets detailing the importance of colorectal cancer screening for the prevention of colon cancer.

She said the FPRC team also puts together kits with screening information and educational materials.

“We’ve given them [employers] a menu of options they can pick from,” Martinez-Tyson said. “Employers can tailor and customize to what their needs are as well as build on the resources they have.”

Some of the campaign materials the FPRC team uses to promote colorectal cancer screening. They were designed by Genentech and are just one of the many promotional materials the team has adapted to use as part of the intervention. (Photo courtesy of Laura Okoli)

While meeting with insured individuals, the FPRC team members will share information about the importance of colonoscopies and also share information about the fecal immunochemical test (FIT), a cancer screening tool that tests for blood in the stool.

“We’re promoting both the use of FIT, a cancer screening tool that can be done in the privacy of your own home, as well as colonoscopies because some of the pushback we’ve received about colonoscopies is that some find them uncomfortable,” she said.

Dr. Alicia Best, assistant professor of community and family health and co-investigator of the grant, oversees the implementation of intervention efforts on the FQHC side and reaching those without insurance.

“Our intervention strategies are aimed at the community around the health center [True Health], and we’re trying to push people in,” she said. “So, if our intervention is successful, we could potentially increase patient volume at the health center; so we selected sites that can handle that.”

Best said FQHCs are federally-funded centers, designated by HRSA, to serve in medically underserved areas, such as an area with a low proportion of physicians to the general population.

“These are facilities that are well-equipped to serve low socioeconomic populations; they can turn no patient away regardless of their ability to pay,” she said. “They already have to meet HRSA performance metrics, one of which includes tracking their colorectal cancer screening rates. So, this was a primary partner for us because they provide primary care and have a vested interest in colorectal cancer, therefore, we partnered with True Health.”

Best said they have designated two True Health clinic sites as control sites and two as intervention sites—at the intervention sites they will implement the social marketing intervention efforts and at the control sites they will collect baseline and follow-up data.

“We are partnering with local businesses within a two mile radius of the sites, such as barbershops and community centers, to share print-based materials that educates about colorectal cancer screening, but also directs people to get screened at our partner site,” Best said.

Best said the intervention is dissemination of those educational materials and then tracking of engagement, as well understanding how to push people into the centers.

“A lot of people who don’t have access to health care only think about health care when they are sick or not feeling well,” Best said. “The uniqueness of this project is we’re trying to get people to think about screening before they get sick and show symptoms.”

In the future, Best will be implementing the use of social media to evaluate community “hot-spots” and track what specific intervention materials are driving individuals to the clinics.

A large walk-through colon the team plans to implement as part of the intervention efforts. The inflatable colon highlights the types of polyps colonoscopies identify and remove in the prevention of colorectal cancer. (Photo courtesy of Manuel Mayor)

The five-year project, now it is fourth year, will continue through to the end of September.

Best said the FPRC is aiming to conduct this pilot study among the FQHC and employers, analyze how effective it was and expand upon it in the next grant cycle.

“We’re trying to reach two distinct groups who need screening,” she said. “We’re trying to create this culture of screening, so if this works, we can expand to other cancers.”

For more information about the FPRC’s prevention and intervention efforts, visit their website.

Story by Anna Mayor, USF College of Public Health

The post FPRC’s intervention combats colon cancer appeared first on College of Public Health News.

Tobacco use among people living with HIV (PLWH) is a public health problem, according to USF College of Public Health’s Dr. Stephanie Marhefka, an associate professor of community and family health.

“People living with HIV are more likely to die due to non-HIV causes than due to HIV-related complications,” she said.

Her research, “Meeting Our Patients ‘Where They Are’: Video-Group Smoking Cessation for People Living With HIV” published in the Journal of The Association of Nurses in AIDS Care,  examines how video-conferencing groups may be the answer to curb the smoking habit for PLWH–a habit Marhefka cautions is extremely dangerous for this population.

“Tobacco related illness represents the number one cause of death among people living with HIV,” she said. “People living with HIV are more likely to smoke than the general population and much less likely to quit.”

While many tobacco cessation interventions have focused on the general population of people attempting tobacco cessation, trials specifically among PLWH have not had long-term success, Marhefka notes, and research suggests a main barrier to in-person program engagement for PLWH is the challenge of attendance.

According to Marhefka, PLWH may not attend in-person counseling sessions due to lack of transportation, living in areas where there is a lack of personnel to deliver HIV-specific cessation programs, or difficulty getting to the cessation program due to other commitments, such as childcare.

She and her colleagues—including recent USF College of Public Health graduate, Dr. Elizabeth Lockhart, and PhD students DeAnne Turner and Shanda Vereen—piloted the web-based program called Positively Smoke Free Video-Group (PSF-VG), to test the acceptability of the program and evaluate factors impacting adoption.

“PSF was developed by Dr. Jonathan Shuter and colleagues at Albert Einstein College of Medicine in NYC and originally tested in in-person groups, but attendance was not as high as would be preferred, primarily due to difficulty traveling to the clinic for the groups,” she said. “Dr. Shuter reached out to me because I was the first researcher to use video-conferencing groups to deliver programs to people living with HIV. He thought video-groups would reduce barriers to participation.”

Tw0 trained facilitators—both tobacco cessation specialists and former smokers, and one a PLWH– delivered eight sessions over six weeks.

“Participants really appreciate that both facilitators are former smokers and they can relate to the challenges participants experience when trying to quit,” she said. “Also, the peer facilitator—who is living with HIV—can relate to many of the HIV-specific burdens participants experience in their everyday lives.”

Stephanie Marhefka, PhD. (Photo courtesy of Stephanie Marhefka)

Marhefka said a master’s level mental health professional facilitating the groups means there is also expertise regarding the science of psychology and behavioral change.

“Those are important ingredients in PSF too,” she said.

Overall, they found that participants responded positively to the video-conferencing groups which led to reduced smoking frequency and lower overall cigarette use.

“Group video-conferencing is great because we can literally meet people ‘where they are.’ We can connect people who would otherwise be unable to connect due to geographic, financial, mobility, and even some mental health limitations,” she said. “We’ve had participants from Florida, California, New York, Tennessee, Texas, etc. Participants come from metropolitan, suburban, and rural areas. No matter their other differences, they all share the experience of living with HIV and trying to quit smoking.”

Marhefka said that video-conferencing presents an opportunity to also increase intervention reach.

“Perhaps most exciting is that it allows us to centralize facilitators, keeps quality high and training costs low, and has tremendous scalability potential,” she said.

Participants liked accessing PSF-VG from home and viewed participation as low risk, Marhefka said, and quit rates were greater than other tobacco cessation programs for PLWH.

“If a program like this was rolled out at a broader scale, we would be able to serve a large number of people over a relatively short time-frame. We could even give participants the option of being in a group only with people outside of their state,” she said. “If Barbara lives in Florida and doesn’t want others in Florida to know she has HIV, she could elect to be in a group with no other Floridians. This would ease her concerns about being in a group with someone who lives in her community and might tell others she knows that she is living with HIV. That’s a huge advantage, given that fear of stigma is one of the greatest concerns people living with HIV express.”

***

Marhefka, S. L., Turner, D., Lockhart, E., Rivara, A., Wang, W., Shuter, J. (2017). Meeting Our Patients “Where They Are”: Video-Group Smoking Cessation for People Living With HIV. Journal of the Association of Nurses in AIDS Care, 2: 338-344.

Story by Anna Mayor, USF College of Public Health

The post Dr. Stephanie Marhefka and students curb smoking in people living with HIV through video groups appeared first on College of Public Health News.

USF College of Public Health doctoral student Stacey Griner has received a $1,000 grant to support her dissertation research efforts.

The endowed Doug Kirby Adolescent Sexual Health Research Grant from the Rural Center for AIDS/STD Prevention (RCAP), Indiana University School of Public Health – Bloomington is provided to support doctoral student research.

Griner, who is currently working toward her PhD in community and family health, said she plans to use it to expand upon her current dissertation work related to the sexual health of adolescents and young adults.

Doctoral student Stacey Griner, MPH. (Photo by Anna Mayor)

“It is truly an honor to receive this award,” she said. “Dr. Douglas Kirby was a leader in the field, and I hope to contribute to public health and sexuality research in the way he did.”

Griner’s dissertation focuses on the factors influencing the use of self-collected samples as a method of sexually transmitted infection (STI) screening among college women.

“Enabling college women to screen themselves at home could reduce barriers and promote sexual and reproductive health among this population, who are disproportionally burdened by STIs,” Griner said. “The award provides funding for me to conduct interviews with college women and understand their needs and perspectives.”

The RCAP established the grant to honor Dr. Douglas Kirby, an internationally renowned authority on adolescent sexual health through his research on the impact of school and community-based programs designed to reduce sexual risk behavior among youth.

Griner said the grant was something she’s always had her eye on, but had to wait until she was in her dissertation phase of her coursework, so she had the reminder set on her calendar.

“I applied because Dr. Douglas Kirby’s work on the effectiveness of programs to reduce unintended pregnancies and sexually transmitted infections has influenced my own research a great deal,” Griner said.

Griner’s public health passion of focusing on the “bigger picture” of sexual health and looking at the social determinants, in addition to individual factors, has been apparent throughout her academic career research endeavors.

She’s previously researched school- and college-based approaches to sexual health, stakeholder support for sexuality education in schools, college-level factors impacting the use of condoms, and violence experienced among gender minority college students–just to name a few.

Now, she’s focusing her research on risky sexual behaviors and the associated reproductive health outcomes among college students.

“Currently, my dissertation work examines the influence of social norms and environmental factors on the use of self-collected sampling methods for STI screening, and I am also interested in the college setting and campus culture as potential factors that influence health,” she said.

Griner, who earned her MPH from the University of Florida in 2014 and who also holds a graduate certificate in Women and Gender Studies from USF, is set to graduate in May 2019.

She said she aspires to become a leader in sexually transmitted infection prevention, conducting research at a large, student-focused university, and utilizing community-based approaches to address disparities in sexual health.

“It is truly an honor to receive this award,” she said.

Story by Anna Mayor, USF College of Public Health

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