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From the Front Row: Exploring racial disparities in cancer care and treatment with Dr. Mya Roberson

Published on October 18, 2021

This week, we explore the issue of racial disparities surrounding cancer detection, care, and treatment with Dr. Mya Roberson, assistant professor in the Department of Health Policy at Vanderbilt University School of Medicine. Dr. Roberson also talks about her path to public health and her experiences as a first generation college student.

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Alex Murra:

Hello, everyone. Welcome back to From The Front Row, brought to you by the University of Iowa College of Public Health. My name is Alex Murra, and if this is your first time with us, welcome. We are a student-run podcast that talks about major issues in public health, and how they’re relevant to anyone, both in and out of the field of public health. Today we are talking with Dr. Mya Roberson. She is an assistant professor in the Department of Health Policy at Vanderbilt University School of Medicine. Dr. Roberson’s research focuses on how to apply epidemiologic methods to health service research to promote health equity using big data. Some of her specific interests are in equity in cancer care delivery for Black people in the Southern United States. Dr. Roberson will be featured at the College’s October 20th spotlight series, where she will be leading a discussion on how researchers can think about how their work impacts health equity. She completed her MSPH and PhD in Epidemiology at University of North Carolina at Chapel Hill. Welcome to the show Dr. Roberson.

Mya Roberson:

Thanks so much for having me, Alex.

Alex Murra:

So just to get us started, can you maybe tell us more about your path in public health, and how you ended up in your current position?

Mya Roberson:

Sure. So I had no idea what public health was when I was in high school, I think like many folks. I went to college, undergrad at Brown University, and I thought that I wanted to major in psychology. And I heard from an upperclassman that Intro to Public Health was a great elective to take. I was looking for a class to fill out my schedule, I didn’t know what to take, and kind of on a whim, this upperclassman who recommended Intro to Public Health to me, and so I took it my freshman year and I realized that I enjoy public health a lot more than psychology, no knock to the psychologists, but I just felt so much more engaged, and it really gripped my interests. And so I kept taking some more public health classes to feel it out and see if it’s what I wanted to do, and ended up finding some really great mentors who have supported me, still continue to support me to this day.

Mya Roberson:

My freshman public health professors ended up being my senior thesis advisors, who introduced me to some folks in graduate school as well at UNC. And so I majored in public health as an undergraduate, as I, I guess, kind of bobbled around in these courses and realized that it was what I really enjoyed doing. And right after my bachelor’s degree, I enrolled straight into graduate school, in a combined MSPH to PhD program in epidemiology at the University of North Carolina at Chapel Hill. I realized very early on in undergrad that I was interested in cancer disparities, I remember taking [inaudible] epidemiology as an undergrad junior, and seeing a figure of breast cancer mortality differences by race. And it was just so stark that Black women had a substantially higher mortality than any other group, and to me that was just so unacceptable.

Mya Roberson:

And so from that time, I decided that I wanted to study, how can we close that gap? How can we have better cancer care for Black women specifically? And that’s why I went to the University of North Carolina to study. I had the great fortune of working with the Carolina Breast Cancer Study for my master’s thesis while there, which was one of the really foundational studies in breast cancer disparities research nationally, not just at North Carolina.

Mya Roberson:

While I was in my graduate program, I realized that I was interested much more in cancer care delivery factors rather than traditional epidemiology exposure outcome. And while the analytic principles really do apply, my way of thinking about these sorts of inequities shifted a little bit. And so I completed my dissertation work earlier this year, in August 2021. And the topic of that work was specifically around cancer care delivery, surgical care delivery for Black women with breast cancer in the state of North Carolina. I’m carrying those interests forward, in equity and cancer care delivery to my faculty position that I just recently started about a month ago at Vanderbilt, in the Department of Health Policy, where we’re broadening out a little bit from breast cancer and thinking about how can we make cancer care delivery more broadly better for Black folks, because some of the issues that are happening in breast cancer are also happening in other cancer types as well, and how can we apply that knowledge to other areas to make sure that cancer outcomes are better for everyone?

Alex Murra:

Yeah, I think your career path is really interesting. I like that the intro to public health class is what sparked it all. I think a lot of the people in my program too, we talk about how that was a big class for us. We didn’t know what public health was.

Alex Murra:

So you kind of touched on this when you were talking about your experience in undergrad, but as a Black first generation student, what role has mentorship had during your career? And then also kind of building off of that, what advice would you have for other first gen students in terms of networking or finding research positions, or even sometimes dealing with things like imposter syndrome?

Mya Roberson:

Yeah, that is such a great question, and truthfully mentorship has been everything. So a little bit more about my personal background, I am from Appalachia, a small town in Pennsylvania. My hometown had around 5,000 people, a decent number of kids went to college every year from my high school, but once I went to college, I realized that there are high schools from which everybody goes to college every year. And that was not the kind of place that I grew up in, certainly most folks stayed relatively local. I had wanted to see what was outside of Pennsylvania as well, but had no real way of knowing exactly how to do that. My mother was a waitress working in food service my whole life, and my dad was a steelworker, a landscaping business owner. And so neither of them had really anything to do with higher education at all, but they, for sure, absolutely encouraged me 100%.

Mya Roberson:

They didn’t know the exact steps for me to get there, but they were behind me 100% when I said that I wanted to leave Pennsylvania, which was very shocking for my small town. When folks go to college, they tend to stay pretty nearby, so they supported me to the best that they could, but when I got to undergrad, it was truthfully very jarring. So I was entirely academically unprepared all around. Quantitatively my writing skills, it was a shock my first semester. And that’s scary. That is really scary to encounter, and I was lucky to have found public health so early on, because the mentors that I’ve found through those classes, I felt that with them nothing was a foolish question, and I felt that I could struggle and they wouldn’t think that I wasn’t intelligent, like the problem wasn’t my intelligences, it was the structural issues that led to my lack of preparedness, that truthfully started at K through 12, which is probably another podcast episode.

Mya Roberson:

But to the point, the Intro to Public Health professor, I remember, was so open about her office hours, and what I mean by that is that she didn’t typically hold her office hours in her office. She held them in one of the main student hubs on campus. And thinking back, that made such a big difference because it made her seem much more approachable. And so I would be there every Friday, whenever she had them to talk about the material for that week or what have you, and really started building a great relationship with her. And once I realized that faculty aren’t so scary, and that there were supports in place to make sure that I did have what I needed to succeed, that I didn’t have to drop out of college or anything like that, I just maybe needed a little extra help to catch up. Things started turning around for me, and I am grateful for those mentors that took me under their wing early on.

Mya Roberson:

A professor that I had had, who taught the second first-year course in the Public Health major, called Healthcare in the United States, he took me on as a research assistant. So because I was a first generation college student from a low-income background, I was also on work study, and for my first couple of years of undergrad, I worked in retail and various odd jobs that have nothing to do with my current or future career path, but I needed to make money. It was the reality of the matter. And I didn’t realize that you could get a work study job as a research assistant. And this professor knew that I was interested in learning more tangibly about public health, knew my reality of needing to work. I couldn’t be an unpaid research assistant, that this was not in the cards for me, and set up for me to do a work study for him.

Mya Roberson:

And I was doing pretty basic tasks like data entry tasks, checking over manuscripts and things like that. It wasn’t that much of a heavy lift, but that truly sparked my initial interest in doing research. The really menial, minute things, I just enjoyed so much. And that’s when I really started thinking about how research might be a path for me. And so I continued working on that project and other ones, as I progressed in my undergraduate education, with increasing responsibility as I develop more useful skills over the course of my education as well, that culminated in a senior thesis, which was an independently-led study that I did, and it was mentored through.

Mya Roberson:

And to your original question about the role of mentorship, I mean, I am fortunate that as an undergraduate senior I was able to have mentors who saw potential in my research ideas, who saw how passionate I was about closing this gap in cancer outcomes, specifically breast cancer outcomes, and let me run with that and develop a patient-centered project on my own, that I went out and conducted, and supported me through that instead of just saying oh, here’s this little piece of something that I’m working on, which for some folks who may not be at a stage where they’re ready to develop their own ideas, that may be a perfectly feasible thing for them. But I think I got pushed out of the nest a little bit in the best way possible, to think independently, think about what kind of contributions that I could make.

Mya Roberson:

And so that started very early on and started quite literally by me simply going to office hours at that early stage, and building relationships, then reaching out to folks after that, once I had gained more confidence about thinking specifically about my research interest in cancer care delivery, and this is a very long winded answer, but I’ll just wrap up by saying that those mentors still haven’t forgotten me. I keep in touch with them every couple of months, in the before times when I would be back up in the Northeast visiting, I would always see them as well. And they additionally introduced me to folks at UNC when I started graduate school, became mentors to me, but then introduced me to additional folks at Vanderbilt where I’m now working.

Mya Roberson:

So it’s truly a chain reaction of mentorship when you’re able to find good ones, and specifically as a first generation college student, finding mentors who understood my reality. Let me ask the silly questions, who didn’t mock or talk negatively about what I did or didn’t know, has honestly made all the difference. And now knowing that there are so few faculty members who they themselves are first generation college students, one of the most important things for me is to pay it forward and to continue mentoring the students who were like me, who went to undergrad, probably unprepared and not really knowing what direction was for them, because it’s truly had a profound impact on my career.

Alex Murra:

Yeah. I connect with a lot of the things that you said. I’m also a first gen student, so I remember when I came to college, I was terrified of office hours. I thought that my professors would eat me alive if I went there, like what are you even talking about with office hours? So questions like that. Yeah. Mentors are great. And actually one of the questions I have as a follow-up is, now as an instructor, as a faculty member, or even for our listeners who are faculty or TAs, how can we be more approachable to those first gen students? Because I tell my students in class, please come talk to me, I don’t bite. I want to see you in office hours, but I know that a lot of them are still afraid. So how can we connect with those students?

Mya Roberson:

Yeah. You know, I will speak more from my experiences as a TA because I just started a month ago, I’m not teaching yet here at Vanderbilt, and with COVID I honestly haven’t gotten that much of a chance to interact with students yet, unfortunately. But when I was a TA for, gosh, more classes than I can count in graduate school, one of the things that I knew and realized is that the way in which we give feedback matters a lot, whether it’s writing, whether it’s on a quantitative data set, the way we guide help students, and the language that we use when we perhaps issue correction has a very big impact on how they see us as instructors, be that TAs, be that professors, whatever level. And one of the things that I really tried to do, and am looking to you to try to do is let folks know they did a good job.

Mya Roberson:

It can really be that simple. I mean, I know when I would pass back assignments, we used to put them in student mailboxes or what have you, I would catch the students in the hallway and say like, Hey, you did a great job, I really appreciated your work. Or if it was a writing assignment, leaving something in the margins about an argument that I felt that they made that was really well thought out, so that the feedback that they get, isn’t always critical or always negative. It’s just as important to point out the things that folks did well or that you liked, as it is about making sure that they’re on the right track, methodologically or analytically or whatever type of assignment that is. So I think that that’s one way that I have definitely tried to make a connection with my students.

Mya Roberson:

And I think after establishing that rapport where they knew that they could trust me a little bit more, and that I wasn’t always going to jump on them or what have you, they could come to me for affirmation as well, regardless of the level of student, is so important because I quite honestly think in higher ed and academia, that there isn’t enough affirmation going around, especially thinking about the power structures that may exist between faculty, TAs and students. There’s enough space for affirmation to go around, even if it’s in a space for you to be critical and make sure that students are on the right track, and provide correction as well. I think that sometimes there is this tension that if you’re kind, or if you’re nice, you’re not rigorous, and I think that those are unnecessarily at odds with each other, quite honestly, in that you can be kind and also rigorous.

Mya Roberson:

I think one of the most memorable things for me being a TA when I was in graduate school, at the end of one semester where I was TA-ing a [inaudible 00:17:03] class, I had gotten the note in my student mailbox about how much of a better writer I made a student, and that they were grateful that I had taken this approach where I could tell them that they needed to restructure the paper because the organization wasn’t great, but at the same time acknowledge that they were making a really clever argument. And this is how I would frame it, “this is how you could improve it”, not “this needs to be entirely redone”. And that goes such a long way in establishing rapport and building relationships, and making yourself more approachable to students who may not necessarily have had affirmation, or may not be walking into your classroom most prepared. There’s always something good in every assignment, I really believe that. Making sure that students know that those things exist as well, can really help out in building those relationships.

Alex Murra:

Yeah. Thank you so much for that insight. I hope that our listeners, at any level of instructors that they are, will hopefully take that into mind.

Alex Murra:

So kind of moving on to about your individual research, can you talk more about how you specifically integrate your training in epi and also health service research? And I also know that you’ve touched on this already with being made aware of the cancer disparities, and that’s why you got interested in cancer as your focus area, but why did you specifically choose cancer? Because there’s racial disparities in a lot of different issues. So I know that I got into public health because of racial disparities in maternal mortality. So I’m just wondering why specifically cancer, out of all the diseases.

Mya Roberson:

I’ll start by answering that question first, and then coming back to the first part of the question about how I integrate epi in health services research. So it was a little bit serendipitous, and a lot of it genuine interest. So as you had mentioned, there are racial disparities in [inaudible 00:19:05] health outcomes, they exist basically everywhere. I took cancer epidemiology as an undergraduate, which means it was an elective that was available [inaudible 00:19:15]. Second semester junior and needed a higher level course, and it seemed interesting, and I really engaged that material and thinking about how cancer touches almost everybody’s life, we all know someone had cancer. Basically I would be surprised if there was someone out there who didn’t, whether it was a friend, a grandparent, a parent, a teacher. It is something that is quite frankly everywhere.

Mya Roberson:

And that was something that resonated with me, and my own older sister is a cancer survivor, my aunt’s a cancer survivor. So it was something that was very closely personal to me as well, so it was partially right place at the right time that I took cancer epidemiology so early in my educational career, and also seeing these connections with broader society and how many lives it really unfortunately touches. And so I just took that and ran with it as a substantive area, and I am glad that I did because it has been a really good fit. I feel like the work that I do is meaningful, and it matters, hopefully my ultimate goal is one day to hopefully shift the needle on the [inaudible 00:20:34] that we see in cancer outcomes.

Mya Roberson:

In terms of how I integrate theology with health services, research and health policy, one of the things that’s important to note about my academic background is that while I was in graduate school, I received the Robert Wood Johnson Foundation Health Policy Research Scholar award, which was a four year graduate training award that allowed me to do just that. So this program through the Robert Wood Johnson Foundation selects a cohort PhD scholars every year, from a wide variety of fields from epidemiology, engineering, anthropology, religious studies, you name it, all with a common goal of integrating health policy into our home fields.

Mya Roberson:

So that training was truthfully invaluable for me, and was really where I found the synthesis of my interests, especially as I realized I was particularly interested in issues related to care delivery. That’s much more about health policy than a classical epidemiological issue. And so through this training program, we learned about how to think about the policy angles for your work, and that’s big P Policy and thinking about legislation and federal policy and state policy, but also potentially organizational policy or local policies so maybe think of the health issues that we cared about.

Mya Roberson:

We learned a lot about science and lay communication, which is something that has always been important to me. One of the things that I say is that for me, it’s very important that I’m able to communicate what I need back to my parents, and back to folks in the places that I grew up, and not just epidemiology or Public Health PhDs, because folks like that are the ones who ultimately benefit the most from my work, and if I can’t communicate with them, then I’ve lost touch of what I wanted to do.

Mya Roberson:

And so for me, I guess in my day to day, thinking about the integration of these two fields, I’m always mapping out what sorts of different levels of policies affect the issues that I care about, what is on the legislative agenda that’s related to cancer? Where have things gone, where are potential windows of opportunity, and definitely being in an academic health policy department now, rather than an epidemiology department, I will continue to lean into those sorts of intersections, to hopefully think about how we can better support folks with cancer throughout their care and treatment trajectories.

Alex Murra:

Yeah, I think it’s a really interesting intersection of fields, because I know that a lot of times in my courses, epi is really good at pointing out the issues, but then it’s kind of like, all right, well now what? What do we do from here? So I think comparing or using the two of them, it’s what we need to do to move forward. We’ve identified these disparities, now we actually have to try and change them, or bring change.

Alex Murra:

So when you’re doing your research, I’ve seen on some of your biography pages that you use big data. So for those who might not know, can you explain what big data is, and why these data sets or big data is important in epidemiology research, but also public health research?

Mya Roberson:

Yeah. So big data means different things to different folks in different fields, so I’ve specifically worked with a lot of big healthcare data. So that is thinking about insurance claims data, or you can think about questions related to health care utilization for a variety of health outcomes, electronic health records data, from integrated healthcare systems to observe a different aspect of care utilization, oftentimes at a deeper level but with a more restricted compensation. One of my favorites, and I’ll delve a little bit deeper into is working with cancer registry data. That to me is also a form of big data, and truthfully one of the best surveillance systems that we have built in across the United States. So all 50 states have cancer registries where all cancers of any type, not just breast cancer, which is what I primarily study, are reported to state or federal agencies with a high level of granularity about the stage of diagnosis and where people live, and these registries also capture a baseline level of treatment that patients have received.

Mya Roberson:

And to me, one of the neat things about cancer registries, specifically thinking about health equity, is that compared to some other sorts of healthcare big data that exists, cancer registries literally include everyone who was diagnosed with cancer. It doesn’t matter if someone is uninsured, it doesn’t matter if they received their treatment at a particular, University of Iowa Cancer Center, or some small cancer center that’s down the road and not nearly as well-known. Everybody who has cancer is going to end up in the registry, and that was part of what my dissertation focused on, actually, is thinking about how we could potentially leverage cancer registries to gain a better idea of cancer trends in under- and unrepresented populations that may not be taught elsewhere in things like insurance plans, which by definition requires someone to be insured, or electronic health records, which require folks to seek care at certain specific places.

Alex Murra:

I’m actually taking a class right now with Dr. Mary Charlton, and we’ve been going over the cancer registries and honestly, I’m constantly amazed at just how detailed some of the information that they get, and how they get the information. Sometimes I’m shocked when we’ve been using these databases, because I’m like, oh my God. How could they record everyone?

Mya Roberson:

I could nerd out about cancer registries for forever, because as you were mentioning, the level of data that’s collected on all of these patients was truly amazing. And the fact that it is so systematic across the United States, that there are very few other things like that. I just feel in my personal opinion, that they’re very often under appreciated.

Alex Murra:

Yeah, yeah. For sure. I almost want to tell everyone that I know about these registries.

Alex Murra:

So this kind of touches on this too, but thinking about this past year, we’ve had an increased attention in racial disparities and health equity, so I was wondering if you see any improvement in the future, particularly with the registries too. When we think about how we’ve been surveilling COVID, there’s a lot of registries that don’t break down things by race, or income or whatever variable. We just have really bad data collection, and we can’t even look at these disparities. So what strategies can public health practitioners or research use to improve outcomes for disadvantaged groups, whether it be COVID, cancer or any other issue?

Mya Roberson:

Yeah, I think truthfully from the baseline, we need to acknowledge that equity matters, and that diseases, whether they be COVID or cancer or maternal mortality, which you mentioned was previously an interest of yours, affect different groups differently. I don’t think that everyone is really willing to acknowledge that previously, quite honestly, that COVID really laid that bare, when we started seeing that Black and brown folks, and folks in certain public-facing low wage occupations were getting severely more impacted by COVID than other folks.

Mya Roberson:

And I think with that increased attention, that’s really forced people to, I don’t necessarily want to say everybody’s paying attention, but I think it at least raised the awareness of these issues. Social epidemiologists and other health disparities and health equity researchers have been screaming this from the rooftops for a while, but to get that mainstream attention, I didn’t honestly think that we’d see the New York Times and Washington Post and other public media covering health equity on a regular basis, and things like that matter quite a bit. So it’s not just those of us who have been doing this work for a bit shouting from the rooftops a bit in the void, that these issues are even in the first place. So I think that level setting before even moving further than that is step number one.

Mya Roberson:

And to your question about what can we do as public health researchers, public health practitioners, something that I think a lot about, and I’ll be talking a bit about in my talk in a couple of weeks, is health equity. Everything has an equity implication, whether we consider ourselves equity researchers or not. Work that we do, different policies, interventions, they are either going to uphold the status quo of inequity, which exists for negative health outcome, and it doesn’t really matter if we’re talking about cancer, COVID or what have you.

Mya Roberson:

Maintain the status quo, they’re going to make inequities worse, which we’ve seen in certain spaces, particularly related to new innovations and treatments, that they can go to folks who can afford them and not necessarily the folks who are most affected by issues, or where we should ideally all strive to is reduce inequities. So one of the things that I really urge researchers and practitioners, is to think about what are the equity implications of what you’re thinking about, what you’re studying, the policies and interventions and issues that you care about. Do they maintain the status quo, are they making inequities worse, or are they doing something to make them better? And if you want to ideally make them better, I don’t think that everybody themselves necessarily needs to be an equity researcher, but they can partner with the equity researchers and practitioners to start thinking about how we can move the needle on these issues.

Alex Murra:

I know that even myself, I guess, before I really got into this graduate program, I didn’t realize that there were social epidemiologists. I came from a microbiology background, so I was kind of like, oh, maybe I’ll just be like infectious disease or something like that. And that’s interesting, but yeah, social epidemiology, really interesting, and health equity is a really important topic. And I think that no matter where you are, there’s still so much to learn, you’re never really going to know it all.

Mya Roberson:

Exactly.

Alex Murra:

Thinking about your spotlight series coming up, is there anything that you would like to tell our listeners as a plug to really come?

Mya Roberson:

Yeah, I mean, I think I probably nestled my plug in my response to the last answer, but I hope the listeners to the Spotlight Series with an open mind, and willing to think about how health equity does, or frankly does not touch their own work, and what they can do to better support health equity research, better support students and others were working in this space as well.

Alex Murra:

I know that I will definitely be making it to that talk. I’ve learned so much just with talking with you for 30 minutes, so I’m excited to see like what your actual talk is about.

Alex Murra:

Just to kind of finish off for today, one of the things that we like to ask all of our guests is, what is one thing that you thought you knew, but were later wrong about?

Mya Roberson:

You know, when you sent me this question in advance, I think this is probably one of the hardest questions I have ever been asked. And I have been sitting with it for a little bit, and it’s not necessarily a research answer, it’s a little bit more of a personal trajectory kind of answer. But one of the things I was definitely wrong about, I think in my own naivete, when I enrolled in graduate school is that life wouldn’t happen. As silly as that seems, I thought that real life would happen when I was onto the next stage, I was after school. I could just sit and focus on my dissertation. And I mean that in both a positive and a negative way. So when I was in graduate school, my dad was hospitalized in my second year, and was in the ICU in the hospital for six weeks.

Mya Roberson:

And I remember my mom calling me at that time and was like, oh, you’re in school, I don’t want to bother you. But school can wait because life happens, UNC is always still going to be there. And I think back about how I was just honestly so shocked and jarred that oh my goodness, what am I going to do? Because I’m in school, I’m having this major, major life event, I wasn’t prepared for this to happen. But truthfully, if anything in this last almost two years have shown us, especially that these sorts of things, life doesn’t pause for us to be enrolled in graduate school. And I thought about that on the opposite, happier side as well. I met my husband while I was in graduate school, and wasn’t ready for that to happen. I was like, oh, I’ll meet my future husband when I’m done and onto the next thing, and life had other plans.

Mya Roberson:

And so particularly for any student listeners, graduate student listeners, and shoot, even undergrad potential listeners, what both the ups and the downs of life still happen in grad school, and I was entirely wrong thinking that I could just push pause on everything that wasn’t academic, good and bad, and just table that until I was onto the next phase. And truthfully, I probably would’ve done some things a little bit differently, I wish I would’ve gone home a little bit more, even though there were very real financial constraints of being a graduate student, particularly early on before I had my side hustles lined up.

Mya Roberson:

But thinking about things like that, that I could have missed a day of class to go home, so I could have seen my niece’s dance recital or something like that. And so that was one of the things that I have experienced a lot of growth from, and I know I’m definitely approaching my faculty position a lot differently than I approached that, that life wasn’t going to wait until after I get tenure. It is happening now, and it’s important to experience all of the seasons of life, the highs and the lows, and not hope that it can hold off or wait until you’re after that next thing.

Alex Murra:

That’s really good advice, and honestly I should probably take a little of that to heart too.

Alex Murra:

Well, thank you so much for coming on and talking to me, and agreeing to come onto this podcast. I had a really great time, and I hope that you did too.

Mya Roberson:

Yeah, thank you so much for having me.

Alexis Clark:

That’s it for our episode this week. Big, thanks to Dr. Roberson for coming on with us today. This episode was hosted, written, edited, and produced by Alex Murra. You can learn more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple Podcasts, and SoundCloud. If you enjoyed this episode and would like to help support the podcast, please share it with your colleagues. Our team can be reached at cph-gradambassador@uiowa.edu. This episode was brought to you by the University of Iowa College of Public Health. Stay happy, stay healthy and keep learning.