R. William “Bill” Field, CPH professor of occupational and environmental health, will be awarded a 2017 Iowa Cancer Champion Award at the Iowa Cancer Summit Oct. 18 in Ankeny, Iowa.
Field, a nationally recognized radon expert, was nominated by Gail Orcutt of Pleasant Hill and Julie Weisshaar of Creston. He was nominated for championing policy and systems change to reduce exposure to radon and ultimately reduce radon-induced lung cancer in Iowa.
Weisshaar writes, “He helped identify radon as the leading environmental cause of cancer deaths in the United States, and remains dedicated to educating the public about the health risks of radon and ways to reduce exposure in homes, schools and at work.”
Among the efforts referenced in Fields’s nominations, were his leadership of the Iowa Radon Lung Cancer Study, acting as a scientific advisor for the School Radon Training & Support System, leading advocacy to develop policy requiring school radon testing, and advocating for required radon testing with real estate sales and required radon mitigation systems in new home construction.
Field serves as a member of United States Environmental Protection Agency’s Science Advisory Board as well as a presidential appointee on the U.S. Centers for Disease Control and Prevention’s Advisory Board on Radiation and Worker Health. He is also the Deputy Director of the National Institute for Occupational Safety and Health’s funded Heartland Center for Occupational Health and Safety based at the University of Iowa.
The awards will be presented from 11:00-11:30 a.m. on Wednesday, October 18, 2017, at the FFA Enrichment Center in Ankeny, Iowa.
Faculty from the Greater Plains Collaborative Iowa Research Center, located in the University of Iowa (UI) Department of Epidemiology’s Health Effectiveness Research Center in collaboration with the UI Institute for Clinical and Translational Science Biomedical Informatics Core, have received funding from PCORnet, the National Patient-Centered Clinical Research Network, to perform rapid-cycle research on cancer molecular targeted therapies. The UI will receive $235,000 of the total $1 million award for this nine-site collaborative study.
Led by co-principal investigators Elizabeth Chrischilles, professor of epidemiology and Pomerantz Chair in Public Health at the University of Iowa, and Russ Waitman, professor of internal medicine, director of medical informatics, and associate vice chancellor for enterprise analytics at the University of Kansas Medical Center, the primary goal of the project is to examine the patterns of use of molecular biomarkers and associated targeted cancer therapies for patients with invasive solid tumors.
Other goals include documenting the frequency of use of targeted therapy agents for each cancer, the frequency of testing prior to use of these agents, the concordance between testing results and choices of therapies, and the frequency with which these therapies are used for approved indications vs. “off-label.”
This project is also designed to test and expand the capacity of PCORnet to describe the details of cancer pathology, test results, cancer treatment, and outcomes. It is intended to inform key stakeholder groups, particularly payers, on current patterns of care and to assess capacity for future comparative outcomes studies, both observational and randomized.
Data for tests and therapies will come from the clinical data warehouses derived from electronic health records at each participating site. These data are coded consistently across sites using the PCORnet Common Data Model (CDM). Furthermore, each site will link their CDM tables to data from their respective tumor registries. Tumor registry tables include data for tumor characteristics, demographics, and first course of treatment. They are also coded consistently across sites using standards from the North American Association of Central Cancer Registries.
The nine participating sites include University of Florida Health; Vanderbilt University Medical Center; Medical University of South Carolina; University of Iowa; University of Kansas Medical Center; University of Texas, Southwestern; Marshfield Clinic; University of Minnesota; and University of Nebraska Medical Center.
These sites represent three PCORnet Clinical Data Research Networks (OneFlorida, Mid-South CDRN, and the Greater Plains Collaborative) and include four National Cancer Institute-designated comprehensive cancer centers (the Vanderbilt-Ingram Cancer Center at Vanderbilt University, the Holden Comprehensive Cancer Center at the University of Iowa, the Masonic Cancer Center at the University of Minnesota, and the Harold C. Simmons Comprehensive Cancer Center at University of Texas, Southwestern). The ABOUT (American BRCA Outcomes and Utilization of Testing) Patient-Powered Research Network is also participating to provide vital patient input at all stages of this research project.
The Greater Plains Collaborative (http://gpcnetwork.org/) is a network of 12 leading medical centers in 8 states committed to a shared vision of improving health care delivery through ongoing learning, adoption of evidence-based practices, and active research dissemination. The University of Iowa leads the cancer research agenda for the network in collaboration with the Holden Comprehensive Cancer Center Population Research Core.
PCORnet is an innovative initiative funded by the Patient-Centered Outcomes Research Institute (PCORI). PCORnet is a large, highly representative, national “network of networks” that collects data routinely gathered in a variety of healthcare settings, including hospitals, doctors’ offices, and community clinics. By engaging a variety of stakeholders – patients, families, providers, and researchers – PCORnet empowers individuals and organizations to use this data to answer practical questions that help patients, clinicians, and other stakeholders make informed health care decisions.
Natoshia M. Askelson, MPH, PhD, assistant professor in the Department of Community and Behavioral Health at the UI College of Public Health, has been named principal investigator of the Cancer Prevention and Control Research Network (CPCRN) collaborating center at the University of Iowa. The CPCRN is a national network of academic, public health, and community partners who work together to reduce the burden of cancer, especially among those disproportionately affected. The Iowa collaborating center, affiliated with the College of Public Health’s Prevention Research Center, is funded by the Centers for Disease Control and Prevention and the National Cancer Institute. The University of Iowa joined the CPCRN in 2014, and is one of eight institutions that participate as collaborating centers nationally.
“We are very pleased to have someone with Dr. Askelson’s experience in cancer prevention and control as the PI of the CPCRN collaborating center at Iowa,” says Edith Parker, DrPH, professor and head of community and behavioral health and director of the Prevention Research Center. “Her expertise in research and applied evaluation in issues related to cancer prevention and control will benefit our investigators as well as our community partnerships.”
The University of Iowa collaborates with other CPCRN centers to investigate areas of research interest, including initiatives to increase Human Papillomavirus (HPV) vaccination rates and colorectal cancer screening rates. Currently, CPCRN investigator Jason Daniel-Ulloa, PhD, clinical assistant professor in the Department of Community and Behavioral Health, is working in the community of West Liberty, Iowa, to establish sustainable community-clinical partnerships aimed at increasing HPV vaccination rates in Latinos. In addition, Askelson and Parker contribute to a collaborative workgroup that is examining the use of evidence-based colorectal cancer screening interventions in Federally Qualified Health Centers.
More information about the University of Iowa CPCRN is available at https://www.public-health.uiowa.edu/prc/cpcrn/. Information on the national network of CPCRN collaborating centers is available at http://cpcrn.org/ .
“Numbers have an important story to tell. They rely on you to give them a voice.”
– Stephen Few, information design educator and author
There’s no shortage of public health challenges to tackle, from long-standing concerns like heart disease and obesity to more recent issues such as opioid addiction and Zika virus.
To make the best choices about where to allocate limited resources, public health practitioners, policymakers, hospital administrators, and other health providers need solid, well-researched information to help guide decisions. Data is not only essential for deciding where to concentrate efforts, but also to inform and advance health policy in the form of regulations, guidelines, and budget priorities.
Many other professionals rely on public health data to support their work: researchers to track health trends, grant writers to complete their applications, community organizers to plan activities, journalists to highlight health issues, and many others.
Several centers based in the College of Public Health produce rich sources of Iowa-specific health data, the collection and storage of which is carefully managed to maintain confidentiality and security. Three online resources of Iowa health data are spotlighted in the following pages.
Iowa Health Fact Book
What percentage of Iowa’s 11th graders smoke cigarettes? How many family practice physicians are there in Sioux County? Is heart disease mortality rising or falling in the state?
The answers to these and a plethora of other public health questions can be found in the Iowa Health Fact Book, a free online resource compiled by the University of Iowa College of Public Health, Iowa Department of Public Health, and other partners.
The Fact Book web site provides information for each of Iowa’s 99 counties and, where possible, includes demographics and vital statistics, data on disease incidence and mortality, health and social determinants of health, health resources, and environmental factors. The information is searchable and available publicly to researchers, public health practitioners, policymakers, and anyone else needing Iowa-specific health facts.
Previously, the Iowa Health Fact Book had been produced in book form and updated every two years. In its new online form, the information is now updated as new statistics become available and is fully searchable by county or aspects of health, such as cancer, infectious diseases, and health care facilities.
“We’re excited about how this new web site will make it easier for users to browse and summarize the data that is specific to their county,” says Jacob Oleson, director of the Center for Public Health Statistics. “Whenever possible, we’ve included the same types of information in the same tabular and graphical format as in the past.”
With ongoing updates, the Fact Book allows for the presentation of data longitudinally, giving a picture of the changing Iowa health landscape, Oleson adds.
“As we continue this effort over the years, we are in a better position to track changes, measure progress, and identify areas of weakness,” Oleson says.
In addition to the UI College of Public Health and Iowa Department of Public Health, contributors to the Iowa Health Fact Book include the Iowa Department of Inspections and Appeals, Iowa Registry for Congenital and Inherited Disorders, Iowa State Trauma Registry, State Health Registry of Iowa/Iowa Cancer Registry, Office of Statewide Clinical Education Programs, Iowa Health Professions Tracking Center, University of Iowa Information Technology Services, Iowa Consortium for Substance Abuse Research and Evaluation, National Center for Health Statistics – U.S. Centers for Disease Control and Prevention, and U.S. Census Bureau.
Burden of Injury in Iowa
Injuries are a major public health concern that affects all Iowans, regardless of age, race, or gender. However, the distribution of the cause, intent, and type of these injuries varies greatly throughout Iowa’s 99 counties, depending on their population demographics and other factors.
The Burden of Injury in Iowa report, produced as a partnership of the UI Injury Prevention Center (IPRC) and the Iowa Department of Public Health, provides statewide rates of injury deaths and non-fatal hospitalizations for all types of injuries, as well as information on the specific burden of injury in each county of Iowa.
With the most recent data presented in an interactive map, users can click on a county to view its corresponding information. Previous reports are also available in PDF format.
“Injuries are preventable,” says Corinne Peek-Asa, director of the IPRC. “The Burden of Injury in Iowa report has been used extensively by both local health departments and agencies to prioritize injury programs and promote the need for injury prevention throughout the state.”
Efforts to reduce the burden of injuries are most effective when they are tailored to the specific injury burden and the needs of the target population, Peek-Asa adds. She encourages communities, health practitioners, and local policymakers to use the report to develop strategies and policies to reduce injuries.
The report is based on death certificate information from the Iowa Department of Public Health, as well as hospitalization data from the Iowa Hospital Association hospital inpatient discharge data.
State Health Registry of Iowa
In 2017, the State Health Registry of Iowa, also known as the Iowa Cancer Registry, will collect data on an estimated 17,400 new cancers among Iowa residents. Investigators at the Iowa Cancer Registry also estimate that 6,200 Iowans will die from cancer in 2017, 18 times the number caused by auto fatalities.
These estimates are based on mortality data the Iowa Cancer Registry receives from the Iowa Department of Public Health. The registry has been gathering cancer incidence and follow-up data for Iowa since 1973 and is one of fourteen population-based registries and three supplementary registries nationwide providing data to the National Cancer Institute.
Each year, the registry releases the Cancer in Iowa report, which provides county-by-county statistics for new cancer cases and cancer deaths, as well as an estimate of the top 10 types of new cancer and cancer deaths for males and females in Iowa for the coming year. Available online, the 2017 report also includes a special section highlighting liver cancer, which is increasing in Iowa, particularly among the “baby-boomer” population; summaries of current research projects; and a selected list of publi-cations produced during the previous year.
The registry web site also houses an interactive map that provides cancer incidence rates and cancer morality in Iowa going back to 1973. The data is searchable by county, cancer site, gender, race/ethnicity, and other parameters.
“The registry makes this data available so health providers, health departments, and cancer organizations can track progress and determine areas of need,” says Mary Charlton, assistant professor of epidemiology and an investigator with the Iowa Cancer Registry.
In addition to reporting on cancer incidence, survival, and mortality among Iowans, the registry responds to requests from individuals and organizations in the state of Iowa for cancer data and analyses, and provides data and expertise for cancer research activities and educational opportunities.
In 2017, the registry is participating in more than 75 studies, including the Agricultural Health Study, a long-term study of agricultural exposures (including pesticides) and chronic disease—especially cancer—among commercial or private pesticide applicators (and their spouses, if married) in Iowa and North Carolina. Now in its 24th year, the study is funded through the National Cancer Institute and involves several federal agencies.
Registry data are also being used to evaluate the treatment received for a first cancer and the risk it places on the patient for development of a second cancer, to monitor the impact of the Human Papillomavirus Virus (HPV) vaccine on HPV types in cancers, and to research the association between organ transplantation and elevated cancer risks.
This story originally appeared in the spring 2017 issue of InSight.
One of the most effective ways to improve the health of large numbers of people is through public health policy. Examples of successful policy initiatives with far-reaching impact include seat belt laws, tobacco regulations, and banning lead from paint.
To help faculty enhance their skills in translating public health research into practice and policy, the College of Public Health recently established a new Policy Fellow Program. Offered through the college’s Iowa Institute of Public Health Research and Policy (IIPHRP), the year-long program creates opportunities for primary faculty to attend training workshops, connect with experts, interact with policymakers and stakeholders, and develop and implement a policy-related project.
“As researchers, we have a desire to impact our community, and that means translating evidence into policy or practice change. Building stakeholder coalitions and creating effective dissemination plans are strategies that work, but are not skills most researchers have been formally trained in,” says Vickie Miene, IIPHRP interim director. “The Policy Fellow Program provides a supportive and individualized learning environment for faculty to experiment and learn these important skills while simultaneously translating their research into public health practice.”
Each fellow develops and implements an “action learning project” that focuses on a critical public health topic. The project includes at least one stakeholder meeting and a final product, such as a policy brief, proposed legislative language, or a how-to guide, to disseminate at the end of the fellowship.
“Our goal is to select fellows who are enthusiastic, who address significant public health issues, and who propose a project that will likely generate an effective example of translating research into policy or practice,” says Miene.
The 2016-2017 Policy Fellows are Mary Charlton, assistant professor of epidemiology; Cara Hamann, associate in epidemiology; and Kelli Ryckman, associate professor of epidemiology. Their projects, described in the following pages, are currently underway and will wrap up at the end of summer 2017, with final summaries posted on the IIPHRP web site.
Modernizing Cancer Reporting
Mary Charlton, assistant professor of epidemiology, is also an investigator with the Iowa Cancer Registry (ICR). Her project recommends policy changes to modernize Iowa’s cancer reporting laws.
The ICR is a population-based cancer registry that has served the State of Iowa since 1973. The registry is funded by the National Cancer Institute as part of its Surveillance, Epidemiology, and End Result’s (SEER) Program. Through its registries, the SEER Program routinely collects cancer data and patient demographics and is the authoritative source of information on cancer incidence and survival in the U.S.
According to SEER, “The ICR provides accurate and thorough reporting of cancer disease. The ICR has been consistently recognized for its extremely high quality data. However, Iowa has some of the weakest reporting laws compared to other states. Iowa also has one of the lowest rates of e-path (electronic) reporting of all SEER registries.”
In Iowa, about 25,000 cancer abstracts per year are collected from hospitals, pathology laboratories, cancer treatment centers, and physician practices. Two-thirds of the abstracts are collected by the 14 Iowa hospitals with accredited cancer centers. Trained staff employed by the ICR collect cancer data from the other 104 hospitals and non-hospital sites of diagnosis. The ICR maintains the confidentiality of the patients, physicians, and hospitals providing data.
To ensure continued funding from NCI, it is necessary to address the low rate of electronic reporting and Iowa’s weak cancer reporting requirements, which require a disproportionate amount of NCI funds to be spent on cancer data collection compared to other SEER registries.
“Existing Iowa cancer reporting requirements were developed long before widespread use of electronic record systems and at a time when nearly every cancer patient received treatment in a hospital,” Charlton says. “Cancer reporting requirements must catch up with technology.”
Charlton’s policy recommendations are to:
- Require all reporting entities to provide data electronically whenever possible.
Benefits include more timely case reporting, enhanced patient privacy, more complete reporting, and significant labor savings.
- Add provisions for cost-sharing mechanisms.
Nearly $2 million of the ICR budget is spent on cancer data collection by trained staff, which results in Iowa having the largest cost per case of all SEER registries.
- Clarify the definition of who is required to report.
Currently, as the Iowa Code is written, it is often interpreted that only hospitals have to report cancer cases. This leads to underreporting of cancers that can often be treated in a clinic or outpatient setting.
Improving Newborn Screening
Kelli Ryckman, associate professor of epidemiology, has long-standing research interests in genetics and the complications of preterm birth.
“My passion is finding ways to improve the care of preterm, low-birth-weight, and sick newborns in the Neonatal Intensive Care Unit,” Ryckman says about her motivation to apply to the Policy Fellow Program.
Her project is to refine the newborn screening policy for babies in the NICU that will result in fewer false-positive screens.
“Through the program, I hope to build consensus based on the evidence and disseminate a uniform set of guidelines for newborn screening in the NICU that allows for better use of resources in Iowa and beyond,” Ryckman says.
State newborn screening programs are critical public health services aimed at screening every child born for specific genetic, endocrine, and metabolic conditions that, if left untreated, can lead to severe disability or death.
There are about 39,000 births in Iowa each year, and approximately 10 percent of all births in Iowa are preterm, low-birth-weight, or transferred to the NICU. This 10 percent also makes up over a third of the follow-up workload required for the newborn screening program due to the high false-positive rate in this population. Transfusions, parental nutrition, medications, and timing of the test in the NICU can affect the validity of the newborn screening test.
“It’s well-recognized that premature, low-birth-weight, or sick newborns are more likely to falsely screen positive for one or more of the newborn screening tests,” Ryckman says. “False positives have adverse impact on parents and require additional testing, which can add to the stress on the baby.”
To address these challenges, the Clinical and Laboratory Standards Institute, a non-profit organization dedicated to improving clinical laboratory testing quality, developed a guideline for screening preterm, low-birth-weight, and sick newborns in 2009. Recent surveys have shown that despite the recommendations, many physicians caring for newborns in the NICU are unaware of its existence and that only 25 percent of states have adopted or were planning to adopt the recommendations, the American Academy of Pediatrics reports. Iowa has not yet adopted the recommendations.
Ryckman’s policy recommendation is to develop and disseminate a uniform set of guidelines to be implemented across Iowa. These guidelines will align with the national recommendations, provide for better utilization of resources, and decrease false positives in this special population of newborns.
Increasing Bicycle Safety
Cara Hamann, an associate in the Department of Epidemiology, developed an issue brief to highlight bicycling safety research, a topic that has received attention recently due to an increasing number of automobile and bicycle crashes in Iowa. In collaboration with the Iowa Bicycle Coalition, she also held a bicycle safety policy action forum of stakeholders in December 2016 and produced a forum recap document containing statewide key issues and action items.
“There were 340 bicycling injuries and 8 fatalities as a result of bicycle–motor vehicle collisions in Iowa in 2016,” says Hamann. “That’s up from 3 deaths in 2014, and 5 in 2015.”
Bicyclists have higher crash-related risk of injury and death due to their lack of physical protection, slow speed, and size differential compared to other roadway users. In alignment with the Iowa Bicycle Coalition 2017 legislative initiatives, Hamann supports several changes in Iowa code to make bicycling safer.
Require motorists to change lanes when passing bicyclists
Motorists hitting bicyclists from behind have accounted for about half of fatal bicycle crashes in Iowa over the past five years, Hamann says. Penalties assessed to motorists at fault in these fatal crashes are generally a traffic ticket with an enhanced penalty of a $1,000 fine and six-month license revocation. A measure to require vehicles to change lanes to pass bicyclists passed both the Senate and House sub-committees (HF 513, SF 450), but did not advance further.
Increase penalties and make distracted driving a primary offense
Most Iowa drivers don’t receive charges in bicycle–motor vehicle crashes, regardless of fault. Two bills that increase penalties were passed during the 2017 legislative session and signed into law by Gov. Branstad. One bill (SF 234) changes hand-held electronic communication (writing, sending, or viewing electronic messages) from a secondary to a primary offense and will go into effect starting July 1. However, this new law still allows drivers to use hand-held devices to make phone calls or check GPS directions. The second bill (SF 444) increases penalties to allow drivers to be charged with reckless driving when their hand-held device use causes a fatality. This type of charge is a Class C felony.
Increase appropriations for bicycling infrastructure
Results from a study of 294 sites in Iowa suggest that bicycle lanes and shared lane markings can reduce crash risk by as much as 60 percent. In a sample of Iowa drivers, shared lane markings improved driver positioning during overtaking, especially among older drivers.
“I was motivated to apply to this program to develop skills to translate my research into tangible products to be used for policy change and real impacts on safety,” says Hamann. “I want to use this opportunity to draw attention to bicycle safety and complement the current grassroots efforts underway in the bicycling community.”
Portraits by John Choate
This story originally appeared in the spring 2017 issue of InSight.
An estimated 6,200 Iowans will die from cancer in 2017, according to a new report released March 22 by the State Health Registry of Iowa, based in the University of Iowa College of Public Health.
Lung cancer will continue to be the most common cause of cancer death for both males and females and will be responsible for about 1,670—or approximately one out of every four—cancer deaths in Iowa, according to “Cancer in Iowa: 2017.”
The annual report also projects an estimated 17,400 new cancers will be diagnosed among Iowa residents this year. Breast cancer will remain the most common type of cancer diagnosed among females, while prostate cancer remains the most common type among males. The 2017 estimate for new cancers is about 800 more cases than last year’s estimate and reflects recent data showing that cancer incidence has not been falling as quickly as researchers projected.
“Each year our projections are based on data from three years prior because of the time it takes to collect and verify data on cancer cases and their treatment and outcomes,” says Mary Charlton, assistant professor of epidemiology at the UI College of Public Health. “Last year we projected the number of breast and colorectal cancer cases would continue to decline rapidly based on trends from previous years. Unfortunately, more recent data has suggested a much slower decline, possibly due to an increase in risk factors such as obesity, as well as an aging population.”
According to Charlton, similar adjustments were made to other cancer types, resulting in a higher total number of cases compared to last year. “There remains a great need for continued research and initiatives surrounding cancer prevention, screening, and treatment of cancer.”
Read the full Iowa Now story
Watch an archived video of the news briefing
http://www.kcrg.com/content/news/State-Health-Report-shows-liver-cancer-on-the-rise-416863373.html (story starts at 1:30 mark)