Strengthening Community Health Connections

The Business Leadership Network collaborates with Iowa’s smaller communities to address health needs.

a participant in a cooking class in Wapello County receives a free slow cooker

 

At one community forum hosted by the Business Leadership Network, an industry leader commented that it was not uncommon for as many as 15 percent of his employees to be sick on any given day. From his individual perspective, the business owner had no way to know if this was part of a trend rep-resenting a community-wide health concern. He didn’t know if other business or the local schools were experiencing similar absences, for instance. And without knowing the cause of the higher numbers, how could he hope to fix the situation?

Finding and addressing the roots of community health issues is a central goal of the Business Leadership Network (BLN). Founded in 2011 through the Iowa Institute of Public Health Research and Policy, the BLN and the grants program it oversees is intended to foster collaboration in Iowa’s smaller communities to tackle areas of identified community health need.

Gathering Community Input

A key to the program, says Tara McKee, coordinator of the BLN, are community forums that foster conversation and help leaders discern patterns and needs.

“We start with a planning group,” says McKee of the process that goes into organizing a forum, “including the chamber of commerce and other business owners, the schools and the nearest community college, United Way, bankers, hospital administrators, and local public health officials. We ask them about the most immediate public health needs in the community, and from there, we narrow to three or four topics.” To date, topics of interest have included food insecurity, diabetes, and dental care.

During the forums, community experts present on the chosen topics, while UI College of Public Health faculty and staff provide relevant research and examples of successes from other communities. Beyond this collaborative sharing of knowledge, McKee says the forums are vital networking opportunities at which local leaders find others with common concerns. That business owner with the high absentee rate, for instance, could compare notes with a county public health official, or connect with a UI faculty member who studies absenteeism.

 

kids enjoy after-school activities at Athletics for Education and Success in Fort Dodge
Kids enjoy after-school activities at Athletics for Education and Success in Fort Dodge.

Partnering for Success

The grant program, which is in its second year, adds another layer. Not only do the BLN Community Grants provide financial support, but the program also requires partnership in order to qualify for funding.

Athletics for Education and Success in Fort Dodge has been awarded funding in both cycles of the BLN grant. Charles Clayton, CEO of the nonprofit that was founded in 2004 to provide more after-school athletic, mentoring, and educational opportunities to young people, says the grant has been helpful in gaining more partners. “People are more likely to jump on board as a result of our work with the University of Iowa,” he says. New partners include the Fort Dodge Police, who are teaching an exercise class, and coaches from the local public schools, who are volun­teering their time as referees.

After receiving the BLN grant last year, the nonprofit was able to expand weekend activities for kids. Hearing from many of the participants’ parents that they wished they had more access to fitness and athletic opportunities, Clayton and his team applied for the second year of the BLN grants and is now offering weekend family sports activities, such as dodgeball and volleyball, as well as fitness classes aimed particularly at single mothers.

 

uniforms await games at Athletics for Education and Success in Fort Dodge
Uniforms await games at Athletics for Education and Success in Fort Dodge.

Making the Most of Meals

In southeastern Iowa, the United Way of Wapello County is using its BLN grant award to extend a burgeoning program intended to help families learn easy, healthy cooking skills based on available and affordable food items. Via the grant, 25 families monthly are receiving free Crock-Pots. During a monthly class led by a registered dietician from the local Hy-Vee grocery store, participants make three meals, which they can take with them, and receive recipes for their slow cookers.

While many families rely on the local food pantry, they tend to gravitate toward easy foods, such as frozen pizzas and pasta. The Crock-Pot program will help them take raw ingredients, including fresh vegetables, dried legumes, and various meats, and create healthy meals that will extend the food and also provide greater nutrition. The recipes are specially designed to be easily edited for changing ingredients. A turkey chili, for example, can be made entirely vegetarian to reflect the availability of beans at the food pantry, or venison can be substituted during hunting season.

“We are hoping to challenge the assumption that everyone in our community is fed,” says Blaire Siems, director of the United Way of Wapello County and point person for the grant. She adds that, “Twenty-five percent of the children in Wapello County are hungry, so there’s a pretty good chance the parents are hungry, too.”

The cooking classes and the families they serve are but one thread in the complex tapestry of a community’s health, but the BLN grants are built on the belief that strengthening such threads is instrumental in supporting the health of the entire community.

This story originally appeared in the spring 2017 issue of InSight.

Watch a video from United Way of Wapello County that highlights the Crock-Pot cooking classes that were partially funded by the Business Leadership Network’s community grant program. The segment starts at the 3:43 mark.

Study looks at role of social connections, socioeconomic inequalities in child nutrition in rural India

A girl in India eating watermelon.

Researchers are increasingly studying how people’s social connections affect poverty and health inequalities. However, little is known about how a family’s social relationships – who they know and what organizations they belong to – contribute to children’s health in low- and middle-income countries such as India, especially when it comes to addressing inequalities in child nutrition.

A recent study led by William Story, University of Iowa assistant professor of community and behavioral health, examined how different forms of social capital may mitigate as well as sustain or reproduce socioeconomic disparities in child underweight. The researchers define social capital as “household members’ actual or potential resources inherent within personal and organization-based networks that can be used for pursuing individual or collective goals.”

For example, a household may belong to community associations, clubs, or religious groups or have ties to influential individuals such as medical professionals, teachers, or government officials. In the context of child nutrition, these social connections may provide immediate access to necessities such as food, informational resources (e.g., parenting advice), and medical services to overcome socioeconomic constraints.

William Story

Story, along with his colleague Richard Carpiano, a sociology professor from the University of British Columbia, analyzed data on 9,008 rural-dwelling children from the 2005 India Human Development Survey. They examined how socioeconomic status shapes household access to and child health benefits from three different forms of social capital located inside and outside the community.

“We found that higher household wealth is associated with greater access to social capital,” says Story. “Additionally, we found that social capital can benefit poorer households in the absence of other resources. However, wealthier households can use social capital to further improve child health and, in some cases, reproduce child health inequalities.”

The study, published in the May 2017 issue of Social Science & Medicine, can be used to guide future research on social capital and disparities in child nutrition and health, and to inform the design of effective interventions in low- and middle-income countries.

Researchers take a ‘collaboratory’ approach to public health concerns

Researchers at the UI College of Public Health will use a “collaboratory” approach for two projects that tackle public health concerns. Funded by the Iowa Institute of Public Health Research and Policy (IIPHRP), the first project will investigate health risks from exposure to insecticides, and the second will work to improve health outcomes for low-birth-weight and premature children.

“A collaboratory is a creative group process designed to solve complex problems,” says Vickie Miene, interim director of the IIPHRP. “The process generates the opportunity for new organizational networks to form. This approach expands the scope, scale, and impact of public health research.”

The projects, which were selected through a competitive application process, provide an opportunity to gather collaborators from different backgrounds and disciplines around a topic to develop an innovative research proposal. A successful collaboratory stimulates an aspirational research proposal such as a large research service or center grant that bolsters and builds upon areas of research closely linked to the college’s three collective areas of excellence: rural health, comparative effectiveness research, and community engagement. The collaboratory leverages existing strengths within the college, while fostering new collaborations within and outside the University of Iowa.

Human Exposure and Health Risks from Neonicotinoid Insecticides

A portrait of William Field of the Department of Occupational and Environmental Health at the University of Iowa College of Public Health.
Bill Field

Bill Field, professor of occupational and environmental health, is the leader of the Collaboratory to Identify Human Exposure and Health Risks from Neonicotinoid Insecticides. Neonicotinoids are a relatively new class of insecticide, but have become the most widely used class of agricultural insecticides in the world.

Historically, neonicotinoid insecticides have been viewed as ideal replacements for more toxic compounds, such as organophosphates, due in part to their perceived limited potential to impact the environment and human health. Within the agricultural sector, they are preferred over other pesticides for several reasons, including their ability to be applied using a variety of methods; lower toxicity in birds, fish, and mammals; and high selectivity and potency for insects.

Few studies have been conducted to characterize human exposure to neonicotinoids or the insecticides’ potential health risks. The collaborative team will develop the infrastructure and preliminary data required to investigate the emerging potential risks of neonicotinoid exposure.

To the researchers’ knowledge, the collaborative is the first group in the U.S. to directly evaluate the potential human exposure of neonicotinoid insecticides. The study is also the first to assess neonicotinoid insecticide contamination in private wells used for drinking water, and the first to validate biomarkers necessary for future neonicotinoid-human health investigations.

Members of the team include: Wei Bao, MD, PhD; Susie Dai, PhD; Manuel Gadogbe, PhD; Michelle Hladik, PhD; Christopher Jones, PhD; Dana Kolpin, MS; Hans-Joachim Lehmler, PhD; Bob Libra, MS; Charles Lynch, MD, PhD; Keith Schilling, PhD; Darrin Thompson, MPH; John Vargo, PhD; and Peter Weyer, PhD.

The collaborative has also received letters of support from the Center for Health Effects of Environmental Contamination, Heartland Center for Occupational Health and Safety, Agricultural Health Study, Environmental Health Sciences Research Center, the Iowa Registry for Congenital and Inherited Disorders, Iowa Center for Agricultural Safety and Health, Iowa Department of Natural Resources, State Hygienic Laboratory at the University of Iowa, and U.S. Geological Survey.

Iowa Perinatal Health Research Collaborative

Portrait of Kelli Ryckman, professor in the Department of Epidemiology at the University of Iowa College of Public Health.
Kelli Ryckman

Kelli Ryckman, associate professor of epidemiology, is the leader of the Iowa Perinatal Health Research Collaborative (IPHRC). The central mission of the IPHRC is to develop a network of perinatal care providers and public health professionals working to improve the health outcomes of children born low birth weight (LBW) and/or preterm through innovative and multidisciplinary research initiatives.

Advances in neonatal intensive care have drastically reduced perinatal mortality related to LBW and/or preterm births. In infants born before 27 completed weeks of gestation, there is a 65% chance of survival and a 56% chance of survival without severe impairment, nationally. In Iowa, survival without severe impairment is even higher.

Follow-up of “high risk” infants is recommended by the American Academy of Pediatrics; however, standard guidelines are lacking on how long follow-up should occur and which infants qualify as “high risk.” Individuals identified for further follow-up widely varies based on the resource availability, and children who may benefit from resources or specialized programs are undoubtedly missed or excluded. This underscores the need for perinatal research collaboratives that bring together providers, public health care professionals, and families to identify outcomes and health care utilization gaps for children born LBW and/or preterm.

The project will focus on three intersecting thematic areas:

  1. The Database Development thematic area will establish a statewide database of children born LBW and/or preterm that provides a platform for outcomes research, quality improvement initiatives, and interventions.
  2. The Health Services and Outcomes thematic area will develop a hospital services and outcomes data source to better understand the health care needs and outcomes in this population of Iowa children.
  3. The Family and Community Engagement thematic area will engage families in research initiatives and provide and promote existing resources for families.

Team members include Mary Charlton, assistant professor of epidemiology; John Dagle, professor of pediatrics; and Lane Strathearn, professor of pediatrics and co-director of the University of Iowa Center for Excellence in Developmental Disabilities. In addition, graduate students Allison Momany and Nichole Nidey will contribute to this work.

Study compares effectiveness of preventive medicines for pediatric migraines

Prescribed medications are no more effective than a sugar pill when used to prevent migraines in children and teens.

A study  published Oct. 27 in The New England Journal of Medicine shows no significant differences among amitriptyline, topiramate, and placebo in reducing headache days or related disability.

“The study was intended to demonstrate which of the commonly used preventive medications in migraine was the most effective. What we found is that we could prevent these headaches with either a medication or a placebo,” says Andrew Hershey, MD, PhD, co-director of the Cincinnati Children’s Headache Center and senior author of the study.  “This study suggests that a multi-disciplinary approach and the expectation of response is the most important, not necessarily the prescription provided.”

Researchers conducted the Childhood and Adolescent Migraine Prevention (CHAMP) study at 31 sites in the United States.

Cincinnati Children’s served as the Clinical Coordinating Center (CCC) for the study, and was responsible for all clinical oversight activities.  The Clinical Trials Statistical and Data Management Center (CTSDMC) at the University of Iowa served as the Data Coordinating Center for the study. It had primary responsibility for data management, implementing the electronic data capture system, and all statistical aspects of the study.

Interpreting the Results

A portrait of Chris Coffey of the University of Iowa College of Public Health
Chris Coffey

“The interpretation of these results is very challenging. In most situations, trials that fail to show benefit of an intervention do so because study participants do not improve. That was not the situation here. A majority of all study participants improved, regardless of their assigned treatment group,” says Chris Coffey, PhD, director of the CTSDMC and professor of biostatistics in the University of Iowa’s College of Public Health, and lead statistician for the study. “Further research is needed to better understand the results and to determine what future strategies might optimize the treatment of headaches in these childhood and adolescent populations.”

The 24-week clinical trial included 328 eligible patients. The trial used a clinically meaningful endpoint of a 50 percent or greater reduction in headache days from the 28 days prior to randomization to the final four weeks of the 24-week study.  Sixty-one percent of those on a placebo saw the days they had a headache reduced by 50 percent or more.

For the two medication groups, 52 percent of those taking amitriptyline and 55 percent of those taking topiramate had this level of reduced headache days. The responder rates were not statistically different between the three groups.

Compared to placebo, those on the two active drugs had a significantly higher rate of side effects, including fatigue, dry mouth and, in three cases, mood alteration.  Thirty-one percent of those on topiramate had paresthesia – a “pins and needles” tingling in the hands, arms, legs or feet.

Preventing Migraines

The results raise questions about the best way to prevent migraines, particularly given that it’s unethical to prescribe a placebo without the patient’s knowledge, according to the authors. They add it’s likely the expectation of responding to a medication may override the actual biochemical and pharmacological changes that are thought to occur with pharmacotherapy.

Major pediatric headache centers, such as Cincinnati Children’s, incorporate a multi-disciplinary approach that includes acute therapy, preventive therapy and behavioral treatment in a systematic approach, says Hershey. The CHAMP study incorporated this approach across all 31 study sites to ensure uniformity.

“Our national team was hoping to develop evidence to drive the choice by medical providers of the first line prevention medication for helping youth with migraine, but the data showed otherwise, says Scott Powers, PhD, pediatric psychologist, co-director of the headache center at Cincinnati Children’s, and first author of the paper. “We see this as an important opportunity for health care providers, scientists, children, and families because our findings suggest a paradigm shift. First line prevention treatment will involve a multidisciplinary team approach and focus on non-pharmacological aspects of care. The good news is we can help children with migraines get better.”

Powers says the study also underscores the importance of conducting more research with a developmental focus on children and young adults. This will allow innovations that can be applied directly to a chronic illness of childhood.

The study was supported by the National Institute of Neurological Disorders and Stroke and the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health through grants U01NS076788 and U01NS077108.

Author Roger Thurow to speak on ending childhood malnutrition

photo of Roger ThurowAuthor and journalist Roger Thurow will be a guest of the Office of the Provost and College of Public Health on Tuesday, October 11.  His visit is by special arrangement with the World Food Prize Organization in Des Moines.

There will be a public lecture at 5:00 pm in the Callahan Auditorium of the College of Public Health Building (CPHB), followed by a reception.  The title of his lecture will be 1,000 Days to Change the World: Stories from the Fight to End Early Childhood Malnutrition.”

Thurow, an alumnus of the University of Iowa, joined The Chicago Council on Global Affairs as senior fellow for global food and agricultural in January 2010 after three decades at The Wall Street Journal.  For 20 years, he served as a Journal foreign correspondent, based in Europe and Africa. His coverage of global affairs spanned the Cold War, the reunification of Germany, the release of Nelson Mandela, the end of apartheid, the wars in the former Yugoslavia and the humanitarian crises of the first decade of this century – along with 10 Olympic Games.

In 2003, Thurow and Journal colleague Scott Kilman wrote a series of stories on famine in Africa that was a finalist for the Pulitzer Prize in International Reporting. Thurow and Kilman are authors of the book, ENOUGH: Why the World’s Poorest Starve in an Age of Plenty. In 2009, they were awarded Action Against Hunger’s Humanitarian Award.

In May 2012, Thurow published his second book, The Last Hunger Season: A Year in an African Farm Community on the Brink of Change. His new book, The First 1,000 Days: A Crucial Time for Mothers and Children—And the World, was published in May this year.

He will also speak that evening at 7:00 pm at the Prairie Lights bookstore.

For further information or requests for special accommodation, please contact Dan McMillan, Strategic Communications Director, College of Public Health, (319) 335-6835, daniel-mcmillan@uiowa.edu.

 

Askelson takes part in Communicating Ideas workshop

Natoshia Askelson, assistant professor of community and behavioral health, recently took part in the UI’s Communicating Ideas workshop. Participants gain practical tips for crafting and honing their messages and have an opportunity to record a brief video clip about their research. Askelson discussed how to support children in making fast, easy, and healthy food choices, especially in the lunch room.