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.
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
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
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:
- 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.
- 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.
- 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.
It’s not every day that students get to interact with leaders from private industry, but a new Executive-in-Residence program at the College of Public Health has made that opportunity a reality.
A number of leaders from a variety of industries, including Deere & Company, a pharmaceutical company, a health coaching enterprise, and a retinal imaging company, are taking part in the program created by the Iowa Institute of Public Health Research and Policy (IIPHRP) based in the college.
Going beyond a visiting guest lecture, “the Executive-in-Residence program integrates senior business leaders into the life of the college,” says CPH Dean Sue Curry.
The institute works with the executives to create an individualized program that could include delivering college-wide seminars and classroom lectures, teaching a workshop using real-life case studies, meeting with students and faculty one-on-one or in small groups, and collaborating on student research projects.
“Students have the opportunity to ask questions and establish a connection with the executives and their companies,” says IIPHRP Deputy Director Vickie Miene. “The executives get to know our students and faculty, better understand the learning environment at the college, and explore opportunities for partnerships—it’s a win-win for everyone.”
“This was an opportunity for me to give back, to share what I have learned over the years in my industry, and to provide encouragement to the new workforce,” adds Executive-in-Residence participant Scott Fowler, manager of Global Occupational Safety at Deere & Company. “I think it provides very meaningful interactions—it’s exciting to hear students’ questions and to think about additional collaborations with the college.”
“I love that the executives bring real-world perspective on public health issues related to their company,” one CPH student responded in a written survey.
The IIPHRP was launched within the College of Public Health in early 2016. The Executive-in-Residence program is just one facet of the institute’s portfolio.
“The institute is a convener,” says Miene. “It’s dedicated to developing and fostering collaborations—including public-private partnerships—that expand the scope and impact of public health research across the state, nationally, and internationally.”
By building partnerships among researchers, public health practitioners, community leaders, private partners, and policy makers, the IIPHRP contributes to the education and research goals of the college in new and innovative ways, such as helping local communities take part in meaningful research, collaborating on a variety of public health initiatives, and engaging large and small businesses. The institute has also inaugurated a community grant project through the college’s Business Leadership Network.
“In addition to making the University of Iowa a more effective research enterprise, this institute enhances scholarly collaborations for faculty and provides exciting new educational opportunities for students,” says UI Provost and Executive Vice President P. Barry Butler.
This story originally appeared in the Fall 2016 issue of InSight.
The Iowa Institute of Public Health Research and Policy (IIPHRP) is pleased to announce the participants selected for its inaugural Policy Fellow Program. The 2016-2017 Policy Fellows are Mary Charlton, assistant professor of epidemiology; Cara Hamann, associate in epidemiology; and Kelli Ryckman, associate professor of epidemiology.
The year-long Policy Fellow Program creates opportunities for primary faculty to enhance their skills for translating public health research into practice and policy. Policy Fellows will attend training workshops, be linked with experts, interact with policymakers and stakeholders, and work as a team to accomplish individualized goals.
Each Policy Fellow proposed an Action Learning Project (ALP) as part of the application process. The ALP is an opportunity for each Fellow to incorporate policy impact into their research portfolio while developing new skills as they are supported by the IIPHRP.
Charlton’s project involves engaging stakeholders to make policy changes and revisions to the Iowa administrative code that will strengthen cancer reporting requirements in the state.
“I know it won’t be a quick and easy road, but with connections to the right people and the support of the program, I look forward to working with experts who can help me navigate around barriers and reach consensus that will bring about positive change,” Charlton says.
“My passion is finding ways to improve the care of preterm, low-birth-weight, and sick newborns in the Neonatal Intensive Care Unit,” says Ryckman about her motivation to apply to the 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 Neonatal Intensive Care Unit that allows for better utilization of resources across the state of Iowa and beyond.”
The ALP approach requires including at least one stakeholder meeting and a product, such as a policy brief, proposed legislative language, or a “how-to-guide” to disseminate at the end of the Fellowship. Hamann intends to develop an issue brief to highlight bicycling safety research, a topic that has received more attention recently due to an increasing number of automobile and bicycle crashes in Iowa.
“I was motivated to apply to this program to develop skills that can take my research and translate it into tangible products to be used for policy change that can have a real impact 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.”
“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,” adds CPH Dean Sue Curry. “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.”
Policy Fellows will participate in learning activities, generate policy documents, and participate in efforts to better educate community members and governmental leaders on the importance of research. In addition, each Policy Fellow may access funds to enhance their learning. The program will invite a variety of experts to share knowledge on important topics, such as how the legislative process works and how to interact with the media to best communicate research findings.