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.

Higher pay, healthier babies

smiling babyTo raise or not to raise the minimum wage? It’s a hotly debated question among policymakers and economists these days, because the overall economic impact of raising minimum wages isn’t yet well understood. But a new University of Iowa study suggests that decision-makers should be looking at broader impacts, for it finds evidence that increases in the minimum wage lead to improvements in infant health.

“Effects of the minimum wage on secondary outcomes such as health often go unconsidered in the debate, which is an oversight,” says George Wehby, CPH associate professor of health management and policy and lead author of the study.

A baby’s health depends critically on the mother’s health during pregnancy, and economists know that a higher income can improve maternal health in various ways, for example by enabling better diet, improving access to prenatal care, and/or reducing stress.

To investigate this issue in the context of minimum wage raises, Wehby and colleagues Dhaval Dave of Bentley University and Robert Kaestner of the University of Illinois at Chicago examined data on U.S. births during 1989-2012 to the millions of mothers aged 18-39 who had no college degree and were therefore most likely to be affected by minimum wage raises.

As the investigators reported in a National Bureau of Economic Research working paper in June 2016, state minimum wage raises during this period were followed by improvement in the birth weight and gestational age—basic measures of infant health— of babies born to these mothers in the affected states. Birth weight increased by about 11 grams on average for every $1 per hour increase in the minimum wage.

“That’s a meaningful and plausible effect,” says Wehby, “and it would translate into an increase of about 85 grams [3 ounces] for a raise in the current federal minimum wage from $7.25 to $15 per hour, as some have proposed.”

The researchers were able to account for differences in time trends between states, as well as changes in state welfare policies during the period, to minimize the effects of confounding factors and thereby isolate the effect of minimum wage raises on infant health. Highlighting two possible routes through which this effect could work, they linked minimum wage increases to greater use of prenatal care and less smoking by the pregnant mothers in their sample.

Wehby and colleagues are following up with studies of broader impacts of minimum wage increases on children’s well-being.

“It’s an active research area for us—we’re now looking at behavioral and learning outcomes throughout childhood,” Wehby says.

The full paper is available at http://www.nber.org/papers/w22373.

This story originally appeared in the Fall 2016 issue of InSight.

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.

 

Bao receives FOE Diabetes Research Center grant

A portrait of Assistant Professor Wei Bao of the Department of Epidemiology in the University of Iowa College of Public Health.
Wei Bao

The Fraternal Order of Eagles (FOE) Diabetes Research Center is pleased to announce the results of its sixth round of pilot and feasibility research grants.  Three 2016-17 recipients were selected to receive $50,000 to support their research proposal, with the possibility of $100,000 over a two-year period.

The committee unanimously selected an additional proposal by Wei Bao, MD, PhD, CPH assistant professor of epidemiology, to receive $20,000 to support his research proposal, “Nontraditional glycemic markers in early pregnancy as predictors of gestational diabetes,” for one year.

Project Summary
Gestational diabetes mellitus (GDM) is a common pregnancy complication that affects ~9% of all pregnancies in the United States. GDM is usually diagnosed at 24-28 weeks of gestation by measuring fasting and post-load glucose in an oral glucose tolerance test (OGTT). Since GDM is associated with adverse health outcomes in the fetus and children, early prediction of GDM is imperative. However, the utility of glucose in early pregnancy for GDM prediction is limited because fasting glucose and OGTT are usually not available at that time. Using non-fasting blood glucose for GDM prediction is problematic due to the substantial glucose variability influenced by food intake. Nontraditional glycemic markers, including fructosamine, glycated albumin, and 1,5-anhydroglucitol (1,5-AG), do not require fasting; therefore they are perfect fit to the current clinical practice and can be measured in the same blood samples collected in early pregnancy for other routine lab tests.

We propose to conduct a nested case-control study in a prospective cohort of pregnant women. In this pilot study, we will measure nontraditional glycemic markers in first-trimester maternal plasma samples of pregnant women, and associate these markers with the risk of incident GDM. Moreover, we will assess the utility of these markers in the discrimination and prediction of GDM, as indicated by improved C-statistic and reclassification measures. Previous studies on the use of these markers for GDM prediction mainly used blood samples collected at the time of GDM diagnosis and the results have been conflicting. The proposed study is innovative because it represents a departure from the status quo by examining nontraditional glycemic markers in early pregnancy as early predictors for GDM. If successful, the proposed study may change the clinical paradigm in the screening and prediction of GDM. Findings from this study will be important to develop Specific Aims for subsequent NIH R01 projects that integrate multiple biochemical and genetic markers for improved GDM prediction in the era of “Precision Medicine.”

Researchers look at effects of higher minimum wage on infant birthweight

A portrait of George Wehby of the Department of Health Management and Policy at the University of Iowa College of Public Health.
George Wehby

A new study suggests that increasing the minimum wage would lead to an increase in birthweight among babies born to women with low education.

The research team included George Wehby, associate professor of health management and policy at the University of Iowa; Dhaval Dave, professor of economics at Bentley University; and Robert Kaestner, professor of economics at the University of Illinois at Chicago.

Their study, published this month by The National Bureau of Economic Research in the working paper series, used U.S. birth certificate data to compare changes in birth weight in states that increased the minimum wage to birth weight changes in states that did not. The researchers analyzed data on virtually every U.S. birth between 1989 and 2012.

Results showed that increasing the minimum wage by $1 led to a birth weight increase of 11 grams among babies born to women with low education. The increase corresponded to a reduction of 2 percent in low birth weight. Their estimates suggest that raising the federal minimum wage to $15 would increase birth weight by 85 grams.  These estimates indicate meaningful changes in average birth weight. They also find evidence of increase in prenatal care use and decline in prenatal smoking as some potential channels.

The full paper is available here: Effects of the Minimum Wage on Infant Health

Read a Washington Post article about the study here: A simple but controversial law that can make babies healthier

UI researcher finalist in challenge to improve maternal, newborn health

Atifa Begum with her new born baby at LAMB hospital.
Atifa Begum with her newborn baby at LAMB Hospital. Photo: GMB Akash

This July, creative thinkers from around the world will gather in Washington, D.C., to pitch their ideas for a chance to secure funding that will take their innovations to the next level. While it may sound like an episode of Shark Tank, the event, called the DevelopmentXChange, is dedicated to finding innovative ideas that address a pressing global health challenge: maternal and newborn mortality.

Will Story, assistant professor of community and behavioral health at the University of Iowa College of Public Health, is among the participants invited to the DevelopmentXChange July 26-28. The event – an inspired mashup of tradeshow, networking opportunities, and mentoring workshops – brings together 50 finalists selected from nearly 650 applications submitted to Saving Lives at Birth: A Grand Challenge for Development.

Story, along with co-principal investigator Dr. Louise Day, a clinician-researcher practicing in Bangladesh, will be presenting their innovation, an illustration-based decision-making tool that helps pregnant, semi-literate women and their families in rural Bangladesh know how and when to seek skilled care for the safe delivery of their baby.

A Vulnerable Time

Every two minutes, a woman dies in childbirth worldwide, according to the Saving Lives at Birth website. The onset of labor marks the start of the highest-risk period for both mother and baby, which continues until at least 48 hours after birth. During this short period of time, 145,000 maternal deaths, 1.45 million neonatal deaths, and 1.2 million stillbirths occur each year, Saving Lives at Birth reports. The vast majority of these deaths occur in low- and middle-income countries.

Women with their infants sitting outside in Bangladesh
Women with their newborns. Photo: LAMB Hospital

The Saving Lives at Birth partnership, launched in 2011, includes the U.S. Agency for International Development, the Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada (funded by the Government of Canada), the U.K’s Department for International Development, and the Korea International Cooperation Agency.

The partnership issues an annual global call for groundbreaking, scalable prevention and treatment approaches for pregnant women and newborns in poor, hard-to-reach communities around the time of delivery. From the hundreds of applications, the most promising ideas are selected to present as finalists at the DevelopmentXChange for a chance to receive additional funding.

Obstetric Care in Rural Bangladesh

In rural Bangladesh, where Story and Day’s research is taking place, only a third of women deliver their babies in a health facility where they have better access to life-saving interventions. One of the primary barriers to obtaining skilled obstetric care is a delay in care-seeking, which is caused by a lack of recognition of the risk during labor by the family and caregivers. Another factor is a lack of support for the mother from the decision makers, including the male family members.

The goal of the team’s project is to expedite obstetric care-seeking among semi-literate women and their families in rural Bangladesh by combining a new home-based, pictographic decision-making tool – also known as a “pictorial partograph” – with a novel approach to involving men during labor and delivery.

The team has already pre-tested a working draft of the pictorial partograph with a group of semi -literate family caregivers and community health workers, who gave it very positive feedback. The pictorial partograph is a two-page, color-printed decision tool with simple illustrations that depict mothers in low-risk, at-risk, and high-risk scenarios with guidance on caregiving, when to seek advanced care, and possible outcomes for mothers and babies.

“Right now, there’s no male-specific component to the tool,” explains Story. “We want to talk to men and women in rural Bangladesh to find out what is most helpful for men to do during labor and delivery, then integrate it into the pictorial partograph.”

Some possible tasks for the men are logistical, Story says, such as arranging for transportation to a qualified health care provider, negotiating any needed financial support, finding appropriate blood donors (since clinics in limited-resource settings typically don’t have blood banks), and offering social support during labor and delivery.

Next Steps

Outside of LAMB hospital in northwest Bangladesh
LAMB Hospital. Photo: GMB Akash

The researchers are seeking $250,000 in seed funding at the DevelopmentXChange event to further test, refine, and evaluate the pictorial partograph in a clinical setting before finalizing it for use at home by rural families and caregivers. The study would be conducted in LAMB Hospital located in Dinajpur, a rural district in northwest Bangladesh.

Currently, Story and Day are honing their elevator speeches about the pictorial partograph in preparation for the DevelopmentXChange event.

“It’s exciting, because our tool is low cost, low tech, and focused on behavior change,” says Story. “We’re different, because a lot of the finalists are more technology-driven.”

In addition to Story and Day, the research team includes co-investigators Shirajum Munira, a Bangladeshi researcher; Stacy Saha, director of the LAMB Management Information Systems- Research Department; and Kavita Singh, a research associate professor in the Department of Maternal and Child Health at the University of North Carolina.

Read more about the DevelopmentXChange finalists.