A creative partnership model brings teams of experts together to solve complex public health problems.
“We have to abandon the conceit that isolated personal actions are going to solve this crisis,” former Vice President Al Gore has said of climate change. Whether a problem is as monumental as global warming, or more emerging, such as the relatively sudden worldwide use of an insecticide whose effects are not fully understood, solutions will rarely arise from a single person or even a single laboratory. Rather, such difficult problems necessitate collaborations that span disciplines and organizations, challenge accepted methods, and even push established lexicons to shift.
This is the founding principle behind the Iowa Institute of Public Health Research and Policy’s collaboratory initiative. Two inaugural collaboratory teams just completed their first year of work via this new funding source available to teams anchored in the College of Public Health but extending beyond it. One team is focused on better understanding neonicotinoids, a relatively new class of insecticides. The other team is invested in creating data that can be leveraged by providers and public health professionals to improve the health outcomes of children born in Iowa.
THE TEAMS INCLUDE research scientists, physicians, public policy experts, epidemiologists, engineers, geologists, chemists, and others. This rich array of expertise and the fertile network of knowledge and contacts that members bring with them is what makes this model so ripe with possibility.
Vickie Miene, interim director of the Iowa Institute of Public Health Research and Policy (IIPHRP), says that in addition to spanning a spectrum of disciplines, the new program is intended to encourage team-building strategies. It is one part of the burgeoning institute’s work, which is focused on fostering new relationships within and outside of the University of Iowa.
Funded by a gift from Dale and Linda Baker and supplemented by the Roy J. Carver Charitable Trust, the collaboratory program is intended to create teams that are ready to respond rapidly to opportunities.
“In today’s funding world, you get maybe 60 days to respond to a call for a new grant or contract, and most of the time they’re looking for existing partnerships that are multidisciplinary,” says Miene.
Ideally, a successful collaboratory will lead to a sustainable research initiative that bolsters and builds upon the college’s three areas of excellence: rural health, comparative effectiveness research, and community engagement. Finding the kinds of complex topics that call for this approach isn’t difficult, but locating faculty leaders who appreciate the necessity and utility in an approach that can take many people out of their comfort zones is another matter. Miene is impressed by the success of the initial two collaboratories, both in the depth of their work and in their willingness to embrace the team-building aspects of the process.
“People have to be willing to get their hands dirty in learning collaboration,” says Miene. “They are the content experts, and our role at IIPHRP is to support them in their efforts.” To do so, the institute helps the teams to develop memorandums of understanding, create a team process, and make a plan for disseminating their work.
According to Miene, the institute could not have chosen better directors for the inaugural collaboratories. CPH Professors Kelli Ryckman and R. William Field, she says, “have been all in and completely willing to learn.”
FIELD LEADS THE TEAM “Human Exposure and Heath Risks from Neonicotinoid Insecticides,” which grew out of his graduate student Darrin Thompson’s strong interest in the occurrence and potential health effects of these emerging chemicals as a dissertation topic.
“Neonicotinoids have only been around for about 20 years,” explains Thompson, “but they are already the most widely used class of insecticides in the world.”
Although they were developed as a safer alternative to other insecticides, there is already substantive evidence that neonicotinoids are playing a role in the decline of honey bee populations. Beyond initial laboratory tests done by the manufacturers, there has been little research on human health effects of this insecticide, which is used by farmers, gardeners, and the timber industry, among others. According to Thompson, laboratory tests simply cannot take into account the myriad of variables that exist when these chemicals interact with environmental factors and other chemicals.
Field says the topic is especially pertinent to the state “since neonicotinoids are used as a seed coating for the majority of corn and soybean seeds in Iowa.” In the long-term, the collaboratory intends to study the potential health risk, if any, posed by chronic exposure to low concentrations. In the shorter term, the central research is that of Thompson’s dissertation, which includes measuring the levels in groundwater and in the urine of people who apply the pesticide. The team now comprises more than 15 active members and includes researchers from the UI College of Engineering, the Iowa Geological and Water Survey, the State Hygienic Laboratory, the U.S. Geological Survey, the Center for Health Effects of Environmental Contamination, and the National Cancer Institute. The collaboratory is ready to publish a paper that will open a whole new portfolio of research, Miene says.
Describing one of their meetings, Miene adds, “I was in awe of the expertise around the table. There were geologists, engineers, epidemiologists, and a major scientist calling in from California. It’s really impressive how they are thinking about sustainability and the intricacies of the conversation.”
Field agrees. “It sort of reminds me—in a real sense rather than an imaginary one—of The Field of Dreams: If you start the collaborative, researchers with a shared interest and vision will come, and with each addition, the collaborative expertise expands.”
RYCKMAN HAS HAD A similar experience as her team, the Iowa Perinatal Health Research Collaborative, has grown since its inception. Ryckman’s biggest challenge wasn’t finding researchers, but rather creating a team committed to sharing research. “There has had to be some breaking down of barriers of what is mine and what is ours,” says Ryckman, a genetic epidemiologist.
“This first year has really been about creating shared resources and a similar language,” she observes. “There were already many projects out there related to this topic, but instead of us each doing our own siloed thing, we were challenged to consider if we could create some synergy to share and collect data. Is there a way to connect initiatives so that we can all benefit?”
The perinatal collaboratory has 12 regular members, including UI researchers from obstetrics and gynecology, neonatology, and pediatric neurodevelopment; as well as partners from the Iowa March of Dimes, the Iowa Department of Public Health, and the State Hygienic Laboratory.
Miene says that how to do research better is a key part of Ryckman’s project: “They are building and testing a database that will allow them to answer a lot of questions about outcomes of children born in Iowa, particularly those born preterm or low birth weight. They are gaining crucial understanding of how kids born under these circumstances are doing in multiple ways.”
It’s such an important issue, Miene adds, that the team has already received generous gifts from donors Dale and Linda Baker and Dr. Roger Williamson to help continue its work.
Traditionally, research comes with a strong sense of turf since success leads to future funding. There is understandable concern for who gets credit and what department or unit “owns” the grant funding around a project. As she’s created and nurtured her team, Ryckman simply wasn’t accepting that model.
As though summing up the modus operandi of the collaboratory and why the College of Public Health initiated it, Ryckman says, “Everything I have is ours—that’s my stance, and you have to give me the same buy-in. That’s the difference between simply collaborating versus really creating something beneficial to the broader research community and to the public.”
This story originally appeared in the spring 2018 issue of Insight magazine.
CPH Professor Bill Field was honored March 6, 2018, with the Iowa Radon Hero Award from the Iowa Department of Public Health for his work as a researcher, educator, and advocate.
He was presented with the award at the EPA Region 7 Radon Stakeholders Meeting in Des Moines. The meeting was attended by more than 200 stakeholders, including radon testers, radon mitigation specialists, members of the American Association of Radon Scientists and Technologists, representatives from the various state cancer coalitions, and representatives from state and local health departments. In addition, EPA representatives from Region 7 and Washington were also in attendance.
The award reads: “We recognize Dr. Field as one of the foremost authorities on radon, not only for his research into the radioactive gas but because of his advocacy and outreach efforts to promote the testing and mitigation of homes and schools for radon, not just here in Iowa, but nationally and internationally.”
A new guide for health care providers is designed to help them reduce their patients’ exposure to radioactive radon gas, the leading environmental cause of cancer mortality in the United States, which is estimated to cause about 21,100 lung cancer deaths per year.
The guide, Reducing the Risk From Radon: Information and Interventions, was developed and drafted by UI Professor of Occupational and Environmental Health and Epidemiology William Field in collaboration with the Conference of Radiation Control Program Directors and the U.S. Environmental Protection Agency.
“Health care providers play a key role in reducing their patients’ exposure to unnecessary radiation,” the report states. “With the rate of medical imaging and related radiation exposure increasing, it is even more crucial to reduce radiation exposure from other sources, including radon.”
The guide has updated information on:
- Radon statistics and public health impact.
- The science behind risk estimates.
- Radon testing and reduction.
- Sample guidance for use in health care settings.
- The role of health care providers in reducing the burden of radon-induced lung cancer.
The full guide is available at http://www.radonleaders.org/resources/reducingtheriskfromradon.
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.
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.