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					2005   public health research at the university of iowa




                                    An Overshadowing
                                        THREAT
welcome     in recent years, the national institutes of health has laid out a so-called “Roadmap,” which
serves as a broad framework of priorities intended to guide biomedical and behavioral research in the 21st
century. The roadmap includes several evolving public health challenges facing the nation and the world,
including acute and chronic conditions, aging populations, health disparities, emerging diseases, and biodefense.

Research activities in the College of Public Health align with these priorities and with the multidisciplinary
team approach that is required to conduct increasingly complex scientific investigations. Investigators such
as Gregory Gray, M.D., M.P.H., and his colleagues in the Center for Emerging Infectious Diseases, profiled
in the cover story about avian influenza, are conducting groundbreaking studies of animal pathogens that may
infect humans. Faculty members in the Department of Biostatistics are at the center of pioneering clinical trials
research, including a large international study investigating new therapies for diabetes.

An important aspect of the NIH roadmap is the translation of scientific knowledge into effective prevention
strategies. Public health faculty have been leaders in this area as well, as illustrated by the work of Anne Helene
Skinstad, Ph.D., and colleagues in the Prairielands Addiction Technology Transfer Center; R. William Field, Ph.D.,
in the area of radon research; and Neal Kohatsu, M.D., M.P.H., in his work to translate nutrition and physical
activity research into practice.

As a result of these and many other innovative projects, some of which are further profiled in the pages
of this publication, faculty in the College of Public Health are recognized as leaders in research not only at
The University of Iowa, but nationally and internationally as well. As biomedical and public health research
continues to evolve, we will seek answers, working in partnership with colleagues across many disciplines
to chart a path toward healthier communities.


Leon F. Burmeister, Ph.D.
Associate Dean for Research and Academic Affairs
The University of Iowa College of Public Health
the university of iowa college of public health




                         2005 contents
                         COVER
                     2   PREPARING FOR THE NEXT PANDEMIC
                         Iowa’s unique mix of birds, pigs, and people creates a rich breeding ground for new, possibly
                         lethal, avian influenza viruses.


                         FEATURES
                     8   TROUBLE IN THE HEARTLAND
                         Relatively easy to manufacture and highly addictive, methamphetamine has invaded homes
                         and public spaces across Iowa, endangering families, communities, and the environment.

                   12    FROM DATA TO DISCOVERY
                         Biostatisticians are at the center of clinical trials research, making sure new medical therapies
                         are safe and effective.

                   16    RETHINKING LONG-TERM CARE AND END-OF-LIFE CARE
                         Researchers are exploring alternatives to provide more care options for older adults.

                   18    HOME SWEET (CANCER-CAUSING) HOME?
                         A recent study reveals a clear link between prolonged residential radon exposure and increased
                         lung cancer risk.


                         Q&A
                   20    A CONVERSATION WITH NEAL KOHATSU
                         With a medical background in orthopedics and professional positions in a state health
                         department and academia, this CPH faculty member has covered a great deal of territory on
                         the public health landscape.


                         CENTER PROFILE
                   23    IOWA REGISTRY FOR CONGENITAL AND INHERITED DISORDERS
                         This long-standing registry tracks selected congenital and inherited disorders in Iowa.


                   24    IN BRIEF
                         News about CPH research.


                   28    RESEARCH ACTIVITY FY05
                         Grant activity report and research highlights.


                   32    FACULTY ESSAY
                         REVIVING THE LOST ART OF THE FAMILY TABLE
                         With childhood obesity on the rise, CPH professor and nutritionist Linda Snetselaar examines
                         why traditional weight loss measures often fail children and suggests alternatives.



                         COVER ILLUSTRATION: DERICK LAVINE


                                                                                                                             1
                        Iowa’s unique mix of birds, pigs, and people creates
                        a rich breeding ground for new, possibly lethal, avian
                        influenza viruses.
in the field 2005




                    2
               Preparing
    for the Next Pandemic
Not since Alfred Hitchcock’s film The Birds has the avian species
ruffled so many feathers. But scientists today aren’t worried about
massive flocks of crows and seagulls attacking people. It’s what the
birds harbor that scares them—viruses that have the potential to
ignite the next influenza pandemic.

                since 1997, scientists have been tracking an avian
                influenza virus called H5N1 as it has decimated poultry
                populations throughout Asia and directly infected 143
                people by the end of 2005, killing 76 of them. Although the
                cases are few in number, the high death rate worries scien-
                tists—if the virus should acquire the ability to spread easily
                from human to human, becoming as contagious as the
                common cold or winter flu, it could spark the next pandemic.
                    How avian influenza viruses transform from being
                harmless in wild waterfowl to becoming highly lethal to both
                animals and humans involves a complex mixing of birds,
                poultry, pigs, and people—a combination found throughout
                much of Iowa. Concerned about Iowa’s residents, as well
                as its large number of agricultural workers and industries,
                Gregory Gray, M.D., M.P.H., and his colleagues are
                conducting several studies on avian influenza viruses in
                the state. Gray is professor of epidemiology and director
                of the University of Iowa Center for Emerging Infectious
                Diseases (CEID). “Iowans have numerous opportunities
                to be exposed to avian influenza viruses. We want to know
                what viruses are out there and how easily they are picked
                up by humans and animals alike,” he said.




                                                                                 3
                                                                                                                                        A Century of Pandemics

                                                                                                                                        According to the World Health Organization, influenza
                                                                                                                                        pandemics occur regularly, about three per century, at
                                                                                                                                        intervals ranging from 10 to 50 years. The 20th century
                                                                                                                                        witnessed three flu pandemics:

                                                                                                                                        • the 1918-1919 pandemic, known to be the most
                                                                                                                                          deadly disease event in human history, killed more
                                                                                                                                          than 40 million people worldwide in less than a year;

                                                                                                                                        • the 1957-1958 pandemic killed around two million
                                                                                                                                          people worldwide, most of whom had underlying
                                                                                                                                          disease and were not healthy;

                                                                                                                                        • the 1968-1969 pandemic was mild overall but struck
                                                                                                                                          the U.S. with vigor, causing 34,000 deaths, mostly        FLYING THE FRIENDLY SKIES
                                                                                                                                          in the elderly.                                           Wild waterfowl and shorebirds are the natural host reservoir
                                                                                                                                                                                                    of all avian influenza viruses. If these wild birds and their
                                                                                                                                        With 38 years having passed since the last pandemic,
                                                                                                                                                                                                    viruses stayed in one place, there wouldn’t be a problem.
                                                                                                                                        the odds of having another one soon are not in our favor.
                                                                                                                                                                                                    But wild waterfowl migrate on continental journeys twice
                                                                                                                                                                                                    each year. As they fly overhead, they shed the viruses in their
                                                                                                                                                                                                    feces, contaminating the land and water below.
                                                                                                                                                                                                       As part of the Mississippi Flyway, North America’s major
                    COURTESY OF THE NATIONAL MUSEUM OF HEALTH AND MEDICINE, ARMED FORCES INSTITUTE OF PATHOLOGY, WASHINGTON, D.C.




                                                                                                                                                                                                    route for migrating birds, Iowa is visited by an astonishing
                                                                                                                                                                                                    number of birds each year, making Iowans particularly
                                                                                                                                                                                                    vulnerable to exposure to avian influenza viruses. About
                                                                                                                                                                                                    40 percent of North America’s waterfowl migrate along
                                                                                                                                                                                                    the Mississippi River, including 11 million ducks and geese
                                                                                                                                                                                                    per year.
                                                                                                                                                                                                       Such heavy avian traffic has prompted Gray and James
                                                                                                                                                                                                    Gill, M.D., Ph.D., health laboratory scientist at the University
                                                                                                                                                                                                    of Iowa Hygienic Laboratory, to study two groups of Iowans
                                                                                                                                                                                                    at high risk of contracting these viruses—Department of
                                                                                                                                                                                                    Natural Resources (DNR) workers and duck and geese
                                                                                                                                                                                                    hunters. “Iowa is rich in opportunities for animal microbes
                                                                                                                                        EMERGENCY HOSPITAL DURING 1918 INFLUENZA EPIDEMIC           to cross species to man,” said Gill. “Wild waterfowl carry the
                                                                                                                                                                                                    viruses in their nasal secretions and fecal matter, so anyone
                                                                                                                                                                                                    who handles these birds can be heavily exposed.” Gill has
                                                                                                                                                                                                    found that 60 percent of mallards tested in Iowa show
                                                                                                                                                                                                    evidence of infection with influenza virus.
                                                                                                                                                                                                       In the study, Gill and Gray will take blood samples from
                                                                                                                                                                                                    Iowa DNR workers during the two banding seasons of wild
                                                                                                                                                                                                    waterfowl and again four to six weeks after exposure.
                                                                                                                                                                                                    They will also examine the birds to isolate viral cultures and
                                                                                                                                                                                                    assess the endemic viral strains among them. “Identifying
                                                                                                                                                                                                    high-risk individuals and their exposures is a first step toward
                                                                                                                                                                                                    developing public health interventions to protect against such
                                                                                                                                                                                                    future infections,” said Gill.




                                                                                                                                                                                                                                                          threat
in the field 2005




                                                                                                                                                                                                    “IN MY MIND THERE IS A TREMENDOUS PUBLIC HEALTH




                                                                                                                                    4
                                         greg outdoor photos




                                                                                          PHOTOS: COURTESY OF THE CEID




      BIRDS OF A DIFFERENT FEATHER                                         quences for a state like Iowa, which as the number one egg
      Influenza viruses are not lethal to the host species. If they were   producer in the country has approximately 30 million laying
      they would kill off their hosts and doom themselves. Rather,         hens that produce more than seven billion eggs per year.
      they become lethal when they mutate and move to another              The WHO reports that the 1983 outbreak in Pennsylvania,
      species that doesn’t have antibodies against the virus.              which took two years to control, resulted in the culling of the
      Although this is good news for wild waterfowl, it’s bad news         state’s entire poultry population of approximately 17 million
      for domestic poultry. “They are often the first victims of a         chickens at a direct loss of $62 million.
      rogue avian virus,” said Tara Smith, Ph.D., assistant professor          Gray is concerned not only about Iowa’s poultry but also
      of epidemiology and deputy director of the CEID. “Since they         Iowa’s poultry workers. “Poultry house workers breathe
      are so closely related to wild waterfowl, they can pick up the       in a tremendous amount of dust that may contain viruses.
      avian influenza viruses, but as domestic birds, they don’t have      Since many viruses produce no symptoms in poultry or only
      the antibodies to fight them off.”                                   mild symptoms in humans, it would be difficult to know
         Poultry play a key role in the making of highly pathogenic        if a virus like H5N1 were circulating in poultry houses.
      or pandemic avian influenza viruses. Smith noted that the            Therefore, we are actively studying various occupational
      viruses replicate and mutate quickly in poultry and may              groups for antibodies to avian influenza viruses,” said Gray.
      acquire virulence in a relatively short period of time. Several          In other studies, CEID graduate students Kendall Myers,
      of the largest poultry outbreaks of avian influenza in the           Ernesto Ortiz, and Alex Ramirez are looking at agricultural
      world, including one in Pennsylvania in 1983, initially began        workers at high risk of contracting avian influenza, such as
      with mild illness in the poultry population. However, within         veterinarians, meat processing workers, and workers in
      six to nine months of circulation, the virus had mutated into        confined animal feeding operations, to find out how easily
      a highly pathogenic form with a mortality rate approaching           the workers can pick up these viruses. Another graduate
      100 percent.                                                         student, Kerry Leedom, is studying Iowans with occupa-
         According to scientists at the World Health Organization          tional exposure to horses for evidence of infection with
      (WHO), both the H5 and H7 influenza subtypes can rapidly             horse influenza.
      mutate from mild to highly lethal forms in poultry and are               The CEID houses the Emerging Pathogens Laboratory
      associated with severe illness and death in domestic chickens        which has federal permissons to conduct these ground-
      and turkeys. Both are also believed to have jumped directly          breaking studies. The laboratory has unique capabilities
      from poultry to humans and to cause high mortality.                  to research a number of animal pathogens that may infect
         Because of the particular stealth and virulence of the H5         humans, including special techniques of culture, molecular
      and H7 subtypes, public health officials recommend aggres-           analyses, and serological study.
      sive control measures, including culling all infected and
      exposed poultry at the first sign of an outbreak, even if
      initially the virus is harmless. This could have serious conse-




THAT OVERSHADOWS THE THREAT OF BIOTERRORISM, AT LEAST FOR NOW.” GREGORY GRAY, PROFESSOR OF EPIDEMIOLOGY




                                                                                                                                             5
                                                Name that Virus
                                                Avian influenza viruses get their name from the number of antigen markers on their surface.
                                                These markers, which protrude from the surface like little spikes, are labeled “H” for
                                                haemagglutinin and “N” for neuraminidase. The various numbers and combinations of these
                                                markers determine what species the virus can infect. Each host cell has receptors that admit
                                                only certain combinations of antigens. Avian influenza viruses are capable of infecting birds,
                                                pigs, horses, seals, whales, and humans. Those that begin with H5 and H7 seem to be the most
                                                likely to mutate and become killer viruses. Scientists keep close tabs on their peregrinations.




                        “In Iowa, a high proportion of jobs involve animals.           public health consequences. With approximately 16 million
                    If agricultural workers are at increased risk of animal            pigs in the state, Iowa is the number one swine producer
                    influenza infections, we want to see that they are high on         in the country.
                    the priority list when new vaccines are developed against              Thacker has spent her career researching swine influenza
                    novel, dangerous influenza viruses. Only health workers            and collaborates with Gray and Gill on their research on
                    and health responders are on the list now,” said Gray.             zoonotic influenza infections. “In Iowa we must continually
                                                                                       monitor the epidemiological relationship between pigs, birds,
                    IOWA—A GEOGRAPHICAL “MIXING VESSEL”                                and people,” she said. “Since we have all three species in
                    Historically, avian influenza viruses have not been on             abundance, we must control disease on a regular basis.”
                    scientists’ shortlist of killers. Only rarely have they passed
                    directly from bird to human, because they lack the surface         A RACE AGAINST TIME
                    antigens required to attach to a human cell. Instead, as may       Scientists and public health officials have various ways
                    have happened during the last two influenza pandemics,             of preventing the spread of infectious disease—surveillance
                    avian viruses gain access to humans indirectly by first            of suspicious viruses, including all avian influenza viruses;
                    infecting poultry and then moving into pigs. Once inside the       culling should an epidemic break out in animal populations;
                    swine host cell, the virus recombines with a human influenza       quarantine and travel restrictions to prevent further spread;
                    virus infecting the same cell to create a new virus. Scientists    and finally vaccinations and antiviral medications, if they
                    dub pigs the perfect “mixing vessel” for the creation of new       can be produced quickly enough. The key factor here is time.
                    influenza viruses.                                                     “The only way to protect against a pandemic is before
                        “Swine is the only species that can carry both human           it happens,” said Smith. “Once a pandemic gets going, it’s
                    and avian influenza viruses. They’ve long been considered          nearly impossible to stop if we aren’t prepared.” This is why
                    the key link in the transmission of lethal influenza viruses       scientists the world over are alarmed about the human deaths
                    to both animals and humans,” said Eileen Thacker, D.V.M.,          caused by H5N1. Although 76 deaths may not seem like
                    Ph.D., associate professor of veterinary microbiology and          many, they can rapidly turn into millions if the virus mutates
                    preventive medicine at Iowa State University.                      so that it can be spread easily from human to human.
                        Thacker knows first-hand how devastating influenza                 Gray recently returned from a workshop sponsored by
                    viruses in swine can be. In 1999 the human influenza virus         the Institute of Medicine’s Forum on Microbial Threats where
                    H3N2 entered Iowa’s swine population, and within two years         scientists discussed how to prepare for an H5N1 pandemic.
                    it had infected nearly every herd in the state. An outbreak        “In my mind there is a tremendous public health threat that
                    of avian influenza in swine could have serious economic and        overshadows the threat of bioterrorism, at least for now,”
in the field 2005




                    6
                                                                  Profile of a Killer
                                                                  The influenza virus is one of nature’s greatest ironies—
                                                                  although it has the potential to decimate entire
                                                                  populations of humans and animals, according to most
                                                                  scientists, it isn’t fully alive.
said Gray. “Preparations are underway in an unprecedented             Essentially, a virus is a stripped-down cell, a strand
fashion.”                                                         of DNA or RNA that is capable of replicating but lacks
   Some of these preparations involve developing rapid            the cellular machinery to survive on its own. Therefore
diagnostic tests for respiratory viruses. Gray and graduate       many scientists don’t consider it to be a full-fledged life
student Sarah Starks are involved in studies evaluating the       form. In order to survive, a virus must attach to a host
effectiveness of these tests, which would be a crucial element    cell so that it can take over the host’s cellular machinery
to treating infection and stopping its spread, a lesson learned   and replicate. In influenza A viruses, the most unstable
from the great 1918 Spanish flu pandemic.                         of the three types of influenza viruses labeled A, B, and
   One reason why the 1918 pandemic was so deadly was             C, this replication process can be risky.
because the flu symptoms so closely resembled those of other          “With each replication the virus has the potential to
non-life-threatening illnesses. Health officials didn’t know      get one step closer to becoming a killer virus,” said
what the patient was suffering from until it was too late.        epidemiologist Tara Smith, Ph.D.
   “There are so many things that look like flu—in nearly
                                                                      During replication, the influenza virus breaks into
every illness you read about the first symptoms are flu-like,”
                                                                  eight segments. If another influenza virus is replicating
said Smith. “In 1918, people died within 48 hours. It was
                                                                  inside the same cell at the same time, as often happens
the worst flu a person could possibly have. They were just
                                                                  when human and avian influenza viruses simultaneously
drowning in their own secretions.” Rapid diagnostic testing
                                                                  infect a pig, the two viruses can get mixed together,
will be especially important in treating an H5N1 outbreak
                                                                  creating an entirely new virus capable of infecting
because antiviral medication must be administered within
48 hours of the onset of symptoms to work.                        humans. Recombined viruses of this sort were the cause
   The trajectory of H5N1 is ominous but uncertain. It could      of the last two pandemics. Another danger is that the
pass through swine and recombine to become deadly to              influenza virus may mutate and slowly acquire the ability
humans, or continue to mutate slowly and acquire the ability      to infect humans. In the few human cases of H5N1, the
to pass directly to humans, or do neither. In the meantime,       virus has gained access to humans through mutation,
scientists can only try to anticipate how the virus might         not recombination. But in the world of the virus where
change next, and continue to look for new avian influenza         each replication is a gamble, anything is possible.
viruses in the making.
   “We know that a pandemic will strike again. It’s a question
of controlling disease as best we can. Measuring it, diagnos-
ing it, and controlling it,” said Thacker.




                                                                                                                                7
                        Trouble in the Heartland
                                               Relatively easy to manufacture
                                               and highly addictive, methamphetamine
                                               has invaded homes and public spaces
                                               across Iowa, endangering families,
                                               communities, and the environment.
in the field 2005




                    8
For many Iowa school children, a popular springtime lesson in civic
responsibility is cleaning up a stretch of highway as part of Iowa’s Adopt-
a-Highway program. Throughout the state, thousands of students have
clattered into the countryside carrying rakes, shovels, and garbage bags,
pumped up to enjoy a real-world lesson in ecology. But today’s young
volunteers may want to consider wearing HAZMAT suits instead of
T-shirts and tennis shoes. Litter on Iowa’s highways isn’t what it used to be.

                    benton county detective mark phippen recently
                    was invited to give a talk to students at Central Lutheran
                    Middle School about what not to pick up before heading
                    out to clean up their adopted highway. “Abandoned
                    coolers, corroded Thermoses, pop cans with holes punched
                    in them, coffee filters stained with red residue, tied up,
                    double-bagged plastic sacks—all of these things could have
                    been used to make methamphetamine,” he said. Phippen
                    works as an undercover police detective for the Benton
                    County sheriff’s department and frequently investigates
                    meth cases.
                        During the last 10 years, as meth has drifted from
                    California and the Southwest to the Midwest, Iowa has
                    seen an astonishing growth in the number of meth lab           Sign in for Sudafed
                    seizures. The state went from two lab seizures in 1994 to      In May 2005, in response to
                    502 in 1999 to a record 1,472 in 2004. That figure earned      Iowa’s growing metham-
                    Iowa a second-in-the-nation ranking in meth lab seizures       phetamine problem, the Iowa
                    both in total numbers and per capita. Missouri topped          state legislature passed a law
                    the list at 2,788. Throughout the state and entire Midwest,    restricting the sales of
                    meth is leaving its mark not only on Iowa’s landscape          pharmaceutical products
                    but on Iowa’s families and communities as well.                containing ephedrine or
                                                                                   pseudoephedrine, key
                    OPENING PANDORA’S BOX
                                                                                   ingredients in the illegal drug.
                    It’s hard to imagine how nasal decongestant mixed with
                                                                                       Pseudoephedrine is found
                    crop fertilizer and a dozen or so common household
                                                                                   in common over-the-counter
                    poisons can create such an addictive substance, but meth
                                                                                   cold and flu medications such
                    is enigmatic in many ways, according to Anne Helene
                                                                                   as Sudafed and Nyquil. All but
                    Skinstad, Ph.D., assistant professor of community and
                                                                                   the lowest-dose products
                    behavioral health. “Meth is unusual because tolerance
                    develops after the first hit,” she said. “The next time,       now must be purchased at
                    the user will need to take significantly more of the drug      a pharmacy. Purchasers also
                    to achieve the same high, and the third time he or she will    will be limited to buying 7,500
                    have to take even more. People get hooked very, very fast.”    mg of the product in a 30-day
                        That first hit seems to open a Pandora’s box as the user   period and will have to sign a
                    gets caught in a cycle of pleasure produced by the drug        log book and show identi-
                    and tension and discomfort in its absence. In a short time,    fication when making the
                    the user no longer experiences the high but needs to take      purchase. Currently some 37
                    the drug just to avoid feeling depressed and irritable.        states have enacted similar
                        Meth’s toxic effects ravage the user’s body, causing       laws. The Iowa Senate voted
                    extreme weight loss, sleeplessness, raw sores, and “meth       50-0 to pass the bill.
                    mouth,” a grisly decaying of the teeth and gums. But the           The law is proving to be
                                                                                   effective. The total number
                                                                                   of clandestine labs seized by
                                                                                   Iowa officials in 2005 was
                                                                                   723, about half the number of
                                                                                   labs busted the previous year.



                                                                                                                      9
                            PHOTOS: MARK PHIPPEN




                                                   drug’s more sinister effects include a malignant combination       Recipe for
                                                   of aggression, hyperactivity, and loss of judgment that makes      Disaster
                                                   many meth users extremely dangerous.                               The toxic chemicals
                                                      “The tweakers are scary,” said Phippen, referring to meth       used to make meth
                                                   users who go on multi-day binges, continually taking the           seem more like
                                                   substance to sustain the high. “They are very paranoid, and        something to keep
                                                   they like guns.” “Tweakers” often experience hallucinations        on the top shelf in the
                                                   and paranoid delusions, which can make them violent in             garage, not something
                                                   confrontations with law enforcement. More frequently,              to ingest. In addition
                                                   however, victims of meth-related violence live in the user’s       to ephedrine or
                                                   own home.                                                          pseudoephedrine, the
                                                                                                                      following ingredients are
                                                   A FAMILY AFFAIR
                                                                                                                      also used to make meth:
                                                   “When someone starts using meth, the family falls apart,”
                                                                                                                      • anhydrous ammonia—
                                                   said Skinstad, who also serves as the director of the
                                                                                                                        a common crop
                                                   Prairielands Addiction Technology Transfer Center (PATTC).
                                                                                                                        fertilizer
                                                   The PATTC is part of a national network of 14 agencies that
                                                   provide trainings, curricula, and resources on substance use       • lantern fuel
                    “EVERY POUND OF METH           issues for counselors, health care professionals, and members      • ether
                                                   of the community. “We often find that when one person in a
                    PRODUCED CREATES                                                                                  • lithium from batteries
                                                   couple starts using, the other one does too, meth is so addic-
                    ABOUT SIX POUNDS               tive,” she said. “If children are around, they often suffer from   • red phosphorous
                    OF TOXIC WASTE.”               abuse and neglect as meth consumes their parents’ lives.”            from matches
                                                      Small children are also vulnerable to the toxic effects         • sulfuric acid and
                    EDWARD BOTTEI, MEDICAL         of home-based meth laboratories. As they crawl on the                muriatic acid used in
                    DIRECTOR OF THE IOWA           floor, they can get the sticky meth substance on their hands,        drain openers
                    STATEWIDE POISON               and they can also inhale meth dust and toxic fumes.
                                                                                                                      • toluene found in
                                                   “In Iowa over 90 percent of meth labs have babies around
                    CONTROL CENTER                                                                                      brake fluid
                                                   while producing meth,” said Ildiko Balint-Hayes, a graduate
                                                   student who has seen the effects of meth up close. For five        • acetone
                                                   years she worked in Waterloo with meth addicts and their           • sodium hydroxide,
                                                   families at Pathways Behavioral Services, an outreach                also known as Red
                                                   office of the Iowa Department of Human Services. She is              Devil Lye.
                                                   now working toward a Ph.D. in the Addiction Studies
                                                   Program, a subtrack in the Department of Community
                                                   and Behavioral Health.
in the field 2005




                    10
                                                                                             PHOTO: TOM LANGDON
                         “WHEN SOMEONE STARTS USING METH, THE      family              FALLS APART.”
                         ANNE HELENE SKINSTAD, ASSISTANT PROFESSOR OF COMMUNITY AND BEHAVIORAL HEALTH


   In Iowa the fastest growing group of meth users is single    addiction. Skinstad warns, however, that continued funding
working mothers—52 percent of women in drug treatment           of meth research is required to be truly effective.
are seeking help for meth addiction. Although meth is often        “We have a long way to go before we understand the
taken for round-the-clock dancing, the women who use meth       effects of this drug on the individuals abusing it and on our
are hardly taking it for fun, according to Balint-Hayes.        environment,” said Skinstad.
“Often they are working two jobs and taking care of children
alone. They need something to keep them going, so they turn     THE REMAINS OF THE DAY
to meth,” she said.                                             As tough as it is to clean up from a meth addiction, it is
                                                                equally difficult and expensive to clean up the toxic waste
WHEN THE PARTY’S OVER                                           produced by meth labs. According to Edward Bottei, M.D.,
Since just one hit of meth can alter brain chemistry for up     medical director of the Iowa Statewide Poison Control Center,
to six months, the compounded effects of continuous meth        every pound of meth produced creates about six pounds of
use require special, intensive treatment. “Meth has a very      toxic waste, and cleanup runs between $5,000 and $7,000
damaging effect on a person neurologically,” said Skinstad.     per lab. “Although 80 percent of meth in Iowa is imported
“Research from California has compared the neurological         from California or Mexico, the 20 percent that is produced
damages caused by meth abuse to signs of early dementia, and    here is very expensive to clean up because it’s made in small,
some of these changes are irreversible, even with treatment.”   makeshift labs,” said Bottei.
   Because of these neurological changes, treatment for meth        Bottei, who also serves as the state medical toxicologist
addiction takes longer than treatment for other addictions.     at the Iowa Department of Public Health, recently spoke at
“Meth impairs a person’s cognitive abilities, such as           the UI about the dangers posed by meth labs in a talk titled
judgment, motivation, and decision-making. Therefore the        “Health Hazards of a Clandestine Methamphetamine
meth-addicted person needs time to recover. Thirty days of      Laboratory.” The talk was sponsored by the Upper Midwest
residential treatment is the minimum,” Skinstad explained.      Center for Public Health Preparedness as part of its Grand
   Although research on meth is still in its infancy, two       Rounds Series, which addresses topics related to public
treatment approaches have been shown to be effective.           health preparedness.
The MATRIX treatment approach developed at the                      Both Bottei and Phippen urge Iowans to be aware of the
University of California at Los Angeles is a comprehensive      presence of meth labs when they are walking through parking
psycho-social approach. The Motivational Incentive treat-       lots, strolling in public parks, or cleaning up highway ditches.
ment approach developed at Johns Hopkins University is          “People need to realize that meth labs are no longer limited to
based on behavioral learning principles and involves giving     remote rural areas,” said Phippen. “Since it only takes a few
prizes or gifts to clients who keep their appointments and      hours to make a batch of meth, the ‘cooks’ set up labs in car
come to them sober.                                             trunks, hotel rooms, public parks, and highway ditches,
   Researchers funded by the National Institute on Drug         anyplace where they can leave the waste behind. It’s every-
Abuse are also studying the neurological, psychological,        where,” he said.
medical, dental, social, and familial consequences of meth




                                                                                                                                   11
                         Biostatisticians are at the center of clinical trials research, making sure new medical therapies are safe and effective.




                                             From Data to Discovery
                    Hemodialysis, pacemakers, cochlear implants, chemotherapy—
                    every day millions of people receive some form of medical treatment.
                    These sophisticated devices, procedures, and medications have
                    improved and extended people’s lives, and patients and doctors
                    throughout the world put great faith in them. But how do they
                    know these therapies will work and are safe?
                                                                                     according to kathryn chaloner, ph.d., professor and
                                                                                     head of biostatistics, controlled clinical trials are where
                                                                                     scientists learn whether a drug or medical procedure is safe
                                                                                     enough to use in human beings. “In a controlled clinical trial,
                                                                                     you learn about the risk-benefit ratio in a certain population.
                                                                                     It’s the best way to find out what the beneficial effects and the
                                                                                     side effects of a drug or certain procedure are,” she said.
                                                                                         Biostatisticians are an integral part of the clinical trial
                                                                                     team, responsible for designing and monitoring the studies
                                                                                     and analyzing the data they yield. Recently William Clarke,
                                                                                     Ph.D., professor of biostatistics and director of the Clinical
                                                                                     Trials Statistical and Data Management Center (CTSDMC)
                                                                                     in the Department of Biostatistics, was awarded a $21 million
                                                                                     grant to operate the data coordinating center for an interna-
                                                                                     tional research consortium studying islet transplantation
                                                                                     in patients with type 1 diabetes. The consortium, sponsored
                                                                                     by the National Institutes of Health (NIH), consists of five
                                                                                     clinical centers that will participate in seven different Phase II
                                                                                     and III studies focused on improving the safety and long-term
                                                                                     success of methods for transplanting islets, the insulin-
                                                                                     producing cells of the pancreas.
                                                                                         Chaloner, who is a co-principal investigator of the study,
                                                                                     will work with Clarke, other UI faculty, and the staff of the
                                                                                     CTSDMC to coordinate the data that come in from the
                                                                                     centers, monitor the studies, and analyze the results. Both
                                                                                     Clarke and Chaloner will work extensively with an interdisci-
                                                                                     plinary team of experts including diabetologists, transplant
                                                                                     specialists, laboratory scientists, and basic scientists.
in the field 2005




                    12
13
                         FROM MICE TO MEN
                         After scientists have established the safety and success
                         of a drug or medical intervention in animal models, they
                         systematically go about testing and experimenting with
                         it in humans. Often, this testing can be viewed as being
                         in four phases, although not all therapies and experiments
                         fit this model exactly. During a Phase I clinical trial,
                         researchers try to answer questions about toxicity and        FORMING QUESTIONS, FINDING ANSWERS
                         establish the maximum tolerable dose in a very small test     A big part of the biostatistician’s job is to work with other
                         population (20-80 people). Phase II clinical trials look at   investigators to come up with a solid scientific question for
                         efficacy and safety in a somewhat larger population           each study as well as a study design. When designing a clinical
                         (100-300 people). These trials try to determine how much      study, the biostatistician provides input into how long the trial
                         of the drug or product is needed to be effective, and how     should go on, how many subjects will be needed to answer the
                         much can be given and still be safe.                          question, and what kind of population should be studied—
                              Phase III clinical trials ask essentially the same       who to leave in, who to leave out. “The main question in a
                         questions as Phase II trials but in a larger population       clinical trial is who to study—someone sick enough to be
                         (1,000-3,000 people) and using clinical outcomes rather       helped by the investigational therapy but not too sick,” said
                         than laboratory markers and tests. Upon completion of
                                                                                       Clarke. Controlling for various factors helps investigators to
                                                                                       establish precise cause and effect.
                         a Phase III trial, the drug or medical intervention may be
                                                                                           One islet transplantation clinical trial, known as the
                         approved, or not, by the Food and Drug Administration.
                                                                                       “Islet after Kidney” study, looks at patients with severe type
                         Phase IV studies are carried out after the drug or
                                                                                       1 diabetes who have had a kidney transplant and asks which
                         intervention has been licensed. They are intended to
                                                                                       is better—to manage their insulin deficiency through trans-
                         monitor side effects over longer periods of time in very
                                                                                       planted islet cells or through the traditional method of intense
                         large populations.
                                                                                       glucose monitoring and insulin shots.
                                                                                           “Insulin therapy can cause complications over time, but
                                                                                       islet transplantation isn’t without risk either,” said Clarke.
                                                                                       “Patients must be immunosuppressed so the transplanted islet
                                                                                       cells can function. We’re trying to find out which of these
                                                                                       methods of glucose control is best.”

                                                                                       MAKING THE CALL
                                                                                       Clinical trials are inherently risky. “If a drug or medical
                                                                                       procedure is 100 percent safe, it doesn’t do anything,” said
                                                                                       Clarke. Once a trial gets underway, biostatisticians must
                                                                                       regularly monitor incoming data in order to evaluate risk
                                                                                       and ensure that it is still ethical and practical to continue the
                                                                                       study. Once an answer is found to the primary question, then,
                                                                                       ethically, the trial must be stopped and the results published.
                                                                                       Biostatisticians must report their findings regularly to data
                                                                                       monitoring boards that are made up of panels of experts
                                                                                       whose primary concern is to make sure that studies are
in the field 2005




                                                                                       conducted ethically.




                    14
“IN A CONTROLLED CLINICAL TRIAL, YOU LEARN ABOUT THE    risk-benefit ratio                                 IN A CERTAIN POPULATION.”
KATHRYN CHALONER, PROFESSOR AND HEAD OF BIOSTATISTICS


    The Islet after Kidney study is a double-blind study in         the possibility is there, but it’s very rare. If it happens once
which neither the subjects nor the clinical investigators know      in a thousand cases and you studied 800 patients, you would
which subjects are receiving the transplants. The islet cells       expect to probably see one event at most. But once it’s licensed
are injected into the portal vein, a major vein that drains         and the drug goes out to millions of people, these rare events
blood into the liver, where the cells settle and produce insulin.   come out,” he said.
Investigators at the five clinical centers will enter the data
they collect during the study onto a special web site where         EXPERIMENTS, ETHICS, AND EQUIPOISE
Clarke, Chaloner, and the CTSDMC collaborators and                  Since clinical trials involve testing on many people, some
staff will monitor the results.                                     of whom may be harmed, what’s the difference between
    “Since clinical investigators are usually blinded to the        today’s clinical trials and yesterday’s human experiments?
accumulating data, we must make sure that we’re getting                 “Ethics,” according to Clarke. “Ethical principles allow
answers as the study goes along, catch any problems that may        researchers to conduct medical experiments in humans.
arise, and monitor for safety issues. We must work with the         We need and will always use medical therapies, so it’s impor-
NIH project officers and medical monitors to catch any              tant that these therapies be tested. Ethical questions arise
unexpected findings along the way so we can make the results        when unproven therapies are used instead of proven ones.”
available,” said Chaloner. “It’s a big responsibility.”                 Ethical human experimentation is founded on the concept
    Should the biostatisticians detect any adverse events, the      of “clinical equipoise.” In this state the clinical investigator
sponsors must decide whether to stop the trial. One example         is genuinely uncertain or ignorant regarding the comparative
of a trial that was stopped due to adverse events was the           therapeutic merits of each arm in a trial. “In a state of clinical
Hormone Replacement Study conducted as part of the                  equipoise, the investigator believes there is no preferred
Women’s Health Initiative. In 2002 the NIH concluded that           therapy, or that available evidence does not support the
women taking estrogen plus progestin had increased risk of          superiority of one treatment over another,” said Clarke.
breast cancer, heart attack, stroke, and blood clots. The study         According to Clarke, equipoise can change if one treat-
ended four years early.                                             ment is found to be superior or harmful, or if it becomes
    Sometimes, however, adverse events are not detected until       evident that the study will never answer the question. If this
after a drug or product is licensed and has been in use by          happens, the study should be stopped.
millions of people. When they occur at this point, the news             The concept of clinical equipoise along with sophisticated
is splashed across major headlines and becomes the subject          statistical modeling techniques allow today’s biostatisticians
of intense public scrutiny. The pain medication Vioxx and           to help scientific investigators pose the right questions in
diet drug fen-phen are two notorious examples. Although             clinical studies, untangle and interpret massive amounts
speculation about the drugs’ licensing was rampant, Clarke          of incoming data, and illuminate the dark corners of medical
has a biostatistical explanation.                                   science. Although biostatisticians never touch or even talk
    “What happened with Vioxx and fen-phen, among other             to patients, modern medicine would not be where it is without
drugs, is that the licensing studies were done short-term in a      their work.
relatively small number of patients. If you think about having
really rare events, like cardiac events in the case of Vioxx,




                                                                                                                                         15
                                       RETHINKING
                                       LONG-TERM CARE AND
                                       END-OF-LIFE CARE
                                       Researchers are exploring alternatives to provide more care options for older adults.




                    In the minds of many rural Americans, including Iowans, aging and
                    death include a trip to the nursing home and a final stint in the hospital.
                    To some extent this is true: in 2002, 6.2 percent of Iowans age 65 and
                    older lived in nursing facilities, compared to 3.8 percent at the national
                    level, and in 2003 about half of all Americans died in an inpatient
                    health care setting. But are nursing homes and hospitals really an
                    inevitable part of aging and death? Do they provide the best and most
                    cost-effective care? Two researchers in the Department of Health
                    Management and Policy are exploring these issues.


                                        “there are many good reasons why the nursing home and hospital have come
                                       to be the primary location to die for rural Americans,” said Brian Kaskie, Ph.D., assistant
                                       professor of health management and policy. “Traditionally, older Iowans have been taken
                                       care of by family members. When family members weren’t around or the person became
                                       too sick to be cared for at home, he or she would move into a nursing home or be admitted
                                       to an inpatient hospital.”
                                          However, as people live longer and family members become more mobile, the family is
                                       becoming a less reliable source of light to moderate caregiving. “When many older Iowans
                                       face some form of functional impairment and need health and supportive care, they move
                                       into a nursing home, even if that impairment isn’t severe,” said Kaskie. As a result, Kaskie
                                       has found, some older Iowans end up going to nursing homes who don’t necessarily need—
                                       or want—to be there.
                                          A recent survey conducted by the American Association of Retired Persons (AARP) found
                                       that 79 percent of Iowans say they want to live in their own homes for as long as possible
                                       even if they need long-term care services. The problem, identified in the AARP survey, is that
                                       Iowans don’t know where to go or how to access long-term care services other than nursing
                                       homes, services such as Meals-on-Wheels, Visiting Nurse Associations, and community
                                       senior centers. “It’s not that home- and community-based services are too expensive or do
                                       not provide quality care, it’s simply that older Iowans don’t know how to obtain them,”
                                       said Kaskie.
                                          This finding has prompted Kaskie and a coalition of representatives from local, state,
                                       and national levels of government and organizations to develop a long-term care assessment
in the field 2005




                                       and counseling program to educate older Iowans about these other services and help them
                                       “live in their own homes for as long as possible.”



                    16
                                                                                                    PHOTO: NANCY MEDWELL



   In her research on end-of-life care, Sara Imhof, doctoral candidate in health management
and policy, finds a similar pattern in which people may be paying too much for end-of-life
services that are not provided in the most efficient or preferred manner. “We may be paying
too much for care that doesn’t meet the preferences of dying individuals and their families,”
she said.
   For example, in 2003 Medicare, the primary insurance provider for eight of every ten
Americans who die, reimbursed an average of $26,000 per decedent for health care services
provided in the last year of life, which represented 30 percent of all Medicare outlays.
According to Imhof, these expenses were often for life-sustaining services and did not cover
supportive services, such as managing pain, relieving symptoms, and reducing the length
of the dying process.
   Looking for better, more cost-effective ways to meet the needs of the dying, Imhof and
Kaskie examined four successful hospital-based, best-practice end-of-life care programs.
Their research revealed that in general, end-of-life care programs that include supportive
services increase the quality of care and decrease costs by increasing staff efficiency, moderat-
ing the consumption of expensive service interventions, and reducing the average length of
inpatient stays.
   “These programs improve patients’ physical and psychological well-being as they approach
death,” said Imhof. She and Kaskie have developed an operational planning process that
will help health care executives to develop effective and efficient end-of-life programs.
They published their results in a recent article in the Journal of Healthcare Management.




                                                                                                                           17
                             Home Sweet
                         (Cancer-Causing) Home?
                              A recent study reveals a clear link between prolonged residential
                              radon exposure and increased lung cancer risk.
in the field 2005




                    18
                                                                                              IMAGE COURTESY OF KARL THOMAS, M.D., UNIVERSITY
                                                                                              OF IOWA DEPARTMENT OF INTERNAL MEDICINE




home is where the heart is, but if you live
in certain regions of the country – such as Iowa –
home also may be where unhealthy levels of
carcinogenic radon accumulate.
radon, a naturally occurring radioactive gas, seeps                 in the March 2005 issue of the journal Epidemiology.
into many houses without the occupants ever knowing it.             Charles Lynch, M.D., Ph.D., professor of epidemiology,
    Invisible and odorless, radon gas is a silent killer, causing   also contributed to the research.
an estimated 21,000 lung cancer deaths per year in the United           Radon is produced from the decay of naturally occurring
Sates alone, according to the U.S. Environmental Protection         uranium in the earth’s soil, and can accumulate in enclosed
Agency (EPA). Due to its geologic history, Iowa has the             areas, such as underground mines and buildings. The initial
highest average radon concentrations in the United States.          link between radon exposure and lung cancer had been
    While scientists agree that radon is a lung carcinogen,         derived from studies of underground miners, who are exposed
there has been some debate about whether prolonged                  at much higher levels to the radioactive gas, and from animal
exposure to lower radon concentrations, such as those in            and in vitro studies. Some previous case-control studies
homes, increases the risk of lung cancer. A number of case-         reported a positive or weakly positive association between
control epidemiologic studies examining this question have          lung cancer risk and residential radon concentrations, while
produced ambiguous results, but a recent study by a group           others found no evidence of an association. The North
of international researchers, including two investigators from      American pooling study was designed to assess the seemingly
the College of Public Health, could settle the question once        disparate findings from these earlier studies.
and for all: The large, multi-center study provides direct              Field and Lynch were part of an international team of
evidence of an association between prolonged residential            researchers who performed the combined analysis of the
radon exposure and lung cancer risk.                                original residential radon studies, conducted in Connecticut,
    The researchers analyzed data pooled from seven                 Iowa, New Jersey, Missouri, Utah, and southern Idaho,
different North American residential radon studies. They            as well as Winnipeg, Canada. The investigators reviewed
found an 11 to 21 percent increased lung cancer risk at             3,662 cases and 4,966 controls from these combined studies.
average residential radon concentrations of approximately           The original studies were funded from several federal sources,
3.0 picocuries per liter of air, during an exposure period of       including the National Institute of Environmental Health
5 to 30 years. The lung cancer risk increased with increasing       Sciences and the National Cancer Institute.
radon exposure. The EPA’s current action level for residential          “The findings from the previously performed Iowa
radon is 4.0 picocuries per liter.                                  Residential Radon Lung Cancer Study indicate the risk
    “This analysis, based on the largest radon data set             estimates from this pooled analysis actually may slightly
assembled in North America, agrees with a similar large-scale       underestimate the true risk posed by prolonged residential
radon pooled analysis performed concurrently in Europe.             radon exposure,” Field said, noting potential exposure
The North American and European pooling provides unam-              misclassification resulting from the pooling techniques.
biguous and direct evidence of an increased lung cancer risk        Investigators are currently pooling the results from the North
even at residential radon exposure levels below the U.S. EPA’s      American and European studies, which they anticipate will
action level,” said R. William Field, Ph.D., associate              be completed in late 2006. Additional information on the
professor of occupational and environmental health and              Iowa Residential Radon Lung Cancer Study can be found
epidemiology, and a co-author of the study, which appeared          online at www.cheec.uiowa.edu/misc/radon.html.




                                                                                                                                                19
                    Q&A
                                                      A Conversation with Neal Kohatsu


                    Making Strides for Better Health

                    NEAL KOHATSU IS INTERESTED IN THE BIG PICTURE OF PUBLIC HEALTH. AS ASSOCIATE PROFESSOR OF
                    EPIDEMIOLOGY AND DIRECTOR OF THE PREVENTIVE INTERVENTION CENTER, KOHATSU JOINED THE COLLEGE
                    OF PUBLIC HEALTH FACULTY IN 2003. PRIOR TO COMING TO IOWA, HE WORKED FOR THE CALIFORNIA
                    DEPARTMENT OF HEALTH SERVICES AND WAS MEDICAL DIRECTOR OF THE MEDICAL BOARD IN CALIFORNIA,
                    WHERE HIS AREAS OF INVESTIGATION INCLUDED GUIDELINES FOR MANAGING ALZHEIMER’S DISEASE AND
                    PHYSICIAN DISCIPLINE, AND SERVED ON THE CLINICAL FACULTY AT THE UNIVERSITY OF CALIFORNIA-DAVIS.
                    HE RECEIVED HIS M.D. FROM THE UNIVERSITY OF PITTSBURGH AND M.P.H. FROM THE UNIVERSITY OF
                    MINNESOTA. HE IS CURRENTLY PRESIDENT OF THE AMERICAN COLLEGE OF PREVENTIVE MEDICINE.


                    Q: You began your career by getting an M.D. degree and starting your clinical training in
                    general and orthopedic surgery. You then went on to get an M.P.H. degree. What made you
                    choose a career in preventive medicine and public health over orthopedics?
                    A: When I was a freshman at Stanford, I was in a program called Human Biology that looked
                    at the human condition from a multidisciplinary perspective. My freshman advisor at Stanford
                    was an orthopedic surgeon, and during the summers I worked with him and another mentor
                    in an orthopedic research lab doing basic science research on cartilage cells and their structural
                    components to better understand arthritis. I decided to go into orthopedics because I wanted
                                                                                                                           “PREVENTION NEEDS TO HAPPEN
                    to do both basic science and clinical research that could be applied to patient care.
                        Then when I was a resident in orthopedic surgery, I read a fascinating article on preventive       IN A NUMBER OF DIFFERENT
                    medicine in the state health department newsletter. I didn’t know anything about the field,            VENUES AROUND THE
                    so I made an appointment to talk to the state health department’s chronic disease epidemiolo-          COMMUNITY—AT SCHOOL, IN A
                    gist, Andy Dean, M.D. We talked for over an hour, and when I left he loaned me one of the
                                                                                                                           PREVENTION CENTER, OR THROUGH
                    leading textbooks in the field. I stayed up nights reading it, and from then on I was hooked.
                                                                                                                           A HEALTH CENTER OR
                    Q: You’ve held governmental posts in public health as well as clinical and academic positions.         COMMUNITY-BASED ACTIVITIES.”
                    What advice would you give to students wanting to pursue a career in public health?
                    A: Quantitative skills are useful for all disciplines within public health, since there is an
                    increasing demand for sophisticated evaluation of public health programs. With advances in
                    fields such as genetics, a strong grounding in the biological sciences will become increasingly
                    important to public health training. It’s also important to develop sound writing skills whether
                    you’re headed to a health department, university, or private company.

                    Q: You’ve had a lifelong interest in health and physical activity. What issues do you feel most
                    passionate about today?
                    A: In general, I think we’ve been poor at translating what we’ve learned from scientific studies
                    into practice. When I say “we” I mean medicine and public health. We invest a lot of money in
                    research and in exploring scientific questions. We are able to answer those questions, but that
                    information often isn’t applied effectively, efficiently, or broadly across the population. And
                    whether you’re talking about patient safety, access to preventive services, or lifestyle issues such
                    as nutrition and physical activity, there is a huge gap between what we know and what we are
in the field 2005




                    able to put into practice.




                    20
                                                                                                      PHOTO: KIRK MURRAY




Q: What do you feel is the most beneficial approach to the obesity epidemic?
A: Environmental influences favoring poor nutrition and physical inactivity are very powerful,
so it’s difficult for individual approaches to work when the environment is so hostile towards a
healthy lifestyle. Because of that it may be most critical that we as a society change our environ-
ment to be much more supportive of good nutrition and a physically active lifestyle. Otherwise,
we shortchange lifestyle-related, pharmacologic, and surgical interventions.

Q: What do you think about approaches that emphasize “willpower”?
A: People misrepresent the American value of self-reliance when they say that everyone chooses
to become obese and therefore they can choose to lose weight. It isn’t true. It’s a much more
complicated issue than individual willpower, and I think there’s danger in the so-called “blame
the victim” approach. It increases the psychosocial burden and makes it much harder for those
who are trying to manage their weight.

Q: What do you think of groups that say there is nothing wrong with being obese, people are
just “differently sized”?
A: There are rights groups for big people, but part of that has been because of the hostility and
disdain often faced by people who are obese. It’s natural to emphasize self-worth issues, which
I think are good. I think that we should probably not frame the issue so much as combating


                                                                                                                           21
                    “LOTS OF PEOPLE IN PUBLIC HEALTH PRACTICE ARE ATTRACTED TO THE POTENTIAL TO MAKE DRAMATIC         changes                 ,
                    FOR THE BETTER, IN PEOPLE’S LIVES.”




                                                     obesity, which might be construed as blaming the victim, but instead as helping people achieve
                                                     the healthiest lifestyle for them. Then the weight will follow.

                                                     Q: Do you think obesity is a trickier issue than tobacco use?
                                                     A: In some ways it’s probably more complicated than tobacco, where we at least understand
                                                     the physiology of nicotine. Also, we don’t have to smoke for survival but we do have to eat.
                                                     There’s a basic difference there. Smoking isn’t the norm but eating is. These fundamental
                                                     differences do make obesity more complicated than tobacco control. But tobacco control still
                                                     remains an important problem. We can’t forget about other important public health issues
                                                     in prevention besides obesity.

                                                     Q: Since primary physicians don’t often have time to discuss prevention with patients,
                                                     who do you think should?
                                                     A: Prevention needs to happen in a number of different venues around the community—at
                                                     school, in a prevention center, or in a prevention program through health clubs and commu-
                                                     nity-based activities. Through the Healthful Living Program that was just started in the
                                                     Preventive Intervention Center, we’re trying to address how we can best deliver prevention
                                                     services in a non-medical setting.

                                                     Q: With the Healthful Living Program, what areas are you focusing on besides nutrition
                                                     and exercise?
                                                     A: We think that a lot of stress in people’s lives relates to time management. This concept
                                                     hasn’t been applied very much to health care. When I was seeing patients at UC Davis
                                                     Medical Center, they would say they didn’t have time to exercise. Well, everyone has the
                                                     same 24 hours in a day, and so they did have the time, it just wasn’t a high enough priority.
                                                     Most time management programs don’t mention health, but few things are more important
                                                     than your health. We think time management fits into that equation.

                                                     Q: In February 2005 you became president of the American College of Preventive Medicine
                                                     (ACPM). Do you have any grand ideas for the organization?
                                                     A: (Laugh). I have some ideas—others can judge how grand they are. My number one priority
                                                     is to secure funding for preventive medicine residency training programs. Since they are not
                                                     funded by Medicare subsidies to teaching hospitals, like other residency programs are, the
                                                     preventive medicine residencies are financially unstable. The ACPM feels that this needs to
                                                     be addressed at the national level.

                                                     Q: You seem like a “big picture” kind of guy. Would you say this is true?
                                                     A: I think that one of the enjoyable things about public health is that it does look at the big
                                                     picture and that potentially, a change in policy can benefit many people. I think that’s what
                                                     a lot of people in public health practice are attracted to—the potential to make dramatic
                                                     changes, for the better, in people’s lives.

                                                     Q: Do you have any other comments you’d like to make?
in the field 2005




                                                     A: No, that was quite painless! (Pulls out pedometer.) I’ve got 5,000 steps, so I’ve got 5,000
                                                     more to go today.



                    22
center profile

Iowa Registry for Congenital and Inherited Disorders

DIRECTOR:   Paul A. Romitti, Ph.D.

DEPUTY DIRECTOR:    Bradley McDowell, Ph.D.

LOCATION:   Department of Epidemiology, College of Public Health, The University of Iowa

WEB SITE:   www.public-health.uiowa.edu/ircid /

ESTABLISHED: In 1983 as the Iowa Birth Defects Registry; in 2004 the program was renamed the Iowa Registry for
Congenital and Inherited Disorders.

MISSION: To maintain statewide surveillance for selected congenital and inherited disorders in Iowa; monitor annual
trends in occurrence and mortality of these disorders; and provide data for research and educational activities for
the prevention and treatment of these disorders.

KEY UI INVESTIGATORS:
• Trudy Burns, Ph.D., M.P.H.; Charles Lynch, M.D., Ph.D.; James Torner, Ph.D. (College of Public Health)
• Kim Keppler-Noreuil, M.D.; Katherine Mathews, M.D.; Jeffrey Murray, M.D.; Hatem El-Shanti, M.D.;
  Roger Williamson, M.D. (Roy J. and Lucille A. Carver College of Medicine)

SURVEILLANCE FUNDING SOURCES:
• Centers for Disease Control and Prevention
• State of Iowa through a Special Appropriation to the Board of Regents
• State of Iowa through a fee on issuance of birth certificates

RESEARCH FUNDING SOURCES:
• Centers for Disease Control and Prevention
• National Institutes of Health

SELECTED RESEARCH PROJECTS:
• Study of Genetic and Environmental Risk Factors for Cleft Lip and Palate (Paul Romitti, Ph.D., Jeffrey Murray, M.D.)
• Study of Genetic and Environmental Risk Factors for 31 Birth Defects (Paul Romitti, Ph.D., Jeffrey Murray, M.D.)
• Study of Genetic and Environmental Risk Factors for Down Syndrome (Paul Romitti, Ph.D.)

SELECTED STUDENT RESEARCH PROJECTS:
• Caffeine, Genes, and Risk of Limb and Neural Tube Defects (Rebecca Schmidt, graduate student)
• Tobacco Use, Genes, and Risk of Orofacial Clefts (Min Shi, graduate student)



“FOR MORE THAN 20 YEARS, THE REGISTRY HAS SERVED IOWANS AND HAS BEEN A NATIONAL LEADER IN SURVEILLANCE,
RESEARCH, AND EDUCATION EFFORTS FOR BIRTH DEFECTS. OUR RECENT NAME CHANGE REFLECTS OUR EXPANDED EFFORTS
TO INCLUDE SURVEILLANCE OF MUSCULAR DYSTROPHY AND FETAL DEATHS. WE WILL STRIVE TO BE A NATIONAL LEADER IN
THESE EFFORTS AS WELL.”
PAUL ROMITTI, ASSISTANT PROFESSOR OF EPIDEMIOLOGY AND DIRECTOR OF THE IOWA REGISTRY FOR CONGENITAL
AND INHERITED DISORDERS




                                                                                                                         23
                    in brief

                                                                                                                         Clarifying a Hazy Subject
                                                                                                                         Beneath the hustle and bustle
                                                                              36 PERCENT OF STUDENTS HAD PARTICIPATED    of college life lurks a potentially
                                                                             IN ONE OR MORE HAZING ACTIVITIES, SUCH AS   dangerous practice that neither
                                                                                    SLEEP DEPRIVATION, DRINKING GAMES,   students nor university officials
                                                                             DESTROYING PROPERTY, OR PHYSICAL ASSAULT    seem to know much about—
                                                                                                                         hazing. Although hazing is
                                                                                                                         prevalent on college campuses,
                    Weighing the Risks of Obesity Surgery                                                                very little is known about it
                    With more and more Americans joining the ranks of the obese, many                                    because it takes place in secret
                    people looking for a “quick fix” for their weight problems point to                                  and often goes unreported.
                    celebrities such as TV weatherman Al Roker and singer Carnie                                         However, Shelly Campo, Ph.D.,
                    Wilson, who slimmed down rapidly following weight-loss surgery.                                      assistant professor of commu-
                    But as with all major operations, obesity surgery entails some risk.                                 nity and behavioral health, is
                    Biostatistics graduate student Wei Zhang, along with colleagues                                      working to change that.
                    from the Colleges of Public Health and Medicine, recently completed                                      Recently Campo was
                    a study that examined factors influencing survival following surgical                                consulted by Cornell University
                    treatment of obesity.                                                                                to examine students’ attitudes,
                        The researchers tracked the survival of 18,972 patients operated                                 behaviors, and beliefs related to
                    on for severe obesity from 1986 to 1999. Of this group, 654 patients                                 hazing. Campo surveyed more
                    died by the end of 2001. The operations were categorized as either                                   than 700 undergraduates about
                    simple (procedures that restrict food intake with devices such as                                    various team-building behaviors
                    bands or rings) or complex (food intake restriction and gastric                                      and found that 36 percent of
                    bypass surgery). The investigators found that simple and complex                                     students had participated in
                    operations were equally effective in keeping patients alive. However,                                one or more hazing activities,
                    six risk factors were significantly associated with survival time: a                                 such as sleep deprivation,
                    patient’s age and body mass index (BMI) at the time of operation,                                    drinking games, destroying
                    gender, and history of smoking, diabetes, and                                                        property, or physical assault,
                    hypertension prior to surgery. Young, female,                                                        even though they may not have
                    non-smoking patients with low BMI at                                                                 recognized that the activity met
                    operation and no history of diabetes or                                                              the definition of hazing.
                    hypertension had the best five-year survival                                                             The discrepancy between
                    probability. The researchers stressed                                                                college students’ perceptions
                    the continued need for lifelong follow-                                                              of hazing and university policy
                    up data for severe obesity and to study                                                              defining hazing activities may
                    the effects of operations that perm-                                                                 be due to students’ narrow
                    anently change digestive function.                                                                   definition of hazing, which
                                                                                                                         includes only extreme types of
                                                                                                                         activities, such as being locked
                                                                                                                         up or kidnapped. In an effort
                                                                                                                         to minimize or eliminate hazing,
in the field 2005




                                                                                                                         Campo advocates educating all
                                                                                                                         students about hazing activities
                                                                                                                         and their health consequences.



                    24
                             Cracking the Code on Cleft Lip and Palate
                             Cleft lip and palate is one of the most common structural birth defects, occurring in one of every 500
                             to 1,000 live births. Correction of the deformity often tops $100,000 per person and involves multiple
                             surgeries, orthodontics, and speech therapy. Although researchers suspect a genetic link behind the
                             defect—the condition tends to run in families—they have yet to analyze the genetic data from enough
                             families to identify the specific genes involved.
                                 A three-year, $471,000 grant from the Roy J. Carver Charitable Trust, awarded to the Center for
                             Statistical Genetics Research (CSGR), will assist a team of UI researchers and their colleagues in
                             conducting the world’s largest study of more than 600 families worldwide who are affected by cleft lip
                             and palate. The grant will be used to develop statistical and computational methods to analyze the
                             complex genetic data required to precisely locate cleft lip and palate genes on a map of the human
                             genome. The researchers expect that the investigations will provide the most complete picture to date
                             of the genomic architecture of this devastating birth defect.
                                 The CSGR is jointly supported by the College of Public Health and the Roy J. and Lucille A. Carver
                             College of Medicine.




Rooting Out Risks for Childhood Asthma
Adding to a growing body of research on farm-related respiratory
exposures, College of Public Health investigators reported that the
prevalence of asthma is elevated among children living on farms
where swine are raised. Children living on swine farms where
antibiotics are added to feed have a significantly higher prevalence
of the respiratory disease, according to the study.
    Farms that add antibiotics to feed tend to have larger numbers of
livestock than farms that do not add antibiotics, according to James
Merchant, M.D., Dr.P.H., dean of the College of Public Health and
professor of occupational and environmental health, who led the
study. While the addition of antibiotics may be an indicator of larger
swine operations, the researchers said it is plausible that antibiotic   COLLEGE OF PUBLIC HEALTH INVESTIGATORS
exposure may also play some causal role in the development of            REPORTED THAT THE PREVALENCE OF ASTHMA IS ELEVATED
childhood asthma.                                                        AMONG CHILDREN LIVING ON FARMS WHERE
    Other risk factors associated with asthma in the study were          SWINE ARE RAISED.
several “early life events,” including premature birth, a respiratory
infection under age three, and high-risk birth. Male gender, age,
personal history of allergies, and family history of allergic disease
were also associated with asthma.
    The research, funded through the Great Plains Center for
Agricultural Health, examined 644 children ranging in age from birth
through 17 years living in Keokuk County, Iowa.




                                                                                                                                      25
                                                                                                Rural Teens Face Treatment
                                                                                                Barriers
                                                                                                Most teenagers hit rough spots
                                                                                                while navigating the bumpy
                                                                                                path to adulthood, but rural
                                                                                                adolescents with mental health
                                                                                                and/or substance use problems
                                                                                                face a particularly rough road.
                                                                                                Rachel Anderson, Ph.D.,
                                                                                                associate professor of health
                                                                                                management and policy, led a         TWO-THIRDS (64 PERCENT)
                                                                                                study showing that rural youths      OF ADOLESCENTS WITH
                                                                                                with co-occurring disorders—         CO-OCCURRING DISORDERS
                                                                                                defined as having at least one       DID NOT OBTAIN TREATMENT
                    Arsenic and Old Toenails                                                    mental disorder as well as an        CONSISTENT WITH GUIDELINES
                    Toenail clippings probably don’t spring to mind as a tool of scientific     alcohol or drug use disorder—        RECOMMENDING THAT SUCH
                    research. But because certain compounds accumulate in the protein           frequently do not receive the full   INDIVIDUALS RECEIVE CARE
                    found in hair and nails, toenails provide an excellent record of a          extent of treatment they require.    FOR BOTH THEIR MENTAL
                    person’s environmental exposures. Researcher Laura Beane                         The researchers reviewed        HEALTH AND SUBSTANCE
                    Freeman, Ph.D., formerly with the Department of Epidemiology,               the cases of 177 adolescents         USE PROBLEMS.
                    and colleagues used toenail clippings as part of a case-control study       living in a three-county region of
                    examining the link between arsenic and cutaneous melanoma,                  Iowa who received outpatient
                    the most deadly form of skin cancer.                                        mental health or substance use       needs. Similarly, those who
                        A naturally occurring metalloid element, arsenic is found at high       treatment. Two-thirds (64            received only substance use
                    levels in the water supplies in some areas of Iowa. The researchers         percent) of adolescents with         treatment showed improvement
                    surveyed and collected toenail clippings from 368 white Iowans              co-occurring disorders did not       on substance use needs, but
                    diagnosed with cutaneous melanoma aged 40 years or older.                   obtain treatment consistent with     not on mental health needs.
                    The clippings were analyzed for arsenic content and compared                guidelines recommending that             The authors noted that
                    against a control group. The investigators found an elevated risk of        such individuals receive care for    barriers to coordinating
                    cutaneous melanoma with increasing toenail arsenic concentration.           both their mental health and         treatment of co-occurring
                    While the researchers could not determine the source of arsenic,            substance use problems.              disorders in rural youth include
                    they noted that the use of private wells—which are not subject              The study revealed that those        insufficient health care
                    to the same testing requirements as public water supplies—                  adolescents with co-occurring        personnel and facilities, a lack
                    appeared to be associated with both increased toenail arsenic               problems who received only           of coordinated care, poor
                    content and increased melanoma risk. Arsenic is also used in                mental health treatment showed       reimbursement for care, long
                    commercial applications, which could have been a source of                  improvement on mental health         travel distances to health
                    exposure for some individuals.                                              needs at discharge, but no           services, and rural residents’
                        The authors believe this is the first study to report the association   improvement on substance use         lack of insurance coverage.
                    between increasing arsenic exposure and melanoma risk, an
                    important finding because of the potential for large numbers of
                    people to be exposed to arsenic.
in the field 2005




                    26
                                                                          The Estrogen-Gallbladder           the U.S. Nearly 8,400 women
                                                                          Connection                         who had hysterectomies
                                                                          Women considering estrogen         received either estrogen or
                                                                          therapy after menopause now        placebo; around 14,200
                                                                          have another factor to blend       women who had not had
                                                                          into the decision. College of      hysterectomies received
                                                                          Public Health researchers have     estrogen plus progestin or
                                                                          found that postmenopausal          placebo.
                                                                          women taking estrogen may              Both trials showed a greater
                                                                          be at an increased risk of         risk of gallbladder disease or
                                                                          gallbladder inflammation or        gallbladder surgery with
One Technology May Not Fit All                                            gallstones, according to a study   estrogen therapy. Women
In this age of information overload, new information technology can       conducted by Robert Wallace,       taking estrogen had an 80
improve the accuracy and efficiency of gathering, recording, and          M.D., professor of                 percent increased risk for
transmitting data and information. Studies in urban hospitals             epidemiology and internal          inflammation of the gallbladder
suggest that implementing health information technology (HIT)             medicine, and Dominic Cirillo,     and an 86 percent greater risk
systems can save lives by reducing medication errors and errors           graduate research assistant in     for gallstone disease. Those
made in the transcription or execution of physician orders. While         epidemiology. Gallstone            taking estrogen plus progestin
research has shown HIT to be beneficial and cost effective in urban       disease affects 10 to15 percent    had a 54 percent increased risk
settings, the financial feasibility of implementing this expensive        of the general population.         for inflammation and 68 percent
technology in small rural hospitals is unknown.                               Using data from two            greater risk for gallstone
     A team of researchers in the Department of Health Management         randomized, double-blind,          disease. 
and Policy, led by Robert Ohsfeldt, Ph.D., examined the costs of          placebo-controlled trials from         The study was published in
implementing a technology called computerized physician order             the Women’s Health Initiative,     the Journal of the American
entry (CPOE) in rural hospitals. They found that implementing CPOE        the researchers studied more       Medical Association. 
is financially prohibitive for these hospitals because they do not have   than 22,500 women, ages 50 to
a large enough patient load or large enough operating margins to          79, from clinical centers across
offset costs. For CPOE to be financially feasible, rural hospitals
                                                                                        WOMEN TAKING ESTROGEN HAD AN 80 PERCENT
would have to be subsidized for initial
                                                                                        INCREASED RISK FOR INFLAMMATION OF THE
and ongoing CPOE costs. Researchers
                                                                                        GALLBLADDER AND AN 86 PERCENT GREATER RISK
are concerned that if rural hospitals
                                                                                        FOR GALLSTONE DISEASE. THOSE TAKING ESTROGEN
are required to implement CPOE, the
                                                                                        PLUS PROGESTIN HAD A 54 PERCENT INCREASED
expenses may prohibit investments                                                       RISK FOR INFLAMMATION AND 68 PERCENT GREATER
in other technologies or programs                                                       RISK FOR GALLSTONE DISEASE. 
that could better enhance patient
safety and health care quality.




                                                                                                                                                27
                    research activity fy05

                    A Record-Breaking Year of Research Funding                        FY05 College of Public Health Research Awards
                    College of Public Health researchers set a new collegiate
                    record for external funding in fiscal year 2005, bringing in
                    $42.6 million as principal investigators on externally funded
                    grants and contracts. Projects on which college investigators
                    served as co-investigators generated an additional $22.3          $60M
                    million. William Clarke, Ph.D., professor of biostatistics, was
                    The University of Iowa’s top grant-getter in FY05, receiving      $50M
                    over $10 million in awards. A total of 12 CPH researchers
                    each were awarded more than $1 million for projects.
                                                                                      $40M

                    College Ranks Highly in NIH-Funded Research
                    The College of Public Health ranks fifth nationally among         $30M
                    state-supported schools of public health and ninth among
                    all schools of public health in National Institutes of Health-
                                                                                      $20M
                    funded research, according to a recent report by the
                    Association of Schools of Public Health (ASPH). The data,
                    which reflect direct cost expenditures from NIH grants and        $10M
                    contracts received, show that the College of Public Health
                    utilized $17.4 million in fiscal year 2003 as part of research
                                                                                        0
                    activities. The FY03 data are the most recent available.
                    Thirty-three of the 36 accredited schools of public health
                    contributed data to the ASPH report.

                    Research Week 2005
                    “Building Bridges in Science” set the theme for the 2005
                    Carver College of Medicine/College of Public Health/VA
                    Medical Center Research Week held May 18-20. This annual
                    event features talks by internationally known health experts,     New Investigators Honored
                    poster sessions, and panel discussions. Larry Robertson,          Each year newly appointed primary or joint faculty in the
                    Ph.D., professor of occupational and environmental health,        College of Public Health or the Roy J. and Lucille A. Carver
                    served on the Research Week organizing committee.                 College of Medicine are invited to apply for a New Investiga-
                       Two College of Public Health-invited speakers focused          tor Research Award. The awards assist new faculty to
                    on asthma. Dr. Erika von Mutius, head of the Asthma and           advance their research with up to $10,000 of funding and are
                    Allergy Department of Munich University Children’s Hospital       granted on the basis of scientific merit, relevance to the
                    in Munich, Germany, spoke on “Childhood Asthma: Defining          College of Public Health mission, and probability of attract-
                    the Role of the Environmental Exposure.” Dr. Carole Ober,         ing subsequent extramural research funding.
                    professor of human genetics at the University of Chicago,            The recipients of the 2004-05 New Investigator Research
                    addressed “Gene-Environment Interactions and the Search           Awards were Tarah T. Colaizy, M.D., assistant professor of
                    for Asthma Genes.”                                                pediatrics, division of neonatology; Thomas M. Peters, Ph.D.,
                       College of Public Health poster award recipients included      assistant professor of occupational and environmental health;
                    graduate students Laura Acion, Veerasathpurush Allareddy,         Philip M. Polgreen, M.D., associate in internal medicine,
                    Katarina Kulhankova, Jana Peterson, and Wei Zhang;                division of infectious diseases; and Tara C. Smith, Ph.D.,
in the field 2005




                    Postdoctoral Fellow and Resident Poster Session winner            assistant professor of epidemiology.
                    Kaitlin Rainwater; and Graduate Student Center on Aging
                    Award winner Dominic Cirillo.


                    28
Grant Activity Report All Grants Funded FY2004-2005


PI               Sponsor/Prime Sponsor          Direct      F&A          Total   Proposal Title
Akamigbo         NIH                            $3,008         $0       $3,008   Health Services and Outcomes in Elderly Black Women
Akamigbo         NIH                           $31,412         $0      $31,412   Health Services and Outcomes in Elderly Black Women
Atchison         CDC                        $1,050,444    $75,635   $1,126,079   Upper Midwest Center for Public Health Preparedness
Atchison         HRSA                         $434,544    $34,764     $469,308   Upper Midwest Public Health Training Center
Burns            Children’s Hosp Calif         $10,000         $0      $10,000   Smoking and Variation of Cardiovascular Disease Genes
Campo            IDPH/NIH                      $88,229     $7,058      $95,287   The Colorectal Cancer Awareness Campaign of Iowa
                                                                                 Comprehensive Cancer Control Program between the IDPH and UI
Chaloner         NSA                          $23,943     $11,373     $35,316    Bayesian Experimental Design
Chrischilles     IDPH/CDC                     $38,451      $2,956     $41,407    State Capacity Building Project
Clarke           Trustees, Columbia U/NIH     $33,276     $14,479     $47,755    Randomized Evaluation of Carotid Occlusion and
                                                                                 Neurocognition (RECON)
Clarke           NIH                        $8,739,599   $833,730   $9,573,329   Clinical Islet Transplantation: Data Coordinating Center
Clarke           NIH                          $645,383   $303,330     $948,713   Data Management Center (DMC) for the Carotid Occlusion
                                                                                 Surgery Study (COSS)
Clarke           Univ Texas/NIH               $73,554     $34,938    $108,492    Data Management Center for ‘A Comparison of Language
                                                                                 Intervention Programs’
Clarke           Univ Michigan/NIH            $70,917     $33,331    $104,248    Cognitive Function after Intracranial Aneurysm Surgery
Cook             NIH                          $41,667      $3,333     $45,000    Iowa International Research & Training in Environmental &
                                                                                 Occupational Health
Cook             NIH                         $233,229     $16,771    $250,000    Iowa International Research & Training in Environmental &
                                                                                 Occupational Health
Dennis           NIH                          $50,000     $23,750     $73,750    Trace Elements among Iowa Pesticide Applicators
Dennis           NIH                         $125,475     $10,038    $135,513    Sun Exposure and Melanoma in Agricultural Workers
Donham           IDPH/NIH                    $187,072     $14,967    $202,039    Comprehensive Assessment of Rural Health in Iowa (CARHI)
Donham           CDC                         $180,000     $70,087    $250,087    Certified Safe Farm: Evaluating Health Insurance Claims
Ferguson         BU/NIH                       $11,806        $944     $12,750    Tobacco Prevention/Cessation Education: Medical Students
Field            NIH                          $30,000          $0     $30,000    Iowa and Missouri Radon Lung Cancer Studies (Phase II)
Field            NIH                         $147,875     $55,989    $203,864    Iowa and Missouri Radon Lung Cancer Studies
Fitz-Randolph    NIH                          $62,945          $0     $62,945    Information Retrieval in the Injury Research Literature
Fuortes          DoD/Army                    $733,068    $186,932    $920,000    Epidemiologic Health Survey of Department of Defense
                                                                                 Contract Workers at the Iowa Army Ammunition Plant in
                                                                                 Middletown, IA: Analyses of Cohort Mortality/Cancer Incidence
                                                                                 and Surveillance for the Prevalence of Positive Beryllium
                                                                                 Lymphocyte Proliferation Tests
Fuortes          DoD/Army                     $43,825     $11,175     $55,000    Epidemiologic Health Survey of Department of Defense
                                                                                 Contract Workers at the Iowa Army Ammunition Plant in
                                                                                 Middletown, IA: Analyses of Cohort Mortality/Cancer Incidence
                                                                                 and Surveillance for the Prevalence of Positive Beryllium
                                                                                 Lymphocyte Proliferation Tests
Gerr             CDC                         $285,266    $120,146    $405,412    Prospective Study of UEMSD and Physical Job Stressors
Gray             NIH                         $200,000     $95,000    $295,000    Population-Based Surveillance for Zoonotic Influenza A
Gray             PPD Dev, Inc                  $3,637        $909      $4,546    A Randomized, Double-Blind Trial to Assess the Safety and
                                                                                 Relative Efficacy of CAIV-T Against Inactivated Influenza
                                                                                 Vaccine in Children 6-59 Months of Age (MI-CP111)
Gray             NIH                          $50,000     $23,750     $73,750    Human Metapneumovirus: Identifying High Risk Populations
                                                                                 and Viral Genotype Variation
Gray             NIH                         $498,392    $229,611    $728,003    National Surveillance for Emerging Adenovirus Infections
Greene           ASPH/NIH                    $169,492     $80,508    $250,000    Prostate Cancer Geocoding: Ensuring Fitness for Use
Heitbrink        Intl Truck/Engine Co         $68,533     $28,397     $96,930    Ultrafine Particles in Heavy Vehicle Assembly and Components
                                                                                 Manufacturing Plants
Johnson          Organon, Inc                 $46,000     $11,500     $57,500    Moonstone (Organon Protocol 177001)
Kohatsu          Berlax Labs, Inc             $50,586     $12,647     $63,233    A Multicenter, Double-Blind, Double-Dummy, Randomized,
                                                                                 Placebo-Controlled Study Comparing a 2.2mg 17 Beta-
                                                                                 Estradiol/0.69mg Levonorgestrel Combination Transdermal
                                                                                 Patch, and a 1mg 17 Beta-Estradiol Transdermal Patch with a
                                                                                 Placebo Patch in Post-Menopausal Women to Determine the
                                                                                 Lowest Effective Dose of Estradiol for the Relief of Moderate to
                                                                                 Severe Hot Flashes
Lehmler          NIH                         $115,213      $9,217    $124,430    Distribution of PCB Atropisomers
Lehmler          Univ Kentucky/NSF            $76,394          $0     $76,394    NIRT- Tailoring Fluorinated Surfactant Templates for the Design
                                                                                 of Nanoporous Ceramics
Lehmler          NIH                         $150,000     $56,430    $206,430    Perfluorocarbon Materials as Drug Delivery Vehicles
Levey            IPRO/CMS                     $78,476      $3,924     $82,400    Joint Study of Hospital Governance and Leadership: An Assessment
                                                                                 of QI Relationships
Levey            IPRO/CMS                     $71,429      $3,571     $75,000    Joint Study of Hospital Governance and Leadership: An Assessment
                                                                                 of QI Relationships
Lowe             CDC                         $377,540     $98,160    $475,700    Improving the Health of the Rural Upper Midwest through
                                                                                 Community Partnerships
Lowe             IDPH/CDC                    $415,738      $9,259    $424,997    Division of Tobacco Use Prevention and Control, Tobacco Cessation
                                                                                 Quitline for Iowa Families



                                                                                                                                                     29
                    PI           Sponsor/Prime Sponsor            Direct        F&A          Total   Proposal Title
                    Lowe         CDC                           $201,744       $1,224     $202,968    Improving the Health of the Rural Upper Midwest through
                                                                                                     Community Partnerships
                    Lowe         Wellmark Foundation            $23,810       $6,190      $30,000    Wellmark Blue Cross/Blue Shield
                    Ludewig      DoD/Army                      $201,401      $95,666     $297,067    Prostate Cancer Risk through Exposure to Halogenated Hydrocarbons
                                                                                                     and Modulation by Dietary Supplementation
                    Lundell      Gov Traffic Safety Bur/DOT      $27,500           $0      $27,500   Observational Child Restraint Survey
                    Lynch        NIH                          $2,636,447   $1,212,861   $3,849,308   SEER Program
                    Lynch        Coda, Inc/NIH                   $15,811       $3,162      $18,973   FAME (Parkinson’s Disease) Study - Iowa Field Station Component
                    Lynch        IA Board of Regents            $178,739           $0     $178,739   Iowa Cancer Registry
                    Lynch        Mayo Clinic/NIH                 $69,018      $32,438     $101,456   Immunogenetic Determinants of Non-Hodgkins Lymphoma (NHL)
                                                                                                     Survival
                    Lynch        CDC                             $5,424       $2,576       $8,000    Field Testing of Respiratory Questions/Questionnaires for Agricultural
                                                                                                     Health Study
                    Lynch        NIH                           $254,518      $70,900     $325,418    Agricultural Health Study Field Station - Iowa Field Station
                    Lynch        NIH                           $242,028     $107,972     $350,000    Agricultural Health Study Field Station - Iowa Field Station
                    Meier        Univ Ill - Chicago/NIH        $108,333       $8,667     $117,000    Midwest AIDS Training and Education Center (MATEC)
                    Parker       DoD/Navy                       $52,987           $0      $52,987    NAMRU-3 Research Science Directorate (RSD), Virology Research
                                                                                                     Program
                    Parker       DoD/Navy                       $52,987           $0      $52,987    NAMRU-3 Research Science Directorate (RSD), Virology Research
                                                                                                     Program
                    Peek-Asa     CDC                           $341,843      $60,342     $402,185    Evaluation of California Initiatives to Reduce Violence in Health Care
                                                                                                     Facilities
                    Peek-Asa     NIH                           $136,565       $9,235     $145,800    International Collaborative Trauma and Injury Research Training (ICTIRT)
                    Pendergast   IA Dept Human Serv/SSA         $23,148       $1,852      $25,000    Bridge to Employment - SSA Cooperative Agreement
                    Pendergast   IDPH/CDC                      $257,697      $20,616     $278,313    BCCEDP & WISEWOMAN
                    Peters       TSI, Inc                       $15,737       $7,475      $23,212    Modification and Evaluation of the APS3321 for Ambient Air Monitoring
                    Peterson     MBHP/Mass                      $62,910       $9,434      $72,344    MassHealth Essential Care Program: Process and Outcome Evaluation
                    Robinson     Wellmark Foundation            $50,000           $0      $50,000    Internet-Based, Integrated Program for Global Cardiovascular
                                                                                                     Risk Management
                    Robinson     Pfizer, Inc                    $30,000           $0      $30,000    Internet-Based Health Risk Tracker for Management of Global
                                                                                                     Cardiovascular Risk
                    Robinson     Merck & Co, Inc                $16,240       $4,060      $20,300    Protocol #058-00/EZT555: A Multicenter, Randomized, Double-Blind
                                                                                                     Study to Evaluate the Lipid-Altering Efficacy and Safety of Ezetimibe/
                                                                                                     Simvastatin Combination Tablet versus Rosuvastatin in Patients with
                                                                                                     Primary Hypercholesterolemia
                    Robinson     Pfizer, Inc                    $94,918      $23,730     $118,648    A Phase 3, Double-Blind, Placebo-Controlled, Randomized, Parallel
                                                                                                     Group, Multicenter Study of the Efficacy, Safety and Tolerability of Fixed
                                                                                                     Combination Torcetrapib/Atorvastatin Administered Orally, Once Daily
                                                                                                     for 6 Months, Compared to Atorvastatin Alone or Placebo, in Subjects
                                                                                                     with Mixed Dyslipidemia (Frederickson Types IIa and IIb) Study #
                                                                                                     A5091018
                    Robinson     Merck & Co, Inc                $32,669       $8,167      $40,836    Title not available until study completion
                    Robinson     Wake Forest Univ/NIH           $81,102       $6,494      $87,596    Effects of Hormone Therapy on Subclinical Neurological Pathology
                                                                                                     (WHIMS-MRI)
                    Robinson     Pfizer, Inc                   $532,480     $133,120     $665,600    A Phase 3, Double-Blind, Placebo-Controlled, Randomized, Parallel
                                                                                                     Group, Multicenter Study of the Efficacy, Safety and Tolerability of Fixed
                                                                                                     Combination Torcetrapib/Atorvastatin Administered Orally, Once Daily
                                                                                                     for 6 Months, Compared to Atorvastatin Alone or Placebo, in Subjects
                                                                                                     With Mixed Dyslipidemia (Frederickson Types IIa and IIb) Study #
                                                                                                     A5091018
                    Robinson     Merck & Co, Inc                $29,975       $7,494      $37,469    Title not available until study completion
                    Robinson     Pfizer, Inc                    $33,351       $8,338      $41,689    Phase 3, Multi-Center, Double-Blind, Randomized, Parallel Group Study
                                                                                                     of the Efficacy, Safety, and Tolerability of Fixed Comination Torcetrapib
                                                                                                     (CP-529,414)/Atorvastatin Administered Orally, Once Daily (QD) for Six
                                                                                                     Months, Compared with Maximally Tolerated Atorvastatin Therapy
                                                                                                     Alone, in Subjects with Heterozygous Familial Hypercholesterolemia
                                                                                                     Study # A5091026
                    Robinson     AEA                             $8,400           $0       $8,400    The Effect of Emu Oil on Plasma Anti-Inflammatory Markers in Humans
                    Robinson     AstraZeneca Pharm               $3,600         $900       $4,500    A Randomized, Double-Blind, Placebo-Controlled, Multicenter, Phase III
                                                                                                     Study of Rosuvastatin (CrestorÆ) 20 mg in the Primary Prevention of
                                                                                                     Cardiovascular Events Among Subjects with Low Levels of LDL-
                                                                                                     Cholesterol and Elevated Levels of C-Reactive Protein (Protocol
                                                                                                     4522US/0011)
                    Romitti      CDC                            $34,003       $9,180      $43,183    Surveillance and Epidemiology of Duchenne and Becker Muscular
                                                                                                     Dystrophy
                    Romitti      Health Research, Inc/CDC       $20,486         $965      $21,451    Iowa Center for Birth Defects Research and Prevention
in the field 2005




                    Romitti      Emory Univ/NIH                 $13,814       $6,561      $20,375    Trisomy 21: Risk Factors for Chromosome Nondisjunction
                    Romitti      CDC                           $782,644     $208,614     $991,258    Surveillance and Epidemiology of Duchenne and Becker Muscular
                                                                                                     Dystrophy
                    Romitti      CDC                           $774,988     $121,915     $896,903    Centers for Birth Defects Research and Prevention
                    Romitti      IA Board of Regents            $44,636           $0      $44,636    Iowa Birth Defects Registry


                    30
PI            Sponsor/Prime Sponsor            Direct        F&A           Total   Proposal Title
Romitti       Health Research, Inc/CDC      $219,068      $17,525      $236,593    Birth Defects Prevention Study
Romitti       CMR/CDC                       $170,595      $81,032      $251,627    Follow-up Study for Children Affected by Craniofacial Malformations to
                                                                                   Assess Access to Services, Impact on the Family and Long-Term
                                                                                   Outcomes
Romitti       CDC                           $326,469      $88,146      $414,615    Surveillance and Epidemiology of Duchenne and Becker Muscular
                                                                                   Dystrophy
Sanderson     CDC                          $1,102,333    $273,227     $1,375,560   Great Plains Center for Agricultural Health
Sanderson     CDC                          $1,050,025    $255,006     $1,305,031   Great Plains Center for Agricultural Health
Schneider     VA                             $240,950                   $240,950   Ergonomics Effects of Clinical Practices Guidelines
Skinstad      SAMHSA                          $92,593      $7,407       $100,000   Prairielands Addiction Technology Transfer Center
Skinstad      SAMHSA                         $509,259     $40,741       $550,000   Prairielands Addiction Technology Transfer Center
Smith         NIH                            $250,000     $50,350       $300,350   Transcriptional and Genetic Profiles in HNSCCs
Smith         Univ Wisc-Madison/NIH           $15,918      $7,481        $23,399   Novel Approaches to Detect Virus-Cancer Associations
Sprince       CDC                          $1,179,945     $80,772     $1,260,717   Heartland Center for Occupational Health & Safety
Sprince       OPSF                            $43,428          $0        $43,428   Occupational Physicians Scholarship Fund
Sprince       CDC                          $1,329,354     $89,175     $1,418,529   Heartland Center for Occupational Health and Safety Education Research
                                                                                   Center (ERC)
Thompson      IDPH/NIH                        $1,115          $89         $1,205   Colorectal Cancer Provider Publications
Thorne        NIH                           $268,906     $126,386       $395,292   Exposure Intervention in a Rural Pediatric Asthma Cohort
Thorne        Univ Ill - Chicago/NIH          $7,970           $0         $7,970   Safer Pest Control Dust Sample Analysis
Thorne        Columbia Univ/NIH               $4,246       $1,995         $6,241   Environmental Health in a Cohort of Minority Women and Infants
Thorne        NIH                           $681,090     $318,910     $1,000,000   Environmental Health Sciences Research Center
Torner        NIH                            $50,000       $7,764        $57,764   Laxity and Malalignment in a Large Cohort Study of OA
Torner        Indiana Univ/NARSAD            $19,644           $0        $19,644   Investigation of Elevated Risk for Brain Tumors in Psychiatric and
                                                                                   Affective Disorders
Torner        Palmer Chiro Univ/NIH           $4,630         $370        $5,000    K-30: Chiropractic Clinical Research Consortium
Torner        NIH                           $266,238     $126,463      $392,701    Unruptured Intracranial Aneurysms: Neurologic Outcome
Torner        NIH                           $382,152      $71,782      $453,934    Multicenter Knee Osteoarthritis Study (MOST)
Uden-Holman   HRSA                           $23,110           $0       $23,110    Public Health Traineeship Grant
Vieland       NAAR                          $211,062      $21,106      $232,168    Autism Genome Project
Vieland       Stanford Univ/NIH              $90,980      $43,216      $134,196    Infrastructure to Facilitate Discovery of Autism Genes
Vieland       Carver Charitable Trust       $167,752           $0      $167,752    Integrated Statistical and Computational Methods for Isolating Genes for
                                                                                   Non-Syndromic Cleft Lip with or without Cleft Palate
Wakefield     Trinity Health/AHRQ            $92,623           $0       $92,623    Rural Iowa Redesign of Care Delivery with HER Function
Wallace       Univ Michigan/NIH              $77,861      $36,594      $114,455    Health and Retirement Study (HRS) - Dementia
Wallace       ISU/NIH                        $45,918       $3,673       $49,591    Epidemiologic Studies of Botanical Supplements (Center for Research on
                                                                                   Botanical Dietary Supplements - Clinicians Scientist Training Program)
Wallace       Yeshiva Univ/NIH               $30,119      $14,156       $44,275    Fat Reduction, HRT Use, and Benign Breast Disease Risk [Benign Breast
                                                                                   Disease Add-on Study to the Women’s Health Initiative (WHI) Clinical Trial]
Wallace       NIH                           $308,970      $91,030      $400,000    Clinical Center for the Clinical Trial and Observational Study of the
                                                                                   Women’s Health Initiative (WHI)
Wallace       NIH                           $537,051     $251,523      $788,574    Lung Cancer Care Outcomes/Surveillance Consortium - Iowa
Wallace       Pfizer, Inc                    $37,428       $9,357       $46,785    Amendment to Lasofoxifene PEARL Study (protocol #A2181002)
Wallace       Wayeth-Ayerst Labs              $2,928         $732        $3,660    Effects of Hormone Therapy on the Development and Progression of
                                                                                   Dementia, a/k/a Women’s Health Initiative Memory Study (WHIMS)
Wallace       Wake Forest Univ/NIH           $35,627       $9,263       $44,890    Safety Monitoring and Surveillance of Estrogen Alone (E-alone) and
                                                                                   Estrogen plus Progestin (E+P) Study Participants for Dementia, Mild
                                                                                   Cognitive Impairment, and Global Cognitive Function [WHIMS Follow-up]
Wallace       Univ Michigan/NIH              $78,706      $37,383      $116,089    Health and Retirement Study (HRS) - Diabetes
Wallace       Univ North Carolina/NIH         $3,051       $1,449        $4,500    Mammographic Density in Invasive Breast Cancer (Women’s Health
                                                                                   Initiative Ancillary Study)
Wallace       Berlex Labs, Inc                $6,256       $1,564        $7,820    Breast Density in ULTRA
Wallace       Wake Forest Univ/NIH           $14,683       $3,818       $18,501    Women’s Health Initiative Study of Cognitive Aging (WHISCA)
Wallis        AECF                           $27,606       $1,380       $28,986    Causes and Consequences of Medical Debt in Des Moines
Wallis        UNI/CDC                        $69,126       $5,530       $74,656    Evaluation of the Iowa Comphrehensive Cancer Control State Plan
Wallis        Mid-IA Health Found/RWJF       $24,480       $1,958       $26,438    Evaluation of the Neighborhood Health Initiative
Wallis        AECF                          $176,892      $14,151      $191,043    Making Connections - Evaluation Consultation
Ward          AHRQ                          $325,543     $153,208      $478,751    Health Information Technology Value in Rural Hospitals
Wolinsky      NIH                           $245,886     $112,236      $358,122    Health and Health Services Use in the HRS/AHEAD
Wolinsky      Wellmark Foundation            $15,000           $0       $15,000    Healthy Aging Policy Conference
Wolinsky      Indiana Univ/NIH               $55,768      $26,490       $82,258    Physical Frailty in Urban African Americans
Wolinsky      VA                             $47,000           $0       $47,000    Postdoctoral Fellowship Program in HSR&D
Zimmerman     IA Dept of Education/DOEd      $26,296       $2,104       $28,400    Services Related to Employment Preparation Study
Zwerling      IDPH/CDC                      $113,970       $9,118      $123,088    Iowa Fatality Assessment and Control Evaluation (FACE) Program
Zwerling      IDPH/CDC                      $113,820       $9,106      $122,926    Iowa Fatality Assessment and Control Evaluation (FACE) Program
Zwerling      CDC                           $659,064     $241,094      $900,158    The University of Iowa Injury Prevention Research Center

                                          $35,118,875   $7,464,617   $42,583,493




                                                                                                                                                                 31
                    faculty essay                                     Linda Snetselaar, R.D., Ph.D.
                                                                      UNIVERSITY OF IOWA ENDOWED CHAIR OF PREVENTIVE NUTRITION EDUCATION
                                                                      AND PROFESSOR OF EPIDEMIOLOGY




                                            Reviving the Lost Art of the Family Table

                                            for the last century, several generations of americans have taken for granted the
                                            expectation that they would live longer than their parents. At the dawn of the 21st century,
                                            however, this trend seems in danger of reversing. Recent research has shown that on
                                            average, people who are obese as children will die nine years younger than their parents
                                            due to complications from cardiovascular disease, diabetes, cancer, and arthritis. As a
                                            dietitian and researcher, this grim forecast has made me think about why the two cornerstones
                                            of weight management—dietary change and increased exercise—don’t often work in
                                            overweight children.
                                                Part of the problem is that food consumption is tied to where we are, what we’re doing,
                                            and who we’re with. Food is everywhere, and unfortunately, most of it is not nutritious.
                                            In my opinion, as we seek to change eating habits, we must consider the many food-related
                                            venues and behaviors that contribute to poor nutrition.
                                                One of these behaviors is the custom of having food, usually unhealthy food, available
                                            during all activities. Pop machines are in every school, office building, and public arena.
                                            Cup holders are in every car. Nearly all sporting events and movie theaters have snack stands
                                            that sell high-fat treats. Stocking these ubiquitous machines and stands with healthy foods
                                            would be a beginning to a societal effort toward better health.
                                                The advertising of high-fat foods also plays a large role in childhood obesity. Manufacturers
                                            of high-fat snack foods target children in advertising whether on television, in grocery stores,
                                            or on billboards. Limiting snack-food advertising strategies aimed at children and promoting
                                            fruits and vegetables would go far in shaping the next generation’s attitudes towards eating.
                                                Finally, the epidemic of over-scheduling has eroded the time that family members spend
                                            eating together. In the rush to attend meetings, practices, and classes, families often eat rapidly
                                            and choose low-nutrient foods that are quick to make or order from the drive-through lane.
                                            In families where there is a genetic predisposition to overweight or obesity, eating on-the-run
                                            day after day can lead to weight gain in the short-term and genetic-related diseases down the
                                            road. Modifying dietary habits—including taking the time to prepare and consume healthful
                                            meals—is one way of reducing disease risk.
                                                In many homes, the marvelous art of calmly talking to each other while eating a nutritious
                                            meal has been lost. The family table is a wonderful place to experience the pleasure of sharing
                                            food and conversation with others and learn the value of eating a healthy meal. Reviving this
                                            old-fashioned custom may well be the best solution to the enormous threat that obesity poses
                                            to our children’s future.


                         POP MACHINES ARE IN EVERY SCHOOL, OFFICE BUILDING, AND PUBLIC ARENA. CUP HOLDERS
                         ARE IN EVERY CAR. NEARLY ALL SPORTING EVENTS AND MOVIE THEATERS HAVE SNACK STANDS
                         THAT SELL HIGH-FAT TREATS. STOCKING THESE UBIQUITOUS MACHINES AND STANDS WITH
                         HEALTHY FOODS WOULD BE A BEGINNING TO A SOCIETAL EFFORT TOWARD BETTER HEALTH.
in the field 2005




                    32
Contact information

Leon Burmeister, Ph.D.
Associate Dean for Research and Academic Affairs
College of Public Health
The University of Iowa
E220G General Hospital
200 Hawkins Drive
Iowa City, IA 52242-1009
319/384-5488
leon-burmeister@uiowa.edu

Kathy Hicklin
Program Assistant
Office of the Associate Dean for Research
  and Academic Affairs
College of Public Health
The University of Iowa
E222 General Hospital
200 Hawkins Drive
Iowa City, IA 52242-1009
319/384-5491
kathy-hicklin@uiowa.edu



Visit the College of Public Health Research Office web site at
www.public-health.uiowa.edu/research/




Credits
College of Public Health Office of Communications
 Daniel McMillan, Director
 Kate Gleeson, Writer
 Debra Venzke, Writer
 Patti O’Neill, Designer




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and activities on the basis of race, national origin, color, creed, religion, sex, age, disability,
veteran status, sexual orientation, gender identity, or associational preference. The University
also affirms its commitment to providing equal opportunities and equal access to University
facilities. For additional information contact the Office of Equal Opportunity and Diversity,
(319) 335-0705. 56163/2-06
2005          public health research at the university of iowa




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