“emerging activities in rural areas” richard f. hamman, md, drph dean

University of Colorado Denver | Colorado State University | University of Northern Colorado

“Emerging Activities in Rural Areas”

Richard F. Hamman, MD, DrPHDean


Overview• Introduction• Rural activities • Training• Joint degrees• Questions

Colorado State

3

What is Public Health?

Public Health is the science and art of protecting and improving the health of communities through

education, promotion of healthy lifestyles, and

research for disease and injury prevention.

University of Colorado Denver | Colorado State University | University of Northern Colorado4

““Health Care is vital to all of us Health Care is vital to all of us

some of the time but some of the time but

public healthpublic health

is vital to all of us all of the time”is vital to all of us all of the time”

C. Everett KoopFormer Surgeon General


Association of Schools of Public Health (ASPH) Report“Confronting the Public Health Workforce Crisis”KEY FACTS: • ASPH estimates that 250,000 more public health

workers will be needed by 2020. • The public health workforce is diminishing over time

(there were 50,000 fewer public health workers in 2000 than in 1980), forcing public health workers to do more for more people with fewer resources.


ASPH Report“Confronting the Public Health Workforce Crisis”

• 23% of the current workforce – almost 110,000 workers – are eligible to retire by 2012.

• Documented and forecasted shortages of – – public health physicians– public health nurses– epidemiologists – health care educators– administrators


ASPH Report“Confronting the Public Health Workforce Crisis”• To replenish the workforce and avert the crisis,

schools of public health will have to train three times the current number of graduates over the next 12 years

(Note, this doesn’t even include the massive need to provide continuing, career long training to those already in the workforce)

In the news

Viral disease sickens hundreds in ChinaThe Associated Press May 19, 2007

BEIJING- An outbreak of a viral disease common in children has sickened almost 900 people in eastern Chinabut the outbreak has been contained, state mediasaid Saturday.

Quarantine laws need strengthening in light of TB case, health official says By KEVIN FREKING Associated Press Writer June 9,2007Plague found in Park Hill critters

Jeremy P. Meyer Denver Post Staff Writer April 28,2007

Five squirrels and one rabbit found dead in the Park Hill neighborhood tested positive for plague, leading health officials to caution the public against handling dead animals.

Chan: Bird flu huge global health threatELIANE ENGELER Associated Press Writer May16.2007

GENEVA- “The U.N. health chief on Wednesday harshly criticized countries that do not share their H5N1virus samples, accusing them of crippling the worldin the fight against a possible flu pandemic.”

New resistant bird-flu strainstrikes Asian fowl, peopleRandolph E. Schmid Associated Press

E. coli triggers ground beef recall Two sickened by bacterium The Denver Post June 4,2007Denver - The Consumer Protection Division of the Colorado Department of Public Health and Environment suggested that Coloradans who purchased certain packages of Moran's ground beef at local Albertsons stores check to make sure it hasn't been recalled due to possible contamination with E. coli.

Moose test positive for Chronic Wasting DiseaseJeremy P. Meyer Denver Post Staff Writer Nov 9, 2006

Two bull moose legally harvested by hunters last month in northern Colorado tested positive for chronic wasting disease, the Colorado Division of Wildlife said today.

Grand Junction woman dies of West NileThe Associated Press Oct 21,2006

Colorado mercury emissions higher?Kim McGuire Denver Post Staff Writer Dec10, 2006

Front Range on brink of clean-air violationsKim McGuire Denver Post Staff Writer Nov 12, 2006

Front Range on brink of clean-air violationsKim McGuire Denver Post Staff Writer Nov 12, 2006

Contaminated pet food fed to hogs in 5 statesThe Associated Press Apr 25, 2007

Too many kids pudgy by preschoolStudy finds Latino children most at risk; using a bottle at age 3 a clueLauran Neergaard Associated Press Dec 28, 2006

Washington - Too many kids are fat by preschool, and Latino youngsters are most at risk, says new research that's among the first to focus on children in poverty. Seventeen percent of U.S. youngsters are obese, and millions more are overweight.

Wednesday, February 4, 2009

Vitamin Cottage recalls ground peanut butter amid salmonella outbreakDenver Business Journal

We need a well trained public health workforce!

We need a well trained public health workforce!

mailto:[email protected]?subject=The%20Denver%20Post:%20Front%20Range%20on%20brink%20of%20clean-air%20violations

mailto:[email protected]?subject=The%20Denver%20Post:%20Front%20Range%20on%20brink%20of%20clean-air%20violations


• University of Colorado Denver• Colorado State University• University of Northern Colorado

together with• CDPHE & Local Health Departments

The Colorado School of Public Health is a collaboration of :


MissionThe mission of the Colorado School of Public Health is to promote the physical, mental, social and environmental health of people and communities in the Rocky Mountain Region and globally.

The mission will be accomplished through collaborations in education, population-based research, and community service that bring together institutions, agencies and diverse populations.


Schools of Public Health: July 1, 2008


UC DenverMedicineNursingDentistryPharmacyGraduateBusiness

Public AffairsLiberal Arts and SciencesArchitecture and Planning

Engineering

CSUVeterinary Medicine

& Biomedical Sciences Agricultural Sciences

Applied Human Sciences Natural Sciences

UNCEducation & Behavioral Sciences

Natural & Health Sciences

Academic

Future Partners: Regional Universities, State and Community Colleges and Private Institutions

Departments and AgenciesCO Dept of Public Health & Environment

Local Health DepartmentsCommunity Agencies

Affiliated Health Care & Environmental OrganizationsAnd others

University Linked Organizations Area Health Education Centers-UCD

CSU Cooperative Extension

Colorado School of Public Health

Center for Public Health Practice

Rocky Mountain Prevention Research CenterNIOSH MAP ERC

Colorado Injury Control Research Center

Center for Global HealthCenter for Native American /

Alaskan Native Health

UCDAltitude Research Center • Barbara

Davis Center for Childhood Diabetes • Center for Health Services & Policy Research • Colorado Comprehensive

Cancer Center

UCB, CU SystemColeman Institute • Institute of

Behavioral Sciences •

CSUArthropod-Borne & Infectious

Disease Laboratory • Center for Environmental Toxicology &

Technology • Tri-Ethnic Center for Prevention Research • Center on Aging • High Plains Intermountain Center for Agricultural Health and

Safety

UNC• Center for Applied Gerontology

Research • Center for Social Science Research •

Collaborative•Bio-Defense & Emerging Infectious Diseases • Consortium for Human

Nutrition •And others

Research

Community

Collaborations


Educational Programs• Goal: Create effective educational programs

characterized by collaborative, multidisciplinary approaches to educate and train highly competent and committed public health professionals and research scientists.


MPH concentrations• UC Denver

o Applied Biostatisticso Community & Behavioral Healtho Environmental & Occupational Healtho Epidemiologyo Health Systems Management & Policyo Generalist

• CSUo Generalist

Focus areas in: Epidemiology, Environmental & Occupational Health, Global Health & Health Disparities, Health and Exercise, Health Communication, Public Health Nutrition

• UNCo Community Health Education


Doctoral programs

• UC Denvero MS/PhD in Biostatisticso PhD in Epidemiologyo PhD in Health Services Researcho DrPH (under development)

• CSUo MS/PhD in Environmental & Occupational

Health


Current Enrollment (Fall 2008)

• MPH 150 (50 new)– Includes 35 in MSPH – 4 DVM/MPH at CSU– 1 MPH at CSU– Will add about 25-30 from UNC in spring

• Certificate Students 60 (35 new)• PhD 53 (10 new)

– Bioinformatics 10 – Biostatistics 12– Epidemiology 21– Health Services Research 10

• MS Biostatistics 23• Preventive Medicine Residents 6• Occupational Medicine Residents 5

• TOTAL 297


FacultyArea Primary 2nd/Affil Total

Biostatistics 23 38 61

Community & Behavioral Health 50 32 82

Environmental & Occupational Health 16 22 38

Epidemiology 24 22 46

Health Systems, Mgmt & Policy 7 21 28

Total 120 135 255


Center for Public Health Practice• Goal: Create a Center for Public Health

Practice to bridge academic public health with state and local health agencies, healthcare providers, and community based organizations.

Community Outreach Continuing Education Service Opportunities Research in Public Health Practice


Research• Goal: Advance the scientific basis for the

practice of public health with research that addresses the important public health issues in Colorado and the Rocky Mountain region.


Current Research - overview• Biostatistical / Informatics

methods• Clinical trials methods• Disease etiology and prevention

– Cancer, Diabetes (Type I, II), COPD, CVD, Injury, Autism, Skin cancer, Obesity, Depression

• Genetic epidemiology– Diabetes, COPD, CVD, Cystic

fibrosis• Lifecourse epidemiology

– Obesity, CVD risk, Asthma, Autism, Diabetes, Birth defects, Behavioral interventions

• Community participatory research

– School policy, nutrition, physical activity, obesity prevention

• PH practice research network• Environmental health

– Built environment, air pollution• Occupational health

– Beryllium, methamphetamine labs, radiation workers

• Health services research– Medicare, Medicaid, costs of

prevention• Health Policy


Facilities Fitzsimons Army HospitalBuilding 500 – 3rd Floor

Colorado State


Timelines

2006 2007 2008 2009 2010 2011 2012 2013 2014

DevelopmentOperational

Phase IIOperationalAccreditedAccredited

Today

First class admitted

Accreditation site visit Spring 2010 Accreditation Fall 2010Self Study

Applicant status for accreditation Spring 2008


Rural Activities• San Luis Valley Programs• School Programs• HICHAS - High Plains Intermountain Center for

Agricultural Health and Safety (CSU)• Community Exposures and the Oil and Gas Industry• Colorado Injury Control Research Center• Colorado Colorectal Cancer Screening Program• Public Health Practice-based Research Network• American Indian Alaskan Native Research (CAIANH)• Training


Family-Based Prevention of Type 2 Diabetes

& its Complications

Principal Investigator: Julie A. Marshall, PhD

Rocky Mountain Prevention Research Center

of the San Luis Valley Health StudiesUniversity of Colorado at Denver

Rocky Mountain

Prevention Research Center


SLV Healthy Family Project*funded by the National Institutes of Health

• Purpose: – Prevention of type 2 diabetes and its complications– Translation of DPP findings

• Population: Families at risk for developing type 2 diabetes and/or its complications– Primary, secondary and tertiary prevention– Social & physical factors support healthy behaviors

• Design:– Randomized control trial of 250 families in SLV

• Randomization ratio 2:1


Diabetes Prevention Program*Percent reduction in diabetes risk by race-ethnicity compared with placebo

-80

-60

-40

-20

0

Caucasian(n=1768)

AfricanAmerican(n=645)

Hispanic(n=508)

AmericanIndian (n=171) Asian (n=142)

%


Intervention Goals

• Improve Diet• Increase physical activity• Achieve and maintain healthy weight• Improve disease management• Increase use of community resources

Healthy FamilyHealthy FamilyProjectProject

NatureWalk

Realization thatwalking can be

good qualitytime with family

Realization thatwalking trailsare close by

Realization that evenwhen feeling tired,still can find energy

to go for a walk

Increase physical activityRealization that

walking doesn’tcost money

Intervention Activity Mediating Factors Outcome


Family LifestyleCoach

Community Resources

•Family•Home

•Worksite•Community

•School

Health CareSystem



SLVHFP Intervention

• Family Lifestyle Coach trained in behavior change strategies using Motivational Interviewing

• Choose target behaviors and develop individualized action plan

• Receive 12-16 home visits over a 4-8 month period



Outcomes

• Weight loss, reduced weight gain• Biochemical markers of insulin

resistance• Nutrition and physical activity

changes• Use of community resources• Mediators of change



School-based programs• School Environment Project (San Luis Valley - 10 schools - CDC)

– intervention to increase opportunities for physical activity and healthy eating through school environment and policy change

• SLV Physical Education Collaborative (CCTSI)– planning grant to form a collaborative that will identify the current state

of physical education in the SLV and barriers/facilitators to increasing quality and quantity of PE

• Integrated Nutrition Education Program– 8 schools in the SLV (joint with Pediatrics)

• What’s Working Project (45 rural low income elementary schools - RWJF)

– evaluation study to understand the initial impact of federally mandated local wellness policy on school environment (nutrition and activity)


Local School Policy Evaluation (“What’s Working Project”)• Described the initial impact of the US federally

mandated Local Wellness Policy in rural, low-income elementary schools located in Colorado.

• Random sample of 45 rural elementary schools (40+% of students qualified for free or reduced-cost lunch)

• Opportunities for physical activity did not change after the policy went into effect:

– time in physical education increased by 14 min per week (P=0.10), but time for recess decreased by roughly 19 min per week (P=0.10)

– Policies supporting student participation in physical education and recess did not change.

• Local Wellness Policies were weakly worded and resulted in minimal impact

• Barriers: (1) competing pressures facing school districts; (2) lack of resources devoted to the Local Wellness Policy; (3) principals’ lack of knowledge about the policy, and (4) lack of accountability mechanisms to ensure policy implementation


High Plains Intermountain Center for Agricultural Health and Safety• Mission: to reduce illness, injury,

and fatalities in agriculture• Major areas:

– organic dust lung disease in multiple regional settings– development of novel and user friendly biomarkers for

pesticides– Engineering research related to development and

retrofitting of tractor rollover protection structures• Strong emphasis on the large Hispanic workforce in

the region and on children


High Plains Intermountain Center for Agricultural Health and Safety (HICAHS)• Current research

– An intervention to improve the design of milking parlors at dairies to reduce injuries and long-term degenerative diseases

– impact of exposure to dust, ammonia and bacterial endotoxins on respiratory disease rates of dairy workers

– development of an educational CD about health and safety for 4-H programs

– evaluating the effectiveness of health and safety information to agricultural workers


Potential Human Health Effects of Oil and Gas Development in Rural Colorado• Exposure to oil and gas activity and chemicals associated with it can adversely

impact human health:– increased risk of cancers, pulmonary, cardiovascular, neurological, and

other diseases; adverse birth outcomes and children’s health• Major gaps in the past assessment of air quality related to oil and gas

development on the Western Slope• Garfield County air quality studies indicate that potential exposures to

hazardous emissions exist • Acute problem with toxic emissions of uncertain proportions and a possible

emergent problem for the health of the citizens of Garfield County due to unmeasured or under-measured toxics in Garfield County, despite the increase in oil and gas development known to produce these chemicals

• Health Impact Assessment of oil and gas development in Colorado should be done

Testimony to Colorado Air Quality Commission, October 2008

Garfield County

Colorado

Potential Exposure-Related Human Health Effects of Oil and Gas Development:Witter R, Stinson K, Sackett H, Putter S, Kinney G,Teitelbaum D,

Newman L


Adverse health outcomesGarfield County, CO

• Garfield County higher (vs. other West Slope counties)– Children hospitalized for seizures and headache,

bronchitis, asthma, respiratory infection– Birth and pregnancy outcome disorders– Alcohol and drug disorders

• 2000-2005:– Violent crime rates increased (per 10,000 residents):

8.5 to 19.7• (Rape/other sex crimes, robbery, aggravated assault)

– Drug violations increased: 19.4 to 39.7Saccomano study 2000-2007


Colorado Injury Control Research CenterCSU-UC Denver collaborative Center• Drug use and risky behavior among rural youth • Laboratory based research

– survival of sensory and motor neurons after injury– protective factors against brain injury

• Motor vehicle mortality in rural and urban areas• Rehabilitation care for individuals suffering traumatic brain

injuries• Risk communication for injuries• Community based traumatic brain injury prevention• Injury among disabled individuals• Alcohol-impaired Driving: Register of Controlled Studies


Colorado Injury Control Research Center

• Marketing Fall Prevention Classes to Older Adults in Faith-Based Congregations: Cluster Randomized Controlled Trial

• Focused on Grand Junction and regional rural populations

• Aims to increase use of fall prevention classes that are known to be effective among rural elderly through social marketing


Colorado Injury Control Research Center – Community Initiated Grant Program

• Salud Family and Health Centers– Provide bicycle helmets & car seats to migrant families at two health

fairs in Northern Colorado• Larimer County Department of Health and Environment - Newborn,

Infant and Toddler Safety Project– Provide home environment safety training and equipment to prevent

early childhood injuries• Centennial BOCES –Migrant Education Program, Greeley, CO Injury

Prevention and Education for Migrant and Homeless Families– Provide migrant and homeless families with information, skills and

resources to prevent and control intentional and unintentional injuries


Colorado Colorectal Cancer Screening Program

• Funded by the tobacco tax revenues competitive grants program

• Goal: Increase colorectal screening rates among Coloradans ages 50 and older to 75% by 2010.

– Provide endoscopic colorectal screening to persons without health insurance who are under 250% Federal Poverty Level and who need screening

– Encourage all Coloradans ages 50 and older to get screened

• Began in January 2006, expanded statewide in November 2006

• Over 6500 patients screened to date – 24% had adenomas removed (most

likely to progress to cancer)– 1% were diagnosed with cancer

A partnership between the University of Colorado Cancer Center, community clinics and their screening partners


Local Public Health Agencies• 54 local public health

agencies that serve 64 counties in Colorado– 15 organized health

departments– 39 public health nursing

services• Serve populations

ranging in size from less than 1000 to over 1.2 million Organized health departments (color)

Nursing services (white)


Colorado Public Health Practice-Based Research Network

• Partnership between The Public Health Alliance of Colorado and CSPH

• Develop network infrastructure to support communication, decision-making, training and priority setting

• Develop data system infrastructure: performance measures, data on environmental health determinants; population-based health status and health behavior measures

• Identify high priority research questions• Identify strategies and resources to institutionalize research

as an integrated component of the public health system• Study the impact of SB08-194


Colorado Public Health Reauthorization ActSenate Bill 08-194

• Passed in June 2008 to address outdated laws • Define public health and core public health services• Require each local public health agency to have a county

or district board of health• Expand powers and duties of the State Board of Health• Expand powers and duties of county/district boards of

health• Outline powers and duties of local public health agencies

and directors• Require a public health planning process to further develop

the new model of public health service delivery and to address related workforce and funding issues


Center for American Indian Alaskan Native Health (CAIANH)

• The CAIANH works in AI/AN communities across the nation

• AI/AN populations remains one of the most rural in the US, though increasingly urbanized

• AI/AN population is a relatively small proportion of the US population and, in urban areas, tends not to live in ethnic enclaves

• Health research with AI/AN often takes place on or near reservations (or villages in Alaska)


Center for American Indian Alaskan Native Health (CAIANH)


Training in rural areas• MPH students

– Practicum; capstone project; electives– Community Health Assessment class

• Preventive Medicine Residents– Training grant has focus on medically underserved

communities: Salud FHC; Health District of Northern Larimer County; AHEC

– Elective courses; visiting faculty• Other health sciences students interested in public

health


Joint Degree Programs• MD/MPH

– Proposed to start July 2009– In the approval process– 5 year program; 42 credit hours– 9 elective credits from MD curriculum + MSA

• DVM/MPH– Collaborative with CSU Veterinary Medicine– 5 students/year; 4 year history

• Discussing MSN/MPH, others


Website: http://publichealth.ucdenver.edu


Questions?

“emerging activities in rural areas” richard f. hamman, md, drph dean

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