Perhaps the main reason that UNT Health Science Center student Shivani Goswami was selected as this year’s Barbara Starfield Medical Scholar by the American Public Health Association (APHA) is because of her desire to build a better healthcare system.

As a future healthcare leader selected for this prestigious national honor, she will be involved in planning and assisting with Medical Section activities for the November APHA Annual Conference in Atlanta.

Seven years ago, Shivani found the road she wanted to take.

Interning as a clinical language assistant with autistic patients, she met 9-year-old Sarah.

Sarah suffered from complicated speech and motor impairments that intensified when she became nervous or excited.

The person that Shivani said she connected with was not a child labeled as autistic but a “bright-eyed young girl with a contagious smile,” individual in her own way.

The experience with Sarah and other children like her moved Shivani to want to learn more about the healthcare delivery system in order to change it.

“I wanted to have impact on what I saw as a very complex system with intricacies that sometimes lose sight of the fact that healthcare delivery is really about caring for people, and in this case, the children,” she said.

“As an intern, I was very limited in my capacity to help Sarah. It was a wonderful feeling to connect with her and make her laugh, but still needing knowledge and training, I couldn’t alleviate her complications or guide her health in the future,” she said.

“As I watched this child fight through challenges every day, I found myself drawn toward a Master’s in Health Administration, where I could develop as a leader and use my experience to manage and enhance the quality of healthcare programs in the future.”

On course now to complete her MHA in May 2018 from the UNTHSC School of Public Health, Shivani took her first leap into health leadership when she co-established a non-profit regional organization called Health Connect South five years ago. The organization, based in Georgia, builds collaborations among health leaders and innovators in the field to advance healthcare in the Southeast.

“Caring for a patient really involves an interdisciplinary focus and a values-based approach,” she said. “With a team of health professionals working together to cover every aspect of a patient’s needs, so much more can be addressed than when one person alone tries to make a difference.”

The UNTHSC public health program has helped Shivani broaden this idea beyond inpatient care services to “communities of care” that partner the patient and family with clinicians and community services addressing nutrition and healthy food access, safe housing, transportation, literacy, employment, education, work training and job opportunities.

“A pediatrician once told me that absolute compassion with humility is the best service a physician can provide. I realized this is also true in public health,” Shivani said.

“To tell the health community what you are working on is easy, but to tell them that you need help involves the humility that can lead to groundbreaking collaborations for advancing healthcare and healthier lives at a faster pace.”

In her role as APHA’s Barbara Starfield Medical Care Scholar, Shivani will be involved in sessions and programs tackling solutions for healthcare challenges like these.

Dr. Harvey Brenner

In a new American Journal of Public Health (AJPH) editorial, a UNT Health Science Center professor challenges a conventional research formula for measuring the health of populations, calling the method age discriminatory.

M. Harvey Brenner, PhD, Professor of Health Behavior and Health Systems at the UNT Health Science Center School of Public Health, said he was prompted to respond to recently published data ranking cancer as a higher health concern than heart disease, based on Years of Life Lost (YLL) comparisons of the years 1995-2015.

The commonly applied YLL formula estimates an average number of years a person would have lived if he or she had not died prematurely, due to certain causes. YLL is used in public health planning to compare the relative importance of different causes of premature deaths within a given population, to set priorities for prevention and compare premature mortality data between populations.

“On the basis of YLL, cancer is now being ranked as a more prominent cause of death than heart disease in the United States,” Dr. Brenner said. “However, heart disease should be logically viewed in conjunction with stroke, also a cardiovascular disease, and with the underlying components of the disease, including hypertension and arteriosclerosis.”

With YLL, a greater weight is correlated to deaths occurring at a younger age.

“Because heart disease impacts older individuals to a greater degree,” Dr. Brenner said, “YLL ranks it lower than other causes of death affecting younger adults with more potential years of life left. Not only does this minimize the health needs of the United States’ growing aging population, it could also greatly impact future health policy decisions related to funding and resources for medical and preventive care to older populations.”

“According to the YLL metric, a 50-year-old person is less worthy than a 35-year-old person, who is less worthy than a 25-year-old person and so on. The formula profoundly discriminates, without consideration of the value and experience of older adults who are still productive and contributing to society, the workplace and the economy in general, and in terms of the knowledge and experience they offer,” he said.

Because the formula is only based on current productivity, it may also discriminate against disabled populations among other groups than the elderly.

The aging Baby Boomer population and continued steady rise in the life span of older adults suggest the need to adjust the YLL model to more realistically address discrimination in older and disabled populations, Dr. Brenner said.

Dr. Jackson (left) and Dr. Ojha (right) with new members of the team from UNTHSC: Mandy Burton, MPH, data analyst; Tzu-Chun Chu, MS, MPH, data analyst; Yan Lu, MPH, epidemiologist; and Kari Teigen, MPH, epidemiologist.

A team of UNTHSC public health graduates is working toward improved patient outcomes in treatment and prevention of cancer, diabetes, infectious diseases like HIV and Hepatitis C, and maternal/child health.

Rohit Ojha, DrPH (SPH ’10), was recruited last year to establish the new JPS Health Network’s Center for Outcomes Research (COR) and serve as Director.

Along with biostatistician Bradford Jackson, PhD (SPH ’12), and a team of research faculty and staff – including four new SPH graduates who were recently hired  in data analyst and epidemiologist positions – they are studying the clinical, lifestyle and behavioral factors that can impact health outcomes of underserved populations.

The goal is to build a healthier community for individuals and families across the JPS service area.

After completing a postdoctoral fellowship with the Dana-Farber Cancer Institute/Harvard Cancer Center in Boston and working as research faculty in the Department of Epidemiology and Cancer Control at St. Jude Children’s Research Hospital in Memphis, Dr. Ojha saw the opportunity to return to Tarrant County as a chance to make a difference in the community’s health.

“By looking at health disparities related to socioeconomic status and other challenges in access to care, we hope to identify factors where we can intervene to reduce disparities in the outcomes of diseases,” Dr. Ojha said.

Working with Tarrant County Public Health and Cook Children’s Medical Center, the COR team also collaborates with UNTHSC and is developing an internship program for epidemiology and biostatistics graduate students.

Dr. Jackson, who previously worked on cancer, chronic disease, radiology projects and clinical trials as an Assistant Professor at the University of Alabama at Birmingham’s Division of Preventive Medicine, calls his role with JPS “a bit of detective work.”

“It’s common for biostatisticians and epidemiologists to wear many hats. My task is to be both consultant and data analyst, to uncover gaps and find answers to questions,” he said. “The research path can identify where certain population groups are not being reached effectively and potentially lead us to new programs and processes for improving care.”

Both Jackson and Ojha feel that the best advice they can offer students planning a career in public health, health research and health care professions is to get as much experience as possible while still in school.

“One thing that worked for me was taking initiative. I tried to get involved in as much as I could. I was fortunate to participate in the design and analysis of diverse studies as a student, which continues to impact my work today,” Dr. Ojha said.

“The million dollar question of what you want to do after you graduate is a difficult one to answer,” Dr. Jackson said. “To better inform your decision, get as much hands-on experience as you can; assisting faculty in their research will provide you with valuable insight. Keep an open mind and learn as much as you can.”

The UNTHSC School of Public Health was in its infancy when Lilly Ramphal-Naley, MD, MPH, joined as adjunct faculty in 2000.

The School had been officially founded just one year before, and plans were underway toward accreditation by the Council on Education for Public Health, which would come in 2002.

As the SPH has continued to grow from those early days on, Dr. Ramphal-Naley has been a constant, teaching and mentoring, actively participating in faculty affairs, serving on advisory boards, developing courses, adapting instruction for online learning and supervising student practice experiences in the field.

In 2014, she created an international SPH student scholarship fund, donating her adjunct stipend each semester as a pledge to the program.

She was inspired, she said, to help “young minds find solutions to global issues like health care access, safe/healthy food and water, isolation of changing or emerging infectious diseases and other major public health issues that need attention.”

“Hopefully, the big world projects and challenges that our students are taking on can be translated back into ways they can help their own native countries and our world in the future,” she said.

In recognition of her longtime commitment to serving others first, Dr. Ramphal-Naley was recently honored at a reception by SPH faculty and staff.

“Over the years that I worked with Lilly in the Environmental and Occupational Health program, I came to consider her as full time faculty,” said professor David Sterling, PhD.  “Her teaching and service alone are not what have made her unique as an adjunct, or a reason for honoring her. It is the dedication and passion she has put into this very part time work.”

SPH Dean Dennis Thombs, PhD, said that another important aspect of Dr. Ramphal-Naley’s contributions has been “the wealth of ‘real world’ public health experience she’s brought to her teaching.”

During her career, she has held Medical Director positions for health care organizations like Baylor Garland and Cook Children’s Medical Center, and most recently her work as Medical Director for Blue Cross Blue Shield of Texas has focused on population medicine for large employer accounts like American Airlines, Phillips Gas and Boeing.

Dr. Ramphal-Naley is a Fellow of the American College of Environmental and Occupational Medicine. She trained as an internal medicine physician at Rutgers University, completed a residency in occupational medicine and obtained a master’s degree in public health from the University of Minnesota.

“As a physician, she well understands public health and population health and has been in key positions to promote public health in multiple areas, from health surveillance to health management and policy. Over the years, she has been both a supporter and a contributor to the success of the SPH and our students,” Dr. Thombs said.

AAFSPHV President Dr. Kelly Vest honors Dr. Fogelberg at the annual American Veterinary Medical Association conference in Indianapolis

For years, SPH Assistant Professor Katherine Fogelberg, DVM, PhD, has donated her spare time and veterinary services to treat and find homes for rescued pets.

She’s worked with zoo and wildlife animals as far away as South Africa, and has helped connect veterinarians with public health emergency preparedness efforts in the U.S.

She developed an international partnership for SPH students that ties veterinary aid services to human/animal public health and disease prevention.

And most recently, to recognize her contributions in the field, Dr. Fogelberg was named as the 2017 Public Health Veterinarian of the Year by the American Association of Food Safety and Public Health Veterinarians (AAFSPHV).

Trained as a vet with a special interest in zoo medicine, Dr. Fogelberg began exploring the connection of animals to the health of people during her doctoral studies, ultimately leading her to work with Dr. David Sterling to develop a class on this topic for the SPH.

Since then, she has designed and now directs a graduate certificate program in Food Security and Public Health for UNTHSC that studies the food chain implications of animal health on people, and she is helping SPH students see public health in different ways.

“One of Dr. Fogelberg’s achievements since joining UNTHSC has been to connect our public health students with the international organization Veterinarians Without Borders. She led the first group of students to Uganda last year, establishing a link between veterinary aid efforts and protections on the health of people,” said Dr. Dennis Thombs, SPH Dean.

“There are many illnesses and diseases that can be passed from animals to people. So far, our student volunteer teams been able to assist with TB testing and prevention efforts,” he said.

Also important is Dr. Fogelberg’s work with the Society for Disaster Medicine and Public Health, to establish collaborations between emergency first responders, public health professionals and veterinarians.

“Disaster situations like those we saw with hurricanes Katrina and Ike impact animals as much as people,” she said. “Roughly 30 percent of people in a disaster will refuse to evacuate without their pets. Shelters may not be able to accept animals, and it’s devastating for individuals and families who become separated from their pets. It impacts the overall health and well-being of a community.”

“The implications of the human/animal bond are far-reaching. In areas where livestock means livelihood, a disaster could also affect the ability of farms and related businesses to make a living and deliver products,” she said.

As SPH Director of Quality Instruction and Assistant Professor of Biostatistics and Epidemiology, Dr. Fogelberg draws on the different aspects of animal/public health to share a broad perspective with students and inspire their passions the way she found hers.

UNTHSC student Tonychris Nnaka, BSN, RN, has been named as the 2017-18 Dr. Gerry C. Gunnin Public Health Memorial Fellowship recipient. The award is presented by Texas Health Resources (THR).

Nnaka is a Master of Public Health (MPH) candidate in Epidemiology and Environmental and Occupational Health Sciences and serves as a research assistant for the Department of Epidemiology and Biostatistics.

He is also President of the UNTHSC Public Health Student Government Association.

The Gerry C. Gunnin, PhD, Public Health Memorial Scholarship was established by THR as a tribute to Dr. Gunnin’s leadership and legacy of advancements in public health.

Dr. Gunnin served as President of the Presbyterian Healthcare Foundation and as Vice President of the THR Community Health Improvement Department from 1995 to 2001.

Fellowship recipients are selected based on their commitment to public health and to the communities in which they live and/or work.

A new article in the Journal of Substance Abuse Treatment suggests that a computer program could be the most effective way of prompting substance-using probationers and parolees to start a treatment plan.

This news is especially important considering the millions of probationers across the United States who need substance abuse treatment yet never actually initiate or complete it.

In 2015, nearly 25 million adults in the U.S. reported illicit drug use in the prior month, and nearly 65 million reported binge alcohol episodes. Of those in need of treatment, only 14% actually started an intervention program.

“Health and justice systems are overburdened in terms of costs and resources,” said Scott T. Walters, PhD, Professor and Chair of Health Behavior and Health Systems at the UNT Health Science Center School of Public Health, who served as an investigator on the study of MAPIT motivational computer technology as a way to increase substance abuse treatment initiation.

With researchers from George Mason University, Dr. Walters and colleagues compared results from MAPIT to in-person motivational interviewing and standard probation intake processes for prompting individuals toward treatment.

More than 300 probationers in Dallas, Texas, and Baltimore City, Maryland, participated in the randomized, controlled study, funded by a grant from the National Institute on Drug Abuse.

MAPIT employs user-friendly, voice-automated online software to stimulate the desire to begin treatment, set goals and stay motivated in recovery.

The program interacts with users by recognizing patterns and preferences in their reasons for wanting to finish probation, making suggestions for strategies that might work specifically for them.

After two months, people who were randomly assigned to MAPIT were more than twice as likely to begin treatment, compared to those routed to standard justice system processes.

“The start of probation is a critical time to educate and motivate individuals. MAPIT provides a platform for addressing substance use and other high-risk behaviors,” Dr. Walters said.

“The success of MAPIT shows that a computerized intervention as part of a screening and treatment referral program can improve short-term treatment initiation among substance-using probationers. Programs like this can significantly impact public safety and health without placing additional burdens on the criminal justice system,” he said.

A new CDC journal article questions the common use of BMI, or Body Mass Index, as a measurement of health for African American women, suggesting instead a more holistic, multifaceted approach to preventing chronic disease and motivating healthy behaviors.

Authors of the article “Beyond Body Mass Index: Are Weight-Loss Programs the Best Way to Improve the Health of African American Women?” published in Preventing Chronic Disease: Public Health Research, Practice and Policy, June 2017, are public health doctoral student Leilani Dodgen, MPH, CHES, and Emily Spence-Almaguer, PhD, Associate Professor and Associate Dean for Community Engagement and Health Equity, at the University of North Texas Health Science Center School of Public Health.

African American women have a higher prevalence (82%) of being overweight and obese than white women (63.2%) or Hispanic women (77.2%), and the rates of chronic disease, disability and premature death among African American women run disproportionately high.

When compared with white women in the same weight-loss programs, African American women lose less weight and maintain weight loss for a shorter time.

Culturally appropriate interventions and motivational themes designed for African American women over the last 20 years have failed to yield significant or sustainable weight loss results.

To address these issues and find solutions, the authors and their team engaged North Texas women in community-based participatory research, gathering data and cooperatively developing a culturally diverse wellness pilot called “SHE Tribe.”

This social network-based healthy lifestyle intervention, which stands for “She’s Healthy and Empowered,” was developed through support from the National Institute on Minority Health and the Health Disparities Exploratory Centers of Excellence of the National Institutes of Health.

At SHE Tribe gatherings, women pursue a lifestyle of health by making small changes that empower action for lifelong wellbeing.

Maximizing the strength of women’s social networks, the program provides participants with online assessment tools, facilitated guidance and a wellness score according to five areas of well-being:  goals, self-care, physical activity, nutrition and relationships/social support. As participants set individual goals, they also practice healthy behaviors and reflect on their interest and motivation for making changes.

A program goal is to also inspire participants to lead their own SHE Tribes to promote a larger culture of health.

Based on SHE Tribe findings and other research, the authors concluded that African American women may benefit from this broader approach to health that aligns with values of the community, shifting beyond BMI as the main measure of wellness.

“The prevalent use of BMI combined with the U.S. obsession with weight has made BMI a primary choice for indicating chronic disease risk and measuring health,” Dodgen said. “But BMI reduces the complexities of health to one primary indicator and its accompanying solution, weight loss.”

In most programs, African American women are unlikely to transition from a range considered obese (BMI above 30) or overweight (BMI range of 25-29) to a normal range (BMI less than 25). The average African American woman weighs approximately 187 pounds with a BMI of 32.2 and would need to lose almost 20 pounds in order to reach just the top of the overweight threshold.

Most participants don’t lose enough to reach the BMI target for reducing cardiovascular disease and diabetes risk, and when measured at 18-month follow-ups, many of those who do lose weight will regain up to 33 percent over time.

A weakness of BMI, the authors said, is that it fails to account for differences in body composition, fitness levels and nutritional variances that can predict health and longevity. People can be obese but in good health because of diet and even a moderate amount of physical activity. Muscle mass can also be a factor in adjusting a person’s weight-loss goals.

“Research increasingly shows mortality to be more dependent on cardiorespiratory fitness than BMI,” Dr. Spence-Almaguer said. “This is good news for people who have been unsuccessful at weight loss or maintenance. A moderate level of physical activity can improve health regardless of whether a person loses weight.”

Alita Andrews

Before

After

As a Health Advocate for the UNT Health Science Center TESSA program serving Tarrant County victims of interpersonal violence, Alita Andrews offices at One Safe Place, a non profit agency in Fort Worth that gives help and hope to families and individuals looking to get back on their feet.

Andrews helps clients focus on their mental and physical well-being, self-care strategies, personal safety and navigation of health resources to connect with primary care services/ information and work toward improving their overall health outcomes.

Her role is different from that of a counselor or case manager, as she specifically focuses on the impact that violence and trauma can have on health.

She works with individuals like the young mom, battling serious effects of diabetes because her abuser wouldn’t allow her to seek medical care for her condition, or the middle-aged woman suffering from high blood pressure, panic attacks and other health issues related to the physical and emotional harm she had been forced to endure for years.

It is Andrews’ mission to help individuals like these in overcoming the barriers to their wellness and recovery.

At first, she met with clients in a very traditional office space.

Standard bookshelves.

Nondescript side table.

Desk facing the door with two chairs in front.

Over time, though, with help from the TESSA and One Safe Place teams, Andrews transformed the environment into a warmer, more welcoming space.

Her desk was moved to the side, eliminating the physical barrier between health advocate and client.

A cozy rug and more relaxing chairs were added to invite quiet, one-on-one conversations.

Clients could feel safe knowing they no longer had to sit with their back to the door.

A storage closet was updated to create a coffee nook.

Dim lighting and calm colors also helped with the change, and stress balls, adult coloring books and other counseling aids were brought in to give relief during difficult moments.

This idea – representing just one of the ways Andrews cares for clients and helps them feel more secure and welcomed – was recently recognized at the One Safe Place five-year anniversary, where she was presented an award for exemplifying one of the agency’s top core values of “safety.”

“The role of the health advocate is to give people choices and help them take control of their lives; it may be overwhelming at first, which is why it’s so important to welcome them in a space that feels comforting,” said Jessica Grace, LMSW, TESSA Program Manager. “We want clients to know it’s more about them than a complicated process or system.”

Andrews, who is a 2016 UNTHSC School of Public Health MPH graduate, said the clients are her main motivator for coming to work every morning.

“They have all come to One Safe Place to find support and a new start. Wherever they are in their journey, I’m happy to be a cheerleader and support system to helping them find themselves,” she said.

Organizations like One Safe Place, which houses 18 different victims’ advocate agencies, are important in connecting individuals with health care resources, children’s services, law enforcement and legal aid, counseling, chaplain’s assistance, case management, employment programs, housing resources and more.

Approximately one in three Texas women will experience domestic violence during their lifetime. For the years 2014 and 2015, Tarrant County was the second highest community in Texas for domestic violence deaths.

Since 2015, TESSA has been led by Dr. Emily Spence-Almaguer, SPH Associate Professor and Associate Dean for Community Engagement and Health Equity. TESSA is funded by the U.S. Department of Health and Human Services, Office on Women’s Health.

“The clients we see are so resilient and are survivors; their strength is awe-inspiring,” Andrews said.

“Some of my best experiences are when clients I haven’t heard from in a while call and update me on their progress and all the things they’re now doing on their own,” she said. ”It’s a great honor to watch this happen, and I’m happy to be a part of it.”

A Clean Air Action Day event will be held on Friday, June 23, from noon to 1 p.m. in the campus Library Mini Auditorium, LIB 110.

UNT Health Science Center students, faculty and staff are encouraged to attend.

Clean Air Action Day encourages North Texans to do one thing to improve the air quality for the health of the local community.

Participants will have an opportunity to take part in an action pledge and watch short videos focused on environmental and human health.

This event is come-and-go.

Attendees are encouraged to save the driving and instead bring their own brown bag lunch to the event.

Free Alchemy Pops will be provided from a local frozen pop store that sources locally when possible, and free water bottles from Air North Texas will be distributed while supplies last.