SPH news

School of Public Health

Fighting racial bias: HSC video-based simulation helps health care leaders prepare to manage complex ethical dilemmas

Simulation has long been recognized as a highly effective andragogical tool for enhancing problem-solving and communication skills.

Actors in such simulations have been used since the 1960s to portray example patients and aid in training programs to assess diagnostic capabilities and empathy. While simulation through standardized patients, manikins, and video-based methods are commonplace in clinical programs, these approaches are not widely employed in health care management programs.

Some of the goals of video simulation in health care management education include teaching and assessing ethical decision-making, inclusive leadership, interprofessional teaming and use of effective communication skills.

The first health care management simulation chosen for development focused on racial bias because of the George Floyd murder case. That case awoke in many Americans a sense that there is a need for change across systems and institutions.

More than half of all health care professionals have reported experiencing or observing bias from patients related to race, ethnicity, age, gender or other personal characteristics.

Research has shown that among physicians, women were 41% more likely to experience bias about their gender than their male counterparts. Women were also more likely to hear comments about their age and weight.

Black and Asian physicians were more likely to hear biased comments regarding race and ethnicity.

Nurses, research has noted, may be even more vulnerable to abuse than physicians because of the extra time they spend with patients. Surveys have found that nurses and nurse practitioners were more likely to hear comments about their weight than other health care professionals.

Dr. Stephan Davis, Director of the Master of Health Administration (MHA) program at the HSC School of Public Health (SPH), and Dr. Arthur Mora, Chair, Health Behavior and Health Systems, worked with Karen Meadows, MSN, RN, Director of the HSC Simulation Center, to create a video-based simulation that was introduced to the graduating MHA students in their Organizational Leadership course this past spring.

Given the program’s commitment to educational scholarship, the video-simulation was also submitted as a presentation proposal and ultimately selected to be showcased at the virtual Association of University Programs in Health Administration Annual Meeting in June of 2021.

To develop and implement the video-based simulation in the midst of a pandemic was a challenging feat.

Karen Meadows reached out to the film and theater directors, Juan Cabrera and Claire Shaffer. After reviewing the script written by Dr. Davis, they put out a casting call for professional actors. The auditions were held virtually, and ultimately Bwayla Chisanga, Chase Crossno, and Gary Payne were selected for the roles of registered nurse, nurse manager, and healthcare consumer, respectively.

“The casting call attracted such great talent. We were fortunate to attract not only actors who were highly skilled but also extremely passionate about the project,” said Karen Meadows.

Following the casting decisions, a filming date was selected for the HSC simulation center.

Executing the filming while following social distancing and masking guidelines necessitated multiple takes of all scenes with two people, utilizing various camera angles and video editing to make segments look as realistic as possible. They wanted to show facial expressions and to portray pre/post-pandemic clinical environments.

Team members from the University Studio and Simulation Center, including Rens Bais, Lee Ann Cunningham, and Joshua Christian expertly managed the entire process.

Since delivering their AUPHA presentation entitled “Simulating Discrimination: A Safe Space to Learn the Harsh Realities of Healthcare, the MHA program has begun to receive inquiries regarding the video simulation being adopted at other institutions.

“When I reflect on the past year and a half, I believe it’s actually astounding that the team was able to pull this all together,” said Dr. Davis. Dr. Mora, Ms. Meadows and I had preliminary discussions regarding simulations for the MHA program pre-pandemic and prior to my arrival at HSC in May of 2020. I am so thankful to have been given this opportunity to be creative and innovative with the full support of the Simulation Center, University Studio, and School of Public Health to make it happen.”

“I see this as only the beginning of our work in health care management simulations”, Dr. Mora explained. “MHA graduates need to be prepared to address these types of complex ethical dilemmas as they enter into their future leadership careers in the industry.”

School of Public Health

HSC researchers receive new NIH grant to study, impact young adults’ risks from alcohol, marijuana

By Sally Crocker

A new study led by researchers at the University of North Texas Health Science Center at Fort Worth (HSC) looks to uncover the perceptions that young adults have toward alcohol and marijuana and the personal safety, or protective, strategies they employ when using one or both substances together, to help reduce their risks for harm and negative consequences.

This three-year study, funded by the National Institutes of Health (NIH)/National Institute on Alcohol Abuse and Alcoholism (NIAAA), is being led by HSC School of Public Health (SPH) Professor Melissa A. Lewis, PhD, Principal Investigator (PI), and SPH Associate Professor Dana M. Litt, PhD, Co-Investigator. They are joined in the project by researchers from the University of Washington.

Melissa Lewis New Photo Final Use This
Dr. Melissa Lewis

“Young adult alcohol and marijuana use is a significant public health concern, and the risks increase when both substances are used together,” Dr. Lewis said. “Recent national estimates show that 62.6% of young adults have been drunk in the past year, and marijuana use among this population has grown in the last decade.”

“Marijuana is viewed by many as more acceptable and as healthier, perhaps because it’s an herb or is used medically under certain conditions.”

Young adulthood is associated with higher alcohol use compared to other developmental periods, the researchers report, with an estimated 29.2% of 18- to 29-year-old previous-year drinkers having an alcohol use disorder.

For marijuana, the lifetime rates of use among U.S. young adults are at 60%, with 24% reporting they have used marijuana in the last 30 days and 8% reporting daily use.

“The majority of people who use alcohol and marijuana use both together,” Dr. Litt said. “Almost one quarter of adolescents and young adults report simultaneous alcohol and marijuana use when asked about the past year or the last party they attended.”

“Simultaneous alcohol and marijuana use, where the effects of both substances overlap, increases the risk for acute and long-term consequences, such as academic/occupational impairment, decreased cognitive functioning, blackouts, sexual or personal victimization, injury, even death,” Dr. Litt said.

The strategies that young adults use or don’t use for reducing alcohol risk – like planning a designated driver, watching their drinks when at a bar, drinking slowly rather than chugging – can vary from person to person and according to different circumstances. Marijuana users have their own strategies, such as waiting to smoke at the end of a day versus when they have to work or attend class, and others.

Dana Litt Photo
Dr. Dana Litt

“Little is known about why young adults choose to use certain protective behavioral strategies on specific occasions or why they might use them differently at different times,” Dr. Lewis said.

“This is an important goal of our research – to determine the motivations, or reasons for when, why and how young adults may or may not use alcohol and/or marijuana protective behavioral strategies in a consistent, quality manner.”

“Better understanding their motivations and use of protective behavioral strategies is an important step for influencing positive changes in young adults’ future behaviors,” Dr. Lewis added.

Interviews, focus groups and online surveys conducted in the project’s first phase will serve as the foundation for developing and testing of a toolkit of novel online and text message strategies to be in used in the pilot study in Phase 2 that young adults can use to limit intake and reduce the risk from both substances, either separately or if combined.

About 200 participants between ages 18-24 will be involved in the pilot study, which will also look at gender differences, to see how protective strategies may vary and tailor the personalized risk-protection messaging accordingly.

“The most successful young adult alcohol or marijuana interventions involve accurate, nonjudgmental, personalized feedback,” Dr. Litt said. “Many such interventions aim to identify a ‘hook,’ or personally-relevant reason to make a change by employing clinical Motivational Interviewing techniques.”

“Our outcomes will follow that model – although the decision to change is left with the individual, young adults will be provided with protective behavioral strategies so they have tools to help them reduce their drinking or marijuana behavior if they decide to do so.”

The results of this work are expected to make new inroads into an age-old public health concern of reducing the dangers for young adults and impacting their future, safer behaviors.

“In this study, we will attempt to dig deeper into the most meaningful motivators and solutions, so we can make a real difference in moving current and future generations of young adults toward positive change and less risky use of both alcohol and marijuana,” Dr. Lewis said.

School of Public Health

New study finds more adults over age 65 are driving under the influence of alcohol and substances

By Sally Crocker

Dr. Andrew Yockey
Dr. Andrew Yockey

One of the first research studies on the national impact of older adults driving under the influence reports that an estimated 3% of those over age 65 do so, which is especially concerning given that older Americans are already more prone to higher crash rates and accident-related deaths due to aging.

The study, recently published in the Journal of General Internal Medicine, was led by R. Andrew Yockey, PhD, Assistant Professor, Department of Biostatistics and Epidemiology at the HSC School of Public Health. Dr. Yockey was joined in this project by research colleagues from East Carolina University, HSC (Stacey Griner, PhD, MPH) and the University of North Carolina School of Medicine.

According to the CDC, more than 20 older adults are killed every day in motor vehicle accidents across the U.S. and almost 700 are injured in crashes.

In 2017, nearly 7,000 individuals aged 65 or older died in collisions and nearly 15,000 were injured, resulting in higher hospitalization rates and increased U.S. health care costs.

This population accounted for 18% of all traffic fatalities in 2017.

“Driving errors tend to increase with age,” Dr. Yockey said. “Perception slows, reaction time is not as sharp, and the risks for accident or injury increase. For those driving under the influence, the potential for negative consequences can double.”

Today there are over 40 million licensed, driving adults aged 65 or older on the roads, representing a 34% increase over the last decade, “making it critical to understand their driving behaviors and risks of driving under the influence, to address injury preventions and ways we can help them reduce this harm,” Dr. Yockey added.

For this study, the researchers analyzed data from the National Survey on Drug Use and Health for the years 2015–2019 to assess the demographic characteristics of Americans over 65 who drove while under the influence of drugs or alcohol within the previous year. Their frequency in wearing a seatbelt was also measured.

“Under the influence” was defined as binge alcohol use or the misuse of substances including marijuana, cocaine, methamphetamines or opioids, taken in any way not directed by a doctor or in greater amounts or for longer periods of time than prescribed.

Gender, race, education and income level were also considered in this analysis of nearly 19,000 participants across the country.

“Our study found that binge alcohol use and drugged driving are up significantly among older adults,” Dr. Yockey reported.

One in 10 of those surveyed were found to binge drink and were up to 8 times more likely to drive under the influence. Nearly 3% of those studied did not wear seat belts. Those identifying as racial/ethnic minorities were all less likely to drive under the influence than non-Hispanic white participants.

“These findings have important health implications for older individuals, not only as the number of older drivers in the U.S. is increasing, but also as aging places them at a higher risk for complex health conditions and physical and cognitive declines,” Dr. Yockey said.

“Adding alcohol or substance-related driving to this mix only magnifies the concerns for this population and other drivers around them,” he added.

The researchers recommend that the next steps from this study should address public health screenings, preventions and patient-centered, culturally-competent approaches to help those over 65 reduce harm and risks from these behaviors.

School of Public Health

New smartphone app provides real-time alcohol recovery support to homeless adults

By Sally Crocker

Scott Walters
Dr. Scott Walters

A new smartphone application is helping residents of a Dallas homeless shelter combat problem drinking through an innovative program that uses machine learning to predict the feelings, triggers and situations that can lead to alcohol misuse.

Scott Walters, PhD, Regents Professor at the University of North Texas Health Science Center at Fort Worth (HSC), leads the study on this health intervention, as recently published in the Journal of Substance Abuse Treatment.

Dr. Walters and a team of researchers are partnering with The Bridge Homeless Recovery Center in Dallas, where residents are provided smartphones to better understand and predict when, where and why they may be more apt to drink and to aid in their journey toward recovery.

“The program begins as these individuals interact with the phone app, responding to surveys at different times throughout the day for several weeks, to gather data on their location, who they are with, their mood, and what’s happening in the moment that could influence them to drink,” Dr. Walters said.

“Much like Amazon Prime or Netflix give suggestions tailored to the individual, this program uses algorithms to evaluate a person’s risk factors and predict –within the next 4 hours, with over 80% accuracy – when that person is likely to drink.”

The app features more than 800 potential messages based on the time of day and the person’s mood, cravings, location, and motivation at that moment.

“For example, if the program predicts a person is about to drink because alcohol is nearby, a pop-up message might encourage them to practice refusal skills, engage in mindful breathing or other awareness techniques, or move to a different location,” Dr. Walters said.

“The content of the message is unique to the particular risk the person is experiencing at that moment.”

In addition to suggestions from the app, individuals also have access to videos and online resources.

The National Institutes of Health (NIH) reports that alcohol problems are prevalent among people experiencing homelessness, with rates of drinking that can be up to 8 times higher than for other groups. The stresses of living on the street or in shelters can be complicated by other life factors as well, impacting not just a person’s reasons for drinking but also success in recovery.

“Treatment provided in homeless shelters can be very effective,” Dr. Walters said, “but people move on or may have complicating mental health needs or other issues, so completion rates tend to be poor. Only around 15% of people who start a substance abuse treatment program finish it.”

With this new program now in its final phase, where the messaging effectiveness is being tested, the hope is that this application can serve other homeless populations in the future, Dr. Walters said, to provide support “in real time, when someone is close to having a drink, to help them interrupt that urge and maintain their treatment plan.”

David Woody, III, PhD, President and CEO of The Bridge, noted that this research and the app provide a “unique communication channel and ongoing assessment that is important to the homeless recovery model, supporting individuals’ resiliency and ultimately their pilgrimage toward recovery.”

Working with Dr. Walters on this application are Professor Eun-Young Mun, PhD, and postdoctoral research fellow Xiaoyin Li from HSC, and faculty researchers from the University of Oklahoma Health Sciences Center and University of Texas Health Science Center.

Scott Walters
School of Public Health

Public health scientist lends expertise to national database addressing safer use of chemicals in our environment

By Sally Crocker

Dr. Katie Pelch
Dr. Katie Pelch

Katie Pelch, PhD, wants you to know what’s in our environment and how the chemicals we’re exposed to every day may affect our health.

Dr. Pelch is a part-time Assistant Professor, Department of Biostatistics and Epidemiology, in the HSC School of Public Health (SPH), where she teaches courses in environmental health.

She and a collaborative group of scientists from universities and non-profit agencies around the U.S. have released the PFAS-Tox Database, a public health resource to support governments, organizations and communities in making informed decisions about the risks that chemicals pose to people and the planet.

The database looks at Per- and Polyfluoroalkyl Substances – PFAS for short – a large class of synthetic chemicals that are widely used in consumer products and industrial processes.

Chemicals like these are often added to products because of their greaseproof, stain-proof, waterproof and nonstick properties. Items like raincoats, nonstick pans, stain-proof carpets and dental floss are examples.

Often referred to as “forever chemicals,” PFAS are extremely persistent and can build up in the bodies of humans and animals. They have one of the strongest chemical bonds, can be highly mobile, spreading quickly in the environment, and can be harmful even at extremely low doses.

“PFAS contamination has grown into a serious global health threat, and our goal in developing the database has been to help citizens, communities and those working to protect human and environmental health stay aware and informed,” Dr. Pelch said.

“PFAS covers a wide class of man-made chemicals – up to 9,000 – that we can be exposed to through personal care products, our air and drinking water,” she noted. “They are not currently regulated, and there have been some large, prominent legal cases in the last several decades where these chemicals were linked to adverse health outcomes including hypertension, cancer, suppressed immune systems in children and other problems.”

A landmark case that SPH students explore in one of Dr. Pelch’s courses involves citizens’ experiences in one of the largest U.S. community-organized studies, where it was discovered that a DuPont factory in West Virginia had been releasing large amounts of chemicals into the drinking water supply. The community was heavily impacted health wise and pushed back against the manufacturer, yet there are still no regulations on this chemical.

This is just one example of what prompted Dr. Pelch and colleagues to look further into PFAS and develop the database. Today it is used by government agencies, manufacturers involved with or working to avoid these types of chemical combinations in their products, citizen groups and organizations lobbying for change.

Although this work is outside of Dr. Pelch’s instructional role within the SPH, it informs her teaching and goes a long way in providing her students with a real-world perspective on how the practices of the chemical industry threaten public health and reveal why there is a need for more stringent government regulation.

While her primary interest area involves public water supply safety, Dr. Pelch works with others in the field addressing PFAS safety across clothing, food products, textile treatment and other consumer goods. She also works directly with communities and legislators across the U.S. to raise awareness and advocate for industry standards.

The PFAS database and resulting work by Dr. Pelch and fellow scientists has been sent to the National Academies of Sciences & Medicine, the U.S. Environmental Protection Agency (EPA), various state-level health and environmental agencies and both domestic and international non-profit organizations.

“This is a global issue and one we should all be concerned about. States and communities are leading the way in taking action, which is good news, but there is still room for improvement and a lot of knowledge still to be shared with the public,” she said.

“The impetus behind our work in making the science easier to access and follow is the direct impact it can have on communities and their safety,” Dr. Pelch said.

Pelch.headshot
School of Public Health

HSC researchers collaborate on new study to reduce alcohol use and risky sexual behaviors among college freshmen

By Sally Crocker

Mun Ray LewisThree School of Public Health (SPH) researchers at the University of North Texas Health Science Center at Fort Worth (HSC) – Eun-Young Mun, PhD, site Principal Investigator, and Melissa A. Lewis, PhD, of the Department of Health Behavior and Health Systems, and Zhengyang Zhou, PhD, Biostatistics and Epidemiology – are collaborating with Principal Investigator Dr. Anne Ray at the University of Kentucky College of Public Health on a new project to create and test a web application designed to reduce alcohol use and risky sexual behaviors among first-year college students.

This new project is funded by a five-year, more than $3 million grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), through the National Institutes of Health (NIH). This collaborative project builds on the previous work in this area by Dr. Lewis, Dr. Mun and Dr. Ray.

Dr. Lewis is nationally recognized for her research on risky sexual behaviors and alcohol use among young adults, and Dr. Mun is a nationally recognized expert in pooling data from brief alcohol intervention studies to provide large-scale evidence of comparative effectiveness and suggest ideas to improve intervention strategies. Dr. Mun first connected with Dr. Ray in 2011, beginning as her postdoctoral mentor at Rutgers University. Dr. Ray brings expertise in Dissemination and Implementation Science to design and adapt technology-delivered interventions for greater impact.

Research has found that freshman year of college can be an especially vulnerable time for hazardous drinking, with potential consequences even more dangerous than parents may realize.

According to the 2018 National Survey on Drug Use and Health, 54.9% of full-time college students aged 18-22 drank alcohol in the previous month, and 36.9% engaged in binge drinking. One in three college students have reported drinking 5 or more alcoholic beverages in a row, with 1 in 10 drinking 10+ in a row.

College drinking has been linked to increased risky sexual behaviors, including unplanned and unprotected sex, potentially leading to negative health outcomes like sexually transmitted infections or dangers from sexual victimization.

“Although some students come to college with some experience in drinking, others do not, and there are many factors of college life, social interactions with peers and other influences that can intensify the problem even more,” Dr. Ray said. “While alcohol education programs do exist, many pay little to no attention to the risky sexual dangers that can result from alcohol use.”

With support from the National Association of Student Affairs Administrators in Higher Education (NASPA), this new study will seek input from Student Affairs personnel, including those at the University of North Texas and University of Kentucky, prior to developing, pilot testing and implementing technology-enhanced feedback for students that can be applied nationally on other campuses. Student input will also be solicited throughout the development process.

A web application will engage students each week throughout their first semester in brief, user-friendly surveys about their alcohol use and sexual activity, providing individualized feedback and text reminders, encouraging them to reflect on their behavioral patterns and offering strategies to reduce risk.

The feedback, Dr. Mun noted, will be very tailored and personal, “much like the way Netflix and other responsive companies learn about you and make recommendations accordingly.”

“Many college campuses have programs addressing alcohol use and programs focused on risky sexual issues, but not often tackling both together,” Dr. Ray said. “What’s also unique about this new study is that rather than offering a single module of training or information session students might attend at a certain point, this application has the real-time, real-world capability to stay at the forefront of students’ minds throughout the semester.”

The value of bringing both student voices and the perspectives of Student Affairs representatives into the development and pilot stages, Dr. Lewis explained, will help the researchers learn more about what these users want to see in a program for their campus.

“Their feedback will give us valuable insight into what works, what they like and where we can make refinements, so that by the end of the project, we will have a tangible product that campuses will be ready to put into place,” Dr. Lewis said.

Other investigators on the project include Drs. Jerod Stapleton, Heather Bush and Seth Himelhoch at the University of Kentucky, and Dr. Dave Buller at Klein Buendel.

Mun Ray Lewis
School of Public Health

The realities of ‘breaking bad’ and how one HSC researcher is attacking the opioid crisis

By Sally Crocker

Scott Walters
Dr. Scott Walters

He didn’t know it at the time, but when Dr. Scott Walters was growing up in San Diego in the mid 1980s, a next-door neighbor was concealing a homemade meth lab just across the fence and mere steps away from his bedroom window.

For quite some time, concerned parents in his family’s quiet cul-de-sac had reached out to police with suspicions about unusual comings and goings in the neighborhood, strange cars outside at odd hours, sometimes loud words or disagreements in the street.

A neighborhood watch was formed. Parents took pictures and wrote down license plates, but the drug trade was so prevalent in California at the time, officials could hardly address all the concerns from this and numerous other neighborhoods.

Drug activity was happening all over, in suburban residential areas where these illicit operations would be least suspected, to abandoned properties and rural geographies into the valleys, mountains and open desert beyond.

“Southern California was considered the methamphetamine capital of the world 35 years ago. In one single day in 1989, dozens of makeshift meth labs were raided by authorities in a surprising reveal of what had been lurking right next door,” said Dr. Walters, now a Regents Professor at the University of North Texas Health Science Center at Fort Worth (HSC) School of Public Health (SPH), and Chair of a multi-state initiative funded by the National Institutes of Health (NIH) to combat the U.S. opioid crisis.

“The Los Angeles Times reported that day’s events of massive, coordinated raids throughout southern California were the largest drug bust in U.S. history,” Dr. Walters noted.

“Now, decades later, the war on drugs is still being waged, with new names and formulations that have entered the market, even more capable of devastating communities, families and the lives of those who use them.”

Working to solve the problem

Since 2019, Dr. Walters has served as Steering Committee Chair for the HEALing Communities Study, part of the NIH HEAL (Helping to End Addiction Long-Term) Initiative, an aggressive, trans-agency effort to speed scientific solutions to stem this public health crisis.

More than $350 million has been designated to this multi-year study under a cooperative agreement supported by the National Institute on Drug Abuse (NIDA), part of NIH, in partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA).

The study’s goal is to reduce deaths by at least 40% over a three-year period in nearly 70 U.S. communities hit hardest by the opioid crisis – and to create a national model for saving future lives.

In the U.S. region that includes Texas, data comparing years 2020 to 2019 showed that use of the powerful, synthetic drug fentanyl went up by 57% and that methamphetamine use increased by 19%. Heroin use was 31% higher for 2020 than 2019.

In Texas specifically, according to the CDC, drug overdose deaths increased 34% – rising by more than one third – in 2020 versus 2019.

“The big takeaway here is the rise of fentanyl use, which explains why more people are dying,” Dr. Walters said.

Fentanyl is similar to morphine but 50-100 times more potent, according to the National Institute on Drug Abuse. Fentanyl is cheap to manufacture, but dosage impact can be unpredictable. Increasingly, it is being mixed with heroin or taken with oxycodone medications to even deadlier effect.

One of the most tragic effects of this drug is that it can cause involuntary muscle contractions, seizing and paralyzing vital parts of the body like the throat and chest before lifesaving treatment can be given.

Taking solutions to the streets

Dr. Walters’ work has long focused on developing evidence-based solutions for substance use and other problem behaviors. Over time, he has become increasingly interested in implementation science, which puts into practice, or action, the findings that research demonstrates can make a difference.

“What’s puzzling to me is that we know what works to solve many of these problems,” he said, “but getting communities to adopt those things can sometimes be a challenge. The overdose antidote Narcan, for example, can make the difference between life and death in an emergency, but communities may resist making it widely available for fear that it could encourage riskier substance use.”

“This is where the HEALing Communities Study comes in, offering the resources, scientific rationale, funding, testing and other support for implementing the tried-and-true interventions that can really work.”

Last fall, partners in the HEALing Communities Study shared results of their work so far in the scientific journal Drug and Alcohol Dependence, reporting on recent public health awareness campaigns and other grassroots efforts that have launched across the U.S. and are beginning to make a difference.

“COVID-19 and the events of the last year threw us for a loop. Not only did drug use go up, but many of the actions we would normally take were inhibited. I’ve just been so impressed with how quickly these communities retooled their efforts, adjusting some strategies and doubling down on others that could have an impact right now.”

“No state has been immune to the effects of the opioid epidemic,” Dr. Walters said. “We all benefit from working together on this problem.”

As a young adult in San Diego, Dr. Walters never imagined where his future might lead, yet the impact of his work now and the work of others is clear – solutions to the nation’s drug crisis are just as needed today as they were decades ago.

“Turning a problem of this magnitude around isn’t easy or quick, but it’s clear we make better inroads when we all work together,” he said.

Scott Walters
School of Public Health

Dr. Diana Cervantes named among Fort Worth’s ‘most influential’ for public health service during the pandemic

By Sally Crocker

Diana Cervantes. Assistant Professor Biostatistics & Epidemiology
Dr. Diana Cervantes

Dr. Diana Cervantes has spent the last year keeping people informed and updated on all things coronavirus, and now she’s being recognized as one of Fort Worth Inc.’s “400 Most Influential People” for helping protect the community’s health during the pandemic.

Dr. Cervantes is an Assistant Professor and Director of the Master of Public Health (MPH) graduate studies program in Epidemiology at the University of North Texas Health Science Center at Fort Worth (HSC) School of Public Health (SPH).

She will be honored along with other award recipients at an upcoming Fort Worth Inc. 2021 Person of the Year reception.

Over the last year, Dr. Cervantes has given countless media interviews on TV, radio and online to answer some of the public’s top questions on COVID-19.

In the pandemic’s early days, and during other peak times as COVID cases resurged at different points in 2020, up through release of the COVID vaccines, it wasn’t at all unusual for Dr. Cervantes to take 3 to 4 calls from different reporters each day.

She’s became a familiar face across North Texas, reassuring the community and advising on ways to stay safe during a public health crisis that most people today had never before experienced in their lifetimes.

“Very little was known about the virus at first, so people wanted help in sorting through the precautions and ways of protecting themselves and their families,” Dr. Cervantes said. “Anytime pandemic restrictions went into place or were lifted, or as we approached holidays, seasonal events, closures and cancellations, there were more questions.”

What were some of most common questions she received?

“How long is this going to last … when can we get back to normal – those were the big ones. Along the way, I’ve tried to advise that we may never go back to exactly the way things were before. While this virus can definitely be reduced, it may always be with us in some form, just like other viruses we’ve learned to manage over time,” she said.

In addition to media interviews in both English and Spanish, Dr. Cervantes engaged in community outreach with Tarrant County Public Health, long-term care facilities, nursing homes and area hospitals’ infection prevention contacts.

She spoke at town halls in cities around North Texas and provided vaccine education to local counties and schools.

She joined Mayor Betsy Price for Facebook Live pandemic information sessions.

She even teamed with a movie historian from the Austin-based Bullock Texas State History Museum for a presentation on outbreaks, how they are portrayed in movies and what is actually real.

Finding balance during the pandemic has been a challenge for everyone. For Dr. Cervantes, the professional priorities of teaching HSC graduate classes, mentoring students, serving the university and collaborating with SPH community partners on ongoing projects and activities have remained a big part of her days.

It also takes time to gather information and stay up to date through changing circumstances like those presented by COVID-19.

Dr. Cervantes closely follows CDC updates, state and local guidance and the work of other epidemiologists in the field.  She follows research publications, public health podcasts and related social media.

She’s also interested in seeing how the public responds, for insight into people’s questions, what they consider most important and where she can fill in the gaps.

She’s been surprised by neighbors who have seen her on TV and stop to say thank you for the down-to-earth information she’s provided during the pandemic.

“It was really humbling and heartwarming to recently walk into my hair salon for the first time in a while and get a standing ovation. I just try to give the best information possible in a balanced, positive way,” she said.

Dr. Cervantes has also been inspired by potential students who have reached out with an interest in public health careers, and the way that COVID-19 efforts have broadened awareness of public health, science communications and how they come together to solve problems and serve the community.

“It’s a really exciting outcome that so many fresh, young minds now have an interest in studying public health and taking the field to a whole new level,” she said.

One of her biggest fans has always been her mother. As immigrants from Mexico many years ago, her parents were proud to see their children grow up and become a part of caring for their communities in Texas.

“The rest of my family is proud too,” she laughed, “but also a little amused that other people really want to hear the things I tell them at home all the time.”

Diana Cervantes. Assistant Professor Biostatistics & Epidemiology
School of Public Health

Nutrition, service and lessons of public health drive, motivate SPH honors graduate in her work

By Sally Crocker

Joanna Li 2021Working as a Public Health Nutritionist in the Greater New York area is a big job. School of Public Health (SPH) 2021 honors graduate Joanna Li understands the job well from experience, having spent three years traveling through different boroughs and neighborhoods to deliver nutrition counseling and services to women and children.

Li worked through a program called WIC, short for the federally-funded Special Supplemental Nutrition Program for Women, Infants and Children that assists low-income pregnant and breastfeeding mothers and children under age 5. State and county health departments are partners in this program.

Over time, Li’s position grew to support 10 area WIC programs, where she evaluated programming, led trainings and helped introduce a new system for monthly payment processing, moving from paper vouchers to debit cards.

With an undergraduate degree in nutrition and dietetic experience working in a large hospital system, Li remembers reflecting at the time on how much the WIC program and her department’s work impacted large populations of families in need.

Transportation, access to nutritious foods near their home and so many other issues influenced the overall health of not just individuals but entire communities.

It was an aha moment where Li realized, “Yes, I’m in public health.”

This year, Li was awarded the SPH Leon Brachman Community Service Award, presented to the graduating public health student best exemplifying the ideals of academic excellence, leadership and community service.

The award is named for Fort Worth philanthropist Leon Brachman, who was a member of the 1992 steering committee that first explored development of a local School of Public Health, leading to founding of the SPH at the University of North Texas Health Science Center at Fort Worth (HSC) in 1999.

Li grew up in Brooklyn and moved to the Fort Worth area several years ago. She had planned to pursue a Master of Public Health (MPH) degree online, but chose the on-campus experience and MPH in Public Health Leadership program instead after visiting HSC.

During her time with the SPH, Li worked as a graduate assistant in the Office of Academic Services and volunteered with the Tarrant Area Food Bank. She has served as Treasurer for the HSC Public Health Student Minority Association (PHMA) and as a Student Assembly Membership Ambassador for the American Public Health Association (APHA). She is a Board member and current Communications Co-Chair for the Dallas Dietetic Alliance. Recently, Li has also begun volunteering with the North Texas Community Table Food Pantry, helping to sort food donations and prepare distributions for local families.

Li has always had an interest in food insecurity, hunger, the issues that affect nutrition and helping people improve their overall health. Public health provided her that avenue in a broader way than one-on-one nutrition counseling or client services could.

“A lot of things influence what a person eats,” she said. “Recommending a diet of fruits, vegetables and other nutritious items is one thing, but if people don’t have access to those foods in their neighborhood, can’t get to stores because of transportation or other reasons, such as balancing time to work more than one job supporting a family, it can present real barriers.”

“Understanding what you should eat and actually being able to get those things can be quite different.”

Being in public health and wanting to serve the community while trying to stay safe during the pandemic has been hard, Li said, and she’s happy now for the light at the end of the tunnel.

She was able this past year to continue her SPH practice experience with the North Texas Area Community Health Centers remotely, developing and conducting a survey for pre-diabetic patients, which resulted in development of a diabetes prevention curriculum that health care providers can now use.

“During the pandemic, I learned to be adaptable, which is a pretty good skill to have,” she said. “Being away from family was probably the most difficult of all, but we managed to stay close through Facetime, showing me how precious every moment really is and how much those moments should be taken to heart.”

“I think all of us, in our personal lives, professional endeavors and service to the community, learned a lot about what is most important to us and what drives us forward,” she said. “If anything, this last year of living and working within the pandemic has made us all stronger.”

Joanna Li
School of Public Health

Circle of life brings SPH honors grad to a new day, new opportunities

By Sally Crocker

Syd Alone Dickies GradThe study of turkeys, fish, native wolves and other wildlife helped one of this year’s University of North Texas Health Science Center at Fort Worth’s (HSC) commencement award winners find connections to the people side of public health and her future career path.

Sydney Manning, Master of Science (MS) in Epidemiology student at the HSC School of Public Health (SPH), was selected as the 2021 Kenneth H. Cooper Award winner for Outstanding Research. Manning graduated from the SPH in May 2021.

This honor is presented annually to the SPH graduate demonstrating excellence and quality in the application of research methods in preparation of a final product or project for the thesis or other research activities. Best-selling author and health/wellness guru Dr. Kenneth H. Cooper, who founded the renowned Cooper Aerobics Center in Dallas in 1970, is the inspiration behind this award.

The turkey industry is big in Michigan, where Manning completed her undergraduate degree in fisheries and wildlife. Wild turkeys are legally hunted as part of a large recreational sporting industry, so governmental and other entities maintain close predictions on the impact to future populations over time.

As a research assistant, Manning helped transform field data into these types of predictive models. The approach, she said, is “basically driven by life” and applies in much the same ways whether studying animal or human populations.

“Consider the way disease predictions are made,” she said. “The science helps us look to the future and predict where adjustments and health interventions may be beneficial.”

Manning worked on another interesting project as an undergraduate, studying reintroduction of wolves to native territory across three states in the Yellowstone area – a job that impacted politics and policy and required an understanding of the needs of different groups, including ranchers, wildlife agencies and other stakeholders.

“Like many of the conversations the world has faced around COVID-19 over the last year, a lot hinged on balancing the needs of those involved and taking their different perspectives and risk factors into account,” she said.

“Sometimes my job was more about managing people and negotiating with different groups than about managing the wildlife.”

Seeing the people applications to this type of work ultimately led Manning to public health and HSC.

Math and science were strong areas for her, providing a natural transition toward a master’s in epidemiology and biostatistics. She matched with SPH Assistant Professor Dr. Zhengyang Zhou and recently completed a data methods paper for publication that is hoped to give other researchers improved ability for uncovering the links between certain diseases and genes.

An interesting year
There have been many ups and downs for students during the pandemic. Thirteen months ago, Manning was living with her brother and another roommate, both state troopers for the Department of Public Safety.

When they were assigned to COVID-19 screenings at the airport, the three agreed that the risks might be too high for Manning to stay. She wanted to keep her parents safe, so moving home wasn’t a good option either.

She moved into her boyfriend’s one-bedroom apartment, where they made do for a while with three cats who didn’t get along, personal possessions that hardly fit and limited space for laptops and work.

Within a few months, they were fortunate to find larger space where she no longer had to live out of a suitcase or double purpose the kitchen table as her desk.

“I missed studying at the library and getting together with friends,” Manning said. “My boyfriend left for work every day, and I did everything from home. There are a couple student research coworkers I never had a chance to meet in person before we graduated.”

Today Manning is fully vaccinated and feeling encouraged, with plans to start meeting friends for lunch on a patio, spending time with her family again, and getting back to the rock-climbing gym and other things she most enjoys.

She’s also excited about her new job with the HSC Department of Pharmacotherapy, as a Senior Research Associate, Data Analyst Health Services.

“I’m looking forward to getting back to life and entering my next stage,” she said.

Smanning Photo 2020