April 6, 2020
The UNC Graduate School has announced that nine of the 17 Impact and Horizon awardees for 2020 are students or recent graduates of the UNC Gillings School of Global Public Health. The awards acknowledge student research that benefits the people of North Carolina.
Gillings School honorees include Liz Chen and Elizabeth Davidson (Heath Behavior), Stacey L. Klaman (Maternal and Child Health), Kathleen Knocke (Health Policy and Management), Nicholas Lenze (Population Health for Clinicians), Libby McClure and Asher Schranz (Epidemiology), Jessica Soldavini (Nutrition) and Kirsten Studer (Environmental Sciences and Engineering).
Lenze received one of six Horizon Awards, and the others received eight of the 11 Impact Awards.
“The 17 awardees represent an impressive 14 master’s and doctoral programs, and this demonstrates the depth and breadth of UNC-Chapel Hill research that is benefiting North Carolina,” said Jennifer Gerz-Escandón, PhD, associate dean for interdisciplinary education and fellowship programs within The Graduate School. “The majority of our award recipients for 2020 are specializing in research toward improved health and environmental outcomes. Throughout the years, these awards have recognized the importance of graduate student research in helping North Carolina’s people and communities.”
Liz Chen, PhD: Developing Tech-Based Solution to Increase Access to High-Quality Sexual Health Education
“While the Healthy Youth Act of 2009 mandates comprehensive sexual health education for students in grades seven through nine in North Carolina, many schools (public, private and charter) do not offer it,” Chen says. “The state of North Carolina just reached its lowest teen pregnancy rate in a decade, but teen pregnancy rates continue to spike in predominantly rural and non-white counties where schools tend to have fewer resources to hire trained health educators or purchase evidence-based interventions.
Frustrated by the limited reach and effectiveness of existing sex education resources, I served as the team lead and principal investigator for two research grants from Power to Decide (formerly The National Campaign to Prevent Teen and Unplanned Pregnancy) and worked to reduce institutional barriers by delivering sex education directly to teens on their phones to increase their access to high-quality sexual health education and to increase their sexual health knowledge.
After following a 24-month human-centered design process and working with more than 400 teens, mostly ages 13-15 — most of whom were in rural eastern North Carolina — we launched the beta version of our Real Talk app in 2017. In the app, teens are able to browse, search and share anonymous stories that are linked to credible resources like amaze.org. To date, we have reached more than 14,500 teens in all 50 states and more than 100 countries. We also have more than 500 users in North Carolina. Among our users, approximately 70% report increased sexual health knowledge after using the app.”
“By developing and disseminating effective sexual health interventions that can be delivered in low-resource school and other settings, Liz has made valuable contributions to the effort to reduce teen pregnancy and sexually transmitted infections, and improve academic performance and opportunities for youth in our state,” says adviser Beth Moracco, PhD, associate professor of health behavior and adjunct professor of maternal and child health at the Gillings School.
Elizabeth Davidson: System to Help Eastern Band of Cherokee Indians Collect, Use Vital Statistics
“The Eastern Band of Cherokee Indians’ (EBCI) constitutional right to govern themselves includes the power to own and use data collected for and about them,” says Davidson. “For EBCI, having the ability to track health information about enrolled members and their families without relying on outside government sources is particularly important. This includes information about deaths in the community, which is critical for planning and evaluating public health programs specific to EBCI. I worked with key public health stakeholders within EBCI to research, design and create a system to help the Tribe collect and use their own data regarding deaths in their community.
The resulting system used death certificates to collect and preliminarily analyze information about cause and manner of death, as well as age at death and contributing factors. Continuous conversations with community members, Tribal government, the Cherokee Indian Hospital Authority, and EBCI Public Health and Human Services guided the project and ensured EBCI had ownership over how death certificate data was used and disseminated. In addition, our system was designed for ease of use and left open to the possibility of integration with health records at the local hospital. Ultimately, the key stakeholders and I envision a system that allows EBCI to identify and respond to public health issues reflected in information collected about deaths in the Cherokee community.”
“Elizabeth worked directly with the Eastern Band of Cherokee Indians to develop a culturally acceptable approach for tracking death records. In so doing, she developed a sustainable system that will generate important public health insights,” says adviser Nisha Gottfredson, PhD, assistant professor of health behavior at the Gillings School.
Stacey L. Klaman, PhD: Improving Reproductive Health Care for N.C. Women with Opioid Use Disorders
“North Carolina is experiencing an opioid epidemic,” Klaman explains. “More than 200,000 women in the state report the misuse of opioid pain relievers. Research shows that women with opioid use disorders have high rates of poor reproductive health outcomes, including unintended pregnancy, sexually transmitted infections and low contraceptive use.
For my dissertation research, under the mentorship of Dr. Hendrée E. Jones, a UNC-Chapel Hill professor and the executive director of UNC Horizons, I examined reproductive health services provided to women enrolled in opioid treatment programs in North Carolina as well as treatment provider and support staff views about integrating more comprehensive reproductive health services for women. Findings indicate that opioid treatment programs fell short of federal mandates to test women for pregnancy, hepatitis C and HIV. Also, while a majority of providers and staff surveyed perceived benefits to reproductive health education and increased access to services, the majority of opioid treatment providers surveyed believe it is outside their scope of practice to provide reproductive health services.
As a result of my research, the N.C. Division of Health and Human Services — Women’s Health Branch contracted with me to develop a training curriculum encouraging collaboration between opioid treatment providers and public health nurses to improve linking women with an opioid use disorder to reproductive health services. More than 100 treatment providers and nurses have already been trained statewide. Study results were shared with the N.C. Association for the Treatment of Opioid Dependence, providing insights into why reproductive health care is critical for the long-term health of women with opioid use disorder, their children and their communities.”
“Dr. Klaman’s training curriculum has the potential to affect the health of the more than 5,000 women with an opioid use disorder who are enrolled in opioid treatment programs across North Carolina by improving access to critical health services,” says adviser Carolyn Halpern, PhD, professor and chair in the Department of Maternal and Child Health at the Gillings School.
Kathleen Knocke: Evaluating Interventions to Enhance Health Care in Rural Communities
“Critical Access Hospitals (CAHs) provide life-saving emergency care and essential health care services to rural communities,” says Knocke. “North Carolina has twice as many rural residents as the national average, with 40% of North Carolinians living in rural communities. All 20 N.C. rural hospitals that meet the criteria for CAH designation have converted to CAH status, which allows these hospitals to receive enhanced reimbursement for Medicare services and to participate in the Medicare Rural Hospital Flexibility Program (Flex Program). The Flex Program provides support to small, rural hospitals designated as CAHs to implement interventions to support access to high-quality health care services in rural communities.
My colleagues and I conducted a 2-part evaluation of financial and operational improvement interventions. This project, based within the North Carolina Rural Health Research Program of the UNC Cecil G. Sheps Center for Health Services Research, investigated 1) whether financially vulnerable CAHs participated in interventions to improve hospital operations and financial stability and 2) the impact of participation on CAH profitability. This evaluation was supported by the Federal Office of Rural Health Policy, a program of the federal Health Resources and Services Administration.
Our analyses suggest that CAHs at greatest risk of financial distress and closure are appropriately targeted to participate in these interventions, and that their sustained participation improves CAH profitability. Knowledge that promotes support for N.C. rural hospitals through the Flex Program has the potential to help maintain access to essential health care services for our rural residents.”
“The results of Kathleen’s work are providing critical information to the Federal Office of Rural Health Policy to improve the Flex Program and maximize its impact on Critical Access Hospitals,” says adviser Kristin Reiter, PhD, professor and associate chair in the Department of Health Policy and Management at the Gillings School.
Nicholas Lenze: Examining Wide Range of Patient Data to Improve Head, Neck Cancer Outcomes
“Patients diagnosed with advanced stage head and neck cancer tend to have poor survival outcomes, and those with low socioeconomic status disproportionately experience delays in diagnosis,” says Lenze. “Our research team, which was led by Dr. Andy Olshan and Dr. Adam Zanation, sought to examine possible mechanisms underlying this relationship.
Using a sample of 1,108 patients diagnosed with head and neck cancer in North Carolina from the Carolina Head and Neck Cancer Epidemiology (CHANCE) study, we examined demographic, clinical, socioeconomic and preventive care factors for associations with advanced cancer stage at diagnosis. We found that patients with annual routine dental visits and at least one colonoscopy over the past 10 years had decreased odds of advanced stage at diagnosis. Alternatively, patients with no insurance or an income below $20,000 had increased odds of advanced stage at diagnosis. Patients in the study sample with an advanced stage at diagnosis had nearly twice the risk of 5-year mortality compared to patients with an early stage at diagnosis.
These findings demonstrate the importance of insurance coverage and access to preventive care services such as routine dental visits in optimizing head and neck cancer outcomes. Policy solutions may involve Medicaid expansion in North Carolina, inclusion of routine dental services in Medicare coverage and oral health literacy campaigns. I am currently working with a team of dentists, physicians and public health leaders to disseminate our findings and advocate for policy change.”
“To my knowledge, Nicholas’ project is the first population-based study to show that use of preventive care services such as dental visits and colonoscopies can decrease the odds of advanced stage of head and neck cancer at diagnosis and reinforces the overall importance of socioeconomic disparities in disease prevention,” says adviser Andrew Olshan, PhD, Barbara Sorenson Hulka Distinguished Professor in Cancer Epidemiology at the Gillings School.
Libby McClure: Understanding Work-Related Disparities at the Aluminum Smelting Facility in Badin, N.C.
“Badin, N.C., is the site of one of the world’s largest aluminum smelting facilities, operated by Alcoa from 1917-2007,” McClure explains. “Residences and jobs were racially segregated, and the former smelting facility and its dumping sites are located in West Badin, where the residents remain predominantly Black. The Concerned Citizens of West Badin (CCWB) formed in 2013 to advocate for remediation of contamination in their community. Since then, they have raised former employees’ reports that the least desirable jobs in the plant were most often assigned to Black workers. The current epidemiology literature about aluminum work does not reflect experiences voiced by the CCWB, nor does it include analyses of race or gender disparities in health or labor divisions. The goals of my collaboration with the CCWB are to: 1) examine how racism has shaped working conditions and diseases and 2) begin to address the limits of epidemiology on aluminum work.
My dissertation characterizes differences in work exposures and health by race and gender. I found that non-white workers were most likely to be hired into dangerous jobs. In partnership with the North Carolina Environmental Justice Network, we also developed surveys documenting work exposures and health. So far, we have completed 25 surveys with Black former workers. Nearly everyone surveyed reported experiencing toxic work exposures, overt racism at work and cancer in their family. This research serves as a starting point in addressing former workers’ concerns about occupational disparities. It can further inform interventions to make manufacturing uniformly safe for workers, regardless of race or gender.”
“Libby’s work will strengthen the Badin community’s understanding of health effects of exposures, as well as contribute to understanding of the aluminum industry’s legacy in terms of worker health, and disparities in exposure for women and minority workers,” says adviser David Richardson, PhD, associate professor of epidemiology at the Gillings School.
Asher Schranz: Investigating Link Between Drug Use, Life-Threatening Heart Infection
“Skyrocketing overdose rates are not the only health threats impacting persons who use drugs,” Schranz says. “My research focuses on the intersection of drug use and infectious diseases, specifically infective endocarditis. This potentially life-threatening infection of the heart valves can affect numerous parts of the body and often requires open heart surgery. Persons who inject drugs can develop endocarditis following introduction of bacteria or fungi into the bloodstream from nonsterile injection.
We sought to characterize the extent to which endocarditis is occurring among N.C. residents injecting drugs in recent years — and to understand its impact to health systems and insurance payers. Collaborating with the N.C. Division of Public Health, we examined statewide trends in endocarditis hospitalizations and cardiac surgeries from 2007 to 2017. We found that hospitalizations for drug-related endocarditis have, overall, increased 12-fold and hospitalizations where cardiac surgery was performed increased 13-fold. Persons undergoing surgery for drug-related endocarditis were primarily young, uninsured or insured by Medicaid, and had hospital stays that were long and expensive.
Our study confirmed that endocarditis is a major emerging concern: Once thought to be a disease primarily impacting older persons with underlying heart disease, endocarditis in North Carolina is increasingly comprised of young persons who use drugs. In addition to afflicting patients with a life-changing illness, endocarditis also impacts health systems and Medicaid, which largely shoulder the high cost of endocarditis care. Our study strongly indicates providers and health systems should address endocarditis not only with antibiotics and surgery, but also with care for patients’ substance use disorders.”
“Asher’s research has had a significant impact in North Carolina. As a leader in addressing drug use-associated infective endocarditis, he is poised to continue advancing practice and policy in North Carolina and across the United States,” says adviser David Rosen, MD, PhD, associate professor in the UNC School of Medicine.
Jessica Soldavini: Evaluating Food for the Summer Program, Toward Even Greater Success
“Food for the Summer (FFTS) provides free meals through the federal Summer Food Service Program and enrichment activities to children in low-income areas of Chapel Hill and Carrboro,” says Soldavini. “It is a community-wide effort to address child hunger led by the Chapel Hill Mayor’s Office, Chapel Hill-Carrboro City Schools and a variety of local organizations, with hundreds of community members volunteering each summer.
I have played a key role in supporting FFTS since it began in 2016, including participating in monthly planning meetings, offering nutrition education at meal sites and leading program evaluation efforts. In 2017, I received a Community Engagement Fellowship from UNC-Chapel Hill’s Carolina Center for Public Service to evaluate FFTS. I worked with representatives from FFTS to develop an evaluation plan that included multiple components. In 2017, more than 45,000 meals were served to children at 42 meal sites throughout Chapel Hill and Carrboro, with an average of 1,100 children participating each day. A key outcome was the community-building aspect of FFTS. The program allowed individuals participating in and helping with the program to build relationships and connect with others at meal sites who they may not have otherwise met. Successful program components and areas of improvement were identified.
The results have been used by FFTS to improve the program, apply for grants, and recruit volunteers and donors. Key findings of the evaluation also have been shared with and used by organizations across North Carolina and the United States. FFTS continues to operate each summer and I remain highly involved with supporting this effort.”
“Jessica is an immeasurable asset to the programs serving hungry children in North Carolina through her work with No Kid Hungry NC and UNC’s Health Promotion and Disease Prevention Center,” says adviser Maureen Berner, PhD, professor of public administration at the UNC School of Government.
Kirsten Studer: Identifying Water Contaminant Risk, Possible Treatment Option
“Increasing numbers of drinking water sources are impacted by waste streams, the treatment of which leaves many contaminants intact,” explains Studer. “At present, we are constantly being exposed to low levels of numerous contaminants in our public drinking water systems, which may induce biological changes after long-term exposure or in association with other chemicals. Vigilance concerning potential chemical interactions within water supplies is of vital importance, especially as new chemicals and new public health concerns develop.
My research on organic iodine contaminants, specifically iodinated contrast agents used in X-ray facilities, shows that wastewater treatments do not remove these contaminants completely and they can enter downstream drinking water treatment plants. Iodinated disinfection byproducts, which are significantly more toxic than regulated disinfection byproducts, can be formed once these chemicals are exposed to disinfectants. Long-term exposure to disinfectant byproducts is associated with increased bladder and colon cancer rates, so limiting their formation is imperative.
One treatment option for removing iodinated contrast agents from water uses powdered activated carbon, which my research has shown to be effective within existing drinking water treatment plants. This research highlights the need for increased drinking water source protection to decrease organic iodine contaminants which can react to form iodinated disinfection byproducts; it has been shared with the N.C. Water Resources Research Institute and the N.C. Urban Water Consortium.”
“Kirsten’s methodical approach to her research has generated an original body of work that is already impacting how utilities think about future planning of drinking water protection and wastewater management,” says adviser Howard Weinberg, PhD, professor of environmental sciences and engineering at the Gillings School.
The longstanding Impact Award, made possible through the generous support of the Graduate Education Advancement Board, recognizes discoveries with a direct impact on North Carolina in the present. The Horizon Award, first presented in 2017, recognizes discoveries with potential to benefit North Carolina and beyond. Master’s and doctoral students, working in close collaboration with faculty mentors, are eligible for the awards, which honor their commitment to improving human health, strengthening communities and/or helping to develop greater understanding of the world’s biggest challenges.
See all of the Impact and Horizon Award winners at the UNC Graduate School website.
Contact the Gillings School of Global Public Health communications team at email@example.com.