FROM THE DEAN
We enter a new academic year with pride in the accomplishments of the School of Public Health during the past twelve months and with excitement about our future direction.
The University has committed funds for the purchase of additional land for our School's new building. While we have continued to improve our existing facilities, perhaps more importantly, we have added several new faculty, introduced in this issue.
We proudly announce that the Kellogg Foundation has chosen the University of Illinois at Chicago as the site for an International Center for Health Leadership Development. Our School will join with other schools in the health professions and academic departments on campus to create new partnerships between institutions and communities which will focus our system of health care more effectively on disease prevention, health promotion and primary health care.
We have completed a two-year strategic planning process and have begun implementing the plan's recommendations. One key finding from our strategic planning assessment is the importance of the School's participation in our community, not only as a direct link to the City of Chicago, Cook County and the State of Illinois, but also as a model of participation and commitment for other universities and schools of public health. We found that our actual involvement in community-based practice, service and collaborative research significantly exceeded perceptions held by us and by community members. We must now make our joint ventures with the community more visible to share more widely what we have learned together.
This issue of HealthPro looks at some of our many community involvements which will take us from storefront clinics on the South Side of Chicago to exercise programs for the elderly to asthma prevention in school children. All these examples involve partnership, empowerment and commitment. These are essential elements in our efforts to move the School's role in public health beyond research and demonstration programs to the broad application of results. Today, more than ever, the bridges between the School of Public Health and the public it serves must be stronger and wider.
Susan C. Scrimshaw, PhD
- IMPROVING HEALTH IN OUR NEIGHBORHOODS
By Bill Brashler
The Indigenous Leader Outreach Model--a model which employs individuals
from within populations to deliver prevention and intervention
services--is now a quarter- century old. Use of this model is
increasing to address diverse public health problems.
Created in the early 1970s by University of Chicago psychiatrist Patrick
Hughes to address neighborhood outbreaks of heroin addiction, the
approach was adapted by Fred Shick, a Hughes colleague formerly with San
Francisco's Haight-Ashbury Medical Clinic, and Wayne Wiebel to target
drug use among teenagers. After joining the faculty at the School of
Public Health, Wiebel along with Antonio Jimenez, Wendell Johnson and
Larry Ouellet applied the model to HIV intervention among injecting drug
users. The model expanded to address the problem among commercial sex
workers, gays and the homeless, and the Community Outreach Intervention
Project (COIP) was born.
"When HIV came along, the drug scene became even more dramatic and
dire," Wiebel said. COIP's inroads over the years, he added, have had "a major
impact on further spread of the disease," which convinces Wiebel that the model
is suitable for attacking other troublesome public health problems. One of
those is tuberculosis. Another is domestic violence. "What better way to
resolve family violence than to have people who themselves have experienced
family violence intervene?" he said. "They can work with families toward
breaking the vicious cycle of physical abuse which is often passed from one
generation to the next."
In the meantime, the COIP intervention model is getting around. COIP
has developed a manual and training curriculum in the Indigenous Leader
Outreach Model for the National Institutes of Health, and over 30 states
have begun using it in training sessions for a variety of
community-based organizations. The Centers for Disease Control and
Prevention (CDC) are also supporting COIP in the development of peer
outreach training, something which can dramatically enhance an
intervention project's effectiveness. Support for international
replication of the intervention to address a wide array of target
populations has been sponsored by the United Nations, the World Health
Organization and the US Agency for International Development for
projects in Brazil, Thailand, Indonesia, the Phillipines, Myanmar
(Burma) and China.
THE STOREFRONTS
They are storefronts with tentacles. Long, probing, obstinate tentacles
that poke into every crevasse of the city's drug scene. Bleach and condoms,
detox and rehab. HIV and syphilis tests. A state I.D. card, a pair of winter
gloves. Dental care, a cup of coffee. Bridge games. A hug. Hope.
That and much more is COIP, the Community Outreach Intervention Project.
No hard-core addict in Chicago--in Austin, Uptown, King Drive, and Humboldt
Park--does not know of COIP and its dogged outreach workers and case managers.
Know them like brothers and sisters.
"I see addicts with abscesses on their arms. They're crying. They ask
me 'What can I do?'" says Don Gonzalez, a former heroin addict and now a case
manager at the Northwest Side office. Gonzalez's reply: "They know I've been
there. I can show them what they can do."
As has Quezethal "Que" Allen, an ex-injector who now fights "denial" by
those she tries to help through correcting myths about AIDS. In the Austin
office "a guy told me he doesn't sleep with dirty (infected) women."
And Matthildur "Matta" Kelley, in Uptown, who looks like everybody's
favorite aunt but who can speak of smack and cocaine--"drugs from hell"--with
chilling eloquence.
Don, Que, Matta, and dozens of other storefront workers are the infantry
of COIP. They have made it one of the most highly regarded AIDS intervention
programs in the world and an increasing community workhorse in an era of
shrinking funding for urban programs.
Utilizing what is known as the Indigenous Leader Outreach Model, COIP is
the street-honed brainchild of Wayne Wiebel of the School of Public Health at
the University of Illinois at Chicago and his staff of ethnographers, Antonio
Jimenez, Wendell Johnson, and Larry Ouellet. In their first major sponsored
program, ex-addicts were hired and trained as indigenous leaders to conduct
outreach and deliver a range of HIV-prevention services to injecting drug users
and their sex partners. They are the "people who've been there," who not only
know the seduction of drugs but who refuse to let addicts be unaware of AIDS,
"the virus," as they call it, which can kill them.
Since 1988 COIP data, from a four-year (1988-1992) study of 641
seronegative intravenous drug users (IDUs), have documented the intervention
model's effectiveness among IDUs in markedly reducing drug and sex risk behavior
and, in turn, reducing HIV infection rates.
Specifically, the study found that among injecting drug users at risk
for infection, unsafe injecting practices in the four-year study period went
from 100 percent to 14 percent, while unsafe sex practices went from 71 percent
to 45 percent. The study also documented a reduction in the
seroconversion rate (per hundred person years) from 9 percent in the first year
to 2 percent in the fourth year.
These findings translate into an estimated 80 prevented cases of
infection among the study's participants. At an estimated lifetime medical
treatment cost of $119,000 per HIV-infected individual, the savings amount to
over $9 million. That just applies to the 641 persons in the study. COIP
records document intervention services to over 10,000 individuals a year.
Such hard data are crucial to the success and credibility of COIP, yet
it is the project's softer touches that make real differences on the street and
reveal the broad reach of the program.
It is estimated that 85 percent of drug users are not in treatment. To get them
you have to know their turf, talk their language, feel their craving. COIP
outreach workers do that as well as anyone. "There isn't a single one of them
who isn't top notch," said Wendell Johnson.
"We clearly do intervention," said Antonio Jimenez of the Northwest Side
office which serves a predominantly Latino clientele. "We've targeted some of
the most notorious shooting galleries, and we go there on a daily basis and drop
off supplies.
"But clients need other things: housing, clothing, transportation,
food-- a lot of these people don't eat well--and that's become a significant
part of our effort."
Said Wendell Johnson of the South Side office: "You just open the door
here and walk in. That's rare on 47th Street. There is a feeling of
acceptance. No rules posted on the wall. Coffee going. Television. Play
bridge. Use the toilet. This is a refuge from the street."
"We're much more than bleach and teach," said Len Haines of the North
Side, in reference to another well-known prevention strategy for IDUs. "We have
to be."
South Side's Valerie Stowe said, "We can't tell people how to live their
lives, but we can say, 'Whenever you're ready, we'll help you.'"
In the ten years since COIP began as a small AIDS prevention and
research program, its four offices and mobile clinic have expanded--often
through workers' ingenuity and insight into client needs--into bustling,
straining, yet tireless social service agencies.
Weekly primary health care clinics, Alcoholics and Narcotics Anonymous
meetings, HIV support groups, tuberculosis outreach in increasingly TB-infected
Latino areas, needle exchanges, even acupuncture treatment--studies show it
reduces drug craving--jam already hectic office schedules.
"We're a lifeline to the neighborhood," said South Side case manager
Mercedes Jones.
"People need so much," said Matta Kelley who interrupted her case
management work last winter to solicit donations of hats, gloves and winter
coats for North Side clients that run the gamut of racial and sexual
identities.
The leaves on the Family Tree Quilt hanging in the Northwest Side office
tell of even greater needs. Its branches are the four COIP offices. Stitched
on the multi-colored leaves are the names of people, now dead of AIDS or
AIDS-related illnesses, who were touched by the project.
"The women in the community did all the work," said Marcia Gomez,
another member of COIP's original team, who is now the project's Service
Director. "The quilt met a deep therapeutic need. It helped these women get
through their denial and realize how many of their friends had died. They were
remembered in a world where people seem to disappear and be quickly
forgotten.
"To be effective in intervention," Gomez added, "you have to respond to
basic human needs that others may take for granted." That thought acutely
applies to clients who are HIV positive.
"To people who are already infected, our staff is invaluable," said
Antonio Jimenez. "People stay healthy longer at a lower cost to society. The
quality of their life improves. Even those who've died of AIDS have done so
with dignity. With people around them."
COIP's level of social impact impresses Oscar Tanner, a senior
interviewer at the South Side office. "I've been in drug research since 1975
and you normally don't see anything positive coming from it," he said. "With
this project I've not only seen behavior changes but I see street people getting
back into the system."
It is a shrinking system, to be sure, with cutbacks in prevention
monies, in rehab and detox programs, in public aid and Social Security benefits,
and an overall squeeze in the availability of treatment for addicts who've
finally decided to change.
"One of our jobs is to be there when people want to get off drugs," said
Austin case manager Audrey Porter. The Austin Office is COIP's newest, opening
in 1993 and drawing on a more working-class African-American population. "Once
they decide they're willing to get help, we have to go all over," said Porter.
"Just hustle for anything we can find for them."
"All these cutbacks mean people are getting pressured out of substance
abuse programs," said Que Allen. "They come to us because they don't know how
to handle their lives. We could be open every day, twenty-four hours, and still
not keep up."
And still not reach everybody. "We're now expanding into Bridgeport,
Pilsen, Back of the Yards," said Antonio Jimenez. Each area has a different
scene, different drug usage patterns.
The drug scene is never static, never predictable, Jimenez pointed out,
which underscores the need for continuing COIP research. "There is still a lot
to learn about drug use. There's a lot about the problems people have
controlling drug use that we still don't know," he said.
Such research is only possible, however, when people communicate. "What
we do on a human level with the IDU population is crucial," said Mercedes Jones
of the South Side. "It opens them up to us, and it allows other drug research
projects access to a population they couldn't otherwise get to."
An important area of COIP research has focused on the relationship of
drugs and sex. "Prostitution among addicts, a lot of it involving unprotected
sex, is a thriving business," said ethnographer Larry Ouellet of the North Side
office. "If you look at the many customers with suburban vehicle stickers
cruising around here at 6:00 a.m.," Ouellet said, "you see that AIDS
is more than just a ghetto problem."
Ouellet is also working on expanding the operations of COIP's mobile
unit, a mini version of a field office which attempts to administer just as many
services in as many new neighborhoods as possible. Part of the effort is a
needle exchange program in conjunction with Chicago Health Outreach, a division
of Travelers and Immigrants Aid.
"We've gone from basic street intervention to being the largest social
service agency in the community for active drug users," said Wendell Johnson.
"We've established an identity."
"I've seen people go from abandoned buildings to jobs, and they're doing
fine now," said Valerie Stowe.
And yet COIP's storefront signs have gotten no bigger. There are no
lights, no loudspeakers, no neon.
For further information, contact the Community Outreach Intervention Projects
offices at 312-996-5523.
COIP ATTACKS TB
"It doesn't matter where they are, I'll go there," says Iris Santiago, a
47-year-old outreach worker in the School of Public Health's Community Outreach
Intervention Project. A typical day for Santiago begins about 8 a.m. when she
reports to a Chicago Department of Public Health clinic, meets with the nursing
staff and picks up her clients' daily doses of anti-tuberculosis drugs. Then
she hits the streets in search of her brood, which takes her into abandoned
buildings converted into "shooting galleries" that are used to buy and inject
drugs; street corners used as "hanging" areas for addicts; and halfway homes,
where users may secure temporary housing. Santiago always stays around long
enough to make sure her clients take the drug.
"Some clients become verbally abusive because they are tired of taking
the medication," Santiago says. Still, every day she heads out. "The best part
of my job is when a client completes treatment and tuberculosis is prevented."
The source of her satisfaction is important because the key to controlling TB is
finding the index, or gateway, cases and providing treatment, the cornerstone of
the COIP intervention. UIC collaborated with the Chicago Department of Public
Health through COIP in response to an outbreak of multiple-drug resistant
tuberculosis in the Humboldt Park area. Injecting drug users who are HIV
positive or have AIDS are at particular risk because their weakened immune
systems make it difficult to fight off infections.
Under the supervision of UIC ethnographer Antonio Jimenez, who tracks TB
disease patterns in neighborhoods like Humboldt Park, Santiago targets networks
of injectors to educate them about their risks for contracting TB and provides
direct observational therapy (DOT) to patients with active TB. DOT is one of
the key strategies used by public health authorities in controlling the spread
of TB--particularly the most troublesome, multiple drug resistant (MDR) strains
of the disease. MDR TB is a consequence of patients failing to adhere to
treatment protocols, especially the failure to complete medication regimens.
A former injection drug user herself, Santiago comes from Humboldt Park
and is "sensitized to the issues of the clients," she says. Santiago's caseload
has been as high as seventeen patients at one time, compared to the four to five
cases which guidelines consider to be reasonable.
- Sidebar contributor: Christine Wirt
THE CENTER FOR HEALTH INTERVENTIONS WITH MINORITY ELDERLY (CHIME)
Luise Van Dyke made a new friend during her regular exercise class
coordinated by UIC's Center for Health Interventions with Minority Elderly
(CHIME). Little did she know that her new friend was actually an old friend, a
classmate she hadn't seen in 30 years. When the twice-a-week sessions were over
for the summer, Van Dyke walked a mile a day and continued to pursue the
friendships she made through CHIME.
Founded three years ago with funding from the National Institute on
Aging and the Office of Minority Health Research and in collaboration with
Chicago State University (CSU), CHIME has been built on the premise that
university-based researchers and the social service system needed a bridge to
have an impact on the neglect that often looms over many elderly people.
Limited social support, relative geographic isolation and lower incomes among
older adults can contribute to limited lifestyle options and sedentary later
lives. But healthy habits taught to elderly minority city dwellers can get the
fire burning within again, CHIME has found.
"Part of the initiative was to try to get researchers out into the
community to deal with the practical reality of a communal setting," says
Lucille Davis, CHIME's co-director and dean of CSU's College of Nursing. "The
practice community and the research community just didn't seem to connect."
CHIME director Tom Prohaska, an associate professor in community health
sciences, realized from the start that "one does not just go into a community
and say `here I am, let me do some good for you.' You work with community
leaders to help identify what the priorities are," Prohaska says.
Physically, the benefits of CHIME are clear. The reluctant seniors who
decided to participate - which Prohaska refers to as "recruiting the
unrecruitable" - have lost weight and have more energy. "People come into the
program saying `I just can't do it,' then get into it and just love it,"
Prohaska says. "We have waiting lists."
CHIME is well received at sites including housing projects, churches,
health clinics, senior centers and social service agencies throughout Chicago.
CHIME staff members, who include faculty, students and academic professionals
from disciplines such as exercise physiology, nutrition, occupational therapy,
public health psychology, sociology, gerontology, medicine and nursing, look for
ways to raise interest in participation by analyzing the perceived barriers that
keep seniors from exercising. One strong motivational factor is recognizing and
reinforcing achievement. "When we talk about incentives, it's more than just
small gifts, more than just a water bottle, more than just a T-shirt," Prohaska
says. "We recognize achievement. There is group identity, group cohesion and
social support."
Luise Van Dyck, for one, believes the formal activities create lasting
friendships with people who were once just "familiar faces" from her church or
within the neighborhood. The exercise strengthened social bonds as well as
bodies. "We did a lot of talking there, and then afterward," Van Dyck says.
"We walk each other part of the way home, maybe stop to get a sandwich. We
exchanged phone numbers so we could stay in contact." Van Dyck says she hopes
the CHIME program becomes a permanent part of her neighborhood and her life.
"I'm always going to be part of it," she says.
Behind the scenes, Prohaska, Davis and the rest of the CHIME staff had
to work hard to shape the program into an approach that would be embraced by
minority seniors. The bridge between research and social services can be
difficult to maintain, but while CHIME staff members conduct basic research into
the health needs of minority elderly, they also put equal time into education
and information transfer.
Unlike a controlled research lab, CHIME must deal with "everybody's
daily situation. Anyone who becomes a member of the Center must develop
materials that go beyond simply just publishing papers," Prohaska says.
"Projects actually have to be designed for consumers, that is, for the older
adults themselves, practitioners, or people in various agencies that serve
minority elderly populations in order to make changes directly."
The Center also has formed a community advisory committee that gives
Chicago senior center directors and community leaders such as clergy and social
service advocates direct input into CHIME's activities. Among other duties, the
committee decides which research projects will be pursued, based on their
relevance to the needs of the community. And the Center is training the older
adult participants to continue the program on their own, which Davis says
empowers them and helps CHIME "keep up with demand." Focus groups with the
seniors also provide feedback by exploring their preferred ways of learning,
while they also educate the Center staff on how to tailor culturally sensitive
health interventions that the seniors will understand and maintain. The
underlying principles of public health remain the basis of the Center's
approach, emphasizing the fact that public health is an amalgam of many
disciplines that constantly overlap and shift according to the time and place.
With an additional year of funding secured last May, CHIME will continue to move
forward with eleven research projects which focus on establishing programs that
further stimulate better health behaviors in the areas of diet, exercise,
preventive health care and health promotion.
- Story contributor: Eve Troczynski
For further information, contact Thomas Prohaska, PhD, at
312-996-6344.
OCCUPATIONAL HEALTH SERVICES INSTITUTE
- THE IMPACT OF HEALTH HAZARD EVALUATIONS
Indoor and outdoor environments and occupations suspected of posing a risk
to human health are facing a threat of their own in the form of UIC's
Occupational Health Services Institute at the School of Public Health. The
Institute focuses a scrutinizing eye on questionable places and practices,
conducting studies through its Health Hazard Evaluation (HHE) Program.
Managers, employees, individuals and community groups can request health
hazard evaluations through the Institute. In accepted projects,
multi-disciplinary teams are assembled, which include industrial hygienists,
physicians, nurses, toxicologists and epidemiologists. They look for disease
transmission routes, toxic chemicals or materials, and methods to control
occupational exposures and injuries.
One example is a project which evaluates ventilation and potential
transmission of tuberculosis at Chicago-area hospitals. Some hospitals have
been seeing an increase in tuberculosis-infected patients in recent years, and
tests of staff members have reflected an increase in sero-conversions among
them. Lorraine Conroy, associate professor in environmental and occupational
health sciences, and John Franke, research assistant professor, are the project
investigators. A team of UIC researchers led by Conroy has already performed
evaluations of tuberculosis patient isolation rooms in three Chicago-area
hospitals.
The team evaluated the rooms according to Centers for Disease Control
(CDC) building engineering guidelines, which were reinforced by the Occupational
Safety and Health Administration (OSHA) in 1993 because cases of TB were on the
rise. TB is easily airborne and aerosolized and is highly infectious.
"Engineering controls are a key element in controlling the transmission of TB in
the workplace," says Sharon Welbel, an epidemiologist at one of the three
hospitals. "We're very excited to have UIC doing this work," Welbel says. "If
the spread of TB can be prevented in the hospital, then it is less likely to
spread into the community."
The UIC team also conducted in-service programs at all three hospitals
to support staff compliance with the CDC guidelines and OSHA TB directives, in
addition to providing feedback on engineering controls that would further reduce
the risk of TB transmission to health care workers.
Projects Vary with the Need
Salvatore Cali, the Institute's program manager, is part of another
project team that has trained Illinois Department of Public Health staff members
to collect air samples for lead.
The project evaluated worker exposure to lead during various hazard
control activities involving lead-based paint. "More than 90% of homes built
before 1960 have some lead-based paint," Cali says. Lead abatement enters the
picture when the paint is disturbed in those older homes, potentially releasing
high levels of lead into the air. Monitoring such sites helps to educate
workers and families on precautions they need to take to minimize the amount of
breathable dust stirred up during home renovation. Homeowners are advised to
have children less than seven years of age screened for blood lead every six to
twelve months and always to ensure that children are not present in the home
during painting and renovation activities. Homeowners can also guard against
children's exposure to lead by wet-cleaning potentially lead-contaminated dust
and addressing paint deterioration in the home. It is highly recommended that
licensed lead abatement personnel be hired when work which disturbs lead-based
paint is performed.
Firefighters Get Practical Help and Advice
The Institute also is evaluating firefighters' and paramedics' tasks,
analyzing how they move with their heavy equipment and how they can minimize the
risk of injury on the job.
"Until you've seen lost time at work or suffered a career-ending injury,
you don't realize that it can have a profound impact on an organization and on
an individual's life," says Glenview Fire Chief John Robberson, a member of the
project advisory board. "Firefighters and paramedics often bend, lift, move and
carry, and not in the best conditions," Robberson says. "That could lead to a
career-ending disability." The project includes Glenview and several other
northwest suburban fire departments that make up the Mutual Aid Box Alarm
System, Division III, an agreement in which regional departments respond to
fires or other emergencies in one another's communities when added manpower and
equipment are needed.
Under the guidance of Karen M. Conrad, associate professor and director
of occupational health nursing at UIC, the project team has conducted focus
groups with firefighters and paramedics, done field studies and developed task
simulations in its effort to analyze how and why injuries occur.
"It is my hope that we're just starting out on a very long relationship
with the University to try and reduce injuries and death involving fire service
personnel," Robberson says.
- Story contributors: Mel Marzan and Christine Wirt
For further information, contact John Dimos, director, Occupational and
Environmental Hygiene Services, or Salvatore Cali at 312-996-5722.
MC2HSC: A CHANGE AGENT FOR COMMUNITIES
The Maternal and Child Community Health Science Consortium (MC2HSC) was
established in 1992 at the UIC School of Public Health to promote collaborative,
community-university research partnerships to improve the health status of
mothers and children and the family as a whole. It was developed after a needs
assessment was conducted through meetings with over 80 individuals in the
Chicago area concerned with maternal and child health issues. Participants
articulated a variety of research needs for communities and made recommendations
which would facilitate meaningful collaborative partnerships between the
community and university.
The Consortium operates as an open body to which anyone can bring a
relevant, community-based issue of concern. Consortium staff helps identify a
diverse team of appropriate university and community partners to develop the
research questions, design the study and its evaluation and interpret the
findings. The findings, which are often based on qualitative as well as
quantitative data, are then linked to action such as developing a new program,
improving service or changing policy. The Consortium takes very seriously the
need to involve academics with the people closest to the real issues in order to
properly understand and address the issues. "If academic research is really
going to have an impact on the health of the community, researchers need to
develop an in-depth understanding and cooperative relationships with community
members on a long-term basis," said Myrtis Sullivan, MD, MPH, principal
investigator.
The Consortium has been successful in bringing together over 100 members
comprised of community organizations and agencies, advocacy groups, residents,
health care providers, government agencies and academic researchers to tackle
difficult community-based health issues. Seven major areas of research focus
have been identified and Consortium members work on one or more of the
following: prenatal care; child health; adolescent health; access to care;
health education and training; oral health; and consortium building. A core
group of Consortium staff contribute technical assistance and resources to
assist each group. Over the last four years, over fifty research ideas have
been submitted to the Consortium by a variety of community sources as well as
academia.
For examples of two research initiatives which the Consortium helped
develop, please see the stories on " Improve Prenatal
Care" and "Education Plays Key Role in Dental Health.". Funded by the Federal
government's Maternal and Child Health Bureau, the Maternal and Child Community
Health Consortium is one of only three such programs in the country.
- Sidebar contributor: Ranjit Bagri
For further information, contact Myrtis Sullivan, MD, MPH, at 312-996-7684 or
Marilyn Willis, RN, MS, Project Director at 312-996-2035.
USING SOCIAL NETWORKS TO IMPROVE PRENATAL CARE
A project based on a partnership between five community health agencies
and the Prevention Research Center is analyzing the influence of social networks
on prenatal care. The project asks the question, "How do family, friends and
community influence a woman's use of prenatal care and other health behaviors
during pregnancy?" Insights into the pathways of influence from the social
environment can be used to tailor prenatal programs to meet the special needs of
women from various ethnic and cultural environments. Programs that are
responsive to their patients and their social environments can encourage women
to enter prenatal care earlier and to continue it longer. Toward this end,
information is being gathered from focus groups of African-American, Mexican,
Puerto Rican, and Caucasian women who have recently given birth for the first
time.
The project grew out of a developmental project of the Maternal and
Child Community Health Science Consortium and the Humboldt Park Infant Mortality
Reduction Initiative (HIMRI), a Consortium partner. "We were concerned about
the high infant mortality rate in Humboldt Park and West Town," said Jaime
Delgado, HIMRI's executive director. "The Consortium asked community
organizations what they saw as key issues and then fostered collaborative
relationships with resources like the Prevention Research Center to study those
issues. If this project succeeds, it will not only provide critical information
for community members and researchers on improving prenatal care, but it will
also offer a model for cooperative efforts between community organizations and
academics."
HIMRI and four other community agencies -- Daniel Hale Williams Health
Center, Alivio Medical Center, Mile Square Health Center, and the Cook County
Department of Public Health -- are involved as community partners in all aspects
of the project, including formulating questions for the focus groups, recruiting
focus group participants, and translating findings into recommendations for
improvement of prenatal services and local health systems reform. The community
agencies know the issues and the people in the neighborhoods they serve, and
they have the necessary sensitivity to their target population to insure that
the questions asked about their prenatal experiences are relevant and
appropriate. As their contribution to the partnership, Dr. Michele Kelley of
the Prevention Research Center and other members of the UIC staff are using
their research expertise to carry out the design, implementation and evaluation
aspects of the project, which is jointly funded by the National Institute of
Nursing Research and the Centers for Disease Control and Prevention.
Findings from this project will be used to develop culturally
appropriate strategies to make prenatal care services more accessible and
acceptable to pregnant women and the families, friends and community members who
support them through their pregnancies. If it turns out, for example, that
women in a certain group rely on a close-knit circle of family for advice, then
health care providers will know that they can't just interact with the expectant
mother alone. "A health care provider may tell a pregnant woman to come back
for prenatal care in two weeks," says Kelley, "but if that woman's grandmother
who raised six children tells her she doesn't need to go back until she's
showing more, she may well not go back."
In fall 1996, Dr. Kelley will present the "Social Networks and Prenatal
Care" project at scientific sessions at the National Institutes of Health and on
Capitol Hill.
- Sidebar contributor: Michelle Yaffee.
For further information, contact Michele Kelley, ScD, at 312-996-9364.
EDUCATION PLAYS KEY ROLE IN DENTAL HEALTH
A lack of good oral health in infancy and early childhood is a
widespread problem, and the problem becomes even more acute when access to
dental care is limited due to socioeconomic status. A study supported by the
School of Public Health is showing how a simple and cost-effective approach can
provide the education parents need to preserve an infant's oral health from
birth.
Health care facilities are brimming with young, first-time mothers who
lack the knowledge and resources for proper parenting, prompting public health
professionals to go to great lengths to help the women prepare. In Chicago,
expectant mothers can get child car seats, food stamps, basic clothing kits and
educational material. They can learn about breast feeding, immunization and
ways to transport an infant. But they leave without knowing even the basics of
good home oral care, such as how to clean the inside of an infant's mouth. Nor
do they realize that oral health and overall health are closely linked.
"Dental health should be right at the top of the list behind
immunization, but instead it is lagging behind, without support to educate the
public on its importance," says Lewis Exum, DDS, a retired public health dentist
who wants to shed light on the importance of providing education to expectant
mothers on proper oral care for their infants. Exum's effort is being supported
by Herbert Hazelkorn, associate professor and director of the program in dental
public health at the School of Public Health. Exum, who practiced at Chicago
public health clinics for 25 years, organized an infant morbidity study whose
subjects were 80 pregnant women from the economically disadvantaged Englewood
neighborhood. Half were provided with routine prenatal care, while the other
half also received free toothbrush and toothpaste kits and educational material
on dental care.
Hazelkorn, a longtime educator and advocate for wider access to dental
care, believes Exum's study will show that the children of mothers who received
the basic tools and the manual will have better oral health.
Hazelkorn notes, for instance, that baby-bottle tooth decay is an easily
preventable condition that can virtually destroy an infant's primary teeth and
lead to serious problems when permanent teeth come in. The solution is
educating women about alternatives to the sweetened liquids they put in bottles
to pacify a child. Even seemingly harmless milk and fruit juices, high in
natural sugars, can drive the process of rampant tooth decay. Left in the mouth
of a sleeping infant, whose teeth receive a long, uninterrupted sugar bath, a
bottle filled with sweetened liquid can be devastating.
Yet many parents are unaware of this condition, let alone of the
importance of cleaning the child's gums even before the first primary teeth pop
through. Often, Hazelkorn says, children will see a dentist for the first time
at age five or six, and only then as a requirement for attending school. Just
as often, the damage is already done.
Hazelkorn and Exum believe that the logical way to prevent baby-bottle
tooth decay and a range of other infant and early childhood dental health
problems is to educate the parents while they still have control over what goes
into a child's mouth and can shape their child's oral health care habits and
perceptions positively -- and for a lifetime.
- Story contributor: Lisa Opoka
For further information, contact Herbert Hazelkorn, DDS, PhD, at
312-996-8350.
THE UIC DENTAL SEALANT RESOURCE CENTER
Like his fellow dentists, Drs. Hazelkorn and Exum, Bill Hall believes
in using a preventive approach to improve dental health. He's just coming at it
from a different angle. Hall, director of the UIC-based Dental Sealant Resource
Center, may run the biggest information booth in the world on one of dentistry's
best preventive weapons.
The Center, which he describes as a "national program gone
international," serves as a clearinghouse for information and materials on
dental sealants, as a facilitator for school-based oral health education
programs and as a hub for dental public health programs. Hall has the Center's
sights set on establishing dental sealant programs in Canada and along the
Pacific Rim as well as throughout the United States.
Pit-and-fissure sealants have been shown in numerous controlled,
peer-reviewed studies to successfully block the decay process by literally
forming a thin, plastic barrier over the nooks and crannies in the chewing
surfaces of children's teeth, where 85 percent of pediatric decay occurs.
Virtually invisible, they are easily and painlessly painted onto a child's
teeth, can last many years and can be touched up. Sealants are potentially the
most cost effective preventive tool dentistry can offer populations of children
who likely do not, and will not, receive regular professional dental care or
practice good oral hygiene at home.
Hall notes that the United States Public Health Service has endorsed the
usefulness of sealants, with a goal of having half of all eight- to
fourteen-year-old children in the country with sealants on their molars by the
year 2000. He believes the best chance to reach that goal is through schools
because "schools are the ideal place to put the sealants on because that's where
the kids are," Hall says.
Nearly 4.8 million school days were lost to dental disease in 1994, and
all were avoidable, Hall says. By educating expectant mothers on the importance
of dental sealants, as well as on proper home care and dental visits, many if
not most of those days could be recovered, Hall believes.
- Sidebar contributor: Lisa Opoka
For further information, contact William R. Hall, DDS, MPH, at 312-413-1951.
THE PREVENTION RESEARCH CENTER
On most any day of the year, a Chicago neighborhood somewhere is
benefiting directly from the community-based research programs at UIC's
Prevention Research Center, one of fourteen Centers for Disease Control and
Prevention (CDC)-designated prevention centers in the United States.
Its title is self-explanatory, with its staff of community-oriented
researchers focusing on finding ways to reduce a wide range of unhealthy and
unsafe behaviors through collaborative prevention efforts that meet communities
on their turf and within their socioeconomic milieu. Often that environment
includes poverty, use of drugs, alcohol and tobacco, unsafe sex practices,
single- or no-parent families, and overburdened and ineffectual schools.
The following are three examples of the more than twenty Center projects
being funded by the National Institutes of Health (NIH), CDC and other
agencies.
.
"It's Time--To Quit"
As part of "It's Time," a smoking cessation program for low income women
of childbearing age, the PRC has recently completed the project's intervention
phase in selected city public health clinics and an evaluation of its
effectiveness. Directed by PRC researcher Clara Manfredi, the study found that
6 percent of the women in a six-clinic control group quit smoking based on a
traditional approach, while 14 percent at the six intervention clinics receiving
"It's Time" have quit. The health clinic project employs posters, a videotape
for waiting rooms, specific counseling by health care providers on smoking
cessation, a motivational, self-help booklet, client agreement form and
follow-up phone calls and letters to participants in the intervention. Manfredi
says those tools are used to "increase their motivation and readiness to quit."
Jean Bridges, a medical assistant at the Holman Neighborhood Center,
believes the project has accomplished those goals. "I think most of the women
involved in the project will quit smoking within a year," Bridges says. "I'm
working with fifteen of the women here, and my fifteen aren't smoking."
In addition to the health clinic project, "It's Time" has included a
news series on WMAQ-TV, an anti-smoking campaign on seven Chicago-area
television stations and a free self-help booklet that was distributed to more
than 20,000 Chicago women. The "It's Time" campaign and materials were
developed by Dee Burton, who researched tobacco use and tobacco advertising and
marketing at the PRC for many years.
Skin Cancer
Another community-based prevention project at the PRC is developing and
evaluating strategies for the primary prevention of skin cancer with a focus on
increasing the use of sun protection among young children and adolescents.
Called the Eclipse Skin Cancer Prevention Project, this initiative is
based on two issues: the rate of skin cancer is increasing faster than any
other cancer in the United States; and much of the risk for skin cancer develops
in the childhood and adolescent years. Directed by Robin Mermelstein, deputy
director of PRC, the project consists of two parts. Once concentrates on
increasing the sun protection practices at day care centers for the children
under their care, while the second focuses on high school students.
Sixteen suburban day care centers have received on-site workshops and
education on skin cancer risk factors and ways to reduce risk to young children.
The centers also were encouraged to develop specific sun protection policies
that involved parents and staff.
At ten Chicago-area high schools, the project has focused on development
of a multi-component and multi-year intervention. The sun protection and sun
exposure habits of students at those schools also have been measured over the
course of three summers.
Students were provided with information about skin cancer and its risk
factors, plus ways to reduce their personal risk for developing skin cancer.
They also received personalized risk information and feedback on their attitudes
and behavior regarding sun protection, along with motivational messages and
stories designed to increase their use of sun protection and decrease
unprotected exposure.
Both portions of the study are now being evaluated for their
effectiveness.
Mermelstein, who also directs a PRC smoking cessation program that has
one of the highest quit rates in the United States, says behavioral change
occurs most often when programs are developed around practical ways to help
smokers -- or sunbathers -- understand their behavior, why they behave that way
and what alternatives they have at their disposal.
Aban Aya
Under the direction of PRC Director Brian Flay, a multi-disciplinary
team of faculty from ten UIC departments has been working to develop an
innovative, comprehensive approach to reducing high-risk behaviors among
students in twelve Chicago-area elementary schools for the past three years.
Called the Aban Aya Youth Project, its name is taken from two Ghanian symbols
that mean "parents and schools supporting healthy choices and a healthy
environment to build self-determination for our youth."
The project is designed to teach children behaviors that will improve
diet, exercise and preventive health habits while reducing health-compromising
habits such as unsafe sex, substance abuse and violence. Three curricular
approaches are used, with each school randomly picked for one approach each.
All three take paths to the same aforementioned objectives, and each curriculum
draws children in with an Afrocentric focus that builds students' sense of self
through an understanding and appreciation of their own culture's contributions
to the world and the richness of its history.
At the same time, the curriculum provides them with the tools needed for
problem solving, decision making, conflict resolution, communication, anger
management and preventive health maintenance, and classroom teachers are trained
to teach the Afrocentric curriculum and to reinforce the positive behaviors they
see in their students.
When the five-year funding period is over, Flay believes the Aban Aya
model, if successful, may be incorporated in classrooms throughout the United
States as a replacement for traditional youth intervention approaches that have
historically missed their mark because the children in the programs could not--
or did not -- relate.
- Story contributor: Michelle Yaffee
For further information, contact William Baldyga, DrPH, at 312-996-0786.
INTERFAITH HOUSE- RESPITE CARE VERSUS HOSPITAL COSTS FOR THE HOMELSS
A UIC School of Public Health pilot study of Interfaith House, a 34-bed
respite care center for the homeless in Humboldt Park, has found that the
grassroots facility may be saving the health care system money while bridging a
gap in lives of the homeless.
Study director Kendon Conrad, an associate professor of health policy
and administration, found that discharging a hospitalized homeless person to
Interfaith House when he is well enough as opposed to keeping him in a hospital
unnecessarily has great cost-effectiveness potential.
"Homeless patients tend to stay in the hospital 3.5 days longer than
they actually need to, due to their inability to receive sub-acute care other
than at Interfaith House," Conrad says. "We found that if participating
hospitals had transferred homeless patients to Interfaith House, 12,410 days of
respite care could have been provided at a cost of $642,000 per year, or
$500,000 less than at a hospital. This is even more cost effective than the
home health care that some hospitals provide," Conrad adds.
Interfaith House is a hybrid collaboration of community-based social
services, medical care providers and health care institutions. Its unique
structure is designed to provide continuity and to ease the physical and
psychological burdens of illness in the homeless population. Interfaith House
offers, beyond its 30-day respite program, a 120-day assessment program and six
months of supportive living. It also helps its patients obtain benefits such as
public aid and Social Security disability insurance, which often leads to
permanent housing for patients after their discharge.
According to Interfaith House's medical director, Dr. Bruce Doblin,
Interfaith House is seen on the street as a "Hilton for the homeless. Not
because it looks like a Hilton, but because it's the one place where people can
actually begin to put the pieces of their lives back together," Doblin says.
Conrad has proposed another study to determine whether Interfaith House
also reduces admissions and readmissions to emergency rooms and whether the
center reduces overall health care costs while maintaining high quality care.
His proposal includes a design for a program manual that would detail the
Interfaith House approach so that it could be duplicated elsewhere.
The basis for the proposed study lies in the fact that homeless patients
typically arrive in emergency rooms with an acute illness exacerbated by their
substance abuse, or with an injury connected to their high-risk lifestyle.
To illustrate that observation, six Interfaith House patients were
interviewed about the circumstances of their need for acute care. All were
substance abusers and their injuries included a gunshot wound, two broken heels
from an attempted suicide, severe head trauma from being stuck with a blunt
object, acute cirrhosis of the liver, chronic blackouts connected with the
substance abuse and a severe bladder infection.
The patient with the bladder infection claimed that he had been recently
released from prison and was having a hard time coping in the outside world. He
said that if he had not been admitted to the new program at the hospital, he
would have been killed on the streets. Interfaith House provides such patients
with detoxification, medical stabilization, and removal from unhealthy,
substance-abusing environments while placing them in a clean, sober, and
health-promoting environment.
- Story contributors: Stephanie Boyer and Maribel Ortiz
For further information, contact Kendon Conrad, PhD, at 312-996-3185.
ADDRESSING ASTHMA AMONG CHICAGO'S CHILDREN
Death rates from asthma in Chicago are among the highest in the United
States, particularly among minorities living in low-income comunities, but the
causes are not clear. Asthma deaths also have been increasing across the United
States since the late 1970s, despite the trend toward cleaner air in the big
cities.
Victoria Persky, MD, associate professor of epidemiology and
biostatistics, has studied asthma in Chicago for five years in community
partnerships, with the focus on examining the home environment for links to
asthma. Her preliminary studies suggest that environmental factors in the home
do indeed play a role in the increase in asthma.
In conjunction with Chicago Head Start program staff, Persky conducted a
survey of 1,085 Head Start families, with 14 percent reporting that their
children had been diagnosed with asthma and 19 percent reporting the child had
wheezed in the past year. About one-quarter of households in the survey
included a member with asthma other than the child, while more than 40 percent
of the parents said someone in those homes smoked, 25 percent had pets and 18
percent had seen dampness or molds in the home in the past year.
Persky says that in several of her studies those selected risk factors
are higher in children with the disease and therefore point to a connection with
asthma prevalence.
To capitalize on the survey findings, Persky developed a pilot
peer-education program in the West Town/Humboldt Park area, where she has worked
as a physician for 20 years. Parent volunteers were trained in evaluating the
environmental contributions to asthma, and eight were selected to serve as
parent educators working with other parents of asthmatic children in their
homes.
"We feel that this is the most effective use of personnel and that
training of selected community-based people has many advantages," Persky says.
"It will permit wider dissemination of appropriate and sensitive educational
material and will facilitate community involvement and employment. This should
be a cost-effective program that could serve as a model for use in other
communities in Chicago and, ultimately, in other areas of the United States."
Adds Eva Hernandez, community service director at the Erie Family Health
Center in West Town: "Vicky is a great asset to our community in general. She
is very culturally sensitive and is able to approach preventive medicine and
illness in a very compassionate and very realistic way. I think being realistic
is the key word. You can go to a suburban hospital and they say do this, do
that, but it's not realistic. Vicky sees the problem in the context of what we
can do and how we can do it in our community. She's willing to listen.
"We want to work with families who have asthma, and we're trying to
educate those parents willing to move one step ahead to educate other parents,
in the same way the economics of the health system allowed the Center to reach
more people and use the limited resources we have more efficiently. There's
been movement in the community. We are a working community, with many survival
issues, and, yet, people have found time to get involved in something that we
haven't considered a priority."
A volunteer parent from the Incarnation Head Start program, Michelle
Flores, believes that going home-to-home in the community has helped many
people.
"Even parents we didn't know came here with their children because of
the program," says Incarnation director Zoraiza Fernandini. "I'd like to get
more parents involved and trained so we can reach even more people. We have
been seeing the numbers of children with asthma increase every year, but we
didn't know much about asthma. We didn't have time or the resources, and this
provided the expertise we needed. To me, this training is something
wonderful."
Another Head Start director, Penny Zimmerman at the Greater Garfield
program, adds that the parent she recommended for peer education training, Anna
Marie Sanchez, was so motivated she was hired as a peer coordinator by the Erie
Family Health Center. "With welfare reform and getting parents off of public
aid and working, she was able to do that. It boosted her self-esteem. It was
the most wonderful thing to see happen to this woman. She herself has asthma,
and she could remember all the difficulty she faced growing up at school and
with teachers because of her illness. The program provided parents with
education and training that they just wouldn't have gotten otherwise."
In another asthma study, Dr. Persky examined the effects of dampness,
molds, and indoor and outdoor pollution and pollens on allergic conditions in
East Moline, a Quad Cities community along the Mississippi River that sustained
record flooding in 1993. A survey of 2,450 students found that 35 percent said
they had wheezing or whistling in their chests in the past. Asthma and wheezing
were associated with self-reported exposure to the flooding, dampness and molds.
Asthma also was associated with family history of the disease and having a
smoker in the house.
Persky was also principal investigator of a prevalence study of asthma
in children sponsored by the Otho Sprague Memorial Institute. Preliminary data
from that study suggest that of the 5,505 school children surveyed, 17.6 percent
of the students in public schools and 13.9 percent of parochial school students
have had asthma. Risk factors for asthma also were examined in detail among
students in parochial schools, with the most consistent associations being
family history of asthma, being African American or Puerto Rican, exposure to
pets or to smokers in the home, and exposure to dampness and molds in the past
year.
Data from this study contributed to the formation of the Chicago Asthma
Consortium, an organization of community groups, health care providers,
consumers and professionals in the research, health care policy, public health,
government and academic fields who are working to reduce asthma morbidity and
mortality in Chicago.
For further information, contact Victoria Persky, MD, at 312-996-4783.
AIDS EDUCATION FOR OLDER ADULTS
Older Americans now account for 10 percent, or 45,000, of the AIDS cases
in the United States -- more than the number of AIDS cases in the American
population under age 24.
Until 1985, the primary mode of AIDS transmission was through blood
transfusions. And because older people receive more blood transfusions than
other age groups, they also were at highest risk for becoming infected through
contaminated blood products and then transmitting the virus to their sexual
partners.
The level of HIV-contaminated blood in the nation's blood supplies
dropped dramatically once accurate tests were developed. Nonetheless, the rate
of infection among older adults has not declined. A belief among the general
population that older persons are not at risk helps to exacerbate the problem,
explains Judith Levy, associate professor of health policy and administration at
the School of Public Health. With funding for Small Business Innovation
Research from the National Institute on Aging, Levy and Dr. Rita Strombeck,
president of HealthCare Education Associates, developed an AIDS educational
program for older adults to address this misconception and promote
risk-reduction efforts.
Today, heterosexual transmission accounts for most cases of AIDS among
older adults. Family planning practices typically end with menopause, thus
reducing the perceived need for condom use. When compared to their male
counterparts, older women are at higher risk for contracting the virus due to
age-related thinning and drying of the vaginal wall that increases the
likelihood of rupture and bleeding during sexual intercourse. Meanwhile, as is
true among younger individuals, older persons who are gay, injecting drug-users,
or their sexual partners are at high risk.
Older people are also at risk of HIV infection due to lower immunity
related to decreasing function of the immune system with age. And onset of the
disease following initial infection with the virus tends to occur relatively
rapidly, with a median onset of 5.8 years among those over 50 as compared to 7.3
among younger adults.
Working with Levy who served as technical consultant, Strombeck laid the
foundation for the educational program on AIDS and older adults by producing an
education videotape and guidebook. Educational modules about AIDS were
developed for peer-led groups using the Study Circle Method, a time-honored
Scandinavian approach to adult learning. An assessment survey of older adults
living in Illinois was conducted to determine the level of interest and
perceived need for an AIDS education program for people over 50. Forty-seven
senior centers across the state responded affirmatively. Together, Levy and
Strombeck developed a full-blown program to be pilot tested in Chicago.
The Chicago Department of Aging agreed to allow use of six regional
senior centers to recruit participants and to serve as sites of weekly meetings.
To this end, a planning meeting was held at UIC with Dr. Mary Ann Cicero,
director of operations, City of Chicago Department of Aging, and the
administrative directors from each of the six proposed sites. The meeting
provided a forum for developing recruitment strategies for participants,
training circle-group leaders, setting up program protocols, and finalizing a
time schedule.
As part of the educational program, participants view the video during
the first study session and discuss the first four sections of the guidebook.
Study circle members then agree to research the topic individually and return to
the study circle to share their newfound knowledge at following meetings.
Over the course of three subsequent meetings, the older adults in the
groups move from basics about HIV and AIDS to the level of risk in their
population, to how the disease impacts their lives and, finally, to the
political and economic issues stemming from the epidemic. Through the program
they have realized, among other things, that their immune system decline places
them at great risk of health impairment; that AIDS can have a significant impact
on their lives even if they are not infected themselves; that, politically,
support for Social Security and Medicare is decreasing as the impact of HIV and
AIDS continues to reduce the younger and middle-aged work force; and how
research dollars and preventive programs on HIV and AIDS are targeted mostly at
other age groups because the older population is less of a priority politically.
Perhaps most important, they learn to empower themselves and become AIDS
educators.
Eleanore Goehrke, 79, led her circle group, although she was skeptical
about participating when first approached by the Chicago Department of Aging.
Goehrke says she wondered "what older people have to do with AIDS" when asked to
join a study circle, but now she plans to speak at her church about what she has
learned. Mary-Martha Daniels, another study circle participant, says she has
organized a study circle for older adults at a Salvation Army center and has
discussed AIDS and aging in Modern Maturity, a leading magazine for the older
adult market.
Despite widespread misconceptions about AIDS, older adults like Goehrke
and Daniels have learned through the program that the disease is having a
significant impact on older age cohorts, their families and children. And they
are leveraging the program developed by Strombeck and Levy by taking what
they've learned to their churches, senior centers and other organizations.
First, they had to break the taboos that began in previous generations,
a retired UIC nurse says. "There was a taboo over tuberculosis" in the older
generation, according to Amy Shaw, 88, a retired former head of nursing at the
UIC Medical Center. "People would hide the fact that they even had a family
member with tuberculosis." That taboo, she says, carried over into the AIDS
epidemic, which left many older adults ignorant of the relevance of AIDS to them
and their peer group.
Says Sameera Ali, who coordinated the programs and pilot testing at the
senior centers, "This form of self-empowerment helps participants address AIDS
in the world outside the study circle -- the world of their families and
communities."
- Story contributors: Donald Dill and Will Huston
For further information, contact Judith Levy, PhD, at 312-996-7825.
THE COMMUNITY COMMUNICATIONS LABORATORY
Organizations in Chicago's low-income neighborhoods often find it
difficult to convey the positive side of their lives, their messages of hope and
achievement. The new Community Communications Laboratory (CCL) at the School of
Public Health is working with those groups, however, to help them access the
power of the media and get their messages across.
Developed and directed by Dee Burton, associate professor of community
health sciences, the CCL trains community activists in media skills, from camera
operation to the design of media campaigns. "The Lab simply provides
communications support for the existing community initiatives," Burton says.
"We help the organizations acquire the skills to present themselves in a
compelling way in order to attract some private foundation's funding or the
attention of the mayor's office or local media. The more they can attract
attention in a compelling way, the more likely they are to attract resources."
"We're not talking about placing cute, fluffy little stories," Burton
says. Channel 5 (WMAQ-TV), for instance, has already agreed to collaborate with
the CCL in airing positive news stories from Chicago's low-income communities
that don't normally get coverage and which most often are portrayed by negative
stereotypes. "The idea you get from mainstream media about these communities is
that 364 days a year there are gang wars and children being murdered and then
for one day, there's a street festival," Burton adds.
The community perspective on the Lab has also been positive. "I think a
picture is worth a thousand words and when you show people where you are and how
you got there, it tells people that communities can accomplish things," says
Leola Spann, president of the Northwest Austin Council (NAC), a grassroots
organization on Chicago's far West Side.
"When we closed the first drug house, we went to other communities all
around the city and told them how we did it. It would have been great if we'd
had a videotape to show the difference between what was going on at the house
before and after it was closed. We don't have that luxury because we're just a
small community group trying to do something about the crime and drug problem."
Spann adds that the NAC has welcomed the help of the CCL and claims the
Lab has already been useful in providing assistance for production of a video
documenting the planning process for the NAC's West Side Community Drug Court
program, a unique response to Austin's drug problem. The idea was to share the
process inexpensively with other Chicago communities that might want to
implement a drug court themselves.
The drug court will provide counseling, treatment, vocational training
and education to misdemeanor drug offenders in Austin's 11th police district and
the neighboring 15th and 25th districts. The NAC believes its rehabilitative
approach will not only help the offenders turn their lives around, but lower
crime in Austin and lower the costs of processing offenders in city courts.
Since the inception of the CCL in June 1994, Burton has met with about 70
neighborhood organizations, whose media skills and resources have varied widely.
While some simply need help with a strategic plan, others requested assistance
in basic writing skills, Burton says.
Burton has garnered the support of a culturally diverse group of media
professionals, including video producers, film makers and freelancers from
related fields, who are eager to work on CCL projects. "I have no agenda that
I'm bringing in, so the content of the message is always from the community,"
Burton says. She adds that the CCL's focus will remain in the realm of public
health where concerns range widely from illiteracy and crime to breast cancer
examinations. "We hope," she says, "this will change the way people view these
communities."
- Story contributor: Charles Mertz
For further information, contact Dee Burton, PhD, at 312-996-6342.
Convocation ceremonies for the 1996 graduates of the School of Public Health
were held on Friday, May 3 at the Chicago Illini Union.
Ceremonies were preceded by a luncheon in honor of faculty emeriti and their
spouses, including Dr. and Mrs. Lyndon Babcock, Dr. and Mrs. Viron
Diefenbach, Mrs. Dorothy Donaldson, Dr. and Mrs. Edward Hermann, Dr. Wadie
Kamel, Dr. and Mrs. Paul Q. Peterson, Dr. Mabel Ross, and Professor and Mrs.
Hiram Sibley. Former Assistant Dean and Mrs. James Wagner also joined the
gathering.
Opening remarks at the convocation were made by Shirley Fleming, CNM, DrPH,
deputy commissioner of the Chicago Department of Public Health, John R.
Lumpkin, MD, MPH, director of the Illinois Department of Public Health, and
Allan Noonan, MD, MPH, health administrator, Region V, US Department of Health
and Human Services. Remarks on behalf of the Class of 1996 were presented by
Tamara D. Nettles. David Satcher, MD, PhD, director of the Centers for Disease
Control and Prevention, gave the convocation address. Dr. Satcher spoke on
current and future challenges facing the public health system in the United
States.
The Delta Omega Society, a national honorary public health fraternity
established to recognize and encourage scholarship and research among those
undertaking post-baccalaureate study in public health and to recognize
attainment in the field, nominated the following graduates as new members:
David Barr, Joseph A. DiCara, Sharon Dooley, LaDeane Fattore, Melissa Gilliam,
Marisa Klein Gitelman, Cecilia Ikinwot, Wrenetha Julion, Melinda Kasher, Martin
McDermott, Kathleen Monahan, Lisa Purdy, Kyran Quinlan, Sharon Rothstein, Laura
Schieve, and Julie Slezak. Also nominated were faculty members Sharon Telleen,
PhD and Bernard J. Turnock, MD, MPH and alumni Fred P. Benjamin, MPH, Mary
Dietrich Tellis-Nayak, MSN, MPH and Cynthia T. Henderson, MD, MPH.
The Alan W. Donaldson Memorial Award, the highest award granted by the School
of Public Health to one graduating student for academic excellence, qualities of
leadership and community service, was presented to Lisa Purdy.
The Golden Apple Award, given each year to a faculty member chosen by the
student body in recognition of outstanding teaching and unusual service to
students at the School, was presented to Lorraine Conroy, ScD.
FOCUS ON FACULTY
Shaffdeen A. Amuwo, PhD, MPH, assistant dean, Office of Student and Alumni
Affairs, hosted a visit to Chicago by Professor Wok Soyinka, first
African-American Nobel Prize winner in literature. Dr. Amuwo was also a guest
presenter at the National Opinion Research Council Luncheon Series where he
discussed "The Public Health Work Force: African-American Context."
Faith G. Davis, PhD, associate professor, Epidemiology and Biostatistics
Division, serves as research director for the Central Brain Tumor Registry of
the United States. Dr. Paul Kleihues, director of the International Agency for
Research on Cancer, visited the School and presented a seminar on new research
directions in cancer.
Sylvia E. Furner, PhD, MPH, associate professor, Epidemiology and
Biostatistics Division, was appointed associate dean of the School of Public
Health, effective May 1, 1996. Dr. Furner replaces Kevin Croke, PhD,
who stepped down in May after nearly seven years in the position. Dr. Croke
will continue to serve as interim director of the Environmental and Occupational
Health Sciences Division and as a faculty member in the Health Policy and
Administration Division.
Paul J. Goldstein, PhD, associate professor, Epidemiology and
Biostatistics Division, taught a course on the "Epidemiology of Violence" at the
University of Michigan's Graduate Summer Session in Epidemiology. Dr.
Goldstein is a Faculty Scholar in UIC's Great Cities Institute and serves on the
Task Force on Drugs/Violence Relationships of the United States Sentencing
Commission. He presented drugs/violence workshops for treatment specialists at
the Annual Meeting of the Wisconsin Association on Alcohol and Other Drug Abuse.
Dr. Goldstein also presented expert testimony regarding drugs and violent crime
in New York City public housing before the US District Court in New York.
Audrey K. Gordon, PhD, assistant professor, Community Health Sciences
Division, contributed an article on deterrents to hospice care for
African-Americans and Latinos in Hospice Care and Cultural Diversity, edited by
Infeld, Gordon and Harper and published by Haworth Press.
William R. Hall, DDS, MPH, clinical associate professor, Health Policy
and Administration Division, made a presentation on the activities of the
National School-Based Oral Health/Dental Sealant Resource Center at the
Pennsylvania School-Based Health Centers Conference in Harrisburg, PA.
William H. Hallenbeck, DrPH, Gary R. Brenniman, PhD and April Richards,
MA, of the Office of Solid Waste Management in the Environmental and
Occupational Health Sciences Division, co-authored Public Service Report #15,
Source Reduction Manual for Businesses, Institutions and Residents, and Public
Service Report #16, Waste-to-Energy Combustion Facilities and Materials
Recycling, published by UIC.
Arden Handler, DrPH, associate professor, Community Health Sciences
Division, was the recipient of the 1996 Loretta Pratt Lacey Award for Academic
Leadership of the Association of Teachers of Maternal and Child Health for her
leadership in academics, training, research and policy advocacy. Dr. Handler
spoke about prenatal care issues on the Mara Tapp Show on WBEZ Radio.
Herbert Hazelkorn, DDS, PhD, director, Dental Public Health Program,
Health Policy and Administration Division, was invited to meet with faculty at
the Dental School of the University of Concepcion in Chile to discuss methods
for evaluating school-based programs in preventive dental care.
Donald R. Hedeker, PhD, assistant professor, Epidemiology and Biostatistics
Division, presented a workshop on longitudinal data analysis as it relates to
mental health at the John F. Kennedy School of Government at Harvard University
in Boston, MA. He also led a session on "Missing Data in the Social Sciences"
at the Stern School of Business at New York University.
Daniel O. Hryhorczuk, MD, MPH, director of the Great Lakes Center for
Occupational and Environmental Safety and Health, was a recipient of an award
for a new International Training and Research Program in Environmental and
Occupational Health. This was one of seven awards made to US universities by
the Fogarty International Center and the National Institute of Environmental
Health Sciences in partnership with the National Institute for Occupational
Safety and Health. The award will support Dr. Hryhorczuk's work with
institutions in Ukraine on epidemiology and exposure assessments. Dr.
Hryhorczuk was invited to an April 10 ceremony at the White House to honor
organizations and individuals who have provided humanitarian assistance to those
affected by the tragedy of Chernobyl.
Judith Levy, PhD, associate professor, Health Policy and Administration
Division, serves as a member of the Behavioral, Social Science and Prevention
Area Review Panel established by the NIH Office of the AIDS Research Evaluation
Working Group. The Working Group and its six subpanels reported their findings
on NIH AIDS research and generated recommendations to develop long-range plans
and budgets for the NIH AIDS research program.
Clara Manfredi, PhD, associate professor, Prevention Research Center, and
the Lake County Health Department received a 1996 Academic Linkage Award from
the Council on Linkages between Academia and Public Health Practice for a
collaborative project entitled "Health Department/University Collaboration:
Studying the Breast and Cervical Cancer Control Program for Lake County,
Illinois."
Michael F. McDermott, MD, assistant professor, Center for Health Services
Research, received the Best Emergency Medicine Faculty Presentation Award for
his presentation on "A Comparison Between Emergency Diagnostic and Treatment
Unit and Inpatient Care in the Treatment of Acute Asthma" at the Fourth
Annual Emergency Medicine Research Forum.
Lawrence Ouellet, PhD, was named the new research director for the Community
Outreach Intervention Project in the Epidemiology and Biostatistics Division.
He is also a co-author of "Team Research Methods for Studying Intranasal Heroin
Use and Its HIV Risks" in Qualitative Methods in the Prevention of Drug Abuse
and HIV Research (NIDA Research Monograph 157) and of "Developing
Community Resources for a Stigmatized Population" in Advances in Medical
Sociology: Volume VI, Case/Care Management, edited by Gary L. Albrecht,
PhD, professor, Health Policy and Administration Division.
Rebecca R. Roberts, MD, assistant professor, Health Policy and
Administration Division, had her study, "Randomized Controlled Trial of a Rapid
Diagnostic Protocol for Chest Pain Patients: Cost and Patient Satisfaction
Outcomes" selected as the Best Oral Clinical Science Presentation for the 1996
Annual Meeting of the Society for Academic Emergency Medicine.
Robert J. Rydman, PhD, associate professor, Health Policy and
Administration Division, delivered the Munuswamy Dayanandan, MD, Memorial
Lecture on "Clinical Effectiveness Research in Emergency Medicine" at the Wayne
State University Emergency Medicine Day on May 30.
Peter Scheff, PhD, associate professor, Environmental and Occupational
Health Sciences Division, spent a week in Cartagena, Spain, as an invited
lecturer on receptor modeling. The University of Murcia (Department of Chemical
Engineering), with support from local business and industry, sponsored the
Second International Course on Environmental Modeling, which focused on
atmospheric processes.
Susan C. Scrimshaw, PhD, dean, was appointed a member of the Board of
Health of the City of Chicago by Mayor Richard Daley. She was also appointed to
the Task Force on Community Preventive Services of the Centers for Disease
Control and Prevention. The Task Force will make recommendations on the most
effective community preventive services and methods for their implementation in
preparation for the development of CDC's Guide to Community Preventive Services.
Dr. Scrimshaw serves on the Executive Council of the Illinois Public Health
Association. She recently attended the US - Mexico Foundation for Science's
governing board meeting in Cuernavaca, Mexico as a delegate named by the
Institute of Medicine.
Carol J. Simon, PhD, associate professor in the Health Policy and
Administration Division and the Institute of Government and Public Affairs,
presented lectures on "The Impact of Capitation on Physician Earnings" at the
American Economic Association Annual Meetings, "Factors Affecting Physician
Participation and Earnings under Managed Care" and "Physician Location and
Managed Care" at the International Health Economics Association Conference, and
"The Impact of 'Any Willing Provider' Laws" at the Industrial Organization and
Health Care Conference.
Gary Slutkin, MD, research professor in the Epidemiology and
Biostatistics Division and director of the Chicago Project for Violence
Prevention, participated in the UNICEF-sponsored Global Child Health 2000
International Meeting on "Programs and Paths Away from Violence" in Vancouver,
Canada. He also participated in a joint WHO-UNICEF-UNESCO planning meeting to
set priorities in adolescent health in Geneva, Switzerland. Dr. Slutkin serves
as the primary consultant to the WHO study group on adolescent health which
establishes future priorities and programs.
Wayne Wiebel, PhD, associate professor in the Epidemiology and
Biostatistics Division and director of the Community Outreach Intervention
Project, presented an ethnographic workshop and an indigenous leader
outreach model program at Beijing Medical University in Beijing, China. He also
presented "Rapid Ethnographic Assessment: Strategic Planning for AIDS
Prevention in Five Indonesian Cities" at the Third International Conference on
AIDS in Asia and the Pacific in Chiang Mai, Thailand. Dr. Wiebel spoke on
"Theorizing Needle Exchange: The Effect of Needle Exchange Design on Its
Intervention Components" at the Annual Meeting of the Society for Applied
Anthropology in Baltimore, MD. He gave a workshop presentation entitled "Back
to the Future: Recent Trends in Opiate and Methamphetamine Use" at the Sixth
National TASC Conference on Drugs and Crime held in Chicago.
Thank you and farewell to faculty
retiring from the School of Public Health ...
Tom Christoffel, JD, a professor in the Health Policy and Administration
Division, retired at the beginning of the fall 1996 semester after almost twenty
years of service to the School of Public Health. Dr. Christoffel will be
moving to Boulder, CO.
Swailem Hennein, PhD, associate professor, Community Health Sciences
Division, also retired in September. Dr. Hennein had served the School
since 1974 and was instrumental in developing a series of courses on
international health and family planning within Community Health Sciences. He
will continue to teach some courses in the area of international health.
THE COMMUNITY OUTREACH
INTERVENTION PROJECT
Outreach workers,
Angela Boyd and Larry Smith
working the streets
Outreach worker,
Armando Lira
(center), distributing
supplies
Artist Felicita
Cosme and COIP
staff member Oscar
Tanner view the
projects's Family
Tree Quilt,
commemorating
victims of AIDS.
COIP
ethnographers
(from left)
Antonoi Jimenez,
Wayne Wiebel,
Larry Ouellet
and Wendell Johnson
Interfaith House
Executive Coordinator
Jacob Starks and
Medical Director
Dr. Bruce Doblin
Leola Spann(left) with
Dee Burton(right)
being filmed by Kimmer
Olesak for the drug
court program
All former SPH
Deans joined the Dean
Susan Scrimshaw at
this year's convocation.
From left to right
Dr Viron Diefenbach,
founder, Dr Paul Q Peterson
and Dr Jacob Brody
Dr David Satcher
speaking at convocation
