Penn Public Health
The Blog of the Center for Public Health Initiatives
- CPHI Seminar with Raina Merchant from the Center for Digital Health
- CPHI Seminar with Jose Benitez from Prevention Point Philadelphia
- CPHI Seminar with Flaura Winston from CHOP
- Get HYPE Philly Event
- CPHI Seminar with Bruce Herdman from Philadelphia Prison System
- CPHI Seminar with Jeffrey Hom from Philadelphia Department of Public Health
- Public Health Pipeline Plus Program
Date: February 2018
On Thursday, February 15th, 2018, students, faculty and members from the community filled Bodek Lounge at the University of Pennsylvania to engaged in a thought-provoking presentation given by Raina Merchant, MD, MSHP, FAHA, Director of the Penn Medicine Center for Digital Health and a Senior Fellow from the Center for Public Health Initiatives. As an emergency physician and a trailblazer in social media research, Dr. Merchant and her colleagues aim to understand the intersection between social media and health outcomes. Merchant and her colleagues are able to achieve this by analyzing the keywords, phrases, images, emoticons/emojis, likes and hashtags from patients’ social media accounts.
As the world shifts to a technological era, Merchant’s current research aims to use the data from social media to identify the trends in human behavior and the ways in which that data is linked to adverse health outcomes. The Center for Digital Health (CDH) utilizes existing social media platforms such as Twitter, Facebook, Instagram and Snapchat to engage with patients, healthcare providers, and communities in order to improve health outcomes. The CDH serves as an important incubator for the evaluation and promotion of digital health ideas while providing innovative solutions for patients as well as health providers at Penn Medicine.
During Dr. Merchant’s presentation, she discussed one of the CDH’s most recent studies related to human health and social media. The Penn Heart Study, recently published in the Journal of American Medical Association (JAMA) Cardiology, identified nearly 5 million tweets related to heart disease and cardiovascular health. The findings from the Penn Heart Study suggest that social media platforms, such as Twitter, can be used to learn more about methods for improving patient care and potential digital health interventions. The Penn Heart Study continues to engage with patients and has expanded to patients with diabetes and hypertension who use social media tools. The research findings could potentially change the way healthcare providers communicate with patients.
In addition, Dr. Merchant discussed how the use of social media and internet technologies leave a “digital health footprint” which can be used as clues for health behaviors, preferences and opinions. This idea of being able to draw health related conclusions from social media posts raises concern about privacy and the ethical standards for research. Merchant, along with CPHI Fellows David Grande and Carolyn Cannuscio, will collaborate with the University of Pennsylvania’s David Asch and Nandita Mitra to explore health in a digital world. Through funding received from the National Institute of Health (NIH), this team will examine the ways in which consumers view using health-relevant information on unregulated social media platforms for research.
The innovative development of digital technology and social media can be vital for improving health outcomes, provider-patient communication and patient engagement. CHPI Fellows and Penn research faculty are leading the way in defining the ethical standards for conducting digital health research and practice.
If you were not able to join us for this talk, the video footage can be found here.
Check out the CPHI Data Brief on Advances in Digital Health Research.
Date: January 2018
(Above left) A sold out and very crowded room! (Above right) Jose Benitez, Executive Director, Prevention Point Philadelphia
The Center for Public Health Initiatives, in partnership with the National Center for Integrated Behavioral Health (NCIBH), hosted Jose Benitez from Prevention Point Philadelphia to speak at The University of Pennsylvania on January 18th, 2018. It was a crowded room in the Class of ’49 Auditorium with over 200 faculty, staff, students, and community advocates, organizations, and members. Mr. Benitez fully engaged audience members as he shared “The Streets Perspective on The Opioid Epidemic” that our city and nation are currently facing.
Death rates in the US due to overdoses have risen by nearly 100 percent in the past 10 years. Drug overdoses are the leading cause of accidental death, surpassing the number of deaths caused by HIV, guns, or car crashes. There are an estimated 55,000 illicit intravenous drug users in Philadelphia and the city is on track to surpass 1,200 overdose deaths in 2017.
(Above left) Jose Benitez discussing harm reduction (Above right) A demonstration of the amount of heroin, fentanyl, and carfentanyl needed to overdose
Prevention Point Philadelphia uses a harm reduction approach in order to combat this growing epidemic in Philadelphia. Benetiz describes this approach as “meeting someone where they are in their process”. The organization initiated harm reduction in 1991 with a syringe exchange program in North Philadelphia. Since 1992, services have expanded to include case management, medical care, overdose prevention education and naloxone distribution, as well as housing, meals, mail services for the homeless, Medication Assisted Treatment (MAT) and legal services.
The fact of the matter, says Benitez, is that the heroin in Philadelphia is the best on the East Coast. It is pure and it is cheap. On the streets, a bag of heroin sells for just $5.00 a bag, whereas a single opiate pill sells for $36.00. In a city where one in three people has an opioid prescription, it is clear why so many people are turning to heroin once addicted to the substance when considering cost alone.
An additional driver of this crisis is stigma. Jose Benitez encouraged providers to change language to reduce stigma. An example is a switch from “dirty urine” to a “positive drug screen” which he shared personal experience from his role as a Social Worker. We also need to remember that Substance Use Disorder (SUD) is a disease and we need to accept someone where they are in their use.
(Above left) Benitez shared a photo of the supplies available at Insite, a Safe Injection Facility (Above right) Benitez urging people to carry Nalaxone, the life-saving opioid reversal drug
Jose Benitez also touched on the harm reduction strategy of Supervised Injection Facilities (also known as Safe Injection Facilities, Safe Consumption Facilities, and Comprehensive User Engagement Sites). There is growing discussion of a site such as this in Philadelphia, and Mr. Benitez shared many of the positives, as well as important considerations for such a site. Evan Anderson, who is Core Faculty in our MPH Program, just published an op-ed piece in this issue in The Inquirer. There is also a CPHI Data Brief on the topic that we handed out at the event.
There were many lessons learned and take homes from this talk, but two in particular stuck out to us. First, we are in trouble as a city and as a nation and we do not know how to tackle this issue. Thus, it is imperative to have honest and tough conversations around the topic with all partners in the room, including law enforcement, city officials, harm reduction advocates, community organizations, providers, and drug users. Secondly, we should hand Naloxone (commonly known as Narcan) out like water. There is a standing order in Pennsylvania that allows anyone to access Narcan from a pharmacy without a prescription. The coverage does vary by insurance provider, but Jose Benitez urged that anyone who is not able to afford the life-saving drug should contact Prevention Point to obtain it.
The Center for Public Health Initiatives is collaborating with the University of Pennsylvania’s School of Nursing to begin a Narcan training using an opioid overdose simulation in the School of Nursing’s simulation lab in hopes to train more people on campus and in the surrounding area to feel comfortable to carry and administer the drug. Stay tuned for more information on that!
Missed the talk or want to listen in again? Video of the talk here.
CPHI Data Brief: Supervised Injection Facilities
Date: December 2017
Students, faculty and community members joined the Center for Public Health Initiatives to hear from Flaura Koplin Winston, MD, PhD, Chair of the Science & Medical Advisory Committee for Entrepreneurship and Innovation at the Children’s Hospital of Philadelphia (CHOP). Dr. Winston’s current research projects focus on the emerging public health trend known as “precision prevention,” a method used tailor specific interventions to an at risk population at the right time. Public health focuses on educating the public, promoting health behaviors, and disease prevention within a population. Precision prevention utilizes the same strategy to individualize treatments and interventions while taking into account the socioeconomic, behavioral, environmental, and biological factors that contribute to adverse health outcomes. In contrast to the tradition and universal approach to illness and injury prevention, precision prevention aims to provide individuals with patient specific care and customized treatment plans.
In recent research studies, health care professionals are shifting from traditional methods to precision prevention methods to modify the protocol for screening and treating prostate cancer. Traditionally, physicians have utilized antigen testing and in-person rectal examinations to screen patients for prostate cancer. The approach using precision prevention accounts for the patient’s previous medical history, predisposed genetic/ family factors as well as the patients current health behaviors that can contribute to prostate cancer (i.e. cigarette smoking). Addressing a patient’s current health behaviors as well as their genetic history ensures that the treatment plan is specific to the individual.
Dr. Winston’s current research examines the intersection between motor vehicle crashes and adolescent drivers with Attention Deficit Hyperactivity Disorder (ADHD). Winston and colleagues, including CPHI Fellow Allison Curry, PhD, MPH, aim to determine if having ADHD increases the crash risk among adolescent drivers. The findings of the study revealed that adolescent drivers with ADHD are 36% more likely to be involved in a motor vehicle crash when compared to adolescent drivers without ADHD. Future research recommendations will investigate the effectiveness of prescription medications used by adolescent drivers with ADHD and the prevalence of motor vehicle crashes. The research conducted by Winston and her colleagues utilizes the precision prevention framework by identifying risk factors associated with adolescent drivers and motor vehicle crashes. The preliminary research allows Winston to determine current prevention strategies that can be used to tailor the intervention to the population in need. Applying the precision prevention framework to the current research, Winston and her colleagues were able to modify the research according the needs of the target population specifically adolescent drivers with ADHD.
Through funding from the National Institute of Health, Winston and collaborators are translating the research findings into tangible interventions. They were able to accomplish this by creating motor vehicle simulations that mimic scenarios that occur during motor vehicle accidents and inclement weather. A component of this research simulation allows teenage participants to “drive” in real-life scenarios. During this simulation, the research team is able to observe the brain activity that occurs during the decision making process that occurs during an adverse event. The findings from the driving simulations can be used in the future to better prepare drivers and to decrease the amount of motor vehicle crashes that involve adolescent drivers. Understanding the “neuroscience of driving” can impact the lives of adolescent drivers while encouraging state lawmakers to focus on strictly motor vehicle laws and regulation.
If you were not able to join us for this talk, the video footage can be found here.
Date: October 2017
On Tuesday, October 17, 2017, the Center for Public Health Initiatives collaborated with The Food Trust to bring local high school students to the University of Pennsylvania for Get HYPE Philly (which stands for “Healthy You. Positive Energy.”) The HYPE campaign supports youth councils in approximately 70 middle and high schools, and is an initiative that was created to promote positive health behaviors and positive development of youth. The HYPE program is a partnership with the School District of Philadelphia and the Philadelphia Department of Public Health’s Get Healthy Philly initiative.
Students were greeted by graduate students from the Master of Public Health program/ Penn Public Health Society, Penn faculty and staff from the Center for Public Health Initiatives, and other HPYE volunteers. Glenn Bryan, Assistant Vice President of Community Relations at the Office of Government and Community Relations at Penn, provided the keynote speech and welcomed the students to the university.
Food Trust partners engaged the students and challenged them to think about community and what it means to them. Students responded saying that community is “teamwork”, “a collaborative effort” and the result of “different people coming together to achieve a common goals”.
Students also were able to attend breakout sessions related to healthy behaviors among their age group. Each breakout session was facilitated by a Food Trust partner and focused on different health behaviors related to nutrition, physical activity and chronic disease prevention.
Student volunteers from the Master of Public program at Penn were excited to meet the local high school students and to learn more about Penn’s partnerships with community based organizations that focus on improving the health of at risk populations in Philadelphia.
Overall, Get HYPE Philly was a great opportunity for students from Philadelphia high schools to engage with different organizations in the Philadelphia community and the University of Pennsylvania.
Date: October, 2017
(Above left) Bruce Herdman, PhD, MBA, Chief of Medical Operations at Philadelphia Prison System with Jennifer Pinto-Martin, PhD, MPH, Executive Director, Center for Public Health Initiatives, and Heather Klusaritz, PhD, MSW, Director of Community Engagement, Center for Public Health Initiatives and Co-Director, National Center for Integrated Behavioral Health.
(Above right) A crowded and engaged audience in the John Morgan Reunion Auditorium.
The Center for Public Health Initiatives (CPHI), the Leonard Davis Institute of Health Economics (LDI), and the National Center for Integrated Behavioral Health (NCIBH) were recently joined by over 150 attendees to hear from Bruce Herdman, PhD, MBA, Chief of Medical Operations at Philadelphia Prison System. Audience members came from both schools and departments within Penn as well as outside government and community organizations.
The audience was captured as Dr. Herdman discussed the living conditions in the prison, the medical care and disease prevalence, and disparities across the system. The top convictions of inmates include drug charges (31%), robbery (12%), and aggravated assault (10%). Of the charged inmates, there are tremendous disparities; over 85% are people of color (66% African American and 19% are Hispanic), a statistic certainly not representative of the City of Philadelphia. Herdman recalled that African Americans are 8X more likely to be arrested for marijuana compared to whites.
(Above) Captured and engaged audience members including Jennifer Pinto-Martin, PhD, MPH, CPHI Executive Director, Sara Solomon, MPH, RD, CPHI Deputy Director, and Chyke Doubeni, MD, FRCS, MPH, Co-Director, National Center for Integrated Behavioral Health.
Dr. Herdman provided important statistics, including 30% of those incarcerated are homeless and 80% are from Medically Underserved Areas (MUAs). In fact, most inmates receive better care in the prison system than they do outside. Additionally, 17% of those treated are seriously mentally ill and 36% of inmates are on the behavioral health caseload. The average length of stay in prison is 102 days, but inmates with Serious Mental Illness (SMI) stay approximately 28 days longer than Non-SMI, on average.
In our first seminar of this series with with Jeffrey Hom on "Opioids in Philadelphia: The Obstacles and Opportunities in Addressing a Public Health Crisis", we heard how large an issue the opioid epidemic is. Bruce Herdman weighed in on this issue from the standpoint of the Philadelphia Prison Systems. Firstly, he shared that 3X the amount of people are coming into the prison system on methadone than they were 4 years ago. Additionally, of the heroine overdoses last year, 27% had just come out of the prison system where they were being treated for their addiction. In order to combat this issue and this epidemic, Narcan is now being handed out to prevent overdoses. They expect that 5,000 doses will be given out this year.
Dr. Herdman and his team have been working hard to deliver innovative care to those they serve and to ensure continuity of care after release. He shared that this is his favorite job that he has had because he is working with those in most need. Many audience members stayed after the talk to find out how they can get more involved with this work.
Check out the CPHI Data Brief on "Reducing Incarceration in Philadelphia."
If you were not able to join us for this event, or if you'd like to view the talk again, the video footage can be found here.
Date: September, 2017
(Above left) Jennifer Pinto-Martin, PhD, MPH, Center for Public Health Initiatives Executive Director, delivering the opening remarks.
(Above right) Jeffrey Hom beginning his talk to a sold out room in Bodek Lounge.
Over 200 people joined the Center for Public Health Initiatives on Thursday, September 21st, to hear from CPHI Fellow Jeffrey Hom, MD MPH, Policy Advisor for the Philadelphia Department of Public Health, about the opioid crisis facing Philadelphia. Members of the audience came from schools and departments across Penn, as well as outside government and community-based organizations. There were even community advocates among the crowd.
Dr. Hom discussed this epidemic, with a focus on the epidemiology of opioid use and overdose, the recommendations from the Mayor's Task Force, and the public health opportunities to overcome the many challenges in this crisis.
(Above left) Jeffrey Hom delivering the staggering statistic that enough opioids were prescribed in Philadelphia for every person to have 29 days of OxyContin.
The unfortunate truth in this city is that Philadelphia has the purest and cheapest form of heroin. Drug overdoses killed 907 people in Philadelphia in 2016, three times the number of homicides. Eighty percent of these involved an opioid, including heroin and fentanyl. Simply put, drug overdoses have become a leading cause of death in Philadelphia. In 2016, they were the number one cause of death among people ages 15-44, the number two cause of death among people ages 45-54, and the number three cause of death among people ages 55-64. Those are deeply troubling numbers. More information on the statistics can be found in this CPHI Data Brief.
(Above left) Guests left with tangible actions that we can all take to combat the epidemic. Dr. Hom advised all members of the audience to get trained and carry naloxone, the drug used to reverse opioid overdose. Pennsylvania's "Standing Order" that began in March 2016 made naloxone accessible and obtainable through pharmacies. Hom described use as being as simple as Flonase and urged all to begin to carry this life-saving drug.
(Above right) Jeffrey Hom also suggested that we begin to change our language around this issue to reduce the stigma surrounding it. As a physician himself, he offered up the point that providers are trained to use person-first language as opposed to labels. For example, "a person with with asthma" is used instead of "Asthmatics" and "a person with diabetes" as opposed to "Diabetics". So how is the use of "Addicts" or "Schizophrenics" different? As quoted from Former US Drug Czar Michael Botticelli, "The language we use to describe this disease can either perpetuate or overcome the stereotypes, prejudice and lack of empathy that keep people from getting the treatment they need."
If you were not able to join us for this event, or if you'd like to view the talk again, the video footage can be found here.
Public Health Pipeline Plus!
CPHI and The Netter Center Merge to Make a New Public Health Pipeline Program at Penn.
CPHI partnered with the Netter Center to host 16 Philadelphia high school students for a public health internship this summer from July 5th - August 11th. This past week, interns presented their final presentations on topics such as healthy eating, lead poisoning, and bicycle safety. This pilot year took a step toward the goal of building a Public Health Pipeline to parallel the existing Educational Pipeline Programs operated by the Perelman School of Medicine in partnership with the Netter Center. CPHI was fortunate to build off of a network of CPHI Fellows and MPH Faculty to help with programming.
“It was a pleasure working with high school students and to engage them in how to think of about injury and violence,” said Therese Richmond, Andrea B. Laporte Professor of Nursing and Associate Dean for Research & Innovation for School of Nursing. “Their age group is at such high risk for injury - having an opportunity to help them see how risks can be identified and mitigated and how science can be used to keep communities safe is important.”
Master of Public Health (MPH) student Elaine Tran, in her second year of the MPH program, took the lead on designing and implementing the program along with two other MPH students and Netter Center staff. On a typical week, students were exposed to one of four primary public health topic areas: environmental health, infectious disease, chronic disease, and injury prevention. Lessons were both classroom and field-based. For example, when learning about chronic disease, interns visited corner stores to audit the amount of tobacco and sugary drink advertising. In addition, during their week with the Center for Excellence in Environmental Toxicology (CEET), interns tested soil and analyzed for lead contamination. Other activities included visiting the CDC Quarantine Station, helping beautify a vacant lot, and learning about bicycle safety while taking a test ride with the city’s Indego bikeshare program with the Bicycle Coalition.
CPHI had the pleasure of talking with Nicholas Nguyen and Amaya Toby, both rising juniors at Mastery Charter Schools, Thomas and Shoemaker Campuses, respectively. Here’s what they said:
CPHI: What got you interested in the program?
Amaya: I was introduced through my internship here at Penn. I always wanted to be a pediatrician but didn’t feel that confident in myself to help kids, so I needed to go to more programs to confirm that I can do it. So far I think I can.
CPHI: What helped build your confidence?
Amaya: Meeting a couple of pediatricians themselves - they made it seem like a fun job and helped me keep an open mind about how to get into the field of work. I was introduced to epidemiology and didn’t even know that existed. Now I know not only can I help children, but I can prevent them from getting hurt. [Through this] I found a little place of where I want to be.
CPHI: What was the most meaningful part of the program?
Nicholas: Putting together the career panel; it was really hectic to put together but fun to see it all work out. It was also really interesting tracking lead in the soil and using maps to see how everything is spread out – I like that kind of data.
Amaya: I really liked the lesson on chronic disease – specifically the smoking part when they showed us the different ways how they [tobacco industry] went around and advertised smoking - targeting our neighborhoods. I was upset about it – how they [tobacco industry] used black power in their ads. And it helped when he [Ryan Coffman, Tobacco and Policy Control Manager, City of Philadelphia] sat down with us and talked about ways to get through to people who smoke. That actually made me talk to my uncle about it.
CPHI: Did the program meet your expectations?
Nicholas: To be completely honest, I had no idea what I was walking into. Thought I was going to be in the hospital, but we never stepped into the hospital!
Amaya: I felt like we’d learn the basics of the human health - the body and everything – but really was like the opposite. It was different. It was mostly like ways to get sick, and know what you can do to make it stop.
CPHI: Is there anything you would change?
Nicholas: I really enjoyed the program. But if I had to change something – more hands-on experience.
CPHI: What would be your advice to a young person interested in joining the program next year?
Amaya: Prepare to socialize a lot. When I stepped in I thought it was just going to be me and my friend – but it was more like making new friends and trying to understand the staff and people that you meet.