Penn Public Health
CPHI Fellow Feature: Eugenia South, MD, MSPH Talks About Health and the Environment
The environment that you live in greatly impacts your health outcomes. In order to learn more about the interaction between health and the environment, we interviewed CPHI Senior Fellow Eugenia South, MD, MSHP, Assistant Professor of Emergency Medicine at the Perelman School of Medicine at the University of Pennsylvania about her work with the environment and health outcomes. See the interview below!
Can you tell us about your work with vacant lot greening? Who does it impact?
I became interested in how the neighborhood environment impacts health and safety after working as a resident on the trauma service unit at a hospital in St. Louis, MO. We took wonderful care of the physical injuries suffered by many gunshot victims, but did nothing to address the root causes of gun violence or interrupt the cycle of violence. I came to Penn in 2010 as a research fellow in the Robert Wood Johnson Clinical Scholars Program and started working with Charles Branas, PhD, who is now the Chair of Epidemiology at Columbia University. He was just starting to evaluate the impact of vacant lot greening on crime, and we have partnered on this work ever since.
The first study I ever published was a qualitative study consisting of almost 50 interviews for people living in 2 Philadelphia neighborhoods with significant blight. I wanted to know what people thought the impact was on their health. Boy did they have a lot to say. People reported that urban blight impacted the health of their overall community through fractured ties with neighbors, crime and decreased property values. People also felt there was a big impact on their mental health – specifically feeling stigmatized, neglected and depressed. So I would say that urban blight, including vacant lots and abandoned houses, impacts many people in a variety of ways.
What were the program findings?
Since 2010, I have published several studies evaluating the impact of vacant lot greening on crime, perceptions of safety, biologically measured stress and mental health. In a pilot trial, I found that people reported feeling safer after greening. I also found that as people walked past vacant lots after greening, their heart rate went down. We used heart rate as a marker of acute stress in this situation, indicating an interaction between the environment and what is happening inside the body. Last year, we published the results of a citywide randomized controlled trial of vacant lot greening. We found reductions in violent crime, improvements in perceptions of safety and people going outside to socialize with neighbors more. Regarding mental health, there was a decline in people feeling depressed and worthless.
What is the relationship between health and the environment?
Our study and results represented the first time that a greening intervention has been studied in such a rigorous manner. It gave us the highest level evidence that making simple, structural, and low cost changes to the environment can impact community health. Because of our results, the City of Philadelphia has incorporated greening into the city violence prevention plan. It’s exciting to see how research can influence policy!
How is Penn addressing health and the urban environment?
There are many ways Penn researchers are addressing health and the urban environment. I continue to grow my portfolio of projects in this space. I am developing an “enhanced” vacant lot greening intervention which will include design elements such as a path and bench, to encourage more use of these microgreen spaces. I am also developing a nature coach intervention to help connect people to nearby nature in their neighborhoods.
City Council and E-Cigarette Hearing on Nov. 20th
By: Matt Kearney, MPH, PhD Candidate
The hearing on November 20th took place before City Council member’s on the Public Health and Human Services committee, and included discussions of an ordinance proposing regulations for electronic smoking devices (ESDs) – Bill No. 190804. ESDs, such as the popular product JUUL, produce an aerosolized gas – which is not a vapor – of nicotine salts, flavoring compounds, and chemical preservatives. The ESD regulations limit where and to whom ESDs could be sold, creating a special class of licenses for selling ESDs in adults-only establishments, such as vape shops. In addition, the bill would limit the type of ESDs that could be sold at non-adults-only establishments. For example, a corner store would no longer be able to sell ESDs that contain nicotine “e-liquids” or “e-juices” in any form in concentrations greater than 20 mg/mL – the current limit in the European Union. For reference, JUUL e-liquid pods in the U.S. typically contain more than 50 mg/mL. In adults-only establishments, the limit could exceed 20 mg/mL. And perhaps most significantly for prevention efforts, flavored ESD products would be restricted to natural tobacco flavors and exclude confectionary-style products that may appeal more to youth and young adult non-smokers, such as fruit and candy flavors. Should Bill No. 190804 be approved by the committee, it would then go to the full City Council, and then Mayor Kenney, who has pledged to sign the bill and given it his full support.
At the bill’s hearing, multiple panels of speakers provided testimony both in favor of and in opposition to Bill No. 190804. The first speaker was Thomas Farley, MD, MPH, Commissioner of Public Health for the City of Philadelphia. Dr. Farley brought samples of flavored ESD products to demonstrate the appeal of such flavors to youth. The second set of speakers spoke in favor of the bill, and included a pediatrician and leaders from the Advocacy Institute. Dr. Michael Madden spoke in opposition to the bill on behalf of RJ Reynolds, one of the world’s largest tobacco producers, and argued that the bill would restrict access to ESDs among smokers seeking to quit combustible cigarettes. Dr. Madden cited statistics from the UK’s National Health Service, which actively promotes ESDs for smoking cessation. Currently, the U.S. Food and Drug Administration (FDA) does not endorse ESDs as smoking cessation devices, and the body of evidence remains weak that ESDs are effective smoking cessation devices. Dr. Madden’s position was supported by a representative from the Pennsylvania Food Merchants Association, which also proposed amending the bill to exempt menthol from the list of excluded flavors. The final speaker was Dr. Farley, who addressed opposition to the bill by commenting that the ESDs promoted in the UK for smoking cessation – with nicotine concentrations less than 20 mg/mL – would still be available in both corner stores and adults-only establishments. Dr. Farley also noted that menthol continues to be among the most popular flavors for youth and young adult non-smokers, and should not be removed from the list of excluded flavors.
Ultimately, no amendments were adopted for Bill No. 190804, and the bill was approved by the committee, as written, for submission to the full City Council. The bill will be considered and brought for a vote in 2020.
Bringing a Data-Driven and Public Health Approach to the District Attorney’s Office
On November 14th, CPHI invited guest speaker Larry Krasner, Philadelphia’s District Attorney, to discuss the ways in which his office is using data to address crime and violence, the opioid epidemic, as well as to work advance criminal justice reform. During the seminar series, entitled “Bringing a Data-Driven and Public Health Approach to the District Attorney’s Office,” DA Krasner began his remarks by describing the origins of his work in civil rights law and social justice activism. He highlighted his early career as a criminal defense attorney with the ACTUP program and Prevention Point and support of their mission to help reduce harm and overdoses. He stated that “Philadelphia and many other municipal governments understand the importance of implementing supervised injection sites to address the opioid epidemic as it relates to prevention.” In fact, prosecutors throughout the United States are in a unique position to work with public health agencies and institutions to influence positive health outcomes. As a result, this presents a great opportunity for cross-collaboration between the judicial system and the field of public health.
While Philadelphia is currently experiencing an opioid epidemic, the city is also faced with high levels of crime and violence. Underscoring the intertwined nature of poverty and violence, DA Krasner stated that “Bullets equal poverty, and poverty equals bullets.” Therefore, the city has to address poverty because there is a correlation between high poverty, poor education and high crime. However, when examining the data, DA Krasner noted the importance of digging into the data to compare neighborhood to neighborhood, rather than city to city, because the challenges vary within zip codes.
DA Krasner proposed a few solutions to Philadelphia’s crime, violence, and opioid problems that include a restorative justice diversion program, where individuals will be given the opportunity to join a resource-rich rehabilitation program instead of being sent to jail. He also mentioned using data to identify neighborhoods with high poverty, poor education, and high crime, and then strategically allocate resources to those areas. Ultimately, DA Krasner would like to scientifically look at crime and violence and figure out how to address it using a public health approach.
To further the conversation of crime and public health, Philadelphia will be hosting the annual Law Enforcement and Public Health Leaders Conference next year!
The Blog of the Center for Public Health Initiatives
- CPHI Seminar with Jennifer Essler and George Preti
- CPHI Seminar with Carrie Kovarick
- CPHI/School of Nursing Naloxone Simulation Training
- 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
Training dogs to detect malignant ovarian cancer – and using them to help produce an early-detection system
On Thursday, April 18th, 2018, students, faculty and members from the community joined Penn’s Center for Public Health Initiatives to hear about the innovative research being conducted by Jennifer Essler, Ph.D., a Postdoctoral Fellow at the Penn Vet Working Dog Center at the University of Pennsylvania. At the center, Essler is primarily responsible for conducting the research with the working dogs who are being trained for various projects including scent detection for cancer. George Preti, Ph.D, who works in the Monell Chemical Senses Center, also presented and gave an overview of how the center is using existing knowledge about how humans detect and process smells and odors, to train the working dogs to detect a wider range of smells and odors.
Penn Today wrote a full article about this event. The article can be found on their website.
Missed the event? Video of the event here.
Use of Teledermatology in Global and Community Health
On Thursday, March 15th, Carrie Kovarick, MD, Associate Professor of Dermatology, Dermatopathology and Infectious Diseases at the University of Pennsylvania discussed the intersection between telemedicine, dermatology and global health initiatives.
Telemedicine uses technology as a form of communication to deliver health care services to individuals at a distance while receiving care from the same healthcare provider. In addition, telemedicine is used to provide care to individuals who would not have access to certain health care services due to lack of infrastructure or personnel in the area. Telemedicine allows patients to self-report symptoms and receive timely diagnoses from health care providers while allowing doctors to reach a wide range of patients.
Dr. Kovarick and her colleagues are using telemedicine to provide dermatology and dermatopathology consultations to individuals using existing technology. Using the internet and smartphones, Dr. Kovarick and many healthcare professionals are able to connect with patients allowing for patients and doctors to have video interacts and on patient self-monitoring.
During Dr. Kovarick’s presentation, she went into depth about the usefulness of telemedicine as well as the potential threats to healthcare. While telemedicine is convenient and addresses health inequalities by improving health delivery, it is not strictly regulated by the government. The increased use of telemedicine has increased the number of doctors who provide healthcare in states in the U.S. without having a license in that state. Stricter health licensing regulation is needed to ensure that the care being provided adheres to state health laws.
In the past few years, telemedicine has been used to provide healthcare to vulnerable, isolated and underserved communities around the world. Dr. Kovarik and her colleagues have traveled to rural communities in developing countries to provide dermatology and dermatopathology to communities that do not have access to specialists due to the lack of health infrastructure, distance to hospitals/ clinics, and/or poor insurance coverage.
Dr. Kovarick’s current research allows her to provide care through the Botswana-UPenn Partnership (BUP) teledermatology program. The program focuses primarily on diagnosing and treating patients who have derma related conditions and diseases in sub-Saharan Africa using cell phones to send and receive photographs of skin diseases. The experiences in Botswana have allowed Dr. Kovarick to identify areas for improving the healthcare and information technology (IT) infrastructure in the country.
Telemedicine is more widely accepted and used throughout the United States and the world. The intersection between health care delivery and emerging technology has allowed doctors, like Kovarick, to make exceptional strides in healthcare and public health. Refining regulations and information technology could potentially provide specialized and timely care to all individuals regardless of income level and distance from health providers. Similar programs and research through partnerships with the University of Pennsylvania are vital for increasing capacity and improving health for all.
Link to the video recording of the seminar -- https://upenn.box.com/s/ln4932x52mv306m2dl8vrw69d2q2shua
Naloxone Simulation Training
(Left) Participants for the Naloxone training including faculty, staff, students, actors, and content experts. (Right)Ann Marie Hoyt-Brennan, lead organizer of the training, is a Simulation Education Specialist in the School of Nursing.
On Friday, February 23, 2018, The Center for Public Health Initiatives collaborated with the School of Nursing to bring opioid overdose and Naloxone (or Narcan) training to life in the Helene Fuld Pavilion for Innovative Learning and Simulation. Using actors and simulators, students from the Master of Public Health program and the School of Nursing learned how to administer Naloxone to a person who has overdosed on opioids, heroin, or fentanyl. This training offered a "real-life" feel while providing practical skills related to Naloxone administration. Naloxone is the drug used to reverse opioid overdose.
(Above) Students learn about signs and symptoms of an opioid overdose and practice rescue breaths and Naloxone administration.
There were about 40 participants in total at the training, broken up in to four groups. Each room had a simulation facilitator, faculty and staff from CPHI/Nursing, a content expert who is working in the field, and an actor to mimic the overdose. The content experts and actors were people in recovery and people actively working with people who inject drugs (PWID). It was truly invaluable to have their expertise in the room as we broke down different scenarios that can arise when resuscitating someone from an overdose.
For each substance (opioid, heroin, or fentanyl), a scenario was created by the actor to demonstrate signs and symptoms of an overdose. The students then performed recue breathing with a barrier device and administered intranasal Naloxone on a high fidelity simulator (after they called for help, assessed the scene for safety, and checked for signs of overdose). Physical signs of opioid use include pinpoint pupils, lethargy, nodding off, and muscle spasms, and signs of overdose include unresponsiveness, little to no breathing, pinpoint pupils, clammy skin, and blue lips or nailbeds.
One of the most meaningful parts of the activity was the debriefing session, which took place in each room after the scenarios were carried out. Led by the content experts, participants had the opportunity to react to the scenarios in real-time, and engage with people who have both used drugs and/or work with people who use drugs. We also discussed resources for an opioid user after resuscitation. Both content experts/actors and participants shared that it was these conversations that really humanized the “addict,” something that is key as we work to combat this epidemic.
(Left) Jennifer Pinto Martin, Executive Director of the Center for Public Health Initiatives and MacInnes Professor in the School of Nursing, facilitates debrief after the training. (Right)Groups learn about the different forms of Naloxone and practice intranasal with a task trainer.
Although we learned a ton during this training, two things in particular stuck out. First, Naloxone is not harmful to someone who has gone unconscious for reasons other than opioid overdose. Therefore, if it is a suspected overdose, it is better to air on the side of caution and administer the life-saving drug with rescue breaths.
Additionally, you cannot give someone Naloxone if they are responsive and do not want it. A content expect shared that he generally will kick someone’s foot to try to wake them and will then state that he is administering Naloxone if they don’t respond before doing so. Because Nalaxone will send someone into withdrawal, many people do not want to take it and they will voice this if they are able to.
Many expressed after the training that being in the simulation lab and actively practicing how to revive someone was invaluable and that they felt much more confident to revive someone in this situation. We hope that this training is just the beginning of a long-standing partnership and that many more people can benefit from this hands-on simulation to save someone’s life.
Date: February 2018
Innovation and Digital Health
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
The Opioid Epidemic: The Streets Perspective
(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
Pushing Boundaries in Public Health: Precision, Prevention, and Entrepreneurship
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
Get HYPE Philly
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
Health Care Within the Prison Walls – and Without
(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
Opioids in Philadelphia: The Obstacles and Opportunities in Addressing a Public Health Crisis
(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.