Carolina Combats Cancer research · prevention treatment · survivorship

FALL 2009 volume 1 · number 7 Public Health Foundation, Incorporated Board of Directors

Susanne Glen Moulton, JD, MPH, Stacy-Ann Christian, JD, MPH Joan C. Huntley, PhD, MPH Jeffrey B. Smith, MHA, CPA President Assistant Director, Clinical and Health Adjunct Professor of Epidemiology Partner Director, Patient Assistance and Services Research UNC Gillings School of Global Ernst & Young LLP Reimbursement Programs New York City Health and Hospital Public Health Paula Brown Stafford, MPH GlaxoSmithKline Corporation Mark H. Merrill, MSPH Executive Vice President, Integrated Jack E. Wilson, MSENV, Michael (Trey) A. Crabb, III, President and Chief Executive Officer Clinical Services Vice President MHA, MBA Valley Health System Quintiles Transnational Corporation Board of Directors Managing Principal - Nashville Stephen A. Morse, MSPH, PhD Russell B. Toal, MPH TEC, Incorporated Stroudwater Associates Associate Director for Environmental Visiting Associate Professor of Public Delton Atkinson, MPH, MPH, PMP Leah Devlin, DDS, MPH Microbiology, National Center for the Health Deputy Director, Division of Vital Former State Health Director and Prevention, Detection, and Control of Institute of Public Health Statistics, National Center for Health Director, Division of Public Health Infectious Diseases Georgia State University Statistics N.C. Department of Health and Centers for Disease Control and John C. Triplett, MD, MPH Centers for Disease Control and Human Services Prevention Regional Medical Officer Prevention Cynthia J. Girman, DrPH Douglas M. Owen, PE, BCEE Bethesda, Md. David J. Ballard, MD, MSPH, PhD, Senior Director, Department of Vice President G. Robert Weedon, DVM, MPH FACP Epidemiology Malcolm Pirnie, Incorporated Adjunct Faculty in Honors and Biology Senior Vice President and Chief Quality Merck Research Laboratories Jonathan J. Pullin, MS University of North Carolina Officer Sandra W. Green, MBA, MHA, President and Chief Executive Officer Wilmington Baylor Health Care System BSPH The Environmental Group of the Chairman Executive Director and BHCS Endowed President, East Coast Customer Carolinas, Inc. New Hanover County Board of Chair Health Management Group Roy J. Ramthun, MSPH Institute for Health Care Research and Senior Partner MedAssets, Incorporated President Improvement College Road Animal Hospital, PLLC C. David Hardison, PhD HSA Consulting Services, LLC Fred T. Brown, Jr., MPH, FACHE Alice D. White, PhD Corporate Vice President, Life Sciences Jacky Ann Rosati, PhD Managing Director, Business Vice President, Worldwide Science Applications International Environmental Scientist and Development Epidemiology Department Corporation Containment Area Lead, U.S. Carolinas HealthCare System GlaxoSmithKline Deborah Parham Hopson, PhD, Environmental Protection Agency Kelly B. Browning, MA RN National Homeland Security Thomas K. Wong, PhD Executive Vice President Assistant Surgeon General Research Center Vice President American Institute for Cancer Research Meganium Corporation Associate Administrator, HIV/AIDS Ilene C. Siegler, PhD, MPH Deniese M. Chaney, MPH Bureau Professor of Medical Psychology Partner Health Resources and Services Duke University Accenture Health and Life Sciences Administration

2009 Gillings School of Global Public Health Advisory Council

Dennis Gillings, CBE, Chair Andrew Conrad, PhD J. Douglas Holladay, MDiv Carmen Hooker Odom, MS Chairman and Chief Executive Officer Chief Scientific Officer Chairman and Chief Executive Officer President Quintiles Transnational Corporation National Genetics Institute PathNorth Milbank Memorial Fund Marcia A. Angle, MD, MPH Keith Crisco, MBA Donald A. Holzworth, MS Jane Smith Patterson Adjunct Professor Secretary of Commerce Chairman Executive Director Nicholas School of the Environment State of North Carolina Futures Group International The e-NC Authority Duke University Nancy A. Dreyer, PhD, MPH David P. King Joan Siefert Rose, MPH William K. Atkinson, PhD, MPH Chief of Scientific Affairs President and Chief Executive Officer President President and Chief Executive Officer OUTCOME Laboratory Corporation of America Council for Entrepreneurial Development WakeMed Ken Eudy A. Dennis McBride, MD, MPH Joseph Carsanaro, MBA, MSEE Chief Executive Officer Health Director Virginia B. Sall General Manager Capstrat City of Milford Co-Founder and Director Sall Family Foundation Personal Communications Sector Robert J. Greczyn, Jr., MPH John McConnell Motorola, Incorporated President and Chief Executive Officer Chief Executive Officer Charles A. Sanders, MD Gail H. Cassell, PhD, DSc (hon) BlueCross and BlueShield of North McConnell Golf Retired Chairman and Chief Executive Officer Vice President, Scientific Affairs and Carolina Guy Miller, MD, PhD Glaxo, Incorporated Distinguished Lilly Research Scholar James R. Hendricks, Jr., MS Chairman and Chief Executive Officer for Infectious Diseases Retired Vice President of Edison Pharmaceuticals, Incorporated Paul M. Wiles, MHA Eli Lilly and Company President and Chief Executive Officer Environment, Health and Safety James Patrick O’Connell, PhD, MPH Novant Health, Incorporated Willard Cates, Jr., MD, MPH Duke Energy Chief Executive Officer President, Research Acea Biosciences, Incorporated Family Health International contentsfall 2009 e dedicate this issue of Carolina Public Health to the people of North Carolina whose lives are changed by cancer. We deeply appreciate the confidence they and the North Carolina General Assembly place in us and in researchers and clinicians across the state through the University Cancer Research Fund. We also are 9 grateful for UCRF’s contributions both to the research featured in this magazine and to the publication itself. Thanks also to GlaxoSmithKline for its generous support of our magazine.

features & news 15 3 new cancer hospital puts research into practice 4 from the Dean’s Desk: Lessons of Cancer Control

5 h. Shelton Earp: The New Face of Cancer Research and treatment

6 conquering cancer: UNC Tackles Cancer as a Public Health Issue

9 unc sweeps state in wide-ranging study to find causes of 18 breast cancer in black women 11 seeking A Quality Life after Head or Neck Cancer

13 olshan leads national effort to examine causes of childhood cancer

14 long Island Breast Cancer Study Project Leads Gammon to More Research 22 15 seeking safe levels of formaldehyde in humans 16 finding the best chemotherapy for you

17 studying the link between sialic acid and colon cancer

18 some nutrients can increase risk for lung cancer

19 unc Selected as AHRQ Cancer Research Site

24 20 eng, CCARES Collaborate to Tackle Racial Disparities in Cancer Care

22 fight against tobacco moves to cyberspace

23 trimming hair, trimming risk: Barbers promote health care

24 colon cancer screening kits FIT for duty in High Point project

continued 8

carolina public health | 1 Dean fall 2009 Barbara K. Rimer, DrPH Director of Communications managing editor Ramona DuBose

Associate Dean for External Affairs 27 34 45 Peggy Dean Glenn contents continued Design and Production Karen Hibbert UNC Design Services

Contributing Writers Sylvia Adcock, Kim Gazella, 26 breastfeeding: good for babies, good for moms Natalie Gott, Linda Kastleman, and Chris Perry 27 unc helps cancer patients, families shift into survival mode Special thanks to Ellen 28 unc COMBATS CERVICAL CANCER VIRUS DeGraffenreid and Dianne Shaw of UNC Lineberger Comprehensive 30 researchers can mine new health registry Cancer Center for their assistance for wealth of data with this publication.

31 the Key to Patient Advocacy: Articles appearing in Carolina resourcefulness Public Health may be reprinted with permission from the editor. Send 33 alumni APPLY UNC TRAINING TO “REAL WORLD correspondence to Editor, Carolina problems” AT NATIONAL CANCER iNSTITUTE Public Health, Gillings School of Global Public Health, Campus Box 34 school News 7400, Chapel Hill, NC 27599-7400.

37 awards & Recognitions Subscribe to Carolina Public Health opportunities to invest www.sph.unc.edu/cph

18,000 copies of this document were 39 honor Roll of Donors printed at a cost of $11,937 or $0.66 per copy. 40 expendable gifts save the day Carolina Public Health (ISSN 1938- 41 arrighis ENDOW EPIDEMIOLOGY SCHOLARSHIP 2790) is published twice yearly by the UNC Gillings School of Global 42 louise AND DEREK WINSTANLY FIND WAYS TO Public Health, Campus Box 7400, make GLOBAL HEALTH LOCAL University of North Carolina at Chapel Hill, 135 Dauer Dr., Chapel 43 school AIMS TO EXPAND SCHOLARSHIP POOL Hill, NC 27599-7400. Vol. 1, No. 7, 45 karthik SUNDARAM: i like to think i’ve helped Fall 2009. a little

47 school INTRODUCES FIRST CLASS OF ANNUAL funD SCHOLARS

2 | FALL 2009 New cancer hospital puts research into practice

PUBLIC INVITED to OPENING of State-of-the-art facility combines NC CANCER HOSPITAL best technology with human touch The official ribbon- cutting and opening celebration for the he N.C. Cancer Hospital will open on the UNC campus N.C. Cancer Hospital is T in fall 2009 as part of the UNC Health Care System. The scheduled for Tuesday, 315,000-square-foot state-of-the-art facility will triple Sept. 15, 2009. An the current space and significantly increase the number of open house will be patients that can be served. The state of North Carolina held Saturday, Sept. 26, authorized $180 million for the project in August 2004. 2009. Both events are “This new hospital will be our clinical home, Other important features include: 1 to 3 p.m. where we put research findings into real-  clinics designed to provide multidisci- world practice,” says H. Shelton Earp, MD, plinary, patient-centered care for which director of the UNC Lineberger Comprehen- UNC is known across the nation sive Cancer Center. LEARN MORE The new facility will create a healing atmo-  an expanded clinical trials unit sphere by providing natural light, indoor  a telemedicine conference center designed To learn more about what courtyards, gardens, public art and other ame- to enable real-time collaboration with the N.C. Cancer Hospital will nities. The design was created with input from doctors across the state mean for North Carolina, visit patients, families and health care providers.  space for a comprehensive support program “We are combining the best technology www.unclineberger.org. tailored to each individual’s needs, from with an environment that emphasizes the initial diagnosis through survivorship. human touch,” says Dr. Earp.

carolina public health | 3 Dean, UNC Gillings School of Global Public Health Barbara K. Rimer, DrPH and Alumni Distinguished Professor

ore than 35 years ago, when I started in this field, Mcancer was universally feared. We have come a long way — today, some cancers can be prevented, others can be found early, and some can be cured. Still, we have far to go.

While cancer is no longer a universal death sentence, too many Many of the lessons about how to control cancer have come from people still get cancers that could be prevented and still die from people at the University of North Carolina at Chapel Hill, including cancers. My family, like most of your families, has been touched faculty within the UNC Gillings School of Global Public Health, 43 by cancer. of whom are members of UNC’s Lineberger Comprehensive Cancer In North Carolina, people with low incomes are less likely to Center. These contributions have enhanced our knowledge about practice behaviors proven to help prevent cancer (like getting regu- important questions, such as: Why are black women more likely to lar exercise and not smoking) and are less likely to get screened for die from breast cancer than white women? What role does weight cancer. African Americans continue to die from cancer in dispro- gain play in breast cancer occurrence? How can we reduce Black/ portionate numbers. We have the opportunity to reduce disparities White disparities in use of mammography? How can we increase in deaths from breast, prostate, colon, cervix, lung and other can- people’s intake of fruits and vegetables? cers. Our faculty members, staff and students are working on mul- Today, we grapple with new issues as well, such as motivat- tiple angles to reduce disparities. These include understanding the ing families to encourage their daughters to be vaccinated for biology and epidemiology of cancers and discovering subtypes that the HPV virus (shown to prevent cervical cancer), changing may be more common among some people; intervening to reduce our eating behaviors to reduce obesity (a major risk factor for risky behaviors; changing policies that act as barriers to reducing multiple cancers) and increasing the proportion of people who the cancer burden and disseminating proven interventions. are screened for colorectal cancer. Our faculty members conduct intervention trials in many locations such as schools and clinics, but also in more unusual venues, includ- ing beauty parlors and barbershops, churches and on the Internet. One of the biggest challenges in cancer, as in other fields, is how to speed the process by which we get from discovery to delivery. Dissemi- nating evidence-based interventions to those who may benefit from them is a fundamental challenge for 21st

Dr. H. Shelton Earp, left, director of the UNC Lineberger Comprehensive Cancer Center,

ner and Dr. Barbara K. Rimer, dean of d the UNC Gillings School of Global ul F Public Health, are looking forward om

T to the opening of the new N.C. Cancer Hospital. Both have spent much of their public health careers hoto by P advancing cancer research.

4 | FALL 2009 Director, UNC Lineberger Comprehensive Cancer Center and Lineberger Professor of Cancer Research H. Shelton Earp, MD

he UNC Lineberger Comprehensive Cancer Center T and the N.C. Cancer Hospital are creating the new face of cancer research and treatment in North Carolina.

At UNC, an unprecedented effort to make and geriatric oncology are becoming a real- strides against cancer and the suffering it ity. Basic approaches to cancer causation and causes is fueled by collaboration across the treatment are growing in areas as diverse as century cancer control. Our faculty mem- population, basic and clinical sciences. UNC computational genetics to nanotechnology bers are among the nation’s leaders in this Lineberger’s 285 members hail from more and drug delivery. UCRF has served as a area as well. than 25 departments across the University of catalyst for programs that supported UNC’s With University Cancer Research Funds, North Carolina at Chapel Hill, including the successful bid for a National Institutes of we are partnering with people around campus Gillings School of Global Public Health, the Health Clinical Translational Sciences Award and across North Carolina to defeat cancer in Eshelman School of Pharmacy, the School of and provided seed funding to produce data this state. The challenges are significant, but Medicine, the School of Dentistry and the that has led to successful competition for we are making progress. We are fortunate College of Arts and Sciences. external grants. to live and work in a state whose leaders are UNC Lineberger and the Gillings School of At the same time, excitement is build- committed to supporting our quest. Global Public Health have a history of highly ing around the opening of the N.C. Cancer productive, collaborative research partner- Hospital. The state-of-the-art facility is part ships that focus broadly on the intersection of the UNC Health Care System. We look of cancer and population health. Creative forward to welcoming all patients and visi- research into community-based preven- tors in coming months. tion and early detection, environmental and UCRF-funded research and the N.C. Can- occupational epidemiology, health disparities cer Hospital are visible symbols of what we Editor’s note: Dean Rimer, a behavioral scien- and equity, cancer survivorship, methods for are achieving through collaboration, creativ- tist, has advanced the field of prevention and improving cancer-related health behaviors, ity and innovation. These investments truly cancer detection throughout her career. Her understanding the role of nutrition in cancer make a difference to everyone we serve here research has focused on developing evidence- and dissemination of public health practices in North Carolina and, we hope, to patients based interventions to encourage positive have produced important findings. These suc- and families around the world whom we cancer prevention behaviors and to increase cessful joint efforts have helped UNC become never meet, but whose lives are improved in use of screening. Among other awards, she has received the American Cancer Society’s Dis- recognized in the top echelon of public uni- some way because of the work we do. tinguished Service Award and the NIH Health versity cancer centers. Director’s Award, and she was elected to the A superb faculty and their public health Institute of Medicine in 2008. She is author of approaches have been given tremendous nearly 300 articles and books. A select list can momentum by the University Cancer be found at www.sph.unc.edu/rimer/biosketch. Research Fund (UCRF). This is an unprec- edented investment by the North Carolina Editor’s note: Dr. Earp is a renowned cancer General Assembly to accelerate progress in researcher. He is principal investigator of the cancer prevention, early detection, effective UNC Breast Cancer SPORE (Specialized Pro- grams of Research Excellence), the Lineberger treatment and improved survivorship for the Center NCI core grants and several individual people of North Carolina. research grants. His laboratory conducts UCRF is allowing UNC to recruit addi- translational breast and prostate cancer and tional outstanding faculty from across the childhood leukemia research as well as basic nation who work in fields ranging from research on the regulation of cancer cell growth, health behavior and the study of health dis- differentiation and death. He has authored parities to genetic epidemiology. Expanded more than 140 biomedical research papers. programs in health outcomes, survivorship, For details, see http://cancer.med.unc.edu/ clinical cancer genetics, and pediatric, adult research/faculty/displayMember.asp?ID=50.

carolina public health | 5 INTRODUCTION CONQUERING CANCER UNC tackles cancer as a public health issue, from research to prevention to treatment to survivorship

very family has a cancer story. So does every neighbor, friend, co-worker and employer. traditional infectious disease emphasis to E an emphasis on chronic diseases like cancer, That’s why it’s not just a statistic — it’s a human and the leading underlying causes of these issue. And that’s why it’s not just a disease — it’s a diseases: tobacco use, physical inactivity and dietary practices,” says Marcus Plescia, significant public health issue. MD, MPH, director of the Division of Cancer Prevention and Control at the Centers for Each year, nearly 1.5 million Americans are has caught up with heart disease as the leading Disease Control and Prevention. diagnosed with cancer – more than 42,000 cause of death, which mirrors global trends. Meanwhile, he continues, “The tobacco in North Carolina. About 562,340 Americans The World Health Organization (WHO) industry has clearly responded to the success – more than 1,500 people a day – will die of predicts that cancer will surpass heart disease of tobacco control efforts in the United States cancer, according to the American Cancer as the world’s top killer by 2010. WHO proj- by exporting this highly addictive product Society. Cancer costs this country more than ects the number of cancer cases to increase 37 and their highly effective marketing strate- $200 billion annually in direct medical costs percent from 2007 to 2030 (from 11.3 million gies abroad. The results will be disastrous for and lost productivity. to 15.5 million) and the number of deaths public health on an international scale.” “Cancer affects the public as broadly as the to increase 45 percent (from 7.9 million to public can be affected by any type of condi- 11.5 million). The projected leaps are due to Research and Outreach tion,” says Jesse Satia, PhD, who, as associate population increases and rising tobacco use There is good news. Like many other states, professor of epidemiology and nutrition in the in highly populated countries like India and North Carolina is fighting back by promoting UNC Gillings School of Global Public Health China, coupled with better cancer diagnostic early detection of cancer and healthier life- and the UNC School of Medicine, studies the techniques and the downward trend in infec- styles. UNC is a national leader in research, impact of diet and other health behaviors tious diseases that once were the world’s leading treatment and outreach. With the creation on cancer survivorship. killers. Thus, as the world of the University Cancer Research Fund “That is why cancer is a becomes increasingly (UCRF), UNC is positioned as a transforma- public health issue!” In the U.S., cancer developed, cancer becomes tive leader in progress against cancer. Cancer is the second accounts for a larger global problem. In 2007, the N.C. General Assembly cre- ated the UCRF to accelerate cancer research leading cause of death in nearly one of “Just as it is in the the U.S.; only heart dis- United States, our inter- across the state, especially at UNC’s School of ease kills more people. In every four deaths. national focus in public Medicine, Lineberger Comprehensive Cancer North Carolina, cancer health is shifting from a Center and the new N.C. Cancer Hospital.

6 | FALL 2009 CONQUERING CANCER

UCRF’s mission is to save lives and reduce says Laura Linnan, ScD, associate professor “One of the most powerful arguments for suffering from cancer in North Carolina and of health behavior and health education at why cancer is a public health issue is that it beyond. The fund is being used to study the the UNC Gillings School of Global Public is preventable,” says Noel Brewer, PhD, assis- causes and course of cancer, to create new and Health. “We need to counter the fear and tant professor of health behavior and health better ways to prevent and treat cancer and misunderstanding with strong public educa- education. “Even if we never find a ‘cure’ to improve cancer care and screening, with tion. We need to help people know they can for cancer, we can still eliminate substantial a particular focus on eliminating racial and do something to reduce their risk, because morbidity and mortality through early detec- socio-economic disparities. when they learn they can take action, that is tion and treatment.” Several UNC researchers are tackling when they feel empowered.” The CDC’s Dr. Plescia agrees, praising disparities among cancer patients, ranging Empowering people is particularly impor- actions by the N.C. General Assembly to invest from Andy Olshan’s study of the ways head tant, given that WHO and other health orga- in cancer research in North Carolina and to and neck cancer treatment affects quality of nizations estimate that about 40 percent of ban smoking in restaurants and bars. life, particularly among African Americans, all cancer deaths can be prevented. Key risk “The choices we make are shaped by the to Geni Eng’s leadership in exploring whether factors for cancer that can be avoided include choices we have, and this is why public policy has emerged as the driving force for cancer control,” says Dr. Plescia, who until recently When people know they can do was chief of the Chronic Disease and Injury Section in the N.C. Division of Public Health. something to reduce their risk...that is “The General Assembly’s investment in can- cer research is profound, as are its actions in when they feel empowered. the 2009 legislative session to ban smoking in – UNC Associate Professor Laura Linnan North Carolina restaurants and bars. Studies show that nonsmokers who are exposed to the burden of cancer is greater among Afri- tobacco and harmful alcohol use, obesity, inac- secondhand smoke at home or work increase can Americans than whites. (See stories, tivity, some environmental and occupational their heart disease risk by 25 to 30 percent pages 11 and 20.) carcinogens and some infections, such as the and their lung cancer risk by 20 to 30 percent. “Cancer touches everyone and is still sexually transmitted human papillomavirus. This legislation will save lives and reduce feared the most in terms of health issues,” In all these areas, public education is crucial. health care costs to the state.” 8

carolina public health | 7 INTRODUCTION

Access to Data a Key “Clearly, good science drives good policy Another emerging area of study – and to Success decisions,” he says. “Health reform, information another area in which UNC stands out – is to technology and systems change in the medical focus on cancer survivors and study how they Another key to successful research and out- care setting all provide us with new and impor- can live fuller and richer lives. A priority of the reach is having access to data. Again, UNC is tant opportunities for cancer prevention and UCRF is to stimulate research about factors taking the lead by creating a comprehensive control. A comprehensive health registry, such that affect the growing population of cancer health registry that will serve as a treasure trove as the UNC Health Registry, will provide data survivors. The Lance Armstrong Foundation, of information for researchers. Beginning this essential to helping to drive these changes.” now known as LIVESTRONG TM, also is com- fall, UNC plans to enroll 10,000 English- and mitted to better quality of life among survivors Spanish-speaking adult North Carolinians in and has named Lineberger a “Survivorship the UNC Health Registry. (See story, page 30.) Survivorship and Center of Excellence.” (See story page 27.) The registry will be a tremendous resource for Advocacy: New Ways When it comes to cancer, UNC plays a research into cancer and other diseases and, as of Looking at Things leading role on the local, state, national and a hospital-based cohort, will complement the More people than ever are becoming bet- global stages. Whether conducting studies in rich history of UNC’s excellent population- ter educated about their disease and, with the laboratory, clinic or community, using based research conducted by the public health, advances in early diagnosis and treatment, are cutting edge technologies to diagnose and medical and other schools. surviving longer. The American Cancer Society treat patients, or helping them piece their lives back together when the chemotherapy The choices we make are shaped by the ends, UNC is transforming the way the world thinks about cancer. choices we have, and this is why public policy has “What we’re proud of is a translational line of work that goes from the laboratory and a emerged as the driving force for cancer control. small set of clinical hospital patients to the pop- ulation at large,” says Robert Millikan, PhD, – Dr. Marcus Plescia, CDC Cancer Prevention & Control Barbara Sorenson Hulka Distinguished Profes- sor of epidemiology and member of the UNC Why does all of this research have public notes that the five-year relative survival rate for Breast Cancer SPORE at Lineberger. “That is health implications? Because while the UNC all cancers diagnosed between 1996 and 2004 how UNC is making a difference all the way faculty members do not make public policy – is 66 percent, up from 50 percent in 1975-1977. from the individual level, by helping patients that is left to the elected and appointed health Nationwide, an estimated 12 million patients and their families, to the global level, by being officials at the state and national levels – they are cancer survivors; North Carolina’s share a leader in research. We cover it all.” n are able to provide the data that drive policy. is 300,000. – By Kim Gazella and Ramona DuBose Even more, the collective actions sparked by UNC’s research, treatment and outreach lead to improved outcomes for patients. Quick Global Cancer Facts Last year, UNC was selected as one of two cancer research sites by the U.S. Agency for • Cancer is a leading cause of death worldwide: it accounted for Healthcare Research and Quality (AHRQ), 7.9 million deaths (around 13 percent of all deaths) in 2007. an arm of the U.S. Department of Health and • Lung, stomach, liver, colon and breast cancer cause the most Human Services. (See story page 19.) cancer deaths each year globally. “We don’t do policy, but we create the • The most frequent types of cancer differ between men and science under which people make policy,” women. says Jean Slutsky, PA, MSPH, director for the Center for Outcomes and Evidence at • About 30 percent of cancer deaths can be prevented. AHRQ. That policy, she says, can range from • Tobacco use is the single most important risk factor for cancer. a patient and doctor agreeing on a treatment to decisions made by Medicare or the head of • Cancer arises from a change in one single cell. The change may a large medical insurance company. be started by external agents and inherited genetic factors. Dr. Plescia calls an evidence-based policy • About 72 percent of all cancer deaths in 2007 occurred in low- agenda “essential” to the public health pro- and middle-income countries. fession’s credibility with the public and with Source: World Health Organization policy makers.

8 | FALL 2009 RESEARCH/studying causes

UNC sweeps state in wide-ranging study to find causes of breast cancer in black women

Photo Courtesy of N.C. General Assembly

Jeanne Hopkins Lucas (left), the first African-American woman to serve in the N.C. Senate, was a strong advocate for ach year in North Carolina, about 8,100 higher education. Lucas is pictured here with N.C.'s Gov. Bev Perdue (middle, then women are diagnosed with breast cancer. lieutenant governor) and Lucas' sister, E Bernadette David-Yerumo (right). And each year, about 1,300 women in the state " Jeanne Hopkins Lucas was a strong woman who turned her personal fight die from breast cancer. with breast cancer into a mission for all breast cancer patients and their families, Overall, more white women get breast can- Named after Jeanne Hopkins Lucas, a both now and in the future. This study’s cer than do black women, yet black women highly-regarded North Carolina state senator objective of identifying causes of breast under age 50 die of the disease almost twice who died of breast cancer in 2007, the study cancer is exactly what Jeanne would want as often as white women under 50. is supported by the state’s University Cancer to happen. She always knew that once Scientists at the UNC Lineberger Com- Research Fund and by the National Cancer the why and how of breast cancer was defined, the cure would follow. And so prehensive Cancer Center want to know why. Institute’s Specialized Program of Research the work of Sen. Jeanne Lucas goes on Led by Robert Millikan, DVM, PhD, they Excellence (SPORE) in breast cancer. – her passion lives on through this study, have launched a study of 2,000 women from “The Jeanne Lucas Study will provide bolstered by UNC’s reputation.” 44 counties in North Carolina, making it the a comprehensive look at treatment deci- – Gov. Bev Perdue largest geographical study of its kind. sions, access to care, and how financial or geographic barriers impact breast cancer Based on 16 years of work, we now have a much outcomes among African-American breast cancer patients in low-income and rural better understanding of how and why breast areas,” says Millikan, the Barbara Sorensen Hulka Distinguished Professor of epidemi- cancer occurs in women in North Carolina. ology in the UNC Gillings School of Global Public Health. “Our study also uses molecu- – UNC Professor Robert Millikan lar subtype information to provide the 8

carolina public health | 9 RESEARCH/studying causes

Study Area spans 44 counties: Alamance, Beaufort, Bertie, Bladen, Brunswick, Cabarrus, Chatham, Columbus, Craven, Cumberland, Davidson, Davie, Duplin, Durham, Edgecombe, Forsyth, Franklin, Granville, Greene, Guilford, Harnett, Iredell, Johnston, Jones, Lee, Lenoir, Martin, Mecklenburg, Moore, Nash, New Hanover, Onslow, Orange, Pamlico, Pender, Pitt, Randolph, Rowan, Sampson, Tyrrell, Wake, Washington, Wayne and Wilson. most systematic evaluation to date of breast of-the-art molecular biology with the tools a 2006 published report by a Lineberger team cancer among African-American women.” of public health,” Millikan says. “Based on that included Millikan, molecular biologist The Lucas study is an extension of the 16 years of work, we now have a much better Charles Perou, PhD, and breast cancer spe- Carolina Breast Cancer Study (CBCS), understanding of how and why breast cancer cialist Lisa Carey, MD, that found a subtype started by Millikan in 1993, which provides occurs in women in North Carolina, particu- of breast cancer called “basal-like” has the one of the largest breast cancer databases in larly younger African-American women.” highest prevalence among premenopausal the United States. That study enrolled more than 2,300 black breast cancer patients. “The Carolina Breast Cancer Study is one women with breast cancer and 2,000 controls The Lucas study – the third phase of CBCS the first research studies to combine state- between 1993 and 2001. The data were key to – also will be used to analyze survival rates

COMMUNITY ADVISERS AN INTEGRAL PART OF STUDY

Community advisers are key to the success of the third phase at a later stage, younger age, and presenting with aggressive of the Carolina Breast Cancer Study, often referred to as the tumors,” she says. “Sisters Network Triangle’s message is that “Lucas Study.” A 10-member advisory board includes breast breast cancer does not have to be a death sentence. We are cancer advocates, an assistant professor at NC State University, living proof that one can survive and thrive after breast cancer.” a registered nurse and representatives of the Sisters Network The study’s principal investigator, Robert Millikan, DVM, Triangle, the local affiliate of Sisters Network® Inc., a national PhD, credits the advocates with “helping us improve re- African-American breast cancer survivorship organization. sponse rates” by revising outreach materials and developing Researchers are relying on the advisers to review all study informed consent for patients. They also helped develop the protocols and materials to make sure they are culturally sensi- Web site (http://cbcs.med.unc.edu) and created a statewide, tive. Sisters Network Triangle President Valarie Worthy, RN, comprehensive resource directory – funded in part by the says her group also provides insight into “the unique chal- UNC Lineberger Comprehensive Cancer Center – for women lenges faced by African-American breast cancer survivors.” who need information about breast cancer diagnosis, treat- She commends researchers for their innovative approach of ment and support in North Carolina. assessing newly diagnosed breast cancer survivors, and said “Both the study Web site and the resource directory the Lucas Study would help identify potential risk factors and/ demonstrate the important role that advocates can play or barriers that women face as they battle cancer. She also in making epidemiologic research more responsive to the says that early detection is key. needs of the communities in which research studies are “The mortality rate is much higher for African-American carried out,” Millikan says. “Advocates have been with us at women diagnosed with breast cancer partly due to diagnosis every step of the way.” n

10 | FALL 2009 RESEARCH/studying causes

Dr. Robert Millikan astleman K a a d L in among the cancer subtypes, with informa- tion from the National Death Index. hoto by by hoto Researchers will follow the women for two P years after diagnosis, which Mary Beth Bell, Brian Kanapkey, speech pathologist at UNC Health Care, applies a heat and MPH, project manager for the Lucas study, moisture exchange system to cancer survivor Joyce Mangum's tracheostoma. says “will give us a really good picture of their treatments and how they are doing.” Using newly diagnosed cancer cases reported to the North Carolina Central Can- cer Registry as a starting point, the four-year enrollment period began on May 1, 2008, and Seeking a quality life continues through April 30, 2012. The goal is to enroll 1,000 black women with newly diagnosed cases of invasive breast cancer – half under the age of 50 and half aged 50 and after head or neck cancer older – and a similar number and distribu- tion of white women with breast cancer. Initially, the women will be interviewed by a nurse about breast cancer risk factors, hroughout his two decades of studying head such as family history, medical history and and neck cancers, Andrew Olshan, PhD, has physical and emotional well-being, and asked T for a DNA blood sample. Then, every six uncovered information that has helped physicians months for the next two years, researchers will touch base with the women, updating treat and possibly prevent the disease. records and gathering information about their treatment and general health. Treatments for these cancers can dramati- That, says Olshan, is why understanding “In other studies, we weren’t really able cally affect function and put patients in the cause and prevention is critical. to go back and reconstruct their medical distressing position of learning to talk, eat, Olshan leads the Carolina Head and Neck treatment histories, so this will allow us to swallow or even breathe in new ways. In addi- Cancer Study (CHANCE), funded by the examine any disparities in treatment and tion to the physical struggle, many patients National Cancer Institute. The study, being access to care,” Bell says. n must navigate a swath of psychological, social, conducted in 46 counties in central and east- – By Kim Gazella emotional and employment challenges. ern North Carolina, has accrued data from 8

carolina public health | 11 RESEARCH/studying causes

In this era of evidence-based medicine and comparative effectiveness research, studies such as this are necessary to ferret out what are really the best treatment strategies. – UNC Professor Mark Weissler astleman K a a nearly 1,400 cases of head and neck cancer to The information can be valuable to sur- d date, making it the largest study of head and geons, including Mark C. Weissler, MD, J.P. L in neck cancer ever conducted in the U.S. Riddle Distinguished Professor of Otolaryn- hoto by by hoto

So far, it has confirmed not only that people gology-Head and Neck Surgery at UNC, who P who smoke tobacco and/or drink alcohol are collaborates with Olshan. Dr. Andrew Olshan more likely than others to develop head and “In this era of evidence-based medicine neck cancer, but also that the risk from smok- and comparative effectiveness research, stud- ing and drinking appears to be higher for ies such as this are necessary to ferret out For the LIVESTRONG project, researchers African-Americans. These are critical links to what are really the best treatment strategies,” are interviewing head and neck cancer survi- understanding ways to prevent the disease. Dr. Weissler says. “Strategies may differ vors one year and three years after their diag- Now, with a grant from LIVESTRONG TM, between different patient populations, and nosis, using interview instruments designed Olshan and his team already are building on that is important to know.” specifically to gauge their quality of life from the CHANCE study and discovering more Head and neck cancer includes oral, pha- several aspects: physical, social/family, emo- about how treatments might affect patients’ ryngeal, and laryngeal cancer – cancers of tional and functional well-being. overall quality of life. the mouth, tongue, throat and other sites. “If we can identify any disparities and “By studying the experiences of head More than 48,000 Americans will develop determine strong predictors, then greater and neck cancer survivors, we hope to cancer of the head and neck in 2009, and attention can be given to recognizing these help health professionals effectively man- nearly 11,260 will die from it, according to factors, and people who treat cancer can age the impact of treatment on a patient’s the American Cancer Society. The cancer take them into account when considering a social, family and work roles,” says Olshan, strikes blacks more often than whites, and patient’s treatment course and quality of life chair of the Department of Epidemiology in survival rates are notably poorer for blacks afterward,” Olshan says. n the UNC Gillings School of Global Public than whites. – By Kim Gazella Health and research professor, Department of Otolaryngology/Head and Neck Surgery, UNC School of Medicine. This new study – in its fourth and final year For more information, visit: of enrolling patients – zeroes in on the experi- ences of African-American survivors, to see The American Academy of Otolaryngology-Head and Neck whether factors influencing their quality of life Surgery: www.entnet.org are different from those of white survivors. “This study focuses on an under-investi- National Cancer Institute, US National Institutes of Health: gated aspect of health disparities in North www.cancer.gov/cancertopics/types/head-and-neck Carolina,” Olshan says. “Do African Ameri- cans surviving with this cancer have a dif- American Cancer Society: www.cancer.org ferent experience than white patients? If so, what are the reasons?”

12 | FALL 2009 RESEARCH/studying causes

Olshan leads national effort to examine causes of childhood cancer

euroblastoma” is a big word for a cancer that in the U.S. each year; compared to some other childhood cancers, the survival rate is affects the smallest among us and in relatively poor, Olshan says. “N He agrees that the number of cases is small numbers. But UNC-led research could bring huge relatively small, especially compared with benefits by zeroing in on risk factors, the role of genet- other widely discussed cancers like breast and colon cancer, but says the potential for ics and whether vitamins taken by pregnant women can discovery and possible preventive measures in the future is significant. make a difference in whether children get neuroblastoma. “This study may give us some insight into the in utero origins of childhood cancer, and Funded by a $2.9-million National Cancer genes in neuroblastoma. It builds on some of it makes a very interesting model, possibly for Institute grant, a five-year study of the causes Olshan’s and other researchers’ earlier work, adult cancers that may have an origin during of neuroblastoma is just getting underway. which suggests that use of vitamins before fetal development,” he says. “No previous Andrew Olshan, PhD, chair of the Depart- and during pregnancy might reduce the risk study of this scale has investigated the role ment of Epidemiology in the UNC Gillings of neuroblastoma. of genetic susceptibility and neuroblastoma. School of Global Public Health, leads the “That raised interesting questions about in The investigation of vitamins and associated study team, which will collaborate with the utero exposure, and whether a vitamin could genetic factors may provide important clues Children’s Oncology Group, the world’s possibly cause a tumor to regress,” Olshan to the etiology and potential prevention of largest childhood cancer research clinical says. “We are not clear which vitamins might this cancer.” trials organization. be involved, but we are targeting different vita- This knowledge might expand more The study will recruit 1,041 patients mins’ pathways to tease out and see if we can broadly to other applications, as well. nationwide from the Children’s Oncology confirm the role of vitamins in this disease.” “What’s new here is that we are focus- Group and examine genetic variation in The most common cancer in babies, neu- ing more on the genetic aspects,” he says, selected vitamin pathways. The study aims roblastoma develops from nerve cells found “and what will be interesting is if maternal to understand how genes that are involved in in several areas of the body. It usually affects vitamin intake may reduce the risk of neu- the metabolism of different vitamins might children aged 5 or younger, and in the U.S., it roblastoma. That could lead to preventive affect a young person’s chances of developing accounts for 7.2 percent of all cancers among measures that might modify someone’s risk neuroblastoma. The study also will examine children younger than 15. Approximately 650 for disease.” n how diet and other lifestyle factors work with children are diagnosed with neuroblastoma – By Kim Gazella

carolina public health | 13 RESEARCH/studying causes

Long Island Breast Cancer Study Project ner d ul F om leads Gammon to more research T hoto by P Dr. Marilie Gammon

t started more than a decade ago, when a group of women on Long Island became concerned I “We can look at what’s happening when about reports that the breast cancer rate in their people live near a busy road or a stop light,’’ where cars and trucks are producing more region was above the national average. exhaust, Gammon says. Gammon also uses these data to examine In 1993, the advocates – many of them breast PAH is one of the few environmentally whether developing and surviving breast cancer survivors – pressed Congress to pass related factors linked to breast cancer risk. cancer is influenced by other factors – not a law requiring a study of potential environ- An example of an established environmental just those that society can change (like pol- mental factors that might be contributing to risk is radiation exposure. lution) – but factors that women can control, the increased breast cancer rate in suburban “More studies have to be done,” Gammon such as diet and exercise. New York. The result was the Long Island says. “We don’t ever believe (just) one study.” For example, Gammon’s work has shown Breast Cancer Study Project, a large popula- Now, Gammon and other researchers are that premenopausal women who gain more tion-based study of breast cancer. trying to determine whether certain individu- than 35 pounds after age 20 – prior to breast Marilie D. Gammon, PhD, professor of als might be more genetically susceptible to cancer diagnosis – are two times less likely to epidemiology at the UNC Gillings School cancer from PAH exposure. Studying PAH survive the disease. Postmenopausal women of Global Public Health, designed the study, exposure in cigarette smoke is complicated by who gain more than 29 pounds after age 50 which focuses on approximately 3,000 women. the fact that smokers are more likely to have are nearly three times less likely to survive. About half were newly diagnosed with breast an early onset of menopause, a process that Adult weight gain is associated with abdomi- cancer, and the rest were healthy women used may decrease a woman’s risk for breast cancer, nal fat, and another study by Gammon pro- as a control group. since it lessens lifetime exposure to estrogen, a vided evidence that excess abdominal fat can Using blood samples, Gammon and her known breast cancer risk factor. adversely affect breast cancer survival. colleagues did not find links between breast The Long Island study also resulted in a “These results demonstrate that obe- cancer and the pesticide DDT or exposure new research tool, a geographic information sity, particularly abdominal fat, decreases a to PCBs, a family of chemicals once used in system that allows researchers to explore new woman’s chance of surviving breast cancer, electrical equipment. They did find a slightly hypotheses on environmental factors for even if she is premenopausal at the time of elevated risk for breast cancer linked to expo- breast cancer. It uses 80 databases to map diagnosis,” Gammon says. “Our goal is to sure to PAH, a chemical carcinogen formed health, demographic and environmental data identify factors that will reduce risk of breast by the incomplete combustion of fossil fuels, in New York’s Nassau and Suffolk counties, cancer and enhance survival once diagnosed. which is driving further studies. including the location of roads, land use and Maintaining a healthy weight throughout PAH exposure can come from sources breast cancer incidence. The information adult life is something women can do to ranging from air pollution to grilled meat. includes air quality data from monitoring reduce their risk of developing breast cancer, It’s found in tobacco smoke, charred and sites set up by the Environmental Protec- and if diagnosed, improve survival.” n smoked foods, and diesel and jet exhaust. tion Agency. – By Sylvia Adcock

14 | FALL 2009 RESEARCH/studying causes

Seeking safe levels ner d of formaldehyde ul F om T in humans hoto by P

f you dissected a frog in high school Ibiology, you may remember the eye-stinging fumes from the preservative chemical known as formaldehyde. ner Scientists know that formaldehyde is a textiles – two of the state’s d ul human carcinogen. But what’s not well historically largest industries F om known among the public is that this impor- – which means that many T tant chemical is also naturally present in our workers have been exposed to

own bodies – a fact that makes establishing it. Other sources include ciga- hoto by P safe exposure levels difficult. rette smoke, auto exhaust and Doctoral student Kun Lu has developed a “It’s an essential chemical in every living cooking fumes. Government- formaldehyde biomarker to measure the cell,’’ says James A. Swenberg, DVM, PhD, issued trailers provided to victims of Hur- amount of the chemical in the human body. head of the Molecular Carcinogenesis and ricane Katrina also were found to have high Mutagenesis Lab housed in UNC’s Gillings levels of formaldehyde. The Environmental School of Global Public Health. “This seems Protection Agency is now working to estab- to be lost on our regulatory agencies.” lish rules to set levels of exposure. While working with the Chemical Indus- Kun Lu, a doctoral student in Swenberg’s the body – which means there is less chance try Institute of Toxicology in 1980, Swenberg lab, developed a formaldehyde biomarker – a that it causes cancer anywhere other than in helped discover that formaldehyde caused nasal way to measure the amount in the body. In nasal cavities. cancer in rats. Today, his lab produces data to the lab, Kun exposed animals to two types “We want to see if we can find it in the help regulators make science-based decisions of formaldehyde molecules. Using mass liver or the bone marrow,” Swenberg says. about safe levels of formaldehyde exposure. spectrometry, he examined whether the mol- “We don’t know what the answer is. We just Formaldehyde is an important issue in ecules had an effect on distant tissues. want to put some good science behind it.” North Carolina because the chemical is So far, their research has not shown that For his work, Lu won a 2009 Impact commonly used to produce furniture and formaldehyde migrates to distant tissues in Award, given to UNC graduate students whose research provides special benefit to North Carolinians. In the recommendation To learn more, see the National Cancer Institute’s fact letter to Impact Award judges, Swenberg wrote “Kun’s research …will strongly drive sheet on “Formaldehyde and Cancer Risk” at cancer risk assessment for North Carolina, www.cancer.gov/cancertopics/factsheet/Risk/formaldehyde. the USA, and the world.” n – By Sylvia Adcock

carolina public health | 15 RESEARCH/studying causes

Finding the best chemotherapy for you

much the genes are turned on or turned off) in 48 genes, they could predict an indi- vidual’s resistance to the compound with 96 percent accuracy. “This kind of strategy could be used for magine you’re a cancer patient, about to discuss different types of tumors and chemother- apy,” says Fry, but notes that it likely will be chemotherapy with your doctor. But first, the several years before scientists will be able to I move the research into a clinical setting and lab draws some blood. Now, imagine that simple work with cancer patients. act allows your oncologist to pinpoint what kind of Another benefit to the research is that it could help doctors predict who might be chemotherapy you would respond to best — and rule more sensitive to certain carcinogens in the environment. With that knowledge, Fry says, out therapies that would do you no good. doctors might someday be able to warn indi- vidual patients they might be particularly Medicine isn’t there yet. But it’s closer, thanks “Even given the same exposure, we saw a susceptible to cancer from cigarette smoke to some groundbreaking work by Rebecca dramatic difference,” Fry says. Those differ- or UV rays, for instance. Fry, PhD, assistant professor of environmental ences surprised even the researchers. “Some Fry’s lab at UNC is now studying the sciences and engineering at the UNC Gillings were resistant, some were sensitive, and some effects of exposure to arsenic, a common School of Global Public Health. were in between.” environmental hazard in North Carolina and “I’m very excited,” says Fry, who began From there, Fry and her colleagues deter- throughout the world. n working on the project several years ago at mined that using the expression level (how – By Sylvia Adcock the Massachusetts Institute of Technology. “No one has studied the response of healthy cells to these agents.’’ In addition to saving lives and avoiding the pain of ineffective chemo treatments, “it would mean you could save a lot of time and money… it’s moving toward what we call individualized medicine,” Fry says. It’s well known that some individuals respond better to chemo than others. Fry and her colleagues at MIT, where she was a research scientist until joining UNC last year, decided to find out just how different those responses could be and find ways to predict them. They worked with 450 cell lines from healthy people, all from North America but with a wide variety of ancestries. Healthy cells were exposed to the carcinogen MNNG, a DNA- damaging agent found in cigarette smoke and certain chemotherapy compounds.

16 | FALL 2009 NUTRITION astleman K a a d Studying the L in hoto by by hoto P link between sialic acid and colon cancer

Dr. Eric Park

hat is it about red meat and dairy products that Wincreases people’s risk of developing colon cancer? Eric Park, PhD, research assistant professor tion associated with colon cancer, thereby of nutrition at the UNC Gillings School of increasing a person’s risk of developing the Global Public Health, is determined to solve cancer. This particular form of sialic acid that puzzle. also has been detected in breast cancer and Park’s research focuses on the relationship liver cancer. between diet and cancer. He is looking at a “If you know what the functions of sialic family of carbohydrates called sialic acids acids are and you know what the normal state and their role in colon cancer. Even more of sialic acids should be, it is a lot easier to specifically, his research focuses on one type find out what happens during the disease,” of carbohydrate that is found in cancer cell Park says. For a different angle on the surfaces but comes mainly from red meat and His research also could help people who red meat debate, read the dairy products, not from humans. suffer from inflammatory bowel disease Archives of Internal Medicine “I want to know if these carbs, these (IBS) because they have a higher risk of colon (http://archinte.ama-assn.org) non-human sugars, could account for the cancer. Red meat is strongly associated with editorial by Barry Popkin, increased risk of [getting cancer from]eat- colon cancer. PhD, Carla Smith Chamblee ing mammal products,” Park says. “There The American Institute for Cancer Research Distinguished Professor of is something unique about cancer cells that recommends consuming no more than 18 Global Nutrition and director they accumulate these non-human sugars.” ounces (cooked) of red meat (beef, pork or of UNC’s Interdisciplinary While many researchers have looked at lamb) per week and avoiding processed meat. Obesity Center. He discusses some of the risks posed by high consumption (For details, visit www.aicr.org.) both the potential cancer and of red meat, such as its high fat or caloric Park says such recommendations are other health risks of eating red content, no one has examined the sialic based on strong evidence. “It is not because meat and the impact on energy acids from red meat in the way that Park is of this particular sugar, but this sugar may consumption and climate doing now. explain why red meat increases your risk for change from producing meat. He hopes to discover whether this spe- cancer.” n cific type of sialic acid increases inflamma- – By Natalie Gott

carolina public health | 17 NUTRITION

Some nutrients can increase risk ner d ul F

for lung cancer om T hoto by P here’s no question that smoking cigarettes is unhealthy. Dr. Jessie Satia If you can’t kick the habit, however, you may want to T Helping a Smoker Quit: rethink what dietary supplements you take each day. Do’s and Don’ts Most smokers struggle to give up ciga- A new study led by Jessie Satia, PhD, suggests more of a specific nutrient than the recom- rettes. You, as a family member or friend, can help out by following these tips from that supplements that contain some of the same mended daily allowances call for, Satia says. the American Cancer Society: nutrients found in fruits and vegetables can “You don’t know what effect taking those Do respect that the quitter is in charge. increase the risk for developing lung cancer in very large doses of supplements is going This is their lifestyle change and their certain people, especially smokers. to have on your health,” says Satia, who is challenge, not yours. Satia, an associate professor of epidemi- also the Special Assistant to the Dean of the Do help the quitter get what she or he ology and nutrition in the UNC Gillings School of Public Health for Diversity. needs, such as hard candy to suck on, straws to chew on, and fresh veggies cut School of Global Public Health and the UNC Beta-carotene is a vitamin that acts as an up and kept cold in the refrigerator. School of Medicine, led a team of researchers antioxidant, protecting cells against oxida- Do spend time doing things with the at UNC and the University of Washington in tion damage. Food sources of beta-carotene quitter to keep his or her mind off smok- ing – go to the movies, take a walk to get Seattle. They used questionnaires to examine include sweet potatoes, carrots, kale, spinach past a craving (what many call a “nicotine dietary supplement use among more than and collard greens. fit”), or take a bike ride together. 77,000 western Washington state residents Earlier double-blinded randomized clini- Don’t judge, nag, preach or scold. This between the ages of 50 and 76. Participants cal trials in the United States and in Europe may make the smoker feel worse about him or herself. You don’t want your friend were asked about their health history, risk also indicated that very large doses of beta- to turn to a cigarette to soothe hurt factors and use of supplements and multivi- carotene supplements increased the risk of feelings. tamins over the previous 10 years. Research- lung cancer in smokers and persons exposed Don’t take the quitter’s grumpiness personally during his or her nicotine ers then tracked them for four years before to asbestos. The UNC and University of withdrawal. The symptoms usually pass using data from the National Cancer Insti- Washington researchers wanted to see if they in about two weeks. tute’s Surveillance Epidemiology and End would get the same results by tracking the Do celebrate along the way. Quitting Results (SEER) cancer registry to identify the general population. The study proved to be smoking is a BIG DEAL! rates of lung cancer among them. pioneering, Satia says. Reprinted by the permission of the American Cancer Society, Inc. from www.cancer.org. All rights reserved. What they found is that smokers who took “It is the first one that showed that people, beta-carotene or other carotenoid-containing particularly smokers, who take moderate doses dietary supplements had a stronger chance of for a relatively long period of time might have ments for four years or longer was 53 percent developing lung cancer than those who did an increased risk of developing lung cancer,” more likely to develop lung cancer. Those not take the supplements, according to the says Satia. In her study, the median 10-year who took lutein supplements for four years study published in the American Journal of daily dose was 4,500 micrograms of beta-car- or longer were 102 percent more likely to Epidemiology. otene, much lower than the 20 milligrams and develop it. Satia cautions, however, that rela- Results show that smokers should be very 30 milligrams of beta-carotene taken during tively few persons took large doses of these cautious about taking these supplements, the randomized clinical trials. supplements for long periods of time, so the says Satia, who also is a member of the UNC In fact, the study showed that a person’s results should not be over-interpreted. Lineberger Comprehensive Cancer Center. risk of lung cancer increased the longer they The findings may be just another reason While vegetables provide a certain took supplements containing beta-caro- why smokers should consider kicking their amount of various nutrients, the sup- tene, retinol and lutein. For example, habit altogether. n plements can provide substantially a person who took retinol supple- – By Natalie Gott

18 | FALL 2009 NUTRITION

Practical information on cancer treatments can lead to better policies, treatments, outcomes

UNC selected as AHRQ cancer research site

sing data from 2.5 million cancer Upatients — fully 25 percent of the nation’s cancer population — two University of North Carolina at Chapel Hill researchers are designing studies that could provide practical information on The first task is to cancer treatments to health care providers examine results from dif- and policy makers. ferent chemotherapy drugs Last year, UNC was selected as one of two given for advanced colorec- cancer research sites by the U.S. Agency for tal cancer, using data from Healthcare Research and Quality (AHRQ), about 200,000 patients. Dr. William Carpenter (left) discusses research data with Dr. Richard Goldberg (center) and Dr. Til Stürmer, associate an arm of the U.S. Department of Health and Among other things, the professor of epidemiology at the UNC Gillings School of Human Services. The other site is Brigham researchers hope to show Global Public Health. and Women’s Hospital in Boston, Mass. whether earlier clinical tri- The work of the Chapel Hill-Boston als were able to accurately predict how these Another project they hope to tackle is consortium is likely to drive public health drugs perform in the general population. looking at whether PET scans (positron care policy. “We’re taking science out of the lab, mov- emission tomography, a test that shows “We don’t do policy, but we create the ing beyond clinical trials and developing new metabolic activity in a tumor) are always a science under which people make policy,” science that says, ‘This works in the commu- better tool for measuring cancer progression says Jean Slutsky, director of the Center for nity,’” Carpenter says. or recurrence than CT scans, a simpler and Outcomes and Evidence at AHRQ. The influ- Carpenter explains that while a clinical less expensive imaging method using x-rays. ence of such policies, she says, can range from trial’s information allows practitioners to Medicare officials are very interested in such a patient and doctor agreeing on a treatment try new treatments, the trial participants are a study, because it could lead to changes in to decisions made by Medicare or the head of not representative of the general population. funding decisions. a large medical insurance company. “People in clinical trials tend to be Cauca- Yet another study with public policy The UNC researchers are led by William R. sian, younger and healthier than most people implications explores an easier screening test Carpenter, PhD, research assistant professor at with cancer,” he says. for colorectal cancer – one that isn’t as costly UNC’s Gillings School of Global Public Health, By looking at outcomes of a drug in the or invasive as a colonoscopy. Carpenter said and Richard Goldberg, MD, associate director population as a whole, they’ll be able to tell he hopes to look at results from an immuno- for clinical research at UNC Lineberger Com- whether the clinical trial accurately reflects chemical test that uses a stool sample to see prehensive Cancer Center and physician-in- the drug’s effectiveness. if it’s a good predictor of cancer. chief of the N.C. Cancer Hospital. They will “Good data already exist,” says Carpenter, Carpenter says the well being of cancer have access to data from tumor registries in but he stressed that researchers would like patients is at the center of the research. “The various states as well as reams of data from to work toward building even stronger data primary order of business when we are look- Medicare claims, totaling 2.5 million cancer sets that contain more detailed information, ing at anything is: does it support cancer patients diagnosed since 1991. They also will including more on a patient’s experience dur- survival and improved quality of life?” n analyze data from dozens of other sources. ing treatment and their quality of life. – By Sylvia Adcock

carolina public health | 19 COMMUNITY OUTREACH

Eng, CCARES collaborate to tackle racial disparities in cancer care

hen breast cancer patients believe that W their disease is being adequately managed, they are likely to stick with a treatment plan,

UNC Gillings School of Global Public Health Dr. Eugenia (Geni) Eng addresses a public health forum in Greensboro, researchers have found. N.C., in June, reporting preliminary findings from the CCARES research. But the research project, led by Eugenia stop or delay treatment are African-Ameri- Eng, DrPH, UNC professor of health behav- can women. A recurring concern expressed is given and received within a local medical ior and health education, also shows that by women in the study was that they were community. Breakdowns in communication when patients’ questions about their treat- unlikely to speak up about their needs or can be caused by cultural differences, Eng ment go unanswered, or their chemotherapy concerns if they had negative encounters with explains, and can lead to racial disparities schedules are inflexible, or inadequate or authority figures at critical points during their in treatment and care. inconsistent information is provided about course of treatment. Instead, they would stop The study led researchers to conclude that follow-up care, then they are more likely to or delay the treatments. the structure of a cancer care system actually stop or delay treatment. Eng’s study is a collaborative effort called can promote racial inequities. While this is For patients, maneuvering through can- CCARES (Cancer Care and Racial Equity not intentional, it can harm patients, and cer treatment can be unnerving – or, as one Study), which has been underway for the past the longer the disparities exist, the more dif- patient described it at a recent health forum, four years in Greensboro, N.C. CCARES uses ficult it becomes to acknowledge the problem it’s like riding a bicycle down a road and try- a community-based participatory research and change the system. The way to improve ing to avoid the potholes. approach to examine the different ways patient care, Eng said, lies in improving Preliminary findings of the study show that patients and caregivers communicate. The health care as a system, not just as a relation- a disproportionate number of the people who study also explores differences in how care ship between doctors and patients.

“I don’t think they treat you like they should. I was getting too much chemotherapy until my doctor discovered the mistake, and then when I had radiation, they didn’t tell me anything about wearing the (compression) sleeve to cut swelling. I hope this (study) will make things better for others in the future.” – Shirley Weatherford, 72 Greensboro, N.C.

20 | FALL 2009 COMMUNITY OUTREACH

Photos by Bonnie Stanley/Bonnie Stanley Photography

Above, a patient at a health forum in Greensboro describes her difficulty rather than just as a relationship between that the system can track them better, and we navigating the health care system for her patient and doctor. hope that it can be a model for others.” and her husband. At right, Brandolyn The study, funded by the National Cancer CCARES was formed by the Greensboro White, community outreach specialist with Institute and Greensboro’s Moses Cone- Health Disparities Collaborative, a joint initia- the Carolina Community Network, chats with CCARES project coordinator Christina Wesley Long Community Health Founda- tive of The Partnership Project (a community Hardy (right) before the forum. tion, also found that doctors typically do organization committed to “undoing racism” not receive specific information about the in Guilford County, N.C.), the UNC Center progress of their patients’ treatment and may for Health Promotion and Disease Prevention not know whether a patient has missed an and the UNC Program on Ethnicity, Culture appointment or decided to stop treatment. and Health Outcomes. Moses Cone Health Improving care for African-American Christina Hardy, MPH, project coordina- System also joined the project, committing to women is especially urgent, she says. tor for CCARES in Greensboro, says one pre- work with local health care providers to help “What we are trying to understand is why liminary study recommendation is to better identify improvements in the care process. there’s a racial disparity in breast cancer treatment – and we are focused on the sys- tem,” says Eng, “We’re not blaming doctors What we are trying to understand is why or nurses or care providers, but we’re trying to understand what it is about the system that there’s a racial disparity in breast cancer produces these disparities.” As part of the study, 50 breast cancer treatment— and we are focused on the system. survivors were interviewed more than once – UNC Professor Eugenia Eng about details of treatment that occurred five or six years earlier. Of these, 15 had delayed inform physicians about patients’ treatment Eng and colleagues are preparing a new or discontinued their care. progress and status. grant proposal that will build on CCARES’ The interviews used a qualitative research “We are making suggestions for how findings and expand research to include the approach called “Critical Incident Tech- health care institutions can be modified to Greensboro Health Disparities Collabora- nique,” first used by the U.S. Army Air Forces better track cancer patients,” Hardy says. tive and cancer centers affiliated with Moses in World War II to improve pilot training “Sometimes, women go in for chemo or radi- Cone Health System, the University of Pitts- programs by determining why missions were ation on a frequent schedule but they won’t burgh and East Carolina University. Using not completed as planned. In this study, the see their oncologist again for six months. If a the collaborative experience, they hope to approach allows researchers to address all woman discontinues her care, how would the improve cancer care for all patients. n aspects of cancer treatment as a system, oncologist know? We are trying to find a way – By Kim Gazella

carolina public health | 21 COMMUNITY OUTREACH

Fight against tobacco moves to cyberspace

Photo by Tom Fuldner Dr. Kurt Ribisl tracks one of the many Web sites that offer online purchase of tobacco products. he drop in the number of Americans who smoke, from 42.4 percent in 1965 to just under 20 “The Internet is now providing a back T channel, a way for people to avoid those higher percent in 2007, is touted as one of the great public prices at stores,” says Ribisl, who also serves as health success stories in the 20th century. director of the UNC Coordinating Center of the Cancer Prevention and Control Research Given the well-known link between smoking count cigarettes” and “tax-free cigarettes” Network, whose members conduct commu- and lung cancer, Kurt Ribisl, PhD, is working into several search engines. By January 2005, nity-based participatory cancer research. to ensure that success doesn’t falter because 664 Internet cigarette vendors in the United Another downside to sidestepping tobacco of the growing number of people selling States and abroad were identified through excise taxes is that federal and state govern- tobacco online. automated searching strategies developed ments depend on the money generated from “We’ve made outstanding progress in by a private online risk-monitoring and them, and some proceeds often go to cancer reducing tobacco use,” says Ribisl, an associ- management firm. screening or tobacco-control programs. No ate professor of health behavior and health The problem with many of these vendors is published estimates of the tax revenue lost have education in the UNC Gillings School of twofold, says Ribisl, who published his findings been peer-reviewed, Ribisl said. He notes, how- Global Public Health. “We don’t want (these in a chapter of the book, Ending the Tobacco ever, that North Carolina has a fair number of gains) unraveled by a new system of market- Problem: A Blueprint for the Nation. First, online cigarette vendors and gains tax revenue ing and distribution through the Internet.” many online tobacco vendors do not charge because those vendors are selling and shipping For the past decade, Ribisl has led a team excise taxes. Further, many do not take steps to customers in states with higher taxes. of researchers who have tracked the number to prevent minors from purchasing cigarettes. Besides not charging taxes, these sites can of online cigarette vendors. That research Excise taxes can serve as a great deterrent make it easier for minors to buy cigarettes has potential for widespread benefits, as it to smoking. Now, however, smokers can find because vendors rarely verify their customers’ could lead to Internet regulations for hand cheaper cigarettes online, Ribisl noted in the ages as required by federal law, Ribisl says. guns and alcohol as well as cigarette sales book. In fact, smokers in areas with high Ribisl, who gave a briefing to Congress on to minors. cigarette taxes, such as New York or Illinois, online cigarette sales a few years ago, is using In January 2000, Ribisl’s researchers iden- are more likely to buy cigarettes online than that research as a springboard for formulating tified 88 unique domestic Internet cigarette those who live where taxes are lower, such as some recommendations for policymakers on vendors by entering key words such as “dis- North Carolina, Ribisl found. how to regulate the online sale and marketing of other age-restrictive and hazardous goods. His work also could help prevent the sexual On June 22, 2009, President Barack Obama signed into law the exploitation of children over the Internet. Family Smoking Prevention and Tobacco Control Act, which gives “If you can successfully figure out how the Food and Drug Administration authority to regulate tobacco to verify the age of the people who buy ciga- products. The legislation has been in development for more than a rettes on the Internet, you can do it for other decade. Key provisions include tighter restrictions on advertising and packaging, and a ban on candy- and fruit-flavored cigarettes. things,” Ribisl says. n – By Natalie Gott

22 | FALL 2009 COMMUNITY OUTREACH

Linnan. “If you look at most of the leading causes of death – heart disease, stroke, dia- Trimming hair, betes, cancer – it would show that African- American men are suffering higher rates than any of those groups.” trimming risk: The BEAUTY, TRIM and CUTS studies are grounded in a strong partnership with direc- tors of cosmetology and barbering schools, Barbers promote barbers/stylists, health care advocates and oth- ers who help guide all aspects of the research. In fact, the barbershop outreach idea came health care from the advisory board members. Hooker is helping researchers train barbers to help pro- mote health in their shops, with their clients. “Our men are very private,” he says. d Hooker has been a barber for more “When you start digging or come on too strong, you can actually push them away. Ethan 20 years. He knows that keeping his A lot of barbers would rather just give him a haircut and let him leave than pester him customers healthy is good for them — and it’s also to get check-ups. That’s when I remind the good for business. barbers that if they don’t have these men, they are going to lose business.” “I want to make sure my clients are healthy “African-American men die, on average, The BEAUTY Project enrolled 40 beauty and let them know someone cares about seven years before white men, and most men salons and more than 1,000 women in the them,” he says. “I also need to keep my cli- often wait until they are really sick before study. So far, Linnan’s team has worked entele alive and teach them how to stay out they talk with a health care provider,” says with more than 20 African-American 8 there in the world so I can continue to make a living with them!” Hooker, owner of E-Style Barbershop in Greensboro, N.C., has been an active advisory board member in several UNC barbershop- based research projects, including “Trimming Risk in Men” (TRIM) and “Cancer Under- standing Today” (CUTS), that engage men in conversations about their health and urge them to get preventive health care. Laura Linnan, ScD, associate professor of health behavior and health education at the UNC Gillings School of Global Public Health, leads the research teams working on these studies. They are offshoots of a success- ful project she started six years ago in beauty shops (N.C. BEAUTY and Health Project), which targeted African-American women to eat healthier, get more physical activity and obtain recommended screening tests.

Greensboro barber Ed Hooker tells a client about the benefits of cancer screenings. Photo by Tiger Butler/Tiger Vision Photo

carolina public health | 23 COMMUNITY OUTREACH

barbershops and nearly 500 of their cus- and that clients are enthusiastic in their Linnan says these studies have continued tomers as part of the TRIM and CUTS support of receiving health information in to build the evidence base for promoting studies. The TRIM study is funded by the the barbershops. Preliminary results from health in beauty salons and barbershops and Centers for Disease Control and Preven- CUTS showed that African-American men that they are willing partners in working tion. Preliminary results demonstrate that were more aware of (and had increased calls toward eliminating the health disparities barbers can be trained to encourage clients to acquire) the free, lifesaving information that exist. Perhaps most importantly, “we to make informed decisions about getting available through the National Cancer Insti- have clearly demonstrated that barbershops colorectal and prostate cancer screenings, tute’s Cancer Information Service. are a great place to reach men, as long as we don’t overwhelm them with too much information,” she says. “The average age of our CUTS participants was 35 years, and Cancer Understanding Today (CUTS) is a two-year there are very few settings where we can National Cancer Institute project designed to increase reach young African-American men with calls from African-American men to its cancer hotline, information about health. The barbershop 1-800-4CANCER. Linnan is encouraged by early is a unique place in that regard.” indications from the study, which relies on barbershops Hooker agrees with that assessment. to promote the health education information. “Men will listen to their barber,” he says. n “The good news is that we definitely are seeing trends – By Kim Gazella toward increased calls” after a recent education campaign about cancer and the hotline, Linnan says.

Colon cancer screening kits FIT for duty in High Point project

Study seeks to boost ne test that screens for colon cancer is pretty cancer screening rates Osimple, but it requires taking three stool samples. That can be a daunting prospect, even for through community people who have the privacy of their own home and health partnership bathroom. When the patient is homeless and living out of his car, the challenges ratchet up quickly.

Yet health care professionals in High Point, “Being able to talk with (the homeless N.C., were able to help a man in this situa- man) and really educate him about the tion – and even provide some follow-up care importance of screening, and also following based on his test results – through a UNC-led up by helping him see a gastroenterologist, study that centers on a strong community made a huge difference,” says Carin Hiott, health care partnership. The study’s goal is director of chronic care for High Point to reduce colon cancer deaths by increasing Regional Health System. The system is one the number of people who are screened early of the project’s partners, which also include for the disease. the UNC Lineberger Comprehensive Can-

24 | FALL 2009 COMMUNITY OUTREACH

cer Center, the High Point Adult Health as 70 percent at one participating Center, Community Clinic of High Point, clinic. The keys, she says, are solid Piedmont Health Services and Sickle Cell education about the disease, clear Agency, High Point Gastroenterology, and instructions about screening and physicians and other agencies in the High ensuring follow-up for positive tests Point community. regardless of a patient’s ability to Education and follow-up can make a huge pay. The screening method used is difference throughout a community. Colon the fecal immunochemical test, or cancer is the second leading cause of cancer FIT, often called a stool test. death in North Carolina, yet it’s highly treat- “In our focus groups, we discov- able if caught early. African Americans tend to ered that people were willing (to die from the disease at a higher rate than any try the test),” she says. “They had other group, according to the Centers for Dis- some reservations, but were reas- ease Control and Prevention (CDC). Screen- sured once they found out the kits ing rates have risen over the years but mostly were science-based, that they didn’t Dr. Cathy Melvin among people with health insurance; those have to change their diet and knew who are uninsured or underinsured tend to they could get diagnostic follow-up.” kits for people who need them is only the first skip the screenings. The CDC reports that “as The focus groups of 28 African-American step. It is also crucial that a “safety net” of many as 60 percent of deaths from colorectal men and women, conducted in March 2007, gastroenterologists and other specialty care cancer could be prevented if everyone age 50 recommended making available more pam- providers are available to provide prompt and older were screened regularly.” phlets, videos and other educational mate- follow-up care to people who need it. UNC researchers, led by Cathy Melvin, rials. Because people over 50 may not read High Point Regional’s Hiott notes that the PhD, research associate professor of maternal small print well, they helped researchers next steps would be tougher for all agencies, and child health at the UNC Gillings School design a more user-friendly kit for the pilot given limited resources and tight budgets. of Global Public Health, and with Katya project, with larger type and photos. During the study, having a research assistant dedicated solely to promoting the FIT tests and talking with patients about colorectal cancer As many as 60 percent of deaths from made a tremendous difference, she says. Moore agrees that the challenges become colorectal cancer could be prevented if everyone greater without the study resources. Many clinics treating people who are uninsured or age 50 and older were screened regularly. underinsured are acute care clinics, which must focus on more immediate problems, including – Centers for Disease Control and Prevention hypertension and diabetes, rather than encour- age preventive screenings for cancer. Roytburd, MPH, a research assistant in the In all, 301 eligible adults have been Moore says that researchers are looking Lineberger Comprehensive Cancer Center enrolled in the study, with an overall FIT for additional partners to share expenses and serving as project manager, set out to see if return rate of 67 percent. Of the 201 FIT that successes. They hope to expand the project they could intervene. were returned, four were positive. All four to additional communities. n They started the outreach screening study, patients have been referred for free diagnos- – By Kim Gazella which is a pilot project of the Carolina Com- tic colonoscopy. munity Network, funded by the National “We are excited about the high return Cancer Institute’s Center to Reduce Cancer rate,” Moore says. “We have learned that the The Comprehensive Cancer Health Disparities. The Comprehensive Can- stool test is affordable and can be distributed Control Collaborative of cer Control Collaborative of North Carolina in clinics, and it’s terrific to know firsthand North Carolina (4CNC) at (4CNC) at UNC’s Center for Health Promo- how many positives from this first sample UNC’s Center for Health tion and Disease Prevention conducted for- will need follow-up.” Promotion and Disease mative research. 4CNC is funded by the CDC Lessons learned in the study have laid a Prevention is funded by the and the National Cancer Institute. good foundation, but questions remain as Centers for Disease Control Alexis Moore, MPH, project director for to whether the clinics can continue the out- and Prevention and the 4CNC, says the early results are very encour- reach on their own and whether follow-up National Cancer Institute. aging, with home testing return rates as high care will be available. Providing screening

carolina public health | 25 COMMUNITY OUTREACH

Breastfeeding: good for babies, good for moms

reastfeeding is great for babies and Bmoms, offering the best nutrition along with bonding opportunities. Now, studies show that breastfeeding cuts the risk of breast cancer as well.

How? Breastfeeding appears to lower the Professor of epidemiology in the UNC Gillings “satisfactory evidence” (requiring the most levels of cancer-related hormones. At the end School of Global Public Health, and other convincing data) that breastfeeding reduces of lactation, the mother’s body also gets rid of researchers have studied the inverse relation- breast cancer risk. A separate analysis of 47 many breast cells, including some that may ship between breastfeeding and breast cancer. published studies reported a decrease in risk of have DNA damage, thereby reducing her risk A 1999 study by Millikan and then UNC 4.3 percent for every year of breastfeeding. of developing cancer later. graduate student Helena Furberg, published Millikan and colleagues Drs. Charles Since the early 1990s, Robert Millikan, PhD, in the International Journal of Epidemiol- Perou and Lisa Carey at the UNC Lineberger DVM, Barbara Sorenson Hulka Distinguished ogy, found that breastfeeding may reduce Comprehensive Cancer Center recently cancer risk by up to 30 percent extended Millikan’s earlier work to show that (20 percent in women aged 20-49; breastfeeding is protective for one of the most Current recommendations 30 percent in women aged 50-74) aggressive types of breast cancer, termed for breast feeding: and was protective regardless of basal-like. This form is difficult to treat the number of children breastfed and is more common in younger African- Breastfeed exclusively for six months; or maternal age during lactation. American women than other groups. then supplement with other food (Furberg is now research assistant Miriam Labbok, MD, professor of the (recommended by AICR and WCRF). professor of genetics in the UNC practice of public health and director of the Other ways to reduce cancer risk: School of Medicine.) Carolina Global Breastfeeding Institute (in • increase physical activity A landmark expert report, public health’s Department of Maternal and • improve eating habits “Food, Nutrition, Physical Activ- Child Health) sees the research as a stepping- • lower alcohol consumption ity and the Prevention of Cancer: stone to better education for women, espe- • maintain a healthy weight a Global Perspective,” published cially black women. Read more at: in January 2008 by the Ameri- Labbok says the School’s job is to ensure • Carolina Global Breastfeeding Institute: can Institute for Cancer Research that “these messages are not only heard, but www.sph.unc.edu/breastfeeding (AICR) and the World Cancer supported and practiced, so that all women • Academy of Breastfeeding Medicine: Research Fund (WCRF UK), con- someday will be truly enabled to make the www.bfmed.org firms this view (www.dietand best preventive health choices for themselves • Unicef: www.unicef.org/nutrition/ index_breastfeeding.html cancerreport.org). The report and their children.” n reviewed 100 studies and found – By Linda Kastleman

26 | FALL 2009 SURVIVABILITY

UNC helps cancer patients, families shift into survival mode

Like being dropped off a cliff. That’s how many patients describe the dif- Working together, LIVESTRONG TM ficult transition from their initial cancer Survivorship Center of Excellence Network treatment to cancer survivorship, says Marci members are examining and transforming Campbell, PhD, MPH. how survivors are treated and served in a And that’s something she and others variety of settings, stimulating survivorship at UNC’s Gillings School of Global Public research, and improving the quality and Health and the Lineberger Comprehensive integration of care among health care Cancer Center are addressing. Last year, providers caring for cancer survivors. LIVESTRONG TM chose Lineberger as a Campbell, a nutrition professor, co-directs TM LIVESTRONG Survivorship Center of the Center. “We are very honored to be cho- Dr. Marci Campbell Excellence, part of a Network of centers that sen,” she says. “We’re only one of eight in the direct survivorship services and increase nation and the only one in the southeast.’’ diagnoses, while treatments and early detection the effectiveness of survivorship care The Center at UNC Lineberger, Carolina bring down death rates. Nationwide, the num- through research, the development of new Well, was formed with a five-year $1.5 mil- ber of cancer survivors is 12 million. About interventions and sharing of best practices. lion grant co-funded by LIVESTRONG and 300,000 of them live in North Carolina. The V Foundation for Cancer Research. Campbell has worked with others, includ- Additional grants will fund three com- ing Paul Godley, MD, PhD, and Donald munity-based centers that will collaborate Rosenstein, MD, to establish community- closely with UNC Lineberger. based centers at hospitals and health care clin- Awareness of the special needs of cancer sur- ics in other locations across the state. Godley vivors is growing. Today, more than 65 percent is associate professor of hematology and of adults and 75 percent of children who are oncology in UNC’s School of Medicine and diagnosed with cancer survive more than five a member of the Lineberger Comprehensive years. It’s a phenomenon expected to continue Cancer Center. Dr. Rosenstein is a professor as an aging population brings more cancer of psychiatry and director of the new UNC Comprehensive Cancer Support Program. As a result of their efforts, full-time out- CANCER SURVIVOR RESOURCES reach coordinators who specialize in sur- vivorship issues are now in place at the • LIVESTRONG: www.livestrong.org Greensboro Area Health Education Center • LIVESTRONG Care Plan: www.livestrongcareplan.org (AHEC), Tri-County Community Health • Carolina Well UNC Lineberger Survivorship Program: Center in Sampson County and the Zimmer www.carolinawell.org Cancer Center at the New Hanover Regional Medical Center in Wilmington. • National Coalition for Cancer Survivorship’s “Cancer Survival Toolbox” “We didn’t want it to be so that everyone (a free, self-learning audio program developed by leading cancer had to come to Chapel Hill,” Campbell says. organizations; contains a set of basic skills, as well as special topics): www.canceradvocacy.org/toolbox The program also helped establish an off- campus clinic at UNC where survivors can • National Cancer Institute’s Cancer Survivorship information site: receive follow-up care, such as psychosocial http://dccps.nci.nih.gov/ocs/ counseling and wellness care. That helps 8

carolina public health | 27 SURVIVABILITY

those “who may not want to return to a hos- cancer patients and caregivers at N.C. Cancer work issues that may put tremendous stress pital setting where many people are still very Hospital in the fall of 2008, asking survivors on the patient and family. ill and in treatment,” Campbell says. whether they had received enough informa- Clinical caregivers may need some edu- The goal is for every cancer survivor to leave tion (about everything from sexual issues to cation as well, Campbell says. While some with a treatment summary and survivorship keeping track of important medical records), caregivers would say, “Well, that’s done,” the care plan. The plan would address physical as and what kind of programs and services they cancer survivor knows that the battle rages well as psychological and support needs and would like to have. on, even without medicine or surgery. include a comprehensive list of medications As they return to work and “the new nor- “We heard several stories about cancer and treatments used, which can be helpful to mal,” cancer survivors say they sometimes patients being given a celebration on the a patient’s primary care physician. feel as though the network of family and last day of treatment,” Campbell says. This In an effort to address survivor needs, friends that supported them had now moved is usually done with the best of intentions – Campbell says, questionnaires were given to on. In addition, many have financial and but to the patient, it can seem as though the warm circle of staff and caregivers is leaving, and the patient may feel fearful and alone. STEPS OF YOUR OWN Caroline Huffman, director of patient navigation services at LIVESTRONG, praised keep track of all treatments • If you or a loved one is battling cancer, Lineberger staff for their progress developing and medications, including dates and places. This list can be helpful a survivorship center program. for your primary care physician later. “Lineberger is poised to accomplish great • Don’t pretend that everything is finished, once treatments are over. things,” Huffman says. “They’ve got a great The patient needs continuing emotional and possibly physical support team put together and they are incredibly beyond chemotherapy or radiation. enthusiastic.” n – By Sylvia Adcock Combating the virus linked to cervical cancer s an epidemiologist, Jennifer S. Smith, PhD, A looks for risk factors that affect our health. As a behavioral scientist, Noel Brewer, PhD, tries to understand how people make health decisions. From those different perspectives, both research- ers provide important weapons in the fight against cervical cancer.

Every year, about 12,000 women in the against human papillomavirus (HPV) and United States are diagnosed with cervical HPV testing for improved diagnosis holds a cancer. Almost 4,000 women die from this new promise to prevent the cancer. disease every year. It is among the most treat- Recent findings by Smith, a research asso- able of cancers – but only if it is caught early. ciate professor of epidemiology at UNC’s Effective screening tools – the pap smear, for Gillings School of Global Public Health, have instance – are available, and today, vaccines demonstrated the strong link between HPV

28 | FALL 2009 SURVIVABILITY

In America, there’s no excuse for anyone dying of cervical cancer...This is a cancer we can conquer. – UNC Assistant Professor Noel Brewer and cervical cancer. She and other research- In June, when the South-Central Partner- ers have conducted global meta-analyses ship for Public Health, a coalition of county demonstrating that HPV is the primary cause public health departments, Dr. Brewer and col- of cervical cancer, and an important cause leagues rolled out a public-relations campaign of anal, penile, vaginal and vulvar cases. Dr. for the vaccine, the materials included pictures Smith also scrutinized 41 studies involving of mothers and daughters and the words: “You 22,500 women and found that persistent HPV have hopes and dreams for your daughter, and infection was consistently associated with an they don’t include cervical cancer.” increased risk of cervical cancer. Since August, Smith, Brewer and Allen Smith’s research, of course, bolsters the Rinas also have been working to increase cer- case for vaccination. Yet many young women vical cancer screening by offering home HPV aren’t getting it. That’s where collaboration testing to women in North Carolina who between Drs. Brewer and Smith comes in. have not had cervical screening in the past Brewer, assistant professor of health behav- four years. Brewer’s work “helped us clarify ior and health education, and Smith recently important components of our message,” says worked together with the CDC in five North Heather Gates, a Gillings School of Global Carolina counties – Duplin, Harnett, Wayne, Public Health graduate and public health Sampson and Cumberland – to interview consultant who heads the project, which is parents of young girls about the perceived bar- designed to inform parents in counties with riers to getting the HPV vaccine. Parents who the highest rates of cervical cancer. were most likely to get their daughters vacci- Smith and Brewer, who come from dif- nated against HPV were those who expressed ferent fields but have common goals, are regret at the thought that their daughter might working together and are excited about the develop later cervical cancer. promise of the vaccine to save women’s lives. Brewer, Smith, and colleagues found that if “Elimination of cervical cancer is certainly a parents saw barriers to getting the vaccine – for possibility in the future,” Smith says. instance, if they didn’t know where to get it or But it continues to be a cancer of dis- whether their insurance would cover it – they parities, one that more often affects women were much less likely to get it. One-third of of lower socio-economic status. Minority health care providers in those counties, Brewer women and rural women are much more found, did not have the vaccine. They also likely to die of cervical cancer than other learned that people who identified themselves women, a fact they both find unacceptable. as born-again Christians were half as likely to “In America, there’s no excuse for anyone get their daughters vaccinated. “We may need dying of cervical cancer,” Brewer says. “This to think of them as a risk group, and a group is a cancer we can conquer.” n we need to reach out to,” Brewer says. – By Sylvia Adcock

More information: • HPV Vaccine Project: www.hpvvaccineproject.org • American Cancer Society: www.cancer.org (choose “cervical cancer” under the cancer topic option) • National Cancer Institute cervical cancer home page: www.cancer.gov/cancerinfo/types/cervical

carolina public health | 29 SURVIVABILITY

Researchers can mine new health registry for wealth of data

a kastlemana orth Carolinians can help make scientific d Nhistory and advance cancer research by hoto by lin by hoto

P enrolling in the groundbreaking new UNC Health Registry funded by the University Cancer Research Fund. In doing so, they’ll be part of a whole new research effort aimed at determining how best to treat and support those with cancer.

There are a lot of things that physicians still Carolinians who come to UNC for cancer don’t know about cancer, a category that evaluation and care. encompasses a wide range of diseases with “The Registry is a chance for researchers to different causes and treatments. They would learn about ways to improve treatment out- like to know why some patients respond comes as well as the quality of life of cancer to therapies better than others, why cer- patients and their families,” says Jeannette Dr. Jeannette Bensen tain individuals experience debilitating side T. Bensen, PhD, research assistant professor effects from treatment while others don’t, of epidemiology at the UNC Gillings School why there are ethnic disparities in cancer of Global Public Health and Lineberger outcomes, and how cancer treatment affects Comprehensive Cancer Center member. She a patient’s quality of life over time. is leading the project, along with an interdis- The UNC Health Registry is a far-reaching ciplinary group of investigators. initiative that aims to answer these questions. Bensen says she hopes that patients will The project will advance cancer research, understand the importance of their partici- prevention, treatment and care, and also pation in this initiative because the questions seeks to reduce health disparities among it can answer will help change the course of North Carolinians. The study will enroll cancer care. 10,000 English- and Spanish-speaking North The Registry will create an integrated record of clinical information, biological specimens and questionnaire data that This resource will give researchers includes safeguards to protect patient privacy. Additionally, those patients with a cancer the potential for groundbreaking work in diagnosis enrolled in the Registry will be followed annually and will comprise a unique the field of cancer research. part of the Registry known as the UNC Cancer – UNC Research Assistant Professor Jeannette Bensen Survivorship Cohort. Bensen says UNC’s

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To participate in the Health Registry, The key to patients must: • Be 18 years or older patient advocacy: • Have a North Carolina address and resourcefulness • Have an appointment in a UNC Hospital (e.g., the N.C. Cancer or N.C. ner Women’s Hospital). d ul F om T public health, medical and other schools hoto by have for decades contributed “excellent P population-based cancer research spanning North Carolina counties, especially in the middle and eastern areas of the state. The new study will be even more comprehensive.” The integrated nature of the project – one of very few being done on such a large scale – will link health outcomes and quality of life to sophisticated genetic analysis that can help doctors better understand how and why patients respond differently to the same treat- ment, how to better manage treatments to avoid side effects, how to better manage cancer after the initial round of therapy is over and how to address long-term health concerns of cancer survivors. Another unique aspect is the Dr. Jo Anne Earp, left, makes a point during a class she teaches with colleague and fellow ability to contact patients for future studies. patient advocacy expert, Elizabeth French. They co-authored the book Patient Advocacy for This will allow patients and their families to Health Care Quality. choose to be involved in exciting new studies that advance the science of cancer prevention, early detection and therapy. ong gone are the days when a seriously ill “This Registry complements UNC’s rich patient had just one doctor, likely one who had research history by adding a hospital-based L cohort that can be used to ask different known her for most of her life. Today, patients with questions and assemble yet another important set of information centered on a patient’s a serious diagnosis enter a medical world filled with clinical care and quality of life,” Bensen adds. “UNC is one of only a few centers in the specialists, advanced technology and mountains of nation to establish an integrated registry and information on the Internet. cancer survivorship cohort such as this. This resource will give researchers the potential “People have to navigate really complicated academic affairs in the Department of Health for groundbreaking work in the field of health systems today, especially when coping Behavior and Health Education at the UNC cancer research.” n with a complicated illness like cancer,” says Gillings School of Global Public Health. “It – By Kim Gazella Elizabeth French, MA, associate director of requires huge amounts of resourcefulness.”8

carolina public health | 31 SURVIVABILITY

ten and oral communication more relevant and understandable. “The advocates really serve as our eyes and In addition to pushing for more research, ears, and play an important role in making epidemiological research more responsive to cancer advocates have helped improve the way the needs of the communities,” he says, cit- ing the Carolina Breast Cancer Study as an care is delivered. Patients and families are example. That study focuses on the causes of breast cancer in African-American women. more involved in decision-making. The community advisory group helped cre- – Elizabeth French ate a statewide, comprehensive resource directory about breast cancer diagnosis, treatment and support around the state, and also developed a Web site for the study. Being well informed is one thing. Actu- holds annual weeklong educational programs Whether an advocate is reminding a ally advocating for yourself or a loved one to train breast cancer advocates in basic provider that her patient is allergic to a is all together something else. And figuring science, epidemiology and clinical medicine. particular kind of medication, pushing for out how to access the latest treatment, push Courses also are offered on how to lobby for redesigned hospital rooms, insisting on a for safer health care or even learn the ter- improved health care. Robert Millikan, PhD, different course of treatment, or lobbying minology for your disease can be exercises DVM, Barbara Sorenson Hulka Distinguished Congress for a new federal law, the goal is in frustration. Professor of epidemiology, has served as an the same: greater dignity, safety, access and “Patients who are newly diagnosed with instructor in the program since 1994. empowerment for the patient and better a serious illness like cancer are scared, vul- Millikan says that advocates can provide communication between patients and their nerable and often disoriented, and this is the insights into different cultures and contrib- health care providers. n time they also need to pretty quickly learn ute to the success of studies by making writ- – By Kim Gazella the ropes of complex medical processes that may also feel dehumanizing,” says French. “But there’s good news, too. In addition to pushing for more research, cancer advo- Advocacy Tips cates have helped improve the way care is 1. Establish a relationship with a primary care provider. This is the delivered. Patients and families are more provider who knows you over time and knows what “normal involved in decision-making. Patients often health” means for you. sit on family councils that help hospitals set 2. Speak up with concerns about your condition. Tell your doctor policy on how care is delivered, so they have about your symptoms, and ask for explanations. Don’t be afraid to an influence that way, too.” ask questions! French and Jo Anne Earp, ScD, profes- sor and chair of the Department of Health 3. Educate yourself. Go online to learn more about your illness, but be sure to confirm information with your doctor or other Behavior and Health Education, teach a reputable sources. graduate level course on patient advocacy. They define patient advocacy as “the wide 4. Ask a family member or close friend to serve as your advocate if range of interventions promoting patient- you are being admitted to the hospital. This person can report centeredness, patient safety and patient voice symptoms, communicate your needs, check your medications and serve as a troubleshooter. in the health care system.” As Earp and French note in their book, Resources Patient Advocacy for Health Care Quality (pub- lished by Jones and Bartlett in 2007), a patient • Patient Advocate Foundation: www.patientadvocate.org advocate can be the patient, a friend or family • Institute for Family-Centered Care: www.familycenteredcare.org member, a palliative care provider (such as hos- pice) or an activist organization that agitates for • National Long-term Care Ombudsman Program (will assess social change and legislative action. and improve situations related to long-term care facilities): One prominent advocacy organization is www.ltcombudsman.org the National Breast Cancer Coalition, which

32 | FALL 2009 ALUMNI

Alumni apply UNC training to “real world” problems at National Cancer Institute

hen Deborah Winn, PhD, began her public W health graduate studies in epidemiology, she had not yet identified a research area that inspired her.

“I was a graduate student shopping around for in which we measure and report data,” says a dissertation topic,” says the 1980 University Brenda K. Edwards, PhD, associate direc-

of North Carolina at Chapel Hill alumna. tor of the Surveillance Research Program NCI When leading cancer epidemiologists at within DCCPS and 1975 graduate of the the National Cancer Institute told Winn School’s biostatistics department. arshman, about a “huge pocket of high mortality rates Edwards’ program collects and analyzes H

from oral cancer in the southeastern United data about cancer incidence rate, prevalence, erri T States, especially among women,” she was survival rate, treatment methods, risk fac- intrigued enough to pursue the problem. tors, screening exams and other measurable hoto by Finding a significant association between factors. “We try to figure out who gets can- P smokeless tobacco and oral cancer, Winn’s cer and what happens to them,” she says. UNC public health alumni (left to right) Drs. Brenda Edwards, Deborah Winn dissertation led to product labeling of smoke- Eric J. “Rocky” Feuer, PhD, chief of the and Eric “Rocky” Feuer less tobacco products and put her on the path Statistical Research and Applications Branch to becoming one of the nation’s top cancer of the Surveillance Research Program and epidemiologists. also a biostatistics alumnus (1983), says the One of the challenges Edwards’ program Now deputy director of the Division of approach his professors took in analyzing faces is finding strong researchers like Feuer. Cancer Control and Population Sciences data laid the foundation for his own desire to “We were trained at UNC in an applied arena,” (DCCPS) at NCI, Winn works to direct fund- make the presentation and analysis of popu- she states, “and it’s hard to find individuals ing and initiatives to the most promising lation-based cancer statistics more rigorous, with interdisciplinary experience and with an areas of research. more interesting and less confusing – so that interest in both statistical methods and applica- “Understanding cancer epidemiology it can make a difference in setting national tions. Our strongest people can apply what they helps me figure out where the research gaps priorities for the control of cancer. know to real-world, messy problems.” are and where the research community needs “The emphasis was on developing meth- “The real world is broad and messy. It to go,” Winn says. “It also gives me a frame- ods that are intuitive and help clearly bring changes rapidly due to social, political and work to help move new findings about can- out the essence of what the data are trying to economic influences,” adds Barbara K. Rimer, cer risk factors to the next step – to inform tell us,” says Feuer. DrPH, dean of the School and first director intervention research to reduce the burden His branch supports the use of simulation of the DCCPS. “Whether developing cancer of cancer in populations.” modeling – synthesizing information over initiatives or measuring and reporting data She and two of her colleagues in the divi- the course of someone’s entire life. in innovative ways, these three alumni are sion credit their education at UNC’s Gillings “We help paint a quantitative picture, char- doing exemplary work in leading advances School of Global Public Health with giving acterize the issue and articulate it to policy in the control of cancer at the national and them the tools they need to make an impact makers,” Edwards says. For example, when global levels. We are proud that they represent on cancer-control planning in the United the data showed a decline in breast cancer our School. Each of them has not only made States and around the world. mortality rates in the 1990s, the program’s important scientific contributions, they also “Because of my training in the Depart- model showed that about half of the decline have fostered major research and proactive ment of Biostatistics, we bring advanced and was due to mammography, other early detec- innovations at the national level.” n sophisticated statistical techniques to the way tion protocols and effective treatment. – By Chris Perry

carolina public health | 33 RESEARCH/studying causes

u n c g i l l i n g s s c h o o l o f g l o b a l p u b l i c h e a l t h SCHOOL NEWS

For more information on these topics and other news, please see www.sph.unc.edu/news_events. New weight gain Practicing what we teach guidelines established for pregnant women with pandemic influenza

Ne w g u i d e l i n e s f o r h o w m u c h w e i g h t a woman should gain during pregnancy have been established by a national team of physi- cians and health care professionals, including Anna Maria Siega-Riz, PhD, UNC epidemi- ology and nutrition professor and associate chair of the Department of Epidemiology. Siega-Riz was one of four team members who presented the new guidelines at a news confer- ence May 28, 2009, at the National Press Club in Washington, D.C. astleman

“This work has K a a important implica- d tions for the lives of L in women, given that in hoto by by hoto

any one year, approx- P imately four million WakeMed chief executive officer Bill Atkinson (right) and emergency responders demonstrate women give birth,” the medical center’s preparedness van to Bill Gentry (in blue shirt), health policy and Siega-Riz says. management faculty member and director of the Community Preparedness and Disaster The team, estab- Management program at the UNC Gillings School of Global Public Health. Dr. Anna Maria Siega-Riz lished by the Institute of Medicine and the Pr e pa r e d n e s s is a c r i t i c a l a r e a o f o u r School’s interdisciplinary expertise. The global National Research Council, updated recom- public health crisis sparked by the H1N1 flu pandemic tested the depth and breadth of the mendations the Institute of Medicine made in School’s many programs and its training and response capabilities. 1990. The new guidelines reflect changing U.S. “The results of our response have confirmed for us the durability and effectiveness of our demographics, particularly the surge in the planning,” says Bill Gentry, director of the School’s Community Preparedness and Disaster number of Americans who are overweight or Management program and health policy and management lecturer. obese. Healthy American women at a normal “We were able to put more than three years of planning into practice,” adds Pia MacDonald, weight for their height should gain 25 to 35 PhD, director of the North Carolina Center for Public Health Preparedness (NCCPHP) and pounds during pregnancy, the guidelines state. research assistant professor of epidemiology. Underweight women should gain more, 28 to Our School worked closely with the UNC School of Medicine, UNC Hospitals, local health 40 pounds, and overweight women should gain departments and, especially, the N.C. Division of Health and Human Services to ensure that less, 15 to 25 pounds. These ranges match the health care providers, public officials and the general public were aware of H1N1 symptoms, 1990 guidelines, but the report also specifies how to avoid spreading the virus, how to contain and treat suspected or confirmed cases and a new range for obese women (BMI greater how to plan for treatment in case of exposure. Our experts were quoted in print, broadcast and than 30) which limits the recommended gain Web news stories across the state and nation. n between 11 and 20 pounds. n For more information, see www.sph.unc.edu.

34 | FALL 2009 school news

USAID awards $8.5 Studies examine genetic role in obesity, million to water and hypertension and early onset of puberty sanitation project in Ge n e s p l a y a r o l e in determining w h o Southeast Asia is obese, has hypertension or goes through puberty earlier than peers, according to three Th e U.S. Ag e n c y f o r International studies published recently by researchers in Development (USAID) awarded up to $8.5 the School’s epidemiology department. million to WaterSHED (Water, Sanitation Nora Franceschini, MD, MPH, research and Hygiene Enterprise Development) – a assistant professor of epidemiology, and Kari E. joint effort of UNC’s Gillings School of North, PhD, associate professor of epidemiol- Global Public Health, Kenan-Flagler Busi- ogy, were lead authors of a report published in Dr. Nora Franceschini Dr. Kari North ness School and the Kenan Institute-Asia. the journal Circulation: Cardiovascular Genet- associated with menorrhea,” Franceschini Mark Sobsey, PhD, Kenan Distinguished ics that shows how cigarette smoking, alcohol says. “There is also some evidence that the Professor of environmental sciences and consumption and exercise level can modify the age of menarche is associated with breast engineering, is the principal investigator. effects of genes on risk of hypertension. cancer and stroke.” She says the genes found Researchers identify sustainable ways to The study examined the average effect of to influence puberty in girls seem to be rel- increase the use of ceramic or biosand water multiple genes tied to hypertension risk and evant to boys, too, but their study was not filters in homes that lack clean drinking showed that behaviors can influence the extended to boys. water, to help reduce diarrhea and related effects of genes on blood pressure. The study Another study, published June 25, 2009, in diseases that kill nearly two million children was funded by grants from the National the journal PLoS Genetics, identified a novel a year worldwide. They also investigate ways Heart, Lung and Blood Institute, part of the link between genes and waist circumference to achieve financially sustainable, scaled- National Institutes of Health. Franceschini and BMI. up access to safe water sources, such as is supported by a grant from the American “Because central abdominal fat has been harvested rainwater; improved sanitation, Heart Association. shown to be a strong risk factor for diabetes including latrines; and greater practice of Franceschini also was one of the leading and cardiovascular disease – a major health personal hygiene, especially hand washing authors for a study published in the June concern around the world – we searched for with soap. issue of Nature Genetics, identifying an genes that might predispose people to a larger The award grew out of the Carolina Global association between genes and age at first waist circumference,” says North. “Finding Water Partnership, one of the first Gillings menstruation (menarche), height and pos- genetic associations with waist circumfer- Innovation Laboratories funded through a sibly body mass index (BMI). ence may help scientists better understand $50 million gift to the public health school “Our findings could trigger new research why some people may be more susceptible to from Dennis and Joan Gillings. n about human growth factors and diseases obesity and cardiovascular disease.” n

UNC injury research center receives $4.8 million award from CDC

Th e UNC In j u r y Pr e v e n t i o n Re s e a r c h Ce n t e r h a s and recreational activities, at work and in the home environment. The received $4.8 million in renewed funding from the National Cen- center also has a strong national focus on professional education. ter for Injury Prevention and Control at the Centers for Disease “We are pleased to work with many partners in the state and Control and Prevention. throughout the world in reducing the enormous public health burden The UNC center is one of 11 Injury Control and Research of injuries – a preventable problem that is responsible for more years of Centers (ICRC) addressing injury prevention in the U.S. life lost and higher medical care expenses than any other health prob- With the help of the grant, the center will add projects on dating lem,” says center director Carol Runyan, PhD. Runyan is also a profes- violence, domestic violence, knee injuries among athletes, safety on sor of health behavior and health education and an adjunct professor college campuses and falls among older adults. The studies add to an of epidemiology in the UNC Gillings School of Global Public Health array of ongoing projects addressing violence, and injuries in sports and a professor of pediatrics in the UNC School of Medicine. n Information about other grants available at www.sph.unc.edu.

carolina public health | 35 school news

Getting more “health,” UNC study: new approach promises greater success for predicting drug safety less “sickness” into marriage vows Ad v e r s e r e a c t i o n s t o d r u g s are one of the leading causes of death in the United States. However, there may be a way to predict which people are most likely to suffer a toxic Pe n n y Go r d o n -La r s e n , PhD, a s s o c i a t e side effect from a drug before they have even taken it. A study published in the online journal professor of nutrition, and Natalie The, nutri- Genome Research (May 4, 2009) describes a more effective and less costly method for testing tion doctoral student, drugs for potential toxicity. The method also could result in more people benefiting from found that newlyweds existing drugs, says senior author David Threadgill, PhD, professor of genetics in the UNC are more than twice School of Medicine and head of the genetics department at North Carolina State Univer- as likely to become sity. Ivan Rusyn, MD, PhD, associate professor of environmental sciences and engineering obese than are people in the UNC Gillings School of Global Public Health, is a study co-author. The National in romantic relation- Institutes of Health funded the research. n ships who are not liv- ing together. Women living with a romantic partner have a 63 per- Dr. Penny Gordon- HPM students’ research contributes Larsen cent increased risk of to Mississippi legislation obesity. The findings were published online and in the July issue of the journal Obesity. A t e a m o f UNC h e a l t h p o l i c y a n d State Board of Health. In April 2009, the According to Gordon-Larsen, when peo- management graduate students helped con- board mandated that all Mississippi com- ple are living together – married or not vince the Mississippi state legislature to munities with populations over 2,000 add – they tend to share behaviors and activity require communities around the state to fluoride to their water supplies. patterns. For instance, they may cook big- fluoridate their water. The students include Later in April, Hammersmith and Kranz ger meals together or eat out more often Lauren Brown, Kim Hammersmith, DDS, took the team’s findings to the National Oral than when they were single, and may watch Ashley Kranz, Presha Patel and Bhav Shukla, Health Conference in Portland, Ore., where TV together instead of going to the gym or as well as Nick Mosca, Mississippi State Hammersmith made a poster presentation playing a sport. Dental Director and student in the School’s to dentists and dental directors from around “If this is a time of shifting behaviors and of distance education DrPH program. the country. influencing each other, then maybe it’s a good As part of a course on health care in the “This project was a great example of stu- time to intervene with these young couples U.S., students were assigned a state and dent activity being an important part of a and get them to have a more positive effect on a broad topic area – in this case, “dental real-world public health benefit,” says Edward each other,” Gordon-Larsen says. “Maybe they health.” Mosca asked the students to conduct “Ned” Brooks, PhD, who taught the course. can exercise together or cook healthy meals research on water fluoridation and other Findings were published in the May together. Couples can use that phenomenon states’ mandates on the process. Last fall, he 2009 Journal of the Mississippi State Medical (of shared behaviors) to their advantage if shared their findings with the Mississippi Association. n they’re aware of what’s going on.” n

Minority health videoconference focused on of Education International and past president educational inequities and health disparities of the National Education Association; Dina C. Castro, PhD, scientist at UNC’s Frank Th e 15t h a n n u a l Summer Public Health Research Videoconfer- Porter Graham Child Development Institute; ence on Minority Health was broadcast live online on June 9, 2009. Nicholas Freudenberg, DrPH, distinguished The event, “Breaking the Cycle: Investigating the Intersection of professor and director of the doctor of public Educational Inequities and Health Disparities,” featured Howard Lee, health program in the Program in Urban Pub- MSW, executive director of the N.C. Education Cabinet, past chair Howard Lee lic Health, Hunter College School of Health of the N.C. Board of Education and former mayor of Chapel Hill, Sciences, City University of New York; and Lillian A. Sparks, JD, N.C., as moderator. Panelists were Reginald Weaver, vice president executive director of the National Indian Education Association. n

36 | FALL 2009 u n c g i l l i n g s s c h o o l o f g l o b a l p u b l i c h e a l t h AWA R DS & RecognitionS

Details of these and other awards are available at www.sph.unc.edu/school/recognitions.

FACULTY STUDENTS spring 2009. Rositch Halpern receives Faculty Award for UNC Nutrition students dominate awards left this summer Excellence in Doctoral Mentoring at major national conference to live in Nairobi, Carolyn Halpern, Kenya, for a year. PhD, associate She is contributing professor of maternal to a study focusing and child health at on human papil- the UNC Gillings lomavirus, cervical School of Global precancerous lesions Anne Rositch Public Health, and HIV transmis- received the UNC sion. Under the auspices of The University of Washington at Seattle and The Univer- Dr. Carolyn Halpern Graduate School’s Scott Ickes Meghan Slining Faculty Award for sity of Nairobi, Rositch conducts research Excellence in Doctoral Mentoring at the Six students in the UNC Gillings School ancillary to a study led by Jennifer Smith, 2009 doctoral hooding ceremony on May 9. of Global Public Health’s Department of PhD, UNC research associate professor of Nutrition were awarded prestigious fellow- epidemiology and Rositch’s mentor. Cai awarded Fellow status by Institute of ships and prizes at the 2009 Experimental Sonia selected by Delta Omega to present Mathematical Statistics Biology Conference at APHA in November Jianwen Cai, PhD, in New Orleans professor of biosta- April 18-22. Jessica Michelle Sonia, 2009 tistics in the UNC Ellis, Scott Ickes, graduate of the Mas- Gillings School Nicole Schwerbrock ter of Science in Pub- of Global Public (May 2009 gradu- lic Health program Health, was selected ate), Megan Slining, in health policy and as one of this year’s Ya Wen Teng and management, will 17 Institute of Math- Natalie The won present her research Natalie The on early detection of Dr. Jianwen Cai ematical Statistics half of the doctoral (IMS) Fellows. She student awards and were finalists for other breast cancer at the Michelle Sonia and other honorees were recognized at prizes presented by the American Society 137th annual Ameri- the IMS Presidential Address and Awards of Nutrition (ASN). can Public Health Association (APHA) session at the Joint Statistical Meetings on meeting, Nov. 7-11, 2009, in Philadelphia, Rositch selected as Fogarty Scholar Aug. 3 in Washington, D.C. Pa. She is one of 19 students from across Anne E. Rositch, epidemiology doctoral the U.S. selected for the honor by The Delta student, was selected as a Fogarty Inter- Omega Honorary Society in Public Health. national Clinical Research Scholar in The APHA poster session, scheduled for 8

carolina public health | 37 AWARDS & RECOGNITION

Nov. 9, will showcase student scholarship to community service as demonstrated and research in accredited schools and pro- through scientific leadership, public grams of public health. education, or community outreach.

STAFF Mande named USDA’s Deputy Under Secretary for Food Safety Robeson receives School’s Staff Excellence Award Jerold R. Mande was named Deputy Under Secretary for Food Safety at Sue Robeson, student the U.S. Department of Agriculture services specialist (USDA) in July 2009. In this position, for the Public Health he is responsible for the Food Safety and Leadership Program Inspection Service, the USDA agency (PHLP), received the that ensures the nation’s supply of meat, UNC Gillings School poultry and processed egg products are of Global Public safe and wholesome. Mande received a Health’s 2009 Staff Master of Public Health degree in nutri- Excellence Award. Sue Robeson tion in 1983 from the UNC Gillings Her friends and School of Global Public Health. Most co-workers at the School attended a recep- recently, Mande served as associate tion in her honor on July 31 in the Michael director for policy at the Yale Cancer Gary White (red shirt) and Matt Damon (right) Hooker Research Center atrium. Center at the Yale University School of Medi- created Water.org. cine. He also served as Senior Advisor and ALUMNI boost for the organization and will bring in- Executive Assistant to the Commissioner of ternational visibility to the issue, White says. Peters receives Presidential award for the Food and Drug Administration, where he WaterPartners International and H2O early-career scientists led design of the Nutrition Facts food label, Africa merged, resulting in the new orga- Ulrike (Riki) Peters, PhD, associate member for which he received the Presidential Award nization, Water.org, which will keep its of the Fred Hutchinson Cancer Research for Design Excellence. headquarters in Kansas City. Center in Seattle, Wash., was named by Damon joins UNC alumnus White to President Obama in July as one of 100 recipi- DEPARTMENTS ents of the Presidential Early Career Awards form Water.org for Scientists and Engineers. This is the Actor Matt Damon has joined forces with ESE tied for 9th place in U.S. News and highest honor bestowed by the U.S. govern- UNC alumnus Gary White and WaterPart- World Report rankings ment on young professionals in early stages ners International to create a new organiza- The UNC Gillings School of Global Public of their independent research careers. Peters tion, Water.org. Health’s Department of Environmental is a 1999 alumna of the UNC Gillings School White founded WaterPartners with Sciences and Engi- of Global Public Health’s Master of Public Marla Smith-Nilson in 1990 while both neering is one of the Health program in epidemiology. Winning were earning master’s degrees in the nation’s best environ- scientists and engineers receive up to a five- School’s Department of Environmental ment/environmental year research grant to further their study Sciences and Engineering. The non-profit health programs, ac- in support of critical government missions. agency helps communities in South Asia, cording to U.S. News Peters’ grant is from the National Institutes Central America and Africa gain access to and World Report. of Health. She will join other recipients at safe water and sanitation through grants The magazine ranks and micro-credit financing. Damon is co- the best graduate a White House ceremony in fall 2009. The Dr. Mike Aitken awards, established by President Clinton in founder of the H2O Africa Foundation, a programs each year. February 1996, are coordinated by the Office nonprofit that sought to help African com- The School’s environmental sciences and of Science and Technology Policy within the munities gain access to safe water. engineering department ranks among the Executive Office of the President. Awardees Having Damon – whose films include top engineering schools in the nation peren- are selected on the basis of two criteria: pur- “Good Will Hunting,” the Bourne tril- nially, even though UNC Chapel Hill does suit of innovative research at the frontiers of ogy and “The Talented Mr. Ripley” – as an not have an engineering school. Michael D. science and technology and a commitment ambassador and advocate for the cause is a Aitken, PhD, chairs the department.

38 | FALL 2009 Honor roll of Donors

“ Your gifts are investments, And we thank you for every one of them. The return on your investment will be far more than the gratitude of public health researchers, teachers and students, though you will have that in abundance. Your return will be your gift’s impact—discoveries made, students trained, publications made possible, clinics sup- ported, lives touched and the public’s health transformed. You will know that your gift—your investment—has made a difference in the protection of the world’s health and America’s future.” – D e a n B a r b a r a k . R i m e r

Gillings School of Global Public Health Honor Roll july 1, 2008 – june 30, 2009 of Donors

$1,000,000+ Fred Hutchinson Cancer $50,000 to University of Minnesota Jackson Medical Mall Research Center Vanderbilt University Foundation Anonymous GlaxoSmithKline $99,999 Medical Center Kraft Foods, Inc. Rhode Island Hospital Donald & Jennifer Alaska Native Tribal Health Wits Health Consortium McDonald’s Corporation Robert Wood Johnson Holzworth Consortium Otsuka Maryland Medicinal Foundation John Rex Endowment American Egg Board $25,000 to Laboratories, Inc. Kate B. Reynolds Charitable American Heart $49,999 Sharon Hill Price $100,000 to Trust Association, Mid-Atlantic Sanofi-aventis $999,999 King Abdullah University of Affiliate, Inc. Anonymous (2) Schwarz BioSciences, Inc. Balchem Corporation Anonymous (5) Science & Technology Amgen Inc. Smith, Anderson, Blount, Blue Cross Blue Shield The Alfred P. Sloan Merck & Co., Inc. Gail & Ralph Cassell Dorsett, Mitchell & of North Carolina Foundation Merck Company Dorothy Fay Dunn* Jernigan, L.L.P. Foundation American Diabetes Foundation Exxon Mobil Corporation Southwest Foundation for Boston Medical Center Association Pennsylvania State The Formaldehyde Council, Biomedical Research Brigham and Women’s American Heart Association University Inc. Tufts University Hospital American Institute for Research Triangle Institute Golden Leaf Foundation University of Georgia TM Canadian Institute for Cancer Research Robbins-de Beaumont LIVESTRONG University of Virginia Advanced Research Association of Schools of Foundation Makhteshim-Agan of North Wake Forest University Children’s Hospital of Public Health Susan G. Komen Breast America, Inc. School of Medicine Philadelphia Centers for Disease Control Cancer Foundation NARSAD Derek & Louise Winstanly The Coca-Cola Company Foundation Triangle Community Novartis Animal Health Inc. Dauer Family Foundation Centre for Research in Foundation Novartis Pharmaceuticals $10,000 to Allison Dauer Family Health University of Nevada, Reno Corporation Edward & Joanne Dauer $24,999 The COPD Foundation University of Texas at Open Society Institute Gen-Probe, Inc. Anonymous (2) The Duke Endowment Houston Pfizer, Inc. Inspire Pharmaceuticals, Adolor Corporation Duke University University of Washington University of California, Inc. Astellas Pharma US, Inc. Elizabeth Glaser Pediatric Water Research Foundation San Francisco AIDS Foundation University of Massachusetts

carolina public health | 39 opportunities to invest

Expendable gifts save the day

nderwater – an ominous word when applied the School. All had seen U to towns – or endowments. This winter, in the values fall. All responded midst of student admissions, the School found itself generously with out-of- with several scholarships and one professorship “un- pocket support when they derwater.” This is a situation in which market declines learned their scholarships cause the value of an endowment to dip below its could not be awarded contributed value. When it occurs, the scholarship in 2009-2010. The Holz- or professorship typically cannot be awarded, unless worths even established excess income has accumulated over time. an entirely new endowed Enter the School’s heroes. Kelly Browning, ex- scholarship – their third – ecutive vice president of the American Institute for with an expendable com- Cancer Research (AICR) and former president of the ponent to permit it to Public Health Foundation Board of Directors, worked be awarded immediately. with AICR President Marilyn Gentry and the AICR “We knew that endow- Board of Directors to secure an additional $25,000 ment returns were suffer- to cover the Carla Smith Chamblee Distinguished ing and, when it became Kelly Browning Professorship held by celebrated nutrition expert clear that the School Barry Popkin, PhD. might lose extraordinary “Professors Barry Popkin, June Stevens and Steve students who could one day become world-class Zeisel were critical contributors when AICR was pro- public health practitioners, we felt that we had to ducing its landmark reports on nutrition and cancer. step up and make a difference,” said Don. The UNC Gillings School of Global Public Health “It has been inspiring to see the way our friends has some of the most brilliant nutrition faculty in the have responded,” said Peggy Glenn, associate dean world, and the AICR was pleased to come to the res- for external affairs. “Eddie and Joanne Dauer and cue when Dr. Popkin’s professorship was underwater,” Gary and Carolyn Koch pioneered expendable schol- said Browning. For copies of the AICR’s acclaimed re- arships for us last year, and the various ways of struc- ports see www.dietandcancerreport.org. turing scholarships are making such a difference for Other heroes included Deniese Chaney, Don and our students. Even though endowments are now re- Jennifer Holzworth, and Derek and Louise Winstanly. covering, Annual Fund and expendable scholarships All had recently established endowed scholarships at will remain an important part of our mix.” n

AstraZeneca Kellogg Company Theratechnologies Inc. $5,000 to $9,999 Elizabeth E. Mumm* Pharmaceuticals – U.S. Koppaka Family Foundation Theravance, Inc. Barry Michael Popkin Anonymous Boston University Lantibio, Inc. ThromboGenics William & Michele Sollecito Sheryl Wallin Abrahams John V. Calipari Diane E. Medcalf University of Kentucky Paula B. & Gregory W. H. Michael & Barbara Campbell Soup Company Momentum Research Research Foundation Stafford Arrighi CV Therapeutics, Inc. Mount Sinai School of University of Connecticut The Tellus Educational Sterling Wilson Bell Deshpande Foundation Medicine University of Texas at Foundation Deniese May Chaney Dr. Pepper/Seven Up, Inc. Mpex Pharmaceuticals, Inc. Austin Lydia Lansangan Tiosejo Leah McCall Devlin The Duke Energy National Water Research University of Wisconsin in honor of Norman Leroy Charles Doughty Foundation Institute – Madison Weatherly Cynthia Johnson Girman Nancy Ann Dreyer Nestlé S.A. U.S. Environmental Mark Trustin & Marcia Peggy & Cam Glenn Florida State University James Edward Nix Protection Agency Angle Sandra Winn Green Forest Laboratories, Inc. Onyx Pharmaceuticals, Inc. Vesta Therapeutics, Inc. David Marc Turner Nancy Logan Haigwood Genentech, Inc. Reckitt Benckiser Washington University in The U.S. Charitable Gift Esther Maria John Sandra Bartholomew Barbara K. Rimer & Bernard St. Louis Trust Miriam Labbok Greene Glassman Thomas K. Wong & Susanne Jack Eugene Wilson March of Dimes North Geraldine G. Guess Pranab Kumar Sen G. Moulton Carolina Chapter Jewish Community Sigma-Tau Pharmaceuticals, XenoPort, Inc. Stephen Allen Morse Foundation of MetroWest NJ Inc.

40 | FALL 2009 Honor roll of Donors

$2,000 to $4,999 Fidelity Charitable Gift Fund Northwestern University State Employees’ Combined Kathleen D. Barboriak Michael & Andrea Griffin Charlotte & Miguel Nuñez- Campaign Frank & Harriet Barr Anonymous (3) C. David & Lucy S. Wolff Joel & Donna Storrow James Joseph Barry III Michael Aitken & Betsy Hardison Douglas Martin Owen Lori Anne Todd S. Mae Beale Rudolph David & Karen Harper John Edward Paul John Chester Triplett in honor of Arthur L. David Ballard & Michela Paula Billingsley Harrison George Pink & Peggy Leatt Charles & Shirley Weiss Smith Caruso HDR Engineering, Inc. David & Julie Potenziani Alice Dickey White Deborah Bender & John in memory of Harry Guess Barbara S. Hulka Alan & Linda Rimer Paul & Janet Wiles Curry Bergen County United Way Joan Cornoni Huntley James & Jennifer Rosen Ronald & Ann Wooten Margaret E. Bentley Fred & Laura Brown James Donald Kinard John Spotswood Russell Chen-Yu Yen Mark Dean Beuhler Edward Carroll Bryant Charles Wayne Kinsey Patricia D. Saddier Steven & Susan Zeisel Michael N. Boyd Ching Kuang Chen Emil J. Klingenfus Jessie Satia Philip & Marina Braswell Kourtney Johnston Davis Gary G. & Carolyn J. Koch in honor of Benedict and $1,000 to $1,999 Julie McClure Chandler Howard J. Dunn Mazie Jones Levenson Philomena Satia Stacy-Ann Christian Harold F. Elkin William Brian Arbuckle Hong Li Anna Pittman & James Dennis A. Clements III & Susan Tompkins Ennett Robert Glenn Arnold Grazyna Janic Lieberman Simpson Schenck IV Martha Ann Keels Sara Anne Ephross Association of North Julie MacMillan Susan Willey & Allen Spalt Terri Ann Colangelo MaryAnn Cross Farthing Carolina Boards of Health Felicia E. Mebane Edward L. Baker Ralph & Joann Cook

It comes down to good people

ichael Arrighi has been an epidemiologist for M nearly 30 years, from Los Angeles to Saudi Ara- bia to Research Triangle Park, N.C. He’s now living in California, working as senior director of epidemiology rrighi

for Elan Pharmaceuticals, Inc., and loves the career A he’s chosen. “Michael is passionate about epidemiology,” said ichael M ichael Barbara Arrighi, his wife of seven years, “and I know a lot of that comes from UNC.” hoto by by hoto

Michael Arrighi earned his doctorate in epidemiol- P ogy from the University of North Carolina’s School of Michael and Barbara Arrighi Public Health in 1992. He had gotten his master’s de- gree in public health from the University of California pledged to endow a scholarship for an epidemiology at Los Angeles in 1980, then took a job as a research student and have included a bequest to the School assistant at the University of Arkansas at Little Rock. in their will. There, he worked with an outstanding alumna of UNC’s “Michael and Barbara’s gift is extraordinary in School of Public Health, Dr. Carol J.R. Hogue. that it addresses the short-term needs of the school “Carol was very influential in my decision to come for unrestricted support, makes a pledge to create to Chapel Hill for my doctorate,” he said. an endowed fund that will mature in the near future He also was drawn by the strength of UNC’s faculty – and creates a repository for a portion of their es- people like the late Harry Guess, PhD, who started the tate so that their legacy will endure in perpetuity,” School’s pharmacoepidemiology program, and Victor said Andy Olshan, PhD, chair of the Department of Schoenbach, PhD, associate professor of epidemiol- Epidemiology. ogy and member of UNC’s Lineberger Comprehensive “A lot of times people think the state supports state Cancer Center. schools and they don’t need additional support,” “It comes down to good people,” Arrighi said. “UNC Michael Arrighi said. “We’ve been fortunate enough has had the best – and continues to have them.” to be able to give back to the School in the short term The Arrighis regularly support the Department and long term. We certainly encourage all graduates of Epidemiology with generous gifts, and now have to support the department and the School.” n

carolina public health | 41 opportunities to invest

Louise and Derek Winstanly: Education is at the heart of progress in public health

In their native country, Derek worked closely with the Medical University of South Africa (MEDUNSA), now part of the University of Lim- popo, one of the first universities in the country to educate black South Africans as physicians. He recognized the need for public health education and training to halt the advance of HIV/AIDS and other infectious diseases in the local communities and the world at large. “Apartheid had a marginalizing effect on education,” Louise says. “Derek and I see education as a keystone for society – the more educated one is, the more likely he or she is to make a difference.” Louise and Derek Winstanly That is why the couple has established The Winstanly Scholarship, funding given at the erek and Louise Winstanly have lived in the dean’s discretion to a deserving graduate student D United States for only four years, but already in public health. they have made a powerful mark as supporters of “We identify with Dean Rimer’s vision and with public health initiatives in North Carolina. Among the School’s mission,” Louise says. “We recognize other activities, Louise is a member of the University the imminent need for funding the best and most of North Carolina at Chapel Hill Institutional Review deserving students – which is why we wanted to give Board (IRB) and the UNC Hospital Ethics Com- – but we also don’t want to be overly prescriptive. mittee, navigating patient protections and other The School’s leaders know where student funding health issues. Both are members of the Acceleration is most needed, and we wanted to allow them the Advisory Committee at the UNC Gillings School of freedom to allocate it.” Global Public Health, guiding the progress of fund- This fall, the 2009 Winstanly Scholar, Virginia ing for innovative public health research. Senkomago of Uganda, will begin the doctoral pro- The South African couple has lived around the gram in epidemiology at UNC. Virginia, who holds world – including the United Kingdom and Japan – an undergraduate degree in chemistry from Berea and everywhere they travel, Derek, a medical doctor College (Berea, Ky.) and a Master of Public Health who has been involved in drug research for 25 years from Yale, currently is working in South Africa in an and is now an executive at Quintiles Transnational HIV/AIDS program sponsored by the private-sector Corp., and Louise, an attorney with a Master of Sci- charitable organization, Africare. ence degree in bioethics, find ways to make global The Winstanlys are confident that Virginia’s con- health local. tributions to public health will be a great return on “Health is definitely a global issue,” Louise says. their investment in her education. n “We’ve seen that through the wide and rapid impact – By Linda Kastleman of the H1N1 virus. The global effects of such a threat are obvious, but we must recognize what is going on at the local level, too, so that outcomes are guided by strong ethical principles.”

42 | FALL 2009 Honor roll of Donors

David Erwin Cooper Fred & Alice Stanback Carol & Pedro Cuatrecasas David Pierce Steffen Georgia G. dela Cruz June Stevens Chester W. Douglass Sarah Lynn Strunk School to focus Shelley & Jo Anne Earp Mary Charles Suther Dan Elliott & Jeanne Stahl John Henry Sweitzer Kenneth LeRoy Eudy, Jr. Michael C. Tarwater on building in honor of Julie Mary S. Thompson MacMillan Russell Barner Toal scholarship pool Edwin B. Fisher Bobbi Wallace Lyne Gamble & Kathryn Dianne Stanton Ward ach spring, schools of public health compete vigorously to Yandell G. Robert Weedon attract the best, most diverse student body. Carolina does Leslie Ann Gura Mark W. & Stacey M. Yusko E well – most of the School’s top candidates accepted our offers. Richard Robert Hammel Haibo Zhou & Jianwen Cai Suzanne Havala Hobbs “There were, of course, students we wanted who chose to go Donald Hoover $500 to $999 elsewhere,” said Dean Barbara K. Rimer. Many students need Deborah Parham Hopson Anonymous financial support, but what is available is often not enough. Joseph G. Ibrahim American Legacy “When the most promising students choose to go elsewhere, Peter Bert Imrey Foundation we often learn that a competing institution offered a bigger Mary Ellen James Eileen Danielle Barrett scholarship or support over a longer period of time, or were Mabel Smith Johansson Gordon Berry able to tell students sooner that support is available,” she said. Lynn Koss Knauff William Cudd Blackwelder “Often, they can tell the applicants sooner and can commit for Michael & Pamela Kosorok Michael Austin Boyd longer periods of time. We must expand our pool of scholarships Sheila Leatherman David Wayne Campbell Danyu Lin Georgia Hobbins Campbell before the spring (of 2010) so that we can compete head-to-head Douglas Seward Lloyd Shine Chang with any offer. This is especially true if we are going to compete A. Dennis McBride Chick-fil-A for the most promising minority and under-represented students. James & Mary Merchant Deborah Lee Covington We must be able to do this. It is the right thing to do, and it is a Mark Hamilton Merrill Amy E. Cunningham matter of maintaining our competitive edge.” Bill & Susan Milner Carol Jane Dabbs Over the next six months, the School will embark on a focused The Minneapolis Julia DeClerque effort to obtain a minimum of 30 new scholarships. These will in- Foundation in memory of Earl Siegel Mona Marie Moon Keith Allen Demke clude scholarships created by gifts to the Annual Fund; endowed Alan Coningsby Moore Michael James Dziamba and expendable scholarships established by individuals, families Hugh Holt Morrison George Roy Elmore Jr. and organizations; and internships with scholarship components Keith Eldon Muller Tom & Jenifer Faulkner funded by corporations. Dara Lee Murphy Angela Frizzell If you would like to discuss options to establish a scholarship Jeanenne Little Nelson Lynda Goldberg in your name or the name of a loved one, please contact Peggy North Carolina Priscilla Alden Guild Glenn at [email protected] or 919 966-0198. Biotechnology Center Ellen Diane Habermacher Jeffrey Oberhaus & Brent Susan Lee Hartmaier What could be more important than training the next gen- Wishart David Lee Hlavac eration of public health leaders? Together we really can make a James P. O’Connell Omar Hopkins & Teresa world of difference. n Andrew Olshan & Linda Savarino Levitch Sallie Craig Huber Leonard Oppenheimer Jonathan V. James Anne Townsend Overman Nathaniel H. James Thomas Cleveland James & Bonnie Yankaskas Jay Michael Bernhardt Herbert Peterson Julian & Barbara Keil Ricketts III Brian A. Zaks Lynn W. Blanchard David Edward Pinsky Michael & Marilyn Knowles Joan Siefert Rose Jason Zaks Meg Marie Booth Roy R. Piscitello & Rebecca Kenneth Scott Ladrach Douglas Schaubel & Yun Li William N. Zelman Douglas Donaldson S. King Donald & Marie Lauria Michael Gerard Schell Bradham James K. Polk Sheri Johnson Lawrence Chuan-Feng Shih & $250 to $499 S. Scott Brown Roy Joseph Ramthun Cynthia Madden Yi-Wen Ma Anonymous James Paul Bulman in memory of Lonnie David Nicholas McNelis Robert E. Silverman Omid & Julie Ahdieh Cabarrus Economic Ramthun Sarah Taylor Morrow William Thomas Small Jr. John Anton & Renee Development Corporation R. Gary & Jeanette C. Rozier Timothy James Mukoda Ellison & Electa Smith Schwalberg Joseph D. Carson James K. Schaefer Mary Margaret H. Mundt Sally C. Stearns Kenneth Ray Argo Robert & Helen Clawson Christopher Roman Schulz Richard Jay Osborne David S. Strogatz & Nikita Arya Mary Foster Cox Jacqueline van der Horst Franco Piazza & Regina Rosalind P. Thomas Stephen Charles Ayala Katherine Elizabeth Sergent Rabinovich David & Jeanie Taylor Terry & Stacey Barnhardt Crosson Gladys Siegel John Stephen Preisser Jr. Richard & Vanessa Thorsten Sheri Ruth Bates Carolyn Elinor Crump Tom E. Smith Raymond James Charitable Fredrick Seymour Whaley Douglas Alan Bell Ronald Gerard Davis Steven & Sylvia Snapinn Endowment Fund Deborah Anne Wheeler Elaine Gantz Berman Clifford Earl Decker Jr.

carolina public health | 43 opportunities to invest

David Louis Dodson Winfred Gray Dodson Dole Food Company, Inc. Mohamed El-Khorazaty & Rosenau Society Amelia Horne Laurel Ann Files July 1, 2008–June 30, 2009 David Bernard Fischer Membership Donald L. Fox Arthur J. Gallagher Th e Ro s e n a u So c i e t y is n a m e d in h o n o r o f Mi l t o n J. Ro s e n a u , t h e f i r s t Stuart & Karen Gansky d e a n o f t h e Sc h o o l o f Pu b l i c He a l t h . Me m b e r s h i p in t h e Ro s e n a u So c i e t y Jerry Gray Gentry is l i m i t e d t o b e n e f a c t o r s m a k i n g a m i n i m u m unrestricted c o n tr i b u t i o n o f Nancy O’Pry Gentry William A. Goolsby $1000+ t o e i t h e r t h e UNC Gi l l i n g s Sc h o o l o f Gl o b a l Pu b l i c He a l t h o r Kerry Brent Hafner o n e o f i t s d e p a rt m e n t s . Me m b e r s h i p m u s t b e r e n e w e d o n a n a n n u a l b a s i s . Paige Elizabeth Heaphy- Crowell Richard John Heggen President’s Circle Charlotte & Miguel Nuñez-Wolff Leslie Ann Gura Gerardo & Jo Eaddy Heiss ($5,000-$25,000) Douglas M. Owen Richard Robert Hammel Karin Janet Hemmingsen George Pink & Peggy Leatt Suzanne Havala Hobbs Margaret Gates Hirsch Marcia Angle & Mark Trustin David Bruce Holstein Sterling W. Bell Barry Popkin Deborah Parham Hopson David & Julie Potenziani Joseph G. Ibrahim Karen Werner House Leroy Charles Doughty Heinz U. Hueper Peggy & Cam Glenn James & Jennifer Rosen Peter Bert Imrey John Spotswood Russell Michael & Pamela Kosorok Theodore & Susan Johnson Nancy Logan Haigwood Baxter Lee Jones Anna Pittman & James Simpson Miriam Labbok Donald & Jennifer Holzworth Thomas V. Jones Schenck IV Sheila Leatherman Esther Maria John Beverly K. Jordan Susan Willey & Allen Spalt Danyu Lin Diane E. Medcalf Linda Marie Kaste Joel & Donna Storrow Douglas S. Lloyd Barbara K. Rimer & Bernard in memory of Lester W. Lee Lori Anne Todd A. Dennis McBride Glassman Neely Kaydos-Daniels John Chester Triplett Mark H. Merrill William A. & Michele A. Sollecito Michelle Crozier Kegler Paula B. & Gregory W. Stafford Charles & Shirley Weiss Bill & Susan Milner James George Kerr Lydia Lansangan Tiosejo Alice D. White Mona Marie Moon Thomas Keyserling & Alice in honor of Norman Weatherly Paul & Janet Wiles Hugh Holt Morrison Ammerman Derek & Louise Winstanly Ronald & Ann Wooten Dara Lee Murphy J. David Kirby Steven & Susan Zeisel Jeanenne Little Nelson John & Judy Klaas Chancellor’s Circle Jeffrey Oberhaus & Brent Wishart Dean’s Circle Amy Lansky Knowlton ($2,000-$4,999) James P. O’Connell Kenneth & Mary Lou Koury ($1,000-$1,999) Andrew Olshan & Linda Levitch H. Michael & Barbara Arrighi Anne Monica Lachiewicz Anne Townsend Overman David Ballard & Michela Caruso Michael D. Aitken & Betsy Jennifer Elston Lafata John E. Paul in honor of Harry Guess Rudolph Gregory Phillip Lathan Herbert B. Peterson Fred & Laura Brown Edward L. Baker Peter Lauria & Kathleen David Edward Pinsky Edward Carroll Bryant Kathleen D. Barboriak Sheehan James K. Polk Kourtney Johnston Davis S. Mae Beale Desmond Frederick Lawler Roy Ramthun Leah McCall Devlin in honor of Arthur L. Smith David Ernest Layland in memory of Lonnie Ramthun Harold Elkin Deborah Bender & John Curry David Stephen Legarth Patricia D. Saddier Marcia Joanne Levenstein Susan T. Ennett Peggy Bentley Jacqueline van der Horst Sergent Robert Carroll Lippard Sara Anne Ephross Jianwen Cai & Haibo Zhou Steven & Sylvia Snapinn Donald Daniel Lisnerski Mike & Andrea Griffin Deniese May Chaney Fred & Alice Stanback Susan Simmons MacLean C. David & Lucy S. Hardison Ching Kuang Chen David Pierce Steffen Norman Angus MacLeod David & Karen Harper Dennis A. Clements III & Martha June Stevens Kannan Mahadevan Paula Billingsley Harrison Ann Keels Sarah Lynn Strunk Craig Stephen Maughan Barbara S. Hulka Terri Ann Colangelo Mary Charles Suther Richard Paul McCoy Joan Cornoni Huntley Ralph R. & Joann C. Cook Michael & Ann Tarwater William Sheffield McCoy James D. Kinard David E. Cooper Russell Barner Toal Barbara Mei Charles Wayne Kinsey Carol & Pedro Cuatrecasas Bobbi Wallace Gary John Mihlan Gary G. & Carolyn J. Koch Jo Anne & Shelley Earp Dianne Stanton Ward Wilbur & Virginia Milhous Hong Li Kenneth L. Eudy, Jr. in honor of Julie MacMillan G. Robert Weedon William Clarence Miller Felicia Mebane Beverly Nieman Mirman Edwin B. Fisher Mark W. & Stacey M. Yusko Susanne Glen Moulton & Thomas Carlon Virgina Jackson Lyne Gamble & Kathryn Yandell K. Wong Mitchell Sandra Winn Green Philip Keith Mitchell

44 | FALL 2009 Honor roll of Donors

Karthik Sundaram: I like to think I’ve helped a little

arthik Sundaram is a Renaissance man. He plays mother, Cheri Sun- K violin and piano and has performed in Vienna daram, after Karthik with the Duke Chapel Choir (www.chapel.duke.edu/ performed with the choir). He is an athlete – partial to swimming, ten- Choir School at UNC’s nis and crew – and a philanthropist, most recently Memorial Hall. spearheading a campaign with his sister to purchase Karthik wanted to books for orphaned children in India. return his part of the He is also a scholar, despite the fact that he never choir’s honorarium attended college. to UNC, his mother Well, at least he hasn’t yet. At 14, Karthik is still explained. As they busy mastering ninth grade. talked about where Karthik Sundaram Sundaram’s resume is astounding for someone the donation could be twice his age, reflecting his prodigious talents and put to the best use, training in vocal performance. He’s an alumnus Karthik kept in mind that his dad (Dr. Senthil Sun- of St. Thomas Choir School in Manhattan (www. daram, a Raleigh, N.C., cardiologist) is a 2000 alum- choirschool.org) and the youngest-ever member of nus of UNC’s Public Health Leadership Program. the famed Duke Choir. “Karthik continues to hear about all the great One doesn’t have to talk to him long, however, to things accomplished by the school of public health learn that this modest young man has a heart even from his father and colleagues,” Cheri Sundaram bigger than his magnificent voice. wrote, and he concluded that he wanted the School Staff members at the UNC Gillings School of to be beneficiary of his $125 gift. Global Public Health were deeply moved recently Karthik has traveled several times with his family when they received a letter from Karthik and his (including sister Arya, 11) to Sivasailam, in the state of Tamilnadu, India, where the family takes on numerous He has traveled extensively and seen projects to benefit children in a local orphanage. “I’ve seen people my age who are very poor and who need a lot of help to be healthy and happy,” he situations in person most teens have never seen says. “They don’t have money or parents to watch out for them. The kind of work my dad’s school does can or may have only discussed in the abstract. really make a difference in their lives, so I like to think I’ve helped a little by sharing the honorarium.” n – Cheri Sundaram, Karthik’s mother – By Linda Kastleman

Hal Morgenstern Margo Lynn Quiriconi Jo Anna Stephens Kimberly Dawn Simpson Gloria Ann Absher Janet Mullaney Martha Jean Reddout James Stipe Tum Suden Daniel & Kathryn Ahlport Patricia Louise Murphy Mark Graham Rodin Maura Ellen Stokes William J. Tyroler Barbara Vineyard Alexander Mary Anne Murray Ruth Rothman Susan E. Strunk Margaret Emily Weydert Jean Elizabeth Alexander Jacob Alan Neufeld William Anthony Rutala Jane Stanfield Stutts Deborah Marie Winn Jose Leonel Alfaro Raymond Joseph Nierstedt SAAPHI James Arthur Swenberg Mary Elizabeth Worstell F. Christopher Alley Donald & Mary Oberlin Susan Marie Sanders Robert Charles Sykes Beverly Ann Young Gert Altmann Timothy Wade Okabayashi Patricia Gail Schnitzer J. Chi-Chung Tang Keri Allman Young John J. B. Anderson David Leonard Parks Victor & Marion Eugene Emerson Taylor Terry P. Anderson Graydon Pleasants & Schoenbach Steven Michael Teutsch $100 to $249 Marijke Lee Annis Margaret Scales Ruth Ann Shults Julie Poh Thurlow Anonymous (6) Matthew Joseph Arduino Lewis William Pollack Jason & Paige Smith Anh Nhat Tran Gill Bailey Abernathy Susan Houts Arnold Stephen Praissman Jonathan Carl Smith Joan Abernethy Richard Allan Aronson

carolina public health | 45 opportunities to invest

Sheena Atkinson Juan & Suzanne Carvajal Alan & Ellen Edmonds Elizabeth Fleming Hammett Kerry Anne Jeffords Annella Jean Auer Joan Canon Catignani Leah Bennett Edwards Rosanne Buckley Hanratty Dale Thomas Jobes David Bruce Babcock Edward Lee Cavenaugh Dolores Marie Eggers Jean Harris Hanson Elmer Marcus Johnson Patricia Michel Backus Linda M. Cecarelli Molly Margaret Eggleston Frank Eanes Harrell Jr. Judith Harris Johnson Mark Daniel Baker Anita Louise Chesney Edward P. Ehlinger Jane Coltrane Harrington Linda P. Johnson Richard D. Bailey Vernon & Jolene Chinchilli Lois A. Ejups Shirley Shell Harrington Morgan Lyn Johnson Sandor Alan Balogh Joan Christison-Lagay Brian K. Ellerby Anita Marie Harris A. Warren Jones Janine Lenore Barden- Dorothy Cilenti Sharon Ellen Epstein Russell Harris & Linda Rhondette Lenice Jones O’Fallon Nancy E. Clapp-Channing Patricia Allen Estes Kinsinger Robert L. Jones Mark & Suzette Bardill Jason Andrew Clapsaddle Lori Ann Turnbull Evarts Jana Harrison Wanda Kaye Jones C. W. Bartholomai Eloise Ann Clark R. Michael & Kimberly Eve J. Bruce Harstad Surendra Bhargav Joshi Alix Lovitz Baxter Kathryn Clark Beth Ann S. Everly Carolyn Cantlay Hart William & Mary Joyner Bruce Anthony Behringer Lawrence Michael Clark John Hume Faulkner Fletcher Lee Hartsell Jr. JustGive Bruce Raymond Belleville Michele Nicole Clark Paul Jay Feldblum Carl G. Hayes Lenni William Kangas Benjamin Bellows J. Steven & Catherine Cline Cynthia Hutton Ferrell Jeanne Lisle Haynes Adena Cohen Kaplan Jonathan Berg & Louise Ronald Harper Clitherow Luther L. Fincher Jr. in honor of Lindsey Haynes Onur Necip Karayal Henderson Cheryl Arthur Coble Amy Ellen Fine Gene Albert Heath Coyt M. Karriker John Franklin Bergner Jr. W. Gerald Cochran Terry Lynn Flanagan Sharon L. Heinrich Janis Gail Kaufman Christopher Douglas Robert Martin Coker Robert & Elizabeth Flewelling Carol Nichols Henes Sarah T. Kavanagh Bergsten Anne Smith Cole M. Holly Flood Paula Chojnacki Herald Dolores O’Brien Kearney Cecelia Potts Berkstresser Linda M. Combs Theresa McCarthy Flynn Marcia E. Herman-Giddens Douglas G. Kelling Susan D. Bernstein Hanna Neale Cooper Robert Harold Forbes Jr. John Malvern Higgins Jr. Sandra E. Kick Sheila S. Bethea Merry Ann Coppage Michele Robin Forman Clyde Higgs Ray Allen Killian Elizabeth Hardaway Janet Louise Cordell James Fitzgerald Fowler* Marion Highriter Donna Gayle King Birkenbeuel Francoise Marie Cornet Claude Earl Fox III Kerry Lynn Hilton Julie Marantette Kinnaird Taffey Louise Bisbee William Irvine Cowden Laurie Judith Fox Ruth Linder Hines Charles Walton Kirby III Michelle Jones Blackmon Michael Alexander Crabb III Nora Franceschini James Scott Hixson Kathy Knight Barry Allan Blick John Paul Creason Margaret A. Franckhauser Kenneth & Jeanne Hoffner Faison Green Knox Heidemarie W. Boas Katherine Anne Cretin Joyce E. Frederick Carol Rowland Hogue Keith Eric Kocher Stephen Bogdewic & Anthony & Rita Cromartie Barbara Freeze Chris Hoke & Elizabeth Helen Rosalie Kohler Elizabeth Lee John Landrum Cromer Alexandra Steiner French Andrews Lawrence David Kornreich David & Elise Bolda Thomas Lawrence Crowe Friends of Ecuador Nicholas M. Hollander Frances Koster Rebekah Sue Bowden E. Stewart Crumpler Patricia Natzke Gadow Audrey Hamlin Kevin & Denise Kreb Kristen Eastwood Bowers Nancy Bosworth Lois Avery Gaeta Hollingsworth Donald K. Krecker Erskine B. Bowles Crutchfield Joseph Anton Galanko Thomas Clemmer Holloway Matthew Walter Kreuter James H. Bowles Mara C. Cusker Gonzalez Robert Ernest Gandley William E. Holman N. Scott Kukshtel Joan Kirkham Boyd Nadine Marie Czoschke Lisa Armsrees Gillespie Richard H. Holmes Arnold Kuypers Jo Ellen Brandmeyer Kathleen Daly-Koziel Peter Gilmore W. Howard Holsenbeck Breana Goldman Lai Michelle Ruth Bressler Sallie Cornwell Darnell Evelyn Joyce Glass Elizabeth Coyner Holtzclaw Stephen & Peggy Lambert William Robert Brieger Harry K. Daugherty Edwin Allan Goering Beverly Diane Hooks John Eugene Lammers Louise Annette Brinton Michol Dawson Larry Martin Goldberg Martin Horowitz & Heidi Timothy & Roberta Lane Margaret Dodd Britton Peter McDonald Dawson Shelley Diane Golden Soumerai Wendy Gwirtzman Lane David Arnold Broaden Charles Gregory Dayvault Amira Elkodsi Goldsmith Cecelia Coughlin Horstman Lisa F. Langhaug Deborah Danzig Brodie Ryan G. Dayvault Nick Joseph Gonchoroff Mark B. Horton Michele Cherry Larson Duncan Brown & Jane Elliott Claude Victor Deal Jr. John Steven Goodnight George & Virginia Howard Bernard Guy LaRue Arthur Emil Bruestle Pamela France DeLargy Susan Cohen Gower Penelope Page Howards Jean Kantambu Latting Alfred Scales Bryant Carrie Anne Delcomyn G. Jay Graepel Embry Martin Howell Paul Thomas Lauria James Lawrence Bryant Gregory Vladimir deLissovoy C. Montrose Graham Jr. Jeffrey Alan Hughes Ava June Lay Wendy Sims Bryant Brian Andrew Dempsey Walter A. Graham Chia Mun Hui Ji-Hyun Lee Lynda Bryant-Comstock Beverly Priddy Derr Angel Evon Gray Charles Humble & Victoria Kelvin K. Lee George & Jennie Budd Juli J. Desjardins Greater New Orleans Freeman Kerry Lamont Lee Byron L. Bullard Robert & Brenda DeVellis Foundation Vernon Brock Hunt Soong Hyun Lee Elizabeth Doan Bushell Linda Webster Dicker David Allan Green Jack Earl Hutcherson Jr. Ann Hogan Leonard Victor Marcial Caceres Harley Dickson Michael Craig Griffiths Marshall L. Hyatt Steven & Barcey Levy Shirley Elizabeth Callahan Vincent Bernard DiFranco Margaret Kneale Groening Deborah Anne Hyland Geraldine Spitzer Lewis Jolynne Campbell Caroline Hoffman Dilworth Thomas Seth Grogan Jr. C. Christopher & Marion Susan Lieff Robert Frederick Campbell Rachael Lynn DiSantostefano Elizabeth Alexander Guthrie Idol Henry N. Lin Mark & Lisa Canada Michael & Wendy Phillip Everette Hagwood Hilary Louise Isacson Stacy Melvin Linick Daniel Jonathan Caplan Dougherty Tricia Hahn Alexander M. Jackson Anne Marie Lipscomb Susan Young Cares William K. Drane Joumana Khalil Haidar Michael Bradley Jacobs Everett Logue II & Claire Mercedes Renee Carnethon James A. Duff III Pamela Sue Haines W. Joe Jacumin Bourguet Rebecca Dinkel Carrel Charles Perry Dunbar Robert McCue Hall Mary Grenz Jalloh Vanna Lombardi-Gillies Sharon Cartier Erin Mary Dusch David Michael Hamby Carol Ruth James Jinnie Lowery

46 | FALL 2009 Honor roll of Donors

Jillian Casey says her interest in public health initially Annual Fund donations stems from experience working with HIV-positive chil- dren in Arusha, Tanzania. She used the $5,000 Annual directly aid students Fund award to return to Tanzania to work with orphans. “I am interested in community health efforts to reduce he UNC Gillings School of Global Public Health’s transmission and provide more effective therapies for T Annual Fund traditionally has been one of the most HIV in low-resource settings,” she says. popular ways to support the School and its public health initiatives. In 2009, for the first time, a portion of the fund Jonathan Crocker wants to study water treatment was designated specifically for scholarship assistance to technologies and infectious diseases so he can cre- outstanding student applicants. This fall, eight Annual ate positive changes through engineering projects Fund scholars – one from each academic department or throughout the world. He recently working in rural program – received a $5,000 award. The School’s leader- Ghana, and taught people there how to install a rain- ship is working to enlarge the amount of the award and water collection system. the number of students who will receive funding. Kristen Kenan is a fourth-year medical student, spe- This year’s scholars are: cializing in pediatrics, who is on leave from the Robert ✦ Christopher Bryant (Biostatistics) Wood Johnson Medical School at the University of Med- ✦ Jillian Casey (Health Behavior and Health Education) icine and Dentistry of New Jersey. She wants a Master ✦ Jonathan Crocker (Environmental Sciences and of Public Health degree, she says, “to expose myself to Engineering) a broader range of concepts, ideas and initiatives to ad- ✦ Christine Hunt (Health Policy and Management) dress the needs of my patients and community.” ✦ Kristen Kenan (Public Health Leadership Program) ✦ Carmen Maria Piernas Sanchez (Nutrition) Heidi M. Soeters wants to focus on the epidemiology of ✦ Heidi Soeters (Epidemiology) and interaction between tuberculosis (TB) and HIV/AIDS, ✦ Jacquetta Woods (Maternal and Child Health) particularly in Africa. She became interested in this (All are master’s students except Sanchez and Soeters, subject through working at the Division of TB Elimina- both working on doctorates.) tion at the Centers for Disease Control and Prevention For more information on all the scholars, visit in Atlanta. This scholarship “will enable me to pursue re- www.sph.unc.edu/annualfund. search opportunities and aid communities in areas most afflicted by these pathogens,” she says.

Jacquetta Woods’ interests include research- ing health disparities in minority pediatric and adolescent populations, including teen preg- nancy and STD transmission, childhood asthma, and racial disparities in infant mortality rates. “My passion for these specific populations is based largely on the fact that the health of children in a community subsequently determines the overall health of that community,” she says.

Clockwise from top left: Kristen Kenan, Jillian Casey, Carmen Maria Piernas Sanchez, Christine Hunt, Heidi Soeters, Jacquetta Woods and Jonathan Crocker. Christopher Bryant was not available for a photo.

carolina public health | 47 opportunities to invest

Margaret A. Lucking Aubrey Christie Nutter Marjorie Sue Rosenthal John Haywood Stanley B. Peyton Watson Erika Gantt Lumsden Alexa Obolensky Alton & Frances Ross Barbara Ellen Starrett Sharon Jean Wayne Patricia Ann Lusk Richard Davis Olin Deborah Renee Roy Gregg Martin Stave Christopher Lee Wearmouth Lorraine Leigh Lutton William Kevin O’Neil Jamie Pace Roycroft Scott Russell Stewart John Talmadge Weaver William Whiting Lyon Marie Sylvia O’Neill Eris Hamrick Russell Anne Nelson Stokley David Bruce Webster Jr. Juliana Meimei Ma Michael O’Reilly & Susan Russell Elizabeth Jane Stoller Patricia Suzanne Weggel Martha Rutledge Macon Kimberley Fox Marjorie Rose Sable Gregory Strayhorn Ganesa Rebecca Wegienka Kathryn Marley Magruder Kevin Wayne Orndorff Lynne Scott Safrit Karthik Sundaram Kathryn Wellman Khalil & Patricia Mancy Jane Therese Osterhaus Mark Hedrick Salley Tamaurus Jerome Sutton Alta Janelle Wells Lewis Harvey Margolis Bernice Green Otudeko Martha Jane Salyers David John Svendsgaard H. Bradley Wells Jr. Meera Tina Markanda Diane Overcash Thomas Sanctis Mark Edward Swanson Roland Willis Wentworth Brian Robert Marshall Karl M. Owen & Susan Kay Sara Moir Sarasua Kara Anne Taff Virginia Lindley Edwin Cochran Marshall M. Buchanan Dianne Sartiano Rodger Ladd Tatken Wereszynski Stephen Marshall & Anna Glenn Morris Palen Susan Mertz Saviteer Reid Tatum Laurence & Constance Waller Aishwarya Palwai Daniel Solomon Schechter Charles D. Taylor Jr. Wescott Christopher & Caroline Janice Ann Paris J. Austin & Gael Scheibel Francis Curtis Thayer Jr. Karen L. Westphal Martens Leland M. Park Jerald Scott Schindler Gene Dennis Therriault Jane Mandeville Wetsel Robert Martin Edith Ann Parker Amy Fox Schmitzer J. Carroll Thomas Elizabeth Anne Whelan Margaret Martin-Goldberg Nancy Jordan Parker Mark Schrader & Karen Joseph Wood Thompson Cheryl Lindsley Williams Theresa Ann Martino Ronald & Cora Parker Whichard Shirley Jean Thompson Edward Richard Williams Katherine Pieper Mason Zoe Henderson Parker Kellogg Jonathan Schwab Samuel Ridley Tipton Jr. Philip Carlton Williams Timothy Mastro Padmaja Patnaik David Seagraves Susan Baker Toal Janet Horsley Willis David Leon Matthews II W. Ward Patrick Kofi & Joyce Semenya John Eric Tobiason Richard Burton Wilson Lisa Renee Maxwell Nancy Casida Pattishall A. Glen Sherrill Paul & Alison Trinkoff David Winterle Colleen Anne McAuliffe Allen Patton Jr. Mohammad Hassan Sherzai Annie Wang Tu Robert Oakley Winters Margaret Ellen Floyd Garland Edward Pendergraph Robert James Shimp J. Allan & Jean Tucker Melvin Ray Witcher Jr. McCann Philip Eugene Penninger Starr Riddle Shive Mary Rose Weber Tully Leonard Leas Wood Leslie Jane McGeorge Jessie Valentine Pergrin Shoe Show, Inc. Lou Flippin Turner Robert & Linda Woolson Susan Lee McIntyre Susan Grant Phelps Aisha M. Shoman Emily Thomason Tyler Linda Kay Worman Evelyn J. McKee Ephraim Henry Phillippe III Valeria Denise Shropshire David Utterback & Mary Wayne Edward Wormsley Robert & Holly McLaughlin Pinehurst Geriatrics, P.A. Jimmie Blake Shuler McCutchen Robert Stanley Wright Katherine Kennedy McLeod Fred & Susan Poole Pam Cindy Silberman Deborah Lee Vacca Joy Wu Heather Frances McNamara Cedric W. Porter Jr. Linda Simoni-Wastila Lauren DeSanty Van Derveer Paul Byron Wyche Jr. Lynn McQueen Linda Simpson Potter Elizabeth Hamerschlag Sims William Alvin Van Wie II Jane Godwin Wydra Debra Fondario Medlin Ellen Johnson Preston Maria Small Edwin van Wijngaarden Jingzhen Yang Anne Ruth Meibohm Barbara Alison Prillaman Alan James Smith Patience Vanderbush & Feng Ye & Jean Pan Michelle Marie Mello Nancy Easter Proia Miles James Smith III Rosalie Dominik Thomas & Diane Yerg Barbara Michalak-Reilly Xiang Qin Miles James Smith Jr. David & Frances Vaughn Carl Nobuo Yoshizawa Melinda Barefoot Michelson Robert Martin Quillin Reginald Kent Smith Joel Ellison Vickers Martha Royster Young Charles & Barbara Milone Rose M. Quinto Leonard Smock Lamar G. Villere Rebecca Ann Young- Christine Lorraine Moe Brian Lee Ramaley Helen Easter Snow Bertold J. Voswinkel Marquardt David & Estelle Momrow Maura Smith Rampolla Douglas James Spegman Edward & Pat Wagner Leah Sophie Zanville Rose Wilcher Monahan Bobby & Carolyn Redding Gerald Eugene Speitel Jr. Robert Irving Wakeley Jun-Guo Zhao & Yu Lou Elizabeth Claire Montague Dennis Revicki & Mary C. Jean Spratt Charles Raymond Wakild Zhi Zhong Leslie A. Montana Lou Poe Valerie Lewis Stallings Bruce Davis Wallace Katherine Shelden Ziegler Joyce Hawkins Moore Shelley Rhudy Vera Hughes Stallings Ralph Gene Wallace Michael Alexander Zustra Karen Strazza Moore Barbara J. Richards Morris Fearin Stamm Susan Wall Wallin Patricia Gripka Moorman Russell Howard Richardson Michael Stangl & Rebecca Laurence Octavius Watkins *Deceased Victoria Stover Mordecai Brian D. F. Richmond Raymond Nancy Burrow Watkins Anna Chaiko Morrill Martha Cornwell Riddell John Lee Morris John Coulter Ridderhof Jennifer Leigh Mullendore Thomas Andrew Ridgik Gary William Murphy Christopher Rimer K. Darwin Murrell Mary C. Rinehart We have made every effort to ensure the accuracy of our Honor Roll lists. Kelly Elizabeth Ritrievi in honor of James Hendricks We regret any errors or omissions that may have occurred and ask that you Timothy Keith Myers Karen Tager Rivo Margaret Newell Nelson Meredith Graham Robb advise us of corrections needed by contacting Kembrie Greene at 919-966-3722 Catherine Barrett Malcolm Clive Roberts or [email protected]. Every gift is vitally important to the UNC Newhouser George L. Robinette Gillings School of Global Public Health and deeply appreciated. Sharon Nicholson-Harrell Larry Philip Robinson Xumin Nie & Ming Zhong Lois Collins Rohrer Richard Recher Nugent Anthony Terrell Rolan Julie Truax Nunez Jacky Ann Rosati

48 | FALL 2009 GlaxoSmithKline and the UNC Gillings School of Global Public Health

a shared goal

GlaxoSmithKline, one of the world’s leading pharmaceutical research companies and an established leader in oncology products, has long been a generous supporter of the UNC Gillings School of Global Public Health. We have a shared goal – to help people throughout the world live longer, healthier lives. The School is grateful for GSK’s support of many projects, including: F The UNC – GlaxoSmithKline Center of Excellence in Pharmacoepidemiology and Public Health. X The program on Ethnicity, Culture and Health Outcomes (ECHO), created to coordinate efforts to reduce health disparities in North Carolina and nationally. J The Minority Health Conference, conducted by the School’s Minority Student Caucus. P The GSK Global Health Program, which provides a formal way for UNC and Duke faculty and students to collaborate on research and training in global health issues (including the 15-501 Global Health Dinner Club). C This issue of Carolina Public Health magazine. (The University Cancer Research Fund also is a major sponsor.) Together, we can–and do–make a world of difference. Nonprofit organization US postage PAID permit #216 Chapel Hill, NC The u n i v e r s i t y of n o r t h c a r o l i n a at c h a p e l h i l l

CAMPUS BOX 7400 CHAPEL HILL, NC 27599-7400