2018-2019 Annual Report

2018-2019 HS-MACA Annual Report 1 The mission of Health Sciences Multicultural and Community Affairs is to promote as a recognized leader in the training and development of a multicultural health care workforce that serves to reduce health disparities in underserved and diverse communities through research, culturally proficient education, community interaction and engagements. •HS-MACA Mission Statement

2 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 3 Reflection The year 2018-2019 was a successful academic year for the department of Health Science-Multicultural and Community Affairs (HS-MACA). Our premier community outreach program, Center for Promoting Health and Health Equity- Racial and Ethnic Approaches to Community Health (CPHHE-REACH) concluded its funding from the Center for Disease Control (CDC) in September 2018. Because of Creighton University’s institution commitment, we continue to implement our sustainability plan for REACH by continuing to promote physical activities in the African American community in North West Omaha. HS-MACA also received a three million dollars ($3M) grant award from the Health Service Resource Administration (HRSA), a division of US Health and Human Service (HHS), to reestablish the Health Careers Opportunity Program (HCOP) at Creighton University. The objective of the HCOP program is to increase the number of underrepresented minorities in the health care professions of Dentistry, Medicine, Pharmacy and Health Professions and Nursing in the nation. Our Post-Baccalaureate Pre-Medical and Pre-Dental programs remain strong with a large percentage of our students matriculating into the health science professions of their choice. On behalf of the dedicated staff of HS-MACA, I want to thank all our constituents and advocates for their support. We remain committed to promoting diversity of our students, faculty and staff at Creighton University and we will continue to prepare all students for an increasingly diverse society and the world at large. This report details the successes of our programs in 2018-2019. “Intelligence plus character…..that is the goal of true education” Martin Luther King, Jr Thank you,

Sade Kosoko-Lasaki, MD, MSPH, MBA Associate Vice provost and Professor.

2019 HS-MACA Post-Bac Awards and Recognition Ceremony 4 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 5 HS-MACA Highlights 2017-2018 87 Since the year 2000, 77 Participants $175,000 Awarded funding for the Center for the operations of the Promoting Health and Since the year 2000, 146 students students have successfully Eighty Five Health Professionals and Health Equity (CPHHE) from LB692 Nebraska Tobacco Settlement. have successfully completed the completed the Post-Bac Pre- Community Members attend the 12th Post-Bac Pre-Medical Program. Dental Program. 96% of Post Annual Continuing Education Creighton 88% of Post-Bac graduates have Bac Dental graduates have Conference on Addressing Health Students 77Students 146 Celebrated the 14th year of COPC matriculated into Medical School matriculated into dental Disparities: Focus on Mental/Behavioral funding by supporting the following Health school. activities through the Community Students Oriented Primary Care Endowment: 16 $1.8 23 Common Ground sessions with Participated HS-MACA Million attendance of over 800, nine (9) research programs; Seven(7) scholarships to Medical students undergraduate students in NIH Endowment totaling $17,500, and eight (4) health (2000 - 2019) biomedical science research, disparities community public health Million Three (3) high-school students $3.07 weeks research for Medical students (2018 - 2023) 10 in community-based health In the Spring 2019, CPHHE 676Students Awarded by the Health Resources and Services partnered with the Creighton 11,000 disparities research, two Administration (HRSA) For the Health Careers University Office of Excellence Middle and High School Students (2) high-school students in Opportunity Program (HCOP). Its mission is to to provide the CHA program as a students exposed to Health- American Chemical Society SEED HS-MACA Pipeline Programs provide students from economically or educationally certificate program recognized Science Profession Careers biomedical research, three (3) have impacted over 11,000 disadvantaged backgrounds an opportunity to develop by Creighton University. The through the Focus on Health M1 Medical Students in COPC inaugural certified training students through Pipeline the skills needed to successfully compete for, enter, Professions program. 46,000 Health Disparities Research, and African Americans in Omaha Impacted and graduate from health professional school. cohort yielded 6 individuals Programs who completed the 10-week on chronic disease awareness through one (1) M4 Students in COPC certificate program. promotion of physical activities Longitudinal Health Disparities 6 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACAResearch Annual. Report 7 HS-MACA Post-Baccalaureate Class of 2019 RecruitmentRecruitment and and Retention Retention NAMME Recruitment for the 2019-2020 academic year began with recruitment at National Association of Medical Minority Educators Conference. The conference took place September 19th – 23rd in Miami, FL. At the Recruitment Fair on September 22nd, HS-MACA’s Recruitment and Retention Manager met with prospective students from Florida International University (FIU). Twelve (12) students expressed interest in Creighton University. Contact cards were completed for follow up requesting information about our health sciences programs in medicine and dentistry as well as the post-baccalaureate program and MCAT prep.

Louisiana State University (LSU) On October 17, 2018, LSU hosted a Professional Graduate Fair. HS-MACA’s Recruitment and Retention Manager attended with a representative from Creighton University’s School of Pharmacy and Health Professions. Eighteen (18) students expressed interest in a number of health care professions to include: Occupational and Physical Therapy, Pharmacy, Physicians Assistant, dental school and medical school.

Dillard University Graduate Fair October 18, 2018, the Recruitment and Retention Manager attended the Graduate and Professional Fair at Dillard University, a historically black college in New Orleans, LA. The Recruitment and Retention Manager met with sophomores, juniors and seniors who expressed interests in the health sciences. Approximately twenty-five (25) students completed contact cards for follow up. Contact was also made with Dillard University faculty and staff that expressed interest in class presentations utilizing software applications.

Xavier University On Friday, October 19, 2018 the Recruitment and Retention Manager visited the campus of Xavier University of Louisiana, a historically black college, recognized as a national leader in the sciences. Twenty (20) students were engaged. Students expressed interest in the Post-Baccalaureate Programs, Physician Assistant Program, MCAT/DAT prep, and summer research programs. Contact cards were submitted for follow up and further information.

Atlanta University Consortium (AUC) The Recruitment and Retention Manager attended Atlanta University Consortium (AUC) held at Clark Atlanta University to recruit students from Morehouse College, Spelman and Clark Atlanta University. The AUC was held on Wednesday, October 24th, 2018. Twenty-one (21) students, ranging from freshman to senior provided their contact information for follow up.

Black Doctoral Network th Recruitment efforts in the year 2018 resulted in the dissemination of information to students with an interest in Creighton’s Health Sciences On Saturday, October 27 , 2018, the Recruitment and Retention Manager attended the Black Doctoral Network’s Annual Conference in Charlotte, NC. The Schools and programs for 2019-2020 academic year. In addition to providing information about the schools of medicine, dentistry, pharmacy Black Doctoral Network (BDN) is an organization for individuals of African descent who are holders of, or scholars engaged in the pursuit of, undergraduate and advanced degrees from accredited institutions of higher learning worldwide. This year yielded contact with four (4) students, however, the networking was and health professions and the physicians assistant program, information was also disseminated about HS-MACA’s Post-Baccalaureate invaluable. Programs, Summer Research Institute, Health Careers Opportunity Program (HCOP) and Mini Health Sciences’ School/Day Camp. 8 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 9 Med-Mar 2018 - 2019 Recruitment Tracking The Medical Minority Applicant Registry (Med-Mar), was created by AAMC to enhance admission opportunities for groups historically underrepresented in medicine. Med-MAR serves as a means of identifying and communicating the availability of applicants from groups who self-identify as underrepresented in medicine and/or as economically disadvantaged. The program's registry distributes basic biographical information about the applicant and their MCAT exam scores to minority affairs and admission offices of AAMC-member schools and certain health-related agencies interested in increasing opportunities for students participating in the program. Access to the Med-Mar registry allowed HS-MACA to disseminate information to 1,893 prospective students eligible for enrollment School/ Total # of Student into the Post-Baccalaureate Pre-Medical Program for the 2019-2020 academic year. Date of Event Location Conference Interactions 11 Post-Bac Pre-Med Star September 22, NAMME Miami, FL 12 Pre-Med Star is a new online recruitment strategy and tool that helps medical schools and programs recruit students by making the recruitment process easier, 2018 October 17, efficient and concise. As a hub for diversity Pre-Med Star helps to increase the depth of recruitment for Creighton University health sciences programs. LSU New Orleans, LA 18 Medical 2018 23 October 18, Recruitment efforts in 2018 resulted in HS-MACA receiving 115 applications from students seeking admittance into Creighton University’s Post- Baccalaureate Pre- Dillard University New Orleans, LA 25 52 Medical and Pre-Dental Programs for the 2019-2020 academic year. 2018 October 19, Dental Xavier University New Orleans, LA 20 2018 Atlanta University October 24, 0 Atlanta, GA 21 Consortium 2018 7 Nursing Black Doctoral October 27, Charlotte, NC 2 Network 2018 Pharm/OT/PT

34 Other (Physicians Assistant etc.)

HS-MACA Post-Baccalaureate Dental Class of 2019 10 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 11 Application and interest into Creighton University’s Health Sciences Schools and the Post-Baccalaureate Programs can be attributed to our academic success, word of Mini Health Sciences School mouth advertising, campus visits, and health science fairs. Recruitment activities have been essential in the development and building of institutional relationships To promote Science, Technology, Engineering, and Mathematics, (STEM) to and securing applications for our Pipeline Programs. students in grade school to high school, HS-MACA collaborates with Creighton University’s Health Sciences Schools to conduct the Mini Health Sciences Summer Research Institute School and Day Camp. Activities include: panel discussions with healthcare The Summer Research Institute supported by HS-MACA and CPHHE includes the Undergraduate Biomedical Research Program, High School Community Research professionals, dissections, hospital tours, simulation labs, interactive hands- Program, and Project SEED which is funded by the American Chemical Society (ACS). In order to ensure a large applicant pool for both programs information was on experimental projects and in class learning. To successful conduct a mini disseminated to several schools and organizations to include: , , Omaha Northwest High School, Central High day camp, it is important to enlist the support of Creighton University health School, Benson High School and its Health Career Academy, Brownell Talbott, Mt. Michael Benectine, University of Nebraska at Omaha, University of Nebraska sciences schools and departments as well as local schools and organizations Medical Center and Metropolitan Community College. The Creighton University community included MHSSA, SNMA, MAPS, Creighton Intercultural Center, like McMillan Magnet Center, St. Augustine Indian Mission School, Jesuit Creighton EDGE, Student Support Services, Project CURA, TRIO/Upward Bound, Ignatian College Connection, Medical Spanish Club, African Students Association and Academy, Partnership 4 Kids, NOAH Clinic and Creighton Preparatory School. HCOP students. Hope Center for Kids, Urban League of Nebraska, Youth For Greater Good, Partnership4Kids and 100 Black Men of Omaha were also encouraged to promote the programs to their student populations. The Summer Research Institute was advertised through The American Association of Medical Colleges (AAMC) Conclusion/Future Directives weekly announcements and via social media outlets like Facebook. In 2018/2019 we received sixty-five (65) Undergraduate Biomedical Research Applications and a HS-MACA continues to develop relationships with students, universities, pre- combined twenty-five (25) application inquiries for the High School Community Research and SEED Programs. health advisors, faculty/staff and administrators, and the community in order to bring awareness to our efforts to bridge the achievement gap by addressing Health Careers Opportunity Program (HCOP) health disparities in education, community, research, and scholarship. The Pipeline to Success Health Careers Opportunity Program (HCOP) is a federally funded grant that provides students from economically or educationally However, with the implementation of new programs and a shift in operating disadvantaged backgrounds an opportunity to develop the skills needed to successfully compete for, enter, and graduate from health professional schools. After practices, we are looking forward to new and innovative strategies to increase receipt of the grant in August 2018, recruitment immediately began for the Fall, Spring and Summer Ambassador Programs. Information was disseminated to a awareness and participation in our programs. number of schools in Nebraska and surrounding areas, community organizations and within Creighton University community. As a result a total of 36 students were recruited and enrolled into the 2018-2019 Ambassadors Program. HS-MACA plans to focus on innovative ways to increase recruitment efforts Health Careers Opportunity Program (HCOP) Distribution List for the 2020-2021 academic year by: (1) continuing to work in collaboration with Creighton’s Health Science Schools (School of Medicine, School of Dentistry, School of Pharmacy and Health Professions, and College of Nursing), (2) participating in more professional recruitment fairs (local, virtual), (3) introducing new marketing strategies and content (4) using technology to track and identify the total number of prospective students that have applied, interviewed and accepted an offer to Creighton University, the Post- Baccalaureate /Pre-Matriculation Programs or any health sciences programs in future recruiting reports (5) expanding community and Pipeline Programming in area schools and organizations within the local communities we represent and (4) enhancing our relationships with other health sciences schools and minority serving institutions with a focus on diversity. HS-MACA Post-Bac Graduates Matthew Ogbeide and Angel Ogbeide 12 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 13 Health Science Retention Activities HS-MACA Scholarship Recipients Mentoring •Assignment of an individual tutor paid for by HS-MACA. The HS-MACA mentoring program continues to grow and benefit students, This year, HS-MACA provide one hundred eighty eight (188) hours of Dr. John T. Elder Post- HS-MACA Post-Baccalaureate Drs. Gbolahan & Sade Lasaki faculty, and staff at Creighton University. The mentoring program is promoted supplemental peer tutoring to Post-Baccalaureate and Pre-Matriculation Baccalaureate Award Family Award throughout the university and its larger community. The Mentoring program students to 12 Post-Bac Students. In the 2018 – 2019 academic year, we trained Alumni Scholarship provides, both formal and informal, opportunities for counseling and twenty-three (23) students as Creighton Medical Students (M2) students as support, making it possible for the students to succeed in their academic and tutors and eight-hundred (800) Creighton Medical Students (M1) students professional careers. attended supplemental instruction sessions. • Open Door: During the academic year, the program director, Dr. Kosoko-La- saki mentored an average of five (5) current and prospective students per Learning Lab week. This translates to one hundred and one (101) students in the aca- HS-MACA continued the operations of the learning laboratory for the 2018- demic year. In addition, she also had a one-hour mentoring class per month 2019 academic school year as an extension of the Academic Success course and for all fifteen (15) Post-Baccalaureate and Pre-Matriculation students. to enhance the existing tutoring program. Under the guidance of the Assistant • Post-Baccalaureate/Pre-matriculation: All fifteen (15) students were Director of Academic Enrichment, fifteen (15) Post-Baccalaureate students Johnny Atenci Albert Cohen-Sedgh Shaneese Longboy assigned individual mentors from the upper class of the medical and dental and three (3) of the SPAHP Pre-Matriculation students received over seventy schools. In addition, the students participated in three formal mentoring (70) hours of Learning Lab experience to improve learning strategies in course gatherings during the academic year. An external guest speaker was content as follows: cooperative learning, content experts to provide guidance, invited to the mentoring event. MCAT/DAT preparation and review, and group tutoring. • The HS-MACA mentoring program worked with over eighty (80) students Elizabeth England Daniel Paku from high school through professional school. Three group sessions Bianca Luna Creighton School of Medicine, M3 Post-Bac Pre-Medical offered students guidance on how to develop successful mentor/mentee Post-Bac Pre Dental relationships.

Tutoring HS-MACA offers a tutoring program for students who need extra assistance Anny Nguyen Geraldine Manansala Alex Sasaki in the Post-Baccalaureate classes, in dental and medical schools, and in the After Dr. John T. Elder died in November 1996, In the 2017-2018 academic year Post-Baccalaureate Alumni The Drs. Gbolahan and Sade Lasaki Family Award “pipeline” programs. Other health professions students are provided individual one of his former students, Thomas Collins, MD, Scholarship was established by HS-MACA Post-Bac alumni. was established in 2008. This award is for $1,000 tutoring as needed. Students are referred by HS-MACA coordinators for tutoring FRCS, a surgeon in Boston, donated funds to start Scholarship are awarded too current Post-Baccalaureate per student for two students in the current in subject areas of biology, chemistry, physics, or math. The following services an endowment in Dr. Elder’s name. Proceeds students based on their financial need. In the 2018-2019 Post-Baccalaureate students who are the most are offered: from the endowment have been awarded to Academic Year six (6) Post-Bac students were awarded improved on the Pre and post Medical and Dental a current medical Post-Baccalaureate alumni scholarship money. The students are Johnny Atencio, Albert (MCAT and DAT) admission test scores. For 2017- •Individual meeting with instructor for additional assistance student. The one-time scholarship was awarded Cohen-Sedgh, Shaneese Longboy, Anny Nguyen, Geraldine 2018, the students who received the awards are •Individual- and peer-tutoring session with classmate to Elizabeth England(M3) in 2018-2019. Manansala, and Alex Sasaki. Daniel Paku (Pre-Medical) and Bianca Luna (Pre- •Access to academic resources offered through the university HS-MACA Spring 2019 Mentoring Dinner Dental.) 14 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 15 Medicine Gender and Sexuality Alliance (MedGSA) Student Organizations MedGSA members hold true to the two-prong mission: to promote and advocate for issues Minority Association of Pre-Health Students (MAPS) affecting LGBTQIA patients and healthcare workers. A safe space is provided for discussion of MAPS is an undergraduate student organization that provides opportunities for students to collaborate with other organizations on campus like the Student various topics in queer politics, socioeconomic disparities, and healthcare policies in a respectful National Medical Association (SNMA) at local, regional, and national levels very early in their college careers. For the 2018-2019 academic year, MAPS’ and educational manner. During the 2018-2019 academic year, 11 students were active members participation on campus and in the community was minimal. MAPS members are eligible to receive mentorship from current SNMA and Multicultural Health of MedGSA. Sciences Student Association (MHSSA) members. This collaboration creates a strong health professions pipeline within Creighton’s student body and perpetuates the future of SNMA on Creighton’s campus. Under new leadership MAPS is looking forward to the 2019 Involvement and Recruitment Fair at Creighton University Multicultural Health Sciences Student Association (MHSSA) MHSSA is an inter-professional organization that involves students in all health sciences schools at Student National Medical Association (SNMA) Creighton University. This includes the school of medicine, dentistry, pharmacy, occupational The Student National Medical Association (SNMA), established in 1964, is the oldest and largest independent, student-run organization focused on the needs and therapy, physical therapy and college of nursing. For the 2018-2019 academic year, 33 MHSSA concerns of African American medical students in the United States. It was established as a subsidiary of the National Medical Association in 1964 by medical members came together to plan a successful HIV/AIDS Awareness Week for the campus and the students from Howard University and Meharry Medical College. SNMA is committed to supporting current and future underrepresented minority medical community. Members of MHSSA also worked closely with Benson High School’s Health students, addressing the needs of underserved communities, and increasing the number of clinically and culturally competent physicians. In 2018-2019 with a Professions Academy where they mentored and tutored students interested in pursuing careers in total of 46 registered student members, SNMA participated in a number of activities on campus, in the Omaha community and abroad. SNMA Leadership was healthcare. MHSSA also worked in collaboration with HS-MACA staff volunteering to help facilitate “Pipeline” Programming through our Initiative. The students were also present at the Annual Medical Education Conference (AMEC) which took place in Philadelphia, PA. Members of SNMA were also instrumental in mentoring HS- 2018-2019 LMSA Leadership Team MACA “Pipeline” health sciences students logging over 150 mentoring hours. In addition SNMA volunteered time to assist with HS-MACA outreach programs, involved in service with the poor, the oppressed, and the marginalized in the Omaha community. conducting health screenings for Lutheran Family Services, organizing toilet paper drives and working with refugee families. These students inspire and lead others to work with them in their efforts. Finally, the students committed to the religious and ethical dimensions and values fostered at Creighton University, whatever their own religious affiliation. 2018-2019 MHSSA Executive Leadership Board Latino Multicultural Student Association (LMSA) LMSA is the newest professional student organization supported by HS-MACA. The mission of the Latino Multicultural Student Association (LMSA) is to promote and advance the presence of Latino professional students in the healthcare field in order to better serve underserved patient populations. The LMSA also focus on improving Latino cultural knowledge to allow for Creighton students to become more culturally competent healthcare professionals. Finally, the LMSA focuses on mentorship to cultivate the professional growth of individuals who will work towards better healthcare outcomes for underserved patient populations.

Ophthalmology Interest Group (OIG) The purpose of OIG is to provide opportunities for current medical students to explore the field of ophthalmology as a career choice. OIG invites local ophthalmologists and faculty to host informational meetings and hands-on workshop sessions as well as facilitate opportunities for students to shadow and work one-on-one with ophthalmologists and optometrist in the community. A primary focus of the OIG is eye care provisions and community service. 16 2018-2019 HS-MACA Annual Report 2018-2019 SNMA Members 2018-2019 HS-MACA Annual Report 17 Post Bac Pre-Medical Student Tracking July 2000 - June 2019 Pre-Dental Post-Baccalaureate Program Academic Programs Total # in 46 Clinical Practice Seven (7) Post-Baccalaureate students were admitted into the fee-driven Total # in Pre-Dental Program for the 2018-2019 academic year, out of an applicant Pre-Medical Post-Baccalaureate Program Residency 36 pool of eighty (80) students. These students were also engaged in year-round 32 Total # in Eight (8) Pre-Medical Post-Baccalaureate Program students, out Medical School coursework including: PAT, Biology, Math, Chemistry, and Physiology. In of a pool of fifty (70) applicants, were admitted to the fee-driven 26 Primary Care Specialties addition, the program offers Pre-Dental Admission Test (DAT) preparations, Pre-Medical program for the 2018-2019 academic year. As a health professions exposure in dental clinical settings, and a Pre-Matriculation part of the Post-Baccalaureate Pre-Medical Program, students Other Post program. Students are awarded scholarships of Ten thousand dollars ($10,000) 17 Graduate Programs are engaged in year-round science coursework which includes: 14 per year during their tenure in dental school based on their successful Biology, Chemistry, Physics, Physiology, Organic Chemistry. In Total # of completion of the Post-Baccalaureate and Pre-Matriculation programs. Current Students addition, the program offers Pre-Medical College Admission Test 7 (MCAT) preparations, health professions exposure in primary care Unknown location and specialties Eight (8) students will matriculate into Creighton University School of Dentistry setting, and a summer Pre-Matriculation Program. (CUSOD) in the fall of 2019; one student (1) from the class of 2016-2017 year 2018-2019 HS-MACA Post-Bac Pre-Dental Graduation and seven students (7) from 2018-2019 academic year. States where students are practicing Medicine AK, AZ, CA, FL, IA, IL, MD, MN, NC, NE, NY, OK, SC, SD, TX, VT, WI Five (5) students will matriculate into Creighton School of * Primary Care is defined as family practice, internal medicine, OB/GYN, pediatrics Medicine in August 2019; Four (4) students from the 2018-2019 Five Alum (4) students from the Pre-Dental Post-Baccalaureate Program Pre-Matriculation Program (School of Pharmacy and Health and one student (1) from the class of 2017-2018 year. Three graduated with a DDS degree in May 2019 from Creighton University’s School post-bac alums will also matriculate to Medical school outside of of Dentistry Professions, Pre-Medical and Pre-Dental Students) Creighton this fall; 1 student from 2016-2018 academic year and two students from 2017-2018 academic year. Four (4) students Post Bac Pre-Dental Student Tracking In the summer of 2019, fifteen (15) students participated in the Pre-Matriculation will take a gap year and apply to other MD and DO schools next July 2000 - June 2018 Programs, eight (8) Pre-Medical and Seven (7) Pre-Dental students; the school year application cycle. was both a success and challenge for the Pre-Dental, Pre-Medical Programs. Eleven

37 (11) students have matriculated into a health professional school. The following Six Alum (6) students from the Pre-Medical Post-Baccalaureate breakout for each professional school is as follows: Seven (7) Dental, four (4) Program graduated with an MD degree in May 2019, from Total # in Medical. Creighton University’s School of Medicine. The students have Clinical Practice matched in residencies in Family Medicine, Internal Medicine, 23 Total # in Subjects of study in the Post-Baccalaureate/Pre-Matriculation Pre-Medical Program and Obstetrics- Gynecology. Dental School include Anatomy, Microbiology, Neurology, Micro Cell Biology, Host Defense, Total # of Pharmacology, and Academic Excellence. Current Students Other Post 7 The Pre-Matriculation subjects for the Pre-Matriculation Pre-Dental program are 6 Graduate Programs 4 Gross Anatomy, Academic Excellence, Histology, Biochemistry, Dental Anatomy, and Unknown Dental Materials.

2018-2019 HS-MACA Post-Bac Pre-Medical Graduation States where students are practicing Dentistry CA, FL, KS, HI, IA, NM, TX 18 2018-2019 HS-MACA Annual Report * General clinical practice is defined as general dentistry *No students from the School of Pharmacy and Health Professions2018-2019 was HS-MACA admitted Annual to the Report Pre-Matric 19 in 2018 or 2019. Community Oriented Primary Care Health Disparities Research gathered to learn about health disparities in Nebraska and the region. Each summer, first-year medical students participate in an eight-week COPC Medical School Tutoring With Funding from the National Institute health disparity research project. Each student is paired with a faculty Endowment of Health (Grant # 1S21MD001102-01), the researcher with expertise in public health and will present their research at COPC continues to support mentoring and tutoring within the medical school. Creighton University Community-Oriented Common Ground during to the 2018 –2019 academic year. Below is a list of Programs offered include: Training Tutors (Train–the-Trainer method), one-on- Primary Care (COPC) Program’s mission is to the medical students with their respective research topics (for the summer of one tutoring, and Supplemental Instruction (SI). In the 2018 – 2019 academic increase the number of health professionals who 2019) and the respective faculty mentors: year, we trained twenty-three (23) students as tutors and eight-hundred (800) are committed to addressing health disparities students attended supplemental instruction sessions. This program is offered • through their research and service in medically- Abigail A. Laudi - Identifying the roles of medical providers in in collaboration with the Office of Student Affairs in the School of Medicine, to addressing barriers to HPV vaccination rates in rural NE clinics; mentor undeserved communities. improve the academic success of the medical students. Meera Varmen , MD From October 2004 to September 2007, Scholarships • Leah Brieger - Assessing Health Disparities in Prenatal Care and Creighton University, through its department of Neonatal Outcomes; Mentor Dr. Terence Zach, MD Health Sciences Multicultural and Community The COPC Scholarship is awarded to increase medical-school enrollment of students interested in participating in health disparity research. During the Affairs (HS-MACA), received an endowment • Abigail Scrogum - Maternal Care and Length of NICU Stay: Effects of 2017-2018 fiscal year, COPC awarded $17,000 in scholarship money to nine of $1,875,000 in perpetuity from the National Health Disparities; Mentor Dr. Terence Zach, MD Institutes of Health (NIH) to increase Creighton’s (9) students: Christopher DeAngelo (M2), Chaitri R Desai (M2), Elizabeth C capacity to train students in public-health One fourth-year (M4) medical students concluded COPC Longitudinal Health England (M3), Patrick S. Hooke (M2), Katlin Mattson (M3), Olivia E. Ochuba research. The grant was disbursed to Creighton Disparities Research. Her paper has been submitted to a peer-reviewed (M2), Thomas Reith (M3), Aakriti Shrestha (M3), and Joshua Ulanday (M3). University at $625,000 per year for each of the journal for publication. Since 2008, the COPC Scholarship committee has awarded a total of $264,600 three years to address health disparities among • Juliana Kennedy (M4) - Risk Factors for Child Maltreatment Fatalities in in scholarships to Creighton University School of Medicine health disparity medically-undeserved populations in Nebraska students. and Iowa. With proceeds from this funding, a National Pediatric Inpatient Database; Mentors Stephen Lazoritz, MD; HS-MACA established a Community-Oriented Vincent Palusci, MD Overall, COPC has had a successful 2018- 2019 academic year. We look Primary Care (COPC) Public Health Research forward to future collaboration with other programs in the community and Common Ground Program to increase student involvement with Creighton students, faculty and staff. in public-health research and to strengthen Common Ground is an inter-professional forum where all students in the health mentoring and tutoring services. COPC is sciences meet every Friday during Spring and Fall semesters. It is an open and currently in its eleventh year of operation. interactive forum in which the students learn the principles of public health and health disparities from health professionals, researchers, and community COPC is made up of four components: Health partners. We held twenty-two (23) Common Ground sessions in the 2018 Disparities Research, Common Ground, – 2019 academic year and a total of 834 (weekly average of 38) students Medical Student Tutoring and Medical Student 20 2018-2019 HS-MACA Annual Report Common Ground 2019 Scholarships. 2018-2019 HS-MACA Annual Report 21 BENEFITS

Creighton University Pipeline to Success Health Creighton University’s Pipeline to Success Health Careers Opportunity Program (HCOP) offers students: Careers Opportunity Program (HCOP) • Formal and informal opportunities for counseling, mentoring, tutoring and group support. • Academic support services, academic enrichment, and skill development.

• Reduction in cognitive or attitudinal barriers to learning through discussion of educational, personal, and/or family issues that may impact academic progress.

• Immersive educational and clinical shadowing activities.

• Training/exposure in primary care settings as well as opioid abuse, mental and behavioral health.

COMMUNITY PARTNERSHIPS

Academic and professional success of a student results from the support and commitment of dedicated individuals and organizations. Creighton University’s Pipeline to Success Health Careers Opportunity Program (HCOP) has established partnerships between several public and nonprofit private health and educational entities whom have promised to establish, enhance and expand educational programs that result in the academic and professional success of students who desire to pursue health professional careers. A total of five (5) community partner organizations are currently participating in the program: Creighton University’s Health Sciences - Multicultural and Community Affairs Department, Metropolitan Community College, , Heart Ministry Center and OneWorld Community Health Centers, Inc.

ACADEMIC SUCCESS 2019 HCOP Participants and Staff Creighton University’s Pipeline to Success Health Careers Opportunity Program’s (HCOP) main purpose is to ensure student success in matriculating through high school, college, and health professional school and entering the health profession of their choosing. To this end, HCOP reinforces student’s chances of succeeding “Success is a journey; not a destination.” academically in several ways. The Academic Success Counselor manages student progress and meets with students to form an Individualized Assessment Plan (IAP). Study skills and other dedicated enrichment courses also allow students to receive foundational knowledge in key subjects necessary to succeed academically in the Creighton University’s Pipeline to Success Health Careers Opportunity Program (HCOP) is a federally funded grant awarded by the Health Resources and Services health sciences. Finally, tutoring is coordinated for students so that any gaps in learning may be filled and barriers to success lessened. Administration (HRSA), an agency of the U.S. Department of Health and Human Services (HHS). Its mission is to provide students from economically or educationally disadvantaged backgrounds an opportunity to develop the skills needed to successfully compete for, enter, and graduate from health professional school. The THE INDIVIDUAL ACADEMIC PLAN (IAP) PROCESS overall purpose is to offer students from disadvantaged backgrounds the access, education and training necessary to become a health professional with the goal of increasing diversity within the healthcare workforce. Ultimately, the program endeavors to provide a multitude of program activities that cultivate the union of Each student who joins the Creighton University Pipeline to Success Health Careers Opportunity Program (HCOP), whether it be the Health Careers Ambassador academics and interpersonal experiences within each student that will prove to be a vital tool along the journey to success. Program or the Structured Summer Program, is assessed initially by the Academic Success Counselor. Then over the course of the program, counselor and student meet to discuss student goals, current academic progress, and potential barriers to success that students may be experiencing. Together, student and counselor create an Individualized Assessment Plan (IAP) based on the student’s individual goals. Not only are goals set, but each student and counselor together discuss 22 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 23 strategies for achieving each goal and record those steps as well. Emphasis is placed on students creating SMART (Specific, Measurable, Attainable, Relevant, and year (every 1st and 3rd Saturday of each month) included students currently enrolled in high school, community college, a 4-year college/university and health Timely) goals. Within the IAP, the Academic Success Counselor also tracks things such as standardized test scores and grades, as well as student strengths and areas professional school. Over the course of five (5) months, students attended an opioid abuse and mental/behavioral health panel; took part in several financial aid to grow. Altogether, the IAP follows students as they progress in school, and allows students to take charge of their success through active goal-setting and strategy workshops; sat in on a health disparities seminar, participated in suicide prevention training, attended college campus tours, got trained on resume-building and discussions. The IAP meeting also allows students to identify any areas they would like to grow in, which in turn allows the Academic Success Counselor to meet personal statement development; learned the importance of study skills; shadowed health professionals at Heart Ministry Center and the NOAH Clinic; created student needs more directly by providing additional services such as tutoring and study strategy advice. their very own hashtag/T-shirt design and much more. As the Spring 2019 session can to a close, it ended with a bang in the form of an awards and recognition luncheon to honor their successful completion of the program session. HCOP staff presented each 2019 Health Careers Ambassador Program student with a ENRICHMENT COURSES Certificate of Completion and as an added bonus each health professional student received a special award acknowledging their dedicated mentorship, leadership, and guidance throughout the session!!! Weekly during the Structured Summer Program, as well as during the bi-monthly sessions of the Health Careers Ambassador Program, students participate in enrichment courses and study skills workshops to improve their performance in school. During the Structured Summer Program, students are enrolled in As one session comes to an end another one is gaining steam – the Summer 2019 Structured Session which is a structured, six-week program that provides a enrichment coursework in subjects that will be foundational and crucial to their future success in the health sciences such as upper level math/science/reading/ plethora of academic enrichment opportunities where students partake in classroom instruction focused on upper-level mathematics/science/reading/writing, writing courses. These courses, taught by experts in the subject, are geared toward building solid foundational knowledge and providing students with the chance standardized test preparation, clinical shadowing, field trips, etc. began June 17, 2019 and will end July 26, 2019. The classroom instruction is geared to help to interact with concepts in a new way to increase understanding. Coursework in academic success as well as test preparation is also available, so that students students strengthen their foundation in subjects that will be integral to them as they pursue careers in the health sciences. The courses are 1 hour and 25 minutes may spend dedicated time learning successful study strategies and improving their test-taking abilities. During the Health Careers Ambassador Program, study skills per day, Monday through Thursday; where Fridays are reserved for workshops, guest speakers, etc. The 1 hour and 25-minute class instruction time includes workshops are held to increase student knowledge of study skills, group study techniques, and ways to increase time management and organizational skills. Test traditional lecture time, time for hands-on application of knowledge, group study and project creation, discussion, in-class work time and much more. preparation resources are also made available to students who participate in the academic year and summer programs, and progress is monitored. Additionally, an ACT Preparation class is held for high school students, accompanied by an online self-paced course to maximize student learning. Creighton University’s Pipeline to Success Health Careers Opportunity Program (HCOP) is committed to inspiring and supporting skilled, diverse students as they successfully pursue health professional careers; ultimately making an impact throughout the global community. STUDENT SUPPORT #TeamHCOP To help ensure all students succeed, the Creighton University Pipeline to Success Health Careers Opportunity Program employs different types of tutors to help reinforce student achievement in areas they may feel less confident in. During the course of an IAP meeting a student and the Academic Success Counselor may identify an area in which a student would benefit from a tutor. The HCOP staff coordinates between students and tutors to ensure that tutoring takes place; and monitors and tracks tutoring hours spent. During the Structured Summer Program, tutoring takes place during a dedicated time weekly, in a setting where students referred for tutoring can “drop in” and have their tutoring needs met and questions answered. Additionally, a tutor is made available during high school test preparation, so that students can receive in-class help with a particular subject as they complete the correction process. During the Health Careers Ambassador Program, tutoring takes place one-on-one on an as-needed basis coordinated by the HCOP staff, and “homework support” activities are also scheduled to allow students to receive help from their peers. IN A NUTSHELL…WHAT’S HAPPENED SO FAR… January 26, 2019 began the journey to success as the 1st day of the Spring 2019 Health Careers (left to right) Aminatu Issaka (Program Supervisor), Ambassador Program session for students. The session which took place during the academic Christina Jelinek (Academic Success Counselor) and Isaac Inkabi (Program Coordinator) 24 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 25 students from the dental, pharmacy, occupational therapy and physical therapy schools as well as volunteers from the HS-MACA post-bac program and a Focus on Health Professions: Pipeline Program Creighton undergraduate student, assisted with the programming. Twenty-seven students volunteered a combined fifty times at some point during the 2018/19 school year. This includes an organized field trip by SNMA that middle schoolers from Marrs Middle School made to Creighton University to learn about the Since its inception in 2000, the Health Sciences Multicultural and Community Affairs Office (HS-MACA) has introduced over ten thousand young individuals careers in medicine, dentistry, pharmacy, and physical and occupational therapy. to careers in the Health Sciences through pipeline programs that serve area students beginning in the 4th grade and continuing through their middle school, high school, college and professional school years. King Science Healthcare Academy During the 2018/19 academic school year the HS-MACA Pipeline Program partnered with King Science Middle School (KSMS) to launch the inaugural year of their The program exposes young people of diverse backgrounds to career opportunities they might not otherwise consider and helps them envision Mini-Health Sciences School. For this program Focus on Health assisted in CPR first-aid training, organizing guest speakers from various health sciences fields to a possible profession in the Health Sciences. Mentors encourage students to establish short- and long-term educational and professional goals and make talk with students about their professions and personal experiences, and sponsored a mental health focused medical student group that provided programming educational choices that will foster an ongoing interest in science. Pipeline programs lay the groundwork that can assist students in becoming competitive at a middle school health class, these events engaging over 60 students. The pipeline program was also responsible for assisting in interviewing student applicants to professional schools of medicine, dentistry, and other health sciences. applicants for the Mini-Health Sciences School and providing a week-long summer program as well as a school-year pharmacy lab activity on Creighton’s campus.

Focus on Health Afterschool program Mini Health Science Camp The HS-MACA Focus on Health Program was created in 2009 as a sustainability program for the Health Career Opportunity Program (HCOP). Through a collaborative Two summer camps were run as an extension of the Pipeline Program. HS-MACA also partnered with Partnership 4 Kids to provide a 4-day camp for 23 high school students from underrepresented backgrounds with an interest in pursuing careers in medicine; providing a glimpse into the many facets of what is agreement we established a partnership with the City of Omaha’s Middle School Learning Initiative to provide STEM (Science, Technology, Engineering, and Math) th programming to their after-school and summer programs. The schools partnered with were Lewis and Clark Magnet School, Marrs Middle School, McMillian Middle considered a part of the Health Sciences and its various professional occupations. The 18 accepted 8 graders from the Mini-Health Sciences School at KSMS also School, and Monroe Middle School, and King Science and Technology Magnet Middle School’s after school program was added this past year as well. A STEM attended a similar 5-day camp with the same objectives. The programs included a tour of the CHI Bergan Mercy Hospital, tour of the Creighton University Schools curriculum was developed by HS-MACA, in which educational and career presentations were given in seven-week sessions during the academic school year as well of Dentistry, the Physical Therapy school, the Exercise Science department, and the Nursing training lab. There were presentations from Occupational Therapy as in the summer. Additional summer STEM classes were also taught at the Hope Center for Kids to students between the ages of 5 and 18. Throughout the year professors as well. To provide the students a sample of the college Creighton student volunteers, many of whom are members of the campus chapter of the Student National Medical Association (SNMA), as well as professional experience and to show what higher education campuses have to Focus on Health Student Attendance offer the students also took a tour of the Creighton Athletic Facilities. Throughout these experiences’ students familiarized themselves with 515 research and activities that various departments perform, as well as TOTAL 2018 -2019 practice their health care skills on mannequins and even participate in 2429 class with PT students. 278 TOTAL 2017 - 2018 Pipeline Programs with the Omaha Community 1704 HS-MACA hosted students from local schools and community organizations for Health Science career exposure. In June 2018 we 0 500 1000 1500 2000 2500 had students come from the Jesuit Academy Middle School, and in Total 2017 - 2018 Total 2018 -2019 # of individual (non-repeating) June 2019 we received students from St. Augustine Indian Mission 278 515 School, McMillian Middle School and the Noah Clinic. Over 120 students students from the various school and community organizations # of total student contact hours 1704 2429 learned about attending college from a Health Science student panel, # of individual (non-repeating) students # of total student contact hours Students from King Science & Technology Magnet toured Creighton’s campus, learned academic success strategies, and Middle School Health Care Academy visit Creighton completed activities such as eye dissections during their visits. 26 2018-2019 HS-MACA Annual Report Pharmacy Skills Lab 2018-2019 HS-MACA Annual Report 27 Center for Promoting Health and Health Equity

(CPHHE) The Center for Promoting Health and Heath Equity (CPHHE) was co- founded in 2008 by executive co-directors Dr. John Stone and Dr. Sade Kosoko-Lasaki. The purpose of the Center is to enhance community health through community-university collaborative research, education, and outreach in Omaha, NE and the region. The Center’s emphasis is on health improvement of communities that have worse health related to social inequalities and inequities. The goal remains to reduce health disparities and increase the health of minority populations through community-university collaborative research, education, and implementation in Omaha, Nebraska, and the surrounding region. The Center’s formation rests on the recognition that, to foster health equality and promote health generally, Health Sciences Centers such as CPHHE should become centers-without-walls that embrace served communities as partners and collaborators. Intersectional collaboration of multiple academic disciplines and health professions is essential and community-based participatory research is the most promising model. Core issues are how social justice, respect, care, and other ethical values should flow throughout such a collaborative-partnering endeavor. Building community-academic relationships and partnering are essential elements for effective Community-Based Participatory Research and are crucial for grant applications (institutional commitment) and for reducing disparities in the community.

2018-2019 CPHHE Community –Academic Partnership

Back Row (left to Right): Dr. Kelly Dineen, Mr. Jeff Lang, D.C. Scott Gray, Mr. Joel Front Row (Left to Right): Mrs. Doris Moore, Dr. Jackie Font-Guzman, Dr. Sade Dougherty, Dr. Jeff Smith, Dr. Martha Nunn, Mr. Luiz Vasquez Kosoko-Lasaki, Dr. Ivelisse Santiago-Stommes, Dr. Roselyn Cerutis Middle Row (left to Right): Dr. Adi Pour, Dr. Alexander Roedlach, Mr. Sal Issaka, Not Pictured: Dr. John Stone, Dr. Richard Brown, Dr. Donna Polk Mr. Thomas Mrs. Doris Lassiter, Dr. Becky Davis, Ms. Jeanne Burke, Dr. Tim Dickel Warren, Mr. John Pierce J.D., Mr. Chris Rodgers The Center for Promoting Health and Health Equity (CPHHE, “Center”) 28 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 29 Focus on Mental/Behavioral Health Health Service Administration (SAMHSA). Ms. Nelson presented on the overall th state of mental health in the Midwest. The 12 Annual Addressing Health On Saturday, April 27, 2019, about eighty-seven (87) healthcare professionals, community leaders, university faculty and staff, interested community members The seminar was sponsored by Office of Health Sciences Multicultural and and students gathered at Creighton University to explore the data, statistics, Community Affairs, Center for Promoting Health and Health Equity, and Disparities Seminar best practices, and current examples that illustrate how certain communities Creighton University Health Sciences Continuing Education. have been affected by various mental health conditions, policies that affect the ability to take care of or provide mental health services, and how communities, Dr. Frank T. Peak Memorial Health Disparities Essay Award including legislature, can improve the state of mental health services provided. The purpose was to spark a candid conversation around the many issues faced The third annual Dr. Frank T. Peak Memorial Health Disparities Essay Award was in the Omaha community and how communities can learn about the state of presented by Dr. Sade Kosoko-Lasaki, Dr. John Stone, and the Peak family at the mental and behavioral healthcare and to discuss what needs to be done from 12th Annual Addressing Health Disparities Seminar on April 27, 2019. Dr. Frank an infrastructural, policy, and community aspect to change health outcomes in Peak was an Omaha, Nebraska, African-American native who worked diligently terms of health disparity intervention and prevention. as an activist in the elimination of health disparities in the African-American community. Dr. Frank Peak was one of the founders of CPHHE. The essay award The seminar objectives were to explain and differentiate the definition of recognizes his work in addressing health disparities at Creighton University and the term “Mental Health”, “Behavioral Health”, and the definition of “Mental in Nebraska. The essay competition is open to all graduate students attending Illness”, to recognize the contributing factors that determine an individual’s any Nebraska collegiate institution. In 2019, the students were required to mental/behavioral health, to discuss strategies for developing, implementing, choose and write on one of the following topics on health disparities: and evaluating policies regarding mental/behavioral health services capacity building, and to recognize the role of individuals and society in reducing the • Analyze a core feature of current mental health inequities. Examples are stigma around mental health. These goals increased collaboration between mental health ideology, mental health norms, and public perceptions institutions and community organizations to benefit the community and explore regarding mental health and age, dis/ability, race/ethnicity, gender, reli- solutions with community leaders. The seminar’s objectives were carried gion, socio-economic strata or occupational group. out through presentations around the mental healthcare crisis in the Omaha • Argue for policy initiatives that a particular community could employ to Community, Legislative involvement and progression on mental health, a hands- significantly reduce mental health inequities/disparities. These policy on workshop on the biases with building relationships and communicating initiatives can include building sustainable support for mental health with patients with mental health issues, issues with Medicaid expansion to services, enhancing communities’ capacity, and/or building mental cover mental health services, the role of spirituality and mental health, mental health organizations’ capacity. Provide an ethical rationale/justification healthcare in the Native community, and the role of violence plays in mental for the proposed policies. health. The conference also featured a panel discussion with various community organizations that are positively affecting mental health access and equity in Entries were reviewed by a CPHHE Partnership committee to determine the Omaha, and the conference featured interactive workshops that divided up the winner of the award. First place was awarded to Dr. Sana Kiblinger with the participants to participate in either meditation, yoga, or a self-care workshop. essay, “Transgender in Omaha: Disparities in Mental Health Care.” Dr. Kiblinger has recently completed her 4th year of medical school and earned her medical The keynote speaker was Kimberly Nelson, LAC, MPA, the Regional degree at the Creighton University School of Medicine. Administrator for Region VII (KS, IA, NE, MO) for Substance Abuse and Mental 30 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 31 The Center for Promoting Health and Health Equality (CPHHE) entrenched its time and effort into benefiting the communities of Omaha and surrounding cities Community Education: CPHHE through health education and outreach activities that engage its community members and further educate them on various health topics. The goal is not to be an outsider of a community and attempt to help, but to be a part of the community so that individuals may learn in an effort to benefit the overall health of the communities within our capacity. The Inspiring Change Program is a chronic-disease management program aimed to build awareness of causal factors and to intervene with chronic conditions such as diabetes, hypertension, heart disease, and other related conditions. The information provided is based off the needs and wants of the community. Some of the topics are action planning, nutrition, exercise, mental and emotional health, and its risk factors. In 2018 - 2019, there were a total of twenty-one (21) participants in the program with fifty-seven (57) contacts. The Omaha Housing Authority and Catholic Charities have been active sites, and we are looking forward to program expansion within the Omaha Housing Authority mixed housing towers, the faith-based organizations, Sudanese community, and Islamic communities for the 2019 - 2020 year. In May 2019, CPHHE hosted the first Inspiring Change Program Train-the-Trainer session where Community Health Advocates and CPHHE-REACH Ambassadors were invited to participate and receive training to be able to host their own Inspiring Change sessions at their churches, housing sites and work sites. There were 4 participants for the first session. There will be 2 additional training sessions in the fall of 2019. The Community Health Advocates Program: The CHA’s are lay-community members who were identified, recruited and trained to serve various communities in Omaha by providing basic health information to the community and will serve as navigators for the healthcare system. This effort was initially funded by Catholic Health Initiatives (CHI) Health and the Omaha Housing Authority. Currently, CPHHE provides support for the program. Continuous training was provided to nine (9) lay community individuals on health management related issues. In addition, the CPHHE Community Health Advocates participated in the Indigenous People Health Fair at OneWorld and the Nebraska Urban Indian Health Coalition Health Fair. Since 2014, CPHHE has trained 75 CHA’s (19 CPHHE + 56 CPHHE-REACH Community Health Ambassadors). In the Spring 2019, CPHHE partnered with the Creighton University Office of Excellence to provide the CHA program as a certificate program recognized by Creighton University. The inaugural certified training cohort yielded 6 individuals who completed the 10-week certificate program. The Drill Program is a physical activity program where middle school students participate in exercise routines and drills derived from collegiate football and trainings. The program is currently offered at the Norris Middle School in Omaha, NE every Tuesday and Thursday afternoon during their afterschool programming. In 2018-2019 academic school year, The Drill averaged 12 participants in the fall semester per class and 11 participants per class in the spring semester. There were 26 classes offered per semester. CPHHE plans to expand the program to 1 additional school during the 2019-2020 academic school year. The Lyrics, Life & Lessons Program is designed to stimulate critical thinking skills around the concepts of public health-related issues that affect communities, primarily minority communities, such as community or gang violence, mental health, and fatherlessness through the use of Hip-Hop music, the fastest growing music form in the United States and the world. The program uses song lyrics to promote various public health topics and attributes and helps the students engage in the discussion activities. This year, the program was presented at the North Omaha Community Care Council Youth Conference (65 students), at the Hip-Hop Literacies Conference at Ohio State University (30 participants), and the University of Nebraska Medical Center Health Professions Career Day (120 students). Spring 2019 CPHHE Community Health Advocates

32 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 33 There were twelve 12) participants in SRI in 2018: seven (7) undergraduates and three (3) high school community research students and two (2) Project SEED Summer Research Institute (SRI) students. Summer Research Institute: Undergraduate Summer Biomedical Research Program A collaborative effort between the Health Sciences Multicultural and Community Affairs (HS-MACA) and the Center for Promoting Health and Health Equity (CPHHE). The purpose of the Summer Biomedical Research in Health Disparities is to increase interest in biomedical and health sciences professions among underrepresented minority groups. The specific objectives of the program are to: • Enable students to better understand the nature and applicability of scientific methods in research, • Instill confidence in students pursuing careers in biomedical research and other health professions • Provide minority students exposure to opportunities inherent in research careers.

Undergraduate students are paired with a Creighton University science research faculty member who mentors the student in an ongoing research project or designs a project especially for the student. The students attend a one-hour weekly seminar series every Friday where Creighton University scientists and community health-based organizations will present their experiences, ethics of research, the importance and impact of research, health disparities, etc. The Seminar Series will stress the specific experimental approaches that are used to address fundamental problems in health and disease. The program is an immersion into the life of a research scientist, including a closely mentored 8-week research project, regular lab meetings, seminar series, professional development, and research colloquium. Opportunities in research career training are provided for undergraduates from individuals underrepresented in science, technology, engineering and math (STEM) fields. Requirements for participants: GPA: 3.0 or above; students must be enrolled in a university/college at time of application; complete an application and essay; send a copy of academic transcripts; and provide references. Student stipends are covered by the program.

Summer 2018 CPHHE Summer Research Institute Participants Summer Research Institute: High School Community Research Program Students perform research at a community-based organization for six weeks. High school students from the greater-Omaha area were selected to participate The Summer Research Institute (SRI) initially began in 1992 as a summer research program for pre-doctoral and collegiate undergraduate students. The high in training in research projects in local Community-Based Organizations (CBOs). The students receive training in chronic disease health disparities subjects school component was introduced in 2000. After a successful run, in 2002 the Creighton University Health Sciences – Multicultural and Community Affairs before they are assigned research projects in the community. Students worked individually or in collaborative groups to develop surveys, examine data, conduct Department (HS-MACA) received a three-year funding award from the National Institute of Health to, “…increase the representation and participation of minority community mapping, and conduct interviews resulting in policy change and recommendations. The program is designed to: U.S. students (high school and college) in biomedical research through their choice of a career in the biomedical sciences.” In 2010, the summer program started • Provide enrichment to underserved minority high-school students its on-going collaboration with the newly-formed Center for Promoting Health and Health Equity (CPHHE). Since 2010, the Summer Research Institute introduced • Provide hands-on, community-based research biomedical research for undergraduates, , community-based participatory research with community partners and organizations for high school students, and biomedical research through a partnership between the American Chemical Society to provide Project SEED (Summer Experience for the Economically • Help CBOs participate in research Disadvantaged) to high school students. 34 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 35 At the end of the program, the students presented their research experiences Former SRI students in STEM Educational Name Professor/ Site Mentor Project Title at a colloquium in the form of a poster and oral presentations in August. The students prepare a short essay, scientific poster, and PowerPoint presentation Programs and Career Fields High School Project SEED presenting the introductory background, experimental design, results, and 14 discussion of the research they performed during the summer. Jude Kouassi Dr. Yaping Tu Androgen Receptor Resistance to TRAIL 12 Inducing Apoptosis in Triple Negative Breast Requirements for Participants: GPA: 3.0 or above; current high school Cancer 10 Marco Pena Dr. Devendra Agrawal Differential expression of Cathepsin L in sophomore, junior, or senior; must have their own transportation to and coronary arteries of atherosclerotic swine from the community site. Student stipend is covered by the program. 8 6 High School Community Research Program 4 Zachary Klimowicz Dr. Eric Haas The Normal Lipid Composition of Whole Squash Bugs Anasa tristis 2 Summer Research Institute: American Chemical Society – Project SEED Elsa Ramirez Ms. Blanca Mejia The Social Reality of Troubled Young Adults in 0 Juvenile Involvement 2015 2016 2017 2018 In the 2018 programming year, CPHHE continued its partnership with Godwin Djossou Dr. Donna Polk Health Disparities based on Attitudes and the American Chemical Society (ACS) and hosted Project SEED (Summer Number of SRI Students Beliefs in Native American Culture Experience for the Economically Disadvantaged). This allowed two high school students to take part in chemistry-based lab research projects at Number of SRI Students who continued in STEM profession, professional school, Undergraduate Biomedical Program Creighton University. or college major Audrey Keim Dr. Shashank Dravid Memory and behavioral analysis of glutamate Requirements for Participants: Current high school sophomores and juniors delta-1 conditional knockout mice in the hippocampus and cortex must have at least a year of science education (preferably chemistry) and must meet certain financial criteria established by the American Chemical Society. This Jessica Grimmond Dr. Yaping Tu Upregulated miR-424 mediates TGF-β induced opportunity exposes high school student to laboratory conditions and while garnering professional development and career exploration prior to entering college. fibroblast differentiation in pulmonary fibrosis Student stipends are funded by the American Chemical Society. Anthony Baker Catherine Opere Effect of L-Cysteine on Cataractogenesis in Summer Research Institute 2018 program Cultured Bovine Lenses Jessica Cabusog Dr. Devendra Agrawal Immune Cell Activation and Inflammation Number of Associated with Incisional Hernia Type of Student Number of Applicants Interviewed Number of Accepted Participants Applicants Nick Choi Dr. Laura Bruce Role of gastrin-releasing peptide and its High School Community receptor in zebrafish fear behavior 16 8 3 Research Lucy Chung Dr. Chris Destache Modified CCR5 Monoclonal Antibodies for HIV protection: Production, purification and High School SEED 3 3 2 characterization Summer 2018 CPHHE Summer Research Institute Haaris Shahid Dr. Eric Haas The Effect of the Pathogen Serratia Colloquium Undergraduate SRI 49 18 7 marcescens on The Lipid Composition in 36 2018-2019 HS-MACA Annual Report Squash bugs Anasa tristis 2018-2019 HS-MACA Annual Report 37 Health Disparities Research Training Program The Health Disparities Research Training Program (HDRTP) is a collaborative effort between the Creighton University Center for Promoting Health and Health HS-MACA in the Community Equality (CPHHE), the Minority Health Research Center at the University of Alabama-Birmingham, Tuskegee University, Rust College, and Morehouse School of Medicine. This two-year program for faculty includes mentoring career development, grants writing, and research training. Currently in its sixth year, ten (10) of Creighton’s faculty have successfully completed the HDRTP. The objectives of the Health Disparities Research Training Program are to: • Develop independent researchers in the area of health disparities research • Provide instruction in scientific research methodology and design • Provide training in health disparities and innovative approaches to reduce them. • Teach scientific writing and grant-preparation skills to produce a grant submission to an external agency.

Through attendance and participation in designed, faculty-development discussions and workshops, research faculty enhances their knowledge and scientific HS-MACA staff visit the Great Plains Black History technical skills, as well as gain expertise in health-disparities research. Scholars are paired with mentors to work on selected projects that are submitted for Museum in Omaha, Nebraska. funding during the second year of training. Examples of topics include Health Disparities Research (HDR), Research Design and Methods, HDR Program Evaluation, 2019 Post-Bac Pre-Dental students volunteer at Biostatistics, Community-Based Research, Translational Research, Study Participant Recruitment and Retention, Models of Behavioral Change, Health Economics, Nebraska Mission of Mercy. Bioethics, and Manuscript and Grant Preparation. The 2018/2019 faculty fellows:

1st Year Fellow: Dr. Kate Nolt, PhD, MPH Department: Interdisciplinary Studies – School of Public Health Mentor: Dr. John Stone and Dr. Kosoko-Lasaki Congratulations to Dr. Sade Kosoko-Lasaki, Research Title: Assessment of the Prevalence of Internet Gaming Disorder (IGD) in Youth Ages 15 - 18 Living in Underserved Communities Associate Vice Provost of Health Scienc- es and professor in Creighton University 2nd Year Fellow: Dr. LeShaune Johnson M.S., ABD. School of Medicine for receiving the 2018 Department: Center for Health Policy and Ethics – School of Public Health Interdenominational Ministerial Alliance Mentor: Dr. Joan Lappe of the Metro Omaha Area (IMA) Drum Research Title: ’Real Talk’: Black Breast Cancer Survivors Speaking from the Margins Major Award for Accountability in celebra- tion of Martin Luther King, Jr. HS-MACA students and staff volunteer at the Charles Drew Health Centers 6th Annual Bike Earn- Creighton Prep students tour Creighton and dissect A-Bike Event. cow eyes with Bryan Benson (HS-MACA Pipeline 38 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 39 Program Assistant). Racial and Ethnic Approaches to Community Health While Omaha Nebraska continues to recover from the cold and difficult winter, the Spring and Summer seasons have arrived and people can again enjoy the outdoors. The environmental improvements created by the Racial and Ethnic Approaches to Community Health (REACH) program continue to provide opportunity to participate in healthy living. The cooperative agreement (2014-2018) between the Center for Promoting Health and Health Equity (CPHHE) and the Centers for Disease Control and Prevention was created to eliminate health disparities among the African-American community with a primary focus on a single risk factor (physical inactivity) and how it relates to the increased incidence of cardiovascular disease. This agreement came to an end last year on October 1, 2018. Lack of physical activity along with obesity, high blood pressure and diabetes, all continue to play a major role in heart disease among the African-American population. This annual report describes the initiatives implemented during the past year designed to reduce the health disparity gap within the African-American community in Omaha, NE. Sustainability efforts continue to reduce the prevalence of cardiovascular disease in the AA community Community Partnerships A total of twelve (12) faith-based organizations continue to participate in the REACH initiative. Among those twelve (12) faith-based organizations, two (2) new faith-based organizations joined the group during the final year of the program: New Beginning Community Baptist Church and St. Mark Baptist Church. The partner churches are listed here: Antioch Baptist Church, Bethesda Seventh Day Adventist Church, Clair Memorial United Methodist Church, Morning Star Baptist Church, Pleasant Green Baptist Church, , Redeemed Christian Church of God, Zion Baptist Church and Mt. Moriah Missionary Baptist Church. Each continues to create and implement organizational policies, system changes, and environmental (PSE) improvements that promote increased physical activity opportunities within the Omaha African-American community. In addition, there are eleven (11) Omaha Housing Authority Towers that continue to participate in the REACH collaborative agreement where residents and staff have rallied together to increase physical activity in and around their homes - Evans Tower, Crown Tower, Jackson Tower, Park North Tower, Park South Tower, Benson Tower, Florence Tower, Underwood Tower, Pine Tower, KayJay Tower, and Highland Tower. Two (2) non-profit organizations, Charles Drew Health Center and the Urban League of Nebraska – Omaha continue to remain REACH community partners. Charles Drew Health Center has enhanced its physical activity initiatives for employees, patients, and the community by offering Zumba classes twice a week, weight- management programs and physical activity resources. The Urban League of Nebraska – Omaha has increased the usage of on-site indoor and outdoor walking trails by its leadership, employees and student population. Health Ambassadors Over the past 3+ years, facilitated by Creighton University’s School of Medicine and the Douglas County Health Department, REACH implemented a Train-the-Trainer Physical Activity Leadership Certification Program that set out to train community members from partnering faith-based organizations, Omaha Housing Authority, Charles Drew Health Center and Urban League of Nebraska – Omaha to be Health Ambassadors promoting physical activity at their specific locations. Upon the completion of the leadership program, which includes extensive training on exercise and health education, health ambassadors were equipped with the necessary skills to implement policies, systems and environmental improvements at their respective locations. Each Health Ambassador has made the commitment to serve as liaisons within the community through the formation of partnerships with the goal of increasing physical activity opportunities, building individual and community 2019 Faith Based Fitness Challenge awareness surrounding physical activity, providing social support to encourage physical activity at their respective site locations, implementing policy, system and

40 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 41 environmental improvements and training others to become trainers while creating a coalition which can sustain the REACH Train-the-Trainer Physical Activity Messaging (Marketing) Leadership Certification Program for years to come. Currently, REACH has fifty-six (56) trained and certified Health Ambassadors encouraging physical activity In 2018, REACH staff allotted a significant portion of time into the refinement and development of “new and improved” marketing/outreach materials. A factsheet among Omaha’s African-American community. is still available and distributed to the community, which describes REACH’s purpose, activities and achievements.. To somewhat complement the factsheet, a general REACH business card sized (laminated) fact sheet was developed that contained REACH contact information on the front and activities and achievements Bicycle Racks on the back, which serves as a great handout during conferences, meetings and presentations. The REACH CD consisting of a jingle covering four (4) genres Since the inception of the cooperative agreement, eighty-six (86) bicycle racks were installed at community partner site locations to promote a healthy lifestyle that describe the value of participation in physical activity continues to be a huge hit throughout the community including our REACH partners for use in their while providing a safe place for a bicycle. These bike racks remain in place throughout the community for use by the public. organizations. Periodic posts and updates appear on Facebook, Instagram and Twitter pages. Walking Trails Advisory Council Walking trail systems created at each REACH community partner site are still present for use by organization members and the public, These trails represent The REACH Advisory Council, which is comprised of five (5) members from several sectors of the community was deactivated in 2018. The purpose of the council indoor and outdoor walking paths which display the various distances that can be completed in increments of up to one mile. Additionally, destination points was to meet quarterly to provide guidance, discuss progress, and generate ideas for continuing to increase the number of people with improved access to physical which represent numerous landmarks throughout the North Omaha area have been identified with signs that show the distance from point A to point B. These 81 activity. The advisory council will be reactivated in 2019. destination signs also include a QR code which can be scanned via mobile device that provides the exact path listed on the sign. Some of the destination points include community basketball courts, parks, schools, recreation centers, grocery stores, restaurants, pharmacies, and other places of interest within the North Sustainability and Looking Toward the Future Omaha community. Sustainability refers to the continuation of a program’s initiatives, principles, and efforts to achieve desired outcomes. REACH community partner organizations along with executive leadership and REACH staff are currently participating in several discussions to identify short-term and long-term sustainability strategies that REACH Physical Activity Opportunity Maps (paper version) are still available to the community at CPHHE-REACH office which identifies the REACH community will work. Reach maintains office space in the HS-MACA Department. Efforts have focused on identifying sources of funding to sustain the program. Applications partner sites, outdoor walking trails, neighborhood parks, bicycle share locations, bicycle racks, key destination points and additional physical activity opportunities. and funding proposals have been submitted to several local organizations and philanthropic communities. The Executive Director continues to attend various The 33 outdoor walking trail signs, 30 indoor walking trail signs, 81 key destination signs and 86 bicycle racks continue to be available for public and private use. community meetings to share ongoing messages about the value of physical activity participation. Two foundations have been contacted and two grant proposals have been written seeking support for REACH continuation. Community Physical Activity Events REACH, CPHHE (Center for Promoting Health and Health Equity) and Health Sciences - Multicultural and Community Affairs (HS-MACA) staff participated in several events including the Faith Based Fitness Challenge and the 12th Annual Addressing Health Disparities Seminar. Faith Based Fitness Challenge, consisting of the REACH partnering faith-based organizations agreed to participate in a one-day Faith Based Fitness Challenge held on Friday, April 26th, 2019 which included a drive, chip and putt competition; a one-mile walk/run; a basketball shooting contest; and a bowling competition. The challenge began bright and early at Benson Championship Golf Course where participating pastors set out their best drive, chip and putt. The remaining portions of the challenge took place at Salem Baptist Church (one-mile walk/run), the North Star Foundation (basketball shooting contest) and West Lanes (bowling competition). Participating pastors were required to participate in 3 out of the 4 challenge events where scores were tallied for each individual event and later summed for an overall score. Several REACH community partners, congregation members and staff were present as cheering spectators. 4rd Annual Let’s Move, Let’s REACH Physical Activity Day In 2015,Creighton University’s CPHHE, HS-MACA, and REACH staff conceptualized, designed, a multi-faceted Physical Activity Day (PAD) in accordance with the Centers for Disease Control and Prevention’s (CDC) Community Action Plan (CAP) of: Increase the number of people with improved access to physical activity opportunities from 0-46,000 by 2018. This was achieved with over 2000 participants from 2015-2018. On Saturday, September 15, 2018, REACH held its annual Physical Activity Day (PAD) celebration called Let’s Move, Let’s REACH. This event consisted of a variety of events for children, young adults, and seniors that promote fitness, physical activity, and a healthy lifestyle. Activities include a one-mile walk/run, basketball, Zumba, dancing, bounce house, dunk tank, and much more. Approximately 1,000 people attended the PAD half day event.

42 2018-2019 HS-MACA Annual Report Third Annual Let’s Move, Let’s REACH2018-2019 Physical HS-MACA Activity Annual Day Report Fall 2018 43 Introduction

Creighton University Preventing Glaucoma Glaucoma is a group of eye diseases colloquially known as the “sneak thief of sight”. Asymptomatic elevated intraocular pressure progressively damages the optic nerve in millions around the world. Classically, the disease effects peripheral vision first and progresses toward central vision. April 2019 marked Health Sciences Blindness: Mission to the Dominican Republic – Multicultural and Community Affairs’ (HS-MACA) 14th annual preventative ophthalmology trip to the Dominican Republic (DR). The annual mission is under the leadership of Dr. Sade Kosoko-Lasaki, glaucoma specialist, professor of surgery and preventive medicine at Creighton University in Omaha, Nebraska. The goal of the mission is to combat blindness from glaucoma and Vitamin-A deficiency, which has been identified as a highly prevalent cause of childhood blindness in the DR by the World Health Organization. For over a decade, Dr. Kosoko-Lasaki and support staff have provided over four-thousand-two-hundred eye examinations in the Dominican Republic. This includes over one-hundred-and-thirty-five (135) surgeries at Creighton’s Institute for Latin American Concern (ILAC) in Santiago, Dominican Republic, and Dr. Sebastian Guzman’s clinic in downtown Santiago. Special thanks to Dr. Guzman and his team for his remarkable support of the mission and generous post-operative care for many of the patients.

The trip’s purpose is glaucoma management, basic ocular health education, examination of children for signs of vitamin A deficiency in the eyes and the distribution of mega-dose Vitamin-A capsules. Glaucoma is the leading cause of blindness in Black and Hispanic populations, putting the Dominican population squarely at risk. In addition to glaucoma, the World Health Organization deems the Dominican Republic at risk for Vitamin-A deficiency. In recent years, we have added instructions on basic hand-washing, proper eye drop administration, introduction to cataract, introduction to pterygium, care of the post-surgery patient and Zika virus prevention measures to the education seminar.

In addition to ocular health examination lectures to the Cooperadores, all the 37 lecture attendees received the annual complete ocular eye exam. Basic spherical glasses were provided to many patients. Single vision glasses for distance and reading are dispensed based on the retinoscopy and spherical subjective refraction. These glasses are donated from various organizations and individuals who are recycling their old glasses. Treating individuals in a developing country who have refractive error and complicated ocular disease is a difficult task, but it is beneficial when done as a complete exam. Identifying and providing those who need glasses has added a much-needed benefit to our outreach process.

After a thirteen hour trip to Santiago on Friday April 5th 2019, the mission began on Saturday, April 6th, 2019 with an educational seminar on ocular health for a group of thirty-seven (37) cooperadores (the primary healthcare workers of the villages). Dr. Kosoko-Lasaki, Dr. Eduardo Martinex and Optometry student Brett Briggs provided instruction on glaucoma, cataract, pterygium, handwashing and alleviating Vitamin-A deficiency. Glaucoma, cataract and other eye diseases are best diagnosed with a routine eye exam. Pterygium is best prevented with UV protection and can often be managed without surgery. The cooperadores took this education and literature to share with their community. The biggest benefit is disease prevention and baseline knowledge to know when to refer.

The next five days involved eye exams, selective laser trabeculoplasty, and Vitamin-A deficiency screening and distribution of the capsules to many children (ages 6 months to 10 years of age)in the rural areas of the DR as needed. The team provided eye exams to individuals at ILAC. New and existing glaucoma patients were provided glaucoma medications or referred for surgery. If other ocular complications were found, such as cataracts or pterygium, patients were referred to Dr. Guzman for treatment and follow-up. On Wednesday, the team visited a school house near Rodeo, DR for Vitamin A megadose (50,000-200,000 IU). Vitamin A 14th annual preventative ophthalmology trip to the Dominican Republic 44 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 45 deficiency causes night blindness, severe dry eye, conjunctival metaplasia, and in severe cases, blindness from cornea involved xerophthalmia. Vitamin A is a fat- Effective management of glaucoma requires patient compliance and diligent education. When patients soluble vitamin; therefore, the body is able to store it for long periods. An administered megadose can provide lasting benefits for two to three years. In addition gain a greater understanding of their chronic disease better outcomes are achieved. Regular follow-up to Vitamin A distribution, patients were refracted and single vision glasses were distributed on an as-needed basis. Lastly, during the visit to the Rodeo, the team care is essential to preserving vision. Patients may develop an allergy to a medication and sometimes also administered an anti-helminthic medication, albendazole, to all the children and the adults. The administration of the albendazole was not related to the the medication loses its effectiveness at controlling intraocular pressure. These patients are on these Vitamin A deficiency. The albendazole was given because of the convenience of multiple dosing of a community with medications that do not interact. medications for life and it is essential that the patient is monitored for these complications. Dr Guzman takes most of these glaucoma patients into his practice for a very low cost of follow-up care. Many were Results also referred to Dr. Guzman for other ocular diseases, including cataract, pterygium, retinal disease. Dr. Guzman and the ILAC clinic will be handling the follow-up visits, post-op care, and further follow-up for Two-hundred-and-seventy (270) individuals were impacted during the six-day mission trip. A total of one-hundred-and-fifty (150) complete slit lamp ophthalmic these patients. exams were performed. These exams included registration, ocular history, risk assessment, visual acuity tests, slit-lamp biomicroscopy, posterior pole evaluation with a 78D lens and Goldmann tonometry. Retinoscopy, automated perimetry, dilation, direct fundoscopy, and indirect ophthalmoscopy were done as needed. Conclusion Patients that were on maximum medical therapy and had high IOP were referred for surgery. The children has a flash light exam for ocular signs of vitamin A deficiency. Some of the children had retinoscopy to identify refractive errors prior to the dispensing of glasses. The children, adults, and health-care personnel in the Dominican Republic all greatly benefited from the collaborative efforts of the mission. New and existing glaucoma patients were served, and the local Travel time to the Haitian border campo of Rodeo took about three hours one-way. Once there, ninety-six (96) children, ages 6 months to 10 years, were team members will continue follow-up to manage their disease. This project is effective, continues to be screened and received 50,000-200,000 IU of Vitamin A. Conjunctival Xerosis, ocular signs of vitamin A deficiency was identified in twelve (12) children. All the 96 sustainable and works in conjunction with other healthcare teams which visit ILAC. The cooperadores children were administered megadose Vitamin A for subclinical signs or clinical signs of xerophthalmia (Vitamin A deficiency). Vitamin A is a fat-soluble compound learned valuable health information that will reduce the incidence of eye infections and incidence of vital to the immune system, epithelial health and visual function. More information about Vitamin A deficiency can be found at www.sightandlife.org. blindness. Using this methodology, ILAC can reach the poor and marginalized residents in the remote, underserved areas of the Dominican Republic better than any other organization. In addition to the aforementioned ninety-six (96) children, twenty-four (24) adults were administered albendazole provided by ILAC, totaling one-hundred-twenty (120) individuals treated with anti-parasitic medication.

Visual Acuity was established in each eye, with a 20-foot Snellen or illiterate-E eye chart. Once the patient’s vision was assessed with and without pinhole, either refractive lenses were used in a refractive lens tree model or retinoscopy was done to improve each eye. Spherical Lens powers ranged from -6.00D to +2.50D. All of the administered glasses improved the vision in one or both eyes. Patients were given single vision eyeglasses for refractive error, including presbyopia. Special thanks goes to the Dr. Jokotoye Babalola Family Foundation (JOBAFF) for providing many single vision glasses for distance and reading.

We were greatly encouraged to see many people previously diagnosed in our past mission trips return for follow up on their conditions. Fifty-two (52) patients examined had new or existing glaucoma. A total of twenty (20) selective laser trabeculoplasties (SLT) were performed. SLT is a minimally invasive outpatient laser surgery that remodels the trabecular meshwork to augment the outflow of the aqueous humor and lower intraocular pressure. It is used when eye drop medications are not lowering the eye pressure enough or are more causing significant side effects. It can also be used as initial treatment in glaucoma. SLT has been in use for than 25 years in the United States and around the world to safely lower intraocular pressure. For more information about SLT, consult: Damji, K. F., Bovell, A. M., Hodge, W. G., Rock, W., Shah, K., Buhrmann, R., & Pan, Y. I. (2006). Selective laser trabeculoplasty versus argon laser trabeculoplasty: results from a 1-year randomised clinical trial. The British journal of ophthalmology, 90(12), 1490–1494. doi:10.1136/bjo.2006.098855

46 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 47 Publications

Grants, Presentations and Publications 1. Wenzel C, Statler B, Kosoko-Lasaki O, Priluck J, McGill E. Review of Diabetic Retinopathy: An update for the primary care provider, American Journal of Clinical Medicine, Academic Institutional or Community Grants, Funded IN PRESS

Principal Investigator 2. Ikpeme A, Ani N, Ago B, Effa E, Kosoko-Lasaki O, Ekpenyong A. The Value of Mobile Ultrasound Services in Rural Communities in South-South Nigeria. Open Access Maced 1. Nebraska Tobacco Settlement: Center for Promoting Health and Health Equality (CPHHE) 2018 – 2019, $175,395) J Med Sci, https://dol.org/10.3889.oamjms.2017.191 eISSN: 1857-9655 Federal Grants, Funded 3. Kosoko-Lasaki O, Ekundayo O, Smith J, Ochuba O, Hayashi G, Sanders R, Brown R, Stone J. Urban Minority Community Safety and its Impact on Physical Activity: The Center for Promoting Health and Health Equity-Racial and Ethnic Approaches to Community Health (CPHHE-REACH) Initiative. Journal of the National Medical Association, Volume Principal Investigator 111, Issue 3, pages 334-344. June 2019 1. National Center of Minority Health Development (NCMHD)/NIH Endowment Program for Increasing Research and Training in Health Profession Schools; 2005-Perpetuity ($1,894,125). National Board Membership 2. Creighton University Pipeline to Success – Health Careers Opportunity Program (HCOP); $3,072,030 over 5 year 1. Education Commission for Foreign Medical Graduates, 2009 – 2018 3. National Center for Chronic Disease Prevention and Health Promotion 2014: Racial and Ethnic Approaches to Community Health (REACH), Supplemental Year 2017 – 2018, $345,048 Co-Investigator 1. National Science Foundation (NSF) – Glutamate Delta-1 Receptor and Metabotropic Glutamate Receptor Interaction, September 2015 – 2019 ($726,146). Grants, Submitted Not Funded Principal Investigator 1. National Institute of Health (NIH) - My Heart Risk App Redesign; $335,270 over 3 years 2. Health Resources and Services Administration - Childhood Obesity Prevention and Education (COPE) Mobile Application; $10,00 for 1 year 3. Omaha Community Foundation - CPHHE-REACH Physical Activity Day; $28,867 over 1 year 4. Blue Cross Blue Shield - CPHHE-REACH Physical Activity Day; $4980 over 1 year Presentations

1. Kosoko-Lasaki O, Brown R, Issaka A. “Promoting Physical Activities in Omaha Housing Towers: The Nebraska REACH Experience” presented at Health and Housing- Collaborative Efforts during the NCRC NAHRO Conference, April 16-18, 2019 at Hilton, Omaha, NE. April 16, 2019 2. Kosoko-Lasaki O. “Cultural Competency Awareness in Health Care: A Seminar for Health Career Ambassadors Students and Community Health Advocates” presented for HCOP and CPHHE Programs, Creighton University, Omaha, NE. March 2, 2019.

3. Kosoko-Lasaki O. “Cultural Awareness in Community Based Participatory Research (CBPR): Center for Promoting Health and Health Equity as a Case Study”, presented in a 2019 HS-MACA Post-Bac and Pre Matric Graduates 48 2018-2019train-the-trainer HS-MACA workshop Annual Report for a PCORI grant award, School of Pharmacy and Health Professionals, Creighton University, Omaha, NE. January 23, 2019 2018-2019 HS-MACA Annual Report 49 Appendix A - 2018 SRI Student Abstracts Role of gastrin-releasing peptide and its receptor in zebrafish fear behavior Nick Choi Hypothesis: Our hypothesis is that the areas of the brain that control fear behaviors that are essential for survival evolved Effect of L-Cysteine on Cataractogenesis in Cultured Bovine Lenses Creighton University (Omaha, NE) early in vertebrate history and were conserved amongst subsequent evolutionary lineages. Gene expression (grp) and behavior Mentor: Laura Bruce, Ph.D analyses will test our hypothesis that homologs of mammalian genes that mediate fear behaviors: (1) are co-expressed in Anthony Baker Purpose: Cataracts, which refers to clouding of the lens, is the leading cause of blindness worldwide1. It is well School of Medicine amygdalar-like areas (DM) of zebrafish; and (2) have conserved roles in controlling fear behaviors in zebrafish and mice, even Nebraska Wesleyan University (Omaha, NE) established that loss of solubility of lens proteins is an underlying pathology in cataractogenesis2. Moreover, amino though bony fish and mammals evolved independently from mammals for about 310 million years. Mentor: Catherine Opere, MBA, PhD. acids have been shown to slow down cataractogenesis in cultured goat lenses3. Therefore, we hypothesize that Behavior: In the brain, the amygdala is the basis of the emotional learning circuit. Specifically, the amygdalar basolateral Department of Biomedical Sciences L-cysteine (LC) can prevent cataractogenesis in cultured bovine lenses. There is evidence that hydrogen peroxide complex (BLC) is crucial for sensory convergence for conditioned stimuli (light), unconditioned stimuli (shock), and for the extinction, retention, and learning of these stimuli. The (H2O2) content is elevated in aqueous humor in cataract patients4. Moreover, human cataracts and H2O2-induced gastrin-releasing peptide (Grp) is a neurotransmitter that is highly expressed in excitatory neurons in rodent basolateral complex. Gastrin-releasing peptide receptor (GrpR) is cataract exhibit some similar lenticular pattern of damage5. Therefore, the aim of this study is to compare the effect expressed in GABAergic inhibitory interneurons, which will help with negative feedback on the basolateral complex neurons. Previous studies in mice show that grp and grpr help LC on cataractogenesis induced by low (10 mM) and high (50 mM) concentrations of H2O2 on cultured bovine lenses using light transmittance and measurement of soluble proteins. regulate the formation of emotional memories and the retention of these memories (other rat studies). Methods: Freshly isolated bovine lenses were cultured in a DMEM buffer solution containing as follows: Group I: Control (DMEM); Group II: H2O2 (10mM or 50 mM); Group III-XII: LC (10-6M to 10-3M; ascorbic acid (AA; 3mM & 10 mM) in presence and absence of H2O2 (10 mM or 50 mM). Lens transmittance was determined using a plate reader (Synergy H1 In order to determine if grp and grpr function is consistent and preserved across species, we tested the zebrafish with a cued fear conditioning task using grp-- and grpr- mutant hybrid reader; Bio Tek Instruments, Inc) and by visual inspection every 3 hours for 6 hours, and then every 24 hours for 72 hours. Pictures of these plates were taken against a black zebrafish that tests amygdalar memory, using freezing to gauge fear behavior. Adult grp-mutant, heterozygote, and wildtype zebrafish rarely froze after the 8 second red light grid immediately following the transmittance measurements. Soluble protein in lens homogenates was assessed using the Fourier Transformed Infrared (FTIR) spectrophotometer stimulus in the adaptation phase. When the last second of the red light phase was paired with the shock (learning trials), all groups reacted similarly, increasing the number of IRPrestige (Shimadzu). average freezing ratios. During the retention and extinction phases that followed, the red light phase continued but no longer paired with the shock. The mutant grp- and grpr- fish Results: DMEM-cultured lenses exhibited a time dependent decrease in transmittance (420nm) and a corresponding loss of lens optical clarity up to 72 hours. LC (10-6M & 10-5M) showed the lowest freezing times during this retention stage, with heterotypes being intermediate to the wild. preserved and improved transmittance up to 72 hours, achieving a significant (p<0.0001; n=6) increase in transmittance of 23.90% and 11.66%, respectively. H2O2 (10 mM; 50 mM; 100mM) decreased light transmittance in a time-dependent manner, achieving an inhibition of 41.98%, 46.37% and 77.12%, respectively. Interestingly, LC (10-6 to 10-3M) partially In situ hybridization: In mice, the formation of emotional memories uses a neuronal circuit involving neurons that express gpc3, prkcd, and grp, so we wanted to see if the reversed H2O2 (10 mM and 50 mM)-induced decline in transmittance in a comparable manner. zebrafish had a similar neuronal circuit. We used in situ hybridization to establish the spatial expression patterns of gpc3, prkcd, and grp in the zebrafish. Fixed brains were cut Conclusion: LC preserved lenses from time-dependent degradation and partially protected lenses from peroxide-induced degradation, suggesting that this amino acid could play a into 30 μm sections using a freezing microtome The brain sections were then digested with Proteinase K and prehybridized in a formamide solution. The digoxigenin (DIG)-labeled significant role in management of cataracts. riboprobe was then added to the solution, and the sections were incubated overnight. The following day, the sections were washed and placed into a block solution. The anti-DIG was then added and the sections incubated overnight. The sections were washed and put in BM purple in order to be stained and visualized. have previously demonstrated that Grp mRNA is highly expressed in the dorsomedial region of the zebrafish (Danio Rerio) forebrain; the proposed homologue of the mammalian basolateral complex that contains grp- and grpr- expressing neurons. Immune Cell Activation and Inflammation Associated with Incisional Hernia After an abdominal surgery, an average of 11% of patients develop an incisional hernia, requiring approximately 200,000 repairs a year. Understanding the mechanism behind Modified CCR5 Monoclonal Antibodies for HIV protection: Production, purification and characterization its formation is important in devising a strategic method in order to prevent these occurrences. An incision is a type of tissue One challenge for effectively treating HIV today is continual adherence to antiretroviral drugs (ARVs). Lack of drug adherence reduces the effectiveness of treatment such as Jessica Cabusog injury that will elicit an inflammatory response to begin the recovery process. Therefore, it is proposed that the activation Lucy Chung viral rebounding, reductions in CD4 cell count, and possible mutations in HIV during replication leading to drug resistance. University of Hawaii (Hawaii) of immune cells and sustenance of inflammation will result in delayed laparotomy wound healing and subsequent incisional Creighton University (Omaha, NE) HIV infection occurs by gp120 binding to CD4 receptors expressed in immune cells, inducing a conformational change in CD Mentor: Devendra Agrawal, PhD. hernia formation. The objective of this experiment was to screen various immune cells associated with tissues harvested from Mentor: Chris Destache, Pharm.D. which exposes gp41to the coreceptor, CCR5. CCR5 binding facilitates viral entry and recent discoveries demonstrate individuals School of Medicine incisional hernia patients. The border fat, border muscle, border tissue, hernia dermis, hernia fat, and hernia sac tissues were Department of Pharmacology homozygous for a delta-32 base-pair deletion in the CCR5 gene are resistant to HIV infection and partially resistant for obtained from 8 incisional hernia patients and screened for 4 immune cells markers: CD16 (neutrophils), CD68 (macrophages), heterozygotes. CCR5 antagonists like maraviroc can effectively inhibit viral entry but have poor bioavailability, low tolerability, CCR7 (M1 macrophages), and CD206 (M2 macrophages). After immunofluorescence and imaging, the presence of these and adverse side effects. Currently, no CCR5 antibodies have been approved for HIV treatment but preclinical and clinical data activated immune cells was confirmed. Sustained neutrophil accumulation is destructive towards tissue by creating oxidative demonstrates several advantages over existing ARVs. This project focuses on the production, purification, and characterization of stress, while sustained macrophage accumulation continues to encourage inflammation by releasing inflammatory cytokines. In addition, higher expression of M1 macrophages the modified XF-CCR5 monoclonal antibodies (mAb) from XF-CCR5 28/27 43E2AA hybridoma. XF-CCR5 mAb conjugated to ARV loaded nanoparticles (NP) further enhances binding (pro-inflammatory) compared to M2 macrophages (anti-inflammatory) indicates that the tissues were still in a state of inflammation, offering supporting evidence to the proposed hypothesis that immune cell activation and inflammation results in delayed laparotomy wound healing and subsequent incisional hernia formation. affinity to CCR5+ CD4+ cells. Future studies will determine the long-acting potency of XF-CCR5 mAb for pre-exposure prophylaxis (PrEP) against HIV infection. 50 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 51 The Effect of the Pathogen Serratia marcescens on The Lipid Composition in Squash bugs Anasa tristis Differential expression of Cathepsin L in coronary arteries of atherosclerotic swine Haaris Shahid The purpose of this study is to elucidate the role of lipids in the immune response of the squash bug, Anasa tristis. We are Marco Pena Drake University (Des Moines, IA) investigating the changes in lipid composition from the squash bugs when injected with nutrient broth (control), versus those Omaha South High School (Omaha, Aim: Heart disease has been the leading cause of death in the United States, and there have been various temporary Mentor: Eric Haas, PhD. injected with the microorganism, Serratia marcescens (experimental). We are ultimately looking for the compound arachidonic treatments. Recently, there has been work done with the cysteine protease cathepsin L. CTSL is found in almost any tissue Nebraska) or cell at low expressions. Recent studies have indicated that CTSL holds a spot as a reliable marker for Coronary Artery Department of Chemistry acid which has an immune function. When under attack, the squash bug releases Arachidonic acid from their cell membranes Mentor: Devendra K. Agrawal, PhD. and from there, a series of chemical reactions occur to convert arachidonic acid into compounds called eicosanoids. There are Disease(CAD). The aim is to see how Vitamin D can inhibit CTSL and benefit atherosclerotic patients by reducing intimal School of Medicine hyperplasia after angioplasty. three main types of eicosanoids. The focus of this research is on one of the eicosanoids called: prostaglandins, they play a major role in the mediation of their immune response. Using the GC/MS, we looked for differences in the components of the fatty acid Method: Micro Yucatan swine were fed a high fat high cholesterol atherosclerotic diet with different vitamin D levels in the diet; vitamin D -deficient, -sufficient and -supplement methyl esters based upon how their immune system responds to infection. The results of this experiment will be focused toward deriving a baseline for lipid composition of infected diet. The pigs were on this diet for 4 months before undergoing angioplasty. The pigs went through angioplasty to damage the endothelium layer in the coronary artery. Then, they squash bugs, so that independent variables can be altered going forward. were kept for another 6 months on the experimental diet. The animals were euthanized and tissue samples were collected for analysis. The tissues were then stained, and imaged in an immunofluorescence microscopy to see the expression of cathepsin L in the coronary arteries. Upregulated miR-424 mediates TGF-β induced fibroblast differentiation in pulmonary fibrosis Jessica Grimmond Background/Objective: Pulmonary fibrosis is a progressive interstitial lung disease characterized by fibrosis, or tissue scarring. Results: The expression of cathepsin L in the coronary artery of the atherosclerotic swine were significantly lower in the vitamin D sufficient and vitamin D supplemental swine than Drake University (Des Moines, IA) The transforming growth factor beta (TGF-β) pathway has been implicated in pulmonary fibrosis. In the lungs, TGF-β is a primary the vitamin D deficient fed animals. fibrotic mediator and triggers Smad3 and Smad4 transcription factors to activate pro-fibrotic genes, leading to fibroblast Mentor: Yaping Tu, PhD. The Social Reality of Troubled Young Adults in Juvenile Involvement Department of Pharmacology differentiation, epithelial mesenchymal transition, and increased collagen deposition. This pathway is regulated by microRNAs. MicroRNAs (miRNAs) are non-coding RNA molecules that regulate gene expression by directly binding to mRNA molecules to Elsa Ramirez prevent translation or cause destabilization of the mRNA. The objective is to find a microRNA that increases its expression after Omaha South High (Omaha, NE) Aim: As we look into the root causes of homelessness and crime involvement, younger individuals appear to be influenced by the TGF-β treatment and determine its effects on fibroblast differentiation. Methods: To determine what microRNAs have a change in Mentor: Blanca Mejia lack of support and feelings of abandonment from parents or caregivers. My aim is to discover the root cause of homelessness and expression after TGF-β treatment, RNA sequencing was used. The real time polymerase chain reaction (RT-PCR) was used to detect the change in expression of miR-424 after TGF-β Latino Community Betterment crime involvement of males from 19 to 25 years old. Ultimately, to understand the social reality of these individuals that end up in and SIS3 treatment. To confirm the role of miR-424 as a pro-fibrotic mediator in human tissue, RT-PCR was done to determine collagen, miR-424, and Slit2 levels in healthy and IPF Corporation transitional homes/ support programs. human tissue samples. Loss and gain of function study was completed using lipofectamine transfection and Western Blot. To elucidate where in the TGF-β pathway miR-424 acts on, (Generation Diamond) a Smad3 phosphorylation study was completed. Results: miR-424 was selected for study due to its high expression levels and little previous research on it. It was discovered that Method: I will be interviewing participants in the Latino Community Betterment Corporation program; that have experienced the adding SIS3 to inhibit Smad3 led to blocking the effects of TGF-β and decreased expression of miR-424, suggesting that miR-424 activation is Smad3 dependent. Collagen and miR- services of the program. We will ask open ended questions to allow participants to share their story on how they feel their life became unmanageable, as well as, how the program has 424 expression levels increase in fibrotic tissues. In the loss of function study, it was found that miR-424 inhibition led to the effects of TGF-β being blocked and a decrease in α-SMA helped change their perspective on their future. We hope to gather the information and to figure out if there is a repeated pattern of events that affect each individual. In addition, to and CTGF. In the gain of function study, the overexpression of miR-424 increases the effects of TGF-β. α-SMA and CTGF increase in the presence of TGF-β and miR-424 mimic. Lastly, understand the services provided from the program I must immerse myself in the daily surroundings of the participants in transitional homes. miR-424 inhibitor decreases p-smad3, indicating that the target of miR-424 is in the TGF-β pathway before p-smad3. Slit2 levels decrease in diseased tissues, indicating that Slit2 could be the target of miR-424. Conclusion: miR-424 is a pro-fibrotic microRNA that mediates TGF-β induced fibroblast differentiation in pulmonary fibrosis. Hypothesis: Participants in transitional homes are experiencing difficulties in their lives that prevent them to pursue and succeed in their daily tasks. I hypothesized that these could be effects of childhood disruptive events; such as having limited influences and resources. Other possibilities include feelings of abandonment or lack of support at an early age. While Memory and behavioral analysis of glutamate delta-1 conditional knockout mice in the hippocampus and cortex being part of a program or transitional house aims to help the individuals succeed they also discover the social realities the participants experience on a daily basis. Audrey Keim Delta receptors are a subfamily of ionotropic glutamate receptors (iGluR) including NMDA, AMPA, and Kainate receptors. These receptors function with the acting agonists, glycine and D-serine and are subdivided into GluD1 and GluD2 receptors. GluD1 KO Results: After interviewing the participants of the Latino Community Betterment Corporation, I collected all the information to see which factor of the ACE’s was more common; abuse, Missouri Western State University mice have been linked to emotional and behavioral abnormalities and been implicated in schizophrenia, autism, and bipolar neglect, violence, addiction, incarceration, mental illness/ depression, or loss of a parent/ caregiver. Up to 26% had some experience of substance abuse prior and during their criminal (Saint Joseph, MO) disorder. The aim of this study is to analyze the behavioral role of GluD1 in the hippocampus and cortex to understand their involvement. The two second highest factors were having divorced parents and/or a family member with a mental illness: this was around 16% of the individuals. According to the Mentor: Shashank Dravid, Ph.D role in learning and memory. Novel object recognition (NOR) involved 3 trials recorded for 10 minutes each. The first trial was ACE’s study, these factors can leave detrimental effects of a person, each participant shared their thoughts of what how these experiences affect their social skills with others around Department of Pharmacology object conditioning, with two of the same objects placed in a bin. The second trial was running 30 minutes after the first trial them. It also affected the way they viewed their own goals and future. Ultimately, this created a new question: what can the community provide to help these individuals change their and replaced one of the objects from trial one with a novel object. The third trial replaced the novel object from trial two with a perspective on their future? different novel object. 5 CSUS conditioning took place over 7 days. Day 1 conditioned the mice with a conditioned stimulus (CS) and unconditioned stimulus (US). Day 2,3 and 7 tested for contextual and short-long term cued recall memory. During NOR no conclusion could be made about the memory of the 52Emx1 2018-2019KO and Emx1 HS-MACA WT mice Annual due Reportto failure of test. Results from 5CSUS allow us to recognize GluD1 signal needed for memory formation. 2018-2019 HS-MACA Annual Report 53 Health Disparities based on Attitudes and Beliefs in Native American Culture Godwin Djossou Intro - Native Americans are mainly viewed with statistics when it comes to research with no real voice. If we look at data Appendix B - Health Disparities Conference Summary 2019 Creighton Preparatory High (Omaha, in 2016, Native Americans made up 31.6% of the poverty rate in Nebraska (“www.talkpoverty.org”). People in poverty Nebraska) face health disparities simply because they can’t afford care and can’t get access to care. We looked into the areas of Preface Mentor: Dr. Donna Polk career exploration, relationships, drug/alcohol abuse, sexual health, domestic violence, and gang violence to find out Nebraska Urban Indian Health Coalition what specifically needed awareness in this community. My hypothesis was that one of the causes of poverty and health The United States’ Center for Disease Control and Prevention (CDC) informs us that “mental health includes our emotional, psychological, and social well-being. It affects how we disparities is the thoughts attitudes and beliefs they grow up with. think, feel, and act. It also helps determine how we handle stress, relate to others, and make healthy choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.” Mental health is influenced by external situations and internal, individual factors. “Mental illness” involves “conditions that affect a Methods - The main methods used were focus groups and a demographic questionnaire to collect data. This was used because the we wanted to know specific beliefs and attitudes person’s thinking, feeling, mood or behavior, such as depression, anxiety, bipolar disorder, or schizophrenia. Such conditions may be occasional or long-lasting (chronic) and affect of Native American youth (ages 12-18). I felt as if youth were the best option because in talking about health disparities you want to find the original roots of the problems. Using someone’s ability to relate to others and function each day.” (Cite source) It is imperative to reduce disparities care for mental illness and to promote mental health equity. focus group we could also hear from their specific experiences on topics that we designated. We had 2 focus groups one of 6 youth and another of 7 for a total of 13 youth. In the United States, the CDC reports that: Results - After we had our focus group we transcribed it into text and used the significant things that the kids said to put a voice on this research project. For the demographic questionnaire we sorted all the data into a chart which shows how many people answered yes, no, and n/a (for the no answers). Future directives - For the future, we need more • Over 50% will of the population will be diagnosed with a mental illness or disorder during their lifetime. Native American representation in the health and science departments to lead these types of research studies. We also need to expand this research further beyond and get more data to solidify the numbers concerning Native American health data. • 1 in 5 Americans will experience a mental illness in a given year.

The Normal Lipid Composition of Whole Squash Bugs Anasa tristis • 1 in 5 children have or have had a seriously debilitating mental illness. Zachary Klimowicz The immune system of Anasa Tristis (Squash Bug) relies on the synthesis of arachidonic acid to several eicosanoids when met • 1 in 25 Americans lives with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression. Millard North High (Omaha, NE) with the enzyme cyclooxygenase. The most prevalent of the eicosanoids in immune response in squash bugs is prostaglandin, Mentor: Eric Haas, Ph.D which is also by the same process responsible in the act of inflammation in the human immune system. This study relied on To decrease the incidence and prevalence of mental illness, we must enhance policies and systems at every level (local, state, national) and improve healthcare, promote Department of Chemistry testing the composition of lipids (including arachidonic acid) when the foreign pathogenic bacterium Serratia Marcescens community development, and enhance insurance coverage. Thus, promoting community mental health equity is complex. Systems should not only systematically review and was introduced in the squash bug, as well as the response when cyclooxygenase was inhibited by dexamethasone to block revise their mental health strategies and structures, they should augment or develop community-centered approaches. prostaglandin synthesis. [Center for Disease Control and Prevention, https://www.cdc.gov/mentalhealth/learn/index.htm] Androgen Receptor Resistance to TRAIL Inducing Apoptosis in Triple Negative Breast Cancer

Jude Kouassi Background: Breast cancer cells are usually classified into 4 different types, HER+, ER+, PR+, and TNBC (triple negative Creighton Preparatory High (Omaha, NE) breast cancer). 1 Here, we focused on the TNBC cells. This cancer is very deadly due to it only being treatable with radiation Mentor: Yaping Tu, Ph.D and chemotherapy as opposed to more targeted therapies. 1 Some cancers can be treated by a more targeted therapy School of Pharmacology called TRAIL, which induces apoptosis (cell programed death) mainly in cancer cells. 3 The problem is that some TNBC cell lines with androgen receptors (AR) manage to resist TRAIL.3 So we asked ourselves, if we can knock out the AR, can we then make the cells susceptible to TRAIL? To answer this question, we compared TRAIL susceptibility in MDA-MB-436 cells without AR and with AR. Method: For this study we used MDA-MB-436 cells and seeded them into 6-well plates. In 3 of the plates there were cells that had AR. In the other 3 we seeded cells without AR. We then added trail and incubated them for 6 hours. After six hours, we harvested the cells and performed western blot analysis to see and compare the ratio of PARP to cleaved PARP, and indicator of apoptosis. Results: Compared to control cells, MDA-MB-436/AR cells decrease TRAIL-Induced PARP- Cleavage Conclusion: The overexpression of AR increases resistance to TRAIL-induced apoptosis by decreasing PARP cleavage. Therefore, we believe that a inhibition of AR will increase the potency of TRAIL against Triple Negative Breast Cancer.

54 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 55 religious communities rather than seeking medical help from hospitals and clinics. A third group that was discussed during the seminar as having mental health disparities was Appendix C - Student Reflections - Health Disparity Seminar the Native American population, who did not seem to be discussed as much as other groups throughout the program.

Albert Cohen Sedgh 2. How can we reduce these disparities in our nation based on lessons learnt from the seminar? The most important solution that was discussed during the seminar sounded much like cultural Health disparities are the inequalities and differences that occur in the provision of healthcare and access to healthcare across different racial, ethnic and socioeconomic groups. Health disparities can happen nation wide and within any population. However, health disparities are a well-known problem among the minority, low income population. competence/humility. This solution was discussed extensively during the presentation about the transgender population. One aspect of cultural competence that could reduce Factors that lead to health disparities include: poverty, poor access to healthcare, and level of education. In the United States, health disparities can be observed among ethnic health disparities is training of health care providers to improve patient-provider communication and break down the barriers that hinder mutual understanding. Patient-provider minorities such as: African American, Latinos, Native Americans, and Asian Americans. Most of these people cannot afford the high costs of healthcare and complain how their communications can be improved through exposing health care providers to diverse patients while they are training as medical students. Furthermore, the best way to break lives is affected by not having access to a good, affordable healthcare. Mental disorders define conditions in which the individual’s behavior and thinking is associated with down the barriers that hinder the patient-provider relationship is to reduce the social stigmas surrounding different conditions, particularly those involving mental health. distress and impaired functioning. Accessing mental health professional for mental and emotional problem and difficulty accessing mental health services are mental health Enacted stigmas and internalized stigmas are large obstacles to effective and efficient treatment due to the effects they have on those who should be seeking help for their disparities among the minority, women and low-income families in Omaha. conditions. Based on what I learned from Health disparities Seminar, I think the first thing we can do to reduce mental/behavior health disparities in our nation is well designed healthcare 3. What recommendations do you have for those that did not attend the seminar base on what you learnt from the keynote speaker? provider which can be trusted by individuals and is available to everyone. Increasing individual’s awareness about other non-professional helps such friends, family and community groups can also reduce these disparities. Providing free language assistance can be very helpful for many minority groups because they feel more comfortable One recommendation I have for those who did not attend the seminar is to practice self-reflection after each experience, whether it is a health care related experience explaining their mental health issue using their native language. Health providers should be well prepared and educated about different culture, beliefs, and religions. Cultural or not, as there is always something new to learn. I believe that doing so is a great way to improve oneself and grow as a person through ways that cannot be taught in a awareness can reduce the health disparities barriers. I think it is a good idea that health providers always follow up with patients and show patients how their health is very classroom. Only by admitting that he or she is not perfect can a person learn to better themselves everyday through every experience they find themselves in. Such self- important and health providers would do anything to improve individuals’ life. evaluation is an important part of cultural humility, and practicing constant self-reflection to improve oneself as a person can greatly reduce the heath disparities that many groups worldwide experience today. As a physician or dentist, these seminars can increase your awareness about health disparities in our nation and states. By attending these types of seminars, individuals can learn about health disparities barriers and learn important concepts which can be useful to improve relationship between patients and healthcare providers. These seminars 4. Any other thoughts? Conclusions? provide good data an information about minority groups and their problems when it come to healthcare, so by attending these seminars, we receive free information which can improve our carrier. The seminar is also useful for any other individual beside healthcare providers because it increases their awareness about what kind of help and assistance I enjoyed the seminar due to the fact that I learned about several new health disparities that I had not known about before, such as possible reasons why Hispanic Americans are available in their area. do not receive or seek as much mental health care/support as other groups in America do. The keynote speaker’s discussion about drug abuse was also enlightening, as there were many statistics in her presentation that helped me gain a better understanding of just how dire the situation really is. In conclusion, the seminar taught me about factors that causing health disparities and how we can reduce health disparities barriers in our community. As a future dentist, this type of seminar can help me to improve that factors needed to improve my relation with patients. Anny Nguyen Health Disparities Seminar Reflection Paper Alex Sasaki 1. Who is experiencing the disparities and what kinds of mental/behavioral health disparities are there in Omaha? The nation?

Health Disparities Seminar Response Mental/behavioral health disparities affects everyone of all ages and stages of life, especially individuals who are unable to access resources to combat these health problems. Within the Nebraskan state, 1 in 5 Nebraskans will report having or experiencing a mental illness in the year. In the nation, the numbers reported are 1. Who is experiencing disparities and what kinds of mental/behavioral health disparities are there in Omaha? The nation? similar to the Nebraska state where 1 in 5 individuals within the United States experiences a behavioral illness. Other individuals that were mentioned within the sem- inar are those who are uninsured, Hispanics, and Native Americans. Mental health is an important issue to understand and solve because it affects every individual at Health disparities are defined as differences in health outcomes in a particular group, typically linked with social, economic, or environmental disadvantages. One group least once or more in their lifetime. For the uninsured it is due to the difficulty of obtaining medical insurance. However, even with having insurance, patients will be on discussed during the seminar that is suffering from health disparities is the transgender population. Surveys and studies found that between 15 to 20% of a group of transgender the waitlist for years before being able to get an appointment or to schedule a visit with a physician for these illnesses. females had attempted suicide at least once in their lifetime, while 41% of transgender and gender non-conforming individuals surveyed nationally had attempted suicide at least once. Another group that was discussed is Latinos in America. Latino Americans suffer from a health disparity in the frequency of mental health support/treatment they receive, The kinds of mental/behavioral illnesses that plague the majority of the 1st world countries can be separated into different categories. First, there are the mood mainly due to the low frequency with which they seek help. 1 in 11 Hispanics with a mental health disorder contact a mental health specialist. At the same time, fewer than 1 in 5 disorders that encompass major depression, persistent depression, bi-polar depression or postpartum depression. Second are the anxiety disorder that include obses- seek general health care. The main reason why this is so is because of their faith. Many Hispanic Americans seek mental health support/treatment first from clergymen from their sive compulsive disorder, phobias, or panic attacks. Several other mental illnesses are schizophrenia, eating disorders, personality disorders, autism, and substance use 56 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 57 disorder. Substance use disorder was discussed a lot, primarily by the keynote speaker, where individuals are unable to get access to the help they need in time. covering for mental health appointments is an issue that contributes to the unending cycle of mental health disparities. There seems to be little movement to bring change to the practice of insurers covering mental health, in Omaha and nationwide. We have to encourage that mental health screening should be a standard annual check-up just like a 2. How can we reduce these disparities in our nation based on lessons learnt from the seminar? physical examination that is required by many health insurance companies. There are certain barriers discussed within the seminar against mental health disparities. These barriers include lack of resources, lack of awareness about mental When we look at the field of healthcare and the technological and medicinal advancements we have achieved as a nation over the last century, it is mindboggling that the health, cultural stigmatization, health care system distrust, and inadequate support for individuals. Certain ways to help reduce these disparities is improve screenings existing disparities seem to be growing at an alarming rate. For someone who did not attend the seminar, I would recommend that they first ask themselves this question: What done by family physicians and increasing awareness of mental health in nonmedical resources like the family and friends. Another method is to help educate and better do I know about health disparities? It’s only when we answer this question personally that we start to open-up our minds to problems that exist beyond our personal struggles. train mental health staff to understand cultural differences regarding these illnesses due to cultures having different ways of responding or coping with mental health. We are finally starting to ask this question and the answers are found in our communities, if we give it an effort. Just in Omaha, the disparities are not prevalent within the Other ways to challenge the stigma of mental health is to increase resources to patients by facilitating partnerships with collaborative care. One of the best ways to in- city limits. There’s a wide gap in healthcare delivery and accessibility in rural Nebraska, just outside of Omaha metro. We have to ask ourselves the right questions about the crease awareness within the nation is to talk and reach out to legislatures like Senator Sue Crawford. disparities that we are currently faced with. Secondly, I would recommend that we must recognize that there are many individuals, many of from advantaged and disadvantaged communities, that are not aware of the existing resources for them to get the help they need. This is our responsibility as students and healthcare professionals to assist them in 3. What recommendations do you have for others that did not attend the seminar based on what you learnt from the keynote speaker? this regard. It starts with us, we have had the privilege to educate ourselves about medicine and our dedication to improve the lives others.

For those who did not attend the seminar, one of the recommendations I would give to these individuals is that there are resources out there and we as a community Daniel Paku can always increase awareness of mental health. These suggestions are those from the keynote speaker. One resource is the substance abuse and mental health services administration (SAMHSA) who’s main mission is to reduce substance abuse and mental illness impact on the community. To accomplish this mission, the administration The twelfth annual health disparity seminar highlighted that the issue of mental health is one that is important nationally as well as in the Omaha community. This issue is has set some goals of focusing on the improvement of access to individuals and addressing social determinants. Other programs and resources include the prevention important because the issues associated with mental health do not discriminate when it comes to who is affected as the issues affect men, women, children of all races and technology transfer center, rural opioid technical assistance, addition technology transfer center, etc. With the increase of these programs, we can help decrease the socioeconomic backgrounds. Although this issue affects people from all walks of like this seminar has taught me that issues in mental health disproportionality affects minorities impact of mental illnesses on the family and victims of substance abuse. such as African Americans and Hispanics more. One of the main problems why this disproportionality exists is because of less access to mental healthcare services. I have learned 4. Any other thoughts? Conclusion. that minorities also have a perceived stigma associated with mental health which leads to not seeking services. Minorites often do not seek professional help because they are afraid of being perceived as being crazy and often downplay the issues that they are struggling with. Minorities especially Hispanics are often more willing to seek help from a The seminar has expanded my knowledge and understanding of mental health and how much it has impacted the community and the nation. Mental illness has affected spiritual leader such as a pastor instead of therapist. This insight is useful because we in the healthcare community can take advantage of the relationships that spiritual leaders every individual from those as young as 14 (or younger) to those who have insurance but are unable to access the resources. I feel the main thing to help with raising have developed and use that to deliver mental health care that is necessary. To those who did not attend I would recommend that they make sure to attend the following year or awareness of mental health is to increase understanding within the community and professional on how to treat individuals with mental illnesses. Mental health is im- read this year’s powerpoints because there was useful information and breakout sessions. portant, especially within this day and age with the increasing stress of everyday life and problems. Bianca Luna Ansar Wali The Annual health disparities seminar asw very inciteful, not only did it speak of issues that were local here in Omaha, but it was very diverse on the races and th ethnicities in which these disparities that are found and not just focused on one. There were various topics discussed; Mental health and Sickle cell anemia, Transforming access The 12 Annual Addressing Health Disparities Seminar focused on the problem we face of providing proper mental health care in our communities across the nation and to mental health through the collaborative care model, Overview on Mental Health/Behavior in the Omaha community, The Native American Community: Mental Health care specifically here in Omaha. The problems persist in many forms. For example, there are individuals in our communities who do not have access to medical treatment. This issue and Religion and spirituality etc. It is very important to me to understand the who is experiencing health disparities and what those disparities are because when I start clinic in has compounded the issues that we face with the lack of mental health. Affected by this mostly are people who are economically disadvantaged and the poor. I will address why dental school and at One World the majority of these people from the local community will coming in for treatment. It is important that I educate myself to understand a new this vicious cycle continues and how we can tackle such issues in the next section. I learned that addressing a health disparity, or disparity in any realm, by stating that it is a home and community to provide and learn how to give better patient care. The speakers at the seminar gave a lot of data on health disparities in Omaha and the nation, Kinnan problem and that its very nature exists in our communities. Shannon and Dr. Roberto Cervantes focused on the Latino population and their health disparities. The large percent of patients that go to one world here in Omaha are Latino. Throughout the seminar the focus was to really dig into what we can do as students and professionals not only address the existing disparities but how we can personally make Dr. Gbadamosi-Akindele’s Sickle cell disease presentation states that this disease is most common in patients of African, Hispanic, Asian and Mediterranean decent. Dr. Donna a difference. One of the main things that struck me right away is that those who are facing challenges in accessing proper and adequate healthcare are usually unaware of the Stewart from Boys Town presented on specially the Omaha community and spoke about the local disparities of Hispanic/Latino, Black/African Americans, Asians and a category of federally funded health centers that they may be able to qualify for. They are not informed and it’s not due to their own ignorance. We have to do a better job of providing proper “other”. Dr. Donna Polk gave a very interesting presentation on Native American and their disparities in the Omaha community. It is important to note that all of these races and information and letting people know that there is available help and where to find it. It certainly does not help that because mental health treatments are less likely to be covered more have health disparities in not only Omaha but nationwide. by insurance there is a large, and significantly growing number of individuals that are forced to pay out of pocket. More times than not, in poorer communities, taking care of One presentation I particularly was interested was Dr. Cervantes on Religion and spirituality because we have always been taught in school, well in non-religious based your own mental well-being does not take precedence over other outstanding factors such as family expenditures, bills, groceries, and other factors. So, the lack of insurers schools to keep religion out of conversations to avoid offending people or making other’s feel uncomfortable. It was interesting to hear about building patient trust through 58 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 59 the use of religious, or spiritual content because it does make patients feel as if you care and are there for them as person. His presentation focused on “Acceptance and with patients from marginalized populations so they can truly be care givers. Aside from individual interactions more needs to be done on a structural and policy level. Financial understanding of inter-religious differences,” which I would like to see more providers attempt to help make not only Latinos as he focused, but all other races as well. Especially resources need to be allocated for treatment of mental and behavioral health resources. Laws need to be created or adjusted to include and protect vulnerable populations or here in Omaha I think it would be helpful because we have a large refugee population and gaining a patient trust is important for optimal patient care. This is one way to help populations that have historically been discriminated against. Those in positions of power and privilege need to utilize those advantages to advocate for those without power and address the disparities locally and nationally but there are other ways such as Medicaid expansion to increase patient access to healthcare services, addition of integrative privilege. consultative strategies, increasing recourses in underserved areas, improve physician screenings, improve awareness of non-professional sources, educate and train medical staff to be culturally competent aware, develop culture-specific mental health education tools and lastly is “reduce the health disparities among residents identified as at risk for The main take away from the seminar was that health disparities in the mental health field is very real and we have a lot of work to do to address those disparities. various conditions and combat socio-economic factors that historically have had a negative impact on resident’s health.” Antonio Igbokidi Attending Seminars and functions such as common ground are very beneficial, and I believe that everyone should make time to attend conferences such as these. That is my advice to people who did not attend, make time to learn about other’s and the issues that surround your community because those disparities revolve around people who Health isn’t just about what you eat, it’s about what you are thinking and feeling too. The 2019 Mental Health Disparities Seminar was paradigm in the understanding live in your community and will be going to your clinic, grocery store, schools, shopping centers and restaurants. Disparity awareness education should not only be fixed on being and discussion of the health of our minds as individuals and the health of our minds as a community. From the seminar, it became evident that mental health is overlooked and learned by health professionals only but for everyone providing a service for others. I very much enjoyed hearing the many presenters at the Seminar and learning of a diverse undernourished when it comes to support. There are many groups of people, underrepresented and underserved, who unfortunately fall into the category of suffering from group of disparities. mental health illnesses. Fortunately, there are many interventions and educative steps that we can take to begin the mitigation of this health disparity and provide services for people suffering from mental health problems.

Olufunmilayo Badejo Mental health is the mental functioning that allows us to live in our day to day lives. Mental illness is the term that refers collectively to all diagnosable mental disorders. It is important to know that suffering from a mental illness is similar to suffering from a broken ankle or the flu, it must be taken seriously and treated expeditiously. However, The 12th annual Addressing Health Disparities Seminar on Saturday April 27th 2019 emphasized Mental/Behavioral Health. Several speakers discussed the challenges Americans we see that it is not. One in five adults in the United States experience a mental health illness in their lifetime, but less than forty-three percent of people with a mental illness face around access to mental and behavioral health care. Attitudes around mental health have been changing over the past few years which has brought attention to the dearth receive mental health treatment. From the seminar, I learned that specifically, those that are suffering from mental health illness are transgenders, homeless, African Americans, of resources in this field of medicine. and poverty-stricken people (just to name a few demographics). I also learned from the Seminar that it is enacted stigma, lack of health coverage, provider distrust, and lack of mental health resources that inhibits individuals and communities from receiving support for their dispositions. Within the lack of resources minorities and individuals from lower socioeconomic statuses were particularly victimized. Many speakers focused on the disparities minorities face in seeking and accessing mental and behavioral health care. Speaker Donna Stewart from Boys Town Behavioral Health Clinic specifically showed data around mental health The best way to address these problems is through confronting these biases in other people and within yourself. Cultural humility must be an intangible that all care accesses and resources in the greater Omaha area. One thing that stood out to me from her presentation was the clear disparity between, North, South and West Omaha. healthcare providers possess as they deal with people with mental illness. PATIENTS ARE MUCH MORE THAN JUST A PATIENT. They are mothers, fathers, sons, daughters, people North Omaha has a predominantly African American population, South Omaha has a predominantly Hispanic population and West Omaha is predominantly Caucasian. Not first. Providers should always make people with mental illness feel welcomed, inspire them to do better and reach treatment and rehabilitation, safe that they won’t be just or surprisingly North and South Omaha were shown to have the highest incidences and lowest resource allocations due to structural racism and its effects. We also heard from physically and emotionally assaulted, and hopeful that they can heal. Senator Sue Crawford on the legislative work being done to address some of the disparities and provide more resources. Tiffany White-Welchen did a really powerful exercise on bias, acknowledging it and working to prevent it from impacting the work. Dr. Shannon Kinnan spoke on the collaborative Care model, an innovative approach to health care Above all, education and awareness are essential to changing the narrative of mental health and mental health illnesses. On a local level, it will inspire those individuals which incorporates mental and behavioral care into the primary care model. Dr. Cervantes spoke on religion and spirituality and its role in mental and behavioral health and his who are apprehensive about their particular problems to get help because they will know themselves and know people will understand them. On a regional level, it will protect goal for physicians reaching out to the faith community who are often on the front lines of mental health issues. As he said most people go to their pastor before reaching out to many of our citizens who suffer from mental health disorder, especially the homeless. One in five homeless individuals suffer or have suffered from mental health. It is important their doctor. This provides a new and culturally competent approach to reach a population of people that may not want to seek out professional help for their issues. The panel for our community members and our police force to be able to understand their issues so that they can handle them and people like them with accordance and with kindness. discussion touched on the mental health implications of living with a chronic disease such as sickle cell, as well as PTSD and the effects of racism and discrimination on mental Lastly, spreading education and awareness can help on a national level, as it will agitate and encourage legislative officials to start allocating more funding to mental health health. Dr. Donna Polk touched on the lack of resources and access in the Native American community and Dr. Stone discussed mental health equity. services and medical coverage for mental health issues. Finally the keynote speaker Kimberly Nelson discussed statistics and strategies around substance abuse and mental health. Ms. Nelson touched on multiple issues but one thing All in all, I enjoyed the seminar. I was humbled and privileged to come in 2nd in the Frank T. Peak Essay Competition and give glory to a man that has done remarkable she said that really stood out to me was changing the language around mental health and substance abuse. Saying discrimination and prejudice instead of stigma. Understanding work for the Omaha community in regards to mental health. I also left the conference feeling inspired. Coming from an immediate family who suffers from mental health the pressures people may face to avoid a diagnosis or a label due to societal repercussions. She also mentioned “treating our way out of addiction rather than punishing our illnesses, I was able to empathize with the cause that the keynote speaker portrayed. Many times we try to criminalize those we don’t understand and minimalize their suffering. way out” which focused on the relationship of mental health and addiction and the prison system. People facing these issues are more likely to encounter law enforcement that It is up to us as future healthcare professionals, community leaders, and as decent human beings to change the narrative on the meaning of mental health illnesses and take medical professionals and that needs to change. Overall her presentation provided a more positive outlook on the changes that are in the works or being implemented to tackle it more seriously. Your health is important, selfcare is important, but your mental health is important too. I will continue to acknowledge that notion in my path as a future the disparities in substance abuse, mental and behavioral care. physician. Overall in order to tackle disparities we must first see and acknowledge them. We then people to be vocal about these disparities and bring attention to them, specifically the attention of those in positions of power that are able to change the way things are. Within the health care field physicians can attend trainings and be more culturally humble

60 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 61 Johnny Atencio One way we can work to reduce these disparities in our nation is to be a part of the solution. We can be a part of the solution by removing the stigma associated with mental health illnesses. As up and coming minority health care professionals, we have an advantage connecting with patients that look like us. They may be more willing to share or Work Force Disparities Reflection receive information if we make the earnest attempt to connect with them farther than just providing services. Part of being a Creighton trained health care provider is the Jesuit value “cura personalis”. We are trained to care for the whole person and that means being an advocate for our patients beyond the operatory room. We may or may not realize it, but there are many others living with disparity. In the case of The Pact, three strangers of different points of view, with living conditions we consider living in disparity, come together and flip the script to fulfill a common dream. Sampson, George, and Rameck, the main characters within the novel, met in an Some recommendations I have for individuals that did not attend the seminar and for individuals that will be working closely with people from all walks of life include educational program and make a promise with one another to succeed in life. It was not sunshine and rainbows prior to meeting each other, the three men grew up in Newark educate yourself on mental health illnesses to disrupt any negative thoughts one may have surrounding the topic, actively seek opportunities to expand your knowledge, talk and with obstacles and pitfalls. There was even jail time that was done. With jail time alone, many people would bow down and call it quits. Most people would settle for their life in share stories, and be open minded. disparity and would continue down the wrong road. Sampson, George, and Rameck however kept their heads up. They wanted to change their lives for the better. With all three of them having the same outlook in life, they decided to make a pact. The incidences of early life of the neighborhoods they grew up in and going to jail is what we could consider One thing that I took away from the seminar was the WISH Creed. The acronym WISH stands for welcoming, inspire, safe, and hope. These are four things that we should the main characters disparities. They were not born with a silver spoon and were not given the foundation for success. make sure that we are providing for our future patients. If an individual feels that they are in a safe place, they will be more open to hear what you’re saying. If we want to make a difference and actively work on reducing health disparities, we have to make sure that we are first addressing any biases we have and then use our space to foster an George mentions how friends can easily influence our decision for the better of for the worst. The pact created by these three individuals exemplifies this perfectly. They environment of non-judgment. The only way we will overcome disparities is changing the stigma and we can only do that together. kept one another accountable to ensure they met their lifelong goal of becoming doctors. They make it to the Pre-Medical/Pre-Dental plus programs with the support they give each other. With all of us currently in the Post-Baccalaureate, we all have a support system that helped us get to this point in our lives. Like George stated, we may want others to think we are cool, but in their case, and in our case, we don’t want to let others down. At the same time, we need to give back to those who support us. Rameck give us this Geraldine Manansala lesson in the book. He does bring up that the gift we give might change someone for the better, and one day they might end up saving our life as a paramedic. This would be the best way to reduce work force disparities in our nation. Supporting one another and giving back. These are topics we have discussed within our own program, and this is how we Health Disparities Reflection Paper The health disparities seminar was focused mainly of the importance of mental health and how it affected those who are can reduce work force disparities. We cannot forget where we came from and we need to ensure that we lay a good foundation for future generations, so others also have the undergoing such challenges. The groups discussed that were mainly affected were Native Americans, Latinos, African Americans, Caucasians, and previous drug users. opportunities as we did to better themselves. Presenters discussed the difficulty the respective groups undergo when it came to obtaining care for mental health issues. Issues arise because health care policy providers do not see the importance and impact mental health affects our community. For other underrepresented minorities trying to get into the health career work force I would recommend keep working hard. Sampson touches upon this too, perseverance. I would recommend that one should always keep their head up. Life is not easy for anyone. No one has anything laid out for them, and if they do happen to be Mental health has and continues to be a taboo topic. The stigma placed unto a person who has “mental health” issues becomes so negative that those affected with born with a silver spoon, they still have their trials and tribulations in life, their own disparity of some sort. I would recommend that we should not compare ourselves to anyone mental health behaviors would hold their issues to themselves. In order to reduce these disparities, I think that just talking about such issues to the community would help in else. We all have different backgrounds and thought processes. If we are constantly comparing ourselves to other people, we will never truly succeed in life. These men did not decreasing the negative outlook of the topic. I believe the more we talk about something, our society slowly accepts the humanistic part of it. An example of a topic that has compare themselves to others, but did what they tell us as readers, support, give back, and persevere. As I have stated earlier, many people will easily let the worst times get the been accepted as a norm would be those who consider themselves transgender- decades ago they would be considered sick or mentally disturbed. Although certain parts of best of them and will not push for their dreams. They will believe the life they were born into is it for them. They will not try and do anything or pursue anything that will better the world still do not accept this concept, the United States has now become more accepting than they would have been decades ago. themselves. I would recommend for others to always have a goal. Always have a goal that is attainable, and once that goal is met, have another goal. There should be no time for anyone to become complacent in life. We should always keep striving for something better. With the right mindset we make the best of ourselves. I think becoming more versed and aware of these topics is a great place to be when trying to help make this change to addressing the mental/behavioral health disparities in our nation. In addition, reaching out to the community and engaging myself in events that involve those affected with such disparities is a great way to see both LaDijah Wood sides of the spectrum. Dispositional Optimism: Erasing the Stigma Attached to Mental Health Illness I truly enjoyed the seminar, as I was not aware of the mental/behavioral health disparities present in my area. It was refreshing to know that there are health care policy makers that are actually trying to make a difference and help those affected. I especially enjoyed the little activity regarding self-care held during our lunch hour. I have The 12th Annual Addressing Health Disparities Seminar addressed concerns related to mental health. Mental health has easily become a taboo subject. Most individuals definitely neglected the importance of my own self-care throughout the months, as school was my number one priority. I have been lately using the advice the presenter who suffer from mental health issues do not acknowledge that they have a problem because we have been socialized to believe that mental health issues mean that a person is shared in my daily routine and it’s helped tremendously. “crazy” or “unstable”. In reality, mental health is a term that covers more territory than the stigma allows. Mental health includes self-care, self-awareness, addressing trauma (PTSD), among many other things. During the seminar, I learned that minorities, including African American and Hispanic/Latinx, are disproportionally impacted by mental health. While 1 in 5 adults in the United States experience a mental health illness in their lifetime (according to the CDC), it is the minority population that suffers worse. A few reasons why minorities are affected is due to specific barriers. Some of these barriers include language, lack of culturally competent providers, distrust within the healthcare system, lack of providers from diverse racial/ethnic backgrounds, denial of mental health problems, and lack of knowledge regarding available treatments.

62 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 63 Nicole McNichols Combining the mental and behavioral healthcare systems and other medical healthcare systems may also be a way to eliminate these disparities. This will help to eliminate some of the stigma surrounding the mental/behavioral system, which many do not consider an illness but rather a moral failing. It would also ensure that doctors in This conference helped to point out that anyone who experiences a mental/behavioral health disorder is dealing with some sort of health disparity. Part of this is due every area of a patients treatment could receive medical records and provide the best care to that patient. to mental health and behavioral health systems are often being separate from other health systems in Omaha and the nation. In the community (and often in other medical settings) those with mental illness are often seen in a negative light. The stigmas that is put on these people, keeps many people from seeking treatment because they don’t want The last method to reduce the disparity was to bring the healthcare to the patients. By having times when the professionals visit those areas where there is no to be treated badly, when they are already feeling badly. treatment, it eliminates the need for those who will have difficulty reaching the areas with treatment to receive treatment. This could also mean that states open more rehabilitation centers in rural areas so that more of the state has access to these facilities, and possibly reduce the waiting time to get into a facility. In many places the type of disparities exist in the mental and behavior health fields are not limited to a certain race, religion, or region of the United States. However, individuals that live in rural areas are more likely to have limited access to healthcare facilities. The facilities where people who are trained to help these patients are more likely I would suggest that those who did not attend the seminar attend the seminar in the future, because it was very helpful in hearing the information. I would also suggest to be in urban areas, meaning that if a patient needs an appointment they must take off work and travel to the areas of the facilities. In some areas of Nebraska, the closest that a person who didn’t attend the seminar go to the United States Department of Health and Human Services website, as there are many helpful aids on many of the topics facilities are hours away. This is especially true if you are looking for a drug rehabilitation center. There are very few of these facilities and they often have waiting lists, which talked about during this seminar. This seminar helped me to see the disparities in the mental and behavioral healthcare system, which is something that I might not have seen limits the accessibility to these facilities. When people must wait a long time they often go without. This is also contributed to by the number of people in areas not covered by much of otherwise. I have learned some tools that I will take with me, to help me to provide better care to my future patients, even if it is not in the same area of medicine. insurance willing to pay for these services. Those in rural areas are also less likely to have insurance. Treatment and visits to the doctor can be expensive. This is an expense that many people will find extraneous and thus go without. Nathan Ramos Another disparity that is faced by patients is the availability of culturally aware or culturally similar physicians. The field of mental and behavioral health is a slowly The Health Disparities Seminar addressed many problems within this nation’s healthcare system that do not have adequate solutions as of today. For example, the shrinking field. This means that people such as immigrants (like those in Omaha) are less likly to find people who they feel they can communicate with and understand their inaccessibility of medical treatment for many individuals, mainly the poor, need to be constantly reassessed. However, there is a growing number of individuals that experience problems. This lessens that willingness of patients to seek treatment. This causes a disparity because it makes people who are pert of cultures or races that are underrepresented the disparity in mental health. Because mental health treatments are less likely to be covered by insurance there is a large, and growing number of individuals that must pay out in the mental and behavior health fields, less likely to receive treatment than those not of those races or cultures. If patients do visit the professionals it is usually only a couple of of pocket to cover these costs. This disparity of healthcare is seen both in Omaha and throughout the nation. Not only is there an inaccessibility to mental healthcare but despite times, which is not effective in a chronic health issue. the need there seems to be little movement to make mental health screenings available and regular for patients. The problems that cause people who have mental health or behavior health issues to not seek medical help is a huge problem. By not seeking help people’s problems Based on the lessons learned in the seminar I think that it would be beneficial to make mental health screenings a regular part of the routine checkup. By gathering tend to escalate. This escalation for many ends in suicide. For those on drugs the result may be an overdose, as they are not given the appropriate treatment for their addiction. baseline data for individual patients it will be easier to correlate a trend between mental health diagnoses and predictors of health. This not only brings about an awareness to All of this means that there is a disparity in the life expectancy and the quality of life for people who suffer from mental health issues when compared to those with out one. mental health as a healthcare issue but it also will help develop a data pool to study the causes and effective treatments of mental health. By creating a significant data pool it would most likely be able to be diagnosed in a way that can be appealed to for insurance companies. This inevitably will increase the availability of mental healthcare as a One way that the mental and behavior health disparities can be reduced is by educating both the public and the professionals on how to treat these patients. whole. Further, data pools can also make their way into government policies that further increase the availability of mental healthcare by seeing it as an epidemic. By seeing the Professionals should try to follow the WISH creed when dealing with patients to make sure that when they are reaching out for help they feel comfortable. This is important numbers of people who are suffering from problems with mental health the stigma can be uncoupled so that individuals can receive optimal care; much like the way alcoholism because it helps to create a relationship where patients will continue to seek help. By continuing the help the patient will have a better outlook on life and a continued had become a health issue over an individual character issue. maintenance of their disease. By educating the public, patients are less likely to feel stigmatized or alone. This means that people will seek to build a community around them in which they feel comfortable enough to get the support they need when dealing with their illness. For those that were not in attendance to the Health Disparities Seminar I recommend that you look over other health disparities found within the field. Mental health is one of many issues that create healthcare disparities across the nation. It is the most significant due to its poignant inaccessibility to people both with and without health Combined with the educating professionals, there was also discussion about creating an environment in which more people want to go into this field. It was mentioned insurance. Other examples of a health disparity one could look into is the inaccessibility to health facilities for rural Americans. These types of disparities are issues with recurrent that by lowering the cost of attendance of school or eliminating the cost completely (like NYU has) that more people would be willing to enter this field of medicine which might consequences and disparities have tended to increase with the passing of time. otherwise be avoided because of the lone debt that people face when entering this field. In conclusion, the Health Disparities Seminar has brought to light the many differing factors of mental health disparities across the field. Both in Omaha and around the Another way to reduce the mental and behavioral health disparities, discussed at the seminar, was through legislation. Some of the legislation that was talked about nation, there is an increase need for mental health professionals in order to reduce the burden imposed by mental health. However, this disparity is an issue that will require allowed/required there to be a mental health care provider in schools, which increases the accessibility to this service to minors. Another thing that was talked about in this innovative and forward thinking as we progress into the future. The further integration of mental health into the current system is ideal but looking forward may not become a section was to pass legislation that would give more money to creating facilities that cater to these problems. Getting this finding would ensure that people can receive treatment possibility. For this issue to be relieved I think that there should first be mental health professionals to fulfill these duties before re-innovating the system. regardless of their background. The Medicare health expansion coverage was a huge step that states have taken to ensure that more people are insured. Those states that have adopted this expansion have seen a decrease in the percentage of people with mental and behavior health issues that are not covered by insurance. This expansion helps to ensure that more people will feel like receiving treatment is an option.

64 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 65 Shaneese Longboy Todd Rhode Mental health as defined by Dr.Donna Stewart, PhD of the Boys Town Behavioral Health Clinic, is the successful performance of mental function to result in productive This last weekend we had the pleasure to listen to presentations regarding the disparities facing our community. We were exposed to the problems facing our activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with challenges. Behavioral health is defined as the emotions, behaviors and community and possible solutions to overcome those obstacles. The main focus and goal of this weekend’s conference was “to increase knowledge, skills, and ability of biology relating to a person’s mental and physical condition, their ability to function in everyday life and their concept of self. Dr.Stewart defines mental illness as a collective term academia, health professionals and community members to address health disparities regarding mental and behavioral health related issues. This includes issues regarding to all diagnosable mental disorders. Mental health and behavioral health are used interchangeably but mental health more of a stigma around the term. For example, substance access to mental health services, recognizing signs and symptoms of mental illness, reducing stigma around the topic of mental and behavioral health, and advocacy and support abuse and eating disorders are considered more behavioral health disorders. Behavioral health is included in mental health, some mental health disorders are genetic and/or due for mental/behavioral health professionals and patients”. This was similar to a common ground presentation; a lot of information was presented to us in a short amount of time, to differences in brain chemistry. Examples of mental health disorders are depression and schizophrenia. but unlike previous common ground presentations, I left the seminar with the hope that I might be able to recognize the role of individuals and society in reducing the stigma around mental health. Minority, rural, low-income, and immigrant communities are experiencing health disparities in Omaha and in the nation. Dr.Roberto Cervantes, MD presented on the role of religion and spirituality in mental and behavioral health practice of the Hispanic population. The studies he shared showed the graphs comparing Hispanics, African Americans, The Health Disparities Seminar began with a presentation by Donna Stewart, PhD, titled Overview of Mental Health/Behavioral Health in the Omaha Community. This and Caucasians who receive mental health treatment. In both cases, the Hispanic population was least likely to receive treatment. Even when treatment is free at community presentation basically laid the foundation for all of the following presenters. The main objective was to define mental health, mental health disorders and mental illness. Mental health centers, this population will not go to receive help. He explained that Hispanics are very religious, they saw seeking mental health treatment as something for bruja’s health is defined as a state of successful performance of mental function, resulting in productive activities…. Mental disorders on the other hand are conditions characterized by (witches). In addition to that, the machismo mentality that men are to work hard and provide for their families can hinder seeking treatment. The first individuals that Hispanics alterations in thinking, mood and/or behaviors associated with distress and/or impaired function. National data collected from the CDC tells us that about 20% of US adults will would seek help from was clergy from their church. He spoke of performing mental health screenings in churches so the Hispanic population can receive treatment. This is a way experience a mental health illness in their lifetime; in Nebraska, 20% of individuals will experience a mental illness within a year. The numbers provided in this presentation are for providers and community members can reduce these disparities in our nation based on lessons learned from the seminar. quite high, but they are not surprising. I think almost everyone at some point in their life will face some sort of mental health obstacle, but depending on their social standing, the resources to overcoming that obstacle vary. Obviously, those with better support will have a better chance at overcoming those challenges than those with little to no support. Tiffany White‐Welchen presented on bias in building relationships and communicating with patients about mental and behavioral health. There is a cultural similarity Some of these barriers linked to mental health disparities around the world, but especially in the Omaha area include limited access or poor mental health insurance coverage, between African Americans and Hispanics where both minority groups are very religious. The first people they seek help from are clergy members and their families, in many cases language barriers, lack of available resources, distrust in the healthcare system and stigmas surrounding mental health care. It is up to us as future health care professionals to they are seen as the first line of mental health providers. Ms.White‐Welchen asked the audience what is the first word that comes to mind when she mentioned a certain phrase, make the necessary changes that will better our communities. this revealed preconceived biases individual’s had. One in three African Americans who need mental health treatment actually receive it, she also proposed to have mental health screenings at churches. This is important to reduce the disparities in our nation by mentioning mental health in discussion to eliminate preconceived biases, lessen the stigma, As future professionals we need to be part of the solution. What can we do to reduce these disparities presented at this seminar? Like everything else, it begins with and change the wording people use when talking about the subject. an open discussion; being able to discuss strategies for developing, implementing, and evaluating policies regarding mental/behavioral health services capacity building is key to overcoming these obstacles. Most importantly we need to develop culture-specific mental health education tools, as Donna Stewart tells us. As well, we need to train Nebraska is a part of region 7, in 2011 before Medicaid Expansion under the Affordable Care Act the state was ranked 7th in the nation for mental health care access. professionals and the general public how to be culturally competent. This idea of cultural competency is something that we have been exposed to almost everyday during our Nebraska choose not to expand Medicaid thus in 2014, it was ranked the 32nd best state for mental health care access. Recently, the state chose to expand Medicaid where its time in the post-baccalaureate program. Being culturally competent means having the ability to interact effect with individuals of different cultures, beliefs and values. It is so effects will start in October 2020. This will help to lessen the mental/behavioral health disparities of communities who are experiencing the disparity in Omaha and the state. important as a professional to understand the point of view of the patient and come down to their level. We must relinquish the role of the expert and become the student From the keynote speaker Kimberly Nelson’s presentation on the state of mental and behavioral health in the Midwest, she showed two maps of distinguishing African Americans sometimes in order to provide adequate care. Another interesting approach was brought up by Dr. Roberto Cervantes. What else can we do to reduce mental health disparities overrepresentation in Medicaid non-expansion states. The states with the highest proportions of African Americans are predominantly located in the South and these states among USA Latinos, discussed alternative approaches to overcoming disparities. Mainly focused on faith and Ignatian values in medical education, his presentation discussed happen to be non-Medicaid expansion states as well. From the keynote speaker’s recommendations, I would advise those that did not attend the seminar to look at what public, the spiritual assessment FICA model which I found very interesting- it explains how faith can play an important role in someone’s overall well-being. F stands for Faith; what is structural, and personal stigmas they see in their communities and in themselves. Those three stigmas’ have a “symbiotic relationship in which each reinforces the other”. Many your faith, what things do you believe in give meaning to your life? I stands for importance and influence; is it (religion) important in your life, what role do your beliefs plan in do not realize that stigma and disparities seen in mental/behavioral health deal with policies/laws, research funding bias, and sentencing minimums associated with structural regaining your health? C stands for Community; are you part of a spiritual or religious community, is this of support to you and how? A stands for address/action in care; how stigma. would you like me, your healthcare provider, to address these issues in your healthcare? It is important to keep all options open when treating a patient, and an examination of faith-based solutions is a great option in some cases. This was my first time at a mental/behavioral health seminar, I thought it was enriching for me because it is common for people to recognize physical health but not mental health. It is common to hear the advice of getting enough exercise and refrain from smoking, drinking, and drugs. I am glad it is becoming more common to discuss taking Overall, this was a great experience that provided solutions on how to alleviate disparities, not only in our community, but in the US. For anyone that was unable to care of your mental well-being and that the seminar included stigmas/bias surrounding mental health disparities. The seminar made me reflect how mental health is viewed in attend this seminar, I would recommend that they do some research and really look into the problems and possible solutions to those problems facing our community. The myself, in my culture, and in my communities in Hawaii/Nebraska. Attending the seminar also gave me recommendations to take care of my well-being through meditation and keynote speaker provided us with great information on how to overcome certain stigmas associated with mental health and how we can chip away at those stigmas. My main how legislature can play a role to dispelling disparities. takeaway from the keynote speaker was that disparities are not just due to a lack of access to health/education resources, or due to poor individual choices. Rather, disparities are primarily the result of policy decisions that systematically disadvantage some populations over others.

66 2018-2019 HS-MACA Annual Report 2018-2019 HS-MACA Annual Report 67 HS-MACA Staff

Sade Kosoko-Lasaki, Tracy Monahan, MBA Mervin Vasser, MPA Jennifer Klimowicz, BS Errik Ejike, MPH Aminatu Issaka, MS MD, MSPH, MBA Senior Finance Director HS-MACA Assistant Manager of Programs and CPHHE Program HCOP Program Supervisor Associate Vice Provost- Director Research Supervisor Health Sciences Recruitment/Retention Manager

Phebe Jungman, MBA Dr. Richard Brown, PhD, Larissa Sanon Bryan Benson, BA Christina Jelinek, BS Isaac Inkabi, BSE Administrative Assistant III FACHE Post-Baccalaureate Pipeline Program Assistant Academic Success Program Coordinator/Data CPHHE-REACH Executive Coordinator Counselor/Case Manager, Manager, HCOP Director HCOP

68 2018-2019 HS-MACA Annual Report