The program, called Retailers Creating a Responsible Environment (Retailers CARE), launched in Montgomery County, Ohio, and may be the first effort in the nation to incentivize retailers to voluntarily reduce promotion of tobacco, alcohol and lottery products, said lead researcher Megan Roberts, associate professor at Ohio State’s College of Public Health.

Rather than focusing only on enforcement and penalties, Retailers CARE treats store owners as community partners. Participating retailers can earn financial incentives by meeting progressively stricter standards aimed at reducing youth access and limiting aggressive advertising.

A new paper outlining the program’s successful implementation appears in the American Journal of Public Health.

“It’s really a novel approach and it could inspire other communities to get creative about ways to incentivize compliance,” said Roberts, who is a member of Ohio State’s Center for Tobacco Research and The Ohio State University Comprehensive Cancer Center.

Public health experts have long viewed convenience stores and carryouts as a major source of exposure to unhealthy products, especially in historically marginalized neighborhoods where stores that sell tobacco products, alcohol and lottery tickets are often concentrated.

“The tobacco industry alone spends about $6 billion annually on point-of-sale advertising and promotions designed to drive sales,” Roberts said.

“Historically, most enforcement, especially around underage sales, has used the ‘stick’ method, punishing retailers for breaking the law. This community-driven project is based on a ‘carrot’ approach, encouraging the retailers to be partners in public health efforts.”

The program includes four levels — bronze, silver, gold and platinum — with rewards ranging from $2,700 to $7,200 for store improvements. To qualify, retailers adopt measures such as removing storefront advertisements, locking tobacco products behind counters, restricting alcohol sales hours, implementing drug-free workplace policies and keeping naloxone kits on site.

The pilot phase ran from fall 2023 through fall 2024 and identified 28 retailers in Montgomery County neighborhoods with poor health outcomes and high levels of tobacco, alcohol and lottery advertising. Seven stores agreed to participate.

After one year, five stores achieved bronze status, one reached silver and one earned gold certification. Among their commitments: Six participating retailers removed storefront window signage and six posted gambling helpline information. Incentive funds were used for practical upgrades including roof repairs, new lighting and redesigned sales counters.

The early results suggest retailers can be motivated to reduce harmful marketing when given financial support and practical resources, Roberts said.

The study also identified challenges, particularly recruiting businesses into the program. Independently owned stores appeared more willing to participate than chain retailers, likely because local owners have greater control over store policies and displays, Roberts said.

The researchers caution that the program still needs long-term evaluation to determine whether it improves community health outcomes. Sustaining funding may also be difficult, although new support from the Centers for Disease Control and Prevention’s Drug Free Communities Support Program will allow the initiative to continue.

Taniayah O’Quinn-Sims with the Alcohol, Drug Addiction and Mental Health Services Board of Montgomery County, Ohio, is a co-author on the study.

The findings come at a time when suicides have been on the rise, alongside a surge in gun ownership — especially among women, said lead author Laura Prater, an assistant professor in The Ohio State University College of Public Health.

In the last two decades, firearm deaths in the U.S., including those involving suicide, increased by almost 50%. Women historically made up 10 to 20% of new gun owners, a percentage that jumped to about 50% in 2020.

“The more guns that are in homes, the more suicides we see among everyone living in those homes,” Prater said.

“Traditionally, firearm suicide deaths have been highest among white men, including veterans, and that’s what most research and most interventions have focused on,” she said. “Now that we’re starting to see gun ownership and firearm suicide increase among women, it’s important to understand contributing factors that might help us on the prevention front.”

The research is published today (April 18, 2025) in JAMA Network Open.

Less than one-third of the women in the study had documented evidence of mental health treatment, and only around one-fifth reported having a known physical health diagnoses. Together, this left a large group for whom there were likely limited prevention opportunities within health care.

Prater’s work has focused primarily on interventions in hospitals, medical practices and other health care settings, an area rich in opportunities to identify people at risk for self-harm and to connect them with appropriate care and services.

But this new data, which included an analysis of more than 8,300 suicides from 2014 to 2018, has her thinking about other options.

“We need to look more closely at women who may not be accessing the health care system, especially because we know intimate partner problems are still common in this group,” Prater said. “We need to look more broadly than the health care system and ask ourselves if at-risk women are seeking any kind of services outside of that system that we’re missing.”

Potential opportunities include reaching out to participants in programs for women who face violence, educating community health workers, and providing screenings and education at events and programs where women gather, Prater said.

And all health care settings, including federally qualified health centers, should be places where providers stress gun safety and open conversations that identify risk and present opportunities to prevent suicide, she said.

“With firearms in at least one-third of American homes, widespread efforts to educate Americans about gun safety and to prevent deaths by firearm suicide are needed,” Prater said.

The study was funded by the National Collaborative on Gun Violence Research.

Other Ohio State researchers who worked on the study are Jennifer Hefner and Pejmon Noghrehchi.

Legionella bacteria occur naturally in freshwater environments, like lakes and streams, and are usually harmless in those settings. But Legionella threatens human health when it gets into building water systems and increases in numbers, and is especially deadly among the elderly and other medically vulnerable people. Outbreaks are notoriously difficult to pin down and contain.

Using easy-to-measure water quality data, the researchers built a model they hoped would allow for rapid, accurate assessment of the water ecosystem to allow for speedy responses to situations that increased the likelihood of Legionella growth. Based on an analysis of water samples from a large New York building, the machine learning method, called statistical learning theory, proved reliable – and more accurate than conventional statistical methods – in predicting threats.

The study appears in the December issue of Water Research.

In health care and other settings, efforts to keep the bacteria at bay vary and there’s no consensus on best practices, said Mark Weir, an associate professor of environmental health sciences at The Ohio State University College of Public Health and part of the university’s Sustainability Institute.

“Water is never going to be sterile and we continue to have a misguided view that we can eradicate Legionella,” Weir said. “Bacteria will always be there, so instead of trying to eliminate that, my lab is looking for answers by examining the entire microbial community and other influences within water systems.”

As soon as a pipe has water running through it, a slimy layer of bacteria and amoeba, known as biofilm, begins to grow. Weir’s approach includes analyzing microorganism activity alongside factors including the pH and temperature of the water, electrical conductivity, chlorine concentration and oxidation reduction potential, a measure of the capacity of a solution to give or receive electrons.

“All of these can be measured in real time and on a regular basis for cheap, or at least much cheaper than some of the other alternatives,” Weir said.

It’s important to look for solutions to water safety that low-resource health care providers can afford to use, he said.

“Outside of a large health system, many of the places that face threats from Legionella can’t afford expensive solutions. They might have to decide between maintaining an MRI machine or doing more complex water sampling,” Weir said.

He said he’s hopeful this work could lead to a clearer blueprint of what makes for an effective water safety plan and more consistency in approaches to protecting people from deadly pathogens.

Other co-authors were Juan Xu from Ohio State and Xin Li and ChuanWu Xi from the University of Michigan.

Results showed that nearly two-thirds of schools in the Englewood neighborhood of Chicago had at least one gun incident within 400 meters (about one-quarter mile) of where children were walking home during the 2021-22 school year.

These findings suggest a need to redefine federal definitions of school gun violence to include indirect forms of violence that take place near schools, not only on school grounds, in order to more appropriately capture the burden on communities of color, said Gia Barboza-Salerno, lead author of the study and assistant professor of public health and social work at The Ohio State University.

“Not all the violence children are exposed to is direct violence or happens on school grounds,” Barboza-Salerno said.

“But that doesn’t mean it doesn’t have an impact. Hearing gunshots on the way to and from school is terrifying and will affect how kids perform in school.”

The study was published recently in the journal SSM-Population Health.

The findings are important because research shows that exposure to gun violence in schools is linked to poor outcomes for students, including diminished performance on standardized assessments in mathematics and English, elevated rates of absenteeism, decreased student enrollment, and lower graduation rates.

In this new study, the researchers found that 4.5 times more gunshots were detected using the acoustic sensors compared to what police recorded in investigative reports.

This sensor data shows how staggering the amount of indirect violence is for children in Englewood, and potentially other areas, said study co-author Sharefa Duhaney, a graduate student in public health at Ohio State.

“You can’t just put metal detectors in schools to deal with violence,” Duhaney said. “Children are exposed to violence on the way to and from school, and we need to recognize that.”

Englewood, a community on the south side of Chicago, is one of the most violent in the United States. In 2022, the Englewood area accounted for about 10% of all gun violence that occurred in Chicago. The community is 94% Black and one of the most socioeconomically vulnerable neighborhoods in the city.

The researchers used computational spatial network methods to analyze data on gunshots detected by acoustic sensors operated along Safe Passage Routes for each school in the Englewood School District. These routes are designated routes created to ensure safer travel for students walking to and from school.

The study analyzed gunshots detected during the morning (6-9 a.m.) and afternoon (3-6 p.m.) commutes of children during the 2021-22 school year.

Acoustic detectors showed 610 gunshots fired in Englewood on days when schools were in session during the school year.  Of, those 52% occurred during afternoon commutes and 12% during the morning commutes.

Results showed that 40% of Englewood schools had at least one gunshot fired within 400 meters of the routes to school during the morning commute, and 62% had at least one during the afternoon commute.

“Hearing gunshots during school has not typically been considered ‘school gun violence,’ but it should be,” Barboza-Salerno said. “Imagine what that is like for children to hear gunshots while walking to school and how scared they must be.”

Analysis of the data showed that shooting incidents cluster along city streets, including safe passage routes, near schools. The configurations of streets that support walking for students also attract other types of foot traffic, and increase the likelihood of violent incidents, Duhaney said.

“Youth in violence-prone areas are not safe along Safe Passage Program Routes,” she said.

One issue in Englewood is that almost half of residents live in households without access to vehicles, meaning that residents are heavily dependent on public transit and walking.  Other studies have shown that students feel safer going to school via car rather than walking, but that is not an option for many in the community.

The researchers noted that the U.S. Department of Education is directed to collect and report on data on school safety, including violence. But they said the definition of gun violence doesn’t currently include witnessing and hearing gun violence.

In addition, the focus on student safety should go beyond what happens on school grounds and beyond direct violence: Hardening schools and using metal detectors and police officers there won’t solve the problem, the researchers said. They emphasized the need for policymakers to focus on violence prevention in the communities at large.

“We are failing to address the underlying issues in the community that lead to violence,” Barboza-Salerno said. “We need to focus on the root causes.”

Hexin Yang, a graduate student in social work and public health at Ohio State, was also a co-author of the study.

“In high school, I had done a lot of advocacy work related to vaccines and vaccine hesitancy,” she said. 

Earlier this month, Patel was one of more than 12,000 students who graduated from Ohio State. She leaves with a bachelor’s degree in public health. She won’t be going far, though. 

Patel plans to apply to medical school, but not before she takes a gap year as a clinical research assistant in otolaryngology at The Ohio State University Wexner Medical Center.

“I’ve had to practice the name a few times,” Patel admitted. “When I’d go for training, I’d sit in my car and say it to myself.”

Patel is taking a gap year to gain more experience for her medical school applications.

“I wanted a gap year for the clinical research component,” she said. “I had participated in research throughout undergrad so I know I like it. I had a couple of different experiences, so I know which components of research I like: I like interacting with patients. I like participating in research that will improve people’s health.”

Before she begins her research position, though, Patel is spending her summer as an intern for the Southern Plains Tribal Health Board’s Tribal Health Experiential Student Internship Seminar, which is funded in part by the Centers for Disease Control and Prevention (CDC).

“I’m really excited about it,” she said. “It’s my dream to work for the CDC in some capacity.”

The eight-week program provides students and recent graduates with public health mentors who guide them through coursework and research, both of which focus on Native American health. At the end of the seminar, students present their research at the CDC Showcase in Atlanta.

“As an Ohio State student, my public health education really prepared me,” she said. “I’ve also had a lot of opportunities to grow as a person. I was a resident adviser; I’ve worked in the Office of Student Life since I was a sophomore. I feel like all those extra components, that may not seem like they’re related to my degree, they really helped me, too.”

Those opportunities are what Patel suggests incoming Buckeyes pursue, even if they are unsure.

“Try everything you feel OK about trying, even if you’re not in love with it,” she said. “See what sticks and what doesn’t. I didn’t pigeonhole myself into one activity. I did a lot of random things, but it all came together in the end. Try everything.”

Through trying different activities, Patel developed friendships across campus. She’ll miss those the most, she said.

Another thing she’ll miss about Ohio State? The school spirit. When Patel was younger, she knew she wanted to study at Ohio State because of how passionate the community is, she said.

“I was a big school spirit person in high school,” she said. “That’s why Ohio State appealed to me so much, that focus on students and school pride and excitement. That whole vibe was something I was really attracted to. I just wanted to go to Ohio State.”

May 6-10 is In-Demand Jobs Week, an annual statewide celebration of the jobs, industries and skills that are in demand in Ohio. Ohio State News highlights students as they transition from graduation into the workforce.

The research highlights the impact of the housing crisis on pregnant women, even on those who haven’t personally been evicted, and the importance of neighborhood conditions to Black maternal health, said lead author Shawnita Sealy-Jefferson, associate professor of epidemiology at The Ohio State University College of Public Health. 

“Black mothers are at least three times more likely than white mothers to die during or in the year after pregnancy, and we are not talking enough about the neighborhoods that people are living in as a predictor of poor maternal mental health,” Sealy-Jefferson said.

She and her colleagues examined trajectories of neighborhood evictions over time, and odds of moderate and serious psychological distress among more than 800 Metro-Detroit Black women during pregnancy. Higher rates of eviction filings and judgments in a woman’s neighborhood before and during pregnancy were associated with two-fold to four-fold higher odds of psychological distress. The study appears today in the American Journal of Epidemiology.

Overall, 68% of the women in the study reported psychological distress during pregnancy, with 8% of them reporting serious psychological distress — the type of health struggles that constitute a diagnosable mental illness. Recent estimates suggest that 3.4% of the U.S adult population has serious psychological distress. 

Mental health conditions, including suicide and overdoses related to substance use disorder, are the leading cause of maternal death.

“It is stressful, even when you’re not the one being evicted, seeing your neighbors’ and friends’ stuff on the curb — baby beds, toys — and knowing they might have nowhere to go, and that you might be next,” Sealy-Jefferson said. 

The estimates in the study inevitably underestimate the true impact of eviction because they don’t reflect illegal evictions — those that don’t go through the courts, Sealy-Jefferson said. Previous research estimates that 40-50% of evictions are illegal. 

Sealy-Jefferson, a Detroit native who has been studying the impact of neighborhoods on Black women’s birth and maternal outcomes for more than a decade, said the results confirmed what her observations have been telling her for years: “Neighborhoods matter. Nobody has connected these violent experiences over time to poor maternal mental health. A lot of the discourse is: ‘Black people have higher rates of everything, what are these people doing wrong that increases their risk?’ But what we’re showing is that the problem is literally the way this society is organized. 

“Neighborhoods with a disproportionate burden of eviction rates stem from historical federal government sponsored redlining, and contemporary racism and sexism.” 

Redlining refers to systemic disinvestment in neighborhoods with predominantly Black residents. 

Beyond policy-level changes that protect tenants and increase funding for affordable housing, a logical next step is to identify modifiable risk factors for psychological distress during pregnancy so that social service and health care providers can use culturally appropriate and relevant interventions for harm reduction, Sealy-Jefferson said. 

“The root cause of inequities in Black maternal health has to be acknowledged and addressed or these inequities are going to continue to worsen over time,” she said.

Study co-authors include Benita Jackson of Smith College, and Brittney Francis of Harvard. 

Support for this research was provided by the Robert Wood Johnson Foundation.

The American College of Surgeons Committee on Trauma requires that trauma centers — hospitals that treat patients with serious, life-threatening injuries — acknowledge mental health and make referrals for patients experiencing psychological distress. But there’s no uniform protocol for how that should be done, said Laura Prater, the study’s lead author and an assistant professor at The Ohio State University College of Public Health.

The research team studied data from patients who had experienced trauma including motor vehicle crashes, firearm injuries (including those that were self-inflicted) and domestic violence. The first analysis of its kind, the five-year study included 171 patients seen at a University of Washington trauma center who were randomized to receive either standard care or a comprehensive intervention designed to address their mental health. The study appears in the journal Annals of Surgery.

The three-prong stepped-up intervention included:

• Having trauma survivors describe their personal post-traumatic concerns.
• Coordinating care management and providing enhanced care specific to mental health needs during hospitalization.
• Offering ongoing 24/7 access to support after trauma survivors left the hospital.

Researchers found significant reductions in emergency department and inpatient hospital use among those who experienced the intervention. Three to six months after the initial trauma, almost twice as many standard care patients found themselves back in the hospital – 27%, compared to 16% of intervention patients. At 12 to 15 months, 31% of those in the standard care group had made a return visit to the hospital, versus 17% of those in the intervention group.

“Being able to manage PTSD and other mental health concerns early on and receive regular follow-up support can prevent adverse long-term health problems and increase a survivor’s ability to live a productive, meaningful life,” Prater said.

About 30 million Americans experience traumatic injuries each year, and 1.5 to 2.5 million of them require hospitalization, previous research has shown. And as many as 4 out of 10 people hospitalized for trauma experience post-traumatic stress disorder, or PTSD, and other psychological challenges.
 
Prater completed the work while at the University of Washington under the mentorship of Douglas Zatzick, a professor of psychiatry and behavioral sciences who has studied interventions to address PTSD in trauma centers for decades.

“The investigation provides support for the importance of the recent American College of Surgeons Committee on Trauma requirement for mental health screening and referral at trauma centers nationwide,” Zatzick said.

Prater said it’s likely that the 24/7 access to support through text messaging or phone calls was particularly helpful in reducing hospital readmissions.

“The immediate text message or phone call response to questions and concerns is potentially the most meaningful element of the intervention, from the perspective of the survivors. A lot of places use MyChart or another form of messaging, but responses can be delayed and that is problematic if someone is feeling overwhelmed,” she said.

“Having an immediate connection helped patients and their families to feel like they weren’t in it alone.”

Fewer readmissions are an indicator that people’s needs are being better met in the community setting, which is better for them and tends to lower health care costs, Prater said.

"Being in the emergency department is traumatic in its own right, plus returning to the scene where you first received care following an injury or assault is not ideal,” Prater said. “Managing trauma and the mental health fallout from that trauma is best done at home, where you’re in a safe location.”

The study’s analysis of costs versus benefit was limited but suggested that the investment in providing this level of coordinated care and support is likely to be offset by decreased use of expensive emergency department resources, she said.

“The bottom line is we need to do a better job in general helping people who are in vulnerable health situations navigate the fragmented health care system,” Prater said, adding that she’s interested in thinking about how an intervention such as this could also work toward preventing future traumas, particularly those associated with firearms.

The study appears in the Journal of Head Trauma and Rehabilitation.

CARE is the first trauma-informed approach that considers brain injury in the complex set of circumstances to be addressed and accommodated in order for domestic violence survivors to access safety, health and social services. It was created in response to 2019 work by Ohio State researchers and the Ohio Domestic Violence Network that found 8 in 10 survivors seeking help have suffered head injuries and strangulation by their abusers.

“Given the pervasiveness of the problem, agencies should be ruling brain injury out, as opposed to ruling it in, and approaching their work with tools to appropriately support these survivors,” said Julianna Nemeth, the study’s lead author and an assistant professor in Ohio State’s College of Public Health.

“These injuries are contributing to common struggles experienced by survivors, including engaging and following through with services and planning for significant life changes. And they are contributing to mental health, substance use and other health concerns.”

The CARE model is based on four cornerstones:

• Connect with survivors by forming genuine relationships and learning what survivors value, want, need and expect.
• Acknowledge that head trauma and strangulation, and related challenges, are common, including brain injury, mental health struggles, substance use and suicidal ideation.
• Respond by collaborating with survivors to develop accommodations for challenges related to suspected brain injury caused by violence and provide effective, accessible referrals and advocacy.
• Evaluate services provided by establishing a strong feedback loop with survivors to see how, and to what extent, the support, accommodations, resources, referrals and services are meeting their needs.

“CARE tools are intended to be used flexibly by domestic violence program staff to open conversations and provide information about head trauma, strangulation and mental health struggles – and help survivors identify short-term and long-term consequences of brain injury and trauma,” Nemeth said.

The research team interviewed 53 staff members, including some volunteers, at five Ohio domestic violence organizations prior to implementation of CARE, and 60 staff members a year after the organizations implemented the approach. The majority of staff indicated that after CARE implementation they felt more confident and comfortable and had more conversations with survivors about head injuries and strangulation.

“These tools help staff proactively recognize these injuries, which can manifest themselves in a variety of ways that present challenges in the daily lives of survivors, and in their ability to access lifesaving services,” Nemeth said.

Though there is growing evidence of brain injury among domestic violence survivors, and recognition of the pervasiveness of the problem is growing nationally, agencies that serve survivors largely still have a long way to go to fully and effectively address brain injury, Nemeth said. The CARE tools are free for download, were designed to be used by people with no formal health training and now have evidence to back them up, she said.

Nemeth said she and her colleagues are hopeful that the CARE framework can help not only staff who work in domestic violence shelters, but those who come in contact with survivors elsewhere and play a role in their health, safety and life circumstances – including the justice system, health care providers and social service organizations.

“Trauma-informed care, including the CARE model, is marked by the entire organization’s ability to be flexible with people and recognize that their current situation may have to do with both traumatic incidents that have happened directly to them and also inter-generational trauma and community trauma,” she said.

“If we want to help them, we have to be flexible with people, and realize that their behavior may also be the result of coping with the troubles arising from an invisible injury.”

The success reported in this study is also important because it speaks to the ease of implementing and sustaining use of the CARE framework, Nemeth said.

“There’s a high degree of turnover in these agencies and while they received training at the beginning, sustaining the work was left to the agencies themselves. We saw that the agencies were able to take the information they had, and the support materials, and train new staff as they came in,” she said.

“All organizations that are working with survivors of violence really should consider the possibility of brain injury in providing services and accommodations. We know that one in four women in her lifetime will experience severe violence. This is a community problem. This is a public health crisis. This is not something that’s just for domestic violence shelters to address.”

Other researchers who worked on the study are Rachel Ramirez, Cathy Alexander and Emily Kulow of the Ohio Domestic Violence Network and Christina Debowski, Alice Hinton, Amy Wermert, Cecilia Mengo, Alexis Malecki, Allison Glasser and Luke Montgomery of The Ohio State University.

A study from researchers at The Ohio State University provides insights into the factors that contribute to racial disparities in use of preventive measures, including genetic testing, prophylactic mastectomies and medication to thwart breast cancer.

In the new study, which appears today (March 1, 2023) in the journal PLOS ONE, the researchers interviewed 20 Black women and 30 white women at high risk of breast cancer to better understand racial differences in the decision-making process, which hadn’t previously been well-studied.

Among their findings: Black women may be less focused on breast cancer risk as an issue to be addressed proactively, may less frequently possess information to help guide their decisions about prevention, and face more constraints when it comes to making and carrying out health-protective decisions.

“We need to recognize that the personal, interpersonal and social dynamics that Black women are experiencing that influence their ability to cope with their risk are complicated and multilayered and need to be taken into account if we’re going to empower people to do something about their risk,” said Tasleem Padamsee, lead author of the study and an assistant professor in Ohio State’s College of Public Health.

Women with strong family histories of breast cancer, genetic predispositions to the disease or other risk factors can face a 20% to 80% risk of developing the disease within their lifetimes, but can cut that risk in half, or more, by using preventive therapies, research has shown. Black women in the U.S. are diagnosed with breast cancer at about the same rate as white women, although at younger ages and later stages of disease, and with higher breast cancer mortality rates.

“I walked away from these conversations feeling like many of these women have experienced horrible things with cancer over and over again, and that they just have an overriding sense that cancer is this thing that comes at you, upends your life and the life of everyone around you, and it’s up to God what happens from there,” said Padamsee, who is a member of The Ohio State University Comprehensive Cancer Center’s Cancer Control Research Program.

“Being in a cutting-edge cancer center, we have ways, and are finding new ones, to head the disease off at the pass and — if we can’t — to catch it earlier, when the prognosis is much better. And we want all high-risk women to have those advantages.”

The researchers found several differences based on race, all of which pointed to potentially worse outcomes for the high-risk Black women.

Overall, the Black women in the study described feeling less ready and equipped to consider and cope with their risk and less informed about their options. They also reported facing more obstacles in availing themselves of those options and having less access to detailed information to help them make decisions about managing their risk.

Previous research using data from the same interviews with this group of women found that experiences with family members had a profound influence on perceptions of their own risk and prevention options. Though Black women generally reported having more up-close experiences with family members who had cancer, that didn’t seem to be associated with awareness of measures they might take to protect themselves, Padamsee said.

The Black women in the study were more likely to describe cancers as a collective group of diseases for which they have an equally high risk, rather than recognizing a particular predisposition to breast cancer. Women who thought this way did not generally believe anything specific could be done to prevent their increased risk, instead viewing a healthy lifestyle and regular health screenings as their sole tools to mitigate risk.

Many white women in the study who were more inclined to pursue preventive medication, such as Tamoxifen, or prophylactic mastectomies, told the researchers they perceived themselves to be at specific risk of breast cancer and that they worried a lot about its impact on them and their families.

In contrast, Black women in the study who worried about their cancer risk were more likely to talk about their faith.

“We’re just a really spiritual family, we believe in God. … I put my faith in God in that everything will be alright,” said one of the middle-aged Black women interviewed for the study.

While worrying less and having a stronger spiritual connection could have mental health benefits for Black women, it also could serve as a barrier to seeking out risk-management options, Padamsee said.

Black women in the study were also more likely to describe other priorities in their lives — including family and work demands and other health struggles — that were top of mind. About 20% of white women in the study had a major health concern besides the high risk of breast cancer, compared to 40% of the Black women.

Access to care from specialists, including genetic counselors, was also uneven. About 15% of the Black women reported access to specialists, compared to 70% of the white women.

That disparity likely has a significant influence on another key finding — that Black women were less likely to know about preventive measures and were much less likely to undergo genetic testing even when they’d heard of it.

Black women’s ability to manage their breast cancer risk also is more significantly impacted by financial barriers, the study suggests. Of the Black women in the study, 40% had experienced a time without insurance, compared to just 3% of the white women. And 40% of the Black women also described significant financial difficulties coping with health challenges, compared to 3% of whites.

These new findings could provide a foundation for building equity within health care, Padamsee said. Among the possibilities she suggests: Find better ways to acknowledge and incorporate patients’ spirituality and religious perspectives into discussions about prevention, ensure that women have access to good insurance coverage or other ways of paying for specialist care, and improve training for primary care physicians who are often the sole source of medical counsel for high-risk Black women. 

“There’s a lot of hand waving when it comes to talking about health equity problems, and discrimination and disadvantage in general,” she said. “One of the things that’s really important in equity work is that we have clear documentation of where the differences are and where they’re coming from, and this study helps provide that.”

Other Ohio State researchers who worked on the study are Anna Muraveva, Megan Hils, Celia Wills and Electra Paskett.

By 

Amy Lauren Fairchild

Dean and Professor of Public Health, The Ohio State University

Marian Moser Jones

Associate Professor and Graduate Director of Family Science, The Ohio State University

COVID-19 emergency status prompted coordinated vaccination efforts by health care providers, paramedics, volunteers and others.

President Joe Biden announced on Jan. 30, 2023, that he intends to end both the national emergency and the public health emergency declarations related to COVID-19 on May 11, 2023.

Biden’s announcement came on the same day that the World Health Organization said it still considers the COVID-19 pandemic to be a public health emergency of international concern, or PHEIC, a status that is reassessed every three months. The WHO’s advisory committee noted that although the pandemic is at a turning point, “COVID-19 remains a dangerous infectious disease with the capacity to cause substantial damage to health and health systems.”

The Conversation asked public health experts Marian Moser Jones and Amy Lauren Fairchild to put these statements into context and to explain their ramifications for the next stage of the pandemic.

What does ending the emergency phase of the COVID-19 pandemic mean?

Ending the federal emergency reflects both a scientific and political judgment that the acute phase of the COVID-19 pandemic crisis has ended and that special federal resources are no longer needed to prevent disease transmission across borders.

In practical terms, it means that two declarations – the federal Public Health Emergency, first declared on Jan. 31, 2020, and the COVID-19 national emergency that President Donald Trump announced on March 13, 2020 – will be allowed to expire in May 2023.

Declaring those emergencies enabled the federal government to cut through a mountain of red tape, with the goal of responding to the pandemic more efficiently. For instance, the declarations allowed funds to be made available so that federal agencies could direct personnel, equipment, supplies and services to state and local governments wherever they were needed. In addition, the declarations made resources available to launch investigations into the “cause, treatment or prevention” of COVID-19 and to enter into contracts with other organizations to meet needs stemming from the emergency.

The emergency status also allowed the federal government to make health care more widely available by suspending many requirements for accessing Medicare, Medicaid and the Children’s Health Program. And they made it possible for people to receive free COVID-19 testing, treatment and vaccines and enabled Medicaid and Medicare to more easily cover telehealth services.

What policy changes will occur once the emergency is declared over?

The end to the federal emergency could substantially reduce the number of people insured under Medicaid. Before the pandemic, states required people to prove every year that they met income and other eligibility requirements.

In March 2020, Congress enacted a continuous enrollment provision in Medicaid that prevented states from removing anyone from their rolls during the pandemic. In a December 2022 appropriations bill, Congress passed a provision that will end continuous enrollment on March 31, 2023.

The Biden administration has defended this time frame as sufficient to ensure that “patients do not lose access to care unpredictably” and that state Medicaid budgets – which have been infused with emergency funds since 2020 – “don’t face a radical cliff.” But many people with Medicaid may be unaware of these changes until they actually lose their benefits.

Some states have already indicated that they will begin disenrolling members in April 2023 or require members to apply to be considered for renewal. This could result in between 5 million and 14 million people losing coverage.

People with Medicare do not have to worry about losing their benefits, since this program is age-based, not income-based. The array of telehealth services that Medicare began covering during the pandemic will continue to be covered through December 2023. Medicare coverage for many telehealth services could also be made permanent after this year.

The end of the emergency could additionally curb access to COVID-19 drugs, tests and vaccines. Federal emergency funding for free treatment or vaccination will end when the emergency status is lifted on May 11. If such programs are to continue, the cost will fall to state and local health agencies or insurance companies.

We are concerned that the withdrawal of federal emergency funds for vaccination may further slow the already sluggish uptake of boosters. As of Jan. 25, 2023, about 20% of the population ages 5 and up and only 40.1% of those 65 and older – who are at the highest risk of death from COVID-19 – had received an updated bivalent booster dose. Once the emergency ends, measures that allowed a broad array of health providers – from pharmacist interns to retired nurses and even veterinarians – to administer vaccines will expire, which could lead to decreased access to vaccination in many parts of the U.S.

What does this mean for the status of the pandemic?

A pandemic declaration represents an assessment that human transmission of a disease, whether well known or novel, is “extraordinary,” that it constitutes a public health risk to two or more states and that controlling it requires an international response.

At some point the WHO will end its pandemic declaration. On Jan. 30, 2023, World Health Organization Director-General Tedros Adhanom Ghebreyesus described the pandemic as being “at a transition point.” But the WHO’s assessment is that the risks are still considerable. Ghebreyesus noted that COVID-19 continues to strain health care systems, exacerbate health care workforce shortages and exceed surveillance system capacities.

The U.S. remains one of the global COVID-19 hot spots. With more than 3,500 hospitalizations per week on average in January 2023, and 3,452 deaths per week as of early February 2023, the U.S. has among the highest deaths per capita in the world.

How does the Biden administration’s stance differ from the WHO’s position?

In some ways they are very similar. The WHO is looking at the pandemic from a global perspective while the Biden administration is examining it from a national perspective. The WHO’s stance reflects the assessment that the world is not sufficiently vaccinated, that health care systems remain vulnerable and that unchecked disease transmission in some parts of the world should remain a source of international concern and attention.

China’s massive outbreak after the lifting of its zero-COVID policy in early December 2022 has received a great deal of media attention. But less noted is the fact that vaccination rates across African nations average 40%, and that vaccination rates are very low in countries that are experiencing conflict, such as Syria, where only 15% of the population has received any COVID-19 vaccine.

The WHO’s continuation of the global pandemic status signals that there is more international coordination and work to be done. In contrast, the Biden administration is making a social and political judgment that it is time to wind down the federal role.

Biden’s order will not affect state-level or local-level emergency declarations. These declarations have allowed states to allocate resources to meet pandemic needs and have included provisions allowing them to respond to surges in COVID-19 cases by allowing out-of-state physicians and other health care providers to practice in person and through telehealth.

Almost all U.S. states, however, have ended their own public health emergency declarations. Eight states – California, Colorado, Delaware, Georgia, Illinois, New Mexico, Rhode Island and Texas – still have emergency declarations in effect, but all of them will expire by the end of February 2023 unless renewed.

While some states may choose to make permanent some COVID-era emergency standards, such as looser restrictions on telemedicine or out-of-state health providers, it could be a long time before either politicians or the public regain an appetite for any emergency orders directly related to COVID-19.

Amy Lauren Fairchild, Dean and Professor of Public Health, The Ohio State University and Marian Moser Jones, Associate Professor and Graduate Director of Family Science, The Ohio State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The AAAS Fellowship, recognizing scientifically or socially distinguished efforts to advance science or its applications, is one of the most prestigious honors a U.S. scientist can receive. Fellows are elected by their academic peers.

“This year’s Fellows are an exceptional class of leaders in their respective disciplines and representative of Ohio State’s world-class faculty,” said Peter Mohler, vice president for research. “I am pleased that their scholarly pursuits and achievements are being recognized by a distinguished group of scientists, engineers and innovators as part of the American Association for the Advancement of Science’s newest inductees.”

The 2022 class includes 505 scientists, engineers and innovators spanning 24 scientific disciplines. 

Ohio State’s newest Fellows are: 

• Antonio Conejo, professor of integrated systems engineering and electrical and computer engineering. For outstanding contributions to power system operations, planning and markets, and service as an educator and leader in power engineering and operations research.
• Amy Fairchild, dean of the College of Public Health and professor of health services management and policy. For her eminent contributions to public health ethics and policy that are grounded in the history and philosophy of science.
• Mohit Randeria, professor of physics. For contributions to the theory of BCS-BEC crossover, to the understanding of angle-resolved photoemission of cuprate superconductors, and for providing rigorous bounds on the superconducting transition temperature in two-dimensional materials.
• Laura Wagner, professor of psychology. For contributions to language and conceptual development, and for broadening participation in publicly engaged science.

The new Fellows will be celebrated in Washington, D.C., this summer.

The review, due to be completed in January 2023, will also consider how to alter the agency’s approach to support appropriate use of opioid painkillers in an expanded public health context, said Patricia Zettler, associate professor in Ohio State’s Moritz College of Law, who is the subject matter lead for the team review.

“The focus of our review is forward-looking,” Zettler said. “How could the FDA use the authority it has to better serve its public health mission, and what additional legal authorities might be useful to improve opioid regulation?” 

An average of 44 people in the United States died each day from prescription opioid painkiller overdoses in 2020, accounting for almost 18% of all opioid overdose deaths that year, according to the Centers for Disease Control and Prevention. The 16,000-plus overdose deaths in 2020 represented a single-year 16% increase in prescription opioid-involved deaths. 

A report on national strategies to address the opioid epidemic issued by the National Academies of Science, Engineering and Medicine (NASEM) in 2017 recommended that the FDA seek this external review. The NASEM report, which was requested by the FDA, generally recommended that the FDA use a comprehensive approach for incorporating public health considerations into the regulatory framework for prescription opioids, including accounting for benefits and risks to patients, households and society as well as incorporating such considerations at the clinical development stage. 

“One of the really challenging things is that these are not products without benefits,” Zettler said. “Prescription opioids have important benefits for a lot of patients under many different circumstances. So there is a need to figure out how to best maximize those benefits while also minimizing the really serious risks of the products.” 

Ohio State is home to a collection of scholars with the right mix of expertise in law, public health, pharmacy and medicine to address the many policy considerations at issue, said review team member Micah Berman, associate professor in the College of Public Health and Moritz College of Law. Both Zettler and Berman have worked at the FDA in the past, and Zettler was a consultant to the NASEM committee that issued the 2017 report. 

“We have the interdisciplinary skills to look at the whole process all the way from the clinical trial to design to some of the post-marketing issues, but also to look at questions of legal authority and how the FDA might want to reconsider the standards it uses for approvals or any new authority that it might need,” Berman said. “It’s a pretty broad mandate to look at all of those things – the process the agency used and the decisions that it came to, and the broader lessons that can be gleaned from the FDA’s past experience regulating opioids – and to approach those questions from the research side, the clinical side and the legal side all at the same time.” 

Ohio State scholars joining Zettler and Berman for the review are Kathy Lancaster, associate professor of epidemiology in the College of Public Health; Macarius Donneyong, assistant professor of outcomes and translational sciences in the College of Pharmacy and College of Public Health; and Marty Fried, clinical assistant professor of internal medicine in the College of Medicine. 

In a recent blog post, FDA Commissioner Robert Califf described the upcoming review. 

“While the FDA’s previous strategies have largely focused on opioid use and overdoses, the evolving nature of the overdose crisis calls for both a new approach and honest reflection about what the FDA can do differently moving forward. … We have initiated this review with the intended goal of understanding what revisions are needed to support appropriate use of opioid analgesics. Our ‘lessons learned’ will actively inform our future approach,” he wrote. 

The opioid crisis was determined in 2017 to be a public health emergency, and that designation is still in effect, Califf wrote, noting that illicit opioids – particularly heroin, fentanyl and compounds with similar chemical structures – are huge contributors to the problem of misuse and overdose deaths. 

For the purposes of this review, the focus will remain on regulatory activities related to existing prescription opioid medications – as well as new pain-management products that will come up for approval in the future. 

“It’s laudable for the government to seek external input on its approach, particularly for a problem this large and this complicated,” Zettler said. “Although there isn’t likely to be one solution, we’re looking forward to using our expertise to help serve the public health and help inform the agency’s regulatory decisions.”

The College of Medicine, College of Nursing, College of Optometry, College of Public Health and College of Veterinary Medicine were recognized for demonstrating an outstanding commitment to diversity and inclusion. Ohio State is the only academic institution in the country to have five colleges honored with the Health Professions HEED award.

“This recognition is meaningful and reflects the outstanding work of these five colleges to further diversity and inclusion,” said Melissa Gilliam, executive vice president and provost at Ohio State. “By fostering a culture of inclusive excellence, the entire university community benefits through a greater sense of belonging.”

INSIGHT Into Diversity magazine evaluated academic institutions on leadership support for diversity, recruitment and retention of students and employees, and other aspects of campus diversity and inclusion. Ohio State diversity and inclusion efforts include:

College of Medicine: The College of Medicine has adopted curriculum and training procedures to explore racial disparities in medicine with the goals of dispelling myths and becoming aware of and rectifying any subconscious bias. Coupled with the classroom education are opportunities to apply learnings in the clinical skills lab through the use of manikins of color and melanated suture pads.

College of Nursing: The Summer Institute for Future Nurses introduces diverse groups of high school students from around the country to nursing. Offered in a hybrid format, students participated in mock clinical skills training sessions on campus and virtual presentations. More than 20 previous attendees of the Summer Institute have graduated from the College of Nursing with a Bachelor of Science in Nursing degree. 

College of Optometry: BuckEye Launch is an immersive five-day program for first-year students that provides strategies for academic success and creates a sense of community among students, faculty and staff. Major themes include effective learning and test taking strategies, self-care and personal wellness, and time management.

College of Public Health: The College of Public Health dean’s administrative leadership team and extended staff applied for and were chosen to be part of the inaugural class of Ohio State’s Office of Diversity and Inclusion’s new Inclusive Excellence Team Certification Program. The nine-month intensive learning and project development opportunity is designed to ensure that each participating faculty and staff member receives the same inclusive excellence education and tools to build a diverse, equitable and inclusive workplace. It includes a capstone project designed to advance the college’s goals around diversity, equity and inclusive excellence in the long term.

College of Veterinary Medicine: Diversity, equity, inclusion and belonging (DEIB) is incorporated as a foundational principle in each of the six goal areas of the College of Veterinary Medicine’s Be The Model® strategic plan. The formation of a new student leadership group, Student Leaders for Inclusive Excellence, is one example of many initiatives designed to support DEIB in the college community. Comprised of student leaders representing the college’s affinity groups and student chapters supportive of DEIB, this group provides mentorship and support to student affinity groups and student organizations that are supportive of diverse populations. The goal is for all student organizations to work together to create a sense of belonging with one another and to develop leadership skills as they plan DEIB educational events for the entire college community. 

Ohio State will be featured in the December 2022 issue of INSIGHT Into Diversity magazine.

One study, published this week in the journal Perspectives on Sexual and Reproductive Health, found that proposed abortion bans in Ohio could substantially increase the distance to care for residents of the state. It’s a finding likely to be repeated in restrictive areas throughout the nation, particularly in the South and Midwest, according to the researchers.

The research team analyzed distance to providers under a “best case” scenario (two of Ohio’s five surrounding states continue to offer care) and “worst case” scenario (no surrounding states offer care after the Supreme Court ruling).

In the researchers’ worst-case scenario, they calculated that, from the center of 85 of the state’s 88 counties, travel would be 191 to 339 miles to an abortion provider. In the best-case version, that dropped to 115 to 279 miles away for 62 of 88 Ohio counties.

As of February of this year, the centers of all Ohio counties were, at most, 99 miles away from an abortion facility.

“This summer, the United States Supreme Court will likely overturn or weaken Roe v. Wade when issuing an opinion in the Dobbs v. Jackson Women’s Health Organization case,” said the study’s lead author, Payal Chakraborty, a graduate student in Ohio State’s College of Public Health.

If this happens, states could prohibit abortion in multiple ways. One way – a “trigger ban” – immediately outlaws abortion if the Supreme Court issues a ruling like the one anticipated this summer. Ohio is currently trying to pass such a ban, which would force residents to leave the state to access abortion care.

Such a scenario would inevitably increase health inequities, Chakraborty said.

“The ability to access abortion care will be retained for the most privileged Ohioans and those who have the most reproductive autonomy. They can fly, pay for hotels, take time off to deal with any waiting periods. But for so many seeking abortion care – including those experiencing financial insecurity – those options are out of reach,” she said.

In the second study, recently published in The Lancet Regional Health - Americas, researchers used 2017 federal data to determine how many patients are already leaving their states for abortion care, and further evaluated that data based on the policy environment and number of providers per million women of reproductive age in each state.

In 2017, an average of 8% of U.S. patients left their state of residence for abortion care. Percentages were much higher in some states – 74% in Wyoming, 57% in South Carolina – and averaged 12% in states with restrictive abortion laws. In states with middle-ground abortion laws, an average of 10% of patients left their states of residence. In those with supportive laws, 3% traveled out of state.

“We’re likely headed toward an abortion rights landscape where states will have greater latitude to restrict access, and we’ve already seen increasingly restrictive policies involving gestation limits, waiting periods and medically unnecessary facility requirements,” said Mikaela Smith, a research scientist at Ohio State’s College of Public Health.

For many patients, going out of state can pose several challenges, including health care coverage obstacles, cost of travel and overnight lodging, and managing the care of their families, including other children, Smith said.

“When we think about other forms of medical care, we don’t think about having to cross state lines,” Smith said, echoing Chakraborty’s concerns that obstacles are likely to be greater for people of color and others who face pervasive reproductive health inequities.

“From an equity standpoint, where you are born or live shouldn’t affect the quality or type of care you receive,” Smith said.

Both studies were conducted as part of the Ohio Policy Evaluation Network (OPEN).

Other researchers who worked on the studies are Alison Norris of Ohio State; Danielle Bessett, Michelle McGowan, Stef Murawsky and Zoe Muzyczka of the University of Cincinnati; Elaina Johns-Wolfe of the University of Missouri; and Jenny Higgins of the University of Wisconsin-Madison.

“What was my reaction after I passed out, you mean?” was Hood’s response to a question about his reaction to the award.

“I was humbled, very much humbled. And then after the humbleness, it called for a bit of introspection and reflection on my career,” he said. “And at that point, I was almost in tears.”

The Ruth C. Bailey award was established in 2012 by alumnus Vincenzo Ferranti to honor Bailey, his adviser and mentor and a member of the university’s international student services staff from 1937-1974. Recipients are selected based on their contributions to campus multicultural interaction and understanding.

“Dr. Hood has woven his passion for diversity enhancement and inclusive excellence through all facets of his career, bringing light to many important topics and issues through research, teaching and service,” said Amy Fairchild, dean, College of Public Health. “To work with Dr. Hood is to know an active recruiter for minority students and an advocate not only for faculty and students of color in the college, but across the university. Within the college, he regularly offers advice and support for junior faculty. This form of engaged mentorship is instrumental in the lives of those who are developing their careers and – importantly – it lifts us all.”

Hood’s academic research focus is in the area of environmental public health. All of his currently funded  projects use the Public Health Exposome framework and Big Data to Knowledge (BD2K) analytics that  seeks to understand disparate health outcomes within the context of historical structural inequities observed through an environmental lens.

An example of this, Hood said, is the federal interstate highway system.

“Transportation is a good thing but there are unintended consequences. The highway system bisected many neighborhoods – most of them were minority neighborhoods,” he said. “So the Public Health Exposome framework allows us to look at the impact of traffic related and environmental pollution on the residents of those communities.”

Hood said he comes by this passion for understanding inequities honestly. His parents were actively involved with the civil rights movement. Hood himself was a plaintiff in Swan v. Charlotte-Mecklenburg Board of Education which was argued before the Supreme Court on October 12, 1970 as one of the resulting test cases from Brown v. Board of Education in 1954. The emphasis his family placed on justice and equality led him to his work today.

In addition to the community-facing nature of his work, Hood was honored for his collegiality inside the university. That spirit of collaboration is what brought him to Ohio State, he said.

“The generation of scientists that I was mentored by represented the highest level of commitment to the academy. You have to be collegial in the academy,” he said. “Discovery in and of itself comes about as the result of collegiality. That is one of the reasons I came to Ohio State – every resource that one might conceive of is at this institution and in Columbus.”

Hood attributes this focus on collaboration to the university’s leadership. He recalls an instance in which former President Michael V. Drake reminded researchers that Ohio State is an urban land-grant institution and that it is the university’s responsibility to serve its community.

More recently, Hood said he finds President Kristina M. Johnson and Provost Melissa L. Gilliam’s continuation of that push for outreach and engagement to be inspiring.

“There is a groundswell of enthusiasm for collaborative interactions and discovery,” he said. “Under President Johnson and Provost Gilliam, I think that we are going to be regarded as the model going forward for our community-facing participatory research programs.”

Hood remains excited by the possibilities unfolding in his work within the university and beyond.

“These are good days for Ohio State.”

The research highlights the importance of not making assumptions about race-based viewpoints regarding health care, and illustrates the likelihood that access — not just distrust or skepticism — is a significant obstacle to higher levels of COVID-19 protection among Black Americans, the study authors said.

The study, led by researchers at The Ohio State University, appears today (Jan. 21, 2022) in the journal JAMA Network Open.

“From the start of the vaccine rollout, we began to hear about how Black Americans were going to resist vaccinations. Our study highlights that any emphasis on hesitance as the primary challenge to vaccination among Black Americans would be a mistake,” said study lead author Tasleem Padamsee of Ohio State’s College of Public Health.

“We must not lose sight of the significant access barriers that persist, including distant vaccine sites, lack of transportation and inflexible work hours.”

The study followed the same group of Americans over time, surveying them about their views regarding the pandemic. This approach allowed the researchers to measure how individual and group perspectives shifted during a time when the world was gaining new information about both the virus and the vaccine by the day.

“As availability of the vaccine approached, and then as it became available, we were hearing as part of the national conversation this assumption that Black Americans would be less likely to seek vaccines because of well-earned distrust shaped by racism,” Padamsee said.

“But we also know that Black Americans are highly motivated to take care of themselves and their communities,” she said.

Data was collected in seven waves from an initial group of 1,200 participants (response numbers decreased modestly as the study progressed). The surveys began before vaccines became available in late 2020, and ended in June 2021. Participants were asked about their likelihood of getting a vaccine and about their beliefs regarding the safety, efficacy and need for the vaccine.

About 38% of Black participants and 28% of white participants were hesitant at the start of the study. By June, 26% of Black participants and 27% of white participants were hesitant. The data pointed to changes in beliefs about the protections the vaccine offered as a key explanation.

“The data suggest that Black communities were particularly focused on ways to protect themselves and their communities as more evidence emerged that vaccines were effective and safe,” said study co-author Kelly Garrett, professor of communication at Ohio State.

COVID-19 has disproportionately affected Black Americans, who’ve experienced inequitable rates of illness and death and worse economic impacts. The vaccination rate for Black Americans continues to lag behind the rate for white Americans.

“While Black Americans’ intention to get vaccinated has gone up, their actual vaccination rates haven’t gone up as quickly. That suggests that there are other obstacles to vaccination. We have good reason to think that has to do with access, something we must continue to work on,” Garrett said.

In their paper, the researchers note that historical traumas such as the Tuskegee Syphilis Study and the unethical use of cancer cells from Henrietta Lacks provide important context for understanding vaccine hesitance in Black communities.

That history, alongside everyday exposures to institutionalized racism within health care, are real obstacles, but they aren’t the whole of the story, said Padamsee, adding that the research findings didn’t surprise her, based on her body of research examining health inequities and race.

“I expected that the same qualities that lead Black communities to be cautious about a new vaccine would lead them to accept the vaccine once they gathered more information. The unifying theme is protection. Black Americans want to protect themselves and their communities,” she said.

“Any story that sounds like ‘Black people don’t want to take care of themselves as much as white people’ sounds immediately suspicious to me. That story is generally wrong – it’s that something is standing in their way.”

The National Science Foundation supported the study.

Other Ohio State researchers who were part of the study are Robert Bond, Graham Dixon, Shelly Hovick and Duane Wegener. Other co-authors include Erik Nisbet of Northwestern University and Kilhoe Na of Merrimack College.

GOHi and several Ohio State University partners will collaborate with the Government of Ethiopia to strengthen workforce capacity within a network of hospitals and a central laboratory as well as processes and systems with the goal to provide rapid detection, response and prevention of infectious disease threats.

As part of a five-year cooperative agreement through 2026, the grant will provide $800,000 in funding for the first year, and allows GOHi to continue its One Health-related work to bolster infection prevention and control measures, implement laboratory quality assurance to maintain high levels of accuracy and proficiency, and build capacity through training, mentoring and evaluation. Funding beyond the first year will be based on satisfactory programmatic progress and availability of funds.

GOHi’s project is part of the Global Action in Healthcare Network, one of two global networks established by the CDC to combat antimicrobial resistance and infectious diseases that will span more than 50 countries worldwide. The CDC has awarded $22 million to nearly 30 organizations around the globe.

The continued use of antimicrobials in health care facilities has resulted in the emergence of a variety of antimicrobial resistant pathogens over the past decade, which has caused the rapid spread of disease, serious health conditions and patients dying from preventable and treatable diseases.

“Antimicrobial resistance (AMR) is an increasing threat to global health security, having economic, social and political ramifications worldwide, and puts an excess burden on resource-poor countries, such as Ethiopia,” said Wondwossen Gebreyes, executive director of GOHi. “To combat AMR, it is critical to implement a collaborative One Health approach that brings together multiple disciplines working globally to address the spread of disease, promote health and emphasize the connection among humans, animals, plants and the environment.”

Since 2009, GOHi has been working extensively on a range of One Health-related projects targeting laboratory, surveillance and health care workforce capacity through applied education, training and research globally.

Over the next five years, the GOHi team and the Ethiopian government will work to ensure the continued collection and entry of quality surveillance and laboratory data to monitor trends and trigger alarms for potential outbreaks at facilities. Successful implementation of these and other activities will improve network preparedness and response to antimicrobial resistance threats.

This award is GOHi’s second from the CDC this year. In April, GOHi received $5.61 million in funding from the CDC to fight the COVID-19 pandemic and strengthen Ethiopia’s public health system capacity for small- and large-scale disease outbreaks and emergencies.

Ohio State partners on this new initiative include the colleges of Medicine (Shu-Hua Wang, Joan-Miquel Balada-Llasat and Xia Ning), Veterinary Medicine (Gebreyes and Zelalem Mekuria) and Public Health (Saira Nawaz and Jiyong Lee), as well as the Global One Health, LLC in Ethiopia (Getnet Yimer and Ebba Watola),

This earlier detection by the Self-Administered Gerocognitive Examination (SAGE test) is critical to effective treatment, especially as new therapeutics for dementia and Alzheimer’s disease are being developed and approved.

“New disease-modifying therapies are available and others are currently being evaluated in clinical trials, and we know that the earlier cognitive impairment is detected, the more treatment choices a patient has and the better the treatments work,” said Dr. Douglas Scharre, director of the Division of Cognitive Neurology at Ohio State Wexner Medical Center and lead author of the study published in the journal Alzheimer’s Research & Therapy.

While the test does not definitively diagnose problems like Alzheimer’s, it allows doctors to get a baseline of their patients’ cognitive functioning, and repeat testing allows them to follow their memory and thinking abilities over time.

“Often, primary care physicians may not recognize subtle cognitive deficits during routine office visits,” Scharre said.

The eight-year study followed 665 consecutive patients in Ohio State’s Center for Cognitive and Memory Disorders. Researchers found that the SAGE test accurately identified patients with mild cognitive impairment who eventually progressed to a dementia diagnosis at least six months earlier than the most commonly used testing method called the Mini-Mental State Examination (MMSE).

Among the 164 patients with baseline mild cognitive impairment, 70 patients converted to dementia. This is a 43% conversion rate over three to four years, which is similar to rates from other academic center-based studies, Scharre said. The distribution of dementia diagnoses included 70% Alzheimer’s disease dementia, 7% Lewy body dementia and 9% pure or mixed vascular dementia.

The test can be taken anywhere whenever there are cognitive concerns. It takes only about 10-15 minutes to complete, and the four interchangeable forms are designed to reduce learning effects from recurrent testing over time. The cognitive domains tested with the 11-item test include orientation, language, calculations, memory, abstraction, executive function and constructional abilities. The MMSE does not test abstractions or executive function abilities.

“Any time you or your family member notices a change in your brain function or personality, you should take this test,” Scharre said. “If that person takes the test every six months and their score drops two or three points over a year and a half, that is a significant difference, and their doctor can use that information to get a jump on identifying the causes of the cognitive loss and to make treatment decisions.”

Scharre has worked closely with BrainTest Inc. SEZC to develop a scientifically validated digital version of the SAGE test called BrainTest that can be taken anywhere on a tablet or touch screen computer. This digital version will also be integrated with the Ohio State Wexner Medical Center’s electronic medical records system to better facilitate self-testing, storing and reviewing results for patients and their health care providers.

“Based on cognitive score changes, clinicians and families may decide it is time to act on safety and supervision needs. This might include, for example, medication oversight, financial assistance, driving limitations, setting up durable Powers of Attorney and other legal arrangements/trusts, change in living arrangements, and enhanced caregiving support,” Scharre said.

More than 6 million Americans have Alzheimer’s disease, and those numbers are expected to rise to more than 13 million by 2050. Deaths from Alzheimer’s and other dementias have increased 16% during the COVID-19 pandemic, according to the Alzheimer’s Association.

Access SAGE or BrainTest at wexnermedical.osu.edu/SAGE

Access BrainTest at BrainTest.com

Scharre is a member of the Scientific Advisory Board and is Head of Medical Affairs for BrainTest.

The College of Medicine, College of Nursing, College of Optometry, College of Public Health and College of Veterinary Medicine were recognized. Ohio State is the only academic institution in the country to have five colleges honored with the award.

“The recognition bestowed upon these five colleges is a testament to our collective commitment to diversity and inclusion,” said Melissa Gilliam, executive vice president and provost at Ohio State. “The entire university community benefits from this recognition as we strive to live up to our land-grant university values.”

The Health Professions HEED Award process consists of a comprehensive and rigorous application that includes questions relating to the recruitment and retention of students and employees, leadership support for diversity, and other aspects of campus diversity and inclusion. Ohio State diversity and inclusion efforts include: 

College of Medicine: The College of Medicine is executing an anti-racism action plan that includes a review of medical curriculum to remove racism and bias. In addition, the college appointed vice chairs of diversity, equity and inclusion in all 26 departments and implemented best practices for inclusive faculty searches, which includes creating a standing search committee within each department whose members will complete implicit bias mitigation training.

College of Nursing: In May 2021, the Office of Diversity, Equity and Inclusion at the College of Nursing held virtual graduate entry welcome panels for incoming graduate entry students of all backgrounds. The panels were designed to enhance incoming graduate students’ understanding of psychosocial, academic, clinical, professional practice and research aspects of the nursing student experience.

College of Optometry: With an aim of cultivating interest in optometry as a career and creating a pipeline of students who exhibit inclusive thinking and behavior, the College of Optometry offers the I-DOC – Improving Diversity in Optometric Careers – summer program for underrepresented diverse students. During this program, students learn about health disparities in optometry, explore different careers in optometry and review how to be successful learners and applicants. 

College of Public Health: In 2020, the College of Public Health launched a trio of scholarships designed to increase diversity and equitable access to public health education: the Ruth Ella Moore, Dr. Amy Acton Future Leaders of Public Health and the Multicultural Public Health Hood scholarships. The scholarships will be awarded annually with the intention of championing those who are first-generation or trailblazing students, those who have overcome significant challenges and those students who seek to advance Black Americans. 

College of Veterinary Medicine: The College of Veterinary Medicine has a strategic focus on recruiting underrepresented minorities and first-generation students by reducing barriers to enter the profession, providing engaging learning opportunities and creating an academic community that fosters inclusion. This includes the creation of several new scholarships and the use of a virtual recruitment platform that provides an opportunity to connect with historically Black colleges and universities for virtual admissions sessions.

Ohio State will be featured in the December 2021 issue of INSIGHT into Diversity magazine. 

Their study is built on previous research that showed that RNA — part of the genetic material from inside the COVID-19 virus — can persist up to a month in dust. For that study, researchers collected dust from residence hall rooms on campus that housed students known to be infected with COVID-19.

Additional research showed viruses do not remain infectious in dust, leaving only the genetic material behind. Analyzing that genetic material offers a noninvasive, low-cost way of monitoring for COVID-19.

“The dust will show if you have even a small number of infected individuals in a building,” said Karen Dannemiller, senior researcher on this study and associate professor of civil, environmental and geodetic engineering and environmental health sciences at Ohio State. “And because we can sequence that genetic material from the virus that is in the dust, we can also tell what variants are present, and track that on campus as well.”

Tracking the variants will be an important part of the campus’s reactivation this semester: The Delta variant is more contagious than previous COVID-19 variants, and the U.S. Centers for Disease Control and Prevention have identified three additional variants of concern.

The scientific method for collecting and analyzing the dust is based on a previously published study by this research team; research that suggests the dust is not infectious has been posted to a pre-print server online. That portion of the research has not been peer-reviewed.

The science behind it essentially starts with a sneeze, Dannemiller said.

“If you have ever seen a picture of a sneeze, with all the droplets coming out, that is where this begins,” she said. “There are a wide range of droplet sizes in that sneeze, and there are droplets that come out when you talk, or sing, or breathe — just by being in that room, you are expelling these droplets, and a lot end up on the floor.”

Once the droplets hit the floor, they mix with dust. The droplets can contain the SARS-CoV-2 virus that causes COVID-19; the team’s research has shown that, while RNA fragments can persist up to a month, the virus itself does not survive that long.

The researchers are working with Ohio State’s facilities management teams and custodial staffs to collect the dust. Custodians will clean the university’s buildings as they usually do, but instead of emptying vacuum cleaners into the trash, cleaning crews will empty vacuum cleaners into plastic bags to be sent to the Ohio State Infectious Diseases Institute’s Applied Microbiology Services Laboratory (AMSL). The laboratory has been processing on-campus COVID-19 tests since the fall of 2020.

The system does not allow the researchers to pinpoint a COVID-19 infection — they could not, for example, identify the specific rooms in a building where the virus’s genetic material was shed. The system does, however, allow them to identify individual buildings where the virus’s genetic material appears in higher volumes. That will allow the university to understand how and where the virus might be spreading, and to make choices that help keep students, faculty and staff safe.

The university already is monitoring wastewater on campus for the virus and conducting regular COVID-19 tests; analyzing dust is “another tool in the toolbox,” Dannemiller said.

“Wastewater testing usually provides data at the sewer-shed level and can be difficult to collect at the building level,” she said. “Individual testing is cumbersome and expensive, but you get high-resolution data — you can tell which individual has the virus. Building dust is in the middle, where you get some increased resolution, and the samples are easier to collect and process than wastewater, but it’s still noninvasive.”

Collection efforts began on a limited basis on Aug. 16. The project launched campus-wide on Monday, Aug. 23. Dust will be collected weekly from 50 buildings on the main campus, including residence halls, the Recreation and Physical Activity Center, and Thompson Library.

Then it will be taken to the AMSL, where researchers will extract virus RNA fragments from the dust, analyzing how prevalent the RNA is in the dust to determine how widespread COVID-19 might be in a given building. They will then sequence the virus’s RNA to identify which variant of the virus — if any — is present.

“It doesn’t give us an answer of whether the person infected others, but it does tell us that this footprint or this marker was left behind, and that at one point, SARS-CoV-2 was in that space,” said Nicole Renninger, an engineering PhD student in Dannemiller’s lab and a lead researcher on this project. “Our hope is that this is helpful as we start up classes and have people coming back on campus. We’ll be able to see what is popping up and where it is popping up.”

Other Ohio State researchers from Dannemiller’s lab who are contributing to this project include Jenny Panescu, Nick Nastasi, John Van Dusen and Josh Blankenship. A team of staff at the AMSL are also contributing, and include Seth Faith, Haley LeBlanc, Rick Shaffer, Jeff Jahnes and Jacob Smith. The teams collaborate on this work with assistant Ohio State engineering professor Natalie Hull and her research team, as well as professor Kyle Bibby and his research team at the University of Notre Dame.

Since 2009, GOHi has been on the front lines in Ethiopia working with in-country partners to strengthen capacity using a One Health approach — one that brings together multiple disciplines working globally to address the spread of disease, promote health and emphasize the connection among humans, animals, plants and the environment.

As new diseases emerge, the need for health system preparedness across the globe is vital for nations to prevent spread of pathogens, detect and report epidemics, and respond to and mitigate the spread of those epidemics. The current COVID-19 pandemic urgently underscored these needs. Under-preparedness in one country is a global risk to all.

“This award exemplifies the critical importance of focusing on public health, which is a global issue and very timely,” said Grace Wang, executive vice president for research, innovation and knowledge. “By harnessing the capability of Ohio State’s world-class research faculty, we are working to find innovative solutions to global challenges and are pleased to partner with the Centers for Disease Control and Prevention and Ethiopia’s public health system.”

With this award, GOHi aims to address three specific focus areas in order to achieve International Health Regulation standards and benchmarks; strengthen surveillance, laboratory and workforce capacity; improve data management; and develop a well-linked response network for disease outbreaks and public health emergencies.

“Right now, the world needs a major effort to strengthen surveillance, laboratory and workforce capabilities,” said Wondwossen Gebreyes, GOHi executive director. “The GOHi consortium on campus along with global partners are committed to tackling the world’s toughest health challenges at the interface of humans, animals, plants and the environment, including COVID-19. The impact of this work will save lives while we continue to fight this pandemic. It will also have a lasting impact on prevention and control of future zoonotic viral and drug resistant bacterial infections among others.”

GOHi, with participation from Ohio State’s College of Medicine, College of Public Health and College of Veterinary Medicine and additional faculty support from the College of Arts and Sciences and College of Food, Agricultural, and Environmental Sciences, will partner with the Ethiopian Public Health Institute and in-country Regional Health Bureaus to accomplish the project.

“It is very exciting to receive this award, which has come at the right time, when we need it the most,” said Getnet Yimer, regional director, Global One Health Eastern Africa Office. “We are committed to continue working with all partners and the government agencies to sustain our gains and achieve beyond the planned milestones.”

Over the next five years, the project will expand the number of laboratories with the ability to test and report Influenza-like illnesses and severe acute respiratory illnesses, like COVID-19; train health professionals and laboratory staff on better specimen collection and transportation techniques; improve data collection and reporting and implementation of appropriate mitigation measures for severe respiratory illnesses based on that data; support equipment procurement; and improve quality management throughout the laboratory network to ensure consistent, reliable quality testing.

The ultimate goal will be to enhance and expand the Ethiopian public health system to more comprehensively and efficiently manage the multiple elements that contribute to epidemics of global (national and international) concern.

This project serves as an example of institutional teamwork that advances the university’s commitment as a global institution, engaging in meaningful and beneficial partnerships to gain and share knowledge and find sustainable solutions to the world’s most complex issues.

Wilson Figueroa, senior consulting research statistician at the Center for Health Outcomes and Policy Evaluation Studies (HOPES), received $75,000 to study the impacts of daily stress on queer people of color, and Jennifer Hefner, assistant professor of health services management and policy, received $25,000 to evaluate 911 response to mental health crises in Columbus.

The racial justice seed grants are designed to help researchers get their ideas off the ground as they work toward larger projects, said Bill Miller, senior associate dean of research and professor of epidemiology.

“By offering these grants, the college is showing its commitment to understanding the effect of racism on public health and, more importantly, to intervening to reduce that impact,” Miller said. 

Wilson Figueroa: Daily stress in queer people of color

Compared to heterosexual people, those who identify as LGBTQ experience health disparities including higher rates of depression, anxiety and cardiovascular problems. Black Americans, straight and queer, face profound health inequity across nearly all measures. Yet few studies look at the intersection of these groups to assess health outcomes for Black sexual minorities, said Figueroa, whose project will focus on daily stressors and health in queer Black individuals.

The study will enlist Black queer adults and white queer adults in central Ohio. They will be asked to answer nightly questionnaires for a week and provide daily saliva samples to be tested for cortisol, a stress hormone linked to health problems.

“Cortisol is released in times of stress, but for some people it becomes dysregulated. Over time this can be harmful and lead to things like heart disease and cancer, which you see a high amount of in queer folk already,” Figueroa said. “This may be related to increased experiences of stress in daily life, such as microaggressions or discrimination.”

The research team — which includes HOPES Research Specialist Kristin Harlow and Ohio University’s Peggy Zoccola — will also analyze diary entries for stress measures and identify potential factors that could contribute to a participant’s resiliency, such as community connectedness and social support.

“One of the bigger things I hope comes from this study is identifying points of intervention — where we might somehow prevent the cycle of stress leading to dysregulation and eventually health disparities,” Figueroa said.

Jennifer Hefner: 911 response to mental health crises

Black people and people with mental illnesses are overrepresented in the American criminal justice system — an injustice at the forefront of the Black Lives Matter movement. In response to community demands, cities across the U.S., including Columbus, have begun exploring alternative public safety responses that better incorporate mental health services.

Hefner’s study will evaluate outcomes and community perceptions of the three behavioral/mental crisis response models currently employed in Columbus:

1. Traditional police officer response.
2. Police response including one or more officers with at least 40 hours of training from the National Alliance of Mental Illness Crisis Intervention Team program.
3. Mobile Crisis Response Units, which include a police officer and a mental health clinician employed by Netcare Access, a local mental health crisis triage center.

“For each model, we’re hoping to get data such as use of force, health care utilization and financial cost, as well as identify any outcome disparities by race,” said Hefner, who’s working with co-principal investigator Leah Bevis (College of Food, Agricultural and Environmental Sciences), co-investigator Steve David (College of Social Work) and community partners from Netcare and Columbus Public Safety.

The team — which connected at Ohio State’s STEAM Factory — will conduct interviews and focus groups with advocacy groups and people of color, as well as consult an advisory board of crisis response administrators, to explore how different stakeholders experience different approaches.

“When you criminalize mental illness, you send people to potentially the wrong sector of society. Instead of getting treatment and being connected to social services, someone could end up going to court or jail,” Hefner said, adding that criminalizing the behavior can be more resource-intensive than alternatives.

With Columbus poised to create a fourth, non-police mental health crisis response option in the near future, Hefner said she hopes the research will provide valuable information to the community.

“There’s a lot of research to be done to make sure these approaches are responding to residents’ needs while also keeping everyone safe,” she added. “It’s not about cutting the police department out of public safety — it’s about developing the right relationships so you can properly triage cases to the right level of care.”

Seven colleges have top 10 graduate and professional programs in the latest rankings: the colleges of Arts and Sciences, Business (Fisher), Education and Human Ecology, Engineering, Law (Moritz), Nursing, and Public Affairs (John Glenn). U.S. News’ rankings of graduate and professional programs cover just a small portion of the programs offered at Ohio State, and not all programs are ranked each year.

“The excellence displayed across the university reflects Ohio State’s focus on developing the next generation of leaders throughout society,” said Executive Vice President and Provost Bruce A. McPheron. “Our comprehensive scope and focus on collaboration across disciplines acts as a force multiplier, preparing our graduate and professional students for leadership roles.”

Ohio State enrolls more than 14,000 graduate and professional students in 90 doctoral and 110 master's programs.

The Top 10 graduate and professional programs include dispute resolution (2), pediatric primary care nurse practitioner (3), business supply chain/logistics (4), psychiatric/mental health nurse practitioner (5), student counseling and personnel (5), doctor of nursing practice: administration (6), higher education administration (8), public management and leadership (8), education administration and supervision (9), business production/operations (9), nursing master’s (9), adult/gerontological primary care nurse practitioner (10), biological/agricultural engineering (10), part-time MBA (10), social stratification (10) and sociology of population (10).

Below are some highlights from U.S. News’ 2022 rankings of Ohio State graduate programs, by college.

The College of Arts and Sciences has five of its social sciences and humanities programs newly ranked this year. Political science is ranked 17th, sociology is ranked 18th, and economics, English and history are each ranked 30th among programs in the United States. Additionally, political science, which ranks sixth among programs at public universities, houses top specialties in American politics (11), international politics (12), political methodology (13) and comparative politics (20). Sociology, ranking eighth among programs at public universities, boasts two specialties ranked 10th in the nation: social stratification and sociology of population. Finally, English’s specialty in American literature after 1865 is ranked 13th.

Led by its MBA for Working Professionals Program (WPMBA), Fisher College of Business is home to two graduate programs highly ranked in the 2022 list. The WPMBA program was 10th among all U.S. programs (rising three spots), and fifth among U.S. publics — up two spots. Its full-time MBA program was 14th among U.S. publics. In addition, several specialty areas were highly ranked: supply chain management (4) and productions/operations (9).

The College of Education and Human Ecology ranks 28 out of 277 graduate education programs nationwide, putting it in the top 10% of similar programs. Three of its specialty graduate education programs were ranked in the top 10 nationally, and four additional programs made the top 20 list.

The College of Engineering’s graduate program is ranked first in Ohio and 16th among all public universities. Several departments within the college also placed among the top programs in the nation. The Department of Food, Agricultural and Biological Engineering ranked 10th among its peers within American universities. The Department of Materials Science and Engineering retained its rank of 12th overall. Other top 25 engineering disciplines at Ohio State include nuclear engineering (15), industrial/manufacturing engineering (16), aerospace engineering (19) and computer engineering (22). Overall, 216 engineering schools that grant doctoral degrees were surveyed. Ohio State Engineering is ranked 30th overall.

Moritz College of Law ranked best in Ohio and 40th in the nation out of 193 accredited law schools. The specialty program in dispute resolution is ranked second in the nation and five programs rank in the top 25 in the country: dispute resolution, criminal law, contract law, health law, and legal writing.

The College of Medicine ranked 28th in the ranking of Best Medical Schools–Primary Care, moving up 10 spots versus last year, and ranked 33rd among Best Medical Schools–Research, moving up one spot. In addition, Ohio State ranked seventh for Most Diverse Medical Schools, a new category this year. Specialty programs in surgery ranked 17th, anesthesiology ranked 18th and pediatrics ranked 21st. This recognizes the College of Medicine as one of the most diverse institutions in the country, providing top-tier medical and graduate education programs.

The College of Nursing’s master of science in nursing and doctor of nursing practice (DNP) programs were recognized for excellence in academic rigor and outcomes, with several specialization tracks singled out as top-five programs among public institutions. The rankings included ninth overall and third among public colleges for the master of science in nursing and 18th overall and eighth among public colleges for the DNP programs. This is the third consecutive year that the College of Nursing’s master’s program ranks in the nation’s top 10 and that its DNP program ranks in the nation’s top 20.

The John Glenn College of Public Affairs is ranked 13th in the country out of 285 ranked schools, placing it among the top 5% of public affairs graduate professional degree programs. No other public affairs program in Ohio is ranked in the top 50 schools. The college is also rated in eight out of 12 specialties ranked by U.S. News.

The College of Public Health is ranked first in Ohio and in the top 25 in the nation among 188 public health schools and programs accredited by the Council on Education for Public Health. The college’s specialty program in health care management — the Master of Health Administration — was also ranked first in the state and seventh overall in the most recent analysis of those programs.

A number of Ohio State programs earned high marks in previous years and the magazine reprints rankings from previous years in some fields.

By

David R. Holtgrave

Dean and SUNY Distinguished Professor, University at Albany, State University of New York

Amy Lauren Fairchild

Dean and Professor, College of Public Health, The Ohio State University

Cheryl Healton

Director of the NYU Global Institute of Public Health (GIPH), Dean of Global Public Health, New York University

 Holiday gatherings with family and friends before the pandemic seemed so simple. FatCamera via Getty Images

President Joe Biden set a goal for the U.S. to have COVID-19 under enough control by summer that Americans can celebrate July 4th with family and friends, at least in small gatherings. Important in achieving this goal is another presidential request: that all U.S. adults be made eligible for COVID-19 vaccinations by May 1.

We are public health deans who lead a variety of COVID-19 response efforts and are involved in public policy discussions. At a time when the nation is weary of hearing “no, you can’t,” we believe that thinking in terms of harm reduction – offering safer but not necessarily risk-free alternatives – is crucial.

Harm reduction strategies are in use all around you. Seat belts and air bags are perhaps the most widespread harm reduction strategy for a leading cause of death in the U.S. Designated driver programs represent a harm reduction technique to reduce alcohol-related traffic fatalities. Another well-known example is the use of sterile syringe exchange services to help prevent HIV infection among people who inject drugs while also creating an important pathway for them to access client-centered medical and social services.

Central to harm reduction strategies is meeting someone where they are, without judgment, yet with support and practical pathways for improving health and wellness. It’s relevant today.

Here are four steps we believe are necessary to achieve the president’s Independence Day goal and a major national population health milestone.

Get the vaccine and help others get vaccinated

Vaccination is a classic harm reduction measure – it may not eliminate risk, but it vastly reduces it.

People can both commit to getting the vaccine and to assisting others in the community to get vaccinated. They can volunteer at vaccination events via the Medical Reserve Corps. Family members can help each other monitor for available vaccine time slots and navigate the sometimes challenging systems to get appointments. Businesses and governmental agencies can allow employees paid time off to get vaccinated. Faith communities can also encourage people to get vaccinated and provide welcoming sites for doing so.

Role models can make a difference, too. Recently, four former presidents and first ladies got their vaccine injections on camera and implored U.S. residents to do the same. On March 16, former President Donald Trump also urged people to get the vaccine in an interview on Fox. We consider this important at a time when nearly half of Republican men say they will not get vaccinated, according to a PBS News Hour/NPR/Marist poll.

A wide variety of outreach efforts for vaccinations are needed to speak to communities with differing outlooks on the pandemic, differing historical experiences with the medical system, and different experiences in getting access to COVID-19 vaccines. Vaccine delivery strategies must directly address the disparities in racial and ethnic minority communities that are most heavily affected by COVID-related illness but are not being vaccinated at a similar rate.

Above all, vaccines need to be distributed in the communities where people live, with rollouts aided by trusted systems and community partners.

To quickly reach “herd immunity” – when enough people are immune to the virus through vaccination or infection to substantially disrupt viral transmission – the vast majority of Americans, communities and organizations will need to be engaged in these strategies.

Wear a mask and keep up social distancing

Think of masks in a context of opening up social activity, not locking down activity. Everyone needs to commit to continuing to wear a mask, practice physical distancing and keep hands sanitized for just a little while longer.

As the nation races to get everyone vaccinated to stay ahead of the very concerning emerging variants, we need to use all evidence-based tools at our disposal. Every shot in an arm is a step forward. And every instance in which other harm reduction measures are kept in place prevents the nation from taking a step backward.

These harm reduction measures are not meant to continue forever, and one can imagine a day when they will not be needed, at least not to the same degree. As social interactions start to resume, now is the time to encourage practical strategies for continuing their use.

Be strategic in scheduling events

As more people are vaccinated, the risk of the virus spreading will fall – but that will still take some time, as currently about 12% of the U.S. population has been fully vaccinated, according to the CDC. How soon the U.S. could reach herd immunity will depend on the speed of vaccine uptake.

To avoid spreading the virus in another wave, people, universities, schools, businesses, community-based organizations and governmental entities can employ “strategic scheduling” of events. This includes limiting relaxation of mask-wearing and social distancing to private settings with other fully vaccinated people for the time being, as the CDC’s guidelines suggest.

People can also postpone events, such as in-person school graduations or Memorial Day community picnics, until later in the summer. A spring vacation this year could have negative individual and collective consequences. Simply scheduling the same trip later in the summer could be both more enjoyable and much safer.

Many of the life events people might like to experience in 2021 may be possible, but perhaps not to their ideal ordering, or at the scale, they crave.

Try to be patient

Public health officials have seldom stressed patience as a tool, but in this circumstance, just a bit more patience regarding higher-risk activities could have great public health benefits.

Thought of in risk reduction terms rather than risk elimination terms, individual, school, business and government planning the next few months might help us all engage in strategic scheduling and have just a bit more patience to benefit everyone.

The nation has lost over 530,000 family members and friends, many of whom died alone. Due to the horrible circumstances of this pandemic, we believe we owe it to their memory to minimize any further loss and to find a pathway to continuing our lives in a way that honors their legacy by urgently employing practical and achievable harm reduction strategies. It may appear small, but a midsummer picnic seems like a great way to start to build upon their legacy.

This article has been updated with charts showing vaccine distribution and daily COVID-19 cases

[Deep knowledge, daily. Sign up for The Conversation’s newsletter.]

David R. Holtgrave, Dean and SUNY Distinguished Professor, University at Albany, State University of New York; Amy Lauren Fairchild, Dean and Professor, College of Public Health, The Ohio State University, and Cheryl Healton, Director of the NYU Global Institute of Public Health (GIPH), Dean of Global Public Health, New York University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The report, the second from the team, comes as the university looks toward fall and makes plans to return to a more traditional on-campus experience for students, faculty and staff.

“Positivity rates among our students are relatively low, and we’re even better-positioned to find cases and eliminate spread than we were last semester. But as much as we’ve accomplished through the vigilance and commitment of our community, we must not allow complacency, pandemic fatigue and the longing for a light at the end of this long tunnel to set us back,” said Amy Fairchild, dean of Ohio State’s College of Public Health.

“Through our collective hard work, we are making reality of our dreams of getting to spend more time together learning, teaching and enjoying good times with our fellow Buckeyes.”

Fairchild heads the monitoring team, a group of experts charged with monitoring the virus, containing its spread and making recommendations to university leadership. In its second report, released today, the team details efforts to routinely test more students, identify trends in transmission and control COVID-19’s reach on and around campus.

Of particular focus at this stage in the pandemic: Looking out for the emergence of highly transmissible variants of the virus and reinforcing the importance of health and safety measures.

“The pandemic is not over just because higher-risk Americans have begun to receive vaccine and the startling numbers we saw in Ohio and throughout the nation have fallen. While we see hope, we remain on guard against a virus that has proven to be and continues to be a powerful force,” Fairchild said.

“Properly-worn masks should remain part of our Buckeye uniform, and we must continue to make sacrifices when it comes to staying physically distant and limiting gatherings. This comprehensive approach continues to protect us, our friends and family, and the entire community during this period when we are still far from achieving herd immunity.”

Key updates in the new report include:

• Expanded testing: Improved spring testing protocols include expanded move-in testing and routine weekly testing for off-campus residents, doubling the number of students tested weekly, to about 40,000 tests per week. Increased testing bolsters Ohio State’s ability to identify cases, most of which are asymptomatic, and to isolate those cases and quarantine their at-risk close contacts.
• Speedier response: The efficiency of Ohio State’s on-site testing program — resulting in faster testing turn-around times — and increased Case Investigation and Contact Tracing Team staffing reduce the time to isolation and quarantine and decrease potential subsequent exposures both on and around campus and within the community.
• Trends in transmission: The team found minimal evidence of people becoming infected while working, learning and teaching on campus. Most cases remain connected to transmission within residential settings, and particularly within group housing.
• Regional campuses: The university expanded its testing efforts at regional campuses, and has monitored prevalence in the counties where the regional campuses are located.

In its report, the monitoring team also noted that spring semester brings new territory: resuming testing for those students who previously tested positive and are now beyond the 90-day window in which continued testing is not recommended by the Centers for Disease Control and Prevention.

After that 90-day period concludes, students who had positive tests in the fall are required to return to the weekly testing schedule. If they test positive, they will have to go into isolation. They will also be required to quarantine if they are identified as a close contact of someone who tested positive.

Though some members of the Ohio State community have begun to receive vaccine, it is important to recognize that a vaccine does not eliminate an individual’s responsibility to continue to follow safe and healthy guidelines, Fairchild said.

Vaccinated students, for example, are currently required to participate in routine COVID-19 testing and to follow isolation and quarantine guidance. The studies supporting use of the current vaccines showed that they were effective in preventing illness, but as of now there is not sufficient evidence to show that they prevent a vaccinated person from transmitting infection to others. The Comprehensive Monitoring Team will continue to evaluate emerging evidence and update recommendations on this front as appropriate. 

“Vaccinations provide another layer of protection and another tool in our safe and healthy toolbox, but their arrival does not signal an end to or a lessening of precautions on and around campus,” Fairchild said.

With this new version of the dashboard, users will be able to view the data going back to the 2020 fall semester as well as the most up-to-date numbers for the 2021 spring semester. The previous version showed the most recent 20 days of testing data. Ohio State’s COVID-19 dashboard has been recognized by “We Rate Covid Dashboards” with an A+ grade.

“Users, for example, can still get to the various testing results by single day, seven-day average and cumulative for both students and employees by using the available filters. New with this version, users can view information compared over a significantly longer period of time,” said Eric Mayberry, director of data and analytics in Ohio State’s Office of the Chief Information Officer and a creator of Ohio State’s dashboard.

“The idea is to increase transparency by giving the campus community and the public additional data points as well as perspective on the prevalence of the virus at Ohio State. It is important to see how the university community’s efforts to slow the spread have fared.”

At this point early in the spring semester – students returned to some in-person classes beginning Jan. 25 following two weeks of online-only instruction – the dashboard shows seven-day average positivity rates for students holding steady at below 1%. Shortly after classes began in the fall semester, the positivity rate was nearly 6%.

The dashboard will continue to provide key measures for the state of Ohio, including daily cases (also available by county) and hospital capacity, along with Ohio State student testing data for all students, on-campus students and off-campus students plus cumulative employee test data. Since surveillance testing began on Aug. 14, the university has conducted more than 350,000 student tests and almost 25,000 employee tests.

The enhanced dashboard also continues to report information about isolation and quarantine bed usage, capacity and availability. Information on PPE safety kits and enhanced cleaning measures in campus facilities have been moved to the text portion of the dashboard page. Information is also available on the Campus Readiness page of the Safe and Healthy Buckeyes website.

Leanne Stanley, a consulting research statistician in the Office of Strategic and Competitive Intelligence, created the dashboard with Mayberry and Henry Zheng, associate vice president for strategic analytics. They collaborated with a team of Ohio State public health, technology and analytics experts, with guidance from university leaders.

The team said the next potential update to the dashboard will be vaccination data for the state of Ohio as well as the university.

A panel of experts continuously monitors the most recent data on COVID-19 infections and transmission factors. In the fall, the university’s Comprehensive Monitoring Team (CMT) issued its initial report on ongoing data analysis designed to stem the spread of infection on and around the Columbus and regional campuses.

“It is possible to drive infection down with an infusion of determined university leadership, resources, and effort through close monitoring and focused intervention,” the CMT concluded in the report.

“The data included in the dashboard are part of the robust toolkit we use to continuously monitor COVID-19 and make informed decisions,” said Ohio State College of Public Health Dean Amy Fairchild, who leads the CMT. “Testing information is a powerful tool – along with wearing masks, physically distancing and practicing good hygiene – in the fight against the spread of the virus.”

For more information on Ohio State’s response to COVID-19, visit the Safe and Healthy Buckeyes website.

Dear Buckeyes:

As we wrap up our final days on campus and look toward the holidays, I’d like to remind you of the critical role you play in preventing the spread of COVID-19.

Most importantly, we know that household transmission is the primary way that this virus is infecting people. One night at a bar or party means that you can bring the virus home, where it can spread rapidly. You have the power to reduce infections, including among your loved ones who may risk severe illness, hospitalization and death. I cannot emphasize enough that what may be a symptom-free inconvenience for one person can be devastating to another — and I say that underscoring that the pandemic’s severity is increasing throughout our nation and our state by the day.

By now you know what is required to do your part — proper masking when you’re in the same room as others, physical distancing, hand hygiene and staying far from large gatherings and within a small, consistent bubble of close friends and roommates. Parties simply aren’t worth it, particularly when cases are increasing in our community and on and around our campus.

I strongly recommend that, if you are able, you head home for the holidays as soon as you can if you receive a negative test result from routine testing this week. If you are not planning to leave this week, I urge you to test twice before heading home for break. The first test, part of our routine weekly screening, should be today, tomorrow or Wednesday. From that point forward, before you depart for home, please be especially careful by limiting unnecessary contact with others, maintaining physical distancing and wearing a mask any time you cannot avoid being with other people. If you plan to leave next week, the second test should be on Monday or Tuesday. Regardless of your planned departure date, out of concern for the safety of your family and friends, you must wait for your final “exit test” results before you head home. Testing hours and instructions are available on the Safe and Healthy Buckeyes website. If you are positive you should work closely with Ohio State’s Case Investigation and Contact Tracing Team to make your plan for isolating to stop spread of the virus.

If your results are negative, remember infection can take several days to be detected, which is why we test routinely. Continuing to follow precautions when you go home is your best bet for limiting illness in your families. Among those precautions: Wear masks on the car ride home, or however you’re getting home. Crack the windows. Limit the family coming to pick you up to one person.

During break, please resist the temptation to let the expectations we’ve set at Ohio State fall by the wayside. I understand that what feels “normal” is to visit with all of the friends and family you’ve missed, but we are in a time when those visits — especially if they include many people who aren’t masked and distant — can have serious repercussions, sending ripples through multiple families and social circles. Think about ways to bundle up against the Ohio fall and winter, keep the group small and spend some time outside.

If you know you were in riskier situations on campus, and especially if you have higher-risk loved ones at home, consider a 14-day self-quarantine in a room by yourself if that is possible. Wait 14 days to visit extended family who are vulnerable to the virus, including grandparents.

Thank you for all you’ve done this semester to keep us Together As Buckeyes and for your continued commitment to keeping your family, friends and our entire community safe and healthy.

Sincerely,

Amy Fairchild, PhD, MPH

Dean of the College of Public Health

Ohio State’s dashboard has received the only “A+” grade from the panel of experts, who rate dashboards on a variety of criteria that include frequency of updates, what data are reported and whether they’re easy to read. As of Oct. 1, the panel had published ratings of 211 dashboards.

“Their mission behind this whole effort is to encourage colleges and universities to be as transparent as possible with their COVID-19 strategies, including the community impact,” said Eric Mayberry, senior manager of data analytics in Ohio State’s Office of the Chief Information Officer and a co-creator of Ohio State’s dashboard.

The dashboard contains key measures for the state of Ohio – daily cases (also available by county) and hospital capacity among them – and student test result data for Ohio State presented in three formats: single day, seven-day average and cumulative, plus cumulative results of employee tests. The university also reports information about isolation and quarantine bed usage, capacity and availability, and indicators of where things stand with personal protective equipment and enhanced cleaning – key mitigation strategies for the pandemic.

At this point in the semester, the trend line of student testing data on the dashboard clearly shows Ohio State has bent its curve in the proper direction: down. Based on the latest data available today, Oct. 2, the seven-day average of positive student test results stands at 0.7% for students living on campus and 1.6% for off-campus students. The trends represent a steady decline in the seven-day average positivity rate over the month of September.

In addition, the U.S. Centers for Disease Control and Prevention recently reported that Ohio State Wexner Medical Center’s pandemic protocols – masking, hand hygiene, physical distancing, and testing of symptomatic patients and staff – were effective at protecting health care providers from contracting the virus. Fewer than 1% of Ohio State providers tested positive for SARS-CoV-2 antibodies in a multicenter study.

Understanding dashboard data

Leanne Stanley, a consulting research statistician in the Office of Institutional Research and Planning, created the dashboard with Mayberry and Henry Zheng, associate vice president for strategic analytics. They collaborated with a team of Ohio State public health, technology and analytics experts, with guidance from university leaders who strongly supported data-informed decision-making and data transparency, Zheng said.

“Many universities have public dashboards, and there are lots of reasons to do it, but probably the first and foremost is to be transparent, trying to be able to show the public where we stand in terms of the epidemic on campus and our response,” said William Miller, professor of epidemiology and senior associate dean of research in Ohio State’s College of Public Health, who helped lead development of the dashboard.

The seven-day average of positive student test results provides the most useful measurement of cases on and off campus, Miller said.

“It’s a rolling average so that today is a seven-day average for the seven days prior to that. It incorporates both the single-day information and … to give you a better indication of where we’re really at, smooths out the variability that you might have,” said Miller, also a member of the Safe Campus and Scientific Advisory Subgroup of the COVID-19 Transition Task Force.

Cumulative data – for students and university employees – is depicted in circle graphs on the dashboard. Since surveillance testing began on Aug. 14, Ohio State has conducted more than 100,000 tests of students and almost 2,400 tests of employees.

“This gives an overall sense of where things are, and the single-day result is an indicator just day by day of the number of tests that have been performed and the positivity rate for that given day,” Miller said. “And that will vary a lot over the course of a week, in part because we have many fewer tests on the weekend. And when you have fewer tests, you have much more variability, potentially, in the test results.”

Miller cautioned against making broad assumptions about any individual statistic. For example, though the daily surveillance testing is an ongoing program, there are other reasons for students to be tested: when they feel sick, if they’ve been identified through contact tracing as likely being exposed to the virus, or when a cluster of positive cases calls for targeted testing of the students living in the affected environment. As for the surveillance itself: All students at all ranks who live on campus are tested weekly, and a random sample of all undergraduate students living off campus is taken each week, which averages to about once per month for individual students.

“Mitigation and surveillance testing is trying to keep the epidemic under control and also give us a very clear look into it,” Miller said. “When we do targeted testing, your positivity rate may be higher than just when you’re testing everyone.

“So when you look from one day to the next, the thing that’s difficult to interpret a little bit is if there was a change in the testing procedures – so you can sometimes have a bump in the positivity rate because we did a whole bunch of testing related to a small cluster of cases and we found several more cases,” he said. “That’s one reason to be careful, especially when you look at the single-day rates. I think that’s really the biggest thing to be cautious of when you’re interpreting the tests of students – the reason for testing doesn’t come through in the number.”

There is a measure for the state of Ohio included on the dashboard that eventually will be added for the university, as well: the R(t), or reproduction number. Essentially, this is a gauge of whether the epidemic is expanding or contracting based on the estimate of how many other people each person who tests positive for COVID-19 infects. It takes some time to arrive at a meaningful figure because the number of positive cases over a period of time is fed into an algorithm to produce the estimate of whether the R(t) is below 1, at 1 or above 1.

“Anything above 1 is concerning,” Miller said. “If the R(t) is greater than 1, that means that the epidemic will be expanding because one person is infecting more than one other person, on average. If the R(t) is at 1, it’s basically under control, but not shrinking. And if the R(t) is less than 1, then it is going to be contracting as long as something doesn’t change to perturb it.”

A part of the Rapid Acceleration of Diagnostics (RADx) initiative, the RADx Underserved Populations (RADx-UP) program will support research that aims to better understand COVID-19 testing patterns among minority and vulnerable populations; strengthen the data on disparities in infection rates, disease progression and outcomes; and develop strategies to reduce the disparities in COVID-19 testing, treatment and contact tracing.

“We decided to pursue this opportunity to benefit the residents of Ohio, especially minority and vulnerable populations who bear the brunt of COVID and its impacts in all facets of life,” said multiple-principal investigator Electra Paskett, director of the Division of Cancer Prevention and Control in the Department of Internal Medicine at The Ohio State University College of Medicine.

As of Aug. 1, Ohio had reported 91,159 COVID-19 cases and 3,489 deaths, and the burden of COVID-19 had disproportionally impacted Ohio’s Black and Latinos/Latinas communities. Although only 13.1% and 4% of Ohio’s population is Black and/or Hispanic/Latino respectively, 26% of Ohio’s cases are among African-American residents and 7% are among Hispanic/Latino populations, researchers wrote in their proposal.

“We plan to go to the populations within communities with the highest rates of health disparities to understand and develop ways to help increase education, testing and contact tracing in concert with the communities. We’ll also facilitate access to testing to those populations,” said Paskett, director of the Diversity Enhancement Program at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Center.

The research team includes more than a dozen investigators at The Ohio State University Wexner Medical Center; Ohio State’s Colleges of Arts and Sciences, Medicine, Public Health and the John Glenn College of Public Affairs, and the Kirwan Institute for the Study of Race and Ethnicity; Nationwide Children’s Hospital; and the State of Ohio. The award is linked to Ohio State’s Clinical and Translational Science Awards grant.

“This project reflects our ongoing commitment to apply rigorous scientific methods embedded in community-engaged research to improve health equity and address the most pressing health issues for Ohioans. If successful, RADx-UP Ohio can be disseminated throughout Ohio and across the United States to scale-up COVID-19 testing and, later, vaccination in minority, underserved and vulnerable populations,” said multiple-principal investigator Rebecca Jackson, director of The Ohio State University Center for Clinical and Translational Science and associate dean for clinical translational research.

Using data from an Ohio State and Ohio Department of Health study, researchers have chosen 12 at-risk counties in Ohio that contain multiple census tracks with disproportionately high concentrations of minority and vulnerable populations and few or no COVID-19 testing sites. The six urban counties in this project are Butler, Cuyahoga, Franklin, Jefferson, Lucas and Trumbull, while the six rural counties are Hardin, Meigs, Muskingum, Ross, Scioto and Washington.

“It is critical that all Americans have access to rapid, accurate diagnostics for COVID-19, especially underserved and vulnerable populations who are bearing the brunt of this disease,” said NIH Director Francis S. Collins. “The RADx-UP program will help us better understand and alleviate the barriers to testing for those most vulnerable and reduce the burden of this disease.”

By testing wastewater on its way to treatment plants for coronavirus RNA, the team — led by Professor of Environmental Health Sciences Jiyoung Lee — is gathering valuable data that could predict where COVID-19 outbreaks may soon occur.

Because coronavirus fragments are shed through waste by people infected with COVID-19 — even when they don't have symptoms — wastewater monitoring is an especially telling tool for disease surveillance, Lee said. Recent science suggests that coronavirus RNA can be detected in wastewater up to seven days before increases in cases and hospitalizations.

“This kind of surveillance can give population-level assessments and be an early warning for disease spread,” said Lee, also a professor of food science and technology and a co-director of the Ecology, Epidemiology and Population Health program at Ohio State’s Infectious Diseases Institute.

Her lab is currently conducting these four COVID-19 wastewater projects in collaboration with partners across the university and state:

• As part of a statewide effort, the team receives and tests wastewater samples from Columbus, Cleveland, Newark, Lancaster, Athens, Delaware, Marysville and Marietta. The research is supported by the Ohio Environmental Protection Agency, Ohio Department of Health and federal CARES (Coronavirus Aid, Relief, and Economic Security) Act.
• Wastewater from Ohio prisons is processed for a project funded by the Ohio Department of Rehabilitation and Correction.
• Most recently, the lab began monitoring wastewater from on-campus sites including residence halls and a quarantine site.
• The team is also testing stormwater from storm sewer systems in Columbus and other Ohio cities.

Looking to wastewater for early signals of disease spread isn’t unique to this pandemic. In the past, wastewater has been monitored for other public health threats like polio, antimicrobial resistance and opioids.

Lee’s lab developed unique methods to process and evaluate wastewater for SARS-CoV-2 (COVID-19) RNA. Every week, they share their data with the relevant state agencies. Campus data is sent to a computational modeling and analysis team led by Mark Weir, assistant professor of environmental health sciences, before being shared with Ohio State’s Comprehensive Monitoring Team.

“We are trying to assess what the level of infection seen in the concentrations actually means, and if rises in the sample numbers indicate something to be concerned about and respond to, Weir said.

The numbers are inherently complicated to interpret considering waste levels vary by person and by day, Weir said.

“You don’t have the same amount of COVID genetic material coming out of you every single day the entire time you’re infected — it’s variable,” he said. “We try to take into account as much of that as possible.”

Weir is also on the campus wastewater sampling team, which twice a week collects wastewater from multiple campus sewers. Collecting, transporting and handling the samples in Lee’s lab all require an extra level of personal protective gear per guidelines from the Centers for Disease Control and Prevention.

Typically, Lee’s team currently spends full days completing filtrations of samples from locations across the state, said Angela Davis, a research associate in Lee's lab and recent graduate of the Environmental Sciences Graduate Program.

“In between sample processing, we are constantly preparing for future samples, such as making more reagents, sterilizing equipment and ordering more materials,” she said. “Days can be long, but the research is very interesting and we enjoy it."

The lab receives wastewater from more than 30 sources and rapidly processes a large number of samples, Lee said.

“I expect the pandemic to continue to be a hot topic for research organizations across the world and having the opportunity to develop techniques for this type of research will be extremely valuable,” Davis said.

Other Ohio State individuals involved in this research include Yuehan Ai, Zuzana Bohrerova, Kent Halloran, Fan He, Natalie Hull, Madeline Lewis, Emily Lu, Judith Straathof and Ryan Winston.

“This is a moment in which if we don’t follow the guidelines, we’re going to go home. And that’s not what anybody wants,” said Amy Fairchild, dean of the College of Public Health.

Ohio State News asked Fairchild and University Chief Wellness Officer Bernadette Melnyk, chair and vice chair, respectively, of the Safe Campus and Scientific Advisory Subgroup of the COVID-19 Transition Task Force, to share how return-to-campus guidelines were established and the importance of thinking in terms of personal – and community – health. (See videos below.)

Tending to our physical and mental health may feel as challenging now as ever, but Melnyk noted that making the effort to take good self-care will help us feel better and make us less susceptible to illnesses of all kinds.

“We will boost our immune systems and feel better physically and mentally if we get a little physical activity in every day, if we eat healthy, if we sleep seven hours a night and we practice stress reduction,” said Melnyk, also vice president for health promotion and dean of the College of Nursing.

Both Fairchild and Melnyk also were unambiguous about the importance of wearing face masks.

“Do your part to prevent spread of the infection. We must wear masks. We must physically distance and, by all means, if you are sick, please stay home and call your primary care provider,” Melnyk said.

This isn’t just advice passed down through the years or popular wisdom, Fairchild noted. The subgroup developed an extensive list of recommendations for a safe return to full operations after completing a rigorous review of existing and new research associated with infectious disease containment.

“Where we encountered the limits of the evidence, we relied on the expertise of a really wide array of faculty from across the university,” Fairchild said.

The faculty experts in the subgroup represented a range of disciplines that included infectious diseases, virology, facilities management, epidemiology, public health, law, medical ethics, nursing and mental health and well-being.

And that is how the task force arrived at a face mask requirement: “We’re really confident masks work to curtail community transmission,” Fairchild said. “I pick that as a particular example because it underscores part of our process – which was to look at the evidence as it came in. And that’s something we’re continuing to do.”

Hearing that physical distancing must continue may cause some in the university community to become more anxious than they already are about the pandemic itself and the stresses of working from home or in an essential position on a campus.

Melnyk encourages maintaining social connections with friends and family through safe means, such as social media or phone conversations, as these relationships are necessary for our well-being.

“Take frequent recovery breaks during the day,” she said. “People are really Zoom fatigued with ‘Hollywood Squares’ right now, but aside from the meetings, it’s still important to reach out on a daily or every-other-day basis to a good friend, a family member, to have that social connection.”

Everyone’s participation in public health precautions while on campus – masks, physical distancing and proper hand hygiene – is the foundation for protecting other people, even if we feel fine, Fairchild said.

“You can feel fine but you can be a risk to other people. The things I do when I’m feeling well are going to be the things that affect other people,” she said. “In order to have a face-to-face – even a covered face-to-face – on-campus experience, we need to keep everybody as safe as possible.”

Miller’s memorable motto, “Time, space, people, place,” can help people remember how to stay safe and physically distant amid COVID-19. The rhyme has been featured several places, including on NPR and in The Washington Post.

“Is it wrong to wish this could get turned into a song?” infectious disease epidemiologist Robert Orellana, a two-time alum of the College of Public Health, commented on Twitter in June.
 

Rayo, also a professor of health and rehabilitation sciences at the College of Medicine, saw the comment and immediately had a burst of creative inspiration.

“I heard the melody right away, starting plunking down verses and ended up writing it in an afternoon,” said Rayo, who before his MS and PhD earned dual bachelor’s degrees in music performance and chemical engineering. He primarily plays trumpet, but also sings and dabbles in guitar, ukulele, piano and drums. He’s also put his musical ear into his engineering work, leading efforts to improve and streamline auditory cues of medical alarms in hospitals.

Rayo’s longtime friend, former bandmate and local music producer Bill Patterson of Wet Sounds Music, produced “Time Space People Place” – a song the pair described as a mix between Bob Marley and Jason Mraz — “a combination of energy and playfulness.”

“I read Bill Miller’s tweet about his rhyme and I felt compelled to write the song, because there is still a lot of confusion in our state and in the country about what we need to do to stay safe in the pandemic,” Rayo said. “We all want to get back a semblance of normal, and these four words (and a mask!) can really help.”

Then, the COVID-19 pandemic hit, derailing his plans and his chance to receive the associated course credit required to complete his degree.

As Gill (right) and other students across the state and nation searched for alternatives to their summer practicums, internships and clinical experiences, health departments were experiencing the unprecedented challenge of tracing the spread of COVID-19. For Gill, this struggle blossomed into a unique opportunity to assist with contact tracing in Ohio.

Contact tracing — identifying the web of people who may have come into contact with an infected individual and advising them to self-quarantine — is a task that typically falls on local and state health departments. The decades-old practice tends to be manageable for diseases like measles, tuberculosis and HIV. But with the scale at which COVID-19 was spreading, plus a lack of resources including testing equipment, it wasn’t clear how it was going to work for the pandemic.

“It was recognized pretty early on that the state and local health departments were going to need assistance with contact tracing,” said Bill Miller, senior associate dean of research and professor of epidemiology at the College of Public Health.

Despite talks of contact-tracing apps, traditional calls and texts are still the most reliable and trusted form of monitoring infectious disease spread, he said.

When the state began searching for more contact tracers, college students like Gill were among the first to know. In May, Columbus Public Health hired him as a COVID-19 contact tracer.

In addition to students like Gill who are paid, dozens of Ohio State students and faculty members are part of the Ohio Department of Health’s volunteer pool called the Public Health Assist Team, which local health departments can tap into for COVID-related needs. They come from the Colleges of Arts and Sciences, Medicine and Public Health, among others.

Similar to his original summer project, Gill’s new role allows him to provide a critical public service while he acquires necessary academic experience. His days begin when he receives a list of names and phone numbers to contact that day — sometimes up to 20. His responsibilities are to alert each person of their possible exposure without revealing the identity of the infected individual, inquire about COVID-19 symptoms and health care access, confirm basic demographic information and provide follow-up resources about the virus and benefits of quarantining.

“People are a little apprehensive at first. It takes a lot of social skills to feel out the situation and speak to each person individually in a different way that you think would make them feel comfortable,” Gill said, adding that his involvement in diversity and inclusion organizations around campus has equipped him to comfortably address people of various backgrounds.

“This is a hard job in that you have to be prepared to repeatedly talk to people who are very stressed and very scared,” Miller said. “You have to be comfortable helping those people stay calm and explaining the complex disease quickly and simply.”

In March, an initial call for contact tracing volunteers yielded around 1,200 applications, including more than 900 students from 27 academic institutions, said Joanne Pearsol, deputy director of the Ohio Department of Health. While the newly funded contact tracing workforce has offset some of the need for volunteers, some have been deployed and may be again if surges become overwhelming, said Pearsol, a former staff member at the College of Public Health.

“I grossly underestimated the interest in volunteering, so it was extremely heartening to see that response,” she said. “Not only was it students looking for credit for their coursework, it was other students who were home for the summer. It was professionals who were retired or not working and wanting to contribute in some way.”

Beyond the calls and text messages required to monitor the spread of COVID-19, contact tracing also involves data — a lot of it, said Kara Galvan, a second-year Master of Public Health Student who’s working for Columbus Public Health as a data entry specialist.

The work “becomes a little tedious, but it is really for the health of our community,” said Galvan, who plans to get a PhD in epidemiology after her master’s. “Even though my interest lies more with chronic disease, this is still an incredible opportunity.”

Both Galvan and Gill need 180 hours to complete their practicums, but both said they plan to work the full 480 hours at which their temporary positions are capped.

“The contact tracing workforce is an increasingly important public health response as the governor and others are committed to reopening,” said Teresa Long, special advisor for community engagement and partnership at the College of Public Health.

And it hasn’t been an easy task to get up and running. With a planned 1,000-plus new contact tracers in Ohio, it’s been all-hands-on-deck to set up employee resources and training, said Austin Oslock, a student at the College of Medicine and Spring 2020 alum of the College of Public Health who was hired to coordinate the state’s contact tracing training efforts in March.

In his role, Oslock has helped shape an eight-hour training course required before state contact tracers can get to work.

“A big part of it is comfort and familiarity with interviews. A lot of our contact tracers come from the medical and public health fields, and many can speak another language,” he said. “Whether you’re telling someone that they have coronavirus or that they may have been exposed to it — those are tough conversations.”

For the students involved, Long said this experience will be foundational and likely set a framework for what students will want to learn more about and how they will be active and thoughtful into their futures.

“There are so many fundamental lessons to be learned about the science, about fairness and justice, about who’s at risk and who’s vulnerable and about how to collectively support everyone.”

Researchers say their study raises concerns about inadequate and inconsistent access to a full spectrum of reproductive health care.

The researchers looked at abortion services performed in Ohio from 2010 to 2018, a time when more than 15 new abortion regulations were instituted and when the number of surgical abortion clinics in the state dropped from 15 to eight. The study, led by Alison Norris of The Ohio State University, appears today (May 21, 2020) in the American Journal of Public Health.

In this study, researchers examined a variety of characteristics of those who received abortions during the eight-year study period, including how far along they were in their pregnancies, county of residence and what methods of abortion were used.

Nationally and in Ohio, abortion rates declined significantly during this time period. But a decrease in early first-trimester abortions and simultaneous increase in later first-trimester abortions was unique to Ohio, and may signal delays in women and teens receiving prompt care because of the burdens they have to overcome to get that care, said Norris, an associate professor of epidemiology in Ohio State’s College of Public Health.

“Abortion care is one of the safest procedures that we have. Because it becomes more complex later in pregnancy, women benefit from quick access to abortion services when they choose to end a pregnancy,” Norris said.

The research is part of a multidisciplinary reproductive health research consortium called the Ohio Policy Evaluation Network, or OPEN, which includes scientists from Ohio State, the University of Cincinnati, Cincinnati Children’s Hospital and Case Western Reserve University.

Ohio’s abortion laws include mandatory in-person counseling 24 hours before the procedure and limitations about how abortion can be funded, which can create significant obstacles to early care for some women, Norris said.

From 2010 to 2018, abortion ratios decreased sharply, and disproportionately, in most rural Ohio counties, the study found. In rural counties, the number of abortions per 1,000 live births dropped more than 32 percent compared to the 24 percent reduction seen in urban counties.

And in areas where clinics closed, use of abortion dropped off among women and teens living both within the county and in surrounding counties.

“This geographic inequity in abortion access is concerning, because it likely means that some people who have unintended pregnancies and want to end those pregnancies are not getting the care they want and deserve,” Norris said, adding that regulations passed in Ohio during the study period, including requirements that clinics have a written patient transfer agreement with a private hospital, have created administrative hurdles for abortion providers.

Norris said there’s no evidence that she’s aware of to support the idea that abortions are happening less frequently in rural Ohio because there are fewer unintended pregnancies or less demand for services. In fact, she said, it’s possible that unintended pregnancies are more common in some rural areas where access to contraceptive options could also be limited.

“It could actually be the case that there are higher rates of unintended pregnancy in some rural areas, because people who live in those areas have reduced access to all kinds of health care, including high-quality reproductive care,” said Norris, adding that the OPEN research team hopes to explore that possibility in future work.

Medication abortion care also decreased significantly in Ohio during this time, likely largely due to the state’s narrow interpretation of how the medications had to be dispensed, Norris said.

Nationally, annual abortion rates overall dropped from about 12 per 1,000 women of childbearing age to fewer than 10 per 1,000 during the study period.

“This national trend, one that has also been seen in Ohio, aligns with increased access to contraception and highly effective modes of contraception, particularly long-acting reversible contraceptives,” Norris said.

“But declines in the use of abortion are being experienced differently by different groups of people, and that’s what we found is happening in Ohio.”

While this study focuses on Ohio, it likely has broader implications, Norris said.

“I think we can expect similar experiences for people who live in states with a high regulatory burden around abortion care. It’s reasonable to imagine that the things that we see in Ohio are playing out in other places.”

Other Ohio State researchers who worked on the study are Payal Chakraborty, Sarah Hayford, Robert Hood, Lisa Keder, Kaiting Lang and Mikaela Smith. University of Cincinnati researchers include OPEN co-lead Danielle Bessett, Molly Broscoe, Carolette Norwood and Michelle McGowan. B. Jessie Hill of Case Western is also a co-author.

Mathematical models — built on a foundation of calculus, statistics and probability theory — have been one of the driving forces behind policies, at least in Ohio, around the COVID-19 pandemic.

“The hospitals need to know, roughly, do we have enough beds, do we have enough ventilators, and if you don’t have some estimate of that you’re really playing with fire,” said Joe Tien, associate professor of mathematics at Ohio State and a leader on the COVID-19 modeling team. “We’re still not going to say our estimates are what’s going to happen but at least you have some process by which you derive an estimate; otherwise, you’re completely guessing.”

Ohio State has a team that has been modeling the COVID-19 pandemic since early March. It is jointly led by Tien and Greg Rempala, a professor of biostatistics in the College of Public Health, and includes researchers who study geography, medicine, environmental health and others. The team has been among the group of scientists, along with officials from the Ohio Department of Health and the Ohio Hospital Association, offering modeling and statistics to the governor’s pandemic task force.

The modeling that has been used by the Ohio State team started a few years ago, long before this particular coronavirus ever jumped from animals to humans. In 2015, in response to the ongoing Ebola outbreak in West Africa, Tien, Rempala and another researcher in the Ohio State Mathematical Biosciences Institute (MBI) decided to study the ways diseases spread on human networks — between co-workers, among friends, from children to parents.

One way to study that spread: a mathematical concept known as a stochastic process, a way to analyze random happenings over time. The researchers realized that they could apply basic calculus to that process when considering disease spread and come up with a set of differential equations to study the rate of change of the number of people susceptible to the disease in a given population.

“This is where your calculus comes in — the rate of change of the number of susceptible people in the population, and that is the underlying base of the model we’re looking at for COVID,” Tien said. “From there, our colleagues have developed some nice statistical techniques for using statistics to find the probability of how fast the disease will spread.”

The model Rempala and Tien have used, first for the Ebola outbreak and now for the COVID-19 pandemic, is an amped-up version of a model developed in the early 1900s to model the 1918-19 influenza epidemic. That model, called an SIR model, attempts to analyze the ways people interact to spread illness. “SIR” stands for “susceptible, infectious, recovered,” and is a way of grouping people: Susceptible people haven’t gotten an illness yet; infectious are currently infected. Recovered are those who’ve had the illness and survived.

An SIR model relies on data about a given disease and how it spreads, but when a disease is new — the “novel” part of “novel coronavirus” in the case of our current pandemic — reliable data can be hard to come by. And a traditional SIR model also doesn’t take into account behavioral and policy changes like social distancing and stay-at-home orders.

The model that Tien and Rempala are using does.

“The model had this feature that allowed these networks to get disrupted or disconnected,” said Rempala. “We didn’t call it social distancing — we called it a drop-out rate. And we assumed we had this network where people were interacting with each other and then stopped – they dropped out of the network. And that allowed us to model what might happen to the disease spread.”

The model was limited at first by a lack of good data — and still is, to some extent. Because testing for the virus has been minimal — only a small percentage of the population has been tested, and generally only when a person is very sick — the model can’t say with certainty what percentage of the population is susceptible, infectious or recovered.

But because the virus had already played out in China, Italy, South Korea and other places by the time it reached the United States, the modelers had some clues. And another type of math — simple addition and subtraction — became important. The state’s hospitals had finite numbers of hospital beds, ventilators and personal protective equipment, things that were critical to being able to treat COVID-19 patients.

“Even with this limited information, we have some idea about how it expands, and that turned out to be exactly the type of information you need to make predictions about the number of hospital beds you will need,” Rempala said. “With this type of approach, you cannot use it to calculate the total number of infected people in Ohio, but you can help the state plan for how much capacity it will need.”

Computational equations do not equate to policies. They simply offer models showing the most educated guess, based on the best available data, of what might happen under different scenarios. In early March, when modelers first put COVID-19 figures into their equations, there were no social distancing measures. Schools, restaurants and hair salons were still open.

The initial models showed very high numbers of COVID-19 patients; after state policymakers issued stay-at-home orders and closed schools and many businesses, the models — and the real-time data of those who were sick — showed those numbers dropping.

As Ohio and other states begin to reopen, slowly in some cases, the models are still running. Those models should give policymakers some insight into how their decisions might play out in the real world.

The American Heart Association announced nearly $17 million in grants on April 21 as part of its ENACT: End Nicotine Addiction in Children and Teens research initiative.

“This study engages experts across our medical center and health sciences colleges collaborating together,” said Dr. Hal Paz, executive vice president and chancellor for Health Affairs at The Ohio State University and CEO of The Ohio State University Wexner Medical Center. “It’s vital to better understand what gets our youth addicted, the long term effects on the lungs and heart and which cessation efforts are most effective.”

Ohio State’s work will be led by Peter J. Mohler, vice dean of research at The Ohio State College of Medicine and director of the Dorothy M. Davis Heart and Lung Research Institute, and researchers from the Center for Tobacco Research at Ohio State’s Comprehensive Cancer Center, including center director Theodore Wagener, Loren Wold, Liz Klein and Megan Roberts. They’ll join colleagues with the colleges of Medicine, Nursing, Public Health and Engineering to work together on the two-year project called VERIFY: Vaping’s End through Research and Innovation For Youth.

The goal is to provide answers in three areas: the short- and long-term effects of e-cigarettes, including their impact on the brain, lungs and heart; the most effective regulations to reduce the appeal and addictiveness of e-cigarettes for youth; and the best methods to help youth kick their addiction to e-cigarettes.

“We’re pleased to receive this grant that will allow us to continue our work examining the health impacts of e-cigarettes and vaping. E-cigarettes are now the most commonly used tobacco product among youth, and there needs to be more research on youth e-cigarette use and addiction and ways to help users quit,” Mohler said.

The VERIFY project consists of investigations that involve pre-clinical, clinical and surveillance-based studies. The aims of the original project are fourfold:

Aim 1: Pre-clinical testing of the health effects of e-cigarettes. Researchers will test the health effects of e-cigarette exposure, specifically cardiovascular, pulmonary, metabolic and neuronal phenotypes in response to changes in nicotine form, concentration and flavors. The principal investigator is Wold, assistant dean for biological health research in the College of Nursing and a professor and vice chair in the Department of Physiology and Cell Biology.

Aim 2: Surveillance-based testing of the behavioral and health effects of e-cigarettes. Experts will study the relationship between nicotine form, concentration and flavors on e-cigarette use, addiction, neurocognitive outcomes and pulmonary health. Principal investigators are Roberts, assistant professor of health behavior and health promotion in the College of Public Health, and Alayna Tackett, assistant professor at the University of Oklahoma Health Sciences Center.

Aim 3: Development of an e-cigarette product standard to reduce its addiction potential. Researchers will examine the influence of nicotine form, concentration and flavor for youth puffing behavior, nicotine delivery, abuse liability, toxicant exposure and acute cardiovascular and pulmonary effects. The principal investigators are Wagener, co-leader of the Cancer Control Program at the OSUCCC and associate professor of internal medicine, and Marielle Brinkman, senior research scientist in the College of Public Health.

Aim 4: Development of an effective and scalable vaping cessation intervention. Experts will develop and test a multipoint, scalable vaping cessation program that includes quit line-delivered phone counseling, text-based cessation, nicotine replacement therapy and online cessation support. The principal investigator is Klein, associate professor of health behavior and health promotion.

“Our hope is that these projects greatly advance our knowledge about youth vaping – in particular what impact it has on young people’s bodies and what the most effective approaches might be to help e-cigarette users, including young people, quit,” Klein said.

Researchers at Boston University and Yale University also received awards. The American Heart Association said the grants are among the highest individual grants awarded in its history.

By Amy Lauren Fairchild

Dean and Professor at the College of Public Health, The Ohio State University

Marian Moser Jones

Associate Professor and Graduate Director of Family Science, University of Maryland

Pence and Trump attend a coronavirus task force briefing. AP Photo/Patrick Semansky

Following Donald Trump’s declaration of a federal state of emergency nearly two weeks ago, every state except West Virginia had also declared a state of emergency over COVID-19.

States have statutes that give police powers to the government in situations like hurricanes, fires or disease outbreaks.

But as experts in public health, we know that different states empower different types of officials to declare an emergency. This is important because a lack of clear lines complicated the response to Hurricane Katrina in Louisiana and, later, Hurricane Rita in Texas.

Who decides?

In most states, the power to declare an emergency lies with the governor. Several have used this authority in cases of weather emergencies or severe flooding, for example.

In some states, both governors and local officials like mayors have the authority to grant such a declaration. Although Gov. Andrew Cuomo declared a state of emergency on March 7, New York City Mayor Bill De Blasio – though having declared a state of emergency in the city on March 11 – kept schools open until March 15. The dual lines of authority underscored the struggles that can unfold between mayors and governors.

The federal government also has power to prevent disease transmission across states and territories because of the 1974 Stafford Act. Evoking this is contingent on a governor’s request, based upon “a finding that the disaster is of such severity and magnitude that effective response is beyond the capabilities of the state.”

In the case of COVID-19, the Department of Health and Human Services, using the federal Public Health Services Act, invoked federal powers to prevent “cascading public health, economic, national security and societal consequences.” In addition to this, federal authority empowers the Centers for Disease Control and Prevention to examine and quarantine anyone entering the U.S. or traveling across state lines.

Another key rationale for invoking emergency powers is to trigger federal disaster relief to states. The amount is being debated in Congress as we write.

Before getting federal assistance, the governor must declare a state of emergency and begin to follow the state’s emergency plan, a provision which emphasizes that the state is the primary authority in the disaster. That is important because emergency powers not only allow state governments to “provide for” populations, but also “decide for” individuals in ways that might limit their rights.

The idea is that sticking to normal legislative processes and legal standards takes time – and that during a crisis delays could cost lives. In an outbreak, such limits on individual rights involve travel restrictions, social distancing measures and isolation and quarantine.

Protecting everyone at once

During an outbreak, people typically accept limits on the liberty of those who are infected as necessary to protect the uninfected.

It doesn’t matter if a person with COVID-19 wants to go to the mall, for example. As a society we are willing to order that individual’s confinement to protect others. But what distinguishes the U.S. from authoritarian nations is that those whose compelled, for instance, into confinement, can always challenge those orders in a court of law.

Emergency powers also allow state and federal governments to cancel public events and close businesses. These kinds of measures are designed to keep unexposed folks safe at home but also to protect those who would be willing to risk getting infected at a bar, restaurant or concert hall.

Emergency orders that protect us from our own poor judgment are the most controversial. After all, we often allow adults to take risks that could harm them. Smoking is legal. In some states, so is riding a motorcycle without a helmet. Neither do we prohibit adults from participating in “extreme sports,” such as rock climbing, sky diving or auto racing, knowing well that some will suffer injuries from these activities.

An outbreak is different. Even mild or asymptomatic COVID-19 cases pose a risk to others. And every case poses a risk to health care personnel, who are called on to treat the most serious cases of infection and who run a high risk of infection. Furthermore, health care systems become strained with a scarcity of human and other resources, including beds, respirators and masks.

Ultimately, emergency public health orders slow the spread of disease, protecting individuals by limiting some choice regardless of their personal perception of risk. This both prevents new infections and protects the ability of the health care system to save lives.

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Amy Lauren Fairchild, Dean and Professor at the College of Public Health, The Ohio State University and Marian Moser Jones, Associate Professor and Graduate Director of Family Science, University of Maryland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Four weeks ago, Ohio Gov. Mike DeWine and Columbus Mayor Andrew Ginther announced they had made the difficult decision to limit spectators and cancel the expo at the Arnold Sports Festival to be held March 4-7. Central Ohio didn’t identify its first case of COVID-19, the disease caused by the novel coronavirus, until 10 days later.

Though the news surprised many, the decision reflected weeks of discussions among community leaders from many sectors about planning for what appeared imminent: an international pandemic that would become a public health crisis in the United States.

During an online panel discussion Tuesday about the COVID-19 pandemic’s impact so far, Andrew Thomas, Ohio State Wexner Medical Center’s chief clinical officer, reflected on the university’s ongoing preparedness efforts. The pandemic planning began with a conference call with 80 university participants on Jan. 22, one day after the first U.S. COVID-19 case was identified.

Disaster preparedness comes with the health care and higher education territory, and Thomas, also senior vice president for health sciences, said the medical center has been effective at ramping up patient testing, partnering with Battelle on filling supply-chain gaps and cooperating with Ohio hospitals near and far to prepare for the expected surge in COVID-19 cases. On March 12, the university announced suspension of face-to-face classes through spring semester and by March 16, employees who could were required to work from home.

Amy Fairchild, dean of Ohio State’s College of Public Health, hosted the panel discussion featuring Ohio State experts and guest speaker Irwin Redlener, director and founder of the National Center for Disaster Preparedness at Columbia University. Redlener, a national expert on the public health ramifications of large-scale catastrophic events, was scheduled to visit Ohio State for the event, which was converted to an online discussion over Zoom. President Michael V. Drake joined the conversation as well.

“Public health is the normally invisible foundation for healthy populations,” Fairchild said. “This moment in time has exposed the ways in which the foundation has collapsed. We need to see investment in a strong, fair, nimble public health infrastructure, not just to prepare for a pandemic, but to support and protect us day in and day out and year in and year out.”

Redlener called attention to the threat the pandemic poses not just to people infected with the coronavirus, but also to uninfected patients who need care for urgent problems or chronic diseases. Outpatient offices are closed and health care professionals are volunteering to shift their attention to the “COVID onslaught,” he said. “We are going to have trouble getting the kind of care that we’re used to. The world of the non-COVID patient is worth talking about.”

There are lots of unanswered questions – like when and how will this end – and a lot of people to worry about: at least 60 million Americans living in rural areas already short on health professionals, and low- and middle-income families that desperately need the federal relief checks approved by Congress to put food on the table.

But, Redlener said, we will emerge more resilient and able to adapt better to crisis as individuals and, ideally, as global citizens.

“If we come out of this situation with a new appreciation for the necessity of the international community to cooperate and collaborate to solve major planetary challenges … that would be a wonderful thing,” he said.

Between now and then, there will be a surge in COVID-19 patients in Ohio, said Michael Oglesbee, director of Ohio State’s Infectious Diseases Institute (IDI) and professor of veterinary biosciences.

The IDI has led a partnership among Ohio State academicians and clinicians, the Ohio Department of Health and the Ohio Hospital Association to design a “contact network” model that takes into account the effects of disrupting networks through social distancing. The model predictions are refined daily based on the latest symptomatic test-positive COVID-19 cases reported.

Current predictions suggest cases will peak in the second or third week of April. The cumulative number of cases over the surge could number as high as 210,000 – compared to an estimated 375,000 cases had Ohio not adopted widespread social-distancing practices. These predictions are still changing as testing capability improves, Oglesbee noted.

“Our most recent results indicate that the social distancing appears to be even more effective than initially estimated,” he said.

The social distancing and stay-at-home orders are taking an enormous toll on businesses around the state and nation, and eventually will cost a lot for the insurance industry, said Philip Renaud, executive director of the Risk Institute at Ohio State’s Fisher College of Business.

In times of crisis, Renaud said, businesses should first establish and maintain daily contact with a critical incident management team. This group can work together to identify essential activities and employees, communicate internally and externally while activities are reduced and help the company make an orderly transition back to normal practices.

“We’re not going to flip the switch and suddenly tomorrow have normal business activity,” he said.

Some people, including a host of Ohio State students, have been able to adapt quickly to what Moritz College of Law Professor Marc Spindelman described as a sort of ad-hoc mutual aid society, looking out for others’ well-being without expecting anything in return in recognition that “need is part of crisis.”

“The social distancing and isolation we’re practicing is a great heroic act of civic friendship,” he said.

Two examples: Medical students whose clinical rotations were suspended set up a child care operation for front-line doctors, nurses and other health care professionals whose lives were upended by the closure of schools. And Ohio State students are also behind the community-outreach Help Columbus Facebook page, where people can offer support or request aid.

This kind of arrangement, not mandated by government or law, Spindelman said, “works because it’s voluntary.”

Panelists pondered what individuals, institutions and governments should do, balancing what the science says with public policy implications, to help prevent an unmanageable spike in COVID-19 cases in the next couple of weeks.

Drake likened the aggressive social-distancing measures taken by colleges and universities to extending 30 feet of rope to someone treading water 20 feet from shore.

“I’d like to look at what’s the most we can do that’s likely to continue to have an effect, get there, bend the curve as flat as we can, and then release restrictions in a gradual fashion as we see that it’s safe,” he said.

Several panelists predicted that people will come out of the other side of the pandemic with more empathy for the needs of others and especially grateful to health care professionals for their loyalty and commitment. Oglesbee noted that we should also be on the ready for the next infectious disease that inevitably will come along.

“We really need to maintain vigilance in the absence of disease,” he said. “The problem goes away and we forget about it. We cannot do that.”

In a piece published online today (Dec. 12, 2019) in the journal Science, the authors, including three public health deans, caution that blanket policies developed in a rush to address two different concerns come with dangerous downsides – most notably the risk of taking away a powerful tool to help smokers quit.

“Illnesses and deaths, which appear to be related to vaping illicit THC oils, have caused justifiable alarm as has the rise of young people who are vaping nicotine. But in our response we must not lump together these troubling developments and fail to consider the powerful evidence supporting the availability of legal nicotine products,” said lead author Amy Fairchild, dean of The Ohio State University College of Public Health.

In Science, she and her co-authors write that “Restricting access and appeal among less harmful vaping products out of an abundance of caution while leaving deadly combustible products on the market does not protect public health. It threatens to derail a trend that could hasten the demise of cigarettes, poised to take a billion lives this century.”

The paper comes after the emergence this year of vaping-related lung injuries and deaths throughout the U.S. The Centers for Disease Control and Prevention has reported 2,291 cases of serious lung injury and 48 deaths as of last week. Authorities have identified vitamin E acetate, a THC-product additive, as a “chemical of concern” and said that many of the products appear to have been acquired through informal sources – not from retail establishments selling products directly from known manufacturers. THC, or Tetrahydrocannabinol, is the primary psychoactive component of marijuana.

Many policymakers and organizations including the American Medical Association have called for an across-the-board ban on vaping, and some municipalities and states have moved to ban either all vaping products or those with flavors other than tobacco flavoring, including menthol.

Fairchild said that vaping policy discussions and debates should include an examination of the immediate crisis in the context of all of the scientific evidence regarding the risks and benefits.

“There are important distinctions to be made between nicotine and THC products, between products manufactured by reputable companies and those sold on the black market, and between the potential risks and benefits to adolescents and to adults,” she said.

Drawing comparisons to initial reluctance to offer needle exchange programs that promote safety by preventing life-threatening infections for people who aren’t ready to quit heroin, the authors write that evidence about harm reduction should outweigh emotional responses.

“We should be careful to remain aware of the unintended consequences of extreme measures and the important lessons that harm reduction has provided us in areas such a heroin use, HIV prevention and alcohol control,” said co-author Cheryl G. Healton, dean of New York University’s College of Global Public Health. 

The authors point to research showing that not only vaping – but flavored products, in particular – can help adult smokers quit and provide a more effective and appealing option than nicotine replacement therapy.

They urge continued efforts to better understand the risks and benefits of vaping and call for regulatory measures that strike a balance between “making regulated nicotine vaping products available to smokers while adopting forceful measures to limit the risks to and use by youth as much as possible.”

Among their suggestions to combat youth use: Implementation and enforcement of laws that restrict purchases to those 21 and older and prohibitions against predatory marketing to children and teens.

They call for the U.S. Food and Drug Administration to implement a product monitoring system and for a surveillance system to detect unanticipated harm early.

Regulatory bans on the menthol front should start with cigarettes and inexpensive little cigars, not with nicotine vape products, they argue.

“Despite two FDA-derived reports that recommended a ban on menthol in combustibles, there has been policy paralysis in the face of appalling evidence,” they write, citing statistics showing that more than half of young people and more than 90 percent of African-American youth start smoking with menthol.

Fairchild and her co-authors stress that they take the illnesses and deaths due to vaping seriously but emphasize that each day more than 2,500 U.S. teens start smoking and about 1,300 adults die due to cigarettes. Taking vaping – including flavored products – away as a smoking-cessation and harm-reduction tool now will amount to a public health failure, they argue.

“It is crucial to identify the source of serious lung injuries and closely monitor and regulate the vaping industry – including how it markets its products to young people,” said co-author James Curran, dean of the Rollins School of Public Health at Emory University.

“But the evidence so far supports continuing to allow nicotine vaping as a harm-reduction alternative to smoking, which remains the largest preventable cause of death and disability in our country.”

Other authors of the paper were Ronald Bayer of Columbia University and David Abrams of NYU.

Researchers at The Ohio State University analyzed claims from more than 22 million enrollees in private insurance plans and found that out-of-pocket costs for non-emergency out-of-network hospital care nearly doubled in five years.

The study included enrollees 18 to 64 years old who were part of an employer-sponsored plan for at least one year from 2012 to 2017 and looked at claims related to emergency department and non-emergency care.

Though the prevalence of use of out-of-network care dropped during the study period, cost-sharing for that care rose rapidly from 2012 through 2016 before slowing down in 2017. About 16 percent of individuals encountered out-of-network care, at an average out-of-pocket cost of $621.

The fastest cost-sharing increases for enrollees arose from non-emergency hospitalizations. The average out-of-pocket cost for this type of out-of-network hospital care increased from $671 to $1,286 during the study period. Consumer costs for out-of-network emergency hospitalizations also rose, but less dramatically – from $452 to $565.

“These out-of-network costs are concerning because many insured Americans cannot afford to pay a higher percentage of their health care bills, and in some cases they may not even be aware that their providers are out of network,” said lead author Wendy Yi Xu, a health economist and assistant professor of health services management and policy at Ohio State.

The study appears online today (Dec. 12, 2019) in the American Journal of Managed Care.

In the paper, the authors call on policymakers and others to consider the burdens on working Americans and to seek solutions.

They acknowledge that networks are important strategies for health plans to lower prices. However, they also note that state and federal consumer protection efforts have not focused on the costs of out-of-network care.

Among the policy recommendations from Xu and her co-authors:

• Patients should be told if providers and facilities are out of network, regardless of the urgency of their care.
• Disclosure requirements should further protect consumers by holding them harmless should providers fail to inform the patient of network status.
• States may need to re-examine criteria for network adequacy in an effort to ensure that patients can get the care they need without going out of network.

In recent years, the increase in out-of-pocket payments – including deductibles, copayments and coinsurance – has outpaced wage growth in the United States, the study authors point out. And as of 2018, almost a fifth of large employers have used narrow networks of medical providers in their plans.

“Health care costs are putting pressure on many American families, and we believe that they shouldn’t be held responsible for these bills if these higher-cost services are provided without their knowledge or consent,” Xu said. “Even when a hospital is in-network, care is often provided by out-of-network physicians.”

Ohio State researchers Macarius Donneyong, Yiting Li and Sheldon Retchin also worked on the study.

Researchers studying HIV in Malawi knew that the drug PrEP (pre-exposure prophylaxis) could prevent infections among female sex workers and their sex partners, but they wanted to know how best to get them the medication and encourage them to use it. So they asked the women themselves.

The women in the study said that the most important considerations for them were the location where they’d receive the medication and the additional services they could receive during those appointments. In particular, they were interested in cervical cancer screenings.

In terms of location, the majority of sex workers preferred to receive the HIV-prevention medication at family planning clinics or non-governmental drop-in centers – not at mobile health clinics near where they live or work.

“We really need to think about integrating care for women, providing them these services at locations where they already feel comfortable and can receive other essential health care,” said lead researcher Kathryn Lancaster, an assistant professor in Ohio State’s College of Public Health. The study appears today (Nov. 13, 2019) in the journal AIDS and Behavior.

PrEP, a daily oral regimen of medication, reduces the risk of getting HIV from sex by about 99 percent when taken as recommended, according to the Centers for Disease Control and Prevention.

“In Malawi, HIV infections have been on the decline in recent years with better education, testing and access to prevention. Nationally, about 10 percent of the population is infected, but about 70 percent of women who are sex workers are currently infected,” Lancaster said.

Barriers to treatment for active infections and to prevention for those who aren’t already HIV-positive are significant for those who are poor and working in a stigmatized, yet legal, field in Malawi, she said.

“There’s an inherent imbalance in power in these transactions. And the women often find themselves forced into sex or may be paid more for having unprotected sex,” Lancaster said.

That makes PrEP an especially important tool because it is something women can use to protect themselves without their sexual partners’ cooperation. And more PrEP use among the workers would also mean fewer infected male customers.

In March of this year, the Malawi government OK’d use of PrEP specifically for sex workers, but there are no guidelines on how to make that happen, Lancaster said.

She’s hopeful that the information collected in this new study, which included 44 sex workers in eight focus groups, will guide programs aimed at preventing HIV infection among these women.

“Convenience was the main underlying factor for the sex workers’ preferences and it is important for the government and others interested in prevention to understand how to best serve the needs of the women they hope to protect,” Lancaster said.

“Currently, the best data we have shows that just a few hundred Malawi sex workers at best are on PrEP when there are thousands who could benefit. There’s so much good that could come of providing PrEP to these women, but if we don’t make it convenient for them, they’re not going to use it,” Lancaster said.

For instance, providing prevention care at a site that is specific to treatment for sexually transmitted infections could be a deterrent, she said.

“They preferred family planning clinics and I think that speaks to feeling more comfortable with receiving this care alongside a service they’re already using,” she said.

Along with convenient locations and extra health services, the women also said they preferred male health care providers and a setup where they would receive two months’ worth of PrEP at a time.

Other Ohio State researchers who worked on the study are Abigail Shoben and William Miller. Researchers from the University of North Carolina at Chapel Hill and the Harvard T.H. Chan School of Public Health also contributed to this work.

The study was supported by the Center for AIDS Research at UNC-Chapel Hill.

The study highlights access barriers to behavioral health providers that lead to high costs for patients, even for those who have private insurance, said lead author Wendy Yi Xu, an assistant professor of health services management and policy at The Ohio State University.

The study appears today (Nov. 6, 2019) in the journal JAMA Network Open.

Xu and her colleagues examined claims from 3.2 million adults with mental health conditions, more than 321,500 with drug use disorders and more than 294,500 with alcohol use disorders. They compared those with claims from people with one of two common chronic conditions – diabetes and congestive heart failure.

Those with behavioral health concerns were more likely to encounter out-of-network providers and to shoulder a greater burden of the cost of their care.

Key findings included:

• Those with drug-use disorders were almost 13 percentage points more likely to have out-of-network hospitalizations and more than 15 percentage points more likely to experience out-of-network outpatient care than those with congestive heart failure.
• Enrollees with mental health conditions had cost-sharing payments for out-of-network care that were $341 higher per year on average than enrollees with diabetes.
• Compared to people with diabetes, those with drug-use disorders paid $1,242 more per year on average for out-of-network care and those with alcohol-use disorders paid $1,138 more.

“Much of this disparity is likely due to the limited availability of behavioral health care providers in insurance plans – the participation rates by these providers are generally low, a problem that is fueled in large part by low reimbursement rates for clinicians, including psychiatrists,” Xu said.

“We saw that people with heart failure and diabetes didn’t go out of network as often and didn’t pay nearly as much for their care, probably because they were able to find care within the network.”

The 2008 federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act aimed to deal with disparities between behavioral health care and other medical care, Xu said.

“But our study included data from 2012 to 2017, years later, demonstrating that those disparities still exist,” she said.

An estimated 57 million U.S. adults have behavioral health conditions, and people with these conditions also frequently have higher risks of poor physical health, according to the National Survey on Drug Use and Health from the federal Substance Abuse and Mental Health Services Administration.

“Policymakers need to address this,” Xu said. “People with behavioral health conditions are not as likely to speak up about their lack of in-network coverage for these conditions because of the stigma that’s still associated with mental illness and addiction in our country.”

Chi Song, Yiting Li and Sheldon Retchin – all from Ohio State – also worked on the study.

Researchers at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) recently reported the first evidence of biological changes correlated with e-cig use in never-smokers in the journal Cancer Prevention Research.

Using a procedure called bronchoscopy to test for inflammation and smoking-related effects, researchers reported a measurable increase in inflammation after four weeks of e-cig use (without nicotine or flavors). Although the magnitude of change was small compared with a control group, the pilot data suggests that even short-term usage can result in inflammatory changes at a cellular level. Inflammation from smoking is an important driver of lung cancer and other respiratory disease development.

Peter Shields, senior author of the study and deputy director of the OSUCCC – James, says any level of cellular inflammation correlated with e-cig use is concerning because the biological and health effects of e-cig constituents such as propylene glycol and vegetable glycerine – while “generally regarded as safe” by the U.S. Food and Drug Administration (FDA) when used in foods and cosmetics – are unknown when heated and inhaled with e-cigs. Researchers note that even in this small study, there were observable effects.

“The implication of this study is that longer-term use, increased daily use and the addition of flavors and nicotine may promote additional inflammation,” Shields said. “The general perception among the public is that e-cigs are ‘safer’ than cigarettes. The reality is the industry is changing so fast ­– and with minimal regulation – that usage is outpacing the rate of our scientific understanding. It’s becoming a public health crisis we should all take very seriously from a general pulmonary health, cancer risk and addiction perspective. E-cigs may be safer than smoking, but that is not the same as safe, and we need to know how unsafe they are.”

For this pilot study, OSUCCC – James researchers recruited 30 healthy non-smoking volunteers to directly assess the impact of tobacco and e-cig use on the lungs through bronchoscopy, an outpatient test in which a doctor inserts a thin tube through the nose or mouth to view the airways. A small sample of lung cells is collected from fluid in the lungs.

Participants were randomized to a four-week intervention with e-cigs containing only 50 percent propylene glycol (PG) or 50 percent vegetable glycerine (VG) without nicotine or flavors. (PG and VG are used in e-cig devices.) Results from these tests were then compared to a separate control group of never-smokers. Researchers did not see levels of inflammation higher than the controls, but there was an increase in inflammation among the users who inhaled more of the e-cigs.

In August 2016, the FDA was granted regulatory authority over e-cig product design. Data about e-cig toxicity in humans is needed to establish scientific evidence-based regulatory policies.

“Human clinical trials can provide valuable information regarding actual toxicant exposure and risk for disease. Through the randomized clinical trial of healthy never-smokers over a month, we found that an increase in urinary propylene glycol, a marker of inhalation-e-cig intake, was significantly correlated with increased inflammatory response in the lung,” says Min-Ae Song, first author of the study and environmental health researcher at the Ohio State College of Public Health. Song said future studies could be of longer duration, include an assessment of flavors, gauge the effect by varying ratios of propylene glycol and vegetable glycerine, and examine randomization of smokers to e-cigs.

Ongoing Clinical Trials at the OSUCCC – James

Recruitment is ongoing for e-cigarette and THC vaping studies at the OSUCCC – James. The study protocol recently expanded to include evaluation of THC and marijuana vapors in qualifying participants ages 18 or older. There are numerous mechanisms to maintain confidentiality. For more information about this and other tobacco product studies, visit go.osu.edu/tobacco-research or contact 844-744-2447 or Ecig-study@osumc.edu.

This study was funded by the National Cancer Institute, Food and Drug Administration Center for Tobacco Products, National Center for Advancing Translational Sciences, Pelotonia (Idea Grant) and Prevent Cancer Foundation.

Additional co-authors include first author Sarah Reisinger, Theodore Brasky, Ewy Mathe, Joseph McElroy, Quentin Nickerson, Daniel Weng and Mark Wewers, all of Ohio State; and Jo Freudenheim of the University of Buffalo.

Researchers from The Ohio State University compared national suicide data with national behavioral health employment data to determine what – if any – relationship existed between the two.

They found that a 10 percent increase in behavioral health workforce jobs in a state was associated with an estimated 1.2 percent decrease in the rate of firearm suicides. A 40 percent increase in mental health care providers and substance misuse specialists would quadruple the firearm suicide rate decrease – to 4.8 percent, they concluded. Extrapolating on their findings, the researchers concluded that even eliminating all federally designated mental health workforce shortage areas in the country would reduce gun-related suicide rates by less than 5 percent.

“While there are countless good reasons to improve mental health and substance misuse services in America, our data suggests that big investments won’t lead to much improvement in saving lives lost to firearm suicide. In Ohio, for instance, we would estimate that more than $15 million in workforce dollars would have to be spent to prevent one suicide,” said study author Thomas Wickizer, a professor of health services management and policy at Ohio State who also holds an appointment at the University of Washington.

“While mental health services are critical and in short supply in many parts of our nation, this research illuminates the need for additional measures to curb gun-related deaths in America.”

The study appears in the October 2019 issue of Health Affairs, a theme issue that focuses on violence.

Firearms are involved in most suicides – and more Americans kill themselves with a gun each year than are murdered with one. During the 10-year study time frame, from 2005 to 2015, the suicide rate rose 17 percent, from 6.7 per 100,000 residents to 7.9 per 100,000 residents, according to the study.

The study took into account a variety of other factors that are known to be related to suicide, including unemployment rates, educational attainment, race and sex composition of state populations, and the number of federal firearm background checks conducted in each state. The researchers used suicide data from the U.S. Centers for Disease Control and Prevention and employment data from the Bureau of Labor Statistics and the Census Bureau’s American Community Survey.

“While our research suggests that more behavioral health treatment workers might be somewhat helpful in reducing suicides, our findings also may underscore an important reality – investing in improving firearm safety initiatives and limiting gun access for at-risk individuals may provide a greater return on investment,” said study lead author Evan Goldstein, a doctoral student in health services management and policy at Ohio State’s College of Public Health.

In their conclusion, the study authors highlight opportunities for health care providers to bolster gun-safety advocacy through lobbying efforts and routinely screen and counsel patients about firearm safety on a one-on-one basis.

Wickizer said the researchers were motivated to conduct the study by the ongoing national discourse on guns and mental health, prompted largely by mass shootings throughout the country.

Suicides are far more common, he said, representing the most substantial burden of gun deaths and directly related to mental health.

Wickizer pointed out that suicide attempts involving a gun are far more lethal than other methods– leading to death 80 to 90 percent of the time.

“A suicide attempt can be a red flag that gets a person in crisis into the mental health system and when a person has access to a gun we have less opportunity to provide them support and care,” said Laura Prater, a study co-author and postdoctoral researcher in general internal medicine at Ohio State’s Wexner Medical Center. “Only 7 percent of people who survive a suicide attempt go on to die from suicide.”

Previous research and many media reports have warned women about a connection between pubic hair removal and STDs – but researchers at The Ohio State University wondered how strong that connection was, if it existed at all.

So they devised a study that, unlike previous work in this area, relied on laboratory-confirmed diagnoses of two common STDs. The study included 214 college students, all women.

The researchers examined any possible links between “extreme” grooming – removal of all pubic hair at least weekly in the past year, or at least six times in the past month – and testing positive for chlamydia or gonorrhea. They found no connection. The study appears today (Sept. 4, 2019) in the journal PLOS ONE.

Jamie Luster, the study’s lead author and a former graduate student in public health at Ohio State, said she wasn’t terribly surprised to find no connection in this study – primarily because there’s no clear biological reason to believe that shaving or waxing would lead to increased risk of these common STDs.

The women in the study, who visited an on-campus location at Ohio State for STD testing, completed a questionnaire that asked about their sexual and grooming behaviors. Almost all (98 percent) of the study participants said they had done some grooming, and between 18 and 54 percent were “extreme” groomers, based on the two measures used in the study.

The participants also agreed to allow the researchers to receive the results of their STD tests. About 10 percent of the women had a positive test.

Though this study was small, it’s important for women to know that the research in this area is not conclusive, despite what they might see in an internet search on the topic or hear from friends, said Luster, who is now a researcher at the University of Michigan.

The new study highlights the importance of taking actions that are known to reduce the risk of STDs, said Luster and her adviser on the work, Ohio State associate professor of epidemiology Maria Gallo.

The Centers for Disease Control and Prevention estimates about 2.86 million new chlamydia infections and 820,000 new gonorrhea infections occur in the U.S. each year, many in teens and young adults. The agency’s prevention recommendations for sexually active people include staying in a long-term mutually monogamous relationship with an STD-free partner and using latex condoms consistently and properly.

Chlamydia and gonorrhea are caused by bacteria, infect both men and women, and can lead to reproductive tract infections that can have lasting damage. Left untreated, both infections can make it more difficult for a woman to become pregnant in the future.

Gallo said this study improves on previous research by carefully taking into account potential confounding factors that include sexual frequency, income, race and age.

“Particularly concerning is that previous work didn’t adjust for sexual frequency. It could be that women who were having more sex with more people – and were therefore more likely to contract infections – were more likely to be grooming,” Gallo said.

By relying on laboratory-confirmed evidence of STDs, the Ohio State study also improves on previous research, which had relied on participants’ self-reports about infections, Luster said.

“Previous research asked participants if they’d ever had a sexually transmitted infection, but didn’t measure whether they had one at the time of survey. That makes connecting any current grooming habits to STDs difficult,” she said.

Abigail Norris Turner of Ohio State and John Henry, Jr. of Columbus Public Health also worked on the study.

Ohio State will seek approval for the $155.9 million health sciences center during next week’s Board of Trustees meeting. Funding sources are to be determined. The project is poised to benefit colleges, including medicine, dentistry, nursing, optometry, pharmacy, public health and veterinary medicine, and strengthen the interdisciplinary curriculum of Ohio State.

“A healthier future demands health care leaders who are prepared to work together to address health challenges,” said Bruce A. McPheron, Ohio State’s executive vice president and provost. “Ohio State’s new health sciences education building is the place where students will become those leaders.”

The multiphase project advances Framework 2.0, the university’s long-term planning vision. It includes a 150,000-square-foot renovation of Hamilton Hall and construction of a new 100,000-square-foot building featuring flexible facilities to serve multiple disciplines. Program space will include:

• 33 interdisciplinary, state-of-the-art classrooms, each with new teaching technology, including virtual reality and enhanced anatomy and surgical practice labs
• 6,000-square-foot informal learning space
• 125-seat grand reading room

“Ohio State is in the process of creating a new model to replace the 100-year-old-plus model of academic medicine in use today,” said Dr. Hal Paz, executive vice president and chancellor for health affairs at Ohio State and Wexner Medical Center CEO. “This new academic health model takes advantage of the latest technology and brightest minds to educate professionals prepared to address the changing health needs of diverse populations. This is the key to building healthier communities.”

The Interdisciplinary Health Sciences Center will focus on inclusive work environments to create:

• Spaces for students in the health sciences to convene conversations and build team approaches to health care — a way to quickly assess patients’ needs and work with the right colleagues to design the best care plans for each individual.
• Opportunities for students to be at the forefront of innovation through modern technology — whether by using realistic virtual reality models to simulate patient care or learning how video chats, texting and other emerging “telehealth” innovations can help health care providers and patients stay in regular communication between in-person office visits.
• Warm and welcoming environments that support Ohio State’s work to build diverse communities of medical students. Research has shown that diversity in medicine — including increasing representation of women and people of color — leads to better health outcomes.

Design for the new Interdisciplinary Health Sciences Center began in August 2018. Pending board approval, construction could begin in October 2019, with completion targeted for late summer 2023.

Progress continues on a separate Health Sciences Faculty Office and Optometry Clinic at 11th and Neil avenues. The 106,000-square-foot building will be home to optometry clinics, retail spaces and faculty offices. The $35.9 million project is 60% of the way through steel work and targeting an October 2020 opening.

For more information about these projects and other major initiatives advancing Framework 2.0, visit Time and Change: Building the Future.

The research, conducted in the Vietnam capital of Hanoi, included four forms of contraception: IUDs, birth control pills, male condoms and withdrawal.

About half of the women in the study who used condoms mistakenly thought they were the most effective pregnancy prevention. Condoms are about 85 percent effective.

Only 31 percent of participants correctly identified IUDs, tiny devices inserted into the uterus, as the most effective method. Women who used an IUD were more likely to correctly identify their method as more effective than condoms, oral contraception or withdrawal than other study participants. IUDs are more than 99 percent effective.

The research highlights a need for better efforts to inform women about which methods work best to prevent unwanted pregnancy, said the researcher who led the study, published online this month in the journal Contraception: X.

“Worldwide, about half of pregnancies are unintended – either these women don’t ever want to become pregnant, or they don’t want to become pregnant at that time,” said Maria Gallo, the study’s lead author and an associate professor of epidemiology at The Ohio State University.

“How do we fix this? We need to make sure we give women the information they need to prevent these pregnancies. The relative effectiveness of various forms of birth control is an important piece of information that should be included in contraceptive counseling.”

In the study, Gallo and her colleagues asked 128 IUD users, 126 birth-control pill users and 167 condom users about their perceptions about various forms of birth control.

Researchers asked the study participants about effectiveness, reversibility (the ability to become pregnant after stopping use of the method), covert use (the ability to use the birth control without a partner’s knowledge) and contraindication (whether there are people who can’t or shouldn’t use the contraception.) The women were 34 years old on average and most were married.

“This study suggests that women may be more likely to believe the form of birth control they choose is the most effective, even if that isn’t the case,” Gallo said.

In addition to the discrepancies in knowledge about IUD effectiveness and condom effectiveness, the researchers found that many women mistakenly believed that IUD use is inappropriate for some women, including those who haven’t been pregnant, and that the pill and other hormone-based contraception can cause infertility.

Next, Gallo is hoping to study how well a short, animated video on contraceptive effectiveness works to address these knowledge gaps.

Other researchers who worked on the study were Nghia Nguyen of Vinmec International Hospital, Chuong Nguyen of Hanoi Obstetrics and Gynecology Hospital and Markus Steiner of FHI 360’s Contraceptive Technology Innovation Division.

The Bill & Melinda Gates Foundation and the National Center for Advancing Translational Sciences supported the research.

Walters, who survived strangulation at the hands of an ex-boyfriend in 2006, said she now understands that all of those things stem from brain injury.

Domestic violence survivors commonly suffer repeated blows to the head and strangulation, trauma that has lasting effects that should be widely recognized by advocates, health care providers, law enforcement and others who are in a position to help, according to the authors of a new study.

In the first community-based study of its kind, researchers from The Ohio State University and the Ohio Domestic Violence Network found that 81 percent of women who have been abused at the hands of their partners and seek help have suffered a head injury and 83 percent have been strangled.

“This is happening to lots of people and it’s a really, really lonely place to be,” Walters said.

The 45-year-old Toledo woman worked in the hospital where she was seen the night of the strangulation, after a neighbor checked in on her and realized she’d been severely beaten. But neither Walters, nor the team of doctors and nurses who cared for her, thought to consider brain injury at the time.

After a car crash in 2017, a brain MRI revealed the problem. She still struggles with the fallout of the damage to her brain, and is determined to keep telling her story in hopes of helping health care providers, police officers and others understand that they should think about brain injury when working with someone who’s been physically abused.

The new research suggests that brain injury caused by blows to the head and by oxygen deprivation are likely ongoing health issues for many domestic violence survivors. Because of poor recognition of these lasting harms, some interactions between advocates and women suffering from the effects of these unidentified injuries were likely misguided, said the authors of the study, which appears in the Journal of Aggression, Maltreatment & Trauma.

“One in three women in the United States has experienced intimate partner violence. What we found leads us to believe that many people are walking around with undiagnosed brain injury, and we have to address that,” said lead researcher Julianna Nemeth, an assistant professor of health behavior and health promotion at Ohio State.

The study included 49 survivors from Ohio and 62 staff and administrators from five agencies in the state.

Previous research has acknowledged brain injury as a product of domestic violence. But this is the first study to gather this kind of detailed information from the field. It’s also the first to establish that many survivors have likely experienced repeated head injury and oxygen deprivation – a combination that could contribute to more-severe problems including memory loss, difficulty understanding, loss of motivation, nightmares, anxiety and trouble with vision and hearing, Nemeth said.

“Nobody really knows just what this combination of injuries could mean for these women,” she said. “When we looked at our data, it was an ‘Oh my gosh’ moment. We have the information we need now to make sure that people recognize this as a major concern in caring for survivors.”

Almost half of the women in the study said they’d been hit in the head or had their head shoved into another object “too many times to remember.” More than half were choked or strangled “a few times” and one in five said that happened “too many times to remember.”

In some cases, the survivors lived through both experiences multiple times.

The reports from women in domestic violence programs throughout Ohio already have prompted changes to how the statewide advocacy group and the programs it works with are helping the survivors they serve. They’ve created a model called “CARE” for “Connect, Acknowledge, Respond and Evaluate.”

They’ve adjusted their training and developed materials that address the “invisible injuries” to the brain. They’re encouraging providers at agencies to tailor care plans to the specific needs of women who’ve had traumatic brain injury, and to help them seek medical care to get an appropriate diagnosis and treatment.

Currently, the team is working on an evaluation to see how well that new programming is working.

“Brain injury was not something we really talked about much until now. It wasn’t part of any routine training and we’re trying to address that now because of what we learned from these survivors,” said Rachel Ramirez, a study co-author and training director for the Ohio Domestic Violence Network. She’s been exploring ways to ensure better diagnosis and treatment for women with brain injuries, and said there’s a long way to go.

“Almost all of the best-practice recommendations for TBI are focused on athletes and soldiers, and some of the guidance is impractical for our population,” she said. “These women could be having trouble being able to plan for the future, to make decisions about their safety, to come to appointments, to do their jobs. Many have likely been wondering for years what’s going on with them.”

Emily Kulow, accessibility project coordinator for the Ohio Domestic Violence Network, said that it’s likely some of the survivors who’ve suffered from severe head trauma and oxygen deprivation have been slipping through the cracks because their symptoms aren’t well-understood.

For instance, someone who can never remember to show up for counseling at the right time or who is combative with a roommate might be seen as a troublemaker when she’s really at the mercy of her brain injury, Kulow said.

“Regardless of why we’re seeing these behaviors, we should be serving all the women who have survived domestic violence and a one-size-fits-all approach won’t work.”

Added Nemeth, “The survivors who have severe brain injury are likely some of those with the greatest unmet need.”

In addition to memory problems and cognitive impairment, poor mental health may arise or be exacerbated by brain injury – and addressing the mental health needs of survivors is an ongoing challenge for agencies, Kulow said.

The researchers also authored another study, recently published in the Journal of Family Violence, that documents challenges that agency employees face when dealing with the complex mental health needs of survivors. The study authors, led by Ohio State Assistant Professor of Social Work Cecilia Mengo, call for care models tailored to survivors who have a mental health disability.

But they also recognize the challenges faced by advocates and survivors, particularly in areas where residents have poor access to counselors, psychologists and psychiatrists.

“It’s not that they don’t recognize the need for mental health services, but that need is difficult to meet in a state with inadequate mental health services,” Ramirez said.

Added Kulow, “We also heard from programs that there’s a lack of understanding of the more-serious mental health disorders that people have, such as bipolar disorder.”

The studies were supported by the U.S. Department of Justice Office for Victims of Crime.

The detailed analysis of health records and other data from patients in a private insurance plan in the Midwest provides a real-world picture of how efforts to reduce heart disease may be contributing to another major medical concern, said Victoria Zigmont, who led the study as a graduate student in public health at The Ohio State University.

Statins are a class of drugs that can lower cholesterol and blood pressure, reducing the risk of heart attack and stroke. More than a quarter of middle-aged adults use a cholesterol-lowering drug, according to recent federal estimates.

Researchers found that statin users had more than double the risk of a diabetes diagnosis compared to those who didn’t take the drugs. Those who took the cholesterol-lowering drugs for more than two years had more than three times the risk of diabetes.

“The fact that increased duration of statin use was associated with an increased risk of diabetes – something we call a dose-dependent relationship – makes us think that this is likely a causal relationship,” Zigmont said.

“That said, statins are very effective in preventing heart attacks and strokes. I would never recommend that people stop taking the statin they’ve been prescribed based on this study, but it should open up further discussions about diabetes prevention and patient and provider awareness of the issue.”

Researchers also found that statin users were 6.5 percent more likely to have a troublingly high HbA1c value – a routine blood test for diabetes that estimates average blood sugar over several months.

The study, published in the journal Diabetes Metabolism Research and Reviews, included 4,683 men and women who did not have diabetes, were candidates for statins based on heart disease risk and had not yet taken the drugs at the start of the study. About 16 percent of the group – 755 patients – were eventually prescribed statins during the study period, which ran from 2011 until 2014. Participants’ average age was 46.

Randall Harris, a study co-author and professor of medicine and public health at Ohio State, said that the results suggest that individuals taking statins should be followed closely to detect changes in glucose metabolism and should receive special guidance on diet and exercise for prevention.

Although statins have clear benefits in appropriate patients, scientists and clinicians should further explore the impact of statins on human metabolism, in particular the interaction between lipid and carbohydrate metabolism, said co-author Steven Clinton, a professor of medicine and member of Ohio State’s Comprehensive Cancer Center.

“In addition, researchers conducting large prospective cohort studies should be considering how statins impact human health overall. They should consider both risks and benefits, not just the disease that is being treated by the specific drug,” Clinton said.

The study was done retrospectively, meaning that the researchers looked back at existing records from a group of patients to determine if there were any possible connections between statin prescriptions and diabetes. Previous research has suggested a connection, but this study design allowed for a glimpse at what is happening naturally in the clinical setting, rather than what happens in a prospective trial that randomly assigns some people to statins and some people to placebo, said Zigmont, who is now an assistant professor at Southern Connecticut State University.

The study was enriched by the availability of a variety of details on the study population, including data from biometric screenings and a health survey that asked about education, health behaviors and ethnicity, Zigmont said. She also had access to medical claims data and pharmacy claims data.

Zigmont was careful to take a wide variety of confounding factors into account in an effort to better determine if the statins were likely to have caused the diabetes, she said. Those included gender, age, ethnicity, education level, cholesterol and triglyceride readings, body mass index, waist circumference and the number of visits to the doctor.

Programs that help patients improve their fitness and diets could be considered and discussed when doctors are prescribing statins, so that patients can be proactive about diabetes prevention, she said.

It would also be helpful for future research to better determine which statins and which doses might lead to the greatest risk, Zigmont said. Her study didn’t allow for an analysis based on different types of statins.

Limitations of the research include the fact that the majority of statin users were white, and that the research team had no way of knowing how closely patients adhered to their doctors’ prescriptions. There also was no way of determining who was at elevated risk of diabetes at the study’s onset, Zigmont said.

Abigail Shoben, Bo Lu, Gail Kaye and Susan Olivo-Marston, all of Ohio State’s College of Public Health, also worked on the study.

When researchers who were 20 and 21 visited a variety of shops in a city on the verge of implementing a law prohibiting sales to people younger than 21, more than 60 percent of cashiers didn’t ask them for identification, found the study, which appears online in the American Journal of Health Promotion.

And these young adults slipped by without an age check most often when they visited small stores, tobacco shops and shops plastered with tobacco ads.

“Our findings suggest that certain types of stores — tobacco shops, convenience stores and those with a lot of tobacco advertising — are more likely to sell tobacco to a young person without checking his or her ID,” said Megan Roberts, an assistant professor of health behavior and health promotion at Ohio State, and a member of the university’s Comprehensive Cancer Center.

“One implication of this finding is that enforcement may benefit from targeted outreach and monitoring at these locations.”

The study included fieldworker visits to a randomly sampled list of 103 tobacco retailers in the summer of 2017. The visits were made in Columbus, Ohio, where enforcement of a new Tobacco 21 law had not yet begun.

The plan was to get a baseline idea of how young adults on the edge of the cutoff age were being carded in the city, information that could potentially drive future enforcement decisions, said Niru Murali, who participated in the study as part of her undergraduate work in Ohio State’s College of Public Health.

Though the frequency of carding found in the study was low – and disappointing from a public health standpoint – it aligned with previous research, she said.

The most interesting new information found in this study was that certain retailers were less likely to ask for ID, Murali said.

More than 64 percent of grocery stores checked IDs, compared with about 34 percent of convenience stores and tobacco shops. Bars, restaurants and alcohol stores were even less likely to card the fieldworkers: only 29 percent requested ID.

“In addition to variation by type of store, we saw that those that heavily advertised were less likely to card us. It makes sense, if you think about it, that people who are plastering their windows with tobacco ads probably are trying to make a lot of money off those products and may be more likely to look the other way when selling to a young adult,” Murali said.

Retailers are supposed to card anyone who looks younger than 30 under the Columbus Tobacco 21 law. The idea behind the city’s law, and others like it, is to decrease the long-term health toll that tobacco takes by preventing young people from starting to smoke. Previous research has shown that those who start by the age of 18 are almost twice as likely to become lifelong smokers when compared to individuals who start after they turn 21.

Murali said strategic enforcement is important, and it may be helpful for those enforcing the laws to be sensitive to the fact that they present a financial hit, particularly for small business owners.

“From a public health standpoint, we’re trying to stop people from smoking initiation that has an effect on the rest of their life. But from the business perspective, tobacco is a huge source of income for them,” she said.

“I think it’s going to be really important to work on this during enforcement – how do you make this an easier pill to swallow for folks who are losing income?”

Added Roberts, “Having a minimum legal sales age for tobacco is important for reducing youth access to tobacco. Not only does it prevent young people from purchasing tobacco for themselves, but it prevents them from buying tobacco and distributing it to other, often younger, peers.”

Amy Ferketich and Brittney Keller-Hamilton, both of Ohio State, also worked on the study.

The National Cancer Institute supported the research.