Cross-Program
In a Forbes magazine op-ed, Investigator Awards recipient Peter Ubel, MD, (’07) highlights a study by Clinical Scholars alumnus Jeffrey Kullgren, MS, MD, MPH, (’09) that analyzed employer-based financial incentives for weight loss. In their study, published in the Annals of Internal Medicine, Kullgren and colleagues found that people receiving financial incentives lost significantly more weight, but started gaining it back when the financial incentives stopped. The op-ed by Ubel analyzes what this study could mean for employer-based weight loss programs.

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Clinical Scholars
Alumni Mahshid Abir, MD, MSc, (’09) Lindsay Jubelt, MD, (’11) and Nicole Lurie, MD, MSPH, (’82) completed a study that assessed the impact of large-scale power outages on the function of hemodialysis centers. The study was published in the journal Prehospital and Disaster Medicine.

Program alumnus Harrison Alter, MD, MS, (’97) co-authored a study that found that the critical care workload in California safety-net hospital emergency rooms is increasing. The trend toward intensification of emergency room care is troubling, as the Affordable Care Act plans to divert funds away from safety-net hospital emergency rooms. The study was published in the October 2013 edition of Health Affairs.

Katherine Auger, MD, MSc, (’11) Stephen Patrick, MD, MPH, MS, (’10) and Clinical Scholars program site co-director and alumnus Matt Davis, MD, MPP, (’98) found lower rates of infant pertussis hospitalizations following the widespread vaccination of adolescents for pertussis. Their study, published in Pediatrics, has been featured on UofMHealth.org (Michigan), CNN, Vaccine News Daily, and Medscape.

Tammy Chang, MD, (’11) and Matt Davis, MD, MPP, (’98) completed a study that details the new enrollee population of Medicaid following the Affordable Care Act. The study was featured on NPR and published in the Annals of Family Medicine. Chang was also recently interviewed on the Michigan Radio show Stateside.

Using the 1997 enactment of the Children's Health Insurance Program (CHIP) as a model for what might happen when the Affordable Care Act is fully implemented, Clinical Scholars alumni Adrianne Haggins, MD, MS, (’10) Stephen Patrick, MD, MPH, MS, (’10) and Matt Davis, MD, MPP, (’98) found that the number of visits to emergency departments will likely stay about the same, while clinic visits are likely to go up. Medical XPress and Science Daily reported on the findings.

Luke Hansen, MD, (’07) Chisara Asomugha, MD, MSPH, FAAP, (’07) Jill Barron, MD, MHS, (’07), Mitesh Rao, MD, MPH, (’07), program site co-director Leslie Curry, PhD, MPH, deputy director Georgina Lucas, MSW, and assistant director and program alumna Marjorie Rosenthal, MD, MPH, (’03) published an article in the Journal of Primary Prevention that focuses on how youth living in communities prone to violence view their options and opportunities.

RWJF/U.S. Department of Veterans Affairs Clinical Scholar alumnus Michael Hochman, MD, (’10) recently published a study, Patient-Centered Medical Home (PCMH) Intervention at an Internal Medicine Resident Safety-Net Clinic, in JAMA. The study found that 24/7 access to physicians, a coordinated care system, and easily accessible appointments for urgent care resulted in an increase in patient satisfaction. The study was featured in a news release on Medical Xpress, and the American Academy of Family Physicians followed up with an article discussing the study’s implementation of components of the PCMH model.

Lenard Lesser, MD, MSHS, (’09) and Brian Lang, MD, (’11) were co-authors on a study that analyzed weight management mobile applications for their inclusion of theory-based content. The study, published in the American Journal of Preventive Medicine in October, found that all apps had low use of theory to guide behavior change.

RWJF/U.S. Department of Veterans Affairs Clinical Scholar Lisa Rosenbaum, MD, (’12) continued her editorial series in the New Yorker with an article in October on the overuse of stents. Her previous articles have featured an interview with Nobel Prize winner James E. Rothman and topics such as residency hour reductions, ways of telling patients what they don’t want to hear, and strategies for sharing impossible decisions with patients.

RWJF/U.S. Department of Veterans Affairs Clinical Scholars alumna Donna Zulman, MD, MS, (’08) and program alumni Steven Asch, MD, MPH, (’92) and Eve Kerr, MD, MPH, (’92) describe how chronic conditions can interact in ways that influence clinical complexity and quality of care, a concept they call “comorbidity interrelatedness,” in their article released online by the Journal of General Internal Medicine.

Cross-Program
In lieu of expanding Medicaid under the Affordable Care Act, Pennsylvania Governor Tom Corbett proposes to direct low-income residents to insurance marketplaces to purchase state-subsidized private plans. Associate director of the Clinical Scholars program and Health & Society Scholars program alumnus David Grande, MD, MPA, (’05) discusses whether the plan will cost more than traditional Medicaid in a Philly.com op-ed.

Charmaine Smith Wright, MD, MSHP, a Harold Amos scholar (’12) and alumna of the Clinical Scholars program (’08), is conducting research she hopes will lead to interventions that can help low-income women avoid excessive weight gain during pregnancy. She presented her preliminary findings at this year’s American Public Health Association annual meeting in Boston.

Harold Amos Medical Faculty Development Program

Alumna Kim Rhoads, MD, MS, MPH, (’13) published a study, “What Factors Influence Minority Use of National Cancer Institute-Designated Cancer Centers?” in the October 2013 issue of Cancer. Since National Cancer Institute (NCI) cancer centers have been cited for providing high-quality care and producing better cancer outcomes, Rhoads and her research team at Stanford University examined what factors influence patients of various racial and ethnic minority groups who have colorectal cancer to seek care or choose these facilities for treatment. This study found that sociodemographic factors and proximity to NCI cancer centers are important predictors of use.

Health & Society Scholars
Jimi Adams, PhD, (’09) and Steven Haas, PhD, MS, (’06) published a study in the October 2013 issue of the Journal of Health Education and Behaviors entitled “Social Networks and Smoking: Exploring the Effects of Peer Influence and Smoker Popularity Through Simulations.” Adolescent smoking and friendship networks are related in many ways that can amplify smoking prevalence. Understanding and developing interventions within such a complex system requires new analytic approaches. The study demonstrates how a simulation-based approach can be used to explore alternative scenarios of peer influence on smoking that may be achievable through intervention efforts. Adams and Haas also offer new hypotheses about the association between friendship and smoking.

Sarah Gollust, PhD, (’10) and Jeff Niederdeppe, PhD, MA, (’08) published a study in the American Journal of Public Health, “Framing the Consequences of Childhood Obesity to Increase Public Support for Obesity Prevention Policy.” The authors examined the effects of messaging on public attitudes about obesity prevention policy. Data collected from two nationally representative Internet-based surveys revealed that respondents perceived a message about the health consequences of childhood obesity as the strongest rationale for government action. Messages relating the consequences of obesity on military readiness were rated particularly strong by conservatives; messages relating obesity to bullying had high ratings from political moderates; and messages relating obesity to health care costs resonated with liberals, according to the survey results. The authors therefore concluded that the public considers several consequences of childhood obesity as strong justification for obesity prevention policy. This information about the way certain health messages are received by different sectors of the public could help to raise awareness about this topic.

Sheryl Magzamen, PhD, MPH, (’09) published a study entitled “Moderate Lead Exposure and Elementary School End-of-Grade Examination Performance” in the November 23, 2013, issue of the Annals of Epidemiology. This study investigated the association between moderate lead poisoning in early childhood with performance on a comprehensive set of end-of-grade examinations at the elementary school level in two urban school districts. Magzamen studied children born between 1996 and 2000 who resided in Milwaukee or Racine, Wis., with a record of a blood lead test before the age of 3 years. Parents of eligible children were mailed surveys to consent to participation and elicit information on potential confounders. Magzamen concludes that household-level social status and childhood health indicators partially explain decreased examination scores.

Andrew Papachristos, PhD, (’12) has a new study, “Network Exposure and Homicide Victimization in an African American Community,” that estimates the association of an individual’s exposure to homicide in a social network with the risk of individual homicide victimization across a high-crime African American community. Papachristos found that 41 percent of all gun homicides occurred within a network component containing less than four percent of the neighborhood’s population. Network exposure to homicide is strongly associated with victimization: the closer one is to a homicide victim, the greater the risk of victimization. His conclusions show that the risk of homicide in urban areas is even more highly concentrated than previously thought. Most of the risk of gun violence is concentrated in networks of identifiable individuals. Understanding these networks may improve prediction of individual homicide victimization within disadvantaged communities.

Christopher Wildeman, PhD, (’10) and Hedwig Lee, PhD, (’11) have published a study in the journal Women’s Health Issues titled “A New Vulnerable Population? The Health of Female Partners of Men Recently Released from Prison.” Despite growing literature on the consequences of having an incarcerated romantic partner on women's risk of contracting sexually transmitted infections, little research considers the broader health profile of the female partners of imprisoned men. Results reveal that the health of the female partners of recently released men is at least as poor as that of their male partners, suggesting a degree of vulnerability that has yet to be considered in the medical or public health literature, and a population that desperately needs medical attention with the full rollout of the Affordable Care Act in 2014.

Investigator Awards in Health Policy Research
Peter Bearman, PhD, (’05) published an editorial in the October issue of the American Journal of Public Health titled “Genes Can Point to Environments That Matter to Advance Public Health.” In his article, Bearman stresses that expanding knowledge of genetic information can hold the key to reducing poor health behavior and lead to improved health outcomes.

David Hemenway, PhD, (’97) presented at the American Public Health Association’s 141st Annual Meeting in Boston on the policies and programs that could prevent gun violence. In his presentation, entitled, “Newtown Shootings: A Policy Perspective,” Hemenway discussed how communities can work together to create a culture of safety across the country.

Investigator Peter Ubel, MD, (’07) authored a perspective, “Full Disclosure: Out-of-Pocket Costs as Side Effects,” in the October 17 issue of the New England Journal of Medicine that says physicians need to start treating the financial cost of a treatment or procedure as they would any other bad side effect. In his piece, Ubel, a physician and behavioral scientist at Duke University, recounts real-life testimonials of how doctors do, in fact, provide their patients with less-costly treatment alternatives, but only after the patient has reached financial ruin. Ubel also authored a corresponding op-ed that appeared in the New York Times on Monday, November 4, titled “Doctor, First Tell Me What It Costs.”

New Connections
Many New Connections grantees and alumni attended and presented at the American Public Health Association conference. Alberto Cardelle, PhD, (’09) presented the paper “Return on Investment Analysis: A Tool for Policy Advocacy,” on the use of return on investment analysis when advocating for more health education funding. Henry Carretta, PhD, MPH, (’11) had a poster in the Public Health Law Poster Session II titled “Community Benefit and the Affordable Care Act: How Will Not-for-Profit Hospitals Respond to Change?” This poster was based on Carretta’s New Connections project. Linda Charmaraman, PhD, (’13) contributed to the presentation “Family Homework Activities in a Comprehensive Sex Education Program Delay Teen Sex for Boys” that was included in the session “Sexual Health Education: Challenges and Achievements.”

New Connections grantee J. Margo Brooks Carthon, PhD, RN, received another research grant award from the Robert Wood Johnson Foundation. The title of the research grant is “Expanding Access to Health Care by Removing APRN Practice Barriers: Lessons from Pennsylvania.”

Nurse Faculty Scholars
J. Margo Brooks Carthon, PhD, RN, (’13) of the University of Pennsylvania and colleagues published “Variations in Postoperative Complications According to Race, Ethnicity, and Sex in Older Adults” in the September issue of the Journal of the American Geriatrics Society. The study found that elderly African Americans and Hispanics have a greater risk of postoperative complications depending on gender, procedure type, and health care status.

Matthew D. McHugh, PhD, JD, MPH, RN, CRNP, FAAN, (’11) of the University of Pennsylvania School of Nursing, led a group of researchers that published a study, “Hospitals with Higher Nurse Staffing Had Lower Odds of Readmissions Penalties than Hospitals with Lower Staffing,” in the October issue of Health Affairs. The study found that hospitals with high nurse staff levels had 25-percent lower odds of being penalized for readmissions under new rules from the Centers for Medicare & Medicaid Services, compared with facilities with lower nurse staffing ratios. Higher nurse-staffed hospitals also had 41-percent lower odds of receiving the maximum penalty for readmissions.

Scholars in Health Policy Research
Scholars in Health Policy Research alumna Rene Almeling, PhD, (’08) authored a new article, “Public Opinion on Policy Issues in Genetics and Genomics,” that was published online on November 7 in Genetics in Medicine, the official journal of the American College of Medical Genetics and Genomics. Based on a survey with a nationally representative sample, the poll found that Americans demonstrate widespread support for federal funding of genetic research, laws protecting citizens against genetic discrimination, and the need to involve medical professionals in the process of genetic testing.

Martha Bailey, PhD, MA, (’05) authored a National Bureau for Economic Research Working Paper titled “Fifty Years of Family Planning: New Evidence on the Long-Run Effects of Increasing Access to Contraception” that provides new evidence on the relationship between family planning and long-term economic outcomes such as educational attainment, labor supply, and family income.

Daniel Carpenter, PhD, (’98) authored an online commentary in the Journal of the American Medical Association titled “Can Expedited FDA Drug Approval Without Expedited Follow-up Be Trusted?” on October 28 that underscores the importance of rigorous research on prescription drug safety and efficacy.