Shinobu Watanabe-Galloway, PhD, Research on Mental Illness and Substance-Related Disorders


Spotlight on Research at COPH – Across the United States, two million persons with serious mental illnesses are booked into jails each year. According to the National Center on Addiction and Substance Abuse at Columbia University, about 40% of state prison and local jail inmates have substance use disorders, and 25% have substance use disorders with mental illness. There is a substantial overlap between the behavioral health and criminal justice systems. Dr. Shinobu Watanabe-Galloway and her research team worked with the Behavioral Health Division of the Nebraska Department of Health and Human Services and county jail and state corrections systems to conduct a study to examine the characteristics of individuals with mental illness who have had criminal justice encounters, and the patterns of those encounters. The study found that half of adults who receive Nebraska’s behavioral health services in a community setting had been to jail at least once in five years. Substance abuse alone and in combination with mental illness appears to increase the risk for a criminal justice encounter. The study also found that about 70% of people in substance abuse treatment had been to jail or prison at least once in five years.

Mental illness and substance-related disorders are also over-represented in the homeless population. In 2011, at least 7,013 people experienced homelessness in Douglas, Sarpy, and Pottawattamie Counties. Our community trails the national rates of reductions in the homeless population in all respects except for homeless people who have mental illness and other disabling conditions. Scarce resources are a reality in our community’s future. The US Department of Housing and Urban Development and the US Department of Health and Human Services are increasingly pushing for human services systems to understand client/patient use patterns in order to achieve systemic outcomes. In the case of homelessness, the Homeless Emergency and Rapid Transition to Housing Act of 2009 set forth system performance expectations that motivate communities to understand the return-on-investment of federal dollars. Dr. Watanabe-Galloway has been partnering with the Metro Area Continuum of Care for the Homeless to plan and conduct a study to investigate health care utilization patterns among chronically homeless adults and the impact of housing support services. The study was funded through the UNMC College of Public Health’s Mutual Fund Program and is expected to be completed in the spring of 2013.

Shinobu Watanabe-Galloway, PhD, is an associate professor in the UNMC COPH Department of Epidemiology.

New Developments in the Fight to End HIV Infection


Public Health in the National News – The Food and Drug Administration approval of a pre-exposure prophylaxis, or PrEP, is an exciting development in the fight to end HIV infection. The public health community working to prevent new infections now has another in a wide array of tools with which to prevent HIV transmission.

Clinical studies have shown those who start a PrEP regimen do not engage in behaviors that transmit HIV with any greater frequency than before using the drug. Despite this, some public health officials are concerned that some may engage in those behaviors more often if they are on a PrEP. Changing behavior is difficult; if someone is engaging in activities that have high potential for transmission of HIV and he or she is not likely to reduce or stop those behaviors in the near future, PrEP could be a life-saving option. For these reasons, it is important that anyone beginning a PrEP regimen also receive counseling and education around HIV prevention and be tested for HIV on a regular basis. A comprehensive approach to HIV prevention is the best scientifically justified prevention method recommended.

As with many newly approved treatments for HIV, PrEP regimens are not cheap—some estimate costs of up to $13,000 a year. It is unclear yet how insurance companies will handle the newly approved on-label use of the drug. While PrEP may be a great new tool in the HIV prevention specialist’s toolkit, it will likely not be available to many of those who most need it because of the cost. Policymakers and drug company marketers will need to take costs of the drug into account when determining how best to implement PrEP as part of a multipronged approach to HIV prevention in the United States.

For those who are good candidates for PrEP and can afford it, the once-a-day pill is not a magic bullet. PrEP doesn’t work for everyone and is not 100% effective, even when taken every day as directed. In addition, numerous side effects can interfere with daily quality of life. In addition, some major side effects could be life-threatening. It is important that those who are considering using PrEP get all the facts and be presented with all prevention options to determine what works best for them.

While we may soon be saying “HIV?! There’s a pill to prevent that,” we need to remember that prevention has never come in a magic bullet. We still need to carry out the multipronged approach to HIV prevention as outlined in the National HIV/AIDS Strategy. We need to ensure that EVERYONE is included in our prevention efforts, not just those who can afford a pill and have the sociocultural support to take it every day.

This article was written by Christopher Fisher, PhD, assistant professor in the UNMC COPH Department of Health Promotion, Social and Behavioral Health. Dr. Fisher is also director of the Midlands Sexual Health Research Collaborative and chair of the APHA HIV/AIDS Section.

Tricia D. Levan, PhD

Tricia D. Levan, PhD

Faculty Highlight – Dr. Tricia LeVan is the course coordinator and instructor for the Master of Public Health core course in epidemiology, “Epidemiology in Public Health.” The course encompasses several teaching paradigms, including traditional lectures and exams; in class exercises and discussion; small group current event topics using news, videos, magazine articles, and state-of-the-art peer-reviewed manuscripts; and a final PowerPoint video presentation on descriptive epidemiology. The course is always evolving to include fresh new teaching ideas. In addition to in-class teaching, she serves as mentor to four MPH students and one PhD student.

At an international level, Dr. LeVan is a lead instructor for MECOR (Methods in Epidemiologic, Clinical and Operations Research), which is an international group to improve global lung health by developing local, country and regional research capacity, with an emphasis on low- and middle-income countries. This year she will travel to Chennai, India, and Cesme, Turkey, for the six-day course.

Dr. LeVan’s long-term research goal is to understand the innate immune processes underlying COPD in agricultural workers, which she hypothesizes to involve interactions driven by genetic polymorphisms as well as by epigenetic modifications, both of which affect gene expression; and the airway microbiome and its influence on host inflammation and antibacterial immunity. To address this goal, her program includes research at the clinical as well as the molecular level that can be described as genetic and molecular epidemiology. Her research program, recently funded by a VA Merit Award, is developing a cohort of veterans with and without agricultural exposure. The program has successfully recruited 500 veterans and plans to recruit an additional 1,000 veterans in the next three years. Data from the clinical cohort will direct Dr. LeVan’s laboratory research in the coming years to achieve her long-term research goal. As part of this research program, she has established a genotyping facility that provides genotyping for investigators at the VA as well as UNMC and nationwide.

Tricia D. LeVan, PhD, is an associate professor in the UNMC COPH Department of Epidemiology.

Douglas Perin

Douglas Perin

Student Highlight – Douglas Marcel Puricelli Perin (Doug) grew up in the metropolis of Porto Alegre, Brazil. While obtaining a law degree from one of Brazil’s most prestigious universities, Universidade Federal do Rio Grande do Sul (UFRGS), he worked for a non-governmental organization helping poor and underprivileged communities regularize their housing conditions. His professional experience with social work would prove beneficial later in his life. After graduating from college, his passion for culture, history, and nature prompted him to travel extensively throughout Latin America. For a brief period, he worked as a diving instructor in Honduras, educating and interacting with people from all over the world.

Eventually, Doug achieved a diving instructor position in Dublin, Ireland. While living within the EU, Doug traveled to many countries, including North Africa. Coming into contact with so many people of such various cultures gave him a global perspective. It also deepened his appreciation for social work, especially since he had witnessed staggering poverty firsthand. Since his ancestors are Italian, he finally transferred to Florence, Italy, where he became a European citizen and met his lovely wife. He began working for one of the top tour companies in Tuscany as an environmental hiking guide in beautiful Cinque Terre. Although his job in Italy was pleasurable and profitable, he wanted to advance social causes and to devote his time to helping others.

Doug learned about public health through a serendipitous conversation. Realizing that his previous work and his interest in addressing societal and public problems aligned with the field of public health, Doug applied to the masters in public health program at UNMC. He is currently in the epidemiology concentration and working as a graduate assistant in the Center for Global Health and Development. He has an interest in public health informatics and environmental issues, mainly long-term sustainability of food production He has co-authored several papers with Drs. Ashish Joshi and Terry Huang. What Doug likes most about the COPH is the versatility of the academic disciplines. His future career goal is to establish programs in developing nations that will teach communities to be self-sustainable and that can free them from dependence on outside forces.

Online Education and the College of Public Health


Public Health in the National News – The College of Public Health announces the launch of new online programs at the University of Nebraska. These programs will address a growing workforce demand for more public health professionals. A master of science in emergency preparedness and professional certificates in public health and emergency preparedness can now be obtained fully online through the University of Nebraska’s Online Worldwide website. All are graduate-level programs offered by the University of Nebraska Medical Center.

The programs aim to strengthen the public health workforce in order to meet the health needs of the U.S. and global populations. The Association of Schools of Public Health estimates that 250,000 more public health workers will be needed by 2020. Compounding this challenge is the fact that 23% of the current U.S. public health workforce—almost 110,000 workers—are eligible to retire this year.

The certificate in public health includes 18 credit hours (six courses) focused on the core areas of health behavior, environmental health, biostatistics, epidemiology, administration, and global health. Students may be able to apply the coursework toward a master’s degree in public health.

The certificate in emergency preparedness is also an 18-credit hour program. The federal Department of Homeland Security’s core focus areas—prevent, protect, respond, and recover—form the structural basis for the program. The master of science in emergency preparedness, a 36-credit hour program, is designed to teach professionals how to plan for and respond to events such as natural and man-made disasters, terrorist attacks, or infectious disease threats.

The College of Public Health recognizes that working professionals have many commitments in their lives. While the academic rigor of our online courses is the same as our on-campus versions, the convenience and flexibility of online learning is appealing to many working professionals. “Learning online is very convenient. You can collaborate and communicate in groups, exchange files, discuss topics with the class, track your progress in the course, and access electronic resources. I particularly like the use of multimedia in my classes,” said Junmin Zhou, a student taking a core course online. Courses are divided into weekly modules where students access learning materials and complete assignments by specific dates. Everything that the student needs is located in one place and accessible through an Internet connection from anywhere in the world.

This article was written by Sergio Costa, PhD, director of distance learning in the UNMC COPH Office of the Dean. Adapted with permission from Online WorldWide, University of Nebraska.

Patrik Johansson, MD, MPH

Patrik Johansson, MD, MPH

Faculty Highlight – Dr. Patrik Johansson joined the College of Public Health 2009. Prior to 2009, he was an assistant professor at The George Washington University School of Public Health and Health Services, deputy chief medical officer for Greater Southeast Community Hospital in Washington, DC, and account executive for Hill and Knowlton Japan in Tokyo. He earned his bachelor of arts in international relations from Brown University and his MD from the UNMC College of Medicine. He did his residency in primary care/internal medicine at Cambridge Hospital in Massachusetts and earned his master of public health (MPH) from Harvard School of Public Health.

Dr. Johansson advises MPH COPH students enrolled in concentrations in the Department of Health Promotion, Social and Behavioral Health. He lectures in the Health Disparities course taught by Dr. Shireen Rajaram and in the Foundations in Public Health course taught by Dr. Shawn Gibbs. Additionally, he teaches a course on health disparities for undergraduate students enrolled in UNMC’s Summer Medical and Dental Education Program and a section of the cultural competence course for M4 students.

Dr. Johansson is the director of the COPH Rural Health Education Network (RHEN) and the director of the COPH Great Plains Public Health Training Center. His research focuses on health services and health disparities. He serves as the chair for the COPH Student Recruitment and Admissions Committee and is a member of the Community Engagement Coordinating Council Committee. At the campus level, Dr. Johansson also serves on the UNMC Legislative Team; Primary Care Center for Education, Research, and Health Care Design Steering Committee; and the Preventive Medicine Advisory Committee. At the regional level, he serves on the Nebraska Rural Health Association Board of Directors. At the national level, Dr. Johansson has a Presidential appointment to the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health, and is a member of the National Medical Association.

Patrik Johansson, MD, MPH, is the director of UNMC COPH Rural Health Education Network, the director of the COPH Great Plains Public Health Training Center, and an associate professor in the UNMC COPH Department of Health Promotion, Social and Behavioral Health.

Niccolette Ramsey

Niccolette Ramsey

Student Highlight – Nicci Ramsey is originally from Albuquerque, New Mexico, but was raised in Omaha. She is a student in the UNMC COPH MPH Program, with a concentration in Public Health Administration.

 Nicci’s path to the field of public health began with her pursuit of a bachelor’s degree in psychology with a minor in peace studies from Chapman University in Orange, California. She continued to pursue her education goals by earning a master’s degree in counseling psychology with a focus on substance abuse and addictions from the Adler School of Professional Psychology in Chicago, Illinois. While earning her master’s degree, Nicci spent her spare time volunteering at the Lincoln Park Community Shelter for the homeless. Nicci describes this volunteer work as “one of the greatest experiences of my life, serving the homeless members of my community and showing my support for their rehabilitation and work toward achieving their goals. My experience volunteering at LPCS gave me new aspirations for myself; I want to give back to the community, to the members who are often overlooked and need the supports of the community most. I began to dream of one day opening a shelter like this in my hometown in Omaha. To be able to provide a multidimensional rehabilitation program in my own community that provides a safe environment to begin to empower those who are often forgotten about became my goal.”

 Through the mix of her background in mental health and substance abuse counseling, mediation, and an enjoyment for listening to the incredible stories that many disenfranchised people have to share, Nicci was drawn to the MPH program with a concentration in public health administration. She hopes to gain the knowledge and skills to one day develop a shelter that provides a variety of services for the members of the Omaha area or become the director of one of the already amazing programs within the community, ultimately providing an empathetic environment that can successfully address the public health needs within the growing community.

 Nicci appreciates the COPH professors who have a variety of experiences in public health and provide a well-rounded exposure to the many dimensions of the field. What Nicci likes most about the COPH is the “dedication of the student advisors. The advisors within the COPH work very hard to support their advisees and help guide us through the program.”