Screenings may have been underreported in part because Hmong women typically keep health decisions private. And while many Hmong have indeed been screened, those screenings tend to be one-time or occasional events rather than regular routines. “It is not enough to have been screened once,” says Jennifer Kue, who grew up in Portland’s Hmong community and conducted the study with Thorburn as a Ph.D. candidate. The risks are especially high among the Hmong, whose cervical cancer rates are some of the nation’s highest.

Another surprising finding: Hmong women make many health decisions independently of their husbands. “In our culture, we place a heavy emphasis on communal decision-making and it’s male-dominant,” Kue, now an assistant professor at Ohio State. “I would have expected men to have more influence.”

Women in Pabna, rural Bangladesh, carry drinking water in large containers. (Photo: Molly Kile)

Fighting a war of independence should be turmoil enough for a small country, but in 1970, the people of Bangladesh also had to deal with a deadly cholera outbreak. This water-borne disease threatened the country’s plentiful surface water and put public health at risk. To solve this crisis, the government, together with international aid agencies, dug thousands of wells. But the clean water they hoped to deliver created a new crisis, what one researcher calls the largest mass poisoning on the planet.

Fast-forward 20 years. Symptoms of arsenic toxicity were beginning to appear in the population. Skin lesions were misdiagnosed as leprosy and led to social exclusion. Worse, skin lesions are a potential precursor to cancer.

Molly Kile, an environmental epidemiologist at Oregon State University, and her Harvard mentor David Christianie first traveled to Bangladesh in 2003 to study the health effects associated with arsenic in drinking water. “Our efforts have largely been understanding the epidemiology (of arsenic exposure) and the human health risk associated with it,” says Kile. She first traveled to Bangladesh as a doctoral student at Harvard and has returned more than 20 times.

Molly Kile studies the health impacts of environmental contaminants. (Photo courtesy of Molly Kile)

Scientists know that exposure to high levels of arsenic can lead to cancer, but Kile, an assistant professor in the College of Public Health and Human Sciences, wants to know how the metal affects other aspects of health, such as reproduction and child development. Local groups, she says, can effectively translate her results into disease prevention, but many participants in her research are among the most vulnerable in the country.

“By and large, the populations that are affected by arsenic in Bangladesh are the rural populations,” she says, “and about 60% of Bangladesh lives on less than $2 a day. So these are places of absolute poverty.”

Reproductive health effects stem from the fact that the toxic metal crosses the placenta and exposes the fetus. Low birth weight and spontaneous abortions have been associated with arsenic exposure in utero. Kile also uses genetics to look for variations among individuals that increase or decrease susceptibility to skin lesions.

Perhaps the most frightening aspect of arsenic is its invisibility. “You can’t taste arsenic. You can’t smell it, you can’t see it, you have no idea its there unless you test for it,” she adds.

Binding Arsenic

Not being able to detect arsenic by sight or taste has raised the stakes for communities that lack the resources to test or treat their drinking water. Kile’s favorite way to test for arsenic in people may come as a surprise: the human toenail.

Toenails are composed of keratin, which contains chemical combinations of sulfur and hydrogen called sulfhydryl groups. As arsenic in the body binds with these sulfhydryl groups, it accumulates in the toenail.

“So keratin is mostly sulfhydral, as is your hair,” says Kile. “Any inorganic arsenic that is circulating in your body will want to bind to a sulfhydral group. So your toenails, your hair, and even your skin all come into equilibrium with the arsenic in your body. You can take a toenail clipping, and you get a lovely integrated exposure of what that person has been exposed to.”

Molly Kile met with residents of Dhaka Community Hospital to discuss her studies of arsenic exposure. She and her team ask what concerns people have and recruit participants in their research. Their findings are then shared with the community. (Photo courtesy of Molly Kile)

Kile calls the health crisis in Bangladesh a preventable disaster. Arsenic was known to be present in large parts of western Asia, but that wasn’t considered in the 1970s when the country transitioned to groundwater.

“And it was seen as the public health triumph of its day, only to find out that it’s now the largest mass poisoning on the planet,” says Kile. “That’s one of the messages of this: This was completely preventable.”

Research elsewhere suggests that as exposure declines, skin lesions may go away with time, but such studies are still in progress.

Despite Kile’s start with arsenic being half-a-world away, the issue isn’t so far from home. She calls Oregon “arsenic country” and has been conducting water-testing workshops in communities east of the Cascades. In the United States, technology can remove arsenic from drinking water. So far, there have been no arsenic-related health problems recorded in Oregon.

“It really is across Oregon,” she adds. “Eugene, Salem…and across the border too. This is a Pacific Northwest Issue.”

Scientists estimate that up to 100 million people are exposed to elevated levels of arsenic in Bangladesh alone. Whether you are drawing from a well in Bangladesh or Oregon, researchers like Kile are racing to fully understand the impacts of this invisible contaminant.

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Listen to a podcast with Kile.

For more information about arsenic in drinking water in Bangladesh:

D. van Halem, S. A. Bakker, G. L. Amy, and J. C. van Dijk, “Arsenic in drinking water: a worldwide water quality concern for water supply companies,” in the Journal Drinking Water Engineering and Science, 2009,

Manouchehr Amini; Karim C. Abbaspour; Michael Berg; Lenny Winkel; Stephan J. Hug; Eduard Hoehn; Hong Yang; C. Annette Johnson; “Statistical Modeling of Global Geogenic Arsenic Contamination in Groundwater,” Environ. Sci. Technol.  2008, 42, 3669-3675.t © 2008 American Chemical Society

Chowdhury, M. A. I., Uddin, M. T., Ahmed, M. F., Ali, M. A. and Uddin, S. M.: How does arsenic contamination of groundwater cause severity and health hazard in Bangladesh, J. Appl. Sci., 6(6), 1275-1286, 2006

In her public health focus for Multnomah County's climate change action plan, Kari Lyons-Eubanks of the Environmental Health Services Department considers a full array of community needs. (Photo: Lynn Ketchum, OSU Extension and Experiment Station Communications)

PORTLAND, Oregon – Some time after paddling the pristine inlets of Vancouver Island in British Columbia, a kayaker came down with a severe headache. Within months the 45-year-old woman was blind and bedridden. She died of a massive brain infection in 2002.

Health workers traced her illness to a strain of deadly fungus called Cryptococcus gattii, once found only in hot spots like Australia, Asia and South America. When inhaled, C. gattii’s tiny spores can lodge in the lungs, attacking respiratory and neurological functions. Over the past dozen years, it has sickened nearly 200 people in the region and killed more than 40. One survivor, a robust Portland outdoorsman named Bob Lewis, told NPR that he’s “one of the lucky ones,” even though his heart, lungs and kidneys were permanently damaged when he was stricken by one of Oregon’s earliest cases in 2007.

Experts point to climate change as a likely culprit for C. gattii’s emergence in the moist soils and decaying trees of the Northwest. As greenhouse gasses warm the region, scientists expect once-tropical fungi and other hot-weather pathogens to migrate northward. “The pathogen emerged as the cause of an outbreak on the east coast of Vancouver Island beginning in 1999,” writes Oregon Public Health Division Director Mel Kohn in a recent article, “Climate Change and Communicable Diseases in the Northwest,” in Northwest Public Health, a University of Washington publication. “Environmental sampling … unveiled an ecological berth among several tree species there, notably our beloved Douglas fir. The researchers hypothesized that the establishment of the fungus in this area may have been due to climate changes.”

Longer summers and hotter temperatures are giving a leg up to other communicable diseases, such as West Nile fever and Lyme disease, according to Kohn, who served with OSU’s Mark Abbott on the Oregon Global Warming Commission and the Governor’s Climate Change Integration Group. That’s because many viruses, bacteria, protozoa, funguses and parasites can survive longer in warmer climates, shifting and expanding their ranges in response.

Heat Islands

Communicable diseases are just one health threat linked to climate change. Others include “heat islands” — patches of concrete and asphalt devoid of greenery — that concentrate solar energy and pollutants to create ground-level ozone. That’s why city dwellers are especially vulnerable to asthma and other lung maladies. In small towns and woodland communities, wildfires can create physical and mental stress. Laborers who harvest crops in the blazing sun risk heat-related illnesses. Floods can contaminate drinking water and displace families.

The young, the old, the sick, the poor and the disabled suffer disproportionately during heat waves, storms and other climate-related events. And linguistic and cultural minorities face extra obstacles. Kari Lyons-Eubanks ranks social justice as a top priority in her role as a policy analyst for Multnomah County Environmental Health Services. She likes to paraphrase the “father of environmental justice,” Robert Bullard, saying: “Sustainability cannot be simply a green or environmental concern.”

So Lyons-Eubanks, who coordinates the public-health piece of the agency’s local climate action plan, pays close attention to the full array of needs across the entire spectrum of neighborhoods — food, transportation, housing, heating, cooling, emergency preparedness — in short, anything that impinges on human health and well-being.

“We need to really engage the impacted communities,” says Lyons-Eubanks, whose background includes HIV prevention work in Kenya, Zimbabwe and Portland’s Somali-Bantu community.

Reaching Out

Making sure human health is folded into climate-change planning initiatives is taking on new urgency for the health division. “Public health has a huge role that often is overlooked,” says Julie Early-Alberts, Office of Environmental Public Health. “It’s important to have a public-health professional at the table, someone who has that lens.”

Of eight states to receive climate-adaptation grants in 2010 from the Centers for Disease Control and Prevention, Oregon is one of four to get a “Category 2” grant for higher levels of implementation. That’s because Oregon is a frontrunner in building “climate-resilient communities,” says Lauren Karam, former grant coordinator. “Some states are just getting started laying the groundwork,” she says. “We already have a lot of the baseline data.”

Early-Alberts and her colleagues have held “Ready for Change” workshops for public-health workers and emergency-preparedness personnel in Hillsboro, Newport, Bend and Grants Pass to gauge readiness for local climate impacts and help lay the groundwork for future planning. Also, five Oregon locales — Multnomah, Benton, Crook and Jackson counties, along with the north-central region of the state — have gotten “mini-grants” for two-year pilot projects. The idea is to raise awareness and build local capacity for keeping residents healthy during climate-related events.

Science — particularly science pertaining to Oregon’s unique mix of ecological and climatic niches — underpins the division’s outreach. For that reason, OCCRI’s Oregon Climate Assessment Report is a key document informing the workshops. The report also is highlighted on the division’s climate-change website. “We see OCCRI as a key partner,” says epidemiologist Mandy Green. “As we work with local public health departments, the localized data collected by OCCRI will be essential for them.”

"Smoking food represents something significant and steeped in time and practice," says Stuart Harris. "A lot of things, when burned, produce smoke. However, when the fire and smoke is started with matches and newspaper verses primitive ember and bark dust, in my experience, they are different and seem to produce different smoke. Essentially, the fire gives meaning to the quality of the smoke produced." (Photo courtesy of Anna Harding)

“My first memories are of smoked buckskin and eating smoked meat,” Harris says. “I also remember as a very young child sitting on the floor of one of our cultural centers near my mother and her friends and sisters where the smell of smoke was as real and regular as the smell of coffee in the morning.”

Though smoking food has long been part of Native American culture and, as for Harris, can recall memories of family and community, scientists are questioning the safety of this centuries-old practice. A team of researchers led by Oregon State University scientist Anna Harding is collaborating with the CTUIR to determine whether smoking food may expose tribe members to dangerous levels of polycyclic aromatic hydrocarbons (PAHs).

Pollutant Exposure

PAHs are created by combustion of organic materials and can cause cancer and respiratory diseases in humans. The combustion of oil, coal and gasoline can create high levels of PAHs in industrialized areas, but rural populations can also be exposed to PAHs through wood fires, which are traditionally used to prepare grilled and smoked foods.

“It is important to engage in collaborative research with tribal communities, because the tribes may have disproportionate environmental exposures relative to other populations in the U.S.,” Harding says. “Tribal communities often do not have the resources necessary to conduct the research that is necessary needed to identify exposures that may adversely impact health.”

Anna Harding examines the public health consequences of environmental processes. (Photo courtesy of Anna Harding)

Harding specializes in public health and is co-director of OSU’s School of Biological and Population Health Sciences in the College of Public Health and Human Sciences. She has worked with members of the CTUIR Department of Science and Engineering since 2002 to assess subsistence and environmental exposure among tribal members.

 Partners in Science

Her work with the tribe, Harding says, is a partnership. Researchers focus on health issues that tribal members want to explore. The goal is to provide the tribe with knowledge that can help them determine how to limit health risks without encroaching upon important cultural traditions.

“We are interested in helping the tribes develop their own scientific capacity to investigate the problems that are most important to them,” Harding says.

Harding suggested studying PAH exposure to the CTUIR, and when the tribe expressed interest in the project, she and her research team submitted a proposal to obtain funding, which resulted in a grant from the National Institute of Environmental Health Science’s Superfund Research Program in 2009. The collaborative research with the CTUIR community is one of a number of funded projects and research cores within the Superfund Research Program at OSU.

Stuart Harris participated in the study of pollutant exposure and wore an air sampler while smoking food. (Photo courtesy of Anna Harding)

Though Native Americans have been practicing traditional methods of smoking food for thousands of years, Harding says the health effects of many native traditions, including smoking food, have never been analyzed. Studying the PAH exposure associated with smoking food, Harding hopes, will help the CTUIR evaluate their PAH exposures and design risk reduction strategies, if needed, that are protective of public health.

Health Benefits

Residents of the Umatilla Indian Reservation, near Pendleton, Oregon, smoke their meat in tipis and smoke sheds where food is slowly cooked over a hearth stoked with chunks of wood. Members of the tribe may be exposed to high levels of PAHs through inhalation while they are smoking foods, Harding says, and by eating smoked foods.

Harris, who is the director of the CTUIR’s Department of Science and Engineering, says he believes the results of the study will help the CTUIR continue traditions while making the best decisions for tribe members’ health.

“The process of preparing food for storage through the winter remains the same in this ancient tribe as well as throughout the world in similar indigenous communities,” Harris says. “Knowing about the details about the exposure of PAHs can serve only to help guide us to make more informed decisions related to this common and time-tested practice.”

To determine the level of PAH exposure caused by preparing and eating smoked food, researchers evaluated air on the reservation as well as inside the food smoking structures. They collected air samples from inside the smoking structures and urine samples from individuals who had spent time smoking food in the tipi or smoke shed, and also took samples of smoked food.

The samples collected throughout the study are being analyzed in labs at OSU. To evaluate the PAH content, researchers extract particles from the samples with liquid solvents and use the processes of gas chromatography and mass spectrometry to separate and identify the different chemicals in the particles, isolating the PAHs.

While the samples are being analyzed, members of the research team will continue to work with the tribe to assess other environmental exposures, Harding says. Collaborating with the tribe, she adds, has allowed the researchers to learn about Native American culture while studying the community’s health.

“We’ve all learned from working with the tribe,” Harding says. “They have their own traditional environmental knowledge and we have learned a great deal about how their environment and their health are connected. It’s been eye opening for me to better understand tribal traditions.”

At Oregon State University, Ruder is pursuing master’s degrees in medical anthropology and in international public health. In Uganda she will combine these disciplines by studying cultural attitudes toward obstetric fistulas, a medical condition that affects 2 to 3 million women worldwide, mostly in developing countries. Fistulas result in incontinence and social isolation for women if left untreated.

“The roots of the problem are complex,” says Ruder. “Training traditional birth attendants would help. But there are deep cultural traditions at work.”

Fistulas can occur when any unnatural passageway opens up between two organs in the body. During childbirth, especially with girls whose bodies have not fully developed, prolonged pressure by the baby can damage the lining of the birth canal, leading to an opening between the vagina and the urinary tract or the rectum.

In collaboration with Terrewode, a nonprofit organization in Uganda, Ruder will interview birth attendants and fistula sufferers about their understanding of causes and preventive measures. As a member of OSU’s Reproductive Health Laboratory, her ultimate goal is to improve maternal health care for women in developing countries as well as the United States.

Ruder will work in the eastern Ugandan city of Soroti until the end of March, 2012, but it won’t be her first trip to Africa. In 1995, after receiving a bachelor’s degree in political science at the University of Arizona, she volunteered with a nonprofit group in Zimbabwe, the Kunzwana Woman’s Association, working with women on commercial farms and in mining communities. “Living conditions on the farms were terrible and tragic,” she says.

OSU master's student Bonnie Ruder, left, used her midwifery skills with Haitian women after the 2010 earthquake. (Photo courtesy of Bonnie Ruder)

That experience inspired her to move to Oregon and become educated in homebirth as a midwife. In June 2010, following the March earthquake in Haiti, Ruder volunteered for three weeks with Mother Health International in a birth center about two hours from the capital, Port-au-Prince.

“The Haitian women were amazing,” she says. “They were so happy and appreciative of the care.” Many would ride a motorbike from the mountainous countryside to the center to give birth. Because they often had other children at home, they would clutch the newborn in their arms a few hours later as they sped away for the jarring ride home. “It was not our ideal post-partum picture,” says Ruder.

On her way back to Oregon from Haiti, Ruder met Dr. Lewis Wall, a medical anthropologist and obstetrician at Washington University in St. Louis, who established the Worldwide Fistula Fund to serve women in developing countries. While at the university, Ruder also met Alice Emasu, a Ugandan woman and coordinator for Terrewode, an organization in Soroti whose aim is to empower women and support families.

With a $50,000 grant from the The Fistula Foundation, Emasu is addressing some of the cultural factors that lead to childbirth-related fistulas such as poor nutrition, lack of adequate medical care and child marriage. The organization will increase advocacy for treatment, prevention and social integration of fistula patients. Ruder’s ethnographic research will provide a better understanding of how Ugandan women and birth attendants view fistulas.

She explains that from a biomedical perspective, the condition is caused by “obstetrically obstructed labor,” but if local people don’t share that understanding, solutions to the problem may not be effective.

“I’ll ask women who have suffered from the fistula what they think caused it and what they think could prevent it. I’ll also ask those same questions of traditional birth attendants,” says Ruder. With Terrewode, she will evaluate her findings in light of existing approaches to preventing fistulas through education. In the long run, she adds, educating girls and empowering women may be the most effective public health option.

Ruder will travel to Soroti with her husband Eric and two children, Lucas, 8, and Soren, 11. Terrewode is not supporting her work financially, so she is raising funds to help pay for expenses for travel, translation and other activities.

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Ruder interviewed 17 fistula survivors in Soroti and working in the regional hospital. See a June 2012 story about her experience.

—   Linus Pauling, 1983

Linus Pauling spent the latter years of his career at Stanford University and at the scientific institute that bears his name exploring the role of micronutrients in health, from the common cold to cancer. By the time he wrote the paragraph above, he had received two unshared Nobel Prizes and had become well known for his advocacy of vitamin C mega-doses. Today, his legacy lives on through the Ava Helen and Linus Pauling Papers Collection, the Linus Pauling Institute (LPI) and a new 105,000-square-foot science center at Oregon State University.

Two recent reports from LPI scientists demonstrate their ongoing efforts to understand the relationship between health and dietary compounds.

Green Tea for the Immune System

Green tea drinkers may be on to something. Scientists have found that a beneficial compound in the ancient beverage has a powerful ability to increase the number of “regulatory T cells” (a type of white blood cell) that play a key role in immune function and suppression of autoimmune disease. This may be one of the underlying mechanisms for the health benefits of green tea, which has attracted wide interest for its ability to help control inflammation, improve immune function and prevent cancer.

Emily Ho's research focuses on naturally occuring compounds that play a role in cell regulation. Better understanding of these processes could lead to treatments for cancer and other diseases. (Photo: Kelly James)

“This appears to be a natural, plant-derived compound that can affect the number of regulatory T cells, and in the process improve immune function,” says Emily Ho, an LPI principal investigator and associate professor in the OSU Department of Nutrition and Exercise Sciences. “When fully understood, this could provide an easy and safe way to help control autoimmune problems and address various diseases.”

The immune system performs a delicate balancing act between attacking unwanted invaders and protecting normal cells. In autoimmune diseases, which can range from simple allergies to terminal conditions such as Lou Gehrig’s disease, this process goes awry, and the body mistakenly attacks itself.

Some cells exist primarily to help control that problem and dampen or “turn off” the immune system, including regulatory T cells. The number and proper function of those regulatory T cells, in turn, are regulated by other biological processes such as transcription factors and DNA methylation.

In this study, scientists exposed laboratory mice to a compound in green tea called epigallocatechin gallate, or EGCG, which has both anti-inflammatory and anti-cancer characteristics. They found that mice with higher EGCG levels had a higher production of regulatory T cells. Its effects were not as potent as some of those produced by prescription drugs, but it also had few concerns about long-term use or toxicity.

“EGCG may have health benefits through an epigenetic mechanism, meaning we aren’t changing the underlying DNA codes, but just influencing what gets expressed, what cells get turned on,” Ho says. “And we may be able to do this with a simple, whole-food approach.”

The findings were published in Immunology Letters, a professional journal. Co-authors included scientists from OSU, the University of Connecticut and Changwon National University in South Korea. The National Institute of Environmental Health Sciences and the OSU Agricultural Experiment Station supported the work.

Tea consumption was also the focus of one of the LPI’s most frequently cited papers. In 2003, scientists Jane Higdon and Balz Frei, LPI director, published a survey of studies on tea and the incidence of cancer, coronary heart disease and other illnesses.

For the Love of Cauliflower

If you ever needed a reason to eat broccoli, Brussels sprouts or cauliflower, consider sulforaphane. Ho and other LPI scientists have shown for the first time that this phytochemical can selectively target and kill prostate cancer cells while leaving normal cells healthy and unaffected.

The findings are another important step forward for the potential use of sulforaphane in cancer prevention and treatment. Clinical prevention trials are already under way for its use in these areas, particularly prostate and breast cancer.

It appears that sulforaphane, which is found at fairly high levels in cruciferous vegetables, is an inhibitor of histone deacetylase, or HDAC enzymes. HDAC inhibition is one of the more promising fields of cancer treatment and is being targeted from both a pharmaceutical and dietary approach, scientists say.

“It’s important to demonstrate that sulforaphane is safe if we propose to use it in cancer prevention or therapies,” says Ho, lead author on the study. “Just because a phytochemical or nutrient is found in food doesn’t always mean it’s safe, and a lot can also depend on the form or levels consumed,” Ho adds. “But this does appear to be a phytochemical that can selectively kill cancer cells, and that’s always what you look for in cancer therapies.”

The findings were published in Molecular Nutrition and Food Research, a professional journal. The research was supported by the National Cancer Institute, National Institute of Environmental Health Sciences and the OSU Agricultural Experiment Station.

Previous OSU studies done with mouse models showed that prostate tumor growth was slowed by a diet containing sulforaphane.

Illustration by Teresa Hall

After nearly 30 years, I’ve returned, criss-crossing the Quad, delighting in rhododendrons, sporting orange and black, ignoring rain. It’s great to feel the familiarity. It’s invigorating to be surrounded by progress.

Now I lead the research enterprise of the university that, early on, enticed me to inquire into real issues. When I was a New York high-schooler, OSU’s pre-college program invited me west, affording the opportunity to bunk in Sackett Hall and to explore Oregon’s coast, mountains and deserts through the state’s land grant university. I was awed by the role the environment plays in so much of what we do. Inspiration by top-notch teachers drew me back for graduate studies, where I found the focus on the “big picture” even stronger. Now I see more K-20 enrichment programs, and I’m personally committed to bringing youth to campus and to encouraging our undergrads to do real research.

Years ago, I considered the campus and Corvallis community just about complete, with close proximity to everything I needed. I wrote most of my thesis sitting at the Beanery! Yet I’m amazed at how much OSU has expanded. From my office, I’m watching a major renovation of picturesque Education Hall, with its huge rough-hewn stones. A short walk away, I visit the new Hallie Ford Center for Healthy Children and Families. The Linus Pauling Science Center, home to a national Center of Excellence for Complementary and Alternative Medicine, is almost complete, and ground was just broken for a $10 million animal science teaching and research pavilion. A new building for the College of Business is on the drawing boards.

The O.H. Hinsdale Wave Research Laboratory, which of course did not exist in my student days, has one of the world’s most sophisticated tsunami test facilities. And progress is not just bricks and mortar: programs are growing in stature and impact. Our 12-year-old Master of Fine Arts in Creative Writing is receiving national accolades, and accreditation of the College of Public Health and Human Sciences will enable us to lead new initiatives in health and wellness.

Richard Spinrad, Vice President for Research, Oregon State University

I studied with a wonderful oceanography professor, Ron Zaneveld, and with such legends as Wayne Burt, June Pattullo and John Byrne. I don’t have room to list our current faculty who are world-respected experts and great mentors. The pace of research was slower back in the ‘70s; students were expected to spend significant time in field work, which I did all over the Pacific and Atlantic oceans. Today’s students have the advantages of cruising via the Internet, of course, yet they still have fantastic experiences in the wide world.

Our research applications are exciting, and many may be of personal relevance to you, as they are to me. OSU prioritizes the health of people, our environment and our economy: improving the human “healthspan”; smart strategies for earthquake and tsunami preparedness; advances in wave energy and other carbon-free energy sources; innovations in manufacturing technologies.

Illustration by Teresa Hall

It may sound like the Olympics, but you don’t have to go to extremes to get benefits that could last a lifetime. Regular exercises can raise or maintain bone mass in children and adults, reducing fracture risks as they age.

Those are the conclusions of studies by Kathy Gunter and her team of undergraduate and graduate students in the OSU Extension Service and Dept. of Nutrition and Exercise Sciences. Here are a few numbers to remember.

15 minutes
Three times a week for an entire school year, more than 300 elementary school-aged children spent part of their physical education period jumping 100 times off a two-foot high platform. Four to seven years after the exercises stopped, jumpers had three to eight percent more bone mass in their hips, compared to control groups. The project known as BUGSY (BUilding the Growing Skeleton in Youth) was funded by the National Institutes of Health.

31 runners
In a recent study by Gunter, pre-adolescent girls had higher bone mineral content in their hips after participating in Girls on the Run for at least three months. The international self-esteem program may promote bone health that lasts well into adulthood. Gunter is following up on the positive association between running and bone mass in girls.

75 instructors
Better Bones and Balance is for older adults. Gunter and former OSU professor Christine Snow demonstrated that weight-bearing physical activity can reduce the risk of osteoporotic fractures in older women. Gunter has trained instructors to deliver the program in communities throughout Oregon, Washington and California. Data show that participants have greater bone mass, reduced fall risk and better functional capacity than those in control groups.

Jennifer Kue is studying the reasons Hmong women are reluctant to undergo screening for breast and cervical cancer. (Photo by Jan Sonnenmair)

Jennifer Kue was just a little girl when she began assisting Portland’s Hmong community. Learning English was a snap for this child of Hmong immigrants, so helping her parents, grandparents, aunts and uncles navigate American society – translating and interpreting, making phone calls, setting up appointments – was a role she fell into naturally.

Over the years, the Ph.D. student in OSU’sDepartment of Public Health has turned her informal advocacy into a professional calling.

“I knew I wanted to work with immigrants and refugees because of the struggles and challenges my own family went through,” Kue explains. “I knew I was in a unique position to help newcomer communities – to help them establish their lives in the U.S. more easily than my parents did.”

Health Screens

Toward that end, Kue is working with Professor (and principal investigator) Sheryl Thorburn and with research assistants and OSU graduates Karen Levy Keon and Patela Lo to understand the barriers that prevent Hmong women from seeking breast and cervical cancer screenings. The team is exploring factors that may explain the extraordinary rates of cervical cancer mortality in this ethnic group from Southeast Asia (three to four times higher than among the broader population of Asians, Pacific Islanders and non-Hispanic white women), as well as their low rates of preventive mammography and Pap tests. Kue is co-investigator and project coordinator of the study that was funded by the National Cancer Institute (NCI). Lo’s participation is funded by NCI through the American Recovery and Reinvestment Act.

“Cervical cancer is so preventable when detected early,” Kue laments. “But in our culture, women don’t talk about issues like these – issues that are so personal, so private.”

About 80 women and men are participating in the study, answering questions about medical mistrust, historical discrimination, cultural beliefs and familial relations. Along with a team of bilingual interviewers, the researchers are exploring topics such as: perceptions of and experiences with the U.S. health care system; men’s influence on women’s decisions; levels of health literacy; and wariness toward hospitals and treatments.

Trust Among Kin

Kue’s own ethnicity, along with a decade’s experience as a caseworker and researcher at Portland’s Asian Family Center, have been essential to building trust among the participants, whose lives typically revolve around close-knit kinship networks.

“Jennifer is highly committed to her community and passionate about improving their health and well-being,” says Thorburn. “She is a critical link between the research team and the Hmong community.”

In addition to her research on the Hmong Breast and Cervical Cancer Project, Kue is focusing her doctoral dissertation on Hmong knowledge of hepatitis B, along with risk perceptions and barriers to screening and vaccination. Previous research, she notes, has found high rates of hepatitis B infection among the Hmong, accompanied by low levels of screening and vaccination.

“It’s not enough to provide written information for people,” Kue insists. “In our community, communication is word of mouth. You have to have that personal connection. You can’t just pass out pamphlets and expect to solve the problem.”

Laotian Dreams

When Kue talks about her homeland, her emotions run raw. She was just a year old when her mother and grandparents fled communist forces after the fall of Saigon in 1975, traveling by foot through the Laotian jungle at night, crossing the Mekong River and eventually finding safety in a Thai refugee camp. There, they were reunited with her father and his two older brothers, both of whom had been soldiers who had fought for the United States during the Vietnam War. A year later, a California church sponsored the family’s emigration to the U.S.

Kue dreams of living and working in Laos someday with her husband and two small children.

“I’ve never been back to see the place I was born,” she says, brushing at the tears welling up in her eyes. “It’ll be an emotional trip.”

As for the study, she hopes to translate the results into tools for change, to design a culturally sensitive intervention based on the findings.

“We have a commitment to the community to go that extra step – not just get this information and let it sit on a shelf,” Kue says. “We need to find what works.”

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Ramirez is a clinical assistant professor in the College of Pharmacy. In addition to teaching classes on pharmacy management and operations, she meets daily with a dozen or more residents at Mid Valley Housing Plus, a residential support facility in Corvallis for people with mental illness. She shares an office with Mid Valley case manager Sam Ortiz where she answers residents’ questions, administers medications — some by court order, others on request — and serves as a liaison with physicians.

No longer focused only on dispensing prescriptions, pharmacists increasingly serve as consultants and sometimes as lifelines for people with chronic illness — diabetes, high blood pressure, schizophrenia. The hope is that as specialists in drug effectiveness and interactions, pharmacists can help stabilize lives and reduce hospital visits. For people with mental illness, that includes staying out of jails and homeless shelters.

In collaboration with OSU faculty members Ann Zweber in Pharmacy and Ray Tricker in the Department of Public Health, Ramirez will evaluate the consequences of her work at Mid Valley, documenting impacts on patient quality of life, interactions with police and visits to the emergency room. Just getting started, the research could have broad implications for developing an innovative role for pharmacists in the health care system.

“I have a patient that I see once a week,” says Ramirez, who serves on boards of directors at Mid Valley and the Oregon State Pharmacy Association. “He let me know that he was hearing voices, and the voices were telling him not to take his medications, not to listen to me anymore. So I got a hold of his physician, made some adjustments to his medications, called and checked on him to make sure he was taking them, to see if the voices had come back. He’s doing much better now.

“Now that’s hard to quantify. What did that do? Did it save him a hospital trip? Maybe,” she adds.

As a mental health specialist, Tricker served on the Governor of Oregon’s Task Force on Mental Health in Oregon. In 2006, he invited Ramirez to work at Mid Valley. The nonprofit organization now accommodates about 65 clients. Two to three new requests for services — a warm apartment, transportation, counseling, case management (known in mental health circles as an Assertive Community Treatment model) — arrive weekly, says Tricker, who is also on Mid Valley’s board and has worked with the nonprofit organization for more than a decade.

At OSU, he offers students in his public health courses the chance to work with Mid Valley residents. Students gain valuable field experience, assisting residents with everything from shopping to a regular exercise program known as Walking Warriors.

“The goal is to find ways to create conditions that prevent people from relapsing,” Tricker says.

In her meetings with Mid Valley residents, Ramirez sees the need daily. “These patients have multiple psychiatric issues,” she says. “They know that unless they see someone every day, their chances of staying on their medication are not as good.”

From her viewpoint, the stakes are far too high to avoid asking the tough questions. Studying the reproductive health of vulnerable women is, she argues, one of our era’s most urgent tasks — a lynchpin in the quest for social justice. Minority women can’t hope to achieve economic parity when they are disproportionately affected by HIV, other sexually transmitted diseases (STDs) and unintended pregnancy.

Helping Latina and African-American women stay healthy and plan their pregnancies will take nothing less than a paradigm shift — a revolution in contraception and disease prevention that gives women wider choices and greater control over their reproductive lives, Harvey says. The first step is to identify factors that put women at increased risk for HIV and STDs. They are complex and not entirely clear — a Gordian knot of social conditions and contextual issues including relationship dynamics, culture, poor housing and access to health care. To tease out the strands, the scientific methods must be as rigorous as the subject matter is delicate.

“We need more data on men’s influence on women’s attitudes, motivations, decisions and behavior related to the prevention of HIV and STDs.”
Marie Harvey
Chair, OSU Department of Public Health

So Harvey and her team of OSU researchers devote countless hours to designing their instruments. Crafting a questionnaire for a $1.3 million Centers for Disease Control and Prevention study on rural Latinos, for example, they hash over every linguistic fine point in excruciating detail. Working shoulder-to-shoulder with members of underserved racial and ethnic minority populations has attuned Harvey to the nuances of words — those shades of meaning that can carry powerful subtexts. “Being respectful of cultural issues and differences,” she says, “is absolutely essential in undertaking this kind of research.”

Harvey’s work also takes her into the trenches of the culture wars. The book she co-edited with Linda Beckman in 1998, The New Civil War: The Psychology, Culture and Politics of Abortion, is a case in point. As Professor Carole Joffe of UC Davis says of the collected writings: “This exhaustive analysis of the way Americans feel about abortion reveals that, at core, abortion continues to be defined primarily as a moral issue, often at the expense of women’s health and well-being.”

Harvey’s groundbreaking studies have earned her a national reputation — one that extends beyond her scores of scholarly articles to include wide citations in the popular press, ranging from the intellectually weighty (Los Angeles Times and National Public Radio’s “All Things Considered”) to the supermarket mainstay (USA Today and Glamour magazine).

Her reformer’s spirit took hold 35 years ago. As a history grad in need of a job, she fell back on her minor in psychology to land a social work position in Los Angeles. The teen moms she worked with sealed her future, inspiring her to earn a doctorate in public health at UCLA with a plan to go “upstream” to find the sources of the poverty defeating her clients.

The barrios of southern California were light years from her early-childhood home in the high desert of eastern Oregon, where diversity meant a mix of Lutherans, Catholics and Baptists. Maybe it was the hardscrabble life on a ranch, helping to herd cattle and bale hay in a one-horse town called Twickenham, that girded her for the challenges of social work. Maybe it was attending a one-room schoolhouse without indoor plumbing or central heating. Or rising at dawn to pick sugar beets, bush beans, and strawberries when her family moved west to a Willamette Valley truck farm.

The CDC study has brought her back to those agricultural roots. After years of studying sexual health in urban populations, she has broadened her research to include the rapidly growing Hispanic communities of rural Oregon. The bigger barriers that block protective behaviors among rural populations are under Harvey’s scrutiny. “We’re interested in how broader issues such as racism, medical mistrust, poverty, health literacy and culture interact and how they impact access to and use of reproductive health services.”

With a $2 million grant from the National Institutes of Health, she is also investigating the skyrocketing rate of HIV infections among primarily African-American and Hispanic men and women in Los Angeles. Unlike the typical reproductive health study, which focuses on women or on men separately, Harvey’s work looks at the interplay between the sexes. How, for example, do gender-based power and control issues affect decision-making about contraception and disease prevention? After all, sex is what Harvey calls a “dyadic” behavior — that is, “It takes two to tango.” How that tango unfolds through personal relationships is still a big unknown.

“Research in this area is in its infancy,” Harvey notes. “A thorough understanding of how relationship dynamics influence sexual behavior is needed.”