The Yale School of Public Health’s longstanding relationship with the Centers for Disease Control and Prevention is providing students with valuable research and public health practice experience as they address chronic disease in New Haven and other Connecticut communities.
CARE (the Community Alliance for Research and Engagement), which is co-housed at the Yale School of Public Health and Southern Connecticut State University (SCSU), currently oversees two major CDC funded grants focused on eliminating health disparities disproportionately experienced by disadvantaged populations.
One CDC grant supports a Prevention Research Center or PRC that is a collaboration between the Yale School of Public Health (YSPH) and Griffin Hospital in Derby, Conn. The Yale-Griffin PRC, one of only 25 such research centers in the United States, has been continuously funded since 1998.
The other funds a REACH grant, for Racial and Ethnic Approaches to Community Health, that helps CARE support community-led initiatives to overcome local barriers to good health — such as increasing access to healthier foods and broadening opportunities for physical activity.
“Engaging with our community partners is key,” said Kathleen O’Connor Duffany, PhD, deputy director of the YSPH Office of Public Health Practice and director of research and evaluation for CARE. “We ask community partners to tell us what their needs are and then work with them to find ways to address those needs.”
At the Yale-Griffin PRC, Yale students work closely with Yale scientists and CARE staff assessing interventions to address chronic disease with a focus on healthy eating, physical activity and social determinants of health, such as food security. Outcomes are reported back to the CDC, which uses the information to develop best practices that can be replicated in other communities.
The PRC is currently studying ways to prevent diabetes in New Haven and towns in Connecticut’s Lower Naugatuck Valley. Diabetes is the seventh leading cause of death in the United States and research has shown that the risk of diabetes is significantly higher among low-income populations. Currently, in New Haven’s lower income neighborhoods, the prevalence of individuals identified as overweight and/or obese is 69%, and as high as 82% among black women. Obesity is a major risk factor for type 2 diabetes.
In response to this important public health issue, the Yale-Griffin PRC is investigating ways to implement a virtual version of the CDC’s national diabetes prevention program (DPP), while also addressing individual and structural social determinants of health.
The DPP program consists of an intensive 16-week healthy lifestyle intervention followed by a maintenance phase, administered via smartphone or computer. The intervention includes support from a community health worker, who guides participants through the program and addresses barriers to healthier living.
Created in 2010, the CDC’s DPP initiative has been shown to reduce the risk of type 2 diabetes by 58%. The program’s new digital version is being tested by the Yale-Griffin PRC to see if it increases engagement and retention.
The five-year study is being led by Yale School of Public Health Professor Rafael Pérez-Escamilla, PhD, director of the school’s Office of Public Health Practice and a globally recognized expert in community nutrition.
O’Connor Duffany, an associate research scientist in the YSPH Department of Social and Behavioral Sciences and the PRC’s co-director, said Yale students are active participants in the DPP study. They assist in developing survey instruments and protocols, train in conducting focus groups and coding, and contribute to community reports and academic papers.
“This is applied public health practice,” O’Connor Duffany said. “The students are on CDC calls and in webinars with me, and they attend meetings with community leaders. They are very much a part of the team, and we teach them the skills they need to get where they want to go.”
With funding from the REACH grant, CARE is helping implement programs to encourage healthier food options in New Haven’s emergency food pantries.
One program, #GiveHealthy, uses an online shopping application to encourage people to donate fresh fruits, vegetables and other healthy food options requested by local food pantries and soup kitchens.
Engaging with our community partners is key
Kathleen O’Connor Duffany, PhD, deputy director of the YSPH Office of Public Health Practice
Another program, Supporting Wellness in Pantries or SWAP, developed by the University of Connecticut Rudd Center for Food Policy and Obesity and FoodShare, helps pantries identify foods high in nutritional content using a stop light system – red for low nutritional value, yellow for moderate value and green for high value. The goal is to encourage pantries to stock more green options. For added support, the REACH grant also provides funding for a community health worker, who is based in the food pantries and helps people access health care and social services.
“Whether we are advocating for better bus service in West Rock, building community gardens, or working to decrease hunger across our city, CARE is proud to be part of the powerful coalitions across New Haven that are fiercely dedicated to improving the wellbeing of all residents,” said Alycia Santilli, CARE’s director, who is based at SCSU.
Santilli, MSW, has been helping New Haven’s food insecure populations for the past decade and she is a former chair of the New Haven Food Policy Council, a city commission devoted to building a just and sustainable food system in New Haven.
Many students use their CARE projects for internship experience and thesis subjects.
Grace Carroll, MPH ‘17, said her public health practice work at CARE dovetailed nicely with her master’s thesis. Carroll designed a study to assess barriers to food security in New Haven that led to a published research paper and contributed to a community report that laid a framework for future action.
“Working with CARE provided me with invaluable academic and professional experience,” said Carroll.
Another Yale student, who took Duffany’s evaluation class and subsequently worked with the New Haven Health Department, was awarded a highly-competitive CDC Evaluation Fellowship. Only about 10% of applicants are accepted for the prestigious fellowship, which trains participants in CDC evaluation procedures and is overseen by the agency’s chief evaluation officer.
Current MPH candidate Ryan Sutherland is working with CARE’s Coordinated Food Assistance Network or CFAN, where he supports community partners in helping make New Haven’s emergency food assistance network more efficient and user friendly. During a recent meeting involving more than 40 community representatives and emergency food providers, pantry managers discussed sharing refrigerator space and working together to bring in more fresh fruits and vegetables and other nutritious foods.
“It was such an honor to be able to sit in on a meeting with so many dedicated community organizations and exceptional advocates and activists,” said Sutherland, who hopes to help those experiencing poverty, homelessness and food insecurity as a future physician/scientist.
Other YSPH students, including Erin Mathios and Jackson Higginbottom, are gathering information for a local food resource guide to improve emergency food services. Higginbottom, a second-year MPH student in the Department of Social and Behavioral Sciences, also worked with CARE to improve pedestrian safety in New Haven’s low-income neighborhoods.
After listening to residents’ concerns about traffic, dangerous walking routes, and a lack of safe crossing areas, CARE launched “Safe Routes for All,” a citywide initiative to make six local intersections safer and more pedestrian friendly. Higginbottom joined residents, CARE staff, and New Haven city workers in painting the sides of the newly designed streets with bright colors signifying pedestrian areas. It was a rewarding experience that allowed him to see the impact of his public health practice work firsthand.
“I am the first to recommend CARE to incoming students interested in community health research,” Higginbottom said. “CARE’s leadership has always prioritized my personal and professional goals when assignment tasks or placing me on projects.”
Pérez-Escamilla said the student testimonials “confirm the extraordinary place that YSPH has become for advancing public health practice education, training and research and how much CARE and the CDC’s PRC and REACH projects are contributing to it.”