Many rural Pennsylvania communities are seeing unique challenges related to the health of residents. Deaths related to heart and liver diseases, diabetes, accidental opioid overdose and suicide are rising in American small towns. Recognizing these unique problems, Penn State Clinical and Translational Science Institute is leveraging the University’s resources to better partner with the communities around its campuses. The institute has been awarded a $416,000 grant from the National Center for Advancing Translational Sciences for a pilot program to better understand the issues facing rural communities and address a decline in American life expectancy.
“At a national level, this is the first time life expectancy for Americans is not rising,” said Dr. Lawrence Sinoway, principal investigator of the institute. “In particular, there is a disturbing increase in death rates for 45- to 64-year-olds. Research suggests that this trend differs from that of other developed countries where life expectancy continues to rise. It appears that the leading edge of this problem is in small towns.”
Research suggests that disease development is related to social and economic conditions. For example, Pennsylvania has seen the peak and decline of several industries, including coal and steel.
“We want to learn more about how these diseases like depression and substance abuse develop because of these social and economic conditions and how they affect the communities that surround us,” Sinoway said. “We want to understand what diseases are part of this constellation and if we can predict who will develop these diseases and, most importantly, if we can treat and prevent these diseases. Penn State is positioned to work with our neighboring communities and health systems to have a positive effect on these challenges.”
The Clinical and Translational Science Institute’s mission is to promote collaborations between scientists and doctors and provide the necessary tools and resources to help research reach the people who need it more quickly. It is funded through the National Institutes of Health’s Clinical and Translational Science Award. Penn State is unique compared to its peer institutions because of its predominantly rural locations. Penn State also is a member of the Appalachian Translational Research Network, which is a partnership of universities committed to addressing the health challenges in Appalachia.
“This problem is particularly troubling in poorer rural areas, such as Appalachia,“ said Daniel George, associate professor of humanities and public health sciences, and a co-investigator on the project. “These communities have suffered, for example, from decades of loss of industry, loss of social safety nets, reduced union membership, stagnant wages, reduced access to higher education, and the infiltration of opioid drugs.”
The institute will share what it learns with other members of the Clinical and Translational Science Award network and within the Appalachian Translational Research Network so that similar communities around the country can build on its successes.
The grant will be used to launch a pilot program to learn what communities are affected by what challenges, and then partner with these communities to find effective solutions. This program will include several stages.
First, the institute will determine what information is available to best identify what health problems are affecting communities in Pennsylvania. This will include using electronic health record data that is combined with census data provided by the Penn State Patient-Centered Outcomes Research Institute; information on reported depression, suicide, substance use, bullying and trauma in the student population collected by the Penn State Evidence-based Prevention and Intervention Support Center; and results from the Penn State Health Community Health Needs Assessment.
“Penn State has several initiatives already underway to identify issues that affect our communities,” Sinoway said. “This project will pull these resources together to see a larger picture by taking into consideration a variety of factors that can negatively affect health, including the social and economic factors.”
Second, George will work with health care professionals in the identified areas to explore what contributors to poor health might be missed in clinics and why; how clinics can adapt to this emerging health crisis; and what opportunities exist for better training. He plans to incorporate medical students from Penn State College of Medicine in this research effort. Educational materials will be developed to share with health clinics and course materials will be created for medical school curriculum.
Dr. Jennifer Kraschnewski, associate professor medicine and public health sciences, and a co-investigator on the project, will concentrate on identifying local partnerships both within and outside the health system that can address the underlying issues that can lead to poor health.
“As a rural Clinical and Translational Science Institute, our regions have been particularly impacted by these diseases,” Kraschnewski said. “This grant will provide us with richer, contextual information about the root causes of these diseases. This is a critical step toward determining how to work toward reversing the shortening lifespan these issues have caused.”
Third, Kraschnewski also will identify influential members of the community who can be trained to help address issues related to poor health through conversations within their social networks. This approach, called the Popular Opinion Leader model, was developed through an effort to address risk factors of HIV infection and is supported by the Centers for Disease Control and Prevention.
“We are extremely pleased that our Clinical and Translational Science Institute has received this award focusing on social and behavioral health issues that are prevalent in our area,“ said Dr. Leslie Parent, vice dean for research and graduate studies in the Penn State College of Medicine. “As the major academic health center in central Pennsylvania, using our research and medical expertise to positively impact our community is a key priority. Enhancing our community partnerships is imperative to helping improve health and wellness throughout the region. We look forward to forging stronger ties with community organizations and combining all our efforts toward the shared goal of a healthier future.”