Lisa Wehr's Public Health Blog

Lisa is originally from Sigourney, Iowa. She attended Iowa State University and received her bachelor’s degree in Music in 2010. She is currently a first year Master’s of Public Health (MPH) student in community and behavioral health (CBH). Lisa works on the medicine-psychiatry unit at the University of Iowa Hospitals and Clinics (UIHC). Through this blog Lisa hopes to let people learn about the CBH department.

This student blog is unedited and does not necessarily reflect the views of the College of Public Health or the University of Iowa.

31 January 2011


So, what are classes in community and behavioral health actually like?

Just a quick bit on where I academically come from. My undergraduate major was pre-med/music. I had a healthy mix of technical and non-technical classes. Some people define technical classes as only those that include problems (e.g. chemistry, physics), but I think classes such as biology and music theory fit into that as well. In those classes there is a lot of technical information that has to be learned even though there aren't "problems." This is in contrast with subjects such as women's studies where knowledge is tested primarily through papers and essay questions.

I think that most undergraduate courses fit into the technical category. And there is a good explanation for that: undergrad is about learning the basics of a subject, the rules and theories and building blocks that support the practice of the field. Psychology majors learn about abnormal psychology, developmental stages, and learning theory, but they don't typically connect all those to help a client or design a new research study. Music majors do a mix. We learn music theory, intervals, history, and composition structure, but we are also expected to put all of that into use as we learn and perform music. And we are graded by our teachers by how well we have applied our technical knowledge.

So far, graduate school in community and behavioral health leans strongly toward the non-technical side. There is some technical learning that has to be done: ten essential services, three core functions, health behavior theories, organization of health care in the U.S., biostatistics. But the technical learning is typically only part of the class, intended to give us a platform to launch into more detailed work. This is shown best by how grades are determined.

Last semester I took Intro to Public Health Practice (All the classes have ridiculously long names, so I use acronyms such as IPHP) and Intro to Healthcare Organization and Policy (I used the acronym HCOP for all my files here). IPHP had no tests, instead we did a series of related papers. We were assigned a public health topic (mine was maternal and child health) and chose a goal within that topic (adequate prenatal care). The first paper was an assessment of the problem, the second paper was a review of the services/interventions used, and the third paper put it all together and made suggestions for future programs.

Healthcare Organization and Policy was a little different where we learned about various aspects of healthcare and wrote essays about it. We also had a final exam and for one of the essay topics we had to give a group presentation from the perspective of either a patient/provider/payer/employer. Examples:
  • Describe at least two benefits of and at least two challenges to the widespread implementation of the Patient-Centered Medical Home model of care delivery in the U.S.,
  • In an ideal world, the financing and insuring of health care in the U.S. would look like this: [insert your position with rationale here] Please be sure to include a discussion of the appropriate role of the individual in financing his/her own health care.
 This semester I am in biostatistics. That is definitely a technical class.

Health Behavior and Health Education (HBHE) has two exams, but the biggest part of our grade is a large paper due at the end of the semester.

  • In the paper you should identify a health-related behavior, review the interventions and theoretical frameworks that have been used to address the behavior and suggest interventions relevant to current practice. (12-15 pages)

Health Promotion and Disease Prevention (HPDP--believe me about the long names yet??) is similar, with no exams and a series of related papers.

  • Ecological Framework: Identify your health topic and a population of interest. Discuss determinants of the disease at each level of the ecological framework. Based on the determinants you identify, talk about the strengths and limitations of what level you might intervene. 
  • Review of the behavior change literature: What kinds of behavioral intervention approaches have been used to address this problem and how successful have they been? What theoretical frameworks were used to drive these interventions? What are the strengths and limitations of these past interventions? Given your understanding of the problem and what you have learned from the behavior change literature, briefly describe a novel approach or combination of approaches to the problem that you believe might be successful. How is your program guided by a theory or theories discussed in class. What are the programs goals and objectives? What program activities will help meet these goals and objectives?
  • Evaluation & Ethics: Describe both process and evaluation plans for your proposed program. Discuss evaluation research questions, data collection methods and design. Include a discussion of any possible limitations of your evaluation approach. Discuss any ethical challenges to your proposed programmatic approach. Describe strategies for overcoming ethical issues.

These three papers are summarized with a poster presentation and oral summary.

Basically with both classes this semester my end product will be equivalent to something that would appear in a peer-reviewed journal.

I find all  of this refreshing and exciting! Choosing a topic I am interested in, researching it, seeing what's been done, what works, what doesn't work. I am doing actual public health work, but I still have the guidance of my professors and the framework provided by the progression of papers. And I continue to add knowledge. I can see my papers improving as I learn more about theories, interventions, and practical considerations (budgets, resources, etc).

I spent much of undergrad preparing for meaningful work like this. (Music was a little different since I started actual performances and auditions while I was still an undergrad). And it's a great step forward, toward the "real" world.

Sorry for the long post...hope it isn't too confusing, and maybe even a little helpful? And now I'm off to do some prep work on a paper ;)

28 January 2011

The Weight Conundrum

I'll start with the thorny issue: is obesity always as bad as we make it out to be? Are there some people who are considered medically "obese," but who are still healthy and fit?

Let's start with simply looking at how to define overweight/obesity. The most common metric for determining weight status is the BMI (Body Mass Index). By using a person's weight and height the BMI attempts to be a proxy for determining body fat percentage (accurate body-fat tests are expensive and complicated). The BMI was originally developed to determine the "fatness" of a population, but because of its simplicity, has been repurposed to compare individuals*. Overweight is defined as having a BMI of 25-30 and obesity is having a BMI greater than 30. Those with a BMI greater than 40 are typically referred to as morbidly obese. Other metrics include determining a person's ideal body weight and assessing how much above/below that they are or measuring actual body fat.

The "fat & fit" side of the argument points out that the BMI fails to consider a person's unique build and the density of lean body tissue. Elite distance runners have BMIs around the 18-20 end of the spectrum while  football players commonly run greater than 25, putting them in the overweight category. Does this mean they are less healthy? [and I can't type BMI this many times without pausing to calculate my own: it's 18.5]

Some studies, such as one done by epidemiologist Edward Gregg say that fitness is what matters.

"What was unexpected was those who tried to lose weight -- but didn't -- those people had a mortality benefit," Gregg tells WebMD. "And our best speculation as to the reason is there are behaviors that go along with weight loss attempts that are good for you. These may have positive effects regardless of whether a person is able to maintain weight loss. They adopt more active lifestyles, they change diets. Over the long haul they are not successful at losing weight, but these lifestyle changes seem to help." [source]

Other studies contend that regardless of fitness status, death risks are increased in overweight people. [like this one]
Body fatness is a better predictor of CVD risk factor profile than aerobic fitness in healthy men. Although habitual physical activity is an effective strategy for preventing CVD, elevated body fatness is associated with an adverse CVD risk factor profile independently of aerobic fitness.

And there are studies that are on the fence about it all, such as this one:
 In recent years, the "fitness vs fatness" issue has led to controversy and heated debate. Although the debate may never be fully resolved, the relative contribution of fitness and obesity to overall health and risk actually may be a trivial matter because a common treatment is already available for both low fitness and excess body weight. Increasing regular physical activity results in predictable increases in fitness, and it is widely accepted that regular physical activity is a core component of successful weight loss programs and, more importantly, of long-term weight loss maintenance. In essence, physical activity is the common denominator for the clinical treatment of low fitness and excess weight, making the "fitness vs fatness" debate largely academic.

Weight is a convenient mode for communicating health risks to people. Everyone has a weight, it's a simple number, no variables. Physical activity and diet are messier; there are different intensities, different lengths, different caloric needs, and no easy way to count any of it. But by taking the focus off weight would people be more likely engage is exercise? Do some people fail at weight loss and thus permit themselves to also forgo a healthy diet and exercise? If diet (I use this term to define a lifetime of eating, not a short-term fix**) and exercise were the goal and not just the means would they have more staying power?

Thoughts, thoughts, and none of it will be solved with this post. In fact, hopefully, I just opened a can of worms in your mind about weight....


*A soapbox issue of mine.
**Yet another issue I get rather involved in...

26 January 2011

Real Food: Pumpkin

I enjoy trying make foods myself that I would typically buy in a store. I think fresh food is best for me and locally grown food (which is also typically fresh) is the best for me and the environment. I also know that I can make things with a lot less sugar, salt and preservatives and a lot more flavor.  I compare the taste, cost, and effort involved and decide if it's "worth" it to me at this time. One of my experiments this fall was with pumpkin puree.

I saw the pumpkins at Hy-Vee and couldn't resist. (my counter is a mess, don't look).
After 10 minutes of hacking away I had only managed to get this far. I decided that if I were to do this again a different knife would be in order.
I then scraped out the insides (and separated the seeds so I could roast them....yum!)

I put the two halves in a baking dish with a bit of water in the bottom. It was baked at 350 F for about 60 min, when the skin was soft enough to be punctured with a fork (hence the fork in the picture).

I scooped out the insides and put them in my trusty blender.

For size reference, this is a quart jar.

It was much better than canned pumpkin. I'm not a huge fan of pumpkin pie so I can't vouch for it there, but I made a lot of really tasty smoothies.

Was it worth it? At this point in my life, probably not.
The pumpkin cost me $2, so it was a little more expensive than buying pumpkin. In terms of health, fresh pumpkin probably has a few more vitamins/antioxidants. But canned pumpkin has very little salt and preservatives so there's not much gain there (I get more rewards for my time by cooking my own black beans). But I enjoyed the flavor so much that if I had a garden where I grew my own pumpkins, I would definitely do it.

Any suggestions as to what else I should try making?

24 January 2011

Old? Hardly.

So this weekend, (instead of you know, reading or studying). I wrote a whole bunch of blog posts! I don't want you all to be overwhelmed and binge on my awesomeness, so I'm keeping them in the background and releasing them one at a time. I have posts set for the next couple weeks and I always have more ideas that I will continue to draft. But having this head start makes me really really happy. It should make you happy too because it means that I will be posting more regularly (you should also be happy that this means most of my posts receive a second round of editing ;)

Read up!

Starting off, thoughts on an article in the NY Times (my favorite newspaper in case you hadn't noticed).

This lady is a rock star. At 91-years-old she continues to compete in "masters" track events. And not just compete, she blows away the competition. Master's track competition begins at the age of 35 and performances are compared using age-graded tables that turn times/distances into percentiles when compared to other athletes in the same age group. Olga's percentiles run at 100% (or more, since the tables are new because of how few athletes in her age group compete). She often beats athletes who are in age-groups one or two classes below her own.

Many scientific disciplines are studying her to determine why she performs better than her peers. There may be some inherent genetic/physiological factors specific to her, and that is being looked into. What interests me, however, is the theory that intense exercise makes a bigger difference on the aging process than the moderate exercise that is generally recommended for the elderly. The reason for this recommendation is to prevent injuries (which are more likely as people age). But if one can find a balance between training hard enough to see the most gain and moderately enough to avoid injury, they can reap the most benefit.

So should we start encouraging older people to exercise more intensely? Are we recommending a sub-optimal level? Or are we being responsible and not encouraging people to test limits (and thus risk injury)?

20 January 2011

Recent Discoveries

Over break I did a lot of web surfing. I came upon some interesting and useful sites, and I want to share them with you!

Study Hacks: Written by Cal Newport, a postdoc at MIT (he started the site when he was still working on his PhD).
Study Hacks is built around the concept that success and stress do not have to go together. He gives great advice for everyone, from high school to graduate school and beyond. There are hundreds of posts in the archives and he has also published three books on the subject. I haven't read the books, but they're on my list.

This is like a database of.....well, everything. My brilliant younger brother introduced it to me. Want to know about benzene, calculate the interest on a loan, compute a pediatric trachial tube size? This is the site for you.

Free Tax Filing: TurboTax, CompleteTax, H&R Block
These sites aren't really new to me, but they are particularly useful this time of year. The first time I had to file taxes I picked up the paper version and was terrified. Take this number from line 10C subtract it from line 27A, add line 437Z, and divide by line 9432AA. Never fear, these programs tell you exactly which forms you need to have, break it down into simple steps, and suggest deductions. And you can file your federal taxes for free if you make less than $58,000 (which most of us students do). If you want to pay a little more, it will also file state returns and allow returns with itemized deductions.

Research Subjects
Are you in Iowa City and looking to make a few extra bucks? Are you willing to let researchers poke and prod you and do some tests? (This past fall I made $500 for just a few hours of my time)

This might be the point where "useful" ends...

QR Code Generator
I'm not sure what I would ever use this for, but it's still pretty neat. It makes 2D barcodes the can be read by smartphones.

Personality Tests
Just in case you don't know who you are yet...

A network that helps you find a "couch" to sleep on wherever you are traveling in the world.

Digital Photography Tips
I do a lot of photography, so I do find this to be rather interesting.

On an unrelated note....some of my music professors from Iowa State (the Ames Piano Quartet) played today at the University Hospital. It was good to see/hear them again.

18 January 2011

Spring Semester

It's time for another round of school! This semester I'm taking 9 credits and continuing to work 60% (I started last semester while working 90%, so I stuck with only 6 credits).

My classes:

  • Health Behavior and Health Education
  • Health Promotion and Disease Prevention
  • Biostatistics
Once again I only have classes on Tuesday, Wednesday, and Thursday. Definitely something I can get used to. But it's not as if my life is completely free: I work [8 hour shifts] every other weekend as well as two weekdays.

With classes in the hospital/med buildings and working at the hospital, I spend a large majority of my life there. Not that it's a bad place to spend most of my time. The Field House is incredibly close, so if I have a break I can go there. Hardin Library is a few yards outside. The hospital has cafeterias, coffee shops, a massage place, computer labs, free wireless internet, a travel agency, and even a hair salon...I could probably get away with never leaving.

If you haven't checked out some of the other pages I recently updated the about me with some pictures and the page for prospective students with a couple links and a pdf of my plan of study.

Have a great start to your semester!

15 January 2011

Food and Health

As promised (many moons ago) my views on food, weight, and health.

It is very hard today to escape the constant discussions on the "obesity epidemic" and how it affects the individuals and public health. The Mayo Clinic lists the following consequences of obesity: depression, heart disease, high blood pressure, lipid abnormalities, increased cancer risk, gallbladder disease, gynecological problems, metabolic syndrome, fatty liver disease, osteoarthritis, skin problems, sleep apnea, type 2 diabetes, stroke. It's no wonder so many in the health care field are concerned about obesity. From patients concerned about declining quality of life to payers wondering how to cover rapidly rising costs, everyone has stakes in the game.

But is obesity (which leads to discussion of weight) the only issue here? And is targeting weight the best way to combat the problem? I don't believe so. Where has battling weight gotten us? Obesity has risen and overall health has declined because we are fighting the symptom of the problem, not the cause. As a society, we have forgotten how to feed ourselves. We have forgotten how to listen to our body's signals and to satisfy its needs with real, wholesome food.

I grew up on a farm. My family ate supper together every night and lunches together whenever we kids weren't in school. All our meat came from our own livestock, milk was from the bulk tank, eggs/chickens were raised on our farm or by friends. During the summer, meal preparations included going out to the garden to pick fresh lettuce, cucumbers, onions, and tomatoes. My younger brother and I had fun times picking green beans and strawberries for hours every couple days. We canned and froze tomatoes, tomato juice, pickles, sweet corn, apples, applesauce, and apricots. We traipsed through timber to pick fresh blackberries and mulberries at their peak of ripeness.

It took me a long time to discover my "nutritional philosophy." How do I think people should eat? What am I comfortable eating? When I read In Defense of Food by Michael Pollan I immediately knew that I had hit upon the philosophy that I wanted to guide my eating: Eat food; mostly plants; not too much. The last two of those rules are pretty clear, plant based foods and all food in moderation. But what does eat food mean? Pollan describes food as "something your grandmother would recognize." (Although I would argue that my generation might want to go back to great-grandparents). He creates a continuum from food to food-like substances. Somewhere in the transformation from corn to creamed corn to cornbread to cornflakes to cheetos to high fructose corn syrup we lost the actual food and created something that was edible, but far from the way nature intended it. I highly suggest Michael Pollan's latest book Food Rules, a quick read of simple, memorable, one-sentence rules that can guide your food decisions for life.

Honestly, this is just the beginning of the issue. I could easily go on for days. I find nutrition fascinating and incredibly important for a healthy life. In future posts I plan to cover the importance of weight, disordered eating, and cooking. And if there is anything else on this subject that you would like me to cover please let me know.

11 January 2011


I have been absent from here for most of the winter break. I had intended to post some, but life got busier than I expected. Other than weekends and holidays I choose which days I work at the hospital (as long as I get my hours in for the week), so over break I built my schedule such that I worked 4-5 days around my weekend/holidays and then I had 5-6 days off. Having that amount of time off gave me the flexibility to go visit people. I didn't have to worry about weather too much because I had enough time to leave a day earlier or later than planned to avoid it. So that's what I've been doing. My boyfriend is still in Ames, many of my other friends are in Des Moines, some of my friends were back home in Sigourney. I caught them all....several times. It was good to catch up with people and actually relax and spend time with them rather than having to rush back home for work/school.
I played lots of scrabble and wii and apples to apples and bananagrams
watched more movies than I did all semester, played in the snow with my dog, threw too many tennis balls to count
built a shelf
celebrated a friend's graduation and impending move to the exciting city of Seattle for a "real" job
I had a great few weeks, but it still feels good to be back....and throwing more tennis balls (even as I type this). I'm excited to write more and I hope that you're just as excited to read it!
a thick winter fog that turned into a stunning frost