Center for Rural Health Page 1

Note from the

Center Director Greetings and Happy New

Year from the director and

staff of the Center for Rural

Health Practice. The end of

calendar year 2011 marked

the beginning of 2012 for the

Center. Despite a 50 percent cut on our state

funding for fiscal year 2012, the Center was still

able to carry on with its research and service

obligations to northwestern Pennsylvanians

through grants, support from the

administration of Pitt-Bradford, and frugal

management of the limited resources. We

extend special thanks to the following

individuals, who have remained steadfast in

collaborating with the Center on funded

projects thus enabled the flow of scarce grant

funds for our research and other projects. Our

current and special partners include:

1) Duncan Clark, MD, Ph.D., University of

Pittsburgh Medical Center, Western Psychiatric

Institute

2) Jeanette South-Paul, MD, Chair, Department

of Family Medicine, University of Pittsburgh

3) Maggie Potter, JD, Director, Center for

Public Health Practice, University of Pittsburgh’s

Graduate School of Public Health,

4) Jill Owens, MD, Bradford Family Medicine

We are making significant progress in achieving

the goals of our currently funded projects,

which include the Northwest Pennsylvania

Adolescent Alcohol Research (NPAARC) Project,

the Pennsylvania Public Health Training Center

(PA-PHTC) project, the pre-doctoral (Pre-Doc), a

federally funded project that enables medical

students from the University of Pittsburgh

School of Medicine to complete a Family

Medicine clerkship and Research project in rural

northwestern Pennsylvania.

Our federally funded Pennsylvania Public Health

Training Center (PA-PHTC) will have a new focus

in 2012. Its goal is to improve the performance

and efficiency of the public health system by

enhancing competencies of the public health

workforce. Cont. on pg. 2.

Program Addresses Physician

Shortage in Rural NW Pennsylvania

Three more students from the University of Pittsburgh School of Medicine have each completed four weeks of family medicine clerkship. Facts: About 9% of the nation's physicians practice in

rural communities

Rural Health Educator, Vol. C; Number 1, Spring 2012

Promoting Health, Preventing Disease and Improving Lives

Inside this Issue Note from our CRHP Director 1-2

Addressing Rural Physicians’ Shortage 1-2

Cervical Cancer Awareness 3

CRHP’s Program Updates 4

CRHP’s Partners Updates 7

Rural PA Health Challenges 9

Dr. Siewe

Stephen Pichler

From left: Dr. Siewe, Dr. Kavitha Bhat-Schelbert, Dr.

Anita Herbert, Dr. Jill Owens, Emily Wheeler, Dr. Robin

Maier, and Brenda Brandon.

Center for Rural Health Practice Page 2

About 3.4 million of the state’s 12.6 million residents lived in Pennsylvania’s 48 rural counties in 2009

9.2 million, or 73 percent of Pennsylvania’s population lived in the state’s 19 urban counties in 2009 (US Census Bureau). Students with rural origins and exposures are more likely to train in primary care and return to rural areas,

Residents trained in rural areas are more likely to choose to practice in rural areas,

Residents practice close to where they train.

In response to the above, faculty from the Department of Family Medicine at the University of Pittsburgh School of Medicine, the UPB Center for Rural Health Practice (CRHP) and McKean County physicians have been working on a program to address the chronic shortage of primary care physicians in rural areas. The program is funded by Health Services Resources and Administration (HRSA) a division of the Health and Human Services. Three more students from the University of Pittsburgh School of Medicine just completed four weeks of family medicine clerkship with a focus on rural medicine through the Center. Jill Owens, MD of the Bradford Family Medicine, served as the preceptor of these students, while Dr. Siewe has been teaching the “Rural Health and Medicine” class to students on the mains campus in Pittsburgh and other remote sites using WebEx—an integrated video and audio online program.

Note from the Center Director Cont.

from pg. 1; Upcoming presentations and

workshops to be delivered to our Northwestern

Pennsylvania residents through the PA-PHTC

grant include: awareness and prevention of

heart disease; stroke and related risk factors;

diabetes and related pathophysiology, basic

epidemiology in public health practice and Rural

Health Leadership. Dr. Siewe will deliver these

presentations. Another presentation on grant-

writing will be done by staff from the University

of Pittsburgh’s Graduate School of Public

Health. Claudia Caminite and Lisa Chapman will

serve as PA-PHTC project support coordinator

and public health staff assistant, respectively.

Please call the Center at (814) 362-5050 or

check our website at for more information on

these presentations and previous newsletters.

Our Walk-Works program, aimed at decreasing

the burden of chronic disease, ended on

February 3, 2012. Community involvement in

this program has been overwhelming, and

significant steps have been taken to ensure its

sustainability after grant funding ends. The “Get

Active” community-based funded project, also

aimed at decreasing the burden of chronic

disease through participating in physical

activity, ended in June 2011.

Departures: Brenda Brandon, who served as

the administrative assistant for the Center,

resigned to accept another position on the

campus. Sherie Wallace resigned as the

coordinator for the PA-PHTC project to join her

family in Virginia. We wish Brenda and Sherie

well in their endeavors.

Arrival: Shelley Whitman

joined the Center in

September as interim

administrative assistant. We

appreciate the experience and

skills she brings in this role.

Physician’s Shortage in Rural NW

Pennsylvania ,cont. from page 1.

Medical Students who just completed four

weeks of clinical rotation through the Center for

Rural Health Practice were Stephen Pichler:

fourth-year student from Butler, Pa. Stephen

spent the month of October with us. “Dr.

Owens was great to work with. I enjoyed

splitting time between out-patient clinic and

the hospital.”

S. Whitman

Center for Rural Health Practice Page 3

Luke Johnson, a third-year medical student

from Utah. Luke was here in November and

said, “I got to see what different providers did

in rural settings, especially the impact they can

make.” Luke is interested in dermatology as a

future specialization. He took some time to

travel with his wife to Niagara Falls and see

some of our beautiful countryside.

Alex Moore, a third-year student from Norfolk,

VA spent the month of January with us for the

rotation. In his spare time, Alex hiked the trails

near the Marilla Reservoir and the Kinzua State

Park. Alex is interested in surgery as a future

specialization, but found the Family Medicine

clerkship valuable. “In our academic setting in

Pittsburgh, the medical student is last in a long

line to see a patient. The experience here gave

me many more opportunities to see and learn

about rural issues and medicine.”

Cervical Cancer Awareness: Warning

Signs to Know, by Dr. Youmasu J. Siewe

The Center joined the National Cancer Institute in recognizing January as National Cervical Cancer Awareness Month. Cervical cancer is the second most common cancer in women

worldwide, but it doesn’t receive as much attention as it should. The National Cancer Institute estimated that more than 12,710 women were diagnosed with cervical cancer in 2011 in the United States, US, and more than 4,290 women died of the disease in the same year, although cervical cancer is highly preventable. According to the Pennsylvania Department of Health (PDOH) cancer registry, an estimated 585 cases of cervical cancer were diagnosed in 2010, and 170 deaths resulted from the disease. What is cervical cancer? It is cancer that affects the tissues of the cervix—an organ that separates the upper end of the vagina from the lower end of the uterus or womb. What causes cervical cancer? It is caused by persistent infections with certain types of the human papillomavirus (HPV). Human papillomavirus is a very common sexually transmitted infection contracted by three out of four adults at some time in their lives. Most of these infections go away on their own without treatment. Infections that don’t go away on their own can lead to cervical cancer. How do you know if you have cervical cancer? The usual signs and symptoms of cervical cancer include vaginal bleeding after intercourse, watery bloody discharge that may be heavy and have a foul odor, pelvic pain or pain during intercourse. Cervical cancer can be detected through a Pap test. If the results reveal abnormal cervical cells, it’s important to follow your healthcare professional’s recommendations for more testing. Who is likely to get cervical cancer? About half of all females diagnosed with cervical cancer are between 35 and 55 years old. What many of these women may not realize is that they were

Rural/Urban Medical Practice Quote:

“Urban doctors take care of patients. Rural

patients take care of their doctors. Urban

patients know their doctors. Rural doctors know

their patients. Urban physicians are more likely

to be fired, whereas rural physicians usually

quit, move, or retire. It's a life choice in rural

health, not just an occupation.” Robert

Bowman, M.D.

Center for Rural Health Practice Page 4

most likely exposed to one of the high-risk types of HPV during their teens and 20s. How can cervical cancer be prevented? Methods commonly used to treat abnormal cervical cells include freezing and removing them with an electrical instrument and conventional surgery. The treatment may have to be repeated if the abnormal cells reappear. How can cervical cancer be prevented? For women 21 and older, getting the Pap test detects abnormal cells that may lead to cervical cancer is an important preventive approach. Clinical studies suggest that prevention methods for cervical cancer for women 30 or older include screening with both a Pap test and an HPV test. This combination offers the best protection against cervical. HPV vaccines have also been shown to be highly effective in preventing infection with the two most common types of HPV that cause approximately 70 percent of all cervical cancers. This vaccine doesn’t protect against all the HPV types that can cause cervical cancer, so it’s still important to be screened by your health care provider even after receiving the vaccine. How can one get more information about cervical cancer? Contact your primary health care provider, the American Cancer Institute at www.cancer.gov, or the American Cancer Society at www.cancer.org. If you have a question or comment about this article, call Dr. Siewe at 814-362-5050.

CRHP Program Update:

NPAARC By Nickole Egger,

Program Coordinator

Background

The Northwest Pennsylvania Adolescent Alcohol Research Cooperative (NPAARC) is a federally funded grant established to address the issue of adolescent alcohol use. Funded by the National Institutes of Health (NIH), specifically the National Institute on Alcohol Abuse and Alcoholism (NIAAA), NPAARC develops the research capacity of primary health care systems in rural northwestern Pennsylvania for conducting research addressing underage drinking. NPAARC has been building the cooperative’s research infrastructure through various projects:

1. A survey of area primary care providers (PCPs) on their alcohol-related practices and attitudes on underage drinking.

2. Focus groups of PCPs, adolescents, and parents further exploring adolescent alcohol use in area communities and factors affecting the use of screening and intervention tools in rural primary care practice.

3. The development and implementation of our Computer Assisted Decision Support for Underage Drinkers (CADSUD) in PCP offices, and evaluation of the influence of this decision support system on PCP assessment and referral practices and adolescent adherence to PCP recommendations over a one-month, two-month and one-year follow-up period.

4. Twelve months of CADSUD

maintenance support and utilization monitoring to determine the sustainability of the approach.

Highlights NPAARC has successfully implemented this research project in five primary care practices and are currently working on incorporating at least five more. With each practice completion and the accumulation of data, NPAARC gains more knowledge on alcohol use within its research region and will be able to compare

Nickole Egger

Center for Rural Health Practice Page 5

such data to urban populations as well as nationally. The percentage of teenagers who drink is slowly declining, and research suggests that comparing adolescents’ alcohol use to those of their peers is the best method to reduce their consumption. Naturally, those adolescents who drink verbalize their belief that more adolescents are drinking than is really occurring. Providing adolescents with statistics on how many adolescents their own age do not consume alcohol appears to be a very effective brief intervention. Another important factor in reducing adolescent alcohol use is parenting. The Underage Drinking Research Initiative through NIAAA emphasizes that parents can play an important role in helping their children develop healthy attitudes toward drinking while minimizing its risks. Parenting styles may influence whether their children follow their advice regarding alcohol use. People are unique, but parenting styles can generally be categorized as:

1. Authoritarian – Exert high control and discipline with low warmth and responsiveness.

2. Permissive – Exert low control and discipline with high warmth and responsiveness.

3. Neglectful – Exert low control and discipline as well as low warmth and responsiveness.

4. Authoritative – Exert high control and discipline along with high warmth and responsiveness.

Regardless of the developmental outcome examined – body image, academic success, or substance abuse – children raised by authoritative parents tend to fare better than their peers (Jackson, 2002). Children raised by such parents learn approaches to problem solving and emotional expression that help protect against the psychological dysfunction that often precedes alcohol misuse (Patock-Peckham and Morgan-Lopez, 2007).

Studies (U.S. Department of Health and Human Services, 2007) have shown that it is important to:

1. Talk early and often, in developmentally appropriate ways, about your concerns and theirs regarding alcohol.

2. Establish policies early on and be consistent in setting expectations and enforcing rules. The majority of adolescents – around 80 percent – feel that parents should have a say in whether they drink alcohol (Jackson, 2002).

3. Work with other parents to monitor where kids are gathering and what they are doing.

4. Work in and with the community to promote dialogue about underage drinking and the creation and implementation of action steps to address it.

5. Be aware of your state’s laws about providing alcohol to your own children.

6. Never provide alcohol to someone else’s child.

Parents can influence their children’s decisions well into adolescence and beyond, despite their natural resistance in adolescence. This is especially important in young people’s decisions regarding whether and how to drink – decisions that can have lifelong consequences.

NPAARC will continue to work with primary care providers to establish effective screening, brief intervention, and potential referrals to treatment. The NIAAA encourages everyone to become involved, especially primary care providers, parents, adolescents, and their peers.

References: Jackson, C. Perceived legitimacy of parental authority and tobacco and alcohol use during early adolescent. Journal of Adolescent Health 31 (5): 425-432, 2002.

Center for Rural Health Practice Page 6

NIAAA, Underage Drinking Research Initiative. Parenting to Prevent Childhood Alcohol Use. NIH Publication No. 10-7467, October 2010. Patock-Peckham, J.A., and Morgan-Lopez, A.A. College drinking behaviors: Mediational links between parenting styles, parental bonds, depression, and alcohol problems. Psychology of Addictive Behavior 21(3): 297-306, 2007. U.S. Department of Health and Human Services. The Sergeon General’s Call to Action to Prevent and Reduce Underage Drinking: A Guide to Action for Families. Washing, DC: U.S. Department of Health and Human Services. Office of the Surgeon General, 2007.

Pre-Doctoral

Program

By Lisa Chapman,

Program

Coordinator

Bradford has welcomed four medical students

from the medical school at the University of

Pittsburgh. Each student has completed a four-

week clerkship in family practice with a

concentration in rural medicine. Under the

guidance of Dr. Jill Owen and her group, these

students have had an opportunity to witness

and participate in the health care of patients in

the office as well as the in-patient setting at the

Bradford Regional Medical Center. The

students have reported being particularly

pleased to have abundant hands on time with

patients and report a very rewarding learning

relationship with their preceptor. Three more

students will round out the academic year.

In addition, the University of Pittsburgh Medical

School will again offer a workshop for all

physicians involved in precepting these

students or others, or who have an interest in

doing so in the future. On Thursday, March 1,

from 5:30-7:30 p.m. a workshop addressing the

problem student and the problem mentor will

be hosted by medical school staff, faculty and

students at the Bradford Regional Medical

Center. If interested please call project

coordinator Lisa Chapman at 362-7959 or by

email lchapman@pitt.edu.

We are currently planning for our research

program to be initiated this summer. We hope

to assist a first-year medical student in a project

exploring some topic in rural medicine for eight

weeks in the summer. Once a topic is outlined,

the student will be mentored by medical school

faculty and aided by local physicians and the

resources here at the Center for Rural Health

Practice. Looking at medical issues unique to

the rural population affords the medical student

an opportunity to design a research project that

may benefit the community as well as enhance

his/her own learning.

Walk Works/Get Active

By Claudia Caminite,

Program Coordinator

WalkWorks is going

strong in McKean County

Even though the grant period for WalkWorks

ended Feb.3, the program continues to do well

in the four participating communities of

Bradford, Smethport, Port Allegany and Kane.

Over last year’s summer months individuals

logged their times and walked competitively for

a total of 4,035 hours. Hamlin Bank in

Smethport was awarded a plaque for

outstanding participation in the program. Bank

President and CEO Marty Diegel was very

supportive of WalkWorks and let his employees

Claudia Caminite

Lisa Chapman

Center for Rural Health Practice Page 7

walk inside the bank during very hot or rainy

days throughout the year.

With more than 50 participants remaining since

WalkWorks kick-off event in spring of 2011, we

have at least one walking group per community

remaining; Smethport still has four active

walking groups. With support from local

boroughs, designated trails were marked with

signs and stencils and are still being used by

walkers today. However with the increasingly

inclement weather, groups are moving their

weekly walks to local high schools.

A successful Ovarian Cancer Awareness Walk

was held in September, and more than 90

walkers participated and raised money for the

cause. During the course of the grant we have

collaborated with many institutions,

organizations, businesses and individuals. Plans

are in place to have our WalkWorks trails be

included in an application for smartphones,

Smethport Elementary School applied for a

Walkability Audit and a Facebook page is in

development, thus ensuring the continuation of

the program beyond the duration of the grant.

We are very proud of the many outstanding

group leaders and walkers for their support of

our program. Feedback for WalkWorks has

been overwhelmingly positive in our

participating communities giving evidence that

walking really works!

Quote: “A vigorous five-mile walk will do more good for an unhappy but otherwise healthy adult than all the medicine and psychological counseling in the world.”

Paul Dudley White

Sign Displaying WalkWorks Trail in Smethport, PA

WalkWorks logo in Kane, PA

Caner Quote: “Everyone needs to be

proactive and know the various warning

signs of cancer. Early detection and

research to make detection easier at

earlier stages, along with the

treatments needs, is still a must. I

salute all those winning the battle”,

Dennis Franz

Center for Rural Health Practice Page 8

Safety At ARG Submitted by ARG (CHRP Partner)

BRADFORD, Pa. -- American Refining Group

employees achieved an elusive milestone Jan. 9

when they completed one year without a lost-

workday injury.

That is, there were no injuries at the Bradford

refinery that caused an employee to miss a day

of work. The last lost workday at the refinery

occurred Jan. 8, 2011. The Bradford refinery

hasn’t accomplished this milestone since 1991,

according to Steve Sherk, vice president of

environmental health and safety.

It is a difficult achievement for refineries.

According to injury statistics on U.S. refineries

compiled by the National Petroleum Refiners

Association for 2010, out of 115 refineries 74

had at least one lost workday.

“The ARG employees committed themselves to

make it a safer place to work,” Sherk said. “They

prevented lost-workday injuries and reduced

their OSHA recordable injuries. This is a

remarkable accomplishment and one that is

good for the employees, their families, the

community and American Refining Group.”

Influenza and Patient Safety Submitted by Bradford Ecumenical Home, Inc.

(CRHP Partner)

Influenza is a serious contagious disease that

can lead to hospitalization and even death.

Influenza vaccination is an important

precaution for health care workers, and other

people who live with or care for high-risk

individuals to keep from spreading the flu to

these high risk people.

Despite well-documented evidence of the

importance and benefits of influenza

immunization of health care personnel,

seasonal influenza vaccination rates among

Pennsylvania Health Care Workers remain

suboptimal (below 60 percent), which is far

below the Health People 2020 Target of 90

percent. Recognizing that the unacceptably low

rate of seasonal influenza vaccinations among

health care workers is a cause of concern for

patient safety and employee health, the

Pennsylvania Department of Health launched

the Pennsylvania Patient Safety and Employee

Vaccination Initiative. This initiative encouraged

all health care providers to play an active role in

promoting influenza vaccination among its

employees and established a 90 percent

vaccination target.

To begin the campaign, in June and July of 2011,

the Pennsylvania Department of Health in

collaboration with the Hospital and Health

System Association of Pennsylvania, the

Pennsylvania Immunization Coalition, the

Center for Vaccine Ethics and Policy at the

University of Pennsylvania, the Pennsylvania

Patient Safety Authority, and Penn State

Hershey School of Medicine, conducted

regional trainings on employee vaccination and

patient safety. Bradford Ecumenical Home Inc.,

a continuing care retirement community,

participated in these trainings to examine the

best and promising practices for improving

employee vaccination and patient safety. They

also participated in a discussion on how to

overcome institutional and individual barriers to

health care worker vaccination.

By implementing the suggested best practices

and initiating a universal coverage vaccination

program, Bradford Ecumenical Home Inc. was

recently awarded a certificate of excellence

from the Pennsylvania Department of Health

for achieving a 96 percent vaccination rate

amongst its health care workers and was

inducted into the health care worker

vaccination honor roll.

Center for Rural Health Practice Page 9

“I am very proud of our employees for

recognizing and understanding the importance

of influenza vaccination as it pertains to patient

safety and employee health. To be recognized

among our peers for our pursuit of excellence is

an honor,” says Linda Howard, director of

facility and staff development of Bradford

Ecumenical Home Inc.

Learning Values One Lap at a Time Submitted by the YMCA (CRHP Partner)

OLEAN/BRADFORD – The Olean-Bradford Area

YMCA is proud to produce two great swim

teams, the Bradford Family YMCA Barracudas

and the Olean Family YMCA Seahawks. Each

team promotes a supportive and encouraging

environment, designed to develop the

swimmer’s body, mind, and spirit and stresses

the Y character values of caring, honesty,

respect, and responsibility. Boys and girls

between the ages of 5 and 18 have the

opportunity to participate in practices and

meets as a team to meet their individual goals.

In Bradford, the Barracudas are led by Coach

Caren Barnes, who has been with the

Barracudas for seven consecutive seasons. Our

competitive swimming program is part of the

Northwestern PA YMCA Swim League. As a part

of this league, the Barracudas are able to

participate in nine swim meets, five of which

are home meets. After the first meet, the

Barracudas finished with a win and, nine

swimmers qualified for districts. “It is extremely

rewarding to both the swim parents and the

swimmers to see all of their hard work in the

pool pay off,” a swim mom commented after

the Barracuda win.

In Olean, the Seahawks are led by Danita Colley

who has been coaching for nine seasons. The

team is a part of the Western NY YMCA swim

league. As a part of this league, the Seahawks

will be playing host to the 2012 YMCA State

swim meet, which will be held in March. “Being

a host of the state meet gives a great

opportunity for all members of our team to be a

part of a huge event and meet kids from all over

the state who they share an interest with,”

added Brian Perkins, aquatics director at the

Olean Family YMCA.

What makes each team special are the kids.

Many of them have learned to swim at the Y

and have grown into being a part of the team

for many years. Whether a first-year participant

or a longtime swimmer, they are all treated

with the same priority and receive a great

amount of attention from the coaches. It is this

attention that has also helped turn a former

swimmer into a current coach helping with the

team.

Sarah Ruszkowski, a swim team parent said,

“My child may not be the best swimmer on the

team, but she is still a part of everything. Sarah,

like many others, is part of a strong group of

parents who help make both teams a success in

many ways – from timing at meets to running

concessions and, of course, the countless

behind the scenes things that all parents of

athletes do.”

All over the country, The Y has swim teams that

develop children not just as swimmers, but as

individuals that are members of a team and a

community. The teams here in your area are

just another shining example of what the Y can

do for you.

Rural PA Health Challenges

“Rural populations report more negative health

statuses, fewer healthy behaviors, and less

health care use than urban populations. Much

of what is noteworthy is well-known among

Center for Rural Health Practice Page 10

public health professionals, including the high

incidence of obesity and overweight, a growing

incidence of diabetes and hyperglycemia, and

poor nutritional practices. All of these trends

could be addressed through public education,

health provider education, and reimbursement

for services related to education, diagnosis, and

treatment.” Compared to urban

Pennsylvanians, rural residents were more likely

to suffer from heart disease, especially rural

males aged 45 to 64. Rural residents 45 to 65

also have a higher prevalence of obesity and ar-

thritis than urban residents in the same age

group. Certain risk factors remain high among

rural residents, including smoking, binge

drinking and insufficient fruit/vegetable

consumption. Rural women are less likely to

have a mammogram than urban women, and

rural males are less likely to have had dental

checkups than urban males.”

Center for Rural Pennsylvania, 2010 at

Individual health is closely linked to

community health -- the health of the

community in which people live, work, and

play. Likewise, community health is

profoundly affected by the collective

beliefs, attitudes, and behaviors of

everyone who lives in the community. ---

Healthy People

2010:http://www.rural.palegislature.us/

Individual & Community Health

“Individual health is closely

linked to community health --

the health of the community

where people live, work, and

play. Likewise, community

health is profoundly affected by

the collective beliefs, attitudes,

and behaviors of everyone who

lives in the community,”

Healthy People 2010

Quote:

“The First Wealth is Health” - Ralph Waldo Emerson