Making sense of the data

mph-2OHSU-trained biostatisticians convert numbers into knowledge to improve community health

Technically, Nicole Smith, MPH '07, is a biostatistician, but you might say she's also a professional interpreter. "Any day that I get to do stats is a good day, but if I can't draw conclusions and put data into words, what is the point?" she said. "That is my primary role as an MPH-level biostatistician."

MPH-trained biostatisticians are more important now than ever as health care reform shifts the national focus to population health and evidence-based medicine. Data are abundant, but they require highly trained professionals to derive accurate meaning from numbers and turn them into policies and practices that others can act on to improve the health of a community.

"Almost anyone can analyze data, but not everyone can see the bigger picture, ask why, and make utility to the tribes a priority."

- Nicole Smith, MPH ’07

The OHSU School of Medicine's Department of Public Health and Preventive Medicine, which leads Epidemiology and Biostatistics Track for the tri-campus Oregon Master in Public Health (MPH) program, graduates approximately 20 epidemiologists and biostatisticians like Smith every year.

These research professionals are trained to use quantitative methods to analyze and address health problems within a larger cultural context. "My education not only prepared me to work with data, but prepared me to work with communities," Smith said. Community partnerships built on collaboration, trust and respect are key, she said.

This is especially important when working with American Indians and Alaska Natives, and the Department of Health and Preventive Medicine has developed long-standing relationships with Northwest tribes and tribal advocacy groups.

One of those is the Northwest Portland Area Indian Health Board (NPAIHB), a non-profit tribal advisory organization serving 43 federally-recognized tribes of Oregon, Washington and Idaho. Smith works as a biostatistician there on many projects for NPAIHB's Northwest Tribal Epidemiology Center. The EpiCenter, as it is known, collaborates with tribes to provide health-related research and training to improve the quality of life for American Indians and Alaska Natives.

For example, unintentional injuries, including those from motor vehicle crashes, are the leading cause of death for all children in the United States.  And, American Indian and Alaska Native children experience much higher mortality from motor vehicle crashes than do children of other races. Why is that so and how the disparity be reduced?

Six Northwest tribes have made reduction of this type of mortality a top priority and are collaborating with researchers to reduce rates using a community-based process.

mph-1As an MPH student, Smith took part in a 2003 study that sought to establish a baseline measurement of child passenger safety for the participating tribes. To collect the data, she and others stationed themselves in parking lots on or near tribal lands, observing how children rode in vehicles. Were they properly restrained in an age- and size-appropriate car seat or restraint device? The researchers discovered that 41 percent of children were unrestrained and 30 percent improperly restrained.

The data collection team, which included tribal members, also interviewed drivers to gather additional information such as the child's age, weight, distance from home and the driver's relationship to the child. Later, the researchers identified risk factors for riding improperly restrained.

Smith's analysis as a student led to her current work on EpiCenter's Native Children Always Ride Safe (Native CARS) study, a five-year, NIH-funded study to improve child passenger safety in the six tribes. The study, which was just awarded an additional three years of funding, is co-directed by Jodi Lapidus, Ph.D., professor of public health and preventive medicine, director of biostatistics education at OHSU and the study's principal investigator. The tribes have been highly engaged in the entire study, says Dr. Lapidus, even presenting some of their tribe-specific results locally and nationally.

After taking baseline and follow-up measurements, Smith, Dr. Lapidus and others are now working with the tribes to design and implement interventions such as enacting child safety seat laws on tribal lands, media campaigns that feature local leaders and community members and safety seat distribution programs for tribal members.

"Our primary outcome is to observe an increase in the number of children properly restrained while traveling in motor vehicles," said Dr. Lapidus. "So far, tribes that have implemented interventions the longest are seeing marked improvement, and that is very encouraging."

That ability to translate numbers into action, both for a community and scientific audience, is one of the most important skills Smith says she learned at OHSU. "Being out in the communities collecting both qualitative and quantitative data gives such perspective to our work," Smith said. "It gives context and purpose to our efforts. My job, though, is to give the tribes something back that they can readily use. Almost anyone can analyze data, but not everyone can see the bigger picture, ask why, and make utility to the tribes a priority."

Producing culturally competent graduates like Smith is one way the School of Medicine is meeting community health needs. Another is working to improve diversity within research training programs, and subsequently, the workforce, to ensure that underrepresented minorities play an integral role in the health of their own communities.

As the Native CARS project suggests, carefully conceived and implemented health research can lead to solutions that are designed to reduce the vast disparities between the health of Northwest American Indians/Alaska Natives and other groups, says Thomas Becker, M.D., Ph.D., professor and chair of public health and preventive medicine. "However, we've found that tribal communities are sometimes distrustful of health research because of past negative experiences with non-Indian researchers."

So Dr. Becker is collaborating with the NPAIHB on two projects funded by federal trainee development grants* that are aimed at increasing the research skills – particularly related to chronic diseases – among American Indian and Alaskan Native health professionals and graduate students in the biomedical sciences.

"The overall goal is to develop a cadre of highly-trained American Indian and Alaska Native biomedical and health researchers who are sensitive to the culture and specific concerns of Indian communities, and who can bring the benefits of research to these communities to reduce health disparities," said Dr. Becker. That goal – good health for everyone – is language we can all understand.

*Funded by the Native American Research Centers for Health (NARCH), a joint partnership of the Indian Health Service, U.S. Department of Health and Human Services, and NIH's National Institute of General Medical Sciences


Article by Gloria Harrison and Rachel Shafer