Brown School › 2021

An oak tree that had guided Illinois travelers for nearly three centuries collapsed on April 20, 2008. Today, its spirit endures on the Washington University in St. Louis campus, maintaining an ancient practice of human connection with nature.

Born in northern Illinois around 1730, that fallen oak, known as “Pathfinder,” was among the last of the “trail marker trees.” Native American people bent these trees, usually red or white oaks, to point toward resources or significant locations. Pathfinder directed sojourners toward a creek crossing of the Sangamon River.

Soon after the tree’s collapse, oak expert and Starhill Forest Arboretum owner Guy Sternberg was on the scene, working to preserve Pathfinder’s legacy. He gathered scion wood (that is, tree cuttings) and then arranged for genetically identical clone trees to be grafted.

WashU lead groundskeeper Cody Azotea initially brought Pathfinder to the university’s attention.

“I was trying to educate myself with other arboreta and plant species to create a unique arboretum experience at WashU,” Azotea said. “And while all tree species have ecological value, oaks in particular are very valuable for ecosystem function. I didn’t know what a trail marker tree was until introduced to them through Guy Sternberg’s work.”

One of Sternberg’s clones was introduced Oct. 30 near Hillman Hall at a Native American-led tree planting ceremony organized by the Brown School’s Kathryn M. Buder Center for American Indian Studies. Invited guests included those who assisted in the grafting process and members of St. Louis’ small yet diverse Native American community, close partners of the Buder Center. Historically, the St. Louis area was inhabited by the Illini, Osage and Missouria peoples, among others, many of whom were removed, displaced or relocated during westward expansion.

“The planting ceremony was as much about education as it was about tradition,” said Eric Pinto, community projects coordinator at the Buder Center. “Not all Native people are going to be aware of trail marker trees, and not all tribes used them.”

Yet this was not the first time Sherry Echohawk Taluc and Saundi Kloeckener of the Native Women’s Care Circle, a prayer group supporting health and welfare in the local Native American community, have prayed for the “long-standing ones.” At the ceremony, Taluc delivered a territorial welcome, while Kloeckener distributed gifts of flat cedar and braided sweetgrass. As the planting took place, people sung as Kloeckener guided attendees in an offering of tobacco to the tree.

“We use tobacco as a way to offer prayer,” Kloeckener said. “The DNA of that tree has seen so much and that’s in the memory of the tree. We need to come back to looking at all those plant relatives as kin.”

The tree will now take root for three to five years before the bending process begins and the tree is pointed in a specific direction. To where is still a matter of discussion among the local Native American community.

One option is eastward.

“The east has spiritual significance among many Native tribes and, in terms of resources, we’ve got the big Mississippi River in that direction,” Pinto explained. “It’s also about decolonizing the teachings of the westward movement. We’re in St. Louis, ‘gateway to the West,’ so pointing to the east fights that ideology of westward expansion.”

Regardless of where the tree points, the Buder Center, Pinto and the Care Circle are pleased to preserve the life and existence of this trail marker tree.

Two Brown School scholars have been recognized for their work’s significant and broad influence in this year’s 2021 Highly Cited Researchers list: Enola Proctor, Shanti K. Khinduka Distinguished Professor Emeritus and Byron Powell, assistant professor and co-director of the Center for Mental Health Services Research (CMHSR).

The list identifies scientists and social scientists who have demonstrated significant and broad influence, reflected in the publication of multiple papers frequently cited by their peers during the last decade. The work of honorees ranks in the top 1% of citations for a field during a publication year in the Web of Science.

Proctor has been recognized previously for the scope of her research by Clarivate during her career. Her research has been funded by the NIA, AHRQ, and the NIMH for 27 consecutive years. She led the establishment of several university-wide centers and cores in implementation science, including the Center for Dissemination and Implementation for the Washington University Institute for Public Health and the Dissemination and Implementation Research Core for Washington University’s CTSA program. With Elvin Geng, Proctor leads a World Health Organization initiative on COVID vaccine implementation for low- to middle-income countries.

At the Brown School, Proctor and Powell are directly connected by their work with the Implementation Research Institute (IRI). Proctor directs IRI, a training program in implementation science funded by the National Institute for Mental Health. Powell will join the IRI Core Faculty as associate director and serves as faculty for other international training initiatives:

Powell is currently the president of the Society for Implementation Research Collaboration.

“Byron is an outstanding researcher. I’m proud that others are recognizing his scholarship so early in his career,” said Proctor, who mentors Powell.

“I’m humbled by this honor,” said Powell. “Everything we do is highly collaborative. I’m so grateful for the opportunity to work with Enola and countless other mentors, colleagues, students, and community partners to advance research on the implementation of evidence-based practices.”

“So, what do you think?” Jeremy Goldbach recalled asking the group of teenagers at a Southern California LGBTQ drop-in center. A seemingly innocuous question, but at the same time monumental. He was asking for feedback on a program his team had been developing for nearly a decade – an intervention for promoting LGBTQ adolescent mental health.

Goldbach, who joined the Brown School community this fall, said he briefly panicked as silence set in. But soon, the feedback was flowing.

In 2010, Goldbach started creating Proud & Empowered (P&E) program to help sexual and gender minority adolescents (SGMA) cope with discrimination and stigma. Studies consistently show this group experiences higher rates of depression, anxiety, self-harm, and post-traumatic stress disorder, as well as discrimination, violence, and victimization – all of which places them at higher risk of mental health concerns. Yet, at the time, no programs existed to support teachers, administrators and social workers to support these youth in an evidence-based way.

Ten years after undertaking the process, outlined in The Development of Proud & Empowered: An Intervention for Promoting LGBTQ Adolescent Mental Health, the intervention is ready for large-scale testing. With funding from the National Institutes of Health, P&E has been tested in four Los Angeles schools. With promising preliminary results from the pilot, the randomized control trial will soon be expanded to 24 schools. But getting to this point took time and effort and required a lot of reading, reflecting and recalibrating.

“We knew that there was a problem, but we knew almost nothing about why it was a problem, what we could even do, where the intervention points should be, where in the system we should intervene, and what coping looks like,” Goldbach explained. “These last ten years taught me the importance of intentional science. It can be unbelievably frustrating, but you don’t get to jump ahead just because you see a need and you want to help, and you’re driven to try and intervene and fix this problem. Passion is one part of the recipe. Science is the other.”

The initial plan was to implement the intervention at LGBTQ drop-in centers, but it soon became apparent that wasn’t the right place to start. Study participants expressed a desire for the program to be in a school setting, where many experience the most stress and victimization.

“It is nice that you are so focused on helping us – but what about the system that created this problem in the first place?” one youth said. “You need to start there.”

“This intervention is quite literally the culmination of thousands of kids’ input,” Goldbach said. “Looking back at all the youth who gave us their time, let us interview them, took our surveys and helped us learn, it is humbling. We hope [the input] makes P&E relevant to the lives of young people today,” he said.

The program, along with information about its early efficacy data, is available at no cost upon request Proud & Empowered consists of 10 sessions that run 30 to 45 minutes each. There are training modules to assist adolescents and supportive adults in administering the program. and are available at no cost by request.

Intervention topics focus on the following areas:

Growing up gay in the 1980’s and 1990’s was “a mostly bad” experience, shared Goldbach. At the time, there wasn’t much interest in developing programs to help parents and teachers because the field generally assumed these were unsupportive actors. But he’s optimistic about the future of LGBTQ+ youth.

“This next generation [of LGBTQ scholars] is so important because they don’t have the baggage that I brought. We’re in a different place,” he said. “It’s amazing for me to watch parents and teachers reaching out for resources to help kids and to see new and emerging scholars answer that call with open arms.”

Goldbach joined the Brown School in fall 2021 after nearly a decade with the University of Southern California. He’s excited to be at the Brown School, particularly in the Midwest, as he continues his research on the disparities that LGBTQ+ youth experience.

“I built my career in Los Angeles, and sometimes we undervalue the work that can be done in smaller cities and particularly more rural areas of the country. I think that’s a huge disservice,” Goldbach said. “Being in Missouri challenges me in a new way and is forcing me to think about how to do my work and present my work in a way that is going to be more accessible for people.”

In a seemingly counterintuitive finding, young adults diagnosed with central nervous system (CNS) tumors might have better survival rates the farther they live from care.

“We think one of the potential causes for this is that patients with non-CNS cancers may live further away from care, which increases the likelihood that they are diagnosed when their tumors are advanced and more difficult to treat,” said Kimberly Johnson, associate professor at the Brown School at Washington University in St. Louis.

“In contrast, those with CNS tumors may travel further for care to access facilities with the most experience treating these types of tumors.”

Johnson is first author of the study “Residential distance from the reporting hospital and survival among adolescents, and young adults diagnosed with CNS tumors,” published in the Journal of Neuro-Oncology.

Johnson and her co-authors examined National Cancer Database data on 9,335 people aged 15 to 39 diagnosed with CNS tumors from 2010-14.

They found that adolescents and young adults diagnosed with CNS tumors who live further from the reporting hospital had a reduced risk of death compared to those who live shorter distances.

The researchers also found a greater survival benefit in association with distance to the reporting hospital for low-grade astrocytic (CNS) tumors and ependymomas, those in the brain or spinal cord, than other tumors; for non-Hispanic whites vs. non-Hispanic Blacks and Hispanics; and for those who live in higher-income areas at diagnosis or initial treatment.

“This seems to indicate that people with more resources may be able to travel further to facilities with more expertise. This in turn may impact survival outcomes,” Johnson said.

The study is a follow-up to earlier research, which found that adolescents and young adults living in rural versus metropolitan U.S. counties and those living farther from the hospital where they were diagnosed are more likely to be detected at a later cancer stage, when it is generally less treatable, and have lower survival rates compared with those living in metropolitan counties and closer to the reporting hospital.

The Brown School, the Institute for Public Health’s Center for Dissemination and Implementation and the School of Medicine’s Infectious Disease Division at Washington University in St. Louis have launched the Infectious Disease Dissemination and Implementation Science (IDDI) Initiative.

Led by Virginia McKay, research assistant professor at the Brown School, the initiative is designed to cultivate local and applied research related to the uptake and implementation of evidence-based innovations, practices, procedures or policies that reduce the spread and improve the treatment of infectious diseases.

Initially, IDDI will help support implementation research in three areas: sexually transmitted infections and HIV; COVID-19; and antimicrobial resistance. This will take place over the next two years through pilot funding, grant development support, strengthening local partnerships, promoting research collaboration and fostering a national scientific conversation about these topics.

For more information about the initiative, contact Virginia McKay.

The Brown School’s cross-campus collaboration for a unique PhD program combining computers, data and social sciences has existed for just a few years, but is already showing great promise in attracting top-tier students focused on innovative solutions to society’s thorniest problems.

“The response has been incredible,” said Patrick Fowler, associate professor and director of the doctoral program in public health sciences at the Brown School and co-director of the Division of Computational & Data Sciences (DCDS). “We’re getting highly competitive pools of applicants and an extremely good acceptance yield – we’re getting our top picks.”

Along with the departments of computer science, political science, and psychology, the program is for PhD students interested in the uses of data-centric methods for addressing social science questions. Public Health/Social Work is one of four tracks; students apply computational approaches to a broad range of questions, such as homelessness and health disparities (the other tracks are computational methodologies, political science, and psychological/brain sciences). The 15 students currently enrolled come from either a computer science or social science background. Co-mentors from different disciplines advise students toward a degree in computational data sciences. A master’s degree is not required to enter the program.

Fowler said the popularity of the program is grounded in its increasing real-world value. “Having a strong foundation in data methods and their social applications is becoming increasingly needed and appealing to students,” he said. “The technology is exploding and creating new opportunities to improve lives.” The program also focuses on the unintended consequences of using new technology. “We’ve got machines making decisions for better or worse,” he said. “Students need to know how these methods are working and their social implications.”

Joshua Landman is a fourth-year student in the program, with only his dissertation left to complete. He’s aiming to build clinical risk-prediction models for hospital admission and mortality rates in the context of COVID-19. He came to the program with a master’s degree in computer science, but decided to focus on public health only after taking a required first-year course in theoretical orientation to public health sciences taught by the Brown School’s Darrell Hudson and Douglas Luke, and Christine Ekenga, now an assistant professor at Emory University’s Rollins School of Public Health.

“Taking that course clarified and shaped how I’ve continued to think about my work,” he said. “I want to find out what drives the creation of this data to inform what we learn when we analyze it.”

“Data is one of the best ways for us to make informed decisions about problems we’re facing, for individuals or societies,” Landman said. “To be able to intelligently reason about this data and how confident we are is incredibly important, especially in health care and public health. DCDS is training us to be, if not subject-matter experts, the next closest thing, and providing an opportunity to collaborate with all of the relevant experts in that area.” He is working with the Institute for Informatics at the School of Medicine.

Landman said the program is special. “It’s not every data science program that lets you pick a field and work with world-renowned experts in it,” he said. “It’s a privilege to be able to do that, and it offers you opportunities for so much more than just working with data; you get a deeper understanding within that area.”

Another student with a public health interest is Abigail Lewis, who came to the program after graduating from Grinnell College and is now in her second year. She’s interested in using data science to understand disparities in access to health care and inpatient outcomes. She’s currently working in the Institute for Informatics to understand the use of biomarker testing in Alzheimer’s diagnoses and racial disparities in access to the tests.

Lewis was drawn to the program by its focus on applied data, as well as the location in St. Louis, her hometown. She said the newness of the program and its wide reach have posed challenges — and opportunities.

“DCDS doesn’t exist anywhere, but it exists everywhere,” she said. “Being in the second cohort, there’s not a lot of precedent for anything, but that has provided more flexibility for us and we’ve had a lot of opportunities to give feedback and shape the program in the future. I definitely would recommend it to students interested in the application of data science. It’s a great program and will improve as they work out the kinks. I have not seen a program like this anywhere else.”

Fowler agreed that the breadth and innovative nature of the program has required flexibility and adjustments as it advances. “We’re walking the walk of transdisciplinary research,” he said. “We’re working at the intersections where problems need to be solved. It’s great that students are the bridge. We thought that by bringing in students with innovative ideas, they’d make innovative connections, and that has been the experience so far.”

Students are engaged in meaningful research. PhD candidate Amanda Kube is studying ways to minimize biases in homeless service delivery. Second-year student Alex DiChristofano is working with a team from the University of Pittsburgh to design a web platform that increases online support for Black-owned businesses from the university’s students, staff, and faculty. The project recently won the New Horizons Award at the Association for Computing Machinery. Ivy Smith, a first-year DCDS student, received the inaugural Center for the Study of Race, Ethnicity & Equity graduate fellowship.

“This program is going, and it’s going gangbusters,” Fowler said.