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New evidence supports integrating strategies to promote increased physical activity as a key part of the action plan for achieving the United Nations Sustainable Development Goals, finds a new study led by researchers at the Brown School at Washington University in St. Louis.

The study, “Physical Activity Promotion and the United Nations Sustainable Development Goals: Building Synergies to Maximize Impact,” was published July 13 in the Journal of Physical Activity and Health. It is the first study to systematically explore the links between the seven strategies known to be effective for promoting physical activity at scale and the 17 U.N. development goals (SDGs).

The study found strong links between physical activity promotion strategies and eight out of the 17 SDGs: good health and well-being (SDG 3); gender equity (SDG 5); industry, innovation and infrastructure (SDG 9); reduced inequalities (SDG 10); sustainable cities and communities (SDG 11); climate action (SDG 13); and peace, justice and strong institutions (SDG 16).

“Physical inactivity has been characterized as a pandemic, accounting for 7% of all premature deaths per year globally and resulting in billions of dollars spent on health-related expenditures,” said Deborah Salvo, assistant professor of public health and lead author on the study.

“Even though we know effective solutions to tackle this major public health problem, they are not being implemented at scale and everywhere.”

Salvo and her co-authors developed a novel simulation model, which they used to test multiple scale-up scenarios of different physical activity promotion strategies in city types representing low-, middle- and high-income country settings.

The simulation results indicated that expected physical activity gains are greater for low- and middle-income countries. In high-income countries with high car dependency, physical activity promotion strategies may help to reduce air pollution and traffic-related deaths, but shifts toward more active forms of travel and recreation and climate change mitigation may require complementary policies that disincentivize driving.

“This paper provides comprehensive evidence on the multiple benefits that at-scale physical activity promotion can bring to individuals, communities and to the planet, with direct contributions to the U.N. sustainable development agenda,” Salvo said.

“Beyond the expected benefits due to chronic disease prevention, promoting physical activity at scale can reduce traffic deaths and pollution in cities,” she said. “It can also help us achieve more equitable societies and mitigate climate change. Through the evidence we present in this paper, we show how physical activity promotion can help in providing much needed small victories for the sustainable development agenda, while making important strides toward a healthier, more active world.”

The international team integrated three major methods: a systematic expert consultation, a systematic review of the literature and a computer simulation model including three city types and six physical activity promotion scale-up scenarios per city.

Rodrigo Reis, professor at the Brown School and associate dean for public health, was one of the paper’s co-authors.

Although the Brown School’s Center for Public Health Systems Science tackles a wide variety of research, its two decades of nationwide success can be traced largely to a single element: collaboration. The center’s largest current project, ASPiRE, is a good example. The $11.6 million tobacco-control effort with teams from Stanford and the University of North Carolina draws on the expertise of academic and community partners around the U.S.

Funded by the National Cancer Institute, ASPiRE (Advancing Science & Practice in the Retail Environment) examines how changes in tobacco retail density and policy could reduce tobacco marketing, limit access to tobacco products, and reduce disparities in tobacco-related health effects. The team works closely with a Community Advisory Board (CAB) comprised of tobacco control practitioners in 30 big U.S. cities.

Although smoking rates have dropped significantly in recent decades, it’s still a major threat to public health. “Tobacco use remains the number one preventable cause of death,” said Douglas Luke, director of CPHSS and the Irving Louis Horowitz Professor of Social Policy at the Brown School. “It’s the most heavily marketed product in the world. ASPiRE’s mission is to research policies and practices at the point of sale, and we’re starting to fill this critical evidence gap. If anybody can walk down to their corner store and easily purchase tobacco products, that’s a bad thing for public health in this country.”

That corner-store scenario is the basis for “Tobacco Town,” the ASPiRE research project at the Brown School led by Luke; Ross Hammond, Betty Bofinger Brown Associate Professor; and Todd Combs, the associate director of CPHSS who manages the project. The research team is using a computer model to estimate the impact of retail policy changes in the 30 U.S. cities partnering with ASPiRE. The models will be tailored to reflect the special characteristics of each city, and could allow communities to tailor retail tobacco control policies to meet the specific demands of their communities.

Including students in ASPiRE’s work has been a priority. “We’re investing in tomorrow’s researchers,” said Combs, assistant research professor. One is Emma Zijlstra, a first-year MPH student and a masters research fellow at the Brown School who’s been working with Combs. She has been completing literature reviews and helping with the quantitative data analysis of surveys of smokers.

“We have a lens of health equity with whatever we do in Tobacco Town,” she added. “Health disparities are very easy to see in the epidemiology of tobacco use, where retailers are located, and where advertising primarily affects racial minorities.” Zijlstra, from Murfreesboro, Tennessee, had been interested in tobacco since she worked with the Tennessee Department of Public Health and experienced youth-led anti-tobacco campaigns. “The Brown School’s focus on social justice and health equity really set it apart from other programs for me,” she said. Her work with ASPiRE was a perfect fit, she said, and will be useful in achieving her career goal of working for a public health policy research firm.

CPHSS is also home to ASPiRE’s Dissemination and Implementation Core, led by Laura Brossart, assistant director for communications & dissemination at the center. The core is responsible for translating ASPiRE’s research and delivering it in useful ways to tobacco-control practitioners, policymakers, and the general public. “We’ve produced more than 200 unique resources, including retail density fact sheets that map the locations of tobacco retailers in the 30 ASPiRE big cities,” Brossart said. That work helped the core score big national attention for ASPiRE last year when it collaborated with the Campaign for Tobacco-Free Kids to publicize the center’s research. Media appearances during the campaign reached over 3 million viewers.

The density fact sheets helped tobacco control advocates in Denver pass new policies, including a new buffer zone limiting tobacco sales near schools. “The Denver fact sheet was just what I needed to be able to give local decision-makers digestible information about retail tobacco,” said CAB member Terry Rousey, Youth Tobacco Policy Specialist with the State Tobacco Education and Prevention Partnership.

Luke founded CPHSS in 2001 at Saint Louis University as the Center for Tobacco Policy Research, then moved to Washington University in 2008. The Center changed its name in 2012 to reflect its broader mission. “From the beginning, our work was a mix of research and evaluation, but over time we started moving beyond tobacco control,” Luke said. “Our focus is on policy to create lasting change; implementation science, to put research findings into practice; and systems science, to target the complex systems where public health problems arise. Other centers do bits of each of those buckets, but our sweet spot is the intersection of those things.”

Other major projects for CPHSS include:

Luke said the availability of a wide range of expertise enables CPHSS to extend its impact in a variety of public health fields. “We have an embarrassment of riches in terms of policy experts here at the Brown School,” he said. “We have powerful tools to help shape policies on violence, physical activity, obesity and infectious disease. We try to get knowledge, skills and resources into the hands of those who can use them.” The result, he said, are collaborations that increase the power and impact of research to benefit those who most need it.

A recent evaluation by a team of researchers at the Brown School at Washington University in St. Louis and other universities found that training in evidence-based public health practices improves practitioner skill levels.

“To our knowledge, this is the first long-term evaluation of evidence-based public health (EBPH) training,” said Rebekah Jacob, research manager and lead author on the paper, “Long-Term Evaluation of a Course on Evidence-Based Public Health in the U.S. and Europe,” published in the American Journal of Preventive Medicine.

“The EBPH course represents one important strategy for increasing the capacity, or individual skills, for evidence-based processes within public health practice,” said Ross Brownson, the Steven H. and Susan U. Lipstein Distinguished Professor and senior author. “Training programs such as the EBPH course cannot be treated as one-time events — they should be funded, integrated into ongoing workforce development efforts and tailored to local priorities.”  

Ross Brownson serves as co-director of the Prevention ­Research Center, where his research focuses on chronic disease prevention by bolstering physical activity. Amy Eyler, deputy director of the PRC, contributed her expertise as one of the article’s co-authors.The researchers conducted five surveys of 723 course participants from 2005-2019. The EBPH training is the largest-scale effort of its kind and has included participants from all 50 states, two U.S. territories and several countries.

The most common reported benefits were identifying ways to apply knowledge in their work; acquiring new knowledge; and becoming a better leader who promotes evidence-based approaches.

Recognizing the diversity of backgrounds among the public health workforce and the need for training in evidence-based approaches to public health challenges, an EBPH course was originally developed in 1997 for state health department staff in Missouri. With support from the Centers for Disease Control and Prevention, the reach then expanded to other states and countries.

Other co-authors on the paper are: Carol Brownson, public health specialist at Washington University; Anjali Deshpande, clinical associate professor of epidemiology at University of Iowa; Kathleen Gillespie, associate professor of health management and policy at Saint Louis University; Jennie Hefelfinger, director of community and environmental health at the National Association of Chronic Disease Directors; Paul Erwin, dean of the School of Public Health at the University of Alabama at Birmingham; and Marti Macchi, senior director of programs at the National Association of Chronic Disease Directors.

A team of researchers at the Washington University School of Medicine and the Brown School has published the first in a series of “community snapshots” of the St. Louis region and the social needs that can impact cancer prevention and treatment. Each snapshot will contain local data, a personal story, resources to address the issue and researchers who may be seeking community partners in connection with the issue.

The first snapshot is about transportation, and how infrastructure like sidewalks, bike lanes, and public transit can help people stay healthy and make it easier to access health care services, including cancer care. Transportation barriers can lead to missed or delayed appointments, overall poorer health and widened health disparities.

“In our discussions with community partners, transportation emerged as a really important need,” said Kia Davis, an assistant professor in the Division of Public Health Sciences at the School of Medicine. She co-leads the practice surveillance unit of Washington University’s Implementation Science Center for Cancer Control (ISC3) with Bettina Drake, professor of surgery.

The ISC3 brings together faculty and researchers from the Brown School, School of Medicine and Olin Business School to address cancer disparities in the region, focusing on rapid implementation research to increase the reach and effectiveness of cancer-control interventions. The focus of the center is the area in Eastern Missouri and Southern Illinois served by the Siteman Cancer Center at the School of Medicine. ISC3 is led by Ross Brownson, the Lipstein Distinguished Professor at the Brown School and the School of Medicine; and Graham Colditz, the Niess-Gain Professor of Surgery at the School of Medicine.

“The snapshots are one way to understand how social determinants like transportation are related to cancer outcomes, such as screenings,” Davis said. The transportation brief uses published data and national resources to create visual tools, such as a map of car ownership in the region. The county-by-county data revealed gaps in transportation availability, particularly in rural areas. “We want our community partners to see this data and find out who else might be interested in it to advocate to improve transportation and other social needs in the region,” Davis said.

The next snapshot will focus on financial hardship, with food insecurity and housing also on the unit’s list of topics. Other snapshots will be suggested by the communities served by ISC3. A complementary data dashboard to share this data at the zip code level is under development. The data dashboard and future snapshots will be available online. 

“Our goal is to activate data that’s out there, make it specific to our catchment area, and make it available in a way that’s useful and meaningful,” Davis said.

Matthew Kreuter, the Kahn Family Professor of Public Health at the Brown School at Washington University in St. Louis, has received a one-year $1.4 million grant from National Institutes of Health’s Community Engagement Alliance (CEAL) Against COVID-19 Disparities. Funding was supported by the American Rescue Plan.

The grant, which will help to increase COVID-19 vaccinations among Black residents in St. Louis City and County, has a number of partners, including the St. Louis City Department of Health, St. Louis County Department of Health, St. Louis COVID-19 Regional Response Team, United Way, Home State Health/Centene, 211, and Washington University’s Brown School, School of Medicine and Sam Fox School of Design & Visual Arts.

“COVID-19 has impacted the Black community in St. Louis unequally in nearly all ways — sickness, death and financial strain,” Kreuter said. “We must do everything possible to avoid the same gaps when it comes to the protection of vaccinations. Every organization in St. Louis can contribute in some way.”

The grant has four aims:

Kreuter and several of the same partners were also awarded a one-year $500,000 grant from the Centers for Disease Control and Prevention as part of the university’s Prevention Research Center.matt

The second grant has three aims:

The Brown School community is saddened by the loss of David Patterson Silver Wolf, associate professor.

An Irish/Cherokee descendent, David’s research focused on two main areas: substance abuse recovery and advocating for underrepresented minority college students, especially those from American Indian/Alaska Native populations.

David was kind, with a brilliant smile and a subversive sense of humor. He did not stand on ceremony or pay much attention to hierarchy –he invited conversation and made those he interacted with feel seen on a deeply personal level. David didn’t suffer nonsense or what he perceived as unnecessary bureaucracy. Rather, he built a life dedicated to improving the lives of others.

Trailblazing Scholar

David was the first professor of Native descent at the Brown School. In his work with the Kathryn M. Buder Center for American Indian Studies, he supported Buder Center staff on many projects, studies and events, including Buder Orientation and the Annual Pow Wow. On one memorable occasion, he sang a traveling song at the annual Buder Center Blessing Ceremony. His photo is included in the slideshow of this year’s virtual ceremony.

“His impact with the Buder Center is far-reaching and powerful,” said Mary McKay, Neidorff Family and Centene Corporation Dean of the Brown School.

“He was an invaluable mentor for Indigenous students and a great advocate for Indigenous peoples. We want to acknowledge and express gratitude for all of his many contributions to our community,” said Kellie Thompson, director of the Buder Center.

Changing the Paradigm for Substance Disorder Treatment

David was passionate about bringing evidence-based approaches to substance-disorder treatment. He served as the chief research officer for the Community Academic Partnership on Addiction (CAPA) Clinic, a partnership between the Brown School and Preferred Family Healthcare.

David hoped the unique partnership model would be replicated by university hospitals and medical schools. He realized that there was a dearth of hard data to guide addiction treatment and behavioral health professionals – the treatment and recovery process is monitored exclusively on a therapist’s intuition. David knew this from his 15 years of experience providing such services.

This led him to co-found Takoda and create PsychoSocial Sync. The performance dashboard tool displays key, real-time performance indicators that enable therapists to evaluate the effectiveness of treatment interventions and recovery progress.

The dashboard, which includes mobile apps, was implemented under David’s leadership in partnership with addiction treatment providers in the St. Louis region. After clinicians were trained to use the dashboard, they saw an 11% increase in addiction treatment completion rates over six months.

Recently, a multi-disciplinary team at Institute of Clinical and Translational Sciences (ICTS) published a new case study highlighting the dashboard’s impact, under the leadership of Professor Doug Luke.

David’s latest book, “The New Addiction Treatment“(Oxford University Press), discusses addiction treatment and the surrounding industry from the perspective of both a patient and a treatment provider.

Improving the Odds for Minority College Students

One prong of his research centered on social-belonging interventions for minority college students. David noted that research showed college graduates had greater overall health, a brighter outlook on life and other benefits that they passed on to their children. But with a drop-out rate of approximately 30%, minority students can miss out on these benefits.

He tested the effectiveness of a structured introduction via a 13-minute video, “You Are College Material — You Belong,” followed by group discussion, among students at St. Louis Community College-Forest Park. The results he published demonstrated the power of community.

“The college culture and traditions oftentimes conflict with minority culture and traditions. Further, when there are feelings of a lack of belonging, small things, like being ignored or getting a poor grade, can cause those feelings to increase. These seemingly small acts can result in the decision to drop out, which has huge consequences,” said David.

This conversation was personal for him. In the monograph “An Education Saved My Life,” David shares how he navigated a difficult family life, educational challenges, and addiction with the support of a foundational community and the pursuit of higher education. He believed any student could thrive in a college setting as long as they were able to create a sense of ‘belongingness’ in spite of perceived flaws.

“The best relationship is not the one that brings together perfect people; it is when each individual learns to live with the imperfections of others and can admire other people’s good qualities.”

David was 57 when he passed away on May 14, 2021. He was surrounded by his loving family, with hospice at home, after being diagnosed with glioblastoma cancer last fall.

In celebration of David’s personal and professional legacy, his colleagues and friends have established the David Patterson Silver Wolf Endowed Scholarship, which will support generations of Brown School students in perpetuity. Those interested in contributing to the scholarship in David’s name may do so online, or by contacting Lia Nunez, associate director of Advancement, at lmnunez@wustl.edu.