Each year, The Graduate School honors graduate students in programs throughout our University for their powerful discoveries that contribute to a better future for people and communities in North Carolina. We’re pleased to present 11 Impact Awards and six Horizon Awards for 2020 — and to share the honorees’ own descriptions of their research projects.
“Three state historic sites sit within 10 miles of downtown Durham: Historic Stagville, Bennett Place and Duke Homestead. All three narrate different moments in Durham’s history; however, the physical landscapes of each are strikingly similar today, dominated by mown grass lawns and surrounded by large stands of trees. Historic Stagville, especially, is noteworthy. Once the largest plantation in North Carolina, Stagville today is covered with trees that shade four original slave cabins from sight and sun. In 1860, however, no trees would have sheltered enslaved families from summer heat or the surveillance of the enslavers’ house on a nearby hill. Despite their designation as historic sites, these spaces are not static; rather, they must be continually maintained in the present with present-day priorities.
My research investigates how historical authenticity is constructed and experienced at public history sites in North Carolina, especially in the context of landscape change over time. I analyze the priorities of site staff responsible for managing historic landscapes alongside visitor experiences of both the landscapes and the history. I examine how present-day understandings of space and nature inform our understanding of history. In doing so, I seek to inform a more complete understanding of how Durham’s history is taught, and what this means for Durham’s present and future generations.”
“Mary’s timely project draws attention to the role of landscape in narrating the past and creating a living history experience in official North Carolina historic sites. Her analysis provides original insights about whose history is represented and how it is experienced,” said co-adviser Banu Gökarıksel, Ph.D.
Mary Biggs is also advised by Christian Lentz, Ph.D.
“While the Healthy Youth Act of 2009 mandates comprehensive sexual health education for students in grades seven through nine in North Carolina, many schools (public, private and charter) do not offer it. The state of North Carolina just reached its lowest teen pregnancy rate in a decade, but teen pregnancy rates continue to spike in predominantly rural and non-White counties where schools tend to have fewer resources to hire trained health educators or purchase evidence-based interventions.
Frustrated by the limited reach and effectiveness of existing sex education resources, I served as the team lead and principal investigator for two research grants from Power to Decide (formerly The National Campaign to Prevent Teen and Unplanned Pregnancy) and worked to reduce institutional barriers by delivering sex education directly to teens on their phones to increase their access to high-quality sexual health education and to increase their sexual health knowledge.
After following a 24-month human-centered design process and working with over 400 teens mostly ages 13-15 (most of whom were in rural eastern North Carolina), we launched the beta version of our Real Talk app in 2017. In our Real Talk app, teens are able to browse, search and share anonymous stories that are linked to credible resources like amaze.org. To date, we have reached over 14,500 teens in all 50 states and more than 100 countries. We also have over 500 users in North Carolina. Among our users, approximately 70% report increased sexual health knowledge after using our app.”
“By developing and disseminating effective sexual health interventions that can be delivered in low-resource school and other settings, Liz has made valuable contributions to the effort to reduce teen pregnancy and sexually transmitted infections, and improve academic performance and opportunities for youth in our state,” said adviser Beth Moracco, Ph.D.
“The Eastern Band of Cherokee Indians’ (EBCI) constitutional right to govern themselves includes the power to own and use data collected for and about them. For EBCI, having the ability to track health information about enrolled members and their families without relying on outside government sources is particularly important. This includes information about deaths in the community, which is critical for planning and evaluating public health programs specific to EBCI. I worked with key public health stakeholders within EBCI to research, design and create a system to help the Tribe collect and use their own data regarding deaths in their community.
The resulting system used death certificates to collect and preliminarily analyze information about cause and manner of death, as well as age at death and contributing factors. Continuous conversations with community members, Tribal government, the Cherokee Indian Hospital Authority and EBCI Public Health and Human Services guided the project and ensured EBCI had ownership over how death certificate data was used and disseminated. In addition, our system was designed for ease of use and left open to the possibility of integration with health records at the local hospital. Ultimately, the key stakeholders and I envision a system that allows EBCI to identify and respond to public health issues reflected in information collected about deaths in the Cherokee community.”
“Elizabeth worked directly with the Eastern Band of Cherokee Indians to develop a culturally acceptable approach for tracking death records. In so doing, she developed a sustainable system that will generate important public health insights,” said adviser Nisha Gottfredson, Ph.D.
“Electronic cigarette (e-cigarette) use or ‘vaping’ has skyrocketed in the United States since its introduction to the market in 2007. In North Carolina alone, there have been over 50 vaping-related lung injury cases, yet no single e-cigarette product or compound has been identified as the culprit. While a great deal of research has focused on the effects of the flavoring compounds and nicotine used in e-cigarettes, little attention has been focused on the base compounds, propylene glycol (PG) and glycerol (GLY), which are used in all e-cigarettes.
We have developed an experimental system to investigate how lung cells respond to e-cigarette generated aerosols. For this project, airway epithelial cells were exposed to a single vaping session consisting of 20 puffs of PG and GLY from an e-cigarette. Our results demonstrate increased markers of cellular stress and damage. Additionally, when airway epithelial cells from non-smokers and smokers were exposed to vaped PG and GLY, only airway epithelial cells from smokers had increased levels of pro-inflammatory proteins.
These experiments indicate that vaped PG and GLY can damage airway cells but that these responses differ in cells from non-smokers and smokers. These data further support the notion that many different components of e-cigarettes can contribute to lung injury, including compounds that were previously considered harmless, such as PG and GLY. These observations will help inform consumers, policymakers and manufacturers regarding the toxicity of e-cigarette formulation and devices.”
“Yael’s research focuses on the adverse health effects of e-cigarette aerosols, a research field that will directly inform federal regulation. Understanding how specific components of e-cigarettes could adversely affect cells lining the lung is of imminent importance,” said adviser Ilona Jaspers, Ph.D.
“North Carolina has a 23% higher rate of stroke than the national rate. Identifying stroke survivors at risk of falls and physical inactivity early after stroke is an important priority to customize delivery of services to minimize these risks, thereby reducing disability, preventing secondary health conditions and lowering the massive economic burden of stroke.
My research involved 47 adults who were discharged home from the hospital after a stroke. Prior to discharge, we examined their ability to successfully walk over an obstacle and to walk while simultaneously performing a verbal task (dual-tasking). These walking tasks are more complex than traditional clinical walking tests. Our goal was to determine if these more difficult tasks could predict fall risk and daily walking activity, respectively, in the first three months after hospital discharge. Our results showed that adults with stroke who failed to successfully step over an obstacle in their path before going home were 10 times more likely to fall in the first three months after discharge than those who could successfully step over the obstacle. In addition, we found evidence that people whose walking speed was slower when walking-while-talking were more likely to be physically inactive.
These findings may improve clinical decision-making by allowing us to provide more personalized rehabilitation to prevent falls and physical inactivity early after hospital discharge. This is a critical time for rehabilitation, because stroke survivors are still adapting to life at home with a disability. Ultimately, we hope to reduce disability and poor health outcomes that result from falls and inactivity after stroke.”
“Dr. Feld’s research has highlighted that it is possible for us to accurately identify many stroke survivors who will fall before they even experience their first fall, which has exciting implications for improving health outcomes in stroke survivors who are discharged home,” said adviser Prue Plummer, Ph.D.
“North Carolina has thriving tourism and shellfish industries, both of which can be negatively impacted by Vibrio bacteria, natural and sometimes disease-causing members of coastal bacterial communities. Strains of two Vibrio species, V. parahaemolyticus and V. vulnificus, are responsible for nearly all Vibrio-related illnesses in the United States, and both species have distinctive and complex ecological requirements with regard to salinity, temperature, nutrient availability and other environmental factors. Also, although certain strains of potentially harmful Vibrio species represent serious human health risks, others are thought to be nonthreatening to human health.
Understanding Vibrio ecology and the differences between strains that are capable of causing disease versus those that are strictly environmental is key to accurately estimating disease risk. I developed and applied a novel DNA sequencing approach to investigate Vibrio communities in the Neuse River Estuary, N.C., revealing complex seasonal and storm-related dynamics. I also used a novel method called protein motif fingerprinting to differentiate clinical strains and identify DNA-based markers for pathogenic V. parahaemolyticus, and used a new statistical method to probe V. vulnificus genomes for markers associated with disease-causing strains.
Through innovative applications of DNA sequencing technology, I discovered key traits to better identify harmful bacteria in coastal waters. The outcomes of my dissertation have and will continue to contribute to the development of new diagnostics and the advancement of the study of Vibrio in both environmental and clinical contexts in North Carolina and worldwide.”
“Kelsey’s dissertation research makes it now possible for us to design and commercialize molecular diagnostic tools specifically for protection of the consumer, through cost-effective testing of raw shellfish products prior to sale,” said adviser Rachel Noble, Ph.D.
“Estuarine habitats such as saltmarshes, seagrasses and oyster reefs are important for the growth, reproduction and survival for many of North Carolina’s recreationally and commercially important fish species. Unfortunately, these habitats are exposed to negative stressors, resulting in loss and degradation of these valuable resources. There is a need to identify habitats that are most conducive to producing healthy fish populations so coastal resource managers can develop and implement effective conservation efforts. Fundamental to such initiatives is understanding how fish use and move among different habitats over tidal, daily, seasonal and life-time scales.
My dissertation incorporated an emerging technology, acoustic telemetry, to monitor fish movement and habitat use. This approach has greater resolution in time and space than some traditional methods such as net- and trap-based surveys. By tracking individuals from three recreationally and commercially important fish populations (red drum, black drum and southern flounder), my research provides managers with: (1) a better understanding of estuarine-scale movement and habitat selection by fishes in targeted N.C. estuaries, (2) fine-scale habitat preferences within estuarine seascapes, and (3) the value of restored oyster reefs as habitat for these fish species. Outcomes from these studies are being utilized by coastal managers to develop targeted conservation initiatives designed to preserve the most critical habitats for estuarine fish species.”
“Matt’s research has expanded the tool-kit for describing the complex – but centrally important – ways in which large fishes depend on estuarine habitats. I anticipate his findings will be used to prioritize areas/habitats most important to conserve for the health and productivity of our estuaries,” said adviser Joel Fodrie, Ph.D.
“North Carolina is experiencing an opioid epidemic. More than 200,000 women in the state report the misuse of opioid pain relievers. Research shows that women with opioid use disorders have high rates of poor reproductive health outcomes, including unintended pregnancy, sexually transmitted infections and low rates of contraceptive use.
For my dissertation research, under the mentorship of Hendrée E. Jones, Ph.D., UNC-Chapel Hill professor and executive director of UNC Horizons, I examined reproductive health services provided to women enrolled in opioid treatment programs in North Carolina, and treatment provider and support staff views about integrating more comprehensive reproductive health services for women. Findings indicate that opioid treatment programs fell short of federal mandates to test women for pregnancy, hepatitis C and HIV. Also, while a majority of providers and staff surveyed perceived benefits to reproductive health education and increased access to services, the majority of opioid treatment providers surveyed believe it is outside their scope of practice to provide reproductive health services.
As a result of my research, the N.C. Division of Health and Human Services, Women's Health Branch, contracted with me to develop a training curriculum encouraging collaboration between opioid treatment providers and public health nurses to improve linking women with an opioid use disorder to reproductive health services. More than 100 treatment providers and nurses have already been trained statewide. Study results were shared with the N.C. Association for the Treatment of Opioid Dependence, providing insights into why reproductive health care is critical for the long-term health of women with opioid use disorder, their children and their communities.”
“Dr. Klaman’s training curriculum has the potential to affect the health of the more than 5,000 women with an opioid use disorder who are enrolled in opioid treatment programs across North Carolina by improving access to critical health services,” said adviser Carolyn Halpern, Ph.D.
“Critical Access Hospitals (CAHs) provide life-saving emergency care and essential health care services to rural communities. North Carolina has twice as many rural residents as the national average, with 40% of North Carolinians living in rural communities. All 20 N.C. rural hospitals that meet the criteria for CAH designation have converted to CAH status, which allows these hospitals to receive enhanced reimbursement for Medicare services and to participate in the Medicare Rural Hospital Flexibility Program (Flex Program). The Flex Program provides support to small, rural hospitals designated as CAHs to implement interventions to support access to high-quality health care services in rural communities.
My colleagues and I conducted a two-part evaluation of financial and operational improvement interventions. This project, based within the North Carolina Rural Health Research Program of the UNC Cecil G. Sheps Center for Health Services Research, investigated 1) whether financially vulnerable CAHs participated in interventions to improve hospital operations and financial stability and 2) the impact of participation on CAH profitability. This evaluation was supported by the Federal Office of Rural Health Policy, a program of the federal Health Resources and Services Administration.
Our analyses suggest that CAHs at greatest risk of financial distress and closure are appropriately targeted to participate in these interventions, and that their sustained participation in targeted interventions improves CAH profitability. Knowledge that promotes support for N.C. rural hospitals through the Flex Program has the potential to help maintain access to essential health care services for our rural residents.”
“The results of Kathleen’s work are providing critical information to the Federal Office of Rural Health Policy to improve the Flex Program and maximize its impact on Critical Access Hospitals,” said adviser Kristin Reiter, Ph.D.
“Patients diagnosed with advanced stage head and neck cancer tend to have poor survival outcomes, and those with low socioeconomic status disproportionately experience delays in diagnosis. Our research team, which was led by Dr. Andy Olshan [Barbara Sorenson Hulka Distinguished Professor in Cancer Epidemiology] and Dr. Adam Zanation [Harold C. Pillsbury Distinguished Professor], sought to examine possible mechanisms underlying this relationship.
Using a sample of 1,108 patients diagnosed with head and neck cancer in North Carolina from the Carolina Head and Neck Cancer Epidemiology (CHANCE) study, we examined demographic, clinical, socioeconomic and preventive care factors for associations with advanced cancer stage at diagnosis. We found that patients with annual routine dental visits and at least one colonoscopy over the past 10 years had decreased odds of advanced stage at diagnosis. Alternatively, patients with no insurance or an income below $20,000 had increased odds of advanced stage at diagnosis. Patients in the study sample with an advanced stage at diagnosis had nearly twice the risk of five-year mortality compared to patients with an early stage at diagnosis.
These findings demonstrate the importance of insurance coverage and access to preventive care services such as routine dental visits in optimizing head and neck cancer outcomes. Policy solutions may involve Medicaid expansion in North Carolina, inclusion of routine dental services in Medicare coverage and oral health literacy campaigns. I am currently working with a team of dentists, physicians and public health leaders to disseminate our findings and advocate for policy change.”
“To my knowledge, Nicholas’ project is the first population-based study to show that use of preventive care services such as dental visits and colonoscopies can decrease the odds of advanced stage of head and neck cancer at diagnosis and reinforces the overall importance of socioeconomic disparities in disease prevention,” said adviser Andrew Olshan, Ph.D.
“Badin, N.C., is the site of one of the world’s largest aluminum smelting facilities, operated by Alcoa from 1917-2007. Residences and jobs were racially segregated, and the former smelting facility and its dumping sites are located in West Badin, where the residents remain predominantly Black. The Concerned Citizens of West Badin (CCWB) formed in 2013 to advocate for remediation of contamination in their community. Since then, they have raised former employees’ reports that the least desirable jobs in the plant were most often assigned to Black workers. The current epidemiology literature about aluminum work does not reflect experiences voiced by the CCWB, nor does it include analyses of race or gender disparities in health or labor divisions. The goals of my collaboration with the CCWB are to: 1) examine how racism has shaped working conditions and diseases and 2) begin to address the limits of epidemiology on aluminum work.
My dissertation characterizes differences in work exposures and health by race and gender. I found that non-white workers were most likely to be hired into dangerous jobs. In partnership with the North Carolina Environmental Justice Network, we also developed surveys documenting work exposures and health. So far, we have completed 25 surveys with Black former workers. Nearly everyone surveyed reported experiencing toxic work exposures, overt racism at work and cancer in their family. This research serves as a starting point in addressing former workers’ concerns about occupational disparities. It can further inform interventions to make manufacturing uniformly safe for workers, regardless of race or gender.”
“Libby’s work will strengthen the Badin community’s understanding of health effects of exposures, as well as contribute to understanding of the aluminum industry’s legacy in terms of worker health, and disparities in exposure for women and minority workers,” said adviser David Richardson, Ph.D.
“Skyrocketing overdose rates are not the only health threats impacting persons who use drugs. My research focuses on the intersection of drug use and infectious diseases, specifically infective endocarditis. This potentially life-threatening infection of the heart valves can affect numerous parts of the body and often requires open heart surgery. Persons who inject drugs can develop endocarditis following introduction of bacteria or fungi into the bloodstream from nonsterile injection.
We sought to characterize the extent to which endocarditis is occurring among N.C. residents injecting drugs in recent years, and to understand its impact to health systems and insurance payers. Collaborating with the N.C. Division of Public Health, we examined statewide trends in endocarditis hospitalizations and cardiac surgeries from 2007 to 2017. We found that hospitalizations for drug-related endocarditis have, overall, increased 12-fold and hospitalizations where cardiac surgery was performed increased 13-fold. Persons undergoing surgery for drug-related endocarditis were primarily young, uninsured or insured by Medicaid, and had hospital stays that were long and expensive.
Our study confirmed that endocarditis is a major emerging concern: Once thought to be a disease primarily impacting older persons with underlying heart disease, endocarditis in North Carolina is increasingly comprised of young persons who use drugs. In addition to afflicting patients with a life-changing illness, endocarditis also impacts health systems and Medicaid, which largely shoulder the high cost of endocarditis care. Our study strongly indicates providers and health systems to address endocarditis not only with antibiotics and surgery, but also with care for patients’ substance use disorders.”
“Asher’s research has had a significant impact in North Carolina, and as a leader in addressing drug use-associated infective endocarditis, he is poised to continue advancing practice and policy in North Carolina and across the United States,” said adviser David Rosen, M.D., Ph.D.
“Food for the Summer (FFTS) provides free meals through the federal Summer Food Service Program and enrichment activities to children in low-income areas of Chapel Hill and Carrboro. It is a community-wide effort to address child hunger led by the Chapel Hill Mayor’s Office, Chapel Hill-Carrboro City Schools and a variety of local organizations, with hundreds of community members volunteering each summer.
I have played a key role in supporting FFTS since it began in 2016, including participating in monthly planning meetings, offering nutrition education at meal sites and leading program evaluation efforts. In 2017, I received a Community Engagement Fellowship from UNC-Chapel Hill’s Carolina Center for Public Service to evaluate FFTS. I worked with representatives from FFTS to develop an evaluation plan that included multiple components. In 2017, over 45,000 meals were served to children at 42 meal sites throughout Chapel Hill and Carrboro, with an average of 1,100 children participating each day. A key outcome was the community-building aspect of FFTS. The program allowed individuals participating in and helping with the program to build relationships and connect with others at meal sites who they may not have otherwise met. Successful program components and areas of improvement were identified.
Results have been used by FFTS to improve the program, apply for grants, and recruit volunteers and donors. Key findings of the evaluation have also been shared with and used by organizations across North Carolina and the United States. FFTS continues to operate each summer and I remain highly involved with supporting this effort.”
“Jessica is an unmeasurable asset to the programs serving hungry children in North Carolina through her work with No Kid Hungry NC and UNC’s Health Promotion and Disease Prevention Center,” said adviser Maureen Berner, Ph.D.
“Increasing numbers of drinking water sources are impacted by waste streams, the treatment of which leaves many contaminants intact. At present, we are constantly being exposed to low levels of numerous contaminants in our public drinking water systems, which may induce biological changes after long-term exposure or in association with other chemicals. Vigilance concerning potential chemical interactions within water supplies is of vital importance, especially as new chemicals and new public health concerns develop.
My research on organic iodine contaminants, specifically iodinated contrast agents used in X-ray facilities, shows that wastewater treatments do not remove these contaminants completely and they can enter downstream drinking water treatment plants. Iodinated disinfection byproducts, which are significantly more toxic than regulated disinfection byproducts, can be formed once these chemicals are exposed to disinfectants. Long-term exposure to disinfectant byproducts is associated with increased bladder and colon cancer rates, so limiting their formation is imperative.
One treatment option for removing iodinated contrast agents from water uses powdered activated carbon, which my research has shown to be effective within existing drinking water treatment plants. This research highlights the need for increased drinking water source protection to decrease organic iodine contaminants which can react to form iodinated disinfection byproducts.
This research has been shared with the N.C. Water Resources Research Institute of the University of North Carolina System and the N.C. Urban Water Consortium.”
“Kirsten’s methodical approach to her research has generated an original body of work that is already impacting how utilities think about future planning of drinking water protection and wastewater management,” said adviser Howard Weinberg, Ph.D.
“In North Carolina, black gay and bisexual men experience the highest burden of HIV/AIDS. This high burden may be attributed to their lack of information about HIV protective and risk reduction behaviors, and underutilization of HIV prevention, treatment and care services. I collected primary data to investigate where black gay and bisexual men (ages 18-34) living in the state of North Carolina acquire HIV/AIDS information, and how they use that information to make decisions about the adoption of HIV protective and risk reduction behaviors. I also explored factors which motivate or deter their utilization of HIV prevention, treatment and care services.
Collaborating with the UNC Center for AIDS Research, the Behavior and Technology Lab in the Division of Infectious Diseases in the UNC School of Medicine, and a host of other community stakeholders, I recruited and surveyed 83 black gay and bisexual men living in urban, rural and suburban areas of North Carolina, and conducted follow-up interviews with 22 survey respondents. Overall, participants reported that they had acquired HIV/AIDS information online via the default search engines on their mobile device, social media sites, dating applications, health care providers and members of their social network. One hundred percent of participants reported that they had not received sexual health information pertaining to same-sex couplings through formal education in the state.
My findings show that peer support for the adoption of HIV protective and risk reduction behaviors, free or low-cost services, and convenient geographic locations of services are the strongest motivators for the utilization of HIV prevention, treatment and care services. Primary deterrents to the utilization of these critical services include misinformation spread about HIV/AIDS through social media sites and social networks, institutional and community stigma, and limited services in the geographic areas where they reside.”
“Megan’s exploration of factors which motivate or deter the utilization of HIV prevention and treatment services have significant implications for health care providers in the state of North Carolina,” said adviser Amelia Gibson, Ph.D.
“Alzheimer’s disease is the most common form of neurodegeneration and the only disease among the top 10 causes of death in the United States without any known treatment, prevention or cure. More than 170,000 North Carolinians are currently living with Alzheimer’s, and as the aging population rapidly grows, the incidence in North Carolina is projected to increase 23.5% within the next few years. The initial cascading events occur within the brain, unbeknownst, more than 20 years before symptoms are observed. Consequently, there is a lack of early diagnostic tools and the only definitive diagnosis is by a postmortem autopsy, examining the brain for deposits of plaques and tangles.
Although both plaques and tangles spread throughout the brain during the disease’s progression, it is the presence and accumulation of the tau tangles that correlate with cognitive decline and neurodegeneration. For that reason, the goal of my research is to determine how the tau protein is ultimately causative in Alzheimer’s. I investigated how tau undergoes the pathological transformation by utilizing purified protein, cell culture, generation of a novel mouse model and human brain tissue.
Results may provide an innovative framework for identifying novel Alzheimer’s therapies, diagnostic tools and genetic risk factors to find a cure for Alzheimer’s disease.”
“Hanna’s work is pushing us in an exciting new direction by allowing us to develop new therapies to treat Alzheimer’s disease, the leading cause of dementia in North Carolina,” said adviser Todd Cohen, Ph.D.
“In today’s world, there are ever-increasing demands placed on marine and coastal habitats. North Carolina’s coastal habitats provide many essential services to humans and support a large economic driver in our state: our commercial and recreational fisheries. Despite their vital role, very little is understood about how the area of any one particular habitat relates to a given amount of fishery production.
Tidal wetlands — otherwise knowns as marshes — are believed to serve as key habitat for many commercially and recreationally valuable fishes and crustaceans. Approximately 90% of the fishery species commercially harvested in North Carolina are considered ‘wetland-dependent.’ However, over the past 200 years, upwards of about 30% of coastal marshes have been lost due to a variety of human-induced stressors. This has resulted in the breaking apart of previously continuous tracts of habitat.
My dissertation research focuses on understanding how ecologically and economically important fishes and crustaceans use different types of marsh habitats as foraging areas to obtain energy and grow, and how fishery species respond to coastal habitat change, including degradation or loss of marshes. My dissertation work offers valuable insight into how these coastal habitats vary in support to fishes and crustaceans geographically. This provides key information to fishery managers toward the conservation and restoration of marshes to best enhance economically valuable species and sustain lucrative fishing industries in North Carolina and beyond.”
“Shelby’s data highlight that marsh size and shape are important controls on the role of this habitat for ecologically and economically prized fishes. The conservation and restoration applications of these data should be significant,” said adviser Joel Fodrie, Ph.D.