Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

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Biosecurity leaders gathered at Stanford this week to offer new ideas and perspectives on a wide range of issues critical to societal health.

The conference, “Emerging Leaders in Biosecurity,” began Sept. 13 with a trip to Lawrence Livermore National Laboratory in the East Bay. The second day featured a series of panel discussions on the Stanford campus. The fellows, chosen by the UPMC Center for Health Security, hailed from a wide array of backgrounds, including biological science, medicine, policy, the military, law, public health and the private sector.

Biosecurity and its relationship to global health is a key issue for Stanford’s Center for International Security and Cooperation (CISAC), which hosted and helped organize the conference along with the sponsoring UPMC Center. The conference was sponsored by the Defense Threat Reduction Agency and the emerging leaders program run by the UPMC. 

With rapid advances in technology and science, biosecurity is increasingly focused on how harmful biological agents could become national security threats and risks.

‘A changing world’

David Relman, co-director of CISAC, addressed the fellows on Wednesday with remarks on the origins of CISAC’s involvement in biosecurity. Relman, a professor in the departments of medicine, and microbiology and immunology, later served as a panelist in a discussion on biosecurity and national and international policy.

Megan Palmer, a fellow and CISAC senior research scholar on biosecurity, panel moderator and organizer of the conference, described the program as one that “brings together some of the most talented and committed rising leaders from multiple organizations and disciplines critical to national and international biosecurity.”

She noted, “Stanford's biosecurity programs are focused on developing strategies for biosecurity in a changing world. Today we face complex biosecurity challenging ranging from emerging infectious diseases, intentional misuse of biotechnology, and potential accidents and unintentional consequences of our increasing ability to manipulate living systems.”

At the same time, biotechnology continues to be an important and growing part of the global economy, Palmer said. “Our scholarship and engagement work seeks to developing new ways to think about and act in this changing environment.”

Research focus

Through the “emerging leaders” program, fellows deepen their expertise in biosecurity, build leadership skills, and forge networks of lasting professional relationships, she added.

The two-day conference included talks on threat awareness, biodetection, a “viral storm” exercise, bioengineering research, computational biology and national security, biosecurity and national and international policy, the evolving biotechnology field, among other topics.

Stanford participants and speakers included CISAC’s William Perry, the former secretary of defense; Drew Endy, a Stanford associate professor of bioengineering; Tim Stearns, chair of the biology department; Milana Trounce, clinical associate professor of emergency medicine; and Manu Prakash, assistant professor of bioengineering.

CISAC activity in biosecurity includes research on:

  • Risks in misusing the emerging life sciences;
  • Social and political factors behind drug-resistant antibiotics, leading to an tight pipeline for new drugs;
  • Examining the ethical responsibilities of scientists in this field and the needs for regulation;
  • Anticipating and pre-empting the misuse of biotechnology by people with the intent to do harm.

Matthew Watson, a senior analyst for the UPMC Center, said, “It is difficult to imagine a more fitting venue for the fall Emerging Leaders in Biosecurity workshop than Stanford. Few institutions can bring together this array of world class talent, including leaders from national security, the life sciences, and the private sector.”

Back in February, the UPMC Center for Health Security chose its 2016 fellows and launched the program with a Washington, D.C. workshop in March.

 

 

 

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Biosecurity experts gathered at Stanford on Sept. 13-14 as part of the conference, “Emerging Leaders in Biosecurity."
Nelson Almeida, AFP (Getty Images)
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Now in its second year, the seminar developed by Dr. Robert Chang, digital health inventor and Assistant Professor of Ophthalmology at Stanford University, recently came to a close at SCPKU, having trained twenty more of the next generation of rising healthcare entrepreneurs.  The seminar is a one-of-a-kind hospital immersion and educational experience with cross-cultural interdisciplinary student teams from Stanford and Peking University on a design sprint culminating in a live pitch in front of investors.  The grand-prize Huawei Bluetooth wearable went to each member of the winning team, MonitorREIN, who presented a novel way to monitor kidney transplant patients at home using a specialized gel insert capsule in the bladder.  Audience attendees also had a chance to win Xiaomi Mi Band wearables through a Wechat drawing. 

 

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Pitch Day winning team Team Purple MonitorREIN
Photo credit:  Stanford University

 

This year, the course was sponsored by Stanford’s Freeman Spogli Institute for International Studies, Peking University School of Innovation and Entrepreneurship in partnership with Prof. Dongmin Chen and Prof. Melody Li, and Director Huang from the Tongtai Zhongyi Traditional Chinese Medicine Institute.

The Medtech Hackathon event blends biodesign, design thinking, lean launch, business model canvas, and expert mentorship to help four teams of the brightest minds of medical, computer science, engineering, and business students tackle pain points in the Chinese medical system.  The students shadow physicians and interview patients to identify unmet needs and market opportunities. Then, they brainstorm solutions and develop rapid prototypes to test their ideas while obtaining real user feedback.  Along the way the teams incorporate real-world business models and receiving valuable feedback from physicians, digital health entrepreneurs, and investors while enjoying the entire process and building life-long friendships.

 

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Marshmallow challenge teamwork
Photo credit:  Stanford University

 

Besides MonitorREIN, the three other teams were Carnation Health focused on a telemedicine approach to postoperative orthopedic care, CANCAN trying to reduce smartphone-related neck strain using VR gaming, and Huhu, a real-time crowdsourced nursing platform for minor injuries.

“This year’s class was particularly impressive with their creativity and depth in business planning as well as the sophistication of their presentations in such a short time,” said Dr. Chang. “China has matured in the digital health and e-commerce markets, and the rapid pace of innovation in online to offline combined with sharing economies business models will certain benefit multiple industries around the world.”  The course is set to expand to include Peking University faculty next year.  Visit the program website for more details. 

 

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Final Pitch Day
Photo credit: Stanford University

 

Dr. Robert Chang can be reached at rchang3@163.com

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Stanford Medicine faculty Randall Stafford, Judith Prochaska, and Michael Baiocchi held a graduate seminar at SCPKU earlier this summer which brought together students from Stanford and Chinese universities to seek solutions to China's growing problems of cancer, stroke and heart disease.  Read more.

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Students from Peking University and Stanford attended a seminar led by Michael Baiocchi (front, far left), Randall Stafford (front, second from right) and Judith Prochaska (front, far right).
Kenny Fu
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Stanford University’s Center on Democracy, Development and the Rule of Law (CDDRL) is proud to announce our four incoming fellows who will be joining us in the 2016-2017 academic year to develop their research, engage with faculty and tap into our diverse scholarly community. 

The pre- and postdoctoral program will provide fellows the time to focus on research and data analysis as they work to finalize and publish their dissertation research, while connecting with resident faculty and research staff at CDDRL. 

Fellows will present their research during our weekly research seminar series and an array of scholarly events and conferences.

Topics of the incoming cohort include electoral fraud in Russia, how the elite class impacts state power in China, the role of emotions in support for democracy in Zimbabwe, and market institutions in Nigeria. 

Learn more in the Q&A below.


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Natalia Forrat

CDDRL Pre-Doctoral Fellow

Hometown: Tomsk, Russia

Academic Institution: Northwestern University

Discipline and expected date of graduation: Sociology, April 2017

Research Interests: authoritarianism, state capacity, social policy, civil society, trust, Russia and post-communist countries

Dissertation Title: The State that Betrays the Trust: Infrastructural State Power, Public Sector Organizations, and Authoritarian Resilience in Putin's Russia

What attracted you to the CDDRL Pre/post-doctoral program? I study the connection between state capacity and political regimes - the topic that is at the core of many research initiatives at CDDRL. Learning more about this work and receiving feedback for my dissertation will enrich and sharpen my analysis, while helping me to place it into a comparative context. I am looking forward to discussing my work with the faculty who study the post-Soviet region. I also will explore policy implications of my work with the help of policy experts at CDDRL.

What do you hope to accomplish during your nine-month residency at the CDDRL? Besides finishing writing my dissertation, I will workshop three working papers to prepare them for publication. The first one argues that Putin's regime used the school system to administer a large-scale electoral fraud in 2012 presidential elections; the second one shows how the networks of social organizations were used by subnational autocrats to strengthen the regime; and the third one will look at the factors that make the abuse of such organizations more difficult in some regions. In addition to these papers I will continue developing my post-graduation research project exploring the relationship between social trust and distrust, institutions, political competition, and democratization.

Fun fact: I have spent 25 years of my life in Siberia, and I can tell you: Chicago winters are worse!

 

 

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Shelby Grossman

CDDRL Postdoctoral Fellow

Hometown: Reading, MA

Academic Institution: Harvard University

Discipline & Graduation Date:  Government, Summer 2016

Research interests: political economy of development, private governance, market institutions, Sub-Saharan Africa, survey methods

Dissertation Title: The Politics of Order in Informal Markets: Evidence from Lagos

What attracted you to the CDDRL post-doctoral program? I was attracted to CDDRL largely for its community of scholars. Affiliated faculty work on the political economy of development and medieval and modern market institutions, topics that are tied to my own interests.

What do you hope to accomplish during your nine-month residency at the CDDRL? I plan to prepare a book manuscript based on my dissertation, a project that explains variation in the provision of pro-trade institutions in private market organizations through the study of physical marketplaces in Nigeria. In addition, I will continue to remotely manage an on-going project in Nigeria (with Meredith Startz) investigating whether reputation alleviates contracting frictions. I also plan to work on submitting to journals a few working papers, including one on the politics of non-compliance with polio vaccination in Nigeria (with Jonathan Phillips and Leah Rosenzweig). 

Fun fact: Contrary to popular belief, not all cheese is vegetarian. I have a website to help people determine if a cheese is vegetarian or not: IsThisCheeseVegetarian.com. 

 

 

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Daniel Mattingly

CDDRL Postdoctoral Fellow

Hometown: Oakland, California

Academic Institution: University of California, Berkeley

Discipline & Graduation Date: Political Science, Summer 2016

Research Interests: Governance, rule of law, state building, authoritarian politics, Chinese politics

Dissertation Title: The Social Origins of State Power: Democratic Institutions and Local Elites in China

What attracted you to CDDRL?  The Center has a fantastic community of scholars and practitioners who work on the areas that I'm interested in, including governance and the rule of law. I'm excited to learn from the CDDRL community and participate in the Center's events. The fellowship also provides me with valuable time to finish my book manuscript before I start teaching.

What do you hope to accomplish during your nine-month residency at the CDDRL? While at CDDRL, I plan to prepare my book manuscript and to work on some related projects on local elites and state power in China and elsewhere. 

Fun fact: I grew up on an organic farm in Vermont.

 

 

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Lauren E. Young

CDDRL Postdoctoral Fellow

Hometown: Saratoga, CA

Academic Institution: Columbia University 

Discipline & Graduation Date: Political Science (Comparative Politics, Methods), May 2016 (defense), Oct 2016 (degree conferral)

Research Interests: political violence, political economy of development, autocratic persistence, democratization, protest, electoral violence

Dissertation Title: The Psychology of Repression and Dissent in Autocracy

What attracted you to the CDDRL post-doctoral program? As a graduate of the CISAC honors program when I was an undergraduate at Stanford, I have seen first-hand how intellectually stimulating, collaborative, and plugged into policy CDDRL is. While at the center I will be revising my dissertation work on the political psychology of participation in pro-democracy movements in Zimbabwe for submission as a book manuscript, and moving forward new projects that similarly seek to understand how different forms of violence by non-state actors affects citizens' preferences and decision-making. Because of its deep bench of experts on autocracy, narco-trafficking, and insurgency, CDDRL will add enormous value to these projects.

What do you hope to accomplish during your nine-month residency at the CDDRL?  During my fellowship year, my primary goal is to revise my research on Zimbabwe into a book manuscript. I defended my dissertation as three stand-alone articles, including two experiments showing that emotions influence whether opposition supporters in Zimbabwe express their pro-democracy preferences and a descriptive paper showing that repression has a larger effect on the behavior of the poor. To prepare the book manuscript during my fellowship, I will bring in additional quantitative and qualitative descriptive evidence and tie the three papers together into a cohesive argument about how opposition supporters make decisions about participation in protest, why emotions have such a large effect on these decisions, and how this affects variation across individuals and the strategic choices of autocrats and activists.

Fun fact: During my fieldwork I took an overnight train from Victoria Falls to a southern city in Zimbabwe and hitch-hiked into a national park. It got a little nerve-wracking when night started to fall, but ended with  an invitation to a barbecue! 

 

 
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Shelby Grossman was a research scholar at the Cyber Policy Center. Her research focuses on online safety. Shelby's research has been published in Comparative Political Studies, PNAS Nexus, Political Communication, The Journal of Politics, World Development, and World Politics. Her book, "The Politics of Order in Informal Markets," was published by Cambridge University Press. She is co-editor of the Journal of Online Trust and Safety, and teaches classes at Stanford on open source investigation and online trust and safety issues. 

Shelby was an assistant professor of political science at the University of Memphis from 2017-2019, and a postdoctoral fellow at Stanford University’s Center on Democracy, Development, and the Rule of Law from 2016-17. She earned her Ph.D. in Government from Harvard University in 2016.

Research Scholar
CDDRL Postdoctoral Fellow, 2016-17
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A study of health insurance claims showed that patients undergoing 11 of the most common types of surgery were at an increased risk of becoming chronic users of opioid painkillers, according to researchers at the Stanford University School of Medicine.

But the slight overall increase in risk of 0.5 percent in no way suggests that patients should skip surgery over concern of becoming addicted to opioids, the study said. Instead, it’s a reminder that surgeons and physicians should closely monitor patients’ use of opioids after surgery — even patients with no history of using the pain-relieving drugs — and use alternate methods of pain control whenever possible.

The study was published July 11 in JAMA Internal Medicine.

“For a lot of surgeries there is a higher chance of getting hooked on painkillers,” said the study’s lead author, Eric Sun, MD, PhD, a Stanford Health Policy researcher and instructor in anesthesiology at Stanford. Sean Mackey, MD/PhD, professor of anesthesiology, is the senior author of the study and SHP's Laurence Baker was another co-author of the study.

Patients who had knee surgery had the largest risk, as they were roughly five times more likely than a control group of nonsurgical patients to end up using opioids chronically, followed by those undergoing gall bladder surgery, whose risk was three-and-a-half times greater than those in the control group.

“We also found an increased risk among women following cesarean section, which was somewhat concerning since it is a very common procedure,” adding that the risk was 28 percent higher than among the control group, Sun said.

Other factors that contributed to an increased risk for chronic opioid use included being male, elderly, taking antidepressants or abusing drugs.

Eric Sun

The opioid abuse epidemic

Since prescription painkillers became cheap and plentiful in the mid-1990s, drug overdose death rates in the United States have more than tripled, according to the Centers for Disease Control and Prevention. Seventy-eight Americans die every day from an opioid overdose, it reported.

Previous studies have shown increased risks of chronic opioid use post-surgery, but unlike past studies, Sun and colleagues set out to examine patients who hadn’t received prescriptions for opioids for at least one year prior to surgery. Among the opioid prescription drugs examined in the study were hydrocodone, oxycodone and fentanyl — the drug responsible for the recent accidental overdose death of legendary musician Prince.

The researchers examined health claims from 641,941 privately insured patients between the ages of 18 and 64 who had not filled an opioid prescription in the year prior to surgery, then compared them with about 18 million nonsurgical patients, who also hadn’t received opioid prescriptions for at least a year. The claims were filed between 2001 and 2013 and provided by Marketscan, a database of 35 million beneficiaries.

Except for the minor procedures known to be somewhat pain-free, such as a cataract surgery and laparoscopic appendectomy, all 11 types of surgery were associated with an increased risk of chronic opioid use, the study said.

Other pain-control measures

“The message isn’t that you shouldn’t have surgery,” Sun said. “Rather, there are things that anesthesiologists can do to reduce the risk by finding other ways of controlling the pain and using replacements for opioids when possible.”

Sun said he and his colleagues in surgery and anesthesia at Stanford try to use regional anesthetics when possible to reduce the need for opioids post-surgery. He added that patients should also be encouraged to use pain-management alternatives such as Tylenol following surgery.

Sun is featured in this CBS news story:

 

“Even when taken exactly as prescribed, opioids carry significant risks and side effects,” said study co-author Beth Darnall, PhD, clinical associate professor of anesthesiology and author of the book Less Pain, Fewer Pills: Avoid the Dangers of Prescription Opioids and Gain Control over Chronic Pain. “Ideally, opioids are avoided in treating chronic pain, and pain treatment should emphasize comprehensive care, including physical therapy, pain psychology and self-management strategies.”

As a pain psychologist and clinician-scientist, Darnall emphasizes alternate methods of pain management based on evidence-based techniques that can help calm the nervous system such as diaphragmatic breathing, progressive muscle relaxation and mindful meditation.

She is studying the use of a pain psychology class at Stanford for women undergoing surgery for breast cancer called “My Surgical Success” designed to help patients develop a personalized pain-management plan to control the anxiety associated with anticipating surgical pain.

“It turns out that a lot of chronic pain develops from surgery, and pre-surgical pain ‘catastrophizing’ is a major risk factor for having a lot of pain,” Darnall said. “We hope that by optimizing patients’ psychology — and giving them skills to calm their own nervous system — they will have less pain after surgery, need fewer opioids and recover quicker.”

The research was funded by a grant from the Foundation for Anesthesia Education and Research and the Anesthesia Quality Institute.

Stanford’s Department of Anesthesiology also supported the work.

 

Tracie White is a science writer for the medical school’s Office of Communication & Public Affairs. Email her at tracie.white@stanford.edu.

 

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The Asia Health Policy Program at Stanford’s Shorenstein Asia-Pacific Research Center, in collaboration with scholars from Stanford Health Policy's Center on Demography and Economics of Health and Aging, the Stanford Institute for Economic Policy Research, and the Next World Program, is soliciting papers for the third annual workshop on the economics of ageing titled Financing Longevity: The Economics of Pensions, Health Insurance, Long-term Care and Disability Insurance held at Stanford from April 24-25, 2017, and for a related special issue of the Journal of the Economics of Ageing.

The triumph of longevity can pose a challenge to the fiscal integrity of public and private pension systems and other social support programs disproportionately used by older adults. High-income countries offer lessons – frequently cautionary tales – for low- and middle-income countries about how to design social protection programs to be sustainable in the face of population ageing. Technological change and income inequality interact with population ageing to threaten the sustainability and perceived fairness of conventional financing for many social programs. Promoting longer working lives and savings for retirement are obvious policy priorities; but in many cases the fiscal challenges are even more acute for other social programs, such as insurance systems for medical care, long-term care, and disability. Reform of entitlement programs is also often politically difficult, further highlighting how important it is for developing countries putting in place comprehensive social security systems to take account of the macroeconomic implications of population ageing.

The objective of the workshop is to explore the economics of ageing from the perspective of sustainable financing for longer lives. The workshop will bring together researchers to present recent empirical and theoretical research on the economics of ageing with special (yet not exclusive) foci on the following topics:

  • Public and private roles in savings and retirement security
  • Living and working in an Age of Longevity: Lessons for Finance
  • Defined benefit, defined contribution, and innovations in design of pension programs
  • Intergenerational and equity implications of different financing mechanisms for pensions and social insurance
  • The impact of population aging on health insurance financing
  • Economic incentives of long-term care insurance and disability insurance systems
  • Precautionary savings and social protection system generosity
  • Elderly cognitive function and financial planning
  • Evaluation of policies aimed at increasing health and productivity of older adults
  • Population ageing and financing economic growth
  • Tax policies’ implications for capital deepening and investment in human capital
  • The relationship between population age structure and capital market returns
  • Evidence on policies designed to address disparities – gender, ethnic/racial, inter-regional, urban/rural – in old-age support
  • The political economy of reforming pension systems as well as health, long-term care and disability insurance programs

 

Submission for the workshop

Interested authors are invited to submit a 1-page abstract by Sept. 30, 2016, to Karen Eggleston at karene@stanford.edu. The authors of accepted abstracts will be notified by Oct. 15, 2016, and completed draft papers will be expected by April 1, 2017.

Economy-class travel and accommodation costs for one author of each accepted paper will be covered by the organizers.

Invited authors are expected to submit their paper to the Journal of the Economics of Ageing. A selection of these papers will (assuming successful completion of the review process) be published in a special issue.

 

Submission to the special issue

Authors (also those interested who are not attending the workshop) are invited to submit papers for the special issue in the Journal of the Economics of Ageing by Aug. 1, 2017. Submissions should be made online. Please select article type “SI Financing Longevity.”

 

About the Next World Program

The Next World Program is a joint initiative of Harvard University’s Program on the Global Demography of Aging, the WDA Forum, Stanford’s Asia Health Policy Program, and Fudan University’s Working Group on Comparative Ageing Societies. These institutions organize an annual workshop and a special issue in the Journal of the Economics of Ageing on an important economic theme related to ageing societies.

 

More information can be found in the PDF below.


 

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Speakers: 

Randall Stafford, MD, PhD, Professor of Medicine (Preventive Medicine), Stanford University
Judith Prochaska, PhD, MPH, Associate Professor of Medicine (Health Psychology), Stanford University
Mike Baiocchi, PhD, Assistant Professor of Medicine (Research Design), Stanford University

Multiple factors have led to China’s increasing burden of non-communicable diseases, including population aging, globalization of dietary patterns, urbanization, sedentary lifestyles, etc.  The country faces new challenges that strain existing health systems and have spawned multiple healthcare reforms. Yet, prevention strategies offer great hopes as China works to tackle such conditions as hypertension, diabetes, heart disease, stroke, and cancer.  While China’s situation is of unique magnitude, much of the world is struggling to cope with the increasing burden of cardiovascular disease and cancer.  Much could be gained by examining China’s predicament and its response to its chronic disease epidemic.

Experts from both the United States and China will discuss the issue from the following perspectives: well-being – an upstream preventive approach, tobacco and emerging nicotine product, how to become the top country in health research, cancer prevalence and geographic information system. This symposium is also the culmination of the seminar series – “Cardiovascular Disease and Cancer Prevention in China” at the Stanford Center at Peking University. Three student groups will also present their solutions to the problems of preventing obesity among male college students, salt-reduction in university student diets, and prevention of the initiation of smoking in adolescents. 

Theis event is open to the public. Please RSVP with Mr. Zhang Sanjiu: sanjiu39@stanford.edu

 

 

 

9:00 – 9:20

Opening Remarks:  The Social Geography of NCDs

 

Randall S. Stafford, MD, PhD

9:20 – 9:50

Guest Speaker from Cancer Hospital

 

Lei Yang

9:50-10:10

Tobacco and Emerging Nicotine Products: from the East and West

 

Judith Prochaska, PhD, MPH

10:10 – 10:30

How to Become the Top Country in Health Research

 

Mike Baiocchi, PhD

10:30 – 10:50

Coffee Break

 

 

10:50 – 11:00

WELL-China: A New Approach to Prevention Research

 

Randall Stafford, MD PhD

11:00-11:05

Introducing the SCPKU Seminar and the Project Reports

 

Yan Min, BM MA

11:05-11:25

SALT: Students and Labeling + Technology

 

Student Team 1

11:25 – 11:45

A Phone App-Based Behavioral Intervention for Overweight/Obesity Prevention in Chinese Males at the University Transition

 

Student Team 2

11:45-12:05

The Effect of Limiting Adolescents’ Exposure to Parental Smoking on Adolescent Girls’ Smoking Incidence and Attitudes Towards Smoking

 

Student Team 3

12:05 – 12:10

Concluding Remarks

 

Jodi Prochaska, PhD, MPH

12:10 – 1:30

Lunch

 

 

 

 

Lee Jung Sen Building, Langrun Yuan

No. 5 Yiheyuan Road, Haidian District 

Beijing, China

 

Symposiums
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