Appendix C: Self-Study Questionnaire Responses

Health Promotion Partnership

1. List the active faculty participating in the Partnership. How has this changed over time?

James O. Prochaska, Director; Laurie Ruggiero, Associate Director; Brian Blissmer, Ph.D.; Marjorie Caldwell, Ph.D.; Phil Clark, Ph.D.; Fran Cohen, M.A.; Geoffrey Greene, Ph.D.; Dayle Joseph, Ph.D.; Robert Laforge, Ph.D.; Norbert Mundorf, Ph.D.; Colleen Redding, Ph.D.; Deborah Riebe, Ph.D.; Joseph Rossi, Ph.D.; Wayne Velicer, Ph.D.; Mark Wood, Ph.D.

There have been several major changes in faculty participation in the Health Promotion Partnership. Two teams are no longer active: 1. The Chronic Back Injury Team with focus on physical therapy. This team was not able to launch an on-going research program due primarily to the intensive teaching demands of the part time faculty and the limited number of faculty in the program. 2. The Medication Compliance Team moved away from the partnership probably due to conflict between the head of that team and the head of the partnership. One team has been less active, namely, the Smoking Cessation Team, in part because Dr. Unto Pallonen, head of the team, left for the University of Michigan, and Dr. Nelson Smith partly retired. These activities have continued primarily through grants in the CPRC. Two others have been added: 1. The Alcohol Abuse Team which has been very active and very successful; and 2. The Minority Health Promotion Team which has had a late start and is headed by a faculty member with many conflicting demands.

2. List the annual number of research papers and presentations made associated with Partnership activities. Do Not list each citation, but just the number of papers or presentations.

Because of the multiple affiliations of HPP faculty, it is very difficult to know when to attribute publications and presentations to HPP or to alternative affiliations. Furthermore, HPP does not track such statistics on an annual basis. Here is our best estimate since the start of the HPP.

Books: 1; Chapters: 30; Journal Articles: 30; Presentations: 70

3. What external funding has resulted from Partnership activities? Give examples of any funding that was directly linked to the Partnership.

1. The HPP Aging and the Weight Management Teams combined to develop the SENIOR Project (Study of Exercise and Nutrition in Older Rhode Islanders): funded for four years by NIA for $2,800,000.

a. A supplemental grant of $216,000 from NIA.

b. A second supplemental grant anticipated for 4/l/01 for $482,000.

c. A pilot project for $35,000 from the Rhode Island Public Health Foundation.

2. The Weight Management Team has been funded for 3 years by ACS for $401,000.

3. The Smoking Cessation Team was funded for 2 years by AHA for $131,780.

As with publications and presentations, it is very difficult to determine which grants to attribute to HPP and which to other affiliations. There are major structural barriers to bringing grants in under HPP. The biggest is the distribution of indirect dollars. The NIA grant, for example, has to distribute indirects across so many colleges and departments, that the funded project itself has little left to use for project purposes.

Since the start of the HPP, faculty affiliated with the HPP have generated more than $14,000,000 in external funding that are not included in the funding cited above. Also, there are over $8,000,000 in health promotion grant proposals that are pending. Finally, there are over $20,000,000 in grant proposals that are being prepared for June submission.

4. Give examples of how the Partnership activities are or will be self-sustaining? For those Partnerships that no longer receive funding from URI, has this objective been met? How? For those Partnerships still receiving URI funding, what is the plan to become self-supporting? For both groups, what is the management plan for self-support?

Almost all health promotion research at URI is being accomplished through self-support, that is, through external grants. Examples include the Senior Project, the multiple Alcohol Abuse projects, the weight management project, the smoking cessation projects and the multiple behavior change projects.

A more difficult question is will the HPP be self-sustaining. Another difficult question is should the HPP be entirely self-supported? Given that the HPP is intended to be an alternative structure that integrates teaching/research/service/commerce as much as possible, there is serious question as to whether all of these activities can be or should be paid by external funding. Why shouldn't the teaching and service functions be supported by tuition dollars or state dollars to the university?

The HPP is currently developing a major training grant from NIH that would help support the teaching and research mission. But these funds can support students primarily. Faculty training time must be paid for primarily by the University, according to NIH policy. The question as to whether the HPP will be self-sustaining will be addressed under questions 5, 10 and 11.

5. How have Partnership activities affected faculty workload? Give examples.

Unfortunately the teaching part of the HPP has most often been accomplished as an over-load for too many of the HPP faculty. Sustaining interdisciplinary involvement of faculty from 6 to 8 departments is one of the biggest problems when each faculty member has demanding and conflicting instructional responsibilities in their own departments or programs.

6. What new courses have been created from the result of the Partnership? List the enrollment in these courses.

1. A Health Promotion course is offered each semester and serves about 20 to 25 students, mostly undergraduates. This course is taught by Dr. Laurie Ruggiero but also includes guest lectures by a variety of HPP faculty.

2. A Health Promotion Minor. This 18 credit minor has been organized by Dr. Nelson Smith.

3. Aging and Health Promotion is offered each semester and is linked to the Senior Project. It serves 4-6 students per semester.

4. Applied Research Methods for Health Promotion. This course has been team taught by faculty on the Alcohol Abuse team and serves 7 students.

5. Alcohol Use and Misuse serves 15 to 30 undergraduates.

7. How many undergraduate students and how many graduate students have participated in the Partnership? How many of the publications and presentations listed in question 2 have had student co-authors?

Typically 8 to 12 students participate on each team with about 2/3's graduate and 1/3 undergraduate students. Students have been co-authors on at least 30 of the presentations and 15 of the publications.

8. What have student participants done after they have left URI? Give examples, especially highlighting how the Partnership benefited the student.

1. Four graduate students went on to faculty type positions at University of Alabama at Birmingham, Hawaii, URI and San Diego State.

2. Two Ph.D's joined a start-up company in Rhode Island.

3. Four went on to post-docs.

4. About 20 have gone on to doctoral or masters programs.

5. Five have joined companies or started personal training businesses.

6. Four are working in Cardiac Rehab.

7. Two are teachers.

8. At least four have won awards for their research, one nationally, one regionally and two locally.

9. Students in general have been extremely enthusiastic about their experiences on health promotion projects, frequently saying things like "This is the best experience I have had at URI", "These experiences played key roles in getting in graduate school.", and "Working on projects really helped me understand team work and what other health professionals do."

9. What service contributions have arisen from Partnership activities, to the professional community, URI, or to the State of Rhode Island?

Health Promotion Projects have served thousands of at risk people at URI, in Rhode Island and nationally. These service projects include enhancing nutrition and exercise in seniors in Rhode Island, high school students in Rhode Island, their parents in Rhode Island. Also alcohol abuse and smoking cessation services have been made available to students at URI, Harvard Pilgrim members in New England, high school student and their parents in Rhode Island and smokers nationally.

Professionally the Health Promotion Programs at URI are seen as standard setters for research and practice nationally and internationally. Dr. Thomas Kottke from Mayo Clinic introduced a colloquium by saying that the center of health promotion has shifted from Stanford and Minnesota to Kingston, Rhode Island. Also, URI services as a coordinating type center for 15 Trans-NIH projects that are seeking to collaborate across 15 institutions funded by NIH for these ground-breaking projects. This leadership role grew out of the SENIOR Project funded as one the first Trans-NIH projects.

10. What does the Partnership need to become more effective?

Frankly, the question should be what does the University need to become more effective? The answer would be to restructure as much of the University as possible. Currently the University follows a factory model with silo structures and functions. So we have the classroom structure with the teaching function; the lab or library structures with a research or scholarship function; committee or community structures for serves functions; and corporations for consulting or commerce functions.

As a knowledge organization in a knowledge society, the university needs to transform itself like most knowledge organizations. Activities should be organized around process not structure or function. The process of learning through teaching, research, service and commerce is a much more viable model.

If the University could transform itself the Partnerships would thrive, because they would be at the cutting edge of the new organization and the synergistic process. Right now the Partnerships are a relatively low cost experiment within a dominant culture that has the power and the structures that can easily defeat this experiment.

11. What changes to the Partnership program could be made to make it better?

For the HPP to survive let alone thrive some major changes would be needed. Ideally the transformation of URI from a factory model to a knowledge model would solve the major problems. Short of that the HPP needs some faculty who can be dedicated full time to making the teaching/research/service/commerce mission sustainable. Here the CPRC is an excellent example of how a few full-time dedicated tenure and research faculty members can sustain a mission that has had major impacts locally, nationally and internationally.

A few faculty whose careers were directly linked to the growth and success of the HPP would make an incredible difference. Such faculty would be freed from the constant conflicts of demands from multiple departments and colleges. The teaching requirements of such faculty would be tied to having growing numbers of students participating in the HPP, especially undergraduate students.

Another change would be to have a substantial portion of indirect funds be returned to the HPP for purposes of growth and sustainability. Perhaps an excellent model for such changes is the GSO that has all of its faculty dedicated full-time to the GSO, are paid by the University and the State and receive considerable indirect as well as direct funds. But a major difference is that the HPP would integrate a growing number of undergraduate students.

The HPP is positioned to have major increases in NIH funding. NIH will more than double its budget in the next 5 years. Disease prevention and health promotion is one of the top priorities at NIH. URI is positioned to more than double its funding in these areas. URI is recognized as an international leader in health promotion. URI must continue to invest and change in ways the would be expected of such a leader.

12. For those Partnerships no longer receiving URI funding: Did the Partnership receive additional funds from the Provost after the initial grant expired to support student activities? How were those funds used?

The HPP received additional funds from the Provost and used the large majority of these funds to support undergraduate participation. Greater funds were provided for the two teams that started after the initial funding, namely the Alcohol Abuse and Minority Health Promotion Teams.