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Thanks to his prior decades of coronavirus research, the lab of Ralph Baric, PhD, William R. Kenan, Jr. Distinguished Professor of epidemiology, has been one of the most industrious and important sites of scientific inquiry during the COVID-19 pandemic. Making key discoveries that have fueled the development and distribution of vaccines and treatments, researchers in the Baric Lab have been at the forefront of the COVID-19 response.

Molnupiravir, a twice-daily pill that stops the virus from multiplying, is one of two authorized drugs available that provides COVID-19 patients with the option to treat the virus at home instead of getting an infusion in the hospital. Tim Sheahan, PhD, led the breakthrough experiments in the Baric Lab that first showed molnupiravir’s effectiveness against coronaviruses in 2020.

“Before the pandemic, we were working on a few antiviral drugs as potential therapies for different types of coronaviruses that were genetically unrelated,” Sheahan says, “and when we found out there was a new virus in China that was a coronavirus, we added SARS-CoV-2 to our paper.”

"Translating research into practice is usually not very common for people like me. ...With the pandemic, almost everything we do is research intended to improve human health or translate into some kind of therapy, vaccine or antibody."

— Tim Sheahan, PhD, assistant professor

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That paper led to a phase 2 clinical trial at UNC. Because Sheahan and his colleagues had done the preclinical work on molnupiravir, they were able to do the virology for UNC’s clinical trial to see whether the drug would work in humans. It did: The trial, and subsequent phase 2 and 3 trials at UNC and elsewhere, found that molnupiravir more rapidly reduced infectious virus in the airway, hospitalizations and deaths significantly in people who had been recently infected with SARS-CoV-2.

“Doing the preclinical research on drugs that ultimately get used in people is gratifying,” says Sheahan, who usually works with cell cultures and small animals instead of human subjects, “but participating in a clinical trial and showing that a treatment is working was a pleasant surprise.”

Sheahan, who originally planned to study water resources and water biology, declared microbiology as his second major after taking a course in it at the University of New Hampshire. After graduating, he worked in a gene therapy lab in Boston that was trying to use viruses to cure genetic disease — finding “a microscopic world where there’s a lot going on that you can’t see” — sparking an interest in virology and a move to Chapel Hill, where he began studying under Baric in 2003.

Continuing his work in antiviral drug development, Sheahan is now focused on oral therapies that have less chance of adverse interactions with other medicines, as well as cocktail-based approaches that would attack the virus in multiple places, reducing its ability to form a drug resistance.

“Translating research into practice is usually not very common for people like me — I’m a virologist who works in a lab, and normally we’re working on answering basic science questions,” Sheahan says. “With the pandemic, almost everything we do is research intended to improve human health or translate into some kind of therapy, vaccine or antibody.”

Timing was everything for David Martinez, PhD, a postdoctoral researcher in the lab of Ralph Baric, PhD, William R. Kenan, Jr. Distinguished Professor of epidemiology, since 2018. He completed his Biosafety Level 3 lab training in March 2020 — just as the virus began to spread in the United States — allowing him to work in the lab studying COVID-19 alongside world-renowned virologist Baric and other coronavirus experts in a lab that was already equipped to be a leader in responding to the pandemic.

“We already had all these systems and protocols in place to work with cousins of this virus, so when it hit, we did not have to reinvent the wheel — we could rapidly transition into SARS-CoV-2 research,” says Martinez, who is a Hanna H. Gray Fellow at the Howard Hughes Medical Institute. “Having expertise like that absolutely positioned us into knowing exactly what questions we needed to answer to make a contribution, and we were able to rapidly produce reagents that were useful to the field — not just in understanding fundamental biology of the virus, but in collaborating with major pharmaceutical companies to actually develop products that are now widely used, including the Moderna and Johnson & Johnson COVID-19 shots.”

"If history is to repeat itself, it’s of critical importance that we work on universal-based approaches now so that we are ready the next time a coronavirus emerges."

— David Martinez, PhD

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Another product is a universal vaccine that would ward off future outbreaks by protecting against several types of coronaviruses that are likely to jump from animals to humans. Martinez, Baric and the research team developed a vaccine to protect against COVID-19 and other group coronaviruses, such as the original SARS virus and bat SARS-related viruses that could emerge at a later time. The vaccine prevented both infection and lung damage in mice, and additional testing could lead to human clinical trials next year. The team continues to work on next-generation vaccines that could introduce additional proteins that may make vaccines work better in controlling breakthrough infections.

“There is absolutely a need for universal-based vaccines that can target a broader group of coronaviruses,” Martinez says, noting that historically, a new type of pathogenic coronavirus tends to emerge within a decade of its predecessor. “If history is to repeat itself, it’s of critical importance that we work on universal-based approaches now so that we are ready the next time a coronavirus emerges.”

Martinez grew up in El Salvador, where his father was a physician who often treated infectious diseases. When his family moved to the U.S. in 2003, he decided to study microbiology at Oklahoma University. After he completed a virology course he took as a senior, he changed his research and career focus. He received his doctoral degree from Duke University.

“And then, in 2018, I had the opportunity to work in the lab of the world’s leading coronavirologist, so I couldn’t turn that offer down,” Martinez says. “This is the Gillings School of Global Public Health, and it’s nice when the name of the school can also serve its purpose. The Baric Lab as a team can do just that — contribute to global public health — and that has been the opportunity of a lifetime.”

One of the key questions about the emergence of a new virus is how readily infection can spread from person to person. UNC researchers conducted an observational study early in the pandemic showing that the SARS-CoV-2 virus transmits “early and often” among people who share a home, where practices like patient isolation and social distancing might not be practical or possible.

Researchers from Gillings include Kimberly Powers, PhD, associate professor of epidemiology; Feng-Chang Lin, PhD, associate professor of biostatistics; Rebecca Rubinstein, MPH, doctoral epidemiology student; Katie Mollan, MS, biostatistician and doctoral epidemiology student; and Haoming Zhang, MS, recent biostatistics graduate. They collaborated with researchers led by Jessica Lin, MD, MSCR, in UNC’s Institute of Global Health and Infectious Diseases to study infection among 100 COVID-positive patients and 208 of their household members in seven N.C. counties.

"This study was conducted very early in the pandemic — before vaccines were available and even more transmissible variants emerged — and it really underscores the importance of using the vaccines we are now fortunate to have to slow transmission and prevent severe disease."

— Kimberly Powers, PhD, associate professor

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The researchers found that SARS-CoV-2 spreads quickly among household members, with the majority of secondary cases occurring within the first week of the initial positive test. They also found that households with a higher living density, or more than three people occupying fewer than six rooms, had a higher risk of infection. With households from underrepresented communities in the study more likely to experience high living density, this finding may provide partial insight into how and why communities of color have suffered disproportionately from the pandemic.

“This study was conducted very early in the pandemic — before vaccines were available and even more transmissible variants emerged — and it really underscores the importance of using the vaccines we are now fortunate to have to slow transmission and prevent severe disease,” Powers says.

The CO-HOST study is one of several COVID-19 studies in which Powers was involved from the outset of the pandemic, with scientists designing, launching and performing research on extraordinarily compressed timelines against an ever-shifting backdrop as pandemic conditions continued to evolve. For example, Powers’ study on N.C. public school teachers’ contact patterns and mask use was a challenge to design because no one knew which school districts would be open for in-person learning during the study’s data collection phase. “Research questions could quickly become obsolete, and potential avenues for pursuing the work could open or close at a moment’s notice,” she says of doing real-time research in a pandemic.

As public health experts worked almost nonstop to understand and respond to the emerging pandemic, feelings of stress and exhaustion were accompanied by unprecedented teamwork and a shared sense of purpose. “Everywhere I looked, both within my own research teams and across my full network of colleagues, people were really charging into this crisis and throwing everything they had at this threat from day one,” Powers says. “It was all hands on deck around the clock, with new collaborations forming and taking off overnight. Everyone really showed up for months and months and months on end in ways that I’ll never forget.”

Improving vaccine access and uptake

Research by Noel Brewer, PhD, Gillings Distinguished Professor in Public Health and professor of health behavior, became an important part of vaccine strategy for the U.S. Centers for Disease Control and Prevention (CDC). Brewer found that people who received COVID-19 vaccine recommendations from their doctors or health care providers were more likely to get vaccinated. Brewer is part of the CDC’s Vaccine Confidence Work Group and, with Melissa Gilkey, PhD, assistant professor of health behavior, created Announcement Approach Training, which teaches health care providers to communicate more effectively about vaccination.

Gillings researchers also were involved in efforts through the UNC Center for Health Promotion and Disease Prevention (HPDP) to boost vaccination rates in areas where rates were low. One of 26 CDC Prevention Research Centers across the country that received support to increase equitable access to COVID-19 vaccines, the HPDP provided 18 primary care clinics with the coaching, data and community partnerships needed to get more people vaccinated, especially Black and Latinx patients.

Evaluating long-term COVID-19 vaccine efficacy

Danyu Lin, PhD, Dennis Gillings Distinguished Professor in the Department of Biostatistics, developed a statistical model to determine the long-term effectiveness of vaccines against COVID-19. Pharmaceutical companies plan to use this method as part of their ongoing trials to determine the optimal timing for booster shots.

Lin worked with Donglin Zeng, PhD, professor of biostatistics at Gillings, and Peter B. Gilbert, PhD, lead statistician with the COVID-19 Prevention Network, which conducts phase 3 efficacy trials for COVID-19 vaccines and monoclonal antibodies. In vaccine trials, some participants get the vaccine while others get a placebo. Lin’s study showed how to estimate time-varying vaccine efficacy (VE) through staggered vaccination of participants, and compares the performance of blinded and unblinded crossover designs in estimating long-term VE.

Understanding COVID-19’s airborne viability

To learn how to reduce the risk of exposure to infectious viruses, Karsten Baumann, PhD, assistant professor of environmental sciences and engineering, led a study of air from the dorm rooms of UNC students who tested positive for COVID-19. This research laid the groundwork for National Science Foundation research investigating several methods to inactivate infectious aerosol and contributed to a better understanding of outdoor exposures and potential methods to prevent indoor exposures, such as modifications to ventilation systems.

COVID-19 simulation shows need for continued safety efforts during vaccine distribution

As vaccines became more widely available in the spring and summer of 2021, Associate Professor Kristen Hassmiller Lich, PhD, and doctoral student Karl Johnson, both with the Gillings Department of Health Policy and Management, helped develop a computer simulation model of North Carolina showing that continued mask-wearing and physical distancing could help prevent spikes in COVID-19 cases even as more people get vaccinated. The team, led by Mehul Patel, PhD, a Gillings alumnus and a clinical and population health researcher in the department of Emergency Medicine at UNC’s School of Medicine, showed that until about half of N.C.’s population was vaccinated, removing non-pharmaceutical interventions (NPIs) such as masks and physical distancing could lead to continued spread of the virus. Such models have helped guide state leaders in making decisions around COVID-19 safety protocols.

Tracking human rights effects of COVID-19 response

As the COVID-19 pandemic continued across the world, public health responses varied greatly, and they rapidly evolved to keep up with changing conditions. The unprecedented nature of the pandemic meant human rights considerations often took a backseat to widespread public health concerns. To help keep track of how the pandemic — and pandemic response — affected human rights, doctoral students Hanna E. Huffstetler, MPH (global health), and Caitlin R. Williams, MSPH (maternal and child health), and Benjamin Mason Meier, JD, LLM, PhD, professor of health policy and management, led a team of Gillings students, faculty and alumni who created the UNC COVID-19 Health and Human Rights Monitor. This free, searchable online database uses media reports to monitor potential violations of human rights, with the goal of informing better responses to public health issues and emergencies without compromising human rights.

‍Dr. Noel Brewer

Gillings Distinguished Professor in Public Health

Download as a PDF poster

Step 1: Ask yourself if you’re ready to listen.

The more your views on vaccination differ, the more you’ll need to listen and find a point of agreement. If you’re already worked up, you’re not in a good frame of mind to have a conversation.

Step 2: Try to find the main concern.

People may have many concerns but are often motivated by a main concern. Until you get that on the table, the conversation can’t progress. Regardless of what someone first says, you might ask, “What is your biggest concern?”

Step 3: Listen and find a point on which you can both agree.

People will only listen to your ideas about vaccination once they have spoken and feel heard. You might say, “I get it. You’re really worried about the potential side effects. It’s reasonable — no one wants unsafe medicine.”

Step 4: Have brief discussions.

Keep discussions between 5–10 minutes, especially the first few. Expect to spend several weeks or months gently coming back to the topic. Once a person has learned that they can talk about their opinions without judgment, you can really start to have a conversation.

Step 5: Know when to take a break ... and come back a few days later.

This is the hardest part. Don’t try to rebut their concern immediately. Just listen, end the conversation for now and come back another time. Doing it slowly gives you time to listen, show respect and do your research in between discussions. At any point, if you feel pressure to get your point across, that’s a clear cue to slow down and step away. Then come back in a few days or a week.

What not to do:

• Don’t do it online or in text. It’s always more effective to have difficult conversations about vaccination in person or over the phone, where you can more easily add warmth.
• Don’t make it a thing. If the first exchange is unpleasant, both parties may avoid conversations about that topic in the future.
• Don’t moralize. Beliefs about vaccination can be deeply held. Moralizing them deepens polarization.
• Don’t belittle or insult. Though you may not intend to be hurtful, saying something that belittles a person’s knowledge can be harmful to both the conversation and the relationship.
• Don’t give medical advice. Leave medical advice to the person’s personal health care provider.

Additional helpful tips:

• Some may not have the ability or the time to get a vaccine, which underscores the importance of accessibility.
• If you don’t have a lot of time to talk to a person, consider whether you should engage at all. Effective discussion will take time.
• Most people who are hesitant to be vaccinated are not “anti-vax” or vaccine deniers. If you do encounter a person who is intentionally spreading harmful misinformation, the World Health Organization Europe has identified effective ways to respond to vocal vaccine deniers in public. In these cases, your audience is other listeners and never the vaccine denier.

Our health is directly impacted by the spaces where we live and work, but there are substantial inequities in access to a clean and safe living environment. Some communities are subject to conditions that contribute to poor health because of institutionalized policies that allow industries to pollute air, water and the very conditions of neighborhoods.

The most frequent targets of institutionalized policies that contribute to ill health are low-income communities and communities of color, perpetuating structural racism and the health and other inequities that result. Communities can endure environmental hazards for decades, putting them at increased risk for chronic conditions. To overcome inequities, community members and organizations must often take on advocacy work that can play out for years.

Environmental justice (EJ) work at the Gillings School seeks to collaborate with communities through participatory research methods that amplify local expertise and knowledge in the fight against environmental racism. Students, faculty and alumni are applying these methods to work in environmental sciences and engineering, epidemiology, health behavior, and beyond in pursuit of a more just environment.

"It’s a deep honor and privilege to be able to collaborate with communities in this way."

— Courtney Woods, PhD, associate professor

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For decades, Associate Professor Courtney Woods, PhD, has been applying her expertise in engineering and toxicology to collaborate with North Carolina communities. Her research team works with local leaders to identify water contaminants and inform supply community policy makers and regulators.

Woods recently collaborated with concerned residents in Sampson County, N.C., to test waterways for pollution from nearby landfills and agricultural operations. By working with the Environmental Justice Community Action Network (EJCAN), Woods’ team identified high levels of polyfluoroalkyl substances (PFAS), emerging contaminants that can suppress immune response and negatively impact cholesterol levels, kidney health and maternal health. PFAS have been called forever chemicals because of their lasting effects. Woods’ team also partnered with the community and Appalachian State University faculty to alert residents to health risks and create strategies to test water supplies.

The success of this endeavor led Woods to co-found the Environmental Justice Action Research Clinic (EJ Clinic) at UNC with funding from Z. Smith Reynolds Foundation. The EJ Clinic partners with EJCAN and the N.C. Environmental Justice Network (NCEJN) to teach students how to apply the principles of participatory research to tackle EJ issues. It is also technical resource for residents seeking policy change.

“Beyond testing for hazardous chemicals and reporting results back to residents,” Woods explained, “we share information on exposure mitigation and well maintenance and information on how to organize residents to connect to public water service, if that is goal. We also encourage residents to get involved locally by attending county council and planning board meetings and public meetings with the N.C. Department of Environmental Quality (DEQ). Collaborating with community organizers in this work is critical because they help sustain the dialogue and momentum and help develop strategy on how research can be used most effectively to support the community’s goals.”

At the Gillings School, Woods co-teaches a class in EJ – formerly taught by the late epidemiology professor Steven Wing, PhD – with the NCEJN and leads Master of Public Health (MPH) concentrations in both Environmental Health Solutions and Health Equity, Social Justice and Human Rights (EQUITY). Through the EJ Clinic, students in these courses and concentrations can build skills to broadly apply work in EJ.

“The Clinic is an opportunity for community groups to gain access to skills and resources that students have, and there are so many topics being addressed,” said Lindsey Savelli, an MPH student in EQUITY who connected with Woods and joined the EJ Clinic to work with residents in Caswell County. “In Anderson, N.C., we’re studying effects of pollution from a proposed asphalt plant and raising awareness of these hazards. We’re also looking at cumulative environmental impacts to see if the DEQ can account for that in permitting processes.”

Woods sees the work as a mutually beneficial way to orient students to community-driven research and practice on real-life public health issues while equipping residents with data and resources to support their advocacy for a healthier community.

“It’s a deep honor and privilege to be able to collaborate with communities in this way,” Woods said.

Graduate research assistant Aleah Walsh collects water samples from a stream in Sampson County.

"Well water, unlike municipal tap water, isn’t tested or regulated. The responsibility falls to private well owners to test."

— Amanda Northcross, PhD, associate professor

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At the undergraduate level, Associate Professor Amanda Northcross, PhD, an expert in assessing the health impact of environmental exposures, engages first-year students through a course called Environmentally Engaged Communities and Undergraduate students Investigating for Public health Protection (ECUIPP). This combined seminar and lab introduces participatory research to incoming Carolina students. For many, it is their first encounter with topics related to public health and EJ.

This year, Northcross is teaching two sections of the ECUIPP lab. One section is collaborating with Michael Fisher, PhD, associate professor and faculty at the UNC Water Institute within the Department of Environmental Sciences and Engineering, to develop water quality testing kits for well water users in Robeson County. Some students are investigating which kits are cost- effective, while others are investigating the most efficient way for residents to test water.

“Most well water users live in rural areas in N.C., and when we look at the percentage of Black, Latinx and Indigenous people who are relying on well water – those are the groups seeing issues with quality,” Northcross explained. “Well water, unlike municipal tap water, isn’t tested or regulated. The responsibility falls to private well-owners do testing, and many people don't know how or don’t have the resources to do that. We are also working to develop a community advisory board to work with K-12 schools in the area and ensure that folks are learning how to use these kits.”

The second section is working to develop a strategy for low-cost air quality monitoring in Robeson County, where concerns about pollution are impacting cardiovascular risks for Indigenous communities. In alignment with work from Jada Brooks, PhD, at the UNC School of Nursing, and Assistant Professor Radhika Dhingra, PhD, in the Department of Environmental Sciences and Engineering, Northcross’ ECUIPP lab team is collecting data from air quality monitors set up at Boys and Girls Club locations around the county and developing a website to communicate findings to the public in an accessible way.

Students in Dr. Northcross’ ECUIPP lab go on a site visit.

Northcross and Brooks have also received funding from UNC’s Whole Community Connection to partner with youth organizations in Robeson County to create maps that identify where the community may encounter hazards and leverage assets to address them. Northcross has also received seed funding from UNC’s C. Felix Harvey Award to address issues of indoor air quality and asthma in Robeson County charter schools.

“All of it is centered around collaborating with community partners so that we can identify where their challenges might be and then work with them to try ensure that we're minimizing the impact of environmental health hazards in a way that’s sustainable,” said Northcross.

Epidemiologists at the Gillings School also have a long history of EJ work, notably, led by the late professor Wing, who for more than 30 years, documented exposure to environmental contaminants and engaged in participatory research to help workers and communities of color in N.C. advocate for a healthier environment.

Though Wing died in 2016, his legacy in EJ lives on through the many alumni he mentored and faculty with whom he collaborated and inspired and through the Epidemiology and Justice Group at Gillings, a student organization that aims to support and educate fellow students on the history and principles of epidemiology for social justice and the practices of community-led public health research. Each year, they help organize the Steve Wing Memorial Lecture, and the School recently developed a fund to help support the annual lecture series.

In commitment to creating a healthier and more just environment, with generous support from alumna Sherry Milan, the Gillings School has newly established the Sherry D. Milan Environmental Justice Scholarship to support students with a demonstrated commitment to work in EJ. As communities across the nation continue to face environmental hazards and the effects of a changing climate, developing skills to apply public health work alongside community experts will be critical to creating lasting and impactful change.

A More Equitable Environment For All

The Gillings community is host to many students, researchers and alumni working towards a more equitable environment for all. Learn more about a few of them:

"I have worked with Lindsay Savelli in the Anderson Community environmental group project in Caswell County. I've also worked with hazard mapping in Sampson County. Additionally, we'll soon be looking at on-site sanitation in eastern N.C. and will be utilizing mixed methods to identify common themes and patterns of on-site sanitation use and barriers to centralized sewer access. We intend on employing community-based participatory research methods and enforcing principles of epistemic justice in this work, particularly as the end results will be policy-oriented."

— Amy Kryston, graduate researcher in the EJ Action Research Clinic

"I feel lucky to have been an advisee of Steve Wing. Through collaborations with Steve and EJN, I was able to help design organizing materials and contribute to Steve’s and Jill Johnston’s work in calculating disparities in exposure to industrial hog operations (IHOs). Those calculations supported civil rights complaints led by community organizers like Naeema Muhammad and Elsie Herring and supported by civil rights lawyers Elizabeth Haddix and Mark Haddix. Since then I’ve contributed to scientific public comments (2019, 2020) and legal challenges (2021, 2022) to environmental justice issues in N.C. and abroad. I also lead a Duke Data+ data science team in building a pilot Environmental Public Health Tracking tool for the N.C. Division of Public Health, enabling them to apply for CDC funding to sustainably support and release that tool publicly. I’ve continued to support that research where I can, including as part of Arbor Quist’s dissertation committee."

— Mike Dolan Fliss, PhD, MPS, research scientist at the UNC Injury Prevention Research Center and 2019 doctoral alumnus in epidemiology

"My dissertation title is Investigating Relationships Among Environment Exposures, Demographic Characteristics, and Preterm Birth. In this dissertation, I examine how sociodemographic characteristics (such as race and maternal education) modify the preterm birth risk. We are using a N.C. Birth Cohort database from 2000-2013 to understand how climate change can affect preterm births. I utilize exposure databases (air pollution, metal mixtures in drinking water, and heat) to understand the differential exposure to vulnerable communities, specifically communities of color. We are also doing a similar project using Lineberger Cancer data and the well water database to associate metals in drinking water to cancer incidence, then examine how sociodemographic characteristics modify cancer risk."

— Eric Brown, doctoral student in environmental sciences and engineering

Our mental health has been strained, with studies reporting rising rates of depression, anxiety, substance use and other negative impacts on well-being. We have lost loved ones to death, isolation or estrangement. Many have lost jobs, homes, or access to vital services like child care, transportation and health insurance.

Those with jobs deemed essential have endured more risk with fewer protections. Black, Indigenous and people of color (BIPOC) have borne the heaviest burdens from COVID-19.

The pandemic’s upheaval shifted our lives in varying ways, creating a spectrum of enduring hardship that mirrors what Professor Edwin Fisher, PhD, calls a mental health continuum. The support of our peers helps us endure this upheaval.

"Peer support is a culture. We would like every sorority and fraternity president, every instructor, every supervisor of a workgroup and all the members in it to be better at listening to and supporting one another. The more those resources are spread, the more we see a healthy culture distinguished by mutuality and achievement."

— Professor Edwin Fisher, PhD

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“Peer support is pertinent to the entire distribution of mental health,” says Fisher, who is a professor of health behavior at the Gillings School. “Whether it’s being available to a student who flunked an exam for the first time or helping somebody who’s labeled as schizophrenic manage social relationships, find a job or stay in housing, peer support is useful across that entire continuum.”

Fisher is director of Peers for Progress, a UNC-Chapel Hill program developed by the American Academy of Family Physicians to help people with chronic conditions find support from a peer – someone who has a shared lived experience and can provide encouragement and resources to manage long-term health. Sometimes that experience comes through a shared health condition, but more often it comes from shared social connections or interests.

“A lot of research shows it’s not the number of friends you have — it’s the variety of social connections,” Fisher explains. “When you’re angry at somebody at work or in your family, you want to talk to somebody who’s not a part of that. Or maybe you need to talk to somebody who understands what it’s like to be working on deadline and have a crying baby and an unsympathetic boss.”

Peer support is a need we all share — one that works best when ongoing access is built into all aspects of life. Since its inception, Peers for Progress has grown into a global network of researchers, experts and advocates who aim to make that support accessible.

“It doesn’t mean going to a group every week for the rest of your life,” Fisher says. “Peer support is a culture. We would like every sorority and fraternity president, every instructor, every supervisor of a workgroup and all the members in it to be better at listening to and supporting one another. The more those resources are spread, the more we see a healthy culture distinguished by mutuality and achievement.”

In recognition of this need, UNC-Chapel Hill established the Peer Support Core, which includes Fisher, Associate Director Samantha Luu, MPH, and a team from Carolina and the Gillings School who are working to increase awareness and create opportunities to provide that listening ear. This includes unit-level programs, individual training and a framework for support pods, which are informal groups based on shared experiences or interests.

"At the end of the day, a lot of people just want another person to talk to, especially someone who is unbiased and will listen without judgement."

— Toby Turla, student

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Gillings is host to pods ranging from support for BIPOC and international students – facilitated by Associate Dean for Student Affairs Charletta Sims Evans, MEd – to pods hosted by the Culture of Health that encourage healthy home environments, which have been critical during the pandemic.

Gillings students Toby Turla and Sonam Shah have also co-founded Peer2Peer, a student-led group at Carolina that offers students free support sessions with a trained peer responder.

“At the end of the day, a lot of people just want another person to talk to, especially someone who is unbiased and will listen without judgement,” says Turla.

A peer support approach to mental health is a multi-layered one, according to Fisher — one that addresses isolation and anxiety by teaching people critical social support skills, helping supervisors support their employees, and addressing systemic or organizational issues that place unrealistic demands on individuals.

“Skills are important,” Fisher says, “but skills need to be implemented in a way that’s complimentary to organizational and system-level interventions. Otherwise, a lack of individual skills can very easily become victim blaming.”

UNC and Peers for Progress provide resources to strengthen peer support skills. UNC’s Heels Care Network is a hub of mental health and well-being resources. Organizations and workplaces looking to establish pods or other peer support services can take advantage of the extensive guides developed by the UNC Peer Support Core.

If you need immediate mental health care, resources are available:

• National Suicide Prevention Lifeline: 800-273-8255 (TALK) or https://suicidepreventionlifeline.org
• ‍National Crisis Text Line: Text HOME to 741741
• Call your organization’s employee assistance program or your health plan for services

“In this line of research, I kept finding that I couldn’t make a lasting impact — when a grant ends, a program ends,” she says. “I needed to find a way to build something that was self-sustaining.”

In 2018, Ammerman founded social venture start-up Equiti Foods and created Good Bowls, nutritious frozen meals that are prepared using products from local farmers. Online and in-store product sales, along with grants and donations, help provide cost-subsidized bowls to communities that otherwise lack access to nutritious, healthy meals.

When the COVID-19 pandemic hit, the Good Bowls team designed an innovative initiative called “Pay it Forward” — a collaboration among Good Bowls, Pittsboro Eats! and other community organizations, small farmers, local restaurants and volunteers — to promote good nutrition and help food-insecure families during the pandemic. The idea was inspired by a story Ammerman heard on the radio about someone in Texas paying a restaurant to provide food for families in California. “I thought if it could work from Texas to California, it could work here,” she says.

"My research has always been very applied and practice-oriented because I’ve always wanted to do something that has a more lasting impact."

— Professor Alice Ammerman, DrPH

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Funded partly by an NIH grant with supplemental COVID funding, the initiative uses social media to urge people to donate a bowl (or more) through an online portal. Ammerman coaches participating restaurants on a healthy bowl recipe along with options for sourcing from local farmers. The restaurant cooks a big batch of food for the bowls, which are then packed and sealed by the Good Bowls team and local volunteer groups. The bowls are frozen and delivered to Communities in Schools (CIS) for distribution in Siler City, where there is a large Latinx population hit hard by COVID-19 and food insecurity.

Since it began in June, Pay it Forward has provided more than 1,500 donated meals to local families, while helping local farmers increase their sales and providing local restaurant partners with a COVID-safe boost in business.

“It made sense for us to partner with Good Bowls because our relationships with local families allow us to get those resources to people in need,” says CIS Executive Director Tych Cowdin. “Distributing perishable foods with a small staff can be difficult, so having healthy frozen meals is a wonderful idea. Another thing I appreciate about Good Bowls is that they are always so responsive to what people want and need — they are always seeking feedback from the clients and from their partners.”

That responsiveness is in keeping with Ammerman’s reliance on community-based participatory research (CBPR), a research approach that focuses on partnerships between researchers and the community in order to improve health outcomes and build community capacity.

“My research has always been very applied and practice-oriented because I’ve always wanted to do something that has a more lasting impact. My focus is on trying to understand what communities need and working with them to develop strategies to address these needs,” she says. “Intensive research-driven interventions may be totally impractical and unsustainable in practice, so involving community partners who are ‘in the trenches’ is really important.”

In the spring of 2020, Durham Mayor Steve Schewel invited local scientists to meet with him and share their thoughts as to how the community could endure the health and economic stresses of the emerging COVID-19 pandemic.

“People were fearful of going out, businesses were struggling and trying to implement best practices, and there was a lot of concern about COVID-19 risks as well as the economic health of essential businesses,” says Kurt M. Ribisl, PhD, Chair and Jo Anne Earp Distinguished Professor in the Department of Health Behavior, who attended the meeting.

A few months later, the mayor asked Ribisl if the department would get involved with Durham’s Back on the Bull campaign, where businesses could publicly share their health and safety practices in hopes of reassuring a wary public that they were safe places to visit. Ribisl turned to Master of Public Health student Marlyn Pulido to partner on the project, hiring her full-time to lead the work upon graduation.

"Helping these businesses weather the economic storm was one big win, and reaching parity in vaccinations — to get to where almost all the groups had the same vaccination rate — was the other big win."

— Kurt M. Ribisl, PhD

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Working with Patsy Polston, PhD, assistant professor of health behavior; Yesenia Merino, PhD, then-director of inclusive excellence and training; and a team of master’s students, Pulido and Ribisl led a phased, community health-based plan focusing specifically on assisting Black-owned and Hispanic-owned businesses in Durham. Partnering with local nonprofit El Centro Hispano and using grant funds from the city, they hired and trained 14 local multilingual, multicultural community members to become Durham Health Ambassadors.

“We were really looking to gear up a community health worker-based program,” Pulido says. “Things were just starting to reopen, and we wanted to offer in-person support to help local businesses figure out what they needed, not just to comply with quickly changing mandates but also to stay safe and be successful.”

Whether sharing information on the latest mandates and best practices, to leveraging the University’s ability to order personal protective equipment when it was in short supply, to personally ordering and delivering masks and hand sanitizer, the ambassadors worked closely with local businesses throughout the next several months to reduce their risks and stay open for business.

When COVID-19 vaccines began to be distributed, appointments were extremely difficult to come by — and Black, Latinx and Indigenous populations already had disproportionately higher rates of COVID-19 illness and death than white populations. The Ambassadors worked to reduce that disparity, focusing on making appointments for essential workers at the grocery stores, gas stations and restaurants they had gotten to know over the summer.

As vaccinations became more widely available, the group’s focus shifted from making appointments to promoting equitable access and ensuring Spanish-language access at vaccine events. The Ambassadors joined the Durham Vaccine Equity Advisory Coalition, a group of nine local community organizations trying to address disparities in vaccine access. By the end of the project, those large gaps in vaccine rates were significantly narrowed or closed altogether.

“Helping these businesses weather the economic storm was one big win, and reaching parity in vaccinations — to get to where almost all the groups had the same vaccination rate — was the other big win,” Ribisl says. “It took a lot of effort — we flooded the community with community health workers who would meet at local businesses, camp out at small grocery stores, attend vaccine information sessions and clinics. Every barrier that was there, the team broke through. The dedication of these community health workers was really, really amazing.”