Photo credit: Peter Tobia
The bicycle leaning against the credenza in Karen Glanz’s office has as much to do with this Penn Integrates Knowledge professor’s interest in public health as it does with her personal dedication to physical fitness. Glanz, a professor of epidemiology and nursing who was recently named the George A. Weiss University Professor, is the director of Penn’s Center for Health Behavior Research.
Appointed to both the School of Nursing and School of Medicine in 2009, Glanz specializes in how individual behavior, community behavior and the built environment affects health and health awareness among people. She has recently concentrated her research on chronic disease prevention and management, working specifically with skin and colon cancer control and prevention. She also focuses on research relating to nutrition and obesity.
Her recent move to Philadelphia completes a professional circle of sorts. She came to Penn from Emory University, where she was Charles Howard Candler Professor and Georgia Cancer Coalition Distinguished Research Scholar at the Rollins School of Public Health. Before that she worked at the University of Hawaii, and before that at Temple University, where she began her career in higher education.
Growing up in an era when girls were not encouraged to participate in sports, Glanz says she used to beg to go to the pool with her brother who was on the swim team. She swam when she could and kept it up as recreation in college and graduate school at the University of Michigan. Then, she says, she began to “dabble” with running and at the age of 40 tackled her first marathon.
Since then, the professor who specializes in changing other people’s behavior has changed her own, becoming a dedicated tri-athlete who at age 49 competed in—and completed—the most daunting triathlon of all, the Ironman World Championship in Hawaii.
Recently, the Current sat down with Glanz to discuss what attracted her back to Philadelphia and to Penn, her current work in health behavior and why getting up at five in the morning to run and swim a few miles before work is her idea of fun.
Q. When you came to Penn in 2009 you were already pretty familiar with the city of Philadelphia, weren’t you?
A. I’d lived here from 1979 to 1993. I was at Temple University at the time. It was my first academic position. I was the first head of their master of public health degree program, and I did a lot of teaching. When I was ready to leave I wasn’t really planning to come back to Philadelphia. Back during that period the city was going in a bad direction, with the MOVE fire and all that stuff. I decided to go west, and I guess I didn’t know when to stop because I moved to Hawaii. I was at the University of Hawaii for 11 years. I didn’t have to teach at all, and it gave me a chance to really build my research. And it was a great place to live.
Q. Where did you go aftter that?
A. I went to Atlanta, where I worked at Emory for about five-and-a-half years.
Q. What was it about the PIK professorships that attracted you to Penn?
A. Of course I already knew Penn was a great university, and when I began to learn more about the PIK professorships they sounded pretty interesting. The idea of attracting people who cut across disciplines; and that the program was coming out of the president’s initiative. I thought, wow, that’s great, Penn actually rewards you for that? A lot of academics focus on purity [in research] and if you cross disciplines they sometimes say you aren’t focused enough in one area. And here was a place that said we like that you cut across research areas. I looked at the PIK professors already here and said boy that is an interesting mix. I’d like to be part of that. I should point out that a lot of people at Penn work across disciplines, but the PIK professorships are just one way of highlighting it.
Q. What do you believe makes multidisciplinary research different from traditional academic research?
A. Traditionally, academia awards depth and focus, studying some very small little thing and being the world’s expert in it. With interdisciplinary research you sacrifice some of that to take more of a problem-solving approach. And I think in healthcare and public health, the areas I work in, that makes sense. I was trained for this kind of approach. My graduate program at the University of Michigan was cutting-edge at the time—30-plus years ago—in that it was a new idea back then to have social scientists being professors at the school of public health—psychologists, sociologists, anthropologists, education folks.
Q. Did you always know you wanted to go into public health as a field of study?
A. No, as an undergraduate I was a Spanish major. I was interested in languages and linguistics. I took a lot of literature, too. I wasn’t particularly career-oriented as an undergraduate. I didn’t really know what I would do with it. But it turned out that it served me well to have that language arts background because a lot of people who take a strict health-training path, go pre-med and all that, often are not good writers or speakers. As an academic, that’s a big part of what we do. This was during the Vietnam era, and I was beginning to see that the humanities field was more esoteric and not as connected to everyday life, and my friends didn’t get what it was that I was studying. I decided to take a year off before I went back to graduate school. I was looking around to see what I wanted to do. I was personally interested in some health issues. I was interested in nutrition at the time. But I didn’t have the basic science background to go into nutrition, so I kind of landed in public health and health behavior. The program I decided on was just beginning to try to bring more research into health education. So I went back for a master in public health degree, and then my department started a doctoral program and I stayed on for that.
Q. I know you are very into physical fitness these days. You are a tri-athlete and we’ll get to that in a minute. But, did you grow up with an interest in fitness; were you an athlete in high school?
A. No, not at all. I grew up in an era when girls were not encouraged to be active and my family was certainly that way. My brother played on sports teams. I liked swimming, but I didn’t do anything competitive at all. There wasn’t a big emphasis on fitness.
Q. When you talk about health education do you mean in the general public sector, or in schools?
A. It really cuts across schools, community, mass media and also patient education and patient care. It cuts across all those areas, and really the theoretical foundation of it is behavioral science and social science and learning theories, how to get people to change habits and so forth.
Q.. Did you do field work?
A. Yes. When I did my master’s, we worked on a project of trying to get food labels and calorie labels into cafeterias. And this was in the ‘70s, so that was kind of radical at the time. And we also were interested in trying to change where food is located. For example, if you move the desserts would people would take fewer desserts? Part of the way that related to my interest is that a lot of health education has a very individual focus, if you teach people what is the right thing, they’ll do the right thing: quit smoking, eat the right foods and so forth. But the other side is the organizational side. If you put foods in a different place, or if you put the information of what is healthy right in front of people, that will help them make a healthier choice. That’s a different way of influencing behavior and it reaches all the way to public policy and how communities and organizations are structured. My interest was always in those two sides of the coin, changing behavior and also changing the environment, which is not what most people think of when they think of a behavioral focus.
Q. Did you at that time know you wanted to be a professor?
A. I think I always wanted to be a professor. I taught swimming when I was in college, mostly at summer camps, but I also taught adults. I really liked teaching, but I knew I didn’t want to teach high school. I wanted to teach at some level where people could really use what they were learning. I figured by the time they are in graduate school, they should be motivated learners. I didn’t want to be teaching Spanish in high school because I know students usually hate it, because it’s a requirement and they just want to get through it. I did have an opportunity to go into the corporate or government sector, but it didn’t feel like what I wanted to be doing. As a professor you have a certain amount of autonomy. You can grow over time and change over time and you have the opportunity to be recognized for what you do.
Q. You talk about how interdisciplinary work was a radical notion years ago. It seems as if these days it’s almost become trendy. How do you keep it from being just a buzzword?
A. For me, one of the great things about being in academia, is that I get to keep learning. Working with different people brings a different language, a different perspective, to what I am doing. I enjoy seeing what they come up with. My feeling is that sort of culture is in the fabric of Penn. The faculty don’t seem to feel that they are stuck in silos.
Q. What projects are you working on at the moment?
A. I work across several different areas, mostly chronic disease prevention and management. I work on cancer control, skin cancer prevention and cancer screening, mainly trying to get people to get colon cancer screenings more than other types. And the other big area I work in is nutrition and obesity. In that area my focus is more on the built environment, policies and communities. That’s a good one to talk about because that was an area that I wanted to grow more when I came to Philadelphia. And it’s an issue that a lot of people are working on here. During my first year there were times I felt there were so many people working on it here that I wouldn’t get any traction, that they didn’t really need me. But that’s turned the corner to where there is a lot of collaboration now, not only with other people at Penn, but also with people around the city.
Q. Can you talk more about that?
A. There is one project I did with Amy Hillier [assistant professor of city and regional planning in the School of Design]. It’s a combined training and research project. The research project is studying what we are calling the food and activities landscape in a community, and that is focused on West Philadelphia. We have completed the first phase: door-to-door surveys in sample zip codes in the neighborhood. The area is a mix of poor and the more affluent. Basically, we asked people where they shop and why they shop there. That was the first phase. The second phase will be more in-depth interviews with a small sample across these different zip codes, and we are actually going to work with maps of their neighborhood, their food environment, and figure out why they go here or there to shop instead of shopping, perhaps, somewhere closer. And then we’ll combine those using some new technologies and cartographic modeling to illustrate the healthy spots and the less healthy spots, for populations not just for individuals. The other part that goes with it is actually measuring what is in their food environment. This tool that we’ve developed, which is being used all over the country and all over the world now, is called the Nutrition Environment Measures Survey.
Q. What does it measure, exactly?
A. It’s an observational measure in which we go out to stores and we look to see if they have certain types of food, particularly if they have healthy options compared to a less healthy option. For example, if they carry milk, do they also carry skim milk? If they carry ground beef, do they carry lean beef? If they carry in the snack food aisle potato chips, do they also carry baked chips? And what are the relative prices of those? And of course we look at things like fruits and vegetables and the quality of those. We take that objective measure of the food environment and hold it up against what people say and put those together. So, the last step of that particular project will be to work with the community to try and come up with ways that the food environment can be improved.
Q. Is this something you teach as well?
A. Yes. We have a weeklong training institute that we do every year. It trains academics, public health practitioners and graduate students about doing these assessments in the built environment relating to obesity, physical activity and nutrition. We’ve done it for three years so far, and with a new grant that we just received we can do it for three more years.
Q. Any other projects you’d like to mention?
A. Well, there are two other related projects on the drawing board. One would be to participate in evaluating the city’s nutrition and physical activity campaign for which they got $15 million in stimulus funding. Our piece of that, together with the city health department, a researcher at Temple University and a bunch of other players, will be to see if the food environment changes in corner stores during the time of this project. The city is trying to get corner store merchants to offer healthier foods, and trying to train them on how to do that without losing money. We’ll also be looking at the environment within schools, in terms of policies on junk food in the classroom and in fundraisers. The other project is that we are trying to work with supermarkets, looking at retail promotion, to see if we can help better market the healthy food and de-market the junk food. We’d do that by doing things like shifting where the food is on the shelves, taste testing and maybe getting the candy out of the cash register aisle, that kind of thing.
Q. That is an ambitious project. You are going up against corporate America with that one.
A. It is. But we are doing some pilot studies right now, and we’ve got some commitment for funding from the Robert Wood Johnson Foundation. On this one we are also working with a colleague at Temple, and we are also getting industry people to advise us and to let us use sales data. We decided to all work together and see what we can come up with. Our hypothetical premise going in is that it has to be at least profit-neutral for the stores. It is challenging, but I think it potentially could make a real difference.
Q. Is this a good time to be doing a project like this, in terms of public awareness?
A. It’s both a good time and a bad time. It’s good because I think people are more aware of obesity going up and up in the last few decades. There is recognition that just telling people to eat healthy and to exercise is not really the answer. It’s not such a good time because of the recession. That’s when people hunker down and go for the cheapest thing, which is often not the healthiest thing. But in general, I think it’s a better time than ever.
Q. You are a tri-athlete. How did you get started in that if, as you said earlier, you weren’t into physical fitness growing up?
A. I did like to swim. I became a regular recreational swimmer in college and I also liked being outside. It wasn’t until I was in my 30s that I dabbled with running. I had some friends who ran, and some friends who did a marathon when they turned 40, and I thought maybe I’d try that. I knew I had good endurance from swimming, so I started running and before I moved away from Philadelphia, when I was at Temple, I did my first half marathon. But it was when I moved to Hawaii that I got the bug seriously. Everybody is into that out there. I did my first marathon when I turned 40. One of the things that appealed to me about triathlons was there were people of all ages participating and it wasn’t just elite athletes. I didn’t have that level of ability, but I’ve gotten a couple of trophies in my age group, and I’ve sort of kept at it.
Q. When do you train?
A. I mostly work out by myself in the morning. But when I trained with groups it was more evenings and weekends. I get up at about five or six in the morning and work out for about an hour-and-a-half to two hours. I run and I swim every day. I run three to five miles on a treadmill in my basement and then I come on campus and swim about a mile at Pottruck.
Q. You did your first triathlon at age 40. When you did it did you think you’d do another one?
A. I thought it was fun, and it’s also a sense of accomplishment. It’s a different kind of goal than the goals you set professionally. I enjoyed it and it became a different way for me to stay fit and a way to meet new people.
Q. How many triathlons have you done?
A. Well, I started in 1994, and I’ve probably done three to eight a year over that many years. They are triathlons of different lengths. I did four this year. I made up my mind when I left Hawaii that I wasn’t going to quit.
Q. You did the Ironman, right?
A. The world championship is in Hawaii and it’s really hard to get into. You have to either win your age group in a big race or get in by a lottery, and I got in by lottery in 2002. It’s 2.4 miles swimming in the ocean, that wasn’t hard. There’s a race every year in Waikiki that does that distance, and I’ve done it since 1990, except this year. So, that wasn’t a problem. The second part is a 112-mile bike ride, and I wasn’t so sure about that. It’s a windy and hilly course. And then there is a marathon [26.2 miles].
Q. How did you train?
A. Well, when you are chosen by lottery you have to finish at least a half Ironman to validate your slot. So, the half Ironman I did was six weeks after I found out I was chosen. I’d just come back from the Netherlands the night before the race.
Q. So, you were jetlagged?
A. I was, but I slept a lot on the plane. In that race you had to finish by a cut-off time of eight hours. I finished with four minutes to spare. After that I had about four-and-a-half months to train for the big race. I got a trainer and I worked with a couple of different coaches and I got a bike trainer. It was challenging.
Q. How did you do?
A. All I wanted was to finish, and I finished. I did it in 16 hours and 43 minutes. The cut-off is 17 hours. I was excited just to do it. For me it’s a counterpoint to work. It’s play. It’s physical. It’s a different kind of goal.
Q. Do you think you’d do it again?
A. I would do it again. I had a lot of fun. But it’s not like I’m trying real hard to do it again. I wish I had been younger. I was 49 when I did it. I wish I had been 10 years younger so it would have been easier.
Q. As a public health professional you must understand that some people just don’t like to exercise?
A. I do, although it’s complicated because it’s such a big part of me that I sometimes can’t understand why people don’t like to do it. But intellectually it’s clear to me that a lot of people really don’t like it. They feel like they don’t have enough time for it, that it’s unpleasant. I can see how making it easier for people is important. That’s the behavior change I want to achieve, to make it easier for people.