Name: Ming Ji & Melbourne Hovel

Faculty/Rank: Assistant Professor & Professor

Department: Graduate School of Public Health

College: College of Health and Human Services

Office phone: (619)594-3454

Other phone: (619)397-6805

Email address: mji@mail.sdsu.edu

Proposal title:
Developing International Health Education and Research Programs in China

Country/ies visited: China

Institution visited:
Fu Dan University
Shanghai Second Medical University
Shanghai Institute of Planned Parenthood Research

Dates of travel: 01/10/05 – 01/21/05 (Only Dr. Ji traveled to China)

Number of student participants: 1 from SDSU; ~ 10 from China

Previous IP proposals submitted and grants awarded
(list titles, countries and dates):
Establishing International Health Programs In China
China, 03/05/04 – 03/15/04

Have all required reports been submitted? Yes

Other funding for this activity available/applied for: None

Proposal Abstract (75 word maximum):
The purpose of this proposal is to strengthen our relationship with the Chinese universities and institutions we visited in March, 2004 and discuss with them on more specific collaboration to further develop international educational and research collaborations. The subjects to be discussed are (1) Developing joint long-distance teaching and learning courses/projects for both Chinese students and US (2) Conducting data analysis and writing scientific paper (3) Planning grants applications for faculty and student exchanges.

Travel report:
I. Opening/overview of intentions/activity
The purpose of this proposal is to strengthen our
relationship with the Chinese universities and institutions we
visited in March, 2004 and discuss with them on more specific
collaboration to further develop international educational and
research collaborations. Funded by another travel grant for
students, one of our MPH students, Ms.
Kanyin Ong, joined me on this trip and experienced the education
and research environment for public health students in China. I
also made the first visit to Shanghai Cancer Institute and started
a talk with its principal investigator for future collaboration.

Our planned visit was successful for all the objectives. The discussion on research and student exchanges are much more specific and detailed than the first visit we made in March, 2004. At Fudan and Shanghai No. 2 Medical School, we started comparing the graduate courses offered at both institutions and tried to establish equivalent courses for future student exchange. I also left a copy of SDSU’s Cooperative Agreement with each of the institution’s faculty who is charge of international exchanges. At Shanghai Research Institute of Planned Parenthood, I discussed with Dr. Wu many exciting ideas for pursuing research grants from HIV/AIDS prevention to longitudinal studies of male sperm quality. Ms. Ong had plenty of opportunities interacting with Chinese graduate students, touring their campus facilities and participating their community based tobacco intervention sessions.

The activities of this trip are as follows: Dr. Ji arrived at Shanghai on Jan 11, 2005. He met Dr. Wu Junqing from Jan 12 to 15, brainstorming various grant proposal ideas. Ms. Ong joined Dr. Ji on Jan 15 and visited Shanghai Research Institute of Planned Parenthood. Ms. Ong interacted with the graduate students in Dr. Wu’s group and exchanged information on their educational and research activities. On Jan 16, 17 and 18, Dr. Ji and Ms. Ong visited Shanghai Fudan University, meeting with Dr. Fu Hua to discuss further grant proposals and student exchanges. During this time period, Ms. One also participated in one session of community intervention for tobacco control run by Dr. Fu’s graduate students in a college. During Jan 19 and 20, Dr. Ji and Ms. Ong visited Shanghai No. 2 Medical University School of Public Health, meeting with Dr. Bao and his colleagues to discuss student exchange programs. On Jan 21, both Dr. Ji and Ms. Ong came back to the US.

This visit is a catalyst for increasing collaborations between Chinese collaborators and us. (1) We are currently revising four manuscripts resulted from their previous studies for joint publication in either English or Chinese journals. The successful publication will be shown to funding agencies (such as NIH) as evidence for existing collaboration between SDSU and the Chinese investigators. (2) Both sides agreed to review each other’s curriculum and further discuss the possibility of student exchange programs. (3) Dr. Fu has allocated funds to send one of his postdocs to SDSU for a short-term visit to study our Behavioral and Ecological Model. (4) Dr. Fu worked with us for the submission of a R03 grant on reducing children’s ETS exposure at home to the Fogarty International Center. Although it was not funded at the first round, the reviewers expressed enthusiasms about the idea and the research team. We are currently working together to develop questionnaires in Chinese and will try to do pilot study and collect preliminary data on the targeted study population. (5) Dr. Wu introduced China’s vast Family Planning Network to us and suggested us to use this network for health education and promotion. The Family Planning Network was developed and maintained directly by China’s central government. It employs 400,000 staff members and branches out all across China, from metropolitan to remote mountainous areas. This network is similar to an army that obeys direct order from China’s Family Planning Committee. It is a potentially very powerful intervention tool for health studies and is a very unique organization in the world. Dr. Wu also expressed intention to introduce Dr. Hovel and me to the people in China’s Family Planning Committee, which is responsible for policy and decision-making in China’s family planning and reproductive health.

II. In preparation for the trip abroad
- Communicated with Dr. Fu, Dr. Wu and Dr. Bao before the trip
- Worked with OIP to secure travel fund for Ms. Kanyin Ong.
- e mail contacts:
- Dr. Fu Hua
- Dr. Bao Yong
- Dr. Wu Junqing
-
- researched university statistics and compared to SDSU(e.g. number of students enrolled.) Yes.
- confirmed that prospective university is “recognized” by the Ministry of Education: Yes

Upon arrival/specific activity
What/who are the contacts made at the prospective partner university?
Dr. Fu Hua at Fu Dan.
Dr. Bao Yong at Shanghai Second Medical University.
Dr. Wu Junqing at Shanghai Research Institute of Planned
Parenthood
What particular major/minor is of interest?
Epidemiology of HIV/AIDS
Tobacco control
Behavioral Research
Community Health
Student Exchange

Conclusion, recommendation, and next step?
Why is this particular institution valuable for SDSU?
- Fu Dan University is a top university in China and their School of Public Health is the largest one in China. Both Fu Dan and Shanghai Second Medical University are located in Shanghai, the largest city in China and currently the economic center of China. With a history of more than a hundred years and a population of about 20 million, Shanghai poses unique challenges for public health. From the two universities and the one Planned Parenthood institution, collaborative projects could be conducted in Shanghai or throughout China. Exchange programs for faculty and students with these advanced institutions in Shanghai will provide unique research and learning opportunities.
-
- Sustainability of project (is there a high likelihood that students in the department will be interested in studying the proposed subject area at the prospective partner university and vice versa)?
- China , with the largest population in the world and a decade of economic booming, is becoming a more important member of the international community. However, there are enormous public health problems in China which can greatly impact the rest of the world such as the outbreak of SARS. The scale of public health risks in China and the humane response to these requires an international approach. This is because the problems are so large in China as to be unlikely to be resolved by any one Nation’s efforts. It is also because the health of all Nations is dependent on understanding and effective public health control of the wide range of devastating diseases now plaguing about 50% of the world’s population. These diseases include but are not limited to TB (with over 400million LTBI cases in China and over 2.5million active disease cases/year), HIV, and malaria. These and other diseases are in the context of over 60% of males smoking, increasing rates of obesity and malnourishment, and diseases such as diabetes. The combination of these conditions, along with poverty, poor sanitation, high-density population living conditions, sets the stage for new and deadly infectious diseases that can span the globe. SARS, while not as virulent as initially thought, is as example of a possible epidemic that could cause untold disease and death to both China and numerous countries, including the U.S.

We think the School of Public Health, SDSU should be party to the study of these public health risks, our students should be fully informed about them, and both students and faculty should be actively involved with our Chinese counterparts to affect public health control of these incredible threats to the world’s health. Given the reception from our Chinese counterparts, SDSU has an opportunity to establish a long-term educational and research program that could become a model for other Universities in the U.S. and other western countries.

This will require an administration commitment to this agenda, identification of seed funds to initiate student and faculty exchanges beyond our initial visit, establishment of distance learning classes and means of including students in SDSU classes even if only from long distance and vice versa; and the possible development of joint degree programs. While these educational efforts are developing, similar support will be needed to establish a collaborative research program, with as much student involvement as possible. This too will require initial support from the SDSU administration to establish pilot studies and demonstrate our ability to conduct small studies that reach the quality of peer reviewed publication. This will set the stage and establish our credibility for foundation and NSF/NIH support for larger scale science. Thus, we believe our initial visit to China has provided such overwhelming positive response, that it is now critical for the SDSU administration to partner with us to develop a proximal program of collaboration that could lead to a successful long-term and larger scale collaborative program of education and research.

Through this second visit, we further consolidated our relationship with targeted Chinese collaborators and pushed the agenda of exchange programs forward. Both parties agreed to review each other’s curriculums and start a conversation about student exchanges. I will work with OIP to study SDSU’s general agreement for international exchanges and will work with Chinese universities (Fudan and Shanghai No.2 Medical School) to develop a mutually acceptable agreement. This will serve as a new foundation for officially establishing student exchange programs.

- How will this exchange program (or expansion) increase participation by students in international activities, or enhance international learning environments for students?
- Students should be able to participate in long-distant educational classes via distance learning technology such as video conferencing and by collaborative participation in thesis and dissertation projects. We are prepared to work with the SDSU administration to identify possible sources of funding for collaborative educational purposes. If possible, good will be greatly enhanced if SDSU can provide initial support for educational initiatives to launch possible collaboration. This will sustain the relationships established to date and allow time to identify possible extramural support. As funds are identified students may be able to visit China to complete classes, work more closely with colleagues and more fully understand the culture and its public health implications. The same should be true for Chinese students work with SDSU students and, once a system of clearing visa requirements are developed, Chinese students should be able to visit SDSU.

What students will benefit?
- These collaborative education opportunities will provide students with a competence in international health well beyond that possible by instruction absent the international and collaborative process. This will benefit the specific students without doubt. However, it should also benefit the world community as we become more familiar and tolerant of one another’s culture. This will also benefit the world community as we provide a new cadre of professionals in public health who are cross-culturally competent for increasingly cross-cultural public health threats.

What will be their activities (e.g. course work, international internships, field research, etc.)?
- The ultimate answer to these questions is to be developed by administrators at SDSU in concert with Faculty from both SDSU and our Chinese counterparts. Academic administrative leadership is necessary to move the potential collaboration now started to a long-term and large-scale program. We are prepared to work with the SDSU and Chinese institutional administration to this end.
- Ms. Ong discovered that some Chinese professors actually hosted international students for summer internships and the cost to live in Shanghai for 3 months is affordable to many of our students. She indicated that our students may be willing to pay their own expenses to gain such international research experience. I will pursue this in my future conversation with the Chinese collaborators. Our students can conduct pilot studies such as working with Chinese graduate students to conduct surveys or community interventions. They can also help the Chinese professors to design studies, revise manuscripts and analyze data.

What will be your role in promoting and supporting these activities?
- The exact scale and organization of an international program with China remains to be developed by administrators in China, at SDSU and their respective faculty. However, we believe it is now possible to initiate such a collaborative program.
- Drs Hovel and Ji will oversee the construction of the exchange programs, identify potential funding sources, help writing grant proposals, direct scientific research and publication and provide staff support from his CBEACH research center. As these initiatives take shape, Dr. Hovel will oversee the emerging research program and promote active participation of a wide and interdisciplinary group of faculty from SDSU in the leadership role for studies to be conducted in China, or in both China and the U.S/California. Dr. Ji will coordinate the educational program to be established with the GSPH (and possibly other departments at SDSU). He also will serve as the liaison with our Chinese colleagues for both research and educational program purposes.

V. Additional Information

V.1. Research Groups Identified
From this visit, we have identified two groups for potential
research collaborations including scientific publications and research grants. They are:
(1) The behavioral research group at Fu Dan headed by Dr. Fu Hua.
Dr. Fu Hua is the deputy Dean of the School of Public Health, Fu Dan University. He is an eminent researcher in behavior studies. He has been the leader of multiple projects in tobacco control and physical activities which lead to numerous journal publications. Recently, he published a book in China introducing new behavioral theories. He has obtained international funding from the Ford Foundation.

(2) The HIV/AIDS research group at Shanghai Research Institute of Planned Parenthood headed by Dr. Wu Junqing
Dr. Wu obtained her MS from London School of Tropical Medicine. She has been working in reproductive health for many years. Dr. Wu has recently initiated her research in HIV/AIDS prevention in China and has already been very successful in research grants. She is doing high quality research in HIV/AIDS surveillance and prevention among the migration workers in Shanghai. This overlaps with CBEACH’s work on HIV/AIDS prevention among Mexican migrant workers. Dr. Hovel is also interested in working with Dr. Wu on FAS (Fraternal Alcohol Syndrome).

The collaboration may start with exchanging research work, analyzing data and writing scientific papers, visiting, organizing international workshop and applying for external funding such as from the Fogarty International Foundation.

V.2 Ms. Kanyin Ong’s Report

Kanyin Ong
Shanghai Trip Report

Between January 13 and January 21, 2005, I traveled to Shanghai, China on an International Travel Grant. The purpose of my trip was to ascertain the feasibility and quality of possible research opportunities and student exchange programs with the Graduate School of Public Health at San Diego State. Dr. Ming Ji and I visited 2 schools: Fudan University and the Shanghai Second Medical College as well as visited the lab of the director of Reproductive studies in China.
China’s movement into the 21st century has been a mix between eastern and western cultures, differing political agendas and the challenges that arise from dealing with a nation comprised of so many different interests. It is an exciting time to be a part of China’s continuing development. Over the past few years, China has been a hotbed for diseases such as SARS and the Avian Flu virus. Other diseases, such as HIV, are predicted to have a significant impact on their society in the next decade and China still faces a population crisis. With the movement towards commercialism and fast pace society, obesity is also becoming an important health issue.
During my stay I was able to meet professors and graduate students whose areas of interest are in chronic diseases, HIV/AIDS, tobacco cessation and reproductive health. Though the health topics of interest are similar to the ones we study and research in San Diego, the diversity of the population, government infrastructure and social culture makes China an interesting and educational endeavor for any student. It was an interesting experience to see the approach of the Chinese government to issues such as reproductive health and how they are attempting to deal with the burgeoning HIV epidemic that is occurring in their countryside. It is easier to understand different approaches to global problems once I had been in that environment. After visiting these school and the clinics, I developed a better understanding for the pressures that Chinese society faces and the reasoning to their approach. An experience to research and live in China would be a beneficial opportunity for anyone choosing Public Health as a career.
Unfortunately, due to the economic status of many students and their educational institutions, it is unlikely that many Chinese students will be able to come to San Diego for school. However, the feedback from the Professors was positive about having San Diego students go to Shanghai for an internship. Some of the professors have previously hosted students from the U.S. and Canada for 2-3 months. These placements often took place in the summer and provided students with time to actively engage in studies. Though Shanghai is one of the most cosmopolitan cities in the world, Mandarin is still the primary language used. As a result, attending public health classes is not a viable option unless SDSU students are proficient in reading, writing and speaking Chinese. Luckily, the professors I met and the graduate students have a fairly good grasp of English. Though it would be challenging for any student without any Chinese training, I feel that students with an open mind will soon blend easily into the society.
Compared to the housing and food costs in San Diego, Shanghai is very economical. Like any major city there is a wide range, but students can live adequately on about 3200 RMB/ month (~ $400 US) which includes, housing, food, transportation and some personal expenses. Biking and walking are two of the more common modes of transportation which costs very little and taxis are also relatively inexpensive. Even if GSPH is unable to provide a stipend for students, I believe that students would be willing to pay for funds out of pocket for this experience.
The international programs available to GSPH students that are sponsored by SDSU are very limited. Most of the major international programs are based out of East Coast or Midwest Universities. Providing an opportunity to travel to China to learn and engage in research will draw more students out to San Diego. Public health issues are not country specific and it is important for Public Health students to have a good grasp of how health problems affect different countries and logic behind different methods. Incorporating internship programs will enhance the educational experience of students and also serve as a draw for prospective classes.