Even though she’s not from Texas, the inaugural Chair of UT Southwestern’s new Department of Population and Data Sciences is adapting as she zips around campus in her red Mustang convertible. She’s often headed to a meeting aimed at improving the health of North Texans.
Another adaptation: Dr. Celette Sugg Skinner has taken up country-western dancing.
“When we moved to Texas, my husband and I decided to learn to two-step. We took lessons and now we like to go two-stepping,” she says with the effervescent laugh that punctuates many of her statements.
Pioneering tailored communications
A pioneer in computer-tailored communications, Dr. Skinner has spent three decades developing and testing innovative behavioral-change interventions, particularly related to cancer screening in underserved populations.
The Department’s work incorporates biomedical informatics techniques and algorithms to identify patients in need of interventions, deliver tailored strategies, and track outcomes. The goal is to develop data-driven insights and scalable approaches to improve the health of large numbers of people. Ideally, interventions developed and tested at UT Southwestern can be implemented in multiple health care settings.
“We have a huge catchment area here. The Dallas-Fort Worth area includes 7.5 million people. It has every need you can name. We have uninsured people. We have people who speak many different languages. We have urban and rural populations. There’s just all kinds of work to be done,” she says. Indeed, the DFW area is considered the largest in the South and the fourth-largest in the nation.
Dr. Skinner, who was a high school state debate champion in her home state of Kentucky, persuasively champions the science coming out of her Department. Those studies – many led by researchers from fields seldom or never before seen on campus – are expanding UT Southwestern’s footprint in new and critically important ways.
Solving pressing problems
The data they generate will be used to help solve pressing problems in the 13-county North Texas region. In addition, she is instrumental in bringing the Department’s findings into the national health care discussion: Dr. Skinner frequently participates in National Cancer Institute (NCI) “think tanks” to address cancer prevention and disparities in cancer risks, care, and outcomes. In 2016, she was the only UT Southwestern faculty member to assist the Cancer Moonshot Blue Ribbon Panel, where she served on the Implementation Working Group to set national priorities for implementation research. Those recommendations have guided the awarding of NCI grants in its multimillion-dollar portfolio that includes research on implementing proven interventions in the real world.
Speaking of persuasion, the NCI makes a less passionate but very compelling case for such research: In order to win and keep their designation, NCI-designated Comprehensive Cancer Centers like the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern must excel in clinical care, in basic research, and in studies of population science and community engagement. The NCI-mandated population research fits into the goal of reducing disparities and spending health care dollars wisely.
It’s important to adapt communications and interventions to targeted populations to encourage appropriate testing while avoiding wasteful over-screening, she explains.
“Screening doesn’t save lives. Screening is a test that produces a result. What you do with that information and whether you move forward through rescreening, clinical follow-up, or treatment – if you need it – that’s what saves lives,” says Dr. Skinner. “My particular focus is studying how people make it all the way through that process and how health systems can find out how to get them through it because that’s what leads to saving lives.”
The Simmons Cancer Center is one of only three NCI-designated Comprehensive Cancer Centers in the state and the only one in North Texas, meaning patients would have to drive hours to reach the next nearest one, she says.
Driven by the ‘why’
Following her years as a high school debater, Dr. Skinner’s interest in communications continued through college, where she majored in political science and resisted all the voices encouraging her to attend law school. Instead, she got a master’s in communications research at The Wheaton College Graduate School, studying with the late Dr. James F. Engel, a pioneer in the field of consumer behavior.
“I wanted to know why people vote the way they vote, why they consume what they consume, and, ultimately, to understand their health behaviors.”
“Throughout my studies, I wanted to know why people vote the way they vote, why they consume what they consume, and, ultimately, to understand their health behaviors,” she recalls. After working with some consulting firms following her master’s, she noticed herself gravitating to health behavior projects. The public health field of communication science did not exist when she entered it, but within five years, it was taking off.
She earned a Ph.D. from the University of North Carolina at Chapel Hill, where she conducted a study comparing standard and tailored communications to encourage breast cancer screening, a project that took advantage of the technological innovations available from Macintosh Plus computers, she says with a laugh. Prior to that everyone received one-size-fits-all materials.
“All of a sudden we could give people surveys and find out what was important to them and then we could create tailored materials that only addressed those factors,” she says. As reported in the American Journal of Public Health, women who received the tailored communications got screened at higher rates than controls.
Dr. Skinner joined UT Southwestern in 2007 as Chief of the Division of Behavioral and Communication Sciences and as the founding Associate Director of Population Research for the Simmons Cancer Center. Prior to working at UTSW, she was the Associate Director for Population Research at the Duke Cancer Institute. She also worked at Washington University in St. Louis and at Indiana University, an early adopter of electronic health records (EHRs) and the use of EHRs to study how to influence and improve quality of care.
Currently, in addition to leading the Department, Dr. Skinner is co-Principal Investigator (PI) on two arms of the national PROSPR II Consortium on health care outcomes in cancer. UT Southwestern/Parkland Health & Hospital System is the lead site for Cervical PROSPR II, on which she and Dr. Jasmin Tiro, Associate Professor of Population and Data Sciences, are co-PIs. The North Texas site is also one of four – along with three West Coast Kaiser Permanente locations – for the Colorectal PROSPR II study. Dr. Skinner and Dr. Ethan Halm, Professor of Internal Medicine and Population and Data Sciences, are co-PIs.
Hubs for the PROSPR study include 12 Dallas-area Parkland primary care and gynecological clinics, which makes the North Texas site unique.
The ability to compare patients of Kaiser Permanente, one of the nation’s best known private health care networks, with Parkland – an outstanding and innovative safety-net hospital system that sees mostly uninsured or underinsured patients – presents the opportunity to study ideal vs. real-world responses to health promotion strategies, she explains. Also, the EHRs and primary care network at Parkland are so good that studies done there should generate data that can be used in health care systems lacking the resources of a Parkland or Kaiser Permanente, she says.
“Screening doesn’t save lives. Screening is a test that produces a result. What you do with that information and whether you move forward through rescreening, clinical follow-up, or treatment – if you need it – that’s what saves lives.”
Faculty members in Dr. Skinner’s Department frequently collaborate with the UT School of Public Health’s Dallas Regional Campus, where Dr. Tiro holds a joint appointment. As a result, Dr. Skinner’s red Mustang can frequently be spotted at the UTSW School of Health Professions building, which houses the UT School of Public Health. Additionally, Drs. Skinner, Halm, and Tiro are all members of the Simmons Cancer Center’s Population Science and Cancer Control Program.
New name, broader focus
The Department of Population and Data Sciences, created earlier this year, grew out of the former Department of Clinical Sciences. The new name reflects the Department’s expansion into many new areas and should help in recruiting faculty members and students.
Dr. Skinner is hard at work recruiting innovative, entrepreneurial faculty members for the Department’s many projects as the field heads toward a systems approach to improving health care.
“EHRs provide the ability to study health care systems to determine what works best for the entire population in order to make a large and sustainable difference in the care of many individuals,” she explains, adding that this systems approach will require faculty members with new types of skills to achieve that goal. “We have faculty members in this Department who are pretty unique.”
Those researchers in Population and Data Sciences include geospatial researcher Dr. Amy Hughes, an Assistant Professor; medical anthropologist Dr. Simon Craddock Lee, an Associate Professor who specializes in implementation of health behaviors; and computational scientist Dr. Lindsay Cowell, an Associate Professor with a secondary appointment in Immunology, working to make powerful analytical immune repertoire tools available to a wide audience of researchers.
Mapping life expectancy
In one study that got a lot of attention earlier this year, Associate Professor of Population and Data Sciences Dr. Sandi Pruitt and other UTSW scientists for the first time calculated and mapped life expectancy by gender and race/ethnicity down to the ZIP code and county levels in Texas. The new analysis and interactive mapping tool, which uses data from the Texas Department of State Health Services (DSHS) Center for Health Statistics 2005-2014 death records, reveals dramatic variation by gender, race/ethnicity, and geography.
More than a matter of geography, there are many factors associated with one’s neighborhood that affect health, such as access to safe places to walk or the availability of nutritious food. This tool allows researchers to compare populations in nearby ZIP codes that show great variations in longevity, Dr. Skinner explains.
“The whole region should be different because we are here.”
The project underscores the special role an academic medical center like UT Southwestern plays in the nation’s most pressing public health issues.
“It’s an obligation. It’s a responsibility. We’ve got all these people in this catchment area who have great needs. We have interventions that can be effective. People can be screened. They can be vaccinated. They can change their behaviors by losing weight, stopping smoking, and getting screened – and that’s not happening nearly enough,” she says.
“The whole region should be different because we are here.”
Dr. Halm holds the Walter Family Distinguished Chair in Internal Medicine in Honor of Albert D. Roberts, M.D.
Dr. Skinner holds the Parkland Community Medicine Professorship.