International collaborations can deeply enrich public health research and education by inspiring new ideas, increasing shared knowledge, and broadening personal perspectives.

Josie Dalton experienced this firsthand when she participated in the 2024 iCREATE Summer School in Cluj-Napoca, Romania, as a University of Iowa (UI) College of Public Health undergraduate student. This week-long program held at Babeș-Bolyai University provided students from multiple countries with the skills needed to design, implement, and evaluate public health intervention programs focused on violence and injury prevention and control.

“In just one week abroad, I gained a deeper understanding of different cultures and global public health than I could have in an entire school year in the United States,” Dalton wrote in a follow-up report about her experience. “Immersing myself in a different culture and interacting with students from diverse countries was incredibly enlightening.”

Building Capacity

The iCREATE summer program is one of several scholarly and research exchanges that have developed from decades-long collaborations between the UI College of Public Health and academic institutions in Central and Eastern Europe. The college’s ongoing partnership with Babeș-Bolyai University (Universitatea Babeș-Bolyai, or UBB, in Romanian) has been particularly productive, and its long-term continuity is a special point of pride as the college celebrates its 25^th anniversary.

One thread of this collaboration stretches back to 2005, when the College of Public Health received a training grant from the Fogarty International Center at the U.S. National Institutes of Health. The grant, led by Corinne Peek-Asa, a UI College of Public Health faculty member from 2001-2022, established an International Collaborative Trauma and Injury Research Training program between the University of Iowa and the Stampar School of Public Health in Zagreb, Croatia.

The purpose of the training program was to build the capacity for injury research in the Central and Eastern European region. The trainees, drawn from low- and middle-income country (LMIC) institutions, including UBB in Romania, received training, mentorship, research experience, and several months of education in the U.S.  When they returned to their home countries, the trainees continued to develop research projects and their leadership skills.

From Trainee to Trainer

Diana Dulf, now an assistant professor at UBB, is a prime example of how the training program helped to develop a cohort of injury and public health researchers in Romania. In 2009, Dulf attended a semester at the University of Iowa as a Fogarty trainee.

“I was mentored by Dr. Corinne Peek-Asa and took classes in violence and injury prevention and program evaluation,” Dulf says.

When Dulf returned home, she conducted pilot grant research on backyard farm injuries with mentorship from Peek-Asa and Ann Stromquist, a UI rural health researcher.  “At that point I was a master’s student and continued working with Dr. Peek-Asa under her mentorship, then I decided to start my PhD in the field of road traffic safety.” 

Dulf returned for a second semester at Iowa as a Fogarty trainee in 2013 while working on her doctoral degree, which she completed two years later in Romania.  

Faculty from the UI College of Public Health also collaborated closely with UBB to develop the first public health degree program taught in English in Central and Eastern Europe. Today, Babeș-Bolyai University is home to a Department of Public Health that now offers bachelor’s, master’s, and doctoral degrees.

In 2017, Dulf joined the UBB public health faculty, where her research interests include road safety, child health and safety, and violence prevention, completing the successful transition from trainee to instructor and researcher.

“A lot of my colleagues in the department had training from Iowa in public health,” Dulf adds, noting that numerous UBB faculty members benefited from Fogarty training programs in injury prevention, noncommunicable diseases, and environmental health.

Establishing iCREATE

As many Central and Eastern European countries, including Romania, continued to develop economically, the Fogarty training grants shifted to other locations. During this time, UBB public health faculty like Dulf advanced in their professional roles as well.

In 2016, a Fogarty International Center grant established iCREATE (Increasing Capacity for Injury Research in Eastern Europe) to build research capacity at universities in Moldova, Georgia, and Armenia. The iCREATE grant was the official transition of Romanian colleagues as trainees to serving as a partner in grant leadership.

Today, Dulf is a co-principal investigator on the iCREATE grant, along with Cara Hamann from the University of Iowa, Peek-Asa, now Vice Chancellor for Research and Innovation at University of California San Diego, and representatives from the three trainee countries.

Dulf and her Romanian colleagues have “learned by being in all stages of the grant,” she says. “We were scholars, then we helped to implement it in our country, and then we became partners and are implementing the project in different countries. I think it’s great, because we work with different universities with different situations, contexts, and cultures when it comes to violence and injury prevention.”

Moldova, Georgia, and Armenia have disproportionately high injury and violence rates, accompanied by a relatively poor health infrastructure, especially in rural areas. iCREATE works to expand public health leadership and build strong networks of collaborators in these countries, which will contribute to a sustainable infrastructure. The first five-year grant cycle focused on acute care, road safety, and interpersonal violence.  The second grant cycle, which is currently ongoing, has added alcohol use and implementation science as focus areas.

Key Achievements

Among its achievements, as of 2024 the iCREATE partnership has conducted six injury-focused symposia, held four summer schools, established trauma registries at eight hospitals, hosted 600 participants at trainings and workshops, mentored numerous experiential learning projects and doctoral students, and published15 papers between 2022-2024.

“From my perspective, iCREATE’s key success is the training of researchers in our partner countries so that they are now conducting and producing impactful injury prevention research,” says Hamann, the grant’s co-PI from the University of Iowa. “We have also helped to stand up injury and violence prevention (IVP) curricula, including whole courses and degree programs focused on IVP.”

The connections that Iowa has formed with Romania and other neighboring countries over the years has been critical to building and sustaining public heath capacity in Eastern Europe, as well as providing learning opportunities for Iowa students and researchers.

“The success of this partnership is clearly measured through its impact and sustainability,” says Peek-Asa. “We introduced the concepts of injury and violence prevention into the region’s public health curricula for the first time in seven countries, which has resulted in permanent curricula. Partners competed for some of the first injury-focused research grants in their countries, and several of these have led to established centers.

“These programs have engaged numerous external partners in government, industry, and communities. Many of our trainees have become leading researchers and administrators in their institutions,” Peek-Asa continues. “Perhaps most importantly, we have built lasting collaborations and friendships that are the foundation on which we continue to build critical mass to reduce the global burden of traumatic injury and violence.”

“International collaboration helps to increase awareness of the different places people are at in terms of our field of research,” Hamann adds. “It’s rewarding to see how some of the progress in terms of methods we used here in the U.S. can be translated to work in our partner countries. It is also helpful to have different perspectives to inspire and inform our ongoing work.”

Learn more about iCREATE.