UCLA Public Health Magazine - Fall 1989 by UCLA Fielding School of Public Health

UNION SAN

FJ~

FRANCISCO

DEAN'SMESSAGE n Lhe University of Califo rnia svstem , com·ersion from a single department into several is a long and ar duo us process. for our school, Lhis process is now complete. The school now h <L~ five deparu11ents: 13iostaLislics, Community Health Sciences (wiLh three divisions: Be ha v io r al Sci en ces and I lealLh Education, Population and Family I lealth, and Nutrit io nal Sciences), Envi ronmenwl Health Sciences, Epidemio lom•, and l lcalLh Serv i ces. Th e sch o o l w i ll continue Lo offer 1\1.P.l I. and Di:P.H. degrees from all departments and divisions, the

The academic year 1988-89 was a trial period for this departmentalized system and the experience has been very positive.

rience has been very posit i,·e. It is now time to entrench ourselves into this structure that is much more appropriate fo r die size and status of our school. Th ree new facu lty members have joined the school: Assistant Professor Gerald Kom inski, heal th ser vices; A~s is tant Professor Matthew Lo ngnecker, epidemio logy; and A~ sociate Professor Shane Que Hee, enviro nmental health sciences. In addition, Professor ArLhur Winer will join our faculty <L<; director o f Environm ental Sciences and Engineering. Other searches arc continuing and we expect to

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;;: M.S. and Ph.D. in biostat istics, and the M.S. and Ph.D. in public health from the Community l lealth Sciences depart ment. In add ition, each of the other three depanments w ill oITer d istinct M.S. and Ph.D. degrees. The ncademic year 1988-89 \V<l<; a tr ial period for this dcpanmental ized system and the expe-

fi nalize appointments in the depart· ments of communiLv health sciences and environ m ental health sc iences shortly. These :md other new faculty are expected to Lake a major part in this dynamic pcricxl of growth and rejuvenat io n fo r d1c school. Pri\'ate fund-raising is becoming an

important activit\· of any major school o r uni,·ersit~: A new era in this direaion ha~ been launched by the appoinu11ent of Lhe Dean 's Ad,·isorv Board. This group o f leaders from the health and business professions w ill help us raise rcsou rce;;s for student fel lmvships, research endowments. endowed chairs ;111d buildi ng funds. Continuing the tradition ofd1is maga1.inc, this issue highlighL<; activities by faculty, students and alum ni in various are<L~ of public health. The article on nutrition describes some o f the timely research that ties in very clearly wid1 the Surgeon General's Report on Nutrition and l lcalth. The l ink between nutrition and human d isC<l~es is funher high1ighted by the school's obtaining a training grant on cancer educat ion. The sch<X>l's stro ng presence in research o n J\J DS is now expanded to include a new role fo r training public heal th professionals from \'arious countries aro und the world in the form of the SPH Fogarty International Cemei: The article abo uL sexual assault repo rts imporLant research results showing Lhat verbal resisLance Gin be an effective deterrent. Th<.: p roject h;L'i generated considerable med ia interest around the countn: The question-and-answer article regarding :L'isessment of healLh risks shO\vs the complex ity of d1e issue and makes some inroads toward understand ing this important pub I ic concern. Finally. the alumnus profile descr ibes the career of a healLh professional who is dC\Ot ing his act ivity to helping solve a major problem of Los Angeles and Southern Ca lifornia, namely the health needs of the homel<.:ss.

~ D1: Abdelmo nem A

Attn

UCLA PUBLIC HEALTH \u lume 8. umber 2

Fall 1989

4 Charles E. Yo ung CiiANCEU.O R

Abdelmo nem A. Afifi, Ph.D. l)l:AN

Michael ·i: McManus ASSISl )\ NT VICE Cl IANCEU.OR, UNIVEl{SllY CO MMI JNICAT IO NS

Rich Elbaum DIRECTO R, Hf!ALTll SCIENCES CO~ lM U !CATIONS

FROM WESTWOOD TO SINGAPORE AND BEYOND: FIGKTING AIDS AROUND TllE WORLD

8 mmlHAL BOARD Abdel monem A. Afi fi, Ph.D. DEAN Peggy K. Convey ASSOCIATE DEAN FOR ADM INIST lv \TION

C. El izabc1h C't~t ro, Ph.D. ASSISTANT PROl'ESSO n. NUTH ITIONAL SCIENCES

JUDGING HEALTll RISKS: HOW SAFE IS SAFE ENOUGH? 10

Michael Go lds1ei n, Ph .D. PRO FESSOR, llEI IAVIORAL SCI ENCES AND l lEAJ:ll l EDIJCAT IO N

13i rgiua Gr.mbcrg D IRECl'OR O F DEVH OPMENT

Ted Millon PRESIDENT, ST UDENT ASSOCIATIO N

Joseph Pomemo

COVER STORY: BON APPETIT 14

EDITOR

Ju l ie1 Beyno n Alff D IRECl'OR

Jackie Mo rrow DESIGNER

Kathy Perdue, l!amo n An inag 1\DM INI Srn1rnVE ASSISTANTS

UCLA Pu blic llcciltb is p ub l ished by I leail h Sciences Co mmunicat io ns, UCLA Public Affairs and Dc"\•elopmc nt. fo r the alu mni, facultv, stud ents, staff and friends of the UCLA Schoo l o f Public I l ealth. Copyright 1989 by The RegentS of the University of Califo rnia. Permission 10 rep r int any po rtion o f UCLA l'ublic Healtb must be obtained fro m 1he editoi: Co ntact UCLA I lcal 1h Sciences Communicat io ns, 1100 Glendon Avenue, Suite 150 1. Westwood Center. Los Angeles, Cal ifo rnia 90024- 1708. ( 2 13) 206-1960

LETTERS We wo uld l ike yo u 10 be a pan of UCLA Public I tealtb magazine. Send yo ur comments, quest io ns and ideas 10: Letters, UCLA Public l lealtb, 1100 Glendon Avenue, Su ite 1501. Los Angeles, Cal ifornia 90024-1708.

ALUMNUS BATTLES FOR HEALTll CARE ACCESS FOR LA'S HOMELESS 16

UCLA RESEARCHERS STUDY RESISTANCE TO SEXUAL ASSAULT 17 NEWS

20 PROJECT UPDATE 21 FACULTY NOTES

'll. CO\ ER Pl/OTO 8YJACJ...7E MORRon-

ALlllNlllJTES

UCLA PUBLIC llEAJJ"ll

fram Westwood to Singapore and Beyond:

fIGHTING AIDS AROUND THf WORlD Dr. Alvaro Matida, (left) Rio de Janeiro and Dr. Paulo Teixeira, Sao Paulo, Brazil IDS no longer is limited to homosexuals and intravenous d r ug users in large cities in the United States. The seeming ly unstoppab le march of AIDS is a g lobal health issue reaching into nations and rural communities regardless of size. The World Health Organi zation he1icves that the actua l number of AIDS cases worldwide is about 450,000 o r mo re than three times the 150,000 cases repo rted. And in the next five years, the number is expected to skyrocket as high as 5 million people infected. Conser vative est imates project that I mil I ion new cases w il I be reported. In Bangkok, about one-ha lf of the IV drug users are infected. Brazi l has the

third highest number of AJDS cases in the world. And public heal th officials project that Southeast M ia may feel the next major outbreak of the AJDS virus. Develop ing countries were struggling to meet the hea lth needs of their peop le lo ng before the AIDS epidemic began. I lowcver, its sudden introd uctio n, wh ich is a~sociated w ith practices that are usually illegal and o ften contrary to the religious tenets of these countries, has created a heal th and economic crisis of unprecedented propo rtio ns. Add i ng to the d ifficulty of responding to this crisis, most o f these nations have few individ uals who arc trained in control of d iseases with long innrbation periods such as AIDS, and very

few have individuals with specific experience in AIDS control and treatment. The UCLA School of Public I lcal th, using a $3 million grant from the Fogarty International Center of the at ional Institutes o f I leal th, is attempting to help several countries in Southeast Asia and Lati n America meet the AIDS crisis by provid ing training both in their home countries and at UCLA. Dr. Roger Detels and a facul ty team from the UCLA School o f Public Health and other institutions have started a training program to assist Brazil, the Ph ilippines, Singapore, Thailand and China to control the spread of AIDS. "The idea is to build up each nat ion's capability to fight AIDS by pro-

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vid ing immed iate trammg in those countries and longer ter m technical training at UCLA," said Detels. " We have mo re informatio n about AJDS and its behavio r in the human body than for most other biologic organisms. The amount o f in format ion is extraordinary. Is it enough? No." The UCLA School of Public Hea lth p rogram has three goals, said Detels, professor of epidemio logy and project leader. The first is to p rovide basic i nformat io n about AJDS, the human immunodeficiency virus, the modes o f transmission, strategies to identi fy the magnitude o f the epidem ic, and contro l strategies. To achieve these objectives, the UCLA School of Pub I ic Heal th and School o f Medicine faculties w ill lead short-term sem inars in each cou111ry on copies ranging from epidemio logy to lab techniques to help local heal th pro fess ionals combat AJDS. The second aspect provides training in speci fic areas of the disease for three to six months at UCLA. A~ part of this program, phys icians and other scientists wi ll receive postdocto ra l trai ning in epidemio logy, immuno logy and r etrovirology. Fi nally, pub I ic heal th o fficials and young scientists fro m the five nations wi ll take pare in master's and doctoral degree train ing programs in epidem io logy. The academic part of the cou rse w il l be taught at the UCLA School of Public Health, wh ile the field studies for the thesis and disser tati o n wil l occur in the student 's ho meland in collabo rat ion w ith local schools o f public heal th and medi cine. But numerous problems exist in sett ing up an internat io nal program to battle AJDS. One hurdle pub lic health officials must clear is political. " Because the spread o f the AJDS virus is associated with act ivities which are considered immoral o r are ii legal in many countries, especially those with a strong re1igio us affiliation, health officials are reluctant to acknowledge that AJDS exists in their country," said Detels. " Furthermore, the presence of AJDS could reduce tourism, a major sou rce of foreign currency i n many deve loping

countries. " For these reasons, it is d ifficul t to identify members of at-risk groups in such countries," continued Detels. '' IL is di fficul t to get people at risk to participate in surveys especially since, fo r som e, if they are found to be infected it w ill cost them their sou rce of income. And, the problem is on ly start ing. The disease is preventable through heal th educatio n and behavio r mod i fication, w hich even in the United States is the most d ifficult kind of intervention. Modifying sex pract ices and illega l behavior is part icularly d i fficu lt. For an internationa l program co succeed . it must be sensitive to the moral values, political scene and customs o f the in dividual countries ...

The seemingly unstoppable march of AIDS is a global health issue reaching into nations and rural communities regardless

BRAZIL

Dr. Paulo Teixeira, a physician and director of the AIDS control p rograms in the state of Sao Paulo, Brazil, estimates that there are at least 40 percent more cases o f AJDS in Brazil than the 8,000 reported. There are currencly 5,000 AJDS cases in Sao Paulo. Based o n recent surveys, there cou ld be mo re than 100,000 AJ DS cases in Sao Paulo in the next five years. To help Teixeira deal with the AJDS problem, he took part in the UCLA School of Pu b l ic Heal th-spo nso r ed t rai ning p rogram. Through sem inars and c lasswork, he lea rn ed med ical and epidemiological ways of dealing with the d iscasc . Visiting nu merous AJDS treatment centers in Los Ange les, he saw an incredibly strong vo lunteer movement - a pan of the equat ion missing in Brazil - that was formed to help AJDS pat ients deal with the d isease. " Another problem is the educatio nal program ," he said. " In Los Angeles, for example, the responsib ili tv for educational and counseling programs is done almost entirely with volunteers. This doesn 't occur in Sao Paulo.

of size.

Dr. Roger Betels

UCLA PUBLIC HEALTH

Dr. Roy Chan, Singapore

In Bangkok, about one-half of the IV drug users are infected. Brazil has the third highest number of AIDS cases in the world. And public health officials project that Southeast Asia may feel the next major outbreak of the AIDS virus.

Dr. Pasakorn Akarsewi, Thailand

We have two small groups, and it is not easy to maintain educational programs this way." An additional concern for Teixeira and other public health officials is the dramatic increase in the number of drug users with AIDS. During the past three years, the number of AIDS-infected drug users in the state of Sao Paulo has skyrocketed from 3 percent to 25 percent, which Teixeira believes is responsible for a 700 percent jump (from 2 percent to 14 percent) in the number of heterosexuals infecte9 with AIDS. "In the past two years, we have seen a great increase of AIDS among IV drug use rs," he said. "In some areas, 75 percent of the AIDS cases are among drug users. A consequence of the growth of AIDS among IV drug users is the growth in the number of cases among heterosexuals and children born from infected women." Teixe ira's concern is shared by Dr. Alvaro Matida, a physician and director of the AIDS control programs in the state of Rio de Janeiro. In the first two mo nths of 1989, public health officials in Rio de Janeiro saw more than 800 AIDS cases. He is concerned that this figure may escalate drastically unless public health officials can intervene. Matida believes that AIDS may be a bigger problem in

Brazil than in the United States, adding that the disease may be underreported by as much as 35 percent. "There is no cure and the way to prevent AIDS is not that specific," Matida said. "There isn't a vaccine people can take to prevent the disease. The way to prevent the spread of the disease is with information, health education and.the control of blood supplies. To change people's behavior in terms of sex is not that easy. It takes a long time; and we are dealing with time, precious time." For Teixeira and Matida, the UCLA program was their first exposure to a systematic program of study on AIDS. Meeting public health officials from other nations, Matida said, pointed out the ways AIDS is handled in those countries. Matida said the most important aspect of his training is learning that the demographics of the at-risk group is changing. "That is the most positive thing that I will be taking back to my country."

THAllAllD

Dr. Pasakorn Akarasewi, a physician in Thailand who work~ in the division of epidemiology at the Ministry of Public Health, found out from his UCLA classmates about the changing patterns of the virus' spread. "We meet people from other countries and learn about the AIDS epidemic. We learn about it from our friends and learn about the situation and management in this countty, especially the scientific methods in research and volunteer organizations to work against the AIDS epidemic." In 1987, Thai public health officials found that 1 percent of the IV drug users at a detoxification center tested seropositive, indicating the presence of the antibody to AIDS in the blood. That number jumped to 16 percent in

UCLA PUBLIC HEALTH

1988, and in a March 1989 survev, i t had cl i mbed to 40 percent. " We found that the main characteristic of the rapidly increasing rate was that the IV drug users were shoot ing up in groups, and thev did not clean thei r needles proper ly, " said Akarase,vi. " AIDS in Bangkok is a great problem amo ng rhe population of 20to 30-vear-olds. We think this group represents rhe g reatest pool of infect ion that can be transmitted to families. In the next five to six years, we expect to see a lot o f AJDS cases in Tha iland. Thar w il l have a g reat impact on the econo my and the heal th burden."

SINGAPORE

AJDS has no t vet become a m ajor problem in Singapo re; however, Dr. Roy Chan , a Singapore physician, be1ieves the 35 known Al OS cases are just th e rip of an iceberg. Unl ike Thailand, Chan said, there are very few drug users in Singapo re. The spread of I llV has to th is po int primarily been among homosex ual and bisexual men. " AJDS was initial ly imported by tr avelers," said Chan, who works at the National Skin Centre and the Communicable Disease Centre. "Since then , the pattern has changed. It has become endemic by a group practicing high-r isk behavio rs. The potential for the spr ead o f the virus is there and not just among homosexual men, but also among bisexuals. Thailand , the Ph ilippines and India have alarming rates. With the frequency of travel and the inter m ingling of people, the r isk of spread ing the vir us in Southeast A~ ia is probably higher than in America ... Chan said the oppo rt unity to sllldy the AJDS programs in Los Angeles was very helpfu l. He learned techniques at UCLA that will improve the r epo rting and surveillance of AIDS cases, and th rough the field trips, saw the need fo r vo lunteers as an adjunct to meet ical ser vices. Volunteer services in Singa-

po re are in their infancy, but Chan and a few col leagues are try ing to change that. In December of 1988, they founded AIDS Singapo re, a nonprofit group that wi ll dissem inate informat ion and educatio n to high-risk groups.

PHILIPPINES

Dr. Teodora \Xii , a physician w ith the Department o f Heal th in the Ph ilipp ines, said what she has learned at UCLA w ill go a lo ng way coward p reventing AJDS in the Phil ippines. "The knowledge ga ined he re is leaps and bounds ahead o f what is available in rhe Ph il ippines,'' said \Xii. " Knowing mo re about AJ DS and rhe ways to conduct rapid surveys was im portant and profitabl e for me." In Baguio, the summer capital of the Philippines, the U.S. Navy is do ing the o n ly HIV screening. Because o f the proximiry and number of m ili tary bases, \Xii sa id most AIDS screen ings have concentrated on the "commercial sex models" o r " hospitality gi rls." Al though AIDS is not a p riority program yet, the number o f' seropositive cases is doubl ing each year. Dr. Caridad Ancheta, a physician and cha ir o f the department of epidemiology and biostatistics at the University o f Phi l ippi nes Co l lege o f Publi c Heal th, fea rs a dramat ic increase in the number of AJDS cases i n th e cou ntry as several " hospitality girls" have tested positive to H IV Ancheta said her participation in the Fogarty lmernatio nal grant is a way to strengthen the academic materials for her students. The department currently has one cou rse in the control of communicab le diseases and AJDS is just one part of th at course.

Dr. Caridad Ancheta (left) and Dr. Teodora Wi, Philippines

UCLA PUBIJC 1IEALTI I

â&#x20AC;˘

How Safe â&#x20AC;˘ IS

Safe fnough? he "greenhouse effect" is warming the p lanet. Some drinking water has been contaminated and innumerable chemicals and pest icides are used to treat our foods. Asbestos in schools and radon seeping up through the fo undat ions of o ur ho mes seem ro present a barrage o f hazards to be sidestepped every clay. \'lie know that cho lesterol has been linked to hean disease, but we arc willing to take a chance and eat that hamburger o r o melet because we figure just o ne wo n't hurt. We face these and numerous other risks every clay. But as consumers, how do we weigh all this infor marion and st ill enjoy life? How do we determine if a substance is a rr ue risk? Dr. Climis A Davos, associate professor of environmental health sciences, specializes in the study of how people evaluate various risks. Davos recentlv talked w ith UCl.A

Public I l ealtb magazine about the influences used Lo decide \vhat risks people a1:c w illing to accept. Q: What is the difference between r isk assessment and risk evaluation? A: Ri s k assess ment gauges th e chances o f something happen ing determining w hether eating a certain number of apples each day that may have been treated w ith Alar might he harmful. Risk evaluatio n looks at the signi ficance of a risk so that a decision can he made whethe r to accept, regulate, o r prohibit the source. Decid ing to eat those apples even though the\' may have been treated w ith Alar and might be harmful implies a risk e\'Jluat io n has been made. Q: Do th e factors used to evaluate risks differ? A: Fo r most of the known risk sources - drugs, alco ho l, pesticides, air travel, automobiles, smoking, X-ravs, nuclear energy, hazardous \vastes - the facto rs are the same. It has been determined that certain factors may influence the attitudes of individ uals to ward these sources. 0. What ar e some of these factors? A: Pe rsonal heal th risks, suc h as t hose fro m sm o king, alcoho l and drugs, may lead us to reject a risk source. On the orher hand, the benefits from certain risk sources, such as those fro m electric appliances, X-rays, auto mobiles, and coal-fi red power plants, may o utweigh any harmful effects. and we would accept the risks invo l ved. Indiv iduals may be more concerned w i th involuntary risks. such as those from pesticides, o r wich irreversible risks than w ith ones they accept voluntarily. They feel more comfo rtable in making judgments when

they believe they understand the risks and have confidence in cheir or societ)' s abil icy to control the risks. Finally. one's sex, age and socioeconom ic class membership have been found by some studies to influence che e\'Jluatio n of risks. 0: Is scientific evidence used co evaluate risks? A: It's interesting co poinc out chat the risk estimates made by experts and laymen are basical ly the same regardless of the info r mation sources. I lowevcr, experts consider these est imates to be decisive, whi le laymen consider them to be only o ne factoc Moreover, in most cases of environmencal risk~. the evidence is presented in such a manner that it is cxtremclv d ifficult, if nm impossible, to weigh. For example, how many individuals can make any kind of decision based on the following: " Exposu re to 0 ..... micrograms per I iter o f benzene in drinking \Yater wil I resul t in an excess of lifetime cancer risk of one case per million." 0: Why do we take risks which may be harmfu l? A: Accord ing to one poinc of view, some m ay wan t t he benefits ro o utweigh the risks. We al I drive despite the chance of an accident. Some drive faster than o thers and some drive very fast, enjoying not only the thril l of speed but also the higher risk. If there is no basis to assume that che benefits balance the risks, \Ye have to conclude that those who still take the r isks m isunderstand them. Th is leads to the rallying c~' of the r isk assessment experts of .. How safe is safe enough?" This view is challenged by those, myself included, who argue that there arc no such things as

UCLA PUBLIC HEALTII 9

S ~

'-'

Dr. Clim is A. Davos

objective data since no truths exist independently o f people. Subjective facts are the best and on ly e\'idence available. I lence, people continue to take risks that may be harm ful for various reasons. Moreover, risk is a pol iti cal matter, and r isk research is a pol it ical tool for political decisions. Since fairness should be the paramount factor in making these decisio ns, the question that ultimately should be answered is Âˇ'Ho"'Âˇ fair is safe enough?.. 0: What is an example of the two points of view'

A: The Air Qua I ity Management District devised a p lan to improve the air qua I iry o f Los Angeles. Some criticized the plan because they said it may lead to loss o f jobs for minorit ies working in risky industries - such as the foam packaging industry and the furn iture industry with its use of solvents. Imp licit in their argument was the belief Lhat mino rities don't care about risks as long as they get paid. Economic, social , or po litica l cond itio ns were not considered to explain why mino rities continue to work in Lhese industries

despite their probable fear of the risks involved. 0: What is your interest in this area? A: I try to test the facto rs influencing the decisions of some environmemal risks, such as hazardous waste management. I also try to get a greater understanding of the role social, economic, and political condit ions p lay in accepting cenain enviro nmencal risks. Part of th is effort is a study of the awareness of and att itudes towar d r i sks o f t he Latino co mmunity in Southern Cali fornia . I also am working o n the concept of a frontier that wou ld al low one to mon iLOr the tradeoffs between society's concerns about equity and science's concern about r isk management. Only by understanding these tradeoffs can we reach decisions that can be carried o ut free o f cont inuous opposition, l itigation and animosity For example, if Los Angeles residems and pol itical leaders had balanced what was scientifically and polit ically sound, we might have had cleaner ai r by now.

l 'CLA PUBLIC I IEA!Jl I

iet has p robably never been taken mo re ser io usly Lhan it has du ri ng the past decade. Nutrit ion scientists have established co rrc~ lat ions between heart d i.~ease and cholesterol. Fiber has been found Lo reduce che risk of certain forms of cance r and th e Su rgeon Genera l has h igh l ighted che correlat ion becween breasc cancer and ro ta ! fac consumption. The cor relations between d iet and d isease have been well establ ished. Sciem ists arc now scudying the underlying mechanism s I inking diet and dise;1se: how and why the lack of certain nutrients contribuces LO d isease. ,\ lanv facto rs innuence the diet-d isease interaction, includ ing environmem al compo nents, ind ivid ual genet ic makeup, and age. Nu t r itio n r esear ch in th e UCLA School of Public I lea lth is add ress ing \'Jr io us aspects of d iet-d isease correlatio ns. Ongoing pro jects include che investigation o f essent ial elements such as zinc and its ro le in gene expression and growt h, and selen ium in the etio log~' of d iabetes. Anot her area o f resea rch is the role of ca lcium iniake and osteoporosis. What all th is means LO consumers is that UCLA School o f Public Heal th nutritio nists are search ing for methods Lo reduce. el im inace or treat \ario us diseases, includ ing cancer - the subject o f a $2 mil I io n g rant fro m the Nathrough Lio nal Cancer l nscitute diet. (See accompanying article for mo re info r mal ion.) " utritio n is a set of processes 1hat includes the ingest io n, digest ion, assimilatio n and metabolism of m uri-

JOSHH

POMfNTO

ents," said Dr. C. El izabeth Cascro, assistant professor of nutritional scie nces. " I t also has a psychosocia l componem chat adds Lo the complexity of studying nutrit ion ... In the 1988 Surgeon General's Report on 1utrition and I lealth. ic \Y~L~ poi nted out chat diet is a means to imp rove heal th s ign i ficant!~: Individuals can have a direct impact o n their heal th through improved nucrit ion. Castro said the report has generated as much interest as d id a report on smoking in the 1960~. O f the I 0 leading causes of death, five are related to nutrition, Ca;,cro said. In the health objective;, for the nat ion through 1990 and 2000, nutrition w i ll continue LO be a priority fo r im provi11g heal ch.

n her research al L1CLA, Castro is studying the effects of zinc deficiency o n the DNA str uctu re and gene expression and how such interact ions affect growth processes. The two-year study is funded by the ,\larch of Dimes Binh Defects Foundation and a UCLA Cl inical Nutrition Research Unit Grant. Al chough se,·ere zinc deficiency occurs primarily in the population;, of developing coumrie~. marginal defic iency is also fou nd in de,·eloped cou ntr ies, accord ing 10 Castro. "We kno"· zinc deficiency cau;.es grow th suppression. but we do not know precisely che mechanisms involved," said Castro, whose zinc studies fol lmv I 0 years of research on d iet and D A. "Examining the molecul:Jr mechan isms involved in zinc deficiency and gene expression is the focus of

UCLA PUBLIC llEALTI I

my research ... A major re:.ison for zinc deficiency in de1·elo ping countries is protein mal nutritio n. she explained. 7.inc is found primari ly in meats, as wel I as in whole g rains, shel Ifish and legumes. Using laboratotY rat models, C 1stro is zeroing in o n how zinc deficiency affects DNA structure to better understand th e ro le o f this n utrient in growth. "Studying zinc deficiency is just one part o f the larger p icture of understanding the role of nutritio n in gl:ne ex pr~ss io n ," she said. 'This research may help p rovide a unifying idea of how nutriellls affect disease processes at the subcel lular le1·el. .. To help Castro 1vith her studies, the Uni1·e rsity h:is spe nt S 182 ,000 $ 17•1,000 o f the cost was paid fo r through the state m ino r capita l im provement pro ject and $8,000 cornribLlled by the School o f Public I lcalth Dean 's Counci l - to refurbish the lab. The lab 1vas completely rl:no1wed. and ''"L~ divided to accommodate thl: modern techno logy needed for Castro's

studies. \Xlhen completed, o ne area of the new lab wil I be used as an isol:u io n room fo r culturing cells and anot her sect ion wil I be used for cxpcri men ts involving recombinam DNA. "The ncw l;Jb wil l allo w me 10 better use sia1e-o f-the-art techno logy for nutrition rescarch," she said. The l:ih was finished in Sep1embei: Lisa Kaspin. a first-year mas1er 's s1udc nt, started work ing with Cas1ro o n the experiments fo llowing her undc r gradume work at the UCLA microbi o logy dcpanmen1. Working w ith Castro, Kaspin is 1rying to determine how a zinc cleficicncv alters D A structure, and any possible connect ions it may have to cancer. Kaspin and ot her graduate studems enjoy partic ipating in research because they get the opportunity to apply 1he know ledge gained in classroo m settings. Kaspi n , 13.S. '88, ex plained that her experience at the School o f Public I lcalth gives her a broader view o f how science app lies to resea rch p ro blems. " Knowing that I can use wha1 I have

Dr. C. Elizabeth Castro examines the molecular mechanisms involved inzinc deficiency, a contributing factor of growth suppression. Anew $182,000 lab is being readied for Castro's work.

UCLA PUBLIC I IEALTH

learned helps me learn bcuer." said Kaspin. ·· 1 am gelling much more out of the independenL ::ipproach - research rather than just learning from the classroom selling."

r. Cunis Eckhen , associate pro fessor and acting head o f the division o f nutritional sciences, is imerested in what happens when gro ups of nor mal cells in the body are fo rced 10 com pete with one another fo r l im iting nutrients. r:or eight years, he has studied

microangiopathy - a d isease of the smal I bl ood vessels caused by the thickening of capillar ies in diabetic, carcliov<1scul<1r and stroke pat icnts and has fo und that d ietary selen ium protects against this breakdown. In the mid- 1970s, selenium - contained in seafood, whole grains, red meats, milk, chicken and other foods - was found to be an essent ial clement of nutrition. Eckhen 's studies arc funded by the ational Eye Institute and the American Diabetes A~sociat ion.

"Nutrition is a set of processes that includes the ingestion, digestion, assimilation and metabolism of nutrients. It also has a psychosocial component that adds to the complexity of studying nutrition."

The electron microscope is a useful tool in unlocking the mysteries of Dr. Curtis Eckhert's research of selenoproteins.

··one of the impl ications of my research is the discovery that selenium is intricately involved in protecting against microv<iscular disease," explained Eckhen. This research could provide an impona111 understanding of ways to protect against tissue damage which occurs in diabetes, as well a-; for coronary heart d isea~e and stroke, which represe111 the major chronic d iseases in technological societies In add ition, Eckhen 's studies have shown that excessive riboflavin - vitamin 132 - increases the risk of lightinduced damage 10 the ret ina. Ribo flavin is readily destroyed by light and its photodegraclat ive p roducts are kno\\'n to be damaging to membranes. David Batey, a doctoral student, ha<; wor ked with Eckhcn for the past six years, and has invest igated various aspects of certain hered itarv d iseases that resu lr in b lindness. "The work that I am doing inrnh·es several nurricional factors that result in bl indness," said Batey. " I have three abstracts pub I ished and wi l I have at least three more before I leave. In this lab, you are al lowed to \\'Ork independently and you have a good deal of r esponsibility for the project." Mei-1lui I lsu, a fifth-year student fro m 'laiwan , has been invo lved in isolating cells to understand ho\\' they interact with selenium. Upon returning to Tai,van, l-lsu hopes to be involved in research, and also in the appl icat ion o f her work to improve the nutritional scat us of her fellow countrymen. " In Taiwan, we ha,·e a lot of nutritio nal problems," she said. " Nutritional ed ucat ion is not emphasized. People in Taiwan sti ll th ink o f nutrit ion as home economics. Al I of our nutritional infor mation is adapted from the United Scares or Japan. \'</e ha,·e no standards for our own people. I wi ll have a lor to do back in my cou111ry"

UCLA PUBLIC HEALTH

UClA Awarded S2 Million Grant for Cancer fducation Training Program

[ very day we hear o r read abo ut a [ new suspected can ce r -causing agenc. Sometimes it is in the foods we eat, and at other times it is in the air we breathe or the water we drink. Several mo nd1S ago, Los Angeles school officials pu l l ed apples o ff school menus after the fruits were found to contain Alar - a pesticide suspected of causing cancer For years cancer researchers and public health officials have warned of cigarette smoking's link tO lung cancer. The Surgeon General's Report o n Nutrition and Health stressed that Americans can improve their health by eating low-fat foods. Nutrition scientists have established correlations between d iet and d isease. Now, trained professionals are needed to develop the programs and bring ways tO reduce the risk of cancer co the populatio n. Through a $2 million grant from the Natio nal Cancer Institute (NCI), d1e UCLA School of Public Health will initiate a doCLo ral program to train studencs in cancer education and control. The NCI awarded its only cancereducation grant in 1989 to the UCLA School of Public Heald1 t0 uÂˇain doctoral students in the behavioral and educational aspects of cancer control, said Or. Virginia C. Li , professor of behavioral sciences and health education and principal investigator of the grant. The program's primary focus w ill be o n nutrition, and how better nutrition can lead to a reduction in the cancer risk. "Nutritio n plays an important role in eancer contro l," said Li, a health educator with two degrees in nutri-

tion. "We are looking at the scientific evidence and developing the research programs we can use co build on that. The field is wide open, but a lot focuses on nutrition and smoking." Also invo lved in the project are: Dr. Ellen Gritz, directo r of the Division of Cancer Contro l, Jonsson Comprehensive Cancer Center at UCLA, and Dr. Marian Swendseid, professor of nutritio nal sciences at the UCLA School of Publ ic Health. Students wil l be trained in methods of cancer contro l and education aimed at special risk populations - women, smokers and patients w ith cancer, Li said. Community-based programs also w ill be developed to help heald1 educators communicate with consumers and w ith ethnic popu lations. "Our hope is to use this training grant co recruit high-caliber doctoral students, who will contribute to our knowledge ba5e about cancer," she said. "What makes our program so stro ng is that we are able to pool resources between the School of Pub! ic Health and the Jonsson Comprehensive Cancer Center. The benefits are mutual. " Li ha<> been involved in smoking prevention programs for the past 10 years, and ha~ worked to train physicians to deliver anti-smoking messages during routine med ical care. The training strategy, Li explained, w il I incorpo rate a comprehensive approach to cancer education and will cover three areas: primary prevention related to cigarette smoking and diet, psychosocial and behavioral issues related to cancer contro l, and program planning and management. Students

Dr. Virginia C. Li also will take pan in ongoing cancer research internships. Students w ill gain experience by working w ith researchers at the Division of Cancer Control at d1e Jonsson Comprehensive Cancer Center, Li said. Fo r example, students may work on any of four projects that are pan of a five-year study funded by a NCI gram co test various inter ventions that increase patient adherence to cancercontrol regimens. The survival rate of chose with cancer has stead ily increased during the past 20 o r 30 years, but Li said there are d isturbing signals chat indicate that the rate of lung cancer in women is now increasing at the same rate as men due to cigarette smoking. Li said 25 doctoral students wil I be trained in the program during the next five years.

14 UCLA PUBLIC HEAJ:rn

Alumnus Battles for

Health Care Access for lA's Homeless hen Michael R. Cousineau was a doctoral swden1 at the UCLA School of Publ ic I lealth , liu le d id he realize that he wou ld later be fighting for the health care rights o f 1housands o f Los Angeles' homeless. Hathe1; he pictured h imsel f working in an academic seiting doing resea rch, working on po l icy d evelopmern o r maybe involved in pol icy oriented r esea rch. Cousineau, w ho graduated in 1987 w ith a Dr.P.11. in behaviora l sciences and health ed ucation, is execut ive d irector o f the Los Angeles Homeless Health Care Project, a posit ion he has held since April 1987. " I turned down rwo offers for 1enure-track teaching pos itions o n 1he West Coas1," said Cousineau, working in an office in downtown Los Angeles shared wi1h o ther no nprofit commun iry agencies. " I felt the best way 10 make significarn changes in my community was to work in an organ ization that was trying to make a difference in the commun ity I d idn't envision myself wor king in the nonprofit sector.

My no1ion of success is when I've seen a change w here I have had an impact. " The Los Angeles Homeless I lealth Care Project started in 1985 w i1h a $1 .3 million gram fro m the Robert Wood Johnson Fo und at io n and the Pew Memoria l Trust. It is a consort ium o f commun ity-based organizat ions that s1rivc to provide opti mal hea lth care for the h ome less th rough d irect ser vices, educat io n, advocacy for ind ividuals, and as advoca tes for insti tutio nal change. Under Cousineau 's leadership, the number o f employees increased fro m three 10 15 and 1he annual budge1 gr ew by 500 percent ( fro m $150,000 10 $800,000). In addition, 1he number o f agencies p rovid ing heal1h services to the ho meless has grown from three to 10. The staff currently includes 1hree graduaies o f the UCLA School of Pub1ic I lealth - Lynn Kersey, M.P.11. '85, Lo is McCloskey, Dr.P.11. '87, and Al Shen, M. P.H. '88. Cousineau feels part icularly p roud of building a staff of dedicated and skilled professio nals. It is they who make the project work, he said. The pri mary function of the Los Angeles Ho meless I lealth Care Project is lO increase access to health-related services for the homeless. One way 1he project does this is by training and educat ing the operator s of the shelters and drop-in cerners for 1he homeless o n topics from CPR training to making sugges1ions on ways to lim it po tential contamination or infect ion in the centers. The projec1 also trains case managers, and campa igns for more cri1ical resources. On some issues, the project has found itself on the opposite side of

powerfu l agencies - a fact that can make fund-ra ising difficult. For example, 1he project is now leading a campaign 10 increase tax-increment funds for human se rvices in Los Angeles from the Community Redevclopmern Agency. The p rojec1 has been acti,Âˇe in increasing pub I ic awareness about the health consequences of homelessness. With the Los Angeles Coumy Health Department, 1he projcc1 cosponso rs a program which pro\'ides meals at a downco,vn tuberculosis cl inic so 1he homeless can ge1 treatmern and a hot meal. Although the projec1 does not provide primary health ca re, Cousineau explained that one of his du1ies is 10 educate other agencies tha t health care and housing are I inked, and both need co be addressed if a sol ut ion to homelessness is to be fou nd. "You can't provide health care wi1hout considering where people li,Âˇe," Cousineau sa id. "\Xie work with health care providers and try to educate them that it is no t enough to treat an individual for a specific p roblem, such as cardiovascular disease, withou1 understanding the environmem where the person I ives. It is not just a housing problem or health care problem. II is both. "The frustrat ing part is the sheer magnitude of the problem and the relative lack of resources available 10 make a elem in the prob lem," he cont inued. "Given the 1remendous barriers people face when trying to find a place to live, health care is often the last 1hing on their minds. " The 37-year-old adm inis1racor is al l

UCLA PUBLIC llEALTI I

"we work with health care providers and try to educate them "'~

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Alumnus Dr. Michael Cousineau, Los Angeles Homeless Health Care Project executive director, has fought to provide sources of health care for the homeless. too familiar with the sad stat istical storv. In Los Angeles, 10,000 lov>'-income housing uniL~ need to be bu il t each year. However, 1hat SLii I fails to provide eno ugh ho using for between th e 30,000 and 50,000 ho meless people in Los Angeles, including 3,000 children under 5 years o ld. The sho rtage of affordable housing i s co mpo u nded, h e said , b eca use there are 50,000 low- income housing unils in the city 1ha1 fail to meet earthquake standards. Landlords have 1wo options: 1ear clown the buildi ngs o r renovate them. Either way, it resul ts in the loss o r affordable housing, even tempo rarily One of 1he things Cousineau poirns to w ith pride is h is wor k that won a $2 mil l ion federal grant for health care to Los Angeles' ho meless po pulm ion. "The orher thing I loo k at is taking on an o rgani zat ion thm no body knew about, and informing the com munity that w hat we are do ing is worthw hile eno ugh LO suppo rt ii fo r a couple of hu ndr ed thousand do llars a vear, Cousineau said.

1-1<: \vas able Lo convince commun ity and local fo undations to support th<: project fo l low ing the encl o f the Robert Wood .Johnson gra111 fu nds. Currently, the project's budget is composed or 30 percent federal funds; 25 percent donations from Com ic Relief - a no nprofit organ izat ion mobil i zing per formers to raise funds to aid the indigem and provide basic heal1h care and related ser vices Lo homeless people nationwide; 20 percent local fo undations; and 25 percent from contracts w ith the city and other organizat io ns and ind ividual clonarions. Cousineau - who lives w ith his wife, Nancy, and his daughter, Rebecca, in West Los Angeles - r eceived a bachelor of science degree in genetics from UC Berkelev. After two years o f genet ic research at Caltech and three years as d irecto r of a free health clinic in Pasadena, he received his M.P.H. from UCLA in 1980. He moved 10 Northern California where he founded Chico's fi rs1 Planned Parenthood clinic and taught at Chico Staie Universitv

While Leaching, Cousineau was contaCLed bv Dr. E. Richard 8rmvn, associate p rofessor of behavioral sciences and health education at the UCLA Schoo l o f Public Heal th, to take pan in a research project on the impact of a state law designed to slow the closure of pub I ic hospitals in California. The resul ts of that imeract ion with 13rown pe rsu aded Cousinea u to retu rn to UCLA in 1982 LO start wor k on his doctoral degree. I le also has panicipated in s1udies o f indigent care in Los Angeles and Orange count ies; the impact on the heal th care system of change in the state and Medi-Cal policies; and in a study of health care access for the homeless. "My docto ral training d id not give me the skil Is to be the administrato r of an agency I ike this," said Cousineau , " but it did g ive me the broad perspective of a no nprofit organizatio n's role in trying to positively affect p ublic health pro blems such as the homeless."

that it is not enough to treat an individual for a specific problem, such as cardiovascular disease, without understanding the environment where the person lives. It is not just a housing problem or health care problem. It is both."

UCLA PUBLIC I IEAJ;n;

o r yea r s the co ntrove rsy has raged wh et h er rap e vic ti ms sho uld attempt co fight the ir assailants. Or does resistance spur on the assailant? i\fany police officers believe it does and have usually advised victims not to resist. However, researchers at the UCLA School o f Public Health found that th ose who ve rb all y resist sexual threats are l e~s I ikely to be assau lted. Although there have been numerous sexual assault stud ies, early o nes relied heavily on pol ice reports for their inf<'> rmat ion abolll the crime. That wasn ·1 the case with researchers fro m the School of Pub I ic I lea I th, who decided it was time co include those who had successfully averted an assault and did nm necessarily report the crime to po lice. Dr. Judith Siegel, principal invest igator and associate professor in behavio ral sciences and heal th educa1ion, said, ·Traditiona lly, most of the data have been supplied from pol ice reports, but most sexual assau lts arc not reported to the police." In the study, approximately 9 percent o f all sex ual ~1 ssau l ts were reported to the pol ice and 3 percent were reported to rape crisis centers, Siegel added. The study was funded b\' the Nat ional Institute of 1\lental Health. Ors. Susan B. Sorenson and .Jacqueline Go lding o f rhe UCLA Schoo l of Publ ic Health, Dr. M. Aud rey ~urn am o f The l{AND Corp. , and.Judith A. Stein, a doctora l student in pub I ic health , also were authors o f the report . The sllldy, w hich generated nationwide med ia auention, includ ing the NBc-·rv ··10day" show, Cable ews ecwor k, Los Angeles Times, USA Today and the Chicago Tribune, was the first in-depth look at resistance to sexual assaul t. The responses o f the victims were classified in six general categories - talk ing, reasoning. saying no sexual interest, loud o r angry tal king, fleeing and physically fighting. Researchers fo und that calking was the most common for m of res istance with 27 percent o f the victi ms indicating they had tried to calk their 'vay ouc o f the sexual assaul l. Fo r ry-fi ve percent o f the victims had used some form or

UClA Researchers Study Resistance

to Sexual Assault Dr. Susan B. Sorenson

Dr. Judith Siegel

ver ba l resistance- ta lking, reasoning, saying no sexual interest, or loud or angry talking. " If cherc is a prior relationsh ip with an assailanc, ir makes sense char someone \YOuld try talking as a first opt io n," sa id Sorenson. Siegel cautions that the study was not intended to draw conclusions about the \Vays o f prevencing sexual assaulc. It does agree wich previous studies indicating that resistance, part icularly verbal, reduces the probability of an assau l t being compleccd. Further more, she explained that resistance - w hich \<tried from talking to physically fighting back - was more effective when che assailant made ver bal chreat5 as opposed to using physical force. The findings were based on the responses o f 240 \YOmen and 120 men who reported using a resistance strategy. Most of those who had indicated they wer e sexually assau lted also said that the assailant was someone thev knew or were acquainted \Vith, Sorenson said. " Po lice typicall y say ·don't fight back· because you will only get hurt worse," sa id Sorenson , whose r esearch and cl inical work deals <>vith l'iccims of violent crime. 'That may be viable fo r stranger attacks, but it has co be an individual, sit uational decision. If the assailant has a weapon, a \Yoman may change her priorit ies to say ·l may be raped, buc I wi ll su r vive."'

UCLA PUBLIC HEALTll

Officials Seek to Improve Health Through Communication

o rld Health Day activities were held in Apr il at the UCLA Sc hoo l o f Pub I i c Heal th and around the world to improve the way heal th informatio n is communicated co the pub1ic. Under the banners o f " Let's Talk Heal th" and " Facts fo r Li fe," public health officials called for an all-out effort ro improve the health of child ren and adults in developing nations. ·· If informal io n can be commun icated ro the publ ic concern ing major health problems, this will make a considerable i mpact," said Dr. Derrick B. .Jelliffe, professor and head of the d ivision of po pu lation and fam i ly health. 'The q uestion is through w hat channels." The goal o f the World Heal th O rgan izatio n ( \XTHO), exp lained jelliffe, is to move towar d " 1leal th for Al l" by the year 2000. To help toward th is goal, IO bas ic areas that cou ld improve the heal th of mothers and children were targeted. The JO "' Facts fo r Life" incl ud e th e fo ll owing ar eas o f knowledge: • Primary Health Care • Women 's Wo rk • Tim ing of Births • Safe Motherhood • Breast Feeding • Ch ild Growth • Immunization • Diarrhea • Coughs and Colds • Hygiene Accord ing to WHO statistics, mor e than 250,000 ch ildren die from infection and malnutrit io n every week. Dr. Ral ph R. Frerichs, professor of epidemio logy, said the excessive mortality rate of the young and d1e ver)' o ld affects the ability

Dressed in traditional attire for World Health Day, public health students, Joel Lamounier of Brazil, Suzanne Westman of Peru, Berkane Wubshet of Ethiopia, and San San Myint of Burma, discuss ways to improve health information distribution. of a natio n to invest in the future. " Health p r o bl em s are well k nown to the peo ple, but they don't know the solutio ns," he said. "They often turn to the government, b ut unfort unately the g o ve rnm e n t ha s I i mit ed r esources. The community health worker, sa i d rreri chs, is the fron t I ine wor ke r best equipped i n the heal th team to bri ng the message to the peopl e. I loweve r, many other channe ls o f communi catio n exist - heads of state and po litical leaders, all branches of national and local government, r e l ig i o us leade r s, ed uc<tti ona l leade r s, the m ass m edi a, e m p loye rs, trade u ni o n l eade rs, heal th pro fessiona ls, develo pm e nt w o r kers and voluntar y agencies, commun ity o rgan i zatio ns and traditiona l leaders, artists, entertainers and sports personal it ies. A~ pa rt of the local program, students fro m Burma, West Africa,

Pakistan , Peru , Ethiopia and Brazil talked abo ut the ''Facts fo r Life'' prog ram and how it can \VOrk to improve heal th cond it io ns in thei r countries. It became evident from the st udents that ther e is no universal way to com m unicate these health facts to people in developing nat io ns. If the goal o f health for all by the year 2000 is to be achieved, communication plans w ill have to be tailo red to meet the indi vidual needs o f each nation. ror Burma, the best way to reach the people w ith a message would he through traditional theatrics o r d rama. In Pakistan , Brazil and Peru , religious institut io ns would be verv valuable channels. West Africa's p roblem is that the number of dialects spoken make statewide heal th messages ineffective. Nevertheless, all agreed the mass med ia, especially rad io, >vere increasingly power ful tools fo r social mar ket ing techniques. Dr. Snehenclu B. Kar; pro fessor

o f popu latio n and family health, i ncluded sever al principles to g uide the ed ucat ional process. Those incl ude - the "demedicalizing" of info r mation, decentral izing poss ible solutio ns, examining the demograph ic reality of the natio n, and reversing the tvpical top-to-bon om wa\· of obtaining and relat ing in format ion.

Students Share Wealth of International Experience r. Myo Thet 1-ltoon, a Burmese physician. had a weal th o f pract ical exper ience in public heal th , but lacked the training to co nduct comp I icated fi e ld studies. Jeanne IJertolli, a docto ral stud e nt fr o m San Fran c isco, had learned the technical skills; however, she has no t had the chance to applv them in an international basis.

LICl.A PUBLIC I IEALTI I

At the UCLA Schoo l of Publ ic I lealth, the rwo students hm路e had the opportuni1y to \York together o n a public health project o f internat io nal significance fo r the \Xtor ld Bank. Berto li i, a doctoral student in epidemiology, has an interest in internm ion al wo r k. I lmon, from Rangoon, Burma, is in the master 's program in epidemiology, and hopes that his training will he lp him to study 1he health problems in his natio n. Altho ugh Bertolli has yet to gain work experience abroad, she already has learned a great deal about international health from classmates like 1l toon. She became interes1ed in other cultures th rough her undergraduate anth ropology stud ies - an interest she is now jo ining w it h public health. Htoon \vas selected for the two-

year UCLA p rogram after a compet itive series o f exams that included a combination of tests and practical experience. r le looked forward to the chance to study cp idemio logv at l.!CLA, and to gain ski lls that w ill enab le him 10 \\路o rk more effect ive ly to wa r d finding solutio ns for health problems in Burma. The epidemiology program at CL.A, exp lained Dr. Ralph Frerichs, professor and chair of epidem io logy, is especially rele\"<1111 for students interested in the health pro bl ems of developing cou ntries. Besides focusing on pa1terns and causes o f disease in populat ions, the program prov ide s a strong founda ti o n in quant itati ve metho ds, ana lvt ic procedures. and the use of microcom puters. Students who remain at UCLA for two years. explained Frerichs,

can learn how to use epidemiology LO help administrators assign resources to improve the health o f the peo p le. Whi le funds mav no t always be m路ailable in de,路elo ping countries for research investigat io ns, s1udents interested in internatio nal work find that epidemio logy is very useful for deter mining the opti m um intervention o r prevent io n strategy. "The microcomputer links theory w ith practice, since students are abl e to app l y concep ts t hey learned in the classroom LO realwo rld problems." For Ben oll i and Htoon , this r e al -wor ld exp erie n ce cam e thro ugh their involvement w ith the Wo rld Bank review of heal th secto r p riorities for devc loping countries. Wo rking w ith Dr. Lies Djakiak Kosasih, an Indonesian p hysician studying popu lat ion and fam ily health, they submitted

a paper o n the cost effectiveness of various irnervention programs on the treatment of leprosy - a disease fam iliar to Htoon and Kosasih - to rhe World Bank. During a May meeting in Woods I lo le, Mass., the paper was presented by I ltoon and was accepted for pub1icat io n as part of rhe Wo rld Bank's review. " Herc are students fro m differen t back grou nds wh o have learned advanced methods that have allowed them to function at an international level." said Frerichs. "They are typ ical of the swdems who come to UCLA in epidemio logy. It doesn't matter if thev come from a rich country or poor country, both have some1hing to learn fro m UCLA."

Students Remembered

;..::,~

ila

Dr. Ralph Frerichs, professor and chair of epidemiology, discusses his techniques for surveys in rural countries with Dr. Myo Thet Htoon of Burma and Jeanne Bertolli of San Francisco.

he UCLA School o f Pub I ic Health ha~ been deeplv saddened by the deaths or' three students during the 1988-89 acad emic year. Two swdcn ts, Tama r a Ann McAl l ister, populat io n and fam ily heal th , and Roy Jeffrey Smddard, epidemio logy, were killed in a Jan. 26 shark auack whi le kayaking off Malibu. Robert Charles Lien, a population and fami ly health doctor al studem. died April 29 after a long baulc with cancei: Ms. 1cAllister, 25, ca me to UCLA in fa l I J 988 to study internat ional health in the School of Public H eal th 's division of pGpulat ion and family heal th. Her goal was to earn a master of public health degree and return to Africa - whe r e she had p revi o usly I ived and studied for five mo nths during her senio r year at Lewis and Clar k College in Portland, O re. - LO wo r k in pub I ic health care. Mr. Stoddard, 25, started his work at UCLA in fall 1986 in the schoo l's d ivision of epidemio -

UCLA PUBLIC HEALTH

logy. He com p leted his course wo rk and research fo r his master of science degree and p lanned to pursue a career in medically related resear ch. Mr. Stoddard enjoyed teaching and was a teaching assistant during the fall quarrer for Dr. Michael Greenfield in bio logy and during the wi nter quar ter was a teaching assistant fo r Dr. j ess Kraus in epidemiology. Mr. Lien, 34, received his master of pub I ic heal th degree in populatio n and family health in 1982 and was a doctoral cand idate in the same program . He had traveled to Hong Kong \vher e he worked to help resettle refugees. He also served as health education coord inator for three years at the Edelman Hea lth Cl inic in West Hollywood.

New Fellowships Announced

\vo special fellmvships recently have been establ ished at the School of Public Heal th. f ellowship support is rapid hÂˇ b eco min g o n e o f th e UCLA School of Pub I ic Health 's greatest needs, echoing UCLA's statemem that "financial aid for g raduate sLudems w ill be a priority concern during the next decade... Linda Lichtenfels, M.N. '72, and other friends have contributed to create the Ann G. Quealy Memorial Fe llowsh ip as a tribute to an alumna who exhibited qualities of high achievement, concern fo r others. humor, and a desire to work to her fullest potential. The fellowsh ip w il I be presented an nual Iv to a student in the M. P.H. program who is speciali zing in heal th ser vices. Fo rest Tennant, 1\11.D., Dr.P. H. '74, is best known fo r his extensive wo rk i n drug educat ion . Thro ugh his Commu nity Health Projects Co. , he operates drug and general heal th clin ics, publishes d rug information booklets. and ser ves as a substance abuse

consultant to many sports o rganizations, includ ing rhe FL. Tennant recently established the Fo rest Tennant Fellowsh ip Award , wh ich w i ll provide financial assistance to s tudenl~ wor king toward careers in communitv health.

International Health Student Network Forming

esides working o n many o f the worlt l"s heal th problems, UCLA School of Public Heal th students are forming a netwo rk fo r fo reign studems and alumni interested in international public heal th. The I nternatio nal Health Student etwor k could ser ve as a r esource for futur e g raduates and cur rent students o f the school. " earl y 3 1 perce nt o f t h e school's students are international," said .Jul ie Matsumoto, M.P.H. '89 and a Los Angeles resident w ho worked o n the organizing committee. "Thai r epresents a lot of diversitv. This would create a wav fo r students to meet other students. It also wo uld assist students w ho arc inter ested in internship s o r \vo rk i n fo r eign countries to meet those pu blic healt.h o fficials who have attended UCLA " The nel\vor k's pur pose is toot: fer support to internatio nal studems, m ake meeting students w ithin the school easie1; and create \Vays so students can be enriched by the d ivers ity for w hich the school is known. In addit io n, Matsu moto said the o rganization would pro mote so lidaritv among alumni o f the UCLA Schoo l o f Publ ic I leal th . Al though still in the fo rming stage, the o rganizat ion has held five international student lectures to increase student awareness of i nternational p ublic heal th issues. Luis Alberto Aviles, a secondyear master 's student in biostatist ics from Puerto Rico, said the

group also would h igh I ight the need fo r collabo ratio n between pub I ic heal th workers and other professionals. Matsumoto said the o rganization would be open to students inter ested in internatio nal heal th. Students and al umn i li ving ab road w ho are interested in the joining the Internatio nal Health Student Networ k should contact Carol Burrows at (213) 825-51 19 o r write Lo t he I nternal ional Health Studem Network in care o f the UCLA School of Puhl ic Heal th Alumn i Associatio n, 16-035 CHS, Los Angeles. California 90024-

1772.

Professionals Offer Tips on Job Market CLA School of Public Heal th stud ents received inside tips during a seminar held in rhe spring fro m professio nals in the field o n how to parlay their public heal th degrees into vital jobs in the community. Dean Abdelmonem A Aftft orig inated the sem inar as a way for students to gain insight on what to expect when they enter di e job marker follow ing graduat ion. Six professionals in the public health

field also offered practical examp les of how they have used dieir degrees and training in die p rivate and die pub I ic sectors. Stu den ts learn ed abo ut the kinds o f skills and training employers are seeking. Verbal and w ritten communicatio ns, as well as summer internships, were by far the most important words of advice to the students. In add itio n , rhe speakers suggested that srudents take a var iety of classes o utside their majors to broaden their experiences. Included in the sym posium were: Roger Clemens, Dr. P.H. '78, manager of nutrition research at Calreco, a Ca li forn ia food comp an y; Caswe ll Eva n s, D.D.S. , M.P.H., director of publ ic health p rograms and ser vices for the Los Angeles Countv Department o f Heal th Ser vices; Arno ld Kisch, M.D., vice president and regional m edical director for Equicor, a nationw ide insurance firm; Mart in Lee, Ph.D. '79, directo r of medical affairs for Baxter Healthca re Cor p ., a p harmaceutical com p an y; Gary Sp i vey, M.D., M.P.H ., manager of Unocal's epidem io logy and environmental med icine d ivision; and Samuel Tibbitts, B.S. '49, M.S., chair man o f the board for UniHealth America, a health care corpo rat ion. Dr. Paul To r rens, professor of health services and chair of the co mmunity affai rs comm i ttee, ser ved as moderato r for the panel cl iscussion.

Dr. Milton Roemer Honored

r. Mil ton Roemer, professor em eritus of heal th ser vices at the UCLA School of Public Heal th, was recogni zed by the Pac ific Southwest Chapter of rhe American Med ical Writers A5sociario n for his I ifet ime achievement in med ical writing. Beverly Sloane, 1988-89 chapter p resident, said the select ion

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Dr. Milton Roemer was made based on al I o f the wri ting Roemer has done, as wel I as being a " big inspiration for other writers. He has given us a pub I ic health conscience in our writing. I le has been a mentor for many." " 1 happen to be a medical person and m~' principal activity has been public health 'i\-Ork. I do writing as part of that," said Roemer. "Some people who are immature try to seem super-scientific and technical. That may go across in some circles, but it doesn't with the general population o r with public health people. Simplicity and clarity are essential to good writing, as is avoiding the impression that you are trying to shO\v how sophisticated you are." Roemer has wriuen 31 books o f which 17 are hardcover volumes. The others were written fo r o rgani zati ons suc h as the World Health Organization or federal agencies. In public health and related journals, he has published mo re 1han 380 articles, spanning a career of nearly 50 years. In 1938, he was the first editor of the journal of the Association o f Medical Students - a forerunner of the Amer ican Medical Students A~soc iation. In 1941 , Hoerner \vent into the public health field, following graduation from medical school ar 1 ew York University. During his 48-year publ ic hea lth ca r eer, he has worked for the ew Jersey State Department o f I lealth , the U.S. Public Health Service. the World

Health Organization and was director of medical and hospital services for the Sa~ katchewan Department of Public I leald1. I le also ha~ taught at Yale and CorneII before coming to UCLA in 1962. Sloane said the chapter started the award in 1988 ro recognize those who have contributed 10 the field of med ical writ ing. Han)' Nelson, the longtime med ical writer for the Los Angeles Times who recently ret i red, was last year 's award recipient. The national association b oasts more than 3,000 members and there are about 200 members in the local chapter.

alumna; Dr. Joel Kovner, chairman of the board and chief executive officer, First Professi onal T3ank; Dr. Lloyd Mil ler, d irecto r and vice p resident, Calreco; Robert A. Ortiz, execut ive vice president, Cushman Realty; Dr. Tom Rockwel l , cha irman, Lifetime Medica l Te levisio n; Dr. For est Tennant, chairman, Community H ea lth Projects Inc.; Samuel ). Tibbitcs, chairman o f the board, Uni I lealth America; Dr. Fred \'ii. Wasserman , adjunct assistant professor, UCLA Schoo l of Pub I ic Health ; and Dr. Elaine Wedral, senior vice president, Calreco.

PROJECT UPDATES

Dean Appoints Advisory Board

his year, the UCLA School of Pub I ic I lea Ith sta rted assembling its first Advisory Board whose members will, according to Dean Abde lmonem A. Afifi , " serve as I iaisons with the pri\-;ue secto r 10 help communicace the school's mission, assist in developing new relationships and resources, and assure that the curriculum continues to deal with the issues that are relevant to the real world ... Alumni contact and strong ties 10 the professiona l commun ity help promote the school 's work and encourages support. Afifi said external relations are an essential component of the administration of the school. Most UCLA professiona I sc hools have vo lunteer boards to help with community and alumni affairs and fund raising. Inaugural members appointed by the dean lO serve as the nucleu s of th e School o f Pub I i c Health's Dean 's Advisory Board include: Ira H. Alpert, president. Wilshire Foundation Inc.; Terrv 0. Hartshorn, president, PacifiCare; James B. Jacobson, chairman, Beneficial Standard Life Insurance Co.; Carolbeth Ko rn ,

Breast-feeding aidGrowth Dr. Der r ick B.Jel I iffe, professor of population and fami ly health, and E. F. Patri ce Jel I iffe, lectu rer o f' populatio n and fam il y health, have completed their breast-feeding research among solely breastfed twins and single infants. Comp leted in December 1988, th e study ind icates a normal growth pattern of the infants \'>'ho were exclusively breast-fed for up 10 one year.

Primary Health Care Dr. Snehendu Kar, professor o f population and fami ly health, will identify the indicato rs of health prommion program effectiveness independent of health status measures. These indicato rs can be used to set program goals and to mo nito r progress o f heal th pro mo1ion and primary health care programs. Funded b~· a Kellogg Foundation grant, the p ro ject invo l ves joint r esearc h b y th e schools of public health in Sao Paulo, Brazil ; Santiago, Chile; Bue nos Aires, Argentina: and UCLA. The second multinational workshop on the project w ill be held Sept. 20-26 in Santiago. Ba~ed on the experience from

this project, a second nel\York of schools of public health in fi\·e Pacific Him nations ha~ been established 10 identify the appropriate heald1 care system response 10 two major demographic changes - increasing proportion of families with one or few children and an i nc rea~ ing elderly population. The schools incl ude Manila, Seoul , 13angkok, Beijing and Hong Kong. The Centers for DisC"Jse Control in Atlanta and the \X'o rld Health Organization in G enC\~t also have contributed funding for the projects. Co-investigators include Di: Rina Alcalav, a~s istant professor of behavioral sciences and health education: Di: Emil Berkmovic, professor of behavioral sciences and health education: Di: Vi rginia Li, professor of behavioral sciences and health education: and Dean Alxlelmonem A Afifi.

Preventive Services Dr. Stuart Schweitzer, p rofessor o f heal th ser vices, received a Sl.7 million grant from the I lealth Care Financing Administration. Started in 1988. the four-year project is designed to determine if expanding Med icare coverage to include p revent ive ser vices increases the qua I ity of I ife and reduces ii lness. J\lore than 2,500 Medicare subscribers have been enrol led and the resea r chers have starred collecting data on hea lth status and risk factors. Working w ith h im are Dr. James Lubben, assistant professor of social work at the UCLA School of Social Welfare; D r: Al lison MayerOakes, assistant professor of geriatri c m ed i c ine at t he UCLA ' chool of Medicine; and Dr. Kath•)'n Atchison, assistant professor o f dentistry at the UCLA School of DentiSLI)'.

Selenium Health Risks Dr. Jane L. Valentine, associate pro fessor of envi ronmental and occupationa l heal th sciences, is preparing a health assessment document on the forms of seleni-

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um fo und in the state's drinking water supplies. Funded by the Califo rnia Department of Health Services, I lazard Evaluatio n Sect io n, researchers w il l collect and review info rmation in o rder to base a maximum contaminant level fo r drinking water. Ors. Peter Lachenbruch, pro fessor o f biostatistics, and Bah ram Faraji, an assistant researcher, are wo rking o n the project.

Rapid Surveys in Developing Nations Dr. Ralph R Frerichs, professor of epidem io logy, is cont inui ng his work using laptop com puters to quickly o b1ain health related info rmatio n o n peop le at 1he comm unity level. During the summer, Frerichs cond ucted a number of workshops on rap id su r vey me1hods in Jakan a, Bangkok, l{io de .Janeiro and Manila. I le also is completing a year-long study of acute respirato ry i nfectio ns i n Indon es ian c hil dre n, a stud y which used spreadsheets showing acute respiratory infect ions to gu ide research investigato rs in Indonesia to fi nd cost effective ways to reduce the mortality rate.

Ca l i forn ia: Imp li catio n o f th e Negative Effect of Fish Introductions."

Dr. llorota M. Dabrowska, assistant professo r o f biostati sti cs, has r eceived a a1 ional Science Foundatio n grant to study inference in non- and semi-parametric models. The two-year project started in June. She has presemed papers o n her research at the Inst itu te of Mathematica l Statistics at Davis and at the l nternat io nal Starist ical Inst itute in Par is. Articles in press include: " Rank 'Ib ts for J'\ latched Pair Experimems w ith Censored Data," " Kap lan-Me ier Estimate o n the Plane: Weak Convergence, LI L and the Bootstrap," " Rank Est imaces in a Class of Semi-parametric Two-samp le 1\lodels," "Uniform Consistency of Kernel Condit io nal Kaplan-J'\ leier Estimates" and " Graphical Comparisons of Cumulative I lazards for T\vo Popu latio ns." Dabrowska also is preparing an article on "Compar isons of I lazards for Kidney Transp lam Stud ies."

m eeting o f the American Ep idemio logical Society at the College o f Public Heal th , Uni versi ty of South Flo rida, he preseni cd his pape r o n the "Re lat ions hip of O ther Infectio ns to Progression o f D isease in HIV Infected Men." In May, he conducted a week- lo ng seminar in Bangkok o n 1hc p ublic heal th aspects o f 1he 111\/ in fectio n. Dctels also was the principal autho r o f "Seroconversio n, Sexual Acti vity an d Condom use Amo ng 2,9 15 H IV Seronegat ive Men Fo llmved for up 10 T\Yo Yea rs" published in the }011r11a/

q( Acquired /1111111111e Deficiency S)•ndrom es. Dr. Ralph R. Frerichs, pro fessor of epi demio logy, was appoi nted chair fo r the 1990 meeti ng o f the Internat io nal Epidemiologica l A~soci atio n meeting in Los Angeles. I lis art icles, " Breast-feed ing, Dietary Intake and Weight-fo r-age o f Children in Rural Burma," "Use of Rap id Survey Methodology to Determ ine lmmunizat ion Coverage in Rural Burma," " Rapid Micro-

FACULTY N0 TES Dr. David Bradford, visit ing assis1an1 professor o f environmental and occupatio nal health sciences, has comp leted a si x-month p ro ject, "'Evaluatio n of Methods to Minimi ze Contaminatio n I lazards to Wild l ife Using Agricultural Evapo rat io n Po nds in the San Joaquin Valley, Califo rnia." Funded by the Cal iforn ia Department of Water Resources, Bradford stud ied the poisoning of waterfowl in the San Joaquin Valley due to selenium in agricu ltural d rainage water In add it ion, he has w ritcen two art icles, "Biogeography and Endemism in the Central Valley of Ca li fornia" and "Al lo topic Distribution o f Native Frogs and Introduced Fishes in I lig h Sierra 1e\rJda Lakes of

Dr. Roger Detels, professor of epidemio logy, presented hb work in January on the "Tram.mission of 11 IVI in I ligh Risk Groups" at the Seco nd l nternat io nal Conference o n AIDS in A~ ia held in Bangkok, Thailand, and in April at the Internacional Scientific Conference on Epidem iology/ I EA Regio nal J'\ leeting in Beijing, China. At the J'\ larch

com puter Surveys," "Computerassisted Rapid Surveys in Developing Coumries" and "Sim p le An alyt ic Procedures for Rapid 1\ l ic r oco mpu1e r -ass is1ed Cl us ter Sur veys in Developing Countries," deal w ith his rapid survey methods i n ru ral areas of developing countries.

Dr. S"1der Greenland, professor of epidemiology, is com p leting a casecontro l sllldy of cancer mo nal iry in transformer -assembly wor kers. The study was funded by the University of Lowell Research Foundat io n. Alberto Salvan, a doctoral cand idate in epidemiology, also wo rked on the project.

Dr. William Hinds, professor of envir on m e ntal and occu pational heal th sciences, was appoimed the Dr. l{Ltl ph R. Sachs Visit ing Schola r 10 the University of Cali fo rnia, Berkeley in March.

Dr. Derrick B. Jelliffe, professor of population and fam ily health, was selected keynote speaker in a six-city traveling seminar in Pakistan during the fal I. Jell iffe submitted recommendations on a bre<L~t-feeding program to the government of Pakistan. In addition, he completed two book~. Pro1vc1111111es to Promote Breast-feeding and Co11111111nity N11tritio11 Assessments. that were co-authored by E.E Patrice Jelliffe. I lis article, "Th irty Key Questions from I lealth Professionals on Brea~t-feeding ," wa<; published by U ICEF. and his data on nucrielll requirements in brc;L<;tfcecl ing w~L'i prese111ecl in 1\larch before the ASEAJ Symposium in Jakarta, Indonesia.

E.F. Patrice Jelliffe, lecturer of populatio n and fam ily health, starred a st udy of nutri ti o n training i n schools of pubI ic health and nun•. ing. In addition, she is updating a I ist o f ex isting schools offering nmr it ion training that revises informat io n pub I ished in 1965 by the World I lealth O rganizat ion. Jell iffe was re-elected chair fo r the Internacional Union of Nutritional Sciences for a third ter m, and she served as keynote speaker for the USAIJ) and 1CI H Washington meeting on bre<tst-feeding strateg ics and ass isted i n the preparat io n of a UNICEF video on breast-feed ing for global use.

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Dr. Snehendu Kar, professor of populat ion and family heal th, was i nvited b y the World I lealth Organizat ion Lo serve as a consul tam and to assist the government o f Pakistan i n developi ng a strategy for eval uating natio nal maternal and child health programs. Kar is a WllO consul talll Lo the Philippines Depanmem of H eal th and the faculty o f the College o f Pub1ic H eal th in Man ila o n their resea rch and eval uation of their masters and doctoral p rograms. The School o f Public Heal th at the University of Sao Paulo, Brazil , in vited Karro serve as a consul tam o n a major pro ject o n the indicators of heal th pro m ot ion am ong high-risk occupat io nal groups. In addition, he presemed papers at the XI I J World Con ference on Heal th Education and the l nteramerican Research Wo rksho p in Cordova, Argem ina, and chaired a panel i n Beijing, China, o n Strategi es for Improv ing Primary Health Care. He was elected a fellow o f the Societv for the Psychologica l Study o f Social Issues, a d ivision of the American Psychological A~soc i aci on . Dr. Phoebe A. Lindsey, assistant prolessor of heal th ser vices, is studving th e effec t i \·eness o f Ivied i ca i d sponsored ho me and com munitY services fo r the treatmem of Al OS pat ients. She also is completing a study of state heal th po l icy o n the o rgan ization and financi ng of o rgan transplan ts - a case study o f po licy devel o pm e m in se l ect states and the impl ications for other states. I ler article. "M edicaid Ut ii izat io n Comrol Programs: Results of a 1987 Survey." was published in I l ea/tb Care Fina n cing Reui eu•. D ur in g th e 1988 APHA annual meeti ng, she presemed a paper o n " The O rgani zatio n and Financi ng of Liver Transp lantation: The Chai lenge to State Gover n me m s."

Dr. Milton I. Roemer, p rofessor emeri tus o f health services, was a visitin g pro fessor i n March at the Un iversity of 'rixomo, Canada, and in Septem ber at Shanghai Med ical University, Chi na. He also is con t inuing h is wo rk on a major analvtical studv, " National 1leal th Systems: Com pa rat ive Strategies, .. under contract w ith the Oxford Un iversity Press. Dr. Nathilliel Schenker, ass istant pr ofesso r of b iostat ist ics, was invited to present a paper on ''M ul t iple Im putation of lndustrv and O ccupatio n Codes fo r Pub I ic-use Data Files" at the American Statistical A'isociation an nual meeting in 1 ew Orleans. I l e also pr esented a paper o n 'The Use o f Imputed Probabi lit ies f'o r i'vlissi ng Binary Data" at the Census Bureau 's fifth annual research conference i n Ar1ington , Va . Dr. Jilte L. Yalentine, associate professor of en vironmental and occupatio nal heal th sciences, co-autho r ed a book chapter, "Selenium an d G lu tath io ne Per ox idase i n Mothers Experiencing Sudden Infant Death Syndrome," in 'fi'ace Ele111ents in ii/an an d A11i111a/s.

ALUMNI NOTES Margaret Cary, M.D., M.P.H. '74, was named O utstand ing MBA Graduate of l 988-89 b v the fa cul tv and staff of the Graduate School o f Business Admi nistration at the University of Colo rado at D enver. Milley Clementino, M.P.11. '8'5, is a seco nd-vear me d i cal stud e nt at Wayne State Un iversity i n Detroit Arturo frillz, M.P.H . '73, has com pleted 20 years in heal th ca re, wo r king in O range County where he is regio nal vice pres ident o f a med ical b rokerage fir m that specializes i n the appraisal and sale o f m ed ical and heal th related business properties. In addition, he heads the recr uitmem divisio n and is resp o nsibl e for p lacing

docto rs through o ut the Southern California regio n. Douglas Hall Freer, M.D., D.P.M., M.P.11. '88, M.A., was named director of occupational heal th/ p r eventi ve mecl ici ne at the U.S. Naval· 1lospital , Camp Pend leton. Freer is a c omman d e r i n the U.S. Navy Medical Corps. Susilt H. Hirsch, M.P.1 1. '82. was appo inted project d i rector in June frir the UCLA Medicar e Demonstrat ion Pro ject, a four-year pro gram ro test the cost effectiven ess of pr eventi ve heal th sc reeni ng and health educatio n fo r approximately 2,000 Part B Medi care reci pients. The p ro ject is a jo int effo rt of the UCl.A School o f Puhl ic I !ealth, the School o f Social Welfare and the School of Medicine Geriatric Medicine D ivision. John C. Hisserich, M.P.11. '66, D r.P.1 1. '70, was appoimed b1· the Cal ifo r nia Legislature Senate J{ules Com minee to serve as a member of the Stat e Bar Examin ing Committee w ith rl'.spo nsib ili11· 10 administer the requ irements to practice law in the state. I lisserich is associate vice president for health affairs at USC. Gerhard Kraske, M.P. H . '84, is current I\· a third-year medical student at G eorge Wash ingto n Uni versity i n Washington D .C., and wi ll g raduate in Mav 1990. Lynn Hagerman McCarthy, M.P.11. '80, was appo inted assist;int vice president fo r heal th and saf'e ty at GT E Ll.S. Telepho ne o perat io ns. She is responsible fo r the health po l iC\', o ccupat ional safetv and heal th programs of the compan y's 8,000 emplovees. Paul E. Pezza, MY.I I. ·70, completed his Ph.D in public heal th in 1988 at the University of M assachusetts, Amherst. 11is d issertat io n is tit led ''Sel f-i nit iated Cues to Act io n: Cogniti ve Determi nan ts of Info rm atio n -seek i ng ab o ut Personal I lealth !~i s k. " He recentlv co-authored a chapter 1irled , " Puhl ic Op i n i on an cl I le a Ith Po l i cy.· · l'ezza is an assistant professor o f

heal th po l ic\· and management at Providence Co llege, Providence, Rt. Michelle Raven, M.P.1 1. '86, is cur rently em ployed w ith Jo hnson & Jo hnson I l ealth Management Inc. as manager of pro\·ider relat ions. Diille Ross Simon, M. P. 11. '78, has resigned . as an administrato r w ith the Arthritis Foundatio n to raise her two sons. She \\·ill remain active as a \·oluntee r with the lo un dat ion , the March of Dimes, \'aIle\· Par ents Support Group for H ighrisk Infants and the Lokranrz Special Edu cat ion Ce mer. Robin B. Shermis, M.D., 1'vl .l'.1-t. '82, is compl eting a rad io log\· residency at the Uni versit\· of Michigan. Sher m is accep ted a staff associate p osit io n at the Henn· Fo rd Hospital in Detroit. James B. Simpson, M.P.11. ·75, h as been named general counsel of the Western Consort ium fo r Public Heal th, a nonpro fit p uhl ic heal th research o rgani1.at ion sponsored b y the UCLA and LIC Berkelev schools of pub I ic heal th Simpson is also co-moderator for the Cal ifo rnia Public Health Fou ndatio n, w hich conducts a number of state hea lth programs, including the Cali fornia Tumo r RegistrY. Richard D. Story, Pharm . B. M.P.11. ·85, was named d i rector of Pacific Rim Hea lth Analvsis. I le is staff pharmacist at San ta Barbara Cottage Hospital. Gayle C. Windham, H P.I I. '80, r eceived her Ph.D . i n epidemio logy from the UC Ber kcle\' School of Public I l eal t h. I !e r disse rtati on w as based o n work conducted as an epidemiologist at the Cali fornia Department of Health Sen·ices, invest igating en vi ron mcmal and o cc upati o n a I r i sk fac to r s fo r spo ntaneous abo rt ion in a large case stuch -. She w i l l co m i n ue working as a heal th sen·ice departmen t ep idem io logist.

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