UCLA Public Health Magazine - Fall 1984 by UCLA Fielding School of Public Health

Vo/11111e 4 . N11111ber 2 Fa/11984

Home Sweet Home is anywhere and everywhere for a growing number of people. A UCLA study probes the plight of the homeless.

UCLA Public Health Magazine of the UCLA School of Public Health

4 5 6 A Message from the Dean Dean Decels wel-

comes che incom ing chairman of che School and pays t ribute co che outgoing .

Study Finds No Medical Side Effects After Vasectomy Men who have had vasectomies are ac no hig her risk for health problems than men who have not .

"ft

New Chairman Appointed

A Look at L.A. County's Homeless

Dr. Snehendu Kar assumes academic leadership in che School.

The homeless of che 1980 s are d ifferent from chose of che 1940s, 1950s , or even che 1960s, according co a UCLA Study.

Heavy Marijuana Smokers Risk Damage to Lungs

N urririon Researchers Probe Mysteries of Nurrients in Health

Maximizing a Team Effort

Research for rhe Present

Dean's Council Support Grows

News

Alumni News

Alum ni Notes

Minority Students Make History

A record number of m inoriry students were admitted co the School, and they aim co bring health care back co their communities.

d Edit<>r/Writer: Judi Goodfriend Writer: Judy Rosenfeld Design: Gretchen Goldie Director of Health Sciences Communications: John Pontarelli

UCLA Public Health is published for rhe alumni , faculty, staff and friends of the UCLA School of Public Health by H ealth Sciences Communications, Weyburn Center, Suire 344, UCLA Center for rhe Health Sciences, Los Angeles, California 90024. (213) 206- 1960.

COiier: The number of homeless is g rowing ar an alarming pace, according to a UCLA srudy. See story page 6 . Edit<>rial Board: Dr. Roger Derels, Dr. Lawrence Ash, Dr. Juel J anis, John Pontarelli , Bruce Shih, Debra Ward , Tom Zeko

will serve him well as chairman and associate dean. We welcome him ta the post and look forward tO his leadership . As we welcome Professor Kar tO the chairmanship it is also appropriate to reflect on the many contributions which the former chairman, Professor Lawrence Ash, has made to the School of Public Health. H e presided over the School during a difficult period. The late 1970s, and Âˇ especially the early 1980s, were periods of shrinking resources and reduced budgets. For the School to survive it was necessary to make very difficult and painful decisions, but it was those decisions which preserved the research and teaching core of the School. Dr. Ash's success is amply demonstrated by the vigor and diversity of the research, academic and community service programs being carried out in the School which are reflected in part in this issue of UCLA Public Health. Throug hout these difficult times Dr. Ash's chairmanship was marked by an atmosphere of warmth , concern and colleg iality which permeated the faculty, staff and student body. During D"r. Ash's tenure, the s this issue of UCLA School consolidated and defined its PJtblic Health goes ta teaching programs , clearly delineatpress, we are in a sense ing the professional tracks (M. P.H ., ushering in a n_ew era Dr.P.H.) and academic tracks (M.S., with the appointment Ph.D.). The full-time faculty expandof Professor Snehendu ed from 43 to 60. The outstanding Kar as chairman and associate dean. quality of the new faculty was the reProfessor Kar comes ta the chairman- sult of Professor Ash 's leadership. Dr. ship after four years as head of the Ash also supervised the smooth inDivision of Behavioral Sciences and corporation of the Southern OccupaH ealth Education. During his tentional H ealth Program into the ure , the division expanded and School. In addition, he g uided the consolidated its programs. His transfer of the interdepartmental prodemonstrated leadership and experigram in Environmental Sciences and ence in broad areas of public health Engineering into the School, g reatly expanding the breadth of the Division of Environmental and Occupational H ealth Sciences. During his

AMEssAGE

tenure, the divisions of Environmental and Occupational Health Sciences and Nutritional Sciences became separate entities with strong programs. Finally, Professor Ash represented the School ably on the Subcommittee on Public H ealth appointed by the Systemwide Academic Program and Policy Review Board. This Committee reviewed the goals of academic public health in the U niversity of Calfornia. T he quality and perception of that report which supported the important role of public health in the University of California is in no small part due to the contributions of Professor Ash. Thus, it is with some sadness and much appreciation that we see Professor Ash return ta his first love, teaching and research , but it is with a feeling of hope and confidence that we at the same time welcom e Chairman Kar.

FROM

THE DEAN

I /

Roger Derels, M.D. , M.S. Dean

r. Snehendu B. Kar was appointed chai rman and associate dean of t he UCLA School of Public H ealth effective J uly I, l984. H e actually assumed the chai rmanship Septem ber l after a short-term consulting visit ro the World H ealth Organization in Geneva, Switzerland. The chairman /associate dean is the academ ic leader of t he School. H e is intimately involved with the 60 fulltime facu lty members who represent seven diverse divisions within the School. H e is also responsible for such varied tasks as reviewing the curriculum , recruiting , selecting and evaluating academic and staff personnel, preparing the departmental budget and ad ministering financial affairs, and assig ning departmental space and facili ties. "Dr. Kar 's public health practice background coupled with his four years of experience as chairm an of the Division of Behavioral Sciences and Healt h Education at the School made him an excellent candidate for the position ," Dean Roger Detels says. Tackling new vistas is routine work for Dr. Kar. An internationally renowned scholar in the field of family planning, Dr. Kar has developed a sophisticated model of behavior change that he has applied to comparative studies in Venezuela, Kenya and the Philippines. Raised in India, Dr. Kar received a bachelor 's degree in natural sciences and a master 's deg ree in psychology from the U niversity of Calcutta. H e served as direcror of India's R esearch and Evaluation Division of the Ministry of Health and Family Planning's Central Bureau of Health Education from 1960- 63 . H e then came ro the United States as a Ford Foundation Communications fellow and earned master's and docroral degrees in public health from the University of California , Berkeley. Before com ing ro UCLA in 1978, Dr. Kar taug ht at the U niversity of Michigan at Ann Arbor for 10 years.

NEw CHAIRMAN APPOINTED By } 1tdi Goodfriend

D1: Snehenc/N Kc1r At UCLA , Dr. Kar served as head of the Division of Behavioral Sciences and H ealth Education from 1980 until his recent appointment. During his tenure, he was intent on streng thening the bond between healt h education and t he other prog rams within the School. In addition , he became respected as a teacher, researcher and scholar. Dr. Kar was in Geneva, Switzerland , as a consultant ro the World H ealth Organization (WHO) during t he summer and t herefore was unavailable ro comment on his new appoint ment before press t ime. His colleag ues, however, were keen on

his quali ficat ions. All believed his emphasis would be on strengthening the academic programs at the School. Ruth Richards , adjunct lecturer in the School , has known Dr. Kar since the l960s when she was on assig nment in India with WHO. She describes Dr. Kar as an intellectual with a determined style of leadership, hig h standards and principles, and a fri endly and g regarious personality. Dr. Emi l Berkanovic, now the head of the Division of Behavioral Sciences and H ealth Education , observes that Dr. Kar is someone who thinks throug h all sides of an issue. H e's also known ro be forceful when necessary and not afraid ro speak his mind. Althoug h "very Americanized," as one colleague described him , D r. Kar will occasionally illustrate a point by relating an Indian folklore tale. H e has also introduced colleagues ro the joys of Ind ian music and food. Besides being a " bit of a gourmet ," the new chairman is an avid photographer and the evidence is displayed throug hout his office. His wife, Barbara, is a health educaror with the American Cancer Society. The Kars have two sons: Robin , l3, and Sanji, 5. Dr. Kar succeeds Dr. Lawrence Ash, who served as chairman for five years. D r. Ash has resumed his teaching and research activities.

A sharp shooter; Dr. Kar captures on slides scenes fi'om his world travels.

)

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he homeless. They are an unsertling reminder of rhe renuous hold we have on our marerial securi ry. For decades, rhe homeless remained well hidden from suburban and ciry neighborhoods in Skid Rows across rhe narion. And rhe siruarion looked promising as rheir numbers decreased narionwide by 5 7 percenr from 1950- 1970 . Bur in rhe pasr decade, rheir numbers have swollen again, and rhey have spilled our from rheir old boundaries, which are no longer able to conrain rhem. Today, rhe homeless are found wandering rhrough ciry and suburban neighborhoods alike, ofren sifring rhrough garbage cans looking for food . Because of rheir increased visibiliry, governmenr officials and social scienrisrs began ro realize rhar rhe problem of rhe homeless, a problem rhar wasn'r supposed to exisr anymore, had in facr become a crisis. The federal governmenr has designared Los Angeles as rhe homeless capiral of America, wirh esrimares of rhe homeless ranging from 35,00050,000 rhroughour rhe counry. Currently, rhere are only 1,918 shelrer beds for rhem; 346 of rhose are designared for vicrims of domesric violence. In rhe pasr rwo years, srudies on homelessness have been conducred in ciries narionwide, and rheir resulrs have sharrered several myrhs abour who rhe homeless are. In Los Angeles, rhe mosr comprehensive srudy on rhe counry's homeless has recenrly been complered by Drs. Richard Ropers and Marjorie Roberrson, borh pose-doctoral scholars in rhe Psychiarric Epidemiology program in rhe School of Public Healrh. Their srudy, called rhe Basic Shelrer Research Projecr,

A100K ATL.A.

COUNTY'S HOMELESS Study finds rise in urban homeless. By J udy Rosenfeld

urilized one of rhe mosr rhorough quesrionnaires (200 irems) developed for a srudy of rhis kind, and irs sample group of 263 was also one of rhe largesr. The pose-doctoral scholarships have been funded by rhe Narional lnsrirure of Menral Healrh (NIMH), bur no ourside agency directly supporred rhe Basic Shelrer Research Projecr. Despire limired financial resources, however, rhe researchers garnered rhe supporr of nearly 100 volunreers who helped conduce inrerviews, compile dara, and arrange to meer wirh rhe homeless in various shelrers in rhe counry, primarily rhe Union Rescue Mission in downrown Los Angeles. Volunreers included srudenrs from rhe School of Public Healrh and rhe UCLA School of Urban Planning, psychiarric social workers, orher researchers, and shelrer sraff workers. Homeless men and women were inrerviewed ar lengrh (each inrerview took approximarely 45 minures) on numerous topics , including: economic and employmenr history and srarus, physical healrh history and healrh care urilizarion, menral healrh srarus and care urilizarion, demographic background, general relief and welfare srarus and urilizarion, homeless srarus and hisrory, drug and alcohol use and abuse, criminal history, and crime vicrimizarion history. Their resulrs validared rhe researchers' rheory rhar rhe homeless of rhe 1980s are differenr from rhose of rhe 1940s, 1950s, or even 1960s. Drs. Ropers and Roberrson say rhar homeless popularions of pasr decades were mostly older whire men , many of whom were drug dependenr , menrally ill or physically disabled. Bur rhe homeless on rhe srreers today are younger, less likely to be menrally ill, and are berrer educared. More rhan 60 percenr of rhose inrerviewed complered ar leasr high school ; 17% had arrended college. Perhaps mosr

striking, the majority of the homeless were new to the streets: 51 percent had been homeless less than one year; nearly one quarter (24 percent) had been homeless less than one month . Only 30 percent had been homeless for two years or more. Ors . Ropers and Robertson also found a wide diversity among the homeless. Along with the traditionally characteristic homeless were immigrants , an increased number of non-whites, political refugees , runaway teenagers, the deinstitutionalized (former psychiatric patients), battered women and their children. Among the men, 52 percent were veterans, with most having served in the Army- 34 percent of those were Vietnam veterans. Fifty-one percent of the men interviewed were looking for work, apparently victims of an American economy whose base had slipped from under them, say the researchers. "This is a new phenomenon in American society: the rise of the urban homeless, which is a significantly different group than previous Skid Row populations," explains Dr. Ropers, co-director of the Basic Shelter Research Project. "Many are, I feel , the dispossessed, the disenfranchised, the disdained. Homelessness has become a way of life, a condition, not confined to one place, and that is why homelessness seems to permeate Los Angeles- the homeless in alleys and doorways, everywhere, men and women, young and old." s recently as the 1970s, social scientists predicted the demise of Skid Rows. Urban renewal projects were to have erased these g hettos of poverty from the national landscape. The researchers point to the recessions of the 1970s and the unprecedented transformation of American industry that rendered jobs for millions of Americans obsolete.

The key to helping the homeless, according to UCLA researchers, is to become more aware of

their plight. One dream of the homeless is to have a key to a warm, safe place to sleep. These photographs were taken in Los Angeles, the homeless capital of America.

"Now there are elevator operators for elevators that don't exist anymore in factories that don't exist anymore," says co-director Dr. Robertson. By 1980, refugees from a quiet industrial revolution, veterans, the deinstitutionalized, and others who comprise the bulk of the homeless population were seen in middle class neighborhoods for the first time since the Depression. In 1982, Congress, alarmed at the stunning rise in the numbers of homeless, held hearings to determine what was going on. "By then," adds Dr. Robertson , "it had become a national crisis." The researchers agree that a major problem in addressing this issue has been that until recently, no one has understood who the new homeless were and where they came from. Dr. Michael Goldstein, associate professor in the UCLA School of Public Health and director of the Psychiatric Epidemiology program, says that very little serious research on the homeless has been conducted until now. Most of what social scientists knew, he says, was "anecdotal and impressionistic . The problem is one that this country hasn't wanted to address." N ot surprisingly, the researchers found a tremendously high number of chronic ailments among the homeless. Although the vast majority (73 percent) rated their overall health as good to excellent, 34 percent reported problems including high blood pressure, cancer, herpes, heart conditions, diabetes, bronchitis, foot ailments and chronic coughs. Dr. Robertson notes that 12 percent of the women and 8 percent of the men had attempted suicide during the past year. "That is probably 30 times the norm of a large urban area," she says .

Numbers of the homeless fluctuate widely, according to Dr. Robertson. Seasonal changes are one determinant. A 1981 stud y by United Way indicated that d uring most of the year, there are about 10,000 runaways in Los Angeles. During summer, that number doubles. Dr. Robertson adds, "In summer, requests for domestic shelter beds go way up because women often wait till kids are out of school before leaving. They cry not to disrupt the family too much." The unemployed from colder regions, especially the Midwest , also mig rate to Southern California. "If they have to be on the street, at least they'll be warmer," explains Dr. Robenson . Still , more people die of hypothermia in Los Angeles than in New York City, according to medical testimony cited by Dr. Ropers. The Basic Shelter Research Project also provided a valuable learning experience for graduate students in the School of Public H ealth . Debbie Maddis, a recent graduate with an M .P. H . in behavioral science/health education, served as coordinator of che volunteer effort on t he project. She learned of the opportunity from Dr. Richard Brown's course on community organizing, and approached the researchers as a willing volunteer. Now staff assistant to the administrator of outpatient services at Thalians Mental H ealth Center, Los Angeles, Maddis recalls her experience as part of che project. "I realized just how needy chis population is, and was amazed to see so few services for chem," she says. "The people we found who were homeless could be your next door neighbor or mine. People who became unemployed in the last year stayed with friends, neighbors, relatives, until they couldn't stay anymore. It's hard for people to understand how someone who has been educated and working ends up on the street."

Ors. Richard Ropers and Marjorie Robertson say the homeless of the 1980s are different from those of the pmt.

r. Goldstein points out the significance and comprehensiveness of che Basic Shelter Research Project considering its shoestring budget. "Richard and Marjorie put together a program based on very little money," he says. "Their personal commitment has really driven the program. Their work represents a giant leap forward in the field." Dr. Ropers studied the unemployed for his doctoral dissertation in sociology at Western Michigan University. He has also worked in putting together crisis intervention programs for the unemployed and studied che psychological consequences of unemployment. Dr. Robertson has been long interested in disadvantaged populations, and holds master's degrees in both social science and psychology in addition to her doctorate in psychology from UC Irvine.

Ors. Ropers and Robertson have earned nationwide recognition for their work on the Basic Shelter Research Project. A report on the nation's homeless from H.U.D. (U.S. Department of Housing and Urban Developoment) issued last spring cited the Project and quoted from its documents. And in Los Angeles, probably as a result of increased attention to the homeless crisis , a city ordi nance prohibiting habitation in a vehicle was struck down after a homeless woman contested the charges brought against her for living in her car. She claimed that the law discriminated against the poor, and the judge ruled in her favor. The Legal Aid Foundation and other law offices in the county have also filed suits against the city and county for not providing adequate shelter for che homeless. Drs . Ropers and Robertson have, individually and together, been interviewed by the Los Angeles Times, the Herald-Examiner, and several local radio and television reporters. Dr. Ropers also appeared on a nationwide news program and has testified as an expert witness on behalf of che homeless, including the trial of the woman living in her car. This increased focus from the media has helped clarify the new condition of homelessness in America. "We have begun to turn around some of the misconceptions and stereotypes t hat have long been prevalent about the homeless," says Dr. Ropers . A clearer picture of the homeless crisis, based on emp irical evidence, must precede legislative and social policy changes which can ease the situation , according to the researchers. "If we have misconceptions about who these people are, then we can't have good social policy," explains Dr. Ropers. "The people involved in the project have made an enormous impact on the public's perception of t his problem. We've facilitated part of the remedy."

Snmy FINDS NO MEDICAL SIDE EFFECTS AFTER VASECTOMY By Rich Elbaum n extensive stud y examining the longterm medical side effects of vasectomy has found that m en who have had the contraceptive procedure are at no hig her risk for health problems than m en who have not . Previous studies in animals had sugges ted a link between vasectomy and vario us disorders, includ ing hardening of the arteries and immunological defects. The study, coordinated by the UCLA School of Public H ealth, was initiated in 1976 and examined the health histories of 10,590 m en who had vasectomies before 1976. (M ost of the subjects had a vasectomy after 1965.) Study results were published in the August 24 issue of the j ournal

of the American Medical Association. For each of the 10,590 m en , a m atching "control" m an (who had not had a vasectomy) was identified, and both health histories were compared. Each control subject was of approximately the same age, race and marital status as his counterpart with the vasectomy. With this m atching, differences in health history between the two men in each pair could be attributed to the vasectom y, and not ro environmental , lifestyle o r socioeconomic d ifferences. The m en who had vasectom ies showed no hig her incidence of disease compared with their counterparts who had not underg one the

procedure. (The only exception is that m en with vasectomies had a hig her frequency of epididymitis during the firs t 12 months after their procedure. Epididymitis is an inflammatio n of the area that is cut during the vasectomy procedure. ) "The results of the study appear to exonerate vasectom y as a health risk ," says Dr. Frank]. Massey, Jr., professor of biostatistics in UCLA's School of Public H ealth and the study's principal investigator. Dr. Massey cautions, however, that because the average time since vasectomy for the subjects in the study was only eight years, m ore research is needed o n the health effects beyond eig ht years post-vasectom y. Also, m ost of the participants were under age 55 at the time of interview and have not entered the ages of hig hest risk for the m ajo r diseases, he notes. he vasectomy procedure was first developed in the 1940s and becam e widely used as a permanent contraceptive method in the 1960s. In the technique, the vas deferens , the tube that carries the sperm from the testicles to the penis, is cut and tied off. After a vasectomy, sexual functio n is not impaired; the only difference is t hat the sem en contains no sperm . During the past 20 years, about 4 0 mi llio n men worldwide have had vasectomies. In the United States, the number of vasectomies done each year has increased from about 2 15,000 in 1969 to abo ut 4 00,000 currently. Past research had raised two main concerns about possible side effects of vasectomies. In one study, monkeys who under went vasectomy developed atherosclerosis (hardening of the arteries due to fatty deposits), which could lead to heart attacks. Other

studies have shown that vasectomy can cause an autoimmune response, in which the man develops an antibody against sperm. Researchers had speculated t hat this could lead to other immunological diseases. In the UCLA-led study, m en with vasectomies d id not have a hig her incidence of either heart disease or imm u nolog ical d isorders. The stud y was coordinated by the UCLA School of Public H ealth under a grant from the National Institute of Child H ealth and Human D evelo pment, National Institutes of H ealth . Co-investigators from the School include Anne Coulson , lecturer; Dr. Roger Detels , professor and dean ; and Dr. Potter Chang, professor. Others involved from the School include Dr. James Sayer, adjunct assistant professor, and J ose Qu iroga, adjunct assistant professor. In add ition to the UCLA School of Public H ealth , the other participating inst itut io ns were: USC School of M ed icine, University of Minnesota School of Public H ealth, and Mayo Clinic.

Rich Elba11111 is a P11blic information Representative in Health Sciences Co11111111nicatiom.

, This rendering of the male sign ill11strates a vasectomy. The vas deferens, the t11be that carries the sperm from the testicles to the penis, is mt and tied off

MINORITY STUDENTS MAKE HISTORY By J udi Goodfriend ust by entering the doors the School this fall, new students m ade their mark in public health . A record number of minorities were adm itted to the first year graduate class, and their presence is certain to have a ripple effect on the population in the years to come. These students wiJI be educated in the next few years to become leaders and role models in health education, to

biostatistics, epidemiology, health services and the various other disciplines of public health . They will have an added advantage in that they are already fam iliar with the cultural concerns of their ethnic groups. "You need people who can communicate with their own people. It's not that everyone can't do it , but it will take a lot more reading and understanding for someone who comes from outside a certain group," says one Hispanic professional. Surveys have shown that the three minority groups most underrepresented in public health in the United States are Hispanics, American Indians and blacks. In an effort to change these statistics, intensive efforts have been made in the last few decades to recruit minorities into the field of public health, and UCLA has been a wiJling participant. The effort is beginning to bear fruit for the School. In 1983, out of a class of 205 entering students , only 13 represented Hispanics, blacks and American Indians. By fall 1984, 56 underrepresented

minority students had been accepted to the fall class. The proportion of minority enroJlees for fall 1984, compared to fall 1983, had increased from 6. 3 percent of the student body ro 20 percent. The increase in minority admissions at the UCLA School of Public H ealth is in large part due to the successful coJlaborative efforts of the faculty, the Admissions Policy Committee, and, in particular, the Health Careers O pportunity Program (HCOP). HCOP was established in 1981 when a three-year federal grant was awarded to the School of Public H ealth by the H ealth Resources and Services Administration in the U.S. Department of H ealth and Human

New students Barbara Sngland and Michael j ones review material handed out at the summer prologue program.

Services. HCOP is currently directed by Kathleen Torres, who has a M.P.H. in health administration from the School of Public Health at the University of California, Berkeley, and who has directed several Hispanic community health centers. Torres came aboard during t he last year of the grant and set out to establish an aggressive minority recruitment, admissions and retention program. If the numbers of the incoming freshman class are any indication, her recruitment efforts seem to have been well rewarded. This increase in minority admissions has been helped by HCOP through recruitment visits last year to 15 universities and colleges in Southern California, applicant forums, counseling services, and student and counselor conferences . The reason, Torres explains, that so few Hispanics , blacks and American Indians enter public health is that many do not even know that the field exists.

"When we go to colleges to recruit students , and we ask how many know what public health is, maybe one or two hands go up. And those few still don't have it right on target ," Torres observes. "They offer the traditional definition of a public health professional: a sanitarian . They do not talk about the administrator, the researcher, the health educator, the scientist." arie La Fargue, a freshman in the health services management program, concurs . When she started as an undergraduate student at UCLA four years ago, she thought that the optimal position within health care was as a physician. After branching out from her pre-med curriculum and taking a course in the School , she discovered public health .

Kctthleen Torres (left), director of the H ea/th Careers Opport1tnity Program . meets with Geri Peak.

"Most minorities I know come to UCLA for either law or medicine because in our communities we think of those roles as the ones that will get you ahead . That is Âˇwhy HCOP is so important: to open new doors . I never realized how much one can affect a population through hospital administration ," La Farg ue says . A few years from now, La Fargue says she wants other minorities to take notice and say, "There's a black woman who is a hospital administrator, and it is possible for me to do that, too ." La Farg ue is one of 123 underrepresented minorities who applied to the School of Public H ealth for admission this fall. Torres and her staff have met personally with each of

these 123, providing counseling, answering questions, and helping them through the application process. Once students are admitted tO the School, HCOP has designed a program tO make sure they stay. HCOP offers a summer enrichment prolog ue program for building skills in writing, rapid reading , math , as well as preparation for epidemiology. In addition, HCOP's retention program includes tutorial services , a student mentoring program, educational moniroring, and peer counseling, as well as access tO research and internship scholarships. nfortunately, HCOP was not approved for refunding when the federal g rant ended last summer. The grant application had been submitted only weeks after Torres had come tO direct the prog ram and the successes noted above in admissions had not yet occurred . Now that Torres is aboard and the number of minority students in the School has increased so dramatically, Torres is optimistic that the School will be able tO secure new support in the next funding period beg inning in September 1985 . In the meantime , the School is comm itted to the prog ram. The incoming freshmen , the students Torres already knows so well , are eager to do their share for HCOP and for their fellow underrepresented minorities. "I would like tO help others who, like me, may question whether they

Marie La fargue is studying to be a hospital administrator.

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;

Alida Vent11rct is ct fi'eshman this year.

can really make it. HCOP gave m e the feeling that someone is behind me tO help," says Lourdes BaezcondeGarbanati, a freshman in the Division of Behavioral Sciences and H ealth Education. In addition t0 its efforts coward student admissions, HCOP was involved in other activities last year. In June, HCOP and the Standing Committee on Minority Affairs of the School of Public .H ealth Alumni Association sponsored a dinner attended by 70 people to recognize minority grad uates and welcome incoming minority students. La Fargue commented that the union of those receiving degrees with those just starting coursework gave her further inspiration. As part of the dinner

program, Dr. Susan Scrimshaw was named Faculty of the Year in recognition of her leadership, dedication and contributions tO the health care of minority populations and her support of public health students and alumni. Dr. Juel Janis , assistant dean of the School, was cited for her support of the goals of the Health Careers Opportunity Program . With HCOP's help, the Standing Committee on Minority Affairs sponsored a Cross Cultural Aspects of H ealth Care Conference in April 1984 . The impetus of the conference was the overwhelming need for health care providers tO understand the health practices of the minority patient. Similarly, HCOP sponsored an intensive review course last spring for the school-wide comprehensive examination which all public health graduate students must take. All 80 participants passed their examinations. As the successes of HCOP gain momentum , the School looks forward to the term "underrepresented" minorities becoming obsolete. By encourag ing Hispanics , blacks and American Indians tO enter the field of public health, the School aims tO improve the health care of these communities as well as tO open new professional doors for them.

I HEAVY MAIUJUANA SMOKERS RISK DAMAGE TO

LUNGS

respiratory tracts, according to collaborative rese-arch between the UCLA School of Public Health and the School of Medicine. Preliminary results of a research study involving 200 habitual marijuana smokers showed that marijuana smokers who do not smoke tobacco had a significantly higher prevalence of such respirarory symptoms as cough, phlegm production, and an increased frequency of lower respirarory tract illness , compared with a control group of non-smokers. Additionally, the function of the lungs was affected. The marijuana smokers experienced increased resistance ro airflow in their large airways which, according ro the researchers , suggests damage to the trachea and major bronchi. Preliminary results of the research study were presented ro the American Lung Association at their annual meeting in Miami Beach, Florida, in May, by Dr. Donald P. Tashkin , professor of medicine at the UCLA School of Medicine, who is the principal investigator. Anne H. Coulson, adjunct lecturer in public health and research epidemiologist in the UCLA School of Public H ealth, is the coprincipal investigaror. A small group of marijuana smokers in the study underwent a bronchoscopy procedure which allowed the researchers to actually view and biopsy a small sample of lung tissue. For each of the research subjects who underwent the bronchoscopy, these tissues had significant abnormalities when examined under the microscope. The report focused on comparisons between individuals who smoke only marijuana, those who smoke marijuana and tobacco, and those who smoke neither.

goal is to determine the relationship, if any, between frequent, habitual use of marijuana alone and with tobacco, and the long-term pulmonary consequences of such marijuana use. "While the harmful effects of tobacco ro the lung have been documented, sufficient time has not yet elapsed for the delayed health consequences of marijuana use to become evident," says Dr. Tashkin. "Right now we are at the same stage with mari juana research as we were in the 1940s concerning the potential damage of cigarette smoking," Coulson adds. H owever, according to the researchers, on the whole, the existing body of research provides sufficient evidence from which to conclude that the habitual use of marijuana does damage to the respiratory tract . They point out that smoking even one marijuana joint a day for two years causes functional abnormality of the air passages and increases the effort necessary to breathe by 25 percent. By j ohn Pontarelli

Nurnr10N

RESEARCHERS PROBE MYSTERIES OF NU1RIENTS IN HEALTH By J udy Rosenfeld

hat role does calcium play . . m preventmg debil itating bone mineral loss as people age? Can vitamin E help offset the lung damage that resulrs from high levels of smog? Does fiber in the diet prevent the incidence of colon cancer or prevent some of the complications of diabetes? Researchers in the School of Public H ealth's Division of Nutritional Science are searching for answers ro these and other questions linking nutrition and health. The Division of Nutritional Sciences, the smallest of the School's seven divisions, became independent of rhe Division of Nutritional and Environmental Sciences in July 1983. Five full-time faculry and one adjunct research professor, in addition ro professors with joint appointments with the School of Medicine, comprise the reaching and research team for the division. The division's 50 ro 60 graduate students have at their fingertips a highly diversified curricula due in part ro the varied research areas of the faculty, according to division head Dr. Marian Swendseid. For example, Dr. Curtis Eckhert, acting associate professor, is looking at rhe

role of trace elements in protecting against some of the complications of diabetes such as rerinoparhy. One of his studies, being conducted in conjunction with scientists at the University of Washington, is monitoring diabetic and nondiabetic women and their plasma levels of the trace mineral selenium . His research has already shown that animals are prone to retinal capillary collapse without adequate levels of selenium in their diet. Another active researcher who has focused her attention on women's nutritional status is associate professor Dr. Isabelle Hunt. She has recently completed a study of low-income pregnant Hispanic women in Los Angeles which revealed t he presence of low serum zinc levels associated with a hig h incidence of pregnancyinduced hypertension . Dr. Hunt plans a follow-up study with the goal of learning m ore about the effects of nutrition on pregnancy-induced hypertension. Nutritional scientists have become interested in studying osteoporosis, a

The amino acid methionine is bei11g examined by researchers at the School to determine how 11111ch h11111ans req11ire in variom diets. One st11dy has shown that methionine. show11 here in a model. can prevent toxicity camed by lctrge doses of certain vitamins.

common ailment in women over 50. O steoporosis is a bone d isorder that results in bone density loss, and has been related to a number of factors, including inadequate calcium intake. When older women fall, they are at a greater peril of breaking their bones because of osteoporosis. Dr. H unt is now studying a test group of women that will number 400, half of whom are Seventh Day Adventists who eat dairy and egg products but no meat , and half of whom are omnivores (those who eat meat). Each woman will be interviewed extensively on her d ietary background and will be tested clinically for bone mineral content as well as calcium levels in the blood and unne. H ypertension, one of t he "killer" d iseases affecting public health, has been studied closely by researchers t rying to control blood pressure through proper nutrit ion. Most of the approaches have involved reducing sodium in the diet . Evidence has

A model of the vita111i11. 11icotinamide.

shown that hig h calcium diets may also lower blood pressure. Dr. Michael Jones , assistant professor in the division, came to this conclusion after studying rats who were fed hig h calcium diets. H e plans to conduct follow-up investigations in humans to examine the relationship between calcium and blood pressure more closely, and also to look at the possible effects of calcium on preventing hypertension.

, I

ilicon , a recently discovered essential trace element in animal nutrition, has also sparked new research . Dr. Edith Carlisle, adjunct research professor, was in fact the first scientist in the world ro identify si licon as an essential nutrient. She is now conducting her own investigation on osteoporosis and the effect of si licon in rhe diet on rhe bone's capacity to heal after a frac-

rure. Dr. Carlisle believes that silicon is req uired for connective tissue formation (bone) and cartilage growth. Silicon is found in foods rich in d ietary fiber such as rolled oats, brown rice, cereals, pect in, and ocher unrefined foods. Althoug h vitamins are essential to human health , there is evidence that some of them ingested in excessive amounts are toxic. Dr. Swendseid , Professor Emeritus Dr. Ralph McKee and their g raduate students have shown through rests that large doses of the vitamin nicorinamide fed to rats produce toxicity, which results in fatty livers and weig ht loss. These effects, however, can be prevented by supplements of the amino acid methionine. In related work, this team is now studying the human requirement for methionine in various diets. Dr. Roslyn Alfi n-Slarer, professor of nutrition and assistant dean for academic affairs, co-authors a weekly nutrition column with Dr. Derrick J elliffe , professor of public health in the Division of Population and Fam-

ily H ealth , in the H ome Section of the Los Angeles Times. Dr. Alfin-Slarer is involved in research on nutrition and agi ng, and nutrition and heart disease and cancer, and has written several articles on these subjects. "Although older people probably need fewer calories and post-menopausal women need less iron , what is nor known is whether older people need more protein to compensate for the process of aging, and how much and what kind of far should be incorporated into their diets. These are all problems that need more exploration ," Alfin-Slarer notes. "H owever, more and more of us are living longer so we must be doing something rig ht ." Dr. Alfin-Slater's students are conducting research that they hope will contribute important clues to nutrition and human health . One such investigation , of special relevance to urban dwellers, is the possible protective effect of vitamin E on lung damage from exposure to excessive ozone levels. Vitamin E is a known anti-oxidant , and thus may be helpful to lungs exposed to smog, which contains the oxidizing agent, ozone. "There are still many frontiers to explore in nutrition," Dr. Alfin-Slarer concludes. Faculty in the Division of Nutritional Sciences enjoy act ive collaborative support for their research with faculty in ocher divisions, including epidemiology, biostatistics and environmental health. Frequently, faculty in the School of Medicine join in inrerdisci plinary invesrigarions as well. Throug h these ream efforts, the division's faculty hopes to broaden thei r knowledge base in human nutrition . According to Dr. Swendseid, the division will continue to aim its efforts to disease prevention and optimal health maintenance, the chief mission of p ublic health .

efore it became widely popular, Dr. Fred Wasserman , M . P. H. '72, Dr. P. H . '76, and Pam Anderson , M. P. H . '72, u nderstood t he wisdom of mergers. In fact , two years after Dr. Wasserman hired UCLA School of Public H ealth classmate Pam Anderson in 197 1 ro join his consulting fi rm , F. W . Wasserman & Associates , rhe rwo were married. They have since gone on ro d evelop one of the fi rst of t he new generat ion (post1970) healrh maintenance organizat ions in the nation. W hen t he Wasserman-Anderson connection srarred, borh were g rad uate srudents in whar was then known as the Division of H ealth Services Ad ministration (now t he Division of Health Services). Althoug h D r. Wasserman was still involved in his consult ing firm , he was also in rhe process of forming a multi-specialty fee-for-service g roup pract ice and com plementary health m aintenance organization (HMO). His riming was prescient. Since 1973, when that effort Aowered into Maxicare H ealth Plans, Inc. (a p ublicly traded company), HMOs have g rown at a fabulous pace. As explained in the 10-year report issued by rhe National lnd usrry Council for HMO Development, an HMO is "a com plete health care organizarion

A n alumni "corporate couple" began Maxicare, one of the first health maintenance organizations.

MAXIMIZING A TEAM EFFORT By } udy Rosenfeld thar combines borh rhe delivery and fi nancing of comprehensive health services . Unlike conven tional health care insurers, HMOs provide health care services rarher than merely reimbursing members for services provided by others." W ith irs fi rst conrracr from Medicaid in 197 3, Maxicare began in earnest , wirh Dr. Wasserman at the helm as execurive di recror and Pam Maxicc1.re Medical Centers. located in Culver City. pr(Wides ccm for 111e111bm of Maxicare. a Hect/th Maintenance Orgcmization founded by Sthool of Public Health alumni Dr. Fred Wasserman and Pam Anderson.

Anderson as full-rime admi nistraror. In 1976, M axicare became qualified under federal HMO act am endments, which created widespread opportunit ies for HMOs ro offer their services ro com panies with 25 or more employees. Since then, t he rise of Maxicare has smoothl y kept pace with rhe HMO ind ustry. M axicare began with three employees and $37,000 in capiral - roday it boasrs over 1,000 employees and a projected 1984 revenue of $300 million. Maxicare provides health care for 400,000 enrollees in California, Ill inois, Indiana, M issou ri, Texas, Wisconsin and Utah . A partial list of employers sig ned up with Maxicare reads like a Who's Who in American ind ust ry : Bethlehem Steel , G eneral Morors Corporation , H ug hes Air-

craft, Lockheed, Rockwell Corporation and TRW, ro name a few. The city of Chicago, the county of Los Angeles, and the states of California, Illinois and Indiana have employees enrolled in Maxicare health care programs. Clearly, Dr. Wasserman and Pam Anderson have enjoyed a wave of consumer enthusiasm for HMOs that has thrust this now popular (but once misundersrood) health care delivery system inro the forefront of American medicine. The g rowth of the entire HMO industry has surprised even its most enthusiastic supporters. In discussing Maxicare and HMOs at corporate headq uarters in H awthorne, Dr. Wasserman noted , 'Tm not surprised at the industry's growth, but I am surprised that it has been so rapid . In the first quarter of 1984, we probably saw more HMO membership growth than in any single quarter in the past LO years. I wouldn't be surprised if invesror-owned HMOs would g row 40 to SO percent in enrollment in the next two or three years." And HMOs have captured the attention of physicians, roo. Dr. Wasserman says that roday there are more M.D. s who want to participate in HMOs than there are opportunities. According ro Dr. Wasserm an, many employers are finding their medical bills for employees ro be lower through HMOs than premi ums

Dr. Wasserman and Pam Anderson at their corporate offices in Hawthorne.

paid ro third-party insurance carriers. Total costs for enrollees have been slashed from 10 to 40 percent , according to a 1979 study conducted by Dr. H arold Luft of the Stanford University School of Medicine. Because HMOs pay for and deliver patients' health care, t hey have a vested interest in encouraging healthful lifestyles. Preventive healt h care and health education prog ram s are understandably popular in HMOs and have been documented to be cost effective. Nowhere have t he savi ngs been more apparent than in the successful prenatal counseling program at Maxicare, which is mandatory for all pregnant enrollees. The coord inated trio of interventions consists of individualized nutrition counseling , a home correspondence sm oking cessat ion program , and infant car safety instruction . In a published report on this prog ram , M axi care researchers (headed by fellow alumnus Dr. Daniel Ershoff) discovered strong evidence linking poor maternal nutri t ional status and maternal smoking with fetal mortality, prematurity, low birth weight , and even neonatal death . The connection between non-use of infant car seat restraints and the severity of injury during an accident is even more strong ly documented. Pam Anderson is actively involved in developing other health intervention programs in response to enrollee requests taken from surveys . Enrollees already have opportunities for courses in hypertension control , smoking cessation , and stress management, all available at the worksite. Aside from the company's emphasis on health prevention programs, Dr. Wasserman feels that Maxicare differs from other HMOs of its size in

its management, which includes several alumni from the School of Public H ealth . "Our management is very young, aggressive, and well educated," Dr. Wasserman explains. Dr. Frank Mat ricardi, Dr. P.H . '82, vice president of Maxicare California, works primaril y in government relations on state and federal legislation affecting HMOs; Dr. Daniel Ershoff, Dr.P.H. Âˇ79, is di recror of research; other alum ni include Bharti Seth , M. P.H . '77, and Nancy Wallace, M . P.H. '83. Dr. Wasserm an himself jokes that he g raduated from UCLA three t imes: he received his bachelor 's degree in business ad ministration in 1961, and returned for both his M.P.H . and Dr. P.H . degrees in health services administration in 1972 and 1976, respectively. Today, Dr. Wasserman is adj unct assistant professor in the School and teaches a course on health maintenance organ1zattons. Pam Anderson received her bachelor 's degree in psychology and her M .P.H. in health services managem ent from UCLA. She and Dr. Wasserman taug ht the first course ever offered at UCLA Extension on health maintenance organizations in 1972. As successful as Maxicare has been , this corporate couple continues to plan for an expanding future. By 1990, just six years from now, Dr. Wasserman and Pam Anderson want Maxicare to be a billion dollar company with one million enrollees. Considering the p henomenal growth of the industry, the goals are not far-fetched. And , they remind anyone who m ay doubt it , it was only 20 years ago that Dr. Milton Roemer, professor emeri tus in the School, spoke to an American Medical Association (AMA) meeting about HMOs and was booed off the stage. "We've gone from being called socialists ro being called entrepreneurs," notes Anderson. "And our goals are t he same ."

research center that will be helping the federal government evaluate its dramatically new payment system for Medicare patients has been formed by the UCLA School of Public H ealth and The Rand Corporation . The center, which was officially established in March, is funded by the H ealth Care Finance Administration (HCFA), the federal agency that manages Medicare. The center has been funded for five years and will be conducting approximately $ 1 million in research each year. This year, the government began a new reimbursement program based on Diagnosis Related G roups (DRGs) in which hospitals are paid for Medicare services on a prospective basis, that is , before service is rendered . Medicare has determined payment rates for each DRG based on a set fee per case. In the past, Medicare providers were paid retrospectively, after the care was g iven and based on what the care actually cost to provide. T he new system is an attempt by the federal government to control what it considers to be skyrocketing health care costs. The Rand/UCLA center is one of two such centers in the country funded by HCFA t hat will be evaluating this new system. The other center is a consortium between Brandeis U niversity, Boston University, MITand t he Urban Institute. That center, based at Brandeis in Waltham, Massachusetts, was recently awarded a second five-year grant. UCLA School of Public Health Associate Professor Shan Cretin is a deputy director of the Rand /UCLA center. J oseph P. Newhouse, head of the economics department at Rand , is the d irector of the center. " It is exciting to be working in an area in which policy decisions are actually being made all the time . Research we do this year could become the basis of a new law next year. So

The UCLA School of Public Health and The Rand Corporation form a research center to study DRGs.

&sEARCH FOR THE

PRESENT By J udi Goodfriend you get a feeling that what you are doing mig ht actually make a difference," Dr. Cretin observes. The center is currently involved in a number of studies that monitor the impact of DRGs on costs and quality of care. Researchers are also evaluating changes that might be made in the system-including paying for physician services on a prospective basis. "There are a lot of technical problems in trying to evaluate something like DRGs because it is a very complicated payment system that has replaced an already complicated payment system ," Dr. C retin says. "Some hospitals started the program in July, others in October. It rakes a while for the institutions involved to understand the system." nother emphasis of the Rand /UCLA center will be to help in the design and evaluation of demonstration programs. These are large-scale programs in a state or several states in which the government tests a new way of financing a service, or a new service it is considering fi nancing. The demonstration site serves as a trial run before a program is implemented nationally. DRGs, for example, were tried in New J ersey hospitals for three years ( 1979- 82) before the program became a national one. The Rand /

UCLA researchers will be helping HCFA to analyze the data from the New J ersey demonstration. "The DRG system is a very dramatic one. It's unusual to change a policy so dramatically for such a large population, and it happened fairly fast. There is a lot of backlash in the industry and I suspect we will see some changes in t he legislation as we go on," D r. Cretin says. The collaboration between Rand and UCLA is an ideal one, Dr. Cretin says. The Rand Corporation employs experts in economics, statistics and policy analysis. H eadquartered in Santa Monica, Rand is a private, nonprofit institution engaged in research and analysis of materials affecting national security and public welfare, and in the operation of education programs. Over the last 15 years, it has become increasingly involved in health issues. The UCLA School of Public Health brings to the center experienced health services researchers, many who have directed hospitals and health departments and are therefore familiar with problems associated with administering regulations. The Division of H ealth Services at the School has very strong ties to hospitals in the area. These connections can be called upon to lend insight to hospitals' points of views about legislation affecting them . As UCLA's liaison to the center, Dr. C retin will be working with other faculty in the Division of Health Services on various projects. She says each project will be treated as an independent grant so that faculty members will direct different projects. A bonus for public health students is that they will have access to data and information before it is widely available. A number of students will be involved in the projects. One spent the summer working for HCFA in Washington, D .C. "This is a chance for all of us to be involved in a dynamic center," Dr. Cretin says.

DEAN' S COUNCIL SUPPORT GROWS n recognition of their annual support, D ean's Council members and other friends were invited ro visit and dine with D ean and Mrs. Roger Detels and Dr. and Mrs. Raymond Goodman one evening last spring . Dr. Goodman has served as Chairman of the D ean's Council since its founding in 1976 . D ean's Council members have contributed more than $40 ,000 ro the School during the past three years. These funds are used ro send students and faculty ro professional meetings where they present research reports; as seed money for the development of research projects; ro assist in faculty recruitment ; ro purchase computer hardware and software; to sponsor distinguished lecturers for presentations ro professionals and community members, and other activities ro support the school. Membership has tripled in that time and currently includes more than 150 alumni , faculty, friends and corporations . Membership in the D ean's Council may be obtained with a tax-deductible contribution of $ 100 or more , made payable to The UCLA Foundation. Contributions should be sent to the School of Public H ealth Dean's Council , P.O. Box 24209, Los Angeles, California 90024 . For further information , contact Cindy D onovan at (213) 206-0 500 . T he School is g rateful to the following 1983/84 members of the Dean's Council for their support:

An n M. Bjorklund , M. P.H . Diana M . Bonta-Mat ricard i, M. P.H . Lester Breslow, M.D., M. P.H . H elene G. Brown Wayne 0 . Buck , M.D .. M.P H . Dennice Caliban Edith M. Carlisle, Ph.D. Carnation R esearch Laboratory Virg in ia A. Clark , Ph. D. Roger A. Clemens, Dr. PH., M. P. H . A nne H . Coulson, M. P.H . Anahid C recelius , Dr.PH ., M . P. H . Irvin M. Cush ner, M. D., M. PH. Bruce N . Davidson , M . P.H. Rog er Detels, M. D. , M.S. . Brian P. Do lan , M.D ., M.P. H . O live J ean Dunn, Ph . D. J oel M . Ellenzweig, M.D ., M . P.H . Sam Elrod , M. P. H. Agnes K. Eubanks, M. P.H . J ean S. Felton , M.D. Paul M . Fleiss, M. D., M. P. H., F. A.A . P. Stephanie Foote, Ph.D., M. P. H . Irene M. Fundaun Charles G oldstein, D. D.S., M. P.H . Raymond D . Good man , M. D., M. P H. Donald]. Goodwin , Dr. PH. Cecele G reenwood Lawrence H art, M. D. Carl E. H opkins, Ph .D., M.P H . J uel J anis Paul S. J arett Derrick B. J elli ffe , M.D ., D.T.M . & H., D.C. H., F. R.C. P. and E.F. Patricc Jcl liffc, R. N., M. PH . O live G. J ohnson W ilbert C. Jordan , M. D., M.P. H . Âˇ Snehendu B . Kar, Dr. P.H . M. So. Leonard E. K leinman , M. D., M.P. H. and Melod yc Klein man, M. P.H . Carolbeth G . K orn J oel W. Kovner, Dr.PH ., M. P. H . Bernard H . Krakower D onald A. Levine , M.D., M. PH . Virg inia C. Li, Ph.D., M. P. H . l rvin M. Lourie, M. D., M. P.H ., M. S. Robert A. Mah, Ph .D. Lo u is E. M ahoney, Jr., M.D., Dr. PH ., M. P.H . Fran k ]. Massey, J r., Ph.D ., M.A. Fran k P. Matricard i, Dr. PH ., M.P.H . J oseph R . McCarthy, M. PH ., M.S.P. H .

Roslyn B. Al fi n-Slater, Ph.D. l ra R . Alpert, M.S. PH . Elise C. W. Anderson , M.S. P.H . Lawrence R . Ash , Ph.D. W ill iam A. Benbassat , Dr. P.H ., M. S. PH .

Lester A. Meis Leonard T. Mendelsohn Marie E. Michnich, Dr. P. H ., M.P.H . J ean L. Mickey, Ph. D. J ames L. Monahan , D. D.S., M. P.H . Ro bert D . Montoya, M. D., M.P. H . Charles N. Moss, M.D., Dr. P. H. Beverlee A. Myers, lVl. P.H . Alfred K. Neumann , M.D., M.A., M.P. H . and Charlotte Neuman n, M. D .. M. P.H . Edward ). O 'N e ill , M. D., M. P. H. R uby S. Okubo, M.P. H. J ean J. Ospital, Dr. P.H ., M. P.H . El izabeth M. O srerkamp , M. PH . J ames]. Palmersheim , Ph. D., M. S. Christos A. Papatheoclorou, M. D., M.P. H . 0 la Faye Pearson , M. P. H . Catheri ne G. Percy Edward L. Rada, Ph. D. Shirley W. Rich, M.P H . Ruth F. Richards, M. A., M. P. H. M ilcon I. Roemer, M. D., M.P. H . Stanley N. Ro kaw, M.D. H arold H . Royalrey, M.D ., M. P.H . Ralph R . Sachs, M.D. Alan Samuels, M. PH . Marlowe H . Schaffner, M. D., M.P. H . Aug ust W. Schara , M.S. PH. M!lx H . Schoen , D.D.S., Dr.P H ., M.P.H . J amar J . Schoessow, M. PH . M arie M. Segarra, M. P. H . Fran A. Sherwood , M. P.H. Marti Slawson H erbert N . Snow, D. V. M., M.P. H . C hauncey Starr Marian E. Swcndseid, Ph.D. Forest S. Tennant , Jr. , M. D., Dr.P H ., M. P.H . Samuel J. Tibbit ts Kathleen A. Torres, M. PH . Sue Verit y, Dr. PH ., M. PH. Barbara R. Visscher, M.D ., Dr. P.H., M. PH . Fred W . Wasserman , Dr. P. H., M. P. H . David H. Wegman , M. D., M.P.H. Emma B . W harton , M. D., M. P.H . J ames L. W hi tten berger, M.D . Graeme A. W. Wi lliams, M. D., M.PH . Alcon E. Wilson M imi C. Yu, M. D., Ph. D., M.S. T homas A. Zeko L

/ Facul ty Achi evement

NEWS Famlty Member Heads New Hospital Network

Dr: Charles Ewell

harles M . Ewell , Jr., Ph . D . , lectu rer in the health services management program at the School, has been named president and chief executive of what is believed to be the nation's largest g roup of nonprofit hospitals. Dr. Ewell heads American H ealthcare Systems, a network of 233 hospitals with 45,000 beds in 21 states. The new network is a result of a merger between Associated H ealth Systems in Phoenix , Arizona, a holding company for LL hospital g roups, and United H ealthcare Systems of Kansas City, Missouri, parent of 15 hospital groups. Dr. Ewell, who taught sem inars in health services management during last spring quarter, will continue tO teach at the School.

$ 5 00, 000 Received For Research F11nd

Health Services Grad11ates Off To A Running Start

he average starting salary of 1983 graduates of the UCLA Program in H ealth Services Management was $32, 000 , according tO a national survey recently released by the Association of University Prog rams in H ealth Administration. This compares with a $27,000 average for the 1, 200 g rad uates of accredited health administration programs throughout the country.

Richard and Veda Weisman (center) tour the School of Pi1blic Health with Dr. Barbara Visscher (right ) and Dean Roger Detels.

$ 500,000 commitment tO establish an endowed research fu nd in the School of Public H ealth has been received from the Richard D. and Veda F. Weisman fami ly of Pacific Palisades. The rota! is a combination of pledges from Mr. and Mrs. Weisman and their sons Michael , of Carmel Valley, and Paul , of Santa Barbara. This is the largest private commitment ever made tO the School. Throug h a series of discussions and rours , the fami ly became committed to advancing the work of the Division of Epidemiology. Some research with which they became familiar includes faculty investigations into multiple sclerosis, AIDS, cardiovascular disease, cancer, accidents, depression, herpes, and the effects of smog on lung function . The Weismans' support for unrestricted funds in epidemiology will allow the

d ivision to respond rapidly t0 newly identified areas of research , according to Dr. Barbara Visscher, head of the Division of Epidemiology. "Our research on AIDS, for example, is now funded by the National Institutes of H ealth , but we initially had to start with funds that were difficult to fi nd ," D r. Visscher explains . Dr. Roger Detels , dean of the School , adds, "Government and large agencies are more apt tO fu nd research that has been validated first on a small scale. But seed money for pilot research is often the hardest t0 secure. This gift will establish a lasting resource with which to test promising epidemiological projects. It is my plan to have, in t ime, similar resources for each of the School's seven divisions."

School-Aged Children Focus Of Health Project cting on the request of the Los Angeles County Department of H ealth Services, the UCLA School of Public H ealth is currently spearheading a project tO investigate issues that affect the health of school-aged children in Los Angeles County. In addition to t he Department of H ealth Services, the School will also work with the Los Angeles County Schools and Los Angeles U ni fied School Districts. A School H ealth Task Force consisting of representatives from the health department , school districts and the School of Public H ealth , and chai red by Dr. Roger D etels, dean of the School, met last summer and developed a list of priorities for the project . An O perations Committee , chaired by Dr. Juel J anis, assistant dean of the School, will follow through on the program outlined by the School H ealth Task Force.

ALUMNI NEWS

New A lumni President: Bruce Davidson

Bruce Davidson stops by Santa Fe Hospital in Los Angeles, one of the hospitals f or which he consults.

ith the advent of DRGs, the American health care delivery system faces some of the most dramatic changes in its history. And the timing could not be better for the new School of Public Health Alumni Association president, Bruce Davidson , '79. D avidson is DRG Coordinator / Analyst for Greatwest Hospitals Inc., which owns six hospitals in Southern California and manages five others in Northern California and Oregon. He is excited to be at the forefront of implementing major policy changes in health care delivery, and has already begun to bring that same enthusiasm, energy, and a multitude of creative ideas to his role as alumni president. The Boston-born but Southern Californ ia-raised Davidson earned his M.P.H. in Population , Family and International H ealth . H e also holds a master's degree in urban planning from USC, and future plans include a return to school for a doctorate in health policy. Since graduating just a few years ago, Davidson has already established impressive credits through his work in diverse settings. In Guatemala and in The Gambia, he worked with the Ministries of Health in developing rural training programs to alleviate malnutrition. Davidson also served as both clinical director and director of

planning at La Clinica Familia del Barrio in East Los Angeles, and was administrator in charge of the pediatric intensive care unit at Children's H ospital in Los Angeles. In his current position at Greatwest H ospitals Inc., he is helping the company prepare for the initiation of Medicare DRGs (Diagnostic Related Groups, or DRGs, is a new payment system in which reimbursement for Medicare patients is based on a set fee per diagnosis). As a young alumnus, D avidson feels a particular tie to students in the School, and is especially interested in establishing job development programs. Last year, when Davidson was Alumni Association secretary, the association co-sponsored a series of meetings with students to help acquaint them with current job opportunities and requirements-the first such program hosted by the association . This year, one of Davidson's goals is to develop a m entor program, in which students would periodically meet with alumni who work in the students' field of interest . "From my own experience, getting to know people in the field has been very valuable in finding jobs," Davidson says. In Davidson's view, the Alumni Association continues to gain momentum as it assumes responsibility for sponsoring or co-sponsoring a number of successful activities. A major challenge for Davidson is to plan activities that will appeal to alumni coming from seven different divisions who undoubtedly have varied interests and concerns. To accommodate these eclectic alumni ,

D avidson wants to develop further committees on leg islative action , job development, and student affairs. A program that will focus on public health policy at the state level is already slated among this year's acttv1ttes. To allow for wider participation, Davidson is helping to revise the bylaws to make room for more people on the board of directors of the Alumni Association. To recruit more alumni (membership is now approximately 250), association members will be calling alumni to invite them to upcoming events, and a quarterly newsletter is in the offing. This year for the first time, first-year alumni have been g iven one year free membership in the association, Davidson says. When not working diligently at Greatwest H ospitals or planning alumni association activities, Davidson helps La Clinica Familia del Barrio in fundraising efforrs.

Alumni Association Board of Directors 1984-1986 President Bruce D avidson, M. P.H. '79 Vice President, Membership Cynthia Callahan Davis, M.P.H. '8 1

Vice President. Progra111s Debra Ward , M.P. H . '80 Secretary Todd Smayda, M.P. H . '80 Treasurer Susan Uretzky, M.P. H . '80 Immediate Past President Paul J arett, B.S. '50 Minority Al11mni Committee Beatrice Beliz , M. P.H. '80 j ob Development Committee Evelyn Fassberg, M .P.H. '83 Deems Offoe Representative Juel J anis, Ph.D.

ALUMNI NOTES

TeamSPH . .

By Eva Damski Muchnick, M.P.H ., '70, Dr.P.H. '82

Eva Damski .M11ch11ik (center) sh(it(Js the team spirit with Arturo Franz and Tony Rogers (/ejt).

uring this summer 's O lympic Games, the 23 venues and three villages scattered about Los Angeles, Orange, Ventura and San Diego count ies provided a home away from home for nearly 8,000 athletes, representing L40 countries and principali ties throug hout the world. The representation from the UCLA School of Public H ealth , although far more modest in size, was certainl y strong in spirit. These same 23 venues and three villages provided home away from home, of varying durations, for Team SPH : Arturo Franz, Bruce Allen, Anne Dachs, Tony Rodgers, Joe Sanchez, and Eva D amski Muchnick. Arturo Franz (M. P.H., Environmental Health , 1972), the first of the School of Public H ealth alumni to get on board the Los Angeles Olympic Organizing Committee staff, ~as instrumental getting other alumni members involved. Franz was appointed associate vice-president, chief ad ministrator for Olympic H ealth Services in July, 1982. H e was soon assisted by Olympic Games Program Manager for H ealth Services, Bruce Allen (M. P.H. , H ealth Services Administration , 1971; Dr. P.H. , Health Services Administration , 1977). The Olympic Health Services staff was responsible for developing personal and

public health services at the 23 spores venues, as well as other v~nues such as the International OlympK Committee headquarters at the Biltmore H otel and the main press center at the Los Angeles Convention Center, and at the three Olympic Villages (UCLA, USC and UC Santa Barbara) where the O lympic family lived and worked . Anne Dachs' involvement in the 1984 O lympics came from another direction : the private sector. When American Med ical International sig ned the contract with the Los 1'.-ngeles Olympic Organizing Committee, Anne D achs (M.P.H., H ealth Care Administration, 1971; UCLA SPH Alumni President, 1976- 1978) volu nteered , and became manager of AMI O lympic Projects. D achs was responsible for the operation of polyclinics (urgent care centers) in the three O lympic Villages. The polyclinics provided a full range of services, including lab and x-ray, on a 24-hour basis. Tony Rodgers, J oe Sanchez and Eva Damski Muchnick , all drawn by a mutual love of sports, an interest in the international experience and a reverence for the Olym pic movement worked as volunteers for the ' LAOCC. Tony Rodgers (M. P.H. , Com prehensive H ealth Planning, 1972), was invited by Arturo Franz first co participate on the Advisory Commission for H ealth Services and t hen later to serve as chairperson of the H ealth Records Subcommission, and also worked as doping control coordinator for volleyball and yachting in which he helped test athletes for any trace of drug abuse.

As a child, Joe Sanchez (M.P.H., Environmental and Nutritional Sciences, 1974; Dr.PH ., Environmental Analysis and Planning, 1982) boxed at the YMCA. The son of parents who emigrated from Mexico, Dr. Sanchez grew up with the sports of soccer and boxing. This, together with his knowledge of Spanish , made him a natural for the role of doping control coordinator at the boxing venue at the Sports Arena. Eva Damski Muchnick (M.P.H. , Medical Care Organization, 1970; Dr. P.H. , H ealth Services Administration, 1982; UCLA SPH Alumni Association President , 1978- 1980), volunteered as an interpreter in the Lang uage Services division of the LAOOC. As an interpreter in both Polish and French, Dr. Muchnick worked with the W orld Archery Championships in the fall of 1983, and continued with the Olympic Arts Festival. During the Games themselves, Dr. Muchnick worked as an interpreter at the fencing and g ymnastics venues. Dr. Muchnick's g randfather was a nat ional gymnastics cham pion in Germany and her father has been a gold medalist in the long jump, triple jump and hig h jump in the U.S. Masters Field and Track Championships for the last several years. H ow did Team SPH feel about their Olympic experiences? Perhaps D r. Allen summed it up best in saying, "It was one heck of an experience!"

Phoco credits: Cover: Craig Collins, Norm Schindler Inside cover and pages 4, 8, 11 (La Fargue), 12, L6 (alumni), 18, 20, 22: Terry O'Donnell Pages 5, 10, 11, 16 (hospital), 21: Norm Schindler Pages 7, 8 (homeless): Paul Canong Pages 6-8 (keys), 13, L4, 15: Henry Blackham

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PROGRAMS HERE!

he School of Public H ealth Alumni Association is planning a variety of social and educational programs for the coming year. Be sure to watch your mailboxes for more information about each of these events: • Alumni and faculty reception at the APHA convention in Anaheim : November 12, 6-8 p .m ., H ilton Anaheim Tower, Pacific Ballroom C. • Career Day for School of Public H ealth students to learn from alumni about careers in public health . • The annual Lester Breslow Disting uished Lectureship featuring a prominent speaker in health. • A Cross Cultural Conference to help health care providers understand the needs of minority patients. • Annual Awards Dinner to honor recipients of Alumni Association Awards. One outstanding student from each of the seven divisions in the School will be chosen. For more information about the School of Public H ealth Alumni Association , call Irene Fundaun in the Dean's O ffice, (213) 825-5140, or Bruce Davidson , (714) 633-5420 .

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