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JUNE 2009
UCLA
PUBLIC HEALTH
UCLA
Health Hazards in Economic Hard Times
School of
Public Health
Onyebuchi Arah, a native of Nigeria, is part of a quintet of new faculty whose expertise and experience have bolstered the school’s global health program.
As an obstetrician, he planned to champion prenatal care. But Michael Lu found addressing deficiencies in maternal and child health requires a broader focus.
Doctoral student Kathleen Kozawa is part of a team gaining insight into pollution in residential areas near the ports of Los Angeles and Long Beach.
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UCLA
PUBLIC HEALTH
Gene Block, Ph.D. Chancellor
Linda Rosenstock, M.D., M.P.H. Dean, UCLA School of Public Health
Sarah Anderson Assistant Dean for Communications
John Sonego Assistant Dean for Development and Alumni Relations
features
Dan Gordon Editor and Writer
Martha Widmann Art Director
E D I TO R I A L B OA R D Richard Ambrose, Ph.D. Professor, Environmental Health Sciences
Roshan Bastani, Ph.D. Professor, Health Services Associate Dean for Research
Thomas R. Belin, Ph.D. Professor, Biostatistics
Pamina Gorbach, Dr.P.H. Associate Professor, Epidemiology
F. A. Hagigi, Dr.P.H., M.B.A. Associate Professor, Health Services
William Hinds, Ph.D. Professor, Environmental Health Sciences
Moira Inkelas, Ph.D. Assistant Professor, Health Services
Michael Prelip, D.P.A. Associate Professor, Community Health Sciences
David Liu President, Public Health Student Association
Christopher Mardesich, J.D., M.P.H. ’98
UCLA
President, Alumni Association
School of
Public Health
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Alumni Hall of Fame: the 2009 Inductees
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CRISIS RESPONSE:
Faculty Travel Abroad to Assist After Disasters Faced with calamities that carry far-reaching public health impacts, nations have benefited from the school’s expertise.
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Michael C. Lu: Redefining Maternal and Child Health
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GOING GLOBAL:
Newest Faculty Recruits Enhance School’s Overseas Presence
in every issue 23 RESEARCH
18 10
The U.S. ranks near the bottom among developed countries on many measures, and racial/ethnic disparities in pregnancy outcomes persist. The obstetrician/gynecologist and public health researcher promotes a broader agenda.
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A strategic goal of enhancing the global health program has gained momentum with five additions in less than two years. A new global health certificate program attracts students.
Health Hazards in Economic Hard Times Lost health insurance. Rising rates of depression and stress. Poor diets. Increased violence and abuse. Growing strain on free clinics. The potential fallout from a downturn is a major challenge for public health.
Pesticides and Parkinson’s risk…pollution exposure near freeways…racism and HIV testing…PFCs and fertility…identifying cancer genes…improving access to dental care.
28 STUDENTS 31 FACULTY 33 NEWS BRIEFS 35 FRIENDS
ON THE COVER
Barely a day goes by that isn’t dominated by news of our economic woes. UCLA School of Public Health experts say a faltering economy can have wide-ranging effects on the population’s health.
PHOTOGRAPHY ASUCLA / TOC: Hall of Fame; pp. 4-5; p. 33: Breslow Lecture Reed Hutchinson / Cover: Arah, Lu; p. 6: Rottman; p. 9: Shoaf; p. 10; p. 15: Zimmerman; p. 17: Slusser; p. 19: von Ehrenstein, Arah, Gipson, Vargas-Bustamante; p. 20; p. 21: Arah; p. 22; p. 31; p. 33: Ponce; p. 34: Iguchi Margaret Sanchez / Cover: Kozawa; p. 29 Yvette Roman / p. 13: clinic waiting room Courtesy of Dr. Michael C. Lu / TOC: Lu Courtesy of Dr. Jessica Gipson / TOC: Going Global Courtesy of Dr. Roger Detels / p. 7 Courtesy of Dr. Haroutune K. Armenian / p. 19: Armenian Courtesy of Dr. Fred Hagigi / p. 21: Vietnam and Armenia Courtesy of Tarun Bhatnagar / p. 28 Courtesy of Billie Weiss / p. 34: Weiss Courtesy of UCLA School of Public Health / p. 2; p. 32: bookshelf; p. 33: Fielding, Ganz, H1N1; back cover
Getty Images © 2009 / p. 6: Sichuan Province; p. 8; p. 9: Nagorno-Karabakh; pp. 12-13: unemployment office; p. 18; pp. 24-26
iStockphoto © 2009 / Cover; TOC: crisis, health hazards; p. 9: Banda Aceh; pp. 14-17; p. 23; p. 27; p. 34: map
School of Public Health Home Page: www.ph.ucla.edu E-mail for Application Requests: app-request@admin.ph.ucla.edu UCLA Public Health Magazine is published by the UCLA School of Public Health for the alumni, faculty, students, staff and friends of the school. Copyright 2009 by The Regents of the University of California. Permission to reprint any portion must be obtained from the editor. Contact Editor, UCLA Public Health Magazine, Box 951772, Los Angeles, CA 90095-1772. Phone: (310) 825-6381.
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dean’s message AS THE NATION STRUGGLES to cope with a severe economic crisis, the headlines on the cover of this issue are, unfortunately, all too familiar. In California, the situation is even bleaker. Following the recent failure of several funding propositions on the May 19 ballot, the state’s coffers are perilously low and, facing a $24 billion shortfall, no program is immune from cuts. Deep and potentially debilitating cuts are being considered in, among others, Healthy Families, the state’s low-cost health insurance program for children; mental health services and children’s welfare programs; and, closer to home for our school, support for students and for the UC system overall, further reducing state support for the campuses. At last writing of this message we anticipated the school would suffer a cut of approximately 4 percent this year. We now know it will be more than twice that amount. Regardless of where you stand, the current financial crisis has a long reach and is wreaking havoc on the health of our communities. Our cover story (see page 12) takes a closer look at the impact a recession has on public health. Rising levels of unemployment result in an increase in the number of people without health insurance or who are underinsured. More people suffer from depression and there is an uptick in substance abuse. With deals like two burgers for $2 at the local fast-food chain, people are tempted by poor dietary choices – and increasingly are making them. The long-term health implications of a poor economy remain to be seen, but this should be of great concern to us in public health. As we grapple with these issues, other public health challenges don’t recede. As if we needed to be reminded, the H1N1 (swine flu) virus generated headlines of its own this spring. While relatively mild in its initial outbreak, the scare of a potential pandemic swiftly brought public health issues front and center. When biological and infectious disease outbreaks occur, whether natural or from bioterror events, public health officials need to make rapid and critically important decisions in order to save lives. Current response capabilities in the United States are not fully equipped to provide such timely information, as was confirmed by the variable and sometimes sluggish response to H1N1. I am pleased to report that the Global Bio Lab at UCLA, a laboratory capable
UCLAPUBLIC HEALTH
of quickly analyzing and processing large quantities of biological samples, is
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nearing completion. The Global Bio Lab will be poised to act as a first line of defense against the deadliest biological threats around the globe. In addition to the research and response capacity, the lab will serve as a cutting-edge classroom for our very talented students. Amid these myriad and mounting challenges, our work as a school is more important than ever. We continue to grow our faculty in ways that will prepare our students to address the changing field of public health. Several years ago our strategic plan addressed the need to create a program in global health. We have met that goal and then some, with our expanding and innovative global health program. This issue includes two articles focusing on international public health activities undertaken by our faculty and students, including a look at the newest additions to our impressive group of global health-oriented faculty (see the articles on pages 6 and 18). As we face our own difficult challenges in these tough economic times, we do so knowing several important things. Our students are among the best and brightest, our faculty is world-class, and our alumni and friends are among the most generous. Efforts to recruit top-notch students remain a high priority; we look to all of you to help us ensure that if a talented student wishes to pursue a career in public health, we make it a reality.
2008-2009 DEAN’S A DV I S O RY B OA R D Ira R. Alpert * Lester Breslow Sanford R. Climan Edward A. Dauer Michele DiLorenzo (Chair) Robert J. Drabkin Gerald Factor (Vice Chair) Jonathan Fielding Michael R. Gardner Dean Hansell Alan Hopkins * Cindy Harrell Horn Stephen W. Kahane * Carolyn Katzin * Carolbeth Korn * Jacqueline B. Kosecoff Kenneth E. Lee * Richard D. Lipeles * Edward J. O’Neill * Monica Salinas Fred W. Wasserman * Pamela K. Wasserman * Cynthia Sikes Yorkin
*SPH Alumni
Linda Rosenstock, M.D., M.P.H. Dean
S AV E T H E D AT E UCLA SCHOOL OF PUBLIC HEALTH
ALUMNI AND FRIENDS RECEPTION
MONDAY, NOVEMBER 9, 2009 6:30 – 8:00 p.m. Philadelphia Marriott, Room: Franklin 6
Check the APHA schedule or stop by the UCLA School of Public Health booth for location information.
UCLAPUBLIC HEALTH
During the Annual Meeting of the American Public Health Association, November 7-11, in Philadelphia
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alumni hall of fame: the 2009 inductees The UCLA School of Public Health Alumni Hall of Fame was established in 2002 to honor alumni with outstanding career accomplishments in public health, as well as those who have volunteered time and talent in their communities in support of public health activities. The 2009 inductees, recognized at the Breslow Lecture and Dinner on April 16, exemplify the school’s commitment to teaching, research and service. This year’s inductees were honored in two categories: Lester Breslow Lifetime Achievement and Young Alumni Achievement.
UCLAPUBLIC HEALTH
LESTER BRESLOW LIFETIME ACHIEVEMENT ROD LEW, M.P.H. ’88 Since graduating with a degree from the school’s Department of Community Health Sciences, Lew has spent more than 20 years working to eliminate health disparities, with a focus on Asian American and Pacific Islander communities. The term “Asian American” includes 68 nationalities; despite being the fastest-growing ethnic group in the United States, Asian Americans are among the most overlooked and underserved. Lew has devoted his career to changing that. He is founder and executive director of the Asian and Pacific Islander Partnership for Education, Advocacy and Leadership (APPEAL), an organization addressing health justice issues for Asian Americans, Native Hawaiians and Pacific Islanders. Prior to APPEAL, Lew was the health education director at Asian Health Services. He was a contributing author on the 1998 Surgeon General’s Report on Tobacco Use and was the 2002 recipient of the Christopher Jenkins Cancer Control Award.
YOUNG ALUMNI ACHIEVEMENT MANAL ABOELATA, M.P.H. ’01 As program director at Prevention Institute, a national nonprofit organization dedicated to achieving equitable health and safety outcomes through primary prevention, Aboelata promotes policy and community-based approaches to improving access to healthy foods, preventing injuries and increasing opportunities for physical activity. She coordinates the Strategic Alliance for Healthy Eating and Activity Environments, a statewide network of advocates working to bring healthy food and physical activity opportunities within the reach of all Californians. Prior to joining Prevention Institute, Aboelata worked in the Department of Family Medicine at UCLA as research manager of the Violence Prevention Program. She is currently a lecturer at UCLA Extension’s Health Education for Teachers, offering courses in school-based injury prevention and sexually transmitted disease prevention.
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hall of fame
PREVIOUS INDUCTEES
Please access information on 2010 nominations at www.ph.ucla.edu/alumni_hall.html or call (310) 825-6464.
UCLAPUBLIC HEALTH
NICOLE MONASTERSKY MADERAS, M.P.H. ’03 At Pharmacy Access Partnership, a center of the nonprofit Pacific Institute for Women’s Health, Maderas has made noteworthy accomplishments in expanding access to vital reproductive health services in California through private pharmacies. As a program administrator, Maderas has been at the forefront of providing educational opportunities to pharmacists about the clinical and psychosocial aspects of women’s health while also conducting research on consumers’ and health care professionals’ opinions about contraceptive access. She has developed a collaborative group of partner organizations – regional and national – that is seeking changes in laws and regulations to improve access to birth control products. She also conducts outreach to community-based organizations, informing women and men that pharmacists are available to help meet their reproductive health needs. Maderas introduced and now manages a program to enhance pharmacy services in the Latino community, and is creating a new initiative to promote pharmacy environments that meet the needs of adolescents.
Ira R. Alpert, M.S.P.H. ’66 Wendy Arnold, M.P.H. ’82 Stanley P. Azen, Ph.D. ’69 Donna Bell Sanders, M.P.H. ’81 Diana M. Bontá, R.N., M.P.H. ’75, Dr.P.H. ’92 Linda Burhansstipanov, Dr.P.H. ’74, M.P.H. ’72 Virginia A. Clark, Ph.D. ’63 Francine M. Coeytaux, M.P.H. ’82 Suzanne E. Dandoy, M.D., M.P.H. ’63 Paula Diehr, M.S. ’67, Ph.D. ’70 Betsy Foxman, M.S.P.H. ’80, Ph.D. ’83 Mark Gold, D.Env. ’94 Harold M. Goldstein, M.S.P.H. ’89, Dr.P.H. ’97 Raymond D. Goodman, M.D., M.P.H. ’72 Richard A. Goodman, M.D., J.D., M.P.H. ’83 Nancy Halpern Ibrahim, M.P.H. ’93 Carolyn F. Katzin, M.S.P.H. ’88, C.N.S. Robert J. Kim-Farley, M.D., M.P.H. ’75 Kenneth W. Kizer, M.D., M.P.H. ’76 James W. LeDuc, M.S.P.H. ’72, Ph.D. ’77 Stanley Lemeshow, Ph.D. ’76 Angela E. Oh, J.D., M.P.H. ’81 Jean Le Cerf Richardson, M.P.H. ’71, Dr.P.H. ’80 Keith S. Richman, M.D., M.P.H. ’83 Pauline M. Vaillancourt Rosenau, Ph.D., M.P.H. ’92 Jessie L. Sherrod, M.D., M.P.H. ’80 Irwin J. Shorr, M.P.H. ’72, M.P.S. Stephen M. Shortell, M.P.H. ’68, Ph.D. Shiing-Jer Twu, M.D., M.P.H., Ph.D. ’91 Barry R. Wallerstein, D.Env ’88 Kenneth B. Wells, M.D., M.P.H. ’80 Zunyou Wu, M.D., M.P.H. ’92, Ph.D. ’95 Michele Yehieli, M.P.H. ’89, Dr.P.H. ’95 Linda M. Yu Bien, M.S.P.H. ’79
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6 FACED
WITH
CALAMITIES THAT CARRY FAR REACHING PUBLIC HEALTH IMPACTS , NATIONS HAVE BENEFITED FROM THE SCHOOL ’ S EXPERTISE .
CRISIS RESPONSE: Faculty Travel Abroad to Assist After Disasters When a 7.9-magnitude earthquake struck China’s Sichuan Province on May 12, 2008, killing more than 70,000 people,
“Disasters don’t stop at the ambulance or the hospital front door. If we want to make a difference in the health of the larger population after a disaster, we have to think well beyond the acute stages of the event.” UCLAPUBLIC HEALTH
— Dr. Steven Rottman
injuring several hundred thousand more and leaving nearly 5 million without their homes, Dr. Roger Detels organized a multidisciplinary campus group of experts interested in offering assistance. At the invitation of Chinese public health authorities, the group – which included Chancellor Gene Block as well as Detels’ School of Public Health faculty colleague, Dr. Zuo-Feng Zhang – traveled to China to offer its expertise and advice for confronting the long-term public health effects of the tragedy. After an 8.0-magnitude quake hit the central coast of Peru on August 15, 2007, killing more than 500 people and destroying 40,000 homes, two members of the school’s Center for Public Health and Disasters, Drs. Kimberley Shoaf and Alina Dorian, along with an engineering colleague, went to the site on behalf of the Earthquake Engineering Research Institute to learn from the disaster and consult with health officials. Following the December 2004 tsunami off the northwestern coast of Sumatra, Indonesia that killed more than 225,000 people in 11 countries and left tens of thousands of families displaced, another member of the Center for Public Health and Disasters, Dr. Merritt Schreiber, provided technical assistance
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The disaster in Sichuan Province came a time when UCLA’s chancellor was already scheduled to travel to China on other business. “Once the earthquake occurred, it was felt that it wouldn’t be appropriate for the chancellor to go without offering some sort of assistance,” Detels says. After discussions
with campus administrators and other faculty, Detels proposed to coordinate a joint workshop on longterm planning for recovery from the Sichuan quake, to be held at the China Centers for Disease Control and include participants from that agency as well as experts from relevant disciplines at UCLA. The workshop was held five weeks after the disaster and included 15 leaders from the China CDC as well as a delegation of eight from UCLA. In addition to the chancellor, that included Drs. Nicholas Entrikin, provost for international studies; Ren Sun, associate dean in the David Geffen School of Medicine at UCLA; Robert Pynoos, professor of psychiatry and an expert in psychological recovery from disasters; Jian Zhang, professor of engineering and an expert in structural engineering; Peter Rossi, professor of neurology and an expert in acute neurological damage; and UCLA School of Public Health professors Detels and Zhang, both of whom are epidemiologists with extensive contacts in China. “This provided an opportunity for people who were on the ground involved in the response to have a discussion with individuals who have a lot of experience in relevant areas,” Detels says. “When the earthquake occurs, it’s easy to become so consumed in the immediate issues that you don’t have a chance to think about getting in place the long-term recovery. This was a chance for them to pause and consider how what they were doing could be translated into an effective long-term response.” For the UCLA School of Public Health experts, responding to international disasters provides both an opportunity to assist and a chance to draw lessons that can be applied at home and in other countries. After the earthquake in Peru, Shoaf and Dorian spent a week at the disaster site learning about the characteristics of the injuries that occurred,
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to authorities in Indonesia and Thailand to help equip the countries for the monumental task of handling the mental health problems resulting from the disaster, particularly among children. These are among the most recent examples of the involvement by members of the school’s faculty when other countries are faced with disasters that have far-reaching public health impacts. The school’s efforts aren’t limited to the immediate response. Since the mid-1990s, Dorian has played an integral ongoing role in shaping the emergency public health infrastructure in Armenia. Through the UCLA/Fogarty AIDS International Training and Research Program, Detels has mentored many international graduate students who have gone on to play leading roles in their countries’ responses to disasters such as the tsunami and the Sichuan Province earthquake, in many cases consulting with Detels during the immediate post-disaster period and beyond. Dr. Steven Rottman, professor in the school and director of the UCLA Center for Public Health and Disasters, has been instrumental in working with the World Association of Disaster and Emergency Medicine for the last two decades to incorporate public health principles into the mission of the organization, which promotes international collaboration and improved disaster preparedness and response. “Disasters don’t stop at the ambulance or the hospital front door,” says Rottman. “If we want to make a difference in the health of the larger population after a disaster, we have to think well beyond the acute stages.”
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OPPOSITE PAGE: An earthquake victim rests outside her tent in Ying Xiu, Sichuan Province, China, more than three weeks after a 7.9magnitude earthquake killed more than 70,000 people and left nearly 5 million without homes. BELOW: After the quake, Dr. Roger Detels (fifth from right) coordinated a joint workshop on long-term planning for recovery involving experts from UCLA and the China Centers for Disease Control. Chancellor Gene Block (center) and, from the school’s faculty, Dr. ZuoFeng Zhang (fourth from left) were among the participants.
UCLAPUBLIC HEALTH
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ABOVE LEFT: After an 8.0-
magnitude earthquake devastated the central coast of Peru in August 2007, a man sits next to his destroyed house in Caneta, approximately 75 miles south of Lima. ABOVE RIGHT: A woman
UCLAPUBLIC HEALTH
prepares food in a refugee camp for the Peru quake’s victims. More than 40,000 homes were destroyed.
identifying building designs associated with injuries and studying how response practices played a role in the injury patterns. “Deaths are almost always associated with the collapse of heavy-framed buildings,” says Shoaf, an associate director at the Center for Public Health and Disasters, “but injuries are quite variable, and we are still trying to determine those patterns so that we can take steps to prevent them.” Shoaf’s group also visited camps that had been set up for displaced populations in an effort to learn more about the second wave of health problems after such a disaster, including the spread of infectious diseases and problems related to poor sanitation and lack of clean water. “As in all events, there was great variation in where relief efforts got to from the government – and yet, there were places that had incredible responses from within the community,” Shoaf says. “We learned that having a wellorganized community with existing communitydevelopment structures translated very well to coming together after a disaster.” Two members of the school’s faculty have had extensive involvement in disaster preparedness and response in Armenia. Dr. Haroutune K. Armenian, professor of epidemiology, has conducted pioneering research on the long-term effects of the 1988 Armenia earthquake that killed more than 25,000 (see page 19). Dorian has worked in Armenia since 1994, mostly in the disputed region of NagornoKarabakh. After a bloody six-year war ended in 1994 with a cease-fire, the governments of Armenia and Azerbaijan began holding talks on the fate of Nagorno-Karabakh that have yet to be resolved. Nagorno-Karabakh functions as its own republic,
although it is not internationally recognized – making efforts to obtain assistance difficult. Starting just before the ceasefire began, Dorian worked with the refugee population and with the ministry of health in developing a public health infrastructure for the war-torn area, virtually from scratch. She wrote the region’s national health plan in 1996 and, the same year, successfully appealed to the U.S. government for assistance in the form of a grant from the U.S. Agency for International Development. With that funding for the last decadeplus, Dorian has led efforts that have included assessing population health needs and building the resources necessary to maintain a public health, primary care and emergency infrastructure. “I’ve tried to expand the definition of emergency public health so that it’s more of a continuum from immediate response leading into sustainable development programs,” says Dorian. “It’s not just a matter of a disaster happening and then two weeks later it’s over. There are always long-term health effects, both physical and mental, and an entire system that has been shaken up and needs rebuilding. Other diseases and chronic conditions don’t stop during the disaster. Pregnancies, deliveries and child development don’t stop. That’s why the planning has to be integrated, to make the community more resilient.” Schreiber was also called on to help put in place a system for tackling longer-term effects of a disaster – in this case a system of early identification and intervention for mental health problems following the tsunami. As a reserve in the U.S. Public Health Service, Schreiber, a clinical psychologist, was initially asked to work with the Centers for Disease Control and Prevention’s Emergency Operations
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Center in Atlanta to provide psychosocial support to the deployed CDC staff. When the Thailand Ministry of Health requested assistance from the U.S. government in handling the country’s mental health needs resulting from the disaster, the CDC asked Schreiber to provide technical support in collecting data pertaining to children. Schreiber employed a mental health triage instrument he had previously developed, PsySTART, to obtain results that were acted on by the Thai health officials. Based on that experience, PsySTART has been adopted by the American Red Cross, as well as by the Los Angeles County Department of Health Services and the 14 Level I trauma centers that comprise the county’s Disaster Resource Center network of hospitals. “The mortality from this disaster was so high that mental health was a substantial public health challenge, requiring us to move beyond individual clinical models to address the population-level consequences of such a large event on mental health,” Schreiber says. “Using a population approach is a new frontier for disaster mental health that is very important because if we think about the potential for a pandemic, a major earthquake or an act of terrorism, so many people could be affected that we would need to rethink how we deliver disaster mental health services.”
ABOVE RIGHT: A woman walks down a deserted street in Nagorno-Karabakh, a disputed region of Armenia where Dr. Alina Dorian of the school’s Center for Public Health and Disasters helped develop a public health and emergency infrastructure following a bloody six-year war.
“We learned that having a well-organized community with existing community-development structures translated very well to coming together after a disaster.” — Dr. Kimberley Shoaf UCLAPUBLIC HEALTH
When the World Association for Disaster and Emergency Medicine was established in 1976, the focus was on the more immediate resuscitation efforts; with Rottman’s assistance, the organization has shifted the paradigm. “There is a much greater recognition that large-scale disasters are public health problems,” says Rottman. “In addition to the direct effects from the hazard, there are secondary implications that go far beyond the first phase of the response.” Faculty at the Center for Public Health and Disasters and elsewhere in the school can serve a valuable purpose in assisting other countries with post-disaster assessment and working with international health departments to craft plans for dealing with day-to-day health issues that arise in the disaster’s aftermath, Rottman says. “We can help them not only to plan for their everyday health responses, but also to build something that is scalable so that they have the resources to respond to the next large event,” he explains. “It’s the same model we’ve been using with health departments all over the United States. It has to be done within the context of a different language, culture, set of resources and system of health-care delivery, but the principles are universal.”
ABOVE LEFT: A house in Banda Aceh, Indonesia, destroyed by the December 2004 tsunami off the northwestern Indonesian coast, in which more than 225,000 people in 11 countries were killed and tens of thousands of families were displaced.
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10 T HE U.S. RANKS NEAR THE BOTTOM AMONG DEVELOPED COUNTRIES ON MANY MEASURES , AND RACIAL / ETHNIC DISPARITIES IN PREGNANCY OUT COMES PERSIST.
T HE
OBSTETRICIAN /
GYNECOLOGIST AND PUBLIC HEALTH RESEARCHER PROMOTES A BROADER AGENDA .
Michael C. Lu:
Redefining Maternal and Child Health
Much has been said about the importance of prenatal care in reducing the risk of health problems for both the mother and infant. Dr. Michael C. Lu believes that’s framing the issue too narrowly. “Increasingly, we’re learning that by the time a woman becomes pregnant, she may have already missed a critical window of opportunity to give her baby the best start in life,” says Lu, an associate professor in both the UCLA School of Public Health and the David Geffen School of Medicine at
UCLAPUBLIC HEALTH
UCLA, who maintains an obstetrics/gynecology practice along with his active research and teaching efforts. In his book Get Ready to Get Pregnant: Your Complete Prepregnancy Guide to Making a Smart and Healthy Baby, Lu provides tips on foods to eat and those to avoid, along with strategies to build stress resilience, give the immune system a “tune-up,” and detoxify one’s environment. “Most women know you should quit smoking and take 400 micrograms of folic acid daily before pregnancy,” he explains. “But there is a growing body of science indicating that there is much more they can do to get ready, and even many doctors don’t know about that.” Preconception health is only one part of what Lu believes should be an even broader agenda. Among developed countries, Lu notes, the United States ranks near the bottom in maternal mortality, in many of the causes of infant mortality and in other conditions that affect infant and child health, from overweight and obesity to early-onset type 2 diabetes. Moreover, Lu and others have hypothesized that many of the seeds of our future health and function – including long-term chronic conditions such as hypertension and heart disease – are planted inside the womb. Particularly troubling to Lu – and the focus of much of his research – are racial and ethnic disparities in pregnancy outcomes. Black infants die at more than twice the rate of white infants in the United States, and
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Clinic continues to operate, having served tens of thousands of homeless and indigent individuals and, just as important to Lu, engaging graduate and undergraduate students in the process. “My hope is that it really changes students’ hearts and minds about what healthcare professionals and people in public health can do to make a difference,” Lu says. When he chose obstetrics/gynecology as his specialty, he figured he would be a champion for prenatal care. But Lu says his public health grounding led him to question whether focusing on prenatal care was enough to make a difference in improving the health of mothers and infants at the population level. “Not to discount the importance of prenatal care, but I think we can do better,” says Lu, voted one of the Best Doctors in America since 2005. Lu is currently involved in several large studies that he hopes will shed light on strategies for improving maternal and child health and eliminating disparities. He is a lead investigator in Los Angeles County for the congressionally funded National Children’s Study, which will follow a representative sample of 100,000 children from before birth to age 21 in an effort to better understand the causes and identify prevention strategies for major childhood disorders such as autism, obesity, diabetes and asthma. He is the principal investigator of the Los Angeles Mommy and Baby Survey, a joint effort between UCLA and the Los Angeles County Department of Public Health to conduct a detailed survey of the determinants of birth outcomes in the county, including potential community-level effects. He leads one of five sites in the National Institutes of Health-funded Community Child Health Network, which is taking a community-based participatory research approach to studying the causes of maternal and child health disparities. And he heads the Maternal Quality Indicators project, a collaboration among UCLA, several other institutions and the California Department of Public Health to develop a statewide system for monitoring and improving the quality and safety of maternity in California. If his parents get much of the credit for Lu’s drive to make a difference in the lives of large numbers of people through public health, having two children of his own – daughters Sasha and Avery, now 6 and 3 – made the goal that much more personal. “When my wife and I were considering pregnancy, it made me start to think harder about what I can do as a father to ensure the best start for my children,” Lu says. “Every day, my girls inspire me to do my best on behalf of maternal and child health.”
“We have to do much more — not just in healthcare but also in policy — to create conditions in which all mothers and babies can be healthy.” —Dr. Michael C. Lu
UCLAPUBLIC HEALTH
Since childhood, Lu has wanted to be a physician – but one who, beyond seeing patients, would through research and policy address broader health and social justice issues affecting the population. His determination to make an impact on the lives of society’s less fortunate members is rooted in his upbringing. Lu was born in Taiwan to parents who weren’t afforded the opportunity to attend college – his mother never got past fifth grade, dropping out to support her family through factory work after her father died. “My parents worked hard to put food on the table and still managed to get their four children through college,” Lu says. “They taught me about making a difference in the world.” With ambitions in both medicine and public health, he graduated from Stanford and enrolled in the M.D./M.P.H. program offered jointly by UC Berkeley and UC San Francisco. In 1990, while still in graduate school, Lu and several other medical students established the Suitcase Clinic, taking their medical equipment to homeless people in the community and offering to provide care for them, under faculty supervision. In launching the clinic, Lu and others quickly learned a lesson in public health: “We realized that the homeless population faced a constellation of problems, of which healthcare might not be the highest priority,” Lu recalls. So his group expanded the model, bringing in students and faculty from the law school to provide legal counseling; from the psychology department to provide crisis intervention services; and from the optometry school to provide vision care. Other volunteers were brought in, from chiropractors to beauticians. Nearly two decades later, the Suitcase
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have much higher rates of low birthweight and preterm birth. The disparities persist even when taking into account differences in income and education, in risk behaviors such as smoking, and in prenatal care. Possible genetic explanations are being studied but are unlikely to fully explain these disparities, Lu says. With his School of Public Health colleague Dr. Neal Halfon, director of the Center for Healthier Children, Families and Communities, Lu has written about the need to change the paradigm and begin embracing a life-course perspective. “For decades we have searched for risk factors during those nine months of pregnancy to explain the disparities, but we can’t expect prenatal care to eliminate all of the disadvantages and inequities that accumulate over the life course,” Lu says. “We have to do much more – not just in healthcare but also in policy – to create conditions in which all mothers and babies can be healthy.”
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12 L OST
HEALTH
INSURANCE .
R ISING
RATES OF
DEPRESSION AND STRESS . DIETS .
P OOR
I NCREASED
VIOLENCE AND ABUSE .
G ROWING
STRAIN ON FREE CLINICS .
T HE
POTENTIAL FALL OUT FROM A DOWNTURN PRES ENTS A MAJOR CHALLENGE FOR PUBLIC HEALTH .
Health Hazards in Economic Hard times
Since last September, barely a day goes by that isn’t dominated by news of our economic woes. As the nation grapples with what many believe to be the worst economic crisis since the Great Depression, most of the focus has been on efforts to revive the health of the economy. But how is the faltering economy affecting the health of the population? Hard times can take their toll in a number of ways,
UCLAPUBLIC HEALTH
UCLA School of Public Health faculty experts say. Perhaps the most obvious and direct effect of an economy in which several hundred thousand people are losing their jobs each month is that, since the vast majority of Americans have employment-based insurance, losing one’s job jeopardizes health coverage. Through COBRA, the federal government requires most employers with group health plans to continue offering terminated employees the same coverage that was previously available for up to 18 months. But the cost is often prohibitive. “The vast majority of employers at large companies make substantial contributions to their employees’ health insurance – on average, around 75 percent of the premium,” says Dr. Gerald Kominski, professor and associate director of the UCLA Center for Health Policy Research. “However, it’s extremely rare for a company to continue to pay health insurance benefits for someone who has been laid off. So, on average, people who are unemployed are being asked to pay more than $1,000 a month for a family – at a time when they have lost their source of income.” Finding a better alternative on the individual market is next to impossible, Kominski notes. Thus, given the expense, many unemployed people simply choose to remain uninsured and hope they can quickly find a job that will give them a generous policy similar to what they previously had. During the time that they are not covered, they are likely to forgo essential healthcare services.
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“On average, people who are unemployed are being asked to pay more than $1,000 a month for a family — at a time when they have lost their source of income.” — Dr. Gerald Kominski
UCLAPUBLIC HEALTH
The problem isn’t limited to the uninsured. “There are many people who are underinsured, and face large deductibles or copayments that reduce their use of preventive and other services,” notes Dr. Jonathan Fielding, professor at the school and director of public health for Los Angeles County. “There have been several reports of people using fewer preventive services, which means that they’re more likely to have serious problems down the line, whether it’s because they didn’t get mammography screening, they’re not taking their medications, or
The economy’s effects on health have numerous manifestations. Dr. Wendelin Slusser, assistant professor in the school, recently found it much more difficult to recruit for a study that required parents of preschool children to attend a once-a-week class for six weeks. “So many people are distracted by higher priorities such as making sure there is food on the table,” she says. On the other hand, she and her colleagues are finding it easier to recruit for studies on stress and depression. At the Venice Family Clinic, the free clinic where Slusser, a pediatrician, helped to create the health and wellness programs, there has been a 30 percent increase in new-patient calls since January, says Liz Forer, the clinic’s executive director. “People are saying, ‘I’m unemployed, don’t have health insurance, and I am not sure how to do this because I’ve never come to a place like the Venice Family Clinic before,’ ” Forer says. Unable to handle all of the growing volume, the clinic for the first time in more than a decade is restricting new patients to those within its primary geographic catchment area (which covers the entire Westside of Los Angeles) and is referring people outside the area to clinics closer to where they live. In talking with her colleagues at other free clinics in Los Angeles County, Forer is hearing similar stories of increased traffic.
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they’re not checking to see if their diabetes or blood pressure is well controlled.” At a time when addressing disparities in health status and access among certain segments of the population is a major focus in public health, the current economic climate threatens to widen existing gaps in health status and disease burden. “Socioeconomic status is consistently among the most important factors driving the disparities and it’s people on the low end of the socioeconomic status who are least likely to have a stable source of health insurance and the most likely to be hard-hit during these times,” says Dr. Roshan Bastani, professor and co-director of the Center to Eliminate Health Disparities. Often, Bastani says, activities that public health professionals consider critical – including cancer screening, preventive services, healthy eating and physical activity – are neglected as people who are struggling focus on their immediate needs: basic food, clothing and shelter.
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“‘Kids feel it. Family environments can become less nurturing, and at the extremes, we see higher rates of neglect and reports to Child Protective Services. It’s surprising how many new people are seeking support and resources but finding out they aren’t eligible.”
UCLAPUBLIC HEALTH
— Dr. Neal Halfon
Slusser says the clinic’s Simms-Mann Health and Wellness Center has experienced a 15-20 percent increase since last July in the number of pediatric visits. “Every day we are seeing a patient who used to have private health insurance and is now at our clinic because of the loss of a job,” she says. The center’s staff is struggling to meet not only the increased volume, but the greater complexity of patient problems. “We have families who are losing their homes,” Slusser notes. “We are working hard to support them in ways that go beyond meeting their medical needs.” The impact of economic hard times on children is significant, as families become more stressed and mental health issues that were dormant in better times begin to manifest, says Dr. Neal Halfon, professor and director of the Center for Healthier Children, Families and Communities. “Kids feel it,” says Halfon. “Family environments can become less nurturing, and at the extremes, we see higher rates of neglect and reports to Child Protective Services.” At one child health facility affiliated with the center, Halfon notes, assessments have shown a steep increase in family stress measures. In many cases, middle-class families experiencing severe financial problems for the first time are learning to their chagrin that they don’t qualify for safety-net services. “It’s surprising how many new people are seeking support and resources but finding out they aren’t eligible,” Halfon says.
Halfon has been a leading voice on behalf of the need to put into place more coordinated and integrated services for children – linking medical care with childcare and children’s mental health providers, for example. In the economic downturn, resourcestrapped organizations often find these collaborative efforts difficult to maintain; as a result, Halfon says, he and his colleagues have been fighting to prevent important recent gains from being set aside. Among adults, mental health is a significant concern in hard economic times. Studies have long shown a rise in suicide in economic downturns, but these are just the tip of the iceberg of broader psychosocial distresses. Dr. Carol Aneshensel, professor at the school, notes that even in normal times, the prevalence of major depression is high: 6.6 percent of the adult population in a 12-month period, which translates to nearly 14 million people. “We know from previous economic downturns that levels of depression go up,” Aneshensel says, “and because this is a recurrent chronic disease, we’re seeing not only new cases, but also people who have had prior episodes of depression relapsing.” Unemployment is a major life stressor, Aneshensel notes, and its impact tends to persist even after the individual gets a new job. But it’s not only the individuals losing their jobs who feel the stress. There is a spillover to other family members: Individuals are more likely to become depressed if a spouse loses a job, for example. The “worried employed” – those who are afraid of losing their job – are also at increased depression risk. In addition, people who
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cover story “A lot of people are facing a triple whammy. They are in an environment in which there is a lot of economic uncertainty. They themselves may be out of work. And they are facing increasing financial strain. All of these are dangerous for their mental health.” — Dr. Frederick Zimmerman
UCLAPUBLIC HEALTH
have jobs may find them more stressful in these times. “When the labor market is tight, employers can pose more demands on workers,” Aneshensel says. “They can increase the workload or impose a pay cut, and the employees are less likely to have the option of finding another job.” Aneshensel has also conducted research in which she found that financial strain alone – separate from the issue of employment – is strongly associated with increased depression risk. “You have this cascading fallout in which financial strain brings the threat of home foreclosure and strains relationships among spouses, which can lead to separations and divorces,” Aneshensel notes, “and these strains are likely to accumulate and add to emotional problems.” “A lot of people are facing a ‘triple whammy,’ ” says Dr. Frederick Zimmerman, an associate professor at the school. “They are in an environment in which there is a lot of economic uncertainty. They themselves may be out of work. And they are facing increasing financial strain. All of these are dangerous for their mental health.” Using a national data set of approximately 3,000 people, Zimmerman has found that both unemployment and the threat of losing a job are major risk factors both for people already at risk or experiencing depression and for those who have more mild symptoms. But he has also found that financial strain – as measured by ratio of debts to assets – is an even better predictor of depression than income and job status. “To the extent that people can protect themselves by making sure they have a financial cushion for these hard times, they are likely to be better off from a mental health standpoint,” Zimmerman says. He has also found that men in jobs that involve conflict – whether they’re constantly denying people benefits or dealing with a hostile boss – are more vulnerable to symptoms of depression. Although depression awareness has grown in recent years, there is still a need for much more public education about symptoms and the importance of treatment, Aneshensel says, adding that awareness campaigns should also target health care providers. Only about half of people who have a clinical diagnosis of depression get treatment, most commonly from their primary care provider. Zimmerman notes that particularly in hard economic times, providers can play an important role by asking patients about whether they are under financial stress – and directing them to the appropriate resources if they are.
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“People’s lives become more uncertain, and they become more concerned with looking for a job. Time becomes an issue, and lack of time tends to be the factor that people say prevents them from being physically active.”
UCLAPUBLIC HEALTH
— Dr. Michael Prelip
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Given studies suggesting that in stressful situations people are more likely to revert to unhealthy behaviors, Fielding is concerned that the economic downturn may lead to an uptick in the use of tobacco, alcohol and illicit drugs, as well as exacerbating what he says is the county’s most serious epidemic: that of overweight and obesity. Food insecurity is on the rise, Fielding notes – the number of people on food stamps is going up and food banks are being overwhelmed. As families struggle with limited budgets, they often look toward items that provide the most calories per dollar – including chips and sodas, which disproportionately contribute to overweight and obesity. “It’s going to make our efforts to reverse this epidemic more difficult,” Fielding says. In addition to stress, practical barriers often get in the way of healthy lifestyles. “People’s lives become more uncertain, and they become more concerned with looking for a job and taking on tasks that they might otherwise outsource to others,” says Dr. Michael Prelip, associate professor at the school. “Time becomes an issue, and lack of time tends to be the factor that people say prevents them from being physically active.” Poor eating habits often return when people are struggling economically because of the perception that a healthier diet is more expensive – although that doesn’t have to be the case, Prelip notes. But when people are stressed, he adds, dinner at a fast-food restaurant may seem like an easier choice than preparing a balanced meal, even if the cost is similar. Anyone working with people on behavior modification – whether it’s for a program of weight management, stress management or exercise, or it’s an individual clinician or mental health professional – should address the issue of vulnerability to relapse during hard times and devise strategies for maintaining the behavioral change, Prelip says. From an environmental health perspective, the current crisis presents opportunities as well as perils, says Dr. Richard Jackson, professor and chair of the Department of Environmental Health Sciences. He argues that today’s most profound environmental threats relate to fossil fuel use and excessive consumption of resources. “We’ve made larger our bodies, our cars, our housing, and our footprint upon the landscape, and we’re paying the price in our economy, our environment and our physical and mental health,” Jackson says. The economic downturn could actually result in short-term environmental benefits – through reductions in automobile usage and port traffic, for example. But Jackson fears that unless the economic challenges are used to change existing patterns, society will continue down a dangerous path. “Just as we built this
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financial house of cards that ultimately collapsed, we have also been building an environmental-health house of cards,” he says. “As a result of our addiction to fossil fuels, we are looking at major loss of life because of climate change and the destruction of our atmosphere. Now that we have a chance to rethink how we spend our money, we should remember that the economic solutions ought to make people and our environment healthier.” Jackson says he has been disappointed to see the bulk of the federal economic stimulus funding going to “short-term fixes and construction that will further abet our addiction to automobiles and gasoline” rather than to mass transit systems and other initiatives that would reduce pollution, encourage walking, and improve quality of life.
– Dr. Wendelin Slusser
UCLAPUBLIC HEALTH
Fielding notes that youth invariably have the highest unemployment rates. “Although we don’t have the data yet, it wouldn’t be surprising to find that that contributes to increases in violence and crime,” he says. “We know, particularly, that young men feeling hopeless and having nothing to do is not a prescription for success.” Studies have also found that both domestic violence and child abuse increase in economic hard times, notes Billie Weiss, associate director of the Southern California Injury Prevention Research Center at the school. Many factors are likely to be involved. “Part of it is the increased anxiety – people being frightened,” says Weiss, former director of the L.A. County Department of Health Services Injury and Violence Prevention Program. “There is also some evidence of a rise during these periods in alcohol consumption, which increases the risk of violence.”
Weiss explains that economic downturns tend to result in more disorganized communities and that regardless of economic conditions, disorganized communities have higher rates of reported domestic or intimate partner violence and child abuse, as well as homicide. She notes that public health professionals should be educating at-risk populations about what preventive and intervention services they can access, potential domestic violence victims should be encouraged to have a safety plan, and pediatricians should be on the lookout for injuries to children that are not consistent with the explanations being offered. But at a time when the social services agencies set up to handle the problem of violence are in the most need of funding, they are feeling the pinch of the economic downturn. “It builds to a perfect storm, and it can be hard to know which comes first – the decreased availability of services or the violent behavior,” says Weiss. It’s a story that’s all too familiar to most everyone involved in efforts to address the health problems created by the financial crisis: At a time when public health is needed the most, the same economic downturn that is contributing to the problems is also resulting in cutbacks that are leaving public health departments and community-based organizations strapped for resources. On the other hand, Jackson, the former public health officer for California, points to one positive outcome. “We are seeing a shift in our youth toward a vision of service,” he says. “Public health is one of the most gratifying and positive service opportunities one can pursue, and a potential result of this crisis is that we will see a cadre of bright young people coming into the profession.”
“Every day we are seeing a patient who used to have private health insurance and is now at [the free Venice Family Clinic] because of the loss of a job. We have families who are losing their homes. We are working hard to support them in ways that go beyond meeting their medical needs.”
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STRATEGIC GOAL OF ENHANCING THE GLOBAL
HEALTH PROGRAM HAS GAINED MOMENTUM WITH FIVE ADDITIONS IN LESS THAN TWO YEARS .
A
NEW
GLOBAL HEALTH CERTIFICATE PRO GRAM ATTRACTS STUDENTS .
Newest Faculty Recruits Enhance School’s Overseas Presence Collectively, they bring experience from Africa, Europe, Latin America, the Middle East, and Asia. They employ different public health disciplines to address wide-ranging topics, sharing a single thread – each is interested in issues of global health.
“They bring not just new experience but new data, new methodologies and a whole new set of contacts on the global scene. They are a great asset to our global health program.”
UCLAPUBLIC HEALTH
—Dr. Jørn Olsen
In less than two years, the UCLA School of Public Health has gained five new faculty members who focus on international concerns, the majority of them having been born and spent most of their lives in other countries. They have added valuable new perspectives to a school that had already taken major steps toward fulfilling its strategic goal of building a world-class global health program. The school’s Center for Global and Immigrant Health, which has become a focal point for the growing cadre of global health faculty, now offers a lunchtime lecture series as well as a Certificate in Global Health to students who fulfill certain academic requirements and complete an international experience (see the sidebar on page 20). “We are helping to address health problems in developing countries by providing technology and insight through our research, as well as by educating students who will work in these countries and students from abroad who come here to be trained before returning home to work,” says Dr. Jørn Olsen, professor and chair of the school’s Department of Epidemiology and himself a transplant from Denmark, where he continues to head the Danish Epidemiology Science Centre. As for the five new faculty, Olsen adds: “They bring not just new experience but new data, new methodologies and a whole new set of contacts on the global scene. They are a great asset to our global health program.”
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Haroutune K. Armenian States for assistance. Armenian, then at Johns Hopkins, worked with the country’s ministry of health to develop a cohort of approximately 35,000 survivors whose experiences were followed for four years. Armenian, who has also been a leader in developing mathematical models to identify incubation and latency periods for chronic diseases including cancer, describes himself as “first and foremost an educator.” After receiving his M.D. from the American University of Beirut and his M.P.H. and Dr.P.H. from Johns Hopkins, he was a faculty member at the American University of Beirut, where he started the region’s first M.S. in Epidemiology program and developed family health education programs throughout the Middle East. He went on to direct the M.P.H. program at Johns Hopkins, and developed an M.P.H. program at the American University of Armenia. He is currently investigating the role of dignity and self-esteem in health, and is planning a 20-year follow-up of the Armenian earthquake survivors.
“My research has always been related to the situations I’ve been in.” Dr. Haroutune K. Armenian
UCLAPUBLIC HEALTH
Dr. Haroutune K. Armenian came to the school last year, having already built a long and impressive résumé as an educator and pioneer in public health research on the long-term effects of civil war and natural disasters. The president of the American University of Armenia and former professor at Johns Hopkins University School of Hygiene and Public Health, Armenian was among the first to apply epidemiologic methods to study a civil war’s impact – specifically the internal strife that took place in Lebanon. “My research has always been related to the situations I’ve been in,” Armenian explains. He was dean of the health sciences faculty at the American University of Beirut when the city was under siege in the summer of 1982, leaving the population without water, electricity and other amenities. When international agencies came in to help, Armenian led an effort to generate data about immediate health needs; beyond that, he established a surveillance system to better understand effects over time on everything from coronary artery disease and rheumatoid arthritis to stress-related illnesses from exposure to violence and living in unsafe quarters. These studies continued over a period of 15 years, involving approximately 3,000 families. In Armenia, he was part of a delegation that went to the country a month after the devastating 1988 earthquake that killed more than 25,000 people. Armenia was then part of the Soviet Union, but Soviet leader Mikhail Gorbachev asked the United
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Ondine von Ehrenstein 20
“I understand environmental factors with an interdisciplinary comprehensive sense. It includes living conditions, behaviors, and community factors as well as ‘pure’ environmental factors.”
In her studies of environmental impacts on children’s health at different stages of development, Dr. Ondine von Ehrenstein takes a global perspective as well as a contextual one. “I understand environmental factors with an interdisciplinary comprehensive sense,” she explains. “It includes living conditions, behaviors, and community factors as well as ‘pure’ environmental factors. I want to look at exposures and consider the settings and cultures where these exposures and related health effects are occurring in those population groups in low-income countries and communities that are most affected.” Globally, in children, environmental risk factors can account for more than one-third of the disease burden, according to the World Health Organization. Although there are also potentially harmful expo-
Dr. Ondine von Ehrenstein
sures in communities in the United States, children in low-income countries and in those facing social, industrial and economic transition and related environmental health problems tend to have it much worse. “In regions of South Asia, for example, you not only have multiple exposures that can be magnitudes higher, but children are also affected by malnourishment, poor living conditions, and a lack of health services for prevention, early detection and treatment,” von Ehrenstein notes. Von Ehrenstein grew up in Germany, completing her doctorate in epidemiology and public health at the School of Public Health in Bielefeld. She went on to a position at the World Health Organization as program manager for children’s environmental health for the European region, including approximately 50 countries in Europe and Central Asia. In that capacity, she co-edited Children’s Health and Environment: A Review of Evidence, a monograph summarizing global environmental health risks to children, including related policy issues. From there she went to UC Berkeley, where she did epidemiological research on effects of widespread arsenic exposure from drinking water on childhood development and pregnancy outcomes in rural India. Coming to the school from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, she is initiating a number of new child health-related research projects internationally.
UCLAPUBLIC HEALTH
Global Health Certificate Program Increases Student Activity Abroad IN THE SCHOOL’S EXECUTIVE M.P.H. (EMPH) Program in Healthcare Management and Policy, student experiences have taken a decidedly international turn. It’s part of a broader trend at the school, where a Global Health Certificate offered beginning last year through the UCLA Center for Global and Immigrant Health has been met with an enthusiastic response. The certificate is awarded to graduate students who, among other things, fulfill additional global health coursework beyond the general requirements and complete an international field experience. “We’re seeing more and more students who want to be better prepared for careers in global health, and most of them are taking advantage of the opportunity to get the certificate,” says Dr. Shira Shafir, assistant professor of epidemiology and coordinator of the program. “Our intention is that in addition to obtaining the knowledge and skills required to get their degrees, students who go through the certificate program will be well equipped to apply those skills in any global environment.”
In the EMPH program, approximately half of the Class of 2009 opted for additional training, according to Dr. Fred Hagigi, professor of health services and the program’s director. Last summer, a dozen EMPH students chose international settings for their applied field projects, with one group going to Armenia and another to Vietnam. Hagigi, who accompanied both student groups, says this summer and fall will find EMPH student groups visiting South America, Africa, Southeast Asia, and the Middle East. In Armenia, Hagigi joined seven students who provided consultation services to Yerevan Medical Center, a 90-bed hospital that had been privatized for a little more than a year. “Armenia is particularly interesting because it has gone from universal healthcare to a private system that is not well funded,” says Dr. Robert Grossman, an interventional cardiologist who enrolled in the EMPH program after 20 years of practice and was part of the student group. “We had the opportunity to conduct an assessment and talk with the CEO of the hospi-
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Onyebuchi (Onyi) Arah
the Netherlands, getting a Ph.D. in Health Policy from the University of Amsterdam and his M.Sc., D.Sc. and M.P.H. degrees from Erasmus University Rotterdam. Prior to joining the UCLA School of Public Health faculty, he was a senior research fellow at the National Institute for Public Health and the Environment and an assistant professor at the Academic Medical Center of the University of Amsterdam. “People are beginning to realize that we can’t necessarily approach global health from the perspective of one discipline,” Arah says. “I ended up training across disciplines, and that, combined with a cultural background that allows me to stay attached to both sides of the world, is very helpful in tackling these issues.”
opportunity to celebrate that progress and learn from each other.” When Pilgrim, a hospital administrator, enrolled in the EMPH program, she was looking for a powerful experience abroad. “The need in the developing world is so tremendous and the people so interested in opening up a dialogue that you become completely enveloped in what you can offer and the support you can provide,” she says. “That’s why I knew I wanted a global health perspective. The Global Health Certificate program gave that to me, and then some.”
“I ended up training across disciplines, and that, combined with a cultural background that allows me to stay attached to both sides of the world, is very helpful in tackling these issues.” Dr. Onyebuchi Arah
Last summer, two groups of students from the school’s Executive M.P.H. Program in Healthcare Management and Policy embarked on consulting experiences, one in Vietnam (left) and the other in Armenia. They were accompanied by Dr. Fred Hagigi (right photo, far left), the program’s director.
UCLAPUBLIC HEALTH
tal about how small changes in the way it operates could make a big difference in patient outcomes.” In Vietnam, an EMPH student group provided evaluation and consultation on pediatric emergency care in the rural provinces of southern Vietnam. The students visited local, district and regional hospitals to discuss care coordination and met with leaders at nursing, dental and health sciences schools to review their training curricula. “Despite the challenges, Vietnam has come a long way in maternal and child health,” says Patti Pilgrim, an EMPH student who participated in the project. “This was an
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Dr. Onyebuchi (Onyi) Arah is also interested in context – specifically, how everything from government healthcare systems and policies to community-level features and environmental factors influence health. Arah conducts these comparative studies across borders. In examining the impact of welfare systems on health outcomes, for example, he found that countries with high levels of social expenditures, such as in Scandinavia, are no more likely to reduce gender-related health disparities than nations such as the United Kingdom and the United States that have more market-oriented welfare systems. “It’s puzzling, and we’re still trying to make sense of this,” says Arah. “It may be that policies encouraging welfare don’t necessarily go hand in hand with those that empower women or other potentially disadvantaged groups.” Arah is the principal investigator of “Beyond Individual-level Determinants: The Role of Healthcare System, Socioeconomic, and Environmental Factors in the Global Burden of Chronic Diseases,” which employs databases on a representative sample of more than 280,000 respondents from 68 countries. He is also tackling methodological challenges of pulling together databases from such disparate sources. In conducting research across borders Arah has a unique perspective, both in his training and his experience. A native of Nigeria, where he earned his M.D. from the University of Ibadan, Arah moved to
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Jessica Gipson 22
For Dr. Jessica Gipson, reproductive health and the ability of men and women to control the timing and number of children they have is a human rights issue – and in many of the countries where Gipson has worked, factors ranging from lack of access to contraception and sex education to women’s lack of economic and relationship equality are impeding these rights. “So much is affected when women and men don’t have control over reproductive decisionmaking, both in terms of their lives and the lives of their children,” she notes. Gipson, who joined the school’s faculty after completing her Ph.D. and postdoctoral fellowship at Johns Hopkins Bloomberg School of Public Health, has spent time in Bangladesh, studying communication and negotiation regarding contraception and childbearing preferences among couples, as well as the motivation of women and couples who decide to seek an abortion. Globally, one in five pregnancies is terminated, and in developing countries, Gipson notes, the majority of abortions are unsafe. However, in Bangladesh, menstrual regulation – vacuum aspiration of the uterus during the first 12 weeks – is available and provided by trained medical personnel,
resulting in lower hospitalization rates due to unsafe abortion than in most developing countries. “This is one of the few countries where, despite little improvement in many economic development indicators, there has been a rapid fertility decline,” Gipson notes. “It was interesting to study how that happened. Although Bangladesh is a more conservative country in some aspects, it has been very progressive and proactive with respect to population policies and family planning programs.” Gipson is now conducting research on pregnancy prevention and management in the Philippines, a predominantly Roman Catholic country where the environment is more restrictive: There is limited access to or education about contraception, despite the fact that nearly half of pregnancies are unintended.
“So much is affected when women and men don’t have control over reproductive decision-making, both in terms of their lives and the lives of their children.” Dr. Jessica Gipson
UCLAPUBLIC HEALTH
Arturo Vargas-Bustamante “With increasing economic interactions among countries, more people traveling abroad and more goods and capital flowing around the world, there are growing concerns about the spread of disease and about healthcare coverage for immigrants or expatriate workers.” Dr. Arturo VargasBustamante
Growing up in Mexico City, Dr. Arturo VargasBustamante became interested in the economics of healthcare, and particularly the ways in which international migration and immigrant integration affect access to care in host countries. “Border health was always seen as an isolated phenomenon concentrated at the border,” Vargas-Bustamante says. “But with increasing economic interactions among countries, more people traveling abroad and more goods and capital flowing around the world, there are growing concerns about the spread of disease and about healthcare coverage for immigrants or expatriate workers.” In an effort to gain a broader perspective, Vargas-Bustamante has conducted international comparative studies on everything from the effects of decentralization and privatization of healthcare in
Latin American countries to cross-border healthcare utilization in North America vs. Europe. “This is a very challenging field with no easy solutions – relying too heavily on either market or state mechanisms leads to different kinds of problems,” he says. After earning his B.A. in Politics and Public Administration at El Colegio de Mexico, where he studied healthcare reform, Vargas-Bustamante started his professional career in the Health Financing Administration of the Mexican Ministry of Health, and in 2002 became the youngest recipient of the National Award of Public Administration Research in Mexico. He went on to graduate education at UC Berkeley, earning a Ph.D. in Public Policy in 2008. He also spent time as a consultant for the InterAmerican Development Bank and for the California Program on Access to Care. He is pleased to be at the UCLA School of Public Health, where the late Dr. Milton Roemer, a pioneer in research comparing health systems across the world, was on the faculty for nearly four decades. “The school was very interested in global health from its origins,” Vargas-Bustamante notes. “It is in a great location, close to Mexico and Asia, and Los Angeles is a city of immigrants. All of these factors make it an ideal environment for someone like me.”
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research highlights Pesticide Exposure Found to Increase Risk of Parkinson’s Disease
Central Valley residents who lived within 500 meters of fields sprayed from 1974 to 1999 had a 75-percent increased risk for Parkinson’s disease.
UCLAPUBLIC HEALTH
THE FERTILE SOIL OF CALIFORNIA’S CENTRAL VALLEY has made it famous as one of the nation’s prime crop-growing regions. But it’s not just the soil that allows for such productivity. Crops such as potatoes, dry beans and tomatoes have long been protected from bugs and weeds by the fungicide maneb and the herbicide paraquat. Scientists know that in animal models and cell cultures, such pesticides trigger a neurodegenerative process that leads to Parkinson’s disease. Now, researchers at the UCLA School of Public Health have provided the best evidence to date for a similar process in humans. A team headed by Dr. Beate Ritz, professor and vice chair of the school’s Department of Epidemiology, reported in the American Journal of Epidemiology that Central Valley residents who lived within 500 meters of fields sprayed between 1974 and 1999 had a 75-percent increased risk for Parkinson’s disease. In addition, people who were diagnosed with the disease at age 60 or younger were found to have been at much higher risk because they had been exposed to maneb, paraquat or both in combination between 1974 and 1989, years when they would have been children, teens or young adults. The researchers enrolled 368 longtime residents diagnosed with Parkinson’s disease and 341 others as a control group. Parkinson’s disease is a degenerative disorder of the central nervous system that often impairs motor skills, speech and other functions. It has been reported to occur at high rates among farmers and in rural populations, contributing to the hypothesis that agricultural pesticides may be partially responsible. Until now, however, data on human exposure has been unavailable, largely because it has been too hard to measure an individual’s environmental exposure to any specific pesticide. So Ritz and colleagues developed a geographic information system-based tool that estimated human exposure to pesticides applied to agricultural crops. This GIS tool combined land-use maps and pesticide-use reporting data from the state of California. Each pesticide-use record includes the name of the pesticide's active ingredient, the amount applied, the crop, the acreage of the field, the application method and the date of application. “The results confirmed two previous observations from animal studies,” Ritz says. “One, that exposure to multiple chemicals may increase the effect of each chemical. That’s important, since humans are often exposed to more than one pesticide in the environment. And second, that the timing of exposure is also important.” Of particular concern, Ritz says, is that the data “suggests that the critical window of exposure to toxicants may have occurred years before the onset of motor symptoms when a diagnosis of Parkinson’s is made.”
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Air Pollution from Freeways Extends Farther Than Previously Thought
UCLAPUBLIC HEALTH
Although traffic volumes are lower in the presunrise hours, air pollution concentrations are higher than even those during the daytime traffic congestion peaks.
DURING THE EARLY MORNING HOURS BEFORE SUNRISE, the effects of air pollutants from the I-10 freeway in Santa Monica extend as far as 2,500 meters (more than 1.5 miles) downwind, according to recent measurements taken by a research team headed by Dr. Arthur Winer, professor of environmental health sciences in the UCLA School of Public Health. That distance – 10 times greater than the pollutant effects from roadways found by previous researchers who measured during the day – has significant implications on exposure levels for people living near freeways, since most people are in their homes during the hours before sunrise. The study was published in the journal Atmospheric Environment. To measure the pollution levels, Winer’s team equipped a pollution-free electric vehicle with fastresponse instruments for gaseous and particulate air pollutants, a GPS and video monitor, and instruments to measure temperature and winds. During both the winter and summer of 2008, Winer and colleagues made repeated measurements between the hours of 4 a.m. and 7 a.m. while driving toward and away from Interstate 10 on a route perpendicular to the freeway in Santa Monica. The researchers found that although traffic volumes are lower in the pre-sunrise hours, the air pollution concentrations are higher than even those during the daytime traffic congestion peaks. That’s because of the unique weather conditions in the presunrise period, explains Dr. Shishan Hu, a postdoctoral scholar who was lead author on the article. These meteorological conditions are very common in the hours before sunrise, according to Dr. Suzanne Paulson of UCLA’s Department of Atmospheric and Oceanic Sciences, and another member of the team, which also included Dr. Scott Fruin of the USC Keck School of Medicine, doctoral student Kathleen Kozawa (see profile on page 29), and Steve Mara of the California Air Resources Board, which sponsored the study. Elevated ultrafine particle concentrations extended not only 2,500 meters downwind but also up to 600 meters upwind of the freeway, another strong difference from daytime observations, which typically show little or no vehiclerelated pollution directly upwind from freeways. Other pollutants, including nitric oxide and particle-bound polycyclic aromatic hydrocarbons, also extended far from the freeway during the pre-sunrise hours. “Until this study, the farthest anyone has measured downwind of a freeway was about half a mile,” Winer notes. “Few researchers have outfitted a vehicle with as many instruments and none have made measurements at such early hours.” The study raises more questions about the potentially significant influence on health outcomes caused by freeway traffic, he adds. “Numerous epidemiologic studies have already shown that traffic-related pollution is linked to increased risk of asthma, respiratory illness, cardiovascular disease and premature mortality,” Winer says. He recommends that residents living near freeways consider keeping their windows closed at night and limiting their outdoor exercise in proximity to freeways.
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AFRICAN-AMERICANS WHO PERCEIVE RACISM – whether subtle or overt – might be more likely to accept readily available HIV testing, according to a UCLA School of Public Health-led study. Although one might expect awareness of racism to be a barrier, the study, involving sexually transmitted disease clinic patients residing in a high HIV and STD prevalence city in North Carolina, seemed to have the opposite effect. “We were investigating the extent to which study participants believe that most blacks still experience racism,” says Dr. Chandra Ford, assistant professor in the school’s Department of Community Health Sciences and the lead study author. “We wanted to understand whether they thought it was still prevalent, and if it was, whether this was a barrier to obtaining CDCrecommended HIV testing, as has been hypothesized.” The study, published in the American Journal of Public Health, included 373 African-Americans seeking sexually transmitted disease diagnoses or screening. Ford and colleagues found that 94 percent of participants perceived everyday forms of racism (examples of which included being followed by white clerks or security guards while shopping). Of note, individuals who perceived racism were more likely to undergo HIV testing, even when taking into account other factors such as perceived risk of HIV infection. “Awareness of racism in the environment is not inherently a barrier to HIV testing,” Ford says, “so it need not be something to avoid discussing.” In fact, she notes, the greatest barrier appears to be reflected in the finding that two-thirds of study participants believed they had a very low or no risk for HIV infection, despite seeking STD testing and despite 40 percent having symptoms. More than one-fourth of HIV-infected individuals are undiagnosed and therefore unaware of their HIVpositive status. African-Americans are disproportionately infected. “This study highlights the importance of moving away from a ‘business as usual’ approach to investigating health behaviors and treatment-seeking behaviors,” says Dr. Craig Demmer, a professor at Lehman College at City University of New York and an author on the study. “Health inequalities connected to race and racism are well established, but our constant preoccupation with looking to race as the definitive explanation or cause for a multitude of health behaviors and attitudes, including HIV/AIDS, is shortsighted.”
research
Perceived Racism Not Found To Be a Barrier to HIV Testing
Although one might expect it to be a barrier, African-Americans who perceived racism were more likely to undergo HIV testing.
Exposure to Perfluorinated Chemicals May Reduce Women’s Fertility
UCLAPUBLIC HEALTH
RESEARCHERS AT THE UCLA SCHOOL OF PUBLIC HEALTH have found the first evidence that perfluorinated chemicals (PFCs) – chemicals that are widely used in everyday items such as food packaging, pesticides, clothing, upholstery, carpets and personal care products – may be associated with infertility in women. The study, published online in the leading reproductive medicine journal Human Reproduction, found that women who had higher levels of perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS) in their blood took longer to become pregnant than women with lower levels. The UCLA researchers used data from the Danish National Birth Cohort to assess whether levels of PFOS and PFOA in pregnant women’s plasma were associated with a longer time to pregnancy. A total of 1,240 women were included in their analyses.
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UCLAPUBLIC HEALTH
Perfluorinated chemicals not only are found in many household goods, but are also used in such manufacturing processes as industrial surfactants and emulsifiers.
Blood samples were first taken 4-14 weeks into the pregnancy so that concentrations of PFOS and PFOA could be measured. The researchers divided the women’s levels of PFOS/PFOA into four quartiles and found that, compared with women with the lowest levels of exposure, the likelihood of infertility increased by 70 to 134 percent for women in the higher three quartiles of PFOS exposure, and by 60 to 154 percent for women in the higher three quartiles of PFOA exposure. “Perfluorooctanoate and perfluorooctane sulfonate were considered to be biologically inactive, but recently animal studies have shown that these chemicals may have a variety of toxic effects on the liver, immune system and developmental and reproductive organs,” says Chunyuan Fei, the study’s first author. “Very few human studies have been done, but one of our earlier studies showed that PFOA, although not PFOS, may impair the growth of babies in the womb, and another two epidemiological studies linked PFOA and PFOS to impaired fetal growth.” “As far as we know, this is the first study to assess the associations between PFOA and PFOS levels in plasma with time to pregnancy in humans,” says Dr. Jørn Olsen, chair of the school’s Department of Epidemiology and the study’s principal investigator. “We are waiting for further studies to replicate our findings in order to discover whether the chemicals should be added to the list of risk factors for infertility.” PFCs, the class of chemicals to which PFOS and PFOA belong, not only are found in household goods, but are also used in such manufacturing processes as industrial surfactants and emulsifiers. They persist in the environment and in the body for decades.
Discovery May Result in New Test to Determine Predisposition to Cancer RESEARCHERS AT UCLA’S JONSSON COMPREHENSIVE CANCER CENTER and School of Public Health have developed a method that can be used to help identify new genes that can predict a predisposition to cancer. Cancer cells show persistent genetic instability, and the researchers, led by Dr. Robert Schiestl, have discovered a mechanism that switches on that instability. If they can uncover and understand the molecular pathways at work in promoting genetic instability, they may be able to develop ways to switch the mechanism off, restoring genetic stability. The study was published in the journal Radiation Research. “We all have several hundred cells in our body that go crazy every day, and they’re taken out by our immune system,” says Schiestl, a professor in the school’s Department of Environmental Health Sciences. “What’s important is that those cells don’t grow and spread and invade other regions of our body. Cancer cells are able to grow, spread and invade because the continued genetic instability can disturb the cellular program and create a growth advantage. Unfortunately, the immune system is not very effective at taking every cancer cell out.” The new method determines the efficiency of the repair mechanism when DNA suffers a double-strand break, meaning both strands in the double helix are severed. These breaks cause genetic instability and are particularly dangerous because they can lead to genome rearrangements or deletions of certain genes that, when gone, result in cancer. In the study, researchers irradiated cells to create double-strand breaks. They wanted to determine if, when a double-strand break occurs in one area of the DNA, the instability is limited to that area or is also evident elsewhere. The
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standard thinking was that the genetic instability would be localized to the area of the break. However, Schiestl and his team showed that a break in one area has an “in trans” effect, meaning the instability could surface anywhere in the genome of the cell. “What we have shown is that DNA damage at one position in the genome causes a certain mechanism of genetic instability all over the genome,” Schiestl says. “Now we have to identify the mechanism of the pathway, identify the genes involved in inducing that pathway, and that might give us targets that we can inhibit with drugs to try to reduce genetic instability. That could lead to a cancer treatment: We might be able to stop the instability before it results in cancer.”
Dental Schools Show Success in Strategy to Improve Access to Care for Underserved
Schools in the “Pipeline, Profession, and Practice: Community-Based Dental Education” program increased their enrollment of underrepresented minority students by 27 percent from 2003 to 2007.
UCLAPUBLIC HEALTH
A SYSTEMATIC EFFORT by U.S. dental schools to increase enrollment of underrepresented minority students as a strategy for improving access to oral health care in underserved populations appears to be having its desired effects, according to a study headed by Drs. Ron Andersen and Pamela Davidson of the UCLA School of Public Health. The study, published in the Journal of Dental Education, was the first to evaluate the effects between 2003 and 2007 of the “Pipeline, Profession, and Practice: Community-Based Dental Education” program. In the pipeline program’s first phase, 15 U.S. dental schools (including the UCLA School of Dentistry) were funded by the Robert Wood Johnson Foundation and The California Endowment to develop community-based clinical education programs for a period of five years to provide care to the most vulnerable populations, and to increase recruitment and retention of low-income and underrepresented minority students. Andersen, Davidson and their colleagues found that the pipeline program brought about “significant and consequential change.” Overall, pipeline schools increased their enrollment of underrepresented minority students by 27 percent during the 20032007 period – almost twice the rate of increase at non-participating dental schools. Among the pipeline schools that had not traditionally served large populations of minority students, that figure was even higher: 54 percent. In addition, all 15 participating dental schools increased the length of time that their senior students spent in extramural rotations – from an average of 16 days in 2003 to an average of 39 days by 2007. The complete monograph is currently available online at www.jdentaled.org/ content/vol73/2_suppl/. “We have seen a substantial increase in the recruitment and enrollment of minority students in most of the pipeline dental schools,” Andersen says. “A majority of the faculty at the schools believe that recruitment of such students should continue, and that senior students are more clinically productive in extramural rotations than in the dental-school clinics.” Previous studies have found that underrepresented minority dental students are more likely than other students to treat underserved minority patients. But, Andersen cautions: “Dental students acquire an exorbitant debt load – sometimes amounting to well over $100,000 – during their years at dental school. This can be a major factor in a student’s decision of whether to serve the residents of a lowincome, minority community or to start a lucrative practice in a more affluent area, especially since state and federal reimbursement rates for treating Medicaid patients tend to be low.” There has been discussion about making federal funding available to provide tuition remission for students who agree to serve for a given period of time in disadvantaged communities, Andersen says, but thus far that has not occurred.
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student profiles Doctoral Candidate and Popular Teaching Assistant Uses Epidemiology Training to Fight HIV/AIDS in India
“I really enjoyed my time with the students, and it felt good knowing I could bring smiles to confused faces.”
UCLAPUBLIC HEALTH
— Tarun Bhatnagar
TARUN BHATNAGAR SPENT HIS CHILDHOOD playing on hospital campuses where his parents worked. Born and raised in New Delhi, India, Bhatnagar grew up in a family of physicians – his father is a radiologist, his mother a gynecologist. Going through school he appeared to be on the same path, preparing to be a clinician. But two things happened to alter his plans. During his clinical internship Bhatnagar found that managing patients made him anxious. “I was having sleepless nights and tense days,” he says. “I was not confident in my ability to handle the stress of clinical work.” That was when Bhatnagar, currently a doctoral candidate in the School of Public Health’s UCLA/Fogarty AIDS International Training and Research Program, learned about the field of epidemiology. “I had never heard of it until my third year of medical school,” he says. Bhatnagar decided to pursue an M.D. in Preventive and Social Medicine. During his three-year study at Banaras Hindu University in Varanasi, India, he was introduced to the subject of epidemiology and took to understanding its nuances. He was taken by the prospect of applying these principles to improving the health of large numbers of people. Looking for more specialized training in epidemiology, he was introduced by his mentors in India to Dr. Roger Detels, director of the UCLA/Fogarty AIDS program. Bhatnagar decided to apply to the program, which builds the HIV/AIDS research capacity of India and other collaborating countries in an effort to control the epidemic. Bhatnagar went on to accept a position as a scientist and core faculty member of the first ICMR School of Public Health at the National Institute of Epidemiology, part of the Indian Council of Medical Research in Chennai. After doing his coursework at UCLA he is now back in Chennai completing his dissertation on the prevalence of HIV and associated risk factors among wives of truck drivers in Namakkal District of Tamil Nadu, India. The district has the highest HIV prevalence among women in the state, and the mobility of male truck drivers is suspected to be a major factor. “Given the unequal gender relationships in Indian society, it is possible that despite knowledge of risky extramarital behaviors of their male partners, many women are unable to negotiate safe sexual practices,” Bhatnagar says. Although HIV prevalence is on the decline in Tamil Nadu, it remains high among women in Namakkal District. “I hope to determine what drives the epidemic in this area so that socio-culturally appropriate interventions can be put in place,” explains Bhatnagar. Beyond the specialty training he was able to receive at the UCLA School of Public Health, Bhatnagar says the most valuable aspects of the experience were the lasting bonds he made with fellow Fogarty trainees from South Asian countries, as well as Detels’ “professional mentoring with a very personal touch.” Bhatnagar himself became a mentor to many at the school; he was voted Teaching Assistant of the Year in 2006-07 by the Public Health Students Association. “I really enjoyed my time with the students, and it felt good knowing I could bring smiles to confused faces,” he says. “Receiving that award in a vote by the students was very special to me, especially being a non-native.”
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Former Basic Scientist Clearing Air on Port Pollution
“I wanted to see that what I was doing was making a difference, while still using my science background.” — Kathleen Kozawa
UCLAPUBLIC HEALTH
AFTER GRADUATING from UC San Diego with a B.S. in microbiology, KATHLEEN KOZAWA spent nearly two years working in a laboratory conducting basic research on cancer. At a certain point she decided this wasn’t for her. “I wanted to do more applied research,” she says. “I wanted to see that what I was doing was making a difference, while still using my science background.” Kozawa enrolled in the M.P.H. program in the school’s Department of Environmental Health Sciences and immediately knew she had found her calling. She was particularly interested in the issue of air pollution, volunteering to participate in a field study characterizing the range of children’s exposure to diesel exhaust during school bus commutes. Kozawa’s professor and the principal investigator of that study, Dr. Arthur Winer, encouraged her to stay beyond her master’s education and pursue her doctorate in the school’s Environmental Science and Engineering Program. Kozawa graduates this spring, having completed her dissertation research through the California Air Resources Board (ARB). Her study, conducted with Winer and Dr. Scott Fruin, a USC assistant professor, investigated pollution concentrations in the communities adjacent to the ports of Los Angeles and Long Beach. “This is a particular concern because of the enormous growth that’s occurred in goods movement through these ports over the last several decades,” Kozawa says. “Thousands of dirty diesel trucks are traveling through these neighborhoods on busy streets close to homes, and people’s exposure to pollutants is very high.” The topic hits home for Kozawa, who grew up in Long Beach. Her study involved measuring air pollution in these near-port communities by using an electric vehicle as a mobile platform, outfitted with state-of-the-art air pollution monitoring equipment and driven around the neighborhoods at various times to collect the data. Unlike traditional fixed-site monitors, the mobile platform enables researchers to gather data with high temporal and spatial resolution. “This gives us a much better measurement of what people are actually being exposed to, particularly in the near-road areas,” Kozawa explains. “We can find out what they’re breathing in their own backyard.” Her group found the concerns that served as the impetus for the study were valid: Within 150 meters of busy roadways in the port-adjacent communities, pollution levels were at least double what they were at more than 150 meters away. Kozawa, who continues to work for the ARB as an air pollution specialist, is currently drafting a five-year plan for the mobile platform that will include continued monitoring in the ports area. “The ARB and the ports have adopted aggressive measures to dramatically reduce emissions from diesel trucks in the next five years, and this will be a great way to assess whether these programs are working,” she says. As part of the research in the port-adjacent communities, Kozawa’s group held meetings with residents and community leaders. “It was eye-opening to hear their concerns and see their passion about the need to improve air quality in their neighborhoods,” she says. The interactions were also a reminder to Kozawa of one of the reasons she chose public health: “It’s exciting to be able to see the research I’m doing is having a direct impact on policy and people’s lives.”
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2008-09 student awards Abdelmonem A. Afifi Student Fellowship Ashley Phelps Health Services
Agency for Healthcare Research and Quality Fellowship Catherine Acquah Andre Barnes Deborah Ling Kannika Damrongplasit Michelle Ko Jennifer Tsui Alice Villatoro Emily Barrett Bapu Jenna Jerry Grenard Health Services
Atlantic Richfield Company Fellowship Valerie Chan Environmental Science and Engineering
Judith Blake Award Bethany Wexler Community Health Sciences
Joseph and Celia Blann Fellowship Claire Dye Community Health Sciences Sarah Starks Health Services
California Center for Population Research Training Program Doctoral Fellowship Malia Jones Community Health Sciences
California Endowment Scholarship
Cancer Epidemiology Training Program
Ruth L. Kirschstein National Research Service Awards for Individual Predoctoral Fellows
Sam Oh Sung-Shim Lani Park Yi Ren Wang Behnaz Pezeshki Rita Velikina Epidemiology
Janet R. Cummings Sarah L. Starks Health Services
Carolbeth Korn Prize
Chancellor’s Prize
Janet Cummings Health Services
Samantha Abraham Environmental Health Sciences
Ursula Mandel Special Fellowships
Alice Villatoro Health Services
Sara Chacko Jessica Miller Epidemiology
Child and Family Health Leadership Training Program (Fellowship)
Maternal and Child Health Training Grant
Portia A. Jackson Health Services
Nelida Duran Community Health Sciences
Competitive Edge Program Scholarship
Ann G. Quealy Memorial Fellowship in Health Services
Chikarlo Leak Health Services
Dean’s Outstanding Student Award Eric Bloomquist Biostatistics Jennifer Erasquin Community Health Sciences Kathleen Kozawa Environmental Health Sciences Hozefa Divan Epidemiology Shana Lavarreda Health Services
Eleanor J. De Benedictis Fellowship in Nutrition Maria Pia Chaparro Maria Koleilat Nabil Community Health Sciences
CAROLBETH KORN PRIZE — Janet Cummings received the prestigious Carolbeth Korn Prize, given annually to the School of Public Health’s most outstanding graduating student. Max Factor Family Foundation June Lim Community Health Sciences
Kimberly Enard Jennifer Tsui Health Services
Brian Chen Epidemiology
Graduate Summer Research Mentorship
Raymond D. Goodman Scholarship
Sara Chacko Epidemiology
Ying Zhou Biostatistics
Hagigi Fellowship in Health Services Finance and Management
Uchechi Acholonu Nelida Duran Community Health Sciences Ximena Vergara Epidemiology
Shana A. Lavarreda Health Services
Graduate Opportunity Fellowship
Ashley Smith Health Services
Dissertation Year Fellowship
California Wellness Foundation Scholarships
Ying Zhou Biostatistics
Andrea A. Amoani Janet Beyan Cristina M. Rodriguez-Hart Erika-Lizet Wilkins Y Martinez Community Health Sciences
Mirna Troncoso Community Health Sciences
Lynn Yamamoto Environmental Health Sciences
Erin Peckham Epidemiology
Environmental Science and Engineering Program Endowment Stephen Estes Un Sam Ha Calvin Kwan Glenn Sias Victor Vasquez
Sara Chacko Jo Kay Chan Ghosh Jessica Miller Epidemiology
Genomic Analysis Training Program Doctoral Fellowship
Dissertation Grant, California Program on Access to Care
Ana E. Martinez Health Services UCLAPUBLIC HEALTH
6/5/09
Leila Lackey Environmental Health Sciences
Andrew Pinesett Health Services
Graduate Research Mentorship Program Award Jennifer Jee-Lyn Garcia Mirna Troncoso Rotrease S. Regan Community Health Sciences Ashley Terrell Parrisa Solaimani Demian Willette Environmental Health Sciences
Rachel Coren Darya Friedman
Eugene Cota Robles Fellowship De Annah Byrd Eva Durazo Community Health Sciences Ciara Remillard Environmental Health Sciences Victor Vazquez Khadeeja Abdullah Environmental Science and Engineering Diana Sanchez Joni Ricks Epidemiology
Ruth Roemer Award in Social Justice
Leaat Dulberg
Christian Eisert Health Services
Health Services Alumni Association Outstanding Consulting Report
Milton and Ruth Roemer Fellowship in Health Services
Ashley Wagman
Minal Patel
Health Services Alumni Association Scholarship
Monica Salinas Internship Fund in Latino and Latin American Health
Allen Suh
William and Flora Hewlett Foundation Environmental Science and Engineering Program Valerie Chan Stephen Estes Melissa Evanson Un Sam Ha Meng Horn Hse Leila Lackey Nicholas Nairn-Birch Glen Sias Victor Vazquez
Jacqueline Torres Maria Lanfranco Community Health Sciences Maura Purcell Epidemiology
Charles F. Scott Fellowship Shubha Kumar Health Services Kabir Chopra Environmental Health Sciences
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new faculty Saipin Chotivichien Epidemiology
Wayne SooHoo Memorial Scholarship Sung-Shim (Lani) Park Epidemiology
State Health Access Reform Evaluation, Robert Wood Johnson Foundation Shana A. Lavarreda Health Services
Student Research Award from the Institute for Research on Labor and Employment Selena E. Ortiz Health Services
Sutter Health Administrative Fellowship Sarah T. Khan Janet Cummings Health Services
Samuel J. Tibbitts Fellowship Sayaka Takaku Environmental Health Sciences
Toxic Substances Research and Training Program Fellowship Kristin Yamada Environmental Health Sciences
UCLA Faculty Women’s Club Award Kimberly Henderson Environmental Health Sciences
University Fellowship, UC Regents Shana A. Lavarreda Health Services
Charles Wacker Summer Fellowship Qian Wu Biostatistics
Wilshire Foundation Endowment in Geriatric Medicine and Long Term Care Elizabeth Anderson Malia Jones Susan Kwan Community Health Sciences
FREDERICK J. ZIMMERMAN, an expert in children’s health issues and community medicine, has been named chair of the Department of Health Services effective July 1. Dr. Robert Kaplan, current department chair, will be returning to the school’s faculty. Zimmerman is an economist who is well recognized for his scholarly work addressing a broad array of pediatric health and healthcare utilization issues, including a focus on the effects of economic and social disparities. His research on the impact of early media exposure on child health and development has garnered national media attention, including coverage on National Public Radio, the BBC, ABC’s Good Morning America, NBC’s Today Show, The New York Times and others. Zimmerman has authored more than 50 peer-reviewed publications and serves as a manuscript reviewer for nearly 20 publications, including the Journal of the American Medical Association, Pediatrics, the American Journal of Pediatric Care and Archives of Pediatrics and Adolescent Medicine. From 2002 to 2006 he served as co-director of the Child Health Institute at the University of Washington, and from 2001 to 2005 he was a member of the Technical Advisory Group for a Mellon Foundation-funded project to improve links between academia and practitioners in international health. He is also a member of the project advisory group for a Healthy Start program in Indonesia. Zimmerman received his Master’s and Ph.D. in Economics from the University of Wisconsin, where he was a Vilas Travel Fellow. ONYEBUCHI (ONYI) ARAH has joined the faculty as associate professor in the Department of Epidemiology. A pediatrician trained in public health, health services research, health policy, and epidemiologic methods, Arah conducts research in areas that include the causal analysis of non-experimental studies, global context of chronic diseases (with a special focus on developing countries), life-course epidemiology, and health services research – particularly the role of health systems in global health and performance assessment in healthcare. Previously, he was a senior research fellow at the National Institute for Public Health and the Environment and an assistant professor at the Academic Medical Center of the University of Amsterdam in the Netherlands. He was a visiting faculty member at the UCLA School of Public Health in 2006-2007 when he was awarded a Rubicon Fellowship by the Netherlands Organization for Scientific Research. Arah received his M.D. from the University of Ibadan, Nigeria; his Ph.D. in Health Policy from the University of Amsterdam; and his M.Sc., D.Sc. and M.P.H. degrees from Erasmus University Rotterdam in the Netherlands.
sion-making and reproductive outcomes (fertility, fertility regulation, and sexually transmitted infections including HIV/AIDS). Gipson comes to UCLA from the Johns Hopkins Bloomberg School of Public Health, where she earned her Ph.D. in Public Health and was granted the Charlotte Ellertson Social Science Postdoctoral Fellowship in Abortion and Reproductive Health. She received her M.P.H. from the Tulane School of Public Health and Tropical Medicine, and a bachelor’s degree in anthropology from UCLA. ONDINE VON EHRENSTEIN, a former investigator at the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health, has joined the Department of Community Health Sciences as assistant professor. Her research interests focus on child and maternal health related to environmental factors, and global health problems, including the interplay with social, biological and lifestyle factors in low-income countries and communities. Von Ehrenstein was a researcher at UC Berkeley, where she studied the effects of arsenic exposure in drinking well water on childhood development and reproductive outcomes in rural India. Previously, she was a scientist and program manager for child health and environment at the WHO Regional Office for Europe, which includes Europe and Central Asia. Von Ehrenstein completed her doctorate in epidemiology and public health at the School of Public Health in Bielefeld, Germany.
UCLAPUBLIC HEALTH
JESSICA GIPSON has joined the faculty as assistant professor in the Department of Community Health Sciences. Her work focuses on international reproductive health, using qualitative and quantitative research methods to better understand the socio-cultural and contextual influences on reproductive deci-
faculty
Juneal Marie Smith Fellowship in International Nutrition
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bookshelf
...recent books by UCLA School of Public Health authors
After the Cure: The Untold Stories of Breast Cancer Survivors by Emily K. Abel and Saskiak Subramanian. New York University Press. The ongoing, debilitating symptoms that plague some breast cancer survivors long after their treatments have officially ended are chronicled in a book that features reallife narratives of women who are living with fatigue, chronic pain, insomnia, depression and other symptoms. Recruiting Minorities and Promoting Community-Based Dental Education edited by Ronald M. Andersen and Pamela L. Davidson. American Dental Education Association. This special supplement to the Journal of Dental Education describes the experiences of 15 dental schools participating in the Pipeline, Profession, and Practice: Community-Based Dental Education program designed to address two problems in dental health: access to oral health care and the underrepresentation of minorities in dentistry. The Case-Control Method: Design and Applications by Haroutune K. Armenian. Oxford Press. Armenian addresses a number of general and specific questions dealing with the casecontrol and other case-based methods that are among the core problem-investigation tools in epidemiology and the health sciences. Written for the epidemiologist as well as for the occasional user of the case-control and other case-based methods. Disease, Diagnosis and Dollars by Robert M. Kaplan. Copernicus Books. Kaplan argues that the U.S. healthcare system is the most expensive in the world because of the overuse of screening tests and modern medicines that many times aren’t needed, or which have unintended side effects that affect quality of life.
UCLAPUBLIC HEALTH
Getting Ready to Get Pregnant: Your Complete Prepregnancy Guide to Making a Smart and Healthy Baby by Michael C. Lu. Harper Paperbacks. By the time a woman gets pregnant, she may have already missed a critical window of opportunity to give her baby the best start in life. Lu offers a step-by-step pre-pregnancy plan that can increase the likelihood of a safer pregnancy and a smarter and healthier child.
faculty honors DR. THOMAS BELIN was elected secretary/treasurer of the Biometrics Section of the American Statistical Association for 2009-2010. DR. ARTHUR K. CHO received UCLA’s 2009 Dickson Emeritus Professorship Award for outstanding teaching and research contributions. DR. ANNE COLEMAN was appointed chair of the National Eye Institute’s National Eye Health Education Program Planning Committee. DR. ROGER DETELS received the American College of Epidemiology’s Abraham Lilienfeld Award for outstanding contributions and leadership in the discipline of epidemiology; and the 2009 Distinguished Teaching Award from the UCLA Academic Senate Committee on Teaching. DR. OSMAN GALAL has been named a Fellow of the American Society of Nutrition. DR. GILBERT GEE received a 2008 National Institutes of Health Merit Award. DR. DEBORAH GLIK was accepted as a Fellow in the American Academy of Health Behavior. DR. SANDER GREENLAND was named Mildred Morehouse Visiting Professor at Albert Einstein Medical College. DR. CHARLOTTE NEUMANN received the UCLA James S. Coleman African Studies Center Honor for 40 years of teaching, research, and public service. DR. GAIL HARRISON has been named a Fellow of the American Society of Nutrition. DR. WILLIAM HINDS is the 2009 recipient of the Donald E. Cummings Memorial Award from the American Industrial Hygiene Association. DR. MARK LITWIN received the 2009 Leonard Tow Humanism in Medicine Award from the Geffen School of Medicine at UCLA. DR. DONALD MORISKY was awarded the Society of Public Health Education Mentor Award for 2008. DR. ALEX ORTEGA received the Distinguished Nationally Known Health Professional Award for 2008 from the American Public Health Association Latino Caucus. DR. NINEZ PONCE received a 2008 National Institutes of Health Merit Award, and the Royal Morales Community Achievement Award from the Pilipino Alumni Association of UCLA. DR. MICHAEL PRELIP was named to the National Eye Institute’s National Eye Health Education Program Planning Committee. DR. SHANE QUE HEE with alumnus Robert Phalen (Ph.D. ’06) won the Michigan Industrial Hygiene Society Best Paper Award. DR. PAUL TORRENS was appointed to the board of directors of The SCAN Foundation, funded by The SCAN Health Plan. DR. ARTHUR WINER was named one of six inaugural Luskin Scholars appointed at the UCLA Luskin Center for Innovation. The appointment carries an unrestricted, endowed stipend of $100,000 to conduct multidisciplinary, policy-relevant research on the major pollution problems facing the Los Angeles region.
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fielding awarded UCLA medal Dr. Jonathan Fielding, director of the Los Angeles County Department of Public Health, county health officer and professor at the UCLA School of Public Health, was awarded the UCLA Medal, the university’s highest honor, for his work as an innovator, leader and public health visionary at the 35th annual Lester Breslow Distinguished Lecture and Dinner. Fielding is responsible for providing public health services to more than 10 million people, including residents of the eighth largest city in the world, and is credited with implementing the lettergrading system in Los Angeles County restaurants, which has reduced restaurant-related food-borne illness outbreaks and hospitalizations by up to 20 percent. He chairs two major national health committees, Healthy People 2020 and the Task Force on Community Preventive Services. “Dr. Fielding’s professional excellence and unwavering dedication to our city and to the next generation of public health leaders is exemplary of the contributions to society that we strive for our students to make with their UCLA degree,” said UCLA Chancellor Gene Block in presenting the award. Fielding joins heads of state; renowned scientists, artists and scholars; peacemakers; social reformers; and visionaries in the realm of commercial enterprise in receiving UCLA’s highest honor.
DISTINGUISHED SCHOLAR LECTURE Dr. Patricia Ganz was selected to deliver the school’s Dean’s Distinguished Scholar Lecture, part of a series created to highlight the work of distinguished faculty. Ganz, a professor of health services and medicine and expert in quality of life after breast cancer, has conducted ground-breaking research that has altered the way the medical field views post-treatment health problems faced by millions of cancer survivors.
SPH hosts expert panel on H1N1 virus DISTINGUISHED TEACHING AWARD Dr. Ninez Ponce, associate professor of health services, was the recipient of this year’s Dean’s Distinguished Teaching Award, created to recognize the best of the school’s faculty and presented at the school’s 2009 Honors and Awards Reception. Said one student: “I can’t say enough good things about Ninez. She is one of the best instructors I have ever had.”
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The H1N1 (swine flu) virus, which raised worldwide fears of a pandemic, prompting many countries, including the U.S., to declare a public health emergency, was the topic of a gathering of UCLA public health and infectious disease experts hosted by the school. The panel, moderated by Dean Linda Rosenstock, featured Dr. Shira Shafir, assistant professor of epidemiology; Dr. Jack Needleman, associate professor in the Department of Health Services; Dr. Scott Layne, professor in the Department of Epidemiology; and Dr. Deborah Glik, professor in the Department of Community Health Sciences. The well-attended presentation was also available remotely via a live webcast accessible through the school’s website. To view streaming video of the discussion, visit www.ph.ucla.edu/H1N1forum.
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34 DID YOU KNOW? You are a lifetime member of the UCLA School of Public Health Alumni Association if you are a graduate of the UCLA School of Public Health and its executive programs. If you would like more information about the activities of the Public Health Alumni Association, please call (310) 825-6464 or e-mail phaa@support.ucla.edu.
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weiss honored for violence prevention efforts Billie Weiss, an epidemiologist who has worked more than 20 years to reduce violence against youth, was one of three recipients of the 16th annual California Peace Prize from The California Wellness Foundation for her efforts to prevent violence and promote peace. The honor comes with a $25,000 cash award. Weiss, associate director of the school’s Southern California Injury Prevention Research Center, has been a pioneer in public health research to assist community-based organizations in becoming more effective in preventing violence. A tireless advocate for reducing gang violence and violence against intimate partners, she is the founder and executive director emeritus of the Violence Prevention Coalition of Greater Los Angeles, which brings together anti-violence advocators, school representatives, police departments, anti-gun groups, private foundations and civil rights agencies. “Things are not changing fast enough,” Weiss says. “We need everybody we can muster. I keep looking to build that critical mass of people that can tip this epidemic so that we really look at prevention and community building as opposed to locking youth up.”
BRESLOW LECTURE — Dr. Jonathan Fielding (center, with Dr. Lester Breslow, professor and dean emeritus; and Dean Linda Rosenstock) was the keynote speaker at the 35th Annual Lester Breslow Distinguished Lecture in April. Fielding, director of the Los Angeles County Department of Public Health, county health officer and professor at the school, outlined challenges for the future of public health in a speech titled "Is the Past Our Future?"
INTERACT WITH US! UCLAPUBLIC HEALTH
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You can learn about happenings at the school, participate in discussions on public health topics of the day or reconnect with former classmates and favorite faculty members through the school's Facebook group. In addition, alumni are invited to join the UCLA School of Public Health Alumni Network on the professional networking site Linkedin.
NEW CHAIR — Dr. Martin Iguchi, professor in the Department of Community Health Sciences, has been named department chair effective July 1, 2009. The current chair, Dr. Anne Pebley, returns to the school’s faculty, where she holds the Bixby Chair of Population Health.
on the road....again From the moment Dave Clark came to the UCLA School of Public Health as dean for student affairs a little more than a year ago, he has made it his business to break through the clutter in order to attract more students to the school. “My goal is not just to recruit students to UCLA, but to generate interest in public health itself,” says Clark. Armed with newly redesigned brochures, booth displays and presentation materials, Clark has logged 22,000 miles crisscrossing the country while attending more than 70 events, distributing nearly 3,000 brochures and sending more than 2,500 emails to prospective students at schools in California and out of state as he delivers his message about the importance of public health and the benefits of a UCLA degree. The approach has paid off: The school has seen an 18 percent increase in applications over the last year. The way Clark sees it, the more public health professionals, the better off everyone will be.
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Breslow Student Fellowship Fund Established THE UCLA SCHOOL OF PUBLIC HEALTH has launched the Lester Breslow Student Fellowship Fund to honor the career of the school’s esteemed dean and professor emeritus. The fund will increase the School of Public Health’s capacity to offer critical support for its students and is part of the UCLA-wide fundraising effort aimed at doubling the amount of endowed funds dedicated exclusively to aiding students. Beloved by students, alumni and faculty, Breslow is a pillar of the public health community. He served as dean of the school from 1972 to 1980, and is internationally recognized as a leader in disease prevention and health behavior intervention. He served as director of public health for the State of California and as president of the American Public Health Association. He is the recipient of the coveted Lasker Award, recognizing extraordinary achievement in health and medical science knowledge and practice. With proceeds from this year’s Lester Breslow Lecture, and the support of so many generous donors (including leadership gifts from Dr. Jonathan Fielding, Dean Linda Rosenstock, Peter Reed and the Center for Health Improvement), the fund is well on the way to the goal of $250,000. For more information on the Lester Breslow Student Fellowship Fund, please contact the UCLA Development office at (310) 825-6464 or email maubrey@support.ucla.edu.
Dr. Lester Breslow with wife Devra Breslow
WOULD YOU LIKE TO HONOR A FAVORITE FACULTY MEMBER? You may not know that you can make a contribution directly to any of the funds listed at the right. Here is a partial list of the School of Public Health’s special funds and their purpose:
ABDELMONEM A. AFIFI FELLOWSHIP Created to honor faculty member and former SPH dean Abdelmonem Afifi, this fund is awarded to students who exemplify academic excellence in Biostatistics. LESTER BRESLOW LECTURE FUND The Lester Breslow Fund supports the Breslow Lecture in honor of the internationally recognized professor emeritus and former SPH dean Lester Breslow. The lecture furthers the School’s educational mission each year via a special evening that includes a nationally recognized keynote speaker and the new members to the SPH Alumni Hall of Fame.
BEVERLEE MYERS FUND This fund was created by Dr. Myers’ widower in 2007 to honor his late wife. Beverlee Myers served for many years at the helm of the
RUTH ROEMER AWARD Ruth Roemer was a nationally known public health advocate and an SPH faculty member for more than 40 years. As a lawyer and an educator, Roemer had a profound effect on public health policies and was an effective and tireless advocate for health issues worldwide. The award is given to an SPH student who exemplifies academic excellence and demonstrates an interest in social justice. DEAN’S OUTSTANDING STUDENT AWARD Established by Dean Linda Rosenstock, this fund supports the most outstanding student in each of the five departments of the School of Public Health. For more information on giving to these or other SPH funds, visit www.ph.ucla.edu/giving or call (310) 825-6464.
UCLAPUBLIC HEALTH
HAGIGI FELLOWSHIP IN HEALTHCARE ACCOUNTING AND FINANCE The Hagigi Fellowship fund was created by Department of Health Services professor Fred Hagigi to support students who anticipate working in the healthcare accounting and finance field.
Department of Health Services and had great impact on the field of public health nationally. The award is given to a Department of Health Services student who exemplifies academic excellence and demonstrates an interest in social justice.
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honor roll 2008 THE UCLA SCHOOL OF PUBLIC HEALTH IS PLEASED TO HONOR our alumni, friends, students, staff and foundation and corporate partners whose generosity strengthens our School and keeps us at the forefront of public health education. This Honor Roll gratefully acknowledges gifts and private grants made to the School from January 1, 2008, to December 31, 2008. Although space limitations allow only the listing of donations of $100 or more, contributions of every amount are of great importance to the School and are deeply appreciated. GIFTS FROM INDIVIDUALS AND FAMILY FOUNDATIONS $75,000 - $99,999 CHARLOTTE AND ALFRED NEUMANN $10,000 - $24,999 SHIRLEY AND RALPH SHAPIRO PALMELA AND FRED WASSERMAN THE DAUER FAMILY JOANNE AND EDWARD DAUER DRABKIN FAMILY FOUNDATION, INC. $5,000 - $9,999 LINDA ROSENSTOCK AND LEE E. BAILEY JACQUELINE B. KOSECOFF AND ROBERT H. BROOK MICHELE DILORENZO CYNTHIA HARRELL HORN AND ALAN HORN DEBORAH A. LEVY AMY AND RICH LIPELES DEAN HANSELL AND JASON MURAKAWA EDWARD J. O’NEILL JANET AND THOMAS UNTERMAN CYNTHIA SIKES YORKIN AND BUD YORKIN LORRAINE AND JERRY FACTOR JANET WELLS-KAHANE AND STEPHEN KAHANE CAROLBETH AND LESTER KORN CORNELIA AND KENNETH LEE
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$2,500 - $4,999 ALLISON AND LAUREN DAUER JANICE AND BENEDICT SCHWEGLER MARIANNE AND ABDELMONEM AFIFI $1,000 - $2,499 SANDRA NAFTZGER AND JEFFREY DRITLEY JUDY HWEE AND GREGORY A. MAGLINTE LORI AND DANIEL PELLICCIONI JEAN AND BARRY SCHUYLER LYNNE APOSTLE AND ROBERT SCOFIELD HARRIET J. SCHARF AND BART B. SOKOLOW CARISSA AND JACK SCHLOSSER MARSHA AND IRA ALPERT KAREN L. MITCHELL AND MICHAEL D. COLLINS DAVID CLARK AND SAMUEL J. ELIAS
LAUREN W. WILSON FRANCESCO FEDERICO HILARY AND PETER GODWIN JENNIE AND RAYMOND JING CAROLYN F. KATZIN JOANNE AND MARC MOSER SUZANNE AND STUART SCHWEITZER LATIFEH AND FARHAD HAGIGI JUDITH AND DONALD LORACK DEVRA AND LESTER BRESLOW AND
$ 5 00 - $ 9 9 9 KAREN AND GREGORY BRODY MARGARET H. LEE AND DONALD S. CHANG KRISTEN I. HEMENEZ AND JAMES J. CLARK JOYCE AND GAROLD FABER PHYLLIS AND THOMAS FARVER RITA FLYNN AND RALPH FRERICHS PATRICIA AND THOMAZ GANZ HAZEL AND M. ALFRED HAYNES RURI AND GORDON HONDA BARBARA R. VISSCHER AND FREDRICK H. KAHN KARLENE AND MASAO KOKETSU KATHERINE DESMOND AND THOMAS H. RICE CORNELIA DALY AND ARTHUR SOUTHAM CHARLANN AND JOSEPH VANDER PLUYM ROSHAN AND SHAROK BASTANI JUDY AND ARTHUR WINER MIKA AND WILLIAM MEIERDING SANDRA AND CHARLES ARONBERG MARY AND ROGER DETELS LAURA AND RICHARD JACOBS $250 - $499 DIANA AND GERALD BOROK CLAIRE AND RALPH BRINDIS WEN LU AND HE PING CHANG JUNA AND GLENN CHIANG HELEN AND GUS DALIS BETH AND AVRAM KAPLAN MELODYE AND LEONARD KLEINMAN SARAH AND CONRAD NEWBERRY MARGARET AND GEORGE SAUNDERS
MARIAN AND ANTHONY SCHIFF FROUKJE AND CLIFFORD SMITH GENEVIVE AND CITRON TOY ANONYMOUS ANONYMOUS ARLENE G. FINK AND JOHN C. BECK MARGARET AND ROBERT BECK ELLIE AND GEORGE BERNARD WILLIAM J. RESNICK AND DOUGLAS L. CORDELL GISELA LESIN AND JEFFREY E. FRIEDMAN GAIL HARRISON AND OSMAN GALAL SARAH ANDERSON AND MATTHEW KAGAN LAURIE AND GERALD KOMINSKI JANE AND RICHARD LOPATT LYNZEE KLINGMAN AND RICHARD I. PEARCE ANTONIA AND H. JEFFREY ROSTAMI HOORI AND CHARLES SADLER., JR. KARINN AND TODD SAMMANN ELLEN MERCIER AND JOSEPH SCHIRRIPA BARBARA J. KOMAS AND GARY J. SLOAN RONDA AND DAVID SOLOMON JOYCE AND ALFRED SOMMER KAREN A. ZOLLER AND DAVID B. TILLMAN MARY AND RICHARD VANIS FLORENCE AND SHEN WANG DALE AND STEVEN WRIGHT CAROLYN A. MENDEZ-LUCK AND JEFFREY LUCK KARIN AND JONATHAN FIELDING ELIZABETH AND BENJAMIN NEUFELD NINEZ A. PONCE AND ROBERT NORDYKE MIRIAM LAUGESEN AND ANDREW SABL JOAN AND ARNOLD TRAVIS DONELL AND RAPHAEL COHEN MICHELE AND SCOTT LAYNE $100 - $249 LILLIAN L. LOU AND JOSEPH AFONG DIANE AND SUDHIR ANAND DIANE AND RONALD ANDERSEN
SANDY AND KENNETH BLEIFER SUZANNE AND WAYNE BUCK JENNIFER AND JOSHUA BURNAM LESLIE AND RICHARD CHEW ALICE AND HUNG CHU VIRGINIA AND WELDEN CLARK KATE E. LANXNER AND MICHAEL C. COSTANZA LAUREL AND DAVID DOLAN MEREDITH AND SAM ELROD ST. CLAIRE AND HENRY FOSTER KATHY AND MARC FRIEDMAN FRANCINE M. COEYTAUX AND DAVID L. GLANZMAN LYNN AND JOSEPH GOETZ SARAH AND DONALD HARLAN, JR. ELIZABETH AND ROBERT HERRICK MARYANN AND JAMES HOOK JOYCE AND TAE HWANG MARLENE AND JOSEF KAMIENNY JANET AND ALEXANDER KIRKPATRICK ELAINE AND STANLEY LEMESHOW JEN-MEI AND KUNG-JONG LUI SANDRA JACOBY KLEIN AND DONALD A. MC CALLUM EMILY AND JUAN MONTES NNEKA AND NDUKWE ODELUGA GENELLE AND FRANCIS PALMER NORMA AND ERNESTO PARRA JYOTI AND PRANAV PATEL LAUREL AND ERIC RABJOHNS ANN P. GARBER-RIMOIN AND DAVID L. RIMOIN JANE AND SHOLOM ROSEN DOLORES AND TAL ROSS DOROTHY AND CURTIS ROZAS CHLOE AND LARRY RUBENSTEIN CONNIE AND ROBERT SANCHIS LESLIE AND KENNETH SATIN BHARTI AND HARSHAD SHETH MARGERY LACKMAN AND DANIEL F. SMITH STELLA AND GUY SOOHOO ANNETTE AND ROBERT SWEZEY ALICE J. GLASSER AND JESSE E. THOMPSON, JR. LINDA AND ALBERT WANG
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FIRST CENTURY SOCIETY
LESTER AND DEVRA BRESLOW MARYAN G. BUNGA ANNE AND JOHN COULSON ROBERT AND DIANA GHIRELLI RAYMOND AND BETTY GOODMAN JOANNE JUBELIER AND JAMES ZIDELL GERALD KOMINSKI DAVID KRASNOW ANNE SULLIVAN REHER LIVIO AND JOSEPH LIVIO JEAN MICKEY JEANNETTE OREL JOYCE PAGE JEAN SANVILLE GURDON AND MARY ANN SMITH SUEBELLE AND DAVID VERITY
KIM LYNN
DAVID MOSEN NEVILLE OSTRICK
AND
AND
KARIE
AND THEODORE SHORACK
LAURIE R. GOODMAN AND DONALD E. SPETNER JACQUELYN F. KASTER AND PAUL R. TORRENS HAE-PYNG AND JUINE-KAI TSANG JENNIFER AND FRANK KOZAKOWSKI JOANNE AND KENNETH WEINMAN JUANITA B. GONZALEZ AND YASSER AL-ANTABLY IOWA FOUNDATION FOR EDUCATION, ENVIRONMENT AND THE ARTS (ANNE COLEMAN AND THOMAS BELIN) DIANA AND JOE HILBERMAN HSIUCHIN AND TEV-HUANG HSIEH CAROLYN AND DONALD HUNSAKER, JR. EILEEN AND ROBERT PLOURDE LISA A. RUSSELL AND JOSHUA A. REILLY MARIA A. TORRES-RIOS AND RICHARD RIOS ELIZABETH AND BRANT SHELOR HELENE AND IRA SMITH DIANA AND ROBERT GHIRELLI MARGARET TUOHY AND DEREK SHENDELL
CORPORATE AND FOUNDATION GIFTS AND GRANTS $1,000,000 A N D A B O V E FRED H. BIXBY FOUNDATION THE ROBERT WOOD JOHNSON FOUNDATION $250,000 - $999,000 BLUE SHIELD OF CALIFORNIA RESEARCH & EDUCATION FOUNDATION THE CALIFORNIA ENDOWMENT UNIHEALTH FOUNDATION $100,000 - $249,999 THE BREAST CANCER RESEARCH FOUNDATION CALIFORNIA HEALTHCARE FOUNDATION THE CALIFORNIA WELLNESS FOUNDATION JOHNSON & JOHNSON MAGEE-WOMENS HOSPITAL, RESEARCH INSTITUTE & FOUNDATION RAND CORPORATION $50,000 - $99,999 AMERICAN PSYCHOLOGICAL ASSOCIATION ENERGY NETWORKS ASSOCIATION, LTD. PREVENTION INSTITUTE MAYO CLINIC THE SUSAN G. KOMEN BREAST CANCER FOUNDATION $25,000 - $49,999 AETNA FOUNDATION INC. FRED HUTCHINSON CANCER RESEARCH CENTER NSABP FOUNDATION, INC. $10,000 - $24,999 AEROSOL DYNAMICS INC. CALIFORNIA COMMUNITY FOUNDATION (SHIRLEY SHAPIRO AND RALPH SHAPIRO, JD). KAISER FOUNDATION HEALTH PLAN INC. WILSHIRE FOUNDATION, INC. PFIZER INC. SPECIAL SERVICES FOR GROUPS
$5,000 - $9,999 CALIFORNIA COMMUNITY FOUNDATION (JANET AND THOMAS UNTERMAN FAMILY FOUNDATION) CEDARS-SINAI MEDICAL CENTER DANA FARBER CANCER INSTITUTE JEWISH FEDERATION FOUNDATION (AMY AND RICHARD LIPELES PHIL FUND) THE ROSE FOUNDATION UNITEDHEALTHCARE SERVICES, INC. $1,000 - $4,999 AMGEN FOUNDATION INC. CALIFORNIA COMMUNITY FOUNDATION (DRITLEY FUND) COLE-BELIN EDUCATION FOUNDATION IOWA FOUNDATION FOR EDUCATION, ENVIRONMENT AND THE ARTS L.A. CARE HEALTH PLAN LAKESIDE HEALTHCARE LVMH FASHION GROUP AMERICAS, INC. $500 - $999 ASPEN ENVIRONMENTAL GROUP COMMUNITY FOUNDATION SILICON VALLEY (MASAO AND KARLENE N. KOKETSU FOUNDATION) HAYNES REVOCABLE TRUST GANZ REVOCABLE TRUST HORIZON RESEARCH ROLL GIVING SCHWAB CHARITABLE FUND (ARONBERG FAMILY CHARITABLE FUND) $100 - $499 BP FABRIC OF AMERICA FUND CITIZEN HEALTH, INC. COMMUNITY PARTNERS EXCEL RESEARCH LLC FIDELITY CHARITABLE GIFT FUND (D. PETER DROTMAN FUND) FIDELITY CHARITABLE GIFT FUND (SAMMANN FAMILY FUND) FIDELITY CHARITABLE GIFT FUND (JUDITH SIEGEL FUND) H. P. CHANG, MD, INC.
It is important to us that we acknowledge your gift properly. Every effort has been made to ensure the completeness and accuracy of this Honor Roll. Please let us know of any omissions or errors in listing your name or gift by calling (310) 825-6464.
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NAOMI S. ROSEN AND BRYAN C. WEARE LINDA AND H. STEPHEN WILLIAMS CONSTANCE H. FUNG AND HAWKIN WOO DANNI BAYLES-YEAGER AND MATT A. YEAGER DENISE L. PERPICH AND JOHN C. BROWN GISKE URSIN AND BRUNO R. GERARD ROCHELLE AND DANIEL GREEN MARILYN AND MARTIN LEE ANN AND JOHN NEWPORT JEANNE M. BERTOLLI AND THOMAS A. PETERMAN SUEBELLE AND DAVID VERITY FREDRIKA AND JERRY SHAPIRO ELLEN AND PAUL ALKON DORIS AND JAMES ARTERBURN MEGAN AND ANDREW AUBREY GWENDOLYN AND HENRY BAKER BETSY FOXMAN AND MICHAEL L. BOEHNKE MARY AND MARTIN CARR, JR. CHERYL M. THOMPSONCROWE AND STEVEN D. CROWE BRIGITTE M. DEWEZ AND J. DAVID FOXMAN FRANCINE AND NEAL KAUFMAN KATHLEEN AND GEYERGY KUILANOFF
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UCLA’s distinguished First Century Society honors alumni, faculty, staff and friends who have chosen to benefit UCLA through a will, living trust, charitable remainder trust, charitable gift annuity, retirement plan, or other estate planning arrangement. The members share a strong common bond of generosity that ensures the university’s continued excellence well into the future. The School of Public Health gratefully acknowledges the philanthropic leadership and foresight of the following First Century Society members who have included the School of Public Health in their estate plans:
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Commencement
2009 Dr. Benjamin Chu, regional president of Kaiser Permanente Southern California, is the featured speaker at the school’s 2009 Commencement.
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