UCLA Public Health Magazine - June 2007 by UCLA Fielding School of Public Health

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JUNE 2007

UCLA

PUBLIC HEALTH INFECTIOUS DISEASES:

UCLA

Stepping up the Fight Against Emerging Threats

School of

Public Health

The increase in asthma has raised many questions, such as why some communities are more affected than others. Alex Ortega is pursuing answers.

While continuing basic studies that explain how lead exposure can interfere with children’s cognitive functions, Hilary Godwin is taking her findings public.

Kunchok Gyaltsen found that merely treating patients didn’t fit with his Buddhist values. So the Tibetan physician came to UCLA to learn public health.

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UCLA

PUBLIC HEALTH

Gene Block 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

Ralph Frerichs, D.V.M., Dr.P.H. 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. Adjunct Associate Professor, Community Health Sciences

Olivia Ross President, Public Health Student Association

Christopher Mardesich, J.D., M.P.H. â&#x20AC;&#x2122;98

UCLA

President, Alumni Association

School of

Public Health

Alumni Hall of Fame: the 2007 Inductees

6 Emerging Infectious Diseases Developing better ways to detect pathogens before they wreak havoc could be the key to staving off the next pandemic. The school is taking a leadership role in a coordinated effort.

ging ous es

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Hilary Godwin: Preventing Children from Being Lead Astray

Eliminating Health Disparities

in every issue 25 RESEARCH

12 Her molecular studies have shown how exposure to the metal can produce cognitive deficits in children. As a newly recruited public health faculty member, she intends to work with communities to prevent these toxic effects.

Animal-to-human viral transmission…flawed child health system…vitamin E and diabetes…lower thresholds for chronic disease…emergency risk communications…locallevel health estimates.

20 14

Childhood Asthma Missed school. Hospitalizations. Emotional distress and physical discomfort. SPH faculty, students and alumni tackle the reasons for asthma’s rise – and the disproportionate burden carried by certain communities.

As befits its title, the Center to Eliminate Health Disparities doesn't stop at identifying problems; working with the affected communities, it intends to get rid of them.

29 STUDENTS 32 NEWS BRIEFS 33 FACULTY 35 FRIENDS

ON THE COVER Once thought to be a shrinking threat, infectious agents are now a critical global health concern. Major efforts are afoot to improve the ability to predict and prevent emerging diseases. Cover photo illustration: Martha Widmann

PHOTOGRAPHY Dr. Lawrence Ash / p. 11: B. procyonis insets ASUCLA / TOC: Hall of Fame; p. 4; p. 32: Breslow lecture; p. 33: Clinton initiative signing Courtesy of Kunchok Gyaltsen / Cover: Gyaltsen; p. 30 Lisa Hancock / p. 16 Reed Hutchinson / cover: Ortega, Godwin; TOC: Godwin; pp. 8, 12; p. 15: Ortega; p. 17; p. 20: Bastani; p. 23:Yancey; p. 24: Mistry; p. 31; p. 32: Salud; p. 33: Lewis lab tour, Godwin

Courtesy of Dr. Anne Rimoin / Cover: monkeypox; pp. 6-7 Courtesy of Dr. Nathan Wolfe / Cover: vial; TOC: diseases; p. 10; p. 11: hunter Courtesy of Dr. Steven Wallace / p. 28 Courtesy of UCLA School of Public Health / p. 2; p. 33: Sonego, Wolfe; pp. 34, 37; back cover Getty Images © 2007 / TOC: disparities; p. 20: disparity photo-illustration; p. 26 iStockphoto © 2007 / Cover: mosquito/virus/chicken/flask/globe; p. 11: raccoon; pp. 14-15: asthma insets; boy with atomizer, traffic, doctor visit; pp. 20-24: puzzle images

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 2007 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 PUBLIC HEALTH CONTINUES to receive unprecedented media attention, we are reminded that our field doesn’t recognize borders or boundaries. From recent headlines, people are learning what we’ve always known – an infectious disease identified in one person can reach a global audience over the course of a few short hours through the ease of air travel. We also know that the reason we are forced to follow the international flight path of one person infected with drug-resistant tuberculosis and all those he encountered is that somewhere along the way, health policies broke down. Our work in the field of public health has never been more vital – or had such a far reach. As public health’s focus becomes more global, our role as educators of the next public health workforce must broaden to encompass a global landscape. The School of Public Health has made great strides over the past several years recruiting infectious disease and global health policy experts to join our faculty. You’ll read of two new hires in our new-faculty section and get a closer look at one through our faculty profile on page 12. We continue to focus energy and resources into recruiting top-notch faculty because we understand the importance of providing our students with access to the best and brightest scientists in the ever-evolving field of public health. Securing funding to recruit new faculty and support our students is an important role for the school. As you’ll see in the accompanying chart, we continue to be successful in our endeavors. As of early June, this year’s total receipt of contracts and grants exceeds $71 million. This jump in funding reflects the momentum of an exciting new project the school is undertaking. The U.S. Department of Defense has awarded $12 million to date and we have also received a $9 million grant from California’s Office of Homeland Security to build the first high speed, high volume infectious disease laboratory network of its kind. This is a major undertaking that will enable real-time surveillance of infectious diseases on a global scale. We have tapped many of our nation’s experts on infectious diseases and laboratory science to serve on

UCLAPUBLIC HEALTH

a Scientific Advisory Board, helping to ensure that we create a facility that

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3 2006-2007 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) 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 * Walter Oppenheimer Monica Salinas Fred W. Wasserman * Pamela K. Wasserman * Cynthia Sikes Yorkin

will be a key national and international resource. To that end, we were honored when the NIH recently named the school a Center of Excellence for Influenza Research. My message is focused on our global work, but that doesn’t diminish the importance of the work we are doing to serve our local communities. In this issue you will also read about the work our new Center to Eliminate Health Disparities is doing to not only understand why health disparities exist, but find real solutions to level the playing field. When I think about all the work of our faculty and students and the global reach of public health I’m reminded that public health really isn’t about the public at all – it is about you, it is about me, it is about all of us.

Linda Rosenstock, M.D., M.P.H.

*SPH Alumni

Dean

$72.1 M*

$47.9 M

CONTRACT & GRANT AWARDS

$42.7 M $40.7 M

$38.2 M

$29 M

$19.2 M

$18.2 M $15.9 M

Federal

1997-98 State

$17.3 M

1998-99 Other

1999-00

2000-01

2001-02

2002-03

2003-04

2004-05

2005-06 *year-to-date

2006-07

UCLAPUBLIC HEALTH

1996-97

$27.1 M

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alumni hall of fame: the 2007 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 2007 inductees, recognized at the Breslow Lecture and Dinner on March 1, exemplify the school’s commitment to teaching, research and service.

UCLAPUBLIC HEALTH

2007 Hall of Fame inductees (l. to r.) Michele Yehieli, Paula Diehr and Jean Le Cerf Richardson

PAULA DIEHR, M.S. ’67, Ph.D. ’70 An educator and researcher whose talent has made her a pioneer in the field of public health, Diehr has established herself as a biostatistician and public health professional and is recognized as an outstanding teacher who has mentored a generation of public health students. As a professor with joint appointments in the departments of Biostatistics and Health Services at the University of Washington, Diehr has excelled in her research contributions and has contributed to the academic vigor of her students. Her focus is primarily in health services research, with special emphases on mental health services, various insurance and provider plans, health status, health promotion evaluation, health services for older adults, the uninsured, utilization and cost of health services, survey methods, community-based analyses, and years of quality living. She published recently on the topic of obesity, survival and years of healthy life for older adults. With nearly 200 peer-reviewed publications, Diehr shines as a creative source for new information in public health. Diehr’s leadership and scholarship have won her widespread recognition. She was elected Fellow of the American Statistical Association for her contributions to statistical research, teaching and applications. She has served as member or chair of a number of influential local, regional, and national committees. She was also elected Fellow of the Association for Health Services Research and Fellow of the American Association for the Advancement of Science, and has served on the editorial boards of prestigious journals such as the Annual Review of Public Health, Health Services Research, and Statistics in Medicine.

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MICHELE YEHIELI, M.P.H. ’89, Dr.P.H. ’95 Yehieli, associate professor in the Division of Health Promotion and Education at the University of Northern Iowa, has worked for more than two decades around the world with nonprofits, government organizations, clinics, and private corporations in public health positions serving at-risk individuals and communities. In 1996, she created the Global Health Corps, a model experiential learning organization that has trained 400 students in the provision of culturally appropriate health care. Based at the University of Northern Iowa, the Global Health Corps has provided culturally appropriate public health programs for more than 40,000 diverse and underserved persons throughout the United States, Africa, Eastern Europe, Asia, and the Caribbean. With funding from the National Institutes of Health, Yehieli founded the Iowa EXPORT Center of Excellence on Health Disparities in 2003, the only such organization in the state devoted to promoting health equity among immigrant, refugee, minority and rural populations. The center conducts applied research, education, training, and outreach activities with health organizations that serve patients from multiple ethnic backgrounds. Yehieli has received numerous local, state and national honors for outstanding teaching, scholarship and service in health and human rights. She has published six books, several chapters, and more than 70 peer-reviewed journal and lay articles. Many of her publications focus on cultural patterns, health practices and underlying belief systems of underserved groups. Yehieli regularly works with dozens of special populations in Iowa, such as Bosnian refugees, the Amish, and Latino immigrants, and she speaks Hebrew, Mandarin Chinese and German. She is also chair of the Black Hawk County Board of Health.

hall of fame

JEAN LE CERF RICHARDSON, M.P.H. ’71, Dr.P.H. ’80 For more than 25 years, Richardson has been a prolific researcher and educator who has made widely acknowledged scientific contributions in the area of disease prevention. She is professor of preventive medicine in the USC Keck School of Medicine and the Institute for Prevention Research, and co-director of the Cancer Control Program of the USC Norris Comprehensive Cancer Center. Richardson’s current work includes an intervention study to decrease unsafe sexual behavior and increase adherence to therapy among persons with HIV disease and an investigation of the psychological and behavioral factors in HIV infection among women. Prior studies have included intervention research to increase cancer screening of twins, to reduce household allergen exposure for children with asthma, and to increase compliance with cancer chemotherapy. She has also examined the effect of child after-school supervision on substance use, depression and school achievement. Her research has wide applicability to important “real-world” problems for vulnerable populations. Richardson is a dedicated mentor to future public health professionals who has chaired and served on more than 30 dissertation committees. She has also mentored post-doctoral fellows and taught undergraduate students. She has served on committees of the American Cancer Society, the National Cancer Institute, and the Department of Defense. Richardson is dedicated to community service, having been on the boards and committees of programs to advance the health and well-being of youth.

PREVIOUS INDUCTEES 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, M.P.H. ’72, Dr.P.H. ’74 Virginia A. Clark, Ph.D. ’63 Francine M. Coeytaux, M.P.H. ’82 Suzanne E. Dandoy, M.D., M.P.H. ’63 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 Keith S. Richman, M.D., M.P.H. ’83 Pauline M. Vaillancourt Rosenau, M.P.H. ’92, Ph.D. 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

Please access information on 2008 nominations at www.ph.ucla.edu/alumni_hall.html or call (310) 825-6464. UCLAPUBLIC HEALTH

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6 D EVELOPING BETTER WAYS TO DETECT PATHOGENS BEFORE THEY WREAK HAVOC COULD BE THE KEY TO STAVING OFF THE NEXT PANDEMIC .

T HE

SCHOOL

IS TAKING A LEADERSHIP ROLE IN A COORDINATED EFFORT.

Emerging Infectious Diseases: Toward a System of Prediction and Prevention What have been the biggest mass killers

“The perception of infectious diseases being a threat only to those in poor nations is misguided. Public health isn’t about other people; it’s about us.”

UCLAPUBLIC HEALTH

— Dr. Linda Rosenstock

in human history? Dr. Jared Diamond, Pulitzer Prize-winning author of Guns, Germs and Steel: The Fate of Human Societies and a member of the UCLA School of Public Health faculty, suspects most people would be surprised by the answer. “We tend to think of wars, but in fact the biggest mass killers have been infectious diseases,” Diamond says. “When Europeans came to the New World, what killed 95 percent of Native Americans were germs, not dying on the battlefield. After World War I, the influenza epidemic was the biggest in history. And in recent times you’ve had the AIDS epidemic. What scares us today is the possibility of more emerging diseases.” Once lulled into a false sense of security by the eradication of smallpox and successes against the likes of malaria and tuberculosis, health leaders are increasingly recognizing that infectious disease outbreaks are not merely a thing of the past, but play a big part in our present and future. The message has been loud and clear in the new century, which has seen diseases previously thought to be under control resurfacing as major problems at the same time that ominous new threats are emerging.

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es: Dr. Anne Rimoin heads the first study to examine dramatic changes in the epidemiology of monkeypox and viral hemorrhagic fevers over the last 20 years in the Democratic Republic of the Congo.

James W. LeDuc, M.S.P.H. ’72, Ph.D. ’77 LeDuc, currently director of global health at the University of Texas Medical Branch in Galveston, spent more than a decade working at the Centers for Disease Control and Prevention (CDC) in Atlanta. There, he helped to craft the global agenda on emerging diseases as a CDC liaison assignee to the World Health Organization, coordinated CDC’s global engagement with scientists from around the world in his position as associate director for global health, and led efforts to control outbreaks of Ebola, Marburg, SARS and monkeypox as director of the division of viral and rickettsial diseases. Perhaps his most challenging assignment was as the agency coordinator for influenza preparedness, a job that brought LeDuc face to face with national leaders and members of Congress eager to be assured that the nation was prepared for the possibility of a global pandemic. “Helping in some small way with the global eradication of polio, the elimination of measles and preparing the nation against the threat of bioterrorism brought satisfaction and a sense of purpose unmatched by any position I have known,” LeDuc says. “I am thankful to the CDC for allowing me to be part of the action, and to the UCLA School of Public Health for preparing me for the challenges and opportunities I faced.”

UCLAPUBLIC HEALTH

Given changing conditions such as more crowded living circumstances and increased travel, new infectious diseases can wreak unprecedented havoc if they aren’t detected quickly – a real possibility at a time when there aren’t enough laboratories to process the volume of suspicious samples collected by public health workers around the world, and when the ability to identify, evaluate and forecast infectious disease threats is limited. “We’re busy looking for life outside of our planet, but we’ve got aliens everywhere, surrounding us,” says Dr. Nathan Wolfe, professor at the school. “We know virtually nothing about the diversity of viruses. If you were trying to predict earthquakes before plate tectonics, that’s where we are now in our ability to predict when and where infectious disease outbreaks are likely to occur.” The urgent need to address these concerns is one reason the school made global health one of its

In hindsight, the idea that infectious diseases could be relegated to the history books strikes Dr. Scott Layne, professor at the school and a longtime proponent of the new lab, as the ultimate in hubris. “Infectious agents reproduce approximately 100,000 times faster than humans, RNA viruses mutate 1,000 times faster than our DNA, and by using vaccines and antibiotics, we’re putting selective pressure on these agents, causing them to reproduce and evolve even more rapidly than they otherwise would,” says Layne. Nonetheless, 30 years ago it seemed to many leaders that the infectious disease threat was shrinking. Most of the major communicable diseases had been brought under control, or seemed headed that way as new weapons in the form of vaccines, drugs, and improved sanitation were applied. “It was thought that we had good drugs for tuberculosis, malaria, and other major infectious diseases, but we soon learned that many of these organisms had developed drug resistance and our tools for stopping them were becoming ineffectual,” says Dr. Roger Detels, dean emeritus, professor at the school and director of the UCLA/Fogarty AIDS International Training and Research Program, whose graduates include a number of leaders currently charged with managing outbreaks in Asia and other parts of the world. “In addition, we hadn’t experienced new organisms that cause pandemics for some decades. The HIV/AIDS epidemic was an eye-

cover story

top two priorities in the strategic plan put forth in 2002. Since that time, several faculty members who are leaders in global health and infectious diseases have been recruited – most recently Wolfe, who arrived from Johns Hopkins University last fall. And with federal and state support, the school has begun assembling the UCLA High Speed, High Volume Laboratory Network for Infectious Diseases. The state-of-the-art facility will be capable of analyzing thousands of biological samples, almost in real time. The goal is to cut months off the time it takes to deliver vaccines, and for the lab to become a core component of the most extensive infectious disease surveillance network in the world. (For more on the lab, see the sidebar on page 9.) “We recognize that in our increasingly global society, the perception of infectious diseases being a threat only to those in poor nations is misguided,” says Dr. Linda Rosenstock, the school’s dean. “Public health isn’t about other people; it’s about us.”

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“The stakes are much higher than ever before. We’re currently looking at the world through a pinhole camera. The high-throughput laboratory network will give us a bigger lens.” – Dr. Scott Layne

UCLAPUBLIC HEALTH

Dr. Roger Detels (right) heads the UCLA/Fogarty AIDS International Training and Research Program, whose graduates include a number of leaders charged with managing infectious disease outbreaks in Asia and other parts of the world.

opener, demonstrating that infectious diseases were far from eliminated. Then we had the SARS outbreak, followed by the more recent concern about an H5N1 avian influenza outbreak. Now we know that infectious diseases are persisting, and that there are going to continue to be new ones.” In many ways, the challenges in controlling outbreaks are far greater today. With globalization and ever-increasing air travel, infectious agents can quickly move from a remote corner of the world to the biggest population centers before being detected.

“Most infectious diseases have a period during which the individual is infected and shedding the agent, but has no symptoms,” Detels notes. “During that time a person can circumnavigate the globe.” Industrialization and crowding create additional concerns. Layne notes that world population is projected to grow by 2-4 billion between now and 2050. With farm animals likely to increase by tens of billions to sustain the additional people, the level of crowding will be unprecedented. Moreover, despite efforts to modernize, many parts of the world remain plagued by malnutrition, unclean water, inadequate sanitation, and a lack of public health infrastructure. It all adds up to fertile ground for the rapid spread of disease. Dr. Anne Rimoin, assistant professor at the school, heads the first study to examine dramatic changes in the epidemiology of monkeypox and viral hemorrhagic fevers over the last 20 years in the Democratic Republic of the Congo (DRC), working closely with the Congolese Ministry of Health. Rimoin points out that not long ago, officials believed monkeypox surveillance to be unnecessary. “They figured it was going to just die out as the population became more urban and less dependent on bushmeat, but in fact the opposite has occurred,” Rimoin says.

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New Infectious Diseases Lab Gains Momentum

A Scientific Advisory Board has been established for the lab. Members include: Nancy J. Cox, Ph.D., director of the Influenza Division at the Centers for Disease Control and Prevention and director of CDC’s World Health Organization Collaborating Center for Surveillance, Epidemiology and Control of Influenza. Margaret A. Hamburg, M.D., who previously served as vice president of biological programs at the Nuclear Threat Initiative (NTI) and now provides strategic advice and expertise to NTI as senior scientist. Virginia S. Hinshaw, Ph.D., provost and executive vice chancellor of UC Davis, and professor of virology in the School of Medicine and School of Veterinary Medicine. King K. Holmes, M.D., Ph.D., chair of the Department of Global Health and director of the Center for AIDS and STDs at the University of Washington, and head of infectious diseases at Harborview Medical Center. Peter B. Jahrling, Ph.D., chief scientist at the National Institute of Allergy and Infectious Diseases Integrated Research Facility and former principal scientific advisor at the U.S. Army Medical Research Institute of Infectious Diseases. Colonel George W. Korch, Jr., Ph.D., commander of the U.S. Army Medical Research Institute of Infectious Diseases, the Department of Defense’s only biosafety level 4 laboratory. David E. Swayne, M.D., director of the Southeast Poultry Research Laboratory of the U.S. Department of Agriculture, Agriculture Research Service – the USDA’s high biocontainment lab for research on exotic and emerging diseases of poultry.

Elizabeth Wagar, M.D., laboratory director for UCLA Clinical Laboratories, a network of five laboratories providing the full spectrum of services. Laurie Zoloth, Ph.D., director of the Center for Bioethics, Science and Society and professor of medical ethics and humanities at Northwestern University, Feinberg School of Medicine.

Ph.D. ’00 As director of the Field Epidemiology Training Program (FETP) for the Thailand Ministry of Public Health, Jiraphongsa was charged with epidemic control following the tsunami that struck in 2004; her program’s success can be measured in part by the lack of a major infectious disease outbreak following the natural disaster. Jiraphongsa, a graduate of the UCLA/Fogarty AIDS International Training Program, can point to her country’s response to SARS and its ability to stop the spread of avian influenza from poultry to humans as further examples of her program’s success. Since 1980, the FETP has trained more than 130 medical epidemiologists and conducted more than 300 investigations in response to emergencies. Jiraphongsa is thankful for her own training as her program confronts continuing challenges of building safeguards against H5 and pandemic flu in a nation where human and veterinary public health disease surveillance and response are still not well integrated, the underlying dynamics of disease transmission are not completely understood and dissemination of findings and recommendations is limited. “Studying at UCLA equipped me with good technical know-how in epidemiology and biostatistics, and gave me the benefit of exposure to many people from different cultures,” she says. “We still support each other.”

Nguyen Tran Hien, M.D., M.P.H., Ph.D. Since 2004, Hien has served as director of Vietnam’s National Institute of Hygiene and Epidemiology (NIHE). In addition to being a leading scientific research institute in epidemiology, medical microbiology, immunology and molecular biology, and vaccine development and production, NIHE provides technical advice to Vietnam’s Ministry of Health about strategies and measures for infectious disease prevention and control, and directs professional activities, postgraduate training and the building of a national preventive medicine network. Thanks to increased public health activities, Vietnam has seen a dramatic decline over the last decade in mortality and morbidity from a host of infectious diseases, including poliomyelitis, cholera, typhoid, shigellosis, pertussis, meningitis, diphtheria, measles, mumps, hepatitis, plague, rabies, and malaria. Other diseases, including HIV/AIDS, tuberculosis, dengue fever, encephalitis and rubella, remain major public health problems, and SARS and avian influenza emerged as new concerns in 2003 and 2004. “As a developing country with limited resources and expertise, Vietnam is facing many challenges in different areas in controlling emerging infectious diseases,” says Hien, who came to the school for his postdoctoral fellowship.

UCLAPUBLIC HEALTH

Jeffrey K. Taubenberger, M.D., Ph.D., senior scientist at the Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases.

Chuleeporn Jiraphongsa,

cover story

Momentum is building – both scientific and financial – for the new UCLA High Speed, High Volume Laboratory Network for Infectious Diseases, whose ultimate goal is to facilitate and enable real-time surveillance of infectious diseases on a national and international scale. The School of Public Health, which is spearheading the effort, has secured $21 million to date in federal and state funding for this global infectious disease laboratory network, garnering both bipartisan support in Congress and a $9 million investment by the State of California. “Core government support will get the lab up and running, but it is up to the school to help fully realize the potential of the lab,” says Dean Linda Rosenstock. To that end, the school has made a commitment through the Clinton Global Initiative to expand the program by an additional $20 million. The school is also seeking other private partners to help launch a Center to Combat Global Emerging Infectious Diseases, which will have the new lab as a core resource. Strong support in these efforts has come from the school’s Dean’s Advisory Board as well as from the Entertainment Industry Task Force, which includes advisory board members Cindy Horn and Cynthia Sikes Yorkin. At the Clinton Global Initiative 2007 Mid-Year Meeting in April, former president Bill Clinton praised the efforts of the school and the task force. “This is really important,” he said. “One of the challenges we face in the 25 countries where my foundations work to develop health care systems to diagnose, treat and care for people with HIV and AIDS is making sure we have sufficient lab capacities. If we had this sort of network it would obviate a lot of those needs.”

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Shira Shafir, M.P.H., Ph.D. ’06

Zunyou Wu,

UCLAPUBLIC HEALTH

MD., M.P.H. ’92, Ph.D. ’95 Wu, director of the National Center for AIDS/STD Control and Prevention at the Chinese Center for Disease Control and Prevention, has made significant contributions to the development of public health policies based on sound scientific principles to prevent HIV infection among the most vulnerable groups, including sex workers, drug users, former plasma donors, migrants, and men who have sex with men. In 1995, Wu first reported an HIV outbreak among commercial plasma donors in China. Since 1996, he has conducted a series of demonstration projects targeting sex workers that have led to the development of national guidelines for HIV prevention among sex workers and a national condom promotion program. His current challenge is to rapidly scale up overall responses to the HIV/AIDS epidemic in China, given great varieties in geography, population, and capacities. Although it has been more than a decade since he studied under Dr. Roger Detels in the school’s UCLA/Fogarty AIDS International Training Program, Wu says he continues to benefit from the experience. “Dr. Detels has provided me with continuing support since I graduated from UCLA in 1995,” Wu says. “He has supported me in conducting meaningful scientific research projects that have important public health policy implications. The findings from these projects have been translated into Chinese government public health policies in response to the HIV/AIDS epidemic.”

Baylisascaris procyonis, the common intestinal roundworm of raccoons, has increasingly been recognized as a source of severe human neurologic disease, particularly affecting children. When the eggs of B. procyonis are accidentally ingested, larvae emerge and migrate through the body, often infecting the brain. While human baylisascariasis appears to be rare, it is untreatable and most cases have resulted in either death or permanent neurologic damage. Adult raccoons infected with B. procyonis can shed millions of unembryonated eggs in feces daily; once infective, eggs can remain viable in the environment for years and are highly resistant to most decontamination methods. “Given the severe and untreatable nature of baylisascariasis, the hardy nature of B. procyonis eggs and the possible use of B. procyonis as a bioterrorism agent, baylisascariasis is a disease of public health importance, and information on approaches to inactivating B. procyonis eggs is needed,” says Shafir, a postdoctoral fellow in the school’s Global Health Training Program. Shafir and Dr. Frank Sorvillo, also an alumnus and faculty member in the school’s Department of Epidemiology, are working on optimal methods to inactivate B. procyonis eggs. They are also collaborating with CDC on the development of a serologic test to provide a method of diagnosis.

“Our research has shown that if you look in the right places, you will find these new viruses crossing over, and our argument is that’s exactly what you need to do to predict the next major pandemic.” — Dr. Nathan Wolfe In poor countries, she notes, it can be difficult to ensure the level of infectious disease reporting necessary for proper surveillance. “It’s hard to convince people to make reporting a priority when they’re busy saving lives,” Rimoin says. “Our job is to help people understand why disease surveillance is so important even though they might not see immediate results.” Rimoin’s work in the DRC is further complicated by logistical challenges. Getting supplies into the field is often no easy feat. “Everything always takes longer than you would expect,” she says. Ironically, she notes, “despite all of the advances in infectious disease surveillance capabilities in the laboratory, my work is the same as it would have been 50 years ago: getting village volunteers to report, and dealing with issues like how you collect and preserve biological specimens in a place where you have no electricity, no running water and are two days from the closest refrigeration source.” The potential for new infectious diseases to emerge is heightened by changes in the interface between humans and wild animals resulting from higher population density, increased and more rapid long-distance travel, and deforestation. While it was once believed that cross-species viral transmissions were rare, Wolfe’s research has been instrumental in changing that thinking. Beginning in the late 1990s, he and his colleagues went to the Central African rainforest of Cameroon – where HIV is believed to have originated – and developed a methodology that allowed subsistence hunters to preserve blood smears from the animals they butchered. Wolfe’s team collected these samples, along with samples of the hunters’ own blood for comparison. In a much-publicized paper published in The Lancet in 2004, Wolfe and colleagues provided the first evidence that retroviruses – such as HIV – could cross directly from jungle primates to indigenous hunters. In May of this year, the journal Nature published an analysis by Wolfe and Diamond in which they found that most of the important diseases in human history originated in animals (see page 25).

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How different would the AIDS epidemic have been with 3-5 years of advance warning? Wolfe likens what he calls the current “fire brigade” mentality for responding to potential pandemics with where cardiology was in the 1950s. “In 20 years, people will look back and say we were just waiting for the heart attack and then trying to manage it,” he says. “We need to move toward a system of prediction and prevention.” The school’s infectious disease experts – buoyed by the public and private supporters who are helping to make possible the new UCLA High Speed, High Volume Laboratory Network for Infectious Diseases – are united in that conviction. Getting to that point,

11 they say, will require a better understanding of how new outbreaks emerge, the establishment of a coordinated system of surveillance and worldwide sample collection, high-throughput laboratory testing, and information analysis using supercomputers. Layne, like Wolfe, has long been convinced that the current infectious disease surveillance system is outdated. “We need the ability to get more comprehensive information, and get it faster,” he says. The new lab is initially focusing on influenza, but the goal is that eventually the strategy will be applied to other infectious diseases, and that additional laboratories throughout the world will join the network. Influenza is the obvious place to start. Worldwide, flu epidemics are responsible for up to 1 million deaths each year. The first wave of a pandemic could claim millions of lives within weeks, Layne says. In 1918, such a pandemic killed as many as 50 million people, the biggest infectious disease catastrophe on record. Historically, Layne notes, we’re overdue for another, but a proactive system such as that envisioned for the new laboratory network could stop it. “The stakes are much higher than ever before,” says Layne. “We’re currently looking at the world through a pinhole camera. The high-throughput laboratory network will give us a bigger lens.”

Below: Baylisascaris procyonis, the common intestinal roundworm of raccoons, has increasingly been recognized as a source of severe human neurologic disease, particularly affecting children. Two SPH alumni are working on optimal methods to inactivate B. procyonis eggs (see page 10).

UCLAPUBLIC HEALTH

Left:The potential for new infectious diseases to emerge is heightened by changes in the interface between humans and wild animals.While it was once believed that cross-species viral transmissions were rare, the research of Dr. Nathan Wolfe, professor at the school, has changed that thinking.

cover story

With a $2.5 million award from the National Institutes of Health, Wolfe has assembled a network of field sites in tropical parts of Central Africa, Southeast Asia and South America to study agents at the interface between humans and animals, and to monitor the cross-species transmissions for the emergence of new diseases. “Our research has shown that if you look in the right places, you will find these new viruses crossing over,” Wolfe says, “and our argument is that’s exactly what you need to do to predict the next major pandemic.”

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12 H ER

MOLECULAR

STUDIES HAVE SHOWN HOW EXPOSURE TO THE METAL CAN PRODUCE COGNI TIVE DEFICITS IN CHILDREN .

NEWLY RECRUITED PUBLIC HEALTH FACULTY MEMBER , SHE INTENDS TO WORK WITH COM MUNITIES TO PREVENT THESE TOXIC EFFECTS .

Hilary Godwin:

Preventing Children from Being Lead Astray At the highest levels of academia,

departments of physics, chemistry

and engineering remain sparsely populated with women. For Hilary Godwin, there was never any doubt where she would end up. Raised in a family of scientists, her research career began in grade school, when

UCLAPUBLIC HEALTH

she would spend her summers assisting her biologist father on his studies. “In science you spend your life constantly learning and doing new things,” she says. “We’re on the steep part of the learning curve. That’s very rewarding.” After earning her Ph.D. in chemistry at Stanford and completing a postdoctoral fellowship at Johns Hopkins University School of Medicine, Godwin in 1996 became the first female faculty member of the Chemistry Department at Northwestern University. She was serving as chair of the department when she was recruited last year to join the UCLA School of Public Health faculty as chair of the Environmental Health Sciences Department. At Johns Hopkins, Godwin’s postdoctoral adviser had introduced her to researchers who were studying the effects of lead poisoning on children. For more than two decades, it had been known that elevated blood levels of lead were associated with a variety of pediatric health problems, particularly affecting the brain and nervous system. But little was known about what makes the metal toxic. Godwin set about to learn that and more. Thirty years ago, the average child had what today would be considered an elevated lead blood level, though the guidelines were different at the time. Beginning in 1978, lead was eliminated as a component of house paint; around the same time, it was phased out of gasoline. While these public health policies substantially reduced the problem, it hasn’t gone away. “There is still residual lead in the soil, and residual contamination in older housing, for which mitigation is fairly expensive,” Godwin explains. Other sources of

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With her interests moving toward using basicscience knowledge to improve outcomes for children, the opportunity to join a renowned school of public health, particularly one with a strong program in molecular toxicology, proved irresistible. As chair of the school’s Environmental Health Sciences Department, Godwin hopes to identify and help facilitate potentially fruitful new collaborations between the department’s faculty and other units within the school and across the campus. She is already feeling the impact of interdisciplinary collaborations in her own work. Godwin has taken an active role in the new UCLA High Speed, High Volume Laboratory Network for Infectious Diseases. The lab, established through state and federal funding to the School of Public Health and housed in UCLA’s California NanoSystems Institute, will enable public health experts to track infectious disease outbreaks in near real time and dramatically shorten the period needed to produce effective vaccines (see page 9). In addition to drawing on her experience to assist in the setup of a laboratory with sophisticated technology, Godwin, at the request of Dean Linda Rosenstock, has served as a liaison within the school and to the larger UCLA community to ensure that the new facility’s design is flexible enough to be able to expand to meet research needs that might emerge in the future. “From an environmental health point of view, one of the exciting things about the lab is that in the course of collecting samples to analyze for infectious diseases, valuable environmental data will be obtained that would enable us to look, at a detailed level, at questions such as how global climate change might affect the spread of infectious diseases,” Godwin says. She also sees substantial opportunity in the interactions with scientists working in the field of nanotechnology, where exciting new tools are being developed with the potential to be applied for public health purposes. Learning from faculty in fields such as epidemiology and nanoscience has been an energizing experience for Godwin, with the potential to move her research into new areas. It fulfills the strong craving for lifelong learning that Godwin has felt since she was a child – and that she enjoys imparting to her students. “Traditionally, introductory science courses have been taught as a memorization of a bunch of facts,” she says. “And yet, almost universally, scientists will tell you that the thrill of discovery is the reason they became a scientist. To draw new people into the field, we need to translate that excitement into a pedagogical style that stimulates students as they are first exposed.”

“Now that lead has been taken out of gas and paint, the key strategy is educating parents about ways they can minimize environmental exposures for their kids.” —Dr. Hilary Godwin

UCLAPUBLIC HEALTH

exposure, particularly in Southern California, are imported candies and foodstuffs from Mexico that are contaminated with lead. Unlike metals that are required for life, such as calcium, iron, zinc, copper and potassium, there is no evidence that lead does anything but harm, Godwin notes. Her laboratory has conducted key studies at the molecular level that have detailed how the damage occurs. Among her group’s most significant findings: Even at relatively low levels, lead interacts with zinc proteins in the body, disrupting their function, which could account for the developmental problems associated with lead poisoning in children. If that conclusion is borne out in follow-up work – Godwin’s group is currently testing its zinc hypothesis in model laboratory organisms – it might point to the need for at-risk children to take zinc supplements; indeed, Godwin notes, a reversal of lead-poisoning symptoms has already been shown in children who take zinc supplements in the form of vitamins. Another focus of Godwin’s lab carries similar implications: Her group is investigating whether there is a molecular basis for the association among children between iron-deficiency and lead poisoning. Some studies have shown that iron supplements can improve symptoms in children with elevated blood lead levels. “This underscores the importance of something the public health community has already been doing – emphasizing good nutrition in addition to good hygiene to prevent not just exposure to lead but also its effects,” Godwin explains. When Godwin began her lead studies, her focus was on the biophysical level – looking at how the interactions between lead and particular proteins affect the proteins’ structure and dynamics. That work helped to elucidate the symptoms associated with lead poisoning and led to Godwin’s hypothesis that lead interactions with zinc proteins affect developmental processes. Now, her group has shifted toward the broader view afforded by studying model systems such as budding yeast to address questions concerning the proteins involved in transporting lead and the effects of lead on gene expression, seeking to understand more comprehensively the activity occurring on the cellular level. A second shift, which began when Godwin was at Northwestern, involved an increasing focus on working with the community groups most affected by lead exposure, both in terms of studying issues such as soil contamination in particular areas and in communicating risks and assisting in primary prevention efforts. “Now that lead has been taken out of gas and paint, the key strategy is educating parents about ways they can minimize environmental exposures for their kids,” Godwin explains.

faculty profile

ren y

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14 M ISSED

SCHOOL .

HOSPITALIZATIONS. E MOTIONAL

DIS -

TRESS AND PHYSI CAL DISCOMFORT.

SPH

FACULTY,

STUDENTS AND ALUMNI TACKLE THE REASONS FOR ASTHMA’ S RISE

–

AND THE DISPRO PORTIONATE BURDEN CARRIED BY CERTAIN COMMUNITIES .

Childhood Asthma:

Preventable Suffering Underscores System Shortcomings Much remains unknown about asthma and the reasons for its rise in certain communities, but plenty is clear: Asthma among children and adolescents is a major public health problem – according to the Centers for Disease Control and Prevention, it is the third-ranking cause of hospitalization for those 15 and younger, accounts for 14 million lost days of school annually, and costs $3.2 billion per year in treatment for the under-18 population. And a significant amount of the suffering, missed

UCLAPUBLIC HEALTH

school and cost is preventable. While there is neither a cure nor a surefire method to prevent asthma or its symptoms, a great deal can be done to control the condition through medications and measures taken to avoid environmental triggers such as cockroaches, furry pets, dust mites, mold and tobacco smoke. But it is also clear that the burden of asthma weighs far more heavily on children in low-income and minority communities, most likely due to a combination of factors that include social and environmental stress, greater exposure to household and air-quality allergens, increased risk for likely aggravating factors (e.g., obesity and decreased exercise), and a health care system that too often falls short in meeting these communities’ needs. The most comprehensive data on asthma in this state comes from the California Health Interview Survey (CHIS), conducted every two years as a collaboration of the school’s Center for Health Policy Research, the California Department of Health Services and the Public Health Institute. CHIS found that lifetime parent-reported asthma prevalence among children ages 1-17 increased from 14.1% in 2001 to 16.1% in 2005. The effect on low-income and minority communities can be seen in both the likelihood of having an asthma diagnosis and in the severity of symptoms among those who do.

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asthma or the mental health problems, Ortega’s current research, in which he is following a cohort of children with psychiatric problems but no asthma and another cohort with asthma but no psychiatric problems, may provide insight. Ortega suspects that the two conditions interact, and that stress can multiply their effects. Ortega notes that focusing on the child alone may not be enough when looking at the relationship between asthma and mental health. In one study, he found a significant association between increasing mental health problems among parents of children with asthma and the risk of asthma attacks in their children. He suggests that depression in children or their parents might interfere with the ability to properly manage asthma. Ortega has also looked into the possibility that parents who are anxious are more likely to report physical and mental health symptoms in their children. In some cases, health care providers may be misdiagnosing patients. “Symptoms of panic disorder and separation anxiety are similar to the symptoms of asthma, particularly dyspnea – short, labored breathing,” Ortega says. The only certain way to dis-

“Asthma and mental illness both have a number of psychosocially oriented symptoms and risk factors. Socioeconomic status, parental education and, for immigrant children, acculturation are all important in both conditions.” — Dr. Alex Ortega

UCLAPUBLIC HEALTH

Even among children with similar levels of social disadvantage, significant disparities can be seen in asthma prevalence rates. For example, Puerto Rican children have rates close to 30% among those living in Puerto Rico and as high as 20% on the mainland – considerably higher than many other minority groups of similar economic status. The research of Dr. Alex Ortega, associate professor and director of research programs in the school’s Department of Health Services, suggests that the interaction between asthma and psychological factors may be significant. Many explanations have been posited to explain this relationship. One is that anxiety and depression play a role in the onset of asthma symptoms. “If a child becomes anxious, typically brought on by a stressor, he or she might start hyperventilating, leading to an asthma exacerbation,” Ortega explains. It could also be the other way around – the chronic stress of having an asthma diagnosis may be what leads to depression. A third possibility for the association between asthma and psychological health is that the two share common risk factors. Under this hypothesis, children who live in stressful environments are simply at higher risk for both asthma and mental health problems, independently. Although there has not been enough research on the subject to be able to determine which comes first, the

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One out of six Californians with active asthma lives below the poverty level (roughly the same as the general population), according to CHIS. The survey found that these individuals experience more frequent symptoms, go to the emergency department more often for asthma care, miss more school and have poorer health status; they are also more likely to lack access to health care and to live in conditions associated with asthma exacerbations. The state’s African Americans and American Indians/ Alaska Natives have far higher rates of active asthma (17%) than whites (10%), Latinos (7%) and Asians (7%), reflecting national trends. CHIS also found that asthma sufferers who live near heavy vehicular traffic are nearly three times more likely to visit the emergency department or be hospitalized for their condition than those who live near low traffic density – and that living in areas of heavy traffic is a burden borne disproportionately by asthma sufferers who are members of ethnic/racial minorities and/or from low-income households.

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UCLAPUBLIC HEALTH

Patricia Barreto, M.D., M.P.H. ’02, is getting positive results from an asthma home-visiting program she established for low-income families. Physicians and health educators visit the families to provide health education and work with them on ways to reduce asthma triggers within their household.

tinguish between the two would be by doing lung function tests or by listening to the chest and hearing wheezing, but often by the time a child sees his or her doctor, the symptoms are gone. Ortega is investigating the hypothesis that physicians, relying on parent reports of these symptoms, may be misdiagnosing mental health problems as asthma attacks. It’s likely that many, if not most, of these factors are contributing to the disparities. “Asthma and mental illness both have a number of psychosocially oriented symptoms and risk factors,” Ortega notes. “Socioeconomic status, parental education and, for immigrant children, acculturation are all important in both conditions.” The physical environment – including allergen and air pollution exposures – is also believed to be a factor in the link between low socioeconomic status and poorer asthma outcomes, but, as with mental health, much more needs to be learned. Drs. Beate Ritz and Michelle Wilhelm of the school’s Department of Epidemiology and Center for Occupational and Environmental Health have been looking into the role of air pollutants, using data from the Los Angeles Family and Neighborhood Survey (L.A.

FANS), a large RAND/UCLA School of Public Health study directed by Dr. Anne Pebley, professor at the school, that seeks to understand how neighborhoods influence children’s health outcomes. Ritz and Wilhelm found that L.A. FANS children living in areas with high levels of ozone (O3) and particulate matter less than 10 microns (PM10) were at increased risk of reporting doctor-diagnosed asthma without attacks in the previous 12 months. They did not find similar relations with risk of doctor-diagnosed asthma with attacks in the past year, which they suspect may be due to under-reporting of diagnoses and symptoms among certain subpopulations in their study. On the other hand, L.A. FANS children diagnosed with asthma and living in areas with high levels of carbon monoxide (CO) did have greater odds of reported attacks in the previous 12 months. “Since carbon monoxide is directly emitted from motor vehicles and does not readily react in the atmosphere to form other compounds,” notes Wilhelm, “the association we observed for CO may be due to the effects of a co-occurring pollutant or mixture of pollutants in motor vehicle exhaust.” Wilhelm and Ritz suspect the culprit may be ultrafine particles, the smallest airborne pollutants

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“Chronic conditions such as asthma require ongoing management and continuous care, which means that families often need more than what is typically provided in the doctor’s office.” — Dr. Moira Inkelas

UCLAPUBLIC HEALTH

Also critical to the public health concern posed by asthma are shortcomings in how it is managed, particularly related to health care interactions. The disparities are especially great as they pertain to Latino and African American children with asthma, according to results of the Centers for Disease Control and Prevention’s 2003-04 National Asthma Survey. Significantly, both populations have lower use of controller medications than white children with asthma. (Corticosteroids and other controller medications, when taken daily, may prevent asthma episodes.) In addition, Latino children in Spanish-speaking households are less likely to be given a written asthma action plan than other children. Access to health care is likely a factor. But using the CDC data, Ortega and Dr. Moira Inkelas, assistant professor and assistant director of the school’s Center for Healthier Children, Families and Communities, found that the volume of care alone doesn’t explain these differences. “Our findings point to the content of what happens during visits, rather than to insurance coverage or the number of visits a child has, as a potential major source of observed disparities,” says Inkelas. “Poor communication about asthma being a chronic disease and the importance of taking controller medications, probably associated with language differences, is resulting in poorer asthma management.” Inkelas and Ortega are preparing a proposal for funding to explore these quality of care disparities in greater detail. “Our goal is to understand more about how parent-provider communication influences quality of care and asthma management or control,” Inkelas explains. “Prior studies have looked at patientlevel factors or health care factors, but have not put them together.” Meanwhile, a variety of efforts are being made to improve the quality of asthma care. Some are focused on physicians, while others aim to improve asthma education outside the clinic. “There is a sense that providers can’t always provide enough information to parents within regular health care visits – that there needs to be some kind of other intervention, whether it’s health educators in the community, a school-based program, or something else outside of the clinical arena,” says Inkelas. Richard Seidman, M.D., M.P.H. ’88, has been involved on both fronts as medical director of L.A. Care Health Plan, which serves nearly 800,000 Los Angeles County residents through the Medi-Cal, Healthy Families, and Healthy Kids programs. In an effort to improve the quality of asthma management – particularly when it comes to more appropriate use by patients of daily controller medications and regular assessment of asthma control – L.A. Care recently instituted a pilot program based on the concept of “pay-for-participation.” The plan’s physicians were financially compensated over the course of a year to conduct brief quarterly chart reviews and to attend a discussion with an asthma expert. The information they submitted was used to provide feedback on how their patient outcomes compared with those of their colleagues in the plan. “Using this model, we were able to show significant improvement in both process – compliance with national treatment guidelines – and outcome measures,” says Seidman. “We believe our program’s success is based on the simplicity

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produced by vehicular exhaust, which are the focus of increasing interest as research shows the damage they can do to human lung cells – and for which there are currently no air quality standards. They hope to be able to learn more about the role of such vehicle exhaust constituents with expanded asthma and exposure assessments being conducted in the current wave of L.A. FANS data collection.

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18 of the intervention – simple tools requiring minimal time – combined with the financial incentive.” The health plan is now developing a similar quality improvement program for the treatment of diabetes. L.A. Care is also involved in a collaboration with the Community Clinic Association of Los Angeles County, Los Angeles Unified School District, and Los Angeles County Department of Public Health to produce a pediatric asthma tool kit for health care professionals and improve the communication between school personnel and community providers on asthma. The kit was distributed widely across the county as part of what Seidman considers “an important attempt to standardize care and improve collaboration between schools and community providers.”

“We believe our program’s success is based on the simplicity of the intervention — simple tools requiring minimal time — combined with the financial incentive.”

Elsewhere, UCLA School of Public Health Dr.P.H. student Gloria Giraldo developed and was the original coordinator of an asthma management program, implemented by community health workers known as promotoras, that has benefited hundreds of low-income, low-literacy Latino parents in Orange County, Calif., since 1999. Working closely with a public health nurse, Giraldo, then with Latino Health Access, developed a curriculum covering traditional asthma management topics but utilizing adult-education principles aimed at the target audience: Spanish-speaking parents with minimal literacy skills. The curriculum, which continues to be used by Latino Health Access, includes hands-on activities that help parents understand what is occurring within their child’s respiratory system and why different medications are needed for different symptoms. Parents learn to identify early signs of an asthma attack and, more importantly, how to prevent them. At home visits, they participate in an environmental assessment and learn how to control environmental triggers. Children are connected to a system of care, including an allergist.

— Dr. Richard Seidman

Prevalence of Asthma-related Emergency Department Visits or Hospitalizations by Traffic Density

Asthmatic Children (Ages 0-17) Asthma disproportionately affects certain minority groups and lowincome families, as illustrated by these findings from the California Health Interview Survey (CHIS). CHIS is conducted every two years by the UCLA Center for Health Policy Research (based in the school), California Department of Health Services and Public Health Institute.

22%

Prevalence of Active Asthma by Race/Ethnicity, California, 2003 17%

20 17%

17% 10

UCLAPUBLIC HEALTH

10%

Latino

Asian

0 White

African American

American Indian/ Alaska Native

Note: Active asthma refers to children who have been diagnosed with asthma and who reported they still had asthma and/or experienced an asthma attack in the past year. Source: 2003 California Health Interview Survey

Low Traffic Density

Medium Traffic Density

High Traffic Density

Sources: 2001 California Health Interview Survey; California Department of Transportation.

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Prevalence of Daily or Weekly Asthma Symptoms by Income Among Those with Active Asthma

19 chronic condition in which multiple factors – including the home environment – are influencing the outcome,” says Barreto, who also takes UCLA pediatric residents on the visits as part of their training, in an effort to give them a fuller sense of some of the unique challenges faced by low-income families in managing asthma. “We also know that patient education at the clinic visits is somewhat limited. This approach provides a different perspective, allowing more time for interaction and to physically demonstrate what in the home is triggering the asthma.” By training health educators, Barreto designed the project so that it would be self-sustaining; it has now been incorporated into routine asthma care for patients at the Venice Family Clinic. “This program suggests home visits might be a good option as part of a multi-tiered asthma management plan,” she says. Inkelas believes the future for asthma quality improvement will likely involve more models of care that don’t rely exclusively on clinicians, but rather include them as part of a team. “Our health care system tends to be episodically oriented – more suited to acute care,” she says. “Chronic conditions such as asthma require ongoing management and continuous care, which means that families often need more than what is typically provided in the doctor’s office.”

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“Asthma is a complex disease,” says Giraldo. “Add to its complexity trying to understand that your child may need to use at least two different medications. Many parents already struggle with this situation, but for parents who have low literacy levels, even in their native Spanish, understanding asthma management becomes a compounded challenge. It was gratifying to prove that creating literacy-appropriate health education and chronic disease management materials does not mean shortchanging parents with less information.” Patricia Barreto, M.D., M.P.H. ’02, an assistant clinical professor of pediatrics at UCLA and faculty member of the school’s Center for Healthier Children, Families and Communities, established an asthma home-visiting program for low-income families in Los Angeles’ Mar Vista area who are patients at UCLA and the Venice Family Clinic. Barreto, who was previously part of a large study showing that effectively reducing antigens in the home leads to better asthma outcomes, has been assessing the impact of a program in which physicians and health educators visit families to provide health education and work with them on ways to reduce asthma triggers within their household. Preliminary results indicate that families receiving the visits have experienced a reduction in asthma symptoms, as well as a better understanding of appropriate medication use. “The biomedical model can get us only so far within the clinic, and asthma is an example of a

Percent with at Least One Emergency Department Visit for Asthma by Race/Ethnicity Among Those with Active Asthma 40

35 33% 30

15 15%

13%

26%

10 10%

19% 15 10

0 Below 100% FPL

100-299% FPL

300% FPL and Above

White

Latino

African American

Note: In 2003 the Federal Poverty Level was $12,384 for a family of two and $18,810 for a family of four.

Note: Estimates for Asian children and American Indian/Alaska Native children are not statistically reliable.

Source: 2003 California Health Interview Survey

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20 AS

BEFITS

ITS TITLE , THE

C ENTER

E LIMINATE H EALTH D ISPARITIES DOESN ’ T STOP AT IDENTIFYING PROBLEMS ; WORKING WITH THE AFFECTED COMMUNITIES , IT INTENDS TO GET RID OF THEM .

eliminating health disparities:

Closing the Gaps Created by Social Inequities When you break down rates of the most common health problems by race, ethnicity and socioeconomic status, the results begin to appear all too predictable. Almost without exception, there are sizable differences – now commonly referred to in public health circles as disparities – in who has these conditions and how they fare with them. Often, exceptions

“Only when everyone benefits in the same way are we going to have a healthy population as a whole.”

UCLAPUBLIC HEALTH

—Dr. Roshan Bastani

seem to prove the rule. White women, for example, have the highest rates of breast cancer – but African American women are the most likely to die from the disease. One of the two overarching goals of Healthy People 2010, the set of health objectives put forth for this decade by the U.S. Department of Health and Human Services, is “to eliminate health disparities among different segments of the population.” The groups consistently on the wrong side of the chasm are communities of color, immigrants, and those with low income and low education. Despite the increased attention, the gaps are, in many cases, widening. “Disparities can be found in virtually every health condition, across the lifespan,” says Dr. Roshan Bastani, the school’s associate dean for research. “Whether we’re talking about infant mortality, childhood vaccinations, pregnancy outcomes, or chronic diseases, all the way up to issues related to aging, it’s almost impossible not to see differences in who gets sick, the type of care received, and health outcomes.”

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Through research, training, outreach, and community-based partnerships, the school’s Center to Eliminate Health Disparities (CEHD), under the leadership of co-directors Bastani and Dr. Antronette together, we could be more effective at producing the changes we hope to bring about,” Bastani explains. (Toni) Yancey, has set out to reverse these trends. Established in 2005, CEHD brings together faculty Although genetic factors play a role in differing from the School of Public Health and other parts of UCLA, as well as community-based groups and local racial and ethnic incidence rates for a handful of conditions, the term health disparities refers to the and state health departments, to learn from each gaps caused by social inequities. These inequities, other and join forces to make a difference in addressYancey says, are pervasive and powerful in making ing these concerns. disenfranchised populations less likely to be able to For the past two decades, Bastani has been a adequately prevent, screen for, or get treatment leader in documenting and addressing disparities in for particular conditions. which populations are most likely to get cancer and “Health disparities generally refer to differences why, through her work as associate director of the involving higher disease incidence, severity, or morDivision of Cancer Prevention and Control Research, tality rates, and those differences are related to sociojointly housed in the school and UCLA’s Jonsson economic marginalization,” Yancey explains. “It can Comprehensive Cancer Center. In that time, affect people who belong to ethnic minority groups, researchers have learned more about primary prewomen, gay and lesbian populations, people who vention strategies that can reduce the risk of devellive in rural areas…there are lots of different reasons oping certain cancers, and methods have improved disparities can exist, all related to social inequity.” for detecting malignancies early – when treatment Health disparities are not new, but they have is far more likely to be successful. Bastani has studmoved to a prominent place on the nation’s public ied factors influencing utilization of screening for a health agenda thanks in part to attention drawn to variety of tumors, starting with breast and cervical the issue by influential leaders such as former U.S. cancer, then colorectal and prostate cancer. Most Surgeon General David Satcher. Yancey also points recently, her focus has expanded with the advent out that with improved data collection, researchers of screening and vaccines for hepatitis B, which can are now much better able to compare health status cause liver cancer, and the human papillomavirus across populations over time, in search of trends. (HPV), which can cause cervical cancer. “Unfortunately, the populations that are at CANCER SCREENING AND MANAGEMENT greatest risk for some of African American women are more likely to die of breast cancer than are women of any other racial or ethnic group, these cancers are the least although they have lower rates of the disease than white women. They are also more than twice as likely to die of likely to benefit from the cervical cancer as white women. Source: National Center for Health Statistics advances,” says Bastani. All too often, those trends show that disparities There are disparities in who is most likely to have are persisting, and sometimes widening. “Most of the certain risk factors for cancer, such as obesity and progress that’s been made has been to elevate everyexposure to environmental carcinogens. But as with one, without reducing the disparities,” Yancey says. cancer screening, Bastani notes, the same populations “Infant mortality rates have improved, but there still that are most likely to be at higher risk are often the are much higher rates among African Americans least likely to benefit from what is known about how than among most other groups. Physical activity those risks can be avoided. levels have improved slightly across the board, but “Twenty years ago there were disparities, and Latinos and African Americans, especially women, there are disparities today,” says Bastani. “We have still fall considerably behind.” made some progress, but not nearly enough.” Because health disparities tend to largely reflect The idea for the center grew out of the realizasocietal inequities, simple solutions are hard to come tion that many of Bastani’s colleagues on the School of Public Health faculty and elsewhere on the UCLA by. But, as befits its title, the Center to Eliminate Health Disparities is taking up the challenge. “We’re campus have also spent much of their careers not just interested in documenting these disparities,” focusing on similar issues involving other diseases. says Yancey. “We’re interested in developing the Despite striking similarities in the factors contributinterventions – the policies, programs, regulations, ing to disparities across the spectrum of health conditions, there had been little collaboration. “We felt that by bringing people from disparate areas

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ted es

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DIABETES In 2000, American Indians and Alaska Natives were 2.6 times more likely to have diagnosed diabetes than non-Hispanic whites, African Americans were 2.0 times more likely, and Hispanics were 1.9 times more likely. Source: National Center for Chronic Disease Prevention and Health Promotion

and organizational practices – that will ultimately eliminate them. We believe it’s entirely possible to do so, and that not doing so is inconsistent with public health, which addresses the health needs of entire populations, and particularly the groups that are most vulnerable.” By studying health conditions across social strata, CEHD researchers are able to glean insight into the causes of disparities, as well as what strategies are most likely to succeed in closing the gaps. African Americans have among the highest hypertension rates in the world – much higher than those of Africans, an indication that environment, more than genetics, is the culprit. Low-income African Americans have much poorer hypertension outcomes than more affluent African Americans, suggesting that class is an important factor. The history of HIV/AIDS in the United States is also telling. “Gay white males were the group most affected in the epidemic’s early years,” notes Yancey, “but because they had the resources in terms of dollars and communication networks, and were distributed at all levels of the power structure of society, they were able to mobilize and, over the course of a generation, drastically reduce infection rates. Now, HIV in this country is an epidemic among poorer people more than it is among gay white men.” “Most public health problems are concentrated in poor communities,” says Dr. Alex Ortega, associate professor of health services at the school and a CEHD member. Ortega studies disparities among populations of children with asthma, particularly Latinos (see page 15). Even among the Latino populations he studies, there are significant disparities in asthma rates and outcomes, with Puerto Ricans – the poorest subgroup – the hardest hit. “There are so many possible contributing factors, including the environment, psychosocial issues, cultural issues, lan-

UCLAPUBLIC HEALTH

CARDIOVASCULAR DISEASE Rates of death from heart disease were 29 percent higher among African American adults than among white adults in 2000, and death rates from stroke were 40 percent higher. Source: National Center for Health Statistics

guage issues, and discrimination,” Ortega says. “What’s important to me is to try to tease out what are the most modifiable factors for improving the health of these populations.” One such effort involved a visit to Cuba to learn about the country’s primary health care system. As part of the Faculty Community Health Leadership Program, Ortega and other representatives from the School of Public Health, Charles Drew University, and the Los Angeles County Department of Health Services accompanied community health leaders from South Los Angeles on the trip, which was undertaken in conjunction with the non-profit MEDICC (Medical Education in Cooperation with Cuba). Despite relatively low health spending, Cuba earns high marks on health indicators such as life expectancy and rates of cardiovascular disease, cancer, and infant mortality. The goal of the project was to assist the community health leaders in determining what lessons they might take from Cuba’s system and incorporate in their community, where limited resources lead to poor outcomes. “Most of the program’s participants felt they had learned something positive from going to Cuba, particularly about the integration of public health and medical care, in which medical professionals are expected to also be involved in public health practice in communities,” Ortega says. The bulk of disparities research has focused on documenting the differences, rather than on studying solutions. CEHD’s primary focus is not only to develop and test appropriate strategies, but also to team with the affected communities at every stage and to ensure that solutions are sustainable. “A lot of disparities work stops at identifying the problem,” says Bastani. “We want to go beyond that and actually conduct interventions in the community to alleviate the problems.” One of the ongoing initiatives exemplifying the community-university partnership is the UCLA Community Research in Cancer (CORICA) Network, a five-year project aiming to tackle socioeconomic and racial/ethnic disparities in cancer through research that links the university with the community, particularly in underserved areas in Los Angeles. The UCLA CORICA Network is one of eight in the nation funded by the Centers for Disease Control and Prevention and National Cancer Institute. “There is too often a lack of communication between these two worlds, and so the university research is not always applicable to what’s going on in the community – or if it is, it’s not adequately disseminated,” says Dr. Ritesh Mistry, a postdoctoral fellow and project director of CORICA. Among the

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“We’re interested in developing the policies, programs, regulations, and organizational practices that will ultimately eliminate [disparities]. We believe it’s entirely possible to do so, and that not doing so is inconsistent with public health.” —Dr. Antronette (Toni) Yancey

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Bastani notes that disparities research has moved away from a previous bias toward thinking about health in terms of individual decisions. “There is now much more emphasis, although still not enough understanding, on larger, societal factors that are very important in determining these disparities,” she says. When trying to prevent obesity in low-income communities, it’s a mistake to ignore factors such as the lack of grocery stores carrying affordable healthy foods, or the inaccessibility of exercise opportunities because of unsafe streets and parks. Similarly, when transportation to an affordable mammography facility requires catching three buses for a woman who is forced to work long hours, disparities in low-income communities’ utilization of breast cancer screening should not come as a surprise. CEHD researchers are focused on policies and programs that would reduce disease rates in disadvantaged communities, with a particular emphasis on tobacco, physical inactivity, poor nutrition, and alcohol, which account for the lion’s share of preventable illness in this country. That means, among other things, working toward policies that reduce tobacco usage and secondhand smoke; ensuring that fruits and vegetables are available in low-income neighborhoods through school programs, farmers’ markets and incentives offered to stores; advocating for conditions that increase physical activity, through greater park access, more mass transit and incentives for worksite policies that promote exercise and healthy food choices; and pushing for improved access to health care. In addition to working directly with the community stakeholders, CEHD is forging strong ties with local health departments, particularly the Los Angeles County Department of Health Services. One of the center’s largest projects is a partnership with the county to go into 30 workplace settings with health and social services staff in a joint effort to identify the types of policy and environmental changes that would help the workers to eat more healthfully and engage in more physical activity during the work day in their own settings; the hope is that by assisting these workers in adopting healthier practices, the workers will be better equipped to assist their clients in doing the same. The collaboration with public health practice and community leaders is part of CEHD’s strategy to ensure that the interventions designed to address health disparities will be both practical and sustainable. “It’s one thing to come up with a great program, but if it can’t be continued once you’re gone, what good is it?” says Yancey.

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CORICA initiatives aiming to bridge that divide is the Korean Health Study, which will work with churches in Los Angeles-area Korean neighborhoods to test educational interventions designed to increase screening and prevention for hepatitis B, which is significantly more prevalent in the Korean community than in other minority communities. “The church is a major part of the social and cultural fabric of the Korean community in Los Angeles, so we want to see if that institution can be used to promote health,” says INFANT MORTALITY Mistry. Half of the African American, American Indian, and Puerto Rican infants have higher death rates churches in the study will than white infants. In 2000, the black-to-white ratio in infant mortality was 2.5. The disparticipate in the hepatiparity between black and white infants has been widening over the last two decades. tis B intervention, while Source: National Center for Health Statistics the other half will focus on exercise and nutrition.

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24 HIV INFECTION/AIDS African Americans and Hispanics, who represented 26 percent of the U.S. population in 2001, accounted for 66 percent of adult AIDS cases and 82 percent of pediatric AIDS cases reported in the first half of that year. Source: National Center for Health Statistics

“There is too often a lack of communication, and so the university research is not always applicable to what’s going on in the community – or if it is, it’s not adequately disseminated.” —Dr. Ritesh Mistry

IMMUNIZATIONS African Americans and Hispanics are approximately half as likely as whites (31% and 30%, respectively, vs. 57%) to receive the pneumococcal vaccine.

UCLAPUBLIC HEALTH

Source: Morbidity and Mortality Weekly Report, 2002

Effectively addressing disparities also means increasing the pool of public health practitioners and academics who are interested in these issues, particularly those who come from the underserved communities themselves. The center has obtained funding from The California Endowment and California Wellness Foundation to support students serving, and often themselves from, underrepresented populations. Neetu Chawla, a second-year Ph.D. student, is the lead instructor for Youth Into Health Professions, an introductory public health course offered by the school at the Watts Labor Community Action Committee. The course, which draws high school and community college students from the Watts and Compton areas, is an effort to increase the pipeline of underrepresented minority students pursuing education in public health. “We are one of the only industrialized countries that doesn’t have a system of universal health care, which means that health care becomes part of the market economy and certain groups get left out,” Chawla says of her interest in addressing disparities. “It’s important to document health disparities and the reasons for them, so that we can adopt strategies to address them.” First-year Dr.P.H. student Marina Alvarez has been motivated to find strategies to eliminate health disparities since she was a teen. When Alvarez was 14, her father, who brought his family to California from Mexico, was diagnosed with a brain tumor. Although Alvarez’s mother became a strong advocate for her husband, Alvarez saw the barriers to adequate care that could hinder families with limited education and English-language skills. While studying for her doctorate, Alvarez is serving as project director of CEHD’s Latino Men’s Health Study, which is testing a community-based educational intervention designed to increase informed decision-making about prostate cancer screening among Latino men. With a fellowship from The California Endowment that funded her first year in the program, Alvarez conducts outreach at community events to recruit students to the School of Public Health and promote CEHD and its activities. Where Mistry grew up in Bombay, India, everyone was poor. He moved to the United States as a child and was struck by the difference that affluence could make in people’s lives, particularly as it affected their health. “That really shaped my thinking,” he says. “I began to ask why life tended to be so much more difficult for certain people, and what could be done about it.” Mistry earned his Ph.D. from the school in 2004, studying how people’s social environment affects their health behaviors. He is continuing that focus as a postdoctoral fellow, looking specifically at the influence of the social environment on adolescents’ tobacco use. Bastani believes the work of Mistry and the other CEHD members is central to the public health mandate. “If there are some populations that are being left behind, it is our responsibility to address those disparities,” she says. “Only when everyone benefits in the same way are we going to have equity in society and a healthy population as a whole.”

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research

research highlights Review of Pathogens’ Route from Animals to Humans Suggests Need for Global Early Warning System

The review illustrates large gaps in the understanding of the origins of even established major infectious diseases.

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COULD THE HIV PANDEMIC HAVE BEEN PREVENTED? Dr. Nathan Wolfe, professor of epidemiology at the UCLA School of Public Health, says yes, and he’s working to prevent the next one. Writing in the May 17 edition of the journal Nature, Wolfe and UCLA colleagues Dr. Jared Diamond and Dr. Claire Panosian Dunavan identified five evolutionary stages in a pathogen’s journey from exclusive transmission among animals to exclusive transmission among humans. They also re-examined the origins and characteristics of 25 of the most important diseases in human history. The extensive review provides evidence supporting the development of the first global monitoring system for tracking the transmission of disease from animals to humans. Such a system would help scientists catalog the diversity of microbial agents, characterize animal pathogens that might threaten humans in the future, and perhaps detect and control emergence of a disease in humans before it can spread (for more on the school’s efforts in this area, see the cover story on page 6). Wolfe and his colleagues began by identifying five intermediate stages through which a pathogen exclusively infecting animals must travel before exclusively infecting humans. The research team found no inevitable progression of microbes from Stage 1 to Stage 5 and noted that many microbes remain stuck at a specific stage. The journey is arduous, and pathogens rarely climb through all five stages: Stage 1. Agent only in animals: A microbe that is present in animals but not detected in humans under natural conditions. Examples include most malarial plasmodia. Stage 2. Primary infection: Animal pathogens that are transmitted from animals to humans as a primary infection but not transmitted among humans. Examples include anthrax, rabies and West Nile virus. Stage 3. Limited outbreak: Animal pathogens that undergo only a few cycles of secondary transmission among humans so that occasional human outbreaks triggered by a primary infection soon die out. Examples include the Ebola, Marburg and monkeypox viruses. Stage 4. Long outbreak: A disease that exists in animals and has a natural cycle of infecting humans by primary transmission from the animal host but that also undergoes long sequences of secondary transmission between humans without involvement of animals. Examples include Chagas disease, yellow fever, dengue fever, influenza A, cholera, typhus and West African sleeping sickness. Stage 5. Exclusive human agent: A pathogen exclusive to humans that involves either an ancestral pathogen present in a common ancestor of chimps and humans or involves a more recent pathogen that evolved into a specialized human pathogen. Examples include HIV, measles, mumps, rubella, smallpox and syphilis.

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“Patchwork” Child Health System Warrants Overhaul

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The authors contend that the current health system is powered by outdated logic, outmoded organization, and misaligned finance strategies.

THE U.S. CHILD HEALTH CARE SYSTEM is a “patchwork of disconnected programs, policies and funding” that lacks “clear accountability of performance goals” and is in need of a major overhaul, according to a team of UCLA School of Public Health professors headed by Dr. Neal Halfon, director of the school’s Center for Healthier Children, Families and Communities. In their report, which appeared in the journal Health Affairs, Halfon and his co-authors argue that even as Congress, the nation’s governors and the Bush administration debate federal spending on the State Children’s Health Insurance Program, which covers low-income uninsured children whose families earn too much to qualify for Medicaid, leaders are not tackling more fundamental challenges facing the nation’s child health system. They contend that the current system is failing to produce the kinds of health outcomes that it could and should because it is powered by outdated logic, outmoded organization, and inadequate and misaligned finance strategies that were designed to be responsive to epidemiology and health goals more relevant to the early part of the 20th century. “An increasing body of science now tells us that the scaffolding for our adult physical, cognitive and socioeconomic health is built in the early years of life,” says Halfon, who prepared the report with Drs. Helen DuPlessis and Moira Inkelas. “We know now that many health problems have their origins during childhood and simply compound over time.” Obesity rates among the nation’s children have doubled in the last 20 years, Halfon said, and the prevalence of diagnosable mental health and behavioral problems in youth has climbed to more than 20 percent, creating the prospect that the current generation of children could be less healthy than their parents.

Vitamin E Supplements Don’t Reduce Type 2 Diabetes IN THE MOST COMPREHENSIVE STUDY to date of the impact of vitamin E supplements in preventing type 2 diabetes in healthy women, a multi-center research team headed by Dr. Simin Liu, professor of epidemiology in the UCLA School of Public Health and professor of medicine in the David Geffen School of Medicine at UCLA, found that the supplements had no effect on the risk of developing the disease. Using data from the federal Women’s Health Study, Liu and colleagues conducted the first randomized, double-blinded controlled trial to examine the efficacy of vitamin E supplementation on the incidence of type 2 diabetes among middleaged and elderly U.S. women. They found that 10 years of vitamin E supplementation (600 IU on alternative days) had no benefit in preventing the disease. “While there is a longstanding interest in the diabetes community regarding the promising yet unproven role of antioxidants in the prevention of diabetes and diabetic complications, direct evidence linking antioxidants to the incidence of type 2 diabetes is very limited,” says Liu, whose group reported the findings in the journal Diabetes. Basic research has long supported the pivotal role of vitamin E in antioxidant functions, and most observational studies have associated increased vitamin E intake with a decreased risk of type 2 diabetes in initially healthy people. But evidence from randomized studies that vitamin E supplementation is beneficial in the primary prevention of type 2 diabetes has been lacking. The results from the Women’s Health Study are similar to previous findings, reported by Liu and colleagues in the Journal of the American Medical Association in 1999, that supplementation with the antioxidant beta-carotene did not affect the incidence of type 2 diabetes among healthy U.S. men in the Physicians’ Health Study. “Our latest findings settle the issue on the role of vitamin E supplements alone for diabetes prevention, although the efficacy of other potent antioxidants

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research

for the prevention of type 2 diabetes remains to be determined by large-scale clinical trials,” says Liu. “For prevention of chronic diseases, these findings indicate the need to shift our focus from the single nutrient-based approach to antioxidant-rich foods such as whole-grains, nuts and fruit and vegetables.”

Lower Thresholds for Treating Cardiovascular Risk Factors: Worth the Cost? Percent of U.S. Population Older

CHANGING PRACTICE GUIDELINES for treatable chronic disease have lowthan 50 with Disease or Preered the thresholds to the point where under the most recent proposals, 97 perDisease Under Latest Proposed cent of the U.S. adult population older than 50 qualifies for a diagnosis of at least Guidelines one of three common risk factors for cardiovascular disease and stroke: high systolic blood pressure, high serum cholesterol, and impaired fasting glu100% cose, according to an analysis by Drs. Robert Kaplan 97 and Michael Ong in UCLA’s School of Public Health and David Geffen School of Medicine. 80% The lower thresholds are substantially expanding the market for health care, which has the potential to 73 place strains on the health care system far beyond 60% any marginal benefits that may come from the earlier, more aggressive treatment of the population, argue Kaplan and Ong, whose findings – based on data 40% from the Framingham Heart Study and National 39 37 Health and Nutrition Examination Survey – were published in the Annual Review of Public Health. 20% “Conditions that were previously thought of as normal are now being defined as targets for treatment,” Kaplan says. “Some would say this is a good 0% Impaired PreHigh Serum One of Three thing, because more people are going to be getting Fasting Glucose Hypertension Cholesterol the new medications, which are widely believed not to harm people. But even if there turn out to be no CONDITION unforeseen long-term side effects to the drugs, there is one immediate side effect that is not well understood: These lower thresholds are forcing the costs of medical care to go up, which leads to more employers not providing health insurance and a higher uninsured rate.” Because the benefits to reducing serum cholesterol, glucose and blood pressure levels are substantially greater for those who are well beyond the treatment threshold, the gains for individuals who are newly qualifying for treatment are extremely small, Kaplan says. “These people may experience a tiny benefit from being treated more aggressively,” he explains. “But we’re spending a lot of resources and producing relatively little in terms of health benefit.”

Emergency Risk Communications Critical to Successful Disaster Response

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THE FAST PACE AND UBIQUITOUS NATURE of modern news-media dissemination means that health departments cannot afford to wait for an emergency or disaster to occur before formulating a risk communication plan; rather, they must have disaster communication teams, plans, materials and even websites in place ahead of time to ensure that they have the wherewithal to quickly and appropriately communicate risks as events unfold. That’s one of many points put forward by Dr. Deborah Glik, professor in the UCLA School of Public Health and faculty member in the UCLA Center for Public Health and Disasters, based in the school. Writing in the Annual Review of

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28 Public Health, Glik outlined basic principles that characterize the rapidly developing field of emergency risk communication practice, which draws on environmental risk communication, disaster management, health education, and public relations for guidance. “Risk communication with the media and the public during emergencies is now a basic skill set public health professionals need to master,” Glik contends. “The 9/11 terrorist attacks, reinforced by large-scale disasters such as SARS, Hurricane Katrina, and foodborne outbreaks, as well as the potential global flu pandemic, have made it clear that public health professionals must play a communications role prior to, during and after emergencies that threaten population health.” While not all disasters can be anticipated, many can, and for the past six years public health agencies at the local, state, and national levels have developed messages, fact sheets, background information, templates for press statements and media advisories, video clips and disaster-preparedness education materials for possible crises, Glik notes. Most important in emergency risk communications is to have timely, credible, articulate and compassionate spokespersons who can deliver clear, consistent, and culturally competent messages, Glik argues. Messages should provide specific information on exposure to the hazard or agent, symptoms, treatment, long- and short-term consequences, preventive and curative actions, and emergency response resources. Communications with the news media must be replicated on websites, blogs, podcasts, and video news releases, given that most people turn to the Internet as well as broadcast media during an emergency, Glik adds. For hardto-reach or more isolated populations, health departments must be prepared to work with community partners to get vital information disseminated.

New Method Enables Local-Level Health Estimates

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With “synthetic estimates” done by the UCLA Center for Health Policy Research, state legislators and members of Congress can get uninsurance rates and other health data for their district.

UCLA SCHOOL OF PUBLIC HEALTH researchers have refined statistical methods that enable them to take county and ZIP code-level data from the California Health Interview Survey, U.S. Census, and Current Population Survey to create “synthetic estimates” of the number of uninsured residents by California Assembly, Senate, and congressional districts. The methodology produces results that state legislators, members of Congress, and groups seeking to influence policy have found useful, says Dr. Steven Wallace, associate director of the UCLA Center for Health Policy Research, based in the school. “Data are of most interest to policy makers when they reflect the experiences of their district,” Wallace says. “But state and federal legislators’ district boundaries wander along unique and irregular paths that are designed for political purposes, not health planning purposes. Almost all health data are designed to provide estimates for areas where health planning and interventions occur – such as states, counties, and cities. So there is a fundamental mismatch between available health statistics and legislators’ needs.” This mismatch is also felt by health advocates. “They go to Sacramento and repeatedly encounter representatives who ask, ‘But what is the situation in my district?’ ” Wallace says. After listening to the concerns of both legislators and health policy advocates, he and his colleagues at the UCLA Center for Health Policy Research decided to address the information gap. The center has published a series of policy briefs with results created by the new method, and reported the methodology in the American Journal of Public Health.

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2006-07 student awards Sara Serin-Christ Community Health Sciences

Agency for Healthcare Research and Quality Fellowship Kimberly Enard Melissa Gatchell Michelle Ko Shana Lavarreda Daniella Meeker Erum Nadeem Sarah Starks Roy Wada Health Services

Amgen Fellowship in Biostatistics at UCLA

Marina Alvarez Eileen Bangaoil Denise Woods Health Services

Environmental Science and Engineering Program Endowment Alex Revchuk

Robert Taylor Molecular Toxicology

California Wellness Foundation Scholarship

EPA STAR Fellowship

Carolbeth Korn Prize

Margaret Krudysz Environmental Health Sciences

Constance Gewa Community Health Sciences

Zhanna Sobol Molecular Toxicology

Bette & Hans Lorenz Fellowship

William and Flora Hewlett Foundation Environmental Science and Engineering Program Jane Curren

Mekeila Cook Community Health Sciences

Mekeila Cook Parichart Wichianson Community Health Sciences Matthew Banegas Health Services

Chancellorâ&#x20AC;&#x2122;s Fellowship Hua Guo Biostatistics

Chancellorâ&#x20AC;&#x2122;s Prize Brian Chen Epidemiology

Xin Huang

Charles F. Scott Fellowship

ASPH/CDC/PRC Minority Fellowship

Sarin Prakobwanakit Community Health Sciences

Typhanye Penniman Community Health Sciences

Class of 1972 Reunion Fund

Biostatistics Training for AIDS Research

Amy Hensley Calvin Kwan Marc-Andre Philibert

Foley and Lardner Fellowships in Health Services

Hortense Fishbaugh Memorial Fellowship

Maternal and Child Health Training Grant Katrina Dornig Community Health Sciences

NSF AGE Professoriate Competitive Stipend Robert Taylor Molecular Toxicology

Seth Clancy Sahba Tafazoli

Ann G. Quealy Memorial Fellowship in Health Services

Melissa Gatchell Health Services

Foreign Language and Area Studies Fellowship

Amy Goldstein Aniko Huffard

Erik Bloomquist Stephanie Kovalchik Lei Qian Corwin Zigler

Zhanna Sobol Molecular Toxicology

Gabriel Garcia Grace Lee Community Health Sciences

Ruth F. Richards Memorial Student Award

Fred H. Bixby Doctoral Fellowship

Grace Song-Ye Park Biostatistics

Claire Dye Kunchok Gyaltsen Community Health Sciences

Yasamin Kusunoki Community Health Sciences

Joseph and Celia Blann Fellowship Wenhua Hu Biostatistics Dana Martinez Community Health Sciences

California Breast Cancer Research Program Dissertation Fellowship Yoshiko Umezawa Community Health Sciences

Dean's Outstanding Student Award

Wenhai Xu Environmental Health Sciences Astou Coly Epidemiology Ada Ying Cheng Health Services

Eleanor J. De Benedictis Fellowship in Nutrition Constance Gewa Maria Koleilat Loan Pham Kim Community Health Sciences

California Center for Population Research Training Program Doctoral Fellowship

Dissertation Year Fellowship

Alison Buttenheim Yasamin Kusunoki Community Health Sciences

Constance Gewa Community Health Sciences

California Endowment Scholarship

Hua Guo Biostatistics

Steven Lee Xiaoyan Liao Environmental Health Sciences

Raymond D. Goodman Scholarship Naja Rod Nielsen Epidemiology Judith Chung Health Services

Graduate Opportunity Fellowship Linda Bahrami Biostatistics Veronica Awan Noriko Boyd Rosa Calva Michelle Doose Eva Durazo Senely Navarrete Community Health Sciences

Graduate Research Mentorship Program Award

Jennifer Erausquin Community Health Sciences Melissa Higdon Epidemiology Narmina Pasha Health Services Sarah Kobylewski Molecular Toxicology

Eugene Cota Robles Fellowship Erica Childs Biostatistics Demian Willette Environmental Health Sciences Joni Ricks Epidemiology

Ruth Roemer Award

Pamela Stoddard Community Health Sciences

Katherine Marcellus Health Services

Marie Sharp Epidemiology

Ruth Roemer Tobacco Scholarship

Hagigi Fellowship in Health Services Finance and Management

Thida Aye Community Health Sciences

Khadeeja Abdullah Environmental Health Sciences Tina Carbajal Epidemiology

Ning An Epidemiology

Christian Shinaberger Epidemiology

Cecilia Chan Molecular Toxicology

Health Services Alumni Association Scholarship

Gordon Hein Memorial Scholarship

Kyle Legleiter

Milton & Ruth Roemer Fellowship in Health Services Georgina Agyekum

Will Rogers Memorial Scholarship Veronica Awan Community Health Sciences

Marie Sharp Epidemiology

Monica Salinas Internship Fund in Latino and Latin American Health Miriam Boxerman Sara Serin-Christ Ariel ShumakerHammond Community Health Sciences Marie Sharp Epidemiology

Philip & Aida Siff Fellowship Angie Otiniano Community Health Sciences Kathleen Kozawa Environmental Science and Engineering

Juneal Marie Smith Fellowship in International Nutrition Shen-Chih Chang Epidemiology

Wayne SooHoo Memorial Scholarship Wenhai Xu Environmental Health Sciences

Samuel J.Tibbitts Fellowship Matthew Wise Epidemiology

Toxic Substances Research & Teaching Program Fellowship Nancy Jennerjohn Environmental Health Sciences Ilona Bebenek Sudheerreddy Beedanagari Peter Bui Matthew Jackson Shareef Nahas Robert Taylor Molecular Toxicology

UCLA Tobacco Control Capacity Building Scholarships, funded by bequests from the Carl E. Hopkins Fund and Kaiser Foundation Health Plan, Inc. Thida Aye Community Health Sciences Suzuho Shimasaki Health Services

Wilshire Foundation Endowment in Geriatric Medicine and Long Term Care Kerry Hood Voranan Pongquan Community Health Sciences Kenneth Frausto Health Services

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Jonathan Friel Health Services

Adrienne Katner Sarah Rothenberg Environmental Science and Engineering

Tommi Gaines Biostatistics

Juan Jia Biostatistics

Monica Salinas Fellowship

students

Abdelmonem A. Afifi Student Fellowship

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student profiles Bringing Public Health to Remote Region of Tibet

“The goal of public health is the well-being of the individual and the community. That fits very well with my beliefs as a Buddhist.”

UCLAPUBLIC HEALTH

— Kunchok Gyaltsen

ONE COULD HARDLY BLAME KUNCHOK GYALTSEN if he experienced a culture shock upon arriving at UCLA, where he is currently a doctoral student in the School of Public Health. Gyaltsen is from the city of Xining in Qinghai Province, part of the Tibetan region of China. The mountainous province is among China’s poorest and most remote areas. “Los Angeles is too big,” Gyaltsen says, laughing. “But I keep my life simple and quiet.” Even in a city as diverse as Los Angeles, Gyaltsen is sure to stand out when he rides the bus from Westwood to his temporary home in Santa Monica. Gyaltsen is a Tibetan Buddhist monk, and a medical doctor trained in traditional Tibetan medicine. Since 2001 he has been executive director of Kumbum Tibetan Medical Hospital, overseeing a staff of 30 medical professionals and trainees. As he became more involved in hospital management, he began to realize that a system in which more patient visits was considered an indicator of success didn’t gibe with his values. “It made me uncomfortable,” says Gyaltsen. “I want to see less patients, because that means less people are suffering from illnesses.” Gyaltsen knew what he wanted, but wasn’t sure how to achieve it until he discovered public health. He learned English and has spent much of the last six years in the United States, most recently at UCLA under the guidance of Dr. Anne Pebley, who helped Gyaltsen secure funding from the school’s Fred H. Bixby Doctoral Fellowship Endowment that was critical to his ability to complete his education: When Gyaltsen works in Tibet, he is lucky to earn the equivalent of $300 in a month. While in the United States, Gyaltsen has also garnered support for the Tibetan Healing Fund (www.tibetanhealingfund.org), the nonprofit organization he founded in 2001 to raise money for education and maternal-and-child-health projects in the Tibetan region. Initiatives have included the training of approximately 3,000 village women to be health educators and community midwives. A natural birth and training center is also being built. “The vast majority of women are not getting prenatal or postnatal care, and are delivering babies at home, often assisted by family members who have no training,” Gyaltsen says. “As a result, the infant mortality rate is high.” Compounding matters, in many parts of Tibetan society it is taboo for women to discuss health issues, even with their husbands, and when problems develop they tend to delay seeking professional care. Observing the U.S. health care system up close has underscored for Gyaltsen some of the shortcomings of the Tibetan system, which has little in the way of a public health infrastructure and lacks the sophistication of medical training found in the West. On the other hand, Gyaltsen believes Tibetan medical doctors tend to be better than their U.S. counterparts at communicating with and showing compassion for their patients. And the biggest surprise when he came to this country was to see that for all of the technological prowess of the U.S. health care system, so many lack access to basic health care – a major concern for those in the profession Gyaltsen hopes to promote when he returns to his native region. “The goal of public health is the well-being of the individual and the community, and to reach that goal means promoting good physical and mental health as well as having good social support and meeting basic needs such as water, sanitation, food and shelter,” says Gyaltsen. “That fits very well with my beliefs as a Buddhist.”

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students

Making Sense of New Census Classifications for Race

“As long as there continue to be differences between races in regard to health conditions, we need to continue to collect and find ways to make sense of the data so that we better understand why these disparities exist.” — Tommi Gaines

UCLAPUBLIC HEALTH

STARTING WITH THE 2000 CENSUS, the federal government revised how it collects data on race and ethnicity – respondents were allowed to identify themselves as a member of more than one category (which 7 million opted to do), whereas in prior censuses they were forced to choose one. The revision was made in recognition of the nation’s growing number of interracial couples, who in turn are producing children whose diverse lineage defies a single classification. But the change also creates potential nightmares for researchers and policymakers who rely on the data from these and other surveys to understand racial and ethnic disparities in health: When you consider all of the possible combinations, including “other,” there are now 63 multiple-race categories along with the six single-race categories. TOMMI GAINES, a UCLA School of Public Health doctoral student in biostatistics, is tackling the challenges arising from the new collection method. “There have been goals that have been set around understanding why differences exist between races and how we can develop policies to try to eliminate or reduce these differences,” Gaines notes. “If there are disparities found between multiracial populations and a single-race category, how do we accurately reflect what’s going on with the multiracial populations, which capture a broad range of people? It becomes harder to tease out the potential problems that are causing these health differences.” (For more on the issue of health disparities, see page 20.) Among the concerns: Analysts who want to compare race-related results from different data collection systems may find that it’s like comparing apples and oranges when one reports statistics by single-race data while the other reports both single-race and multi-race data. Similarly, studying trends over time using census standards for racial classification becomes challenging. “If I want to see whether the gap between two races on a specific health outcome is being reduced over a 10-year period, it’s more difficult with the revised system,” Gaines says. Finally, with so many racial classifications, there is the problem of samples sizes becoming too small in specific multiple-race categories to generate reliable estimates. For her doctoral dissertation, Gaines is testing three methods for analyzing multiracial data. She is testing the validity of these methods by measuring the state’s progress in meeting the national Healthy People 2010 objectives, which set out to eliminate racial disparities, using data from the California Health Interview Survey (CHIS). CHIS, based in the school’s Center for Health Policy Research, allows respondents to check multiple race categories but, unlike the census, also asks respondents in a follow-up question to select the one race with which they primarily identify. This type of data enables Gaines to investigate the advantages and disadvantages of the methodologies by comparing single-race health statistics generated under each methodology to those based on the actual data captured by the follow-up question. After completing her degree, Gaines plans to pursue a career in academia or with a government agency; in either case, her focus will be on helping to better understand racial disparities in health. “Interracial marriages are projected to increase over time, which means a growing interracial population,” she says. “As long as there continue to be differences between races in regard to health conditions, we need to continue to collect and find ways to make sense of the data so that we better understand why these disparities exist.”

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sph designated a national center of excellence for influenza research

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. If you are not already receiving and would like to receive the SPH ALUMNI e-NEWS that brings information on events and people of special interest to alumni three times a year, send your e-mail address with your name and current home and business addresses to publichealth@ support.ucla.edu.

The National Institute of Allergy and Infectious Diseases (NIAID) awarded the UCLA School of Public Health $18.5 million to create the Center for Rapid Influenza Surveillance and Research (CRISAR), one of six Centers of Excellence for Influenza Research and Surveillance established by NIAID to expand its influenza surveillance program both internationally and in the United States. Dr. Scott Layne, professor of epidemiology, is principal investigator of this new effort. The goal of the newly created centers is to provide the federal government with important information to inform public health strategies for controlling and lessening the impact of seasonal influenza as well as a potential influenza pandemic. A team of physicians, veterinarians, researchers and biologists has been assembled from across the United States to conduct research on influenza viruses with pandemic potential. “UCLA’s School of Public Health has assembled many of our country’s leading influenza experts to monitor the path of influenza in the United States and abroad,” says Dr. Linda Rosenstock, dean of the school. “CRISAR will be instrumental in early detection of the next influenza outbreak, providing a head start in preventing a pandemic.” CRISAR will utilize the federally and state-funded UCLA High Speed, High Volume Laboratory Network for Infectious Diseases, created to quickly analyze and process large quantities of biological samples. Improving the global capacity to make rapid and critically important decisions to save lives, the lab will enhance animal and human surveillance and permit an up-to-date view of infectious disease outbreaks for effective decision-making and public health interventions.

BRESLOW LECTURE — Dr. Larry Brilliant (l.), executive director of Google’s philanthropic enterprise Google.org, was the speaker at the 33rd Annual Lester Breslow Distinguished Lecture. Brilliant, who is spearheading Google’s initiatives to reduce global poverty, improve the health of the least advantaged, and halt or reverse the effects of the climate crisis, spoke on “Healing a Broken World.” With Brilliant is Dr. Lester Breslow.

S AV E T H E D AT E

DID YOU KNOW?

UCLAPUBLIC HEALTH

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news briefs

6/5/07

MOVIE PREMIERE — Dean Linda Rosenstock with actor, producer and humanitarian Danny Glover at the Los Angeles premiere of ¡Salud!, co-hosted by the school in May. Glover introduced the film, which depicts Cuba’s highly regarded health care system and highlights the work of the non-profit MEDICC (Medical Education in Cooperation with Cuba), with which the school has enjoyed a long relationship.

UCLA SCHOOL OF PUBLIC HEALTH ALUMNI AND FRIENDS RECEPTION MONDAY, NOVEMBER 5, 2007 6:30 – 8:00 pm Location To Be Announced

During the Annual Meeting of the American Public Health Association, November 3 – 7, in Washington, D.C. Check the APHA schedule or stop by the UCLA School of Public Health booth for location information.

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new faculty

john sonego joins sph leadership team John Sonego has joined the school as assistant dean for development and alumni relations. Sonego brings a distinguished background in fundraising, marketing and communications. He worked most recently as an independent consultant after serving as director of programs and communications for the Gay & Lesbian Alliance Against Defamation. Previously, Sonego served as vice president at the public relations agency Rogers & Associates and was director of marketing and public relations for the Detroit Historical Museums.

CLINTON GLOBAL INITIATIVE PROCLAMATION — Dean Linda Rosenstock signs a commitment by the school to “help identify, monitor and combat emerging infectious diseases at their genesis” as part of the Clinton Global Initiative. With Rosenstock are Cindy Horn (left) and Cynthia Sikes Yorkin, members of the school’s Dean’s Advisory Board and the Entertainment Industry Task Force, who, along with President Bill Clinton, also signed the proclamation.

faculty

CONGRESSIONAL TOUR — Rep. Jerry Lewis (R-CA) visits the School of Public Health and tours the future UCLA High Speed, High Volume Laboratory Network for Infectious Diseases, a project that has received core federal support. With Lewis are Dean Linda Rosenstock (left) and Associate Dean for Research Roshan Bastani.

DR. HILARY GODWIN has joined the faculty as chair of the Department of Environmental Health Sciences. Godwin comes to UCLA from Northwestern University where she served on the Department of Chemistry faculty, most recently as chair. Her research focuses on the basic chemical and biological mechanisms by which toxic metal ions affect neurological signaling and development. Lauded for her work, Godwin is a Howard Hughes Medical Institute Professor. Additional awards include receipt of the Camille Dreyfus TeacherScholar Award, an Alfred P. Sloan Research Fellowship, a National Science Foundation CAREER Award, and the Burroughs Wellcome Fund Toxicology New Investigator Award. Godwin received her Ph.D. in Physical Chemistry from Stanford. She conducted postdoctoral research at Johns Hopkins University School of Medicine, where she was a National Institutes of Health postdoctoral fellow. For more on Godwin’s background and work, see page 12.

DR. NATHAN WOLFE has joined the faculty as professor in the Department of Epidemiology. Wolfe’s research combines methods from molecular virology, ecology, evolutionary biology, and anthropology to study the biology of viral emergence. The recipient of a Fulbright fellowship, Wolfe was awarded the highly prestigious NIH Director’s Pioneer Award in 2005 to work in regions of high biodiversity with subsistence hunters, who will collaborate in a sentinel surveillance system to monitor the spillover of novel viruses into the human species. He received his doctorate in Immunology and Infectious Diseases from Harvard University and most recently served on the faculty at Johns Hopkins University Bloomberg School of Public Health. For more on Wolfe’s work, see page 10.

ALSO JOINING THE FACULTY:

ONYEBUCHI ARAH Epidemiology MARJAN JAVANBAKHT Epidemiology RAJESH NANDY Biostatistics MARC SUCHARD Biostatistics

UCLAPUBLIC HEALTH

JOELLE BROWN Epidemiology

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faculty honors DR. THOMAS BELIN received the 2005/2006 Excellence in Mental Health Policy and Economics Research Award from the International Center on Mental Health Policy and Economics for his paper, “Geographic variation in alcohol, drug, and mental health services utilization: What are the sources of the variation?” DR. DIANA BONTÁ is serving on the boards of the Health Professions Education Foundation, the Council of Education in Public Health, and Hollywood, Society and Health. DR. LESTER BRESLOW received UCLA’s Dickson Emeritus Professorship Award, which honors outstanding research, scholarly work, teaching and educational service to the university and the profession. DR. FRED HAGIGI was the first School of Public Health recipient of UCLA’s Distinguished Teaching Award. DR. NEAL HALFON received the Ambulatory Pediatric Association’s Annual Research Award for “lifetime contributions to the field of child health research.” DR. GAIL HARRISON was appointed to the Board of Directors of California Food Policy Advocates. DR. ROBERT KAPLAN was named Fred W. and Pamela K. Wasserman Chair at the UCLA School of Public Health. He received the Astra-Zeneca 2006 prize for best original research article for his paper entitled “Estimating the risk of long-term erectile, urinary and bowel symptoms resulting from prostate cancer treatment.” DR. GANG LI was elected fellow of the American Institute of Mathematical Statistics. DR. SIMIN LIU was named a member of Dietary Carbohydrates in Health and Diseases, a joint scientific committee of the World Health Organization and the Food and Agriculture Organization of the United Nations; and of the Diabetes, Endocrinology and Metabolic Diseases B Subcommittee of the National Institute of Diabetes, Digestive and Kidney Diseases. DR. LEO MORALES was elected to the American Society for Clinical Investigation. DR. CHARLOTTE NEUMANN received the 2007 Harvard School of Public Health Alumni Award of Merit, the highest honor bestowed by the school on its alumni in recognition of outstanding contributions to the field of public health.

UCLAPUBLIC HEALTH

DR. LINDA ROSENSTOCK is serving as president of the Society of Medical Administrators, chair-elect of the Association of Schools of Public Health, board member of the Health Effects Institute and a member of the Health Sciences Policy board of the Institute of Medicine.

bookshelf

...recent books by UCLA School of Public Health authors

Atlas of Human Parasitology, 5th Edition, by Lawrence R. Ash and Thomas C. Orihel. ASCP Press. A comprehensive guide for the identification and diagnosis of human parasites. Optimizing Health: Improving the Value of Healthcare Delivery, edited by Franz Porzsolt and Robert M. Kaplan. Springer. As health care costs soar, there is increasing interest in examining what society and, particularly, patients receive in return for these expenditures. This book brings together the best thinking from both sides of the Atlantic to examine these issues, employing disciplinary perspectives from economics, ethics, philosophy, psychology, clinical practice, and epidemiology to explore various ways that value for patients has and can be determined. Pharmaceutical Economics and Policy, 2nd Edition, by Stuart O. Schweitzer. Oxford University Press. The pharmaceutical industry is praised as a world leader in high-technology innovation and the creator of products that increase both longevity and quality of life for people throughout the world. At the same time, the industry is also criticized for its marketing and pricing practices and for its apparent anticompetitive responses to generic competition. This book uses the tools of economic analysis to explore the conflicting priorities and aims of the pharmaceutical industry, from both an American and worldwide perspective. Suffering in the Land of Sunshine: A Los Angeles Illness Narrative (Critical Issues in Health and Medicine), by Emily K. Abel. Rutgers University Press. The history of medicine is much more than the story of doctors, nurses, and hospitals. Seeking to understand the patient’s perspective, historians scour the archives, searching for rare personal accounts. Bringing together a trove of more than 400 family letters by Charles Dwight Willard, this book provides a unique window into the experience of sickness.

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honor roll 2006

friends

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, 2006, to December 31, 2006. 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 $100,000 - $200,000 RAYMOND AND BETTY GOODMAN $25,000 - $49,999 RALPH AND SHIRLEY SHAPIRO $10,000 - $24,999 EDWARD AND JOANNE DAUER ROBERT J. DRABKIN GERALD AND LORRAINE FACTOR FARHAD A. HAGIGI CARL AND FLORENCE HOPKINS FAMILY TRUST LESTER AND CAROLBETH KORN KENNETH AND CORNELIA LEE DEBORAH A. LEVY MONICA SALINAS FRED AND PAMELA WASSERMAN

RICHARD AND AMY LIPELES WILLIAM D. MEIERDING WALTER OPPENHEIMER DANIEL AND LORI PELLICCIONI KENNETH J. RESSER MARY JANE ROTHERAM BENEDICT R. SCHWEGLER TODD C. THEODORA AYAKO UTSUMI

$1,000 - $2,499 LESTER AND DEVRA BRESLOW SANFORD R. CLIMAN AND LORRAINE R. TODD BRUCE N. DAVIDSON JAMES AND MARTA ENSTROM GAROLD AND JOYCE FABER STEVE GUTEKUNST SUSAN D. HOLLANDER DAVID M. HUMISTON GERALD AND LAURIE KOMINSKI

$250 - $499 CRAIG M. ACOSTA DONALD AND LUJEAN AVANT LAURIE MEIER BAUER MICHAEL J. BELMAN GERALD AND DIANA BOROK E. RICHARD AND MARIANNE BROWN DWIGHT L. CAREY SUSAN J. CARR GRACE K. CROFTON KATHRYN P. DEROSE

$5,000 - $9,999 ABDELMONEM AND MARIANNE AFIFI IRA AND MARSHA ALPERT MICHELE DILORENZO ROBERT W. GILLESPIE JACQUELINE B. KOSECOFF EDWARD J. O'NEILL

MILDRED G. STERZ IRMA H. STRANTZ LINDA A. THOMAS DIANNE K. TOMITA CITRON AND GENEVIEVE TOY LEAH J. VRIESMAN H. G. WALLACE BARRY R. WALLERSTEIN ROBERT S. WALLERSTEIN KENNETH B. WELLS ARTHUR AND JUDY WINER DAYLE K. WRIGHT STANLEY C. YUEN $100 - $249 JOSEPH M. AFONG DEBORAH AGURKIS RICHARD F. AMBROSE AND BOBETTE NELSON RONALD AND DIANE ANDERSEN CRAIG L. ANDERSON SARAH ANDERSON AND MATTHEW KAGAN FREDERICK J. ANGULO JAMES D. ARTERBURN TAKAMARU ASHIKAGA STANLEY AZEN AND JOYCE NILAND NASREEN BABU-KHAN RICHARD A. BARFIELD SHAROK AND ROSHAN BASTANI CHRISTY L. BEAUDIN ROBERT AND MARGARET BECK THOMAS R. BELIN AND ANNE L. COLEMAN BARBARA W. BERG SUSAN K. BLACKWELL LINDA B. BOURQUE KATHRYN J. BRAUDE LESLIE W. BRECKENRIDGE BONNIE BRINTON PETER C. UTAS AND BARBARA L. BROIDE HAROLD V. BROWN ERIC BUBBERS AND SANDRA WELGREEN MARC G. BULTERYS AND ANN CHAO MICHELLE R. BURTON CELIA BYRNE MARIA D. CANFIELD KATHLEEN C. CAPAROSO MICHAEL P. CAPELESS DAVID E. CARDENAS RALPH AND MARTHA CARMEL

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.

UCLAPUBLIC HEALTH

$2,500 - $4,999 DAVID L. CALLENDER RAYMOND AND JENNIE JING STEPHEN W. KAHANE AND JANET A. WELLS-KAHANE CAROLYN F. KATZIN ROBERT AND ADELINE MAH ERNEST PRETE JR. LINDA ROSENSTOCK AND LEE BAILEY RICHARD AND PATRICIA SINAIKO MICHAEL AND DIANE STEPHENS

$500 - $999 SANDRA ARONBERG LEONARD AND JOAN BEERMAN JOY T. BLEVINS DIANA M. BONTA ASIS CHATTOPADHYAY JOHN AND ANNE COULSON THOMAS AND PHYLLIS FARVER JONATHAN AND KARIN FIELDING RONALD C. FORGEY ALISA M. GOLDSTEIN FRANK C. GOMEZ ROBERT HELTZER DONALD AND CAROLYN HUNSAKER CHARLES N. KAHN MASAO AND KARLENE KOKETSU MARIE M. LA FARGUE KERRY J. MATSUMOTO MARC AND JOANNE MOSER KYLE A. MURPHY NIEL S. NATHASON RYAN AND SAMANTHA OLSEN THOMAS H. RICE AND KATHERINE DESMOND MIRIAM SCHOCKEN ROBERT SCOFIELD STEVEN R. SIM ARTHUR M. SOUTHAM BARBARA R. VISSCHER AND FREDRICK H. KAHN

DARYL V. DICHEK ROBERT DONIN SAM W. DOWNING JOEL M. ELLENZWEIG RALPH R. FRERICHS AND RITA FLYNN ANNE L. FUJIOKA CAROLYN A. FULLER BRUCE GERDING HERBERT AND SHARON GLASER OSCAR T. GO MARK A. GOLD AND LISETTE BAUERSACHS JANE G. GOODALL KENNETH D. GRAHAM ROCHELLE S. GREEN MELVIN A. GREENSPAN HARLAN H. HASHIMOTO TIM AND BARBARA JEAN HEINZEL HORACE W. HINKSTON MARK JAMES HOWARD MING-YI HU AND TINA CHEN JACK AND MARJORIE HUDES W. MARK JASPER AVRAM AND BETH KAPLAN ROBERT M. KAPLAN NEAL AND FRANCINE KAUFMAN LEONARD AND MELODYE KLEINMAN JAMES J. KORELITZ DAVID KRASNOW CHRISTOPHER J. MARDESICH AND EDEN KUSMIERSKY GWENDOLYN L. ISAACS HERBERT L. LUNDBLAD ANN G. MAHONY GREG MANSUR RICHARD AND BARBARA MARCINIAK NICHOLAS AND JOANNE MARDESICH JON B. MARSHACK ALLEN MILLER ROBERT W. MURPHY JOAN E. NICHOLS SHARON L. NICHOLS NELLY A. NIGRO WALTER AND CINDA NOCE ELLEN QUIGLEY ALAN P. SANDLER ANTHONY H. SCHIFF JACK R. SCHLOSSER IRWIN J. SHORR IRA AND HELENE SMITH LISA SOROKA

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UCLAPUBLIC HEALTH

36 ANGELICA CASTANEDAJIMENEZ DANIEL CHAN DONALD S. CHANG AND MARGARET H. LEE GRACE H. CHANG CHENG-TAI CHEN SUI-SHENG CHEN WELDEN AND VIRGINIA CLARK JEFFREY AND LISA COHEN BRIAN L. COLE RICHARD D. CORDOVA MARK E. COSTA THOMAS SAFIR AND LINDA COTTINGHAM-SAFIR DEL M. COVINGTON MILLICENT COX-EDWARDS WILLIAM H. CRAIG MITCHELL AND DEBRA CREEM JULIE E. CRONER JANET A. CUNNINGHAM PETER C. DAMIANO ADAM DARVISH ANN M. DELLINGER ROGER AND MARY DETELS KIM DICKINSON CHERYL DIFATTA MARGIE R. DIKE ANNE B. DILLEY ARAM DOBALIAN BRIAN P. DOLAN CATHERINE I. DUDA KRISTINE A. EDWARDS ELLEN R. EISEMAN AMER M. EL-AHRAF SAM AND MEREDITH ELROD GAYLE ETIENNE ELEONOR G. EVANGELISTA JANET L. FAHEY DANIEL J. FAIRLEY JESUS FERNANDEZ DON J. FINEGOLD FELICIA A. FLORES-WORKMAN JILLIAN S. FORE ANDREW J. FORSTER HENRY W. FOSTER JOHN R. FROINES AND ANDREA M. HRICKO OSMAN GALAL AND GAIL HARRISON ANACLETO D. GANO MATTHEW S. GERLACH AND LINDA TESLOW-GERLACH CAROL J. GILBERT SUZAN E. GIVEN DENISE R. GLOBE BERNARD H. GOLDNER MICHAEL S. GOLDSTEIN DON SPETNER AND LAURIE GOODMAN CLAUDIA GRAHAM JOHN D. GRAHAM JANET C. GREEN NEAL HALFON ANN S. HAMILTON NEVINE M. HANNA DONALD AND SARAH HARLAN

NANCY A. HESSOL JOE AND DIANA HILBERMAN WILLIAM HINDS LYNDA S. HOGGAN ELISE M. HOLLOWAY KAREN Y. HSU JOHN D. IVIE RICHARD B. JACOBS DARIUS AND VIDA JATULIS ELIZABETH D. JENKINS LUOHUA JIANG KRISTIN JOHNSON AZAR KATTAN JUDITH R. KATZBURG JOHN A. KAUFMANN LAURIE H. KAYNE MARY ANN KELLY VICTOR AND NOLA KENNEDY JINSOOK KIM EVAN J. KING NANCY J. KINGSTON JEFFREY S. KIRSCHNER CAROLE A. KLOVE GARY J. SLOAN AND BARBARA J. KOMAS JENNIFER L. KOZAKOWSKI KIET A. LAM BARBARA M. LANGLANDORBAN EDWARD G. LAUBACHER SCOTT P. LAYNE WENDY LAZARUS JOON LEE LAUREL A. LEE MARTIN AND MARILYN LEE STANLEY A. LEMESHOW GERO LESON REBECKA K. LEVAN JOHN AND SANDY LIBBY JOAN H. LOPES JEFFREY LUCK AND CAROLYN MENDEZ-LUCK KUNG AND JEN-MEI LUI GEORGE H. MACK MAXINE G. MANTELL SIDNEY AND JOAN MARANTZ MICHELLE M. MARCINIAK GAIL L. MARGOLIS MEGHAN E. MARTIN WENDY BLAVAT MC GRAIL WILLIAM E. MC REE SHERMAN AND JUNE MELLINKOFF HILDY B. MEYERS RUTH M. MICKEY ROSS AND EVA MILLER JUAN AND EMILY MONTES ZAHRA MOVAGHAR CLAIRE J. MUELLER CRAIG G. MYERS JUDITH A. NAKAMATSU WILLIAM AND ELIZABETH NASH RAYMOND J. NASSIEF JACK NEEDLEMAN ALFRED AND CHARLOTTE NEUMANN

SUSAN S. NIMMO FELIX L. NUNEZ JORN OLSEN WALTER J. ORZECHOWSKI NEVILLE AND LYNN OSTRICK CLAIRE B. PANOSIAN PATRICIA H. PARKERTON LISA I. PARKS ERNESTO O. PARRA CORINNE L. PEEK-ASA ELLA PENNINGTON CATHERINE G. PERCY DENISE L. PERPICH LAURA J. PETERSEN ROBERT AND EILEEN PLOURDE ROBERT NORDYKE AND NINEZ A. PONCE MICHELLE L. POPOWITZ JENNIFER L. POWELL STEPHEN R. PRATT SHANE S. QUE HEE VERONICA QUIMPO ERIC AND LAUREL RABJOHNS DARCY A. RATNER JENNIFER A. RAYMOND CYNTHIA O. RECIO LOREN D. REED CORI D. REIFMAN ANURAG RELAN DAVID L. RIMOIN AND ANN P. GARBER-RIMOIN LOUISE A. ROHRBACH WILLIAM P. ROSE BRYAN C. WEARE AND NAOMI S. ROSEN SHOLOM ROSEN MARTIN B. ROSS CURTIS AND DOROTHY ROZAS MARIA S. RUIZ BARBARA E. RYDGREN JAIME G. SALAZAR ALAN SAMUELS CONNIE C. SANCHIS PAUL R. SANTOYO KENNETH P. SATIN SUSAN R. SAZER CYNTHIA C. SCALZI GERALDINE SCHICK STUART AND SUZANNE SCHWEITZER DONNA A. SEID ELESTIA E. SHACKELFORD HARSHAD AND BHARTI SHETH WALEED W. SHINDY MICHAEL AND SUSSAN SHORE GALE F. SHORNICK LINDA H. SHULTZ W. JUNE SIMMONS JAMES B. SIMPSON GARY AND MARY SMITH LISA V. SMITH REBECCA A. SMITH WILLIAM E. SMITH PAUL E. SMOKLER SAM S. SNYDER

FIRST CENTURY SOCIETY 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.

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 WALTER OPPENHEIMER JEANNETTE OREL JOYCE PAGE JEAN SANVILLE GURDON AND MARY ANN SMITH SUEBELLE AND DAVID VERITY

CYNTHIA J. SO VICKY I. SOBSCHAK DAVID AND RONDA SOLOMON GILBERT AND JUDITH SOLOMON GUY W. SOOHOO NICOLETTE P SPOLTORE ERIC D. STEIN DANIEL J. STONE IRA S. STUDIN CAROLE L. SUAREZ CONSTANCE B. SULLIVAN LINDA S SURAPRUIK MARCIA H. SUZUKI ANNETTE M. SWEZEY JUDY P. SY DOUGLAS TEUBER DIANE R. THOMAS HEATHER C. TINDALL GREGORY D. TREROTOLA JANE H. TURNER GUSTAVO A. VALDESPINO MANUEL VANEGAS SUEBELLE S. VERITY STEVEN L. VOLLA

DOROTHY E. VURA-WEIS JEANNE C. WAITE STEVEN P. WALLACE ALBERT B. S. WANG ELOISE WATKINS DAVID S. WEINBERG BRUCE G. WENIGER TARA J. WESTMAN CHARLES AND THERESA WOLF FLORENCE L. WONG JANICE W. WOODS ANTRONETTE K. YANCEY ELIZABETH M. YANO FRANCIS L. YEMOFIO HERMAN A. ZAMPETTI GREG L. ZEISLER

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37 $1,000,000 - $1,999,999 THE CALIFORNIA WELLNESS FOUNDATION THE ROBERT WOOD JOHNSON FOUNDATION $500,000 - $999,999 BREAST CANCER RESEARCH FOUNDATION THE CALIFORNIA ENDOWMENT $100,000 - $499,999 FRED H. BIXBY FOUNDATION OCHSNER CLINIC, LLC RAND CORPORATION THE SUSAN G. KOMEN BREAST CANCER FOUNDATION $50,000 - $99,999 SCLERODERMA FOUNDATION $25,000 - $49,999 AMGEN INC. THE PARKINSON’S INSTITUTE $10,000 - $24,999 BRIGHAM AND WOMEN’S HOSPITAL CEDARS-SINAI MEDICAL CENTER FOLEY & LARDNER LLP WILSHIRE FOUNDATION, INC. $5,000 - $9,999 BLUE CROSS OF CALIFORNIA KAISER PERMANENTE PACIFICARE HEALTH SYSTEMS, INC. PRICEWATERHOUSECOOPERS UNIVERSITY OF FLORIDA $1,000 - $4,999

CAROLBETH KORN RECEIVES DEAN’S AWARD Carolbeth Korn will receive the Dean’s Award for sustained and generous support at the School’s 2007 commencement ceremony on June 15. Korn was a founding member of the Dean’s Advisory Board and has served as a tireless and generous advocate for the School for more than three decades. In 2006, Korn donated $200,000 to the UCLA School of Public Health to endow, in perpetuity, an annual $10,000 prize honoring the outstanding graduating student each year. Every spring, the annual recipient of the Carolbeth Korn Prize is selected by the faculty leadership and dean of the School of Public Health and is announced during the School’s annual student awards event. In 1997, Korn gave her first major gift of $100,000 to the UCLA School of Public Health, at the time the largest unrestricted gift in the School’s history. The Dean’s Meeting Room was renamed the Carolbeth Korn Meeting Room in recognition of her generosity. Korn graduated from UCLA in 1959 with a bachelor’s degree in public health. While at UCLA she also received a National Institutes of Health fellowship in biostatistics. In addition to her work on the Dean’s Advisory Board, she serves on the Board of Directors of The Music Center and Women and Philanthropy at UCLA, and as a member of the UCLA Foundation Governors. PROFESSOR ROSLYN B. AFLIN-SLATER’S LEGACY CONTINUES The School of Public Health mourned the passing in 2002 of Professor Emerita Roslyn B. Alfin-Slater, an international authority on nutrition. Dr. Alfin-Slater served on the UCLA School of Public Health faculty from 1959 until her retirement in 1987. At UCLA, she was a founder of the program in Public Health Nutrition and head of the division of Environ-mental and Nutritional Sciences. After the passing of her husband Dr. Grant G. Slater earlier this year, the School of Public Health became aware that Alfin-Slater had graciously remembered the School in her estate planning. “We are profoundly thankful for the generosity and vision she showed her former School by providing this generous gift that will strengthen the School’s continuing excellence,” says Dean Linda Rosenstock. “Her lifelong commitment to education and UCLA will live on in the projects her bequest will support.”

UCLAPUBLIC HEALTH

CALIFORNIA ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS CERNER CORPORATION CHEVRON CORPORATION COMMUNITY OUTREACH FOR PREVENTION & EDUCATION DELOITTE & TOUCHE SERVICES LP HEALTH BENCHMARKS INC. CONRAD N. HILTON FOUNDATION L.A. CARE HEALTH PLAN NWQ INVESTMENT MANAGEMENT COMPANY RUSTIC CANYON PARTNERS SCAN HEALTH PLAN SEDGWICK DETERT MORAN & ARNOLD LLP UCLA HEALTH SERVICES ALUMNI ASSOCIATION UNIVERSAL CARE VHA INC.

$100 - $999 ADVENTIST HEALTH ASPEN ENVIRONMENTAL GROUP ASTRAZENECA LP CFHS HOLDINGS INC. CHEVRON USA INC. COURSE READER MATERIAL DUVALL ENTERPRISES GENENTECH INC. GLAXOSMITHKLINE FOUNDATION GOOD SAMARITAN HOSPITAL GREATER NEWPORT PHYSICIANS HEALTHCARE PARTNERS LIMITED HENRY MAYO NEWHALL MEMORIAL HOSPITAL HOSPITAL ASSOCIATION OF SAN DIEGO & IMPERIAL COUNTIES HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA HOSPITAL COUNCIL OF NORTHERN AND CENTRAL CALIFORNIA JOHNSON & JOHNSON CONTRIBUTION FUND KENNAMETAL FOUNDATION MATCHING GIFTS PROGRAM MERCK COMPANY FOUNDATION NORTHROP GRUMMAN LITTON FOUNDATION PFIZER FOUNDATION INC. PROGRESSIVE HEALTHCARE SYSTEMS SHARP HEALTHCARE SPENCER STUART SUTTER MEDICAL CENTER FOUNDATION UCLA ACHE STUDENT CHAPTER WELLPOINT FOUNDATION WEST ANAHEIM MEDICAL CENTER

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CORPORATE AND FOUNDATION GIFTS AND GRANTS

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Commencement

2007 Antionette Smith Epps, the administrator of Martin Luther King, Jr. Harbor Hospital (MLKH), is the featured speaker at the schoolâ&#x20AC;&#x2122;s 2007 Commencement.

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