UCLA Public Health Magazine - June 2010 by UCLA Fielding School of Public Health

JUNE 2010

UCLA

PUBLIC HEALTH New Directions in Education: from there

to here

UCLA

Innovative teaching approaches help today’s students become tomorrow’s leaders.

School of

Public Health

With new concerns atop traditional ones, public health faces a busy future. Jørn Olsen is among a halfdozen SPH experts who discuss the challenges ahead.

As a nation, we spend more on health care than anyone, but the quality of care is less than optimal. Hector Rodriguez’s research aims to change that.

What impact does exposure to air pollutants have on birth outcomes for pregnant women? For her doctoral studies, Jo Kay Ghosh is seeking answers.

UCLA

PUBLIC HEALTH

Chancellor

Gene Block, Ph.D. Dean, UCLA School of Public Health

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

Assistant Dean for Communications

Sarah Anderson

Assistant Dean for Development and Alumni Relations

John Sonego

features

Editor and Writer

Dan Gordon Art Director

Martha Widmann

E D I TO R I A L B OA R D Professor, Environmental Health Sciences

Richard Ambrose, Ph.D.

Professor, Health Services Associate Dean for Research

Roshan Bastani, Ph.D.

Professor, Biostatistics

New Directions in Education

Thomas R. Belin, Ph.D.

Associate Professor, Epidemiology

Pamina Gorbach, Dr.P.H.

Professor, Health Services

F. A. Hagigi, Dr.P.H., M.B.A.

Assistant Professor, Health Services

Moira Inkelas, Ph.D.

Professor and Chair, Environmental Health Sciences

Richard Jackson, M.D., M.P.H. Associate Professor, Community Health Sciences

Michael Prelip, D.P.A.

Co-Presidents, Public Health Student Association

Julia Caldwell and Goleen Samari President, Alumni Association

UCLA

Christopher Mardesich, J.D., M.P.H. ’98

School of

Public Health

Innovative teaching approaches help today’s students become tomorrow’s leaders.

10 Hector P. Rodriguez:

A Systematic Approach to Improving Care After seeing firsthand how organizational structures and policies can affect the quality of health services, he decided to shed light on the issue through research.

All Over the Maps

Alumni Hall of Fame:

the 2010 Inductees

in every issue 24 RESEARCH

22 12 GIS has emerged as an invaluable research tool for discovering and presenting spatially based trends and connections.

Aerobic fitness and K-12 test scores…financial incentives and physician performance…heart drug for Parkinson’s…junk-food TV commercials and childhood obesity…racial discrimination and healthrelated quality of life.

28 STUDENTS 31 FACULTY

Forward Thinking

33 NEWS BRIEFS

UCLA School of Public Health experts discuss the challenges the field will face in the years ahead – and the opportunities for public health to make a difference.

35 FRIENDS

ON THE COVER As the school rethinks what and how students learn, the traditional style of passively listening to a lecture is becoming increasingly rare.

PHOTOGRAPHY ASUCLA: Don Leibig / TOC: Education; pp. 6-7 Reed Hutchinson / Cover: Rodriguez, Ghosh, clickers; TOC: Rodriguez, Forward Thinking; p. 4: classroom; pp. 5, 9-10; p. 16: Jackson; p. 17: Ford; p. 18: Ponce; p. 19: Rosenstock; p. 20: Olsen; p. 21: Zimmerman; pp. 28-29 Courtesy of UCLA University Archives / Cover: historical lecture hall Courtesy of Beate Ritz / p. 12: Ritz; p. 13 Courtesy of Robert Blair, Kaiser Permanente / p. 8: Blair Courtesy of Ying-Ying Meng / p. 12: map Courtesy of Neal Halfon / p. 14 Courtesy of May C. Wang / p. 15: map Courtesy of UCLA School of Public Health / Cover: education destinations, Olsen; TOC: Hall of Fame; p. 2; p. 4: Godwin; p. 7: Hilberman; p. 8: internship images; pp. 22-23, 30-34; back cover

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 2010 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.

dean’s message THESE ARE EXCITING TIMES for public health. With the historic passage of national health care reform, the opportunity to recalibrate the way our nation addresses health care and health promotion has never been greater. The Congressional Budget Office estimates that the health reform bill will provide insurance coverage for nearly 95 percent of Americans while reducing the overall federal budget deficit by $138 billion over the next decade. In the end, the numbers may not be exactly as estimated, but to provide health coverage for an impressively large number of the United States population while reducing the deficit means that public health and prevention must be a driving part of the equation. We know that individual care explains a very small proportion of people’s health and lifespan – we can get much better results with broader, populationbased strategies that are the foundation of public health. Faculty members at the School of Public Health have spent their careers building expertise in areas critical to the success of meaningful reform. They are poised to take a lead in this effort – an opportunity that has not been afforded our field in decades. Opportunities for our faculty become opportunities for our students. Long gone are the days of simply soaking up information in the classroom; our students today are in the lab, in the field and traveling the world learning firsthand how to implement and evaluate public health programs and practices. This hands-on approach gives them the capacity to become public health leaders of the future – and in the short-term, it makes them highly employable. This issue’s cover story shows the ways our faculty are embracing innovation and technology to ensure we graduate students who are well equipped to make an impact from the moment they graduate. Our faculty members’ willingness to evolve and change the way they teach has helped our programs remain relevant and in great demand. The class selected for entrance next fall endured one of the most competitive climates we’ve had in years, resulting in what may be our most talented, diverse student body yet. Many of our students don’t come from considerable means, but all possess tremendous smarts, talent and the desire and commitment to do well

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for their communities, their nations and our world.

2009-2010 DEAN’S A DV I S O RY B OA R D If you’ve been tracking the California economy you know that the state woes have translated into devastating system-wide cuts for the UC system. To help balance the shortfall, once again the UC Regents have agreed to an increase in student fees. When you look at our students and their resources, it is a tremendous burden. We generally make small adjustments to keep the magazine fresh and interesting, but in this issue we are utilizing something we haven’t used in many, many years – a remit envelope for donations. I wish we didn’t have to be so direct in asking for your support, but unfortunately the times don’t afford the luxury of subtlety. We’ve included an envelope to make it easy for you to directly support the school and our students. We have an amazing opportunity to enable students to join our faculty in contributing to the important task of health reform. Thank you for considering an immediate donation to the school, and keep an eye out for how our faculty and students are joining forces with the leaders in Washington, D.C. to make a difference. For a preview, take a look at page 33 and read about Dr. Antronette Yancey’s partnership with First Lady Michelle Obama. This is the first glimpse of many to showcase how our faculty and stu-

Ira R. Alpert * Lester Breslow Sanford R. Climan Edward A. Dauer Michele DiLorenzo Robert J. Drabkin Gerald Factor (Vice Chair) Jonathan Fielding Michael R. Gardner Dean Hansell (Chair) Alan Hopkins * Cindy Harrell Horn Stephen W. Kahane * Carolyn Katzin * Carolbeth Korn * Jacqueline B. Kosecoff Kenneth E. Lee * Richard D. Lipeles * Edward J. O’Neill * Monica Salinas Fred W. Wasserman * Pamela K. Wasserman * Cynthia Sikes Yorkin

*SPH Alumni

dents are influencing health care reform.

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

S AV E T H E D AT E UCLA SCHOOL OF PUBLIC HEALTH ALUMNI AND FRIENDS RECEPTION

During the Annual Meeting of the American Public Health Association, November 7-11, in Philadelphia

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MONDAY, NOVEMBER 8, 2010 6:30 – 8:00 p.m. Colorado Convention Center, Room: Korbel Ballroom 2A

4 I NNOVATIVE TEACHING APPROACHES HELP TODAY ’ S STUDENTS BECOME TOMORROW ’ S LEADERS .

NEW DIRECTIONS IN PUBLIC HEALTH EDUCATION If your experience in higher education

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goes back more than a few years you have no doubt spent ample time in a large

“In the past, schools of public health have focused on the knowledge students need. The competency model is aimed at ensuring that students acquire the skill set that will enable them to be effective public health professionals. For a professional degree program, itʼs very clear that this is a positive direction.” — Dr. Hilary Godwin

lecture hall, where the instructor does most of the talking and students listen and take notes. But with the UCLA School of Public Health in the process of rethinking what students should learn and how they should learn it, scenarios resembling this traditional didactic style are becoming increasingly rare. More than ever, students are being sent off campus for real-world lessons in public health practice. Back at the school, new technologies are transforming classrooms by making them more interactive. Leaders from industry and the public health practice community are being invited to come to UCLA and assist with teaching. And as the curriculum becomes more dynamic and hands-on, it’s no coincidence that applications to the School of Public Health are at an alltime high. The shift in what students learn is part of a national movement toward competency-based public health education. “In the past, schools of public health have focused on the knowledge students need,” says Dr. Hilary Godwin, professor of environmental health sciences and associate dean for academic programs. “The competency model is aimed at ensuring that students acquire the skill set that

cover story

“Technology makes it easier to be nimble in adjusting the lesson depending on your cohort… E-learning is becoming a major component of the professional learning process, both for people who werenʼt at the presentation and for those who were there and want to use it as a supplement.” — Dr. Fred Hagigi demic programs for the school. “Rather than focusing solely on content, we’re more interested in how you apply that content in a public health setting. In the past, the model was that students received knowledge and then had to learn on the job how to apply it.” Particularly in a climate of constrained budgets, that model needed changing, says Dr. Diana Hilberman, professor of health services. “The argument from the employers’ perspective is that the field is now so complex and resources so scarce that they can’t hire graduates just because they’re smart, then spend six months bringing them up to speed,” says Hilberman. “Our graduates are now expected to be able to perform from their first day on the job.” Hilberman headed the Department of Health Services’ participation as a demonstration site in a nationwide project to bring competency-based education in health administration programs, which resulted in the department’s implementation of a competency model. For their part, students are supportive of the shift toward competency-based education, says Julia Caldwell, a second-year M.P.H. student who is copresident of the Public Health Student Association. “Students are concerned about the jobs they will get after they graduate,” Caldwell says. “They want to make sure the coursework they complete will make them marketable to employers.”

ABOVE LEFT: New class-

room technologies such as the student response system (“clickers”) employed by Dr. Hector Rodriguez are helping to make learning a more active process.

UCLAPUBLIC HEALTH

will enable them to be effective public health professionals. Particularly for a professional degree program, it’s very clear that this is a positive direction.” For the past several years, professional organizations including the Association of Schools of Public Health (ASPH) have convened working groups of public health practitioners and academics (including UCLA School of Public Health faculty) to identify core competencies designed to enhance quality and accountability in graduate public health education and training. The ASPH panel identified more than 100 competencies in a dozen broad categories – from technical skills such as data analysis and information management, program planning and assessment, and systems thinking to interpersonal skills such as communication, leadership, professionalism, and diversity and cultural proficiency, along with skills specific to each of the disciplines within public health. With the ASPH competency model serving as a template, the school has begun the process of making the linkage between the courses being offered and the skills students should have upon earning their degree. Beginning this fall, new systems will be implemented for gathering data from faculty and students along with alumni and other employers of graduates to ensure that students are obtaining the appropriate skills. “This is changing the way we conceptualize our teaching,” says Dr. Gerald Kominski, professor of health services and former associate dean of aca-

UCLAPUBLIC HEALTH

For a course she teaches on geographic information systems, Dr. Hilary Godwin runs group exercises in which students work through examples and tutorials at their computers.

Competency-based education has also been embraced by the school’s Executive M.P.H. (EMPH) Program in Healthcare Management and Policy. Dr. Fred Hagigi, professor of health services and the program’s director, says the approach means greater accountability for both students and faculty. “In the past we just had to say what we taught, but now we are going to have to measure what students have learned,” says Hagigi, who recently ran a workshop for faculty on competency-based instruction and active learning methodologies. It’s not just what students are learning but how they are learning that is undergoing change. Hagigi firmly believes the competency-based approach requires a more participatory and experiential style of education, and his program is leading the way in introducing technologies that are facilitating the transformation. “Technology makes it easier to be nimble in adjusting the lesson depending on your cohort,” he explains. One tool that helps instructors move away from a one-size-fits-all approach to teaching is the student response system – more commonly known as “clickers.” During a class discussion, the instructor can pose a question and instantly obtain online feedback, projected onto a screen, to gauge what students are easily grasping and where they might need additional explanation, for example.

With this and other active-learning technologies, successful implementation in the executive program has led faculty in the school’s day program to follow suit. Dr. Hector Rodriguez, who teaches in both, saw what the clicker technology brought to the EMPH classroom and began using it in his course on organizational behavior for M.P.H. students. Clickers can fulfill many purposes, notes Rodriguez, assistant professor of health services (see the profile on page 10). One is factual – posing questions to see in real-time whether students understand what is being taught. But the technology can also be used to elicit responses to subjective questions. “It can be great for facilitating discussion,” says Rodriguez, who suspects the technology contributed to his students’ stronger-than-expected performance on his most recent final exams. “Teaching competencies requires active learning methodologies,” agrees Godwin. “Having someone just sit in a classroom taking notes builds knowledge, not skills.” Like Rodriguez, Godwin relies on clickers as well as small-group discussions in her introductory environmental health course. For a course she teaches on geographic information systems, an increasingly powerful tool in public health (see the article on page 12), students work through examples and tutorials at their computers in a group exercise. “It’s an active learning paradigm geared toward developing students’ skills in both GIS technology and analysis,” Godwin explains.

“The field is now so complex and resources so scarce that [employers] canʼt hire graduates just because theyʼre smart, then spend six months bringing them up to speed. Our graduates are now expected to be able to perform from their first day on the job.” — Dr. Diana Hilberman

UCLAPUBLIC HEALTH

The school is also increasingly seeking input from public health practitioners and employers – many of them alumni – in shaping the curriculum: both by providing feedback through surveys and participation on advisory boards, and by teaching students as adjunct faculty and guest lecturers. California’s public health laboratories play a vital role in a variety of functions, whether it’s screening newborns for various genetic and congenital disorders; watching for disease-producing agents in food, humans, and animals; or testing for new infectious and bioterrorism threats. But the state faces a critical shortage of directors to run these laboratories. The school has joined with UC Davis and UC Berkeley in a program called LabAspire to establish a pipeline of qualified personnel by training a new generation of lab directors. This year, for the first time, the school is also offering a microbiology lecture and lab course, using a renovated laboratory certified for Biosafety Level 2 activities. “Public health laboratories are a vital and neglected resource of public health departments,” says Dr. Sydney Harvey, associate professor in the Department of Epidemiology, who heads the LabAspire program at UCLA as well as teaching the microbiology course. “In California there is a desperate need for individuals with the expertise and knowledge to fill existing public health laboratory positions. The School of Public Health recognizes this need and is taking action in the form of a new program and relevant courses designed to give students hands-on public health laboratory experience.” The link between the school and the public health practice community in establishing the program is further strengthened by the presence of Harvey, former director of the public health laboratory for Los Angeles County. “This is a new paradigm – not the way we have generally trained people in the past,” says Godwin. “We’re providing students with both an overarching public health background and the specific training needed to run a public health laboratory. And we’re addressing a critical need in the public health workforce by investing resources and infrastructure in specific training.” In addition, as the school considers how best to implement a competencybased curriculum for the M.P.H. degree, it can look to individual School of Public Health programs that have already been engaged in the process. The UCLA Industrial Hygiene program and Southern California NIOSH Education and Research Center, both based in the school’s Department of Environmental Health Sciences, have long sought input from alumni and employers in shaping the curriculum, says Dr. Shane Que Hee, professor and director of the Industrial Hygiene program. “We have found the process to be hard work but rewarding as our program continues to improve in quality and timeliness,” Que Hee says. “These programs are doing their best to try to send graduates out to the community who can contribute immediately to the people who employ them,”

cover story

Other technological tools are extending learning opportunities outside the classroom. Elluminate, a virtual classroom and meeting tool, is used to webcast presentations so that they can be watched by those who are unable to attend. The program is also designed to enhance instruction – for example, a PowerPoint presentation can be synced with the voice presentation so that anyone with Internet access can watch, either live or at a later date. The EMPH program has adopted a similar tool, Mediasite, to post presentations online, synchronizing the presentations with PowerPoint slides and videos. “E-learning is becoming a major component of the professional learning process, both for people who weren’t at the presentation and for those who were there and want to use it as a supplement,” Hagigi says. Godwin notes that these and other distance-learning technologies give the school the potential to reach a broader audience through continuing education programs.

“The program is more in touch with those of us out in the field and itʼs a richer experience for the students as a result. It gives us confidence that when students graduate, they are better prepared to walk into a job and be a valuable asset to our organizations.” — Robert Blair (M.P.H. ʼ88)

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Through the Bixby and Neumann-Drabkin Summer Internship programs, students’ education at the school is augmented by invaluable experiences overseas. Left to right: Jennifer McGee in Nairobi, Kenya; Maria Pia Chaparro in Lima, Peru; and Cristina Rodriguez-Hart (center) and Ellen Rippberger (left) in Kathmandu, Nepal.

says Howard Spielman, president of Health Science Associates, an industrial hygiene, safety and environmental consulting and technical organization. Spielman, who serves on advisory boards for both programs, says advice on how to make the training more practical has been heeded. “I consider the UCLA graduates to be better equipped to meet my needs as an employer than most,” he says. Similarly, the Department of Health Services has sought feedback from members of its professional advisory council, many of whom are alumni. Hilberman says certain themes are consistently heard from prospective employers of the program’s graduates. “They want people who have strong interpersonal and communication skills, strong leadership skills and, because the field is increasingly data-driven, strong quantitative and financial skills,” she says. It’s been more than 20 years since Robert Blair (M.P.H. ’88) graduated from the program, but Blair, medical group administrator at Kaiser Permanente in Harbor City, Calif., is among many alumni who remain actively involved. In addition to serving on the program’s professional advisory council and mentoring students, Blair teaches a course session at the school each year on the use of data to drive performance and periodically gives guest lectures for other courses as well. As an alumnus who has employed many of the program’s graduates, Blair has seen the impact of the emphasis on competency-based education. “Students today are doing more work where they’re engaged with an organization looking at real-world problems,” he says. “The program is more in touch with those of us out in the field and it’s a richer experience for the students as a result. It gives us confidence that when students graduate, they are better prepared to walk into a job and be a valuable asset to our organizations.” Although the shift to competency-based education at the school is still in its formative stages, faculty such as Kominski have already begun to rethink the way they teach. In the process of developing a new course on cost-effectiveness analysis in health systems, Kominski considered the skills he wanted students to obtain by the end of the quarter and listed them on the syllabus. To meet those objectives Kominski has introduced hands-on computer lab sessions for material on which he would have merely lectured in the past. In these labs, students learn to use a software program that facilitates cost-effectiveness analysis. “Ten years ago this course would have been mostly lectures and some homework assignments where the students taught themselves,” Kominski says. “Now it’s more about working with the students in a much more applied way.” For two of her classes in health communications, Dr. Deborah Glik, professor of community health sciences, helps students build skills in effectively communicating health messages using both new media and old media employed in innovative ways. This year, students in these courses created a photo novella (a short narrative told through photography) aimed at low-income Latino families on the risks of salmonella infection for young children with pet turtles; the students then distributed it in settings where large numbers of the target population congregate. “The issue is how to successfully engage a population that might not respond to the traditional fliers and brochures that have been used in public health,” Glik explains. “There has been a shift in our thinking about health communications. Whether it’s through a photo novella, a YouTube video or social media, it’s important to find different ways to reach our audiences by engaging them and bringing them into the dialogue. Giving students hands-on experience in implementing these strategies is much better than simply talking about them.”

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For more than a decade, Prelip has facilitated opportunities for students to gain hands-on experience with the Greater West Hollywood Food Coalition (GWHFC), a volunteer organization that serves food to the homeless and transient population of West Hollywood and surrounding areas. Prelip received a call in 1999 from GWHFC directors who were concerned that their clients needed more than just food. Out of that concern was born the Mobile Clinic Project, an ongoing effort in which public health, medical, law and undergraduate students from UCLA provide the homeless and other vulnerable populations of greater Los Angeles with direct medical care, health promotion and disease prevention activities, legal advocacy and referrals to health and social services. “Obviously, this is a chance for students to become involved in an important activity,” says Prelip, who continues to serve as the public health faculty adviser for the project. “But more than that, I see this as a phenomenal opportunity for our students to learn how to create and sustain a program with minimal resources. They’re learning about the realities of working with a population that has great needs, collaborating with students from other disciplines, and developing leadership skills. It’s a lesson in how public health works that they just aren’t going to get from a lecture.”

Dr. Sydney Harvey (left), associate professor in the Department of Epidemiology and former director of the public health laboratory for Los Angeles County, provides hands-on training that is helping to establish a pipeline of qualified personnel with the skills to work in public health laboratories – an area of great need in California.

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Students in Dr. Michael Prelip’s course on resource development for community-based programs have gained invaluable hands-on experience writing grant proposals for public health agencies. Prelip, associate professor of community health sciences, says he finds small agencies to be highly receptive to the offer of student assistance. Most community-based organizations write grant proposals, but particularly smaller agencies often lack a person on staff who is skilled at the task. “There is a great need for that kind of capacity, and for students to be able to partner with an organization working on an actual proposal makes the project more meaningful,” Prelip says. “That’s something we would have a hard time simulating in the classroom.” In a number of cases, he notes, the students’ contributions have led to agency funding. Prelip, who serves as field program supervisor for the Department of Community Health Sciences, views students’ experiences outside the confines of the classroom as critical to their education. At most schools of public health, field experiences have been compartmentalized – students take didactic courses, followed by a field internship, followed by more didactic courses. But Prelip says he and a number of his colleagues at the school are increasingly seeking to blend classroom and field experiences in ways that optimize students’ skill development.

10 A FTER

SEEING

FIRSTHAND HOW ORGANIZATIONAL STRUCTURES AND POLICIES CAN AFFECT THE QUALITY OF HEALTH SERVICES , HE DECIDED TO SHED LIGHT ON THE ISSUE THROUGH RESEARCH .

Hector P. Rodriguez: A Systematic Approach to Improving Care

The United States spends a higher percentage of its gross domestic product and more per capita on health care than any other nation, but across a host of measures the quality of care we receive in return for that investment is less than optimal. Moreover, says Dr. Hector P. Rodriguez, assistant professor in the Department of Health Services at the UCLA School of Public Health, little evidence is available to inform leaders of health care organizations and public health systems about the impact

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of various approaches to improving quality performance. Rodriguez, who joined the school’s faculty last year, is doing his part to change that. Applying his expertise in organizational behavior, he studies organizational influences on the quality of medical care and effectiveness of public health systems. “Many aspects of health organizations can affect performance, whether it’s policies, the composition of the care teams, communication among care team members or relationships with community partners,” Rodriguez says. “My work is aimed at better understanding how these organizational factors influence quality so that organizational leaders can effectively design and implement evidence-based strategies to improve system performance.” A recent study published in the Journal of General Internal Medicine illustrates the potential impact of organizational structures and policies – and the importance of measuring their impact. Rodriguez and colleagues studied the effects of a statewide pay-for-performance program initiated in 2004. In accordance with the program, which was launched with the goal of improving health care quality in California, the 25 medical groups participating in the study awarded financial incentives to physicians aimed at improving the quality of care. Rodriguez’s group found that certain financial incentives, in combination with public reporting of medical group performance ratings, had a significantly positive impact. But those focusing on productivity

“One of the reasons I chose academia is that I really enjoy seeing the lights go on in studentsʼ heads and helping them become excited about what theyʼre learning.” —Dr. Hector P. Rodriguez

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Rodriguez’s career path was guided in part by his early professional experiences. After earning his M.P.H. in Health Policy and Administration from UC Berkeley, he spent six years as a heath care management consultant before going back to school to earn his Ph.D. in Health Policy with a medical soci-

11 ology concentration from Harvard University. “In my work as a consultant, I saw potential for breakthrough quality improvements that wasn’t being realized because of the organizational context,” Rodriguez says. “I decided to pursue my doctorate so that I could have a broader impact.” He also had a personal interest, having seen firsthand the experiences of his family members – particularly Rodriguez’s father, who has diabetes and Parkinson’s disease – with a fragmented health care system. That experience is consistent with emerging evidence that racial and ethnic minorities tend to receive care from clinics that have fewer resources and are less likely to have adopted innovative care management strategies than clinics that serve more affluent, predominantly white populations. Rodriguez, whose own past work has examined physician practice contributions to racial and ethnic disparities in patients’ experiences, believes research on how to provide quality care in resourceconstrained settings is more vital than ever at a time when health care reform promises a larger role for “safety-net” providers. Rodriguez is also strongly committed to his role as a teacher. While at Harvard he was twice recognized for teaching excellence. At the UCLA School of Public Health he has played a key role in efforts to bring interactive teaching methods into the classroom (see the cover story on page 4). Rodriguez recently integrated a student response system – known as “clicker” technology – that enables him to pose a question during class discussions and obtain online feedback from his students, projected onto a screen. “Organizational theory can be difficult to understand,” says Rodriguez. “The clicker technology has proved very useful both for gauging students’ understanding of the material and for encouraging discussions.” Rodriguez is also spearheading the Department of Health Services’ implementation of a Web-based system for tracking student self-assessments over time. The effort is integral to the department’s efforts to move toward a competency-based curriculum. “There are many opportunities for scholars of organization and management to work in the private sector,” Rodriguez says. “One of the reasons I chose academia is that I really enjoy seeing the lights go on in students’ heads and helping them become excited about what they’re learning. It’s rewarding to see that, and to know that I can indirectly affect the workforce through that education.”

faculty profile

negatively affected how patients experienced their care. (For more on the study, see page 24.) “We want to offer incentives to improve patient care, but it’s important to offer the right incentives and to encourage the right kind of care,” Rodriguez says. “There appear to be unintended consequences – poorer experiences reported by patients – to focusing too much on productivity and efficiency in physician incentive formulas. Because the evidence base in this field is so small, managers in these groups have struggled to determine the right thing to do. I’m hopeful that studies such as this one will help to guide them toward the best decisions from the standpoint of quality.” Patients’ evaluations of the care they received are an important measure of quality that is too often neglected, Rodriguez says. “In a fragmented system of care, when we focus only on making sure patients get certain types of procedures and fail to pay attention to how they are experiencing the services, we diminish their active role in the care they receive,” he explains. Among the other questions Rodriguez has addressed: the impact of multidisciplinary ambulatory care teams on the quality of care, and the quality trade-offs of these teams vs. offering the continuity of a single physician. Rodriguez developed a conceptual model of health care team performance, published in the journal Medical Care Research and Review, that will be used to guide future research on understanding how team structure and processes affect performance in ambulatory care settings. In January, Rodriguez and investigators from the Veterans Affairs Center for the Study of Healthcare Provider Behavior received a $10 million grant in which Rodriguez will evaluate the effectiveness of the primary care team approach being implemented in the VA system. Among other things, Rodriguez and colleagues will develop ways to measure how well the teams function in areas such as communication, role clarity, and decision-making, and will determine whether these teamwork dimensions predict the success or failure of quality improvement interventions. “This research has great potential for equipping practice leaders with important information for enhancing team functioning and facilitating improvements in patient-centered care,” Rodriguez says.

12 GIS

HAS

EMERGED AS AN INVALUABLE RESEARCH TOOL FOR DISCOVERING AND PRESENTING SPATIALLY BASED TRENDS AND CONNECTIONS .

ALL OVER THE MAPS From documenting the effects of air pollution

on adverse birth outcomes in Southern California to linking exposure to certain

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“If you can show on a map that people in proximity to roadways are at greater risk of negative health effects from pollutants, or that where there is poverty there are more liquor stores and no green spaces, it makes a much stronger case.” — Dr. Beate Ritz

pesticides with increased Parkinson’s disease risk in California’s Central Valley, a series of studies led by Dr. Beate Ritz over the last decade-plus has garnered considerable attention from affected communities and policy-makers alike. And Ritz, professor and vice chair of the school’s Department of Epidemiology, says these important discoveries would have been less likely – and in some cases not possible – without a technology once more closely associated with fields such as urban planning: geographic information systems (GIS). As an environmental epidemiologist, Ritz uses GIS in all of her major studies to assess the potential health impacts of exposures to pesticides, air pollutants and, most recently, ultraviolet radiation from the sun. Her group’s studies combine data sets map-referenced for pollutants with land-use and residential maps. “We’re interested in both time and space data,” Ritz explains. “We take into account when people lived where, and what the exposures were at those times. It’s quite complex, but without that complexity you can’t get an accurate assessment.”

Above: Dr.Ying-Ying Meng of the UCLA Center for Health Policy Research uses mapping to investigate associations between traffic density and air pollution levels near residences and poorly controlled asthma.

the physician who helped to pioneer the field of epidemiology with his response to London’s deadly cholera epidemic. With the aid of a hand-drawn map on which he superimposed the locations of cholera deaths and public water supplies, Snow concluded that a contaminated communal water pump was the culprit. Removing the Broad Street Pump proved a turning point in the fight against the epidemic. In 2000, Dr. Ralph Frerichs, now professor emeritus of epidemiology at the school, used GIS to create maps of London in 1859 tied to a history of Snow’s work (linked on the Department of Epidemiology site: www.ph.ucla.edu/epi/). GIS was introduced in public health most notably through maps plotting cancer rates in the United States and Europe in the 1990s. It continues to be employed to show spatial patterns of specific diseases – whether for public health planning, to mobilize affected communities or to trigger investigations into why diseases might cluster in certain geographic areas. But its applications have broadened. For example, in the school’s Center for Public Health and Disasters, GIS has been employed to show where resources are allocated and identify potential areas of concern. GIS is also an important ally for infectious disease epidemiologists such as Dr. Anne Rimoin, assistant professor at the school, who has used it to examine potential associations between ecological factors and spread of monkeypox. GIS is a major tool in social epidemiology – displaying the density of convenience stores or fastfood establishments in particular areas, for example, to show potential associations with poor health outcomes. For Jackson and others who are interested in the effect of the built environment on physical activity – the impact of green spaces and bike routes, for instance – GIS has become a key methodology. “It’s like having a microscope with finer resolution – it enables you to see things you might otherwise miss,” Jackson says. Mapping can also bolster community planning efforts. In the Center for Healthier Children, Families and Communities, based in the school, a group led by the center’s director, Dr. Neal Halfon, is working with local communities to identify early childhood needs through an initiative called Transforming Early Childhood Community Systems (TECCS). Halfon’s group uses the Early Development Instrument (EDI), a tool first developed by researchers in Canada that measures key

Land-use and pesticide map for a study headed by Dr. Beate Ritz, professor of epidemiology, shows crop types grown on fields around the small Central Valley community of Shafter.

Pesticide map assesses how much of a specific pesticide was applied on a crop within 500 and 1,000 meters around the circled residence in a specific year.

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The use of maps to analyze and present spatial information in public health can be traced as far back as the mid-19th century and the work of Dr. John Snow,

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What impact has GIS had on her work? In the mid-1990s, when Ritz was analyzing pollutant exposure estimates over time and space without the use of computerized mapping software, crunching the numbers took as long as two years. With today’s GIS technology, the same type of task takes 2-3 days. GIS – in simple terms, a computer-driven system for capturing, analyzing and presenting data linked to location – is increasingly becoming an indispensable tool in public health, both for conducting certain types of research and for communicating trends and needs to community-based groups and policy-makers so that resources can be more effectively targeted. “Where we are located is a big predictor of all kinds of health attributes,” says Dr. Richard Jackson, professor and chair of the school’s Department of Environmental Health Sciences. “The brilliance of GIS is it allows you to take a coordinate in space and stack all sorts of information on it. When you do this across many individuals over large spaces, you get a robustness to your data and the ability to look at questions in ways you would miss with crude geographic identifiers such as state or ZIP code.” When he served as director of the Centers for Disease Control and Prevention’s National Center for Environmental Health, Jackson says, he pushed to make GIS a “common language” for the agency’s environmental epidemiologists. Since then, the ranks of GIS supporters have swelled. When Dr. Hilary Godwin was recruited to join the school’s faculty and teach an introductory environmental health course for the first time, she conducted an informal survey of faculty throughout the school as well as professionals at the L.A. County Department of Public Health and other employers, asking what single skill would be most important to teach students as part of their introduction to the field. Uniformly, the answer was GIS. “Often in public health we have very complex data sets, and maps can be much more powerful than technical graphs for conveying the meaning you’ve gotten from that data to different stakeholders,” says Godwin, currently the school’s associate dean for academic programs. Godwin became so convinced of the importance of teaching GIS to students that when she served as chair of the Department of Environmental Health Sciences she co-developed a course devoted entirely to introducing students to the tool. Godwin, who teaches the class, says it draws students from a wide variety of departments in the School of Public Health as well as from other parts of the campus.

“Mapping shows where the needs are in much richer detail. Itʼs been a gamechanger as a way to facilitate community engagement, measurement, and mapping of resources and assets.”

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— Dr. Neal Halfon

factors known to affect school readiness: physical health and well-being, social competence, emotional maturity, language and cognitive development, and communication skills and general knowledge. By combining EDI data collected by kindergarten teachers with health, economic and other data on resources available at the census tract level, TECCS helps local communities map their needs and service gaps by neighborhood. Halfon’s group piloted the system in Orange County, and, with funding from the Kellogg Foundation, is now implementing it in 14 cities across the country. More than merely a measurement and mapping system, TECCS includes a collaborative improvement process. TECCS experts review EDI reports with coalitions of local leaders working to promote school readiness. “Mapping shows where the needs are in much richer detail,” Halfon says. “It’s been a game-changer as a way to facilitate community engagement, measurement, and mapping of resources and assets.” Arguably the most vital role GIS plays in public health research is in environmental epidemiology. “In air pollution epidemiology, unless it involves monitoring individuals, almost every study is using mapping,” says Dr. Michelle Wilhelm, an assistant researcher in the Department of Epidemiology who works with Ritz on air pollution studies. For estimating exposure to pollutants, equipping individuals with personal monitors is usually too expensive to be done on a large population, Wilhelm

notes. The challenge is that air pollutants vary over space and time, and individuals move around. The group headed by Ritz overlays information about air pollution levels at particular times and places with data on where people live and work. For example, in one study, 200 air monitors were hung in various neighborhoods throughout Los Angeles to measure traffic pollutant concentrations. These data were then used to create a pollution “surface” for the entire L.A. basin using a GIS-based method called land use regression. People’s residences were overlaid with this surface to estimate exposure levels at a finer spatial resolution than would have been possible using only government-operated air quality monitors, which are much fewer in number. The approach enabled Ritz’s group to demonstrate an increased risk of adverse birth outcomes for women in high-density traffic areas. “If you only plot people on a map by disease rate, you don’t necessarily know why there are differences between one area and the next,” Ritz says. “It could be exposure levels but it could also be sociologic or demographic factors that cause people who happen to be at higher risk for that disease to cluster in a certain area.” Rather than mapping where disease rates cluster geographically and then trying to determine the reasons, Ritz maps spatial patterns of certain air pollutants or pesticides and then finds out when people with the disease resided in areas where they would have been exposed to a specific toxin. The long-standing and widespread datacollecting efforts of agencies such as the California

A group led by Dr. Neal Halfon, director of the Center for Healthier Children, Families and Communities, maps data on factors known to affect school readiness along with census-tract data on health, income and resources. The maps assist communities in Orange County, Calif., and elsewhere in assessing needs and service gaps at the neighborhood level.

“With GIS we can see the specific geographic areas where healthy food is lacking, along with the effects this lack of access has on early childhood obesity risk. That can make a powerful case to policy-makers.”

— Dr. May C. Wang

FOOD ESTABLISHMENTS IN CONTRA COSTA COUNTY, CA AND MEDIAN INCOME BY CENSUS TRACT

Dr. May C. Wang, associate professor of community health sciences, uses GIS maps to examine how the neighborhood food environment affects the risk of obesity. This map, taken for a prior study in Contra Costa County, Calif., combines data on fastfood restaurants and other food establishments with census-tract data on household income.

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Dr. May C. Wang, associate professor of community health sciences, is employing GIS to examine how the neighborhood food environment affects the risk of obesity in low-income preschool-aged children. Wang’s study uses a database containing sociodemographic, height and weight information collected from 2003 to 2008 on 670,664 Los Angeles County children ages 2-5 who were participants in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). The addresses of the children are geo-coded into census tracts, enabling Wang to link the child-level data with neighborhood-level food environment data (such as the density of fast-food restaurants and accessibility of supermarkets), as well as socioeconomic data from the census. “Findings from this study will have policy implications and contribute to our understanding of the effects of the environment on obesity risk in early childhood, a life stage that has received relatively little attention in studies of obesity development,” Wang says. Over the last decade, studies have increasingly shown that where people live influences their diet, Wang notes, but little has been done to document the impact of the neighborhood food environment on the diets of the youngest children. By studying participants in the WIC program, Wang is looking at both a large population – more than 60 percent of babies in California are born into the program – and one in which nutrition education is provided and vouchers are given to buy only healthy foods. “With this population we can’t say that if children aren’t eating a healthy diet it’s because their parents lacked nutrition education,” Wang says. “And with GIS we can see the specific geographic areas where healthy food is lacking, along with the effects this lack of access has on early childhood obesity risk. That can make a powerful case to policy-makers.” Indeed, given the integral nature of advocacy to public health’s mission, the power of GIS as a communication tool can’t be overstated. “It goes back to the expression that a picture is worth a thousand words,” says Ritz. “If you can show on a map that people in proximity to roadways are at greater risk of negative health effects from pollutants, or that where there is poverty there are more liquor stores and no green spaces, it makes a much stronger case.”

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Air Resources Board, Environmental Protection Agency and Department of Pesticide Regulations make these exposure maps possible, Ritz notes. Dr. Ying-Ying Meng, a senior research scientist at the School of Public Health-based UCLA Center for Health Policy Research, recently headed a study in which she found that heavy traffic and high air pollution levels near residences are associated with poorly controlled asthma in adults. The study team, which also included Ritz and Wilhelm, relied on health data from the California Health Interview Survey (CHIS), air pollution data from the California Air Resources Board, and traffic density data from the California Department of Transportation. “Without GIS we couldn’t have made the linkages,” Meng says. “It’s a very powerful tool.” The UCLA Center for Health Policy Research, which conducts the state’s largest state health survey in CHIS, uses GIS for other analyses as well. Researchers at the center have mapped characteristics of dentists along with data on access to and affordability of dental care. Another project employs the mapping technology to show the relationship between distance of Asian American populations to community clinics and rates of breast and cervical cancer screening. In 2008, the center mapped concentrations of fast-food restaurants in neighborhoods along with obesity and overweight rates. This widely reported “Retail Food Environment Index” prompted, among other things, a moratorium on the construction of new fast-food restaurants in South Los Angeles.

FORWARD THINKING From the emergence of new infectious disease outbreaks and the potentially devastating health effects of global climate change around the world to the growing obesity epidemic and soaring cost of health care at home, it is clear that public health will have its hands full for the foreseeable future. We asked a group of UCLA School of Public Health faculty members, including Dean Linda Rosenstock, to weigh in on key issues the profession will face in the years to come. Participants in the discussion include:

UCLA S CHOOL

P UBLIC H EALTH EXPERTS DISCUSS THE CHALLENGES THE FIELD WILL FACE IN THE YEARS AHEAD

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AND THE

DR. CHANDRA FORD, assistant professor in the Department of Community Health Sciences. Ford, a former W. K. Kellogg Foundation Kellogg Health Scholar, examines links between societal inequities and health disparities/inequities. Her recent empirical and theoretical work promotes the use of Critical Race Theory to study public health problems. DR. RICHARD JACKSON, professor and chair of the Department of Environmental Health Sciences. For nine years, Jackson was director of the Centers for Disease Control and Prevention’s National Center for Environmental Health. He also held many leadership positions in the California Health Department, including state health officer. DR. JØRN OLSEN, professor and chair of the Department of Epidemiology. A world-renowned epidemiolo-

gist, Olsen is co-founder of the Danish National Birth Cohort, a study that has followed 100,000 mothers and children from conception to early childhood to determine how this period influences health conditions in later stages of life. DR. NINEZ PONCE, associate professor in the Department of Health Services and a senior research scientist

OPPORTUNITIES

at the UCLA Center for Health Policy Research. Her work focuses on informing policies to reduce health disparities generated by health-system and community-level barriers.

FOR PUBLIC

DR. LINDA ROSENSTOCK, dean of the school. A recognized authority in occupational and environmental

HEALTH TO MAKE A DIFFERENCE .

health as well as global public health and science policy, Rosenstock served for nearly seven years as director of the National Institute for Occupational Safety and Health (NIOSH) prior to becoming dean in 2000. She currently chairs the Association of Schools of Public Health (ASPH). DR. FREDERICK ZIMMERMAN, professor and chair of the Department of Health Services. A health econo-

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mist, Zimmerman is well recognized for his scholarly work addressing a broad array of pediatric health and health care utilization issues, including a focus on the effects of economic and social disparities.

DR. RICHARD JACKSON

What comes to mind when you think about the challenges ahead? ROSENSTOCK: To me, one of the biggest issues

JACKSON: Clearly, we face tremendous economic

challenges, both at home and abroad, that complicate our efforts to do the things we know are needed. In the United States, medical care is 17 percent of the GDP, and I don’t see it being any less than 2025 percent within the next decade. So we have, unfortunately, this perfect storm of an economic downturn, rising health care costs, and not much improvement in health…with an aging society and the obesity and diabetes epidemics raring to go.

PONCE: Health care reform provides access to a doctor and a usual source of care for many people who lacked it before, which is very exciting. But we can’t lose sight of the fact that there will still be people who won’t be covered – including not only undocumented immigrants but legal immigrants who haven’t been here long enough. Allocation of benefits will still be exclusionary for some, whether it’s translation services not being afforded to a recent immigrant who doesn’t speak English, or same-sex partners not being recognized when it comes to employer-based insurance for spouses. So even with something closer to universal access to health care, we will face challenges in making sure people are getting the services they need.

Even with the new law, won’t health care costs continue to be a significant challenge?

FORD: Social inequities are also a great concern to

ZIMMERMAN: Absolutely. Estimates vary, but it

me. If the current trends of widening socioeconomic inequalities persist, preventable conditions such as asthma and basic needs such as access to good water will become huge issues for poor and underserved populations domestically and globally.

appears that health care is going to eat up most or perhaps all of the growth in the size of the economy over the next 50 years. Perhaps this would be OK if we decided health is really important to us and all of this money we’re spending were actually buying us better health. The problem is that’s not the case: The increasing costs are not leading to any improvements in population health.

For decades, people in public health have advocated for health care reform, and this was the year reform legislation was finally passed and signed into law. How much of a difference will that make?

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is the need to continue paying attention to the traditional challenges in public health – providing safe and clean working and living environments and conditions in which people can be healthy. For example, a traditional public health issue such as worker health and safety has received less attention than it should. Mine fatalities have been in the headlines recently, but behind the headlines is an erosion in regulatory muscle for providing healthy work environments – not only in mines, but elsewhere.

under-funded prevention and over-funded treatment. In that sense, a health care reform law with $16 billion for prevention is a good start. There’s going to be plenty of work for public health by putting prevention up front.

JACKSON: This country was just crying out for a

decent health care safety net. A lot of people held off on preventive care and intervening early in the disease process, when they really should. We have

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DR. CHANDRA FORD

ROSENSTOCK: Whether it’s H1N1 or avian influenza,

This is an issue in public health not just for those of us who are health economists. As medical care eats up more and more of personal budgets, business budgets and the public budget, less money is left for other things. This represents a significant threat to just about everything we do in public health. What can people in public health do to help steer the country in the right direction? ZIMMERMAN: There are small steps built into the

health care reform bill – increased use of electronic medical records, better prevention strategies, increased reliance on primary care providers. On a somewhat larger level, we can do something about the way providers are reimbursed and fees are set. Congress always tries to limit the increase in reimbursement rates, with very little success – but that’s not a reason to stop trying. These things are all part of the solution. But it’s not as if there is one step that can be taken that’s going to make a huge difference, within the confines of our current system. ROSENSTOCK: Comparative effectiveness research – increasingly referred to as Patient Centered Outcomes Research – is a mechanism by which society can identify the most cost-effective medical care interventions to provide guidance on funding. We can go even further than that by identifying cost-effective public health interventions.

In thinking beyond our own borders, what impact will globalization have on, for example, the spread of infectious diseases? OLSEN: There is no question that with the increase

we have already begun to see the impact of globalization on the risk of infectious disease outbreaks, and the need to move quickly in response. We also know that globalization has exposed populations to new and/or more severe environmental hazards. Such as climate change? ROSENSTOCK: Certainly. Global climate change in

and of itself is already having an impact on public health and will continue to have a greater impact in the future, even if we take important steps to mitigate those effects. And if we look at where the greatest burden of these effects will be felt, it’s not in the developed world; it’s in the poorer countries of South Asia and Africa. Thus, these countries are dealing with the traditional hazards developing countries face – issues around clean air, clean water, and the effects of what we call the health transition, as their populations begin to live longer and chronic disease rates increase – complicated by this new set of hazards accompanying the climate change disaster, to which they barely contributed. JACKSON: Climate change is the ultimate environ-

mental justice issue of the 21st century: The countries that use the least amount of fossil fuels are bearing the greatest burden. With our release of greenhouse gasses over the last 100 years, we’ve warmed the climate, threatened the crops and fresh water supplies of some of the poorest parts of the world, and made many areas virtually unlivable. This will lead to more migration of people into cities that are already crowded. As it gets warmer, mosquitoes are multiplying more rapidly and surviv-

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in travel and with people across the globe being in closer contact, we will see new diseases spreading much more rapidly to all parts of the world, as well as the re-emergence of old diseases that we thought had disappeared.

DR. NINEZ PONCE

Do you envision an expanding role for the U.S. public health workforce in tackling these and other health issues in the developing world? ROSENSTOCK: I do – both because it’s the right

thing morally and also out of a recognition that the health of people in other countries affects the health of those in the United States, both directly and indirectly. We will need to build public health workforce capacity both globally and at home to be at the forefront of taking on these overseas issues. It’s important to point out that the trends are not all negative. We have opportunities to advance global health by harnessing information technology and other new technologies that will emerge. We will soon have the ability to go into even the most remote parts of the world and perform simple laboratory tests for a variety of health conditions that will provide a better understanding of local needs. Returning to domestic challenges, health disparities based on factors such as income, education, race/ethnicity and immigration status have been a growing concern. What forces do you see affecting these disparities, for better or worse? FORD: I think social factors are likely to become

much more important over the next few decades in determining health. Despite all of our technological and biomedical advances, if we continue to see increasing socioeconomic inequities we will experience more health problems related to poor living conditions. Largely poor and unskilled populations are migrating to urban areas en masse, exacerbating issues around sanitation, access to healthy food, limited physical activity and the like. Outdated

and overloaded infrastructure has implications for issues such as water quality. And, as we focus on the needs of rapidly expanding urban populations, we can’t lose sight of the needs of rural populations. For them, access to quality health care may be exacerbated if resources are disproportionately shifted toward urban populations, and the unique problems facing rural populations – such as high levels of pesticides exposure – may, unfortunately, fail to receive adequate attention.

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ing at elevations where they couldn’t survive 15 years ago, spreading malaria and other mosquitoborne diseases to new areas. Sadly, all of this is going to ensure that there is plenty of work in this area for people in public health over the next 100 years.

PONCE: Obviously, access to quality care is a

major factor in the disparities. Having a minimum benefit for most people – though, again, not all – will help. The challenge will be to ensure that benefits are allocated in a way that ensures quality care. Many of the decisions will be based on clinical evidence, and populations that are low-income and from ethnic minority groups are often not represented in these studies. Those who don’t speak English may not have access to language services, compromising the quality of their care. And certain disadvantaged populations might not have the wherewithal to navigate the health care system and avail themselves of options that would yield the best outcomes for them. We need to push for more investment in clinical evidence that incorporates racial/ethnic minorities. But we also have to promote the importance of non-clinical evidence – including population-based information on context, neighbor-

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DRS. RICHARD JACKSON, LINDA ROSENSTOCK, and JØRN OLSEN

hoods, and cultural/linguistic care – in making allocation decisions.

FORD: Public health researchers and practitioners

are going to have to develop more sophisticated approaches to investigating, understanding, and responding to the needs of our increasingly diverse society. We know that African Americans and Latinos are disproportionately adversely affected across almost every health outcome. But the way we think about race can blind us to the fact that, for instance, poor whites can also be severely impacted – and that disparities can exist within a racial group. We might need to reframe the lens through which we view at-risk populations, with the help of more sophisticated approaches to collecting data on diverse populations. Traditionally we have defined at-risk communities as poor communities of color. As we move into the future, we will need to expand on these approaches, or we will risk excluding other communities (e.g., certain kinds of immigrant populations) that could benefit from our interventions. In clinical care there has been a movement in recent years toward wider adoption of evidencebased medicine – applying the best available knowledge from biomedical research in decisions about patient care. Might there be broader use of evidence-based public health? JACKSON: There should be, and there will be.

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Whenever a new technology is put in place it tends to have substantial health implications. Now, finally, we are beginning to see health impact assessments. Within a few years I expect these will be a requirement for major infrastructure changes in our society. It will be very interesting for our next

DR. JØRN OLSEN

generation of public health and environmental health leaders, because they will be brought to the table for the first time as these prospective decisions are made. In the United States and other developed countries, chronic diseases are the leading killers, with heart disease and cancer topping the list. Don’t new screening techniques and preventive strategies present opportunities for public health? PONCE: As a basic component of health care

reform, disparities in access to preventive services such as cancer screenings should decrease. On the other hand, with the greater overall identification of diseases, we could see increasing disparities in outcomes resulting from expensive treatment. The trend toward genetic testing and more personalized medicine is also likely to increase disparities, since historically it’s the higher-income, better-educated members of society who benefit first from these types of advances. OLSEN: There is another side to the issue of diagnos-

tic testing and treatment of risk factors. For the first time we are beginning to see people treated over decades of time for things like hypertension and high blood cholesterol, and I would suspect that we will learn that some of these drugs have long-term side effects that we weren’t aware of. In addition, screening for disease in many cases does have side effects, including the fact that the more we screen, the more false-positive results we will get – and in the concept of false positives we have to include those who had the disease but would have been better off by not having the disease diagnosed. We have known for a long time that we have this problem of “over-diagnosis” in prostate cancer, but the problem is also frequent for other cancers and other diseases. It will be important to study these types of issues in epidemiology.

OLSEN: Certainly in more affluent parts of the

world – but also in parts of the developing world – obesity will continue to be a major problem. We’re seeing it increase rapidly now in countries such as India and China. We still don’t fully understand the reasons for this epidemic. Part of it, of course, is related to people being less physically active, but that doesn’t appear to explain everything, and there may be other causes that we don’t yet appreciate. Some of it may be related to very early time periods of life. So first of all, we need to do a better job studying the causation. And then we need to develop better strategies to prevent it – most of the preventive efforts thus far have not proved very promising. Solutions are likely to be complicated. JACKSON: The tobacco epidemic provides a model

for how public health can be effective. Leaving it up to doctors to tell their patients not to smoke did little; to drop the average Californian from 144 packs a year to 40 took classic public health interventions – such as making it more expensive and making it illegal or difficult to smoke indoors. We have to apply the same tools to the obesity epidemic. We should be taxing sweetened beverages and using the revenue for anti-junk food advertising, farmer’s markets in poor communities, decent food in schools – interventions that work. We are already starting to see a

When it comes to obesity and other issues related to personal health, is there an overemphasis on individual responsibility rather than public health solutions?

ZIMMERMAN: We have a very strong cultural value

that says we all should decide what’s best for ourselves – that it’s up to individuals to have an appropriate diet and exercise. In public health, though, we know that there are social forces and structures that influence people’s ability to do that. Public health began with the insight that the health of the population is not simply the aggregation of the health of individuals. From the first cholera epidemic, there was a recognition that the solution has to come at a social level, and can only be undertaken by a very large group of individuals or by governments. Those of us in public health still believe that, but we need to do a better job of sharing that insight with the larger society. Many believe public health has been under-funded and underappreciated, partly because it’s not as obvious to people when they’re benefiting from public health measures as when they are cured of an illness through medicine. Is that changing? ROSENSTOCK: In some ways, yes. The last year of health care reform discussions brought much greater attention to the importance of public health and resulted in some new initiatives that we have never seen at the national level. Unfortunately, we still tend to be crisis-responsive. We get through one scare and react – whether it’s H1N1 or the recent oil spill in the Gulf of Mexico – and then people become complacent. Having said that, I do think we are more visible than we have been in the past, and that the public and decision-makers will continue to gain a greater appreciation for the critical role of public health in our society.

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DR. FREDERICK ZIMMERMAN

flattening off in child obesity, in part because of the school interventions that have been put into place.

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No discussion about public health challenges in the years ahead would be complete without touching on the issue of obesity. What are the challenges and opportunities for public health in taking on this epidemic?

alumni hall of fame: the 2010 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 2010 inductees, recognized at the Breslow Lecture and Dinner on March 18, exemplify the school’s commitment to teaching, research and service. This year’s inductees were honored in two categories: Lester Breslow Lifetime Achievement and Young Alumnus Achievement.

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LESTER BRESLOW LIFETIME ACHIEVEMENT LISA BOHMER, M.P.H. ’94 Bohmer, director of global partnerships for the Elizabeth Glaser Pediatric AIDS Foundation in Los Angeles, has more than 20 years of experience in the fields of HIV/AIDS, sexual and reproductive health and the empowerment of women and girls. She worked in Ethiopia for five years, including a stint as director of UNICEF’s HIV/AIDS program, where Bohmer introduced services to prevent the vertical transmission of HIV/AIDS (from mother to unborn child) and adolescent-friendly voluntary counseling and testing. As regional representative of the nonprofit organization Ipas, Bohmer led efforts to strengthen care for complications of abortion throughout East Africa during the 1990s. As an associate with the Pacific Institute for Women’s Health from 1994 to 2002, she conducted qualitative research on unsafe abortion and adolescent reproductive and sexual health issues to bridge the gaps between communities and health facilities, as well as to bring the perspectives of young women and men to the fore.

D. PETER DROTMAN, M.D., M.P.H. ’75 A board-certified specialist in preventive medicine and a fellow of the Infectious Diseases Society of America, Drotman received his medical degree from the University of Southern California and his M.P.H. and preventive medicine training at UCLA, where he did his field epidemiology elective while serving with the World Health Organization’s Global Smallpox Eradication Program – assisting in the effort to eradicate smallpox from Bangladesh in 1975. After Drotman left UCLA, he entered the Epidemic Intelligence Service of the Centers for Disease Control and Prevention in Atlanta in 1979. There, he was among the first medical epidemiologists to become involved in the investigation of AIDS after it was first recognized in 1981. With the grounding he received in chronic disease prevention and health services at the School of Public Health, he was trained and worked as an infectious disease epidemiologist in smallpox and AIDS for the next 14 years. Drotman currently serves as editor-in-chief of Emerging Infectious Diseases, the peer-reviewed monthly journal published by the CDC.

NANCY HESSOL, M.S.P.H. ’82 After receiving her M.S.P.H. in Epidemiology, Hessol worked on occupational, environmental, and reproductive epidemiological studies at the Hanford Nuclear facilities in Richland, Wash. In 1986 she joined the San Francisco Department of Public Health, where her research focused on HIV disease progression. Seven years later Hessol was recruited to UC San Francisco, where she is currently an associate professor in the departments of clinical pharmacy and medicine as well as project director for the San Francisco Bay Area site of the United States Women’s Interagency HIV Study (WIHS) and chair of the WIHS cancer and pathology working group. Hessol’s research interests include HIV disease progression and mortality, HIV-related malignancies, human papillomavirus infection, recruitment and retention of women and minorities in research studies, and disparities in health care.

hall of fame

PREVIOUS INDUCTEES

YOUNG ALUMNUS ACHIEVEMENT

For information on 2011 nominations, call (310) 825-6464.

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IGNACIO FERREY, M.P.H. ’04 Ferrey is an educator and advocate committed to community involvement and eliminating health disparities as they affect communities of color – specifically Latino families, men, and youth. He has experience working in education, the county health department, restorative justice, and community-based organizations in Los Angeles and the San Francisco Bay Area. Since 2005, Ferrey has worked at La Clínica de La Raza, Inc., a community health center serving three Bay Area counties. His responsibilities include restricted fund development for various health education, prevention and intervention programs, strategic planning, clinic expansion, and project management for quality infrastructure redesign and Latino male health. Pursuing his passion for education, Ferrey has taught at City College of San Francisco in the Health Education and Community Health Department, and is a graduate and past adjunct trainer of the Coro Center for Civic Leadership. Ferrey is currently a participant in the Clinic Leadership Institute, whose goal is to build the next generation of safety net providers and leaders.

Manal Aboelata, M.P.H. ’01 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. Bonta´, R.N., M.P.H. ’75, Dr.P.H. ’92 Linda Burhansstipanov, Dr.P.H. ’74, M.P.H. ’72 Virginia A. Clark, Ph.D. ’63 Francine M. Coeytaux, M.P.H. ’82 Suzanne E. Dandoy, M.D., M.P.H. ’63 Paula Diehr, M.S. ’67, Ph.D. ’70 Betsy Foxman, M.S.P.H. ’80, Ph.D. ’83 Mark Gold, D.Env. ’94 Harold M. Goldstein, M.S.P.H. ’89, Dr.P.H. ’97 Raymond D. Goodman, M.D., M.P.H. ’72 Richard A. Goodman, M.D., J.D., M.P.H. ’83 Nancy Halpern Ibrahim, M.P.H. ’93 Carolyn F. Katzin, M.S.P.H. ’88, C.N.S. Robert J. Kim-Farley, M.D., M.P.H. ’75 Kenneth W. Kizer, M.D., M.P.H. ’76 James W. LeDuc, Ph.D. ’77, M.S.P.H. ’72 Stanley Lemeshow, Ph.D. ’76 Rod Lew, M.P.H. ’88 Nicole Monastersky Maderas, M.P.H. ’03 Angela E. Oh, J.D., M.P.H. ’81 Jean Le Cerf Richardson, M.P.H. ’71, Dr.P.H. ’80 Keith S. Richman, M.D., M.P.H. ’83 Pauline M. Vaillancourt Rosenau, Ph.D., M.P.H. ’92 Jessie L. Sherrod, M.D., M.P.H. ’80 Irwin J. Shorr, M.P.H. ’72, M.P.S. Stephen M. Shortell, M.P.H. ’68, Ph.D. Shiing-Jer Twu, M.D., M.P.H., Ph.D. ’91 Barry R. Wallerstein, D.Env ’88 Kenneth B. Wells, M.D., M.P.H. ’80 Zunyou Wu, M.D., Ph.D. ’95, M.P.H. ’92 Michele Yehieli, M.P.H. ’89, Dr.P.H. ’95 Linda M. Yu Bien, M.S.P.H. ’79

research highlights Poor Aerobic Fitness Associated with Lower Standardized Test Scores in California Schools

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The researchers found a consistent, linear increase in math and language scores on California Standards Tests with increasing physical fitness.

HAVING A LOW LEVEL OF AEROBIC FITNESS or a high body mass index (BMI) indicating overweight or obese status puts students at risk of scoring lower on California standardized tests compared to students with a desirable fitness level or BMI status, even when taking into account factors such as parent education and socioeconomic status, according to a UCLA School of Public Health study published in the Journal of Pediatrics. The study, by Drs. William McCarthy, professor of health services, and Christian Roberts, a researcher in epidemiology, found that students’ aerobic fitness level predicts their performance on standardized tests across all ethnic groups. With increasingly constrained budgets, many K-12 schools have disinvested in physical education and school nutrition in recent years. “The argument has been that school districts’ limited resources need to be focused on traditional curricula to optimize student learning,” McCarthy says. He and others assert that this is a false dichotomy – and the study by McCarthy and Roberts suggests that good health and optimal learning, in fact, go hand in hand. The researchers obtained scores on California math, reading, and language tests for an ethnically diverse sample of nearly 2,000 students in fifth, seventh, and ninth grades. Aerobic fitness was determined by results on a one-mile run/walk test and BMI was obtained from state-mandated measurements. McCarthy and Roberts found a consistent, linear increase in math and language scores on California Standards Tests with increasing physical fitness. Although the researchers couldn’t conclude from this type of analysis that being physically fit causes students to perform better on the tests, McCarthy notes there is ample evidence from other studies to suggest that the association is causal. More research is needed to determine the physiological mechanisms by which aerobic fitness might contribute to improved academic performance, McCarthy adds. “Schools that don't invest in the personnel, equipment and recreational land use necessary to promote students’ physical fitness may see their students perform poorly not only on the state’s annual fitness tests, but on the California Standards Tests as well,” McCarthy says. “Schools should not fear that devoting more time and resources to physical education will hurt their students’ academic achievement. On the contrary, it might help.”

Financial Incentives for Physician Performance Can Improve Care – But Not Always LIKE EVERYBODY, HEALTH CARE PROFESSIONALS enjoy a pay raise for a job well done. But in some instances, financial incentives for health care performance may actually backfire. Reporting in the Journal of General Internal Medicine, a team that included Dr. Hector P. Rodriguez, assistant professor at the school, found that patient-care performance ratings for 25 medical groups across

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California improved significantly following the launch of a statewide pay-forperformance program in 2004 – but not when incentives focused on doctors’ productivity. The researchers analyzed how medical group performance ratings changed over time and found that ratings in specific measures representing three broad categories – physician communication, care coordination, and office-staff interactions – improved substantially during the period after the start of the Integrated Healthcare Association’s (IHA) pay-for-performance program. Incentives for addressing the quality of patient-clinician interaction and the overall experience of patient care tended to result in improved performance in those three areas, especially when the additional funds were used broadly by medical groups to positively reinforce a patient-centered work culture. But the greatest improvements were seen within those groups that placed less emphasis on physician productivity and greater emphasis on clinical quality and patient experience. And within groups where financial incentives were paid directly to physicians – rather than being used more broadly – placing too much emphasis on physician productivity actually had a negative impact on the experiences patients had when visiting their primary care doctor. “These findings provide timely information about the kinds of things medical groups can do – and can avoid doing – with financial incentives to improve the quality of patient health care experiences,” says Rodriguez, lead author of the study. The researchers looked at information collected from 124,021 patients of 1,444 primary care physicians at 25 California medical groups between 2003 and 2006 and conducted interviews with group medical directors to determine how financial incentives were used. All 25 groups, which represent six insurers, were awarded financial incentives for achievements in the broad categories of clinical care processes, patient care experiences and office-based information systems, in accordance with the IHA program, which was launched with the goal of improving health care quality in California. Medical groups were free to use the additional funds in various ways, with some groups paying incentives directly to physicians and others using the incentives more broadly, with a focus on organizational priorities. “Our results suggest that the nature of financial incentives can affect the provision of patient-centered care,” says Rodriguez. “Therefore, quality improvement and reimbursement reform efforts should integrate patient-reported experiences of care as a central metric for evaluating reform effects.”

The greatest improvements were seen within medical groups that placed less emphasis on physician productivity and greater emphasis on clinical quality and patient experience.

Common Heart Medication May Also Protect Against Parkinson’s Disease

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A MEDICATION USED TO TREAT CARDIOVASCULAR CONDITIONS such as hypertension, angina and abnormal heart rhythms may also decrease the risk of developing Parkinson’s disease. In the first large-scale population-based study of its kind, Dr. Beate Ritz, professor of epidemiology at the UCLA School of Public Health, in collaboration with researchers from the Danish Cancer Society, found that a specific sub-class of dihydropyridine cardiovascular medications was associated with a 26-30 percent decrease in the risk of Parkinson’s. The findings were published in the journal Annals of Neurology. Neurons that are important in Parkinson’s disease are known to have calcium channels – structures that enable the cells to transmit electrical charges to each other – in their cell membranes. Muscles like the heart also contain calcium channels, and the opening of the calcium channel in the heart causes a muscle contraction. Because cardiac and smooth muscles depend on calcium channels to function, substances that block or modify their action have been used for decades

to treat hypertension, angina and arrhythmia in humans. In the heart, the dihydropyridine class of drugs acts on a specific type of channel known as the Ltype. Within the dihydropyridine class is a sub-class of medications that can cross the blood-brain barrier, giving them the potential to act on neurons in the brain. It turns out that the neurons that degenerate in Parkinson’s disease also contain a type of L-type calcium channel. Ritz and her colleagues evaluated medical histories and medication usage for 1,931 Parkinson’s patients and 9,651 unaffected subjects for a period of up to 12 years prior to the diagnosis of Parkinson’s. In evaluating different classes of a variety of drugs prescribed for hypertension, they found that only calcium channel blockers of the dihydropyridine sub-class that cross the blood-brain barrier were associated with a significant decrease in the risk of developing Parkinson’s. Other classes of anti-hypertension medications, and dihydropyridines that were not able to cross the blood-brain barrier, were not associated with a lower risk. “The key was to consider the mode of action of these drugs and whether or not they cross the blood-brain barrier,” Ritz says. “Some do and some don’t. We found that of all the hypertension medications taken by our study subjects, only the subset of dihydropyridine-class drugs that cross into the brain, where they might be able to act on the calcium channels of neurons, provided a protective effect. This supports the idea that the mode of action of a given drug and whether it penetrates into the brain are important factors when studying drugs for neuroprotection.”

Childhood Obesity and TV Viewing: Junk-Food Commercials to Blame

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The findings strongly suggest that steering children away from commercial television may be effective in reducing childhood obesity, given that food is the most advertised product on children’s television.

THE ASSOCIATION BETWEEN TELEVISION VIEWING and childhood obesity is directly related to children’s exposure to commercials that advertise unhealthy foods, according to a UCLA School of Public Health study published in the American Journal of Public Health. The study, conducted by Drs. Frederick J. Zimmerman and Janice F. Bell, is the first to break down the types of television children watch to better determine whether different kinds of content may exert different effects on obesity. The researchers gathered data from primary caregivers of 3,563 children, ranging from infants to 12-year-olds. Through time-use diaries, study respondents reported their children’s activities, including television viewing, throughout the course of an entire weekday and an entire weekend day. Caregivers were also asked to report the format – television programs, DVDs or videos – and the names of the programs watched. This information was used to classify television viewing into either educational or entertainment programming and to determine whether or not it contained advertising or product placement. Among all children, commercial viewing was associated with higher body mass index (BMI), although the effect was stronger for children younger than 7 than for those older than 7, the study found. Noncommercial viewing, including watching DVDs or educational television programming, had no significant association with obesity. According to the authors, the findings strongly suggest that steering children away from commercial television may be effective in reducing childhood obesity, given that food is the most commonly advertised product on children’s television and that almost 90 percent of children begin watching television regularly before the age of 2. By the time they are 5, children have seen an average of more than 4,000 television commercials for food annually. During Saturday morning cartoons, children see an average of one food ad every five minutes. The vast majority of these

ads – up to 95 percent – are for foods with poor nutritional value, the researchers say. “Commercial television pushes children to eat a large quantity of those foods they should consume least: sugary cereals, snacks, fast food and soda pop,” says Zimmerman, professor and chair of health services at the School of Public Health and lead author of the study. The authors conclude that the availability of high-quality, enjoyable and educational programs for all ages on DVD should make it relatively easy for health educators and care providers to nudge children’s viewing toward content that does not contain unhealthy messages about food and eating. “Just as there are far better and more nutritious foods than those advertised on television, there are also far better and more interesting shows on television than those supported by advertising,” Zimmerman says.

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Racial Discrimination Reduces Health-Related Quality of Life for Asian Americans

Asians who reported racial discrimination or who had limited English proficiency were at increased risk of having a poor health-related quality of life.

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ASIAN AMERICANS IN CALIFORNIA WHO REPORT encountering racial discrimination are more likely to experience decreased health-related quality of life than those who do not, according to research from the UCLA School of Public Health. The study, published in the May issue of the American Journal of Public Health, also found that limited English proficiency was associated with decreased health-related quality of life among Asian American living in the state. Two members of the school’s faculty, Drs. Gilbert C. Gee and Ninez Ponce, studied responses to the 2003 and 2005 California Health Interview Surveys from six Asian subgroups, including 2,576 Chinese, 1,426 Filipino, 833 Japanese, 1,128 Korean, 822 South Asian, and 938 Vietnamese participants. The study assessed both self-rated health and two measures adopted by the Centers for Disease Control and Prevention for health-related quality of life: activity limitation days and unhealthy days. The study found that Asians who reported racial discrimination or who had limited English proficiency were at increased risk of having a poor health-related quality of life. For example, in an average year, South Asian participants who reported discrimination experienced an estimated 14.4 more activity limitation days (defined as days in which poor physical or mental health kept the respondent from doing his or her usual activities, such as self-care, work, or recreation) than South Asians who did not report discrimination. “Research shows that discrimination is related to many health problems, ranging from heart disease to depression to injury,” Gee says. “Hence, it makes sense that discrimination is related to CDC’s summary measure of quality of life.” The study observed similar results across the six Asian subgroups that were studied. “There are many differences in these groups – whether it’s cultural or the circumstances of their immigration – but it is striking that Asians are experiencing discrimination and its effects regardless of their background,” Ponce says. Previous studies have indicated that Asian Americans with limited English proficiency are less likely to report discrimination, even if they are being treated unfairly; thus, Ponce notes, it may be that the results of this study understate the extent of the problem. “This finding counters the popular belief that Asian Americans are a successful ‘model’ minority who no longer experience racial adversity,” Gee concludes. “A sizeable number of Asian Americans reported encountering discrimination. If our findings are true, they suggest that policies that promote civil rights may also promote health.”

student profiles Promoting Prevention in the Response to HIV/AIDS

“We need to mount a better prevention effort that addresses the social and economic factors that put communities at risk.” — Mario J. Pérez (left, with Dr. Fred Hagigi,

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EMPH program director)

WHEN HE WAS INTERVIEWING for his current position as director of the Office of AIDS Programs and Policy (OAPP) for the Los Angeles County Department of Public Health, MARIO J. PÉREZ promised his boss, county health officer and UCLA School of Public Health professor Jonathan Fielding, that if hired he would return to school to pursue his M.P.H. degree. “It was clear that as I assumed more responsibility in a Department of Public Health program, having formal training was crucial,” says Pérez, who had been forced to forgo his original graduate-school plans after the death of his parents in a car accident left him with responsibility for his younger siblings. He fulfilled that promise this spring, completing the school’s Executive M.P.H. (EMPH) Program in Healthcare Management and Policy while maintaining his busy work schedule: At the OAPP, Pérez is responsible for managing, planning and guiding the annual investment of more than $85 million in local, state and federal resources that support a comprehensive HIV/AIDS service delivery system. L.A. County is second only to New York City in number of HIV/AIDS cases. Of the estimated 62,000 people in the county who are living with the virus, as many as a quarter don’t know it and many of those who are aware they are HIV-positive aren’t receiving life-saving treatment. In addition to efforts to ensure that infected individuals receive appropriate care, OAPP is charged with implementing strategies to prevent new infections, which currently number about 3,100 a year in the county. The county’s geography adds to the challenge. “We have many more square miles to cover than other counties around the nation where the epidemic is concentrated,” Pérez notes. As a result, his office tailors efforts to specific geographic areas where the needs are greatest. Since becoming OAPP director in 2006, Pérez has fought to preserve HIV prevention programs in the face of substantial budget cuts resulting from California’s economic crisis. He has also taken on a national leadership role after being appointed last February to serve as one of 24 members of the Presidential Advisory Council on HIV/AIDS, formed to advise the Obama administration on the response to the epidemic. “We have significant room to improve on what’s been done in the last decade,” Pérez says. “The focus domestically has been on efforts to treat the disease rather than investing in preventing new infections. We need to mount a better prevention effort that addresses the social and economic factors that put communities at risk.” Pérez’s commitment to raising awareness and serving persons with HIV/AIDS began in 1991 when, as a student at UC Berkeley, he helped to launch a volunteer group called the Multicultural AIDS Peer Program. A few years later, as a coordinator of HIV prevention services at a nonprofit drug treatment center in Los Angeles, he played a key role in launching needle exchange programs in the county. “It took a lot of political advocacy, but this was a critical harm reduction intervention that has helped to keep rates of HIV low among injection drug users – some of the most disenfranchised segments of our communities,” Pérez asserts. Despite his ample on-the-job experience, Pérez says the EMPH program has made a significant difference in the way he approaches his work. “You learn the foundations of public health along with important skills,” he says. “But just as important, being with a cohort of professionals who bring different experiences to the classroom has broadened my perspective in a profound way.”

students

Doctoral Student’s Air Pollution Studies Assume Greater Urgency with Motherhood

“My work has taken on a whole new meaning now that I’m raising a child in Los Angeles.” — Jo Kay Ghosh

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FOUR YEARS AGO, JO KAY GHOSH was contemplating job prospects as she prepared to complete her M.P.H. in Epidemiology and Biostatistics at UC Berkeley. That’s when a friend told her about the work of Dr. Beate Ritz, professor of epidemiology at the UCLA School of Public Health. The conversation proved pivotal: Ghosh ended up getting a job on Ritz’s research team and, a year later, enrolling in the school’s Ph.D. program. Since joining Ritz’s group, Ghosh has worked on studies examining the impact of exposures to various air pollutants on birth outcomes in Los Angeles County. A history of strong regulations in California provides researchers with rich monitoring data from the state’s Air Resources Board and Air Quality Management District. For the studies on which Ghosh has worked, these data have been used along with birth certificate records and surveys to demonstrate that exposure to air pollutants at certain levels increases the risk for preterm deliveries and low birthweight babies. Ghosh plans to continue pursuing the topic for her doctoral dissertation. The studies are particularly compelling because they are addressing the issue at a finer level of detail than in the past, Ghosh notes. “Critics of air pollution studies have suggested that maybe, for example, people who live in highly polluted areas have poorer outcomes because they are more likely to smoke,” she says. “Now we’re able to see that even after taking into account the mother’s smoking or smoking by someone else in the household, the air pollution effect is still present.” For another study, Ghosh helped to coordinate an effort in which air monitors were hung in 200 L.A. County neighborhoods to create a detailed exposure map of the region. This map is being used to determine risks for childhood asthma and adverse birth outcomes among those living near high traffic areas. “When you’re looking at larger areas, you often can’t differentiate exposures of the person who lives right next to the busy street from someone who lives up on a hill away from the traffic,” Ghosh says. “This allowed us to learn more about the impact of specific pockets in the county where exposures are particularly high.” Ghosh hasn’t for a moment regretted her decision to come to UCLA. “One of my motivations to go into public health is that I was interested in studying issues on a large scale, and being able to make a broad impact,” she says. The prospect of influencing policy that could prevent some of the ill effects from air pollution has become more important since she started the program: In early 2009, Ghosh and her husband had a son. “My work has taken on a whole new meaning now that I’m raising a child in Los Angeles,” she says. The ability to apply epidemiologic methods she has learned in the classroom to the air pollution studies she conducts with Ritz has been gratifying, Ghosh says, as has the level of responsibility and hands-on experience Ritz provides. “She gives her students a lot of opportunities to interact with experts in the field,” Ghosh says. “It’s been amazing to be able to meet some of the people whose names I see on scientific papers all the time. She is so well connected, energetic and passionate about her work that anyone would be excited to be a part of it.”

2009-10 student awards

students

Judith Blake Award

ESE Program Endowment

Naomi Greene Epidemiology

Khadeeja Abdullah Valerie Chan Lisa Fong Erica Halchak Meng-Horng Hsu Environmental Science and Engineering

Celia and Joseph Blann Fellowship Qing Yang Biostatistics Aya Westbrook Molecular Toxicology

California Endowment Fellowship

CAROLBETH KORN PRIZE — Corwin Zigler (center) received the prestigious Carolbeth Korn Prize, given annually to the School of Public Health’s most outstanding student. Abdelmonem A. Afifi Student Fellowship Melanie Pitts Health Services

Agency for Healthcare Research and Quality Fellowship Dasha Cherepanov Jerry Grenard Audrey Jones Deborah Ling Eric Sun Srinivasu Sunkara Lori Uyeno Alice Villatoro Jessica Williams Health Services

AGEP Competitive Edge Program

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Jeremiah Garza Jenna Jones Selena Ortiz Chikarlo Leak Health Services

American Cancer Society Postdoctoral Fellowship Award Karim Chamie Health Services

American Evaluation Association Graduate Education Diversity Award

Gates Millennium Scholarship

California Wellness Fellowship

Laura Barrera Jessica Insisoulath Health Services

Eliva Clinton Brent Langellier Community Health Sciences

Raymond Goodman Scholarship

Cancer Epidemiology Training Grant

Xuyang Lu Heidi Fischer Biostatistics

Sam Oh Sung-Shim Lani Park Erin Peckham Heather Tarleton Gina Wallar Yi Ren Wang Epidemiology

Chancellor's Prize Adam King Biostatistics

Christina M. Batteate Oscar Pichardo Leah T. Sanchez Community Health Sciences Jessica Insisoulath Health Services

Graduate Research Mentorship Award

Jessica Williams Health Services

Brent Langellier Camilia Lui Community Health Sciences

American Heart Association Pre-Doctoral Fellowship

Child and Family Health Leadership Training Fellowship

Loan Kim Community Health Sciences

Jeremiah Garza Portia Jackson Health Services

Dean's Outstanding Student Awards Ying Zhou Biostatistics Jocelyn Chen Community Health Sciences Demian Willette Environmental Health Sciences

AIDS Institute Fellowship Award

Lawrence R. Birkner and Ruth K. McIntyre-Birkner Memorial Scholarship

Kristen Hess Ryan Murphy Epidemiology

Carina Tina Kouyoumji Saba Moshirvaziri Environmental Health Sciences

American Association of University Women

Bixby Doctoral Fellowship in Population

Patience Afulani Community Health Sciences

Kristen Hess Epidemiology

Chunyuan Fei Epidemiology

Bixby Research Mentorship

Neetu Chawla Health Services

Cristina Rodriguez-Hart Community Health Sciences

Graduate Opportunities Fellowship

Weiming Zhu Epidemiology

Ciara Remillard Molecular Toxicology

Mai Yang Vang Community Health Sciences

Kimberly Kisler Community Health Sciences

Daisy Le Community Health Sciences

Deborah Ling Health Services

Asian American Studies Center 21st Century Graduate Fellowship

Faculty Women’s Club

Sun-Shim Lani Park Epidemiology Oi Ka Vicky Wu Health Services

Dissertation Year Program

Demian Willette Environmental Health Sciences Jennifer Tsui Alison K. Herrmann Health Services

Graduate Summer Research Mentorship Fellowship Sara Chacko Tracy Becerra Nicole Hoff Epidemiology Selena Ortiz Jenna Jones Mona AuYoung Audrey Jones Annalyn Valdez-Dadia Alice Villatoro Health Services

Hagigi Fellowship in Healthcare Accounting and Finance Tingting Yu Health Services

Health Resources and Services Administration Traineeship

NIEHS Training Grant in Molecular Toxicology

Charles Senn Scholarship

Aya Westbrook Molecular Toxicology

Khadeeja Abdullah Environmental Science and Engineering

NIH Genomic Analysis Training Program

Phillip and Aida Siff Fellowship

Brian Chen Epidemiology

Brent Langellier Community Health Sciences

Northern California Local Section Scholarship

Juneal Smith Fellowship

Hildebrand Fellowship Nelida Duran Community Health Sciences

Carina Tina Kouyoumji Environmental Health Sciences

William and Flora Hewlett Foundation ESE Program

St. Mark Parry Environmental Scholarship

Leila Lackey Nicholas Nairn-Birch Setal Prabhu Tiffany Yap Environmental Science and Engineering

Khadeeja Abdullah Environmental Science and Engineering

Raul Sobero Health Services

Health Services Alumni Association Award Ashley Phelps Health Services

Jonsson Comprehensive Cancer Center Foundation Grant Karim Chamie Health Services

Kirschstein-NRSA Institutional Traineeship Suzanne Spear Community Health Sciences

Carolbeth Korn Prize Corwin Zigler Biostatistics

Ursula Mandel Fellowship Brent Langellier Community Health Sciences Sara Chacko Jessica Miller Epidemiology Nadim Ouladi Nikravan Health Services

Maternal and Child Health Trainee Kristen Ng Community Health Sciences

Nanotoxicology Research and Training Program Fellowship Kristin Yamada Molecular Toxicology

National Institute of General Medicine & Science Traineeship

National Research Service Award Karim Chamie Health Services

Kelley Carameli Maria Nabil Koleilat Community Health Sciences

Ann G. Quealy Memorial Fellowship in Health Services Allen Suh Deanne Canieso Health Services

Eugene Cota Robles Fellowship Khadeeja Abdullah Victor Vasquez Environmental Science and Engineering Jeremiah Garza Jenna Jones Health Services Ciara Remillard Molecular Toxicology

Ruth Roemer Award

Wayne Soohoo Memorial Scholarship Atsushi Goto Epidemiology

Southern California American Industrial Hygiene Association Scholarship Sayaka Takaku-Pugh Environmental Health Sciences

Tellus Leadership Foundation Patience Afulani Community Health Sciences

Samuel J.Tibbits Fellowship Sayaka Takaku-Pugh Environmental Health Sciences Suzanne Spear Community Health Sciences

UCLA Dissertation Year Fellowship Eunice Muthengi Community Health Sciences

Weisman Memorial Fellowship Kei Hang Katie Chan Epidemiology

Eli Tomar Health Services

Wilshire Foundation Internship Award

Monica Salinas Internship Fund in Latino and Latin American Health

Elizabeth Anderson Malia Jones Susan Kwan Community Health Sciences

Maria Lanfranco Jacqueline Torres Community Health Sciences Maura Purcell Epidemiology

Scaiha Student Scholarship Mary Anne Seif Environmental Health Sciences

Albert Schweitzer Fellowship Anne Sutkowi Community Health Sciences Sean Prendergast Epidemiology

Women’s Environmental Council Scholarship Lisa Fong Environmental Science and Engineering

CARLA WOHL has joined the school as associate director of development, with a focus on cultivating support from alumni and friends of the school. A former news correspondent, most recently for ABC, Wohl has covered many of the most visible public health topics of recent years including H1N1, gender-based medicine, health issues in underserved populations, climate change and the environment, and disasters such as Hurricane Katrina and the California wildfires. A native of New York City, Wohl received her B.A. in journalism from the University of Wisconsin-Madison.

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Uchechi Acholonu Bethany Wexler Community Health Sciences

Quality of Graduate Education Fellowship

Brian Chen Epidemiology

DR. RON BROOKMEYER joins the faculty as professor in the Department of Biostatistics. Brookmeyer was formerly at the Johns Hopkins University Bloomberg School of Public Health, where he was a professor in the biostatistics and epidemiology departments and also served as director of the school’s Master of Public Health program. His research focuses on statistical and quantitative approaches to measuring the health of populations to address global public health problems. Brookmeyer has developed methods for tracking the course of the global HIV/AIDS epidemic. In addition, he focuses on statistical issues of biosecurity such as models for response and containment of anthrax outbreaks, as well as ongoing projects in Alzheimer’s disease and aging. Brookmeyer is an elected member of the National Academy of Sciences’ Institute of Medicine (IOM) and in 2009 was appointed to the IOM panel to evaluate the President’s Emergency Fund for AIDS Relief (PEFAR). He is associate editor of the International Journal of Biostatistics, and is currently chair of the Statistics in Epidemiology Section of the American Statistical Association. He received both his M.S. and Ph.D in statistics from the University of Wisconsin, and his B.S. from Cooper Union.

faculty/staff

welcome

faculty

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

Oxford Textbook of Public Health, Fifth Edition edited by Roger Detels, Robert Beaglehole, Mary Ann Lansang, and Martin Gulliford This thoroughly updated edition, with editors from four continents, continues to be the ultimate resource on the subject of public health and epidemiology. Contributors drawn from across the world provide perspectives from vastly different health systems with wideranging public health needs and priorities. An Introduction to Epidemiology for Health Professionals by Jørn Olsen, Kaare Christensen, Jeff Murray, and Anders Ekborn. Springer. Amid growing concerns about emerging diseases and epidemics, epidemiology should be a basic component of medical training – yet often it is under-taught or even neglected. This book goes beyond standard textbook content to ground the reader in scientific methods most relevant to the current health landscape. Teaching Epidemiology: A Guide for Teachers in Epidemiology, Public Health and Clinical Medicine, Third Edition

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by Dimitrios Trichopoulos, Jørn Olsen (editor), and Rodolfo Saracci (editor). Oxford University Press. This book serves as a guide to new epidemiology instructors who are teaching basic courses for undergraduates, as well as for those teaching more advanced courses for students at the postgraduate level. Subjectspecific methodology and disease-specific issues (from cancer to genetic epidemiology) are presented in detail.

faculty honors ROGER DETELS received the 2009 Distinguished Teaching Award from the UCLA Academic Senate. JONATHAN FIELDING is chairing the U.S. Department of Health and Human Services Secretary’s Committee on Healthy People 2020: Health Objectives for the Nation. HILARY GODWIN was named a Luskin Scholar at the UCLA Luskin Center for Innovation. WILLIAM HINDS received the David Sinclair Award from the American Association for Aerosol Research in recognition of sustained excellence in aerosol research and technology. MARK LITWIN received the Distinguished Mentor Award from the American Urological Association Foundation. GANG LI was elected as a 2010 fellow of the American Statistical Association for outstanding contributions to the statistical profession. SIMIN LIU was appointed by the National Heart, Lung and Blood Institute to serve a five-year term on the scientific advisory board for its Global Health Initiative. RON BROOKMEYER was appointed to the National Academy of Sciences’ Institute of Medicine Panel to evaluate the President’s Emergency Fund for AIDS Relief. He was named chair of the Statistics in Epidemiology Section of the American Statistical Association. CHARLOTTE NEUMANN received a “Living Legend” award at the International Nutrition Congress in Bangkok last September. THOMAS PRISELAC served as chair of the American Hospital Association Board of Trustees in 2009. BEATE RITZ received an award from the American Parkinson Disease Association in recognition of outstanding contributions to the medical and scientific communities and for her work toward the advancement of Parkinson’s disease research. LINDA ROSENSTOCK was appointed to the Climate and Health Council International. ANTRONETTE YANCEY has been named to the board of directors of the Partnership for a Healthier America (see page 33).

DISTINGUISHED SCHOLAR LECTURE Dr. Carol Aneshensel was selected to deliver the school’s Dean’s Distinguished Scholar Lecture, a series created to highlight the work of distinguished faculty. Aneshensel, professor of community health sciences, is a nationally recognized researcher in social origins of stress and mental disorder. Her lecture, “Developing an Understanding of the Role of Social Stratification in Mental Health,” was delivered to faculty, staff and students.

DISTINGUISHED TEACHING AWARD Dr. Catherine Sugar, associate professor of biostatistics, was the recipient of this year’s Dean’s Distinguished Teaching Award at the school’s annual 2010 Honors and Awards Reception. The award, chosen on the basis of nominations from fellow faculty members, was created to recognize the best of the school’s faculty educators. Sugar’s research focuses on clustering, functional data analysis, classification and patterns of covariation in data.

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yancey joins first lady’s childhood obesity fight Dr. Antronette Yancey, professor of health services and co-director of the school’s UCLA Kaiser Permanente Center for Health Equity, has been named to the board of directors for the Partnership for a Healthier America. The partnership, an independent, nonpartisan organization, was created to mobilize the private sector, thought leaders, media, and local communities to further the goals of First Lady Michelle Obama’s “Let’s Move!” campaign to curb childhood obesity within a generation. The first lady’s nationwide initiative seeks to solve the challenges of childhood obesity by offering parents the tools and information to make healthy choices for their children; getting healthier food into the nation’s schools; ensuring that families have access to healthy, affordable food; and increasing opportunities for children to be physically active, both in and out of school. The partnership will support these efforts through a campaign to inspire families to eat better, be more active and make a commitment to embrace healthier lifestyles.

You are a lifetime member of the UCLA School of Public Health Alumni Association if you are a graduate of the UCLA School of Public Health and its executive programs. If you would like more information about the activities of the Public Health Alumni Association, please call (310) 825-6464 or e-mail phaa@support.ucla.edu.

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BRESLOW LECTURE — Playwright, actress and professor Anna Deavere Smith (pictured, right, with Dean Linda Rosenstock and model/actress Lauren Hutton), hailed by Newsweek as “the most exciting individual in American theater,” performed her singular brand of “documentary theater” at the 36th Annual Lester Breslow Distinguished Lecture and Dinner in March. Smith presented excerpts from her one-woman show “Let Me Down Easy,” which uses health care settings as the backdrop for themes of life, death, and the resilience and vulnerability of the human body.The Lester Breslow Distinguished Lecture was established by the Raymond and Betty Goodman Foundation to provide a forum for outstanding leaders to address important public health topics and issues of our time. The lecture honors Dr. Lester Breslow, dean emeritus of the school, for his remarkable scholarship, service and vision.

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health and climate symposium held SPH an NIH disparities center The UCLA School of Public Health has received a major grant from the National Institutes of Health to establish a Center for Population Health and Health Disparities in partnership with the University of Southern California, the Los Angeles County Department of Public Health and several community collaborators. The award, $10 million over five years, will help the center work toward the goal of reducing cardiovascular disease risk among Latinos in East Los Angeles, where 96 percent of the population is of Mexican or Central American ancestry. This community experiences higher rates of obesity-related chronic diseases, including heart disease, diabetes, hypertension and stroke, especially in comparison with residents in other areas of Los Angeles. The new effort will be directed by Dr. Alex Ortega, professor of health services, in collaboration with other faculty members at the school.

The Los Angeles Health and Climate Symposium, hosted at the school, brought together more than 240 community leaders to inspire creative solutions to the health challenges facing the greater Los Angeles region from climate change. Attendees participated in interdisciplinary work groups with experts in the natural environment, public health, water, infrastructure, green economy, agriculture, and food security, with the goal of developing climate adaptation strategies for people and the environment in the Los Angeles area and beyond. Dr. Richard Jackson, chair of the Department of Environmental Health Sciences and a featured speaker, noted that the average minimum temperature in downtown Los Angeles at night has gone up more than 7 degrees Fahrenheit since 1876. The temperature increase has been driven by climate change, but also by a “built environment” – the buildings and paving of the city – that affects health in major ways. “Place is at the core of health,” Jackson said. “Our built environment is a product of our social policies and our beliefs about our communities. We must change our thinking and our imaginations to construct environments that work for health.” The symposium was co-sponsored by The Nature Conservancy, Communities for a Better Environment, the California Department of Public Health, Physicians for Social Responsibility-Los Angeles, and the UCLA Institute of the Environment’s Center for Climate Change Solutions. A link to the webcast of the symposium can be found on the school’s website: www.ph.ucla.edu.

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You can learn about happenings at the school, participate in discussions on public health topics of the day or reconnect with former classmates and favorite faculty members through the school’s Facebook page, and follow UCLASPH on Twitter for important updates. In addition, alumni are invited to join the UCLA School of Public Health Alumni Network on the professional networking site Linkedin.

FIRST GLOBAL HEALTH SUMMIT — The First Global Summit of Schools of Public Health was held last December to foster common efforts in education and research in global health. The summit was organized by the Association of Schools of Public Health (ASPH), the Asia-Pacific Academic Consortium for Public Health (APACPH) and the Association of Schools of Public Health in the European Region (ASPHER) and held at the 41st APACPH conference in Taipei. Above: Dr. Linda Rosenstock, dean of the UCLA School of Public Health and chair of the ASPH board, signed a common declaration on behalf of ASPH with Professor Wen-Ta Chui of APACPH (second from right) and Professor Antoine Flahault of ASPHER (second from left).

honor roll 2009

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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, 2009, to December 31, 2009. 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. CORPORATE AND FOUNDATION GIFTS AND GRANTS $5,000,000 A N D A B O V E CALIFORNIA COMMUNITY FOUNDATION/ KAISER PERMANENTE CALIFORNIA FUND THE CALIFORNIA ENDOWMENT $1,000,000 - $4,999,999 BURROUGHS WELLCOME FUND KAISER FOUNDATION HEALTH PLAN INC. $250,000 - $999,999 THE ROBERT WOOD JOHNSON FOUNDATION THE CALIFORNIA WELLNESS FOUNDATION NSABP FOUNDATION, INC. THE BREAST CANCER RESEARCH FOUNDATION FRED H. BIXBY FOUNDATION $100,000 - $249,999 CALIFORNIA HEALTHCARE FOUNDATION PREVENTION INSTITUTE THE SUSAN G. KOMEN BREAST CANCER FOUNDATION RESEARCH TRIANGLE INSTITUTE $50,000 - $99,999 MAGEE-WOMENS HOSPITAL, RESEARCH INSTITUTE & FOUNDATION NORTHEAST VALLEY HEALTH CORPORATION MOUNT SINAI MEDICAL CENTER $25,000 - $49,999 MAYO CLINIC KUWAIT INSTITUTE FOR SCIENTIFIC RESEARCH FRED HUTCHINSON CANCER RESEARCH CENTER SEPULVEDA RESEARCH CORPORATION JOHNSON & JOHNSON

$5,000 - $9,999 DANA FARBER CANCER INSTITUTE ALVARADO HOSPITAL, LLC SALINAS VALLEY MEMORIAL HEALTH CARE SYSTEM LOS ANGELES BIOMEDICAL RESEARCH INSTITUTE CEDARS-SINAI MEDICAL CARE FOUNDATION CEDARS-SINAI MEDICAL CENTER CENTER FOR HEALTH IMPROVEMENT CHEVRON CORPORATION KAISER FOUNDATION HEALTH PLAN INC. $1,000 - $4,999 ANTHEM BLUE CROSS QUINCY JONES PRODUCTIONS CHILDREN’S HOSPITAL LOS ANGELES L.A. CARE HEALTH PLAN COLE-BELIN EDUCATIONAL FUND IOWA FOUNDATION FOR EDUCATION, ENVIRONMENT AND THE ARTS THE SAGE GROUP, LLC SOUTHERN CALIFORNIA EDISON COMPANY $500 - $999 ROLL GIVING & PARAMOUNT COMMUNITY GIVING $100 - $499 FOLEY AND LARDNER MOLINA HEALTHCARE, INC. WEST ANAHEIM MEDICAL CENTER MARLENE D. BELSTOCK TRUST INTEGRE, INC. MISSION STREET CONSULTING DUVALL ENTERPRISES DRIVEWISE AUTO INC. HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA

GIFTS FROM INDIVIDUALS AND FAMILY FOUNDATIONS -$50,000 and Above JOANNE AND EDWARD DAUER FAUCETT FAMILY FOUNDATION $10,000 - $24,999 LINDA ROSENSTOCK AND LEE BAILEY DRABKIN FAMILY FOUNDATION INC. ANDREA RAPKIN AND CURTIS ECKHERT KARIN AND JONATHAN FIELDING DEBORAH LEVY PEDRAM SALIMPOUR SHIRLEY AND RALPH SHAPIRO PAMELA AND FRED WASSERMAN $5,000 - $9,999 NOLINDA AND WILLIAM CASWELL LORRAINE TODD AND SANFORD CLIMAN NILOU AND ALLAN DAVIDOV ELIAS FAMILY FOUNDATION LORRAINE AND JERRY FACTOR LATIFEH AND FARHAD HAGIGI DEAN HANSELL CAROLBETH AND LESTER KORN AMY AND RICHARD LIPELES EDWARD O’NEILL MONICA SALINAS JANET AND THOMAS UNTERMAN CYNTHIA SIKES YORKIN AND BUD YORKIN

$2,500 - $4,999 LINDA BOLTON COLE-BELIN EDUCATION FOUNDATION JANET WELLS-KAHANE AND STEPHEN KAHANE CORNELIA AND KENNETH LEE ADELINE YEN MAH AND ROBERT MAH KIYOTO AND ALLEN MILLER JANICE AND BENEDICT SCHWEGLER ATSUKO SHIBATA PATRICIA SOLOMON SINAIKO AND RICHARD SINAIKO MAE-FAY AND FEI-FAN YEH $1,000 - $2,499 ROKYA AND MAMDOUH ABOELATA LAURA BELIN DEVRA AND LESTER BRESLOW KRISTEN HEMENEZ AND JAMES J. CLARK MICHELE DILORENZO SANDRA NAFTZGER AND JEFFREY DRITLEY JOYCE AND GAROLD FABER RITA FLYNN AND RALPH FRERICHS PATRICIA AND TOMAS GANZ HILARY AND PETER GODWIN MIRIAM GOLDSTEIN BETTY AND RAYMOND GOODMAN BARBARA JEAN HEINZEL AMANDA JENNINGS

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$10,000 - $24,999 NATIONAL BUREAU OF ECONOMIC RESEARCH AMERICAN PSYCHOLOGICAL ASSOCIATION AMERICAN HEART ASSOCIATION, WESTERN STATES AFFILIATE

GENERAL MILLS, INC. PS TWO LLC ARCHSTONE FOUNDATION AEROSOL DYNAMICS INC. UNITED HEALTHCARE SERVICES, INC. WILSHIRE FOUNDATION

36 JENNIE AND RAYMOND JING RURI AND GORDON HONDA CAROLYN KATZIN ROSALYNN AND STERLING KING JUDITH AND DONALD LORACK EDEN KUSMIERSKY AND CHRISTOPHER MARDESICH DIANA BONTA AND FRANK MATRICARDI JOANNE AND MARC MOSER LORI RICHARDSONPELLICCIONI AND DANIEL PELLICCIONI KENNETH RESSER SUZANNE AND STUART SCHWEITZER CARISSA AND JACK SCHLOSSER JANE LEE VALENTINE AND THEODORE SWEETSER III DONNA JEAN TESI $500 - $999 MARIANNE AND ABDELMONEM AFIFI PETER AGRONICK SANDRA ARONBERG JOYCE NILAND AND STANLEY AZEN CHRISTY BEAUDIN MATTHEW BERRY MICHAEL BRENNAN KAREN AND GREGORY BRODY MARGARET LEE AND DONALD CHANG WEN LU AND HE CHANG CALVIN S. Y. CHUN DAVID COHEN DUANE DAUNER PHYLLIS AND THOMAS FARVER RONALD FORGEY JESSICA LAUFER AND NEAL HALFON SUSAN HOLLANDER RICHARD JACKSON

SARAH ANDERSON AND MATTHEW KAGAN BARBARA VISSCHER AND FREDRICK KAHN KARLENE AND MASAO KOKETSU LAURIE AND GERALD KOMINSKI REBECKA LEVAN KEVIN LIU ELLEN AND RUSSELL LUEPKER CHARLOTTE AND ALFRED NEUMANN WILLIAM DAVID MEIERDING POURAN AND PARVIZ NAZARIAN ANNA REALINI ANN GARBER-RIMOIN AND DAVID RIMOIN DEBORAH AND ANTHONY RODGERS DAPHNA AND PEJMAN SALIMPOUR RICHARD SCHEITLER PAUL SMOKLER CORNELIA DALY AND ARTHUR SOUTHAM AYAKO UTSUMI CHARLANN AND JOSEPH VANDER PLYUM TINA WEYLAND SARAH STEIN AND FREDERICK ZIMMERMAN $250 - $499 ROSHAN AND SHAROK BASTANI DAVID BAYLYFF ANTHONY BEILENSON DIANA AND GERALD BOROK LINDA BOURQUE KIMBERLY BRADLEY SUSAN CARR SAMUEL CHANG JUNA AND GLENN CHIANG CLINTON COIL RACHEL COREN VALERIE AND FARAZ DANESHGAR

CAROL HOGUE GORDON DEFRIESE VERNA AND JOEL ELLENZWEIG FRANCES AND JOHN FARHOOD LAUREN WILSON AND FRANCESCO FEDERICO GAIL HARRISON AND OSMAN GALAL DANA GALLAGHER HARLAN HASHIMOTO DIANA AND JOE HILBERMAN PEGGY DA SILVA AND DAN HODAPP LIQIN CAI AND XIANYANG JIN BETH AND AVRAM KAPLAN ROBERT KAPLAN NINA AND PHILLIP KASS PETER KATONA ELIZABETH SLOSS AND JAMES KORELITZ CATHY AND JAMES LARSON MICHELE AND SCOTT LAYNE LILLIAN LEW JANE AND RICHARD LOPATT JOHN LOURIE CAROLYN MENDEZ-LUCK AND JEFFREY LUCK BRUCE MARSHACK MARSHALL MORGAN ZAHRA MOVAGHAR JACK NEEDLEMAN ELIZABETH AND BENJAMIN NEUFELD NELLY NIGRO THERESA NORMAN KATHERINE DESMOND AND THOMAS RICE ERNIE RODRIGUEZ MARIAN AND ANTHONY SCHIFF GITA AND FREDRIC SCHLUSSEL ELSA AND PAUL SHEKELLE BARBARA KOMAS AND GARY SLOAN HELENE AND IRA SMITH AND

JOHN SOHL DENISE SPAULDING IRMA STRANTZ IRA STUDIN ROSLYN AND ALLAN SWARTZ CAROL AND STEVEN TEUTSCH CHRISTOPHER THURIN GENEVIEVE AND CITRON TOY CYNTHIA IFTNER-TRAUM AND JEFFREY TRAUM HAZEL WALLACE STEVEN WALLACE GRAEME WILLIAMS HUIKONG FUNG AND HAWKIN WOO KATHLEEN AND STEVEN WRIGHT ANTRONETTE YANCEY STANLEY YUEN SHARON AND SAMSON ZARNEGAR $100 - $249 GRACE AND CRAIG ACOSTA ROSHANAH AND RAVIN AGAH JUANITA GONZALEZ AND YASSER AL-ANTABLY ELLEN AND PAUL ALKON ALLAN ALT DIANE AND SUDHIR ANAND DIANE AND RONALD ANDERSEN PATRICIA ANDERSON FREDERICK ANGULO CAROLYN AND RODNEY AYMOND MARA BAER MARION BAER JAMES BARBER RICHARD BARFIELD MARGARET AND ROBERT BECK PATRICIA BECKWITH BECKY AND DAVID BIGELOW TRISTA BINGHAM JUDITH BJORKE JEANNE BLACK

FIRST CENTURY SOCIETY

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UCLA’s distinguished First Century Society honors alumni, faculty, staff and friends who have chosen to benefit UCLA through a will, living trust, charitable remainder trust, charitable gift annuity, retirement plan, or other estate planning arrangement. The members share a strong common bond of generosity that ensures the university’s continued excellence well into the future. The School of Public Health gratefully acknowledges the philanthropic leadership and foresight of the following First Century Society members who have included the School of Public Health in their estate plans:

LESTER AND DEVRA BRESLOW • MARYAN G. BUNGA • ANNE AND JOHN COULSON • ROBERT AND DIANA GHIRELLI RAYMOND AND BETTY GOODMAN • JOANNE JUBELIER AND JAMES ZIDELL • GERALD KOMINSKI • DAVID KRASNOW ANNE SULLIVAN REHER LIVIO AND JOSEPH LIVIO • JEAN MICKEY • JEANNETTE OREL • JOYCE PAGE JEAN SANVILLE • GURDON AND MARY ANN SMITH • SUEBELLE AND DAVID VERITY

37 MARGARET BANEZ NATHASON AND NEIL NATHASON IRINA N. NEMIROVSKY PENELOPE AND RAYMOND NEUTRA NINA NIU-OK ALICE NORIEGA FELIX NUNEZ RITA Oâ&#x20AC;&#x2122;CONNELL JORN OLSEN LYNN ROSEMAN OSTRICK AND NEVILLE OSTRICK MITSUYOSHI OZAWA NORMA GOMEZ PARRA AND ERNESTO PARRA GENELLE AND FRANCIS PALMER DOROTHY PAYNES CORINNE PEEK-ASA VICTORIA AND PETER PELLERITO MARQUETTE PENNIMAN JEANNE BERTOLLI AND THOMAS PETERMAN EILEEN AND ROBERT PLOURDE CATHERINE POWERS LAUREL AND ERIC RABJOHNS BEVERLY AND ALAN ROBINSON JANE AND SHOLOM ROSEN JULIE AND JESSE ROSS LORRAINE AND MARTIN ROSS DOROTHY AND CURTIS ROZAS LARA SALLEE LESLIE AND KENNETH SATIN LINDA SCHAEFFER DONIK SCHNELL CHERYL SERVAIS HALEH SHAPIRO KATIA AND DAVID SHENASSA KARINN AND TODD SAMMANN MARY AND RICHARD SHAKER MARGARET TOUHY AND DEREK SHENDELL BHARTI AND HARSHAD SHETH KAY SHISHIMA GALE SHORNICK IRWIN SHORR STEPHEN SHORTELL JUDITH SIEGEL PAUL SIMON MARJORIE KAGAWA-SINGER AND PETER SINGER KATHRYN ANN SMITH STELLA AND GUY SOOHOO LAURIE GOODMAN AND DONALD SPETNER MILDRED STERZ LAVEEZA BHATTI AND XAVIER SWAMIKANNU

SORA PARK TANJASIRI PAULA TAVROW TAMIZA ZAHIR TEJA ANN MARIE AND PAUL TONKIN JACQUELYN KASTER AND PAUL TORRENS JACQUELINE HONGHANH TRAN JANET AND ROBERT TRANQUADA JUINE-KAI TSANG AND HAE PYNG JEA MITCHELL TURK JANE TURNER SUEBELLE AND DAVID VERITY ERICA AND TONY VICKERS RITA AND MALVIN VINCENT ASHLEY WAGMAN YIE-CHIA AND BAO TYAN WANG ELOISE WATKINS PENNY AND BERNARD WAYNE NAOMI ROSEN AND BRYAN WEARE RENE AND KERRY WEINER BILLIE WEISS JUDY AND ARTHUR WINER DAVID WEINBERG CAROL AND DANNY YING WONG KENNETH WONG JENNIFER WORTHAM ELIZABETH MARTIN YANO FRANCIS YEMOFIO MICHOU AND GORDON YENOKIDA JON YIPP PARVANEH ZARNEGAR JOHANNA ZIMMERMAN

It is important to us that we acknowledge your gift properly. Every effort has been made to ensure the completeness and accuracy of this Honor Roll. Please let us know of any omissions or errors in listing your name or gift by calling (310) 825-6464.

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SHIRLEY HEATHMAN ELIZABETH AND ROBERT HERRICK LEE HILBORNE JEAN AND PARKER HINSHAW BOB HOKE MARYANN AND JAMES HOOK HOWARD HORWITZ HSIUCHIN AND TEV-HUANG HSIEH MARJORIE AND JACK HUDES CAROLYN AND DONALD HUNSAKER LETICIA IBARRA MARTIN IGUCHI MOIRA INKELAS ELAINE ISHIHARA LISSY AND MURRAY JARVIK DARIUS JATULIS BARBARA AND CLIFFORD JOHNSON KATHERINE JONES JOYCE AND JEFFREY JOSEPH MANSURUR KAHN MARLENE AND JOSEF KAMIENNY FRANCINE AND NEAL KAUFMAN DEBORAH AND EUGENE KENIGSBERG HARVEY KERN IGNA KIRAKOSIAN JENNIFER AND FRANK KOZAKOWSKI KATHLEEN AND GEYERGY KUILANOFF JANE RUBIN-KURTZMAN AND CALMAN KURTZMAN DAVID KRASNOW MARIE LA FARGUE HELEN AND PAUL LAUGHLIN JOON LEE LAUREL AND PAUL LEE MORELLE AND NORMAN LEVINE SANDY AND JOHN LIBBY GENE LIU REBECKA LUDGREN KRISTEN MBOIJANA LENOR MCCALL-RODRIGUEZ SUSAN MCGILLIS MARY MCCORMACK WENDY MCGRAIL HILDY MEYERS MARYSIA MEYLAN RUTH MICKEY EVA AND ROSS MILLER ADRIENNE MIMS CHRIS MIYAKAWA RUTH ANN MOHR EMILY AND JUAN MONTES MARGERY AND HERB MORRIS ROBERT MURRAY CRAIG MYERS ELIZABETH TISEI NASH AND WILLIAM NASH

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JOY BLEVINS NANCY BOLLAY V. JOYCE BOYKIN BONNIE BRINTON MARIANNE AND E. RICHARD BROWN DENISE PERPICH AND JOHN BROWN TIMOTHY BURKE LUDMILA AND NAUM BURKOY REGINA BUSSING ANNA AND VISOTH CHEA JANE CHAN CHENG-TAI CHEN JOAN CHOW ALICE AND HUNG CHU RACHEL CIVEN ADA CLARK THOMAS CLOUD WILLIAM COMANOR DUSTIN CORCORAN OLIVIA CROOKES HOLLY AND WILLIAM CUMBERLAND ZHAOPING LI AND KENNY DANG ANN DELLINGER KATHRYN DEROSE KATHLEEN DINSMORE NANCY DOWNEY-JANKA STEVE DUVALL VICKY EBIN SUSAN COLE AND PYSER EDELSACK ELLEN EISEMAN MEREDITH AND SAM ELROD BING FANG SUSIE FAN MARAL FARSI LOURDES AND ANDREW FORSTER BROCK FOSTER JAMES FREED JUDITH KATZBURG AND STUART GABRIEL STEVEN GELB ROBERTA AND BRUCE GERDING LINDA TESLOW-GERLACH AND MATTHEW GERLACH DIANE AND ROBERT GHIRELLI FRANCINE COEYTAUX AND DAVID GLANZMAN GERTRUDE AND SAMUEL GOETZ GEORGE GOLDBERG ROBERTA RIVA GOLDMAN RUTH AND DAVID GOMEZ GAIL GRANT MARJAN KEYPOURGREENBLATT AND JONATHAN GREENBLATT DEBRA LOTSTEIN AND BRUCE GREENSPAN PEGGY HARRIS MARY MILLER AND JOSEPH HAFEY

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