UCLA Public Health Magazine - June 2003

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JUNE 2003

UCLA

PUBLIC HEALTH HIV/AIDS

UCLA

Population-Based Strategies for a Global Problem

School of

Public Health

Robert Kim-Farley is one of a number of faculty at the school who are helping to prepare the public health response to the possibility of bioterrorism.

Genetics or the environment?

Robert Schiestl knows it’s not so simple. His new center is unraveling the complex interactions underlying disease.

Documentary filmmaker Terry Young uses what she learns in the classroom to educate the public on important environmental issues via her art.

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UCLA

PUBLIC HEALTH

Albert Carnesale, Ph.D. Chancellor

Linda Rosenstock, M.D., M.P.H. Dean, UCLA School of Public Health

Julie Tisdale Pardi, M.A. Assistant Dean for Communications

Dan Gordon Editor and Writer

fe a t u r e s

1

Martha Widmann Art Director

E D I TO R I A L B OA R D Richard Ambrose, Ph.D. Associate Professor, Environmental Health Sciences

Roshan Bastani, Ph.D. Associate Professor, Health Services

Thomas R. Belin, Ph.D. Associate Professor, Biostatistics

William Hinds, Ph.D. Professor, Environmental Health Sciences

Jeffrey Luck, Ph.D. Assistant Professor, Health Services

Hal Morgenstern, Ph.D. Professor, Epidemiology

Michael Prelip, D.P.A. Assistant Professor, Community Health Sciences

Susan B. Sorenson, Ph.D. Professor, Community Health Sciences

Jill Donofrio, Amanda Shelly-Babcock Co-Presidents, Public Health Student Association

Joyce A. Page, M.S.P.H., J.D. President, Alumni Association

Joanne Clarey

UCLA

Director of Development and Alumni Relations

School of

Public Health

4

Nature and Nurture Researchers in the emerging field of environmental genomics are identifying who’s at risk and what they can do about it.

8

Robert Schiestl: Center of Attention The director of UCLA’s initiative to study gene-environment interactions says the wide-ranging expertise and culture of collaboration make UCLA the ideal place to carry out the effort.

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Alumni Hall of Fame:

Public Health & HIV/AIDS

the 2003 Inductees

10

20

departments 22 RESEARCH Tiny air pollutants cause lung damage...HMO population diverse...knowledge of domestic violence victims... understanding treatment cause-and-effect...use of sewage sludge to restore lagoon...prevalence of food insecurity in state.

27 STUDENTS

16 While a vaccine remains elusive, public health approaches – including those of the school’s faculty, alumni and students – can and have made a difference.

30 FACULTY

Fundamentals for a New Era

With increased visibility and funding following 9/11, public health faces unprecedented opportunities and extraordinary challenges.

On many fronts, the school is playing a key role.

31 NEWS BRIEFS 34 FRIENDS ON THE COVER The global problem of HIV/AIDS, symbolized by the red ribbon, continues to challenge public health researchers and practitioners. While there have been setbacks, successes in certain populations have shown the value of prevention strategies. Cover photo/illustration by Martha Widmann. Images sourced from: 2003 © Getty Images.

PHOTOGRAPHY Maryann Stuehrmann / cover: Kim-Farley, Schiestl; TOC: Schiestl, HIV, Fundamentals; p. 2; pp. 7-8; pp. 10-11: community outreach; pp. 13-14; p. 16; p.18; p.19: Glik; pp. 28-29

Yvette Roman / TOC: Nature; p. 4; p. 21: Gold Reed Hutchinson / TOC and p. 20: Hall of Fame Award; p. 5; p. 15; p. 30: Oxford Textbook and Who Will Keep the Public Healthy?

ASUCLA / p. 20: Goldstein, Shortell; p. 21: Twu; p. 27; p. 31: Getting LA on the Move; pp. 32-34; p. 36 Courtesy of Terry Young / cover Courtesy of Roger Detels / pp. 11-12 Courtesy of Raymond Goodman / p. 19 Courtesy of the UCLA School of Public Health / p. 17; p. 30; p. 31: Needleman Courtesy of Hall of Fame Awardees / pp. 20-21 Courtesy of John Froines / p. 22 Courtesy of Richard Ambrose / p. 25 Courtesy of Ralph Frerichs and the Epidemiology Web site / p. 32 Courtesy of Beth Kaplan / p. 37

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 2003 by The Regents of the University of California.

Permission to reprint any portion must be obtained from the editor. Contact Editor, UCLA Public Health Magazine, Box 951772, Los Angeles, CA 90095-1772. Phone: (310) 825-6381.

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dean’s message IN A YEAR OF STATE BUDGET CUTS and financial uncertainty, the school has continued to remain on track and has much to be proud of this year.

In the 2003 U.S. News & World Report ranking of schools of public health, announced in April, UCLA ranked in a two-way tie for seventh. The school received its highest overall score to date (3.7 out of 5) and the ranking represents a slight improvement from our 2000 position, where we were in a three-way tie for seventh place.

The school continues as among the most diverse schools of public health in the United States. Twenty-five percent of our entering fall 2002 class come from countries outside the United States; among the others, about half are racial and ethnic minorities. These data reflect the school’s commitment to training a diverse public health workforce.

To further our efforts in this area, the school was recently awarded $150,000 for student support and outreach from the California Wellness Foundation as part of its Diversity in the Health Professions initiative. This, coupled with the $450,000 recently received from The California Endowment for traineeships in underserved areas, will significantly aid the school’s efforts to target our support to students committed to working in these areas.

Our faculty continue to conduct exciting and important research.

The fact that the school’s grants and contracts have increased 85 percent over the past three years is a testament to the value of the school’s research in the eyes of grant makers. Significant increases in grants and contracts will be the primary mechanism for growth in the coming years.

In March, we held a very successful and productive faculty retreat.

Many innovative and exciting ideas for propelling the school forward were discussed, including implementing the strategic plan, recruiting new faculty, and maintaining excellence in tough economic times. We have already begun to implement recommendations from the retreat, including undertaking school-wide recruitment for two new faculty positions in the areas of global health and public health genomics.

There is much exciting news at the school in the area of genomics (see pages 4-9). A generous gift from Art Alper in memory of his wife, Ann Fitzpatrick Alper,

UCLAPUBLIC HEALTH

has created the Ann Fitzpatrick Alper Program in Environmental Genomics. The program is a collaborative venture with the Jonsson Cancer Center and is housed in the School of Public Health’s new Center for Environmental Genomics.

Professor Robert Schiestl heads both the program and the center.

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2002-2003 DEAN’S A DV I S O RY B OA R D It is with great pleasure that I welcome the three newest members to the Dean’s Advisory Board. Michele DiLorenzo, who leads new ventures at CarseyWerner-Mandabach, the preeminent independent studio in the television industry, brings a wealth of entertainment experience to the board. Previously, DiLorenzo held leadership positions at Viacom, Virgin Interactive, and MTV Networks. Ken Lee (M.S. ’75) is the founding principal of Lee, Burkhart, Liu, Inc. (LBL), a provider of planning, architectural and interior design services primarily for health care, academic, institutional and corporate clients. He has more than 25 years of professional experience in the planning and programming of health care institutions. Mickey Gardner is a Washington, D.C., telecommunications attorney who represents many clients in Los Angeles. The board will benefit from his business savvy and bicoastal perspective.

Over the past year, the field of public health has experienced unprecedented visibility on a host of pressing issues — SARS, smallpox vaccinations, West Nile Virus, and bioterrorism preparedness, to name a few. The SARS epidemic has demonstrated yet again that one country’s health problem can easily and quickly

Ira R. Alpert* Linnae Anderson Diana Bontá* Lester Breslow Michele DiLorenzo Robert J. Drabkin Tom Epley Gerald Factor (Vice Chair) Michael R. Gardner Robert W. Gillespie Roger F. Greaves Alan Hopkins* Stephen W. Kahane* Carolyn Katzin* (Chair) Carolbeth Korn* Kenneth E. Lee* Richard D. Lipeles* Edward J. O’Neill* Walter Oppenheimer Monica Salinas David Walker Fred Wasserman* *SPH Alumni

become an international health crisis. This is true of emerging infectious diseases as well as the more traditional public health issues such as AIDS. The school’s work on the HIV/AIDS issue is detailed in the cover story beginning on page 10.

We are fortunate to have Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, as our commencement speaker. I can think of no one better to address our graduates at this critical time in public health.

It is at this critical time, this time of great need and great opportunity, that our graduates can make their mark on the world. They will draw on their experience at UCLA and from their diverse backgrounds to shape the future of public health and ultimately all of our lives. I look forward to their many successes.

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

TOTAL EXPENDITURES Grants and Contracts State-Generated Funds Gifts and Other UCLAPUBLIC HEALTH

Fiscal Year 01-02 = $37.6 million

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4 R ESEARCHERS IN THE EMERG ING FIELD OF ENVIRONMENTAL GENOMICS ARE IDENTIFYING WHO ’ S AT RISK AND WHAT THEY CAN DO ABOUT IT.

Nature and Nurture

In Disease, the Gene-Environment Interaction Matters Most Discoveries of inherited genes that make

UCLAPUBLIC HEALTH

Dr. Zuo-Feng Zhang (center), a molecular epidemiologist who studies cancer, is codirector of the new Center for Environmental Genomics, based in the School of Public Health and Jonsson Cancer Center.

individuals dramatically more likely to develop certain types of cancer, cardiovascular disease or neurodegenerative disorders have received much fanfare in recent years. But often overshadowed in the coverage of these findings is the important fact that the implicated genes are extremely rare.

“We’ve seen big headlines when molecular geneticists have been able to clone single genes and show that a certain inherited mutation is responsible for a disease,” says Dr. Beate Ritz, associate professor of epidemiology at the UCLA School of Public Health. “When this is reported, a lot of people think we’ve found ‘the breast cancer gene,’ or ‘the heart disease gene,’ not realizing that these are highly unusual cases. In the vast majority of the population, genes play a much more minor role in these diseases.”

Disease was once thought to have one of two causes: environmental or genetic. The scientific revolution fueled by modern molecular biology and the sequencing of the human genome has taught us that it’s rarely that simple; much more typically, it’s an interaction between the two. This has spawned a new scientific field, environmental genomics, of considerable public health importance. Earlier this year the UCLA Center for Environmental Genomics

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Such complex questions could never have been answered prior to the advent of the Human Genome Project, the ambitious, recently completed effort to determine the DNA sequence of the more than 30,000 human genes; and technologies subsequently developed to simultaneously view the expression of large numbers of genes or proteins – the workhorses of cells. The experiments facilitated by these technologies can be illuminating. For example, researchers can view how all genes are expressed in a normal state, then see how the cells they produce respond to a particular environmental exposure as a way to understand differential genetic responses. “What we’re doing with these methods

Dr. Robert Schiestl, director of the Center for Environmental Genomics, notes that a molecular understanding of gene-environment interactions can facilitate studies attempting to prevent interactions that lead to disease.

UCLAPUBLIC HEALTH

“There are high-risk genes in which, for people with a certain mutation, the lifetime chance of getting a particular disease is 80 or 90 percent,” says Dr. Zuo-Feng Zhang, professor of epidemiology and co-director of the new center. But, Zhang notes, these types of genes – perhaps the most high-profile of which are BRCA-1 and BRCA-2 for inherited breast cancer – have a low prevalence in the general population, usually affecting less than 1 percent.

By contrast, Zhang explains, when there are mutations in “low-risk genes,” such as those that detoxify carcinogens and activate DNA repair mechanisms, the relative risk increases on a much smaller scale – but the prevalence of these genes in the population is often quite high, and they are much more highly dependent on interactions with environmental exposures for disease to result. For example, GSTM-1, a gene that can detoxify the tobacco-related carcinogen, is dysfunctional in close to half of the U.S. white population. “If you’re a smoker and you don’t have the function of this gene, your cancer risk is much higher,” says Zhang, a molecular epidemiologist who studies cancer.

“What genetics has done for the last 100 years is identify the single gene for an inherited disease, where one change is usually sufficient,” says Ritz.

“These are usually young-onset and extremely rare diseases – not the ones that public health has focused on. And because they are so rare, genetics alone has worked – you could analyze families, then with the molecular tools that came along you could find the one gene that this family had.”

The far more common low-risk genes increase one’s propensity to develop a certain disease, but only in conjunction with other genes and with particular environmental factors – from air pollutants or occupational exposures to tobacco smoke, alcohol, or a certain diet. “These are the complex dis-

eases, which are much more widespread, much more of a public health concern,” Ritz says. “And I am certain we’ll never find the ‘one gene’ for those.”

The challenge facing researchers in environmental genomics is to determine why people with a gene variant that increases their likelihood for getting a certain disease wind up with the disease, while others with the same mutation do not. Are the different outcomes related to other genes, or are environmental factors at play? Toxins are being introduced into the environment that have never been encountered in 100,000 years of human genetic development – to what effect? Which genetic make-ups are able to detoxify these potential carcinogens, and which are not?

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was established within the School of Public Health in collaboration with the Jonsson Cancer Center, with the goal of bringing together leading experts from a variety of fields – cancer, environmental health, epidemiology, biostatistics, human genetics, pathology and pharmacology, to name a few – to investigate the molecular mechanisms by which environmental agents such as air pollutants and radiation interact with genetic predisposing factors to cause disease.

A better understanding of these processes would pave the way not only for targeted drug therapies, but also for targeted public health efforts to reduce environmental exposures in high-risk populations.

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6 is going back to descriptive biology,” says Dr. Robert H. Schiestl, professor of pathology, environmental health sciences and radiation oncology and director of the UCLA Center for Environmental Genomics.

“In the early days of biology, organisms were described; now, we describe the molecular mechanisms of organisms after exposure to environmental agents.

Once we know those mechanisms, we can do studies to try to interfere with the negative effects through nutritional interventions or chemopreventive therapies.” (For more on Schiestl’s work, see page 8.)

Researchers at Schiestl’s center use a variety of approaches and bring different types of expertise to the problems the center is tackling. The Southern California Particle Center and Supersite, also based in the School of Public Health, is involved in studies to identify factors that make certain people more vulnerable to the biological effects of air pollutants.

Pesticides, another issue of particular importance in agriculture-rich California, have been catalogued and are now being investigated by researchers, including Ritz, for their potential role in neurological disorders such as Parkinson’s disease. Ritz is working with 50 “candidate” genes that have been described for Parkinson’s, and is examining the impact of pesticides, air pollution, diet and smoking on these genes in residents of California’s Central Valley. Zhang is involved in identifying molecular genetic susceptibility markers that might interact

with environmental exposures such as air pollution to increase the risk of diseases such as lung, oral, and esophageal cancers; and in intervention studies weighing the effects of targeted chemotherapies on such markers. Other center researchers are studying the interaction between genes and occupational exposures, including beryllium and radiation, to which certain people appear to be more sensitive than others.

There is no shortage of questions to pursue; indeed, one of the major challenges in the field is knowing where to start. “The Human Genome Project is complete,” says Zhang, “but we know only a very few disease-related genes. With more than 30,000 genes, we have a long way to go to identify their function and role in the disease-development process.” There are two main approaches researchers take, Ritz notes. Some investigate hypotheses about specific “candidate genes,” while others use statistical tools in an effort to find genetic differences, or polymorphisms, that correlate with increased disease risk.

Those methods remain crude, but researchers hope experts in the emerging field of bioinformatics will help to develop new techniques that will make such an approach less of a needle-in-a-haystack search.

When studies find that some in the population have genes that make them susceptible to particular environmental influences, what then? There are

UCLAPUBLIC HEALTH

Leadership Gift Establishes Ann Fitzpatrick Alper Program to Conduct Further Research on Environmental Causes of Cancer A leadership gift by Art Alper in memory of his wife, Ann Fitzpatrick Alper, has helped to establish a $1 million research effort at UCLA’s School of Public Health and Jonsson Cancer Center to investigate the environmental causes of cancer.

The Ann Fitzpatrick Alper Program in Environmental Genomics, part of the Center for Environmental Genomics, is headed by Dr. Robert H. Schiestl, professor of pathology, environmental health sciences and radiation oncology and the center’s director. The program is exploring such issues as the risk of lung cancer in non-smokers, the effects of air pollution particles on human cells, prostate cancer and pesticide exposure, a possible link between boron and prostate cancer, and hypersensitivity to radiation.

The gift, which is being augmented with a donation from the Kenneth Jonsson Family Foundation and UCLA’s Jonsson Cancer Center Foundation, was made in memory of Ann Fitzpatrick Alper, who died last year from complications of lung cancer. Art Alper met his wife at UCLA, where both were students, and they married in 1955. A former teacher turned author and marriage and family counselor – and an environmental activist who drove a hybrid car – Ann Fitzpatrick Alper developed the disease despite not having smoked since she was a college student in the early 1950s, making smoking alone an unlikely cause of her cancer.

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Dr. Beate Ritz is studying the impact of pesticides, air pollution, diet and smoking on 50 previously described Parkinson’s disease “candidate” genes in residents of California’s Central Valley.

“The key to the future is to understand why certain people develop certain cancers.

Through this kind of research, merging environmental factors and molecular genetics, we may be able to find the answers.”

— Dr. Linda Rosenstock Dean, UCLA School of Public Health

UCLAPUBLIC HEALTH

Researchers in the program are looking for subtle variations in DNA that predispose some individuals to developing cancer after contact with environmental pollutants, and to shed new light on how pollutants interact with genetics to cause a variety of cancers. About 95 percent of the nearly 2.5 million Americans who will be diagnosed with cancer this year have no known genetic predisposition to the disease. It’s believed that these people develop malignancies due to complex interactions between their genes and their environment. The goal for scientists looking to prevent cancer is to discover what specific combination of an individual’s genetics and factors such as diet, air pollution, exposure to tobacco, and sensitivity to sunlight result in disease.

“The key to the future is to understand why certain people develop certain cancers,” says Dr. Linda Rosenstock, dean of the UCLA School of Public Health.

“Through this kind of research, merging environmental factors and molecular genetics, we may be able to find the answers.”

“This program promises to be a unique effort that we hope will unravel many of the mysteries surrounding the interaction of genes and the environment in the development of cancer,” adds Dr. Judith C. Gasson, director of UCLA’s Jonsson Cancer Center. “This work will reflect Ann’s passion for a safer environment along with her hope that future generations will not suffer the devastation of cancer.”

Additional gifts for the Ann Fitzpatrick Alper Program in Environmental Genomics may be sent to UCLA’s Jonsson Cancer Center Foundation at 8-950 Factor Building, Box 951780, Los Angeles, CA, 90095-1780.

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social, economic and ethical concerns that are still being debated surrounding the issue of genetic testing and how to deal with the results. “Much of the science is still in its infancy, and in most cases it’s premature to make recommendations,” says Ritz. On the other hand, drug companies are rightfully moving in the direction of screening patients to determine which ones might be prone to suffering adverse effects from a particular compound.

As the environmental genomics field advances, few doubt that there will be revolutionary effects on both medicine and public health. “It now costs about $500,000 to have your entire genome sequenced,” says Schiestl. “In 10 years, it might be down to $1,000, because of the advancing technology. That means that many people will have a complete profile of their genetic factors. It means medicine can be individualized – we’ll know which drugs are better for which patients, for example. But it also has strong public health implications. People can be brought up to avoid certain exposures that would be particularly harmful to them.”

“The knowledge we get from molecular genetic research will enable us to conduct risk assessments in the general population of people without disease,” agrees Zhang. “This is very important in public health, because if people know they are at risk of getting a certain cancer, for instance, they might be more eager to take preventive measures.” Moreover, he adds, this knowledge can be used to make public health interventions more cost-effective. Smoking cessation programs could target smokers with genomes that make them particularly susceptible to tobacco-related diseases. The identification of genetic changes foreshadowing the onset of disease will reduce the cost of chemoprevention studies by providing earlier results.

“These are all public health impacts,” says Zhang. “Environmental genomics will help us to prevent diseases rather than waiting until they occur.”

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8 T HE OF

DIRECTOR

UCLA’ S

INI -

TIATIVE TO STUDY GENE - ENVIRONMENT INTERACTIONS SAYS THE WIDE - RANGING EXPERTISE AND CULTURE OF COL LABORATION MAKE

UCLA

THE IDEAL

PLACE TO CARRY OUT THE EFFORT.

Robert Schiestl:

Center of Attention

As a Ph.D. student in Vienna, Austria, in the early 1980s, Robert H. Schiestl read newly published studies describing for the first time how exposure to certain chemicals could cause genetic instability – damaging DNA, the blueprint for life, and starting the cascade leading to cancer. Two decades later he heads UCLA’s new Center for Environmental Genomics, which takes a far more sophisticated approach to the topic of our genes, what affects them, who’s at risk and what can be done to protect susceptible groups – using tools that would have seemed the stuff of science

UCLAPUBLIC HEALTH

fiction when Schiestl was starting his career.

So much has happened in the last 20 years, not the least of which was the sequencing of the 30,000 human genes and the development of methods to rapidly screen large numbers of them at once for mutations. “Today we know a lot more about genetic factors that help us to avoid DNA damage, as well as the DNA repair mechanisms,” Schiestl says. During this period of rapid advance, Schiestl weighed in with his own seminal contribution: further characterization of types of genetic instability, and the development of methods to screen large numbers of chemicals for potential carcinogenic effects – tests of considerable interest to pharmaceutical companies.

The Center for Environmental Genomics, based in the School of Public Health, brings together faculty from many parts of the UCLA campus. The goal is to characterize the molecular processes by which occupational and environmental agents cause subtle changes in DNA that can lead to disease, and why certain sub-populations are more prone to harm from particular exposures than others. This knowledge will help

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“The idea is to identify people’s genetic predispositions and the environmental factors to which they are sensitive so that they can make an informed decision.”

—Dr. Robert Schiestl

UCLAPUBLIC HEALTH

makes a difference,” Schiestl says. “We can see whether a nutritional or drug intervention could reduce the frequency of deletions in genetically predisposed mice who are exposed to air pollution, or to cigarette smoke.”

Schiestl’s arrival at UCLA three years ago came at a time when the research tools for determining gene-environment interactions – including techniques for measuring the expression level of large numbers of genes in response to a given environmental exposure – were just coming of age. “The technologies have really matured,” he says. “I used them at Harvard, but on a much smaller scale.

With the sequencing of the human genome, they are becoming more and more available.”

There are other reasons his research has benefited from the move west, he adds – reasons that have nothing to do with the technology, or the weather. “The scientific culture here is very interactive, very collaborative,” he says. “And at UCLA, you have so much expertise in so many different disciplines, all on one campus. In this field, you need to bring together experts in many areas – epidemiology, toxicology, chemistry, molecular biology, genetics, biostatistics and others – to make progress.” The interdisciplinary and broad-based nature of Schiestl’s work is reflected in his appointments in three departments: environmental health sciences within the School of Public Health, and pathology and radiation oncology within the School of Medicine.

The Center for Environmental Genomics was established earlier this year, and its director clearly is a strong believer in the potential for making a major public health impact through the center’s research. His excitement is evident as he leans forward in his chair and offers a visitor the example of beryllium disease to illustrate the point. Beryllium is an extremely lightweight and hard metal used in many industries, including aerospace and weapons production, he explains. A small percentage of workers exposed to dust or fumes from beryllium metal develop the lung disease. “The majority of the population is not sensitive to beryllium,” Schiestl notes. “But it’s been found that people with a certain polymorphism – a single genetic change – are extremely sensitive. And they would never know it unless they worked in a beryllium factory.

“The idea is to identify people’s genetic predispositions and the environmental factors to which they are sensitive so that they can make an informed decision, in this case about whether to keep working in that factory. People can’t change their genetic predispositions, but they can change their environment.”

faculty profile

center researchers develop “biomarkers” that indicate exposure levels, identify high-risk groups, and design strategies to prevent disease in these susceptible populations.

The center is addressing questions that couldn’t have even been asked when Schiestl was completing his Ph.D. in biology and genetics at the University of Vienna, and yet his 6,000-mile journey to the Westwood campus has followed a logical path. “I was always interested in genetics and the biological effects of xenobiotics – external chemicals – in humans,” he says. It’s a theme that goes back to his doctoral thesis, which focused on the cancer-causing effects of the foreign substances. “I wanted to try to understand how cells become genetically unstable, which is a mechanism for carcinogenesis,” he says.

“Why do they become increasingly unstable in successive rounds of reproduction, finally metastasizing to other parts of the body? And what is the initial insult that makes this happen? I thought understanding that could be a key in preventing cancer.”

Shortly after receiving his Ph.D. in 1983, Schiestl came to North America, first to the University of Alberta in Canada and then to the University of Rochester, where he joined the biology department as a postdoctoral fellow. After more than three years there and two at the University of North Carolina at Chapel Hill, he landed at the Harvard School of Public Health, where he spent nearly a decade before being recruited to UCLA in 2000.

At Harvard he continued to tackle the issue of genetic instability, including the interaction between environmental agents and genetically predisposing factors. Most significantly, his research group developed tests in yeast, human cells and mice that detect chemicals which trigger cancer-causing mutations – specifically, DNA deletions – as well as those that don’t cause mutations but are nonetheless carcinogenic. “We were building on the knowledge that mutations which cause a high frequency of genetic instability often predispose to a high risk of cancer,” Schiestl explains, “and also that a class of chemicals do not cause mutations but can cause cancer.” Some of these assays are now being used by drug companies to screen for potentially cancer-causing chemicals.

The assays provide an invaluable research tool not only for determining whether compounds that might come into human contact are carcinogens, but also for investigating the interplay between environmental exposures and particular genes – and how damaged DNA can be repaired. “We can determine the effect of these exposures on the frequency of deletions, and then, for example, if we find that a chemical causes oxidative stress in mice, we can treat them with anti-oxidants to see whether that

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10 W HILE

A VACCINE

REMAINS ELUSIVE , PUBLIC HEALTH APPROACHES

–

INCLUDING THOSE OF THE SCHOOL ’ S FACULTY, ALUMNI AND STUDENTS

–

CAN AND HAVE MADE A DIFFERENCE .

Public Health & HIV/AIDS Proactive Strategies to Combat a Stubborn Foe

Cynthia Davis (M.P.H. ’81, pictured in foreground at left), assistant professor at Charles R. Drew University of Medicine and Science, runs a mobile HIV testing and counseling program that reaches underserved areas of Los Angeles.

More than 20 years

after the first AIDS case was

described, the worldwide HIV epidemic seems unlikely to go away any time soon. Highly active anti-retroviral therapy (HAART), while potentially lifesaving, requires a complicated medication-taking regimen and financial wherewithal, posing significant barriers, particularly in the developing world.

Meanwhile, scientists continue to be frustrated in their efforts to develop a vaccine. Last year alone, HIV claimed 3 million people worldwide. Forty-two

UCLAPUBLIC HEALTH

million are living with the virus.

While much attention over the last two decades has focused on finding a “cure” for AIDS, the battle to control the spread of HIV has been waged by public health researchers and practitioners. Their ledger includes both victories and setbacks. In the United States, public health strategies initially contributed to a sharp reduction in the incidence of HIV transmission among gay males, but more recently the nation has seen an ominous resurgence of new HIV cases, with increases among gay men as well as other population groups. Abroad, public health initiatives in several countries have dramatically curbed the epidemic, but elsewhere rates are soaring.

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“Treatment on its own will not make the epidemic go away. We will continue to need prevention strategies.”

—Dr. Roger Detels

One of Taiwan’s leading public health officials dates his interest in HIV/AIDS control to 1991, when he completed his doctoral thesis and dissertation, “Does Hepatitis B Viral Infection Promote HIV-1 Infection and Progression to AIDS?” under the supervision of Dr. Roger Detels. Ever since, he has been dedicated to developing and implementing public health strategies for fighting the epidemic. That work has included publishing the first HIV/AIDS monograph issued in Taiwan, as well as providing voluntary testing of outpatients at the National Taiwan University Hospital and the Taipei City STD Control Center. In 1995, Twu was awarded the Prize of Medical Contribution (Group Category) from the HIV/ AIDS Medical Group of the National Taiwan University for his efforts. He founded “Light of Friendship Volunteer Organization,” the first nongovernmental organization dedicated to HIV/AIDS prevention. The organization published “International HIV/ AIDS Prevention Handbook” to promote the dissemination of information on preventing transmission of the disease, and to promote anonymous testing using the “filter paperdried blood method.” Twu has also successfully implemented cross-ministry cooperation for prevention and treatment. He proposed creating a cabinet-level position in Taiwan’s government for control of HIV.

UCLAPUBLIC HEALTH

In 1984, before HIV had even been identified as the culprit, the Multicenter AIDS Cohort Study (MACS) was launched as the first and largest study to examine the natural history of AIDS. MACS has been ongoing at four institutions including UCLA, which runs the largest site under the leadership of Dr. Roger Detels, professor of epidemiology at the School of Public Health. More than 5,000 gay men have participated in the study, which has contributed landmark findings on the virologic, immunologic, psychosocial and neurologic aspects of the disease.

In 1989, Detels published a controversial paper demonstrating that HIV could be isolated in MACS participants who tested antibody-negative.

Subsequently, he discovered that the ability to isolate the virus ceased among men in this group who did not continue to have multiple sexual partners.

“If this had been a latent infection, their sexual activity should have had no bearing on the ability to isolate the virus,” he notes. “I realized that these men were probably clearing the virus due to a combination of factors, including some sort of natural protective mechanism. At the same time, we continued to isolate the virus in the antibody-negative men

who remained sexually active with multiple partners. That said to me that these men were somehow clearing the virus and then being re-infected.”

Detels’ observation that some men are resistant to HIV infection, borne out by other research groups, identified a particularly interesting population that Detels has continued to study. “The idea is that if we can identify what the factors are that allow these men to clear the virus, perhaps we can confer those factors on individuals who do not naturally have this resistance,” he explains.

Four years after MACS began, another program was established under Detels’ leadership that continues to be an invaluable asset in the international fight against HIV/AIDS. The UCLA/Fogarty AIDS International Training and Research Program has provided master’s- and doctoral-level training to more than 130 health professionals from China, India, Brazil, Thailand, Vietnam, Cambodia, Myanmar, Indonesia, the Philippines and Laos, with these students then returning to their home countries to serve in leadership roles. Detels continues to consult and collaborate with many of his former students on HIV/AIDS-related research and policy development in their respective countries.

The Fogarty program has also proved to be an invaluable resource for many of Detels’ UCLA colleagues in the field of HIV prevention. Dr. Mary Jane Rotheram-Borus, director of the Center for HIV Identification, Prevention, and Treatment Services and a professor in the school, has led about a dozen large intervention studies in the last decade for high-risk U.S. adolescents, four of which have

M.D., Ph.D. ’91

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Shiing-Jer Twu,

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Zunyou Wu M.D., Ph.D. ’95

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Wu, one of China’s leading HIV/AIDS researchers, is director of the Division of Health Education and Intervention of the country’s National Center for AIDS/ STD Control and Prevention.

He received his Ph.D. in epidemiology from the school as part of the UCLA/Fogarty AIDS International Training and Research Program, and has been involved in HIVprevention intervention research focusing on highrisk groups in China since 1994. Along with his former advisor, Dr. Roger Detels, Wu was the first to report HIV infections among former plasma donors in China in 1995. Wu and Detels then conducted a survey of former plasma donors and their family members, followed by a program to promote condom use in that population.

Studies by Wu and Detels of drug users in southern Yunnan Province in 1993 led to the researchers designing a community intervention program that successfully reduced the incidence of new drug users by threefold compared with control villages. Wu was the first to demonstrate that female sex workers in China could be reached for behavioral studies and interventions.

been designated by the Centers for Disease Control and Prevention as “effective programs to be replicated.” These programs have demonstrated that even in the high-risk groups, people are interested in and able to change their behaviors, RotheramBorus notes.

But, she adds, the most severe HIV problems are currently in nations outside the United States, “and to really make a difference internationally, you have to have skilled collaborators in the country that’s affected.” In recent years, Detels has brought Rotheram-Borus together with graduates who were heading HIV programs in China, India and Uganda, enabling her to launch similar interventions abroad with critical assistance from collaborators who help to tailor the programs to the culture and needs of the population. “The existence of UCLA/Fogarty program graduates in leadership positions in all of these countries has allowed a lot of us, in a short period of time, to do important work that would not have been possible without the pipeline established by the UCLA/Fogarty program,” Rotheram-Borus says.

The importance of cultural factors in HIV prevention efforts is illustrated by differences in countries’ approaches to sex. “The tradition in much of Asia has been that men are expected to have multiple partners, while women are not,” Detels says. He notes that Thailand and Cambodia have developed strategies based on this cultural acceptance by focusing on the class of women who are sex workers in brothels. “That has a very important cultural

implication for control of the epidemic, because if most of the HIV transmission is occurring through brothels, you can attempt to control its spread by putting economic pressure on the owners of establishments to force clients to use condoms,” Detels says. Both countries have done just that, developing 100 percent condom-use programs that have resulted in a downturn of the epidemic. On the other hand, in countries that have attempted to suppress commercial sex rather than developing this practical approach, interventions must be directed at independent sex workers, who have little power in their relationships with clients; and at a client group that is difficult to identify.

Dr. Donald Morisky, professor of community health sciences at the school, has similarly concluded that efforts to change individual behaviors to reduce the spread of HIV are far more effective when supported by the health care structure and environmental factors. In the Philippines, Morisky has found a substantial reduction in STD rates when commercial establishments that employ sex workers are required by the government to ensure that the women are registered and undergo bimonthly examinations at the social hygiene clinic. Morisky, who has also had an active HIV/AIDS research program in Thailand, has found that training the managers of these establishments in HIV prevention strategies – including the display of safe-sex materials – can also make a major difference, particularly when they are made aware of the economic impact of adopting such strategies.

The UCLA/Fogarty AIDS International Training and Research Program has made an enormous impact by providing gradutate education to health professionals who return to their home countries to serve in leadership roles.

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13 M.A.

Sung-Jae Lee, M.P.H. Lee, a doctoral student at the school, spent much of his childhood in Thailand, a country that was hard-hit by the HIV/AIDS epidemic.

As an M.P.H. student at Yale in the summer of 1997, he was able to arrange a fieldwork opportunity in Northeast Thailand, serving as an HIV/ AIDS project coordinator for a non-governmental organization. He participated in a study focusing on the economic, emotional and socialsupport needs of individuals and families affected by the epidemic, which produced findings that were instrumental in developing HIV/AIDS services in the area. Lee has continued to pursue his interest in psychosocial HIV/ AIDS research as a doctoral student working at UCLA’s Center for Community Health under the guidance of Drs. Mary Jane Rotheram-Borus and Roger Detels. “It’s been a very rewarding experience to be able to translate and apply my epidemiologic tools into practice,” Lee says. He is currently helping to develop a series of tutorials to assist HIV/AIDS community-based organizations in Los Angeles in using Microsoft Excel in data construction, management and analysis for the purpose of HIV/AIDS program evaluation.

UCLAPUBLIC HEALTH

Most recently, Morisky and doctoral student James Jacobs have been funded by the UCLA Globalization Research Center-Africa to work with the Uganda Ministry of Health in assessing the knowledge, attitudes, beliefs and practices of students, teachers and administrators in more than 70 high schools. Morisky and Jacobs recently went to Uganda to share the results of their surveys with members of the Ministry of Education and discuss potential ways to revise curricular content based on the findings. “Uganda is one of the world’s success stories with regard to reducing the prevalence of HIV/AIDS – from about 25 percent to 12-15 percent,” Morisky notes. “That’s due to a very concerted effort on the part of the government and non-governmental organizations, early involvement when they saw the epidemic coming, and a proactive educational program in the schools.”

Successful campaigns to turn the tide on the epidemic in Uganda, Thailand and Cambodia are compelling examples of the power of behavioral strategies, says Dr. Pamina Gorbach, an assistant professor of epidemiology at the school who has worked in Cambodia and Vietnam as well as in the United States.

Gorbach’s focus is on the risk behaviors that expose individuals to sexually transmitted infections, including HIV. But unlike many researchers, she analyzes these behaviors in the context of partnerships – seeking to identify factors that make a sexual encounter more likely to be one in which the individuals engage in risky behaviors and a disease is transmitted. “Research that focuses on the individual only tells part of the story,” Gorbach says. “For example, unprotected anal intercourse is considered a high-risk behavior, but what if it’s practiced by men who have been together and monogamous for the past 10-15 years?”

More nuanced relationship dynamics can also play a role in the risk level, Gorbach notes. Among the questions that interest her: Is a casual encounter less likely to include communication about precautions? What effect do drugs such as methamphetamine have on the duration and type of sex and its effect

Dr. Donald Morisky, shown with doctoral student Taigy Thomas, focuses on the social and behavioral determinants of acquiring HIV/AIDS, with active research and intervention programs in the Philippines, Thailand and Uganda.

Undergraduate studies at UC Irvine proved to be an awakening for Thomas.

“Although I noticed the lack of equity in many areas of our society – whether it is access to services, education, or jobs – I hadn’t previously grasped how social injustice affected the health of minority groups,” she says. “The more I heard about the proliferation of HIV rates in communities of color, the more I got interested in health experts’ ability to assist in the management of the disease.”

While pursuing her M.A., Thomas worked as a health educator at UC Irvine, with sexual health as her primary topic of interest. She became a state-certified HIV/AIDS risk assessment counselor and worked in the campus’s HIV clinic, ultimately as the coordinator of HIV testing.

As a doctoral student at the UCLA School of Public Health, where she is developing her HIV research under the guidance of Dr. Donald Morisky, Thomas is also serving as an instructor for an undergraduate “Life Skills” course for women, offered through the Arthur Ashe Student Health & Wellness Center. “I am continually amazed at how components of our identity such as ethnicity, socioeconomic status and gender influence our thoughts, beliefs and behaviors regardless of our knowledge,” Thomas says, “especially as they relate to sexual risk-taking.”

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Taigy Thomas,

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Trista Bingham,

14

M.P.H. ’94, M.S. ’96

Janni Kinsler, M.P.H. ’98, Ph.D. ’02

UCLAPUBLIC HEALTH

Belize currently has the highest HIV prevalence rate in Central America. In the summer of 1997, Kinsler conducted a pilot study assessing HIV/AIDS-related knowledge, attitudes, beliefs and behaviors among Belizean adolescents ages 13-18. Approximately 14 youth-based non-governmental organizations participated.

Based on the results, Kinsler designed, implemented and evaluated a school-based peer education program in Belize City, the nation’s largest urban area. She found that the intervention had a significant impact on condom use, intention to use condoms, and attitudes toward condoms. Still, Kinsler says, “to fully understand the AIDS situation in Belize, one must understand the socio-cultural norms surrounding sexuality and HIV/AIDS in Belize, as well as the relationship between AIDS and the country’s economic and political structures.” With that in mind, she recently submitted a grant to continue her work in Belize with a study that would examine the socio-cultural norms surrounding sexuality and HIV/AIDS; the stigma associated with AIDS, homosexuality and bisexuality; and the role of cultural constructs of machismo and marianismo.

Bingham is chief of the Seroepidemiology Unit at the Los Angeles County Department of Health Services’ HIV Epidemiology Program, serving as principal investigator of five Centers for Disease Control and Prevention-funded studies: “HIV Incidence Study in Commercial Sex Venues,” “Finding and Characterizing Persons with Recent and Newly Diagnosed HIV Infection in Metro and South Los Angeles,” “Context of HIV Infection Project,” “Epidemiologic HIV/AIDS Research in Latino Men Who Have Sex with Men,” and the “National Behavioral Surveillance” study. Through these investigations, Bingham and her team of epidemiologists and field research interviewers collect data to best identify the subpopulations and social, environmental and economic factors contributing to the county’s HIV epidemic.

Among her challenges are to disseminate study findings to local and national audiences while continually seeking funding to support her research team’s work. During her tenure, Bingham and her staff have made important strides in gaining the trust and respect of key stakeholders and spokespersons for communities at risk in Los Angeles. “I get tremendous satisfaction from working closely with the range of community collaborators and the various communities at risk for HIV infection in Los Angeles,” she says.

on disease-transmission risk? What is the impact of Dr. Pamina Gorbach knowing whether one’s partner engages in sex outside (above right, with Peter the relationship? Gorbach has developed population- Kerndt of the L.A. County specific methods to categorize partnerships based on the Department of Health Serlevel of risk. “This research can help us develop inter- vices) studies partnershiplevel HIV risk factors. ventions that work on a partnership level,” she says.

To be sure, prevention strategies are most effecDr. William Cunningham tive when they are developed with an understanding (next page) identifies and seeks to overcome barriof the targeted population. Dr. Susan Cochran, proers to HIV treatment. fessor of epidemiology at the school, and Dr. Vickie Mays, professor of clinical psychology at UCLA, began collaborating in 1987 as one of the first research teams to try to understand the HIV epidemic in gay African American men ages 18-24 – a particularly high-risk group. “The prevention messages are not resonating with this audience,” says Mays, “because too often they’re messages that have been used for the white gay community with an African American poster child put on them. They don’t take into account the lives of the targeted individuals and the difficulties they have in remaining safe.”

It’s important to recognize not just that interventions aimed at African American gay men might need to be different from those aimed at whites, but also that there is a great deal of diversity within the African American gay community, Cochran notes. “Typically, a focus group of 20-30 gay men will have one person who is African American, and he is supposed to represent the entire community,” Cochran says. “We take an African American-centric approach as opposed to that type of comparative approach. When your group is made up predominantly of African Americans, you’re going to have a much deeper discussion and gain a better understanding of the diversity within the community.”

In their studies, Cochran and Mays have looked beyond behaviors to also learn about motivations and social support, including the role and influence of family and friends. “What everyone in the field keeps coming back to is, ‘Tell us more about the population so that we can do a better job at intervention,’ ” explains Mays. “Understanding the dynamics of their lives will pave the way for interventions that get more bang for the buck.”

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Wiwat Peerapatanapokin, M.D. Peerapatanapokin, a medical doctor and computer expert who recently completed the Ph.D. program in the school’s Department of Epidemiology, has worked with Dr. Tim Brown in developing a computer model for the HIV/AIDS epidemic in Asia. “Most models focus on the epidemic in Africa,” he explains. “But we recognized that the epidemic of HIV in Africa and in Asia have different patterns.” The Asian Epidemic Model (AEM) divides people into subpopulations relevant to the epidemic, including injecting drug users, female sex workers, general females, male clients and male non-clients. After further dividing these subpopulations into uninfected and infected groups, Peerapatanapokin developed mathematical equations and computer software to calculate the interaction and movement among these groups.

The program records the number of new infections that occur in each route of transmission and tracks the size of each subpopulation, infected and uninfected, over time. AEM has been successfully applied in Cambodia and Thailand. Among other things, the model projected that without any public health interventions, Thailand would have had approximately 6.5 million instead of 700,000 people living with HIV in the year 2000.

Peerapatanapokin and Brown are continuing to refine the model and produce additional applications.

UCLAPUBLIC HEALTH

But one of the major findings of HCSUS was that patients who were assigned case managers were more likely to receive HAART, as well as to have other health care needs met. Cunningham is now applying that finding, as well as other conclusions drawn from HCSUS, to a community-based intervention study seeking to improve access to care and outcomes for the underserved population reached by a mobile HIV-testing program run since 1993

by Cynthia Davis (M.P.H. ’81), assistant professor at Charles R. Drew University of Medicine and Science.

The program sends two vans to provide free testing, counseling, and a small amount of primary care and supportive services to between 2,000 and 5,000 people each year in South-Central Los Angeles, the Skid Row section of Downtown Los Angeles, Hollywood and West Hollywood.

In the recently completed first phase of the study, Cunningham’s group interviewed people who have been tested HIV-positive by the mobile van program to determine the level of care and services they have received, barriers to optimal care, and their health status. In focus groups, the researchers learned more about the needs of a population that gets its health services on the streets – a high-risk group that includes sex workers, substance abusers, people who are homeless, gang members, undocumented individuals, and a large proportion of minorities and women – and confirmed that case managers could make a difference. Now, in the study’s second phase, Cunningham’s group is implementing “mobile case management.”

“The idea is that a case manager who assesses unmet needs for supportive social services, gives referrals and does follow-up can help ensure that people also get the medical care they need,” Cunningham says. “That’s what we found with HCSUS. But in HCSUS, we were looking at the half of the people with HIV in the United States who are in care. With this study, we’re trying to reach the other half.”

No matter what population they’re attempting to reach, HIV/AIDS researchers recognize that public health strategies are at the forefront of efforts to control and one day eliminate the epidemic.

Says Detels: “Even when you consider the issues of treatment, getting infected people treated in developing countries requires the establishment of an infrastructure to deliver the care, which is public health. And treatment on its own will not make the epidemic go away. We will continue to need prevention strategies.”

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HAART – powerful therapy simultaneously using three classes of drugs – has been shown in clinical trials to have a significant impact. But the results on a population level are more mixed. “HAART came out as a very complicated regimen, involving upwards of 15-20 pills a day, some of which you were supposed to take with meals and some between meals,” Detels notes. The high cost of the therapy has also prevented HAART from making a comparable impact in developing countries, he adds.

Dr. William Cunningham, associate professor of health services at the school, was a co-investigator on the HIV Cost and Services Utilization Study (HCSUS), the first study to examine the care of people with HIV/AIDS in a large, nationally representative sample. Cunningham’s group found that only about half of the study’s HIV/AIDS patients were on HAART, due to factors that included the complicated medication regimen and access barriers such as competing needs for subsistence – a significant portion of patients reported that they didn’t get necessary care because they needed the money for food, clothing and housing.

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Fundamentals for a New Era Public Health and the Threat of Bioterrorism

W ITH

INCREASED

VISIBILITY AND FUNDING FOLLOW ING

9/11,

PUBLIC

HEALTH FACES UNPRECEDENTED OPPORTUNITIES AND EXTRAORDINARY CHALLENGES .

ON

MANY FRONTS , THE SCHOOL IS PLAYING A KEY ROLE .

UCLAPUBLIC HEALTH

September 11, 2001 and its aftermath, raising the Dr. Robert Kim-Farley, a medical epidemiologist with the Centers for Disease Control and Prevention, splits his time between the school’s faculty and the L.A. County Department of Health Services’ Bioterrorism Preparedness Program.

specter of future chemical, radiological or biological attacks, have focused attention on public health like no events in recent memory. “Out of this tragedy has come an enormous opportunity for our field,” says Dr. Linda Rosenstock, dean of the UCLA School of Public Health. “It has led to an appreciation for how vital public health is to us all – that it’s not just for other people who are too poor to afford medical care. We’re seeing increased visibility, increased respect, and increased funding after decades of neglect.”

At the school, the response to the bioterrorism threat is occurring on several dimensions. A number of faculty were already focused on public health preparedness for, and response to, emergencies; others have become newly interested, and related course offerings have expanded. The school is also playing a vital role in

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“We are now driving the system back to the fundamentals of disease detection, reporting, control, laboratory surveillance, and restoring the impact of public health systems that had been otherwise diverted.”

—Dr. Steven Rottman

UCLAPUBLIC HEALTH

Educating the next generation of public health professionals is one of several important roles the school can play in the bioterrorism preparedness effort, Kim-Farley says. Others include in-service training of current health department professionals, and assistance in evaluating state and local health departments’ readiness and plans of action.

The school’s Center for Public Health and Disasters is active on all three fronts, with curriculum now including seven courses offered to UCLA graduate students and to non-full-time students through UCLA Extension; many professionals from public health agencies have enrolled. As an academic Center for Public Health Preparedness – a CDC designation that funds specific schools of public health to collaborate with state and local health departments to prepare for bioterrorism and other public health

emergencies – the center has faculty working with a number of health departments in California and neighboring states, offering training programs to orient rank-and-file public health workers to the threat posed by natural and intentional disasters and how they can best prepare their departments to respond to such emergencies.

“There are obvious differences between preparing for the natural disasters you expect in California – earthquakes, fires, floods – and for biological hazards,” says Dr. Steven Rottman, the center’s director.

“We know natural disasters are going to occur and we recognize them when they do. With bioterrorism, conditions will not necessarily emerge at once, which introduces the element of detection and reporting through central epidemiologic surveillance to track the incidence and significance of the outbreak, its route and possible contacts of infected cases, and how the health departments will respond not only for the people infected but for those who may have been exposed. This is like the evaluation of any other infectious disease outbreak – except that you’re adding the issue of criminality, as well as the fact that these are unusual diseases or odd expressions of previously recognized diseases.” In addition to offering training to local health department workers on these threats, Rottman’s group will assist the California Department of Health Services by conducting training needs assessments for all local health departments to determine the most pressing educational needs.

Another type of assistance comes from Rick Greenwood, director of UCLA’s Office of Environment, Health and Safety and member of the school’s Department of Environmental Health Sciences faculty, who has received CDC funding through the county to set up a system for evaluating equipment used by first responders in potential or real terrorist events. Greenwood is assembling an advisory committee of officials from local police, sheriff, FBI and fire departments to help develop what he likens to a “Consumer Reports” for radiationdetection instruments, field equipment for evaluating substances, respirators, and protective clothing, among other products.

“Most local jurisdictions don’t have the expertise or the resources to evaluate which instruments are best,” Greenwood explains. “The military has used a lot of these things for a long time, but what works in that setting isn’t necessarily best for civilian police forces and fire departments.” Testing will take place both at UCLA, by Greenwood’s team, and in the field by experts from the advisory committee, with

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the community – linked to the public as a provider of information, to first responders through training, and to the county health department charged with disaster preparedness in the school’s backyard.

The link between the school and the L.A. County Department of Health Services in emergency preparedness efforts – already substantial considering that Dr. Jonathan Fielding, a member of the school’s faculty, is the county’s director of public health – was bolstered last year with the arrival of Dr. Robert KimFarley. A medical epidemiologist with the Centers for Disease Control and Prevention who has spent most of his career in the infectious disease field, Kim-Farley is currently splitting his time between the county’s Bioterrorism Preparedness Program and the school, where he is a visiting professor.

In addition to teaching – in 2002-03 he offered a course on preparing for a smallpox or other bioterrorist event, and another on the principles of infectious disease control – Kim-Farley has worked with Rosenstock to bring together faculty with bioterrorismrelated interests. An informal school-wide group, which meets once per quarter, has helped to facilitate new collaborations as well as discussion about developing a more cohesive curriculum in bioterrorism preparedness, potentially to the point of providing special certification for students who complete a track of core courses. “Anyone graduating from a school of public health who is planning to work in a state or local health department needs to have some orientation toward bioterrorism,” Kim-Farley explains. “The idea is to look at the bioterrorismrelated courses that are being offered at the school and make them more seamless from the student’s point of view.”

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reports posted on the Center for Public Health and Disasters Web site (www.ph.ucla.edu/cphdr).

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Alumnus Raymond D. Goodman (M.P.H. ’72), a retired physician, was so moved after attending a November 2002 lecture on bioterrorism by KimFarley that he approached him with an offer to help.

“After listening to that lecture, I realized that if we were ever to have a major disaster – natural or intentional – it could overwhelm the capacity of the established health care systems to meet the multiple needs,” he says. “So I thought, why not get all of the retired doctors and other health professionals, who are still so capable and have a sense of public dedication, and use them as volunteers?”

UCLAPUBLIC HEALTH

Dr. Scott Layne is interested in developing a high-capacity laboratory for rapid genetic fingerprinting of potential bioterrorist agents, such as anthrax.

Kim-Farley introduced him to the executive director of the county’s Bioterrorism Preparedness Program, and the result is the Medical Reserve Corps of Los Angeles County, a plan Goodman conceived to enlist the services of retired health care professionals as volunteer responders in the event they’re needed after a community disaster.

Goodman has been working as an officer without compensation for the Bioterrorism Preparedness Program. Among other things, he has collected names and addresses of more than 6,000 retired physicians and nurses in the county who could serve as potential volunteers. He has assembled a staff of 20 health care professionals who will assist in developing a curriculum and training program for the volunteers, with help from the emergency medical services agency

that trains paramedics in the fire department to respond to regional medical disasters. Goodman expects the initiative to be officially recognized by the U.S. Office of the Surgeon General, at which time the recruitment of volunteers will begin.

At the federal level, Dr. Scott Layne, associate professor of epidemiology, is interested in developing a high-capacity laboratory for rapid genetic fingerprinting of potential bioterrorist agents. “We need a laboratory response as well as traditional education of first responders,” says Layne, who teaches three bioterrorism-related courses at the school. He has developed a proposal for a prototype facility that would be engineered at Los Alamos National Laboratory and installed and operated at UCLA, initially focused on influenza viruses and anthrax, with the ultimate intent to develop a small network of high-capacity laboratories nationwide that would serve public health, law enforcement and national security purposes. The laboratories, which would comprehensively characterize all known strains of the potential agents in a database, would rely on the same high-throughput assay systems currently used by pharmaceutical companies for drug-discovery development.

“From the point of view of science and public health, we need much more comprehensive information on some of these organisms for making better vaccines and therapies,” Layne says. “And we need to be moving more toward real-time surveillance, so that when SARS or a bad influenza strain pops up, we can determine what type of virus it is and answer questions about it very quickly.” Layne notes that his system could be easily duplicated for institutions that could support law enforcement and national security purposes.

“The world is shrinking, and so we need new tools in addition to the traditional tools of public health surveillance, vaccines and drug therapies – tools that will give us the very rapid and comprehensive information we’re going to need to deal with acute problems,” Layne says.

Confusing and sometimes conflicting messages following the anthrax outbreak in late 2001 led the federal government to enlist the assistance of faculty at UCLA and three other schools of public health.

Dr. Deborah Glik and colleagues at the school’s Health and Media Research Group are working with Center for Public Health and Disasters faculty on a CDC effort to develop and pre-test messages to be disseminated before, during and after terrorist attacks.

In collaboration with schools of public health in three other states, the UCLA researchers are identifying what the public needs to know and conducting focus groups to determine what the public wants to know in the event of various scenarios. “The CDC would like to use this information to create available materials so that information isn’t delivered in an off-the-

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cuff manner,” Glik explains. “Clearly, there is going to be adaptation depending on the nature of the event, but it is helpful to have general messages worked out in advance that can be distributed to health departments so that the information delivered is consistent, clear and concrete.”

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In addition to assisting public health officials in developing messages to be used in the event of an attack, the school plays an important role in communicating directly with the community about real and perceived threats. “As independent observers and experts, we have a position of trust that we should use to describe the reality of the risks and put things into perspective, particularly when communication from the government is not clear and, in some cases, is not trusted,” says Rosenstock.

In fact, Rosenstock is concerned that the national focus on bioterrorism preparedness, while shining the spotlight on public health, has the potential to distract attention from important everyday public health issues, such as chronic disease prevention and the quality of air, water and food. Rosenstock and many of her colleagues in public health and medicine have also been wary of the federal government’s smallpox vaccine policy, concerned that public health principles were being abandoned by launching a campaign without open discussion of the threat of exposure vs. the risk posed by the vaccine.

On the other hand, Rosenstock notes, there are tremendous advantages when preparing for bioterrorist events also helps to beef up traditional public health surveillance and response systems. Kim-Farley agrees. “Those of us in public health who are working in the bioterrorism area recognize that many disease surveillance systems in the United States have eroded and that if we are going to invest in bioterrorism surveillance, let’s make sure that the system we put in place also strengthens our capability of dealing with natural disease outbreaks,” he says.

Adds Rottman: “Over the past few decades, the concentration in the field of public health has been away from infectious disease and outbreak investigation, due to strong immunization programs and powerful antibiotics. The emphasis shifted toward other areas of public well being, and as a consequence, public health laboratories were under-funded and had become less sophisticated, and there had been less emphasis on communicable disease reporting. We are now driving the system back to the fundamentals of disease detection, reporting, control, laboratory surveillance, and restoring the impact of public health systems that had been otherwise diverted.”

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“I thought, why not get all of the retired doctors who are still so capable and have a sense of public dedication, and use them as volunteers?”

—Dr. Raymond D. Goodman, M.P.H. ’72

Dr. Deborah Glik, (back row, third from the right) is part of a CDC effort to develop and, through focus groups such as this one, pre-test messages to be disseminated before, during and after terrorist attacks.

UCLAPUBLIC HEALTH

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alumni hall of fame: the 2003 inductees FOR PROFESSIONAL ACHIEVEMENT

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 2003 inductees, recognized at the Breslow Lecture and Dinner on March 10, represent an outstanding group of individuals who exemplify the school’s commitment to teaching, research and service.

Honorees are inducted into one of two categories: Community Service or Professional

UCLAPUBLIC HEALTH

Achievement.

HAROLD M. GOLDSTEIN, M.S.P.H. ’89, Dr.P.H. ’97 In his position as executive director of the California Center for Public Health Advocacy, Goldstein leads the effort to raise awareness about public health issues and mobilize communities to establish effective health policies. An outspoken advocate for improving children’s nutrition and physical activity through schools, he has been instrumental in winning passage of tough new nutritional standards for all foods sold on elementary school campuses in California. More recently, he helped to win support from the Los Angeles County Board of Education for a ban on soda sales in the Los Angeles Unified School District, the second-largest district in the nation. These efforts have spurred advocates in school districts across the country to challenge entrenched school officials and food industry giants to help create healthier school environments for children.

Goldstein’s commitment to community empowerment, grassroots organizing, and savvy social marketing is fortified by an appreciation for the power of the right kind of public health data placed in the hands of decision makers, resulting in effective public health reforms for the benefit of all.

RICHARD A. GOODMAN, M.D., J.D., M.P.H. ’83 Goodman has successfully combined medicine, law and public health. In his current position as director for law and science of the Centers for Disease Control’s Public Health Law Program, he strengthens public health practice through better understanding and use of public health law.

Goodman’s office assists states in reviewing their public health emergency legal powers, develops training in effective use of public health emergency powers, and initiates national training in the practical use of public health laws for public health purposes.

After beginning his career as an Epidemiologic Intelligence Service officer with CDC’s Immunization Division, Goodman served as medical epidemiologist to the State of Georgia, acting chief of the Epidemiologic Studies Branch of CDC’s Epidemiology Program Office, director of CDC’s Office of Scientific and Health Communications, and editor in chief of CDC’s premier public health publication, Morbidity and

Mortality Weekly Report. He has taught epidemiology at UCLA and continues to draw on his experiences to link CDC’s public health sciences to educational efforts in middle- and high school classrooms.

PAULINE M. VAILLANCOURT ROSENAU, Ph.D., M.P.H. ’92 A leader among academics in public health, Rosenau applies her skills in political science and public health to the analysis of cutting-edge health policy issues.

As professor of management and policy sciences at the University of Texas School of Public Health, she focuses her scholarship on the comparative study of health policy, health systems organization, and health system reform in industrialized countries.

Although she turned her attentions from political science to public health in mid-career, Rosenau has already published extensively on U.S. health policy and health system reform. Her new book, The Competition Paradigm: America’s Romance with Conflict, Contest, and Commerce, discusses destructive forms of competition as a public health problem. Rosenau was editor of two other recent books on the national dialogue about competition in health care, Public/Private Policy Partnerships and Health Care Reform in the Nineties, which was awarded Choice Magazine’s “Outstanding Academic Book” award for 1994.

STEPHEN M. SHORTELL, M.P.H. ’68, Ph.D. One of the nation’s preeminent scholars in health policy and organizational behavior, Shortell has built a distinguished career examining the strategy, structure and performance of health care systems and their relationships to quality of care, health care outcomes, and physician-organizational interactions. The Blue Cross of California Distinguished Professor of Health Policy and Management at UC Berkeley holds a joint appointment at the Haas School of Business and the UC Berkeley School of Public Health, where he also serves as dean.

Shortell has received extensive recognition for his scholarship, including the Baxter-Allegiance Prize, considered the highest honor worldwide in the field of health services research. He has also been awarded the Distinguished Investigator Award from the Association for Health Services Research and the Gold Medal Award from the American College of Healthcare Executives. He is an elected member of

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KEITH S. RICHMAN, M.D., M.P.H. ’83 As a physician he was committed to patient care; as a politician he is committed to improving public health for the benefit of all Californians. In the California Assembly, Richman has taken his medical training, public health education, and clinical experience directly to the policy arena. He has championed legislation on health care; health insurance for the state’s 7 million uninsured; Medi-Cal asset test, enrollment and income verification reforms; workers’ compensation; bioterrorism; and disaster preparedness. His energy, dedication and bipartisan approach were recognized last year when he was named Rookie of the Year by the California Journal.

Prior to his election to the California Assembly, Richman was a founding member of the Keystone Health and North Valley Independent Practice Association, which later merged with Lakeside HealthCare, Inc., to become the San Fernando Valley’s predominant managed health care organization. Despite the demands of his profession, he still finds time for community service with the American Diabetes Association’s San Fernando Valley Chapter and the Valley Community Clinic.

MARK GOLD, D.Env. ’94 As executive director of the environmental action group Heal the Bay, Gold has been a leading advocate for enhancing and maintaining the environmental quality of the Santa Monica Bay and Southern California’s coastal waters. He has led the fight to win passage of new legislation to reduce the flow of polluted runoff into California’s coastal waters and beaches, contributed to the establishment of new state and national standards for water quality, and successfully fought to ensure that local, state, and federal agencies enforce and comply with existing environmental laws.

Combining his scientific background with a problem-solving approach, Gold has had a major impact on environmental policy. His research on pathogens and pathogen indicators in urban runoff and the health risks to swimmers in runoff-contaminated waters led to California adopting the nation’s toughest beach water quality standards and creating and funding the $78 million Clean Beach Initiative to help clean up the state’s most polluted beaches.

Thanks to the efforts of Gold’s organization, Santa Monica Bay water quality and marine ecology have improved dramatically.

NANCY HALPERN IBRAHIM, M.P.H. ’93 Ibrahim brings advocacy, compassion, determination and dedication to the largely immigrant community she serves in downtown Los Angeles. As a founding member and director of community health programs for the Esperanza Community Housing Corporation in Los Angeles, Ibrahim has helped to expand the organization’s initial focus on housing for the poor to also encompass health education and public health outreach for the downtown community.

She developed and directs the organization’s nationally recognized Community Health Promoters Program, an innovative effort that gives community residents technical skills and training to become effective public health and community outreach workers.

Prior to her work in Los Angeles, Ibrahim spent time in the West Bank in both Jerusalem and Bir Zeit, helping to coordinate community health worker training, organize mobile health campaigns, and implement maternal and child nutrition education programs. Her efforts on behalf of the socially disenfranchised serve as a powerful example of the difference a dedicated social activist can make in bettering the lives of those around her.

2004 ALUMNI HALL OF FAME CALL FOR NOMINATIONS Please access nomination forms at www.ph.ucla.edu.

If you have questions about the nomination process or would like forms mailed to you, please contact the Office of Development and Alumni Relations for the School of Public Health at 310-825-6464 or by e-mail at publichealth@support. ucla.edu.

UCLAPUBLIC HEALTH

SHIING-JER TWU, M.D., M.P.H., Ph.D. ’91 Known as the “anti-AIDS warrior” to the local media in his native Taiwan, Twu has played an outspoken leadership role in improving his nation’s ability to prevent and control disease. He rose rapidly through the ranks of Taiwan’s governmental health infrastructure, from director of Taipei City’s Department of Health and director-general of Taiwan’s Center for Disease Control to his most recent position as minister of health, the top public health official.

Throughout his career, Twu has championed not only the country’s traditional public health problems such as hepatitis, enteric disease, osteoporosis, occupational disease and injury, but also the much more sensitive issues of AIDS prevention and control. His efforts have resulted in the creation of the first outpatient service to AIDS patients at the Venereal Disease Control Center, the establishment of AIDSrelated courses at National Taiwan University, and the founding of Taiwan’s first AIDS organization, the Light of Friendship AIDS Control Association.

FOR COMMUNITY SERVICE

hall of fame

the prestigious Institute of Medicine of the National Academy of Sciences, where he has served on the governing council.

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research highlights Smallest Airborne Pollutants Can Cause Severe Damage to Human Lung Cells, Adversely Affecting Function

UFP-treated

M Mag. x8,500

MM

M M

Mag. x8,500

UCLAPUBLIC HEALTH

Electron micrographs demonstrating mitochondrial destruction in BEAS-2B cells treated with 8.4 µ g/ml of ultrafine particles for 16 hours.

Notice the disappearance of cristae, formation of myelin figures (MF), and presence of particles (P) inside the mitochondria (M).

BEAS-2B cells

Untreated

Ultrafine Particles Lodge Inside Lung Cells and Damage the Mitochondria

ULTRAFINE PARTICULATES – the smallest airborne pollutants produced by automobile and diesel truck exhaust – can inflict severe damage to human lung cells, adversely affecting their function, according to findings reported by UCLA and USC researchers in the April edition of Environmental Health Perspectives.

The tiny particles are far more potent than the fine and coarse particulate matter currently targeted by regulators when it comes to inducing oxidative stress, according to a study by UFP-treated researchers at the Southern California Particle Center and Supersite, based in the UCLA School

P of Public Health and Institute of the Environment.

M Previous epidemiological studies have shown M an association between ambient air particulates M from automobile exhaust and adverse health outMF comes, including lung dysfunction, cardiovascular effects, allergic disorders and cancer. But those studies have focused on particulates that measure Mag. x26,300 less than 2.5 microns, the size range currently regulated by the U.S. Environmental Protection Agency. The new results are among the first to show a direct link between ultrafine particulates – those smaller than 0.1 micrometers – and destruction of a specific entity in a human cell.

Through laboratory analyses, the researchers found that ultrafine particulates not only lodge deep inside the lungs, but also penetrate the mitochondria, the human cell’s power source, and remain there indefinitely – ultimately causing severe structural damage that affects cellular function. How the tiny particles gain access to the mitochondria and induce damage is not clear and needs to be investigated in future studies, the researchers note. In addition, more research is needed to establish a link between the cell damage observed by this study and the adverse health effects found previously.

The study also reports that ultrafine particles have the ability to catalyze the production of reactive oxygen species capable of damaging proteins and DNA within cells.

“The results of this study are consistent with data from animal and human clinical studies and human epidemiology developed by our center which demonstrate that exposure to airborne particulate matter, especially fine and ultrafine particulates, is capable of producing adverse respiratory and cardiovascular effects,” says Dr. John Froines, director of the Southern California Particle Center and Supersite, professor at the school, and a co-author of the study. In addition, Froines notes, there is developing evidence for reproductive and neurological toxicity from mobile-source pollution, such as from cars and trucks.

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research

California’s HMO Population More Diverse Than Believed; Plans Face Many Challenges in Meeting Members’ Needs

Percentage of HMO Members with Limited English Proficiency,

by Region

2%

3%

4%

5%

6%

7%

Notes: Limited language proficiency defined as HMO members who report that they speak English “not well” or “not at all.”Ventura County has too few observations to report.

UCLAPUBLIC HEALTH

CALIFORNIA’S 17.7 MILLION CHILDREN AND ADULTS who are enrolled in HMO plans are a more diverse group than previously believed, according to a UCLA Center for Health Policy Research report.

The study, funded by the California Office of the Patient Advocate, is the first detailed population-based profile of the state’s HMO population. It found that the citizenship status, language fluency, level of education and ethnicity of HMO enrollees across the state vary widely, posing significant challenges for HMOs in Los Angeles providing quality services to all of their San Francisco members. Because of this diversity, HMOs Santa Clara face major challenges in communicating Orange with members regarding health plan beneCentral rural fits, policies, and procedures, according to Statewide the report, which noted that these challenges are greatest in Los Angeles, San Southern rural Francisco, Santa Clara and Orange counSanta Cruz ties (see the accompanying graph).

Oakland “This study is of critical importance to Riverside the large number of Californians enrolled in Sonoma HMOs when demanding member services Napa and materials responsive to their diverse San Diego needs,” says Dr. Gerald F. Kominski, professor and associate dean for academic affairs Sacramento at the school, associate director of the Northern rural Center for Health Policy Research, and the Ventura study’s principal author. “HMOs can also benefit from these findings as they strive to 1% 0% provide appropriate services and materials to all of their members, a major challenge as suggested by these data.”

The report, titled “Profile of California’s HMO Enrollees: Findings from the 2001 California Health Interview Survey,” presents HMO enrollee profiles for the entire state and for each of 15 geographic regions. A wide range of socioeconomic characteristics were examined, among them citizenship status, language spoken at home, English proficiency, educational attainment, income and employment, age, and race and ethnicity.

Among the key findings about HMO enrollees statewide: • Twenty-seven percent are immigrants, including 15% who are naturalized citizens and 12% who are noncitizens.

• Thirty-four percent communicate at home in a language other than English or solely in another language.

• Thirty-five percent of adults ages 18-64 and 45% of adults ages 65 and over have a high school education or less.

• Forty-one percent are nonwhite, including 19% Latino, 12% Asian American and Pacific Islander, and 7% African American.

The full report is available online at www.healthpolicy.ucla.edu.

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Nearly Half of State’s Adults Know a Friend, Relative or Coworker Who Has Been Domestic Violence Victim

24

Personal Knowledge of Domestic Violence, California 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Know victim of domestic violence

Knew while abuse was happening

Victim is 1 of 3 closest friends or relatives

NEARLY 11 MILLION ADULT CALIFORNIANS — 46% of the state’s adult population — personally know a victim of domestic violence, according to a UCLA School of Public Health study headed by Dr. Susan B. Sorenson and published in the Journal of the American Medical Women’s Association. The first peerreviewed study to examine the extent to which people in this country know victims of domestic violence also found that while women are more likely to know a victim than men and more likely to have specific information about the violence, there are few distinctions across ethnic, educational, and geographic groups.

“An often overlooked resource in domestic-violence intervention and prevention efforts is the victim’s social support network of friends, relatives and coworkers,” says Sorenson. “Those individuals may be powerful allies in helping — or hindering — victims of domestic violence.”

The study asked 3,713 California adults whether a friend, relative or co-worker had been threatened or harmed by an intimate partner.

Unlike previous surveys on domestic violence, which have mostly focused on personal experience, Sorenson’s study provides a window into whether victims talk with others about the abuse.

“Given that nearly half of Californians know someone close to them who has been a victim of domestic violence, the answer is yes,” Sorenson says. “This also tells us that Californians, particularly women, already know about the problem.

Our legislators are mostly men, and their efforts to increase awareness of domestic violence might reflect their own experience, or that of Victim Victim other men they talk to. But this suggests that incurred left physical relationship rather than educational campaigns, we need harm action. If half of the people in California knew somebody who had a certain disease, we would not say, ‘Let’s increase the awareness about the disease.’ We need to prevent domestic violence from occurring.”

Sorenson believes the findings also suggest the importance of health care providers encouraging victims to identify and use their social networks for safety and emotional support. “Such efforts can increase the level of support and options available to domestic-violence victims, as well as increasing community awareness, involvement and investment in reducing domestic violence,” she says. “This may eventually lead to changes in social norms within a community — namely, less tolerance for domestic violence and less consideration of the practice as a private family matter.”

UCLAPUBLIC HEALTH

Addressing Cause-and-Effect Issues in Treatment Results ONE OF THE MAJOR CHALLENGES facing biostatisticians in analyzing data from medical treatment studies is how to determine the true causal relationship between treatment and some health outcome of interest, particularly when there are so-called confounders – variables related to the treatment and outcome that, if not accounted for, can lead to a misrepresentation of the causal nature of the relationship. A study finding an association between carrying matches and developing lung cancer, for example, would clearly be misguided to conclude that there is a causal relationship without considering the obvious confounder, smoking – the reason that most people would carry matches.

Not all cases are so clear. And, while randomized controlled clinical trials are designed to ensure that comparison groups don’t differ in any way that would

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influence the outcome beyond the treatment, the growing use of data stored by hospitals and other health care organizations means that analyses are often taking place outside the clinical trials environment, presenting more opportunities for confounders to cloud the waters.

“We have this wealth of data that isn’t necessarily being collected within the classical clinical trials parameters,” says Dr. Tanya Henneman, a postdoctoral researcher at the UCLA School of Public Health. “This provides a great opportunity to observe how treatment is being given in a naturalistic setting and how people are responding, but because treatment assignment isn’t randomized, if you want to use data from these sources you have to deal with the issue of confounders. When it is thought that the treated group differs systematically from the non-treated group in ways that confound the comparison, the challenge to statisticians becomes identifying the actual causal relationship between treatment and outcome.”

Henneman is among those who have been addressing this problem in explicit terms in the emerging sub-field known as causal inference. She has explored how methods evaluating treatment effect using data from observational studies can be improved. To account for unmeasured confounders, Henneman has applied concepts originally used by economists. “Sometimes you have situations where you know there are confounders and you have access to them in your data set, but other times you know they’re there and don’t have the data on them,” she explains. “We’re trying to find ways we can implement these ideas from econometrics in our own statistical analyses so that we can make use of existing data in ways we haven’t been able to before.”

25

research

Study Fuels U.S. Navy Effort to Restore Coastal Wetland Using Sewage Sludge

The beginning of construction that incorporates sewage sludge into the restoration of Mugu Lagoon in Ventura County, Calif., and the restored wetland at the beginning of its “life.”

UCLAPUBLIC HEALTH

SEWAGE SLUDGE IS AN UNLIKELY ALLY to the cause of cleaning up California’s coastal wetlands. But recently completed research by a UCLA School of Public Health environmental biologist and colleagues on the use of the sludge in restoring a coastal wetland is fueling an ambitious U.S. Navy-led effort to return the Mugu Lagoon to its original salt marsh condition.

In collaboration with experts from UCLA, including Dr. Richard Ambrose, professor at the School of Public Health and director of the Environmental Science and Engineering Program, the Navy has begun work on what it hopes will be one of the most successful salt marsh restoration projects in the country – an effort that would produce revenue savings in the process.

The project, located at Point Mugu in Ventura County, Calif., dates to 1995, when the Los Angeles Regional Water Quality Control Board required the Navy to remove 56,000 tons of sludge that had accumulated in sewage oxidation ponds. The board was concerned about groundwater contamination from the metals contained in the sludge. In the year that followed, the Navy worked with the board, the U.S. Environmental Protection Agency, and others to determine the best clean-up method.

The long-term strategy of using the sludge to restore the salt marsh was developed as an alternative to digging and hauling the sewage sludge off site for disposal, which would have cost up to $15 million. “The current strategy has the dual benefit of significant cost savings as well as restoring the ponds to their original salt marsh wetland condition,” Ambrose explains.

Researchers had to be careful, however, that the metals in the sludge did not harm the environment.

To ensure the environment was protected, the researchers employed a phased experimental approach, called adaptive management. The recently completed phase involved a 2.5-acre test of several different mixtures of sludge, soils and plant types to determine the optimum combination. Several years of sam-

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pling and analyses have confirmed the proper site restoration requirements, Ambrose says. In the second phase, constructed last year, a 9-acre plot was restored, using heavy equipment to mix sludge and the underlying clay soil, and creating contours to maximize tidal flow and plant growth. That work has been monitored to ensure the restoration is effective, both in terms of wetland creation and in making sure no metals are leaching off site. If the second phase shows that the restoration is safe for the environment, the final phase of the project will restore the remaining 19.5 acres.

“California has lost 91% of its original wetlands,” Ambrose notes. “When the Mugu restoration is completed, it will provide essential habitat for a variety of plants, fish and birds, including several endangered species. This also demonstrates how innovative approaches to environmental problems can lead to winwin solutions, improving the natural environment while saving taxpayers millions of dollars.”

“Food-Insecure” Adults in State: More than 2.2 Million

45% 40% 35% 30% 25% 20% 15% 10% 5%

UCLAPUBLIC HEALTH

0%

MORE THAN 2.24 MILLION LOW-INCOME ADULTS in California can’t always afford to put food on the table, and as a result, one in three of these adults experiences episodes of hunger, according to a UCLA School of Public Health team, whose findings were based on data from the California Health Interview Survey (CHIS 2001).

The ranks of “food-insecure” Californians include not just the most impoverished individuals, but also working adults, retired older persons with fixed incomes, and many parents with children, reports Dr. Gail G. Harrison, professor at the school, associate director of the UCLA Center for Human Nutrition and lead author of the study. “This is a sad reality in a state that has the largest agriPrevalence of Food Insecurity cultural economy in the United States and produces abundant high-quality fruits (with and Without Hunger) Among and vegetables for much of the nation,” Harrison says.

Vulnerable Adult Groups, Below The study found that more than 8% of low200% Poverty, California, 2001 income California adults – defined as those in households with incomes below 200% of the fedFOOD INSECURE WITH HUNGER eral poverty level, or below $36,200 for a family of FOOD INSECURE WITHOUT HUNGER four – experience food insecurity with hunger, while another 20% experience food insecurity that falls short of hunger. With or without hunger, food insecurity – lack of assured access to enough food through socially acceptable means – causes 25.1 28.3 families to forego such basic needs as rent, utili28.5 ties, and medical care in order to put food on the 22.2 table, and is a threat to health, the study authors note.

10.8 14.1 To better address the problem, Harrison rec13.6 7.3 7.3 ommends that hunger and food insecurity be rou3.6 tinely included as basic health indicators in all Older Pregnant Single Unemployed Undocumented health surveillance surveys in California; that adults adults women adults with adults (Age 65+) (Ages 18-44) children looking for enrollment procedures be streamlined and appliwork cation processes simplified to increase participation in federal food programs; and that legislators invest in outreach for the Food Stamp and Women, Infants, and Children (WIC) Special Supplemental Nutrition programs, whose target populations are the groups with the highest prevalence of food insecurity and hunger. A longer-term solution would include improved wages and adequate cash assistance programs for seniors, the disabled, and the unemployed and underemployed.

CHIS 2001, the largest health survey ever conducted in any state and among the largest in the nation covering a broad range of public health concerns, is a collaborative project of the UCLA Center for Health Policy Research, the California Department of Health Services and the Public Health Institute.

More information on CHIS 2001 and the food insecurity study can be found at www.healthpolicy.ucla.edu.

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2002-03 student awards Celia & Joseph Blann Fellowship Susan Alber Biostatistics

Fred H. Bixby Doctoral Fellowships in Community Health Sciences Allison Buttenheim Chi Chiao Yasamin Kusunoki Anita Yuan

Chancellor’s Fellowship Ning An Epidemiology Amy Carroll Community Health Sciences Hua Guo Biostatistics

California Endowment Scholarships Marcelo Divine Health Services Tommie Gaines Biostatistics Gabriel Garcia Community Health Sciences Carla Howard Health Services Kynna Wright Community Health Sciences

Dissertation Year Fellowship Roberto De Vogli Community Health Sciences Yunda Huang Biostatistics Sung-Jae Lee Epidemiology Victoria Ojeda Community Health Sciences Craig Shuman Environmental Science and Engineering Irene Tetreault Environmental Health Sciences Yifang Zhu Environmental Health Sciences

California Wellness Foundation Scholarships Jabar Akbar Epidemiology Autumn DeVore Epidemiology Marisol Lopez Biostatistics Rita Velikina Epidemiology

L.S. Goerke Memorial Award Na He Epidemiology Raymond Goodman Scholarship Audrey Fisher Health Services Julia Prentice Community Health Sciences Graduate Opportunity Fellowship Program Norma Sanchez Community Health Sciences Health Policy and Management Alumni Association Scholarship Jessica Louie Gorden Hein Memorial Award Christian Shinaberger Epidemiology Dr. Ursula Mandel Scholarship Constance Gewa Community Health Sciences Hsin-Ju Hsieh Biostatistics Soon Huh Health Services

NIH AIDS Training Grant in Biostatistics Tyson Rogers Myungshin Sim Yun Chon Li-Jung Liang

Ruth F. Richards Outstanding Student Award Amanda Babcock Community Health Sciences Anne Marie Cruz Health Services Jose Matud Biostatistics Matthew Redelings Epidemiology Weiguang Zhong Environmental Health Sciences

NIH Genomic Anaylsis & Interpretation Fellowship Sonia Minassian Biostatistics

Roemer Fellowship for Dr.P.H. Studies in Health Services Randal Henry

Tony Norton Memorial Fellowship Samantha Yaussy Chua Environmental Health Sciences

Charles F. Scott Fellowship Sue Dao Health Services

Maternal & Child Health Program in Community Health Sciences Christine Park Caroline Salinas Raphael Travis Lisa Thompson

Ann G. Quealy Memorial Fellowship in Health Services Osvaldo Martinez Vesna Grubic Research Mentorship Program Hector Lemus Biostatistics Taigy Thomas Community Health Sciences

The Centers for Disease Control and Prevention (CDC) selected UCLA School of Public Health student RAPHAEL TRAVIS as one of four Prevention Research Centers fellows for 2003.

Travis will work with the UCLA/RAND Center for Adolescent Health Promotion, where he will analyze whether community-based youth programs in Carson, Calif., support positive youth development. The Prevention Research Centers Program engages communities as participants in research by sending academics who build relationships with communities that help define research questions and conduct research and interventions. The fellowship program, now in its second year, is sponsored by CDC and the Association of Schools of Public Health for students of minority racial or ethnic origin.

Wayne SooHoo Fellowship Tu-Uyen Nguyen Community Health Sciences Samuel J. Tibbitts Fellowship Jun Wu Environmental Health Sciences

UCLAPUBLIC HEALTH

NINA ADATIA was presented first prize in the essay contest of the Professional Schools Seminar Program for “Tobacco Advertising and the First Amendment,” written for UCLA School of Public Health faculty member Ruth Roemer’s course “Public Health Law and Policy: Private Rights and Social Responsibility.” Adatia received her award at a luncheon held at the UCLA Faculty Center in May. The Professional Schools Seminar Program enables freshman and sophomore undergraduate students at UCLA to investigate various professions through lower-division seminars taught by distinguished faculty from UCLA’s professional schools. Roemer’s course examines legal and policy issues affecting the U.S. health care system.

Foley & Lardner Fellowship Osvaldo Martinez Health Services Emma Wollschlager Health Services

students

Abdelmonem A. Afifi Fellowship Kristin Yarris Community Health Sciences

27

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student profiles Spreading the Word on Epidemiologic Research

“People would be surprised at how little many individuals in communities of color know about health disparities and how they fit into the picture.”

UCLAPUBLIC HEALTH

—Jabar Akbar

JABAR AKBAR LOVES RESEARCH, considers himself a “people person,” and is dedicated to promoting health in underserved minority communities. After exploring several career options in search of one in which he could use skills in both science and communication to address critical health needs among people of color, he settled on one he considers ideal. The first-year UCLA School of Public Health student is now on a path to a Ph.D. in epidemiology, with plans to remain in academia as an epidemiologist focusing on community-based public health nutrition – particularly the role of diet in cancer.

The choice crystallized for Akbar after his father suffered a fatal heart attack in 2001. “On my dad’s side of the family, most of the men do not live past the age of 60,” says Akbar, who is African American.

“Heart disease, diabetes, hypertension and physical inactivity are all particular problems in the black community.” By that time, Akbar had received his M.P.H from the University of Michigan and was working as a research assistant at the University of North Carolina, helping to implement a pilot study of the role of diet in prostate cancer among African Americans. “I made a pact with myself after my father passed away that I would pursue a Ph.D. at UCLA, and that my research would address health disparities among certain ethnic and racial minority groups,” he says.

He entered the school’s M.S. program and already has become involved in community-based work. Akbar has served as coordinator of an initiative by the Diabetic Amputation Prevention Foundation to collect health-risk data among attendees of the annual Los Angeles African Marketplace and Cultural Faire. He designed, implemented and analyzed results of a cross-sectional survey that garnered 1,147 responses – three-fourths of them from self-identified African Americans – at last year’s fair, and will follow up at this year’s event in an effort to obtain more comprehensive data on risk factors in the community.

Through this and future epidemiologic studies, Akbar hopes not only to provide important health-related data on underserved communities, but also to assist the affected communities in understanding and disseminating the results and in developing programs designed to reduce such risk factors. “In the past, too many researchers have gone into communities of color, collected their results and left, never to be heard from again,” he says. “What is much more needed, and respectful, is for researchers to share their results.” Akbar notes that there are many ways to do that – at town halls, in meetings with community leaders and politicians, and through articles or service announcements in the local media, to name a few. He sees a role for himself as a liaison between academia and the community, helping to translate epidemiologic research so that it can be better put to use.

“People would be surprised at how little many individuals in communities of color know about health disparities and how they fit into the picture – how their current lifestyles are setting them up for a higher risk of developing chronic disease,” Akbar says. “We need as many individuals from different backgrounds to pursue careers as public health professionals as possible – people who will return to their communities to make a difference.”

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“So many people have trouble understanding the technology and science coming at them at a very fast pace. A powerful medium like film can contribute to bridging that gap.”

—Terry Young

UCLAPUBLIC HEALTH

TERRY YOUNG SUSPECTS THAT IF SOMEONE HAD TOLD HER, at age 16, that she would eventually pursue a master’s degree in a scientific field, she would have had a simple response: “You’ve got to be kidding.”

At that time she was part of a dance company performing at the Dorothy Chandler Pavilion. She would go on to explore other artistic passions, earning a Bachelor of Fine Arts degree in photography and ceramics from Mount St. Mary’s College before attending the Art Center College of Design in Pasadena, Calif., to study photography and film, with a special concentration in documentary filmmaking. For more than a decade she worked with her grandfather, a photographer who owned a documentary film company. “I really like the medium,” Young says. “I think as an education tool it’s very powerful.”

That thinking, combined with a concern about environmental issues, has driven Young as she went through an undergraduate program in biological sciences at Wright State University and then enrolled in the UCLA School of Public Health’s M.S. program, where she is completing her second year in the Department of Environmental Health Sciences.

With her M.S. education, Young intends to produce documentary films as a way to de-mystify difficult biological concepts and ecological hot topics for the general public. “The problem is that not all of the information is on the table,” she says. “I find that the Environmental Protection Agency has one perspective, the Army Corps of Engineers has another, scientists have another, environmental groups still another, and the general population, which outnumbers all of them, has an entirely different perspective. It would be nice to clarify the issues and get everyone on the same page.”

Her film credits include “The Crisis at the Salton Sea,” an educational video short that Young produced, photographed and edited for the Pacific Wildlife Project, an environmental rescue organization. For the video, she ventured into the Salton Sea in a kayak during a period of heavy fish and bird die-off. She also edited an updated version of Sheila Laffey’s awardwinning documentary “The Last Stand,” detailing efforts to preserve the Ballona wetlands.

While pursuing her M.S., Young has engrossed herself in her current film project, “Ya Don’t Miss the Water,” a video documentary on the problems of water in Los Angeles in which she uses the San Gabriel River basin as a model for water-strapped communities with high-population pressures. Young, who has shot more than 40 hours of interviews and footage, says the point of view emerged during the filmmaking process. She prefers it that way – keeping her own biases to herself. “If you shoot enough and you open it up to as many people as are willing to talk to you, issues start sticking out like sore thumbs,” she explains.

For a right-brained person, the scientific aspect of the M.S. program has been “very hard,” Young concedes, laughing. But she is convinced it will help her make a more powerful impact through her art. “There are so many people who have trouble understanding the world around them with all of the technology and science that seems to be coming at them at a very fast pace,” she says. “A powerful medium like film can contribute to bridging that gap.”

students

Filmmaker Uses Art to ‘De-Mystify’ Ecological Hot Topics; SPH Education Informs Environmental Documentaries

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honors DR. LESTER BRESLOW was honored by the UC Berkeley School of Public Health as a Public Health Hero. The annual awards program recognizes individuals and organizations for their outstanding achievements in the advancement of public health and health care.

DR. JOHN FROINES received the Center for Community Action and Environmental Justice’s Zweig Community Health Advocate Award in recognition of his commitment to improving the health and well being of people living in Southern California.

DR. PATRICIA GANZ was selected as a member of the National Cancer Institute’s Board of Scientific Counselors.

DR. DIANA HILBERMAN is chair-elect of the Association of University Programs in Health Administration. She has also been named a member of the ACEHSA/NCHL Blue Ribbon Task Force on Accreditation, a joint effort of the Accrediting Commission on Education in Health Services Administration and the National Center for Healthcare Leadership.

DR. JOANNE LESLIE was elected to the board of Freedom from Hunger.

DR. DONALD MORISKY was selected as a fellow of the American Academy of Health Behavior, a society of distinguished researchers and scholars in the areas of health behavior, health education, and health promotion.

DR. LINDA ROSENSTOCK received the Woodrow Wilson Award for Distinguished Government Service from the Johns Hopkins University.

DR. JANE VALENTINE has been elected president of the American Water Resources Organization.

UCLAPUBLIC HEALTH

DRS. ARTHUR WINER and LOUIS IGNARRO have been identified as being among the most highly cited scientists in the environmental field by ISIHighlyCited.com, a Web site featuring influential scholars in science and technology.

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

Everything You Never Wanted Your Kids to Know About Sex, but Were Afraid They’d Ask,

by Justin Richardson and Mark A. Schuster. Crown Pub. With confidence, wisdom and humor, the authors offer practical and often surprising answers to questions that bedevil parents at every stage in their children’s coming-of-age.

Oxford Textbook of Public Health, 4th Edition, edited by Roger Detels, James McEwen, Robert Beaglehole, and Heizo Tanaka. Oxford University Press.

The first three volumes provide a comprehensive review of the field, focusing on the scope, methods, and practice of public health, respectively. The fourth edition updates the many changes that have occurred since the third edition was published, expands to include issues of developing countries and presents the perspectives of public leaders on strategies to resolve existing and anticipated public health problems.

Prevention Effectiveness: a Guide to Decision Analysis and Economic Evaluation, 2nd Edition, edited by Anne C. Haddix, Steven M. Teutsch, Phaedra A. Shaffer and Diane O. Dunet, with contributing authors including the UCLA School of Public Health’s Jonathan Fielding. Oxford University Press.

Provides public health practitioners with a tool kit for assessing the effectiveness and cost-effectiveness of prevention interventions.

Multilevel Modeling: Methodological Advances, Issues and Applications, 4th Edition, edited by by Steven P. Reise and Naihua Duan. Lawrence Erlbaum Associates.

Leading multilevel modeling researchers from around the world critically examine the real problems that occur when trying to use MLMs in applied research, such as power, experimental design, and model violations.

Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century, by the Committee on Educating Public Health Professionals for the 21st Century, edited by Kristine Gebbie, Linda Rosenstock and Lyla Hernandez. Institute of Medicine of the National Academies.

Suggests specific ways to improve public health professionals’ capabilities to address new and complex challenges.

Because the extent to which the nation can continue to protect the public’s health depends in large part on the quality and preparedness of its public health work force, the findings of an inadequately prepared work force are of particular concern and need to be squarely addressed.

Dr. Lester Breslow: Reflections on Public Health in California,

by Adele Amodeo. Partnership for the Public’s Health (a collaboration of The California Endowment and the Public Health Institute).

An in-depth interview with one of the world’s leading public health professionals offers a unique and compelling perspective on the state of public health in California covering more than a half-century.

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news briefs

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NEW FACULTY

PLEASE REMEMBER

news briefs

“getting LA on the move!”

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.

DR. JACK NEEDLEMAN joins the school’s Department of Health Services, effective July 1.

Needleman most recently served as assistant professor of economics and health policy at Harvard’s Department of Health Policy and Management.

Previously he was vice president and co-director of public policy practice at Lewin/ICF in Washington, D.C. He is widely known for his seminal work on the relation between the nursing shortage and the quality of patient care.

At the first lunchtime forum sponsored by the Public Health Alumni Association, faculty speakers included Drs. E. Richard Brown and Antronette Yancey, who brought attendees such as Jean Armbruster of the L.A. County Department of Health Services to their feet for a series of exercises.

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

UCLAPUBLIC HEALTH

“Getting LA on the Move! Using Health Data to Change Health Policy,” the first in what is planned to be an ongoing series of educational programs organized by the Public Health Alumni Association (PHAA), generated an enthusiastic response among alumni, who turned out in large numbers – with a waiting list of others wanting to attend – for the Downtown Los Angeles event.

The lunchtime forum, held in March at the Cathedral of Our Lady of the Angels, connected public health professionals – including the large number of alumni who work downtown – with the UCLA School of Public Health.

Featured speakers were E. Richard Brown and Antronette Yancey of the school’s faculty. Brown illustrated how health data, such as that collected for the California Health Interview Survey, can be used to understand health care access issues and disease prevalence and, as a result, can influence change in health policy. Yancey addressed the challenge of skyrocketing obesity rates and the need for new intervention strategies, including in the workplace.

The PHAA, which sponsored the event in collaboration with the Los Angeles County Department of Health Services, intends to hold annual forums of special interest to alumni in locations where many of them work – including the San Fernando Valley, Long Beach area, West Los Angeles, and Downtown Los Angeles, among others. Members of the PHAA Program Committee – Rosa Pechersky (Dr.P.H. ’83), Joy Blevins (M.P.H. ’97), Clifford Howell (Dr.P.H. ’76), Maureen Valentine (M.P.H. ’81), and faculty member Ruth Roemer — welcome ideas from alumni for future topics and speakers.

Suggestions may be sent to phaa@support.ucla.edu.

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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popularity of epi site grows A Web site launched by a faculty member in the school’s Department of Epidemiology has rekindled interest in a 19th-century public health icon, provided a popular repository for epidemiologic information on bioterrorism, and, in doing so, brought considerable attention to the school.

The Department of Epidemiology site (www.ph.ucla.edu/epi/) is now receiving 4 million to 5 million hits per year, according to Dr. Ralph Frerichs, professor of epidemiology and creator of the site. The most popular section focuses on John Snow, the famed physician who addressed London’s deadly cholera epidemic in 1854 with the removal of a pump handle that he found to be the culprit. Snow had previously argued that several diseases thought to be spread through the air, including cholera, were actually transmitted through drinking water, but his ideas had been mostly ignored.

The Snow site (www.ph.ucla.edu/epi/snow.html) includes multiple layers of information that enable users to dig deeply into Snow’s background, pursue the facts surrounding his investigation of the 1854 epidemic and locate key sites on a detailed period map of London, with relevant events tied to particular locations. It also includes links to present-day information on cholera and the London Epidemiological Society, founded by Snow; a photographic tour of Snow’s London; and a peek at the John Snow Pub. “I was disturbed that in public health, there were no heroes recognized by the general public,” Frerichs says of his decision to create the site. “John Snow, a leading figure in our field, was commemorated not with a museum but with the name of a London pub.”

Frerichs established the bioterrorism site (www.ph.ucla.edu/epi/bioter/ bioterrorism.html) in response to Sept. 11 and the anthrax attacks that followed.

The site, intended for both health professionals and the general public, includes news-media articles on potential biological weapons, viewed through an epidemiologic and public health context.

In addition to appealing to public health professionals, the sites help to create interest in the field among young people, Frerichs says. “This is an enormously inexpensive modality for information-sharing and recruitment,” he adds. “It’s a place where people can get information about public health and, at the same time, see that UCLA is where they can come to learn more.”

UCLAPUBLIC HEALTH

u.s. news & world report: school one of nation’s best The UCLA School of Public Health graduate program ranks in a two-way tie for seventh among peers nationwide in U.S. News & World Report’s triennial evaluation “Best Graduate Schools 2004.” The ranking, released by the news magazine in April, reflects the school’s highest overall score to date (3.7 out of 5 possible points), and shows improvement from a three-way tie for seventh in 2000.

“The top 10 represents an array of renowned public health graduate programs, and I am gratified that our school’s progress has been noted,” says Dean Linda Rosenstock. “That progress represents the dedicated work and achievements of our world-class faculty, staff, students and alumni.”

The rankings are based on the results of peer assessment surveys sent to deans, other administrators, and/or faculty at accredited degree programs or schools in each discipline.

DR. JARED DIAMOND (right, with Professor Emeritus Lester Breslow) was the guest speaker at the 2003 Lester Breslow Distinguished Lecture and Dinner in March. Diamond, a Pulitzer Prize-winning scientist who is a member of the UCLA School of Public Health faculty, delivered a talk titled “Coca-Colonization and Public Health.” The second annual Alumni Hall of Fame Awards were also presented at the lecture (see pages 20-21).

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paris hookup adds breadth to pharmaceutical course

33

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Dr. Stuart Schweitzer, professor of health services at the school, held his Health Services 205 course – Pharmaceutical Economics and Policy – with students in Los Angeles and Paris via videoconference in February.

The class is organized by Gerald Viens, a prominent health economist in France at the Ecole de Science Economique et de Commerce (ESSEC), one of France’s most prestigious business schools.

Health Services 205 is one of the courses offered through the Department of Health Services’ Program in Pharmaceutical Economics and Policy. The program, directed by Dr. William Comanor, is one of a handful of programs in the nation on research and teaching in the pharmaceutical industry, and the only one located in a school of public health rather than in a pharmacy school or a school of business.

Schweitzer, who conducted a similar session two years ago, notes that students benefit from a comparison of the two health care systems and their policies toward pharmaceutical regulation, access, and reimbursement.

in search of...all alumni In an effort to bring together alumni from around the globe, the school is preparing to publish its most comprehensive alumni directory to date.

Scheduled for release in the summer of 2004, the UCLA School of Public Health Alumni Directory will feature biographical listings on the more than 6,000 graduates of the school, including current name and name when a student (if different), class year(s) and degree(s) earned from the school, home address and phone number, names of spouse and children, and detailed professional information. The 2004 edition will list alumni alphabetically, by class year, by geographic location and by occupation in a special career networking section.

Data to be included in the directory will be obtained by mailing a questionnaire to all alumni. Alumni who believe the school does not have their current address should contact the Office of Development and Alumni Relations at (310) 825-6464.

ALLIED HEALTH STUDENTS VISIT UCLA CAMPUS — Students of Color for Public Health sponsored a field trip on April 3 for students enrolled in the public health outreach course offered by the School of Public Health and Compton Community College. Attended by Dean Linda Rosenstock and several faculty, the visit introduced the students to the campus, the school, and the health-related activities available to them, and included a "public health scavenger hunt" as well as meetings with studentled health organizations on campus.

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

occupational health nurse honored

During the Annual Meeting of the American Public Health Association November 15 – 19, 2003 San Francisco Check the APHA schedule or stop by the UCLA School of Public Health booth for location information.

UCLAPUBLIC HEALTH

The UCLA School of Public Health-based Center for Occupational and Environmental Health has created a memorial award in the name of the late Joyce Simonowitz, an occupational health nurse who spent most of her career with the California Occupational Safety and Health Administration.

Simonowitz was a leader in the field of occupational safety and contributed a great deal of time and energy to UCLA as a trainer and mentor to occupational health nurses, industrial hygienists, and occupational medicine students.

Monday, November 17, 2003, 6:30 – 8:00 pm Location To Be Determined

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sph lifetime giving THE SCHOOL IS PLEASED TO RECOGNIZE the generous alumni, friends and corporate and foundation partners whose cumulative gifts and grants to the UCLA School of Public Health total more than $50,000.

Their sustained support has helped the school achieve its nationally and internationally recognized stature.

$1,000,000

AND

A B OV E

ALDO DEBENEDICTIS FRED H. BIXBY FOUNDATION THE CALIFORNIA ENDOWMENT THE CALIFORNIA WELLNESS FOUNDATION THE ROBERT WOOD JOHNSON FOUNDATION $500,000 - $999,999 AMERICAN CANCER SOCIETY INC. ASSOCIATION OF SCHOOLS OF PUBLIC HEALTH CALIFORNIA HEALTHCARE FOUNDATION COMMONWEALTH FUND HENRY J. KAISER FAMILY FOUNDATION THE JOHN A. HARTFORD FOUNDATION, INC. U. S. BORAX INC.

$250,000 - $499,999

$50,000 - $99,999

ANNETTE BLANN LIVING TRUST BESTFOODS INCORPORATED INSURANCE INSTITUTE FOR HIGHWAY SAFETY MARCH OF DIMES BIRTH DEFECTS FOUNDATION MAXICARE HEALTH PLANS INC. THOMAS AND ELIZABETH PLOTT RAND CORPORATION THE FORD FOUNDATION THE WILLIAM AND FLORA HEWLETT FOUNDATION THRASHER RESEARCH FUND FRED AND PAMELA WASSERMAN RICHARD AND GWEN WEISMAN ROBERT AND MARION WILSON WORLD AIDS FOUNDATION NATIONAL INSTITUTE OF HEALTH

IRA R. AND MARSHA L. ALPERT AMERICAN CANCER SOCIETY CALIFORNIA DIVISION INC. AMERICAN FOUNDATION FOR AIDS RESEARCH AMERICAN INSTITUTE FOR CANCER RESEARCH AMERICAN OCEANS CAMPAIGN INC. AMGEN INC. ARCO FOUNDATION INC. ASSOCIATION/AID TO CRIPPLED CHILDREN LESTER AND DEVRA BRESLOW CIGNA FOUNDATION EGYPTIAN CULTURAL AND EDUCATIONAL BUREAU JERRY AND LORRAINE FACTOR GLORIA GALVEZ-CARLISLE GLADYS A. EMERSON ESTATE TERRY AND SHARON HARTSHORN HEALTH RENEWAL RESEARCH FOUNDATION DERRICK JELLIFFE MAX FACTOR FAMILY FOUNDATION LESTER MEIS MERCK AND COMPANY INC. MERCK RESEARCH LABS NATIONAL DAIRY COUNCIL NUTRITION FOUNDATION INC. MONICA SALINAS A. HENRY SCHUYLER, JR. SIMPSON AND SIMPSON BUSINESS AND PERSONNEL SERVICES INC. GURDON AND MARY ANN SMITH THE DANA FOUNDATION THE DOW CHEMICAL COMPANY THE KENNETH T. AND EILEEN NORRIS FOUNDATION

$100,000 - $249.999

UCLAPUBLIC HEALTH

Fred H. Bixby Foundation Trustee John Warren will accept the Dean's Award for sustained and generous support on behalf of the Bixby Foundation at the 2003 graduation ceremony.

ALZHEIMER'S ASSOCIATION LOS ANGELES AMERICAN HEART ASSOCIATION ARCO CONRAD N. HILTON FOUNDATION COUNCIL FOR TOBACCO RESEARCH U.S.A. INC. DOLE FOOD COMPANY, INC. ROBERT DRABKIN RAYMOND AND BETTY GOODMAN JUVENILE DIABETES FOUNDATION INTERNATIONAL AMBASSADOR AND MRS. LESTER B. KORN LOS ANGELES COLLEGE OF CHIROPRACTIC MERCK AND COMPANY, INC. MILBANK MEMORIAL FUND PUBLIC HEALTH FOUNDATION ENTERPRISES PUBLIC HEALTH INSTITUTE MILTON AND RUTH ROEMER JEAN SANVILLE SCHISTOSOMIASIS RESEARCH PROJECT MEDICAL SERVICE CORP INTL RALPH AND SHIRLEY SHAPIRO THE DAVID AND LUCILE PACKARD FOUNDATION THE DORIS DUKE CHARITABLE FOUNDATION THE UPJOHN COMPANY SAMUEL AND AUDREY TIBBITTS WALLACE GENETIC FOUNDATION INC. MICHAEL WEISMAN PAUL WEISMAN WESTERN CONSORTIUM FOR PUBLIC HEALTH WESTRECO INC. WILSHIRE FOUNDATION INC.

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honor roll 2002

35

friends

THE SCHOOL THANKS ALL OF ITS DONORS for their financial support. The following list acknowledges gifts made to the UCLA School of Public Health from January 1, 2002 to December 31, 2002. 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. It is important to us that we acknowledge your gift properly. Please let us know of any omissions or errors in listing your name or gift, by calling (310) 825-6464.

$1,000,000

AND

ABOVE

THE CALIFORNIA ENDOWMENT

$250,000 - $499,999 CALIFORNIA HEALTHCARE FOUNDATION W M KECK FOUNDATION

$100,000 - $249,999 ASSOCIATION OF SCHOOLS OF PUBLIC HEALTH JOHNSON & JOHNSON ROBERT WOOD JOHNSON FOUNDATION ANDREW W. MELLON FOUNDATION ROCKEFELLER BROTHERS FUND JEAN SANVILLE RALPH J. AND SHIRLEY SHAPIRO

$50,000 - $99,999 ARCHSTONE FOUNDATION AUGUSTUS OLIVER BROWN FOUNDATION HENRY J. KAISER FAMILY FOUNDATION NATIONAL IMMIGRATION LAW CENTER ALFRED AND CHARLOTTE NEUMANN RAND CORPORATION U.S. BORAX INC.

$25,000 - $49,999 HEALTH RESEARCH & EDUCATIONAL TRUST MERCK AND COMPANY, INC. MONICA SALINAS

$10,000 - $24,999

IRA R. AND MARSHA L. ALPERT CEDARS SINAI MEDICAL CENTER CAROLYN F. KATZIN MARCH OF DIMES BIRTH DEFECTS FOUNDATION MERIDIAN HEALTH CARE MANAGEMENT INC. EDWARD J. O’NEILL ORTHO MC NEIL PHARMACEUTICAL INC. PACIFICARE BEHAVIORAL HEALTH RUTH J. ROEMER RICHARD L. AND MILDRED G. STERZ TENET HEALTHCARE CORPORATION PAUL R. TORRENS DAVID AND VICKI WALKER WILSHIRE FOUNDATION INC.

$1,000 - $4,999 ABDELMONEM A. AND MARIANNE AFIFI MICHAEL J. AND DIANE K. ALPER ASPEN ENVIRONMENTAL GROUP LEE BAILEY AND LINDA ROSENSTOCK THOMAS R. BELIN ROBERT D. BLAIR GUOXUAN CAI CATHOLIC HEALTHCARE WEST BRUCE N. DAVIDSON EASTERN RESEARCH GROUP INC. JAMES E. AND MARTA V. ENSTROM HAROLD M. GOLDSTEIN GAIL HARRISON MELINDA LOUISE HAYES HEALTH BENCHMARK INC. DIANA W. HILBERMAN SUSAN DIANE HOLLANDER ALAN R. AND TERI HOOPS HORN FOUNDATION IOWA FOUNDATION FOR EDUCATION, ENVIRONMENT AND THE ARTS RICHARD B. JACOBS RAYMOND AND JENNIE S. JING JENQUEST STEPHEN W. AND JANET A. WELLS-KAHANE BARBARA J. KOMAS

AMBASSADOR LESTER B. AND CAROLBETH KORN L.A. CARE HEALTH PLAN DIANE W. LAIRD KENNETH E. AND CORNELIA D. LEE JEFFREY LUCK MCINTYRE BIRKNER & ASSOCIATES OLGA E. MOHAN KYLE A. MURPHY NATIONAL ASSOCIATION OF INJURY CONTROL RESEARCH CENTERS PETER J. PELLERITO POPULATION COMMUNICATION PRICEWATERHOUSECOOPERS PROGRESSIVE HEALTHCARE SYSTEMS RUSTIC CANYON VENTURES JACK R. SCHLOSSER JAMES H. SHINABERGER GRANT G. SLATER GARY J. SLOAN ARTHUR M. SOUTHAM TENET HEALTH CARE JEROME VACCARO

$500 - $999 STANLEY P. AZEN LEONARD I. AND JOAN G. BEERMAN ROY P. BETANCOURT KEITH P. CERNAK SHELDON E. COHEN STEVEN S. COHN COURSE READER MATERIAL INC. JEFFERY E. FLOCKEN RONALD C. FORGEY DANIEL P. GROSZKRUGER BARBARA W. GUGGENHEIM JOANNE D. HALE HARLAN H. HASHIMOTO ARIANNA S. HUFFINGTON LAURA JACOBS AVRAM W. KAPLAN LARRY KING GERALD AND LAURIE KOMINSKI ORTHO BIOTECH INC. FARAH RAMCHANDANI LYNDA R. RESNICK KENNETH J. RESSER MIRIAM SCHOCKEN DAVID L. SCHRIGER ATSUKO SHIBATA STEVEN R. SIM XAVIER SWAMIKANNU TR FAMILY TRUST

CYNTHIA S. YORKIN BEATRICE B. ZEIGER

$250 - $499 JAMES P. AGRONICK AMGEN FOUNDATION INC. RONALD M. ANDERSEN STEVEN H. BARON CHRISTY L. BEAUDIN MATTHEW S. BERRY SUSAN K. BLACKWELL LINDA B. BOLTON GERALD M. BOROK J. J. BRANDLIN WAYNE O. BUCK THERESA L. BYRD LAURALEE P. CASTELLANO MARK E. COSTA OLIVIA A. CROOKES LAYTON R. CROUCH SAM W. DOWNING ROBERTA A. EIDMAN MARK N. EMTIAZ PATRICIA A. ENGLISH JONATHAN E. FIELDING ROBERT P. GHIRELLI CAROL J. GILBERT DAVID M. GITTELMAN ALISA M. GOLDSTEIN MICHAEL S. GOLDSTEIN CLAUDIA GRAHAM ROCHELLE S. GREEN JOHN A. HIRSHLEIFER MARK J. HOWARD FREDRICK H. KAHN LEONARD E. KLEINMAN ANNE C. LAWLER PAULINE T. LE ANN G. MAHONEY ADRIENNE D. MIMS DAVID S. MOEHRING HAL MORGENSTERN ELIZABETH TISEI NASH THANH HAI NGUYEN NELLY A. NIGRO WALTER W. NOCE CHRISTOPHER J. PANARITES LORI S. RICHARDSON PELLICCIONI NINEZ A. PONCE SAMUEL QUI THOMAS H. RICE ANTHONY DALE RODGERS CHRISTINE DOBAK ROGEN AND BRUCE I. ROGEN STUART O. SCHWEITZER ROBERT SCOFIELD JOHN D. SHOEMAKER

Dr. Jean Sanville has recognized the UCLA School of Public Health in her estate plans with an endowed fellowship in global health.

JUDITH M. SIEGEL LISA SOROKA DONNA J. TESI BARTON WALD

$100 - $249 ALLHEALTH HUGO A.ALMEIDA RICHARD F. AMBROSE SHERIN L. ANDERSON JOHN W. ARMSTRONG SANDRA ARONBERG MARY E. ASHLEY DONALD W. AVANT ENKHJARGAL BADAMGARAV JAMES D. BARBER MICHAEL J. BELMAN A. E. BENJAMIN PATTI J. BENSON MICHAEL K. BERRY BOEING CO. GIFT MATCHING PROGRAM LINDA B. BOURQUE JOYCE V. BOYKIN KIMBERLY J. BRADLEY BONNIE BRINTON RICHARD E. BROWN JAMES R. BROWN NICOLE F. BRZESKI CAROL W. BUITRAGO CALIFORNIA COMMUNITY FOUNDATION DENNICE L. CALIHAN MARIA D. CANFIELD FRIEDA R. CAPLAN DWIGHT L. CAREY MARY E. CARR LORRAINE J. CARTER

UCLAPUBLIC HEALTH

AVENTIS FOUNDATION BLUE CROSS OF CALIFORNIA ROBERT J. DRABKIN JERRY AND LORRAINE FACTOR FOLEY AND LARDNER RAYMOND D. GOODMAN FARHAD A. HAGIGI KAISER PERMANENTE PFIZER INC. U.S. PHARMACEUTICALS GROUP PRICEWATERHOUSE COOPERS LLP HENRY A. SCHUYLER RICHARD E. SINAIKO AND PATRICIA SOLOMON SINAIKO SPECIAL SERVICE FOR GROUPS

$5,000 - $9,999

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36 WILLIAM B. CASWELL DONALD S. CHANG CHEVRONTEXACO CORPORATION ALICE W. CHU FRANK J. CHU FRED AND JOANNE CLAREY VIRGINIA A. CLARK TESSIE A. CLEVELAND LISA B. COHEN JO ANN COHN LINDA S. COTTINGHAM JOHN E. COULSON FINBARR CRISPIE JULIE E. CRONER TERESA K. DAVID ELIZABETH C. DE LAMATER ANN MARIE DELLINGER NASREEN DHANANI BRIAN P. DOLAN MARGARET A. DRING L. DONALD DUKE HELEN M. DUPLESSIS JOHN EDELSTON KRISTINE A. EDWARDS ROSALIND ESSNER RUTH B. EVANS DIONE M. FARRIA THOMAS B. FARVER EVE PICARDY FIELDER BETSY FOXMAN LEI CHUN FUNG MARGARET C. FUNKHOUSER

ANN P. GARBER RIMOIN LINDA RIEDER GARDNER CHERYL KANE GATES ROBERT B. GERDING DENISE R. GLOBE ELI GLOGOW RUTH E. GOMEZ SUSAN REETZ GOODGAME ALLAN E. GORDON MELVIN A. GREENSPAN JOHN G. GRIFFITH JOHN H. GRIFFITH MARILYN WEINSTEIN GRUNZWEIG NANCY R. HALL ANN S. HAMILTON SARAH HARROW HARLAN PHYLLIS E. HAYES REAMS HEALTHCARE ASSOCIATION OF SOUTHERN CALIFORNIA ARTHUR G. HEATH ROBERT R. HERRICK ELISE M. HOLLOWAY GORDON D. HONDA JAMES D. HOOK JACK H. HUDES JOHN D. IVIE ROBERT A. JACKSON JEFFREY L. JOSEPH KENNETH E. JOSLYN SUSAN KANOWITH KLEIN JULIE LEVIN KANTROWITZ HERMAN E. KATTLOVE

UCLAPUBLIC HEALTH

Above: Dean Linda Rosenstock visits with donor Arthur Alper and Dean’s Advisory Board member Michele DiLorenzo at a dinner held at the dean’s home on May 15, 2003.

Right: Dean's Advisory Board members Robert Gillespie and Monica Salinas have an opportunity to visit at the same dinner.

NEAL D. KAUFMAN JOHN A. KAUFMANN KAREN P. KENNEDY HARVEY D. KERN DANIEL S. KERR DIANA L. KIEL KINDRED HEALTHCARE OPERATING INC. NANCY J. KINGSTON JANET L. KIRKPATRICK ANNETTE W. KLEEMAN COREY E. KLEIN ROBERT S. KLEINERMAN JEFFRY A. KLONOFF JAMES J. KORELITZ JENNIFER L. KOZAKOWSKI YVONNE C. KRIENS ALICE KWAN JEAN P. LA COUR HWAI TAI CHEN LAM PETER D. LANDRES JAMES R. LARSON TERI DALY LAUENSTEIN DAVID LAWRENCE TERRENCE LEE ALAN T. LEFOR LAWRENCE B. LEISURE RUTH T. LEONG CHIT KAM LI JOHN H. LIBBY JOSEPH P. LIBERATORE VIOLET J. LIM MARY MARGARET LOBNITZ

BRYAN R. LUCE KUNG JONG LUI HERBERT L. LUNDBLAD MICHAEL J. MADDEN SANDRA V. MALDAGUE MAXINE GAY MANTELL SIDNEY GARY MARANTZ ANA MARIA MARIN LISA G. MATRAS FRANK P. MATRICARDI AND DIANA BONTÀ MILDRED G.MAYNE WENDY BLAVAT MCGRAIL MEDTRONIC FOUNDATION GARY M. MEUNIER DAVID A. MEYER FRANK MEZA JEAN L. MICKEY ROSS M. MILLER JAMES A. MODECKI LINDA L. MORAGA JULIAN MOY CAROLYN CRAVERO MURRAY ROBERT ALAN MURRAY CRAIG G. MYERS DENISE MYERS RAYMOND J. NASSIEF NINA NIU OK NOVARTIS U.S. FOUNDATION TERRY R. OBRYAN PAMELA A. OSTER LYNN ROSEMAN OSTRICK PAMELA J. OW SORA PARK PANJASIRI CHRISTOS A. PAPATHEODOROU ERNESTO O. PARRA ROSA LEE PECHERSKY CORINNE LEE PEEK ASA DENISE L. PERPICH CARL E. PIERCHALA ROBERT S. PLOURDE SCOTT P. POLANSKY ANDREA E. PORTENIER ANNE R. POTTER SHANE S. QUE HEE ALIREZA RABIZADEH ERIC P. RABJOHNS MARILYN A. RAY LOREN D. REED JOSHUA A. REILLY JUANA RENTERIA JEAN LE CERF RICHARDSON KEITH S. RICHMAN ROSALYN RIOS RIGUIS TRAPP ELENA V. RIOS SIDNEY ROBERTS NAOMI S. ROSEN PAULINE VAILLANCOURT ROSENAU MARTIN B. ROSS CURTIS J. ROZAS LISA VAN HORNE RUBENSTEIN SHERYL M. RUDIE DELIA V. RUIZ ROBERT R. RYGG JAIME G. SALAZAR ALAN SAMUELS

SAN GABRIEL VALLEY DENTAL CENTER CONNIE CARTER SANCHIS ALAN P. SANDLER KENNETH P. SATIN PAUL M. SCHACHTER LINDA MOESSL SCHAEFFER THOMAS P. SCHMALZRIED BENEDICT R. SCHWEGLER KYUNG MAN SEO ELESTIA E. SHACKELFORD RICHARD V. SHAKER LARRY SHARFSTEIN LISA BERRY SHAW MIKE SHEAD BRIAN T. SHERRINGTON KAY YAMADA SHISHIMA GALE F. SHORNICK JERALD F. SIGALA JAMES B. SIMPSON DANIEL F. SMITH GARY W. SMITH LOWELL W. SMITH WILLIAM E. SMITH HERBERT N. SNOW SAM S. SNYDER RAUL A. SOBERO SOUTHERN CALIFORNIA EDISON COMPANY CARL L. SPEIZER CAROL LEE SPENCER ELIZABETH A. STANLEY SALAZAR SUSAN B. STEIN DANIEL J. STONE IRMA H. STRANTZ BONNIE P. STURNER CHRISTOPHER M. SULLIVAN CRUZ ELENA SUNDQUIST JAMES B. TEHAN LINDA A. THOMAS ZOE ANN TILTON CITRON TOY WARWICK G. TROY TRW FOUNDATION JANE H. TURNER LINDA UMBDENSTOCK DIANE UNG BRIAN J. VAN DER LINDEN MANUEL VANEGAS SUEBELLE S. VERITY PAUL R. WALES H. G. WALLACE FLORENCE WANG WASHINGTON MUTUAL FOUNDATION MATCHING GIFT PROGRAM DAVID SHAEL WEINBERG KENNETH B. WELLS TARA J. WESTMAN CAROLYN M. WHITE ARTHUR M. WINER CHRISTINA J. WITSBERGER THERESA WOEHRLE JUDITH SHAW WOLSTAN CATHARINA SUK JING WONG ELEANOR DAY YOUNG MICHAEL A. ZAPF

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FIRST CENTURY SOCIETY First Century Society members are alumni, faculty, staff and friends who have made provisions for UCLA in their Will, Trust, or other planned giving arrangements.

With generosity and foresight, the following members have designated the School of Public Health as a beneficiary:

AS AVRAM KAPLAN (M.P.H. ’72) explains it, he and his classmates concluded it was time to be more proactive in honoring the faculty and school that had helped them achieve career success.

Many of the graduates of the UCLA School of Public Health’s Class of ’72 had reunited at the memorial services for two beloved faculty members, Drs. Milton Roemer and Carl Hopkins. At the second service, they began discussing the idea of a 30th reunion to relive fond memories and honor their mentors. And, going a step further, they decided to establish a Class of ’72 Gift Fund for student support.

The reunion, held last October, drew approximately 50 alumni, friends, and faculty – including all four living deans – to Maggiano’s Little Italy Restaurant in Los Angeles. “It was a great evening,” says Kaplan, who chaired a reunion committee that also included Daniel Ershoff (M.P.H. ’72, Dr.P.H. ’79), Ruth Gomez (M.P.H. ’72, Dr.P.H. ’78), Raymond Goodman (M.D., M.P.H. ’72), and Frank Matricardi (M.P.H. ’72, Dr.P.H. ’82). “It was so rewarding to be able to honor our deans and professors, to say the things we wanted to tell them. Everyone felt full of pride and thanks.”

In establishing the gift fund, the committee set a five-year goal of raising $25,000 toward an endowment for student support based on need. Students from all of the school’s programs who graduated in 1972 have been invited to contribute. “We always felt the Class of 1972 was special,” says Kaplan, executive director in charge of physician services at Saddleback Memorial Medical Center in Laguna Hills, Calif. “There was an energy, a camaraderie. We hope all of our classmates will get together to create this fund as a testimony to our class and as a way to help current and future students.”

ANONYMOUS LESTER & DEVRA BRESLOW ANNE & JOHN COULSON RALPH FRERICHS ROBERT & DIANA GHIRELLI RAYMOND & BETTY GOODMAN FLORENCE HOPKINS GERALD KOMINSKI DAVID KRASNOW LESTER & GENEVA MEIS JEAN MICKEY WALTER OPPENHEIMER JEANNETTE OREL ANNE REHER-LIVIO JEAN SANVILLE GURDON & MARY ANN SMITH SUEBELLE & DAVID VERITY

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friends

class of ’72 shows school spirit!

For more information on the Class of ’72 Gift Fund, contact the school’s Office of Development and Alumni Relations at (310) 825-6464.

C A M PA I G N U C L A S C H O O L O F P U B L I C H E A LT H Annual Progress as of March 31, 2003 $30,000,000 $26,020,530

25,000,000

$23,336,915 20,000,000

$18,852,239

15,000,000

$ 8,165,239 5,000,000

$ 4,453,851 $ 1,969,479

0

FY 96

FY 97

FY 98

FY 99

FY 00

FY 01

FY 02

FY 03 YTD

UCLAPUBLIC HEALTH

$10,037,344 10,000,000

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Commencement

2003 Julie Louise Gerberding, M.D., M.P.H., an infectious disease and public health expert, is the featured speaker at the school’s 2003 Commencement.

Dr. Gerberding is director of the Centers for Disease Control and Prevention.

UCLA

UCLA

PUBLIC HEALTH School of

Public Health

School of Public Health Box 951772 Los Angeles, California 90095-1772 www.ph.ucla.edu Address Service Requested

Nonprofit Org. U.S. Postage PAID

UCLA