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NOVEMBER 2002
UCLA
PUBLIC HEALTH developing a clearer picture of
UCLA
WOMEN’S HEALTH
School of
Public Health
Curing cancer is everyone’s goal, but wouldn’t it be better if we never got it? An SPH-based group headed by Patricia Ganz thinks so.
Anne Pebley combines the demographer’s interest in population trends with a drive to improve the lives of the people being counted.
Yasser Aman is applying the lessons he learns as an M.P.H. student to UMMA Clinic, the freecare facility he has run since age 24.
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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
EDITORIAL BOARD 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. Adjunct 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.
UCLA
President, Alumni Association
School of
Public Health
4
Cancer Prevention & Control Research Exciting strategies are emerging to prevent tumors or detect them at the early, treatable stage. SPH-based division looks to ensure that all populations benefit.
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Anne Pebley: Big Thinking for Local Change Population demographer examines the effect of social and political forces on individual behavior and well-being — and studies ways to ensure positive conditions.
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A New Look at Women’s Health Issues
Student Profiles
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departments 22 RESEARCH
20 Public health researchers and practitioners are shedding new light on issues that only, uniquely, or disproportionately affect women.
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Translating Science into Policy
A focus on improving population health demands academics’ participation in the political process beyond publishing results.
Kynna Wright teaches, lobbies, sees patients as a nurse practitioner, and manages a fellowship program. Yasser Aman has run a large volunteer clinic since age 24. They exemplify what’s special about the school’s students.
Freeways and ultrafine particle exposure...meat intervention and cognition in Kenya...assessing early childhood care...bottled water perceptions vs. reality... emotional injury and future disaster preparedness... improving cancer screening in AAPI women.
27 FACULTY 30 CLASS NOTES 32 NEWS BRIEFS 33 FRIENDS
ON THE COVER After years of neglect, the many facets of women’s health are now an important part of the research picture. Beginning on page 10, some of the activities of faculty, students and alumni in the area of women’s health are featured. Cover photo/illustration by Martha Widmann. Images sourced from: 2002 © BrandXPictures/Punchstock, 2002 © Getty Images, and 2002 © Corel Draw.
PHOTOGRAPHY Mary Ann Stuehrmann / cover: Ganz, Pebley, Aman; p. 2; pp. 4-9; pp. 20-21; p. 33: Davidson Yvette Roman / p. 13: Robbins Reed Hutchinson / p.11: Upchurch; p. 14: Sorenson; pp. 27, 32 Courtesy of Jared Diamond / back cover Courtesy of PATH for Women / p. 26 Courtesy of the UCLA School of Public Health / p. 19 Courtesy of Daniel Pardi / p. 12 Courtesy of the alumni / pp. 30-31 Courtesy of Punchstock / © 2002 / p. 12: breastfeeding; p. 15 Courtesy of Comstock / © 2002 / p. 17: hand with pen
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 2002 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 WE CONTINUE WITH OUR EFFORTS to inform the public about the importance of public health in general and, specifically, the school. While outreach activities are conducted throughout the school, I’d like to highlight a few specific efforts centered in the Dean’s Office. In September, we convened a panel to brief the Southern California Association of Philanthropy at a forum titled “Public Health: It’s Everybody’s Business.” Also in September, Drs. Lester Breslow, Jonathan Fielding, and I participated in a forum addressing the crisis facing the Los Angeles health system, sponsored by The California Endowment, the California Department of Health Services, and the Los Angeles County Department of Health Services. In October, I had an opportunity to address the Rotary Club of Los Angeles – one of the oldest and largest rotary clubs in the United States. Each of these efforts is an important part of increasing the school’s presence among local decision makers and helps to better position the school to have an impact in the health policy arena (see the related article, page 16). As we all brace for more negative budget news from the state, I’d like to share some good news from the school. We recently received $450,000 from The California Endowment for student support focused on traineeships in underserved communities (the first recipient is highlighted on page 21). Coupled with our previous California Endowment grant to strengthen our capacity to address disparities in health among underserved communities, we believe this will help to further one of our new strategic goals – establishing new and strengthening existing collaborative partnerships with a major focus on working with communities to improve health in greater Los Angeles. In addition, the school recently received two Scholarship, Training, and Education Program for Tobacco Use Prevention (STEP UP) awards from the Association of Schools of Public Health. Funded by the American Legacy Foundation, the program supports graduate students, faculty, and schools of public health in tobacco use prevention scholarship, training, and education. These successes are only part of the continued growth in faculty-generated research support (see the accompanying graph). This year the school welcomed an enthusiastic and talented group of new
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students. I am pleased to report that applications to the school were up about 10
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percent for 2002-2003. In addition, the excitement about our executive degree programs continues to grow, with applications to the Community Health Sciences executive program increasing by more then one third and the Health Services executive program increasing by about 10 percent. One of the most fulfilling aspects of my job is the opportunity to interact with our students who are so talented, inspired, and driven. I am particularly excited about a new section of the magazine highlighting individual students. After reading about Kynna Wright and Yasser Aman (see pages 20 and 21), I’m sure you will be as impressed as I am with their accomplishments. We often say our students are the future of public health. As evidenced by the work of these two students, they are also making a significant impact in the present. This is why opportunities to support our students, as described above, are so important. Along these lines, I’d like to recognize an extremely generous $100,000 gift from Monica Salinas for student support. Her gift will enable more students to make their mark on the world. Finally, it is my pleasure to announce that one of our own faculty members, the Pulitzer-Prize-winning author of Guns, Germs, and Steel, Jared Diamond, Ph.D., will be the speaker at the annual Breslow Lecture and Dinner on March 10, 2003 (see the back cover for more information). When planning the upcoming lecture, we knew it would be difficult to top the success of the 2002 lecture with Donna Shalala, Ph.D. But with Dr. Diamond as the speaker, we are well on our way. I hope to see you there.
$38.2 M Linda Rosenstock, M.D., M.P.H. Dean
$29 M CONTRACT & GRANT AWARDS
$19.2 M
$18.2 M $15.9 M
Other State Federal
1997-98
1998-99
1999-00
2000-01
2001-02
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1996-97
$17.3 M
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4 E XCITING STRATEGIES ARE EMERGING TO PREVENT TUMORS OR DETECT THEM AT THE EARLY, TREATABLE STAGE . SPH - BASED DIVISION LOOKS TO ENSURE THAT ALL POPULATIONS BENEFIT.
Cancer Prevention & Control Research
Using Public Health Tools to Tame a Formidable Foe As a practicing medical oncologist
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At an outreach event held by the South Asian Network (SAN) at Gurudwara of Los Angeles in North Hollywood, important information about breast cancer and screening services is conveyed in Punjabi, one of nine languages spoken by SAN outreach workers and educators. SAN is one of 11 community partners of the Asian American Network for Cancer Awareness, Research & Training program, for which UCLA is a regional site.
who
gives chemotherapy to cancer patients, Dr. Patricia Ganz hopes that one day she will be put out of business by a lack of demand. And when she’s not seeing patients, the UCLA professor of public health and medicine is doing something to help get to that day. Ganz heads the Jonsson Cancer Center’s Division of Cancer Prevention and Control Research, based in the School of Public Health. The division’s multi-disciplinary efforts apply the scientific disciplines of public health – including epidemiology, environmental health, health services, behavioral sciences and biostatistics – in research spanning the prevention-and-control continuum. The focus is on both healthy and at-risk populations, where the aim is either to prevent cancer from occurring or detect it at the earliest, most treatable stage; and on patients and survivors, where the focus is on quality of care, quality of life and prevention of secondary malignancies. Many of the division’s more than 30 members come from the School of Public Health, though there are also researchers from the schools of medicine and nursing, as well as other parts of the UCLA campus. As basic scientists identify the early molecular processes and risk factors for tumor development, exciting new strategies are emerging for prevention and early detection of cancer. But biomedical advances don’t automatically filter
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“Even if you understand what the molecular lesion is, if you can’t get people to change their behavior, it’s not necessarily going to make a difference.”
feature
—Dr. Patricia Ganz and Dr. Katherine Kahn have collaborated on projects related to the quality of care for breast cancer patients since 1996; in 2000, they received funding from the National Cancer Institute (NCI) to study “Processes and Outcomes of Breast Cancer Care.” Through telephone interviews and medical record review, they are examining how breast cancer care is delivered and how that care is associated with different types of health insurance (or lack thereof), ethnicity, access to specialists, and other factors, along with the linkage to important outcomes. Ganz has also devoted a major portion of her career to the study of quality of life of cancer patients and survivors, and is recognized as an international leader in this area. She is currently conducting a national three-site NIH/NCI project focused on quality of life issues during the transition period from the end of primary breast cancer treatment and adjuvant therapy to becoming a cancer survivor. On the primary prevention side of the continuum, tobacco is an important focus of the division’s research. “Smoking prevalence in this country has come down enormously, but 25 percent of U.S. adults are current smokers, and kids are initiating every day,” says Dr. Barbara Berman, who has conducted tobacco-related research in the division for more than two decades, and whose current focus includes smoking prevention and control in lowincome populations and among the deaf. Dr. William McCarthy is studying ethnic differences in factors that predict tobacco use among young people. Researchers in the division, led by Drs. Gail Harrison and David Heber, are also examining the impact of diet – fat and fiber, as well as individual micronutrients – on specific cancers. “The estimates are that between 30 and 40 percent of the cancer burden is diet-related,” Harrison notes. “So the impact that we could make, if we understood all the mechanisms and could effectively make the right interventions, is very large.” One intervention currently being tested by Harrison expands the fresh
UCLAPUBLIC HEALTH
down to all segments of the population, notes Dr. Roshan Bastani, the division’s associate director and associate dean for research at the School of Public Health. “There is a gap between new knowledge and uptake of that knowledge by individuals and physicians,” Bastani notes. “Cancer control takes the public health approach to ensure that the advances reach the people who need them most.” It was the public health approach that led to the steep decline in cervical cancer incidence and mortality, through the widespread adoption of the Pap smear. Today, the field is confronted with the huge burden of colorectal cancer – the second most common malignancy among both men and women. Half of the men and women who develop colorectal cancer die within five years of diagnosis – despite the fact that the technology is in place to accurately detect and treat precancerous lesions, as well as to detect and treat early cancers through the use of screening tests such as fecal occult blood testing, sigmoidoscopy and colonoscopy. “Public health expertise is desperately needed to increase the very low utilization of screening by the general public and physicians,” Bastani asserts. The division is doing its part, conducting two large National Institutes of Health (NIH)-funded studies targeting high-risk individuals (led by Bastani) and physicians and medical groups (led by Ganz) to test strategies for increasing colorectal cancer screening. The division also features one of the nation’s premier research groups in studying health disparities in cancer. Many projects focus on low-income and minority populations, with the goal of identifying disparities and their underlying causes and then designing, testing and evaluating interventions targeting physicians and individuals to determine the best strategies for improving the health of the population. Bastani, a social and health psychologist who heads the division’s Healthy & At-Risk Populations program area, studies access to care and barriers to cancer screening among low-income and minority populations. “Even when good screening techniques become available, there are factors, including economics, transportation, education and cultural issues, that prevent certain populations from taking advantage of them,” she explains. “By identifying those barriers we can attempt to develop interventions to overcome them.” Other division researchers are studying disparities in cancer diagnoses and outcomes across ethnic, cultural and socioeconomic groups. The cancer control mission also encompasses a focus on the quality of care and quality of life of cancer patients and survivors. For example, Ganz
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“Public health expertise is desperately needed to increase the very low utilization of [colorectal cancer] screening.”
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—Dr. Roshan Bastani
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fruits and vegetables provided in the food package for Women, Infants and Children (WIC) program beneficiaries. In addition, Drs. Antronette Yancey and McCarthy are conducting research among overweight African American women and adolescents in an effort to develop interventions to increase exercise and healthy eating.
Joyce Seldon provides genetic counseling as part of the UCLA Familial Cancer Registry and Genetic Evaluation Program.
Although research is the primary focus of the division, it also has significant teaching and service components. Courses in cancer-prevention-andcontrol topics are offered through the School of Public Health. Most recently, under the leadership of the division, the school received two Scholarship Training and Education Program for Tobacco Use Prevention (STEP UP) awards from the Association of Schools of Public Health. The program, funded by the American Legacy Foundation, supports graduate students, faculty and schools of public health in tobacco-use prevention, scholarship, training and education. Along with assisting faculty in incorporating tobacco content into courses, Berman and Associate Dean for Academic and Student Affairs Gerald Kominski, the grant’s principal investigators, have developed a new graduatelevel course, “Tobacco: Prevention, Use and Public Policy,” offered through the school. The grant will also support two doctoral students. In addition, the division has an NIH/NCI-funded postdoctoral training grant that is currently supporting seven fellows to obtain training in and conduct translational cancer control research. Other active NIH-supported training programs in the division include those in cancer epidemiology, nutrition and obesity, and quality of life.
Since so much of its research is done in the community, the division also has strong ties with many local organizations, including physician groups and grassroots organizations working to prevent cancer and promote early detection. Among other things, the division’s researchers give lectures and provide educational materials, as well as placing interns in cancer-related community-based organizations. Many also offer their expertise to state and local committees on issues related to cancer research and education. Among the best examples of the division’s community-based work is IMPACT: Improving Access, Counseling and Treatment for Californians with Prostate Cancer, headed by Dr. Mark Litwin, which provides no-cost prostate cancer care to indigent patients statewide; and the Asian American Network for Cancer Awareness, Research and Training (AANCART), led by Bastani and Dr. Marjorie Kagawa-Singer. Part of a national network with sites at UCLA, UC San Francisco, the University of Washington, and Columbia University, AANCART aims to increase cancer control research and training among specific sub-groups of underserved Asian-Americans such as Filipinos, South Asians and the Hmong. AANCART-Los Angeles has established collaborations with 17 community-based organizations serving Asians-Americans, and has conducted significant training, research, outreach and awareness activities. In 1998, the division established the UCLA Familial Cancer Registry and Genetic Evaluation Program, which serves as both a resource for researchers and a service for individuals with a family history of the same type of cancer or associated cancers, or a family history of one of the known mutations in a hereditary susceptibility gene. These individuals receive free counseling, genetic tests when appropriate, and opportunities to participate in future trials. Data from the volunteer participants – including questionnaire responses, pedigrees, and tissue and blood specimens – are made available for research protocols. Ganz and Bastani note that exciting new targets for prevention and early detection of tumors are presenting themselves with growing regularity, thanks to the revolution in molecular biology and what that’s meant for understanding cancer. “We now understand that cancer doesn’t begin with the discovery of a lump in your breast or a shadow on the X-ray; it’s had a 20-30 year period to develop,” says Ganz. “There are many years of opportunities in that genehost-environment interaction to prevent or delay the development of cancer. Along with ensuring that people are diagnosed early and receive high-quality
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feature School of Public Health faculty in the Division of Cancer Prevention and Control Research include (back row, left to right) Annette Maxwell, Barbara Berman, Antronette Yancey, Julienne Bower, Coen Bernaards, Mark Litwin, (front row, left to right) Roshan Bastani, Beth Glenn, Patricia Ganz, and William McCarthy.
UCLAPUBLIC HEALTH
care, we want to try to take advantage of some of those earlier opportunities to prevent the disease.” In a sense, the advances in the laboratory have resulted in a convergence between the cancer-prevention-and-control researchers and basic scientists. In the same way that aspirin, statins, beta blockers and ACE inhibitors are used to reduce cardiovascular risk, cancer prevention researchers hope to identify and test chemopreventive agents that would lower tumor risk. Division researchers have participated in several national chemoprevention trials, such as the trial testing the drug tamoxifen for the prevention of breast cancer. But unlike cardiovascular disease, in which atherosclerosis is the primary mechanism, cancer is some 100 different diseases resulting from multiple exposures. The division’s answer is to conduct its research on many fronts, with an eye toward developing targeted strategies aimed at populations identified as being at high risk for particular cancers. One research area with potential for having a major impact is the relatively new field of molecular epidemiology, characterized by the work of Dr. ZuoFeng Zhang. Zhang and colleagues hunt for early molecular changes that foreshadow tumor development. Molecular “biomarkers” signifying high cancer risk can be helpful in several ways, Zhang explains. In addition to identifying high-risk groups, the biomarkers serve as valuable tools for chemoprevention studies. “They are intermediate markers that enable us to assess the effects of the intervention,” Zhang explains. “Otherwise, in a prospective cancer prevention study, it would take much longer to make an evaluation.” And, using biomarkers to identify high-risk groups, researchers can select from that pool of individuals for the chemoprevention trials – a much more effective process than drawing from the general population. Zhang’s group is involved in two such trials, both funded by the NCI. In the future, Bastani predicts, research such as Zhang’s will give cancerprevention-and-control educators the ability to replace the mass messages that currently prevail with information about how to reduce cancer risk that is more targeted toward particular high-risk sub-groups. “Instead of a one-size-fits-all approach, we will, for example, be able to tell certain people that their genetic profile makes them more susceptible to DNA damage from the sun, while telling others that tobacco smoke puts them at particularly high risk,” Bastani says. “Messages tailored to an individual’s risk are more likely to be persuasive.” As basic scientists illuminate the malignancy process and identify at-risk groups, it is up to behavioral scientists and educators to find the ways to capitalize on the information. “Even if you understand what the molecular lesion is, if you can’t get people to change their behavior, it’s not necessarily going to make a difference,” Ganz observes. With that in mind, basic scientists and behavioral scientists are becoming more interested in learning about each other’s province. Much of the attention surrounding the advances in understanding the biology of cancer has focused on new treatments that attack the disease at the molecular level. But members of the Division of Cancer Prevention and Control Research are setting the bar higher. “Everyone is always asking when we’re going to cure cancer,” says Ganz. “Wouldn’t it be better if people didn’t get cancer?”
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P OPULATION DEMOGRAPHER EXAMINES THE EFFECT OF SOCIAL AND POLITICAL FORCES ON INDIVIDUAL BEHAVIOR AND WELL - BEING
—
AND
STUDIES WAYS TO ENSURE POSITIVE CONDITIONS .
Anne Pebley:
Big Thinking for Local Change The online version of Merriam-Webster’s Collegiate Dictionary defines demography as “the statistical study of human populations especially with reference to size and density, distribution, and vital statistics” – which, to the uninitiated, may seem at odds with the study of neighborhood conditions and their influence on individual behaviors and health outcomes. But Dr. Anne Pebley views her role as director of the Los Angeles Family and Neighborhood Survey (LA FANS) as perfectly consistent with her expertise as a demographer and holder of the endowed Fred H. Bixby Chair at the UCLA School
UCLAPUBLIC HEALTH
of Public Health. LA FANS is an analysis by RAND and UCLA researchers of 65 neighborhoods in L.A. County, focusing on the impact of the surrounding environment on children’s health, social development, school performance, stress and other variables. The first wave of the survey was recently completed and the data are being analyzed. The research stems from a widely held view that neighborhoods are where social interventions should occur. “The idea is that if you’re trying to improve the life of one child at a time, you might not have as much impact as if you change the environment in which the child lives,” Pebley explains. The movement afoot in Los Angeles to create neighborhood councils and service planning areas raises questions that are being addressed by Pebley’s team: What defines a neighborhood? What impact does improving the immediate environment have on residents? What specific improvements have the most impact, and what aspects of well-being do they affect? “Understanding these issues is crucial to cost-effective policy intervention,” Pebley asserts.
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“Individuals are not isolated. The environment in which we function may have a much bigger impact than we typically would like to think on our behavior and on our health.” —Dr. Anne Pebley
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Program in Population. “The Bixby Program is critical to our goal of expanding research, training and service in the areas of family planning, reproductive health and population,” says Pebley, who serves as chair of the program’s steering committee. “We are very grateful for the fund’s continuing support.” In 1998, just before being named to the Bixby Chair, Pebley served as president of the Population Association of America, the national professional organization for demographers, sociologists, economists, public health professionals and others interested in research and education in the population field. That year she delivered an address on a topic that was receiving little attention among her peers: the relationship between population policy and environmental consequences. Concern about the environment had moved to the periphery of demographic research ever since the 1960s, when many were predicting that rapid population growth would soon lead humans to exhaust natural resources and face environmental collapse. Pebley’s warning of the potential impact on health and mortality of environmental change – from global warming and air pollution to land-use trends – is now being heeded by a growing number of researchers. Pebley conveys that message to UCLA students each fall in her sought-after Population Change and Public Policy course. “I love teaching that course, because it forces me to stay up to date on what’s going on, and to think about these issues,” says Pebley, who was honored by the Public Health Students Association as Professor of the Year for the Department of Community Health Sciences in 2002. Being around students – particularly given the diversity of backgrounds and experiences of the School of Public Health’s – is invigorating, she says. “They think about things in ways I never have. I always learn a lot from them.” For Pebley, the ability to constantly learn about matters of concern to her is half of what makes her work rewarding; the other half is the knowledge that what she learns can be used to improve people’s lives. “I guess you could say that, like most people in academia, I am infinitely curious,” she says. “Researchers have a tremendous luxury in the sense that we can, to a certain extent, follow our interests. But at the same time, when I work with people in the community through my research and volunteering, I am reminded that these are real issues affecting real people, that we don’t have a lot of money to spend on public policy and we have to be very strategic in how we spend it. I would like to think that what I do has a positive impact in guiding such decisions.”
faculty profile
LA FANS examines terrain that is at the heart of Pebley’s research interest, which is focused on the effect of the social and political environment on individual behavior and well-being. “Individuals are not isolated, despite the feeling you might get from the ideology prevalent in the United States,” she says, smiling. “The environment in which we function may have a much bigger impact than we typically would like to think on our behavior and on our health – economic, mental and physical.” Indeed, Pebley explains, to view demography only through the lens of global trends is to miss the drivers of those trends. “I’m interested in what’s going on at the macro level,” she says. “But if you want to understand the process that leads to population growth and change, you have to also conduct research at the micro level.” Pebley’s career course was launched in graduate school at Cornell University, where she enrolled in a master’s degree program in international development. The focus was on agricultural economics, nutrition and demography of population; the last captured her interest, particularly at a time – the 1970s – when population growth rates in poor countries were at unprecedented levels. “It seemed to me you had to understand these underlying demographic processes if you wanted to make any difference in the world,” she recalls. In a career that has taken her to a number of countries in Latin America, Asia and Africa to conduct her studies, Pebley’s interests have diverged toward related issues, including children’s health. One major focus of her work has been on social and political determinants of health behaviors and outcomes in developing countries. Pebley continues to publish results of research she started in rural Guatemala in 1990 on how parents and expectant mothers decide among health care providers – ranging from biomedical professionals to the more traditional providers common in the indigenous villages – for pediatric and reproductive care. The research has captured the interest of the country’s Ministry of Health. “If pregnant women in these communities are going to midwives rather than physicians, as a policy-maker you want your focus to be on providing the best possible training for midwives,” Pebley explains. After 14 years on the faculty at Princeton University and six as director of the Population Research Center and senior sociologist at RAND, she joined the full-time faculty at the UCLA School of Public Health in 1999 as professor and Fred H. Bixby Chair. The endowed chair supports research, teaching and service in the population field. Last year, the foundation gave a large new gift to the school that helped establish the Fred H. Bixby
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RESEARCHERS AND PRACTITIONERS ARE SHEDDING NEW LIGHT ON ISSUES THAT ONLY, UNIQUELY, OR DIS PROPORTIONATELY AFFECT WOMEN .
A New Look at
Women s ’ Health Issues
Expanded Focus, Clearer Picture Long overlooked
or viewed through a narrow lens,
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women’s health research has arrived in a major way in recent years. A tradition of biomedical research trials using only males as subjects left a legacy of limited data on how cardiovascular disease, certain cancers and other biological processes, along with the medications designed to treat them, manifest in women. Health issues specific to women, such as breast cancer and perimenopausal concerns, received little funding considering their impact. That began to change in the 1990s, with the Women’s Health Initiative marking a major turning point. The 15-year, $625 million multi-center study funded by the National Institutes of Health has focused on prevention and treatment of diseases that disproportionately kill and disable women. Grassroots efforts on behalf of women’s health added to the momentum, as did the growing consensus that there remained much to be learned from focusing on the health needs of a traditionally underserved – albeit sizable – segment of the population.
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cover story
“There’s been a conceptual shift that integrates the multiple roles of women’s lives into thinking about women’s health issues.” —Dr. Dawn Upchurch
Upchurch, a demographer and sociologist, studies women’s health over the life course, with an emphasis on reproductive health. Her early work examined the social and behavioral correlates of STD transmission and acquisition in high-risk populations. She has extensively investigated how women’s life-course experiences such as finishing school, marriage and divorce influence their reproductive decisions, with a special focus on the educational consequences of teen childbearing and the determinants and consequences of non-marital childbearing. Upchurch is currently studying the ways in which social contexts (such as neighborhood, school and family) influence adolescents’ sexual risk-taking behaviors, including STD outcomes. The expanding view of reproductive health is also characterized by the research of Dr. Michael C. Lu, an obstetrician/gynecologist on the School of Public Health faculty. Lu studies racial and ethnic disparities in birth outcomes. “Eliminating health
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“In recent years, interest in women’s health has substantially increased, and the field has evolved to cover a greater breadth of topics,” says Dr. Dawn Upchurch, associate professor of community health sciences at the school. “This increased interest has resulted in a growing literature in women’s health, and a stronger commitment among federal, state and local agencies and academic institutions to better understand women’s health. Women’s health issues are now prominently represented in the national public health agenda, as exemplified by the priority areas of Healthy People 2010.” Women’s health issues are generally defined as those that disproportionately affect women, affect men and women differently, or are unique to women. Traditionally, the focus has been on the latter – and specifically, on reproductive health. “From a public health perspective, women’s health was once synonymous with maternal and child health,” says Upchurch. “Other issues were often neglected.” As put forth in Healthy People 2010, the nation’s public health agenda now includes issues such as domestic violence, environmental and occupational exposures, mental health, physical activity, and nutrition, all of which have unique effects on women, Upchurch notes.
Reproductive health has also evolved to encompass much more than it once did. The focus on pregnancy and childbearing was expanded in the 1950s and ’60s to include contraception and family planning issues, and then was broadened again in the ensuing decades to include social, behavioral and biological components of sexually transmitted diseases, as well as sexuality, relationship dynamics, and intimate partner violence. Similarly, perimenopausal research is no longer confined to the pros and cons of hormone replacement therapy, but also includes the social aspects of life-course changes – including the so-called “empty nest” phenomenon. “There’s been a conceptual shift that integrates the multiple roles of women’s lives into thinking about women’s health issues,” Upchurch says.
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J.C. Walsh As a Rotary Scholar at the University of Ghana, School of Public Health, Walsh pursued an interest in intimate-partner violence that began in Dr. Susan Sorenson‘s Family and Sexual Violence course at UCLA. The issue was personalized by the experiences of her best friend and roommate, a Ghanaian doctor who told Walsh of her harrowing experiences as a battered wife. “She made it very clear that women in Africa were in no way immune to the negative health impacts of a society that views the exercise of power by men over women, justified by culture, as a natural and socially acceptable process,” Walsh says. Eventually, the second-year UCLA M.P.H. and M.A. in African Studies student, with assistance from experienced researchers, launched her first field-based research project, collecting qualitative and quantitative data on the violence experienced by Liberian refugee women both during their flight from Liberia and as refugees living in Danane, Ivory Coast. Almost 85 percent of the 108 respondents had experienced some kind of rape, torture, sexual slavery, or physical abuse while trying to escape from Liberia. “Very few women escaped unscathed,” Walsh says, “but the strength and coping ability of these women were evident as they talked about their experiences.”
disparities is one of the two major goals of Healthy People 2010, and nowhere are the disparities more disgraceful than in birth outcomes,” Lu asserts. For example, an African American baby is twice as likely as a white baby to be born premature and with low birth weight, and twice as likely to die within the first year of life. “Traditional explanations, such as differences in maternal cigarette smoking, socioeconomic status, access to and utilization of prenatal care have not explained these disparities very well,” Lu notes. African American women who start prenatal care in the first trimester have higher infant mortality rates than white women who initiate prenatal care later or not at all. In addition, African American women with 16 years of schooling have higher infant mortality rates than white women with fewer than nine years. “Something else is going on,” Lu says. He is testing the hypothesis that these disparities are the result of disadvantages and inequities accumulated over a life course of differential exposures – from poorer nutrition and health care access to poorer housing, impoverished neighborhoods and racism. Making an impact on birth outcome disparities, Lu suggests, requires addressing women’s health concerns not only during pregnancy but also long before it. Other members of the school’s faculty are focusing on the impact of exposure to specific environmental and occupational toxins on reproductive health outcomes. Dr. Beate Ritz of the Department of Epidemiology recently launched a study in which 2,000 women will be interviewed about environmental exposures during their pregnancy in an effort to gain insight into whether certain exposures increase the risk of negative child health outcomes. Earlier this year, Ritz found that when exposed early in their term, pregnant Los Angeles-area women living in regions with higher levels of ozone and carbon monoxide pollution were as much as three times as likely as women in areas with the cleanest air to give birth to infants with serious heart problems. Dr. Wendie Robbins, an assistant professor in the schools of nursing and public health, evaluates human sperm cells for chromosomal abnormalities resulting from environmental, occupational or lifestyle exposures. Her studies have looked at the effects of organophosphate pesticides, air pollution,
tobacco smoke, alcohol, caffeine, cancer chemotherapeutics and the antiretroviral agents used for HIV infection. Among other things, she has found that exposure to air pollution and tobacco smoke can lead to aneuploidy (an abnormal number of chromosomes) – subtle changes suggesting the need for further study. Aneuploidy is the largest single genetic cause of mental retardation and developmental disabilities. “By better understanding people’s reproductive risks from various environmental or occupational exposures, we can take measures to reduce those risks, prevent negative reproductive effects from occurring and promote healthy outcomes for parents and children,” she says. The realization that heart disease manifests differently in women than men – and indeed, that it is a leading killer for both sexes – marked a turning point in funding for women’s health research. Similarly, cancer control researchers such as Dr. Roshan Bastani, professor of health services and associate dean for research at the school, are attempting to change dangerous misperceptions among many women and their physicians. “A lot of women think that they are less susceptible than men to certain cancers,” she says. Bastani points out that although more women die of lung cancer than breast cancer, the myth that women are less
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susceptible to the disease might make them less likely to take preventive measures such as not smoking. Many women also mistakenly assume colorectal cancer affects primarily men, which could result in their not getting important screenings or reporting early symptoms. (See the related story on page 4.) Whether it’s a cancer affecting only females or both sexes, women often have different issues as it concerns prevention, early detection, treatment, quality of life, and adjustment to and rehabilitation from cancer, notes Bastani, who conducts research on access to care and barriers to cancer screening among low-income and minority populations. For example, research has suggested that women are more affected than men by the desire to smoke to control weight and by the perception that smoking controls negative moods; other studies have found that men and women respond differently to strategies for increasing coping and enhancing quality of life after cancer.
Dallas Swendeman, M.P.H. Swendeman, a doctoral student at the school, traveled to Calcutta, India last December to serve as project liaison on a World AIDS Foundation-funded evaluation of the Sonagachi Project, an empowermentbased STD/HIV intervention program for commercial sex workers in Calcutta and West Bengal. The project was conceived in 1992 as a health education program to promote condom use, but the intervention team quickly realized that there were strong barriers to condom use by the sex workers, including fears of violence and abuse by madams, pimps, police and clients – all indicative of the lack of power the women had over their lives. “The sex workers’ primary concerns were the basic survival needs of themselves and their children,” Swendeman explains. “Condom use ranked low on their list of priorities, even after they learned about their vulnerability to HIV/AIDS and STDs.” These barriers were addressed by creating a sense of solidarity among the sex workers, while simultaneously convincing the madams, pimps, and brothel owners that condom use was necessary for their economic survival: If the Sonagachi red-light area developed a reputation for STD/HIV infection, they would lose clients and money. Swendeman returned to India twice to provide technical assistance on research design, implementation, data analysis and publication to the project’s evaluation team.
Juli Byrum, M.P.H. ’00 Pregnancy, notes Byrum, is a time when women have many questions about their health and the health of their baby. As project director for the March of Dimes in Kern County, Byrum is in a position to answer many of those questions or direct women to resources that have the answers. The March of Dimes received funding from the Kern County Children and Families Commission (formed by the passage of Proposition 10) to conduct perinatal outreach and education. Programs in Kern County include prenatal education curricula, a monthly Spanish-language radio program, a print-media campaign educating women about the dangers of alcohol and drug use during pregnancy, and professional education about perinatal topics. The mission of the March of Dimes is to improve the health of babies by preventing birth defects and infant mortality. “Healthy babies come from healthy women, so I always take every opportunity to educate women about healthy behaviors, whether they are pregnant or not,” says Byrum, who has been known to share folic acid information and other important preconception health information at bridal and baby showers. “It’s very exciting for me when I have the opportunity to share some of the knowledge I’ve learned about pregnancy or other issues of women’s health with people in my community.”
UCLAPUBLIC HEALTH
When Dr. Susan B. Sorenson began studying violence against women in the mid-1970s, few considered it to be a women’s health issue, or even a public health concern. That has changed. “Violence against women is a clear threat to women’s health,” says Sorenson, professor of community health sciences. She notes that although men have higher rates of homicide mortality, when it comes to homicide as a cause of death, men and women rank similarly. “The big difference is that a woman is most likely to be killed by her male intimate in her home, while a man is most likely to be killed outside the home by a friend or acquaintance,” Sorenson explains. But Sorenson, whose research has examined the intersection of gender, ethnicity and nativity and its relationship to the risk of becoming a victim of violence, points out that domestic violence exacts a toll on women’s health beyond the mortality rates. “It’s also the injuries and emer-
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Dr. Wendie Robbins evaluates human sperm cells for chromosomal abnormalities resulting from environmental, occupational or lifestyle exposures.
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Laura Hoyt D’Anna,
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Cindy Chow,
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R.N., B.S.N., M.P.H. ’00 Chow had been working in the Los Angeles County Department of Health Services on a project to better align and coordinate county services when she was asked to help implement a pilot nurse home visitation program as a joint effort among the county, UCLA, and California Hospital and Medical Center. The NurseFamily Partnership Program targets first-time pregnant young women living in poverty for home visits. “The nurse-family partnership model was developed more than 25 years ago, and has demonstrated many benefits – including better birth outcomes, increased maternal self-sufficiency, and decreased criminal behaviors by the mother and even the first-born child at the age of 15,” says Chow, who serves as program coordinator/ nurse manager. When the L.A. County Board of Supervisors and Department of Health Services were interested in expanding the pilot project county-wide, Chow and the project director obtained funding, mapped the high-need areas of the county, hired staff and began program expansion and implementation. “We worked hard to make sure the project met the needs of the county’s many first-time, pregnant young women,” says Chow. “The experience has been very rewarding and has mightily contributed to my continued growth in the field of public health.”
Before enrolling in the school’s doctoral program, D’Anna accumulated more than a decade of experience in the development and administration of public and community health agencies and programs, most recently as vice president of community affairs for Planned Parenthood of Orange and San Bernardino Counties. Her interest in public health was piqued while completing her master’s in public administration. For her master’s thesis on HIV partner notification, she utilized the Long Beach Department of Health and Human Services as a case study. “I had wonderful experiences interviewing staff and the director at the time, Dr. Diana Bontá [currently director of the California Department of Health Services and a member of the UCLA School of Public Health faculty], and I decided that I was passionate about assisting in the efforts to halt the HIV epidemic,” D’Anna explains. Her commitment to assisting women of all walks of life in attaining quality health services led her to take the position at Planned Parenthood. “I also felt that the organization’s focus and successes in the area of teen pregnancy prevention were remarkable, and I wanted to support and improve those efforts if possible,” she says. After obtaining her doctorate, D’Anna intends to pursue a position that will enable her to make a significant impact on how health policies that affect disenfranchised populations are formulated, implemented and evaluated.
Dr. Susan Sorenson began studying violence against women as a women’s health issue at a time when few researchers viewed it that way.
gency department visits, court visits, time missed from work to deal with injuries or to avoid being seen with a black eye, the effect it has on kids and the emotional impact it has on a woman to be under this threat,” she says. One out of two Californians personally knows a victim of domestic violence, Sorenson has found in an ongoing statewide study examining knowledge and social norms about violence in intimate relationships. “We need to have a better understanding of how both the written and unwritten rules of society affect behavior,” she says. Sorenson was particularly interested in testing assumptions that have been made about the belief systems and norms within various ethnic and immigrant populations regarding domestic violence. In a survey of six ethnic and cultural groups taken in four languages, the findings have defied stereotypes, with fewer ethnic differences than expected. Dr. Anne Pebley, professor of community health sciences and Fred H. Bixby Chair, has studied the impact of relationship dynamics on women’s health from a different perspective. In Bangladesh, she and a colleague examined the effects of micro-credit programs – very small loans given to poor people, usually women, to start their own businesses. “It’s very clear that these programs had a huge impact on power dynamics within households,” Pebley says. The program, which has been replicated in other countries, affected such things as fertility-related decisions and the amount of money spent on health care, with women who received the loans having more say in these matters than those who did not. Analogous transformations – though on a different scale – have occurred in the United States in recent decades as more women have joined the workforce, Pebley notes. (See the profile of Pebley on page 8.) In developing countries, rural women’s health concerns tend to be much different from those in the urban areas, says Dr. Virginia Li, professor of community health sciences, whose studies have focused on health and capacity-
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Alice West Dalva, M.P.H. ’00
Debbie Lam, M.P.H. ’00
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Following graduation, Dalva and Lam worked at UCLA Reproductive Health Services co-directing a twoyear project to improve the health of women with developmental disabilities. The Lanterman-UCLA Peer Advocacy for Reproductive Health Project aimed to empower women with developmental disabilities to become peer advocates, educate them about women’s health and self-advocacy, and train providers on giving accessible, competent and sensitive care to women with developmental disabilities. “Historically, women with developmental disabilities have been among the least empowered in making decisions about their reproductive health,” notes Dalva, now a health educator at the Frank D. Lanterman Regional Center. Among other challenges, these women have been denied their rights to sexual expression, relationships, marriage, and parenting; been neglected in efforts to provide basic reproductive health information for informed decision making; and have not had equal access to basic reproductive health care. Lam, who is now working for the Institutional Review Board at UC Irvine, was struck by the enthusiasm and curiosity of the participants concerning reproductive health issues. “Many think that people with disabilities don’t have an interest or need to learn about reproductive health issues,” she says. “Working with these incredible women has taught me how wrong that presumption is.”
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building among women in rural villages of China. “In the cities, the women are more literate, have better access to health services and the standard of living is so much higher that there’s a tremendous advantage over women living where the environment is hazardous, often there is no clean water, and health care may be inaccessible due to lack of transportation,” she says. In such populations, she notes, women’s health is often still dominated by issues of maternal and child health, as well as social concerns such as education. Li and Dr. Roger Detels, professor of epidemiology, are pilot-testing a Web site designed to deliver health messages to village doctors and midwives, family clinic workers, teachers and village leaders who work with women in four rural counties in Yunnan, China. “Having worked in China for many years, we realized that one of the major problems in upgrading rural health services is the difficulty of communication between the rural areas and the central planning and educational resources,” Li says. “The establishment of a Web site dedicated to improving reproductive services and establishment of computer literacy in rural facilities is one step in closing the disparity gap between urban and rural areas.”
Increasingly in the international arena, women’s health is being framed within a human rights perspective, observes Dr. Joanne Leslie, adjunct associate professor of community health sciences. “In a sense, the most important women’s health issues in the world are poverty, lack of decision-making power, lack of education, and other human rights concerns such as lack of access to safe and legal abortion,” she says. “If we look at women’s health too narrowly in a disease or even healthcondition perspective, we risk overlooking the underlying causes as well as missing out on potentially powerful allies among the human rights activists and organizations.” Leslie finds that this broader view resonates in her own work in underserved communities of Los Angeles County, which focuses on inadequate access to food, sedentariness, and unbalanced diets. “Women tend to be the gatekeepers on dietary choices, not only for themselves but for their families,” she says. “And women need the empowerment of access to information as well as income and safe and convenient neighborhoods in order to make the healthiest nutrition choices for themselves and their families. There has been excessive focus on individual-level behavior, and not enough on the barriers that they face in terms of poverty and access to good-quality food, transportation and unsafe environments.” Societies that pay no heed to women’s health issues invite problems far greater than the harm done to individual women, says Dr. Jared Diamond, a Pulitzer Prize-winning UCLA scientist on the faculty of the schools of public health and medicine. Diamond studies past societies whose population growth and resulting demands on the environment resulted in their overexploiting their resources, with the result that the society collapsed. Countries with very high reproductive rates, for example, produce a population top-heavy with children, with a shortage of adults to support them financially, nutritionally and educationally. Ultimately, Diamond notes, the population becomes too large for the environment to support, often leading to unpleasant methods of population control such as war and starvation. “The lesson for today,” Diamond says, “is that if one neglects women’s health and population issues, it’s not only a tragedy for the women, but ultimately it’s a disaster for the entire society.”
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SCIENCE + politics
IMPROVING POPULATION HEALTH DEMANDS ACADEMICS ’ PARTICIPATION IN THE POLITICAL PROCESS BEYOND PUBLISHING RESULTS .
Translating Science into
POLICY
The Role of Public Health Researchers in the Debate As a society, we rely on good decisions to form policies that affect our lives. But what is policy, and how is it created? Dean
Linda Rosenstock, who came from academia to confront policy issues head-on as director of the National Institute for Occupational Safety and Health in Washington, D.C., defines policy as science plus politics. “Often times, it is difficult for the public to know where the science ends and the politics begin,”
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she says. “The role for our faculty is not only to produce quality science, but also to ensure that the science is used to inform policy decisions.” A prominent alumnus and policy maker echoes the importance of this role. “It’s often naïve to think that publication in a professional journal will do anything to influence policy or other decisions that might be very important,” says Kenneth W. Kizer, M.D., M.P.H. ’76, who was director of the California Department of Health Services for more than six years, recently completed a five-year stint as under secretary for health in the U.S. Department of Veterans Affairs and is now president and CEO of the National Quality Forum. “If researchers really want to have their results influence something, they have to
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make sure they get them into the hands of people who make the decisions.” Many academics cringe at the notion of venturing away from the pristine realm of peerreviewed journals and seemingly value-free science and into the political battleground on which policies are decided. But in the field of public health, there is a growing sense of a special obligation to go beyond publishing results. “We tend to do applied research involving real-world interventions that affect the health of populations,” says Dr. Gerald Kominski, professor of health services and associate director of the UCLA Center for Health Policy Research. “The opportunity to have an impact on policy is why many of us got involved in the field in the first place.” The commitment to engaging more actively in the public health policy process is reflected in the school’s current strategic plan. “Translating our science into actions that will improve public health is a very important part of our mission,” says Rosenstock. “We want to help facilitate the efforts of our faculty to disseminate and interpret their findings, create an environment in which this is a valued aspect of what they do, and make sure
Direct contact with policy makers, such as through invited testimony or face-to-face meetings, represents only one of many ways that faculty at the school make an impact on the policy process. Dr. Ronald Andersen, professor of health services, contends that, while going beyond the publication of findings is important, advancing the research literature on a topic of policy significance is a critical prerequisite. In addition, he notes, faculty influence policy by teaching future public health decision-makers. “Students are our most important product, and we can help prepare them for positions in which they can make a difference,” he says. Outside of the university, Andersen is among a number of faculty from the school who serve on important statewide, national or international committees. Andersen is on the Institute of Medicine’s “Consequences of Uninsurance” committee, which was formed to assess the evidence and then communicate to the public the burden of lacking health insurance both on the uninsured and on their families and communities. Dr. Gail Harrison, professor and chair of community health sciences, serves on an IOM committee on the implications of dioxin, a compound recently shown to have carcinogenic and other harmful effects, in the food supply. Rosenstock serves as co-chair of the IOM Committee on Educating Public Health Professionals for the 21st Century. Dr. John Froines, professor of environmental health sciences and director of the Center for Occupational and Environmental Health, chairs the influential Scientific Review Panel of the California Air Resources Board – a committee that has had a profound effect on the regulation of air toxics in California, including its recommendation that diesel exhaust be regulated as a human carcinogen and by approving risk assessments for more than 100 chemicals. Public health professionals and academics also can make a difference by helping to strengthen public health institutions, notes Dr. Lester Breslow, professor emeritus, former dean of the school and one-time director of the California Department of Health Services. “We can, and should, participate in and lend expertise to state and local health departments, federal and international health agencies, and non-governmental organizations that are concerned with issues affecting the health of populations,” he says. As a California state legislator with a strong interest in health issues, Assemblyman Keith
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= POLICY
that policy is an important part of the education of the future public health leaders who enroll in our school.”
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“We should participate in and lend expertise to state and local health departments, federal and international health agencies, and nongovernmental organizations that are concerned with issues affecting the health of populations.”
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—Dr. Lester Breslow Richman, M.D., M.P.H. ’83, sees more than his share of public health studies. But there are many more that he doesn’t see. “I get piles and piles of mail every day, so making me aware of academic findings requires a proactive approach on the part of the academician,” says Richman, who has recently met with faculty on issues of the uninsured and bioterrorism. “It’s very important for public health researchers to be involved in the policy discussion.” Mara Baer, M.P.H. ’01, a Congressional fellow with Sen. Edward M. Kennedy’s Health, Education, Labor and Pensions Committee, observes that public health researchers often become an extension of the legislative staff. “Staff rely on researchers to provide solid, unbiased information and to raise awareness about emerging public health issues,” she says. “Without the important work and input of university public health researchers, policy makers would be ill-equipped to make informed public health decisions.” In other cases, researchers can empower others to make the case for particular policies. Visibility in the news media helps to promote public understanding of the need for science-based health policies, which in turn can have an impact on elected officials. Many faculty conduct research for private foundations that have an expressed interest in using the findings to influence policy. Advocacy groups, armed with the researcher’s data and assistance where needed, are often the best vehicle for disseminating information to policy makers and mobilizing support in the community. Recently, a grassroots campaign led in part by the California Center for Public Health Advocacy resulted in a decision by the Los Angeles Unified School District (LAUSD) to ban the sale of sodas in its schools, and by the California Legislature to establish nutritional standards for foods and beverages sold in elementary schools throughout the state. Helpful in supporting this effort, says Harold Goldstein, M.S.P.H. ’89, Dr.P.H. ’97, the center’s executive director, was a 1998 UCLA School of
Public Health study by Drs. Charlotte Neumann and Wendelin Slusser in which 40 percent of LAUSD elementary school students were found to be overweight or obese. Slusser subsequently spoke at a town-hall meeting sponsored by the center. In some cases, the demands of academic scientists and those of policy makers are so different that working in concert toward the public good is challenging. “Research that provides useable data is critical to sound policy making,” says Kizer. “But the problem that policy makers are very frequently confronted with is that issues of policy importance are not necessarily of academic importance, and the timeline of public policy development is generally much shorter than the research timeline. Quite simply, policy frequently cannot wait for all of the research questions to be answered. Many investigators have a hard time understanding that and delivering research to policy makers in a timely, useable manner.” In some cases, Kizer observes, short-term, policy-driven research lacks the “purity” that academicians prefer. “It might not be pure, but it might be very helpful in guiding a policy decision,” he says. In choosing his research topics, Dr. E. Richard Brown, professor and director of the UCLA Center for Health Policy Research, says he is driven not only by findings reported in the literature, but also by input he seeks from the populations affected by his studies, the community-based groups advocating for those populations, and the policy makers whose decisions affect their health. “I use those groups as sources to better understand what issues are important, and then I draw conclusions about how I can best contribute through research that will shed light on a given issue and help identify policy options for improving outcomes,” he explains. Dr. Susan B. Sorenson, professor of community health sciences, says her research, too, is increasingly shaped by policy concerns. Sorenson, who conducts studies on violence and firearms issues, recently met with staff at the California Department of Justice to brainstorm on domestic violence research questions that would best advance the knowledge base of the field and inform future legislation. While advocates use her findings to advance their positions, Sorenson tends to keep her personal opinions on policy matters to herself. “Whether I like a policy or not isn’t relevant,” she says. “My role is to lay out the logic by showing what our research indicates – to provide data that would be useful in informing decisions, but not to give my opinion about what decision should be made.” Froines proposes that the issue of whether an environmental or occupational risk assessment process is fair, adequately addresses equity, empha-
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The UCLA Center for Health Policy Research produces policy briefs and reports for use by decision-makers.
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Where public health is an issue, scientists should recognize the need for protective interventions even when the available information may be uncertain or have significant variability, Froines says. He is concerned the requirement for greater proof may have significant health consequences and ultimately can serve as a delaying tactic rather than being meaningful. “We have to worry about the call for ‘sound science’ where it limits protection,” he says. Breslow points out that the basis for the U.S. Surgeon General’s landmark report on smoking and health in 1964 was well established more than a decade earlier by a number of studies, including two conducted by the California Department of Health Services. More recently, opponents of a national ergonomics standard have successfully argued that the science is lacking, despite compelling data that indicates the opposite. The same argument has been made, with varying degrees of success, by opponents of regulations to reduce global warming, diesel exhaust and the level of arsenic in drinking water. “It’s important that we have an active voice,” says Rosenstock, “because there are a lot of forces that might try to distort the science to reach a different policy outcome than would naturally follow had the science been heeded.” Naturally, having an active voice or otherwise participating in the policy-development process doesn’t ensure the desired result. Andersen devoted much of his early career to involvement in what were thought to be baseline studies that would document conditions prior to implementation of a national health insurance plan. The effort wasn’t fruitless, playing a role in the 1965 passage of Medicare. Yet, 40 years later, despite powerful evidence from these and other studies of the societal importance of comprehensive coverage, some 15 percent of the U.S. population remains uninsured. Recent history is also full of examples of issues on which the arguments of public health researchers and advocates have carried the day: from immunization policies, sanitation and pollution control to more stringent tobacco policies and the legalization of abortion – a court decision that was facilitated by public health studies, notes Dr. Ruth Roemer, a member of the school’s faculty who has played a leading role on the issue for more than three decades. Brown suggests that public health research, particularly when findings are well disseminated, has the power to draw attention to the problems and, as a result, compel policy makers to put these issues on the agenda for policy action. “Our research can help to shape the debate,” he says, adding that once the issue is on the table, coalition-building and other political activities play a larger role. Rosenstock supports the active involvement of the faculty in using the best science to influence policy decisions. “The ability to maintain the capacity for evidence-based policy is vitally important to our society,” she says. “Our faculty are well positioned to defend the best science and recognize the interface between science, politics, and policy.”
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sizes openness, and ultimately sets explicit goals for public health protection is a matter for public discourse and decision-making. “The research and evaluation work of scientists should inform the public policy decisions,” says Froines, “but the ultimate decisions on the level of public health protection are issues of social values and public decision-making.” He offers as examples the replacement of diesel vehicles with alternative technologies, the regulation of arsenic in water, and the use of perchloroethylene in dry cleaning. “These are ultimately public policy decisions made with the use of evaluations by scientists.”
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student profiles Running Free Clinic in South-Central Los Angeles, Executive M.P.H. Student Puts “Faith into Action”
“I fell in love with the place, and realized there was more to health than medicine.”
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—Yasser Aman
JUST A FEW YEARS AGO, YASSER AMAN was a UCLA undergraduate majoring in molecular biology and intending to enroll in medical school. But something happened along the way. Aman began to volunteer at the upstart UMMA (University Muslim Medical Association) free clinic, founded by UCLA and Charles R. Drew University students as a place for the indigent and underserved community of South-Central Los Angeles to receive no-cost health care from volunteer physicians and medical students. “I fell in love with the place, and I realized there was more to health than medicine,” Aman says. In 1999, a year out of college, Aman was named executive director and CEO of the clinic. He was 24. UMMA, though conceived as a vehicle for the Muslim community to provide service, is run by and for the community at large. The vast majority of the patients are Latino and African American, many of whom have no employment-based insurance and do not qualify for Medi-Cal; volunteer physicians come from all over Southern California, UCLA medical students fulfill their third-year community medicine rotation there, and UCLA undergraduates continue to follow in Aman’s footsteps as volunteers. After his meteoric rise to the leadership position at UMMA, Aman realized he knew little about health services management. He began to aggressively educate himself, enrolling in extension classes and, eventually, in the school’s executive style M.P.H. for Health Professionals in Health Services Management program. There’s been no shortage of challenges in running a free clinic at a time when fiscal woes have led to the closure of 11 Los Angeles County-run clinics, many of which were initial access points for the uninsured. “I’m struggling to figure out how we’re going to handle the influx of patients,” Aman says. Although UMMA has few paying positions, securing the funding needed to cover overhead costs is becoming increasingly difficult as the economy suffers and foundations tend to be more attracted to start-up projects. Meanwhile, the 3,000-square-foot facility seems smaller every day as the waiting rooms overflow with patients. (UMMA hasn’t needed to advertise its services since 1996, the year it first opened its doors.) Aman says his ability to meet these challenges has been greatly enhanced by the M.P.H. program, in which he has begun his second year. “It’s an amazing program, especially for people who are in a management position,” he says. “From the beginning, I would learn something one day and implement it the next. That practical knowledge is so helpful.” His appetite whetted, Aman is considering continuing his studies in the school’s Dr.P.H. program. But regardless of his future educational plans, he has no intention of leaving UMMA any time soon. “This clinic is like my baby,” he says, “and I plan to be here to help it mature.” From a personal standpoint, Aman, himself a Muslim, says the most rewarding aspect of going to work every day is that “It’s an obligation for every Muslim to help humanity, and I am fulfilling that obligation. This position enables me to put faith into action.”
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Nurse/Teacher/Advocate Finds Time for Doctoral Studies 21
student profiles
“I can be an advocate, helping kids physically, mentally and socioemotionally so that they have a good trajectory in life.” —Kynna Wright
UCLAPUBLIC HEALTH
KYNNA WRIGHT IS BUSY — teaching, running a program, advocating for maternal and child health, and seeing patients as a certified pediatric nurse practitioner. Oh, and she also finds time to meet the rigorous demands of a UCLA School of Public Health doctoral student. After earning a master’s degree in nursing in 1997, Wright entered the school’s M.P.H. program. Two years in the school’s Child and Family Health Program – an interdisciplinary training program for health professionals in practice, research and policy analysis, directed by Dr. Neal Halfon – changed her clinical perspective. “I’m able to help my patients much more,” says Wright, who currently works at two community-based clinics. “Before the M.P.H., I had a patient with a cockroach in his ear. I was able to treat the infection, but didn’t quite know what to do with the underlying problem at home. The patient’s mother was looking for me to refer her to various social services, and I didn’t know how.” Now, Wright says, she not only treats patients’ medical problems, but also examines factors such as housing, transportation and access to care. “That’s made a world of difference,” she says. Through the Child and Family Health Program, Wright met Vivian Weinstein, the renowned child advocate who became Wright’s mentor. Before she died, Weinstein saw one of her dreams come to fruition when The Vivian Weinstein Child Advocacy Fellowship program was established within the school’s Center for Healthier Children, Families and Communities. Wright is the manager of this program, which provides an opportunity for students to gain the knowledge, skills, and tools necessary for child advocacy while spending a year with a communitybased program or policy-oriented group focused on improving children and family programs. Wright’s interest in policy has landed her on several advisory boards and has taken her to Sacramento, where she has lobbied on behalf of the March of Dimes and L.A. Care Health Plan. She worked for the California Children and Families Commission, helping to implement Proposition 10 (First 5), the cigarette-tax initiative that created new revenue for early-childhood programs. Wright is in her fourth year as a doctoral student at the school, studying the special health needs and quality of care for disadvantaged children with HIV and AIDS. She is the first recipient of a new California Endowment initiative that supports students working in underserved communities. Once she earns the degree, Wright hopes to keep one foot in academia – but doesn’t intend to stop seeing patients. “I’m first and foremost a nurse,” she says. “I love that role, and as an African American woman, since there are not too many of us out there, I feel it’s important not only personally but also to be a mentor to others.” So she teaches – at the UCLA School of Nursing and, last spring, at the first offering of Allied Health 35, an introductory public health course for high school and community college students, offered at Compton Community College through the UCLA School of Public Health. “That was an extremely rewarding experience,” Wright says. “Seeing the light bulbs go off in these kids and having many of them decide they wanted to become public health practitioners was really exciting.” Wright laughs when the subject turns to her frenetic schedule. “Time management is key,” she says. “There’s just a lot to do, and the opportunities keep presenting themselves. While I have the energy, I want to take advantage.”
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research highlights
UCLAPUBLIC HEALTH
BEING ON OR WITHIN 50 METERS DOWNWIND OF A FREEWAY may expose individuals to particle concentrations up to 30 times greater than normal background concentrations, according to new findings published by a UCLA School of Public Health team. With many Los Angeles residents living and working near freeways or major roadways, and 10 million vehicles contributing to daily traffic, mobile-source air pollution is a concern of great importance. The research findings of Yifang Zhu and Dr. William C. Hinds show that proximity to a freeway dramatically influences exposure to ultrafine particles (particles less than 0.1 micrometers in diameter), which may in Relative Ultrafine Particle Number turn have important health consequences. The federal Environmental Protection Concentration vs. Distance from Agency currently regulates particles less than 2.5 the Edge of the Freeway micrometers in diameter; the ultrafines represent the very smallest particles inhaled by the public. 1.0 “We believe this is the first study in the United States to provide detailed spatial profile of ultrafine particles near freeways,� says Hinds, professor of environmental health sciences. 0.8 Two projects by Hinds and doctoral candidate Zhu, conducted through the Southern California Particle Center and Supersite (SCPCS), aimed to 0.6 assess the size distribution and concentration of ultrafine particles near major freeways. The first study focused on Interstate 405, one of the busiest free0.4 ways in the United States, with 93 percent of the traffic composed of gasoline-powered vehicles. The second study looked at the 710 Freeway, which has more than 25 percent of its traffic consisting of heavy0.2 duty diesel trucks. The studies were designed to provide scientists with a way to predict exposure concentrations to ultrafine particles near freeways in 0.0 order to facilitate health studies and provide data for -100 0 100 200 300 the development of an air quality standard for ultraDistance in the Wind Direction (left to right) from the Edge of the Freeway (m) fine particles. By taking measurements of particle number and size at varying distances from the 405 and the 710, Zhu and Hinds showed that ultrafine particle number concentration near both freeways was approximately 25-30 times greater than upwind concentrations. The drop in ultrafine particle number concentrations occurred rapidly with increasing distance from the freeway, falling to 30 percent of peak concentration at 100 meters. This is due to many factors, including atmospheric dispersion, coagulation, wind direction, and speed. Recent toxicological studies have shown that ultrafine particles may be more toxic than larger particles, potentially leading to increased mortality and illness with increased exposure to particulate matter. Ultrafine particle exposure has been associated with neurological changes, mild pulmonary inflammation, and perhaps cardiovascular effects. The most significant source of ultrafine particles in urban environments is motor vehicle emissions. FREEWAY
Ultrafine Particle Number Concentration (Relative Scale)
First U.S. Study on Ultrafine Particles Near Freeways Measures Exposure to Potentially Dangerous Toxins
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SALES OF BOTTLED WATER TRIPLED FROM 1988 TO 1998, and more than half of the U.S. population now drinks bottled water, despite the fact that it costs from 240 to more than 10,000 times more per gallon than tap water. The most common reasons for the preference are taste and the perception of greater safety – an assumption that there is a lower concentration of microorganisms and chemical pollutants in bottled water. But, according to a review by Dr. I.H. (Mel) Suffet, professor in the school’s Environmental Science and Engineering Program, tap water is at least as safe as bottled water. In an article published by the UCLA Institute of the Environment as part of its annual Southern California Environmental Report Card, Suffet notes that standards for tap water in the United States are more rigorous than bottled-water standards for chemicals. In California, he adds, standards are comparable. What explains the difference between perception and reality? “In relation to the safety and taste and odor issues, when was the last time you observed a public drinking water utility advertise the healthy attributes of its drinking water?” Suffet says. “On the other hand, when was the last time you observed bottled water advertised and, by innuendo, indicate it is purer, safer and better regulated than tap water?” Suffet notes that until recently, the main concern of most drinking-water utilities has been meeting health-based safety standards. Meanwhile, consumers tend to equate drinking-water safety with water-quality aesthetics, including taste and odor. “These two objectives are not the same,” says Suffet, calling on utilities to do more to address these secondary aesthetic concerns. “Inexpensive drinking water will depend upon maintaining our natural water resources and minimizing microbiological and chemical contamination,” says Suffet. “However, the general public must be part of the debate of how to maintain water resources, how much to pay for new water treatment options, and how to help define what is good water quality.” As for taste, Suffet says, “Water purveyors should value tap water the same as any essential food product, and address off-flavors with the same effort as meeting drinking-water standards.” The report is at www.ioe.ucla.edu/publications/report01/BottledWater.htm.
research
When it Comes to Bottled Water, Public Perceptions Often Don’t Match Realities
Sales of bottled water tripled from 1988 to 1998, and more than half of the U.S. population now drinks bottled water, citing taste preference and safety concerns.
Kenya Findings Highlight Importance of Food-Based Solutions to Combat Multiple Micronutrient Deficiences
UCLAPUBLIC HEALTH
IN A STUDY CONDUCTED BY Drs. Charlotte Neumann of the UCLA School of Public Health and Nimrod Bwibo of the University of Nairobi, the addition of meat and milk to the daily diet of school-age children in Kenya not only eliminated severe vitamin B-12 deficiency, but significantly boosted the children’s cognitive abilities, leadership behaviors, physical activities and muscle mass. The research was funded by the U.S. Agency for International Development and the Global Livestock Program. Neumann contends that food-based solutions are required to combat the problem of multiple micronutrient deficiencies. “Food-based solutions are potentially far more sustainable than long-term distribution of pills and capsules, particularly in rural areas,” she says. “As a colleague of mine says, we need to go back to the farm – not to the pharmacy.”
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Effect of Meat Intervention on Cognitive Function in Kenyan School Children 21
COGNITIVE FUNCTION SCORE
FOOD SUPPLEMENTATION Control Non-Animal Source Meat Milk
20
19
18
17 -0.5
0
0.5
1 TIME (Years)
The researchers concluded that significant gains can be made in cognitive performance over time when both the quality and the quantity of the diet are substantially improved. The four-year study in Kenya was the first to demonstrate a causal relationship in children in a rural area of a developing country, underscoring the importance of improving nutrition in order to improve mental development. Meat, added to the diet of school children, resulted in a statistically significant increase in cognitive abilities when compared to diets supplemented with milk or additional calories from non-animal source foods, and to a control group. The findings were highlighted at an international conference of nutritionists and agriculturists who gathered recently at the University of California’s Washington Center in Washington, D.C. They noted that, in the world’s impoverished countries, animal-based foods, which are being reduced in segments of the population, represent a concentrated gold mine of critically needed micronutrients and energy. With that in mind, the conference participants argued that international funding agencies and relief organizations should help to put more of these foods into the mouths of chronically malnourished people, particularly children and pregnant and lactating women. “For too long, we in the developed world have been practicing a form of nutritional imperialism,” said Dr. Montague Demment, director of the UC Davis-based Global Livestock Collaborative Research Support 1.5 2 2.5 Program. “Because we struggle with the health consequences of an overabundance and overconsumption of meat and other animal-based foods, we forget that these same foods are a rich source of energy, iron, zinc and other micronutrients that are vitally important, particularly for children. Micronutrients are needed to ensure that these children not only survive but develop to their full mental and physical capacity.”
UCLAPUBLIC HEALTH
Emotional Injury from Natural Disaster Heightens Preparation for Next Event, Survey Indicates BEING EMOTIONALLY INJURED BY A NATURAL DISASTER is associated with better preparedness for a subsequent disaster, according to an analysis by UCLA School of Public Health researchers, who also found that the emotional scars from the first disaster predispose individuals to emotional injury from the second. More than 400 respondents studied after the 1994 Northridge earthquake were re-contacted four years later to determine whether that experience impaired or enhanced their ability to deal with a second natural disaster – the slower, more predictable onset of the 1998 El Niño weather pattern. The research team – Drs. Linda Bourque, Judith Siegel and Kimberley Shoaf – found that, while sustaining financial damage from or being physically injured by the Northridge quake were not predictors of preparedness for El Niño, those who were emotionally injured by the quake, on average, performed more of the preparedness activities (such as cleaning rain gutters) recommended by government and service agencies prior to
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El Niño than those who were not emotionally injured by the Northridge experience. “These findings are consistent with the notion that self-perceived emotional injury, which likely reflects anxiety and depression, is fueling a heightened sensitivity to messages about an impending disaster, even three years past the initial event,” says Siegel. “One way to manage anxiety about an impending disaster is to prepare. From this perspective, emotional injury facilitates appropriate preparation.” On the other hand, the researchers found that sustaining an emotional injury from the Northridge quake made individuals much more likely than those with no quake-related emotional injury to experience emotional injury from El Niño – and increased the likelihood of reporting property damage from the second disaster, independently of whether one was emotionally injured by that event. “It is notable that neither physical injury nor property damage in Northridge had an impact on reports of damage in El Niño, suggesting that it is something unique to emotional responses that is contributing to this effect,” says Siegel. In addition, the researchers noted, there was no relationship between overall mental health status and reports of damage from the disasters, suggesting that emotional injury in response to a natural disaster is more than merely a proxy for poor mental health.
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research
Strategies Identified for Increasing Cancer Screening In Asian American and Pacific Islander Women
Cancer screening-related outreach and education programs are being conducted in seven Asian American and Pacific Islander communities in Los Angeles and Orange Counties as part of the Promoting Access to Health Project for Pacific Islander and Southeast Asian Women.
UCLAPUBLIC HEALTH
ASIAN AMERICAN AND PACIFIC ISLANDER (AAPI) WOMEN have the lowest breast and cervical cancer screening rates of all ethnic groups, and are the only ethnic group in which breast cancer is the leading cause of cancer-related mortality. The reasons include a lack of in-language materials and recommendations by health care providers as well as structural, language and cultural barriers to screening, according to a needs assessment conducted by Dr. Marjorie Kagawa-Singer, associate professor of community health sciences, along with Dr. Sora Park Tanjasiri and Mary Anne Foo (both of whom are UCLA School of Public Health alumni). The Promoting Access to Health (PATH) Project for Pacific Islander and Southeast Asian Women, formed as part of the Centers for Disease Control and Prevention’s REACH 2010 Program, aims to reduce the disparities in breast and cervical cancer screening for seven AAPI populations (Cambodian, Chamorro, Lao, Samoan, Thai, Tongan, and Vietnamese) in Los Angeles and Orange counties. The pilot needs assessment, based on focus groups and survey interviews in each of these seven communities, was conducted to determine the best way to design and implement outreach and education efforts. Breast cancer is the leading site for cancer incidence and mortality for AAPI women in the nation, according to research previously conducted by KagawaSinger and colleagues. Moreover, cervical cancer rates for many AAPI women are significantly higher than for white women. “Despite the fact that AAPI women have the lowest breast and cervical cancer screening rates of all ethnic groups, few programs have specifically targeted these women to promote and sustain screening practices,” says Kagawa-Singer. The pilot study for PATH found that the proportion of women who reported performing breast self-examinations ranged from 40 percent (among the Cambodian women) to 70 percent (Chamorro women), with an average of 52 percent. The proportion reporting ever having received a clinical breast exam ranged from 10 percent (Tongan women) to 87 percent (Laotian women), with an average of 69 percent. The proportion obtaining yearly mammograms ranged from 19 percent (Tongan women) to 77 percent (Vietnamese women), with an average of only 50 percent. Only 10 percent of Tongan women had ever had a Pap smear test,
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vs. 97 percent of Chamorro women, with an average of 70 percent across all communities. Only 43 percent of the AAPI women in the survey received Pap tests yearly. The findings identified unique needs within each community, along with common themes and needs across all seven groups. A more comprehensive survey will expand on these findings, and culturally tailored, in-language outreach efforts and education programs are being conducted in each of the communities.
research
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Comprehensive Assessment of Health Care for Young Children Indicates Room for Improvement
UCLAPUBLIC HEALTH
0%
Ipecac
Toilet training
Guidance & discipline
Reading
Words and phrases
Weaning
Car seat
10%
Food/feeding
20%
Immunizations
30%
Sleeping w/bottle
40%
Night waking & fussing
50%
Child care
Parent Reports of Topics Not Covered in Health Care Visits
THE FIRST COMPREHENSIVE ASSESSMENT OF ACCESS and the content and quality of health care for young children in the United States has been developed by the Center for Healthier Children, Families, and Communities and several collaborator agencies and organizations. The National Survey of Early Childhood Health (NSECH) provides new information on the health-promoting behaviors of parents with young children, such as reading and injury prevention. The report was developed by the UCLA School of Public Health-based center in conjunction with the American Academy of Pediatrics, the Centers for Disease Control and Prevention, the National Center for Health Statistics, the Foundation for Accountability, and the Maternal and Child Health Bureau. “Prior national surveys indicate that parents want information and guidance to optimize their child’s development,” says Dr. Moira Inkelas, assistant professor of community health sciences and a co-investigator on the study. “Some children with developmental problems are identified at school entry, not earlier. This is a policy concern facing many states and is relevant to statewide ‘school readiness’ initiatives such as California’s First Five (Proposition 10 Commission).” The survey found that most parents of young children discuss traditional topics such as immunization, food and feeding with their child’s pediatric provider. Yet, despite professional standards for health supervision issued by the American Academy of Pediatrics and the Maternal and Child Health Bureau’s “Bright Futures” initiative, not all parents discuss psychosocial topics or developmentally relevant issues such as the child’s experiences in, or the quality of, child care. “These patterns of care have important policy implications by pointing to missed opportunities in pediatric care to promote children’s development and well-being,” Inkelas says. She notes that well child visits are where almost all young children in the United States have contact with professionals trained in health and development. These visits provide a potential opportunity to address developmental and psychosocial needs, in addition to traditional medical concerns. Few studies have looked at parents’ perspectives regarding health supervision visits. “It is important to understand parenting practices in early childhood, and parent needs for services and support,” says Inkelas. “NSECH gives us a snapshot of the quality of early childhood services.” NSECH provides nationally representative data on health care in early childhood. It includes a large oversample of African American and Hispanic children and can thus be used to identify racial/ethnic disparities in health care content and unmet needs. For more information, see http://www.cdc.gov/nchs/data/slaits/ summary_sech00.pdf.
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new faculty
Babette Brumback
Paul Fu, Jr.
Jon Fukuto
David Hayes-Bautista
DR. BABETTE BRUMBACK (Biostatistics) received her Ph.D. from UC Berkeley, completed postdoctoral training at the Harvard School of Public Health, and served three years on the faculty of the University of Washington before arriving at UCLA. Her research focuses on improving analysis and design of observational studies and subsequent interventions pertaining to AIDS and sexually transmitted diseases. Brumback’s methodologic research interests in causal modeling of longitudinal data are central to these aims. She recently developed a statistical model useful for settings in which individuals less likely to receive treatment might benefit more from it, as can happen with differential access to care. Ongoing collaborative research includes an observational study of newly homeless youths and an intervention study in secondary schools with high STD and teen pregnancy rates. DR. PAUL FU, JR. (Health Services) received his M.D. from the Boston University School of Medicine in 1993 and his M.P.H. from the UCLA School of Public Health in 1999, supported by the UCLA Center for Healthier Children, Families, and Communities’ Maternal and Child Health Training Program. He has a joint appointment in the School of Medicine’s Department of Pediatrics. Fu is medical director for information systems and part of the Office of the CIO for the Los Angeles County Department of Health Services. His research interests lie in applied medical informatics and public health informatics, an emerging discipline that focuses on the intersection of computer and information science with public health practice, research, and learning. Among other things, he is exploring the development of integrated population health data repositories and integrated training programs for public health informaticians.
DR. DAVID HAYES-BAUTISTA (Health Services), also a professor in the School of Medicine, studies Latino demographics and health policy, culturally effective care delivery, and Latino culture, identity and behavior. He established the UCLA Center for the Study of Latino Health & Culture in 1992 to provide a focus for efforts related to teaching, research and public service in the “Latino epidemiological paradox” – the fact that, despite having high risk factors such as low income, low education, and poor access to health care services, Latinos have relatively low rates of heart disease, cancers, strokes, and most other common causes of illness and death, in addition to unexpectedly good birth outcomes. The focus on community-wide and population-based culturally oriented research provides a natural cross-over to the School of Public Health, where he will make his research team and data available to colleagues studying the health of California’s multicultural population. Other new faculty appointments include MARY ANN LIMBOS and SCOTT HALDEMAN (Epidemiology); and ROBERT NORDYKE (Health Services).
Two visiting faculty are also teaching at the school in 2002-03. DR. ROBERT KIM-FARLEY, a prominent medical epidemiologist in the international health field, is on assignment from the Centers for Disease Control and Prevention. In addition to working on bioterrorism and global health at the school, he is assisting the Bioterrorism Preparedness Program of the Los Angeles County Department of Health Services to strengthen the county’s epidemiology capacity and, thus, preparedness for potential or real acts of terrorism and other public health emergencies. DR. ADRIANA BABAN will join the Department of Community Health Sciences as a visiting professor this spring for the second year in a row. Baban, a professor from Babes-Bolyai University in Romania who holds a doctorate of psychology, will teach Advanced Research Topics in Community Health Sciences: Social and Behavioral Dimensions of Public Health in Central and Eastern Europe. Her presence on campus will be sponsored by the UCLA Center for European and Eurasian Studies.
UCLAPUBLIC HEALTH
DR. JON FUKUTO (Environmental Health Sciences) has received a joint appointment in the School of Public Health, having served on the faculty in the UCLA School of Medicine’s Department of Molecular and Medical Pharmacology since 1989. He was the principal investigator of a grant from the National Heart, Lung and Blood Institute to study the biological activity of N-Hydroxy-L-Arginine, an understanding of which could lead to the development of new strategies for the treatment of infection or cancer. Fukuto currently heads a National Science Foundation-supported study seeking to validate the cellular biochemistry of nitric oxide by examining its chemical and biochemical interactions
with two proteins. Prior to joining the UCLA School of Medicine faculty, Fukuto, who earned his Ph.D. in biochemistry from UC Berkeley, was a research chemist in the private sector, where he studied the metabolism and environmental fate of pesticides.
faculty
Seven individuals joined the UCLA School of Public Health faculty for 2002-03.
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contracts & grants 2001-02 DEBORAH L. ACKERMAN OCD Treatment Outcomes: Beyond Phase 3 Drug Trials (NIH/National Institute of Mental Health, $95,941) Grants cover the fiscal year from July 1, 2001 to June 30, 2002. Due to space limitations, only grants of $50,000 and above are listed. Grants are listed by principal investigator.
ABDELMONEM A. AFIFI Pacific Public Health Training Center (PPHTC) (DHHS/Health Resources & Services Administration, $378,191) RICHARD F. AMBROSE Environmental Monitoring and Bioassessment of Ventura and Los Angeles County Watersheds (CA/Water Resources Control Board, $125,000); Feasibility Study for the Restoration of Natural Resources in Rocky Intertidal Habitats in Santa Monica Bay (CA/Coastal Conservancy, $88,421) RONALD M. ANDERSEN UCLA/RAND Health Services Research Training Program (DHHS/Agency for Health Care Research and Quality, $385,249); Community Based Dental Program to Improve Access (Planning Phase) (Robert Wood Johnson Foundation, $150,000) CAROL S. ANESHENSEL Neighborhood, Socioeconomic Status, and Adolescent Distress (NIH/National Institute of Mental Health, $264,247) MARION T. BAER Leadership Training in Maternal and Child Nutrition (DHHS/ Health Resources & Services Administration, $256,395) ROSHAN BASTANI UCLA Cancer Education and Career Development Program (NIH/National Cancer Institute, $409,581); Asian American Network for Cancer Awareness, Research & Training (Ohio State University, $162,000); Understanding Why Asians Do Not Participate in Genetic Evaluation and Susceptibility Testing for Breast Cancer (U.S. Army/Medical Research Acquisition Activity, $76,500) THOMAS R. BELIN Imputation for Moderate Sized Mental Health Studies (NIH/National Institute of Mental Health, $266,780); Geographic Variation in Alcohol, Drug Abuse, and Mental Health Services Utilization: What Is the Role of Physician Practice Patterns? (Robert Wood Johnson Foundation, $101,012)
UCLAPUBLIC HEALTH
EMIL BERKANOVIC Statewide Technical Assistance Training of Unserved/ Underserved Domestic Violence Agencies (Interface Children and Family Services, $148,825) BARBARA A. BERMAN Breast Cancer Prevention and Control Among Deaf Women (UC/Breast Cancer Research Program, $73,772); School Based Anti-Tobacco Programs for Deaf/HH Youth (UC Tobacco-Related Disease Research Program, $50,092) JULIENNE ELIZABETH BOWER Mechanisms of Radiation-Induced Fatigue in Cancer (NIH/Cancer Institute, $127,170)
E. RICHARD BROWN California Health Interview Survey (CHIS) (NIH/National Cancer Institute, $1,979,273); California Health Interview Survey (CA/HHS/Department of Health Services, $1,855,000); California Health Interview Survey (CA/HHS/Department of Health Services, $1,855,000); California Health Interview Survey (CA/California Children and Families Commission, 1,018,775); The State of Health Insurance in California (HIPP) (California Wellness Foundation, $400,000); Measuring Access to Physicians in Medi-Cal and Healthy Families (California Healthcare Foundation, $299,708) SUSAN D. COCHRAN Risk for Psychopathology Among Lesbians and Gay Men (NIH/National Institute of Mental Health, $337,643) MICHAEL D. COLLINS Murine Strain Sensitivity to Cadmium Teratogenesis (NIH/National Institute of Environmental Health Sciences, $302,322) STEVEN D. COLOME Childen’s Microenvironmental and Personal Pollutant Exposures for SB25 with NAPS Health Status Survey (CA/EPA Air Resources Board, $399,464) WILLIAM G. CUMBERLAND Biostatistics Training for AIDS Research (NIH/National Institute of Allergy and Infectious Diseases, $200,200) WILLIAM E. CUNNINGHAM The Effect on Health Outcomes of Access to Medical Care for Persons with HIV Disease in the United States (Doris Duke Charitable Foundation, $108,000) PAMELA LEE DAVIDSON Geographic Variation in Breast Cancer Stage at Diagnosis (UC/Breast Cancer Research Program, $425,497) ROGER DETELS Natural History of AIDS in Homosexual Men (NIH/National Institute of Allergy and Infectious Diseases, $3,157,313); International Training Grant in Epidemiology Related to AIDS (NIH/Fogarty International Center, 1,166,716); Interdisciplinary Training in HIV/AIDS Epidemiology (NIH/National Institute of Allergy and Infectious Diseases, $245,914); Training & Community Intervention to Prevent Drug Use & HIV Transmission in Vietnam (NIH/Fogarty International Center, $232,200); South-to-South HIV/AIDS Intervention Workshop (World AIDS Foundation, $60,000) CHARLES A. DiSOGRA California Fruit and Vegetable Intake Calibration Study (CA/HHS/Department of Health Services, $249,975) DONALD L. DUKE Effectiveness Assessment of NPDES Regulations for Storm Water Discharges (U.S. Environmental Protection Agency, $111,200)
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JOHN R. FROINES An Automated System for Task-Based Evaluation of Size Distributions of Beryllium Aerosol at the Los Alamos Beryllium (UC Los Alamos National Scientific Laboratory, U.S. DOE, $228,000); UCLA-Mexico/Latin America Training and Research Program (NIH/Fogarty International Center, $163,962) PATRICIA A. GANZ Breast Cancer – Preparing for Survivorship (NIH/National Cancer Institute, $331,241); Neuroimaging Correlates of Cognitive Dysfunction After Breast Cancer Treatment (The Breast Cancer Research Foundation, $225,000); Cancer Risk and Biomarkers of Tamoxifen Chemoprevention (University of Pennsylvania, $83,620); Adjuvant Tamoxifen Therapy in Old Age: Determinants and Consequences (Boston University, $56,365); Breast Cancer Treatment Outcomes in Older Women (Boston University, $53,372) DEBORAH C. GLIK Media Campaign to Prevent Alcohol Use During Pregnancy (Association of Schools of Public Health, $279,043); Evaluation of “Make Yours a Fresh Start Family” Demonstration Project (American Cancer Society, California Division; $157,043) PAMINA M. GORBACH HIV Prevention Trials Network (HPTN) (Health Research Association, Inc., $112,144); Natural History of New Partnerships: STD/HIV Behaviors (NIH/National Institute of Allergy and Infectious Diseases, $108,000); Partnership Types & Primary HIV Infection & Transmission (UC Universitywide AIDS Research Program, $100,375) NEAL HALFON School Readiness Expansion (CA/California Children and Families Commission, $675,000); The Interdisciplinary Maternal and Child Health Training Program (DHHS/Health Resources & Services Administration, $360,990); Strategic Planning Guide Regional Trainings (CA/California Children and Families Commission, $146,192); Prop 10 Public Opinion Survey (Field Research Corporation, $100,000)
MOIRA INKELAS Access to Specialty Care for California’s Children with Special Health Care Needs (California Healthcare Foundation, $246,385); Managed Care and Children with Special Health Care Needs: Economic and Policy Realities for the Future of CCS (California Healthcare Foundation, $132,330) MARJORIE KAGAWA-SINGER Increasing Diversity in Cancer Control Research (Northern California Cancer Center, $95,364) GERALD F. KOMINSKI Managed Care in California (Department of Managed Health Care, $499,263); Workers’ Compensation Inpatient Hospital Fee Schedule and Outpatient Study (CA/Department of Industrial Relations, $68,835) JESS F. KRAUS Injury Prevention Research Centers (DHHS/Centers for Disease Control and Prevention, $905,500); Evaluation of Workplace Violence Hospital Safety Initiatives in California (University of Iowa, $87,955) GANG LI Topics in Semiparametric Analysis of Survival Data (NIH/National Cancer Institute, $114,157) MARK S. LITWIN Urologic Diseases in America (NIH/National Institute of Diabetes, Digestive and Kidney Disease, $1,589,383) WILLIAM J. McCARTHY Analysis of California Adolescent Tobacco Data (UC TobaccoRelated Disease Research Program, $138,920) HAL MORGENSTERN Marijuana Use and the Risks of Lung and Other Cancers (NIH/National Institute on Drug Abuse, $411,966) CHARLOTTE G. NEUMANN Program Evaluation for the Los Angeles Unified School District Nutrition Network (Los Angeles Unified School District, $260,510); Diet Quality Improvement and Child Health and Survival (University of California, Davis, $125,368) PATRICIA H. PARKERTON Provider Organizations: Assessment of a Quality Improvement Intervention (California Healthcare Foundation, $199,479) NADEREH POURAT Medi-Cal Managed Care and STD Practices of Physicians in CA (University of California, San Francisco, $105,002); Medi-Cal Managed Care and STD Practices of Physicians in CA (CA/HHS/Department of Health Services, $66,750)
GAIL G. HARRISON Increasing Fruit and Vegetable Intake Through WIC (Public Health Institute, formerly CA Public Health FDN, $106,624)
MICHAEL L. PRELIP March of Dimes Prop 10 San Bernardino County Evaluation (March of Dimes Birth Defects Foundation, $92,334)
WILLIAM C. HINDS Education and Research Center (DHHS/Centers for Disease Control and Prevention, $763,363); Analytical Chemistry Cores (Southern California Environmental Health Sciences Center, $120,000)
SHANE S. QUE HEE Field Glove Permeation Instrumental Methods Development (Association of Schools of Public Health, $100,000) THOMAS H. RICE Retiree Health Benefits: Past Determinants and Projection for the Future (Henry J. Kaiser Family Foundation, $60,000) BEATE R. RITZ Parkinson’s Diseases Susceptibility Genes and Pesticides (NIH/National Institute of Environmental Health Sciences,
UCLAPUBLIC HEALTH
NANCY D. HARADA Patterns of Rehabilitation Use Following Stroke (DHHS/Agency for Health Care Research and Quality, $99,677)
ERIC L. HURWITZ Psychosocial Behavior and Immune Factors in Back Pain (NIH/National Center for Complementary and Alternative Medicine, $121,770)
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faculty
JONATHAN E. FIELDING Developing a Health Forecasting Model for California: An Effective Strategy to Promote Health in the 21st Century (California Endowment, $249,641)
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faculty
30 $489,616); Air Pollution and Adverse Birth Outcomes in Southern California, 1994-1999 (NIH/National Institute of Environmental Health Sciences, $263,245); Extended FollowUp of the Rocketdyne Worker Cohort (University of California, Davis, $108,090) LINDA ROSENSTOCK Health Disparities Prevention Project (California Endowment, $250,000) STEVEN ROTTMAN Training and Education for Disasters in Public Health (Association of Schools of Public Health, $196,980); Bioterrorism Training Program for California (CA/HHS/ Department of Health Services, $66,151) MARK A. SCHUSTER UCLA Center for Adolescent Health Promotion (DHHS/Centers for Disease Control and Prevention, $3,587,921) KIMBERLEY I. SHOAF Collection of Perishable Data from the Nisqually Earthquake for Improving Casualty Loss Estimation Methodologies (National Science Foundation, $94,548) WENDELIN M. SLUSSER Establishing a Breastfeeding Resource and Technical Assistance Program for Los Angeles County (County of Los Angeles/Department of Children and Family Services, $72,994) CARL DENNIS SNEED Transitions Through Adolescent Psychosexual Behaviors (UC Universitywide AIDS Research Program, $50,197) IRWIN H. SUFFET Effects of Ozone/Biofiltration on Reverse Osmosis Membrane Performance (Metropolitan Water District of Southern California, $96,000); Development of Extraction Methods for the Analysis of Nitrosoamines in Water Reuse Systems (Long Beach Water Department, $72,500) STEVEN P. WALLACE Health Data for Advocacy and Technical Assistance Program (California Endowment, $470,955) RICHARD G. WRIGHT AIDS Caregiving Stress Among Midlife and Older Women (NIH/National Institute of Mental Health, $377,498) ARTHUR M. WINER Characterizing the Range of Children’s Pollutant Exposure During School Bus Commutes (University of California, Riverside, $178,515)
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ROBERTA WYN Women’s Health in California (California Wellness Foundation, $50,000) ANTRONETTE KAY YANCEY Community Steps to Minority Youth Fitness (NIH/National Institute of Child Health and Human Development, $138,250) ZUO-FENG ZHANG Cancer Epidemiology Training Program (NIH/National Cancer Institute, $272,899)
class notes PETER DROTMAN, M.D., M.P.H. ’75, has been named interim editor-in-chief of Emerging Infectious Diseases, the peer-reviewed monthly journal published by the Centers for Disease Control and Prevention. RUDOLF L. BRUTOCO, M.D., M.P.H. ’77, received The Courage Award from the International Myeloma Foundation at its annual gala at the St. Regis Hotel in Century City, Calif. Brutoco has previously been honored by the Leukemia Society of America, the State of California, Los Angeles County, the National Marrow Donor Program and many others, including President George H. Bush as a “point of light” for his humanitarian work in facilitating marrow donation/transplantation for cancer patients. He established Life-Savers Foundation of America, co-founded the World Marrow Donor Association, and was named director emeritus of the National Marrow Donor Program. He continues to head up two nonprofit foundations and serves on boards or committees of several others, including Familia Corazon and Radiation Public Health Project. He practices educational, behavioral and developmental medicine and serves as medical director for Lifestages Center for Developmental Medicine, a multidisciplinary health care group in Irvine, Calif. JANET O’KEEFFE, M.P.H. ’81, DR.P.H. ’88, has left Washington, D.C. after 12 years of policy work to take a position as senior policy researcher at RTI International in Research Triangle Park, N.C. She works in RTI’s Aging, Disablement, and Long-Term Care Program on a number of projects, including a study of Medicaid’s role in assisted living, the development of quality indicators for inpatient rehabilitation facilities, and an evaluation of a federal grant program to help states increase the availability and quality of home and community services for people with disabilities of all ages. Prior to taking this position, she worked in the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services to develop a Primer on Medicaid Home and Community Based Services.
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ANNICE BURDEOS, M.P.H. ’96, is currently employed at the Motion Picture Association in Encino, Calif., as the international box office coordinator, tracking how much money a film makes in the international marketplace. Previously, she worked at the Sherman Oaks Grossman Burn Center as a public health consultant. Burdeos is nearing completion of a paper entitled “Aesthetics of Beauty: Self Image: Burn Injuries on Film,” for which she is using her M.P.H. in Community Health Sciences. MARK F. SUDOL, D.ENV. ’96, has been appointed chief of the Army Corps of Engineers Regulatory Branch in Washington, D.C. Sudol, who has been the regulatory chief at the Los Angeles District since the beginning of last year, assumed the new position Oct. 1. He is a former Navy pilot and flight instructor who had served intermittently at the L.A. District since 1991. He also started and ran for one year his own environmental consulting business.
BEN SCHWEGLER JR., D.ENV. ’99, is chief scientist and vice president of Walt Disney Imagineering’s research and development unit. He was recently cited for his contributions to industry advancement of research, partly to recognize his years of work in creating 4D design simulation tools. He received the 2002 Henry L. Michel Award from the Civil Engineering Research Foundation/Institute for Energy Conservation, an affiliate of the American Society of Civil Engineers. Schwegler has been involved in the design and construction of Walt Disney Imagineering’s projects for nearly 20 years. GRETCHEN BIRBECK, M.D., M.P.H. ’00, assistant professor of neurology and epidemiology at Michigan State University, has been named a recipient of the 2002 Rockefeller Brothers Fund Charles E. Culpeper Scholarship in Medical Science. Through this award, she will receive $100,000 a year for up to three years to fund her research. Birbeck’s research will determine whether recurrent febrile seizures, which are particularly common in Zambia, contribute to excess epilepsy. Her ongoing work in this malariaendemic region has established a high prevalence of epilepsy in the rural population. JESSICA NUNEZ, M.D., M.P.H. ’00, assumed the position of deputy public health officer for public health preparedness for the Kern County Department of Public Health Services in Bakersfield, Calif. LORENA ESPINOZA, D.D.S., M.P.H. ’01, has been accepted into the Epidemic Intelligence Service program. Espinoza has been working with the National Center for Chronic Disease Prevention and Health Promotion in Atlanta on a project entitled “Community-based Oral Health Promotion, Disease Prevention, and Applied Research.” ARMINE LULEJIAN, M.P.H. ’01, was chosen to deliver a poster presentation at this year’s American Public Health Association annual meeting on “Health Survey of Armenian Elderly,” a project she completed as a student with funding from the school’s Community Health Promotion Program. Lulejian, who is currently on the adjunct faculty at West Los Angeles College and Los Angeles Mission College, was also given Honorable Mention recognition for this project through the APHA’s Gerontological Health Section.
Please send us an update of your professional or personal activities so that we may include it in a future issue. Photos are welcomed. Also, please let us know if you have a new address. Mail to: Editor, UCLA Public Health Magazine, Box 951772, Los Angeles, CA 90095-1772; fax to (310) 825-8440; or e-mail to jtisdalepardi@ support.ucla.edu. In addition to your name, please include a telephone number and/or e-mail address so that we may contact you.
UCLAPUBLIC HEALTH
TIMOTHY J. DOWNS, D.ENV. ’98, is coordinator of the Program in Environmental Science and Policy at Clark University in Worcester, Mass. He helped to develop “National Action Plan: The Evaluation and Management of Water Quality and Associated Health Risks” with the Environmental Health Directorate, Ministry of Health in Mexico City, and spearheaded the National Strategy for Environmental Health to respond to priority problems of water quality and health risks. Downs contributed to the position paper on Integrated Water Resources Management prepared by the International Water Association and UNEP for the 2002 Earth Summit in Johannesburg.
class notes
LESLIE M. ALEXANDRE, M.P.H. ’82, DR.P.H. ’87, has been named president and chief executive officer of the North Carolina Biotechnology Center. Alexandre, a veteran health care professional with extensive public and private experience in national health policy, government affairs, communications, marketing and business development, previously served as assistant director for industrial relations at the National Cancer Institute, where she was responsible for building relationships with the private sector and encouraging scientific collaborations with industry to accelerate cancer research.
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news briefs IN MEMORIAM DR. ROSLYN B. ALFIN-SLATER, a long-time member of the school’s faculty, died August 9. Alfin-Slater, an international authority on nutrition and co-author of the
Los Angeles Times column on Science, Food, and Health from 1972 to 1982, was one of the first scientists to examine how diet affects health status. She studied the relationship between cholesterol and essential fatty acid metabolism, evaluated the role of saturated and unsaturated fats and trans-fatty acids, and was among the first to show that dietary intake of cholesterol is not directly related to levels of cholesterol in the blood. She joined the school’s faculty in 1959 and was one of the founders of the program in Public Health Nutrition. Alfin-Slater wrote more than 200 scientific papers and co-edited the four-volume series on Human Nutrition, A Comprehensive Treatise and the book Nutrition for Today.
AskCHIS Quick access to health information from THE CALIFORNIA HEALTH INTERVIEW SURVEY (CHIS) is now available online at www.chis.ucla.edu through a unique interactive Web tool called AskCHIS, provided as a public service. AskCHIS, supported by a grant from The California Endowment, is a user-friendly system for making inquiries about health topics and populations covered by CHIS, the largest-ever ongoing state health survey, conducted as a collaborative project of the UCLA Center for Health Policy Research, the California Department of Health Services and the Public Health Institute. AskCHIS was developed by
faculty and researchers in the center.
UCLAPUBLIC HEALTH
The system enables requestors, whether laypersons, members of the news media or researchers, to obtain estimates tailored to their needs, with immediate results presented in tables and graphs. Estimates on California’s population or for specific counties are available for health conditions, health-related behaviors, insurance coverage, race/ethnicity, age, and income/ employment, in almost unlimited combinations.
minority training grant awarded The UCLA Division of Cancer Prevention and Control Research, based in the School of Public Health, has been awarded a five-year grant for the Minority Training Program in Cancer Control Research from the National Cancer Institute. The program’s aim is to increase ethnic diversity in the field of cancer control research by encour-aging minority students to enroll in master’s-level health programs, and master’s-trained professionals to pursue a doctoral degree and a career in research. The program, which is also based at the UC San Francisco Comprehensive Cancer Center, is headed at UCLA by Drs. Marjorie Kagawa-Singer and Antronette K. Yancey. It will be launched this summer with a five-day Careers in Cancer Control Research Summer Institute designed to showcase the opportunities and needs for minority researchers in cancer control. Through the institute, 25-30 students will acquire skills and resources needed to apply to a doctoral program. For more information, contact Tawnya N. Lewis, project coordinator, at (310) 794-7314, or email tlewis@ph.ucla.edu.
endowment for student support The California Endowment has given $450,000 to the school for student support, including field placements in underserved communities. Coupled with a previous California Endowment grant, the funding strengthens the school’s capacity to address disparities in health among underserved communities, enabling the school to make a significant impact in the community as well as in supporting its own students.
NEW ASSOCIATE DEAN FOR ADMINISTRATION KATHLEEN KISER has joined the School of Public Health as associate dean for administration, effective November 12. Kiser brings broad experience in finance, administration, and academic management. Since 1997, she served as the assistant dean of finance and administration for the UCLA School of Dentistry. Prior to that, she was chief administrative officer for UCLA’s Department of Microbiology and Immunology. “It is truly a privilege to work with Dean Rosenstock, the administrative team, faculty, staff and students,” Kiser says. “I look forward to a challenging and exciting future with the School of Public Health.”
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Desire to ‘Give Back’ Motivates Alumni to Make Donations to School a Yearly Habit MORE THAN TWO DECADES AGO, at a time when many current UCLA School of Public Health students were toddlers, Bruce Davidson (M.P.H. ’79, Ph.D. ’90) began what would become an annual tradition. Davidson made a gift to the school’s annual fund. He did it again the following year. And the year after that, and every year since – 21 and counting. “I just believe in supporting the school,” says the director of resource and outcome management at Cedars-Sinai Medical Center in Los Angeles with a shrug. “I’ve gotten a lot out of my relationships with the school, both in my master’s program and in my doctoral program, as well as in my continuing relationships with alumni groups and faculty. I’m happy to give back.” Davidson is among a special group of donors who have made giving back to the school an annual habit. Alumni who have given each year for the past 15 years or more constitute a generous baker’s dozen of loyal contributors who are important to the school’s ability to achieve its mission of excellence through research, teaching, and service. (For a complete accounting of this special group, see the accompanying list.) To ensure that this mission continues to be fulfilled, the school has initiated a five-year campaign to increase by 50 percent the number of alumni who give annually. Currently, just over 7 percent of all alumni donate to the school. By 2007, the goal is to attract 11 percent of alumni in building a stronger donor base. Annual gifts play a critical role by providing flexible funds that can immediately be put to use where the need is greatest. For example, such funds can target support for student recruitment, retention, and resources, as well as providing seed dollars for innovative projects and programs. “I am very comfortable delegating the decision-making process about what’s the best use of my contribution to the school,” Davidson says, calling his unrestricted gifts “unconditional love.” Daniel Smith (Dr.P.H. ’83), an epidemiologic research scientist with the California Department of Health Services since the year he received his doctoral degree, began providing the school with annual unconditional love 17 years ago. “I got a very good education, at a cost of next to nothing,” says Smith, who was supported by a U.S. Public Health Service traineeship. “That education helped me get a great job, and I’m very grateful for that. I feel like I owe the school something, and giving back on an annual basis seems like the obvious thing to do.”
For more information on how to contribute to the school’s annual fund, contact Susan Kanowith-Klein at (310) 267-0447 or skklein@support.ucla.edu.
Bruce Davidson, M.P.H. ’79, Ph.D. ’90
ANNUAL FUNDERS The following alumni have given to the UCLA School of Public Health for at least 15 consecutive years: IRA R. ALPERT, M.S.P.H. ’66 DIANA BONTÁ, R.N., M.P.H. ’75, DR.P.H. ’92 BRUCE N. DAVIDSON, M.P.H. ’79, PH.D. ’90 AGNES K. EUBANKS, M.P.H. ’71
Daniel Smith, Dr.P.H. ’83
PAUL M. FLEISS, M.D., M.P.H. ’76 RAYMOND D. GOODMAN, M.D., M.P.H. ’72 STEPHEN W. KAHANE, M.S. ’74, D.ENV. ’78 FRANK P. MATRICARDI, M.P.H. ’72, DR.P.H. ’82
CARL E. PIERCHALA, M.S. ’72, PH.D. ’81 SHIRLEY W. RICH, M.P.H. ’67 DANIEL F. SMITH, DR.P.H. ’83 SUEBELLE S. VERITY, M.P.H. ’66, DR.P.H. ’76
UCLAPUBLIC HEALTH
MARC D. MOSER, M.P.H. ’72 EDWARD J. O'NEILL, M.D., M.P.H. ’69
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DATE
The annual Breslow Lecture and Dinner will be held at 6:00 p.m. on March 10, 2003 at the Faculty Center. Pulitzer-Prize-winning author Jared Diamond, Ph.D., will deliver the address titled “Coca-Colonization and Public Health.” For more information, contact Joanne Clarey at 310/825-6464 or jclarey@support.ucla.edu
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