UCLA Public Health Magazine - November 2008

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NOVEMBER 2008

UCLA

PUBLIC HEALTH moving toward

UCLA

SUSTAINABLE ENVIRONMENTS

School of

Public Health

Martin Iguchi believes the failing war on drugs could benefit from a shift to public health strategies.

Exhibit A: The more successful war on smoking.

As a public health nurse, Wendie Robbins saw the end results of toxic exposures on reproductive outcomes. Now she’s working to prevent them.

For pediatrician Alma Guerrero, an M.P.H. provides the tools to improve the health of Latino children outside of the patient care setting.

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UCLA

PUBLIC HEALTH

Gene Block Chancellor

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

Sarah Anderson Assistant Dean for Communications

John Sonego Assistant Dean for Development and Alumni Relations

features

Dan Gordon Editor and Writer

Martha Widmann Art Director

E D I TO R I A L B OA R D Richard Ambrose, Ph.D.

1

Professor, Environmental Health Sciences

Roshan Bastani, Ph.D. Professor, Health Services Associate Dean for Research

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

Ralph Frerichs, D.V.M., Dr.P.H. Professor, Epidemiology

F. A. Hagigi, Dr.P.H., M.B.A. Associate Professor, Health Services

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

Moira Inkelas, Ph.D. Assistant Professor, Health Services

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

David Liu President, Public Health Student Association

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

UCLA

President, Alumni Association

School of

Public Health

4

Style over Substances: Lessons from the Wars on Tobacco and Drugs One has emphasized public health, the other law enforcement. Why efforts to curtail smoking are working, and the approach to illegal drugs is not.

10

FACULTY PROFILE:

Wendie Robbins

Reproductive Toxicology Under the Microscope

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Minor a Major Success: Introducing Undergraduates to Public Health

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TOWARD SUSTAINABLE ENVIRONMENTS: Thinking Proactively About Our Surroundings

in every issue 23 RESEARCH

Potential lung cancer risk reduction for smokers… education and voluntary HIV testing…impact of disease management on disparities…obesity gene and diabetes…quality of life for cancer survivors… changing health insurance may be hazardous.

12 The Public Health Minor at UCLA is one of many ways in which the school is accommodating growing interest in public health among college students and addressing the public health workforce crisis.

16

28 STUDENTS

Too often, short-term benefits have trumped longterm consequences in environmental policies.

But from green chemistry and nanotechnology testing to discussions on creating healthier cities, momentum is building for a new approach.

30 NEWS BRIEFS 32 FACULTY

ON THE COVER

A growing movement demands that we give more forethought to what we introduce into our environment. Cover photo illustration: Martha Widmann

PHOTOGRAPHY Reed Hutchinson / Cover: Iguchi, Robbins, Guerrero; TOC: Robbins, student; p. 5: Iguchi; p. 6: McCarthy; p. 9: Berman; pp. 10-15; p. 18; p. 21; p. 22; p. 31: becoming fit; p. 32; p. 33: VargasBustamante, Wang Courtesy of UCLA School of Public Health / p. 2; p. 30; p. 33: Ford Getty Images © 2008 / Cover: flask; TOC: substance abuse; pp. 4-5: kid smoking in restroom; p. 8; pp. 16-17: molecule model, molecule; p. 24 iStockphoto © 2007 / TOC: carbon nanotubes; p. 17: corn, pumping gas; p.19; p. 20; p. 23; pp. 26-27 Veer © 2008 / Cover: globe; p. 7

School of Public Health Home Page: www.ph.ucla.edu E-mail for Application Requests: info@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 2008 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 FOR THOSE OF US getting nearer to retirement age, the downward spiral of the stock market and declines in the global economy are certainly reason for pause. People across the country are tightening their belts and cutting costs to address economic shortfalls. We are feeling a similar pinch at the School of Public Health, bracing for a 4 percent cut from our core budget this year and the threat of one perhaps two or more times larger next year.

Given that in just 12 years the United States will be short approximately 250,000 trained public health workers, we must address the workforce crisis now. We can’t be slowed by budget shortfalls; instead we must redouble our fundraising efforts to ensure that we can continue to provide top-notch public health training to interested students. Through the Public Health Minor (see page 12), we are introducing UCLA undergraduates to the field and this year doubled our enrollment due to overwhelming interest. We have also broadened our recruiting efforts, traveling nationally to educate potential students about what we have to offer. There is the interest and will from students who want to enter the field of public health. The onus is on us to take financial considerations out of the equation of whether a student is able to enroll in our program.

At the School of Public Health we consider ourselves fortunate to have the best and brightest scientists and scholars serving on our faculty. Through their innovative work we continue to bring in significant resources by way of contracts and grants, as illustrated by the chart on the right. Most recently, UCLA and a dozen collaborating institutions were awarded a grant to create the University of California Center for Environmental Implications of Nanotechnology. Rounding out our portfolio as one of the leaders in environmental health, the school continues to be at the forefront in studying the health effects of climate change and how communities can be designed and developed to make their residents healthier – and now we will assess the health effects of nanotechnology. Our cover story (see page 16) looks in depth at how our country can move toward a sustainable environment and what we are doing to ensure the $1 trillion nanotech industry doesn’t bring unintended adverse health consequences.

Despite trying economic times, we recently learned that Congress allocated an additional $5 million for a new high speed laboratory at the school. This brings the total to $30 million ($21 million federal and $9 million from the

UCLAPUBLIC HEALTH

State of California) allocated to create a laboratory network with the capacity

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3 2008-2009 DEAN’S A DV I S O RY B OA R D

to quickly analyze and process high quantities of biological samples, improving the nation’s ability to respond to an avian flu outbreak, bioterrorist attack or other rapidly emerging public health threats. When we began to look for support for this critical project, we told members of Congress that we would request only four years of core funding to establish the lab. True to our word, the latest $5 million is the final funding for the lab build-out. I’d like to thank Dean's Advisory Board member Cindy Horn for her tireless efforts. She was instrumental in taking the vision of one of our faculty members (Dr. Scott Layne, professor in the Department of Epidemiology) and making it a reality.

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

*SPH Alumni

We anticipate the lab will be operational in mid-2009.

Times are tight, but our work is important enough that we will continue to seek and secure gifts and endowments from our alumni and friends that will enable us to continue to recruit and retain a world-class faculty and provide students every opportunity to enter what promises to be one of the most sought-after careers in the coming decades.

Linda Rosenstock, M.D., M.P.H. Dean TOTAL EXPENDITURES Grants and Contracts State-Generated Funds Gifts and Other Fiscal Year 07-08 $62.8 million

UCLAPUBLIC HEALTH

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4 O NE

FIGHT

HAS EMPHASIZED PUBLIC HEALTH STRATEGIES , THE OTHER LAW ENFORCEMENT.

W HY

EFFORTS TO

CURTAIL SMOKING ARE WORKING , AND THE APPROACH TO ILLEGAL NARCOTICS IS NOT.

STYLE OVER SUBSTANCES:

Lessons from the Wars on Tobacco and Drugs Among public health’s many successes

23.7%

UCLAPUBLIC HEALTH

of U.S. prisoners are incarcerated for nonviolent drug offenses.

over the

last few decades, few have been as dramatic or instructive as the continuing fight to curtail tobacco use and involuntary exposure to secondhand smoke. In 1964, when the U.S. surgeon general report sounded the first government warning about the harms caused by cigarettes, 42 percent of the nation’s adults smoked; at one point, estimates were that 70 percent of adult men had ever smoked.

Going up against a highly addictive substance and the politically formidable tobacco industry, public health efforts have cut that percentage in half: Today, 21 percent of U.S. adults are smokers.

On their own, the surgeon general’s report and the many warnings that followed did little to change behaviors – much like today’s warnings about the health dangers of obesity seem to be insufficient by themselves to curb that epidemic. Rather, the halving of the nation’s No. 1 preventable cause of death has been the result of a series of public health strategies that have supplemented educational messages with policy-level changes, from limiting advertising and levying

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“The war on drugs was successful in decreasing some of the excesses of recreational use. But in terms of decreasing the more damaging aspects of drug use, it’ s been a miserable failure.”

—Dr. Martin Iguchi

UCLAPUBLIC HEALTH

The first war on drugs, declared in the early 1970s

by President Nixon in response to a Vietnam Warera heroin epidemic, was largely oriented toward treatment, Iguchi notes. Then in 1986, with attention focused on a crack cocaine epidemic, Speaker of the House Thomas P. “Tip” O’Neill declared a new “legislative war on drugs,” and the Reagan administration quickly took up the cause as its own. The second war, which for the most part continues to this day, has emphasized criminal-justice sanctions.

Penalties for possession and trafficking were increased dramatically, and tough new laws were introduced.

While the impact of this approach on overall drug use can be argued, certain effects are undeniable. The number of drug offenders in prison has increased substantially. “It used to be that approximately 15,000 people would enter prison every year on a drug offense, and now it’s more like 100,000 per year,” says Iguchi. “That has resulted in very large costs and the development of a much

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taxes that drive up the price of cigarettes to banning smoking in public places.

With illicit substances, it’s been a very different story. The $60-billion-per-year underground illegal drug industry is patronized by at least 16 million Americans, 7 percent of the U.S. population over the age of 12. “Substance abuse – including illegal drugs, inappropriate alcohol and prescription drug use, and tobacco dependence – is a huge public health problem on several levels,” says Dr. Martin Iguchi, professor in the UCLA School of Public Health and a senior behavioral scientist at RAND, where he formerly served as director of the Drug Policy Research Center. “The use in and of itself seriously affects people’s lives and health, as well as the lives of their family members. It costs society tremendous amounts of productivity and dollars for treatment. It is related to riskier behaviors that result in disease transmission, and it increases violent or other antisocial behaviors. From a health disparities perspective, these problems also tend to be disproportionately concentrated in areas of poverty.”

A sound public health approach to the problem, Iguchi adds, would promote the development of

appropriate prevention and treatment approaches, improve access to care, and advocate for policies that minimize the impact of illegal drugs on individuals and communities. But for the most part, this significant public health problem has not been treated as such. Instead, the effort to curtail illicit drug use has relied on a law-enforcement approach – the so-called war on drugs – with poor results. Casual drug use is down, but overall consumption is up, Iguchi notes.

Drugs are cheaper and more available than ever, and on average, drug users are starting at a younger age.

Moreover, the criminal-justice emphasis has inflicted significant collateral damage, particularly in lowincome urban communities.

“The war on drugs was successful in decreasing some of the excesses in recreational use that we saw in the late 1970s and early 1980s,” says Iguchi. “But in terms of decreasing the more damaging aspects of drug use, it’s been a miserable failure. And we are now seeing an entire generation of African American males who have lived much of their lives in an incarcerated capacity, which has long-term implications for the health of future generations.”

Two very different battles: one on illegal substances, one on a legal substance. One has focused on law enforcement while giving short shrift to public health approaches, with limited success and clear failures. The other has relied on public health strategies, with great success – though the war is far from won.

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“Because California has deployed so many tobacco control strategies at the same time, we don’ t know which components are most effective, but we do know that as a package we are making more of an impact than other states.”

UCLAPUBLIC HEALTH

—Dr. William McCarthy

more prominent prison industry. But the biggest impact has been on African American males.”

Although the percentages of African Americans, Latinos and whites using illegal drugs are similar, the number of white prisoners incarcerated for drug offenses increased seven-fold between 1983 and 1998, while Latino drug admissions increased 18-fold and African American drug admissions increased more than 26-fold. (With many prisons having reached capacity, incarceration rates leveled between 1998 and 2003, the most recent year for which data are available, but the racial and ethnic disparities persisted.) “Poorer communities are often targeted because the people living in those communities who don’t use drugs demand that police make their neighborhoods safer,” Iguchi explains. “The problem is that there is indiscriminate enforcement of these laws, so that people who are not involved in creating problems for neighborhoods are arrested along with those who are.”

To what effect? Iguchi notes that there is no evidence suggesting that incarceration reduces illegal drug use by offenders after they are released, and it is not clear whether the threat of arrest acts as a deterrent. On the other hand, a felony drug conviction carries punishment beyond the jail time served, with consequences on health. Federal laws passed in the 1990s decrease access to public housing, health benefits such as food stamps, student loans, and many jobs for convicted drug offenders. Lack of employment options also reduces access to health insurance, much of which is job-based. These restrictions have the perverse effect of increasing the already-high probability for relapse and reincarceration and exacerbating the community disparities, Iguchi notes. “In many ways, being arrested for drug use sets the stage for more drug use as a result of the loss of life options,” he says. “Without resources, drug abusers face a higher risk of recidivism and increase the burden on their communities.”

Two UCLA School of Public Health faculty members who have been involved in the far more successful war on tobacco remember when things were different.

In 1980, when Dr. William McCarthy was starting his public health career, he would commute twice a week on an Amtrak train from New Haven, Conn., to Washington, D.C. In what at the time was seen as a forward-looking policy, smoking was per-

mitted only on certain cars. “The problem was that no one bothered to adhere to the signs,” recalls McCarthy, now an associate professor at the UCLA School of Public Health. “As a confirmed nonsmoker, I spent most of my trips asking people to put out the cigarettes or move to another car.

Usually they would, but they would glower at me.”

When Dr. Barbara Berman was in college, she and all of her friends smoked – as did both of her parents. “People who came into our home never thought to ask if it was OK if they smoked – there were ashtrays everywhere; why would they need to ask?,” recalls Berman, also an associate professor at the school and, like McCarthy, a member of the Division of Cancer Prevention and Control Research, housed in the school and part of UCLA’s Jonsson Cancer Center. “Today, people coming into my home wouldn’t think to ask, because they know I wouldn’t even want them smoking in my yard.”

The shift in societal norms related to smoking represents one of many triumphs for public health.

Restrictions on public smoking have played an important role not only in putting up barriers in the way of individuals who would otherwise smoke, but also in helping to influence public perceptions about the acceptability of smoking, notes Berman.

Effective and targeted messages about the dangers of tobacco are critical to the effort, but education alone often isn’t enough. “Most people who smoke know it’s bad for them,” Berman says.

She argues that the effort has to be multi-faceted – as it has been. Laws limiting print, TV and billboard ads made a significant difference. Taxes to drive up the cost of cigarettes have also had a big impact, particularly on young people. Efforts to encourage physicians to counsel their patients are important – although to be truly effective, Berman notes, physicians must go beyond telling their patients that smoking is bad for them and instead direct them toward concrete strategies and resources that will help them quit.

For all of the successes, no one involved in the effort against tobacco considers the fight to be anywhere near over. On the one hand, there has been great progress; on the other, more than 20 percent of the U.S. adult population still smokes – and in some populations, the proportion is significantly higher. While California has been setting the pace in public policy, it’s easy for Californians to forget that in many states, smoking is still permitted in restaurants and other public settings. In addition, the

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tobacco industry serves as a powerful and well-financed adversary. “Anything that’s been done can be easily undone,” says Berman. “We can’t rest on our laurels. We have to be vigilant, continuing what we’ve been doing and constantly looking down the road to think about what other steps we can take.”

The current battlegrounds are a diverse lot. Although Berman is quick to defend freedom of expression among filmmakers, she laments that smoking is often portrayed in a positive light in movies – used to portray relaxation, rebellion, socializing, and sensuality, to name a few – and particularly in youth-related films. Many public health leaders have been working with studios in an effort to discourage portrayals of smoking in the movies. In California, McCarthy and others are focusing on worksites with fewer than five employees – taxi cabs, for example – which are not yet protected against involuntary exposure to smoke; and multi-family dwellings, where residents subjected to smoke through ventilation systems or open windows typically have no recourse.

of all regular drug users in the United States are African American

62.7%

of all drug offenders admitted to prison are African American

UCLAPUBLIC HEALTH

Since 2000, McCarthy has served as the chief evaluator for California’s In-School Tobacco Use Prevention Education Program, which includes a legally mandated biannual survey of tobacco use in schools. Among other things, the survey results have underscored the important role of context in tobacco use among adolescents, including the effect of neighborhood tobacco retailers on the likelihood that students will smoke. McCarthy and his colleagues found a significant relationship between the density of retailers around a school and the number of experimental smokers – defined as students who had smoked fewer than 100 cigarettes in their lives and had smoked in the last month. “Once students are addicted, they will find cigarettes regardless of how many or how few stores there are, but experimental smokers are more opportunistic, and if there are fewer retailers they appear to be less likely to begin to smoke,” McCarthy says.

He hopes that more definitive data might lead to zoning policies restricting how close tobacco retailers can locate around schools. (Although it’s against the law to sell tobacco products to minors, statewide assessments consistently find that a significant minority, lured by the additional profits, fail to adhere to the law.)

13%

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42%

of the U.S. adult population smoked in 1964, the year the surgeon general linked lung cancer with cigarette smoking

21%

of the U.S. adult population smokes today

UCLAPUBLIC HEALTH

13%

of the adult population smokes in California, where public health efforts have been most aggressive

Using the same data set, McCarthy’s group examined the role of school context in ethnicity-related risk of tobacco use among adolescents. When broken down by ethnicity, white adolescents are more likely to smoke than African American, Latino, or Asian-American adolescents. McCarthy found that ethnic minority students at overwhelmingly white schools had a higher risk of becoming smokers than ethnic minority students at predominantly minority schools.

Similarly, McCarthy and others have found that among immigrants, acculturation has a marked effect on smoking rates. “In China and Japan, smoking rates among men are typically above 50 percent, but second-generation ChineseAmerican men in California have the lowest smoking rates of any males – 20 percent or less among the first-generation men, and less than 10 percent among their sons,” McCarthy notes. “Our analysis suggests this is partly because the California environment encourages not using tobacco, but also because antismoking norms are strongest among the most highly educated California residents. Immigrants who value educational attainment highly are getting a strong and consistent message that smoking is frowned upon in California.”

Berman, whose past tobacco-related studies include an examination of the counseling practices of African American physicians and a project aimed at reducing exposure to secondhand smoke among low-income children with asthma, has recently been focused on research to prevent smoking among deaf and hard-of-hearing youth – a particularly vulnerable population. “These children are not necessarily getting all of the incidental preventive information that hearing children might get,” Berman notes. Her group found that although deaf teens and young adults describe doctors as a trusted source of information about the dangers of smoking, the percentage reporting that their doctor had communicated anti-smoking messages to them was very low.

Funded by a series of grants from California’s Tobacco Related Disease Research Program over nearly a decade, Berman and her colleagues have developed the first tobacco-prevention education curriculum tailored specifically for deaf and hard-of-hearing youth and tested it in four schools for the deaf. Berman found that, compared to students at schools that did not receive the curriculum,

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“Anything that’ s been done can be easily undone.

We can’ t rest on our laurels.

We have to be vigilant, continuing what we’ ve been doing and constantly looking down the road to think about what other steps we can take.”

—Dr. Barbara Berman

UCLAPUBLIC HEALTH

When he was starting his career in the 1980s, Iguchi’s efforts were focused on developing behavioral treatments and other interventions for individual drug abusers. In the last two decades, his work has evolved from that micro-level focus to a broader public health approach to influencing policies and communities.

Small steps have been taken in recent years toward what Iguchi sees as more sensible drug policies – including a drug court movement that seeks to integrate treatment into the criminal justice system. California’s Proposition 36, passed by voters in 2000, offers non-violent drug abusers three chances at treatment before they are imprisoned after a guilty

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students at the schools where the program was implemented showed a significant decline in current smoking, along with an increase in anti-tobacco attitudes and knowledge about the dangers of smoking.

She recently applied for funding to disseminate the curriculum more widely.

Some anti-tobacco activists have argued that money spent trying to prevent youths from taking up smoking is wasted, since the majority are prone to experimentation and yet most will not become lifelong smokers. McCarthy strongly disagrees. While it’s true that for all the money spent on school-based education there has been remarkably little change in rates of experimental smoking among students – though no one can say what the effect of not having spent the money would have been – he believes there is synergy to implementing a wide array of public health strategies, including school-based tobacco use prevention.

“You shouldn’t focus resources in just one area,” he says. “It has been helpful for adolescents to see workplace restrictions – if their parents are smokers and they are grousing about how they can’t smoke at work anymore, it sends a message to kids that this is unhealthy and they should never start. Conversely, messages that kids bring home from school can help parents – ‘I learned in health class how bad smoking is, Dad. Why are you still smoking?’ Because California has had an ambitious program that has deployed so many tobacco control strategies at the same time, we don’t know which components are most effective, but we do know that as a package we are doing more things and making more of an impact on tobacco use rates than other states. I say keep doing everything – let 100 flowers bloom – because it’s hard to argue with success.”

plea; if they complete a full course of treatment, they can be eligible to have the charges removed from their record. “In recognition that our policies have been failing, people are looking more toward treatment,” Iguchi observes. “But for these alternative policies to work you need resources, and states tend not to invest as much in treatment as they do in the building of new prisons.”

Iguchi’s prescription for better U.S. drug policy includes three components: • Recognize that poverty and lack of opportunity play into the hands of those seeking to increase drug sales. “When young people are deprived of the ability to work and be productive citizens, either because there are no opportunities or because they have been criminalized, it leads to increases in antisocial and pathological behaviors like drug use and is very damaging to society,” Iguchi says.

• Ensure there is no wrong door to treatment.

Nothing should be emphasized more, Iguchi argues, than aggressively offering treatment to drug abusers.

“It goes beyond user-initiated treatment,” he says.

“We need to make it easily accessible and to use motivational approaches that help abusers decide that treatment is the appropriate option for them.”

Resources are best spent on the demand-reduction side, Iguchi says: “Supply-reduction policies are expensive and difficult, if not impossible, to fully implement in a way that removes this problem.”

• Promote evidence-based approaches to treatment and prevention. Many of the strategies now being employed are ineffective, Iguchi notes, while approaches that are potentially more efficient and effective are often neglected. “By treating this as any other medical problem is treated, and applying the same kinds of quality assurance approaches, we can bring drug abuse treatment into the mainstream and reduce the stigma attached to it,” he says.

Unfortunately, Iguchi argues, drug addiction is not yet viewed in the same way as other chronic medical or mental health conditions. “There is unlikely to be any one medication or technological advance that will cure the problems of addiction,” Iguchi says. “On the other hand, we can do quite a bit for people with a combination of the proven behavioral and medical treatments we have now.

I spent much of my career developing treatments because I saw that we were able to use them effectively. There just hasn’t been a willingness to pay for them.”

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10 AS

A PUBLIC

HEALTH NURSE , SHE WAS DISTURBED

BY WHAT SHE SUSPECTED WERE POOR REPRODUC TIVE OUTCOMES RESULTING FROM ENVIRONMENTAL EXPOSURES .

T ODAY

SHE IS PART OF MULTIDISCIPLINARY TEAMS STUDYING THESE EFFECTS AND LOOKING TO PREVENT THEM FROM OCCURRING .

Wendie Robbins:

Reproductive Toxicology Under the Microscope As a nurse practitioner working in rural public health clinics in

Arizona and Texas in the 1980s, Dr. Wendie Robbins saw patterns in families with poor reproductive out-

UCLAPUBLIC HEALTH

comes that led her to suspect links to environmental or occupational exposures.

“We would travel long distances through flat desert to get to one particular clinic, and as we approached you would see a plume of dense smoke coming from the main industry in town, a copper smelter,” she recalls. “You couldn’t help but wonder whether some of the clinical outcomes you were encountering were related to that plume drifting over the homes in the community surrounding the plant.” Robbins was particularly troubled by the reality that the residents of that town – and of another she visited, where copper mines were polluting the water supply – had little recourse against the toxic exposures: These industries fueled the towns’ economies and represented many families’ livelihood.

Longing to help these communities in a more proactive way, Robbins concluded that she could do so by pursuing a career as a laboratory research scientist, learning more about the potentially toxic reproductive effects of certain environmental exposures and disseminating her findings to help prevent many of these tragic outcomes from occurring. She earned a Ph.D. in epidemiology at UC Berkeley and for more than a decade has been at UCLA, bringing her unique perspective to reproductive toxicology studies and teaming with epidemiologists, environmental scientists, nurses and other clinical experts to translate the findings into better health outcomes for parents and their children.

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“The exposures are changing, and there is a lot we don’ t know.

We have to remain vigilant if we want to continue to protect the health of the next generation.”

—Dr. Wendie Robbins

UCLAPUBLIC HEALTH

The research tools Robbins can now draw on to answer questions such as these have become far more powerful since her bench career began. But Robbins points to another change as being equally significant in advancing her efforts. “Scientific inquiry is increasingly collaborative,” she says. “The goal is to learn things from bench research that can be implemented in patient care and health, and to do that you need to work in multidisciplinary teams.”

As much as anyone, Robbins embodies that collaborative spirit. She holds a joint faculty appoint-

ment in the School of Nursing (where she is the Audrienne H. Moseley Endowed Chair in Biologic Nursing Science) and the School of Public Health, and has served as a bridge for her students and colleagues to other parts of the UCLA campus.

Robbins originally came to the School of Public Health after being recruited to fill a position for a nursing faculty member in the school’s Center for Occupational and Environmental Health (COEH), directed by Dr. John Froines. The position was funded as part of the mandate from the state legislature that established occupational and environmental health centers in California, following the discovery in the late 1970s of infertility among workers exposed to the pesticide DBCP. “What really appealed to me about UCLA was the fact that it has this COEH that is committed to education, training, and research involving nurses, chemists, toxicologists, and others in environmental health, all working together to protect workers from occupational hazards,” Robbins says.

While she continues to serve as a COEH faculty member, Robbins now also heads the Occupational and Environmental Health Nursing Program, part of the School of Public Health-based Southern California Education and Research Center. That center, under the direction of Dr. William Hinds, trains students in industrial hygiene, occupational medicine and nursing. Graduate nursing students in Robbins’ program take environmental health, occupational safety, ergonomics, industrial hygiene and epidemiology courses in the School of Public Health. Robbins also fosters cross-disciplinary ties as a faculty member in UCLA’s Interdepartmental Program in Molecular Toxicology.

The industries responsible for the reproductive effects Robbins first saw as a public health nurse more than two decades ago have been forced to clean up their act by policies resulting from the research of Robbins and her colleagues across the country. But Robbins suspects there are still many preventable birth defects stemming from exposures that are not yet fully understood. The field is becoming even more challenging with the explosion of new chemicals being introduced and the realization by scientists that exposure windows may be much wider than previously believed: For example, a male fetus exposed in the womb to even low doses of certain chemicals can have affected sperm as an adult.

“The exposures are changing, and there is a lot we don’t know,” Robbins says. “We have to remain vigilant if we want to continue to protect the health of the next generation.”

faculty profile

Robbins evaluates human sperm cells for chromosomal abnormalities resulting from environmental, occupational or lifestyle exposures, developing biomarkers that can be used in epidemiologic studies of male reproductive toxicology. “In almost any health outcome, environment and underlying genetics both play a role,” she explains. “If we want to understand these outcomes, we need to try to understand the interplay between genes, the environment and reproductive health, and how we might promote health through that knowledge. By better comprehending people’s reproductive risks from various exposures, we can take measures to reduce those risks.”

Her group has published studies of the effects on sperm DNA from smoking, alcohol and caffeine; from chemotherapy; from the antiretroviral agents used to treat HIV infection; from organophosphate pesticides; from high levels of workplace exposure to boron; and from air pollution. Robbins has found that certain chemotherapy drugs increase aneuploidy – a condition characterized by an abnormal number of chromosomes – in sperm cells during and immediately after treatment, with the sperm returning to pre-treatment chromosome numbers by six months after conclusion of the therapy. Conceptions taking place during this period are at risk for spontaneous abortion, Klinefelter syndrome, Down syndrome, mental retardation and other developmental disabilities. Robbins further found that sperm aneuploidy can result from high levels of exposure to air pollution, smoking, and alcohol consumption. Her pesticide studies have detected an increase in nullisomy – a missing sex chromosome – in sperm cells that could increase risk for Turner syndrome in offspring.

She traveled abroad for a study of the reproductive effects of occupational exposure to boron among male workers who mine the element in Liaoning Province, China. Robbins and colleagues – including Drs. Curt Eckhert, Nola Kennedy and David Elashoff from the School of Public Health – found that high exposure levels changed the ratio of Y- to X-bearing sperm, potentially influencing the gender of the workers’ offspring – and suggesting a need for further study.

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Minor a Major Success: Introducing Undergraduates to Public Health

“I didn’ t know how public health was supposed to work, but I knew how important it was, and that I should somehow get involved in it.”

—Bogdana Kovshilovskay

Bogdana Kovshilovskay grew up with the sense that sound public health practices could make a difference – mostly because she

“The minor increases the visibility of the public health option for a very smart and passionate group of undergraduates.”

UCLAPUBLIC HEALTH

— Dr. HIlary Godwin, Associate Dean for Academic Programs

spent a good portion of her childhood watching her family struggle to cope with a lack of much-needed information and health services.

Kovshilovskay was born in the Ukraine, and was two weeks old in 1986 when an explosion occurred at the Chernobyl nuclear power plant, just 40 miles away. In search of answers about the health risks and what they could do about them, Kovshilovskay’s family took her to various hospitals and clinics in Kiev and rarely got answers. “None of the doctors were even admitting that the radiation exposure might have adversely affected people,” Kovshilovskay says.

The lack of a public health response to the disaster had an indelible effect long after her family moved to California in 1994. “I didn’t know how public health was supposed to work,” Kovshilovskay explains, “but I knew how important it was, and that I should somehow get involved in it.” So, as a pre-med student at UCLA, when she learned about a public health course that was being offered to undergraduates, she enrolled. The course, Public Health 150, made a huge impact: “I knew this was for me,” Kovshilovskay says. When she discovered she could minor in public health, she applied. With the benefit of six more courses, she decided to place her medical school plans on hold, and is now a first-year M.P.H. student in the UCLA School of Public Health’s Department of Community Health Sciences.

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sciences, epidemiology, and health services – along with an additional elective course.

The Public Health Minor is one way the school is doing its part to address the national and global public health workforce crisis. An estimated 250,000 more public health professionals will be needed by 2020, according to the findings of an Association of Schools of Public Health taskforce headed by Dr. Linda Rosenstock, dean of the UCLA School of Public Health (see the June 2008 issue of this magazine). “The minor increases the visibility of

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Elizabeth Kuilanoff says the public health courses she took as part of the Minor in Public Health were the most interesting and enjoyable of her undergraduate career. “Through them I learned that there is more to keeping people healthy than doctor visits,” she says. “There is a need for continual health education, marketing of healthy behaviors, preventative health programs, and focusing on populations rather than individuals.”

For as long as she can remember, Kuilanoff wanted to be a physician, and that goal hasn’t

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“I still want to be a doctor, but receiving an M.P.H. is more important to me right now.

With a public health background, I will be more effective in making changes in the larger population.”

—Elizabeth Kuilanoff

changed. But like Kovshilovskay, she has put aside her medical school plans, at least for the next two years.

“I still want to be a doctor, but receiving an M.P.H. is more important to me right now,” says Kuilanoff, a first-year student in the school’s Department of Epidemiology. “With a public health background, I will be more effective in making changes in the larger population. I will further my understanding of the determinants of disease and the societal factors that affect health.”

“The minor continues to be extremely popular,” says Dave Clark, the school’s assistant dean for student affairs. This year, he notes, nearly 100 qualified

UCLAPUBLIC HEALTH

Kovshilovskay and Kuilanoff are among a handful of current UCLA School of Public Health students who are at the school in large part because of the exposure to public health they received as UCLA undergraduates. The undergraduate Minor in Public Health, offered by the school since the fall of 2003, comprises seven courses designed to give students broad exposure to the core public health functions. Students start with Public Health 150, an overview of the field, and then take introductory courses offered by the school in the five public health disciplines – biostatistics, community health sciences, environmental health

the public health option for a very smart and passionate group of undergraduates,” says Dr. Hilary Godwin, the school’s associate dean for academic programs. “It prepares students for the profession, and even those who end up not pursuing a graduate degree can bring the public health perspective to whatever career they do enter.”

Kovshilovskay says that without the minor, many of her undergraduate peers would have known little, if anything, about the foundations of public health. “A lot of people think it’s just about something like clean water supply, when that’s a small aspect of the field,” she says. “The minor is wonderful because it allows undergraduates to learn about all of the disciplines that make up public health from faculty experts. All of my professors were friendly and open with their office hours, and getting that exposure from them solidified my desire to apply to the UCLA School of Public Health.”

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students applied. Typically, only 25-27 have been admitted each year, but given the overwhelming response and the talented pool of applicants, the school accepted 50. Clark also notes that the minor program has attracted an ethnically diverse group of students.

The Public Health Minor program is one of many proactive efforts by the school to interest talented students, particularly those from underrepresented communities, in graduate public health education. For the 2009-10 class, the school has dramatically increased recruiting efforts, both locally and nationally – including attendance at a number of conferences specifically for underrepresented

preparatory and mentoring support to UCLA undergraduates, most of whom enter the Public Health Minor.

“This program has been an important resource for disadvantaged students on campus,” says Dr. Alma Guerrero, a clinical instructor in pediatrics and M.P.H. student at the school (see profile on page 29), and one of the program’s three co-directors (Dr. Moira Inkelas, associate professor at the school, is also a co-director; Dr. Alice Kuo, an adjunct member of the school’s faculty, heads the program).

“It provides academic mentoring and career counseling to students who are passionate about giving back to their communities. We introduce and expose

groups and communities. Outreach has increased to historically black colleges, Hispanic-serving institutions and tribal colleges and student groups, Clark says, along with continued efforts on campuses within the California State University system and at other UC campuses.

Another effort to build interest in public health among undergraduates from underrepresented communities is administered by the school’s Center for Healthier Children, Families and Communities. The Pathway for Students into Health Professions (PSHP) program aims to increase the presence of underrepresented people of color in the field of maternal and child health. Funded since 2005 by the federal Maternal and Child Health Bureau/Health Resources and Services Administration, and sponsored by both the School of Public Health and the Department of Pediatrics within the medical school, PHSP provides

students to diverse maternal and child health professions as career options, which some students would have never considered before.”

“It was such a great overview of the wide range of possibilities within public health, with guest speakers who gave us a firsthand account of what it was like to be in the field.”

UCLAPUBLIC HEALTH

—Nupur Gupta

Having been surrounded by extreme poverty as a child growing up in India before her family moved to the United States when she was 10, Nupur Gupta always knew she would pursue a career working with disadvantaged populations. She wanted to go into a field where she could make an impact on the health of a large number of people, perhaps in developing countries, but didn’t realize there was a route to doing so outside of medicine – until she was an undergraduate at UCLA. As a sophomore, she had two experiences that piqued her interest in public health. She became involved in a campus-based internship program called COPE (Community Outreach for Prevention

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ance, she began to explore other options. He introduced her to a colleague, Dr. Patricia Ganz, director of the Division of Cancer Prevention and Control Research, part of UCLA’s Jonsson Cancer Center and housed in the School of Public Health. Ganz counseled Wagman on the wide-ranging career options within public health. Wagman ended up taking a position as a research assistant to Dr. Beth Glenn, a faculty member at the school and in Ganz’s division, and applying for the Public Health Minor.

The minor helped Wagman find her niche.

“I realized that health services was for me,” she says.

“For that course we had so many great guest speakers – physicians, malpractice lawyers, a chief financial

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and Education), which gives students the opportunity to become involved in providing preventive health services to at-risk youth and families as well as taking related coursework. She also volunteered for a nonprofit organization, Project Rishi, which was working in a village in south India to build a medical clinic and improve sanitation through water purification and a better sewage system. Gupta, who had never heard of public health before, was hooked. She went to UCLA’s career center to learn more about the profession, found out about the Public Health Minor, and applied.

Her first class as part of the minor, Public Health 150, was led by one of the School of Public Health’s most renowned faculty members – Dr. Roger Detels,

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“I was one of the younger students in my class and at first I felt intimidated.

I expected a hard transition, but I found that the minor had prepared me so well that I was able to quickly get up to speed.”

—Ashley Wagman

professor of epidemiology. “That course confirmed for me that this was the direction I wanted to take,” says Gupta, now in her second year as an M.P.H. student in the Department of Epidemiology. “It was such a great overview of the wide range of possibilities within public health, with guest speakers who gave us a firsthand account of what it was like to be in the field.”

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In her sophomore year at UCLA, Ashley Wagman began to feel trapped.

The daughter of a surgical oncologist, Wagman had spent much of her adolescence around medicine – accompanying her father on hospital rounds, helping to organize his slides, going with him to professional conferences. She remained passionate about the health care field but had come to realize she didn’t want to be a physician. With her father’s guid-

officer, a nurse… It was a great overview of the health care system and it helped me realize that this was a field within public health that I really liked.”

The minor also proved extremely helpful when she began her graduate education at the UCLA School of Public Health. “I was one of the younger students in my class and at first I felt intimidated,” Wagman says. “I expected a hard transition, but I found that the minor had prepared me so well that I was able to quickly get up to speed.”

Today, Wagman is a second-year M.P.H. student in the Department of Health Services, with a concentration in Health Services Management. Far from feeling trapped about her options, she is eagerly anticipating a career in the medical device industry – and thankful that her undergraduate exposure to all that public health can offer enabled her to choose a path with confidence.

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OFTEN ,

SHORT- TERM BENEFITS HAVE TRUMPED LONG - TERM CONSEQUENCES IN ENVIRONMENTAL POLICIES .

B UT

FROM GREEN

CHEMISTRY AND NANOTECHNOLOGY TESTING TO DISCUS SIONS ON CREATING HEALTHIER CITIES , MOMENTUM IS BUILDING FOR A NEW APPROACH .

TOWARD SUSTAINABLE ENVIRONMENTS:

Thinking Proactively About Our Surroundings Tiny as they are

– as much as a million times smaller than

the head of a pin – nanoparticles burst onto the scene a few years ago in a big way.

The National Science Foundation predicted that nanotechnology – a vast frontier of functional materials, devices and systems to be created by manipulating objects at the level of molecules and atoms – would become a $1 trillion industry within a decade, driving progress in a wide-ranging spectrum of arenas, from manufacturing and computers to energy, electronics and health care. Already, nanomaterials are used in clothing, sunscreens, electronic devices, pharmaceuticals and other

UCLAPUBLIC HEALTH

biomedical products, to name a few.

But as nanomaterials begin to be introduced into the environment in a major – and, to some extent, irreversible – way, are we being sufficiently mindful of the potential for harmful effects?

“We don’t know if the chemical and physical properties of the nanomaterials are going to make them more harmful because of their size, which is entirely possible,” says Dr. John Froines, professor in the UCLA School of Public Health and director of the Center for Occupational and Environmental Health (COEH), based in the school. “And yet, because of the potential benefits, we are racing

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way that makes economic sense, and we are no longer making decisions that lead to major inequities in who bears their burdens.”

Considerable activity has been taking place on this front at UCLA, with School of Public Health faculty among the key players. Ambrose is active on a new Campus Sustainability Committee that seeks to engage the UCLA community in advancing sustainability through education, research, operations, and community service activities. Froines and Timothy Malloy, a member of the UCLA Law School faculty, head a multidisciplinary team that has established the UCLA Law and Environmental Health Initiative on

UCLAPUBLIC HEALTH

ahead on a technology for which the testing protocols are not adequate.”

While it’s not clear how much harm, if any, nanomaterials might cause, there is plenty of precedent for negative environmental and health effects resulting from an absence of proactive thinking. Few appreciated the potential harmful impacts when plastics began to be mass-produced after World War I, and the materials have ended up having profound effects – either by themselves, through their manufacturing byproducts or from their decomposition in the environment. The pesticide DDT, which hasn’t been used in decades after its harmful environmental effects were chronicled by scientists, can still be found in children born today. The chemical MTBE, added to gasoline to prevent air pollution, went on to cause groundwater contamination.

Chemicals used as flame retardants have shown up in human breast milk at levels associated with adverse health effects in laboratory animals.

And it’s not just in the introduction of new chemicals where a lack of foresight has exacted health and environmental costs. Dr. Richard Jackson, who recently joined the school’s faculty as chair of the Department of Environmental Health Sciences (see page 32), argues that poorly designed physical environments are playing a major and underappreciated role in many of the nation’s ills, by contributing to

cover story

everything from energy overconsumption to social isolation and lack of physical activity – a key factor in the epidemic of obesity and related diseases such as hypertension, diabetes, cardiovascular disease and stroke.

Environmental sustainability – assuring that we meet today’s needs without compromising future ones – refers to arenas as seemingly disparate as climate change, energy and chemical policy, and the built environment.

“Over and over again in environmental public health, we haven’t looked at long-term costs adequately,” Jackson says. “Too often, when we make our economic, development, and social decisions we are stealing from future generations.”

A growing movement within public health and other circles calls for a more balanced approach, and there are signs that policy makers are listening.

“Environmental sustainability means that we’re accomplishing our objectives today in a way that isn’t going to cause harm in the future,” says Dr. Richard Ambrose, professor of environmental health sciences and director of the school’s Environmental Science and Engineering Program. “We’re minimizing environmental degradation while managing resources in a

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Ben Schwegler,

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D.Env. ’99

As senior vice president and chief scientist of Walt Disney Imagineering R&D, Schwegler is responsible for Imagineering’s Sustainable Design and Engineering group, which consists of engineers, architects, scientists and other design professionals chartered to understand the interaction of the built and natural environment, and to design infrastructure and buildings to minimize their negative impacts. One of the unusual features of this approach is that it merges innovations in productivity for the design and construction industry with more traditional scientific approaches to sustainability, such as ecosystem functions and services, habitat protection, and control of air, water and soil pollution. “By explicitly identifying ecosystem functions and their associated services, we are establishing the basis whereby they can be made an integral part of the typical business financial models,” Schwegler explains. “This approach enables the explicit linking of resources used in construction and operation of buildings and infrastructure to those of the ‘natural’ environment.” Schwegler, a consulting professor at Stanford and member of the Jet Propulsion Laboratory’s Technical Divisions Advisory Board, is a winner of the Henry R. Michel Award from the American Society of Civil Engineers.

“We will be taking a proactive approach to chemical policy in the state, as well as examining federal policies on regulation and prevention.”

Dr. John Froines, on the new UCLA Law and Environmental Health Initiative on Sustainable Technology Sustainable Technology to tackle key environmental sustainability issues from the policy perspective.

UCLA’s COEH teamed with UC Berkeley’s COEH to produce the widely circulated “Green Chemistry: Cornerstone to a Sustainable California,” commissioned by the California Environmental Protection Agency. And last month, UCLA – with the School of Public Health again playing an important role – received federal funding as one of two lead campuses in a national effort to learn more about the implications of nanotechnology for the environment and human health.

Of the estimated 60,000-80,000 different chemical compounds used in commercial applications – with more added each day – only about 1,000 have undergone extensive toxicity testing. In the United States, the policy has been to allow chemicals to be used commercially until there is evidence that they are harmful – by which time much damage has often been done to the air, waterways, and human health.

And while some chemicals break down immediately, others can remain in the environment for decades, even after they are no longer in use.

“We’ve gone after the chemical threats in our environment one by one, operating on the presumption that all chemicals are innocent until proven guilty,” says Jackson. “The amount of science, dialogue, and regulation it takes to get one chemical

reduced or removed is extraordinary, and politically untenable in many situations. We are much better off coming up with a list of what’s safe and expanding from there rather than endlessly chasing after one more bad actor that we’re worried about.”

In 2006, the European Union took such a tact, adopting the Regulation, Authorization, and Restriction of Chemical Substances policy known as REACH. The European approach, along with progressive policies coming out of Canada, represented a major shift in the approach to chemicals by requiring companies to provide health and safety data on compounds before they are introduced on the market. It also jump-started a “green chemistry” movement in the United States that aims to take a more precautionary approach to the use of new chemicals and to design safer ones in place of those found to be hazardous. California has been at the forefront, with Gov. Arnold Schwarzenegger launching a Green Chemistry Initiative under the leadership of the Department of Toxic Substances Control, and the state Legislature considering new policies on toxic chemicals. UCLA’s COEH has worked with both parties to support the initiative.

“Green Chemistry: Cornerstone to a Sustainable California,” released earlier this year, makes a compelling case for a new strategy. The report concludes that existing state laws regulating the production and use of hazardous chemicals have “serious gaps” and fail to protect public health and the environment.

Chemical- and pollution-related diseases among chil-

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products and processes,” says Dr. Elinor Fanning, assistant director for research at UCLA’s COEH and one of the report’s authors. “We’re faced with a global crisis that requires a fundamental change in thinking.”

D.Env. ’00

The chemistry of the world’s oceans is undergoing rapid change, as excess CO2 from the burning of fossil fuels and deforestation makes its way into marine ecosystems where the water is becoming more acidic. While the chemistry of ocean acidification is well understood, the impacts to marine biota and their ecology are only now beginning to be appreciated, says Miller, a scientist at the Smithsonian Environmental Research Center in Edgewater, Md., who studies the effects of ocean acidification in coastal marine ecosystems. “Most attention has focused on plankton and coral reefs, yet nobody has been studying coastal waters or estuaries, where the effects of CO2 will likely be most rapid and acute,” Miller notes. These ecosystems are among the most biologically productive on Earth and maintain some of the most extensive and measurable ecosystem services – commercial and recreational fisheries, water purification, flood and storm surge protection, and human recreation among them. “While most people are aware of CO2 as a greenhouse gas, few realize its global impact on our oceans,” Miller says. His experimental research aims to understand how this “other inconvenient truth” is affecting the biology and ecology of our coastal ecosystems.

Mark Gold, D.Env. ’94

Gold is president of Heal the Bay, a leader in the fight against coastal pollution in Santa Monica and beyond. The group’s current focus is on tackling California’s marine debris problem, including a statewide legislative push.

“Our addiction to singleuse plastic packaging has led to a global marine debris crisis, and the impacts to fish, sea birds, sea turtles and marine mammals have been well documented,” Gold says.

“Even the most remote places on the globe are strewn with plastic trash, and our own beaches look like landfills after every rain.” Deciding that Heal the Bay’s focus on public education wasn’t enough, Gold began working with the Regional Water Board and local cities to ensure adherence to zero-trash Total Maximum Daily Loads (water-body-specific standards that prohibit trash in receiving waters) for the Los Angeles River and Ballona Creek. As a result, more than 40,000 catch basin inserts and screens have been installed by Los Angeles city and county, as well as other cities. The devices keep the trash out of the storm-drain system. Heal the Bay has made a successful legislative push to reduce plastic trash in Santa Monica, Malibu and Manhattan Beach, and Los Angeles city and county are considering similar measures.

UCLAPUBLIC HEALTH

How best to address these and other challenges from the policy standpoint is the work of the new UCLA Law and Environmental Health Initiative on Sustainable Technology. Co-directed by Froines and the law school’s Malloy, it includes faculty from the School of Public Health, School of Public Affairs, and Anderson School of Management. Explains Fanning, one of the group’s founding members: “We want to bring together academics from a variety of disciplines to craft this sustainable future. We need to identify, track, and prioritize hazardous substances; support good legislation and rule-making; provide information and support to non-governmental organizations that are concerned about these issues and attempting to implement change; and develop a better curriculum in the university, including partnerships with industry where appropriate.”

Froines says the initiative intends to develop approaches that would offer alternatives to traditional chemical-use and industrial policies in the United States,

Whitman Miller,

cover story

dren and workers in California cost the state’s insurers, businesses and families an estimated $2.6 billion in direct and indirect costs; an additional $1.2 billion in direct and indirect costs comes from 240,000 cases of preventable childhood diseases related to environmental exposure to chemical substances. In 2004, more than 200,000 California workers were diagnosed with deadly chronic diseases such as cancer and emphysema attributable to chemical exposures in the workplace.

The report presents data from the Department of Toxic Substances Control showing that 61 of the state’s 85 largest hazardous waste sites are leaking toxic material directly into groundwater. An estimated 1 million California women of reproductive age have blood mercury levels that exceed what the U.S. Environmental Protection Agency considers safe for fetal development, and biomonitoring studies have detected more than 100 synthetic chemicals and pollutants in breast milk, umbilical-cord blood, and other bodily fluids and tissues.

A set of policy recommendations for California includes passing new laws to remedy the insufficient data available on the toxicity of chemicals; providing the state’s agencies with a new legal framework to better enable them to act when there are reasonable concerns; and investing in the design of chemicals, materials and manufacturing processes that are inherently safer for humans.

“The ability of scientists to understand the environmental and health implications of chemicals hasn’t kept pace with the development of new chemical

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Amy Hensley

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Robert Gilbert

Gilbert, a doctoral candidate in the school’s Department of Environmental Health Sciences, has been supporting the Campus Sustainability Committee as a graduate student researcher for the past year. The committee provides an opportunity for administrators, staff, faculty, and students to share their sustainability initiatives and, as a group, strategize on reaching the goals outlined in the UC Policy on Sustainable Practices. “Individual departments and groups have been implementing sustainability initiatives independent of a central campus goal,” Gilbert explains. “This committee is the first step toward centralizing UCLA’s efforts and building synergies that will accelerate progress.”

Through the committee, Gilbert has taken part in many campus sustainability initiatives, including setting up a composting program in the residence hall cafeterias, developing a highresolution electrical and water-monitoring system, and mentoring students engaged in sustainability projects. “It has been very motivating to see how excited students, faculty, and staff are about improving sustainable practices on campus,” says Gilbert.

“I believe the individual efforts across campus will come together over the next few years, and UCLA will make great strides in sustainability operations and educational programming as a result.”

During the 2006-2007 academic year, Hensley, a doctoral student in the school’s Environmental Science and Engineering Program, studied awareness of and interest in sustainability among UCLA students and faculty under the guidance of the Campus Sustainability Committee’s Academic Subcommittee.

As part of the project, Hensley investigated the pre-existing state of academic initiatives in sustainability at UCLA. Departmental chairs of sustainability-related fields were interviewed and surveys were sent to faculty and students with questions ranging from whether they thought sustainability is an important issue to whether they taught or were interested in taking sustainabilityrelated classes. “Although almost all of the faculty and student respondents were interested in sustainability, few had taught or taken classes, studied the subject, or planned to do any of these activities,” Hensley reports. A list of current courses related to sustainability was also compiled using information collected.

“The results of the surveys are an informative first look at the state of academic activities at UCLA related to sustainability, and are informing subsequent investigations and projects,” Hensley says.

derived from the European Union’s REACH. “We will be taking a proactive approach to chemical policy in the state, as well as examining federal policies on regulation and prevention and looking at international opportunities,” he says.

Proactive is not a word that could be used to describe U.S. policy on chemicals in the past, Froines says. For all the excitement about nanotechnology, he worries that “we are rushing to judgment the way we did with MTBE and a whole range of other chemicals.”

There are some positive signs that a more precautionary approach may be taken on nanomaterials than with previous materials, although Froines believes it remains to be seen whether the reality will match the rhetoric. At UCLA, the new campus initiative will be developing policy recommendations. In addition, the Nanotoxicology Research and Training Program was established last year as part of UCLA’s California NanoSystems Institute. That program, co-directed by Dr. Curtis Eckhert, professor of environmental health sciences in the UCLA School of Public Health, draws from the expertise of faculty from eight departments and four schools on campus in training a new generation of students to understand nanomaterials, their potential toxicity, and risk assessment.

In October, UCLA was the lead institution in a consortium of 13 institutions awarded $24 million in funding from the National Science Foundation and U.S. Environmental Protection Agency for a new center to study the ways in which

nanomaterials interact with the environment and living systems, and to translate that knowledge into risk assessment and mitigation strategies related to the development of nanotechnology. The University of California Center for Environmental Implications of Nanotechnology (UC CEIN), one of two centers to come out of the grant (the other is at Duke University), is housed in UCLA’s California NanoSystems Institute (CNSI). Dr. Hilary Godwin, professor and associate dean for academic affairs in the School of Public Health, is co-principal investigator of the new center, which will bring together experts from a wide variety of fields (see page 30).

Although little is currently known about the effects nanoparticles might have, early studies have raised concern. Research at UCLA and elsewhere – some of which involved the COEH – has found a strong association between exposure to ultra-fine particles from combustion byproducts such as diesel exhaust and increased incidence of respiratory diseases and cardiovascular disease. In the laboratory, studies have shown that engineered nanoparticles called carbon nanotubes, whose shape resembles asbestos fibers, produce a lung-inflammation response similar to that caused by asbestos. Nanotubes have been slated for use in a wide range of nanotechnologies, including electronics and pharmaceuticals.

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M.P.H. ’05

“There has been a huge amount of money invested in the development of nanotechnology, but as excited as we are about the technology, we have to make sure it’s developed in a safe manner.”

Dr. Hilary Godwin, on the new UC Center for Environmental Implications of Nanotechnology policy. “These nanomaterials are new, which means we know less about them,” Godwin says. “But it also means we have an opportunity to do this right.”

UCLA has also been paying closer attention to its own sustainability practices. The Campus Sustainability Committee, which includes high-level administrators, faculty, staff, and student representatives, has begun to take an inventory of UCLA’s sustainability practices in an effort to determine ways in which the campus might improve and measure progress in the future. Ambrose, one of five faculty members on the committee, also serves on the academic and communications subcommittees. Among the goals are to bring more visibility and coordination to the sustainability-related courses and activities on the campus. “There’s a lot going on in terms of sustainability, but it’s all occurring in a decentralized way,” Ambrose says.

When America’s cities were redesigned with an emphasis on suburbanization after World War II, it seemed like a good idea.

“We thought that by moving people out of the dense, dirty cities and putting them out in the suburbs they’d get healthier,” says Jackson, a pediatrician who has served as California’s state health officer and director of CDC’s National Center for Environmental Health. “In fact, there are some benefits to living in the suburbs, but no one benefits from sitting in traffic for three hours a day and walking only 300 yards a day.”

UCLAPUBLIC HEALTH

“There has been a huge amount of money invested in the development of nanotechnology, because nanoparticles tend to have such interesting properties,” says Godwin. “But as excited as we are about the technology, we have to make sure it’s developed in a safe manner, and that we avoid properties that would be hazardous to human health and the environment.”

Given that the traditional, one-at-a-time approach to toxicity testing in humans and the natural environment can’t keep up with the rapid pace at which nanotechnology-based enterprises are generating new materials and ideas, the UC CEIN seeks to develop a broad-based, computational model of predictive toxicology, continually updated as nanotechnology evolves. Godwin notes that the center has prioritized the nanomaterials it will study based on characteristics including principles of toxicology likely to pose the greatest threat and those materials that are currently or anticipated to be in the greatest use in the near future. The materials’ toxicity will be tested in a variety of settings, from how they interact with biological systems in cell-based studies to how they interact with the environment in model ecosystem studies.

Although nanomaterials are already in circulation, it is still early enough that research indicating potential public health concerns can make a difference, Godwin says. Given the backing of the federal government in funding the center, she believes the results will have the potential to significantly inform

A third-year doctoral candidate in the school’s Environmental Science and Engineering Program, Kwan has for the last year conducted research for UCLA Transportation Services to quantify the CO2 emissions associated with UCLA-related air travel. The study supports UCLA’s goal of establishing an inventory of CO2 emissions from campus operations, and releasing a strategic plan to offset or mitigate these emissions by the end of 2008. Overcoming a number of methodological challenges, Kwan designed and implemented a survey to estimate the extent of faculty travel, then developed a transparent carbon calculator. He estimated that in 2007, more than 70 million miles were logged on UCLA-related air travel, corresponding to more than 13,000 metric tons of CO2. “Although this is less than UCLA ground transportation emissions, it is important to note that the effects of aircraft emissions and ground emissions are not equal,” he says.

“Aircraft emissions are released in the stratosphere, where they have augmented global warming impacts compared to ground-level emissions. As UCLA air travel is projected to increase, we must investigate methods to offset or mitigate aircraft CO2 emissions.”

cover story

Calvin Lee Kwan,

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Douglas Meffert,

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D.Env. ’96, M.B.A

Meffert’s doctoral research in the 1990s brought him to New Orleans, where he currently serves as deputy director and the Eugenie Schwartz Professor of River & Coastal Studies at Tulane/Xavier Center for Bioenvironmental Research, and has participated in efforts to rebuild post-Katrina New Orleans in a more sustainable way. “Hurricane Katrina has increased the sense of urgency for implementing sustainable recovery practices on home, neighborhood, metropolitan, and coastal scales – all based on sound science, engineering, economic, social, and design principles,” Meffert says.

His research has involved demonstrations that will provide for flood protection, phytoremediation, urban forestry, coastal wetland storm-surge protection and wastewater treatment.

As chair for the Mayor’s Sustainability Subcommittee of the Bring New Orleans Back Commission, he is participating in demonstrations of hydrokinetic renewable energy in the Mississippi River that aims to transform a carbon-neutral mixed-use affordable housing unit into a net producer of energy.

“With collaboration among researchers, policy experts, and practitioners in the fields of natural, built, economic, and social environments,” Meffert says, “New Orleans has the potential to serve as a model for some of the world’s largest urban areas that are vulnerable to gradual environmental threats or more sudden disasters.”

“If you want to change people’s health, you have to change the conditions in which they live.

That requires not always just going for another narrow technical fix, but reordering our physical world.”

Dr. Richard Jackson To some, it also seemed like a good idea when schools increasingly began to be located on cheap land, away from housing developments. Though a money-saver in the short run, Jackson laments the long-term price. “A generation ago, two-thirds of our children walked to school,” he says. “Now, only about 13 percent do.”

In Urban Sprawl and Public Health, Jackson and his co-authors document how growth and development have contributed to many of the nation’s biggest current health woes, including depression and the obesity epidemic. Research has shown, for example, that residents of cities characterized by urban sprawl are likely to walk less and weigh more than people in cities that are denser and less car-dependent. “When I was a young doctor, only 7 percent of the gross domestic product went to medical care, and now we’re approaching 20 percent,” says Jackson. “If we really want to deal with chronic diseases, we have to invest in prevention – a big part of which is assuring the conditions in which people can be healthy.”

For Jackson, that means creating physical environments that improve energy efficiency, reduce consumption of limited resources, encourage walking and other forms of exercise, allow people to grow and purchase healthier foods, and improve their social-

ization. “One of our nation’s leading disorders is depression, and in part it’s being driven by social isolation and lack of physical activity,” he notes.

With a backdrop of rising gas prices, concern about global climate change, and the growing problem of obesity, there are signs that Jackson’s message is being heard. In New York City, Mayor Michael Bloomberg has proposed that every resident live within a quarter mile of a park. Parks bring enormous value to cities, Jackson notes, from lowering temperatures and improving air quality to bolstering the economic value of homes and promoting physical activity.

In Los Angeles, planners have begun to articulate a vision in which sprawl would be reduced by dividing the city into seven self-contained nodes, with quality mass transit taking residents from one to another.

Jackson argues that the public health benefits of such forward-looking thinking – whether in urban planning, chemical policy, or other environmental issues – are substantial.

“Sustainability is the public health issue of the 21st century,” he says. “If you want to change people’s health, you have to change the conditions in which they live. That requires not always just going for another narrow technical fix, but reordering our physical world in ways that work better for us, better for nature, and better for future generations.”

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research highlights Fruits, Vegetables, and Teas May Reduce Smokers’ Risk of Lung Cancer

Flavonoids such as those found in green or black tea may protect against lung cancer by blocking the formation of blood vessels that tumors develop so they can grow and spread.

UCLAPUBLIC HEALTH

TOBACCO SMOKERS who eat three servings of fruits and vegetables per day and drink green or black tea may be reducing their risk of lung cancer, according to a first-of-its-kind study.

A research team headed by Dr. Zuo-Feng Zhang, professor of epidemiology in the School of Public Health and a member of UCLA’s Jonsson Cancer Center, found that smokers who ingested high levels of natural chemicals called flavonoids in their diet had a lower risk of developing lung cancer – an important finding, since more than 80 percent of lung cancers are caused by tobacco smoking. The study appeared in the journal Cancer, published by the American Cancer Society.

Flavonoids are water-soluble plant pigments that have antioxidant and anti-inflammatory properties, both of which can counteract damage to tissues. For the UCLA study, Zhang and colleagues looked at 558 people with lung cancer and 837 people who did not have lung cancer and analyzed their dietary history. They found that study participants who ate foods containing certain flavonoids seemed to be protected from developing lung cancer. Zhang said the flavonoids that appeared to be the most protective included catechin, found in strawberries and green and black teas; kaempferol, found in Brussels sprouts and apples; and quercetin, found in beans, onions and apples.

Should smokers run out and stock up on the teas, apples, beans and strawberries? Quitting smoking is the best course of action, Zhang says, but eating more fruits and vegetables and drinking more black and green teas won’t hurt. “Since this study is the first of its type, I would usually be hesitant to make any recommendations to people about their diet,” he explains. “We need to have several larger studies with similar results to confirm our finding. However, it’s not a bad idea for everyone to eat more fruits and vegetables and drink more tea.”

Zhang says flavonoids may protect against lung cancer by blocking the formation of blood vessels that tumors develop so they can grow and spread, a process called angiogenesis. They also may stop cancer cells from growing, allowing for naturally programmed cell death, or apoptosis, to occur. The antioxidant properties found in the flavonoids also may work to counteract the DNA-damaging effects of tobacco smoking, Zhang adds, explaining why they affected the development of lung cancer in smokers but not in nonsmokers.

A next step, Zhang says, involves laboratory-based studies of flavonoids on cell lines and animal models to determine how they are protecting smokers from developing lung cancer.

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In Effort to Increase Voluntary HIV Testing, Education Alone Proves Not Enough

A high level of stigma against individuals infected with HIV and the groups most at risk keeps many in China from getting tested.

THE CHALLENGE FACED BY A CHINESE CAMPAIGN to increase HIV testing in areas where free care is offered to those who are infected underscores the ineffectiveness of health education alone for such purposes and points to the need for China to develop better strategies to make testing acceptable, concludes a study by a group including Dr. Roger Detels, professor of epidemiology in the UCLA School of Public Health, and published in AIDS Patient Care STDS. In 2003, with estimates suggesting that as many as 840,000 people were living with HIV/AIDS in China, the government implemented an ambitious program, The China Comprehensive AIDS Response (“China Cares”). China Cares provides free treatment for those infected with HIV who cannot afford it. But the program’s success has been limited by the fact that the majority of HIV-infected people in China don’t know they are infected. “Unfortunately, there is a high level of stigma in China against individuals who are infected with HIV and against the groups most at risk of HIV infection,” says Detels. “Even being seen at an HIV testing site potentially subjects the test seeker to stigma. As a result, many people who are at risk are unwilling to be tested.”

Realizing this, the government of China has implemented an educational campaign to encourage HIV testing, especially in the areas covered by the China Cares program. The study, headed by Dr. Wei Ma (Ph.D. 0 ’ 6), evaluated the success of this program in Guizhou Province (where there is a relatively high prevalence of HIV) by comparing the proportion of residents who were willing to be tested in the China Cares area to those in a non-China Cares area. Although the levels of knowledge were greater in the urban areas of the China Cares program, the researchers found no difference between the two areas in the proportion actually getting tested. “If the China Cares program is to succeed, more effective strategies must be developed to make testing acceptable,” Detels says.

UCLAPUBLIC HEALTH

Newly Identified Gene Found to Be Associated with Obesity Risk, but Not Diabetes A UCLA RESEARCH TEAM headed by Dr. Simin Liu, professor in the schools of public health and medicine, has provided additional evidence on a newly identified gene for obesity as it affects whites, and has uncovered significant differences regarding the extent to which variants of the gene are associated with the risk of obesity and diabetes across ethnic groups.

Several high-profile genomic studies in Europe recently identified a gene on chromosome 16, called the fat mass and obesity-associated (FTO) gene, that has high statistical significance in its relation to both obesity and type 2 diabetes.

To confirm these findings, Liu and colleagues from the Program on Genomics and Nutrition at UCLA, in collaboration with colleagues at Harvard and elsewhere, examined whether variations of the FTO gene could serve as risk indicators for obesity and diabetes in a multiethnic cohort of postmenopausal women enrolled in the Women’s Health Initiative. Their findings were published in the journal Obesity.

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Disease Management Program Reduces Use of High-Cost Services, but Disparities May Persist

Hospital Utilization Rates Before and After Patients Enrolled in a Disease Management Program

Before Enrollment After Enrollment

Annual Hospital Inpatient Days

BY IMPROVING SELF-MANAGEMENT of chronic illnesses such as diabetes, congestive heart failure, asthma and hypertension, disease management 1.4 programs are effective in reducing utilization of highcost services. But in doing so they don’t necessarily reduce the racial and ethnic disparities that exist in 1.2 the utilization of services among chronically ill Medicaid populations, according to the findings of a UCLA School of Public Health study.

1.0 Despite evidence that disease management (DM) programs can improve clinical outcomes among 0.8 individuals with chronic illnesses, few large-scale studies have examined the effects of these programs for publicly insured patients. “The assumption of 0.6 these programs is that appropriate ambulatory management of chronic diseases will lead to reductions in unnecessary hospitalizations and emergency depart0.4 ment visits, and increased use of appropriate outpatient visits,” says Dr. Gerald Kominski, professor of health services and associate director of the UCLA 0.2 Center for Health Policy Research, based in the school. As more states adopt DM programs for pub0 licly insured beneficiaries, he adds, an important White issue in evaluating their success is how the programs affect any racial/ethnic differences in utilization that exist before their implementation.

Kominski, working with colleagues who included Drs. Donald Morisky and Abdelmonem A. Afifi of the School of Public Health, examined the racial and ethnic differences in utilization of services among more than 15,000 chronically ill, high-risk beneficiaries of the Florida Medicaid program both before and after they enrolled in a DM program. The results were published in the American Journal of Managed Care.

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The researchers confirmed two variants of the FTO gene that were most significantly associated with obesity in the white ethnic group. There was no evidence of any increased diabetes risk associated with the FTO variants in any of the four ethnic groups in the study. Although both genetic variants were significantly associated with an increase in body mass index (BMI), the research team found no significant interactions between FTO variants and traditional diabetes risk, including age, smoking, alcohol intake, and exercise. The researchers also found that the gene had no significant effect on other obesity-related metabolic conditions, such as fasting glucose, insulin, and markers for inflammation and endothelial dysfunction.

“Despite the association between variants of this FTO gene and BMI, the precise mechanism underlying the effect of the FTO protein on body fat regulation remains largely unknown,” Liu says.

He and his colleagues proposed that FTO may be a gene predisposing carriers to early increased weight gain, but with less influence on the progression of weight gain to obesity-associated metabolic disorders such as diabetes. “Our observation that genetic effects of FTO on BMI differ by ethnicity may reflect potential gene-gene or gene-environment interactions,” Liu says. “Further studies are necessary to elucidate whether FTO is a true obesity-predisposing gene or a potential candidate gene for obesity-associated metabolic disorders.”

Black

Hispanic

Other

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Disparities were found to exist prior to the program’s implementation: For example, Latino and African American beneficiaries had significantly lower average annual inpatient hospitalization days than white beneficiaries, with whites averaging nearly 50 percent more inpatient days per year than Latinos. DM significantly reduced inpatient utilization among all of the groups by similar amounts. Emergency department visits and outpatient visits, where there weren’t significant disparities prior to DM implementation, were also reduced in all of the racial/ethnic groups, by similar amounts.

The authors recommended that states adopting DM programs for their Medicaid populations investigate possible sources of racial/ethnic utilization differences that exist prior to the programs’ implementation, and whether the programs are appropriately reducing or eliminating these differences. “In light of financial pressures facing many state Medicaid programs,” says Kominski, “our results should prove promising to other states attempting to identify programs to manage scarce resources more efficiently.”

Research Tool Assesses Effects of Cancer Diagnosis, Treatment on Long-Term Quality of Life

UCLAPUBLIC HEALTH

Cancer diagnosis, treatment and survival can engender lingering impacts on quality of life.

Survivors can experience not only continuing physical health problems, but also disruptions in mental health and psychological well-being.

A NEW RESEARCH TOOL HAS BEEN DEVELOPED by a UCLA School of Public Health team to monitor the effects of cancer diagnosis and treatment on the quality of life of long-term cancer survivors.

The United States currently has more than 10 million cancer survivors – a number that has been increasing each year thanks to improvements in early detection and treatment, as well as rising numbers of new cases associated with the aging of the population. But the experiences of cancer diagnosis, treatment and survival can engender lingering impacts on the quality of life. Survivors can experience not only continuing physical health problems, but also disruptions in mental health and psychological well-being. Although these effects have been known, there has been a scarcity of tools for measuring them in this growing population.

A group led by Dr. Catherine Crespi, assistant professor of biostatistics, and Dr. Patricia Ganz, professor of health services and director of the Jonsson Cancer Center’s Division of Cancer Prevention and Control Research (housed in the school), has refined a questionnaire-based instrument, the Impact of Cancer Scale Version 2, for measuring such impacts in long-term cancer survivors. The scientific evaluation of the new instrument, published in the Journal of the National Cancer Institute, indicates that it can effectively measure both negative effects on quality of life such as worry about the future and body-change concerns, and positive effects such as a heightened sense of purpose and awareness about one’s health.

“Increasingly, research on cancer survivors has emphasized their frequent report of meaning and benefit finding,” explains Ganz. “The Impact of Cancer Scale is designed to capture these impacts as well as negative effects.” She notes that the availability of the new instrument has the potential to improve understanding of quality of life in cancer survivors and can be used to identify factors associated with better outcomes, leading to more effective interventions and improved care for this population.

The research by Crespi, Ganz and colleagues is part of ongoing national studies investigating the late effects of cancer, and builds on prior work by Ganz

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and Dr. Brad Zebrack, now at the University of Michigan. The new version was developed using the responses of 1,188 breast cancer survivors to an 81-item survey, which were rigorously analyzed to identify specific areas of life that were affected by the cancer experience. “Because the number of cancer survivors who were recruited into the study and responded to the survey was so large, we were able to conduct a very comprehensive analysis,” says Crespi.

The new instrument and instructions for scoring responses to produce the Impact of Cancer scales will soon be available online through the Journal of the National Cancer Institute website.

Changing Insurance Coverage May Be Hazardous to Health

Adults who switched plans were found to be less likely to have a regular medical provider, and both adults and children who changed their coverage were more likely to report delaying care due to cost or insurance issues.

UCLAPUBLIC HEALTH

SWITCHING FROM ONE HEALTH INSURANCE PROVIDER to another may be bad for one’s health, according to a study from the UCLA Center for Health Policy Research (CHPR), based in the School of Public Health.

Reporting in the journal Medical Care, lead author and CHPR senior research associate Shana Alex Lavarreda, working with School of Public Health faculty members Ninez Ponce and E. Richard Brown, found that adults and children who changed health insurance plans experienced significantly reduced access to care and delayed treatment of medical problems as compared to those with continuous coverage. Adults who switched plans were found to be less likely to have a “usual source of care” – a regular medical provider – and both adults and children who changed their coverage were more likely to report delaying care due to cost or insurance issues. This was especially true of children in fair or poor health.

In California alone, up to 2.3 million people – including 619,000 children – switch insurance over the course of a year. The study, which drew upon the responses of more than 32,000 adults and 13,000 children to the 2003 California Health Interview Survey, found that income, race/ethnicity, age, gender, and rural status were significant factors associated with changing coverage. Younger, “middle-class” individuals were more likely to switch coverage than all other groups.

Although members of such an economically advantaged group may switch coverage voluntarily, the study’s authors noted that involuntary changes to employer-sponsored health care plans are also increasingly common as businesses seek ever more cost-effective coverage options. Lavarreda points out that the patient rules and regulations specific to each health insurer are often complex and difficult to navigate, creating a potential barrier to care for new patients. “Our system isn’t set up to help people through transitions,” she says.

“It puts the burden of navigating health plan transitions on the individual – you’re really on your own. People need more help knowing where to go and what to do.”

In the short term, the research served to highlight the advantages of retention of enrollees as one means of promoting access to health care. In the long term, Lavarreda believes the study illustrates the potential benefit of a continuous national health insurance program that would allow users to maintain their current health care provider. “The data suggest that keeping people in a single system they understand, and with a single doctor they know, is a key to ensuring consistent and preventative health care,” she says.

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student profiles A Politically Active Voice for Science

“With my background I will be able to work with pure scientists as well as communicating the importance of their work with pure policy people. There are very few fields that have that kind of overlap.”

UCLAPUBLIC HEALTH

— Kabir Chopra

KABIR CHOPRA REMEMBERS SITTING IN A LABORATORY as a UCLA undergraduate in 2005, asking one of the lab’s investigators why he thought more of his colleagues didn’t get involved in the political fray. The answer – that, with funding coming from the government, many were afraid to r‘ ock the boat’ – led Chopra, a molecular, cellular and developmental biology major who had been pondering becoming a scientist, to reexamine his career ambitions.

“I said, I‘ don’t think I can stay on the sidelines,’” Chopra recalls. “Science gets used to make political points, and it always seems to take a back seat to political agendas. With so much at stake, and things moving at such breakneck speed, more scientists need to become politically active.”

While taking a year off after completing his undergraduate education to contemplate his next move, Chopra worked on the Yes on 87 campaign, an unsuccessful statewide initiative that would have supported alternative energy research and development through a tax on oil profits. The experience led Chopra to decide that he was happiest working at the interface of environmental science and policy. To get the type of graduate education that would allow him to straddle the two worlds, he applied to the school’s M.P.H. program in the Department of Environmental Health Sciences.

Now in his second year, Chopra has found his niche.

Through the school’s Center for Occupational and Environmental Health he is working with faculty members John Froines and Hilary Godwin, along with Timothy Malloy, a professor in the law school, to develop policy recommendations on nanomaterials. Nanotechnology is predicted to be a $1 trillion industry within the next decade, but there are human health and environmental safety concerns; the work on which Chopra is assisting will draw on lessons learned from policies on previous technologies, and will help to inform the new University of California Center for Environmental Impacts of Nanotechnology (see page 30).

Chopra is also helping to increase his peers’involvement in public health-related social issues as chair of the Public Health Student Association’s social action committee. Last year, the committee held a discussion about post-traumatic stress syndrome in relation to combat veterans and discussed how public health professionals should be prepared for the repercussions of the nation’s current military conflicts. This fall, the committee’s activities have included voter registration. “We remain non-partisan, focusing on social issues that the health field will have to deal with,” Chopra says.

Raised by parents – both with science degrees – who came to the United States from India the year before he was born, Chopra was impressed from an early age about the importance of civic participation. “Voting was always a big deal in our house,” he says. “My parents stressed that it was important to have an opinion and make it known, because we live in a country where you can do that.”

He now eagerly anticipates a career in environmental policy. “With my background I will be able to work with pure scientists as well as communicating the importance of their work with pure policy people,” Chopra says. “There are very few fields that have that kind of overlap.”

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Seeking to Make a Broader Impact on Health of Latino Children, Pediatrician Adds an M.P.H.

“Above all, I have a much better appreciation for the importance of the life-course approach – understanding the social determinants of health and how early factors have an impact on young children for the rest of their lives.”

— Dr. Alma Guerrero

UCLAPUBLIC HEALTH

AS A UCLA MEDICAL STUDENT, ALMA GUERRERO concluded that to effectively address her goal of improving health in Latino communities, an M.D. wouldn’t be enough. “I realized that we are trained as physicians to focus on individual care, but it was important to me to do something more,” says Guerrero, a pediatrician who is about to complete her M.P.H. studies at the School of Public Health. “So I decided that after my residency training I would get my M.P.H. to help me better understand the factors affecting the health of a community and how to plan, implement, and evaluate programs to improve it.”

Guerrero is interested in promoting health among young Latino children through a better understanding of the role of parental perceptions and cultural barriers.

Under the mentorship of two of her medical school faculty members, Drs. Alice Kuo and Wendy Slusser (the latter also a member of the School of Public Health faculty), she became involved in a focus-group study at the Venice Family Clinic seeking to understand parental perceptions of young children's weight. “We found that these mothers do consider physicians to be important resources for understanding issues related to their children’s weight – and that they are fairly knowledgeable on strategies to prevent overweight or manage an overweight child,” Guerrero says.

When it comes to diet, her research group concluded, the problem is not that these mothers don’t understand what should be done, but that their efforts to change their child’s dietary habits are often undermined by other family members, such as the father and grandparents. Guerrero believes this problem might be addressed with a more family-centered approach to the issue of overweight and obesity among Latino children – bringing other family members in for at least one visit, for example. Her study also found that more emphasis needs to be placed on the importance of physical activity for this population.

After completing her degree, Guerrero plans to stay at UCLA as a junior faculty member in the medical school’s Department of Pediatrics, focusing on child health policy. In particular, her goal is to promote health in Latino communities by continuing to learn more about the role of family in early childhood development and implementing community-based interventions to apply that knowledge toward better health outcomes. Guerrero recently put this concept into practice through a School of Public Health partnership with several local Women, Infants, and Children (WIC) programs. She developed a "train-the-trainer" module for WIC staff to help parents better understand how their child develops and how to have more meaningful encounters with their child's doctor around health and development.

She is confident that the M.P.H. program has prepared her well for such a career. “The knowledge and tools I have gained through this program have been invaluable,” Guerrero says. “I now have the skills that will enable me to implement and evaluate programs focusing on early childhood and Latino parents. Above all, I have a much better appreciation for the importance of the life-course approach – understanding the social determinants of health and how early factors have an impact on young children for the rest of their lives.”

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news briefs center to study environmental effects of nanotechnology DID YOU KNOW...

You are a lifetime member of the UCLA School of Public Health Alumni Association if you are a graduate of the UCLA School of Public Health and its executive programs.

If you would like more information about the activities of the Public Health Alumni Association, please call (310) 825-6464 or e-mail phaa@support.ucla.edu.

UCLA is the lead institution in a consortium of 13 institutions that have been awarded $24 million in federal funding from the National Science Foundation and U.S. Environmental Protection Agency to establish the University of California Center for Environmental Implications of Nanotechnology (UC CEIN), with the goal of ensuring that nanotechnology is introduced and implemented in a responsible and environmentally compatible manner. Dr. Hilary Godwin, professor and associate dean for academic affairs in the School of Public Health, is co-principal investigator for the new center.

UC CEIN will convene recognized experts in the fields of engineering, chemistry, physics, materials science, ecology, cell biology, marine biology, bacteriology, particle and chemical toxicology, computer modeling, high-throughput screening, and risk prediction to explore the impact of nanomaterials on life forms and the interactions of these materials with various biological systems and ecosystems, creating a new discipline: environmental nanotechnology and nanotoxicology.

Nanomaterials, which are currently used in clothing, electronic devices, cosmetics, pharmaceuticals, and other biomedical products, have attracted increasing attention from manufacturers, academic researchers and policymakers. Nanotechnology is expected to become a $1 trillion industry within the next decade. (See the related article beginning on page 16.)

$5M investment completes core support for high-speed lab

UCLAPUBLIC HEALTH

The recent omnibus spending bill passed by Congress and signed into law included an additional $5 million in support for the new high-speed, high-volume laboratory network based in the UCLA School of Public Health. This brings to $30 million the total allocated by state ($9 million) and federal ($21 million) funders. The fourth and final year of core federal funding will allow the lab to be completed in mid-2009. The lab will have the capacity to quickly analyze and process high quantities of biological samples, improving the nation’s ability to respond to an avian flu outbreak, bioterrorist attack or other rapidly emerging public health threats.

By analyzing numerous influenza viruses in great detail, the lab may be utilized to assist in influenza vaccine strain selection efforts should an influenza pandemic arise. It will enhance animal and human surveillance and permit an up-to-date view of infectious disease outbreaks for effective decision-making and public health interventions. Additionally, the laboratory will train public health and lab experts in infectious disease management, addressing a welldocumented need for skilled personnel in bio-emergency situations.

Initially funded by a congressionally directed Department of Defense investment, the lab has also garnered support from the State of California’s Office of Homeland Security, and helped to earn the school a designation as a Center of Excellence for Influenza Research and Surveillance.

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A recent UCLA study found that as many as 94 percent of first-year college students use social networking sites, and 80 percent use them weekly for more than an hour. Facebook is the most popular website among U.S. college students, concluded a separate survey conducted by a leading Internet marketing group.

As a way of reaching out to current and potential students and giving alumni a place to call home, the UCLA School of Public Health has launched a group on Facebook, the social networking site on which millions around the world have profiles.

Joining the group can enable members to learn about happenings at the school, participate in discussions on hot public health topics of the day or reconnect with former classmates and favorite faculty members.

In addition to the group on Facebook, the UCLA School of Public Health Alumni Network now has a presence on the professional networking site LinkedIn. Alumni are invited to join the online community by going to www.linkedin.com. In the drop-down box at the top of the page, select “Search Groups” and type UCLA School of Public Health in the text box located to the right of the drop-down box. The UCLA School of Public Health Alumni Networking link will then appear. Click on the

news briefs

SPH gets social

link to join the group. Your request to join will be approved within 24 hours.

Rounding out the school’s expanded presence on the Web: UCLA’s channels on YouTube and iTunes now feature School of Public Health videos, lectures and podcasts.

becoming fit, 10 minutes at a time Starting this fall, a morning walk by the fountain in front of the School of Public Health may find a group of students, faculty and staff stretching, twisting and moving to exercises set to music. Ten-minute exercise interludes, or Lift Offs, are part of a program developed by Dr. Antronette Yancey, professor of health services, to improve overall health by incorporating short exercise breaks into people’s daily routines at workplaces, schools and churches.

According to research by Yancey, more than 40 percent of Los Angeles County adults are getting less than 10 minutes of continuous moderate-tovigorous physical activity per week. Coupled with research showing that nearly two-thirds of U.S. adults are overweight, this underscores the need for changing behaviors, particularly among the sedentary and overweight.

While most efforts to encourage physical activity have relied on individual initiative, Yancey, a former basketball player and fashion model, has instead designed a program that has been shown to reduce fatigue, increase productivity and help improve circulation and general health in just 10 minutes as part of each school or work day. Lift Offs have been successfully adopted by a variety of state and private entities, such as the San Diego Padres Baseball Team, L.L Bean, the Los Angeles Department of Health Services, the WIC program, AME churches, and now UCLA. UCLAPUBLIC HEALTH

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new faculty DR. RICHARD JACKSON, a public health leader whose work, especially in environmental health, has been lauded nationally and internationally, has joined the school as the new chair of the Department of Environmental Health Sciences.

Before coming to UCLA, Jackson was director of the Graham Environmental Sustainability Institute at the University of Michigan and an adjunct professor at UC Berkeley. He held many leadership positions in the California Health Department, including state health officer. Jackson’s work led to the establishment of the California Birth Defects Monitoring Program, and pushed for state and national laws that eliminated a series of dangerous pesticides.

For nine years, Jackson was director of the Centers for Disease Control and Prevention’s National Center for Environmental Health in Atlanta. There, he was the CDC leader in establishing the U.S. National Pharmaceutical Stockpile, which was activated on September 11, 2001 to prepare for terrorism and other disasters.

He also established the national asthma epidemiology and control program and oversaw the childhood lead poisoning prevention program.

He is the co-author of Urban Sprawl and Public Health: Designing, Planning, and Building for Healthy Communities, which examines the impacts of the built environment on human health and well-being, and discusses the prospects for improving public health through alternative approaches to design, land use, and transportation.

Jackson, a board-certified pediatrician, has a medical degree from UC San Francisco, and a master’s in epidemiology from UC Berkeley.

contracts & grants 2007-08 This section includes new contracts and grants awarded in fiscal year 2007-2008. Due to space limitations, only funds of $50,000 or more are listed, by principal investigator.

DEBORAH ACKERMAN Patient-Reported Outcomes from Complementary, Alternative, & Integrative Medicine (PROCAIM) (Samueli Institute for Information Biology, $80,000) RONALD M. ANDERSEN Dental Pipeline, Profession, & Practice: Evaluation Monograph (Robert Wood Johnson Foundation, $164,909) CAROL ANESHENSEL Neighborhood SES and Emotional Distress in Old Age (NIH/National Institute on Aging, $1,477,188 for 3 years)

UCLAPUBLIC HEALTH

SUSAN BABEY Soda Consumption by County, City and Legislative Districts (California Center for Public Health Advocacy, $66,100) E. RICHARD BROWN The California Health Interview Survey (California Children and Families Commission, $1,500,000; Kaiser Foundation Research Institute, $371,913 for 2 years; Kaiser Foundation Hospital, $371,913 for 2 years; NIH/National Cancer Institute, $1,330,146; California Department of Public Health, $1,855,000; Centers for Disease Control, $50,000; County of San Diego, $230,865 for 1.5 years; California Department of Mental Health, $1,000,000 for 2 years; National Cancer Foundation – OBRSS, $150,000); Health Care Reform Publications (The California Endowment, $103,060); Evaluation of 12-month Continuous Eligibility in Medicaid in California (Robert Wood Johnson Foundation, $117,398)

JOELLE BROWN Women’s Attitudes Towards Microbicides (UC Universitywide AIDS Research Program, $95,995 for 2 years) JONATHAN E. FIELDING Population Health Forecasting: Supporting Hospitals and Other Community Organizations in Assessing Current and Future Characteristics and Needs of Local Communities (UniHealth Foundation, $748,745 for 3 years); Developing a Population Health Forecasting Model to Support Effective Public Health Practice (Robert Wood Johnson Foundation, $446,749 for 2 years); Expanding the Application of Health Forecasting to Quantify the Community Health Burdens Related to Air Pollution Using Placer County Data and Risk Factors (The California Endowment & Placer County, $149,812) PATRICIA A. GANZ A Model Clinical/Translational Research Program for Breast Cancer Survivors (The Breast Cancer Research Foundation, $250,000) WILLIAM HINDS Preparing Small Business Workplaces for Influenza Pandemic (U.S. DOL/Occupational Safety & Health Administration, $259,795) LEEKA I. KHEIFETS Feasibility of Trafexpo Study (Electric Power Research Institute, $252,545 for 2 years) GERALD KOMINSKI Acute Care Access Study (Children’s Hospital of Los Angeles [UniHealth], $100,000); Health Care Coverage Initiative Evaluation

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DR. CHANDRA FORD has joined the faculty as assistant professor in the Department of Community Health Sciences, specializing in social determinants of HIV/AIDS disparities and in the health of sexual minority populations.

After earning her Ph.D. in Health Behavior and Health Education from the University of North Carolina, Ford completed a postdoctoral fellowship in social medicine at the University of North

(Department of Health Care Services, $2,495,702 for 5 years); Developing a Rapid Assessment of Performance Systems for Health Care Coverage Initiative (HCCI) (The California Endowment, $350,086 for 2 years) SUNGHEE LEE Responsive Design for Random Digit Dial Surveys Using Auxiliary Survey Process Data & Contextual Data (National Science Foundation, $90,000 for 2 years) YING-YING MENG Development of Exposure & Health Outcome Indicators for Those with Asthma or Other Respiratory Problems (U.S. Environmental Protection Agency, $500,000 for 3 years); Is Disparity in Asthma Among Californians Due to Higher Pollution Exposures, Greater Susceptibility, or Both? (CA/EPA Air Resources Board, $299,794 for 2 years) ANNE R. PEBLEY Neighborhood Effects on Children’s Health & Access to Care (DHHS/ Health Resources & Services Administration, $754,443 for 3 years) MICHAEL L. PRELIP LAUSD Nutrition Network Impact Evaluation (Los Angeles Unified School District, $690,806 for 3 years)

DYLAN ROBY HMO Profile Report & African American HMO Enrollee Brief (Office of the Patient Advocate, $259,965)

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DR. MAY-CHOO WANG has joined the faculty as associate professor in the Department of Community Health Sciences. A former codirector of the Dr. Robert C. & Veronica Atkins Center for Weight and Health at UC Berkeley, Wang addresses disparities in diet-related health behaviors and conditions among different ethnic and socioeconomic groups in the United States. Her research focuses on the effects of diet in early life on obesity development and bone health, neighborhood environments and their effects on dietary behavior, diet-related behaviors and chronic health conditions of immigrants, and evaluations of school-based nutrition programs. She is the recipient of numerous awards, including the Established Investigator Award from the American Heart Association and Excellence in Education Award from the California Dietetic Association. Wang received her master’s and doctorate degrees in public health nutrition from UC Berkeley.

KIMBERLEY SHOAF L.A. County Community Emergency Response Teams (CERT) & Joint Bioterrorism Investigation (DHHS/Centers for Disease Control [Including CDC Foundation] & County of Los Angeles/Department of Health Services, $ 250,000); Community Outreach for Public Health Preparedness (CA/HHS/Department of Public Health, $149,500) ANNETTE L. STANTON Cancer-related Cognitive Processing in the Genetic Testing Context (The Breast Cancer Research Foundation, $237,304) STEVEN WALLACE Evaluation Place Based Projects (The California Endowment, $110,105); Data & Democracy (The California Endowment, $506,251 for 2 years); Politics & Policy in California Health Reform: Lessons for California, Other States, & the Federal Government (The California Endowment, $57,500); Datos y Democracia: New Train the Trainer Certificate Course (California Wellness Foundation, $110,000 for 2 years); Chronic Health Conditions in California (California Healthcare Foundations, $84,332) PHYLLIS B. WEISS Urban Networks to Increase Thriving Youth Through Violence Prevention (UNITY) (DHHS/Centers for Disease Control [Including CDC Foundation] & Prevention Institute, $85,000) ANTRONETTE YANCEY Community Action to Address Health Disparities (DHHS/Centers for Disease Control [Including CDC Foundation], $4,250,000 for 5 years)

UCLAPUBLIC HEALTH

ANNE W. RIMOIN Emergence of Human Monkeypox in Central Africa (NIH/National Institute of Allergy and Infectious Diseases, $608,850 for 5 years)

Carolina and a second postdoctoral fellowship in epidemiology at Columbia University, where she was a W. K. Kellogg Foundation Kellogg Health Scholar. Ford has received several competitive awards, including the Ruth L. Kirschstein National Research Services Award (an individual dissertation grant) from the National Institutes of Health and a North Carolina Impact Award for her research contributions to North Carolinians.

faculty

DR. ARTURO VARGAS-BUSTAMANTE, an expert in cross-border health care and Latino health, has joined the faculty as assistant professor in the Department of Health Services. VargasBustamante’s work considers the ways in which international migration and immigrant integration affect access to health care in host countries, particularly in the United States. As part of his professional experience, he worked as a consultant for the Inter-American Development Bank and for the California Program on Access to Care, where he was responsible for the cross-border health insurance project.

Vargas-Bustamante started his professional career in the Health Financing Administration of the Mexican Ministry of Health. In 2002, he became the youngest recipient of the National Award of Public Administration Research in Mexico. He received his Ph.D. in Public Policy from UC Berkeley in 2008, where he specialized in program evaluation and contingent valuation.

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