UCLA Public Health Magazine - Summer 1986 by UCLA Fielding School of Public Health

UCLA Public Health

On the cover (and page4) AlDS logotype comp! iments of Southern Ca li fornia CARES/ Al OS Project Los Angeles

Volume 6, Number 1

Summer 1986

AIDS: Fighting Fear with Knowledge

Wi th a vari ety of research, facul ty members are taking a leading role in the study of o ur #1 publ ic heal th prio rity.

Danger: Employees Only

When employees say, " This job is kill ing me," they may be r ight. Research by rwo faculty members suggests cancer dangers in the wor kp lace.

Public Health Gets Its PC Degree

The School's new personal computing lab wil I help students plug in to the 21st cen tury and bridge the gap between academia and their fu ture careers.

Doing a Capitol Job in National Health Policy

On the staff of the Senate majority leader, alu mna Dr. Marie Michnich helps Congress seek a cure for ail ing heal th pol icy.

News

Faculty Notes

Project Updates

Alumni News

Dean's Message

UClA Public /-lea/th is pub! ished by

Pbotograpby: Courtesy of Nat ional

Heal th Sciences Communications, UCLA Public Communications/Public Affairs, for th e UCLA School of Public Health. It is issued rwice a year for the alumni, facul ty, staff and friends of the School.

Institutes of HealLh (NIH), pages 4, 8. Bob Witkowski, Page 10. Courtesy o f De Marie Michnich, page 15. Courtesy of De Charlotte Neumann, page 17. ASUCLA Photographv, Terry O 'Donnell, pages 18, 22.

Charles E. Young, Chancellor Abdelmonem A Afifi, Acting Dean Michael T McManus, Assistant Vice

Editorial Board: Dr. A. A. Afi fi, Dr.

Chancel/OJ; Public Communications John Pontarel Ii, Directo1; f-lealtb Sciences

Communications Editor: Fran Tardiff Writers: Gail Polevoi , Fran Tardiff Art Director: Juliet Beynon Designer: Barbara Kitzmiller

Snehendu Kar, Dr. Shoshanna Churgin, Nan Roberts, Bruce Davidson, Lester Reams, John Pontarel Ii

ÂŠ Cop)irigb1 1986 bv Tbe Regents of tbe University qf Cal!(ornia. Permission to reprint any portion qf UCLA Publ ic Health must be obtained.from tbe edito1: Contact I-Iealtb Sciences Communications, Weyburn Cen1e1; Suite 344, Center/or tbe I-fealtb Sciences, UCl.J\, Los Angeles, Cal(fomia 90024. (2 73) 206-1960.

UCLA Pl Bl.IC llEAI:rll St'.\\,\ IER 1986

by Fra n

Tard~ff

l.1e AIDS vi ctim has many unwanted companions. One of them is fear ; another is ignorance. The prime targets of the virus-gay men and intravenous d rug users-I ive in fear that a headache and fever are more than the flu, o r a purplish spot on the heel is not an ord inary blemish. They know AIDS (Acquired Immu ne Deficiency Syndrome) is irreversib le. Ir's the mystery cl isease that attacks the immune system, wreaking a slow process of emaciation and death from opportunistic infections like Pneumocystis carinii pneumonia, o r cancers such as Kaposi's sarcoma. Beyond that, many are ignorant of how ro cope wi th the ravaging physical and emotio nal effects. Most experts call AIDS the number one pub lic heal th priority today, although deaths from other d iseases may o utnumber the AIDS 50 percent fatality rate in 22,000 cases. fear, however, might just be the most contagious d isease there is. Teamed with ignorance, fear cripples the publ ic's abil ity to respond ratio nally. UCLA School of Public Heal th facu lty are responding w ith research into the cost of AIDS, the bathhouse connectio n to AIDS transmissio n, the natural histor y of the d i sease, as wel I as community ser vice and educational programs. The knowledge they g lean may be the best ant idote to the fear and ignorance surrounding AID S, until a cure can be found.

Cost of Aids

Along the border qf this white blood cell, a number of 1IN p articles (circles) indicate the p resen ce q( AJDS.

Dr. Stuart Schweitze1~ professor .i n the Divisio n of Heal th Services, thinks it 's less expensive to have AIDS in San Francisco than it is in Los Angeles. He won 't know fo r sure unti l he tests h is hypothesis in a $400,000, two-year study funded by the Ca liforn ia Department of I l ea I.th Services. His work wil I parallel a study completed in San Francisco on the med ical costs of treating AIDS patients in that city. Accord ing to the study clone by the Palo Alto Medical Foundation Research Insti tute, the total hospital cost per ALDS case in San Francisco is $29,000. Thar compares to an estimated $147,000 per case nationally. Or. Schweitzer, in association with An ne Scirovsky, M .A., and Dr. Philip Lee of the Insti tute for I lea I th Policy Studies at the University of Califo rnia, San Francisco, w ill find our how much similar care costs in Southern Cal ifo rnia- the Los Angeles and San Diego areas, specifically.

Fo ur hund red Al DS patients w il l be inter viewed about the elements of their med ical care: hospital sta~·s,"phy sician visits, nursing home, hospice or home care. " We wil I also track the p roviders, possibly between five and 10 per patient, ancl find out what charges were incurred from diagnosis to death, where that applies," says Dr. Schweitzer. "AIDS str ikes at one of our most vital resources, young men in their prime-20- to 40-year-o lds," he adds. "These are people who would otherwise be productive contributors to the economy." A study pub I ished earlier this year from th e Centers for Dise<t~e Control (CDC), charted the economic impact of the first 10,000 AIDS cases nationally I t said these patients will require 1.6 mill ion clays in rJ1e hospital, at a cost of $1.4 bill ion. The esri mated 8,387 years of lost work rime from d isability and premature dearJ1 translares to $4.8 billio n. Researchers know the med ical cost of AIDS is high. Bur information about the exact nature of rhose costs and w hy they d iffer in various parts of the country is fragmentary We know, for instance, that the average length of a hospital stay for an AIDS patient in San Francisco is J2 davs; in ew York it 's 50 c.lavs and in Philadelphia, 31. fotal aver<;ge hospital time for an entire ALDS episode ( from diagnosis to death) in San Francisco is 35 clays: nationally it is 167 days. One reason fo r these variations has to do w ith the type of patient. Thirty percent of AIDS patients in New Yor k are intravenous drug users-often ho meless, malnourished. obi i\·ious to good heal th habits. In San Francisco the AIDS population is 90 percent homosexual males. most of them with a home and stable I ifestyle. Dr. Schweitzer sees Cali forn ia as an excellent laboratory for Jefin ing hmv a coordinated svstem of AJDS care, I ike the o ne in San Francisco, can loosen the economic stranglehold of the d isease. In San Francisco, care is centra lized. Most AIDS pat ients, when hospitalized. go to San Francisco General I Iospi tal. A teaching hospital of UC San Francisco, it has a special AI DS unit called Five-A, the first of its kind in the country. The unit ho uses abo ut 18 patients and has hand led 700 coral admissions since the AIDS epidemic materialized in the earl y "80s. Then it was commo n to treat these patients in lCUs, the most technically ach·::inced

l 'Cl.A PllBl.IC llEAJ:rll Sl':'.IMER 1986

and che coscl iesc s rvices in che hospital. The incen.路iry of th treatment o nly heighcened atiencs error. Now the brightly designed unit envelo pes patients in a c mforting atmosphere. AJDS patien s are encouraged to cake an accive part in their own nursing care. The AJDS unit at San Francisco General is complemented by a netwo rk of organizations that \vork together co plan ouc-of-hospital ser vices, ranging from ho use cleaning to hospice care. These readily available suppo rt servic s help to keep hospital cime to a minimum. In Los Angeles, care is d ispersed among centers I ike UCLA, HarborUCLA, and Los Angeles CountySC tedical as communicy hospitals and local physicians, De Schweitzer notes. And there ha-;

consolidate the care co major sites or co estab l ish a specialized AJDS home care svscem. Sho uld the state encourage centralized care modeled after the San Francisco experience? 110\v will the cost of AJDS care affecc the larger population? Dr. Schweitzer's cosc of AJDS scudy will help answer these lingering quescions for the state. le wi ll also give privme insurers an idea of whm co expect. 'The question is, w it I chey scramble even harder to gel out from under the cloud of expecced losses?" notes Dr. Schweiczer. If AlDS cases double in che next two years as projecced , and the cosc per case rema ins at $70,000 LO $109,000 in Los Angeles Councy (estimated by the California Deparcmenc of Health Services), the system w ill be over-

whelmed, Dr. Schweiczer concludes. Severe rarionin of care for AJDS and ocher patients may result. "AJDS is a problem that tests the abil ity of our heal th care system to adapc and cope, and rm not sure it's going to be successfu l,'' he adds. " There has to be a rescructuring co deal with this epidemic. k s che biggesc challenge in heal th poliC\' we'll see in o ur lifetime."

Community Service and AIDS Treatment o f AJDS patiencs in most urban areas l ike Los Angeles is. ar best, a scatter gun approach. They may be tested and diagnosed in an AJDS cl inic, treated by a famil~路 doctor, be hospitalized several different times in mo re than one hospital , and discharged with o r witho ut so meone to care for them at ho me. A number of community agencies may be wi lling to help w ith everything from educatio nal materials to a " buddy" who will stay with a patient during the roughest times. But in Los Angeles those agencies, for the most part, work independencly. The Ro bert Wood Jo hnson Foundatio n believes what is needed in large cities is a communi~路-based system for o ut-of-hospital care of AJDS patiencs. Thro ugh its Health Services Program, the fo undatio n has set aside $2 mill ion for each of three metropolitan areas with the largest AIDS caseloads- ew York (5,000), San Francisco (1 ,800), and Los Angeles (1 ,300). The fo undation hopes these areas w ill develop programs that make services mo re accessible to AJOS patients, treat them mo re humanely at a lower cost, and educate the populatio n in prevencion. The money is there fo r the asking, in the form of a wo rkable proposal , the R\X.J Foundation is saying to the cities. So Beverlee Myers, professor and head of the Division of Heal th Services, along w ith an advisory group from the School, is-helping AJDS Project Los Angeles (APLA) with a p lan for delivering AJDS-related care in Los Angeles County. Their proposal was submitted in June o n behalf of the Metropolitan Advisory Commitcee of some 40 health and religious o rganizatio ns in the greater Los Angeles area. "If funds are allocated, faculty and students in the School w ill be doing a fair amount of data collection and analysis to support the program . APLA will be responsible for administering the grant," Myers explains.

The project will review informacion o n the services people with AJDS and ARC (AIDS Related Complex) currently receive. "~e w ill see how patiencs enter the system and where in the system their needs are not being met, o r where there is a d uplicatio n of services. Then we'll help design models o f delivery systems that will be more efficient and provide high quality care," she says. In addition to the 1,300 AJ OS cases in Los Angeles today, there are about 13,000 with ARC (a complex of symptoms like fever, node swelling, d iarrhea, fat igue and weight loss). Jf no p rogress is made to slow it 路 growth , AJ OS could strike 40,000 people in the next two years. Caring for these peop le will be physically and financially impossible unless communities develop a workable care network, Professor Myers cautio ns. "AJDS has the potential for redefining what public heal th i all about," she savs. " It touches o n everv substantive and procedural functio n' of pub! ic heal th- preventio n, control, deli very of ser vices and protect ion of people's heal th. I t's absolutely essential that the UCLA School of Public Heal th participate heavily in a variety of activit ies related to this very impor tant issue."

Natural History of AIDS Not everyone infected with the AJDS virus eventually gets the disease. Studies have reported that about 70 percent of those infected w il I show no sympto ms, 30 percent wil I develop ARC, and about 10 percent of the total infections will proceed to irreversible immune deficiency and death. Is it heal th habits, other infect io ns o r simple bad luck that decides who the AJDS victim w ill be? Or Roger Detels, professor of epidemio logy and for mer dean of the UCLA School of Pub! ic Heal th, is heading a large AJDS epidem iological . tudy to d iscover the "1 acural History of OS." " The virus has been identified and isolated , and we know how to avoid getting the disease. Our study is attempting o learn w 1ich people of the infected gro P. go n to develop d1e clinical d isease and why," Dr. Detels says. The $3.8 million project, funded by the National Institutes of JIealth, is a cohort scudy of 1,637 homosexual men the researchers will follow for at least three years. Some wit I get AJDS,

l 'CLA Pl ' Ill.IC llEAI J'fl SL:.\l:\IER 1986

some wit I be infected who were not infected at the beginning, and so me will develop sympto ms of ARC. Dr. Detel's group will check the correlation between those end po ints and the men's sexual practices, other infect io ns and rypes o f immuno logi c changes. Whar they find 1ay pierce the armor tha ·hiekls this disea. e. There may be a co-factor, for instance, a second virus that triggers the actio n o f Lhe Hrv ( Hu man Immunodeficiency Virus) that causes AIDS. The cytomegalovirus (CMVJ and EpsteinBarr virus, members of the herpes fami ly, have been suggested as possible co-factors. Dr. Detels explains that it m ight be possible to develop a vaccine for a co-factor like CMV, " which behaves more predictably than a retrovirus. From a public heal th point of view, if researchers know what factors are associated with an increased r isk of getting the d isease o nce infected, they can aim intervention strategies at those characteristics." Before rhe AIDS epidem ic, scientists knew relat ively I ice le about al 1 the T-cell 's funct ions o'r the special group of viruses called retroviruses, he adds. 'T here has been a tremendous explosion of knowledge that is relevant co the who le field o f immuno logy, infect ious disease and probably cancer. " I n isolating the I I IV retrovirus that causes AIDS, scientists have learned much abo ut this new class of viruses that can be appl ied co preventi ng other diseases. The Al OS natural history scudy has its own histo ry of tria l, error and discovery. When Dr. Detels and Dr. Barbara Visscher, head of the Division of Epidem io logy, did their original AIDS study in 1982, a project that paved the way for this larger natural history study, they tested the T -cell componems in homosexual male students at UCLA. With the help of researchers from the UCLA Schools of Med icine and Publ ic l lealth, they d iscovered that the o riginal marker- immunologic changes associated with the rati< o fT-helper cells co T-suppressor cells - was misleading ·'Sitting in my offic~1 a Satur<ti} mo rning," Dr. Detels says, " I realized thar, ace >r ing to our information, over one-third of these students had the marker that was then the sine qua non of AIDS. My God, I thought, surely al I these students aren't going to get AIDS." I le discussed his observ.:u ion with Dr. Michael Gottlieb, the UCLA physician who first described

the disease in 1981 , and Dr.John Fahey, directo r of the L'CLA Center fo r Interdisciplinary Research. The conclusion? The real marker is the absolute number of T-helper eel Is. " Ir's hard to match the excitement o f that kind o f discovery." Dr. Detels comems. Be ause a natu ral history study with sufficient subjects could not be do ne in one 't ', Dr. Oetels and UCLA col leagues ar collaborating with three other cent s around the country: the Univers ity f Pittsburg, Jo hns I lopkins and o rthwestern University. ''The col laborat i(l>n allows us to bounce ideas around amo ng a group of very creative clinicians, immuno logists and virologists," sa~s Dr. Detels w ho is head ing the UCLA study. '"At times I feel a l ittle li ke a maitre c.I', coord inating the running of the d ining roo m with the kitchen and making sure the meal arrives on time and in the proper o rd e r~ .. he quips. This spr ing, Dr. Derels put together the fi rst AIDS cl ass in the School's curricu lum , "AIDS, A Major Pub lic I leal th Challenge." The two-unit course incorporates basic science, epidem iology, social science, heal th pol icy and mi nority issues. " We've tried to pull in al I the discipl ines and demonstrate how they work together,.. Dr. Detels says. Guest lecturers have included Dr. Michael Gottlieb and Dr. j o hn Fahey from the School of Medicine. He has also invited people I ike Dr~ Manin Fi nn, " the AIDS czar '" who heads a special AIDS task fo rce in the Los An geles Coumy Heal th Deparrment, and j ohn Mo rt imer, educat io n d irector fo r AI DS Project Los Ange les. Students are excited by the class so far, reports Dr. Detels. " !like it when students give me a lot of noise. Th ey debate and argue wi th me, so I know they're inter ested ," an interest no doubt spurred by the growing AIDS threat. he adds.

Education for self-care " OK, so I've go S. l'n going to die. But when? flow painful will it be' What do I do now ?" For most AIDS victims, life as they are used to i is over the mo ment they hear the d iagnosis. Dealing with the physical threa 'lJs o nlv o ne wo tT\'. Manv are immobilized witi1 fear over·tel 1i ng their fam ii ies, lovers, o r employers. The majo rity o f people with AJDS end up living alo ne, some literally left with their belong-

ings o n the street by rol mmates, e ·en families. It becomes ea ·y to slip into had health habits. '" I diUn't eat right o r keep myself clean. I w as obsessed with the idea that I \\'as <tl read,· dead. Why bother ?" o ne AIDS \'ictim confesses. Ne\\'ly diagnose people ~ ·ith Aii;), ( PWA'i) can surmount the \val I of fear and isolati m, says Dr: Dona d f\ lorisky. <t'is1. ·ral'lt professor in beha,·ioral science:-. and he-Jld1 educmion. '"But they need help to learn w; much <L'i pos.)ihle about d1eir disease. then take control by acti\'d y cari ng for themsclve. ... A program create by student'> in the d ivisio n addces: cs in detail the educat ional and psycho logical needs of PWA-;. The Al DS Self-Care (ASC ) Program was o r iginally a master 's project of four s~ude~ ts: Michelle Raven. Adrienne Kilb r/ Dorinda Manicorena and Ad r ienne Duque. With Dr. Morisky as the pr incipal investigator, it w ill be subm itted a · a proposal to the Cali fornia State l "l:1s Fo rce o f the state legislature for a grant of $120.000 to test the program in Los Angeles County In a format;>f five videotapes. the ASC Program reaches out to recently d iagnosec.J P\XIAo; \Vith the direct approach '(he imroductory tape, "So you've got AIDS, what are yo u going to do a]i>out it?" offers a basic undersea Kling of the disease. The other fo ur tapes cover the act ion of the virus in the body; dealing with fear, lost selfesteem , anxiety and stress; " heating the system " or how to communicate yo ur needs to physicians, public agencies and employers: and finally. a resource tape describes medical and social suppo rt groups available to P\X/\s in Los Angeles Coum~: The tapes " ·ii 1 be presented at Al OS Project Los Angeles ( APLA) and could evencuallv be shown aro und the country. Dr. ~!~r isky says. Programs like this one give the AIDS victim so me ammunition with which to fight. Health educators ~·ill conduct info rmation sessions afier each videotape to fill in details about caring physically fo r o ncself-- washing hands frequently, maintaining g od d ntal hygiene, keeping home

l '.Cl.A Pl ' Ill.IC l IEl\l'.fl I Sl l.\ lf\IEH 1986

and pets as ck.:an as possible ...These are all measures that can hel p prevem oppo rtunist ic infections and may actu ally prolong an All)S pat ien t's life, .. comments ,\ lichelle Raven, 1\1.P.l I. '86, '"ho led the School's studem group in developing the ASC proposal. In o ne month last spring, Dr. 1\llorisky rcpons, as many as 76 new cases of All)S were d iagnosed. The CDC expects l'l,000 to 15,000 new cases of Al DS in J986; 2') percent of those cases could occu r in California. Consequently, the community and funding agencies are seeing the need for educat ional programs and psychological counse ling for PWA'i ... Our program is not just in for mm ion d issem i nai ion: it's based on sound behavioral and psychological principles, .. Dr: i\ lorisky acids. " It's a program that can be useful ~L'i long ;L'i new AIDS GL'ies are d iagnosed.路路 The ASC project has already been valuable to Dr. Mo risky's students. " Jt's unusual that students get to see their work in the classroom appl ied to an actual situatio n," he remarks. " But the ASC project is giving them experience in developing a program that has been submitted for funding and has a good chance of being implemented in a 'real wor lcl' environment. "

Bathhouse Study About 92 percent of rhe Los Angeles AJ DS population is gay males. O ne of their most popular meeting places is the bathhouse, and Los Ange les has more gay bath houses, about 15, than any other majo r city. Whatever else the patrons have in common, they are also gay men w ho willingly put themselves at high risk of getting AJDS. But exactly what role, if any, does the bathhouse play in the exposure and transmissio n of the d isease? Dr. Gary Richwalcl, assistant professor in populat ion and fam ily heal th, contacted bathho use owners because he believes that pub I ic heal th officials and those concerned about the connection ber;veen bathhouses and AJDS are lacking this basic information. The Los Angeles Count~' Bathhouse Owners Association has since given $20,000 to fund the "UCLA 13arhho use Research Study" cond ucted by Dr. Richwald and co-investigator Dr. Donald Morisky.

The six-month study, to be completed this fall, is searching for usable scientific information amid fear and increasing prejudice toward gay " institutio ns" I ike bathhouses and gay bars. The sllldy's goals are to find our what effects the bathhouse milieu has on the rising incidence of AIDS in the county and to determi ne if bathho uses should be regu lated. To date, researchers have interviewed bathhouse owners and about 2,000 patro ns, collecting information on the " nature of the bathhouse ..m anagement and business practices, cl ientcle, structure and any educational m easures introduced since the epidemic's onset five years ago. 1ext, the study w ill narrow its survev to abo ut 200 men fro m six bathho uses to get an idea of who a bathhouse patron is-his social behavior, lifestyle, sexual activity and demographic information. In the third stage of the project, Dr. l{ich wa ld w i II survev pub! ic heal th officials across the coun try to fi nd out what they know about bathhouses and what their a ll itudes are about regulation o r closure. .. If ultimateh路 we want to control Al OS, we must 路give pub I ic officials all the research data possible so they cm make sound policy decisions,.. De Richwa ld explains... We need to know what patrons \YOuld do i f the bathho uses were closed. \X'ould they scatter and be rnon..: difficult to o rgan ize for an v ed ucat iona l or risk reduction measures~" he adds. As the first phase of Dr. Richwakfs study progressed, he found some unexpected results. The bathho use provides more than sexual connectio ns; it's a social theme in the lives of many gay men. Fo r a fee ranging from abo ut $5 to $10, the jacuzzi, sauna, body build ing area, health bar, whirlpool, suncleck and recreation lounges of the var ious bathhouses are an acceptable way to spend a Saturday evening. They're also a recreat ional al ternative to mingl ing in the gay bars, especially for those who don't smoke

The Los Angeles County Board of Supervisors is inching toward some contro l of bathhouse activi ty with regulat ions enacted in December 1985. The ru les define unsafe sex practices and requ ire that bathhouses g ive patrons educational materials about the risks of unsafe sex. The regu lations also requ ire that monitors he hiredone for each 20 clients-to " police" bathhouse areas \vhere sex may be conducted, explains Jim Petzke, senior deputy to Supervisor Ed Edelman. The regulatio ns are to be enforced , afrer a city inspection, on ly in the bathhouses that actually promme or al low unsafe sexua l practices, Petzke explains. Bathhouses present a unique opponunity in the history of AIDS to work w ith a concentrated population clearly at high risk, Dr. Ri chwald believes. "And the UCLA bathhouse study represents imJX)Jlanl suppon from the private secto r for the kind of good research that can benefit us al I." Addit ional AIDS research lw School of Public Health faculty is summarized in the " Project pdares" colum n beg inning on page 20.

UCLA PUBLIC llEAIJH SUMl-IER 1986

By fran Tardiff he fire started just before quitting time in a pile of scraps under a sewing machine. In minu1es flames incinerated Lhree floors of the Triangle Shirtwaist Company in New York City. Fire doors were routinely locked to keep Lhe 500 women employees, most o f them immigrants in their teens, from leaving with stolen property, owners claimed. It w~Ls over in half an hour: 146 " 'Orkers killed. Some fell to their deaths when the only fire escape collapsed. Others jumped 10 stories to d1e pavemem in panic and despair. The infamous Triangle Shirtwaist fire happened 75 years ago and was a turning po int in movements around the count!)' to improve workplace safety. Despite creation o f the Occupational Safety and Health Administra-

tion (OSHA) in 1970, and dozens of new laws regulating everything from mine safety to labeling of hazardous substances, workers still face dangers on the job-many of them much mo re subtle than fire or accidents. A recent New York Times article quoted Eula Bingham, former head of OSHA under President Jimmy Caner: "At least 100,000 workers are dying from workplace exposures to toxic substances every year, and rhe total might be much higher." Other estimates suggest that about four to 10 percent of all cancer deaths in the U.S. are occupation-related (al-

though research is not yer conclusive on the subject). And because cancer takes time to develop in the body, workers with cancer today may have been exposed to the carcinogens 20 years ago. Thus, preventive measures taken now to reduce or eliminate workplace carcinogens could reduce occupational cancers into the next centul)'. Or. David Wegman, professor and head o f the Division of Environmental and Occupational Health Sciences, and Dr. John Froines, associate professor, have uncovered mo re information on the subject o f cancer caused in the workplace. They believe that substances breached, absorbed, handled or otherwise contacted by employees may be responsible for colon or lung cancers. Dr. Fro ines spent the last year and a half investigating the cancer risks fire-

UCLA PUBLIC 1IEAIT H . U~ l1\ IEH 1986

fighters encounter from diese l fuel emissions. " Imagine someone backing a diesel-po,vered car into your living room and lett ing it run for a couple m inutes, eight to 16 times a day," says Dr. Froines. Firefighters are used to it. As fire engines leave and retu rn to the statio n, they spew exhaust into rooms adjacem to the quarters where firemen work, eat and sleep. Since d iesel engines were introduced about 15 years ago, fire department personnel have increasingly not iced sooty b lack particles clinging to TV screens, collecting on bed sheets and smudg ing kitchen surfaces. Recently, the Internatio nal A'isociation of Firefighters and the Los Angeles, 1ew York and Boston fire departments asked Dr. Froines to investigate the issue of d iesel emissions in fire stations. When Dr. Froines began his study, "The Quantitative Evaluation of Firefighter Exposure Inside Fire Stat ions to Emissions from Diesel Engines," he didn't ant icipate much ofa problem. That view changed sharply as he began spend ing time in fire stat ions. "Vc1y soon it became cl ear that there really are probl ems associated w ith diesel em issions," says Dr. Froines, and firefighters are prominent among the occupatio nal groups at r isk. When the trend to produce d iesel autos speeded up a few years ago, the

government and pub Iic environmental watchdogs were concerned about the risk'> of lung cancer. The Environmental Protection Agency ( EPA) conducted studies in the late 7 0s, but when dieselpowered cars didn't catch on, official interest waned. everchcless, comments Dr. Froines, "The real d iesel exposure in the U.S. is occupational: bus d rivers, truckers, truck mechan ics and , of cou rse, firemen are among the large number of occupations exposed to d iesel exhaust each clay." The EPA a<>.'iessmencs of lung cancer risk fro m d iesel exhaust go like this: lf a person were to breathe one microgram of cl iesel particulate continuously, the lifetime risk of developing lung cancer would increase J percen t. " In fire stations we saw I 00 to 500 micrograms per cubic meter of pan iculate, w hich may considerably increase the cancer risk," says Dr. Fro ines who studied

about 300 firemen in New York, Los Angeles and Boston. The men wore sampling devices to measure the amount of part iculate collected O\Âˇer 24-hour periods, at least t\\"O days at a time. Understandably, measurements varied according to circu mstances. In Los Angeles fire stations, doors are left open for long periods, letting in fresh air. But during ew York and Boston w inters, station doors are closed immediately after trucks leave o r return. " Couple that practice with the high frequency of alarms in these metropolitan areas and you have a serious situation," Dr. Froines says. I le cautions that an actual increase in lung cancer among firefighters has nm been documented. And there are no epidem io logic stud ies that bear on firefighters' exposure to diesel particulate. Studies by other researchers are underway, however, on d iesel-exposed workers-rail road employees in particular- to determ ine the lung cancer r isk. Even w ith the uncertainties, Froines stresses, "Do we have to wait 20 years Lo see if cancer develops? This is a risk that can be corrected easily and cheaply. We can nip it in the bud nO\\~ Clearly, prudent public health practice indicates that steps be taken co lim it firefighter exposure to these emissions. It's a good pub I ic health issue because we are not icing and addressing the problem early," emphasizes Dr. f"roines.

Control would be easy, he adds. Simple methods of ventilating the exhaust, like " elephant trunks" ( flexib le tubing attached to engine exhaust) would be one way to safely red irect emissions, he suggests. The American Cancer Society estimaces 149,000 new cases of lung cancer will appear in 1986. About 130,000 o f those people wil l die of the disease. Early lung cancer is d ifficul t to detect, so the rationa l method of control is to el im inate as many known risks as possible, like smo king o r breath ing d iesel exhaust. On an encouraging note, fi re departments are committed to addressing the problem. Since Or. Froines presented prelimina1y resul ts of the firefighter study last fall at the Redmond Foundation/Firefighters Symposium in Housto n, he has received five calls a month from fire departments around the country interested in the study. "The Los Angeles Fire Department has made a report to the city fire commission," says Fro ines, "and the comm ission is definitely interested in making changes co a ll ev i ~lte the problem. " My view of firefighters has risen o ne millio n-fold since we started this study. They qualify, in my mind, as true heroes in our society And they sho uldn 't have to live with the added danger of possible cancer caused by diesel exhaust. "

Co lorectal Can ce r in the Workplace Colorectal cancer is one of the most frequently diagnosed cancers in the U.S. An est imated 140,000 ne\v cases wi II occur in J 986, accord ing to the American Cancer Society. Combined deaths from colo n and rectal cancer may reach 60,000 this yea r. The incidence and death rares from colo rectal cancer are second o nly to lung cancer. Nutrition , speci fical Jy a high fat/low fi ber diet, has most often been ser ved up as the or iginating factor in colo n cancer. Or. David Wegman strongly suspected that, although diet may be

771e ji'remen of Station # 3 7 in Westwood were part q/D1: Froines' diesel emissions research.

UCLA Pl ' Bl.IC 1IEAITI I SL';<.J.\IER 1986

"... nwe wait untl we

can count enough of the bolles so the answers are obvious, we wil already have established a large debt."

sign ificant, there are also impo rtant work environment carcinogens that contribute to colorectal cancer. One of his clues came from the concentration o f colorectal cancer deaths around industr ial regio ns I ike the o rth Atlan tic Coast, MassachusetL'>, New Jersey, ew York and the urban Great Lakes. His study, " Occupation-Related Risks for Colo rectal Cancer," created a hypothesis associating colo rectal cancer and workplace exposures to such substances as wood dust, asbestos, gri nding wheel dust, chrom ium oxide. cutting o il , products of combustio n, dye, aro mati c hydrocarbo ns, solvents, fuel o il and abrasives. The study used three ex ist ing data bases to reach this hypothesis. The Third ational Cancer Survev \Yas used to select 343 males and 208 females with co lo rectal cancer, as well as a contro l group. A second data base, the National Occupational Hazard Survey, supplied information o n the substances to which wo rkers in specific jobs were exposed. To adjust for nutritional factors, Dr. Wegman used the NI LANES ( ational Health and utrit ion Examination Survey) which provides demographic occupational and nutrit io n informat ion on a national sample of people. " Because of the way we had to integrate data, all you can say is that th is study leads us to hypotheses that now o ught to be fo rmally tested ," Dr. Wegman explains. "We came up w ith some first-order associations that suggest we should look more closely at specific work-related cancer r isks." Fo r instance, the research found that males exposed to solvents, fuel o il and abrasives were approximately 1.6 times mo re likely to have colon cancer than the contro ls. Females w ith relatively higher exposures to dyes, solvents, grind ing wheel dust and aromat ic hydrocarbons were about 1.5 t imes more likely than controls to develop colon cancer.

If results of the study can be documented w ith further epidemiologic studies, then it means some risks of colo rectal cancer can be contro l led by preventing exposures. I lerein lies an interest ing public health challenge. " It is d i fficult to educate people o ut of a pleasure like smoking. It's a continuo us educatio nal effort because vou have to keep people off cigarettes o nce you get them to qu it and con vince potential smokers not to start," notes Dr. Wegman. " But to a much greater extent, th e workplace environment is controllable. You can ban the use of a mater ial, as \Ve have recenthÂˇ done with asbestos. Or you can im- Âˇ pose certain rigorous environmental controls on a substance so that exposures are not sufficient to cause cancer. And these controls can be done central ly so you don't have to focus on a person's behavior. " Or. Wegman brings up another point from his study important to epidem io logists. I f a researcher does case control studies in cancer registries, some cancer is used as a case cancer ( l ike lung cancer ), and another cancer is the control cancer. In the past, colon cancer has been commonly chosen as a con trol cancer for studies of toxic exposures because it is assumed to he a nutritional cancer. " If colo n cancer does have other o rigins in toxic substances then you 're biasing the study because the controls are not free of associat io n with the exposures you 're testing for," explains Or. Wegman. "That just means that people doing case contro l studies w ithin tumor registries need to be careful abou t how they use colo n cancer as a co ntrol cancer." The j ournal of the Nat ional Cancer Inst itute published Dr. Wegman's study last ovember. ow will other researchers take this hypothesis and r un w ith it? He would I ike to th ink that " they'l l be attracted by the new informatio n and study it directly. l am less concerned , however, with overreaction than with a du ll ing of the senses," Or. Wegman says. " l fwe wait until we can count eno ugh of the bodies so the answers are obvious, we w il I alreadv have established a large debt. " Âˇ

UCLA PUBLIC I IEAIT H SUMMER 1986

Public

Health Gets

PC Degree by Gail Polevoi

l 'Cl.A PUBLIC llEAJ:rll

emember the typewriter that didn't plug in' The calculator that didn't turn on? Today's young professionals probably can't recal I when the manual typewriter and the adding machine were the tools of the modern public health office. In hospitals, in pub I ic and private agencies, they are turning instead to the personal computer, or PC, for the answers to contemporary health problems. But, while the professional world long ago embraced the desk-top computer for it'i convenience and skill in word processing, data management and statistical analysis, the academic world has lagged behind. Lack of funds, not lack of interest, ha'i prevented many schools from joining the personal computer parade. Students and faculty of the UCLA School of Public Health may now, however, join in step. With a grant of more than $300,000 from IBM Corporation, the School has purchased 47 personal computers, 20 printers, and established an instructional computing labo ratory. Known officially as the School of Public Health Microcomputer Instructional Center (SoPHMIC), the lab serves as an electronic dassroom for formal instruction and as a high-tech study hall for students' independent work. But it's more than just a convenient place to hold class or complete homework assignments. The bb will help bridge the gap, administrators say, between university studies and the 2lst-centu1y careers thac await public health graduates. The lBM funds helping boost those students toward their careers were provided under Project ADVANCE, a $13 million program to install computers throughout UCLA for educacional purposes. When the funding was announced more than two years ago, Or. Virginia Clark, professor of biostatistics and former head of the School's Computer Committee, helped develop the necessary proposal. " We wanted a central computing laborato1y," Or. Clark recalls, " where a number of students could get together in one spot and do on-line computing. But once you have a lab, you've got to

~D l ~IER

have homework problems, and someone's got to decide what programs to use on what problems. So we thought about a sate II ite situation, where each division would get a small number of computers. These would be used b~ · the instructors to make up the course material and test it for themselves.·· Today, as planned, the laboratory acts as the hub of a sate I I ite system. Twenty-four IBM PC-XTs (for "extended techno lom1" ) and fo ur PC-ATs ("advanced technology" ) were installed last year in a conven ed biostaristics laboratof); room Al -24 1, in the School of Public Health. The remaining equipment went to division offices and 15 faculty offices. A networking system enables al I of the computers in the lab to communicate with each other, and soon w ill link them to the terminals in the upstairs offices, and to the university's mainframe computer. Before the lab opened, public health students were forced to rely on a scattered computing system that often sent chem scurrying about campus to complete their work. Students who wished to use a microcomputer had to scout for a machine and often ended up sharing a set with others. ~ !any students relied strictly on the mainframe. the l arge and powerful computer run by the Office of Academic Computing in the Math Sciences 13uikling. A set of cerminals in the School of Public Health allows students to hcx)k up to the mainframe, but a terminal is not always available. Now, with 24 terminals in the new lab and-so far- no waiting, public heal th students have ready access to personal computing. For very large projects that are more efficiently performed on the mainframe, student<; w ill still be able co use the larger computer. without leaving the microcomputer lab. They'll send, or " upload," their data from a PC to the mainframe. perform their analyses, and "download" back to the PC. All of the microcomputer time is available at no charge to students, staff and faculty. Overseeing the entire operation is Or. Peter Lachenbruch, professor of biostatistics and current chair of the Computer Committee. Directing clayto-day lab operat ions is Dr. James Sayre, adjunct assistant professor of biostatistics, with Diana Thatcher working as assistant programmer. Or. Lachenbruch was the first faculty member to hold a class in the lab; his advanced biostatistics course mer chere during winter quarter. ··1 felt I

1986

UCLA PUBLIC I IEAITI I SU~ l ~ IE R 1986

needed to get my baptism of fire," he says jokingly, while pecking o n the keyboard of the PC-AT in his office. " I wanted co find out where the bugs were before I let other facul ty have the same pleasure." By spring, many of the bugs were el iminated and eight classes-in biostatistics, epidemiology, heal th services and nutritionmovecl in. When the lab operat ion goes into fu ll swing this fall, the number of classes in the facility may do uble. When classes are not in session, students may come in co wo rk on their ho mework, their theses or d issertations, and lab assistants like Gil Finewho just completed his master's in biostatistics-are there to help. I f students have no computer know ledge, Fine refers them to a software package that ex plains the machine's basic functions. " If they \Vant to start with word processing, they could be writ ing their paper with in two hours," Fine says. "They can learn how co type in a file and how co print it o ut." Computer neophytes need not be shy, Fine says. Many of the students who visit the lab are not fam iliar w ith microcomputers. That situatio n will be changing, however. Biostatistics lOOA, a core course required of all master's candidates, w ill be caught regularly in the lab, so that al I entering students w il I learn to use the system. Facul ty, of course, are not req uired to structure their courses around the computer, but their participation is desired and encouraged. A sho rt computer orientat ion class was offered to facul ty members last year, and more sessions are planned. It is hoped that these classes w ill help instructors overcome any computer phobias they may harbor. "Some reluctance to learn the svstem is o nlv natural," Dr. Savre concedes. '"But tl~eir students wili know the computer, so they'! I have to know it, too. " I ndeed, the success of the microcomputer system will depend largely o n the faculty. ''If they don't make computer assignments, the students won 't use the lab," Dr. Lachenbruch says. But that probably won't be the case. At least 28 professorsÂˇhave said they would use the microcomputers in 36 courses. Dr. Virginia Flack, for one, assistant professor of biostatistics, prom ises "to use the micros in eveiy class I'm teaching. "

Dr. Clark, too, sees the computers as an integral part of the pub I ic health curr iculum. "We're a profession that deals with info rmat io n o n groups of people, not just individuals," she exp lains. " So we deal w ith a lot of data. And that's the type o f thing the com puter does best-what's ted io us and bori ng fo r an ind ividual co do. Manipulat ing numbers-or "' number crunching," as so me faculty cal l it- is a large part of the work o f the publ ic heal th researcher, panicularly the biostat istician. Biostatistics cl asses will use the computers frequently for statist ical ana lysis, but faculty and students in every division w ill find the computers useful-even vita l to their work. Students in health services, for example, can use the computer to create spreadsheets when preparing a budget for a grant proposal. In nutritional sciences, students can anal yze nutrient intake data o n the PC. Students in environmental and occupatio nal health sciences may use the com puter to simulate the effects of airbo rne contaminants on industrial workers. And , in population and family heal th, students use the word processing function to design sur vey questio nnaires. The potential uses of the microco mputers are almost I imitless; they will expand as softwa re manufacturersand professors in the School-develop more advanced programs. Mario Panaqua, adjunct lecturer in nutrition, is awaiting a program fro m Beckman I nstruments, I nc., that w il I allow him to simulate the operation of an ultracentrifuge. Anne Co ulson, adjunct lecturer in epidemio logy, is wor king o n a program that will simulate the spread of an epidemic through a co mmunity But no matter the task, the co mputer w ill wo rk at a faster rate than was previo usly thought possib le. " Back in the o lden days before computers," Coulson says, "a reasonable size multiple regression might take a statistician two or three weeks on an electri c calculato r. Now this is do ne in seven to ten seconds on a computer. " But the increased capacity fo r work created by the computer will place increased demands on the public heal th researcher, Coulson believes. " More elaborate statistical analysis will be expected of us," she says. "We'll have to explo it the data- get everything out of it that 's there.'' Researchers have an ob i igat ion to themselves, Coulson says, to make the fu l lest possible use of the computer

for data analysis. But they are also ob1igated to their spo nso rs. "We owe it to o ur research fund ing agencies to get the most out of the money we've spent collecting the data," she says. " And we owe it to the people who 've helped us by hold ing st il l fo r questio ns, b lood tests and examinations.'' Pub I ic heal th students are also obligated to master the personal computer ; they w ill find it almost everywhere they go after graduat ion. " Maybe not in rural Idaho," says Dr. Linda Bourque, associate professor of popu latio n and family health, "but if they work fo r the Co unty of Los Angeles o r large hosp itals o r heal th agencies, they'll find computers there." Students who choose to work abroad will use PCs, too, programmer Diana Thatcher says. "They can't take huge computers to the Third Wor ld if they work as advisors," she po ints out. " They'll have to take portables." Indeed, microcomputers have become so p revalent in the wor ld of the public heal th professional chat comp uter skills are almost mandatory, Coulson says. " Publ ic hea l th graduates today who do n't have some acquaintance with the computer w ill have to get that pretty fast. The time has come when the computer is just as much a too l of the p rofessio n as the typewriter and the telepho ne." But just as the typewriter and telephone rap idly evolved, so is the personal computer quick ly changing. The microcomputer system in the School of Publ ic Health w ill remain current fo r about three years, De Sayre says, and wil l be upgraded as IBJ\11 develops new equipment. Anne Coulson, for one, wonders if the techno logy will evolve so fast that co mputers themselves w ill be obsolete ten years fro m now. 'Just look at what happened to the typewr iter," she says. "We used to have typewr iters in the I ibrary Yo u put a clime in and they worked for half an houc But the machines were removed. Why? Because everyone has a typewriter." Making typewr iters available now, she says, " would be I ike checking out fountain pens." How quick ly the computer may go the way of the typew riter o r the fountain pen remains to be seen. And Coulson knows it is r isky to make any predictions. "Anybody who has tried to put a ceiling on the computer industry," she says, " has bad ly failed. "

~~...-""'~

signment to the committee, Dole became Senate majority leader. Dr. Michnich moved with the senator and his staff to offices in the Capitol building. --.. When the fellowship ended in August of '85, she -,.e4 as a full-time staff member. Her responsibilities now encompass

UCLA PUBLIC 1IEALTH SUMMEH .1986

all manner of heal th pol icy matters. For the last several mo nths she has been wor king on a major piece of legislation, the " Med icare Physician Payment Reform Act of 1986," recently submitted to the Finance Committee. " Medicare has been paying physicians the same way since 1973. There has been reform in the way Medicare pays hospitals, so now is the time to rethink how physicians are paid as well," says Dr. Michn ich, admitt ing this bill faces controversy that will mean its life o r death. Her work o n the bil l involved pulling together experts from al l groups affected- retired persons, insurance carriers, congressmen and health fi nancing researchers. Physicians and their professional lobbyists have also had input so that the bil I offers an improved basis, al l around, for physician payment, Dr. Michnich comments. But anyone who frequents Capito l Hi l l for long knows "You may help give birth to a bill , but it grows o n its own after that," she notes. A bil I actu ally evolves, accumulat ing views and perspectives as it travels through comm ittee, the floor of the Senate, then numerous conferences between the House and Senate. " One of the most marvelo us things about this experi ence is learn ing how it al l comes together. ow that I've been so close co the process, I have a much better understanding of how the pub I ic, interest groups, the administratio n and Congress all interact to shape our laws." Close co the process is an understatement. A<; Senato r Do le's assistant special izing in heal th care, she presents co the senator any issue of heal th policy facing the natio n. The job demands a lot of legwork, which in Wash ingto n is the same as pho ne work. Fourteen-ho ur clays are routine. She spends at least part of the day tracking information on the current state of heal th care--on the phone w ith the Department of .H eal th and Human Ser vices, the Heal th Care Financing Adm inistration o r representatives from the legislature and med ical societies. She also does constituent work, answeri ng questions from Kansans about the senator's stand o n certain issues. She hears the words of suppo rt, as well as the problems- malpractice and to n reform in the state, or how individ uals feel they are treated by the Kansas hospital system- then capsu-

I izes these matters for the senator. She works closely with Sheila Burke, his chief of staff and " one o f the most expert heal th staffers o n the Hi I I. " The major ity leader 's o ffice is not a single-issue place, however. O ther assistants hand le tax reform, banking, trade or defense, and part of the excitement is being exposed to these issues, too. There's no way to avoid it, working shoulder-to-shoulder wi th 14 other staffers in a four-office complex just 10 feet from the Capitol Rotunda, Dr. Michnich exp lains. "A private office on Capito l Hil l is not something yo u expect. I share o ne with three other staff members." She shares a bit of historic opulence as wel I. The office suite has four firep laces, vaul ted ceiling and an antique chandel ier fro m the Wh ite Ho use. Reminders of U.S. hiscory are every-

Anyone who frequents capitol Hill knows "You may give birth to a bil, but it grows on its

heâ&#x20AC;˘

own after that." where in Harpers' prints of 19th-century scenes from the Senate chamber, and paintings I ike the one of Pocahantas that graces the senato r 's office. Dr. Michnich has also watched history being played out at jo int sessions of Congress w hen President Reagan, Pr ime Minister Margaret Thatcher, and Italy's Bettino Craxi testified recently. Even mo re of a pleasure is seeing fam iliar faces. She was there smiling in approval w hen Dr. Lester Breslow, pro fessor emeritus, testified about heal th promotion and d isease preventio n for the Senate Finance Heal th Subcommittee. Although surrounded by the accoutrements (and the realities) of power, Dr. Michnich is find ing her tenure in Washington " fascinating as opposed to heady " She and husband Brian Luce, who received his doctorate in heal th ser vices from UCLA in 1979, have a sense of humility about the who le situatio n. Dr. Luce is a senio r researcher at Battel le Cor poratio n, an o rgani zatio n similar co Rand, w here he is working o n a health care technology

assessment program. Mar r ied last September, the couple commutes to D.C from their Bethesda, Md., home each clay, a time they cher ish together before they each take off at a run in d ifferent directio ns. The path to Capitol H il I has been smoothed for her, Dr. Michnich says, by the good foundat ion she received during her UCLA days. After receiving a B.S.N. from the University of Connect icut, she earned master's and doctora l degrees in health services from the UCLA School of Publ ic Health. She wor ked as a clinical nurse special ist at Yale- ew Haven Hospi tal and in the ICU burn unit at Brotman Med ical Center in Los Angeles. At the time she was selected for the Johnson fellowship, she had been an assistant professor in heal d1 services administration at die University of Washington for five years. As a UCLA doctoral student, Marie Michnich was research coordinator fo r D r. Paul Tor rens on developing qual ity assurance systems in ambulatory care centers, an earl y project that has ser ved as a model for sim ilar systems today And she assisted Dr. Char les Lewis with a "Survey o f Innovat ive Changes in Health Care." " Dr. Afifi taught me b iostat ist ics and l also owe a lot to Drs. Ruth and Milton Roemer. I received a solid , ethical fo undat io n of knowledge from UCLA. It's great to know that w hen I have a problem , those people are there for me, w illing to offer profess ional advice and support. " Dr. Michnich's major research projects have included " Physician Effectiveness in Preventive Care;" " Heal th Promotion and Disease Prevention at the Worksite;" and " Physician Effectiveness in Colo rectal Cancer Screening," to be published in September in Medical Care. " My earlier research tended to be w ith cl irect delivery of health care at the practitioner and patient level. Now I look at the larger pictur e, at how funding impacts the level of care we al I receive. "The Washington experience has added another dimension to my career. If I go back to teaching, it w il I be w i th a better understand ing and ability to teach heal th policy. In a research setting, it will influence the kind of projects I take on. From here forward, I will always be sensitive to what goes o n in Congress and how the political climate affects heal th care legislation."

News Your Vote Counts on Issues Crucial to UC al ifornia voters w il l face decisions November 4 o n two issues crit ical to the University of Cal iforn ia. A const itutional amendment to put a ceil ing on compensation fo r pub I ic employees is being proposed by Paul Gann . The Gann Public Pay Limi t Init iative would raise the governo r 's salary from $49,000 to $80,000 and, at the same time, I im ir salaries of stare and local employees to no more than 80 percent of the governor's salarv - or $64,000. The Gann proposal also places new restr ict io ns on h iring outside contractors and proh ibits state and local employees from accum ulat ing vacat ion and sick leave from one year to the next. It would have the greatest impact on the Universit-v's professional schools, includ ing public health, medicine. nursing, de nti st r~·. business, law and educat ion. About 83 percent of the health sciences facul t\' would be affected. " It's no overstatement to sav that. should the Gann initiative be voted into lmv and ruled applicable to the University, the UC svsrem \vould never again be what it is now... President David P. Gardner told the Universit\· of California's Board of Regents. lf the Gann init iat ive passes. approx imately 7,400 emplovees and facu lty \vould be subject to pav cuts or freezes. These severe salary restrictions would wipe our the Universit,·'s abil ity to attract and retain superio r reaching and research facu l ty. A resulting loss of qual itv facu lty and staff would mean that some health care ser vices at UC reaching hospitals may be seriously curtailed or eliminated. And wi thdrawing sick leave and vacat ion accruals from emp lovees would take its ro ll in money, as wel I as employee morale. Acting Dean of the School Dr. A. A. Afifi commented, ;'The consequences of the Gann proposit ion, if applied to schools of public health, would be unthinkable. We in pub! ic health should, therefore, do al I we can to prevent it from passing...

UCLA PUBLJC I IEAIT H SUMMER 1986

Bond Issue Shock waves from declining oil prices w ill soon be felt by the University of Califo rnia. The state is d ue to receive only $100 mill io n from tidelands o il revenue this year, instead of the $425 million expected. The University's capital program , for new build ings and renovatio ns, is amo ng the entities funded w ith this money. After funds are d istributed, it's anticipated that no tidelands oil revenue will be available for the University - no r for the California State University and community college systems. The three Califo rnia education systems, therefore, are asking for voter support of a $400 million general obligation bond issue on the November ballot. If this alternative funding is not approved, several important UCLA building projects would be severely delayed. Substantial improvements or additions to time-worn or technologically inadequate campus buildings would be set aside. "Safe, efficient clas.srooms and research facilities are critical ro keeping California's higher education systems among the best in the world, not only now but for generations to fo llow," remarked Dr. Afill.

Kenya Researchers Return ith four years of work behind them and two more to go, UCLA part icipants in the Kenya Project, a study of marginal malnutrition, returned to Los Angeles from Africa this spring, Dr. Charlotte eumann repo rts. Their field work complete, the researchers have now begun to analvze the data they col lecred in this East African nation. The study, known forma lly as the " Kenya Project on Energy Intake and Human Functio n," represents a joint effo rt of health professio nals from UCLA and the Universiry of Nairobi. Dr. Neumann, professor of pub I ic health and pediatr ics, is pri ncipal investigator o n the American side.

Funds Available for Industrial Hygiene Studies tudents who w ish to pursue a career in industrial hygiene may receive financial support w hile they earn a post-grad uate degree in the Division of Environmental and Occupational Health Sciences, according to associate professor Will iam C. Hinds. Tuitio n payment and a monthly sti pend are available to eligible students under a program sponsored by the National I nstitute of O ccupational Safety and Health (NIOSH ). Students with a strong background in physics, chemistry and math are encouraged to apply. Ten students rook part in the industrial hygiene program in the 198586 academic year. NIOSH designated the Division of Environmental and Occupational Health Sciences as part of its Southern California Educatio nal Resource Center in 1984. The institute sponsors 14 such centers across the country for students in occupational health.

Kenya woman takes maize kernels of/ the cob. The research reams stud ied the relationship between energy intake levels and fucntio nal outcomes among 1,200 villagers in Embu District, Eastern Province, Kenya. They will reunite next year, probably in Nairobi, to d iscuss their findings. That con ference should yield some answers to what Dr. Neumann calls "the big quesrionhow to improve the nutritional status and functio n of people who are marginally malnourished." The research design was compl icated temporarily when famine struck the study regio n in the summer of 1984. UCLA researchers instituted a famine relief project, bringing food and seed into the strickened area. The Kenyans are now recovering fro m the famine, w hich lasted through December 1984, Dr. eumann says.

UCLA PUBLIC HEAITH SUMMER 1986

New Assistant Dean: From Civil Rights to Human Service

Dr. Kar Receives Kellogg Fellowship

eggy K. Convey still remembers the day Dr. Martin Luther King,Jr., came to town. His visit changed the d irection of her life. Inspired by the reverend's call for civil rights workers, Convey, a University of Nebraska student, postponed her plans for graduate school and headed south after graduation. It was 1965. When she got to Mississippi, she learned that the civil rights group she'd planned to work for had disbanded. She ended up, instead, writing a grant proposal for a child-care center. Convey didn't know it at the time, but her career in social service and health administration had begun. Some 20 years and 2,000 miles later, Convey's career path led her to the UCLA School of Public Health, where she became assistant dean for administration April 1. She comes to UCLA from the University of Southern Califo rnia. At the USC Department of Contracts and Grants she ser ved as associate director, administering research awards for the heal th sciences. Before joining USC, Convey worked in Chicago as assistant director of the j o int Commission on Accreditation of Hospitals. She has also worked extensively in family planning ser vices. In her new ro le, Convey's majo r concern will be school funding. But although she w il l assist Acting Dean A. A. Afifi w ith the business side of the school, her own academic background is strictly l iberal arts. She earned her bachelo r 's degree in Eng lish at the University of Nebraska (1965) and just completed a master's in I iberal an s at USC. A l iberal ans educatio n is an asset to administrators, Convey bel ieves. " With it, you're able to develop solutio ns to problems that are not geared o nly to financial concerns," she exp lained. Whacever concerns may 1ie ahead, Convey is relishing her new post. " ! love the experience of starting a new job," she said. "You can see very clearly what needs to be done and you can't see the barriers. "

r. Snehendu B. Kar, associate dean of the School, chair of the Division of Population and Family Health and professor of behavio ral sciences and heal th education, received a fel lowship this spring from the W K. Kellogg Foundatio n of Battle Creek, Mich. H e was one of five U.S. health care leaders to receive the first Kellogg Internatio nal Fellowships in health awarded by the foundation. The fellowship program was established to promote leadership in primary heal th care and heal th management and to develop an international network of experts in these fields. A total of 30 heal th care leaders from 18 countries were selected for the ho nor. Each w il l receive $25,000 per year for three years and 25 percent release time from their institutio ns to pursue ind ividual projects and overall program objectives. Dr. Kar's project focuses on the field-testing of international primary health care indicato rs, the signs that individuals and societies are promoting physical, mental and social health.

Assistant Dean Peggy Convey

Primary Health Care: A World View

ealth professionals worldwide must intensify their effo rts in primary health care to meet the World Health Organization goal of " heal th for al l by the year 2,000," a public heal th expert fro m Southeast Asia told a UCLA aud ience recently. In a speech to students and facul ty of the School of Public Heal th, Dr. Krasae Chanawongse, M.D., Dr.P.H., called the primary health care approach the " major strategy" for heal th care leaders in the remaining years of this century. " People must learn to care for themselves, " Dr. Krasae said, "and, to that end, health professionals must demysti fy the heal th care process." Dr. Krasae directs the ASEAN Primary Heal th Care Training Center near Bangko k, Thailand. He was named the Ralph R. Sachs 1986 Visiting Scho lar of the Western Consortium for the Heal th Professio ns and spoke at UCLA in March during a tour of western universities. Much of the Thai effo rt in primary health care is concentrated in the rural vii lages, Dr. Krasae said, where community clinics are being establ ished and staffed w ith trained volunteers. The volunteers are taught to administer basic health care and to counsel villagers in family planning.

In Memoriam

r. Irvin Cushner, professor of populat ion and family heal th in the School of Pub1ic Heal th and professor of obstetrics and gynecology in the School of Med icine, d ied April 7 in Cincinnati, Ohio. He was 62. A long-t ime advocate of reproductive health rights, Or. Cushner was internationally recogn ized for his contributions to women's health care. In 1975, he created the Division of Women's Heal th within the Department of Obstetrics and Gynecology and headed that d ivison at the t ime of his death. Last year, he was appointed chair of the UCLA Medical Center Ethics Committee. Dr. Cushner served as deputy assistant secretary of population affairs in the Department of Heal th, Education and Welfare from 1979 to 1980. '

UCLA PUBl.IC ll EAJ:rH SUM~ 1E H 1986

FacullJ• Notes

he fo llow ing is a capsule of some o f the activit ies of o ur facul ty during the past several months.

Dr. Roslyn B. Al.fin-Slater, profes· sor o f nutrit io nal sciences and assistant clean for academ ic affairs, received the Delta O mega Society natio nal mer it aware.I for outstanding achievement in public heal th at the natio nal meet ing of the American Public Health Association last November.

Dr. Linda B. Bourque, associate professor of population and familv heal th, co-wrore the art icl e, "Com.mun icatio n After Laryngecto my, .. which appeared in the fal l 1985 ed it io n of the j ournal of Psychosocial Oncologli ~he also co-wrote an article appear ing m the March 1986 issue of Arc/Jives of OpbtbalmologH " Repo rted Satisfact io n, Fluctuat io n o f Vision, and Glare Amo ng Pat ients One Year After Surgery in the Prospective Evaluation of Rad ial Keratoromy ( PERK) Study." Her co-autho rs o n the PERK art icle were Bever ly Cosand, programmer at the School of Public Heal th, and Carolvn Drews, docto ral cand idate in epidemio logy. Dr. Albe rt Chang, associate professor of populatio n and fam ih· health has publ ished two articles o n auto- ' mobile safety. 'T eaching Car Passenger Safety co Pre-school Children" appeared in the September 1985 issue of Pediatrics; " Automobile Passenger Safety Educat ion fo r Pregnant Women and Infants: Atti tudes and Pract ices of Obstetrician-Gynecologists" was publ ished in the j ournal qf Rep roduct iue Medicine in November 1985. Dr. William H. Glaze, professor of environmental and occupational heal th sciences and d irector of the environmental sciences and engineer ing program, received the 1986 E J. Zimmermann Award in Environmental Sciences. He was sel ected from a natio nw ide field of no minees for his cumulat ive contributio ns co the environmental sciences. The Zimmer mann award is bestowed bv the Central Wisconsin Sect io n of the American Chem ical Society and Zimpro, I nc., a research and development, and manufacturing firm in the field of environmental control. Dr. Glaze accepted his award June 2 at Marquette Universitv in M ilwaukee, Wis. ·

Dr. De rrick B. Je lliffe, professor o f population and fa milv heal th and E. F. Patrice j e lliffe, acljunct l~crurer o f po pulati o n and farni lv heal th have w r itten three books d ue fo r pul; licarion th is year: "Child 'utririon in Developing Countri es," " Dietary Management of Acute Dehyd rating Diar rhoea in Yo ung Ch ild ren," and " Trad it ional Practices in r eed ing During and After D iarrhoea. " Dr. Derrick j elliffe chaired a symposium o n child heal th in develo p ing countr ies at the Internat ional Congress of Ped iatrics held in I Io no lulu in Ju ly. Patr ice j elli ffe presemed a paper o n breast-feed ing at the same gatheri ng. Dr. Alfre d H. Katz, professor of population and fam ilv health saw die second ed ition of his book, .:The Strength in Us,'· publ ished mis summer: His art icle, "\.Xthere are Self-Studies Go ing'" appeared in the winter 1985 ed it ion of j ournal qf Primcoy Prel'en t ion. Dr Katz currentlv serves a<> consul tant to the European Regional Office of the Wo rl c.l I lealth Organization and the Public I Ieal th Foundation in Los Angeles. I le W<L'i recently appointed to di e ed ito rial board of Ilea /th Promotion, a new internat ional quarterly published by the Oxford niversit:v Press. · Dr. Milton I. Roe m e r, professor of heal th ser vices, has published t\vo books: " 1atio nal Strategies for Heal th Care O rga nizatio n: A Wor ld Ove r v i e~· .. appeared in Ju ly 1985: "An Introduct ion to the U.S. I leal th Care Svstem . Second Ed it io n .. was released last March. I le has also publ ished rwo recem arti cles: "The eed for Professional Docto rs of Pub l ic I leal th. " in Public I leal tb l<eports, j anuarv-February 1986; and " Prio r irv for Pri;m trv I l eal th Care: Its Deveio prnent ancl Prob lems," in the March 1986 issue of the British jo urnal, I Ieal tb Polic)' and Planning · RuthJ. Roe m e r, adjunct professor o f heal th law, co-authored the article "Sex Educatio n Laws and Po licies" ' w hich appeared in dle july-Augus'c 1985 issue o f Studies in Fa mily Planning. Her article, " Legislatio n o n Contracept io n and Abo rt ion fo r Adolescents," was published in the September-O ctober 1985 issue of the same journal. Roemer will begin her o neyear ter m as president o f the Amer ican Public I leal ch Associat ion this fal l. At the associat ion's nat ional meeting lase November, she was awarded a cer -

tificate of mer it, med ical care sect ion. Roemer also serves as consul tant to a Wo r ld Health Organization studv group o n strengthening nursing.educatio n and pract ice co promote pr imary heal th care.

Dr. Paul R. Torrens, professor of heal th services, was appointed to the board o f tr ustees of Incarnate Word Heal th Ser vices of San Anto nio, Texas, the parent organization for 12 Sisters o f Charity hospitals in that state. He also serves as a trustee fo r Mercy Heal th Care Organ izat io n of Sacramento.

Retirements '

s of July 1, 1986, the fol lowi.ng facul ty mem.bers .retired from their pos1c1ons 111 the UCLA School of Publ ic

H eal th:

Dr. Wilfrid J. Dixon held a joint appo intment as professor in the Division of Biostatist ics in die School and professor of biomathematics and psvchiatry in die UCLA School of Medicine. He had been at UCLA since 1955. While at die School Dr Dixon developed programs leading to a Ph.D. in b iostatistics. Dr. Milto n I. Roem e r, professor of heal th services and professor of prevent ive med icine in the UCLA School of Med icine, had been a faculrv member since I 962. D1: Roemer ha.,; ·studied heal th care organization in 51 countries on eve1y continent. I le has audiored J 7 books and over 300 articles on the social ~tspects of med icine. Dr. Alfre d H. Katz, professor of population and family healdi held a joint appointment in preventive medicine and social welfare in die School of Medicine. Dr. Katz Carne to UCLA in 1958. I le is best known as a pioneer analyst in self-care and self-help a-; die\' apply co public healdl. · Dr. Edward L. Rada, professor of economics in public health had been at UCLA since 1953, fi rst in the Department of Home Economics and later a-; Division I l ead in Behavioral Sciences and I Iealth Educat ion (1970-79). Dr Rada h~L~ publ ishecl widelv on food economics and nutrit ion. ·

UCl..A PUBLIC H EALTll SUMM ER 1986

M edicare Insurance Cho i ces

Editor's Note: We are inaugu rating a new column with this issue of UCLA Public Healtb. " Pro ject pdates" features short report-; of majo r p rojects and research by School faculty. We hope these slices of in fo rmation w ill stir pro fessio nal recognit ion, as wel I as the exchange of ideas with colleagues in other divisio ns and around the country w here the magazine is d istributed. Faculty suppo rt fo r o ur first column has been gratifying. With continued good response we'l l bring you up-todate news of the fol lowing items and report on new projects as they develop. Nutrition

Dr. Roslyn B. Alfin-Slater, professor of nutritional sciences and assistant dean fo r academic affairs, is studying the effects of vitamin E as a d ietary supplement on lung cancer induced by ozone, the major oxidant in photochem ical sm og. Dr. Alfin-Sl ater 's resul ts to date suggest that d ietary defi ciencies in vitamin E may increase the risk of ozone-induced lung injury, and that moderate increases above the E requirement may be beneficial in such cases. Wo rk ing wi th Or. AlfinSlater is research associate Mohammad Z. Abed in. The project, begun in January 1984 with fund ing from the Am erican I nst itute fo r Cancer Research, is t itled " The Possib le Protective Effects of D ietary and Aerosol Vitamin E and Glutathio ne Against Lung Cancer Resul ting fro m Oxidizing Po llutants." Contact number: ( 213) 8255657. Breast Cancer i n Families

Dr. Robert W. C. Haile, assistant professor of ep idem io logy, is exam ining the fam ilial occurrence of breast cancer to deter mine if a genetic facto r is at work in transm issio n o f the disease. H is project, t itl ed "Genetic-Epidem fo logic Study of Bilateral Breast Cancer," focuses on a high-risk group of wo men, the relatives o f premenopausal bilateral breast cancer patients. Dr. Haile's results to date suggest that a major gene may be transmitted in these famil ies; he and his associates are trying to identi fy an effect ive marker for this presumed gene. The study began in Janua1y 1984. Contact number: (213) 825-8193.

Dr, Shoshanna Churgin, assistant professor o f health services, is conduct ing research to help Med icare beneficiaries make in fo r med decisio ns about the amount and kind of heal th insurance they may purchase. Med icare enrol lees, facing costly copayments and deductibles and limitat io ns on covered ser vices, are increasingly turning to I IMOs and supplemental insurance coverage, Dr. Chu rgin explains. Her project, t itled " In fo rmatio n for Prudent Insurance Cho ices," wil l com pare the out-ofpocket costs Medicare beneficiaries wit I incur under vario us heal th insurance options i f they experience ii 1nesses commo n to the elder ly. Wo rking with Dr. Churgin are docto ra l students Bruce Davidson and Erin Kenney and master 's student<; Alex Ross and ancy Mo nk. The study w il l conclude by March 1988. Contact number: (21 3) 825-5773. Chronic Illness

Dr. Alfred H. Katz , professor of populatio n and fam ily heal th, is studying psychosocial adaptat ion to SLE (system ic lupus errhematosis) and myocard ial infarct ion w ith fund ing from the Kroc Foundat io n. His study is titled " Life Ad justment Problems and Cop ing Behavio r in Chronic Illness." Dr. Katz started the project in March 1985 and p red icts complet io n by June 1987. Wo rking w ith him is Or. Carl Maida, research associate. Contact number: ( 213) 825-5333. AIDS Research

Dr. Gary Richwald, assistant professor in population and fam ily heal th, has received approval fro m the Centers fo r Disease Contro l for a project to develop and evaluate educational programs and interventio n strategies for h igh-r isk AIDS populati o ns. The target groups are pregnant women, IV drug users and staff of community agencies who may come in contact w ith AIDS patients. The primary contractor fo r the three-year, $375,000 grant is the Lo ng Beach Department of Heal th. O ther UCLA facul ty involved in the project are Or. Donald Morisky, Dr. Hal Morgenstern, associate professor of epidem io logy, and Dr. Michael Ross, assistant professor of OB/ GYN and public heal th at Harbo r-UCLA Med i cal Center. Contact number: (21 3) 825-8196.

M edical R egimens and TB Patients

Dr. Do nald E. Morisky, assistant professor of behavioral sciences anc.1 heal th education, is stud~Âˇi ng \\'ays to improve adherence to med ical reg imens and appo intment-keeping behavior among patients with tuberculosis. The two-year project, begun last O ctober, is being conducted in cooperati on w ith the Hollvwood-Wilshire Heal th Center and the Los Angeles County I l eal th Department. A'lsisting Dr. Mo r isky are doctoral cand idate C. Kevin Malotte and master 's students Barbara Sugland, Sara Hig ler and Jennifer Ac.lams. The project, titl ed " Innovative Methods fo r Improving Pat ient Comp I iance w ith Anti tuberculosis Drug Regimens," is funded by the Centers for Disease Contro l. Contact number: (213) 825-8508. Drug Addiction Treatm ent

Dr. Forest S. Te nnant, Jr., adjunct associate professor of epidemiology. is test ing a var iety of med ical agents for w ithdrawal from nicotine, cocaine, marijuana, phencycl id ine, and amphetamine dependence. I lis study is t itled " Development of Med ical \Xlithdrawal Agents for Drug Addicrion." " Part of the problem in dealing with addict ion to these substances is the lack of med ical withdrawal treatments," Dr. Tennant reports. " New treatment agents are based on knowledge that abused d r ugs deplete speci fic neurotransm itters and alter receptor sites in the ner vous system." The subjects used in these studies are add icts Lo the above-named substances. To date, o ne o r more med ical wi th drawal agents appear p ro mising for al l the add ict ions mentio ned. The studv w il l be completed in 1987. Contact Âˇ number: (818) 919-1879. Childhood Accid ents

Dr. Albe rt Chang, associate professor o f populat ion and family health, recently comp leted three ped iatric studies. Work ing w ith him on one project, "Accidents in Child ren Enro l led in Day Care Centers," was Dr. Marle ne Lugg, assistant professor of heal th services. The study was sponsored by the Committee on Research o f the UCLA Academ ic Senate. Or. Chang also invest igated the management of il lness in day care centers and t he incidence of pediatri c drownings and near-d rownings in Los Angeles. Contact number : (213) 825-9481.

UCLA PUBLIC HEAITH Sl'1'11'1ER 1986

Dr. Kenneth Kizer Lectures on Public Health Challenges

e'l l be taking some fami liar publ ic heal th problems w ith us into the 1990s, said Dt: Kenneth Kizer, M.P.H . '76, cl irector of the Cal ifornia Department of Health Services. The aging populat ion wi ll increase pressures for developing better longterm care systems. AIDS treatment wil l consume larger amounts of o ur heal th care resources, and a growing number of ind igent persons wil l receive care for which providers are uncom pensated. Those were a few of the pub Iic health issues Dr. Kizer confronted in the Lester Breslow Distinguished Lectureship clel iverecl April 22 at the James West Center on campus. In his lecture titled " Preparing for the Public Heal th Chai Ienges of the 1990s," Dr. Kizer also commented that we may notice an increase in some communicable diseases as pharmaceutical firms stop producing certain vital vaccines because of expensive liability claims. The DPT (cliphtheriapenussis-tecanus) vaccine is an example.

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The annual Lester Breslow Lectureship is sponsored by the School of Publ ic Health and supported by a gift from the Raymond and Betry Goodman Foundation. It is named for Dr. Lester Breslow, professor of pub I ic heal th and clean emeri tus of the School. I n addit ion to his publ ic heal th degree, Dr. Ki zer earned an M.D. from UCLA and is board cert i fied in emergency med icine, medical toxicology, occupatio nal medicine and preventive medicine. I-le has written more than 75 scientific publ icat ions.

Almnnt Notes Sister Julia Mary Farley, M.S. P.H. '62, is founder and director of the Good Shepherd Center, a shelter fo r homeless \VOmen in Los Angeles. Eugene C. Beck, M.P.H. '70, has been appointed president and chief executive officer of the Utah Hospital A'isociat ion. He is a leader in developing heal th programs and services in rural commun it ies throughout the state and is currently vice president, Office of Rural Health, for Intermountain I Ieal th Care, l nc., in Salt Lake City.

Richard M. Oksas, IVl. P.11. '7 J, is program director of the Medicarion Informat ion Service in Manhattan Beach, Cal if. , a phone I ine for information on prescription drugs. He is also author of a new month ly ne,vsletter, the Pal ienl illedical ion Bullet in, which evaluates the efficacy, safety and cost of prescription and non-prescription products. Jeffrey S. Kirschner, M.P. 11. '74, was honored by I l o::.pitals magazine as "one of the new and innovat ive generation of health care leaders in the United States.,. Kirschner was the Cali fornia honoree in a nationwide aware.I naming one health care leader from each state. He is currently group vice presiden t and regio nal directo r of American Medical International (AM I). Kirschner also received his bachelo r 's degree in economics and pol iti cal science from UCLA Ellen Eisman, M.P. I I. '78, was recently promoted to director of human resources, management and training for the department of international projects and development at American Medica l International. S. Marie Harvey, M.P.H. '79, Dr.P. 11. '84, is assistant professor of public heal th at the University of Oregon, Eugene.

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Alumni Information Update

I I

Let's hear from you'

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Dean's Message ''The ID.A School of Niie Heald• is among Ille insDbdions most m:liValy COIDlclilll

AIJI 1'888m'Ch."

uring the 198';-86 academic year, the UCLA School of Public I lealth celebrated the 2';1h anniversary of its accred iwlio n as an independent school. It was a year uf chaI lenges, both internal and extc.::rnal. On the national level, our Schoo l joined its sister schools of pub I ic health in protecring public health graduate educu io n from the fallo ut of the Gramm· Rudman -1lo llings Bill. We were able to convince 1he legislature thac che federa l training grams and capiwtion funds were essent ial to successfully carrying ouc our mission and have ensured a com inua1 ion of chose funds for the next academic year. Toge1her with other schools o f public health, \Ve "·ere also able to ensure 1he approval of re~carch funds for several imponant aspects of pub I ic health, particularly heallh promot ion and dbease prevemion. lmernally. the Schoo l reviewed its academic programs and adrn iniscra1ive scrucwrc, as well as its relationships with ocher areas uf the campus. Resul ts from this sou l-search· ing shou ld he vigorous growth and development o f 1he School on many front->. I low far the School and the field of Pub lic Hea lth have emlved during the past quarter century is reflected in recem issues of 1his magazine. This issue. in particular. high I ights the most frighren ing cur rent problem of pub I ic healthAlDS. The UCLA School of Public Heal th is among the institut ions most actively conducting research to " fight fear with knowledge" relative to this disease. Boch the etio logical and behavioral aspects of this problem arc being considered. In the anicle " Danger: Employees On ly, " some of the activities of our Environmenta l and Occupm ional I l ealth Services Division are ourlined. Another area of active growth high I ighted in chis issue is the development and use of computer techno logy in public health. On anrnher front, a very exciting ac1ivi ty is taking place righr now! The students and alumni are working together wich the School Administration 10 stage a much mo re extensive Orientation Program for the Fat I 1986 incoming stu· dents. The program \vi ii include, in addi1ion to the usual o ri entation, several activities planned to get the students involved right away in the School's affairs and make 1hem feel at home in rhe School of Public I lealth now and forever.

<2.

Dr. Abclelmo nem A. Afifi

UCl.A School of Public Health 405 Hilgar<l Avenue Los Angeles, California 90024 Address Correction Requested GS14

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