UCLA
School of
PUBLIC HEALTH
FALL 2000
Newsletter
TAKING IT TO THE STREETS
FOR A HOST OF POPULATIONS IN LOS ANGELES, THE SCHOOL IS A VALUABLE RESOURCE
NIOSH DIRECTOR APPOINTED NEW DEAN OF UCLA SCHOOL OF PUBLIC HEALTH
D DEAN’S MESSAGE The role of an interim dean is by definition “in between.” Thus, I find myself in between the administrations of two deans, one who left after 15 productive and successful years and one who is incoming, with great promise and excitement. Dean Abdelmonem Afifi stepped down on June 30, 2000. We honored him with a lively and warm farewell party (page 12). After spending a year on sabbatical, Professor Afifi plans to resume his research and teaching in the Department of Biostatistics. Dr. Linda Rosenstock joins our faculty as dean and professor of environmental health sciences as of Nov. 1. We are extremely pleased to have found an individual with such a wide range of experience and skills (see the article on this page). We have all been impressed by her energy, enthusiasm, and vision, and have very high expectations for the years ahead. Although my term as interim dean has been short, it has been both fulfilling and enjoyable. The particular highlights for me have been the involvement with strategic planning at the campus level, and the interaction with many of the individuals who devote their time and financial resources to the betterment of the School of Public Health.
Judith M. Siegel, Ph.D., M.S.Hyg.
r. Linda Rosenstock, director of half years in Washington, D.C. Howthe National Institute for Occu- ever, when I left my lifelong profesp a t i o n a l S a f e t y a n d H e a l t h sional association with universities, I (NIOSH), has been appointed always thought I’d return, and I’m dean of the UCLA School of Public very excited to be doing it at UCLA. Health effective Nov. 1. She replaces “Some of the best and most known Dr. Abdelmonem A. Afifi, who served talents in public health in the country for a 15-year period ending June 30. are at UCLA,” she added. “While Dr. Judith M. Siegel had UCLA is very secure in its been serving as interim place as a well-regarded dean since July 1. school, I’m excited at the “Dr. Rosenstock’s disopportunity to help the tinguished leadership of outstanding staff and stuthe National Institute for dents bring the school to a Occupational Safety and new level.” Health and her career in Rosenstock has been teaching and research proactive internationally in vide the UCLA School of teaching and research in ocPublic Health with a dean cupational health. She has Dr. Linda Rosenstock whose expertise and vision served as an adviser to the will enable the school to World Health Organization “Some of the best continue playing a vital role and conducted pesticide and most known in our community and our health effect studies in talents in public nation,” said Chancellor health in the country Latin America. Born and Albert Carnesale in anraised in New York City, are at UCLA. nouncing the appointment. she earned her undergradI’m excited at the Since April 1994, Rosenuate degree in psychology stock has served as director opportunity to help from Brandeis University in the outstanding of NIOSH, which is part 1971. She studied medicine staff and students of the Centers for Disease at Johns Hopkins Univerbring the school Control and Prevention. sity, where she earned her to a new level.” She spent the earlier porM.D. and M.P.H. in 1977. tion of her career at the While at the University University of Washington in Seattle. of Washington, Rosenstock conducted “I am thrilled at the chance to work research and published extensively on at an outstanding school on a premier occupational diseases, including campus,” Rosenstock said. “I’ve had asbestos-related illnesses and the efan exciting and productive six-and-a- fects of exposure to pesticides.
EXPANDING SCHOOL BEGINS LEASING SPACE IN WESTWOOD As the school’s research enterprise continues to expand, finding adequate space for research has become a growing concern. So, with space at a premium all across the UCLA campus, the school has begun to lease space in Westwood and the surrounding community. Three of the school’s expanding centers — the Center for Health Policy Research, the Southern California Injury Prevention Research Center, and the Center for Public Health and Disaster Relief — now occupy the second and third floors of the three-story Weyburn Building in Westwood. The centers, which had outgrown their 4,000 collective square feet of space at the school’s home in UCLA’s Center
for the Health Sciences building, now have 10,000 square feet between them. In addition, their move opened up much-needed space for the school’s faculty within the CHS. The school leased another 5,000 square feet on the corner of Olympic and Sepulveda boulevards to house the Technical Assistance Group. “As faculty at the school continue to attract more research funding, we’re adding staff, which exacerbates the already existing shortage of space,” says Dr. E. Richard Brown, director of the Center for Health Policy Research. “The expansion has been wonderful for our center — we more than doubled our space, and have already completely filled it.”
UCLA SPH SELECTED BY HRSA AS ONE OF EIGHT U.S. CENTERS TO IMPROVE TRAINING OF PUBLIC HEALTH PROFESSIONALS In an effort to bolster the education and train“This represents a significant step in ing of the country’s public health workforce, the development of public health workforce the Health Resources and Services Adminis- training because it links the five schools to tration (HRSA) has launched a five-year, $15.4 the practice community through a structure million program to create a designed to identify specific “This will permit nationwide network of Public training needs and resources,” Health Training Centers at eight says Dr. Emil Berkanovic, directhe strengths academic institutions — includtor of the school’s Technical of the schools ing the UCLA School of Public Assistance Group. “Once needs and the practice Health. and resources are identified, community to be An estimated 80 percent of this structure will permit the coordinated in an public health professionals have strengths of the schools and the efficient system had no public health training, practice community to be coorfor training the according to HRSA, which is dinated in an efficient system for workforce.” part of the U.S. Department of training the workforce.” Health and Human Services. The For the first year of the procenters will be training grounds gram, the school and its partners for public health students and are conducting a needs assesspracticing professionals to learn ment and building a training curthe latest techniques and pracriculum. In addition, a coalition tices in the field. has been formed to develop disAlthough the UCLA School of tance learning strategies that Public Health was the award will be applied when the center recipient, the school is developbegins training professionals ing the Pacific Public Health next year. Training Center in partnership “We have worked aggresDr. Emil Berkanovic with the three other California sively for nearly a decade to public health schools, the University of Hawaii strengthen our relationship with the public and practice partners that include the Califor- health practice community,” says Associate nia Department of Health Services under the Dean for Administration V. Gale Winting. “This leadership of Dr. Diana Bonta (M.P.H. ’75, represents yet another major step in solidifying Dr.P.H. ’92). that linkage.”
UCLA School of
PUBLIC HEALTH Newsletter
V OLUME 20, N UMBER 3 F ALL 2000 ALBERT CARNESALE, Ph.D. Chancellor
JUDITH M. SIEGEL, Ph.D., M.S.Hyg. Interim Dean
3 NEWS
E DITORIAL B OARD JUDITH M. SIEGEL, Ph.D., M.S.Hyg. Interim Dean
MICHAEL S. GOLDSTEIN, Ph.D. Associate Dean for Student Affairs
V. GALE WINTING Associate Dean for Administration
LAUREL WRUBLE Director of Development
JEFFREY LUCK, Ph.D. Assistant Professor, Health Services
THOMAS R. BELIN, Ph.D. Associate Professor, Biostatistics
JOYCE A. PAGE, M.S.P.H., J.D. Alumni Association President
MARA BAER President, Public Health Students Association
DAN PAGE Public Information Representative
DAN GORDON
STATISTICALLY SIGNIFICANT: ANOTHER ELASHOFF JOINS FACULTY
Editor and Writer
MARTHA WIDMANN Art Director
What are the odds of this? “Growing up, I always David Elashoff’s grandknew about the possibilities father was a biostatistician. presented by a career in staBoth of his parents are biotistics,” says David Elashoff. “I statisticians, as is his older wouldn’t say we all sat and brother and his brother’s wife. talked about statistics around David Elashoff started at the dinner table, but it was MIT as a physics major, but definitely a scientific-oriented that foray turned out to be household.” nothing more than a standard Given his interest in statisdeviation. He switched to tical genetics, Elashoff narmathematics, then followed rowed his search for academic his B.S. from MIT with a Ph.D. David (l.) and Robert Elashoff positions to universities where in statistics from Stanford. And now he has he could do genetics research in a biostatistics joined his father, Robert Elashoff, on the fac- department. He ended up at UCLA, working not ulty in the Department of Biostatistics at only with his father — with whom he hopes to the UCLA School of Public Health. (David collaborate in future research — but also with Elashoff’s mother, Janet, director of the statis- faculty he has known since he was a child. tical unit at Cedars-Sinai Medical Center, also More new faculty coverage: page 9. has an adjunct faculty appointment at UCLA.)
Photography: ASUCLA (p. 2: Siegel; p. 3: Berkanovic; p. 4; p. 8: Food Coalition; p. 10: Donor Wall Inset; p. 12: Afifi Recognition Dinner); Reed Hutchinson (p. 3: Elashoffs; p. 7: Cancer Screening; p. 10: Donor Wall; p. 12: Afifi Portrait); Bob Knight (p. 10: Reiner). Hope Street photo courtesy of Hope Street Family Center; Malibu Creek photo courtesy of Dr. Richard Ambrose; Workplace Violence Prevention Project photos courtesy of Dr. Corinne Peek-Asa; XIII International AIDS Conference photo courtesy of Dr. Susan Cochran.
School of Public Health Home Page: www.ph.ucla.edu E-mail for Application Requests: app-request@admin.ph.ucla.edu The UCLA School of Public Health Newsletter is published by the UCLA School of Public Health for the alumni, faculty, students, staff and friends of the school. Copyright 2000 by The Regents of the University of California. Permission to reprint any portion must be obtained from the editor. Contact Editor, UCLA School of Public Health Newsletter, Box 951772, Los Angeles, CA 90095-1772. Phone: (310) 825-6381.
IN THE NEWS: SHOULD HEALTH INSURANCE PLANS PROVIDE MORE COVERAGE FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE?
YES
NO
BY MICHAEL S. GOLDSTEIN, Ph.D.
BY PAUL SHEKELLE, M.D., Ph.D. ’93
Health insurance plans in the United States have already begun to offer coverage for what is usually called complementary or alternative medicine (CAM). I see this as a positive trend that should be expanded. Some may fear that coverage will result in more people using CAM instead of effective conventional therapies. I doubt that this is true. Numerous studies have shown that almost everyone who uses CAM does so only after finding that the conventional means of dealing with his or her symptoms or illnesses are ineffective, or ridden with unacceptable side effects. Many users of CAM have problems such as chronic pain, arthritis, insomnia, loss of physical functioning, anxiety, and depression. Often, they are unaffected by conventional therapies. Another significant group of CAM users are people seeking to improve their health by changing their diet, starting to exercise, or overcoming various addictions. They are also likely to find that, beyond a description of what they should be doing and exhortations to go and do it, medicine has little of practical benefit to offer them. Any intervention that will bring about even a modest degree of change for these individuals is worthwhile for them, and the community. The health care system potentially benefits when more people use CAM if the number of people seeking costly treatments with limited impact is replaced by interventions that are generally low cost, and have minimal side effects. It is sometimes claimed that insurers should cover only those therapies that have been shown to be effective using rigorous scientific methods — a requirement that would exclude most forms of CAM. But this claim is largely rhetorical. Only a small portion of conventional medical treatments have been validated by double-blind randomized control trials. For now, the reality is that clinical medicine is a scientifically informed, yet highly pragmatic enterprise that must deal with the infinite range of human difficulties and individual differences. Goldstein, professor and associate dean for student affairs at the school, is the author of Alternative Health Care: Medicine, Miracle, or Mirage? (Temple University Press).
There is no convincing evidence that the use of complementary and alternative medicine saves money. It, like most things in medicine, costs money. Therefore, if health plans are to begin providing complementary and alternative medicine as new covered benefits, one of two things must occur. The plans must stop covering some existing therapies in order to offset the increased cost of covering these therapies, or their premiums must go up. The consequences of the first action are, of course, more obvious — some care that some patients have been receiving will require out-of-pocket payments if those patients want to continue receiving it. But raising premiums also has consequences. We know that when health insurance becomes more expensive, the number of uninsured persons increases, as employers drop employee health care coverage altogether and individual purchasers find the premiums too expensive to continue paying them. In the RAND Health Insurance Experiment, when people in the HMO arm were offered free chiropractic care, a service for which they previously needed to pay out-of-pocket, their use of chiropractic services exploded 10-fold. Consequently, if plans begin to offer complementary and alternative medicine we can expect the costs to be substantial. Therefore, my question to those who advocate coverage of complementary and alternative medicine is: How are you going to pay for it? Which existing health services will you drop, or how many people do you wish to add to the ranks of the uninsured, in order to offer complementary and alternative therapies? Before we can be convinced that any therapies should be added as covered benefits, society should require convincing evidence that the expected health gain from use of the therapy is worth the cost. For the great majority of complementary and alternative therapies, that evidence is simply not there. Shekelle is associate professor of medicine at the UCLA School of Medicine, senior research associate at the VA Health Services Research and Development Service, and a senior natural scientist at RAND.
PATIENTS AND THE SYSTEM STAND TO GAIN
WHICH SERVICES WILL BE DROPPED?
In public health circles from Sacramento to Washington, D.C. and abroad, the UCLA School of Public Health is well known for its outstanding students, faculty and alumni. But one of the most significant aspects is the school’s growing prominence in its own backyard, where faculty and students are serving as valuable resources to a variety of populations. Examples follow.
A
NEW CHILDREN’S INSTITUTE: COMMUNITY DEVELOPMENT WITH A DEVELOPMENTAL TWIST
t Hope Street Family Center in Los Angeles (pictured above), families are offered prenatal care, health care, Early Head Start, and on-site child care. Services for school-age children include one-onone literacy mentoring, after-school and weekend recreational activities, music and art classes, and summer camp. For adults, there are parenting programs, English as a Second Language classes, basic education programs, and access to vocational training. The partnership between this center and UCLA’s Center for Healthier Children, Families and Communities, along with other, similar ventures, is why the School of Public Health-based center has become a flagship in campus efforts to become more active in community-based work. Since its establishment in 1994, the UCLA center, under the leadership of Dr. Neal Halfon, has followed a nontraditional course, perhaps best described as holistic. Integrating research, policy analysis and community engagement strategies, the center is dedicated to forging partnerships among university-based researchers, service providers, community agencies and affiliated institutions. While the specifics of individual projects vary, the overall objectives are shared: to develop innovative and responsive services and programs, increase the effectiveness and distribution of health and social services, and assist communities in becoming healthier environments for their children.
Vivian Weinstein and Dr. Neal Halfon
CHILD ADVOCACY ENDOWMENT HONORS A CHAMPION FOR KIDS Now, that model is being expanded with the creation of the campus-wide Institute for Children, Families and Communities. While the existing center will continue to thrive as the public health and medicine arm of the institute, the new entity is seen as a superstructure that will bring other children-oriented centers, programs and individual faculty from across the UCLA campus into the fold. “This represents a different model of community development that includes a strong family and child health focus, in addition to traditional infrastructure, landlord-tenant and jobcreation issues,” Halfon says. “Those traditional components of development are important, but the institute will be trying to build on past efforts with a more comprehensive, coordinated approach.” Halfon points out that California over the past two decades has taken major positive steps to improve the health, development and educational attainment of the state’s children — and yet, many indicators of children’s health, well being, and education have not improved, and in some cases have actually gotten worse. “The problems facing children and families are broad, and real solutions to these problems demand multidisciplinary approaches,” says Halfon. “A more coordinated effort on campus will enable us to focus resources more precisely, and emphasize strategies that really work for communities seeking to reverse current trends and improve their well being on many fronts.”
For a program aiming to equip professionals in health, education, child welfare and other fields with the knowledge and skills necessary to advocate effectively on behalf of children, there could be no better namesake than Vivian Weinstein. As associate professor of pediatrics at the Charles Drew Medical School, Vivian Weinstein helped to form the Drew Child Development Corporation. A founding member and important contributor to the Los Angeles Round Table for Children, she currently serves as director of the Mayor’s Commission on Children and as a non-voting member of the Los Angeles Proposition 10 Commission. Weinstein has also taught child advocacy in the School of Public Health for several years, so it’s fitting that a new child advocacy program in the school’s Center for Healthier Children, Families and Communities bears her name. The Vivian Weinstein Endowment in Child Advocacy was established in June by a challenge gift of $200,000 from the California Wellness Foundation. The program and endowment were announced at a reception at which Chancellor Albert Carnesale, First Lady of California Sharon Davis, First Lady of Los Angeles Nancy Daly Riordan and Dr. Neal Halfon paid tribute to Weinstein. Nearly 200 donors have contributed another $100,000 toward the endowment to date. “Vivian Weinstein has long been a potent force on the side of children,” says Halfon. “She has enjoyed a stellar career as a child development authority, and has educated, inspired and mentored several generations of child advocates, many of whom now play prominent roles on behalf of children.”
BRIDGING THE INFORMATION GAP OVER TROUBLED WATERS
I
f you ignore the political, economic and legal concerns, restoring wetland habitats in the Malibu Lagoon and managing the problems in the lower Malibu Creek watershed is simple. Of course, communities don’t have that luxury. So in a departure from many traditional university-based environmental studies, a team headed by Drs. Richard Ambrose of the UCLA School of Public Health and Antony Orme of UCLA’s Department of Geography concluded by presenting a range of options to the inter6 ested community COVER STORY parties, taking into account the diverse interests of the community stakeholders in offering the pros and cons of each alternative. The dysfunctional state of Malibu Creek had been the subject of meetings involving residents and representatives of federal, state and local agencies, municipalities, and user groups by the time Ambrose’s group was brought in to conduct a study in 1997. The Malibu Lagoon Task Force, which formed out of these meetings, had identified restoration of the lagoon and protection of the habitat and recreational uses of the lower creek and lagoon as high priorities. With funding from the California Coastal Conservancy, Ambrose and his colleagues in UCLA’s Institute of the Environment studied the physical processes occurring in lower Malibu Creek and Lagoon, assessed enhancement opportunities, and considered strategies for long-term management of the lower watershed. Ultimately, the researchers evaluated 38 alternatives using five criteria: feasibility, cost, effectiveness, environmental impact, and potential for controversy. “Some of the options would be quite effective, but are very expensive,” says Ambrose, director of the school’s Environmental Science and Engineering Program. “Others would be cheap, but might not be effective because they depend on changing attitudes and habits.” For example, engineering solutions could be applied at individual storm drains in the upper watershed to treat the water as it goes through. That would require a commitment from several ju-
risdictions, each of which would have to agree to assume a significant cost. Or the excess water could be treated and diverted away from the lagoon, piped directly into the ocean instead. But this, too, would be relatively costly. A conservationist solution would require reducing water usage in the upper watershed area. In the natural ecosystem, the creek dried up in the summer time, but the high volume of water use in the upper watershed is now keeping it full year-round, wreaking havoc in
the lagoon. “A lot of the problems could be solved if people cut down on washing their cars and watering their lawns,” Ambrose says. “But you’re talking about thousands of residents, along with golf courses and everything else.” Complicating matters further, the people who would be asked to make lifestyle changes — residents in the upper watershed — wouldn’t benefit directly from their sacrifices. Their water usage affects the residents at the end of the pipe, who live in a different jurisdiction — in the City of Malibu. At the conclusion of the study, Ambrose’s group presented the pros and cons of various alternatives to the Malibu Lagoon Task Force. Those recommendations have been the focus of mediated discussions, as the task force grapples with how to counteract the problems plaguing the lagoon. “We were the information providers,” says Ambrose. “It doesn’t make sense for us to try to impose a solution. In the end, it’s the community that has to live with it.”
VIOLENCE PREVENTION PROJECT HELPS SHOP OW
F
or many people, workplace violence conjures images of disgruntled employees opening fire or otherwise assaulting their coworkers or superiors. In fact, though, approximately 80 percent of workplace homicides and as many as 60 percent of nonfatal assaults occur in the course of a robbery or other criminal act. Most of these robberies take place in small retail- and serviceindustry establishments. But even among owners of businesses that are frequent targets, there is often a sense that the threat of violence from outsiders simply comes with the territory. Previous research by the school’s Southern California Injury Prevention Research Center and other institutions suggests that businesses can do a great deal both to minimize the risk of robbery and reduce the likelihood that if a robbery does occur, it will have a violent outcome. Now, researchers at the center are working with 500 small businesses — grocery stores, liquor stores, restaurants, hotels/motels, gas stations and convenience stores — to evaluate an ap-
proach called Crime Prevention Through Environmental Design (CPTED), based on the theory that well-designed, well-run businesses become less attractive to criminals. The elements of CPTED include cash control, good visibility and lighting, good entry and exit control, good product placement, and specific training for employees covering what to do during a robbery. “Those programs have been established in convenience stores such as 7-11, which has a distinct look that is mostly for the purpose of reducing robberies,” says Dr. Corinne Peek-Asa, the center’s associate director and principal investigator of the Workplace Violence Prevention Project, funded by the National Institute of Occupational Safety and Health. “And they appear to be very effective.” Unlike the Southland Corp., which owns 7-11, the businesses in the Workplace Violence Prevention Project tend to be too small to hire security consultants. “Some of them are robbed as often as once a month,” says Peek-Asa. “We’ve worked with owners who have been shot in their place of business,
RESEARCH HOPES TO REMOVE POPULATION-SPECIFIC BARRIERS, OPEN THE CANCER SCREENING DOORS
C
olorectal cancer is the secondleading cause of cancer death in the United States. But, despite the fact that good screening tools are available to detect pre-cancerous polyps that, when removed, can prevent colon cancer from developing, many individuals fail to get screened. Dr. Roshan Bastani’s research identifies the factors that facilitate or impede cancer screening among various ethnic populations — and then uses that information to design and test programs aimed at increasing screening and, thus, saving lives. Since barriers tend to differ across ethnic and cultural groups, the strategies for overcoming them are geared to specific populations. “One of the big lessons we’ve all learned is that the one-sizefits-all model doesn’t work,” says Bastani, associate professor of health services at the school and associate director of UCLA’s Division of Cancer Prevention and Control Research.
To address the issue of colorectal cancer screening, Bastani is heading a large community-based project focusing on first-degree relatives of colorectal cancer cases obtained from the statewide California Tumor Registry. “Despite their increased risk, these individuals continue to have very low screening rates,” Bastani says. Bastani is recruiting an equal number of African American, Asian, Hispanic and white firstdegree relatives, ages 40 and older, who have not had a fetal occult blood test in the past 12 months and/or a sigmoidoscopy or colonoscopy in the past three years. At the beginning of the survey, information pertaining to knowledge, attitudes, beliefs and barriers to screening is col-
OWNERS TAKE STEPS TO ENSURE SAFETY
Top: Bullet-resistant barrier wall at this liquor store leaves a large gap at the ceiling, and the narrow counter offers a step to robbers who wish to climb over the enclosure to rob the business and/or point a weapon at the clerk. Bottom: At a restaurant in a high-crime area, a mural helps to discourage graffiti artists — they respected the mural but climbed to the roof and tagged the sign.
and didn’t do anything about it. The information concerning what they can do is not readily available to them.” So Peek-Asa and colleagues (including center director Jess Kraus and project director Carri Casteel), working with a number of community agencies in Los Angeles, are providing 400 of these high-risk small businesses with a complete security program. (One hundred control businesses will get the program at the end of the study.) As part of the package, two full-time security professionals design and help to implement a personalized plan for each business. By 2002, Peek-Asa expects to have six years of crime statistics (the LAPD, in addition to assisting with recruitment, is providing robbery-related data) that will enable her group to determine whether the security programs made an impact in reducing robbery and robbery-related assaults and homicides. So far, the response from the businesses has been overwhelmingly positive. “This has brought us to the grassroots of the business community,” Peek-Asa says. “It’s been very rewarding.”
As part of the UCLAled Asian American Network for Cancer Awareness Research & Training (L.A. site), women wait for mammography screenings and attend a lected from each food festival at Thai individual. The Health and Information Services in Hollywood.
first-degree relatives in the intervention group are then mailed a personalized notification of their risk, their personal barriers to screening are addressed, and they are encouraged to be screened. After three months, members of the intervention group who still don’t obtain screening are given telephone counseling. All materials and the counseling are tailored to the ethnicity of the individual. Results of past work done by Bastani and others underscore the value of identifying barriers and then using that information to guide education campaigns. When it was found that a key to screening participation was whether the patient’s doctor recommended it, increasing physician awareness of the importance of discussing cancer screening with their patients became a priority. Similarly, the finding that many women failed to get mammograms due to fear of radiation exposure led to increased publicity about the safety of low radiation levels, changing public perception. Unfortunately, Bastani notes, increasing people’s awareness of the importance of being screened for one type of cancer doesn’t seem to affect their likelihood of being screened for other cancers. Thus, in addition to tailoring messages for the audience receiving them, cancer prevention advocates are compelled to devise separate messages for different cancers.
BEYOND SUSTENANCE: SPH STUDENTS JOIN WITH FOOD COALITION TO EXPAND SERVICES FOR HOMELESS
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or more than 12 years, the nonprofit, volunteer-run Greater West Hollywood Food Coalition (GWHFC) has served nightly meals to the Hollywood and West Hollywood homeless community. Last year, the GWHFC approached the school about getting students involved in helping to distribute food to the population. The students who did so quickly found what the volunteer organization already knew: that feeding 8 the population was a COVER STORY tremendous service, but there was much more to be done. Two of the school’s students have organized a collaborative project with the GWHFC designed to formalize the coalition’s efforts to go beyond providi n g f o o d . Wi t h f u n d i n g f r o m t h e school’s Community Health Promotion Program, doctoral student Koy Parada and second-year M.P.H. student Kevin Riley have spearheaded the UCLA/GWHFC Mobile Clinic Project — a student-run, street-based effort to provide basic medical and social support services to the GWHFC population. UCLA public health and medical students, along with undergraduates, have brought their skills and expertise to the planning of the project, and are playing roles in the clinic’s operation.
Going to the same street corner where the GWHFC serves meals, the UCLA students are offering a variety of basic services. The medical students take health histories and vital signs; the public health students provide health education; the undergraduates help address other needs, including legal, housing and mental health services. The students have assessed the needs of the population, and will ultimately evaluate the success of their service. Parada and Riley are also recruiting new students to ensure that the project will be sustainable after they graduate. The project uses the site where the food coalition passes out meals and targets the same population of clients that the coalition sees on a regular basis. “We’ve been fortunate in that we have a ready population that trusts the organization we’re working with and is stable, which is unusual when you’re working with the homeless,” says Riley. Although both Parada and Riley had previously worked with homeless populations, they have run into unexpected challenges. “I don’t think we realized how much planning is involved in creating a new communitybased service project,” says Parada. “We’ve learned a lot from the popu-
Doctoral student Koy Parada (above right) and M.P.H. student Kevin Riley (inset photo, center) are working with the Greater West Hollywood Food Coalition to expand the services of the nonprofit, volunteer-run homeless-support organization beyond distributing meals.
lation,” she adds. “Sometimes we think we know what the resources are in the community, and we talk to the people and find out about barriers we couldn’t even conceive of that they face because they’re homeless.” The UCLA/GWHFC Mobile Clinic Project welcomes donations of medical supplies and personal items, as well as the participation of community physicians in supervising the medical students as attending physicians. Anyone interested can contact Koy Parada at koy@ucla.edu or Kevin Riley at kriley@ucla.edu.
CLINIC-BASED PROJECT AIMS TO IDENTIFY REASONS FOR LOW MEDI-CAL PARTICIPATION Low Medi-Cal enrollment figures in Los Angeles County have caused concern, from the perspective of both low-income patients’ access to care and the primary care clinics that serve STEPHANIE SURBIDA these patients and depend on revenues from Medi-Cal (California’s Medicaid program) for financial solvency. M.P.H. student Stephanie Surbida hopes to shed light on some of the reasons behind lagging Medi-Cal participation by interviewing patients at the To Help Everyone (T.H.E.) Clinic, a private, not-for-profit primary care center located in the Crenshaw District of Los Angeles.
With funding from the school’s Community Health Promotion Project, Surbida is analyzing the barriers to Medi-Cal participation and retention in the Crenshaw District. Following the patient interviews, she will be working with patients, providers and the clinic’s administrative staff to develop an intervention plan designed to increase the number of Medi-Cal beneficiaries who utilize the services at T.H.E. The T.H.E. Clinic serves mostly African Americans and Latinos (81 percent), and individuals earning less than $20,000 a year (89 percent). Ninety-three percent of the clinic’s insured patients are covered by Medi-Cal. But nearly half of the clinic’s patients have no insurance, despite the fact that many are eligible for the public program.
“The lower Medi-Cal beneficiary rates mean T.H.E. isn’t receiving the same amount of patient revenue as in the past,” explains Surbida, who worked for a Medi-Cal managed care organization before coming to the school. “The Medi-Cal beneficiary dollar is important to community clinics because those payments help share the cost of providing charity care to the uninsured in that community.” Surbida hopes her analysis will help T.H.E. gain insight into how it can best assist its clients in obtaining and retaining their Medi-Cal benefits. “This is not only about the financial solvency of the organization,” she says. “When patients have coverage, they’re going to be more likely to receive comprehensive care from a regular physician, and that’s going to contribute to increased patient satisfaction.”
DR. DONALD MORISKY
COCHRAN
DETELS
THREE PERSPECTIVES ON THE XIII INTERNATIONAL AIDS CONFERENCE
MORISKY
The XIII International AIDS Conference in Durban, South Africa last July was attended by more than 10,000 AIDS researchers and health professionals, including several UCLA School of Public Health students and alumni as well as three faculty members who offered the following impressions: DR. SUSAN COCHRAN
DR. ROGER DETELS
Over the years I have been to many, if not most, of the international AIDS meetings. In the early years, there was an edgy mix of science and activism linking the epidemic at its multiple levels of the person, the social context, attempts at prevention and treatment, and the bench science. I will always remember this past meeting for reintroducing that feeling of being on the front lines. There were actually concurrent meetings in Durban; only the formal AIDS meeting required a badge (and entrance fees that most Africans could not afford). At a nearby off-site meeting open to anyone, I watched a health educator demonstrate in Zulu how to use a female condom to women who had never seen such a device. The event was memorable because in South Africa, as in much of the continent, women have far fewer rights and opportunities for individual autonomy than we enjoy here. I was also deeply moved by the personal courage of local activists, their views forged in the struggle to end apartheid, who were doing their darndest to stop this epidemic and to save their country once again.
The major achievements of the meeting were political. Because more than 90 percent of new HIV infections are occurring in developing countries, this meeting, the first held in such a country, was a landmark. Further, the prevalence rates of HIV/AIDS among young adults in many parts of South Africa and other southern African countries is as high as 30 percent. Holding the meeting in South Africa brought the attention of the world to the impact of the HIV/AIDS epidemic and its devastating effect on the countries of Africa. A high point of the meeting was the closing address by former president Nelson Mandela, who displayed sensitivity to the political situation that the HIV/AIDS epidemic has created in African countries, but also emphasized the urgent need of these countries and of the countries of the developed world to recognize the impact of the epidemic and act now to combat it. Participants left with a guarded feeling of optimism, along with a greater feeling of the urgency of the situation and the need to mobilize all potential sources to stop the epidemic.
The theme of the Durban conference, “Breaking the Silence,” reaches far and wide. There are many silences that need to be broken, including the fact that AIDS most affects those regions and countries least able to afford AIDS treatments — a silence that was broken at the meeting. In many settings, there have been delays in implementing proven effective measures to reduce the spread of HIV. Governments, the private sector, and non-governmental organizations have been hindered in translating knowl9 edge into meaningFACULTY ful programs by apathy, budgetary constraints, religious objections, corruption and mismanagement. The conference broke the silence on this inaction. Finally, the conference broke the silence on the urgent need for a vaccine and femalecontrolled prevention methods. The conference provided in-depth discussions, debates and numerous poster sessions on each of these important issues.
NEW FACES PATRICIA PARKERTON (Department of Health Ser vices) had a 20year career as a medical administrator that paralleled the growth of managed care. Research interests include the relationships between academic health centers and managed care organizations, organizational effects on quality of care, and the impact of affiliations and mergers on operations. HONGYU ZHAO (Department of Biostatistics) has been an assistant professor in the Department of Epidemiology and Public Health at Yale School of Medicine since 1996. His research interests are to develop mathematical, statistical, and numerical methods to address scientific questions raised in molecular biology and genetics.
MONICA SALINAS ESTABLISHES INTERNSHIP FUND FOR LATINO, LATIN AMERICAN HEALTH
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onica Salinas has established the Monica Salinas Internship Fund in Latino and Latin American Health. The fund is intended to provide fieldwork support to public health and Latin American Studies students whose work focuses on Latino or Latin American health and well being. This fund will be particularly supportive to students in one of the school’s cooperative
degrees, the M.A./M.P.H. in Latin American Studies. A native of Mexico City, Monica Salinas is a practicing psychologist with a strong interest in “culturation” issues. She has been a consultant to the Santa Monica/Malibu School District, advising parents of under-represented groups on the differences between Latino and American cultures. She also serves UCLA on the boards of Women and Philanthropy and the UCLA Foundation.
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aunched in May 1997 as the most ambitious private fund-raising effort in the history of public higher education, Campaign UCLA reached its initial goal of $1.2 billion two years ahead of schedule. Chancellor Albert Carnesale celebrated this achievement with UCLA donors and fund-raising volunteers, and announced an increased Campaign UCLA goal of $1.6 billion, to be raised by June 30, 2002. The School of Public Health’s goal within Campaign UCLA remains at $15 million. As of August 31, 2000, the school was 85 percent toward its goal.
People walking into the UCLA School of Public Health can now view the names of the individuals, corporations and foundations whose generous financial contributions are helping to secure the school’s standing among the nation’s leaders. The Donor Wall, located around the fountain at the school’s main entrance, recognizes contributors who have made cumulative gifts of $50,000 or more to the school. Inset: former dean Abdelmonem A. Afifi (center) with Dean’s Advisory Board Chair Carolyn F. Katzin and Vice Chair Gerald Factor at the dedication ceremony.
Chancellor Albert Carnesale bestowed the UCLA Medal upon Rob Reiner at the UCLA School of Public Health Commencement in June. The actor, director and children’s advocate was the keynote speaker at the ceremony. The UCLA Medal, the campus’s highest honor, recognizes singularly important lifetime contributions to UCLA or society.
ALUMNI NEWS MELVIN H. KIRSCHNER, B.S. ’49, M.P.H., M.D., continues to practice as a family physician. He is chair of biomedical ethics at the L.A. County Medical Assn., as well as at several hospitals and skilled nursing facilities. Kirschner has also been an advocate for a national health program. PATRICIA H. RUSCH, M.P.H. ’70, R.D., F.A.D.A., was recently certified as Fellow of the American Dietetic Assn., one of 340 fellows out of a membership of 70,000. She owns Dietary Directions Inc., a California statewide consulting firm providing consultation to health care facilities in food services and nutrition. CHERYL SERVAIS (STIPEK), M.P.H. ’70, is president of HIM Consulting Services, specializing in computerized patient record solutions and health information management operations reengineering. MARGARET CARY, M.D., M.P.H. ’74, M.B.A., coauthored Telemedicine and Telehealth: Principles, Policies, Performance and Pitfalls (New York City: Springer Publishing), a comprehensive review of the current transition of health care and health information services onto the Internet. The book explores the key issues affecting the physician-patient relationship from the perspective of creating successful clinical tele-health services, and discusses tele-health’s effects on the general health care environment. Positive reviews of the book are published on the Amazon.com Web site. ELLEN R. EISEMAN, M.P.H. ’76, is currently living in Lima, Peru, working as the deputy director of the technical assistance team for Project 2000, a maternal-child health project funded by the governments of the United States and Peru through the USAID and the Ministry of Health. BONNIE FAHERTY, M.P.H. ’76, Ph.D., F.N.P.C.S., co-authored “Introduction to Home Health Nursing: An Interactive CD-ROM,” published by Mosby. The program features four case studies based on medical conditions commonly seen in home health care: diabetes, heart failure, cerebrovascular accident, and chronic obstructive pulmonary disease. Interactive case studies include aspects of the nursing process such as assessment and nursing diagnosis, as well as topics such as intake referral, continuity of care, safety, and reimbursement.
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as a health policy advisor to the U.S. Senate Committee on Labor and Human Resources. DAVID TILLMAN, M.D., M.P.H. ’85, has been appointed president and chief executive officer of the Motion Picture & Television Fund (MPTF), a service organization promoting the well being of California’s entertainment community since 1921. Prior to the appointment, he was CEO of the Industry Advantage Health System of MPTF. Tillman has served as regional vice president and chief medical officer of Catholic Healthcare West, as well as president and CEO of St. Mary Medical Center Long Beach. He is an associate clinical professor of medicine at UCLA. ERASTUS K. NJERU, M.S. ’88, a lecturer in the Department of Community Health at the University of Nairobi since 1988, is now also director of the University of Nairobi Clinical Epidemiology Unit and president of the Injury Prevention Initiative for Africa. MARILYN GRUNZWEIG, M.S.P.H. ’89, was appointed president of WebCVO, a national Webbased practitioner credentials verification organization headquartered in Los Angeles, last year. U L I C H E T T I PA L LY, M . D . , M . P. H . ’ 9 0 , o f Burlingame, Calif., founded an e-healthcare company, ClinicAmerica.com, and began recruiting management team members. Any interested persons can send an e-mail to Chettipally at trulyuli@hotmail.com.
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ANNETTE E. GHEE, M.P.H. ’90, returned to the United States in 1998 after living in the Philippines for three years and working for the World Health Organization for two of them. She is currently working toward a doctoral degree in epidemiology at the University of Washington. She has completed her coursework and hopes to do data collection in Peru in early 2001. She continues to work in the AIDS and STD field,11 but has a particular interest in behavioral epidemiolALUMNI ogy and sexual networking patterns. Her husband has begun a consulting business in pollution prevention; they have a 7-year-old daughter. She urges her former classmates to get in touch at ghee@u.washington.edu. ANDREW B. SHELDON, M.S. ’90, completed his Ph.D. in environmental science and engineering at Colorado School of Mines, and has joined URS Corporation in Oakland, Calif., as a senior environmental scientist. JILL E. GORZE, M.P.H. ’96, a third-year medical student, was inducted into the Honors Society at New York Medical College last spring. She was one of 16 in her class to receive the distinction. ROSS M. MILLER, M.D., M.P.H. ’98, is medical director, quality management, for CIGNA Healthcare in Glendale, Calif. He was recently awarded a fellowship in the American College of Physician Executives.
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SAM STUART SNYDER, M.P.H. ’76, Ph.D., is now the Emergency Management and Safe Schools consultant for the Los Angeles County Office of Education.
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STEPHEN N. KEITH, M.D., M.S.P.H. ’82, was appointed president and chief operating officer of Antex, which develops vaccines and antibiotics to prevent and treat infections and related diseases. Keith has experience both as a clinician and a researcher, and has held positions in the government and the pharmaceutical and biotechnology industries. Most recently, he served as vice president of marketing and sales at North American Vaccine. From 1982 to 1987, Keith served on the faculty of the Charles Drew Medical School and the UCLA School of Medicine in the Department of Pediatrics. He later served
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THANKS, AFIFI On June 2, 2000, 250 people gathered at the Loews Santa Monica Beach Hotel for “Celebrating a Multivariate Life” honoring Dean Abdelmonem A. Afifi. Afifi was lauded by Chancellor Albert Carnesale, Supervisor Zev Yaraslovsky, and Executive Assistant Dorothy Breininger. He was gently teased throughout the program by Master of Ceremonies Stan Azen, Ph.D. ’69, one of Afifi’s first graduate students. Deans Emeriti Roger Detels and Lester Breslow welcomed a new neighbor to the portrait gallery, as Afifi’s portrait joined theirs in the Walter and Helga Oppenheimer Lobby of the school.
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