FSPH Magazine Autumn/Winter 2013

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AUTUMN 2013

PUBLIC HEALTH The UCLA Fielding School of Public Health Magazine

change starts here

Community Partnerships for Better Health

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dean’s message IN MY FIRST YEAR as dean of the UCLA Fielding School of Public Health, it has been deeply rewarding to learn more about and seek to support the remarkable contributions of our faculty, students and alumni in advancing the health of communities. But make no mistake: We are not going it alone.

Among our greatest riches as a school are our partnerships. We provide and pass along expertise to our partners, but just as important are the lessons we learn from them – people who spend each day steeped in the challenges of their neighbors and dedicated to improving their health.

This issue of UCLA Public Health depicts some of the many Fielding School partnerships that have taken root in communities throughout Southern California, across the nation and beyond. In fact, while we are deeply committed to forging collaborations that better the lives of communities in our backyard, we are equally devoted to partnerships that address the critical health needs of populations around the globe. In addition to the domestic initiatives you will read about, we have remarkable ongoing work that is affecting countless lives in, for example, the Democratic Republic of the Congo, where Dr. Anne Rimoin guides an all-Congolese team building disease surveillance capacity; or in China, where Dr. Virginia Li has worked with village leaders on a crop substitution program for tobacco farmers in Yunnan Province.

The stories you will read continue the Fielding School’s rich history of community partnerships. These partnerships begin with one handshake, one pilot program, one shared vision. Many start on a single neighborhood block, then go on to serve as blueprints for change far and wide. This issue is dedicated to them.

Jody Heymann, M.D., Ph.D. Dean

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PUBLIC HEALTH Jody Heymann, M.D., Ph.D. Dean, UCLA Fielding School of Public Health

Carla Wohl Assistant Dean of External Affairs

Carla Denly Director of Communications and Executive Editor

feature

Dan Gordon Editor and Writer

Martha Widmann Art Director

in every issue

Shweta Saraswat Communications Officer

E D I TO R I A L B OA R D

30 SCHOOL WORK

Thomas R. Belin, Ph.D.

32 FACULTY

Professor, Biostatistics

Pamina Gorbach, Dr.P.H. Professor, Epidemiology

Moira Inkelas, Ph.D. Associate Professor, Health Policy and Management

Richard Jackson, M.D., M.P.H. Professor and Chair, Environmental Health Sciences

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

May C. Wang, Dr.P.H. Associate Professor, Community Health Sciences

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CHANGE STARTS HERE Across the country, grassroots efforts – driven by residents, in partnership with public health – are transforming communities into healthier places.

This issue showcases the work of Fielding School faculty, students, alumni and community partners in instigating the change.

Masako Horino and Willetta Waisath Co-Presidents, Public Health Student Association

Beatriz Solis, M.P.H. ’96, Ph.D. ’07 President, Public Health Alumni Association

“This country will not be a good place for any of us to live in unless we make it a good place for all of us to live in.”

– Theodore Roosevelt

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f e a t u r e

c o n t e n t s 4 Fitness Blueprint on the Move Until her final days, Dr. Toni Yancey was a leading advocate for making healthy eating and exercise the “default” choices in our daily environments. Now her signature “Instant Recess” is gaining momentum across the country.

8 Speaking Their Language 29

The indigenous Mixtec farmworkers of Oxnard, CA, face financial hardships and a host of other factors that threaten their health. In a pioneering partnership, a Fielding School team is working with a community-based organization to assist the population.

24 28

11 Exit Strategy Providing a relatable peer to assist HIV-positive men with their transition from jail to society promises a smoother transition – and improved community health.

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14 Figures of Speech By providing local-level data on diverse populations, the California Health Interview Survey paves the way for community-based organizations to achieve health goals.

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16 Healthy Surroundings Fielding School alumni and students are playing an integral role in L.A. County’s innovative efforts to transform communities so that they are more conducive to healthy living.

18 Home Improvement

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With assistance from a dietitian and community health worker, residents of a low-income community are changing their living environment in an effort to reduce their diabetes risk.

20 Seeking Food Justice 18 8

In low-income communities across the nation, the scarcity of nutritious options contributes to poor diets. That is changing in East Los Angeles and Boyle Heights, where scores of young people educated through a Fielding School project have become public health leaders.

24 Community Teachers 11

Five Fielding School students recount lessons learned from their experiences on the front lines of public health.

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27 Tribal Tribune Drs. Emmett Chase and Eva Marie Smith, both Fielding School alumni, bring quality health care to the Hoopa Valley Reservation.

28 Community Building 14

After closure of Martin Luther King, Jr. Harbor Hospital, Dr. Elaine Batchlor leads the effort for a new hospital for South Los Angeles.

29 Housing Development Alum Nancy Halpern Ibrahim’s organization empowers families to fight poverty and the health problems related to it.

PHOTOGRAPHY Margaret Molloy / TOC: photos for the articles on pp. 3, 4, 8, 11, 16, 18, 28; p. 5; p. 6: “10”; p. 7: “S”; pp. 8-10; p. 11: Brown; pp. 12-13; p. 16; p. 19; p. 25: strawberry field; p. 28; p. 30: Fielding Fall Fiesta

Shweta Saraswat / TOC: photo for article on p. 24; p. 24: Gonzalez, Chen; p. 25: Camarena; p. 26: Arzinger, Xiong; p. 27 Betsy Winchell / Dean’s Message York Knowlton / p. 4: Yancey Todd Cheney, UCLA Photographic Services / p. 31: Zhang 2013 © ImageZoo Illustration/Veer / Cover 2013 © iStockphoto / p. 11: prison cells; p. 14; p. 18; pp. 20-22: protest signs; pp. 24-26: folder, notebook background 2013 © PhotoDune / p. 30: Global Media Center for Social Impact Courtesy of: Public Matters / TOC: photo for article on p. 20; pp. 20-23; back cover • Denise Woods / p. 7: Woods and Yancey Melicia Whitt-Glover / p. 6: “NU” • Active Living Research / p. 6: “MI”; p. 7: “TE” • Palomares Academy of Health / p. 17 UCLA Center for Health Policy Research / p. 15 • Nancy Halpern Ibrahim / TOC: photo for article on p. 29; p. 29 Karla Gonzalez / p. 24: Wellness Center • Marianne Chen / p. 25: Autism Speaks Jenna Arzinger / p. 26: Violence Prevention Coalition • UCLA FSPH / p. 31: Ganz, alumni

UCLA Fielding School of Public Health Home Page: www.ph.ucla.edu E-mail for Application Requests: app-request@admin.ph.ucla.edu UCLA Public Health Magazine is published by the UCLA Fielding School of Public Health for the alumni, faculty, students, staff and friends of the school.

Copyright 2013 by The Regents of the University of California. Permission to reprint any portion must be obtained from the editor. Contact Editor, UCLA Public Health Magazine, Box 951772, Los Angeles, CA 90095-1772.

Phone: (310) 825-6381.

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“The good we secure for ourselves is precarious and uncertain until it is secured for all of us and incorporated into our common life.”

– Jane Addams

change starts here

community partnerships for better health THE BEGINNING of a healthier society can be found on a bustling

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urban schoolyard on a Saturday, where residents take advantage of once-dormant facilities to enjoy safe outdoor play. It’s on display at a monthly gathering in a farming town, where members of a traditionally isolated culture are empowered to address the health needs of their peers. You’ll find it in churches, at ballgames and in meeting rooms, where a fun-filled strategy to incorporate fitness into people’s lives is becoming part of the routine; and in a low-income area, where teens are turning knowledge into action as they rally their community behind changes in the local food environment.

More than most professions, public health embraces community partnerships to improve the health of the population. These partnerships represent collaboration at its best: Public health professionals and academics bring their technical expertise, while often the community members provide guidance on priorities, as well as their onthe-ground knowledge of the approaches most likely to succeed. In many cases, the community is integral to the implementation of these initiatives – and given the community’s stake in the sustainability of any health-promoting strategy, public health experts must pass on their technical know-how so that the work flourishes long after they leave.

The following pages showcase some of the community-based initiatives of Fielding School faculty, students, alumni and their community partners. As these accounts illustrate, our school can be found in a wide array of everyday settings – places where residents are sowing the seeds of better health at home, and sending ripples of change across the nation.

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Until her final days, Dr. Toni Yancey was a leading advocate for making healthy eating and exercise the “default” choices in our daily environments.

Now her signature “Instant Recess” is gaining momentum across the country.

Fitness Blueprint on the move In the face of a growing obesity epidemic disproportionately affecting low-income and minority populations, Dr. Antronette (Toni) Yancey (below left) became a leading

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voice for a new approach to promoting healthy eating and physical activity.

Yancey, a Fielding School professor who died in April, argued that expecting busy, often stressed people in low-resource neighborhoods to find opportunities to be physically active and eat nutrientrich foods wasn’t working. Instead, efforts should focus on engaging captive audiences in the settings they already frequent – schools, workplaces, churches, sporting events. Make healthy foods and beverages the norm at meetings and events, in cafeterias and in vending machines, so that people have to go out of their way to eat poorly. Incorporate exercise opportunities into adults’ work time as default options that can be avoided only with deliberate effort or by “opting out.” Send the same message about the value of healthy living from all sectors of society, so that it is reinforced.

Starting in the 1990s, when surprisingly few obesity prevention efforts were focused on promoting physical fitness, Yancey became a powerful and unrelenting advocate for what would become known as Instant Recess – a 10-minute bout of activity in the form of low-impact dance movements. Requiring only a boom box and culturally relevant music, Instant Recess was designed by Yancey to be fun, accessible for people of all fitness levels, and easily incorporated into school, work and community life. “For many people – especially in lower-income communities where park space is scarc e and the neighborhood might not be safe – the outside environment isn’t always conducive to physical activity,” she explained. “Instant Recess can be done inside, and it doesn’t require a lot of space or a fitness room.”

Yancey’s commitment was such that even as her energy waned in the final weeks of her life, she led a successful effort by a team of Fielding School faculty from the UCLA Kaiser Permanente Center for Health Equity to secure funding from the U.S. Centers for Disease Control and Prevention for a national program promoting these principles. Healthy by Default – part of the CDC’s Racial and Ethnic Approaches to Community Health (REACH) initiative – aims to systematically influence the social and cultural environments in which people live, learn, work, play and worship. Following Yancey’s death, the grant is led by Dr. Roshan Bastani; Bastani and Yancey were the founding codirectors of the UCLA Kaiser Permanente Center for Health Equity, in the Fielding School.

In 14 urban metropolitan areas throughout the United States, the Healthy by Default REACH project is working with community organizations to promote policies and other research-tested strategies that make enjoyable physical activity and appealing nutritious options default choices in people’s everyday settings. The Fielding School team provides organizations that have deep roots in a community with funding, training, technical assistance and support in the implementation and dissemination of the strategies; it’s left to the organizations to bring together a coalition of community stakeholders to choose the evidence-based strategies most likely to make a sustainable local impact. For

Fun, culturally adaptable and accessible for all fitness levels, the 10-minute Instant Recess is increasingly being incorporated into everyday settings, including workplaces, schools, sporting events and places of worship.

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some of the participating communities – and in a growing number of settings across the country, outside of the CDC project – one way to introduce exercise is through Instant Recess.

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When Yancey, as director of the L.A. County health department’s Division of Health Promotion and Disease Prevention, first introduced the Instant Recess concept (at the time it was called the Los Angeles Liftoff), at least one of her colleagues was skeptical.

“She said this was going to be a great way to improve the health of workers,” says Dr. William McCarthy, a professor at the Fielding School and longtime research collaborator of Yancey’s, who is co-investigator of the CDC study. “I told her, ‘But it’s only 10 minutes, and the federal recommendation is 30. You’re not going to see any benefits.’ She said, ‘Oh yes you will.’ ” McCarthy became less skeptical and figured that Yancey might be on to something as they analyzed the results from the first study of the approach. It wasn’t so much the physical benefits as it was the behavioral impact: The 10-minute activity served as a wake-up call for adults who had been sedentary for years, motivating many of them to do more.

Yancey’s rationale for the strategy was compelling.

“She pointed out that in workplace settings many of the clerical staff were minorities, that they were the ones who were most likely to be overweight or obese, and that they were the least likely to be able to find their own time for physical activity,” McCarthy says.

“She argued that to reach those who most need more physical activity, you had to get them in the workplace, and a 10-minute bout might be as much as they were capable of doing when starting out.”

McCarthy also appreciated the other appealing aspects of what came to be known as Instant Recess.

“It’s intrinsically fun,” he says. “She made a variety of culturally specific invitations to engage in rhythmic dance – gospel music, salsa music, Native American pow-wow music – where all you need is a boom box and a CD.” From the beginning, Yancey was also adamant that Instant Recess be an “opt out” rather than an “opt in” program. “When workplaces open

up gyms for employees, people who are already in great shape tend to be the only ones who use them,” McCarthy notes.

Yancey’s 2010 book, Instant Recess: Building a Fit Nation 10 Minutes at a Time, issued a call to action for a sedentary nation, and the response has been profound. Instant Recess materials have been purchased by organizations in 47 states as well as in 10 foreign countries. Partnerships with professional athletes and teams have promoted the Instant Recess model, both within sports venues and in outreach to schools and other youth-serving programs.

A Washington, DC, Instant Recess initiative involving the local health department and public employees’ union was launched in the summer of 2010, featuring three months of daily Instant Recess broadcasts on a public radio station with a predominantly African American audience. Through a collaboration with a wellness campaign of the California League of Cities and a health advocacy group, 22 of the state’s cities have adopted policies advocating activity breaks in meetings lasting an hour or longer. Since 2008, Instant Recess has been part of the San Diego Padres’ FriarFit initiative, incorporated outside the baseball stadium before every Sunday home game. The Instant Recess concept has been embraced by First Lady Michelle Obama’s “Let’s Move” campaign, for which Yancey was an advisor.

“We save souls in the sanctuary and we kill bodies in the fellowship hall.”

The observation of a fellow pastor hit home for Rev. Dr. Art Cribbs, executive director of Clergy and Laity United for Economic Justice, California (CLUE CA), a federation of faith-based organizations throughout the state advocating on behalf of lowincome workers, migrants, immigrants and communities of color. “What he meant is that the good word is preached from the pulpit, and then after church we serve unhealthy food, in quantities that contribute to these health disparities,” Cribbs says.

Two years ago, Cribbs changed his own eating and physical activity habits, losing 40 pounds, and decided he wanted to share his story to help other

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and colleague – a onetime college basketball player and fashion model who, in addition to her work as an academic scholar and public health practitioner, was a published poet. “She felt very strongly about it, she was enthusiastic, and she had a lot of credibility.”

Yancey was also convincing – she once quipped that the biggest compliment she had been paid was that she could “talk a hungry dog off a meat wagon.”

Denise Woods, Dr.P.H. ’11, a former student of Yancey’s who now serves as project director of Healthy by Default, knows all about her former mentor’s powers of persuasion.

Woods met Yancey at a pickup basketball game in 2005. They were the two tallest players – Woods 6-3, Yancey about an inch shorter – so they guarded each other. After the game, a mutual friend introduced them. “Toni started telling me about her vision and the things she was doing, and I was in awe,” Woods recalls. Having recently earned a graduate degree in communications, Woods at the time was unsure of what she wanted to do next. By the end of the brief conversation, she knew. “I had always been interested in talking to people about physical activity and eating healthy, but I didn’t know what public health was,” she says. “Toni told me about it and said I would be perfect for the doctoral program.

I don’t think she realized how persuasive she was.

I went home, called my parents and told them I thought I had found what I was going to do.”

Woods enrolled in the Fielding School’s doctoral program in 2006 and accompanied Yancey as she

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preachers and congregants. Soon he was introduced to Yancey. Together they launched Faith, Fitness, and Fellowship on the Move to promote physical activity and nutrition education in predominantly African American, Latino and Samoan churches in Los Angeles. The program, which introduces Instant Recess to the congregations, is based on the notion that if clergy and their spouses become interested in healthy eating and physical activity, their congregants will be motivated to follow.

“You look around the sanctuaries and see smiles and laughter on people’s faces as they and their fellow congregants are standing, stretching and moving together,” Cribbs says. “They’re supporting each other in an experience of laughter, joy and health.”

A similar movement is underway in North Carolina, where the health department’s Faithful Families program is adopting Instant Recess as part of a statewide effort to improve nutrition and increase physical activity in church congregations.

Dr. Melicia Whitt-Glover, president and CEO of Gramercy Research Group, began working with Yancey in 2008 to disseminate and study the effects of Instant Recess in churches and schools in WinstonSalem, where Whitt-Glover’s research firm is based.

Impressed by the effects of the physical activity breaks (she found, for example, that elementary school children showed improved attention and increased overall physical activity after Instant Recess was introduced), Whitt-Glover has spearheaded an effort that has led to a substantial increase

Dr. Denise Woods (far right), shown with Dr. Toni Yancey on the day Woods received her Dr.P.H. from the Fielding School in 2011, is helping to carry forward the work of her late mentor.

Part of the success of Instant Recess can be attributed to the determination and charisma of its messenger. “Toni was amazing,” says Bastani of her friend

worked with policymakers and community leaders in promoting physical activity breaks. Now, Woods is one of many Yancey admirers at UCLA and in communities across the country working to spread the Instant Recess gospel.

“The thing I took away from my work with Toni more than anything was that she was an advocate for social justice, and she wanted to make it easier for people in disadvantaged communities to live healthier lives,” Woods says. “She believed in this and promoted it until her last day. It’s an honor to carry that work forward.”

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in Instant Recess use in settings throughout the state – from schools and churches to workplaces and day care facilities. “It’s gotten to the point where, when our staff walks into a meeting, people get excited because they know someone will be leading an exercise break,” Whitt-Glover says. “It’s becoming the norm, which was Dr. Yancey’s goal – ‘healthy by default.’ Instant Recess is helping to change the culture here.”

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speaking their language

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The indigenous Mixtec farmworkers of Oxnard, CA, face financial hardships, discrimination, and a host of other factors that threaten their health. In a pioneering partnership, a Fielding School team is working with a community-based organization to assist the population in assessing and addressing its needs.

In the city of Oxnard, one of the largest suppliers of strawberries for California, the majority of the pickers are indigenous farmworkers from one of the poorest regions in Mexico. Mixtecs representing large swaths of certain villages in Oaxaca migrate to the community 60 miles north of Los Angeles, typically drawn by the prospect of farm work and better futures for their children. Most speak only Mixteco, a language with no written form. Many are undocumented, going out of their way not to draw attention. “They interact among themselves, but little with people outside their community,” says Dr. Annette Maxwell, a Fielding School professor. “They take some of the hardest jobs and are often exploited. They have many needs, and have been mostly overlooked.”

Maxwell was part of a team of UCLA Kaiser Permanente Center for Health Equity and Center for Can cer Prevention and Control researchers who were conducting studies and training activities in Ventura County’s farmworker community when they were introduced to the Mixtecs. As they learned more about the population, Maxwell

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populations. Together, UCLA and MICOP have embarked on one of the first research projects in the Mixtec community to focus on breast health – and one of the largest systematic efforts to survey the needs of any indigenous community, undertaken by peers speaking the indigenous language.

After learning of the presence of the Mixtec population and their needs, the UCLA Kaiser Permanente Center for Health Equity and the Center for Cancer Prevention and Control decided to invest resources

in the community. The researchers approached MICOP about using one of its monthly meetings to recruit women from the community interested in being trained as bilingual Spanish- and Mixtecospeaking promotoras (health promoters). Paying the women with stipends from a Cancer Prevention and Control Research Network-funded grant headed

by Dr. Roshan Bastani, director of the UCLA Kaiser Permanente Center for Health Eq uity, the Fielding School team trained them so that they could learn more about the community’s needs. “These women felt really empowered that they could do something that would help Mixtec families,” Maxwell says.

With that as a foundation, UCLA and MICOP jointly applied for funding from the California Breast Cancer Research Program. Their pilot study, “Building Mixtec Community Capacity to Address Breast Health,” is exploring attitudes and barriers to breast cancer screening, as well as the strategies most likely to encourage utilization of services.

Nine indigenous Spanish/Mixteco bilingual promotoras were trained to carry out a needs assessment involving 1,000 households in their community. Conducting a scientifically rigorous survey for a

Left photo: Sandy Young (r.), a family nurse practitioner who founded Mixteco/ Indigena Community Organizing Project (MICOP), leads a discussion on women’s health at one of MICOP’s monthly community meetings. Promotora Silvestre Hernandez serves as interpreter for the Mixtec participants.

Above: Promotora Virginia Garcia conducts surveys of the Mixtec community as part of a needs assessment.

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Sandy Young’s first hint that a substantial Mixtec population resided in the community came more than a decade ago, when the family nurse practitioner began noticing that a growing number of her patients understood no English and little Spanish. “They were virtually unknown in Ventura County,” Young recalls.

“Our health care system and school systems didn’t recognize that this population existed.”

Young decided to act. First she persuaded her own clinic to employ a part-time Mixteco- and Spanish-speaking interpreter to help the staff communicate with the patients. Then, through word of mouth, she invited Mixtec residents for a meeting in the back room of her clinic to discuss basic issues – from Medicaid enrollment requirements to accessing the bus system for transportation to and from the clinic. “At the end of the meeting, everyone wanted to know when we were going to do it again,” Young says.

Based on that initial response, in 2001 Young founded MICOP – English-, Spanish-, and Mixtecospeaking people who join together to empower and help improve the health and well being of indigenous Oaxacans in Ventura County. Monthly community

9 meetings, having evolved into a celebration of culture and language as well as an opportunity to discuss issues of importance, now regularly draw several hundred Mixtec community members.

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and colleagues found that many of the Mixtec women knew little about preventive services such as breast cancer screening, much less how to access them. For those who did, cultural norms dictating that no one should touch a woman’s body other than her husband posed a formidable barrier to seeking the exams.

Now the two Fielding School centers have forged a partnership with the Mixteco/Indigena Community Organizing Project (MICOP), an organization founded more than a decade ago as a means of addressing the pressing concerns of this most vulnerable of

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Above photos: In Oxnard, one of the largest suppliers of strawberries in California, many of the pickers are Mixtecs. Coming from a poor region of southern Mexico, they are drawn by the prospect of better futures for their children, but face many hardships.

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largely non-literate, monolingual population without a written language was no easy feat. In collaboration with a Mixtec advisory committee, the research team devised a questionnaire in Spanish and had the bilingual promotoras agree on the translations and audio-record them in Mixteco; the recording was then provided to all of the promotoras to practice as a way of ensuring consistency in the face-to-face surveys.

The needs assessment revealed that among the Mixtec women 40 and older, only 32 percent had ever had a mammogram (Maxwell notes that in the general U.S. population, an estimated 80-85 percent have had one). What’s more, only 42 percent even knew what a mammogram was – the concept of preventive health is foreign to much of the community, Young says. The next steps for the study will include a series of focus groups (two among women as well as two among men, given the importance of their role in the decision) to discuss strategies for promoting breast cancer screening that would be acceptable to the Mixtec community.

Speaking in Spanish as she took time out from a recent MICOP community meeting, one Mixtec woman describes migrating from Oaxaca in the hope that her children – a 5-year-old son and the daughter she’s expecting to deliver any time now – will have a better life. Hers is not easy. She describes 12-hour days on the farm – including work on weekends – followed by precious little time with her son before he goes to bed. “Here we don’t get to enjoy our children,” she says. The seasonal nature of the work

brings another kind of hardship. “When the work is over, the money is also gone and we don’t have enough [for] rent, food, clothing.”

Well aware that breast health isn’t the most pressing need for the Mixtec women, the UCLA/ MICOP team decided that the needs assessment should be much broader to help point the way toward a range of health and social services that would be welcomed. The results indicate a strong desire for more knowledge about health issues. Maxwell intends for this to be the first of many projects with the Mixtec community in Ventura County: Among the stated aims of the current study is to strengthen the collaboration between MICOP and UCLA to facilitate future joint projects that will benefit the community.

As deforestation and soil erosion in Oaxaca drive entire communities north in search of work, the Mixtecs have become one of the largest indigenous groups of workers in California. Although they suffer substantial hardships, Young points to a resilience that comes from their tight-knit and highly organized community life; indeed, the reason Oxnard has such a large Mixtec population is both for its farm work and because it became a “receiving village” for entire Oaxacan communities.

“This population faces difficult conditions,” Young says, “but we should also recognize that this is a culture and a language that has survived for 1,500 years, and that there is a strong sense of community and loyalty. From a public health perspective, these are very positive characteristics that should not be overlooked.”

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Providing a relatable peer to assist HIV-positive men with their transition from jail to society promises a smoother transition – and improved community health.

Al Brown is used to the surprised looks on the faces of his clients – men taking their first steps of freedom following release from L.A. County jails – when he meets them at the gate.

Brown is a “health navigator” in a joint study of the Los Angeles County Sheriff’s Department, Los Angeles County Department of Public Health and UCLA aiming to improve the likelihood that these men, who have tested positive for HIV, will continue with life-sustaining medical care once they re-enter society. He’s gotten to know the men during their incarceration, and promised to be there when they got out. Nonetheless, when they find Brown waiting upon their release – often with a cell phone and their $25 study participation fee to help get them started – many are taken aback.

Al Brown (left) “A lot of people have been failed by the system,” Brown says. “Often, I’m the first person to actually follow through with them.”

Brown has walked in his clients’ shoes.

Imprisoned at 16 for being “at the wrong place at the wrong time,” he spent many years behind bars.

Brown dramatically turned his life around upon his release, ultimately landing a full-time position with the Los Angeles-based Center for Health Justice.

Now he’s a health navigator assisting formerly

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EXIT STRATEGY

“When incarcerated people see guys in suits and ties or wearing badges, they think, ‘How could you possibly understand what I’ve been through?’ When I talk to them, they know I went through the fire and came out on the other side.”

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incarcerated men as they struggle to begin their lives anew. “Many of these people haven’t learned how to live in society,” says Brown. “Who better to assist them than somebody who’s walked the walk.”

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In efforts to address the HIV epidemic in U.S. communities, from a public health perspective few populations are as important to target as men in the criminal justice system. Each year, approximately one in seven people infected with HIV passes through a correctional facility. “The jail system represents an important aspect of the epidemic that hasn’t been addressed sufficiently,” says Dr. William Cunningham, a professor at the Fielding School and in the David Geffen School of Medicine at UCLA. “Recidivism rates for HIV-positive men are extremely high – it’s like a revolving door between the community and the jail.”

Cunningham is leading LINK LA, a first-of-its-kind study of a strategy that employs health navigators such as Brown, who come from similar backgrounds as the study participants, to help ensure that the newly released men receive their care. In addition to addressing the health of these men as they re-enter society, the approach is designed to improve the health of the communities they live in by suppressing their so-called viral load (the level of circulating HIV in the blood), and thus reducing the likelihood that they will transmit HIV to others. If shown to be effective, the National Institutes of Health-funded randomized controlled trial could serve as a model for communities across the country.

The study is part of a larger initiative of the “The jail system represents an important aspect of the National Institute of Drug Abuse promoting a new public health model known as “Seek, Test, [HIV] epidemic that hasn’t been addressed sufficiently. Treat and Retain” for addressing HIV among Recidivism rates for HIV-positive men are extremely high – criminal justice and other populations. “The old it’s like a revolving door between the community paradigm looked at prevention and treatment as two separate things,” Cunningham explains.

Dr. William Cunningham Prevention involved strategies such as condom and the jail.” distribution designed to reduce transmission risk, whereas treatment efforts focused on making highly active antiretroviral medications available to HIV-positive people, on the premise that anyone with the disease would access medical care to get the life-saving drugs.

But study after study has shown that at least 20 percent of the HIV-positive population isn’t receiving care. Moreover, Cunningham and others have found that people with a history of incarceration – particularly African American and Latino men – are far less likely to receive HIV treatment. Under the new model, getting the HIV-positive population on antiretroviral drugs isn’t only a strategy to keep them healthy, but part of an effort to prevent the spread of the virus in the community. “The medications reduce the viral load,” says Dr. Mark Malek, director of infection control and epidemiology for the L.A. County Sheriff’s Department jail system and a member of the Fielding School faculty, who is part of the study. “This significantly reduces the likelihood that people who are HIV-positive will infect others if they engage in risky behavior.”

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From left to right: Dr. William Cunningham, Dr. Mark Malek and Al Brown.

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mining whether the intervention is cost-effective and prevents avoidable hospital and emergency room use. Says Cunningham: “If we can demonstrate that the costs of this program are offset in the bigger picture, that would make it more attractive.”

It’s often difficult to convince policymakers to invest in such efforts. “Public opinion hasn’t always supported devoting resources to inmates,” says Malek. “It’s very easy to demonize them.” But he argues that from a public health standpoint, few populations present as great an opportunity to make a difference. “We’re incarcerating people with drug habits, and you don’t make good decisions when you’re high,” Malek notes. “So they’re engaging in high-risk behaviors that lead to a high prevalence of sexually transmitted diseases, as well as high rates of infections and chronic diseases. Most of them are male, young, poor and minority. When they get out they return to crowded urban areas. If we are looking at ways to get a big bang for our buck, improving the health of this population so that we don’t have to spend a lot more when they and others end up in the hospital makes a lot of sense.”

Malek is helping to make future public health professionals aware of these issues by exposing his Fielding School students to the jail system. In his Epidemiology of Communicable Disease in Correctional Populations course (taught jointly with Emory University through a video link), he brings Brown in as a guest speaker. Then he takes his students on a field trip to the jail, walking them through all of the steps that inmates go through on their way in.

“It’s really eye-opening,” says Nazia Qureshi, a second-year M.P.H. student in epidemiology who was so moved by the experience that she now works as an intern for Malek at the facility. “When you’ve never been exposed to incarcerated populations, it’s easy to ignore them. This was a reminder that these are human beings entitled to health care, just like the rest of us.”

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The research team is conducting a rigorous assessment of the strategy – through interviews at the start of the study and after the participants have re-entered the community, as well as a review of medical records – to measure the men’s treatment- and prevention-related behaviors and health changes over time. They will also analyze re-arrest and jail recidivism, along with deter-

13 “A lot of these men have unstable lifestyles, and incarceration is a chance to get their attention.

They’re more lucid, they have time on their hands and they’re more apt to listen to someone talking to them Dr. Mark Malek about their health.”

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Commonly, says Cunningham, incarcerated HIVpositive men receive treatment while in jail but fail to continue following their release, focusing instead on other basic concerns such as housing and transportation. Many among the incarcerated population also struggle with substance abuse and mental illness.

LINK LA looks to make a difference by establishing connections for the target population while they are jailed and sustaining those relationships beyond their release. “A lot of these men have unstable lifestyles, and incarceration is a chance to get their attention,” explains Malek. “They’re more lucid, they have time on their hands and they’re more apt to listen to someone talking to them about their health.”

LINK LA, now in its fourth year, is based on the hypothesis that successfully reaching these men requires relatable peers – trained staff with backgrounds similar to the study participants, who can impress upon them the importance of taking medications to control their disease and provide hands-on guidance through the complex health care system.

The health navigators, hired by the county public health department’s Division of HIV and STD Programs, provide social support and inspiration as well as practical assistance – going so far as to accompany the men on appointments as they make the transition back into the community – be it for substance abuse treatment, mental health services or following through on their HIV care.

“We bring a certain credibility to the program,” says Brown, who remains in regular face-to-face and phone contact with his clients for up to six months after their release. “When incarcerated people see guys in suits and ties or wearing badges, they think, ‘How could you possibly understand what I’ve been through if you’ve never been there?’ When I talk to them, they know I went through the fire and came out on the other side, and they start to believe they might be able to do that too.”

“Al helped me make the contacts I needed in order to get stable,” says one study participant, who describes being in daily contact with Brown for the first month after his release from jail earlier this year.

“We made plans as to how I would progress. He listened to my problems without being judgmental, but at the same time if I had wanted to backslide, I don’t think Al would have accepted that.”

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Figures of Speech By providing local-level data on diverse populations, the California Health Interview Survey paves the way for community-based organizations to achieve health goals.

In Long Beach and Boyle Heights, CA, 54 residents concerned about health risks from emissions generated by the many diesel-powered freight trucks in and around their neighborhoods were educated in how to access relevant data from the California Health Interview Survey (CHIS). After going through the training – offered by the UCLA Center for Health Policy Research, the Fielding School-based center that conducts the ongoing survey – the residents, many of them Latino immigrants, educated others in the community, further fueling opposition to the proposed expansion of a train and die sel truck facility and construction of a new rail yard.

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“CHIS includes issues around access to care and health behavior that tell us not only which diseases we need to focus on, but how.”

Eric Wat, Special Services for Groups

In Bakersfield, leaders of the Central California Regional Obesity Prevention Program used CHIS data showing high rates of obesity among the community’s Latino population to rally police, parks-and-recreation officials and residents behind an initiative to make a local park safe for physical activity.

The Oakland-based California Pan-Ethnic Heal th Network (CPEHN) used an analysis by the California Simulation of Insurance Markets – a micro-simulation model developed by UCLA and UC Berkeley that draws on CHIS data to estimate the likely impact of initiatives under the Affordable Care Act – to alert policymakers to the potential for more than 100,000 Californians being deterred by language barriers from enrolling in Covered California, the state’s Health Benefit Exchange. Following CPEHN’s efforts, Covered California committed to translating its materials in multiple languages, as well as ensuring the availability of bilingual customer service representatives.

“Even when we know that language access needs to be a priority, the data is critical to making the case and without CHIS, we don’t have the data,” says Ellen Wu, CPEHN executive director.

As the nation’s largest state health survey, CHIS is viewed as an invaluable resource by many policymakers, researchers and advocates for the detailed portrait it paints of the health and health care needs of California’s diverse population. Smaller surveys, for example, are rarely able to provide sample sizes significant enough to enable users of the data to glean meaningful information about local health trends in a community, or the health status and/or access to care of a racial or ethnic subpopulation.

Beyond standing apart as a large survey, CHIS has proved particularly useful to community-based groups because the survey design is responsive to their needs. “From the start, CHIS has had advocates at the table alongside academics to ensure that we accurately depict the diverse populat ions of the state,” says Dr. Ninez Ponce, a Fielding School professor and principal investigator of CHIS. “And because the design is meaningful for communities, the data we get from it is often used by community-based groups to promote change.”

CHIS data is easily accessed thanks to AskCHIS, a free online tool that allows anyone to quickly and easily generate customized statistics from the survey. Ap proximately 10,000 queries are run through AskCHIS per month. To promote use of the system, the center regularly holds no-cost workshops up and down the

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“The compelling one-off stor ies are important,” Dalesandro Mindnich says, “but when you can back them up with solid data on children’s needs you have a much stronger case, and that’s what CHIS allows us to do.” Dalesandro Mindnich says she frequently hears from children’s advocates outside of California who are envious of her ability to apply CHIS data. As the survey’s success inspires similar efforts across the nation, communitie s across the country may soon have numbers of their own.

“The compelling one-off stories are important, but when you can back them up with solid data on children’s needs you have a much stronger case.”

Jessica Dalesandro Mindnich, Children Now

Left and top: The UCLA Center for Health Policy Research’s Health DATA program has trained more than 5,000 community representatives in how to access and use results from the California Health Interview Survey to advance population health. Above: After going through the training, Long Beach residents concerned about health risks from diesel exhaust mobilized their community to take action.

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code level proved vital to groups that successfully argued for a 2008 Los Angeles city council ordinance placing a moratorium on new fast-food restaurants in South Los Angeles. At the request of the Los Angeles Depar tment of City Planning, CHIS provided data on obesity and diabetes in Los Angeles County service planning areas, along with statistics on the density of fast-food establishments. This came after Community Health Councils, a nonprofit health-policy education group that was a leader in the fight for the moratorium, approached the center seeking data on the con-

15 nection between the food environment and rates of obesity and diabetes in South Los Angeles. “It’s really difficult to find data at the granular level that we need, and CHIS provides that,” says Gwendolyn Flynn, policy director of Community Health Councils.

Although the survey itself is confined to California, the influence of CHIS is increasingly national, as many states and cities – from Ohio and Colorado to Houston and New York City – look to emulate its success. To assist them in establishing their own surveys, the UCLA Center for Health Policy Research has led an informal national network that provides technical assistance and advice while promoting comparable data collection processes for research and policy-making purposes. Twenty-three states are represented in the network.

Dr. Jessica Dalesandro Mindnich, director of research at Oakland-ba sed Children Now, knows her counterparts in other states would welcome the addition of a CHIS-like survey. Children Now has relied on CHIS data as part of its technical assistance to Building Healthy Communities, a 10-year project of The California Endowment to help 14 communities throughout the state develop into places where children are healthy, safe and ready to learn.

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state and online, now funded by The California Endowment and Kaiser Permanente; through these workshops, more than 5,000 community representatives have been trained in how to use AskCHIS. “We’re building capacity to access and evaluate data in the context of what people are trying to do within their community,” says Peggy Toy, director of the center’s Health DATA program, through which the training ses sions are offered. “These sessions help people to feel comfortable using the data to communicate what it says about their community.”

Eric Wat participated in a Health DATA training nearly a decade ago, not long after he joined Special Services for Groups, a nonprofit health and human service organization in Los Angeles dedicated to building and sustaining community-based programs that address the needs of vulnerable populations. Wat has been a regular user of the CHIS data ever since, most recently as part of a collaboration with Kaiser Permanente Southern California to conduct community health needs assessments for six of its medical centers. “You can have good epidemiological data, but sometimes you need more details to make sense of why certain diseases are more prevalent now than at other times,” Wat says. “CHIS includes issues around access to care and health behavior that tell us not only which diseases we need to focus on, but how.”

The ability to home in on health data at the ZIP

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16 Fielding School alumni and students are playing an integral role in L.A. County’s innovative efforts to transform communities so that they are more conducive to healthy living.

HEALTHY SURROUNDINGS For decades, public health campaigns have emphasized the importance of healthy living. But if the messages have been heard, they haven’t always been heeded: According to the U.S. Centers for Disease Control and Prevention (CDC), nearly 70 percent of the U.S. population age 20 and older is overweight or obese. Perhaps most telling are the wide disparities in the

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rates of obesity, diabetes and heart disease between low-income and more affluent communities.

Faced with these realities, there is a growing consensus among public health leaders that health education isn’t enough – particularly in communities where finding nutritious meals and safe, open spaces for exercise is challenging; mental health and preventive clinical services are difficult to access; and the environment is more likely to promote smoking and other unhealthy behaviors. That conclusion is reflected in the federal Community Transformation Grant (CTG) program. Launched by the CDC in 2011, CTG was rolled out with an initial award of $103 million to 61 state and local government agencies, tribes and territories, and nonprofit organizations, enabling them to work with community partners in creating environments more conducive to healthy living.

In the communities that make up Los Angeles County, millions of people stand to benefit from CTG through healthy lifestyle-promoting changes in their surroundings – from more nutritious food choices and limits on secondhand tobacco smoke to the addition of outdoor spaces for physical activity. “This is an innovative approach to working with communities that addresses the environments where people work, live, learn and play that influence their decisions and outcomes,” says Dr. Tony Kuo, M.S. ’03, deputy director of the Division of Chronic Disease and Injury Prevention within the Los Angeles County Department of Public Health, one of the CTG recipients. “Instead of investing most of our efforts in educating individuals and putting the onus on them to make healthy choices, we’re partnering with communities to change social norms so that it’s easier to make those healthy decisions. Traditional health education continues to be vitally important, but it is much more likely to be effective when the surrounding environment supports a healthy lifestyle.”

In L.A. County, the CTG initiative is addressing five strategic areas: tobacco-free living; active living and healthy eating; clinical and other preventive services; social and emotional wellness; and healthy and safe environments. The department’s effort to transform communities is overseen by

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17 the nutritional value of school meals; supporting cities within the county in implementing strategies to increase access to healthy food and beverage options; and working to increase the acceptance rate of the CalFresh nutritional assistance program at farmers markets across the county, to name a few. “We’re seeing a paradigm shift in the focus on systems-level interventions, particularly in lowincome communities, where it hasn’t always been easy to have a healthy diet,” says Brenda Robles,

The wide-ranging strategies to transform communities into healthy living environments in L.A. County include (opposite page) increasing the acceptance rate of the CalFresh nutritional assistance program at farmers markets, and (above) developing shared-use agreements with districts to open school facilities for after-hours and weekend recreational activities in park-poor neighborhoods.

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M.P.H. ’10, a research analyst for the public health department who is co-leading the CTG evaluation. “Instead of a top-down educational approach, we’re addressing the root issues and coupling that with nutrition education so that patrons will understand and embrace the changes.

The idea is to empower people to take control of their health, and give them the tools to do so.”

Aragon notes that the CTG funding has necessitated hiring additional staff, and many Fielding School students have been enlisted in the effort as interns – among them Jamie Cassutt, a second-year M.P.H. student. Cassutt has assisted with recruitment for the Choose Health LA Restaurants program, which gives special designation to restaurants that offer smaller portion-size options, healthier children’s meals and free chilled water. “Every time I was able to go into a restaurant and get management excited about this, I felt like I was making a difference,” Cassutt says. “It’s exciting to be out in the community, contributing in some small way to making people healthier.”

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Dr. Paul Simon, director of the Division of Chronic Disease and Injury Prevention and a member of the Fielding School faculty. Kuo is among several alumni who are playing important roles in implementing the program.

With the CTG initiative, the public health department and its community partners are building on similar efforts that the department had already launched. But with the infusion of CDC funding (nearly $10 million a year), the department is casting a much wider net – bringing in partners from sectors such as education, transportation and business, as well as faith-based organizations. The initiative provides important funding to community-based organizations to ensure broad participation.

“This has given us the opportunity to be at tables where we haven’t previously been, expanding the scope of what we do in public health,” says Linda Aragon, M.P.H. ’91, chief of programs and policy for the Division of Chronic Disease and Injury Prevention. For example, the public health department has worked with the Los Angeles Department of City Planning on its Health Atlas – used to guide urban planning in the city; has provided comment on transportation plans, including provisions for bicycles paths and safe routes to schools; and has made recommendations on county food procurement contracts. As part of the tobacco-free living strategy, which Aragon oversees, the department is partnering with communities to mobilize residents in working with landlords and city officials to address secondhand smoke in multi-unit housing; and to reduce youth access to tobacco products.

To increase opportunities for physical activity in communities with high rates of obesity, the department is working with school districts to develop a variety of shared-use agreements that would open school facilities for after-hours and weekend use for the area’s residents. “In L.A. County, generally the communities most hard-hit by obesity, hypertension and diabetes are the same ones that are the most park-poor,” says Dr. Eloisa Gonzalez, M.P.H. ’99, the department’s director of cardiovascular and school health, who oversees initiatives under the CTG’s healthy and safe physical environments strategy. “The existing green and open space in most of these communities is the school. Since this is a public resource, we see shared use as a viable way to increase access to safe places for physical activity, as opposed to trying to get more park space.”

As part of the active living and healthy eating strategy, the department is working with school districts in low-income communities to improve

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HOme ImprOvement With assistance from a dietitian and community health worker, residents of a low-income community are changing their living environment in an effort to reduce their diabetes risk.

For the population of East Los Angeles, which is overwhelmingly Mexican American, the risk of obesity-related conditions such as diabetes and heart disease is markedly higher than for most other populations. Research suggests that this is largely attributable to the environment, both in the neighborhood and in the home. “There is a much greater reliance on processed foods, higher rates of TV watching, and less physical activity, particularly where neighborhoods are not considered safe,” says Dr. William McCarthy, a professor at the UCLA Fielding School of Public Health. “All of these factors are associated with obesity risk.”

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Most people appreciate the importance of eating well and staying fit. But a Fielding School group led by McCarthy, in partnership with researchers at USC and leaders from the East Los Angeles community, has devised a strategy that goes beyond “Our goal is to create a home and neighborhood merely advising residents about their diet and environment where the healthier option physical activity. Through the use of community health workers and a registered dietitian, the becomes the easy choice, and the less healthy Cardiovascular Disease Risk Reduction Study option becomes the more difficult choice.” works with at-risk residents on a makeover of the Dr. William McCarthy family living environment. A major part of these makeover sessions involves changing the “choice architecture” of the home – including moving the healthiest foods to the front of the refrigerator and pantry, confining the television to parts of the home where it’s less likely to be used during meal times, and strategically placing athletic shoes and exercise equipment so that they are accessible and in plain sight – and, thus, never out of mind.

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It’s an approach that takes its cue from the field of behavioral economics, which says that people’s moment-to-moment choices are heavily influenced by what’s immediately in front of them. “Our goal is to create a home and neighborhood environment where the healthier option becomes the easy choice, and the less healthy option becomes the more difficult choice,” McCarthy explains.

When McCarthy and colleagues originally conceived the idea of including face-to-face coaching sessions in the home as part of the study, they figured it was impractical. They assumed residents would be suspicious of community health workers (known as promotores) wanting to enter their home. But members of the project’s community advisory board assured the research team that the promotores would be warmly welcomed into the study participants’ homes, and that has proved to b e the case. Indeed, McCarthy says, to a greater extent than in any study he has previously directed, the community has shaped the content of the intervention.

As part of the UCLA-USC Center for Population Health and Health Disparities, the project targets healthy adults in families that have one member diagnosed with diabetes. “What can happen to one member of the family is likely to happen to anoth er member, given their shared home environment,” McCarthy says. Over the course of more than a dozen interactions – two in the home, as well as group sessions at the Roybal Comprehensive Health Center in East Los Angeles – the promotores provide counseling on diabetes prevention through healthier eating, exercise and limited TV viewing.

To make the healthy food choice the easier choice, a registered dietitian accompanies a promotora on the home visits and, with permission from the study participants, affixes an adhesive-backed colored dot onto every food product in the refrigerator and pantry. Red dots are applied to food prod-

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tion to providing counseling, they assist with a home makeover that includes labeling and positioning healthy food items where they are most accessible, and placing running shoes by the front door.

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The cornerstone of the project is the peer-to-peer educational approach using promotores – members of the community who are trained to advise the families on minimizing their risk of obesity-related conditions. “I speak their language, understand their struggles and customs, and can talk to them about what we’re doing without using scientific terms,” says Rosalba Cain, one of the promotores. “I am recognized as one of them, which makes it easier to talk about nutrition in our

community, how we cook, how we become busy and how we can go about finding time to educate ourselves.”

Most of the project’s staff, like Cain, has close ties to the community. The majority of the staff members are housed in the Roybal Comprehensive Health Center, located in East Los Angeles. A series of interviews and meetings held in East Los Angeles prior to the project helped to gather information on barriers to healthy eating and physical activity, as well as guidance on a culturally appropriate and East L.A.-specific intervention strategy and educational curriculum. Community volunteers helped to recruit participating families.

“It’s a lot easier to help people modify their behavior when you’re familiar with their everyday lives,” says Rudy Salinas, a longtime resident recruited to the community advisory board through his membership in the Rotary Club of East Los Angeles. “That’s the kind of input we’ve been able to provide.”

The study team has sought to earn the community members’ trust by looking out for the best interests of the residents even as it adheres to the rigors of scientific research. Study participants who aren’t randomly assigned to the experimental group receive education about cancer screening and early detection. “Offering an alternative program of helpful health information as the control condition shows them that we are serious about helping every study participant,” says Nancy Calderón, an M.P.H. student at the Fielding School who serves as the project manager.

The researchers have impressed upon the community participants their desire to ensure that the changes made through the project are sustainable. “They are concerned about what’s going to happen after the funding is gone,” Calderón says. “So we have invited them to be agents of change. By providing appropriate education and discussing healthier lifestyle choices possible given the constraints of their neighborhood environment, we are equipping them to be the educators of the community in the As part of the Fielding School study, promotora Rosalba Cain (in black) and registered dietitian Brenda Robles (in blue) visit participating families. In addifuture.”

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ucts that should be consumed once a month or less, such as sugary beverages and high-fat pastries. Green dots are applied to what should be “everyday” foods – fresh fruits and vegetables, minimally processed foods and whole grains. Yellow dots are applied to foods of intermediate nutritional quality – refined bread, sugar-sweetened cereals – that, if eaten more frequently than once a week, might jeopardize health. Rather than banning the red-dot foods, the dietitian recommends placing them in the back of the refrigerator or pantry, so that extra effort is required to retrieve them.

A similar tactic is used to promote physical activity.

Multiple studies have concluded that the positioning of the television affects the amount of viewing, which is associated with obesity risk. The study participants are advised to keep the television out of the kitchen and bedrooms – where, in addition to promoting sedentary ways, it interferes with family conversation and homework for the children. “TV watching should be a social affair,” McCarthy says. By positioning athletic shoes where they’re conspicuous – next to the front door – they are not only easy to retrieve, but they serve as a visual reminder not to watch TV without first getting in some activity.

McCarthy notes that while many studies have focused on the effects of the neighborhood and community on diet and exercise, surprisingly little attention has been paid to the role of the home environment. “The home is where a lot of people spend many hours a day, and it’s common sense that what’s in the home is going to affect people’s lifestyle choices,” he says.

“We suspect this general approach is going to become a model for communities all over the country.”

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20 In low-income communities across the nation, the scarcity of nutritious options contributes to poor diets and high rates of chronic conditions.

But that is changing in East Los Angeles and Boyle Heights, where scores of young people educated through a Fielding School initiative have become public health leaders.

Lilybeth Hernandez (above) traces her transformation from shy teen to public health activist to the moment she agreed to march in a Mexican Independence Day parade dressed as an avocado.

The parade is a major annual event in Hernandez’s predominantly Mexican American community of East Los Angeles, and she had attended with her family as a spectator for as long as she could remember. Now she was a junior at Esteban Torres High School’s East Los Angeles Renaissance Academy (ELARA), where a new elective course – offered as part of a larger effort by a Fielding School team to improve cardiovascular health in East L.A. and Boyle Heights – was teaching students about the perils of their food environment, and empowering them to change it.

“I’m not a social person,” says Hernandez, recalling her trepidation about wearing the costume and handing out fresh produce to promote healthy eating. “But I danced, I engaged with the community, and it was really nice.”

More than anything, Hernandez’s involvement in “Corner Store Makeover in East L.A.: Proyecto MercadoFRESCO,” a project of the Fielding School’s UCLA-USC Center for Population Health and Health Disparities, served as a wake-up call. It introduced her to the concept of a “food desert” – an area with an abundance of fast food, a scarcity of fresh produce and other healthy options, and high rates of obesity and obesity-related chronic conditions as a result. “This is what I always saw growing up, so I didn’t think it was noteworthy,” Hernandez says. “A lot of people in my community still don’t.”

As she learned more and became an active participant in the studentled activities, Hernandez no longer hesitated to make the case for change.

In the autumn of her senior year, she presented on Proyecto MercadoFRESCO at the national conference of the Community Food Security Coalition in Oakland. She learned about gardening and, with a classmate, successfully pitched the idea of offering a gardening class at the local elementary school, focusing on the need for fresh produce in low-income communities and growing in limited space. After three years with Proyecto MercadoFRESCO – the last as a community liaison, mentoring the high school students who were following her path – Hernandez is a freshman at NYU, majoring in global public health with a concentration in food studies.

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Seeking

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To oversee the educational, community and social marketing efforts, the Fielding School team brought in Public Matters, a Los Angelesbased social enterprise that designs and implements neighborhood-oriented new media, education and civic engagement projects for social change. Since 2010 Public Matters has trained students at two partner high schools in the area – ELARA at Esteban Torres High; and the School of Communications, New Media and Technology at Roosevelt High in Boyle Heights – to be food justice advocates.

Students are given a year-long curriculum in issues such as nutrition, food justice, media production and social marketing as juniors, then take to the streets their senior year as agents of change – supporting the stores they have helped to transform while promoting healthy eating and improving the community’s access to nutritious foods. What started as a high school program has expanded, as graduating students have embraced the opportunity to continue with the project while in college. Thanks to funding from the Goldhirsh Foundation, more than a dozen now work as paid community liaisons, assisting the high school students in the implementation of their activities.

Whether the young people are speaking at community events, performing healthy-cooking demonstrations at the stores, producing promotional videos or donning costumes to make themselves visible at parades, one thing is always clear: “The students and community liaisons are out in front of everything,” says Mike Blockstein, principal at Public Matters. “They’re responsible for conceptualizing, organizing, promoting and

21 Below: Through the Fielding School-led Proyecto MercadoFRESCO, corner stores such as Ramirez Meat Market are being transformed into physically inviting environments where healthy products are prominently displayed.

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Farmers markets, comprehensive grocery stores and other sources of healthy foods have historically been in short supply in low-income communities. All too typical is the story of East Los Angeles, where fast-food establishments reign and groceries are often purchased at one of the ubiquitous corner stores – mostly dark and unappealing spaces where chips, candy, beer and lottery tickets are front and center and fresh produce is rarely found.

Proyecto MercadoFRESCO, led by Drs. Michael Prelip, Deborah Glik and Alex Ortega of the Fielding School and part of a larger UCLA-USC Center for Population Health and Health Disparities initiative headed by Ortega and Dr. William McCarthy, represents a multipronged effort to transform the narrative – and serve as a model for similar communities across the nation. The National Institutes of Healthfunded project employs a business consultant to assist the owners of mom-and-pop stores in converting their establishments into more physically inviting environments, with healthy foods prominently displayed while unhealthy items are relegated to the back.

But this is no “build it and they will come” approach. Instead, a critical piece of the Fielding School team’s effort involves community-based promotion of the revamped stores, and increasing the demand among East L.A. and Boyle Heights residents for the stores’ healthy products. That’s where Hernandez and the scores of other students who have participated in the project fit in.

Bottom of the page: Scores of students at high schools in East Los Angeles and Boyle Heights have been trained to be food justice advocates, educating their community and spearheading change through a variety of projects.

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Above: After learning about the concept of a food desert – and that he lived in one – high school student Steven Cardona turned his anger into activism.

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Below: Proyecto MercadoFRESCO’s students take the lead in conceptualizing, organizing and implementing their community activities.

They go to great lengths to promote a healthier food environment – including the donning of colorful costumes.

running the events. This gives them agency, and it turns them into passionate advocates for making their community healthier.”

Steven Cardona reacted with anger when he first learned about food deserts – and realized he lived in one. “I thought, ‘Why does it have to be this way?’ says Cardona, a senior at Roosevelt High now in his second year in the Proyecto MercadoFRESCO program. “When I realized that this affects my whole community – that everybody has these same problems with high cholesterol and high blood pressure, connected to the food we eat and what’s available to us – that really got me going.”

Cardona turned his anger into activism, relishing the opportunity to become “part of something greater than myself.” With his classmates he attends events in the community where they

can discuss healthy eating and pass out flyers promoting the revamped corner stores. Cardona also knew he had to embody the change, so over time he broke his own fast-food habit. His friends have noticed. “They still eat the way I used to,” Cardona says. “When they’re having a bag of chips or some fries, they try to get me to eat some. I tell them I don’t do that anymore, and I explain why. It’s a slow process but I think they will get there.”

Cardona thought little of all the unhealthy food he ate through his childhood. His father worked at a fast-food restaurant, and his family took advantage of the free meals when they weren’t enjoying traditional Mexican staples such as rice, beans and carne asada. Now he’s seeing the effects. Cardona’s mother suffers from hypertension and often has to stop for breath after walking any significant distance. “I don’t like seeing that,” Cardona says. Emboldened by what he’s learned through the project and by his mother’s support for his newfound convictions, he has begun to help her shop for groceries in an effort to find healthier meal options. Cardona’s mother has attended the healthy-cooking demos and is looking to change her eating habits. “She’s the main reason I want this,” Cardona says. “I want my mom to be around.”

For nearly every student who gets involved in the project, there is a close family member who is overweight and/or has diabetes or cardiovascular disease. “As we start to talk about healthy eat-

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Above: Darinee (DeeDee) Barba is among many of the student activists who have led healthy-cooking demonstrations.

Below: As a result of his participation in Proyecto MercadoFRESCO, Andy Alvarez is now a nutrition sciences major – and considering a public health minor – at California State University, Los Angeles.

UCLAFIELDING SCHOOL OF PUBLIC HEALTH

“The challenge with the makeovers is that everyone has a negative concept about these corner stores – that they’re places to get chips, candy or beer,” says Andy Alvarez, a graduate of Torres High’s ELARA program who has been with Proyecto MercadoFRESCO for more than three years, currently as a community liaison. “You have to transform that mindset so the community thinks of these as places where you can get your fruits and vegetables.”

Through the project, Alvarez experienced a personal revelation about the impact of his food environment. His father had studied to be a nutritionist while in Mexico, but the credits didn’t transfer to U.S. programs and rather than starting over he got a job as a truck driver. He

arrived from Mexico with a 28-inch waist; before long he was a size 44. “Even for someone like my dad, who knows so much about how he’s supposed to be eating, it was hard,” Alvarez says. “If you’re a working-class person in this neighborhood, you don’t always have the energy to shop and cook a healthy meal, so you resort to what’s convenient, which around here is fast food.”

As Alvarez began to connect Proyecto MercadoFRESCO with his father’s experience, his interest grew. He assisted with the corner store conversions, attended the store re-openings and took part in the cooking demos. He participated in presentations at “movie nights” in the park, engaging with community members. When he began mentoring some of the project’s firstyear students, his confidence soared. And for the first time, Alvarez began to see himself in the career his father had once intended to pursue. Now he is a sophomore at California State University, Los Angeles, majoring in nutrition sciences and considering a public health minor.

Among the many rewarding experiences he’s had since starting with the project more than three years ago, Alvarez says one encounter stands out.

It was the grand re-opening of Yash La Casa Market, the first of the corner stores Alvarez and the project’s other students had helped to convert and promote. An elderly man approached.

“He looked to be about 80,” Alvarez says. “And he said he was so thankful for us opening this store close to him, because it was the first time in many years that he could actually shop for his own fruits and vegetables.”

AUTUMN 2013

ing, the students begin having conversations with their families about what they eat and how that affects them,” Blockstein says. “Most are very active in getting their families to change their shopping, their diet and their cooking practices.”

Darinee (DeeDee) Barba’s experience fits that profile. “Our main food was red meat, we didn’t have many greens or fruits, and we were always eating until late at night,” she says. After Barba began learning about the consequences of unhealthy eating as a student at Roosevelt High, she started a dialogue within her family. “Our eating habits have changed a lot,” says Barba, now in her first year at Pasadena Community College and continuing to work for Proyecto MercadoFRESCO as a community health liaison.

“I’m not going to say we don’t eat any more meat but we’ve cut back – we’ll substitute fish, or chicken.”

For Barba and other youths growing up in food deserts, family choices don’t occur in a vacuum. Surrounded by fast-food outlets, street vendors, ice cream trucks and traditional corner stores, it’s hard to eat well. “You walk out of school and you’re hungry, so you get a soda and a bag of chips because that’s what’s available,” Barba says. “But that’s changing.”

In addition to promoting the fresh produce and healthier snacks at the corner stores that Proyecto MercadoFRESCO supports, Barba is among the participants in the cooking demos.

“We show step by step how to make healthy meals with recipes that we know families will use, since we’re all Hispanic,” Barba explains.

“We want them to see that it’s easy, tastes good and is something they can do at home rather than eating out.”

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Community teachers

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Promoting Wellness— at a Familiar Site

Karla Gonzalez, M.D./M.P.H. Candidate

Z video

ph.ucla.edu

The perfect fieldwork opportunity presented itself when I learned that a wellness I WAS DRAWN to medicine center was to be built on the by my grandmother’s home very grounds of our former remedies, kind doctors who hospital. The Wellness Center comforted my mother when I at the Historic General Hospital became sick with meningitis, is a collaboration of more than and the obesity epidemic I a dozen nonprofit organizations witnessed unfolding as a high with a long history of dedication school teacher. But nothing to the community, coming had a greater impact than rushing with family together to deliver comprehensive members to LAC+USC Medical Center, dubbed services – from diabetes education and mental El General by the locals, for fully preventable health to healthy-cooking demos, legal advice situations that had somehow become life threaten- and work trainin g – that are essential in keeping ing because of a lack of financial resources and patients healthy and reducing health care health insurance. spending.

I set out to become a doctor to address the Through my experience assisting in the issue of physician shortages in medically underplanning of the collaborative programming to be served areas but quickly learned that a healthy offered at the center I was reminded that health community requires a more complex solution. is not achieved in a clinic but rather out in the Patients cannot begin to improve their diet, medcommunity – and through the efforts of organizaication compliance and glucose levels when faced tions such as those that have come together as with issues of citizenship status, violence, poverty The Wellness Center. While walking through those and low educational attainment, none of which doors after many years brought back memories can be addressed adequately in a 15-minute clinic of my childhood, it also filled me with hope that visit. I concluded that a dual degree in medicine as a future physician and public health advocate, and public health was my best approach.

I can make a difference for my community.

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Increasing Autism Awareness, Enhancing Services

UCLAFIELDING SCHOOL OF PUBLIC HEALTH

Marianne Chen, M.P.H./M.S.W. Candidate THE GROWING prevalence of Autism Spect rum Disorders (ASD) is a call to action for public health professionals to addre ss stigma and barriers to care by developing innovative solutions that fit the needs of the communities affected

by ASD. I had the opportunity to work with the public health team at Autism Speaks in New York City on its Early Access to Care Initiative. The goal is to lower the age of diagnosis and increase access to high-quality, evidence-based interventions for all children with ASD. Through this initiative, I took part in two comm unity partnership projects.

The New York City Korean Community Autis m Project aims to increase awareness of early warning signs for ASD and link Korea n families to local evidencebased services that are linguistically and culturally sensitive. It is a partnership

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Five Fielding School students recount lessons learned from their experiences on the front lines of public health.

Paul Camarena , M.P.H. Candidate

MY INTERNSHIP with the Occupational Health Branch of the California Department of Public Health (CDPH) enabled me to work in support of a community-based project addressing some of the health concerns of a traditionally underserved Spanish-speaking farmworker population in the Northern California counties of Monterey and Santa Cruz. The valuable role these workers play in the agricultural vitality of the state and nation also places them at risk for a variety of health issues, including the potential negative effects of pesticide exposure. Such exposure is of particular concern for children as well as women of childbearing age or pregnant women, who comprise a substantial number of farmworkers in the area.

Text4Salud (T4S), a collaboration between the CDPH and a coalition of Monterey and Santa Cruz county community organizations, tests the effectiveness of a low-cost text-messaging service

25 AUTUMN 2013

Helping Farmworkers Get the Message About Pesticides in providing this historically difficult-to-reach community with critical information on pesticide safety at work, including where pesticides are being applied locally and how to report exposures easily and without fear of repercussion. T4S is guided by data showing immigrant workers are sophisticated users of technology, as well as pointing to high rates of mobile phone use among Spanish-speaking farmworkers.

State agencies collect data on pesticide use and exposures and offer high-quality pesticide safety content that infrequently reaches the farmworkers most at risk; T4S will bring this data to the farmworkers’ mobile phones and offer them a way to report unsafe practices and exposures.

In monthly meetings with T4S partners, I was able to contribute to discussions of scope, messaging content, incentives, evaluation measures and fund development/grantsmanship. More importantly, I was witness to the potential of this model of collaboration between a state agency and local organizations to engage communities in the realization of their health potential.

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UCLAFIELDING SCHOOL OF PUBLIC HEALTH

project among the Korean community in the great er New York area, a research team from the University of Pennsylvania, and Autism Speaks. The Community-Partners Deve lopmental Screening Events Project seeks to provide acces s to services related to the early identification and early interv ention of ASD in communities across the United States. Events provide families – particularly from underserved ethnic mino rity populations – with the opportunity to receive free developme ntal screenings, meet with expert clinicians to discuss developme ntal concerns, and be linked with local resources and services recommended by the clinicians.

My field studies placement at Autism Speaks in New York City proved to be an invaluable learn ing experience that instilled my passion for autism public health work. Among other things, I learn ed about the importance of building relationships with community partners to increase ASD aware ness.

And I learned how we, as public health profession als, are best equipped to further examine the cause s of ASD and develop cost-effective and culturally sensitive services that meet the urgent needs of the autism community.

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ivism , ReducinggRHeceid Promotin alt.Ph.H. Candidate Jenna Arzinger, M

unialth of our comm EFFECT on the he AL TI N TA it BS t, ye SU A uth; VIOLENCE HAS for our nation’s yo ng causes of death di lea e th The Violence s. of ue e iss on ties and is blic health pu r he ot as n io nt treatment e same atte in prevention and ng doesn’t receive th sti ve in by ns tio lu itted to finding so the effort. n (VPC) is comm inspired me to join rk at th ch Prevention Coalitio oa pr ap an – ced me was my wo n io at that most influen and incarcer e st on re e ar th an C, th VP er an e th en ra for th years there has be d in many projects C). In the last two AR (P While I was involve cil th no un wi ls Co jai n io ty at from coun /Altadena Reintegr ers being released nd fe of ly al th with the Pasadena xu on se m na d no PARC, us, non-violent an ugh the efforts of ro Th . sm ivi moval. re cid influx of non-serio o re hood of h to tatto from mental healt increasing the likeli g in tly ng ea ra gr s, s, ce ice rv ur se so re a myriad of these individuals individuals resource fair offers erly incarcerated rm fo w ho of ts accoun I heard firsthand with emotion. nd and was filled ou ar es liv eir th then had turned to succeed. I knew sperately wanted de ey th rmerly w fo e ho th w sa th I uld work wi co I ich wh in er re that I wanted a ca ciety – improving reintegrate into so em th lp he to ed at unities. incarcer alth of their comm he e th as ll we as ate, this poptheir health ccessfully reintegr su to s ce ur so re e stem and Without th the cracks in the sy h ug ro th ll fa ely lik of crime ulation will most d detrimental cycle an y stl co e th ng inui rtnerships such return to jail, cont that community pa ed rn lea I n. io at and incarcer public health. ntial to promoting as this one are esse

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ilding u -B y it n u m m o C n a si A Southeas t nifer Xiong, M.P.H. Candidate

UCLAFIELDING SCHOOL OF PUBLIC HEALTH

Jen

—-

in Southeast Asian erican, my interest Am g on m H N ERATIO rces in 1975, the AS A FIRST-GEN ll to communist fo fe os La r te Af l. ding is persona ited States – inclu community health resettling in the Un y an m the e, k fle lac to ll sti ed encies Hmong were forc h providers and ag alt he er, lat As the s ar h. ye alt 40 mong he my parents. Nearly ctively improve H fe ef to s ce ur so re ne y and ity, the ed to r. cultural competenc es in my commun rg su s sse ne never been greate ill c ni ating chro ed population has rv rse de to un s is m th ra incidence of debilit to ring prog services and tailor health lth (FiGH) in tailo ea ta H da d e bl oo G lia e re in ur ct es nt colle joint ve assist Famili ished in 1987 as a bl e opportunity to ta th es d s ha wa I H ly G nt Fi ce Re ip es in Long Beach. , Inc. – a partnersh d Lao communiti bodian Community m Ca d formed ite in e Un the Cambodian an e ak th m er and unity to ary Medical Cent within the comm y cit pa ca ild bu between the St. M to . It seeks re and community between health ca 1980s to escape social resources. h ited States in the needed healt and Un ss e ce th ac to e to m d ca an s ns choice of the most America ps represent some y Southeast Asian ou an gr m e s, es nt re Th a. pa y di m bo e Like Vietnam and Cam ericans who achiev countries of Laos, otype of Asian Am re ste ” d ity an or n in io from the war-torn m at ts, educ e “model urces, media outle so unities. Far from th re m ic m ist co gu le , lin rk ab d er wo an ln vu my field e cultural they face. During ccess, they lack th es su iti e ar ag sp er di -av d an an th s th higherr sense of e e hardship developing a bette eliorate some of th ile am d wh s ul ian wo As at t th as he netadvocacy e tailored to Sout nt communication, te a resource guid learned that consta I . rk wo eir I was able to crea th t ff abou ing with FiGH sta community by talk to gaining trust. ial nt ration are esse bo lla co d an g in work

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Physicians Bring Quality Care to an Underserved Population Like many physicians trained in public health, Drs. Emmett Chase, M.P.H. ’90, and Eva Marie Smith, M.P.H. ’90, have devoted much of their careers to addressing issues of access to care in their community.

But for the couple, who have spent the last 16 years tending to the health needs of the Hoopa Valley Reservation in rural Northern California, the issues are unlike those faced by most of their former classmates.

Smith, a member of the Shinnecock Tribe of New York, In 1997 Chase, a member of the Hoopa Valley Tribe, met Chase at an Association of American Indian Physicians accepted an invitation by his tribal chairman to serve as meeting in 1984; they were married in 1988 and had their founding director and CEO of the new K’ima:w Medical Center. Smith, also a family physician, became medical director first child while both were students at the Fielding School.

By that time, both were leaders in the Indian Health Service shortly after the clinic opened and continues to serve in that (IHS). Chase was director of the IHS’s HIV/AIDS program role; after nine years as CEO, Chase is now a staff physician. for seven years; Smith led efforts on the prevention and treatLocated in a remote wooded community where life revolves around the Trinity and Klamath rivers, K’ima:w is the ment of substance abuse – an issue of particular concern in Native American populations. only clinic within 60 miles in an area with winding roads that Shortly after the couple moved to Hoopa Valley, they are difficult to navigate in the winter. “This population had faced the challenge of their careers. The Megram wildfire in limited access for a long time,” says Chase. In addition to perithe summer of 1999 burned 125,000 acres and produced odically bringing in specialists on site, K’ima:w has established dangerously high levels of smoke in the area for a month. an active telemedicine program that enables patients to conIn addition to overseeing the clinical care of the community, nect with university specialists. Beyond that, Chase and Smith log many miles making house calls, and regularly receive home Chase and Smith found themselves addressing the acute needs of patients with heart and respiratory conditions. Hoopa’s visits and phone calls from patients.

Given the emphasis on extended family in Native American population doubled from the fire fighters working in the community; along with supporting them, the couple helped culture, many patients with chronic conditions who might to evacuate 200 of the most vulnerable community members otherwise prefer to live closer to a university hospital choose to the California coast. to remain at home with their family, able to participate in “We were determined that Hoopa wasn’t going to be one tribal ceremonies and enjoy the area’s impressive beauty. “It’s of those communities studied in the books years later for what our job to help them do that, and provide them with what went wrong,” says Smith. Thanks to the couple’s leadership, they need,” says Smith, who was recently honored with the the community got through the period with no mortality.

California Medical Association’s 2013 Frederick K.M. Plessner Reflecting on the ordeal, Smith concludes: “Every ounce of Memorial Award, given to the member who best exemplifies our UCLA public health training paid off.” the practice and ethics of a rural practitioner.

27 AUTUMN 2013

TRIBAL TRIBUNE:

UCLAFIELDING SCHOOL OF PUBLIC HEALTH

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COMMUNITY BUILDING 28

UCLAFIELDING SCHOOL OF PUBLIC HEALTH

DEVELOPING A NEW HOSPITAL FOR SOUTH LOS ANGELES The 2007 cLosure of Martin Luther King, Jr. Harbor Hospital (MLK) after it failed a federal inspection dealt a blow to the traditionally underserved South Los Angeles community’s access to health care.

Now, under a public/private partnership involving Los Angeles County, the University of California and Martin Luther King, Jr. Los Angeles Healthcare Corporation, a new Martin Luther King, Jr. Community Hospital (MLKCH) is nearing the final stages of construction – and the Fielding School alum who is helping to lead the effort says the new facility, projected to open in early 2015, will go far to fill the void. child care and an assisted living facility, along “This is going to be an innovative, state-ofwith connected community gardens, pedestrian the-art hospital designed specifically to meet the walkways and recreational facilities. needs of this community,” says Dr. Elaine Batchlor, With the county effort to build the new M.P.H. ’90, CEO of MLKCH. “We will be pro“We will viding access to quality, patient-centered care facility nearly complete and MLKCH poised to that this community needs and deserves.” start installing equipment and hiring staff, the be providing Batchlor, hired as the new hospital’s CEO hospital leadership is increasing its engagement access to quality, in 2012, has played an integral role since the with the community. Batchlor’s plan is to conpatient-centered start as part of the seven-member board formed tinue to engage local organizations, provider care that groups and community health clinics that are shortly after the original MLK hospital closed. this community serving the population to ensure the hospital At that time, the county and UC system forged needs and will meet the community’s needs. a partnership to reopen a new MLK community deserves.”

The closure of the original MLK hospital hospital as a private not-for-profit entity – with the county providing the new building and has had a significant impact. A needs assessment Dr. Elaine Batchlor startup funding, and UC providing physician conducted by the new leadership found a deficit staffing and quality oversight. of approximately 700 primary care physicians Most importantly, notes Batchlor, MLKCH and 1,000 specialists in the facility’s service area; will be designed with a scope of services that home health care, skilled nursing facilities and meet the needs of South Los Angeles residents, other medical services are also in short supply.

The lack of an acute care facility has forced including an emphasis on maternal care; general patients to travel to other communities for medicine and general surgery; management of hospital care. “Part of our mission is to improve chronic conditions that disproportionately affect the population; and programs that promote access to a coordinated system of primary and healthy patients, healthy families and a healthy specialty services,” says Batchlor, previously chief community. Situated on a large piece of countymedical officer at L.A. Care, the nation’s largest owned land, the new hospital is the hub for the publicly operated health plan. “We are designing county’s so-called Campus Master Plan, which a facility to serve the entire community, regardless of insurance. Our intent isn’t just to open a was developed with input from residents, civic hospital, but to create a system of care focused leaders, business owners and health care advoon population health. That will help us to look cates. The plan envisions a web of community wellness resources around the hospital – includat the community’s health outcomes and design ing medical office space, psychiatric urgent care, appropriate programs to address them.”

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HOUSING DEVELOPMENT:

empowerment

begins at home

AUTUMN 2013 UCLAFIELDING SCHOOL OF PUBLIC HEALTH

jusT in case you weren’t sure whether housing is a public health issue, spend a few moments talking with Nancy Halpern Ibrahim, M.P.H. ’93, about the work of the Esperanza Community Housing Corporation and any lingering doubts will disappear.

“There is a glut of housing for people who are at a comfortable economic level, and not nearly enough for what 80 percent of the population can afford,” Ibrahim notes. “That means many people are choosing between the streets and uninhabitable slum housing. And where people understand they have no better place to go, they often stay under a roof regardless of the fact that the housing is causing their family to become ill.”

The health concerns of substandard housing are widespread, Ibrahim says. Inappropriate moisture in the homes can produce mold, mildew and the proliferation of vermin, all of which can trigger problems with asthma.

In units built before the 1978 federal ban on lead paint, the moisture can pose serious health risks for young children and pregnant women. Mental health problems resulting from residents living in overcrowded conditions, or being harassed and threatened with eviction under difficult housing circumstances, are common. There are sanitation issues – open running sewage, bursting pipes. Many families endure periods without hot water; others live with broken windows that don’t get repaired, and without heat in the winter.

Since joining Esperanza in 1995 – initially as its founding director of health programs, and since 2006 as executive director – Ibrahim has helped to broaden the organization’s mission beyond its original focus on quality affordable housing. Esperanza partners with the low-income families along the Figueroa Corridor neighborhood of South Los Angeles, as well as with other organizations, to help fight poverty and the problems that spring from it. The nonprofit organization now has five program areas – housing, health, economic development, arts and culture enrichment, and education. “We consider these fundamental pillars of what makes a healthy community,” says Ibrahim. “And we use these program areas – and indeed everything we do – for the purpose of developing relationships with families and individuals in the community.”

At the heart of Esperanza’s work is the Community Health Promoters Program designed by Ibrahim shortly after she arrived. The program has trained nearly 400 community members as bilingual promotores – equipping them with skills to improve the health of families while preparing them for employment opportunities in health and social-service fields.

“The majority of our graduates remain engaged with our organization on many levels,” says Ibrahim. “Their children have gone to college. Many have opened their own businesses, and many are homeowners.” Beyond the personal successes, the program’s graduates have been among the most active members of the community, Ibrahim notes, mobilizing other residents on a host of health, human rights and social justice issues.

The promotora concept was far less common in 1995, when Ibrahim was brought to Esperanza based in part on work she had been doing in the Middle East in women’s health and economic development. “While there, I learned that when you want to make progressive change in a community your greatest resource is the community-based expertise,” says Ibrahim. “It’s been a privilege to be doing that type of meaningful and lasting community-building in Los Angeles, as part of an organization that believes in digging deep community roots to make a measurable impact on families.”

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school work Global Media Center for Social Impact Will Raise Awareness of Public Health Issues By harnessing the storytelling power of television, film, music and new media, a newly established Fielding School center promises to increase awareness of important public health issues, toward the goal of improving the well-being of people throughout the world.

The Global Media Center for Social Impact will work with the entertainment industry and news media – assisting content creators and reporters in crafting compelling stories on climate change, the social determinants of health, early childhood health and other important public health topics. The center was launched with funding from a generous donation by public health leader and Fielding School professor Jonathan Fielding and his wife, Karin.

Two prominent entertainment industry figures head the new center. Founding director Sandra de Castro Buffington, a pioneering force for public health information in the industry, created a global network for entertainment education – based in Hollywood, with locations in India and Nigeria. Dr. Neal Baer, the center’s project scientist, is a pediatrician as well as executive producer of the current hit TV show “Under the Dome”; his past TV producing and writing credits include “Law & Order: Special Victims Unit" and "ER.”

UCLAFIELDING SCHOOL OF PUBLIC HEALTH

FIELDING FALL FIESTA

From kicking off a Grand Rounds lecture series to launching the Global Media Center for Social Impact and welcoming new students, life at the Fielding School this autumn is off to an eventful start.

Dean Jody Heymann gave a rundown of what’s new at the 2013 Fielding Fall Fiesta, which was attended by students, alumni, faculty, staff and friends of FSPH, including the Fielding family.

Z

Dean Heymann’s welcome address and more photos ph.ucla.edu

These pages offer a small sampling of the goings-on at the Fielding School. For more, visit us online: ph.ucla.edu

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Report Urges Major Changes in U.S. Cancer Care System

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Dr. Patricia Ganz (r.) chaired the Institute of Medicine committee that made the recommendations.

The U.S. cancer care delivery system is in crisis, according to a new report from the Institute of Medicine (IOM), which warns that major changes are needed to boost the quality of care and improve outcomes of people with the disease.

More than 1.6 million new cases of cancer are diagnosed each year – a figure expected to jump to 2.3 million within the next decade.

Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis attributes the urgent situation to the growing demand for cancer care among the aging baby boom generation, rapidly rising costs, a shrinking pool of cancer care professionals and dramatic changes in cancer therapies over the last decade – changes that sometimes make it difficult to determine which patients should receive what treatment. The report was prepared by an IOM committee chaired by Dr. Patricia Ganz, a Fielding School professor who is also director of cancer prevention and control research at UCLA’s Jonsson Comprehensive Cancer Center.

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AUTUMN 2013

Zhang Named Associate Dean for Research Dr. Zuo-Feng Zhang, an internationally renowned epidemiologist who began his career as a “barefoot doctor” in China, is the Fielding School’s new associate dean for research.

A professor of epidemiology at the Fielding School, Zhang has served as co-director of the UCLA Alper Center for Environmental Genomics since 2002, director of the Molecular Epidemiology Training Program since 1999, and scientific director of the UCLA Central Tumor Registry since 1997. He has held numerous leadership roles nationally and globally, including World Health Organization consultant for national noncommunicable disease prevention and control in China, senior scientific consultant of Jiangsu Provincial CDC and Zhejiang Provincial CDC in China, and member of the Board of Directors of the American College of Epidemiology.

To read the full report, visit ph.ucla.edu

keep in Touch Visit us online ph.ucla.edu

UCLAFIELDING SCHOOL OF PUBLIC HEALTH

ALUMNI ASSOCIATION RETREAT – Graduates from all five departments of the Fielding School reconnected at the UCLA Public Health Alumni Association annual retreat, held at UCLA in October and attended by Dean Jody Heymann.

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contracts & grants 2012-13 This section includes new contracts and grants awarded in 2012-13.

Due to space limitations, only funds of $50,000 or more are listed, by principal investigator.

SANGEETA AHLUWALIA An Implementation-based Approach to Integrating Palliative Care into the Intensive Care Unit (National Palliative Care Research Center, $154,000 for 2 years)

PATRICIA GANZ A Model Clinical/Translational Research Program for Breast Cancer Survivors: A Focus on Cognitive Function after Breast Cancer Treatment (Breast Cancer Research Foundation, $240,000)

RICHARD AMBROSE Low Energy Options for Making Water from Wastewater (National Science Foundation & UC Irvine, $455,998 for 5 years)

BETH GLENN A Safety Net Collaboratory to Improve the Use of Patient-Reported Outcome Measures of Health Behaviors and Psychological Status (UCLA Clinical and Translational Science Institute, $50,000)

ONYEBUCHI ARAH Comparative Effectiveness of Dialysis Modalities (National Institute of Diabetes and Digestive and Kidney Diseases & University of Washington, $54,485 for 3 years) SUSAN BABEY Soda Consumption in California Update (The California Endowment & California Center for Public Health Advocacy, $57,000) MARION BAER Partners in Excellence for Maternal and Child Health Nutrition (DHHS/Health Resources and Services Administration, $915,923 for 5 years) ROSHAN BASTANI UCLA Healthy-By-Default (HBD) Reach Project (DHHS/Centers for Disease Control and Prevention, $4,298,179 for 2 years) EMMELINE CHUANG Treatment Access for Families: An Application of QCA and Regression Techniques (National Institute on Drug Abuse, $79,438); Mixed Methods Study to Explain Heterogeneity in Drug Use After Early Foster Care (National Institute on Drug Abuse & Judge Baker Children’s Center, Harvard University, $334,356 for 2 years) ROGER DETELS UCLA/China CDC Training Program in Advanced Research Methodologies (Fogarty International Center, $1,356,690 for 4.5 years); Aging and Fracture Risk Among HIV-Infected and HIVUninfected Men (Johns Hopkins University & National Institute of Allergy and Infectious Diseases, $276,139 for 5 years)

UCLAFIELDING SCHOOL OF PUBLIC HEALTH

JOHN FROINES In Vivo Assessment of the Adjuvant Effect of Vapor-Phase Pollutants on Allergic Sensitization (South Coast Air Quality Management District & British Petroleum Group, $213,268)

PAMINA GORBACH Epidemiologic Impact of Human Papillomavirus Vaccine Introduction (National Institute of Allergy and Infectious Diseases & Cincinnati Children’s Hospital Medical Center, $91,641 for 5 years) PAMINA GORBACH AND STEVEN SHOPTAW Men Who Have Sex With Men (MSM) and Substances Cohort at UCLA Linking Infections Noting Effects (MASCULINE) (National Institute on Drug Abuse, $8,307,001 for 5 years) DAVID GRANT California Health Interview Survey (CHIS 2011-2012) (Blue Shield of California Research and Education Foundation, $220,500) NEAL HALFON The Interdisciplinary Maternal Child Health Training Program (Health Resources and Services Administration, $79,859) GAIL HARRISON Food Insecurity, Health, and Disability in the National Health Interview Survey (U.S. Department of Agriculture/Economic Research Service, $300,000 for 2 years) MOIRA INKELAS Improvement Support to the Magnolia Place Community Initiative Network (Children’s Bureau of Southern California, $71,036 for 1.5 years)

DAVID EISENMAN Collaborative Research: Prioritizing Cooling Infrastructure Investments for Vulnerable Southwest Populations (National Science Foundation, $296,122 for 3 years)

GERALD KOMINSKI Demographic Analysis and Microsim Model Comparisons (DHHS/Center for Medicare and Medicaid Services & California Health Benefit Exchange, $2,026,300 for 3 years) The State of Health Insurance in California Project (SHIC) (California Wellness Foundation, $125,000 for 2 years); CHIS 2011-2012 Policy Research Studies (The California Endowment, $581,935 for 2 years)

YVONNE FLORES The Impact of Genetic and Environmental Risk Factors on Liver Disease Susceptibility in a Cohort of Mexican Adults (American Association for the Study of Liver Diseases, $150,000 for 2 years)

NIKLAS KRAUSE Southern California Education and Research Center (DHHS/ Centers for Disease Control and Prevention, $7,815,065 for 5 years)

JONATHAN FIELDING Efficiently Combining Survey Data to Improve Local Area Estimates: Estimating and Forecasting Health Outcomes for Los Angeles County (Kaiser Permanente Community Benefits Grants Program, $97,414); Health Forecasting for Nonprofit Hospital Community Benefit Planning (Unihealth Foundation, $450,177 for 3 years)

ANNETTE MAXWELL Building Mixtec Community Capacity to Address Breast Health (UC/California Breast Cancer Research Program, $168,750 for 1.5 years); Using Community-Based Participatory Research to Promote Environmental Justice in Wilmington California (UC/California Breast Cancer Research Program, $93,750 for 1.5 years)

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ANNE PEBLEY Los Angeles Family and Neighborhood Survey (L.A. FANS) Integrated User Training and Support (National Institute of Child Health and Human Development, $489,784 for 3 years) NINEZ PONCE Patient-Centered Outcomes Research in Community Health Centers (DHHS/Health Resources and Services Administration & Association of Asian Pacific Community Health, $122,916); Disparities in Utilization of Gene Expression Profiling and Subsequent Chemotherapy Decisions (Aetna Life Insurance, $325,433 for 2 years); Monitoring the ACA with California Health Interview Survey (CHIS 2013-2014) Access Measures (California Healthcare Foundation, $580,883 for 2.5 years); AskCHIS Neighborhood Edition (California Wellness Foundation, $245,000 for 2 years); California Health Interview Survey (CHIS) (CA/Department of Public Health, $153,200; The East Bay Community Foundation, $316,375; Kaiser Foundation Research Institute, $316,375; Kaiser Foundation Research Institute (Northern California), $1,000,000 for 2 years; Kaiser Foundation Research Institute (Southern California), $1,000,000 for 2 years; Public Health Institute, $297,278 for 2 years; The California Endowment, $3,132,537 for 2 years) NADEREH POURAT Chronic Care Management (CA/Department of Health Care Services, $270,702 for 3 years); Assessing Costs of Maternal Hypertension and Maternal Hemorrhage (CA/Department of Public Health, $52,541) MICHAEL PRELIP Corner Store Makeovers in East Los Angeles/Boyle Heights (The California Endowment, $350,058 for 2 years)

HECTOR RODRIGUEZ Routine HPV and Health Behavior Screening in Safety Net Primary Care Practices (National Cancer Institute, $160,000) HECTOR RODRIGUEZ AND ROSHAN BASTANI Women’s Health Collaborative Research to Enhance and Advance Transformation and Excellence (CREATE) Quality Improvement (Veterans Affairs, $98,000); Women’s Health Teamlet Effectiveness (Veterans Affairs, $250,000); Health Care Information Exchange (HIE) Use in Small and Medium-sized Primary Care Practices: Understanding and Eliminating the Disparity (University of Minnesota and UCLA Clinical and Translational Science Institute, $60,000)

33 AUTUMN 2013

YING-YING MENG Office of Statewide Health Planning Development Diabetes Hospitalization (The California Endowment & California Center for Public Health Advocacy, $63,000); Improvements in Air Quality and Health Outcomes Among California Medicaid Enrollees Due to Goods Movement Actions: Phase 1 (Health Effects Institute, $499,215 for 2 years)

ROBERT SCHIESTL Mechanisms of Intestinal Inflammation-Associated Systemic Genotoxicity (National Institute of Allergy and Infectious Diseases, $378,400) KIMBERLEY SHOAF Preparedness and Emergency Response Research Centers: Public Health System (DHHS/Centers for Disease Control and Prevention, $442,797); Making Disasters Less Disastrous: Integration of Health Care, Public Health and Emergency Management (DHHS/Centers for Disease Control and Prevention, $599,079 for 3 years) PETER SINSHEIMER Alternative Analysis on Non-Leaded Alloys for Public Water System Applications (California Metals Coalition, $180,000) ARTURO VARGAS BUSTAMANTE Examining the Costs of a Medical Home Transformation for Seniors (DHHS/Agency for Health Care Research and Quality, $100,000) ONDINE VON EHRENSTEIN Inflammatory Cytokine Polymorphisms, Air Pollution, and Very Preterm Birth (National Institute of Environmental Health Sciences, $413,900 for 2 years)

ANNE RIMOIN Estimating Population Immunity to Polovirus in the Democratic Republic of Congo (Bill and Melinda Gates Foundation, $1,057,667 for 2 years)

MAY WANG AND MICHAEL PRELIP The Impact of Natural Experiments on Child Obesity: A Systems Science Approach (Eunice Kennedy Shriver National Institute of Child Health and Human Development, $2,406,503 for 5 years)

BEATE RITZ Air Pollution and Parkinson’s in the Danish Parkinson in Demark (PASIDA) Study (National Institute of Environmental Health Sciences, $381,884 for 2 years)

ANTRONETTE YANCEY Faith, Fellowship, and Fitness on the Move! (The California Endowment & Clergy and Laity United for Economic Justice, $90,000 for 2 years)

DYLAN ROBY Analyzing the Impact and Return on Investment of Wellness and Prevention Programs (Robert Wood Johnson Foundation & Trust for America’s Health, $130,081); Low Income Health Program (LIHP) Data and Transition Operations (Blue Shield of California Research and Education Foundation, $125,000)

YIFANG ZHU Assessing and Reducing Taxi Drivers’ Exposure to Ultrafine Particles (DHHS/Centers for Disease Control and Prevention, $423,500 for 2 years); Effects of Complete Street on Travel Behavior and Exposure to Vehicular Emissions (CA/EPA Air Resources Board, $250,000 for 3 years)

UCLAFIELDING SCHOOL OF PUBLIC HEALTH

THOMAS RICE Los Angeles Area Health Service Research Training Program (DHHS/Agency for Health Care Research and Quality, $2,380,676 for 5 years)

STEVEN WALLACE Helping Older Adults Maintain Independence Through Optimizing Options (HOME TOO) (The Scan Foundation, $274,986 for 1.5 years); Enhancing Economic and Health Security for Older Californians (California Wellness Foundation, $220,000 for 2 years)

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