FSPH Magazine Autumn/Winter 2015-16

PUBLIC HEALTH AU T U M N/ W I N T E R 2 0 1 5 –1 6

The UCLA Fielding School of Public Health Magazine

M I N D

MAT TE RS

Focusing Attention and Taking Action to Improve Mental and Cognitive Health

DEAN’S MESSAGE

ACCORDING TO THE WORLD HEALTH ORGANIZATION, 14 percent of the global burden of disease — a measure that takes into account both years of life lost due to premature death and the reduced quality of life during the time spent living with a condition — is attributable to mental and cognitive health issues. Mental health conditions can affect people beginning at an early age, potentially costing decades of productivity and fulfillment — as well as deeply eroding quality of life and relationships when they strike later in life.

The enormity of this problem demands public health solutions. We need to invest in prevention and ensure that care and treatment are widely available for all affected. We must change societal attitudes about mental health, removing the stigma that prevents individuals and families with mental health needs from discussing their risk factors and condition, and from seeking services that could help. This is true both in the U.S. and globally, where the lack of access to routine mental health care and the absence of sufficient prevention strategies are sometimes compounded by tragedy. We must be concerned with the mental health as well as the physical survival of the millions of refugees fleeing Syria, for example, and of the victims of massive droughts and other natural disasters.

As the articles in this issue of our magazine attest, Fielding School faculty, students, staff and alumni are engaged in wide-ranging public health efforts to identify problems and find solutions to improve mental and cognitive health. Whether it’s addressing the mental health effects of violence and discrimination; ensuring access to evidence-based treatment for people with depression, anxiety, and other mental health conditions; removing the stigma surrounding mental illness; providing more precise projections on the looming Alzheimer’s disease epidemic, including the potential impact of new prevention and treatment strategies; or assisting those dealing with cognitive decline today, including the family caregivers of people with dementia, our community is making an impact through the power of public health.

Mental and cognitive health conditions currently exact a needlessly heavy toll. We can do much more by investing in prevention, increasing access to effective treatment, and removing the stigma that too often makes these conditions worse for individuals and families. We at the Fielding School are committed to pursuing these public health strategies to ensure that all of us can lead healthier lives.

Jody Heymann, MD, PhD Dean

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The UCLA Fielding School of Public Health Magazine

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CONTENTS 16

11

22

06

18

PHOTO CREDIT: Kariné Armen

FEATURES

Q&A: 04 “ Mental Health Is

Inseparable from

Physical Health”

Pushing for stronger

prevention efforts

COMMUNITY ENGAGEMENT:

06 An Uplifting Partnership Untraditional

collaboration improves

depression care

IMPACT OF DISCRIMINATION:

08 Unhealthy Treatment

The need for a robust

public health response 11

ACCESS TO CARE:

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Righting a Wrong Working to prevent struggles like her family endured

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Putting Parity to the Test An FSPH-led study assesses the impact of a landmark law on access to mental health care

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DISASTER RESPONSE:

Rebuilding After Tragedy PTSD, resilience, and Armenia earthquake survivors

“ Black Lives Matter”:

A Public Health Issue Making the case for the field confronting racism

KEEP IN TOUCH Visit us online ph.ucla.edu

ADDRESSING SUBSTANCE USE:

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FSPH Students Pursue a Path to Solutions Public health provides a powerful tool

VIOLENCE PREVENTION AND IMPACT:

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Indirect Victims of Violence Mexico’s rising homicide rate elevates fear levels

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Motivating Teens to Make Healthy Choices Providing outlets for discussion on alcohol and drug use

Leading the Fight Against Violence No longer just a law enforcement issue

COGNITIVE EFFECTS:

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Seeing Through the Fog of “Chemo Brain” A leader in the effort to address cognitive effects of cancer treatment

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Sounding the Alarm on a Looming Public Health Threat Projections underscore urgent need for progress

26 The Invisible Patient

Seeking relief for an often overlooked population

DEPARTMENTS 27 School Work 30 Grants & Contracts 32 Transformative Investments

PHOTOGRAPHY & ILLUSTRATION Rent Control: cover; charts on pp. 4-5, 25. Betsy Winchell: Dean’s Message. Lori Strauss: TOC: photo for article on p. 22; p. 4: Aneshensel; p. 9: Mays, Cochran; pp. 15, 22, 24; pp. 27-29: Fielding Fall Fiesta, Maya Kumar (water fountain), stairwell makeover. ©iStockphoto: TOC: photo for article on p. 11; pp. 2-3, 11, 26. Kariné Armen, photokarine.com: TOC: photo for article on p. 16; pp. 16-17: all Spitak earthquake photos from Gyumri, Armenia. Margaret Molloy: TOC: photo for article on p. 18; p. 18, back cover. Owen Lei: p. 9: Gee. Cam Sanders: p. 21. COURTESY OF: Imelda PadillaFrausto: p. 13. Jenna van Draanen: p. 19: van Draanen. Centre for Addiction and Mental Health: p. 19: Waters. Billie Weiss: p. 20. Skirball Cultural Center/Photo by Robert Wedemeyer: p. 29.

Jody Heymann: p. 32: Ann and Phil Heymann. Natalie Dickson: p. 32: Dickson. Joe Mango: TOC: photo for article on p. 6; pp. 6-7. CORRECTION: The Spring/Summer 2015 issue mistakenly omitted a credit to Nathan Dappen/Day’s Edge Production for their photo on page 16. Thank you to Day’s Edge.

MIND MAT TE RS AS A SOCIETY, it’s a topic we rarely discuss. When we do, too often we stigmatize, leaving many among us to struggle in silence. But mental and cognitive health are every bit as vital to our wellbeing as physical health.

At the Fielding School, we are working to bring public health solutions to problems that affect hundreds of millions of people around the world — promoting prevention strategies, ensuring access to appropriate care, and providing information and education in an effort to change the way these conditions are viewed.

Our state of mind affects our daily function, our work productivity, our relationships, our capacity to lead fulfilling lives — and in many cases, our ability to maintain sound physical health.

When we struggle, so do those around us. That struggle should never be a cause for shame, or silence.

MAGAZINE STAFF

Carla Denly Executive Editor & Director of Communications Dan Gordon Editor & Writer Rent Control Design Direction

Jody Heymann, MD, PhD Dean Carla Wohl Assistant Dean of External Affairs

Lisa Rau & Lori Strauss Production Coordinators 2

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UCLA Fielding School of Public Health Home Page: www.ph.ucla.edu Email for Student 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 2015 by The Regents of the University of California.

Permission to reprint any portion must be obtained from the school.

Please send requests to communications@ph.ucla.edu.

EDITORIAL BOARD Haroutune K. Armenian, MD, DrPH Professor in Residence, Epidemiology; Thomas R. Belin, PhD Professor, Biostatistics; David D. Clark Assistant Dean for Student Affairs; Hilary Godwin, PhD Associate Dean for Academic Programs; Professor, Environmental Health Sciences; Pamina Gorbach, DrPH Professor, Epidemiology; Moira Inkelas, PhD Associate Professor, Health Policy and Management; Richard J. Jackson, MD, MPH Professor, Environmental Health Sciences; Marjorie Kagawa-Singer, PhD, MN Professor Emerita, Community Health Sciences; Michael Prelip, DPA Associate Dean for Practice Across the Life Course; Professor in Residence, Community Health Sciences; Beate Ritz, PhD Professor, Epidemiology; May C. Wang, DrPH Professor, Community Health Sciences; Zuo-Feng Zhang, MD, PhD Associate Dean for Research; Professor and Interim Chair, Epidemiology; Frederick Zimmerman, PhD Professor, Health Policy and Management; Hannah Brosnan and Chelsea Shover CoPresidents, Public Health Student Association; Neil Sehgal, MPH ’05 President, Public Health Alumni Association ph.ucla.edu

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A

AND

“MENTAL HEALTH IS INSEPARABLE FROM PHYSICAL HEALTH” FSPH professor and leading expert in the field Dr. Carol Aneshensel argues that the far-reaching individual and societal effects of mental and cognitive health conditions require public health to do more.

OVER THE LAST THREE DECADES, Dr. Carol Aneshensel has earned a reputation as a leading scholar in how societal factors affect the mental health of populations. Much of her research in recent years has focused on the impact of social inequalities.

Aneshensel has shown, for example, that where we live can have a significant effect on both our emotional wellbeing and cognition. In large national studies, she has found that the psychological benefits of living in affluent neighborhoods are greatest for residents with fewer financial resources. Similarly, Aneshensel and her colleagues were among the first to show that the cognitive function of individuals who are socioeconomically disadvantaged is higher, on average, when they live in a more affluent neighborhood compared to similar individuals who live in a low-income neighborhood.

Aneshensel, professor and vice chair of the Fielding School’s Department of Community Health Sciences, is also a leading voice on behalf of intensifying public health efforts to improve mental health while preventing and addressing mental disorders.

She spoke with the Fielding School’s UCLA Public Health magazine on that topic.

MENTAL HEALTH

BY THE NUMBERS

Approximately

4

1 in 5 Adults

DR. CAROL ANESHENSEL SAYS PRIMARY PREVENTION EFFORTS SHOULD ADDRESS “MENTAL HEALTH LITERACY.”

Only

41% in the U.S. — 43.8 million, or 18.5% — experiences mental illness in a given year.

of adults in the U.S. with a mental health condition received mental health services in the past year.

Source: National Alliance on Mental Illness (2015)

Source: National Alliance on Mental Illness (2015)

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“Efforts should include universal programs in school that help students develop views of themselves that are protective.”

Q: People often think of public health goals in terms of physical outcomes. Why is it important to view mental health as a public health issue?

A: Mental health is inseparable from physical health. One in two Americans is at risk for having a mental, emotional, or behavioral disorder in their lifetime. One in four is affected in any given year. A major depressive disorder can sap people of their ability to concentrate. They may lose interest in the things that they usually enjoy, or their ability to function. The lost productivity runs in the billions of dollars – and that’s for depression alone, which is the single most common disorder. Anxiety disorders are also highly prevalent. And the suffering isn’t confined to the people with the disorder. Spillover to families is substantial and it is not uncommon for families to be unaware that something is seriously wrong until a crisis has occurred.

ways of keeping stressful experiences from becoming instances of depression, anxiety, or other mental or behavioral disorders.

Also, primary prevention activities should address mental health literacy: Adults as well as children should know the signs and symptoms of mental illness, so that they know when to get help or when to assist others in getting help before a crisis erupts.

Q: And it’s also important for public health, as a field, to work toward removing the stigma and encouraging people who are suffering to get treatment.

A: Right. I think that’s the number one thing here – working to remove the stigma so that those who are suffering aren’t afraid to come forward.

Q: What is public health’s role in trying to address mental health? Do we need to focus more on prevention for people who are at risk?

A: We do. The median age of onset for psychiatric disorders in the U.S. is 14, which means that primary prevention efforts should begin early in life. These efforts should include universal programs in school that help students develop views of themselves that are protective, such as programs that promote self-esteem and self-efficacy, along with positive social relationships that help people cope with life’s difficulties. Specific coping strategies, such as those involved in cognitive behavioral therapy, can be taught as

Q: What developments make you hopeful about progress toward these goals?

A: The most promising sign is the increasing attention to mental health by the World Health Organization through its annual World Mental Health Day, observed October 10, and its Comprehensive Mental Health Action Plan 2013–2020. Pending legislation at the national level in the U.S. also promises better and more accessible, comprehensive and integrated mental health treatment services.

At the same time, the media has begun a noticeable shift in its coverage of mental health issues, from focusing exclusively on instances in which a person with mental illness perpetrates an act of violence to covering instances in which people lead productive lives and contribute to the community.

In 2014, about

Approximately

1 in 10 Young People

15% experienced a period of major depression.

of adults aged 60 and over suffer from a mental disorder.

Source: MentalHealth.gov (2015)

Source: World Health Organization (2015)

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COMMUNIT Y ENGAGEMENT

AN UPLIFTING PARTNERSHIP Using an untraditional model, a university-community project increases access to depression care and improves mental health in under-resourced parts of Los Angeles.

THE SEEDS OF A GROUNDBREAKING PARTNERSHIP to improve depression care in under-resourced parts of Los Angeles were sown more than a decade ago.

As the leader of a non-profit advocacy organization aiming to improve the health of African American, Latino, and Korean communities of Los Angeles, Loretta Jones was deeply concerned about the mental wellbeing of the communities she represented – and the stigma that kept many from seeking help for clinical depression. “Depression wasn’t a word that people were even using in our communities,” says Jones, founder and CEO of Healthy African American Families II. “We needed to get the word out that this is an illness that can be treated, that the treatment people needed could be found in the community, and that the community would be there for them.”

As a psychiatrist and health services researcher interested in improving mental health services in under-resourced com-

munities, Dr. Kenneth Wells (MPH ’80), a professor in the Fielding School’s Department of Health Policy and Management and David Geffen School of Medicine at UCLA, as well as a staff member at RAND, had completed a major national study, Partners in Care, finding that African Americans, Latinos and other ethnic minority groups were significantly less likely than more affluent whites to receive the care they needed for depression. But the Wells-led study also showed that expanding access to appropriate depression care led to 4-5 times greater mental-health outcome improvements for ethnic minorities than for whites.

“It was clear there was a tremendous opportunity because there had been so little prior exposure to evidence-based treatment in these under-resourced communities,” Wells says.

The question was how to translate the promise of high-quality depression care into a public health reality in communities of color. To help find answers, Wells approached Jones, and for the next several years “I became Loretta’s apprentice,” Wells says, as they engaged in discussions about the best ways to establish a dialogue in the community about depression; to improve the quality and accessibility

of depression care; and to build on existing community strengths in doing so. The result is the ongoing Community Partners in Care (CPIC), which “has made it safe to talk about depression in my community,” says Jones, one of the leaders in the effort, which involves nearly 100 community organizations in South Los Angeles and Hollywood-Metro Los Angeles.

CPIC has used rigorous study methods to determine whether agencies and communities working together through a community engagement process is a better way of improving depression services and quality of life outcomes for people who need the services than agencies working alone. Most notably, CPIC employs a model that draws on the strengths of the university and the community in an equal partnership. “This is a truly level playing field that allows communities to give input to universities on what needs to be done, and the university to respond with evidence-based but community- involved research,” says Jones. “There is no decision made by the university that is not vetted in the community first. No publications are submitted without the community’s input into them.”

More than any collaboration she has seen, Jones says, CPIC values the expertise residing in the community – including individuals who possess what she refers to as “the PhD of the sidewalk.” Because of community input, for example, CPIC expanded on the Partners in Care concept, which was based in primary care clinics, to also bring depression education and

COMMUNITY PARTNERS IN CARE (CPIC) STEERING COUNCIL MEETING IN 2008

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CPIC TEAM AND COMMUNITY PARTNERS GATHER IN 2014.

services to homeless and social service agencies, prison re-entry populations, substance-use treatment clinics, faithbased institutions, and other community programs and settings.

The work of Dr. Thomas Belin, professor in the Fielding School’s Department of Biostatistics and co-chair of the methods committee that designed the CPIC study, exemplifies the value of the project’s

“This is a truly level playing field.” close partnership. Belin has given talks on integrating traditional statistical ideas into community-partnered research, underscoring the importance of cultivating trust given the legacy of research abuses that have historically occurred in minority communities. In his role of helping to ensure that CPIC remains on a secure scientific foundation, Belin has benefited greatly from community input. “This project illustrates how much we have to gain by bridging strong science with the needs of the community in a way that is based on mutual respect,” Belin says. “When we combine

academic strength in rigorous science with community partners’ credibility and knowledge of the local environment, the result can be amazingly powerful.”

The results of the study have fulfilled the hopes of its architects. In a randomized trial involving more than 1,000 depressed, primarily low-income African American and Latino clients drawn from 93 community settings, the community engagement approach led to improved mental healthrelated quality of life, a lower risk for homelessness, and a reduction by approximately 50 percent in hospitalizations for behavioral health conditions. As the randomized phase has drawn to a close, CPIC has entered a dissemination phase in which the results are shared with the community and workshops are held to discuss strategies for sustainable efforts to apply the findings to improving depression services.

CPIC’s success hasn’t gone unnoticed.

The project has earned national acclaim, including the Team Science Award of the Association of Clinical and Translational Science in 2014, Community-Campus Partnerships for Health’s annual award for 2015, as well as the Landmark Award as the UCLA Community Program of the Year.

In 2014, based on early results from the study, the L.A. County Board of Supervisors approved a proposal led by the county’s Department of Mental Health Services to

adopt the Health Neighborhood Initiative, which uses the CPIC engagement model to respond to community behavior health needs under expanded Medicaid services.

The Veterans Health Administration, based on CPIC’s findings on reducing homelessness risk, is working with CPIC leadership on research and training initiatives to improve services for homeless veterans.

Wells and Jones are teaching current and future professionals in public health and related fields about the CPIC partnership model, applying it to a wide variety of health concerns. Wells directs the Community Based Participatory Health Research course at the Fielding School with staff from Healthy African American Families II, the L.A. County Department of Health Services and the L.A. County Department of Mental Health Services.

Jones, honored in 2014 by the UCLA Fielding School of Public Health Alumni Association with the Ruth Roemer Social Justice Leadership Award, has dedicated more than 40 years to eliminating health disparities and improving health outcomes in Los Angeles. “The work we’re doing with CPIC has allowed communities to feel like they’re being heard in a way they haven’t before,” she says. “We’ve been working a long time to try to reduce health disparities, and with this model we are finally starting to see that we can make a difference.” ph.ucla.edu

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unhealthy treatment

With evidence showing that discrimination puts people at greater risk for stress-related conditions, FSPH faculty point to the need for a robust public health response.

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IMPACT OF DISCRIMINATION

TOP TO BOTTOM: DRS. VICKIE MAYS, GILBERT GEE AND SUSAN COCHRAN ARE AMONG THE FSPH FACULTY TAKING A PUBLIC HEALTH PERSPECTIVE ON DISCRIMINATION.

FEW WOULD ARGUE WITH THE NOTION that discrimination based on race, ethnicity, sexual orientation and other characteristics continues to be a problem in U.S. society, or that historical and current injustices have contributed to everything from economic inequalities to inequities in some physical health outcomes.

But to what extent does being on the receiving end of overt mistreatment, as well as subtler but no less pernicious structural biases, affect one’s mental health?

“We now have decades of research showing that when people are chronically treated differently, unfairly, or badly, it can have effects ranging from low self-esteem to a higher risk for developing stressrelated disorders such as anxiety and depression,” says Dr. Vickie Mays, a Fielding School professor in the Department of Health Policy and Management whose research, in collaboration with Dr. Susan Cochran, professor in FSPH’s Department of Epidemiology, has helped to document the links.

And as Mays notes, when any one person’s mental health is affected, it can produce a domino effect extending beyond the individual. “We know that when people have a psychiatric disorder, it’s not good for any of us,” she says. “For example, it can affect parenting – a depressed mom might not be able to interact with her child in a way that best promotes that child’s development, leaving the child more vulnerable to certain behavioral disorders. In that sense, we all suffer from the effects of discrimination.”

Dr. Gilbert Gee, professor in FSPH’s Department of Community Health Sciences, sought in a 2007 study to determine the extent to which Asian Americans who reported being the victims of discrimination were more vulnerable to developing clinically diagnosable mental disorders. “Much of the research has focused on symptoms of sadness and anxiety resulting from the mistreatment, and that’s very important, but we wanted to look at clinical outcomes,” Gee says. Even after taking into account other potential causes of stress, Gee found a clear relationship between discrimination and increased risk of mental disorders.

Since that study, other research has reported similar results in African American and Latino populations, as well as in other populations around the world, Gee says. He also found, in a 2014 study of Latinas/os, that discrimination was significantly associated with increased risk of alcohol abuse among women and increased risk of drug abuse among men. In 2015, Gee and colleagues performed an analysis drawing from approximately 300 studies conducted around the world over the last three decades. This meta-analysis concluded that self-reported racial discrimination is consistently related to poor mental health.

Discrimination is incredibly complex and experienced in so many different ways that it can be difficult to pinpoint the process by which it undermines mental health. “There are so many different routes, some of them direct and some of them indirect,” Gee explains. He points out that while a hate crime occurring in a community is certain to affect the mental health status of the victim and the victim’s family, it can also have a spillover effect for acquaintances and non-acquaintances in the community. Poor treatment based on race, ethnicity, sexual orientation and other factors can occur through interpersonal insults as well as through more insidious routes. “If you don’t get a job and you’re left to wonder whether it had to do with your race or gender, that can have an impact on your mental health,” Gee says. “We know that when people are worried about things, it affects their mood.”

Emerging research using neuroimaging tools is helping to isolate the brain mechanisms at play in these scenarios. A study led by one of Gee’s postdoctoral fellows recorded South Asian women talking about their experiences of being treated poorly, then had the women listen to the recordings while their brains were scanned using functional magnetic resonance imaging. The parts of the brain that responded as the women listened were the same as those that regulate emotions and stress.

More recently, Mays has collaborated on a study showing that experiencing significant amounts of discrimination over time can lead to changes in the way the brain processes information – disrupting, for example, the regions involved in planning and decision-making.

“When we’ve had these experiences and anticipate that other incidents might lead us to be discriminated against, it can interfere with our ability to cognitively function at our best,” Mays says.

For much of the 20th century, homosexuality was classified as a mental illness. That thinking began to change after the publication in 1957 of an influential paper by UCLA research psychologist Evelyn Hooker, in which experts administering mental health tests found no detectable difference between homosexual and heterosexual men. The American Psychiatric Association and American Psychological Association stopped classifying homosexuality as a mental disorder in the 1970s. Now, Cochran is part of a group of experts working with the World Health Organization to eliminate the last remaining mental health diagnoses linked to homosexuality from the organization’s International Classification of Diseases.

“This recommendation, to remove diagnoses that have no scientific basis, is a way of cleansing our public health apparatus of the social ph.ucla.edu

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“Public health can do a great deal to improve the mental health status of people who are mistreated.”

animus directed at a group of people for reasons that have no health justification,” Cochran says.

She notes that the mental health impact of the poor treatment long directed at people who are gay could not even be adequately studied until the end of the 1990s, when health surveys first began to include questions about sexual orientation.

Since that time, Cochran has used state and national data sets for studies in which she has found that lesbians and gay men report much higher levels of discrimination and experiences with disrespect and daily hassles than heterosexuals, and that these experiences are strongly correlated with current levels of psychological distress.

Amid changing societal attitudes toward homosexuality, Cochran and other researchers are interested in what impact the increased acceptance might have on the mental health of lesbian, gay and bisexual people. On the question of samesex marriage, for example, Pew Research polling found that only 35 percent of Americans were in favor vs. 57 percent opposed in 2001, the year Cochran and Mays published a widely cited American Journal of Public Health paper pointing to high levels of discrimination corresponding with levels of mental distress among lesbians and gay men. By 2015, Pew had found that 55 percent of Americans supported samesex marriage, vs. 39 percent opposed. “It’s certainly reasonable to anticipate that the levels of distress should go down as the levels of discrimination go down, although 10

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we haven’t seen much evidence of that yet,” says Cochran, who points out that even as attitudes toward homosexuality change, high levels of discrimination and poor treatment remain.

In May 2015, Mays addressed the American Psychological Association’s annual meeting with a presentation called “Racial/ Ethnic Minority Lives Matter: Bridging Science and Practice in Policy Solutions.” She argued that, even as research continues to unravel the mental health effects of discrimination, more action should be taken to apply what is already known. “Public health can do a great deal to improve the mental health status, as well as the physical health, of people who are mistreated,” Mays says. “There is science that can help us to design effective interventions.”

Among other strategies, Mays suggests that a coordinated public health effort is needed to better integrate what is known about the outcomes of discrimination into health care profiles.

“We screen for mental health disorders when we are putting together an individual’s electronic health record, but maybe we also need to ask about their experiences with discrimination, which would identify people at risk who could benefit from prevention efforts,” Mays says. “And among patients who experience high levels of discrimination, we need to be concerned with the potential for distrust of the health care provider. It could be that if we want better health care outcomes, we should allow these patients to know more about the provider they are selecting to ensure it’s someone they are comfortable with.”

But Mays says the focus shouldn’t be only on the victims of discrimination. “We need to target prevention strategies at the perpetrators of racism, just like we’ve targeted people who are developing bullying behaviors, starting in the school system,” she says. “We can do more to learn about the processes that lead people to treat others this way, and how to disrupt those through early education.”

Gee believes public health can also do more to help shape future legislation that would both reduce discrimination and improve the mental health of its historic targets. “Policies that promote human rights can not only buttress the foundations of a civil society,” Gee says, “but they can also make for a healthier one.”

IMPACT OF DISCRIMINATION

“ BLACK LIVES MATTER” : A PUBLIC HEALTH ISSUE In an American Journal of Public Health commentary, FSPH student, alumna state their belief that the field must confront racism in addressing disparities.

THE 2014 DEATHS OF TWO UNARMED BLACK MEN at the hands of police in Staten Island, NY, and Ferguson, MO, along with the non-indictment of the officers involved, sparked a national outcry and debate over racial injustices in the legal system, in policing, and in society as a whole. But glaringly absent, from the standpoint of a current Fielding School student and a recent graduate, was a public health perspective in response to these and related events both before and after.

So Mienah Zulfacar Sharif, a current doctoral student in FSPH’s Department of Community Health Sciences, and alumna Jennifer Jee-Lyn García (PhD ’14) decided to address the issue themselves in the American Journal of Public Health. Their August 2015 article “Black Lives Matter: A Commentary on Racism and Public Health,” written under the mentorship of Dr. Chandra Ford, associate professor in FSPH’s Department of Community Health Sciences, calls on the field to recognize the role of racism in undermining public health goals, and to shift the discourse and agenda of

public health to more actively engage in racial justice efforts.

“The idea for writing a commentary grew out of our frustration with the lack of a public health framing for these deaths and the limited dialogue about racism more generally,” says García.

In the commentary, Sharif and García express a desire to expand the dialogue beyond the well-publicized incidents of police-related deaths and toward a broader discussion of racism in America and how it affects the health and wellbeing of people of color. “Racism as a social condition is a fundamental cause of health and illness … [and] a social determinant of health that perpetuates and exacerbates the very trends our field works to reverse,” they argue. “Health disparities, discrimination, and residential segregation, which are topics familiar to public health researchers, are byproducts of racism. Yet, these topics are often discussed without explicit acknowledgement of their connection to racism.”

The article goes on to call on public health to use training, research, and community-engaged advocacy to implement an agenda that “recognizes the connection between structural racism and racialized disparities in health.”

“As we argue in the commentary, public health at its core is anti-racism work,” Sharif says. “Racism is pervasive, whether in covert or overt forms, at all levels in society. Avoiding the topic facilitates the perpetuation and exacerbation of the racialized inequities, including but not limited to health disparities, that impede progress on all fronts.”

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ACCESS TO CARE

RIGHTING A

WRONG After living through her family’s struggles with lack of information and services, an FSPH doctoral student contributes to improved mental health policies.

WHEN IMELDA PADILLA-FRAUSTO (MPH ’07) WAS STILL IN MIDDLE SCHOOL, her older brother became ill and, after several challenging years, was diagnosed with schizophrenia. “Living in a small rural town in Texas, my family had trouble finding services or even information to help us understand what was going on with him,” Padilla-Frausto recalls. “I took it upon myself to learn more so I could help him, and eventually decided that I wanted to dedicate my career to improving mental health awareness and services, particularly in Latino communities.”

Since earning her MPH at the Fielding School, Padilla-Frausto has worked at the FSPH-based UCLA Center for Health Policy Research where, as a graduate student researcher, she plays a key role in the center’s mental health research and policy work.

Padilla-Frausto now divides her time between the center and her studies as a doctoral student in the Fielding School’s Department of Community Health Sciences. Her dissertation will examine the inequities in mental health service use among Latinos.

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Through her work at the center, Padilla-Frausto has helped to put a spotlight on the extent to which adults and children in California need mental health services, and in many cases are not receiving them. In 2012 she was the lead author on a study that found, based on results from the center’s 2009 California Health Interview Survey (CHIS), that an estimated 1.6 million adults ages 18-64 reported they had symptoms consistent with severe psychological distress, and that their mental health status interfered with their day-to-day functioning. Approximately one-third of those adults were uninsured for all or part of the year.

Implementation of the Affordable Care Act may improve access to mental health services for some communities, but not all, PadillaFrausto notes. In particular, she says, the exclusion of the state’s 2.2 million undocumented immigrants from purchasing coverage through the state-run health insurance exchange or obtaining coverage under state Medicaid expansion is “extremely shortsighted in ensuring the overall health and wellbeing of our society.”

“I want to use my education to help make things better for people who are in situations similar to what I experienced growing up.”

Barriers to Latinos accessing mental health services go beyond insurance-related issues, Padilla-Frausto notes, which is why she is focusing in her doctoral studies on additional factors. “There are important structural issues,” she says. “We find a shortage of mental health professionals overall, but particularly in Latino communities, as well as a shortage of mental health professionals who are bilingual and/or able to provide culturally sensitive services. In the Latino community, as in all of U.S. society, there are additional issues contributing to the stigma associated with mental illness that keeps many people from seeking the care they need.”

Padilla-Frausto’s work at the center has led to an ongoing relationship with the office of California state Sen. Jim Beall, who chairs both the Select Committee on Mental Health and the Mental Health Caucus. Padilla-Frausto is frequently called upon to provide Beall and his staff with mental health and service-use data and has been invited to speak at the Mental Health Caucus, as well as to provide specific data on Latinos for members of the senate’s Latino Caucus.

In early 2015, Padilla-Frausto responded to a request from Beall’s office to provide CHIS data on the mental health needs and service use of California schoolchildren. Padilla-Frausto had been the lead author on a 2014 UCLA Center for Health Policy Research policy brief reporting that in 2011-12, only one-fourth of the more than 300,000 California children ages 4-11 with mental health needs were receiving any type of counseling. Beall used the data to request a state audit of mental health services provided to students in California schools. Under Assembly Bill 114, signed into law in 2011, school districts rather than county mental health agencies are responsible for providing mental health services to students who need them.

The audit, designed to examine whether school districts are appropriately using state mental health funds to meet the needs of their students, was approved. “Imelda’s help in identifying the necessary data to demonstrate the problem in our schools was invaluable, and I know contributed to the passage of the audit request,” Sen. Beall says.

Padilla-Frausto knew little about the potential for public health to address the problems her family had experienced following her brother’s diagnosis until, as a college undergraduate, she volunteered for a community-based research project that involved training Latino lay health workers to be mental health practitioners. After seeing how enthusiastic Padilla-Frausto was about the work, the principal investigator suggested that public health would be an ideal field for

IMELDA PADILLA-FRAUSTO WITH HER BROTHER, ROBERTO, AND HER SON, ANTONIO, AT ROBERTO’S GRADUATION FROM TEXAS TECH UNIVERSITY IN 2013.

her and introduced her to the late Dr. E. Richard Brown, founding director of the UCLA Center for Health Policy Research, who ultimately served as one of Padilla-Frausto’s mentors when she went to work at the center following completion of her MPH at the Fielding School. A few years later, Brown and Dr. Steven P. Wallace, the center’s associate director, encouraged Padilla-Frausto to pursue her interest in returning to FSPH for her PhD. “I want to use my education to help make things better for people who are in situations similar to what I experienced growing up,” Padilla-Frausto says. “I will never forget what it was like, in the beginning, to be part of my family’s struggle – not understanding mental illness or what mental health services were, and not having any place to speak about it. I also know that with the appropriate mental health services and other supportive services, recovering from a mental illness is possible. My brother courageously continued his educational pursuits and received his BA in 2013, 25 years after being diagnosed.

I want to help others, especially in the Latino community, to realize that they don’t have to go through this alone, and I hope to inform policies that will provide them with better services.” ph.ucla.edu

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ACCESS TO CARE

PUTTING PARITY TO THE TEST An FSPH-led study assesses the impact of a landmark federal law on access to mental health and substance abuse services.

THE PAUL WELLSTONE AND PETE DOMENICI Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) was heralded as a landmark law with the potential to dramatically improve access to mental health and substance use treatment in the United States. Requiring commercial health plans that offer such benefits to provide them on par with medical and surgical benefits, the new law went further than any policy before it in its effort to ensure that more people who need mental health and substance use services are able to get them.

“There is a long history of inequities in insurance coverage for medical care vs. coverage for behavioral health care, including treatment for both mental illness and substance use disorders,” says Dr. Susan Ettner, a professor in FSPH’s Department of Health Policy and Management. “Earlier laws had tried to address those disparities, including one previous federal parity law and a number of state parity laws. But all of those policies had limitations that led to the persistence of the inequities.”

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U C L A F I E L D I N G S C H O O L O F P U B L I C H E A LT H M AG A Z I N E

DR. SUSAN ETTNER, PROFESSOR IN FSPH’S DEPARTMENT OF HEALTH POLICY AND MANAGEMENT.

MHPAEA promised to be different, and now Ettner, an economist with an interest in how policies aiming to change financial incentives can influence health services utilization and outcomes, is in the midst of a federally funded effort to determine whether it’s fulfilling that promise. She heads a four-year, National Institute on Drug Abuse-funded study that uses administrative data from Optum, the nation’s largest managed behavioral health organization, to address key questions related to how MHPAEA is affecting the coverage, utilization and cost of mental health and substance use services.

MHPAEA’s provisions went beyond previous federal and state parity legislation in important ways, Ettner says. Self-funded insurance plans – an increasingly popular option among large employer groups – are exempt from any benefit mandates coming from states, but as a federal law, MHPAEA was able to apply to such plans, ensuring that far more people would be affected. The new law is also much more comprehensive than anything before in the way it mandates parity in three key aspects of coverage: financial requirements, including co-payments and deductibles; quantitative treatment limits, including maximum number of outpatient visits or inpatient nights covered; and, perhaps most significantly, non-quantitative treatment limits – including medical necessity reviews, prior authorization requirements, and other stipulations that can be used to limit coverage. In addition, unlike the previous federal law and many state mandates, MHPAEA applies to substance use disorders as well as mental health diagnoses.

Among the fundamental concerns Ettner’s study addresses is whether MHPAEA might have the unintended effect of reducing access to mental health and substance use services.

“The law doesn’t require that plans cover a mental health or substance use diagnosis; it just says that if they do cover it, they have to cover it at parity with medical care,” Ettner says. “Our concern was that some employer groups, rather than offering more generous coverage of behavioral health disorders, might choose not to cover these diagnoses at all. But we haven’t found any evidence that employer groups are dropping coverage for behavioral health.”

The study is also exploring the impact on mental health and substance use benefits offered by employers that do continue to cover them under the parity law. “We expected that cost-sharing would decline; that the quantitative treatment limits would either be eliminated or would become more generous, depending on what was happening on the medical side; and that the non-quantitative treatment limits – in other words, the direct management of care – would be relaxed,” Ettner says. “And if all that occurred and the benefits did become more generous, you would expect to see greater utilization and expenditures for the services, along with a shift of costs away from the patient and toward the plan.”

Thus far, Ettner and her study colleagues are finding some positive changes in all of these areas. Most striking, Ettner notes, are the changes in quantitative treatment limits. “Before

“When you have inequities in insurance coverage, it contributes to the idea that there’s something wrong with seeking treatment for mental illness or substance use disorders.” parity, it was very common for a health plan to place limits on the number of inpatient nights or outpatient visits, which meant that anyone who was a high utilizer of services was going to run up against the limit, at which point coverage stopped,” she says.

“Post-parity law, this has been completely eliminated. We have found that consistently across different types of plans.”

By partnering with Optum – which contracts with more than 3,000 employers, health plans and public sector agencies, covering nearly 25 million people across all 50 states – Ettner has access to the company’s administrative data, which is more reliable for analysis than data that would be obtained from surveying members, who are often uncertain about the nature of their benefits. At the Fielding School, Ettner is partnering on the research with her doctoral student, Sarah Friedman, who is using the same data to write her dissertation about how members’ utilization of mental health services is affected by the changes in benefit features before and after the parity law. “Given the important role mental health plays in maintaining overall health, as well as helping individuals enjoy productive and fulfilling lives, there are so many important questions to explore.

I hope to pursue future research that informs policy and practice in this arena,” Friedman says.

For all of its strengths, MHPAEA doesn’t fully solve the issue of access to appropriate mental health and substance use disorder services, Ettner says. Although removal of the treatment limits is important for patients with the most severe needs, most people never hit their limits. The law doesn’t require that plans cover specific disorders, and applies only to commercially insured, large-employer groups. “We don’t want to lose sight of the fact that the sickest of the sick tend to be publicly insured or uninsured individuals, who are not affected by this law,” Ettner says. “And unfortunately, public services tend to be underfunded and mentally ill and substance abusing populations lack political clout.” However, she notes, provisions under the Affordable Care Act will extend the reach of the parity provisions to many of these vulnerable patients in the future.

Nonetheless, she believes that the law represents a milestone – not only by increasing access for a large population of individuals in need of the services, but because of the message it sends. “An issue that always arises with behavioral health care is stigma,” Ettner says. “When you have inequities in insurance coverage, it contributes to the idea that there’s something wrong with seeking treatment for mental illness or substance use disorders. This law makes a statement that these are illnesses that need treatment, just like any other medical condition.” ph.ucla.edu

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DISASTER RESPONSE

REBUILDING AFTER TRAGEDY By following up with survivors of the Spitak, Armenia, earthquake more than 20 years later, FSPH researchers learn about PTSD and ways to promote resilience.

THE 6.9-MAGNITUDE EARTHQUAKE that struck northern Armenia on December 7, 1988, almost entirely destroyed the town of Spitak, closest to the epicenter, and caused damage to nearly one-third of the country. More than 25,000 people died, an estimated 100,000 were injured and half a million people lost their homes.

In the initial years after the tragedy, as many as half of the earthquake survivors suffered from symptoms of post-traumatic stress disorder (PTSD) ranging from palpitations, sweating and anxiety to flashbacks and recurring nightmares about the event.

More than two decades later, many of the survivors had put the psychological distress behind them and were leading productive and fulfilling lives, but a substantial portion – as many as 20-25 percent – continued to experience PTSD and other mental health after-effects that severely impaired their quality of life.

These and other findings about the long-term mental health impact of living through a disaster, as well as the potential for public health to successfully intervene, come from follow-up surveys of thousands of Spitak earthquake survivors in the first several years after the tragedy, and then again starting in 2012. “Many of these psychological effects that were initially identified continued to persist in this population some 23 years later, affecting not only their mental health and quality of life, but in many cases their physical health as well,” says Dr. Haroutune K. Armenian, professor of epidemiology at the Fielding School, who has headed the studies. “But by following up with the same population all these years later, we are able to look at factors that make a difference in helping 16

PHOTOS FROM GYUMRI, ARMENIA, WHICH WAS DEVASTATED BY THE 1988 SPITAK EARTHQUAKE.

photography by

Kariné Armen

people overcome such a traumatic experience. And we have found that well-targeted public health efforts following a disaster can make a tremendous difference in improving the long-term quality of life of survivors.”

Armenian notes that although other studies have shown the effects of disasterrelated experiences on mental and physical health, little is known about the long-term quality of life of disaster survivors, or the factors associated with positive and negative outcomes – knowledge that could go a long way toward informing public health strategies in a disaster’s aftermath.

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In 1990, Armenian began one of the first and largest population-based assessments of earthquake survivors’ mental and physical health, collecting data in 1990, 1992 and 1994 on more than 32,000 Spitak earthquake survivors to learn how their lives unfolded in the disaster’s aftermath. Then in 2011, while Armenian was teaching at the American University of Armenia, one of his MPH students, Vahe Khachadourian, approached him about re-contacting participants from those early phases of the study to see how they were doing 23 years after the quake. Today, Khachadourian is a Fielding School doctoral student continuing to work with Armenian on follow-up studies of more than 1,700 individuals from the original cohort. Funding for the initial 23-year follow-up research, as well as for the first year of Khachadourian’s doctoral studies, came from The Turpanjian Family Educational Foundation of Los Angeles.

The impact of the lingering PTSD on the survivors is profound, Khachadourian says.

Beyond the PTSD-related symptoms, the FSPH researchers have found the condition to be associated with other mental health

problems such as depression, anxiety, and alcohol and substance abuse. “The PTSD has a major impact on quality of life,” Khachadourian explains. “People will avoid places, other individuals, discussions, and events that remind them of the trauma.”

By following up with the survivors over such a long period of time, Armenian and Khachadourian are beginning to identify factors associated with being able to move beyond the psychological difficulties and rebuild their lives – in some cases even reporting better quality than they had before the earthquake. Among their findings: Survivors with high scores on measures of dignity have fared much better in the post-earthquake years. In addition, for those who experienced the most severe losses from the quake, immediate support in the form of food, shelter, and financial resources was critical to the long-term psychological recovery. The findings have also pointed to the importance of social support. “People who experienced the earthquake with someone else have shown better resilience than those who experienced the trauma alone,” Armenian explains. The researchers are

now preparing to embark on a much larger follow-up study with the same population.

Khachadourian is a physician who, after a year as a general practitioner in Armenia, decided to move into public health – and particularly research that explores the factors associated with positive and negative mental health outcomes. Presented with the opportunity to work with Armenian on a follow-up of the Spitak earthquake survivor cohort, he didn’t hesitate to move to the United States, apply and later enroll in the Fielding School’s PhD program in the Department of Epidemiology.

Born in Iran, Khachadourian moved to Armenia in 2003, when he was 17. Although it had been 15 years since the earthquake, he could see the enduring impact. “It was always interesting to hear stories of what people went through and how it affected their lives,” he says. “I have known some people who overcame the adversity and are now successful, while others continue to suffer.

By learning more about what is most helpful to the recovery, public health can develop programs and policies that will make a difference following future disasters.”

ph.ucla.edu

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17

ADDRESSING SUBSTANCE USE

MOTIVATING TEENS TO MAKE HEALTHY CHOICES By learning what draws youth to initiate alcohol and drug use and providing outlets for discussion, an FSPH faculty member paves the way toward better outcomes.

IN DEVELOPING, IMPLEMENTING AND EVALUATING drug and alcohol prevention programs for adolescents, Dr. Elizabeth D’Amico, adjunct professor in the Fielding School’s Department of Community Health Sciences, is regularly reminded of the important role of mental health.

“There is a lot of evidence that youth who have anxiety or depressive symptoms may be more likely to use alcohol or drugs – and that youth who use alcohol and drugs also tend to show anxiety and depressive symptoms,” says D’Amico, a licensed clinical psychologist who, in addition to her Fielding School faculty position, is a senior behavioral scientist at RAND. “As a result, it’s important to provide opportunities for youth to discuss why they might want to use, and to help them understand that there are healthier ways to address these feelings.”

Through programming in a variety of settings, D’Amico is providing outlets for youth to discuss and better understand why some are drawn to using alcohol and drugs, dispelling myths about the prevalence of use among their peers, and empowering them to consider the healthier options available to them. Her programs employ an evidence-based approach called “motivational interviewing” that emphasizes respectful interactions, listening to the youth, and supporting them in meeting their goals. “We try to reach them in innovative ways, because we know that most teens aren’t going to access traditional services – whether it’s because they don’t see a need, are concerned about confidentiality, or don’t know how to find the necessary resources,” she explains.

18

CHOICE, a program D’Amico developed for middle school youth in Southern California, differs from typical school-based programs designed to prevent alcohol and drug use in that it is voluntary and held after school. Offered in five sessions during which youth can drop in at any time, the program provides snacks as well as answering questions – a setup designed to reduce barriers to attendance. D’Amico has found that youth who attend the program are less likely to initiate alcohol and drug use, and that schools offering CHOICE have overall lower initiation rates than schools that don’t have the program, even among youth who don’t choose to attend.

Among her other initiatives, D’Amico is teaming with Dr. Daniel Dickerson, an Alaska Native (Inupiaq) addiction psychiatrist at UCLA’s Integrated Substance Abuse Programs, to implement a program

U C L A F I E L D I N G S C H O O L O F P U B L I C H E A LT H M AG A Z I N E

for urban Native American youth that integrates motivational interviewing and traditional practices. She also heads a major effort to learn about factors that predict initiation of alcohol and drug use. D’Amico’s study examines substance use patterns over eight years among a large and diverse sample of youth, beginning in middle school and high school and continuing through their late teens and early 20s. “We hope this will help us identify both successful prevention strategies and factors associated with lower likelihood of initiating alcohol and drug use, so that we can better tailor our approaches in developmentally appropriate ways,” D’Amico says. “Teens are often in vulnerable positions and have a lot of choices to make about risk behaviors. Providing them with evidence-based programming and information that can help them make the healthier choice is extremely important.”

FSPH ST U DEN TS PU R SU E A PATH TO SOLU TIONS Public health provides a powerful tool for addressing substance use challenges.

Jenna van Draanen began to

has already begun to gain

see the connection between

knowledge that she intends

mental illness and substance

to bring back to CAMH, with

use disorder during her work in

the promise of more to come.

Canada with homeless, mentally

LEFT: FSPH PHD STUDENT JENNA VAN DRAANEN. RIGHT: SARAH WATERS, WHO IS

“One of the classes I will have

ill and substance use popu-

PURSUING AN EXECUTIVE MPH DEGREE AT THE FIELDING SCHOOL.

the opportunity to take in the

lations, as well as evaluating

spring is on integrated health

programs designed to address

two diagnoses.” By identifying

Executive MPH Program in

systems, which has direct

these issues. Now a third-year

predictors of the timing and

Health Policy and Management,

relevance to the needs of my

PhD student in the Fielding

sequencing for the onset of the

views the public health response

organization,” she says. Among

School’s Department of Com-

disorders in the dual-diagnosis

to the substance use disor-

Waters’ other interests: devel-

munity Health Sciences, van

population, van Draanen hopes

der population as an essential

oping a checklist that would

Draanen plans to study factors

to pave the way toward more

entryway to better health. “If

allow primary care providers to

that determine the timing of the

tailored prevention strategies.

we want people with a depen-

more efficiently and accurately

onset of a mental illness and

“When you look at some of the

dence problem to be able to live

screen patients to detect early

substance use disorder in peo-

social determinants of sub-

healthy and productive lives, we

concerns about substance use

ple who end up developing both

stance use disorder and mental

can’t tackle anything else until

and dependence.

– a condition referred to

illness, it’s really profound,”

we take care of that one issue

as co-occurring disorders or

van Draanen says. “People who

for them,” she says.

about her decision to make

dual diagnosis.

come from low socioeconomic

the unusual commute from

“We don’t know much

positions are more likely to

Fielding School two weekends

Toronto to L.A. “This is such a

about why, for some of these

struggle with substance use

a month from Toronto, where

stimulating academic environ-

individuals, the mental illness

disorders, and that strikes me

for the last four years she

ment, with supportive faculty

comes first, while in others the

as incredibly unfair. Your life cir-

has worked at the Centre for

and students, in a city with an

addiction comes first, and in

cumstances shouldn’t determine

Addiction and Mental Health

ideal population for someone

still others the two occur at the

whether you are going to face

(CAMH) as a clinical researcher

with my interests,” she says.

same time,” van Draanen says.

these problems, or whether you

in geriatric neuropsychiatry.

“As soon as I arrived, I could

“But we do know that people

will have access to treatment for

The program seeks to discover

see that all of these doors were

who develop these co-occurring

them. I’m hoping my work can

new approaches to enhance the

opening for me, both at the

disorders really struggle, and

contribute to changing that.”

effectiveness of treatment for

school and in the community, to

have far worse outcomes than

Sarah Waters, a first-year

mood and addiction disorders

make a difference in addressing

those who have only one of the

student in the Fielding School’s

across the lifespan. Waters

this important issue.”

Waters travels to the

ph.ucla.edu

Waters has no regrets

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VIOLENCE PREVENTION AND IMPACT

LEADING THE FIGHT

AGAINST VIOLENCE Fielding School alumna Billie Weiss has helped to bring a public health approach to an issue once seen primarily as the domain of law enforcement.

BILLIE WEISS (MPH ’81) HAS BEEN A LEADER IN VIOLENCE PREVENTION EFFORTS AT THE L.A. COUNTY DEPARTMENT OF PUBLIC HEALTH, AT THE FIELDING SCHOOL, AND IN THE COMMUNITY.

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BILLIE WEISS (MPH ’81) was a new epidemiologist analyzing death records at the L.A. County Department of Public Health in the early 1980s when she realized that her position’s traditional focus on infectious disease was missing a big part of the story.

“In the younger population, injuries and violence were causing more death and disability than anything else,” Weiss recalls.

“I went to my bosses and said we should be doing something about this. So we got funding, but we also realized we had no idea what we should be doing.”

More than 30 years later, violence is widely recognized as a problem that can be prevented through public health approaches, and Weiss is renowned in Los Angeles and beyond for research and leadership efforts that have pointed the way toward effective strategies. In November, she received the prestigious 2015 Victor Sidel and Barry Levy Award for Peace at the American Public Health Association annual meeting.

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Weiss’ efforts to increase L.A. County’s attention to the issue led to her becoming director of the department’s Injury & Violence Prevention Program, a position she held until 2004, when she moved to the Fielding School to serve as associate director of the school’s Southern California Injury Prevention Research Program. Throughout her career, Weiss has led public health research aimed at assisting community-based organizations in effectively preventing violence. Her impact has been felt across the country. Weiss co-chairs Urban Networks to Increase Thriving Youth (UNITY), a national initiative to strengthen and support local efforts to prevent violence in the nation’s largest cities. She has consulted with public health leaders in metropolitan areas of several states who were interested in adopting the grassroots approach to preventing violence by building coalitions and partnerships that Weiss helped to spearhead in Los Angeles. Weiss has also been involved in efforts to address domestic violence and

THE VIOLENCE PREVENTION COALITION OF GREATER LOS ANGELES AND OTHER PUBLIC HEALTH ENTITIES ARE TRAINING COMMUNITY-BASED WORKERS IN PROVIDING SERVICES THAT RECOGNIZE THE MENTAL DISTRESS VIOLENCE INFLICTS. ABOVE, AGENCIES ATTEND THE ANNUAL L.A. GANG CONFERENCE TO DEVELOP SOLUTIONS TO GANG AND YOUTH VIOLENCE IN LOS ANGELES.

violence against women in Scotland and the United Kingdom, and participated in drafting the World Health Organization’s Melbourne declaration, which calls on nations and organizations to reduce preventable injury rates.

Upon realizing how little was known in the 1980s about strategies to prevent violence, Weiss and other public health leaders began talking about the need to bring in the perspectives of people in multiple fields who were involved with the issue. Those discussions led to the establishment in 1991 of the Violence Prevention Coalition of Greater Los Angeles (VPC), which has become a model for similar coalitions around the world. Co-founded by Weiss, then-Fielding School professor Susan Sorenson, and Paul

Juarez, then at Charles R. Drew University School of Medicine, the VPC’s wideranging membership encompasses leaders and organizations from public health, law enforcement, the legal community, youth development, and victim support services, as well as those working to prevent gun violence, domestic violence, gang violence, and child abuse, among others. Weiss now serves as the organization’s executive director emeritus.

Through the VPC, Weiss has been a leader in efforts to educate gang intervention workers and law enforcement officers in public health concepts and strategies, including education about domestic violence. “We have seen a nexus between gang violence and intimate-partner violence that

is not well investigated or documented,” Weiss says. “I see this as a major issue.

Most of the gang members I have worked with were either victims of, or witnesses to, intimate-partner or family violence.

Among the girls involved in gangs, we see a great deal of domestic or intimate-partner violence. If you look at homicides in the 15-24 age group, the majority of them are gang-related, and if we are trying to prevent these without addressing intimate-partner violence, it limits how successful we might be.”

The VPC and other public health entities are increasingly training community-based workers in providing services that recognize the mental distress violence inflicts.

“Violence is a public health issue that ph.ucla.edu

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IN DIR ECT V ICTIMS OF V IOL ENCE The rising homicide rate in Mexico elevates fear levels, with wide-ranging effects.

“Violence and the threat of violence can hinder children’s ability to learn, and can lead to chronic disease later in life.”

When Dr. Hiram Beltrán-Sánchez returned to his hometown in Michoacán, Mexico for a visit several years ago, he noticed that things were different.

“People weren’t going outside much anymore,” he recalls.

“Several of the parks in the neighborhood where I grew up were mostly abandoned.”

From 2005 to 2010, Mex-

ico’s homicide rate more than doubled – from 9.5 to 22 deaths

affects mental as well as physical wellbeing,” Weiss says. “We have entire communities where people are affected daily by the trauma of living in violent environments. Violence and the threat of violence can hinder children’s ability to learn, and can lead to chronic disease later in life. The people who work with these individuals need to be informed about what that means and how it can be addressed.”

After spending much of her career focused on the issue of violence, Weiss is more convinced than ever about what it takes to address it. “The public health model is critical in addressing violence, because it focuses on the community,” she says. “We can continue trying to change individuals from now until forever, but if we then send them back into the same communities with the same problems, we haven’t really fixed anything.”

Weiss laments cutbacks in support for public health research in violence prevention. In particular, she says, limits on funding for studies related to gun violence should be of serious concern to public health professionals. “We haven’t been able to evaluate what’s working and what’s not, or which strategies are better than others,” Weiss notes. “Meanwhile, we have more and more gun violence – mass shootings, domestic shootings, and suicides. We have to get a handle on this, and one thing we do know from the limited research is that states with looser gun laws have more shootings and more gun deaths.”

On the positive side, she has seen a significant shift among law enforcement agencies, policy makers and others in their willingness to view violence as a public health issue and embrace public health strategies to prevent it. “I’m proudest of the fact that I’ve been able to get people to look at this in a different way,” Weiss says.

“Without a collaborative, coordinated effort focused on prevention, little will change. But we can do it – we’ve shown it with tobacco, we’re showing it now with diet and exercise. Prevention works, there is no question in my mind about that.”

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U C L A F I E L D I N G S C H O O L O F P U B L I C H E A LT H M AG A Z I N E

DR. HIRAM BELTRÁN-SÁNCHEZ IS STUDYING HOW VIOLENCE IN MEXICO AFFECTS FAMILY DYNAMICS.

per 100,000 people – with the most impact felt in the northern

leagues to determine whether

part of the country, just south of

the implications of the high

Texas and New Mexico, accord-

levels of fear go even further

ing to Beltrán-Sánchez, assistant

than the social and economic

professor in the Fielding School’s

consequences resulting from

Department of Community

people being more likely to

Health Sciences. But when

stay indoors. They are asking

Beltrán-Sánchez saw for himself

whether the reports of rising

how life had changed in his old

violence in the country could

neighborhood, even among

contribute to changes in

people not personally touched

family dynamics, potentially

by the killings, it struck him that

including increased risk for

the public health impact of the

domestic violence.

violence was more widespread

than he had realized.

levels of stress on individuals,

and we know that stress is

While a research associate

“Fear imposes significant

at the University of Wisconsin,

related to a number of nega-

Beltrán-Sánchez and colleagues

tive physical and mental health

analyzed national surveys taken

outcomes,” Beltrán-Sánchez

in Mexico on perceptions of

says. “We are interested in

public safety and found that

learning whether people

the proportion of people living

repeatedly hearing news about

with fear of becoming victims of

violence in their community

violence skyrocketed between

leads to certain stress-related

2005 and 2014. The study found

outcomes, including a reduced

that in 2014, the average Mexi-

threshold for acting violently.

can adult could be projected to

That would be an unfortunate

spend more than half of his/her

byproduct of the upsurge

remaining life in fear of violence.

in violence in Mexico, but it

would identify an important

Since joining the FSPH

faculty in 2015, Beltrán-Sánchez

target for public health pre-

has been working with his col-

vention strategies.”

COGNITIVE EFFECTS

Dr. Patricia Ganz is a leader in the effort to recognize and address cognitive effects of cancer treatment.

S E E I N G T H R O U G H T H E

F

G O F

“ C H E M O

B R A I N ”

WITH ADVANCES IN TREATMENT OVER THE LAST SEVERAL DECADES, the number of cancer survivors continues to grow – currently estimated at 14 million, and expected to reach 18 million within the next decade. But survivorship can come with a cost. “As more people are cured of their cancer, living with the long-term consequences of cancer treatment has become more of an issue,” says Dr. Patricia Ganz, a Fielding School professor of health policy and management.

A hematologist-oncologist whose pioneering studies helped to bring the issue of cancer patients’ post-treatment quality of life into the mainstream, Ganz has for much of the last two decades focused on the phenomenon known as “chemo brain” – the mental fogginess that can persist indefinitely for some cancer survivors, affecting their ability to concentrate, stay organized, multitask and complete other everyday cognitive functions. Her work has shed light on the biological basis for the lingering cognitive symptoms. “Many doctors had thought it must be related to depression or something else, because they could give the same chemotherapy to 100 people and only 15 or 20 would have trouble,” Ganz says. “But it turns out that some may be more genetically predisposed to these late effects.”

Cancer therapies cause inflammation that can affect the functioning of the brain’s neurons, Ganz explains. She and her colleagues have found that certain individuals are more prone to persistent inflammation following treatment – an effect associated with both fatigue and cognitive difficulties.

Through large ongoing clinical trials, Ganz and others are seeking to better understand which patients are most likely to experience these chronic treatment effects. In the meantime, Ganz says, “As oncologists, before we treat our cancer patients with something that is potentially toxic we need to be very sure that they need it.”

Ganz, director of prevention and control research for UCLA’s Jonsson Comprehensive Cancer Center, has also worked with UCLA Semel Institute for Neuroscience and Human Behavior researchers on rehabilitation strategies for breast cancer survivors suffering from post-treatment cognitive difficulties. Led by Ganz, the group recently published a study showing that women in an early-intervention group who were given strategies to help them with their memory and focus reported improvements in their cognitive symptoms and performed better on a battery of neuropsychological tests than women who didn’t receive the early intervention, and that these improvements persisted two months after completion of the rehabilitation program. “It was encouraging that the patients told us that they were doing better and also tested better. They also had improvements in brain wave patterns,” Ganz says.

While continuing to study the biological mechanisms underlying chemo brain in an effort to identify patients at risk and pave the way for new therapies, Ganz also serves as a leading voice on the importance of researchers paying close attention to patient reports about their symptoms. “The message of our work is that patient self-report is reliable and something that can be measured and tracked if you give the right tests,” she says. “Too often in the past, patients’ complaints haven’t been taken seriously. As physicians, one of the most important things we can do is to listen to what our patients tell us.” ph.ucla.edu

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COGNITIVE EFFECTS

SOUNDING THE ALARM ON A LOOMING PUBLIC HEALTH THREAT Through his widely cited projections, an FSPH biostatistician underscores the importance of making inroads against Alzheimer’s disease.

WE’RE LIVING LONGER. The number of U.S. adults 65 and older, roughly 40 million as of the 2010 census, is expected to nearly double to 71 million by 2030, and to reach 98 million by 2060. In much of the rest of the world, the story is the same. But if the aging trend illustrates the success of public health strategies, it also raises the specter of a major public health crisis – a sharp rise in the number of people living with Alzheimer’s disease.

Dr. Ron Brookmeyer, a professor in the Fielding School’s Department of Biostatistics, has called attention to the looming Alzheimer’s epidemic through widely cited studies in which he has employed sophisticated computer models to project the number of cases, as well as the potential positive impact of future therapies and other strategies to prevent or delay the onset and progression of symptoms. Brookmeyer’s work in this arena began nearly 20 years ago with an American Journal of Public Health paper projecting that Alzheimer’s disease prevalence in the United States would nearly quadruple by the middle of this century, by which time approximately 1 in 45 Americans will be afflicted. His 2007 study applying the model globally projected that the worldwide Alzheimer’s disease prevalence would quadruple by 2050 to approximately 107 million, by which 1 in 85 persons will be living with the disease – nearly half of them requiring a level of care equivalent to that of a nursing home.

Brookmeyer’s development of statistical models to make forecasts on epidemics began in the late 1980s with HIV/AIDS, but after DR. RON BROOKMEYER’S MODEL PROJECTS A QUADRUPLING OF THE WORLDWIDE ALZHEIMER’S DISEASE PREVALENCE BY 2050.

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becoming involved in a study on aging, he turned his attention to the threat posed by Alzheimer’s disease. “Obviously it’s not a transmissible epidemic like the ones I had been looking at, but with the aging of the population, it was clear that the numbers were going to explode,” he explains.

“The projected increase in Alzheimer’s cases represents a huge public health problem when you think about the costs associated with caring for a person with the disease.”

As part of his modeling, Brookmeyer and his colleagues consider both demographic trends and how people with Alzheimer’s progress in their disease severity. “This is a long illness,” he says.

“Once you’re diagnosed, you might live with it for 10 or more years, and the intensity of the care required will vary during that time.

From a public health point of view, it’s very important to look at where people will be in different stages of the disease and the needs we will be facing as a society.”

Through a systematic review of Alzheimer’s studies, Brookmeyer’s team has found that the rate of being diagnosed with the disease doubles every five years in older populations – for example, the likelihood of a diagnosis at age 77 is approximately 1 percent; by age 82 it is 2 percent, and at age 87 it is 4 percent. This rate of increase with aging is consistent across the world. Combining those factors with trends in other causes of aging-related mortality, such as cardiovascular disease and cancer, the group forecasts the future Alzheimer’s disease prevalence.

Equally important, the modeling also allows Brookmeyer and colleagues to factor in the future impact of advances in Alzheimer’s disease prevention and treatment – what Brookmeyer calls “what if” scenarios. “What if we could delay the onset of the disease for a few years?” he says. “In an aging population, even modest advances could be home runs in terms of their public health impact.” For example, Brookmeyer has found that if an intervention could delay the average disease onset by even a single year, it would reduce by 9 million the number of projected worldwide cases by mid-century.

Brookmeyer is currently working with researchers at UC Irvine on a study of “the oldest old” – persons over the age of 90, the fastestgrowing segment of the U.S. population – to better understand

the predictors of successful aging and factors that might protect against dementia. The study follows a cohort of individuals living in a retirement center who, as far back as the 1980s, began filling out detailed questionnaires designed to capture lifestyle characteristics. “Over the next 50 years in the U.S., the over-90 population is going to grow six-fold, so this is a very important group to understand when it comes to the issue of dementia,” Brookmeyer says.

While Brookmeyer’s projections of the increase in Alzheimer’s given the current state of prevention and treatment paint a bleak picture, he points out that recent developments in the field – including new insights into how the disease develops, as well as the identification of new biomarkers that can assist in diagnosing Alzheimer’s and tracking the impact of potential therapies – offer plenty of room for optimism.

“Among the most promising interventions currently under investigation are those that target the buildup of amyloid beta proteins in an effort to slow the onset and progression of Alzheimer’s,” Brookmeyer says. Brookmeyer is now developing new models to better understand the potential impact of these so-called anti-amyloid beta interventions.

“The projected increase in Alzheimer’s cases represents a huge public health problem when you think about the costs associated with caring for a person with the disease, along with the emotional burden for family members – and yet, funding for Alzheimer’s disease studies represents a relatively small part of the overall federal research budget,” Brookmeyer says. “With the better understanding and tools we now have, the time is ripe for an investment in research that will help us address this major public health threat.”

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THE INVISIBLE PATIENT Shedding light on the experiences of family caregivers of people with early-onset dementia, a PhD student hopes to bring relief to an often-overlooked population. written by

Mikkel Allison

ELVIRA JIMENEZ’S VIEW OF DEMENTIA CHANGED when she encountered “Mrs. X,” a woman in her 40s struggling to care for her husband and twin school-age daughters.

“The consequences of dementia go well beyond the effects of the disease on patients,” says Jimenez (MPH ’02), a Fielding School doctoral student in the Department of Community Health Sciences whose dissertation is delving into the mental health implications of early-onset dementia for family caregivers. “These caregivers are also victims of the illness – they are the ‘invisible patients’ whose needs are often unnoticed and untreated.”

Early-onset dementia, which most often takes hold of individuals in their 40s and 50s, presents a significant public health challenge and is striking in that it upends the typical perception of the disease – that of caring for an elderly, frail, forgetful parent. But with an estimated 200,000 people living with earlyonset dementia nationally, many of their loved ones are forced into caregiving roles in the prime of their working years, displacing every aspect of their lives.

At the time of Mrs. X’s initial visit to the free clinic at UCLA’s Department of Neurology, where Jimenez works as a senior research staff associate in the Behavioral Neurology program, she was her husband’s primary caregiver. Diagnosed with behavioral variant frontotemporal dementia – an early-onset subtype of the disease – Mr. X became unable to work and exhibited apathy, compulsive behaviors, and decreased hygiene and self-care.

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Mrs. X began working to support the family, and at times had to leave her husband alone at home. She lacked support from relatives, and found that there were no formal resources or services tailoring to dementia caregivers’ needs. A year later the disease progressed so rapidly that Mrs. X could no longer manage her husband’s behaviors and he had to be institutionalized in a psychiatric ward in order to receive the care he needed.

“Parents with young children have multiple demands, but if you put on top of that a layer of having to be the primary caregiver of a person with dementia, it just multiplies their needs and complicates things like employment, family, and relationships,” says Jimenez.

“That’s going to affect caregivers’ ability to physically take care of themselves, to financially secure their lives and the lives of their loved ones, and to be happy. Many become depressed. Often they don’t have the resources and just can’t handle or manage everything that is coming their way.”

Jimenez’s dissertation research into the mental-health effects of caring for a loved one with early-onset dementia highlights the lack of resources available to these invisible patients, whose wellbeing is closely tied to the quality of life of the people struggling with the disease. She hopes that her research will contribute to better support, services, and targeted patient management to relieve the burden of caregiving and decrease institutionalization. “One important way to improve the quality of life of patients with dementia,” Jimenez notes, “is to address the needs of the caregiver.”

SCHOOL WORK FSPH STUDY CONFIRMS

L.A.’S CICLAVIA IMPROVES AIR QUALITY IN HOST AREAS

AT CICLAVIA IN OCTOBER (L. TO R.): MADELINE BROZEN OF THE UCLA LUSKIN SCHOOL OF PUBLIC AFFAIRS; CHRISTINA BATTEATE OF THE FIELDING SCHOOL; STEVEN GALLEGOS OF BREATHE CA OF LA COUNTY; BRIAN COLE OF THE FIELDING SCHOOL; AND LOS ANGELES MAYOR ERIC GARCETTI.

A new FSPH study reveals that CicLAvia – a series of one-day events organized by a local nonprofit in which neighborhood streets are closed to motor vehicles so that people can walk and cycle freely – significantly reduces air pollution along its designated route and on other streets in the communities where the event is held.

“Los Angeles does not meet the EPA’s air quality goals, and traffic is a major source of the problem,” says Dr. Yifang Zhu, associate professor of environmental health sciences at FSPH and the study’s principal investigator. “Not only does CicLAvia reduce the concentrations of traffic-emitted air pollutants, but we were also struck that the reduction of particulate pollution extends beyond the CicLAvia route.” The study’s co-authors are FSPH postdoctoral researcher Shi Shu, Professor Emeritus John Froines, Adjunct Assistant Professor Brian Cole and Christina Batteate (MPH ’12).

FSPH ESTABLISHES FORMAL PARTNERSHIP IN THE DEMOCRATIC REPUBLIC OF THE CONGO FSPH has launched a new partnership with the University of Kinshasa School of Public Health in the Democratic Republic of the Congo (DRC).

Professor Emile Okitolonda, dean of the Kinshasa School of Public Health, and FSPH Dean Jody Heymann signed a memorandum of understanding (MOU) between the two schools last summer.

Located in the DRC’s largest city, the University of Kinshasa School of Public Health has had a longstanding research collaboration with FSPH Associate Professor of Epidemiology Anne Rimoin, who founded the UCLA-DRC Research Program in 2004. The MOU opens up the potential for new opportunities, including student internships, visits, and exchanges of faculty and scholars.

Students, faculty, staff, alumni and friends gathered at UCLA in October for the

3RD ANNUAL FIELDING FALL FIESTA

KINSHASA SCHOOL OF PUBLIC HEALTH DEAN OKITOLONDA AND FSPH DEAN HEYMANN AFTER THE SIGNING

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INAUGURAL BOOK PARTY A celebration of public health books written and edited by members of the FSPH community took place last spring at the Fielding School.

Dozens of books were on display during the book party, and several authors were on hand to talk with guests about their work.

✺

FSPH’S STAIRWELL MAKEOVER

photos & video ph.ucla.edu

Taking the stairs is better for our health than taking the elevator.

And with a new Vertical Art Gallery that spans all eight floors of the stairwell just off FSPH’s main lobby, it just got a lot more fun.

STUDENT-LED WATER FILTRATION SYSTEM MAKING AN IMPACT In 2014, FSPH students spearheaded a campaign to have an environmentally conscious water filtration system installed on the main floor of the UCLA Center for Health Sciences building. The system was installed in January 2015 and, in less than one year, has already saved more than 26,000 plastic water bottles from ending up in landfills.

The project was envisioned, planned, and implemented by FSPH students including Tyler Watson (MPH ’13), Jimmy Tran, and Noelle Watanabe (MPH ’15), in collaboration with the Public Health Student Association, the FSPH Dean’s Office and UCLA’s Healthy Campus Initiative. All of the artwork in the Vertical Art Gallery is by artist Jane Gottlieb, who generously donated her work and time to the school.

The stairwell makeover project aims to increase stairwell use and will serve as a pilot for other buildings on campus.

LEFT, BEFORE; RIGHT, AFTER

KEEP IN TOUCH Visit us online

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JOIN TEAM FSPH FOR THE 2016 LOS ANGELES MARATHON For the second year in a row, the Fielding School is coming together as a community to raise money for student support by running the 2016 LA Marathon and Charity Relay on February 14.

Team FSPH raised more than $25,000 in last year’s Race to Health — enough to fund five students’ summer fieldwork. The students did invaluable work in the community: from youth development and violence prevention in Boyle Heights and East L.A., to extending access to health care for veterans and Native Americans in rural Virginia, to better understanding how social and economic assets impact the health of adolescent girls in Nairobi, Kenya.

For information about how you can join the Fielding School in running, supporting and/or cheering on Team FSPH, please call 310-825-6464 or visit us online at bit.ly/RaceToHealth.

CELEBRATING OUR TEACHERS FSPH faculty, students and staff gathered last spring for the first-ever FSPH: Celebrating Our Teachers reception. The event honored Fielding School faculty members who have been recognized by students for their outstanding instruction during the 2014-15 academic year.

A PATH APPEARS:

ACTIONS FOR A BETTER WORLD In November, the Skirball Cultural Center in Los Angeles opened a new exhibit, A PATH APPEARS: Actions for a Better World, designed to inspire visitors to find their own paths to making a difference in the world. Dr. Neal Baer, adjunct professor at the Fielding School and co-founder of the school’s Global Media Center for Social Impact (GMI), is guest curator. The exhibition, presented in cooperation with GMI and the WORLD Policy Analysis Center at the Fielding School, explores four humanitarian issues — education, health, jobs, and empowerment — and reveals how organizations, both local and global, are developing workable solutions to these worldwide challenges. Rounding out the exhibition is GMI’s ActionLab (ActionLab. org), where visitors are invited to choose what has inspired them most and learn practice-proven methods for effecting change.

The exhibition is inspired by the best-selling book “A Path Appears: Transforming Lives, Creating Opportunity,” co-written by Pulitzer Prize-winning journalists Nicholas D. Kristof, of the New York Times, and Sheryl WuDunn. ph.ucla.edu

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GRANTS & CONTRACTS NEAL BAER Developing Transmedia Approaches to Improve Nutrition and Decrease Obesity to Accompany a Book on Soda by Marion Nestle and Neal Baer Robert Wood Johnson Foundation, $87,249 NEAL BAER, JODY HEYMANN, AND SANDRA DE CASTRO BUFFINGTON Film Outreach and Social Engagement: Software Development for Audience Mobilization John Templeton Foundation, $357,075 SUDIPTO BANERJEE Hierarchical Statistical Modeling and Bayesian Melding for Occupational Exposure DHHS-Centers for Disease Control and Prevention, $623,508 for 2 years EMMELINE CHUANG Women’s Health Patient Aligned Care Teams (PACTS) Implementation Process Evaluation Department of Veterans Affairs, $80,000 Mixed Methods Study of Factors Affecting HPV Vaccine Uptake in a Large Federally Qualified Health Center UCLA Jonsson Cancer Center Foundation, $50,000 Care Team Redesign: National Evaluation Project The Hitachi Foundation & Georgia State University, $65,241 for 2 years BRIAN COLE AND JOHN FROINES Proposal for Seed Funding: Heart of Los Angeles and South Los Angeles Routes CicLAvia, $64,994 BRIAN COLE, MICHAEL JERRETT, FRED ZIMMERMAN, AND RICHARD JACKSON Health Impact Assessment on the California High Speed Rail Project California High Speed Rail Authority, $429,735 SANDRA DE CASTRO BUFFINGTON Hollywood and Youth Sexuality, Reproductive Health and Rights Ford Foundation, $325,001 for 2 years ROGER DETELS China-US HIV/TB Multidisciplinary Training Program National Health and Family Planning Commission-People’s Republic of China & Chinese 30

This section includes new grants and contracts awarded in 2014-15. Due to space limitations, only funds of $50,000 or more are listed, by principal investigator.

Center for Disease Control and Prevention [China], $396,456 for 2 years Aging and Fracture Risk Among HIV-Infected and HIV-Uninfected Men — Supplement National Institute of Allergy and Infectious Diseases & Johns Hopkins University, $53,786 Cardiovascular and HIV/AIDS Effects on Brain Structure Function and Cognition — Supplement National Institute on Aging & University of Pittsburgh, $59,122 JONATHAN FIELDING Quantitative Policy Tools for Big Cities De Beaumont Foundation, $99,948 JANET FRANK California Mental Health Older Adult System of Care Project CA/Mental Health Services Oversight and Accountability Commission, $400,000 for 2 years JOHN FROINES Protecting Human Health from the Cumulative Effects of Exposure to Multiple Fumigant Pesticides Clarence E. Heller Charitable Foundation, $90,000 DAPHNA GANS AND NADEREH POURAT Self-Management Strategies for Children with Special Health Care Needs and Their Families: Bridging Needs and Provider Capacity Lucile Packard Foundation for Children’s Health, $267,865 PATRICIA GANZ A Model Clinical/Translational Research Program for Breast Cancer Survivors: A Focus on Cognitive Function The Breast Cancer Research Foundation, $250,000 Developmental Funding to Support a Behavioral Intervention Trial to Reduce Psychosocial Distress in Younger Breast Cancer Survivors The Breast Cancer Research Foundation, $249,286 DEBORAH GLIK AND MICHAEL PRELIP UCLA-Réseau Africain de l’Education pour la Santé (RAES)-University of Cheikh Anta Diop (UCAD) Health Communication and Information and Communication Technologies (ICT) Research Education Program Fogarty International Center, $306,587 for 3 years

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PAMINA GORBACH AND STEVEN SHOPTAW Men Who Have Sex With Men (MSM) and Substances Cohort at UCLA Linking Infections Noting Effects (MASCULINE) – Supplement National Institute on Drug Abuse, $86,513 NEAL HALFON The UCLA Center of Excellence in Child and Family Health DHHS/Health Resources and Services Administration, $1,750,000 for 5 years MOIRA INKELAS Population Change Learning Community Doris Duke Charitable Foundation, $350,000 for 3 years MICHAEL JERRETT Air Pollution and Risk of Incident Hypertension and Diabetes in U.S. Black Women National Institute of Environmental Health Sciences & Boston University, $115,602 Health Effects from Wildfire Air Pollution: A Spatiotemporal Modeling Approach Department of the Interior Bureau of Land Management & UC Berkeley, $319,072 for 2 years LEEKA KHEIFETS Asthma and EMF – Supplement Electric Power Research Institute [EPRI], $116,563 TransExpo Study Development Electric Power Research Institute [EPRI], $93,296 GERALD KOMINSKI California Health Policy Research Program Renewal 2015-2016 The California Endowment & UC Berkeley, $87,012 JAMES MACINKO Understanding the Diffusion and Impact of State Alcohol and Traffic Policies National Institute on Alcohol Abuse and Alcoholism & New York University, $159,977 for 1.5 years ANNETTE MAXWELL Colorectal Cancer Control Program (CRCP) Grantee Survey National Association of Chronic Disease Directors & University of Washington, $60,000

NINEZ PONCE AND DAVID GRANT California Health Interview Survey (CHIS) CA/Department of Public Health, $3,207,500 for 5.5 years; Kaiser Foundation Research Institute [Northern California], $108,200; Kaiser Foundation Research Institute [Southern California], $108,201; County of Marin, $300,000; CA/Department of Public Health & UC San Diego, $305,577; The East Bay Community Foundation, $1,100,000 for 2 years; CA/Department of Health Care Services, $1,600,000 for 2 years California Health Interview Survey 2015: Building Healthy Communities Study The California Endowment, $1,754,816 for 2 years California Health Interview Survey 2013-14 – Japanese Oversample Keiro, $95,677 Monitoring the Affordable Care Act with California Health Interview Survey 2015-2016 Access Measure California Healthcare Foundation, $726,866 for 2 years NADEREH POURAT Evaluation Of Innovative Workforce Interventions Designed to Promote Oral Health and Prevent Dental Disease Robert Wood Johnson Foundation & UC San Francisco, $100,222 Remaining Uninsured Subcontract to University of California, Berkeley Blue Shield of California Research and Education Foundation & UC Berkeley, $57,054 for 2 years NADEREH POURAT AND GERALD KOMINSKI Evaluation of the Delivery System Reform Incentive Pool (DSRIP) Program, Year 2 CA/Department of Health Care Services, $150,000 MICHAEL PRELIP Public Health Training Program on Population Health Advocacy The California Endowment, $484,982 for 2 years ANNE RIMOIN Digitization and Support for Development of a Human African Trypanosomiasis Information and Decision and Support System in the Democratic Republic of the Congo Bill and Melinda Gates Foundation, $425,081 for 1.5 years Ebola Human Antibody Initiative Bill and Melinda Gates Foundation & Atreca Inc., $1,007,404 for 1.7 years

BEATE RITZ Environment and Cognitive Decline in Older Hispanics National Institute of Environmental Health Sciences, $1,790,968 for 3 years

Smokefree Air for Everyone (S.A.F.E.): Reducing Tobacco Related Health Disparities for Vulnerable Populations of Los Angeles Through Smoke Free Housing DHHS-Centers for Disease Control and Prevention, $2,900,000 for 3 years

DYLAN ROBY Analytic Support and Technical Assistance for Delivery System Reform Projects Cope Health Solutions, $68,527 Newborn Hearing Screening Program Evaluation CA/Department of Health Care Services, $298,649 for 2 years

MAY WANG Reducing Early Childhood Obesity Collective Impact Evaluation L.A. County Children and Families First [AKA First 5 LA] & ABT Associates, Inc., $199,341

DYLAN ROBY AND NADEREH POURAT California Children’s Services Redesign Planning and Technical Assistance CA/Department of Health Care Services, $623,662

MAY WANG AND MICHAEL PRELIP Assessment of Nutrition Education and Obesity Prevention (NEOP) Programming Medium Stores County of Los Angeles Department of Public Health, $90,000

SANGHYUK SHIN The Effect of Mixed-Strain Mycobacterium Tuberculosis Infections on Treatment Outcomes National Institute of Allergy and Infectious Diseases, $668,427 for 5 years Utility of Deep Sequencing for Detecting Heteroresistant Mycobacterium Tuberculosis Infections Among HIV-Infected Persons National Institute of Allergy and Infectious Diseases, $404,621 for 2 years

Assessment of Nutrition Education and Obesity Prevention Programming - Small Stores County of Los Angeles Department of Public Health, $94,800

PETER SINSHEIMER Piloting a Combined Heat and Power/Distributed Generation System Powered by Anhydrous Ammonia California Energy Commission [EISG Program], $929,504 for 3 years

ZUO-FENG ZHANG Cancer Epidemiology Training Grant National Cancer Institute, $1,601,400 for 5 years

ANNETTE STANTON Contributors to Adherence in Breast Cancer Patients Initiating Endocrine Therapies: From Understanding the Phenomenon to AdherencePromoting Intervention The Breast Cancer Research Foundation, $250,000 JASVEER VIRK Maternal Diabetes During Pregnancy and Neurodevelopment in the Offspring National Institute of Child Health and Human Development, $291,974 for 2 years STEVEN WALLACE Gauging the Capacity of Community Health Centers to Serve the Uninsured Commonwealth Fund, $269,150 for 2 years Healthy Aging Partnerships in Prevention Initiative (HAPPI) DHHS-Office of Research on Women’s Health, $1,499,172 for 3 years

RICHARD WIGHT Exploring Stress, Aging and Health Among Parents of Sexual Minorities National Institute on Aging, $423,500 for 2 years

YIFANG ZHU Air Pollution and Cardiovascular Diseases: Identification of Novel Biomarkers National Institute of Environmental Health Sciences, $423,500 for 2 years Application of a High Efficiency Filtration System for Air Pollution Exposure Reduction Inside School Buses South Coast Air Quality Management District & IQAir North America, Inc., $120,000 Car-Free CicLAviaSundays: A Natural Experiment BREATHE California of Los Angeles, $75,000 Characterization of Emissions from Electronic Cigarettes UC Tobacco-Related Disease Research Program, $239,750 for 2 years FREDERICK ZIMMERMAN Win-Win Interventions to Build a Culture of Health: Quantitative Policy Tools for the Nation Robert Wood Johnson Foundation, $1,171,210 for 1.5 years

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TRANSFORMATIVE INVESTMENTS

ANN AND PHIL HEYMANN IN BOTSWANA

FSPH STUDENT NATALIE DICKSON IN KENYA

HONORING TWO CAREERS WHILE LAUNCHING OTHERS In a remarkable career that included high-level positions in the State and Justice Departments of four presidential administrations, Phil Heymann has repeatedly worked at historic moments to protect and increase civil, democratic and political rights in the United States and globally in countries ranging from Northern Ireland to South Africa. From her work analyzing policy on health and retirement for the United Mine Workers to directing efforts in state government departments on educational and social services and employment and training, Ann Heymann’s career was dedicated to the enormous role government and civil society can play in creating equal opportunities and improving health and quality of life.

Now, Fielding School Dean Jody Heymann is honoring her parents’ commitment to global work, health and public service with a gift to establish The Ann and Phil Heymann Global Fellowship

FELLOWSHIPS SUPPORT EFFORT TO CURB VIOLENCE 32

Fund. Awards will be given to students based on their demonstrated interest in a career in global health addressing inequalities, the merits of their proposal, and financial need.

“It is a great joy to have the opportunity to honor people I love and respect in a way that can also help to launch a new career,” says Heymann of her gift.

For Natalie Dickson, the first Ann and Phil Heymann Global Fellowship Fund recipient, the opportunity to spend last summer as an intern at the Population Council in Nairobi, Kenya was transformative.

A first-generation college student, she held as many as three jobs at a time to fund her undergraduate education and is currently pursuing master’s degrees concurrently in the Fielding School’s Department of Community Health Sciences and UCLA’s African Studies M.A. Program.

“There is absolutely no way I could have afforded this experience on my own,” says Dickson. “I am passionate about East Africa, and this affirmed my interest in working alongside populations in the region to carry out and monitor reproductive health programs.

By allowing me this experience, the fellowship has contributed to training a future scholar, activist and advocate for public health in East Africa.”

Dean Hansell, who serves on the Fielding School’s Board of Advisors, has made a gift to establish the Dean Hansell Fellowship to Address Gun Violence. Hansell’s gift will provide crucial seed funding for students and faculty conducting innovative research projects with potential for high impact in stemming the epidemic of gun violence. The

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inaugural recipient of the fellowship is Danielle Dupuy, a PhD student in the Department of Community Health Sciences, whose work addresses violence among the populations most adversely affected. Dupuy’s project will teach coping and de-escalation techniques to youth detainees who are 6-8 months pre-release from detention facilities in Los Angeles County.

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Nonprofit Org. U.S. Postage PAID UCLA Box 951772 405 Hilgard Avenue Los Angeles, CA 90095-1772 www.ph.ucla.edu Address Service Requested

“At the root of this dilemma is the way we view mental health in this country.

Whether an illness affects your heart, your leg or your brain, it’s still an illness, and there should be no distinction.”

-First Lady Michelle Obama