FSPH Magazine Spring/Summer 2016

PUBLIC HEALTH SPRING/SUMMER 2016

The UCLA Fielding School of Public Health Magazine

AGING WELL Public health has helped us live longer.

Now the challenge is to help us live better.

DEAN’S MESSAGE

IN THE UNITED STATES AND AROUND THE WORLD, a transformation is under way: As a society we’re getting older, with profound and wideranging implications.

The driving force behind this aging revolution is clear. In the United States, life expectancy increased by 30 years during the 20th century; the Centers for Disease Control and Prevention estimates that public health was responsible for giving us 25 of those additional 30 years. By focusing on preventing disease and promoting health through research, education, policy, partnerships and so many other means, public health has sown the seeds of the aging revolution.

Of course, this success has introduced new challenges, many of which are outlined in the articles on some of the aging-related work of our faculty, students and alumni that are featured in this issue of our school’s magazine. Advanced older age is associated with higher risk of many chronic conditions — including most cancers, cardiovascular disease, diabetes and dementia, as well as declines in physical function. Thus, the steep rise in older adults projected in the United States and most of the rest of the world over the next several decades demands new ways of thinking about prevention and health promotion across the life course; health care financing; and long-term care. Public health must be at the forefront of these discussions.

But along with these challenges come exciting opportunities. Public health is poised to lead the way in another kind of revolution — one in which we focus on what we know about successful aging that can help us to maximize the health, quality of life and contributions of our elders. We must embrace the benefits older workers and entrepreneurs bring to companies, along with the critical role of older people in civic life, philanthropy and families. We must build communities that better meet the needs of elders and facilitate intergenerational opportunities that take advantage of their invaluable experience. And, needless to say, we must continue to promote ways of living and prevention strategies that will keep all members of our society healthier. We invite you to partner with the Fielding School as we work toward these and other goals to ensure that everyone has the opportunity to live a long and fruitful life.

Jody Heymann, MD, PhD Dean

2

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

The UCLA Fielding School of Public Health Magazine

S P R I N G /S U M M E R 2 0 1 6

CONTENTS 14

20

12

18

FEATURES

POWER OF PREVENTION

04 Spreading the Word

Promoting key services

for low-income elders 07

Transforming Mental

Health Services for Older Adults Examining the impact of the “millionaires’ tax”

08 Seeking Safer Ground

Public health prevention

strategies for falls 10 Changing Course

Nearly half of CA’s adults

headed toward diabetes 11

HIV Testing Overlooked for Older Population Few in the 50-64 age group are being screened

12 Matter of Time

A tool to measure, and

possibly slow down, aging

HEALTHY AGING

18 Minding China’s Elders

How urbanization affects

the older population

DEMOGRAPHIC IMPACT

MIDLIFE STRATEGIES

LEARNING FROM ELDERS

14 Center Stage

Investing in lifestyles

for robust later years

16

AGING AND MENTAL HEALTH

A Path-Setting Generation Grays Identifying challenges many older gay men face

KEEP IN TOUCH

Visit us online ph.ucla.edu

20 Bridging the Gap

UCLA freshmen gain

invaluable lessons

FINANCIAL BURDENS

22 Out of the Blind Spot

Shining light on elders

struggling economically 24 When Drug Costs Are

Hard to Swallow

The toll of high-priced pharmaceuticals

BUILDING CAPACITY 25 Preparing for a

Challenging Future

Dementia care needs

Q&A

26 California’s

Right-to-Die Law

Dr. Cindy Cain on

implementation of

state’s landmark act

29

PATIENT PREFERENCES

Medicine, Culture and Faith PhD candidate studies decision-making among foreign-born Latinos

DEPARTMENTS 30 School Work 33 Faculty Honors

& Service 34 Student Awards 36 Transformative Investments

PHOTOGRAPHY & ILLUSTRATION © iStockphoto: cover; TOC: photo for article on p. 14; pp. 2-4, 14-15, 17, 18-19: Guangzhou cityscape. Betsy Winchell: Dean’s Message. Margaret Molloy: TOC: photo for article on p. 20; pp. 8-9, 20, 25, 28; p. 30: Los Angeles Marathon; p. 31: Cynthia Davis (Ruth Roemer Symposium), Paul Torrens Health Forum; p. 32: Breslow Distinguished Lecture; back cover. Rent Control Creative: TOC: illustration for article on p. 12; pp. 10, 12, 23, 24. Lisa Rau: pp. 6, 7, 14: Upchurch; pp. 27, 29; p. 31: National Public Health Week; p. 36: Kayne Public Health Fellows photos. Shweta Saraswat: p. 30: Tyler Watson (UC President’s Leadership Award). Anahi C Felch Design: inside back cover. COURTESY OF: Di Liang: TOC: photo for article on p. 18; p. 19: family photos. Chandra Ford: p. 11. Steve Horvath: p. 13.

Richard G. Wight: p. 16. Annual Reviews: p. 32: Annual Review of Public Health digital rendering. Tom Weinberger: p. 36 (End of Life Law).

AGING WELL IF YOU WERE BORN IN AMERICA in 1900, the likelihood that you would reach what we now consider old age was far from assured. Life expectancy at the beginning of the 20th century was 47 in the United States. Now it’s pushing 80 — and is higher than that in more than 30 countries.

For that we can thank public health.

Immunization campaigns and infectious disease control, healthier mothers and babies, education and policies to reduce smoking, and countless other public health advances have contributed to more than 30 years of extra life for the average person. But public health’s resounding success has created a daunting challenge — the mounting health, social and economic concerns associated with our aging society.

As the stories that follow attest, Fielding School faculty, students, and alumni are confronting the challenge head–on by identifying problems, finding solutions, and promoting strategies for healthier aging. Public health has created conditions in which a 47th birthday is often merely a midpoint; now it is helping to ensure that the many years that follow are full of life.

MAGAZINE STAFF

Carla Denly Executive Editor & Director of Communications

Mikkel Allison Writer & Contributing Editor

Dan Gordon Editor & Writer

Lisa Rau Visuals Coordinator & Contributing Editor

Rent Control Creative Design Direction

Jody Heymann, MD, PhD Dean

2

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

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 2016 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; 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; Elizabeth Yzquierdo, MPH, EdD Assistant Dean for Student Affairs; 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

S P R I N G /S U M M E R 2 0 1 6

3

4

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

POWER OF PREVENTION

S

P

R

E

A D

I

N

G

T H E

W O R D Cancer screenings, cholesterol tests, and flu and pneumonia shots save lives. An FSPH initiative aims to increase the use of these services among low-income older adults.

WITH THE NUMBER OF OLDER ADULTS IN THE U.S. expected to double by 2050, public health strategies to reduce premature death and disability from cancer, heart disease, flu, pneumonia and other conditions that disproportionately affect the older-adult population have taken on added urgency.

“In public health our goal is to keep people healthy longer, and we know that prevention and early detection through immunizations and screenings are critical strategies for doing that in the older population,” says Dr. Steven P. Wallace, professor and chair of the Fielding School’s Department of Community Health Sciences and associate director of the FSPH-based UCLA Center for Health Policy Research. “We also know, given current population trends, that unless we increase the use of preventive services the number of people with these conditions will rise sharply, which will be a huge burden on both the population and the health care system.”

Wallace notes that many older adults aren’t receiving the full set of recommended clinical preventive services (CPS). Utilization rates are particularly low among older African-Americans and Latinos, two groups that are aging even faster than the overall population. The number of African-American elders is projected to triple by 2050, and

the population of Latino elders is projected to increase by a factor of six.

The Healthy Aging Partnerships in Prevention Initiative (HAPPI) aims to increase CPS use among low-income African-Americans and Latinos 50 and older in Los Angeles. An academic-community partnership that includes the UCLA Center for Health Policy Research, the Southside Coalition of Community Health Centers, the Los Angeles County Department of Public Health and the City of Los Angeles Department of Aging, HAPPI is one of 10 new and innovative community health programs funded by the U.S. Department of Health and Human Services’ National Prevention Partnership Awards Program. As the only program focusing on older adults, HAPPI is being closely watched as a potential model for improving older-adult health in low-income communities across the country.

HAPPI has set out to improve the ability of eight federally qualified health centers (FQHCs) in South Los Angeles to promote and deliver CPS to their predominantly African-American and Latino patients 50 and older. The initiative focuses on six CPS that the U.S. Centers for Disease Control and Prevention (CDC) has prioritized based on » ph.ucla.edu

S P R I N G /S U M M E R 2 0 1 6

5

POWER OF PREVENTION

evidence of their public health impact in preventing disease and saving lives at a relatively low cost. These include screenings for colorectal, breast and cervical cancer; cholesterol screening; and immunizations for flu and pneumonia.

Nationally, use of these services is well below goals set by the CDC’s Healthy People 2020 recommendations, particularly among African-Americans and Latinos.

“We want the clinics to be places that are providing high-quality care across the life span.”

Currently in its second year, HAPPI seeks to address these disparities through tailored strategies at the participating clinics that include education, training and technical assistance. To complement the work with FQHCs — federally funded community health centers that serve low-income patients — HAPPI is engaging community-based organizations in South Los Angeles to assist the clinics by increasing awareness and promoting the use of CPS among older adults.

“Historically, community health centers have done an excellent job providing care to children and their parents, but haven’t developed the expertise in caring for an older population,” says Nina Vaccaro, executive director of the Southside Coalition of Community Health Centers, a network of eight FQHCs representing more than 45 community- and schoolbased health clinics in South Los Angeles that are participating in HAPPI. Vaccaro explains that 50-and-older adults have made up a small portion of the patient population at community clinics in the past, but the numbers are increasing; moreover, to receive government funding, FQHCs are held accountable for the quality of the care they provide, and are under greater pressure to meet the needs of the over-50 population.

“We want the clinics to be places that are welcoming and providing high-quality care across the life span,” Vaccaro says. “HAPPI is an opportunity to address the needs of older low-income patients in a more targeted way.”

As the academic arm of the partnership, the UCLA Center for Health Policy Research team headed by Wallace is working with the community clinics to assess areas of need and identify strategies for increasing CPS use. Training sessions are being held with clinic staff to raise awareness and orientation to the services, and Wallace’s group has begun working with the community organizations to promote the services and forge partnerships with the clinics.

“Part of our goal in working with the clinics is to make sure we’re developing approaches that will be financially sustainable so that they will be able to institutionalize these projects after the pilot phase is over,” Wallace says. “Our role is to provide knowledge and resources. The clinics take that information and determine, based on their day-to-day realities, what will work best, and then we help them implement what they decide to do and assist with the evaluation.”

At South Central Family Health Center, an FQHC pro6

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

viding care to approximately 20,000 low-income patients at five sites in South Los Angeles, the HAPPI team has trained and offered continuing medical education presentations for providers, as well as working with the staff to identify and implement effective strategies to increase screening rates for colorectal and cervical cancer, which the center identified as top priorities. Wallace’s team has shared data on approaches that other clinics have implemented successfully; as a result, says Dr. Brendan Mull, South Central Family Health Center’s quality improvement director and disease management supervisor, the center’s providers have begun bundling services. “When a patient comes in for a flu shot, we will offer a colorectal cancer screening kit to take home,” he says. “When a woman comes in for a mammogram, we will offer her a Pap smear at the same appointment.”

Prior to HAPPI, Wallace’s team surveyed public health departments, aging-service providers, and community health centers to identify more than a dozen strategies that have proven to be effective in increasing uptake with multiple CPS and involving community partners, particularly with low-income populations. At each of the participating clinics HAPPI has also identified a champion — someone on the staff who is empowered by the medical director to conduct quality assurance activities designed to improve CPS rates. HAPPI is also working with community organizations to implement evidence-based strategies to increase awareness and use of the clinic services.

DR. STEVEN P. WALLACE, FSPH PROFESSOR, HEADS THE PARTNERSHIP’S ACADEMIC ARM.

“Past efforts to increase clinical preventive services have focused on either clinics or community organizations, and we want to bring the two together,” says Peggy Toy, director of the UCLA Center for Health Policy Research’s Health DATA (Data, Advocacy, Training, Assistance) program, who is working closely with the community partners as HAPPI project director. “We believe this is a partnership that benefits both sides, and most importantly one that can improve the health of the older-adult population.”

TRANSFORMING MENTAL HEALTH SERVICES FOR OLDER ADULTS A Fielding School research team examines the impact of California’s “millionaires’ tax.”

THE MENTAL HEALTH SERVICES ACT

diversity of the older-adult population.

(MHSA), a ballot initiative passed by Califor-

California is the most diverse state in the

nia voters in 2004 and commonly referred

nation, and this includes not only racial

to as the “millionaires’ tax,” was welcomed

and ethnic populations, but also diver-

by many mental health advocates as an

sity in gender identity, sexual orientation,

important step in expanding and trans-

immigration status and variations in income

forming the state’s historically underfunded

levels — from the millionaires funding the

county mental health care systems. With an

MHSA to people living on the streets who

additional 1 percent tax on income earned

are hungry, Frank says.

in excess of $1 million, the MHSA brought

increased funding for California’s 58 coun-

California have used MHSA funding for

ties to allocate to mental health programs at

older adults, Frank and her colleagues have

their discretion.

focused on six — Los Angeles, San Diego,

Tulare, Siskiyou, Alameda and Monterey —

More than a decade later, a Fielding

School team is in the midst of a two-year

DR. JANET FRANK AND COLLEAGUES ARE

study examining the extent to which the act

For their analysis of how counties in

that reflect the regional, geographic, ethnic

STUDYING THE EXTENT TO WHICH THE

and income diversity of California, and

has facilitated or bolstered the implemen-

ACT IS MEETING THE MENTAL HEALTH

are now documenting the changes these

tation of systems of mental health care for

CARE NEEDS OF OLDER ADULTS.

counties have put in place for meeting the

older adults. The researchers also plan to

needs of older adults with mental illness and

identify opportunities for further improve-

older adults in need of mental health ser-

promoting mental health. The assessment

ments in the quality of mental health

vices: those with longstanding mental health

covers everything from service delivery,

services for California’s over-60 population.

issues who have grown older — people who

partnership development, consumer input

may be “in the system” and receiving ser-

and planning services to issues of access,

programs for older people specifically;

vices already, but require services that are

gaps in care, transitions in care and referrals.

older adults are included in general adult

tailored or appropriate to their older-adult

services being delivered,” says Dr. Janet

status and the complexities that often evolve

develop potential indicators for older-adult

Frank, adjunct associate professor in FSPH’s

with older age — and older adults who

mental health outcomes and to highlight

Department of Community Health Sciences,

develop mental health issues later in life. For

best practices and programs made possible

faculty associate at FSPH’s Center for Health

this second group, recognition and access

by MHSA funding that are making a positive

Policy Research and principal investigator of

to services can be challenging. For example,

impact for older adults across the state.

the two-year study, which is funded by the

Frank notes, late-life depression is an often

Among other things, MHSA has provided

California Mental Health Services Oversight

unrecognized and yet treatable condition.

funding for Full Service Partnerships within

and Accountability Commission. “Ours is

If the older adult becomes depressed, and

clinical service delivery. In this intensive

the first study since the act was passed that

the condition is not treated, this can lead

program, the county can organize and

is looking at the complexities of older-adult

to a reduction in needed self-care activities

provide “everything it takes” to help people,

mental health needs and systems. We are

for ongoing chronic conditions. “This type

such as facilitating short-term housing. The

focusing on the continuum of mental health

of issue is a recipe for disaster,” Frank says,

MHSA has also led to increased funding for

services, from prevention to residential treat-

“since almost all chronic conditions require

prevention efforts. “MHSA put prevention

ment, including values of consumer involve-

intensive self-management.”

on the map from a mental health standpoint

ment, access, diversity in the broadest sense,

with the funding of the prevention and early

integration of medical and mental health

care that promote resiliency and the mental

intervention component,” Frank says. “These

services, and outcome accountability.”

health of older adults must also take into

types of programs are especially important

account two types of diversity: the diversity

for older adults. People may need, for exam-

differences to consider when planning and

of California’s counties — from larger urban

ple, a community-based peer counseling

providing mental health services for older

areas such as Los Angeles to rural and

program, such as those funded through the

adults is the presence of multiple chronic

frontier counties such as Siskiyou, which

MHSA, to address isolation and link them to

conditions. There are two major groups of

stretches to the Oregon border — and the

the care they need.”

“Many counties do not have separate

Frank notes that one of the important

Statewide efforts to support systems of

The study team is also planning to

ph.ucla.edu

S P R I N G /S U M M E R 2 0 1 6

7

POWER OF PREVENTION

SEEKING SAFER GROUND FSPH alum Geoffrey Hoffman aims to identify cost-effective public health strategies for preventing falls among older adults.

8

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

THE AGING OF THE U.S. POPULATION and the economic strains this brings to the health care system underscore the importance of public health approaches emphasizing prevention and community-level strategies to keep older adults healthy.

That’s the conclusion of Geoffrey Hoffman (MPH ’08, PhD ’15), supported by the research that he and others have conducted on fall-related injuries, a major public health concern affecting elders. “Doctor visits to assess medications and fall risk are part of the solution, but we also need to support social and community approaches, both for financial reasons and to ensure that we are effective in reducing risk and allowing older adults to maintain their independence,” Hoffman says.

Currently a postdoctoral research fellow at the University of Michigan School of Nursing, Hoffman became

interested in studying falls after earning his MPH from FSPH’s Department of Health Policy and Management and then completing a two-year Presidential Management Fellowship in the executive branch of the federal government in Washington, DC. Working in the Veterans Health Administration’s Office of Geriatrics and Extended Care, Hoffman gained practical policy experience in aging-related issues before moving on to the Congressional Research Service, where he assisted Congress members and staff in understanding Medicare provisions of the Affordable Care Act and their potential impact on older adults. Hoffman then returned to the Fielding School for his PhD, focusing his dissertation on risk predictors and outcomes of falls and

impairments, vision, reflexes and muscle strength as people grow old. “But falls don’t just involve clinical factors; they are also related to social factors and the environment in which older adults live,” Hoffman says.

He explains that physicians have an important role to play, particularly when it comes to management of medications, the side effects of which can lead to dizziness or other symptoms that can increase fall risk. But other strategies shown to reduce risk include balance and gait training, physical fitness, use of assistive devices when needed, and modification of the home environment for optimal safety — such as installing handrails, removing carpeting that can pose a tripping hazard, and keeping all items within easy reach.

“The cost is substantial, and [falls] have a tremendous impact on quality of life and mortality. Yet, we know fallprevention strategies can make a big difference.” fall-related injuries. The topics he addressed, and continues to study at the University of Michigan, include the impact of caregiving on fall risk, the relationship between depressive symptoms and falls, and the broader economic cost of falls.

“From a health-economics research perspective, we’re always interested in issues in which actions can make a difference for many people,” Hoffman says. “Falls affect a sizable proportion of the population, the cost to the health care system is substantial, and they have a tremendous impact on quality of life and mortality. Yet, we know fall-prevention strategies can make a big difference.”

Hoffman notes that each year in the United States, more than one-third of adults 65 and older who are living independently experience at least one accidental fall. Of those who do, 20-30 percent are injured, in many cases leading to rapid declines in their health and functional independence.

Annually, more than 2 million older adults visit the hospital emergency department as a result of a fall, one-third of whom are hospitalized. Nearly two-thirds of older adults who are hospitalized for a fall-related injury are later admitted to a long-term care facility, and one-third of those who fracture their hip die within a year of their injury. Fall rates among older adults are increasing, as is the number of older adults in the U.S. population.

Not surprisingly, Hoffman says, this is resulting in not just a rise in fall-related disability and deaths, but mounting costs — from $19 billion in fall-related emergency department and hospitalization costs in 2006 to a projected $43 billion by 2020. Hoffman has found that the average cost to Medicare per fall-related injury is $9,389 in the first year, with out-of-pocket costs to the patient of approximately $1,350.

Much of this is preventable. Hoffman explains that falls are related to “geriatric syndrome,” or the decline in a number of bodily systems affecting balance and gait, cognitive

Hoffman has even found that treating depression can reduce risk, since it increases the focus of older adults when walking.

He is currently focusing on whether caregivers, both informal (such as family members) and paid, help to reduce the fall risk of older adults.

“Medicare was built as a hospital-based system to provide acute care, but at the time it was established, life expectancy was 67 years,” Hoffman says. “We need to move toward a system that better addresses the needs of older adults who are living in the community and trying to stay healthy. Falls are a social phenomenon as well as a clinical one, and we can address them using some low-tech social solutions. By focusing on the scalability and sustainability of the community-based falls-prevention programs that we know are effective, we can potentially save the system a huge amount while keeping older adults independent and healthy.”

BALANCE AND GAIT TRAINING CAN REDUCE FALL RISK FOR OLDER ADULTS.

ph.ucla.edu

S P R I N G /S U M M E R 2 0 1 6

9

POWER OF PREVENTION

C H A N G I N G

C O U R S E

A study by FSPH’s UCLA Center for Health Policy Research suggests that nearly half of California adults are on a path toward diabetes.

55% of adults

in California

have either diabetes or prediabetes

IT’S NO SECRET that there is an epidemic of diabetes in the United States. Nationally, diabetes rates have tripled over the past 30 years, and in California, diagnoses have increased by 35 percent since 2001. But a recent study by the Fielding School-based UCLA Center for Health Policy Research suggests that the problem is even worse than that in California — particularly given the growing number of older adults, who are at the highest risk of any age group for developing the disease.

The study found that approximately 13 million adults in California, or 46 percent, have prediabetes — a precursor 10

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

to type 2 diabetes — in addition to the 2.5 million adults (9 percent) who already have been diagnosed with diabetes.

Combined, the two groups represent 15.5 million people, 55 percent of the state’s adult population.

Prediabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diabetes diagnosis. Up to 30 percent of people with prediabetes will develop type 2 diabetes within five years, and as many as 70 percent will develop the disease in their lifetime. The complications of diabetes can be severe. It is associated with a

dramatically increased risk of amputation, nerve damage, blindness, kidney disease, heart disease, hospitalization and premature death.

As expected, the study found that the prevalence of prediabetes in California is highest among older adults. In the 55-and-older age groups, prediabetes rates are approximately 60 percent. Equally alarming, the study found that 33 percent of young adults (ages 18-39) have prediabetes, suggesting that the number of older adults with the disease will continue to climb in the coming decades. Among adults ages 40-54, nearly half have prediabetes.

“Having these estimates specific to California and broken down by county can help to get the message out that we need to do more to prevent people with prediabetes from developing type 2 diabetes,” says Dr. Susan Babey, co-director of the UCLA Center for Health Policy Research’s Chronic Disease Program and lead author of the study, the first analysis and breakdown of California’s prediabetes rates by county, age and ethnicity.

Babey notes that because people with prediabetes tend not to have symptoms, most aren’t aware they have this precursor to type 2 diabetes unless they have been screened by their health care provider. “There are significant barriers not only to people knowing their status, but to getting

effective help,” Babey says. “A simple blood test for diabetes should be covered by all insurers, as should the resources and programs that can make a real difference in stopping the progression of this terrible disease.”

Established diabetes prevention programs focusing on lifestyle changes have been shown to be effective, in some cases cutting in half the risk that people with prediabetes will develop type 2 diabetes, Babey says. In addition to making such programs more accessible and increasing screening, the study’s authors recommend policy and other changes to encourage healthy, active lifestyles.

“With limited availability of healthy food in low-income communities, a preponderance of soda and junk food marketing, and urban neighborhoods lacking safe places to play, we have created a world where diabetes is the natural consequence,” says Dr. Harold Goldstein (MSPH ’89, DrPH ’97), executive director of the California Center for Public Health Advocacy, which commissioned the study. “If there is any hope to keep health insurance costs from skyrocketing, health care providers from being overwhelmed and millions of Californians from suffering needlessly from amputations, blindness and kidney failure, the state of California must launch a major campaign to turn around the epidemic of type 2 diabetes.”

HIV TESTING OVERLOOKED FOR OLDER POPULATION FSPH-led study finds few in the 50-64 age group are being screened, despite CDC recommendation.

HIV IS NOT OFTEN TALKED ABOUT as an

living with HIV, the risk of infection and the

issue for older U.S. adults, even as a growing

need for HIV testing are likely to increase.”

number are living with the disease. People

55 and older now make up about 20 percent

Centers for Disease Control and Prevention

of the more than 1 million people living with

(CDC), National Institutes of Health and

HIV in the United States, and the 50-54 and

UC San Diego, Ford served as the principal

55-59 age groups each account for more

investigator of a study to determine the HIV

diagnoses of HIV infection every year than

testing trends of U.S. adults ages 50-64 both

the 15-19 age group.

before and after 2006, when the CDC began

And yet, according to Dr. Chandra Ford,

Working with researchers from the U.S.

recommending that doctors routinely screen

associate professor in the Fielding School’s

all patients ages 13-64 for HIV unless they

Department of Community Health Sciences,

opt out. Ford and colleagues found that HIV

lines for people in these older age groups

only about 5 percent of adults between the

testing among older adults increased initially

would be an efficient way to prevent HIV

ages of 50 and 64 have been tested for HIV

following the recommendation, but never

infections among people who tend to have

infection in the last year.

went above 5 percent and is now declining.

other medical complications, or at least get

infected people linked to care and treated

“It’s not like at age 50 sex stops, drug

Ford suspects that many health care

use stops, or anything else that carries the

providers decide not to screen older adults

early,” she says. “With more people access-

risk of HIV transmission stops,” Ford says.

because they judge them not to be at risk

ing the health care system, not screening for

“So as more people in this age group are

for HIV infection. “Following the CDC guide-

HIV represents a missed opportunity.” ph.ucla.edu

S P R I N G /S U M M E R 2 0 1 6

11

HEALTHY AGING

MATTER F TIME Dr. Steve Horvath has developed an invaluable tool for measuring the aging process — and potentially slowing it down.

ALL OVER THE WORLD, PEOPLE ARE LIVING LONGER. Life expectancy at birth is now 80 or older in 33 countries (it is 79 in the United States). Today, one of every nine people is over 60; by 2050, one in five will be.

But Dr. Steve Horvath, professor in the Fielding School’s Department of Biostatistics, points out that as the life span continues to rise, the “health span” isn’t keeping pace. “Advances in medical treatment often keep people alive longer without preventing or reversing the decline in overall health,” Horvath explains. “As a result we have more older people plagued by chronic diseases, which leads to more disabilities and massive health care costs.”

12

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

Horvath notes that age is arguably the most important determinant of chronic disease risk. But he and other researchers who study aging draw a distinction between chronological and biological age. “Biological age is what is important,” says Horvath, who in addition to his Fielding School appointment is a professor in the Department of Human Genetics at the David Geffen School of Medicine at UCLA. “If we can learn what accelerates the aging process and also what helps to keep people biologically young, we might be able to delay the onset of many age-related conditions.”

Finding reliable biological measures of aging has been a longstanding research priority, based on the premise

that these so-called biomarkers would lead to a better understanding of how aging increases susceptibility to certain diseases, along with identifying strategies for promoting healthy aging. In recent years, fueled by breakthrough technologies that allow researchers to analyze genetic patterns with unprecedented speed and precision, a once elusive pursuit has come into focus.

In 2013, Horvath made a seminal contribution to the effort in the scientific journal Genome Biology with the publication of what is now a widely used method for estimating and comparing biological ages of different parts of the human body. His “epigenetic clock” is a culmination of more than three years of collecting and analyzing publicly available data on more than 13,000 tissue samples from laboratories around the world. The clock has been likened to determining the age of a tree by counting its rings.

Although Horvath is quick to state that the tree analogy is hyperbole, his method was hailed by the prominent international journal Nature, which featured Horvath under the headline “The Clock Watcher” and wrote that

“If we can learn what accelerates the aging process and also what helps to keep people biologically young, we might be able to delay the onset of many age-related conditions.” the epigenetic clock “has impressed researchers with its accuracy, how easy it is to read and the fact that it ticks at the same rate in many parts of the body — with some intriguing exceptions that might provide clues to the nature of aging and its maladies.”

Horvath believes the epigenetic clock, available to other researchers through free software, is helping to usher in a new frontier for aging research. Among other things, studies using the biomarkers may help to distinguish which diseases are related to cellular aging as opposed to toxic exposures or other factors — for example, smoking does not appear to affect biological aging, despite all of its other harmful effects. A better understanding of aging-related diseases, Horvath says, might lead to more targeted lifestyle strategies to delay the onset of cognitive and physical decline, and potentially even therapeutics designed to slow the biological aging process, much like statin drugs control cholesterol levels.

The clock estimates the biological age of human tissues, cells, and organs through epigenetic changes — chemical modifications to the genome that can influence the way genes are expressed. Using several hundred epigenetic markers in the human genome, Horvath and his colleagues showed that the epigenetic clock pinpoints with

unparalleled accuracy the age of nearly every tissue or cell type that contains DNA, across the entire age spectrum.

Subsequent studies have found that the epigenetic clock can be used to predict life span.

“There is no debate that epigenetic changes play a critical role in development, but our findings provide compelling evidence that these changes play a similarly important role in aging and make people more susceptible to a host of chronic diseases, as well as cognitive decline,” Horvath says. “As a trained biostatistician, I looked at the genomic data without any biases, and these epigenetic biomarkers dwarfed any other data.”

Now the question for Horvath and other researchers is whether interventions that slow down the epigenetic clock also slow the biological aging process. “We have seen associations between a faster-running epigenetic clock in late life and poorer physical and cognitive health, in addition to a shorter life span,” says Dr. Riccardo Marioni, an epidemiologist at the University of Edinburgh in Scotland.

Marioni is collaborating with research teams around the world, including Horvath’s, on studies seeking to understand what factors cause the epigenetic clock to run faster — and to see if the clock can be “wound back” via lifestyle changes.

“This research could help inform older individuals about lifestyle choices to maximize healthy aging,” Marioni says.

Concludes Horvath: “It is a demographic certainty that our society will face catastrophic health care costs unless we rise to the challenge of delaying disabilities and the onset of chronic diseases. If we could extend the health span by a mere five years, we could prevent a tsunami of suffering and economic hardship due to health care costs, disability costs, and retirement costs. I think of the epigenetic clock as night vision goggles in our fight against aging. It allows us to measure how fast tissues and organs age. What we can measure, we can study — and ultimately defeat.”

DR. STEVE HORVATH’S WIDELY USED RESEARCH TOOL ESTIMATES THE BIOLOGICAL AGE OF HUMAN TISSUES, CELLS AND ORGANS THROUGH CERTAIN CHEMICAL MODIFICATIONS TO THE GENOME.

ph.ucla.edu

S P R I N G /S U M M E R 2 0 1 6

13

MIDLIFE STR ATEGIES

C E N T E R S TAG E Dr. Dawn Upchurch views midlife as a pivotal time for women, when establishing healthy lifestyles can set them up for robust later years.

AS A HEALTH DEMOGRAPHER devoted to better understanding and promoting women’s health over the life course, Dr. Dawn Upchurch concluded that a pivotal phase was being largely ignored by researchers.

“The social and behavioral aspects of women’s health at midlife have been vastly understudied,” says Upchurch, professor in the Fielding School’s Department of Community Health Sciences. “The research has mostly focused on physiological changes with menopause, and while that is important, much more is going on in women’s lives that affect their health.”

Lifestyle changes at any phase can pay off in better health. But Upchurch sees middle age as a critical window of opportunity to embrace habits that go a long way toward determining longevity and quality of life in older age. “Midlife is a time when risk factors accelerate and chronic diseases become increasingly prevalent,” she says. “Adopting healthy practices — in particular, engaging in appropriate levels of physical activity, making changes in weight and diet, maintaining good social and familial 14

relationships, and developing ways to cope with life’s stresses — sets the stage for more robust later years.”

After studying factors associated with poorer health at midlife, Upchurch concluded that more attention needed to be paid to identifying and promoting factors associated with better health. That led to her interest in complementary and alternative medicine (CAM). In 2004, Upchurch received a prestigious career development award from the National Institutes of Health to support her research on the use of CAM for wellness and health promotion in the U.S., and for the last decade-plus she has published extensively on the topic. Among other things, the funding allowed Upchurch to go to school at night, while continuing in her FSPH faculty position, so that she could train to become a licensed acupuncturist.

“There is a growing body of scientific studies demonstrating the positive health benefits of certain types of CAM,” Upchurch says. “For example, practicing tai chi has been shown to reduce general inflammation, a risk factor for many health problems; to

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

increase flexibility; and to reduce risk of falling. There is strong evidence that acupuncture can be used to treat and manage pain, especially chronic pain.

There are also a number of yoga studies among midlife and older adults showing improvements in a variety of outcomes, including lower levels of stress.”

Early CAM research had focused on how people were using it for treating health ailments, but Upchurch was among the first in the field to highlight the importance of these strategies for prevention and health promotion, finding that nearly nine out of 10 CAM

DR. DAWN UPCHURCH HAS STUDIED THE USE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE FOR WELLNESS AND HEALTH PROMOTION.

users reported wellness, or wellness in combination with disease management, as their reason for use. Upchurch notes that chiropractic is an example of a common therapeutic CAM modality; those used for wellness include yoga, meditation, tai chi and nutritional supplements, while practices such as acupuncture and massage are employed for both purposes. “What I have discovered in a number of studies using national data is that people who use these modalities are really not any different from those who use conventional care,” Upchurch says. “They’re using CAM in addition to conventional care, not instead of it — hence the growth of ‘integrative medicine,’ which incorporates CAM into conventional medical practices.”

Overall, Upchurch has found public attitudes toward CAM are highly positive, and these approaches are embraced widely among midlife women in the United States. Using data from the National Health Interview Survey, she reported in a 2010 study that 46 percent of women ages 40-59 had used CAM in the past 12 months. Upchurch believes that given the growing

popularity and evidence of certain CAM approaches in enhancing wellness, public health professionals should do more to incorporate information about proven practices into health promotion campaigns while also educating consumers about untested and potentially risky services and products — over-the-counter supplements, for example, are not well regulated by the U.S. Food and Drug Administration.

“In the past, CAM has been viewed through the biomedical treatment paradigm, but so many of these modalities align with the public health perspective of prevention,” Upchurch explains. “Most importantly, this is about empowering people to engage in practices that can benefit them.”

Whether it’s through CAM or other strategies, reducing stress appears to be critical to the healthy aging process, Upchurch notes. Over the last two decades, researchers have developed a measure of the “wear and tear” on the body resulting from chronic stress, known as allostatic load, that can serve as an early warning sign for greater susceptibility to chronic conditions. “When individuals are

exposed to chronic or unremitting stress, the body becomes maladaptive, leading to small changes in biological markers across multiple systems,” Upchurch says.“Allostatic load serves as an index to these changes that seems to be a strong indicator for subsequent disease. We know that higher allostatic load at midlife, for example, is associated with poorer health at older ages.”

In recent studies, Upchurch and her colleagues have found that midlife women who report more discrimination tend to have a higher allostatic load, and that women who report higher levels of perceived stress over time experience a faster rate of allostatic load increase — in effect, more rapid aging. In a related study, Upchurch’s group found that higher levels of physical activity were associated with lower levels of allostatic load in midlife women, and that physical activity might lower some of the cumulative biological risk associated with aging. Upchurch is now looking at other factors that may help to reduce allostatic load and thus contribute to healthier aging, including regular sleep and healthy diets.

“Adopting healthy practices [at midlife] sets the stage for more robust later years.”

As with other aspects of women’s health, Upchurch says, early investments can go a long way toward healthy aging. “We’re finding that these differences in allostatic load emerge very early in the life course,” she says.

“If we can use that warning sign to successfully intervene at younger ages through both individual-level and community-level changes, the impact on people’s health in middle and older ages could be profound.” ph.ucla.edu

S P R I N G /S U M M E R 2 0 1 6

15

AGING AND MENTAL HEALTH

A PATH-SETTING GENERATION GRAYS An FSPH researcher investigates challenges faced by many gay men as they move into older age.

MIDLIFE AND OLDER GAY MEN IN THE UNITED STATES have lived through a remarkable period of crisis and change. On the heels of the burgeoning gay rights movement in the 1970s, the AIDS epidemic robbed these men of many of their friends and partners beginning in the 1980s. For all of the social progress in recent years, this group has endured DR. RICHARD G. WIGHT DREW FROM discrimination throughout THREE DECADES’ WORTH OF DATA. their lives, with many feeling the need to conceal an important aspect of their identities. And now they have reached a time in their lives that many men, regardless of their sexual orientation, find stressful.

Dr. Richard G. Wight, a researcher in the Fielding School’s Department of Community Health Sciences, has recently studied mental health trajectories of midlife 16

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

and older gay men against the backdrop of these societal shifts. Wight and his colleagues (including Dr. Carol S. Aneshensel, professor in the Department of Community Health Sciences) have drawn from an invaluable resource — the Los Angeles site of the ongoing Multicenter AIDS Cohort Study (MACS), one of the world’s largest and longest-running studies examining the natural history of HIV/AIDS. Led at UCLA by Dr. Roger Detels, professor of epidemiology at the Fielding School, the MACS has followed the lives of nearly 5,000 HIV-positive and HIV-negative gay and bisexual men at four U.S. sites since 1984 through twice-annual assessments.

“It dawned on me that we have three decades’ worth of data,” says Wight. “This was an opportunity to see how the historic societal changes affecting gay men have intersected with the natural aging process.”

Wight has found that on top of aging-related stress that is common regardless of sexual orientation — financial strains, health-related hardships, caregiving burdens, concerns about independence — many midlife and older gay men experience sexual minority stress, including the perception that they need to conceal their sexual orientation, or that others are uncomfortable with or avoid them because they are gay. In a study Wight published in 2012, he found that men

ages 44-75 who identified as gay and reported both sexual minority stress and aging-related stress were at high risk of experiencing poor mental health.

Older gay men are more likely than heterosexual men to endure other types of stress common to the aging population, Wight notes. “They often don’t have the same level of social resources,” he says. “Older gay people are much less likely to have children or to be in a committed relationship than heterosexual people, and are more likely to be living alone, so they have fewer resources to fall back on as they get older.”

In a 2015 study, Wight found that some midlife and older gay men experience what he and his colleagues termed “internalized gay ageism,” which Wight defines as “feeling denigrated or depreciated as they grow older within the context of a gay male culture in which youth and physical attractiveness are disproportionately valued.”

While most of the men in the study did not experience this phenomenon, those who did were more likely to report symptoms of depression. “Midlife and older gay men have traversed unparalleled historical changes across their adult lives and have paved the way for younger generations of sexual minorities to live in a time of less institutionalized

“Midlife and older gay men have traversed unparalleled historical changes across their adult lives.” discrimination,” Wight and his co-authors observed. “Still, they are at distinct risk for feeling socially invisible and devalued in their later years.”

But Wight has also found certain characteristics to be associated with better mental health and a lower risk of depression among the midlife and older gay men he has studied. For the men who experienced internalized gay ageism, a sense of mattering, which Wight describes as “the degree to which people feel they are an important part of the world around them,” was a key factor in mitigating stress-related mental health problems. Wight’s research also suggests that having a high level of mastery, or a sense of control over one’s life, helps to offset some of the damaging effects of sexual minority and aging-related stress. Moreover, his research has concluded that legal marriage for persons in same-sex partnerships may protect against poor mental health.

Wight got his start at the school in 1985, working for MACS as a research interviewer. At the time there were approximately 1,600 men being followed at the UCLA MACS site; more than three decades later that number is down to about 500, with many from the original cohort having died of AIDS-related illness. “When the study started in 1984, HIV hadn’t even been identified as the cause of AIDS,” Wight says.

“These men were motivated to help figure out why so many of their friends were dying, and as time went on and we learned more, much of the study’s focus shifted to long-term survival and aging for these HIV-positive and HIV-negative men.”

MIDLIFE AND OLDER GAY MEN MAY EXPERIENCE SEXUAL MINORITY STRESS ON TOP OF AGING-RELATED STRESS, BUT HAVING DEALT WITH SO MUCH ADVERSITY HAS MADE MANY OF THESE MEN MORE RESILIENT.

The findings from Wight’s research on the lives of these men as they advance in age suggest that targeted campaigns may be necessary to address their heightened risk for poor mental health. Many study participants have related how difficult it is when they think of the close friends and partners they have lost, and how their lives could be different if those individuals were still alive. “On the other hand,” Wight says, “having dealt with so much adversity in their lives has made many of these men stronger, more resilient, and better equipped to deal with some of the hardships people encounter when they get older.”

Homophobia and discrimination continue to be significant, but there is no doubt that the legal and social landscape has shifted dramatically since today’s midlife and older gay men were youths. “These men have lived through tumultuous times,” Wight says. “Their contributions should be valued. Because of what they have been through, life will be that much easier for younger gay people.” On the other hand, Wight points out that recent legislative actions undertaken by some states are once again creating circumstances that put sexual minorities at risk of discrimination and its harmful consequences. ph.ucla.edu

S P R I N G /S U M M E R 2 0 1 6

17

DEMOGR APHIC IMPACT

MINDING CHINA’S ELDERS FSPH doctoral candidate Di Liang looks at how urbanization is affecting the fast-growing older population in her native country.

THE WORLD’S MOST POPULOUS NATION IS GETTING OLD, and fast. In 2000, one in seven people living in China was older than 60; by midcentury, the World Health Organization projects that nearly one in three will be. This trend is occurring against the backdrop of equally dramatic urbanization. In 1978, only 18 percent of China’s population lived in urban areas; by 2020, roughly 60 percent of the population will be urbanized.

Di Liang, a Fielding School Department of Health Policy and Management PhD candidate from China, is concerned about how this seismic demographic shift will affect the health and well-being of Chinese elders. Will expanded opportunities associated with urbanization translate to better mental and physical health outcomes for the older population? Or will any economic benefits be offset by lower levels of family support?

It’s a concern rooted in the experience of Liang’s own family. She grew up in Chengdu, the capital of Sichuan Province in southwest China.

“The place where my parents live was 18

rural 10-15 years ago, and now there is no farmland left,” Liang says. “The lives of the people in the community have changed so much, and yet the effects have not been well studied.”

Liang notes that urbanization has major implications on the way older people live. That is especially relevant in China, where elders residing with their adult children and other family members is common, and where rural elders have relied on their family, rather than the government, for financial and social support. “The question is how this urbanization will influence elders’ family support, mental well-being, and health care,” Liang says.

Researchers interested in examining the impact of urbanization on the lives of the affected populations traditionally have faced the challenge of self-selection bias — those who decide to move to urban areas may have different demographic, personality, or other characteristics from those who choose to remain in their rural environment, making it difficult to know to what extent the new environment is responsible for the

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

outcomes. The urbanization movement in China, though, is distinct in a way that affords Liang a rare opportunity to learn about its effects on rural elders’ health and well-being: It is being fueled to a considerable extent, she explains, not by people’s decisions to move, but by a state-led, economically motivated effort to urbanize rural communities through compulsory land acquisition and development of villages.

A 2014 report by the World Bank found that among the 100 million people who became urban residents in China between 2000 and 2010, for 42 percent it came as a result of this urban land expansion effort, a phenomenon known as passive urbanization.

“Normally with urbanization we think about people migrating to the cities,” Liang explains. “With passive urbanization, people are not choosing to move to the city, but the city is moving to them.”

Using data from the China Health and Retirement Longitudinal Study, a Peking University-led survey that collects demographic and health information from a representative

“With passive urbanization, people are not choosing to move to the city, but the city is moving to them.”

CENTER: DI LIANG WITH HER MOTHER AND GRANDMOTHER IN DUJIANGYAN, NEAR THEIR HOME IN CHENGDU. BOTTOM: LIANG’S FAMILY MEMBERS ENJOYING A MEAL AT HOME.

sample of China’s 45-and-older population every two years, Liang in her doctoral dissertation compares rural elders who have experienced passive urbanization (passively urbanized elders) with those who have not (long-term rural elders). She is particularly interested in the impact on elders’ mental health. “The mental health issues among Chinese elders are really striking to me,” Liang says. “Depression rates are high, and although the overall suicide rate has significantly declined in China over the past decade, it has been increasing among elders.” Given the cultural importance of family in China, one of the key questions for Liang is how family support is affected by urbanization, and how that bears on elders’ mental well-being along with other issues, including informal caregiving, chronic disease management, and financial support.

Liang notes that passive urbanization is controversial in China, sparking land disputes and concerns about the lack of involvement of urbanized former rural residents in decisions about their community’s development. But her ongoing analysis suggests that compared to long-term rural elders, those who live in the newly urbanized communities receive more financial support and are less likely to experience symptoms of depression. She has found no significant differences between the two groups in levels of informal caregiving of the elders by their children. “The explanation is that urbanization, in whatever form, can reduce the amount of poverty, and in my study higher income levels are closely associated with better access to health care along with lower levels of depression,” Liang says.

That isn’t to say that there aren’t other concerns about the effects of passive urbanization on Chinese elders. Liang believes her findings underscore the imperative for policies that target the very different needs of the population groups she has studied. In the case of rural elders, she argues for higher public pensions to protect them from extreme poverty, along with efforts to train village health workers for the aging population. In the newly urbanized communities, Liang says, services can be provided for rural elders who were previously more difficult to reach. For all urban elders, Liang adds, more professional long-term care services are needed to relieve the burden of family members.

Liang hopes her work will help to inform polices on behalf of Chinese elders amid the ongoing state-led urbanization efforts. “As an only child, I am particularly motivated to focus on how these demographic changes are affecting elders,” she says. “I want to make sure my parents and grandparents are going to be supported and happy.” ph.ucla.edu

S P R I N G /S U M M E R 2 0 1 6

19

LEARNING FROM ELDERS

B R I DG I N G

UCLA freshmen learn about aging and older adults — in the classroom, and from the elders themselves.

20

the

ONE OF THE FIRST ASSIGNMENTS in Frontiers in Human Aging, part of a year-long cluster of courses offered to UCLA freshmen, is a reflection on ageism in America. Students discuss negative stereotypes about older adults, from television portrayals of grumpy old men who are set in their ways, to birthday cards that equate getting older with being “over the hill” and worse. Then the students are challenged to examine their own ageist attitudes and stereotypes.

For some, the reflection becomes something of a revelation.

“I didn’t even know ageism was a thing, but I learned that it is,” says Suzannah Henderson, who completed the cluster in June. “It was eye-opening, and that was just the beginning.”

Each year, approximately 120 UCLA freshmen journey through Frontiers in Human Aging, learning about growing old from multiple vantage points — biology, psychology, sociology, ethics, policy and public health — through lessons delivered by a wide-ranging group of faculty experts and from older adults themselves, via hands-on community service experiences.

While many instructors are brought in for guest lectures to cover the vast scope of disciplinary approaches to the study of aging, the cluster’s three core faculty members include two with Fielding School connections: Dr. Paul Hsu (MPH ’03, PhD ’06), adjunct assistant professor in FSPH’s Department of

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

EMMA SKEIE, WHO TOOK THE YEAR-LONG FRONTIERS IN HUMAN AGING SERIES OF COURSES AS A UCLA FRESHMAN, GAINED HANDS-ON EXPERIENCE AT THE NONPROFIT WISE ADULT DAY SERVICE CENTER IN SANTA MONICA, CALIF.

Epidemiology; and Dr. Lené LevyStorms (MPH ’92, PhD ’98), an associate professor of social welfare in the Luskin School of Public Affairs and geriatrics in the David Geffen School of Medicine (DGSOM) at UCLA. Also on the team is Dr. Rita Effros, a DGSOM professor of pathology and laboratory medicine who specializes in immunology.

“Our goal is to convey to students the concept of aging as a lifelong phenomenon, and to show students that there are multiple dimensions to the aging process, which is inherently interdisciplinary,” LevyStorms says.

“You don’t typically encounter 18-yearolds who are interested in gerontology. To see it in these students is inspiring.”

She notes that students are enlightened by the positive aspects of aging, including the wisdom that comes with experience and the increased time older age affords to giving back to society. They also gain a fuller appreciation of their elders through an assignment in which they are required to interview someone about his or her life. “The students tend to forget that older adults were once young,” LevyStorms says, “or that they will one day be old too.”

In addition, students learn about aging at the cellular level, including

what is known and being investigated about the biological aging processes and the potential to manipulate them for better health. Issues are raised about how gender, race, ethnicity and social environment interact with aging. Ethical questions, economic concerns and intergenerational dynamics are explored. Students also learn about aging-relevant policy — from Medicare to the implications of the Affordable Care Act for older adults. Psychological and social elements of aging are discussed, as are the differences between chronological, social and functional age — including successful approaches to remaining mentally, socially and physically engaged later in life.

FSPH faculty member Paul Hsu notes that nearly all of these discussions are guided by public health concepts, including the importance of prevention and health promotion and the role of public health in increasing life expectancy in the U.S. by more than 30 years in the last century.

“Many students haven’t really heard about public health before,” Hsu says. “I try to introduce them to what it means to treat populations as opposed to individuals, including promoting immunizations and other strategies as opposed to waiting for people to get sick.”

Students also spend meaningful time interacting with older adults in the winter quarter through a five-week service-learning experience in which they are placed in agencies that serve elders, such as senior centers, assisted living facilities and adult day care centers. The students complete journals in which they are asked to reflect on their experiences and link them with classroom and book concepts.

The lessons can be poignant. Henderson spent her service-learning time at a senior living community, interacting with residents who have dementia.

She found herself bonding with one older man who reminded her of her grandfather. “He was a kind, soft-spoken person who would be reading his Bible when I came in,” Henderson says.

“He was always eager to participate

in conversation. He would talk about how he had done track and field when he was younger and how much he loved physical activity.”

But Henderson learned that people with dementia commonly experience ups and downs in their cognitive and physical functioning. “One day I came in and he wasn’t doing well at all,” she recalls. “He tried to stand up after lunch and his knees buckled and he almost fell. It broke my heart to see someone I had really connected with struggling like that.”

Nonetheless, Henderson came away from her year in the Frontiers in Human Aging cluster energized, to the point that she is now contemplating enrolling in UCLA’s Gerontology Interdisciplinary Minor and ultimately pursuing a career working with older adults. “When I was younger I really didn’t think about these things, but in college your perspective broadens and you begin to become more analytical about the world,” she says. “Now I see

GAP older people and realize they are more than just grandparents; they are individuals with a wealth of knowledge, wisdom and life experiences to share.”

Levy-Storms says one of the unstated goals of the year-long cluster is that it will lead to more students like Henderson becoming interested in careers working with older adults or on elder-related issues. “There is such a need and so many opportunities, whether it’s in public health, medicine, law, policy, or any other field you can think of,” she says.

The students aren’t the only ones who come away from Frontiers in Human Aging feeling energized. “You don’t typically encounter 18-year-olds who are interested in gerontology,” Hsu observes. “To see it in these students is inspiring.” ph.ucla.edu

S P R I N G /S U M M E R 2 0 1 6

21

FINANCIAL BURDENS

O U T

O F

T H E

BLIN D SPOT FSPH study spotlights the “hidden poor,” a large and overlooked group of older adults who are struggling economically.

USING THE TRADITIONAL STANDARD of the federal poverty level, 259,000 Californians age 65 and older are considered poor. But a study released this year by the Fielding School-based UCLA Center for Health Policy Research reveals that many more elders in the state are struggling with severe economic insecurity, despite having incomes above the poverty line. These additional 655,000 older adults, the “hidden poor,” don’t qualify for public assistance, yet are unable to make ends meet on their own.

Twenty-four percent of California’s 65-and-older adults living alone or only with their spouse/partner are part of the hidden poor as defined by the Elder Index, a measure of poverty refined and expanded by the FSPH center that con-

22

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

siders the true cost of living in each California county. The study found that the hidden poor are almost twice as likely to identify themselves as being in poor or fair health, to feel depressed, and to report that they can’t get timely health care compared to older adults who have higher incomes.

“There are more older adults in California sitting just above the poverty line than there are sitting below it, and their health and access to care look more like the ‘officially’ poor than the non-poor,” says Dr. Steven P. Wallace, professor and chair of the Fielding School’s Department of Community Health Sciences, associate director of the UCLA Center for Health Policy Research and lead author of the study. “They have financial troubles and health issues that may be related to their economic situation, but outdated poverty measurements keep them in the blind spot of planners and policymakers.”

Despite not qualifying for most public services, the elders in the hidden poor category tend to struggle economically in

HEALTH STATUS of

Poor, Hidden Poor and Non-poor Californians Age 65+

“There are more older adults in California sitting just above the poverty line than below it, and their health and access to care look more like the ‘officially’ poor.” ways that can affect their health, Wallace says, whether it’s living in substandard housing; skipping meals or forgoing healthy but more expensive foods that meet their dietary needs; or splitting costly pharmaceutical pills in half to make them last longer. Even with Medicare coverage, he notes, over 10 percent of all older adults’ spending nationally is on health care.

“The high cost of housing in California is one of the biggest drivers in an older adult’s budget,” adds Imelda Padilla-Frausto (MPH ’07), an FSPH doctoral student and UCLA Center for Health Policy Research graduate researcher who co-authored the study. “Policies addressing the shortage of decent affordable housing for our elders will enable them to allocate more of their limited income to taking care of their health through proper nutrition and adequate health care.”

The Elder Index, which enabled Wallace and Padilla-Frausto to identify an all-tooeasily overlooked group in the hidden poor study, is becoming an increasingly valuable tool for researchers, public health planners and policymakers in California and beyond.

The method to calculate the federal poverty guidelines that are used to determine income eligibility for programs such as Medicaid and food stamps hasn’t been updated since it was created in the early 1960s, despite significant changes in consumer spending patterns and the standard of living during that time.

Moreover, the federal poverty level fails to take into account the local cost of living, which is a significant disadvantage in highcost states such as California.

In response, gerontology experts sought to devise a more accurate measure of poverty using widely accepted national and state data sources such as the U.S. Census Bureau and the U.S. Department of Housing and Urban Development. The UCLA Center for Health

47.3%

of the POOR assess their health status as being fair or poor

Policy Research and the Oakland-based Insight Center for Community Economic Development have partnered to refine the tool for California — calculating the location-specific costs for older adults to meet basic needs and examining the implications for those who fall below the index.

Currently, for example, the federal poverty level counts a single person as poor if his or her annual income is under $11,770.

But in high-cost areas of California, people with incomes much higher than that may still struggle to make ends meet. In 2013, the average cost of basic living expenses in California as measured by the Elder Index was $23,112 for single older renters.

The Elder Index is now widely used in California by organizations that work with low-income older adults, as well as by local health departments in their planning efforts. In 2011, California became the first state to institutionalize the Elder Index through legislation that made it the standard of measurement for gauging income security among the state’s elders.

“Poverty isn’t generally associated with older people because we assume that their needs are being addressed by Social Security and Medicare, but that’s not always the case, at least in Los Angeles,” says Laura Trejo, general manager of the City of Los Angeles Department of Aging and a major proponent of the state legislation. Trejo uses the index both for planning and to educate policymakers and others on the challenges confronting older people with limited means, often seeking assistance from Wallace to obtain numbers specific to the city.

“If you think people are taken care of, you don’t necessarily view assisting them as a priority,” Trejo says. “The Elder Index gives us the scientific backing when we educate and advocate for older people who are in fact struggling.” ph.ucla.edu

33.9%

of the HIDDEN POOR assess their health status as being fair or poor

17.5%

of the NON-POOR assess their health status as being fair or poor

10.6%

HIDDEN POOR

10.2% POOR

3.4% NON-POOR

Self-reported FEELINGS OF DEPRESSION some, most or all of the time

Difficulty obtaining TIMELY MEDICAL CARE

30.7%

22.2%

11.9%

POOR

HIDDEN POOR

NONPOOR

POOR = below federal poverty level (FPL) HIDDEN POOR = above FPL but unable to make ends meet as defined by the Elder Index Source: 2013-14 California Health Interview Survey

S P R I N G /S U M M E R 2 0 1 6

23

FINANCIAL BURDENS

WHEN DRUG COSTS ARE HARD TO SWALLOW FSPH professor Stuart Schweitzer offers his prescription for the problem of high-priced pharmaceuticals, a particular concern for older adults.

THE ADVENT OF MEDICATIONS

effective for a number of chronic

Nationally, 85 percent of prescriptions are filled with generic drugs,

conditions has improved the quality of

which often cost in the neighborhood of $5 for a 30-day supply, Sch-

life of millions of people in the United

weitzer notes. But there are also well-publicized cases of exorbitant

States and abroad. But steep out-of-

prices for medications used to treat chronic conditions that are most

pocket costs for expensive drugs puts

prevalent in older populations. The Canadian company Valeant Phar-

many of them out of reach for people

maceuticals, for example, recently raised the price of a hypertension

with limited means — or forces them

drug by 625 percent ($1,346 per vial), a heart drug by 820 percent

to make difficult choices between pills

($36,811 for 25 pills) and a rheumatoid arthritis drug by 2,949 per-

that can improve, or even save, their

cent ($26,189 for 100 capsules). Turing Pharmaceuticals raised the

lives and other basic necessities.

price of a life-saving anti-infective drug from $13.50 to $750 per pill.

For the older-adult population in

The problem isn’t high pharmaceutical prices across the board:

“The cost of drug development is high, and in the long run those

the U.S. that relies on medications more than any other age group,

costs have to be met by sales revenue, but it has never been true that

expensive drugs are a particular concern because pharmaceuticals

the price of a particular drug is based on that drug’s research and

impose higher cost-sharing requirements than other services such

development costs,” Schweitzer says. He explains that the cause of

as doctor visits and hospital stays, notes Dr. Stuart Schweitzer,

exorbitant drug prices is not usually manufacturer greed, but a market

professor in the Fielding School’s Department of Health Policy and

that allows barriers to entry for competing products that would cause

Management and co-director of the UCLA Research Program in

prices to fall. Some markets, even for generic drugs, have only one

Pharmaceutical Economics and Policy. “Worse yet is that insurers

manufacturer. Schweitzer notes that patent laws restricting compet-

are more strict when it comes to covering drugs than they are with

itors from entering markets until the company producing a new drug

respect to physician or hospital services,” Schweitzer says. “Phy-

has had a reasonable period to recover its development costs are

sicians and hospital administrators encounter coverage denials

important for encouraging product innovation, but he believes steps

with respect to some of their services, but they typically are aware

can be taken to make generic drug markets more competitive. The U.S.

of these constraints ahead of time and work around them, so that

Food and Drug Administration could encourage more competition,

patients are not affected. With drugs the story is different.”

Schweitzer says, through increased speed in approving licenses to

competing companies interested in producing generic products, and

Schweitzer believes that the high cost of certain drugs for older

adults is cause for concern, but he suggests the source of the solu-

by allowing competition from compounding pharmacies in the case of

tion lies less with pharmaceutical companies than with third-party

products that are comprised of combinations of generic drugs. Such

payers, both public (through Medicare Prescription Drug Plan - Part

actions could result in lower prices, to the benefit of older adults.

D) and private (through private health insurance). “Pharmaceuticals

are no less crucial to medical treatment than are physician services,

thus more expensive, Schweitzer adds, insurers should be encour-

medical devices, diagnostic procedures or hospital care,” Schweitzer

aged to follow the lead of Great Britain, France, Germany and other

says. “Insurers should be encouraged to reduce cost-sharing to

countries in using new value-based pricing tools to decide which

patients, especially for costly medications.”

drugs are worth the high cost and which are not. He suggests that

insurers could develop higher-premium plans that are more accept-

He notes that the emphasis on Accountable Care Organizations

For new innovative drugs that have patent protection and are

under the Affordable Care Act is a step in that direction. “Treat-

ing of high prices, along with other policies that are more stringent,

ment patterns will be more transparent and patients will not have

at lower premiums. Beyond that, he says, “we as consumers will have

to go through negotiations concerning choice of drug and cost,”

to get used to expensive drugs if they do wonderful things, just as

Schweitzer explains. “Insurers will have incentives to use the most

we have gotten used to higher costs for diagnostic equipment, surgi-

cost-effective therapies, just as hospitals do now.”

cal interventions, and other medical procedures.”

24

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

BUILDING CAPACIT Y

PREPARING FOR A CHALLENGING FUTURE FSPH alumna trains health care and aging-service providers to meet the needs of the fast-growing Alzheimer’s disease population.

GIVEN THAT ALZHEIMER’S DISEASE RISK INCREASES WITH AGE and there is currently no effective prevention strategy or cure, the unfortunate math points to a steep rise in the number of cases in the United States and other countries where the number of older adults is growing rapidly. Currently, 5.3 million U.S. residents — including one-third of those older than 85 — are living with the disease, according to the Alzheimer’s Association. The number of cases is projected to triple by 2050.

As director of professional training and health care services for the nonprofit support and advocacy organization Alzheimer’s Greater Los Angeles, Jennifer Schlesinger (MPH ’07) is on the front lines of efforts to build the capacity of health care and aging-service providers, as well as family caregivers, to handle the growing caseload.

Much of her department’s recent focus has been to work with managed-care health plans. Schlesinger is managing a grant from the federal Administration for Community Living and the California Department of Aging to assist the health plans in developing systems of care that meet the needs of individuals with cognitive impairment, along with their family members. The effort is part of a pilot program within the Cal MediConnect Program, a partnership among California’s Medi-Cal program, the federal Medicare program and health plans to promote coordinated health care delivery to elders with cognitive impairment who are in both programs because of their age and financial status.

“Our work has been gaining national recognition, which is both exciting and encouraging,” Schlesinger says.

Among other things, her team is working with the managed care plans

IN HER ROLE AT ALZHEIMER’S GREATER LOS ANGELES, JENNIFER SCHLESINGER (MPH ’07) BUILDS THE CAPACITY OF PROFESSIONALS AND FAMILY MEMBERS TO WORK WITH PEOPLE WITH DEMENTIA.

and their providers to better detect people experiencing cognitive impairment. “With most diseases people go to the doctor, get a diagnosis and receive treatment, but for Alzheimer’s the narrative is very different,” Schlesinger says. “And for myriad reasons, about half of individuals with the disease are never diagnosed.”

For patients who are found to be impaired, Schlesinger’s group is preparing the health plans to identify family caregivers and make sure they are educated and supported. “Most systems of care don’t identify the people who will be providing the support, let alone assess their needs,” Schlesinger says. “As a result, we see high rates of burnout, fatigue, stress and depression

among family caregivers who are often unsupported. We encourage providers to educate and engage these caregivers in care coordination processes, and then make sure they are connected to psychosocial and other communitybased resources.”

In the broader sense, Schlesinger says, “Public health professionals in the United States need to begin to take Alzheimer’s and related dementias into account when discussing age-related health care issues. When we are developing programs for the management of chronic diseases in older adults, to be effective we will need to consider that many among the target population will also have cognitive impairment, even if it isn’t diagnosed.” ph.ucla.edu

S P R I N G /S U M M E R 2 0 1 6

25

A

AND

CALIFORNIA’S RIGHT-TO-DIE LAW FSPH faculty member Cindy Cain, an expert on end-of-life care issues, examines the state’s landmark act as implementation begins.

WITH THE END OF LIFE OPTION ACT signed into law

by Gov. Jerry Brown last October and taking effect in June 2016, California became the fifth state to legalize physicianassisted dying. The new law allows terminally ill patients to request a prescription for medication that will hasten their death. Restrictions include: a prognosis of six months or less to live; two oral requests for the drugs at least 15 days apart along with one written request, with witnesses; and confirmation by two physicians of the patient’s prognosis and mental competency to make the decision.

While the law appears to have widespread support in California — 65 percent in favor vs. 27 percent opposed, according to a Field Poll published in October 2015 — it also raises concerns, even among supporters.

Dr. Cindy Cain, a medical sociologist and assistant professor in the Fielding School’s Department of Health Policy and Management, studies quality of life issues for older adults, including those at the end of life. Cain heads a Fielding School team that is examining the End of Life Option Act in an effort to educate policymakers, physician groups, and the public about the law, its effects, and what can be learned from the experiences of the states that currently permit physician-aided dying — most notably Oregon, whose 19-year-old Death with Dignity Act served as a model for the California law. Cain spoke with the Fielding School’s Public Health Magazine on these and other issues.

Q: Why is California’s End of Life Option Act so significant?

A: To me, it’s best to think of this law as providing another option within a range of options for people when they get to those last few months of life. The law has implications 26

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

beyond physician-aided dying by opening up conversations about end-of-life issues. We have to also think about hospice and palliative care, and about what it means to stop curative efforts, and then to support comfort efforts. When we talk about person-centered care and empowering patients, we should consider what that means at the end of life. We need to provide education about these options, have real conversations with people where we talk about what matters most to them, and then find ways to meet those needs for individuals at the end of life.

Q: What do you think the role of public health should be in these efforts?

A: I think our role should be to help gather the necessary data and to take as neutral of a position on these issues as possible. Physician-assisted dying is still a very controversial practice, and we need to know a lot more before we jump to strong conclusions. But public health is uniquely situated, for example, to work with people in medicine to understand how physicians and other providers are viewing the law and its implementation, as well as to understand the patient side, and to bring those two sides into the larger conversation.

Q: You have stated that the new law should be used as an opportunity to improve all forms of end-of-life care.

What do you mean by that, and where in particular do you see room for improvement?

A: We do a good job of curing people in the U.S., and we have a very good system of hospice care, as well as a growing system of palliative care. But we don’t do such a great job moving people from the curative side of things to the

“When we talk about person-centered care and empowering patients, we should consider what that means at the end of life.” comfort arena because it’s hard to have those conversations.

As a result, patients often move through the system not feeling empowered to make decisions for themselves.

More than 40 percent of deaths each year in the U.S. are supported by hospice, but the vast majority of Americans might not be able to tell you when they’d become eligible for hospice, or what hospice care actually does for them. The new law presents an opportunity to bring attention to endof-life care issues generally.

Q: What are some of the most important lessons to be drawn from Oregon’s experience?

A: There has been a lot of discussion about whether

vulnerable populations — including racial and ethnic minorities and people who don’t have a lot of resources — are coerced or subject to undue influence through laws like this. It’s fairly clear from the data so far, though, that most of the people who have taken advantage of Oregon’s Death with Dignity Act are white, highly educated, and have private health insurance. That doesn’t mean we should stop asking the question. We should continue to think about ways that people may be made vulnerable and how this kind of decision-making affects different people.

There are also still questions about how best to implement the law in California. While it’s written to protect providers, it doesn’t include educational or peersupport efforts that would be helpful to them. Research has shown that even among providers who believe physician-aided dying is the right thing to do for qualified patients, many have a difficult time working through the decision-making process and feeling OK about the decision. We need to make more effort on that front.

DR. CINDY CAIN’S INTEREST IN QUALITY OF LIFE AND DECISION-MAKING AT THE END OF LIFE STEMS FROM BOTH HER WORK AS A MEDICAL SOCIOLOGIST AND HER EXPERIENCE AS A HOSPICE VOLUNTEER.

Q: Some opponents of this type of law raise the concern that it undermines the sanctity of life. Do you think public health has a place in that debate?

A: It’s an important question that’s hard for us to answer

in public health, but we do have a role in collecting and providing data for people who want to have such discussions.

This also illustrates how important it is for us to have interdisciplinary conversations. It’s not just physicians who should be talking about these issues. We also need to bring in people who have expertise in the spiritual realm; we need to understand how social workers, pharmacists, and others within the health care system think about the ethical dimensions of this; and then we need to expand beyond the health care system to understand how the public thinks about it. This is a societal-level debate, and public health should not sit it out.

Q: How did you become interested in these issues?

A: As a medical sociologist, I have always been interested

in the limits to the practice of medicine, and I see death and dying as an important moment when we come up against those limits. I am very interested in the kinds of quality of life issues that come up in hospice, as well as how to support hospice providers. Through my personal experience with » ph.ucla.edu

S P R I N G /S U M M E R 2 0 1 6

27

“Anything that empowers people and helps them think through what matters most to them improves their quality of life. ”

loved ones dying, I have also found that I’ve been comfortable talking about these types of issues in a way that many others are not. And so I have been a hospice volunteer for the last eight years, which has given me a great deal of insight into how people at this life stage think about their lives.

Q: What have you learned from your personal encounters in hospice settings that informs how you view the new law?

A: Sometimes we assume that when a law like this passes, everyone is going to rush out and want to take advantage of it, but what I have seen is that the vast majority of people don’t necessarily want to hasten their deaths; they really want to make the best of the life they have left. Hospice and palliative care can work toward alleviating pain and existential suffering, so that people can feel better about their remaining time. But sometimes even with the interventions of hospice and palliative care, we’re not able to completely control those things that cause suffering, and in those situations, laws such as this allow people to have more control and another option at the end of life.

Q: So you see this as a quality of life issue, even though the issue has to do with death?

A: Absolutely. Anything that empowers people and helps them think through what matters most to them improves their quality of life.

28

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

PATIENT PREFERENCES

MEDICINE, CULTURE & FAITH FSPH doctoral candidate Rosana Leos Bravo studies how members of a community make decisions at the end of life.

DISPROPORTIONATELY BURDENED by chronic diseases such as asthma, cancer and diabetes, foreign-born Latinos in Southern California highly value culture and faith when making decisions about their health. That’s according to the research of Rosana Leos Bravo, who has found that elder Latinos experience, on average, 7-13 chronic conditions compared to the 4-5 average of other ethnicities. This health disparity is at the root of her work to understand how elders in the community in which she grew up make medical decisions at the end of life.

“I wanted to understand how people in such critical stages of life make decisions — do they include family?

What factors do they take into account?” says Bravo, a doctoral student in the Department of Community Health Sciences and researcher at the Fielding School’s Center for Health Policy Research.

For years, Bravo has served her community in East Los Angeles while volunteering at her church, Our Lady of Guadalupe, where members offer end-of-life care and bereavement services to Latinos struggling with multiple chronic conditions. But Bravo’s research interests also stem from a more personal experience, the painful memory of how her grandfather died fighting multiple diseases. Born in Mexico and later faced with critical medical decisions as he neared the end of his life in Southern California, his experience is all too similar to millions of other people in the community in which Bravo was raised.

Through interviews with foreign-born Latinos living in Southern California trying to manage the burden of multiple chronic diseases, Bravo has found some answers. In addition to doctor interactions, she has found, culture and faith are integral to making such decisions.

While older foreign-born Latinos tend to trust their doctors as experts, for many the trust is also based on the belief that physicians are instruments of God, Bravo has found in her research. People across many cultures use faith as a supplement — praying after going to the doctor, for example.

But Bravo notes that faith and culture can also affect the way people make decisions about their health — such as deciding not to go to a doctor for mental health services, preferring instead the support systems offered through the church and community. Bravo is quick to point out that the influence of culture and faith does not necessarily conflict with doctor recommendations, especially in treating chronic conditions.

Rather, Bravo believes these values are avenues of hope and resilience, helping people manage multiple diseases and the end of life. Ultimately, she hopes her research will help physicians understand and respect these perspectives, improving their ability to provide culturally relevant care to this growing population of Southern California.

“Respecting culture and faith is crucial to delivering patient-centered care,” Bravo says. “Doing so doesn’t interfere with doctors’ work and ultimately benefits the health care experiences of all populations.”

FSPH DOCTORAL STUDENT ROSANA LEOS BRAVO IS MOTIVATED TO STUDY HOW FOREIGN-BORN LATINO ELDERS MAKE DECISIONS ABOUT THEIR MEDICAL CARE

BY THE EXPERIENCE OF HER LATE GRANDFATHER.

ph.ucla.edu

S P R I N G /S U M M E R 2 0 1 6

29

SCHOOL WORK FSPH RUNS TO SUPPORT FELLOWSHIPS FOR STUDENTS Twenty-four FSPH runners — including students, alumni, staff and friends of FSPH — came together for the second straight year to take part in the 2016 Skechers Performance Los Angeles Marathon. Team FSPH ran the #RaceToHealth to raise money in support of summer fieldwork fellowships for students.

PHD CANDIDATE EARNS UC PRESIDENT’S LEADERSHIP AWARD Tyler Watson, PhD candidate in the Department of Environmental Health Sciences, has been honored by University of California President Janet Napolitano with the President’s Award for Outstanding Student Leadership in recognition of his work to help make UCLA’s campus healthier. Watson is co-leading a multipronged project to address food insecurity at UCLA. He is also collaborating with the L.A. Food Policy Council and Los Angeles County Department of Public Health to ex-

plore expansion of food recovery across the county. In addition, Watson is a researcher with the UCLA Healthy Campus Initiative. He has helped UCLA assess how the built environment affects the initiative’s goals, and, as an outgrowth of that work, helped launch the Fielding School’s Stair Well project, which encourages campus residents and visitors to take the stairs instead of the elevator. Watson has also been involved in developing methods to increase bicycle use on and near campus.

KEEP IN TOUCH Visit us online ph.ucla.edu

30

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

2016 NATIONAL PUBLIC HEALTH WEEK AT UCLA As part of National Public Health Week 2016, April 4-8, the Fielding School’s Students of Color for Public Health organized a week of events around the theme “The Moving Pieces of Public Health.” With a series of lectures, panels and activities — including the “Tour de UCLA” featured in the accompanying photo — students sought to educate and engage the UCLA campus and the broader community about public health.

RUTH ROEMER SYMPOSIUM The Fielding School of Public Health Alumni Association awarded Cynthia Davis (MPH ’81, pictured left) the 2016 Ruth Roemer Social Justice Leadership award. Named after the late FSPH professor Ruth Roemer, JD, who advocated for the importance of human rights in public health, the award recognizes community leaders’ efforts to advance and protect the health of vulnerable populations. An assistant professor at Charles R. Drew University of Medicine and Science, Davis has extensive experience developing, implementing and evaluating HIV/AIDS prevention and education programs for at-risk populations, including an HIV mobile testing project that has provided free screenings to more than 60,000 L.A. County residents. Dr. David Carlisle (MPH ’88, PhD ’92), president and CEO of Drew University of Medicine and Science, presented the award.

HEALTH FORUM RENAMED TO HONOR DR. PAUL TORRENS

The Health Forum at UCLA FSPH was renamed The Paul Torrens Health Forum at the UCLA Fielding School of Public Health in honor of Dr. Paul Torrens (pictured above center), professor in the Department of Health Policy and Management at the Fielding School and longtime mentor to countless FSPH students and alumni.

CONRAD N. HILTON FOUNDATION AWARDS $5.44 MILLION TO UCLA TO CREATE PROGRAM TO TRAIN FUTURE WORLD LEADERS The Conrad N. Hilton Foundation announced a $5.44 million grant to the Fielding School’s WORLD Policy Analysis Center in March for the creation of an initiative that will bring together leading faculty from across campus to train the next generation of world leaders and thinkers.

Over the next 15 years, trillions of dollars and millions of human hours will be invested to achieve the Sustainable Development Goals (SDGs). Unanimously adopted by the United Nations General Assembly in 2015, the SDGs are a set of 17 universal goals that include the aim to reduce poverty and hunger, improve health, advance education, make cities more sustainable, and combat climate change.

Beyond governments, a wide range of civil society and private sector stakeholders have committed themselves to the implementation of the goals by 2030.

“We believe that, in order to achieve the SDGs, we must invest in training a new generation across all fields related to the goals to give these future leaders and practitioners the cross-discipline knowledge and skills needed for necessary implementation,” said Peter Laugharn, president and CEO of the Hilton Foundation. “We are confident in the breadth of experience that Dean Jody Heymann and the UCLA Fielding School of Public Health bring to this program, and we are proud to be supporting this initiative.” ph.ucla.edu

S P R I N G /S U M M E R 2 0 1 6

31

2016 BRESLOW DISTINGUISHED LECTURE, STUDENT WRITING COMPETITION, AND ALUMNI HALL OF FAME Dr. Richard Jackson, professor in FSPH’s Department of Environmental Health Sciences, spoke on “Weathering Climate Changes: Public Health’s Urgent Work” at the Fielding School’s 42nd Annual Lester Breslow Distinguished Lecture in April. The annual event, held in honor of the late Dr. Lester Breslow, former FSPH dean and renowned public health leader, included the induction of this year’s FSPH Alumni Hall of Fame members: Dr. Ralph Brindis (MPH ‘72), chief medical officer of the American College of Cardiology’s National Cardiovascular Data Registry and clinical professor of medicine at UC San Francisco’s Philip Lee Institute for Health Policy Studies, who has devoted his professional life to integrating population health and clinical care; Dr. Neal Lonky (MPH ‘97), an entrepreneur-inventor who has developed several surgical tools and devices, and is a clinical professor of obstetrics and gynecology at UC Irvine School of Medicine; and Billie Weiss (MPH ‘81), executive director 32

HONOR ROLL 2016 The UCLA Fielding School of Public Health is pleased to honor our alumni, friends, students, staff, and foundation and corporate partners whose generosity strengthens our school and keeps us at the forefront of public health education. Please visit ph.ucla.edu/ honorroll2015 to view the 2015 Honor Roll.

BOOKSHELF Recent books by UCLA Fielding School of Public Health authors: Annual Review of Public Health, Vol. 36 Edited by Jonathan E. Fielding, Ross C. Brownson, and Lawrence W. Green Child Health: A Population Perspective Edited by Alice A. Kuo, Ryan J. Coller, Sarah Stewart-Brown, and Mitch Blair

emeritus and founder of the Violence Prevention Coalition of Greater Los Angeles and co-chair of Urban Networks to Increase Thriving Youth, who has conducted pioneering public health research to help community-based organizations become more effective in preventing violence. The evening also included presentations by the 2016 Breslow Student Writing Competition finalists: Alvan Cheng, Yan Lin, Stephanie

Ly, Priscilla Yen and Dahai Yue. All finalists received $1,000 from the competition co-sponsor, Molina Healthcare, for their presentations on climate change and priorities for addressing its public health impact. A panel of judges selected Priscilla Yen, PhD candidate in the Department of Biostatistics, as the winner of the competition. Yen received a $5,000 prize courtesy of the Lester Breslow Student Fellowship Fund.

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

Deadly River: Cholera and Cover-Up in PostEarthquake Haiti

By Ralph R. Frerichs

Handbook of Spatial Epidemiology Edited by Andrew B. Lawson, Sudipto Banerjee, Robert P. Haining, and Maria Dolores Ugarte Improving Outcomes for Breast Cancer Survivors: Perspectives on Research Challenges and Opportunities Edited and co-authored by Patricia A. Ganz

FACULTY HONORS & SERVICE Patrick Allard received the 2015 Innovation in Regulatory Science Award from the Burroughs Wellcome Fund.

Onyebuchi Arah was one of two recipients of the 2016 Causality in Statistics Education Award from the American Statistical Association.

Haroutune Armenian was honored with the Armenian American Medical Society’s Health and Heritage Award.

Sudipto Banerjee was selected as a 2015 Institute of Mathematical Statistics Fellow and received the 2016 Distinguished Achievement Medal from the American Statistical Association Section on Statistics and the Environment.

Thomas Belin and Kenneth Wells, members of the Community Partners in Care program, shared in the UCLA Community Program of the Year, Landmark Award 2015.

Ron Brookmeyer received the American Statistical Association’s 2016 Karl E. Peace Award for Outstanding Statistical Contributions for the Betterment of Society.

William Comanor was honored for 50 years of contributions to the field of pharmaceutical economics at a 2015 conference held in his name at the University of British Columbia.

Aram Dobalian was appointed to the Standing Committee on Medical and Public Health Research During Large-Scale Emergency Events of the National Academies of Sciences, Engineering, and Medicine.

Julie Elginer was reappointed to the City of Calabasas Environmental Commission.

Award from the Asian American Network for Cancer Awareness, Research, and Training.

Jonathan Fielding was selected as a member of the Advisory Committee to the Director of the Centers for Disease Control and Prevention, and appointed to the national Advisory Group on Prevention, Health Promotion, and Integrative and Public Health.

Emmett Keeler was selected to serve on a committee for the National Academies of Sciences, Engineering, and Medicine that will conduct a study and provide a report with findings and recommendations on the status and utilization of molybdenum-99 for medical use.

Chandra Ford was selected to serve on the National Academies of Sciences, Engineering, and Medicine committee, Community Based Solutions to Promote Health Equity in the United States.

Gerald Kominski was named chairperson of the Healthcare Systems and Value Research study section of the Agency for Healthcare Research and Quality; and was selected to serve on a committee for the National Academies of Sciences, Engineering, and Medicine: Developing a Smarter National Surveillance System for Occupational Safety and Health in the 21st Century.

Patricia Ganz was honored with the inaugural Joseph V. Simone Award and Lecture by the American Society of Clinical Oncology at the 2016 Quality Care Symposium.

Shane Que Hee won the Leadership Award of the American Industrial Hygiene Association.

Richard Jackson was named FSPH’s 2016 Dean’s Distinguished Scholar.

Michael Jerrett was identified

by Thompson Reuters as one of the World’s Most Highly Cited Researchers for 2015.

Marjorie Kagawa-Singer received the Lifetime Achievement Award at the 2015 Asian & Pacific Islander Caucus, hosted by the American Public Health Association; and was one of two recipients of the C. Doris and Toshio Hoshide Distinguished Teaching Prize in Asian American Studies at UCLA for 2014-15. She also received a Lifetime Achievement

Jack Needleman was selected to serve on the 2015 National Academies of Sciences, Engineering and Medicine Committee for Assessing Progress on Implementing the Recommendations of the Institute of Medicine Report, “The Future of Nursing: Leading Change, Advancing Health.” He was appointed to membership of the Agency for Healthcare Research and Quality Indicator Standing Workgroup, and the Centers for Medicare and Medicaid Technical Expert Panel for the 2018 Impact Assessment of CMS Quality and Efficiency Measures.

Charlotte Neumann received a 2016-17 Council on Research Award from the UCLA Academic Senate to complete her research and fieldwork on nutrition in Kenya.

ph.ucla.edu

Ninez Ponce was selected as cochair of the Standing Committee to Address Healthcare Disparities for the National Quality Forum, and executive planning committee member of the 2015 AcademyHealth Annual Research Meeting. She was chosen to serve as advisor for the National Institute of Minority Health Disparities Visioning on Measures and Methods, and served on an advisory panel for the journal Health Affairs on a multi-year initiative focused on health equity and the elimination of health disparities.

Lisa Rubenstein received the 2016 John M. Eisenberg National Award for Achievement in Research from the Society of General Internal Medicine, and earned a Certificate of Recognition from the VHA Health Services Research and Development Service, Quality Enhancement Research Initiative, Outstanding Service Award.

Marc Suchard was selected as a 2015 Institute of Mathematical Statistics Fellow.

Steven P. Wallace received the 2016 Pearmain Prize from the USC Roybal Institute Distinguished Scholar Advisory Board.

Yifang Zhu was invited by the State Council of the People’s Republic of China and the China Overseas Exchange Association to participate in the 2015 Eminent Young Overseas Chinese Forum held in Beijing.

For more information ph.ucla.edu

S P R I N G /S U M M E R 2 0 1 6

33

2015-16 STUDENT AWARDS Abdelmonem A. Afifi Student Fellowship Alec Chan-Golston Biostatistics

Catherine Cheshire and Lan Sing Wu Scholarship Naada Azeemuddin Epidemiology

Agency for Healthcare Research and Quality Fellowship Andrea Morris, Petra Rasmussen, Deborah Sophie Snyder, Andrea Sorensen, Claire Than, Adriane Wynn Health Policy and Management

Celia G. and Joseph G. Blann Fellowship Tabashir Sadegh-Nobari Community Health Sciences

American College of Toxicology (ACT) North American Graduate Fellowship Jessica Camacho, Julie Castaneda Molecular Toxicology IDP American College of Toxicology (ACT) Travel Grant Julie Castaneda Molecular Toxicology IDP American Industrial Hygiene Foundation 2016 Lawrence R. Birkner and Ruth K. McIntyre-Birkner Memorial Scholarship Teni Adewumi Environmental Health Sciences American Society of Safety Engineers - Thompson Scholarship for Women in Safety Teni Adewumi Environmental Health Sciences

The Ann and Phil Heymann Global Fellowship Natalie Dickson Community Health Sciences Ann G. Quealy Memorial Fellowship Bridget Bohannon, Vivian Lei Health Policy and Management Anne Sullivan Reher Livio Fellowship for the Health and Well-Being of the Homeless Jaime La Charite Community Health Sciences Association of Scientists of Indian Origin (ASIO-SOT) of the Society of Toxicology- Best Graduate Student Award Priti Prasad Molecular Toxicology IDP Breslow Student Writing Competition Award Priscilla Yen Biostatistics Burroughs Wellcome Fund InterSchool Training Program in Metabolic Diseases Yu-Hsuan Chuang, Roch Nianogo, Kimberly Paul Epidemiology

Calouste Gulbenkian Global Excellence Scholarship for Armenian PhD Students Vahe Khachadourian Epidemiology Carolbeth Korn Scholar Award Lauren Gase Health Policy and Management

34

Child and Family Health Program Fellowship Juliane Nguyen, Sally Saleh Community Health Sciences Jane Liu Epidemiology Clinical Translational Science Institute (CTSI) Training Grant Amy Bonilla, Natalie Bradford, Julian Brunner, Anna Davis, Sarah Friedman, Lauren Gase, Charleen Hsuan, William Boyd Jackson, Michelle Keller, Selene Mak, Sara McCleskey, Narissa Nonzee, Helen Ovsepyan, Andrew Siroka, Andrea Sorensen, Diane Tan, Linda Tran, Joseph Viana, Ayae Yamamoto Health Policy and Management Cornelius Hopper Award, California TRDRP Zuelma Contreras Epidemiology Dean’s Global Health Fellowships Alexis Cooke, Natalie Dickson, Roz Fanaieyan, Ryan Loong, Tony Yao, Mindy Zhao Community Health Sciences Rica Ann Dela Cruz, Heidi Ransohoff, Elizabeth Van Dyne Epidemiology Dean’s Leadership Grant David Phak Biostatistics Joyce Adesina, Jacob Beckerman, Katie Cobian, Nandini Inmula, Mara Ortenburger, Erik Pena, Tania Perez, Vanessa Perez, Alexandra Prince, Estelle Robinson, Vanessa Rodriguez, Jaime Ruiz, Jose Velasquez Community Health Sciences Jasneet Bains, Carlos Barragan, Therese Chen, Jimmy Phong, Amanda Wagner Environmental Health Sciences Marisol Arguelles, Victoria Autelli, Jesse Bendetson, Rishi Das, George Dewey, Rene Garcia, Elbert Hsiung, Rachael Jackson, Larry Lai, Amanda Landrian, Laureen Masai, Adriel Neely, Chelsea Shover, D’Andre Spencer, Kartavya Vyas, Epidemiology Naada Azeemuddin, Kristin Calsada, Albert Funes, Jason Gilleylen, Xiang Li, Minerva Pineda, Rathi Ramasamy, Nahal Sabrhkani, Ivan Torres, Jason Williamson Health Policy and Management Dean’s Outstanding Student Award Jason Estes Biostatistics Héctor Alcalá Community Health Sciences Elaine West Environmental Health Sciences Aolin Wang Epidemiology Claire Crawley Delgado Health Policy and Management

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

Dean’s Supplemental Grant Naada Azeemuddin Epidemiology Delta Omega Honorary Society in Public Health, Iota Chapter Michelle Clark, Jason Estes, Zizhao Zhang Biostatistics Jacob Beckerman, Eva Durazo, Anne Fehrenbacher, Nicole Garcia, Chiara Kuryan, Tamara Marzouk, Brittany Morey, Juan Carlos Rodriguez Tapia, Emerald Snow, Shayla Spilker Community Health Sciences Sabrina Adelaine, Elaine West Environmental Health Sciences Priya Bhagwat, Claire Kim, Victoria Tseng, Elizabeth Van Dyne, Aolin Wang, Jie Wu Epidemiology Kelly Benshoof, Robin Blythe, Susan Fredericks, Danielle Janes, Rachel Landauer, Alicia Macklin, Kimberly Narain Health Policy and Management Aaron Lulla, Daniel Malkin Molecular Toxicology IDP Delta Omega National Poster Competition Award, Sharona Sokolow Environmental Health Sciences Dissertation Year Fellowship Michelle Clark, Jason Estes Biostatistics Elinam Dellor, Eva Durazo Community Health Sciences Bryan Moy, Nu Yu Environmental Health Sciences Daniel Keebler, Roch Nianogo Epidemiology Charleen Hsuan, Kimberly Narain Health Policy and Management Drabkin/Neumann Global Public Health Field Experience Mindy Zhao Community Health Sciences

E. Richard (Rick) Brown Social Justice Award William Boyd Jackson Health Policy and Management

Eugene Cota Robles Fellowships Angela Gutierrez Community Health Sciences Jenna Harrigan, Ellen O’Connor Molecular Toxicology IDP Courtney Coles, Isomi Miake-Lye, Mayra Rascon Health Policy and Management Fielding School of Public Health Nonresident Scholarship Qian Li Biostatistics Naada Azeemuddin Epidemiology Fielding School of Public Health Scholarship Sharona Sokolow Environmental Health Sciences Albert Funes, Jason Williamson Health Policy and Management Foster G. McGaw Scholarship Claire Crawley Delgado Health Policy and Management

Fred H. Bixby International Internships on Population and Reproductive Health Emerald Snow Community Health Sciences Fred H. Bixby Certificate on Population and Reproductive Health Ruth Hsu, Sally Saleh, Emerald Snow Community Health Sciences FSPH Future Public Health Leaders Fellowship Award David Phak Biostatistics Anika Akhter, Meron Begashaw, Jacob Beckerman, Jessica Coates, Mara Ortenburger Community Health Sciences Elbert Hsiung Environmental Health Sciences Jesse Bendetson, Rishi Das, Adriel Neely, Chelsea Shover, Kartavya Vyas, Epidemiology, Rathi Ramasamy, Nahal Sabrhkani Health Policy and Management FSPH Global Health Certificate Banke Balogun, Anne Fehrenbacher, Ryan Loong, Erik Pena, Tony Yao, Mindy Zhao Community Health Sciences Michelle Romero Environmental Health Sciences Rica Ann Dela Cruz, Heidi Ransohoff, Elizabeth Van Dyne Epidemiology FSPH Marathon Student Fellowship Natalie Dickson, Amelia Fay-Berquist, Roya Mason, Jessica Parry, Alexandra Prince Community Health Sciences Gordon Research Conferences on Cellular and Molecular Mechanisms of Toxicology Poster Award Jessica Camacho, Julie Castaneda Molecular Toxicology IDP Gordon Research Seminar on Cellular and Molecular Mechanisms of Toxicology - GRS Funding Award Julie Castaneda Molecular Toxicology IDP Global SAS Forum Scholarship Clinton Hall Epidemiology

Gordon Heim Memorial Scholarship Caitlin O’Connor Community Health Sciences Graduate Opportunity Fellowship Program Eder Abellaneda, Esmeralda Melgoza Community Health Sciences Mercede Ramjerdi Environmental Health Sciences D’Andre Spencer, Melissa Wiles Epidemiology Jazmine Gutierrez, Jeanette Reynaga, Julie Son Health Policy and Management Graduate Research Mentorship Award Evan Krueger, Subasri Narasimhan Community Health Sciences Tyler Watson Environmental Health Sciences

Drew Westmoreland Epidemiology Aaron Dawes, Isomi Miake-Lye, Greg Sacks Health Policy and Management Graduate Student Researcher Opportunity Award Lucia Chen Biostatistics Yan Lin Environmental Health Sciences Zuelma Contreras Epidemiology Graduate Summer Research Mentorship Fellowship Qian Li, Gregory Watson Biostatistics Paul Chandanabhumma, Monique Gill, Stephanie Ly, Chiao-Wen Lan, MariaElena Young Community Health Sciences Tyler Watson Environmental Health Sciences Priya Bhagwat, Dvora Davey, Adva Gadoth-Goodman, Cynthia Kusters, Solomon Makgoeng, I-Fan Shih Epidemiology Tina Phan Molecular Toxicology IDP Di Liang, Andrea Sorensen, Joseph Viana Health Policy and Management Hal E. Martin Scholarship Jasneet Bains Environmental Health Sciences Hatos Center for Neuropharmacology Fellowship Maureen Sampson Molecular Toxicology IDP Health Policy and Management Alumni Association (HPMAA) Award Kaitlyn McBride, Deepa Thaker Health Policy and Management Incoming Student Opportunity Award Aiyu Chen, Thomas Gibson, Kristen Keller, Javier Mercado, Tahmineh Romero, Yuguang Yue, Yiyang Zhu Biostatistics Alexis Balina, Amber Brink, Iris Guzman Camarena, Vanessa Deleon, Thu Le, Makaela Newsome Community Health Sciences Yuge Bian, Jimmy Phong, Mercede Ramjerdi, Amanda Wagner Environmental Health Sciences Ashima Bhatti, Katrina Blust, Katelyn Corey, Phong Huynh, Laureen Masai Epidemiology Carlos Casillas, Armand Flores, Isabel Guerrero, Jennifer Liang, Lilly Nguyen, Fay Saepharn Health Policy and Management Institute of Transportation Studies Fellowship Jasneet Bains Environmental Health Sciences Jim Keogh Award - Occupational Health & Safety Section of the APHA Katherine McNamara Environmental Health Sciences Judith Blake Memorial Fellowship Jessica Camacho Molecular Toxicology IDP

Juneal Marie Smith Fellowship in International Nutrition Linghui Jiang Community Health Sciences Leadership Training in Maternal and Child Nutrition Rebecca Halvorson, Jocelyn Harrison, Jasmine Mercado Community Health Sciences Max Factor Family Foundation Summer Internship Elida Ledesma Community Health Sciences Molina Healthcare Student Writing Competition Award Priscilla Yen, Biostatistics, Stephanie Ly Community Health Sciences Yan Lin Environmental Health Sciences Alvan Cheng Epidemiology Dahai Yue Health Policy and Management Monica Salinas Internship in Latino and Latin American Health Elida Ledesma Community Health Sciences Regem Corpuz Health Policy and Management

Raymond D. Goodman Scholarship Jee Won Park, Aolin Wang Epidemiology

UCLA Competitive Edge Jenna Harrigan , Ellen O’Connor Molecular Toxicology IDP

Ric and Suzanne Kayne Public Health Fellowships Nicole Garcia, Ruth Hsu, Elizabeth Jacoby, Ashley Lewis, Tanya Moreno, Vanessa Rodriguez, Devin SaragosaHarris, Marisol Torres, Katelyn Tran Community Health Sciences Hannah Brosnan Epidemiology Claire Crawley Delgado, Joel Gonzalez Health Policy and Management

UCLA Fellowship in Epidemiology Aryana Amoon, Marisol Arguelles, Aileen Baecker, Zoe Baker, Priya Bhagwat, Rachel Bolanos, Paul Brendel, Yan Chai, Chun-Pin Chang, Zuelma Contreras, Ryan Cook, Bryant Dao, Dvora Davey, Rica Ann Dela Cruz, M. Claire Dillavou, Aline Duarte Folle, Adva Gadoth-Goodman, Sohum Gokhale, Clinton Hall, Brian Huang, Kexin Jin, Vahe Khachadourian, Diana Khuu, Cynthia Kusters, Chenxiao Ling, Solomon Makgoeng, Kaila McDonald, Travis Meyers, Negar Omidakhsh, Josh Quint, Brittney Redick, I-Fan Shih, Chelsea Shover, Samuel Wing, Xiaoqing Xu, Yanglu Zhao, Yuhui Zhu Epidemiology

Roemer Health Services Fellowship Robin Flint, Ashley Parks Health Policy and Management Ruth L. Kirschstein National Research Service Award for Individual Predoctoral Fellowships to Promote Diversity in Health-Related Research (Parent F31 - Diversity) Jessica Camacho Molecular Toxicology IDP Samuel J. Tibbitts Fellowship Héctor Alcalá Community Health Sciences Kimberly Narain Health Policy and Management

National Institute on Aging Predoctoral Training Program (CCPR) Helene Riess, Mienah Sharif Community Health Sciences

National Institute of Child Health and Human Development Predoctoral Training Program (CCPR) Alexis Cooke Community Health Sciences

SCERC Research Training Program Pilot Grant Negar Omidakhsh Epidemiology

National Institute of Environmental Health Sciences T32 Training Grant in Molecular Toxicology Lisa Barnhill, May Bhetraratana, Daniel Malkin, Priti Prasad Molecular Toxicology IDP

Southern California Society of Toxicology (SCCSOT) Graduate Student Travel Award Jessica Camacho, Priti Prasad Molecular Toxicology IDP

National Institutes of Health (NIH) Individual Predoctoral Fellowship (F31) Julie Castaneda Molecular Toxicology IDP National Institute for Occupational Safety and Health - Southern California Education and Research Center Fellowship Charlene Nguyen, Jimmy Phong, Chanbopha Sen, Ivan Torres, Elaine West Environmental Health Sciences National Science Foundation (NSF) Graduate Research Fellowship Jessica Camacho, Maureen Sampson Molecular Toxicology IDP NEHA/AAS/APU Scholarship Jennie Wung Environmental Health Sciences Nonresident Graduate Academic Doctoral Award Yuhui Zhu Epidemiology Public Health Foundation Women, Infants, and Children Program Jane Liu Epidemiology

Southern California Society of Toxicology (SCCSOT) Award for Poster Presentation Jessica Camacho, Priti Prasad Molecular Toxicology IDP

Southern California/Orange County American Industrial Hygiene Association Scholarship Katherine McNamara, Jimmy Phong, Chanbopha Sen Environmental Health Sciences Supplemental Nutritional Program for Women, Infants, and Children Fellowship Jane Liu Epidemiology Thrasher Early Career Award Elizabeth Van Dyne Epidemiology Tony Norton Memorial Fellowship Ivan Torres, Elaine West Environmental Health Sciences UCLA Biostatistics AIDS Training Program Hilary Aralis, Daniel Conn, Benjamin Rogers, Priscilla Yen Biostatistics UCLA CFAR/AI Seed Grant M. Claire Dillavou Epidemiology UCLA CHIPTS Pilot Grant Laura Anderson Epidemiology ph.ucla.edu

UCLA Pre- and Post- Doctoral Program in Molecular Genetic Epidemiology of Cancer Aileen Baecker, Zuelma Contreras, Daniel Keebler, Claire Kim, Travis Meyers Epidemiology UCLA/Cambodia HIV/AIDS Training Program in Data Management and Analysis Kennarey Seang, Phirom Toeng Epidemiology UCLA/Fogarty AIDS International Training and Research Program Myanmar Thet Wai Nwe Epidemiology UCLA/Fogarty AIDS International Training and Research Program Thailand Kaewalee Soontornmon Epidemiology UCLA/Fogarty China NCAIDS Program Yue Gao, Dai Gu, Yuan Ji, Sitong Luo, Xiaoyu Xu Epidemiology Upsilon Phi Delta National Honorary Society Thomas Armentrout-Wiswall, Ailene Bui, Andrew Do, Claire Crawley Delgado, Callie Jaques, Vivian Lei, Jessica Schumer, Alicia Shewmaker Health Policy and Management Dr. Ursula Mandel Scholarship Paul Chandanabhumma Community Health Sciences Aaron Dawes, Greg Sacks Health Policy and Management Tyler Watson Environmental Health Sciences Wilshire Health and Community Services Internship in Geriatric Medicine Elizabeth Jacoby, Justin Kumar, Juan Carlos Rodriguez Tapia, Marisol Torres, Jennifer Tran Community Health Sciences Claire Jang Epidemiology Nahal Sabrkhani Health Policy and Management

S P R I N G /S U M M E R 2 0 1 6

35

TRANSFORMATIVE INVESTMENTS EXAMINING LANDMARK END-OFLIFE LAW FIELDING SCHOOL Advisory Board chair Tom Weinberger has been interested in patient autonomy and end-of-life issues since his time in the Army Medical Service Corps during the Vietnam era and more recent master’s degree in bioethics. Anticipating the implementation of Califor-

SUPPORTING STUDENTS DETERMINED TO MAKE A DIFFERENCE WHILE STILL IN THE FIELDING SCHOOL’S MPH PROGRAM, Elizabeth Jacoby began putting her public health knowledge into practice. With fellow FSPH student Nicole Wainwright, Jacoby co-designed and co-launched Equity Eatz, which provides at-risk youth with the opportunity to gain applicable job skills and knowledge of nutrition, access to quality food and obesity prevention.

Jacoby was among 12 inaugural Kayne Public Health Fellows — students who have faced financial barriers to pursuing their education and have demonstrated a commitment to working in underserved communities, each of whom received tuition support to attend the Fielding School and pursue their dreams of making a difference. The fellowships were made possible by a $500,000 gift from

36

Ric and Suzanne Kayne that will enable a similar group of students to be supported in the 2016-17 academic year. Kayne fellows are selected based on need, merit and demonstrated commitment to working on a core public health problem such as nutrition, physical activity or maternal and child health.

“The determination of the inaugural Kayne Public Health Fellows to continue their education and make a difference in all communities is extraordinary,” says Dr. Jody Heymann, FSPH dean. “The Kaynes’ generous gift to the Fielding School made it possible for these talented and committed students to complete their training with far less debt, and graduate in a much better position to solve the major public health problems facing our country.”

Elizabeth Jacoby has already begun laying the foundation for the growth of Equity Eatz (funded by The California Endowment) as an innovative program that can transform the health and opportunities of those it serves.

Through weekly programming at the Weingart East Los Angeles YMCA, teen participants learn to cook, market and promote their recipes, and sell them at events sponsored by the YMCA and the non-profit Volunteers of East Los Angeles. “Entering graduate school was the largest financial risk I ever undertook,” Jacoby says. “The Kayne Fellowship enabled me to dedicate the energy and time required to build Equity Eatz into a sustainable program while attending school.”

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

nia’s landmark End of Life Option Act starting in June 2016, Weinberger made a gift that provides pilot funding for Fielding Schoolled research. The research is designed to assist policymakers, health care providers, patient groups and others in understanding how best to transform end-of-life care based on the experiences of states that have enacted similar laws and the recent implementation in California (see page 26). “In the U.S., we do not do a good job of navigating end-of-life matters,” Weinberger says. “With this important new law we have a wonderful opportunity to study these issues.”

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

“Aging is not lost youth but a new stage of opportunity and strength.”

— Betty Friedan