UCLA Public Health Magazine - December 2001

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DECEMBER 2001

UCLA

PUBLIC HEALTH the Air

UCLA

POLLUTION we breathe

School of

Public Health

Globalization began long ago at the School, which enrolls 150 foreign students a year and conducts research or provides service in 70 countries.

It’s been a natural progression from barefoot doctor to molecular epidemiologist, Zuo-Feng Zhang says. It’s all about prevention.

Well before 9/11, the Center for Public Health and Disaster Relief prepared public health systems for intentional and unintentional calamities.

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UCLA

PUBLIC HEALTH

Albert Carnesale, Ph.D. Chancellor

Linda Rosenstock, M.D., M.P.H. Dean, UCLA School of Public Health

Julie Tisdale Pardi, M.A. Assistant Dean for Communications

Dan Gordon Editor and Writer

Martha Widmann Art Director

fe a t u r e s 6

8

EDITORIAL BOARD Roshan Bastani, Ph.D. Associate Professor, Health Services

Thomas R. Belin, Ph.D. Associate Professor, Biostatistics

William Hinds, Ph.D. Professor, Environmental Health Sciences

Jeffrey Luck, Ph.D. Assistant Professor, Health Services

Hal Morgenstern, Ph.D. Professor, Epidemiology

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

Susan B. Sorenson, Ph.D. Professor, Community Health Sciences

Raphael Travis President, Public Health Student Association

Joyce A. Page, M.S.P.H., J.D.

UCLA

President, Alumni Association

School of

Public Health

Preparing Public Health Professionals for the Worst The UCLA Center for Public Health and Disaster Relief addresses growing concerns about the ability of the public health system to respond to masscasualty episodes, from earthquakes to terrorist acts.

Zuo-Feng Zhang: New Science, Old Goals Findings on the benefits of green tea are the latest example of one faculty member’s application of molecular epidemiology toward his passion since serving as a “barefoot doctor” in China: disease prevention.

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Executive-Style M.P.H. Programs: New Skills for Practicing Professionals

Clearing the Air

10

20

departments 24 RESEARCH

HIV/AIDS prevention in China...following up on suspicious breast abnormalities...Medicare HMOs and minority access...role models and health...promoting nutrition and fitness through faith institutions...TB medicationtaking strategies.

Despite great progress, the air we breathe in Southern California remains fraught with peril. Researchers at the School are sifting through the haze to put the issues into better focus.

15 From Westwood

to the World: SPH Faculty Seek to Improve Global Health Dozens of faculty think locally and act globally, traveling to all corners of the Earth to conduct research aimed at preventing disease and promoting health.

Health professionals seek to expand their scope of practice with intensive weekend instruction leading to an M.P.H.

29 NEWS BRIEFS 32 FACULTY 35 CLASS NOTES 37 ALUMNI TRIBUTE Dora Menchaca

ON THE COVER

Anyone living in Southern California is all too familiar with the sight of bumper-to-bumper traffic.

What impact do vehicle emissions have on the region’s air, and what are the health effects of breathing various types of airborne particulate matter? Researchers at the School are among the leaders of the effort to find answers to these and many other pressing air quality questions.

Lung X-Ray: Corbis Images. Freeway Traffic: Eyewire. Cover collage by Martha Widmann.

PHOTOGRAPHY Yvette Roman / cover: Zhang; TOC: Zhang, Clearing the Air; p. 2; pp. 4-5; pp. 8-9; p.13: interiors of trailer and trailer roof; p.14; p. 17; p. 22; p. 23: Harvey; p. 36: Baer

Reed Hutchinson / TOC: M.P.H. Programs; p. 20; p. 21: Upchurch Courtesy of Dr. John Froines / p. 12: bus with exhaust; p. 13: exterior of trailer Courtesy of Dr. Charlotte Neumann / p. 15 Courtesy of Dr. Gail Harrison / TOC: Global Health; p. 16 Courtesy of Tracy Hazelton / p. 18 Courtesy of Dr. Joanne Leslie / p. 27 Courtesy of USC School of Dentistry / p. 35: Goldstein Courtesy of John Menchaca / p. 37 PhotoDisc / TOC and p. 6: earthquake aftermath; pp. 10-11: L.A. skyline Courtesy of the UCLA School of Public Health / cover: Harrison, Rottman; p. 3; p. 6: Rottman; p. 7; p. 10: Winer; p. 11: Froines; p. 19; p. 21: Kar; p. 23: Torrens; pp. 29-32

School of Public Health Home Page: www.ph.ucla.edu E-mail for Application Requests: app-request@admin.ph.ucla.edu UCLA Public Health Magazine is published by the UCLA School of Public Health for the alumni, faculty, students, staff and friends of the School. Copyright 2001 by The Regents of the University of California. Permission to reprint any portion must be obtained from the editor. Contact Editor, UCLA Public Health Magazine, Box 951772, Los Angeles, CA 90095-1772. Phone: (310) 825-6381.

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dean’s message THESE ARE TRYING TIMES for all of us. As the country struggles to deal with the new bioterrorism threats, public health has been thrust to the forefront. The attention to our field surrounding these events is virtually unprecedented. We have all heard talk about the inadequacies of the public health infrastructure. As a leading school of public health, we can be part of the solution. The School of Public Health offers our students training in bioterrorism, public health preparedness, and other disaster-related issues (see article on the Center for Public Health and Disaster Relief, page 6). In addition, we are uniquely positioned to train the health professional workforce of California and the West Coast region in responding to these new threats. The School is also well poised to become the national model for linkages between state and local health departments, academia, and community services to provide the public health infrastructure necessary to prepare for, train, and respond to acts of terrorism. The School is playing its part as a public presence in light of these recent events, responding to media, government, professional, and public inquiries on the bioterrorism threat.

This year we celebrate our 40th anniversary as an independent accredited school of public health (from 1946 to 1961, UCLA was part of a University of California system-wide School of Public Health).

Our celebration will center around this year’s Breslow Lecture on April 1, 2002. I’m pleased to announce that Donna Shalala, Ph.D., President of the University of Miami and former Secretary of the U.S. Department of Health and Human Services during the Clinton Administration, will be our featured speaker.

At this time it is appropriate that we reflect on our successes over the past 40 years (see pages 4-5) and look forward to the future. In an effort to address the latter, last spring I initiated a strategic planning process for the School.

After receiving considerable internal and external input, including two community meetings held over the summer, we now have a final strategic plan. The plan will be a useful tool as we chart the future course for the School. The vision, mission, and strategic goals are listed in the sidebar at right. The entire document can

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be found on the Web at: www.ph.ucla.edu/strategic_planning.html

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vision: Building healthy futures . . . in greater Los Angeles, California, the nation, and the world.

mission:

As you can see, the fifth strategic goal deals with the School’s infrastructure.

The mission of the UCLA School of Public Health is to enhance the public’s health by conducting innovative research, training future leaders and health professionals from diverse backgrounds, translating research into policy and practice, and serving our local communities and the communities of the nation and the world.

I am happy to announce that Advisory Board member Tom Epley has agreed to chair the planning phase of the new building project. We will officially kick off the campaign in 2002, but I am thrilled that we have commitment across campus for a new building to be located across Westwood Boulevard from the new hospital.

While many of the building specifics will be worked out over the next few years, we have designed a conceptual image of the building (see above) that will be useful for planning and fundraising purposes.

I would like to take this opportunity to welcome a new member to the Dean’s Advisory Board, David Walker, president of Rastiff Business Ventures.

David and his wife Vicki are committed to helping us launch our new global health effort.

Finally, I’m happy to announce that the Fred H. Bixby Foundation provided another major gift of $1.2 million to the School establishing the Fred H. Bixby Fund in Population and Family Planning, which will allow the development of faculty leadership, student training, and research in domestic and international

strategic goals: The following strategic goals support the School’s vision and mission: 1. Advance the mission of the School through achieving excellence in our three core functions: research, education, and service.

2. Establish new and strengthen existing collaborative partnerships with a major focus on working with communities to improve health in greater Los Angeles.

3. Enhance the School’s contributions and visibility in global health.

reproductive and population issues.

I look forward to working with our faculty, students, staff, alumni, and many partners as we implement the strategic plan, raise money for our new building, and create the next generation of successes for the School.

4. Increase the School’s visibility and impact on public health issues, including health policy development.

5. Build the School’s infrastructure to support and facilitate expanded research, education and service initiatives.

Linda Rosenstock, M.D., M.P.H. Dean UCLAPUBLIC HEALTH

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40 milestones Although UCLA has offered undergraduate instruction in public health from 1946 to 1983 and a program leading to an advanced degree in public health since 1957, it wasn’t until 1961 that the University of California Regents created an independent School of Public Health on the Westwood campus, which had previously been part of a UC system-wide public health school. The 40 years that have followed have included numerous events critical to the School’s growth and countless contributions by the School’s faculty, students, alumni and friends toward a healthier society.

The important publications produced by the faculty; students prepared for public health practice, research, and teaching; and the wealth of consultations and contributions to community service provided by the School are so numerous that they can’t possibly all be listed here. But, on the occasion of the 40-year anniversary of an independent UCLA School of Public Health, we present 40 of the many milestones worth celebrating.

1 Dr. Gladys Emerson conducts pioneering laboratory research leading to the isolation and discovery of the nutritional value of vitamin E. Emerson later chairs UCLA’s Home Economics Department, which in 1961 moves into the new School of Public Health’s Division of Public Health Nutrition.

2 After 15 years as the southern branch of a University of California system-wide public health school, the UCLA School of Public Health is established as an independent school by the UC Regents on March 17, 1961.

3

Lenor S. (Steve) Goerke, head of the medical school’s Department of Preventive Medicine, is named first dean of the newly independent School of Public Health.

4

Following the Watts riots in 1965, Dr. Milton Roemer serves as health consultant to the McCone Commission and documents the need for construction of a hospital to serve the people of South-Central Los Angeles. The hospital becomes King-Drew Medical Center, which today serves 1.2 million people.

5

The Danfa Comprehensive Rural Health and Family Planning Project is launched under the leadership of Dr. Alfred Neumann, providing collaborative activities between the University of Ghana Medical School and the UCLA School of Public Health. The project results in sustained national health programs for the African nation and the establishment of the University of Ghana School of Public Health.

6

Using data from the Alameda County Human Population Laboratory, Dr. Lester Breslow publishes a paper showing a clear link between healthy habits and a longer, healthier life. Breslow’s study demonstrates that simple health practices such as eating breakfast, maintaining a moderate weight, eating regular meals, using alcohol in moderation (if at all), exercising moderately, getting enough sleep, and not smoking are linked to living a longer life and greater freedom from disability.

7 UCLAPUBLIC HEALTH

Dr. Lester Breslow is named the School’s second dean in 1972, and serves until 1980.

8 The School of Public Health Alumni Association is founded by alumnus Ray Goodman in 1974. The same year, Goodman creates the annual Breslow Lecture Series. Later, two other alumni associations are established within the School: the Health Policy and Management Alumni Association and the Environmental Science and Engineering Alumni Society.

9

The Fred H. Bixby Chair in Population, Family and International Health is established in 1975 as the School’s first endowed chair. Dr. Judith Blake is appointed as the first chair holder.

10 Research by Dr. Roslyn Alfin-Slater demonstrates that the level of cholesterol in normal diets, including diets containing eggs, does not raise serum cholesterol. The result has since been confirmed in population-based epidemiological studies.

11 Faculty members Derrick and Patrice Jelliffe lead efforts to promote the benefits of breastfeeding on a global scale.

With colleagues, they are instrumental in developing the International Code of Marketing of Breast Milk Substitutes and the subsequent World Health Organization resolution, Wellstart — an international breastfeeding training program for health professionals — along with the Baby Friendly Hospital Initiative and the World Alliance for Breastfeeding Action.

12

Dr. Roger Detels is named the School’s third dean, serving from 1980 to 1985.

13 Early in the AIDS epidemic, a team headed by Detels demonstrates how HIV-related immune deficiency is transmitted among homosexual men, a discovery that has prevented millions of infections. UCLA School of Public Health faculty go on to lead international efforts to control the spread of the disease, particularly in China, Thailand, Cambodia, Myanmar, and other areas of Southeast Asia.

14 Research by Dr. Lawrence Ash and his students leads to the development of a small rodent model for the study of lymphatic filariasis, which serves as a major catalyst for the expansion of work on a disease now targeted for eradication.

15 The Health Careers Opportunity Program is established, laying the foundation for the School to become a leader in training minority students among schools of public health in the continental United States.

16 In “Health Status of the American Male,” a group of faculty led by Dr. Frank J. Massey Jr. establishes, among other findings, the safety of vasectomy as an effective birth-control procedure.

17 Dr. Abdelmonem A. Afifi is appointed the school’s fourth dean in 1985, and goes on to serve a record 15 years.

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19 Research by Drs. E. Richard Brown, Robert Valdez and Hal Morgenstern documents the nature and extent of the problem of people lacking health insurance in California.

Responding to requests from governmental leaders, faculty also are active in helping formulate policy options at the national, state, and local levels for dealing with the issue.

20

Faculty show that chronic exposure to air pollutants is associated with compromised growth of respiratory capacity in children, and with irreversible changes in lung function in adults.

21

Faculty demonstrate a genetic susceptibility to multiple sclerosis, and determine that individuals who develop MS are more likely to have childhood virus infections after the age of 10, at which time the immune system has undergone changes associated with puberty and adolescence.

22

The UCLA Environmental Science and Engineering Program moves administratively into the School of Public Health, giving the School its first interdisciplinary degree program.

23 The Dean’s Advisory Board is established in 1988 for the purpose of increasing private support on behalf of the School. Alumni Ira Alpert, Carolbeth Korn, Joel Kovner, Samuel Tibbitts, and Fred Wasserman are founding members.

24

Research by Dr. Judith Blake challenges the presumption that an only child grows up feeling isolated. Rather, only children are found to have a clear social advantage — deflating notions that they are more isolated, less involved in extracurricular activities, and less liked.

25 Research by Dr. Jess Kraus documents the health benefits and cost savings of helmet use among motorcycle riders.

31 Executive-style M.P.H. for Health Professionals programs are developed in the departments of Health Services (1995) and Community Health Sciences (1997).

32

At the request of the Los Angeles County Department of Health Services, the School’s faculty conduct a review of public health services in the county and make recommendations to the director for improvements.

33

Faculty, sponsored by Samuel J. and Audrey Tibbitts, write Changing the U.S. Health Care System: Key Issues in Health Services Policy and Management, edited by Drs. Ronald Andersen, Thomas Rice and Gerald Kominski. The second edition of the book, published by Jossey-Bass, is released in 2001.

34

The California Health Interview Survey, the largest state health survey in the United States and the first in California to interview people from every county, is established as a collaboration involving the UCLA Center for Health Policy Research (based in the School), the California Department of Health Services, and the Public Health Institute.

35

Faculty, including Drs. John Froines, Michael Collins and Wendie Robbins, conduct critical research on the exposures to and adverse health effects of major environmental toxic chemicals including diesel exhaust, MTBE, lead, arsenic, chromium, cadmium and pesticides. Faculty also play important roles in translating scientific research findings into policy for protecting workers and the public from these and other toxic chemicals.

36

The Molecular Toxicology Interdepartmental Ph.D. Program is established to train students, many of whom are in the School of Public Health, in the molecular mechanisms of toxicological injury.

37

Dr. Linda Rosenstock, director of the National Institute for Occupational Safety and Health, becomes the School’s fifth dean on November 1, 2000.

38

Playing leadership roles in California’s successful campaign against tobacco use, faculty are instrumental in determining the allocation of Proposition 99 funds from the tax on cigarettes for tobacco control to researchers, local health departments, schools, community health agencies, and the media.

As the School celebrates 40 years as an independent entity, more than a dozen centers sponsored by or associated with the School promote interdisciplinary research among faculty and students: Center for Health Policy Research; Center for Health Promotion and Disease Prevention; Center for Health Services Management; Center for Healthier Children, Families, and Communities; Center for Human Nutrition; Center for Occupational and Environmental Health; Center for Public Health and Disaster Relief; Division of Cancer Prevention and Control Research (part of UCLA’s Jonsson Comprehensive Cancer Center); Pollution Prevention Education and Research Center; Southern California Environmental Health Sciences Center; Southern California Injury Prevention Research Center; Southern California NIOSH Education and Research Center; and Southern California Particle Center and Supersite.

28

Dr. Susan Sorenson is among a small group of researchers pioneering the study of violence as a public health issue in the United States — not solely as a criminaljustice issue.

39

29

40

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In one of the first studies examining the impact of surgical treatment for breast cancer on quality of life, Dr. Patricia Ganz and colleagues find that during the year after surgery, women who have had a mastectomy or breast conservation surgery (lumpectomy) recover from their treatment at the same rate and report no differences in mood or quality of life. However, as might be expected, there are more difficulties with clothing and body image among those who had a mastectomy.

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The School survives proposed elimination in 1994 and maintains its position as an independent school of public health, working in partnership with UCLA’s medical, dental, nursing, and public policy schools.

CALL FOR NOMINATIONS: UCLA School of Public Health Alumni Hall of Fame Commemorating the 40th anniversary of the School of Public Health, the School is establishing a new, annual awards program.

This program will recognize accomplishments of alumni in two categories: 1. Professional Achievement 2. Community Service The first inductees into the Alumni Hall of Fame will be recognized at the Breslow Lecture and Dinner, April 1, 2002.

A faculty committee will select inductees from individuals nominated for this honor. Please access nomination forms at www.ph.ucla.edu and submit nominations by January 11, 2002. If you have questions about the nomination process, please contact the Office of Development for the School of Public Health at (310) 267-0447 or by e-mail at jclarey@support.ucla.edu

Seven among the School’s faculty have been elected members of the Institute of Medicine: Lester Breslow, Jonathan Fielding, Dean Jamison, Charles Lewis, Milton Roemer, Linda Rosenstock and Max Schoen.

Three members of the School’s faculty have served terms as president of the American Public Health Association: Lester Breslow, Ruth Roemer, and E. Richard Brown.

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Investing in Health: World Development Report 1993 is published, with Dr. Dean Jamison as a lead author.

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40 milestones

18 The School is reorganized, going from seven divisions (Biostatistics, Epidemiology, Health Administration, Occupational Health, Health Education, Environmental Health, and Public Health Nutrition) to five departments (Biostatistics, Community Health Sciences, Environmental Health Sciences, Epidemiology and Health Services).

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T HE UCLA 6

C ENTER

FOR

P UBLIC H EALTH

AND

D ISASTER R ELIEF ADDRESSES GROWING CONCERNS ABOUT THE ABILITY OF THE PUBLIC HEALTH SYSTEM TO RESPOND TO MASS - CASUALTY EPISODES , FROM EARTHQUAKES TO TERRORIST ACTS .

Preparing Public Health Professionals

for the Worst For many Americans,

“We began by looking at how public health professionals and health departments address issues following natural disasters. Our efforts have since expanded to include intentional disasters such as the events of September 11 and the anthrax episodes that followed.”

UCLAPUBLIC HEALTH

—Dr. Steven Rottman

the tragic events of

Sept. 11, 2001 and the subsequent anthrax scares raised new questions about the ability of the nation’s public health system to respond to a human-generated disaster, perhaps involving large-scale biological or chemical terrorism.

Through both its research and course offerings, the UCLA Center for Public Health and Disaster Relief has been focusing on the topic of healthrelated preparedness and response to both human-caused and natural disasters since it was established in 1997, as one of the first of its kind in the country.

“We began by looking at how public health professionals and health departments address issues following natural disasters that affect a large percentage of the population,” explains Dr. Steven Rottman, the center’s director, whose background is in emergency medicine. “Our efforts have since expanded to include intentional disasters such as the events of September 11 and the anthrax episodes that followed.”

Beginning in 1997, the center developed a curricular focus to teach M.P.H. students and public health professionals how to identify problems, look for likely hazards that may affect communities, and examine pre-existing resources and systems to determine how best to prepare for potential disaster scenarios. Participating faculty — a multidisciplinary group with backgrounds that include emergency medicine, environmental health sciences, epidemiology, gerontology, health services, social work, sociology, urban planning and community health — conducts research that delves into risk factors for injuries, illnesses and deaths from disasters, and seeks ways to improve the public health response to such events.

“Much of our work has looked at the consequences of natural hazards on populations,” says Rottman. Earthquakes have been a major field of study, given the center’s location in temblor-prone California. Dr. Linda Bourque, associate

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center’s courses focuses on how best to integrate the participating agencies.

There is an urgent need to train more public health professionals in disaster response, Bourque says. Many people know that the fire department sends the first responders after a major earthquake such as the one centered in Northridge in 1994 or Loma Prieta in 1989; fewer are aware that public health nurses are not far behind. The ability of hospitals to continue functioning is also an issue of critical concern. After both Northridge and Loma Prieta, hospital supplies dropped off shelves and broke, records were water-damaged, and some emergency departments were physically incapacitated, compromising the ability of some facilities to continue functioning.

While bioterrorism is currently attracting more attention, natural disasters such as earthquakes, floods and fires are no less salient as public health threats than they were before. The center’s faculty and staff have been identifying common features of all forms of disasters in an effort to assist planners.

“It’s important to establish a baseline level of preparation for everything, and then add the specifics that apply to particular events,” says Shoaf. “The best preparedness is an all-hazard preparedness.”

7

UCLA Center for Public Health and Disaster Relief staff and participating faculty, left to right: Judith Siegel, Linda Bourque, Kimberley Shoaf, Steven Rottman.

Course Offerings from Center for Public Health and Disaster Relief Faculty Bioterrorism: An Intentional Public Health Disaster Selected Topics in Disaster Relief and Humanitarian Assistance Program Planning in Community Disaster Preparedness: Hazard Risk Assessment to Response Planning Cooperative Interagency Management in Disasters Post-Disaster Community Health Disaster Epidemiology

UCLAPUBLIC HEALTH

Students completing the center’s curriculum have gone on to positions in a variety of venues, ranging from local municipalities to international relief agencies; from hospitals and community-based medical practices to academia.

One former student, Kristin Peterson, M.P.H. ’00, is the emergency services specialist for the City of West Hollywood — responsible for helping the city and its residents prepare for, respond to, and recover from disasters and emergencies. “The center provided me with a solid background in public health and research issues as they relate to disasters,” Peterson says. As an emergency manager, though, she has found that balancing the interests of the many public safety and emergency management stakeholders while managing existing resources is challenging.

“In the general field of public safety, public health concerns are not always given priority,” she says.

“My sense is that the ongoing functions of public health have been so taxed that it’s difficult to

allocate resources to what-if scenarios that rarely happen,” says Rottman.

Of course, after September 11, these scenarios no longer seem so far-fetched. “It’s shined a light on the need for public health preparedness,” says Dr. Kimberley Shoaf, the center’s research director.

She believes a major priority must be improving communication, both among the public health professionals involved and between public health and other agencies that work in emergency management and response. Bourque agrees. “After disasters there are always five or six different entities involved, which can lead to confusion,” she says. One of the

feature

director of the center, began studying public health issues associated with earthquakes in the early 1970s.

The center’s faculty have collaborated with researchers in countries including Japan, Turkey and Colombia to learn how such disasters affect various populations and cultures.

In the last couple of years, the center has also sharpened its focus on intentional disasters. A one quarter course entitled “Bioterrorism: An Intentional Public Health Disaster” was developed last year and is now offered to graduate students and health providers from the surrounding community. The center’s Web site (www.ph.ucla.edu/cphdr/) now includes a training program, “Bioterrorism: Are You Prepared,” specifically aimed at emergency and primary care physicians. The course provides an overview of bioterrorism agents and their clinical syndromes, as well as information pertaining to hospital labs and other public health authorities. The center has nearly completed the development of a series of two-day seminars for public health department officials to orient them to the issues of mass-population disasters, how to organize resources within their departments, and how their response to a more familiar natural disaster will be applicable or different from the response to a bioterrorism incident. Faculty at the center have also responded to numerous media, professional, and public inquiries on the bioterrorism threat, and have provided testimony before several governmental entities. In addition to the bioterrorism work conducted at the center, the School’s Department of Epidemiology is offering a course entitled “Public Health Responses to Bioterrorism — The New Challenges.”

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8 F INDINGS

ON

THE BENEFITS OF GREEN TEA ARE THE LATEST EXAM PLE OF ONE FACULTY MEMBER ’ S APPLICA TION OF MOLECULAR EPIDEMIOLOGY TOWARD HIS PASSION SINCE SERVING AS A

“ BAREFOOT IN

C HINA :

DOCTOR ” DISEASE

PREVENTION .

Zuo-Feng Zhang: New Science, Old Goals Zuo-Feng Zhang was 16

when he arrived on the Nantong

Farm one chilly spring day in 1969 for the beginning of a four-year assignment. His native China was in the midst of Mao Tse-Tung’s Cultural Revolution, and Zhang was one of more than 1 million students sent to the countryside to accept “re-education.” He was then chosen by farmers as a “barefoot doctor” to bring basic preventive medicine to the poor. “It was a basic network to treat the farmers in remote rural areas,” he explains.

“The farmers would choose a student they trusted, then the student would go to a mid-level hospital for

UCLAPUBLIC HEALTH

three months of training and come back as a doctor.”

More than three decades later, Zhang’s base of operations has moved to Westwood, Calif., and the UCLA School of Public Health. Rather than treating Chinese peasants for diarrhea, colds and other common ailments, he’s using the latest techniques in the emerging field of molecular epidemiology to hunt for tumor markers and identify genetic mutations, inherited susceptibilities, and the like.

He’ll acknowledge that more than just time and distance separate what he does today from what he was doing 30 years ago. But the way Zhang sees it, his primary goal — preventing disease — has remained rock-steady.

As a cancer molecular epidemiologist, though, his work affects far more people. A case in point is his recent finding — widely publicized around the world — that green tea has a protective effect against stomach

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“I saw people in their 30s and 40s dying of this disease, and I realized nothing could be done for them.

That’s when I decided to devote my career to preventive medicine.”

—Dr. Zuo-Feng Zhang

UCLAPUBLIC HEALTH

risk-takers are more susceptible to disease than others. Why, for example, do some heavy smokers live to be 90 while 10-year smokers die of lung cancer in their 50s?

As a molecular epidemiologist, Zhang looks at intermediate steps between exposure and disease, including the amount of exposure to the carcinogen, the effect of a given dose on the target tissue, the inherited susceptibility to cancer, the link between environmental exposures and gene mutations, and the gene-environment interaction that produces clinical disease and affects prognostic factors.

How did a former barefoot doctor get to this point? Zhang believes it was a natural progression.

After his four years at Nantong Farm, he attended Yangzhou Secondary School of Hygiene, where he earned a diploma in public health. He then worked for three years as an infectious disease epidemiologist in the Schistosomiasis Control Program in Yangzhou.

In 1978 he began five years of medical school at Shanghai Medical University, followed by two years of an M.P.H. program in cancer epidemiology and then another two years toward his Ph.D., all at Shanghai. Zhang came to the United States in 1988 and obtained his Ph.D. from the State University of New York at Buffalo in 1991. He has been on the UCLA School of Public Health faculty since 1997.

In his final year of medical school, Zhang’s rotation took him to an area with an extremely high rate of liver cancer. “I saw people in their 30s and 40s dying of this disease every day, and I realized there was nothing that could be done for them,” he says. “That’s when I decided to devote my career to working in preventive medicine.”

Much excitement surrounds the field of molecular epidemiology, given the sequencing of the human genome and the powerful tools that are being developed to enable multi-gene studies aimed at identifying the biological underpinnings of diseases. But Zhang’s public health focus distinguishes his work from that of many of his molecular biology colleagues.

“Using this new genetic knowledge for public health and environmental health science is very important,” he says. “Clinical scientists are interested in genes that can predict the outcome of disease related to the decision on treatment of the patient.

We’re interested in using molecular genetics to prevent the disease.

“Prevention is what I’ve always done, even when I was a barefoot doctor. It’s just that now the techniques look different, and my patients are entire populations.”

faculty profile

cancer and chronic gastritis. Though the rates are lower in the United States, stomach cancer remains the second-most common malignancy internationally — and the most common cancer among both sexes in China, where 38% of the world’s cases occur.

Green tea is particularly popular in Asian countries.

While previous studies had looked at possible health benefits of green tea in that part of the world, they had found little; Zhang suspects this may be because consumers of green tea are often also heavy consumers of alcohol and tobacco.

Zhang conducted a population-based casecontrol study where the incidence of mortality from stomach cancer is highest — on the small island of Yangzhong, China, situated on the Yangtze River in Jiangsu Province. After adjusting for age, gender, education, body mass index, and levels of smoking and alcohol consumption, green tea drinkers had a 48% lower risk of stomach cancer than non-drinkers, and a 51% lower risk of chronic gastritis.

“Green tea seems to have several important anti-cancer properties,” Zhang says. “All tea comes from the same plant — Camellia sinensis. Certain chemicals in that plant, known as polyphenols, appear to have antioxidative activities.” (No such luck for black tea drinkers — the majority of tea consumers in the United States. Zhang notes that black tea loses many of its polyphenols in the fermentation process.)

The results of the study, published in the International Journal of Cancer, did more than boost sales of green tea (one can even find a green-tea specialty shop in Westwood these days). It also set Zhang and colleagues on a hunt for so-called tumor markers — early genetic changes that, in this case, would foreshadow stomach cancer development.

Indeed, Zhang’s aim in population-based studies such as the one involving green tea and another, similarly well-publicized paper in which Zhang linked smoking marijuana to increased risk of head and neck cancers is to illuminate in greater detail the sequence of events that lead to cancer. Understanding these molecular changes would help researchers intervene at a more curable stage, or before malignancy ever takes hold.

“Traditional epidemiological studies have looked at the correlation between risk factors and disease — to show, for example, that smoking is linked to cancer,” Zhang says. “But we don’t know exactly how that process occurs. We know that smokers are much more susceptible to certain cancers than non-smokers, but we don’t know why.” Nor is it clear why some

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C ALIFORNIA REMAINS FRAUGHT WITH PERIL .

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Clearing the

When historians look back on the

UCLAPUBLIC HEALTH

most successful environmental clean-up stories of the late 20th century, they

“We haven’t met the air quality standards for ozone, fine particles, or carbon monoxide yet. And the projections for growth in the basin are formidable.

So we are not in a position to say we have solved the problem.”

—Dr. Arthur Winer

might well start in Southern California, where a period of rapid growth coincided with improvements in air quality.

Thirty years ago, ozone levels in the basin were routinely high, often in the range of 500 parts per billion. For the past three summers, ozone hasn’t even cracked 200 parts per billion, the level at which a first-stage smog alert is announced; in fact, overall ozone levels are two-thirds what they were in the mid-1970s, despite a doubling of the population and vehicle miles traveled over the same period. Visibility has improved. The region no longer violates the regulatory standards for sulfur dioxide, lead or nitrogen dioxide.

“When you consider what air quality would have been in the absence of emission controls, given the growth in population and vehicles, this is a great success story,” says Dr. Arthur Winer, professor of environmental health sciences at the School and a leading scientist in the air quality field for three decades.

But lest we become complacent, Winer points out there is plenty of work to be done. “We haven’t met the air quality standards for ozone, fine particles, or carbon monoxide yet,” he says. “And the projections for growth in the basin — both in people and vehicles — are formidable. So we are not in a position to

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—Dr. John Froines

say we have solved the air pollution problem by any means, especially as it concerns susceptible populations, including children, the elderly, and those with asthma and emphysema.”

Barry R. Wallerstein, D. Env. ’88

Wallerstein, one of the early graduates of the Environmental Science and Engineering Program, serves as executive officer of the South Coast Air Quality Management District, the regional air pollution control agency for Southern California. As SCAQMD’s highest-ranking employee, Wallerstein is responsible for implementing policy as directed by the agency’s 12-member governing board, and working proactively with state and federal regulatory officials. He also oversees an 860-person staff with an annual operating budget of approximately $100 million.

In recent years, the agency has carried out programs to address community environmental justice issues, identify and reduce air toxics exposure (especially diesel particulate), integrate voluntary cleanup incentives and flexible credit-trading into regulatory structures, expedite permit processing, and strengthen public-private investment in clean fuels and sustainable energy technologies. Wallerstein has more than two decades of experience in urban environmental planning and policy-making.

UCLAPUBLIC HEALTH

At the top of the list of priorities for today’s air quality researchers is to sort out the impacts of particulate matter of various shapes, sizes and chemical compositions in the air we breathe — and the health impacts of being exposed to the particulate matter at various concentrations. In recent years, environmental scientists have amassed compelling evidence linking exposure to airborne particulate matter with an increase in the incidence of lung dysfunction, cardiovascular effects, allergic disorders and cancer. But the specific causes of the increased morbidity and mortality associated with breathing particulate matter have remained as hazy as the L.A. air on a smoggy day.

To address this issue, the Southern California Particle Center and Supersite (SCPCS), based at the

UCLA School of Public Health and Institute of the Environment, was established in 1999 with an initial funding base of nearly $15 million from the California Air Resources Board (ARB) and U.S. Environmental Protection Agency (EPA). The EPA funded five centers across the country, including the SCPCS, to define and understand the health effects from exposure to airborne particulate matter.

The center is directed by Dr. John Froines, who is also professor of environmental health sciences and director of the Center for Occupational and Environmental Health at the School. It includes an interdisciplinary group of researchers from several schools on the UCLA campus, as well as from other leading universities in the region.

The five research centers are funded to reduce the uncertainties and either solidify or make a case for altering controversial particulate matter regulations. Among the uncertainties: Are the epidemiologic findings regarding health effects valid? What are the agents causing ill health? What are the differences between what researchers measure in the air and what people are personally exposed to?

What specific chemicals attached to the particles are most important? Does the size of the particle one breathes make a difference? And what model for measuring health effects from human exposures is most reliable?

Unlike the four other national centers, the SCPCS focuses on health effects related to mobile pollution sources. For the most part, that means the relationship between diesel- and gasoline-powered vehicles and health. “When you’re in Southern California, that’s one of the key air quality issues,” says Froines. With funding from ARB, the center’s researchers are conducting animal and human studies to learn about the health effects associated with

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“Traditionally, EPA has focused on controlling a small number of primary pollutants.

But those aren’t the chemicals that are probably causing asthma and these other effects. We’re trying to bring greater definition to the problem.”

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Derek Shendell

A doctoral candidate in the School’s Environmental Science and Engineering Program, Shendell’s interest is in environmental health issues affecting children.

He is currently conducting an internship at Lawrence Berkeley National Laboratory, where he is working on studies related to his dissertation topic, portable classroom indoor air quality and the surrounding school environment. In a pilot study — launched while Shendell was still in residence at UCLA — toxic organic air contaminants were measured in portable and main-building control classrooms in seven public schools in two Los Angeles County school districts.

Questionnaires and technician walk-through surveys were used to better understand the cleaning and operations and maintenance practices at the schools, as well as the overall school environment. “The industry in the state predicts a need to build approximately 10,000 of these classrooms per year for the rest of the decade to meet the demand created by a combination of the increasing student population, class-size reduction policies, and the lack of resources to put permanent school facilities in place,” Shendell says. “Given the health concerns and that existing school facilities are in need of maintenance and modernization, indoor environmental quality in these classrooms is important to assess.”

exposure to particles close to freeways, as well as examining how the atmospheric chemistry that occurs as the particles move inland affects particulate toxicity.

The SCPCS is breaking new ground by looking in greater detail at the specific chemicals responsible for the adverse health effects. “Traditionally, EPA has focused on controlling a small number of primary pollutants — carbon monoxide, nitrogen oxides, sulfur dioxide, lead, particles, and ozone,” says Froines.

“We’ve been looking for the proverbial keys under the lamp post because that’s the easiest place to look. But those aren’t the chemicals that are probably causing asthma and these other effects.”

The SCPCS is using a combination of epidemiology, toxicology, dosimetry (how particles deposit in the lung), and assessment of particulate exposure in an effort to obtain more specific information about the causes of ill health. The current particulate matter standard discriminates only by size — regulating so-called fine (less than 2.5 microns) particles. Where to draw the line is a debate the five centers were designed to settle, but there are other questions. For example, a diesel particle might contain more than 1,000 chemicals — which ones are the most hazardous? “We’re trying to bring greater definition to the problem,” says Froines, who has also been better defining the problem as chair of the Scientific Review Panel, an influential committee created by the California Legislature to make policy recommendations based on scientific data on toxic air contaminants.

“We’re taking the laboratory out into the field,” explains Dr. William Hinds, professor of environ-

mental health sciences and one of the center’s investigators. Hinds is responsible for the Particle Instrumentation Unit, a mobile trailer that is being deployed at various sites throughout the basin for 36 months at a time, during which there is continuous monitoring of the concentration and size distribution of air particles, and periodic monitoring of size-segregated samples for detailed chemical analysis. Laboratory studies that have sought to simulate the atmosphere work well enough for ozone, Hinds says, but not when it comes to studying airborne particles. “Because of their complex and dynamic nature, you really have to go where the particles are,” he says.

Never before have investigators taken such detailed measurements of particle distribution — down to the size of a nanometer — for such an extended period of time and in different locations in order to determine how the particles travel, Hinds explains. In addition, the center’s researchers are conducting toxicology studies using mice to measure health effects of exposure to high concentrations of ultra-fine, fine and coarse particles at various distances from the freeway.

In a then-controversial paper published in the journal Science in 1992, Winer and colleagues used a sophisticated model to calculate that approximately 1,600 Southern Californians died each year from exposure to fine particulate matter. “Although at the time we felt that this was a somewhat controversial result to publish, it turns out that we were at the lower bound of the estimates of mortality that have emerged in the last 10 years,” Winer says.

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Bill Grant, a staff research

Marijke Bekken, D.Env. ’95

Bekken has been with the California Air Resources Board for more than a decade. For about half of that time she served in the offroad regulatory emissions section, focusing on locomotives — work that culminated in a Memorandum of Understanding with the railroads to reduce emissions in the South Coast Air Basin by more than 60% through the use of a fleet composed of the cleanest available units.

Bekken has spent the last several years in the Emission Research section working on a variety of projects, including one that examined the environmental impacts of electric vehicle battery recycling for a wide variety of battery technologies. She has also contributed to the recreational marine regulatory package.

Among other tasks, she is currently managing a contract developing a methodology to accurately measure particulate matter emissions from recreational marine engines, and is working on ARB’s current strategic clean air plan.

UCLAPUBLIC HEALTH

Within the past several years, Winer’s research associate with the Southfocus has moved into the area of air pollution expoern California Particle sure assessment. “Our view of how to understand Center and Supersite, is what people are breathing has changed,” he explains. helping to conduct a study at the center’s Until recently, a relatively small number of fixed-site Particle Instrumentation ambient air monitors were used to measure known Unit, a mobile trailer that air pollutants. Increasingly, Winer notes, researchers continuously monitors in the field are interested more in the air pollutant the concentration and levels in micro-environments — the spaces in which size distribution of air people are actually spending their time — which particles at various sites. can produce more specific data than ambient measGrant calibrates the instruurements can provide. ments on top of and Winer and Dr. Steven Colome, adjunct profesinside the trailer, and sor of environmental health sciences, recently comenters data on the sampleted a study, “Relationship Between Indoor, ples collected.

Outdoor and Personal Air,” investigating 100 residences in four communities in Los Angeles County. In addition to setting up instruments just outside and on the inside of each home, the researchers asked study participants to wear a backpack specially designed to measure the air within their individual breathing zones. “Because of what’s called the personal cloud effect, in which our actions can stir up a cloud of particles, the air people are breathing can be different from the air elsewhere in the same room,” Colome says. Initial findings from the study suggest that freeways and busy street arteri-

Sax, a doctoral candidate in the School’s Environmental Science and Engineering Program, works in the Community Health Section of the California Air Resources Board, a section responsible for initiating environmental justice programs and implementing studies that evaluate the cumulative health risks posed by toxic air contaminants. Sax is helping to implement ARB’s Neighborhood Assessment Program, which uses emissions inventories and dispersion models to predict average annual concentrations of toxic air contaminants. “We’re trying to determine whether or not pollutant concentrations in selected communities are different from region-wide monitored pollutant concentrations,” Sax explains.

His dissertation focuses on building an emissions inventory in one of these areas, the Los Angeles community of Wilmington, through existing data and surveys of nearly 100 industrial facilities.

“Typical assessment techniques use a top-down approach, monitoring the regional air quality and then allocating emissions to certain parts of the region based on population characteristics and other factors,” Sax notes. “We’re building it from the bottom up.” The results of the community surveys will be the first step in understanding the extent to which certain communities are disproportionately affected by air pollution — the so-called environmental justice issue.

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Todd Sax

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Michael Benjamin,

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Yifang Zhu

UCLAPUBLIC HEALTH

For her doctoral thesis in the Department of Environmental Health Sciences, Zhu is characterizing ultra-fine particles in the vicinity of major highways, particularly as the particles are transported downwind from the freeway.

Ultra-fine particles are suspected to play a role in the increase in mortality and morbidity associated with greater particulate matter concentration. “In an urban environment, motor vehicle emissions usually constitute the most significant source of ultra-fine particles; yet, little is known about the concentration and size distribution of these particles in the vicinity of major highways,” Zhu notes. Working with Dr. William Hinds with funding from the Southern California Particle Center and Supersite, Zhu is conducting field measurements at various distances just downwind of the 405 Freeway near UCLA in an effort to develop a theoretical model to predict ultra-fine particle concentration and size distribution close to freeways.

For the past eight years, Benjamin has worked at the California Air Resources Board, the state agency responsible for regulating air quality in California.

He is currently a manager in the Emission Inventory Branch, responsible for maintaining and distributing emissions data from all sources of air pollution in the state. Benjamin’s primary interest is in changing the way emissions inventories are built and viewed. “Until recently, air pollutant emission inventories were simply warehouses of numerical information that only experts could access and decipher,” he says. “But with the development of Geographic Information System (GIS) software, emission inventories can be constructed on a spatial platform and viewed in the form of maps that are much more understandable to policy makers and the average layperson.” With GIS, Benjamin explains, emission sources are no longer simply records in a database but can be represented as points on a map that can be related to population centers and other sensitive air pollution receptors.

Moreover, Benjamin’s office can provide these new emissions maps to the public and other stakeholders via the Internet. “With the development of these new tools, this is an exciting and challenging time to be working as an environmental scientist in the public sector,” he says.

Corice Farrar (l.) and Jennifer Jones, doctoral students in the Environmental Science and Engineering Program, process particulate samples in Dr. Arthur Winer’s laboratory. The samples were collected for the study “Relationship Between Indoor, Outdoor and Personal Air.”

als produce a clear signature in which the concentration of air toxics is reduced as residences move farther away from the heavily traveled areas.

Two other ARB-funded exposure assessment projects involving Winer, Colome and their graduate students are also examining micro-environments, though without the personal breathing space instrument. An ongoing pilot study measures a set of air toxics and oxygenated compounds in selected Los Angeles Unified School District portable classrooms (see the sidebar on Derek Shendell, p. 12). The use of portables is growing in California due to an exploding K-12 population and the scarcity of funding for new buildings, but complaints of an unknown etiology by teachers and students have raised health concerns. A second study uses state-of-the-art real-time measurement techniques to examine vehicle-related pollutants in the micro-environments of children who ride school buses using diesel fuel — roughly 70% of all school buses in California.

“If we understand what the exposure is where people spend their time, indoors and in vehicles, then we should be able to design more cost-effective policies to mitigate those exposures,” Winer says. “Rather than using a brute-force approach in terms of overall ambient air, we might be able to find focused strategies that yield more bang for the buck when it comes to reducing exposure.”

That’s not to minimize the importance of the control programs to date, Winer adds. The introduction of catalytic converters, the removal of lead from gasoline and the subsequent additional improvements in the quality of fuels have successfully reduced sulfur, toxics, vapor pressure and photochemical reactivity, he notes.

The value of federal, state and regional controls on vehicular emissions is well illustrated by observations of the air quality in developing countries where such programs don’t exist. “The level of particles in much of Latin America and Asia dwarfs the particle level in the United States,” says Froines.

But Froines warns that making too much of the progress in Los Angeles can breed complacency. “Even with the improvements, we still have the worst air in the United States,” he notes. “All you have to do is look outside to know that it’s very bad. And without constant vigilance, the problem will get worse.”

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From Westwood to the World: SPH Faculty Seek to Improve

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Global Health OF

FACULTY THINK LOCALLY AND ACT GLOBALLY, TRAVELING TO ALL CORNERS OF THE

E ARTH

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CONDUCT RESEARCH AIMED AT PREVENTING DISEASE AND PROMOTING HEALTH .

In Iran, Dr. Gail Harrison adapts to the local dress code for women while consulting and conducting research on issues of food security and the need for vitamin additives to protect children’s vision.

Dr. Roger Detels is a frequent visitor to Asia, where he has monitored the spread of HIV/AIDS and worked with national leaders to prevent the disease. Dr. Steven Rottman and his faculty colleagues with the Center for Public Health and Disaster Relief take regular trips to Central and South American countries, where health officials are eager to obtain training for workers in advance of the next

In rural Embu, Kenya, children participating in a school-feeding program designed to address micronutrient deficiencies gather with Dr. Charlotte Neumann (r.), the study’s principal investigator; and Dr. Catherine Chow (M.P.H. ’01), a pediatrician who assisted while she was a student at the School.

major earthquake or other natural calamity. Dr. Donald Morisky studies behavioral strategies to prevent the spread of HIV among commercial sex workers in the Philippines. Drs. Osman Galal and Snehendu Kar work in Egypt and India, respectively, to bring public health training to physicians and other health workers, who have not been prepared in community prevention and health education.

Dr. Charlotte Neumann’s research aims to improve child health and nutrition in

These are but a few of the dozens of UCLA School of Public Health faculty who log numerous frequent flier miles through their work outside the United States. All told, the School conducts research and provides community service in 70 countries. Ample evidence of the School’s global reach can also be found in Westwood. The School enrolls an average of 150 students per year

—Dr. Charlotte Neumann UCLAPUBLIC HEALTH

rural communities of Africa.

“The most severe health problems in these countries are light years away from the worst problems here.”

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“Malnutrition resulting from riboflavin deficiency is a big problem affecting large parts of the world. And you can’t study it except where it is highly prevalent.”

UCLAPUBLIC HEALTH

—Dr. Gail Harrison

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from nations other than the United States — more than two-thirds of whom return to their home countries after graduation to put their education to use.

And the School has a steady flow of short- and longterm visiting postdoctoral scholars and international faculty, enriching the experience for all students.

International health has always been a central focus, but it has assumed even greater importance in an era of increasing interdependence among nations.

“Globalization was initiated by economists, and the initial focus was on combating poverty in developing countries,” says Galal, director of the School’s International Health Program and professor of community health sciences.

“Health was not originally considered an element in the process of improving the socioeconomic status of developing countries. But now people are realizing that you can’t develop a country as long as the population is unhealthy.”

“We are living in a shrinking world,” says Detels, professor and chair of epidemiology. “The health situation in other countries is not irrelevant to the United States. The potential for African countries to operate in an international economy has been decimated by AIDS. Asia is a particularly important region for the United States in international trade.

If countries in that region lose their workforce, it’s going to have a tremendous impact on our economy.”

Detels adds: “Of course, the humanitarian reasons for promoting health in developing countries go without saying.”

Indeed, to those who ask why UCLA School of Public Health faculty should focus on health in developing countries when there are so many problems at home, Dr. Charlotte Neumann responds: “The most severe health problems in these countries are light years away from the worst problems here.”

Many public health researchers, including Harrison and Galal, are interested in what is called the nutrition-and-health transition — the notion that, as countries develop, their health problems shift from communicable diseases and high mortality to the chronic illnesses associated with older age and obesity, including cancer and heart disease. But in the rural areas of Africa where Neumann, professor of community health sciences, has concentrated her

efforts throughout her career, globalization has had little impact. “Sadly, the basic problems are still related to under-nutrition, especially a lack of micronutrients in the diet,” she says. “And AIDS and wars have only made things worse.”

Neumann’s focus is on child health and nutrition — she recently completed a school-feeding controlled intervention study designed to address micronutrient deficiencies in rural Kenya, in collaboration with researchers at the University of Nairobi. The strategy is an outgrowth of observational studies Neumann and colleagues conducted in the 1980s, which suggested that adding even a tiny amount of meat to the diet of the population’s children could dramatically improve their growth, learning, and resistance to infection. “A food-based solution is more sustainable than the use of pills or capsules,” says Neumann, whose study was recently expanded to include toddlers — an age group at even greater risk than school children for poor growth and development.

In China, Dr. Virginia Li, professor of community health sciences, is focusing on the substantial reproductive health problems of rural women. The country’s Ministry of Health reported a 1997 maternal mortality rate of 80.4 per 100,000 live births, and an infant mortality rate of 37.7 per 1,000 live births — both significantly higher than in urban areas.

“In their struggle to eliminate this disparity, rural health workers in this vast country are hampered by the lack of practical and measurable reproductive health indicators that explore beyond basic mortality data, and that would enable them to monitor and target specific and comprehensive reproductive health needs and services,” Li says.

To help address this concern, in 1998 Li and her colleagues joined researchers from the United States and China in launching a major effort to develop and field-test community-based reproductive health indicators for rural areas. Li hopes the effort, which was completed last year, will help foster a more comprehensive approach to monitoring and evaluating reproductive health in rural China.

Since 1999, Dr. Paul Torrens, professor of health services, has been actively involved in a management training program for hospital directors throughout China. The program, sponsored by the Ministry of Health, includes seminars; site visits to Los Angelesarea hospitals; creation of a hospital management professional journal; supervision of visiting scholars, many of whom come to the School; and preparation of a textbook on modern hospital management, written

by U.S. authors and published in Chinese in China.

Dr. Zuo-Feng Zhang, professor of epidemiology, has also conducted research in China, most recently on the health effects of green tea (see p. 8). continued on page 19

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UCLA/Fogarty Program Proves to Be a Launching Ground for HIV/AIDS Leaders in Southeast Asia, India and China

HONGJIE LIU (CHINA): “I came to UCLA in 1995, having worked as an epidemiologist and biostatistician in the field of prevention and control of infectious diseases for more than 10 years. It was the year that the HIV/AIDS epidemic spread rapidly across China. At that time, China faced not only a serious epidemic, but also a shortage of public health personnel specializing in HIV/AIDS prevention and control. Our research has helped the local health authorities implement prevention strategies.

After my graduation, I will use Professor Detels as a model and work in a university, disseminating what I have learned here to Chinese students.”

THANDAR LWIN (MYANMAR): “I am a general physician as well as the senior research officer from the Department of Medical Research under the Ministry of Health in Myanmar. We have very few Ph.D.trained health personnel in the public health field. I would like to apply the advanced knowledge I gain from this program in conducting field research on HIV/AIDS. Moreover, I will have an opportunity to impart my knowledge as a part-time lecturer to postgraduate and undergraduate students from the Institutes of Medicine, public health staff, social workers and project staff. The advanced epidemiologic methods, along with my medical and research knowledge, can greatly improve the quality of practice in the field.”

my job and apply the skills I have gained. I will also keep in touch with professors in this school and with other fellows from different countries to obtain stateof-the-art knowledge on efforts to combat the epidemic. Besides being part of a great school, this program creates a warm study environment for trainees.”

CHULEEPORN (JIRAPHONGSA) CHANOKOVAT, M.D. (THAILAND): “I am now working as a member of the faculty at the international Field Epidemiology Training Program in Thailand. My Fogarty training gave me not only education, but also many good friends and contacts. When we started this international program in Thailand, we needed people to help us supervise our trainees. We got precious support from my Fogarty fellow friends in Myanmar, Vietnam and Laos. I am certain that the network I acquired will continue to provide many such benefits.”

TRUNG NAM TRAN, M.D. (VIETNAM): “I have completed the coursework for my Ph.D. at UCLA and am here to conduct my dissertation in Hanoi, Vietnam.

Epidemiology is quite new in Vietnam, where we are facing many public health challenges. We lack human resources — epidemiologists who have advanced knowledge and can conduct high-quality research. I feel fortunate to be a Fogarty fellow, able to receive the training that will help me contribute the most to the people in my country. Even though I am now in Vietnam, the program still supports me in my work. Dr. Detels continues to contribute ideas and advice on my research. It is like a family.”

Dr. Roger Detels (right), director of the UCLA/ Fogarty AIDS International Training and Research Program, with current trainees. The program prepares students who return to their home countries to help lead HIV/ AIDS control programs.

UCLAPUBLIC HEALTH

VONTHANAK SAPHONN (CAMBODIA): “Poverty and war produce a vicious cycle of severe public health problems in my country, which now has the worst HIV/AIDS epidemic in Southeast Asia. I have worked for the National Center for HIV/AIDS, STDs and Dermatology in the Ministry of Health since 1996.

After I complete the Fogarty program, I will return to

feature

Since its inception in 1988, the UCLA/Fogarty AIDS International Training and Research Program has trained more than 130 health professionals from China, India, Brazil, Thailand, Vietnam, Cambodia, Myanmar, Indonesia, the Philippines and Laos in HIV/AIDS epidemiology. Fogarty students conduct their master’s and doctoral research projects on HIV/AIDS-related problems in their home country, and return home upon completion of their training to participate in HIV/AIDS prevention, control and research programs.

“The goal is to prepare people for leadership positions in HIV/AIDS prevention programs in their home countries,” says Dr. Roger Detels, the program’s director. Clearly, that goal has been met: The UCLA/Fogarty program has staffed most of the HIV/AIDS control programs in Southeast Asia, India and China. In their own words, three current students and two graduates of the program describe what it has meant to them:

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“I was not only able to use the tools I had learned at the UCLA School of Public Health, but I was also able to expand my knowledge base in terms of Peruvian culture, Spanish skills, the politics of funding and how a non-governmental organization is run.”

—Tracy Hazelton

UCLAPUBLIC HEALTH

Tracy Hazelton is one of 53 students whose international fieldwork has been funded by the NeumannDrabkin program since it was established in 1995.

Hazelton spent three months in the lowland jungles of northeastern Peru working on a child survival project as an intern with Project HOPE.

Neumann-Drabkin International Fieldwork Program Provides Invaluable Overseas Experiences for Students UCLA seems far away when you’re working in the lowland jungles of northeastern Peru, where the main economic activity is subsistence farming on small plots of land, and where transportation, electricity and clean water are in short supply.

Thanks to funding from the Neumann-Drabkin International Fieldwork Fellowship Program, Tracy Hazelton spent three months there in the summer of 2000 working as an intern with the non-governmental organization Project HOPE. Approximately a half-dozen M.P.H. students are funded each year by NeumannDrabkin grants, named after Drs. Charlotte and Alfred Neumann, community health sciences faculty and renowned international researchers; and Robert Drabkin, the Los Angeles businessman who has underwritten students’ trips every year since 1995.

“The one thing our students in international health need more than anything is to get that first experience, both to see whether working in a developing country is for them and so that if it is, they will have made contacts and had an experience that will help them when they are looking for jobs,” says Charlotte Neumann. Upon their return, the students share their experiences with others from the School at an annual seminar.

Hazelton was assigned to a child survival project focusing on family planning, micronutrient deficiencies, diarrheal case management, and breastfeeding.

Working with a team of Peruvian women, she helped gather data from women and children who had previously been interviewed during baseline and midterm points.

“A typical day for us was to set off in our truck well before dawn, usually around 4:30 a.m.,” she recalls. “We would drive for an hour or so and then get dropped off at the side of the road and hike anywhere from one to six hours to reach these small communities.

“Once in the village, we would set up camp for the day, interview, weigh the children, collect blood samples from about 15 women and children, have lunch, and then hike back to the road and wait for our driver. On a good day he was waiting for us; a not-so-good day we would have to wait for him. Back in town we would check and restock our supplies and then head off to the market for food for the next day.”

After the data collection process was completed, Hazelton helped enter and analyze a large portion of it, then went on to write a final report for the U.S. Agency for International Development describing the program improvements and setbacks. She reviewed educational materials and made recommendations on ways to improve various training modules.

“My time in Peru was amazing,” she says. “I was not only able to use the tools I had learned at the UCLA School of Public Health, but I was also able to expand my knowledge base in terms of Peruvian culture, Spanish skills, the politics of funding and how a non-governmental organization is run.”

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continued from page 16

“Globalization was initiated by economists, and the initial focus was on combating poverty in developing countries. But now people are realizing that you can’t develop a country as long as the population is unhealthy.”

—Dr. Osman Galal

UCLAPUBLIC HEALTH

In some cases, public health researchers in the United States can gain important insights into health problems only by conducting their studies where the problem is most severe. For an epidemiologic study of the relationship between workplace exposure to boron-containing compounds and adverse male reproductive effects, UCLA School of Public Health researchers needed to go where the exposures would

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It isn’t only faculty who are representing the School in other countries. Since 1995, Los Angeles businessman Robert Drabkin has annually funded international field internships in the Department of Community Health Sciences (p. 18). To date, 53 students have benefited from gifts totaling more than $90,000. In April 2000, a generous gift of $50,000 established the Monica Salinas Internship Fund in Latin American Health, which will be used to provide fieldwork support to public health and/or Latin American studies students in the School of Public Health whose work focuses on Latino and Latin American health and well being. Since 1996, the Minority International Research Training Program, sponsored by the Fogarty International Center of the National Institutes of Health, has sent 18 of the School’s students to train overseas for between three months and a year.

Fogarty grants are also responsible for two long-term programs that bring students from other countries to the School for their training. In the Department of Epidemiology, the UCLA/Fogarty AIDS International Training and Research Program assists developing countries in controlling the AIDS epidemic by providing research training for health professionals and technical staff (p. 17).

In the Department of Environmental Health Sciences, the UCLA-Mexico/Latin America Training and Research Program, funded by Fogarty in collaboration with the National Institute of Environmental Health Sciences, the National Institute for Occupational Safety and Health and the Environmental Protection Agency, has trained scientists to effectively address environmental and occupational issues through research in epidemiology, toxicology, medicine, environmental chemistry, occupational hygiene/exposure assessment, ergonomics and other related areas.

Even for American-born public health students who never make it overseas, the experiences of peers — those who come to the School from other countries as well as students who return after their internships — enrich the overall learning experience, says Galal. Galal has also helped to spearhead exchange programs between the School and universities in several countries in the Middle East and Africa, further enriching the exposure of the School’s students to international health issues.

be high enough to yield meaningful results.

“Although animal studies show that low levels of boron may be essential to health, high exposures cause adverse reproductive effects,” explains Dr. Wendie Robbins, who is conducting the study along with Dr. Curt Eckhert, her colleague in the Department of Environmental Health Sciences. “Human studies to determine the level at which boron may be a reproductive toxicant are limited and inconclusive, perhaps due to the limited range of exposures evaluated.” In order to determine the dose at which the substance becomes toxic to humans, Robbins’ group found it necessary to go to a plant in Liaoning Province, China, where the exposure levels are reported to be significantly higher than in the only boron mining plant in the United States, U.S. Borax.

Contacts that Harrison established through her work as a consultant to UNICEF on food and nutrition security planning issues in Iran have led to a collaborative study with public health researchers at Teheran University of Medical Sciences. The project involves a systematic examination of malnutrition resulting from riboflavin (vitamin B2) deficiency.

“While most of the international micronutrient work in the last 10 years has focused on iodine, iron and vitamin A, this particular problem has received little attention, even though it’s endemic in many places,” Harrison says. Her group, which also includes Eckhert and Dr. William Cumberland from the School, is launching a clinical trial involving children in rural Kerman Province to test the hypothesis, based on tantalizing epidemiologic and biological evidence, that riboflavin deficiency may represent an unrecognized pathway to night-blindness. “This is clearly a big problem affecting large parts of the world,” Harrison says. “And you can’t study it except where it’s highly prevalent.”

The School’s international presence will likely increase given that one of the five goals of the School’s new strategic plan is to enhance its contributions and visibility in global health. Objectives under this goal include developing degree-granting potential in global health, expanding the School’s global health course offerings, and increasing training opportunities for both U.S. and foreign students.

One of the side benefits of the School’s international research efforts is the good will that has been spread in parts of the globe where the UCLA name once sparked little recognition. “If you go into any country in Southeast Asia now, the people have positive feelings about UCLA and their young people want to come here for training,” says Detels in describing the impact of the UCLA/Fogarty AIDS program, which has focused on that region. “That wasn’t something that I saw at the time we initiated this program, but it’s amazing how true it is now.”

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H EALTH P ROFESSIONALS SEEK TO EXPAND THEIR SCOPE OF PRACTICE WITH INTENSIVE WEEKEND INSTRUCTION LEADING TO AN

M.P.H.

Executive-Style M.P.H. Programs: New Skills for Practicing Students in the M.P.H. for Health Professionals program in the Department of Community Health Sciences (above) follow an executivestyle format of once-amonth, Friday-throughSunday class sessions.

A similar program is offered in the Department of Health Services.

Professionals It’s a different group

of students that

congregates at the School for an intensive weekend of instruction either once or twice a month, depending on the program. These are M.P.H. programs — one in health education and health promotion, based in the Department of Community Health Sciences; one in health services management, in the Department of Health Services. They require the same core courses that M.P.H. students take during the week. But the students are working professionals — successful, midcareer individuals driven to gain skills that will enable them to expand their

UCLAPUBLIC HEALTH

scope of practice.

“The traditional M.P.H. program takes bright young people, who may or may not have prior experience, and gives them public health education with the hope that someday they will become leaders in their field,” says Dr. Snehendu B. Kar, director of the M.P.H. for Health Professionals (MPHHP) program in Community Health Sciences. “The executive program, on the other hand, starts with applicants who have already demonstrated leadership qualities; what they lack is public health training. We are taking these known public health leaders and helping them to become more effective.”

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“The executive program starts with applicants who have already demonstrated leadership qualities; what they lack is public health training. We are taking these known public health leaders and helping them to become more effective.”

—Dr. Snehendu B. Kar

Dr. Dawn Upchurch, associate professor at the School, is among the instructors in the M.P.H. for Health Professionals program in Community Health Sciences.

UCLAPUBLIC HEALTH

As an emergency physician, Federico Vaca always saw himself as being on the front line of medicine’s interface with the community. “We see everything that comes through the hospital, a lot of which could be prevented with public health strategies,” says Vaca, assistant clinical professor of emergency medicine at UC Irvine. Practicing in the hospital’s trauma center, Vaca developed a strong interest in child occupant safety relating to motor vehicle crashes. Among other reasons, he enrolled in the Community Health Sciences MPHHP in the fall of 2000 to learn more about the public health approach to injury research and prevention.

Vaca won’t get his M.P.H. until June, but he’s already applying what he’s learning. As a Hispanic physician with a particular interest in the Latino population, he is collaborating with community-based organizations on ways to better educate Orange County Latinos on traffic safety, tackling similar issues in conjunction with the National Highway Traffic Safety Administration, and conducting injury prevention research.

“It’s challenging to go through a very rigorous program at the same time you have all of these professional activities and a family as well,” he says. “But it’s been an incredibly rich experience.”

One of Vaca’s classmates, Akiko Tagawa, has been an environmental health specialist for the Los Angeles County Department of Health Services, specializing in food inspections. She recently became a staff trainer, and now also works as a liaison to other governmental agencies, industry and the public, explaining the inspectional process. One focus has been on educating groups from diverse cultures on the local regulations. “That part of my job helped me realize the importance of health education, and how helpful an M.P.H. program would be,” she says.

Tagawa has been particularly impressed with the enthusiasm of the MPHHP students. “Everyone is so concerned with improving his or her program,” she says. “Both in class and outside of class, we talk with each other about what we’re doing and help each other figure out how to do it better.” Although she didn’t enroll with the intention of changing jobs, Tagawa has since received a number of offers, including one with the U.S. Food and Drug Administration in which she would train environmental health specialists in local health departments across the country.

The program similarly opened a career door for Julia Causey. A month after she earned her degree, Causey landed a position as director of health education, promotion, and community outreach for the Venice Family Clinic, the largest free clinic in the United States. Causey says the M.P.H. program helped her understand the foundations for what she was already doing in her previous role as a clinic administrator. “It exposed me to a world that I was in, but didn’t understand in such a big-picture, conceptual way,” she says. “I still have probably 10 of my textbooks here on my bookshelf, and I refer to them all the time.”

In his position as director of health and wellness for the Los Angeles Police Department, Kevin Jablonski oversees the evaluation, research and development of programs to promote psychological and physical health among the depart-

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In the case of the Community Health Sciences executive program, Kar explains, the goal is to educate professionals in planning, implementing, and evaluating population-based disease prevention and health promotion programs, as well as preparing them to effectively lead organizations or programs involved in developing public health policies. “These students already have a commitment to the health of the community, their goals are already set, but they need a grounding in the principles, theories and methods of public health, including training in program planning, implementation and evaluation,” he says.

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ment’s employees. Jablonski decided he could be more effective in this capacity if he supplemented his training as a medical psychologist. “My previous education included some general health promotion, but it was focused on the individual,” he says. “The M.P.H. is much more focused on the community.” Jablonski, who completed the program last June, learned to apply social marketing principles to develop effective health messages and “sell” the importance of positive health behaviors to a mass audience. “I already knew how to do that on an individual level, but with 15,000 employees, you can’t approach each person individually,” he says.

“The benefits were immediate,” relates Kathryn Peterson, who graduated from the Community Health Sciences MPHHP last June. “Each time I returned from a weekend at UCLA, I brought to work with me a new skill set or a different way of looking at things.” Peterson has devoted her career to serving the public health needs of vulnerable populations in rural communities. After 12 years in Alaska, she and her husband sought the more temperate climate of Bishop, Calif., where Peterson was named program coordinator for the newly state-funded Male Involvement Program in Inyo County, a program designed to reduce teen pregnancy by increasing the involvement of teenage males. Most recently, she was hired to serve as executive director of the Inyo County Children and Families Commission, set up to carry out the mandate of the state initiative Proposition 10 at the county level. “I owe much of my success in landing this job to my M.P.H. degree from UCLA,” she says.

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UCLAPUBLIC HEALTH

Kevin Jablonski decided he could be more effective in his position as director of health and wellness for the Los Angeles Police Department with an M.P.H., so he enrolled in the Community Health Sciences MPHHP.

“For schools of public health, a program like this is much more the exception than the rule,” says Dr. Paul Torrens, director of the Executive M.P.H. in Health Services Management program. In the mid-1990s, the dramatic changes transforming the health care system convinced Torrens of the need for a program that would impart public health and health management principles to professionals in public health agencies, hospitals, medical groups, managed care organizations and pharmaceutical companies, to name a few. The response was immediate, with 19 people enrolling in the inaugural class in 1995. This fall, nearly double that number — 33 students — entered the program.

Linda Tolbert entered in the fall of 2000, and will complete the program in June. A practicing physician with the Southern California Permanente Medical Group who also has a law degree, she resolved to position herself to pursue opportunities to affect health care delivery in a more systematic way. “I certainly enjoy the one-to-one interaction with patients, but I’d also like to make a more global impact,” she explains. Tolbert, who currently sits on the organization’s board of directors and chairs the risk management committee, hasn’t settled on the specifics of her future career path.

“I just know that in order to get where I want to be, this degree is attractive because it will give me management tools as they are applied in the health venue.”

One of the strengths of the Health Services MPHHP, Tolbert believes, is its current-events focus. Each weekend that the class meets, an hour is spent reviewing and discussing recently published articles from journals and the popular press, covering all aspects of health care. Denise Mathes, one of Tolbert’s classmates, says the diversity of the students’ backgrounds — both professionally

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feature After advancing to a nurse manager position at Kaiser Permanente, Patricia Harvey decided she needed to improve her leadership and management skills. She enrolled in the Health Services MPHHP — and has since been promoted again.

“These aren’t students who have just come back to school because they have to.

They are all driven to learn, and they work hard at it.

That’s what brings them together and that’s why it works so well.”

—Dr. Paul Torrens UCLAPUBLIC HEALTH

and culturally — makes for rich discussions. “We get to learn about the issues from so many different vantage points, including ones I may not have considered,” she says.

Mathes, a registered nurse, is a clinical research associate at Amgen, responsible for monitoring investigative sites that are conducting Amgen-sponsored clinical trials. She describes her first year in the MPHHP as enlightening. “I’ve gotten to know other people I probably never would have crossed paths with,” she says. “It’s opened my eyes to what’s going on in all aspects of health care delivery.”

For Roosevelt Jacobs, the MPHHP began to appear attractive when, after working in psychiatry for 22 years, he was asked to take over a fledgling program to train substance abuse counselors at the Charles R. Drew University of Medicine and Science.

“I needed to better understand the issues related to managing health service organizations and the impact of the managed care industry on health care financing, as well as developing knowledge and skills in areas of organizational theory and leadership, and financial planning and analysis,” he says. Shortly after graduating from the program in 1998, Jacobs was appointed director of urban public health, and asked to take the lead in developing an urban public health program, which the university plans to implement next year. In August, he was appointed interim dean of Drew’s College of Allied Health. “None of this would have been possible without my M.P.H. education,” Jacobs says.

By the time Patricia Harvey had advanced from staff nurse to nurse manager of three inpatient hospital units for Kaiser Permanente, she concluded that she was missing critical skills she needed to enhance her leadership and management abilities. In 1999, while working on a hospital operations improvement project, she met a consultant from the organization’s analysis department — an attorney who had recently completed the MPHHP at UCLA. “We spoke about how health care will be provided in the future and the skill set that a successful leader should have,” Harvey recalls. “He recommended that I contact Dr. Torrens.”

Even before graduating from the program last June, Harvey had taken a new job within her organization as a project manager for clinical content in the computer information system. In that position, she interacts with physicians and the administrative leadership, as well as personnel in information technology services, financial services, benefit services, and front line staff.

“What makes this program stand out above other programs is the atmosphere of collegiality,” Harvey says. “The concern and caring of the MPHHP staff and professors, and the bonding among the students, will carry this program long into the future.”

Torrens agrees that the technical knowledge and skills that faculty impart to the students are only part of what makes the MPHHP so successful. “The characteristic of our program is not competition but collaboration,” he says.

“There’s a tremendous exchange of information among the students, and also a tremendous amount of professional growth, because you find out how to survive and thrive as a professional within a group consisting of a lot of other very bright people.

“These aren’t students who have just come back to school because they have to,” he concludes. “They are all driven to learn, and they work hard at it.

That’s what brings them together and that’s why it works so well.”

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research highlights Community-Based Intervention Reduces Initiation of Drug Use in China Province Hard Hit by HIV/AIDS

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A COMMUNITY-BASED INTERVENTION PROGRAM implemented in a rural area of China where the HIV epidemic is spreading rapidly was successful in substantially reducing the number of new drug users.

The study was implemented by two UCLA School of Public Health faculty members, Drs. Roger Detels and Virginia Li, along with Dr. Zunyou Wu, a graduate of the UCLA/Fogarty AIDS International Training and Research Program. It was based on findings from Wu’s Ph.D. dissertation on factors associated with drug use and injecting drug use in villages in southern Yunnan Province, China, where the HIV epidemic began among heroin-injecting drug users, and then spread to all of the provinces.

Detels, Li and Wu met with local health officials and village leaders in Yunnan Province, where the epidemic of drug use is concentrated among young men. Two similar areas of 19 villages each were designated as intervention or control areas. In the intervention areas, village leaders, teachers, women, and youth leaders were recruited to participate in the development of appropriate Model for Factors Influencing community efforts to prevent initiation of Initiation of Drug Use drug use. Strategies included providing recreational centers for youths in the vilcommunity involvement lages, providing training to improve farming techniques and yield, developing youth service activities, holding vil< lage sessions to discuss drug problems, community norms minority membership having youths write small plays or vignettes about the dangers of drug use, and initiating a program in the schools. education < peer pressure < age The researchers reported a 2.7-fold greater reduction in initiation of drug use in the intervention villages compared < with the non-intervention villages. The family norms smoking drug use reduction was highest in the groups that previously had shown the highest rates of drug use: young men ages 15-19, sinparental pressure self-efficacy gle men, illiterate men, and the Jingpo minority group. There was also a significant increase in HIV/AIDS knowledge in drop-in centers youth groups improved youth the intervention areas. agricultural community “Although the village leaders initially productivity service blamed the central government, they gradually accepted the idea that this was a local problem and that ultimately they would have to take responsibility for solving it,” says Detels, professor and chair of epidemiology. On the basis of the study, his group has been funded to evaluate similar community intervention/mobilization strategies in villages in northern Vietnam. In addition, Detels and colleagues will evaluate the long-term impact of the intervention in southern Yunnan.

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UCLAPUBLIC HEALTH

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ONLY 60%-65% OF THE INDIGENT, MOSTLY MINORITY WOMEN attending two Los Angeles County medical centers are receiving appropriate and timely medical follow-up after learning that they have breast abnormalities suspicious for cancer — an ominous figure given that for as many as 10% of these women, the initial abnormality ultimately proves to be malignant. These findings, by Dr. Roshan Bastani, associate dean for research at the School and associate director of the UCLA Division of Cancer Control and Prevention Research, are from Patients Receiving Appropriate the first study to determine whether telephone counseling could increase the Diagnostic Care After Suspicious likelihood of a population of underserved women seeking Breast Abnormality Is Found follow-up leading to a definitive diagnosis (benign or malignant) for their suspicious breast abnormality.

Telephone interventions have been shown in prior 60% research to be successful with low-income and minority 58% 54% populations. But in her study, Bastani found that the telephone intervention failed to increase the percentage of 40% 42% women who received a definitive diagnosis within six months of the abnormality being identified — most likely because the intervention did not reach the very women who 20% needed it most.

Women with the suspicious abnormalities were randomly assigned into either a control group receiving usual did not receive received care or a group receiving a telephone intervention. The latter telephone telephone consisted of an average of six phone calls over a period of 6intervention intervention 8 months encouraging the women to have the recommended tests and procedures leading to a definitive diagnosis, and INTERVENTION GROUP CONTROL GROUP assisting them with tangible, emotional and social barriers to receiving appropriate care.

Women in the telephone counseling group expressed highly positive feelings about the intervention — and within that group, those actually receiving the intervention were much more likely than those who didn’t to pursue appropriate follow-up care. But the intervention group as a whole fared no better than the control group, probably because approximately one-third of the women in the intervention group could not be reached.

“In many cases, either the phone number was disconnected or the counselor would be told the woman was not home or that nobody by that name lived there,” Bastani says. “Often, the counselor was convinced that the person was at home but just didn’t want to talk.” A follow-up survey indicates that women who could be reached for the telephone counseling probably would have gone for the follow-up care even without it, Bastani adds.

“To be effective, the point of intervention might have to be at the time that the abnormality is identified, while the woman is still at the clinic,” she says.

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For Indigent Women Not Following Up on Suspicious Breast Abnormalities, Phone Strategy Has No Impact

Medicare HMOs Increase Access for State’s Latinos, But Satisfaction with Physician Interaction Lags UCLAPUBLIC HEALTH

MEDICARE HMOs PROVIDE INCREASED ACCESS TO CARE for elderly Latino patients in California, according to a UCLA School of Public Health study headed by Dr. Steven Wallace, professor of community health sciences and associate director of the UCLA Center for Health Policy Research. But Wallace also found that the state’s Latinos in Medicare HMOs are less satisfied with the interactions with their physician than those in fee-for-service Medicare.

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Wallace and colleagues analyzed data from the 1996 Medicare Current Beneficiary Survey, which involved 1,550 California seniors and more than 26 14,000 seniors nationwide. Approximately 40% of older persons in California are in Medicare HMOs at any one time. Nationally, an estimated 17% of the elderly population is in a Medicare HMO. The researchers found that managed care improves access to health services among the minority elderly (specifically Latinos and African Americans) in Issues of Access to, and certain significant ways that involve location and finances. For example, Satisfaction with, Care Among California Latinos in Medicare HMOs were more likely than their counterparts in Elderly California Latinos in traditional Medicare to report satisfaction with the availability of weekend and Medicare HMOs and Fee-Forevening hours, care not being delayed due to Service Medicare Plans cost, ease in seeing their doctor, receipt of followup care, and their doctor’s concern for their health. On the down side, they were more likely than Latinos in fee-for-service Medicare to have 21.9% EASY TO GET TO MD been going to their current doctor for a shorter 8.2% period of time, indicating a lack of continuity in CARE DELAYED 1.8% their care. They were also more apt to report that DUE TO COST 7.9% their doctor seemed to be in a hurry, and were SUFFICIENT EVENING/ less likely to express confidence in their doctor — 16.8% WEEKEND HOURS 3.2% indicating potential problems in the process of care.

26.5% CONFIDENT IN MD 40.9% Despite the advantages in location and financial access in California, the gap in access 10.9% MD NOT IN A HURRY between the minority elderly and white elderly pop28.9% ulations was narrowed by Medicare HMOs in only a few areas — principally in the percentage having 0% 15% 30% 45% a usual doctor. By a number of measures at the HMO national level, the gap between Latino and white Fee for Service elders was larger in HMOs, particularly when it came to acceptability of care.

“Previous research has shown that problematic access to care in HMOs is particularly severe among groups that historically are considered at risk,” says Wallace. “The findings of continued disparities in the Medicare setting indicate that further efforts are needed to improve access for Latino and African American elders in managed care before considering mandatory HMO enrollment of Medicare beneficiaries.”

UCLAPUBLIC HEALTH

Role Models Associated with Protective Health Effects CONSIDERABLE EVIDENCE SUGGESTS that role models or mentors have a positive effect on adolescents, particularly those from ethnically or socioeconomically disadvantaged backgrounds. But few studies have specifically addressed the relationship between the selection of role models/mentors and the psychological functioning and health-risk behaviors of urban adolescents.

Now, researchers at the UCLA School of Public Health and Los Angeles County Department of Health Services have found that role model selection is indeed associated with protective psychosocial characteristics.

Their study linked role model choices and characteristics with self-perception, academic performance, and substance use in a population-based, multiethnic sample of Los Angeles teens. Fifty-six percent of the adolescents identified a person they could “admire or look up to” — most commonly a parent (22%), a sports figure (18%), a sibling (10%) or a singer (10%). Nearly three in four (72%) teens chose role models of like ethnicity and 86% chose models of like gender. Ninety-six percent of African Americans selected a role model of the same ethnicity, compared with 79% of whites and 64% of Latinos.

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The research group, headed by Dr. Antronette Yancey, associate professor at the School who was director of the county’s Division of Chronic Disease Prevention before joining the faculty full time, found that having a role model was associated with higher levels of ethnic identity, higher self-esteem, higher grades and, for white males without fathers living in the home, decreased substance use.

“The modest protective effect of role modeling demonstrated in this study should encourage teen health and social service professionals in their efforts to provide their patients and clients with positive and ethnically diverse adult images,” says Yancey. “It should also stimulate research further elucidating the nature of role modeling and opportunities for using it as a tool in intervening with high-risk youth. For providers serving increasingly diverse and at-risk youth populations, ethnic identity may be more malleable and amenable to intervention than addressing the structural inequalities that contribute to adverse outcomes.”

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research

Faith Institution Proves Helpful in Promoting Nutrition and Fitness in Hard-to-Reach Groups

The Inglewood Nutrition and Fitness Project aims at hard-to-reach population groups, including lowincome African Americans and Latinos.

UCLAPUBLIC HEALTH

A PROJECT AIMED AT IMPROVING DIETARY PRACTICES and increasing physical activity among a low-income population of African Americans and Latinos has demonstrated the potential in using a faith institution to reach these individuals.

The Inglewood Inspiration Nutrition and Fitness Project has been funded by the California Nutrition Network for three years — one of a number of statefunded church-based nutrition and fitness promotion programs aimed at “hard to reach” population groups, including low-income African Americans and Latinos.

The state-sponsored California Dietary Practices Survey has found that fruit and vegetable consumption by the state’s African American adults is the lowest of any ethnic group, at three servings per day, and has declined since 1989. The fruit and vegetable consumption of Latino adults is somewhat higher, at almost four servings a day, but is still below the recommended five servings per day.

Moreover, adults from households with the lowest annual incomes and the lowest levels of education are at the highest risk of consuming inadequate fruits and vegetables.

In its Healthy People 2010 report, the U.S. Department of Health and Human Services noted that people with lower incomes and less education are typically not as physically active as those with higher incomes and education. In addition, African Americans and Latinos were found to be less physically active than whites.

Working with the Inglewood-based Holy Faith Episcopal Church, a team headed by Dr. Joanne Leslie, adjunct associate professor in the UCLA School of Public Health, has instituted a number of activities designed to educate the population and promote better nutrition and exercise habits.

“We’ve learned that it’s possible to change the dietary culture at a church, which in turn can affect a large group of people,” Leslie says. At the outset of the project, she notes, the church tended to favor high-fat, meat-oriented foods at its events. Three years later, the balance has shifted toward fruits and vegetables.

“The church almost never has an event now without several raw vegetable plates and fruit salads,” Leslie says. The project has also resulted in an increase

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in exercise participation, with the program’s yoga classes proving to be especially popular, particularly as an entry point for people who were not previously exercising.

“Faith institutions are a convenient location where many people in a community gather and can be reached,” Leslie says. “In addition, these institutions often have a social justice and outreach mandate, so there’s a synergy of goals.”

research

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UCLAPUBLIC HEALTH

COMPLETION OF CARE

Innovative Educational Strategies Boost Likelihood of Adolescents Completing Treatment for Latent TB ACTIVATION OF LATENT TUBERCULOSIS INFECTION into tuberculosis disease, the primary killer among infectious diseases worldwide, can be prevented with six months of anti-tuberculosis medication. Although the TB case rate in the United States has decreased since reaching its peak in 1992, the current rate — 6.8 cases per 100,000 in 1998 — remains well above the national goal of 3.5 per 100,000. Contributing to this problem is the fact that a large percentage of adolescents who start on medication for latent TB infection fail to complete their Association Between TB treatment. But a research team headed by Dr. Donald Morisky, vice chair of comMedication-Taking Behavior munity health sciences at the School, has found and Completion of Care that innovative educational strategies aimed at TB-exposed adolescents significantly improve their rate of completion.

100% The study — a collaborative effort involving researchers at California State University, 88.8% Northridge; California State University, Long 85.3% 80% Beach; the Los Angeles County Department of Health Services; and the Long Beach Department 73.2% of Health and Human Services — targeted TB60% exposed adolescents at two health centers serving ethnically diverse populations. The researchers weighed the independent and com40% bined effects of peer counseling and a participant/parent contingency contract intervention (in which the parent and adolescent negotiate a 20% reward to be given if the adolescent adheres to the prescribed TB treatment) against a control group receiving usual care.

Of the nearly 800 adolescents recruited into high medium low the study, the overall rate of treatment completion was 80%. Those randomized to the combined MEDICATION-TAKING BEHAVIOR peer counseling and contingency contracting group had the highest completion rate, 85%, vs.

78% for the group receiving usual care.

Participants randomized to the peer-counseling groups demonstrated significantly higher improvements in the effectiveness of their medication-taking behavior than those in the usual-care control group. The effectiveness of one’s medication-taking behavior was strongly correlated with completion of care.

“The results demonstrate the significance of tailored educational reinforcement from both peers and parents in improving completion of treatment for latent tuberculosis,” Morisky says. Based on the study results, seminars and workshops have been implemented for continuing education among TB control staff at the two health clinics, as well as all Tuberculosis Control Division staff at the L.A. County Department of Health Services. Educational materials and a training manual for enhancing completion of latent TB infection treatment through tailored educational approaches have been developed and disseminated to the clinics.

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The UCLA Center for Health Policy Research, based in the School, has launched a new Web site for its groundbreaking CALIFORNIA HEALTH INTERVIEW SURVEY (CHIS).

The site (www.chis.ucla.edu) features extensive information on the survey design and topics, a special section for individuals who were contacted for an interview, and information targeted toward various CHIS stakeholders, including researchers, county health departments, community-based organizations, policy makers and the media. The site will be the portal through which ongoing information about CHIS, including data and results, can be accessed. Beginning next spring, users will also be able to use the site to obtain publications, download public-use data files, and make customized data queries.

CHIS is a collaboration involving the UCLA Center for Health Policy Research, the California Department of Health Services, and the Public Health Institute. Data collection, which began in November 2000, will capture health information on adults, adolescents and children from a random sample of more than 55,000 households throughout the state.

rescatando salud honored “Rescatando Salud” (Rescue Health), a communitybased project headed by DR. SNEHENDU KAR, professor of community health sciences, has won the 2001 National Award for Excellence in Immunization in the category “Addressing Disparities.” The award, given by the National Partnership for Immunization, honors the highly successful UCLA School of Public Health project, which is based on empowering women and mothers to promote health and quality of life in multicultural and underserved communities.

Rescatando Salud promotes timely childhood immunization by empowering local women as community health promoters, or promotoras, to conduct outreach within their own underserved and hardto-reach Latino communities. Collaborators on the project include the Los Angeles County Immunization Program, the Esperanza Community Housing Corporation, and South Central Family Health Center.

TIES

for adoption

The U.S. Department of Health and Human Services honored UCLA’s TIES (Training, Intervention, Education and Services) for Adoption program with the Adoption Excellence Award in the category of Support for Adoptive Families for the program’s work in finding permanent, loving homes for abandoned, neglected or abused children.

TIES for Adoption is a unique collaboration of the UCLA Center for Healthier Children, Families and Communities (based at the School of Public Health); the UCLA psychology department; the Los Angeles County Department of Children and Family Services; the Los Angeles County Department of Mental Health; and private foundations. The project has been successful in working with more than 400 children, most of whom have special needs due to abuse, neglect, frequent placement changes, developmental delays or biological vulnerabilities.

UCLAPUBLIC HEALTH

The UCLA School of Public Health was well represented at this year's American Public Health Association annual meeting, held in Atlanta October 21-25. Faculty and students made more than 50 presentations, and the alumni reception drew a strong turnout. The School's booth also received a great deal of traffic. Above: Kirstin Chickering, Tasneem Malik, Dr. Michael Prelip and Dr. Susan Cochran visit at the alumni reception held at the CNN Center. Left: SPH students LeConte Dill (l.) and Taigy Thomas help out at the booth.

news briefs

CHIS

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bixby gift A generous gift of $1.2 million from the Fred H. Bixby Foundation will establish the FRED H. BIXBY FUND IN POPULATION AND FAMILY PLANNING at the School of Public Health. This fund will address both national and international aspects of the issue through: research support for School and visiting faculty engaged in population studies and family planning; fellowships, travel, and project support for students; and public health practice grants to faculty, students, and community-based organizations involved in collaborative population studies and family planning.

joining the team DR. ROSHAN BASTANI

DR. GERALD KOMINSKI

UCLAPUBLIC HEALTH

community college public health course The UCLA School of Public Health and UCLA Community Education Resource Initiative have been working with Compton Community College to develop an INTRODUCTORY COURSE ON PUBLIC HEALTH AT THE COMMUNITY COLLEGE LEVEL, to which both community college and high school students will have access. The objectives of the course are to provide relevant honors-level courses to high school students in educationally disadvantaged areas, in order to improve their chances of admission to the UC system; and to introduce students to the broad array of issues involved in the public health field, as well as its potential as an interesting and rewarding career path.

The course will expose students to the myriad ways they can have a direct, positive impact on the communities in which they live. In addition, because many of the potential students for the course face difficulties in attending courses at locations outside of their communities, the School has made arrangements with Compton Community College and King-Drew High School to offer the course within the local community itself. The course will take place on Thursdays from 3:30 p.m. to 6:30 p.m., January 10 to May 23, 2002, at the King-Drew High School campus.

DIANE PORTER

JOANNE CLAREY

SUSAN KANOWITH-KLEIN

Three new associate deans, along with a director and assistant director in the Office of Development and Alumni Relations, have joined the School’s administration.

DR. ROSHAN BASTANI, already a member of the faculty, has

assumed the newly created position of associate dean for research. In her new role, Bastani, who is also associate director of the UCLA Division of Cancer Prevention and Control Research, will establish a focal point and infrastructure to expand the School’s research enterprise. One of her goals is to serve as a catalyst for new collaborations across departmental and disciplinary lines. “The issues we tackle in public health tend to be complex,” she explains, “and so at the same time that we foster individual creativity, we also hope to bring people together who might reap larger benefits through collaborations.”

As the new associate dean for academic programs, DR. GERALD KOMINSKI is responsible for academic personnel actions and student affairs. Kominski, who continues as a faculty member and associate director of the UCLA Center for Health Policy Research, hopes to increase the size of the School’s faculty by using research funds and structuring incentives for existing faculty to increase the portion of their salaries funded through extramural grants and contracts. He will also work with students to address their concerns, including upgrades of the equipment available for classroom instruction, continued improvement of the diversity of the School’s student body and increased sources of student financial aid.

DIANE PORTER joined the School in June as associate dean for administration. Porter previously served as deputy director for management at the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention. In that position, she was the principal advisor to the director of NIOSH on all management issues relating to the institute and its research program. She managed a budget of $350 million, 1,400 employees and 200 contractors.

JOANNE CLAREY is the School’s new director of development. Clarey previously served as development director for the School of Engineering at Southern Methodist University in Dallas, Texas. She also worked as director of corporate relations at the California Institute of Technology. Her top priority will be to work with Dean Linda Rosenstock in raising $30 million to fund a new building for the School. “I was attracted to this position by the issues that the School addresses, which are so relevant to our lives,” she says. Working with Clarey as assistant director of development and alumni relations is SUSAN KANOWITH-KLEIN. Previously, Kanowith-Klein served as director of the UCLA School of Medicine’s Science Education Partnership, which links the university with K-12 schools and the business community in developing and implementing grant-supported programs. In her new role, she will work with Clarey to strengthen connections between the School and its alumni, as well as staffing annual fund activities.

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student award for excellence

31 Executive Board Raphael Travis, Jr. President Betha Schnelle Internal Vice President Melinda Kwan External Vice President Kitty Lim Vice President of Finance

news briefs

2001-2002 PUBLIC HEALTH STUDENT ASSOCIATION

Officers Biostatistics

Stanley Yuen Shine May Hung Community Health Sciences LeConté Dill Crystal Keeler Candice Taylor Amanda Babcock Environmental Health Sciences Susan Srour Zahid Iqbal KOY PARADA, a doctoral student at the School, and KEVIN RILEY, a 2001 M.P.H. graduate, were selected

as recipients of the Student Award for Excellence in Public Health Practice, presented by the Association of Schools of Public Health, Health Resources and Services Administration, and Council on Linkages Between Academia and Public Health Practice. Parada and Riley recruited an interdisciplinary group of students as a steering council to provide services to the homeless and transiently housed in West Hollywood. They served as co-founders for “UCLA/GWHFC Mobile Clinic Project,” implemented by UCLA students and the Greater West Hollywood Food Coalition.

Epidemiology Carrie Breton Riti Shimkhada Jill Donofrio Matt Wise Health Services Heidi Cho Neté Grimmett-Tejedor

students of color for public health The recently established Students of Color for Public Health (SCPH) is dedicated to strengthening the support and networking resources for public health students and alumni of color. SCPH will provide avenues for students to express public health interests as well as health issues of concern to populations of color. In addition, SCPH will contribute to efforts to improve the orientation, retention, and graduation of students of color while maintaining on-going alumni involvement. For more information, contact Raphael Travis, PHSA president, at rtravis@ucla.edu.

UCLAPUBLIC HEALTH

Dean Linda Rosenstock hosts students at Cresson Elementary School in Norwalk, Calif., who were invited to visit the UCLA School of Public Health last spring after they decided to raise money for their school in a healthy way — with a successful jog-a-thon.

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faculty

Left to right: Robert Schiestl, Stefan Horvath, Christina RamirezKitchen, Pamina M. Gorbach, Moira Inkelas

More than a dozen new faculty members were appointed to the School for 2001-02.

DR. ROBERT SCHIESTL (ENVIRONMENTAL HEALTH SCIENCES),

who also has an appointment in the School of Medicine’s Department of Pathology and Laboratory Medicine, comes to the Molecular Toxicology Program from the Harvard School of Public Health.

Schiestl’s research is focused on how environmental agents, as well as genetic predisposing factors, can cause cancer. Building on the knowledge that mutations which cause a high frequency of genetic instability often predispose to a high risk of cancer, Schiestl’s research group has developed tests in yeast, human cells and transgenic mice that detect chemicals which trigger cancer-causing mutations, as well as those that do not cause mutations but are carcinogenic.

Some of these assays are now being used by pharmaceutical companies to conduct high-throughput screenings of potentially cancer-causing chemicals.

DR. STEFAN HORVATH (BIOSTATISTICS), who also has

a joint appointment in the School of Medicine’s Department of Human Genetics, conducts biostatistical and bioinformatics research in two broad areas: family-based association tests and tissue microarray data. Family-based association tests are designed to determine whether a candidate gene affects the risk of developing a disease.

Together with colleagues, Horvath has developed association tests that don’t require parental information, but instead use sibling controls, which are often easier to ascertain in the case of late-onset diseases such as Alzheimer’s. Horvath also develops and implements software for addressing data analysis challenges that arise from the study of tissue microarray data, which enable researchers to identify and evaluate highly specialized gene expression patterns.

UCLAPUBLIC HEALTH

DR. CHRISTINA RAMIREZ-KITCHEN (BIOSTATISTICS) earned

her Ph.D. at Caltech before coming to UCLA as a postdoctoral scholar. She was appointed to the School of Public Health faculty immediately after completing her postdoctoral fellowship. Her research is in statistical genetics; Ramirez-Kitchen examines molecular sequence data as it relates to HIV — for example, co-receptor utilization as it affects HIV dis-

ease progression and pathogenesis, and how resistance mutations affect the ability of the virus to evade drugs designed to treat it. Researchers believe that directing certain mutations at the virus could be beneficial for patients with pre-existing drug resistance.

DR. PAMINA M. GORBACH (EPIDEMIOLOGY) is a behavioral epidemiologist whose research focuses on three areas: the risk behaviors that expose individuals to sexually transmitted infections, including HIV; the types and dynamics of sexual partnerships; and the social context of sexual health. She is currently director and co-investigator of the HIV Prevention Trials Network in Los Angeles, funded by the National Institute of Allergy and Infectious Diseases, and is principal investigator of several studies on HIV-related behaviors, as well as one on the prevalence of human papillomavirus (HPV) infection.

For the past five years, she has provided technical assistance in Cambodia. She has also conducted research in Latin America, West Africa, and Southeast Asia.

DR. MOIRA INKELAS (COMMUNITY HEALTH SCIENCES)

received her M.P.H. from the UCLA School of Public Health in 1993 and recently earned her Ph.D. from RAND, where her work focused on risk adjustment for quality of care measures, studies of prepayment policies, and welfare reform evaluation. Her research interests are in the area of health care access and financing for vulnerable populations, particularly children with chronic illness. Inkelas was recently funded by the California HealthCare Foundation to evaluate care coordination for children with special health care needs in California’s Medicaid managed care plans. Other ongoing research includes an evaluation of health services delivery to children in foster care, and analysis of the National Survey of Early Childhood Health (NSECH).

Other new faculty appointments include SUSANNE MAY (Biostatistics); MICHAEL REGALADO (Community Health Sciences); NOLA KENNEDY (Environmental Health Sciences); CHRISTIAN GIANGRECO, JESAL MEHTA, and LISA SMITH (Epidemiology); and STUART BOWNE, PAMELA DAVIDSON, BRENDA FRESHMAN, NILSA GALLARDO, BETH ANN GLENN and ANTHONY RODGERS (Health

Services).

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DEBORAH L. ACKERMAN Assessment Scale for End-of-Life Care for End-Stage Dementia (Alzheimer’s Association, $239,342); OCD Treatment Outcomes: Beyond Phase 3 Drug Trials (NIH/National Institute of Mental Health, $76,081); Proposal to Develop a Clinical Assessment Scale to Predict Survival in End-Stage Dementia (Rockefeller Brothers Fund, Inc., $110,000) ABDELMONEM A. AFIFI Pacific Public Health Training Center (DHHS/Health Resources & Services Administration, $265,607); Pediatric Indicators Project (CA/HHS/Department of Health Services, $127,440); Public Health Traineeship (DHHS/Health Resources & Services Administration, $117,059) RICHARD F. AMBROSE Inventory of Rocky Intertidal Resources in Southern Santa Barbara, Ventura and Los Angeles Counties (University of California, Santa Barbara, $68,587) RONALD M. ANDERSEN UCLA/RAND Health Services Research Training Program (DHHS/Agency for Health Care Research and Quality, $440,819) CAROL A. ANESHENSEL Neighborhood, Socioeconomic Status, and Adolescent Distress (NIH/National Institute of Mental Health, $257,868) MARION T. BAER Leadership Training in Maternal and Child Nutrition (DHHS/ Health Resources & Services Administration, $196,395) ROSHAN BASTANI Colorectal Cancer Screening in High Risk Individuals (NIH/ National Cancer Institute, $465,914); UCLA Cancer Education and Career Development Program (NIH/National Cancer Institute, $238,560) THOMAS R. BELIN Methods for Incomplete Mental Health Services Data (NIH/ National Institute of Mental Health, $112,863) E. RICHARD BROWN California Health Interview Survey (CHIS) (CA/HHS/ Department of Health Services, $1,855,000); California Health Interview Survey (CHIS) (California Children and Families Commission, $1,018,775); California Health Interview Survey: Oversampling and Dissemination (California Endowment, $2,989,585); The Decline of Employment-Based Health Insurance and the Changing Social Contract in California’s Labor Market (California Wellness Foundation, $190,000)

*Grants cover the fiscal year from July 1, 2000 to June 30, 2001. Due to space limitations, only grants of $50,000 and above are listed.

WILLIAM G. CUMBERLAND Biostatistics Training for AIDS Research (NIH/National Institute of Allergy and Infectious Diseases, $176,864) WILLIAM E. CUNNINGHAM The Effect on Health Outcomes of Access to Medical Care for Persons with HIV Disease in The United States (Doris Duke Charitable Foundation, $108,000) ROGER DETELS International Training Grant in Epidemiology Related to AIDS (NIH/Fogarty International Center, $1,166,716); International Training Grant in Epidemiology Related to AIDS (NIH/Fogarty International Center, $685,000); Natural History of AIDS in Homosexual Men (NIH/National Institute of Allergy and Infectious Diseases, $1,660,822) JONATHAN E. FIELDING Recognizing Health Effects in Policy Development: Lessons from Environmental Impact Statements and the Feasibility of Health Impact Statements (Partnership for Prevention, $533,917) JOHN R. FROINES An Automated System for Task-Based Evaluation of Size Distributions of Beryllium Aerosol at the Los Alamos Beryllium (UC Los Alamos National Scientific Laboratory, $228,000); UCLA-Mexico Collaborative Training and Research Program (NIH/Fogarty International Center, $138,963) PATRICIA A. GANZ Breast Cancer — Preparing for Survivorship (NIH/National Cancer Institute, $571,791); Breast Cancer Treatment Outcomes in Older Women (Boston University, $53,372) Breast Cancer Treatment Outcomes in Older Women (Boston University, $52,142) Improving Colorectal Cancer Screening Rates (NIH/National Cancer Institute, $450,127); Mechanisms of Radiation-Induced Fatigue in Breast Cancer (UC/Breast Cancer Research Program, $75,000); Process and Outcome of Breast Cancer Care (RAND Corporation, $50,069); SelectSelenium and Vitamin E Cancer Prevention Trial (CTRC Research Foundation, $69,250) DEBORAH C. GLIK Community Education and Outreach, Santa Susana Field Laboratory Studies (Eastern Research Group, Inc., $107,738) NEAL HALFON The Interdisciplinary Maternal and Child Health Training Program (DHHS/Health Resources & Services Administration, $360,990); Strategic Planning Guide Regional Trainings (CA/California Children and Families Commission, $146,192) Vivian Weinstein Child Advocacy Program (California continued on next page

UCLAPUBLIC HEALTH

SUSAN D. COCHRAN Risk for Psychopathology Among Lesbians and Gay Men (NIH/National Institute of Mental Health, $335,245)

MICHAEL D. COLLINS Murine Strain Sensitivity to Cadmium Teratogenesis (NIH/ National Institute of Environmental Health Sciences, $297,287)

faculty

contracts & grants 2000-01*

33

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34 continued from previous page Endowment, $250,000); Vivian Weinstein Child Advocacy Program (Conrad Hilton Foundation, $100,000) GAIL G. HARRISON Functional Effects of Riboflavin Deficiencies in Iranian School Children (Thrasher Research Fund, $299,586); Increasing Fruit and Vegetable Intake Through WIC (Public Health Foundation Enterprises, Inc., $69,441); Nutrition Greenbook Project (CA/HHS/Department of Health Services, $154,673)

SHANE S. QUE HEE Permeation of Irritant Mixtures Through Protective Materials (DHHS/Centers for Disease Control, $225,788)

WILLIAM C. HINDS Education and Research Center (DHHS/Centers for Disease Control, $607,198)

BEATE R. RITZ Extended Follow-Up of the Rocketdyne Worker Cohort (University of California, Davis, $107,218); Parkinsonâ&#x20AC;&#x2122;s Diseases Susceptibility Genes and Pesticides (NIH/National Institute of Environmental Health Sciences, $449,741)

ERIC L. HURWITZ Psychosocial Behavior and Immune Factors in Back Pain (NIH/National Center for Complementary & Alternative Medicine, $121,770)

JON M. RIDDLE Asthma: Cost Effectiveness Analysis (California Endowment, $278,219)

MARJORIE KAGAWA SINGER Breast Health Education Project for Hmong Women and Men (UC/Breast Cancer Research Program, $171,535)

STEVEN ROTTMAN Bioterrorism Training Program for California (CA/HHS/ Department of Health Services, $88,201); Training and Education for Disasters in Public Health (Association of Schools of Public Health, $189,420)

SNEHENDU B. KAR Immunization Promotora Project (County of Los Angeles/ Department of Health Services, $52,870)

MARK A. SCHUSTER UCLA Center for Adolescent Health Promotion (DHHS/Centers for Disease Control, $1,028,206)

JESS F. KRAUS Injury Prevention Research Centers (DHHS/Centers for Disease Control, $760,000)

KIMBERLEY I. SHOAF Earthquake Injury Data Collection for 1999 Urban Earthquakes (National Science Foundation, $74,986)

GANG LI Topics in Semiparametric Analysis of Survival Data (NIH/ National Cancer Institute, $109,904)

SUSAN B. SORENSON Academic Fellows Program (California Wellness Foundation, $195,000); Academic Fellows Program (Public Health Foundation Enterprises, Inc., $105,000); Adolescent Gun Survey (David and Lucille Packard Foundation, $199,929); Adolescent Gun Survey (Joyce Foundation, $132,786); Defining Domestic Violence: Views of Six Ethnic Groups (CA/HHS/Department of Health Services, $112,953)

HAL MORGENSTERN Epidemiologic Component of the Santa Susana Rocketdyne Facility Community Study (Eastern Research Group, Inc., $100,000); Marijuana Use and the Risks of Lung and Other Cancers (NIH/National Institute on Drug Abuse, $482,973) DONALD MORISKY HIV/AIDS Risk Reduction Program for Belizean Adolescents (NIH/Fogarty International Center, $80,640) CHARLOTTE G. NEUMANN Diet Quality Improvement and Child Health and Survival (University of California, Davis, $174,632); Role of Animal Source Foods to Improve Diet Quality and Growth and Cognitive Development in East African Children (University of California, Davis, $155,953) ANNE R. PEBLEY Central American Demographic Research Program (Andrew W. Mellon Foundation, $145,000)

UCLAPUBLIC HEALTH

NADEREH POURAT Medi-Cal Managed Care and STD Practices of Physicians in CA (CA/HHS/Department Of Health Services, $223,139)

CORINNE L. PEEK-ASA Work-Site Intervention to Reduce Work-Related Assault Injury (DHHS/Centers for Disease Control, $401,604)

DAWN M. UPCHURCH Contextual Effects of Adolescent Risk Taking and STD/HIV (NIH/National Institute of Child Health and Human Development, $174,817) STEVEN P. WALLACE Health Data for Advocacy and Technical Assistance Program (California Endowment, $470,955) WENG KEE WONG Efficient Design Strategies in Arthritis Research (NIH/National Institute of Arthritis & Musculoskeletal & Skin Diseases, $112,757) ANTRONETTE KAY YANCEY Community Steps to Minority Youth Fitness (NIH/National Institute of Child Health and Human Development, $251,748) ZUO-FENG ZHANG Cancer Epidemiology Training Program (NIH/National Cancer Institute, $240,119)

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class notes

CHARLES M. GOLDSTEIN, D.D.S., M.P.H. ’67, has been inducted into the USC School of Dentistry Hall of Fame, the highest honor the school bestows on an individual.

He became a member of the school’s part-time faculty in 1959 and returned as the fulltime director of USC’s mobile dental clinic program in 1970, a position he held until 1981. As chair of the school’s Department of Practice Dynamics from 1981 to 1987, Goldstein oversaw the establishment of the curriculum in geriatric dentistry, practice management and ethics. He was instrumental in planning and designing the USC Dental Clinic at the Union Rescue Mission and became the clinic’s first director in 2000.

RICHARD ENOCHS, M.P.H. ’71, DR.P.H. ’77, is chairman of the Health Care Administration program at Tennessee State and Meharry Medical College in Nashville, Tenn. He is in his 15th year as coordinator of the Black History Program at Born Again Church in Nashville. In May, his daughter Regina completed her bachelor’s degree at Tennessee State University, his daughter Renee graduated from Vanderbilt University Law School and Enochs’ wife, Peggy, earned her doctorate in education from Tennessee State.

ELLEN CANEPA BRZYTURA, M.P.H. ’72, is a health consultant with local and national clients, as well as a civic leader in her community of Lakewood, Ohio. With her husband John, an attorney, she has four children, ages 17-24.

MARGARET CARY, M.D., M.P.H. ’74, M.B.A., was appointed senior vice president and medical director for Philadelphia-based Vox Medica, one of the nation’s largest health care communications groups. From 1994 to 2000, she served as regional director, Region VIII, for the U.S. Department of Health and Human Services, with management responsibility for health and social care services in six states. Cary is an expert in health care information technology, and co-author of the recent book Telemedicine and Telehealth: Principles, Policies, Performance, and Pitfalls.

JACK SCHLOSSER, M.P.H. ’74, was hired to cohead the health care services practice in the Los Angeles office of Spencer Stuart, a global consulting firm specializing in senior-level executive search and board director appointments.

Schlosser’s areas of focus for the firm include health systems, physician practice management, non-institutional health care services, hospitals, and managed care. He is a fellow and former regent of the American College of Healthcare Executives, and serves on the UCLA School of Public Health Program in Health Policy and Management Advisory Board.

SAM STUART SNYDER, M.P.H. ’76, PH.D., was named the risk management coordinator for the Los Angeles County Office of Education in December 2000.

GOLETI BALA KRISHNAMURTY, DR.P.H. ’63, died in December 2000 of a brain tumor.

He taught at California State University, Northridge (CSUN) for 31 years and published an innovative book, Statistics, Interactive Text, which was given an Advancement of Teaching Effectiveness award at CSUN. His classes were eagerly sought-after by students.

He had previously worked for USAID in the Office of Health Planning in India, and had short-term assignments for the World Health Organization.

At the time of his death, he was working on rapid literacy in Indian languages.

VERONICA J. SCOTT, M.D., M.P.H. ’78, is associate director for education and evaluation for the VA Tennessee Valley Geriatric Research, Education and Clinical Center in the VA’s VISN 9.

MARY F. VANDENBROUCKE, M.P.H. ’83, has returned to the Washington, D.C. area after working for the past nine years in Bolivia and Peru. She began a four-year fellowship at USAID in February, where she is the regional coordinator for Latin America and the Caribbean, and senior technical advisor in reproductive health in the global bureau. continued on next page

UCLAPUBLIC HEALTH

DANIEL F. FAHEY, M.P.H. ’72, accepted a position as associate professor in the Health Services Administration Program, School of Health Sciences, at California State University, San Bernardino.

class notes

BURTON SOKOLOFF, B.S. ’52, has been retired from his private practice in pediatrics since 1990. In addition to enjoying life with his wife Marilyn (with whom he recently celebrated 50 years of marriage), four children and five grandchildren, he currently serves as a parttime pediatrician in the Los Angeles County Department of Health Services pediatric clinics. In that role, he helps staff the mobile clinics that participate in school health programs at various north San Fernando Valley elementary schools. He is also a milk commissioner for Los Angeles County.

35

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36 continued from previous page CHRIS HAFNER-EATON, M.P.H. ’88, PH.D. ’92, has expanded the perinatal integrated health clinic, Infant Cuisine and Mother Care, that she founded after leaving her Oregon State University faculty position in 1995. The clinic assists families welcoming new additions — pregnancies, births and adoptions — in establishing positive health and nutritional practices, including breastfeeding. Infant Cuisine and Mother Care not only offers lactation consulting, health education and doula services, but also instructs new parents on infant massage, attachment parenting, and child nutrition. Hafner-Eaton has recently published and presented articles on clinical outcomes in breastfeeding, including the treatment of breast yeast and thrush, and is conducting clinical trials on the efficacy of alternative therapies in breastfeeding populations. For more information about Infant Cuisine and Mother Care, she can be reached at drmom@proaxis.com.

UCLAPUBLIC HEALTH

STANTON COPE, PH.D. ’89, was recently promoted to Commander in the U.S. Navy during a ceremony at the Bureau of Medicine and Surgery in Washington, D.C. His career as a military medical entomologist began in 1989 with a first assignment at the Navy Disease Vector Ecology and Control Center in Jacksonville, Fla. In 1992 he moved to the Middle East to head the Medical Zoology Division and the Risk Assessment Branch at the Naval Medical Research Unit No. 3 in Cairo, Egypt. He was reassigned to Pearl Harbor, Haw., in 1994. In 2000 he became executive assistant to the assistant chief for operational medicine and fleet support at the Bureau of Medicine and Surgery in Washington, D.C. With his recent promotion, he is executive officer of the Naval Dental Research Institute in Great Lakes, Ill.

ANN M. DELLINGER, M.P.H., PH.D. ’93, is a medical epidemiologist with the Centers for Disease Control and Prevention. Since 1995, she has served on the Motor Vehicle Injury Prevention Team of the CDC’s National Center for Injury Prevention and Control, which provides national leadership in preventing non-occupational injuries and controlling the severity and impact of intentional and unintentional injuries. Dellinger is conducting several studies, including one that seeks to assess the public health burden of older and younger drivers on other road users and one comparing the functional ability of older persons dying in traffic crashes with those dying from other causes.

CYNTHIA LAKON, M.P.H. ’95, is in her fourth year of a doctoral program at the University of North Carolina-Chapel Hill, Department of Health Behavior and Health Education. She recently received an NIH training grant that will support her dissertation work on social network influences acting on injection drug users in Los Angeles County.

KIVA TURK IVERSON, M.P.H. ’96, M.D., graduated from medical school at Wright State University in Dayton, Ohio, in 2001, and has returned to the Los Angeles area to start a residency in internal medicine at Huntington Memorial Hospital in Pasadena.

MARA BAER, M.P.H. ’01, is a postgraduate fellow with the Presidential Management Internship program in Washington, D.C. Through the program, she will rotate for two years through various governmental entities. She is currently on a four-month rotation with the Department of Health and Human Services, Administration on Aging, Budget Division, where she is focusing on budget and formulation activities.

Subsequent rotations will include the Administration on Aging’s Office of Program Operations and Development, the Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation, and the U.S. Senate.

Please send us an update of your professional or personal activities so that we may include it in a future issue. Photos are welcomed. Also, please let us know if you have a new address.

Mail to: Editor, UCLA Public Health Magazine, Box 951772, Los Angeles, CA 90095-1772; fax to (310) 825-8440; or email to frodic@support.ucla.edu. In addition to your name, please include a telephone number and/or e-mail address so that we may contact you.

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alumni tribute

37

AT AMGEN, the Thousand Oaks, Calif., biotech company where Dora Menchaca (Ph.D. ’86) had worked as associate director of clinical research for the past decade, a memo sent out on Wednesday, Sept. 12, 2001, told part of the story.

“Today we mourn the loss of our colleague and friend,” wrote Amgen CEO Kevin Sharer. “Her passion and belief in doing whatever it takes to help patients and advance science will have a lasting impact.”

Dora Menchaca, who died aboard American Airlines Flight 77, the hijacked plane that crashed into the Pentagon, made a lasting impact on many lives. There were the people she never knew, who benefited from Menchaca’s scientific expertise and devotion to finding and testing new and better treatments for diseases. There were those she knew well, including her devoted family, friends and coworkers, an estimated 2,000 of whom gathered to pay tribute to her at an Amgen memorial service.

And there were those she didn’t know well, but touched anyway with a warm smile, an infectious laugh or a helping hand.

She was born 45 years ago and raised in San Antonio, Texas, where her parents, first-generation Mexican-Americans, were civil servant employees at one of the military bases. The oldest of six children, Dora was the first in her family to attend college (three siblings would follow suit). After graduating from Notre Dame with a degree in biology, she enrolled in the M.P.H. program at the University of North Carolina. From there, she went on to earn her doctorate in the Department of Epidemiology at the UCLA School of Public Health.

“In addition to doing a fine dissertation, Dora was very lively, just a good person to have around in the department,” remembers Dr. Lawrence Ash, professor of epidemiology, who was on Menchaca’s doctoral committee. Glenda Baker, director of student affairs at the time, says Menchaca “had a smile for everyone.”

During a difficult period in which a new computer system was bogging down the enrollment process, Menchaca and two other students took it upon themselves to volunteer in the student affairs office. “There are a few students over the years whom I really considered friends,” says Baker. “Dora was one of those who stood out.”

She certainly stood out to Earl Dorsey, an M.P.H. student at the time. “I was attracted to her warmth and her great sense of humor,” he says.

“She was just a very fun person, a very generous person.” They met at the School in 1981 and married two years later.

At Amgen, where Menchaca designed, monitored and interpreted data from clinical trials, colleagues spoke of her rare blend of scientific know-how, administrative abilities, and people skills.

Dorsey believes science was the ideal profession for his wife, combining an intellectual challenge with the opportunity to make a difference in individuals’ lives.

“The fact that through good science she could find ways to help people is what motivated Dora,” he says. Her public health efforts went beyond her job description. While immersed in a trial on a new prostate cancer drug, Menchaca urged all of her male co-workers to get screened for the disease.

She also prevailed upon her husband to get checked, and that may have saved his life. Earl Dorsey was found to have early-stage prostate cancer, which was successfully treated.

Menchaca was proud of her Mexican-American heritage and frequently visited schools, where she would encourage girls, particularly minorities, to consider careers in science. “She was very caring,” says John Menchaca, Dora’s brother. “She was always doing things to help people, even people she barely knew.” But more than anything, John Menchaca says, his sister loved her family — she and Dorsey had two children: daughter Imani, 18, a student at the University of Portland; and son Jaryd, who was 4 at the time of his mother’s death.

It was a desire to spend time with her family that led Menchaca to book a last-minute seat on Flight 77. She had left for Washington, D.C. on Sunday for two days of meetings in which she briefed Food and Drug Administration officials on a new prostate cancer drug. The meetings ended late Monday, a day earlier than expected. Early Tuesday morning, Dora left a message on her husband’s cell phone, an update on her travel plans.

“She told him she wanted to get home,” says John Menchaca. “She said she wanted to play in her garden and spend time with her family.”

alumni tribute

Dora Menchaca Touched Countless Lives Through Her Science and Caring

UCLAPUBLIC HEALTH

SPH Mag.OCT 01.cvr2

11/29/01

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Save the

DATE

The annual

BRESLOW LECTURE AND DINNER

will be held at 6 p.m. on April 1, 2002 at Covel Commons.

This yearâ&#x20AC;&#x2122;s guest speaker is Donna Shalala, Ph.D., President of the University of Miami and former Secretary of the U.S. Department of Health and Human Services during the Clinton Administration.

For more information, please call (310) 825-6464.

UCLA

PUBLIC HEALTH School of Public Health Box 951772 Los Angeles, California 90095-1772 www.ph.ucla.edu Address Correction Requested

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UCLA