UCLA Public Health Magazine - June 2004

June04.cvr.FINAL

6/7/04

11:17 AM

Page 2

JUNE 2004

UCLA

PUBLIC HEALTH

UCLA

Is living in the U.S. hazardous to immigrants’ health?

School of

Public Health

Obesity is on the rise, even as much of the world’s population goes hungry. Charlotte Neumann and her school colleagues tackle nutrition from both sides.

Lester Breslow sounded early warnings about tobacco, chronic diseases and harmful habits.

Now he’s talking about a new era of health.

Taraneh Salke traveled far as an M.P.H. student to learn about reproductive health and family planning in developing countries.

SPHmag.June04.2-19

6/7/04

11:20 AM

Page 1

UCLA

PUBLIC HEALTH

Albert Carnesale, Ph.D. Chancellor

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

Sarah Anderson Assistant Dean for Communications

Julie Tisdale Pardi, M.A. Senior Editor

fe a t u r e s

1

Dan Gordon Editor and Writer

Martha Widmann Art Director

E D I TO R I A L B OA R D Richard Ambrose, Ph.D. Associate Professor, Environmental Health Sciences

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

F. A. Hagigi, Dr.P.H., M.B.A. Associate Professor, Health Services

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

Ralph Frerichs, D.V.M., Dr.P.H. Professor, Epidemiology

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

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

Thomas Cruz, Genus Heidary Co-Presidents, Public Health Student Association

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

UCLA

Past President, Alumni Association

School of

Public Health

4

Feast & Famished In a world where malnourishment coexists with super-sized portions, healthful eating is all too rare.

10

Lester Breslow: Still Setting the Pace With a track record for prescience dating back to the Second World War, the dean emeritus and public health pioneer continues to command attention.

SPHmag.June04.2-19

6/7/04

11:20 AM

Page 2

21st Century Challenge: Educating the Public Health Workforce

Promoting the Health of Immigrants

12

in every issue 23 RESEARCH

18

Alumni Hall of Fame:

Post-treatment symptoms for breast cancer patients…bullies and selfesteem…concerns about MTBE alternatives…benefits of mental health services… air pollution and SARS… adolescents and gun access.

20

28 STUDENTS

the 2004 Inductees They face language and cultural gaps, unhealthy environments and difficulties in accessing services.

Staying in good health can be a challenge.

31 FACULTY 32 NEWS BRIEFS 34 FRIENDS ON THE COVER Immigrants tend to arrive in this country in better health than native-born Americans of comparable socioeconomic status, but soon decline to the point that their health, on average, begins to reflect that of their adopted community. Why is this happening and what can be done?

Cover photo/illustration by Martha Widmann. Images sourced from: 2004 © Getty Images.

PHOTOGRAPHY Reed Hutchinson / Cover: Neumann; TOC: nutrition, Breslow; pp. 2, 7, 9, 10; p. 14: Ponce; p. 28, p. 32: Pendleton; p. 33:Yancey

ASUCLA / Cover: Breslow; TOC: Alumni Hall of Fame; pp. 18, 19; pp. 34-37 Yvette Roman / p. 5; p. 14: Venice Family Clinic waiting room Courtesy of Tananeh Salke / cover; p. 29 Courtesy of Gail Harrison / p. 4 Courtesy of Osman Galal / p. 6 Courtesy of Charlotte Neumann / p. 8 Courtesy of Annette Maxwell / p. 15 Courtesy of UCLA-LOSH program / p. 16 Courtesy of Koy Parada / p. 17 Courtesy of Marjorie Kagawa-Singer / p. 17 Courtesy of Wendy Hunter / p. 21 Courtesy of the UCLA School of Public Health / p. 12: Hayes-Bautista; p. 31: Ganz; p. 33: Bastani Courtesy of Latino Health Access / back cover Courtesy of UCLA Center for Public Health and Disasters / TOC: workforce; p. 22; p. 32: workbook cover Courtesy of Orange County Asian & Pacific Islander Community Alliance, Susan Lee / TOC: immigrants Getty Images © 2004 / p. 4: vegetables; pp. 24, 27; p. 32: asthma

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 2004 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.

SPHmag.June04.2-19

6/7/04

11:24 AM

Page 3

2

dean’s message Is the United States hazardous to immigrants’ health?

THE ANSWER, in some ways, is yes. Studies show that immigrants come here in generally better health than U.S.-born individuals in their age, income and educational groups, but lose that advantage in a short time due to a number of barriers they face to maintaining good health.

This issue’s cover story (see page 12) highlights several ongoing programs aimed at identifying, treating and, most importantly, preventing health risks in immigrant communities. Additional vulnerabilities are explored, including the preponderance of immigrants who work in high-risk jobs and the likelihood that they will lack health insurance. The lessons learned are that as our nation continues to undergo significant changes in our population, public health professionals must be able to understand and incorporate the needs and perspectives of culturally diverse communities.

As a school of public health, we have an obligation to ensure that the research we conduct and the education we provide adequately address the burgeoning health care challenges. To that end, I’m pleased to announce the creation of the Center to Eliminate Health Disparities (see page 33). Made possible by seed support from The California Endowment, Ralph and Shirley Shapiro and Dean’s Advisory Board members Linnae Anderson and Tom Epley, the center will concentrate on keeping the public healthy by targeting health promotion and disease prevention as well as access to timely and high-quality care for those who are ill. The center will also explore the barriers preventing more effective collaboration with local health departments and other key partners engaged in the practice of

UCLAPUBLIC HEALTH

public health.

To support the development of exciting new projects like this center, the school has devoted more attention to our capital campaign. In the last four years

SPHmag.June04.2-19

6/7/04

11:24 AM

Page 4

3

we have nearly doubled our annual expenditures thanks in large part to the increasing success of our faculty in obtaining extramural support, and this year we raised twice as much for the annual fund due to the generosity of individual donors. One of our top fundraising priorities is scholarships for students.

Providing financial assistance enables us to recruit and retain the best and brightest public health students.

With applications to our school up 10 percent for the second year in a row, admission is more competitive than ever, encouraging an even more selective application process. We continue to be among the most diverse schools of public health in the United States. Twenty percent of our students come from countries outside the United States, and nearly half of our students are racial and ethnic minorities. These data reflect the school’s commitment to training a diverse public health workforce.

Finally, I’m pleased to announce our Commencement speaker, Dr. America Bracho. Dr. Bracho is the executive director of Latino Health Access, a center for health promotion and disease prevention located in Santa Ana, Calif. The center was created under her leadership to assist with the multiple health needs of Latinos in Orange County. With the challenges outlined above and elsewhere in the magazine, I can think of no one better to deliver the address.

We in the public health field have the amazing privilege of knowing that our work makes a tangible difference on a local, national and international level. I am

2003-2004 DEAN’S A DV I S O RY B OA R D Ira R. Alpert* Linnae Anderson Diana Bontá* Lester Breslow Sanford R. Climan Edward A. Dauer Michele DiLorenzo Robert J. Drabkin Tom Epley Gerald Factor (Vice Chair) Michael R. Gardner Robert W. Gillespie Alan Hopkins* Stephen W. Kahane* Carolyn Katzin* (Chair) Carolbeth Korn* Jacqueline B. Kosecoff Kenneth E. Lee* Richard D. Lipeles* Edward J. O’Neill* Walter Oppenheimer Monica Salinas David Walker Fred Wasserman*

*SPH Alumni

excited about the opportunities awaiting our new graduates as they enter the field, and am confident in their abilities to do great things.

Linda Rosenstock, M.D., M.P.H. Dean TOTA L E X P E N D I T U R E S Grants and Contracts State-Generated Funds Gifts and Other Fiscal Year 02-03 $40.4 million

UCLAPUBLIC HEALTH

SPHmag.June04.2-19

6/7/04

11:25 AM

Page 5

4 IN

A WORLD WHERE

MALNOURISHMENT COEXISTS WITH SUPER - SIZED PORTIONS , HEALTHFUL EATING IS ALL TOO RARE .

FEAST& FAMISHED

Fighting the Twin Scourges of Obesity and Hunger You would be hard-pressed these days to find a public health concern as far-reaching as nutrition, with both malnourishment and obesity wreaking havoc with huge portions of the world’s population.

“The problems are big enough that unless the entire public health community puts some effort into it from the standpoint of whatever their expertise is, it’s going to be hard to make progress.”

UCLAPUBLIC HEALTH

—Dr. Gail Harrison

In the United States, poor diet and lack of physical activity could soon overtake smoking as the leading cause of death, according to an analysis published in the March 10 Journal of the American Medical Association. Of the top 20 risk factors contributing to disability and premature death around the world, nine – underweight, alcohol, cholesterol, iron deficiency, overweight, zinc deficiency, low fruit and vegetable intake, vitamin A deficiency, and physical inactivity – are nutrition-related, according to the World Health Organization’s World Health Report 2002.

“Even small changes in overweight prevalence make a tremendous difference, given how many people are affected,” says Dr. Gail Harrison, professor and vice chair of the school’s Department of Community Health Sciences.

“And something like an economic crisis in Asia or a drought in sub-Saharan Africa drives huge amounts of disability and mortality.”

At the UCLA School of Public Health, faculty and students study nutrition both at home and abroad, tackling very different concerns. “In the United States and other developed countries, we have solved, or at least controlled, many nutritional problems with food fortification and enrichment,” says Harrison.

“With the exception of universal salt iodization, most developing countries have not done that – for many of them it’s not even on the radar screen – so other

SPHmag.June04.2-19

6/7/04

11:25 AM

Page 6

5

Yancey is working locally with the CDC-funded Racial and Ethnic Approaches to Community Health (REACH 2010) project, which has hired and trained individuals from the community to document the quality and variety of healthy food options available in low-income neighborhoods.

Among other things, her group has found that stores in low-income communities offer half the variety of fruits and vegetables as those in affluent communities and that, on average, the quality of produce on the shelves in low-income neighborhoods is significantly worse. These neighborhoods also tend to have fewer supermarkets per capita, and a higher proportion of fast-food restaurants. Exacerbating matters are print, billboard and broadcast advertisements for unhealthy foods and beverages – often

Dr. Antronette Yancey’s “Community Steps to Minority Youth Fitness” brings increased physical activity and education about healthier diet to middle-school children.

UCLAPUBLIC HEALTH

Even in the United States, a significant number of people go hungry. Using data from the 2001 California Health Interview Survey (CHIS 2001), based in the school’s Center for Health Policy Research, Harrison found that more than 2.24 million low-income adults in California can’t always afford to put food on the table and, as a result, nearly one-third of them experience episodes of hunger. Further, being food insecure makes adults less likely to properly manage a chronic condition such as diabetes, asthma, hypertension or heart disease, with high probability of failing to fill prescriptions for needed medicines and not following up on medical care referrals.

But the phenomenon attracting more attention and concern in this country is the dramatic rise in obesity. Approximately 59 million U.S. adults are obese, according to the Centers for Disease Control and Prevention – up more than 60 percent in just 10 years. Since 1980, obesity rates have doubled among children and tripled among adolescents. More than one in seven young people ages 6-19 is obese.

“The public health community was slow in reacting to this trend, partly because there isn’t an easy technical fix,” says Harrison.

Given the disappointing success rates of curative approaches to obesity, public health has shifted the focus to prevention, hoping to establish environments more conducive to physical activity and healthy eating. On both counts, Harrison notes, there is plenty of room for improvement. “We’re eating out more, and super-sized portions have become a cultural value,” she says. “Meanwhile, you have to look at the fact that if you hide the stairwells inside buildings, people aren’t going to take the stairs. If there are no sidewalks, people aren’t going to find it easy to walk. If there aren’t any safe places to play soccer, kids aren’t going to be outside kicking a ball.”

Mindful that individual choices with regard to nutrition are heavily influenced by one’s environment, another member of the school’s faculty, Dr. Antronette Yancey, has focused on changing

organizational policies and practices. She helped the state Department of Health Services prepare its report promoting better eating choices and physical activities in the workplace. Yancey is also working with organizations to begin incorporating healthy refreshments into their activities. “If it’s a work site that has a meeting in which refreshments are provided, we want to make sure that fruits are offered in addition to, or instead of, pastries; that water is available rather than just soda; and that if a meal is involved, there is a salad or other vegetables and lean protein sources,” she explains.

feature

ways of dealing with malnutrition problems have to be considered.” An ominous trend is the emerging burden of obesity in developing countries, threatening to unleash an epidemic of chronic diseases such as diabetes, cancer and heart disease that are well known to the developed world. “It’s not unusual to see malnourished children in the same household as obese adults, because the causative pathways are different,” says Harrison.

SPHmag.June04.2-19

6/7/04

11:25 AM

Page 7

6 used for comfort during times of stress, Yancey notes – targeted at low-income communities.

“All of these issues are gaining traction, especially because of the childhood obesity epidemic,” Yancey says. “People recognize that when it comes to children, to the extent that we abdicate our responsibility for providing nutritious foods in schools or after-school programs, we’re contributing to the problem.”

UCLAPUBLIC HEALTH

Scholars from 13 countries attended “School Children: Health and Nutrition,” a conference at the UCLA School of Public Health organized

by Drs. Charlotte Neumann (seated, second from left) and Osman Galal (seated, far right).

The importance of targeting children has driven several nutrition-related activities of the school’s faculty. In February, an international workshop, “School Children: Health and Nutrition,” drew approximately 50 scholars from 13 countries to the UCLA School of Public Health. The conference, organized by Drs. Charlotte Neumann and Osman Galal with support from the UCLA International Institute, brought together experts from the fields of economics, education and public health to explore the effects of malnutrition on educational outcomes in the developing world and to recommend intervention strategies.

“Although common sense tells us that poor health, particularly malnutrition, contributes to poor school performance, and although there is a substantial body of literature backing up this common sense, there has not been adequate research on the subject, nor adequate dissemination and application of the research that has been done, in terms of policies and programs to combat ill health and malnutrition among school-age children,” explains Galal, who also serves as secretary general of the International Union of Nutritional Sciences. As a follow-up to the conference, attendees are preparing documents on the evidence of the link between

nutrition and school performance for policy makers in developing countries as well as for international organizations such as the World Bank, WHO, UNICEF and UNESCO. Both Neumann and Galal are urging ministries of education to take responsibility for school feeding rather than relegating this critical input into education to other ministries.

For several years, a team that includes Neumann and faculty colleagues Drs. Michael Prelip and Wendelin Slusser have worked with the Los Angeles Unified School District on projects designed to foster healthier environments in disadvantaged schools. In one project, they are evaluating the educational programs and activities the district has established through the California Nutrition Network, a state initiative funded by the U.S. Department of Agriculture. A second, funded by the CDC and initiated by Neumann, Prelip, Slusser, and project director Stephanie Vecchiarelli, is called Nutrition-Friendly Schools and Communities.

Inspired by the WHO/UNICEF program that designates hospitals meeting certain criteria as “baby friendly,” and based on the Coordinated School Health Model, the research project is examining the impact of an intervention in eight elementary schools in low-income Hollywood and East Los Angeles communities. The faculty team developed criteria for nutrition-friendly schools – including those that have undertaken efforts such as reining in junk food, adding salad bars, promoting physical activity, integrating nutrition into the classroom curriculum, and actively engaging teachers, staff, and parents in the process of changing the school environment. The schools have instituted wellness programs and offered cooking and yoga for parents and staff, worked with local parks to create recreational

SPHmag.June04.2-19

6/7/04

11:25 AM

Page 8

Preparing Future Leaders: Students, Postdocs Receive Valuable Training 7

DENA HERMAN — A postdoctoral fellow in the

School of Public Health-based Division of Cancer Prevention and Control Research, Herman’s focus has been on changing the food package offered by the Women, Infants, and Children (WIC) program to include fresh fruits and vegetables. Herman initially studied food security and dietary quality among the WIC population, which is at increased risk for obesity and cancer; a follow-up intervention project gave postpartum women and their families certificates to buy fruits and vegetables. The intervention was designed to show policy makers that if provided with the financial means to do so, a low-income population will purchase fruits and vegetables – which tend to be more expensive than other, less healthy foods – and include them in their diet.

The U.S. Department of Agriculture is currently considering a change in the WIC food package, and Herman hopes data from her project will help to inform the decision.

LOAN PHAM — Pham, who has a master’s degree in

nutrition and is a registered dietitian, enrolled in the school’s doctoral program last fall after having spent several years on a Berkeley, Calif.-based project to develop a series of nutrition booklets that are culturally and linguistically tailored to the Vietnamese community. Her main interest is in cancer prevention through diet and lifestyle. A Vietnamese American with bilingual language skills, Pham has observed in her work that Vietnamese immigrants tend, over time, to transition away from the diet of their native country, which is high in fruits and

feature

Students and postdoctoral fellows receive training to become leaders in the nutrition field through several UCLA School of Public Health programs (see page 9), pursuing a variety of important interests.

Future leaders include: vegetables and low in saturated and total fat. She plans to use her doctorate to facilitate communitybased work aimed at promoting maintenance of the traditional diet in this population.

CONSTANCE GEWA —

While working toward her M.S. in applied human nutrition at the University of Nairobi in Kenya, Gewa met Dr. Charlotte Neumann, professor at the UCLA School of Public Health, who has conducted research in Kenya for more than two decades.

Gewa was in charge of food intake measurement and served as field coordinator on Neumann’s study of the effects of animal-source foods on the growth and cognitive development of children; Neumann told her about the UCLA program, and Gewa is now a doctoral student at the school. “This is helping me to expand my horizons so that I can focus on nutrition through a larger paradigm of health and social issues,” she says. Once she receives her doctorate, Gewa hopes to return to her native country to teach and conduct research focused on improving the nutritional status of communities.

Once she completes her doctoral education, Constance Gewa (right, with Dr. Charlotte Neumann) plans to apply it to improving the nutritional status of communities in her home country of Kenya.

programs for kids, and introduced SPARK, a San Diego-based program that trains teachers to be better physical education instructors.

“The idea is to teach kids, staff and parents about the importance of making better food choices and being physically active, and then provide them with the opportunity to act on those choices,” says Prelip. “It’s important to change not just the schools but the communities as a whole, so that kids can continue to make the right choices when the school day is over, and so they have adult role models who are doing the same thing.”

UCLAPUBLIC HEALTH

Neumann, who has conducted nutritional studies in Kenya as well as other parts of Africa for more than 20 years, focuses on very different problems when she is overseas.

Working mostly with researchers at the University of Nairobi and Kenyan government agencies, Neumann found in observational studies that a high proportion of the nation’s school children are lacking in the vitamins, minerals, and

SPHmag.June04.2-19

6/7/04

11:25 AM

Page 9

8

With a small amount of animal-source food added to the local diet, “kids went from being sluggish in the classroom to being quite active and animated.”

—Dr. Charlotte Neumann

UCLAPUBLIC HEALTH

In rural Kenya, Dr. Charlotte Neumann and colleagues from the University of Nairobi have studied the health, energy and cognitive impacts of giving meat to school children who normally have little or no access to it.

energy they need for adequate functioning, learning and growth. The same studies provided hints that adding small amounts of meat to the diet of both children and adults in the population – much of which eats little or no animal products due to issues of affordability and accessibility – makes a significant difference in their health, energy levels and cognitive function. So Neumann and her Kenyan colleagues sought and received funding for a randomized controlled study of more than 9,000 school children in rural Kenya to determine the impact of adding a small amount of animal-source food to the local diet through a school snack.

Neumann and colleagues are continuing to analyze the data, but have already reported that children in the group receiving a small amount of meat increased their cognitive function and physical activity levels at higher rates than the other children in the study, and showed more initiative and leadership during periods of free play. “It was a significant difference – kids went from being sluggish in the classroom to being quite active and animated,” Neumann says. The children in the meat group also showed increased muscle mass and increases in vitamin B12, which is important for blood formation and brain function and development.

In sub-Saharan Africa, malnutrition has worsened in the last decade due to factors such as drought, civil strife and HIV/AIDS, which has decimated several countries economically as well as socially – all adding to the immense burdens facing a poverty-stricken region. But Neumann believes that relatively simple public health interventions such as the one used by her group can still make a significant impact. “Of course, if we were able to end wars, reduce debt repayment and eliminate HIV we could make a huge difference, but in the meantime there is much that can be done on a household and community level,” she says.

While daunting challenges remain, there are many examples of public health successes in tackling nutrition concerns. In the United States, the federal Women, Infants, and Children (WIC) program, designed to provide nutritious foods, information on healthy eating, and health care referrals for low-income

SPHmag.June04.2-19

6/7/04

11:26 AM

Page 10

9

feature In the NutritionFriendly Schools and Communities project, faculty at the UCLA School of Public Health are studying the impact of an intervention in eight elementary schools in low-income parts of Los Angeles. Among the many activities is a cooking class for parents.

Through several programs that support students, the school is helping to train the next generation of public health leaders in the nutrition arena, both in the United States and abroad (see the sidebar on page 7). UCLA’s is one of three public health schools in the country to have a Maternal-Child Health Nutrition Leadership Training Program, funded by the federal Bureau of Maternal and Child Health. The program, directed by Dr. Marion Taylor Baer, prepares registered dietitians to assume leadership roles in public health. Through the generosity of a private donor, the school provides fellowship support for additional doctoral students who are nutritionists, both domestic and international.

A joint program with the West Los Angeles VA Medical Center supports a half-dozen M.P.H. students each year who also receive clinical training in dietetics. The Center for Human Nutrition, directed by Dr. David Heber, is a joint effort of UCLA’s schools of public health and medicine bringing together faculty, postdoctoral research fellows, and graduate students to focus on the roles of nutrition and food in human health and disease.

Harrison points out that improving nutrition at home and abroad will take the efforts of far more personnel than the public health academics and professionals devoted entirely to the field. “My motto is always to try to make nutritionists out of everybody I see,” she says, “because the problems are big enough that unless the entire public health and medical community puts some effort into it from the standpoint of whatever their expertise is, it’s going to be hard to make progress.”

UCLAPUBLIC HEALTH

women, infants and children considered to be at nutritional risk, has consistently proven be an investment that saves money in intensive care costs, improves dietary quality, and increases the likelihood that children will have a usual source of medical care. Globally, perhaps the biggest success story is salt iodization. Even mild levels of iodine deficiency can cause cognitive defects; more significant deficiencies are associated with mental retardation.

Nearly every country has taken measures to fortify its salt supply with iodine, resulting in dramatic improvements in human capital and quality of life.

Where other types of supplementation are not in the offing, different strategies can be employed.

With support from the school’s Bixby Program in Population & Reproductive Health, Harrison has launched an effort in the Middle East to increase the number of women who take folic acid supplementation around the time of conception. Potentially, 60-70 percent of the major birth defects can be prevented with adequate folic acid intake, but supplementation as part of prenatal care comes too late, Harrison notes. While developed nations such as the United States have fortified the food supply to ensure a higher level of intake in the general population, other strategies are needed in poorer countries.

Harrison’s project, with Dr. Michael Lu, is analyzing the maternal health care systems of several countries to find ideal opportunities to introduce folic acid supplementation to women who are at high risk of becoming pregnant.

SPHmag.June04.2-19

6/7/04

11:26 AM

Page 11

10 W ITH

A

TRACK RECORD FOR PRESCIENCE DATING BACK TO THE

S ECOND

W ORLD W AR , THE DEAN EMERITUS AND PUBLIC HEALTH PIONEER CONTINUES TO COMMAND ATTENTION .

Lester Breslow:

Still Setting the Pace

Lester Breslow has been explaining

why he believes we

are at the dawn of the third revolution in health, and any time this leading public health figure of the last

UCLAPUBLIC HEALTH

half-century articulates his vision in his distinctly clear, authoritative manner, you pay close attention.

It’s not just Breslow’s knack for thoughtful discourse that compels you to listen; it’s also his long track record for being ahead of his time, dating at least as far back as the 1940s, when he linked tobacco use to disease in three studies that were later cited in the U.S. Surgeon General’s landmark 1964 report.

His record of public health leadership at the local, state, national and international levels is unparalleled.

Breslow has served as president of the International Epidemiological Association (1967-68), president of the American Public Health Association (1968-69), and president of the American Schools of Public Health (1973-75). He was a member of the Tobacco Education Oversight Committee for the State of California (1990-96) and has served since 1995 as a commissioner on the Los Angeles County Public Health Commission. He was founding editor of the Annual Review of Public Health (1978-1990) and editor-in-chief of the first-ever Encyclopedia of Public Health, a four-volume set, published in 2001, that has found worldwide use. He was California’s director of public health (1965-68) and dean of the UCLA School of Public Health (1972-80).

In April, a month after turning 89, Breslow for the first time was the featured speaker at the annual lecture and dinner established in his name at the school 30 years ago, when he was dean. His characteristically forward-looking topic: “The Third Revolution in Health: Implications for Public Health.”

The first revolution, Breslow says, was marked by the successful fight against communicable diseases.

“It began in the 19th century and is continuing, by no means complete,” he notes. “We haven’t wiped out tuberculosis and a lot of other important communicable diseases in this country and around the world, and new ones are arising. But we’ve made substantial progress.”

SPHmag.June04.2-19

6/7/04

11:26 AM

Page 12

11

“People are now living into their 70s, 80s, 90s...we even have centenarians.

Increasingly, they’re concerned not as much with avoiding particular diseases as with preserving the capacity to do the things they want to do.”

—Dr. Lester Breslow

UCLAPUBLIC HEALTH

vide me with good nutrition,” Breslow says. “And then, having in my early 20s gotten an orientation to public health, I’ve been aware of things and have tried to incorporate them into my own life.”

Several years ago, Breslow suffered a severe heart attack. “People always ask me, ‘Why, if you’re so smart, did you have a heart attack?’ ” Breslow says. “My answer is that when I was growing up, we didn’t know much about how to prevent them. So my mother gave me a lot of butter and cream and whole milk, as well as plenty of meat. I was probably, for most of my life, carrying a pretty good lipid level. I’ve also had a sedentary situation. I never had to work hard, physically. And we didn’t appreciate the importance of exercise until recent years.”

The newfound appreciation owes much to Breslow’s own research, most notably the Alameda County studies he launched in the early 1960s as a member of the California Department of Health Services, which he would later direct. He found, among other things, that a 45-year-old male who followed six of seven healthy habits identified in the study – getting regular exercise and sleep; not smoking, excessively drinking, or snacking between meals; eating breakfast; and maintaining a normal weight – had a life expectancy 11 years longer than a peer who followed three or fewer, and had betterquality years to boot.

Such a result might be dismissed as obvious today, but at the time, making a connection between lifestyle and health was seen as “bizarre,” says Breslow, who remembers that the initial response to his study proposal by a panel of National Institutes of Health scientists had been “unanimous rejection.”

It wasn’t the first time Breslow was ahead of the curve. After completing his service in World War II, he approached California’s director of public health with a proposal to start a chronic disease program in the state. Breslow, who had previously worked as a local health officer for the Minnesota Health Department, now saw that while communicable diseases were declining, heart disease, cancer and stroke had emerged as leading causes of death and should become the focus of public health attention. Breslow recalls that the California state health officer told him to “go back to Minnesota and try those ideas out there.”

Ultimately, others in the department viewed it differently and Breslow was appointed to head a new chronic disease bureau in the state. And so he helped to usher public health into the “second revolution.” Today, mindful of the prescience that has marked his career, anyone on the receiving end of Breslow’s description of the third does well to listen.

faculty profile

By the middle of the 20th century, with the reduction in communicable diseases resulting in longer life expectancies, the focus began to shift to chronic conditions – from arthritis and hypertension to cancer and heart disease. “At the time, some people thought these were simply manifestations of senescence – ‘If you reach 70 or 80, what do you expect?’ ” Breslow recalls. But some epidemiologists, Breslow among them, sought to learn more about the causes. As risk factors and prevention strategies have been identified, developed nations have made remarkable headway against the leading killers.

“Heart disease has come down dramatically and, since 1990, so has cancer, though many people don’t realize it,” Breslow says.

Which brings us to what Breslow calls the third revolution. “We’ve covered communicable and noncommunicable diseases, so what’s left?” he asks, smiling. “I would say health is what’s left.” The third era is not just about combating disease, he contends; it’s about achieving health. Breslow’s preferred definition of health is the one advanced by the oft-cited Ottawa Charter, a World Health Organization document resulting from the First International Conference on Health Promotion in Ottawa, Canada in 1986.

“It said health is a resource for everyday life,” Breslow explains. “It’s the capacity for doing what you want to do – to climb a mountain, to go to the opera, to play bridge…” These and other activities of daily living require different types of competence, he notes – anatomical, physiological, chemical, sensory, and mental, all part of good health.

“People are now living into their 70s, 80s, 90s… we even have centenarians,” Breslow says. “Increasingly, they’re concerned not as much with avoiding particular diseases as with preserving the capacity to do the things they want to do.” Public health, while continuing to fight communicable and chronic diseases, must recognize the importance of this third era and its role in promoting health as it is now being defined. “We’re already doing some of these things,” Breslow says. “The third revolution will simply make them more comprehensive and coherent.”

That he continues to command a rapt audience while spelling out his vision for the profession he’s helped steer for more than six decades attests to the role public health has played in Breslow’s own life.

At 89, his mental acuity remains the envy of people half his age. Near the end of his ninth decade, he shows up for work each day, avidly maintains his fruit and vegetable garden and walks 12-15 miles a week with his wife, Devra.

“I was fortunate to be born in this country, and to be raised by parents who had the means to pro-

SPHmag.June04.2-19

12

6/7/04

T HEY

11:27 AM

Page 13

FACE

LANGUAGE AND CULTURAL GAPS , UNHEALTHY ENVIRONMENTS AND DIFFICULTIES IN ACCESSING SERVICES .

S TAYING

IN GOOD

HEALTH CAN BE A CHALLENGE .

Promoting the Health of Immigrants Formidable Barriers Often Stand in the Way Could immigrating to the United States be hazardous to one’s health? It’s a question raised by considerable evidence that immigrants tend to arrive in this country with better health indicators in some areas than native-born Americans of comparable socioeconomic status, only to see their health decline as they gradually take on the less healthy lifestyles that

“They’re

UCLAPUBLIC HEALTH

bombarded with images telling them this is the way to do things – we eat fast food, we have super-sized portions – and it’s hard to resist that.”

—Dr. David Hayes-Bautista

prevail in their new places of residence.

“Immigrants and their children tend to adopt the health-related behaviors of their new communities,” says Dr. E. Richard Brown, professor of community health sciences and director of the UCLA Center for Health Policy Research, based in the School of Public Health. “All too often, that means increased consumption of fast food, diets higher in fat and lower in fruits and vegetables, less exercise, more time in front of the television, and increased smoking and drinking.”

The most striking illustration of this pattern can be found in data on birth outcomes among low-income Latinas with little education. Dr. David Hayes-

SPHmag.June04.2-19

6/7/04

11:27 AM

Page 14

13

cover story

Guadalupe Gonzalez, M.P.H. ’88, Ph.D.

Bautista, professor in the schools of medicine and public health and director of UCLA’s Center for the Study of Latino Health and Culture, found that Latina mothers who are recent immigrants from El Salvador and other Central and South American countries and are now living in California give birth to significantly healthier babies than would be predicted by their access to health care and education levels – and healthier than those of better-educated U.S.-born Latinas.

“The classic assimilation model holds that as these women gain in income and education, their health should improve, but that’s not what we see,” says Hayes-Bautista. “Compared to U.S.-born Latinas, these immigrant women are less likely to smoke, drink, do drugs, or engage in risky sexual behavior. One has to wonder, at what cost acculturation?”

UCLAPUBLIC HEALTH

The so-called Hispanic epidemiologic paradox, in which Latinos in the United States show similar or lower mortality rates than non-Hispanic whites despite being at a social and economic disadvantage,

is magnified in immigrant populations, HayesBautista notes. For reasons that are not entirely clear, Latinos have lower rates of mortality from heart disease, cancer and stroke, and longer life expectancy by five years, than non-Hispanic whites.

But despite starting at an advantage, Latino and other immigrant groups face considerable impediments to maintaining their good health.

In addition to adopting the unhealthy behaviors of their community through assimilation, they encounter barriers to their ability to access quality health care. “Opportunities for employment are limited for immigrants who are not well educated and don’t speak English, and who may also face immigration-related restrictions or fears that further limit the kinds of jobs they can get,” says Brown.

“As a result, many end up with lower-skilled jobs that pay badly and don’t provide the health insurance that would give them access to services like preventive screenings, early identification and management of chronic diseases, and counseling on health behaviors.”

Studies have shown that even legal immigrants who can’t afford private health insurance but qualify for public programs such as California’s Healthy Families or Medi-Cal don’t always enroll, partly because of concerns that it might be held against them when they apply for citizenship or come up for renewal of their green-card status, Brown explains. Politically charged discussions and backand-forth policy changes around welfare reform and California’s Proposition 187 (the 1994 initiative designed to curb social services to illegal immigrants) have added to the confusion and exacerbated fears, he says. “We need to systematically remove barriers to immigrants getting covered in our public programs and seeking services,” Brown asserts.

A postdoctoral research fellow in the UCLA Jonsson Cancer Center’s Division of Cancer Prevention and Control Research, based in the school, Gonzalez holds a doctorate in counseling psychology as well as an M.P.H. Her postdoctoral research has focused on cancer prevention and control issues as they relate to underserved immigrant populations. In particular, she has been interested in understudied subgroups such as Latino migrant farm workers and their families.

Gonzalez is currently working with her faculty mentor, Dr. Roshan Bastani, on development of a pilot study to assess factors that influence participation in cancer screening behaviors among the farm worker population.

“The goal is to understand the life circumstances and experiences of farm workers and how these shape their health behaviors,” she explains. Last year, Gonzalez completed a study with Bastani assessing the social support networks and health beliefs among Latinas diagnosed with a breast abnormality suspicious for breast cancer. The study’s results have been accepted for publication and are in press.

SPHmag.June04.2-19

6/7/04

11:27 AM

Page 15

14 The health care system tends to be complicated to navigate, particularly for people who haven’t been in the country long.

“There have been few populationbased studies looking at how [linguistic and cultural] gaps impede access or affect health status.”

UCLAPUBLIC HEALTH

—Dr. Ninez Ponce

Certain segments of the immigrant population face particular burdens when it comes to access.

Many elderly persons immigrate to the United States to provide care for their grandchildren so that both parents can work, notes Dr. Steven Wallace, professor of community health sciences.

In addition to the difficulties in adjusting to an unfamiliar society, they are unable to qualify for Medicare, which requires that an individual or his or her spouse have 10 years of social securitycovered employment. Though these individuals might qualify for Medi-Cal, Wallace has found that older immigrants are generally no more likely than non-immigrants with similiar incomes to seek public assistance.

When they do have health insurance, immigrants often live in areas with few health care facilities and providers, notes Hayes-Bautista. He points out that the problem is particularly acute for Latino immigrants because of the shortage of Latino providers, who are far more likely that non-Hispanic whites to practice in heavily Latino underserved communities. Many immigrants also have jobs in which they work long hours for low hourly wages, and lose income if they take time off during the day for a medical appointment.

“There are structural issues that limit access to care,” says Dr. Marjorie Kagawa-Singer, associate professor of community health sciences and principal investigator for evaluation of PATH: Promoting Access to Health for Pacific Islander and Southeast

Asian Women, a project funded by the Centers for Disease Control and Prevention to promote breast and cervical cancer screening in seven low-income, monolingual Asian American and Pacific Islander populations in California. Kagawa-Singer points out that in addition to the hardships often encountered by immigrants in finding a health care provider who can speak their language and leaving work for appointments if the provider’s office hours are 9-5, the health care system tends to be complicated to navigate, particularly for people who haven’t been in the country long.

Once they’re past the barriers to seeing a health care provider, immigrants often find themselves in a setting where communication is hindered by a language mismatch. A study by Hayes-Bautista of U.S. Census data revealed that approximately 3 percent of non-Latino physicians speak Spanish; patients who communicate in one of the more than 200 other non-English languages spoken in California are likely to experience greater difficulty in finding a match. The negative consequences are seen in studies such as Wallace’s analysis of the health status of older Californians, in which he found that limited-English speakers – the vast majority of whom are immigrants – are more likely than English speakers to have fair or poor health status, including higher rates of diabetes and mental health problems.

In the clinical setting, the language barrier can have a negative impact on immigrants’ health in a number of ways. “Media announcements and patient

SPHmag.June04.2-19

6/7/04

11:28 AM

Page 16

Victoria Ojeda, 15

M.P.H. ’97, Ph.D. ’03

Differences in culture can also play a role. Some immigrants come from societies that are less likely to challenge authority, notes Wallace – putting them at a disadvantage in a managed care system in which assertiveness is often required to obtain needed services.

D.D.S., M.P.H. Legislative and administrative policies have sought to restrict immigrants’ access to means-tested public assistance – including publicly funded health insurance – based on studies showing immigrants’ disproportionate dependence on public assistance, explains Kim, a doctoral candidate at the school.

But, she points out: “Studies have been inconclusive about the distribution of public health insurance, and few studies have focused specifically on the enrollment of immigrants in public health insurance programs.” The debates on health care access for the immigrant population attracted the attention of Kim, who has been interested in health disparities among the diverse U.S. population. In writing a paper for her minor in sociology, she used 2001 California Health Interview Survey data to study the health insurance status of immigrants in California, and found that immigrants and their adult children were no more likely to enroll in public health insurance programs than native-born Californians of U.S. parentage with comparable characteristics. In addition to working on her dissertation, which focuses on the influence of school and neighborhood contexts on adolescent smoking and drinking behavior, Kim plans to continue her research on immigrants’ access to health care by examining the health insurance status of immigrants.

UCLAPUBLIC HEALTH

At a recent focus group with Filipino men at a senior center in Long Beach, Calif., Dr.P.H. student Gabriel Garcia (left), a research assistant to Dr. Annette Maxwell, adjunct associate professor in the school, discussed smoking.

Jinsook Kim,

cover story

education materials are often translated into Spanish, but that still leaves out a lot of people who don’t speak English or Spanish,” says Kagawa-Singer. Doctorpatient language barriers raise the possibility of diagnostic errors resulting from miscommunication about symptoms, misunderstanding about treatment choices, or inability to correctly comply with medication regimens or other instructions.

“In many cases, the only option for the patient is to bring in a family member as an interpreter, and we know that misinformation is communicated in informal situations like that,” says Brown.

Of course, providing professional interpreters and training providers in how to serve their diverse population come with price tags, and public and private health plans have been slow to implement changes that would offer reimbursement for such services, notes Dr. Ninez Ponce, assistant professor of health services. “Part of the problem is that despite the fact that there is a lot of interest in bridging these linguistic and cultural gaps, there have been few population-based studies looking at how these gaps impede access or affect health status,” she says.

Ponce is currently conducting such research, using data from the UCLA Center for Health Policy Research-based California Health Interview Survey and the Medicaid program to identify any health care disparities that might exist as a result of linguistic factors. In the meantime, she notes, at a minimum, patients who speak a different language than their health care provider should be given access to effective telephone translation services, which offer a less-expensive alternative to in-person translators.

In addition to potentially yielding insights into the importance of language barriers to health care access and outcomes, data from the 2001 California Health Interview Survey (CHIS 2001) documented the impact of immigration status and citizenship on access to insurance coverage. CHIS 2003, which is still being analyzed, will enable researchers to examine these issues in even greater detail.

Ojeda, now a postdoctoral research fellow at Harvard Medical School, began studying health care issues affecting immigrants and their families in 1998, under the guidance of her advisor, Dr. E. Richard Brown. She collaborated with Brown and other colleagues on two projects examining patterns of health insurance coverage and use of health services by undocumented immigrants and other immigrant families.

Later, she studied the role of immigrant and immigration policies in shaping immigrants’ connections to the health system. Her doctoral dissertation centered on disentangling disparities in health insurance coverage among Latino children who are native born but might belong to families that include immigrant parents. Ojeda’s research showed that parental citizenship doesn’t entirely explain why Latino children are vulnerable to being uninsured or underinsured by workplace insurance; rather, Latino children and their families face a myriad of social, economic, and labor-market challenges that result in their higher uninsured rates and lower rates of coverage through the workplace. “Continued immigration from Latin America and the growth of the Latino population, which includes a large proportion of nativeborn children, make Latinos’ access to health insurance an important public policy priority,” she says. Ojeda’s future research will focus on further identifying the social barriers experienced by Latino and other immigrant groups as they attempt to navigate public and private health insurance systems.

SPHmag.June04.2-19

6/7/04

16

UCLAPUBLIC HEALTH

Julia Prentice,

11:28 AM

Page 17

Koy Srirojanakul Parada,

M.S.P.H. ’01

M.P.H. ’98

Most research on health insurance considers only whether or not an individual has coverage at one point in time, notes Prentice, a doctoral student at the school; however, using the unique data collected as part of the Los Angeles Family and Neighborhood Survey (LA FANS), directed by her faculty mentor, Dr. Anne Pebley, Prentice has been able to study why people gain and lose insurance – and whether citizenship status is a factor, even after controlling for socioeconomic and employment characteristics. Prentice’s results suggest that different social policies would be necessary to alleviate the uninsured problem for different citizenship groups. For example, undocumented immigrants are less likely to gain insurance and more likely to lose insurance than the native born. In contrast, legal noncitizens are less likely to gain insurance than the native born but are no different in their ability to keep insurance. Thus, Prentice has concluded that to improve health insurance coverage among immigrants, policies should focus on barriers to initially obtaining coverage for legal noncitizens and barriers to both obtaining and maintaining coverage for undocumented immigrants. “Past research has overlooked these differences by not considering the role of citizenship status when examining losing and gaining health insurance,” she says.

Parada, a Ph.D. student, serves as project director for the Los Angeles region of the Asian American Network for Cancer Awareness, Research & Training (AANCART). AANCART works with 17 community-based organizations to reduce the burden of cancer in the Asian communities of Los Angeles and Orange counties, particularly targeting linguistically and culturally isolated Asians, many living in ethnic enclaves. AANCART works to increase cancer awareness, timely screenings, and cancer research in these communities. Recent examples include hepatitis B screening events aimed at the Thai community, which were hosted throughout Los Angeles County in conjunction with the Thai New Year celebrations in April. Parada, whose dissertation topic is “Ethnicity, Acculturation, and Cancer-Relevant Behaviors,” became interested in immigrant health when she noticed early during her time in the school’s M.P.H. program that immigrants – particularly those who were newer and less acculturated – had health problems that were different from those of the general population. Of particular interest to Parada was that as immigrants lived in the United States longer, they became more likely to develop chronic diseases, with the most prevalent conditions beginning to parallel those of the general population. “I became curious as to the reasons, and started to look into the impact of acculturation on disease risk,” she explains.

The UCLA Labor Occupational Safety and Health program provides health and safety training to various workers, many of whom are immigrants – a population found to be particularly concerned about work-related injuries, and reluctant to report them.

On issues of prevention, many immigrant groups come from countries where health care is largely confined to treating disease, says Dr. Roshan Bastani, professor and associate dean for research in the School of Public Health and associate director of the UCLA Jonsson Cancer Center’s Division of Cancer Prevention and Control Research. These immigrant populations have been a major focus for Bastani’s research group, which studies barriers to important cancer screenings and other prevention-related activities, and develops interventions that address the barriers.

For cancer screenings, Bastani, says, “It’s important to create awareness among immigrant populations of the importance of preventive cancer screenings and provide guidance on how to access the services.” Bastani notes that screening services are more likely to be utilized by immigrant groups when they are provided in a familiar setting – whether it’s a community clinic, a church or synagogue, or a senior center – by volunteers or professionals who speak their language.

It shouldn’t be assumed that immigrants won’t take preventive measures when encouraged to do so, says Kagawa-Singer. “Often they’re just not familiar with the services,” she explains. “Once they’re educated about them, and especially if their physicians recommend them and the services are accessible, they will use them. For prevention-related activities such as immunizations, screenings, and management of chronic diseases, utilization by immigrants has more to do with having access and accurate information about the importance of prevention than cultural beliefs.”

While there are certain instances in which cultural beliefs and practices can pose barriers to effective treatment (in Latino culture, caida de mollera is often treated ineffectively by indigenous practices and can lead to severe dehydration) or be misinterpreted by health care professionals (as in the practice of “coining” for fever in Southeast Asian culture, which has been incorrectly perceived as child abuse), Kagawa-Singer contends that culture is usually misinterpreted as discrete beliefs and practices rather than understood holistically and dynamically as a way of adapting to circumstances.

SPHmag.June04.2-19

6/7/04

11:28 AM

Page 18

17

“For prevention-related activities such as immunizations, screenings, and management of chronic diseases, utilization by immigrants has more to do with having access and accurate information about the importance of preventions than cultural beliefs.”

cover story

For a variety of reasons, immigrants who come to the United States with minimal financial means also are at higher risk for work-related illnesses and injuries, notes Marianne Brown, lecturer in the School of Public Health and director of the UCLA Labor Occupational Safety and Health (UCLALOSH) program. “Immigrants tend to work in the riskier jobs that no one else will take,” she says.

“In addition, there is often a language disconnect between them and their supervisor, which can affect their training and communication about dangers. There is also a feeling of vulnerability – particularly if they don’t have legal working status – which makes many immigrants feel unsafe about speaking up.”

In an ethnographic study of 75 immigrant workers in six industries in Southern California – day labor, domestic work, garment work, home care, hotel and restaurant work – the UCLA-LOSH program found that 90 percent were concerned that they would be injured on the job. The majority had experienced work-related injuries or illnesses, but only two-thirds of those told their employers. Most of the immigrants in the study were not aware of their rights to safe and healthful working conditions, Brown says. The UCLA-LOSH program has ongoing efforts to provide health and safety training and educate worker groups about their rights and how to effectively advocate for themselves.

—Dr. Marjorie Kagawa-Singer

At what cost acculturation?

There is virtually no community in the United States not touched by the epidemic of obesity.

But for immigrants, the trend is particularly vexing: Groups come to the country with healthy diets and transition to the high-calorie, high-fat, low-fruitsand-vegetables diets and sedentary lifestyles that create the problem.

“They’re bombarded with images telling them this is the way to do things – we eat fast food, we have super-sized portions – and it’s hard to resist that, particularly for their children,” says HayesBautista. “We need to get ahead of this rising obesity and inactivity curve in a way that immigrant groups can relate to – perhaps inspiring them to go back to their original diets.”

Outreach workers staff a hepatitis B screening booth at the Thai New Year celebration at Wat Thai LA, a Thai temple in North Hollywood, Calif.

UCLAPUBLIC HEALTH

SPHmag.June04.20-37

18

6/7/04

Page 1

alumni hall of fame: the 2004 inductees

The UCLA School of Public Health Alumni Hall of Fame was established in 2002 to honor alumni with outstanding career accomplishments in public health, as well as those who have volunteered time and talent in their communities in support of public health activities.

The 2004 inductees, recognized at the Breslow Lecture and Dinner on April 19, exemplify the school’s commitment to teaching, research and service.

Honorees are inducted into one of two categories: Community Service or Professional Achievement.

UCLAPUBLIC HEALTH

11:34 AM

FOR PROFESSIONAL ACHIEVEMENT

FOR COMMUNITY SERVICE

STANLEY P. AZEN, Ph.D. ’69 Recognized as a pioneer in the field of statistical analysis, Azen has left a major mark as both academician and teacher at USC. The professor at USC’s Keck School of Medicine is also codirector of the Division of Biostatistics in the Department of Preventive Medicine, senior investigator at the Doheny Eye Institute, and assistant associate dean of scientific affairs. Azen directs the Statistical Consultation and Research Center and is considered one of the founding fathers of the USC graduate programs in biostatistics, epidemiology, public health, molecular epidemiology and statistical genetics.

With former UCLA School of Public Health dean Abdelmonem A. Afifi, Azen co-authored Statistical Analysis: A Computer Oriented Approach, and has published more than 230 scientific papers.

He is the founding editor and editor-in-chief of Computational Statistics and Data Analysis, the official journal of the International Association of Statistical Computing and a standard reference in the statistics literature.

Azen is a fellow of the American Statistical Association, an elected member of the International Statistics Institute and president of the International Association of Statistical Computing. He has served the UCLA School of Public Health Alumni Association as board member and officer for six years. In 1998, he received a USC Associates Award for Excellence in Teaching in recognition of his programmatic development and mentoring of students. Last year, the American Occupational Therapy Association awarded him a certificate of Appreciation for Research Contributions for his work on one of the largest intervention studies designed to improve the quality of life in older adults. Among his many and diverse talents, Azen continues his career as a professional pianist.

ROBERT J. KIM-FARLEY, M.D., M.P.H. ’75 Kim-Farley’s distinguished career in international health began in 1975, after he graduated from the UCLA School of Public Health’s Division of Population, Family and International Health and completed his medical education at UC San Francisco. While with the Centers for Disease Control and Prevention, he undertook international assignments in Taiwan, Yemen and Indonesia before being transferred to India in 1984 to serve as medical officer in the World Health Organization’s Expanded Programme on Immunization (EPI). Kim-Farley was quickly promoted to team leader of EPI for the entire Southeast Asia region, and eventually became director of the program worldwide.

In 1994, Kim-Farley took on the post of WHO representative to Indonesia, where he led the organization’s efforts to focus on polio eradication and HIV/AIDS prevention in the world’s largest Muslim nation. In 1999, he assumed the post of WHO representative to India, the organization’s largest country program. Kim-Farley’s stellar career as an international civil servant has been recognized with numerous honors and awards from the U.S. Public Health Service, professional medical organizations and the governments of countries in which he has served.

While his career has been primarily devoted to program development and administration in international health, Kim-Farley has also sustained an active scholarly agenda, publishing more than 40 peerreviewed articles and maintaining a critical and creative approach to his work, particularly in the field of infectious disease control. In 2003, he joined the UCLA School of Public Health faculty where, in addition to his scholarly contributions as a lecturer and teacher, he serves as a role model for students aspiring to careers in global health.

SPHmag.June04.20-37

6/7/04

11:34 AM

Page 2

19

hall of fame

ANGELA E. OH, J.D., M.P.H. ’81 An attorney, teacher and lecturer, Oh’s steadfast commitment to social justice has earned her widespread recognition as a leading commentator on diversity and race relations in the United States. In 1997, she was appointed by President Clinton as an advisory board member of his Initiative on Race and charged with the task of opening dialogue on national race relations, building community awareness, and supporting leadership development.

Oh also served as an advisory board member to the U.S. Department of Housing and Urban Development, Secretary Andrew Cuomo’s Community Builder Fellowship program, and was a sixyear appointee by the mayor of Los Angeles to the City Human Relations Commission.

Oh’s work has included advocacy for civil rights, women’s rights and access to justice in the civil courts. She currently serves as member of the American Bar Association Commission on Women in the Profession, Women’s Policy Inc. in Washington, D.C., and the Western Justice Center Foundation.

She has spoken internationally on topics that include women in leadership positions, the role of women in the law and politics, Asian Americans in politics and the international implications of the emerging role of multicultural race relations in the United States.

Oh’s activism and community service have earned her numerous honors, including the 1996 Distinguished Alumni Award from the UC Davis School of Law, the 2001 Inspirational Spirit of Excellence Award of the American Bar Association Commission on Racial and Ethnic Diversity in the Profession, and the 2003 UCLA Community Service Award. Oh is also an ordained priest, Zen Buddhist Rinzai sect.

IRWIN J. SHORR, M.P.H. ’72, M.P.S. Shorr is renowned in the international health community as the preeminent expert in the techniques and use of childhood anthropometry for growth assessment and nutritional monitoring. His book How to Weigh and Measure Children is considered the definitive manual on anthropometry procedures for assessing and monitoring children’s nutritional and health status. Shorr is considered the standard bearer of childhood growth assessment, especially in the developing world, where he has had a profound impact on the anthropometric methodological techniques used by international agencies and organizations. In the United States, he has designed and implemented the anthropometry components of surveys, research projects and special studies for federal agencies, universities and private organizations.

A nutritionist by training, Shorr has worked in 36 countries with a specific emphasis on anthropometry training as part of large-scale national and regional household surveys. He has consulted extensively with international and bilateral agencies including UNICEF, the World Health Organization, the United Nations High Commission for Refugees, the Food and Agriculture Organization of the United Nations, the World Bank and the United States Agency for International Development (USAID), as well as for universities, non-governmental and private organizations.

Shorr has lectured on anthropometric nutrition assessment at universities around the world and was assistant director of the UCLA School of Public Health Nutrition Assessment Unit, a USAID-funded project to conduct national household nutrition surveys worldwide. He currently holds an appointment as lecturer at the Johns Hopkins University School of Hygiene and Public Health. In 1994, he received the Mid-Career Award from the International Health Section of the American Public Health Association.

For Professional Achievement Donna Bell Sanders, M.P.H. ’81 Diana M. Bonta´, R.N., M.P.H. ’75, Dr.P.H. ’92

Virginia A. Clark, Ph.D. ’63 Suzanne E. Dandoy, M.D., M.P.H. ’63 Harold M. Goldstein, M.S.P.H. ’89, Dr.P.H. ’97

Richard A. Goodman, M.D., J.D., M.P.H. ’83

Kenneth W. Kizer, M.D., M.P.H. ’76 Keith S. Richman, M.D., M.P.H. ’83 Pauline M. Vaillancourt Rosenau, Ph.D., M.P.H. ’92

Jessie L. Sherrod, M.D., M.P.H. ’80 Stephen M. Shortell, M.P.H. ’68, Ph.D. Shiing-Jer Twu, M.D., M.P.H., Ph.D. ’91

For Community Service Ira R. Alpert, M.S.P.H. ’66 Mark Gold, D.Env. ’94 Raymond D. Goodman, M.D., M.P.H. ’72

Nancy Halpern Ibrahim, M.P.H. ’93 Carolyn F. Katzin, M.S.P.H. ’88, C.N.S.

UCLAPUBLIC HEALTH

Please access information on 2005 nominations at www.ph.ucla.edu/alumni_hall.html, or call 310-825-6464.

PREVIOUS INDUCTEES

SPHmag.June04.20-37

20

6/7/04

11:35 AM

Page 3

“Unfortunately, there is a several-decade history of underinvestment in professional training of the public health infrastructure.

Now, there is a realization that we need to do things differently.”

—Dr. Linda Rosenstock Dean, UCLA School of Public Health

21st Century Challenge: Educating the Public Health Workforce Public health initiatives of the 20th century – MAJOR RESPONSIBILITIES FOR SCHOOLS OF PUBLIC HEALTH:

• Educate the educators, practitioners, and researchers as well as prepare public health leaders and managers • Serve as a focal point for multi-school trans-disciplinary research as well as traditional public health research to improve the health of the public • Contribute to policy that advances the health of the public • Work collaboratively with other professional schools to assure quality public health content in their programs • Assure access to lifelong learning for the public health workforce

UCLAPUBLIC HEALTH

• Engage actively with various communities to improve the public's health – as concluded by the Institute of Medicine’s Committee on Educating Public Health Professionals for the 21st Century, 2003

from sanitation and immunization to tobacco control – have been remarkably successful in enhancing the quantity and quality of lives. But at the dawn of a new century, public health threats loom as large as ever – from AIDS, Ebola and West Nile virus to the epidemic of obesity and the threat of bioterrorism. Moreover, the task of protecting and promoting the public’s health is made increasingly complex by developments that include globalization, scientific and technological advances, and changing demographics. Both nationally and in California, this has led to a serious examination of the public health workforce and how to ensure that it is prepared to address the many challenges it faces.

As an educator of future public health leaders and a resource for providing continuing education and training to the current workforce, schools of public health such as UCLA’s are playing a central role.

“The extent to which we are able to address these challenges and make additional improvements in the health of the public depends in large part on the quality and preparedness of our public health workforce, which, in turn, depends on the relevance and quality of public health education and training,” says Dean Linda Rosenstock. “Unfortunately, there is a several-decade history of underinvestment in professional training of the public health infrastructure. Now, there is a realization that we need to do things differently.”

Rosenstock recently co-chaired an Institute of Medicine committee charged with developing a framework for how education, training and research can be strengthened to better assist public health professionals in improving population health. The committee’s recent report, Who Will Keep the Public Healthy?

Educating Public Health Professionals for the 21st Century, found that only a fraction of the nation’s 450,000-plus public health workers receive formal public health training – and suggested specific ways to improve public health professionals’ capabilities to handle new and complex challenges.

SPHmag.June04.20-37

6/7/04

11:35 AM

Page 4

21

A major effort to develop and support effective public health training opportunities addressing community health needs is being undertaken by the Pacific Public Health Training Center (PPHTC), a consortium led by the UCLA School of Public Health that includes California’s four schools of public health and the University of Hawaii, funded by the federal Health Resources Services Administration.

After spending much of its first year examining the two states’ public health training needs and how to deliver them most effectively, the PPHTC has focused on meeting some of these needs through both face-to-face and distance learning initiatives.

Trainings have been both statewide – last fall, for instance, a two-day program in epidemiology was

held for health officers in California – and regional, including a series of environmental health trainings throughout the state and a number of activities aimed at assisting rural health departments.

“The training sessions are very practice- and learner-focused, identifying specific outcomes and objectives that the participants want to achieve to improve the way they do their jobs,” says Dr. Michael Prelip, assistant professor of community health sciences and the UCLA School of Public Health’s lead faculty representative on the PPHTC. Faculty at all five universities have participated in the design and delivery of training. “The health officers of California and Hawaii see the faculty resources as a great strength in working with the Pacific Public

The UCLA-Fogarty Training Program in Occupational and Environmental Health prepares scientists from Mexico in environmental and occupational fields.

Above, program participants are trained in an instrument used to measure air particulate matter.

UCLAPUBLIC HEALTH

California faces particularly daunting challenges, with a fast-growing elderly population, tens of thousands of people living with AIDS, several million having been diagnosed with asthma or diabetes, and more than 6 million lacking health insurance and/or access to needed health services.

“The IOM report raises worrisome concerns about the training of the nation’s and California’s future public health professionals,” says Sen. Jack Scott (D-Pasadena), who chairs the California State Senate Budget Committee on Education. “Preventive public health interventions are incredibly cost-effective compared to dealing with problems once they have happened. If the last 20 years of epidemics have taught us anything, it is that scrimping on educating a skilled public health workforce is shortsighted and a serious mistake.”

As part of its ongoing process of evaluating systemwide professional education needs, the UC Office of the President (UCOP) recently convened a task force to study the demand for public health education in the state; a final report was being prepared as this issue was going to press. The task force reviewed data strongly suggesting that the state’s public health workforce faces both shortages and deficiencies in training and continuing education opportunities.

“There is clear evidence of a need for increased training in public health in California,” says Dr. Gerald Kominski, associate dean for academic programs at the school and a member of the UCOP task force. Among other things, he notes, California has fewer public health professionals as a proportion of its population than other large states.

The committee’s background work also points to the need for improved education in the area of cultural competency. Underrepresented minority groups are negatively affected by widening health disparities, often resulting from cultural and linguistic barriers. “The demographics in California are such that it is particularly important to have a public health workforce trained to communicate effectively with a diverse population,” says Kominski.

Kominski also believes the state’s schools of public health should expand educational opportuni-

ties offered to the current workforce, particularly in the area of short-term, targeted training. “We’ve learned through the efforts of the committee and other sources that there is a tremendous demand and unmet need for specialized, so-called certificate training in areas such as health care administration and management, epidemiology, and specific aspects of environmental health sciences,” he says.

feature

“Public health professionals need a framework for action and an understanding of the ways in which multiple factors – such as education, housing, employment and health care – affect the health of individuals and their communities,” says Rosenstock.

“Our training needs to keep pace with a rapidly changing world, whether due to globalization, technological advances or demography.” Her committee further argued that other health professionals, including all of the nation’s physicians, should receive core public health training.

SPHmag.June04.20-37

6/7/04

22

The school’s Center for Public Health and Disasters provides specialized training in disaster preparedness, including last year’s Orange County Operational Area Biological Tabletop Exercise.

11:35 AM

Page 5

Health Training Center,” says Prelip. “Considering the collective experiences and knowledge of the faculty at these schools, they feel like they can ‘go to the well’ and get whatever they need.”

More intensive education of the current public health workforce is provided by the school’s two executive M.P.H. programs, which are aimed at midcareer, full-time working professionals. Two programs are offered: one in health services management and one in health education and health promotion.

Several of the school’s programs also offer training to meet specific workforce needs. The Center for Public Health and Disasters (CPHD) was recently designated by the Centers for Disease Control and Prevention as an Academic Center for Public Health Preparedness, part of a collaboration of schools of public health, government agencies and state and

UCLAPUBLIC HEALTH

local public health departments to coordinate preparedness of the public health workforce by addressing training needs in bioterrorism, infectious disease, and other public health threats and emergencies, and improving the ability of front-line public health workers to respond to current and emerging public health threats. CPHD offers on-site training for local and state health agencies in California, Nevada and Utah, and designs and conducts exercises as well as providing technical assistance for health departments.

Similar efforts occur under the auspices of the Southern California NIOSH Education and Research Center, based in the school, which serves as one of 16 multidisciplinary centers in the United States supported by the National Institute for Occupational Safety and Health.

Meanwhile, two of the school’s training programs, both sponsored by the Fogarty International Center, are helping to meet international public health needs. The UCLA/Fogarty AIDS International Training and Research Program provides training leading to M.S. and Ph.D. degrees in epidemiology

of HIV/AIDS for health professionals from China, Vietnam, Cambodia, Myanmar and India, and in special circumstances for health professionals from Laos, Thailand, the Philippines and Indonesia. In addition, the UCLA-Fogarty Training Program in Occupational and Environmental Health was established to provide training to graduate students from Mexico in environmental and occupational health fields.

Several philanthropic efforts are enhancing the school’s ability to meet the growing need for public health professionals who will work in underserved areas. The Health Disparities Prevention Project, funded by The California Endowment, is designed to strengthen academic-based research activities in health promotion and disease prevention among at-risk communities of color in Los Angeles, and to improve training of health professionals, students and other community health workers focused on reducing disparities of health status. In addition, a grant from the California Wellness Foundation as part of its Diversity in the Health Professions initiative offers significant support to students committed to working in underserved areas. Finally, the Monica Salinas Internship Fund in Latino and Latin American Health provides fieldwork support to public health students whose work focuses on Latino and Latin American health and well-being.

The school has also brought public health education at UCLA to a new audience, undergraduates, with the addition of the Public Health Minor.

Each year, 50-60 undergraduates take the minor’s core course, which is taught as a collaborative effort by many of the school’s most prominent faculty members. “A lot of these students have no idea what public health is, or have misconceptions about what public health does,” says Dr. Susan Sorenson, who has taught the introductory course for the last two years.

“By exposing them at the undergraduate level, we can encourage some to enroll in graduate public health education when they might not have otherwise considered it. And for those who will go on to pursue medicine or other health careers, we can provide a broader view of health that will also be beneficial.”

As critical health threats have thrust public health into the spotlight, there appears to be strong support for making the necessary investments in improving public health training.

“At no time has the mission of promoting the public’s health and safety resonated more clearly with the public and the government than now,” says Rosenstock. “To improve health in our communities for the 21st century, we must seize this opportunity and make sure our public health infrastructure consists of high-quality and well-educated public health professionals.”

SPHmag.June04.20-37

6/7/04

11:38 AM

Page 6

23

research

research highlights Post-Treatment Symptoms More Severe for Breast Cancer Patients Following Mastectomy, Chemotherapy Physical and Mental Health Composite Scores for Women After Mastectomy or Lumpectomy, with or Without Chemotherapy (mean = 50)

SCORES

WOMEN WHO HAVE MASTECTOMIES or undergo chemotherapy for breast cancer have more severe physical symptoms immediately following treatment than women who have lumpectomies without chemotherapy treatment, according to a study headed by Dr. Patricia Ganz, director of the Jonsson Cancer Center’s Division of Cancer Prevention and Control Research, based in the School of Public Health. The findings were published in the Journal of the National Cancer Institute.

There have been many studies of the physical and emotional experiences of women newly 54 diagnosed with breast cancer, and in recent years several studies have examined the experiences of long-term cancer survivors. But little information 52 had been available on the experiences of women in the transitional period between the end of initial 50 treatment and survivorship, when they must move beyond cancer to reestablish normal life patterns.

48 Information from earlier studies suggests that this can be a stressful time period. Women have reported that their fear of recurrence increases, 46 they miss ready access to the health-care system, they may have lingering side effects of therapy 44 and they often feel uncertain about what to expect after treatment.

42 “I was surprised by the finding that women who had mastectomies are doing significantly worse physically after treatment, because that is 40 contrary to what we’ve seen in over 20 years of research,” says Ganz. “What this suggests to me Mastectomy is that with earlier detection, we are finding much

PHYSICAL*

Lumpectomy

MENTAL

Mast + Chemo

Lump + Chemo

UCLAPUBLIC HEALTH

smaller tumors that result in minimal surgeries *Physical score is statistically worse for those with mastectomy (p<.001). and less overall trauma, especially likely for women receiving lumpectomy.”

Ganz and her colleagues collected information on the health status and quality of life of 558 women who had just had surgery for breast cancer, making theirs one of the largest and most comprehensive studies of such patients. They found that mood and emotional functioning were similar among all women at the end of their primary treatment, with little evidence of a depressed mood or negative effect. Yet, a wide variety of physical symptoms were reported in all treatment groups, such as hot flashes, night sweats, aches and pains, and vaginal dryness. Women who had mastectomies reported the poorest physical functioning, both immediately following surgery and at the end of primary treatment.

Sexual functioning was worse for women who received chemotherapy than for those who did not, regardless of the type of surgery.

“It is clear that more attention must be paid to the symptoms that women report at the end of treatment because they are associated with poorer physical and emotional well-being,” Ganz says. In particular, she notes, post-treatment fatigue is a major concern that is being addressed by ongoing studies in Ganz’s laboratory.

SPHmag.June04.20-37

6/7/04

11:38 AM

Page 7

24

Bullies Don’t Need Ego-Boosters; Anti-Bullying Programs Should Focus on Changing Peer Culture

One-fourth of the students reported incidents of acting as a bully, being bullied, or both. All three groups showed less interest in school and had more difficulty getting along with classmates.

CONTRARY TO POPULAR BELIEF, most adolescent bullies are not depressed, lonely or suffering from low self-esteem, a large UCLA study of sixth-grade bullies and their victims indicates. The study, by the School of Public Health’s Dr. Mark Schuster, psychology professor Jaana Juvonen and education professor Sandra Graham, found that bullies are often popular and respected among classmates; thus, efforts to curtail their destructive behavior should focus more on changing the peer culture that views the instigators as “cool.”

“These findings show us that bullies are not necessarily suffering from low self-esteem,” says Schuster, director of the UCLA/RAND Center for Adolescent Health Promotion. “The bullies in our study were the popular ones. They already had a high dose of self-esteem. They don’t need ego boosters, but that’s what they’re getting from many current anti-bullying programs. We need to pay more attention to the issue of popularity and how to change the peer culture that encourages bullying. That means looking at the bystanders, too. We need to teach them not to encourage bullying by their response to it.”

The study, published in the journal Pediatrics, collected confidential reports from more than 1,900 sixth graders and their teachers in 11 Los Angeles-area public middle schools with predominantly minority and low-income students.

Bullying was defined as “starting fights and pushing other kids around,” “putting down and making fun of others,” and “spreading nasty rumors about others.”

Approximately one-fourth of the students reported incidents of acting as a bully, being bullied, or both. All three of these groups showed less interest in school and had more difficulty getting along with classmates than other students.

Students who witness bullying rarely intervene, the researchers found.

Depression, social anxiety and loneliness are common among victims of bullies, according to the study. “Youth who are victims of bullying are often emotionally distressed and socially marginalized,” says Schuster. “Victims are reluctant to talk about it. They suffer in silence and may even blame themselves. This is one of the challenges: We need to provide students with educational settings in which they feel comfortable talking about being bullied or witnessing other kids being bullied. But we also need to give kids tools to effectively deal with bullying.”

UCLAPUBLIC HEALTH

MTBE Alternatives Could Also Pose Threat; Further Investigation of Fuel Oxygenates Needed WELL-PUBLICIZED STUDIES indicating widespread groundwater and drinkingwater contamination from methyl tertiary-butyl ether (MTBE) have led many states to consider prohibiting the fuel additive and several, including California, to enact bans. But a UCLA School of Public Health study suggests that MTBE alternatives could also pose a threat to groundwater.

The study by Tom Shih, a doctoral student in the school’s Environmental Science and Engineering Program, Dr. Mel Suffet, a professor in the program,

SPHmag.June04.20-37

6/7/04

11:38 AM

Page 8

25

Cumulative Percentile

research

and colleagues examined the extent and magnitude of groundwater contamination beneath approximately 500 Los Angeles-area gas-station facilities. The researchers investigated groundwater samples for the presence of fuel-additive alternatives to MTBE, including tertiary butyl alcohol (TBA), tertiary amyl methyl ether (TAME), di-isopropyl ether (DIPE), and ethyl tertiary butyl ether (ETBE).

The alternatives, particularly TBA, were found to be spreading rapidly away from leaking storage tanks. “The sheer number of gasoline-station facilities with underground fuel tanks that are leaking, or have leaked, in proximity to drinkingwater sources presents a significant risk and a special challenge to state and federal environmental regulators,” says Shih, who wrote the paper, published in Cumulative Percentile of Site Environmental Science & Technology, as part of his dissertation thesis at the Maximum Concentration for Various school. “These facilities continue to represent Fuel Hydrocarbons and Oxygenates major point sources of gasoline constituents and the leading cause of petroleum and oxygenate groundwater contamination.”

100 TBA, TAME, DIPE and ETBE, which have 90 chemical and physical properties similar to MTBE, 80 are currently present in formulations supplied to 70 gas stations across the United States. But, 60 whereas MTBE has been well studied, there had 50 been little research on the environmental behav40 ior of these alternative fuel oxygenates, notes 30 Shih, who graduated with his D.Env. in December 20 and is currently employed at Cal-EPA and the 10 State Water Resources Control Board in Los 0 Angeles. As a result, the extent and magnitude of 100,000 1,000,000 1 10 100 1,000 10,000 oxygenate groundwater contamination in the Site Maximum Concentration (ug/L) United States remain unknown.

Shih says his study provides a basis for makDIPE TBA ETBE TPHg TAME Benzene ing preliminary predictions on the implications of MTBE the expected shift to alternative oxygenates as MTBE is phased out, or reduced, in gasoline.

“The possible phase-out of MTBE and its replaceSubstances with curves to the right on the graph, ment with another fuel oxygenate necessitates a thorough assessment of the e.g. TPHg, TBA, MTBE, and benzene, indicate environmental impacts of the alternatives, or we risk repeating the MTBE probgreater source concentration and strength. lem,” he says.

Benefits of Mental Health Services Demonstrated for Low-Income Minority Women, Depressed Elderly

UCLAPUBLIC HEALTH

THE VALUE OF MORE INTENSIVE MENTAL HEALTH services for depressed elderly persons and low-income minority women has been demonstrated in two separate UCLA studies recently published in the Journal of the American Medical Association, both co-authored by Dr. Thomas Belin, associate professor of biostatistics in the School of Public Health.

In one study, headed by Dr. Jürgen Unützer, then an associate professor of psychiatry at UCLA’s David Geffen School of Medicine and now at the University of Washington, men and women ages 60 and older who presented in a primarycare clinic with depression symptoms were assigned either to usual care or to a “depression care manager” – a specially trained nurse or psychologist working in close collaboration with the patient’s regular physician for up to 12 months to educate and support patients, track symptoms and side effects, assist with changes in antidepressant treatment, and provide counseling. Within three months and across a year of follow-up, patients assigned to this collaborative care approach showed greater reduction of depression symptoms and reported better quality of life than usual-care patients.

SPHmag.June04.20-37

6/7/04

11:38 AM

Page 9

26 The second study, headed by Dr. Jeanne Miranda, a professor in UCLA’s Department of Psychiatry and Biobehavioral Sciences, evaluated mental health outcomes among low-income, predominantly minority women who were participants in county-run food subsidy programs or family planning clinics, and showed signs of depression. The women were randomly assigned to either receive a referral to a community mental-health provider (usual care) or treatment with psychotherapy or medication. Within six months, women in both the psychotherapy and medication groups showed improvement compared to community referral patients on measures of depression and ability to function in home, work, and social settings.

Belin’s involvement in both projects grew out of his longstanding participation in the UCLA-NPI Health Services Research Center, directed by Dr. Kenneth Wells (M.P.H. ’80), which focuses on improving quality of care for psychiatric and neurologic disorders across the lifespan. Belin notes that both studies presented complex statistical analysis issues, given that not all individuals could be expected to participate at all time points. “In the field of biostatistics, cutting-edge research focuses on developing better statistical computing strategies, allowing us to process more information simultaneously and to accommodate the complexity of incomplete data,” he explains.

Regions of Mainland China with Highest Levels of Air Pollution Found to Have Highest SARS Death Rates INDIVIDUALS WITH SEVERE ACUTE RESPIRATORY SYNDROME (SARS) are more than twice as likely to die from the disease if they come from areas with high levels of air pollution, according to a UCLA School of Public Health study.

“Long-term and short-term exposure to air pollution has been associated with a variety Tianjin of adverse health effects including acute respiratory inflammation, asthma and chronic Beijing obstructive pulmonary disease – and now SARS,” says Dr. Zuo-Feng Zhang, professor of epidemiology at the school and a lead scientist on the study, which was published in the journal Environmental Health: A Global Access Hebei Science Source. “Our findings suggest that careShanxi givers need to pay close attention to exposure to pollutants in the living and working environments of SARS patients. These factors and others related to exposure to airborne toxins could leave some individuals at greater risk of death from the illness than others.”

In mainland China, where 5,327 SARS cases had been diagnosed and 349 patients had 85 90 95 100 105 died from the disease at the time of the study, a Air Pollution Index team of researchers from the school – also including Drs. Roger Detels and John Froines – joined with investigators from the Jiangsu Provincial Center for Disease Control and Prevention and Fudan University School of Public Health to determine whether death rates that varied by region could be explained by differences in air pollution levels. They found that mortality rates of patients with SARS increased as pollution levels increased. In regions of China with low air pollution, the death rate was 4 percent, whereas in areas with moderate or high air pollution levels the death rates were 7 percent and 9 percent, respectively.

Association Between Short-Term Exposure to Ambient Air Pollution and Case Fatality of SARS in China 8.0

SARS Case Fatality (%)

7.5 7.0 6.5 6.0 5.5 5.0 4.5 4.0

Guangdong

3.5

UCLAPUBLIC HEALTH

75

80

SPHmag.June04.20-37

6/7/04

11:38 AM

Page 10

27

research

The researchers were unable to examine the socioeconomic status or the smoking habits of the SARS patients, nor did they consider the treatment that the patients were given. All of these could have contributed to the patients’ outcomes.

However, the two regions with the highest case fatality rates were Beijing and Tianjin, where, the researchers suspect, patients would probably have received better clinical support. If this is the case, air pollution might play an even greater role in increasing death rates than their data suggest.

Nearly One in Five California Adolescents Live in Household with at Least One Firearm, Survey Finds

Those most likely to have firearms in their homes are whites, boys, adolescents between 14 and 17 years old, U.S. citizens and teens living in higherincome or rural households.

UCLAPUBLIC HEALTH

NEARLY 20 PERCENT OF CALIFORNIA ADOLESCENTS live in a household with at least one firearm, though only 3 percent say they have their own gun, a UCLA School of Public Health study has found.

The survey of more than 5,800 adolescents in the state shows that those most likely to have firearms in their homes are whites, boys, adolescents between 14 and 17 years old, U.S. citizens and teens living in higher-income or rural households.

Teens living in lower-income homes, however, are more likely than adolescents in higher-income homes to have their own handgun. The data were taken from the 2001 California Health Interview Survey, based in the school’s Center for Health Policy Research. Interviews were conducted in English, Spanish, Chinese, Vietnamese, Korean and Khmer to reach the widest possible sample of teens. The study, by Dr. Susan Sorenson, professor of community health sciences, and doctoral student Katherine Vittes, was published in the May 2004 American Journal of Public Health.

The researchers found that employed adolescents are more likely to have a firearm of their own, regardless of their parents’ income level. “It may be that adolescents with jobs have the resources to obtain their own guns; they might have the money with which to purchase a gun and, by fact of their employment, a larger social network that includes persons who might be willing to supply a firearm,” says Sorenson.

Although African American and Latino teens are less likely to report having a gun in their homes, they are more likely to say that they know someone their age with a handgun. Those without guns might wrongfully feel they are in the minority of their peers when it comes to having guns, Sorenson and Vittes suggest. “If these findings are confirmed by subsequent research, interventions designed to change perceptions and expectations of African American and Latino adolescents about handguns among their peers could be a focus of prevention,” Sorenson says.

Long guns such as rifles were the most common gun in the households of those surveyed. About 10 percent of teens live in a house with a handgun, and less than 1 percent say they personally own a handgun, the survey found.

Nonetheless, Sorenson notes, this low percentage translates to more than 23,000 California 12- to 17-year-olds with their own handgun, when Californians in this age group cannot legally purchase a handgun and, with a few exceptions, cannot legally possess one.

In 2000, 3,913 youths ages 10-19 died from intentional gunshot wounds, second only to unintentional injuries as a cause of death in that age group.

SPHmag.June04.20-37

28

6/7/04

11:42 AM

Page 11

student profiles An Active Policy Participant, at Home and Abroad

“It was incredible to be in a foreign country sitting in the parliamentary chambers as they were crafting the health rights to go in the new constitution.”

UCLAPUBLIC HEALTH

—Peter Long

DOCTORAL CANDIDATE PETER LONG NEVER HAD A MOMENT to second-guess his decision to forgo medical school in favor of public health. Long, a history major as an undergraduate, quickly became a participant in momentous events.

While a graduate student at Johns Hopkins University School of Hygiene and Public Health in the early 1990s, Long served as a health policy analyst for the Kaiser Commission on the Future of Medicaid in Washington, D.C., which put him in the midst of the national debate over health care reform during the Clinton administration. Among other things, Long prepared briefing notebooks for then-First Lady Hillary Rodham Clinton and was a frequent source providing analysis for news media articles.

A year later, he found himself in a completely different – but no less historic – environment, working as a legislative analyst for South Africa’s leading health care advocacy organization during the country’s transition to democracy. In his role as the first American ever hired by the indigenous National Progressive Primary Health Care Network, Long served as a delegate to the constitutional assembly.

“It was incredible to be in a foreign country sitting in the parliamentary chambers as they were crafting the health rights to go in the new constitution,” Long says. “The beauty of that experience was that one day I would be sitting with national parliamentarians, and the next I would be in a rural village of 400 people asking them what the national health act should look like in a workshop that represented the first time these people had been asked about anything the government did for them.”

As he nears completion of his doctoral dissertation at the UCLA School of Public Health, Long is also a senior program officer at The California Endowment, where he is leading the foundation’s grant-making, policy and advocacy, and research efforts to ensure universal coverage for the state’s children. One day, he hopes to run a foundation of his own. “I really enjoy this environment,” Long says.

“It’s a great position from which to influence policy, yet to be nimble, innovative and able to think about interesting, cutting-edge topics.”

For his dissertation research, Long has compared the impact of health insurance with that of behavioral factors such as smoking, physical activity and nutrition on the health of average-risk adults. His data, based on 35-year follow-up studies, suggest that while health insurance and access to a regular physician might be very important to patients who need chronic disease management, for average-risk adults the impacts of smoking and obesity are greater. “Right now we’re allocating about 95 percent of our health spending to medical care and 5 percent to non-personal health interventions,” Long says. “I’m not saying we shouldn’t be concerned about the 43 million people who don’t have insurance, but with limited resources it’s important to at least see where the best investments are.”

In addition to his dissertation research, Long has participated in several projects with faculty in the Department of Health Services, and says he has benefited greatly from the interactions. “The projects I’ve worked on have all included outside-the-box thinking about big questions,” he says. “UCLA has given me the rounding out of my public health education so that I will be not just a health policy person, but a full-service public health professional.”

SPHmag.June04.20-37

6/7/04

11:42 AM

Page 12

29

“One thing I learned was that not everything we in the Western world consider health problems are considered problems by other populations, and vice versa.”

—Taraneh Salke

UCLAPUBLIC HEALTH

AFTER SPENDING A NUMBER OF YEARS working in business, TARANEH R. SALKE changed course. “I decided to follow my heart,” she says. That path led her to the UCLA School of Public Health, where she completed her M.P.H. this year.

Taraneh has long been interested in social issues, having first become involved as a teen working for Greenpeace. She became passionate about reproductive health and family planning in developing countries through her studies and activities related to the environment. “I learned about the effects of overpopulation and how low fertility could improve people’s lives, particularly women in developing countries,” she says. “I strongly believe that access to reproductive health and family planning services is a fundamental public health right, is the main factor in decreasing maternal mortality and morbidity and improving child survival, and is the prerequisite for social and economic development in developing countries. Women in these countries face many obstacles and need assistance, and I hope that I can be a small part of providing that.”

Through studies of a wide variety of populations in several countries, Taraneh has gained firsthand knowledge of the issues that concern her – and has gone to great lengths in the process. As a UCLA undergraduate in the summer of 2000, she spent two months in Iran conducting field research on the health practices of, and available services for, a seminomadic Kurdish community in the mountains of Kurdistan.

She was permitted to set up her own tent and live as a member of the community, walking to the stream for water and fighting the elements – including extreme heat and dust, a sandstorm, and encounters with wolves.

While a student at the UCLA School of Public Health she received funding from the Bixby Program in Population & Reproductive Health for overseas trips to Afghanistan and Iran. In Afghanistan, Taraneh conducted an assessment of reproductive health programs, making recommendations to Afghan non-governmental organizations and establishing links between the school and these organizations. In Iran, she attended and presented at a first-of-its-kind National Seminar on Abortion. Taraneh, who grew up in Iran, spent the summer of 2002 working at the Family Planning Association in Iran, an affiliate of the International Planned Parenthood Federation. There, she developed proposals for health intervention programs for submission to international funding agencies, and worked on evaluating reproductive health programs for the Afghan refugees in Iran.

Last year she spent six weeks living with local families in a blue-collar section of Cairo. Taraneh visited Egypt’s Family Planning Association and women’s clinics, interviewing staff and health workers, and contacted a number of non-governmental organizations active in reproductive health projects to learn about their activities and programs. She also attended an intensive Arabic language program at a school run by religious Muslims.

She believes her diverse experiences will contribute greatly to her ability to be an effective public health professional. “I have gotten an in-depth look at other ways of life and thought processes,” says Taraneh, who, since graduating in December, has been working as a consultant to the Bixby program and International Medical Corp. “One thing I learned was that not everything we in the Western world consider health problems are considered problems by other populations, and vice versa.”

students

Journey on Behalf of Reproductive Health and Family Planning in Developing Nations Includes Unusual Stops

SPHmag.June04.20-37

Abdelmonem A. Afifi Student Fellowship Cynthia Recio Health Services Agency for Healthcare Research and Quality Award Nicole Bronson Burt Cowgill Janet Cummings Michelle Gurvitz Richard Hector Amalia Issa Amanda Schofield Atlantic Richfield Company Fellowship Fund Myranda Austin Environmental Health Sciences Biostatistics Training for AIDS Research Myung Shin Sim Li-Jung Liang Yan-Jung (Tina) Liu Fred H. Bixby Doctoral Fellowship Endowment Allison Buttenheim Chi Chiao Yasamin Kusunoki Community Health Sciences Astuo Coly Epidemiology Joseph and Celia Blann Fellowship Lisa Diane Sabin Environmental Science and Engineering Program

UCLAPUBLIC HEALTH

11:42 AM

Page 13

2003-04 student awards

students

30

6/7/04

California Endowment Scholarships Shonali Mona Choudhury Grace Lee Vanessa Shaw Community Health Sciences Elisa Priest Epidemiology April Bud Kimberly Enrad Tamu Jones Raul Sobero Health Services

Dissertation Year Fellowship Catherine Mary Crespi Biostatistics Angelica CastanedaJimenez Jennifer Jones Environmental Science and Engineering Program Jun Wu Environmental Health Sciences Nirav Shah Yingxu Zhao Epidemiology

California Wellness Foundation Scholarships Hector Lemus Miguel Marino Biostatistics Gloria Giraldo Rotrease Regan Yates Community Health Sciences Mirna Ponce Epidemiology

Eleanor J. De Benedictis Fellowship in Nutrition Andrea Conner Constance Awuor Gewa Community Health Sciences

Chancellorâ&#x20AC;&#x2122;s Fellowship Ning An Epidemiology Amy Carroll Community Health Sciences Hua Guo Biostatistics Jennifer Liebeler Environmental Science and Engineering Program Mitsuko Yamamoto Molecular Toxicology Deanâ&#x20AC;&#x2122;s Outstanding Student Award Catherine Mary Crespi Biostatistics Julia Prentice Community Health Sciences Robert Phalen Environmental Health Sciences Michelle Wilhelm Turner Epidemiology Ramesh Raghavan Health Services

Environmental Science and Engineering Program Endowment Angelica CastanedaJimenez Gang Quin Foley & Lardner Fellowships in Health Services Todd Drasin Genus Heidary L.S. Goerke Memorial Fellowship Chuen-Yen Lau Epidemiology Raymond D. Goodman Scholarship Laurie Ikuta Environmental Science and Engineering Program Graduate Opportunity Fellowship Lan Nguyen Elizabeth Sharp Epidemiology Norma Sanchez Sandy Li Tam Community Health Sciences Health Policy and Management Alumni Association Scholarship Adrienne Sweet Gordon Hein Memorial Scholarship Christian Shinaberger Epidemiology

Bette & Hans Lorenz Endowment Fund Amy Hensley Environmental Science and Engineering Program Xin Huang Biostatistics Kristin Yarris Community Health Sciences Dr. Ursula Mandel Scholarship Constance Awuor Gewa Community Health Sciences Kimberly Ann Henderson Molecular Toxicology Hsin-Ju Hsieh Biostatistics Soon-Im Huh Health Services Maternal and Child Health Grant Rupal Badani Diana Farid Yolandra Hancock Rekha Krishnankutty Community Health Sciences Judith Chung Nicole Garro Kyra Samson Kathryn Smith Health Services Max Factor Family Foundation Internship Program Ignacio Ferrey Raphael Travis Community Health Sciences Paulson Scholarship Fund Carl Ericksson Epidemiology Ann G. Quealy Memorial Fellowship Endowment in Health Services Genus Heidary Vida Montgomery Research Mentorship Program Hector Lemus Biostatistics Taigy Thomas Community Health Sciences Roemer Health Services Administration Fellowships Yasser Aman Randal Henry Tom Williams

Ruth F. Richards Outstanding Student Award Rachel Baldwin Environmental Health Sciences Lynn Salahi Community Health Sciences Stephanie Sun Epidemiology Janet Wang Health Services Xiao Zhang Biostatistics Monica Salinas Internship Fund in Latino and Latin American Health Kristin Yarris Mercedes Perez Community Health Sciences Charles F. Scott Fellowship Sue Dao Health Services Sarah Rothenberg Environmental Science and Engineering Program Phillip and Adia Siff Educational Foundation Scholarship Melissa Hilario Community Health Sciences Samuel J.Tibbitts Fellowship Gabriel Garcia Community Health Sciences UCLA Affiliates ScholarshipHortense Fishbaugh Memorial Fellowship Takahiro Higashi Health Services Melissa Hilario Community Health Sciences Margaret Krudysz Environmental Health Sciences Wilshire Foundation Endowment in Geriatric Medicine Hsia Chai Community Health Sciences

SPHmag.June04.20-37

6/7/04

11:43 AM

Page 14

honors DR. THOMAS BELIN is serving as co-chair of the 2005 International Conference on Health Policy Research, to be held in Boston in October 2005 in conjunction with the American Statistical Association Health Policy Statistics Section.

faculty

DR. ROSHAN BASTANI was appointed to the Scientific Advisory Committee of the UC Tobacco Related Diseases Research Program.

31

DR. WILLIAM CUNNINGHAM was selected to the American Society for Clinical Investigation, an honor society of physician-scientists.

DR. ROGER DETELS served as an external examiner for the National University of Singapore Program on Public Health Medicine.

DR. PATRICIA GANZ received the UCLA Alumni Association’s Professional Achievement Award at a May 22 ceremony honoring seven prominent individuals for their professional achievement and public, community and university service.

Ganz, who received her M.D. from UCLA in 1973, is professor of health services in the School of Public Health and director of the UCLA Jonsson Comprehensive Cancer Center’s Division of Cancer Prevention and Control Research, based in the school.

She is also a professor in the David Geffen School of Medicine at UCLA. Ganz is considered a pioneer in the areas of quality of life for cancer survivors, quality of care for cancer patients and cancer prevention.

“If one were to ask anyone in the oncology area for a short-list of the top breast-cancer-survivorship or quality-of-life experts, Dr. Ganz’s name would be among the first to be cited,” says Dr. Linda Rosenstock, dean of the UCLA School of Public Health.

“Dr. Ganz embodies the purpose of the award, fulfilling the highest levels of expectation for superior achievement in her field through a record of distinguished career accomplishments complemented by her outstanding contributions to the profession.”

DR. JONATHAN FIELDING is serving on the Health Promotion and Disease Prevention Board of the Institute of Medicine, National Academy of Sciences.

DR. DEBORAH GLIK received the Mohan Singh Award for Use of Humor in Public Health Education from the American Public Health Association’s Public Health and Health Promotion Section.

DR. NEAL HALFON is serving as an honorary professor of University College London, Institute of Child Health from 2003-08. He was the 2003 Creswick Professor of Early Childhood at the University of Melbourne and Royal Children’s Hospital and the 2003 Croc Professor of Pediatrics at Columbia University and Children’s Hospital of New York.

DR. DIANA HILBERMAN is chair-elect of the Association of University Programs in Health Administration.

DR. MICHAEL LU received the Coalition for Excellence in Maternal and Child Health Epidemiology’s Young Professional Achievement Award.

DR. BEATE RITZ served as part of the expert working group on environmental health tracking in California, as established in 2001 by the California Legislature and signed by the governor.

DR. RUTH ROEMER received the 2003 Lifetime Achievement Award from the International Network of Women Against Tobacco.

DR. MARK SCHUSTER was the winner of the 2003 Nemours Child Health Services Research Award from AcademyHealth.

DR. KIMBERLEY SHOAF was appointed to represent disaster public health on the National Research Council’s Committee on Disaster Research in the Social Sciences: Future Challenges and Opportunities.

DR. SUSAN SORENSON is serving on the Attorney General’s Task Force on Law Enforcement Responses to Domestic Violence, established by the California Department of Justice.

DR. STEVEN P. WALLACE assumed the role of chair of the Gerontological Health Sections of the American Public Health Association.

DR. ROBERT WEISS was elected Fellow of the American Statistical Association.

DR. ARTHUR WINER received the Carl Moyer Award for Scientific Leadership and Technical Excellence from the Coalition for Clean Air. UCLAPUBLIC HEALTH

SPHmag.June04.20-37

6/7/04

11:43 AM

Page 15

news briefs

faculty

32 NEW FACULTY

DR. LINWOOD PENDLETON joined the school’s faculty this spring as an associate professor in the Department of Environmental Health Sciences.

Pendleton is an expert in the valuation of environmental improvements such as those that would flow from enhanced management of watersheds, coasts, and air basins.

He is a principal investigator on three projects that seek to better inform policy makers about coastal and marine non-market values, including a $1 million effort to value the economic impacts of coastal water quality improvements in Los Angeles and Orange counties.

Pendleton also directs the National Ocean Economic Project’s Non-market Values Database, a program to collect, organize, and make available to policy makers environmental value data from the thousands of valuation studies that have been conducted for coastal and watershed resources and uses around the country.

VISITING FACULTY INCLUDE: ADRIANA BABAN Community Health Sciences DONALD LIGHT Health Services MAI ZHOU Biostatistics

UCLAPUBLIC HEALTH

PETER SCHNALL Community Health Sciences

consortium looks at effects of air pollution on asthma Amid growing concern about the link between air pollution and asthma, the UCLA School of Public Health has received a $700,000 grant from the South Coast Air Quality Management District to create the Asthma and Outdoor Air Quality Consortium. The consortium will conduct research to better understand how air pollution affects asthma and to guide the crafting of regulations intended to decrease the impact.

“We are pleased to be able to sponsor the creation of the Asthma and Outdoor Air Quality Consortium,” says William Burke, chairman of the South Coast Air Quality Management District’s governing board. “A better understanding of asthma and the air pollution impact is central to reducing risks and protecting public health. This research will benefit efforts nationwide.”

The first-year funding will allow consortium researchers at UCLA, UC Irvine, UC San Francisco, and USC to pursue six projects, including three studies involving traffic-related pollutants in the City of Los Angeles, east Los Angeles County, Riverside and Long Beach. Two other projects will investigate asthma at the cellular and subcellular levels, exploring the biology and chemistry of pollutants on airway inflammation processes. An additional project will develop a research tool for measuring air pollutants.

Dr. John Froines, professor of environmental health sciences at the UCLA School of Public Health, will direct consortium activities. Froines is also director of the school’s Centers for Environmental Quality and Health.

More information on the consortium can be found at www.scpcs.ucla.edu.

workbook helps preschools prepare for disasters A disaster preparedness workbook recently released by the school’s Center for Public Health and Disasters (CPHD) provides administrators of Head Start and other preschool programs with the resources they need to be prepared. The workbook is funded by Johnson & Johnson and is available free of charge on the center’s Web site (www.cphd.ucla.edu).

Until now, there has not been a disaster plan in place to aid the nearly 1 million children enrolled in the federal Head Start Program. “Our children spend 70 percent of waking hours in the school setting,” says Dr. Kimberly Shoaf, CPHD assistant director. “Head Start has the responsibility for taking care of the youngest members of our school-aged population.”

SPHmag.June04.20-37

6/7/04

11:43 AM

Page 16

33

At a time when studies consistently show potentially preventable health disparities among population groups, the Center to Eliminate Health Disparities has been established at the UCLA School of Public Health to address the factors that lead to differences in the incidence, prevalence, mortality and burden of disease that occur based on such factors as gender, race and ethnicity, education level, income and place of residence. The center was started with seed money from Tom Epley and Linnae Anderson, Ralph and Shirley Shapiro, and The California Endowment.

The center, directed by Drs. Antronette K. Yancey and Roshan Bastani, will study and promote population-based intervention approaches to health promotion and disease prevention and control, targeting underserved groups.

Center members will also explore the barriers preventing more effective collaboration with local health departments and other key partners engaged in the practice of public health. The center will take a collaborative approach, including members from academia, government, foundations and private/ nonprofit organizations. With a focus on Los Angeles County, the center will facilitate community and academic partnerships in research, train new investigators in health disparities research and assist community partners in implementing effective programs to reduce disparities.

Three early initiatives include: • Studying the pandemics of obesity and sedentariness, which contribute to most health disparities.

• Strengthening the university’s linkage with local health departments, particularly the Los Angeles County Department of Health Services, to assist in their core functions of assurance, assessment and policy development – including highlighting scientific evidence and evidentiary gaps, investigating promising intervention approaches, identifying relevant best practices and providing technical assistance in their implementation.

• Creating training opportunities to foster county and community-based organization leadership development, faculty development in community practice-based scholarship and student learning in applied research settings.

news briefs

new center focuses on eliminating health disparities PLEASE REMEMBER

Dr. Antronette K.Yancey

Dr. Roshan Bastani

ALUMNI DIRECTORY

S AV E T H E D AT E UCLA SCHOOL OF PUBLIC HEALTH ALUMNI AND FRIENDS RECEPTION MONDAY, NOVEMBER 8, 2004 6:30 - 8:00 pm at the Hyatt Regency Capitol Hill

Check the APHA schedule or stop by the UCLA School of Public Health booth for location information.

If you would like more information about the activities of the Public Health Alumni Association, please call (310) 825-6464 or e-mail phaa@support.ucla.edu.

If you are not already receiving and would like to receive the SPH ALUMNI e-NEWS that brings information on events and people of special interest to alumni three times a year, please send your e-mail address with your name and current home and business addresses to publichealth@ support.ucla.edu.

UCLAPUBLIC HEALTH

During the Annual Meeting of the American Public Health Association, November 6 - 10, 2004 in Washington, DC

The first-ever SPH Alumni Directory will be available in July.

If you have not already ordered your directory and would like to do so, please call Harris Customer Service at 1-800-877-6554.

You are a lifetime member of the UCLA School of Public Health Alumni Association if you are a graduate of the UCLA School of Public Health and its executive programs.

SPHmag.June04.20-37

34

6/7/04

11:44 AM

Page 17

honor roll 2003 THE SCHOOL THANKS ALL OF ITS DONORS for their financial support. The following list acknowledges gifts made to the UCLA School of Public Health from January 1, 2003, to December 31, 2003. Although space limitations allow only the listing of donations of $100 or more, contributions for every amount are of great importance to the school and are deeply appreciated. It is important to us that we acknowledge your gift properly. Please let us know of any omissions or errors in listing your name or gift by calling (310) 825-6464.

$1,000,000 ABOVE

AND

THE CALIFORNIA ENDOWMENT THE ROBERT WOOD JOHNSON FOUNDATION

$250,000 - $499,999 THE DORIS DUKE CHARITABLE FOUNDATION

$100,000 - $249,999 ROYAL ADELAIDE HOSPITAL FRED H. BIXBY FOUNDATION BREAST CANCER RESEARCH FOUNDATION THE CALIFORNIA WELLNESS FOUNDATION L.A. CARE HEALTH PLAN

$1,000 - $4,999

CENTER ON BUDGET AND POLICY PRIORITIES EDWARD AND JOANNE DAUER GERALD AND LORRAINE FACTOR FOLEY AND LARDNER RAYMOND D. AND BETTY J. GOODMAN AMBASSADOR LESTER B. AND CAROLBETH KORN LOS ANGELES REGIONAL FOOD BANK ALFRED AND CHARLOTTE NEUMANN PFIZER INC. U. S. PHARMACEUTICALS GROUP

ABDELMONEM AND MARIANNE AFIFI MICHAEL J. ALPER ASPEN ENVIRONMENTAL GROUP LEE E. BAILEY AND LINDA ROSENSTOCK ROBERT D. BLAIR CALIFORNIA PUBLIC HEALTH ASSOCIATION-NORTH MICHAEL D. COLLINS AND KAREN L. MITCHELL COURSE READER MATERIAL BRUCE N. DAVIDSON SAM W. DOWNING JAMES E. ENSTROM TOMAS AND PATRICIA GANZ ROBERT W. GILLESPIE STEVE GUTEKUNST ALAN R. HOOPS IOWA FOUNDATION FOR EDUCATION, ENVIRONMENT AND THE ARTS RAYMOND AND JENNIE JING STEPHEN W. KAHANE AND JANET A. WELLS-KAHANE SEYMOUR F. AND CAROLINE W. KAUFMAN GERALD AND LAURIE KOMINSKI ROBERT AND ADELINE MAH NATIONAL ASSOCIATION OF INJURY CONTROL RESEARCH CENTERS WALTER OPPENHEIMER PACIFICARE BEHAVIORAL HEALTH LORI S. PELLICCIONI

$50,000 - $99,999

$5,000 - $9,999

CANCER RESEARCH FOUNDATION OF AMERICA THE FORD FOUNDATION KAISER FOUNDATION HEALTH PLAN INC. RAND CORPORATION RALPH AND SHIRLEY SHAPIRO U. S. BORAX INC.

IRA AND MARSHA ALPERT AMGEN, INC. BLUE CROSS OF CALIFORNIA CALIFORNIA FOOD POLICY ADVOCATES CEDARS-SINAI MEDICAL CENTER MICHELE DILORENZO ROBERT J. DRABKIN GLAXOSMITHKLINE PLC HELD PROPERTIES INC. SAUL D. LEVY FOUNDATION EDWARD J. O’NEILL THE PROCTER AND GAMBLE COMPANY RUTH J. ROEMER RICHARD E. AND PATRICIA S. SINAIKO TENET HEALTHCARE FOUNDATION WILSHIRE FOUNDATION, INC.

$25,000 - $49,999 AMERICAN CANCER SOCIETY CALIFORNIA DIVISION INC. AVENTIS PHARMACEUTICALS THOMAS E. EPLEY AND LINNAE ANDERSON KAISER PERMANENTE NATIONAL MARCH OF DIMES BIRTH DEFECTS FOUNDATION MONICA SALINAS SPECIAL SERVICES FOR GROUPS

UCLAPUBLIC HEALTH

$10,000 - $24,999

UCLA School of Public Health faculty member and 2003 Lester Breslow Distinguished Lecturer Jared Diamond (left) with the 2004 lecturer, Dr. Lester Breslow, at this year’s event.

PRICEWATERHOUSECOOPERS THOMAS AND JODY PRISELAC ANTHONY AND JEANNE PRITZKER FAMILY FOUNDATION KENNETH J. RESSER WILLIAM T. ROSS RUSTIC CANYON PARTNERS SALINAS VALLEY MEMORIAL HEALTH CARE SYSTEM DAVE SCHMIDT HASKEL SIMONOWITZ GRANT G. SLATER TENET HEALTH CARE PAUL R. TORRENS PAUL S. VIVIANO XIANG ZHANG AND ERIKA LIU

$500 - $999 JAMES P. AGRONICK VICTORIA R. ALLA RUTH M. AREVALO STANLEY P. AZEN AND JOYCE NILAND LEONARD AND JOAN BEERMAN JOY T. BLEVINS FRED AND JOANNE CLAREY DOROTA DABROWSKA FALCON WATERFREE TECHNOLOGIES, LLC FEDERATION OF AMERICAN HOSPITALS FRANCESCO FEDERICO JONATHAN E. FIELDING RONALD C. FORGEY LISA Y. FUNG DAVID M. GITTELMAN ALISA M. GOLDSTEIN HARLAN H. HASHIMOTO HOOPER, LUNDY, & BOOKMAN, INC. THE HORN FOUNDATION MICHAEL S. GOLDSTEIN LEONARD AND NANCY JACOBY AVRAM AND BETH KAPLAN NEAL D. KAUFMAN CHRISTOPHER J. MARDESICH AND EDEN KUSMIERSKY KENNETH E. LEE EDWARD AND JUDITH MALECKI DENISE C. MATHES FRANK P. MATRICARDI AND DIANA M. BONTÁ MARCELO E. MENDOZA ROBERT AND HELEN RAND JACK R. SCHLOSSER MIRIAM SCHOCKEN JUDITH M. SIEGEL

GARY J. SLOAN DONNA J. TESI VERIZON FOUNDATION HONGJIAN YU AND YIHUI WANG

$250 - $499 CRAIG AND GRACE ACOSTA AMGEN FOUNDATION INC. RONALD M. ANDERSEN JAMES D. BARBER CHRISTY L. BEAUDIN LINDA B. BOLTON LESTER AND DEVRA BRESLOW RALPH AND CLAIRE BRINDIS E. RICHARD AND MARIANNE BROWN CALIFORNIA ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS SIMON CHAN ANNE L. COLEMAN AND THOMAS R. BELIN MARK E. COSTA DARYL V. DICHEK KEVIN J. DOODY STEVE DUVALL MICHAEL AND SALLY EBERHARD SAM AND MEREDITH ELROD RANDALL ESPINOZA DANIEL J. FINK PAUL M. FLEISS RITA FLYNN ROBERT AND ROBERTA GERDING FRANK C. GOMEZ ROCHELLE S. GREEN DANIEL P. GROSZKRUGER ANN GURTNER FARHAD AND LATIFEH HAGIGI RONALD JOEL HALBERT JOE AND DIANA HILBERMAN SUSAN D. HOLLANDER DAVID AND BETSY SWANSON HOLLINGER GORDON D. HONDA CAROLYN F. KATZIN KINDRED HEALTHCARE OPERATING INC. COREY AND SUSAN KLEIN LEONARD AND MELODYE KLEINMAN DAVID L. KORCHEK TERI D. LAUENSTEIN KENNETH AND ANNE LAWLER JACK G. LEVINE

SPHmag.June04.20-37

6/7/04

11:44 AM

Page 18

Left to right: Dr. Raymond Goodman, Lester Breslow Distinguished Lecture founder, with faculty member Ralph Frerichs and his wife RIta Flynn, and faculty member Al Neumann.

$100 - $249

JAMES A. MODECKI NICOLE J. MONASTERSKY DORY E. MOORE HAL MORGENSTERN DONALD E. MORISKY ZAHRA MOVAGHAR EDWARD MULLEN CAROLYN C. MURRAY CRAIG G. MYERS JO-ANNA NAKATA ELIZABETH T. NASH RAYMOND AND JANE NASSIEF ROBERT G. NELSON BENJAMIN S. NEUFELD THANH-NGHIA NGUYEN SHARON L. NICHOLS NINA NIU-OK ALICE NORIEGA ROBERT P. NUGENT JUNE F. O’LEARY MARY K. OLOUGHLIN RICHARD CORGEL AND JOAN OTOMO-CORGEL PATRICIA H. PARKERTON LISA I. PARKS ERNESTO O. PARRA

Monica Salinas will accept the Dean’s Award at the 2004 Commencement ceremony for her sustained and generous support.

UCLAPUBLIC HEALTH

MARTIN AND DIANE ADLER JULIE B. AKABOGU-GEORGE ELLEN ALKON AMERICAN HEALTH MANAGEMENT ANTHONY ARMADA SANDRA ARONBERG FRANCES M. ARROWSMITH JAMES D. ARTERBURN TAKAMARU ASHIKAGA DONALD W. AVANT RICHARD A. BARFIELD STEVEN AND CHER BARLEVI ROSHAN BASTANI EVA G. BAUDIN ROBERT N. AND MARGARET BECK MICHAEL J. BELMAN MARLENE D. BELSTOCK STEPHEN J. BENDER PATTI J. BENSON MICHELLE A. BHOLAT SUSAN K. BLACKWELL LINDA B. BOURQUE KATHRYN J. BRAUDE ROBERT J. BRAUN DOROTHY K. BREININGER BONNIE BRINTON HAROLD V. BROWN ELLEN BRZYTWA WAYNE AND SUZANNE BUCK MICHELLE R. BURTON CALIFORNIA COMMUNITY FOUNDATION DENNICE L. CALIHAN CALMAN KURTZMAN MARIA D. CANFIELD MARTIN AND MARY CARR SUSAN J. CARR YING Y. CHAO CHEVRONTEXACO CORPORATION JOAN M. CHOW ALEIN TSE-EN CHUN CALVIN S. Y. CHUN WELDEN AND VIRGINIA CLARK DOUGLAS B. CLARKSON BASIL AND KATHERINE CLYMAN

JOHN COCHRAN MICHAEL AND JUNE COHEN JULIE E. CRONER ANNE R. DACHS STACY DALGLEISH PETER C. DAMIANO TERESA K. DAVID SUZANNE F. DAY DAMON A. DE CROW ANN M. DELLINGER MARTHA J. DEMAREE MICHELLE C. DEMONTEVERDE ROGER DETELS BRIAN P. DOLAN VICTOR G. DOMINGUEZ CONSTANCE E. DUNBAR JOHN EDELSTON ELLEN R. EISEMAN DANIEL AND JACQUELINE ERSHOFF GERALD ESTRIN GAYLE ETIENNE HAMILTON H. FAIRBURN RANDOLPH N. FARBER THOMAS AND PHYLLIS FARVER HELEN H. FEDER LORETTA W. FITZGERALD MAUREEN M. FLANNERY JILLIAN S. FORE PETER FRIEDMAN JOHN R. FROINES SUSAN K. GARDIN ROBERT AND DIANA GHIRELLI STUART GODIN SAMUEL GOETZ REBECCA R. GOMEZ RUTH E. GOMEZ JEFFREY A. GORNBEIN GAIL A. GOSS CLAUDIA GRAHAM KENNETH D. GRAHAM GRANCELL, LEBOVITZ, STANDER, BARNES AND REUBENS MELVIN A. GREENSPAN JAMES E. HADEN BEN AND LOIS HALPERN ANN S. HAMILTON ELISE M. HANDELMAN ELISABETH HANSEN NINA T. HARAWA

friends

STEVEN S. LEWIS MINZHI LIU LOS ROBLES REGIONAL MEDICAL CENTER KENNETH D. MALAMED GREGGORY D. MANSUR THE MARBLEHEAD GROUP LLC RICHARD B. MARCINIAK XIANGYI MENG GARY M. MEUNIER ALLAN E. GORDON AND NANCY J. MONK MARC D. MOSER VIRGIS NARBUTAS NELLY A. NIGRO WALTER W. NOCE PHILIP M. ORAVETZ CHRISTOPHER J. PANARITES JONG-SOON P. PARK PHFE MANAGEMENT SOLUTIONS CARL E. PIERCHALA NINEZ A. PONCE ANDREA E. PORTENIER MICHAEL C. RANDALL THOMAS H. RICE ANTHONY AND DEBORAH RODGERS HOWARD AND JEAN ROSENFELD STUART AND SUZANNE SCHWEITZER ROBERT SCOFIELD BRIAN AND JEANETTE SHERRINGTON RONALD J. SMITH GUOWEN SUN AND WENJIE WANG FOREST S. TENNANT CITRON AND GENEVIEVE TOY BARBARA R. VISSCHER KENNETH M. WEINMAN ADAM B. WEISSBURG WESTCHESTER GENERAL HOSPITAL ARTHUR AND JUDY WINER DAVID K. WOODLY

GINGER HARMON PHYLLIS E. HAYES-REAMS ARTHUR G. HEATH WILLIAM HINDS HORACE AND EDYTHE HINKSTON JOHN A. HIRSHLEIFER ELISE M. HOLLOWAY ALAN HOPKINS JACK H. HUDES ALEX IVERSON JOHN D. IVIE EDWARD H. JEON RICHARD AND JOHANN JONAS KATHERINE M. JONES MARY L. KANE HAN K. KANG ANNE KATTEN HERMAN AND ROSE KATTLOVE RAYMOND A. KEMPF DIANA L. KIEL ROBERT J. KIM-FARLEY NANCY J. KINGSTON JANET L. KIRKPATRICK CHARLES AND ANNETTE KLEEMAN MARA V. KOHN MASAO KOKETSU JAMES J. KORELITZ KOSZDIN FIELDS AND SHERRY ATTORNEYS AT LAW YVONNE C. KRIENS BARBARA M. LANGLANDORBAN HARRISON LATTA BARRON N. LEE MARTIN AND MARILYN LEE ALAN T. LEFOR RONALD AND BETTY LEITER STANLEY A. LEMESHOW JOHN H. LIBBY JOHN A. LINDON KUNG J. LUI HERBERT L. LUNDBLAD MICHAEL J. MADDEN HELEN I. F. MARIESKIND KATHRYN G. MARTI JANE E. MARTIN DONALD A. MCCALLUM HILDY B. MEYERS MAX AND JEAN MICKEY RUTH M. MICKEY ALLEN MILLER ROSS M. MILLER KATHERINE L. MINNIUM LESLIE MINTZ GABRIELLA M. MIOTTO

35

SPHmag.June04.20-37

6/7/04

11:44 AM

Page 19

36 KAREN H. PAWLUK GARY AND ROSA PECHERSKY CORINNE L. PEEK-ASA CATHERINE G. PERCY GARY R. PETERSON ROBERT S. PLOURDE MICHELLE L. POPOWITZ JOEL J. PRELL GEORGE PRESSLER

Tom Epley and Linnae Anderson visit with Dean Linda Rosenstock at a dinner held at the deanâ&#x20AC;&#x2122;s home on May 25.

SHANE S. QUE HEE ALIREZA RABIZADEH ERIC AND LAUREL RABJOHNS EMILY RAMICONE WANDA T. RAMSER ALVIN H. RANSOM MARILYN A. RAY JEAN LE CERF RICHARDSON CRAIG AND ROXANE RICHMAN DAVID J. RICHMAN KEITH S. RICHMAN FRED AND JANET RIEDMAN RIVERSIDE COMMUNITY HOSPITAL NAOMI S. ROSEN SHERYL A. ROSENTHAL MARTIN B. ROSS

CURTIS J. ROZAS JAIME G. SALAZAR SAMUEL SALE SCOTT AND CAROL SANBORN CONNIE C. SANCHIS ALAN P. SANDLER SUSAN M. SAZER LINDA M. SCHAEFFER MAREN T. SCHEUNER ANTHONY H. SCHIFF PETER L. SCHNALL BENEDICT R. SCHWEGLER DEANE C. DEFONTES AND KATHRYN D. SCOTT CHERYL E. SERVAIS EUGENE H. SEYMOUR ELESTIA E. SHACKELFORD DOUGLAS AND LESLIE SHAFFER JAMES J. SHEA JESSIE L. SHERROD GALE F. SHORNICK JESSIE S. SIAU JEFFREY D. SIEGEL JERALD F. SIGALA JAMES B. SIMPSON DANIEL F. SMITH GARY W. SMITH STEVEN SMITH WILLIAM E. SMITH HERBERT N. SNOW GUY AND STELLA SOOHOO CARL L. SPEIZER BRUCE AND NANCY STEELE MILDRED G. STERZ RICHARD L. STERZ KIM C. STEWART CHRISTOPHER M. SULLIVAN LINDA S. SURAPRUIK MARIKA J. SUTTORP JUDY P. SY JOSEPH AND MARY SYIEK SORA P. TANJASIRI NICK TERRANOVA

DOUGLAS G. TEUBER LINDA A. THOMAS MICHAEL PARDI AND JULIE A. TISDALE PARDI JERRY A. TORGERSON JANE H. TURNER DAWN M. UPCHURCH GUSTAVO A. VALDESPINO THEODORE H. SWEETSER III AND JANE L. VALENTINE DAVID AND SUEBELLE VERITY PAULA G. VOORHEES LEAH J. VRIESMAN FRANK H. WAHPEPAH JEANNE C. WAITE MARY J. WAKEFIELD BARTON WALD H. G. WALLACE ANNE F. WALONKER ALBERT B. WANG DAVID M. WEINSTEIN CARL I. WEISSBURG CARRIE L. WELCH KENNETH B. WELLS AND M. CHRISTINA BENSON BRUCE G. WENIGER TARA J. WESTMAN PAULA S. WILLIAMS CHRISTINA J. WITSBERGER THERESA WOEHRLE CATHARINA S. WONG FLORENCE L. WONG STEVEN AND DAYLE WRIGHT THOMAS WRIGHT BERHANE WUBSHET RICHARD AND ROBERTA WYDE CHIERI YAMADA FRANCIS L. YEMOFIO FRANCIS N. YEMOFIO P. STANLEY YODER HERMAN A. ZAMPETTI MICHAEL A.ZAPF HENRY W. ZARETSKY ZHONGWEI ZHANG

FIRST CENTURY SOCIETY First Century Society members are alumni, faculty, staff and friends who have made provisions for UCLA in their will, trust, or other planned giving arrangements.

With generosity and foresight, the following members have designated the School of Public Health as a beneficiary: LESTER & DEVRA BRESLOW ANNE & JOHN COULSON RALPH FRERICHS ROBERT & DIANA GHIRELLI RAYMOND & BETTY GOODMAN GERALD KOMINSKI DAVID KRASNOW JEAN MICKEY WALTER OPPENHEIMER JEANNETTE OREL ANNE S. REHER-LIVIO JEAN SANVILLE GURDON & MARY ANN SMITH SUEBELLE & DAVID VERITY

C A M PA I G N U C L A S C H O O L O F P U B L I C H E A LT H Progress toward goal as of April 15, 2004 Faculty $ 1,984,696 Students $ 2,358,537

UCLAPUBLIC HEALTH

Discretionary $ 2,261,313 Capital $ 56,042 Program/Research $ 29,116,020

SPHmag.June04.20-37

6/7/04

11:44 AM

Page 20

DRIVEN BY THE OPPORTUNITY TO ASSIST the school’s current students at the same time that they’re reconnecting with friends and former classmates, the Public Health Alumni Association (PHAA) Student Support and Alumni Networking Committee has begun holding events to discuss public health careers and offer advice to students.

During events held last winter and this spring, alumni offered information and internship advice in both large-group discussions and informal conversations. Students received assistance in making potential connections for informational and/or job interviews in a variety of public health fields and organizations. In addition, representatives from the UCLA Career Center presented students with general job-seeking, résumé-writing, and interview advice. Dean’s Advisory Board member Eddie Dauer and his wife Joanne have generously provided support for these events.

The PHAA Student Support and Alumni Network Committee is headed by Catharina Wong, M.P.H. ’01. Participating alumni and faculty have included (listed by department): BIOSTATISTICS

Marika Suttorp, M.S. ’98 COMMUNITY HEALTH SCIENCES

Elaine Cheung, M.P.H. ’03 Gale Feldman, M.P.H. ’96 Maureen Flannery, M.P.H. ’81 Betsy Swanson Hollinger, M.P.H. ’97 David Swanson Hollinger, M.S.W., M.P.H. ’99 Laura Ojeda, M.P.H. ’98 Katherine Minnium, M.P.H. ’96 Elaine Robinson-Frank, M.P.H. ’98 Hoa Su, M.P.H. ’98 Marcela Tetta, M.P.H. ’00 Erin Wilson, M.P.H. ’02 Kynna Wright, M.P.H. ’99

37

friends

Public Health Alumni Association career nights

If you have jobs to offer graduating students, have information about student internships, or would like to talk about careers in your chosen area of public health, please e-mail phaa@support.ucla.edu.

Members of the PHAA Student Support and Alumni Networking Committee are planning additional student career events for the academic year 2004-05.

ENVIRONMENTAL HEALTH SCIENCES

Kitty Lim, M.S. ’02 Akiko Tagawa, M.P.H. ’02 EPIDEMIOLOGY

Ralph Frerichs, Dr.P.H. Laura Park, M.P.H. ’03 Marc Strassburg, Ph.D. ’81 HEALTH SERVICES UCLAPUBLIC HEALTH

David Krasnow, O.D., Ph.D., M.P.H. ’98 Christopher Mardesich, J.D., M.P.H. ’98 Nancy Monk, M.P.H. ’87 Dorothy Seleski, M.B.A., M.P.H. ’87 Catharina Wong, M.P.H. ’01

June04.cvr.FINAL

6/7/04

11:17 AM

Page 1

Commencement

2004 America Bracho, M.D., M.P.H., executive director of Latino Health Access, a center for health promotion and disease prevention in Santa Ana, Calif., is the featured speaker at the schoolâ&#x20AC;&#x2122;s 2004 Commencement.

UCLA

UCLA

PUBLIC HEALTH School of

Public Health

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

Nonprofit Org. U.S. Postage PAID

UCLA