UCLA Public Health Magazine - June 2006

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JUNE 2006

UCLA

PUBLIC HEALTH OBESITY’S HEAVY BURDEN

UCLA

an epidemic threatens the nation’s health

School of

Public Health

Biostatistician Christina Ramirez Kitchen seeks to make sense of the complex DNA sequences of the HIV virus – information that could save lives.

Health care costs continue to soar in the United States.

Faculty such as Jack Needleman help us to understand whether we are spending our money wisely.

Typhanye Penniman was not exposed to public health growing up. As a doctoral student, she returns to her community to spread the word.

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UCLA

PUBLIC HEALTH

Albert Carnesale, Ph.D. Chancellor

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

Sarah Anderson Assistant Dean for Communications

Anita Mermel Executive Director of Development

fe a t u r e s

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. Professor, Biostatistics

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

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

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

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

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

La Shawnta Bell-Lewis, Ashley Peterson Co-Presidents, Public Health Student Association

Christopher Mardesich, J.D., M.P.H. ’98

UCLA

President, Alumni Association

School of

Public Health

4

Alumni Hall of Fame: the 2006 Inductees

6 Obesity’s Heavy Burden Diets are higher in fat.

Portions are larger.

Workplaces, schools and communities are more sedentary. Our environment has changed, leading more of us to tip the scales at dangerous levels.

12

ty’s Burden

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Are We Getting Our Money’s Worth?

Formulas for Success

in every issue 23 RESEARCH

12 By developing methods for analyzing the genetic sequences of patients with HIV, Christina Ramirez Kitchen shows scientists how the virus evolves over time and with treatment – information that could save lives.

18 14

Building Capacity Overseas In many parts of the world, the school is helping to strengthen the ability of developing nations to tackle health challenges. Here are six examples.

As new drugs and high-tech advances continue to drive up the price of medical services, experts question whether we are putting enough consideration into how we spend.

Chromium and cancer risk...the value of R.N.’s... discrimination against HIV patients...residential fields and childhood leukemia... the importance of medical interpreters...testosterone’s gender-specific influence on type 2 diabetes.

28 STUDENTS 31 FACULTY 32 NEWS BRIEFS 34 FRIENDS

ON THE COVER More and more of us are tipping the scales at unhealthy levels. As an obesity epidemic grips the developed world, public health professionals and academics are pointing to the need for changes in an environment that has become less conducive to positive diet and physical activity choices.

Cover photo: Getty Images © 2006

PHOTOGRAPHY ASUCLA / TOC: hall of fame; p. 4; p. 32: Brook John Decker / p. 11: Goldstein Lisa Hancock / cover: Needleman, Penniman; p. 18: Rice; pp. 19, 21-22 Reed Hutchinson / cover and TOC: Kitchen; pp. 7-8, 11-12; p. 32: Kaplan Martha Widmann / TOC and p. 18: photo illustration; p. 23 Courtesy of Dr. Ralph Frerichs / p. 16 Courtesy of Dr. Osman Galal / p. 17 Courtesy of Dr. Fred Hagigi / p. 15 Courtesy of Dr. Anne Rimoin / TOC: building capacity; p. 17 Courtesy of Dr. Paul Torrens / p. 15 Courtesy of UCLA School of Public Health / p. 2; p. 31; p. 32: Diamond, lab, stem cell; pp. 33, 37; back cover Getty Images © 2006 / TOC: obesity; pp. 9-10 iStockphoto © 2006 / p. 14 Superstock © 2006 / p. 26 Veer © 2006 / pp. 6-7

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 2006 by The Regents of the University of California.

Permission to reprint any portion must be obtained from the editor. Contact Editor, UCLA Public Health Magazine, Box 951772, Los Angeles, CA 90095-1772. Phone: (310) 825-6381.

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dean’s message THERE IS AMPLE EVIDENCE that ease and convenience are among the most common drivers of daily food and activity decisions.

Unfortunately, contemporary American society has created an environment in which it is easy for adults and children to make poor decisions about exercise and nutrition and difficult for them to make good decisions. The result is an epidemic that unless addressed decisively could lead, for the first time in 100 years, to a shorter life expectancy for the next generation.

Although the consequences of the obesity epidemic fall squarely on the health care system, true solutions fall largely outside. As with other public health problems, we know that the most effective treatment rests with approaches that deal with populations and communities to prevent the problem before it starts, rather than with trying to solve an individual’s obesity problem. If we focus on an individual, rather than look for societal factors and interventions, we will wait a very long time before we turn around this staggering epidemic.

A recent announcement that the beverage industry will remove high-calorie soft drinks from all the nation’s schools is an example of how corporate America can help in tackling this burgeoning problem. But we also need national leadership and courage to combat the forces that are all too comfortable with the epidemic. This means having the courage to stand up to economically vested interests while recognizing that partnering with business and other sectors to craft a myriad of interventions – at local, state and national levels – is needed.

Our cover story (page 6) looks at the causes, including genetic and physiologic factors as well as environmental factors, of the obesity epidemic and more importantly seeks to find solutions. Our faculty members are working closely with business leaders, community groups, government agencies and schools to forge partnerships that will make it easier for people to make healthier decisions. We need to gear our interventions to practical and societal steps that make eating badly less likely, make getting appropriate exercise more likely, and are not simply relying on the magic bullet – the miracle drug or cure – which almost never arrives, and when it does, is never quite as good as originally advertised.

Also grabbing national headlines and much focus at the school is Avian Flu and a potential pandemic. I’m pleased to announce that the UCLA School of

UCLAPUBLIC HEALTH

Public Health will soon be home to the first-of-its-kind high-speed, high-volume laboratory network (page 32). The lab will be capable of quickly analyzing and processing high quantities of biological samples to enhance our ability to gather and analyze more surveillance data, improving our nation’s ability to respond quickly to a bio-emergency such as a bioterrorist attack or flu pandemic.

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This effort introduced me to the newest member of the Dean’s Advisory Board and winner of this year’s Dean’s Award, Cindy Harrell Horn. I met Cindy when she came to my office to talk about the necessity of such a lab. With an initial federal investment of $6 million in federal funding, we are poised for additional federal dollars as well as seeking funding from the State of California and private supporters. Behind each of these investments is the investment of time and energy from Cindy Horn. She has become an ardent supporter of the school and our work and has been a key to helping us realize our fundraising goals.

As the decade-long Campaign UCLA comes to a close, I’m pleased to report that the School of Public Health raised more than $56 million in private support – exceeding our original goal by more than three-fold and our revised goal by 183% (page 34). These funds enabled us to provide financial assistance to more than 500 students and helped launch important new public health initiatives to address global health, emerging infectious diseases and eliminating health disparities. Additionally, major classroom renovations and updates of our information technology infrastructure have been made possible, as has the creation of a new career services office to assist our graduating students in their career exploration and job placements.

With the close of another school year, I am reminded once again that 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

2005-2006 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 (Chair) Robert J. Drabkin Tom Epley Gerald Factor (Vice Chair) Michael R. Gardner Robert W. Gillespie Alan Hopkins* Cindy Harrell Horn Stephen W. Kahane* Carolyn Katzin* 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 know that their skills, enthusiasm and commitment to doing good things will allow them to do just that.

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 04-05 $42.2 million

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alumni hall of fame: the 2006 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 2006 inductees, recognized at the Breslow Lecture and Dinner on April 24, exemplify the school’s commitment to teaching, research and service.

UCLAPUBLIC HEALTH

2006 Hall of Fame inductees (l. to r.)

Zunyou Wu, Barry R. Wallerstein and Stanley Lemeshow

STANLEY LEMESHOW, Ph.D. ’76 Whether it’s as an educator, researcher or administrator, Lemeshow’s leadership has made him an ambassador for public health in the educational setting. Lemeshow, who has served as dean of the School of Public Health and director of the Center for Biostatistics at Ohio State University (OSU), studies the use of statistical modeling in medical and public health research and has published extensively, including four books, 130 individual publications and more than 20 book chapters. His current research is in the areas of intensive care outcomes, cancer research and stress and healing. In his capacity as dean, Lemeshow is laying the foundation for OSU’s School of Public Health to become a strong and independent entity within the university’s prominent Center for Health Sciences. He directs the Summer Program on Applied Statistical Methods, is on the faculty of the Erasmus Summer Program held each August in Holland, and has taught more than 75 short courses in the United States, Europe and Australia.

Lemeshow has earned widespread recognition for his leadership and teaching over the course of his career, which included 23 years on the faculty at the University of Massachusetts School of Public Health prior to joining the OSU faculty in 1999. Among others, he was elected Fellow of the American Association for the Advancement of Science, awarded the Wiley Lifetime Award, selected Distinguished Graduate Alumnus (Biostatistics) by the University of North Carolina Graduate School Centennial, elected Fellow of the American Statistical Association and awarded the Statistics Section Award from the American Public Health Association.

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ZUNYOU WU, M.D., M.P.H. ’92, Ph.D. ’95 Wu is making his mark in global health as director of the National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, the highest position for HIV/AIDS control in China. He was the first public health investigator to report the HIV epidemic among former plasma donors in rural China in 1995 and initiated a health promotion program supporting condom use. Wu was also the first to successfully implement outreach programs for female sex workers through extensive behavioral interventions.

He led China’s first research project for harm reduction among drug users, then took a leadership role in scaling up China’s national methadone maintenance program. His research sparked the creation of national guidelines in China for sex workers and substance users, translating science into life-saving public health programs. For his role in stopping the SARS outbreak in China, Wu received special commendation from the Chinese government.

Wu also serves on committees that oversee HIV intervention projects in Russia, India, Peru and Zimbabwe, as well as the Task Force on Drug Use and HIV for the United Nations Office on Drugs and Crime and the Joint United Nations Programme on HIV/AIDS in the Asia-Pacific region. He has competed successfully for research and training grants from the National Institutes of Health (NIH), numerous non-governmental organizations, the Rockefeller Foundation, the World Bank, and the World Health Organization. Wu was also one of the first non-Americans to be awarded an International Clinical, Operational, and Health Services Research Training Award from the NIH. As the China director for the UCLA/AIDS International Training and Research Program, he has played a key role in recruiting students and mentoring Ph.D. students.

PREVIOUS INDUCTEES Ira R. Alpert, M.S.P.H. ’66 Wendy Arnold, M.P.H. ’82 Stanley P. Azen, Ph.D. ’69 Donna Bell Sanders, M.P.H. ’81 Diana M. Bontá, R.N., M.P.H. ’75, Dr.P.H. ’92 Linda Burhansstipanov, M.P.H. ’72, Dr.P.H. ’74 Virginia A. Clark, Ph.D. ’63 Francine M. Coeytaux, M.P.H. ’82 Suzanne E. Dandoy, M.D., M.P.H. ’63 Mark Gold, D.Env. ’94 Harold M. Goldstein, M.S.P.H. ’89, Dr.P.H. ’97 Raymond D. Goodman, M.D., M.P.H. ’72 Richard A. Goodman, M.D., J.D., M.P.H. ’83 Nancy Halpern Ibrahim, M.P.H. ’93 Carolyn F. Katzin, M.S.P.H. ’88, C.N.S. Robert J. Kim-Farley, M.D., M.P.H. ’75 Kenneth W. Kizer, M.D., M.P.H. ’76 James W. LeDuc, M.S.P.H. ’72, Ph.D. ’77 Angela E. Oh, J.D., M.P.H. ’81 Keith S. Richman, M.D., M.P.H. ’83 Pauline M. Vaillancourt Rosenau, M.P.H. ’92, Ph.D. Jessie L. Sherrod, M.D., M.P.H. ’80 Irwin J. Shorr, M.P.H. ’72, M.P.S. Stephen M. Shortell, M.P.H. ’68, Ph.D. Shiing-Jer Twu, M.D., M.P.H., Ph.D. ’91 Kenneth B. Wells, M.D., M.P.H. ’80

UCLAPUBLIC HEALTH

Please access information on 2007 nominations at www.ph.ucla.edu/alumni_hall.html, or call (310) 825-6464.

hall of fame

BARRY R. WALLERSTEIN, D.Env. ’88 For more than two decades, Wallerstein has developed and implemented ground-breaking strategies to attain clean air standards – and their accompanying health benefits – for all residents of Southern California. As executive officer of the South Coast Air Quality Management District (AQMD) since August 1997, he serves as chief of staff to implement environmental protection policies as approved by the agency’s Governing Board, and to work proactively with state and federal regulatory officials, local governments, and community stakeholders.

In recent years, he has carried out innovative programs to: address specific community and neighborhood environmental justice issues, including the evolving area of disproportionate and cumulative impacts; identify and reduce air toxics exposure (especially diesel particulate); integrate voluntary cleanup incentives into regulatory structures; and strengthen public-private investment in clean fuels and sustainable energy technologies.

Wallerstein was first charged with carrying out the historic set of Environmental Justice Initiatives adopted by the AQMD Governing Board in 1997, including a variety of strategies to improve two-way communication between local residents and the air district. Together, these strategies have resulted in a sea change in the way the South Coast air district scientifically assesses health risk from air pollutants, and residents now have a much stronger voice in shaping and prioritizing regional pollution control efforts. Wallerstein has demonstrated that strengthened partnerships among all community sectors can lead to the successful accomplishment of clean air initiatives.

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6 D IETS

ARE

HIGHER IN FAT.

P ORTIONS LARGER .

ARE

W ORK -

PLACES , SCHOOLS AND COMMUNITIES ARE MORE SEDEN TARY.

O UR

ENVIRON -

MENT HAS CHANGED , LEADING MORE OF US TO TIP THE SCALES AT DANGER OUS LEVELS .

Obesity’s Heavy Burden

An Epidemic Threatens the Nation’s Health Where did this bulging waistline come from?

UCLAPUBLIC HEALTH

Among the nation’s children 34% are overweight and 17% are obese, up from 28% and 14% at the beginning of this decade.

In the evolutionary equivalent of the blink of an eye, overweight is suddenly the overwhelming norm in the United States.

Two of every three U.S. adults – 129.6 million people – are classified as overweight. Nearly half of them – more than 60 million – are obese. The proportion of obese adults, now estimated at 32%, has more than doubled in 30 years.

Among the nation’s children 34% are overweight and 17% are obese, up from 28% and 14% at the beginning of this decade. Since 1980, the prevalence of overweight U.S. children has doubled; overweight in adolescence has tripled.

A study by researchers at UCLA and RAND found that the effects of obesity are similar to 20 years of aging, and that obese adults have 30%-50% more chronic medical problems than those who smoke or drink heavily. Obesityrelated health care conditions contribute as much as $93 billion to the nation’s annual medical bill, according to a 2003 study by the Centers for Disease Control and Prevention (CDC). A 2005 study in the journal Health Affairs estimated that such conditions accounted for 11.6% of total health care spending in 2002, up from just 2% in 1987.

Not long ago, medical students were taught that they were unlikely to see type 2 diabetes in anyone under 40; now, type 2 – no longer called “adult-onset”

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— Dr. Antronette Yancey

UCLAPUBLIC HEALTH

“If two-thirds of the population is overweight, you have a societal issue, and individual solutions are not going to be enough.”

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cover story

– is being diagnosed at alarming rates in children under 10. That’s one reason U.S. Surgeon General Richard Carmona calls childhood overweight and obesity “the fastest growing, most threatening disease in America today.”

How big a threat? Dr. Linda Rosenstock, dean of the UCLA School of Public Health, raises this alarming specter: “It’s plausible that we’re going to see for the first time in 100 years that the generation coming up behind us will have a shorter life expectancy than the current one.”

What has happened? Why are so many people in this country carrying so many extra pounds? On the one hand, the calculus is simple: Excess calories going in for calories burned means people are gaining weight. But the fact that this equation applies to twice as many of us as it did a generation ago suggests that something is different.

“We know several things about this epidemic,” says Rosenstock. “It came upon us very quickly; it is global, although one in which the United States not too proudly leads our counterparts in the developed world; and it likely reflects a number of factors, including genetic and physiologic factors, coupled with environmental factors such as increased food availability, decreased expenditure of energy due to

more sedentary work, and environments that aren’t conducive to walking or other forms of exercise.”

To be sure, we are eating differently than we were a few decades ago. Fast food – notoriously high in fat and calories – represented 4% of total U.S. food sales outside the home in the middle of the 20th century…and 34% by the end of it. A recent study by the UCLA Center for Health Policy Research, based in the School of Public Health, found that half of California teens eat fast food at least once a day. By comparison, less than 25% of the state’s teens meet the daily recommendation of five servings of fruits and vegetables.

For many communities, the road to healthy eating is arduous. Dr. Antronette Yancey, associate professor at the school, works locally with the CDCfunded Racial and Ethnic Approaches to Community Health (REACH 2010) project, which has hired and trained community members to document the quality and variety of healthy food options in low-income neighborhoods. Yancey’s group has found that stores in such neighborhoods 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 areas is significantly poorer. These neighborhoods also tend to have fewer supermarkets per capita, and a higher proportion of fast-food restaurants. Exacerbating matters, Yancey notes, are print, billboard and broadcast advertisements for unhealthy foods and beverages – cheap sources of comfort in managing lives that are highly stressful.

In an era when adults are more likely to work in sedentary jobs than their parents and grandparents, their children are spending more time in front

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Stephanie Vecchiarelli,

UCLAPUBLIC HEALTH

M.P.H. ’01 Vecchiarelli’s experiences studying adolescent reproductive health and working for the Division of Adolescent and School Health at the Centers for Disease Control and Prevention during her internship as an M.P.H. student, along with her background in teaching, led to her desire to work in school health. “I strongly believe that if students are not healthy, they will not be able to reach their full academic potential,” Vecchiarelli says. “If students aren’t eating nutritionally, getting enough sleep, are worrying about violence in their homes, or don’t receive proper medical, dental, or vision care, how can we expect them to concentrate in school? I also know that schools cannot do this work alone. They must work with parents and the entire community to make lasting changes.” Vecchiarelli, who says she grew up in a family with poor dietary habits and has had to make major dietary and physical activity changes as an adult, is currently a project director for the UCLA School of Public Health’s Nutrition Friendly Schools and Communities program, helping to determine the impacts of schoolbased environmental changes on student, staff, and parent dietary and physical activity knowledge, attitudes, and behaviors. She also completed a study of the development, implementation, and impact of the LAUSD soda and junk food ban as part of her doctoral dissertation in the UCLA School of Education.

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of the TV or computer than previous generations – roughly a quarter of their waking hours. Many schools have cut back on physical education and after-school sports and dance programs, particularly in lowincome areas, where obesity is rising most rapidly.

The number of children who walk to school declined over a single generation from 80% to just 10%. Many urban neighborhoods are considered unsafe for walking, or are not conducive to exercise due to poor design and urban sprawl.

“A lot of people don’t realize that there is a huge environmental component to this obesity epidemic,” says Yancey. “Human beings didn’t just suddenly become lazy and unwise in their eating choices.

What has happened is that our environment has changed dramatically in a very short period of time.”

The rapid rise in the epidemic has left researchers and public health professionals scrambling to determine how best to combat it. Federal funding supports studies aimed at everything from getting a better grasp of obesity’s pathophysiology to identifying successful ways of influencing healthy eating and physical activity levels. “There are so many factors influencing this problem that it’s going to take multiple approaches,” says Dr. Mark Schuster, professor at the school and director of the UCLA/RAND Center for Adolescent Health Promotion.

On one front, researchers are attempting to better understand the gene-environment interactions that are fueling the epidemic. Dr. Simin Liu, professor of epidemiology at the school, has spent the last decade analyzing data from large long-term studies in an effort to home in on dietary patterns as they relate to obesity and type 2 diabetes risk. His work

“A molecular understanding alone is not going to provide the solution.

We already know that people need to eat less and exercise more, but there are many forces that are working against their ability to do that.”

— Dr. Simin Liu

has been influential: For example, looking at historical data provided by the CDC along with dietary consumption data from the U.S. Department of Agriculture, Liu and colleagues at Harvard concluded that the increased consumption of rapidly absorbed, refined carbohydrates in the U.S. diet has paralleled the rise in obesity and type 2 diabetes. His findings helped to establish regulatory and labeling guidelines for the FDA’s whole grains and heart disease health claims, and informed the Healthy People 2010 and 2005 Dietary Guidelines.

Liu believes that studies seeking to understand the molecular underpinnings of obesity have the potential to strengthen the argument for a population approach to prevention as well as improving efforts by enabling more targeted messages to be delivered about diet, based on people’s genotypes.

But he shares the view of many in public health that prevention efforts aren’t failing for lack of knowledge about obesity’s causes. “A molecular understanding alone is not going to provide the solution,” Liu says. “We already know that people need to eat less and exercise more, but there are many forces that are working against their ability to do that.”

Yancey contends that much can be gained by learning about the role of the sociocultural environment in encouraging or discouraging healthy eating and physical activity. While a growing body of research is documenting the impact of access to parks, walking trails and health clubs on people’s exercise levels, Yancey is addressing the potential health benefits of changing the culture of a workplace or organization. Corporate strategies such as encouraging gym membership through subsidies or on-site facilities are important, she notes, but Yancey believes workplaces also need to be more proactive, to the point where healthy on-the-job lifestyles become almost unavoidable. If healthy snacks replace doughnuts at meetings and events, structured group exercise breaks become an entitlement on par with coffee breaks, and parking near work facilities is limited to people with physical disabilities, employees will have an easier time getting, and staying, in shape. “The public is so unfit right now that most people have lost touch with how much better it feels to be active,” she says.

Yancey is currently co-leading a project with a Georgia Tech researcher to assess the potential influence of architectural design in that regard. Their study compares the physical activity levels of employees on either end of a downtown Los Angeles building: On one side, there is easy access to stairs in an aesthetically pleasing location, providing a desirable alternative to elevators that don’t go to every floor; on the other, the stairs are tucked away in an inconvenient location and elevators stop at each floor.

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Shauna Harrison Jabar Akbar, M.P.H. Obesity is affecting the health outcomes of the general population, particularly the poor and many underserved minority communities. Akbar, a doctoral student at the school, works with a team of researchers from Georgia Tech University and UCLA on a project that assesses the utilization of stairs in a building whose architectural design is mostly conducive to physical activity. The main elevators stop at select floors, forcing employees to use the stairs to get to a desirable floor, while employees who work on the other side of the building don’t have access to the “skip” elevator design. Akbar is collecting data on the amount of stair usage by employees on both sides.

For another project, Akbar helped to create a research tool that is assessing the weight-related outdoor advertising appearing in geographical areas that are predominantly African American, Latino or white in five U.S. cities. “The media have been used to market unhealthy products such as junk food, alcohol, and tobacco to specific consumer populations,” Akbar says.

“With the growing disparities debate, many communities are being unfairly singled out as targets of these products.”

Akbar hopes eventually to use his doctoral degree to pursue further obesity-related community intervention research as a junior faculty member and researcher.

UCLAPUBLIC HEALTH

“One of the key questions is whether engaging in more physical activity in the work environment will translate to doing more to stay in shape in one’s spare time,” Yancey explains.

Other faculty are working to improve the school and home environment for children. The Nutrition-Friendly Schools and Communities program established

by Drs. Charlotte Neumann, Michael Prelip and Wendelin Slusser provides schools in the Los Angeles Unified School District (LAUSD) with a flexible, lowcost roadmap for creating a positive environment for good health. The effort has identified 15 steps schools can take toward becoming more “nutrition friendly,” including increasing parental involvement around health issues, providing healthy school lunches, integrating nutrition education in the curriculum, and promoting physical activity. In a pilot study involving eight schools, the researchers found that outlining these steps and providing a program liaison who works closely with educators and parents to tailor strategies to individual schools and communities resulted in significant changes in the school environment.

Schuster was recently awarded a grant from the National Institutes of Health to work with LAUSD, the Los Angeles County Department of Health Services, and other community partners in developing and testing a strategy for obesity prevention in middle-school-age youth. “As children grow older, parents and schools have less influence over what they eat,” he notes. “They’re going off on their own to buy food for the first time, and the choices they are making are often unhealthy ones.”

Interventions aimed at this population need to take into account the delicate issue that adolescents tend to be particularly self-conscious about their bodies. “At a time when they are developing their self-confidence, we don’t want the health care system to be undermining it in the process of trying to help them be healthier,” Schuster says. Nonetheless, he adds, parents should be assisted in recognizing that they can still have an influence on their child’s lifestyle during adolescence; all parents, Schuster contends, should be encouraged to provide a good example by exercising and eating well.

Targeting not only parents but also others with the potential to influence behaviors is viewed as an important strategy. With a grant from the National

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cover story

Fast food, notoriously high in fat and calories, represents 34% of U.S. food sales outside the home.

As a schoolteacher, Harrison noticed the poor health habits of her students and how that affected their inclass behavior. Although she was teaching Spanish, she also used the classroom to educate her students on proper nutrition and lifestyle habits. Harrison wanted to create an entire class dedicated to such health topics, but her school’s administration failed to embrace the idea.

“This created a fire in me to want to improve the nutrition and fitness of children,” she says. Harrison came to UCLA for the joint M.P.H. and M.A. program in Latin American Studies. She spent her internship (supported by funds from the school’s NeumannDrabkin-Bixby program) teaching nutrition to preschool children in Costa Rica, where she had gone as an undergraduate to study the influence of American media on body image in Costa Rican girls. This fall, she will start a Ph.D. program in health communications at Johns Hopkins University. “I plan to examine the spectrum from obesity to eating disorders, with attention to the importance of mental health and the role of the media,” says Harrison, a certified personal trainer and group fitness instructor. “I hope to bring health education that improves nutrition, increases physical activity and builds self-esteem to our schools so that children have the opportunity to make healthier choices as they grow older.”

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Judith Mercado,

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Lauren Neel

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Before coming to UCLA, Neel was an AmeriCorps member serving the Yolo County Health Department, First 5 Yolo and the Yolo County Children’s Alliance.

She coordinated the efforts of each of these organizations in promotion of the community goal: to reduce the incidence of childhood obesity in Yolo County. “My favorite project was going into the high schools and presenting a health education workshop using the film Super Size Me,” Neel says. “Getting into the schools and having the opportunity to talk directly with the students was a great opportunity and made me excited to continue working toward my goals.” Her experience as an M.P.H. student has solidified Neel’s commitment to promoting healthy eating and increased physical activity. She works with the Nutrition Friendly Schools and Communities study investigating nutrition and physical activity behaviors in elementary school students in LAUSD. Through a summer internship at Neutrogena Health and Fitness Corporation, she is designing employee wellness materials, creating fitness challenges and coordinating healthy eating initiatives. Ultimately, she plans to get a personal training license and is considering becoming a registered dietitian after completion of her M.P.H. “At the end of the day,” Neel says, “I hope I end up somewhere where I can help people reach their health goals and make a real difference.”

M.P.H. ’04 As part of her M.P.H. program, Mercado completed an internship in which she helped design, implement and evaluate a summer fitness and nutrition program for children at a church in Inglewood. “It was really fulfilling to expose the kids to nutrition and fitness in a fun, healthy way,” she says. That summer, as she realized that her younger sister, then 7, had been gaining weight considerably, Mercado developed an even stronger inclination to pursue a career in which she could help. Now a wellness coordinator for the Johnson & Johnson company Biosense Webster, Mercado coordinates, markets, implements and evaluates health education/ behavior change programs around weight management, physical activity, smoking cessation, blood pressure and cholesterol management. She also teaches nutrition to overweight children for an organization called PowerPLAY MD. Her sessions for these children and their families help them with understanding portion sizes, reading labels, healthy snacking, and navigating fast food choices. “I have been fortunate to see very positive changes and understand what lies underneath many overweight children’s struggles,” Mercado says. “In some cases, parental involvement is the key to helping their children take the excess weight off. In other cases, the children’s own motivation is much stronger than their parents’ lack of understanding and support, and to witness that is beyond inspirational.”

Adults are more likely to work in sedentary jobs than their parents and grandparents. Children spend one-fourth of their waking hours in front of the TV or computer.

Center for Minority Health and Health Disparities, Yancey is attempting to promote healthy eating and physical activity among health and social services workers with the idea that if they are successful it will, in turn, make them more likely to promote those behaviors among their clients.

Similarly, a study led by Dr. Judith Siegel, professor of community health sciences at the school, aims to enhance opportunities for teachers and staff at eight LAUSD elementary schools to engage in physical activity and healthy eating at work. The project came out of observations from the Nutrition Friendly Schools and Communities program that the rate of overweight and obesity among the faculty and staff at the schools mirrored the high rate in the overall population. “We felt that by helping these individuals work toward becoming healthier, we might also improve the likelihood that they would be good role models and enthusiastic supporters of promoting healthy behaviors among the children and families at their schools,” Siegel explains.

The study uses a participatory approach, allowing a committee of teachers and staff at each school to develop their own worksite health promotion program within the project’s financial constraints. “We’re trying to find success with interventions that cost little, if anything, and are sustainable,” says Prelip, co-principal investigator on the study. Activities chosen have ranged from walking clubs, yoga and exercise classes to healthier food options at staff meetings and in lunch rooms.

While the researchers hope that promoting healthier lifestyles among the faculty and staff will ultimately have a more far-reaching influence, their immediate concern is how it will affect the participants. “There are major advantages to doing health promotion in the workplace,” says Siegel. “It’s where people spend the largest proportion of their waking hours, and if there is collective involvement and enthusiasm for these programs, that creates a good environment for behavior change that can carry over to other aspects of people’s lives.”

For all California schools, the nutrition environment will be improved by two new state laws that go into effect next year, implementing the nation’s most rigorous standards on the nutritional content of a la carte foods, snacks, and beverages sold on K-12 public school campuses. The signing by Gov. Arnold

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“We felt that by helping [school teachers and staff] work toward becoming healthier, we might also improve the likelihood that they would be good role models and enthusiastic supporters of promoting healthy behaviors among the children and families at their schools.”

— Dr. Judith Siegel

ents to buy products that we know to be unhealthy for them – it’s impossible to say this is all a matter of personal responsibility. When there’s fast food on every corner and physical education is being taken out of the schools, it’s not just the individual who needs to be held accountable.”

“If two-thirds of the population is overweight, you have a societal issue, and individual solutions are not going to be enough,” agrees Yancey.

“Certainly education and motivation are important, but we also need to figure out, as a society, ways we can share in the cost of adopting and maintaining healthy lifestyles.”

Rosenstock also agrees that more proactive action is needed – and that focusing too heavily on individual-level behaviors is a mistake. “So much of what is happening with regard to obesity is truly beyond the control of the individual,” she says.

More than just trying to educate people about the importance of healthy diet and exercise, she believes a partnership among the medical and public health systems as well as industry, communities and all levels of government is needed. “We have to get ahead of this one,” she says, “because the obesity problem has been worsening while we’ve been taking baby steps to address it.”

Ying-Ying Goh, M.D. Goh, a research fellow pursuing an M.S. in health services, is a pediatrician who has seen firsthand the health consequences – from asthma exacerbations to diabetes – of children being overweight. “It made me interested in pursuing research about both medical and environmental causes of overweight in children – in particular, how public policy can help to reduce childhood overweight,” she says. While in residency training at Children’s Hospital Boston, Goh conducted a survey of pediatric residents and found that most viewed childhood overweight as an important problem, but that there were significant barriers to being able to address it as a physician. Currently, she is working on a study with a team at the UCLA/RAND Center for Adolescent Health Promotion and the Los Angeles Unified School District (LAUSD). The Adolescent Healthy Living Study is a research partnership to develop and pilot an intervention that addresses weight-related health issues among LAUSD middle school students. Goh is conducting interviews with a wide range of community leaders, and will assist with parent and student focus groups in order to inform the development of an intervention that will be implemented in middle schools. She is also interested in the impact of media use on children’s health, and plans to pursue projects in that area.

UCLAPUBLIC HEALTH

California Gov. Arnold Schwarzenegger signs legislation establishing the nation’s most rigorous nutrition standards for foods and beverages sold on K-12 public school campuses.The legislation was championed by the California Center for Public Health Advocacy, led by Dr. Harold Goldstein (M.S.P.H. '89, Dr.P.H. '97), pictured third from left.

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cover story

Schwarzenegger of the laws – which establish limits on fat and sugar content and portion size, effectively banning sales of “junk food” and soda at the schools – culminated six years of work by the California Center for Public Health Advocacy (CCPHA). The center, under the leadership of UCLA School of Public Health alumnus Harold Goldstein (M.P.H. ’89, Dr.P.H. ’97), was established in 1998 to raise awareness about public health issues and mobilize communities to promote the establishment of effective health policies. CCPHA has helped lead efforts to improve children’s food and physical activity environment, helping to ensure that they can make healthy eating and activity choices.

Following up on the success of its campaign for new nutrition standards, CCPHA is sponsoring legislation that would provide funding to train elementary school teachers in new guidelines on how to teach physical education. “With all of the academic testing going on, physical education has fallen by the wayside,” says Goldstein, “and it’s time to make children’s physical health as important as their intellectual health.” CCPHA is also backing a bill in the California Legislature that would create an incentive for companies to open grocery stores in low-income communities or refurbish ones that are already there, improving residents’ access to healthy foods.

Goldstein is finding considerable support for both bills. “The passage of the school nutrition standards was a landmark, but it was a small first step in creating environments in schools and communities that support adults and children in making healthy food and physical activity choices,” he says.

“Too many policy makers have had the mistaken belief that the obesity epidemic is all a matter of personal responsibility. But they are starting to understand that it’s also a matter of government responsibility and corporate responsibility. When the food industry in the United States spends billions of dollars advertising unhealthy foods and beverages to our children – hiring psychologists and marketers to figure out the best ways to convince kids and par-

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12 BY

DEVELOPING

METHODS FOR ANALYZING THE GENETIC SEQUENCES OF PATIENTS WITH

HIV, C HRISTINA R AMIREZ K ITCHEN SHOWS SCIENTISTS HOW THE VIRUS EVOLVES OVER TIME AND WITH TREATMENT

–

INFORMATION THAT COULD SAVE LIVES .

Formulas for Success

Biostatistician Decodes DNA Patterns to Fight HIV As scientific debuts go,

it would be hard to top the splash made

by Dr. Christina Ramirez Kitchen, whose first peer-reviewed publication was co-authored with a famous

UCLAPUBLIC HEALTH

HIV/AIDS clinician – and generated considerable controversy.

In the mid-1990s, Ramirez Kitchen was pursuing a graduate degree in statistics at Caltech when her thesis adviser asked if she would be interested in participating in a study of HIV progression. The project involved working with the adviser’s neighbor, Dr. Michael S. Gottlieb – the physician who, while at UCLA in 1981, published the first report describing cases of AIDS. Now, amid reports from clinical trials that the introduction of protease inhibitors and highly active antiretroviral therapy (HAART) was resulting in dramatic improvements in patients, Gottlieb, who was running a large HIV clinic, was looking for help in investigating why what he was seeing in his own practice seemed different from what he was reading about in the clinical trials. Ramirez Kitchen agreed to assist with the statistical analysis, working with Gottlieb and HIV researcher Scott Kitchen – her future husband.

It would be years before their findings would be accepted for publication.

Among the group’s conclusions: The decrease immediately seen in HIV morbidity and mortality following the advent of HAART treatment was most likely transient, the result of a period of delayed disease progression. “We found that resistance was winning – that certain patients were still failing these HAART regimens,” Ramirez Kitchen recalls. “It was so contrary to what had been reported that the journals didn’t want to believe it at first. People were talking about HAART as a possible cure for HIV because of the good results in the clinical trials. But in the clinic, where there is a more diverse patient population and there

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devise an important new clinical strategy that would drive the virus into a less fit state. “We believe this could provide hope for patients in whom the virus has been resistant to treatment,” she says.

Another novel methodology helped Ramirez Kitchen make important discoveries about the virus and its response to HAART treatment. HIV typically has two types of co-receptors, CXCR4 and CCR5. Ramirez Kitchen’s group found that even when HAART fails to control the virus, it can still change it into a less pathogenic form by forcing it to switch from the CXCR4 co-receptor to the lesspathogenic CCR5 co-receptor. “We believe that’s one of the reasons that some patients who fail to respond to treatment still fare better if they stay on it,” Ramirez Kitchen explains. In particular, she says, for patients who express the CXCR4 phenotype, switching to CCR5 appears to lead to an improved clinical prognosis.

“The real importance of this work is the methodology that allows us to quantify the proportion of a patient’s virus that uses CXCR4 or CCR5,” Ramirez Kitchen says. “That is especially important to know with the advent of co-receptor specific therapy and entry inhibitors.” She and her colleagues subsequently obtained a patent on the methodology.

Ramirez Kitchen has long been drawn to using math as a way to solve important problems. “That’s probably why I’m a bit more applied than most biostatisticians,” she says. “I like to be able to ask a question and try to come up with an answer, especially as it relates back to the clinic.” Some of her most rewarding moments as a faculty member, she adds, occur when she can see the excited look in her students’ eyes as they realize through their research that the theoretical concepts they learned in the classroom can be used to help scientists and physicians understand clinical problems, and thus can make a difference in patients’ lives.

Ramirez Kitchen tells her students that one of the most important skills for biostatisticians is a strong understanding of the subject matter to which they’re applying their formulas. “As a statistician, you need to be able to develop new methodology that is appropriate for your data, implement that methodology and then translate it so that it’s understandable to the other scientists and clinicians,” she says. “To do that, it’s extremely helpful to have a good understanding of the biological system you’re working with. That way, you can bring more to the problem, and even help to initiate new inquiries.”

13

“We try to use these long strings of DNA components to make sense of what the virus is doing so that we might be able to outsmart it – to use its own ability to mutate against itself.”

—Dr. Christina Ramirez Kitchen

UCLAPUBLIC HEALTH

tends to be less compliance to the regimen, we were finding viral resistance.”

Although it took time, the results ultimately gained widespread acceptance in the scientific community, as did another element of the team’s findings: that a patient’s initial response to HAART is predictive of future clinical prognosis.

Ramirez Kitchen, who joined the UCLA School of Public Health faculty as an assistant professor of biostatistics in 2001, has been bringing her statistical expertise to HIV/AIDS studies ever since.

“It’s such an interesting problem,” she says.

“At the time I started, protease inhibitors were new, HIV sequencing was new, and the virus and our perception of it were changing so much. It was an exciting time to become involved.”

Ramirez Kitchen has focused on how HIV mutates in response to the drugs used to treat it, the process by which the virus resists drug treatment, and its “fitness” – the Darwinian process by which the strains of the virus that survive attacks by drugs and the immune system and are able to replicate tend to be the strongest, making the next generation more fit and difficult to combat.

Many of these questions can be answered with molecular sequence data. Using DNA and RNA sequences, Ramirez Kitchen and Dr. Marc Suchard, an assistant professor of human genetics and biomathematics at UCLA, have developed a methodology enabling the simultaneous analysis of multiple sequences across multiple patients over a period of time. “We try to use these long strings of DNA components to make sense of what the virus is doing so that we might be able to outsmart it – to use its own ability to mutate against itself,” she explains.

“Prior methods didn’t allow for longitudinal observation, and that’s where things get interesting – studying how the virus evolves. We use our methods in an effort to translate what’s going on in the clinic so that we can better understand how the virus is affecting patients.”

Ramirez Kitchen is excited about her most recent studies and what they could ultimately mean for HIV patients who have not responded to HAART. Working with her husband, who is now a virologist at UCLA, and Dr. Jerome Zack, an immunologist and associate director of the UCLA AIDS Institute, she developed a statistical methodology to determine which protease mutations are most harmful to the virus, and confirmed its validity in a study with Zack’s SCID-hu mouse model of HIV. Now, Ramirez Kitchen is working with other UCLA colleagues in an effort to use that information to

faculty profile

ess

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14

IN

MANY PARTS

OF THE WORLD , THE SCHOOL IS HELPING TO STRENGTHEN THE ABILITY OF DEVEL OPING NATIONS TO TACKLE HEALTH CHALLENGES .

H ERE

ARE SIX

EXAMPLES .

Building Capacity Overseas

Faculty Lend Expertise to Public Health Efforts Abroad As each day brings new evidence “A number of faculty are working internationally to help build public health capacity. At a time of enormous challenges in global health, we have an obligation to continue to support these efforts.”

—Dr. Linda Rosenstock

that we are living in a global community, the school is strengthening its commitment to improving the health of people outside the United States — particularly in developing countries, where the needs are most urgent.

“In addition to helping to fulfill our important research and teaching mission, a significant number of faculty — and many students as well — are working internationally with government agencies, non-governmental organizations, and academic institutions to help build the public health capacity of these entities,” says Dr. Linda Rosenstock, dean of the UCLA School of Public Health. “At a time of enormous challenges in global health, we have an obligation to con-

UCLAPUBLIC HEALTH

tinue to support these efforts.”

Following are six among the many examples in which the school’s faculty and students are providing service that is contributing to a healthier global community.

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As part of a program established by the Anderson School of Management at UCLA, two UCLA School of Public Health faculty participated in a training effort to build management capacity for HIV/AIDS providers in developing countries of Africa.

Dr. Paul Torrens (r.), in Shanghai, China with one of several visiting scholars who came to the UCLA School of Public Health as part of a program to train Chinese hospital administrators in management concepts.

In China and Los Angeles, Dr. Paul Torrens, professor of health services, worked with the Chinese Ministry of Health to organize and conduct 12 hospital management training workshops for nearly 1,000 Chinese hospital administrators between 1999 and 2004. Four were held in China – in Shanghai, Nanjing, Beijing, and Zhuhai – and eight were in Los Angeles. The workshops were carried out with the cooperation and participation of many Los Angeles-area hospital administrators, who taught in the seminars and made their hospitals available for site visits. Most of the administrators were UCLA School of Public Health alumni, including Kenny Deng (M.P.H. ’96), a Beijing University Medical School graduate now working for Blue Cross in California. Deng served as the link with the Ministry of Health and hospitals in China.

As a result of the effort, a new journal of hospital administration was established in China and continues to be published regularly, with Torrens serving as the honorary editor. In addition, seven postdoctoral scholars have spent between six months and one year at the school, sponsored either by their government, their university, or the World Health Organization.

UCLAPUBLIC HEALTH

In East Africa, two UCLA School of Public Health associate professors of health services recently took part in a Johnson and Johnson-funded pilot program for a worldwide training effort to build management capacity for HIV/AIDS providers in developing countries. Drs. Fred Hagigi and Jeff Luck helped to develop the curriculum and teach modules in financial management and health management information systems, respectively.

The program was established by Senior Associate Dean Victor Tabbush of the Anderson School of Management at UCLA, based on the premise that limited management capacity is often the impediment to successful delivery of HIV/AIDS services. Conducted in cooperation with the African Medical and Research Foundation, a leader in African community health care, the pilot program drew participants from Kenya, Ethiopia, Somalia, Sudan, Uganda, Tanzania, and Ghana, coming from the ranks of management at community-based organizations involved in the care, treatment and support of HIV/AIDS patients.

Low-cost generic antiretroviral medication has opened new possibilities for treating HIV and AIDS in developing countries, Luck notes. Non-governmental organizations, funded by international donors and governments, are attempting to rapidly scale up their treatment programs. “To do that effectively requires a multidisciplinary clinical team, strong community involvement and a well-organized management structure,” Luck says, “so it is especially important to have strong management capacity.”

One of the main goals, adds Hagigi, is to ensure the sustainability of the teaching efforts. “We used North American instructors for the pilot program, but we wanted African faculty to be able to continue the program and teach future generations,” he says. To that end, each Western faculty member was paired with a faculty member from an African university who participated in teaching the sessions and will carry the program forward beginning this fall.

15

feature

as

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16

UCLAPUBLIC HEALTH

Dr. Ralph Frerichs (seated) with attendees of his workshop on rapid surveys at the Hanoi School of Public Health.

In Vietnam, Dr. Ralph Frerichs, professor of epidemiology, provided assistance to the Hanoi School of Public Health by conducting a five-day workshop on rapid surveys for faculty, staff and associates last August. Rapid surveys are small, two-stage cluster surveys of about 300 people that usually take less than a month to complete. The methodology – combining sample survey methods with computer software programs used in portable, battery-powered microcomputers – enables decision-makers in developing countries to obtain quick answers to questions about the health status and activities of people in the community.

The Hanoi School of Public Health faculty intend to expand their curriculum in this area, Frerichs says. Since the workshop, they have translated the slides Frerichs presented into Vietnamese and are incorporating them into a course at the school on rapid surveys. Other participants were there to learn the approach and apply it in field studies in northern Vietnam.

The workshop was based on EPI 418: Rapid Surveys in Developing Countries, a course Frerichs teaches at UCLA. “Over the years, I have had many students from Vietnam take EPI 418, most being supported by the school’s Fogarty International AIDS Training Program,” Frerichs says. “These two groups – the Fogarty graduates and faculty at the Hanoi School of Public Health – help ensure that small community-based surveys will increasingly be done in Vietnam.”

In Delhi, India, Dr. Roshan Bastani represented the UCLA School of Public Health in a successful collaborative effort to address India’s severe shortage of public health professionals. In March, Prime Minister Manmohan Singh announced the launch of the Public Health Foundation of India (PHFI), which will address this shortage through capacity-building in public health education, training and research. Through the Association of Schools of Public Health (ASPH), Bastani and other public health school representatives have spent the last two years providing input for this effort, working with various stakeholders in India and the international community, including state and central government health authorities, academicians from renowned Indian and international public health institutions, and public health agencies such as the WHO and World Bank.

“The primary purposes of PHFI are to act as a think tank on policy issues related to the health system, to establish standards in public health education, and most importantly, to create a network of innovative, world-class, India-relevant institutes of public health in India,” explains Bastani, professor of health services, associate dean for research at the school and co-director of the school’s Center to Eliminate Health Disparities. “This is a first-of-itskind autonomous public-private partnership in this sphere in India.”

The effort, which is to include the establishment of five new schools of public health as well as the strengthening of existing schools, has received substantial support in India and in the global community, Bastani says. The Indian government has set aside part of the seed capital for the initiative, and the Gates Foundation has committed $15 million.

Other funds have been secured from several Indian corporations and private donors. ASPH will continue to remain an active partner and offer technical assistance. A number of UCLA faculty have expressed interest in becoming involved through curriculum development, short-term teaching assignments and long-term sabbaticals.

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17

feature Above left: Representatives of 13 countries attended a task force meeting in Cairo, Egypt, to establish the Middle East and North African Nutrition Association, an effort spearheaded by Dr. Osman Galal.

Below: Dr. Anne Rimoin works closely with the Congolese Ministry of Health in building capacity to fight monkeypox, viral hemorrhagic fevers, and other diseases of epidemic potential.

UCLAPUBLIC HEALTH

In the Middle East, Dr. Osman Galal, professor of community health sciences at the school and secretary general of the International Union of Nutritional Sciences, has worked to develop human and institutional capacities in nutrition. Galal helped to establish the Middle East and North African Nutrition Association as part of a global health initiative spearheaded by the United Nations University and International Nutrition Foundation. The initiative, which aims to develop and enhance national and institutional nutrition leadership capacities, had not included the Middle East region prior to 2003. Galal convened a task force, housed at the Egyptian National Nutrition Institute, that has provided technical support to national institutions and helped to build nutrition capacity through the pooling of resources.

“We wanted to create a political, social and economic environment in the region that is conducive to effective participation of nutrition and public health organizations in strengthening the capacity to prevent malnutrition and diet-related chronic diseases,” Galal explains.

The first regional workshop was held in July 2004 in Cairo, with representatives of 13 countries attending. Among other things, the group resolved to establish a regional Nutrition Capacity Building website that will include a database of simple nutrition status indicators to monitor regional nutrition status; conduct short-term regional training courses; and prepare a 10-year plan of action in the areas of nutrition research, training, education and advocacy.

Already, the initiative has resulted in development of a nutritional status monitoring system in the Middle East and establishment of an iron and vitamin fortification program in Libya.

In Kinshasa, the capital of and largest city of the Democratic Republic of the Congo (DRC), Dr. Anne Rimoin works closely with the Congolese Ministry of Health as she heads the first study to examine the dramatic changes in the epidemiology of monkeypox and viral hemorrhagic fevers in the last 20 years. Rimoin, assistant professor of epidemiology, runs disease surveillance for these infectious diseases for an entire district of the DRC. Her project is housed at the National Laboratory, where her co-principal investigator is the director, Dr. Jean Jacques Muyembe, considered the world’s leading expert on the ebola virus.

Rimoin’s field director is the national director for monkeypox and viral hemorrhagic fevers, and her group supports all disease surveillance activities in the region.

“Our focus is on monkeypox and viral hemorrhagic fevers, but we do trainings with the Ministry of Health that include all diseases of epidemic potential,” Rimoin explains. “Our surveillance project is, in essence, a pilot program for the rest of the country. Our forms, educational materials, and operations manuals will be adopted by the rest of the country as part of the national program.”

Like the other faculty featured in this article and many others at the UCLA School of Public Health, Rimoin is dedicated to ensuring that her contributions will have a lasting impact. Her group is working to expand the DRC’s laboratory capability and train as many Congolese scientists and lab technicians as possible. “My goal is sustainable research,” Rimoin says. “I’m interested in developing research and public health infrastructure in the country. I am very committed to the DRC and intend to have a long relationship with my Congolese collaborators.”

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18 AS

NEW DRUGS

AND HIGH - TECH ADVANCES CON TINUE TO DRIVE UP THE PRICE OF MEDICAL SERVICES , EXPERTS QUESTION WHETHER WE ARE PUTTING ENOUGH CONSIDERATION INTO HOW WE SPEND .

Are We Getting Our Money’s Worth?

Cost, Quality, and Health Care Spending Savvy consumers pursue value – the best return for each dollar spent. But when it comes to health care, how savvy are we as a nation? The cost of medical services is soaring – and as a society, we’re paying. Yet many experts, including those who study cost and quality at the UCLA School of Public Health, cast doubt on whether we’re spending wisely, and get-

UCLAPUBLIC HEALTH

“With the prospect of genetic therapy and other high-tech services, it’s likely that cost increases exceeding the growth of the economy will remain with us into the indefinite future.”

—Dr. Thomas Rice

ting the most for our money.

After a leveling-off period during the 1990s, health care expenditures are again growing faster than the rest of the U.S. economy. National health spending constituted 15% of U.S. Gross Domestic Product expenditures in 2002, up from 12% in 1990 and 9% in 1980. By 2013, that figure is projected to surpass 18%.

One of the primary reasons for the nation’s rising health care tab is the rapid growth of medical technology and pharmaceuticals. “Medical care and drugs can do more good for people now than they did in the past,” says Dr. Thomas Rice, professor of health services at the school, “and with the prospect of genetic therapy and other high-tech services, it’s likely that cost increases exceeding the growth of the economy will remain with us into the indefinite future.” It’s not merely the availability of expensive medicine that is responsible for the soaring costs, he notes; it’s also a U.S. financing system that covers most of these expensive services – often with minimal prior evaluation of their effectiveness.

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the impact of RN staffing on quality of hospital care. Needleman, who began the research while on the faculty at Harvard and has continued it since joining the UCLA School of Public Health faculty in 2003, found compelling evidence that the quality and size of a hospital’s nursing staff makes a difference in patient outcomes and quality of care. In a seminal 2002 article in the New England Journal of Medicine, Needleman estimated that patients in hospitals whose nurse staffing ranked them in the top half of hospitals experienced cardiac arrest and shock 9% less often and suffered 9% fewer urinary tract infections, 5% fewer episodes of bleeding in their upper gastrointestinal tract and 6% less hospitalacquired pneumonia than patients in hospitals in the bottom half, along with 4% shorter admissions. More recently, he found that increasing the use of RNs and hours of nursing care per patient could help hospitals to avoid more than 6,700 patient deaths and 4 million days of care each year (see page 24).

“Nursing care is central to what the hospital provides,” Needleman says, “but because nurses are everywhere doing everything, their contribution to care is frequently overlooked.”

Measuring the quality of services delivered by health care providers has only recently become a popular phenomenon in the United States. Dr. Robert Brook, professor in the UCLA schools of medicine and public health and director of RAND Health, began conducting pioneering work in the field of quality measurement in the 1960s and established the scientific basis for determining whether various medical and surgical procedures were being used appropriately – contributions recently recognized by the Institute of Medicine, which awarded Brook its prestigious Gustav O. Lienhard Award (see page 32).

Thanks to Brook and other health quality researchers who joined in the growing effort, quality has become a more vital interest to policy-makers, providers and patients alike.

“Without measuring quality of care and using those measures in making policy, health care reform will essentially mean doing things cheaper,” Brook says. “If we do not know the impact of organizational change or clinical services on quality and health then it will be very easy just to do less. Making quality an equal partner to cost is essential as we go about reforming the health care delivery system.”

Quality has several dimensions. One component, notes Needleman, is that the patient gets the right care at the right time, delivered effectively. At the same time, he adds, the care should be safe – the patient should not be injured by his encounter with the health care system.

19

“The issue [in qualityinvestment decisions] isn’t always whether we’re saving money; it can also be whether we are getting value for the money we’re spending.”

—Dr. Jack Needleman

UCLAPUBLIC HEALTH

The United States has been unable to adopt a strategy for long-term success when it comes to controlling health costs, says Rice. For a time in the 1990s, so-called heavy-handed managed care – health maintenance organizations with strict limits on which providers could be seen and which services would be covered – appeared to be making an impact in containing costs. But that approach proved unpopular, and the market responded to the backlash. “The reason people aren’t as angry at their HMOs anymore is that these organizations have become less strict,” Rice says.

“In addition, there has been a movement in enrollment away from HMOs and toward preferred provider organizations, which have very few restrictions. So the one thing that seemed to be working to control costs is no longer available as a strategy because people disliked it.”

The current trend is toward what is known as consumer-directed health care, with many plans shifting the cost to consumers until a high annual deductible, ranging from $1,000 to as high as $3,000, is met. “The rationale is that this will make individuals more sensitive to the prices they’re paying for health care services,” says Dr. Gerald Kominski, professor of health services at the school and associate director of the UCLA Center for Health Policy Research. “The problem is that as individuals it can be difficult for us to assess the true medical benefit of various services, and so this price sensitivity may cause people to forego necessary and highly effective treatments.”

Indeed, Kominski notes, health cost and health quality are often related, raising concerns that efforts to reduce spending will lead to declines in the level of care. He is currently conducting a study for California’s Division of Workers Compensation looking at the quality-of-care impact of recent legislative changes designed to control the system’s costs; the new regulations place restrictions on access to providers and limits on the number of services injured workers can receive for certain injuries.

Kominski and colleagues are surveying injured workers and providers to determine whether workers are having significant difficulties accessing medically necessary services and getting referrals to appropriate specialists. “There have been data published indicating that workers comp expenditures in the state have gone down and premiums have been reduced as a result of these legislative changes,” Kominski says. “The question is whether that is at the cost of denying access to medically appropriate care.”

As financially strapped hospitals sought ways to reduce costs in the 1990s, many cut back on their use of registered nurses. This prompted a number of researchers, including Dr. Jack Needleman, to study

feature

Our h?

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The Standard of Care Is Received on Average 55% of the Time

20

Alcohol dependence

11%

Dyspepsia and peptic ulcer disease

32% 45%

Diabetes mellitus Asthma

54%

Colorectal cancer

54%

Depression

58%

Coronary artery disease

68% 76%

Breast cancer

79%

Senile cataract 0%

20%

30% 40% 60% 80% 100%

Source: McGlynn et al., Quality of Health Care Delivered to Adults in the U.S., NEJM 2003.

National Health Expenditures, 2002 $1.553 Trillion

Construction 1% Research 2% Public Health 3% Administration 7% Personal Health Care 87%

UCLAPUBLIC HEALTH

Source: Levit et al., Health Spending Rebound Continues in 2002, Health Aff 2004.

On both measures, there appears to be plenty of room for improvement.

Typically, peer groups of clinicians will define the standard of care for particular conditions based on available evidence; one way to gauge the quality of care nationally for patients with that condition is to measure how often that evidence-based standard is achieved. A 2003 RAND study found that only 55% of patients in a random sample of adults received recommended care (see the graph above). Separate studies have found that more than half of patients with diabetes, hypertension, tobacco addiction, hyperlipidemia, congestive heart failure, asthma, depression and chronic atrial fibrillation are managed inadequately.

As for the “do no harm” measure, a widely publicized report by the Institute of Medicine (IOM) of the National Academy of Sciences estimated that between 44,000 and 98,000 U.S. hospital deaths each year could be attributed to medical errors. Nationally, the cost associated with preventable adverse events is estimated at $17-$29 billion. Since 1996, the IOM has had an ongoing effort to assess and make recommendations to improve the nation’s quality of care, which it defines as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” The IOM has summed up the issue as one of “overuse, misuse, and underuse of health care services.” (IOM President Harvey V. Fineberg recently spoke at the school. See page 33.)

Part of the problem is that U.S. health care is structured to meet the needs of acute care patients, but is not well suited for chronic care. “The system is set up to diagnose and treat problems as they arise and then send patients home,” says Dr. Emmett Keeler, adjunct professor in the school and a researcher at RAND. “But because we’re now living longer and people aren’t dying as much from infectious diseases, we have more chronic illnesses in which patients have to be able to take care of themselves for the rest of their lives or they won’t function well. The system is not well suited for those kinds of needs.”

With RAND and UC Berkeley colleagues, Keeler recently completed an analysis of a chronic care model developed by Dr. Ed Wagner, national director of Improving Chronic Illness Care, a Robert Wood Johnson Foundation program.

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“There is a hypothesis that if you improve the quality of mental health care, it’s not as expensive as it may seem because it results in medical cost savings over the long term.”

—Dr. Susan Ettner

UCLAPUBLIC HEALTH

Of course, not all quality-investment decisions can be made solely on the basis of whether they save someone money. “The cheapest way to treat heart attack patients is to let them lie on the ground until they either die or get up,” notes Needleman. “But we as a society feel that spending to effectively treat that patient is good value. So the issue isn’t always whether we’re saving money; it can also be whether we’re getting value for the money we’re spending.”

Dr. Kenneth Wells (M.P.H. ’80), a psychiatrist on the faculty at UCLA’s schools of medicine and public health, has focused on the cost-effectiveness

of programs to improve quality of care in mental health. Psychiatric disorders such as depression exact a huge toll, Wells explains, not so much in the cost of treating them as in the social cost to the people who have them.

As director of the UCLA Health Services Research Center, Wells has been examining the impact of investing in better treatment of depression by primary care providers, measured in patients’ improved functioning over the long term. In one study, depressed individuals, particularly Latinos and African Americans, who were part of 6-12 month interventions to improve the quality of their mental health care were found to be faring better five years later than those who weren’t. “We think they had learned how to manage their lives differently,” Wells explains. He found that investing in better depression care improves patients’ employment status – they are more likely to stay in a job or to find a job if they need one – and that underserved minority populations stand to gain the most. “These populations tend to have had much less prior exposure to mental health treatment, which makes them especially inclined to benefit in the long run from an investment in better care up front,” Wells says.

Only about one-fourth of the nation’s depressed people receive care for their depression within the same year. “To increase that treatment penetration would cost health care dollars,” says Wells, “but there is a great return in terms of both the improved quality of life and the economic payoff resulting from their higher functioning. These are substantial social and individual benefits that we get in return from investing in their care that haven’t been captured.”

In a separate study through Wells’ center, Dr. Susan Ettner, professor in the schools of medicine and public health, is developing an intervention to test the impact of financial and non-financial incentives for providers of a managed behavioral health organization to improve the quality of its depression care. “There is a hypothesis, based on the research literature, that if you improve the quality of mental health care, it’s not as expensive as it may seem because it results in medical cost savings over the long term,” says Ettner, who is working with fellow economists at RAND and colleagues at United Behavioral Health on the pilot study.

In previous research, Ettner found that money spent on early substance abuse treatment results in long-term financial benefits from lower crime and increased employment among former substance abusers. “If early investments can prevent higher costs down the road by lowering the risk of hospitalizations, emergency room visits or even accidents among people with depression, substance abuse

feature

In evaluating the quality of care for patients at more than 40 organizations that volunteered to implement the model for patients with specific chronic conditions, Keeler found that these organizations were more successful than others in helping their patients learn to take care of themselves.

“All of these methods for taking better care of people with chronic illnesses were developed by HMOs, and the reason is that HMOs benefit financially by keeping patients out of the hospital,” Keeler observes. “But in a fee-for-service environment, there is no incentive to do that.”

In some cases, a business argument can be made for investing in quality. In Needleman’s research on nurse staffing, he concluded that for hospitals with higher proportions of registered nurses rather than the less-skilled licensed vocational nurses, the increased labor costs were offset by savings resulting from patients’ shorter lengths of stay and reduced risk of complications. Needleman believes these and other findings that support the business case for quality investment when it comes to R.N. staffing are conservative. For example, his group didn’t take into account the cost associated with nursing turnover in hospitals, which has been relatively high.

Other research suggests that investing in improved working conditions for nurses – by having a higher proportion of nurses to patients, for example – would result in lower turnover, and more cost savings.

On the question of whether investing in quality saves money, the answer often depends on whose money is being considered. Hospitals that are reimbursed at a certain rate for each admission receive benefits from making quality improvements that reduce patients’ length of stay. For hospitals that are paid on a per diem basis, it’s the payer, not the hospital, that benefits from quality care resulting in patients being discharged earlier. In cases where the system saves, explains Needleman, a business case can be made for quality investments on the basis that money can be moved between payers and providers so that it makes financial sense.

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“If you assume that there is a fixed amount of money, we want to be able to use that money to provide the most health for the most people.”

—Dr. Robert Kaplan

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and other treatable mental health problems, you’re recouping some of these costs,” Ettner explains.

Dr. Robert Kaplan, professor and chair of health services at the school, is also interested in value – specifically, how to maximize the health care expenditure dollar in relation to the potential benefit. “If you assume that there is a fixed amount of money, we want to be able to use that money to provide the most health for the most people,” he says. “That means looking at quality not only in the sense of whether something is the best treatment, but also whether spending on that treatment is using our resources in the best way. If we allocate resources to very expensive treatments, for example, we might give up the opportunity to spend on other treatments that would better serve the population.”

As a way of conducting cost/utility analyses of disparate health services, Kaplan has developed a research instrument that measures what he calls quality-adjusted life years. The approach, considered radical when Kaplan first began the work in the 1970s, has become part of the vocabulary of health policy. “A lot of health services don’t produce an extension of life expectancy but have a big impact on quality of life and functioning,” Kaplan notes. His indices combine life expectancy with quality of life: For example, if a person with a life expectancy of 75 years develops an illness at age 50 that reduces by half the quality of life for his remaining 25 years, that illness is considered to have cost 12.5 quality-adjusted life years, and an intervention that could have prevented it or returned the individual to full function might produce or save the equivalent of 12.5 life years. Using that approach, researchers analyzing a major clinical trial on the prevention of type 2 dia-

National Health Spending as a Share of Gross Domestic Product, Selected Years, 1970-2013 20.0%

18.4% 15.9%

16.0% 13.8%

13.8%

1993

2000

12.0% 9.1%

UCLAPUBLIC HEALTH

8.0%

7.2%

4.0%

0%

1970

1980

2004

2013 (Projected)

Source: Center for Medicaid and Medicare Services, Office of the Actuary.

betes complications for people at risk found that lifestyle interventions, though appearing to be more costly than medicines, were actually less expensive per quality-adjusted life year than drugs because of the extra benefit they produced.

The premise behind Kaplan’s approach – that hard choices need to be made in considering how to spend finite health care dollars – seems to be one that many in this country have yet to accept.

“One of the reasons we have so many uninsured people is that health care has become so expensive,” says Keeler. “If we could figure out ways of delivering care more efficiently, we could bring down the cost. But part of the problem is that we have a culture in which people expect that they are entitled to whatever services are available, even if those services aren’t going to work very well, and that’s driving up the cost. For a lot less money, we might be able to get 98% of what we’re getting right now, and that would be a better deal for the society as a whole.”

Most analysts agree that there is a great deal of inefficiency in the U.S. health care system, adds Kominski. “There are clearly large administrative costs that are the result of the multiplicity of payers and payment rules in place,” he notes, “as well as a general lack of coordination of care across different settings and providers.” In a market in which most services are purchased using someone else’s money, he adds, it’s not surprising that the demand tends to be high for the “latest and greatest” – and most expensive – technological services. “It’s not that these new technologies aren’t effective,” Kominski says. “But we don’t always know, prior to their introduction, whether the additional benefit is being achieved at a reasonable cost per unit of outcome.

Those studies are often not done until well after a product has been developed and adopted broadly in medical practice.”

The last decade has seen the emergence of quality measurement as a fundamental area of concern in health care policy and delivery, Kominski notes. As a result, much research is now under way to measure and make information about quality available to patients and the purchasers of services.

Kaplan foresees a dramatic increase in efforts to better define which health services are producing the most value for the money spent. The bottom line, he asserts, is that the nation needs to be more thoughtful in the way it spends its health care dollars.

“People need to recognize that there are too many options and it’s too expensive,” he says. “If we took away all the limits and told doctors to do whatever they want, we would probably destroy the economy, without clear evidence that the greater expenditures would result in a healthier population.”

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research

research highlights Concerns Raised About Carcinogenic Potential of Chromium from Drinking Water, Supplements

Chromium III, ingested by millions of people seeking to boost energy and muscle mass through nutritional supplements and present in 95% of multivitamin preparations, might not be as safe as previously believed.

UCLAPUBLIC HEALTH

NEW FINDINGS FROM THE LABORATORY of a UCLA School of Public Health faculty member raise questions about the carcinogenic potential of the environmental contaminant chromium VI when consumed via drinking water, and of chromium III, which is widely used in nutritional supplements.

Chromium VI has been identified as a lung carcinogen when inhaled in relatively high concentrations, such as through occupational exposure, but its cancer-causing potential in drinking water has not been confirmed. It is known to be present in high concentrations in the groundwater of certain communities, and concerns about its effects have been widely publicized, most notably in the 2000 film Erin Brockovich. A two-year carcinogenesis study in mice and rats is currently ongoing at the National Toxicology Program of the National Institute of Environmental Health Sciences (NIEHS).

In the meantime, results of a smaller study in the laboratory of Dr. Robert Schiestl, professor at the school, raise concerns. Schiestl, director of the Center for Environmental Genomics (based in the UCLA School of Public Health and Jonsson Cancer Center), studied mice exposed for 10 days to chromium VI via drinking water. The doses were equivalent to the two lowest of the four doses currently being studied at the NIEHS. Publishing in the journal Cancer Research, Schiestl reported that the exposure induced DNA deletions predictive of cancer.

Schiestl and colleagues also studied the effects of chromium III and found similar harmful effects.

Chromium III, ingested by millions of people seeking to boost energy and muscle mass through nutritional supplements and present in 95% of multivitamin preparations, has been assumed to be non-toxic because it is not taken up by cells. But Schiestl’s group found that once it is absorbed, chromium III is an even more potent inducer of DNA deletions than chromium VI. “The supplement industry is a huge business that is not subject to regulation, as pharmaceuticals are,” says Schiestl. “There has never been a scientifically reported benefit of chromium III for healthy people, and because these supplements haven’t been subjected to rigorous testing, we haven’t known about its potential toxicity.” While the first long-term carcinogenesis study of chromium III is being planned, it will be several years before results are reported. “Our findings on chromium III and chromium VI should raise some eyebrows,” Schiestl says. “We need to be concerned about levels of chromium VI in the drinking water. We also should be wary of consuming chromium III as supplements when there is no evidence of benefit – and the possibility that certain levels may be carcinogenic.”

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Increasing Nursing Staff Improves Quality; Greater Use of RNs Appears to “Pay for Itself”

UCLAPUBLIC HEALTH

INCREASING THE NUMBER OF REGISTERED NURSES and hours of nursing care per patient would save 6,700 lives and 4 million days of patient care in hospitals each year, according to the findings of a study by UCLA School of Public Health and Vanderbilt University School of Nursing researchers.

Their study, published in the journal Health Affairs, also found that for hospitals that use both RNs and licensed practical nurses (LPNs), greater use of Estimated Costs and Avoided RNs appears to pay for itself in fewer patient deaths, reduced lengths of hospiCosts, Days and Deaths from Three tal stay, and decreased rates of hospital-linked complications such as urinary Approaches to Increasing Nurse arrest and upper gastrointestinal bleeding.

Staffing in Hospitals “All hospitals are feeling pressure to improve quality and contain costs,” says Dr. Jack Needleman, Raise Raise Approaches to Increasing associate professor of health servBoth RN Licensed Nurse Staffing in Hopitals Proportion* Hours* ices at the UCLA School of Public Health, who was joined in the $8.5 Billion $811 Million $7.5 Billion Cost of higher nursing research by Dr. Peter Buerhaus of Avoided costs (full cost) $6.9 Billion $2.6 Billion $4.3 Billion Vanderbilt. “For hospitals where nurse staffing is low, this study Avoided days 4.1 million 1.5 million 2.6 million makes an unequivocal business Avoided deaths 4,997 1,801 6,754 case for using more RNs in nurse staffing and a strong case based on Long term cost increase as a percentage of hospital costs -0.50% 0.80% 0.40% value to patients for increasing the *to that of the top quarter of U.S. hospitals Note: Long-term savings are based on the assumption that all costs are recovered by the hospital. hours of nursing care.”

Source: Needleman, et al., “Nurse Staffing in Hospitals: Is There a Business Case for Quality?,” Health Affairs, 2006.

“We’re entering the ninth consecutive year of a national nursing shortage,” adds Buerhaus. “We hope this study stimulates a fresh debate on the contributions of nurses in improving the quality of hospital care.”

In 2002, U.S. general hospitals employed 942,000 full-time RNs and 120,000 full-time licensed practical nurses. The study simulated the effect of several options that would increase nurse staffing to a “feasible” level for most hospitals.

Among the key findings: • Greater use of RNs translates into fewer patient deaths, reduced hospital stays and a decreased rate of hospital-linked complications.

• Increasing the number of hours of nursing care provided by both RNs and LPNs would result in fewer deaths, avoidable complications and days of care.

• Expanding both the proportion of RNs and number of hours provided by licensed practical nurses to reach the top quarter of hospitals – a combination of the other two options – would save the most lives and greatest number of patient days.

Needleman and Buerhaus concluded that increasing the proportion of RNs would require hospitals below that top quarter of hospitals to replace more than 37,000 LPNs with RNs, at a cost of $811 million. But this option also held the most benefits to hospitals and patients alike.

“From a hospital’s perspective, increasing nurse staffing is costly,” the authors wrote. “Nevertheless, greater use of RNs in preference to LPNs appears to pay for itself.”

One-Fourth of HIV-Infected Adults Perceive Discrimination by Health Care Providers TWENTY-SIX PERCENT OF HIV-INFECTED ADULTS believe they have been the victims of discrimination by a health care provider, according to a study by a

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UCLA School of Public Health and RAND research team headed by Dr. Mark Schuster, professor of health services at the school and pediatrics at the David Geffen School of Medicine at UCLA. Schuster and colleagues analyzed data from the HIV Cost and Services Utilization Study, which conducted in-person interviews with a nationally representative sample of 2,466 HIV-infected adults receiving care. The participants were asked whether they felt health care providers had been uncomfortable with them, treated them as inferiors, preferred to avoid them, or refused to provide service. Their findings were reported in the Journal of General Internal Medicine.

The study found that nearly one in three white respondents (32%) perceived being discriminated against by a provider, making whites significantly more likely than Latinos (21%) and African Americans (17%) to report the problem. The authors suggest that one possible reason for this result may have to do with the greater likelihood that members of minority populations have been discriminated against previously. “African Americans and Latinos may typically experience worse care and thus be unaware that better care exists,” Schuster’s team wrote.

Among the HIV-infected adults who reported discrimination, more than half (54%) identified physicians as culprits, with 39% reporting discrimination by clinical staff, 32% by dentists, 31% by hospital staff, and 8% by case managers or social workers. Out of the entire sample, 8% said they had at one time been turned away from receiving services. Respondents whose first positive HIV test was longer ago were more likely to report discrimination.

The authors noted that the perception or experience of discrimination by clinicians could result in HIV-positive patients being less likely to seek care, follow prescribed treatment regimens, or return for follow-up care. “Many HIV-infected adults believe that their clinicians have discriminated against them,” says Schuster. “Clinicians should make efforts to address circumstances that lead patients to perceive discrimination, whether real or imagined.”

Percentage of Adults Receiving Health Care for HIV Who Perceived Discrimination

Gender

%

Male

26

Female

22

Race/ethnicity

%

African American

17

Latino

21

Other

27

White

32

Date of first HIV-positive test

%

Prior to 1986

34

1986 to 1989

31

1990 to 1993

24

1994 to 1996

20

Impact of Exposure to Residential Magnetic Fields on Childhood Leukemia May Be Limited

UCLAPUBLIC HEALTH

ALTHOUGH PREVIOUS STUDIES HAVE FOUND POSITIVE ASSOCIATIONS between exposures to high levels of residential magnetic fields and childhood leukemia, an analysis by two UCLA School of Public Health epidemiologists questions the public health impact of residential fields.

But, publishing in the journal Risk Analysis, Dr. Sander Greenland, the study’s lead author, and co-author Dr. Leeka Kheifets note that in light of the available data, “a large impact” and “no impact” are both possibilities.

Magnetic fields originate from anything with an electrical current. A field spreads from a source in a manner analogous to a ripple emanating from a pebble thrown in a pool of water, penetrating objects in its path. Elevated field levels can occur in homes close to power lines; improper household wiring is a more common reason for increased exposure to these fields.

Substantial research efforts have been devoted to evaluating the potential risk of cancer in children posed by magnetic field exposure, with most of the research focusing on brain tumors and leukemia. “Nearly every epidemiologic study of residential magnetic fields and childhood leukemia has exhibited a positive association,” says Greenland.

But Greenland and Kheifets, professors in the school’s Department of Epidemiology, note that these studies suffer from various methodologic limitations, making it uncertain as to how much, if any, of the associations are causal.

In addition, because the observed associations between the residential magnetic fields and childhood leukemia are small and involve only the highest and most infrequent levels of exposure, researchers have postulated that the public health impact of an effect would be limited.

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26 Using data from 15 studies of residential fields and leukemia along with five surveys of residential-field prevalence, Greenland and Kheifets analyzed the potential impact of high residential field exposure as measured by populationattributable fractions, accounting for uncertainties about study biases and about exposure distribution. Nearly all information on effects and exposure distribution came from fully industrialized countries, with the majority of the data from the United States and Canada.

The methodologic limitations of the 15 studies, which the authors call “profound,” include unknown and probable low accuracy of measurement, potential selection bias, and very small numbers of exposed cases. After careful accounting for the study biases, the authors conclude, it is “improbable” that magnetic fields account for as much as 20% of childhood leukemias in Canada and the United States, and the percentage is probably much lower – including the possibility that there is no effect at all.

Access to Medical Interpreters Improves Patient Satisfaction, Reduces Health Disparities

UCLAPUBLIC HEALTH

Use of interpreters reduced white-Hispanic disparities in reports of care by up to 28% and whiteAsian/Pacific Islander disparities by up to 21%.

HAVING ACCESS TO MEDICAL INTERPRETERS can significantly improve patients’ satisfaction with their health care and reduce health disparities between whites and Hispanics and between whites and Asian/Pacific Islanders, according to a research team led by Dr. Leo S. Morales of the UCLA School of Public Health.

Morales and colleagues analyzed data collected by the California State Children’s Health Insurance Program (SCHIP) from 26,298 parents of children enrolled in participating plans between 2000 and 2001. The results were published in the journal Medical Care Research and Review.

Hispanic and Asian/Pacific Islander members who needed interpreters and didn’t always get them reported significantly worse provider and office-staff communication, access to care, and customer service than members who didn’t need interpreters. On the other hand, Hispanic and Asian/Pacific Islander members who needed and were always provided interpreters gave higher marks to their plan on these measures than members who didn’t need interpreters. “This suggests that interpreters may enhance the health care experience in ways that go beyond language translation,” says Morales. “Interpreters might mediate cultural and educational differences between doctors and their non-English speaking patients, or serve as wayfinders for these patients.” Morales’ team concluded that use of interpreters reduced white-Hispanic disparities in reports of care by up to 28% and white-Asian/Pacific Islander disparities by as much as 21%.

In California, which has the highest percentage of residents with limited English proficiency, all health insurance plans participating in SCHIP are required by state law to provide trained medical interpreters to members who need them.

But Morales’ group found that among the 15% of SCHIP members who reported needing an interpreter in the previous six months, less than half (47%) were always provided with one. Another 27% reported that they usually had one, and 26% said they were provided an interpreter only sometimes or never. “Although health plans are contractually required to provide interpreter services by a payer like SCHIP, our study suggests that members with limited English may frequently receive care without the benefit of interpreters,” says Morales.

Patients who speak limited English often struggle to communicate with their clinicians, compromising both the ability of the patient to accurately convey symptoms or ask questions and the physician’s ability to counsel the patient on the care being provided, Morales notes. Many of these patients turn to family members, friends, or other ad hoc interpreters, who are typically unable to match trained interpreters in ensuring that important messages aren’t lost in the translation. “Our findings strongly support the need to expand the use of interpreters by hiring more bilingual staff, expanding the use of telecommunications tools, and increasing providers’ and patients’ awareness of the availability of these services,” Morales concludes.

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2

UCLAPUBLIC HEALTH

HIGHER LEVELS OF THE SEX HORMONE TESTOSTERONE appear to lower the risk of type 2 diabetes in men while increasing the type 2 diabetes risk in women, according to research led by Dr. Simin Liu, professor in the UCLA School of Public Health. The findings, reported in the Journal of the American Medical Association, help to explain inconsistent previous data on the role of endogenous sex hormones in the disease, and point the way toward potentially fruitful future studies on how and why hormones affect diabetes risk and complications differSummary of Findings from 36 ently in men and women.

Testosterone Studies of 3,825 The research team, which included Liu’s colleagues from Harvard University, Men and 4,795 Women with conducted a pooled analysis of 43 large studies that included data on diabetes staType 2 Diabetes tus and levels of the hormones testosterone, sex hormone-binding globulin (SHBG) and estradiol in more than MEN WOMEN 13,000 men and women. They found Belgium-Leige Pre-Menopausal UK-Surrey Greece that testosterone worked against type Belgium UK-Indian Asian 2 diabetes in men: Those who had the USA-New York USA-Chicago disease had significantly lower testosUK-Scotland S. Korea Fr. Polynesia-Europeans Thailand-Bangkok terone levels than those who didn’t. In Fr. Polynesia-Melanesians United Arab Emirates 1 addition, men with higher testosterone UK- Scotland United Arab Emirates 2 levels were found to have a 42% lower China-Taiwan USA-SWAN (national) Sweden-Goteborg Turkey risk for the disease than control subSweden-Men Born in 1913 jects.

Germany-Diebetomobil Post-Menopausal In contrast, women with type 2 Thailand-Bangkok Sweden-Goteborg USA-Rancho Bernardo Australia-Melbourne diabetes had, on average, higher S. Korea Australia-Victoria testosterone levels than those who Turkey Germany-Diebetomobil did not have the disease. Women Norway-Tromse Thailand-Bangkok Spain-Salamanca USA-Manhattan who had higher levels of SBHG – Finland-Men born in1900-1919 USA-Rancho Bernardo which is believed to reduce testosSweden-Malmo; USA-Mass.

-2.33 (-3.45, 1.86) 0.21 (0.08, 0.35) terone activity – had an 80% lower -10 -5 0 3 -1 0 1 risk of the disease. The associations Testosterone Testosterone Testosterone Testosterone in the effects of sex hormones on lower in cases higher in cases lower in cases higher in cases type 2 diabetes risk for men and MEAN DIFFERENCE MEAN DIFFERENCE women were significant even after adjusting for body mass index.

Sizes of the boxes reflect the relative number of The findings suggest that physicians who prescribe testosterone patches to people in each study. Horizontal lines indicating women to improve sexual function should consider the impact it could have in the confidence intervals that cross zero show that increasing their type 2 diabetes risk, the researchers noted. Similarly, men who on their own, the findings of most of these studies undergo prostate cancer treatment to reduce androgen levels could also see would not be statistically significant. Bottom diaincreased risk. monds, showing overall meta-analysis results by Further research to clarify the mechanisms by which the sex hormones difsex, show statistically significant lower levels of ferentially affect type 2 diabetes risk in men and women could provide future thertestosterone among men with diabetes and higher apeutic targets. “These age-old sex hormones are extremely powerful and had levels among women. yet to be carefully evaluated in a comprehensive and formal manner,” says Liu. With support from two large grants from the National Institutes of Health, Liu’s team is currently conducting an in-depth investigation of the roles of these plasma sex hormones and related genetic variants in the development of type 2 diabetes in men and women. Says Liu: “It is our hope that data emanating from our studies will help to better characterize the complex pathogenesis of type 2 diabetes, have important therapeutic implications, and increase the potential for plasma hormone biomarkers for the clinical risk assessment and management of type 2 diabetes, ultimately benefiting the public’s health.”

research

High Testosterone Lowers Type 2 Diabetes Risk in Men, Increases Risk for Women

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student profiles A Decade-Plus Later, Back to Finish What She Started

“I know I have a lot to share.

In helping to define the role of the CIO and the electronic medical record, I was able to be involved in a lot of groundbreaking work.”

UCLAPUBLIC HEALTH

— Jean Balgrosky

JEAN BALGROSKY (M.P.H. ’80) HAD ADVANCED TO CANDIDACY FOR HER Ph.D. at the UCLA School of Public Health in the early 1990s and had already begun writing up the results of her dissertation. But she was also serving as chief information officer for Holy Cross Health System and building a family. Work and family obligations became so demanding that Balgrosky couldn’t find uninterrupted time to complete her scholarly work. So she decided to take a break, promising herself that she would one day finish.

True to her word, Balgrosky is back – more than a decade after leaving. She returned to the program with experience that few doctoral students could match: nearly 20 years as a chief information officer. Balgrosky began at Holy Cross at a time when the CIO title was only beginning to become prominent in health care organizations. She established and implemented IT strategies and information systems for an organization with annual revenues in excess of $1.5 billion. In 1997 she left to become CIO for Scripps Health, taking an organization that had grown by merger and acquisition and building the IT architecture from the ground up. Her goals included designing and implementing an integrated electronic medical record.

By 2005, having completed what she had set out to do at Scripps, Balgrosky was ready to shift gears. With the support of her family, she contacted two of her former mentors, Drs. Jonathan Fielding and Paul Torrens, who both encouraged her to return. Dr. Jack Needleman, now at the school as an associate professor of health services, took Balgrosky under his wing and worked with her to determine where she might need refresher courses.

She will explore a new dissertation topic: Balgrosky’s original, on the utilization of endoscopic technologies in the office-based setting under three different reimbursement scenarios, was on the cutting edge in the early 1990s, but now, she says, the question has been well addressed. But she has a new passion: IT and the electronic medical record. “It’s important to study the difference the electronic medical record makes in health care – to find out its impact on clinical and organizational outcomes – as well as where the potential benefit is not being realized,” she says. “The Institute of Medicine has pointed out that there are far too many errors occurring in our hospitals, and institutions are struggling to fix that. As health care becomes more complex, we have an obligation to look at our processes and make sure we’re connecting all the dots and integrating our processes so that we are providing the best possible care.”

Although she still gets plenty of calls from professionals who want to tap into her wealth of work experience, Balgrosky is now a full-time student. She has ideas about what she might want to pursue after she completes her dissertation, but no specific plans, other than to do some teaching and research. “I know I have a lot to share,” she says. “In helping to define the role of the CIO and the electronic medical record, I was able to be involved in a lot of groundbreaking work. Even though I hadn’t finished my doctorate, I felt I was living out part of what a school wants from its Ph.D.’s, which is to develop new knowledge. Now I can take that knowledge and advance it through research and teaching.”

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students

Returning to Her Roots, She Shows High School Students Possibilities She Never Knew WHEN TYPHANYE PENNIMAN WAS GROWING UP in the South Los Angeles city of Compton, she had no role models to tell her about public health. It wasn’t until Penniman had completed her undergraduate education at UCLA and then gone on to work as a health educator in Inglewood that she began to appreciate the impact public health could make in underserved communities such as the one where she was raised.

“It’s easy to take things for granted where you live and not realize that it could be different,” she says. “It never dawned on me, for example, that there were no healthy places to eat in my community – until I moved to Westwood as a UCLA student and saw places like Whole Foods and Jamba Juice, with soy protein and tofu being sold everywhere. There was none of that in Compton.”

Her work as a health educator for a nonprofit agency – in which she counseled high-risk youth on reducing risk for unwanted pregnancies and sexually transmitted diseases, including HIV – awakened Penniman to the difference she could make in people’s lives through public health. “I became very interested in learning how to affect behaviors in my community,” Penniman says. So she went back to school, earning her M.P.H. at Cal State Long Beach in 2002, and then enrolling in the doctoral program at the UCLA School of Public Health, where she has completed coursework and is preparing her dissertation on the impact of family dynamics on people with HIV. Penniman’s research has been funded for the last four years by the National Institute of Mental Health, and she recently was awarded two more years of funding from the Centers for Disease Control and Prevention. After earning her degree, Penniman hopes to go on to a career in academia.

For the last year, Penniman has also served as the instructor for the school’s Youth Into Health Professions course, which is taught in South Los Angeles and draws high school students from the Watts and Compton areas. The introductory public health course, offered free of charge for college credit, serves the dual purpose of motivating high school students from underserved communities to go on to college and exposing them to public health as a potential field of study. “Most of the students who are interested in a health profession have been focused on medicine,” Penniman says. “That’s because they haven’t learned about public health – or, if they have, they didn’t know that’s what it was.” The course’s students are paired with mentors from the Students of Color for Public Health, a UCLA School of Public Health interest group in which Penniman has been active.

The opportunity to show high school students from her community the possibilities in public health – something Penniman never knew at that age – has been especially rewarding, she says. “It’s wonderful to see the light bulbs go off as they realize the difference that public health measures such as taking junk food out of schools can make,” she says. “They get excited when they learn what public health professionals can do, and as we talk about advocacy and show them that they can have a voice in what goes on in their communities.”

The opportunity to show high school students from her community the possibilities in public health has been rewarding. “They get excited when they learn what public health professionals can do.”

— Typhanye Penniman (center), with high school students Jesus Torres and Yvette Aguilar, part of the Youth Into Health Professions course.

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2005-06 student awards

students

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Abdelmonem A. Afifi Student Fellowship Sara Serin-Christ Community Health Sciences Agency for Healthcare Research and Quality Fellowship Shana Lavarreda Daniella Meeker Sarah Starks Jean Yoon Health Services Atlantic Richfield Company Fellowship Felicia Federico Environmental Science and Engineering Biostatistics Training for AIDS Research Erik Bloomquist Stephanie Kovalchik Lei Qian Yan-Jung Liu Fred H. Bixby Doctoral Fellowship Laura Chyu Claire Dye Jennifer Erausquin Yasamin Kusunoki Eunice Muthengi Community Health Sciences Joseph and Celia Blann Fellowship Wenhua Hu Biostatistics Dana Martinez Community Health Sciences

UCLAPUBLIC HEALTH

California Endowment Scholarships Vincecia Garcia Angie Otiniano Jennifer Simmons Steve Sortijas Community Health Sciences Brandon Brown Epidemiology Diana Porral Health Services California Wellness Foundation Scholarships Glenn Sias Environmental Health Sciences Marie Sharp Epidemiology Sylvia Paz Health Services Chancellor’s Fellowship An Ning Menghua Tao Epidemiology

Chancellor’s Prize Hua Guo Yu Zhao Biostatistics Ryan Vaughn Environmental Health Sciences Class of 1972 Reunion Fellowship Zhanna Sobol Environmental Health Sciences Melissa Gatchell Health Services Dean’s Outstanding Student Award Hsin-Ju Hsieh Biostatistics Nathalia Allevato Community Health Sciences Robert Phalen Environmental Health Sciences Marjan Javanbakht Epidemiology Michelle Marciniak Health Services Eleanor J. De Benedictis Fellowship in Nutrition Constance Awuor Gewa Maria Koleilat Loan Thi Kieu Pham Community Health Sciences Dissertation Year Fellowship Megumi Kano Community Health Sciences Robert Phaleni Environmental Health Sciences Menghua Tao Epidemiology Erik Larsen Environmental Science and Engineering Erin Hsu Molecular Toxicology Emerson Fund Xiaoyan Liao Environmental Health Sciences Environmental Science and Engineering Program Endowment Maria Echarte Felicia Federico Calvin Kwan Carla Ward

Hortense Fishbaugh Memorial Fellowships Chhandasi Bagchi Community Health Sciences Foley and Lardner Fellowships in Health Services Kristyn Dixon Yasmeen Dixon Foreign Language and Area Studies Fellowship Natalie Drorbaugh Gabriel Garcia Steve Sortijas Kristin Yarris Community Health Sciences L.S. Goerke Memorial Fellowship Megumi Kano Community Health Sciences Raymond D. Goodman Scholarship Naja Rod Nielsen Epidemiology Judith Chung Health Services Graduate Opportunity Fellowship Veronica Awan Alma Vega Community Health Sciences Hagigi Fellowship in Healthcare Accounting and Finance Jonathan Friel Health Services Health Services Alumni Association Scholarship Laura Green Gordon Hein Memorial Scholarship Christian Shinaberger Epidemiology William and Flora Hewlett Foundation Environmental Science and Engineering Program Trust Fund Maria Echarte Rahul Kumar Calvin Kwan Carla Ward Xueying Wu Jennifer Liebeler Carolbeth Korn Prize Luohua Jiang Biostatistics Leadership in Maternal and Child Health Training Grant Dana Ellis Community Health Sciences

Bette & Hans Lorenz Fellowships Lily Altstein Biostatistics November McGarvey Community Health Sciences Ryan Vaughn Environmental Health Sciences Michelle Ornelas Epidemiology Georgina Ageykum Health Services Maternal and Child Health Grant Laura Chyu Community Health Sciences Rachel Effros Nicole Garro Kathryn Smith Health Services Neumann-Drabkin-Bixby Fieldwork Fellowships Jennifer Brody Chloe Gans-Rugebregt Tanya Gonzalez Shauna Harrison Grace Lee Larisa Mori Jamie Morse Cara Wooledge Community Health Sciences Bita Amani Anthony Wang Epidemiology Ann G. Quealy Memorial Fellowship in Health Services Evan King Allen Lee Ruth F. Richards Memorial Student Award Juan Jia Biostatistics Jennifer Erausquin Community Health Sciences Sarah Kobylewski Environmental Health Sciences Melissa Higdon Epidemiology Narmina Pasha Health Services Eugene Cota Robles Fellowship Tommi Gaines Erica Lockwood Biostatistics Jennifer Garcia Community Health Sciences

Ruth J. Roemer Award Heather Richardson Katherine Marcellus Health Services Roemer Health Services Administration Fellowships Jabar Akbar Helen Jung Tracy Yee Will Rogers Memorial Scholarship Candace Coffee Community Health Sciences Christian Shinaberger Epidemiology Monica Salinas Internship in Latino and Latin American Health Shauna Harrison Community Health Sciences Mirna Ponce Epidemiology Juneal Marie Smith Fellowship in International Nutrition Shen-Chih Chang Epidemiology Wayne Soohoo Memorial Scholarship Wenhai Xu Environmental Health Sciences Thai Health Outreach Internship Koy Parada Community Health Sciences Samuel J.Tibbitts Fellowship Matthew Wise Epidemiology Toxic Substance Research & Teaching Program Fellowship Xioyan Liao Elizabeth Marshall Environmental Health Sciences Wilshire Foundation Endowment in Geriatric Medicine and Long Term Care Katie Maggard Diep Tran Community Health Sciences

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faculty honors DR. JONATHAN FIELDING was chosen for the Distinguished Alumnus Award by the Harvard School of Public Health.

DR. PATRICIA GANZ served on an Institute of Medicine committee that prepared a report released in November 2005 on adult cancer survivors, “From Cancer Patient to Cancer Survivor: Lost in Transition.”

DR. SANDER GREENLAND was elected chair of the American Statistical Association’s Section on Statistics in Epidemiology.

DR. NEAL HALFON received the annual research award from the Ambulatory Pediatric Association at the Pediatric Academic Societies meeting.

DR. GANG LI served on the Scientific Committee for the International Conference on Statistics, held in Hong Kong in June.

DR. JACK NEEDLEMAN was a winner of the first Health Services Research Impact Award given

by AcademyHealth, for his research establishing a relationship between hospital nurse staffing and adverse patient outcomes.

DRS. CHARLOTTE NEUMANN and JOEL KOPPLE were named fellows of the American Society for Nutrition.

DR. THOMAS RICE assumed the role of chair of the board for AcademyHealth.

DR. MARK SCHUSTER is serving as chair of the Child Health Services Research Steering Committee. He also chairs the Health and Nutrition Committee of the L.A. City Commission on Children, Youth, and their Families.

DR. LINDA ROSENSTOCK was appointed to the UC Advisory Council on Future Growth in the Health Professions. She also was the Annie Lee Shuster Alumni Speaker for the Robert Wood Johnson Clinical Scholars Program.

DR. ARTHUR WINER received a 2006 HaagenSmit Clean Air Award from the California Air Resources Board.

KERI GARDNER Health Services DENA HERMAN Community Health Sciences ADRIANA SMARANDA BABAN Community Health Sciences

...recent books by UCLA School of Public Health authors

Contemporary Multivariate Analysis and Design of Experiments, edited by Jianqing Fan and Gang Li. World Scientific Publishing Company Explores new developments in experimental designs, multivariate analysis, biostatistics, model selection and related subjects, with articles contributed by prominent and active figures in their fields.

Modeling Longitudinal Data,

by Robert E. Weiss. Springer Texts in Statistics.

Longitudinal data – which come from assessing the same measure repeatedly over time on the subjects in a study – are ubiquitous across medicine, public health, public policy, psychology, political science, biology, sociology and education – yet, many longitudinal data sets remain improperly analyzed. This book teaches the art and statistical science of modern longitudinal data analysis.

Monitoring Rocky Shores,

by Steven N. Murray, Richard F. Ambrose, and Megan N. Dethier. UC Press.

As we advance into an era of global climate change, monitoring changes in the intertidal zone of rocky shores – the sensitive habitat at the interface of land and ocean – has never been more crucial. This handbook describes effective methods and procedures for monitoring the ecological and environmental status of these areas, and provides critical discussions and evaluation of the various sampling techniques and field procedures for studies of intertidal macroinvertebrates, seaweeds, and seagrasses.

Oncology: An Evidence-Based Approach, edited by Alfred E. Chang, Patricia A. Ganz, Daniel F. Hayes, Timothy J. Kinsella, Harvey I. Pass, Joan H. Schiller, Richard M. Stone, and Victor J. Strecher. Springer.

Covers the principles and current practice of oncology, with contributors from the fields of medical, surgical, and radiation oncology. The textbook incorporates an evidencebased clinical approach, enabling the reader to make decisions on the basis of concrete data. Includes in-depth sections on cancer prevention and control, cancer survivorship, the economics of cancer care, and cancer informatics, as well as an innovative section on survivorship.

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new faculty

bookshelf

faculty

DR. THOMAS BELIN received the 2005 Gertrude M. Cox Award from the Washington Statistical Society, the Washington, D.C., chapter of the American Statistical Association.

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news briefs

faculty

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INSTITUTE OF MEDICINE (IOM) HONORS DR. ROBERT BROOK DR. ROBERT BROOK, professor in the UCLA schools of medicine and public health, received the Institute of Medicine’s prestigious Gustav O. Lienhard Award for the advancement of personal health services. The award honors Brook for his dedication and commitment to improving the effectiveness of health care services and shaping the discourse on health care policy.

An internationally renowned expert on health quality issues, Brook is credited as the individual who, more than any other, developed the science of measuring the quality of medical care and focused U.S. policy-makers’ attention on quality-of-care issues and their implications for the nation’s health. He established the scientific basis for determining whether medical and surgical procedures are being used appropriately and has led teams that have developed quality measures used today by government agencies, physicians, and others to determine the benefits of new health care technologies and the effectiveness of changes in health policy.

Brook is the 20th recipient of the Lienhard Award, which includes a medal and a $25,000 prize. Given annually, the award recognizes outstanding national achievement in improving personal health care services in the United States.

UCLAPUBLIC HEALTH

NEW IOM MEMBERS

DRS. ROBERT KAPLAN and JARED DIAMOND were honored with election to the Institute of Medicine for their contributions to health.

Kaplan, who chairs the school’s Department of Health Services, is an internationally renowned scholar known for his ground-breaking work in quality of life and health outcomes assessment. His interest in measuring functional and quality of life outcomes has led to an increased focus in recent years in issues of cost-effectiveness and resource allocation – particularly questions of how to optimize the use of health care dollars to manage the health of populations (see the article on page 18).

Diamond, a professor of geography at UCLA with joint appointments in the schools of public health and medicine, is the Pulitzer Prize-winning author of Guns, Germs, and Steel: The Fates of Human Societies. Most recently, in Collapse: How Societies Choose to Fail or Succeed, a New York Times best seller, Diamond examined the fall of great civilizations of the past and the lessons modern societies can draw from their fates. Widely recognized as a founder of conservation biology, Diamond was the recipient of the National Medal of Science in 1999, among many other awards.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to honor professional achievement in the health sciences and to serve as a national resource for independent analysis and recommendations on issues related to medicine, biomedical sciences and health. Seven of the school’s other faculty members have been elected to the IOM: Drs. Ronald Andersen, Lester Breslow, Robert Brook, Thomas Coates, Jonathan Fielding, Gail Harrison, and Linda Rosenstock.

lab network will improve response to emerging threats

SPEARHEADING THE EFFORT (l. to r.) — Dean’s Advisory Board member Cindy Harrell Horn, Dean Linda Rosenstock and Dr. Scott Layne, faculty leader of the new high-speed, high-volume laboratory network.

A new high-speed, high-volume laboratory network based in the UCLA School of Public Health will be capable of quickly analyzing and processing high quantities of biological samples, improving the nation’s ability to respond to an avian flu outbreak, bioterrorist attack, or other rapidly emerging public health threats.

The new lab, spearheaded by Dr. Scott Layne, associate professor of epidemiology, will enable public health experts to track diseases in near real-time and dramatically shorten the time needed to produce effective vaccines. Additionally, the laboratory will train public health and laboratory experts in infectious disease management, addressing a well-documented need for skilled personnel in bio-emergency situations. Initial funding of $6 million was secured in the FY 06 Department of Defense appropriations bill and efforts are currently underway to secure additional federal funding as well as funding from the State of California and private supporters.

STEM CELL SYMPOSIUM — Dean Linda Rosenstock moderated a session featuring two UCLA School of Public Health faculty members at “Stem Cells: Promise and Peril in Regenerative Medicine,” a research conference and public symposium held at UCLA in February. In addition to Rosenstock, Drs. Gerald F. Kominski (“Issues of Cost, Quality and Access”) and Simin Liu (“Implications for Prevention and Chronic Disease”) presented.

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survivorship center for cancer established

Cindy Harrell Horn was selected to receive the Dean’s Award for sustained and generous support. A tireless advocate for the school and its new effort to combat emerging infectious diseases, Horn has volunteered hundreds of hours and traveled thousands of miles to help secure funding and support for the school’s new high-speed, high-volume laboratory network (see the article on opposite page).

Horn is well known locally and throughout the nation as an advocate for improving education, health and the environment. Following a successful career as an actress and model, she co-founded the Environmental Media Association (EMA) in 1989 to mobilize the entertainment industry to increase public awareness of environmental problems. In addition to her continued involvement with EMA, she serves on boards of numerous organizations, including the UCLA School of Public Health Dean’s Advisory Board.

UCLA’s Jonsson Cancer Center has been named as one of five Survivorship Centers of Excellence by the Lance Armstrong Foundation. A five-year, $1.7 million grant from the foundation establishes the Jonsson Cancer Center Survivorship Program. The new program will build on two decades of survivorship research and put into place important clinical programs to help cancer survivors transition into their disease-free lives. The program will be directed

by Dr. Patricia Ganz, professor in the schools of public health and medicine and head of the cancer center’s Division of Cancer Prevention and Control Research, based in the School of Public Health.

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PLEASE REMEMBER 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.

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.

BRESLOW LECTURE — Dr. Harvey V. Fineberg, president of the Institute of Medicine, spoke at the 32nd Annual Lester Breslow Lecture in April. In his talk, “Why Prevention Is a Hard Sell,” Fineberg outlined some of the reasons: There is no drama in prevention; non-events are not counted; statistical lives don’t have immediacy; prevention is not profitable; prevention often runs against commercial interests; it may conflict with personal preferences or religious beliefs; and there is declining trust in leaders and institutions, challenging people’s willingness to follow guidelines.

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 provide this information at publichealth@ support.ucla.edu.

S AV E T H E D AT E UCLA SCHOOL OF PUBLIC HEALTH ALUMNI AND FRIENDS RECEPTION MONDAY, NOVEMBER 6, 2006 6:30 - 8:00 pm at the Boston Convention & Exhibition Center, Room 104A

During the Annual Meeting of the American Public Health Association, November 4 - 8, in Boston Check the APHA schedule or stop by the UCLA School of Public Health booth for location information.

UCLAPUBLIC HEALTH

COMMUNITY PARTNERSHIP AWARD — Dr. Michael Prelip (center), assistant professor and head of the school’s Field Studies Program, received the Ann C. Rosenfield Distinguished Community Partnership Prize from the UCLA Center for Community Partnerships, in recognition of Prelip’s collaboration with the Greater West Hollywood Food Coalition to serve the homeless population of Hollywood and West Hollywood. The $25,000 award recognizes partnerships that have enhanced the quality of life in Southern California.

news briefs

cindy harrell horn receives dean’s award

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campaign closes on a high note “The school is enormously grateful for the generous support of our alumni, corporate and foundation partners, friends, faculty and staff in bringing Campaign UCLA to such a successful close for the School of Public Health.”

— LINDA ROSENSTOCK, DEAN

During Campaign UCLA — the largest and most successful fundraising effort in the history of higher education — the UCLA School of Public Health surpassed its goals and the result is farreaching throughout the school. Over the campaign’s decade-long run, the school generated $56.6 million in private support, strengthening excellence in teaching, research, and service in support of keeping the public healthy.

More than 550 students have benefited from new fellowships, international internships, scholastic prizes, and other forms of student support generated from 1995 to 2005. As some of these gifts were endowments, they will continue to grow and support the school’s students for generations to come.

The school’s research and operating programs were propelled to new levels by the major portion of the monies raised during the campaign. During this period, the school received its first-ever research center endowment with a generous gift of $5 million to establish the Fred H. Bixby Center for Population and Reproductive Health.

The campaign also produced a tremendous increase in undesignated gifts, large and small, making it possible for the school to invest in important new public health initiatives such as eliminating health disparities, global health, and emerging infectious diseases. The school’s investors have also supported classroom and student lounge upgrades, updates of the school’s information technology infrastructure, and the creation of a new career services office to assist students in their career exploration and job placements.

With state funding comprising less than 15% of UCLA’s budget, private support has become critical to maintaining and enhancing the school’s excellence. The school will continue to strengthen its partnerships to ensure that it provides the state and nation with a well-trained public health workforce.

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 Final Count: July 1995-December 2005 | SPH Campaign Goal: $31 M (183%) $60,000,000 $56,596,368

55,000,000

$51,565,872

50,000,000 45,000,000 40,000,000

$37,969,674

35,000,000 revised goal

30,000,000

$33,029,500 X

25,000,000 $23,336,915 20,000,000

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15,000,000

$18,852,239 original goal

X $12,364,174 $10,037,344 $ 8,165,239

10,000,000 5,000,000

$ 4,453,851 $ 1,969,479

0 FY 95-96 FY 96-97 FY 97-98 FY 98-99 FY 99-00 FY 00-01 FY 01-02 FY 02-03 FY 03-04 FY 04-05 FY 05-06* *through 12/31/05

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THE SCHOOL IS PLEASED TO HONOR the alumni, friends, students, staff, foundations and corporations whose generosity over the past decade has made a lasting mark on the school and has firmly planted us at the forefront of public health education. This Campaign Honor Roll gratefully acknowledges gifts and private grants made to the UCLA School of Public Health from July 1, 1995 to December 31, 2005. Although space limitations allow only the listing of cumulative donations of $1,000 or more, contributions of every amount have been and continue to be of great importance to the school and are deeply appreciated.

$15,000,000 + THE CALIFORNIA ENDOWMENT $5,000,000 - $9,999,999 FRED H. BIXBY FOUNDATION THE ROBERT WOOD JOHNSON FOUNDATION $1,000,000 - $4,999,999 AMERICAN CANCER SOCIETY INC. THE BREAST CANCER RESEARCH FOUNDATION CALIFORNIA HEALTHCARE FOUNDATION THE CALIFORNIA WELLNESS FOUNDATION ALDO DEBENEDICTIS THE SUSAN G. KOMEN BREAST CANCER FOUNDATION HELGA AND WALTER OPPENHEIMER $500,000 - $999,999 ASSOCIATION OF SCHOOLS OF PUBLIC HEALTH THE DORIS DUKE CHARITABLE FOUNDATION THE HENRY J. KAISER FAMILY FOUNDATION RAND CORPORATION U.S. BORAX INC. $250,000 - $499,999 THE COMMONWEALTH FUND THE JOHN A. HARTFORD FOUNDATION CARL AND FLORENCE HOPKINS THE JOYCE FOUNDATION KAISER PERMANENTE CAROLBETH AND LESTER KORN RALPH AND SHIRLEY SHAPIRO THRASHER RESEARCH FUND W. M. KECK FOUNDATION BOB AND MARION WILSON WORLD AIDS FOUNDATION / NATIONAL INSTITUTE OF HEALTH

$50,000 - $99,999 THE AHMANSON FOUNDATION IRA R. AND MARSHA L. ALPERT AMERICAN OCEANS CAMPAIGN INC. AMGEN LINNAE ANDERSON AND THOMAS E. EPLEY ARCHSTONE FOUNDATION BLUE SHIELD OF CALIFORNIA LESTER AND DEVRA M. BRESLOW AUGUSTUS OLIVER BROWN TRUST CANCER RESEARCH FOUNDATION OF AMERICA CEDARS-SINAI MEDICAL CENTER CIGNA FOUNDATION COMMUNITY TECHNOLOGY FOUNDATION OF CALIFORNIA EDWARD AND JOANNE DAUER JOSEPH DROWN FOUNDATION EGYPTIAN CULTURAL AND EDUCATIONAL BUREAU

MAX FACTOR FAMILY FOUNDATION JERRY J. AND LORRAINE H. FACTOR DANA FARBER CANCER INSTITUTE GLAXOSMITHKLINE RAYMOND D. AND BETTY J. GOODMAN HEALTH RESEARCH ASSOCIATION THE WILLIAM AND FLORA HEWLETT FOUNDATION LESTER AND GENEVA MEIS MERCK AND COMPANY, INC. NATIONAL IMMIGRATION LAW CENTER THE KENNETH T. AND EILEEN L. NORRIS FOUNDATION ORTHO-MC NEIL PHARMACEUTICAL, INC. PACIFICARE HEALTH SYSTEMS, INC. THE PARKINSON'S INSTITUTE PHARMACIA CORPORATION PRICEWATERHOUSECOOPERS LLP LINDA ROSENSTOCK AND LEE BAILEY A. HENRY SCHUYLER, JR. SIMPSON AND SIMPSON BUSINESS AND PERSONNEL SERVICES INC. RICHARD E. AND PATRICIA J. SINAIKO GURDON AND MARY ANN SMITH TARGET CORPORATION TENET HEALTHCARE AUDREY TIBBITTS $25,000 - $49,999 ABDELMONEM A. AND MARIANNE H. AFIFI ALLIANCE HEALTHCARE FOUNDATION AMERICAN PARKINSON'S DISEASE ASSOCIATION, INC. THE ASSOCIATION FOR DRESSINGS AND SAUCES FRANK J. BIONDI, JR. AND CAROL O. BIONDI DAVID G. AND SUZANNE D. BOOTH BRAIN INJURY ASSOCIATION, INC. CALIFORNIA AVOCADO COMMISSION CALIFORNIA FOOD POLICY ADVOCATES THE NANCY M. DALY FOUNDATION

JAMES E. AND MARTA V. ENSTROM FARHAD A. AND LATIFEH E. HAGIGI HEALTH NET, INC. HEALTH RESEARCH & EDUCATIONAL TRUST IOWA FOUNDATION FOR EDUCATION, ENVIRONMENT AND THE ARTS RAYMOND AND JENNIE JING STEPHEN W. KAHANE AND JANET WELLS-KAHANE CAROLYN F. KATZIN DEBORAH A. LEVY ROBERT AND ADELINE MAH MILDRED MASSEY EDWARD O'NEILL PFIZER INC. US PHARMACEUTICALS GROUP MILTON I. AND RUTH J. ROEMER JEAN SANVILLE LEONARD D. AND PAMELA SCHAEFFER PAUL R. TORRENS WILSHIRE FOUNDATION $15,000 - $24,999 ROSALIND & ALFRED BERGER FOUNDATION, INC. ROBERT BLAIR, JR. BLOCK MANAGEMENT, INC. COMMUNITY VISIONS UNLIMITED BRUCE DAVIDSON MICHELE DILORENZO ENVIRONMENTAL DEFENSE CENTER JOHN E. FETZER INSTITUTE INC. JONATHAN E. AND KARIN B. FIELDING HOAG MEMORIAL HOSPITAL PRESBYTERIAN ALAN R. AND TERI HOOPS JAPANESE FOUNDATION FOR AIDS PREVENTION KENNETH AND CORNELIA LEE RICHARD AND AMY LIPELES LOS ANGELES REGIONAL FOOD BANK MARTI S. SLAWSON AND TED C. LILYEBLADE ST. JOSEPH HEALTH SYSTEM ROBERT STEINER $10,000 - $14,999 RONALD M. AND DIANE ANDERSEN CALIFORNIA COMMUNITY FOUNDATION

Traditionally in the June issue of UCLA Public Health, we include an annual Honor Roll in grateful acknowledgement of the school’s supporters during the previous calendar year.

As this year we have published a decade-long cumulative Honor Roll that covered the Campaign UCLA, we kindly direct the reader to visit the school’s website at www.ph.ucla.edu/ giving_honor.html where we have posted our special thanks to all our supporters who generously gave $100 or more during 2005.

UCLAPUBLIC HEALTH

$100,000 - $249,999 ROYAL ADELAIDE HOSPITAL ALZHEIMER'S ASSOCIATION LOS ANGELES AVENTIS PASTEUR ANNETTE BLANN LIVING TRUST BLUE CROSS OF CALIFORNIA DOLE FOOD COMPANY, INC. ROBERT J. DRABKIN

FOLEY AND LARDNER THE FORD FOUNDATION CONRAD N. HILTON FOUNDATION JONSSON CANCER CENTER FOUNDATION JOHNSON & JOHNSON JUVENILE DIABETES FOUNDATION INTERNATIONAL L.A. CARE HEALTH PLAN LOS ANGELES COLLEGE OF CHIROPRACTIC SUSAN LOVE M.D. BREAST CANCER FOUNDATION THE ANDREW W. MELLON FOUNDATION MARCH OF DIMES BIRTH DEFECTS FOUNDATION ALFRED K. AND CHARLOTTE G. NEUMANN THE DAVID AND LUCILE PACKARD FOUNDATION PUBLIC HEALTH FOUNDATION ENTERPRISES PUBLIC HEALTH INSTITUTE SHANE S. QUE HEE ROCKEFELLER BROTHERS FUND MONICA SALINAS MEDICAL SERVICE CORP INTERNATIONAL SPECIAL SERVICE FOR GROUPS WESTERN CONSORTIUM FOR PUBLIC HEALTH

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friends

campaign ucla | honor roll 1995-2005

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UCLAPUBLIC HEALTH

THE ANNIE E. CASEY FOUNDATION ANNE H. AND JOHN E. COULSON COURSE READER MATERIAL THE EL ADOBE CORPORATION EMBASSY OF THE ARAB REPUBLIC OF EGYPT MICHAEL R. GALPER GAIL HARRISON AND OSMAN GALAL HEALTH BENCHMARKS, INC. HOECHST MARION ROUSSEL INC. DAVID B. KATZIN GERALD AND LAURIE KOMINSKI MERIDIAN HEALTH CARE MANAGEMENT, INC. MIDWEST STEEL INC. ONCOLOGY NURSING FOUNDATION THE PROCTER AND GAMBLE COMPANY RESOURCE CONSERVATION DISTRICT OF THE SANTA MONICA MOUNTAINS DONALD W. REYNOLDS FOUNDATION ROHM AND HAAS COMPANY JACK R. AND CARISSA SCHLOSSER JOHN AND LINDA SIEFKER THE STREISAND FOUNDATION MARIAN E. SWENDSEID $5,000 - $9,999 ARTHUR ANDERSON FOUNDATION AL-AZHAR UNIVERSITY ASPEN ENVIRONMENTAL GROUP ASSOCIATION OF UNIVERSITY PROGRAMS IN HEALTH ADMINISTRATION THE AUTRY FOUNDATION STANLEY AZEN AND JOYCE NILAND LEONARD I. AND JOAN G. BEERMAN DIANA M. BONTA AND FRANK P. MATRICARDI ROBERT H. BROOK AND JACQUELINE B. KOSECOFF CAROLLO ENGINEERS CALVIN S. Y. CHUN CIGNA HEALTHCARE OF CALIFORNIA INC. COALITION FOR CLEAN AIR DA VITA INC. SAM W. DOWNING ELI LILLY AND COMPANY LAWRENCE ERLBAUM ASSOCIATES, INC. GAROLD L. AND JOYCE E. FABER LAWRENCE R. FELDMAN AND JO K. KAPLAN FOUNDATION FOR ACCOUNTABILITY ALAN V. AND SUSAN F. FRIEDMAN GAY AND LESBIAN MEDICAL ASSOCIATION

BARRY E. AND JANE B. GERBER BRUCE AND ROBERTA GERDING ROBERT W. AND KATHERINE GILLESPIE GREENBERG GLUSKER FIELDS CLAMAN MACHTINGER & KINSELLA LLP TERRY HARTSHORN FAMILY FUND HEALTHCARE PRACTICE ENHANCEMENT NETWORK INC. HEIDRICK AND STRUGGLES INC. HELD PROPERTIES INC. HEMATOLOGY ONCOLOGY CONSULTANTS DIANA W. AND JOE W. HILBERMAN SUSAN D. HOLLANDER ALAN AND VALERIE HOPKINS THE HORN FOUNDATION HOSPITAL ASSOCIATION OF SOUTHERN CALIFORNIA HUGHES AIRCRAFT COMPANY RICHARD B. AND LAURA JACOBS MARVIN AND FERN G. JUBAS MARJORIE L. KAGAWASINGER AND PETER SINGER JERRY LEEN LESTER J. AND JOANNE E. MANTELL MAXICARE HEALTH PLANS INC. MCDERMOTT WILL & EMERY CHARITABLE FOUNDATION MEREDITH/BOLI AND ASSOCIATES INC. METROPOLITAN WATER DISTRICT JOHN D. AND CHARLENE U. MILLER NATIONAL ASSOCIATION OF INJURY CONTROL RESEARCH CENTERS NORTHROP GRUMMAN LITTON FOUNDATION JOYCE A. PAGE LORI RICHARDSONPELLICCIONI AND DANIEL PELLICCIONI PHARMACEUTICAL RESEARCH & MANUFACTURERS OF AMERICA FOUNDATION POPULATION COMMUNICATION THOMAS M. AND JODY J. PRISELAC PRUDENTIAL SECURITIES INC. RADIAN INTERNATIONAL LLC THOMAS H. RICE AND KATHERINE DESMOND ANTHONY D. AND DEBORAH RODGERS ROTH FAMILY FOUNDATION RUSTIC CANYON VENTURES RALPH SACHS ESTATE SALINAS VALLEY MEMORIAL HEALTH CARE SYSTEM THE SAVE THE EARTH FOUNDATION INC.

SHELL OIL COMPANY FOUNDATION JAMES H. SHINABERGER IRWIN J. SHORR CYNTHIA L. & WILLIAM E. SIMON, JR. FOUNDATION GARY J. SLOAN AND BARBARA KOMAS ARTHUR M. SOUTHAM AND CORNELIA DALY RICHARD L. AND MILDRED G. STERZ DAVID A. AND VICKIE L. WALKER FRED W. AND PAMELA K. WASSERMAN CARL AND EDITH WEISSBURG TOM & MARLA WILLIAMS CHARITY FUND ARTHUR M. AND JUDY A. WINER $2,500 - $4,999 JAMES P. AGRONICK ROSLYN ALFIN SLATER ALLIANCE IMAGING INC. ANDREW AND BRENDA K. ALLOCCO MICHAEL J. AND DIANNE K. ALPER ALTA MEDICAL HEALTH SERVICES CORPORATION AMERICAN INDUSTRIAL HYGIENE ASSOCIATION AMERICAN MEDICAL GROUP ASSOCIATION AMERICAN SOCIETY OF CLINICAL ONCOLOGY AMI INC. JAMES D. BARBER CHRISTY L. BEAUDIN LINDA B. BOURQUE E. RICHARD BROWN AND MARIANNE PARKER BROWN THE CAMDEN GROUP PAULA A. CARABELLI AND THOMAS M. FALLO MICHAEL D. COLLINS AND KAREN L. MITCHELL WILLIAM COMANOR COMMUNITY OUTREACH FOR PREVENTION AND EDUCATION THOMAS G. AND JANE P. DAVID DAVIS WRIGHT & TREMAINE LAW OFFICE CLIMIS A. AND IRENE DAVOS EASTERN RESEARCH GROUP JEFFREY E. AND MARTHA M. FLOCKEN RONALD C. FORGEY RALPH R. FRERICHS AND RITA FLYNN TOMAS AND PATRICIA A. GANZ CAROL J. GILBERT DANIEL P. AND LOUISE E. GROSZKRUGER HARRIMAN JONES MEDICAL GROUP HARLAN H. HASHIMOTO MARK J. HOWARD SUSAN M. HULL IMPACT ASSESSMENT, INC.

LEONARD D. AND NANCY P. JACOBY TARA G. KAMRADT AVRAM W. AND BETH F. KAPLAN SNEHENDU B. AND BARBARA KAR KATTEN MUCHIN ZAVIS ROSENMAN FOUNDATION NEAL D. AND FRANCINE R. KAUFMAN FRANK P. AND JENNIFER L. KOZAKOWSKI LANDMARK PROGRAMS, INC. JOANNE LESLIE LITTLE COMPANY OF MARY HOSPITAL CHRIS J. MARDESICH AND EDEN L. KUSMIERSKY MCINTYRE, BIRKNER & ASSOCIATES MEDECINS SANS FRONTIERES MEDICAL EDUCATION COOPERATION WITH CUBA MEDICAL SERVICE CORPORATION INTERNATIONAL WILLIAM MEIERDING KYLE A. MURPHY WALTER W. NOCE, JR. THE RALPH M. PARSONS FOUNDATION PAUL, HASTINGS, JANOFSKY & WALKER LLP PEPSI-COLA CANADA LIMITED NEAL PORGMAN LYNDA AND STEWART RESNICK KENNETH J. RESSER SCAN HEALTH PLAN MIRIAM SCHOCKEN BENEDICT R. AND JANICE A. SCHWEGLER, JR. STUART O. AND SUZANNE U. SCHWEITZER ROBERT SCOFIELD, JR. ROBERT C. AND LISA B. SHAW ATSUKO SHIBATA JUDITH SIEGEL GRANT G. SLATER AND GENE H. KAULA STATE FARM COMPANIES FOUNDATION ZHUANG TANTIWASADAKRAN AND UCHUMAS SUPHAVARODOM UCLA HEALTH POLICY AND MANAGEMENT ALUMNI ASSOCIATION UNIHEALTH AMERICA VERIZON FOUNDATION PAUL S. VIVIANO VICTORIA C. WATTS BEATRICE BLAU ZEIGER AND IRVING ZEIGER $1,000 - $2,499 2C SOLUTIONS CRAIG M. AND GRACE N. ACOSTA ADVENTIST HEALTH ALLIEDSIGNAL FOUNDATION INC.

RICHARD F. AMBROSE ARCO RUTH M. AREVALO SANDRA AND CHARLES ARONBERG TAKAMARU ASHIKAGA SYLVIA E. AND ALLAN R. BARR MICHAEL J. BELMAN MARLENE D. AND ROBERT L. BELSTOCK ROY P. BETANCOURT SUSAN K. BLACKWELL JOY T. BLEVINS BLUE CROSS BLUE SHIELD ASSOCIATION GERALD M. BOROK TEYMOUR BOUTROS-GHALI J.J. AND JUDY BRANDLIN DOROTHY K. BREININGER RALPH AND CLAIRE BRINDIS WAYNE O. AND SUZANNE BUCK THERESA L. BYRD CHARLES E. AND VICKY C. CABLE GUOXUAN CAI CALIFORNIA ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS CALIFORNIA ATHLETIC TRAINERS ASSOCIATION CALIFORNIA CENTER FOR PUBLIC HEALTH ADVOCACY CALIFORNIA MEDICAL CENTER, LOS ANGELES CALIFORNIA PUBLIC HEALTH ASSOCIATION-NORTH CAP GEMINI ERNST & YOUNG U.S. LLC CAREAMERICA SOUTHERN CALIFORNIA MARTIN F. AND MARY ELIZABETH CARR CATHOLIC HEALTHCARE WEST CENTER FOR CORPORATE INNOVATION, INC. STEVEN H. AND FRANCES CHASEN CHEVRON CORPORATION CHILDRENS HOSPITAL LOS ANGELES VIRGINIA A. AND WELDEN E. CLARK SHELDON E. COHEN JO ANN COHN STEVEN S. COHN JEFFREY AND JOELLA CONKLIN CONSULTANTS FOR PATHOLOGY & LABORATORY MEDICINE MARK AND KATHLEEN COSTA CREDIT SUISSE FIRST BOSTON CORPORATION LYNN W. CREELMAN JULIE E. CRONER LAYTON R. CROUCH WILLIAM G. AND HOLLY H. CUMBERLAND THE DAVID FAMILY FOUNDATION, INC ROBERT A. DAY AND KELLY DAY

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37 CARL E. PIERCHALA ROBERT S. PLOURDE NINEZ PONCE AND ROBERT NORDYKE MICHAEL L. PRELIP ANTHONY & JEANNE PRITZKER FAMILY FOUNDATION PROGRESSIVE HEALTHCARE SYSTEMS BRUCE I. RABEN AND LYNN LERMAN JEAN LE CERF RICHARDSON RIVERSIDE COMMUNITY HOSPITAL PATRICIA ROSENBURG FUND HOWARD L. AND JEAN E. ROSENFELD DOLORES B. AND TAL C. ROSS WILLIAM T. ROSS RSKMGMT. INC. SAINT VINCENT MEDICAL CENTER ALAN AND SUE SAMUELS MARJORIE A. SANTORRE BESSON KENNETH P. AND LESLIE H. SATIN MARK D. AND SHING S. SCHLUCHTER RICHARD M. SEIGEL FOUNDATION BRIAN T. AND JEANETTE E. SHERRINGTON JERALD F. AND DONNA JEAN FREDERICK STEVEN R. SIM HASKEL SIMONOWITZ JAMES B. SIMPSON CLIFFORD J. SMITH DANIEL F. SMITH WILLIAM E. SMITH, JR. HERBERT N. AND MARIAN E. SNOW SONOMA STATE UNIVERSITY ACADEMIC FOUNDATION, INC SAMUEL AND HELENE SOREF FOUNDATION DAVID M. SOULELES SOUTHERN CALIFORNIA GAS COMPANY DENISE M. SPAULDING STONE SOUP CHILD CARE PROGRAMS IRMA H. STRANTZ IRWIN AND EILEEN H. SUFFET JOSEPH A. AND MARY H. SYIEK LINDA A. THOMAS DAVID B. TILLMAN TRACY S. AND KEITH A. TOBIAS CITRON AND GENEVIEVE TOY UCLA GWHFC MOBILE CLINIC PROJECT UCLA MEDICAL CENTER UNIVERSITY OF SOUTHERN CALIFORNIA GUSTAVO A. VALDESPINO ROBERT O. VALDEZ AND MARY E. WINTER

MANUEL VANEGAS SUEBELLE S. AND DAVID S. VERITY BARBARA R. VISSCHER AND FREDRICK H. KAHN H. G. WALLACE WALT DISNEY IMAGINEERING INFORMATION RESEARCH CENTRE WELLNESS CONCEPTS, PA KENNETH B. WELLS AND M. CHRISTINA BENSON WELLSPRING PARTNERS CONSTANCE WHITNEY MILTON A. AND MISTY WIDELITZ WILLAMETTA K. DAY FOUNDATION GRAEME A. AND VIVIAN R. WILLIAMS WITT KIEFFER FORD HADELMAN AND LLOYD WENG KEE WONG WOOD KAUFMAN FAMILY TRUST BUD AND CYNTHIA S. YORKIN MIMI C. YU AND ALEXANDER S. CHAI BEATRICE B. ZEIGER EDUCATION FUND DAPHNA AND RICHARD S. ZIMAN MEL AND NANCY ZIONTZ

It is important to us that we acknowledge your gift properly.

Every effort has been made to ensure the completeness and accuracy of this Honor Roll.

Please let us know of any omissions or errors in listing your name or gift by calling (310) 825-6464.

ANNUAL PRIZE WILL HONOR OUTSTANDING UCLA PUBLIC HEALTH STUDENT Carolbeth Korn (B.S. ’59, pictured above) has donated $200,000 to the UCLA School of Public Health to create an annual $10,000 prize honoring the outstanding graduating student each year. Recipients of the Carolbeth Korn Prize will be selected by the dean and academic leaders of the School of Public Health and announced during the school’s annual awards event.

“By establishing this annual prize, I hope to encourage the best and brightest public health students to become our nation’s public health leaders,” she says. “After receiving a first-rate public health education at UCLA, I’m very proud to be investing in the School of Public Health’s most outstanding students.”

UCLAPUBLIC HEALTH

JANET L. AND ALEXANDER W. KIRKPATRICK SUSAN AND COREY E. KLEIN LEONARD F. AND MELODYE T. KLEINMAN MASAO AND KARLENE N. KOKETSU JAMES J. KORELITZ AND ELIZABETH M. SLOSS KORN/FERRY INTERNATIONAL DAVID KRASNOW DIANE W. AND JAMES D. LAIRD BARBARA M. LANGLAND ORBAN GAIL C. LARSON LATHAM & WATKINS LLP NED LAUBACHER, JR. TERI DALY LAUENSTEIN ANNE C. AND KENNETH P. LAWLER J. JACK AND VEI-VEI C. LEE JOON YOP LEE MARTIN L. AND MARILYN LEE ANDREW B. LEEKA STEVEN S. AND DEBRA H. LEWIS JOHN H. AND SANDY LIBBY BRYAN R. LUCE AND MARIE E. MICHNICH JEFFREY LUCK AND CAROLYN MENDEZ-LUCK KUNG J. AND JEN-MEI LUI MAUREEN MANGOTICH LEO AND GERTRUDE MARANTZ FAMILY FOUNDATION MARBLEHEAD GROUP LLC HARVEY M. AND EVE MASONEK DENISE C. MATHES JAMES C. MC DERMOTT AND DEBRA CINCOTTA GEORGE A. MC KRAY MCGRAW HILL COMPANIES GARY M. MEUNIER JEAN L. AND MAX RAY MICKEY RUTH M. MICKEY OLGA SIMMONS MOLINA MEDICAL CENTERS NANCY J. MONK AND ALLAN E. GORDON HAL MORGENSTERN MARC D. AND JOANNE L. MOSER CRAIG G. MYERS ABOO NASAR ELIZABETH T. NASH NIEL S. NATHASON SHARON L. NICHOLS NELLY J. NIGRO PETER NORTON FAMILY FOUNDATION ONCOLOGY NURSING PRESS PHILIP M. ORAVETZ ORTHO BIOTECH INC. JONG SOON P. AND HYEON K. PARK ERNESTO O. PARRA AND NORMA GOMEZ PARRA THE PERMANENTE FEDERATION, LLC

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DARYL V. DICHEK WILFRID J. AND GLORYA U. DIXON HELEN M. DUPLESSIS LYNNE A. EMMA EQUITABLE REAL ESTATE MANAGEMENT GROUP ROSALIND ESSNER THOMAS B. AND PHYLLIS C. FARVER DANIEL J. FINK FIRST CONSULTING GROUP DAVID I. FISHER AND MARIANNA J. FISHER JEFFREY S. AND DEBBIE L. FRIEDMAN GENENTECH ROBERT P. AND DIANA L. GHIRELLI DAVID M. GITTELMAN ALISA M. GOLDSTEIN HAROLD M. GOLDSTEIN MICHAEL S. GOLDSTEIN FRANK C. GOMEZ SUSAN R. GOODGAME SEYMOUR F. AND SHARON M. GORELICK KENNETH D. GRAHAM GREATER PACIFIC MEDICAL MANAGEMENT DANIEL AND ROCHELLE GREEN MARILYN W. GRUNZWEIG JAMES E. HADEN HAGOPIAN FAMILY FOUNDATION RONALD J. HALBERT NORA L. HAMILTON PHYLLIS E. HAYES REAMS HEALTH CARE REVIEW HEALTHCARE PARTNERS HORACE W. AND EDYTHE HINKSTON JOHN A. HIRSHLEIFER ELISE M. HOLLOWAY GORDON D. AND RURI T. HONDA DONALD B. AND CAROLYN T. HUNSAKER HUNTINGTON HOSPITAL PATRICIA AND GILBERT IALONGO IBM INTERNATIONAL FOUNDATION JOHN D. AND CHRISTINA N. IVIE ROBERT A. JACKSON JENQUEST ALLAN K. AND DOROTHY N. JONAS JIM M. KADA NATHAN KAPROFF HERMAN E. AND ROSE KATTLOVE ALBERT M. AND AUDREY KATZ KECK SCHOOL OF MEDICINE AT USC KINDRED HEALTHCARE OPERATING THE MICHAEL KING FAMILY FOUNDATION

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Commencement

2006 John Garamendi, California insurance commissioner and author of the report Priced Out: The Crisis in California Health Care, is the featured speaker at the school’s 2006 Commencement.

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

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