UCLA Public Health Magazine - November 2005

NOVEMBER 2005

UCLA

PUBLIC HEALTH

UCLA

Lessons Beyond the Classroom

School of

Public Health

In mentoring students through their hands-on public health experiences, Michael Prelip also helps them develop their professional self.

SPH faculty go far in their efforts to track disease outbreaks and identify prevention strategies.

In Anne Rimoin’s case, as far as central Africa.

Rotrease Regan Yates graduated in June with valuable training in reproductive health, thanks to support from the Fred H. Bixby Foundation.

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. Associate 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

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After KATRINA: Disaster Response, Lessons Beyond the Displaced Students, Classroom: Students What We Learned Gain Experience The tragedy of Hurricane Katrina sent several faculty and students to the Gulf Through Practicum Coast region to assist and brought disRequirement placed public health students to UCLA.

FAMILY VALUES: The Fred H. Bixby Center for Population and Reproductive Health

Michael Prelip: Helping Students to Find Their Way

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in every issue 23 RESEARCH

17 14 In running his department’s Field Studies program, he guides students through the process of obtaining realworld public health experiences. But for this faculty member, mentorship means much more.

Worldly Pursuits: School’s Global Health Program Transcends Borders

One country’s problems are the world’s. International initiatives, a central part of the UCLA SPH Strategic Plan, recognize the interconnectedness of nations and the need for cooperative actions to address health concerns.

The Fred H. Bixby Program has fostered overseas internships for students, supported research, and promoted key public health issues. A new gift will enhance the effort, creating a newly endowed center.

Chiropractic vs. medical care for low-back pain...breast cancer and the elderly... work-relatedness of suicide... electromagnetic fields and children...dairy products and metabolic syndrome risk...jobbased insurance rates decline.

28 STUDENTS 30 FACULTY 32 NEWS BRIEFS

ON THE COVER Opportunities for UCLA School of Public Health students to learn are not confined to lectures and textbooks.

Their experiences in the field are preparing them for success – and contributing to a better community.

PHOTOGRAPHY Reed Hutchinson / Cover: King, Coffee, Sharp, Reyes, Maggard, Prelip, Rimoin, Regan Yates; TOC: Maggard, Prelip; p. 4: Tulane students; p. 5: Shoaf and Rottman; p. 8; p. 9: King; p. 10: Sharp; p. 11: Reyes; p.12; pp. 15-16; p. 18: Pebley; p. 21: Tavrow; p. 29; p. 32: Schuster

ASUCLA / p. 2 Ryan Tuchmayer (DMAT CA-9) / TOC: Katrina; p. 7: mass vaccination Andre Lee (DMAT CA-9) / p. 7: Tuchmayer Hudson Hou / p. 32: symposium Courtesy of Steven Rottman / pp. 4-5: emergency relief center Courtesy of Jonathan Fielding / p. 6 Courtesy of Shelley Berridge / p. 9 Courtesy of Dahianna Lopez / p. 10 Courtesy of Austin Chan / p. 11 Courtesy of Anne Rimion / TOC: global health; p. 14 Courtesy of Leah Maddock / TOC: student practicum; p. 17; p. 18: meeting; p. 20 Courtesy of Kristen Shellenberg / cover: Shellenberg; p. 18: Shellenberg and Maddock during practicum; p. 22 Courtesy of Rotrease Regan Yates / p. 21 Courtesy of Larisa Mori / cover: Mori; p. 28 Courtesy of Ray Goodman / p. 33 Courtesy of the UCLA School of Public Health / pp. 30-31; p. 32: Roemer; p. 33: Jones, Schuster iStockphoto © 2005 / pp. 25-26

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 2005 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 THE EVENTS OF 9-11 and their aftermath brought unprecedented attention to the field of public health. Simply put, we were not prepared.

With the nation resolving to do better the next time tragedy struck, public health became the buzzword for politicians. Many of us in the field called for increased federal funding to ensure that when, not if, disaster struck again we would be prepared at the national, state and local levels. In response, there was barely a nudge on the 3 percent of all national health expenditures allocated to public health. Public health needed major surgery and they sent us a Band-Aid. In late August, we were tragically reminded how unprepared we still were as Hurricane Katrina hit the Gulf Coast with a vengeance. For the first time, our country witnessed a vivid picture of the vulnerability of displaced people. We saw firsthand that the suffering did not fall equally on those in the hurricane’s path – that elderly, the poor and people of color were disproportionately affected.

Katrina's devastation created a textbook public health crisis resulting from the absence of essentials for survival – not just food, water, hygiene and shelter, but the inability to get even basic medical services, including refilling critical prescriptions.

Faculty and students from UCLA’s School of Public Health played a significant role in relief efforts, traveling to the devastated area to assess health conditions. As highlighted in the article on the hurricane (page 4), in addition to relief efforts, we have taken in seven displaced students from Tulane’s School of Public Health. I believe this will be one of very few positive outcomes of Katrina.

Welcoming these students provides an opportunity for our students and faculty to benefit from the knowledge gained from witnessing perhaps the greatest public health disaster in United States history. We know that there is a lot more to a public health education than can be found in a textbook. Because of that, our students are each required to participate in a practicum to give them the tools that can be gained only from hands-on experience. Our cover story (page 8) provides case studies on students’ experiences both here and abroad. Not only does their experience benefit them individually, the lessons that they bring back to share with other students and faculty members are invaluable.

Furthering opportunities for students to gain experience abroad is the new Fred H. Bixby Center for Population and Reproductive Health. A recent $5 million gift (page 18), the largest donation in the school’s history, will add to our stuUCLAPUBLIC HEALTH

dents’ opportunities to gain practical international experience while helping women around the world. The gift from the Fred H. Bixby Foundation also creates a permanent home at the school dedicated to expanded research, service and training in the fields of population and family planning. These efforts add to other global health efforts – including our being on the cutting edge of innovative

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approaches to tackling emerging infectious diseases, such as avian flu – that remain a focus of our strategic plan (see page 14).

Finally, on December 31, the highly successful Campaign UCLA – a comprehensive fundraising effort to support academic programs, students, faculty and facilities across the campus – will come to a close. I am pleased to report that the School of Public Health has far exceeded its Campaign goal of $31 million. As of June 30, with six months remaining, the school had reached the $51.7 million mark, an exceptional 167 percent of goal.

Reaching these development milestones means that our school is doing all we can to provide the best educational framework in which to prepare our students to meet the public health challenges of tomorrow. We can’t wait for federal and state governments to realize the importance of a solid public health infrastructure and invest accordingly. The stakes are way too high.

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

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 Cumulative Progress Through Fiscal Year 2004-05 | SPH Campaign Goal: $31 M (167%) $55,000,000 $51,655,872

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

$37,969,674

35,000,000 $33,029,500 30,000,000 25,000,000 $23,336,915 20,000,000

$18,852,239

15,000,000

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

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

10,000,000

After KATRINA

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T HE OF

TRAGEDY

H URRICANE

K ATRINA

SENT

SEVERAL FACULTY AND STUDENTS TO THE

G ULF C OAST

REGION TO ASSIST, AND BROUGHT DISPLACED PUBLIC HEALTH STUDENTS TO

UCLA.

Disaster Response, Displaced Students, What We Learned Shannon Navarro had been in New Orleans for three days – long enough to have moved her belongings into on-campus housing at Tulane University, where she was about to begin the M.P.H. program at the School of Public Health and Tropical Medicine. She was in the process of setting up her new apartment on Saturday, August 27, when she learned of the impend-

UCLAPUBLIC HEALTH

ing hurricane.

The school welcomed seven displaced Tulane public health students, including (l. to r.)

Shannon Navarro, Brandon Dean and Erika Sugimori.

Brandon Dean had returned from a two-year religious mission in the Brazilian Amazon determined to pursue education that would lead to a career in which he could help to address health and development disparities. He was accepted into Tulane’s International Health System Management M.P.H. program and, with his wife, loaded up a U-Haul truck and drove from their home in San Diego, arriving in New Orleans August 23. Four days later, they, like Navarro, were leaving.

Hurricane Katrina hit New Orleans on Monday, August 29, the day Tulane’s new-student orientation had been scheduled to take place. “When the levees broke on Tuesday and we saw our neighborhood under water, we knew that our well-thought-out plans were about to change,” says Dean.

Navarro and Dean are among seven displaced Tulane public health students welcomed to UCLA through a coordinated effort with other members of the

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Association of Schools of Public Health to ensure that all of these students could continue their studies after Tulane closed for the fall semester. Hurricane Katrina was a tragedy felt far beyond the Gulf Coast, affecting not only these students but also at least one UCLA School of Public Health alum. Several members of the school’s faculty and one student were among those called on to participate and advise in the response. In October, the school’s new Center to Eliminate Health Disparities hosted a symposium, “Lessons from Hurricane Katrina: Poverty, Race and Health in America.”

UCLAPUBLIC HEALTH

Cathy Taylor (M.S.W., M.P.H., Ph.D. ’03) was still in the process of setting up her office and meeting people in her new position as an assistant professor at Tulane when news of the impending hurricane began to spread. After graduating with her Ph.D. from the UCLA School of Public Health, Taylor had completed a two-year postdoctoral fellowship at Columbia University. Her tenure-track faculty position at Tulane had taken effect August 1.

She was fortunate enough to secure a flight to San Antonio on Sunday morning – many airlines were sold out – and figured she would stay there for a few days, until the hurricane blew over and power was

restored. “By Tuesday,” she says, “I started to realize I wasn’t going back any time soon.”

A week later, Dr. Scott Lillibridge, director of the Center for Biosecurity and Public Health Preparedness at the University of Texas Health Sciences Center at Houston, called the UCLA Center for Public Health and Disasters (CPHD), based in the School of Public Health, requesting that a team be sent to Houston to help conduct health assessments of the 20,000 displaced persons housed in the Astrodome complex.

Both centers are part of a national network of Centers for Public Health Preparedness funded by the Centers for Disease Control and Prevention (CDC). Drs. Steven Rottman and Kimberly Shoaf, CPHD’s director and assistant director, led a contingent of six that arrived in Houston the next day and immediately began assisting with cot-by-cot health status surveys of those being sheltered in the complex’s three facilities.

“When you have large numbers of people together in a situation like that, they bring their own medical issues – chronic problems that need to be treated, such as high blood pressure and diabetes – while at the same time, some people might be incubating respiratory illnesses and once you put them all in very close quarters, the transmissibility factor goes up,” Rottman explains. “In addition, when so many people are compacted together for so long, it poses a greater risk of communicable disease being spread.”

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Drs. Steven Rottman (below right) and Kimberly Shoaf (below left), director and assistant director of the UCLA Center for Public Health and Disasters, were called on to participate in cot-by-cot health status surveys of those being sheltered following Hurricane Katrina at the Houston Astrodome complex’s three facilities.

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Using a health-questionnaire assessment tool that had been developed by the existing team, the CPHD group helped to collect data that was used by the local health department’s epidemiology unit to track any syndromes that would suggest a communicable disease outbreak. By the third night, the CPHD team was able to direct the effort, providing a much-needed break for the University of Texas group. “Although the CDC preparedness centers have been sharing academic and training approaches, this inter-center mutual aid was something different – university and practice partners working together in an ongoing public health emergency,” says Rottman, an emergency physician who also worked closely with personnel who had set up a makeshift hospital facility on the grounds.

Back at UCLA, Rottman, Shoaf and their CPHD colleagues have drawn lessons from the events that unfolded post-Katrina. “It’s caused many of us to rethink a lot of things,” says Shoaf, who, along with Dr. Deborah Glik, professor of community health sciences, had already been working with the Los Angeles County Department of Health Services on a disaster-preparedness media campaign.

Meanwhile, a student who chose to pursue a degree at the school because of the expertise he

UCLAPUBLIC HEALTH

“Katrina reinforced the importance of the basic public health protections we take for granted — adequate sewage, potable water, safe food and reduced environmental threats.”

— Dr. Jonathan Fielding

would gain through the CPHD was being deployed as part of the Disaster Medical Assistance Team (DMAT) from Los Angeles County.

Ryan Tuchmayer, a second-year M.P.H. student and emergency trauma technician at UCLA Medical Center looking toward a career in disaster and emergency management, was sent to Thibodaux, La., an evacuation center 50 miles west of New Orleans. For two weeks, his team – part of the National Disaster Medical System within the Department of Homeland Security’s Federal Emergency Management Agency – provided basic emergency care, helped run a special needs shelter, assisted in the public health department’s mass vaccination campaigns, and formed “strike teams” to provide medical care at shelters.

“In my epidemiology course we were talking about mass vaccination campaigns against smallpox, and here I was able to see a mass vaccination campaign taking place,” Tuchmayer says. “Many of the ideas I learned about in health communications were also put into action.”

Dr. Jonathan Fielding had been concerned in the initial days of the disaster that misinformation was being propagated. “People were spreading the word that there were epidemics of typhoid and cholera, and that the water was so toxic you couldn’t touch it,” says Fielding, professor at the school and director of public health for Los Angeles County. “These were not what I understood to be the facts.”

At the request of the State of Louisiana, Fielding was a senior member of a team from L.A. County that went to New Orleans to provide assistance with the emergency response. Fifteen people went, including Fielding, who ended up working directly with Dr. Kevin Stevens, New Orleans’ health director, and with a team from the CDC sent to assist in monitoring health and safety issues and restore essential public health functions. In addition to assisting in developing priorities, helping to plan for the recovery, and ensuring that appropriate public health resources were brought to bear, Fielding advised Stevens on getting the right messages to the public.

“It was important to let people know exactly what was going on – to tell them what was real and what wasn’t,” he says. While unfounded rumors were being spread, there were also serious concerns that needed attention. “The sanitation system wasn’t working, there was no potable water to many parts of New Orleans, there were safety risks from problems with the structural integrity of many residences, possibilities of high levels of some toxic substances in the soil as the water receded, and extensive amounts of mold in many buildings,” Fielding explains. “A key issue was how to make it safe for residents to reenter the city as soon as possible.”

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Fielding, who continued to provide consultation and advice to Stevens and an on-site team from the CDC following his return to Los Angeles, notes that a disaster of Katrina’s magnitude points out the importance of public health systems. “Katrina reinforced the importance of the basic public health protections we take for granted — adequate sewage, potable water, safe food and reduced environmental threats,” Fielding says.

M.P.H. student Ryan Tuchmayer (above), an emergency trauma technician and member of the Los Angeles County Disaster Medical Assistance Team, was deployed to an evacuation center in Thibodaux, La. (above left), 50 miles west of New Orleans.

UCLAPUBLIC HEALTH

With Tulane closed for the fall semester, Taylor was invited to return to Columbia University, where she is a visiting associate researcher in the School of Social Work. She intends to go back to her position at Tulane in the spring, but might need to broaden her research focus. Taylor’s expertise is in family violence prevention. “I’m interested in doing research in the community – working with home visiting services and primary prevention strategies – and as of now there is no community, at least geographically speaking,” she reflected, a month after Katrina struck.

Erika Sugimori had completed her first year as an M.P.H. student at Tulane and was vacationing when the hurricane hit. It would be nearly two weeks before she reached her roommates and friends. “Every day I thought of someone else from the neighborhood or from my bike ride to school who probably didn’t fare well,” she says. “I felt frustrated, impotent and disconnected.”

Sugimori, who enrolled at UCLA for the fall, expects to return to Tulane and to graduate on schedule. “The hurricane has made its mark on my conscience, serving as a bold reminder of the disparities that remain in the U.S. and reinforcing the reasons for my decision to study public health,” she says. “I’m treating this as an unexpected ‘semester-abroad’ experience – an opportunity to study at another university and make connections with my peers in the public health community. Things have gone much smoother than I had expected. I know I am very lucky.”

It hasn’t been easy for Karen Chin, who had enrolled in Tulane’s Master’s Internationalist Program, where she intends to pursue an M.S.P.H. In late August, she packed her belongings and drove east with her family from Southern California, getting as far as Lafayette, La., before learning that an evacuation of New Orleans was under way. She stayed in Lafayette until Tulane announced it would be closed for the fall, then headed back home.

“I am incredibly grateful to UCLA for going out of its way to host us,” Chin says. “Even though I am fully intending on going back to Tulane to complete my degree, I will never forget the kindness and education I received here.”

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LESSONS BEYOND THE CLASSROOM:

Students Gain Experience Through Practicum Requirement At the UCLA School of Public Health, students gain the skills and knowledge they will need to become leading professionals. But their education is not confined to the classroom. As part of their M.P.H. degree requirement, students find a health-related field placement and work there for a period of time, applying the concepts they have learned in real-world settings. As the following case studies illustrate, this practicum requirement not only affords students invaluable learning opportunities, but also enables them to make significant contributions to the community en route to getting their degree.

Securing Safe Travels for Seniors Katie Maggard, M.P.H. Student Community Health Sciences

UCLAPUBLIC HEALTH

At Santa Monica’s Center for Healthy Aging, Maggard (above left) helped to launch a nonprofit transportation service for seniors.

For Katie Maggard, it was the perfect internship – one that combined her interest in public transportation with work on an important issue affecting older adults: the decision to stop driving.

“Moving from the driver’s seat to the passenger’s seat can be traumatic,” Maggard explains. “Automobiles are symbols of independence. They offer freedom, control, convenience, and social interaction.” Public transportation is often difficult to navigate or limited, she adds, forcing many older people to become dependent on family and friends. Thus, Maggard says, “Older adults experiencing age-related changes that compromise their safety may continue to drive because they see no alternative equal to owning and piloting their own vehicle.”

With funding from the Wilshire Foundation, Maggard assisted Santa Monica’s Center for Healthy Aging as it prepared to launch the first replication of the Independent Transportation Network (ITN), a community-based, nonprofit transportation service for seniors that has operated in Portland, Maine, for 10 years, and is now being brought by the Center for Healthy Aging to seniors in the greater Santa Monica area, thanks to support from the Archstone Foundation. ITN mimics private vehicle ownership by using automobiles with both paid and volunteer drivers to provide service 24 hours a day, seven days a week. “Seniors who use the service become dues-paying members and open ‘personal transportation accounts’ to pay for rides,” Maggard explains. “The program is self-sustaining via innovative payment programs and voluntary local community support, without relying on taxpayer dollars.” Rides are scheduled to begin next spring.

Maggard helped to move the replication project forward by following up with media contacts; conducting research on automobile insurance policy, dealership laws, and licensure regulations; expanding the stakeholder list; creating informative literature; and assisting with the first ITNSantaMonica public forum, which was held at Emeritus College in September and attracted nearly 70 community members. As a result of her internship, Maggard was invited to the ITNAmerica National Summit in Maine the following month. “I now have an opportunity to pursue research on the phases of older adult mobility,” Maggard adds. “This project provided great exposure to the field and experience with an exciting and innovative program.”

9 Shelley Berridge, M.P.H. Student, Health Services

Berridge’s internship took her to the World Health Organization in Switzerland.

Early in her career, Shelley Berridge sought front-line health care experience, both domestic and international. She managed nonprofit community clinics focusing on HIV/AIDS and reproductive health for vulnerable and underserved populations. “I understood that gaining diverse health perspectives would contribute to my effectiveness as a public health professional,” she says.

Berridge saw her department’s required summer internship as an opportunity to explore health care systems at the macro-level. When she received two extraordinary internship offers – both of which would find her working with well-placed alumni of UCLA and the School of Public Health – she felt she had to accept both.

Last summer, Berridge served as an administrative intern at Cedars-Sinai Medical Network System in Beverly Hills. She was attracted to the organization by the leadership and mentoring qualities of its CEO, Tom Gordon. “He sharpened my management skills while giving me broad exposure to the components of operating a multi-specialty group with almost 80 physicians,” says Berridge, who took part in the purchase negotiations and implementation phase of a new electronic medical record system.

For this fall, Berridge deferred classes to join the Evidence and Information for Policy (EIP) cluster at the World Health Organization headquarters in Geneva, Switzerland. EIP provides technical support and policy recommendations to health systems in 192 member countries. Under the supervision of Dr. Ritu Sadana (M.S.P.H. ’87, D.S.), senior scientist and policy analyst, she spent the fall contributing to the analysis of a survey module on financial flows for health research, and to a sub-analysis guide for national health accounts. “Working in a multidisciplinary setting and international team is extremely rewarding,” Berridge says. WHO interns gain exposure to other UN organizations and are able to attend regularly held seminars. On her first day, Berridge listened to Dr. Gro Harlem Brundtland, WHO director-general emeritus, speak on world health and security.

Berridge plans to return to UCLA for the Winter Quarter. “I look forward to applying what I have learned from both internships to my coursework and class discussions, and future career,” she says.

cover story

Macro-Level Experience at Home and Abroad

Prevention Services to Help At-Risk Youth and Families COPE Evan King, M.P.H. Student, Health Services M.A. Student, Latin American Studies

King (left) works with Allen Miller (M.P.H. ’01), CEO of Community Outreach for Prevention and Education (COPE).

UCLAPUBLIC HEALTH

When he went in to the offices of the non-profit health care corporation COPE (Community Outreach for Prevention and Education) to accept an internship position in which he would work with CEO Allen Miller (M.P.H. ’01), Evan King was confident he had chosen the right organization for the experience he sought. COPE’s mission – to make communities healthier – matched King’s interest in being part of an innovative, community-driven organization.

King knew that Miller would be anxious to orient him with the work ahead, a continuation of efforts begun by the previous UCLA School of Public Health intern. “That said,” King notes, “to say that I hit the ground running is an understatement.” Anxious not to forego the final week of his spring break, he had planned to merely offer his formal acceptance of the position and discuss his schedule for the following quarter. Some hours later, as he sat in his new office, revising his first draft of an IT strategy proposal, King marveled at his preceptor’s management style. “Both endearing and persuasive, Allen has a way of empowering those within the organization by inviting them to manage a project that at first may appear to be just out of reach,” he says. “Six months later, I had completed a consulting report for a major medical center, immersed myself in the development and daily operations of a groundbreaking community-based program, and met with phenomenal staff, administrators, executives, and various health care stakeholders.”

From the outset, King understood the purpose of taking on challenges presented to the organization by the health care system and its patients; with time, he says, he came to realize that above all else, he worked for an organization that simultaneously builds the capacity of its team members with each additional project and program. “Knowing that as much consideration is put into developing staff as to finding health care solutions reassures me that COPE is a personal investment in my career,” he says.

Building a Patient Education Resource Center 10

Dahianna Lopez, M.P.H. Student, Community Health Sciences

At the West Los Angeles VA, Lopez built the PERC from scratch.

Dahianna Lopez’s summer experience was one she never imagined she would have as a graduate student. As an intern at the West Los Angeles Veterans Administration Hospital, the largest hospital in the nationwide VA network, Lopez was asked to help establish a patient education resource center (PERC) in the main lobby of the hospital. The PERC was envisioned as a place where patients could obtain free health information in the form of pamphlets, brochures, videos, online resources, 3-D models, individual counseling, and classes taught by certified clinicians. “I started off with an empty room,” Lopez recalls, “and my job was to network with members of different departments at the VA in order to establish the center.”

The internship was both hands-on and varied. “Sometimes I would dress in jeans and a sweatshirt and get my hands dirty by unpacking boxes and stocking the shelves,” Lopez says. “Other times, I came in with heels and a suit because I had presentations to give to hospital executives and doctors about the importance of health education and the opening of the new center. Every day was different.” In 12 weeks, the empty room was transformed to an attractive center with substantial amounts of well-organized health information. At the grand opening ribbon-cutting ceremony in September, the hospital’s CEO and a former prisoner of war cut the ribbon.

When the internship was over, Lopez was asked to stay for another year to help run the center and direct its new staff. “I look forward to helping expand the services the PERC offers and making it a place where veterans can improve their health by becoming better informed,” she says. The experience has convinced her that she wants to become an advanced practice nurse with a public health and administrative position. Explains Lopez: “I would like to be able to make an impact on patients’ lives through improvements in primary care standards, changes in hospital policies, and an increase in programs focused on prevention.”

Clearing the Air on Environmental Health Disparities Among Children

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Marie Sharp, Dr.P.H. Student, Epidemiology For Marie Sharp, last summer was spent working with Communities for a Better Environment (CBE), an environmental health and justice nonprofit organization whose mission is to combat the disproportionate location of environmental hazards in low-income California communities of color.

As a Colombian-American, Sharp wanted to work in the Latino community, and as an epidemiology student, she was interested in CBE’s study, “Children’s Health Disparities, Ambient Air Toxics and Health Risks in Southeast Los Angeles,” funded by First 5 LA and the UCLA Center for Community Partnerships. The study used “participatory action research” methods in which the focus was on collaborating with community members to design, develop, and implement a strategy to examine environmental issues, asthma in young children, and health disparities in Southeast Los Angeles.

In collaboration with her faculty advisor, Dr. Beate Ritz, and Guadalupe Vidales, a UC Irvine Ph.D. student in social ecology, Sharp conducted the statistical data analysis and wrote up the final report of the study findings. Her group examined the distributions of demographic, environmental, and health variables and described the prevalence of asthma and other respiratory symptoms experienced by children ages 0-5. Sharp’s group also compared the demographics and symptom reports with findings from the Los Angeles County Health Survey.

The study results suggest that there were adverse health disparities in young children compared to the general Los Angeles County population. “The report will serve as a starting point for future research into lifestyle, environmental, and health care factors affecting children,” Sharp says, adding that the findings will be disseminated into the community and to policy-makers.

“It was a tremendous experience for me to work with these data and help transform the results into a voice for the community from which they came,” Sharp concludes. “I learned that there is much work to be done to improve the environment and provide accessible health care for disadvantaged Americans and immigrants living in Los Angeles.”

Sharp (right) teamed with Guadalupe Vidales of UC Irvine on the Communities for a Better Environment study.

11 Austin Chan, M.P.H. Student, Environmental Health Sciences

Chan conducted safety inspections at Shell Los Angeles Refinery.

Austin Chan describes his summer internship at Shell Los Angeles Refinery as an “eye-opening experience like no other” – a chance to practice his industrial hygiene skills in a very traditional setting, yet with a freedom to explore on his own.

As an industrial hygiene intern, Chan was given the opportunity to assess worker exposure to chemical threats such as benzene and hydrogen sulfide, evaluate heat stress during hot summer days, and implement a new eye-protection policy. Looking for a challenge, he entered the internship expecting a “grimy” work environment and uncooperative employees; instead, Chan says, he found a high priority for health and safety at all levels in the plant, from the hourly contract workers to the upper management.

With an array of industrial hygiene instrumentation available to use at his discretion, Chan became technically savvy faster than he had anticipated. “Through my daily interactions with the refinery field operators, I learned that an industrial hygienist’s ability to clearly, succinctly, and convincingly communicate health risks to workers is paramount – perhaps even more so than any analytical skills,” he says. “While an industrial hygienist’s daily responsibilities may involve a lot of safety monitoring, exposure assessment, and health education, I came to learn that every day offers exciting, and sometimes unexpected, challenges.” One morning, for example, Chan found himself helping to investigate the chemical cause of a swollen tongue; later that day, he was involved in an emergency response to a gas leak.

“Working in an oil refinery is inherently very dangerous, and definitely not for the faint of heart,” Chan says. “Nonetheless, it is surely an environment that I wouldn’t mind returning to, because now I truly appreciate the importance of industrial hygiene in mitigating that danger, and even preventing disaster.”

cover story

An ‘Eye-Opening’ Experience in Industrial Hygiene

Community Education at the Border Cristina Reyes, M.P.H. Student, Community Health Sciences

Reyes designed and implemented an evaluation of a health promotion program.

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Christina Reyes’ interest in public health stems from her desire to improve access to services and prevention education for low-income monolingual Spanish-speaking populations in California. Thus, she was excited to have the chance last summer to work for the Binational Border Health Program (BBHP) of the Los Angeles County Department of Health Services. Reyes designed and implemented an evaluation of the BBHP’s Road to Health Project, which sends community health workers to 10 Latin American consulates in Los Angeles to conduct presentations to clients on topics varying from breast and prostate cancer to obtaining low-cost medical and dental services in Los Angeles County.

“Conducting the evaluation afforded me an excellent opportunity to understand the inner workings of a local government health program,” says Reyes, whose responsibilities included analyzing data collected by the health educators regarding the Road to Health participants and conducting interviews and focus groups with the health education staff, program directors and consulate personnel. The internship experience, she says, gave her a better understanding of the importance of communication among agency staff and between the agency and outside collaborators for ensuring that effective public health messages are delivered to the community.

“Improvements can always be made in even the most successful public health programs, whether in resources and materials, presentation and delivery, or internal adjustments to program objectives and performance measures to better serve the population,” Reyes says. “I believe the evaluation was a great asset to the program, and that all programs and/or agencies would benefit from taking a step back to evaluate their effectiveness not only with their target populations, but also in their internal functioning.” Her experience at BBHP heightened Reyes’ interest in the field of evaluation of community health programs, and she plans to continue to pursue similar work in the future.

12 IN

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F IELD S TUDIES PROGRAM , HE GUIDES STUDENTS THROUGH THE PROCESS OF OBTAIN ING REAL - WORLD PUBLIC HEALTH EXPERIENCES .

B UT

FOR THIS FACULTY MEMBER , MENTOR SHIP MEANS MUCH MORE .

MICHAEL PRELIP:

Helping Students to Find Their Way From his first post-college work experiences as a grammar- and middle school teacher, Dr. Michael Prelip was drawn to the role of mentor. It was a role he would frequently revisit

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as he embarked on a career as a public health professional after earning his M.P.H. from the school in 1985.

“In most of my jobs, there were lots of people without formal training,” Prelip explains. “These individuals had incredible experiences and passion toward the work, but they lacked specific technical skills that would enable them to reach their full potential. Wherever I was, I often found myself in the role of teaching, mentoring and guiding.” While continuing to work in public health for more than a decade, mostly in the field of health promotion, Prelip also began to teach part-time at community colleges. Every chance he got, he served as a preceptor for M.P.H. students doing their fieldwork. “I really enjoyed that experience,” he says.

So much so that in 1996, Prelip jumped at the opportunity to join the faculty at the UCLA School of Public Health. He is currently an assistant professor in the Department of Community Health Sciences and runs the department’s Field Studies Program, which, as part of the degree requirement, gives students the opportunity to apply the skills and knowledge they learn in the classroom in a community-based or healthrelated organization (see related article on page 8). Prelip helps to place and supervise approximately 65 students each year throughout Southern California and, in some cases, beyond.

Prelip brings his experience as a public health professional to the classroom, teaching applied courses focusing on developing and evaluating programs for community-level interventions. He is involved in several research projects focusing on promotion of physical activity, nutrition, and other healthy behaviors, including

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“There has been a struggle between the academic world and the practice world in public health – each of the worlds thinks the other doesn’t quite get it. Health professionals with M.P.H. degrees have an important role in bringing these worlds together.”

—Dr. Michael Prelip

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pursue. “It’s a reflection of changes in public health practice in general, with students focusing not only on government entities – which are still very important – but also on community health and social service nonprofit agencies,” he explains. Prelip has also attempted over the years to give the program more structure and closer faculty supervision in planning and guiding the experience.

Most of the school’s M.P.H. students fulfill their 400-hour field requirement through work experience in the summer after their first year. Each winter, Prelip holds orientation sessions to acquaint students with their options, and later meets individually with students on more than one occasion, offering guidance as they contemplate their choices.

Once students have lined up their practicum position, Prelip works with them in developing a detailed scope-of-work plan. As they go through their internship, students are required to submit weekly logs, which Prelip reviews and returns with comments; once the students have completed the experience, they write a final report that Prelip grades. Prelip makes site visits and maintains contact with each preceptor, getting feedback on their students. Having worked in public health in Los Angeles for more than 20 years, Prelip has an extensive network of contacts that he can draw from to assist students in finding the right fit, although he notes that many arrive with unique interests and create their own preceptor relationships.

Prelip believes students’ practicum experiences are a critical piece in their overall education. “We have faculty who are extremely accomplished, but most of them are focused on specific topics, and not all of them have worked in practice settings,” he says. “There has been a struggle between the academic world and the practice world in public health: In general, each of the worlds thinks the other doesn’t quite get it. Health professionals with M.P.H. degrees have an important role to play in bringing these worlds together.”

The students he supervises range from established professionals who return to pursue their degree to younger students with little work experience. Even more than the skills they attain, the younger students tend to grow significantly simply from working full-time in a health-related organization, Prelip says. “Often, they come to me with an idea of what they want to do based on their hopes and dreams, and then after the field experience they reexamine their goals,” Prelip explains. “When these students come back and say, ‘Now I’m confused about what I should do with my life,’ my response is, ‘Congratulations, I’m excited for you. You’re supposed to be asking those questions at this point.’ ”

faculty profile

“Nutrition-Friendly Schools and Communities,” a pilot study in which Prelip and faculty colleagues Drs. Charlotte Neumann and Wendelin Slusser are evaluating the impact of nutrition education programs and activities at eight elementary schools in the Los Angeles Unified School District. He is also the faculty advisor for the student-run UCLA Mobile Clinic/Greater West Hollywood Food Coalition.

But it is Prelip’s role as a mentor that has had a lasting effect on so many of the school’s students, as well as new public health professionals outside of the school’s traditional M.P.H. program. He has taken an active role in the school’s M.P.H. for Health Professionals Program, which is designed for working professionals seeking to attain leadership positions in public health while maintaining a full-time career.

Prelip is also principal investigator for the Pacific Public Health Training Center, a federally funded effort to develop and support effective public health training opportunities through a consortium that includes California’s four schools of public health – led by UCLA – and the University of Hawaii.

Whether he’s mentoring students or new professionals, Prelip says, his focus is on not only honing skills and fostering appropriate work experiences, but also on helping develop a better sense of their professional self. “Mike has provided an incredible amount of support and guidance for me, both professionally and personally,” says Stephanie Vecchiarelli (M.P.H. ’01, Ed.D.), who has worked with Prelip for six years, beginning when she was a student and continuing as a colleague on Prelip’s school-based nutrition research projects. “He is usually one of the first people I turn to when I’m seeking advice.” In helping her to prepare for her M.P.H. practicum with the Centers for Disease Control and Prevention’s Division of Adolescent and School Health in Atlanta, Prelip pushed Vecchiarelli to develop a work plan that turned out to be instrumental in making the experience more meaningful, she says.

Prelip traces his own interest in public health to 1976, when, as an undergraduate at UC San Diego, he volunteered as a night-time receptionist at the Laguna Beach Free Clinic. “The dedication of the volunteer doctors and nurses was just overwhelming to me,” he says. After graduating with his M.P.H., Prelip served in a wide variety of health promotion roles for many different organizations, including a community-based pregnant and parenting teen program, an immigrant health program, HIV and STD prevention programs, the Los Angeles County Department of Mental Health, and many more.

In the nine years he has headed his department’s field studies program, Prelip has overseen a broadening in the scope of experiences that students

Worldly Pursuits

14 O NE

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PROBLEMS ARE THE WORLD ’ S .

I NTERNATIONAL INITIATIVES , A CENTRAL PART OF THE

UCLA SPH

S TRATEGIC P LAN , RECOGNIZE THE INTERCONNECTED NESS OF NATIONS AND THE NEED FOR COOPERATIVE ACTIONS TO ADDRESS HEALTH CONCERNS .

School’s Global Health Program Transcends Borders As the world

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Above: Dr. Anne Rimoin, assistant professor of epidemiology at the school, spends approximately half of her time in the Democratic Republic of Congo, where she heads the first study to examine the dramatic changes in the epidemiology of monkeypox in the last 20 years.

braces for the possibility of a pandemic

influenza outbreak, the UCLA School of Public Health is developing the basis for a global laboratory network that will provide rapid, accurate and up-to-date information critical for dealing with avian flu and other deadly infectious diseases.

While the high-throughput laboratory is being spearheaded by Dr. Scott Layne, associate professor of epidemiology, Layne’s colleague in the school’s Department of Epidemiology, Dr. Anne Rimoin, is spending approximately half of her time in remote sections of the Democratic Republic of Congo, attempting to elucidate the epidemiology of monkeypox and viral hemorrhagic fevers through active disease surveillance with subsistence hunters and other individuals who are at high risk for cross-species disease transmission.

Dr. Jørn Olsen, professor and chair of the department, continues to head the closely watched Danish National Birth Cohort Study, which is following 100,000 children from fetal life into adulthood in an effort to find early determinants for the most common childhood health problems, from obesity and asthma to behavioral conditions. Dr. Alex Ortega, associate professor of health services, has been leading a team of community leaders and health professionals on a series of excursions to Cuba in an effort to apply successful aspects of that country’s health care system to improving health in South-Central Los Angeles.

“Infectious diseases have the potential of spreading throughout the world, and some of the health problems we have had in the industrialized countries are now being exported to developing countries.

For these and other reasons, we must spread the expertise we have to help solve health problems in all parts of the world.”

—Dr. Jørn Olsen

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There are many important reasons for the school to emphasize global health. “Infectious diseases have the potential of spreading throughout the world, and some of the health problems we have had in the industrialized countries are now being exported to developing countries,” says Olsen. “For these and other reasons, we must spread our expertise to help solve health problems in all parts of the world.”

Recently, the school was awarded a three-year global health training grant from the Fogarty International Center, led by Dr. Gail Harrison, professor of community health sciences, and Olsen.

Among other things, the grant provides funding for seminars, guest speakers, and the establishment of a curriculum for students and postdoctoral fellows who want to specialize in global health. “UCLA has a unique opportunity to provide expertise in this field,” says Olsen. “We have so many students coming from abroad, spreading their experience and providing research opportunities in their home countries as well as working with the students and faculty here.”

Recent worldwide attention focusing on the threat of highly pathologic avian influenza – a rapidly mutating virus related to other influenza viruses that infect wild migratory birds and farm animals and, officials fear, could spread to humans, sparking a pandemic – has underscored the need for a highthroughput automated laboratory long advocated by

Layne. “In an outbreak situation, rapid, accurate and up-to-date information on the geographic location of avian influenza and on the genetic mutations taking place will be essential for infection control and public health interventions,” Layne notes.

The global laboratory network, capable of highspeed, high-volume epidemiologic and genetic analyses of deadly human and animal pathogens, is based on pilot work Layne completed with colleagues at Los Alamos National Laboratory a decade ago and applies to infectious disease control efforts the same type of high-throughput technology that pharmaceutical companies use for drug discovery. It would increase the annual worldwide capacity for detailed analysis of influenza gene samples by 10-fold, and would enable much more rapid assessment of the strains and their effects on populations. “This will give us near real-time surveillance for avian flu and, potentially, other emerging infectious diseases,” Layne says. “The question is, Do we count on human hands to do what needs to be done, or do we take advantage of technology?” Dean Linda Rosenstock and Dean's Advisory Board member Cindy Horn have spearheaded efforts to secure private and federal funds to launch the global laboratory network. The U.S. Congress included $6 million in the Defense Appropriations bill to establish such a network, and funding to start the initiative is anticipated in 2006.

Sometimes, as in the case of the school’s involvement with the Medical Education Cooperation with Cuba (MEDICC), global health initiatives can serve to improve the health of populations at home.

MEDICC was founded in 1997 as a bridge between U.S. and Cuban clinicians, faculty, students and researchers; the non-governmental organization promotes sharing of medical practice education, policies and research that contribute to improving health

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These are but a few illustrations of the school’s vibrant program in global health – a central part of the school’s Strategic Plan, which states: “Each day it becomes more and more evident that the world is actually one global community. With the farthest reaches of the world no more than a plane ride away, it is not enough to simply ensure the health of individual countries. In fact, working to ensure the health and well being of all people throughout the world is an important step toward stability and peace.”

The school’s international reach is considerable.

Dozens of UCLA School of Public Health faculty are active in approximately 70 countries outside of the United States. Each year, approximately 150 students are enrolled in the school from other nations, the majority of whom return following graduation to apply their education in their native countries. For many of the school’s students, funding opportunities are available for overseas field internships through programs established by generous donors including Robert Drabkin, Monica Salinas and the Bixby Foundation (see page 17). Grants from the Fogarty International Center of the National Institutes of Health bring students from other countries to the school for training in controlling the HIV/AIDS epidemic and addressing environmental and occupational issues in Mexico and Latin America.

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A new high-throughput global laboratory network, based at the school and led by Dr. Scott Layne (above), promises to increase the annual worldwide capacity for detailed analysis of influenza gene samples, including avian flu, by 10-fold.

care quality and accessibility in both countries.

Ortega has headed a team of UCLA School of Public Health faculty and doctoral students, along with faculty from Charles Drew University, that has been accompanying a group of community health leaders from South-Central Los Angeles on a series of visits to Cuba; the MEDICC project aims to understand how successful aspects of Cuba’s health care system could be applied to tackling the health problems of South-Central Los Angeles.

“The Cubans are recognized in the international health community for having highly positive health indicators despite considerable social disadvantage and limited resources,” Ortega notes. “These indicators are often attributed to the strengths of their primary care system, which is very integrated and community-based.”

We are one global community, but when looking at the state of that community’s health, there is a sharp divide between the developed and developing world.

In the developing world, infant mortality is 10 times greater than in the developed world, and maternal mortality 100 times greater. Life expectancy, more than 70 years in the developed world, is fewer than 50 in parts of the developing world. Poor countries that continue to face the scourge of infectious diseases are also beginning to bear the burden of emerging chronic diseases. The more effective treatments for HIV/AIDS that have been brought to populations of wealthier countries have yet to make a dent in the poorest ones: In 2004, the disease took an estimated 2.3 million lives in sub-Saharan Africa.

Globalization has had little impact in rural Africa, where Dr. Charlotte Neumann, professor of community health sciences, has concentrated her efforts; while the epidemic of obesity plagues the developed world, the problems in much of Africa are related to malnutrition and micronutrient deficiencies. In September, Neumann convened a workshop in conjunction with the 18th International Congress of Nutrition in Durban, South Africa. The meeting was an outgrowth of research by Neumann’s group that has shown substantial benefits on health, growth, cognitive function and school performance from intervention feeding with animal-source foods to improve the diet quality of micronutrient-deficient young children in developing countries. “The challenge is to develop feasible, affordable and sustainable programs to provide more meat and milk in the diets of children globally,” Neumann says In the Democratic Republic of Congo (DRC), Rimoin’s study is the first to examine the dramatic changes in the epidemiology of monkeypox in the last 20 years, during which a civil war that claimed millions of lives drove segments of the population into the rainforest and led them to become exclusively reliant on bushmeat, causing a substantial increase in the number of cases of the deadly disease.

Since 2002, Rimoin has developed a research infrastructure that now features a large team of disease surveillance officers who help to reinforce the DRC’s existing Ministry of Health system. With her colleague Dr. Nathan Wolfe at Johns Hopkins University, she has expanded the work to include a cohort of hunters who will be followed every six months and given filter paper to obtain dried blood spots of any animals they kill, as a way of enabling the researchers to track the cross-species transmission of disease. “Because there has been no money and no motivation in the system to report these cases, it’s been impossible to understand the extent and epidemiological nature of monkeypox,” Rimoin explains. “No one had been out there for years.

Establishing this research infrastructure has been helpful not only for studying the epidemiology of human monkeypox, but also for its potential to be expanded to the study of other emerging diseases.”

The Democratic Republic of Congo is a long way from UCLA, but Rimoin insists a strong global health program is essential for a leading school of public health. “Health problems transcend national boundaries and are influenced by circumstances and experiences in other countries,” she says. “The problems of one country are problems for the world. An international health program looks at health problems from a global perspective and determines how to address them with cooperative actions and solutions.”

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T HE F RED H.

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FAMILY VALUES:

B IXBY P ROGRAM HAS FOSTERED OVERSEAS INTERN SHIPS FOR STU DENTS , SUPPORTED RESEARCH , AND PROMOTED KEY PUBLIC HEALTH ISSUES .

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GIFT WILL ENHANCE THE EFFORT, CREATING A NEWLY ENDOWED CENTER .

The Fred H. Bixby Center for Population and Reproductive Health Leah Maddock (M.P.H. ’05) and Kristen Shellenberg (M.P.H. ’05) will remember their two years at the UCLA School of Public Health as a remarkably rich and varied experience, thanks to the Fred H. Bixby Program in Population and Reproductive Health.

With funding from the Bixby Summer Internship Program, Leah Maddock (l.) worked for the Population Council in Guatemala.

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As first-year students, they were drawn to Bixby-sponsored talks on topics ranging from contraceptive technologies and childbirth to HIV/AIDS, health needs of sex workers and global health trends. They got to know like-minded students at these talks and at meetings of the Reproductive Health Interest Group (RHIG), established by the Bixby program to bring together the school’s students, faculty and staff interested in learning about and discussing reproductive health issues, sharing information, and engaging in service/advocacy projects. “We decided to focus our efforts at UCLA on bringing more reproductive health issues to prominence on campus,” says Maddock. With that in mind, RHIG registered as an official UCLA student group, with Maddock and fellow student Rotrease Regan Yates serving as co-presidents, and Shellenberg as a member of the leadership team.

18 Kristen Shellenberg (in the center of the photo at right) returned from the Bixbysponsored internship that she and Leah Maddock (far right) conducted at Guatemala’s Population Council with a strengthened commitment to the field of reproductive health.

“Starting in the 1980s and continuing into the 1990s, there were dramatic declines in birth rates, even in very poor countries. That led people to ask whether family planning should continue to be the central goal in international population work.”

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—Dr. Anne Pebley

With funding from the Bixby Summer Internship Program, these and other students dispersed for 12 weeks to Mexico, Indonesia, Bangladesh and other countries for reproductive health field experiences. Shellenberg and Maddock journeyed to Guatemala. “I gained an in-depth understanding of the incredible impact that research has on the types of programs that are created, funded and implemented worldwide,” says Shellenberg, who returned from her internship at the Population Council’s Family, Gender and Development Program with a strengthened commitment to the field of reproductive health.

Back at UCLA, Maddock, Shellenberg and their RHIG colleagues worked with UCLA’s Arthur Ashe Student Health Center to ensure that students and staff had access to important contraceptive technology and information (for more on the RHIG, see the sidebar on page 20). They worked closely with faculty members of the Bixby Steering Committee to establish guidelines and requirements for a certificate in reproductive health. With funding from the Bixby program, they attended the March for Women’s Lives in Washington, D.C., and traveled to Sacramento to participate in the annual Speak Out for Reproductive Freedom lobbying day.

“The Bixby-sponsored events, speakers and Reproductive Health Interest Group were a perfect complement to my academic coursework and professional interests in domestic and international reproductive health issues,” says Shellenberg.

In June, the Fred H. Bixby Foundation made a $5 million donation to create an endowment to expand and sustain a program that since 2001 has enabled faculty and students such as Shellenberg and Maddock to advance population, reproductive health, and family planning issues in developing countries and domestically through internships, research, lectures and conferences, and service and advocacy work. The gift will create a permanent center dedicated to these activities, increase support for faculty research and outreach projects, and double the number of doctoral fellowships available each year from three to six.

“The Bixby Foundation is dedicated to ensuring the continued excellence of population studies and research at UCLA’s School of Public Health,” says John

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Changing demographics made the need for such a shift more apparent. “Between 1950 and 1990, the central theme for population experts in public health was family planning efforts, because birth rates were so high,” says Pebley. “Family planning supplies and ideas hadn’t gotten out in large portions of the world.

But starting in the 1980s and continuing into the 1990s, there were dramatic declines in birth rates, even in very poor countries. That led people to ask whether family planning should continue to be the central goal in international population work.”

The answer, Pebley says, is that it remains an important goal, because even with declining fertility rates, too many couples lack access to adequate contraception and family planning services. But at the same time, the focus has expanded to consider reproductive health in a larger context that encompasses far more than just population growth. This shift was crystallized in 1994 at the United Nations International Conference on Population and Development in Cairo, Egypt, which defined reproductive health as: “…a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters

Since its incepton, the Fred H. Bixby Program in Population and Reproductive Health has supported student internships in 17 countries, as indicated on the map above.

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Worldwide, as many as 40 percent of births are unwanted or mistimed; approximately 150 million couples have unmet family planning needs. Each year, 20 million unsafe abortions are performed and 600,000 women die of pregnancy-related causes; 333 million new cases of curable sexually transmitted diseases and 5 million new HIV/AIDS infections are diagnosed; and 2 million girls undergo female genital cutting. Nearly one in three women report having been forced or coerced into having sex.

A field that once focused primarily on population control has broadened significantly over the last decade-plus to take on these and other challenges.

“Beginning in the 1950s there was a great deal of concern that we would soon become overpopulated and that, in particular, the high birth rates of developing countries were going to impede their economic

growth,” says Tavrow. That led to a major push to establish family planning programs in the developing world – and to some extreme measures, most notably China’s one-child policy. But by the 1990s, Tavrow notes, a growing number of voices could be heard calling for a more holistic focus for the field: one that takes into account reproductive freedom and health.

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Warren, trustee for the foundation. “The creation of the Bixby Center will enable UCLA students to step up their efforts on behalf of women and their families worldwide.”

The Fred H. Bixby Foundation was established in 1972 to support activities related to the problems of overpopulation, and the foundation has supported such programs at the UCLA School of Public Health since 1975. In 2001, a gift exceeding $1 million established the Bixby Program in Population and Reproductive Health, guided by a steering committee composed of members of the school’s faculty.

Beginning that year, the committee and the program’s newly hired director, Dr. Paula Tavrow, established new courses to the extent that graduating M.P.H. students could develop expertise through coursework and field studies to qualify for a Bixby certificate, which was awarded for the first time last June to 11 students. In addition, the Bixby Doctoral Fellows Program provides up to two years of funding for public health doctoral students who specialize in population, reproductive health, and family planning.

“We have built an active interdisciplinary program for faculty and students in which all of the pieces fit very well together,” says Dr. Anne Pebley, professor and chair of the Department of Community Health Sciences. Pebley, who holds the Fred H. Bixby Chair in Population and will head the new center, adds: “The new gift ensures that we have sustained support in perpetuity, and it gives us a base so that we can bring in additional faculty, enhance our coursework, and leverage funding from other sources to greatly expand our research, training and outreach efforts.”

20 relating to the reproductive system and to its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.”

The Reproductive Health Interest Group: One Student’s Experience

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By Robin Lowney Lankton The mission of the Reproductive Health Interest Group (RHIG) is to bring together students, faculty and staff at the UCLA School of Public Health to learn about and discuss reproductive health issues, share information and engage in service/advocacy projects related to reproductive health.

Through RHIG I have gained hands-on experience working in reproductive health issues on campus and in the community. I have attended speaking events hosted by RHIG on topics such as domestic and international policy issues, safer sex for sex workers, and providing medical care for HIV-positive pregnant women.

RHIG creates a supportive network for students. I heard more than 20 students share their reproductive health internship experiences from Guatemala, Kenya, Indonesia, the United States, and other locations.

These RHIG meetings created an atmosphere of learning and guidance for finding the best internship to meet my interests and fulfill my public health field studies requirement.

I became co-chair of RHIG’s On-Campus Committee and worked on advocacy issues with the Arthur Ashe Student Health Center. A small group of us met with clinicians to discuss educational materials and approaches to health education regarding testicular cancer self-screening at UCLA, and we are continuing to promote this initiative. The OnCampus Committee has worked with the Bixby Steering Committee to create a reproductive health certificate at UCLA. This has led to new reproductive health courses. One of my favorite experiences in my first year was taking the “Building Advocacy Skills: A Reproductive Health Focus” course and then receiving funding from Bixby to participate in the Speak Out for Reproductive Freedom event in Sacramento. I used my practical skills from the classroom to discuss legislation regarding pharmacists refusing to fill contraceptive prescriptions with Sen. Sheila Kuehl’s staff member.

The support from the Bixby Foundation has created new opportunities in reproductive health within the School of Public Health. The program is conducive to incorporating students’ ideas and is very effectively preparing us to be reproductive health professionals. After completing the program, I plan to stay in Los Angeles and work on reproductive health issues, especially in the Latina community. I will be confident in the reproductive health field as a result of the skills I gained through RHIG and in the classroom.

Robin Lowney Lankton, a second-year M.P.H. student in the Department of Community Health Sciences, is co-president of the RHIG. Approximately 65 current UCLA School of Public Health students are RHIG members.

While the international population community was changing philosophies, HIV/AIDS was becoming a growing worldwide crisis. “As a sexually transmitted disease very much related to contraceptive use and childbearing, particularly in poorer countries, where much of the transmission is heterosexual, HIV/AIDS has become an important focus for our field,” says Pebley. “Until we collectively work to improve the social and economic status of African populations and get the epidemic under control, it’s going continue to be a huge problem.”

The Bixby program’s focus has reflected this larger view of population and reproductive health. “The issues supported by Bixby are key to a school of public health,” says Dr. Roger Detels, professor of epidemiology and a member of the Bixby Steering Committee. “The program is particularly important because it provides funding for students to study overseas and gives them an opportunity to take courses that make them competent in reproductive public health and demography, both of which are important areas that not all schools of public health cover in-depth.”

There is a significant unmet need for professionals who can work across the continuum of women’s reproductive health, says Dr. Michael Lu, assistant professor of community health sciences at the school and of obstetrics and gynecology at UCLA’s David Geffen School of Medicine. “Preconceptional family planning, interconceptional care, good quality prenatal care and safe pregnancy-related care are all things that could be done better,” asserts Lu, a Bixby Steering Committee member. “The Bixby program has been valuable in increasing interest among the school’s students in reproductive health, and providing opportunities for faculty and students to be involved in research and service activities related to reproductive health.”

Many of the school’s students who take part in the Bixby program pursue international careers, whether with non-governmental organizations, foundations, or as overseas employees of the United States government. Other students stay closer to home, seeking program development, education or advocacy roles

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in the public or private sector. “There is such a range of interesting and important jobs, and many opportunities for students who specialize in this area, whether they want to work domestically or overseas,” says Tavrow.

Students can find faculty experts in a variety of topics and covering disparate geography. Tavrow specializes in reproductive health research in Africa: She is currently focusing on adolescents, evaluating a peer-education and -service program called Youth for Youth that aims to reach rural Kenyan school-age children on issues that include AIDS prevention, family planning and sexual violence. Pebley, who has also worked extensively overseas, is currently focused in Los Angeles: She co-directs the Los Angeles Family and Neighborhood Survey (L.A. FANS), a longitudinal study of the impact of neighborhoods on families in L.A. County. Among the topics being examined are the sexual activity and use of contraception and reproductive health services for the county’s teens, and specifically for its immigrant population. Dr. Gail Harrison heads a Bixby-supported project in the Middle East that disseminates safe birth practices to health professionals. With Bixby funding, Detels and Dr. Virginia Li have used the Internet to reach practitioners in rural areas of Yunnan Province, China, in an effort to improve the quality of contraceptive services, family planning programs, sexually transmitted disease services, and services promoting safe motherhood and women’s health.

In addition to funding faculty studies, Bixby has established a research mentorship program to give M.P.H. students an opportunity to work with faculty on projects related to population and reproductive health. Students receive a stipend based on the number of quarters they work with the faculty member. The Bixby Summer Internship Program, which sent Shellenberg and Maddock to Guatemala, has sponsored more than three dozen M.P.H. and pre-doctoral students’ international field experiences.

“There is such a range of interesting and important jobs, and many opportunities for students who specialize in this area, whether they want to work domestically or overseas.”

—Dr. Paula Tavrow

Support from the Bixby program enabled Rotrease Regan Yates (R.N., M.P.H. ’05) to enhance her public health training with international research experiences she says she might not have otherwise had. “The financial burden of going abroad for an unpaid summer internship was of major concern,” she says. With financial assistance from the Bixby program, Regan Yates went to Bangladesh at the completion of her first year to work with Helen Keller International, studying maternal health in rural Bangladesh as well as assisting in the construction of a new maternal

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With Bixby funding, Rotrease Regan Yates (far left and above right) went to Bangladesh for an internship with Helen Keller International, studying maternal health and assisting with the development of a new assessment tool.

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Bixby funding enabled students such as Kristen Shellenberg (above) to participate in the March for Women’s Lives in Washington, D.C., in April 2004.

health assessment tool. In her second year, an award through the Bixby Research Mentorship Program enabled Regan Yates to work closely with Dr. Donald Morisky, professor of community health sciences, on Morisky’s study of sexual behavior and STD/HIV transmission in the Philippines. The experiences convinced Regan Yates that she wanted to continue studying reproductive health.

She is now in the school’s Ph.D. program as a National Institute of Mental Health pre-doctoral trainee in HIV/AIDS research.

“It can be very difficult for students to get their foot in the door, because when you apply for international jobs, the first question is always how much international experience you have,” says Dr. Pamina Gorbach, associate professor of epidemiology and a member of the Bixby Steering Committee. “If you’re a young person without a lot of specific skills, unless you can volunteer – not an option for many students who are strapped for funds and can’t afford to travel internationally for no pay – that first international experience can be elusive. The Bixby internship not only opens up opportunities for students who can’t afford to fund their own international experience, it also allows opportunities to be created for students in resource-poor settings. When students have Bixby funding, it’s easy for those of us who work internationally to place them in resource-poor countries that don’t have the ability to pay students, but are willing to supervise students who come with their own support.”

Gorbach has helped to find internships for Bixby-supported students in Bangladesh and Cambodia. “The experience of living in a different cultural setting and seeing firsthand how public health works in a developing country is something that just can’t be learned from a textbook,” she says. “When the students return, they have a new understanding of the things we’re teaching.”

Back at the school, the education that takes place in the classroom is enhanced in a number of ways. The Bixby Lecture Series features public health professionals from around the world speaking on global reproductive health policies and program developments. The Bixby Reproductive Health moderated listserv provides updates on news, job vacancies and local events concerning population and reproductive health to faculty, students, community members, and alumni. (To join, email ptavrow@ucla.edu.) The Bixby program also maintains an active Web site (http://bixbyprogram.ph.ucla.edu).

In 2004, the Bixby program co-hosted a two-day conference, “Youth Reproductive Health in a Controversial Climate: Reclaiming Strategies that Work,” which brought together researchers, program managers, advocates and legislators.

The program also provides funding for students to attend conferences and workshops on reproductive health, as well as advocacy events such as the lobbying in Sacramento undertaken by Maddock, Shellenberg and their peers.

After graduating in June, Maddock accepted a position at UC San Francisco’s Bixby Center for Reproductive Health Research and Policy as an evaluator for the state’s teen pregnancy prevention program and an after-school collaborative program at a west Oakland high school. “These programs couldn’t be more opposite in size and structure, which keeps my days exciting,” she says.

Shellenberg is now at The Bloomberg School of Public Health at Johns Hopkins University, pursuing a Dr.P.H. in the Department of Population and Family Health Sciences. “My involvement with the Bixby program helped to define my career path,” she says. “I feel fortunate to have had the opportunity to interact so closely with faculty and fellow students who are also committed to ensuring that people all over the world are able to make safe and healthy decisions about their reproductive health.”

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research highlights Chiropractic Care Found More Expensive than Medical Care for Treatment of Low-Back Pain

AVERAGE OUTPATIENT COSTS

Average Outpatient Costs Over 18-Month Period, Adjusted for Demographics and Health Status, Excluding Pharmaceuticals

$760

$560

Chiropractic

$579

Chiropractic + Medical + Physical Physical Modalities Therapy

TREATMENT GROUP

UCLAPUBLIC HEALTH

CHIROPRACTIC CARE IS MORE EXPENSIVE than medical care for treating lowback pain without producing significantly better results, according to the first randomized trial comparing treatment costs for a condition that is the second most frequently cited reason for seeking primary care services among U.S. adults.

A team headed by Dr. Gerald Kominski, professor of health services at the school and associate director of the UCLA Center for Health Policy Research, compared the outpatient costs over an 18-month period of four common low-back pain treatments received by 681 patients in a large group practice: medical care alone, medical care with physical therapy, chiropractic care alone, and chiropractic care with physical modalities. The results were $800 published in the journal Medical Care.

Kominski’s team found that chiropractic care alone $700 was 52 percent more expensive on average than medical care alone during the 18-month period. Medical $600 care plus physical therapy was the most expensive of the four treatment groups – more than double the cost of medical care alone and more than 35 percent more $500 expensive than chiropractic care alone – without producing better clinical outcomes. $400 Kominski points out that an important limitation of the study was its inability to include data on pharma$369 $300 ceutical costs. “We do know that medical providers are more likely to prescribe pain medication and muscle $200 relaxants to their patients than chiropractors,” he says.

“Thus, our results are likely to have underestimated the costs of medical care.” However, in conducting a sepa$100 rate analysis using the limited data available on the use of prescription drugs by study participants, Kominski’s $0 group found that chiropractic care was still more expenMedical sive, even when accounting for medication costs.

Studies have found that chiropractic patients tend to be more satisfied with their low-back pain care than medical patients – a phenomenon often attributed to chiropractors’ greater involvement and better communication than medical doctors’. But the same intensity of care that could be responsible for higher satisfaction levels might also be contributing to the expense of chiropractic care. “The higher cost of chiropractic care is primarily driven by the fact that patients have more visits,” says Kominski.

Low-back pain is believed to result in more disability among working-age adults than any other health condition. National estimates of the direct cost of care for the condition range from $25 billion to $33 billion annually. “For initial episodes of lower back pain not related to an injury,” Kominski concludes, “medical treatment alone appears to be both an effective treatment and the least costly approach.”

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UCLAPUBLIC HEALTH

Does Breast Cancer Risk Decline Among Older Women?

MOST STUDIES SHOW THE RISK of being diagnosed with cancer to increase with age, but these analyses typically lump everyone older than 65 or 75 into one category. This can produce misleading results, notes Dr. Robert Kaplan, professor and chair of the Department of Health Services at the UCLA School of Public Health. “As people live longer, it doesn’t make sense to put all people over 65 in the same category because the age range in that category might go from 65 all the way up to 100,” Kaplan says.

Number of Diagnosed Breast Publishing in the Journal of the American Geriatrics Society, Kaplan and Dr. Cancer Cases Per 100,000 and Sidney Saltzstein, a professor of pathology at UC San Diego, showed that when it Percent Mammography Use, by comes to the incidence of breast canAge Group cer in California and U.S. populations, including separate age categories for 100 those who are 85-89, 90-94, or 95-99 presents a different picture. “When sep90 arate age categories were created for 80 the older groups, something very inter70 esting happened,” Kaplan explains.

60 “The number of new breast cancer cases systematically increased until 50 about age 75. After that, the rate of new 40 cases systematically decreased. In 30 other words, the analyses show that once women age beyond about 75 20 years, the chance of being diagnosed 10 with cancer declines.”

0 The challenge, Kaplan says, is in 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99 determining whether or not this repAGE resents a true decline in cancer. In Percent Mammography (source: CDC) reviewing pathology studies, Kaplan Breast Cancer Diagnosis Per 100,000 (source: California Cancer Registry) and Saltzstein found that the chance of having undiagnosed breast cancer systematically increased with age, even among the most senior citizens. Using the California Cancer Registry, a source that includes every new case of breast cancer identified in the state, and the CDC’s Behavioral Risk Factor Surveillance System to identify the utilization of cancer screening tests, the researchers showed that the rate of diagnosis of breast cancer increases with age until about 75; thereafter, identification of new breast cancer systematically declines with age. Similarly, the use of mammography increases until about age 75 and systematically declines in a manner parallel to the rate of known new cancer cases.

Do these results suggest that older women should ask their doctors to order screening mammograms? Perhaps not, say Kaplan and Saltzstein, who believe their findings support a “disease reservoir hypothesis.” Explains Kaplan: “When disease is common, particularly among the oldest members of society, the more we look for it, the more likely it is to be found. Yet, much of detected disease may actually be ‘pseudodisease,’ a subcategory of subclinical disease that has little or no clinical importance.” This “pseudodisease” will go undetected unless there is surveillance or autopsy, Kaplan notes, concluding: “It is very likely that most of those undetected cases will never progress to the point that they threaten the life or the well being of women in their eighth or ninth decade of life.”

Work-Relatedness of Suicides Often Misclassified THOUSANDS OF SUICIDES IN THE UNITED STATES are either misclassified as work-related or wrongly classified as not being related to the workplace,

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according to a study by the Southern California Injury Prevention Research Center, based in the School of Public Health. The findings, published in the International Journal of Occupational and Environmental Health, have important implications for suicide prevention efforts, since the success of such efforts depends on an understanding of risk factors.

“Suicide is the most common mechanism of violent death in the United States, but epidemiological studies have been difficult to undertake because of uncertainty on the circumstances surrounding the event,” says Dr. Jess Kraus, professor of epidemiology and director of the center. “Suicides occurring at a work location have been defined as ‘work-related’ by California and other states’ coroners, yet the basis or motivation underlying these events remains obscure.”

To determine the extent to which the work-relatedness of suicides is misclassified, Kraus and colleagues examined all California suicide cases between 1994 and 1998 that coroners had classified as work-related, along with a matching sample of cases not found to be related to work. Kraus found that the coroners’ reports tended to categorize fatal outcomes depending on where they occurred, without regard to the underlying motivation of the act. His study concluded that approximately one in nine suicides – over 11 percent – were misclassified as work-related. In addition, nearly one in four suicides – 23 percent – were misclassified as not being work-related.

Kraus believes these misclassifications have the potential to impede efforts, often workplace-based, to reduce suicide risk – for instance, by focusing on the work environment for individuals who might be distressed from a domestic dispute, and vice versa. “These findings point to misappropriation of the work-relatedness of suicide and, hence, an inaccurate understanding of underlying risk factors and their intervention potential,” he explains. “This misclassification affects our ability to study the problem epidemiologically so that we can identify effective interventions. We know the workplace can be a very effective setting for intervening with people who are at risk for suicide. Employers and employees should take these findings into account when implementing work-based programs for counseling, or other risk-reduction measures.”

Children’s Increased Exposure to Electromagnetic Fields Raises Concerns

Kheifets and colleagues recommend that studies on health consequences associated with mobile phone use by children be given a high priority.

UCLAPUBLIC HEALTH

TECHNOLOGICAL DEVELOPMENTS are bringing both social and economic benefits to large sections of society, but the health consequences of these developments can be difficult to predict and manage. Even if the effects are small, a widespread exposure can have large public health consequences. When risks are complex, an established cause-effect relationship is absent, or the scientific findings are not robustly quantifiable, there is a need for timely preventive action, particularly for children, a research team headed by Dr. Leeka Kheifets, professor of epidemiology at the UCLA School of Public Health, has concluded.

Based on the findings of an expert workshop held by the World Health Organization in Istanbul, Turkey, in June 2004, Kheifets and colleagues assessed the potential susceptibility of children to electromagnetic fields (EMFs). Their conclusions were published in the journal Pediatrics.

“Exposure to electric and magnetic fields has been growing steadily as countries increase their capacity to generate and distribute electricity and take advantage of the many new technologies such as telecommunications to improve lifestyle and work efficiency,” Kheifets states. “With the rapid advances in EMF technologies and communications, children are increasingly exposed to electromagnetic fields.”

Epidemiologic evidence of an association between childhood leukemia and exposure to extremely low frequency (ELF) magnetic fields has led the International Agency for Research on Cancer to classify ELF magnetic fields as

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a possible human carcinogen, Kheifets notes. In addition, concerns have been raised about children’s vulnerability to radiofrequency fields for several reasons: the potentially greater susceptibility of their developing nervous systems, the fact that their brain tissue is more conductive and radiofrequency penetration greater relative to their head size, and their longer lifetime exposure than adults. These issues are of particular concern since some of the exposures are close to guideline limits, Kheifets notes. Given the paucity of data regarding the long-term health effects of mobile phone use, particularly for children, Kheifets and colleagues recommend that studies on the health consequences from exposure to the radiofrequency fields associated with mobile phone use by children be given a high priority.

In the meantime, Kheifets and her co-authors recommend that when giving advice to their patients, physicians weigh the strength of scientific evidence of an adverse health outcome, if any, against the benefits of the technology and the feasibility of reducing exposure. “Some options include reducing exposure by minimizing the use or by increasing the distance to certain electrical appliances such as computers or hairdryers,” Kheifets explains. “People living near overhead power lines should be advised that proximity is just an indicator of exposure and that homes far away from power lines can have similar or higher fields because of the type of wiring. Children’s radiofrequency exposure can be reduced by restricting the use of cell phones, or by using ‘hands-free’ devices to keep mobile phones away from the head and body.”

Calcium, Dairy Products May Lower Risk of Metabolic Syndrome in Middle-Aged, Older Women

UCLAPUBLIC HEALTH

Calcium and vitamin D are believed to be primarily responsible for the beneficial effect of dairy consumption on body weight and insulin sensitivity.

FOR MIDDLE-AGED AND OLDER WOMEN, high intakes of calcium and dairy products appear to lower the risk of the metabolic syndrome – the combination of disorders, including impaired glucose tolerance, hypertension, and high cholesterol, that often affect people in clusters – according to the findings of a group headed by Dr. Simin Liu, professor of epidemiology and director of the Program on Genomics and Nutrition at the UCLA School of Public Health. Though its cause remains a mystery, the metabolic syndrome is considered important for identifying individuals at especially high risk for type 2 diabetes and coronary heart disease.

Liu and colleagues examined the relationships between dietary calcium, vitamin D intake, and the prevalence of metabolic syndrome using plasma samples collected in a large cohort of approximately 10,000 middle-aged and older U.S. women participating in the Women’s Health Study. Their results were published in the journal Diabetes Care.

Although the underlying mechanisms are unclear, Liu notes that calcium and vitamin D, two major components of dairy products, are believed to be primarily responsible for the beneficial effect of dairy consumption on body weight and insulin sensitivity. Previous studies have shown that dietary calcium intake may have favorable effects on body weight, hypertension, and coronary heart disease. In animal studies, vitamin D improves insulin sensitivity and insulin secretion.

Liu and colleagues found that women in the highest 20 percent of calcium intake levels – mainly from greater consumption of dairy foods – were 36 per-

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cent less likely to have metabolic syndrome than women in the lowest intake group. While dietary intakes of vitamin D were not significantly associated with metabolic syndrome prevalence, low plasma levels of vitamin D remain a significant predictor of increased risk of metabolic syndrome, Liu notes.

“Although animal studies have indicated that both vitamin D and calcium may play critical roles in maintaining glucose regulation, direct evidence in humans is very limited,” says Liu. “Our study represents a first attempt to examine the joint effects of dietary calcium and vitamin D in relation to metabolic syndrome in a large cohort of humans. Serum-based epidemiological studies, including clinical trials that examine the genetic pathways related to vitamin D and calcium metabolism along with their interactions with dietary factors, are needed to understand these effects with greater certainty.”

California’s System of Job-Based Health Insurance Continues to Decline

UCLAPUBLIC HEALTH

JOB-BASED HEALTH INSURANCE COVERAGE – the backbone of California’s Employer-Based Health Insurance system of health insurance – is declining, according to a report produced by the Coverage During Last 12 Months, UCLA Center for Health Policy Research, housed in the School of Public Health Ages 0-64, Calif., 2001 and 2003 and affiliated with the School of Public Affairs. The report also concludes that while job-based family coverage plummets, children’s coverage is being protected by public insurance programs, such as Medi-Cal and Change Percent from in Insurance Status Healthy Families.

20011 2003 “We are seeing a shift to govern40.0% +0.6* ment programs, like Medi-Cal and % of Adults Ages 18-64 with Own Job-Based Coverage Healthy Families, as employers fail to % of Adults Ages 18-64 with Job-Based Coverage Through Spouse 14.5% -2.2 provide affordable health insurance % of Children Ages 0-17 with Job-Based Coverage Through Parent 52.1% -3.9 for working families,” says Dr. E. Richard Brown, director of the UCLA Note: Numbers are rates and will not add to 100%.

Center for Health Policy Research, *1 = not a statistically significant change Change in percentage points, not in the percent of the total estimate. Change is from reweighted 2001 California Health Interview Survey. professor in the School of Public Source: 2001 and 2003 California Health Interview Surveys Health and the study’s lead author.

“The data show that California’s health insurance system is increasingly unstable and unable to provide for the basic medical needs of millions of residents.”

While a majority of Californians are still insured through their jobs or those of relatives, those numbers are declining, specifically among dependents.

Pushed by a 79 percent increase in the cost of job-based family coverage for the average worker, enrollment of dependents dropped four percentage points for children and two percentage points for adults from 2001 to 2003.

For children, these losses were balanced by a five percentage-point increase in enrollment in Medi-Cal and Healthy Families, leading to an actual increase in children’s insurance overall. Many adults shifted to privately purchased heath plans, and many of those bought high-deductible health plans, potentially risking bankruptcy and/or significant financial losses due to high medical bills. Approximately 50 percent of all personal bankruptcies in the United States are due to medical debt, according to Harvard researchers.

The shrinking of job-based health insurance is one of many trends identified in “The State of Health Insurance in California: Findings from the 2003 California Health Interview Survey.” The study found that more than 6.6 million Californians under age 65 – more than one in five nonelderly residents – went without insurance for at least part of 2003, and more than 3.7 million lacked health coverage for the entire year. Those without health insurance were much less likely to have seen a doctor, gotten vital preventive screenings for cancer, or taken medication for high blood pressure.

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student profiles M.P.H./J.D. Student Finds Intersection of Public Health and the Law in Advocating for Reproductive Rights

“I would like to use existing international laws and public health advocacy to ensure that women all around the world have the option of safely practicing family planning.”

UCLAPUBLIC HEALTH

— Larisa Mori (second from right)

WHEN SHE JOINED THE PEACE CORPS and moved to rural Kenya to begin a two-year stint teaching health in 2001, LARISA MORI was convinced she would return after her service to pursue a law degree leading to a career as a civil rights lawyer. Along the way, her ambitions changed. Mori did enroll in law school at UCLA, but chose to simultaneously apply to the School of Public Health as part of its M.P.H./J.D. joint program. “I still believe that the courtroom could be a fulfilling route, but Kenya got me thinking that it was not the life for me,” Mori explains. “I liked the hands-on experience of working with local community members to decide what was best in their lives instead of waiting for the courts to undertake this task.”

Mori concluded that being educated in both disciplines would lend her the authority necessary to use the law to implement important public health measures – particularly in the area of international family planning, where her passion lies. “Women carry so much of the world’s burden that not allowing them access to accurate family planning information and technologies only serves to further relegate them to an inferior position in society,” she contends. “Giving women the power to control their own bodies and regulate the timing of their children would facilitate their ascension to equal footing with men. I would like to use existing international laws and public health advocacy to ensure that women all around the world have the option of safely practicing family planning.”

Mori believes reproductive health issues represent an ideal intersection between the law and public health, particularly at a time when Roe v. Wade is endangered in the United States and developing countries are grappling with issues of contraception and family planning services. She was able to see some of these issues up close last summer when, with funding from the school’s Bixby and Drabkin programs, she served as a community and reproductive health intern for a U.S. Agency for International Development-funded program in Asmara, Eritrea, that was attempting to strengthen the government’s capacity to implement healthservices programs. (For more on the Fred H. Bixby Program, see page 17.) “It was somewhat frustrating,” Mori says, “because the culture is very conservative and the government wasn’t always willing to provide family planning services, even though we were hearing from women in the community that this was what they needed.”

The experience strengthened Mori’s resolve to return to working in the developing world following completion of the four-year M.P.H./J.D. program. “Seeing the progress in the United States in terms of women’s reproductive rights, and then seeing how laws and policies have begun to chip away at those rights in recent years, I have become aware of how important this issue is,” she says. “Then, being in the international field and seeing the lack of access that women have – and knowing that things could either drastically improve with just a few simple policies, or become even more difficult for women – I see this as an exciting time to be part of the field and to attempt to influence which way these policies go.”

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“It’s taking 5- to 8-day old masses of cells that are going to be discarded and using them for something amazing.

Once I learned that, I couldn’t understand why everyone wouldn’t be on board.”

— Candace Coffee (center)

UCLAPUBLIC HEALTH

THE CROWDED NEWS CONFERENCE at UCLA’s new Neuroscience Research Building last August featured comments from many of California’s most powerful political figures, united in their opposition to congressional legislation that would place new limits on human embryonic stem cell research. But arguably the most memorable moment came when a 26-year-old UCLA School of Public Health student spoke eloquently about the personal nature of her opposition to the bill.

“I am not a governor or a senator or a famous researcher,” said CANDACE COFFEE, a second-year M.P.H. student who was diagnosed, at the age of 24, with a rare and potentially fatal autoimmune condition called Devic’s disease. “But this legislation is about me. Don’t take away my hope.”

A former Miss Bakersfield who aspired to a career in the performing arts, Coffee graduated with honors from UC Irvine. After college, she decided to spend time traveling and doing volunteer work in Tibet. While there, she fell ill. Within a week, Coffee was blind in her left eye. After returning to California, she went totally blind for several months and was, for a time, unable to walk without assistance. In April 2003, she was diagnosed with Devic’s, which causes the body to attack the myelin sheath covering the central nervous system.

Coffee was treated with steroids and has been in remission for more than two years, but she remains blind in one eye and contends daily with stabbing headaches, nausea and fatigue. Remarkably upbeat, Coffee quips that her doctors call her a “professional patient” – she exercises daily and adheres without fail to the extensive drug regimen she is prescribed.

Nonetheless, the chronic nausea and pain occasionally force her to leave the classroom, listening to lectures through the door.

Devic’s changed her priorities. “When something like that happens, you come to terms with what really matters,” Coffee says. “I realized I had been very selffocused and hadn’t been contributing anything to my community.” After her diagnosis, she took a position as a health services coordinator with the Muscular Dystrophy Association; that experience helped her decide public health was the field for her.

“This is a school filled with amazing people – passionate, idealistic and dedicated,” says Coffee, who has also worked part-time at the Santa Monica-based nonprofit environmental organization Heal the Bay, where one of her tasks has been to teach children about ocean pollution from urban runoff. Her ultimate goal is to open a comprehensive care center for women newly diagnosed with chronic diseases.

Meanwhile, she continues to be a prominent spokesperson on behalf of stem cell research, a role that originated when Coffee sent unsolicited ideas to the campaign for Proposition 71, the successful 2004 California initiative to provide $3 billion in bond funding for human embryonic stem cell research in the state.

Coffee acknowledges that not everyone from her conservative hometown agreed with her stand, but she has never regretted expressing her convictions in public. “These are embryos that are already designated for destruction,” she says. “It’s taking 5- to 8-day-old masses of cells that are going to be discarded and using them for something amazing – to take life that’s already in existence and keep it there.

Once I learned that, I couldn’t understand why everyone wouldn’t be on board.”

students

Rare Autoimmune Disease Leads Her to Enter Public Health, Speak out on Behalf of Stem Cell Research

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contracts & grants 2004-05 This section includes new contracts and grants awarded in fiscal year 2004-05. Due to space limitations, only funds of $50,000 or more are listed, by principal investigator.

ROSHAN BASTANI UCLA Cancer Prevention and Control Research Network (DHHS/Centers for Disease Control and Prevention, $1,500,000 for 5 years)

Resources Board, $117,986 for 14 months); Determination of Reactive Oxygen Species Activity in PM and Enhanced Exposures Assessment for the NIH/NIEHS Study (UC Irvine, $119,779 for 3 years)

E. RICHARD BROWN The 2005 California Health Interview Survey (California Department of Health Services, $3,710,000 for 2 years; California Department of Mental Health, $375,151; NIH/ National Cancer Institute, $2,660,292 for 20 months; Robert Wood Johnson Foundation, $698,035 for 18 months; The California Endowment, $3,383,088 for 2 years; UC Davis, $151,200); Disability Questions on the 2005 California Health Interview Survey (California Department of Health Services, $62,000); Epilepsy Questions on the 2005 California Health Interview Survey (DHHS/Centers for Disease Control and Prevention, $74,154)

PATRICIA A. GANZ Does Blocking Proinflammatory Cytokines Diminish CancerRelated Fatigue? (The Breast Cancer Research Foundation, $248,761); Enhancing Patient Outcomes Across the Cancer Control Continuum (American Cancer Society, $300,000 for 5 years)

ROGER DETELS China Multidisciplinary AIDS Prevention Training Program (NIH/Fogarty International Center, $1,250,367 for 5 years) JONATHAN FIELDING Using Health Impact Assessment for Policy Analysis to Support the California Endowment’s “Healthy Eating, Active Communities” Initiative (The California Endowment, $325,000 for 2 years) JOHN FROINES Monitoring and Modeling of Ultrafine Particles and Black Carbon at the Los Angeles International Airport (California Air

UCLAPUBLIC HEALTH

new faculty DR. SIMIN LIU has joined the faculty as professor of epidemiology and director of the Program on Genomics and Nutrition. His current research is at the interface of nutrition and genetics/ genomics and focuses on how dietary, biochemical, and genetic factors influence the development of many degenerative disorders in human populations. Liu’s research in nutrition and health has been translated into public policy such as the Healthy People 2010 and the 2005 Dietary Guidelines. His pioneering work in carbohydrate nutrition ultimately served as the scientific evidence in establishing regulatory and labeling

DEBORAH GLIK California Statewide Training in Outreach for Immunization and Bioterrorism (California Department of Health Services, $55,440) MICHAEL GOLDSTEIN CHIS CAM Supplemental Analysis of Support Groups (NIH/ National Cancer Institute, $98,813) GAIL HARRISON Energy Balance and 5-a-Day Promotion (UC Davis, $101,803) WILLIAM HINDS Health Effects of Fine and Ultrafine Particles During Freeway Travel (California Air Resources Board, $580,205 for 2 years) ROBERT KAPLAN Norms and Performance Comparisons for 5 Health Indexes (University of Wisconsin, $64,969); Web-based Evaluation of Tools for Shared PSA Decisions (University of San Diego, $140,418)

guidelines for the FDA’s whole grains and heart disease health claims. Liu is an elected fellow of the American College of Nutrition and of the Council of Epidemiology and Prevention of the American Heart Association, and currently serves as a standing member of the Diabetes, Endocrinology and Metabolic Diseases Study Section of the National Institutes of Health, as well as co-chair of the Endocrine Council of the American College of Nutrition. Previously, he was a fellow in preventive medicine and public health with the Epidemic Intelligence Service (EIS) of the Centers for Disease Control and Prevention. He earned his medical degree from Jinan University Medical School in China and his master of public health and doctoral degrees in epidemiology and nutrition from Harvard University.

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GERALD KOMINSKI California Health Benefits Program (University of California Office of the President, $92,284); California’s Managed Care Enrollees: A New Health Plan Report Card Based On Findings From the 2003 California Health Interview Survey (Department Of Managed Health Care, $214,121) CLIFFORD KO Analysis of Ovarian Cancer Surgeries Using State Hospital Discharge Data (Centers for Disease Control and Prevention, $174,999) ANNETTE MAXWELL Increasing Colorectal Cancer Screening Among Filipino Americans (American Cancer Society, $997,000 for 4 years) WILLIAM MCCARTHY Ethnicity and School-level Effects on California Student Tobacco Use (UC Tobacco-Related Disease Research Program, $383,120 for 3 years) JACK NEEDLEMAN Evaluation of Transforming Care at the Bedside (TCAB) Phase II (The Robert Wood Johnson Foundation, $550,000 for 2 years) ANNE PEBLEY Los Angeles Family and Neighborhood Survey Wave 2 (NIH/ National Institute of Child Health and Human Development, $3,145,704 for 4 years) MICHAEL PRELIP LAUSD Nutrition Network 2004-2007 Evaluation (Los Angeles Unified School District, $411,972 for 2 years); Pacific Public

NINEZ PONCE Do Socio-Ecological Variables Influence Cancer Screening Behaviors? (NIH/National Cancer Institute, $635,850 for 5 years) BEATE RITZ Aggregate Exposure Assessment: Longitudinal Surveys of Human Exposure-Related Behavior (UC Davis, $310,886) MAREN SCHEUNER Risk Algorithms/Matrices Supporting Family Healthcare (Ogilvy Public Relations Worldwide for CDC, $80,250) KIMBERLY SHOAF Public Health Preparedness Education and Training (DHHS/ Centers for Disease Control and Prevention, $165,992) JUDITH SIEGEL Obesity in School Staff: Participatory Environmental Model (DHHS/Centers for Disease Control and Prevention, $1,367,313 for 3 years) DAWN UPCHURCH Training and Research in Acupuncture and Menopause (NIH/ National Center for Complementary & Alternative Medicine, $216,000 for 2 years) ANTRONETTE YANCEY Healthy Eating and Physical Activity Program Evaluation Phase 2 (Samuels and Associates, $299,500 for 4 years); Health Impact Assessment on Policies Supporting Physical Activity in Low Income Communities (Public Health Institute, $119,912); Media Content Analysis (Public Health Institute, $114,007)

and residency in primary care internal medicine at UC San Francisco/San Francisco General Hospital and is board certified in internal medicine. In addition to his research activities, Morales sees patients and supervises medical residents at the UCLA Internal Medicine Clinic and Medical Center.

Also joining the faculty: LIN CAI Epidemiology ALINA DORIAN Community Health Sciences KERI GARDNER Health Services DENA HERMAN Community Health Sciences NOLA KENNEDY Environmental Health Sciences MIRIAM LAUGESEN Health Services JIAN YU RAO Epidemiology ANDREA VODERMAIER Health Services KENNETH B. WELLS Health Services YIFANG ZHU Environmental Health Sciences

UCLAPUBLIC HEALTH

DR. LEO S. MORALES has joined the faculty as an associate professor of health services. He is also an associate professor in the Division of General Internal Medicine and Health Services Research at the UCLA School of Medicine and a natural scientist at The RAND Corporation. Morales recently received a Robert Wood Johnson Foundation Health Policy Investigator Award to study the effects of acculturation to the United States on the health of Mexican immigrants. His principal areas of research are Latino health, health care disparities and outcomes research for Spanish-speaking populations. Morales received a medical degree from the University of Washington and a doctorate in philosophy from the RAND Graduate School of Policy Studies. He completed an internship

Health Training Center (Health Services Resource Administration, $1,825,000 for 5 years)

faculty

LEEKA KHEIFETS Risk Assessment and the Development of the Environmental Health Criteria (World Health Organization, $166,636)

news briefs

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UCLAPUBLIC HEALTH

RUTH J. ROEMER, 1916-2005 Ruth Roemer, a pioneer in public health law and advocacy and a stalwart member of the UCLA School of Public Health faculty for more than four decades, died August 1 at age 89.

In a career spanning more than 50 years, Roemer made lasting contributions in areas that included reproductive health services, environmental health, tobacco control and health services organization. She remained an influential figure in public health well into her 80s, initiating what later became the International Framework Convention on Tobacco Control, adopted by the World Health Organization (WHO) in 2003.

Born Ruth Joy Rosenbaum in Hartford, Conn., Roemer graduated from Cornell Law School and began her career as a labor lawyer. She switched to health law in the 1960s after participating in a landmark study of the laws governing admission to mental hospitals in the State of New York.

With her husband Milton, himself a giant in the field of public health who died in 2001, Roemer joined the UCLA School of Public Health faculty in 1962, and promptly became the principal organizer and vice president of the California Committee on Therapeutic Abortion, formed to provide public education and leadership in reform of California’s century-old abortion law. The group spearheaded abortion law reform in California in 1967, six years before the U.S. Supreme Court’s decision in Roe v. Wade.

In ensuing years she would make her mark with analyses of the functions, education and regulation of health personnel; as an ardent campaigner for fluoridation of public water supplies in California and worldwide; with an early-’70s study examining the gap between the advanced technology available to roll back pollution and the application of this technology to protect people’s health and living conditions; and with seminal work in tobacco control that started with a world review of tobacco control legislation, carried out for the WHO and first published in 1982. She went on to present at international tobacco control conferences on five continents, and to help prepare a document that led to WHO’s first international convention on tobacco control and the treaty adopted in 2003.

Roemer, who taught health law, ethics and policy at UCLA, was preparing for her fall courses at the time of her death. Last spring, she was honored with the Dean’s Award for her sustained and generous support of the school.

At the family’s request, contributions in Ruth Roemer’s memory can be made to the Ruth Roemer Fellowship Award Fund, c/o UCLA School of Public Health, Box 951772, Los Angeles, CA 90095.

symposium addresses lessons from katrina

The school’s newly established Center to Eliminate Health Disparities sponsored a symposium in October to discuss the continuing role of race and poverty in health status and health outcomes – a problem that was underscored in the aftermath of Hurricane Katrina.

At “Lessons from Hurricane Katrina: Poverty, Race and Health in America,” held at UCLA’s Covel Commons, faculty from the school as well as from other parts of the UCLA campus and from UC Berkeley addressed these issues and speculated on the implications the disaster could have for Los Angeles.

The Center to Eliminate Health Disparities identifies, investigates, and addresses differences among various population groups in health status and disease burden, with a heavy focus on community-based intervention research to mitigate observed disparities.

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To celebrate the launch of the school’s Center to Eliminate Health Disparities, Obie award-winning playwright, actor and poet Sarah Jones presented “A Right to Care,” her one-woman show, on the UCLA campus in October.

Jones’ performance piece explored the ways in which economic, racial and ethnic disparities affect people’s daily lives. Using voices of modern America, she illuminated key public health topics.

The Center to Eliminate Health Disparities aims to advance understanding of health disparities across the lifespan and foster multidisciplinary research, particularly in Los Angeles County, to improve the health of underserved communities.

southern california particle center renewed for five years

news briefs

jones’ onewoman show celebrates launch of center

PRESIDENTIAL AWARD – Raymond D. Goodman, M.D., M.P.H. ’72, who was instrumental in establishing the Medical Reserve Corps of Los Angeles and has been its volunteer medical director since its inception, received the President’s Volunteer Service Award in October.

Developed under the supervision of the Los Angeles County Department of Health Services, the Medical Reserve Corps of Los Angeles provides the established health care community with teams of trained and experienced health professionals, most of them retired, who are prepared to respond to major community disasters.

The Southern California Particle Center (SCPC), directed by Dr. John Froines, professor of environmental health sciences at the UCLA School of Public Health, has been renewed with five years of funding from the U.S. Environmental Protection Agency. The center brings together outstanding scientists from leading universities in Southern California to conduct high-priority research on the underlying basis for health effects associated with exposure to airborne particulate matter, toward the goal of ensuring protection of the public’s health.

APPOINTED – Dr. Mark Schuster, professor of pediatrics and health services at the UCLA schools of medicine and public health, was appointed to the Los Angeles Commission for Children, Youth and Their Families by Los Angeles Mayor Antonio Villaraigosa.

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