UCLA Public Health Magazine - November 2006

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NOVEMBER 2006

UCLA

PUBLIC HEALTH TROUBLED

WATERS

UCLA

Science, Policy and the Fight to Preserve Our Natural Resources

School of

Public Health

Jeff Luck is among SPH faculty and alumni who are using informatics to change the way hospitals, health departments and the public use health information.

Angie Otiniano and her fellow members of Students of Color for Public Health work toward effecting positive change for diverse populations.

As a physician in Kenya, Charles Otieno saw deaths emergency services could have prevented.

With his SPH education, he plans to change that.

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UCLA

PUBLIC HEALTH

Norman Abrams Acting 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

Dan Gordon Editor and Writer

fe a t u r e s 4

Martha Widmann Art Director

E D I TO R I A L B OA R D Richard Ambrose, Ph.D. 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

Kevin Loh President, Public Health Student Association

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

UCLA

President, Alumni Association

School of

Public Health

Troubled Waters – Science, Policy and the Fight to Preserve Our Natural Resources Pollution. Drought. Overdevelopment. Overconsumption. SPH faculty, students and alumni lead the effort to keep our oceans, streams, wetlands and drinking water healthy, clean and abundant.

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Charlotte Neumann: Pediatrician Provides Food for Thought

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Students of Color for Public Health: Engaging Diverse Communities, Supporting Each Other

in every issue 22 RESEARCH

18 12 Her seminal work in Africa shows that adding small amounts of meat to malnourished children’s diets improves school performance. In Los Angeles, she tackles a very different nutritional problem.

Making Healthy Connections: Unleashing the Power of Information Technology Systems As computers have gotten faster and cheaper, health care and public health are beginning to apply informatics and other strategies to improve the way they do business.

Group making its mark by fostering discussion and action among SPH students committed to working on behalf of populations of color, and helping members succeed.

Salad’s benefits...hypertension and long work hours...air pollution’s risk to infants...health benefits of marriage...weight obsession and exercise motivation...risky behavior after new HIV infection...correcting refractive error in elderly.

28 STUDENTS 30 NEWS BRIEFS 32 FACULTY

PHOTOGRAPHY Reed Hutchinson / Cover: Luck, Otiniano; TOC: Students of Color for Public Health; pp. 4-7, 9-12, 15, 19, 21, 28; p. 32: Keeler

Lisa Hancock / p. 17: Balgrosky; p. 32: Rice Glenn Wong / Cover: Otieno; p. 29 Judith Ernst / TOC: Neumann Danny Moder / p. 31 Courtesy of Shannon Pankratz / TOC: Water; p. 8 Courtesy of Paul Fu, Jr. / p. 16 Courtesy of Jeff Luck / p. 17: CHIS website home page Courtesy of Raphael Travis / p. 18 Courtesy of the UCLA School of Public Health / pp. 2, 20, 30, 31: Oppenheimer; p. 32: Symposium Getty Images © 2006 / Cover: Water; pp. 22, 24-25 Punchstock © 2006 / TOC: Making Healthy Connections; pp. 14, 27

School of Public Health Home Page: www.ph.ucla.edu E-mail for Application Requests: app-request@admin.ph.ucla.edu UCLA Public Health Magazine is published by the UCLA School of Public Health for the alumni, faculty, students, staff and friends of the school. Copyright 2006 by The Regents of the University of California.

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

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dean’s message “EITHER YOU BRING THE WATER TO L.A., or bring L.A. to the water” is a memorable quote from 1974’s Chinatown. The movie, based in the 1930s, told a tale of politics, murder and betrayal — all having to do with water. As discussed in our cover story (see page 4), the water issue is highly charged and extremely complex. In Southern California we worry about the cleanliness of our beaches, about surfing and about the seafood we eat. We seem at times less concerned about our drinking water as long as tap water is safe and bottled water continues to be delivered to our homes and offices. But should we worry more?

Research and work currently conducted by UCLA School of Public Health faculty, students and alumni confirm that we are on a dangerous course. We learn why we need to address critical water issues now in order to plan for the future.

The issues on our horizon have evolved into a global crisis linked directly with poverty, malnutrition and disease caused by inadequate sanitation and water scarcity. In addition, we are witnessing an increase in water-related disasters, including the Indian Ocean tsunami; hurricanes in the Caribbean, west Pacific and United States; floods in Central and Eastern Europe; and extensive droughts in Niger, Mali, Spain and Portugal. These extreme events are among the most prominent, but serve to illustrate the profound global impact of water.

I recently had the opportunity to attend the Clinton Global Initiative (CGI) Annual Meeting along with advisory board member Cindy Horn. It is the second year in a row that former President Bill Clinton hosted the event to find and fund solutions to the world’s most pressing problems. This year global public health was introduced as one of four main themes. Attendees included more than 50 current and former heads of state, plus a high-profile group of CEOs, philanthropists, journalists and representatives of nonprofit organizations. The meeting is unique because of the action-oriented focus; participants are not only expected to bring ideas, but concrete investments and plans for change.

Being in the company of those attending CGI was inspiring. I was encouraged by listening to leaders from all over the globe with the means and resolve to make a difference in our world. Upon reflection, the resolve and goals of the meeting embody what we strive to do in the field of public health. We have the unprece-

UCLAPUBLIC HEALTH

dented opportunity and responsibility to help people meet their needs.

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Armed with training in public health, our students and faculty are actively engaged in research and consultation in nearly 70 countries throughout the world.

And the work we do at UCLA has a global reach. A new high speed, high volume laboratory network (see page 30) will utilize technology to allow real-time disease surveillance around the globe. Meanwhile, our faculty and alumni are utilizing advanced information technology to change the way health care services are delivered and public health is practiced — work that transcends all borders (see page 14).

Attending the Clinton Global Initiative Meeting and reflecting on the global importance of work currently underway at the school has reinforced, in my mind, the necessity to continue broadening our vision and extending our reach. Our strategic plan written nearly five years ago charted a course for expanding our global efforts. Much as the movie Chinatown foreshadowed the importance of water, our plan correctly focused more of our efforts abroad.

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

TOTA L E X P E N D I T U R E S Grants and Contracts State-Generated Funds Gifts and Other Fiscal Year 05-06 $51.4 million

UCLAPUBLIC HEALTH

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4 P OLLUTION .

D ROUGHT. OVERDEVELOPMENT. OVERCONSUMPTION .

SPH

FACULTY,

STUDENTS AND ALUMNI LEAD THE EFFORT TO KEEP OUR OCEANS , STREAMS , WETLANDS AND DRINKING WATER HEALTHY, CLEAN AND ABUNDANT.

Troubled

WATERS

Science, Policy and the Fight to Preserve Our Natural Resources For an essential natural resource, water – in our oceans, lakes, reservoirs, streams, wetlands or coming out of our taps – hasn’t

UCLAPUBLIC HEALTH

always gotten the protection it warrants.

The stakes are high. Clean water is critical for human health and ecosystem survival – a point that is particularly pronounced in the Los Angeles region, no stranger to droughts or closed beaches. Here, leaders in the scientific and policy struggles on behalf of our aquatic resources – many of them faculty, students, or graduates of the UCLA School of Public Health – report mixed results.

Significant progress has been made in the Santa Monica Bay, thanks in part to the science, education and advocacy of Heal the Bay, the nonprofit organization led by Mark Gold (D.Env. ’94). In the 20 years since Heal the Bay was founded, plant and animal life has been restored to the “dead zone” that previously existed in the middle of the bay and the amount of sewage solids discharged into the bay has been reduced by 90%. Beach water quality during the summer has taken a dramatic turn for the better. But there is still a long way to go. “The biggest challenge before us is storm water runoff, where there has been little progress,” Gold says. “The runoff is still found to be toxic to aquatic life almost everywhere it’s tested, and our beaches look like landfills after every rain.”

In September, the Los Angeles Regional Water Quality Control Board implemented the nation’s most stringent bacteriological regulations for beach

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cover story

RS tion of ocean water will be cost-effective in 10-20 years,” says Suffet, professor of environmental health sciences and a member of the ESE faculty. “If that occurs, it could solve the water-quantity problems of Southern California. Of course, then we would really have to keep the ocean clean, and right now too many people don’t care about that.”

Water issues fall into two major classes: those that have to do with water that is treated, delivered and consumed by humans, and those related to water in the environment – from streams, lakes and reservoirs to coastal waters. In some cases there is overlap.

Contaminants in a reservoir used for drinking water affect both the population that consumes it and the ecology it supports.

Faculty and students at the school are studying both classes of water issues. “We have people concerned with the chemistry – the effects of what goes into the water; the ecological consequences of these effects; and the human health and economic impact of these interventions,” says Dr. Richard Ambrose, professor of environmental health sciences and director of the ESE program. Again, the distinctions often blur. When oceans are contaminated by bacteria from sewage spills or storm water, for example,

— Dr. Richard Ambrose

UCLAPUBLIC HEALTH

water quality. In making the case to government officials, the board argued that any further delay in enforcing the stricter standards would carry substantial economic and public health costs. One of the key studies cited was published in July by Dr. Linwood Pendleton, associate professor of environmental health sciences at the school, who teaches in the Environmental Science and Engineering (ESE) program, an interdisciplinary, policy-oriented doctoral program based in the school.

On the downside, Pendleton’s research focus is prompted by the reality that coastal waters are not always treated with the care they deserve. “People don’t appreciate how important beaches are, because they’re largely free,” he says. “But they’re an important part of the coastal economic engine. My work is pulling together how big that economic contribution is, and then looking into the damages to that economic contribution caused by having dirty water and closed beaches.”

Exciting new technologies are being developed to treat drinking water – including a desalination process currently being studied by Dr. Mel Suffet and two of his students that could one day lead to a feasible way of treating water from the ocean so that it’s acceptable for drinking. “I predict desalina-

“The huge unknown is what’s going to happen with global climate change. That covers every possible dimension —the quality of water and its sources, as well as what will happen from our local rainstorms.

We may have more extreme storms and more flooding, as well as more droughts.

All of these will have human and ecosystem consequences that will have to be dealt with.”

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“People don’t appreciate how important beaches are, because they’re largely free.

But they’re an important part of the coastal economic engine.

My work is pulling together how big that economic contribution is, and then looking into the damages to that economic contribution caused by having dirty water and closed beaches.”

UCLAPUBLIC HEALTH

— Dr. Linwood Pendleton

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the people who depend on the ocean’s fish supply suffer along with the sea life.

Suffet, an environmental chemist, studies potentially toxic compounds and their effects on drinking water as well as on the ecology of streams and coastal waters. In his research on drinking water, he focuses not only on health concerns but also on palatability – studying compounds that, even if not unhealthful, may result in taste and odor problems. In one study, he is tackling the taste and odor problems caused by two nontoxic chemicals found in natural waters: geosmin and 2-methylisoborneol. Both are released by algae, making them a concern in Southern California wherever there are lakes and warm weather. The Metropolitan Water District of Southern California and the Los Angeles Water Department have begun using ozone at water treatment plants to remove these chemicals. Suffet is studying the effect of that approach, as well as strategies of adding chlorine or chloramines to minimize the flavor of these materials.

He has also begun applying his work in drinkingwater odor issues to air pollution, particularly from compost facilities and wastewater treatment plants.

Taste and odor are minor concerns in parts of the world where water is particularly scarce. An estimated 1.1 billion of the world’s nearly 7 billion people lack access to clean water. Developing countries currently bear the brunt of the crisis, but if current

trends continue, water scarcity could one day become a major problem for Southern California. “The global climate change models indicate that in the future we’re going to get a much higher percentage of our precipitation as rain rather than as snow,” says Ambrose. “Right now, one of nature’s services is that it stores the water for us in the form of snow, and then releases it over an extended period of time so that we can use it. The Sierra Nevada snowpack is currently serving as a huge water reservoir, but if the precipitation comes in as rain, a lot of that water is going to fill the reservoirs to capacity, run out to the ocean, and not be available later in the year.”

That’s where the research of Suffet and others to improve water treatment technology comes in.

Working with the Metropolitan Water District of Southern California, Suffet and his students are focusing their desalination effort on the Colorado River, a major source of water for the region that has experienced deterioration in quality as its chemistry changes and demand increases. Among other things, the salt content in the Colorado River water must be decreased to be acceptable for drinking. The ideal solution would involve the use of membrane filtration, but the technology’s cost has been a barrier.

“The future of drinking water is developing membranes that are inexpensive and can be used by the water industry not only for desalination, but also

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Ambrose’s work spans the gamut from water chemistry to human health, with a focus on how contaminants that are put into fresh water, often as a result of urbanization of watersheds, affect the health of ecosystems. In addition to studying ecosystem changes, he and his students are exploring how to assess their effects. “We need to determine how we should measure an ecosystem’s health and how we can integrate that information to better understand the policies or management changes that would ensure that it remains healthy – or regains its

Shannon Pankratz Fred Gerringer More than 1 billion people throughout the world lack safe drinking water and basic sanitation. Gerringer, a doctoral student in the ESE program working with Dr. Richard Ambrose, hopes to contribute to alleviating the problem through water treatment research. “As my education and career progress, my goal will be to help society maintain the balance between economic prosperity, access to clean water, and a healthy environment,” he says. Gerringer’s dissertation research involves water treatment technologies that may be used to desalinate Colorado River water diverted to Southern California. “This crucial source of water carries millions of tons of salt into the region each year,” Gerringer explains. “Much of this salt accumulates in the soil and leaches into the ground during irrigation, threatening agricultural productivity and aquifers used for drinking water.” One approach to this issue is to separate salts from the water using reverse osmosis (RO) membrane desalination, which can achieve removals greater than 95%. But the water must be pre-treated to remove particulates, microorganisms, and other constituents that can impair RO desalination. Gerringer’s research compares potential pre-treatment processes that could be used to optimize RO membrane performance.

UCLAPUBLIC HEALTH

Pankratz, a student in the interdisciplinary Environmental Science and Engineering (ESE) program, based in the School of Public Health, works with Dr. Mel Suffet in focusing on storm water runoff pollution. Two storm water sampling projects that she has been involved in, locally for Ballona Creek and at Sweetwater Reservoir in Spring Valley, Calif., characterize various pollutants in urban runoff. The Sweetwater project also involved the characterization and evaluation of the Sweetwater Authority Urban Runoff Diversion System, which had been constructed to protect the Sweetwater reservoir and drinking water supplies.

Pankratz is now involved in an assessment of the fate of urban runoff pollutants in simulated wetland microcosms. “The major goals of this Sweetwater greenhouse project are to determine the most important environmental compartments involved in the sequestration of the pollutants, ultimately in order to develop best-management practices for maintaining and constructing wetlands to treat urban runoff and improve water quality,” she says. The findings will also be used to help protect drinking water sources and aquatic ecosystems. “Urban runoff issues are a major hurdle to be overcome in addressing non-point source pollution in watersheds,” explains Pankratz, who is working for the U.S. Army Corps of Engineers, Regulatory Branch while completing her doctoral studies. “The Sweetwater greenhouse project is just one small step forward in investigating a cost-effective and semi-natural means of treating urban runoff.”

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cover story

for removing bacteria, viruses, hazardous chemicals and chemicals that cause taste and odor problems,” Suffet explains. “The key to the expense of the membrane is that it fouls or gets clogged and fails to operate for long periods of time.”

Suffet and colleagues are studying the fouling process in the hopes that a better understanding will help to identify ways to prevent it. They have found that a mixture of a high-molecular-weight natural background organic matter, humic material, fouls the small-sized membrane channels. In field studies in Yuma, Ariz., Suffet’s group is exploring how to overcome that hurdle. “It’s a long-term effort, but if we can get a handle on this, it could one day lead to making desalination of ocean water cost-effective,” Suffet says.

As housing developments continue to go up in Southern California, water scarcity looms as a major issue, as do potential issues of contamination caused by urban runoff. Suffet heads another group working with Sweetwater Reservoir, which supplies the drinking water for Spring Valley and the surrounding area near San Diego. When rain runs off the soil and roads, it picks up pesticides and poly-aromatic hydrocarbons – carcinogenic compounds deposited by automobiles – and brings them into the reservoir. To combat this concern, Sweetwater created a wetland to intercede between the reservoir and the runoff and treat the water. Suffet’s and Ambrose’s groups are studying ways to optimize this urban runoff diversion system so that the pollution going into the reservoir is minimized.

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Steven Lee Suzan Given

UCLAPUBLIC HEALTH

As a requirement of the ESE program, Given is conducting her internship at the County of Orange, Watershed and Coastal Resources Division, where she has been working on various projects related to implementation of national pollution discharge elimination system permit requirements. Given sees the Clean Water Act, which mandates the requirements, as “a vehicle to improve not only water quality, but also the quality of life for the public.” She recently co-authored a paper with her adviser, Dr. Linwood Pendleton, in which she modeled health impacts from bathing in water polluted with fecal indicator bacteria. “The most important accomplishment of the publication of this paper was getting people to think about and discuss water quality issues,” Given says. “It also helped to make possible the L.A. Regional Water Board’s decision to protect beaches by putting teeth in the storm water permit for Los Angeles County.”

Given was asked to present the paper at a conference on Sustainable Management of Coastal Recreational Resources in Malta. She will soon begin her dissertation, which she hopes will lead toward better understanding of the bacterial/water pollution problem at Los Angeles and Orange County beaches as a way to better protect the beach-going public.

An aquatic ecologist with diverse interests and experiences in marine and freshwater research, Lee’s investigations have led him to far reaches of the globe to study intertidal and subtidal community ecology in temperate and tropical systems.

He came to the school in 1999 to work as a staff researcher with Dr. Richard Ambrose, professor of environmental health sciences (EHS). Since then, Lee has managed numerous research studies involving long-term ecological monitoring of the rocky intertidal, coastal wetland restoration, ecological/ hydrological monitoring of stream/riverine systems, and the assessment of wetland regulatory programs. In 2003, Lee entered the EHS Ph.D. program. For his dissertation, he is investigating whether wetland mitigation projects, required as compensation for affected wetlands, have been successful in meeting the goals of state and federal regulations, and whether the national goal of “no net loss of remaining wetlands” is being achieved.

He has produced two lengthy reports on the topic, and believes his results are having an early impact on the regulatory practices of both state and federal agencies.

Following his doctorate, Lee plans to continue his pursuits in the ecology and environmental management of California’s coastal aquatic ecosystems through some combination of academic, nonprofit, and consulting work.

Students of Drs. Mel health,” he explains. One of Ambrose’s current research directions focuses on how degraded systems Suffet and Richard Ambrose study ways can be restored back to health. to optimize an urban In addition to his interest in ensuring that the runoff diversion system aquatic environment for animals and plants is a designed to minimize healthy one, Ambrose’s research is documenting the pollution at Sweetwater benefits that healthy ecosystems provide to society.

Reservoir, which supIt’s an area of research that has gained momentum plies drinking water for among ecologists in recent years. “If we lived in areas near San Diego.

Louisiana and people were going out and trapping fur-bearing animals or catching fish from the wetlands, people would appreciate that the wetlands were supplying goods to them, and they would see a value,” Ambrose says. “But in areas like Southern California, where not that many people are getting goods out of wetlands or other habitats, it becomes more important to describe the benefits.”

Among them are reduced flooding – wetlands can hold water and release it slowly. They can provide a habitat for birds and other wildlife. And they appear to have a protective effect on water quality in ways that Ambrose is attempting to better understand. In more than one ongoing study, Ambrose and colleagues are looking into the extent of this effect, and whether restoring the health of wetlands could improve water quality. Under the federal Clean Water Act, developments that are going to affect streams need to mitigate the impacts.

Ambrose recently completed a study looking at 129 mitigation projects throughout California to determine whether the developers were compliant with the permits, and, moreover, whether the outcomes were naturally functioning wetlands with adequately protected water quality. Preliminary findings suggest that in the latter two areas, the developers are falling short. Ambrose and colleagues issued a final report to the state Water Resources Control Board, and are working with the board on implementing the recommendations.

In some cases, wetlands may be able to act as cleansers. “We’ve known for a long time that certain wetlands can clean up the water by removing pollutants, potentially including bacteria,” Ambrose says. “But there has been little work done on whether that is the case for salt marshes – coastal wetlands that are tidal.” That information is of particular interest in Southern California, where wetlands were once a significant part of the landscape. “At one time, every major river went through a wetland before it went into the ocean, and the plants that lived in those wetlands would have been removing the contaminants,” Ambrose says. “But now that we’ve eliminated approximately 90% of all wetlands, the

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each year within a few miles of the coast on parking, eating, hotels and shopping,” Luce says. “There is a major recreational fishing industry, along with scuba diving and surfing, that all contribute a great deal to our economy. And if people who swim, surf or scuba dive in the bay are getting sick, that has economic impacts as well. The bay provides food for thousands of subsistence fishers who are affected when the fish they catch are not healthful to eat.

And the diversity of life in the bay is enormous.”

The Santa Monica Bay is undoubtedly cleaner than it was 20 years ago, she says, but many problems remain, including DDT on the ocean floor, which contaminates fish that people eat as well as moving through the food chain to contaminate marine mammals; and sewage effluent that contains both hormones and chemicals that mimic hormones, leading to reproductive problems along the food chain.

Storm water in the region was recently addressed at the policy level with the establishment of total maximum daily loads (TMDLs), which sets a cap on aggregate bacterial levels in the coastal waters. Storm water pollution occurs when rain picks up pollutants on the land surface and transports them through the storm drainage system and into the rivers, streams, and coastal waters. When

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“These issues don’t get solved overnight, as much as we would like them to be. You have to stay with them, and you have to use creativity in coming up with solutions. Solving complex environmental problems is not a one-sizefits-all approach.

Whether you need a legislative remedy, an engineering remedy or an educational remedy, you have to have the ability to be successful in all arenas.”

— Mark Gold (D.Env. ’94)

UCLAPUBLIC HEALTH

Water pollution typically falls under two classifications. Point source pollutants are what comes out of a pipe, whether from a water treatment plant or an industrial facility, and goes into a stream or ocean.

These discharges are regulated by federal, state and local laws. Nonpoint source pollutants are less traceable – they come from a wide range of sources, from driveways and streets to the storm-drain system.

“Since the Clean Water Act took effect, we’ve done a good job addressing the point sources – the pollution that comes out of pipes is significantly lower than it was 30 years ago,” says Eric Stein (D.Env. ’95), who heads the Watershed Department of the Southern California Coastal Water Research Project (SCCWRP). “But we’ve been much less effective at dealing with the nonpoint source pollution because it’s much harder than putting a control measure at the end of a pipe or improving a treatment process.”

SCCWRP is a joint-powers agency formed by several government entities that sought to pool resources and knowledge to learn more about the marine environment. In his position, Stein oversees a variety of projects related to storm water and mass emissions monitoring, watershed and water quality model development, and assessment of wetlands and other aquatic resources.

He notes that there are technical measures that could be taken to reduce nonpoint source pollution, but their cost is often considered prohibitive. “It’s a combination of needing better technologies – ones that are cheaper and easier to implement – and appealing to the public on the amount of resources people want to put into solving this problem,” Stein says. A considerable body of research indicates that the easiest way to solve the problem would be to

reduce the amount of pollution that’s generated.

“That involves changing people’s behaviors – how they fertilize their lawns and clean their yards and what types of products they use in their homes,” Stein notes. “It’s a more cost-effective, long-term solution, but much more difficult to implement.”

As executive director of the Santa Monica Bay Restoration Commission, Shelley Luce (D.Env. ’03) is among those who make the case that the Santa Monica Bay is vital to the regional economy, local ecology, and collective well-being of the community.

The commission brings together a diverse group of stakeholders to work toward the goal of pollution prevention and restoration programs.

“The beaches and ocean of Los Angeles are a huge tourist attraction, with billions of dollars spent

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question is whether those that are left are doing anything to remove contaminants.”

Ambrose is specifically researching the impact of wetlands on so-called fecal indicator bacteria going into the ocean. Fecal indicator bacteria are used as indicators of contamination by human sewage, and have been associated with human health risks. The study was prompted by recent findings that in one area of Orange County, Calif., more fecal indicator bacteria were going into the ocean after the water went through a wetland than had gone into the wetland. “It looked like wetlands were actually producing these bacteria, and degrading water quality in the ocean,” Ambrose says. Given that hundreds of millions of dollars are being spent trying to restore wetlands along the coast, the finding was especially troubling. Ambrose’s team is currently doing a more extensive study involving four wetlands up and down the coast, with preliminary results suggesting that if anything, the wetlands are reducing the bacteria.

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“I predict desalination of ocean water will be cost-effective in 10-20 years.

If that occurs, it could solve the water-quantity problems of Southern California.

Of course, then we would really have to keep the ocean clean, and right now too many people don’t care about that.”

UCLAPUBLIC HEALTH

— Dr. Mel Suffet

the federal Clean Water Act was amended in 1987, it required controls in urban areas to reduce pollution transported by storm water. Xavier Swamikannu, D.Env. ’94, has led the effort by the California Water Quality Control Board and the Los Angeles Region to set the cleanup framework for municipalities and industries. In addition to helping to develop the TMDLs for trash, bacteria, and heavy metals in storm water discharges, Swamikannu was central to the Los Angeles board’s action that amended the L.A. County Municipal Storm Water Permit to incorporate enforceable provisions to protect public health during summertime beach recreation.

“This is a long-term matter, but things are improving,” says Swamikannu. “At first it was difficult to get people to understand why it is so important to clean up storm water. But once studies began to demonstrate the health impacts, the problem was better understood, and now officials are serious about reducing this form of pollution.”

Pendleton’s study made a strong argument that the board ultimately heeded in passing the guidelines.

Publishing in the journal Environmental Science and Technology, he and his colleagues estimated from their data that in Los Angeles and Orange counties in the year 2000, 1.5 million people became sick as

a result of swimming in bacteria-contaminated coastal waters. Using a conservative estimate, the authors concluded that annual public health costs associated with these illnesses – including gastroenteritis, skin rash, and ear, eye, and respiratory infections – are $51 million.

Pendleton’s research looks at the economic impact of water quality changes, including both the costs associated with pollution of coastal waters and the economic benefits associated with cleaning them. His focus is entirely on day-use beachgoers in Los Angeles and Orange counties, who log 80 million beach visits per year. “So many cities have resisted regulation and have called storm water management procedures too expensive,” Pendleton notes. “So it’s important to determine the costs of not cleaning up, and how the benefits of cleanup compare to the cleanup costs.”

Costs associated with polluted coastal waters include fewer people going to the beach, which represents an economic loss for businesses that cater to beachgoers as well as other businesses in the immediate area, Pendleton explains. People who pay higher housing prices to be near the beach also suffer, as do those who become sick from swimming in the polluted waters. And Pendleton invariably finds that the benefits of cleanup are greater than expected. In one

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Ryan Vaughn 11

Robert Gilbert

UCLAPUBLIC HEALTH

Gilbert, a doctoral student in environmental health sciences, is using highresolution mobile sensing to elucidate the impact of urban development on streams. “Freshwater streams are critical natural resources that have complex physical, chemical and biological processes,” he says. “Urban development degrades these systems, reducing their ability to perform human services such as water retention and chemical processing.” One effect of urbanization is that algal biomass may reach nuisance levels. In excess, algae can be unsightly, odiferous, and harmful to aquatic stream life. “Trying to assess and reduce the urban impacts leading to nuisance algae is difficult given the complexity of these relationships,” Gilbert says. The mobile sensing system is part of a multi-method approach to characterizing these complex relationships. The technology, developed at UCLA’s Center of Embedded Networked Sensing, enables the determination of shortterm temporal and spatial patterns of biologically important stream conditions.

These patterns are determined by deploying the technology at a stream and then performing repeated autonomous scans of the stream reach with a payload of water quality sensors.

For his dissertation, Gilbert is attempting to combine this technology with static sensor arrays and an algal productivity bioassay to quantify physical, chemical, and algal conditions in a way that enables comparability both within and between stream reaches.

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study, he estimated the annual recreational value of beach-going in California to be more than $2 billion a year. While continuing to delve further into these topics, he is increasingly focused on bringing them to the attention of policy makers.

Pendleton is the lead non-market economist for the National Ocean Economics Program, which compiles studies on the economic value of coastal and ocean resources and makes the information available through an online database.

Pendleton wasn’t the only person with a UCLA School of Public Health connection who testified at the Los Angeles Regional Water Quality Control Board hearing on TMDLs. Swamikannu and Gold, both alumni of the school’s ESE program, also provided important input. “So many of our students and alumni are playing an important role in Southern California,” Pendleton says.

“Without a doubt, UCLA is the leader in the region in the water quality field.”

The expertise and leadership that come out of the school will be much needed in the future, since the issues won’t get any easier.

“The huge unknown is what’s going to happen with global climate change,” says Ambrose. “That covers every possible dimension – the quantity of water and its sources, as well as what will happen from our local rainstorms. We may have more extreme storms and more flooding, as well as more droughts. All of these will have human and ecosystem consequences that will have to be dealt with.”

Gold, whose success at Heal the Bay has served as a model for other environmental advocacy organizations, believes that persistence and flexibility are two of the keys to progress. “These issues don’t get solved overnight, as much as we would like them to be,” he says. “You have to stay with them, and you have to use creativity in coming up with solutions. Solving complex environmental problems is not a one-size-fits-all approach. Whether you need a legislative remedy, an engineering remedy or an educational remedy, you have to have the ability to be successful in all arenas.”

Vaughn, a doctoral student in the Department of Environmental Health Sciences program, is working with Dr. Linwood Pendleton on a study to assess the nonmarket values of recreation in the Channel Islands and Monterey Bay national marine sanctuaries. The study addresses a gap in information needed to assess the economic magnitude of private non-consumptive activities within marine sanctuaries and the ways in which marine protection affects these values. Nonconsumptive recreation includes any recreation activity that does not involve removing sanctuary resources, including scuba diving, snorkeling, whale watching, bird watching, viewing other wildlife, viewing/photographing scenery, canoeing, kayaking and sailing. Study outcomes will include the first geographically organized inventory of private non-consumptive users and values, insight into how biological and physical attributes influence user behavior and values, and the economic impacts associated with these users in terms of local expenditures and social welfare. Vaughn is interested in investigating the consequences of the spatial distribution of environmental resources on the practice of economic valuation, and hopes to develop and interpret an econometric modeling technique that takes into account individual preferences for environmental services that are spatially bundled, as well as latent effects that a resource’s spatial location may have on its value.

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12 H ER

SEMINAL

WORK IN

A FRICA

SHOWS THAT ADDING SMALL AMOUNTS OF MEAT TO MALNOURISHED CHILDREN ’ S DIETS IMPROVES SCHOOL PERFORMANCE .

I N L OS A NGELES , SHE TACKLES A VERY DIFFERENT NUTRITIONAL PROBLEM .

CHARLOTTE NEUMANN:

Pediatrician Provides Food for Thought In choosing where to devote her energies after her medical, pediatric and public health training, Dr. Charlotte Neumann was motivated by a desire to make a maximum

UCLAPUBLIC HEALTH

impact. And for a pediatrician looking to have the most effect, the choice was clear.

“If you want to make a difference in the lives of large numbers of children in the developing world, you have to deal with malnutrition,” she says. “It affects everything – diet quality and quantity, physical growth, mental development and learning, infection risk, and mortality. Malnutrition is the basis for more than half of all the deaths of children in developing countries – and it is almost completely preventable.”

Neumann has spent more than three decades addressing the problems of under-nutrition among children in developing nations – specifically the lack of energy and insufficient level of micronutrients (vitamins and minerals essential in small quantities for normal growth) in the diet. Much of her work has been in India and West and East Africa, where poverty, poor infrastructure, HIV/AIDS, droughts and military strife have only compounded an already bleak situation. “We have serious problems in the United States, but the most severe health problems in developing countries are light years away from the worst problems here,” she says.

Neumann was introduced to these concerns shortly after she completed her training. While at Harvard’s School of Public Health, she and her husband, Alfred K. Neumann – who was also interested in international health – were approached by a prominent nutritionist, Jean Mayer. A leading expert on hunger who would later serve as president of Tufts University, Mayer had a new training grant to bring researchers to developing countries. He invited the Neumanns to spend a summer in Ghana. “We went with our one-year-old son and were overwhelmed with the nutrition and infection problems of mothers and children we encountered,” Charlotte Neumann says. “From that point, we were hooked and determined to work in developing countries.”

Their early research was in rural India. In 1969, when Alfred Neumann was recruited to join the faculty of the UCLA School of Public Health (where he is currently professor emeritus), Charlotte joined the UCLA Department of Pediatrics. In 1975 she also became part of the School of Public Health faculty, lured back to

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“If you want to make a difference in the lives of large numbers of children in the developing world, you have to deal with malnutrition.

It affects everything – diet quality and quantity, physical growth, mental development and learning, infection risk, and mortality.

Malnutrition is the basis for more than half of all the deaths of children in developing countries — and it is almost completely preventable.”

—Dr. Charlotte Neumann

UCLAPUBLIC HEALTH

malnourished – and that approximately half of the children surveyed were overweight or obese. So Neumann, working closely with faculty colleagues Dr. Wendelin Slusser and Dr. Michael Prelip and staff research associate Dr. Stephanie Vecchiarelli, began a series of projects aiming to improve the nutrition environment in schools.

Their Nutrition-Friendly Schools and Communities concept has been testing the impact of eliminating junk food, adding salad bars, promoting physical activity and integrating nutrition into the classroom curriculum at eight low-income elementary schools in Hollywood and East Los Angeles.

Neumann initially obtained a grant and played a leading role in UCLA’s evaluation of the educational programs and activities established through the California Nutrition Network, a state initiative funded by the U.S. Department of Agriculture. “I have thoroughly enjoyed working in the schools in Los Angeles to try to turn around this obesity epidemic,” Neumann says. “I think we have called attention to some very important problems.”

Neumann has also been actively involved with the Venice Family Clinic since the early 1970s, when she helped to obtain a grant to introduce pediatric care at the then-nascent facility, which is now the largest free clinic in the nation. As a volunteer pediatrician she sees patients at the clinic, albeit less than in past years because of a heavy travel schedule.

She and her husband, along with their friend, philanthropist and School of Public Health Dean’s Advisory Board member Robert Drabkin, have given back in another important way. Each year, the Neumann-Drabkin fellowship program sends UCLA School of Public Health students to developing countries for their first overseas field internships. “A lot of students say they are interested in going into international health, but unless they get that first experience, they can’t really know what it’s like and it can be just a pipe dream,” Neumann says. “This has been a great way for these students to get some real experience working in a developing country to see if that’s what they want to do. Quite a few have stayed in international health, and some have ended up in the agencies where they interned.”

In addition to these students, Neumann has trained a number of students who come to the school from developing countries and then return home to assume leadership positions. “There’s more interest in global health at our school than ever before,” she says. “In our research and training we’re adding to a body of knowledge and helping to build infrastructure. Eventually I think we’ll be able to look back and say that has made a difference.”

faculty profile

her work in international health and nutrition by the arrival of the late Dr. Derek Jelliffe. “Dr. Jelliffe was the hero of all in international nutrition and health – he played a pivotal role in bringing pediatrics to Africa – and I always said that if he ever showed up, I was going to work with him,” Neumann recalls. In addition to co-teaching courses and developing curricula with Jelliffe, Neumann began to move her studies to Ghana and then Kenya, where she has been conducting seminal research since the late 1970s.

In collaboration with researchers at the University of Nairobi and Kenyan government agencies, Neumann carried out studies on infection, immune function and immunization response in newborns born malnourished. Ultimately, Neumann and her colleagues conducted a randomized controlled schoolfeeding intervention study in which they found that a high proportion of schoolchildren were lacking in the vitamins, minerals, and energy they needed for adequate functioning, learning and growth. They proceeded with a randomized controlled study of more than 9,000 schoolchildren in rural Kenya in which they confirmed that adding a small amount of meat to the diet dramatically increased the children’s school performance, physical activity, muscle mass and ability to ward off infection. (Populations in rural Africa consume little or no animal food due to poverty and inaccessibility.)

Any large-scale effort to enhance nutrition in a developing country such as Kenya has to consider the economic realities. “Many of the people we’re trying to reach are subsistence farmers who can’t purchase much, but rather are dependent on their abilities to raise food to be eaten by the family and sold for money,” Neumann says. While it would be costly to try to add beef to their diet, Neumann believes a feasible approach would be for households to raise small animals such as rabbits and chickens as food sources, along with fish from the lakes. So far, though, she and her colleagues in Kenya have had difficulty persuading officials to take action. “It’s been a slow process and frustrating, particularly given the striking differences in children’s cognitive performance and growth with what could be a relatively inexpensive addition to their diets,” Neumann says.

In Los Angeles, Neumann has often looked at the other end of the spectrum, studying over-nutrition and obesity in children. In the early 1990s, after the Los Angeles Times ran a series of articles about local children who were going to school malnourished, Neumann decided to investigate the nutritionrelated problems in UCLA’s backyard. Sure enough, she found that 11% of the children in the Los Angeles Unified School District schools studied were

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14 AS

COMPUTERS

HAVE GOTTEN

Page 1

Making Healthy Connections

FASTER AND CHEAPER , HEALTH CARE AND PUBLIC HEALTH ARE BEGINNING TO APPLY INFORMAT ICS AND OTHER STRATEGIES TO IMPROVE THE WAY THEY DO BUSINESS .

Unleashing the Power of Information Technology Systems Computer technology isn’t new to health care or public health. But in the last few years, as traditional barriers have been removed, the potential for information systems to improve clinical performance and contribute to healthier populations has become clear – and in many cases, the

UCLAPUBLIC HEALTH

benefits are already being seen.

Whether it’s developing electronic medical records or mining local-level health data for important trends, the management of large amounts of health-related information through the use of computer technology – sometimes called medical, health, or public health informatics – has been slow in developing, particularly when compared to other industries. In health care, two problems have long stood in the way.

“Health care data are challenging to manage and transmit in computerized form because of their diversity and volume,” says Dr. Jeff Luck, associate professor of health services at the UCLA School of Public Health and a leading scholar in public health informatics. Patient files often include many images, which are considerably larger than digital text, and the amount of documentation from even a short hospital stay can be massive. As a result, Luck says, the hardware infrastructure required to store patient records electronically was prohibitive.

That has changed in this decade with the increasing power and decreasing cost of computers.

Combined with the spread of the Internet and broadband connections, it has become economically feasible to leave the paper world behind. “With that being the case, a lot of us are interested in how to take advantage,” says Luck, “because we are all too familiar with how inefficient health care processes are, and those inefficiencies contribute to quality and cost problems. Ideally, information technology could increase quality,

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15 Beyond eliminating errors, electronic systems facilitate measurements of the quality of care that would be much more costly and time-consuming to compile by going through paper records. As director of Resource and Outcomes Management at CedarsSinai Medical Center, Bruce Davidson (M.P.H. ’79, Ph.D. ’90), also an adjunct assistant professor at the school, uses electronic data to establish measures of patient-care quality and efficiency, then provides analyses that help to inform clinical performance improvement activities and administrative decisionmaking. Among other things, Davidson’s department analyzes large data sets to assess where health care is failing to follow the best practices based on research.

Promoting evidence-based practice has been a high priority in public health and medicine. Bell serves as co-director of a project designed to facili-

tate more research in primary care environments, where patients tend to be most representative of the general population. The UCLA Practice-Based Research Network is charged with developing systems for integrating research studies into routine clinical care environments.

In the short run, says Luck, the goal of the electronic medical record is to computerize paper records for efficiency and ease of communication.

The hope is that these records, along with computerized physician order entry systems, will eventually incorporate “clinician decision support systems” – ways in which computers could aid providers in the decisions they make at the point of care by integrating patient-specific data with computer-represented clinical knowledge.

“The number of diagnostic tests, medications and other treatments is so dramatically increasing,”

“We are all too familiar with how inefficient health care processes are. Ideally, information technology could increase quality, reduce cost, and enhance access to services.”

— Dr. Jeff Luck

UCLAPUBLIC HEALTH

reduce cost, and enhance access to services.”

Luck believes the conversion in health care to electronic medical records – the accumulation of health information about patients (accessible only to authorized users) that can be managed in ways that create opportunities for new clinical knowledge, administrative efficiencies and safety provisions – has great potential for impact. A 2003 General Accounting Office study concluded that more than $8.6 million was saved in a large teaching hospital by replacing paper medical charts with an electronic records system. Other studies have found that numerous laboratory and imaging tests are repeated because of the unavailability of prior results.

A major perceived benefit of going digital is patient safety. To Err is Human: Building a Safer Health System, an influential report by the Institute of Medicine (IOM) of the National Academies, estimated that as many as 98,000 patients die each year from medical errors. Many of these adverse events could be prevented, Luck suspects, through the use of simple clinical information systems that would offer reminders and treatment plans, and education for physicians and their patients. The IOM report pointed to the need for making better use of information technology in combating the problem.

Douglas Bell (M.D., Ph.D. ’00) started medical school nearly two decades ago, before the IOM report put the issue of medical errors on the national agenda. But even then, he says, “I was conscious of the mistakes we often make in medicine and the ways we harm patients, and it bothered me.” Bell, who had a computer science background, notes that the research literature is now replete with evidence of all-too-common errors involving drug administration, diagnosis and poor communication in patient handoffs. “I sensed that better management of information could improve the delivery of care,” he says.

“We could make fewer mistakes and amplify the process of learning from what we do.”

Bell did a postdoctoral research fellowship on developing information systems for health care, and then went on to get his Ph.D. in health services at the UCLA School of Public Health. He is currently an assistant professor of medicine at UCLA and a research scientist at RAND, where he is leading one of the electronic prescribing pilot studies authorized in the Medicare Modernization Act to evaluate standards for advanced e-prescribing transactions.

Computerized physician order entry systems are seen as having great potential for reducing medication errors. Physicians enter prescriptions and other orders directly into a computer in a standardized format, eliminating the miscommunication that comes from illegible handwriting or use of confusing terms.

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“By aggregating large, disparate data sets, standardizing terminologies, and developing techniques to mine electronic medical records, we can assist policy makers by painting a much more detailed picture of health status and the needs of the population.”

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—Dr. Paul Fu, Jr.

Luck says. “Decision support systems are designed to check the physician’s order against a database of evidence or best practice.” If the physician orders a medication that would interact adversely with one the patient is already on, for instance, an alert would immediately appear. Ultimately, Luck says, in an era in which it is has become impossible to keep up with all of the latest medical advances, such a system could bring medical knowledge to the point of care.

Health insurers have always been computerintensive, but as the field of health informatics matures, they are finding new non-administrative uses for information technology. Kaiser Permanente’s HealthConnect, a decade-long, $3.3 billion initiative, is a program-wide system that will integrate the clinical record with appointments, registration, and billing, enhancing patient care and service. HealthConnect gives Kaiser Permanente clinicians access to the health plan’s knowledge base at the point of care, along with decision-support tools to enhance quality and patient safety. When a provider opens a patient’s chart, automatic alerts note clinical best practices indicated by the patient’s demographics and medical history. “Health maintenance reminders” ensure that patients and their doctors don’t overlook appropriate screening tests, and that patients with chronic conditions are following the prescribed regimens.

The new system has great potential for improving patient education, notes Josh Kohrumel, M.P.H. ’05, a project manager working on Health-Connect outpatient applications. After the provider documents the visit in the system, a print-out can be given to the patient summarizing the findings and recommendations. “Patients walk away feeling empowered and much more involved in their care,” says Kohrumel.

Public health informatics has lagged behind medical informatics, but that has begun to change. In the last several years the Centers for Disease Control and Prevention has promoted the development of software solutions that can be used by multiple public health jurisdictions.

The most direct application for public health informatics is in the data collection and dissemination functions. Currently, Luck notes, infectious disease reporting is done on paper, and the vast majority of cases go unreported; electronic reporting would likely save money and improve adherence. Similarly, an electronic immunization registry would simplify the dissemination process for childhood vaccina-

tions. “Informatics is being applied first to streamline standard public health functions such as collecting disease data,” says Luck. “Potentially, there is the hope that information technology will be used to analyze and disseminate data in ways that were not feasible with paper reports and documents.”

Writing in the July/August 2006 issue of the journal Health Affairs, Luck and colleagues argued that with the development of proper information technology systems, public and private organizations would be able to collect valuable local-level health information that could assist communities in pinpointing problems and developing targeted solutions, serving as a “powerful vehicle for improving health.”

Though cost is much less an issue than in the past, they wrote, there is still a need for the development of flexible tools that can be used by a variety of organizations, including Web-enabled systems that assist users in obtaining the information they require in predefined, customized or interactive formats.

Luck, a senior research scientist with the UCLA Center for Health Policy Research (CHPR), based in the school, has led the center’s effort to develop a user-friendly, interactive database for its California Health Interview Survey, the largest state health survey and a key source of information on health and access to health care services. “The survey design is very complicated, so downloading the data sets and trying to run analyses on your own computer would require a lot of statistical training as well as some specialized software,” Luck explains. Instead, a CHPR team headed by Luck have created AskCHIS (www.chis.ucla.edu), an Internet query system that is free to all users and requires only a browser. The system’s strength is its flexibility and simplicity – users can run customized searches on hundreds of health topics related to the survey. “It’s one of the only places you can go to get complete access to full survey data sets with real-times calculations and a simple menu system,” Luck says. AskCHIS has more than 10,000 registered users, including personnel from government agencies, health care and community-based organizations, academics and others.

Linking different data sets, such as surveys about health behaviors, access to care, and information on hospitalizations for particular medical conditions, is an important application of informatics, Luck says.

Dr. Paul Fu, Jr., a member of the school’s faculty who serves as chief medical information officer for the Los Angeles County Department of Health Services, is pursuing that goal in his research. “By aggregating large, disparate data sets, standardizing terminologies, and developing techniques to mine electronic medical records, we can assist policy makers by painting a

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AskCHIS, a simple and flexible Internet query system, allows any registered user with a browser to take advantage of the wealth of data coming out of the California Health Interview Survey, based in the school’s Center for Health Policy Research.

“Automation of various health care processes requires rethinking how we do our work, and we still have many people who for a variety of reasons are resistant to doing things differently.”

—Jean Balgrosky

UCLAPUBLIC HEALTH

For all of the benefits to be reaped from new applications of information technology in the health care and public health settings, significant barriers remain.

Data standards are still needed to overcome problems of incompatibility when multiple sources are sharing or combining information. Privacy issues continue to be an important requirement of information systems, with concerns about protecting privacy and adhering to existing legislation needing be addressed. There is also a shortage of personnel who have information systems training, particularly in the public health field.

Jean Balgrosky (M.P.H. ’80), a doctoral student at the school with nearly 20 years of experience as a chief information officer at Scripps Health and Holy Cross Health System, sees organizational resistance to change as one of the biggest challenges to overcome.

“Automation of various health care processes requires rethinking how we do our work, and we still have many people who for a variety of reasons are resistant to doing things differently,” she says.

That resistance has lessened significantly, though, particularly since the Institute of Medicine report. “That was a huge wake-up call,” says Balgrosky.

“Until then, people were in their comfort zones and didn’t feel an imperative that there was something to fix. Now, no one can deny that we need to make changes – or that information technology has the potential to usher in dramatic improvements in how we operate.”

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much more detailed picture of health status and the needs of the population,” says Fu, who co-teaches a course on health informatics with Luck in the School of Public Health.

There are myriad other applications. In response to the need for more public health training, distance learning is being pursued in many places, including at the school, using information systems to transmit knowledge through audio, video and text, both in real time and archived. The school has also become a major player in the use of informatics for the rapid analysis of potential pandemics or bioterror attacks. The UCLA High Speed, High Volume Laboratory Network for Infectious Diseases will help to guide emergency outbreak control efforts (see page 30).

The Internet can be a valuable tool for rapidly solving urgent public health problems. Dr. Marc Strassburg, M.P.H. ’75, Ph.D. ’81, an adjunct professor of epidemiology at the school and chief of the Division of Web Development and Informatics for the Los Angeles County Department of Public Health Services (http://ladhs.org and http://lapublichealth.org/), notes that during the flu vaccine shortage last year, when it became clear that some physicians in the county held an excess of vaccines, his division quickly developed a Web-based software program in which physicians could log on to the website to indicate whether they needed or had excess vaccines to share; with such an information system, data were quickly centralized, and the necessary parties could be connected.

When Dr. Jonathan Fielding, professor at the school, was appointed director of public health for the county in 1999, he asked Strassburg to build the site into an important and trusted resource for constituents. “Our goal has been to better present both resource data and statistical data and reports to the public and, most importantly, to make it easy for users to find what they are looking for,” Strassburg says. His group is currently pursuing improved search engines to enable users to find information tailored to their needs – for example, a physician typing in the same key word would get different hits than a layperson.

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18 G ROUP

MAKING

ITS MARK BY FOSTERING DISCUSSION AND ACTION AMONG

SPH

STUDENTS

COMMITTED TO WORKING ON BEHALF OF POPULATIONS OF COLOR , AND HELPING MEMBERS SUCCEED .

Students of Color for Public Health:

Engaging Diverse Communities, Supporting Each Other

UCLAPUBLIC HEALTH

What started in 2001 as an informal support Above: Raphael Travis (lower right), a doctoral student and a founder of the school’s Students of Color for Public Health (SCPH), also serves as youth liaison at the UCLA Center for Adolescent Health Promotion. Here, he leads a Youth Community Advisory Board meeting at the UCLA Challenge Course, along with Typhanye Penniman (standing, third from left), also a doctoral student and SCPH member.

network among a handful of students has blossomed into a major asset at the UCLA School of Public Health and beyond. Students of Color for Public Health (SCPH), now an officially recognized UCLA student group with funding from the school and the California Wellness Foundation, is making its mark as a leader in recruiting populations of color to the field of public health, supporting students from diverse communities, and fostering discussion on critical issues affecting these communities.

SCPH was the brainchild of several students who bonded over common backgrounds and interests, including a commitment to working on behalf of populations of color. “We would get together and talk about classes and the work we were doing, work in the communities we were from, and to generally support one another as we were going through the program,” recalls Raphael Travis, who came to the school in the fall of 2000 and is now completing his doctoral studies. “Eventually it got to the point where we thought we should do something more formal.”

One of the group’s primary goals was to help entering students of color feel welcomed. “We wanted to make sure these students knew they had a place in

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difficult to do that when you are constantly bombarded by the negative aspects of your community,” says Vincecia Garcia, a second-year M.P.H. student who currently serves as SCPH co-chair. “We think it’s important to take a more optimistic point of view and help shed light on what students can do in a way that will inspire them to go in and make a difference.”

Adds Angie Otiniano, also a second-year M.P.H. student and SCPH co-chair: “Students in SCPH are passionate about these issues because these are things that are happening in their community, not just things they’re learning about. Having this network gives us the opportunity to meet people who are interested in and knowledgeable about different aspects of public health affecting populations of color, and to bounce ideas off of each other.”

Discussions on health issues of concern to populations of color range from the informal to the more structured, including presentations by faculty and public health professionals, many of whom are involved in community-based activities similar to what SCPH members plan to pursue after graduation. “Sometimes issues affecting low-income communities don’t get as much attention as they should,” says Jabar Akbar, a doctoral student and SCPH member. “This organization not only keeps these issues at the forefront, but ensures that diverse voices are heard when we’re talking about communities of color, and that those voices include people from those communities.”

SCPH members note that given how much of the effort to eliminate health disparities affecting

Doctoral student Taigy Thomas, here giving a lecture on meditation as a form of stress reduction, was an SCPH founder.

UCLAPUBLIC HEALTH

Increasing attention is being paid to the persistent – and in many cases widening – health disparities across racial and ethnic groups, with underserved minority populations being disproportionately afflicted when it comes to many health conditions.

Among SCPH’s aims is to facilitate efforts among students interested in working to address these concerns. “In public health we work toward social justice and making things more equitable, and it’s

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the school, and a community available to them that was committed to public health as a profession, committed to working with disenfranchised populations, and committed to supporting them during their time as students,” says Travis.

“Some of us always seemed to be bumping heads in the same circles and talking about the same issues,” adds Taigy Thomas, a doctoral student who was also among the founders. “So we decided to become more organized, so that we could have a collective voice and advocate as a group for the communities we worked in, and for ourselves.”

Once that decision was made and SCPH was established, the ranks of the group quickly grew.

SCPH – open to any student interested in public health issues affecting communities of color – now has approximately 100 members, including students in the master’s and doctoral programs, as well as alumni who are active supporters. It is dedicated to the recruitment, retention and graduation of students of color at the UCLA School of Public Health, and to strengthening the social support, career networking and advocacy efforts for the school’s students and alumni of color.

The first participants were so committed to making a difference in their communities and in each other’s lives that initial activities were funded out of their own pockets. But before long, they were receiving support from the Dean’s Office. “We approached Dean [Linda] Rosenstock to get her buy-in and she was 100 percent behind it, both in her words and in her actions, which made it a lot easier for us,” says Dr. Kynna Wright, one of the group’s original members, who has since been awarded her Ph.D. In addition to offering SCPH support through the school’s discretionary fund, Rosenstock assisted the organization in writing grant proposals for additional funding. Since 2002, SCPH has received financial support from the California Wellness Foundation.

“This extraordinary organization was built from within from the passions of several students and their knowledge that we as a school could do better,” says Rosenstock. “In a few short years, SCPH has grown and become increasingly influential and respected.”

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Below: Dean Linda Rosenstock with students from the Youth Into Health Professions program, an introductory public health course offered to high school and community college students in South Los Angeles; SPH staff; and members of Students of Color for Public Health.

populations of color involves grassroots, communitylevel strategies, it is important that more of the people implementing those strategies be people who are from those communities and understand their dynamics. “There is a heavy push to get more people of color into public health so that they can go into the communities and do the work that needs to be done,” says Typhanye Penniman, a doctoral student who has been active in SCPH since coming to the school in 2002. “If you’re familiar with the community and you’re involving the community in your work, you are more likely to know who the key people are that you need to reach.”

With that in mind, SCPH has placed a high priority on encouraging talented students of color to apply to the UCLA School of Public Health. SCPH members have logged many hours at community colleges and other settings where they can talk to undergraduates in underserved communities about the field of public health and the school’s communitybased efforts. “If you’re a student in an affluent community, you tend to have a lot more opportunities to hear about what’s out there for you,” says Penniman.

“We want to make sure students in low-income communities are getting the same information.”

One of the key outreach efforts that SCPH has helped to spearhead is the school’s Youth Into

Health Professions (YIHP) course. The introductory public health course, which Penniman taught last year, is offered free of charge in South Los Angeles and draws high school and community college students from the Watts and Compton areas, giving them the opportunity to earn college credit and to be exposed to the possibilities in public health. In addition to serving as instructors and co-instructors for the course, SCPH members have been paired with the youths to serve as mentors. Among the activities is “A Day Away at UCLA,” in which YIHP enrollees are brought to the campus for a tour and further guidance.

“It’s great for students from these communities to see people who look like them,” says Wright, who was involved in establishing the YIHP course and served as its first instructor. “They can see what we’re doing and know not only that we care, but that we are there to help them if they want to pursue education in public health.”

SCPH outreach efforts have also included talks about public health to members of other student organizations at UCLA, including those that support students of color at both the graduate and undergraduate levels; participation in community health fairs throughout Los Angeles; and presentations at conferences such as the Pilipinos for Community Health Pre-Health Panel, the California State University, Northridge Pre-Health Panel, and the 4th Annual Womyn of Color Conference at UC Santa Barbara.

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feature Left: Vincecia Garcia, SCPH co-chair, greets incoming students at a welcome luncheon in September.

SCPH also works closely with the school’s Student Affairs Office at orientations and other student events.

This year’s group is interested in expanding on SCPH’s reach to become involved in more off-campus activities, as well as working with other student groups to assist with recruitment and other forms of supporting youths in underserved communities. “We feel that since we have the privilege of being at this excellent institution in this amazingly diverse city, we should be doing more to apply what we learn in the classroom to assisting the communities we’re learning about,” says Jennifer Garcia, a second-year doctoral student.

—Angie Otiniano (below left)

“In public health we work toward social justice and making things more equitable. We think it’s important to help shed light on what students can do in a way that will inspire them to go in and make a difference.”

—Vincecia Garcia (above right)

UCLAPUBLIC HEALTH

Upon entering the school as a Ph.D. student last year, Jennifer Garcia was immediately drawn to the sense of community she felt at SCPH’s social events. She was asked to serve as the group’s treasurer, and is now in her second year in that position. “Many of us have similar situations, going through the stresses of balancing school with family and work, and when you are in academia at this level as a student of color, it’s easy to feel a common bond,” Garcia says. “Knowing that there are other students I can count on for support and encouragement is extremely valuable.”

Indeed, many SCPH activities have nothing to do with recruitment of new students or outreach to the community, but are simply about enhancing the social and academic environment for current students. Members of SCPH have set up their own mentoring system in which new students are given guidance by second-years and second-years by doctoral students. Many alumni also continue to be active supporters, including Wright, whom Penniman continues to identify as a role model. “Mentoring is central to the cultures of many communities of color,” Wright explains. “It’s a part of who we are and what we do in the community, and it shouldn’t stop once we get to the academic level.”

“This is a group in which everyone cares about making sure that we all succeed,” says Thomas. “I know that if I have a problem, these are the first people I’m going to go to for help or advice.”

At the end of each academic year, a small celebration event is held for graduating students of color, allowing SCPH members to celebrate their achievements. Many of the SCPH members point to that event as an annual highlight – emblematic of the level of mutual support and the sense that they and their peers are on to something important.

“Whenever I feel overwhelmed,” says Vincecia Garcia, “these are the people who inspire me.”

“Students in SCPH are passionate about these issues because these are things that are happening in their community, not just things they’re learning about.”

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research highlights Salad Eaters More Likely to Achieve High Nutrient Levels, but Few Are Biting

UCLAPUBLIC HEALTH

Each serving of salad correlates with a 165% higher likelihood of meeting the recommended dietary allowances for vitamin C in women and 119% greater likelihood in men.

REGULAR SALAD EATERS are significantly more likely to achieve high nutrient levels in the bloodstream and meet recommended dietary allowances (RDA) for vitamin C, according to a UCLA School of Public Health/Louisiana State University epidemiologic study.

Published in the September edition of the peer-reviewed Journal of the American Dietetic Association, the study analyzed dietary data on more than 17,500 men and women and found that consumption of salad and raw vegetables correlates with higher concentrations in the bloodstream of folic acid, vitamins C and E, lycopene and alpha and beta carotene. The study also found that each serving of salad consumed correlates with a 165% higher likelihood of meeting the RDA for vitamin C in women and 119% greater likelihood in men.

This was the first study to examine the relationship between normal salad consumption and nutrient levels in the bloodstream, and also the first to examine the dietary adequacy of salad consumption using the latest nutritional guidelines of the Food and Nutrition Board of the National Academy of Sciences.

The findings blunt concerns about the human body’s ability to absorb nutrients from raw vegetables, as well as concern that the structure and characteristics of some plants undercut nutritional value.

“The consistently higher levels of certain nutrients in the bloodstream of salad-eaters suggest these important components of a healthy diet are being well-absorbed from salad,” says Dr. Lenore Arab, visiting professor of epidemiology at the UCLA School of Public Health and co-author of the study with Dr. L. Joseph Su, assistant professor at the LSU School of Public Health. “The findings endorse consumption of salad and raw vegetables as an effective strategy for increasing intake of important nutrients.”

Arab and Su found that daily salad consumption is not the norm in any group, and is particularly uncommon among African Americans. “We have so many food choices in this country,” Arab says. “Increasing vegetable consumption is a wise strategy for composing a nutrient-rich diet. In fact, our findings suggest that eating just one serving of salad or raw vegetables per day significantly boosts the likelihood of meeting the recommended daily intake of certain nutrients.”

The study examined the relationship between reported salad consumption and blood serum nutrient levels, as well as dietary adequacy in pre- and postmenopausal women and men of comparable ages. The research team analyzed dietary data from 9,406 women and 8,282 men ages 18-45 and 55-plus contained in the National Health and Nutrition Examination Survey III conducted in 19881994. Salad consumption was based on reported intake of salad, raw vegetables and salad dressing.

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research

Hypertension Risk Grows as Work Hours Increase

UCLAPUBLIC HEALTH

UCLA AND UC IRVINE RESEARCHERS have published the first evidence suggesting that self-reported hypertension increases the more hours per week that workers put in, with those who clock more than 50 hours a week being 29% more likely to report hypertension than those who work fewer than 40. Publishing in the journal Hypertension, the researchers also reported that nearly one in five working Californians said they log more than 50 hours a week.

The research team from the UCLA and UC Irvine Centers for Occupational Increased Likelihood of SelfReported Hypertension When and Environmental Health used data from the California Health Interview Survey Working 40 or More Hours a (based in the UCLA School of Public Health) to study the role played by the work Week vs. 11-39 Hours Per Week environment in causing hypertension and coronary artery disease. The survey responses of 24,205 working California adults were analyzed.

Previous research has shown that by the age of 30 60, three of five American workers will have developed 29% hypertension, a major risk factor for stroke and cardio25 vascular disease.

“Work can negatively impact our health, an impact that goes well beyond the usual counts of injuries and 20 exposure to toxic chemicals that we more commonly associate with occupational health,” says Dr. Peter 17% Schnall, director of the Center for Social Epidemiology, 15 a member of the UCLA Center for Occupational and Environmental Health, and one of the study authors. “It 14% turns out that the way work is organized – its pace and 10 intensity, the space it allows or doesn’t for realizing a sense of self-efficacy and self-esteem, the level of control over the work product or process, the sense of 5 justice or injustice, and job security or growth – can be as benign or ‘toxic’ to the health of workers as the chemicals one breathes in the air.”

0 It was unclear from the study whether the long 40 hrs 41-50 hrs 51 or working hours per se are responsible for the increased more hrs hypertension risk. Based on past findings, the authors estimated that job strain – work characterized by high demands and low control – accounts for one-fourth of all heart disease-related illness and death among working people after controlling for individual risk factors such as personality, diet, obesity, and cigarette smoking. This might explain why clerical and unskilled workers had far higher rates of diagnosed hypertension – 23% and 50%, respectively – than did whitecollar workers who worked the same number of hours.

“Tomorrow’s jobs must be deliberately crafted to allow the full development of the human spirit through work that encourages – not discourages – human potential,” says Schnall. “A key characteristic will be the full participation of all working people in the decision-making processes surrounding the organization of work.”

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Exposure to High Levels of Outdoor Air Pollution Linked to Greater Risk of Death in Infants’ First Year

The findings concur with previous studies that have reported associations between air pollution and risk of respiratory-related death in infants.

HIGH LEVELS OF OUTDOOR AIR POLLUTION in the South Coast Air Basin of Southern California are associated with increased risk of death during an infant’s first year of life, according to the findings of a research team headed by Dr. Beate Ritz, associate professor of epidemiology at the UCLA School of Public Health.

Ritz and colleagues obtained birth and death certificates for infants who died between 1989 and 2000. For every infant who died during that period, they matched 10 living control subjects and estimated average air pollution concentrations for periods preceding each subject’s death using data from existing air monitoring stations in the basin.

Their results, published in the journal Pediatrics, founds links between exposure to carbon monoxide (CO) and particles in the basin and risk of respiratoryrelated death during the first year of life. Infants exposed to the highest CO levels two weeks prior to death (in the top 25% of exposure) experienced an almost threefold increase in risk of respiratory-related death between the ages of 28 days and three months compared to infants who were exposed to low levels of CO (in the lowest 25%). Infants with the highest particle levels two weeks prior to death had an approximately 40% increase in risk of respiratory-related death during the ages of 4-12 months. Risk of respiratory-related death more than doubled for infants 7-12 months of age who were exposed to high particle levels in the prior six months. Low birth-weight and premature infants appeared to be more susceptible to air pollution-related deaths.

The findings concur with previous studies around the world that have reported associations between air pollution and risk of respiratory-related death in infants.

“Although post-neonatal respiratory-related infant death is rare – about two per 10,000 live births in our study group – the potential for disease prevention through further air pollution abatement may be substantial, since millions of infants are exposed to similar or greater air pollution concentrations worldwide,” notes Ritz.

The researchers also estimated that infants with high nitrogen dioxide (NO2) levels two months before death were 44% more likely to die of Sudden Infant Death Syndrome (SIDS) than those with low NO2 levels. Previous studies have reported conflicting findings for this outcome, and the mechanisms by which air pollution may act to cause SIDS are still to be uncovered.

UCLAPUBLIC HEALTH

Marriage Lowers Risk of Dying Young; Social Connectedness the Likely Factor MARRIAGE IS A POWERFUL PREDICTOR OF LIFE EXPECTANCY, with adults who never marry having a 58% higher likelihood of dying early than those who are married and living with their spouse, according to a study headed by Dr. Robert Kaplan, professor and chair of health services at the UCLA School of Public Health.

The study, which used U.S. Census data and death certificates for 67,000 adults between 1989 and 1997 and was published in the Journal of Epidemiology

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and Community Health, also found that widowers were nearly 40% more likely to die than same-aged marrieds during the study period, and that those who had been divorced or separated were 27% more likely to die than married adults in the same age group.

“The risks of being never married rival the risks of having increased blood pressure or high cholesterol,” Kaplan and colleagues concluded.

Kaplan also found that the protective effects of marriage are stronger for men than for women. Bachelors between the ages of 19 and 44 were found to be twice as likely to die as married men in the same age group – an outcome that could not be explained by “risky” behaviors: Unmarried men were only slightly more likely to smoke and less likely to drink alcohol regularly; exercised more; and were less overweight than their married counterparts. The risk of dying early was found to be three times less among never-married women under 35 than it was for never-married men under 35.

While previous research has shown that unmarried adults have a higher probability of early death than adults who are married, this was the first study to differentiate between those who never marry and those who are separated and divorced. The findings associating never having married with the highest probability of early death reinforce the conclusion that social connectedness – more likely with marriage – appears to confer key health benefits, Kaplan says. The study noted that widowed and divorced people are more likely to have children and are thus more likely to be socially connected than never-married adults.

“We showed that the impact of social isolation is not constrained to the elderly,” Kaplan says. “In fact, it is comparatively stronger early in life. This phenomenon may have been overlooked in previous studies because early death is uncommon.” The project evaluated a significantly larger sample than has been used in earlier studies.

The findings associating never having married with the highest probability of early death reinforce the conclusion that social connectedness appears to confer key health benefits.

Weight Obsession Can Undermine Motivation to Exercise

UCLAPUBLIC HEALTH

OUR MEDIA AND CULTURAL OBSESSION with achieving a certain weight does little to convince couch potatoes of any size to abandon their favorite sofa cushions and get active, according to a UCLA School of Public Health study. In fact, the study concludes, those messages may actually undermine motivation to adopt exercise and other healthy lifestyle habits.

Publishing in the June edition of the peer-reviewed journal Obesity, the research team, headed by Dr. Antronette Yancey, associate professor of health services at the school, found that women are more likely to categorize themselves as overweight than men, both overall and within each ethnic group analyzed. African Americans are least likely and whites most likely to consider themselves overweight. Yancey and colleagues found that even among many adults of average or normal weight – men in particular – a self-perceived weight problem correlates with sedentary behavior.

White women of average weight were the only ethnic-gender group studied in which the proportion of sedentary individuals was not higher among those who consider themselves overweight vs. those who consider themselves average weight, the study showed. White women were also the only ethnic-gender group in which average-weight individuals constitute the majority.

The researchers noted that in addition to cultural expectations, greater access to fitness programs, “walkable” neighborhoods, quality child and elder

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26

Reported HIV Status of Partners of Newly HIV-Infected Men Who Have Unprotected Anal Intercourse with Men

100% First Interview After Diagnosis Three-Month Follow-up

80% 60% 52 40%

48 30

20% 18 0% Positive

Negative

UCLAPUBLIC HEALTH

HIV Status of Partner

care, and flexible work hours all help make the choice to be active easier for white women overall than for their Latina and African American counterparts.

“These data suggest that our society’s emphasis on weight loss rather than lifestyle change may inadvertently discourage even non-obese people from adopting or maintaining the physical activity necessary for long-term good health,” says Yancey. “All groups may benefit from messages that shift the focus away from a specific target weight and associated calorie counting, and instead promote increased physical activity and healthy eating habits.”

The study used data from the 2002-03 Los Angeles County Health Survey, a random telephone survey conducted by the Los Angeles County Department of Health Services. Among the specific findings: • The prevalence of overweight and obesity among adult Angelenos by race/ethnicity and gender was fairly typical of national samples. The combined prevalence of overweight and obesity was highest in African Americans and Latinos, intermediate in whites, and lowest in Asians-Pacific Islanders. The pattern was consistent among both men and women within each group.

• 73% of overweight/non-obese and 24% of average-weight women considered themselves overweight, compared with 45% of overweight/non-obese and 6% of average-weight men.

• 41% of overweight/non-obese African Americans identified themselves as overweight, compared with 61% of overweight/non-obese whites.

• Overweight self-perception, vs. average-weight self-perception, correlated with sedentary behavior among average-weight adults (45% vs. 33%), overweight adults (43% vs. 34%), average-weight and overweight men (38% vs. 28%), overweight whites (42% vs. 30%), and African Americans and Latinos (42% vs. 34%).

Newly HIV-Infected Men Who Have Sex With Men Report Reduced Risk Behaviors in First Three Months NEWLY HIV-INFECTED MEN who have sex with men reported a modest but significant decrease in risk behaviors in the first three months after diagnosis, according to the findings of a study by Dr. Pamina Gorbach, associate professor in residence of epidemiology at the UCLA School of Public Health, and collaborators at UC San Diego’s Antiviral Research Center and Harbor-UCLA Hospital.

34 Beginning in 2002, the researchers invited individuals being enrolled in an ongoing clinical cohort 18 study of those with acute or early HIV infection in The Southern California Primary Infections Program multiUnknown site NIAID Acute HIV Infection and Early Disease Research Program to complete a computer-assisted self interview approximately six weeks after their HIV diagnosis and then every three months for the first year, and every six months after that. More than 95% of those interviewed were men who have sex with men (MSM). The researchers were interested in whether these men would change their behavior over time as a result of the diagnosis.

Nearly half reported fewer sexual partners in the three months following their initial interview than in the three previous months. “This suggests that the HIV diagnosis and/or symptomatic illness associated with HIV seroconversion precipitated a drop, although not elimination of transmission risk,” says Gorbach.

In addition to fewer total numbers of partners, significantly fewer anonymous and one-time partners were reported. Unprotected anal intercourse

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occurred frequently within the primary partnerships – and more often than in other types of partnerships – raising concerns about transmission within these primary partnerships. The results were published in the Journal of Acquired Immune Deficiency Syndromes.

“As access to technologies that allow for detection of early HIV infection increases, new prevention strategies for individuals diagnosed with recent HIV infection that support them in achieving rapid behavior change are urgently needed for those with new partnerships, and especially for those with primary partners, to help them negotiate a balance between protecting that partner and achieving the intimacy perceived to be acquired from unprotected intercourse,” says Gorbach.

The collaboration has continued beyond the results published in the first paper, with more than 240 individuals joining the cohort and some having been followed for more than three years. Gorbach and colleagues are now analyzing data on those who have completed at least one interview after one year or more to see whether the changed behavior reported in the initial study persists beyond the first three months following diagnosis. Other papers on this study are also in press looking at the role of substance use and Internet sex-seeking in risky behavior reported by these men at enrollment.

Correcting Refractive Error Improves Vision-Specific Quality of Life in Older Persons

Participants who immediately received new prescriptions and vouchers for eyeglasses/magnifiers reported better mental health and preservation of independence with activities of daily living than those who had to wait.

UCLAPUBLIC HEALTH

CORRECTION OF UNCORRECTED REFRACTIVE ERROR improves the vision-specific quality of life of community-dwelling older persons, according to the findings of a research team led by Dr. Anne L. Coleman, professor of epidemiology in the UCLA School of Public Health and professor of ophthalmology at UCLA’s David Geffen School of Medicine.

Uncorrected refractive error affects 25%-54% of adults ages 40-80 in the United States and is the most common cause of visual impairment in older individuals. Visual impairment is one of the leading causes of physical decline with aging; if left untreated, it can increase the risk of functional decline, social isolation, falls, hip fractures, accidents, and mortality.

Coleman’s research team screened 1,309 adults at 48 different locations, including senior community centers, senior apartment buildings, senior assisted living facilities, health fairs, and Native American cultural centers in Los Angeles County. The UCLA Mobile Eye Clinic was brought to each location to provide eye examinations for eligible participants, 65 or older, whose distant or near vision could be improved by at least two lines of acuity. Participants were randomized to receive a prescription and voucher for free eyeglasses and/or magnifiers either immediately or after a three-month follow-up visit. Participants were evaluated in their homes three months after randomization.

The study, published in the Journal of the American Geriatric Society, found that participants who had received new prescriptions and vouchers for eyeglasses/magnifiers experienced better self-reported general vision, near vision, distance vision, mental health, perceptions of vision-related quality of life, and preservation of independence with activities of daily living, than participants in the group that waited to receive their prescriptions and vouchers.

“Since the correction of uncorrected refractive error in older individuals may improve their vision-related quality of life and help preserve their independence, we may want to rethink our current policies regarding the provision of eyeglasses and/or magnifiers to older individuals,” says Coleman.

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student profiles Making Waves: Surfrider Foundation’s Environmental Director Fights to Protect Beaches, Oceans

“Much of the erosion and water quality problems come down to our development patterns.

We’re building too close to the ocean and we’re paving too much of our watersheds.”

UCLAPUBLIC HEALTH

— Chad Nelsen

GROWING UP IN LAGUNA BEACH, CALIFORNIA, as a “beach kid” who surfed and worked as a lifeguard, CHAD NELSEN saw his hometown transformed through development – and watched the beaches he loved suffer as a consequence. “At the time, everyone I knew accepted the beach-erosion and water-quality issues as something that just happened, even though it didn’t sit well with us,” he says.

It wasn’t until college that Nelsen realized he could do something about it. He got a master’s degree at Duke University’s Nicholas School of the Environment and Earth Sciences and eventually landed his dream position: as environmental director for the San Clemente, California-based Surfrider Foundation. Nelsen is continuing in that position while commuting to the UCLA School of Public Health, where he is in his third year as a doctoral student in the interdisciplinary Environmental Science and Engineering (ESE) program.

The nonprofit Surfrider Foundation works at the grass-roots level to protect beaches and oceans. In his role as environmental director, Nelsen provides science and policy support for 64 chapters – volunteer-run groups that address important coastal and ocean protection issues in their communities through public meetings and educational events. The 50,000-plus Surfrider Foundation members have proved to be potent advocates in their struggle to preserve the ocean environment they love; some of that success can be attributed to Nelsen, who heads a team of scientists who volunteer their expertise to assist the chapters as issues arise.

More than 180 million people visit the beach for recreation in this country every year, according to the Surfrider Foundation. But the organization also warns that beaches are disappearing at an alarming rate, with human interventions partly to blame. “Much of the erosion and water quality problems come down to our development patterns,” says Nelsen. “We’re building too close to the ocean and we’re paving too much of the watersheds.

The coastal system is very dynamic, and we’re trying to build things that we want to stick around for hundreds of years, which is just not compatible. Meanwhile, if more than 10% of a watershed is impervious surface, it leads to all sorts of water quality problems.”

Nelsen was encouraged to enroll in the ESE program by Dr. Linwood Pendleton, associate professor at the school and a member of the program’s faculty, who had worked with the Surfrider Foundation on issues in the past. Nelsen, who tackles a broad array of issues in his position, was attracted to the program’s interdisciplinary nature, as well as its focus on engineering. With Pendleton, a resource economist, as his adviser, Nelsen is focusing on the economics of surfing – a sport that, like many other recreational activities, has a value that is difficult to calculate.

“We always know how much money a housing development is going to bring in to a community,” says Nelsen. “But when a recreational resource is going to be taken away or somehow damaged, if we can’t quantify its economic value it becomes more difficult to make the case that it should be preserved. Surfing supports a giant economy. By applying rigorous research methods to this recreational activity, I hope to be able to increase the appreciation for its value.”

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“I look back and realize that so many deaths that I saw in my medical training in Kenya were preventable.”

— Charles Otieno

UCLAPUBLIC HEALTH

DR. CHARLES OTIENO HAD COMPLETED MEDICAL SCHOOL in his native Kenya and was planning to pursue training in neurosurgery when he realized, while working in an informal emergency department at Kenya’s main teaching and referral hospital, that his country had a more urgent need for expertise in emergency medicine.

“Our emergency departments are just triaging zones for other specialist departments,” Otieno says. “They are poorly equipped, with no formal training of health care personnel and first responders in emergency medical care. Most of the ambulance services are just transport vehicles. Almost all patients are brought in to the hospital informally by private means.” The absence of a formal emergency medical services (EMS) system has contributed to significant death and disability, he notes.

Raised in a remote military camp in a militiainfested region of northern Kenya bordering Somalia, Otieno grew up watching his father, the sole paramedic military officer stationed in the area, work tirelessly in the only available medical facility that cared for trauma victims of Somalia militia attacks. Otieno’s resolve to get formal training in emergency medicine was strengthened after the 1998 American Embassy bombings in Kenya and Tanzania. Working with the U.S. Agency for International Development as an instructor in the implementation of a disaster management program in East Africa, Otieno saw firsthand the difference that effective triage and other features of an EMS system could make.

So Otieno came to the United States to train in the UCLA/Olive View-UCLA Emergency Medicine Residency Program. Upon completing the residency in 2005, he entered the UCLA School of Public Health’s Executive M.P.H. (EMPH) program and is now part of the Executive Education Programs in Healthcare Management and Policy, established earlier this year to enhance the existing program and promote health care leadership development (see page 30).

Otieno hopes to use his EMPH education to develop an EMS system for Kenya that could be replicated in the rest of the region. “I went into public health because I realized that just having the emergency medicine training was not enough if I wanted to develop a good system,” he explains. Already, Otieno and three other students in the program, under the guidance of their adviser, Dr. Fred Hagigi, have undertaken a needs assessment that Otieno hopes will be a first step toward building such a system. Kenya’s Ministry of Health and three of the nation’s leading hospitals are providing support.

The lack of an EMS system in sub-Saharan Africa is particularly troubling in a region with a long history of wars, disasters, severe poverty and disease pandemics, Otieno notes. “I look back and realize that so many deaths that I saw in my medical training in Kenya were preventable,” he says. “People think that emergency care is expensive, but there is so much that can be done even with limited resources. We can set up a system that is tailored to the environment and would save lives.”

Once he completes the UCLA School of Public Health program, Otieno plans to return to Kenya to address these problems as one of the first trained emergency physicians in that region. “My dream is to be the ‘father of emergency medicine’ and help in the development of the emergency medical system in Kenya and within the subSaharan region as a whole,” he says. “My dream will be realized with more training in health services management and health policy at the UCLA School of Public Health.”

students

Physician Aims to Establish EMS in Native Kenya

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news briefs hagigi, dobalian guide program for executives Drs. Fred Hagigi and Aram Dobalian have been appointed director and associate director, respectively, of the Executive Education Programs in Healthcare Management and Policy, part of the school’s Department of Health Services. Since July, Hagigi, an associate professor of health services, and Dobalian, an assistant adjunct professor in the department, have led the expansion of the Executive Masters of Public Health (EMPH) program.

More on the EMPH program can be found at www.ph.ucla.edu/hs/mphhp/.

UCLAPUBLIC HEALTH

fielding awarded $9 million grant from state sedgwick medal expands new biological lab Dr. Jonathan E. Fielding, professor at the school, was chosen to receive the oldest and most prestigious award bestowed by the American Public Health Association (APHA), the Sedgwick Memorial Medal for Distinguished Service in Public Health, at APHA’s 134th Annual Meeting in Boston.

Since 1929, the Sedgwick medal has been awarded annually to an individual who has demonstrated a distinguished record of service to public health and who has tirelessly worked to advance public health knowledge and practice.

Fielding has worked for more than 40 years in the public health field and is considered a leader in evidence-based practice. In addition to his role as professor at the UCLA School of Public Health, he serves as director of the newly created Los Angeles County Department of Public Health. Under Fielding’s leadership, the health department has launched several innovative programs, including a restaurant inspection program that requires businesses to post sanitation inspection results and a chronic disease control program featuring nutrition and physical activity.

A $9 million grant issued by the State of California to the UCLA School of Public Health will expand and enhance the new high speed, high volume laboratory network capable of quickly analyzing and processing large quantities of biological samples. Gov. Arnold Schwarzenegger made the announcement at a recent news conference on the UCLA campus.

The UCLA High Speed, High Volume Laboratory Network for Infectious Diseases, initially funded by a congressionally directed Department of Defense investment, will improve the nation’s ability to make rapid and critically important decisions to save lives in the event of bioterror attacks or infectious disease outbreaks.

“State funding will allow UCLA’s School of Public Health to get our lab up and running more quickly and expand our reach,” says Dr. Linda Rosenstock, the school’s dean. “By utilizing existing technologies, the UCLA Laboratory Network will be able to analyze data and provide potentially life-saving information in days instead of weeks or months.

“As with any innovative, cutting-edge effort, there are many who deserve credit,” Rosenstock adds. “Professor Scott Layne had the vision for the lab and the good sense to enlist the support of School of Public Health Advisory Board member Cindy Horn. Cindy has been an inspired leader, working tirelessly to secure the necessary support and funds to launch the lab. Finally, I’d like to thank the congressional leaders who secured initial funding for the lab, and the governor for helping to expand our efforts.”

The lab will analyze numerous influenza viruses in great detail and thereby assist in influenza vaccine strain selection efforts should an influenza pandemic arise. It will enhance animal and human surveillance and permit an up-to-date view of infectious disease outbreaks for effective decision-making and public health interventions.

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alumni and friends

Raymond D. Goodman, M.D., M.P.H. ’72, has made numerous lasting contributions to the school and the Los Angeles community. He has long been known as the alumnus of many “firsts.” In 1976 he was the first alumnus to endow a fellowship fund at the school. He later became the founding president of the Public Health Alumni Association, and later still, he became founding chair of the Dean’s Council, a long-standing support group of the school.

He and his wife, Betty, also founded the annual Lester Breslow Distinguished Lecture, now in its 32nd year. The Breslow Lecture has grown to become the school’s preeminent annual gathering of alumni, faculty, students, staff and community public health leaders. Goodman was inducted into the first class of the school’s Alumni Hall of Fame in 2002. The UCLA Alumni Association also bestowed upon Goodman the prestigious University Service Award in 1987.

Last summer, Goodman contributed an additional $100,000 to the endowed scholarship fund that bears his name. The Raymond Goodman Scholarship has benefited more than 100 public health students since its inception in 1976. With Goodman’s recent generosity, the endowment is now valued at over $200,000, and will continue to grow and support top students for generations.

As if that weren’t enough, Goodman recently notified Dean Linda Rosenstock that he has included $2 million in his estate trust for the school, funds that he has stipulated will establish the Raymond D. Goodman Distinguished Professor in Health Services. This promised endowed chair will strengthen the Department of Health Services’ ability to attract and retain world-class faculty.

Walter Oppenheimer is a man of many passions. Whether supporting higher education, running a fashion business or collecting art, he does it with dedication and deep commitment.

Born in Berlin, he moved first to Caracas, then to London, before finally arriving in the United States in 1938.

Settling in New York, he found work in the retail industry and married a budding fashion designer named Helga, a fellow Berliner.

Their partnership brought them great personal happiness, but little did they know just how fortitous it would be. “While I served in the Army for three years, Helga nurtured her talent in design,” Oppenheimer recalls. After he was discharged, they relocated to California and, in 1947, they launched Helga Inc. Specializing in couture suits, gowns and cocktail dresses, the company prospered. During their professional and personal travels, they also amassed an enviable art collection consisting mainly of modern works by Picasso, Braque and others.

The Oppenheimers have always been passionate about supporting education because, as Walter Oppenheimer puts it, “It’s where life begins. It gives you the tools to be successful – and UCLA is doing a fabulous job at it.” He is a strong believer in deferred gifts, which provide him a lifetime income.

Before Helga’s death in 2003, the couple arranged to support the School of Public Health through the establishment of two charitable gift annuities that will provide funds for student education, and the school’s main lobby was named in their honor.

Says Oppenheimer, a member of the school’s Advisory Board: “I like that the school trains professionals and scientists who work to benefit the health of the general community, not just individuals.”

For more information on how you can combine your philanthropic wishes for the UCLA School of Public Health and personal financial planning, please contact Anita Mermel at (310) 825-6464 or amermel@support.ucla.edu.

DID YOU KNOW...

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

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

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UCLAPUBLIC HEALTH

ACTRESS JULIA ROBERTS VISITS UCLA — During a recent visit to UCLA, actress Julia Roberts met with Dean Linda Rosenstock to discuss air pollution in the Los Angeles area and its potential health risks for young children. SPH researchers have raised important issues with studies on the potential dangers to children from exposure to diesel fuel exhaust while riding school buses and the association between high levels of outdoor air pollution and increased risk of infant death (see page 24), among others.

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goodman: an alumnus who keeps giving

oppenheimer’s planned gift supports school

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IOM elects sph faculty rice, keeler

contracts & grants 2005-06 This section includes new contracts and grants awarded in fiscal year 2005-06. Due to space limitations, only funds of $50,000 or more are listed, by principal investigator.

RICHARD AMBROSE Development of a Response Protocol to Spills That Can Be Formalized into ‘Coastal Habitats Quick-Response Procedures Kits’ for Sandy, Rocky, and Wetland Shoreline Habitats (CA/Department of Fish and Game, $59,104 for 2 years)

Drs. Thomas H. Rice (left) and Emmett B. Keeler (right), both members of the UCLA School of Public Health faculty, were honored with election to the prestigious Institute of Medicine of the National Academies. Rice, professor of health services and UCLA vice chancellor for academic personnel, has conducted research projects and published in areas including physicians’ economic behavior, health insurance for the elderly, the Medicare program, health care cost containment, the role of competition in health care reform, and managed care. Keeler, adjunct professor of health services at the school and a professor and senior mathematician at RAND, leads a large study to evaluate a new model for helping people with chronic diseases better manage their health. He also directs a project that provides cost-effectiveness analyses to a variety of UCLA geriatric interventions, and one to develop a business case for providers to offer higher-quality care.

LENORE ARAB Validation of Web-Based Multimedia Dietary Assessment Tools (NIH/National Cancer Institute, $524,597 for 5 years) ROSHAN BASTANI UCLA Cancer Education and Career Development Program (NIH/National Cancer Institute, $2,330,288 for 5 years) BARBARA BERMAN A Breast Cancer Education Program for Deaf Women (Komen Foundation, $250,000 for 2 years) E. RICHARD BROWN 2005 California Health Interview Survey: Data Collection Measuring Access and Satisfaction of Managed Care Enrollees (CA/Dept of Managed Health Care, $353,031); California Health Interview Survey 2005 (County of San Diego, $300,000; CA/Department of Social Services & University of California, Davis, $151,200; Solano County Health & Social Services Department, $87,366 for 2 years; County of Marin, $170,366; NIH/National Cancer Institute, $1,330,146; CA/California Children and Families Commission, $1,000,000; CA/Dept of Health Services, $1,855,000; DHS/Multicultural Health, $100,000)

UCLAPUBLIC HEALTH

JONATHAN FIELDING California Health Forecasting Model: Refining the Model and Implementing a User Interface (The California Endowment, $393,370); Using Health Impact Assessment to Increase Understanding of the Linkages Between Public Markets and Community Health (Robert Wood Johnson Foundation, $149,900)

ADDRESSING INEQUALITY — “Dreams Deferred, Denied, Realized: Confronting Inequality in Los Angeles and Beyond,” a two-day symposium in October, featured participation by four UCLA School of Public Health faculty members, including Drs. Roshan Bastani (left) and Antronette Yancey (third from right). The event was the inaugural activity of the Social Sciences Initiative (SSI), which combines the resources of traditionally separate disciplines to advance social science theory, research, practice and policy. SSI was started through the vision of the leaders of the School of Public Health, School of Public Affairs, School of Education and Information Sciences, and the UCLA College.

JOHN FROINES Monitoring and Modeling of Ultrafine Particles and Black Carbon at the Los Angeles International Airport (CA/EPA Air Resources Board, $113,986); Southern California Particle Center (SCPC) (U.S. Environmental Protection Agency, $7,999,997 for 5 years); Exposure Assessment Research and Facilities Core of the SCEHSC (NIEHS & USC, $617,696 for 5 years); Physicochemical and Toxicological Assessment of the Semi-volatile and Non-volatile Fractions of PM from Heavyand Light-duty Vehicles Operating with and Without Emission Control Technologies (Air Resources Board & USC, $279,999 for 3 years)

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33 PATRICIA A. GANZ UCLA Center of Excellence for Cancer Survivorship (Lance Armstrong Foundation, $400,000 for 4 years) BETH GLENN South Asian Women with Breast Cancer: What Are Their Needs? (UC/California Breast Cancer Research Program, $81,951) GAIL HARRISON Risk for and Prevention of Early Childhood Overweight: Does the WIC Program Play a Role? (US Dept of Agriculture/Coop State Research & Extension Svc, $887,020 for 4 years); Impact Evaluation of a Breast Pump Loan Program (DHHS/ Centers for Disease Control [Including CDC Foundation] & Association of Schools of Public Health, $99,993) WILLIAM HINDS Cardiovascular Health Effects of Fine and Ultrafine Particles During Freeway Travel (CA/EPA Air Resources Board, $502,050 for 3 years) MOIRA INKELAS Early Developmental Screening and Intervention Strategic Partnership (LA County Children & Families 1st Proposition 10 Commission, $5,598,136 for 5 years) LEEKA KHEIFETS Updated Pooled Analysis of Childhood Leukemia and Magnetic Fields (Children with Leukemia U.K., $192,410 for 2 years); Pooled Analysis of Childhood Brain Tumors and Magnetic Fields (Electric Power Research Institute, $121,380 for 3 years); Occupational Exposures, Cohort Evaluation and Other Activities (Energy Networks Association, Ltd, $91,305); Pooled Analysis of Childhood Brain Tumors and Magnetic Fields (Southern California Edison, $90,000) CLIFFORD KO Patient Reported Outcomes in Long Term Survivors with Colon and Rectal Cancer (American Cancer Society, Inc, $1,129,000 for 4 years) GERALD KOMINSKI California Health Benefits Program (UCOP, $185,612 for 3 years); Access to Medical Treatment (Division of Worker’s Compensation, $596,398) YING-YING MENG Access, Utilization and Quality of Care Among HMO And NonHMO Members with Chronic Diseases (CA/Dept of Managed Health Care & UC/Office of the President, Systemwide, $69,787) JACK NEEDLEMAN Evaluating the Success of Spreading Transforming Care at the Bedside Across Health Care Networks (Robert Wood Johnson Foundation, $79,997)

BEATE RITZ Traffic Related Air Pollution & Asthma in Economically Disadvantaged & High Traffic Density Neighborhoods in Los Angeles County, California (CA/EPA Air Resources Board, $422,087 for 3 years) KIMBERLY SHOAF Disaster Emergency Training Plan (Santa Clara County Office of Disaster Medical Services, $149,025); Joint Bioterrorism Investigation (DHHS/Centers for Disease Control [Including CDC Foundation] & County of Los Angeles/Dept of Health Services, $298,320); Public Health Response to Disasters 2005-2006 (DHHS/Centers for Disease Control [Including CDC Foundation] & County of Los Angeles/Dept of Health Services, $297,573); HSD SGER: Assessing the Public Health Impacts of Hurricane Katrina (National Science Foundation, $92,523); Team Safe-T School Evaluation Plan (Team Safe-T: CA Partnership for Safety and Preparedness, $50,000) SUSAN SORENSON Social Change for the Public’s Health Curriculum Development (The California Endowment, $161,677) ANNETTE STANTON Predicting Biopsychosocial Outcomes after BRCA1/BRCA2 Mutation Testing: An Extension (The Breast Cancer Research Foundation, $250,000) STEVEN WALLACE Datos Y Democracia: Building Capacity of Latino Communities in the Strategic Use of Data (California Wellness Foundation, $200,000 for 2 years); Data and Democracy (The California Endowment, $539,251 for 2 years); Evaluation – LA Collaborative (The California Endowment, $195,194)

new faculty JULIA E. ALEDORT Visiting Assistant Professor, Health Services CATHERINE SUGAR Assistant Professor in Residence, Biostatistics

ARTHUR WINER Investigation and Characterization of Pollution Concentration Gradients in Wilmington, CA, Using a Mobile Platform (CA/EPA Air Resources Board, $179,264 for 2 years) WENG K. WONG Cost Effective Designs for Practitioners (NIH/National Institute of General Medical Sciences, $241,354 for 3 years) ANTRONETTE YANCEY Joining Forces with a Key Community to Reduce Obesity Disparities (NCMHHD, $1,529,968 for 3 years); Health Impact Assessment to Maximize Disparities Reduction (CA/HHS/Dept of Health Services & Public Health Institute [Formerly CA Public Health Foundation], $119,912) Healthy Eating and Physical Activity Program Evaluation Phase 2 (The California Endowment & Samuels & Associates, $299,500 for 4 years)

UCLAPUBLIC HEALTH

ALEX ORTEGA Anxiety, Depression and Asthma in Puerto Rican Youth (NIH/National Institute of Mental Health, $421,745 for 4 years)

THOMAS RICE Manacled Competition: Limiting Health Care Choices for the Elderly (Robert Wood Johnson Foundation, $269,532 for 2 years)

faculty

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