A BROADER VIEWOF HEALTH: - UCLA School of Public Health

U C L A
PUBLIC HEALTH
NOVEMBER 2010
A BROADER VIEW OF HEALTH:
Policies in All Sectors Make a Difference
UCLA
School of
Public
Health
Few see dental
care as a core
public health
issue, but access
and disparities
concerns are great.
Ron Andersen is
among SPH faculty
studying the issue.
Working with local
investigators in
one of the world’s
poorest nations,
Anne Rimoin is
helping to build
an infrastructure
that didn’t exist
previously.
Myralyn Nartey
went to Ghana
to play on the
national women’s
soccer team.
Now she is
pursuing a Ph.D.
to help girls
in Africa.

PUBLIC HEALTH
UCLA
U C L A
Gene Block, Ph.D.
Chancellor
Linda Rosenstock, M.D., M.P.H.
Dean,UCLA SchoolofPublicHealth
Sarah Anderson
AssistantDeanforCommunications
John Sonego
AssistantDeanforDevelopment
andAlumniRelations
Dan Gordon
EditorandWriter
Martha Widmann
ArtDirector
E D I TO R I A L B OA R D
Richard Ambrose, Ph.D.
Professor,EnvironmentalHealthSciences
Roshan Bastani, Ph.D.
Professor,HealthServices
AssociateDeanforResearch
Thomas R. Belin, Ph.D.
Professor,Biostatistics
Pamina Gorbach, Dr.P.H.
AssociateProfessor,Epidemiology
F. A. Hagigi, Dr.P.H., M.B.A.
Professor,HealthServices
Moira Inkelas, Ph.D.
AssistantProfessor,HealthServices
Richard Jackson, M.D., M.P.H.
ProfessorandChair,
EnvironmentalHealthSciences
Michael Prelip, D.P.A.
AssociateProfessor,
CommunityHealthSciences
Andrew Tsui and Tarah Griep
Co-Presidents,PublicHealthStudentAssociation
Christopher Mardesich, J.D., M.P.H. ’98
President,AlumniAssociation
features
4
WISDOM ON TEETH:
A Growing Focus on
Dental Care Needs
Poor oral health has been called a “silent
epidemic,” with disparities and access problems
calling for more attention from public health.
8
ANNE RIMOIN:
Bringing
Emerging
Diseases Above
the Radar
She is working with the
Congolese to build a disease
surveillance system that
has already revealed the
surprisingly dramatic growth
of human monkeypox.
1
School of
Public
Health

A BROADER
VIEW OF
HEALTH:
Policies in
All Sectors Make
a Difference
HIGHER
EDUCATION:
New Strategies for
Promoting Health
in every issue
0
As momentum builds for considering the
public health effects of decisions outside
health’s traditional purview, SPH faculty
are leading the way.
16
With the one-size-fits-all approach a distant
memory, efforts to change health behaviors are
relying on better-targeted messages delivered in
proactive and innovative ways.
23
28
30
32
RESEARCH
Monkeypox rising in
Africa…children not getting
dental care…insurance
inequities for same-sex
couples…dangerous
nanoparticles…home
kitchens not making
grade…centralized health
care fares well.
STUDENTS
FACULTY
NEWS BRIEFS
ON THE COVER
A broader view of health takes into account that policies in a wide variety of sectors can directly
or indirectly influence the health of populations. Matt LeBarre © 2010
PHOTOGRAPHY
Reed Hutchinson / Cover: Nartey; pp. 28-29
Sandra Shagat, UCLA School of Dentistry / TOC: dentistry; p. 6
Todd Cheney, ASUCLA / p. 7: Westwood Predoctoral Dental Clinic
J. Rose Photography by Jessica Williams / p. 7: toothbrush learning station
Matt LeBarre / Cover: Broader View; TOC: Broader View; pp. 11-12, 14-15
Shoshee Jau, Daily Bruin / p. 32
Courtesy of Anne Rimoin / Cover: Rimoin; TOC: Faculty Profile; pp. 8, 23
Courtesy of Beatriz Solis / p.16: Solis
Courtesy of Philip Massey / pp. 16-17
Courtesy of David Gere / TOC: Higher Education; pp. 18-19
Courtesy of Antronette Yancey / p. 20
Courtesy of Roshan Bastani / p. 21
Courtesy of UCLA School of Public Health / Cover: Andersen; TOC: Dentistry; p. 2; p. 4: Andersen; pp. 5-6;
p. 7: dentist cleaning teeth; p. 10: Fielding; p. 11: Guerrero;
p. 12: Jackson; p. 19: Yancey; pp. 31, 33; back cover
iStockphoto © 2010 / Cover; p. 4: teeth; p. 22; pp. 25-26
School of Public Health Home Page: www.ph.ucla.edu
E-mail for Application Requests: info@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 2010 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.

2
dean’s message
PUBLIC HEALTH HAS LONG ESPOUSED the role of many factors
– such as education, housing, employment and the environment – contributing
to overall health status. There is a growing movement to take this broader view
of health into all aspects of society. As a result, with leadership from several
faculty members at our school, there is a push for policy and decision-makers
to utilize the Health Impact Assessment (HIA) when making decisions in
any sector.
Our cover story takes a look at this innovative approach and how, in
addition to our faculty, our students and alumni are working to encourage the
use of HIA to evaluate objectively the potential health effects of a project
(e.g., a light rail system) or policy (e.g., curbing diesel emissions) before it is
built or implemented. They are applying one of the tenets of public health –
prevention – not just to individual and community health, but to the policymaking
process.
We are also taking a broader view when it comes to global health. In
addition to activities at the school, faculty and students in a number of UCLA
schools and colleges are participating in active global health programs. Crosscampus
collaborations in global health are emerging, representing a new frontier
of academic opportunity. In order to capitalize on this opportunity the campus
is launching a UCLA-wide Global Health Initiative; I have been asked to chair
the steering committee.
To support the campus-wide effort, in which I expect our school to play a
central role, and to further implement one of our school’s strategic goals to build
a world-class global health presence, I am pleased to announce the appointment
of Dr. Onyebuchi Arah, associate professor in the Department of Epidemiology,
as the first associate dean for global health. You can read more about Dr. Arah’s
appointment on page 33.
Finally, I’m pleased to share that we have an exciting year ahead of us.
In 2011, the School of Public Health celebrates its 50th. We plan to spend the
year celebrating our past, present and future.
Many of us have a vague recollection of what life was like in the early
1960s, and for those who don’t, the TV show Mad Men reminds us of a few
critical changes we’ve seen since the school was founded in 1961. Long gone
UCLAPUBLIC HEALTH

2 0 0 9 - 1 0 D E A N ’ S
A DV I S O RY B OA R D
3
are the days of the three-martini lunch, smoke-filled office and advertising
campaigns to convince smokers to keep on puffing. Fifty years ago cars were
not required to have seat belts and the notion of a child restraint system was
your mother’s arm flung across your chest. It would be 20 years until the first
positive case of HIV/AIDS in the United States was reported to the Centers for
Disease Control.
It was into this environment that the UCLA School of Public Health was
born. As part of an institution consistently rated among the top schools of
public health in the country, our faculty, students and alumni have led the way
in improving the quality of life and longevity for people across the globe.
I would like to personally invite all of you – our alumni, friends, faculty,
staff and students – to join us in celebrating the enormous contribution we have
made, as well as our potential for even greater contributions in the years ahead.
Whether you join us online for our new webinar series (see page 32), join us
at the 50th Anniversary Gala, or simply provide your updated information for
the alumni directory, let us hear from you this year. You are the reason for our
success, and the key to our ability to continue to make a difference in the health
of populations locally and globally. Thank you for being part of something great.
Ira R. Alpert *
Lester Breslow
Sanford R. Climan
Edward A. Dauer
Deborah Kazenelson Deane*
Michele DiLorenzo
Samuel Downing*
Robert J. Drabkin
Gerald Factor (Vice Chair)
Jonathan Fielding
Dean Hansell (Chair)
Cindy Harrell Horn
Stephen W. Kahane *
Carolyn Katzin *
Carolbeth Korn *
Jacqueline B. Kosecoff
Kenneth E. Lee *
Edward J. O’Neill *
Thomas Priselac
Monica Salinas
Fred W. Wasserman *
Pamela K. Wasserman *
Thomas Weinberger
Cynthia Sikes Yorkin
*SPH Alumni
Linda Rosenstock, M.D., M.P.H.
Dean
TOTAL REVENUES
Grants and Contracts
State-Generated Funds
Gifts and Other
Fiscal Year 09-10
$70.5 million
UCLAPUBLIC HEALTH

4
POOR ORAL
HEALTH HAS BEEN
CALLED A “SILENT
EPIDEMIC,” WITH
DISPARITIES AND
ACCESS PROBLEMS
CALLING FOR MORE
ATTENTION FROM
PUBLIC HEALTH.
WISDOM ON TEETH:
A Growing Focus
on Dental Care Needs
Few public health issues have received
more attention in recent years than lack of access to essential medical services
UCLAPUBLIC HEALTH
“Oral health
issues fit so
closely with
public health’s
mission, and
through efforts
aimed at prevention, education and
addressing access issues, we have
the potential to get more in return
from our investment than from
many other investments.”
—Dr. Ronald Andersen
and its disproportionate effect on certain population groups. Meanwhile, a parallel
issue has gone relatively unnoticed.
“Access problems appear to be considerably greater with respect to oral
health services than general health services, and the disparities by income and
minority status are probably larger,” says Dr. Ronald Andersen, professor of health
services at the UCLA School of Public Health. “But because dental care isn’t
associated with saving lives, it hasn’t been emphasized in public health to the
extent that it should be.”
Overall, oral health has improved dramatically in the United States over
the last half-century, thanks in part to public health efforts such as fluoridation
of drinking water and education about the benefits of fluoride toothpaste. It
wasn’t long ago that the majority of Americans lost their teeth by middle age;
today, most can expect to retain their natural teeth over their lifetimes.
But there is significant cause for concern. A decade ago, in the first-ever
Surgeon General’s report on oral health, Dr. David Satcher pointed to a “silent
epidemic” of dental and oral diseases with “profound disparities that affect those
without the knowledge or resources to achieve good oral care.” In addition,
although dental care might not seem as critical as medical care, poor oral health
can cause significant problems…and can be related to health ailments outside

the mouth. Untreated, tooth decay (cavities) – the
most common chronic disease in children – can
cause everything from pain and difficulty eating to
lost school and work time. Serious oral disorders can
undermine self-esteem, inhibiting children and adults
from smiling. Gum disease has recently been linked
in studies to increased risk for diabetes, heart disease
and stroke.
And while much attention has been paid to
the problem of lack of health insurance, the fact
that even more are without dental coverage is often
overlooked. Although public insurance programs
such as Medicaid have increased coverage for children,
dental benefits tend to be vulnerable to cuts in
tough economic times. By the same token, for many
low-income families struggling financially and, in
some cases, lacking education about the importance
of regular dental visits, dental care may be viewed
as optional.
“Oral health issues fit so closely with public
health’s mission,” observes Andersen, “and through
efforts aimed at prevention, education and addressing
access issues, we have the potential to get more in
return from our investment than from many other
investments.”
Dental public health issues haven’t been ignored
at UCLA, where faculty in the School of Public
Health and School of Dentistry have worked – often
together – to address some of the major concerns.
One of the key efforts began in 2001 when The
Robert Wood Johnson Foundation provided funding
for a national demonstration program aiming to
reduce dental-care access disparities. Fifteen dental
schools were selected to participate in the Dental
Pipeline Program, which would receive additional
funding from The California Endowment. The
program’s national evaluation team was based in the
UCLA School of Public Health, with Andersen as
the principal investigator and Dr. Pamela Davidson,
associate professor of health services at the school,
as co-principal investigator. (The original project
ended in 2007, but a follow-up study to measure its
sustainability is ongoing.)
The pipeline program was established in an
effort to increase access to dental care in low-income
and minority communities by recruiting more students
from underrepresented minority groups to
dental schools, improving dental school curricula to
better prepare students to provide culturally competent
care, and providing more clinical practice experiences
for students in underserved communities.
“If you look at the ethnicity of dentists compared to
the distribution of the population, there are greater
differences than in medicine,” Andersen notes. That
has contributed in part to the shortage of oral health
providers in minority communities, he says.
Dental schools have faced significant challenges
in their efforts to recruit minority students into
dental careers, Andersen notes. For one, the shortage
of providers in minority communities means there
are few family members or friends serving as role
models and mentors. Nonetheless, through steppedup
efforts, including the establishment of pre-dental
programs to assist students in meeting prerequisites,
the pipeline program schools increased applications
from underrepresented minority students by 77
percent from 2003 to 2007, while enrollment of
underrepresented minority students increased by
27 percent.
Beyond the effort to increase the number of
minority dental providers, the pipeline program
sought to revamp education and training experiences
that would make all students more likely to consider
careers in public health and service to underserved
communities. While curricula were revised and the
number of days senior dental students practiced
in underserved communities increased, it’s unclear
whether there was a corresponding increase in graduates
going on to practice in these communities.
Unfortunately, Andersen notes, dental students tend
to enter practice with huge debts; thus, many who
want to go into public service positions are deterred
by the lower salaries and instead feel compelled to
opt for private practice.
The problem of disparities in utilization of dental
services – particularly among children – is underscored
by a recent study conducted by Dr. Nadereh
Pourat, professor of health services and director of
research for the Center for Health Policy Research,
which is based in the school. Using data from the
2005 California Health Interview Survey, Pourat
found that nearly 25 percent of California children
ages 11 and under had never seen a dentist, and
that among those who had, there were significant
differences by race, ethnicity and type of insurance
in the amount of time between dental care visits
(see page 24).
Having any kind of insurance significantly
increased the odds that a child would see a dentist
on a regular basis, but the type of coverage mattered:
54 percent of privately insured children had seen
a dentist within the previous six months, vs. 27
percent of publicly insured children (Medicaid or
the Children’s Health Insurance Program) and 12
“Public programs
are designed to
improve access
to care for
underserved
populations,
and our study
shows that they
are successful
in doing so.
However,
they don’t close
the gap.”
—Dr. Nadereh Pourat
5
feature UCLAPUBLIC HEALTH

6
An analysis of children
who suffer the most from
dental disease suggests
it’s not only children
from low-income families
and underserved minority
groups, but also those
from families with
what is referred to as
low oral health literacy.
UCLAPUBLIC HEALTH
percent of children without any coverage. Even
when taking into account only those with public
insurance coverage, though, the study found that
Latino and African-American children went to
the dentist significantly less often than white and
Asian-American children.
“Public programs are designed to improve access
to care for underserved populations, and our study
shows that they are successful in doing so,” Pourat
says. “However, they don’t close the gap. There is
more work to do in addressing disparities in dental
care for children.”
Pourat suspects a key factor in the persistence
of these disparities is that public insurance programs
reimburse dentists at a lower level than private
insurance. Unlike medical care, in which managed
care and group practices encourage more providers
to see patients in public programs, dental care is
dominated by solo practitioners in private offices –
many of whom don’t see patients with public
insurance. A study conducted by Pourat and colleagues
in 2003 found that only about 40 percent
of California dentists accepted public-insurance
patients. Coupled with the general shortage of
providers in low-income communities, this has
posed a major barrier, and may be the reason many
families choose to forgo care. Pourat has begun a
new study, funded by the National Institute of
Dental and Craniofacial Research, to examine the
impact of the local supply of oral health providers
on access to care.
Addressing reimbursement inequities is one
of several potential solutions that Pourat and others
have proposed. Another is to strengthen the safety-
net system by broadening the types of dental
providers – including preparing other licensed professionals,
such as hygienists, who can deliver primary
pediatric dental care. Pourat notes that many general
dentists are uncomfortable delivering care to very
young children, an issue that could be addressed in
dental school training with more clinical experiences
involving young patients.
Pourat believes more education is needed for
all families about the importance of dental visits
and preventive oral health care in childhood. “Many
parents figure it’s not that important because their
children are going to lose their primary teeth anyway,”
she says. “But the reality is that when you
have a poor oral health environment, the problems
are likely to continue when the secondary teeth
come in. Teaching children good oral hygiene can
have a major impact on their oral health as adults.”
An analysis of children who suffer the most from
dental disease suggests it’s not only children from
low-income families and underserved minority
groups, but also those from families with what is
referred to as low oral health literacy, says Dr. James
Crall, professor and chair of pediatric dentistry in
the UCLA School of Dentistry and a faculty member
in the UCLA Center for Healthier Children, Families
and Communities, based in the School of Public
Health. “There are issues of culture, language, nutrition
and use of health services that are amenable to
public health as well as primary care approaches,”
he explains.
Crall has been a leader in dental public health
for more than a decade. In 1997 he was appointed
the first dental scholar-in-residence at the Agency for

Health Care Policy and Research and he has been actively involved in national,
state and professional oral health policy development ever since. From 2000
to 2008 he was director of the Health Resources and Services Administration/
Maternal and Child Health Bureau National Oral Health Policy Center, colocated
within the Center for Healthier Children, Families and Communities.
Crall also directs a pediatric dentistry leadership training program in collaboration
with other members of the center’s faculty. Since 2007 he has been project
director of the American Academy of Pediatric Dentistry’s Head Start Dental
Home Initiative, which is building networks of providers in every state to
improve access to dental services for children in Head Start programs.
Crall, who was part of Andersen’s national evaluation team for the Dental
Pipeline Program, believes public health efforts to address the current challenges
in oral health require a combination of innovative training initiatives and community
programs, along with policies that effect change in the practice environment,
such as increased reimbursement and other incentives to work with underserved
populations.
The subspecialty area of dental public health is small, Crall notes; it will
take more than dentists to make a difference. “We need to encourage more dentists
to go into public health, but we also must find ways to foster collaborations
with non-dentists in public health and medicine,” he says. “That’s now occurring
at UCLA in a way that we haven’t seen before, and it’s a goal that has gained
increasing recognition at the national level.”
M.P.H. Degree Informs Her Effort to
Organize American Indian Dentists
Nowhere are oral health problems more severe than among American Indians. The last
survey by the Indian Health Service (IHS), published in 1999, found that 87 percent of
American Indian children ages 6-14 and 91 percent of 15-19 year olds had a history of
tooth decay. Seventy-eight percent of adults ages 35-44 and 98 percent of those 55 and
older had lost at least one tooth because of dental decay, gum disease or oral trauma.
Dr. Ruth Bol (M.P.H. ’09), a pediatric dentist in private practice in Menifee, Calif.,
who is herself American Indian, is drawing on her UCLA School of Public Health
education to organize American Indian dentists in response to the problem. Bol worked
four years with the IHS (part of the U.S. Public Health Service) and became frustrated
with the lack of leadership, which she believed had much to do with the scarcity of
American Indians among the dentists practicing on the reservations.
So she worked her way up the ranks of the Society of American Indian Dentists
(Bol is currently vice president), was elected to the California Dental Association board
of directors and became active in the American Dental Association. Realizing the value
a public health education could bring, Bol enrolled at UCLA for both her pediatric dentistry
residency and M.P.H. from the School of Public Health. With a grant she wrote in one of
her School of Public Health courses, Bol secured funding from Delta Dental of California
to support the Society of American Indian Dentists’ efforts to mentor American Indians
before, during and after dental school. She is currently meeting with other potential
funders.
“The more I got involved with these big-picture issues, the more I realized there
was a lot I didn’t know,” Bol says. “Getting the M.P.H. has given me credibility as well
as knowledge on everything from developing and evaluating programs to writing grants.
It’s provided me with the tools to work with underserved communities.”
Ruth Bol, D.D.S. M.P.H. ’09
7
feature UCLAPUBLIC HEALTH

8
SHE IS
WORKING WITH
THE CONGOLESE
TO BUILD A
DISEASE
SURVEILLANCE
SYSTEM THAT
HAS ALREADY
REVEALED THE
SURPRISINGLY
DRAMATIC GROWTH
OF HUMAN
MONKEYPOX.
ANNE RIMOIN:
Bringing Emerging Diseases
Above the Radar
UCLAPUBLIC HEALTH
Although her specific focus is studying the epidemiology of human
monkeypox in the Democratic Republic of the Congo (DRC), Dr. Anne Rimoin also has an eye on the
bigger picture: working with the Congolese government and local investigators to develop an infrastructure
that will enable the Central African nation to conduct proper surveillance of all emerging infectious diseases.
“To me, if you’re a researcher working in a low-resource setting, you have a moral obligation not just to
collect your data and leave, but to build capacity and collaborate with the people who, by their good graces,
are allowing you to do this work in their country,” she says.
Over the last six years, Rimoin, assistant professor of epidemiology at the school, has established a
research site in central DRC that now serves as headquarters for a variety of studies of cross-species transmission
of disease. Heading an all-Congolese team, Rimoin collaborates closely with the DRC Ministry of
Health, the Kinshasa School of Public Health and the National Laboratory to improve disease surveillance
capacity in a nation that is one of the world’s poorest, and has been devastated by civil war. “There is a long
way to go – what we’ve done so far represents just a drop in the bucket – but I’m pleased just to be able
to contribute as I can,” Rimoin says.
Already, though, Rimoin and her Congolese collaborators have produced tangible evidence of the
critical nature of building a disease surveillance infrastructure. In August, they published the first results
of their human monkeypox study in the Proceedings of the National Academy of Science, showing that rates
of the disease had increased by an astounding 20-fold in the DRC since 1980.

Ironically, Rimoin’s group noted, one of public
health’s greatest success stories opened the door for
the dramatic increase. The eradication of smallpox,
announced in 1980, spelled the end of a vaccination
program that had also provided protective immunity
against monkeypox, a related virus believed to be
carried primarily by squirrels and other rodents.
(Although generally less lethal than smallpox,
monkeypox can cause serious symptoms, including
severe eruptions on the skin, fever, headaches,
swollen lymph nodes and, in some cases, blindness
and death.) Particularly in rural areas, where displaced
populations rely to a greater extent on bushmeat, the
growing number of unvaccinated individuals over
time led to a gradual increase in the rate of infection.
But in the absence of any surveillance, Rimoin notes,
monkeypox “fell under the radar.” (For more on the
study, see page 23.)
Growing up in Los Angeles, Rimoin always had
positive associations with Africa. In a home adorned
with African art, her father would recall fondly his
research experiences working with a Pygmy population
in the Central African Republic. At Middlebury
College in Vermont, Rimoin earned her undergraduate
degree in African History. It was only after graduating
and going into the Peace Corps that she became
interested in science, and particularly epidemiology.
In Benin, West Africa, Rimoin spent two years as a
volunteer coordinator for the guinea worm eradication
effort. “It was a perfect public health program
that taught me to do disease surveillance,” she says.
“It really brought home the importance of using
basic epidemiologic methods to solve a problem.”
Upon completing the program, Rimoin enrolled
at the UCLA School of Public Health, where she
received her M.P.H. in 1996. For her internship
she worked in Nepal doing disease surveillance for
the World Health Organization’s polio eradication
program. Rimoin was then hired by the WHO as a
logistics officer, assisting in the expanded polio surveillance
and eradication program in Ethiopia and
Eretria. She also initiated a collaborative relationship
between the WHO and the Peace Corps, including
development of a program and training materials for
health-oriented Peace Corps volunteers to carry out
disease surveillance activities in Africa and Nepal.
After completing her Ph.D. at the Johns Hopkins
Bloomberg School of Public Health in 2003, Rimoin
worked as a program scientist for the National
Institute of Child Health and Human Development,
coordinating clinical studies in Africa. While at a
meeting at the DRC Ministry of Health, she was
part of a discussion in which it was noted that there
had been an increase in reported cases of human
monkeypox in the country. Rimoin’s interest was
piqued. “It made sense to me that given the lack
of infrastructure and absence of disease surveillance,
if there were any significant reports of monkeypox
out there it was likely a much bigger problem than
anyone was anticipating,” she says. Rimoin promptly
proposed to head the first epidemiologic study
assessing the burden of human monkeypox in
DRC, and received funding to begin setting up
her program in 2004.
Ever since, Rimoin and her team have been training
local health workers in identifying and reporting
cases as well as interviewing monkeypox patients to
learn about their potential exposures. The workers
collect biological samples that are transported to the
project’s field station and then to Kinshasa, as well
as to collaborators in the United States who conduct
laboratory analyses and report back to the Congolese
field workers.
One reason the DRC was in such dire need
of a disease surveillance program is that there are
tremendous logistical challenges to implementing
one. From the beginning, Rimoin’s team has faced
problems such as how to collect and preserve biological
specimens in settings that often lacked electricity,
running water and refrigeration sources. A
country of 900,000 square kilometers has only about
300 kilometers worth of roads. Given the expense
of gasoline and the DRC’s scarce economic resources,
cost is never far from Rimoin’s mind. “Our supervisors
have motorcycles, but for day-to-day surveillance
we give our health care workers bicycles so they can
take supplies from the headquarters to their village,”
she says. “That can be as many as 200-300 kilometers
away, but it’s a sustainable approach.”
At the UCLA School of Public Health, where
she has been a member of the faculty since 2004,
Rimoin teaches her students the importance of
working with local collaborators, understanding the
socio-cultural and political context in which problems
occur, and designing and implementing interventions
that are practical and feasible, particularly in lowresource
settings. “Emerging infectious diseases are
definitely out there,” she says. “You just need to
identify the populations at the highest risk and
make sure you’re asking the right questions or you’re
going to miss important events that signal the early
emergence of a disease.”
Rimoin, who spends roughly a third of her time
working in the field in the DRC, is committed to
being there for the long haul. “My goal is sustainable
research,” she says. “I am fully invested in my work
in the DRC and intend to have a long relationship
with my Congolese collaborators.”
“It made
sense to me
that given
the lack of
infrastructure
and absence
of disease
surveillance,
if there were
any significant
reports of
monkeypox
out there it
was likely a
much bigger
problem than
anyone was
anticipating.”
—Dr. Anne Rimoin
9
faculty profile UCLAPUBLIC HEALTH

10
A BROADER
Policies in All Sectors
Make a Difference
UCLAPUBLIC HEALTH
AS MOMENTUM
BUILDS FOR
CONSIDERING THE
PUBLIC HEALTH
EFFECTS OF
DECISIONS
OUTSIDE HEALTH’S
TRADITIONAL
PURVIEW, SPH
FACULTY ARE
LEADING THE WAY.
Although the details were much debated during the
year-long politicking over health care reform, no one would disagree that there
were major health implications to the bills under consideration – and ultimately
to the law passed in Congress and signed by President Obama last March.
But what about debates over alternative energy, agricultural subsidies, and
even extending the Bush tax cuts? Few would call these health issues…yet their
potential impact on health is profound. Similarly, it might seem outside of
health’s purview when municipalities consider mass-transit systems or major
commercial developments – but whether an urban environment is conducive to
safely walking and biking can go a long way toward determining the health of the
local population. When public schools face massive budget reductions there is
concern, rightfully, about the effects on education. But this, too, is a health issue:
With physical education and other health-promoting school programs becoming
vulnerable, those reductions ultimately affect obesity and children’s health. And
formal education is a major determinant of longevity.
Dr. Jonathan Fielding, professor of health services at the UCLA School of
Public Health and director of the Los Angeles County Department of Public
Health, is among the leaders of a growing movement to consider health impacts
across a wider range of societal discussions – a movement known as Health in
All Policies. “If you look at what determines health in populations, as well as
disparities in health between communities, to a considerable extent it has to do
with the social and physical environment – the societal underpinnings that are
typically considered issues of economic development, education, transportation
and housing, to name a few, but not health issues,” Fielding says.
But Fielding concluded long ago that even prevention-oriented strategies by
health departments to reduce health risk factors – though of great importance –
fail to address major conditions that affect health in less-than-obvious ways.
“We’ve gotten too used to segregating issues by sector,” he says. “We have to do
a better job crossing over and working with people in other sectors to help them
understand the effects of their decisions – whether it’s decisions on subsidizing
high-fructose corn syrup production or decisions on how much is invested in the

11
VIEWOF HEALTH:
highway system as opposed to bikeable and walkable
cities and mass transit-oriented development.”
In the same way that Health in All Policies
requires educating leaders in non-health agencies
about the health consequences of decisions, it also
calls for more broadly trained public health professionals,
contends Dr. Richard Jackson, chair and
professor of environmental health sciences at the
school and, like Fielding, a national leader in promoting
the Health in All Policies concept. “It’s clear
that if you’re graduating from a school of public
health, you should have at least a basic familiarity
with issues such as housing, engineering and economics,”
says Jackson, who has served as California’s
state health officer and as director of the National
Center for Environmental Health, part of the U.S.
Centers for Disease Control and Prevention.
With passage of health care reform earlier
this year came tangible evidence that the voices of
Fielding, Jackson and other public health leaders
at UCLA and elsewhere are being heard when it
comes to their argument that health impacts should
be considered in a broader array of policy decisions.
The law created the National Prevention, Health
Promotion, and Public Health Council, composed
of top government officials, to elevate and coordinate
prevention activities and design a national
prevention and health promotion strategy in conjunction
with communities across the country.
Chaired by the U.S. surgeon general, it includes
the secretaries of Agriculture, Labor, Health and
Human Services, Education, and Homeland Security;
the administrator of the Environmental Protection
Agency; the chair of the Federal Trade Commission;
and the director of the National Drug Control
Policy, among others.
The movement is catching on at the state
and local levels as well. In California, the state
health department has established a Health in All
Policies Task Force as part of the governor’s Strategic
Growth Council. In Los Angeles County, Fielding’s
department conducted a health impact assessment
outlining the potential benefits of a proposed
restaurant nutritional menu-labeling law in addressing
the obesity epidemic. The assessment is believed
to have played a key role in the passage of
California’s first-in-the-nation menu-labeling law
in 2008, which in turn led to the inclusion of
menu labeling in the federal health reform law.
When public schools face
budget reductions, it’s also
a health issue: Physical education
is jeopardized, and formal education
is related to longevity.
cover story UCLAPUBLIC HEALTH

12
UCLAPUBLIC HEALTH
“If you look
at what
determines health
in populations,
to a considerable
extent it has
to do with
the societal
underpinnings
that are typically
considered
issues of
economic
development,
education,
transportation
and housing,
to name a few,
but not health
issues.”
—Dr. Jonathan Fielding
The idea of viewing health more broadly isn’t
new – in fact, Fielding notes, in some ways Health
in All Policies harkens back to an earlier time for
the public health field. “You would see health effects
of malnutrition, or of poor housing and inadequate
sanitation, and the effects of investments in other
sectors on health and health disparities were obvious,”
he says. The United States fell behind other
parts of the developed world – particularly Europe,
which has used the health impact assessment (HIA)
as a widespread policy-making tool for some time.
But in the last decade, the concept has gained
momentum – with the UCLA School of Public
Health playing an important leadership role.
Jackson, while serving as the director of CDC’s
environmental health center in the late 1990s, was
among the first to advocate for including assessment
of health impact in major policy deliberations.
He notes that since passage of the National
Environmental Policy Act in 1969, major federal
projects have required environmental impact
assessments; at the state level, the California
Environmental Quality Act passed the following
year, requiring environmental impact reports for
projects with potentially significant environmental
effects. Although the environmental studies that take
place as part of the state and federal mandates often
give a nod toward health impacts, thorough public
health assessments for proposed policies are rare.
As a result, “you can have a significant project that’s
outlining what will happen to endangered species
but offering little analysis of what happens to
children, old people, poor people and everyone
Transportation
safety issues are also
community health issues:
Airports present
potential noise and air
quality concerns for the
local population.
in between,” says Jackson, who is currently chairing
an Institute of Medicine committee, “A Framework
and Guidance for Health Impact Assessment,” on
which Fielding also serves.
Recent U.S. history is replete with examples of
major undertakings that would have benefited from
advance consideration of health impacts, Jackson
says, starting with the Interstate Highway System,
an enormous expenditure undertaken by the federal
government in the 1950s. “We know the built environment
has major health impacts, from respiratory
diseases and injuries to obesity and many other
chronic diseases,” he says, “and yet transportation and
other sister agencies are scarcely aware of them.”
In 2001, Fielding brought together a group of
UCLA School of Public Health faculty to begin a
joint endeavor with the Washington, D.C.-based
Partnership for Prevention. With support from the
Robert Wood Johnson Foundation, the UCLA Health
Impact Assessment Project aimed to assess the
feasibility of HIAs and develop prototypes, applied
to specific policies. Starting by evaluating the health
impacts on the Los Angeles City Living Wage
Ordinance, the group crossed traditional boundaries
within public health as well as seeking out
researchers in other fields. “With a lot of these issues,
we don’t start with inherent expertise in the subject
matter,” Fielding explains. “We need to partner with
experts from other fields and use resources from
other disciplines to determine how changes in different
sectors positively or negatively affect health.”
While the HIA tradition in Europe had emphasized
bringing stakeholder communities into the
process of decisions with potential health consequences,
the UCLA team developed methods that
are more quantitative. “We wanted to show through

Health Impact Assessment of Santa Monica Airport Teaches
UCLA Pediatric Residents to Broaden View of Physician’s Role
For the pediatric residents training at Ronald Reagan
UCLA Medical Center, it was an unusual project – but one
that reflects a recognition that social and environmental
conditions are every bit as important to children’s health
as what occurs in a clinical setting.
In response to concerns from members of the community
surrounding Santa Monica Airport, the 10 pediatric
residents – part of the UCLA Community Health and
Community leaders meet with officials to discuss concerns
about potential health impacts from Santa Monica Airport.
Advocacy Training (CHAT) program – conducted a health
impact assessment (HIA) of the Santa Monica Airport to
organize, analyze and summarize existing information on
the potential health impacts of the airport’s activity related
to three issues: air quality, noise and the lack of an airport
buffer zone.
“Pediatricians increasingly recognize that environmental
health is actually closer to pediatrics than it is to
adult medicine, and that we need to set environmental
standards to protect kids because their exposures are
much higher per pound of body weight than adults,” says
Dr. Richard Jackson, chair and professor of environmental
health sciences at the UCLA School of Public Health and
a pediatrician who has specialized in the issue of children
and environmental health. Jackson, who was brought in
to teach part of the course, is also a longtime proponent
of the need to assess proactively the impacts on health
of transportation, construction, and other major decisions.
The residents conducted what’s known as a rapid
non-participatory HIA over two weeks last February.
Their analysis was based on reviews of relevant scientific
publications; regulations and guidance relevant to airport
planning and health; input from expert consultants; public
comment and testimony; and participation in community
forums and meetings. The group concluded, among other
things, that there has been a rise in the number of jet
plane operations in recent decades, potentially increasing
the air and noise pollution exposure in the surrounding
area. The report noted that the airport’s proximity to
schools, daycare centers, parks and residential homes
may pose certain health risks for children and families
living in the nearby community. The HIA offered recommendations
for mitigating the potentially adverse health
impacts.
Whether the recommendations are acted on remains
to be seen, but the effort did not go unnoticed. “It had a
huge political impact,” says Ping Ho (M.P.H. ’05), a Santa
Monica resident who is a member of Concerned Residents
Against Airport Pollution and Friends of Sunset Park
Airport Committee, two grassroots groups that have
lobbied the City of Santa Monica and airport officials on
airport-related concerns. “They showed the community
and our elected officials that the problem is of concern to
front-line medical professionals, and their summary made
it clear that there is sufficient science to justify the concerns
of the community.” Drawing on her own education
in the school’s M.P.H. for Health Professionals Program
in Community Health Sciences, Ho has synthesized
scientific studies and written briefings for the communitybased
group.
“Medical practitioners haven’t been very involved
in HIAs to this point,” says Brian Cole (M.P.H. ’90, Dr.P.H.
’03), a researcher at the school who has been a leader in
the HIA movement as part of the UCLA HIA Project, and
who served as a consultant to the pediatric residents.
“It was exciting to see that the pediatric training program
recognized the importance of learning about some of the
upstream determinants of health problems and using the
HIA as a way of addressing that.”
Dr. Alma Guerrero (M.P.H. ’08), an assistant clinical
professor of pediatrics and CHAT program faculty member,
believes the pediatric residents benefited as much as the
community. “What we try to instill in the residents is the
importance of thinking broadly about health,” she says.
“The Santa Monica Airport is near where a lot of our
patients live, and it’s easy to take it for granted. By having
the residents review the science and engage with the
community on an important health concern, we’re encouraging
them to think outside the walls of the clinic in how
they define their role as physicians.”
“By having
the residents
review the
science and
engage with
the community
on an important
health concern,
we are
encouraging
them to think
outside the
walls of
the clinic.”
—Dr. Alma Guerrero
13
cover story UCLAPUBLIC HEALTH

14
“We know the
built environment
has major health
impacts, from
respiratory
diseases and
injuries to obesity
and many other
chronic diseases,
and yet
transportation
and other sister
agencies are
scarcely aware
of them.”
—Dr. Richard Jackson
our HIAs that a more systematic approach would be a valuable tool in the policy
process,” says Dr. Gerald Kominski, professor of health services at the school and
a key member of the initial UCLA Health Impact Assessment Project team. “Our
goal was to lay out the plausible downstream health effects of a variety of initiatives
or laws that might be enacted, casting as broad a net as possible to show
that virtually all public programs have potential health consequences.”
The UCLA group also argued for bringing in an evidence base. “It’s a twostep
process,” Kominski explains. “The first is analytical – mapping out the possible
pathways by which a policy can affect health. But the second important step
is to say whether there is scientific evidence showing that these plausible effects
have been measured. And the answer is that there is a lot of literature out there.”
For an HIA of California’s Proposition 49, a successful 2002 ballot initiative to
significantly expand state funding of after-school programs, the UCLA researchers
found substantial evidence – in the education literature – that providing targeted
after-school programs for at-risk children confers secondary health benefits, from
increased physical activity and improved mental health to lower rates of substance
abuse, teen pregnancy and sexually transmitted diseases. Unfortunately,
notes Kominski, the initiative wasn’t designed to address the challenges facing
these at-risk children.
In recent years, one leader in the HIA movement at UCLA and nationally
has been Brian Cole (M.P.H. ’90, Dr.P.H. ’03), a researcher in the school’s
Department of Health Services who was hired as the team’s original project
director while he was a doctoral student in the Department of Community
Health Sciences. Cole has led the effort to create the HIA Clearinghouse
Learning and Information Center (www.hiaguide.org). In addition to providing
a single online location for all ongoing and completed HIAs in the United States,
the clearinghouse provides links to research used to inform the HIAs and presents
different methods for preparing an HIA. “One of our goals is to lower the
bar, particularly for smaller agencies, so that they can do these more easily,”
Cole explains.
Meanwhile, Cole has continued to contract with municipalities and community
groups to conduct HIAs. He recently served as a consultant on an HIA of the
Santa Monica Airport done by a group of pediatric residents at UCLA’s David
Geffen School of Medicine (see the sidebar on page 13). With funding from the
UCLAPUBLIC HEALTH
Agricultural policies can
affect health by, for instance,
subsidizing high-fructose corn syrup –
and indirectly fueling the obesity
epidemic.

Pew Charitable Trust, Cole and his UCLA School
of Public Health colleagues are working to ensure
that health concerns are addressed in the environmental
impact report for the Wilshire Corridor
Transit Alternatives – the so-called Subway-to-the-
Sea proposed to be built on Los Angeles’ Westside.
Beyond addressing health concerns, Cole says, the
UCLA group is seeking to maximize potential health
benefits from the development: how, for instance,
the system might be able to tap into existing pedestrian
and bicycle routes to encourage people to
walk and bike more. In addition, with funding from
Robert Wood Johnson Active Living Research, the
UCLA group is conducting rapid HIAs around
physical activity in schools.
HIAs related to proposed developments – from
a new shopping center to a new highway or subway
system – are a natural fit, Cole explains, since they
can be coupled with environmental impact assessments.
But he and others have also been grappling
with the more challenging but no-less-important
type of HIA, ones attached to policies that don’t
involved bricks-and-mortar projects. “The question
is how we get people thinking about the upstream
determinants of public health in labor, energy or
agricultural policies, for example,” Cole says.
Much of the work of the UCLA HIA project
has involved building the tools and evidence base
for agencies to apply to these population-level HIAs.
In 2008, Cole and Fielding co-wrote a white paper
published by the Partnership for Prevention on how
Congress and federal agencies could incorporate
HIAs into large-scale policy-making (“Building
Health Impact Assessment Capacity: A Strategy
for Congress and Government Agencies”).
Beyond the formal processes of analyzing
the potential impacts of a project or policy, Cole
Promoting decent,
affordable housing
reduces problems
associated with allergens,
increases community
stability and improves
mental health,
to name a few.
explains, the HIA as well as other tools can play
a broader role by simply educating the public and
policy-makers about the connections between decisions
that are not primarily about health and their
potential public health impacts.
Indeed, notes Fielding, the HIA isn’t an end
in itself. “The HIA is a tool for operationalizing and
concretizing the Health in All Policies concept,” he
says. “But it does nothing unless it’s coupled with
efforts to use that information to educate those
who are making policy about why they should pay
more attention to the health impacts of decisions
in other sectors.”
Kominski points out that the Health in All
Policies movement is based on a notion that has long
been recognized in public health – and championed
by UCLA School of Public Health faculty including
Dr. Lester Breslow, dean emeritus of the school.
“In public health we know that the medical care
delivery system is just one determinant of the population’s
health – an important component, but a
relatively small one, especially when you consider
the cost,” Kominski says. “There are also social
determinants of health, and we are likely to reap
much greater health improvements from investments
in those areas than from additional medical
care expenditures.”
Fielding believes many outside of public health
are beginning to come around to that point of view.
“When we’re spending 50-100 percent more than
our developed-country trading partners and doing
worse in terms of health, it becomes obvious that
we can’t just work through the medical care system
to improve health,” he says. “We won’t move from
being 37th in the world in life expectancy until the
determinants of health and health impacts of decisions
become a focus of public policy at all levels.”
15
cover story UCLAPUBLIC HEALTH

16
WITH THE
ONE-SIZE-FITS-ALL
APPROACH A
DISTANT MEMORY,
EFFORTS TO
CHANGE HEALTH
BEHAVIORS ARE
RELYING ON
BETTER-TARGETED
MESSAGES
DELIVERED IN
PROACTIVE AND
INNOVATIVE WAYS.
Higher Education:
In the short video, a young couple has just returned
late one evening from a party. Obviously inebriated, they are moving toward
a sexual encounter. The scene ends and in the next shot it is morning. The
camera zooms in on an unopened condom at the bedside, then shows the nowsober
young man and young woman, appearing regretful as they reflect on a
missed opportunity.
UCLAPUBLIC HEALTH
“There’s an appreciation
that we need to challenge
our traditional ways of thinking
about how to do outreach
to populations.”
—Dr. Beatriz Solis
The frankness of the HIV-prevention message targeting youth audiences
would be notable anywhere, but what’s particularly striking about this one is
that it was produced by high school students for their peers – in the Republic
of Senegal, a predominantly Muslim nation in western Africa. Shot using mobile
digital technology, it is one of many artistically produced peer-to-peer health
messages made widely available to youth in several Senegal high schools and
beyond through a specially created website, www.sunukaddu.com (“our
voices” in Wolof).
The project, which has involved two members of the UCLA School
of Public Health faculty and several of their students, is one of many examples,
both inside and outside the school, of innovative new approaches to health
education. The days of relying on staid, top-down, one-size-fits-all messages are
long gone, replaced by more dynamic, interactive communications, delivered
in carefully selected settings in ways that resonate with the target audience.
It’s a time of opportunity for the field of health education, says Beatriz
Solis (M.P.H. ’96, Ph.D. ’07), director of healthy communities for the south

egion at The California Endowment. Solis notes,
among other things, provisions in the new health
care reform law call for increased education and
engagement of linguistically diverse populations
through community health workers. Funding for
prevention that will become available under the
new law will help to bolster the population-based
perspective, including education. Next year will
bring additional dollars to upgrade and expand
community health centers and federally qualified
health centers, providing new opportunities to
reach populations that have traditionally been
underserved by the health care system.
At the same time, there has been a reexamination
of traditional health education efforts.
In some cases, Solis says, that has meant capitalizing
on new technologies and communication
approaches that enable communities to “own”
their education – for example, through the use
of social media in youth-oriented initiatives.
In other cases, it has meant looking more broadly
at social determinants of health problems and
bringing in experts outside of the health arena
to assist in the design and implementation of
initiatives.
“We’re seeing much more crossing of traditional
silos, as well as the building of relationships
with leaders and organizations that have an ‘in’
within communities and can help to build capacity,”
Solis observes. “There’s an appreciation that we need
to challenge our traditional ways of thinking about
how to do outreach to populations.”
The Senegal project was the latest in a series of
technical assistance and evaluation efforts by two
members of the school’s Department of Community
Health Sciences, Drs. Deborah Glik and Michael
Prelip, to enhance digital and innovative health
communication in West Africa. Funded by the
Open Society Initiative for West Africa, the project’s
research component asked two overarching questions:
whether messages generated by youth would
be more effective in changing behaviors than the
more traditional government-generated messages;
and whether the new media technologies currently
booming in much of Africa would be effective in
facilitating the desired health behavior changes.
Students at three high schools in Dakar, Senegal
received both content and technology training, then
led clubs at their schools where students could
create messages through dramatic video, song,
poetry and journalistic approaches. Although the
major focus was on issues around HIV (including
prevention, testing and stigmatization), students
were also able to bring in their own health-related
topics. In addition to being posted on the website,
the student-created content was entered into a
contest in which peers and professional artists serving
as judges voted on the winners, which became
part of a national campaign.
In the urban center of Dakar, the adoption
of new media technologies has been rapid. A
post-study survey conducted by the UCLA team
found that 60 percent of the students reported
going online at least once a week – in many
cases multiple times a day – and roughly the
same proportion said they had easy access
to the Internet. Two-thirds had access to
mobile devices, including cell phones, and
were regularly engaging in text messaging. “West
Africans, like most of the developing world, are
moving very quickly into these technologies,”
says Prelip. “There is a great opportunity to take
New Strategies for Promoting Health
advantage of their excitement at having access to
information – especially by working with young
people, who are quick adopters, to influence how
they consume information about health.”
The project has also provided an opportunity
for UCLA School of Public Health students to gain
invaluable experience in the field. In 2008, two
students then in the M.P.H. program, Philip Massey
and Bozena Morawski, went to Dakar to work on
the study as summer interns and published a peerreviewed
paper on their findings. Another M.P.H.
student, Brock Dumville, recently returned after
spending 11 weeks in Dakar, working with the
youth and collecting research data. “It was such
a fulfilling experience,” says Dumville. “It showed
UCLA School of Public
Health faculty and
students have worked
on a project in which
students at three high
schools in Senegal
received content and
technology training, then
led clubs where peers
could create messages
through various media
approaches.
17
feature UCLAPUBLIC HEALTH

18
UCLAPUBLIC HEALTH
“If you add
creative artists
to the mix,
you get a jolt
of new ideas
and innovative
communication
methods that
make everyone’s
work stronger.”
—Dr. David Gere
me that I have the potential to use what I’ve learned
in the classroom at UCLA to create a program on
the ground.”
Massey, now a second-year doctoral student at
the school who has remained involved in the study,
notes that the intervention had the desired effect.
Among his group’s findings: Students in the three
participating schools had nearly two times the odds
of knowing a place to get tested as students in the
control school, where the program was not offered.
“Although the actual number of people serving as
peer mentors and creating content was small, having
the contest and giving students the ability to go to
the website and view the entries was hugely successful
in creating widespread awareness and interest,”
says Massey.
Given the project’s success, there is now interest
in expanding it throughout Senegal and other
parts of West Africa. “For youth audiences in particular,
standing up and lecturing to a group isn’t going
to be the most effective approach,” says Glik. “It’s
important to reach them where they are, and with
messages that resonate. Using technology we can
reach large numbers of people and provide opportunities
for the audience to delve deeper into topics.”
In India’s largest government HIV hospital, patients
hear seven hours of programming each day over a
public address system. The content, cycled over 14
days, is all about HIV/AIDS, but it’s not what you’d
expect. Through a collaboration between the UCLA
Art | Global Health Center and a theater troupe in
Chennai, where the hospital is located, entertainment
programming is used to convey everything
from the basics of HIV/AIDS and treatment adherence
to psychosocial issues, including coping with
deeply ingrained stigma issues associated with HIV.
“Are You Well? Arts in Hospitals,” one of several
initiatives currently ongoing in India as part of the
UCLA center’s Make Art/Stop AIDS Project, started
with the theater group putting on short plays as well
as epic-style theater performances and grew over
several years – to the point that the head of the hospital,
which was treating as many as 1,000 patients a
day, asked the collaborators to deliver the entire curriculum
to patients using their uniquely arts-based
presentation. The program has resulted in reductions
in stigma as well as improved knowledge and behavior
change, including adherence to drug protocols.
Another of the center’s projects finds community
organizers partnering with multimedia village artists
who use scroll painting, poetry and song to deliver
HIV education in rural India.
Dr. David Gere, associate professor in UCLA’s
Department of World Arts and Cultures and founding
director of the UCLA Art | Global Health
Center – whose mission is “to unleash the transformative
power of the arts to advance global health” –
has attracted considerable international attention
with his approach. Gere regularly teaches UCLA
School of Public Health students in his Make
Art/Stop AIDS course, which is where many of the
project’s idea are born, and has recently begun discussions
with the school about conducting collaborative
work in India.
Gere stresses that public health professionals,
physicians and community organizers all play a vital
role in fighting the AIDS epidemic. But he started

19
his center out of the conviction that “if you add creative artists to the mix, you
get a jolt of new ideas and innovative communication methods that make everyone’s
work stronger. A person delivering a lecture in a white coat is not the same
as a puppeteer delivering what might be the same message but in a way that is
easier to grasp, as well as more memorable and attention grabbing.”
In the United States, for all of the messages about the health benefits of regular
physical activity and risks of being sedentary, only about 20 percent of adults
have made it part of their lives, and an estimated 40 percent are entirely sedentary
during their leisure time. Dr. Antronette (Toni) Yancey, professor of health
services and co-director of the UCLA Kaiser Permanente Center for Health
Equity, based in the school, has begun to popularize a new approach, called
Instant Recess breaks.
Offered in 10-minute intervals, Instant Recess breaks are incorporated into
the routine activities of workplace and other organizations, and are low-impact
and moderate enough to engage the entire group rather than only its fittest
members. Yancey outlines her approach in a new book, Instant Recess: Building a
Fit Nation 10 Minutes at a Time (University of California Press). Grounded in
science, the book is written in an engaging, lay-friendly style to reach beyond
health professional audiences to decision makers in corporate, education, government,
sports and faith-based organizations.
“In the past, we have tended to leave behind the most sedentary people,”
Yancey explains. “A workplace wellness program might provide a free fitness
center or offer incentives for gym membership, but the only ones taking advantage
were individuals who probably would have been active regardless. Instant
Recess aims to get the most people a little bit of activity rather than getting
some people a large amount.”
By incorporating exercise into work and organizational settings, the Instant
Recess approach seeks to overcome another traditional barrier. “For many people
– especially in lower-income communities where park space is scarce and the
“Jogging alone
might be culturally
compatible for
affluent white
men, but often it
isn’t for women
or ethnic minority communities.
On the other hand, moving to music
in a group setting tends to appeal
to these groups.”
—Dr. Antronette Yancey
The UCLA Art |
Global Health Center
aims to “unleash the
transformative power of
the arts to advance global
health.” Opposite page,
left: The “Medicine Man”
sculpture was part of the
center’s Make Art/Stop
AIDS exhibition at
the 2010 World AIDS
Conference; right:
UCLA students in an
HIV-education performance
for Los Angeles
high school students.
This page: HIV-related
street theater in India.
feature UCLAPUBLIC HEALTH

20
neighborhood might not be safe – the outside environment isn’t always conducive
to physical activity,” Yancey explains. “Instant Recess can be done inside,
and it doesn’t require a lot of space or a fitness room.”
Beyond the commonality of being 10 minutes integrated into an organizational
setting and appealing to all levels of fitness, Instant Recess breaks are
meant to be adapted to culturally diverse settings. Various programs have been
devised with distinct target audiences in mind, featuring different types of music
and movement types. In some cases, Yancey has enlisted celebrities with close
identification among certain groups to help increase interest.
In all cases, the Instant Recess makes exercise a social activity. “Jogging
alone might be culturally compatible for affluent white men, but often it isn’t
for women or ethnic minority communities,” Yancey says. “On the other hand,
moving to music in a group setting tends to appeal to these groups.”
Dr. Antronette (Toni) Yancey has begun to popularize
Instant Recess exercise breaks – offered in 10-minute
intervals and incorporated into the routine activities
of workplace and other organizations. Delivered in
culturally compatible formats, they are designed to
appeal to everyone, not merely the fittest.
Health educators have long understood the importance of knowing the target
audience and tailoring messages accordingly. But in some cases, efforts haven’t
been as well refined as they could be. “When your message is aimed at a population
that speaks a different language, it’s not enough just to translate,” says Dr.
Roshan Bastani, professor of health services, associate dean for research and codirector
of the UCLA Kaiser Permanente Center for Health Equity. “You need
to really understand the culture and align the messages with the way people
live, their family structure, and other important characteristics.”
But even the most well crafted messages won’t make a difference if they
don’t reach their intended target. “If you’re putting an ad in the newspaper,”
says Bastani, “do you know that the community you’re trying to reach reads
that newspaper – or any newspaper?” In preparing for a major study aiming to
increase Hepatitis B screening in Los Angeles’ Korean community, Bastani concluded
through extensive focus-group research that the best way to engage large
groups of Koreans was through churches in Korean neighborhoods. “At least 95
percent of Koreans in Los Angeles regularly attend church, and it’s a major part
of the social fabric of the community,” Bastani explains.
Bastani and colleagues also learned through the pilot work that the population
was interested in receiving health-related programs at church, and was open
to discussions of a topic as sensitive as Hepatitis B – a sexually transmitted virus
associated with an increased risk of liver cancer. Bastani’s group has implemented
a randomized controlled trial of nearly 1,500 people at Korean church
sites throughout Los Angeles aiming to reduce the disproportionate burden of
Hepatitis B and liver cancer among Korean Americans. The trial is close to
completion and preliminary findings indicate that the intervention has had its
intended effect of increasing receipt of Hepatitis B testing.
UCLAPUBLIC HEALTH
The delivery and content of health messages can be critical to their success –
and too often, health education efforts have fallen flat in racial/ethnic communities
because they have failed to take key cultural factors into account, contends
Dr. Marjorie Kagawa-Singer, professor in the School of Public Health
and UCLA’s Department of Asian American Studies, whose work focuses on
reducing disparities, particularly in cancer, among Asian-Americans and other
populations of color.
“Different initiatives might have the same goal – such as helping the
population get access to health care – but the messages have to be acceptable,
understandable and relevant to the particular community, using the appropriate
vernacular and metaphors,” she says.
As an example of where efforts have gone astray, Kagawa-Singer notes
that initiatives aimed at increasing the use of mammography screening among
women in the appropriate age groups have tended to emphasize a “take care of

21
yourself” message that might resonate among white
women but is more likely to fall on deaf ears in
other communities, where a more effective
approach might emphasize the importance of the
woman taking care of herself so that she can fulfill
her role as family caretaker. Similarly, Kagawa-Singer
notes, among cancer survivors beliefs about pain can
be vastly different. While the Western model focuses
on relieving suffering, members of some cultures see
pain as a necessary repayment for sins, and are thus
less likely to seek or want relief.
Kagawa-Singer ensures the cultural relevance of
her research by closely involving community groups
at every stage. As principal investigator of the Los
Angeles site of the Asian American Network for
Cancer Awareness Research and Training (AAN-
CART), she formed a steering council consisting of
representatives from 17 community-based groups
serving the diverse Asian-American communities in
the Los Angeles area. Kagawa-Singer’s group was
recently funded for a third five-year period to continue
leading the Los Angeles site of AANCART,
the first cancer prevention and control research initiative
targeting Asian-Americans.
“In the community-based participatory research
model, we don’t do anything without the input of
our community partners,” Kagawa-Singer explains.
“The design and development of the interventions
are always conducted with community people who
inform us about what’s going to be most helpful and
most effective. The process is longer, but it’s been
very productive.”
Kagawa-Singer also recently completed a project
on community navigators for cancer screening.
The health navigator concept has gained favor in
recent years as a way to assist underserved populations
in overcoming barriers to obtaining important
health care services. In partnership with organizations
working closely with Asian-American immigrant
communities, Kagawa-Singer’s group tested a
model in which trained members of those communities
conduct the outreach and education, and
assist women – most of whom are uninsured and
non-English speaking – in everything from making
and following up on appointments to providing
transportation and accompanying the women to
the doctor’s office.
Navigating and properly using the health care system
can be challenging for even the most educated
consumers – and, Prelip asserts, the ability to do so
has become more important than ever with the passage
of health care reform. “If we are increasing people’s
access to care, we need to make sure they are
utilizing the system appropriately or we aren’t going
to be able to pay for it all,” he says.
Earlier this year, the U.S. Department of Health
and Human Services released the National Action
Plan to Improve Health Literacy, aiming to make
health information and services easier to understand
and use. Now a UCLA School of Public Health
research team led by Prelip and Glik, in partnership
with Health Net of California, has received funding
from the National Institutes of Health to launch an
innovative effort that uses a social-media strategy to
improve the health literacy of teens.
The recently launched project defines health
literacy more broadly than in the past, recasting it
to include health care literacy. “Rather than focusing
Dr. Roshan Bastani
and colleagues have
designed and implemented
a major study
aiming to reduce the
disproportionate burden
of Hepatitis B and liver
cancer among Korean
Americans. The educational
intervention is
being delivered at
Korean church sites
throughout Los Angeles.
feature UCLAPUBLIC HEALTH

22
UCLAPUBLIC HEALTH
“For youth
audiences
in particular,
standing up and
lecturing to a
group isn’t going
to be the most
effective
approach.
It’s important
to reach them
where they are,
and with
messages that
resonate.”
—Dr. Deborah Glik
only on health information, we want our teen members
also to know how and when to make appointments
and get referrals, as well as their rights to
services and confidentiality,” says Nancy Wongvipat
Kalev (M.P.H. ’98), director of health education/
cultural and linguistic services for Health Net Inc.,
and one of five of the school’s alumni at Health
Net who are part of the study. (Others are Elaine
Robinson-Frank, M.P.H. ’98; Hoa Su, M.P.H. ’98;
Vinia Pangan, M.P.H. ’99; and Sharon Nessim,
Dr.P.H. ’81.)
The study focuses on adolescent Health Net
members who are covered through public insurance
programs (in California, Medi-Cal or the Healthy
Families Program). Many of these teens are the first
in their family to have health coverage and may
not know who their primary care provider is, much
less take the step of making appointments for recommended
adolescent well-care visits, Wongvipat
Kalev explains. In many cases, she notes, this leads
to emergency room visits that could have been prevented.
Despite rights to confidentiality about medical
care in California, some teens shy away from
seeing health care providers for fear that sensitive
information, such as reproductive health discussions,
will be shared with their parents.
The research team has developed an interactive
website, www.teen2extreme.com, designed to
engage teens on issues about their health as a way to
improve their health care literacy. The site employs
Facebook-style applications. “There are plenty of
fact-laden websites out there,” says Prelip. “We want
this to be interactive and fun. We know that social
media has become hugely popular among teens, and
we’re excited to find out whether it can be used to
have a desired effect on health literacy.”
Over the course of a year, a series of health
themes will be presented. The site will include
quizzes, polls and contests, as well as encouraging
participation and interactivity through blogs, live
chats and opportunities to ask questions of a nurse.
Users will have the opportunity to upload photos
and video, and to comment on others’ postings.
Embedded in the site will be information about
how and when to make appointments.
Teens with Health Net coverage through the
public programs will be randomly assigned to either
the intervention group with access to the social
media website, or a control group receiving standard
information provided to Health Net members.
Participants will be surveyed both before and after
the study to determine what effect the intervention
had on their health care knowledge and behaviors,
and Health Net data will be studied to weigh the
intervention’s impact on utilization of services.
In some ways, the project illustrates the evolving
set of tools available to health educators as they
develop new strategies to engage target populations
in an effort to improve their health. “We were using
computers 10-20 years ago, but it was mostly flat,
content-driven websites,” says Glik. “Now we’re able
to offer more – links, resources and the ability to
interact with people who have similar interests and
concerns.”

esearch highlights
Virus Related to Smallpox Rising Sharply in Africa
In the wInter of 1979 the world celebrated the end of smallpox, a highly contagious
and often fatal viral infection estimated to have caused between 300-
and 500 million deaths during the 20th century. Smallpox was defeated through
an aggressive worldwide vaccination campaign – a campaign that ended in
1980, with the virus having been eradicated. But a UCLA School of Public healthled
research team has found that the elimination
of the smallpox vaccine had an unintended side
effect.
In the Proceedings of the National Academy
of Sciences, Dr. Anne rimoin and colleagues
reported that 30 years after the mass smallpox
vaccination campaign ceased, rates of a related
virus known as human monkeypox have increased
dramatically in the rural Democratic republic of
Congo, with sporadic outbreaks in other African
nations and even in the United States.
Until 1980, rimoin notes, the smallpox vaccine
provided cross-protective immunity against
monkeypox, a “zoonotic orthopoxvirus,” meaning
it can be passed from animals to humans.
Symptoms of monkeypox in humans include
severe eruptions on the skin, fever, headaches,
swollen lymph nodes, possible blindness and
even death. there is no treatment.
once the smallpox vaccination program
ended, new generations of people who were “vaccine
naïve” were exposed to the monkeypox virus
in the Democratic republic of Congo over time,
and the number of people who became infected gradually increased. But the
increase went unnoticed because the nation has little or no health infrastructure
and thus no way to monitor the spread of such diseases.
As a result, monkeypox was thought to be very rare. rimoin’s research
shows, however, that it has become quite common.
rimoin travels frequently to the Democratic republic of Congo (DrC),
where she has established a research site to study and track cross-species
transmission of the disease (see the profile on page 8). for their recent report,
rimoin and her colleagues conducted a population-based surveillance in nine
health zones in the central region of the country between 2006 and 2007, gathering
epidemiologic data and biological samples obtained from suspected cases.
they then compared the current, cumulative incidences of infection with data
gathered in similar regions from 1981 to 1986. the results were startling, showing
a 20-fold increase in human monkeypox in the DrC since smallpox vaccinations
were ended in 1980.
Because it is unlikely that smallpox vaccinations would be resumed, rimoin
is calling for improved health care education in the Democratic republic of
Congo and better disease surveillance. there is an urgent need to develop a
strategy for reducing the risk of a wider spread of infections, she says.
The results were startling, showing a 20-fold
increase in human monkeypox in the Democratic
Republic of Congo since smallpox vaccinations
were ended in 1980.
23
research UCLAPUBLIC HEALTH

24
One in Four California Children
Has Never Seen a Dentist
Time Since Last Dental Visit
Among California Children
Younger than 11 Years of Age
24% 22% 25% 26% 22% 27%
5% 3%
5% 7%
18%
17%
22% 20%
53% 57% 47% 47% 59% 50%
Total White African-American Latino Asian-American Other
Had a dental visit within past six months
Had last dental visit 6-12 months ago
Last dental visit was more than a year ago
Never had a dental visit
neArLy 25 PerCent of CALIfornIA ChILDren have never seen a dentist,
and for those who have, disparities exist by race, ethnicity and type of insurance
when it comes to the duration between dental care visits, according to the
findings of a study by Dr. nadereh Pourat, professor of health services at the
UCLA School of Public health and director of research for the Center for health
Policy research.
for the study, published in the July issue of the journal Health Affairs,
Pourat and co-author Dr. Len finocchio of the California healthCare foundation
examined barriers to dental care in nearly 11,000 California children ages 11 and
under using data from the 2005 California health Interview Survey, the nation’s
largest state health survey, conducted by the Center for health Policy research.
Among their findings: Latino and African-American children with all types of
insurance were less likely than Asian-American and white children to have visited
the dentist in the previous six months, or even in their entire lifetime.
the researchers also found that Latino and African-American children in
public insurance programs, including Medicaid and the Children’s health
Insurance Program (ChIP), went to the dentist less often than white and Asian-
American children with the same insurance coverage. overall, children with private
insurance saw a dentist more often than those in Medicaid or ChIP.
“Lack of dental care continues to be a significant problem for American children,
and our findings suggest that having insurance isn’t always enough,” says
Pourat. “we need to address the other barriers that keep children from getting
the help they need.”
the authors noted that
the findings raise concerns
about Medicaid’s ability to
address disparities in dental
care access. Ultimately,
3%
16% 4%
they argued, more strategic
18%
efforts are necessary to
overcome systemic barriers
to care, including raising
reimbursement rates paid
to dentists who serve the
Medicaid population and
increasing the number of
participating Medicaid
providers.
Despite the disparities,
having any form of dental
insurance significantly increased the odds of seeing a dentist on a regular basis
– 54 percent of privately insured children and 27 percent of publicly insured children
had seen a dentist in the last six months, compared to 12 percent of children
without dental coverage.
“the data tell us that Medicaid and ChIP have improved children’s ability to
get dental care,” says Pourat. “however, both programs need to do more to
reduce disparities.” (More on this topic can be found in the article on page 4.)
UCLAPUBLIC HEALTH
Same-Sex Couples in California
Face Sizable Health Insurance Inequities
whILe CALIfornIA IS generALLy weLCoMIng to individuals of all sexual
orientations, employers in the state tend to discriminate when it comes to samesex
partners and health care, according to a UCLA School of Public health study.
Dr. ninez Ponce and colleagues are the first to show a large gap between
employer-sponsored dependent coverage received by heterosexual employees

and lesbian and gay employees. their study, whose findings were published in
the journal Health Affairs, concludes that sexual-orientation disparities are
greater than previously thought. Partnered gay men living in California, for example,
are only 42 percent as likely as married heterosexual men to receive
employer-sponsored dependent health insurance, while partnered lesbians have
an even smaller chance – 28 percent – of getting coverage compared to married
heterosexual women.
the report used data from the California health Interview Survey. the
researchers combined three years of adult surveys: 2001, 2003 and 2005. the
final sample included 63,719 women and 46,535 men between the ages of 18
and 64. of the sample, 51 percent of lesbians and 38 percent of gay men
reported being in a partnered or married relationship, compared with 64 percent
of female and 64 percent of male heterosexuals.
“we found no strong evidence to suggest that California
employers are discriminating in providing health insurance to gay
and lesbian workers as individuals,” says Ponce, an associate
professor at the school. “however, we did find that employers
were setting coverage rules for dependents that favored legally
and heterosexually married employees.”
the authors noted that most of the data were collected
before full implementation of the California Insurance equality Act
of 2005; they expect that the law, once fully enacted and combined
with the federal Patient Protection and Affordable Care Act,
may alleviate some of the disparities documented in their study.
But they also noted that the way government agencies and
employers define dependents, and the federal taxation of health
benefits for a same-sex spouse or partner, continue to be “a relevant
underlying structural determinant of whether or to what
extent sexual-orientation minorities will have more equal access
to employer-sponsored insurance.”
Achieving universal coverage, Ponce says, "will depend in
part on remedying inequalities in state and federal marriagerelated
rules."
Nanoparticles in Common Household Items
Cause Genetic Damage in Mice
tItAnIUM DIoxIDe (tIo2) nAnoPArtICLeS, found in everything from cosmetics
and sunscreen to paint and vitamins, cause systemic genetic damage in
mice, according to a comprehensive study conducted by researchers at UCLA’s
Jonsson Comprehensive Cancer Center and School of Public health.
the tio2 nanoparticles induced single- and double-strand DnA breaks and
also caused chromosomal damage as well as inflammation, all of which increase
the risk for cancer. the study, published in the journal Cancer Research, was the
first to show that the nanoparticles had such an effect, according to Dr. robert
Schiestl, a Jonsson Cancer Center scientist and professor in the School of Public
health, who was the study’s senior author.
once in the system, the tio2 nanoparticles accumulate in different organs
because the body has no way to eliminate them. And because they are so small,
they can go everywhere in the body, even through cells, and may interfere with
sub-cellular mechanisms, Schiestl’s team noted.
In the past, these tio2 nanoparticles have been considered non-toxic in that
they do not incite a chemical reaction. Instead, it is surface interactions that the
nanoparticles have within their environment – in this case, inside a mouse – that
is causing the genetic damage, Schiestl says. they wander throughout the body
causing oxidative stress, which can lead to cell death.
It is a novel mechanism of toxicity, a physicochemical reaction, that these
particles cause in comparison to regular chemical toxins, which are the usual
subjects of toxicological research. “the novel principle is that titanium by itself is
Partnered gay men living in California are only
42 percent as likely as married heterosexual men
to receive employer-sponsored dependent health
insurance, while partnered lesbians have an even
smaller chance – 28 percent – of getting coverage
compared to married heterosexual women.
25
research UCLAPUBLIC HEALTH

26
chemically inert,” Schiestl explains. “however, when the particles become progressively
smaller, their surface, in turn, becomes progressively bigger and in
the interaction of this surface with the environment, oxidative stress is induced.
given the growing use of these nanoparticles, these findings raise concern
about potential health hazards associated with exposure.”
the manufacture of tio2 nanoparticles is a huge industry, Schiestl notes,
with production at about 2 million tons per year. In addition to paint, cosmetics,
sunscreen and vitamins, the nanoparticles can be found in toothpaste, food colorants,
nutritional supplements and hundreds of other personal care products.
“It could be that a certain portion of spontaneous cancers are due to this
exposure,” Schiestl says. “And some people could be more sensitive to nanoparticle
exposure than others. I believe the toxicity of these nanoparticles has not
been studied enough.”
UCLAPUBLIC HEALTH
Only 61 percent of home kitchens received scores
that would give them an A or B grade, compared to
98 percent of L.A. County restaurants. Twenty-five
percent received a C, and 14 percent scored lower
than the 70 percent required for a passing grade.
Many Home Kitchens Not Making
the Food-Safety Grade
MoSt PeoPLe ASSUMe that when they are experiencing
food poisoning the culprit is something they
ate outside their home. But a study co-authored by a
UCLA School of Public health faculty member in his
role as director of the Los Angeles County
Department of Public health suggests that home
kitchens are more prone to causing foodborne infections
than most people realize.
Publishing in the Morbidity and Mortality
Weekly Report of the Centers for Disease Control
and Prevention, Dr. Jonathan fielding and colleagues
detailed findings from a study of approximately
13,000 Los Angeles County adults who
voluntarily completed an online quiz on their home
food-handling and preparation practices. Based on a
scoring system adapted from that used for restaurant
grading in the county, only 61 percent of home
kitchens received scores that would give them an A
or B grade, compared to 98 percent of L.A. County
restaurants. twenty-five percent received a C, and 14 percent scored lower than
the 70 percent required for a passing grade. “If they got below a C, I’m not sure
I’d like them inviting me to dinner,” fielding says.
from 1999 to 2007, foodborne diseases caused a reported 2,590 hospitalizations
and 17 deaths in Los Angeles County – numbers that are considered
underestimates given that not all foodborne illnesses leading to hospitalization
or death are confirmed by laboratory testing.
In 1998, under fielding’s leadership, Los Angeles County established
numeric scores for restaurant inspections and posted grades for these inspections
publicly. the initiative was credited with helping to reduce the number of
hospitalizations for foodborne infections by 13 percent in the first year. In 2006
the county launched the voluntary home Kitchen Self-Inspection Program,
which includes a quiz aiming to provide feedback and education that will promote
safer food hygiene practices at home. the quiz emphasizes such food
handling practices as the need to clean and sanitize cutting boards after handling
poultry, the safe handling of raw eggs, and appropriate methods for the
refrigeration of cooked and uncooked foods.
fielding’s group noted that the results of the quiz can’t be used to directly
compare conditions in homes with those of restaurants, since they are based on
self-reports rather than inspections by trained food safety professionals. But
given the likelihood that people more interested and conscientious about food

safety were more apt to take the quiz, the results probably understate the problem.
“the findings in this report show that even among interested and motivated
persons, food handling and preparation deficiencies occur frequently in the
home setting,” fielding and colleagues wrote.
Centralized Health Care More Cost-Effective,
Offers Better Access to Preventive Services
fAMILIeS froM rUrAL MexICo who receive health care from centralized
clinics run by the federal government pay up to 30 percent less in out-of-pocket
expenses and utilize preventive services more often than families who access
decentralized clinics run by states, according to a study by researchers at the
UCLA School of Public health. the findings were published in the September
issue of the Journal of Social Science and Medicine.
the findings, drawn from a comprehensive survey of 8,889 rural families
from seven Mexican states conducted in 2003 by Oportunidades, Mexico's principal
anti-poverty program, contradict the widely perceived notion that decentralized
systems are superior, since local knowledge and
resources can be more effectively used to address local needs.
Since the 1990s, centralized and decentralized health care
services have co-existed in 17 Mexican states without competing
against one another. Because centralized and decentralized
organizations rarely operate within the same country during the
same time period or cater to comparable populations, Mexico’s
health care system provides a rare opportunity to compare the two
approaches side by side.
In the study, households serviced by decentralized providers
reported higher out-of-pocket health expenditures and lower utilization
of preventive services, spending almost 40 percent more
out of pocket and utilizing preventive care 7 percent less than
households serviced by centralized providers. the households
studied showed no differences in terms of age, years of schooling,
family size, insurance status, employment, need and most
community infrastructure measures.
“the Mexican experience can be useful to other developing
countries in Latin America (e.g., Chile or Brazil) and other areas
of the developing world (e.g., China, Iran, turkey) where centralized
governments have considered decentralization as a policy
mechanism to reform their national health systems," says Dr.
Arturo Vargas-Bustamante, the study’s lead investigator and an
assistant professor of health services at the UCLA School of
Public health.
Vargas-Bustamante suggests that the centralized providers have four attributes
that may give them an advantage:
Type of Service. Because the types of services provided to rural populations
do not require a high degree of specialization and are relatively homogeneous
and less sensitive to local taste and variation, centralized providers may
be able offer these services more efficiently.
Quality of Care. Centralized providers have more public resources to provide
better services and employ more incentives and monitoring to improve the
quality of care.
Experience. In the three decades since decentralization began in Mexico
centralized providers may have resolved functional issues that decentralized
providers may still be tackling.
Local Capacity. even if local authorities are closer to their communities and
are more familiar with their characteristics and limitations, they still need managerial
skills to provide health services that require some level of expertise.
Preventive Health Care Utilization
by Type of Health Care Provider
in Mexico
74%
72%
70%
68%
66%
64%
62%
60%
Centralized
Provider
Decentralized
Provider
27
research UCLAPUBLIC HEALTH

28
student profiles
UCLAPUBLIC HEALTH
“Promoting sports participation
in developing countries
of Africa could be a great
strategy for catalyzing some
of the health outcomes we
want for young women.”
— Myralyn "Mimi" Nartey
For Former Pro Soccer Player, Future Kicks
Will Promote Health Among African Girls
When she Was 15, MYRALYN "MIMI" NARTEY ventured far from her family’s home
in arizona to the Republic of Ghana, where her father had been raised, to play professional
soccer for the Ghanian women’s national team.
While there, she contracted malaria. at first the team
administrators and medical staff failed to appreciate the
magnitude of her illness. When nartey began to deteriorate,
she was taken to the nearest hospital, which she
barely recognized as a medical care facility. “It felt more
like an open-air marketplace,” she recalls. as she waited
a seemingly interminable period to be seen, nartey saw
frightened-looking women with sick babies on their backs.
“They had no idea what was going on, or if they were going
to be able to pay for what they needed,” she says.
The experience made a huge impression. “here I was,
born and raised in the United states with all the resources
anyone could have, and commissioned by Ghana to play a
sport – yet, I was having problems getting access to health
care when I was sick,” nartey says. “It struck me that if I
was having a hard time, what about everyone else in this
country that was so impoverished?”
With that in mind, nartey majored in environmental
biology as an undergraduate at Columbia University and
went on to do a fellowship in which she conducted
research to develop anti-malarial drugs. Ultimately she
shifted her focus to policy. she got an M.a. in Climate and
society at Columbia, then came to UCLa, where she is
pursuing an M.a. in african studies and a Ph.D. at the
school of Public health as part of a dual-degree program. since arriving in 2006,
nartey has channeled the energy she once used on the soccer field into a myriad
of activities: In addition to her studies, she serves as an appointee on the student
health advisory Committee and is the sPh Diversity Coordination Team co-chair, as
well as co-chair of students of Color for Public health. she also has a daughter,
born in February 2009.
nartey continues to be interested in malaria – it is an important focus of an
undergraduate seminar she has taught the last three years on the dynamics of climate
and health in sub-saharan africa. But her goals have evolved. after recovering
from her bout with malaria, nartey went on to a fruitful career in professional
soccer, representing Ghana in the 2002 FIFa african Cup of nations and 2003 FIFa
Women’s World Cup. now she has her sights set on developing africa-based programs
to promote participation in sports as a way of achieving better health outcomes.
“The benefits of sports participation for young women are well documented
in the Untied states, including delayed sexual initiation, better ability to negotiate
condom use with partners, and reduced risk of gender-related violence and genderrelated
medical problems,” nartey notes.
Reflecting on her own soccer experience, nartey remembers the benefits
accrued by her teammates, many of whom were uneducated. “They became much
more confident,” she says. “It made me realize that promoting sports participation in
developing countries of africa – and especially soccer, which is so woven into the
cultural fabric – could be a great strategy for catalyzing some of the health outcomes
we want for young women.”

M.P.H./J.D. Dual Program a Recipe for Policy Influence
MoRe Than Many graduate students, ELI TOMAR has spent enough time in the
thick of the policy-making process on Capitol hill to know the challenges – and in
many cases, frustrations – of passing meaningful health-related legislation.
Prior to embarking on his M.P.h./J.D. through a four-year concurrent degree program
offered by the UCLa school of Public health and school of Law, Tomar spent
several years working in Washington, D.C. – as a congressional intern, a government
relations aide for the U.s. soccer Foundation, and a legislative assistant and public
policy analyst for two law firms, advocating in Congress as a registered lobbyist.
“It’s easy to become disheartened when you see that even getting something
passed that everyone agrees on is an uphill battle,” he says. “so often, opposition
to a proposal is based on politics, not policy. But it’s important to understand the inertia
that exists and learn how to accomplish what you can.”
Tomar remains enthusiastic about the opportunity to positively affect people’s
lives through legislation. In his workspace he proudly displays a copy of the
Medicare Improvements for Patients and Providers act of 2008, which included
provisions to expand coverage for patients with endstage
renal disease as well as providing funding for
patient education and prevention programs. Tomar had
lobbied for the bill as part of a large coalition that
included health care providers, dialysis centers and
patient groups; it became law after Congress overrode
a veto by then-President Bush. “These were relatively
uncontroversial provisions, and yet this coalition had
been trying to get them for five years,” Tomar says. “I
was thrilled to see it pass.”
Tomar says he knew he wanted to go to law
school well before he considered getting an M.P.h.
although he was exposed to health care policy as a
child – his mother served as a policy director for the
american hospital association – it was only after he
began working with health care clients as a public
policy analyst for the law firm Patton Boggs that he
decided to pursue a joint-degree program.
Through the M.P.h./J.D. – the first program of its
kind west of the Mississippi River – Tomar is gathering
credentials that will strengthen his ability to make a difference
in the nation’s capital, where he plans to return
after completing the four-year program. The M.P.h./
J.D. is designed to prepare students to work in health
law, a field that was already growing rapidly but offers even more opportunities since
the passage of health care reform. Tomar intends to resume his work in health law
and policy; ultimately he would like to help shape policies as part of a think tank or
as legal counsel to one of the health-related committees on Capitol hill.
“With the entire nation focusing on health care, it’s an exciting time to be studying
these issues,” says Tomar, who is in the school’s Department of health services.
“I’m getting a different perspective on policy and a much better grasp of everything
from the evaluation of programs to the economic forces behind health care, as well
as management-oriented issues such as strategy and marketing. all of this is going
to be extremely helpful in my future work.“
“With the entire nation
focusing on health care,
it’s an exciting time to be
studying these issues.”
— Eli Tomar
29
students UCLAPUBLIC HEALTH

30
UCLAPUBLIC HEALTH
contracts & grants 2009-10
This section includes
new contracts and grants
awarded in fiscal year
2009-10. Due to space
limitations, only funds
of $50,000 or more are
listed, by principal
investigator.
RICHARD AMBROSE
Determining Long-Term Changes in Species Abundances and
Community Structure in Southern California Rocky Intertidal Habitats
(Samueli Institute for Information Biology, $80,000 for 2 years)
ONYEBUCHI ARAH
Beyond Individual-Level Determinants: The Role of Healthcare
System, Socioeconomic, and Environmental Factors in the Global
Burden of Chronic Diseases (Netherlands Organisation for Scientific
Research & Universiteit Van Amsterdam, $310,489 for 2 years)
ROSHAN BASTANI
Los Angeles Regional Cancer Prevention and Control Research
Network (Centers for Disease Control and Prevention, $1,499,955
for 5 years)
RONALD BROOKMEYER
Clinical and Pathological Studies in the Oldest Old: Statistical Design
& Analysis (National Institute on Aging & UC Irvine, $75,822)
E. RICHARD BROWN
The 2009 California Health Interview Survey (County of Marin,
$200,000 for 2 years; California Children & Families Commission
– First 5, $1,500,000 for 2 years; California Department of
Managed Health Care – Office of the Patient Advocate, $251,805;
The California Endowment, $1,729,643 for 2 years; California
Department of Mental Health, $1,568,000; County of San Diego,
$394,091 for 2 years; National Cancer Institute, $300,000); The
State of Health Insurance in California Report (SHIC) (California
Wellness Foundation, $175,000 for 2 years)
CATHERINE CRESPI
New Methods for the Design of Cancer Studies with Clustered
Binary Outcomes (National Cancer Institute, $154,000 for 2 years)
ROGER DETELS
Multidisciplinary HIV and TB Implementation Sciences Training in
China (NIH Fogarty International Center & Chinese Center for
Disease Control and Prevention [China], $540,000 for 5 years);
Natural History of AIDS in Homosexual Men: ARRA Supplements
(National Institute of Allergy and Infectious Diseases, $1,309,694)
JONATHAN FIELDING
Comprehensive School Physical Activity Opportunities: Using
Health Impact Assessment to Develop Accountability and
Reporting Systems (Robert Wood Johnson Foundation, $99,850);
UCLA/LA County HIA Demonstration and Training Project (Pew
Charitable Trusts, $321,580 for 2 years)
JOHN FROINES
Toxicologic Pathways of Rail Yard Emission Exposure on Non-
Cancer Health Impacts (British Petroleum Group, $620,480 for 2
years); International Forum on Disability Management (IFDM)
2010 (California Department of Industrial Relations, $60,600)
PATRICIA GANZ
A Model Clinical Translational Research Program for Breast Cancer
Survivors: A Focus on Cognitive Function after Breast Cancer
Treatment (The Breast Cancer Foundation, $198,566); Reducing
Breast Cancer Recurrence with Weight Loss: A Vanguard Trial
(National Cancer Institute & UC San Diego, $96,417 for 4 years)
BETH GLENN
Sun Protection Among Children with a Family History of Melanoma
(National Cancer Institute, $154,000 for 2 years)
DEBORAH GLIK and MICHAEL PRELIP
Adolescent Health Literacy: Improving Use of Preventive Health
Services (National Institute of Child Health and Human
Development, $1,306,662 for 2 years)
HILARY GODWIN
Public Health Traineeships (DHHS/Health Resources and Services
Administration, $177,392 for 3 years); SARRA – Public Health
Traineeship Program (DHHS/Health Resources and Services
Administration, $184,319 for 3 years)
NEAL HALFON
The Interdisciplinary Maternal and Child Health Training Program
(DHHS/Health Resources and Services Administration, $1,725,000
for 5 years)
GAIL HARRISON
Developing the Immigrant Health Component of UCLA’s Center for
Global and Immigrant Health (The California Endowment, $76,750)
SHEHNAZ HUSSAIN
Nucleotide Variation in the Prolactin Receptor and its Agonists and
Breast Cancer Risk (Susan G. Komen Breast Cancer Foundation,
$299,912 for 2 years); Molecular Epidemiology of B-Cell Activation,
DNA Repair & HIV-Associated Lymphoma (National Cancer
Institute, $640,376 for 5 years)
MARJAN JAVANBAKHT
Rectal Transmission of STIS/HIV Among Women (UC California
HIV/AIDS Research Program [CHRP], $185,776 for 2 years)
ROBERT KAPLAN
UCLA/RAND Center for Adolescent Health Promotion – Category 1
(Centers for Disease Control and Prevention, $5,180,000 for 5
years); Women’s Exercise Injuries: Incidence and Risk Factors
(National Institute of Arthritis & Musculoskeletal and Skin Diseases
& The Cooper Institute, $74,189); Comparative Effectiveness and
Outcomes Improvements (CEOI) Center (National, Heart, Lung, and
Blood Institute, $3,855,398 for 2 years)
LEEKA KHEIFETS
Cell Phone Use and the Health of Children in the Danish National
Birth 7-1-09 (National Institute of Environmental Health Sciences,
$423,500 for 2 years)
NOLA KENNEDY
Program to Continue Training to Prevent Workplace Injuries and
Illness Among Low Wage Workers in Hazardous Jobs (California
Wellness Foundation, $200,000 for 3 years)
GERALD KOMINSKI
Pediatric Palliative Care Waiver Evaluation (CA/HHS/Department of
Health Services, $700,000 for 4 years)
SIMIN LIU
Biochemical Predictors of Type 2 DM in Women (National Institute
of Diabetes, Digestive and Kidney Disease, $230,187)
CAROLYN MENDEZ-LUCK
Elder Caregiving in Los Angeles County: Creating a Profile of
Caregiver Health and Health Risks (Kaiser Foundation Research
Institute, $150,000 for 2 years)

SHANE QUE HEE
Whole Glove Permeation/Penetration of Organic Liquids with a
Dextrous Robot Hand (Centers for Disease Control and Prevention,
$1,060,110 for 3 years)
ANNE RIMOIN
Research and Policy for Infectious Disease Dynamics (RAPIDD)
(Fogarty International Center, $81,712 for 2 years); The Emergence
of Human Monkeypox in Central Africa (National Institute of
Allergy and Infectious Diseases, $88,532); Collaborative Program
Development with GVFI (USDS Agency for International
Development & Global Viral Forecasting Initiative, $207,587)
BEATE RITZ
Sunlight Exposure & Vitamin D Metabolic Gene Variations in
Parkinson’s Disease (National Institute of Environmental Health
Sciences, $154,000 for 2 years); Air Pollution and Childhood
Cancers in California (National Institute of Environmental Health
Sciences, $423,095 for 2 years)
HECTOR RODRIGUEZ
Local Health Department Influences on the Health of Older Adults:
A Statewide Evaluation (Robert Wood Johnson Foundation,
$200,000 for 2 years); The Effect of Differential Item Functioning on
the Measurement of Racial and Ethnic Disparities in Patients’
Experiences of Ambulatory Care (Robert Wood Johnson
Foundation, $75,000 for 2 years)
LINDA ROSENSTOCK
Diversity in Health Professions (California Wellness Foundation,
$150,000 for 2 years)
STEVEN ROTTMAN
UCLA Center for Public Health Preparedness (Centers for Disease
Control and Prevention, $500,000)
KIMBERLEY SHOAF
Public Health Emergency Management Training and Education
Academy (City of Long Beach Department of Health and Human
Services, $703,000 for 1.5 years); Preparedness & Emergency
Response Research Centers: A Public Health Systems Approach
(Centers for Disease Control and Prevention, $4,723,148 for 4 years)
PETER SINSHEIMER
California Garment Care Technology Demonstration Project, Non-
Toxic Dry Cleaning Incentive Program (California Environmental
Protection Agency Air Resources Board, $265,000 for 2 years)
STEVEN WALLACE
Assessment of Local Environmental Risk Training (ALERT) (National
Institute of Environmental Health Sciences, 1,000,000 for 2 years)
MAY WANG
Stimulus: Agent-Based Model of Individual-Level Food Choice and
Physical Activity Behavior (National Institute of Diabetes and
Digestive and Kidney Diseases, $860,216 for 2 years)
PHYLLIS WEISS
Resource Program for Policy Development and Program Evaluation
for Violence Prevention Organizations (California Wellness
Foundation, $150,000 for 2 years); Community Gang and Violence
Reduction Strategy Planning Project (Centers for Disease Control
and Prevention & The Advancement Project, $73,613)
new faculty
DR. YIFANG ZHU joins the faculty
as assistant professor in the
Department of Environmental
Health Sciences. Her research
focuses on identifying key factors
that affect human exposure to
ultrafine particles on and near
roadways by measuring and
modeling their emissions,
transport and transformation
in the atmosphere, as well as into the in-cabin and
indoor environments. Zhu’s studies are supported
by two prestigious national awards: the National
Science Foundation’s Faculty Early Career
Development Award and the Walter Rosenblith
New Investigator Award from the Health Effects
Institute. Zhu, who was most recently an assistant
professor in the Environmental Engineering
Department at Texas A&M University-Kingsville,
received her B.S. in Environmental Engineering
from Tsinghua University in China and her Ph.D.
in Environmental Health Sciences from the UCLA
School of Public Health.
ALSO JOINING THE FACULTY:
BRIAN BRADBURY
Assistant Professor, Epidemiology
31
faculty UCLAPUBLIC HEALTH

32
news briefs
INTERACT WITH US!
You can learn about happenings at the school,
participate in discussions on public health topics of the day
or reconnect with former classmates and favorite faculty
members through the school’s Facebook page,
and follow UCLASPH on Twitter for important updates.
In addition, alumni are invited to join
the UCLA School of Public Health Alumni Network
on the professional networking site Linkedin.
SPH hosts
lunchtime webinars
Starting in October, the School of Public Health began hosting a monthly
series of lunchtime webinars. These lunchtime discussions, available through
the school’s website, present a valuable opportunity to hear from faculty
experts about some of today’s most critical public health issues. Among
other things, webinar participants will learn what they can do to create healthier
environments in the face of disease and environmental challenges; receive
a virtual tour of the new Global Bio Lab at UCLA, a state-of-the-art facility
that will vastly increase the rate at which infectious agents are submitted,
tested and analyzed; hear how food marketing has vastly altered the culture
of food and eating, leading to the current obesity epidemic; and see the role
and impact that population health surveys have on implementing health care
reform. For a schedule of upcoming webinars and to view previous webinars,
please visit http://ph.ucla.edu/.
curbing teen suicide
motivates SPH students
Ashley Roberts and Anne Sutkowi, second-year students at the School of
Public Health, are working with students at Olympic High School in Santa
Monica as part of a health promotion and suicide prevention program they
created called STRIDES. The program, inspired by research linking suicide
rates and emotional health, promotes physical, mental and emotional well
being through physical activity, stress relief and development of a positive
self-image.
During the 10-week project, Roberts and Sutkowi are working at the
continuation high school with students who have faced great challenges in
their home life and those who know someone who has thought about suicide
or committed suicide. Twice a week they lead students in stretches and
jogs on campus, hoping to help the students integrate running into their daily
lives, since it is an activity that is both an individual and a team sport. Says
Roberts: “We encourage them to encourage one another, but it's a solitary
thing that they can do by themselves for stress relief.” The project culminates
in the STRIDES 5K Run/Walk at Dockweiler Beach in November. The program
was made possible by support from the Albert Schweitzer Fellowship, which
assists leaders addressing the needs of underserved communities.
UCLAPUBLIC HEALTH

new associate dean
for global health
Dr. Onyebuchi Arah, an associate professor in the Department
of Epidemiology, has been appointed the school’s first associate
dean for global health. Arah will help implement one of the school’s
strategic goals: building a world-class global health presence.
Arah brings a unique perspective in both his training and his
experience. A native Nigerian, he received much of his advanced
academic education in Holland. As a pediatrician trained in public
health, health services research, health policy and epidemiologic
methods, Arah studies issues such as the role of health systems
in global health and performance assessment in health care.
He has been a member of the school’s faculty since 2006.
special edition
of alumni directory
A special anniversary edition of the Alumni Directory will be
produced to celebrate the School of Public Health's 50th
Anniversary in 2011. The directory will feature contact information,
photos and essays from five decades of distinguished alumni.
All alumni will be soon contacted by the vendor Harris Connect
to gather directory information. You may also visit www.ucla.edu/
sphalumni to ensure the school has up-to-date information about
you so that you will be able to reconnect with fellow alumni.
school turning 50
On the eve of the school’s 50th anniversary, preparations are
underway for a year of celebrating five decades of innovative
and high-impact research, teaching and community service.
Beginning with a gala on the evening of February 2, 2011
(more details on the back cover), the school will be hosting
numerous events and activities throughout the year to enable
all friends and supporters to participate in the celebration.
Those not in Los Angeles can join in one of the lunchtime
webinars (see previous page). The school will also hold a
special celebration for alumni at the annual American Public
Health Association meeting to be held in San Francisco in
November 2011.
UCLA’s School of Public Health didn’t start out as a
graduate school. From 1946 to 1983, UCLA provided undergraduate
instruction leading to an advanced degree in public
health, which was offered beginning in 1957. It wasn't until
1961 that the University of California Regents created an
independent School of Public Health on the Westwood campus.
Join us in celebrating the myriad accomplishments of alumni,
students and faculty during the past 50 years, and help the
school continue on the same trajectory for the next 50.
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.
33
news briefs UCLAPUBLIC HEALTH

U C L A
PUBLIC HEALTH
Nonprofit Org.
U.S. Postage
PAID
UCLA
UCLA
School of
Public
Health
School of Public Health
Box 951772
405 Hilgard Avenue
Los Angeles, California 90095-1772
www.ph.ucla.edu
Address Service Requested
The 50th Anniversary Gala of the School of Public Health
ATUL GAWANDE, M.A., M.D., M.P.H.,
distinguished surgeon and bestselling author,
is the featured speaker at the school’s
50th Anniversary Gala.
FEBRUARY 2, 2011 at 6 P.M.
The Hyatt Regency Century Plaza Los Angeles
To purchase tickets and for sponsorship opportunities
please visit www.ph.ucla.edu/2011gala or call (310) 825-6464.