JUNE 2001 - UCLA School of Public Health

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16 UCLAPUBLIC HEALTH Rhea Durr After graduating from the School with her M.P.H. this spring, Durr will begin a California State Senate Fellowship this fall. Once Durr has learned the inner workings of the political system, she intends to use her skills to provide a voice for underserved community residents through advocacy and policy analysis efforts, particularly on issues related to violence prevention. It is a field that has interested her since, as an adolescent, one of her close friends was the innocent victim of a drive-by shooting, and an acquaintance was killed in a gangrelated incident. Durr also witnessed domestic violence as a child. “I wanted to understand why these things were happening,” Durr says. “And as I learned more about it, I began to focus my efforts on advocating for prevention of these acts, so that what I experienced doesn’t happen to someone else.” “The public health perspective brought a sense of hope and optimism that reducing violence wasn’t a futile endeavor.” —Dr. Susan Sorenson Mary Ann Limbos, M.D., M.P.H. ’97 Limbos, a general pediatrician at Children’s Hospital in Los Angeles, became interested in studying pediatric injuries while getting her M.P.H. at the School. She is currently working with Dr. Corinne Peek-Asa on a study examining intentional and unintentional injuries in the Los Angeles Unified School District. Nearly 12,000 injuries occur in the district each year, about one-fifth of which are intentional. The researchers have spent the past two years laying the groundwork by gathering general data; beginning this summer, they will focus on a specific area, around Children’s Hospital. Limbos hopes to get a sense of not only the school-related factors that contribute to intentional injuries, but also the community and individual risk factors that play a role. “The media has focused a great deal of attention on school violence, and it’s hard for us to say that there’s been an increase because there has been little data,” she says. While she hopes the study will point the way toward effective interventions to reduce intentional injuries in school, Limbos also believes it’s important to point out that children are at considerably greater risk for unintentional injury. something in our culture that accepts violence, and even glorifies it.” Often, though, public perceptions don’t mesh with the actual risks. Fear of violence rose during the 1990s, a period during which the occurrence of violent crimes was declining dramatically. Weiss attributes this to the influence of media that play on people’s anxieties. Toward that end, she adds, one of the greatest fears among parents is that their child will be abducted on the streets by a stranger — an extremely rare event. “A child is much more likely to be harmed by a gun found in a friend’s house, or to be hit by a car,” she says. And for all the attention given to school shootings, kids are at greater risk of being the victims of violence in the home or on their way to and from school. Another example of perception not matching reality is in workplace violence. Based on media portrayals, the general perception in the 1990s was that most workplace homicides resulted from disgruntled workers taking out their frustrations on coworkers or supervisors. In fact, 75% of all workplace homicides are robbery-related. More than half occur in retail trade and service industries, where the almost daily killings of taxicab drivers, convenience store clerks and other retail workers go virtually unnoticed. Moreover, most work-related homicides are committed by strangers, unlike homicide in the general population. Despite lingering misperceptions, public health has made a significant impact in focusing attention on the biggest problems. “When research told us that you’re much more likely to be killed by someone you know — particularly an intimate partner if you are a woman — it had a great effect on law enforcement,” says Peek-Asa. “There is now training throughout most of the country in how to deal with domestic disputes.” One of the best illustrations of public health’s unique approach to violence is in the area of firearms. The handgun is the most common weapon used in both homicide and suicide in the United States. “The criminal justice system focuses on the user, whereas public health looks more upstream,” says Sorenson. Upstream strategies in reducing handgun-related injuries and deaths generally fall into one of two categories. Sorenson is among those who have focused on mechanism and design issues. The federal government is investing substantial resources in the development of “smart gun” technology, in which guns would
Left to right: Postdoctoral fellow Douglas Wiebe, doctoral students Cathy Taylor and Kate Vittes, and M.P.H. student Rhea Durr with the “human target.” Students visit a shooting range as part of the School’s gun policy course. fire only when held by the authorized user. Other designs, such as built-in locking mechanisms and magazine disconnects, reduce accidental shootings, Sorenson notes. Public health also focuses on firearms distribution — keeping guns out of the hands of people who shouldn’t have them. The second category, a social-change approach, emphasizes the inequalities that might give rise to violence. “Researchers try to understand why the differences exist, and then seek to identify ways to remedy the situation,” Sorenson explains. Examples include increasing educational, employment and recreational opportunities in communities. Sorenson believes both strategies — along with those not specific to public health, such as criminal justice — are needed. As the public health approach to violence has gained acceptance, a number of strategies have been employed, and studies have borne out the effectiveness of specific programs in working with specific populations. What’s needed now, experts in the field agree, are more global, community-wide evaluations of what works in reducing levels of violence. “Up until 1994, we saw escalating rates of violent crime,” says Peek-Asa. “Then, all of a sudden, rates plummeted across the board — rural, urban, workplace, school, domestic...almost every type of violent crime went down. And we don’t really know why. Economics probably had something to do with it, changing law enforcement practices may have contributed, community organizations were starting to play a very strong role — but we don’t really know. Now, we see rates starting to rise again. We desperately need comprehensive studies that evaluate what drives these broader trends.” Other issues Weiss sees as ripe for further study include the link between family violence and community violence. “Anecdotally, when I speak to kids who are in gangs or have been involved in gangs and violence, they’ve typically been victims or witnesses of family violence,” she says. Cultural differences related to violence are also important to examine. Peek-Asa and colleagues are completing Stephanie Monteleone, M.P.H. ’00 After graduating from the UCLA School of Public Health last year, Monteleone began working full-time as a Rape Prevention Education Coordinator at the Los Angeles Commission on Assaults Against Women (LACAAW). As part of the program, Monteleone conducts outreach to the 22 communities in her office’s service area in the West San Gabriel Valley, giving presentations on teen-relationship violence prevention, domestic violence prevention and sexual assault prevention education, as well as selfdefense classes. Among other sites, Monteleone facilitates these presentations at middle schools and high schools in the Pasadena, Arcadia, San Gabriel, El Monte, and Alhambra Unified School Districts. “I believe it is valuable for youths to learn about domestic violence and how to prevent violence against women,” she says. “Teens have told me they appreciate having the opportunity to discuss ways that they can build healthy relationships and prevent violence and abuse from occurring in their own lives.” “When research told us that you’re much more likely to be killed by someone you know ... it had a great effect on law enforcement.” —Dr. Corinne Peek-Asa Kate Vittes Vittes, a Ph.D. student, has been part of a study headed by Sorenson on straw purchasers — people who commit the crime of buying guns for someone else, such as a felon or, as in the Columbine tragedy, a minor. The study examines the likelihood of gun dealers selling to a straw purchaser, using a national probability sample. Vittes, who is also analyzing data about attitudes toward firearms from a national survey of high school students, says she began to realize the importance of a public health approach to violence after a visit to Folsom State Prison last fall. "It became clear to me that more has to be done on the prevention side," she says, "and that’s where I feel I can make the most difference." She believes focusing on firearms access is the type of "upstream" approach that can make a major impact. "The United States has had a violence problem for a long time," Vittes says, "but in recent times, firearms are the most common weapons used in homicide and suicide." 17 cover story UCLAPUBLIC HEALTH
Page 1 and 2: UCLA PUBLIC HEALTH JUNE 2001 UCLA S
Page 3 and 4: When the Best Medicine Is Public He
Page 5 and 6: DEAN’S ADVISORY BOARD 3 ANDREW AL
Page 7 and 8: Chiropractic Care Appears Slightly
Page 9 and 10: Disadvantaged Groups Less Likely to
Page 11 and 12: The Healthcare Collaborative at UCL
Page 13 and 14: 11 Why so much bickering over the r
Page 15 and 16: 13 There is a national shortage of
Page 17: measure it and find places to inter
Page 21 and 22: Pillars of the Community FOUR YEARS
Page 23 and 24: alumni profile Heal the Bay’s Mar
Page 25 and 26: 2001 student awards 23 DAVID M. SOU
Page 27 and 28: honor roll 2000 THE SCHOOL THANKS A
Page 29 and 30: ALEXANDER CAPRON AND KATHLEEN WEST
Page 31 and 32: WILLIAM AND FLORA HEWLETT FOUNDATIO

JUNE 2001 - UCLA School of Public Health

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