Full Magazine - UCLA School of Public Health

UCLA
PUBLIC HEALTH
JUNE 2006
OBESITY’S
HEAVY BURDEN
an epidemic threatens the nation’s health
UCLA
School of
Public
Health
Biostatistician
Christina Ramirez
Kitchen seeks to
make sense of
the complex
DNA sequences
of the HIV virus –
information that
could save lives.
Health care costs
continue to soar in
the United States.
Faculty such as
Jack Needleman
help us to understand
whether
we are spending
our money wisely.
Typhanye
Penniman was
not exposed to
public health
growing up. As
a doctoral student,
she returns to her
community to
spread the word.

PUBLIC HEALTH
UCLA
UCLA
Albert Carnesale, Ph.D.
Chancellor
Linda Rosenstock, M.D., M.P.H.
Dean, UCLA School of Public Health
Sarah Anderson
Assistant Dean for Communications
Anita Mermel
Executive Director of Development
features
Dan Gordon
Editor and Writer
Martha Widmann
Art Director
EDITORIAL BOARD
Richard Ambrose, Ph.D.
Associate Professor,
Environmental Health Sciences
Thomas R. Belin, Ph.D.
Professor, Biostatistics
Ralph Frerichs, D.V.M., Dr.P.H.
Professor, Epidemiology
F. A. Hagigi, Dr.P.H., M.B.A.
Associate Professor, Health Services
William Hinds, Ph.D.
Professor, Environmental Health Sciences
Michael Prelip, D.P.A.
Assistant Professor,
Community Health Sciences
Susan B. Sorenson, Ph.D.
Professor, Community Health Sciences
La Shawnta Bell-Lewis, Ashley Peterson
Co-Presidents, Public Health Student Association
Christopher Mardesich, J.D., M.P.H. ’98
President, Alumni Association
4
Alumni Hall of Fame:
the 2006 Inductees
6
Obesity’s
Heavy Burden
Diets are higher in fat.
Portions are larger.
Workplaces, schools and
communities are more
sedentary. Our environment
has changed, leading more
of us to tip the scales at
dangerous levels.
1
School of
Public
Health

Formulas
for Success
Are We
Getting Our
Money’s Worth?
2
By developing methods
for analyzing the genetic
sequences of patients with
HIV, Christina Ramirez
Kitchen shows scientists
how the virus evolves over
time and with treatment –
information that could
save lives.
14
Building
Capacity
Overseas
In many parts of the world,
the school is helping to
strengthen the ability of
developing nations to tackle
health challenges. Here are
six examples.
18
As new drugs and high-tech
advances continue to drive up
the price of medical services,
experts question whether we are
putting enough consideration
into how we spend.
in every issue
23
28
31
32
34
RESEARCH
Chromium and cancer
risk...the value of R.N.’s...
discrimination against HIV
patients...residential fields
and childhood leukemia...
the importance of medical
interpreters...testosterone’s
gender-specific influence
on type 2 diabetes.
STUDENTS
FACULTY
NEWS BRIEFS
FRIENDS
ON THE COVER
More and more of us are tipping the scales at unhealthy levels. As an obesity epidemic grips the developed
world, public health professionals and academics are pointing to the need for changes in an environment
that has become less conducive to positive diet and physical activity choices.
Cover photo: Getty Images © 2006
PHOTOGRAPHY
ASUCLA / TOC: hall of fame; p. 4; p. 32: Brook
John Decker / p. 11: Goldstein
Lisa Hancock / cover: Needleman, Penniman; p. 18: Rice; pp. 19, 21-22
Reed Hutchinson / cover and TOC: Kitchen; pp. 7-8, 11-12; p. 32: Kaplan
Martha Widmann / TOC and p. 18: photo illustration; p. 23
Courtesy of Dr. Ralph Frerichs / p. 16
Courtesy of Dr. Osman Galal / p. 17
Courtesy of Dr. Fred Hagigi / p. 15
Courtesy of Dr. Anne Rimoin / TOC: building capacity; p. 17
Courtesy of Dr. Paul Torrens / p. 15
Courtesy of UCLA School of Public Health / p. 2; p. 31; p. 32: Diamond, lab, stem cell; pp. 33, 37; back cover
Getty Images © 2006 / TOC: obesity; pp. 9-10
iStockphoto © 2006 / p. 14
Superstock © 2006 / p. 26
Veer © 2006 / pp. 6-7
School of Public Health Home Page: www.ph.ucla.edu
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UCLA Public Health Magazine is published by the UCLA School of Public Health for the alumni, faculty,
students, staff and friends of the school. Copyright 2006 by The Regents of the University of California.
Permission to reprint any portion must be obtained from the editor. Contact Editor, UCLA Public Health
Magazine, Box 951772, Los Angeles, CA 90095-1772. Phone: (310) 825-6381.

2
dean’s message
THERE IS AMPLE EVIDENCE that ease and convenience
are among the most common drivers of daily food and activity decisions.
Unfortunately, contemporary American society has created an environment in
which it is easy for adults and children to make poor decisions about exercise
and nutrition and difficult for them to make good decisions. The result is an
epidemic that unless addressed decisively could lead, for the first time in 100
years, to a shorter life expectancy for the next generation.
UCLAPUBLIC HEALTH
Although the consequences of the obesity epidemic fall squarely on the
health care system, true solutions fall largely outside. As with other public health
problems, we know that the most effective treatment rests with approaches that
deal with populations and communities to prevent the problem before it starts,
rather than with trying to solve an individual’s obesity problem. If we focus on
an individual, rather than look for societal factors and interventions, we will wait
a very long time before we turn around this staggering epidemic.
A recent announcement that the beverage industry will remove high-calorie
soft drinks from all the nation’s schools is an example of how corporate America
can help in tackling this burgeoning problem. But we also need national leadership
and courage to combat the forces that are all too comfortable with the epidemic.
This means having the courage to stand up to economically vested
interests while recognizing that partnering with business and other sectors to
craft a myriad of interventions – at local, state and national levels – is needed.
Our cover story (page 6) looks at the causes, including genetic and physiologic
factors as well as environmental factors, of the obesity epidemic and more
importantly seeks to find solutions. Our faculty members are working closely
with business leaders, community groups, government agencies and schools to
forge partnerships that will make it easier for people to make healthier decisions.
We need to gear our interventions to practical and societal steps that make
eating badly less likely, make getting appropriate exercise more likely, and are
not simply relying on the magic bullet – the miracle drug or cure – which almost
never arrives, and when it does, is never quite as good as originally advertised.
Also grabbing national headlines and much focus at the school is Avian Flu
and a potential pandemic. I’m pleased to announce that the UCLA School of
Public Health will soon be home to the first-of-its-kind high-speed, high-volume
laboratory network (page 32). The lab will be capable of quickly analyzing and
processing high quantities of biological samples to enhance our ability to gather
and analyze more surveillance data, improving our nation’s ability to respond
quickly to a bio-emergency such as a bioterrorist attack or flu pandemic.

3
This effort introduced me to the newest member of the Dean’s Advisory
Board and winner of this year’s Dean’s Award, Cindy Harrell Horn. I met Cindy
when she came to my office to talk about the necessity of such a lab. With an
initial federal investment of $6 million in federal funding, we are poised for additional
federal dollars as well as seeking funding from the State of California and
private supporters. Behind each of these investments is the investment of time
and energy from Cindy Horn. She has become an ardent supporter of the school
and our work and has been a key to helping us realize our fundraising goals.
As the decade-long Campaign UCLA comes to a close, I’m pleased to
report that the School of Public Health raised more than $56 million in private
support – exceeding our original goal by more than three-fold and our revised
goal by 183% (page 34). These funds enabled us to provide financial assistance
to more than 500 students and helped launch important new public health initiatives
to address global health, emerging infectious diseases and eliminating
health disparities. Additionally, major classroom renovations and updates of our
information technology infrastructure have been made possible, as has the creation
of a new career services office to assist our graduating students in their
career exploration and job placements.
With the close of another school year, I am reminded once again that we
in the public health field have the amazing privilege of knowing that our work
makes a tangible difference on a local, national and international level. I am
excited about the opportunities awaiting our new graduates as they enter the
field, and know that their skills, enthusiasm and commitment to doing good
things will allow them to do just that.
2005-2006 DEAN’S
ADVISORY BOARD
Ira R. Alpert*
Linnae Anderson
Diana Bontá*
Lester Breslow
Sanford R. Climan
Edward A. Dauer
Michele DiLorenzo (Chair)
Robert J. Drabkin
Tom Epley
Gerald Factor (Vice Chair)
Michael R. Gardner
Robert W. Gillespie
Alan Hopkins*
Cindy Harrell Horn
Stephen W. Kahane*
Carolyn Katzin*
Carolbeth Korn*
Jacqueline B. Kosecoff
Kenneth E. Lee*
Richard D. Lipeles*
Edward J. O’Neill*
Walter Oppenheimer
Monica Salinas
David Walker
Fred Wasserman*
*SPH Alumni
Linda Rosenstock, M.D., M.P.H.
Dean
TOTAL EXPENDITURES
Grants and Contracts
State-Generated Funds
Gifts and Other
Fiscal Year 04-05
$42.2 million
UCLAPUBLIC HEALTH

4
alumni hall of fame:
the 2006 inductees
The UCLA School of Public Health Alumni Hall of Fame was established in 2002
to honor alumni with outstanding career accomplishments in public health,
as well as those who have volunteered time and talent
in their communities in support of public health activities.
The 2006 inductees, recognized at the Breslow Lecture and Dinner on April 24,
exemplify the school’s commitment to teaching, research and service.
UCLAPUBLIC HEALTH
2006 Hall of Fame
inductees (l. to r.)
Zunyou Wu, Barry R.
Wallerstein and
Stanley Lemeshow
STANLEY LEMESHOW, Ph.D. ’76
Whether it’s as an educator, researcher or administrator, Lemeshow’s leadership has made him an ambassador
for public health in the educational setting. Lemeshow, who has served as dean of the School of Public
Health and director of the Center for Biostatistics at Ohio State University (OSU), studies the use of statistical
modeling in medical and public health research and has published extensively, including four books,
130 individual publications and more than 20 book chapters. His current research is in the areas of intensive
care outcomes, cancer research and stress and healing. In his capacity as dean, Lemeshow is laying the foundation
for OSU’s School of Public Health to become a strong and independent entity within the university’s
prominent Center for Health Sciences. He directs the Summer Program on Applied Statistical Methods, is
on the faculty of the Erasmus Summer Program held each August in Holland, and has taught more than 75
short courses in the United States, Europe and Australia.
Lemeshow has earned widespread recognition for his leadership and teaching over the course of his
career, which included 23 years on the faculty at the University of Massachusetts School of Public Health
prior to joining the OSU faculty in 1999. Among others, he was elected Fellow of the American Association
for the Advancement of Science, awarded the Wiley Lifetime Award, selected Distinguished Graduate
Alumnus (Biostatistics) by the University of North Carolina Graduate School Centennial, elected Fellow
of the American Statistical Association and awarded the Statistics Section Award from the American Public
Health Association.

5
BARRY R. WALLERSTEIN, D.Env. ’88
For more than two decades, Wallerstein has developed and implemented
ground-breaking strategies to attain clean air standards – and their accompanying
health benefits – for all residents of Southern California. As executive officer of
the South Coast Air Quality Management District (AQMD) since August 1997,
he serves as chief of staff to implement environmental protection policies as
approved by the agency’s Governing Board, and to work proactively with state
and federal regulatory officials, local governments, and community stakeholders.
In recent years, he has carried out innovative programs to: address specific community
and neighborhood environmental justice issues, including the evolving
area of disproportionate and cumulative impacts; identify and reduce air toxics
exposure (especially diesel particulate); integrate voluntary cleanup incentives
into regulatory structures; and strengthen public-private investment
in clean fuels and sustainable energy technologies.
Wallerstein was first charged with carrying out the historic set of
Environmental Justice Initiatives adopted by the AQMD Governing Board in
1997, including a variety of strategies to improve two-way communication
between local residents and the air district. Together, these strategies have
resulted in a sea change in the way the South Coast air district scientifically
assesses health risk from air pollutants, and residents now have a much stronger
voice in shaping and prioritizing regional pollution control efforts. Wallerstein
has demonstrated that strengthened partnerships among all community sectors
can lead to the successful accomplishment of clean air initiatives.
ZUNYOU WU, M.D., M.P.H. ’92, Ph.D. ’95
Wu is making his mark in global health as director of the National Center for
AIDS/STD Control and Prevention, Chinese Center for Disease Control and
Prevention, the highest position for HIV/AIDS control in China. He was the
first public health investigator to report the HIV epidemic among former plasma
donors in rural China in 1995 and initiated a health promotion program supporting
condom use. Wu was also the first to successfully implement outreach
programs for female sex workers through extensive behavioral interventions.
He led China’s first research project for harm reduction among drug users, then
took a leadership role in scaling up China’s national methadone maintenance
program. His research sparked the creation of national guidelines in China for
sex workers and substance users, translating science into life-saving public health
programs. For his role in stopping the SARS outbreak in China, Wu received
special commendation from the Chinese government.
Wu also serves on committees that oversee HIV intervention projects in
Russia, India, Peru and Zimbabwe, as well as the Task Force on Drug Use and
HIV for the United Nations Office on Drugs and Crime and the Joint United
Nations Programme on HIV/AIDS in the Asia-Pacific region. He has competed
successfully for research and training grants from the National Institutes of
Health (NIH), numerous non-governmental organizations, the Rockefeller
Foundation, the World Bank, and the World Health Organization. Wu was
also one of the first non-Americans to be awarded an International Clinical,
Operational, and Health Services Research Training Award from the NIH.
As the China director for the UCLA/AIDS International Training and Research
Program, he has played a key role in recruiting students and mentoring Ph.D.
students.
Please access information on 2007 nominations at www.ph.ucla.edu/alumni_hall.html,
or call (310) 825-6464.
PREVIOUS INDUCTEES
Ira R. Alpert, M.S.P.H. ’66
Wendy Arnold, M.P.H. ’82
Stanley P. Azen, Ph.D. ’69
Donna Bell Sanders, M.P.H. ’81
Diana M. Bontá, R.N., M.P.H. ’75, Dr.P.H. ’92
Linda Burhansstipanov, M.P.H. ’72, Dr.P.H. ’74
Virginia A. Clark, Ph.D. ’63
Francine M. Coeytaux, M.P.H. ’82
Suzanne E. Dandoy, M.D., M.P.H. ’63
Mark Gold, D.Env. ’94
Harold M. Goldstein, M.S.P.H. ’89, Dr.P.H. ’97
Raymond D. Goodman, M.D., M.P.H. ’72
Richard A. Goodman, M.D., J.D., M.P.H. ’83
Nancy Halpern Ibrahim, M.P.H. ’93
Carolyn F. Katzin, M.S.P.H. ’88, C.N.S.
Robert J. Kim-Farley, M.D., M.P.H. ’75
Kenneth W. Kizer, M.D., M.P.H. ’76
James W. LeDuc, M.S.P.H. ’72, Ph.D. ’77
Angela E. Oh, J.D., M.P.H. ’81
Keith S. Richman, M.D., M.P.H. ’83
Pauline M. Vaillancourt Rosenau, M.P.H. ’92, Ph.D.
Jessie L. Sherrod, M.D., M.P.H. ’80
Irwin J. Shorr, M.P.H. ’72, M.P.S.
Stephen M. Shortell, M.P.H. ’68, Ph.D.
Shiing-Jer Twu, M.D., M.P.H., Ph.D. ’91
Kenneth B. Wells, M.D., M.P.H. ’80
hall of fame UCLAPUBLIC HEALTH

6
DIETS ARE
HIGHER IN FAT.
PORTIONS ARE
LARGER. WORK-
PLACES, SCHOOLS
AND COMMUNITIES
ARE MORE SEDEN-
TARY. OUR ENVIRON-
MENT HAS CHANGED,
LEADING MORE OF
US TO TIP THE
SCALES AT DANGER-
OUS LEVELS.
Obesity’s Heavy Burden
An Epidemic Threatens
the Nation’s Health
UCLAPUBLIC HEALTH
Among the nation’s
children 34%
are overweight
and 17% are obese,
up from 28% and 14%
at the beginning
of this decade.
Where did this bulging waistline come from?
In the evolutionary equivalent of the blink of an eye, overweight is suddenly the
overwhelming norm in the United States.
Two of every three U.S. adults – 129.6 million people – are classified as overweight.
Nearly half of them – more than 60 million – are obese. The proportion
of obese adults, now estimated at 32%, has more than doubled in 30 years.
Among the nation’s children 34% are overweight and 17% are obese, up
from 28% and 14% at the beginning of this decade. Since 1980, the prevalence
of overweight U.S. children has doubled; overweight in adolescence has tripled.
A study by researchers at UCLA and RAND found that the effects of
obesity are similar to 20 years of aging, and that obese adults have 30%-50%
more chronic medical problems than those who smoke or drink heavily. Obesityrelated
health care conditions contribute as much as $93 billion to the nation’s
annual medical bill, according to a 2003 study by the Centers for Disease
Control and Prevention (CDC). A 2005 study in the journal Health Affairs
estimated that such conditions accounted for 11.6% of total health care spending
in 2002, up from just 2% in 1987.
Not long ago, medical students were taught that they were unlikely to see
type 2 diabetes in anyone under 40; now, type 2 – no longer called “adult-onset”

– is being diagnosed at alarming rates in children
under 10. That’s one reason U.S. Surgeon General
Richard Carmona calls childhood overweight and
obesity “the fastest growing, most threatening disease
in America today.”
How big a threat? Dr. Linda Rosenstock, dean
of the UCLA School of Public Health, raises this
alarming specter: “It’s plausible that we’re going to
see for the first time in 100 years that the generation
coming up behind us will have a shorter life
expectancy than the current one.”
What has happened? Why are so many people
in this country carrying so many extra pounds? On
the one hand, the calculus is simple: Excess calories
going in for calories burned means people are gaining
weight. But the fact that this equation applies
to twice as many of us as it did a generation ago
suggests that something is different.
“We know several things about this epidemic,”
says Rosenstock. “It came upon us very quickly; it is
global, although one in which the United States not
too proudly leads our counterparts in the developed
world; and it likely reflects a number of factors,
including genetic and physiologic factors, coupled
with environmental factors such as increased food
availability, decreased expenditure of energy due to
more sedentary work, and environments that aren’t
conducive to walking or other forms of exercise.”
To be sure, we are eating differently than we
were a few decades ago. Fast food – notoriously high
in fat and calories – represented 4% of total U.S. food
sales outside the home in the middle of the 20th
century…and 34% by the end of it. A recent study
by the UCLA Center for Health Policy Research,
based in the School of Public Health, found that
half of California teens eat fast food at least once
a day. By comparison, less than 25% of the state’s
teens meet the daily recommendation of five servings
of fruits and vegetables.
For many communities, the road to healthy
eating is arduous. Dr. Antronette Yancey, associate
professor at the school, works locally with the CDCfunded
Racial and Ethnic Approaches to Community
Health (REACH 2010) project, which has hired and
trained community members to document the quality
and variety of healthy food options in low-income
neighborhoods. Yancey’s group has found that stores
in such neighborhoods offer half the variety of fruits
and vegetables as those in affluent communities and
that, on average, the quality of produce on the shelves
in low-income areas is significantly poorer. These
neighborhoods also tend to have fewer supermarkets
per capita, and a higher proportion of fast-food
restaurants. Exacerbating matters, Yancey notes, are
print, billboard and broadcast advertisements for
unhealthy foods and beverages – cheap sources of
comfort in managing lives that are highly stressful.
In an era when adults are more likely to work
in sedentary jobs than their parents and grandparents,
their children are spending more time in front
“If two-thirds of the population
is overweight,
you have a societal issue,
and individual solutions are not
going to be enough.”
— Dr. Antronette Yancey
7
cover story UCLAPUBLIC HEALTH

8
UCLAPUBLIC HEALTH
Stephanie
Vecchiarelli,
M.P.H. ’01
Vecchiarelli’s experiences
studying adolescent reproductive
health and working
for the Division of Adolescent
and School Health at the
Centers for Disease Control
and Prevention during her
internship as an M.P.H.
student, along with her background
in teaching, led to
her desire to work in school
health. “I strongly believe that
if students are not healthy,
they will not be able to reach
their full academic potential,”
Vecchiarelli says. “If students
aren’t eating nutritionally,
getting enough sleep, are
worrying about violence in
their homes, or don’t receive
proper medical, dental, or
vision care, how can we
expect them to concentrate
in school? I also know that
schools cannot do this work
alone. They must work with
parents and the entire community
to make lasting
changes.” Vecchiarelli, who
says she grew up in a family
with poor dietary habits and
has had to make major
dietary and physical activity
changes as an adult, is
currently a project director for
the UCLA School of Public
Health’s Nutrition Friendly
Schools and Communities
program, helping to determine
the impacts of schoolbased
environmental changes
on student, staff, and parent
dietary and physical activity
knowledge, attitudes, and
behaviors. She also completed
a study of the development,
implementation, and
impact of the LAUSD soda
and junk food ban as part
of her doctoral dissertation
in the UCLA School of
Education.
of the TV or computer than previous generations –
roughly a quarter of their waking hours. Many schools
have cut back on physical education and after-school
sports and dance programs, particularly in lowincome
areas, where obesity is rising most rapidly.
The number of children who walk to school
declined over a single generation from 80% to just
10%. Many urban neighborhoods are considered
unsafe for walking, or are not conducive to exercise
due to poor design and urban sprawl.
“A lot of people don’t realize that there is a
huge environmental component to this obesity epidemic,”
says Yancey. “Human beings didn’t just suddenly
become lazy and unwise in their eating choices.
What has happened is that our environment has
changed dramatically in a very short period of time.”
The rapid rise in the epidemic has left researchers
and public health professionals scrambling to determine
how best to combat it. Federal funding supports
studies aimed at everything from getting a
better grasp of obesity’s pathophysiology to identifying
successful ways of influencing healthy eating and
physical activity levels. “There are so many factors
influencing this problem that it’s going to take multiple
approaches,” says Dr. Mark Schuster, professor
at the school and director of the UCLA/RAND
Center for Adolescent Health Promotion.
On one front, researchers are attempting to
better understand the gene-environment interactions
that are fueling the epidemic. Dr. Simin Liu, professor
of epidemiology at the school, has spent the last
decade analyzing data from large long-term studies
in an effort to home in on dietary patterns as they
relate to obesity and type 2 diabetes risk. His work
“A molecular understanding alone
is not going to provide the solution.
We already know that people need to
eat less and exercise more, but there
are many forces that are working
against their ability to do that.”
— Dr. Simin Liu
has been influential: For example, looking at historical
data provided by the CDC along with dietary
consumption data from the U.S. Department of
Agriculture, Liu and colleagues at Harvard concluded
that the increased consumption of rapidly absorbed,
refined carbohydrates in the U.S. diet has paralleled
the rise in obesity and type 2 diabetes. His findings
helped to establish regulatory and labeling guidelines
for the FDA’s whole grains and heart disease health
claims, and informed the Healthy People 2010 and
2005 Dietary Guidelines.
Liu believes that studies seeking to understand
the molecular underpinnings of obesity have the
potential to strengthen the argument for a population
approach to prevention as well as improving
efforts by enabling more targeted messages to be
delivered about diet, based on people’s genotypes.
But he shares the view of many in public health that
prevention efforts aren’t failing for lack of knowledge
about obesity’s causes. “A molecular understanding
alone is not going to provide the solution,”
Liu says. “We already know that people need to eat
less and exercise more, but there are many forces
that are working against their ability to do that.”
Yancey contends that much can be gained by
learning about the role of the sociocultural environment
in encouraging or discouraging healthy eating
and physical activity. While a growing body of
research is documenting the impact of access to
parks, walking trails and health clubs on people’s
exercise levels, Yancey is addressing the potential
health benefits of changing the culture of a workplace
or organization. Corporate strategies such as
encouraging gym membership through subsidies or
on-site facilities are important, she notes, but Yancey
believes workplaces also need to be more proactive,
to the point where healthy on-the-job lifestyles
become almost unavoidable. If healthy snacks
replace doughnuts at meetings and events, structured
group exercise breaks become an entitlement
on par with coffee breaks, and parking near work
facilities is limited to people with physical disabilities,
employees will have an easier time getting, and
staying, in shape. “The public is so unfit right now
that most people have lost touch with how much
better it feels to be active,” she says.
Yancey is currently co-leading a project with a
Georgia Tech researcher to assess the potential influence
of architectural design in that regard. Their
study compares the physical activity levels of employees
on either end of a downtown Los Angeles building:
On one side, there is easy access to stairs in an
aesthetically pleasing location, providing a desirable
alternative to elevators that don’t go to every floor;
on the other, the stairs are tucked away in an inconvenient
location and elevators stop at each floor.

Fast food, notoriously high in fat
and calories, represents 34% of
U.S. food sales outside the home.
“One of the key questions is whether engaging in more physical activity in the
work environment will translate to doing more to stay in shape in one’s spare
time,” Yancey explains.
Other faculty are working to improve the school and home environment for
children. The Nutrition-Friendly Schools and Communities program established
by Drs. Charlotte Neumann, Michael Prelip and Wendelin Slusser provides
schools in the Los Angeles Unified School District (LAUSD) with a flexible, lowcost
roadmap for creating a positive environment for good health. The effort has
identified 15 steps schools can take toward becoming more “nutrition friendly,”
including increasing parental involvement around health issues, providing healthy
school lunches, integrating nutrition education in the curriculum, and promoting
physical activity. In a pilot study involving eight schools, the researchers found
that outlining these steps and providing a program liaison who works closely
with educators and parents to tailor strategies to individual schools and communities
resulted in significant changes in the school environment.
Schuster was recently awarded a grant from the National Institutes of
Health to work with LAUSD, the Los Angeles County Department of Health
Services, and other community partners in developing and testing a strategy for
obesity prevention in middle-school-age youth. “As children grow older, parents
and schools have less influence over what they eat,” he notes. “They’re going off
on their own to buy food for the first time, and the choices they are making
are often unhealthy ones.”
Interventions aimed at this population need to take into account the delicate
issue that adolescents tend to be particularly self-conscious about their bodies.
“At a time when they are developing their self-confidence, we don’t want the
health care system to be undermining it in the process of trying to help them be
healthier,” Schuster says. Nonetheless, he adds, parents should be assisted in recognizing
that they can still have an influence on their child’s lifestyle during
adolescence; all parents, Schuster contends, should be encouraged to provide a
good example by exercising and eating well.
Targeting not only parents but also others with the potential to influence
behaviors is viewed as an important strategy. With a grant from the National
Shauna
Harrison
As a schoolteacher, Harrison
noticed the poor health
habits of her students and
how that affected their inclass
behavior. Although she
was teaching Spanish, she
also used the classroom to
educate her students on
proper nutrition and lifestyle
habits. Harrison wanted to
create an entire class dedicated
to such health topics,
but her school’s administration
failed to embrace the idea.
“This created a fire in me to
want to improve the nutrition
and fitness of children,” she
says. Harrison came to UCLA
for the joint M.P.H. and M.A.
program in Latin American
Studies. She spent her internship
(supported by funds
from the school’s Neumann-
Drabkin-Bixby program)
teaching nutrition to preschool
children in Costa Rica, where
she had gone as an undergraduate
to study the influence
of American media on
body image in Costa Rican
girls. This fall, she will start
a Ph.D. program in health
communications at Johns
Hopkins University. “I plan to
examine the spectrum from
obesity to eating disorders,
with attention to the importance
of mental health and
the role of the media,” says
Harrison, a certified personal
trainer and group fitness
instructor. “I hope to bring
health education that
improves nutrition, increases
physical activity and builds
self-esteem to our schools
so that children have the
opportunity to make healthier
choices as they grow older.”
Jabar Akbar,
M.P.H.
Obesity is affecting the health
outcomes of the general
population, particularly the
poor and many underserved
minority communities. Akbar,
a doctoral student at the
school, works with a team
of researchers from Georgia
Tech University and UCLA on
a project that assesses the
utilization of stairs in a building
whose architectural design
is mostly conducive to physical
activity. The main elevators
stop at select floors, forcing
employees to use the stairs
to get to a desirable floor,
while employees who work
on the other side of the building
don’t have access to the
“skip” elevator design. Akbar
is collecting data on the
amount of stair usage by
employees on both sides.
For another project, Akbar
helped to create a research
tool that is assessing the
weight-related outdoor
advertising appearing in
geographical areas that are
predominantly African
American, Latino or white in
five U.S. cities. “The media
have been used to market
unhealthy products such as
junk food, alcohol, and
tobacco to specific consumer
populations,” Akbar says.
“With the growing disparities
debate, many communities
are being unfairly singled out
as targets of these products.”
Akbar hopes eventually to use
his doctoral degree to pursue
further obesity-related community
intervention research
as a junior faculty member
and researcher.
9
cover story UCLAPUBLIC HEALTH

10
UCLAPUBLIC HEALTH
Lauren Neel
Before coming to UCLA,
Neel was an AmeriCorps
member serving the Yolo
County Health Department,
First 5 Yolo and the Yolo
County Children’s Alliance.
She coordinated the efforts of
each of these organizations
in promotion of the community
goal: to reduce the incidence
of childhood obesity in Yolo
County. “My favorite project
was going into the high
schools and presenting a
health education workshop
using the film Super Size
Me,” Neel says. “Getting into
the schools and having the
opportunity to talk directly
with the students was a great
opportunity and made me
excited to continue working
toward my goals.” Her experience
as an M.P.H. student
has solidified Neel’s commitment
to promoting healthy
eating and increased physical
activity. She works with the
Nutrition Friendly Schools
and Communities study
investigating nutrition and
physical activity behaviors in
elementary school students
in LAUSD. Through a summer
internship at Neutrogena
Health and Fitness
Corporation, she is designing
employee wellness materials,
creating fitness challenges
and coordinating healthy
eating initiatives. Ultimately,
she plans to get a personal
training license and is considering
becoming a registered
dietitian after completion
of her M.P.H. “At the end of
the day,” Neel says, “I hope
I end up somewhere where
I can help people reach their
health goals and make a real
difference.”
Judith
Mercado,
M.P.H. ’04
As part of her M.P.H. program,
Mercado completed
an internship in which she
helped design, implement
and evaluate a summer fitness
and nutrition program
for children at a church in
Inglewood. “It was really fulfilling
to expose the kids to
nutrition and fitness in a fun,
healthy way,” she says. That
summer, as she realized that
her younger sister, then 7,
had been gaining weight
considerably, Mercado developed
an even stronger inclination
to pursue a career in
which she could help. Now
a wellness coordinator for
the Johnson & Johnson
company Biosense Webster,
Mercado coordinates, markets,
implements and evaluates
health education/
behavior change programs
around weight management,
physical activity, smoking
cessation, blood pressure
and cholesterol management.
She also teaches
nutrition to overweight children
for an organization
called PowerPLAY MD. Her
sessions for these children
and their families help them
with understanding portion
sizes, reading labels, healthy
snacking, and navigating fast
food choices. “I have been
fortunate to see very positive
changes and understand
what lies underneath many
overweight children’s struggles,”
Mercado says. “In
some cases, parental
involvement is the key to
helping their children take
the excess weight off. In
other cases, the children’s
own motivation is much
stronger than their parents’
lack of understanding and
support, and to witness that
is beyond inspirational.”
Adults are more likely to work
in sedentary jobs than their parents
and grandparents. Children spend
one-fourth of their waking hours
in front of the TV or computer.
Center for Minority Health and Health Disparities, Yancey is attempting to promote
healthy eating and physical activity among health and social services workers
with the idea that if they are successful it will, in turn, make them more
likely to promote those behaviors among their clients.
Similarly, a study led by Dr. Judith Siegel, professor of community health
sciences at the school, aims to enhance opportunities for teachers and staff at
eight LAUSD elementary schools to engage in physical activity and healthy eating
at work. The project came out of observations from the Nutrition Friendly
Schools and Communities program that the rate of overweight and obesity
among the faculty and staff at the schools mirrored the high rate in the overall
population. “We felt that by helping these individuals work toward becoming
healthier, we might also improve the likelihood that they would be good role
models and enthusiastic supporters of promoting healthy behaviors among the
children and families at their schools,” Siegel explains.
The study uses a participatory approach, allowing a committee of teachers
and staff at each school to develop their own worksite health promotion program
within the project’s financial constraints. “We’re trying to find success with interventions
that cost little, if anything, and are sustainable,” says Prelip, co-principal
investigator on the study. Activities chosen have ranged from walking clubs, yoga
and exercise classes to healthier food options at staff meetings and in lunch rooms.
While the researchers hope that promoting healthier lifestyles among the
faculty and staff will ultimately have a more far-reaching influence, their immediate
concern is how it will affect the participants. “There are major advantages
to doing health promotion in the workplace,” says Siegel. “It’s where people
spend the largest proportion of their waking hours, and if there is collective
involvement and enthusiasm for these programs, that creates a good environment
for behavior change that can carry over to other aspects of people’s lives.”
For all California schools, the nutrition environment will be improved by two
new state laws that go into effect next year, implementing the nation’s most
rigorous standards on the nutritional content of a la carte foods, snacks, and
beverages sold on K-12 public school campuses. The signing by Gov. Arnold

Schwarzenegger of the laws – which establish limits
on fat and sugar content and portion size, effectively
banning sales of “junk food” and soda at the schools
– culminated six years of work by the California
Center for Public Health Advocacy (CCPHA). The
center, under the leadership of UCLA School of
Public Health alumnus Harold Goldstein (M.P.H.
’89, Dr.P.H. ’97), was established in 1998 to raise
awareness about public health issues and mobilize
communities to promote the establishment of effective
health policies. CCPHA has helped lead efforts
to improve children’s food and physical activity
environment, helping to ensure that they can make
healthy eating and activity choices.
Following up on the success of its campaign for
new nutrition standards, CCPHA is sponsoring legislation
that would provide funding to train elementary
school teachers in new guidelines on how to
teach physical education. “With all of the academic
testing going on, physical education has fallen by the
wayside,” says Goldstein, “and it’s time to make children’s
physical health as important as their intellectual
health.” CCPHA is also backing a bill in the
California Legislature that would create an incentive
for companies to open grocery stores in low-income
communities or refurbish ones that are already
there, improving residents’ access to healthy foods.
Goldstein is finding considerable support for
both bills. “The passage of the school nutrition standards
was a landmark, but it was a small first step in
creating environments in schools and communities
that support adults and children in making healthy
food and physical activity choices,” he says.
“Too many policy makers have had the mistaken
belief that the obesity epidemic is all a matter
of personal responsibility. But they are starting to
understand that it’s also a matter of government
responsibility and corporate responsibility. When the
food industry in the United States spends billions of
dollars advertising unhealthy foods and beverages to
our children – hiring psychologists and marketers to
figure out the best ways to convince kids and par-
“We felt that by helping [school
teachers and staff] work toward
becoming healthier, we might also
improve the likelihood that they would
be good role models and enthusiastic
supporters of promoting healthy
behaviors among the children and
families at their schools.”
— Dr. Judith Siegel
ents to buy products that we know to be unhealthy
for them – it’s impossible to say this is all a matter
of personal responsibility. When there’s fast food on
every corner and physical education is being taken
out of the schools, it’s not just the individual who
needs to be held accountable.”
“If two-thirds of the population is overweight,
you have a societal issue, and individual solutions
are not going to be enough,” agrees Yancey.
“Certainly education and motivation are important,
but we also need to figure out, as a society, ways we
can share in the cost of adopting and maintaining
healthy lifestyles.”
Rosenstock also agrees that more proactive
action is needed – and that focusing too heavily on
individual-level behaviors is a mistake. “So much of
what is happening with regard to obesity is truly
beyond the control of the individual,” she says.
More than just trying to educate people about
the importance of healthy diet and exercise, she
believes a partnership among the medical and public
health systems as well as industry, communities
and all levels of government is needed. “We have to
get ahead of this one,” she says, “because the obesity
problem has been worsening while we’ve been taking
baby steps to address it.”
California Gov. Arnold Schwarzenegger signs legislation
establishing the nation’s most rigorous nutrition standards
for foods and beverages sold on K-12 public school campuses.The
legislation was championed by the California
Center for Public Health Advocacy, led by Dr. Harold Goldstein
(M.S.P.H. '89, Dr.P.H. '97), pictured third from left.
Ying-Ying Goh,
M.D.
Goh, a research fellow
pursuing an M.S. in health
services, is a pediatrician
who has seen firsthand the
health consequences – from
asthma exacerbations to diabetes
– of children being
overweight. “It made me
interested in pursuing
research about both medical
and environmental causes of
overweight in children – in
particular, how public policy
can help to reduce childhood
overweight,” she says. While
in residency training at
Children’s Hospital Boston,
Goh conducted a survey of
pediatric residents and found
that most viewed childhood
overweight as an important
problem, but that there were
significant barriers to being
able to address it as a physician.
Currently, she is working
on a study with a team at
the UCLA/RAND Center for
Adolescent Health Promotion
and the Los Angeles Unified
School District (LAUSD). The
Adolescent Healthy Living
Study is a research partnership
to develop and pilot an
intervention that addresses
weight-related health issues
among LAUSD middle school
students. Goh is conducting
interviews with a wide range
of community leaders, and
will assist with parent and
student focus groups in order
to inform the development
of an intervention that will
be implemented in middle
schools. She is also interested
in the impact of media
use on children’s health,
and plans to pursue projects
in that area.
11
cover story UCLAPUBLIC HEALTH

12
BY DEVELOPING
METHODS FOR
ANALYZING THE
GENETIC SEQUENCES
OF PATIENTS WITH
HIV, CHRISTINA
RAMIREZ KITCHEN
SHOWS SCIENTISTS
HOW THE VIRUS
EVOLVES OVER
TIME AND WITH
TREATMENT –
INFORMATION THAT
COULD SAVE LIVES.
Formulas for Success
Biostatistician Decodes
DNA Patterns to Fight HIV
As scientific debuts go, it would be hard to top the splash made
by Dr. Christina Ramirez Kitchen, whose first peer-reviewed publication was co-authored with a famous
HIV/AIDS clinician – and generated considerable controversy.
UCLAPUBLIC HEALTH
In the mid-1990s, Ramirez Kitchen was pursuing a graduate degree in statistics at Caltech when her
thesis adviser asked if she would be interested in participating in a study of HIV progression. The project
involved working with the adviser’s neighbor, Dr. Michael S. Gottlieb – the physician who, while at UCLA
in 1981, published the first report describing cases of AIDS.
Now, amid reports from clinical trials that the introduction of protease inhibitors and highly active antiretroviral
therapy (HAART) was resulting in dramatic improvements in patients, Gottlieb, who was running
a large HIV clinic, was looking for help in investigating why what he was seeing in his own practice seemed
different from what he was reading about in the clinical trials. Ramirez Kitchen agreed to assist with the
statistical analysis, working with Gottlieb and HIV researcher Scott Kitchen – her future husband.
It would be years before their findings would be accepted for publication.
Among the group’s conclusions: The decrease immediately seen in HIV morbidity and mortality following
the advent of HAART treatment was most likely transient, the result of a period of delayed disease
progression. “We found that resistance was winning – that certain patients were still failing these HAART
regimens,” Ramirez Kitchen recalls. “It was so contrary to what had been reported that the journals didn’t
want to believe it at first. People were talking about HAART as a possible cure for HIV because of the good
results in the clinical trials. But in the clinic, where there is a more diverse patient population and there

tends to be less compliance to the regimen, we were
finding viral resistance.”
Although it took time, the results ultimately
gained widespread acceptance in the scientific community,
as did another element of the team’s findings:
that a patient’s initial response to HAART is
predictive of future clinical prognosis.
Ramirez Kitchen, who joined the UCLA School
of Public Health faculty as an assistant professor of
biostatistics in 2001, has been bringing her statistical
expertise to HIV/AIDS studies ever since.
“It’s such an interesting problem,” she says.
“At the time I started, protease inhibitors were new,
HIV sequencing was new, and the virus and our perception
of it were changing so much. It was an
exciting time to become involved.”
Ramirez Kitchen has focused on how HIV
mutates in response to the drugs used to treat it, the
process by which the virus resists drug treatment,
and its “fitness” – the Darwinian process by which
the strains of the virus that survive attacks by drugs
and the immune system and are able to replicate
tend to be the strongest, making the next generation
more fit and difficult to combat.
Many of these questions can be answered with
molecular sequence data. Using DNA and RNA
sequences, Ramirez Kitchen and Dr. Marc Suchard,
an assistant professor of human genetics and biomathematics
at UCLA, have developed a methodology
enabling the simultaneous analysis of multiple
sequences across multiple patients over a period of
time. “We try to use these long strings of DNA components
to make sense of what the virus is doing so
that we might be able to outsmart it – to use its
own ability to mutate against itself,” she explains.
“Prior methods didn’t allow for longitudinal
observation, and that’s where things get interesting –
studying how the virus evolves. We use our methods
in an effort to translate what’s going on in the clinic
so that we can better understand how the virus is
affecting patients.”
Ramirez Kitchen is excited about her most
recent studies and what they could ultimately
mean for HIV patients who have not responded to
HAART. Working with her husband, who is now a
virologist at UCLA, and Dr. Jerome Zack, an immunologist
and associate director of the UCLA AIDS
Institute, she developed a statistical methodology
to determine which protease mutations are most
harmful to the virus, and confirmed its validity in a
study with Zack’s SCID-hu mouse model of HIV.
Now, Ramirez Kitchen is working with other UCLA
colleagues in an effort to use that information to
devise an important new clinical strategy that would
drive the virus into a less fit state. “We believe this
could provide hope for patients in whom the virus
has been resistant to treatment,” she says.
Another novel methodology helped Ramirez
Kitchen make important discoveries about the virus
and its response to HAART treatment. HIV typically
has two types of co-receptors, CXCR4 and
CCR5. Ramirez Kitchen’s group found that even
when HAART fails to control the virus, it can still
change it into a less pathogenic form by forcing it
to switch from the CXCR4 co-receptor to the lesspathogenic
CCR5 co-receptor. “We believe that’s
one of the reasons that some patients who fail to
respond to treatment still fare better if they stay on
it,” Ramirez Kitchen explains. In particular, she says,
for patients who express the CXCR4 phenotype,
switching to CCR5 appears to lead to an improved
clinical prognosis.
“The real importance of this work is the
methodology that allows us to quantify the proportion
of a patient’s virus that uses CXCR4 or
CCR5,” Ramirez Kitchen says. “That is especially
important to know with the advent of co-receptor
specific therapy and entry inhibitors.” She and her
colleagues subsequently obtained a patent on the
methodology.
Ramirez Kitchen has long been drawn to using
math as a way to solve important problems. “That’s
probably why I’m a bit more applied than most
biostatisticians,” she says. “I like to be able to ask a
question and try to come up with an answer, especially
as it relates back to the clinic.” Some of her
most rewarding moments as a faculty member, she
adds, occur when she can see the excited look in her
students’ eyes as they realize through their research
that the theoretical concepts they learned in the
classroom can be used to help scientists and physicians
understand clinical problems, and thus can
make a difference in patients’ lives.
Ramirez Kitchen tells her students that one
of the most important skills for biostatisticians is a
strong understanding of the subject matter to which
they’re applying their formulas. “As a statistician,
you need to be able to develop new methodology
that is appropriate for your data, implement that
methodology and then translate it so that it’s understandable
to the other scientists and clinicians,” she
says. “To do that, it’s extremely helpful to have a
good understanding of the biological system you’re
working with. That way, you can bring more to the
problem, and even help to initiate new inquiries.”
“We try to
use these
long strings
of DNA components
to
make sense
of what the
virus is doing
so that we
might be able
to outsmart
it – to use its
own ability
to mutate
against itself.”
—Dr. Christina
Ramirez Kitchen
13
faculty profile UCLAPUBLIC HEALTH

14
IN MANY PARTS
OF THE WORLD,
THE SCHOOL IS
HELPING TO
STRENGTHEN THE
ABILITY OF DEVEL-
OPING NATIONS TO
TACKLE HEALTH
CHALLENGES.
Building
Capacity Overseas
Faculty Lend Expertise to
Public Health Efforts Abroad
HERE ARE SIX
EXAMPLES.
“A number of faculty
are working internationally
to help build public health
capacity. At a time of
enormous challenges
in global health,
we have an obligation
to continue to support
these efforts.”
—Dr. Linda Rosenstock
As each day brings new evidence
that we are living in a global community, the school is strengthening its commitment
to improving the health of people outside the United States — particularly
in developing countries, where the needs are most urgent.
“In addition to helping to fulfill our important research and teaching mission,
a significant number of faculty — and many students as well — are working
internationally with government agencies, non-governmental organizations,
and academic institutions to help build the public health capacity of these entities,”
says Dr. Linda Rosenstock, dean of the UCLA School of Public Health. “At
a time of enormous challenges in global health, we have an obligation to continue
to support these efforts.”
UCLAPUBLIC HEALTH
Following are six among the many examples in which the school’s faculty
and students are providing service that is contributing to a healthier global
community.

In East Africa, two UCLA School of Public
Health associate professors of health services
recently took part in a Johnson and Johnson-funded
pilot program for a worldwide training effort to
build management capacity for HIV/AIDS providers
in developing countries. Drs. Fred Hagigi and
Jeff Luck helped to develop the curriculum and
teach modules in financial management and health
management information systems, respectively.
The program was established by Senior
Associate Dean Victor Tabbush of the Anderson
School of Management at UCLA, based on the
premise that limited management capacity is often
the impediment to successful delivery of HIV/AIDS
services. Conducted in cooperation with the African
Medical and Research Foundation, a leader in
African community health care, the pilot program
drew participants from Kenya, Ethiopia, Somalia,
Sudan, Uganda, Tanzania, and Ghana, coming from
the ranks of management at community-based
organizations involved in the care, treatment and
support of HIV/AIDS patients.
Low-cost generic antiretroviral medication has
opened new possibilities for treating HIV and AIDS
in developing countries, Luck notes. Non-governmental
organizations, funded by international donors
and governments, are attempting to rapidly scale
up their treatment programs. “To do that effectively
requires a multidisciplinary clinical team, strong
community involvement and a well-organized management
structure,” Luck says, “so it is especially
important to have strong management capacity.”
One of the main goals, adds Hagigi, is to ensure
the sustainability of the teaching efforts. “We used
North American instructors for the pilot program,
but we wanted African faculty to be able to continue
the program and teach future generations,” he
says. To that end, each Western faculty member was
paired with a faculty member from an African university
who participated in teaching the sessions and
will carry the program forward beginning this fall.
As part of a program
established by the
Anderson School of
Management at UCLA,
two UCLA School of
Public Health faculty
participated in a training
effort to build management
capacity for
HIV/AIDS providers in
developing countries
of Africa.
In China and Los Angeles, Dr. Paul Torrens,
professor of health services, worked with the Chinese
Ministry of Health to organize and conduct 12
hospital management training workshops for nearly
1,000 Chinese hospital administrators between
1999 and 2004. Four were held in China – in
Shanghai, Nanjing, Beijing, and Zhuhai – and eight
were in Los Angeles. The workshops were carried
out with the cooperation and participation of many
Los Angeles-area hospital administrators, who
taught in the seminars and made their hospitals
available for site visits. Most of the administrators
were UCLA School of Public Health alumni,
including Kenny Deng (M.P.H. ’96), a Beijing
University Medical School graduate now working
for Blue Cross in California. Deng served as the link
with the Ministry of Health and hospitals in China.
As a result of the effort, a new journal of
hospital administration was established in China
and continues to be published regularly, with
Torrens serving as the honorary editor. In addition,
seven postdoctoral scholars have spent between six
months and one year at the school, sponsored either
by their government, their university, or the World
Health Organization.
Dr. Paul Torrens (r.), in
Shanghai, China with
one of several visiting
scholars who came to the
UCLA School of Public
Health as part of a program
to train Chinese
hospital administrators
in management concepts.
15
feature UCLAPUBLIC HEALTH

16
UCLAPUBLIC HEALTH
Dr. Ralph Frerichs
(seated) with attendees
of his workshop on rapid
surveys at the Hanoi
School of Public Health.
In Vietnam, Dr. Ralph Frerichs, professor
of epidemiology, provided assistance to the Hanoi
School of Public Health by conducting a five-day
workshop on rapid surveys for faculty, staff and
associates last August. Rapid surveys are small,
two-stage cluster surveys of about 300 people that
usually take less than a month to complete. The
methodology – combining sample survey methods
with computer software programs used in portable,
battery-powered microcomputers – enables decision-makers
in developing countries to obtain quick
answers to questions about the health status and
activities of people in the community.
The Hanoi School of Public Health faculty
intend to expand their curriculum in this area,
Frerichs says. Since the workshop, they have translated
the slides Frerichs presented into Vietnamese
and are incorporating them into a course at the
school on rapid surveys. Other participants were
there to learn the approach and apply it in field
studies in northern Vietnam.
The workshop was based on EPI 418: Rapid
Surveys in Developing Countries, a course Frerichs
teaches at UCLA. “Over the years, I have had many
students from Vietnam take EPI 418, most being
supported by the school’s Fogarty International
AIDS Training Program,” Frerichs says. “These two
groups – the Fogarty graduates and faculty at the
Hanoi School of Public Health – help ensure that
small community-based surveys will increasingly
be done in Vietnam.”
In Delhi, India, Dr. Roshan Bastani
represented the UCLA School of Public Health in
a successful collaborative effort to address India’s
severe shortage of public health professionals. In
March, Prime Minister Manmohan Singh announced
the launch of the Public Health Foundation of India
(PHFI), which will address this shortage through
capacity-building in public health education, training
and research. Through the Association of Schools
of Public Health (ASPH), Bastani and other public
health school representatives have spent the last two
years providing input for this effort, working with
various stakeholders in India and the international
community, including state and central government
health authorities, academicians from renowned
Indian and international public health institutions,
and public health agencies such as the WHO and
World Bank.
“The primary purposes of PHFI are to act as a
think tank on policy issues related to the health system,
to establish standards in public health education,
and most importantly, to create a network of
innovative, world-class, India-relevant institutes of
public health in India,” explains Bastani, professor
of health services, associate dean for research at the
school and co-director of the school’s Center to
Eliminate Health Disparities. “This is a first-of-itskind
autonomous public-private partnership in this
sphere in India.”
The effort, which is to include the establishment
of five new schools of public health as well as
the strengthening of existing schools, has received
substantial support in India and in the global community,
Bastani says. The Indian government has set
aside part of the seed capital for the initiative, and
the Gates Foundation has committed $15 million.
Other funds have been secured from several Indian
corporations and private donors. ASPH will continue
to remain an active partner and offer technical assistance.
A number of UCLA faculty have expressed
interest in becoming involved through curriculum
development, short-term teaching assignments and
long-term sabbaticals.

In the Middle East, Dr. Osman Galal,
professor of community health sciences at the
school and secretary general of the International
Union of Nutritional Sciences, has worked to
develop human and institutional capacities in nutrition.
Galal helped to establish the Middle East and
North African Nutrition Association as part of a
global health initiative spearheaded by the United
Nations University and International Nutrition
Foundation. The initiative, which aims to develop
and enhance national and institutional nutrition
leadership capacities, had not included the Middle
East region prior to 2003. Galal convened a task
force, housed at the Egyptian National Nutrition
Institute, that has provided technical support to
national institutions and helped to build nutrition
capacity through the pooling of resources.
“We wanted to create a political, social and
economic environment in the region that is conducive
to effective participation of nutrition and
public health organizations in strengthening the
capacity to prevent malnutrition and diet-related
chronic diseases,” Galal explains.
The first regional workshop was held in July
2004 in Cairo, with representatives of 13 countries
attending. Among other things, the group resolved
to establish a regional Nutrition Capacity Building
website that will include a database of simple nutrition
status indicators to monitor regional nutrition
status; conduct short-term regional training courses;
and prepare a 10-year plan of action in the areas of
nutrition research, training, education and advocacy.
Already, the initiative has resulted in development
of a nutritional status monitoring system in the
Middle East and establishment of an iron and vitamin
fortification program in Libya.
In Kinshasa, the capital of and largest city
of the Democratic Republic of the Congo
(DRC), Dr. Anne Rimoin works closely with the
Congolese Ministry of Health as she heads the first
study to examine the dramatic changes in the epidemiology
of monkeypox and viral hemorrhagic
fevers in the last 20 years. Rimoin, assistant professor
of epidemiology, runs disease surveillance for
these infectious diseases for an entire district of
the DRC. Her project is housed at the National
Laboratory, where her co-principal investigator is
the director, Dr. Jean Jacques Muyembe, considered
the world’s leading expert on the ebola virus.
Rimoin’s field director is the national director for
monkeypox and viral hemorrhagic fevers, and her
group supports all disease surveillance activities in
the region.
“Our focus is on monkeypox and viral hemorrhagic
fevers, but we do trainings with the Ministry
of Health that include all diseases of epidemic
potential,” Rimoin explains. “Our surveillance
project is, in essence, a pilot program for the rest
of the country. Our forms, educational materials,
and operations manuals will be adopted by the rest
of the country as part of the national program.”
Like the other faculty featured in this article
and many others at the UCLA School of Public
Health, Rimoin is dedicated to ensuring that her
contributions will have a lasting impact. Her group
is working to expand the DRC’s laboratory capability
and train as many Congolese scientists and
lab technicians as possible. “My goal is sustainable
research,” Rimoin says. “I’m interested in developing
research and public health infrastructure in
the country. I am very committed to the DRC
and intend to have a long relationship with my
Congolese collaborators.”
Above left:
Representatives of 13
countries attended a task
force meeting in Cairo,
Egypt, to establish the
Middle East and North
African Nutrition
Association, an effort
spearheaded by Dr.
Osman Galal.
Below: Dr. Anne Rimoin
works closely with the
Congolese Ministry of
Health in building capacity
to fight monkeypox,
viral hemorrhagic fevers,
and other diseases of
epidemic potential.
17
feature UCLAPUBLIC HEALTH

18
AS NEW DRUGS
AND HIGH-TECH
ADVANCES CON-
TINUE TO DRIVE
UP THE PRICE OF
MEDICAL SERVICES,
EXPERTS QUESTION
WHETHER WE ARE
PUTTING ENOUGH
CONSIDERATION
INTO HOW WE
SPEND.
Are We Getting Our
Money’s Worth?
Cost, Quality, and
Health Care Spending
Savvy consumers pursue value – the best
return for each dollar spent. But when it comes to health care, how savvy are we
as a nation? The cost of medical services is soaring – and as a society, we’re paying.
Yet many experts, including those who study cost and quality at the UCLA
UCLAPUBLIC HEALTH
“With the
prospect of
genetic therapy
and other high-tech services,
it’s likely that cost increases
exceeding the growth of the
economy will remain with us
into the indefinite future.”
—Dr. Thomas Rice
School of Public Health, cast doubt on whether we’re spending wisely, and getting
the most for our money.
After a leveling-off period during the 1990s, health care expenditures are
again growing faster than the rest of the U.S. economy. National health spending
constituted 15% of U.S. Gross Domestic Product expenditures in 2002, up from
12% in 1990 and 9% in 1980. By 2013, that figure is projected to surpass 18%.
One of the primary reasons for the nation’s rising health care tab is the
rapid growth of medical technology and pharmaceuticals. “Medical care and drugs
can do more good for people now than they did in the past,” says Dr. Thomas
Rice, professor of health services at the school, “and with the prospect of genetic
therapy and other high-tech services, it’s likely that cost increases exceeding the
growth of the economy will remain with us into the indefinite future.” It’s not
merely the availability of expensive medicine that is responsible for the soaring
costs, he notes; it’s also a U.S. financing system that covers most of these expensive
services – often with minimal prior evaluation of their effectiveness.

The United States has been unable to adopt
a strategy for long-term success when it comes to
controlling health costs, says Rice. For a time in the
1990s, so-called heavy-handed managed care – health
maintenance organizations with strict limits on which
providers could be seen and which services would be
covered – appeared to be making an impact in containing
costs. But that approach proved unpopular, and
the market responded to the backlash. “The reason
people aren’t as angry at their HMOs anymore is that
these organizations have become less strict,” Rice says.
“In addition, there has been a movement in enrollment
away from HMOs and toward preferred provider
organizations, which have very few restrictions. So the
one thing that seemed to be working to control costs
is no longer available as a strategy because people
disliked it.”
The current trend is toward what is known
as consumer-directed health care, with many plans
shifting the cost to consumers until a high annual
deductible, ranging from $1,000 to as high as $3,000,
is met. “The rationale is that this will make individuals
more sensitive to the prices they’re paying for
health care services,” says Dr. Gerald Kominski, professor
of health services at the school and associate
director of the UCLA Center for Health Policy
Research. “The problem is that as individuals it can
be difficult for us to assess the true medical benefit
of various services, and so this price sensitivity
may cause people to forego necessary and highly
effective treatments.”
Indeed, Kominski notes, health cost and health
quality are often related, raising concerns that efforts
to reduce spending will lead to declines in the level
of care. He is currently conducting a study for
California’s Division of Workers Compensation looking
at the quality-of-care impact of recent legislative
changes designed to control the system’s costs; the
new regulations place restrictions on access to
providers and limits on the number of services
injured workers can receive for certain injuries.
Kominski and colleagues are surveying injured workers
and providers to determine whether workers
are having significant difficulties accessing medically
necessary services and getting referrals to appropriate
specialists. “There have been data published indicating
that workers comp expenditures in the state
have gone down and premiums have been reduced
as a result of these legislative changes,” Kominski
says. “The question is whether that is at the cost
of denying access to medically appropriate care.”
As financially strapped hospitals sought ways
to reduce costs in the 1990s, many cut back on their
use of registered nurses. This prompted a number of
researchers, including Dr. Jack Needleman, to study
the impact of RN staffing on quality of hospital
care. Needleman, who began the research while on
the faculty at Harvard and has continued it since
joining the UCLA School of Public Health faculty
in 2003, found compelling evidence that the quality
and size of a hospital’s nursing staff makes a difference
in patient outcomes and quality of care. In a
seminal 2002 article in the New England Journal of
Medicine, Needleman estimated that patients in hospitals
whose nurse staffing ranked them in the top
half of hospitals experienced cardiac arrest and shock
9% less often and suffered 9% fewer urinary tract
infections, 5% fewer episodes of bleeding in their
upper gastrointestinal tract and 6% less hospitalacquired
pneumonia than patients in hospitals in the
bottom half, along with 4% shorter admissions. More
recently, he found that increasing the use of RNs
and hours of nursing care per patient could help
hospitals to avoid more than 6,700 patient deaths
and 4 million days of care each year (see page 24).
“Nursing care is central to what the hospital provides,”
Needleman says, “but because nurses are
everywhere doing everything, their contribution to
care is frequently overlooked.”
Measuring the quality of services delivered by
health care providers has only recently become a
popular phenomenon in the United States. Dr. Robert
Brook, professor in the UCLA schools of medicine
and public health and director of RAND Health,
began conducting pioneering work in the field of
quality measurement in the 1960s and established
the scientific basis for determining whether various
medical and surgical procedures were being used
appropriately – contributions recently recognized by
the Institute of Medicine, which awarded Brook its
prestigious Gustav O. Lienhard Award (see page 32).
Thanks to Brook and other health quality researchers
who joined in the growing effort, quality has become
a more vital interest to policy-makers, providers and
patients alike.
“Without measuring quality of care and using
those measures in making policy, health care reform
will essentially mean doing things cheaper,” Brook
says. “If we do not know the impact of organizational
change or clinical services on quality and health
then it will be very easy just to do less. Making
quality an equal partner to cost is essential as we go
about reforming the health care delivery system.”
Quality has several dimensions. One component,
notes Needleman, is that the patient gets the right
care at the right time, delivered effectively. At the
same time, he adds, the care should be safe – the
patient should not be injured by his encounter with
the health care system.
“The issue
[in qualityinvestment
decisions] isn’t
always whether
we’re saving
money; it can
also be whether
we are getting
value for the
money we’re
spending.”
—Dr. Jack Needleman
19
feature UCLAPUBLIC HEALTH

20
The Standard of Care Is Received on Average 55% of the Time
Alcohol dependence
Dyspepsia and peptic ulcer disease
Diabetes mellitus
Asthma
Colorectal cancer
Depression
Coronary artery disease
Breast cancer
Senile cataract
11%
32%
45%
54%
54%
58%
68%
76%
79%
0% 20% 30% 40%
60% 80% 100%
Source: McGlynn et al., Quality of Health Care Delivered to Adults in the U.S., NEJM 2003.
UCLAPUBLIC HEALTH
National Health Expenditures, 2002
$1.553 Trillion
Construction 1%
Research 2%
Public Health 3%
Administration 7%
Personal Health Care 87%
Source: Levit et al., Health Spending Rebound
Continues in 2002, Health Aff 2004.
On both measures, there appears to be plenty of room for improvement.
Typically, peer groups of clinicians will define the standard of care for particular
conditions based on available evidence; one way to gauge the quality of
care nationally for patients with that condition is to measure how often that
evidence-based standard is achieved. A 2003 RAND study found that only 55%
of patients in a random sample of adults received recommended care (see the
graph above). Separate studies have found that more than half of patients with
diabetes, hypertension, tobacco addiction, hyperlipidemia, congestive heart failure,
asthma, depression and chronic atrial fibrillation are managed inadequately.
As for the “do no harm” measure, a widely publicized report by the Institute
of Medicine (IOM) of the National Academy of Sciences estimated that
between 44,000 and 98,000 U.S. hospital deaths each year could be attributed
to medical errors. Nationally, the cost associated with preventable adverse events
is estimated at $17-$29 billion. Since 1996, the IOM has had an ongoing effort
to assess and make recommendations to improve the nation’s quality of care,
which it defines as “the degree to which health services for individuals and populations
increase the likelihood of desired health outcomes and are consistent
with current professional knowledge.” The IOM has summed up the issue as one
of “overuse, misuse, and underuse of health care services.” (IOM President
Harvey V. Fineberg recently spoke at the school. See page 33.)
Part of the problem is that U.S. health care is structured to meet the needs
of acute care patients, but is not well suited for chronic care. “The system is set
up to diagnose and treat problems as they arise and then send patients home,”
says Dr. Emmett Keeler, adjunct professor in the school and a researcher at
RAND. “But because we’re now living longer and people aren’t dying as much
from infectious diseases, we have more chronic illnesses in which patients have
to be able to take care of themselves for the rest of their lives or they won’t
function well. The system is not well suited for those kinds of needs.”
With RAND and UC Berkeley colleagues, Keeler recently completed an
analysis of a chronic care model developed by Dr. Ed Wagner, national director
of Improving Chronic Illness Care, a Robert Wood Johnson Foundation program.

In evaluating the quality of care for patients at more
than 40 organizations that volunteered to implement
the model for patients with specific chronic
conditions, Keeler found that these organizations
were more successful than others in helping their
patients learn to take care of themselves.
“All of these methods for taking better care of
people with chronic illnesses were developed by
HMOs, and the reason is that HMOs benefit financially
by keeping patients out of the hospital,” Keeler
observes. “But in a fee-for-service environment, there
is no incentive to do that.”
In some cases, a business argument can be made
for investing in quality. In Needleman’s research on
nurse staffing, he concluded that for hospitals with
higher proportions of registered nurses rather than
the less-skilled licensed vocational nurses, the
increased labor costs were offset by savings resulting
from patients’ shorter lengths of stay and reduced
risk of complications. Needleman believes these and
other findings that support the business case for
quality investment when it comes to R.N. staffing
are conservative. For example, his group didn’t take
into account the cost associated with nursing
turnover in hospitals, which has been relatively high.
Other research suggests that investing in improved
working conditions for nurses – by having a higher
proportion of nurses to patients, for example –
would result in lower turnover, and more cost savings.
On the question of whether investing in quality
saves money, the answer often depends on whose
money is being considered. Hospitals that are reimbursed
at a certain rate for each admission receive
benefits from making quality improvements that
reduce patients’ length of stay. For hospitals that
are paid on a per diem basis, it’s the payer, not the
hospital, that benefits from quality care resulting in
patients being discharged earlier. In cases where the
system saves, explains Needleman, a business case
can be made for quality investments on the basis
that money can be moved between payers and
providers so that it makes financial sense.
Of course, not all quality-investment decisions can
be made solely on the basis of whether they save
someone money. “The cheapest way to treat heart
attack patients is to let them lie on the ground until
they either die or get up,” notes Needleman. “But we
as a society feel that spending to effectively treat
that patient is good value. So the issue isn’t always
whether we’re saving money; it can also be whether
we’re getting value for the money we’re spending.”
Dr. Kenneth Wells (M.P.H. ’80), a psychiatrist
on the faculty at UCLA’s schools of medicine and
public health, has focused on the cost-effectiveness
of programs to improve quality of care in mental
health. Psychiatric disorders such as depression
exact a huge toll, Wells explains, not so much in
the cost of treating them as in the social cost to the
people who have them.
As director of the UCLA Health Services
Research Center, Wells has been examining the
impact of investing in better treatment of depression
by primary care providers, measured in patients’
improved functioning over the long term. In one
study, depressed individuals, particularly Latinos and
African Americans, who were part of 6-12 month
interventions to improve the quality of their mental
health care were found to be faring better five years
later than those who weren’t. “We think they had
learned how to manage their lives differently,” Wells
explains. He found that investing in better depression
care improves patients’ employment status –
they are more likely to stay in a job or to find a job
if they need one – and that underserved minority
populations stand to gain the most. “These populations
tend to have had much less prior exposure to
mental health treatment, which makes them especially
inclined to benefit in the long run from an
investment in better care up front,” Wells says.
Only about one-fourth of the nation’s depressed
people receive care for their depression within the
same year. “To increase that treatment penetration
would cost health care dollars,” says Wells, “but there
is a great return in terms of both the improved quality
of life and the economic payoff resulting from
their higher functioning. These are substantial social
and individual benefits that we get in return from
investing in their care that haven’t been captured.”
In a separate study through Wells’ center, Dr.
Susan Ettner, professor in the schools of medicine
and public health, is developing an intervention to
test the impact of financial and non-financial incentives
for providers of a managed behavioral health
organization to improve the quality of its depression
care. “There is a hypothesis, based on the research
literature, that if you improve the quality of mental
health care, it’s not as expensive as it may seem
because it results in medical cost savings over the
long term,” says Ettner, who is working with fellow
economists at RAND and colleagues at United
Behavioral Health on the pilot study.
In previous research, Ettner found that money
spent on early substance abuse treatment results in
long-term financial benefits from lower crime and
increased employment among former substance
abusers. “If early investments can prevent higher
costs down the road by lowering the risk of hospitalizations,
emergency room visits or even accidents
among people with depression, substance abuse
“There is a
hypothesis that
if you improve
the quality of
mental health
care, it’s not as
expensive as
it may seem
because it results
in medical cost
savings over
the long term.”
—Dr. Susan Ettner
21
feature UCLAPUBLIC HEALTH

22
UCLAPUBLIC HEALTH
“If you assume
that there is a
fixed amount of
money, we want
to be able to use
that money to
provide the most
health for the
most people.”
—Dr. Robert Kaplan
20.0%
16.0%
12.0%
8.0% 7.2%
4.0%
0%
9.1%
and other treatable mental health problems, you’re
recouping some of these costs,” Ettner explains.
Dr. Robert Kaplan, professor and chair of health
services at the school, is also interested in value –
specifically, how to maximize the health care expenditure
dollar in relation to the potential benefit. “If
you assume that there is a fixed amount of money,
we want to be able to use that money to provide
the most health for the most people,” he says. “That
means looking at quality not only in the sense of
whether something is the best treatment, but also
whether spending on that treatment is using our
resources in the best way. If we allocate resources to
very expensive treatments, for example, we might
give up the opportunity to spend on other treatments
that would better serve the population.”
As a way of conducting cost/utility analyses
of disparate health services, Kaplan has developed
a research instrument that measures what he calls
quality-adjusted life years. The approach, considered
radical when Kaplan first began the work in the
1970s, has become part of the vocabulary of health
policy. “A lot of health services don’t produce an
extension of life expectancy but have a big impact
on quality of life and functioning,” Kaplan notes. His
indices combine life expectancy with quality of life:
For example, if a person with a life expectancy of 75
years develops an illness at age 50 that reduces by
half the quality of life for his remaining 25 years, that
illness is considered to have cost 12.5 quality-adjusted
life years, and an intervention that could have prevented
it or returned the individual to full function
might produce or save the equivalent of 12.5 life
years. Using that approach, researchers analyzing a
major clinical trial on the prevention of type 2 dia-
National Health Spending as a Share of Gross
Domestic Product, Selected Years, 1970-2013
13.8% 13.8%
15.9%
18.4%
1970 1980 1993 2000 2004 2013
(Projected)
Source: Center for Medicaid and Medicare Services, Office of the Actuary.
betes complications for people at risk found that
lifestyle interventions, though appearing to be more
costly than medicines, were actually less expensive
per quality-adjusted life year than drugs because of
the extra benefit they produced.
The premise behind Kaplan’s approach – that hard
choices need to be made in considering how to
spend finite health care dollars – seems to be one
that many in this country have yet to accept.
“One of the reasons we have so many uninsured
people is that health care has become so expensive,”
says Keeler. “If we could figure out ways of delivering
care more efficiently, we could bring down the
cost. But part of the problem is that we have a culture
in which people expect that they are entitled to
whatever services are available, even if those services
aren’t going to work very well, and that’s driving up
the cost. For a lot less money, we might be able to
get 98% of what we’re getting right now, and that
would be a better deal for the society as a whole.”
Most analysts agree that there is a great deal
of inefficiency in the U.S. health care system, adds
Kominski. “There are clearly large administrative
costs that are the result of the multiplicity of payers
and payment rules in place,” he notes, “as well as a
general lack of coordination of care across different
settings and providers.” In a market in which most
services are purchased using someone else’s money,
he adds, it’s not surprising that the demand tends
to be high for the “latest and greatest” – and most
expensive – technological services. “It’s not that
these new technologies aren’t effective,” Kominski
says. “But we don’t always know, prior to their introduction,
whether the additional benefit is being
achieved at a reasonable cost per unit of outcome.
Those studies are often not done until well after a
product has been developed and adopted broadly
in medical practice.”
The last decade has seen the emergence of
quality measurement as a fundamental area of concern
in health care policy and delivery, Kominski
notes. As a result, much research is now under way
to measure and make information about quality
available to patients and the purchasers of services.
Kaplan foresees a dramatic increase in efforts to
better define which health services are producing the
most value for the money spent. The bottom line, he
asserts, is that the nation needs to be more thoughtful
in the way it spends its health care dollars.
“People need to recognize that there are too
many options and it’s too expensive,” he says. “If we
took away all the limits and told doctors to do whatever
they want, we would probably destroy the economy,
without clear evidence that the greater expenditures
would result in a healthier population.”

esearch highlights
Concerns Raised About Carcinogenic Potential of
Chromium from Drinking Water, Supplements
NEW FINDINGS FROM THE LABORATORY of a UCLA School of Public Health
faculty member raise questions about the carcinogenic potential of the environmental
contaminant chromium VI when consumed via drinking water, and of
chromium III, which is widely used in nutritional supplements.
Chromium VI has been identified as a lung carcinogen when inhaled in relatively
high concentrations, such as through occupational exposure, but its cancer-causing
potential in drinking water has not been confirmed. It is known to be
present in high concentrations in the groundwater of
certain communities, and concerns about its effects
have been widely publicized, most notably in the
2000 film Erin Brockovich. A two-year carcinogenesis
study in mice and rats is currently ongoing at the
National Toxicology Program of the National Institute
of Environmental Health Sciences (NIEHS).
In the meantime, results of a smaller study in the
laboratory of Dr. Robert Schiestl, professor at the
school, raise concerns. Schiestl, director of the
Center for Environmental Genomics (based in the
UCLA School of Public Health and Jonsson Cancer
Center), studied mice exposed for 10 days to
chromium VI via drinking water. The doses were
equivalent to the two lowest of the four doses currently
being studied at the NIEHS. Publishing in the
journal Cancer Research, Schiestl reported that the
exposure induced DNA deletions predictive of cancer.
Schiestl and colleagues also studied the effects
of chromium III and found similar harmful effects.
Chromium III, ingested by millions of people seeking
to boost energy and muscle mass through nutritional
supplements and present in 95% of multivitamin preparations, has been
assumed to be non-toxic because it is not taken up by cells. But Schiestl’s group
found that once it is absorbed, chromium III is an even more potent inducer of
DNA deletions than chromium VI.
“The supplement industry is a huge business that is not subject to regulation,
as pharmaceuticals are,” says Schiestl. “There has never been a scientifically
reported benefit of chromium III for healthy people, and because these
supplements haven’t been subjected to rigorous testing, we haven’t known about
its potential toxicity.” While the first long-term carcinogenesis study of chromium
III is being planned, it will be several years before results are reported. “Our findings
on chromium III and chromium VI should raise some eyebrows,” Schiestl
says. “We need to be concerned about levels of chromium VI in the drinking
water. We also should be wary of consuming chromium III as supplements when
there is no evidence of benefit – and the possibility that certain levels may be
carcinogenic.”
Chromium III, ingested by millions of people seeking
to boost energy and muscle mass through
nutritional supplements and present in 95% of
multivitamin preparations, might not be as safe as
previously believed.
23
research UCLAPUBLIC HEALTH

24
Estimated Costs and Avoided
Costs, Days and Deaths from Three
Approaches to Increasing Nurse
Staffing in Hospitals
Approaches to Increasing
Nurse Staffing in Hopitals
Cost of higher nursing
Avoided costs (full cost)
Avoided days
Increasing Nursing Staff Improves Quality;
Greater Use of RNs Appears to “Pay for Itself”
INCREASING THE NUMBER OF REGISTERED NURSES and hours of nursing
care per patient would save 6,700 lives and 4 million days of patient care in hospitals
each year, according to the findings of a study by UCLA School of Public
Health and Vanderbilt University School of Nursing researchers.
Their study, published in the journal Health Affairs, also found that for hospitals
that use both RNs and licensed practical nurses (LPNs), greater use of
RNs appears to pay for itself in fewer patient deaths, reduced lengths of hospital
stay, and decreased rates of hospital-linked complications such as urinary
arrest and upper gastrointestinal bleeding.
“All hospitals are feeling pressure
to improve quality and contain
Raise
RN
Proportion*
$811 Million
$2.6 Billion
1.5 million
Raise
Licensed
Hours*
$7.5 Billion
$4.3 Billion
2.6 million
Both
$8.5 Billion
$6.9 Billion
4.1 million
Avoided deaths 4,997
1,801 6,754
Long term cost increase as a percentage of hospital costs -0.50% 0.80% 0.40%
*to that of the top quarter of U.S. hospitals
Note: Long-term savings are based on the assumption that all costs are recovered by the hospital.
Source: Needleman, et al., “Nurse Staffing in Hospitals: Is There a Business Case for Quality?,” Health Affairs, 2006.
costs,” says Dr. Jack Needleman,
associate professor of health services
at the UCLA School of Public
Health, who was joined in the
research by Dr. Peter Buerhaus of
Vanderbilt. “For hospitals where
nurse staffing is low, this study
makes an unequivocal business
case for using more RNs in nurse
staffing and a strong case based on
value to patients for increasing the
hours of nursing care.”
“We’re entering the ninth consecutive
year of a national nursing
shortage,” adds Buerhaus. “We hope this study stimulates a fresh debate on the
contributions of nurses in improving the quality of hospital care.”
In 2002, U.S. general hospitals employed 942,000 full-time RNs and 120,000
full-time licensed practical nurses. The study simulated the effect of several
options that would increase nurse staffing to a “feasible” level for most hospitals.
Among the key findings:
• Greater use of RNs translates into fewer patient deaths, reduced hospital
stays and a decreased rate of hospital-linked complications.
• Increasing the number of hours of nursing care provided by both RNs and
LPNs would result in fewer deaths, avoidable complications and days of
care.
• Expanding both the proportion of RNs and number of hours provided by
licensed practical nurses to reach the top quarter of hospitals – a combination
of the other two options – would save the most lives and greatest
number of patient days.
Needleman and Buerhaus concluded that increasing the proportion of RNs
would require hospitals below that top quarter of hospitals to replace more than
37,000 LPNs with RNs, at a cost of $811 million. But this option also held the
most benefits to hospitals and patients alike.
“From a hospital’s perspective, increasing nurse staffing is costly,” the authors
wrote. “Nevertheless, greater use of RNs in preference to LPNs appears to pay for
itself.”
UCLAPUBLIC HEALTH
One-Fourth of HIV-Infected Adults Perceive
Discrimination by Health Care Providers
TWENTY-SIX PERCENT OF HIV-INFECTED ADULTS believe they have been
the victims of discrimination by a health care provider, according to a study by a

UCLA School of Public Health and RAND research team headed by Dr. Mark
Schuster, professor of health services at the school and pediatrics at the David
Geffen School of Medicine at UCLA.
Schuster and colleagues analyzed data from the HIV Cost and Services
Utilization Study, which conducted in-person interviews with a nationally representative
sample of 2,466 HIV-infected adults receiving care. The participants
were asked whether they felt health care providers had been uncomfortable with
them, treated them as inferiors, preferred to avoid them, or refused to provide
service. Their findings were reported in the Journal of General Internal Medicine.
The study found that nearly one in three white respondents (32%) perceived
being discriminated against by a provider, making whites significantly more likely
than Latinos (21%) and African Americans (17%) to report the problem. The
authors suggest that one possible reason for this result may have to do with the
greater likelihood that members of minority populations have been discriminated
against previously. “African Americans and Latinos may typically experience
worse care and thus be unaware that better care exists,” Schuster’s team wrote.
Among the HIV-infected adults who reported discrimination, more than half
(54%) identified physicians as culprits, with 39% reporting discrimination by clinical
staff, 32% by dentists, 31% by hospital staff, and 8% by case managers or
social workers. Out of the entire sample, 8% said they had at one time been
turned away from receiving services. Respondents whose first positive HIV test
was longer ago were more likely to report discrimination.
The authors noted that the perception or experience of discrimination by clinicians
could result in HIV-positive patients being less likely to seek care, follow
prescribed treatment regimens, or return for follow-up care. “Many HIV-infected
adults believe that their clinicians have discriminated against them,” says
Schuster. “Clinicians should make efforts to address circumstances that lead
patients to perceive discrimination, whether real or imagined.”
Impact of Exposure to Residential Magnetic
Fields on Childhood Leukemia May Be Limited
ALTHOUGH PREVIOUS STUDIES HAVE FOUND POSITIVE ASSOCIATIONS
between exposures to high levels of residential magnetic fields and childhood
leukemia, an analysis by two UCLA School of Public Health epidemiologists
questions the public health impact of residential fields.
But, publishing in the journal Risk Analysis, Dr. Sander Greenland, the
study’s lead author, and co-author Dr. Leeka Kheifets note that in light of the
available data, “a large impact” and “no impact” are both possibilities.
Magnetic fields originate from anything with an electrical current. A field
spreads from a source in a manner analogous to a ripple emanating from a pebble
thrown in a pool of water, penetrating objects in its path. Elevated field levels
can occur in homes close to power lines; improper household wiring is a more
common reason for increased exposure to these fields.
Substantial research efforts have been devoted to evaluating the potential
risk of cancer in children posed by magnetic field exposure, with most of the
research focusing on brain tumors and leukemia. “Nearly every epidemiologic
study of residential magnetic fields and childhood leukemia has exhibited a positive
association,” says Greenland.
But Greenland and Kheifets, professors in the school’s Department of
Epidemiology, note that these studies suffer from various methodologic limitations,
making it uncertain as to how much, if any, of the associations are causal.
In addition, because the observed associations between the residential magnetic
fields and childhood leukemia are small and involve only the highest and most
infrequent levels of exposure, researchers have postulated that the public health
impact of an effect would be limited.
Percentage of Adults Receiving
Health Care for HIV Who Perceived
Discrimination
Gender %
Male
Female
Race/ethnicity
African American
Latino
Other
White
Date of first HIV-positive test
Prior to 1986
1986 to 1989
1990 to 1993
1994 to 1996
26
22
%
17
21
27
32
%
34
31
24
20
25
research UCLAPUBLIC HEALTH

26
Using data from 15 studies of residential fields and leukemia along with five
surveys of residential-field prevalence, Greenland and Kheifets analyzed the
potential impact of high residential field exposure as measured by populationattributable
fractions, accounting for uncertainties about study biases and about
exposure distribution. Nearly all information on effects and exposure distribution
came from fully industrialized countries, with the majority of the data from the
United States and Canada.
The methodologic limitations of the 15 studies, which the authors call “profound,”
include unknown and probable low accuracy of measurement, potential
selection bias, and very small numbers of exposed cases. After careful accounting
for the study biases, the authors conclude, it is “improbable” that magnetic
fields account for as much as 20% of childhood leukemias in Canada and the
United States, and the percentage is probably much lower – including the possibility
that there is no effect at all.
Access to Medical Interpreters Improves
Patient Satisfaction, Reduces Health Disparities
UCLAPUBLIC HEALTH
Use of interpreters reduced white-Hispanic disparities
in reports of care by up to 28% and white-
Asian/Pacific Islander disparities by up to 21%.
HAVING ACCESS TO MEDICAL INTERPRETERS can significantly improve
patients’ satisfaction with their health care and reduce health disparities between
whites and Hispanics and between whites and Asian/Pacific Islanders, according to
a research team led by Dr. Leo S. Morales of the UCLA School of Public Health.
Morales and colleagues analyzed data collected by the California State
Children’s Health Insurance Program (SCHIP) from 26,298 parents of children
enrolled in participating plans between 2000 and 2001. The results were published
in the journal Medical Care Research and Review.
Hispanic and Asian/Pacific Islander members who needed interpreters and
didn’t always get them reported significantly worse provider and office-staff communication,
access to care, and customer service than members who didn’t need
interpreters. On the other hand, Hispanic and Asian/Pacific Islander members
who needed and were always provided interpreters gave higher marks to their
plan on these measures than members who didn’t need interpreters. “This suggests
that interpreters may enhance the health care experience in ways that go
beyond language translation,” says Morales. “Interpreters might mediate cultural
and educational differences between doctors and their non-English speaking
patients, or serve as wayfinders for these patients.” Morales’ team concluded that
use of interpreters reduced white-Hispanic disparities in reports of care by up to
28% and white-Asian/Pacific Islander disparities by as much as 21%.
In California, which has the highest percentage of residents with limited
English proficiency, all health insurance plans participating in SCHIP are required
by state law to provide trained medical interpreters to members who need them.
But Morales’ group found that among the 15% of SCHIP members who reported
needing an interpreter in the previous six months, less than half (47%) were
always provided with one. Another 27% reported that they usually had one, and
26% said they were provided an interpreter only sometimes or never. “Although
health plans are contractually required to provide interpreter services by a payer
like SCHIP, our study suggests that members with limited English may frequently
receive care without the benefit of interpreters,” says Morales.
Patients who speak limited English often struggle to communicate with their
clinicians, compromising both the ability of the patient to accurately convey symptoms
or ask questions and the physician’s ability to counsel the patient on the
care being provided, Morales notes. Many of these patients turn to family members,
friends, or other ad hoc interpreters, who are typically unable to match
trained interpreters in ensuring that important messages aren’t lost in the translation.
“Our findings strongly support the need to expand the use of interpreters
by hiring more bilingual staff, expanding the use of telecommunications tools, and
increasing providers’ and patients’ awareness of the availability of these services,”
Morales concludes.

High Testosterone Lowers Type 2 Diabetes
Risk in Men, Increases Risk for Women
HIGHER LEVELS OF THE SEX HORMONE TESTOSTERONE appear to lower
the risk of type 2 diabetes in men while increasing the type 2 diabetes risk in
women, according to research led by Dr. Simin Liu, professor in the UCLA School
of Public Health. The findings, reported in the Journal of the American Medical
Association, help to explain inconsistent previous data on the role of endogenous
sex hormones in the disease, and point the way toward potentially fruitful future
studies on how and why hormones affect diabetes risk and complications differently
in men and women.
The research team, which included Liu’s colleagues from Harvard University,
conducted a pooled analysis of 43 large studies that included data on diabetes status
and levels of the hormones testosterone,
sex hormone-binding globulin
(SHBG) and estradiol in more than
13,000 men and women. They found
that testosterone worked against type
2 diabetes in men: Those who had the
disease had significantly lower testosterone
levels than those who didn’t. In
addition, men with higher testosterone
levels were found to have a 42% lower
risk for the disease than control subjects.
In contrast, women with type 2
diabetes had, on average, higher
testosterone levels than those who
did not have the disease. Women
who had higher levels of SBHG –
which is believed to reduce testosterone
activity – had an 80% lower
risk of the disease. The associations
in the effects of sex hormones on
type 2 diabetes risk for men and
women were significant even after
adjusting for body mass index.
Belgium-Leige
UK-Surrey
Belgium
USA-New York
UK-Scotland
Fr. Polynesia-Europeans
Fr. Polynesia-Melanesians
UK- Scotland
China-Taiwan
Sweden-Goteborg
Sweden-Men Born in 1913
Germany-Diebetomobil
Thailand-Bangkok
USA-Rancho Bernardo
S. Korea
Turkey
Norway-Tromse
Spain-Salamanca
Finland-Men born in1900-1919
Sweden-Malmo; USA-Mass.
The findings suggest that physicians who prescribe testosterone patches to
women to improve sexual function should consider the impact it could have in
increasing their type 2 diabetes risk, the researchers noted. Similarly, men who
undergo prostate cancer treatment to reduce androgen levels could also see
increased risk.
Further research to clarify the mechanisms by which the sex hormones differentially
affect type 2 diabetes risk in men and women could provide future therapeutic
targets. “These age-old sex hormones are extremely powerful and had
yet to be carefully evaluated in a comprehensive and formal manner,” says Liu.
With support from two large grants from the National Institutes of Health,
Liu’s team is currently conducting an in-depth investigation of the roles of these
plasma sex hormones and related genetic variants in the development of type 2
diabetes in men and women. Says Liu: “It is our hope that data emanating from
our studies will help to better characterize the complex pathogenesis of type 2
diabetes, have important therapeutic implications, and increase the potential for
plasma hormone biomarkers for the clinical risk assessment and management
of type 2 diabetes, ultimately benefiting the public’s health.”
-10
-2.33 (-3.45, 1.86)
-5
Testosterone
lower in cases
MEN
MEAN DIFFERENCE
Summary of Findings from 36
Testosterone Studies of 3,825
Men and 4,795 Women with
Type 2 Diabetes
0 3
Testosterone
higher in cases
Pre-Menopausal
Greece
UK-Indian Asian
USA-Chicago
S. Korea
Thailand-Bangkok
United Arab Emirates 1
United Arab Emirates 2
USA-SWAN (national)
Turkey
Post-Menopausal
Sweden-Goteborg
Australia-Melbourne
Australia-Victoria
Germany-Diebetomobil
Thailand-Bangkok
USA-Manhattan
USA-Rancho Bernardo
WOMEN
-1 0 1 2
Testosterone
lower in cases
0.21 (0.08, 0.35)
Testosterone
higher in cases
MEAN DIFFERENCE
Sizes of the boxes reflect the relative number of
people in each study. Horizontal lines indicating
the confidence intervals that cross zero show that
on their own, the findings of most of these studies
would not be statistically significant. Bottom diamonds,
showing overall meta-analysis results by
sex, show statistically significant lower levels of
testosterone among men with diabetes and higher
levels among women.
27
research UCLAPUBLIC HEALTH

28
student profiles
UCLAPUBLIC HEALTH
“I know I have a lot to share.
In helping to define the role
of the CIO and the electronic
medical record, I was able
to be involved in a lot of
groundbreaking work.”
— Jean Balgrosky
A Decade-Plus Later, Back to Finish What She Started
JEAN BALGROSKY (M.P.H. ’80) HAD ADVANCED TO CANDIDACY FOR HER Ph.D.
at the UCLA School of Public Health in the early 1990s and had already begun writing
up the results of her dissertation. But she was also serving as chief information
officer for Holy Cross Health System and building a family. Work and family obligations
became so demanding that Balgrosky couldn’t find uninterrupted time to complete
her scholarly work. So she decided to take a break, promising herself that she
would one day finish.
True to her word, Balgrosky is back – more than a decade after leaving. She
returned to the program with experience that few doctoral students could match:
nearly 20 years as a chief information officer. Balgrosky began at Holy Cross at a
time when the CIO title was only beginning to become prominent in health care
organizations. She established and implemented IT strategies and
information systems for an organization with annual revenues in
excess of $1.5 billion. In 1997 she left to become CIO for Scripps
Health, taking an organization that had grown by merger and acquisition
and building the IT architecture from the ground up. Her goals
included designing and implementing an integrated electronic medical
record.
By 2005, having completed what she had set out to do at
Scripps, Balgrosky was ready to shift gears. With the support of her
family, she contacted two of her former mentors, Drs. Jonathan
Fielding and Paul Torrens, who both encouraged her to return. Dr.
Jack Needleman, now at the school as an associate professor of
health services, took Balgrosky under his wing and worked with her
to determine where she might need refresher courses.
She will explore a new dissertation topic: Balgrosky’s original,
on the utilization of endoscopic technologies in the office-based setting
under three different reimbursement scenarios, was on the cutting
edge in the early 1990s, but now, she says, the question has
been well addressed. But she has a new passion: IT and the electronic
medical record. “It’s important to study the difference the electronic
medical record makes in health care – to find out its impact on
clinical and organizational outcomes – as well as where the potential
benefit is not being realized,” she says. “The Institute of Medicine
has pointed out that there are far too many errors occurring in our
hospitals, and institutions are struggling to fix that. As health care
becomes more complex, we have an obligation to look at our
processes and make sure we’re connecting all the dots and integrating
our processes so that we are providing the best possible care.”
Although she still gets plenty of calls from professionals who
want to tap into her wealth of work experience, Balgrosky is now a
full-time student. She has ideas about what she might want to pursue
after she completes her dissertation, but no specific plans, other
than to do some teaching and research. “I know I have a lot to share,” she says. “In
helping to define the role of the CIO and the electronic medical record, I was able to
be involved in a lot of groundbreaking work. Even though I hadn’t finished my doctorate,
I felt I was living out part of what a school wants from its Ph.D.’s, which is to
develop new knowledge. Now I can take that knowledge and advance it through
research and teaching.”

Returning to Her Roots, She Shows High School
Students Possibilities She Never Knew
WHEN TYPHANYE PENNIMAN WAS GROWING UP in the South Los Angeles city of
Compton, she had no role models to tell her about public health. It wasn’t until
Penniman had completed her undergraduate education at UCLA and then gone on to
work as a health educator in Inglewood that she began to appreciate the impact public
health could make in underserved communities such as the one where she was raised.
“It’s easy to take things for granted where you live and not realize that it could be
different,” she says. “It never dawned on me, for example, that there were no healthy
places to eat in my community – until I moved to Westwood as
a UCLA student and saw places like Whole Foods and Jamba
Juice, with soy protein and tofu being sold everywhere. There
was none of that in Compton.”
Her work as a health educator for a nonprofit agency – in
which she counseled high-risk youth on reducing risk for
unwanted pregnancies and sexually transmitted diseases,
including HIV – awakened Penniman to the difference she
could make in people’s lives through public health. “I became
very interested in learning how to affect behaviors in my community,”
Penniman says. So she went back to school, earning
her M.P.H. at Cal State Long Beach in 2002, and then enrolling
in the doctoral program at the UCLA School of Public Health,
where she has completed coursework and is preparing her dissertation
on the impact of family dynamics on people with HIV.
Penniman’s research has been funded for the last four years
by the National Institute of Mental Health, and she recently was
awarded two more years of funding from the Centers for
Disease Control and Prevention. After earning her degree,
Penniman hopes to go on to a career in academia.
For the last year, Penniman has also served as the
instructor for the school’s Youth Into Health Professions course,
which is taught in South Los Angeles and draws high school students from the Watts
and Compton areas. The introductory public health course, offered free of charge for
college credit, serves the dual purpose of motivating high school students from underserved
communities to go on to college and exposing them to public health as a potential
field of study. “Most of the students who are interested in a health profession have
been focused on medicine,” Penniman says. “That’s because they haven’t learned
about public health – or, if they have, they didn’t know that’s what it was.” The course’s
students are paired with mentors from the Students of Color for Public Health, a UCLA
School of Public Health interest group in which Penniman has been active.
The opportunity to show high school students from her community the possibilities
in public health – something Penniman never knew at that age – has been especially
rewarding, she says. “It’s wonderful to see the light bulbs go off as they realize
the difference that public health measures such as taking junk food out of schools can
make,” she says. “They get excited when they learn what public health professionals
can do, and as we talk about advocacy and show them that they can have a voice in
what goes on in their communities.”
The opportunity to show high
school students from her
community the possibilities in
public health has been rewarding.
“They get excited when
they learn what public health
professionals can do.”
— Typhanye Penniman (center), with high school students
Jesus Torres and Yvette Aguilar, part of the Youth Into Health
Professions course.
29
students UCLAPUBLIC HEALTH

30
2005-06 student awards
students
Abdelmonem A. Afifi
Student Fellowship
Sara Serin-Christ
Community Health Sciences
Chancellor’s Prize
Hua Guo
Yu Zhao
Biostatistics
Hortense Fishbaugh
Memorial Fellowships
Chhandasi Bagchi
Community Health Sciences
Bette & Hans Lorenz
Fellowships
Lily Altstein
Biostatistics
Ruth J. Roemer Award
Heather Richardson
Katherine Marcellus
Health Services
UCLAPUBLIC HEALTH
Agency for Healthcare
Research and Quality
Fellowship
Shana Lavarreda
Daniella Meeker
Sarah Starks
Jean Yoon
Health Services
Atlantic Richfield
Company Fellowship
Felicia Federico
Environmental Science and
Engineering
Biostatistics Training
for AIDS Research
Erik Bloomquist
Stephanie Kovalchik
Lei Qian Yan-Jung Liu
Fred H. Bixby
Doctoral Fellowship
Laura Chyu
Claire Dye
Jennifer Erausquin
Yasamin Kusunoki
Eunice Muthengi
Community Health Sciences
Joseph and Celia Blann
Fellowship
Wenhua Hu
Biostatistics
Dana Martinez
Community Health Sciences
California Endowment
Scholarships
Vincecia Garcia
Angie Otiniano
Jennifer Simmons
Steve Sortijas
Community Health Sciences
Brandon Brown
Epidemiology
Diana Porral
Health Services
California Wellness
Foundation Scholarships
Glenn Sias
Environmental Health
Sciences
Marie Sharp
Epidemiology
Sylvia Paz
Health Services
Chancellor’s Fellowship
An Ning
Menghua Tao
Epidemiology
Ryan Vaughn
Environmental Health
Sciences
Class of 1972
Reunion Fellowship
Zhanna Sobol
Environmental Health
Sciences
Melissa Gatchell
Health Services
Dean’s Outstanding
Student Award
Hsin-Ju Hsieh
Biostatistics
Nathalia Allevato
Community Health Sciences
Robert Phalen
Environmental Health
Sciences
Marjan Javanbakht
Epidemiology
Michelle Marciniak
Health Services
Eleanor J. De Benedictis
Fellowship in Nutrition
Constance Awuor Gewa
Maria Koleilat
Loan Thi Kieu Pham
Community Health Sciences
Dissertation Year
Fellowship
Megumi Kano
Community Health Sciences
Robert Phaleni
Environmental Health
Sciences
Menghua Tao
Epidemiology
Erik Larsen
Environmental Science and
Engineering
Erin Hsu
Molecular Toxicology
Emerson Fund
Xiaoyan Liao
Environmental Health
Sciences
Environmental Science
and Engineering Program
Endowment
Maria Echarte
Felicia Federico
Calvin Kwan
Carla Ward
Foley and Lardner
Fellowships
in Health Services
Kristyn Dixon
Yasmeen Dixon
Foreign Language and
Area Studies Fellowship
Natalie Drorbaugh
Gabriel Garcia
Steve Sortijas
Kristin Yarris
Community Health Sciences
L.S. Goerke
Memorial Fellowship
Megumi Kano
Community Health Sciences
Raymond D. Goodman
Scholarship
Naja Rod Nielsen
Epidemiology
Judith Chung
Health Services
Graduate Opportunity
Fellowship
Veronica Awan
Alma Vega
Community Health Sciences
Hagigi Fellowship in
Healthcare Accounting
and Finance
Jonathan Friel
Health Services
Health Services Alumni
Association Scholarship
Laura Green
Gordon Hein
Memorial Scholarship
Christian Shinaberger
Epidemiology
William and Flora Hewlett
Foundation Environmental
Science and Engineering
Program Trust Fund
Maria Echarte
Rahul Kumar
Calvin Kwan
Carla Ward
Xueying Wu
Jennifer Liebeler
Carolbeth Korn Prize
Luohua Jiang
Biostatistics
Leadership in Maternal and
Child Health Training Grant
Dana Ellis
Community Health Sciences
November McGarvey
Community Health Sciences
Ryan Vaughn
Environmental Health
Sciences
Michelle Ornelas
Epidemiology
Georgina Ageykum
Health Services
Maternal and Child
Health Grant
Laura Chyu
Community Health Sciences
Rachel Effros
Nicole Garro
Kathryn Smith
Health Services
Neumann-Drabkin-Bixby
Fieldwork Fellowships
Jennifer Brody
Chloe Gans-Rugebregt
Tanya Gonzalez
Shauna Harrison
Grace Lee
Larisa Mori
Jamie Morse
Cara Wooledge
Community Health Sciences
Bita Amani
Anthony Wang
Epidemiology
Ann G. Quealy
Memorial Fellowship
in Health Services
Evan King
Allen Lee
Ruth F. Richards
Memorial Student Award
Juan Jia
Biostatistics
Jennifer Erausquin
Community Health Sciences
Sarah Kobylewski
Environmental Health
Sciences
Melissa Higdon
Epidemiology
Narmina Pasha
Health Services
Eugene Cota Robles
Fellowship
Tommi Gaines
Erica Lockwood
Biostatistics
Jennifer Garcia
Community Health Sciences
Roemer Health Services
Administration Fellowships
Jabar Akbar
Helen Jung
Tracy Yee
Will Rogers Memorial
Scholarship
Candace Coffee
Community Health Sciences
Christian Shinaberger
Epidemiology
Monica Salinas
Internship in Latino and
Latin American Health
Shauna Harrison
Community Health Sciences
Mirna Ponce
Epidemiology
Juneal Marie Smith
Fellowship in
International Nutrition
Shen-Chih Chang
Epidemiology
Wayne Soohoo
Memorial Scholarship
Wenhai Xu
Environmental Health
Sciences
Thai Health Outreach
Internship
Koy Parada
Community Health Sciences
Samuel J.Tibbitts
Fellowship
Matthew Wise
Epidemiology
Toxic Substance Research
& Teaching Program
Fellowship
Xioyan Liao
Elizabeth Marshall
Environmental Health
Sciences
Wilshire Foundation
Endowment in Geriatric
Medicine and Long
Term Care
Katie Maggard
Diep Tran
Community Health Sciences

faculty honors
DR. THOMAS BELIN received the 2005 Gertrude
M. Cox Award from the Washington Statistical
Society, the Washington, D.C., chapter of the
American Statistical Association.
DR. JONATHAN FIELDING was chosen for the
Distinguished Alumnus Award by the Harvard
School of Public Health.
DR. PATRICIA GANZ served on an Institute of
Medicine committee that prepared a report
released in November 2005 on adult cancer
survivors, “From Cancer Patient to Cancer
Survivor: Lost in Transition.”
DR. SANDER GREENLAND was elected chair of
the American Statistical Association’s Section
on Statistics in Epidemiology.
DR. NEAL HALFON received the annual research
award from the Ambulatory Pediatric Association
at the Pediatric Academic Societies meeting.
DR. GANG LI served on the Scientific Committee
for the International Conference on Statistics,
held in Hong Kong in June.
DR. JACK NEEDLEMAN was a winner of the first
Health Services Research Impact Award given
by AcademyHealth, for his research establishing
a relationship between hospital nurse staffing
and adverse patient outcomes.
DRS. CHARLOTTE NEUMANN and JOEL KOPPLE
were named fellows of the American Society for
Nutrition.
DR. THOMAS RICE assumed the role of chair of
the board for AcademyHealth.
DR. MARK SCHUSTER is serving as chair of
the Child Health Services Research Steering
Committee. He also chairs the Health and
Nutrition Committee of the L.A. City Commission
on Children, Youth, and their Families.
DR. LINDA ROSENSTOCK was appointed to the UC
Advisory Council on Future Growth in the Health
Professions. She also was the Annie Lee Shuster
Alumni Speaker for the Robert Wood Johnson
Clinical Scholars Program.
DR. ARTHUR WINER received a 2006 Haagen-
Smit Clean Air Award from the California Air
Resources Board.
new faculty
KERI GARDNER Health Services
DENA HERMAN Community Health Sciences
ADRIANA SMARANDA BABAN
Community Health Sciences
bookshelf
...recent books by UCLA School of Public Health authors
Contemporary Multivariate Analysis
and Design of Experiments,
edited by Jianqing Fan and Gang Li.
World Scientific Publishing Company
Explores new developments in experimental designs, multivariate
analysis, biostatistics, model selection and related
subjects, with articles contributed by prominent and active
figures in their fields.
Modeling Longitudinal Data,
by Robert E. Weiss. Springer Texts in Statistics.
Longitudinal data – which come from assessing the same
measure repeatedly over time on the subjects in a study –
are ubiquitous across medicine, public health, public policy,
psychology, political science, biology, sociology and education
– yet, many longitudinal data sets remain improperly
analyzed. This book teaches the art and statistical science
of modern longitudinal data analysis.
Monitoring Rocky Shores,
by Steven N. Murray, Richard F. Ambrose,
and Megan N. Dethier. UC Press.
As we advance into an era of global climate change, monitoring
changes in the intertidal zone of rocky shores – the
sensitive habitat at the interface of land and ocean – has
never been more crucial. This handbook describes effective
methods and procedures for monitoring the ecological
and environmental status of these areas, and provides critical
discussions and evaluation of the various sampling
techniques and field procedures for studies of intertidal
macroinvertebrates, seaweeds, and seagrasses.
Oncology: An Evidence-Based Approach,
edited by Alfred E. Chang, Patricia A. Ganz, Daniel F.
Hayes, Timothy J. Kinsella, Harvey I. Pass, Joan H.
Schiller, Richard M. Stone, and Victor J. Strecher. Springer.
Covers the principles and current practice of oncology, with
contributors from the fields of medical, surgical, and radiation
oncology. The textbook incorporates an evidencebased
clinical approach, enabling the reader to make
decisions on the basis of concrete data. Includes in-depth
sections on cancer prevention and control, cancer survivorship,
the economics of cancer care, and cancer informatics,
as well as an innovative section on survivorship.
31
faculty UCLAPUBLIC HEALTH

32
faculty
UCLAPUBLIC HEALTH
INSTITUTE OF MEDICINE (IOM)
HONORS DR. ROBERT BROOK
DR. ROBERT BROOK, professor in the UCLA schools of medicine and
public health, received the Institute of Medicine’s prestigious Gustav O.
Lienhard Award for the advancement of personal health services. The award
honors Brook for his dedication and commitment to improving the effectiveness
of health care services and shaping the discourse on health care policy.
An internationally renowned expert on health quality issues, Brook is
credited as the individual who, more than any other, developed the science
of measuring the quality of medical care and focused U.S. policy-makers’
attention on quality-of-care issues and their implications for the nation’s
health. He established the scientific basis for determining whether medical
and surgical procedures are being used appropriately and has led teams
that have developed quality measures used today by government agencies,
physicians, and others to determine the benefits of new health care technologies
and the effectiveness of changes in health policy.
Brook is the 20th recipient of the Lienhard Award, which includes
a medal and a $25,000 prize. Given annually, the award recognizes outstanding
national achievement in improving personal health care services
in the United States.
NEW IOM MEMBERS
DRS. ROBERT KAPLAN and JARED DIAMOND were honored with election
to the Institute of Medicine for their contributions to health.
Kaplan, who chairs the school’s Department of Health Services, is
an internationally renowned scholar known for his ground-breaking work in
quality of life and health outcomes assessment. His interest in measuring
functional and quality of life outcomes has led to an increased focus in
recent years in issues of cost-effectiveness and resource allocation – particularly
questions of how to optimize the use of health care dollars to manage
the health of populations (see the article on page 18).
Diamond, a professor of geography at UCLA with joint appointments
in the schools of public health and medicine, is the Pulitzer Prize-winning
author of Guns, Germs, and Steel: The Fates of Human Societies. Most
recently, in Collapse: How Societies Choose to Fail or Succeed, a New York
Times best seller, Diamond examined the fall of great civilizations of the
past and the lessons modern societies can draw from their fates. Widely
recognized as a founder of conservation biology, Diamond was the recipient
of the National Medal of Science in 1999, among many other awards.
The Institute of Medicine was established in 1970 by the National
Academy of Sciences to honor professional achievement in the health
sciences and to serve as a national resource for independent analysis and
recommendations on issues related to medicine, biomedical sciences and
health. Seven of the school’s other faculty members have been elected to
the IOM: Drs. Ronald Andersen, Lester Breslow, Robert Brook, Thomas
Coates, Jonathan Fielding, Gail Harrison, and Linda Rosenstock.
news briefs
lab network will
improve response
to emerging threats
SPEARHEADING THE EFFORT (l. to r.) — Dean’s Advisory Board
member Cindy Harrell Horn, Dean Linda Rosenstock and Dr. Scott Layne,
faculty leader of the new high-speed, high-volume laboratory network.
A new high-speed, high-volume laboratory network based
in the UCLA School of Public Health will be capable of
quickly analyzing and processing high quantities of biological
samples, improving the nation’s ability to respond
to an avian flu outbreak, bioterrorist attack, or other rapidly
emerging public health threats.
The new lab, spearheaded by Dr. Scott Layne, associate
professor of epidemiology, will enable public health
experts to track diseases in near real-time and dramatically
shorten the time needed to produce effective vaccines.
Additionally, the laboratory will train public health
and laboratory experts in infectious disease management,
addressing a well-documented need for skilled personnel
in bio-emergency situations. Initial funding of $6 million
was secured in the FY 06 Department of Defense appropriations
bill and efforts are currently underway to secure
additional federal funding as well as funding from the
State of California and private supporters.
STEM CELL SYMPOSIUM — Dean
Linda Rosenstock moderated a session
featuring two UCLA School of
Public Health faculty members at
“Stem Cells: Promise and Peril in
Regenerative Medicine,” a research
conference and public symposium
held at UCLA in February. In addition
to Rosenstock, Drs. Gerald F.
Kominski (“Issues of Cost, Quality
and Access”) and Simin Liu
(“Implications for Prevention and
Chronic Disease”) presented.

cindy harrell
horn receives
dean’s award
Cindy Harrell Horn was
selected to receive the Dean’s
Award for sustained and generous
support. A tireless advocate
for the school and its
new effort to combat emerging
infectious diseases, Horn has
volunteered hundreds of
hours and traveled thousands of miles to help
secure funding and support for the school’s new
high-speed, high-volume laboratory network (see
the article on opposite page).
Horn is well known locally and throughout the
nation as an advocate for improving education,
health and the environment. Following a successful
career as an actress and model, she co-founded
the Environmental Media Association (EMA) in
1989 to mobilize the entertainment industry to
increase public awareness of environmental problems.
In addition to her continued involvement with
EMA, she serves on boards of numerous organizations,
including the UCLA School of Public Health
Dean’s Advisory Board.
COMMUNITY PARTNERSHIP AWARD — Dr. Michael Prelip
(center), assistant professor and head of the school’s Field
Studies Program, received the Ann C. Rosenfield Distinguished
Community Partnership Prize from the UCLA Center for Community
Partnerships, in recognition of Prelip’s collaboration
with the Greater West Hollywood Food Coalition to serve the
homeless population of Hollywood and West Hollywood. The
$25,000 award recognizes partnerships that have enhanced
the quality of life in Southern California.
survivorship
center for cancer
established
UCLA’s Jonsson Cancer Center has been named
as one of five Survivorship Centers of Excellence
by the Lance Armstrong Foundation. A five-year, $1.7
million grant from the foundation establishes the
Jonsson Cancer Center Survivorship Program. The
new program will build on two decades of survivorship
research and put into place important clinical
programs to help cancer survivors transition into
their disease-free lives. The program will be directed
by Dr. Patricia Ganz, professor in the schools of
public health and medicine and head of the cancer
center’s Division of Cancer Prevention and Control
Research, based in the School of Public Health.
BRESLOW LECTURE — Dr. Harvey V. Fineberg, president
of the Institute of Medicine, spoke at the 32nd Annual Lester
Breslow Lecture in April. In his talk, “Why Prevention Is a Hard
Sell,” Fineberg outlined some of the reasons: There is no
drama in prevention; non-events are not counted; statistical
lives don’t have immediacy; prevention is not profitable; prevention
often runs against commercial interests; it may conflict
with personal preferences or religious beliefs; and there is
declining trust in leaders and institutions, challenging people’s
willingness to follow guidelines.
SAVE THE DATE
UCLA SCHOOL OF PUBLIC HEALTH ALUMNI
AND FRIENDS RECEPTION
MONDAY, NOVEMBER 6, 2006
6:30 - 8:00 pm
at the Boston Convention & Exhibition Center, Room 104A
PLEASE
REMEMBER
You are a lifetime member
of the UCLA School
of Public Health
Alumni Association
if you are
a graduate of the
UCLA School
of Public Health
and its
executive programs.
If you would like
more information
about the activities
of the Public Health
Alumni Association,
please call
(310) 825-6464
or e-mail
phaa@support.ucla.edu.
If you are not
already receiving
and would like
to receive the
SPH ALUMNI e-NEWS
that brings information
on events and people
of special interest
to alumni three times
a year, please provide
this information at
publichealth@
support.ucla.edu.
During the Annual Meeting of the American Public Health Association,
November 4 - 8, in Boston
Check the APHA schedule or stop by the
UCLA School of Public Health booth for location information.
33
news briefs UCLAPUBLIC HEALTH

34
campaign closes on a high note
“The school
is enormously
grateful for the
generous support
of our alumni,
corporate and
foundation
partners, friends,
faculty and staff
in bringing
Campaign UCLA
to such a successful
close for the School
of Public Health.”
— LINDA ROSENSTOCK,
DEAN
During Campaign UCLA — the largest and most successful fundraising effort in the history of
higher education — the UCLA School of Public Health surpassed its goals and the result is farreaching
throughout the school. Over the campaign’s decade-long run, the school generated
$56.6 million in private support, strengthening excellence in teaching, research, and service in
support of keeping the public healthy.
More than 550 students have benefited from new fellowships, international internships,
scholastic prizes, and other forms of student support generated from 1995 to 2005. As some of
these gifts were endowments, they will continue to grow and support the school’s students for
generations to come.
The school’s research and operating programs were propelled to new levels by the major
portion of the monies raised during the campaign. During this period, the school received its
first-ever research center endowment with a generous gift of $5 million to establish the Fred
H. Bixby Center for Population and Reproductive Health.
The campaign also produced a tremendous increase in undesignated gifts, large and small,
making it possible for the school to invest in important new public health initiatives such as eliminating
health disparities, global health, and emerging infectious diseases. The school’s investors
have also supported classroom and student lounge upgrades, updates of the school’s information
technology infrastructure, and the creation of a new career services office to assist students
in their career exploration and job placements.
With state funding comprising less than 15% of UCLA’s budget, private support has become
critical to maintaining and enhancing the school’s excellence. The school will continue to
strengthen its partnerships to ensure that it provides the state and nation with a well-trained
public health workforce.
CAMPAIGN UCLA SCHOOL OF PUBLIC HEALTH
Final Count: July 1995-December 2005 | SPH Campaign Goal: $31 M (183%)
$60,000,000
55,000,000
50,000,000
$56,596,368
$51,565,872
45,000,000
40,000,000
$37,969,674
35,000,000
$33,029,500
30,000,000
revised goal
X
25,000,000
$23,336,915
20,000,000
$18,852,239
15,000,000
original goal
X
UCLAPUBLIC HEALTH
10,000,000
5,000,000
0
FY 95-96 FY 96-97 FY 97-98 FY 98-99 FY 99-00 FY 00-01 FY 01-02 FY 02-03 FY 03-04 FY 04-05 FY 05-06*
*through 12/31/05
$12,364,174
$10,037,344
$ 8,165,239
$ 4,453,851
$ 1,969,479

campaign ucla | honor roll 1995-2005 35
THE SCHOOL IS PLEASED TO HONOR the alumni, friends, students, staff, foundations and corporations
whose generosity over the past decade has made a lasting mark on the school and has firmly planted us at
the forefront of public health education. This Campaign Honor Roll gratefully acknowledges gifts and private
grants made to the UCLA School of Public Health from July 1, 1995 to December 31, 2005. Although space
limitations allow only the listing of cumulative donations of $1,000 or more, contributions of every amount
have been and continue to be of great importance to the school and are deeply appreciated.
$15,000,000+
THE CALIFORNIA ENDOWMENT
$5,000,000 - $9,999,999
FRED H. BIXBY FOUNDATION
THE ROBERT WOOD
JOHNSON FOUNDATION
$1,000,000 - $4,999,999
AMERICAN CANCER
SOCIETY INC.
THE BREAST CANCER
RESEARCH FOUNDATION
CALIFORNIA HEALTHCARE
FOUNDATION
THE CALIFORNIA WELLNESS
FOUNDATION
ALDO DEBENEDICTIS
THE SUSAN G. KOMEN
BREAST CANCER FOUNDATION
HELGA AND WALTER
OPPENHEIMER
$500,000 - $999,999
ASSOCIATION OF SCHOOLS
OF PUBLIC HEALTH
THE DORIS DUKE
CHARITABLE FOUNDATION
THE HENRY J. KAISER
FAMILY FOUNDATION
RAND CORPORATION
U.S. BORAX INC.
$250,000 - $499,999
THE COMMONWEALTH FUND
THE JOHN A. HARTFORD
FOUNDATION
CARL AND FLORENCE
HOPKINS
THE JOYCE FOUNDATION
KAISER PERMANENTE
CAROLBETH AND
LESTER KORN
RALPH AND SHIRLEY SHAPIRO
THRASHER RESEARCH FUND
W. M. KECK FOUNDATION
BOB AND MARION WILSON
WORLD AIDS FOUNDATION /
NATIONAL INSTITUTE
OF HEALTH
$100,000 - $249,999
ROYAL ADELAIDE HOSPITAL
ALZHEIMER'S ASSOCIATION
LOS ANGELES
AVENTIS PASTEUR
ANNETTE BLANN
LIVING TRUST
BLUE CROSS OF CALIFORNIA
DOLE FOOD COMPANY, INC.
ROBERT J. DRABKIN
FOLEY AND LARDNER
THE FORD FOUNDATION
CONRAD N. HILTON
FOUNDATION
JONSSON CANCER CENTER
FOUNDATION
JOHNSON & JOHNSON
JUVENILE DIABETES
FOUNDATION INTERNATIONAL
L.A. CARE HEALTH PLAN
LOS ANGELES COLLEGE
OF CHIROPRACTIC
SUSAN LOVE M.D. BREAST
CANCER FOUNDATION
THE ANDREW W. MELLON
FOUNDATION
MARCH OF DIMES BIRTH
DEFECTS FOUNDATION
ALFRED K. AND
CHARLOTTE G. NEUMANN
THE DAVID AND LUCILE
PACKARD FOUNDATION
PUBLIC HEALTH
FOUNDATION ENTERPRISES
PUBLIC HEALTH INSTITUTE
SHANE S. QUE HEE
ROCKEFELLER BROTHERS
FUND
MONICA SALINAS
MEDICAL SERVICE CORP
INTERNATIONAL
SPECIAL SERVICE
FOR GROUPS
WESTERN CONSORTIUM
FOR PUBLIC HEALTH
$50,000 - $99,999
THE AHMANSON FOUNDATION
IRA R. AND
MARSHA L. ALPERT
AMERICAN OCEANS
CAMPAIGN INC.
AMGEN
LINNAE ANDERSON AND
THOMAS E. EPLEY
ARCHSTONE FOUNDATION
BLUE SHIELD OF CALIFORNIA
LESTER AND
DEVRA M. BRESLOW
AUGUSTUS OLIVER BROWN
TRUST
CANCER RESEARCH
FOUNDATION OF AMERICA
CEDARS-SINAI
MEDICAL CENTER
CIGNA FOUNDATION
COMMUNITY TECHNOLOGY
FOUNDATION OF CALIFORNIA
EDWARD AND JOANNE DAUER
JOSEPH DROWN FOUNDATION
EGYPTIAN CULTURAL AND
EDUCATIONAL BUREAU
MAX FACTOR
FAMILY FOUNDATION
JERRY J. AND
LORRAINE H. FACTOR
DANA FARBER
CANCER INSTITUTE
GLAXOSMITHKLINE
RAYMOND D. AND
BETTY J. GOODMAN
HEALTH RESEARCH
ASSOCIATION
THE WILLIAM AND FLORA
HEWLETT FOUNDATION
LESTER AND GENEVA MEIS
MERCK AND COMPANY, INC.
NATIONAL IMMIGRATION
LAW CENTER
THE KENNETH T. AND
EILEEN L. NORRIS
FOUNDATION
ORTHO-MC NEIL
PHARMACEUTICAL, INC.
PACIFICARE HEALTH
SYSTEMS, INC.
THE PARKINSON'S INSTITUTE
PHARMACIA CORPORATION
PRICEWATERHOUSECOOPERS
LLP
LINDA ROSENSTOCK
AND LEE BAILEY
A. HENRY SCHUYLER, JR.
SIMPSON AND SIMPSON
BUSINESS AND PERSONNEL
SERVICES INC.
RICHARD E. AND
PATRICIA J. SINAIKO
GURDON AND
MARY ANN SMITH
TARGET CORPORATION
TENET HEALTHCARE
AUDREY TIBBITTS
$25,000 - $49,999
ABDELMONEM A. AND
MARIANNE H. AFIFI
ALLIANCE HEALTHCARE
FOUNDATION
AMERICAN PARKINSON'S
DISEASE ASSOCIATION, INC.
THE ASSOCIATION FOR
DRESSINGS AND SAUCES
FRANK J. BIONDI, JR. AND
CAROL O. BIONDI
DAVID G. AND
SUZANNE D. BOOTH
BRAIN INJURY
ASSOCIATION, INC.
CALIFORNIA AVOCADO
COMMISSION
CALIFORNIA FOOD POLICY
ADVOCATES
THE NANCY M. DALY
FOUNDATION
JAMES E. AND
MARTA V. ENSTROM
FARHAD A. AND
LATIFEH E. HAGIGI
HEALTH NET, INC.
HEALTH RESEARCH &
EDUCATIONAL TRUST
IOWA FOUNDATION FOR
EDUCATION, ENVIRONMENT
AND THE ARTS
RAYMOND AND JENNIE JING
STEPHEN W. KAHANE AND
JANET WELLS-KAHANE
CAROLYN F. KATZIN
DEBORAH A. LEVY
ROBERT AND ADELINE MAH
MILDRED MASSEY
EDWARD O'NEILL
PFIZER INC. US
PHARMACEUTICALS GROUP
MILTON I. AND
RUTH J. ROEMER
JEAN SANVILLE
LEONARD D. AND
PAMELA SCHAEFFER
PAUL R. TORRENS
WILSHIRE FOUNDATION
$15,000 - $24,999
ROSALIND & ALFRED BERGER
FOUNDATION, INC.
ROBERT BLAIR, JR.
BLOCK MANAGEMENT, INC.
COMMUNITY VISIONS
UNLIMITED
BRUCE DAVIDSON
MICHELE DILORENZO
ENVIRONMENTAL
DEFENSE CENTER
JOHN E. FETZER
INSTITUTE INC.
JONATHAN E. AND
KARIN B. FIELDING
HOAG MEMORIAL
HOSPITAL PRESBYTERIAN
ALAN R. AND TERI HOOPS
JAPANESE FOUNDATION FOR
AIDS PREVENTION
KENNETH AND CORNELIA LEE
RICHARD AND AMY LIPELES
LOS ANGELES
REGIONAL FOOD BANK
MARTI S. SLAWSON AND
TED C. LILYEBLADE
ST. JOSEPH HEALTH SYSTEM
ROBERT STEINER
$10,000 - $14,999
RONALD M. AND
DIANE ANDERSEN
CALIFORNIA COMMUNITY
FOUNDATION
Traditionally
in the June issue
of UCLA Public Health,
we include an annual
Honor Roll in grateful
acknowledgement
of the school’s supporters
during the previous
calendar year.
As this year we have
published a decade-long
cumulative Honor Roll
that covered the
Campaign UCLA,
we kindly direct
the reader to visit the
school’s website at
www.ph.ucla.edu/
giving_honor.html
where we have posted
our special thanks
to all our supporters
who generously gave
$100 or more
during 2005.
friends UCLAPUBLIC HEALTH

36
UCLAPUBLIC HEALTH
THE ANNIE E. CASEY
FOUNDATION
ANNE H. AND
JOHN E. COULSON
COURSE READER MATERIAL
THE EL ADOBE CORPORATION
EMBASSY OF THE ARAB
REPUBLIC OF EGYPT
MICHAEL R. GALPER
GAIL HARRISON AND
OSMAN GALAL
HEALTH BENCHMARKS, INC.
HOECHST MARION ROUSSEL
INC.
DAVID B. KATZIN
GERALD AND
LAURIE KOMINSKI
MERIDIAN HEALTH CARE
MANAGEMENT, INC.
MIDWEST STEEL INC.
ONCOLOGY NURSING
FOUNDATION
THE PROCTER AND GAMBLE
COMPANY
RESOURCE CONSERVATION
DISTRICT OF THE SANTA
MONICA MOUNTAINS
DONALD W. REYNOLDS
FOUNDATION
ROHM AND HAAS COMPANY
JACK R. AND
CARISSA SCHLOSSER
JOHN AND LINDA SIEFKER
THE STREISAND FOUNDATION
MARIAN E. SWENDSEID
$5,000 - $9,999
ARTHUR ANDERSON
FOUNDATION
AL-AZHAR UNIVERSITY
ASPEN ENVIRONMENTAL
GROUP
ASSOCIATION OF UNIVERSITY
PROGRAMS IN HEALTH
ADMINISTRATION
THE AUTRY FOUNDATION
STANLEY AZEN AND
JOYCE NILAND
LEONARD I. AND
JOAN G. BEERMAN
DIANA M. BONTA AND
FRANK P. MATRICARDI
ROBERT H. BROOK AND
JACQUELINE B. KOSECOFF
CAROLLO ENGINEERS
CALVIN S. Y. CHUN
CIGNA HEALTHCARE
OF CALIFORNIA INC.
COALITION FOR CLEAN AIR
DA VITA INC.
SAM W. DOWNING
ELI LILLY AND COMPANY
LAWRENCE ERLBAUM
ASSOCIATES, INC.
GAROLD L. AND
JOYCE E. FABER
LAWRENCE R. FELDMAN AND
JO K. KAPLAN
FOUNDATION FOR
ACCOUNTABILITY
ALAN V. AND
SUSAN F. FRIEDMAN
GAY AND LESBIAN MEDICAL
ASSOCIATION
BARRY E. AND
JANE B. GERBER
BRUCE AND
ROBERTA GERDING
ROBERT W. AND
KATHERINE GILLESPIE
GREENBERG
GLUSKER FIELDS
CLAMAN MACHTINGER &
KINSELLA LLP
TERRY HARTSHORN
FAMILY FUND
HEALTHCARE PRACTICE
ENHANCEMENT NETWORK
INC.
HEIDRICK AND
STRUGGLES INC.
HELD PROPERTIES INC.
HEMATOLOGY ONCOLOGY
CONSULTANTS
DIANA W. AND
JOE W. HILBERMAN
SUSAN D. HOLLANDER
ALAN AND VALERIE HOPKINS
THE HORN FOUNDATION
HOSPITAL ASSOCIATION OF
SOUTHERN CALIFORNIA
HUGHES AIRCRAFT COMPANY
RICHARD B. AND
LAURA JACOBS
MARVIN AND FERN G. JUBAS
MARJORIE L. KAGAWA-
SINGER AND PETER SINGER
JERRY LEEN
LESTER J. AND
JOANNE E. MANTELL
MAXICARE HEALTH
PLANS INC.
MCDERMOTT WILL & EMERY
CHARITABLE FOUNDATION
MEREDITH/BOLI AND
ASSOCIATES INC.
METROPOLITAN
WATER DISTRICT
JOHN D. AND
CHARLENE U. MILLER
NATIONAL ASSOCIATION OF
INJURY CONTROL RESEARCH
CENTERS
NORTHROP GRUMMAN
LITTON FOUNDATION
JOYCE A. PAGE
LORI RICHARDSON-
PELLICCIONI AND DANIEL
PELLICCIONI
PHARMACEUTICAL RESEARCH
& MANUFACTURERS OF
AMERICA FOUNDATION
POPULATION COMMUNICATION
THOMAS M. AND
JODY J. PRISELAC
PRUDENTIAL SECURITIES INC.
RADIAN INTERNATIONAL LLC
THOMAS H. RICE AND
KATHERINE DESMOND
ANTHONY D. AND
DEBORAH RODGERS
ROTH FAMILY FOUNDATION
RUSTIC CANYON VENTURES
RALPH SACHS ESTATE
SALINAS VALLEY MEMORIAL
HEALTH CARE SYSTEM
THE SAVE THE EARTH
FOUNDATION INC.
SHELL OIL COMPANY
FOUNDATION
JAMES H. SHINABERGER
IRWIN J. SHORR
CYNTHIA L. & WILLIAM E.
SIMON, JR. FOUNDATION
GARY J. SLOAN AND
BARBARA KOMAS
ARTHUR M. SOUTHAM AND
CORNELIA DALY
RICHARD L. AND
MILDRED G. STERZ
DAVID A. AND
VICKIE L. WALKER
FRED W. AND
PAMELA K. WASSERMAN
CARL AND EDITH WEISSBURG
TOM & MARLA WILLIAMS
CHARITY FUND
ARTHUR M. AND
JUDY A. WINER
$2,500 - $4,999
JAMES P. AGRONICK
ROSLYN ALFIN SLATER
ALLIANCE IMAGING INC.
ANDREW AND
BRENDA K. ALLOCCO
MICHAEL J. AND
DIANNE K. ALPER
ALTA MEDICAL HEALTH
SERVICES CORPORATION
AMERICAN INDUSTRIAL
HYGIENE ASSOCIATION
AMERICAN MEDICAL GROUP
ASSOCIATION
AMERICAN SOCIETY OF
CLINICAL ONCOLOGY
AMI INC.
JAMES D. BARBER
CHRISTY L. BEAUDIN
LINDA B. BOURQUE
E. RICHARD BROWN AND
MARIANNE PARKER BROWN
THE CAMDEN GROUP
PAULA A. CARABELLI AND
THOMAS M. FALLO
MICHAEL D. COLLINS AND
KAREN L. MITCHELL
WILLIAM COMANOR
COMMUNITY OUTREACH FOR
PREVENTION AND EDUCATION
THOMAS G. AND
JANE P. DAVID
DAVIS WRIGHT & TREMAINE
LAW OFFICE
CLIMIS A. AND IRENE DAVOS
EASTERN RESEARCH GROUP
JEFFREY E. AND
MARTHA M. FLOCKEN
RONALD C. FORGEY
RALPH R. FRERICHS AND
RITA FLYNN
TOMAS AND PATRICIA A.
GANZ
CAROL J. GILBERT
DANIEL P. AND
LOUISE E. GROSZKRUGER
HARRIMAN JONES
MEDICAL GROUP
HARLAN H. HASHIMOTO
MARK J. HOWARD
SUSAN M. HULL
IMPACT ASSESSMENT, INC.
LEONARD D. AND
NANCY P. JACOBY
TARA G. KAMRADT
AVRAM W. AND
BETH F. KAPLAN
SNEHENDU B. AND
BARBARA KAR
KATTEN MUCHIN ZAVIS
ROSENMAN FOUNDATION
NEAL D. AND
FRANCINE R. KAUFMAN
FRANK P. AND
JENNIFER L. KOZAKOWSKI
LANDMARK PROGRAMS, INC.
JOANNE LESLIE
LITTLE COMPANY
OF MARY HOSPITAL
CHRIS J. MARDESICH AND
EDEN L. KUSMIERSKY
MCINTYRE, BIRKNER
& ASSOCIATES
MEDECINS SANS FRONTIERES
MEDICAL EDUCATION
COOPERATION WITH CUBA
MEDICAL SERVICE
CORPORATION INTERNATIONAL
WILLIAM MEIERDING
KYLE A. MURPHY
WALTER W. NOCE, JR.
THE RALPH M. PARSONS
FOUNDATION
PAUL, HASTINGS, JANOFSKY
& WALKER LLP
PEPSI-COLA CANADA LIMITED
NEAL PORGMAN
LYNDA AND
STEWART RESNICK
KENNETH J. RESSER
SCAN HEALTH PLAN
MIRIAM SCHOCKEN
BENEDICT R. AND
JANICE A. SCHWEGLER, JR.
STUART O. AND
SUZANNE U. SCHWEITZER
ROBERT SCOFIELD, JR.
ROBERT C. AND
LISA B. SHAW
ATSUKO SHIBATA
JUDITH SIEGEL
GRANT G. SLATER AND
GENE H. KAULA
STATE FARM COMPANIES
FOUNDATION
ZHUANG TANTIWASADAKRAN
AND UCHUMAS
SUPHAVARODOM
UCLA HEALTH POLICY AND
MANAGEMENT ALUMNI
ASSOCIATION
UNIHEALTH AMERICA
VERIZON FOUNDATION
PAUL S. VIVIANO
VICTORIA C. WATTS
BEATRICE BLAU ZEIGER AND
IRVING ZEIGER
$1,000 - $2,499
2C SOLUTIONS
CRAIG M. AND
GRACE N. ACOSTA
ADVENTIST HEALTH
ALLIEDSIGNAL
FOUNDATION INC.
RICHARD F. AMBROSE
ARCO
RUTH M. AREVALO
SANDRA AND
CHARLES ARONBERG
TAKAMARU ASHIKAGA
SYLVIA E. AND
ALLAN R. BARR
MICHAEL J. BELMAN
MARLENE D. AND
ROBERT L. BELSTOCK
ROY P. BETANCOURT
SUSAN K. BLACKWELL
JOY T. BLEVINS
BLUE CROSS BLUE SHIELD
ASSOCIATION
GERALD M. BOROK
TEYMOUR BOUTROS-GHALI
J.J. AND JUDY BRANDLIN
DOROTHY K. BREININGER
RALPH AND CLAIRE BRINDIS
WAYNE O. AND
SUZANNE BUCK
THERESA L. BYRD
CHARLES E. AND
VICKY C. CABLE
GUOXUAN CAI
CALIFORNIA ASSOCIATION OF
HOSPITALS AND HEALTH
SYSTEMS
CALIFORNIA ATHLETIC
TRAINERS ASSOCIATION
CALIFORNIA CENTER FOR
PUBLIC HEALTH ADVOCACY
CALIFORNIA MEDICAL
CENTER, LOS ANGELES
CALIFORNIA PUBLIC HEALTH
ASSOCIATION-NORTH
CAP GEMINI ERNST
& YOUNG U.S. LLC
CAREAMERICA SOUTHERN
CALIFORNIA
MARTIN F. AND
MARY ELIZABETH CARR
CATHOLIC HEALTHCARE WEST
CENTER FOR CORPORATE
INNOVATION, INC.
STEVEN H. AND
FRANCES CHASEN
CHEVRON CORPORATION
CHILDRENS HOSPITAL
LOS ANGELES
VIRGINIA A. AND
WELDEN E. CLARK
SHELDON E. COHEN
JO ANN COHN
STEVEN S. COHN
JEFFREY AND
JOELLA CONKLIN
CONSULTANTS FOR
PATHOLOGY & LABORATORY
MEDICINE
MARK AND KATHLEEN COSTA
CREDIT SUISSE FIRST
BOSTON CORPORATION
LYNN W. CREELMAN
JULIE E. CRONER
LAYTON R. CROUCH
WILLIAM G. AND
HOLLY H. CUMBERLAND
THE DAVID FAMILY
FOUNDATION, INC
ROBERT A. DAY AND
KELLY DAY

37
DARYL V. DICHEK
WILFRID J. AND
GLORYA U. DIXON
HELEN M. DUPLESSIS
LYNNE A. EMMA
EQUITABLE REAL ESTATE
MANAGEMENT GROUP
ROSALIND ESSNER
THOMAS B. AND
PHYLLIS C. FARVER
DANIEL J. FINK
FIRST CONSULTING GROUP
DAVID I. FISHER AND
MARIANNA J. FISHER
JEFFREY S. AND
DEBBIE L. FRIEDMAN
GENENTECH
ROBERT P. AND
DIANA L. GHIRELLI
DAVID M. GITTELMAN
ALISA M. GOLDSTEIN
HAROLD M. GOLDSTEIN
MICHAEL S. GOLDSTEIN
FRANK C. GOMEZ
SUSAN R. GOODGAME
SEYMOUR F. AND
SHARON M. GORELICK
KENNETH D. GRAHAM
GREATER PACIFIC MEDICAL
MANAGEMENT
DANIEL AND
ROCHELLE GREEN
MARILYN W. GRUNZWEIG
JAMES E. HADEN
HAGOPIAN FAMILY
FOUNDATION
RONALD J. HALBERT
NORA L. HAMILTON
PHYLLIS E. HAYES REAMS
HEALTH CARE REVIEW
HEALTHCARE PARTNERS
HORACE W. AND
EDYTHE HINKSTON
JOHN A. HIRSHLEIFER
ELISE M. HOLLOWAY
GORDON D. AND
RURI T. HONDA
DONALD B. AND
CAROLYN T. HUNSAKER
HUNTINGTON HOSPITAL
PATRICIA AND
GILBERT IALONGO
IBM INTERNATIONAL
FOUNDATION
JOHN D. AND
CHRISTINA N. IVIE
ROBERT A. JACKSON
JENQUEST
ALLAN K. AND
DOROTHY N. JONAS
JIM M. KADA
NATHAN KAPROFF
HERMAN E. AND
ROSE KATTLOVE
ALBERT M. AND
AUDREY KATZ
KECK SCHOOL OF
MEDICINE AT USC
KINDRED HEALTHCARE
OPERATING
THE MICHAEL KING FAMILY
FOUNDATION
JANET L. AND
ALEXANDER W. KIRKPATRICK
SUSAN AND COREY E. KLEIN
LEONARD F. AND
MELODYE T. KLEINMAN
MASAO AND
KARLENE N. KOKETSU
JAMES J. KORELITZ AND
ELIZABETH M. SLOSS
KORN/FERRY INTERNATIONAL
DAVID KRASNOW
DIANE W. AND
JAMES D. LAIRD
BARBARA M. LANGLAND
ORBAN
GAIL C. LARSON
LATHAM & WATKINS LLP
NED LAUBACHER, JR.
TERI DALY LAUENSTEIN
ANNE C. AND
KENNETH P. LAWLER
J. JACK AND VEI-VEI C. LEE
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DEBRA H. LEWIS
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EVE MASONEK
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MAX RAY MICKEY
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ALLAN E. GORDON
HAL MORGENSTERN
MARC D. AND
JOANNE L. MOSER
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NIEL S. NATHASON
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PETER NORTON FAMILY
FOUNDATION
ONCOLOGY NURSING PRESS
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JEAN E. ROSENFELD
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TAL C. ROSS
WILLIAM T. ROSS
RSKMGMT. INC.
SAINT VINCENT
MEDICAL CENTER
ALAN AND SUE SAMUELS
MARJORIE A. SANTORRE
BESSON
KENNETH P. AND
LESLIE H. SATIN
MARK D. AND
SHING S. SCHLUCHTER
RICHARD M. SEIGEL
FOUNDATION
BRIAN T. AND
JEANETTE E. SHERRINGTON
JERALD F. AND
DONNA JEAN FREDERICK
STEVEN R. SIM
HASKEL SIMONOWITZ
JAMES B. SIMPSON
CLIFFORD J. SMITH
DANIEL F. SMITH
WILLIAM E. SMITH, JR.
HERBERT N. AND
MARIAN E. SNOW
SONOMA STATE UNIVERSITY
ACADEMIC FOUNDATION, INC
SAMUEL AND HELENE SOREF
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COMPANY
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IRMA H. STRANTZ
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KEITH A. TOBIAS
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MARY E. WINTER
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DAVID S. VERITY
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MISTY WIDELITZ
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FOUNDATION
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VIVIAN R. WILLIAMS
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ALEXANDER S. CHAI
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EDUCATION FUND
DAPHNA AND
RICHARD S. ZIMAN
MEL AND NANCY ZIONTZ
It is important
to us that we acknowledge
your gift properly.
Every effort has been made
to ensure the completeness
and accuracy of
this Honor Roll.
Please let us know
of any omissions or errors
in listing your name or gift
by calling (310) 825-6464.
ANNUAL PRIZE
WILL HONOR
OUTSTANDING
UCLA PUBLIC
HEALTH STUDENT
Carolbeth Korn
(B.S. ’59, pictured
above) has donated
$200,000 to the UCLA
School of Public Health
to create an annual
$10,000 prize honoring
the outstanding graduating
student each
year. Recipients of the
Carolbeth Korn Prize
will be selected by the
dean and academic
leaders of the School
of Public Health and
announced during
the school’s annual
awards event.
“By establishing
this annual prize, I
hope to encourage
the best and brightest
public health students
to become our nation’s
public health leaders,”
she says. “After receiving
a first-rate public
health education at
UCLA, I’m very proud
to be investing in the
School of Public Health’s
most outstanding
students.”
friends UCLAPUBLIC HEALTH

Commencement
2006
John Garamendi,
California insurance commissioner
and author of the report
Priced Out: The Crisis in California Health Care,
is the featured speaker
at the school’s 2006 Commencement.
UCLA
PUBLIC HEALTH
Nonprofit Org.
U.S. Postage
PAID
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UCLA
School of
Public
Health
School of Public Health
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Los Angeles, California 90095-1772
www.ph.ucla.edu
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