Health sciences campus becomes largest in U.S. to adopt open access policy.

Richard Schneider, UC San Francisco

The UC San Francisco Academic Senate has voted to make electronic versions of current and future scientific articles freely available to the public, helping to reverse decades of practice on the part of medical and scientific journal publishers to restrict access to research results.

The unanimous vote of the faculty senate makes UCSF the largest scientific institution in the nation to adopt an open access policy and among the first public universities to do so.

“Our primary motivation is to make our research available to anyone who is interested in it, whether they are members of the general public or scientists without costly subscriptions to journals,” said Richard A. Schneider, Ph.D., chair of the UCSF Academic Senate Committee on Library and Scholarly Communication, who spearheaded the initiative at UCSF. “The decision is a huge step forward in eliminating barriers to scientific research,” he said. “By opening the currently closed system, this policy will fuel innovation and discovery, and give the taxpaying public free access to oversee their investments in research.”

UCSF is the nation’s largest public recipient of funding from the National Institutes of Health (NIH), receiving 1,056 grants last year, valued at $532.8 million. Research from those and other grants leads to more than 4,500 scientific papers each year in highly regarded, peer-reviewed scientific journals, but the majority of those papers are only available to subscribers who pay ever-increasing fees to the journals. The 10-campus UC system spends close to $40 million each year to buy access to journals.

Such restrictions and costs have been cited among the obstacles in translating scientific advances from laboratory research into improved clinical care.

The new policy requires UCSF faculty to make each of their articles freely available immediately through an open access repository, and thus accessible to the public through search engines such as Google Scholar. Articles will be deposited in a UC repository, other national open access repositories such as the NIH-sponsored PubMed Central, or published as open-access publications. They will then be available to be read, downloaded, mined or distributed without barriers.

Hurdles do remain, Schneider noted. One will be convincing commercial publishers to modify their exclusive publication contracts to accommodate such a policy. Some publishers already have demonstrated their willingness to do so, he said, but others, especially premier journals, have been less inclined to allow the system to change.

Under terms negotiated with the NIH, a major proponent of open access, some of the premier journals only allow open access in PubMed Central one year after publication; prior to that only the titles and summaries of articles are freely available. How such journals will handle the UCSF policy remains to be seen, Schneider said.

The UCSF policy gives the university a nonexclusive license to distribute any peer-reviewed articles that will also be published in scientific or medical journals. Researchers are able to “opt out” if they want to publish in a certain journal but find that the publisher is unwilling to comply with the UCSF policy.  “The hope,” said Schneider, “is that faculty will think twice about where they publish and choose to publish in journals that support the goals of the policy.”

Worldwide open access movement

UC was at the forefront of the movement to open scientific papers to the public through its libraries, and generated the first major effort to create a policy of this kind in 2006. It was a complex policy, though, requiring faculty to “opt in,” and for a variety of reasons failed to garner enough faculty votes across the UC system, said Schneider.  But since then, he said, the academic and economic climate has changed substantially in favor of the open access movement.

In the past few years, 141 universities worldwide, including Harvard University and Massachusetts Institute of Technology, have learned from UC’s initial missteps and have created very effective blanket policies similar to the one just passed at UCSF, Schneider said. Universities throughout Europe and Latin America also have pursued similar policies. Moreover, many funders have adopted open access policies for their grant recipients as a requirement for getting a research award, so faculty are now used to the practice of making their work freely available.

Last year, scientific, technical and medical journals generated billions of dollars in profits for their publishers, and, for the largest publishers, profit margins were around 30 percent to 40 percent, Schneider said, “yet, our research papers are largely funded by taxpayers, submitted to the journals without compensation and edited and reviewed on a volunteer basis by colleagues throughout the world.” Due to the high fees incurred in subscribing to such journals, many universities and the general public have access only to an abstract on each paper, which includes a short description of the research and its results.

The UCSF vote was the result of a faculty-led initiative, and makes UCSF the first campus in the UC system to implement such a policy. It has been developed in collaboration with other UC campuses and systemwide committees, especially the UC Committee on Library and Scholarly Communication, with the ultimate goal of implementing the policy across all 10 UC campuses.

“This vote is very, very good news,” said Karen Butter, UCSF librarian and assistant vice chancellor. “I am delighted that UCSF will join leading institutions in changing the model of scientific communications, and that UCSF authors have chosen to take control of their scholarship, providing new audiences with incredible opportunities to translate UCSF’s remarkable research into improving health care.”

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. For further information, please visit www.ucsf.edu.

New report offers proposals to reform nation’s financial safety net for senior citizens.

Carroll Estes, UC San Francisco

After a lifetime of lower wages and time out of the labor market for caregiving, women typically receive less from Social Security than men, with millions of widows and women of color falling into poverty in old age.

Now, in a significant new report led by a UC San Francisco social scientist, a team of leading advocates for women and senior citizens seeks to correct the inequities through sweeping proposals to reform the nation’s financial safety net for senior citizens.

The report will be unveiled at a Congressional briefing Friday, May 11, at 9:30 a.m. (ET) in Washington, D.C.

The authors represent three national organizations for seniors and women: the National Committee to Preserve Social Security & Medicare Foundation, the National Organization for Women Foundation (NOW), and the Institute for Women’s Policy Research.

“This is an urgent call for our retirement system to catch up with the changing needs of women,’’ said the lead author of the report, Carroll L. Estes, Ph.D., founder and former director of the UCSF Institute for Health & Aging. She is the chair of the board of directors of the National Committee to Preserve Social Security & Medicare and its foundation.

“Social Security is crucial to the future of our children and grandchildren,’’ Estes said. “It is there for Americans when catastrophic events befall them, such as 9/11 when about 2,600 children lost a working parent. We must keep the social contract that it represents, and improve the lives of women and other workers who have paid into Social Security for decades.’’

The report, “Breaking the Social Security Glass Ceiling: A Proposal to Modernize Women’s Benefits,’’ examines the changing role of women in the workforce as well as the smaller incomes women receive in retirement as a result of lower wages on average and time spent out of the labor market for unpaid caregiving of children and aging parents. Retired women of color are particularly vulnerable, experiencing two to three times the poverty rates of whites.

Along with a slate of reforms earmarked at women, the report calls for dramatic changes in Social Security benefits for children and for same sex couples.

The proposals include:

• Improve survivor benefits to be 75 percent of a couple’s combined benefits;
• Provide Social Security credits for caregivers;
• Restore student benefits for children up to age 22;
• Equalize rules for disabled widows;
• Provide Social Security benefits to domestic partners and members of same-sex marriages, including the children of these relationships.

In the decades since the establishment of Social Security in 1935, women transformed the American workforce. Some broke through the rungs to reach the corporate board room, but far more found themselves in part-time positions, lower-levels jobs or entirely out of the workforce for periods as they juggled job and family.

On average, federal statistics show that women earn 19 percent less than men, leaving them with lower lifetime earnings and lower Social Security payments — $12,155 annually compared to $15,620 for men, according to 2009 data from the U.S. Social Security Administration. Additionally women – with longer life expectancies – are less likely to have employer pensions and more likely to outlive their retirement savings.

Even with monthly Social Security payments, 12 percent of older women and 15 percent of widows live in poverty, according to federal poverty statistics. The problem is even more acute for women of color: 26 percent of African American women 75 or older and on Social Security were living in poverty in 2009, while 21 percent of Hispanic women the same age were in the same plight, according to the Institute for Women’s Policy Research.

“For too many women, retirement is the culmination of an entire career…of pay and income inequality,’’ said the authors.

Noting their opposition to privatizing Social Security and to raising the retirement age, the authors said that for more than 20 million women aged 65 and older, Social Security represents “a critical source of income, and is often their only hedge against inflation.’’

To pay for the proposed overhaul, the authors recommend that the earnings cap on contributions to Social Security – currently set at $110,100 and affecting approximately 6 percent of working Americans – be permanently lifted.

“This option by itself would eliminate most of Social Security’s solvency issues in perpetuity,’’ said Estes, a professor in the UCSF School of Nursing and in the Department of Social & Behavioral Sciences.

The authors also suggest that salary reduction plans such as flexible spending accounts become subject to Social Security taxes, and that the Social Security contribution rate be slowly increased by 1/40th of one percent over 20 years.

“Social Security is earned through hard work and contributions,’’ Estes said. “It is insurance against the loss of wages in retirement, loss of the ability to work through disability, death of parents for surviving children and spouses. Every generation and every family with a worker is covered. The private sector is unable to ensure economic security in old age through private pensions, 401(k)s, home equity and interest on savings. This universal, secure source of retirement income for all working Americans and their families has never been more important.’’

Co-authors of the report are NOW president Terry O’Neill and Heidi Hartman, president of the Institute for Women’s Policy Research.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. For further information, visit www.ucsf.edu.

May 15 event will unite diverse groups, people to determine local needs, priorities.

Ellen Olshansky, UC Irvine

The Orange County Women’s Health Project is holding its first Women’s Health Policy Summit at UC Irvine on Tuesday, May 15, to identify needs and priorities related to women’s health issues in the nation’s sixth-largest county.

The event will take place at the Student Center and bring together a diverse group of health professionals and administrators, nonprofit and public agency staff, educators and researchers, and others concerned about women’s health in Orange County. The public is invited to attend.

Highlighting the summit will be a presentation by Brittany Goettsch — who recently earned a master’s degree in public health at UCI — called “A Snapshot of Women’s Health in Orange County” that evaluates local women’s health data culled from a variety of sources.

Diana Bonta, president and CEO of The California Wellness Foundation, and Terri Thorfinnson, chief of the California Office of Women’s Health, will deliver keynote speeches on health policy and opportunities for women’s health under healthcare reform.

“This summit marks the beginning of a process to engage the community to identify policy priorities and develop recommendations that address gaps and disparities affecting women’s health,” said Allyson Sonenshine, founding director of the Orange County Women’s Health Project.

Established in 2010 by five local women — including UCI’s Susan Bryant, retired vice chancellor for research; Karol Gottfredson, coordinator of the Department of Education’s intern teacher credential program; and Ellen Olshansky, nursing science professor and director — the OCWHP aims to facilitate and sustain improvements in women’s health in Orange County. To date, it has united more than 25 community-based organizations and individuals who have met monthly to plan the summit and chart the future direction of the project.

“In many ways, our society has become too complacent about issues related to women’s health,” Olshansky said. “In fact, women have concerns not only about specific health problems, but also about access to quality care for those problems. Our Women’s Health Policy Summit will address these issues with an eye toward influencing important policy decisions.”

The all-day event, which begins at 8 a.m., features a welcome by U.S. Rep. Loretta Sanchez and afternoon sessions on issues disproportionately affecting Orange County women, such as breast and cervical cancer, domestic violence and teen reproductive health. For more information and to register, visit www.ocwomenshealth.org.

About the University of California, Irvine: Founded in 1965, UCI is a top-ranked university dedicated to research, scholarship and community service. Led by Chancellor Michael Drake since 2005, UCI is among the most dynamic campuses in the University of California system, with nearly 28,000 undergraduate and graduate students, 1,100 faculty and 9,000 staff. Orange County’s second-largest employer, UCI contributes an annual economic impact of $4 billion. For more UCI news, visit www.today.uci.edu.

Collaboration brings together UCSF, other partners to link research with practice to improve health.

Kevin Grumbach, UC San Francisco

In March, a committee of the Institute of Medicine (IOM) released a report, Primary Care and Public Health: Exploring Integration to Improve Population Health, that includes a case study of the San Francisco Health Improvement Partnerships (SF HIP), a public health and primary care integration in San Francisco.

“This report highlights the need for public health departments and primary care clinicians to work together more closely,” said Kevin Grumbach, M.D., co-director of the Community Engagement and Health Policy (CE&HP) program of UCSF’s Clinical and Translational Science Institute (CTSI). CE&HP serves as the administrative core of SF HIP, and is supporting the effort through planning and implementation phases.

For example, public health campaigns to encourage people to consume less sweetened beverages or not smoke work best when these messages are reinforced by doctors and nurses caring for individual patients, Grumbach says. The report also pointed out that the research assets of academic health centers have a valuable role to play in the integration of public health and primary care by helping to ensure that these efforts are guided by scientific evidence and are systematically evaluated.

“We need to move out of our traditional silos and bring people together across disciplines and sectors if we are to make greater progress in improving the health of our communities and eliminating disparities,” Grumbach said. “I am proud of how SF HIP has brought together such diverse partners—from UCSF, community-based organizations and the SF Department of Public Health to the SF Unified School District and private medical groups—to harness our collective assets and tackle the most pressing public health problems in San Francisco.”

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UCLA professor, 70, advocated for the uninsured.

E. Richard Brown

E. Richard (Rick) Brown, a nationally recognized public health leader who advocated for health care reform and pioneered the collection and broad dissemination of health survey data to influence policy, died Friday, April 20. He was 70.

As a past president of the American Public Health Association and a member of dozens of health advisory committees and boards, and through his work for two U.S. presidents (Bill Clinton and Barack Obama) and three U.S. senators (Bob Kerrey, Paul Wellstone and Bill Bradley), Brown forged a reputation for his intense determination to make health care services more accessible and more affordable to all Americans.

He was a tireless advocate for the uninsured, and he promoted the development of health data surveys to both dispel persistent myths about the uninsured and document the devastating consequences of the chronic lack of health insurance for millions of Americans.

Brown, who received his doctorate at UC Berkeley, was a professor in the departments of health services and community health sciences at UCLA’s Fielding School of Public Health and founder of the California Health Interview Survey (CHIS), the nation’s largest state health survey and a critical source of information for California and national lawmakers.

Brown was also the founding director of the UCLA Center for Health Policy Research, which was formed in 1994 to translate academic research into practical evidence that policy audiences and community health organizations could use in their work. Central to this vision was the concept of credible and comprehensive data that could make a non-partisan case for policies and programs aimed at improving the health and well-being of all Californians and the nation.

In 2001, the Center for Health Policy Research produced the first CHIS data from interviews with more than 55,000 California households, creating in the process a wealth of health data on the nation’s most populous and diverse state.  Subsequent iterations of the survey followed from 2003 to 2009. CHIS has become an essential source for policymakers, advocates, researchers, media and others interested in understanding the health of Californians and that of previously under-studied ethnic, racial, disabled and sexual minority groups.

“Rick Brown has left a tremendous mark on the field of public health,” said Linda Rosenstock, dean of the UCLA Fielding School of Public Health. “Rick was a passionate teacher, an innovative and acclaimed scholar, and a formidable advocate for health. The creation of CHIS stands out among his many professional accomplishments. It is without question the leading source of self-reported health data in California used by policymakers to identify problems and allocate resources.”

CHIS data and research by the center have been at the heart of some of the state’s and nation’s most pressing health policy debates. CHIS findings were used extensively by then-Gov. Arnold Schwarzenegger and both parties in the Legislature during California’s first attempt to institute comprehensive health care reform in 2007 and 2008. CHIS-based research also focused national attention, in 2010, on the problem of recession-driven loss of insurance by many and helped propel the passage of the federal Affordable Care Act (ACA) that year. Since then, California lawmakers have used CHIS to help prepare for the implementation of the ACA in 2014.

CHIS data and center research have also been the cornerstone of dozens of California laws and initiatives, including efforts to increase participation in the federal food-stamp program; develop new public–private expansion programs for children ineligible for private insurance, Medi-Cal or Healthy Families; collect health data on sexual minorities; impose a fast-food restaurant moratorium in impoverished areas of Los Angeles; and remove soda and other sugar-sweetened beverages from schools and government vending machines.

“There are few areas of public health in California that Rick has not, in some way, touched, influenced or informed,” said Dr. Robert K. Ross, CEO and president of The California Endowment. ”He understood that good-quality information was the engine that powered all the things he cared most passionately about, from expanding health insurance coverage to feeding and caring for the state’s poorest and most marginalized residents.

Brown’s passion for health policy was rooted in harsh personal experience. He was born to Eastern European immigrant parents in a working-class community in Plainfield, N.J., and moved to Southern California at an early age. His father was a union and social-justice organizer on the East and West coasts. Times were often hard for the family. At one point, they all lived in a tent behind their friends’ restaurant. Brown’s parents separated when he was 12, and he and his brother were raised by their single mother, Sylvia, who worked as a bookkeeper.

When his brother smashed his bike into a tree and needed medical care, Brown got his first taste of what it was like to be poor and without basic health coverage.

“My mother always remembered the stigma she felt when the eligibility workers at the county hospital grilled her about her income and were very demeaning to her because she couldn’t pay the medical bills,” he would remember later.

That firsthand experience of being a medical “charity case” inspired him to not only study public health but to link it to ways to improve health coverage for all.

As an activist, Brown co-authored California’s first single-payer health care legislation in 1990 and co-wrote several other health care reform bills in the 1990s and 2000s, which helped shape the policy and political dialogue on health care reform during those decades.

“Throughout his full life, he looked for ways to build bridges between the most underserved Californians and the people who were supposed to help them — lawmakers, academics, advocates,” said Gerald Kominski, the current director of the UCLA Center for Health Policy Research, since Brown stepped down in January. ”For Rick, helping people was a personal mission.”

Teased by his family that he was “a serious man,” Brown had a broad smile and deep-throated laugh that was infectious. His ever-present generosity of spirit made him beloved by many, including his wife of 46 years, Marianne Parker Brown, his daughters Delia Brown and Adrienne Faxio, his son-in-law John Faxio, his granddaughter Makeda, and his brother Julian Horowitz.

Notes of condolence and support may be left at a memorial website: www.rememberingrick.com.

UCSF’s Robert Lustig, other experts detail science behind sugar’s impact on our waistlines.

Is sugar a toxin that’s fueling the global obesity epidemic? That’s the argument UC San Francisco Dr. Robert Lustig makes in “Sugar: The Bitter Truth,” a video that appeared on University of California Television’s (UCTV) YouTube channel in 2009 and has since gone viral with over 2.2 million views, sparking a national dialogue and warranting coverage in The New York Times and most recently on “60 Minutes.”

On UCTV Prime’s new series, “The Skinny on Obesity,” Lustig and two of his UCSF colleagues tease out the science behind this alarming claim and the dire threat it poses to global public health. The seven-part documentary series premieres April 13 on UCTV Prime, a YouTube original channel, with new episodes every Friday. Video and bonus content are available at www.uctv.tv/skinny-on-obesity.

Throughout the series, Lustig, a pediatric endocrinologist at UCSF Benioff Children’s Hospital, and his colleagues Elissa Epel and Barbara Laraia, co-directors of the UCSF Center for Obesity Assessment, Study and Treatment (COAST), unpack the scientific and sociological factors that have contributed to the startling rise in obesity rates over the last 30 years. Featuring interviews, charts and graphic visualizations, the six- to 10-minute episodes provide a comprehensive perspective on an issue that affects everyone, of any weight.

Episode guide:

April 13: An Epidemic for Every Body

How did we get so fat, so fast? The debut episode debunks the theory that obesity only affects the “gluttons and sloths” among us and is, in fact, a public health problem that impacts everyone.

April 20: Sickeningly Sweet

Lustig illustrates the overabundance of sugar in today’s processed convenience foods and explains how our bodies metabolize these sugars in the same way as alcohol or other toxins, causing damage to the liver and other organs.

April 27:  Hunger and Hormones: A Vicious Cycle

Sugar impacts the brain just as much as the waistline. In this episode, Lustig explains the biochemical shifts that sugar causes, making us store fat and feel hungry at the same time.

May 4: Sugar: A Sweet Addiction

Sugar isn’t just sweet, it’s addictive. This episode explores the cycle of addiction that sugar causes in the brain, much in the same way as drugs and alcohol.

May 11: Generation XL

An unnerving trend of obese infants is just one indication that obesity can be passed on from mother to fetus. This installment looks towards the next generation, with an emphasis on preventive care and prenatal health.

May 18: A Fast-Paced, Fast Food Life

The pace of modern life is a key contributor to today’s obesity epidemic. Elissa Epel and Barbara Laraia explain the connection and offer practical and effective solutions that don’t involve dieting and exercise.

May 25: Drugs, Cigarettes, Alcohol … and Sugar?

Our experts offer a frank indictment of the country’s agricultural policy and food industry, which have made it nearly impossible to avoid sugar in our daily diet, and suggestions for possible remedies.

UCTV Prime launched March 1 as the first university-run channel to be included among YouTube’s new production partnerships with recognizable brands like The Wall Street Journal, Madonna and TED. With documentary mini-series, interviews, commentaries and video shorts each week, UCTV Prime brings to light the innovations, trends, issues and personalities that shape our world, drawing on the tremendous knowledge resources of the University of California’s ten campuses, five medical schools, three national labs and other affiliated institutions.

Based on the UC San Diego campus, UCTV presents educational and enrichment programming from the campuses, national laboratories, and affiliated institutions of the University of California. UCTV delivers science, health and medicine, public affairs, humanities and the arts to a general audience, as well as specialized programming for health care professionals, teachers and researchers. UCTV is available worldwide via live stream, video archives and podcasting at www.uctv.tv, on YouTube at www.youtube.com/uctv and www.youtube.com/uctvprime, on iTunesU in the Beyond Campus section, and on cable in select cities throughout California. For a complete list of UCTV’s outlets, visit www.uctv.tv/wheretowatch.

UC’s Tobacco-Related Disease Research Program is studying the health risks.

The stale smell of cigarette smoke moves many a traveler to request a smoke-free hotel room. Who wants to smell someone else’s bad habit? But the lingering odor may be telling us something else — something more troubling.

Research funded by the UC-run Tobacco-Related Disease Research Program (TRDRP) shows that long after smoke has cleared from a room, toxic pollutants from cigarette smoke adhere to bedspreads, carpets, clothing — even furniture, walls, ventilation systems and hallways of hotels that allow smoking. Similar toxicants cling to surfaces in rental cars driven by smokers.

Byproducts of cigarette burning produces potent carcinogens when they combine with common indoor compounds. Many can remain in rooms for months.

“In the 1950s, we found that smoking could kill you; then research in the ’80s and ’90s, showed that secondhand smoke is dangerous,” said Georg Matt, a psychology professor of at San Diego State University who focuses on policies to protect nonsmokers.

“The potential health risks of what we call thirdhand smoke are only now being studied. This is a new frontier.”

Matt is a member of the Cancer Prevention and Control Program at UC San Diego and an investigator in a new thirdhand smoke research effort by the TRDRP.

The TRDRP funded the research consortium in 2011 to bring together experts in a range of fields, from toxicology and chemistry to behavioral and policy research, in order to determine the scope of thirdhand smoke risk and help develop policies to protect people where needed. Consortium researchers presented their findings on thirdhand smoke at the “Linking Tobacco Control Research and Practice for a Healthier California” conference — held April 10-12 in Sacramento. The conference was sponsored by TRDRP and the state’s Tobacco Control Program.

“We don’t yet know the degree of risk, but we are already finding that indoor smoking leaves a nearly indelible imprint,” Matt said. “We need to find out what risk this pollution poses.”

Risks to infants and toddlers are of particular concern to consortium scientists. Young children crawl on rugs and carpets and often put their hands in their mouths. They have more contact with pollutants that cling to surfaces in the home.

An infant’s developing brain is very susceptible to low levels of toxins, and immature immune systems are particularly vulnerable to persistent pollutants. Researchers suspect that children with respiratory diseases like asthma are likely to be at highest risk.

“This is a newly emerging concern, but one we think is very important to study,” said Anwer Mujeeb, program officer for TRDRP’s thirdhand smoke research effort. “We are leading the way in research to learn how these pollutants form, how long they remain and how they interact. Of course, it’s critical to determine at what concentrations they pose a threat to health.”

TRDRP is funded by California state cigarette taxes and managed by UC. The program launched the thirdhand smoke research consortium with $3.35 million to support a range of investigations.

“We’re very fortunate to have in California scientists who are already making an impact in tobacco research,” said Mujeeb. The research goes hand in hand with efforts to reduce the number of people who take up smoking in the first place.”

Matt and his colleagues in the THS consortium have shown that about 90 percent of nicotine from cigarette smoke remains on indoor surfaces long after the butt is in the ashtray. Their new research shows how much nicotine nonsmokers pick up on their hands from furniture and bedding in hotel rooms where cigarettes have been smoked. Cotinine, a byproduct of nicotine metabolism, shows up in the urine of these nonsmokers after a single night in the hotel room.

“Secondhand smoke is a mixture of more than 4,000 compounds, including some 50 carcinogens, plus irritants and teratogens (substances that can cause developmental or birth defects). But the potential dangers don’t end with direct exposure to smoke,” Matt said.

In effect, the smoke never really clears.

Consortium research brings together scientists and policy scholars at UC campuses, the Lawrence Berkeley National Laboratory (LBNL) and other sites in and out of the state. Experts vet research proposals, and studies are selected to answer the many unknowns in this new field and integrate findings from different areas of expertise.

Hugo Destaillats and colleagues at LBNL, UCSF and Portland State University have recently found that in just three hours, cigarette smoke and a common indoor home compound known as nitrous acid combine to form a carcinogen at levels 10 times higher than normal. Unvented gas appliances and car engines commonly emit nitrous acid. (See video at top of this page for more about research at LBNL and UCSF.)

The carcinogen formed by the smoke residue and nitrous acid may persist on surfaces in the home long after the cigarette is extinguished, exposing residents any time they are home, Destaillats said.

“Smoking a cigarette can last maybe 10 minutes,” he said. “But the pollutants remain for hours.”

Destaillats is a staff scientist in the Indoor Environment Group of the Environmental Energy Technologies division at Lawrence Berkeley National Laboratories (LBNL) and a professor at Arizona State University. The new research has been published in the Proceedings of the National Academy of Sciences.

“Tackling thirdhand smoke is tough because it’s pushing the technological sensitivity of measurements of pollutants,” said UCSF scientist Neal Benowitz, an authority on nicotine metabolism and principal investigator of the TRDRP thirdhand smoke consortium.

The only way to make solid ressarch progress, he said, is to look at it from many angles: developing biomarkers to measure levels of pollutants, assessing their persistence in the indoor environment and determining how much they are absorbed by the body.

“The effort requires many skills, like environmental chemistry, toxicology, pharmacology and the ability to track and measure the pollutants over time,” said Benowitz, who is vice chair of the UCSF’s Department of Biopharmaceutical Sciences and co-leader of the Center for Tobacco Control Research and Education at UCSF. He is also the leader of the Tobacco Control Program of the UCSF Comprehensive Cancer Center.

“I think the state of California is very forward thinking to try to pursue this question. If anyone has the expertise to make real progress, it’s this talented, multi-discipline research group,” Benowitz said.

The thirdhand smoke trail may well lead to changes in attitudes about smoking and to decisions to give up the habit or not ever start it, Matt said.

“Afterall, there would be no third or secondhand smoke without ‘firsthand’ smoking,” he said.

One positive sign he’s found is an uptick in the number of people demanding smoke-free used cars, rental cars, apartments and hotel rooms.

A 2008 study found that used nonsmoker cars were offered for sale at a considerably higher price than their published value and above comparable smoker cars.

“These findings suggest that community preferences are affecting the value of smoke-free cars,” Matt said. “That’s how norms change. And as we close more research and policy loopholes, we’ll have more ammunition to cut down smoking and save lives.”

UC Davis’ Kenneth Kizer discusses health reform strategies in Beijing.

UC Davis' Kenneth Kizer (center) and representatives of the Chinese Academy of Social Sciences (left) and the leadership of Beijing Chao-Yang Hospital (right).

China is increasingly becoming an urbanized and mobile society, and with that tremendous growth has come a number of health care challenges. The county has a rapidly rising elderly population and increased rates of cancer and other chronic diseases. The expanding upper and middle classes are changing their expectations on the delivery of health care services, and more than 800 million low-income individuals in rural and remote settings need better access to health care.

To meet these emerging needs, Chinese officials have begun a massive strategic planning process to update the health care delivery system. Last month, they invited Kenneth W. Kizer, director of the Institute for Population Health Improvement at UC Davis Health System, to deliver the keynote address and discuss reform strategies in Beijing at the first international conference on restructuring China’s public hospital system.

The conference was organized by and held at the Chinese Academy of Social Sciences (CASS), the primary “think tank” for the People’s Republic of China. CASS includes 31 research institutes and more than 50 research centers and is China’s highest academic research organization.

“China’s health care delivery system is at a pivotal point,” said Kizer. “The county is poised for major change although the challenges are enormous. Health care is perhaps at a comparable stage today as their manufacturing industries were in the mid-to-late 1990s, and a central question they are wrestling with is to what degree the health care transformation should be driven by initiatives in the public or private sectors, or both.”

Public hospitals and other publicly funded programs provide nearly all of the health care for China’s 1.3 billion people. About 4.5 percent of China’s gross domestic product is spent on health care, compared to 17.3 percent in the U.S. and 8 to 9 percent in most other western countries.

Private health insurance and private hospitals are largely not available in China, although there is growing interest in establishing private sector health care options.

Kizer’s lecture focused on lessons learned in transforming publicly funded health care delivery systems in the U.S. His talk was followed by a question-and-answer session with administrators, clinicians and researchers who were most interested in health care financing strategies, the role of competition in health care, and the advantages and limitations of public versus private-sector financing strategies.

“Governments can provide high-quality and efficient patient-centered care, and rapid and dramatic change is possible even in large, politically sensitive and financially stressed publicly administered health care systems,” said Kizer. “Having a clear vision of and explicit goals for the new system, and measuring and publicly reporting performance data, are essential to ensuring the success of health care change efforts.”

Kizer also emphasized the importance of continuously involving frontline clinicians in the planning and implementation of changes, incorporating automated information-management tools such as electronic health records, communicating frequently about goals and milestones, and educating and training the workforce in essential new skills.

Kizer is a distinguished professor at UC Davis and former under secretary for health at the U.S. Department of Veteran Affairs (VA). In the latter capacity, he engineered what is widely regarded as the largest and most successful health care “turnaround” in U.S. history. He transformed the VA system from a fragmented hospital-centered system to a system of integrated regional networks of care that routinely provides some of the highest quality health care in the U.S.

Kizer currently leads the Medi-Cal Quality Improvement Program, a partnership between UC Davis Health System’s Institute for Population Health Improvement and the California Department of Health Care Services aimed at improving care delivery in the state’s $46 billion a year Medicaid program (Medi-Cal).

During the past few years, UC Davis has established new partnerships and collaborations with China to advance medical education, medical research, patient care, hospital management and health care policy. These include the agreements with BGI, the world’s largest genomics organization, and memoranda of understanding with Tongji University School of Medicine, Soochow University and Nanjing Medical University, as well as leaders of the Shanghai Medical Tourism Products & Promotion Platform.

UCSF initiative helps accelerate use of large, public data sets in conducting health studies.

Janet Coffman, UC San Francisco

If you’re a researcher looking for large data sets it may be difficult to know where to start, what resources are available, and how to find what you’re looking for.

That’s where CELDAC comes in. The Comparative Effectiveness Large Data Set Analysis Core (CELDAC) was created to accelerate the use of large, public data sets in conducting studies of health and health care.

“CELDAC is the combination of a concierge service and a social network,” says Janet Coffman, M.A., M.P.P., Ph.D., director of CELDAC and assistant adjunct professor in the Philip R. Lee Institute for Health Policy Studies and the Department of Family and Community Medicine at UC San Francisco. “We’re in the business of linking investigators to both relevant data sets and other researchers who can assist them in carrying out their research.”

In support of UCSF faculty and trainees CELDAC provides several resources, including:

• a searchable online inventory of large, public data sets;
• a repository of select data sets available to UCSF researchers at no cost through MyResearch;
• a consultation service to assist researchers in identifying data sets, obtaining data sets, finding faculty with relevant expertise, and performing data analyses.

Expanding beyond UCSF

With support from the California HealthCare Foundation (CHCF) in the form of a one-year grant award, CELDAC is continuing to expand its reach beyond UCSF. Much of the work under the CHCF grant will focus on improving CELDAC’s online, searchable inventory of large, public data sets, which are publicly available.

The Clinical and Translational Science Institute (CTSI) at UCSF is also currently providing funding and in-kind assistance to support CELDAC expansion. That includes communications and technology assistance through CTSI’s Virtual Home program.

“CTSI’s involvement is a good example of putting UCSF’s resources on the table to leverage greater resources from external funders,” says Coffman. “With CTSI, we’re working to improve the online user interface, enhance the information available about data sets in the inventory, and facilitate downloading of search results. We are also identifying additional sources of state and sub-state level data on health and health care.”

In terms of what’s to come, Coffman is focused on partnerships and exploring ideas for how to expand services to health care researchers at other institutions, policymakers and community-based organizations in California.

A focus on partnerships

CELDAC is collaborating with the Society for General Internal Medicine (SGIM), another organization that has created an online inventory of large, public data sets to leverage the respective strengths of the two inventories. SGIM is the professional society of primary care internal medicine faculty at medical schools and teaching hospitals, and its research data compendium is overseen by Alexander Smith, M.D., M.S., M.P.H., an assistant professor of medicine UCSF. The online cross-sharing of information about data sets includes a SGIM link to CELDAC’s search engine and CELDAC link to SGIM’s expert commentaries on data sets contained in both inventories.

Coffman also demonstrated CELDAC’s online, searchable inventory of data sets at a briefing in Sacramento, sponsored by CHCH in partnership with the Lucile Packard Foundation for Children’s Health, The SCAN Foundation, the California Health Policy Forum and the West Wireless Health Institute. The event was designed to engage policymakers and stakeholders in a conversation about improving access to health care data collected by state government agencies. As an outgrowth of this event, CELDAC received additional funding from CHCF to conduct interviews with state policymakers to assess their needs for data on health care coverage, access and quality and identify their priorities for expanding access to data.

Another partnership involves CTSI’s Community Engagement & Health Policy (CE&HP) program. CELDAC is participating in consultations that CE&HP provides to community-based organizations and local governments in the San Francisco Bay Area and exploring other ways in which it can help community-based organizations and local governments access data pertinent to their work.

CELDAC is a partnership between the Philip R Lee Institute for Health Policy Studie (IHPS) and Academic Research Systems (ARS), which is part of CTSI’s Biomedical Informatics program.

CTSI is a member of the National Institutes of Health-funded Clinical and Translational Science Awards network. Under the banner of Accelerating Research to Improve Health, it provides a wide range of services for researchers, and promotes online collaboration and networking through tools such as UCSF Profiles.

Learn more about working with large data sets, how to find large data sets or other research resources offered by CTSI.

Study authors call for national health care policies designed to discourage inappropriate care, regardless of region.

Salomeh Keyhani

There is no solid evidence to support the widely held belief that regions of the United States that spend more on health care and have higher rates of health care use deliver more unnecessary care to patients, or that low-cost areas deliver higher quality and more efficient care, according to a study led by Salomeh Keyhani, M.D., a physician at the San Francisco VA Medical Center and an assistant professor of medicine at UCSF.

The study authors called for national health care policies designed to discourage inappropriate care, regardless of region.

“Geographic variations in health care have captured the attention of researchers for the past 30 years, especially during the recent health care reform debate,” said Keyhani. “The assumption is that areas that spend more are delivering more inappropriate care in the form of unnecessary tests and procedures.” In turn, she said, “this has led policy makers to hold up low-cost areas as models of high-quality health care, and to propose policies that cap spending.”

That assumption is unwarranted, according to Keyhani and her co-authors. “The literature is so limited that you cannot either support or refute such an assertion. There is just not enough data,” said Keyhani.

In their study, the scientists reviewed 114,830 peer-reviewed articles, published between Jan. 1, 1978, and Jan. 1, 2009. They found only five that analyzed detailed clinical data in relation to geographic region, and concluded that the results of those papers “did not lend support” to the idea that higher cost regions deliver more inappropriate care. Their literature review was published in the March issue of the journal Medical Care.

“Do we have any evidence to say that the differences in cost of care in different localities are actually related to inappropriate care? No,” asserted Keyhani.

She concluded that “instead of focusing on geographic variations, more of our efforts should be directed at designing policies that will reduce inappropriate care in general, regardless of region.”

However, said Keyhani, “you need good scientific evidence to design such policies, and right now, that evidence is lacking.” In a related literature review based on the same 30-year data base, published on January 23 in the Archives of Internal Medicine, Keyhani and her colleagues found only 172 peer-reviewed articles that addressed the general topic of health care overuse.

One reason for the dearth of such literature, Keyhani said, is an overall lack of patient care guidelines by which researchers might judge overuse of tests and procedures: “There are not enough guidelines, and most of those that do exist don’t address inappropriate care. Guidelines state when you should give a diagnostic test, for example, but they don’t say when you shouldn’t. And if you have no standards, how can you say when care is inappropriate?”

Creating guidelines is “expensive and very labor intensive,” acknowledged Keyhani. “And it’s not something one health system can do by itself. There needs to be a national investment.”

Nonetheless, she said, the long-term benefits of such guidelines for the U.S. health care system would be considerable. “Overuse isn’t just a matter of unnecessary expense, but of patient safety,” she noted. “People assume that more care is better. In fact, we know that unwarranted procedures can add to health risks and lead to poor outcomes.”

Co-authors of the Medical Care paper are Raphael Falk, M.D., M.P.H., of UCSF; Tara Bishop, M.D., M.P.H., of Weill Cornell Medical College; and Elizabeth A. Howell, M.D., M.P.P., and Deborah Korenstein, M.D., of Mount Sinai School of Medicine. The study was supported by funds from the Commonwealth Fund and the Department of Veterans Affairs.

Co-authors of the Archives paper are Deborah Korenstein, M.D.; Raphael Falk, M.D.; Elizabeth A. Howell, M.D.; and Tara Bishop, M.D., M.P.H. The study was supported by funds from the Commonwealth Fund and the Department of Veterans Affairs.

SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.

Limited English proficiency could limit those who enroll for coverage, UC Berkeley-UCLA study finds.

Language barriers could deter more than 100,000 Californians from enrolling in the Health Benefit Exchange, according to a study released today by the California Pan-Ethnic Health Network, the UCLA Center for Health Policy Research, and the UC Berkeley Center for Labor Research and Education.

The study presents findings from a UC Berkeley-UCLA micro-simulation that estimates the likely enrollment in health care reform programs in California. Specifically, the study projects that more than 1 million limited-English proficient (LEP) adults will be eligible to receive tax credits to purchase affordable coverage in the state’s Health Benefit Exchange, which expands access to affordable health coverage as part of the Patient Protection and Affordable Care Act.

However, only 42 percent of eligible LEP adults are expected to enroll in the program.

“The evidence suggests that Californians who do not speak English very well are at a disadvantage in terms of accessing health care reform programs,” said Daphna Gans, a research scientist at the UCLA Center for Health Policy Research and the lead author of the study.

The UC model shows that if language is not a barrier, participation by LEP adults could increase to 53 percent, a difference of approximately 110,000 individuals.

“These are difficult times for California families, and ensuring every Californian has access to quality, affordable health care is vital for our economic recovery,” said California Assembly Speaker John A. Pérez, who authored legislation (AB 1602) in 2010 establishing the exchange. “The Health Benefit Exchange will help lower the cost of health insurance for every Californian, but it’s vital for every eligible Californian to enroll to ensure we bring health care costs down as much as possible for California’s working families.”

In California, more than 15 million residents speak a language other than English at home and nearly half (7 million) of them have limited proficiency in English. The study shows the importance of adopting a diverse strategy for outreach and education.

“The exchange is a key opportunity to make Californians healthier,” said Ellen Wu, executive director of the California Pan-Ethnic Health Network. “We have to do this right. Our success in implementing this new program will be measured not just by the number of people enrolled but by the state’s ability to reach those who are most often left behind. We have to target resources through multicultural and multilingual outreach to ensure that communities of color who are eligible, particularly people who speak English less than very well, enroll in coverage.”

The study was conducted based on analyses using the California Simulation of Insurance Markets model, a micro-simulation developed by UCLA and UC Berkeley researchers, which uses a range of official data sources (including the California Health Interview Survey) to estimate the impact of various elements of the Patient Protection and Affordable Care Act on employer decisions to offer insurance coverage and on individual decisions to obtain coverage in California.

The development of the model was supported through funding by The California Endowment, the California Health Benefit Exchange and the California Pan-Ethnic Health Network.

Read the study, “Achieving Equity by Building a Bridge From Eligible to Insured.”

The California Pan-Ethnic Network (CPEHN), celebrating 20 years as a champion for health equity, works to eliminate health disparities by advocating for public policies and sufficient resources to address the health needs of communities of color.

The UC Berkeley Center for Labor Research and Education is a public service and outreach program of the UC Berkeley Institute for Research on Labor and Employment that conducts research and education on issues related to labor and employment.

The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health policy information for California.

UC Irvine co-authored study indicates results of newly enacted reforms.

David Neumark, UC Irvine

Enrollment of uninsured patients in a program with benefits comparable to those offered under the Affordable Care Act of 2010 resulted in significant health care cost savings, a new study finds. Published in the February issue of Health Affairs, the research sheds light on the potential outcomes of newly enacted health care reforms.

“In a case study involving low-income people enrolled in a community-based health insurance program, we found that use of primary care increased but use of emergency services fell, and — over time — total health care costs declined,” said study co-author David Neumark, UC Irvine Chancellor’s Professor of economics and director of UC Irvine’s Center for Economics & Public Policy study.

Working with researchers from the Virginia Commonwealth University Health System, Neumark tracked the emergency room, inpatient, outpatient and primary care service utilization of about 26,000 previously uninsured Richmond residents between 2000 and 2007 whose household incomes fell 200 percent below the federal poverty level. Qualified enrollees were granted health insurance and assigned a primary-care provider for one year. They were required to proactively re-enroll for subsequent annual coverage.

The demographics of these participants paralleled those of the population that will be affected by changes under the Affordable Care Act of 2010, Neumark said. The legislation is set to extend Medicaid benefits to about 16 million uninsured, low-income adults and children by the end of 2014.

The study found that primary-care visits for patients who enrolled continuously over three years rose from 1.06 in year one to 1.60 annually, while emergency-room visits fell from 1.02 in year one to 0.74 by year three. Costs per visit for both inpatients and outpatients also decreased, as did the length of inpatient stays. On average, total health care costs per enrollee per year for this subset were cut nearly in half — from $8,899 in year one to $4,569 in year three. Overall costs per enrollee per year for all participants with at least one year of enrollment declined from $7,604 to $4,726.

“A lot of the debate about health care reform surrounds the issue of whether we’re setting up something that’s going to cost us more by increasing use of medical services or something that will cut costs through more appropriate and timely use of medical services,” Neumark said. “Our research shows that, over time, costs can be reduced through increased use of primary care and reductions in emergency-department visits and hospital admissions, but it may take several years of coverage for substantive savings to occur.”

Co-authors of the study include Cathy Bradley, professor and chair of health care policy & research at Virginia Commonwealth University; Sabina Gandhi, who earned a Ph.D. in economics at UC Irvine and is now a VCU assistant research professor; Sheryl Garland, vice president of health policy and community relations at the VCU Health System; and Dr. Sheldon Retchin, VCU professor of internal medicine, gerontology and health administration and CEO of the VCU Health System.

A full copy of the study is available at http://content.healthaffairs.org/content/31/2/350.full.

About the University of California, Irvine: Founded in 1965, UC Irvine is a top-ranked university dedicated to research, scholarship and community service. Led by Chancellor Michael Drake since 2005, UC Irvine is among the most dynamic campuses in the University of California system, with nearly 28,000 undergraduate and graduate students, 1,100 faculty and 9,000 staff. Orange County’s second-largest employer, UC Irvine contributes an annual economic impact of $4.2 billion. For more news, visit www.today.uci.edu.