TAG: "Public health"

Recommendations for improving farmworker health to be unveiled


Briefing will be held March 17 at UC Center Sacramento.

>>Register for briefing

By Pat Bailey, UC Davis

An update on the status of health among agricultural workers and their families, as well as policy recommendations for making related health care advances, will be presented from noon to 1 p.m. Tuesday, March 17, at UC Center Sacramento.

“A variety of social, economic and political factors have converged to create a uniquely opportune moment to take action and improve the health of farmworkers and their families,” said Marc Schenker, distinguished professor of public health sciences and medicine at UC Davis and co-director of the Center of Expertise on Migration and Health of the UC Global Health Institute (UCGHI).

Policy recommendations will involve health care funding and insurance, occupational safety, labor law enforcement, and improving farmworker living conditions.

The presentation is free and open to the public, however attendees are asked to register at http://tinyurl.com/pjlgge7. The UC Center Sacramento is located at 1130 K St., Sacramento.

The event is sponsored by the UC Global Health Institute, with support from the California Program on Access to Care, Western Center for Agricultural Health and Safety, Migration and Health Research Center, and Health Initiative of the Americas.

Related link:
Registration opens for UC Global Health Day

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UC plans to require vaccinations for incoming students


The plan is being phased in over three years.

Credit: iStock

By Alec Rosenberg

The University of California will require incoming students to be screened for tuberculosis and vaccinated for measles, mumps, rubella, chicken pox, meningococcus, tetanus and whooping cough, under a plan set to take effect in 2017.

Currently, the UC system only requires students to be vaccinated against hepatitis B, though several campuses have additional requirements.

The plan — designed to help protect the health of students and campus communities — has been in the works for a year. But the need is more pressing than ever, given the current multistate measles outbreak and the re-emergence of other vaccine-preventable diseases among those not completely immunized.

“I’m really excited that there’s support and momentum for this new immunization plan,” said Dr. Gina Fleming, medical director for the UC Student Health Insurance Plan. “We know that these preventive measures are effective.”

Three-year phase-in

The plan is being phased in over three years. The first phase focuses on building awareness among students about the upcoming requirement, with all fall 2015 incoming UC students receiving notification of the recommended vaccines and the process for making them mandatory. The intent of the plan is to set a baseline for all of UC, but does not prevent individual campuses from setting immunization standards for all students, or implementing the plan more rapidly.

It was developed based on recommendations from the California Department of Public Health, and in consultation with UC’s student health center directors, vice chancellors for student affairs and the UC system senior vice president for health sciences and services.

It will require that by 2017 all incoming students show documentation not only for hepatitis B vaccination but also for TB screening and four more vaccines: measles, mumps and rubella; meningococcus; varicella (chicken pox); and tetanus, diphtheria and pertussis (whooping cough).

“The University of California is committed to protecting the health and well-being of our students,” said Mary Knudtson, executive director of the UC Santa Cruz Student Health Center and chair of the UC Immunization Policy Committee. “Therefore, all of the UC campuses are implementing procedures to ensure that students are educated about, and receive, vaccinations to prevent potentially dangerous illnesses and undergo screening to identify those who may have infectious tuberculosis.”

Starting in fall 2016, all incoming UC students will be expected to have their required vaccines and enter the data into the university’s electronic medical record platform. But the plan is not to enforce the requirement until the following year. Starting in fall 2017, UC students who do not meet the vaccination requirement will have a hold put on their registration. The rationale for the phased approach is to ensure that the process runs smoothly before potentially impacting students’ ability to register for classes.

All UC campuses have experienced cases of vaccine-preventable diseases in recent years — something not unique among college campuses, which have varying vaccination requirements. For example, only about half of states have laws requiring all college students to be vaccinated against measles, according to a U.S. Centers for Disease Control and Prevention database.

“Despite the fact that many people receive the recommended vaccines, there are still documented cases of outbreaks of vaccine-preventable diseases in California and on the campuses each year amongst those who were not properly immunized,” Knudtson said. “All students are strongly encouraged to obtain the vaccines recommended by the California Department of Public Health prior to starting classes.”

Breaking down barriers

While getting such vaccines has long been considered a good public health practice, the cost of vaccines and the difficulty for student health staff to obtain and verify the information have been barriers to implementation.

Two developments have broken down those barriers, Fleming said. Now that the Affordable Care Act provides insurance coverage for vaccines, the cost of vaccination is less of a problem. Also, a new electronic medical record platform soon will allow UC students to directly enter their vaccination date. Four campuses will be piloting the module for entering vaccination data this fall, and the remaining campuses anticipate being able to use it by fall 2016.

The issue of immunization has evolved into a hot topic of discussion in California and across the nation in recent weeks after a measles outbreak that started at Disneyland. On Wednesday, state Senators Richard Pan and Ben Allen announced they will introduce legislation that would eliminate the ability for parents of school children to opt out of vaccinating their kids based on a personal belief.

UC’s plan will allow exemptions for medical or religious purposes, Fleming said. In the coming months, officials will discuss how to handle requests for other exemptions and how to validate the vaccination information.

“We need to be mindful of the population we’re serving,” Fleming said.

UC’s plan might be extended to already enrolled students and additional vaccines could be added later, such as meningococcus B, Fleming said. Vaccines recommended for preventive care include vaccines for hepatitis A, HPV, influenza, polio and pneumococcal pneumonia.

Officials are determining whether additional approvals are needed to adopt the plan, Fleming said, even as they move forward with implementation.

Meanwhile, leadership in student affairs and student health centers are working with other campus departments to inform students about the plan.

“That’s really a critical piece,” Fleming said. “We can’t expect students to adhere to a requirement that they haven’t heard about. They need to know what the plan is.”

Related link:
Associated Press: Los Alamos National Lab creates website for measles fight

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Income inequality is taking toll on health of American workers


The degree of income inequality can lead to shortened life expectancy.

By Mark Wheeler, UCLA

“Income inequality” has already become a buzz phrase for the campaigns leading up to the 2016 elections. Likely candidates and pundits on both ends of the political spectrum have begun to talk about how fairness, social justice and — even after the implementation of the Affordable Care Act — the cost of health care insurance are contributing to the large and growing gap between the rich and poor.

But a commentary by researchers at the UCLA Fielding School of Public Health points out another disturbing impact of income inequality: its effect on people’s health. The article appears in the current online edition of the American Journal of Public Health.

It has long been recognized that, even beyond access to high quality health care, people’s income is a key factor in determining how healthy people are. But the commentary provides evidence that the degree of income inequality also can lead to a long list of health issues, including shortened life expectancy and poorer self-reported health status.

Dr. Linda Rosenstock, the report’s senior author, said lower- and sometimes middle-income wage workers often face additional workplace stresses that take a toll on their health — among them, lower pay, lack of paid sick leave, an inability to find full-time work, the need to work double shifts to make ends meet. Those challenges can lead to high levels of stress, exhaustion, cardiovascular disease, lower life expectancy and obesity, and the effects can easily trickle down to impact families and children.

“We interpret the evidence to find that income inequality is taking a toll on worker health,” said Rosenstock, a UCLA professor of health policy and management and the former dean of the Fielding School. “Low- and middle-income workers face stagnant wages and pressures from a changing work environment. These changes in the work environment changes — such as increasing job insecurity, work performed outside of a regular full-time contract, and having fewer workers to do the same amount of work — are taking their toll on a workforce.”

The gap between the rich and the poor has expanded significantly since 1980, when the top 5 percent of wage earners accounted for almost 17 percent of all incomes, according to U.S. Census Bureau data. In 2013, that segment of the population earned 22 percent of total income. The changes were even more dramatic for those at the highest end of the income ladder, the top 1 percent and even the top one-tenth of a percent.

Another measure that reflects the divide between the economic elite and all others is the gap in pay between production workers and the CEOs of the companies they work for. In 1970, CEOs’ cash compensation averaged $25 for every $1 earned by nonsupervisory workers. Yet a mere 30 years later the ratio was 90 to 1, and, if the expected value of stock options in CEOs’ compensation is included, the ratio reaches more than 500 to 1.

“Out-of-pocket expenses for health care such as premiums, deductibles and co-payments are an increasing portion of stagnant wages,” Rosenstock said. She noted that one organization estimated that such costs increased by 89 percent from 2003 to 2013. “In 2013, among firms with at least 35 percent of their workforce making $23,000 or less per year, 48 percent of workers for single coverage had a deductible of at least $1,000 — a significant portion of their income.”

The commentary points to the health care industry — where there is a large disparity between the salaries for the lowest earners, such as nurses aides, and the top earners, such as surgeons — as one microcosm of the problems caused by inequality and changes in work organization.

“As the costs of medical care have risen in the United States, pressure on the industry has increased to improve efficiency,” said Jessica Allia Williams, the report’s first author, a former UCLA doctoral student in health policy and management who is now a postdoctoral fellow at the Harvard School of Public Health.

As a result, she said, lower-paid workers face the perfect storm of income inequality — being asked to work more with less, while also paying more for insurance premiums and out-of pocket medical expenses.

“Also, across the spectrum, health care workers face relatively high rates of injury owing to physical hazards such as lifting patients or getting stuck by needles,” Williams said, adding that they also are likely to work nonstandard shifts and more overtime and to face hazards such as violence in the workplace that further contribute to poor health.

Rosenstock said the effects of the Affordable Care Act on these trends are still unclear, especially because of the delay in implementing the employer mandate for health insurance. But despite the benefit of having more of the population insured, early evidence suggests that the ACA is causing lower-income workers to have to pay more of the costs of care out of their cash compensation.

“It’s clear that income inequality and working conditions affect the health of the U.S. workforce,” she said. “Although political differences may divide the policy approaches our elected officials may take, addressing income inequality is likely to improve the overall social and health well-being of those currently left behind.”

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Eat.Think.Design: A public health course for the startup generation


UC Berkeley course feeds need for rethinking problems of food and nutrition.

By Tamara Straus, UC Berkeley

For the creators of the UC Berkeley course Eat.Think.Design, two things are certain.

First, the United States is facing a food and nutrition crisis, with rocketing rates of diabetes, hunger and health disparity.

Second, graduate students today — from fields as different as public health, business, information technology and engineering — want their education to be more hands-on, more interdisciplinary and more “impactful” to society at large.

In the case of the Eat.Think.Design course, they want to spend class time not just learning about food and nutrition problems, they want to devise actual food and nutrition solutions.

This may sound grand, but for the course’s three instructors — Jaspal Sandhu, a UC Berkeley lecturer in design and innovation; Nap Hosang, a longtime Kaiser Permanente medical doctor and UC Berkeley School of Public Health instructor; and Kristine Madsen, an associate professor in the Joint Medical Program and Public Health Nutrition at Cal’s School of Public Health — there is nothing grand or inappropriate about letting students attempt societal solutions while in graduate school.

“The reason we emphasize experiential learning is because it has proved to be more effective,” says Sandhu, who is also a partner at the Gobee Group, a consulting firm he runs with two other multilingual Fulbright scholars with UC Berkeley roots. Sandhu speaks Punjabi, Spanish, Mongolian and English, and prior to Gobee worked with the Mongolian Ministry of Health designing mobile health information systems.

Sandhu emphasizes that his students’ backgrounds demand more than lecturing. Among the 25 people enrolled in Eat.Think.Design this spring, many have relevant work experience. At least three have started their own companies, several have worked for big companies like IBM, Deloitte and Eli Lilly, and most have about five years under their belts working for government agencies or large nonprofits. “To keep the attention of such students,” says Sandhu, “we need to give them actual problems to focus on.”

Working in interdisciplinary teams of three under an instructor, Eat.Think.Design students spend the bulk of the semester on one project, conducting ethnographic and market research, investigating models and constantly devising and then revising potential solutions. Members of last year’s class, for example, streamlined SNAP federal nutrition benefits payments at San Francisco’s Heart of the City Farmer’s Market, worked with the Kossoye Development Program in Ethiopia on strategies to make home gardening more accessible and built a pilot program with Partners In Health: Navajo Nation to test a pop-up grocery store in areas that are one hour’s drive from fresh food. Although the project in the Navajo Nation helped COPE to receive a three-year, $3 million REACH grant from the Centers for Disease Control & Prevention to pursue healthy eating programs in the vast American Indian territory — Hosang argues that the course is not designed to incubate social innovations per se.

“Our goal is to incubate innovative people — people who can be influencers in the public health sector,” he says.

Hosang, who has served as head of the interdisciplinary online MPH degree program for the past 15 years and executive director of the Interdisciplinary MPH degree program since 2010, is not subtle in his criticism of public health teaching.

“Most academics are in a silo,” he said, “and their silo has driven them more and more into their specialist thinking.”

Yet this specialist thinking, Hosang argues, is running counter to the view that public health is enmeshed in almost every field — from architecture and transportation, to product design and education.

“We need to change the way public health professionals approach problems,” said Hosang, “and we need them to be in touch with people from other disciplines to inform their problem-solving processes.”

Hosang and Sandhu started working on their public health course in October 2010, after Hosang read Sandhu’s dissertation on public health design research in rural Mongolia and was impressed by the combination of grassroots and trial-and-error learning. In the spring of 2011, they launched their course, with financial support from the Blum Center for Developing Economies, which seeds interdisciplinary, social impact courses on campus. Madsen joined the course in 2014 when the focus narrowed from designing innovative public health solutions to designing innovative food solutions. In a forthcoming article in the American Journal of Public Health titled “Solutions That Stick: Activating Cross-Disciplinary Collaboration in a Graduate-Level Public Health Innovations Course at the University of California,” the three instructors describe how their approach is part of a much-needed pedagogical shift. They write:

A Lancet Commission, convened to discuss the education of health professionals in the 21st century, argued that educational transformation is critical to meet the public health problems we face in this century. Specifically, the commission called for a higher level of learning, moving beyond informative learning, which transmits knowledge to create experts, to transformative learning, which transmits leadership attributes to create agents who can successfully implement change.”

Sandhu explained that when he and Hosang came up with the idea for the course, not only was this “change agent” approach novel but no one was applying design thinking or human-centered design approaches at the School of Public Health at UC Berkeley. (He describes those approaches as ones that enable teams to systematically develop novel, effective solutions to complex problems.) Yet Sandhu says it is clear there’s a demand for this kind of problem solving.

Sandhu’s proof is the continual over-enrollment in and rave reviews of his course. This year, 60 students applied for 25 spots. And for the past four years, 40 percent of students indicated it was the “best course” they took at UC Berkeley, with the other 40 percent stating it was in the “top 10 percent” and the rest saying it was in the “top 25 percent.”

Christine Hamann, an M.B.A./M.P.H. candidate who took Eat.Think.Design in 2014, confirmed that “the teaching team is phenomenal — both in terms of the academic leadership and the mentoring of graduate students.”

She also confirmed that she and her fellow students want “practical challenges in graduate school,” adding, “we are tired of theory.”

Hamann is one of the many students who has brought past work into the classroom. Before grad school, she worked for seven years at Partners In Health, most recently on the nonprofit’s COPE Project in the Navajo Nation. She said the course forced her to look at Navajo Nation residents’ consumer needs around food and nutrition — and to see food less as a supply issue and more of a demand issue.

“Traditional public health approaches focus on supply, but that is why you see programs that don’t meet the needs of the community,” she said.

Hamann and the three other graduate students opted not to focus on the best truck routes to bring fresh produce into the 27,000 square mile territory — and instead focused on seeing what citizens there want to consume and what can last in what is a food (and actual) desert. During the summer of 2014, with funding from the Blum Center, Hamann created pop-up grocery stores in Navajo, to determine which food items were most in demand and could help reduce chronic diseases like diabetes, which affects 20 percent of residents. This exploration helped lead to the aforementioned $3 million CDC grant for COPE.

As to why so many Cal students are so focused on food and nutrition, Hamann has this to say: “From a public health perspective, I think we’re seeing the ramifications of the American diet play out in really scary chronic disease indicators.” She also noted that there is a general heightened awareness of food systems — “of where food is coming from, the corporations that own it, and the detrimental effects those relationships can have on both health outcomes and business models.” Third, Hamann said a growing number of students want to see tech innovation applied to less wealthy and less urban populations—“the people,” she said, “who need it.”

Then, there are the galling statistics: Americans throw out an estimated 40 percent of food grown per year. An estimated 50 million Americans do not have access to enough food. As of 2012, about half of all adults — 117 million people — have one or more chronic health conditions, such as heart disease, stroke, cancer, diabetes, obesity and arthritis. And childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years.

Sandhu is aware that a course on food innovation is well timed at UC Berkeley. In 2013, UC Berkeley’s College of Natural Resources, the Goldman School of Public Policy, the Graduate School of Journalism, Berkeley Law and the School of Public Health joined forces to create the Berkeley Food Institute to improve food systems locally and globally. A year later, UC President Janet Napolitano launched the UC Global Food Initiative — to prompt all 10 campuses, UC’s Division of Agricultural and Natural Resources, Lawrence Berkeley National Lab, and a consortium of faculty, researchers and students to address food security, nutrition and sustainability issues. Even BigIdeas@Berkeley, the annual student innovation prize, has a contest category on food systems innovation.

“Our timing is either well forecasted or extremely lucky,” said Sandhu.

Eat.Think.Design may be a popular course — and may inspire copycats — but both students and instructors are quick to point out that the course cannot serve as a model for every graduate-level class.

“It is difficult to take more than one experiential class per semester,” said Hamann. “The time commitment with fellow students and with our client is just too big.”

Amy Regan, who took the course in 2013 and now works with the San Francisco Unified School District’s Future Dining Experience program, agrees that “compromising and agreeing on the best approach among a group takes time.”

For instructors, professor Madsen estimates the course requires one and a half to two times more time than an average School of Public Health offering, because she, Sandhu and Hosang each mentor three student groups during and after class time. The three instructors also spend time cultivating their connections to bring in student projects from nonprofits and government agencies. During the class on Feb. 4, 16 pitches were made by representatives of various organizations, including California Farm to Fork, San Quentin State Prison and Project Open Hand.

“Much more work goes into creating the class because of all the connections to be made,” said Madsen.

And very little is scripted. This gives the course the feeling of a kind of pedagogical startup, exciting but uncertain. Madsen said this atmosphere comes with a distinct disadvantage for professors.

“You have to admit you don’t know as much,” she said. “If your identity is wrapped up in being an academic expert, this won’t work; you’ll always default to the more narrow but comfortable path.”

For Sandhu and Hosang, who are adjuncts, there is less face to lose.

“I think over the last seven years, since the start of the Great Recession, there’s been a transformative energy happening in higher education,” said Hosang. “It’s coming from the younger generation who see the world has changed and who no longer see college as a ticket to success. That’s where this move toward an interdisciplinary, hands-on approach is coming from.”

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It’s a bird, it’s a plane, it’s a ‘superhero of public health’


UC Irvine professor’s article finds creative way to highlight public health giants.

Brandon Brown, UC Irvine assistant professor of public health, found a novel way to honor the heroes in his field in the current issue of the Journal of Public Health.

His article, “Childhood Idols, Shifting from Superheroes to Public Health Heroes,” promotes the use of superheroes in campaigns to teach young children about the vast world of public health — from basic hygiene to emerging diseases.

Pioneering physician and cholera foe John Snow is transformed into “the hero of Broad Street” in a poster that raises awareness of the British doctor’s role in bringing about changes in the water and waste systems of London.

“Public health figures serve as role models to fight diseases or promote healthy living and serve as an inspiration to improve global health for future generations,” Brown says. “We must strive to realize the imagined world where children idolize heroes that they can become in the future.”

Other public health giants immortalized in Brown’s article are Ignaz Semmelweis and Luther Terry. Brown co-authored the article with Melissa Nasiruddin, Alejandra Cabral and Melissa Soohoo.

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Doctorate program will study substance abuse, its consequences


Collaboration between UC San Diego, SDSU among first in nation.

By Scott LaFee, UC San Diego

A new Joint Doctoral Program (JDP) in Interdisciplinary Research on Substance Use has been launched by the Division of Global Public Health in the UC San Diego School of Medicine and San Diego State University’s School of Social Work. The program will emphasize research devoted to studying the use and misuse of alcohol and drugs – and related social and health consequences.

“This program is the first of its kind,” said JDP co-director Steffanie Strathdee, Ph.D., professor and head of the UC San Diego Global Health Initiative. “Given that substance use has a growing health and societal impact in the U.S. and globally, this program could not come at a better time.”

The JDP will focus on research designed to identify and assess substance use risk and create intervention programs for preventing or ameliorating high‐risk behaviors related to substance use. It will include training to craft and evaluate disease prevention and health promotion recommendations and help guide public health policies.

María Luisa Zúñiga, Ph.D., JDP co-director and associate professor in SDSU’s School of Social Work, said “SDSU and UC San Diego have a long history of jointly offering cutting edge, high-demand programs. This new doctoral program is designed to train the next generation of researchers to lead interdisciplinary research efforts that will meaningfully address substance use issues of national and global impact. Our graduates will be highly sought after in fields including medicine, social work and public health, as well as research firms and governmental health departments.”

The new JDP is the 14th such program offered by UC San Diego and SDSU. Others include highly acclaimed programs in public health and clinical psychology.

Funding from SDSU Division of Academic Affairs and College of Health and Human Services will cover tuition fees and a teaching associate stipend for four students per year for up to four years. Students will spend the first year of study at SDSU, the second at UC San Diego and subsequent years working with faculty from both campuses.

For more information on the joint doctoral program in Interdisciplinary Substance Use Studies, visit socialwork.sdsu.edu/degrees-programs/graduate-programs/phd-substance-use-studies/phd-overview.

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ACOs improving health care in California


Report: ACOs improve quality of care, increase patient satisfaction, may reduce costs.

California has more accountable care organizations (ACOs) than any other state in the country, with particularly rapid growth over the past two years. This is a good thing, according to the Berkeley Forum for Improving California’s Healthcare Delivery System, which released a report today (Feb. 17) with new evidence that ACOs improve the quality of care, increase patient satisfaction and may reduce costs.

“The next few years are likely to bring continued growth and diversity in accountable care models that move increasingly toward being paid for meeting cost and quality targets,” said Stephen Shortell, lead author of the report and chair of the Berkeley Forum. Shortell is also a professor and dean emeritus of the UC Berkeley School of Public Health.

ACOs are defined as medical groups that contract with Medicare and/or commercial insurers to care for a defined population of patients and that are held accountable to meet cost and quality criteria. In a 2013 report, Berkeley Forum leaders called for at least 50 percent of Californians to be receiving care under new payment models that encourage keeping people well by 2022; and having at least 60 percent of Californians receiving their care from integrated care systems, versus only 29 percent today.

“California is fortunate to have many integrated health care delivery systems at various stages of development. The advancement of these systems into accountable care organizations and partnerships should be viewed as an important and very positive innovation in payment and health care delivery,” said Tom Williams, immediate past-president of the Integrated Healthcare Association and vice president of accountable care operations and strategy at Stanford Health Care.

The report presents emerging evidence that suggests that the quality of care that ACOs provide is as good, and on some measures, better than that provided by other models of care. For the analysis, the team compared medical groups with an ACO contract to medical groups without an ACO contract on widely used HEDIS quality of care measures for asthma care, cancer screening, chlamydia screening, diabetes care, heart care and pediatric care. ACOs scored significantly better for cancer screening. In addition, patients receiving care from medical groups with ACO contracts had consistently higher satisfaction scores than patients receiving care from groups without ACO contracts. This included measures of access to care, overall coordination of care, actions to promote health, communication with doctors, helpfulness of office staff and overall ratings of care.

While full cost-savings data are not yet available, preliminary evidence from an ACO contract in Sacramento found savings of $20 million, with no increase in health insurance premiums for California’s CalPERS enrollees. The study also addressed the concern that as ACOs grow in size they may exert pressure to increase prices.

“At this point in time, our analysis indicates there is little evidence to support such concern,” said Richard Scheffler, report co-author and vice chair of the Berkeley Forum.

Based on existing and ongoing study, the report identifies six factors associated with more successful ACOs. These include:

  • Achieving sufficient size to spread costs,
  • Developing new models of caring for high complex/high risk patients,
  • Expanding the use of electronic health records,
  • Developing effective partnerships with post-acute care providers and specialists,
  • Motivating patients and families to become more engaged in their care, and
  • Using standardized and transparent quality of care data for the purposes of public reporting and internal quality improvement.

The Berkeley Forum for Improving California’s Healthcare Delivery System is a partnership between private and public sector leaders in California to address the challenge of developing a more affordable and cost-effective healthcare system that will contribute to improved population health for all Californians. The UC Berkeley School of Public Health serves as a neutral facilitator for discussions and as the analytic staff for this effort.

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Tobacco-smoking parents increase diabetes risk for children exposed in utero


“Smoking of parents is by itself a risk factor for diabetes, independent of obesity or birth weight.”

Credit: iStock

By Michele La Merrill and Kat Kerlin, UC Davis

Children exposed to tobacco smoke from their parents while in the womb are predisposed to developing diabetes as adults, according to a study from the University of California, Davis, and the Berkeley nonprofit Public Health Institute.

In the study, published today (Feb. 9) in the Journal of Developmental Origins of Health and Disease, women whose mothers smoked while pregnant were two to three times as likely to be diabetic as adults. Dads who smoked while their daughter was in utero also contributed to an increased diabetes risk for their child, but more research is needed to establish the extent of that risk.

“Our findings are consistent with the idea that gestational environmental chemical exposures can contribute to the development of health and disease,” said lead author Michele La Merrill, an assistant professor of environmental toxicology at UC Davis.

The study analyzed data from 1,800 daughters of women who had participated in the Child Health and Development Studies, an ongoing project of the Public Health Institute. The CHDS recruited women who sought obstetric care through Kaiser Permanente Foundation Health Plan in the San Francisco Bay Area between 1959 and 1967. The data was originally collected by PHI to study early risk of breast cancer, which is why sons were not considered in this current study.

In previous studies, fetal exposure to cigarette smoke has also been linked to higher rates of obesity and low birth weight. This study found that birth weight did not affect whether the daughters of smoking parents developed diabetes.

“We found that smoking of parents is by itself a risk factor for diabetes, independent of obesity or birth weight,” said La Merrill. “If a parent smokes, you’re not protected from diabetes just because you’re lean.”

The study was supported through funding from the National Institute of Environmental Health Sciences, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the California Breast Cancer Research Program Special Research Initiative.

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Forecasting the flu better


Combination of ‘big’ and traditional data improves power of prediction.

By Inga Kiderra, UC San Diego

Three UC San Diego researchers say they can predict the spread of flu a week into the future with as much accuracy as Google Flu Trends can display levels of infection right now.

The study – appearing in Scientific Reports, an online journal from the publishers of Nature – uses social network analysis and combines the power of Google Flu Trends’ “big data” with traditional flu monitoring data from the U.S. Centers for Disease Control and Prevention (CDC).

“Our innovation,” said corresponding author Michael Davidson, a doctoral student in political science at UC San Diego, “is to construct a network of ties between different U.S. health regions based on information from the CDC. We asked: Which places in years past got the flu at about the same time? That told us which regions of the country have the strongest ties, or connections, and gave us the analytic power to improve Google’s predictions.”

Google Flu Trends (GFT) is very good, Davidson said, at showing where in the U.S. people are searching for information on flu and flu-like symptoms. And these data are valuable because they come in real time, he said, about two weeks ahead of when the CDC can issue its reports. But GFT has also made some infamous errors – errors that probably reflect widespread public concerns about flu more than actual confirmed illness.

By weighting GFT predictions with a social network derived from CDC reports on laboratory-tested cases of flu, the researchers were able to refine and improve GFT’s predictions.

The researchers are optimistic their work will soon be put to public use. “We hope our method will be implemented by epidemiologists and data scientists,” Davidson said, “to better target prevention and treatment efforts, especially during epidemics.”

Davidson’s co-authors are Dotan A. Haim, who is also a political science graduate student at UC San Diego, and Jennifer M. Radin, of the UC San Diego/San Diego State University Joint Doctoral Program in Public Health.

The study was funded in part by the Robert Wood Johnson Foundation and the James S. McDonnell Foundation.

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Kids of melanoma survivors need better protection from sun’s harmful rays


UCLA study is first to include Latinos, whom have often been left out of skin cancer prevention research.

Credit: Sean Brenner, UCLA

By Reggie Kumar, UCLA

UCLA researchers have found that children of melanoma survivors are not comprehensively adhering to sun protection recommendations, despite them being at an increased risk for developing the disease as adults.

In the study led by Beth Glenn, associate director of the UCLA Jonsson Comprehensive Cancer Center’s Healthy and At-Risk Populations Research Program, researchers asked parents about their attitudes toward melanoma prevention, how at risk for melanoma they believed their child to be, and their current use of sun protection strategies for their child. They found that about three-quarters of parents relied on sunscreen to protect their child against sun exposure, but less than a third of parents reported that their child wore a hat or sunglasses or attempted to seek shade when exposed to the sun.

Additionally, Glenn said, 43 percent of parents surveyed reported that their child experienced a sunburn in the past year. This is concerning because sunburns are a major risk factor for melanoma.

The UCLA researchers used the California Cancer Registry (which tracks all cases of cancer across the state) to identify and survey 300 melanoma survivors with children ages 17 and younger during a three-year period. The study targeted both non-Latino white melanoma survivors and for the first time Latino melanoma survivors as well.

Latinos have often been left out of skin cancer prevention research due to a common misconception that sun protection is not important for this group.

“Sunburns were common among the children in our study despite their elevated risk for skin cancer. Also, children of Latino survivors were just as likely as children of non-Latino white survivors to have experienced a recent sunburn, which highlights the importance of including this group in our work,” said Glenn, associate professor of Health Policy and Management in the UCLA Fielding School of Public Health.

The survey results will be used to apply for additional funding to develop an intervention program that combines a text message reminder system with educational materials and activities for parents and children. The intervention program is designed to help melanoma survivors more effectively monitor and properly protect their child against UV radiation.

“Protecting kids against the sun’s harmful rays at an early age is vitally important. Our goal is to develop an intervention that will help parents protect their children today and help children develop sun safe habits that will reduce their risk for skin cancer in the future,” said Glenn.

The study will be published online Jan. 13 in the journal Cancer Epidemiology, Biomarkers & Prevention.

The research was supported in part by the National Cancer Institute.

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Public housing type a strong predictor of kids’ use of ER


Investments in living conditions could foster better health, reduce health care spending.

By Juliana Bunim, UC San Francisco

San Francisco children living in non-redeveloped public housing are 39 percent more likely to repeatedly visit emergency rooms, according to new research from UC San Francisco and UC Berkeley.

“The average emergency department (ED) visit costs two to five times more than an office visit, and many children visit EDs for potentially preventable reasons,” said Nancy Adler, Ph.D., senior author of the research, and vice chair of the department of psychiatry and director of the Center for Health and Community at UCSF. “There is a clear need to better understand the range of social and economic factors that lead to these high visit rates, and understand the link between housing and health.”

The paper, San Francisco Children Living In Redeveloped Public Housing Used Acute Services Less Than Children in Older Public Housing, appears in the December issue of the journal Health Affairs.

The researchers looked at the number of children under age 18 with public insurance who sought emergency care from any of three large San Francisco medical systems including San Francisco General Hospital, UCSF Medical Center and Sutter Health, and linked that information to whether they lived in non-redeveloped public housing, redeveloped HOPE VI public housing or nonpublic housing the same neighborhood as public housing.

HOPE VI is an initiative by the U.S. Department of Housing and Urban Development to revitalize the worst public housing projects in the United States into mixed-income developments.

From 1998 to 2006, the San Francisco Housing Authority revitalized five obsolete public housing sites with 1,149 units of new public and affordable housing with 2,607 bedrooms. Eight more sites are planned under the City’s HOPE SF Program.

“Low-income children living in redeveloped HOPE IV public housing were less likely to have repeat visits to the emergency room than their peers living in older public housing,” said Adler. “This suggests that investing in physical infrastructure may not only provide better housing but also foster better health among children and reduce spending on acute care services.”

The researchers were not able to identify which aspects of housing played a role in the children seeking emergency care.

“It could be that renovated environments have fewer toxins and allergens like lead and mold, or fewer injury-inducing hazards, or that there are more social services,” said lead author Ellen Kersten, a Ph.D. candidate in the UC Berkeley Department of Environmental Science, Policy and Management. “We are currently doing more in-depth analysis of the diagnosis codes assigned to children at the time of their hospital visits to understand if and how children’s health conditions differ by housing type.”

Co-authors of the study are Kaja Z. LeWinn, Ds.C., and Laura Gottlieb, M.D., in the department of psychiatry at UCSF, and Douglas Jutte, M.D., M.P.H., in the School of public health at UC Berkeley.

Funding was provided by the John D. and Catherine T. MacArthur Foundation Research Network on Socioeconomic Status and Health, and from the Lisa and John Pritzker Family Foundation.

Related link:
UC Berkeley: Study links revitalized public housing to fewer ER visits

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Is life in America hazardous to immigrants’ health?


Over time, the health status of immigrant groups tends to decline.

By Dan Gordon, UCLA

America is a nation of immigrants drawn from all parts of the world by the promise of freedom and a good life. But a substantial body of evidence suggests that for the newly arrived, life in the United States can be hazardous to their well-being.

When they get here, immigrants are on average healthier than their native-born American counterparts. But the longer they stay, the worse they fare on measures such as heart disease, hypertension, diabetes and mental health.

Faculty at the UCLA Fielding School of Public Health are working on identifying factors contributing to the declining health status of immigrant groups that’s occurring over time and through the generations.

Part of it has to do with an unfamiliarity with U.S. society and its complicated health care system. Many immigrants lack health insurance. But Marjorie Kagawa-Singer, a professor at the Fielding School who focuses on the delivery of care that appropriately considers a patient’s culture, notes that it’s more than just cost.

“If someone is new to this country, doesn’t speak the language and has to learn to navigate our system, it’s like plopping us in the middle of Siberia and expecting us to figure out what we need,” she said.

For example, many immigrants across the educational and cultural spectrum hold beliefs about disease and how the body works that diverge from the biomedical model practiced in the U.S., Kagawa-Singer added, and many health care practitioners are uneducated on those differences.

“When you have problems in both health literacy among patients and cultural competence among practitioners, you get this ‘perfect storm’ of people who will not be able to utilize the health care system even when it’s offered,” said Kagawa-Singer.

Since 2000, Kagawa-Singer has headed the Los Angeles site of the Asian American Network for Cancer Awareness, Research and Training, the first federally funded cancer prevention and control research initiative focusing on Asian Americans. In lectures and short courses on cultural competence, Kagawa-Singer advises health professionals to demonstrate their trustworthiness and compassion.

“It’s not the health problem you’re treating, it’s the person,” she said. “When patients recognize you’re making the effort and respecting their dignity, they’re going to be much more forgiving and willing to teach and learn.” The challenge, she noted, is that the U.S. health care system is designed for short encounters, despite the fact that it may take longer to get to know and understand patients from different backgrounds.

Adopting the American diet

Public health experts have postulated that immigrants decline in health as they assimilate and adopt the health habits of their new communities — including high-fat diets and processed foods, along with reduced physical activity. To some extent, though, that equation has changed with globalization of the food supply, said May C. Wang, a Fielding School professor who focuses on early childhood obesity.

“Most low-income countries now have access to the processed foods we’ve been eating for the past few decades,” Wang noted. But even when immigrants’ tastes are similar to those of non-immigrants, immigrants with minimal financial means face considerable challenges to eating well. “Education alone doesn’t work in a community that doesn’t have the ability to access healthy food,” Wang said. “And in the very poorest communities, trying to change the environment by placing healthier foods where people live, work and go to school is challenging.”

The problem is compounded for immigrant groups, she explained, because they tend to have fewer social ties, are constricted by language barriers and often lack the know-how to pursue resources that could help them.

Wang works closely with the Public Health Foundation Enterprises Women, Infants, and Children (WIC) Program, the largest local WIC agency in the country. It serves 300,000-plus families a year, the vast majority of them non-English-speaking immigrants. The overall childhood obesity rate has plateaued or declined in the U.S. in recent years, Wang noted, but the obesity rate among the mostly immigrant Latino children remains substantially higher than for other groups. Among the low-income, preschool-aged Latino children enrolled in L.A. County’s WIC program in 2011, nearly 22 percent were obese.

To better understand the impact of various strategies to improve diet and reduce early childhood obesity, said Wang, “We are examining the social and physical environments in which immigrants live and how these affect their ability to put into practice nutrition knowledge they acquire from participation in the WIC program.”

The work aligns with the University of California Global Food Initiative, which seeks to harness the resources of all 10 UC campuses to address a critical issue of our time: How to sustainably and nutritiously feed a world population expected to reach eight billion by 2025.

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