Day: August 27, 2018

In defense of needle exchange programs

Ricky Bluthenthal, professor of preventive medicine at Keck School of Medicine of USC, is defending needle exchange programs as they face closure in various U.S. cities.

The programs offer clean needles in exchange for old ones to lower the risk of HIV and hepatitis C outbreaks among drug users. Some cities, including Charleston, West Virginia, and Santa Ana, California, have recently shut down needle exchange programs, citing perceived increases in drug use, crime rates, and needle litter—sparking debate about the programs’ effectiveness.

“The studies show that places that have robust programs have lower HIV incidents among people who inject drugs,” Bluthenthal said in an interview with WBUR’s Here & Now May 14.

He addressed misconceptions, addiction stigma and the lack of evidence to support fears around needle exchange programs in Vox’s in-depth look at why Orange County’s Santa Ana program shut down in January.  Outside the U.S., he said, needle exchanges “are part and parcel of a gold-standard response to HIV and hepatitis C prevention.”

Read the article »

How a USC professor is refining the global health toolkit

by Carolyn Barnes

Pictured: Shubha Kumar, PhD, MPH, assistant professor of global health and director of USC’s MPH Online Program.

A global health professor is determining the best ways to evaluate the impact of global health initiatives.

This post is part of our National Public Health Week series! We’re putting the spotlight a different area of public health each day. We hope you are as inspired as we are by the featured change-makers in this series.

Monitoring and evaluation is critical to public health program funding, and can determine if and how future efforts should be implemented. Shubha Kumar, PhD, MPH, has made it her mission to discover the efficacy of and improve upon tools and best practices used to monitor and evaluate global health programs.

What is your work focused on?

My work and research is in the field of global health, with an emphasis on monitoring and evaluation of programs.


What inspired you to get involved in global health?

There is a lack of information and transparency around evidence based decision-making in global health, and I felt this was something I could have an impact on.


What are your goals in the field of global health?

I work to identify both the tools and best practices involved in the approaches we take to monitor and evaluate global health programs. By understanding and implementing these tools and approaches, we hope to prove and improve the value of public health interventions.

What types of activities does your work entail?

My research entails mixed methods approaches to programming, including quantitative and qualitative analysis. This work is often conducted in teams and with organizations working to serve public health and development. It often involves traveling and meeting with various stakeholders including the communities being served.


Why is it so critical to use the proper tools in evaluating global health programs?

In a world of limited resources, we need to be allocating them most effectively. We also need to make sure resources and programs are effective in serving those whom they are intended to serve. Best practices in monitoring and evaluation in global health is relatively limited as far as research is concerned, and it is important that we work to provide actionable approaches that agencies can easily implement in their work routinely.

Who should be concerned about best practices and evaluation tools in global health?

Many different types of public health workers, leaders and members of the public are effected by the efficacy of tools used to monitor and evaluate global health programs. This includes program planners, evaluators, managers, policy-makers and communities.


What are the biggest challenges when determining best practices and tools in global health?

The biggest challenges are getting timely and accurate data and resources. There is also a need for more trained workers inside and outside of communities participating in programs.


What can the public do to get involved?

The public can look for accountability when donating to organizations. It is important to know where your money is going, and what type of impact your donation is having. Public health workers can take part in monitoring and evaluation of programs in their work. Get trained in this area and foster a culture of learning and accountability within organizations.

Community outreach inspires salutatorian to think outside the clinic

The aspiring surgeon has helped the homeless get to medical appointments and find available resources — and he’s just getting started

Every week, Sammy Cohen heads to Skid Row, the part of Downtown Los Angeles known for its large homeless population.

Roughly 5,000 folks live on the streets there, according to a 2017 count.

Working at homeless shelters, Cohen, 21, stands close as doctors perform checkups and give referrals to homeless patients. It’s part of the Mobile Clinic at USC program.

“There’s not a lot of places you can get those hands-on experiences,” said Cohen, a USC senior and one of the two USC 2018 salutatorians, who has plans to be a pediatric orthopedic surgeon.

Working on Skid Row, Cohen noticed that while patients wanted to continue treatment, getting to doctor’s appointments across town was difficult.

“They didn’t have a way to get there,” he said, adding that public transit was unpredictable.

Cohen came up with an idea: What if student volunteers helped them get to the appointments?

“That increased the follow-up rate from 15 percent to over 95 percent now,” he said.

They use Uber, which reimburses rides the students take with the homeless patients.

Riding together has been a way to build rapport with the patients, many who have lost trust in doctors or the health care system, said Cohen, who is majoring in health promotion and disease prevention at the Keck School of Medicine of USC with a minor in health care studies at the USC Dornsife College of Letters, Arts and Sciences.

Read the full story on USC News »


Why did you choose the degree program you’re in?

I chose the Bachelor of Science in Health Promotion & Disease Prevention from the Keck School of Medicine of USC because it emphasizes an interdisciplinary approach to medicine. I knew that I was going to need to learn core sciences like biology, chemistry and physics in preparation for medical school, but I wanted my other courses to focus on the human components of medicine in a more intimate setting. I wanted to learn about cultural competence, Eastern and alternative medicine, and the social determinants of health because regardless of how well we can regurgitate information from textbooks, if we cannot interact with our patients and connect and communicate with them on a personal level, our scientific knowledge is rendered useless.

What has been your biggest accomplishment in the time you pursued this degree?

I feel my biggest accomplishments have occurred outside of the classroom. For the student organization USC Mobile Clinic, I created a program where undergraduates such as myself transport homeless patients to follow up medical appointments after we set up primary care clinics at local homeless shelters. I developed a meaningful relationship with one of the patients whom I met through the program and worked with him to secure permanent housing. The message he sent to me the day he received the news that he would no longer be homeless was one of my greatest moments at USC.

Another one of my biggest accomplishments stemmed from the research I conducted at Children’s Hospital Los Angeles studying the social determinants of health. The research I performed confirmed that there were many unmet non-medical needs of families visiting the Emergency Department such as a need for food banks, primary care doctors and safe housing services. I presented my research at the Pediatric Academic Societies international conference and have worked with my research mentors to launch a community resources help desk in the CHLA Emergency Department so that families can learn about community resources in their area. The help desk will be run by USC students via a directed research course that I helped to create. The course is at full occupancy for next semester!

What’s an important lesson you learned?

My experiences both in the CHLA Emergency Department and working with the homeless population have taught me the art of listening before judging. This lesson was poignantly conveyed by a homeless man I befriended, who, I was shocked to discover, has a doctorate from UCLA. Unfortunate circumstances had left him homeless and needy. His story was far more common than I previously believed, teaching me the perils of stereotyping and reinforcing the concept that behind every patient is a story that must be told and heard.

What’s one of your favorite memories from the time spent in your program?

One of my favorite memories from my time spent in the program was working with the other Keck Student Ambassadors at the Los Angeles Food Bank. This was an amazing opportunity to bond with the other KSA members while giving back to the community. The several hours that we worked there early on Saturday mornings exemplified to me what it means to be a member of the Trojan Family: to create and participate in programs that migrate beyond USC’s gates to advance a greater good.

What are you doing after you graduate?

After I graduate, I will continue my work at CHLA, ensuring the smooth launch of the CHLA CHAT (Community Health Advocates Team) program in the Emergency Department. I will also continue my work at USC and act as an advisor for the USC Mobile Clinic, Keck Student Ambassadors, and WorldMed @ UPC organizations that were so instrumental to my college career. I will then apply to medical school and aspire to become a pediatric orthopedic surgeon

What do you look forward to in your career path?

I’ve realized from my time at USC that although science is integral to any health profession, what makes the field of medicine so desirable is the people who compose it. Every day I go to work I will have the opportunity to improve the lives of those whom I interact with. I especially look forward to the first patient whom I heal, which will make the hours of hard work and dedication required to break into the field absolutely worth it.

What advice do you give to future grads?

I would advise future graduates to take advantage of USC’s unique location by constantly searching for opportunities to serve the community. The most important lessons that I’ve learned at USC have come from experiences in the community rather than in the classroom. Additionally, by joining organizations early in your college career, you will find a community of students who have similar interests as you, enabling you to meet friends that make a school of nearly 17,000 undergrads feel more like home.

— by Joanna Clay

(USC Photo/Gus Ruelas)

USC students discuss health care policy with legislators

Students at the Keck School of Medicine of USC do more than learn to be physicians: A group of them got a taste of government policymaking after meeting with state legislators in Sacramento on June 6 and 7.

To give students firsthand experience in working with policymakers, Professor of Clinical Preventive Medicine Michael Cousineau, DPH, regularly takes students on a trip to the capital as part of his Public Health Policy and Politics class, not just to meet state lawmakers but to seriously discuss health care policy concerns with them.

Cousineau’s most recent trip brought 10 policy students — eight MD/MPH students, one social work student and a PhD candidate — to the Capitol for one-on-one meetings with their individual elected representatives.

“Most of our work has been on access to care — financial needs, insurance coverage, Obamacare,” Cousineau said. “Increasingly, you have people with insurance cards, but they don’t know how to get access or make appointments.”

Focusing on vulnerable groups in L.A. County

Most of Cousineau’s work has been in Los Angeles County, including issues involving vulnerable groups such as immigrants and the homeless.

“Beyond issues of access — how to get people coverage financially — and assurance — making sure people actually get the coverage — a lot of these issues are driven by state policy and increasingly by federal policy,” Cousineau said, adding that federal changes to the Affordable Care Act have caused state policymakers to scramble to find ways to continue coverage for Californians.

Before the trip, students are assigned to first make an appointment with their own regional representatives — ideally, one Democrat and one Republican. Cousineau said that, contrary to what one might expect, it’s more effective for USC students to not identify themselves as such.

“You say, ‘I’m a constituent,’ and remember that they work for us,” he said.

Cousineau estimates that about two-thirds of his students succeed in getting one-on-one face time scheduled in Sacramento. For the rest, Cousineau intercedes with assistance from the USC staff in state government affairs at the Capitol. He also schedules a group meeting with a senior legislator involved in health care policy.

“I take them through the steps: This is how you make an appointment, this is how you go into the legislature, and what you say — and what you don’t say,” he said. “These are lifetime skills.”

Ahead of their meetings, Cousineau counsels students with the acronym PPO: prepared, professional and on time.

USC medical students meet lawmakers, discuss single-payer proposal

With support from the Keck School, this summer’s participants flew to Sacramento for two days and met as a group with Democratic Assemblyman Jim Wood, co-chair of the special committee formed in the wake of last year’s failure in the Legislature to enact a single-payer health plan. Cousineau said students focused on the state’s response to the lack of federal support for the Affordable Care Act, specifically: If we’re not going to do a single-payer plan, under which the state would handle all health care funding and payments centrally, what are we going to do?

Wood took the students seriously enough to extend his planned 20-minute meeting to an hour and ask them to send their final course project, Cousineau said. Other legislators found themselves drawn into earnest discussions with students about health care policy.

“They take us seriously,” Cousineau said, “because these aren’t just students. They’re medical professionals who have clinical training and research skills with real patients and projects. It’s good to have all the data, but the personal anecdotes are often what gets policy makers’ attention.”

In return, Cousineau said he hopes that personally meeting legislators with practicing medical backgrounds — Wood is a dentist — will inspire some of the students to run for office themselves.

“We met with [state Sen.] Richard Pan,” he said. “Here’s this guy who was a practicing pediatrician for 15 years and decided to run for office. One of the students came away saying, ‘I could do this. I could run for office.’ I can’t teach that.”

— by Paul Boutin

Photo courtesy / Michael Cousineau

Fewer uninsured since Obamacare, but disparities remain

The percentage of adults and children without health insurance declined dramatically in Los Angeles between 2011 and 2015, according to a new report from the LA County Department of Public Health, compiled with assistance from USC.

The sharp decline—from 28.5 to 11.7 percent—spanned racial, ethnic, age, gender and geographic groups of adults 18 to 64 years old throughout the county.  The news was even better for children: The percentage of uninsured dropped to 3.4 in 2015—a clear improvement from 10.1 percent in 2002.

Good news—for now

The county findings are consistent with trends reported in California and nationally. The report notes private insurance coverage declined between 2007 and 2011, and attributes the lack of further decline between 2011 and 2015 to the expansion of Covered California—the state’s health care marketplace—and the improving economy.

The Patient Protection and Affordable Care Act—also known as Obamacare—was signed into law in 2010, and fully took hold in 2014. In addition to providing more private insurance options, the bill expanded Medicaid, the nation’s free low-income health program, to cover millions more Californians than were previously eligible. Today, those individuals may lose parts of their coverage, or get dumped from their insurers, should the ACA get repealed or replaced.

“This report shows that we should be working to extend the benefits of the ACA, not to repeal it,” said Mitchell Katz, director of Los Angeles County Health Agency, in a press release.

Michael Cousineau, USC professor of clinical preventive medicine and a contributor to the report, agreed. “It’s not perfect, but the ACA has gotten us closer to a more equitable health care system,” he said. “Research shows that, even in Los Angeles, more people are receiving life-saving medical treatment, hospitals are facing lower uncompensated care costs and health care spending projections continue to fall.”

The statistics spell good news for LA County, according to Barbara Ferrer, director of the LA County Department of Public Health. “We know that having health insurance coverage is an essential step in ensuring people get the medical care they need, including access to preventive services,” she said in a press release.

Unequal Improvement

While the positive news means more LA residents have access to affordable health care, glaring disparities persist among the uninsured.

Among Latinos, the percent of uninsured adults was nearly three times higher than African American, Asian or white uninsured adults.

In addition, the uninsured adults percentage in the “South Service Area,” which includes Athens, Compton, Crenshaw, Florence, Hyde Park, Lynwood, Paramount and Watts, was more than triple that in the “West Service Area” of Beverly Hills, Brentwood, Culver City, Malibu, Pacific Palisades, Playa del Rey, Santa Monica and Venice.

Numerous USC public health programs in the Department of Preventive Medicine are working to eliminate  health disparities at the local, state, national and global levels, including the USC Institute for Global HealthUSC Environmental Health CentersImmigrant Health InitiativeCenters for Health Equity in the AmericasInstitute for Health Promotion & Disease Prevention Research and the Program on Global Health & Human Rights.

In the classroom, Cousineau is teaching his Master of Public Health students about the ACA debate—and even took 18 to Sacramento in February to meet with legislators and attend a health reform conference.

“In order for us to continue our work to minimize health disparities and inequity, policymakers need to protect the gains we’ve already made,” Cousineau said.

Photo: A representative from L.A. Care Health Plan, a public agency that provides health coverage to low-income Los Angeles County residents, speaks to USC students and alumni Mar. 24 at a career fair hosted by the Department of Preventive Medicine.


— by Larissa Puro

Michael Cousineau is the  director of the USC Master of Public Health program’s Health Services and Policy TrackInterested in learning more about health services and health policy education at USC?  Learn more about our MPH programs »

Es Tiempo campaign raises awareness of cervical cancer prevention among Latinas

USC’s local campaign to encourage Latinas to get tested for cervical cancer extends further into the community this year, with the hiring of local health care professionals who already work with residents.

Es Tiempo is an annual public awareness campaign that was conceived a few years ago when Laila Muderspach, chair of the Los Angeles County+USC Medical Center’s Department of Obstetrics and Gynecology, observed that women in the Latino communities around L.A. County had unusually high rates of cervical cancer, which can be fatal if not diagnosed early. Pap smear tests every few years and a vaccination at a young age against the human papillomavirus (HPV) that can cause cervical cancer have proven effective in reducing the number of late-stage diagnoses.

“Dr. Muderspach believed it was not only access, but lack of information,” said Lourdes Baezconde-Garbanati, one of the program’s principal investigators in the Department of Preventive Medicine at the Keck School of Medicine of USC. “Women didn’t know about coming in for screening or that they have to do that regularly.”

But communicating that information to the community required a broad field of talent and expertise. The result was a multidisciplinary effort that included the USC Annenberg School for Communication and Journalism Professor Sheila Murphy and the Designmatters program at the Art Center College of Design, Baezconde said.

Baezconde-Garbanati noted that the interdisciplinary team conducted a dozen focus groups.

“We took students and faculty from the Designmatters program to local clinics to observe what was going on, what the clinics were like, and to see how a Pap smear was done on a dummy. It was quite eye-opening for students coming from the world of design.”

Cervical cancer prevention and Pap smears

Working with local residents as well, the team developed a campaign that associates regular Pap smears with the yearly springtime purple bloom of the Jacaranda Trees in local neighborhoods — Boyle Heights and other areas of East Los Angeles. When the trees are in bloom, signs on billboards, bus benches and lamp posts announce that es tiempo — literally “it’s time” to get tested or have one’s sons and daughters vaccinated against HPV.

The signs tout in both Spanish and English that testing is safe, important and easy. They display a toll-free phone number that women can call at the Office of Women’s Health to get more information on where to get tested, possibly at reduced or no cost.

The team also produced The Tamale Lesson, a 12-minute video available in Spanish and English in which a young woman explains to others gathered in a Latino family kitchen getting ready for a quinceañera how a Pap test works, using a chicken to demonstrate. She dismisses several common myths about testing and cancer, and the film takes a sad turn as it reveals that undetected cancer has already taken its toll in the family. This prompts the women in the family to go in for a screening, even those who did not think they were at risk.

Health care professionals step in to help

Now in its fourth year, the Es Tiempo program is extending its roots from USC staff into the local health care network.

“We have data that show changes in knowledge, attitudes and beliefs in the community as a whole regarding cervical cancer and have been working with our clinic partner, Clinicas Moñsenor Oscar Romero,” Baezconde said. “We no longer need to test the campaign. We just need to put it out there in the community.”

To that end, USC has hired and trained women who work locally as promotoras de salud (community health care professionals) and others who have an established relationship with local residents through clinics, churches and community agencies.

Promotoras de salud are trained, they are from the community and have won the trust of the community. These women are very well known in the communities where they work,” Baezconde-Garbanati said.

What began as a physician’s urgent concern is becoming a regular part of community-run health care.

“Ideally, there will be a point where we no longer put out the campaign,” Baezconde-Garbanati said. “Women will just see the trees blooming and say, ‘It’s time.’”

— By Paul Boutin