21st Century Science
A Vision for Resilience and Health Equity
Research teams in the Herbert Wertheim School of Public Health and Human Longevity Science at UC San Diego are addressing key public health challenges using methods that promote resilience and health equity.
With new strategic priorities in place, the school is expanding its research activities in unparalleled ways in key areas: climate and environmental health, health equity and global health justice, health services research and health policy, healthy aging and human longevity science, mental health and substance use, quantitative methods in public health, and women’s health and reproductive justice.
“While as a single school we can accomplish a lot, true greatness is achieved when collaborating with the entire UC San Diego campus,” said Cheryl A.M. Anderson, Ph.D., M.P.H., Herbert Wertheim School of Public Health founding dean and Hood Family Endowed Dean’s Chair in Public Health. “We have experienced tremendous growth over the last year and we have seen our research portfolio grow strategically.”
Danielle M. Campbell, M.P.H.
Longevity is in Our Name
UC San Diego has a storied history on aging research including work by Andrea Z. La Croix, Ph.D., M.P.H., Distinguished Professor at the Herbert Wertheim School of Public Health, who in November 2022 was one of eight researchers from UC San Diego listed in the first-ever ranking of the “1,000 Best Female Scientists in the World” by Research.com.
In addition, the National Heart, Lung, and Blood Institute, part of the National Institutes of Health (NIH), awarded LaCroix a $6.2 million grant to expand her research into the impact of physical activity on cardiovascular disease health and resiliency in older women.
“Despite higher rates of cardiovascular disease and the disproportionate burden of disability and co-morbidity among older women compared to men, prevention of cardiovascular disease in this vulnerable population is vastly understudied,” said LaCroix.
Due to the success of the Women’s Health Initiative Objective Physical Activity and Cardiovascular Health (OPACH) Study, which measured physical activity and sedentary behavior among 7,048 women ages 63 to 99 and their cardiovascular disease risk, the NIH grant is funding OPACH2.
Results of the initial OPACH Study reported a 20 percent reduction in coronary heart disease, a 10 percent decrease in cardiovascular disease, and a 24 percent drop in all-cause mortality for every additional hour spent in light physical activity as well as 12 percent increased risk of cardiovascular disease for every additional hour spent sedentary.
Adults aged 65 and older are projected to reach 95 million by 2060 in the United States, the majority of whom will be women.
Resting metabolic rate and maximal aerobic capacity decline with aging, while the energy cost of aerobic activity increases with age. For this reason, the newly funded OPACH2 aims to accurately classify individualized physical activity intensity among women aged 70 to more than 100 years old by combining heart rate measurements using a non-invasive cardiac monitor patch with measurements of movement and rest using a hip worn accelerometer device. When combined, this measure of how hard the heart is working during usual activities will be studied in relation to changes in cardiovascular disease risk factors, novel biomarkers of cardiac injury and resiliency, physical functioning and incidence of cardiovascular illness and death.
Andrea Z. La Croix, Ph.D., M.P.H.
“Adults aged 65 and older are projected to reach 95 million by 2060 in the United States, the majority of whom will be women.”
Activity is More than Physical
UC San Diego ranks among the universities worldwide with the most influential researchers in a variety of disciplines. Among these experts is James F. Sallis, Ph.D., Distinguished Professor Emeritus, whose research in physical activity and walkable neighborhoods has been highly cited.
In 2023, Sallis was a senior author on a study published in the journal Health & Place that reported adults who live in walkable neighborhoods are more likely to interact with their neighbors and have a stronger sense of community than people who live in car-dependent communities.
Sallis’ findings are important because a 2023 Surgeon General Advisory stated that loneliness and isolation can lead to a 29 percent increased risk of heart disease, a 32 percent increased risk of stroke, a 50 percent increased risk of developing dementia among older adults, and increases risk of premature death by more than 60 percent.
“Our built environments create or deny long-lasting opportunities for socialization, physical activity, contact with nature and other experiences that affect public health,” said Sallis. “Transportation and land use policies across the United States have strongly prioritized car travel and suburban development, so millions of Americans live in neighborhoods where they must drive everywhere, usually alone, and have little or no chance to interact with their neighbors.”
Neighborhood walkability may promote social interactions with neighbors — like waving hello, asking for help or socializing in their homes, said first author, Jacob R. Carson, M.P.H., a student in the UC San Diego – San Diego State University Joint Doctoral Program in Public Health. Carson began the research while a Master of Public Health student at the Herbert Wertheim School of Public Health. This opportunity enabled him to contribute to the research area that sparked his interest in public health.
“Promoting social interaction is an important public health goal. Understanding the role of neighborhood design bolsters our ability to advocate for the health of our communities and the individuals who reside in them,” said Carson.
James F. Sallis, Ph.D.
Equitable Access to Health
While improvements in public health may contribute to an individual’s quality of life and longevity, structural barriers to health care can have the opposite effect.
For example, people who use drugs would rather access preventive services through syringe service programs than via the health care system, said Angela Bazzi, Ph.D., M.P.H., associate professor at the Herbert Wertheim School of Public Health.
With HIV incidence on the rise among this population, public health experts need to design an intervention that improves access to HIV testing, antiretroviral pre-exposure prophylaxis (PrEP) and HIV treatment, said Bazzi.
“We have decades of evidence that people who use drugs prefer receiving services through syringe exchange programs and there is great evidence that these programs can provide a range of infectious disease testing and referrals to health care services,” said Bazzi.
As a result, Bazzi is leading a National Institutes of Health Research Project Grant (R01)-funded randomized controlled trial that tests whether an intervention can improve delivery and use of PrEP through syringe service programs, which are trusted and patronized by people who use drugs.
Syringe service programs previously provided regular HIV testing, but the COVID-19 pandemic and the rise of drug overdose deaths has caused the programs to shift their focus to provide more overdose prevention services, Naxolone education and distributions services, said Bazzi. The clinical trial will test whether an optimized organization-level intervention can effectively increase HIV testing, referrals to prevention services like PrEP and HIV treatment in communities nationwide with high increase in HIV incidence.
Angela Bazzi, Ph.D., M.P.H.
“People experience incredible stigma in health care settings, causing them to avoid those settings. They prefer community settings where they know the staff and where they may already be frequenting for daily access to other services,” said Bazzi. “Many of the staff have lived experiences similar to theirs resulting in higher levels of trust.”
From her research, Bazzi learned that people who use drugs were frequently unfamiliar with PrEP, questioning why physicians or public health departments had not informed them about its availability and effectiveness.
“We have seen dramatic disparities emerge among who can access PrEP and related care,” said Bazzi. “Improving access to prevention services starts with meeting people where they are and bringing services directly to them through community-based settings.”
Danielle M. Campbell, M.P.H., a student in the health behavior track in the Joint Doctoral Program in Public Health, developed a qualitative assessment of the factors that increase or decrease participation in HIV-related care among communities disproportionately affected by HIV in the County of San Diego.
Funded by the San Diego Centers for AIDS Research Community Research Kick Start grant, Campbell’s project aims to develop a best practices document, driven by real world experience from impacted communities.
“This report will serve as a foundation for policymakers and stakeholders to build services that address the HIV epidemic using community-informed perspectives from individuals who are disproportionately affected by HIV. This is how we believe truly informed, culturally-tailored services should be derived,” said Campbell.
The analysis underscored barriers to HIV care, including stigma, mental health and substance use, and transportation. Among the top concerns for community members was the location of HIV services, which were often found in more affluent neighborhoods.
Chadwick K. Campbell, Ph.D., M.P.H., assistant professor at the Herbert Wertheim School of Public Health who has no relation to Danielle Campbell, signed on as faculty principal investigator after recognizing the importance of working with a community partner.
“Danielle came to me with a fully thought-out idea. She is engaged in work with community and organizations working on health equity nationally,” said Chadwick Campbell. “We wrote up our grant application so that the Neighborhood House Association was a central player because their clients have their trust. Participants were overwhelmingly well connected to care and services.”
The aim of public health is to prevent disease and promote healthy longevity among entire communities. To achieve this goal, the Herbert Wertheim School of Public Health is building resilience in communities by identifying structural barriers and solutions to equitable access to health and social services. The school will continue to focus on aging research, physical activity and equitable health care in addition to developing programs and research that directly confront key 21st century public health challenges.
Chadwick K. Campbell, Ph.D., M.P.H.