Bernadette Boden-Albala, MPH, DrPH
Director and Founding Dean
Dear UCI Community,
Who among us has not heard stories about—or experienced first-hand—the frustrations of trying to get the COVID-19 vaccine since local health agencies including here in Orange County have expanded eligibility to residents over age 65? As public health experts, we advise everyone who is eligible to get vaccinated, but the reality is not so simple. It’s frustrating to compete with thousands of others to make an appointment on the county’s overwhelmed registration app, especially if you do not speak English or have yet to master Zoom gatherings with your grandchildren, let alone your smartphone.
California is not alone in its vaccine rollout challenges. The CDC estimates that 6% of Americans have received at least one dose of a COVID-19 vaccine. Indeed, this number suggests positive momentum, but the harsh truth is that, upon close inspection, phased local roll-outs of the COVID-19 vaccine in the U.S. promulgate the widespread ethnic and racial health disparities that we witness in the spread of the disease itself. Controversial decisions about who to prioritize, rumors about who is eligible, first-come-first-served policies, poor communications, and logistical snafus seem to be universal issues across states, each making access to the vaccine harder than the last for those who need it most.
I have said it before, and I will say it again: COVID-19 is a disease of disparities. The public health community, policymakers, and other stakeholders face a moral imperative to confront and address the persisting disparities and systemic inequities that threaten to undermine our collective work to fight the COVID-19 pandemic.
While millions await their turn to receive their doses of the Pfizer or Moderna vaccines,
 more than 400,000 Americans are dead. In the U.S., COVID-19 kills Black, Hispanic, and Native people at nearly three times the rate of White people. Our ownactOC seroprevalence study revealed that, among the approximately 3,000 Orange County residents screened for antibodies, Hispanic and low-income adults bore the greatest burden of the disease.
Yet Black Americans are getting vaccinated at lower rates—in some cases, 
two to three times lower—than White Americans. Black and Hispanic Americans are nearlytwice as likely to say their access to COVID-19 vaccines and resources (for example, treatment and care) is worse than other racial and ethnic groups.
If we don’t change the trajectory of the vaccine roll-out, fewer doses will continue going to the communities of color who need them most. Currently, barriers are baked into the CDC’s vaccine priority tier groups that contribute to different trajectories for COVID-19 vaccine uptake.

Research suggests that COVID-19 vaccine uptake history is associated with past flu vaccination, in which race/ethnic disparities also persist. During the 2018-2019 flu season, White non-Hispanic adults had greater flu vaccination coverage (49%) compared to Asian (44%), Black non-Hispanic (39%), American Indian/Alaska Native (38%) or Hispanic (37%) adults.

Disparities in vaccination can be explained by a number of barriers disproportionately experienced by low-income communities of color, from individual barriers, such as vaccine hesitancy due to medical mistrust, to community and structural barriers influencing access, such as poverty, physician shortages, and lack of reliable transportation to local healthcare facilities.
These barriers should inform the ways in which we implement ethical and equitable COVID-19 vaccine programs. Solutions as simple as multilingual vaccine registration apps, for example, can help to address inequities. Now is the time to work on achieving health equity. While we wait for COVID-19 vaccines to arrive, we must create and support programs and practices that understand the social determinants of health to ensure that vulnerable communities have the resources they need to stay safe and healthy.
Ivy Torres
PhD Student

Critical Considerations for Inoculating Farmworkers Against COVID-19

Agricultural workers across the country have been hit hard by COVID-19. In a 
white paper published by the University of California, Berkeley, researchers noted that in October, approximately 20% of farmworkers participating in a SARS-CoV-2 study tested positive for the virus compared to 5% of the general population in the state of California. While Governor Newsom’s vaccine plan situates farmworkers in Phase 1b, it remains unclear how the vaccine will be administered to this population.
As the vaccine is provided to agricultural workers, there are a number of factors that must be considered and addressed to ensure the successful inoculation of this population. It is estimated that between
 one-half to three-fourths of farmworkers are undocumented. Workers’ legal status raises concerns about the public charge rule, a policy that bars immigrants from obtaining lawful permanent residence in the U.S. if they receive one or more public benefits. Concerns about being designated a public charge may discourage farmworkers from obtaining the vaccine. Moreover, anecdotal evidence suggests that undocumented people have been turned away from COVID-19 testing sites because they were not able to provide identification. If this practice spills over into vaccine distribution, undocumented farmworkers may be excluded.
Agricultural work is primarily seasonal, and workers move within and across states. However, not all states are prioritizing farmworkers in vaccine distribution plans. The patchwork approach to vaccine distribution might present a logistical problem. Ensuring farmworkers receive both doses of the vaccine will require coordination between agencies across states.
Communication about COVID-19 and the vaccine from public health agencies has fallen short for non-English speaking communities. The information has been slow and, at times, has lacked cultural competency. This issue is further complicated by the reality that
 approximately 6% of farmworkers identify as indigenous from Latin America and may only speak an indigenous language. Although their numbers may be small, the inoculation of farmworkers cannot be achieved without indigenous farmworkers. Therefore, it is imperative that public health agencies develop culturally and linguistically competent information about the vaccine to distribute to all farmworkers.
The COVID-19 pandemic has illustrated the vital role farmworkers play not only in our economy but also in keeping this country running. Their vulnerability to COVID-19 warrants that they be prioritized in obtaining the vaccine. The public health community, especially those charged with vaccine prioritization and distribution, must come together to address the disparities that farmworkers face so they are successfully inoculated against COVID-19.
Santa Ana Surveillance Study

During the Fall semester, the UCI Program in Public Health partnered with the city of Santa Ana to conduct COVID-19 antibody testing of over 3,300 residents to determine exposure throughout the community. Since the start of the pandemic, the city has been disproportionately burdened by the threat of COVID-19 with significant impact of social determinants of health on disparities in incidence and severity.

The project is now nearing completion and results are forthcoming. We look forward to sharing our findings soon. In the meantime, learn more by watching KTLA's recent coverage of the study
Student volunteers assist with antibody testing at one of the Santa Ana study drive-through testing sites
A Surveillance-Based Approach to Estimating Uncounted COVID-19 Cases

The COVID-19 pandemic is estimated to cause an overall case fatality rate of 1.4-2%, though the true case fatality rate remains unknown. This is due in part to lack of testing of key groups and current protocols that likely underestimate the number of asymptomatic or minimally symptomatic cases.

UCI researchers including Dean Bernadette Boden-Albala, Dr. Tim Bruckner, andDr. Ilhem Massaoudi from the School of Biological Sciences are currently conducting a study that aims to address this issue and determine the true case fatality rate of COVID-19. The study will use antibody testing to calculate the incidence of the virus by race/ethnicity, age, gender, and place. Results will have an immediate impact on understanding the reach of COVID-19 in Orange County and also serve as foundational preliminary data for a more ambitious project using population-based surveillance.
Department of Environmental and
Occupational Health
Clinic Residency Match

The Occupational Medicine Residency program at UCI recruited 3 well-qualified candidates to start their 2-year training in the residency on July 1, 2021, bringing the program to a total of 4 residents. Residents come from a variety of backgrounds including the U.S. Navy, ophthalmology, and pathology. We look forward to welcoming our new residents this summer.
COEH Staff Certificates in Language Proficiency 

Congratulations to Center for Occupational and Environmental Health (COEH) medical assistants Jocelyn Carmona and Idalia Reynoso for passing a Language Proficiency Assessment by Cyracom International, Inc. Jocelyn and Idalia have key roles at the clinic and help provide translation services for Spanish-speaking clients.
Department of Epidemiology and Biostatistics
Feb. 2021 NIH Kidney, Nutrition, Obesity and Diabetes (KNOD) Study Section

Dr. Karen Edwards will serve as a reviewer for a special emphasis panel and scientific review group for the February 2021 NIH Kidney, Nutrition, Obesity and Diabetes (KNOD) study section meeting. The NIH KNOD study section reviews applications on the epidemiology and genetic epidemiology of kidney, diabetes, obesity, urinary, gastrointestinal and liver diseases in human populations. The focus of interest can include molecular, genetic, epigenetic, pharmacologic, behavioral, environmental, microbiome, diet/nutrition, and physical activity.
Feb. 2021 NIH Pathophysiological Basis of Mental Disorders and Addictions (PMDA) Study Section

Dr. Elizabeth Thomas will serve on the NIH Pathophysiological Basis of Mental Disorders and Addictions (PMDA) study section on February 3-4, 2021. The PMDA Study Section reviews applications that use in vitro and animal models to investigate the pathophysiology of psychiatric, addictive and neurological disorders and the biological systems that mediate cognitive, behavioral, emotional, social and learning abnormalities.
Department of Health, Society and Behavior
Recent Publications of Note

Congratulations to Dr. Suellen Hopfer, who published two exciting articles this month:

1) HPV Vaccine Intent among Adult Women Receiving Care at Community Health Centers: This study reports the development and evaluation of an intervention designed to overcome barriers by using culturally grounded narratives to promote HPV vaccination. Learn more >>
2) Let's Chat: A process evaluation of an intergenerational group chat intervention to increase cancer prevention screening among Vietnamese American families (co-authored with PhD student Huong Duong): Vietnamese Americans have a higher rate of cervical and colorectal cancer (CDC) compared to other ethnicities. This study describes the successes and challenges of implementing a novel intergenerational family group chat intervention that encourages CRC screening, Pap testing, and HPV vaccination. Learn more >>
Department of Population Health and
Disease Prevention
Andrew Noymer Named Among Orange County's Top 100 Influencers

This achievement is in recognition of Dr. Noymer's essential work in becoming an interpreter of pandemic trends in Orange County. Read more >>
Institute for Future Health Memberships

Dean Bernadette Boden-Albala and Dr. Daniel Parkerare members of the newly-created Institute for Future Health (IFH), a UCI initiative that aims to integrate lifestyle, community, environment, and socioeconomic factors in conjunction with clinical knowledge to radically transform health systems away from hospitals and clinics, and into the hands of each individual. Learn more >>
Chao Family Comprehensive Cancer Center Health Disparities Pilot Project Award

Cancer remains the leading cause of death in Latinos and the growing number of young adult survivors highlighs the need for a focus on cancer caregiving in the cultural context in which it occurs. In recognition of his work aiming to address this public health issue, Dr. Michael A. Hoyt was recently awarded the Chao Family Comprehensive Cancer Center Health Disparities Pilot Project Award. Congratulations, Michael!
Title: Ovarian cancer in California: Guideline adherence, survival, and the impact of geographical location

PI: Dr. Veronica Vieira and recent PhD graduate Dr. Carolina Villanueva

Description: This study investigates how the association between residential location and ovarian cancer-specific survival in California varies by race/ethnicity and socioeconomic status. Learn more >>
Title: A stratified generalized additive model and permutation test for temporal heterogeneity of smoothed bivariate spatial effects

PI: Dr. Veronica Vieira and recent PhD graduate Dr. Yannan Tang

Description: Generalized additive models (GAMs) with bivariate smoothers are frequently used to map geographic disease risks in epidemiology studies. This study estimates time-specific spatial risk patterns of patent ductus arteriosus (PDA) by accommodating time-stratified smoothers into the GAM framework while borrowing information from confounding effects across time. Learn more >>
Title: Emotional approach coping among young adult cancer survivors: Relationships with psychological distress, post traumatic growth, and resilience

PI: Dr. Michael A. Hoyt

Description: Cancer, particularly during young adulthood, can evoke difficult emotions, interfere with normative developmental activities, and challenge coping responses. This study examines relationships of emotional processing (EP) and emotional expression (EE) with psychological distress, posttraumatic growth (PTG), and resilience. Learn more >>
Title: Comparative effectiveness of technical and regulatory innovations to reduce the burden of electronic waste

PI: Dr. Oladele Ogunseitan

Description: Waste Electrical and Electronic Equipment (WEEE) contain toxic metals and organic compounds, posing significant threats to human health and environmental quality. To disentangle the relative impacts of these influences in protecting health and environment, this study investigated 13 WEEE and 14 components and analyzed Waste Mobile Phones (WMPs) and Waste Printed Circuit Boards (WPCBs) to identify trends of toxic chemicals and potential adverse impacts associated with technological configurations and regulatory policies. Learn more >>
UCI BioSci Dean's Distinguished Lecture Series: COVID-19 -- Moving Beyond the Pandemic

Thursday, Feb. 4 // 4:00 p.m. - 5:30 p.m.

Esteemed biologists, researchers, and scholars -- including our very own Dr. Andrew Noymer -- will discuss developments in their areas of expertise and findings in the battle against COVID-19.

Innovations in Online and Digital Education Speaker Series: Diversity, Equity, and Inclusion Online

Friday, Feb. 5 // 12:00 p.m. - 1:00 p.m.

How are UC faculty and staff supporting diversity, equity and inclusion in their online courses? What are effective strategies to help students feel welcome in courses during the pandemic? Hosted by the Innovative Learning Technology Initiative, this webinar features instructors, including the Program in Public Health's Dr. Dele Ogunseitan, from three different campuses discussing their experiences in 2020–21. 
Emy Armanus

Undergraduate Public Health student Emy Armanus was recently featured in a New York Times article for her work as part of the National Summer Undergraduate Research Program (NSURP), which matches students to over 150 mentors with expertise in microbiology. As a a member of the program, Emy spent the summer investigating how the use of nicotine products can worsen cases of COVID-19. 
Malak Kudaimi

Malak Kudaimi, an alumna of our undergraduate program, was recently awarded the Marshall Scholarship. Recipients of this prestigious scholarship are selected for academic excellence and leadership potential.

Malak is now a staff member at the UCI FRESH Basic Needs Hub where she plays an essential role in promoting equitable access to basic needs -- like food and housing security -- on campus and beyond.
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