UC Merced Magazine | Volume XVIII, Issue IV

MAGAZINE

A Swift Response TO COVID Continues to Benefit Community

Fall/Winter 2023-24

Volume XVII, Issue 4

Chancellor Juan Sánchez Muñoz met with leaders from UCSF Fresno and UCSF, including UCSF Chancellor Sam Hawgood, as part of the planning phases for the new medical education pathway for UC Merced students.

MESSAGE FROM THE CHANCELLOR O ne of the main reasons UC Merced was located here is to improve the lives of Central Valley residents. When you know more about the health-related research and programs our faculty members and students are participating in, you will see us ful lling that mission. It can take time for the fruits of research to be realized, but this issue’s cover story demonstrates that sometimes research takes immediate — and lifesaving — e ect. From health equity and better understanding the needs of families with chronically ill children to Valley fever, diabetes and HIV prevention, our researchers are touching countless lives while also training the next generations of health care professionals. We also have a critically important new program in medical education: the SJV PRIME+ B.S. to M.D. pathway, through which students can prepare to attend medical school a er earning their bachelor of science degrees. You likely remember our participation in SJV PRIME, in which our students could attend a tailored track at UCSF’s medical school speci cally designed to address the physician shortage in the Valley. SJV PRIME was designed for medical students who are committed to ensuring high-quality, culturally appropriate, and accessible medical care to improve health for individuals and communities in the Valley. e PRIME+ pathway is still a partnership between UC Merced, UCSF Fresno and UCSF, and still has the same goals, but a new roster of classes will ful ll more pre-med requirements. Applicants to this competitive program must demonstrate deep ties to the Valley and an intent to practice in the region. We are working toward constructing a new medical education building, but students at UC Merced can already begin their journeys toward becoming doctors, nurses, physician’s assistants and other health care providers right here at home. Fiat Lux, Juan Sánchez Muñoz, Ph.D. Chancellor

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ON THE COVER: Jose Lopez, LVN, a member of Golden Valley Health Centers’ Street Medicine Team, provided COVID vaccines at a Merced flea/farmers’ market earlier this year.

MAGAZINE

Fall/Winter 2023-24 Volume XVII, Issue 4

In this Issue:

Chancellor Juan Sánchez Muñoz Vice Chancellor/ Chief External Relations Officer E. Edw. Klotzbier Assistant Vice Chancellor and Senior Advisor, External Relations Danielle Armedilla

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Nicotine and Cannabis Policy Center Eyes Smokers, Lawmakers Immigration Enforcement is Bad for Health Alumni Improving Valley Healthcare Take a Deep Breath: Stress-relieving Information and Tips University Launches New Medical Education Pathway

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Editor Senior Writer and Public Information Officer Lorena Anderson Writers Barbara Anderson Jim Chiavelli Francesca Dinglasan

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Patty Guerra Jody Murray Brenda Ortiz Sam Yniguez

Cannabinoids may help medical conditions.

Photographers Veronica Adrover Melvin Diaz Alfaro Jaylan Catacutan Claudia Corchado

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Cover Story: Promotoras Crucial to Vaccine E ort Childhood Diabetes Management Gets a Psychological Evaluation

Josue Herrera Roger J. Wyan Sam Yniguez Helen Zheng Elena Zhukova

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Graphics / Design / Printing Chris Abrescy Elizabeth Lippincott Colemar Design Dumont Printing, Fresno Mailing Address UC Merced External Relations 5200 Lake Road Merced CA 95343

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Catch Up on Health Research Projects

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Basketball Championships Coming to Campus for the First Time

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Every effort has been made to contact copyright holders of any material printed in this magazine. Any omissions will be righted in subsequent issues if notice is given to the editors.

Health information available at Merced flea/farmers’ market.

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Nicotine and Cannabis Center Working to Make Inroads Among Smokers, Policymakers By Sam Yniguez As the new director of UC Merced’s Nicotine and Cannabis Policy Center (NCPC), Project Scientist Arturo Durazo has his work cut out for him. Previous Director Professor Anna Song, who led the center for its first five years of existence and is now taking on an advisory role, believes he’s the man for the job. And while some of the internal operations may be changing, Durazo and Song both stress that the mission of the NCPC remains the same: to support tobacco control in this region and be part of California’s Endgame initiative to end tobacco use in the state by 2035. “We are very fortunate to have someone of Arturo’s caliber taking the reins,” said Song, who has assumed the role of the

university’s interim associate vice provost for Academic Personnel. “We have worked very closely over the years, and I am supremely confident in his ability to lead the NCPC as it transitions into its next phase.” That next phase involves securing funding for renewal – which would allow the researchers to continue the work that started in 2018 – and creating a strategic plan to disseminate all the data that has been accumulated over the years. “The long-term goal is to leverage all of the data that we have as well as the relationships we’ve established,” said Durazo. “There’s a network now that’s been created to effect change and what I’ve been working on is a systematic plan of attack.” The NCPC’s mission is a heavy lift in the San Joaquin Valley, an area Song and Durazo agreed is greatly underserved and under-resourced. “We’re in a health-professional desert,” said Song. “And because we don’t have a lot of health professionals, cessation clinics and support are way down the list in terms of priorities.”

Passivity and Silos Lack of infrastructure, Song said, is behind the high smoking prevalence rates in the Central Valley (18-19%) relative to coastal regions (4-5%). She also cited a tendency for others in the field to “work in silos.” The NCPC plans to use its network to knock those walls down. The center also plans to use its advocacy army to catalyze a movement aimed at breaking through the passivity that Durazo said is prevalent in Valley city halls on this issue, despite the well-documented harmful effects of tobacco. “Because it’s not illegal to smoke or sell, there’s a general laissez-faire attitude across the Valley,” said Durazo. “Also, elected leaders don’t want to be seen as anti-business, so it’s put on the back burner.”

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Lab Studies How Cannabis Might Mitigate High Blood Pressure, Heart Disease By Sam Yniguez When the national movement to legalize marijuana started gaining traction in the late ’90s and early 2000s, it caught the attention of Department of Molecular and Cell Biology Professor Rudy M. Ortiz, who began looking into how it could fit with his own research. Ortiz’s lab focuses on metabolism and how it is affected by different interventions, both pathological and physiological. Due to restrictions and limitations placed on cannabis research at the time, the pitch for his work – specifically with cannabidiol (CBD), which is one of the non-psychoactive chemical compounds (cannabinoids), found within cannabis – was based on data only available outside the United States. Those studies showed that cannabinoids had benefits in regulating metabolism and were behind the initial grant Ortiz received to delve further. “While we have found that there are greater benefits than detriments, we haven’t gone through all of the data,” said Ortiz. “And I think that if we are going to research CBD, we have a duty to identify what both the pros and cons are. This goes back to the Nicotine and Cannabis Policy Center’s mission of helping disseminate the information to help with policy.” The Nicotine and Cannabis Policy Center (NCPC), part of the Health Sciences Research Institute (HSRI), works to gather, understand and promote the thoughts and feelings of rural California residents on current tobacco and cannabis policy. Among the findings is the mitigating effect CBD has on hypertension, which is one of the risk factors that can lead to a condition known as metabolic syndrome and, ultimately, cardiovascular disease – the leading cause of death in the country. Early results have been promising, but Ortiz stressed that even though the studies began in 2018, they are still very much a works in progress.

Next-Generation Advocates

To make this issue a priority among policymakers, Song urges people to show up at council meetings as well as the polls. Her experience and previous successes have proven that consistency is key to getting traction and that it will take a multi-pronged approach. One of those prongs involves a new program that trains undergrads to be tobacco control advocates. rough a partnership with CSU Stanislaus and Fresno State, faculty on all three campuses arm students with empirical data and then strategically place them in commu nities. In its second year, the program is already bearing fruit. “Our inaugural class is doing amazing things with some already working in public health,” said Song. “Others have gotten into top-tier graduate programs, and they tell me they aren’t done. ey want to get their Ph.D.s and are planning to come back and serve the Valley.” is program highlights the grassroots approach the NCPC has taken since the beginning and underscores the progress it has made in a relatively short amount of time. By working side-by-side and in the trenches with community advocates, the center became very familiar with the challenges they faced, including the need for the next generation of advocates to carry on when the current ones retire. Now there will be a fresh crop hitting the streets every year, thanks to the campus mentorship program. “A big reason why we have been success ful is our approach,” said Durazo. “We aren't outsiders coming in with an agenda. For several years now, we have built trust within communities and with leaders and organizations through the work we have done together.”

Ortiz’s research showed that, if caught early on, treatment could greatly reduce and sometimes completely ameliorate hypertension.

Ortiz is in the process of publishing his papers, applying for patents and securing another grant to further this work, which would include clinical trials. He said that, as regulations and the stigma surrounding cannabis continue to lift and as more funding becomes available, future studies will help people and policymakers better understand cannabis’s value.

“I wasn’t always interested in cannabis research, but I jumped on the bandwagon at the right time,” said Ortiz. “Now that we’re actually studying it and generating a lot of positive data, I’m interested to see what else we can do to contribute to that arena. I’m hopeful.”

Professor Rudy M. Ortiz

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Researchers Say Immigration Enforcement In California is Detrimental to Public Health

Professor Maria-Elena Young

By Alyssa Johanson California is known across the world for having some of the most welcoming policies for immigrants. But despite calling itself a sanctuary state, research conducted by UC Merced and UCLA shows California immigration enforcement is harming the health of many of the state’s Latino and Asian immigrants. UC Merced public health Professor Maria-Elena Young said while they may appear to be completely unrelated issues, immigration enforcement policies and people’s physical and mental health are indeed linked. “We found that having contact with the immigration enforcement system is bad for people’s health,” she said. From 2018-2020, Young and colleagues at UCLA surveyed 2,000

foreign-born adults —1,000 Latino and 1,000 Asian — across California. Surveys asked about direct and indirect contact with immigration enforcement as well as about each participant’s physical and mental health. Questions included whether a person had been racially profiled, seen immigration authorities in their neighborhood, knew someone deported or had been deported themselves. Those responses were linked with each individual’s health outcome data. Self-rated health (SRH) was the measure used to gather information from respondents. According to the National Institutes of Health, SRH is commonly used in psychological research, clinical settings and in general population surveys. Respondents rated their health as excellent, very good, good, fair or poor.

Analysis revealed three major findings: People had higher levels of psychological distress, were more likely to report worse health and would be more likely to delay needed medical care the more contact they had with immigration enforcement. “It’s a pretty solid base of evidence that when the enforcement system has direct impact on people’s lives, there are immediate harms to their well-being,” said Young. The research showed that Latino participants had overall higher levels of exposure to immigration enforcement — 50 percent of all Latino respondents knew somebody who had been deported, compared with 12 percent among Asians. However, when analyzing the health outcomes, there was no difference between the two racial groups.

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“We found that having contact with the immigration enforcement system is bad for people’s health”

“If a person knew somebody who had been deported, it doesn’t matter their race or ethnicity,” said Young. “That is a risk for psychological distress. It’s a risk for reporting worse health.” According to the study, 65% of those surveyed felt that they would be prevented from gaining legal U.S. immigration status if they used government benefits such as income assistance, health care, food programs and housing aid. Young said a significant takeaway was that responses varied substantially, by region. Immigrants in the San Joaquin Valley immigrants in the Bay Area or in Los Angeles/Southern California. In the San Joaquin Valley, immigrants were five times more likely to see had higher rates of negative experiences compared with

immigration enforcement authorities in their neighborhood compared to those in the Bay Area neighborhoods. Compared to immigrants in Los Angeles/Southern California, twice as many in the San Joaquin Valley reported being watched by law enforcement. Young said she hopes the research findings establish evidence that the enforcement system is harmful to health and serve as information to policymakers. “If they endorse policies that expand or permit enforcement, there are going to be negative repercussions to the well-being of Californians,” she said. Because results showed that immigrant experiences differed by region, Young has concluded that there are inconsistencies with

enforcement in different locations. She is now working to understand what is leading to the geographical discrepancies. This research consists of interviews with service providers, healthcare providers and those responsible for bringing social services to immigrants. Young is asking why people feel safer despite sanctuary-state policies in California. “Recent reports indicate that California’s policies to disentangle local law enforcement and federal immigration enforcement have been inconsistently implemented across regions, with some local law enforcement agencies continuing to collaborate with immigration enforcement authorities,” said Young. “It is critical to ensure that the policies California has enacted to protect immigrants from immigration enforcement provide protection across all regions and immigrant groups.”

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Profiles in Giving Back Many UC Merced graduates have gone on to careers in health care. Here are two who didn’t just enter the medical field but chose to give back by practicing in the San Joaquin Valley.

By Jody Murray

Dr. Zi Wang (’11) Neurologist, Memorial Medical Center, Modesto Background: Wang was born in China and immigrated to the United States at age 3. His grade school years started in San Francisco and continued in Castro Valley, where he graduated from Castro Valley High.

Dr. Maricela Rangel-Garcia (’09) Gastroenterologist and hepatologist, UCSF Fresno Background: Born in Selma and raised in Clovis, Rangel-Garcia is a third-generation Mexican

American. She has been a folklorico dancer since age 3. When she was a child, Rangel-Garcia’s primary care physician was Dr. Katherine Flores, now director of UCSF Fresno’s Latino Center for Medical Education. Both of her parents work in the mental health field. Being a Bobcat: In the early ’00s, when Rangel-Garcia was in high school, her father drove her to the UC Merced construction site. “There was nothing out there,” she said. “Some foundations, but no buildings.” Dad made a strong pitch — it’s close to home but not too close, and it’s going to be an outstanding university, he said. She agreed. She enrolled at UC Merced figuring she would go into law, but an introduction to biology class turned her head. She was inspired by Professor Maria Pallavicini, the founding dean of the School of Natural Sciences who today is the provost at University of the Pacific. Rangel-Garcia changed her major to human biology. “From that point on, I never veered off the doctor pathway.” She joined the national Latino Medical Student Association and went to its pre-med conferences, accumulating knowledge and motivation. Medical education: Rangel-Garcia entered the San Joaquin Valley PRIME program and spent four years at UC Davis and UCSF Fresno. She completed her residency at UC Davis, followed by a gastroenterology fellowship at UC Irvine. Career: Rangel-Garcia works for the Central California Faculty Medical Group, which is affiliated with UCSF Fresno. Her duties include seeing patients from underserved communities who may have waited up to a year to see a gastrointestinal (GI) specialist. Rangel-Garcia also practices hepatology, which focuses on the liver, gall bladder and pancreas. “A big thing for me is the prevention of colon cancer,” she said. “It’s becoming more prevalent in the younger generation and it’s preventable.” She also has a private clinic and is on call for hospital cases. Quotable: “UC Merced was small, but you could create your own pathway. It pushed me out of my comfort zone and made me think outside the box. We all took a risk on UC Merced, and it paid off.”

Being a Bobcat: He enrolled at UC Merced in 2007, two years after the campus started offering undergraduate classes. He was a psychology major and a career in health care seemed possible but hardly definite. Then, in that first year, he took a job as a medical scribe at Memorial Medical Center in Modesto. He worked there for four years, lapping up knowledge and experiencing the living-preserving energy of an emergency room. How did he juggle classwork working two or three days a week at a job an hour from campus? “Basically,” he said, “I had no social life.” One of his UC Merced mentors, Professor Anna Song, taught a class on health disparities – something he witnessed at Memorial. “I saw a community very challenged with health access, primary doctors and specialists,” said Wang, who also served as a research assistant in Song’s lab. “I told myself I need come back after medical training and serve this community.” Medical education: Wang attended medical school at Temple University and did his residency – and the bulk of his training in neurology – at Yale University. He completed a fellowship in stroke vascular neurology at UCSF. Career: Wang performs most of his work at Modesto’s Memorial Medical Center. He is, by training, a vascular neurologist, focusing on blood-flow issues that involve the central nervous system, including stroke and brain hemorrhages. His attraction to neurology sounds much like why he chose UC Merced. “The brain remains the new frontier,” he said. “We’re at the very edge of developing new therapies, procedures and surgeries to care for patients with neurological disorders.” Quotable: “I’m someone who is attracted to the novel, to something that has big potential but is not quite there yet. UC Merced was that – a new campus in its infancy, but you could see a lot of big changes were going to happen. I was attracted to that.”

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Primed to Make a Difference Medical Education Collaboration SJV PRIME+ LV D %ROG 6WHS 8& &DPSXV /HDGHUV 6D\b

By Jody Murray, UC Merced, and Barbara Anderson, UCSF Fresno

A multi-campus UC collaboration aspires to jumpstart health care in the heart of California. “From the Valley and for the Valley,” Margo Vener, M.D., said in describing the program that recruits Central Valley high school students who express commitments to practice in the region. e students follow a pathway that starts with undergraduate medical education at UC Merced and continues through the UC San Francisco School of Medicine with clinical work at the UCSF Fresno campus. Vener leads the bachelor’s of science-to-M.D. (B.S.-to-M.D.) pathway as UCSF assistant dean and UC Merced director of undergraduate medical education. SJV PRIME+ includes a four-year baccalaureate component, leading into the UCSF Doctor of Medicine curriculum. All elements of the program, o ered through UC Merced and UCSF Fresno, focus on preparing a physician workforce to address communities’ unmet health and health care needs in the Valley. e rst B.S.-to-M.D. cohort of 15 students began instruction at UC Merced this fall. Due to numerous socio-economic and cultural pressures, access to health care is a struggle in the Valley. e region

has 130 physicians per 100,000 people, compared to 191 per 100,000 in all of California, according to a 2020 study by the Accreditation Council on Graduate Medical Education. e study also looked at what it called Health Professional Shortage Areas (HPSAs). Examples of a HPSA include low-income communities, homeless populations and groups of migrant farmworkers. In California, 28% of the population lives in an HPSA. In the Valley, the number soars to 92%. “We have huge health disparities, especially when you start looking at vulnerable communities, rural communities, communities of color,” said Dr. Kenny Banh, assistant dean for undergraduate medical education at UCSF Fresno. “Many people must be transferred out of the region, or they won’t receive care at all.” We talked to six leaders from the collaborating UC campuses about SJV PRIME+, about UC Merced’s expanded role in pre-medical education, and about the future of Valley health care and medical training. Here’s what we heard:

Chancellor Muñoz and Rufus the Bobcat with the first cohort of SJV PRIME+ students.

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Q

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How can the SJV PRIME+ medical education collaboration improve KHDOWK FDUH LQ WKH 6DQ -RDTXLQ 9DOOH\"b Vener: e Valley has the single biggest shortage of health professionals in the state. e goal of this program is to cultivate a diverse workforce of health care providers who are from the Valley, for the Valley. Nancy Burke, UC Merced professor of public health and anthropology: A mission of UC Merced is to impact this region economically in terms of health writ large – reducing health disparities, increasing access to care and health professionals. Describe some of the important features of the UC Merced pathway. Vener: We’ve added experiences to the traditional bachelor’s of science pathway to help learners get an early sense of what it means to be a health care professional. For instance, what does it really mean to take care of patients? How does one listen with compassion? Can they embrace the privilege – that grace – of being a young, healthy person taking care of someone who is older or sicker or struggling? ere’s a lot of identity formation. Also, physicians are reaching out to say, “I’d love to have a student volunteer.” We’re working to create an engaged cadre of clinicians in the community through which our students can rotate. Deborah Wiebe, professor of health psychology, faculty director of UC Merced Health Sciences Research Institute: Nearly a third of the UC Merced faculty are interested in health science issues. ey came here because they are interested in the complex health issues our region faces.

Why has it been difficult to improve physician-to-patient ratios in the Valley? How can SJV PRIME+ FKDQJH WKLV"b Wiebe: I think young people grew up in this region not viewing themselves as being able to address the problem. Having UC Merced in the region has started to change that. ese are individuals who want to be here, who have been exposed to the Valley’s health problem through their families and personal experiences. ey have seen the inequities, but also how they can be part of that solution. Banh: e San Joaquin Valley has the lowest per-capita amount of primary care and specialty physicians in California. San Francisco, for example, has more than two and a half times that amount. e gap is immense. Consequently, there aren’t enough doctors to perform surgeries, so patients are forced to travel to larger cities to receive care, which is tough to do with limited income and transportation options. On top of that, many people in underserved populations are uninsured or on Medicare.

We hope students enrolled in SJV PRIME+ will practice medicine in the Valley, but there’s no guarantee of that. How does the program SJV PRIME+ counter the attraction of bigger opportunities and larger FRPSHQVDWLRQ RXWVLGH WKH 9DOOH\"b Dr. Loren Alving, SJV PRIME director, professor of neurology at UCSF Fresno: Research shows that the best predictors of where a person ends up practicing is where they were trained and where they grew up. Keeping them here is hugely important. By combining the two, we increase the likelihood students will remain in the Valley to practice. Vener: When we interviewed candidates for our rst cohort, the rst thing we asked was, ‘Why are you interested in being a physician for your community?” eir answers went right to the core of what matters. “I want to be the rst health care provider from my family.” “Because my family come to this country as immigrants and didn’t have health insurance.” “I want to be a role model for people who look like me.”

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Campus Gets the Go-ahead for Med Ed Building At their Nov. 15 meeting, the University of California Board of Regents gave final approval for the construction of a new medical education building at UC Merced. The four-story building, designed by the firm ZGF, will have 203,500 square feet of instructional, academic office, research and community facing space and common areas. The project has a price tag of $300 million, with funding coming from a combination of State General Fund appropriations — pledged by Gov. Gavin Newsom in a campus press conference in October 2021 — campus budget and donor gifts. “We are very pleased by the regents’ show of support for medical education at UC Merced,” said UC Merced Chancellor Juan Sánchez Muñoz. “The lack of quality healthcare options in the region is well-documented, and this new building will enable UC Merced to train physicians uniquely qualified to address the Valley’s health needs.” The new facility will be home to UC Merced’s medical education program, which was developed in partnership with UCSF and UCSF Fresno and had its first cohort of students begin classes this fall. It will also house: • The Departments of Psychological Sciences and Public Health • The Health Sciences Research Institute • Allied healthcare-related programs (developed in partnership with community colleges) • A range of medical education and general assignment learning environments • Specialty learning spaces for medical education, general assignment classrooms, and class laboratories to support several new and existing academic programs This project will comply with the University of California Sustainable Practices Policy, which establishes goals for green building, clean energy, transportation, climate protection, facilities operations, zero waste, procurement, food service and water systems. Supporting UC Merced’s carbon neutrality status, the building will be run entirely on clean electricity, without the use of natural gas. Construction is anticipated to begin in spring 2024 with completion slated for fall 2026. Current growth projections show the facility serving approximately 2,220 undergraduates by 2030. Read more about the Medical Education Building in the spring/summer 2024 of UC Merced Magazine.

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What do medical students learn from clinical rotations in an underserved FRPPXQLW\"b Wiebe: ey learn to develop trust with patients. Just prescribing medicine isn’t enough. ey need to make recommendations a patient can carry out in real life, in an underserved community. at’s the art of medicine. Vener: For trainees working in underserved settings, you really feel like you’re making a di erence.

What are your hopes and expectations IRU 6-9 35,0( "b

Dr. Peter Chin-Hong, associate dean of regional campuses, UCSF School of Medicine: We hope this will lead to getting not just the Valley’s brightest of the bright, but people who wouldn't have thought about medicine before, so we can make them the best physicians they can be for the communities they serve.

Banh: Most people don't understand how di erent we are. UCSF Fresno answered a need for graduate medical education in the Valley. UC Merced is the newest UC on the block. On one end are graduating internists and surgeons. On the other are undergrads and grad students. SJV PRIME+ is building a bridge between them. Vener: My goal for this is that eventually some medical professional out there in, I don’t know, say Bakers eld, says to a young person, “Oh, you’re interested in health care? I hear UC Merced has a strong pathway to a professional career.”

How can Valley communities and patients benefit from physicians with Valley roots? Burke: ey are acutely aware of issues common to their community. For instance, a number of my students, when they were younger, served as interpreters at medical appointments. ey talk about how the doctors would o en leave their parents or grandparents out of the discussion because they didn’t speak English, and how demeaning that was. So, somebody who comes in with that knowledge will know how to work with an interpreter appropriately.

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Quick Response, Teamwork Gets immunizations and health information to Underserved People Vaccinating the Valley

Cover Story

A nurse prepares vaccines while promotoras gather health information to be shared at the Merced flea/farmers’ market at the Merced County Fairgrounds.

By Patty Guerra Most people in the area’s

“ ey wanted to channel funds to the areas hardest-hit by COVID-19,” Burke said. “We responded to this call within two weeks with an 11-site proposal.” A consortium led by UCLA that included UC campuses in Merced, Davis, Riverside, Irvine and San Francisco, along with Scripps Health and Stanford University, worked together on the program. Burke collaborated with Cultiva la Salud in Merced, which has an active network of promotoras, or community health workers, Golden Valley Health Centers, a nonpro t health services provider, and the Merced County Department of Public Health to get vaccines and information where it needed to go the fastest. Promotoras are residents who work as liaisons between hard-to-reach community members and health care services. ey are o en able to gain the trust of people in the community and explain for lay people what health care providers are trying to do and why it is important. “ e start of the COVID-19 pandemic was a stressful time. We were working very hard to set up testing sites throughout the (San Joaquin) Valley, get information out to residents and protect the community,” said Stacey Kuzak, Golden Valley

underserved communities go to local ea markets and farmers markets to get necessary items and fresh food. ey don't go to get lifesaving vaccines. But that all changed when the COVID-19 pandemic hit in 2020. UC Merced public health Professor Nancy Burke has been part of a statewide e ort that worked swi ly to address inequitable access to information, education, testing and vaccines, through a grant from the National Institutes of Health (NIH). e award, part of the NIH Community Engaged Alliance Against COVID-19 Disparities, was designed to support community-university partnerships that were poised to respond.

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Immediate and Ongoing It can take time for the vital work UC Merced researchers do to make its way into the community at large. But sometimes, the e ects are immediate and even lifesaving. In addition to providing more than 1,300 potentially lifesaving vaccinations and over 32,000 COVID-19 rapid tests, the pop-up events served another purpose: the building of relationships with a group of people who don’t regularly trust, or interact with, government o cials. “Our goal was establishing trust and providing education,” Kuzak said. “ e rst few ea market events we attended, we brought general information and GVHC outreach teams joined the nurses in chatting with people to gain their trust. Once they saw us there every week, the nurses started to have lines of people. People we met were thankful to see us there and appreciative.” Corchado said while the vaccinations and health information are vital, it was getting to know the people that made the project work. “It was a community we built at the ea market,” Corchado said. “ e vendor next to us sold speakers and he became our deejay, encouraging people to come get vaccinated. Other vendors would bring us something to drink. And toward the end, they’d ask, “Are you “ is was the beginning of a multi-year collaboration,” Burke said. e team has since distributed home tests and information about COVID and other issues, including extreme heat and water conservation. ey are at the ea market the last weekend of each month. “I’m truly grateful for what we’ve built,” Corchado said. “ ere is no doubt we helped save people’s lives.” coming back?’” Indeed, they are.

Health Centers’ director of nursing. “Our partnership with UC Merced was invaluable. We were brought in to administer COVID-19 vaccines to the students during the beginning of each quarter, and we worked with faculty and students to o er information as broadly as possible at di erent community gatherings — even at ea markets,” Kuzak said. Information and Access It wasn’t just about getting shots into arms. “We wanted to address inequities in access to information,” Burke said. Much of what was available early on was in English or required navigating websites to access. “We went into communities that hadn’t been a part of rollouts, that didn’t have major testing sites or vaccination events.” At Cultiva la Salud, the sta quickly realized that even when information and vaccines were available, they weren’t easily accessible to many of the people the organization serves. “ e system to access vaccinations was not created to support our most vulnerable community,” said program Director Claudia Corchado. ere were people who didn’t have access to vaccines via the system and others who didn’t trust entering their information into it. “It was a huge challenge to our community residents, especially to our elders and immigrant residents.” “We were honored Nancy Burke reached out to partner in this endeavor and to establish a system built on trust to serve our community residents most in need,” she said. “We knew we were going to be able to create a delivery system that would bring services directly to the most vulnerable.” e team quickly homed in on the idea of creating pop-up vaccine clinics at the Merced and Atwater ea and farmers markets. ese markets are a vital source of food and goods for many in the underserved communities around Merced and Atwater.

“Where can we go where people are already there? And where we think people will come back for the booster?” Burke said. ey started with outreach to the vendors selling at the ea markets. ese are people who are considered essential workers — many of them farmworkers and small-scale farmers — and who would be back at the market for booster shots simply because their livelihoods depended on it. e student volunteers and promotoras got creative in getting the vaccines into arms.

Some vendors were the sole workers at their booths, so promotoras took over for them brie y while they visited the vaccine booth. When even that wasn’t feasible, the group put together a cart and went from vendor to vendor to provide the vaccines. “We made it personal and built a sense of family,” Corchado said. “Elders would pull up chairs and chitchat. We would hold their hands if they needed comforting, provide encouragement and earn their trust. I don’t think they would have gotten that at drive-up pharmacies.”

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UC Merced Project Scientist Rosa Manzo, Ph.D. (center) with Camarena Health’s Claudia Fabian Chavez (left) and Maria Meraz (right)

Genentech Grant Supports New UC Merced Center for Health Equity By Francesca Dinglasan UC Merced was recently awarded a signi cant grant from Genentech, a member of the Roche group, to create the UC Merced Center for Health Equity. e initiative will focus on eliminating health disparities and advancing health equity throughout the San Joaquin Valley, particularly among the region’s Hispanic, Latinx, immigrant and rural communities. Led by Principal Investigator and Project Scientist Rosa Manzo, Ph.D., the Center will implement a community-engaged collaboration model that aims to facilitate and improve communication and engagement among health professionals and the communities they serve. rough the support of the $1 million grant, the Center will invest in training and promoting community health workers – or promotoras – who will not only assist in addressing cultural gaps and understanding between patients and health care providers but will also participate as co-researchers and policy advocates for issues related to local health disparities.

Manzo and her team are launching the promotora- and community-based education model in Merced, Tulare and Madera counties in conjunction with agency partners Kaweah Health, Golden Valley Health Centers and Camarena Health. Together, the partners are preparing volunteers and agency sta members to ll the roles of community health workers by training them in such core competencies as service coordination and navigation, outreach, public health principles and social determinants of health. Manzo said the uniqueness of this model is that promotoras will have the opportunity to directly assist with research e orts on projects of interest to them. rough their status as UC Merced a liates, they will have access to training and resources that enable them to participate in various research activities, including data collection and analysis, survey administration, and Spanish-language feedback and input. “ ere are a handful of these models, which are mostly centered around outreach and engagement e orts,” said Manzo. “Our promotoras will be involved in data dissemination, research design and research materials. ey are participating as researchers and contributing to every aspect of the research process.”

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“ e cultural element o ered by the promotoras is critically important,” added UC Merced Health Sciences Research Institute Executive Director Trevor Hirst. “ ey are a ecting their communities because the way they communicate is di erent, and that is bringing the community up as a whole.” Camarena Health Community Engagement Manager Claudia Chavez has observed the positive e ects of the work for both the volunteers and the community members. “ e project not only empowers the promotoras with the tools and resources to help people in their communities, but also makes a tremendous impact on the participants’ lives in managing their health conditions,” she said. “To be able to watch promotoras share their stories of the impact they have made on participants’ lives is immeasurable.”

is latest grant from Genentech is a continuation of its commitment to Manzo’s community-engaged research, with a prior grant contributing support to her project “Promotoras and Community Based Education.” at grant, totaling nearly $500,000, provided funding for the initiative that paired community health workers and medical students in the UCSF San Joaquin Valley Program in Medical Education (SJV PRIME) to address asthma-related health disparities and deliver asthma-management education to the Valley’s underserved populations. Maria Meraz, who participated in the initial project and will continue serving as the lead promotora at Camarena Health, noted the impact of the work on the local community. “It was satisfying to know that this collaboration allowed us to bring information to minority communities,” she said. “ e comments we received

were positive, and people were happy to receive education from promotoras because they inspired con dence.” “We are deeply grateful to Genentech for its exceptional investment in UC Merced and Manzo’s work to address health inequities by promoting community health workers whose cultural and linguistic competencies help engage the diverse individuals and families of our region,” said UC Merced Vice Chancellor and Chief External Relations O cer E. Edward Klotzbier. “We look forward to nding new opportunities for collaboration that build on and further grow these important e orts.” Genentech’s $1 million grant is among the pivotal philanthropic gi s that are advancing Boldly Forward: e Campaign for UC Merced. Boldly Forward aims to raise $200 million over the next decade, with gi s and pledges received since the campaign's launch nearing $100 million.

The promotoras have played a crucial role in increasing the number of people in Merced County who got COVID vaccines and in sharing important health information with people who might not otherwise have access.

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By Brenda Ortiz

For the past 20 years, more than a decade of those at UC Merced, health psychology Professor Deborah Wiebe has been researching how family relationships of children with chronic illnesses, especially parent-child relationships, play a role in preventing and managing chronic diseases. “Broadly, my research is to understand how people cope with chronic disease, and to use this information to help individuals and families better manage their illness,” said Wiebe, director of the campus’s Health Sciences Research Institute. “Diabetes and other chronic diseases are more prevalent and progress more rapidly in the Central Valley region, so the work we do has important implications for our communities.” Recently, her work in the Department of Psychological Sciences has focused on understanding how children, families and healthcare professionals work together to manage Type 1 diabetes, a chronic metabolic disease, from adolescence into adulthood. “My prior research shows that social relationships — especially family relationships — matter for diabetes management. Getting support and having people involved in helpful ways related to the day-to-day grind of diabetes is crucial,” she said. Wiebe’s lab is testing an intervention originally designed for adults with Type 2 diabetes by her collaborator, Professor Lindsey Mayberry at Vanderbilt University in Tennessee. Wiebe’s research team has adapted the intervention to young

people with Type 1 diabetes because previous studies show that the worst time across the entire lifespan for managing Type 1 diabetes is 18 to 24 years old — what they call emerging adulthood. “Our data suggest that a major reason is that they're leaving home, entering new social situations at work and school, and the support they had experienced from family and friends is changing. Young adults may wish to keep diabetes private, so new peers may not know they have diabetes or how to be helpful, or may unintentionally be unhelpful,” she explained. “At the same time, emerging adults are still developing the self-regulation skills necessary to manage their illness independently.” ey recruited their rst participant for the 5-year study, funded by the National Institutes of Health, in April, and plan to have 280 participants, half in California and half in Utah, where Wiebe is working with a long-time collaborator at the University of Utah. Participants are randomized into either the control group or the intervention group. Each member of the intervention group meets remotely with a counselor monthly to set and prioritize diabetes goals, as well as to develop skills to optimize social relationships to achieve those goals. ey also receive text messages to facilitate goal attainment and the helpful involvement of others. Participants can also invite a support person to receive text messages to encourage dialogue and help the participant stay on track. (Continued on page 16)

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Americans under age 20 are estimated to have diagnosed diabetes

Americans are diagnosed with diabetes every year

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“We get blood samples to index blood sugar levels,” Wiebe said. “We also measure self-reported self-care behaviors, as well as diabetes distress, a measure that captures feeling frustrated or overwhelmed by diabetes. Diabetes distress is an important variable because it can turn into depression if symptoms last for too long.” Turning Illness into Passion At age 13, Aislinn Beam was diagnosed with Type 1 diabetes. “My mom always came to my doctor’s appointments; I was learning how to give myself injections and things like that,” the Orange County native said. “We shared the responsibility instead of it primarily being on one of us.” When she was learning more about diabetes, she found that much of the research was not easily accessible, especially to an adolescent. “I wanted nd a way to change that,” Beam said. Years later, she graduated from UC Irvine with a bachelor’s degree in comparative literature and worked as an applied behavior analysis (ABA) therapy behavioral interventionist. She said that sparked her interest in psychology research. Beam decided to pursue graduate studies at UC Merced a er learning about Wiebe’s health psychology research focus. She joined the lab in 2018. Her research centers on insulin restriction — when a person with diabetes who needs to be taking insulin does not, for whatever reason. Beam is examining how parents’ involvement may prevent or reduce this risky behavior during emerging adulthood. Beam was part of the pilot study Wiebe’s team completed in 2020-21 to determine if the intervention was feasible. Beam conducted exit interviews and qualitatively coded the interviews to gauge how participants felt about their experience. “Aislinn was heavily involved in helping translate the original intervention to the young adult Type 1 diabetes population,” Wiebe said. “She has been crucial in giving us a perspective from a patient’s viewpoint.” Beam said she is proud to be part of the Wiebe lab because she knows rsthand what it is like trying to gure out diabetes management in her early 20s and she hopes this research can help someone who's going through that. “I have done what I set out to do as a Ph.D. student — contribute to the research and knowledge about what we can do for people who are struggling with Type 1 diabetes,

especially in emerging adulthood when it is such a hard time for diabetes management,” she said. Seventeen years a er her initial diagnosis, she is slated to earn her doctoral degree in Psychological Sciences in December. “I would like to continue to contribute in some way to help young people with chronic illnesses — adding more knowledge that could help with future interventions or working at a company that is trying to help people with chronic illnesses by providing better technologies for disease management.” Beam said. Examining Culture and Communications Another aspect of Wiebe’s research is examining how sociocultural factors, including socioeconomic status, cultural beliefs and race/ethnicity a ect how young people and their families manage diabetes. Developmental Psychology Professor Alexandra Main, who studies child and adolescent development, started a study in collaboration with Wiebe, Health Psychology Professor Linda Cameron and others, on family diabetes communication a decade ago when Main was a postdoctoral scholar in Wiebe’s lab. Main joined the UC Merced faculty in 2014 and led a study focused on Latinx families who have an adolescent with diabetes. e research team viewed recorded interactions between parents and adolescent participants from Valley Children’s Hospital in Madera and Children's Hospital Los Angeles (CHLA), two diabetes clinics that have large Latinx patient populations, to examine Latinx cultural values and parent-child communications around diabetes. Most of the study’s participants are from underresourced backgrounds or lower-income families, Main said, which could make their ndings highly signi cant for many communities in the Valley.

A graduate student helps analyze family dynamics by coding certain behaviors on a video of family interactions.

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