Living Donor Program From Keck Medicine of USC Is a Win-Win

To save her brother’s life, Elizabeth is getting in shape.

The 38-year-old Kern County, California, resident, whose last name is not being used to ensure the family’s privacy, changed her cooking and her workout routines and has dropped 32 pounds since September 2020. Keck Medicine of USC physicians told her she would be an ideal kidney donor for her older brother–if it weren’t for her weight, which put her out of range to donate safely.

Her transformation was aided by a donor wellness program launched last year by the USC Transplant Institute. Transplant surgeons realized that as many as a third of living donors were turned away because they didn’t meet the necessary health requirements. The donor wellness program aims to solve two problems: increase the pool of available living donors while also improving the donor’s own health and well-being.

The program is one part of the university’s effort to improve organ transplant outcomes. From helping potential donors get healthy to examining racial disparities to protecting patients from COVID-19, Keck Medicine physicians are searching for more and better ways to keep both donors and recipients healthy and active.

A Game Plan for Success

Elizabeth’s journey began because she wanted to help her brother, who had been on dialysis for several years. He is the third of the six siblings; Elizabeth is the fifth.

The siblings agreed Elizabeth was the best candidate. For one thing, she had one child, a teenage daughter, and didn’t plan to have more.

But USC’s transplant coordinators told her that she would have to lose at least 20 pounds to qualify as a viable donor. She dieted and worked out as many as five times a week, but after a year, lab tests showed she was still 10 pounds over the target weight.

That’s when Elizabeth was introduced to Susan Kim, a nurse and clinical nutrition and wellness manager. Kim headed up the newly launched donor wellness program, and Elizabeth became one of its first participants. Kim knew she was already working out and counting calories, so she started talking about nutrition.

For example, Elizabeth liked to snack on flavored yogurt. Kim advised her to look at the label and see how much added sugar it had. The numbers startled her. “I was like, ‘Wait, I was eating this?'”

Kim suggested she switch to plain Greek yogurt and add fresh fruit. “Less sugar, less calories, but you get the same result,” Elizabeth says. “Small changes like that.”

The small changes added up, and the pounds started to drop off.

When Demand Exceeds Supply

Elizabeth’s success is part of the vision of the living donor program–an initiative born of frustration.

Southern California is one of the most difficult places in the nation to live if you need a new liver or kidney.

Aaron Ahearn

Southern California is one of the most difficult places in the nation to live if you need a new liver or kidney, says Aaron Ahearn, associate director of the liver transplantation program at Keck Medicine of USC. That’s partly because of good trends: A healthier population means fewer people collapsing and dying of heart attacks or strokes, which frees up organs for donation. On the other hand, the large metro area also includes many residents whose health is declining, often the result of living for decades in impoverished and underserved neighborhoods. “You essentially have to be in the ICU in multi-organ failure before you can get a liver transplant,” Ahearn says.

One solution to this dilemma is living organ donor transplantation. Keck Medicine has one of the few living donor programs in Southern California, but surgeons were turning away about 30% of candidates.

“We realized it was a problem on both sides,” he says. “The donors were at higher risk of developing their own diseases due to the health consequences of being overweight. And the recipients were in desperate need of an organ. This was an opportunity to improve everyone’s health.”

Saving Lives and Saving Money

It turned out that not only was a donor wellness program “good karma,” as Ahearn puts it, but it also made good financial sense. If a patient couldn’t get a living donor transplant, she would have to wait until she was deathly ill to get one from a deceased donor. The cost of caring for her in the ICU while she awaited that transplant and later recovered was greater than offering free services to potential living donors, he says.

Besides nutrition counseling, the donor wellness program offers participants personalized meal plans and help with time and stress management from occupational therapists. A welcome packet includes a bathroom scale, a blood pressure monitor and a step-tracking watch. “You want to make it all as easy as possible, as manageable as possible,” Kim says.

Addressing Health Inequities

Keck Medicine also took a hard look at its own team and began examining its own structural biases.

After news reports of racial disparities in kidney transplants, Jim Kim, a surgeon at Keck Medicine specializing in organ transplants, worked with his team to review how they calculated kidney function for patients.

We no longer use equations that take race into account.

Susan Kim

They were surprised to realize that the equations they used contained racial biases. These were the same equations used for decades around the country, but Black patients didn’t qualify for transplants until they were at a more advanced state of kidney disease than white patients, he says.

Keck Medicine decided to eliminate those calculations from its system. “We’ve rectified that,” Kim says. “We’re no longer using any of these equations that take race into account.”

Taking Cover from COVID

The coronavirus threw a wrench into the transplant program when it landed in the U.S. in 2020, particularly when a bad COVID-19 wave hit Southern California in November and December of that year.

Ahearn started getting calls from transplant patients who tested positive. Because their immune systems were suppressed, they had a high mortality rate. “We realized COVID was devastating for our recipients, and we needed to do something to retard disease progression,” he says.

Ahearn and his team built a system on the fly. The kidney and liver transplant programs set up regular telemedicine visits, sent patients pulse oximeters to measure oxygen levels and heart rates and provided monoclonal antibody infusions to fight the first signs of disease.

As a result, coronavirus hospitalizations for USC transplant recipients dropped from 54% to 35%, and deaths dropped to zero in a two-month period for transplant patients who received monoclonal antibody infusions.

“It was really important that our transplant patients be educated that their risk is different than the general population,” Ahearn says, “but there are things they could do to reduce their risk, so they needed to communicate with us.”

A Diet Overhaul

They asked me when would I be available to do the transplant. I told them, whenever my brother is ready, I’ll be ready.

Elizabeth

Communication has also been key for Elizabeth’s success. Regular telemedicine visits with Susan Kim helped the potential donor overhaul her diet and lose 12 more pounds. She’s now a fan of lentils and brown rice, vegetables and nuts. Her daughter has also embraced the changes to their meals, and her sisters-in-law ask her to share her new recipes. “This is a new lifestyle for me,” she says.

She is hopeful that at her next appointment, the transplant team will give her the green light to proceed with the donation.

“I just want to make my brother feel better,” she says. “They [the transplant team] asked me when would I be available to do the transplant. I told them, whenever my brother is ready, I’ll be ready.”

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Pivoting from tech to health care, Trojan finds new career success

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For online Executive Master of Health Administration (EMHA) student Diana Qi, health care was not a first love.

Early in her career, Qi, who is bilingual, had aspirations to pursue a position in overseas business, and she focused on marketing management and international business throughout her undergraduate studies.

While she went on to work in software marketing and sales development for more than a decade, a career break later inspired Qi to reconsider her life path.

“When I had my second son, I took a break and kind of reevaluated my career and thought about where I want to go and accomplish the next 10 or 20 years. So, I did a substantial amount of research, and as much as I love technology and I still do, I feel like there’s a lot more potential and room for growth and just so much to learn in health care. That’s when I started to research into shifting my career path,” Qi told USC Online.

That research included health care classes at a local university, consulting with different advisors and companies, and doing plenty of online exploration. Amidst this investigative phase, she was even hired at a local community hospital, which helped reinforce that health care administration was the correct next step for her. Eventually, Qi determined she would need additional education to succeed in her newfound passion, and she decided upon the online EMHA program as a top choice.

Offered by USC Sol Price School of Public Policy, the EMHA online program prepares students to become leaders who are tasked with transforming and improving the health care system. Graduates come away from the program with a deeper understanding of administrative initiatives and are equipped to breach the C-suite at hospitals, clinics and more.

Qi pointed to two essential parts of the program that helped make USC the right decision. It’s online and flexible, which is a must for a working professional — it’s allowed her to thrive in both her career and schoolwork at the same time. She also noted that USC’s stellar reputation played a big role in her decision to enter the program.

“It gives me peace of mind that I’m getting the best education … USC is by far one of the smartest choices I’ve ever made because not only does the criteria fit in terms of what I’m trying to learn about and capitalize in health care, but being in health care administration already, the master’s program really helps me accelerate the different type of goals that I wanted to accomplish. I definitely needed to get that education under my belt, and luckily, it worked out,” Qi, who is now working as the program and project coordinator at Stanford Health Care in Silicon Valley, explained.
When it comes to the EMHA classes and coursework — which focus on topics such as health information systems, quality of care concepts, and managing organizations’ financial health — Qi loves their discussion-based format, which encourages students to share their own experiences and opinions.

“It is just like one big family sitting around on Zoom discussing all these various issues that we face in health care, and then how we can exchange ideas and really find better ways or new ways to engage in health care to overcome these challenges,” she said.

Qi also pointed toward the professors as being a highlight of the master’s program. They act as mentors, she explained, providing students with the necessary guidance to become executive leaders in health care. They also, however, give students the room to take those pointers and chart their own paths. All in all, it’s an encouraging environment with plenty of room to grow and experiment.

“I feel like one of the most influential factors that I really appreciate about USC is the fact that the classes are really respectful. You could be new in health care, or you could be this executive in health care. USC cultivates each one of us to think in our own right, to think for ourselves, to kind of understand that you need to do your own research, you need to think critically, and you need to put in the work to really engage in a conversation,” she said.

Qi is graduating in the spring of 2022, and she is looking forward to tackling several goals after receiving her diploma. On the top of her list is obtaining a Certified Associate in Project Management (CAPM) certification. She also noted she wants to enroll in data mining and analytics classes, describing the practice as “the future” of many careers.

When asked what she would tell others considering the EMHA program, she advised potential students to not be intimidated and to be sure to ask questions. Do the research to determine what exactly you want to do in life, and once you discover that, it can all fall into place, she described.

“I think education opens the door to different possibilities and opportunities … There are so many fields you can go into … USC definitely gave me that broader and macro picture so that I can go micro and pick out what I want to focus on for the next five to 10 years,” she explained.

As a working mother, it’s been thrilling for Qi to realize what she can accomplish at USC — motherhood, career and education are all well within her grasp.

“It’s exciting because people always think that once you have kids, once you start working, you don’t have these opportunities anymore. But it’s not true if you really want it. USC … provides the education, the network [and] the professional knowledge,” Qi said. “There have been times where I’m just going to the park, pushing my son’s stroller and being in class at the same time, trying to get my discussions done … If you can still gain your education while taking care of your kids, it’s the best feeling ever. Not only are you setting a good example for your kids that you never stop learning, but [you’re gaining] opportunities. You can do it, I promise.”

Learn more about the Executive Master of Health Administration online program today.

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For online EMHA student Diana Qi, it was vital to enroll in a master’s program that allowed her to balance her family responsibilities with her education and career goals. The USC Price program provided exactly that.
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Ending disparities in Black health is a year-round priority for USC experts

The national theme for Black History Month 2022, “Black Health and Wellness,” is a subject that USC researchers discuss year-round. Some of the largest public health and medical organizations in the country have declared racism itself a public health crisis, drawing attention to racial discrimination’s harm to health.

Experts across the university have made racism the focus of their work in multiple contexts: maternal, fetal and infant mortality; homelessness; poverty; Alzheimer’s and other diseases.

The evidence that USC researchers have uncovered demonstrating the links between racism and health issues underscores that prejudice in America’s communities, politics and economic systems is a serious detriment to Black Americans.

For example, Tyan Parker Dominguez, a clinical professor at the USC Suzanne Dworak-Peck School of Social Work, studies racial disparities in adverse birth outcomes and infant mortality.

“Of all major racial and ethnic groups in the country, African American women are more likely to deliver babies too early or too small, to bury them before their first birthday and to die in pregnancy, during delivery or in the postpartum year,” Parker Dominguez said.

“African American women are not simply ‘wired’ this way. Rather, research into the social determinants of health indicates that the context of our lives matters. Long-standing health inequities are the physical consequence of pervasive and enduring social inequities.”

Inequities are widespread, statistics show. But the harmful effects of racism are manifest on Los Angeles’ streets. The high homelessness rate for people of color is evidence of “residential segregation” in Ricky Bluthenthal‘s research.

Black people comprise about 13% of the U.S. population, but they account for 39% of homeless individuals and approximately half of all homeless families with children.

“The disproportionate impact of homelessness on African Americans is due to systematic racism that excludes our populations from educational opportunities, employment opportunities, and housing opportunities. That’s been the case historically, and it continues to this day,” said Bluthenthal, an associate dean for social justice and a professor in the Department of Preventive Medicine and the Institute for Prevention Research at the Keck School of Medicine at USC.

“We have a problem with our political economy, where large corporations suppress wages to keep them as low as possible,” he said. “We are generating more unhoused people than we can build housing for and it’s because of these systems: structural racism, a political economy that keeps wages low, and high housing costs in places like Los Angeles.”

Health disparities: Why representation matters in Alzheimer’s research

Doris Molina-Henry, an assistant professor of neurology at the Keck School of Medicine of USC, has her sights on helping solve one of the biggest health challenges facing the world today – Alzheimer’s disease.

“Black adults in the United States are disproportionately affected by Alzheimer’s disease, and this is coupled with very limited representation in clinical trials [less than 5%] — an essential pathway for the testing and approval of medications,” said Molina-Henry, whose work at USC’s Alzheimer’s Therapeutic Research Institute in San Diego focuses on recruiting participants for clinical trials.

“This can have unfortunate implications for Black community members who are two times at higher risk, less likely to be diagnosed and carry a significant proportion of the financial and caregiving burden. Black participation in Alzheimer’s research that aims to treat, slow, or prevent the disease is imperative to the preservation of the unique cultural richness of the Black community.”

Inspiration tucked into the middle of hardship

In spite of these challenges, Parker Dominguez finds inspiration tucked into a concept called “Sojourner syndrome.” The concept, named for Sojourner Truth, the famous 19th century former slave turned evangelist, abolitionist and activist, “refers to the constellation of class, race and gender oppression that Black women experience, which intensifies their risk for adverse health outcomes.”

“Sojourner syndrome also recognizes the tremendous resilience of Black women who historically have had to make a way out of no way, to keep on keeping on as the heart and soul of their families and pivotal leaders in their communities,” Parker Dominguez said.

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Among young Latino adults, noncitizens are at greater risk of death than naturalized and U.S.-born citizens

Latino immigrants, especially noncitizens, face a much greater risk of dying than their U.S.-born peers, USC researchers have found.

The findings were published Tuesday in the American Journal of Preventive Medicine.

“We know that noncitizens are more likely to face poverty, segregation and inadequate access to healthcare — mechanisms that adversely impact health,” said Jenny S. Guadamuz, the lead study author and a postdoctoral research fellow at the USC School of Pharmacy and the USC Leonard D. Schaeffer Center for Health Policy & Economics.

“It’s also widely known that immigrants make less use of health care,” Guadamuz said. “But do they spend less on health care because they are healthier and do not need it? Or is it rather because they do not have access and are dying at younger ages?”

Until now, no study had examined Latino immigrants’ risk of death in young adulthood when compared with U.S.-born Latinos. The study evaluated mortality differences across citizenship status among Latino young adults aged 18 to 44 who were living in the United States.

Excessive cancer deaths also raise questions about role of citizenship

Researchers looked at mortality rates and health risk factors among 48,000 noncitizens, 16,000 naturalized citizens and 63,000 U.S.-born citizens, using National Health Interview Survey data from 1998 through 2014.

They found noncitizens were at a greater risk of death because of health issues such as cardiometabolic diseases — which include heart disease, stroke and hypertension, as well as metabolic diseases such as Type 2 diabetes and obesity — than peers who were naturalized and U.S.-born citizens. Noncitizens also faced a greater risk of death because of accidents.

But noncitizens and naturalized citizens were twice as likely to die of cancer than U.S.-born Latinos.

“Young Latino immigrants may be more susceptible to death from cancer because they face screening and treatment barriers, including lack of access to insurance or interpreters, increasing their risk of death from highly treatable cancers,” Guadamuz said.

The researchers say the increased risk of death from cancer needs more study. Earlier studies suggesting that immigrants have lower cancer mortality rates have largely examined all ages rather than focusing on young adults.

COVID-19 pandemic likely worsening disparities

The study does not include recent deaths from the COVID-19 pandemic, although researchers believe COVID-19 has not helped.

Last year, a separate study by researchers at the Keck School of Medicine of USC found Latino immigrants of working age — 20 to 54 — were more than 11 times more likely to die of COVID-19 than U.S.-born men and women who were not Latino. The study was based on California death certificate data from 2020.

The mortality disparities observed in the pre-pandemic study data have likely been exacerbated by COVID-19 deaths, Guadamuz said.

“The socioeconomic conditions that made mortality risk higher among young Latino noncitizens in our study have worsened over time,” she said. “COVID-19 is likely killing the same immigrant populations that were already vulnerable to earlier deaths because of other social structures.”

The research team said efforts to reduce these disparities should focus on improving Latinos’ socioeconomic conditions and healthcare access in early adulthood.


About the study: Additional authors include Ramon A. Durazo-Arvizu of the Keck School of Medicine of USC, Josefina Flores Morales of the California Center for Population Research at UCLA and Dima M. Qato of the USC School of Pharmacy and the USC Schaeffer Center.

Guadamuz and Flores Morales were funded by the Robert Wood Johnson Foundation Health Policy Research Scholar program.

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L.A. Residents Get Their Start in Health Careers Through These USC Programs

Could a career as a physician assistant be right for you? Hundreds of South and East Los Angeles residents have explored the field through a career outreach health program — one of several available through USC.

The USC Physician Assistant Pipeline Program introduces students — who range from elementary school to college — and their families to a profession that might otherwise remain a mystery. They learn about other jobs in medicine, too, like emergency services, nursing, physical therapy and primary care. They also attend workshops to develop their skills and meet with health professionals to learn about their careers.

Maria Maldonado, who runs the program, says when a student attends an event, it can touch others in their family as well.

She recalls one high school student who attended a Saturday workshop and encouraged her nephew to go, too. He came with his mother, who ended up being so inspired by a guest from an optometry technician program that she decided to join.

“The next year I saw her doing outreach for the optometry program that she was now enrolled in,” Maldonado says. “That’s always been the vision and the dream.”

The physician assistant pipeline program is one of USC’s many free workforce development health programs, part of a longstanding commitment to support Los Angeles-area communities and increase access to careers in medicine. Here are a few more partnerships that put Southern California residents on the path to medicine:

K-16 Pipeline Program

This program, a branch of the physician assistant pipeline program, connects 60 to 100 high school students from underserved areas of Los Angeles each year with professionals in fields like dentistry, nursing, pharmacy and physical therapy. The health professionals speak with students about their career interests and run workshops that teach some of the clinical skills necessary for those jobs.

Tom Bradley Mini Medical School

Once a month, USC medical students volunteer at the Tom Bradley Environmental Science and Humanities Charter Magnet School in South Los Angeles. Those volunteers talk about topics like diabetes and nutrition to stimulate students’ interest in medicine and higher education.

Health Career Academy

USC medical students teach L.A. high school students a curriculum based on the drama series ER. They cover medical challenges like heart attacks and gunshot wounds. At the end of the course, participants deliver their own medical presentation at the USC Health Sciences Campus.

LeAD (LEadership & Academic Development) and CReW (College REadiness Workshops)

Middle and high school students who live near USC’s Health Sciences and University Park campuses can get advice and pick up practical skills to help them in school and their careers through these programs. USC graduate students, faculty members and professional tutors meet with students over a 10-week period to work on everything from building a resume to dealing with stress.

Medical Counseling, Organizing, and Recruiting Program (Med-COR)

High school students of color living in underserved communities of Los Angeles County can receive mentoring and tutoring to help them get into college — with the hope that many go on to medical school. Students attend Saturday sessions where they receive tutoring in English, math and science, as well as other assistance. College students of color and USC medical students provide support. USC’s Good Neighbors Campaign and Keck School of Medicine of USC fund the longstanding health program.

Pre-PA Pipeline

The USC Physician Assistant Pipeline Program wants physician assistants to better represent the communities they serve. As such, a branch of the program called the Pre-PA Pipeline encourages people from diverse, often underrepresented backgrounds to pursue medicine. Faculty members help people apply to physician assistant programs to expand the applicant pool and ensure care providers reflect the surrounding neighborhoods. Sessions are devoted to helping participants practice interviewing, write essays and develop their resumes, among other topics.

Hippocrates Circle Program

This USC health program shows middle school students from underrepresented communities that a career as a physician is possible. School districts, hospital systems, medical schools and local doctors all take part. Medical students speak with participating students, guide campus tours and conduct medical workshops.

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Keck Medicine of USC and Methodist Hospital take next steps toward affiliation

Keck Medicine of USC and Methodist Hospital of Southern California in Arcadia have submitted formal written notice of their proposed affiliation to the Office of the Attorney General of California for regulatory review and approval.

“We are delighted to take this significant step forward with our colleagues at Methodist Hospital,” said Rod Hanners, CEO of Keck Medicine. “We are eager to bring the strengths of our organizations together to better meet the evolving needs of our patients and the community for many years to come.”

Following regulatory approval, Methodist Hospital will officially join the Keck Medicine clinical enterprise as USC Arcadia Hospital.

“Our discussions over the last 18 months have given us full confidence that we will operate more strongly together,” said Dan Ausman, president and CEO of Methodist Hospital. “We remain wholly committed to the San Gabriel Valley community and hope to expand residents’ access to highly specialized care in the years to come.”

Methodist Hospital has provided full-service patient care to the community for almost 120 years, delivering nearly 2,000 babies each year and treating more than 50,000 adults and children through the emergency department annually.

“We look forward to welcoming USC Arcadia Hospital to our health system,” said USC President Carol L. Folt. “This new affiliation will bring our medical enterprise to the San Gabriel Valley, while welcoming outstanding doctors, nurses and administrative staff to the Trojan Family. As one united team, we will be able to deliver groundbreaking treatments and compassionate care more broadly in the region — and improve health and well-being for even more individuals.”

In addition to operating more than 40 outpatient locations across Southern California, Keck Medicine offers world-class tertiary and quaternary care at Keck Medical Center, which is nationally ranked in 12 specialties by U.S. News and World Report. The proposed affiliation is founded on the principle that access to a broader spectrum of care will be available to residents of the San Gabriel Valley through collaboration with respected community physicians and Keck School of Medicine of USC faculty.

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Vulnerable Groups Came First in USC’s COVID-19 Vaccination Efforts

Maria Saravia was so terrified of exposing her parents to COVID-19 that she would shower thoroughly after her shift at the hospital before going home. And that was just the beginning of her ritual.

When she arrived, she would enter through the back door, take off her shoes and head inside. “I’d shower again, put my clothes in a plastic bag, then wash them separately without any clothes from the rest of my family,” Saravia says. “Nobody would talk to me until I was done.”

Saravia, 57, cleaned patients’ rooms for hours on end in the COVID-19 wing at Keck Hospital of USC as a member of the facility’s environmental services staff. Seeing so many patients on ventilators scared her at first. So did having to cover herself with protective gear before entering their rooms. Even when she was vaccinated during the first wave of COVID-19 vaccine clinics for health care workers, she still feared for the health of her elderly parents and other family members in her Boyle Heights community. This working-class, heavily Latino enclave was one of the areas hit hardest by the pandemic.

At the time, vaccine appointments for the public were scarce. But as the pandemic peaked, she got good news: Keck Medicine of USC had prioritized doses for family members of front-line workers who were eligible based on government guidelines. Saravia quickly signed up her parents.

“For me, it was like a blessing,” she says. “I am a privileged woman because I work here.”

Keck Medicine focused first on vaccinating communities most impacted by the pandemic: those most likely to live with essential workers and those often lacking consistent access to health care.

Yet Saravia’s parents received the vaccine precisely because Keck Medicine leaders wanted to overcome privilege. As the USC health system expanded its vaccine outreach during the beginning of the rollout, equity became its guiding principle. Amid high demand for the initial doses, Keck Medicine focused first on vaccinating communities most impacted by the pandemic: those most likely to live with essential workers and those often lacking consistent access to health care.

“I think there’s a moral responsibility,” says Felipe Osorno, executive administrator for continuum of care operations and value improvement. “We’re a huge health care provider, we’re in the middle of Boyle Heights, a predominantly Latino neighborhood, and we looked at the data. We felt it was the right thing to do.”

USC Prioritizes COVID-19 Vaccines for Underserved Communities in L.A.

Saravia had reason to fear for her family’s safety. Grandparents, parents and grandchildren all share the same home, raising the risk of spread. They’re essential workers who can’t work remotely. And they’re Latino–a community with a COVID-19 death rate three times higher than non-Latino white and Asian residents in Los Angeles County.

She felt relieved when Keck Medicine included environmental services staff members alongside doctors, nurses and other health workers in its first round of vaccinations in December 2020. Not all hospitals included their custodial and cleaning teams in that initial wave.

Osorno, though, remembers when vaccination planners prioritized the environmental services staff as they started their rollout. “It was unique among health care systems,” he says. “Everyone else only included clinicians first.”

To further ensure all health workers had equitable access, Keck Medicine sent out information about the vaccination process in multiple languages. “We also realized that most of our communications had been via email until then,” Osorno says. “So we started to hold in-person meetings. I personally talked with the staff in different shifts and answered their questions.”

When California expanded eligibility to people aged 65 or older, the vaccine quickly became a scarce commodity.

When California expanded eligibility to people aged 65 or older, the vaccine quickly became a scarce commodity. Keck Medicine leaders prioritized access for older family members and friends of its health care team, knowing they might not be able to get them otherwise.

Seeing the hospital staff’s elderly relatives lining up for a shot reminded Osorno of his own family back home in Colombia: “To me, it was like seeing my parents and grandparents getting the vaccine.”

USC Community Outreach Brings Vaccines to Angelenos in Need

As more people became eligible for vaccinations, the health system expanded outreach. It partnered with nonprofits and government agencies to vaccinate Angelenos. At one point, Keck Medicine ran a free shuttle from Mariachi Plaza in Boyle Heights for people who had no way to get to vaccine appointments.

The USC School of Pharmacy and USC Pharmacies collaborated with county and city officials, local health insurance organizations and churches to set up community walk-in and drive-thru vaccine clinics throughout Los Angeles. USC also worked with school districts in East Los Angeles to vaccinate teachers. The university launched a vaccination site at Lincoln Park across the street from the USC Health Sciences Campus in Lincoln Heights, another hard-hit community. Keck Medicine offered pickup services for patients who had no access to transportation. Some USC physicians even made house calls to provide vaccines to homebound seniors.

We have and will continue to vaccinate all who are clinically eligible for the COVID-19 vaccine, regardless of factors such as insurance or immigration status.

Michelle Hormozian

“USC Pharmacies held both indoor events and outdoor events, including drive-thru and walk-up COVID-19 vaccine clinics across Los Angeles, with a focus on underserved communities,” says Michelle Hormozian PharmD ’18, clinical coordinator for USC Medical Plaza Pharmacy. “We have and will continue to vaccinate all who are clinically eligible for the COVID-19 vaccine, regardless of factors such as insurance or immigration status.”

The pharmacy school also helped launch the vaccine clinic at Dodger Stadium, one of the largest mass vaccination sites in the country. Volunteers administered 12,000 shots a day there at the peak of the rollout. USC students, faculty and alumni staffed the site from day one.

The impact they made speaks for itself: Of the 1.3 million vaccines that the city of Los Angeles administered by June 1, more than half were delivered at sites and pop-up clinics staffed by Trojans.

Says Richard Dang ’09, PharmD ’13, an assistant professor of clinical pharmacy who helped lead the vaccination effort: “We showed that we can accomplish really big tasks when we work together.”

USC Vaccination Efforts Focus on Vulnerable Groups

To get vaccines to the most vulnerable in Los Angeles, Keck Medicine staff members worked with USC’s community relations team to meet leaders of local churches and community organizations. They built new partnerships with the Ramona Gardens Senior Center, the L.A. County Office of Education and other groups and agencies in East Los Angeles.

About 40 Keck Medicine staff members worked phones, pitched ideas and set up the infrastructure needed to administer the shots. Employees from information technology, ambulatory operations, nursing, marketing, communication, pharmacy and other groups pitched in, Osorno says.

One anecdote, he says, captures the breadth of USC’s impact. L.A. officials identified 128 ZIP codes that were most vulnerable during the pandemic based on health and socioeconomic data. Focusing vaccine efforts in these underserved neighborhoods would be critical. But USC was one step ahead of them: Its health professionals and volunteers already had vaccinated residents from all 128 neighborhoods.

“That was just amazing,” Osorno says.

Now that demand for the COVID-19 vaccine is declining, Keck Medicine is applying lessons learned from the pandemic to other areas, including vaccination efforts linked to the upcoming flu season.

Another related focus: ensuring that patients have equitable access to quality medical care.

A newly launched health equity committee will identify gaps in treatment and care at Keck Medicine based on factors like age, language, race, gender and sexual orientation. “For example, one of the first things we are going to focus on is ensuring that our patients can access care in the language they prefer,” Osorno says.

We have to eradicate this pandemic; we have to protect ourselves.

Maria Saravia

Making systemwide changes to ensure equity will be an ongoing process across USC, but each member of the team plays a role in bridging those gaps. For Saravia, it’s still about protecting her family and community. She encourages her neighbors in Boyle Heights to get the COVID-19 vaccine if they haven’t already.

“You should vaccinate,” she says. “We have to eradicate this pandemic; we have to protect ourselves. I do it principally out of love for my family and my parents because they are high risk and I don’t want them to die on my account. If you have love for yourself, you have love for others.”

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Steve Shapiro brings a big-picture approach to medicine at USC

Steve Shapiro takes the macro view of medicine. This spring, he became the first senior vice president for health affairs at USC, where he will oversee — and build bridges between — clinical operations at Keck Medicine of USC and research and medical training at the Keck School of Medicine of USC.

Previously, he was executive vice president, chief medical officer, chief scientific officer and president of health services at the University of Pittsburgh Medical Center — all at the same time. USC News sat down with him recently to find out what makes him tick.

Were you interested in science when you were a little boy? Was there a doctor in your family?

No doctor in my family — my father was an accountant. All I really remember was a real passion for sports and maybe a general intellectual curiosity that’s served me well. But my father died way too early — when I was 13. And maybe the combination of that, finding out that I really did love science and wanting to help people in difficult times led me to become a doctor.

Is there a memorable experience from your time training to become a doctor that you’ve carried forward with you?

First of all, it is incredible how much detail from different cases you remember from a long time ago. Probably the most memorable patient experience was right after my training. I was the attending physician in the ICU — attending means the buck stops with you — and there was a patient who was flown to our ICU, 23 years old, on maximum ventilatory support and hemodynamic support.

We really had no expectations that she would survive, and that was before one of the residents accidentally punctured her lung while putting in a venous line. I remember wheeling the patient quickly to the operating room where a surgeon and anesthesiologist really saved her. Eventually, the patient walked out of the hospital.

What lesson did you take away from that?

A really bad lesson! I now thought I was a super doc who could save everyone. Over time, I learned the painful lesson that sometimes doing everything to ‘save’ a patient is actually prolonging death. It’s a critical skill that one has to learn in the ICU: when to be aggressive and when to back off and let someone die in dignity.

You’ve been a researcher focused on molecular pathways of inflammation and tissue destruction in lung disease. What do you like about academic medicine?

It is really rewarding as a doctor to be able to decipher patients’ underlying illnesses and help them get better. It is even more exciting to see the underlying molecular and cellular abnormalities and really try to unravel disease mechanisms and develop therapies to help lots of people. As an educator, it’s satisfying to teach the next generation of doctors and health science leaders.

What drew you to the administrative side of medicine?

I still love doing medicine. I love research. But the more I was pushed toward leadership positions, the more important I saw American health care in general. Until recently, as chief medical officer at the University of Pittsburgh Medical Center, I still saw a mixture of patients and had a small lab. But I realized that, in a way, those were guilty pleasures and I should be spending my time making sure everyone else is successful.

What is exciting about this new job and being in Los Angeles?

It’s one thing to be able to build the largest academic health care system starting in Pittsburgh and growing northeast. But I really wanted to see if I could take these skills and help Keck apply them to one of the most important and diverse cities in the country with, by far, the most complex health care market.

Health care is really at a dynamic inflection point, and few places are going to navigate it and thrive. With our relationships with Los Angeles County+USC Medical Center and Children’s Hospital Los Angeles, USC and Keck can really be the role model for health equity in the country.

You’ve said that L.A. traffic will give you more time for audiobooks. Any recommendations, audio or otherwise?

I’ve just finished a couple of books. One was called Broken, Bankrupt and Dying by our chief medical officer at LAC+USC, Brad Spellberg. It’s the best argument I’ve heard for a single-payer system, as well as explaining the nuances of what single-payer means. It’s really impressive.

I’m just starting The Intuitionist by Colson Whitehead. I’ve read his other books more recently. This was his first book.

Tell us about your family.

My wife is the smartest person I’ve ever met, and she and our five daughters really keep me humble and inspire me to be a champion for women’s issues. One’s a software engineer in New York, one’s a health care lawyer in the Senate in D.C. and we have three teens/preteens here with us. The kids really like going to the beach. Though, truth be told, they like going shopping in beach towns.

Moving from Pittsburgh to L.A., was there a moment of culture shock?

I grew up in Chicago, another big city. Even when I step back and look at all the unsolved challenges we have in Los Angeles, I find I’m really enjoying it here.

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As Health Disparities Grow in America, USC Researchers Look for Answers in the Data

He survived the Vietnam War and came home alive, unlike so many others his age.

Four decades later, the veteran was living on the streets of Los Angeles — and he was HIV-positive. He had been kicked out of his home when the property manager found out about his methamphetamine use. Homeless for more than nine months, he struggled to control his HIV. His anti-viral medications kept getting lost, stolen or confiscated by police officers and sanitation workers. He struggled to find food to eat and bathrooms to relieve himself. And his meth use continued.

USC health researcher Ricky Bluthenthal thinks of the man often — and of his downward spiral to street life. He also considers the health risks the veteran’s HIV poses to others and how they could’ve been avoided. Whether through unprotected sex or drug use, the chances the man would spread the virus to others were “quite high,” says Bluthenthal, associate dean of social justice at the Keck School of Medicine of USC. And it happened because of the stigma surrounding drug use.

We’ve created a system that really immiserates a particular subpopulation of people. And then when we go to help them, we often don’t even try very hard.

Ricky Bluthenthal

This raises crucial questions about how we structure society, he says: If people become homeless, do they have a say in how they live their lives? If they use drugs, do they lose the right to housing and health care? If their needs and desires are at odds with the system trying to serve them, whose fault is it when their lifestyle leads to disease and dysfunction on our streets?

“We’ve created a system that really immiserates a particular subpopulation of people,” says Bluthenthal, professor in the Division of Population and Public Health Sciences. “And then when we go to help them, we often don’t even try very hard.”

With racial and socioeconomic inequality comes health inequality — but USC researchers and experts are shining light on this issue. For Bluthenthal, that means examining the complex ways drug addiction, homelessness and HIV infection are linked and searching for solutions. Other USC researchers bring expertise in psychology, economics, communication, sociology and biomedical engineering to bear on the study of health disparities. They tackle varied challenges, from vaccine hesitancy to personal fitness to the wealth gap. But they share a common goal: creating a more equitable society.

Why Gay Black Men Face Health Disparities in HIV Risk, and How to Help

1 in 99 Americans are likely to contract HIV. For Black men who have sex with men, that figure drops to 1 in 2.

Nationally, the rate of new HIV infections is plateauing, if not declining. But that’s not the case among young Black gay and bisexual men. According to 2016 data from the Centers for Disease Control and Prevention, 1 in 99 Americans are likely to contract HIV, the virus that leads to AIDS. For gay white men, the risk is significantly higher: 1 in 11. For Black men who have sex with men, though, the numbers are startling: an estimated 1 in 2 will be diagnosed with HIV.

Lindsay Young wants to know why — and what can be done to reduce transmission in this vulnerable population.

Young is an assistant professor of communication at the USC Annenberg School for Communication and Journalism who completed her postdoctoral studies at the Chicago Center for HIV Elimination. Working extensively with the Black community in Chicago, Young and other researchers found that the area’s young Black gay and bisexual men tended to report fewer risky behaviors, fewer partners and more preventive behaviors than their white counterparts, yet their HIV rates are much higher.

When the researchers dug deeper, they found the answer in the men’s environment. They were more likely to lack access to health care. They faced more stigma in their community around having sex with men, so they shied away from seeking help and tended to go undiagnosed for longer periods. And the community itself was small and insular, making it easier for the virus to travel from person to person.

In response to these conditions, Young’s team went into the community and identified highly connected and influential people who agreed to be trained in talking about HIV prevention with their peers. They learned how to persuade friends to use pre-exposure prophylaxis, a daily medication that is highly effective at preventing HIV.

The researchers then checked people who called a local information line about the medication against lists of friends provided by the study participants. Young and her team confirmed that people who called the info line were more likely to be connected to study participants who had undergone peer training compared with study participants who had not yet been trained.

One man in his late 20s who went through the training had grown up in South and West Chicago and was born with HIV. When the researchers met him, he had only recently started identifying publicly as bisexual. As he participated in the study, he grew increasingly comfortable in his own identity and began to understand the importance of helping others feel the same way.

“If we achieve nothing else in these types of interventions,” Young says, “making people feel more empowered and comfortable in their own skin — and increasing their desire to share that experience with others — is quite important.”

How Genetics and Family Factors Combine to Create Health Disparities

In a sense, life can be seen as starting with two lotteries, says researcher Titus Galama. “One is the genetic lottery,” he says. “The other lottery is your family. You cannot choose your family or your genetic makeup.” Someone born with a “lucky” genetic draw in a wealthy household is more likely to live a longer life and receive more and better education.

“What I’m interested in is the implications for our understanding as a society of the meaning of equality of opportunity,” Galama says. “What does meritocracy mean when families and genetic makeup are such important factors?”

He studies the nexus of economics and genetics as a senior economist with the Center for Economic and Social Research at the USC Dornsife College of Letters, Arts and Sciences. He also directs the Center for the Study of Health Inequality. In his research, he tries to understand how early-life conditions — like nutrition, a mother’s education and household resources during a child’s first few years — can influence outcomes later in life. This area of research is called gene-by-environment interplay, and it’s at the cutting edge of a field called social-science genetics.

As people get older, the disparities in health between rich and poor widen. Workers from lower socioeconomic groups tend to work in more physically demanding, and perhaps more dangerous, jobs than workers with higher socioeconomic status. “If you look at doctors, they live much longer on average, while construction workers are literally doing back-breaking work,” Galama says. “Basically, if you don’t have much wealth or education, you have to rely more on your physical health, whereas wealthy people have the luxury to protect their health, because they can afford it. And being in good health helps people be more productive.”

By age 60, 7% to 8% of people earning high incomes report being in fair to poor health. That figure rises to 45% among people earning low incomes.

In later adulthood, the disparities among people from different socioeconomic groups can be vast. By age 60, Galama says, 7% to 8% of high-income individuals report being in fair to poor health, compared with about 45% of low-income individuals. By finding out what causes these disparities, Galama and other social science geneticists hope to start building critical bridges to improve health and well-being for all.

In one real-world example, Galama and his colleagues studied a basic income program in Colombia that provided extra money to poor families — on the condition that their children go to school and visit the doctor. Three years into the program, they found it led to more wealth, better jobs and more happiness for participating families. Financially supporting people, particularly those at the margins of society, and encouraging their children to get an education and health care has the potential to lift communities out of poverty.

Wearable Tech Helps USC Scientists Study Factors Behind Health Disparities

Activity trackers like an Apple Watch or Fitbit can help people stay healthy. Not only do they measure exercise but they also collect useful data on heart rate, sleep and circadian rhythm. Not everyone has access to these devices, however, which can leave some vulnerable people in the dark about their health.

Ritika Chaturvedi wants to find out more about those people, so the research scientist provided Fitbit trackers to 1,200 study participants, most with low-income and minority backgrounds. The idea is to see how they go about their daily lives in real time. She conducts the work through the USC Schaeffer Center for Health Policy and Economics, in partnership with USC’s Understanding America study.

Most people answer questions about their health when they visit their doctor, she says. “But doctors only see individuals maybe once a year, or once every two years, when something is wrong or they come in for a physical. You don’t really have a sense of how people behave over time.”

Fitbits, on the other hand, track steps, sleep and heart rate, day in and day out. The study’s participants — Blacks, Native Americans and people from households where Spanish is the primary language — wear the wrist devices for a year. The data collected are available to them as well as the USC researchers.

The point of this entire experiment is to identify the barriers to healthy behavior so we can develop interventions, all measured through something that’s very objective.

Ritika Chaturvedi

Participants also fill out a survey about what researchers call “social determinants of health”: racism, discrimination, poor access to health care, food insecurity, economic instability, educational issues and so on. By combining survey results and tracking data, the researchers hope to understand the factors that keep people from staying healthy and then come up with ways to counter them.

For example, in a neighborhood with a high crime rate, Fitbit data may confirm what participants say in their survey: They feel it is unsafe to walk or exercise outside. But what if many in the neighborhood go to church? Maybe a local organization or government agency could provide churches with treadmills and a plan that incentivizes community exercise.

Says Chaturvedi: “The point of this entire experiment is to identify the barriers to healthy behavior so we can develop interventions, all measured through something that’s very objective.”

USC Research Reveals Why Some People Don’t Want COVID-19 Vaccines

The same Understanding America study at USC is providing invaluable information on another area of health disparities: COVID-19 vaccines. With colleagues in USC’s Center for Economic and Social Research, researcher Wandi Bruine de Bruin started tracking Americans’ reactions to the coronavirus pandemic starting on March 10, 2020. More than a year later, the team has found disparities by age, race and political affiliation as people across the country reacted to the threat of this highly infectious, sometimes lethal virus.

Study researchers now survey a panel of about 6,000 people in the U.S. every two weeks. Since April 2020, they’ve asked respondents if they would be willing to get vaccinated. “There have been differences in vaccine hesitancy in racial and ethnic groups, but they are getting smaller,” says Bruine de Bruin, Provost Professor of Public Policy, Psychology and Behavioral Science at the USC Price School of Public Policy.

A bigger predictor of vaccine hesitancy than race, she says, is education. The lower their education level, the less inclined they are to get vaccinated. The percentage of adults without a college degree who say they are unlikely to get vaccinated is about the same among Black and white people — 32% and 35%, respectively. But the percentage of adults without a college degree who are unsure about getting vaccinated is much higher among Blacks (23%) than whites (11%).

Another intriguing finding from the study: Older adults are more likely to believe they could die from the virus than younger adults, but they perceive less risk of getting COVID-19, having to quarantine or running out of money. Additionally, an American’s likelihood of wearing a mask and observing social distancing guidelines could be predicted by whether they identify as a Democrat (more likely) or a Republican (less likely).

People look to others around them to inform their behaviors.

Wandi Bruine de Bruin

Long before COVID-19, Bruine de Bruin had studied why people do or don’t get vaccines. “One insight from that work,” she says, “is that people look to others around them to inform their behaviors.” That led her to advocate for the “vaccine selfie” — when newly vaccinated people take a picture of themselves at the vaccine site to share on social media.

“Then their friends and family will realize that this person has gotten vaccinated,” she says. “That should increase the likelihood that they will also get vaccinated.”

Bruine de Bruin saw this dynamic play out in her own life when she posted a vaccine selfie. A friend reached out after seeing the picture, wanting to know why she got vaccinated and how she could be sure it was safe. Bruine de Bruin explained her thinking and in doing so, persuaded her friend. “She decided to get vaccinated,” she says, “because she trusted my opinion.”

Where We Live Can Harm Our Health — and Our Kids

It’s clear that many aspects of our personal lives, like our racial and ethnic background, class status or the neighborhood where we live, can affect our well-being. To untangle those factors and their links to health disparities, Brian Finch, a research professor of sociology at USC Dornsife and director of the Southern California Population Research Center, crunches big data.

One study Finch published this year explored how living in neighborhoods with gangs affects birth outcomes like being born early or underweight, even among residents who aren’t gang members. When gangs take over a neighborhood, the violence can scare businesses away, he says, creating fewer economic opportunities. Neighbors stop talking to neighbors because it feels unsafe to be outside. Shootings put whole blocks on edge.

If you’re not allowed to use social spaces because they are controlled by gangs or if you’ve got to keep your eyes out constantly for gang activity, it’s just not a healthy environment.

Brian Finch

“It’s ambient stress,” he says. “You don’t have to experience it yourself. It’s there in your neighborhood. If you’re not allowed to use social spaces because they are controlled by gangs or if you’ve got to keep your eyes out constantly for gang activity, it’s just not a healthy environment.”

And we now know, Finch adds, that the health of a woman at the time she becomes pregnant and the conditions during her pregnancy can affect the health of her baby.

Scouring Los Angeles County and city data, they found that accounting for the presence of gangs “explained a number of disparities between non-Hispanic Black infants and non-Hispanic white infants,” he says. And tragically, mothers-to-be could only do so much to mitigate the damage. “All your behaviors during pregnancy, whether you attend prenatal care and that kind of thing — even controlling for those factors didn’t completely reduce the disparities.”

USC Experts Press for More Action on Health Disparities

For years, Finch has studied health disparities in specific populations, hoping his work would lead to solutions for underserved communities mired in poverty. Instead, he’s watched these disparities spread to great swaths of American society.

We’ve been under a longstanding, long-term onslaught of income inequality. It seems there’s a big bifurcation going on in this country right now.

Brian Finch

“We’ve been under a longstanding, long-term onslaught of income inequality,” he says. “It seems there’s a big bifurcation going on in this country right now.”

Addiction. HIV. Early childhood health and well-being. Barriers to fitness. Vaccination rates. Life expectancy. USC experts say the evidence is there: Health disparities in the United States are real and in many cases, profound. Even more concerning, the problems aren’t getting any better. Finch fears they may be getting worse.

Twenty-five years ago, as a graduate student, Finch wrote papers documenting health disparities and cited research that came before him. Today, his grad students cite the papers he and his colleagues wrote in the 1990s on the same inequities. He wonders when, as a nation, we will finally decide we have enough evidence to act.

“We’ve spent so many decades documenting disparities,” he says. “We’ve got to begin to turn the corner on that. If you do believe, like I do, that the social determinants of health are driving disparities, then it all just seems kind of intractable and almost unfixable — unless we are willing to deal with the major social problems of our time.”

The issue is gaining attention, as evidenced by President Joe Biden’s recent appointment of a health equity czar to address health disparities. But until major progress is made, Bluthenthal knows that people like the veteran he met on the streets of Los Angeles will continue to struggle. His research shows that homelessness alone puts individuals at higher risk of poor health outcomes. That effect is magnified for people from marginalized and underserved populations.

In a study published in May, Bluthenthal and colleagues found that certain groups of drug users were less likely than others to have access to naloxone, a drug that can prevent death from opioid overdose. Whites were more likely to have access to the drug than Blacks or Latinos, as were housed people relative to those without housing.

Bluthenthal’s goal for his research is to connect such data to the larger social inequities that lead to intractable addiction problems, both at the individual level and for communities. “The other thing is beginning to advocate, through telling stories, for a more systemic, more structural response to the problem of substance use disorder.”

“We have to get better at creating the evidence that connects structural conditions to institutional problems,” he says. “We have to begin asking new questions.”

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