RESEARCH & PRACTICE

Faculty scholarship at LLUSPH

Studies, publications and projects by faculty at the school of public health. These are some of the scholarship highlights from the past year.

The shrinking shoreline of the Salton Sea.

With funding from the California Endowment, we're doing research in the Coachella Valley on emerging health risks associated with the shrinking shoreline of the Salton Sea. We're taking a Neighborhood Action Team approach seeking environmental justice answers in the area.

Partnering with communities

  • We had several workshops with youth this summer in the Eastern Coachella Valley to map out and explore the shrinking shoreline of the Salton Sea
  • We built a wiki page for the community to better understand the Salton Sea. You can view it at http://sph.wiki/EJ/doku.php
  • We wrote three policy briefs about specific issues regarding the Salton Sea.

The Loma Linda team has developed community science modules to fit into the Alianza campaign (an alliance in the Coachella valley bringing together community members, nonprofits, and government to lead efforts to help the region thrive.) to train community members on topics such as air quality, water quality and GIS (balloon mapping). These modules are designed to function within the youth and adult organizing efforts of Alianza. The modules fit within the curriculum of area youth groups and the two community groups in the North Shore and West Shore areas. The Community Science modules have three general operating goals: to build power, generate data and provide an output for action and ownership.


We are also continuing our project on the Drinking water vending machines. Testing the quality of water available to the Coachella community.

Habitual Diet and Avocado Trial

The HAT Study

The primary aim of this study is to determine whether providing one avocado per day for consumption for six months will produce a greater decrease in visceral adiposity as measured by MRI in Americans who have an increased waist circumference compared to habitual diet. Check it out at hatstudy.org.


The secondary outcomes for the study are as follows.


To assess whether providing one avocado per day for six months will reduce the severity of metabolic syndrome markers, hepatic lipid content or hsCRP concentrations as compared to habitual diet.

Study summary

This is a multicenter trial, with Loma Linda University being one of the main research sites along with UCLA, Tufts University and Pennsylvania State University. Wake Forest University in North Carolina is the coordinating and statistical site for the trial. Each site will recruit 250 participants each with a total sum of 1000 participants overall.


At Loma Linda, recruitment began in July of 2018 and data collection began in August of the same year. LLU successfully recruited all 250 participants by July of 2019. The projection is to finish data collection by March of 2020. The study was funded by Hass Avocado Board.


Participants in this study were randomly assigned to one of two equally sized groups. Both groups are instructed to continue to follow their habitual diet, but the intervention group will receive one avocado per day. Participants will be followed for outcomes over a six-month period. All the participants get an MRI at the beginning and end of at the end of 6 months. Blood collection and full body assessments are done three times during the study: at the beginning, 3 months and 6 months. There are also 4 diet recalls done throughout the study, and these recalls help to assess participant compliance. Those assigned to the Avocado group come bi-weekly to pick up their avocado supply and keep a log of their daily avocado intake. The control group only comes once a month to a monthly compliance assessment clinic, where they get their blood pressure measured and fill out a health assessment questionnaire. Loma Linda is also conducting an ancillary study looking at the effects of daily avocado intake on cognition. Trained Behavioral Health Professionals at the beginning and end of 6 months administer a battery of cognitive tests to participants.


Once participants have successfully completed the study, they receive $300 as an incentive and the control group receives an additional box of 24 avocados.

Buzz over avocados

During the recruitment phase, news of the study was broadcast by major news channels and went viral over social media. Nutrition Research Center (NRC), where the study is being conducted, received more than 30,000 applications for the study including the ones from outside the state and even the country!


Another interesting fact is that the NRC will receive, sort and distribute 24,000 avocados over the course of the entire study. Finally, we provide several recommendations to Fresno County for programs and policies designed to address the inadequate wastewater service in the county. Several of these programs and policies may be replicated in other jurisdictions throughout the state.

Antimicrobial silver project

In partnership with the Loma Linda University School of Dentistry, under a GRASP grant, we're looking at how the use of silver embedded in silicone breast implants can prevent Staphylococcus Epidermidis biofilms.

Using silver to prevent bacterial growth

Silver has emerged as an alternative antimicrobial agent to bacitracin, the current premier standard. Our goal was to investigate the efficacy of coated and embedded silver against bacterial growth on silicone. We also aimed to test the effects of UV light on the silver’s inhibition. Silicone is a major component of implants and tissue expanders used in breast augmentation. Staphylococcus epidermidis is a gram-positive facultative anaerobic bacteria and a part of the human body’s natural flora. This bacteria is the most common infection because it can enter the body via a surgical incision. This could eventually lead to biofilm formation. We hypothesize that silver inhibits Staphylococcus epidermidis bacterial growth on silicone implants and tissue expanders. We also believe the discs exposed to UV light for a longer period will be oxidized, which will result in larger zones.

Wastewater infrastructure in Fresno and Riverside Counties, CA

The PEW charitable trust project worked with communities in the Eastern Coachella Valley and Fresno County to produce a Health Impact Assessment (HIA). The HIA recommends county-level policy to build sanitary sewer to low-income disadvantaged communities. We did this through a science-based approach where we used a microbial risk assessment to look at the health risk to children who play in soil that is contaminated by sewage.

Project summary

We found through testing of soils there were high concentrations of bacteria and pathogens in soils near septic systems and we also found that there were heightened concentrations of bacteria and nitrates in water supplied by domestic wells in neighborhoods without centralized wastewater service. Our risk assessment model predicts the significant and elevated risk of infection and gastrointestinal illness for people, especially small children living near contaminated soils, however reportable disease data from Fresno County demonstrates less conclusive results. We also found that lack of access to centralized wastewater systems causes increased stress and anxiety among residents and decreases – or even eliminates – economic and community development opportunities. We also found, based on the data available, that the lack of centralized wastewater service in communities least likely to be able to sustain adequate non-centralized systems disproportionately impacts Latino residents.

Finally, we provide several recommendations to Fresno County for programs and policies designed to address the inadequate wastewater service in the county. Several of these programs and policies may be replicated in other jurisdictions throughout the state.

Macadamia Nut Study

The Effect of Macadamia Nuts on Cardiometabolic Risk Factors and Adiposity: A randomized Intervention study. Check out the MAC study website.

Study summary

The purpose of this project is to study the effects of macadamia nuts on cardiometabolic risk factors including adiposity, inflammation, oxidative stress, insulin resistance and blood lipids in adult men and women. The contract for the study was signed in mid-August of 2018, after getting IRB approval, hiring, training of various personnel and setting up all the protocols, the study officially began recruiting in May of 2019. Currently, all the required participants for the study have been recruited and data collection has begun. It is a controlled, randomized cross over study where the selected participants will be randomly assigned to two diets (macadamia nut diet or control diet). They will be on each diet phase for a time period of 8 weeks with a two-week wash out period in between the two diet phases. While on the macadamia nut diet, subjects will be provided the appropriate portion of macadamia nuts [15% of daily calories or 30-45 grams based on kcal requirement of the individual], instructions for, and menus to assist with incorporating the nuts into their daily diet. During the macadamia nut diet phase, subjects will add macadamia nuts to their habitual diet, while during the control diet phase, they will abstain from consuming macadamia nuts. The study subjects will be instructed to refrain from all other nuts for the duration of the study. Hort Innovation Australia has funded this research study. The research staff has been packing all the macadamia nuts for the participants, themselves. They filled 1 and 2-ounce plastic pouches with macadamia nuts according to the individual needs of each participant.

Fermented Soy Study

The Soy Study

The fermented soy study is looking at the effects of a fermented soy-based dietary food product on cardiometabolic risk factors in individuals at high risk of cardiovascular disease. Take a look at the Soy study website.

Study summary

The purpose of this research study is to investigate the effects of a dietary food product made from soybeans on serum lipids, selected inflammatory and oxidative parameters and genome-wide methylation. A secondary objective of the study is to explore the potential effects of Q CAN PLUS powder on body weight, adiposity, and insulin sensitivity. This dietary supplement intervention trial is a randomized, 2x2 crossover design with 24 subjects in free-living conditions. There was a two-week run-in (acclimation period), after which subjects were randomized to receive either Q CAN powder or placebo powder for 12 weeks. Following a two-week washout period, subjects were switched over (cross over) to the alternate treatment. Thus, the intervention of the study lasted for a total of 28 weeks. Throughout the duration of the study, subjects were asked to refrain from consuming any other soy-containing products. A list of foods that may contain soy was provided. Blood drawing and Body assessments were done at the beginning and twice at the end of each phase.


Data collection is complete for the study and data cleaning and analysis began in mid-August of 2019. The study is scheduled to finish by August 2020. The study was funded by BESO Biological Research Inc.

Drayson Center Office of Preventive Care

At the DC Office of Preventive Care, we focus on the modern lifestyles that lead to disease. Our professionals and interns will work with you individually and take care of your lifestyle needs.


The assessments and information provided from the sessions are utilized to recommend lifestyle changes that will help maintain a high quality of life without significant health complications. A personal wellness profile is created for each client through subsequent sessions based on individual needs.


The Office of Preventive Care offers weight loss and weight management classes as well as health fairs at local churches and organizations. Check out their website.

Health Geoinformatics Systems

Services

By applying geotechnology principles to health practices, LLUGIS has brought an unprecedented level of scientific exploration to public health policy decision-making. Following are some of the GIS professional service applications LLUGIS has been or is currently involved.

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Research

A deeper understanding of the associations of health-relevant behaviors in their full geographic environment can provide valuable insights to possible mechanisms and factors that can have altering effects, as well as enhance clinical practice and quality of care. As a result, LLUGIS has established a research agenda to expand the current understanding of how the environmental and socio-cultural context of a community interacts with individual behaviors and health outcomes.

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Academics

Over the past several years, course offerings in health geoinformatics have proven to be an important factor in students’ education. Therefore, it is imperative that we continue to innovate through our curriculum to provide students with cutting-edge GIS technology to enable them to become competitive in the job market and more efficient industry leaders. Thus, the goal is to ensure that every School of Public Health student is exposed to GIS capabilities.

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Global Tobacco Prevention & Control

Almost 80% of the world’s 1 billion smokers live in low- and middle-income countries, with no affordable smoking cessation products. In 2002 we received a $1 million grant to fight big tobacco in Southeast Asia. As of 2018, grants from the NIH, Pfizer and other organizations have helped fund our work in Cambodia, Laos, and Mongolia. Our ultimate aim is to reduce tobacco dependence to zero.

In Mongolia, we are testing cytisine, a plant-based smoking cessation treatment, costing less than 30 USD for the entire course of medication. Using GIS software, we identify locations where tobacco vendors and companies violate the World Health Organization (WHO) regulations on packaging and price of cigarettes.

In Cambodia, we’ve been able to increase the price of cigarettes from 0.20 USD to 0.45 USD per pack. We discovered that women chewing tobacco during morning sickness were associated with high rates of infant mortality.

Compensating for its decline in the West, Big Tobacco is growing in Southeast Asia and other parts of the world. Infants, toddlers, and young children are encouraged to smoke to decrease their appetite for food. A high density of vendors sell low-cost cigarettes to children near their schools.

“There is much work to be done and we need help. Private donors have allowed us to collect pilot data and publish papers to support submitting roughly $6 million in grants.” - Pramil Singh, DrPH & Principle Investigator of Tobacco Research at Loma Linda University School of Public Health. 

Adventist Health Studies

Adventist Health Studies are long-term studies exploring the links between lifestyle, diet, and disease among Seventh-day Adventists. More than 96,000 church members from the U.S. and Canada are participating in the current study, AHS-2, conducted by researchers at the Loma Linda University School of Public Health.

News & Updates

Environmental Nutrition

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Environmental Nutrition emerged from a recognition that the complex interactions within the food system related to health and environment need to be considered simultaneously. Environmental Nutrition goes beyond the scope of current discussions on sustainable diets and systematically considers the interrelationships within food systems to necessarily incorporate a complete understanding. Nourishing a growing population while balancing what the Earth can provide and absorb is increasingly recognized as a major global challenge. 

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The conventional food system threatens our health and overall well-being with increased air and water pollution, toxic chemical exposure, antibiotic-resistant bacteria, soil erosion, climate change inducing greenhouse gas emissions, and loss of biodiversity. Widely held consensus among medical and public health professionals finds that today’s typical ‘diet of affluence’ contributes to a range of costly health problems, including obesity, diabetes, cardiovascular disease, cognitive decline and dementia, other neurodegenerative disorders, and various kinds of cancer.  Environmental nutrition, therefore, is a useful tool for critically analyzing the wide-reaching environmental, social, and health impacts of industrial agriculture.

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2018-2019 Publications

#LLUSPH | @LLUSPH | Publichealth.llu.edu

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