About

Ralph Garcia has over 20 years of experience in project management, successfully leading large-scale, complex programs worldwide from concept to deployment in industries such as aerospace and defense, medical technology, communications, and transit. He has served as Vice President of Program Management at both L-3 Communications and Benchmark Electronics, and has held executive-level roles at Becton Dickinson and Raytheon. Ralph holds a Doctorate in Public Administration from the University of La Verne, an MSc in Major Programme Management from the University of Oxford, an MS in Systems Architecture and Engineering from the University of Southern California, and an MS in Medical Informatics from Northwestern University. Additionally, he has earned an MBA from Pepperdine University and an MS in Aeronautical Science from Embry-Riddle Aeronautical University. His research interests include adaptive systems for complex program environments.

Research topics

• Medicine

Selected publications

• Acknowledgments

  New York University Press eBooks · 2022

  • Medicine

  Many people helped in this project, and in many different ways.

  DOI

• The Effects of Health‐Related Policy

  The Wiley Encyclopedia of Health Psychology · 2020-09-02

  other1st authorCorresponding

  Many policies are enacted by the different levels of government in the United States in order to ensure a healthy population. The creators of these policies hope that they will help to also decrease the burden of disease. A successful example of this is tobacco-related policies, which have significantly decreased tobacco use behaviors. There were several historical iterations of tobacco policies necessary to eventually lead to this change. The history surrounding the regulation of tobacco is decades long and can provide lessons for the creation of policy regarding other areas of health.

  PublisherDOI

• Comparison of e-cigarette marketing and availability in tobacco retail outlets among diverse low-income communities in California

  Tobacco Control · 2019-07-19 · 11 citations

  articleOpen access

  OBJECTIVE: Research examining marketing and availability of electronic cigarettes (e-cigarettes) within tobacco retail stores is limited, especially among vulnerable communities. However, tobacco retailers tend to be the first point of access to e-cigarette exposure, especially among youth. In response, store observations were conducted among tobacco retailers across five ethnically diverse, low-income communities. DESIGN: Trained community health workers recorded the presence of e-cigarette products, marketing, self-service displays, product pricing and product placement in the tobacco retail environment across American-Indian Tribal lands in California (n=96) and low-income African-American, Hispanic/Latino (HL), Korean-American (KA) and Non-Hispanic White (NHW) communities in Southern California (n=679) from January 2016 to January 2017. Store characteristics and pricing were analysed by ethnic community. RESULTS: Compared with retailers in NHW communities, retailers across all other communities were less likely to sell e-cigarette and flavoured e-cigarette products and were less likely to have self-service displays. Compared with retailers in NHW communities, retailers across all other communities were less likely to have e-cigarettes placed near youth-friendly items, while retailers in KA and HL communities were less likely to have exterior advertising compared with retailers in NHW communities. CONCLUSIONS: Findings indicate differences in e-cigarette availability and marketing by ethnic community. In addition, placement of products and marketing that expose youth to e-cigarette and other tobacco products within the retail environment should be restricted and regulated by policymakers and tobacco regulatory agencies to reduce the burden of tobacco-related diseases among vulnerable populations.

  PublisherOA PDFDOI

• Environmental issue conceptualization by race, ethnicity, and socioeconomic status (SES)

  2019-06-25

  articleOpen access

  <p>This project was a collaboration involving researchers from Purdue University, Cornell University, the Environmental Defense Fund, Yale University, and Pomona College. The aim of the study was to find how various social groups of different race, ethnicity and socioeconomic status have different conceptualizations of what constitutes an environmental issue. More specifically, racial/ethnic minorities and lower-income groups face disproportionate environmental risks, which may hold implications for how different segments of the public construe environmental issues.</p> <p>We explored this possibility with a racially and socioeconomically diverse online sample of 1,191 U.S. adults, hypothesizing that, relative to White and higher-SES respondents, non-White and lower-SES respondents would report perceiving a greater number of pressing societal issues as “environmental.” Across 18 issues ranging from more <em>ecocentric</em> (e.g., climate change, industrial pollution), reflecting physical environmental hazards, to more <em>anthropocentric</em> (e.g., poverty, lack of access to grocery stores), reflecting social determinants and consequences of environmental risk, non-Whites and lower-SES respondents perceived them as more environmental. These differences were larger among anthropocentric issues and appear to be mediated by environmental justice concerns. Results hold implications for the measurement of environmental attitudes and efforts to promote collective action in racially and economically diverse populations.</p>

  PublisherOA PDFDOI

• Impact of Litigation on Compliance With California Physical Education Laws in Elementary Schools

  Journal of Physical Activity and Health · 2018-06-06 · 22 citations

  article

  BACKGROUND: School physical education (PE) is one of the most effective public health tools to increase youth physical activity, yet compliance with PE mandates is low. In an effort to ensure adherence to state PE law, a 2013 lawsuit was filed against 37 California school districts that were found to be noncompliant. This study sought to assess school personnel's perceptions of the lawsuit's impact on PE mandate compliance, understand barriers and facilitators to lawsuit compliance, and identify potential unintended consequences of the lawsuit. METHODS: Phone interviews (n = 97) were conducted with personnel in districts/schools that were parties to the lawsuit and in matched control districts/schools that were not parties to the lawsuit. RESULTS: Interviewees reported that PE minutes increased in schools that were parties to the lawsuit, primarily due to settlement requirements mandating PE tracking and reporting, thereby increasing accountability for PE. Time lost on paperwork was the most often cited barrier to compliance. Unwillingness to participate in PE-related research for fear of incrimination was the primary unintended consequence. CONCLUSIONS: When existing PE minute laws are not implemented or enforced, greater accountability is needed. In this case, litigation appears to be an effective accountability mechanism to increase compliance with law.

  PublisherDOI

• A Descriptive Longitudinal Study of Changes in Vape Shop Characteristics and Store Policies in Anticipation of the 2016 FDA Regulations of Tobacco Products, Including E-Cigarettes

  International Journal of Environmental Research and Public Health · 2018-02-11 · 22 citations

  articleOpen access

  After proposing the "Deeming Rule" in 2014, the U.S. Food and Drug Administration (FDA) began regulating the manufacturing, marketing, and sales of electronic cigarette (e-cigarette) products as tobacco products in 2016. The current study conducted vape shop store observations and surveyed Los Angeles-area shop employees (assessing their beliefs, awareness, and perceptions of e-cigarettes and related FDA regulations) at two time points one year apart to better understand what vape shop retailers would do given FDA's soon-to-be-enacted Deeming Rule. The study also compared retailer beliefs/awareness/actions and store characteristics immediately after the Deeming Rule proposal versus a year after the Rule had been proposed, right before its enactment. Two data collection waves occurred before the Deeming Rule enactment, with Year 1 surveying 77 shops (2014) and Year 2 surveying 61 shops (2015-2016). Between the data collection points, 16 shops had closed. Among the shops that were open at both time points, the majority (95% in Year 1; 74% in Year 2) were aware of some FDA regulations or other policies applying to vape shops. However, overall awareness of FDA regulations and state/local policies governing e-cigarettes significantly decreased from Year 1 to Year 2. At both time points, all shops offered customers free puffs of nicotine-containing e-liquids (prohibited by the then upcoming Deeming Rule). Perceptions of e-cigarette safety also significantly decreased between the years. Exploring vape shop retailer perceptions and store policies (i.e., free puffs/samples displays, perceptions of e-cigarette safety, etc.) over time will help the FDA assess the needs of the vape shop community and develop more effective retailer education campaigns and materials targeted to increase compliance with the newly enacted regulations.

  PublisherOA PDFDOI

• Vape shop retailers’ perceptions of their customers, products and services: A content analysis

  Tobacco Prevention & Cessation · 2017-05-11 · 17 citations

  articleOpen access

  INTRODUCTION: The popularity of electronic cigarettes (e-cigarettes) has spurred the growth of vape shops, but little is known about the retailers who may play an important role in the introduction and dissemination of vape products. In this paper we examine how retailers profile their customers and their perceptions of vaping, and the services their shops provide. METHODS: Semi-structured interviews were conducted with a convenience sample of retailers (n=77) located across southern California. Open-ended questions were coded and analyzed using a content analysis approach. RESULTS: Three themes emerged from the content analysis: who vapes, why people vape, and the vape shop environment. Retailers profiled customers as friendly, health conscious, and interested in tobacco cessation or cessation maintenance. Retailers believed e-cigarettes were used recreationally or as products that help curb other addictive behaviors. While most retailers reported positive experiences with vaping, some reported potentially negative experiences including failed cessation attempts, dual use of e-cigarettes and combustible cigarettes, and increased nicotine dependence. Retailers reported that they regularly answer questions about vaping and believe their shops function as social lounges that are tied to other recreational activities. CONCLUSIONS: Retailers attach certain characteristics to their clientele, perceive certain health benefits associated with vaping, and seek to establish their shops as places that provide guidance on vape products as well as shops with a recreational aesthetic. As vape shops grow in popularity, additional research on, and regulation of, these retailers will be necessary. Education campaigns are needed to inform retailers of the benefits and consequences of vaping.

  PublisherOA PDFDOI

• Employee and customer handling of nicotine-containing e-liquids in vape shops

  Tobacco Prevention & Cessation · 2017-01-20 · 15 citations

  articleOpen access1st authorCorresponding

  Vape shops sell electronic cigarettes and related products such as e-liquids, which may contain nicotine. Direct contact with nicotine can lead to adverse health effects, and few regulations exist on how nicotine is handled in vape shops. This study examined how customers and employees come into contact with, and handle, nicotine-containing e-liquids in vape shops with the goal of informing potential future regulation of nicotine handling in vape shops. METHODS Data were collected from 77 vape shops in the Los Angeles basin. Characteristics of the shops were documented by employee interviews and in store observations. Data collection was focused on shops located in areas with high concentrations of communities of interest; 20 shops from African-American communities, 17 from Hispanic communities, 18 from Korean communities, and 22 from non-Hispanic White communities. RESULTS Half of the vape shops allowed customers to sample e-liquids with nicotine. Most of the shops (83%) provided self-service sampling stations for customers. A majority of shop employees (72%) reported that spills of e-liquids containing nicotine had occurred in the past. While 64% of the shops provided safety equipment, only 34% provided equipment for proper nicotine handling. Furthermore, 62% of shop employees reported handling nicotine without gloves or other safety equipment. CONCLUSIONS Regulation on the handling of nicotine by customers and vape shop employees is important to prevent unsafe practices and subsequent injury. The frequent occurrence of spills and limited availability of safety equipment in vape shops highlights the need for the creation and enforcement of regulations to protect employees and customers. Appropriate safety training and equipment should be provided to employees to prevent accidental exposure to nicotine. Information on ways to safely handle nicotine should be communicated to vape shop employees and customers.

  PublisherOA PDFDOI

• Marketing activities of vape shops across racial/ethnic communities

  Tobacco Prevention & Cessation · 2017-09-25 · 19 citations

  articleOpen access1st authorCorresponding

  INTRODUCTION: There has been a surge in the number of vape shops in the USA. Research on the marketing practices of e-cigarette manufacturers is scarce and even less known are the practices of vape shop retailers. Past research on tobacco marketing has shown differences in the amount and content of marketing material, based on a community's demographic profile. This study examined marketing strategies in vape shops and explored differences among vape shops located in communities that differ by ethnic composition. METHODS: Data was gathered in 2014 from a pilot-study on vape shops (n=77) in Los Angeles, which documented the characteristics of shops through employee interviews and in-store observations. Data were collected from shops located in communities that were predominantly, African-American (n=20), Hispanic (n=17), Korean (n=18), or non-Hispanic White (n=22). RESULTS: Sixty-one percent of vape shops had advertisements (print ads and posters) for e-cigarettes and 84% offered discounts. Vape shops in Hispanic communities were more likely to have ethnic specific marketing material compared to shops in other communities. All the shops provided customers with free samples, however those in Korean and non-Hispanic White communities had a significantly higher prevalence of customer accessible free samples. CONCLUSIONS: Vape shop marketing practices differed by ethnic community. A large majority of shops provided free samples to their customers, a practice which is now banned by the FDA. It will be important to monitor how vape shops will adjust their marketing strategy because of this ban. Future research should expand on the findings presented here to provide regulators with further crucial information.

  PublisherOA PDFDOI

• Abstract A10: Facebook advertisement effects on conversions and enrollment to a SMS/text smoking cessation service for young adult Latinos

  Cancer Epidemiology Biomarkers & Prevention · 2016-03-01

  article

  Abstract Evidence shows that variations in the degree and type of a message's emotional arousal, particularly disgust, can influence message impact on smokers' interest in quitting and likelihood of seeking help. Negative emotional appeals are widely used to attract attention of Latino audiences, but positive appeals, especially those designed to increase smokers' confidence in their ability to quit, are also recommended as a way to attract them to enroll in cessation services. Methods: We employed positive and negative variations in Facebook advertising appeals to study their effects on “conversions” and subsequent enrollment in a tobacco cessation service (a bilingual text messaging and mobile media service specifically targeting Latino young adults in South Texas). Differences in advertisement characteristics on conversion rate and enrollment were examined using exact Chi-squared tests for proportions and 95% confidence intervals for their corresponding odds ratios. Results: The negative advertisement received a higher conversion rate than the positive ad, with 1,441/130,000 (1.11%) vs. 1,249/130,000 (1.96%) clicking the ad to visit our service's home page (OR= 1.16, 95% CI 1.07, 1.25). But subsequent texted enrollments in the cessation service were received by 76/1,249 (5.76%) of those exposed to the positive message and 55/1,441 (3.82%) of those exposed to the negative message (OR= 1.54, CI1.06, 2.25). The former were 54% more likely than the latter to become enrolled. Conclusion: Negative-appealing advertising attracted more clicks to further information, but positive appeals were more likely to lead to subsequent enrollment. Negative advertising can gain attention and spark minor actions toward behavior change, but positive advertising appealing to the consumer's self-confidence is more likely to lead to an actual first step toward behavior change. Citation Format: Patricia Chalela, Alfred L. McAlister, Kipling J. Gallion, Edgar Muñoz, Cliff Despres, David Akopian, Arely Perez, Robert Garcia, Amelie G. Ramirez. Facebook advertisement effects on conversions and enrollment to a SMS/text smoking cessation service for young adult Latinos. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A10.

  PublisherDOI

Frequent coauthors

• Shel Levine

  Regional Medical Center

  13 shared

• C. Michael Minder

  Intermountain Medical Center

  13 shared

• Juan Carlos Soliven

  University of the Incarnate Word

  13 shared

• Mahesh Patel

  Cadila Healthcare (India)

  13 shared

• Lisa C. Colvin

  Texas A&M University

  13 shared

• Brian J. Coyne

  Duke Medical Center

  13 shared

• Lourdes Báezconde‐Garbanati

  Southern California Clinical and Translational Science Institute

  11 shared

• Jennifer B. Unger

  University of Southern California

  10 shared

Education

• Ph.D.

  University of Southern California

• M.S.

  University of Southern California

• Other

  University of Southern California