Karen Calfas Memories

By Jim Sallis

April 2019

PACE poster at Society of Behavioral Medicine. Early 1990s

This is my personal memorial to Karen Calfas Polarek as a colleague, friend, and fan. On the very sad occasion of her early death on March 7, 2019, it gives me relief and pleasure to have the chance to bring back many happy and warm memories. For a biography and family photos, see her obituary at https://www.dignitymemorial.com/obituaries/encinitas-ca/karen-calfas-polarek-8200170.

[I apologize in advance about the length of this piece, but I knew Karen over 30 years and was inspired to share many memories.]

Student years in San Diego I met Karen during her first year in the UCSD/SDSU Joint Doctoral Program in Clinical Psychology (JDP). It was also the very first year of the JDP, in the middle of the 1980s. Along with the rest of her class, Karen showed a lot of courage by being willing to endure the difficulties of being pioneers. Predictably, chaos was a constant companion as this first class progressed through the program, because the two universities had to agree on, and work out procedures for, Everything. It did not take long to notice one of Karen’s most notable traits that I always admired. I’ll call it grace under pressure, but she exuded grace and equanimity all the time. She almost never complained about the confusion, delays, and changes of plans, but she did laugh about them. For a young person, she seemed so wise and composed. I instantly liked and respected her, and that appreciation only grew over time. Though Dr. Bob Kaplan was her primary mentor, he was generous enough to let her make decisions about working with a variety of supervisors on specific projects, and that was a big benefit to me.

I believe the first project we worked on together was the Preventive Cardiology Clinic. This is when I was in the UCSD Department of Pediatrics, and Dr. Mike Criqui had just obtained a Preventive Cardiology teaching grant from NIH, with the goal of increasing content on prevention during medical school. A requirement of the JDP was for students to work for 2-3 months with a succession of faculty members to build a breadth of experiences. Fortunately, she chose me. One of my tasks was to help develop a Preventive Cardiology Clinic that medical students and residents could co-lead for hands-on learning about behavior change. Karen and I took the lead in developing a brief curriculum that would fit into a 4-week placement. It was not ideal for creating long-term behavior change, but it was meant to fulfill both clinical and teaching goals. Karen and I jointly designed the curriculum and critiqued each other’s drafts of the leaders’ manual and patient materials. We also developed an evaluation plan. She and I co-led the first version of the clinic, then she rotated to another supervisor, and the clinic continued for several years. Karen played important roles in writing the paper on the evaluation of the clinic.

I don’t recall how Karen got involved in the next project, but it may have been on a similar short rotation the next academic year. I was working with Dr. Phil Nader on a study of eating and physical activity in young children, and we needed to develop several measures. Karen played a key role in developing measures of health knowledge and preference for specific foods and activities. Our strategy was to pair photos of less- and more-healthy foods and activities, and ask the children which one was healthier and which they liked better. Karen took the photographs, because that was one of her skills. The study was published in 1991, and though the results were not particularly encouraging, there is still interest in the measure. I received a request for the measurement materials the month Karen passed away. As always, her work performance was very professional, and she took the initiative to contribute many good ideas.

Karen was literally the first graduate from the JDP. She then went on clinical internship to Brown University in Rhode Island. This pleased me, because that was where I went. There, she met Dr. Bess Marcus, which started another long and productive relationship. During her internship year, Dr. Kevin Patrick responded to a call for proposals from the Centers for Disease Control and Prevention to develop materials to assist primary health care providers to counsel their patients to become more active. Kevin was Director of Student Health Services at SDSU at the time. I had just moved to the Department of Psychology at SDSU, so he recruited me to work on this proposal, along with pediatrician Dr. Barbara Long. We were successful and won the small grant. We needed to hire a behavioral scientist, and I enthusiastically recommended we make an offer to Karen, because I had such confidence in her abilities. Kevin sweetened the deal with a permanent position as head of health promotion at Student Health Services. To our delight, Karen accepted the offer and moved back to San Diego. She remarked later that this one-year position turned into a 30-year career. Actually, it was two 30-year careers as I summarize below.

The PACE Saga The physical activity counseling project became known as PACE. There are many projects with this name, but ours originally stood for “Physician-based Assessment and Counseling for Exercise.” Karen played a crucial role in conceptualizing and writing the manual and training materials. To pilot-test the program in diverse clinical settings we enlisted Bess Marcus and colleagues so we could have sites in San Diego and Providence. The encouraging findings led us to obtain another grant to conduct a controlled trial. The study showed strong short-term effects of the counseling among people who were inactive but ready to become active. We presented and published our results, and they attracted some attention. This early-1990s work continues to have an effect. A month after her death, I was at an obesity workshop at the National Academy of Sciences building in Washington, DC when a presenter cited two of her papers.

Our attempt to obtain another grant to disseminate the program to many clinics was not successful. I think we were ahead of our time because the field of “dissemination and implementation” research did not exist. We offered some professional societies the opportunity to adopt the program as their own and disseminate it among their members, but there were no takers.

PACE symposium group at American College of Sports Medicine. 1990s

Since no one else was interested in our evidence-based program, we decided to disseminate it ourselves. We started a company for this purpose, which we initially called the San Diego Center for Health Interventions (CHI), in collaboration with the SDSU Foundation. This is when we got to know Karen’s father, John. He was a corporate attorney and helped us set up a company as a pro bono case. He was a patient but tough teacher who asked us questions about what we wanted to accomplish and how we wanted the company to end. Karen’s family was extremely important to her, and they were fascinating to me. Her Greek father and Norwegian mother touched on some cultural stereotypes. He was more boisterous and extroverted, and I could see his influence in her ready smile and willingness to befriend everyone. Her mother was more reserved, and Karen’s calm demeanor and warm interactions must have come from her.

PACEplus group, including colleagues from Brazil. 1997

The company was set up to sell PACE manuals, conduct trainings of health care providers, and consult on implementation in clinics. We had a handful of contracts. Though the business was not booming, Karen and I made a few trips to conduct trainings that I remember well. We had a contract with the Veterans Administration in Buffalo, New York. The training went well, and we took a side trip to see nearby Niagara Falls. What was most meaningful to me were the long flights. I learned about her family’s substantial involvement in leadership of the Lutheran Church in Los Angeles, where she grew up. I believe one of her relatives was a bishop. This helped me understand how deep her values were, where her integrity came from, and why she treated people with such kindness.

One of most enjoyable contracts was with the Japanese company, Omron. Karen, her husband Tom, and I had a great trip to Japan for consulting and training. Yukio Yamaguchi, on left, translating the materials and conducted an evaluation study. Tokyo and Kyoto, January 2001

During the early 1990s Kevin Patrick spent a couple of years in Washington, DC working at the Office of Disease Prevention and Health Promotion. His goal was to make greater use of technology for prevention. When he returned he led the effort to turn the paper-based PACE materials into a computer-based system. Kevin led two additional grants from CDC in the mid-1990s to develop and evaluate computer-based systems to assess diet and physical activity behaviors that would support provider counseling for adults and adolescents. This was the beginning of a series of grants that used increasingly sophisticated technology as the internet became more powerful and smartphones exploded on the scene. These grants were initially based at SDSU until Kevin moved to UCSD. Karen was an important contributor to all of them, while my involvement diminished over the years.

We still had a vision of using our business to disseminate the technology-based interventions we were developing. We also wanted to develop products through the business. So we changed the nature of the corporation and became SanTech (note the name incorporates sante, French for health—credit to Kevin). For many years SanTech survived on SBIR (Small Business Innovation Research) grants from NIH, and we developed some promising products. We became more professional, hired technology experts, and recruited a CEO. The company had ups and downs, but it lasted for over 15 years. Though there was interest in some of the products and we had multiple contracts, we were never profitable, so we dissolved the business in the early 2010s.

SanTech holiday party, with Marion Zabinski and Karen’s young children. December 2008

The most enjoyable part of the business for me were the regular meetings, which for years were my primary point of contact with Karen. She would bring good cheer to every meeting and lift my spirits, no matter what was happening with the company. We had many tests of her ability to maintain “grace under pressure,” and she never disappointed. My respect and admiration for Karen only grew as she provided calm guidance for the business, while managing her main career in student health and enjoying family life. It was comforting that even when the business was falling apart, Karen, Kevin, and I never had acrimonious moments. I think Karen’s cool head deserves much of the credit.

Though research was a secondary focus of her career, she was highly successful at it. She has at least 111 scientific publications, which is remarkable given her other duties and interests. Many of these publications resulted from her mentoring of doctoral students, and you can be assured Karen was a sought-after mentor, because word got around about her skillful and supportive approach. I counted my joint publications with Karen and was pleased to find 61, ranging from 1990 to 2018. Early in her career she played leadership roles on projects, such as with PACE and GRAD, but later, she was in demand mainly as a collaborator. She remained involved in Kevin Patrick’s ever more sophisticated studies of technological applications, often serving as the lead behavioral scientist to make sure the interventions were well grounded in theory, evidence, and practicality.

Speakers at the Cooper Institute Conference on Physical Activity Interventions. Dallas, TX. 1997

After the intervention meeting we went out for country music. Karen’s entourage includes Kevin Patrick, Claudio Nigg, Rod Dishman, Neville Owen (hiding behind Karen), Nick Cavill, Brian Oldenburg, Greg Norman, and me. Dallas, TX. 1997

Dedication to Student Health The second career that began the year Karen returned to San Diego in 1990 was as a champion of, then leader for, student health. As Director of Health Promotion at SDSU Student Health Services, she jumped into the role enthusiastically and with professionalism. She built up student engagement activities and adopted evidence-based approaches whenever possible. After nearly 20 years at this position she moved in early 2009 to UCSD where she was appointed Assistant Vice Chancellor for Student Wellness. The folks at UCSD were wise to recognize Karen’s many talents as a student health visionary, effective leader, mentor, and researcher. Even with her expanded duties, she stayed involved in the studies that grew out of PACE. A few years ago, she was promoted to be Executive Director of Student Health and Wellbeing, within UCSD Health. This was a very responsible position, and one of her achievements was designing an expanded Student Health Center for the planned Trident Pavilion. It will now be named after her.

Inspired by Karen’s rapidly growing expertise in student health, in 1992 I invited her to develop an NIH proposal with me that would prepare university students to continue active lifestyles in the transition after graduation. We jointly developed the proposal with some wonderful colleagues, shown below. We had a chance to present our ideas and answer questions from the NIH review panel in Washington, DC. Of course, with Karen’s charm and brilliance on our side, the reviewers could not refuse us. This became Project GRAD, and it was a constant pleasure to work with Karen on the development and evaluation of the interventions. I learned a great deal from her during this project, about student health issues, navigating the SDSU administration, and being an effective team leader. Though the intervention had disappointing results, it was scientifically productive, and we all had a very positive experience.

The GRAD team at SDSU. Celebrating someone’s birthday. 1994

Family Above All Karen’s enduring passions were student health and her family. She was always speaking about her family of origin, and her love for her parents and siblings was evident. She was proud of what her siblings were doing. She was fortunate to find a caring and devoted husband, Tom Polarek. He instantly recognized how lucky he was to win the love of such a wonderful person. Their two children, Jonathan and Jordan, are a delightful legacy of their parents’ love for each other. The video presentation of photos on the online obituary is bursting with the joy of their family life.

A Personal Tribute Karen was not only one of my most valued collaborators, she was a treasured friend. I said numerous times in public that she was one of my favorite people in the world. So many superlatives describe her as a psychologist, collaborator, mentor, and business partner. But most importantly, she was a superior human being. I always felt good being around her, and I felt better as a person after a talk with her. I was not alone in holding Karen above almost everyone else. Her kindness was very apparent, her smile could dissolve a foul mood, and her words of wisdom or comfort stayed with you. That’s why Karen was beloved by virtually everyone who came in contact with her.

It was devastating when she told me she was diagnosed with advanced cancer. It seemed so unjust. She was too young. Too vital. Too good a person. She had more to give the world.

She lived for several years, and she was always the Karen everyone loved and respected. Focusing on the positive. Appreciating every moment of life. Looking beyond the periodic cancer treatments. Using her limited energy to fulfill her mission of improving student health. Intensifying the love of her family. I like to say her “Karen-ness” was undiminished.

Not wanting to take time away from her work and family, I did not see her very often after her diagnosis. But every encounter was special. During a lunch together she inspired me as she described her approach to savoring every minute. That is one of most important lessons of life, and she was putting it into practice beautifully. I was amazed at her positivity when she said she would “routinely” join meetings by phone while she was getting a chemotherapy infusion.

There were two special moments that I will always treasure because they spoke to her qualities as a special friend, that I tried my best to reciprocate. Both happened after her diagnosis. In 2016 my wife Shemi passed away. Even though it was risky for Karen to be around groups of people, due to her compromised immune system, she came to the gathering at my home after Shemi’s funeral. She was thin and looked weak, but her smile was as big as ever, and her eyes were bright. Her presence was a great comfort to me that I appreciated. The other moment was a small party for my retirement in 2017 on the UCSD campus. I was so happy to see her. I paid tribute by saying she was first doctoral student I worked with, and she set the bar very high. She said some kind things about me that touched me deeply. That was the kind of person Karen was, until the end. Not even cancer could dim her inner glow.

Karen’s passing was a special moment as well. Karen was a frequent attendee at the Society of Behavioral Medicine (SBM), and she had many friends who looked forward to seeing her there. Karen was a charter member of a small group of physical activity researchers who had a long-standing tradition of a dinner at SBM. In the past few years, she could not attend, so we drank a toast to her well-being and sent her pictures of the outings. At this year’s 2019 SBM meeting in Washington DC I learned through Kevin Patrick that Karen was very sick and was not expected to survive. I informed some of her close friends, and we talked of our hopes for her comfort and our wonderful memories of Karen. At the dinner of our physical activity group we gave tributes to Karen and sent her the third photo below. The next day we learned that she had died the day of our dinner.

Karen and friends enjoying some nightlife after SBM conference. San Francisco 1997.

Physical activity dinner group at SBM. 2015

Physical activity dinner group at SBM waving our good wishes to Karen. Washington, DC. March 7, 2019

Honoring Karen After returning home from SBM I could not find contact information for Tom, so I was very pleased when he called me a few days after her death. He told me that her passing was a beautiful moment. She was at home and surrounded by the love of her family, including her two children. Tom said it was a “magnificent” end to Karen’s life. She was poised and prepared as always, and her family was ready to see her pain and suffering end.

I had to tell Tom I was not able to attend Karen’s memorial service because of a planned trip to Australia. He said they were expecting hundreds of attendees, and I heard it was a memorable event to see the outpouring of affection from so many people. This write-up of my memories of her is my attempt to honor Karen and help others appreciate some of the special times I had with her over 30 years.

It was not a secret that Karen was a special person. Almost everyone she encountered was touched in some way. Not surprisingly, there are several plans getting started to honor her. Her boss at UCSD, Patty Maysent, is organizing a Foundation in her name to support student health. The new student health center at UCSD will be named after her. During the SBM meeting several of her colleagues/friends/admirers discussed raising funds for an award in her name. As I write this I am planning to meet with Tom to discuss some ideas for ways to keep Karen’s memory alive in a way that benefits others. [l will post an update on my website as plans are solidified.]

The world has lost a calming and uplifting presence, and we have all lost an irreplaceable friend and colleague. But Dr Karen Calfas Polarek improved the lives of everyone she contacted, and we have our memories of her to cherish.

Dori Rosenberg’s graduation. June 2010