Publications

Recent trends in US government healthcare & behavioral health workforce departures.

Healthcare and behavioral health professionals employed by local, state, and federal governments are essential to maintaining public health infrastructure, ensuring access to care, and responding to emergencies. Despite their importance, limited research has examined how recent policy, budgetary, and labor market changes are influencing their employment stability and retention within government sectors.

Health affairs scholar

Integrating child mental health responses into recovery, development, and peacebuilding in fragile and conflict affected settings.

BMJ (Clinical research ed.)

Accessibility, acceptability, and usage during COVID-19 of the evidence-based intervention Healthy Eating and Active Living Taught at Home (HEALTH): implications for implementation strategies.

The international journal of behavioral nutrition and physical activity

Embracing complexity and innovation to tackle the social determinants of health.

BMJ global health

Short and disrupted sleep is related to perceptions of neighborhood in pregnant African American women of low socioeconomic status.

Poor sleep is linked to increased pregnancy complications. African Americans disproportionately reside in disadvantaged neighborhoods with higher crime and traffic, and are more likely to experience poor sleep compared to Caucasians. This study aims to evaluate the relationship between neighborhood environment perceptions and sleep in African American pregnant women of low socioeconomic status (SES).

Public health in practice (Oxford, England)

Internalized stigma among pediatric patients with osteosarcoma and retinoblastoma in Guatemala, Jordan, and Zimbabwe.

Internalized stigma adversely impacts childhood cancer survivors, limiting their ability to reintegrate with their communities and maintain social networks. However, the impact of internalized stigma on children undergoing cancer treatment is unknown, and no interventions exist to mitigate it. The Activating Events-Beliefs-Consequences (ABC) model from Cognitive Behavioral Theory (CBT) has been used to analyze internalized stigma and inform interventional work. This study employs the ABC model as a conceptual framework to explore how internalized stigma manifests for children recently diagnosed with osteosarcoma and retinoblastoma in Guatemala, Jordan, and Zimbabwe.

Frontiers in oncology

A Content Analysis of Physical Activity and Priority Climate Action Plans Across US States.

Climate change and physical inactivity are urgent public health challenges with intersecting effects on health, environmental sustainability, and community resilience. Physical Activity Plans (PAPs) and Priority Climate Action Plans (PCAPs) provide strategic frameworks for advancing both agendas. This study aimed to identify opportunities to leverage physical activity as a strategy for climate mitigation and adaptation and to recommend coordinated actions for policy and practice.

Journal of physical activity & health

Perceived HIV Risk, Barriers, and Preferences for HIV Testing in Structurally Vulnerable Communities in St. Louis: A Best-Worst Scaling Survey.

BackgroundPersistent gaps in efforts to end the HIV epidemic in the United States highlight the need for community-specific, evidence-based HIV testing strategies. This study investigated barriers and preferences around HIV testing among underserved populations, including Black, queer, and young adults in the St. Louis, Missouri area.MethodsWe conducted a Best-Worst Scaling (BWS) survey with adults (16+ years) recruited at community events, collecting responses electronically and providing a $25 incentive. The survey assessed the relative importance of 13 potential barriers to HIV testing such as stigma, structural barriers, and perceived HIV risk, chosen based on literature review and community input. Mean preference weights (MPWs) were derived from participants' most and least selected barriers in a set of 13 choice tasks and rescaled using Hierarchical-Bayes estimation. We applied latent class conditional logit models to explore variability in preferences among participants.ResultsAmong 152 participants, 53% identified as women, 39% as men, and 7% as nonbinary; 49% identified as Black, with a median age of 29 years (IQR: 23-37). Additionally, 49% identified as nonheterosexual. The most prominent barrier to testing was low perceived risk for HIV (MPW: 13.9; 95% CI: 12.5-15.2). Black participants reported lack of trust in testing organizations and the absence of peer encouragement for testing as significant barriers compared to White participants (P = .03, P = .003). Queer participants identified stigma, limited access, and fear of a positive result as more critical barriers than their heterosexual counterparts (P < .001, P = .023, P = .004). Latent class modeling identified 2 distinct groups: (1) "Low-risk perceivers" (67%) who emphasized low perceived risk of HIV (MPW: 16.7, 95% CI: 15.4-18.1) and lack of healthcare provider recommendation (11.9, 95% CI: 10.7-13.2), and (2) "Stigma avoiders" (33%) who were concerned about stigma (17.1, 95% CI: 16.0-18.3) and fear of a positive diagnosis (16.1, 95% CI: 14.5-17.8).ConclusionsThis BWS analysis provides insights into HIV risk perception and testing barriers among affected communities in the St. Louis region, revealing that low perceived HIV risk and social stigma are substantial deterrents. Tailored HIV testing initiatives should be developed to address these barriers and improve testing uptake across diverse community members.

Journal of the International Association of Providers of AIDS Care

Parenting under the triple burden of violence, depression, and poor diet quality: An intergenerational mother-child syndemic in Nepal.

Parenting while experiencing intimate partner violence (IPV), depression, and poor diet quality can contribute to child health inequities. Syndemic theory offers a framework to understand how maternal conditions can lead to inequitable child health outcomes, such as diarrheal disease: a risk factor for childhood mortality and stunting. This study uses the 2022 Nepal Demographic and Health Survey to test an intergenerational syndemic model addressing three key questions: (1) Do IPV, depression, and absent dietary iron intake co-occur among mothers? (2) Does the probability of child diarrhea increase with concurrent maternal exposures to these three factors? (3) Are these relationships stronger in disadvantaged households? The analysis included 2,019 mother-child dyads. Interaction models on additive and multiplicative scales were constructed to predict child diarrhea as a function of maternal syndemic exposures, accounting for complex survey design. The prevalence of single exposure to IPV, depression, and absent dietary iron intake was higher among mothers in poorer households. In disadvantaged households (two lowest household wealth quintiles), children's odds of diarrhea were higher when mothers experienced syndemic vulnerability (IPV, depression, and absent iron intake) on multiplicative (aOR=1.321, 95%CI:1.000, 1.745) and additive scales (B = 0.027, 95%CI:-0.002, 0.055). Household disadvantage may exacerbate the synergistic effects of IPV, depression, and iron deficiency, increasing the likelihood of child diarrhea. Interventions targeting these maternal health adversities in disadvantaged households may reduce the impact on child health.

PLOS global public health