Research
My research examines how structural/social contexts and life course stressors impact perinatal, mental, and other health outcomes and seeks to clarify how these forces contribute to health inequities across time and generations. In other work, I interrogate how new types of data and methods can expand research to rare and hard-to-reach populations. I detail select ongoing and completed projects below.
Structural and Social Determinants of Health Inequities
My primary line of research considers the structural and social determinants of (perinatal) health and related inequities. I incorporate theories of reproductive justice, symbolic empowerment, and fundamental cause to interrogate how structural and social contexts contribute to enduring racial-ethnic and geographic inequities in birth and health outcomes across the US. Together, these studies emphasize the importance of policies, symbolic meanings or values, and localities in perpetuating health inequities and suggest that changing these contexts can mitigate or exacerbate inequities over time.
In an ongoing, sole-authored paper (draft available upon request), I leverage the pre-Dobbs (2005-2017) Texas environment to explore how birth and infant health outcomes vary alongside a state’s rapidly evolving reproductive health environment. I focus on two sets of laws: 2011 legislation limiting the funding of family planning clinics and 2013 legislation targeting, and reducing the number of, abortion providers across the state. Using demographic standardization and decomposition techniques, I find that the real rates of infant mortality spiked among NH Black births in the year following the 2011 laws limiting family planning funding. Compositional changes and real rate changes among other racial-ethnic groups are not evident. All groups see small 1-year increases in real low birth weight rates in the year following the 2013 legislation. Results demonstrate that restrictions on family planning funding--a reproductive health resource currently under threat--may have particularly deleterious effects on standardized Black infant mortality rates, thus exacerbating health inequities.
In addition to policies, symbolic changes in the political environment may also shape perinatal health. In a first-authored paper (published in Social Science and Medicine), I situate the 2008 Obama Presidential campaign and electoral win in the symbolic empowerment framework to consider the potentially salubrious perinatal impacts of the election of the first Black US President. Using a novel measure of fetal death--male twinning rates--and interrupted time series analysis, results suggest a significant reduction in susceptibility to fetal loss among NH Black male twin cohorts conceived during the 2008 campaign. These findings underscore the symbolic importance of elections and join growing work demonstrating the potential for sociopolitical contexts to mitigate racial-ethnic health inequities.
A collaborative project (published in SSM-Population Health) integrates data on county characteristics from multiple sources to demonstrate how the relationships between county-level overcrowding and poverty rates and COVID-19 mortality rates vary across three theoretically-motivated periods of the pandemic. Results suggest that the relationship between overcrowding and mortality is positive and changes non-linearly over time. These findings underscore the need for policymakers to consider the ever-changing dynamics between local contexts and COVID-19 and other health outcomes, as social disparities are likely to change with advancements in knowledge and disease spread.
In another body of work, I examine how individual-level stressors shape health and birth outcomes, focusing on heterogeneity across multiple dimensions of socially constructed identities and life course stages. These studies center on theories of cumulative disadvantage, sensitive periods, and social identity. They also emphasize the need for health stratification studies to incorporate an understanding of timing and heterogeneity within race-ethnicity to improve our understanding of how social conditions shape inequities.
In an ongoing sole-authored paper (draft available upon request), I extend the weathering hypothesis to examine if the risk of low birth weight differs across maternal age and skin tone—a marker of exposure to a unique dimension of discrimination. Results suggest that, despite similar risk of low birth weight across skin tone at maternal age 16, risks diverge with age. Black mothers with the darkest skin tones experience the steepest increases in risk. These findings underscore the importance of considering heterogeneity both within race and across life course stages when studying health inequality.
Other work examining the linked lives of parents and their children (published in Journal of Health and Social Behavior) shows that the relationship between parental death and mid-adulthood depressive symptoms varies by the child's life course stage at the time of death and the bereaved parent's gender. In particular, the loss of a mother in childhood or a father in early adulthood has long-lasting consequences that increase the risk of poor mental health in mid-adulthood.
A first-authored paper (published in SSM-Mental Health) leverages social identity theory to explore how COVID-19-related experiences of perceived discrimination and racism-related vigilance shape generalized perceptions of stress among Chinese immigrants in the Raleigh-Durham area of North Carolina, and how those relationships vary by strength of ethnic identity. Results suggest that racism-related vigilance significantly predicts higher perceived stress among only those identifying as completely Chinese, while new perceptions of being feared by others significantly predict higher perceived stress among only those identifying as at least partly American.
Social Positioning, Stressors, and Life Course Helath
New data & techniques to forward population health research
I have worked on several research projects that examine social scientists' ability to use new types of data or data collection methods to make population inferences about small and hard-to-reach populations. Findings from a collaborative, innovative data collection project (published in Demography) support social scientists' ability to use network sampling with memory for population research, which can forward both social policy and population health research among small and hard-to-reach populations. A separate first-authored manuscript (published in Social Science and Medicine) estimates the proportion of local children captured in the Duke University Health System's Electronic Health Records (EHRs) and examines the suitability of using EHR data to study local child population health. Findings suggest that EHRs from a large health system can be used to assess local children's health, but that analyses should account for differences in capture rates (i.e., rates of local children included in the EHRs) by census tract characteristics.
In an ongoing, first-authored manuscript (draft available upon request), I explore the many ways that county-level racial disparities can change over time and offer a framework for categorizing and studying disparity changes in future work. For example, I demonstrate that about half of all county decreases in NH Black-NH white disparities in preterm birth between 1995-1999 and 2015-2019 were driven by increasing NH white risks of preterm birth. The paper then offers four unique typologies of disparity change that account for the underlying trends among both NH Black and NH white births. By organizing counties into these four typologies, we identify counties demonstrating: (a) health equity improvements (i.e., counties showing simultaneous population health improvements and disparity decreases), (b) counterintuitive risk increases, (c) uneven progress, and (d) universal harm.
Program & policy evaluations
As a researcher at the Urban Institute, I worked on several program evaluations that sought to understand how job training and health-related programs improved individuals' well-being. For example, interim evaluations of the Health Profession Opportunity Grant (HPOG) found that most participants remained in or completed their health care training programs or were employed one and two years into the program. An RCT study of a mentoring program (Promotor Pathway program) at the Latin American Youth Center in DC found that youth in the treatment group (i.e., received mentoring) were more likely to remain in school, were less likely to have a child, had higher rates of housing stability, and were more likely to report having a special adult in their life compared to youth in the control group. An evaluation of the Teen ACTION program in New York City, which sought to reduce risky behaviors among teens, found that teens largely benefited from the program and its encouragement of self-reflection. My work on these projects included training 32 US-wide grantees on data entry procedures and managing and analyzing program data for interim reports (HPOG), conducting qualitative interviews and focus groups and analyzing data for program evaluations (Teen Action), and using program data to conduct quantitative analyses (Promotor Pathway program).
I also worked on the Mapping America's Futures project, which estimated possible population growth scenarios for commuting zones across the US between 2010 and 2030.