BA, Brown University, Community Health & Education Studies (2009)
MPH, University of California Berkeley, Epidemiology & Biostatistics (2012)
PhD, University of California Berkeley, Epidemiology (2017)
"Constant Stress Has Become the New Normal": Stress and Anxiety Inequalities Among U.S. College Students in the Time of COVID-19.
The Journal of adolescent health : official publication of the Society for Adolescent Medicine
PURPOSE: The purpose of this study is to document young adults' perceived stress and anxiety in a diverse sample of college students across the U.S. during the COVID-19 pandemic.METHODS: We recruited, via Instagram, a sample of full-time college students aged 18-22 from across the U.S. We surveyed them in April (baseline; N= 707; mean age= 20.0, SD= 1.3) and July (follow-up) 2020. This study presents overall levels of perceived stress and general anxiety symptoms and inequalities across each of these outcomes by gender, sexual orientation, race/ethnicity, and household income. We also explore potential explanations for these health issues by analyzing baseline qualitative data.RESULTS: All students, on average, were suffering from perceived stress and anxiety, with especially high levels in April. We also identified inequalities in college student mental well-being, particularly by gender identity and sexual orientation. Women reported worse well-being compared with men; transgender and gender diverse and sexual minority youths reported worse outcomes than their cisgender, heterosexual peers at both time points. Qualitative data illustrate how the COVID-19 pandemic has generated educational, economic, and environmental stressors that are affecting college students' well-being.CONCLUSIONS: As colleges and universities think about how to manage and mitigate the infectious disease dimensions of COVID-19 among their student populations, they must also consider who is most at risk for increased stress and anxiety during the pandemic.
View details for DOI 10.1016/j.jadohealth.2020.10.030
View details for PubMedID 33288459
Preventing maternal mortality in the United States: lessons from California and policy recommendations.
Journal of public health policy
Maternal mortality remains a large concern in the United States (US), although other Western countries are making progress. In this scoping review, we identify four problems that may contribute to the maternal mortality burden in the US: inadequately investing in women's health, poor quality of care, increasing disparities, and poor data collection and monitoring of maternal health issues. Because maternal mortality is decreasing in California, we identify strategies implemented there that could improve maternal health outcomes nationwide: funding programs to address social determinants of maternal health; supporting health care strategies to improve maternal health (including national standards and goals for health care systems); and investing in maternal health monitoring and surveillance (including use of technology). We encourage researchers, practitioners, and policymakers to work together to develop evidence-based policies and practices to improve maternal health and reduce maternal. We conclude with recommendations for the United States and globally.
View details for DOI 10.1057/s41271-020-00264-9
View details for PubMedID 33268845
- A family-centered mixed-methods needs assessment for the system of care for young children with social-emotional and behavioral concerns CHILDREN AND YOUTH SERVICES REVIEW 2020; 117
- "Allergic to the Region": A Population-Based Study of the Diversity of Health Experiences in the Industrial Zone of Marseille, France ENVIRONMENTAL JUSTICE 2020
A Descriptive Study of COVID-19-Related Experiences and Perspectives of a National Sample of College Students in Spring 2020
JOURNAL OF ADOLESCENT HEALTH
2020; 67 (3): 369–75
This is one of the first surveys of a USA-wide sample of full-time college students about their COVID-19-related experiences in spring 2020.We surveyed 725 full-time college students aged 18-22 years recruited via Instagram promotions on April 25-30, 2020. We inquired about their COVID-19-related experiences and perspectives, documented opportunities for transmission, and assessed COVID-19's perceived impacts to date.Thirty-five percent of participants experienced any COVID-19-related symptoms from February to April 2020, but less than 5% of them got tested, and only 46% stayed home exclusively while experiencing symptoms. Almost all (95%) had sheltered in place/stayed primarily at home by late April 2020; 53% started sheltering in place before any state had an official stay-at-home order, and more than one-third started sheltering before any metropolitan area had an order. Participants were more stressed about COVID-19's health implications for their family and for American society than for themselves. Participants were open to continuing the restrictions in place in late April 2020 for an extended period of time to reduce pandemic spread.There is substantial opportunity for improved public health responses to COVID-19 among college students, including for testing and contact tracing. In addition, because most participants restricted their behaviors before official stay-at-home orders went into effect, they may continue to restrict movement after stay-at-home orders are lifted, including when colleges reopen for in-person activities, if they decide it is not yet prudent to circulate freely. The public health, economic, and educational implications of COVID-19 are continuing to unfold; future studies must continue to monitor college student experiences and perspectives.
View details for DOI 10.1016/j.jadohealth.2020.06.009
View details for Web of Science ID 000564241500019
View details for PubMedID 32593564
View details for PubMedCentralID PMC7313499
Association of Adult Depression With Educational Attainment, Aspirations, and Expectations
PREVENTING CHRONIC DISEASE
2020; 17: E94
Social factors across one's lifespan may contribute to the relationship between low educational attainment and depression, but this relationship has been understudied. Previous studies assessing the association between educational attainment and depression did not fully account for prior common determinants across the life course and possible interactions by sex or race/ethnicity. It is also unclear whether the link between educational attainment and depression is independent of the role of aspired educational attainment or expected educational attainment.We used generalized linear log link models to examine the association between educational attainment at age 25 and depression at age 40 in the National Longitudinal Survey of Youth 1979 cohort, adjusting for confounders and mediators from childhood, adolescence, and adulthood.Members of each educational attainment group were less likely to be depressed at age 40 than those with less education. After adjusting for educational aspirations and educational expectations, the risk ratios became closer to the null. Neither sex nor race/ethnicity interacted with educational attainment. Additionally, low educational expectations in adolescence, but not low educational aspirations, was associated with a higher risk of depression at age 40.Our study provides a nuanced understanding of the role of education, educational expectations, and educational aspirations as part of education's effect on risk of depression after controlling for a thorough set of confounders and mediators. Our findings may help advance the study of social determinants of depression.
View details for DOI 10.5888/pcd17.200098
View details for Web of Science ID 000573066000001
View details for PubMedID 32857033
View details for PubMedCentralID PMC7478148
Use of Research Evidence Generated by Youth: Conceptualization and Applications in Diverse US K-12 Educational Settings
AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY
2020; 66 (1-2): 81–93
Youth-Led Participatory Action Research (YPAR) is a social justice-focused approach for promoting social change and positive youth development in which youth conduct systematic research and actions to improve their schools and communities. Although YPAR is oriented to generating research for action, with evidence-based recommendations often aimed at influencing adults with power over settings and systems that shape youths' lives, we have little understanding of how YPAR evidence influences the thinking and/or actions of adult policymakers or practitioners. In general, the participatory research field lacks a theoretically informed "use of research evidence" lens, while the use of evidence field lacks consideration of the special case and implications of participatory research. To start to address these gaps, this paper presents a conceptual linkage across these two fields and then provides six illustrative case examples across diverse geographic, policy, and programmatic contexts to demonstrate opportunities and challenges in the use of YPAR evidence for policy and practice. Our illustrative focus here is on U.S. K-12 educational contexts, the most-studied setting in the YPAR literature, but questions examined here are relevant to YPAR and other systems domestically and internationally, including health, educational, and legal systems. HIGHLIGHTS: The use of research evidence (URE) field identifies characteristics of research and conditions that strengthen URE. Youth-led Participatory Action Research is a special case for factors that influence research use. Six case examples across diverse K-12 contexts illustrate facilitators and barriers for YPAR use. We propose next steps for community psychology research and action to promote the study and use of YPAR evidence.
View details for DOI 10.1002/ajcp.12425
View details for Web of Science ID 000537594500001
View details for PubMedID 32497266
- Opportunities for youth participatory action research to inform school district decisions EVIDENCE & POLICY 2020; 16 (2): 317–29
- Community-Based Participatory Research in the News: A Qualitative Case Study of the Online Media Characterization of a French Health Study SCIENCE COMMUNICATION 2020; 42 (2): 172–94
Does the Type and Timing of Educational Attainment Influence Physical Health? A Novel Application of Sequence Analysis.
American journal of epidemiology
Non-traditional education trajectories are common, but their influence on physical health is understudied. We constructed year-by-year education trajectories for 7,501 National Longitudinal Survey of Youth 1979 participants, from age 14 to 48 (262,535 person-years of education data from 1979 - 2014). We characterized trajectory similarity using sequence analysis (Halpin's optimal matching) and used hierarchical clustering to group similar educational trajectories. Using linear regression, we predicted age 50 physical health summary scores from the 12-item short-form instrument, adjusting for available confounders and evaluated effect modification by sex, race/ethnicity, and childhood socioeconomic status (cSES). We identified 24 unique educational sequence clusters based on highest schooling (
View details for DOI 10.1093/aje/kwaa150
View details for PubMedID 32676653
Fostering youth civic engagement through effective mentorship: Understanding the college student volunteer mentors who succeed.
Journal of community psychology
College student volunteers play a critical role in many school-based educational programs and can foster valuable near-peer relationships with adolescents, yet how to best select these volunteers has been understudied. We studied college student volunteer mentors for Generation Citizen, a non-profit that provides school-based action civics education programming, and their adolescent students. We identify three common characteristics possessed by the strongest college mentors. Participants were nine college volunteer mentors (67% female; 78% White); these mentors worked in pairs (and one trio) in four different classrooms. Using an action research approach, we conducted semistructured interviews, surveys, and classroom observations to generate quantitative and qualitative data. Effective mentors were: person-oriented, emphasizing the mentor-student connection; aligned with the organization's mission; and constantly honing their craft of mentorship. We recommend college volunteer programs select applicants for positions based on these key indicators to foster mission-driven and motivating educational programming.
View details for DOI 10.1002/jcop.22482
View details for PubMedID 33270915
- How to Respond to the COVID-19 Pandemic with More Creativity and Innovation. Population health management 2020
- Youth Civic Action Across the United States: Projects, Priorities, and Approaches YOUTH & SOCIETY 2019
Collaborative Workshops for Community Meaning-Making and Data Analyses: How Focus Groups Strengthen Data by Enhancing Understanding and Promoting Use
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
2019; 16 (18)
Community-based participatory research is a growing approach, but often includes higher levels of community engagement in the research design and data collection stages than in the data interpretation stage. Involving study participants in this stage could further knowledge justice, science that aligns with and supports social justice agendas. This article reports on two community-based participatory environmental health surveys conducted between 2015 and 2019 in an industrial region near Marseille, France, and focuses specifically on our approach of organizing focus groups to directly involve residents and community stakeholders in the analysis and interpretation process. We found that, in these focus groups, residents triangulated across many different sources of information-study findings, local knowledge, and different types of expert knowledge-to reach conclusions about the health of their community and make recommendations for what should be done to improve community health outcomes. We conclude that involving residents in the data analysis and interpretation stage can promote epistemic justice and lead to final reports that are more useful to community stakeholders and decision-makers.
View details for DOI 10.3390/ijerph16183352
View details for Web of Science ID 000489178500126
View details for PubMedID 31514327
View details for PubMedCentralID PMC6765948
- Building a culturally-responsive, family-driven early childhood system of care: Understanding the needs and strengths of ethnically diverse families of children with social-emotional and behavioral concerns CHILDREN AND YOUTH SERVICES REVIEW 2019; 100: 31–38
Similarities in Maternal Weight and Birth Weight Across Pregnancies and Across Sisters
MATERNAL AND CHILD HEALTH JOURNAL
2019; 23 (2): 138–47
Objectives The current study examined how prepregnancy body mass index (BMI), gestational weight gain, and birth weight cluster between births within women and between women who are sisters. Methods Using data from the National Longitudinal Survey of Youth 1979 cohort, we utilized nested, multivariable hierarchical linear models to examine the correlation of these three outcomes between births (n = 6006) to women (n = 3605) and sisters (n = 3170) so that we can quantify the clustering by sibship and by woman for these three pregnancy-related outcomes. Results After controlling for confounding covariates, prepregnancy BMI (intraclass correlation (ICC) 0.24, 95% CI 0.16, 0.32), gestational weight gain (ICC 0.23, 95% CI 0.16, 0.31), and infant's birthweight (ICC 0.07, 95% CI 0.003, 0.13) were correlated between sisters. Additionally, all three outcomes were significantly correlated between births for each sister, suggesting that prepregnancy BMI (ICC 0.82, 95% CI 0.81, 0.83), gestational weight gain (ICC 0.45, 95% CI 0.42, 0.49), and birth weight (ICC 0.31, 95% CI 0.28, 0.35) track between pregnancies in the same woman. Conclusions for Practice The observed clustering both within women and between sisters suggests that shared genetic and environmental factors among sisters play a role in pregnancy outcomes above and beyond that of women's own genetic and environmental factors. Findings suggest that asking a woman about her sisters' pregnancy outcomes could provide insight into the possible outcomes for her current pregnancy. Future research should test if collecting such a family history and providing tailored clinical recommendations accordingly would be useful.
View details for PubMedID 30032445
- Making civic engagement go viral: Applying social epidemiology principles to civic education JOURNAL OF PUBLIC AFFAIRS 2019; 19 (1)
- Civic Engagement Among Youth Exposed to Community Violence: Directions for Research and Practice JOURNAL OF YOUTH DEVELOPMENT 2019; 14 (1): 24–47
Can a school-based civic empowerment intervention support adolescent health?
Preventive medicine reports
2019; 16: 100968
Meaningfully engaging and supporting youth in their communities can promote their sense of efficacy and potentially their health and wellbeing. The objective of this study was to test whether a school-based youth civic empowerment program, Generation Citizen (GC), was associated with self-reported mental and physical health among participants, and whether these associations differed by two potential modifiers: civic self-efficacy and a sense of meaningful contributions to one's community. Participants were middle and high school students (N = 364) who participated in GC in the fall semester of 2014 and completed surveys at the beginning and end of the semester. Analyses revealed a small but statistically significant increase in self-reported physical health after GC and no statistically significant change in self-reported mental health. There was evidence of effect measure modification by civic self-efficacy such that the difference in physical health as civic self-efficacy increased was smaller post-intervention compared to pre-intervention. This could suggest that GC participation is particularly beneficial for those with lower civic self-efficacy. While our findings suggest that public health interventions may benefit from centering empowerment opportunities for youth, future research is warranted to better understand the particular role of civic self-efficacy in that process.
View details for DOI 10.1016/j.pmedr.2019.100968
View details for PubMedID 31508296
View details for PubMedCentralID PMC6722393
Evaluating the Implementation of a Collaborative Juvenile Reentry System in Oakland, California
INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY
2018; 62 (12): 3662–80
Traditional juvenile reentry systems often inadequately meet offenders' complex needs. Policymakers and researchers increasingly recognize the importance of a collaborative community- and development-based reentry system to improve recidivism, youth developmental outcomes, and public safety. Yet, system-level process evaluations of integrated reentry systems are scarce. California's Alameda County juvenile reentry system implemented evidence-based strategies and practices to better serve reentry youth. We report findings from a process evaluation, using data from 15 key stakeholder interviews, focus groups with community-based providers, a reentry system-wide stakeholder survey, site visit observations, and document reviews. We identified strengths, challenges, and lessons learned. System-level strengths included increased multidisciplinary assessments, interagency collaboration, and specialty courts. Challenges included differing agency agendas, limited family and youth engagement, and data sharing. We recommend future researchers and practitioners to further examine and implement integrated system-level processes and organizational change, informed by the ecological-developmental perspective, to help promote positive outcomes for reentry youth.
View details for DOI 10.1177/0306624X18755480
View details for Web of Science ID 000441719600003
View details for PubMedID 29426252
School climate and physical adolescent relationship abuse: Differences by sex, socioeconomic status, and bullying
JOURNAL OF ADOLESCENCE
2018; 66: 71–82
Little is known about the association between school climate and adolescent relationship abuse (ARA). We used 2011-2012 data from surveys of California public school students (in the United States of America) who were in a dating relationship in the last year (n = 112 378) to quantify the association between different school climate constructs and physical ARA. Fifty-two percent of students were female, and all students were in 9th or 11th grade (approximately ages 14-17). Over 11% of students reported experiencing physical ARA in the last year. Increased school connectedness, meaningful opportunities for participation, perceived safety, and caring relationships with adults at school were each significantly associated with lower odds of physical ARA. Increased violence victimization and school-level bullying victimization were associated with higher odds of physical ARA. These school climate-ARA associations were significantly moderated by student sex, school socioeconomic status, and school-level bullying victimization. School climate interventions may have spillover benefits for ARA prevention.
View details for DOI 10.1016/j.adolescence.2018.05.001
View details for Web of Science ID 000437074100008
View details for PubMedID 29783104
- Health issues in the industrial port zone of Marseille, France: the Fos EPSEAL community-based cross-sectional survey JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2018; 26 (2): 235–43
An instrumental variables approach to assess the effect of class size reduction on student screen time
SOCIAL SCIENCE & MEDICINE
2018; 201: 63–70
An emerging area of research considers links between characteristics of the school setting and health. The existing small evidence base assessing the association between class size and health is inconclusive. This quasi-experimental study uses an instrumental variables approach based on North Carolina's elementary class size reduction policy to assess the relationship between class size and student screen time. Specifically, data are from public school students in North Carolina, USA, who were in 3rd grade any time between fall 2005 and spring 2011. There was no association between class size and screen time (measured as recreational television and/or electronic device use), after accounting for grade size and school size, year fixed effects, and clustering at the school and district level. These findings suggest that, in statewide policy implementation settings, there may not be any immediate spillover benefits of class size reduction policies on student screen time.
View details for DOI 10.1016/j.socscimed.2018.02.005
View details for Web of Science ID 000431159800009
View details for PubMedID 29455052
Do the health benefits of education vary by sociodemographic subgroup? Differential returns to education and implications for health inequities
Annals of Epidemiology
View details for DOI 10.1016/j.annepidem.2018.08.014
Motherhood, fatherhood and midlife weight gain in a US cohort: Associations differ by race/ethnicity and socioeconomic position
2017; 3: 558–65
While there is an association of greater short-term weight gain with childbearing among women, less is known about longer-term weight gain, whether men have similar gains, and how this varies by race/ethnicity and socioeconomic position. Our cohort consisted of a nationally representative sample of 7,356 Americans with oversampling of Black and Hispanic populations. We estimated the associations between number of biological children and parental weight, measured as both change in self-reported body mass index (BMI) from age 18 and overweight/obese status (BMI ≥ 25) at age 40. We performed multivariate linear and logistic regression analysis and tested for effect modification by gender. For change in BMI, men gained on average 0.28 BMI (95% CI: (0.01, 0.55)) units per child, while women gained 0.13 units per child (95% CI: (-0.22, 0.48)). The adjusted odds ratios for overweight/obesity associated with each child were 1.32 (95% CI: (1.11, 1.58)) for men and 1.15 (95% CI: (1.01, 1.31)) for women. Stratified analyses by race/ethnicity and socioeconomic position suggested that the observed full-cohort differences were driven primarily by gendered differences in low-income Hispanics and Whites - with the greatest associations among Hispanic men. For example, among low-income Hispanic men we observed a positive relationship between the number of children and weight change by age 40, with average weight change of 0.47 units per child (95%CI: (-0.65, 1.59 For low-income Hispanic women, however, the average weight change was -0.59 units per child (95%CI: (-1.70, 0.47), and the P-value for the test of interaction between gender and number of children was P < 0.001. Our findings suggest that the shared social and economic aspects of raising children play an important role in determining parental weight at mid-life.
View details for PubMedID 29204513
Excessive Gestational Weight Gain and Subsequent Maternal Obesity at Age 40: A Hypothetical Intervention
AMERICAN JOURNAL OF PUBLIC HEALTH
2017; 107 (9): 1463–69
To model the hypothetical impact of preventing excessive gestational weight gain on midlife obesity and compare the estimated reduction with the US Healthy People 2020 goal of a 10% reduction of obesity prevalence in adults.We analyzed 3917 women with 1 to 3 pregnancies in the prospective US National Longitudinal Survey of Youth, from 1979 to 2012. We compared the estimated obesity prevalence between 2 scenarios: gestational weight gain as reported and under the scenario of a hypothetical intervention that all women with excessive gestational weight gain instead gained as recommended by the Institute of Medicine (2009).A hypothetical intervention was associated with a significantly reduced estimated prevalence of obesity for first (3.3 percentage points; 95% confidence interval [CI] = 1.0, 5.6) and second (3.0 percentage points; 95% CI = 0.7, 5.2) births, and twice as high in Black as in White mothers, but not significant in Hispanics. The population attributable fraction was 10.7% (95% CI = 3.3%, 18.1%) in first and 9.3% (95% CI = 2.2%, 16.5%) in second births.Development of effective weight-management interventions for childbearing women could lead to meaningful reductions in long-term obesity.
View details for PubMedID 28727522
View details for PubMedCentralID PMC5551596
The accuracy of self-reported pregnancy-related weight: a systematic review
2017; 18 (3): 350–69
Self-reported maternal weight is error-prone, and the context of pregnancy may impact error distributions. This systematic review summarizes error in self-reported weight across pregnancy and assesses implications for bias in associations between pregnancy-related weight and birth outcomes. We searched PubMed and Google Scholar through November 2015 for peer-reviewed articles reporting accuracy of self-reported, pregnancy-related weight at four time points: prepregnancy, delivery, over gestation and postpartum. Included studies compared maternal self-report to anthropometric measurement or medical report of weights. Sixty-two studies met inclusion criteria. We extracted data on magnitude of error and misclassification. We assessed impact of reporting error on bias in associations between pregnancy-related weight and birth outcomes. Women underreported prepregnancy (PPW: -2.94 to -0.29 kg) and delivery weight (DW: -1.28 to 0.07 kg), and over-reported gestational weight gain (GWG: 0.33 to 3 kg). Magnitude of error was small, ranged widely, and varied by prepregnancy weight class and race/ethnicity. Misclassification was moderate (PPW: 0-48.3%; DW: 39.0-49.0%; GWG: 16.7-59.1%), and overestimated some estimates of population prevalence. However, reporting error did not largely bias associations between pregnancy-related weight and birth outcomes. Although measured weight is preferable, self-report is a cost-effective and practical measurement approach. Future researchers should develop bias correction techniques for self-reported pregnancy-related weight.
View details for DOI 10.1111/obr.12486
View details for Web of Science ID 000398536600006
View details for PubMedID 28170169
Action Civics for Promoting Civic Development: Main Effects of Program Participation and Differences by Project Characteristics
AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY
2016; 58 (3-4): 377–90
Using both quantitative and qualitative data, this study examined the effect of participating in an action civics intervention, Generation Citizen (GC), on civic commitment, civic self-efficacy, and two forms of civic knowledge. The sample consisted of 617 middle and high schools students in 55 classrooms who participated, or were soon to participate, in Generation Citizen. Hierarchical linear models revealed that participating in Generation Citizen was associated with positive gains in action civics knowledge and civic self-efficacy. Qualitative coding identified three types of project characteristics that captured variability in the action projects student chose to complete: context, content, and contact with decision makers. Interactions between project characteristics and participation in GC revealed differences in civic outcomes depending on project characteristics.
View details for DOI 10.1002/ajcp.12103
View details for Web of Science ID 000392621900019
View details for PubMedID 27982470
View details for PubMedCentralID PMC5654523
Redesigning a Participatory Health Study for a French Industrial Context
NEW SOLUTIONS-A JOURNAL OF ENVIRONMENTAL AND OCCUPATIONAL HEALTH POLICY
2016; 26 (3): 458–74
The Marseille, France, metropolitan area is home to a heavily concentrated industrial region directly adjacent to residential communities. These towns have been subjected to a wide variety of social science and public health studies, but residents continue to have many questions about health concerns for which they currently have primarily anecdotal evidence. Reflecting on our in-progress research in two of these towns, we argue that community-based participatory research that draws from both social science and public health science can be successfully adapted to the French political and cultural context and is key for developing environmental health research that is relevant for community residents and local leaders. Understanding and working within the customs of the local values and practices culture is critical for community-based participatory research regardless of location but is particularly paramount when working in non-United States contexts, since local values and practices will shape the particular techniques used within the community-based participatory research framework.
View details for DOI 10.1177/1048291116662997
View details for Web of Science ID 000439925400007
View details for PubMedID 27549362
- Surveying for Environmental Health Justice: Community Organizing Applications of Community-Based Participatory Research ENVIRONMENTAL JUSTICE 2016; 9 (5): 129–36
Adverse childhood experiences and later life adult obesity and smoking in the United States
ANNALS OF EPIDEMIOLOGY
2016; 26 (7): 488-492
Prior work demonstrates associations between physical abuse, household alcohol abuse, and household mental illness early in life with obesity and smoking. Studies, however, have not generally been in nationally representative samples and have not conducted analyses to account for bias in the exposure.We used data from the 1979 U.S. National Longitudinal Survey of Youth to test associations between measures of adverse childhood experiences with obesity and smoking and used an instrumental variables approach to address potential measurement error of the exposure.Models demonstrated associations between childhood physical abuse and obesity at age 40 years (odds ratio [OR] 1.23; 95% confidence interval [CI], 1.00-1.52) and ever smoking (OR 1.83; 95% CI, 1.56-2.16), as well as associations between household alcohol abuse (OR 1.53; 95% CI, 1.31-1.79) and household mental illness (OR 1.29; 95% CI, 1.04-1.60) with ever smoking. We find no evidence of association modification by gender, socioeconomic position, or race and/or ethnicity. Instrumental variables analysis using a sibling's report of adverse childhood experiences demonstrated a relationship between household alcohol abuse and smoking, with a population attributable fraction of 17% (95% CI, 2.0%-37%) for ever smoking and 6.7% (95% CI, 1.6%-12%) for currently smoking.Findings suggest long-term impacts of childhood exposure to physical abuse, household alcohol abuse, and parental mental illness on obesity and smoking and that the association between household alcohol abuse and smoking is not solely due to measurement error.
View details for DOI 10.1016/j.annepidem.2016.06.003
View details for Web of Science ID 000380866600007
View details for PubMedCentralID PMC4966898
Educational Attainment and Gestational Weight Gain among US Mothers
WOMENS HEALTH ISSUES
2016; 26 (4): 460-467
Education is an important social determinant of many health outcomes, but the relationship between educational attainment and the amount of weight gained over the course of a woman's pregnancy (gestational weight gain [GWG]) has not been established clearly.We used data from 1979 through 2010 for women in the National Longitudinal Survey of Youth (1979) cohort (n = 6,344 pregnancies from 2,769 women). We used generalized estimating equations to estimate the association between educational attainment and GWG adequacy (as defined by 2009 Institute of Medicine guidelines), controlling for diverse social factors from across the life course (e.g., income, wealth, educational aspirations and expectations) and considering effect measure modification by race/ethnicity and prepregnancy overweight status.In most cases, women with more education had increased odds of gaining a recommended amount of gestational weight, independent of educational aspirations and educational expectations and relatively robust to sensitivity analyses. This trend manifested itself in a few different ways. Those with less education had higher odds of inadequate GWG than those with more education. Among those who were not overweight before pregnancy, those with less education had higher odds of excessive GWG than college graduates. Among women who were White, those with less than a high school degree had higher odds of excessive GWG than those with more education.The relationship between educational attainment and GWG is nuanced and nonlinear.
View details for DOI 10.1016/j.whi.2016.05.009
View details for Web of Science ID 000380748900014
View details for PubMedID 27372419
View details for PubMedCentralID PMC4958525
Diverging Paths: Understanding Racial Differences in Civic Engagement Among White, African American, and Latina/o Adolescents Using Structural Equation Modeling
AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY
2016; 57 (1-2): 102–17
There is increasing concern about the large civic engagement gap between Whites and Latina/o and African American youth. Some suggest this may be because traditional models and measures of civic engagement may not be as applicable for youth from historically marginalized groups. With an urban sample of middle and high school-age youth (n = 903, 52% female), we used structural equation modeling to identify differences in civic pathways between youth from different racial/ethnic backgrounds. We found significant differences between groups including much stronger relationships between exposure to democratic practices and civic self-efficacy and knowledge for African American and Latina/o youth than for White youth and a stronger relationship between civic knowledge and future civic engagement for Whites and Latina/os than for African Americans. These findings suggest that educators and researchers interested need to take into account the diversity of youths' racial experiences when examining youth civic development.
View details for DOI 10.1002/ajcp.12027
View details for Web of Science ID 000374704500009
View details for PubMedID 27217315
Biological and Sociocultural Factors During the School Years Predicting Women's Lifetime Educational Attainment
JOURNAL OF SCHOOL HEALTH
2016; 86 (3): 215–24
Lifetime educational attainment is an important predictor of health and well-being for women in the United States. In this study, we examine the roles of sociocultural factors in youth and an understudied biological life event, pubertal timing, in predicting women's lifetime educational attainment.Using data from the National Longitudinal Survey of Youth 1997 cohort (N = 3889), we conducted sequential multivariate linear regression analyses to investigate the influences of macro-level and family-level sociocultural contextual factors in youth (region of country, urbanicity, race/ethnicity, year of birth, household composition, mother's education, and mother's age at first birth) and early menarche, a marker of early pubertal development, on women's educational attainment after age 24.Pubertal timing and all sociocultural factors in youth, other than year of birth, predicted women's lifetime educational attainment in bivariate models. Family factors had the strongest associations. When family factors were added to multivariate models, geographic region in youth, and pubertal timing were no longer significant.Our findings provide additional evidence that family factors should be considered when developing comprehensive and inclusive interventions in childhood and adolescence to promote lifetime educational attainment among girls.
View details for DOI 10.1111/josh.12368
View details for Web of Science ID 000369746400008
View details for PubMedID 26830508
View details for PubMedCentralID PMC4741106
Changing national guidelines is not enough: The impact of 1990 IOM recommendations on gestational weight gain among U.S. women
International Journal of Obesity
Gestational weight gain (GWG) is associated with both long- and short-term maternal and child health outcomes, particularly obesity. Targeting maternal nutrition through policies is a potentially powerful pathway to influence these outcomes. Yet prior research has often failed to evaluate national policies and guidelines that address maternal and child health. In 1990, the U.S. Institute of Medicine (IOM) released guidelines recommending different GWG thresholds based on women's pre-pregnancy body mass index (BMI), with the goal of improving infant birth weight. In this study, we employ quasi-experimental methods to examine whether the release of the IOM guidelines led to changes in GWG among a diverse and nationally representative sample of women.Our sample included female participants of the National Longitudinal Survey of Youth who self-reported GWG for pregnancies during 1979-2000 (n=7442 pregnancies to 4173 women). We compared GWG before and after the guidelines were released using difference-in-differences (DID) and regression discontinuity (RD) analyses.In DID analyses we found no reduction in GWG among overweight/obese women relative to normal/underweight women. Meanwhile, RD analyses demonstrated no changes in GWG by pre-pregnancy BMI for either overweight/obese or normal/underweight women. Results were similar for women regardless of educational attainment, race or parity.These findings suggest that national guidelines had no effect on weight gain among pregnant women. These results have implications for the implementation of policies targeting maternal and child health via dietary behaviors.
View details for DOI 10.1038/ijo.2016.97
View details for PubMedCentralID PMC5050079
InvitedCommentary: Multigenerational Social Determinants of Health-Opportunities and Challenges
AMERICAN JOURNAL OF EPIDEMIOLOGY
2015; 182 (7): 579–82
An emerging area of social epidemiology examines the relationship between grandparental education and grandchild health. In an accompanying article, Huang et al. (Am J Epidemiol. 2015;182(7):568-578) join the small but growing body of research on this topic. It is useful to contextualize Huang et al.'s work within the much larger body of research examining relationships between education and health within a single generation or across 2 generations. These investigators have generally concluded that higher educational attainment is robustly associated with better health. There are many potential mechanisms through which education and other social exposures may affect health outcomes in a single generation or across generations, and estimating direct and indirect effects can be helpful for assessing specific mechanisms. Researchers conducting multigenerational analyses are faced with several challenges, including limited availability of data for some measures (e.g., educational attainment, and sometimes for 1 grandparent only), limited age ranges of participants, disparate social and political contexts in which study participants of different generations have lived, and patterns of social class reproduction. We encourage future researchers to weave together the careful analytical considerations illustrated by Huang et al. with a rich understanding of the social context for each of the generations studied to help overcome these challenges and advance our understanding of multigenerational social determinants of health.
View details for DOI 10.1093/aje/kwv145
View details for Web of Science ID 000361811100003
View details for PubMedID 26283087
Racial/Ethnic Disparities in Inadequate Gestational Weight Gain Differ by Pre-pregnancy Weight
MATERNAL AND CHILD HEALTH JOURNAL
2015; 19 (8): 1672-1686
Pre-pregnancy body mass index (BMI) varies by race/ethnicity and modifies the association between gestational weight gain (GWG) and adverse pregnancy outcomes, which disproportionately affect racial/ethnic minorities. Yet studies investigating whether racial/ethnic disparities in GWG vary by pre-pregnancy BMI are inconsistent, and none studied nationally representative populations. Using categorical measures of GWG adequacy based on Institute of Medicine recommendations, we investigated whether associations between race/ethnicity and GWG adequacy were modified by pre-pregnancy BMI [underweight (<18.5 kg/m(2)), normal weight (18.5-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)), or obese (≥30.0 kg/m(2))] among all births to Black, Hispanic, and White mothers in the 1979 USA National Longitudinal Survey of Youth cohort (n = 6,849 pregnancies; range 1-10). We used generalized estimating equations, adjusted for marital status, parity, smoking during pregnancy, gestational age, and multiple measures of socioeconomic position. Effect measure modification between race/ethnicity and pre-pregnancy BMI was significant for inadequate GWG (Wald test p value = 0.08). Normal weight Black [risk ratio (RR) 1.34, 95 % confidence interval (CI) 1.18, 1.52] and Hispanic women (RR 1.33, 95 % CI 1.15, 1.54) and underweight Black women (RR 1.38, 95 % CI 1.07, 1.79) experienced an increased risk of inadequate GWG compared to Whites. Differences in risk of inadequate GWG between minority women, compared to White women, were not significant among overweight and obese women. Effect measure modification between race/ethnicity and pre-pregnancy BMI was not significant for excessive GWG. The magnitude of racial/ethnic disparities in inadequate GWG appears to vary by pre-pregnancy weight class, which should be considered when designing interventions to close racial/ethnic gaps in healthy GWG.
View details for DOI 10.1007/s10995-015-1682-5
View details for Web of Science ID 000358064600003
View details for PubMedCentralID PMC4503500
Socioeconomic disadvantage in childhood as a predictor of excessive gestational weight gain and obesity in midlife adulthood.
Emerging themes in epidemiology
2015; 12: 4-?
Lower childhood socioeconomic position is associated with greater risk of adult obesity among women, but not men. Pregnancy-related weight changes may contribute to this gender difference. The objectives of this study were to determine the associations between: 1. childhood socioeconomic disadvantage and midlife obesity; 2. excessive gestational weight gain (GWG) and midlife obesity; and 3. childhood socioeconomic disadvantage and excessive GWG, among a representative sample of childbearing women.We constructed marginal structural models for seven measures of childhood socioeconomic position for 4780 parous women in the United States, using National Longitudinal Survey of Youth (1979-2010) data. Institute of Medicine definitions were used for excessive GWG; body mass index ≥30 at age 40 defined midlife obesity. Analyses were separated by race/ethnicity. Additionally, we estimated controlled direct effects of childhood socioeconomic disadvantage on midlife obesity under a condition of never gaining excessively in pregnancy.Low parental education, but not other measures of childhood disadvantage, was associated with greater midlife obesity among non-black non-Hispanic women. Among black and Hispanic mothers, childhood socioeconomic disadvantage was not consistently associated with midlife obesity. Excessive GWG was associated with greater midlife obesity in all racial/ethnic groups. Childhood socioeconomic disadvantage was not statistically significantly associated with excessive GWG in any group. Controlled direct effects were not consistently weaker than total effects.Childhood socioeconomic disadvantage was associated with adult obesity, but not with excessive gestational weight gain, and only for certain disadvantage measures among non-black non-Hispanic mothers. Prevention of excessive GWG may benefit all groups through reducing obesity, but excessive GWG does not appear to serve as a mediator between childhood socioeconomic position and adult obesity in women.
View details for DOI 10.1186/s12982-015-0026-7
View details for PubMedID 25755672
View details for PubMedCentralID PMC4353468
- Inequalities in school climate in California JOURNAL OF EDUCATIONAL ADMINISTRATION 2015; 53 (2): 237–61
Invited commentary: How research on public school closures can inform research on public hospital closures
SOCIAL SCIENCE & MEDICINE
2014; 114: 197–99
The literature on social capital and civic engagement as they relate to health and health services outcomes is nuanced and sometimes conflicting, and has been a topic of much investigation in the pages of Social Science and Medicine. Ko et al. (2014) add to this research by considering two health services outcomes: the closure and privatization of public hospitals. We draw from education research on the role of community/civic engagement in public school closures to identify areas for future research to better understand these nuances. Qualitative research on school closures suggest that there are both well-managed and poorly managed closure decisions, and there are diverse community groups with interests in the decision who can interact with each other in nuanced ways. Furthermore, across stakeholder groups, there is not always agreement as to if closure would help or harm their students' education. We encourage health and health services researchers to glean insights from education research and other disciplines disparate but related and relevant to public health when developing research questions and considering alternative methodologies.
View details for DOI 10.1016/j.socscimed.2014.05.008
View details for Web of Science ID 000339131500023
View details for PubMedID 24840783
Excessive gestational weight gain over multiple pregnancies and the prevalence of obesity at age 40
INTERNATIONAL JOURNAL OF OBESITY
2014; 38 (5): 714-718
Although several studies have found an association between excessive gestational weight gain (GWG) and obesity later in life, to the best of our knowledge, no studies have explored the role of GWG events across the life course.We describe how the prevalence of midlife obesity (BMI⩾30 at age 40 or 41) among women varies by life course patterns of GWG (using 2009 IOM guidelines) in the USA's National Longitudinal Survey of Youth 1979 cohort.Among women who reported 1-3 births before age 40, the prevalence of midlife obesity increased with a rising number of excessive GWG events: from none (23.4%, n=875) to one (37.6%, n=707), from none (23.4%, n=875) to two (46.8%, n=427) and from none (23.4%, n=875) to three (54.6%, n=108), P<0.00005 for trend. Obesity prevalence was similar for the same number of excessive GWG events, regardless of parity. No clear pattern emerged for the sequencing of excessive GWG event(s) and later obesity.In our descriptive exploratory study, excessive GWG events appear to be associated with increased prevalence of obesity for parous women, suggesting the importance of preventive interventions regardless of timing of pregnancy-related weight changes over the life course.
View details for DOI 10.1038/ijo.2013.156
View details for Web of Science ID 000335445300014
View details for PubMedID 23958794
View details for PubMedCentralID PMC3930624
Pregnancy and post-delivery maternal weight changes and overweight in preschool children.
2014; 60: 77-82
High maternal weight before and during pregnancy contributes to child obesity. To assess the additional role of weight change after delivery, we examined associations between pre- and post-pregnancy weight changes and preschooler overweight.Sample: 4359 children from the Children and Young Adults of the 1979 National Longitudinal Survey of Youth (NLSY) born to 2816 NLSY mothers between 1979 and 2006 and followed to age 4-5years old. Exposures: gestational weight gain (GWG) and post-delivery maternal weight change (PDWC). Outcome: child overweight (body mass index (BMI) ≥85th percentile).Adjusted models suggested that both increased GWG (OR: 1.08 per 5kg GWG, 95% CI: 1.01, 1.16) and excessive GWG (OR: 1.29 versus adequate GWG, 95% CI: 1.06, 1.56) were associated with preschooler overweight. Maternal weight change after delivery was also independently associated with child overweight (OR: 1.12 per 5kg PDWC, 95% CI: 1.04, 1.21). Associations were stronger among children with overweight or obese mothers.Increased maternal weight gain both during and after pregnancy predicted overweight in preschool children. Our results suggest that healthy post-pregnancy weight may join normal pre-pregnancy BMI and adequate GWG as a potentially modifiable risk factor for child overweight.
View details for DOI 10.1016/j.ypmed.2013.12.018
View details for PubMedID 24370455
Educational attainment and obesity: a systematic review
2013; 14 (12): 989-1005
Although previous systematic reviews considered the relationship between socioeconomic status and obesity, almost 200 peer-reviewed articles have been published since the last review on that topic, and this paper focuses specifically on education, which has different implications. The authors systematically review the peer-reviewed literature from around the world considering the association between educational attainment and obesity. Databases from public health and medicine, education, psychology, economics, and other social sciences were searched, and articles published in English, French, Portuguese and Spanish were included. This paper includes 289 articles that report on 410 populations in 91 countries. The relationship between educational attainment and obesity was modified by both gender and the country's economic development level: an inverse association was more common in studies of higher-income countries and a positive association was more common in lower-income countries, with stronger social patterning among women. Relatively few studies reported on lower-income countries, controlled for a comprehensive set of potential confounding variables and/or attempted to assess causality through the use of quasi-experimental designs. Future research should address these gaps to understand if the relationship between educational attainment and obesity may be causal, thus supporting education policy as a tool for obesity prevention.
View details for DOI 10.1111/obr.12062
View details for Web of Science ID 000326764500005
View details for PubMedCentralID PMC3902051
Behavioral Adaptation Among Youth Exposed to Community Violence: a Longitudinal Multidisciplinary Study of Family, Peer and Neighborhood-Level Protective Factors
2013; 14 (6): 606–17
Several studies across fields have documented the detrimental effects of exposure to violence and, separately, the power of developmental assets to promote positive youth development. However, few have examined the lives of youth exposed to violence who demonstrate resilience (that is, positive adjustment despite risk), and hardly any have examined how developmental assets may shape resilient trajectories into adulthood for youth exposed to violence. What are these resources and relationships that high-risk youth can leverage to tip the balance from vulnerability in favor of resilience? We used generalized estimating equations to examine multilevel longitudinal data from 1,114 youth of ages 11-16 from the Project on Human Development in Chicago Neighborhoods. Behavioral adaptation was a dynamic process that varied over time and by level of violence exposure. In the short term, being a victim was associated with increased aggression and delinquency. In the long term though, both victims and witnesses to violence had higher odds of behavioral adaptation. Baseline family support and family boundaries, friend support, neighborhood support, and collective efficacy had positive main effects for all youth. Additionally, having family support, positive peers, and meaningful opportunities for participation modified the effect of exposure to violence and increased odds of behavioral adaptation over time. Policies, systems, and programs across sectors should focus on building caring relationships/supports with family members and friends, positive peers, and meaningful opportunities especially for witnesses and victims of violence, to promote behavioral resilience and related outcomes into adulthood for high-risk youth.
View details for DOI 10.1007/s11121-012-0344-8
View details for Web of Science ID 000325820800008
View details for PubMedID 23404664
Education: A Missed Opportunity for Public Health Intervention
AMERICAN JOURNAL OF PUBLIC HEALTH
2013; 103 (6): 997–1001
Educational attainment is a well-established social determinant of health. It affects health through many mechanisms such as neural development, biological aging, health literacy and health behaviors, sense of control and empowerment, and life chances. Education--from preschool to beyond college--is also one of the social determinants of health for which there are clear policy pathways for intervention. We reviewed evidence from studies of early childhood, kindergarten through 12th grade, and higher education to identify which components of educational policies and programs are essential for good health outcomes. We have discussed implications for public health interventions and health equity.
View details for DOI 10.2105/AJPH.2012.300993
View details for Web of Science ID 000330977900028
View details for PubMedID 23597373
View details for PubMedCentralID PMC3698749
Revitalizing Communities Together The Shared Values, Goals, and Work of Education, Urban Planning, and Public Health
JOURNAL OF URBAN HEALTH-BULLETIN OF THE NEW YORK ACADEMY OF MEDICINE
2013; 90 (2): 187–96
Inequities in education, the urban environment, and health co-exist and mutually reinforce each other. Educators, planners, and public health practitioners share commitments to place-based, participatory, youth-focused, and equitable work. They also have shared goals of building community resilience, social capital, and civic engagement. Interdisciplinary programs that embody these shared values and work towards these shared goals are emerging, including school-based health centers, full-service community schools, community health centers, Promise Neighborhoods, and Choice Neighborhoods. The intersection of these three fields represents an opportunity to intervene on social determinants of health. More collaborative research and practice across public health, education, and planning should build from the shared values identified to continue to address these common goals.
View details for DOI 10.1007/s11524-012-9733-3
View details for Web of Science ID 000316759600001
View details for PubMedID 22711169
View details for PubMedCentralID PMC3675725
The relationship between adolescents' civic knowledge, civic attitude, and civic behavior and their self-reported future likelihood of voting
EDUCATION CITIZENSHIP AND SOCIAL JUSTICE
2013; 8 (1): 43–57
A long-standing objective of American public education is fostering civically engaged youth. Identifying characteristics associated with likelihood of future voting, a measure of democratic participation that predicts future voting behavior, might yield targets for education programs to increase civic participation. Survey data from urban adolescents were analyzed to elucidate how civic knowledge, civic attitudes, and civic behaviors are associated with self-reported likelihood of future voting. In a multivariable ordered logistic regression model with latent constructs for civic knowledge, attitudes, and behavior, two civic knowledge constructs and two civic attitude constructs maintained a positive, statistically significant independent association with future voting likelihood after adjusting for race/ethnicity and advanced coursework: knowledge of American governance, current events knowledge, general self-efficacy, and skill-specific self-efficacy. Further research is necessary to determine whether education programs can intervene upon these civic knowledge and civic attitude factors to increase voting participation later in life.
View details for DOI 10.1177/1746197912456339
View details for Web of Science ID 000437571200004
View details for PubMedID 24847376
View details for PubMedCentralID PMC4024445
Education and obesity at age 40 among American adults
SOCIAL SCIENCE & MEDICINE
2013; 78: 34-41
Although many have studied the association between educational attainment and obesity, studies to date have not fully examined prior common causes and possible interactions by race/ethnicity or gender. It is also not clear if the relationship between actual educational attainment and obesity is independent of the role of aspired educational attainment or expected educational attainment. The authors use generalized linear log link models to examine the association between educational attainment at age 25 and obesity (BMI≥30) at age 40 in the USA's National Longitudinal Survey of Youth 1979 cohort, adjusting for demographics, confounders, and mediators. Race/ethnicity but not gender interacted with educational attainment. In a complete case analysis, after adjusting for socioeconomic covariates from childhood, adolescence, and adulthood, among whites only, college graduates were less likely than high school graduates to be obese (RR = 0.69, 95%CI: 0.57, 0.83). The risk ratio remained similar in two sensitivity analyses when the authors adjusted for educational aspirations and educational expectations and analyzed a multiply imputed dataset to address missingness. This more nuanced understanding of the role of education after controlling for a thorough set of confounders and mediators helps advance the study of social determinants of health and risk factors for obesity.
View details for DOI 10.1016/j.socscimed.2012.11.025
View details for Web of Science ID 000314739300005
View details for PubMedID 23246398
View details for PubMedCentralID PMC3545063
A community cohort study about childhood social and economic circumstances: racial/ethnic differences and associations with educational attainment and health of older adults
2013; 3 (4)
Typical measures of childhood socioeconomic status (SES), such as father's occupation, have limited the ability to elucidate mechanisms by which childhood SES affects adult health. Mechanisms could include schooling experiences or work opportunities. Having previously used qualitative methods for concept development, we developed new retrospective measures of multiple domains of childhood social and economic circumstances in ethnically diverse older adults. We administered the new measures in a large sample and explored their association with adult SES.We used a cross-sectional survey design with a community sample.The San Francisco Bay Area in California.400 community-dwelling adults from diverse racial/ethnic backgrounds (Whites, African Americans, Latinos and Asians/Pacific Islanders) aged 55 and older (mean=67 years); 61% were women.We measured attitudes towards schooling, extracurricular activities and adult encouragement and discouragement during the childhood/teen years. Bivariate analysis tested racial/ethnic differences on the various measures. Multivariate regression models estimated the extent to which retrospective circumstances were independently associated with adult educational attainment and adult health.Most of the childhood circumstances measures differed across racial/ethnic groups. In general, Whites reported more positive circumstances than non-Whites. Family financial circumstances, respondent's perception of schooling as a means to get ahead, high school extracurricular activities, summer travel and summer reading were each statistically significantly associated with adult SES. Family composition, age began work, high school extracurricular activities, attitudes towards schooling and adult discouragement were associated with adult health.
View details for DOI 10.1136/bmjopen-2012-002140
View details for Web of Science ID 000329809200020
View details for PubMedID 23562813
View details for PubMedCentralID PMC3641446
- Why We Need Urban Health Equity Indicators: Integrating Science, Policy, and Community PLOS MEDICINE 2012; 9 (8): e1001285
The Implementation of REACH: Initial Perspectives from Government, Industry, and Civil Society
INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH
2011; 17 (1): 57–62
The European Union's 2006 Registration, Evaluation, Authorization, and Restriction of Chemicals (REACH) legislation represents a new wave in regulating chemicals and has set far-reaching goals for protecting and enhancing public health, the environment, and markets. Despite substantial public debate during the development and passage of the REACH legislation, in interviews conducted from 2009-2010, respondents from government, industry, and civil society expressed general agreement on some key issues in the implementation of REACH, which are addressed in this study. At the same time, respondents expressed nuanced differences in how some of the outstanding implementation issues should be addressed. Industry respondents' main concern was their ability to comply with REACH; while government respondents reported wanting to ensure they can implement and enforce it; and civil society respondents wanted to ensure that REACH accomplishes its ambitious goals.
View details for Web of Science ID 000287382500008
View details for PubMedID 21344820