I am a Sociologist and Postdoctoral Fellow in Cardiovascular Disease Prevention at the Stanford Prevention Research Center. My research examines health, gender, and social inequality.
My primary research agenda investigates health disparities across class, race, and gender in the United States. I draw on both qualitative and quantitative methods to understand how neighborhoods, schools, and families shape our health behaviors and outcomes. My work has been published in journals such as Social Science & Medicine, Obesity, Sociological Science, and the Journal of Adolescent Health.
I hold a Ph.D. in Sociology from Stanford University, a M.A. in Anthropology from the University of Bremen, and a B.S. in Education and Social Policy from Northwestern University.
Doctor of Philosophy, Stanford University, SOCIO-PHD (2018)
Master of Arts, University of Bremen, Anthropology (2011)
Bachelor of Science, Northwestern University, Education and Social Policy (2008)
Christopher Gardner, Postdoctoral Research Mentor
- Nutrition Study Design Issues-Important Issues for Interpretation. American journal of health promotion : AJHP 2020; 34 (8): 951–54
Occupying multiple stigmatized identities: Smoking and unemployment stigmas among the unemployed.
SSM - population health
2020; 11: 100598
Stigma - which involves stereotyping, discrimination, and status loss - is a central driver of morbidity and mortality. Given the de-normalization of smoking and the status loss of unemployment, unemployed individuals who smoke may occupy multiple stigmatized identities. As such, this study examined aspects and correlates of smoking and unemployment stigmas among unemployed job-seekers who smoke. Adult job-seekers who smoke tobacco (N=360) were recruited at government-run employment development departments (EDDs) in the San Francisco Bay Area in 2015-2018. Participants completed measures of smoking and unemployment stigma and self-reported their demographic, tobacco use, and physical and mental health characteristics. Smoking and unemployment stigmas were moderately positively correlated, and the sample reported higher unemployment stigma than smoking stigma. A sample majority endorsed at least one element of smoking and unemployment stigmas; most common for both was self-disappointment. Two sets of linear regression analyses using a general-to-specific modeling procedure were run to identify significant correlates of smoking stigma and unemployment stigma. Both stigmas were significantly associated with depressive symptoms and with preparing to quit smoking. Participants in poorer health and those with stable housing endorsed greater smoking stigma, while unemployment stigma was endorsed more among White individuals and those with past-year e-cigarette use. The findings highlight the need to examine multiply occupied stigmas as a social determinant of population health.
View details for DOI 10.1016/j.ssmph.2020.100598
View details for PubMedID 32490137
Tobacco Product Promotions Remain Ubiquitous and are Associated with Use and Susceptibility to Use among Adolescents.
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
INTRODUCTION: The decline in tobacco smoking among US adolescents has been exceeded by the exponential rise in nicotine vaping with an overall net gain in youth tobacco product use. While cigarette companies are restricted from advertising on television/radio, vaping promotions have been largely unrestricted. This study examined exposure to tobacco product promotions in a US sample of 1003 adolescents and its associations with product use and susceptibility to use.METHODS: Adolescents (13-17) were recruited online and anonymously surveyed in 2019 about their ever and current (past 30-day) tobacco smoking (cigarette and cigar) and nicotine vaping behaviors, and among never-users, susceptibility to vaping. Multivariate models tested associations with past-month exposure to tobacco product promotions controlling for demographic features, harm perceptions, and family and peer influences.RESULTS: Tobacco product use was 34%ever-use and 20% current-use. Most had seen cigarette (91%) and nicotine vaping (80%) product promotions in the past 30 days. A majority reported exposure at point-of-sale and on major (television, cinema) and social media. In adjusted multivariate models, greater exposure to tobacco product promotions was significantly associated with ever and current smoking and vaping; and among never-users, susceptibility to vaping (all p<.01, effect sizes 1.03 to 1.05). Family/peer use and attitudes also were significant correlates.CONCLUSIONS: Tobacco product promotions remain ubiquitous and are significantly associated with adolescents' tobacco product use and susceptibility to vape. Peers and family are important social influences and may reflect indirect channels of tobacco marketing. Stricter regulatory restrictions on tobacco marketing to young people is warranted.IMPLICATIONS: This study adds to mounting evidence showing that tobacco marketing remains pervasive and is associated with tobacco use and susceptibility to use. Most youth report seeing cigarette and nicotine vaping product promotions, with notable differences by channel: traditional media predominating for cigarettes and social media/email for e-cigarettes. Greater exposure to tobacco promotions is significantly associated with ever and current smoking and vaping, and among never-users, susceptibility to vaping. The accumulating findings support stricter regulatory restrictions on marketing of tobacco products in media channels accessed by youth.
View details for DOI 10.1093/ntr/ntaa136
View details for PubMedID 32722775
Integration of Tobacco Treatment Services into Cancer Care at Stanford.
International journal of environmental research and public health
2020; 17 (6)
As part of a National Cancer Institute Moonshot P30 Supplement, the Stanford Cancer Center piloted and integrated tobacco treatment into cancer care. This quality improvement (QI) project reports on the process from initial pilot to adoption within 14 clinics. The Head and Neck Oncology Clinic was engaged first in January 2019 as a pilot site given staff receptivity, elevated smoking prevalence, and a high tobacco screening rate (95%) yet low levels of tobacco cessation treatment referrals (<10%) and patient engagement (<1% of smokers treated). To improve referrals and engagement, system changes included an automated "opt-out" referral process and provision of tobacco cessation treatment as a covered benefit with flexible delivery options that included phone and telemedicine. Screening rates increased to 99%, referrals to 100%, 74% of patients were reached by counselors, and 33% of those reached engaged in treatment. Patient-reported abstinence from all tobacco products at 6-month follow-up is 20%. In July 2019, two additional oncology clinics were added. In December 2019, less than one year from initiating the QI pilot, with demonstrated feasibility, acceptability, and efficacy, the tobacco treatment services were integrated into 14 clinics at Stanford Cancer Center.
View details for DOI 10.3390/ijerph17062101
View details for PubMedID 32235713
A randomized crossover trial on the effect of plant-based compared with animal-based meat on trimethylamine-N-oxide and cardiovascular disease risk factors in generally healthy adults: Study With Appetizing Plantfood-Meat Eating Alternative Trial (SWAP-MEAT).
The American journal of clinical nutrition
Despite the rising popularity of plant-based alternative meats, there is limited evidence of the health effects of these products.We aimed to compare the effect of consuming plant-based alternative meat (Plant) as opposed to animal meat (Animal) on health factors. The primary outcome was fasting serum trimethylamine-N-oxide (TMAO). Secondary outcomes included fasting insulin-like growth factor 1, lipids, glucose, insulin, blood pressure, and weight.SWAP-MEAT (The Study With Appetizing Plantfood-Meat Eating Alternatives Trial) was a single-site, randomized crossover trial with no washout period. Participants received Plant and Animal products, dietary counseling, lab assessments, microbiome assessments (16S), and anthropometric measurements. Participants were instructed to consume ≥2 servings/d of Plant compared with Animal for 8 wk each, while keeping all other foods and beverages as similar as possible between the 2 phases.The 36 participants who provided complete data for both crossover phases included 67% women, were 69% Caucasian, had a mean ± SD age 50 ± 14 y, and BMI 28 ± 5 kg/m2. Mean ± SD servings per day were not different by intervention sequence: 2.5 ± 0.6 compared with 2.6 ± 0.7 for Plant and Animal, respectively (P = 0.76). Mean ± SEM TMAO concentrations were significantly lower overall for Plant (2.7 ± 0.3) than for Animal (4.7 ± 0.9) (P = 0.012), but a significant order effect was observed (P = 0.023). TMAO concentrations were significantly lower for Plant among the n = 18 who received Plant second (2.9 ± 0.4 compared with 6.4 ± 1.5, Plant compared with Animal, P = 0.007), but not for the n = 18 who received Plant first (2.5 ± 0.4 compared with 3.0 ± 0.6, Plant compared with Animal, P = 0.23). Exploratory analyses of the microbiome failed to reveal possible responder compared with nonresponder factors. Mean ± SEM LDL-cholesterol concentrations (109.9 ± 4.5 compared with 120.7 ± 4.5 mg/dL, P = 0.002) and weight (78.7 ± 3.0 compared with 79.6 ± 3.0 kg, P < 0.001) were lower during the Plant phase.Among generally healthy adults, contrasting Plant with Animal intake, while keeping all other dietary components similar, the Plant products improved several cardiovascular disease risk factors, including TMAO; there were no adverse effects on risk factors from the Plant products.This trial was registered at clinicaltrials.gov as NCT03718988.
View details for DOI 10.1093/ajcn/nqaa203
View details for PubMedID 32780794
- Intentional Invisibility: Professional Women and the Navigation of Workplace Constraints SOCIOLOGICAL PERSPECTIVES 2019; 62 (1): 23–41
Baseline Psychosocial and Demographic Factors Associated with Study Attrition and 12‐Month Weight Gain in the DIETFITS Trial
View details for DOI 10.1002/oby.22650
E-Cigarettes: Harmful or Harm-Reducing? Evaluation of a Novel Online CME Program for Health Care Providers.
Journal of general internal medicine
Patients are asking health care providers about e-cigarettes, vaping, and other electronic nicotine delivery systems (ENDS). Provider advice on ENDS has varied greatly, suggesting a need for evidence-based continuing medical education (CME).A novel free online CME course was developed on ENDS risks and benefits, product types (e.g., vape pens, pods), and screening and counseling best practices for adults, adolescents, and different smoker profiles (e.g., daily, social).From January 2017 through June 2018, 1061 individuals accessed the course: 46% physicians, 7% physician assistants, 7% nurse practitioners, 15% nurses, 4% pharmacists, and 28% allied health/student/other; 41% were international.The course was built from observed online patient-provider interactions. Through video role-plays, expert interviews, and interactive activities, the course engaged learners in the evidence on ENDS. Completers earned 1.5 CME units.A total of 555 health care providers earned 832.5 CME units. Pre- to post-test scores significantly increased from 57 to 90%; 76% rated the course as above average (41%) or outstanding (35%); 99% indicated the course was free of commercial bias.Addressing the growing need for balanced provider education on ENDS, this interactive online CME engaged learners and increased knowledge on devices and evidence-based cessation approaches.
View details for DOI 10.1007/s11606-019-05388-7
View details for PubMedID 31630366
You're worth what you eat: Adolescent beliefs about healthy eating, morality and socioeconomic status.
Social science & medicine (1982)
2018; 220: 41–48
Amidst growing concern about adolescents' diets and dietary health in the United States, this article asks: what does healthy eating mean to adolescents? Using data from in-depth interviews conducted with 74 adolescents across socioeconomic status (SES) in California in 2015-2016, I show how adolescents view healthy eating as a moral, affluent practice and use discussions of healthy eating to assert their own morality and socioeconomic position. Adolescents associate healthy eating with 1) financial privilege and 2) moral superiority. Adolescents differ, however, in how they view their own families' healthy eating habits, and accordingly, their own moral worth. Most middle- and high-SES adolescents depict their families as healthy eaters. They trace their families' healthy diets to financial privilege while simultaneously framing these diets as morally superior. In the process, middle- and high-SES adolescents distinguish their families - as healthy eaters - from poor, "unhealthy" families. In contrast, few low-SES adolescents describe their families as healthy eaters. On the one hand, these adolescents report that financial constraints limit their families' abilities to eat healthily. But most also subscribe to the same discourses that label healthy eating as morally superior. While a minority of low-SES adolescents push back against these discourses to regain a sense of moral worth, overall, more privileged adolescents' beliefs about healthy eating enable them to assert themselves as good, moral people, while those shared beliefs challenge less privileged adolescents' abilities to do the same. In this way, beliefs about healthy eating serve as a powerful medium for adolescents to mark and moralize socioeconomic groups, and each other.
View details for DOI 10.1016/j.socscimed.2018.10.022
View details for PubMedID 30391640
How Food Rules at Home Influence Independent Adolescent Food Choices.
The Journal of adolescent health : official publication of the Society for Adolescent Medicine
PURPOSE: The prevalence of unhealthy dietary behaviors among adolescents is high. We examined the effect of having health-oriented food rules at home on the healthiness of adolescents' independent food choices, and the necessity of parental oversight for such rules to be effective.METHODS: We surveyed a socioeconomically and racially diverse San Francisco Bay Area public high school in May 2017 (N=1,246). We used ordinal logistic regressions to assess the relationships between adolescent-reported presence of health-oriented food rules at home and the healthiness of snacks selected by adolescents in a raffle, which included a randomized controlled experiment to manipulate the level of parental approval students needed to pick up their snacks.RESULTS: Adolescents reporting at least one health-oriented food rule at home were significantly more likely to choose healthier snacks in the raffle (adjusted odds ratio, 1.85; 95% confidence interval [CI] 1.41-2.45). Telling adolescents that a parent needed to approve the snacks did not have a significant effect on snack choice healthiness relative to a no-approval baseline condition (adjusted odds ratio, 1.01; 95% CI .55-1.86). Post hoc analyses suggest that rules may affect adolescent food-related attitudes and perceptions of parental reactions; for example, adolescents with rules reported that their parents would be more disappointed (adjusted mean difference on five-point scale, .5; 95% CI .36-.64) if they made an unhealthy food choice.CONCLUSIONS: Having health-oriented food rules at home is associated with healthier snack choices. Findings suggest that adolescents with rules also hold beliefs that may correspond to healthier independent dietary choices.
View details for PubMedID 29779673
Dining with dad: Fathers' influences on family food practices
2017; 117: 98–108
Scholars have documented multiple influences on family food practices. This article examines an overlooked contributor to family diet: fathers. Using 109 in-depth interviews with middle and upper-middle class mothers, adolescents, and fathers in the United States, I show how fathers can undermine mothers' efforts to provision a healthy diet. While family members perceive mothers as committed to provisioning a healthy diet, many fathers are seen as, at best, detached and, at worst, a threat to mothers' dietary aspirations. Fathers not only do little foodwork; they are also viewed as less concerned about their own and other family members' dietary health. When tasked with feeding, many fathers often turn to quick, unhealthy options explicitly avoided by mothers. Mothers report efforts to limit fathers' involvement in foodwork to ensure the healthiness of adolescents' diets, with variation across families by mothers' employment status. Fathers' dietary approaches reflect and reinforce traditional gender norms and expectations within families. In highlighting how and why fathers can undermine mothers' efforts to provision a healthy diet, this study deepens our understanding of the myriad dynamics shaping family food practices.
View details for PubMedID 28629930
- A Taste of Inequality: Food's Symbolic Value across the Socioeconomic Spectrum SOCIOLOGICAL SCIENCE 2017; 4: 424–48
Table talk: How mothers and adolescents across socioeconomic status discuss food
SOCIAL SCIENCE & MEDICINE
2017; 187: 49–57
This article reports findings from a qualitative study of food practices among families of differing socioeconomic circumstances. Using in-depth interviews from sixty-two families in the San Francisco Bay Area in 2015-2016, we find socioeconomic differences in how mothers and adolescents talk about food. Across SES, mothers and adolescents engage in discussions about healthy eating. However, these conversations are more commonplace and embedded within high-SES family life than among low-SES families. Beyond conversations about 1) healthy eating, the topics of 2) food quality and 3) price are discussed to varying degrees across SES. Within high-SES families, frequent discussions of healthy eating are paired with dialogue highlighting the importance of consuming higher quality food. Price is largely absent as a topic of conversation among high-SES families. On the other end of the socioeconomic spectrum, low-SES mothers and adolescents frequently engage in conversations about price when discussing food. Mentions of food quality are rare, but when they do occur, they underscore important trade-offs between food's healthiness, quality and price. Given prior research showing the impact of dialogue between parents and adolescents on adolescents' dietary behaviors, these findings help us understand how family discussions contribute to shaping adolescents' approaches to food. An important implication is that high-SES families' discussions of food quality may strengthen messages about healthy eating, while conversations about affordability within low-SES families may highlight financial barriers to healthy eating.
View details for PubMedID 28654821
- Collaborative and Transformational Leadership in the Environmental Realm JOURNAL OF ENVIRONMENTAL POLICY & PLANNING 2015; 17 (3): 360-380