Research & Publications
My transdisciplinary research has investigated the interplay of complex biomedical, behavioral, social and psychological factors that influence individual and community health. I use this lens to examine challenges faced by those often marginalized by the health care system and by society. I have expertise running large, scientifically-rigorous randomized trials in clinical and community settings with pregnant women and school-aged children. My research – funded by more than US$40 million in grants from the National Institutes of Health, Centers for Disease Control and Prevention, and private foundations – is characterized by methodological rigor and cultural sensitivity. In collaboration with colleagues, community partners, post-doctoral scholars and students, we have published more than 220 peer-reviewed publications in maternal and child health, health equity, mental health, and chronic disease prevention. A large focus of my work for more than a decade has been the development and implementation of an innovative group prenatal care model that results in a 33% reduction in preterm birth and other salutogenic outcomes for mothers and babies.
In addition, as Director of the Community Alliance for Research and Engagement (CARE), I spent more than a decade working in grassroots community health and development with colleagues at Yale University and in alliance with local, regional and national networks. Before leaving for Singapore, I assured the continuity of the alliance. In the ensuing years, CARE received major grants from the US Centers for Disease Control and Prevention and the Patient-Centered Outcomes Research Institute to sustain its work. Building on successes of the first decade, CARE continues to reduce racial and ethnic disparities and promoting health equity in chronic disease. More recently, they also have been involved in COVID response and influenza vaccination, food security, and multi-sector interventions focused on social and economic determinants of health.
Specialized Terms: Maternal and Child Health; Prenatal Care; Teen pregnancy and STD risk; Obesity and chronic disease prevention; Community engaged research; Interventions; Randomized controlled trials
Extensive Research Description
1. Innovations in Prenatal Care: Nearly 4 million women give birth annually in the US. Rates of preterm birth (>12%) and low birth weight (>9%) have been intransigent for more than three decades. These are leading causes of infant morbidity and mortality, cost >$30 billion annually, and represent extreme racial/ethnic health disparities. The US Department of Health and Human Services refers to preterm birth as “one of the most pressing challenges to maternal, infant, and child health.” An independent review of studies on models of prenatal care found only one randomized controlled trial demonstrated improved birth outcomes. This study, from my research team, compared an innovative model of group prenatal care to standard individual care, and found women randomized to group prenatal care had a 33% lower rate of preterm delivery overall, and a 41%lower rate of preterm delivery for African American women. Moreover, we found that all perinatal and postpartum outcomes were as good or better for women randomized to group care compared to those randomized to traditional individual care (e.g., delivery complications, breastfeeding, psychosocial outcomes, repeat pregnancy, incident postpartum STDs). A second cluster RCT (14 New York City community hospitals and health centers) found that group prenatal care reduced risk for small for gestational age infants and depressive symptoms (which in turn were associated with preterm birth). I was the principal investigator on these two multi-site NIH-funded randomized controlled trials (R01MH/HD61175, R01MH074399). Based on successful outcomes, United Health Foundation funded a dissemination study of group prenatal care in Detroit MI and Nashville TN with an eye toward national scale-up. This work has been recognized as “innovative” as part of the Harvard Health Acceleration Challenge and the Hemsley Challenge.
2. HIV/STD Risk Reduction for Women: Prior to our randomized interventions, I have been PI and co-PI on numerous longitudinal studies of teens and young women to identify factors that influence behavioral and biological outcomes associated with HIV and STD risk. These studies were among the very first focused on women at risk for HIV, impact of testing, and then subsequently on pregnant women and preventing maternal to child transmission. Additional research focused on psychosocial factors impacting HIV progression among women (i.e., viral load, CD4 count). I continue to conduct research on reproductive risk as part of our ongoing RCTs in group prenatal care, and in support of pre- and post-doctoral fellows in our NIH T-32 training program.
3. Training the Next Generation of Prevention Scientists: I was the Founding Director and Principal Investigator of a US National Institutes of Health Training grant for 15 years (now in its 22nd year). The primary objective is to train the next generation of scientists to advance prevention research in general and with regard to HIV risk reduction specifically. We designed the training programme to provide opportunities for professional and personal development to ensure that our scholars have the tools to develop long and productive academic careers. We have trained nearly 100 pre- and post-doctoral scholars. A transdisciplinary program, this included physicians, epidemiologists and psychologists, as well as those from social welfare and social work, applied mathematics, anthropology, education, economics and law. Almost all now hold academic appointments at leading private and public academic institutions. Beyond the NIH Training Program, I have served as a primary mentor with more than two dozen doctoral students and post-doctoral scholars as well as more than 60 women and men as dissertation committee member, master’s, medical school or undergraduate thesis advisor. I was the recipient of the 2018 Strickland-Daniel Mentoring Award from the American Psychological Association.
4. Community Health Needs Assessments: Driven by unprecedented growth in obesity, chronic diseases such as diabetes, heart disease, stroke and cancer account for 7 of 10 deaths in the US annually. I have made significant contributions to public health’s understanding of the influence of the social and environmental factors that contribute to poor health outcomes. My team has received a number of foundation grants related to this topic, leading community-based interventions that change environments and more fully involve community members to ensure sustainable reductions in obesity (e.g., Kresge, Aetna, Donaghue Foundations). We work directly with New Haven neighborhoods to form local partnerships, empower residents, identify challenges, and provide resources to promote wellness through action. Triennially (beginning in 2009) we have conducted community stratified, population-level health surveys (N>1200, response rate >75%, each year). Concurrently, we conducted a regional survey in 13 cities and towns in the New Haven region (2012) and a Connecticut statewide community health needs assessment (2015, with DataHaven, Inc.). In addition, we conduct collaborative interventions to improve community/population health. Forty percent of residents report that there are people encouraging a healthy lifestyle in their neighborhoods, and 42% report that it has become easier to lead a healthy lifestyle over the past three years. We documented a 7% reduction in obesity from 2012 to 2015.
5. School-based Obesity Prevention: I was the Principal Investigator (MPI with Dr. Marlene Schwartz) on a NIH-funded cluster randomized controlled obesity prevention trial at 12 middle schools in collaboration with the Rudd Center and the New Haven Public Schools (1R01 HD070740). Health for Achievement is a 5-year study that examines the impact of school-based policies on risk factors and outcomes related to obesity, chronic disease and academic achievement. With data from students at 12 participating schools, we have developed and/or implemented interventions to enhance student health. We have conducted research with >1,800 middle school students regarding their physical health, health behaviors, school and neighborhood environments. The results of our research have been disseminated both locally and nationally, aiming to educate our communities and encourage better health for all students.
Chronic Disease; Community Health Services; Epidemiology; Obesity; Pregnancy; Prenatal Care; Urban Health
Public Health Interests
Clinical Trials; Community Health; Obesity; Reproduction; Health Equity, Disparities, Social Determinants and Justice