Research

Keywords:

Population aging • public health demography • social epidemiology • social determinants of health • rural-urban health disparities • health care services utilization • healthcare labor force • methodology development

Here are some of the substantive areas that I currently research:

Public Health Demography and Social Determinants of Population Health

I am the Principal Investigator of the Rhode Island Life Expectancy Project, a recently completed study funded by the URI Council for Research that examined the social determinants of life expectancy and mortality in Rhode Island. The purpose of this study was to determine which small area factors are predictive of LE in Rhode Island cities and towns. We obtained an array of established social determinants of health from the latest (2010) US Census and American Community Survey and related data on environmental factors, occupational factors, and other sociodemographic characteristics from other sources to create a large, publicly-available database of determinants. These include, but are not limited to, education, income, poverty, green space, health care availability, etc.  

RIIIIIII

Rural-Urban Health Disparities in Older Adults

I examine the changing scope of disparities in health and health care access for older adults across the rural-urban spectrum.  Preliminary research suggests that one-size-fits-all approaches to policy and programs designed to reduce these disparities may not be the most effective approach.  The overall trends in health across the rural-urban spectrum differ among regions in the US.

I also examine the methods and measures of defining rurality itself.  There are numerous measures designed to capture rural-urban status, but there is only limited consistency among them.  As of May 2020, we have four papers published in the Journal of Rural Health, the International Journal of Circumpolar Health, and Frontiers in Public Health on measuring rurality and its implications for population health among older adults:

We also published an article re-evaluating the role of socioeconomic inequality and population health among older adults.  The article was published in December 2019 in the International Journal of Health Geographics.

Informal Caregiving to Older Adults

  • Billions of dollars are saved in the US economy annually due to the care provided to the vulnerable older adults by informal caregivers, of whom 92% are the spouses, children, or other relative of the beneficiary.  
  • The US population aged 65 and above is expected to increase from over 34 million to 71 million by 2030, during which time the population aged 85 and above will grow from 6 to 9 million. 
  • Despite the benefits of informal caregiving to the health care system, the American economy, and care recipients, caregivers spend substantial time and resources on informal caregiving, especially to those patients with the most severe functional and cognitive limitations, rendering it a highly demanding activity for the caregiver. 

In my current research, I am assessing the relationships between caregiving intensity and health outcomes in informal caregivers, and how these relationships vary based on area-level socioeconomic and demographic factors–namely urbanicity and income.  Examples of my research on informal caregiving burden domains in the National Study of Caregiving can be found in these articles:


Here are some areas of research I have focused on previously:

The Healthcare Labor Force Shortage

One of the major challenges of health care in the 21st century is to find viable, ethical, and permanent solutions to the growing shortage in the healthcare labor force. My research was published in the Journal of Public Health Management and Practice, focusing on the demographic and infrastructural dynamics that contribute to the this impending crisis, particularly for physicians and nurses.

Geographic Patterns of Health Services Overutilization

I study utilization patterns of preventative health services, such as cancer screening and routine physical examinations, in Massachusetts, where there is health insurance coverage is mandatory for all residents.  Findings will be forthcoming.

Influenza

   Herd Immunity

My recent work focuses primarily on the possibility of preventing flu in the older population by vaccinating children, who tend to spread infection easily from person to person. Our research is among the first such research to examine vaccination of children and the older population simultaneously.  Findings were published in Vaccine and the Journal of the American Geriatrics Society.

   Social Epidemiology

We found that increased income inequality is associated with higher levels of flu in older adults, and this association was present even after accounting for income, itself. Another topic being researched is the role of grandparental caregiving and flu dynamics in the older population. After controlling for other factors, areas with high levels of grandparental caregiving for their grandchildren had higher rates of flu, and this was especially true in low income areas, where grandparents may have more intimate contacts with their grandchildren.  Some of this research was published the Journal of Epidemiology and Community Health.

   Cohort and Age Effects

My latest research involves examining the effect of birth cohort on influenza patterns, after accounting for age and seasonal effects.  Our research was published in the journal Epidemiology and Infection in 2010.

   Methodology Development

Epidemiology and Demography are two closely related disciplines, yet many of the methods used in demographic research can be adapted for use to improve epidemiological research. I am interested in bridging the gap between these two disciplines and developing methods that are statistically sound, yet at the same time useful and informative that will enable the researcher to better assess the population burden of disease and more fully evaluate population-level risk factors of disease. We have developed several methods, including the Slope-Intercept Method for Population Linear Estimation (S.I.M.P.L.E.) Method for assessing disease burden in the 65+ population. Our manuscript demonstrating the use of this method was published in Statistics in Medicine.