Jonathan Purtle
Jonathan Purtle
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Associate Professor of Public Health Policy & Management
Director of Policy Research at NYU’s Global Center for Implementation Science
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Professional overview
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Jonathan Purtle is Associate Professor of Public Health Policy & Management and Director of Policy Research at NYU’s Global Center for Implementation Science.
Dr. Purtle is an implementation scientist whose research focuses on mental health policy. His work examines questions such as how research evidence can be most effectively communicated to policymakers and is used in policymaking processes, how social and political contexts affect policymaking and policy implementation, and how the implementation of policies “on the books” can be improved in practice. He is also interested in population-based approaches to mental health and how mental health can be integrated in to mainstream public health practice.
Dr. Purtle’s work has been consistently funded by the National Institute of Mental Health (NIMH) and Robert Wood Johnson Foundation (RWJF). He is currently leading NIMH-funded projects focused on the implementation of financing policies related to the 988 Suicide & Crisis Lifeline (R01MH131649) and policies that earmark taxes for mental health services (R21MH125261) and understanding the dynamics of research evidence in mental health policymaking (P50MH113662) . He recently completed a RWJF-funded project that experimentally tested different ways of communicating evidence about child maltreatment to the public and policymakers. His research is regularly published in journals such as Implementation Science, Psychiatric Services, The Milbank Quarterly, and Annual Review of Public Health. He is Core Faculty of the NIMH-funded Implementation Research Institute, was Chair of the Policy Section of the AcademyHeath/NIH Dissemination and Implementation in Heath Conference from 2017 to 2022, was awarded the 2018 Champion of Evidence-Based Interventions Award from the Association for Behavioral and Cognitive Therapies for his work on evidence use in mental health policymaking.
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Education
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BA, Psychology, Roger Williams UniversityMSc, Sociology, Universiteit van AmsterdamMPH, Drexel UniversityDrPH, Drexel University
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Publications
Publications
Examining the possible impact of daily transport on depression among older adults using an agent-based model
AbstractYang, Y., Langellier, B. A., Stankov, I., Purtle, J., Nelson, K. L., & Diez Roux, A. V. (n.d.).Publication year
2019Journal title
Aging and Mental HealthVolume
23Issue
6Page(s)
743-751AbstractObjectives: Daily transport may impact depression risk among older adults through several pathways including facilitating the ability to meet basic needs, enabling and promoting contact with other people and nature, and promoting physical activity (e.g. through active transportation such as walking or walking to public transit). Both daily transport and depression are influenced by the neighborhood environment. To provide insights into how transport interventions may affect depression in older adults, we developed a pilot agent-based model to explore the contribution of daily transport and neighborhood environment to older adults’ depression in urban areas. Method: The model includes about 18,500 older adults (i.e. agents) between the ages of 65 and 85 years old, living in a hypothetical city. The city has a grid space with a number of neighborhoods and locations. Key dynamic processes in the model include aging, daily transport use and feedbacks, and the development of depression. Key parameters were derived from US data sources. The model was validated using empirical studies. Results: An intervention that combines a decrease in bus fares, shorter bus waiting times, and more bus lines and stations is most effective at reducing depression. Lower income groups are likely to be more sensitive to the public transit-oriented intervention. Conclusion: Preliminary results suggest that promoting public transit use may be a promising strategy to increase daily transport and decrease depression. Our results may have implications for transportation policies and interventions to prevent depression in older adults.Modeling HPV vaccination scale-up among urban young men who have sex with men in the context of HIV
AbstractGoldstein, N. D., LeVasseur, M. T., Tran, N. K., Purtle, J., Welles, S. L., & Eppes, S. C. (n.d.).Publication year
2019Journal title
VaccineVolume
37Issue
29Page(s)
3883-3891AbstractIntroduction: Young men who have sex with men (YMSM) are at high risk to contract human papillomavirus (HPV). While an effective vaccination exists, its use among YMSM is markedly lower compared to non-MSM and women. This study compares scaling up HPV vaccination in conjunction with other prevention strategies. Methods: An agent-based model of urban YMSM (≤26 years of age) reflective of the demography of Philadelphia, PA, simulated for up to ten years of follow-up to examine anal and oral transmission of the HPV genotypes covered in the nonavalent (9v) vaccine: 6, 11, 16, 18, 31, 33, 45, 52, 58. Starting HPV prevalences ranged from a high of 18% (type 6) to a low of 6% (type 31); overall 65% of individuals carried any HPV genotype. Simulated levels of vaccination were ranged from 0% to 13% (present-day level), 25%, 50%, 80% (Healthy People 2020 target), and 100% in conjunction with condom use and HIV seroadaptive practices. The primary outcome was the relative reduction in HPV infection. Results: Compared to present-day vaccination levels (13%), scaling-up vaccination led to expected declines in 10-year post-simulation HPV prevalence. Anal HPV (any 9v types) declined by 9%, 27%, 46%, and 58% at vaccination levels of 25%, 50%, 80%, and 100%, respectively. Similarly, oral HPV (any 9v types) declined by 11%, 33%, 57%, and 71% across the same levels of vaccine uptake. Comparing the prevention strategies, condoms blocked the greatest number of anal transmissions when vaccination was at or below present-day levels. For oral transmission, vaccination was superior to condom use at all levels of coverage. Conclusions: Public health HPV preventions strategies should continue to emphasize the complementary roles of condoms and vaccination, especially for preventing oral infection. Improving vaccination coverage will ultimately have the greatest impact on reducing HPV infection among YMSM.Perceptions of patient-provider communication and receipt of mental health treatment among older adults with depressive symptoms
AbstractNelson, K. L., & Purtle, J. (n.d.).Publication year
2019Journal title
Aging and Mental HealthVolume
23Issue
4Page(s)
485-490AbstractObjectives: This study aimed to: (1) determine if and how perceptions towards healthcare providers differ between older adults with and without clinically signifcant depressive symptoms (CSDS), and (2) assess whether perceptions towards providers are associated with receipt of mental health treatment among older adults with CSDS. Methods: Data from the 2013 and 2014 Medical Expenditure Panel Survey were used to examine CSDS prevalence, receipt of mental health treatment, and perceptions of provider communication among community-dwelling adults ≥ age 65 (N = 6,936) using four of the ‘How Well Doctors Communicate’ composite items from the Consumer Assessment of Healthcare Providers and Systems(CAHPS). Multivariate logistic regression was used. Results: CSDS are associated with greater odds of having ‘poor’ perceptions of provider communication on all four CAHPS communication measures. Perceptions of provider communication are similar among older adults with CSDS who received and did not receive mental health treatment, except on an item measuring a provider's ability to explain information in ways patients understand. Conclusion: Older adults with CSDS have more negative perceptions of the quality of their communication with healthcare providers than their peers. Healthcare systems should consider how to accommodate these patients’ unique needs and communication preferences to ensure receipt of quality care.Population-based approaches to mental health: History, strategies, and evidence
AbstractPurtle, J., Nelson, K. L., Counts, N. Z., & Yudell, M. (n.d.).Publication year
2019Journal title
Annual Review of Public HealthVolume
41Page(s)
201-221AbstractThere is growing recognition in the fields of public health and mental health services research that the provision of clinical services to individuals is not a viable approach to meeting the mental health needs of a population. Despite enthusiasm for the notion of population-based approaches to mental health, concrete guidance about what such approaches entail is lacking, and evidence of their effectiveness has not been integrated. Drawing from research and scholarship across multiple disciplines, this review provides a concrete definition of population-based approaches to mental health, situates these approaches within their historical context in the United States, and summarizes the nature of these approaches and their evidence. These approaches span three domains: (a) social, economic, and environmental policy interventions that can be implemented by legislators and public agency directors, (b) public health practice interventions that can be implemented by public health department officials, and (c) health care system interventions that can be implemented by hospital and health care system leaders.State legislators' opinions about adverse childhood experiences as risk factors for adult behavioral health conditions
AbstractPurtle, J., Lê-Scherban, F., Wang, X., Brown, E., & Chilton, M. (n.d.).Publication year
2019Journal title
Psychiatric ServicesVolume
70Issue
10Page(s)
894-900AbstractObjectives: Adverse childhood experiences (ACEs) increase risk of adult behavioral health conditions. State legislators are an important audience to target with evidence about ACEs because they make policy decisions that can prevent ACE exposure and enhance resilience. This study sought to describe state legislators' opinions about ACEs as risk factors for adult behavioral health conditions and identify how opinions vary between legislators with different characteristics. Methods: A multimodal survey was conducted in 2017 (response rate, 16.4%; N=475). Dependent variables were the extent to which legislators thought that four ACEs-sexual abuse, physical abuse, witnessing domestic violence, and childhood neglect-increase risk of adult behavioral health conditions. Independent variables were legislator characteristics (e.g., ideology and gender). Rao-Scott chi-square tests and multivariable logistic regression were conducted. Results: Childhood sexual abuse was identified as a major risk factor by the largest proportion of respondents (77%), followed by childhood physical abuse (59%), witnessing domestic violence (39%), and childhood neglect (38%). The proportion identifying each ACE as a major risk factor was significantly higher among Democrats than among Republicans, liberals than among conservatives, and women than among men. For example, 56% of liberals identified witnessing domestic violence as a major risk factor, compared with 29% of conservatives (p,.001). Conclusions: Opinions about ACEs as risk factors for adult behavioral health conditions varied between legislators with different characteristics, especially liberals and conservatives. To enhance the policy impact of evidence about ACEs, advocates might consider developing multiple versions of ACE evidence summaries that are tailored on the basis of these characteristics.State Legislators’ Support for Behavioral Health Parity Laws: The Influence of Mutable and Fixed Factors at Multiple Levels
AbstractPurtle, J., Lê-Scherban, F., Wang, X., Shattuck, P. T., Proctor, E. K., & Brownson, R. C. (n.d.).Publication year
2019Journal title
Milbank QuarterlyVolume
97Issue
4Page(s)
1200-1232AbstractPolicy Points When communicating with state legislators, advocates for state behavioral health parity laws should emphasize that the laws do not increase insurance premiums. Legislators’ opinions about the impacts of state behavioral health parity laws and the effectiveness of behavioral health treatment have more influence on support for the laws than do their political party affiliation or state-level contextual factors. Reducing legislators’ stigma toward people with mental illness could increase their support for state behavioral health parity laws. Context: Comprehensive state behavioral health parity legislation (C-SBHPL) is an evidence-based policy that improves access and adherence to behavioral health treatments. However, adoption of C-SBHPL by state legislators is low. Little is known about how C-SBHPL evidence might be most effectively disseminated to legislators or how legislators’ fixed characteristics (eg, ideology), mutable characteristics (eg, beliefs about the policy's impact), and state-level contextual factors might influence their support for behavioral health policies. The purpose of our study is (1) to describe the associations between legislators’ fixed and mutable characteristics, state-level contextual factors, and support for C-SBHPL; and (2) to identify the mutable characteristics of legislators independently associated with C-SBHPL support. Methods: We conducted a multimodal (post mail, email, telephone) survey of US state legislators in 2017 (N = 475). The dependent variable was strong support for C-SBHPL, and the independent variables included legislators’ fixed and mutable characteristics and state-level contextual factors. We conducted multivariable, multilevel (legislator, state) logistic regression. Findings: Thirty-nine percent of the legislators strongly supported C-SBHPL. After adjustment, the strongest predictors of C-SBHPL support were beliefs that C-SBHPL increases access to behavioral health treatments (aOR = 5.85; 95% CI = 2.41, 14.20) and does not increase insurance premiums (aOR = 2.70; 95% CI = 1.24, 5.90). Stigma toward people with mental illness was inversely associated with support (aOR = 0.86; 95% CI = 0.78, 0.95). After adjustment, ideology was the only fixed characteristic significantly associated with support for C-SBHPL. State-level contextual factors did not moderate associations between mutable characteristics and support for C-SBHPL. Conclusions: Legislators’ mutable characteristics are stronger predictors of C-SBHPL support than are most of their fixed characteristics and all state-level contextual factors, and thus should be targeted by dissemination efforts.State Mental Health Agency Officials' Preferences for and Sources of Behavioral Health Research
AbstractPurtle, J., Lê-Scherban, F., Nelson, K. L., Shattuck, P. T., Proctor, E. K., & Brownson, R. C. (n.d.).Publication year
2019Journal title
Psychological ServicesAbstractState mental health agencies (SMHAs) are integral to public behavioral health service systems. As such, senior-level officials within SMHAs are important targets for advocacy and dissemination of behavioral health research findings. Evidence-informed decision making in SMHAs can potentially be enhanced by developing summaries of behavioral health research (e.g., policy briefs) that reflect SMHA officials' information preferences, but knowledge about these preferences is lacking. An exploratory study was conducted with the aims of characterizing senior-level SMHA officials' preferences for behavioral health research and describing where they turn for this research when making policy decisions. A crosssectional, web-based survey of senior-level SMHA officials (1 per state) was conducted in March±May 2017 (n = 43, response rate = 84%). The features of behavioral health research that SMHA officials identified as "very important" most frequently were research being relevant to state residents (93.0%), providing data on cost-effectiveness (86.0%) and budget impact (81.4%), and being presented concisely (81.0%). The primary sources that SMHA officials turned to for behavioral research when making policy decisions were professional organizations (79.1%), SMHA agency staff (60.5%), and university researchers (55.8%). Compared with state legislators' responses to the same survey questions, results suggest that senior-level SMHA officials and legislators have similar preferences for behavioral health research but turn to different sources for this research. Advocates and researchers who seek to promote evidenceinformed decision making in SMHAs should consider developing policy briefs that are concise, provide state-level prevalence data about behavioral conditions, and contain economic evaluation data, and they should disseminate these materials to multiple sources.Strengthening partnerships between substance use researchers and policy makers to take advantage of a window of opportunity
AbstractMeisel, Z. F., Mitchell, J., Polsky, D., Boualam, N., McGeoch, E., Weiner, J., Miclette, M., Purtle, J., Schackman, B., & Cannuscio, C. C. (n.d.).Publication year
2019Journal title
Substance Abuse: Treatment, Prevention, and PolicyVolume
14Issue
1AbstractBackground: The National Institute on Drug Abuse has identified a persistent research-to-practice gap in the implementation of evidence-based prevention and treatment programs for substance use disorder. To identify mechanisms to close this gap, we sought to obtain and characterize the range of policy makers' perspectives on the use of research in substance use disorder treatment and coverage decisions. Methods: We conducted open-ended, semi-structured interviews with a purposive sample of eighteen policy makers involved in the delivery of health services. The aim was to identify barriers and facilitators, attitudes, beliefs, and experiences surrounding the use of research related to the treatment and economics of substance use disorder. Results: The analysis generated four themes: 1) policy maker engagement with evidence and researchers; 2) strategic use and usefulness of research; 3) scientific rigor versus relevance; and 4) communication of evidence. Within each theme, the participants identified barriers, facilitators, current practice, and gave their perspectives on "ideal conditions" for research design, conduct and communication. Conclusions: Recommendations for investigators are the following actionable steps: 1) partner with policy makers early in the research process, 2) formulate and use research designs to meet the strategic goals of end-users; 3) systematically test alternative phrasing of scientific terminology - particularly in the realm of cost effectiveness research - that allow end users to better understand and repurpose the data; 4) incorporate qualitative research methods to uncover the narratives that explain the context and relevance of evidence; 5) incorporate study designs that prioritize timeliness of results; and 6) promote and reward researcher involvement in policy discussions.Trends and characteristics of proposed and enacted state legislation on childhood vaccination exemption, 2011–2017
AbstractGoldstein, N. D., Suder, J. S., & Purtle, J. (n.d.).Publication year
2019Journal title
American journal of public healthVolume
109Issue
1Page(s)
102-107AbstractObjectives. To examine trends and characteristics of proposed and enacted state legislation that would directly affect states’ immunization exemption laws. Methods. We performed content analysis of proposed bills in state legislatures from 2011 to 2017. We classified bills as provaccination or antivaccination. Results. State legislators proposed 175 bills, with the volume increasing over time: 92 (53%) bills expanded access to exemptions, and 83 (47%) limited the ability to exempt. Of the 13 bills signed into law, 12 (92%) limited the ability to exempt. Bills that expanded access to exemptions were more likely to come from Republican legislators and Northeastern and Southern states. Conclusions. Although most proposed legislation would have expanded access to exemptions, bills that limited exemptions were more likely to be enacted into law. Legal barriers to exempt one’s children from vaccination persist despite vaccine hesitancy, which is encouraging for public health. Public Health Implications. Most vaccine exemption laws introduced in state legislatures would pose threats to the public’s health. There is a need for constituents to engage their elected legislators and advocate provaccination policies.Urban–Rural Differences in Older Adult Depression: A Systematic Review and Meta-analysis of Comparative Studies
AbstractPurtle, J., Nelson, K. L., Yang, Y., Langellier, B., Stankov, I., & Diez Roux, A. V. (n.d.).Publication year
2019Journal title
American journal of preventive medicineVolume
56Issue
4Page(s)
603-613AbstractContext: Depression among older adults (aged 60 years or older) is a problem that could be exacerbated by global trends in urbanization and population aging. The study purpose was to assess whether urban, relative to rural, residence is associated with depression among older adults and whether associations differ in countries with developed versus developing economies. Evidence acquisition: In 2017, the authors identified and extracted information from comparative studies of urban–rural depression prevalence among older adults. Studies were identified in PubMed, PsychINFO, and Web of Science and limited to English language articles published after 1985. Eighteen studies met inclusion criteria. Random effects meta-analysis was conducted to produce weighted pooled ORs estimating the association between urban–rural residence and depression for all study participants (N=31,598) and sub-analyses were conducted for developed (n=12,728) and developing (n=18,870) countries. Evidence synthesis: Depression prevalence was significantly higher among urban residents in ten studies and significantly higher among rural residents in three studies (all three conducted in China). Associations between urban–rural residence and depression generally remained significant after adjusting for covariates. In developed countries, the odds of depression were significantly higher among urban than rural residents (pooled OR=1.44, 95% CI=1.10, 1.88). However, in developing countries, this association was not observed (pooled OR=0.91, 95% CI=0.46, 1.77). Conclusions: Converging trends of urbanization and population aging could increase the global burden of depression among older adults. The pathways through which urban–rural residence influences depression risk among older adults might differ by country context. Future research should focus on measuring variation in these contexts.Uses of Population Health Rankings in Local Policy Contexts: A Multisite Case Study
AbstractPurtle, J., Peters, R., Kolker, J., & Diez Roux, A. V. (n.d.).Publication year
2019Journal title
Medical Care Research and ReviewVolume
76Issue
4Page(s)
478-496AbstractPopulation health rankings are a common strategy to spur evidence-informed health policy making, but little is known about their uses or impacts. The study aims were to (1) understand how and why the County Health Rankings (CH-Rankings) are used in local policy contexts, (2) identify factors that influence CH-Rankings utilization, and (3) explore potentially negative impacts of the CH-Rankings. Forty-four interviews were conducted with health organization officials and public policy makers in 15 purposively selected counties. The CH-Rankings were used instrumentally to inform internal planning decisions, conceptually to educate the public and policy makers about determinants of population health, and politically to advance organizational agendas. Factors related to organizational capacity, county political ideology, and county rank influenced if, how, and why the CH-Rankings were used. The CH-Rankings sometimes had the negative impacts of promoting potentially ineffective interventions in politically conservative counties and prompting negative media coverage in some counties with poor rank.A Case Study of the Philadelphia Sugar-Sweetened Beverage Tax Policymaking Process: Implications for Policy Development and Advocacy
AbstractPurtle, J., Langellier, B., & Lê-Scherban, F. (n.d.).Publication year
2018Journal title
Journal of Public Health Management and PracticeVolume
24Issue
1Page(s)
4-8AbstractContext: Policymakers are increasingly proposing sugar-sweetened beverage (SSB) taxes as an evidence-based strategy to reduce chronic disease risk; and local health departments (LHDs) are well-positioned to play a role in SSB policy development and advocacy. However, most SSB tax proposals fail to become law and limited empiric guidance exists to inform advocacy efforts. In June 2016, Philadelphia, Pennsylvania, passed an SSB tax. Objective: To identify features of the Philadelphia SSB tax policymaking process that contributed to the proposal's passage. Design: Qualitative case study. Semistructured interviews were conducted with key informants closely involved with the policymaking process. Interviews were audio-recorded and transcribed. Local news media about the SSB tax proposal were analyzed to triangulate interview findings. Analysis was conducted in NVivo 10 using inductive qualitative content analysis. Setting: Philadelphia, Pennsylvania, during the SSB tax policymaking in process. Participants: Nine key informants (2 city councilpersons, 4 city agency officials, 1 community-based advocate, 1 news reporter, and 1 researcher). Results: The Philadelphia SSB tax proposal was introduced with the explicit goal of financing universal prekindergarten and deliberately not framed as a health intervention. This framing shifted contentious debates about government involvement in individual behavior toward discussions about how to finance universal prekindergarten, a goal for which broad support existed. The LHD played an important role in communicating research evidence about potential health benefits of the SSB tax proposal at the end of the policymaking process. Conclusions: During local SSB tax policy development processes, LHD officials and other advocates should encourage policymakers to design SSB tax policies so that revenue is directed toward community investments for which broad public support exists. When communicating with policymakers and the public, LHDs should consider emphasizing how SSB tax revenue will be used in addition to presenting evidence about the potential health benefits of the SSB tax at the local level.A Content Analysis of Hospitals’ Community Health Needs Assessments in the Most Violent U.S. Cities
AbstractFischer, K. R., Schwimmer, H., Purtle, J., Roman, D., Cosgrove, S., Current, J. J., & Greene, M. B. (n.d.).Publication year
2018Journal title
Journal of Community HealthVolume
43Issue
2Page(s)
259-262AbstractThe emergence of evidence-supported interventions allows hospitals the opportunity to reduce future reinjury among patients who are violently injured. However, hospital knowledge of these interventions and their perceived role in violence prevention is unknown. The Patient Protection and Affordable Care Act created new legal requirements for non-profit hospitals to conduct community health needs assessments (CHNA) every three years to maintain not-for-profit status. In turn, this allows an empiric evaluation of hospital recognition and response to community violence. To do so, this study performed a content analysis of hospital CHNAs from the 20 U.S. cities with the highest violent crime rates. A total of 77 CHNAs were examined for specific violence-related keywords as well as whether violence prevention was listed as a priority community need. Overall, 74% of CHNAs mentioned violence-related terms and only 32% designated violence prevention as a priority need. When discussed, 88% of CHNAs referenced community violence, 42% intimate partner or sexual violence, and 22% child abuse. This study suggests that hospitals may lack awareness of violence as an actionable, preventable public health issue. Further, evidence-based program models are available to hospitals that can reduce the recurrence of assaultive injuries.Assessing the spatial heterogeneity in overall health across the United States using spatial regression methods: The contribution of health factors and county-level demographics
Tabb, L. P., McClure, L. A., Quick, H., Purtle, J., & Diez Roux, A. V. (n.d.).Publication year
2018Journal title
Health and PlaceVolume
51Page(s)
68-77Audience segmentation to disseminate behavioral health evidence to legislators: An empirical clustering analysis
AbstractPurtle, J., Lê-Scherban, F., Wang, X., Shattuck, P. T., Proctor, E. K., & Brownson, R. C. (n.d.).Publication year
2018Journal title
Implementation ScienceVolume
13Issue
1AbstractBackground: Elected officials (e.g., legislators) are an important but understudied population in dissemination research. Audience segmentation is essential in developing dissemination strategies that are tailored for legislators with different characteristics, but sophisticated audience segmentation analyses have not been conducted with this population. An empirical clustering audience segmentation study was conducted to (1) identify behavioral health (i.e., mental health and substance abuse) audience segments among US state legislators, (2) identify legislator characteristics that are predictive of segment membership, and (3) determine whether segment membership is predictive of support for state behavioral health parity laws. Methods: Latent class analysis (LCA) was used. Data were from a multi-modal (post-mail, e-mail, telephone) survey of state legislators fielded in 2017 (N=475). Nine variables were included in the LCA (e.g., perceptions of behavioral health treatment effectiveness, mental illness stigma). Binary logistic regression tested associations between legislator characteristics (e.g., political party, gender, ideology) and segment membership. Multi-level logistic regression assessed the predictive validity of segment membership on support for parity laws. A name was developed for each segment that captured its most salient features. Results: Three audience segments were identified. Budget-oriented skeptics with stigma (47% of legislators) had the least faith in behavioral health treatment effectiveness, had the most mental illness stigma, and were most influenced by budget impact. This segment was predominantly male, Republican, and ideologically conservative. Action-oriented supporters (24%) were most likely to have introduced a behavioral health bill, most likely to identify behavioral health issues as policy priorities, and most influenced by research evidence. This was the most politically and ideologically diverse segment. Passive supporters (29%) had the greatest faith in treatment effectiveness and the least stigma, but were also least likely to have introduced a behavioral health bill. Segment membership was a stronger predictor of support for parity laws than almost all other legislator characteristics. Conclusions: State legislators are a heterogeneous audience when it comes to behavioral health. There is a need to develop and test behavioral health evidence dissemination strategies that are tailored for legislators in different audience segments. Empirical clustering approaches to audience segmentation are a potentially valuable tool for dissemination science.Inter-Agency Strategies Used by State Mental Health Agencies to Assist with Federal Behavioral Health Parity Implementation
Purtle, J., Borchers, B., Clement, T., & Mauri, A. (n.d.).Publication year
2018Journal title
Journal of Behavioral Health Services and ResearchVolume
45Issue
3Page(s)
516-526Legislators' Sources of Behavioral Health Research and Preferences for Dissemination: Variations by Political Party
AbstractPurtle, J., Dodson, E. A., Nelson, K., Meisel, Z. F., & Brownson, R. C. (n.d.).Publication year
2018Journal title
Hospital and Community PsychiatryVolume
69Issue
10Page(s)
1105-1108AbstractOBJECTIVES: This study sought to characterize primary sources of behavioral health research and dissemination preferences of state legislators and assess differences by political party. METHODS: A 2017 cross-sectional survey of state legislators (N=475) assessed where legislators seek, and the most important features of, behavioral health research. Bivariate analyses and multivariate logistic regression were conducted. RESULTS: Advocacy organizations (53%), legislative staff (51%), and state agencies (48%) were identified most frequently as sources of behavioral health research. Universities were identified by significantly more Democrats than Republicans (34% versus 19%; adjusted odds ratio=1.79). Data about budget impact and cost-effectiveness were most frequently rated as very important, but by significantly fewer Democrats than Republicans (77% versus 87% and 76% versus 89%, respectively). CONCLUSIONS: To reach legislators and satisfy their information preferences, behavioral health researchers should target diverse audiences, partner with intermediary organizations, and craft messages that include economic evaluation data.The Impact of Law on Syndromic Disease Surveillance Implementation
AbstractPurtle, J., Field, R. I., Hipper, T., Nash-Arott, J., Chernak, E., & Buehler, J. W. (n.d.).Publication year
2018Journal title
Journal of Public Health Management and PracticeVolume
24Issue
1Page(s)
9-17AbstractContext: Legal environments influence how health information technologies are implemented in public health practice settings. Syndromic disease surveillance (SyS) is a relatively new approach to surveillance that depends heavily on health information technologies to achieve rapid awareness of disease trends. Evidence suggests that legal concerns have impeded the optimization of SyS. Objectives: To (1) understand the legal environments in which SyS is implemented, (2) determine the perceived legal basis for SyS, and (3) identify perceived legal barriers and facilitators to SyS implementation. Design: Multisite case study in which 35 key informant interviews and 5 focus groups were conducted with 75 SyS stakeholders. Interviews and focus groups were audio recorded, transcribed, and analyzed by 3 coders using thematic content analysis. Legal documents were reviewed. Setting: Seven jurisdictions (5 states, 1 county, and 1 city) that were purposively selected on the basis of SyS capacity and legal environment. Participants: Health department directors, SyS system administrators, legal counsel, and hospital personnel. Results: Federal (eg, HIPAA) and state (eg, notifiable disease reporting) laws that authorize traditional public health surveillance were perceived as providing a legal basis for SyS. Financial incentives for hospitals to satisfy Meaningful Use regulations have eased concerns about the legality of SyS and increased the number of hospitals reporting SyS data. Legal issues were perceived as barriers to BioSense 2.0 (the federal SyS program) participation but were surmountable. Conclusion: Major legal reforms are not needed to promote more widespread use of SyS. The current legal environment is perceived by health department and hospital officials as providing a firm basis for SyS practice. This is a shift from how law was perceived when SyS adoption began and has policy implications because it indicates that major legal reforms are not needed to promote more widespread use of the technology. Beyond SyS, our study suggests that federal monetary incentives can ameliorate legal concerns regarding novel health information technologies.Understanding policymakers' opinions can help foster policy change
Purtle, J., Henson, R. M., Carroll-Scott, A., Kolker, J., Joshi, R., & Roux, A. V. (n.d.). In American journal of public health (1–).Publication year
2018Volume
108Issue
9Page(s)
e6An audience research study to disseminate evidence about comprehensive state mental health parity legislation to US State policymakers: Protocol
AbstractPurtle, J., Lê-Scherban, F., Shattuck, P., Proctor, E. K., & Brownson, R. C. (n.d.).Publication year
2017Journal title
Implementation ScienceVolume
12Issue
1AbstractBackground: A large proportion of the US population has limited access to mental health treatments because insurance providers limit the utilization of mental health services in ways that are more restrictive than for physical health services. Comprehensive state mental health parity legislation (C-SMHPL) is an evidence-based policy intervention that enhances mental health insurance coverage and improves access to care. Implementation of C-SMHPL, however, is limited. State policymakers have the exclusive authority to implement C-SMHPL, but sparse guidance exists to inform the design of strategies to disseminate evidence about C-SMHPL, and more broadly, evidence-based treatments and mental illness, to this audience. The aims of this exploratory audience research study are to (1) characterize US State policymakers' knowledge and attitudes about C-SMHPL and identify individual- and state-level attributes associated with support for C-SMHPL; and (2) integrate quantitative and qualitative data to develop a conceptual framework to disseminate evidence about C-SMHPL, evidence-based treatments, and mental illness to US State policymakers. Methods: The study uses a multi-level (policymaker, state), mixed method (QUAN→qual) approach and is guided by Kingdon's Multiple Streams Framework, adapted to incorporate constructs from Aarons' Model of Evidence-Based Implementation in Public Sectors. A multi-modal survey (telephone, post-mail, e-mail) of 600 US State policymakers (500 legislative, 100 administrative) will be conducted and responses will be linked to state-level variables. The survey will span domains such as support for C-SMHPL, knowledge and attitudes about C-SMHPL and evidence-based treatments, mental illness stigma, and research dissemination preferences. State-level variables will measure factors associated with C-SMHPL implementation, such as economic climate and political environment. Multi-level regression will determine the relative strength of individual- and state-level variables on policymaker support for C-SMHPL. Informed by survey results, semi-structured interviews will be conducted with approximately 50 US State policymakers to elaborate upon quantitative findings. Then, using a systematic process, quantitative and qualitative data will be integrated and a US State policymaker-focused C-SMHPL dissemination framework will be developed. Discussion: Study results will provide the foundation for hypothesis-driven, experimental studies testing the effects of different dissemination strategies on state policymakers' support for, and implementation of, evidence-based mental health policy interventions.Factors Perceived as Influencing Local Health Department Involvement in Mental Health
AbstractPurtle, J., Peters, R., Kolker, J., & Klassen, A. C. (n.d.).Publication year
2017Journal title
American journal of preventive medicineVolume
52Issue
1Page(s)
64-73AbstractIntroduction Local health departments (LHDs) are potentially well positioned to implement population-based approaches to mental health promotion, but research indicates that most LHDs are not substantively engaged in activities to address mental health. Little is known about factors that influence if and how LHDs address population mental health. The objectives of this qualitative study were to (1) understand how LHD officials perceive population mental health; (2) identify factors that influence these perceptions and LHD activities to address population mental health; and (3) develop an empirically derived conceptual framework of LHD engagement in population mental health. Methods Twenty-one semi-structured interviews were conducted with a purposive sample of LHD officials and analyzed using thematic content analysis in 2014–2015. Transcripts were double coded, inter-rater reliability statistics were calculated, and categories with κ ≥0.60 were retained. Results Respondents perceived mental health as a public health issue and expressed that it has emerged as a priority through community health needs assessment processes, such as those conducted for health department accreditation. However, most LHDs were not substantively engaged in population mental health activities because of limited resources, knowledge, data, and hesitancy to infringe upon the territory of local behavioral health agencies. LHDs and local behavioral health agencies had difficulty communicating and collaborating because of divergent perspectives and financing arrangements. Conclusions LHD officials are eager to embrace population mental health, but resources, training and education, and systems-level changes are needed. Contemporary reforms to the structure and financing of the U.S. health system offer opportunities to address these challenges.Funding quality pre-kindergarten slots with Philadelphia's new 'sugary drink tax': Simulating effects of using an excise tax to address a social determinant of health
AbstractLangellier, B. A., Lê-Scherban, F., & Purtle, J. (n.d.).Publication year
2017Journal title
Public Health NutritionVolume
20Issue
13Page(s)
2450-2458AbstractObjective Philadelphia passed a 1·5-cent-per-ounce sweetened beverage tax (SBT). Revenue will fund 10 000 quality pre-kindergarten slots for poor children. It is imperative to understand how revenue from SBT can be used to fund programmes to address education and other social determinants of health. The objective of the present study was to simulate quality pre-kindergarten attendance, educational achievement and sugar-sweetened beverage (SSB) consumption among Philadelphia children and adolescents under six intervention scenarios: (i) no intervention; (ii) 10 000 additional quality pre-kindergarten slots; (iii) a 1·5-cent-per-ounce SBT; (iv) expanded pre-kindergarten and 1·5-cent-per-ounce SBT; (v) a 3-cent-per-ounce SBT; and (vi) expanded pre-kindergarten and 3-cent-per-ounce SBT. Design We used an agent-based model to estimate pre-kindergarten enrolment, educational achievement and SSB consumption under the six policy scenarios. We identified key parameters in the model from the published literature and secondary analyses of the Panel Study of Income Dynamics-Child Development Supplement. Setting Philadelphia, Pennsylvania, USA. Subjects Philadelphia children and adolescents aged 4-18 years. Results A 1·5-cents-per-ounce tax would reduce SSB consumption by 1·3 drinks/week among Philadelphia children and adolescents relative to no intervention, with larger effects among children below the poverty level. Quality pre-kindergarten expansion magnifies the effect of the SBT by 8 %, but has the largest effect on moderate-income children just above the poverty level. The SBT and quality pre-kindergarten programme each reduce SSB consumption, but primarily benefit different children and adolescents. Conclusions Pairing an excise tax with a complementary programme to improve a social determinant of health represents a progressive strategy to combat obesity, a disease regressive in its social patterning.Infusing Science into Politics and Policy: The Importance of Legislators as an Audience in Mental Health Policy Dissemination Research
AbstractPurtle, J., Brownson, R. C., & Proctor, E. K. (n.d.).Publication year
2017Journal title
Administration and Policy in Mental Health and Mental Health Services ResearchVolume
44Issue
2Page(s)
160-163AbstractLegislators (i.e., elected Senators and House Representatives at the federal- and state-level) are a critically important dissemination audience because they shape the architecture of the US mental health system through budgetary and regulatory decisions. In this Point of View, we argue that legislators are a neglected audience in mental health dissemination research. We synthesize relevant research, discuss its potential implications for dissemination efforts, identify challenges, and outline areas for future study.Is this thing on? Getting the public to listen to the pro-vaccine message
Goldstein, N. D., LeVasseur, M. T., & Purtle, J. (n.d.). In Vaccine (1–).Publication year
2017Volume
35Issue
9Page(s)
1208Mapping “Trauma-Informed” Legislative Proposals in U.S. Congress
AbstractPurtle, J., & Lewis, M. (n.d.).Publication year
2017Journal title
Administration and Policy in Mental Health and Mental Health Services ResearchVolume
44Issue
6Page(s)
867-876AbstractDespite calls for translation of trauma-informed practice into public policy, no empirical research has investigated how the construct has been integrated into policy proposals. This policy mapping study identified and analyzed every bill introduced in US Congress that mentioned “trauma-informed” between 1973 and 2015. Forty-nine bills and 71 bill sections mentioned the construct. The number of trauma-informed bills introduced annually increased dramatically, from 0 in 2010 to 28 in 2015. Trauma-informed bill sections targeted a range of sectors, but disproportionally focused on youth (73.2%). Only three bills defined “trauma-informed.” Implications within the context of a changing political environment are discussed.