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 a mental health policy researcher and implementation scientist. His work examines questions such as how the implementation of policies “on the books” can be improved in practice, how research evidence can be most effectively communicated to policymakers and is used in policymaking processes, and how social and political contexts affect mental health policymaking and policy implementation. He is also studies population-based approaches to mental health and suicide prevention.
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/recently led 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 also recently completed a RWJF-funded project that experimentally tested different ways of communicating evidence about child maltreatment to the public and policymakers.
He has published over 150 peer-reviewed journal articles, is an Associate Editor at Implementation Science, and Co-Chairs the Policy Advisory Board at Psychiatric Services. 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
State and Federal Legislators’ Responses on Social Media to the Mental Health and Burnout of Health Care Workers Throughout the COVID-19 Pandemic: Natural Language Processing and Sentiment Analysis
AbstractAbrams, M. P., Pelullo, A. P., Meisel, Z. F., Merchant, R. M., Purtle, J., & Agarwal, A. K. (n.d.).Publication year
2023Journal title
JMIR InfodemiologyVolume
3AbstractBackground: Burnout and the mental health burden of the COVID-19 pandemic have disproportionately impacted health care workers. The links between state policies, federal regulations, COVID-19 case counts, strains on health care systems, and the mental health of health care workers continue to evolve. The language used by state and federal legislators in public-facing venues such as social media is important, as it impacts public opinion and behavior, and it also reflects current policy-leader opinions and planned legislation. Objective: The objective of this study was to examine legislators’ social media content on Twitter and Facebook throughout the COVID-19 pandemic to thematically characterize policy makers’ attitudes and perspectives related to mental health and burnout in the health care workforce. Methods: Legislators’ social media posts about mental health and burnout in the health care workforce were collected from January 2020 to November 2021 using Quorum, a digital database of policy-related documents. The total number of relevant social media posts per state legislator per calendar month was calculated and compared with COVID-19 case volume. Differences between themes expressed in Democratic and Republican posts were estimated using the Pearson chi-square test. Words within social media posts most associated with each political party were determined. Machine-learning was used to evaluate naturally occurring themes in the burnout- and mental health–related social media posts. Results: A total of 4165 social media posts (1400 tweets and 2765 Facebook posts) were generated by 2047 unique state and federal legislators and 38 government entities. The majority of posts (n=2319, 55.68%) were generated by Democrats, followed by Republicans (n=1600, 40.34%). Among both parties, the volume of burnout-related posts was greatest during the initial COVID-19 surge. However, there was significant variation in the themes expressed by the 2 major political parties. Themes most correlated with Democratic posts were (1) frontline care and burnout, (2) vaccines, (3) COVID-19 outbreaks, and (4) mental health services. Themes most correlated with Republican social media posts were (1) legislation, (2) call for local action, (3) government support, and (4) health care worker testing and mental health. Conclusions: State and federal legislators use social media to share opinions and thoughts on key topics, including burnout and mental health strain among health care workers. Variations in the volume of posts indicated that a focus on burnout and the mental health of the health care workforce existed early in the pandemic but has waned. Significant differences emerged in the content posted by the 2 major US political parties, underscoring how each prioritized different aspects of the crisis.State Legislator Social Media Posts about the 988 Suicide and Crisis Lifeline
Purtle, J., Soltero, M., Crane, M. E., McSorley, A. M. M., Knapp, M., & Drapeau, C. W. (n.d.).Publication year
2023Journal title
JAMA network openVolume
6Issue
10Tailoring dissemination strategies to increase evidence-informed policymaking for opioid use disorder treatment: study protocol
AbstractCrable, E. L., Grogan, C. M., Purtle, J., Roesch, S. C., & Aarons, G. A. (n.d.).Publication year
2023Journal title
Implementation Science CommunicationsVolume
4Issue
1AbstractBackground: Policy is a powerful tool for systematically altering healthcare access and quality, but the research to policy gap impedes translating evidence-based practices into public policy and limits widespread improvements in service and population health outcomes. The US opioid epidemic disproportionately impacts Medicaid members who rely on publicly funded benefits to access evidence-based treatment including medications for opioid use disorder (MOUD). A myriad of misaligned policies and evidence-use behaviors by policymakers across federal agencies, state Medicaid agencies, and managed care organizations limit coverage of and access to MOUD for Medicaid members. Dissemination strategies that improve policymakers’ use of current evidence are critical to improving MOUD benefits and reducing health disparities. However, no research describes key determinants of Medicaid policymakers’ evidence use behaviors or preferences, and few studies have examined data-driven approaches to developing dissemination strategies to enhance evidence-informed policymaking. This study aims to identify determinants and intermediaries that influence policymakers’ evidence use behaviors, then develop and test data-driven tailored dissemination strategies that promote MOUD coverage in benefit arrays. Methods: Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, we will conduct a national survey of state Medicaid agency and managed care organization policymakers to identify determinants and intermediaries that influence how they seek, receive, and use research in their decision-making processes. We will use latent class methods to empirically identify subgroups of agencies with distinct evidence use behaviors. A 10-step dissemination strategy development and specification process will be used to tailor strategies to significant predictors identified for each latent class. Tailored dissemination strategies will be deployed to each class of policymakers and assessed for their acceptability, appropriateness, and feasibility for delivering evidence about MOUD benefit design. Discussion: This study will illuminate key determinants and intermediaries that influence policymakers’ evidence use behaviors when designing benefits for MOUD. This study will produce a critically needed set of data-driven, tailored policy dissemination strategies. Study results will inform a subsequent multi-site trial measuring the effectiveness of tailored dissemination strategies on MOUD benefit design and implementation. Lessons from dissemination strategy development will inform future research about policymakers’ evidence use preferences and offer a replicable process for tailoring dissemination strategies.Unintended consequences of disseminating behavioral health evidence to policymakers: Results from a survey-based experiment
AbstractPurtle, J., Nelson, K. L., Lê-Scherban, F., & Gollust, S. E. (n.d.).Publication year
2023Journal title
Implementation Research and PracticeVolume
4AbstractBackground: Communication research demonstrates that messages often have unintended consequences, but this work has received limited attention in implementation science. This dissemination experiment sought to determine whether state-tailored policy briefs about the behavioral health consequences of adverse childhood experiences (ACEs), compared to national policy briefs on the topic, increased state legislators’/staffers’ perceptions of the policy brief relevance and parental blame for the consequences of ACEs, and whether effects differed between Democrats and Republicans. Method: A preregistered, web-based survey experiment with U.S. state legislators/staffers was conducted in 2021 (n = 133). Respondents were randomized to view a policy brief about the behavioral health consequences of ACEs that included state-tailored data (intervention condition) or national data (control condition) and then answered survey questions. Dependent variables were perceived policy brief relevance and parental blame for the consequences of ACEs. Results: The mean policy brief relevance score was 4.1% higher in the intervention than in the control condition (p =.24), but the mean parental blame score was 16.5% higher (p =.02). When outcomes were dichotomized, 61.2% of respondents in the intervention condition rated parents as “very much to blame” for the consequences of ACEs compared to 37.1% in the control condition (p =.01). When the sample was stratified by political affiliation, the effect of the state-tailored policy brief on parental blame was larger in magnitude among Democrats and not significant among Republicans. The intervention policy brief increased the mean parental blame score by 22.8% among Democrats relative to the control policy brief (p =.007) and doubled the proportion rating parents as “very much to blame” (52.2% vs. 26.1%, p =.03). Conclusions: Despite limited statistical power, state-tailored policy briefs significantly increased state legislators’/staffers’ perceptions of parental blame for the behavioral health consequences of ACEs, relative to a policy brief with national data. Unintended messaging effects warrant greater attention in dissemination research and practice.Use of qualitative systems mapping and causal loop diagrams to understand food environments, diet and obesity: a scoping review protocol
AbstractStankov, I., Henson, R. M., Headen, I., Purtle, J., & Langellier, B. A. (n.d.).Publication year
2023Journal title
BMJ openVolume
13Issue
3AbstractIntroduction Food systems can shape dietary behaviour and obesity outcomes in complex ways. Qualitative systems mapping using causal loop diagrams (CLDs) can depict how people understand the complex dynamics, inter-relationships and feedback characteristic of food systems in ways that can support policy planning and action. To date, there has been no attempt to review this literature. The objectives of this review are to scope the extent and nature of studies using qualitative systems mapping to facilitate the development of CLDs by stakeholders to understand food environments, including settings and populations represented, key findings and the methodological processes employed. It also seeks to identify gaps in knowledge and implications for policy and practice. Methods and analysis This protocol describes a scoping review guided by the Joanna Briggs Institute manual, the framework by Khalil and colleagues and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist reporting guidelines. A search strategy was iteratively developed with two academic librarians and the research team. This strategy will be used to search six databases, including Ovid MEDLINE, Embase, EmCare, Web of Science, Scopus and ProQuest Central. Identified citations will be screened by two independent reviewers; first, by title and abstract, and then full-text articles to identify papers eligible for inclusion. The reference lists of included studies and relevant systematic reviews will be searched to identify other papers eligible for inclusion. Two reviewers will extract information from all included studies and summarise the findings descriptively and numerically. Ethics and dissemination The scoping review will provide an overview of how CLDs developed by stakeholders have been elicited to understand food environments, diet and obesity, the insights gained and how the CLDs have been used. It will also highlight gaps in knowledge and implications for policy and practice. The review will be disseminated through publication in an academic journal and conference presentations.Use, Potential Use, and Awareness of the 988 Suicide and Crisis Lifeline by Level of Psychological Distress
Purtle, J., McSorley, A. M. M., Adera, A. L., & Lindsey, M. A. (n.d.).Publication year
2023Journal title
JAMA network openPage(s)
E2341383Using audience segmentation to identify implementation strategies to improve PrEP uptake among at-risk cisgender women: a mixed-methods study protocol
AbstractPellowski, J. A., Price, D. M., Desir, A., Golub, S., Operario, D., & Purtle, J. (n.d.).Publication year
2023Journal title
Implementation Science CommunicationsVolume
4Issue
1AbstractBackground: In the USA, 19% of new HIV infections occur among cisgender women (cis women); however, only 10% of eligible cis women have been prescribed pre-exposure prophylaxis (PrEP) for the prevention of HIV infection (an evidence-based intervention). A fundamental challenge for expanding HIV prevention to cis women is ensuring implementation strategies are tailored to the various healthcare settings in which cis women seek care and the heterogeneous providers nested within these settings. This project’s specific aims are to (1) explore clinician-level characteristics and organizational climate factors that are related to variability in adoption of PrEP service delivery as an evidence-based intervention for cis women; (2) identify latent audience segments of women’s health providers as the related to PrEP acceptability, adoption, and maintenance and analyze demographic correlates of these segments; and (3) identify audience segment-specific implementation strategies to facilitate the adoption of PrEP as an evidence-based intervention among at-risk cis women. Methods: Using the i-PARIHS framework, this mixed-methods study examines three domains for guiding audience segmentation to facilitate PrEP implementation for cis women: innovation (degree of fit with existing practices, usability), recipient beliefs and knowledge and context factors (organizational culture, readiness for change), needs to determine appropriate facilitation methods. To achieve aim 1, qualitative interviews will be conducted with PrEP-eligible cis women, women’s health providers, and other key stakeholders. Aim 2 will consist of a quantitative survey among 340 women’s health providers. Latent class analysis will be used to facilitate audience segmentation. To achieve aim 3, a panel of 5–8 providers for each audience segment will meet and engage in iterative discussions guided by Fernandez’s implementation mapping to identify (1) implementation outcomes and performance objectives, determinants, and change objectives and (2) determine and refine of implementation strategies for each audience segment. Discussion: This exploratory mixed methods study will provide an empirical foundation to inform the development implementations strategies aimed at increasing PrEP delivery to cis women among heterogenous groups of providers.Where do psychologists turn to inform clinical decisions? Audience segmentation to guide dissemination strategies
AbstractKwon, N., Stewart, R. E., Wang, X., Marzalik, J. S., Bufka, L. F., Halfond, R. W., & Purtle, J. (n.d.).Publication year
2023Journal title
Implementation Research and PracticeVolume
4AbstractBackground: Audience segmentation is an analysis technique that can identify meaningful subgroups within a population to inform the tailoring of dissemination strategies. We have conducted an empirical clustering audience segmentation study of licensed psychologists using survey data about the sources of knowledge they report most often consulting to guide their clinical decision-making. We identify meaningful subgroups within the population and inform the tailoring of dissemination strategies for evidence-based practice (EBP) materials. Method: Data come from a 2018–2019 web-based survey of licensed psychologists who were members of the American Psychological Association (APA; N = 518, response rate = 29.8%). Ten dichotomous variables assessed sources that psychologists regularly consult to inform clinical decision-making (e.g., colleagues, academic literature, and practice guidelines). We used latent class analysis to identify segments of psychologists who turn to similar sources and named each segment based on the segment's most salient characteristics. Results: Four audience segments were identified: the No-guidelines (45% of psychologists), Research-driven (16%), Thirsty-for-knowledge (9%), and No-reviews (30%). The four segments differed not only in their preferred sources of knowledge, but also in the types of evidence-based posttraumatic stress disorder (PTSD) treatments they provide, their awareness and usage intention of the APA PTSD clinical practice guideline, and attitudes toward clinical practice guidelines. Conclusion: The results demonstrate that licensed psychologists are heterogeneous in terms of their knowledge-seeking behaviors and preferences for knowledge sources. The distinctive characteristics of these segments could guide the tailoring of dissemination materials and strategies to subsequently enhance the implementation of EBP among psychologists.Who’s “in the room where it happens”? A taxonomy and five-step methodology for identifying and characterizing policy actors
AbstractCruden, G., Crable, E. L., Lengnick-Hall, R., & Purtle, J. (n.d.).Publication year
2023Journal title
Implementation Science CommunicationsVolume
4Issue
1AbstractBackground: Engaging policy actors in research design and execution is critical to increasing the practical relevance and real-world impact of policy-focused dissemination and implementation science. Identifying and selecting which policy actors to engage, particularly actors involved in “Big P” public policies such as laws, is distinct from traditional engaged research methods. This current study aimed to develop a transparent, structured method for iteratively identifying policy actors involved in key policy decisions—such as adopting evidence-based interventions at systems-scale—and to guide implementation study sampling and engagement approaches. A flexible policy actor taxonomy was developed to supplement existing methods and help identify policy developers, disseminators, implementers, enforcers, and influencers. Methods: A five-step methodology for identifying policy actors to potentially engage in policy dissemination and implementation research was developed. Leveraging a recent federal policy as a case study—The Family First Prevention Services Act (FFPSA)—publicly available documentation (e.g., websites, reports) were searched, retrieved, and coded using content analysis to characterize the organizations and individual policy actors in the “room” during policy decisions. Results: The five steps are as follows: (1) clarify the policy implementation phase(s) of interest, (2) identify relevant proverbial or actual policymaking “rooms,” (3) identify and characterize organizations in the room, (4) identify and characterize policy actors in the “room,” and (5) quantify (e.g., count actors across groups), summarize, and compare “rooms” to develop or select engagement approaches aligned with the “room” and actors. The use and outcomes of each step are exemplified through the FFPSA case study. Conclusions: The pragmatic and transparent policy actor identification steps presented here can guide researchers’ methods for continuous sampling and successful policy actor engagement. Future work should explore the utility of the proposed methods for guiding selection and tailoring of engagement and implementation strategies (e.g., research-policy actor partnerships) to improve both “Big P” and “little p” (administrative guidelines, procedures) policymaking and implementation in global contexts.Comparing two federal financing strategies on penetration and sustainment of the adolescent community reinforcement approach for substance use disorders: protocol for a mixed-method study
AbstractDopp, A. R., Hunter, S. B., Godley, M. D., Pham, C., Han, B., Smart, R., Cantor, J., Kilmer, B., Hindmarch, G., González, I., Passetti, L. L., Wright, K. L., Aarons, G. A., & Purtle, J. (n.d.).Publication year
2022Journal title
Implementation Science CommunicationsVolume
3Issue
1AbstractBackground: Sustained, widespread availability of evidence-based practices (EBPs) is essential to address the public health and societal impacts of adolescent substance use disorders (SUD). There remains a particularly significant need to identify effective financing strategies, which secure and direct financial resources to support the costs associated with EBP implementation and sustainment. This protocol describes a new project comparing two types of U.S. federal grant mechanisms (i.e., a type of financing strategy), which supported the implementation of the Adolescent Community Reinforcement Approach (A-CRA) EBP for SUD, through either organization-focused or state-focused granting of funds. The Exploration-Preparation-Implementation-Sustainment (EPIS) framework will guide our study aims, hypotheses, and selection of measures. Method: We will employ a longitudinal, mixed-method (i.e., web surveys, semi-structured interviews, document review, focus groups, administrative data), quasi-experimental design to compare the grant types’ outcomes and examine theoretically informed mediators and moderators. Aim 1 will examine the proportion of eligible clinicians certified in A-CRA with adequate fidelity levels (i.e., penetration outcomes) at the end of grant funding. Aim 2 will examine the sustainment of A-CRA up to 5 years post-funding, using a 10-element composite measure of treatment delivery and supervision activities. We will integrate the new data collected from state-focused grant recipients (~85 organizations in 19 states) with previously collected data from organization-focused grant recipients (Hunter et al., Implement Sci 9:104, 2014) (82 organizations in 26 states) for analysis. We will also use sensitivity analyses to characterize the effects of observed and unobserved secular trends in our quasi-experimental design. Finally, aim 3 will use comparative case study methods (integrating diverse quantitative and qualitative measures) to identify and disseminate policy implications about the roles of state- and organization-focused federal grants in efforts to promote adolescent SUD EBP implementation and sustainment. Discussion: The proposed research will have direct, practical implications for behavioral health administrators, policymakers, implementation experts, and the public. It will offer new knowledge that can directly inform financing strategies to support large-scale, sustained EBP delivery in behavioral health—while advancing implementation science through the use of novel methods to study financing strategies and sustainment.Heterogeneity in Disparities in Life Expectancy Across US Metropolitan Areas
AbstractSchnake-Mahl, A. S., Mullachery, P. H., Purtle, J., Li, R., Diez Roux, A. V., & Bilal, U. (n.d.).Publication year
2022Journal title
EpidemiologyVolume
33Issue
6Page(s)
890-899AbstractBackground: Life expectancy in the United States has declined since 2014 but characterization of disparities within and across metropolitan areas of the country is lacking. Methods: Using census tract-level life expectancy from the 2010 to 2015 US Small-area Life Expectancy Estimates Project, we calculate 10 measures of total and income-based disparities in life expectancy at birth, age 25, and age 65 within and across 377 metropolitan statistical areas (MSAs) of the United States. Results: We found wide heterogeneity in disparities in life expectancy at birth across MSAs and regions: MSAs in the West show the narrowest disparities (absolute disparity: 8.7 years, relative disparity: 1.1), while MSAs in the South (absolute disparity: 9.1 years, relative disparity: 1.1) and Midwest (absolute disparity: 9.8 years, relative disparity: 1.1) have the widest life expectancy disparities. We also observed greater variability in life expectancy across MSAs for lower income census tracts (coefficient of variation [CoV] 3.7 for first vs. tenth decile of income) than for higher income census tracts (CoV 2.3). Finally, we found that a series of MSA-level variables, including larger MSAs and greater proportion college graduates, predicted wider life expectancy disparities for all age groups. Conclusions: Sociodemographic and policy factors likely help explain variation in life expectancy disparities within and across metro areas.Impacts of COVID-19 on Mental Health Safety Net Services for Youths: A National Survey of Agency Officials
AbstractPurtle, J., Nelson, K. L., Horwitz, S. M. C., Palinkas, L. A., McKay, M. M., & Hoagwood, K. E. (n.d.).Publication year
2022Journal title
Hospital and Community PsychiatryVolume
73Issue
4Page(s)
381-387AbstractOBJECTIVE: Mental health agencies provide critical safety net services for youths. No research has assessed impacts of the COVID-19 pandemic on services these agencies provide or youths they serve. This study sought to characterize agency officials' perceptions of the pandemic's impacts on youths and challenges to providing youth services during the pandemic and to examine associations between these challenges and impacts. METHODS: Surveys were completed in September-October 2020 by 159 state or county mental health agency officials from 46 states. Respondents used 7-point scales (higher rating indicated more severe impact or challenge) to rate the pandemic's impact on youth mental health issues, general service challenges, and telepsychiatry service challenges across patient, provider, and financing domains. Multiple linear regression models estimated associations between service challenges (independent variables) and pandemic impacts (dependent variables). RESULTS: Most agency officials perceived the pandemic as having disproportionately negative mental health impacts on socially disadvantaged youths (serious impact, 72%; mean rating=5.85). Only 15% (mean=4.29) perceived the pandemic as having a seriously negative impact on receipt of needed youth services. Serious service challenges were related to youths' lack of reliable equipment or Internet access for telepsychiatry services (serious challenge, 59%; mean=5.47) and the inability to provide some services remotely (serious challenge, 42%, mean=4.72). In regression models, the inability to provide some services remotely was significantly (p≤0.01) associated with three of five pandemic impacts. CONCLUSIONS: Officials perceived the COVID-19 pandemic as exacerbating youth mental health disparities but as not having a dramatic impact on receipt of needed services.Inter-agency collaboration is associated with increased frequency of research use in children's mental health policy making
AbstractPurtle, J., Nelson, K. L., Lengnick-Hall, R., Horwitz, S. M. C., Palinkas, L. A., McKay, M. M., & Hoagwood, K. E. (n.d.).Publication year
2022Journal title
Health Services ResearchVolume
57Issue
4Page(s)
842-852AbstractObjective: To determine whether the self-report frequency of inter-agency collaboration about children's mental health issues is associated with the self-report frequency of using research evidence in children's mental health policy and program decision making in mental health agencies (MHAs). Data Sources: Primary data were collected through web-based surveys of state (N = 221) and county (N = 117) MHA officials. Design: The primary independent variable was a composite score quantifying the frequency of collaboration about children's mental health issues between officials in MHAs and six other state agencies. The dependent variables were composite scores quantifying the frequency of research use in children's mental health policy and program decision making in general and for specific purposes (i.e., conceptual, instrumental, tactical, imposed). Covariates were composite scores quantifying well-established determinants of research use (e.g., agency leadership, research use skills) in agency policy and program decision making. Data Methods: Separate multiple linear regression models estimated associations between frequency of inter-agency collaboration and research use scores, adjusting for other determinants of research use, respondent state, and other covariates. Data from state and county officials were analyzed separately. Principal Findings: The frequency of inter-agency collaboration was positively and independently associated with the frequency of research use in children's mental health policy making among state (β = 0.22, p = 0.004) and county (β = 0.39, p < 0.0001) MHA officials. Inter-agency collaboration was also the only variable significantly associated with the frequency of research use for all four specific purposes among state MHA officials, and similar findings we observed among county MHA officials. The magnitudes of associations between inter-agency collaboration and frequency of research use were generally stronger than for more well-established determinants of research use in policy making. Conclusions: Strategies that promote collaboration between MHA officials and external agencies could increase the use of research evidence in children's mental health policy and program decision making in MHAs.Partisan Differences in Legislators' Discussion of Vaccination on Twitter During the COVID-19 Era: Natural Language Processing Analysis
AbstractEngel-Rebitzer, E., Stokes, D. C., Meisel, Z. F., Purtle, J., Doyle, R., & Buttenheim, A. M. (n.d.).Publication year
2022Journal title
JMIR InfodemiologyVolume
2Issue
1AbstractBackground: The COVID-19 era has been characterized by the politicization of health-related topics. This is especially concerning given evidence that politicized discussion of vaccination may contribute to vaccine hesitancy. No research, however, has examined the content and politicization of legislator communication with the public about vaccination during the COVID-19 era. Objective: The aim of this study was to examine vaccine-related tweets produced by state and federal legislators during the COVID-19 era to (1) describe the content of vaccine-related tweets; (2) examine the differences in vaccine-related tweet content between Democrats and Republicans; and (3) quantify (and describe trends over time in) partisan differences in vaccine-related communication. Methods: We abstracted all vaccine-related tweets produced by state and federal legislators between February 01, 2020, and December 11, 2020. We used latent Dirichlet allocation to define the tweet topics and used descriptive statistics to describe differences by party in the use of topics and changes in political polarization over time. Results: We included 14,519 tweets generated by 1463 state legislators and 521 federal legislators. Republicans were more likely to use words (eg, "record time,""launched,"and "innovation") and topics (eg, Operation Warp Speed success) that were focused on the successful development of a SARS-CoV-2 vaccine. Democrats used a broader range of words (eg, "anti-vaxxers,""flu,"and "free") and topics (eg, vaccine prioritization, influenza, and antivaxxers) that were more aligned with public health messaging related to the vaccine. Polarization increased over most of the study period. Conclusions: Republican and Democratic legislators used different language in their Twitter conversations about vaccination during the COVID-19 era, leading to increased political polarization of vaccine-related tweets. These communication patterns have the potential to contribute to vaccine hesitancy.Partisan differences in the effects of economic evidence and local data on legislator engagement with dissemination materials about behavioral health: a dissemination trial
AbstractPurtle, J., Nelson, K. L., Gebrekristos, L., Lê-Scherban, F., & Gollust, S. E. (n.d.).Publication year
2022Journal title
Implementation ScienceVolume
17Issue
1AbstractBackground: State legislators make policy decisions that influence children’s exposure to adverse childhood experiences (ACEs), such as child maltreatment, and their effects on behavioral health. Effective dissemination of scientific research can increase the likelihood that legislators’ decisions are aligned with evidence to prevent ACEs and their consequences, and effective dissemination requires legislators to engage with dissemination materials. Informed by the elaboration likelihood model of persuasive communication and Brownson’s Model of Dissemination Research, we tested the hypothesis that inclusion of economic evidence and local data would increase legislator engagement with dissemination materials about evidence-supported policies related to ACEs and behavioral health. Methods: A three-arm randomized dissemination trial was conducted. A university researcher e-mailed dissemination materials which contained evidence about ACEs and behavioral health problems to state legislators (two e-mails sent 2 weeks apart, 12,662 e-mails delivered to 6509 legislators). The e-mail subject lines, text, and policy brief content were manipulated across the study arms. The intervention condition received state-tailored data about rates of ACEs and state-tailored economic evidence about the costs of ACEs for public systems, the enhanced control condition received state-tailored data and not economic evidence, and the control condition received national data and not economic evidence. Outcomes were rates of e-mail views, policy brief link clicks, requests for researcher consultation, and mentions of child maltreatment terms in legislators’ social media posts. Results: For the first e-mail, the e-mail view rate was 42.6% higher in the intervention than in the enhanced control condition (22.8% vs. 14.8%) and 20.8% higher than in the control condition (22.8% vs. 18.5%) (both p <.0001). Similar results were observed for the second e-mail. These differences remained significant after adjustment for demographic differences across study conditions in individual-level models, but not multilevel models. There was a significant interaction between the experimental condition and political party (p <.0001) in which the intervention increased e-mail view rates among Democrats but not Republicans. The intervention had no effect on policy brief link clicks or requests for consultation and a mixed effect on social media posts. Conclusions: Inclusion of state-tailored economic evidence in dissemination materials can increase engagement with research evidence among Democrat, but not Republican, legislators. Dissemination strategies tailored for legislators’ political party affiliation may be needed.Policy Makers' Priorities for Addressing Youth Substance Use and Factors That Influence Priorities
AbstractPurtle, J., Nelson, K. L., Henson, R. M., Horwitz, S. M. C., McKay, M. M., & Hoagwood, K. E. (n.d.).Publication year
2022Journal title
Hospital and Community PsychiatryVolume
73Issue
4Page(s)
388-395AbstractOBJECTIVE: Understanding public policy makers' priorities for addressing youth substance use and the factors that influence these priorities can inform the dissemination and implementation of strategies that promote evidence-based decision making. This study characterized the priorities of policy makers in substance use agencies of U.S. states and counties for addressing youth substance use, the factors that influenced these priorities, and the differences in priorities and influences between state and county policy makers. METHODS: In 2020, a total of 122 substance use agency policy makers from 35 states completed a Web-based survey (response rate=22%). Respondents rated the priority of 14 issues related to youth substance use and the extent to which nine factors influenced these priorities. Data were analyzed as dichotomous and continuous variables and for state and county policy makers together and separately. RESULTS: The highest priorities for youth substance use were social determinants of substance use (87%), adverse childhood experiences and childhood trauma (85%), and increasing access to school-based substance use programs (82%). The lowest priorities were increasing access to naloxone for youths (49%), increasing access to medications for opioid use disorder among youths (49%), and deimplementing non-evidence-based youth substance use programs (41%). The factors that most influenced priorities were budget issues (80%) and state legislature (69%), federal (67%), and governor priorities (65%). Issues related to program implementation and deimplementation were significantly higher priorities for state than for county policy makers. CONCLUSIONS: These findings can inform the tailoring of dissemination and implementation strategies to account for the inner- and outer-setting contexts of substance use agencies.Promises and pitfalls in implementation science from the perspective of US-based researchers: learning from a pre-mortem
AbstractBeidas, R. S., Dorsey, S., Lewis, C. C., Lyon, A. R., Powell, B. J., Purtle, J., Saldana, L., Shelton, R. C., Stirman, S. W., & Lane-Fall, M. B. (n.d.).Publication year
2022Journal title
Implementation ScienceVolume
17Issue
1AbstractBackground: Implementation science is at a sufficiently advanced stage that it is appropriate for the field to reflect on progress thus far in achieving its vision, with a goal of charting a path forward. In this debate, we offer such reflections and report on potential threats that might stymie progress, as well as opportunities to enhance the success and impact of the field, from the perspective of a group of US-based researchers. Main body: Ten mid-career extramurally funded US-based researchers completed a “pre-mortem” or a group brainstorming exercise that leverages prospective hindsight to imagine that an event has already occurred and to generate an explanation for it — to reduce the likelihood of a poor outcome. We came to consensus on six key themes related to threats and opportunities for the field: (1) insufficient impact, (2) too much emphasis on being a “legitimate science,” (3) re-creation of the evidence-to-practice gap, (4) difficulty balancing accessibility and field coherence, (5) inability to align timelines and priorities with partners, and (6) overly complex implementation strategies and approaches. Conclusion: We submit this debate piece to generate further discussion with other implementation partners as our field continues to develop and evolve. We hope the key opportunities identified will enhance the future of implementation research in the USA and spark discussion across international groups. We will continue to learn with humility about how best to implement with the goal of achieving equitable population health impact at scale.Public Opinion About Adverse Childhood Experiences: Social Stigma, Attribution of Blame, and Government Intervention
AbstractPurtle, J., Nelson, K. L., & Gollust, S. E. (n.d.).Publication year
2022Journal title
Child MaltreatmentVolume
27Issue
3Page(s)
344-355AbstractAdverse childhood experiences (ACEs) are receiving increasing attention in academic, policy, and media discourses. However, no public opinion research has focused on ACEs. We conducted a nationally representative survey of U.S. adults to address this knowledge gap. A web-based survey was conducted using the Ipsos KnowledgePanel (N = 503, completion rate = 60.5%) in fall 2019. We found that inter-personal stigma and parental blame related to ACEs were prevalent, with 25.0% of respondents unwilling to have a person with “a lot of ACEs” as a close co-worker and 65.2% believing that parents were very much to blame for the consequences of ACEs. Fifty percent of respondents believed that government intervention to prevent ACEs was very important. After adjustment for demographic characteristics, inter-personal stigma toward people with ACEs and conservative ideology were significantly associated with lower perceived importance of government intervention to prevent ACEs. Black race, Hispanic ethnicity, and female gender were significantly associated with higher perceived importance of government intervention. These findings provide an empirical foundation to inform strategies to communicate ACE science to public and policymaker audiences.Selecting evidence to frame the consequences of adverse childhood experiences: testing effects on public support for policy action, multi-sector responsibility, and stigma
AbstractGollust, S. E., Nelson, K. L., & Purtle, J. (n.d.).Publication year
2022Journal title
Preventive MedicineVolume
154AbstractWhile clinical and public health researchers have produced a high volume of research evidence about the consequences of ACEs, there is limited research on public understanding of ACEs or how to most effectively communicate about this body of science. The objective of this study was to determine which messages describing evidence about the consequences of adverse childhood experiences (ACEs) affect public perceptions. We conducted an online experiment with a nationally-representative sample of U.S. adults in July–August 2020. Participants were randomized to control groups receiving messages describing ACE prevalence or resilience, or treatment groups receiving messages describing consequences of ACEs on mental health and substance use, economics, racial equity, or biology. We compared respondents' perceptions of prevention policies and likelihood of policy engagement, attributions of multi-sector responsibility, and blame and stigma across experimental groups. Messages about economic consequences increased respondents' support for policy and attributions of multi-sector responsibility relative to control groups, while also increasing parental blame. The message describing racial equity lowered respondents' perceptions of importance of state policy action and attributions of responsibility to health care. None of the messages affected stigmatizing attitudes. Describing the economic consequences of ACEs on public systems boosts public support for policy action. More research is needed on how the public responds to messaging connecting systemic racism with childhood adversity and health.Simulating the role of knowledge brokers in policy making in state agencies: An agent-based model
AbstractCombs, T., Nelson, K. L., Luke, D., McGuire, F. H., Cruden, G., Henson, R. M., Adams, D. R., Hoagwood, K. E., & Purtle, J. (n.d.).Publication year
2022Journal title
Health Services ResearchVolume
57Page(s)
122-136AbstractObjective: To model children's mental health policy making dynamics and simulate the impacts of knowledge broker interventions. Data sources: Primary data from surveys (n = 221) and interviews (n = 64) conducted in 2019–2021 with mental health agency (MHA) officials in state agencies. Study design: A prototype agent-based model (ABM) was developed using the PARTE (Properties, Actions, Rules, Time, Environment) framework and informed through primary data collection. In each simulation, a policy is randomly generated (salience weights: cost, contextual alignment, and strength of evidence) and discussed among agents. Agents are MHA officials and heterogenous in their properties (policy making power and network influence) and policy preferences (based on salience weights). Knowledge broker interventions add agents to the MHA social network who primarily focus on the policy's research evidence. Data collection/extraction methods: A sequential explanatory mixed method approach was used. Descriptive and regression analyses were used for the survey data and directed content analysis was used to code interview data. Triangulated results informed ABM development. In the ABM, policy makers with various degrees of decision influence interact in a scale-free network before and after knowledge broker interventions. Over time, each decides to support or oppose a policy proposal based on policy salience weights and their own properties and interactions. The main outcome is an agency-level decision based on policy maker support. Each intervention and baseline simulation runs 250 times across 50 timesteps. Principal findings: Surveys and interviews revealed that barriers to research use could be addressed by knowledge brokers. Simulations indicated that policy decision outcomes varied by policy making context within agencies. Conclusions: This is the first application of ABM to evidence-informed mental health policy making. Results suggest that the presence of knowledge brokers can: (1) influence consensus formation in MHAs, (2) accelerate policy decisions, and (3) increase the likelihood of evidence-informed policy adoption.State Policies that Impact the Design of Children’s Mental Health Services: A Modified Delphi Study
AbstractNelson, K. L., Powell, B. J., Langellier, B., Lê-Scherban, F., Shattuck, P., Hoagwood, K., & Purtle, J. (n.d.).Publication year
2022Journal title
Administration and Policy in Mental Health and Mental Health Services ResearchVolume
49Issue
5Page(s)
834-847AbstractTo identify the state-level policies and policy domains that state policymakers and advocates perceive as most important for positively impacting the use of children’s mental health services (CMHS). We used a modified Delphi technique (i.e., two rounds of questionnaires and an interview) during Spring 2021 to elicit perceptions among state mental health agency officials and advocates (n = 28) from twelve states on state policies that impact the use of CMHS. Participants rated a list of pre-specified policies on a 7-point Likert scale (1 = not important, 7 = extremely important) in the following policy domains: insurance coverage and limits, mental health services, school and social. Participants added nine policies to the initial list of 24 policies. The “school” policy domain was perceived as the most important, while the “social” policy domain was perceived as the least important after the first questionnaire and the second most important policy domain after the second questionnaire. The individual policies perceived as most important were school-based mental health services, state mental health parity, and Medicaid reimbursement rates. Key stakeholders in CMHS should leverage this group of policies to understand the current policy landscape in their state and to identify gaps in policy domains and potential policy opportunities to create a more comprehensive system to address children’s mental health from a holistic, evidence-based policymaking perspective.State-Level Social and Economic Policies and Their Association With Perinatal and Infant Outcomes
AbstractWebster, J. L., Paul, D., Purtle, J., Locke, R., & Goldstein, N. D. (n.d.).Publication year
2022Journal title
Milbank QuarterlyVolume
100Issue
1Page(s)
218-260AbstractPolicy Points State-level social and economic policies that expand tax credits, increase paid parental leave, raise the minimum wage, and increase tobacco taxes have been demonstrated to reduce adverse perinatal and infant health outcomes. These findings can help prioritize evidence-based legislated policies to improve perinatal and infant outcomes in the United States. Context: Rates of preterm birth and infant mortality are alarmingly high in the United States. Legislated efforts may directly or indirectly reduce adverse perinatal and infant outcomes through the enactment of certain economic and social policies. Methods: We conducted a narrative review to summarize the associations between perinatal and infant outcomes and four state-level US policies. We then used a latent profile analysis to create a social and economic policy profile for each state based on the observed policy indicators. Findings: Of 27 articles identified, nine focused on tax credits, eight on paid parental leave, four on minimum wages, and six on tobacco taxes. In all but three studies, these policies were associated with improved perinatal or infant outcomes. Thirty-three states had tax credit laws, most commonly the earned income tax credit (n = 28, 56%). Eighteen states had parental leave laws. Two states had minimum wage laws lower than the federal minimum; 14 were equal to the federal minimum; 29 were above the federal minimum; and 5 did not have a state law. The average state tobacco tax was $1.76 (standard deviation = $1.08). The latent profile analysis revealed three policy profiles, with the most expansive policies in Western and Northeastern US states, and the least expansive policies in the US South. Conclusions: State-level social and economic policies have the potential to reduce adverse perinatal and infant health outcomes in the United States. Those states with the least expansive policies should therefore consider enacting these evidence-based policies, as they have shown a demonstratable benefit in other states.The impact of Medicaid funding structures on inequities in health care access for Latinos in New York, Florida, and Puerto Rico
AbstractRivera-González, A. C., Roby, D. H., Stimpson, J. P., Bustamante, A. V., Purtle, J., Bellamy, S. L., & Ortega, A. N. (n.d.).Publication year
2022Journal title
Health Services ResearchVolume
57Page(s)
172-182AbstractObjective: To study the impact of Medicaid funding structures before and after the implementation of the Affordable Care Act (ACA) on health care access for Latinos in New York (Medicaid expansion), Florida (Medicaid non-expansion), and Puerto Rico (Medicaid block grant). Data Sources: Pooled state-level data for New York, Florida, and Puerto Rico from the 2011–2019 Behavioral Risk Factor Surveillance System and data from the 2011–2019 American Community Survey and Puerto Rico Community Survey. Study Design: Cross-sectional study using probit with predicted margins to separately compare four health care access measures among Latinos in New York, Florida, and Puerto Rico (having health insurance coverage, having a personal doctor, delayed care due to cost, and having a routine checkup). We also used difference-in-differences to measure the probability percent change of having any health insurance and any public health insurance before (2011–2013) and after (2014–2019) the ACA implementation among citizen Latinos in low-income households. Data Collection: The sample consisted of Latinos aged 18–64 residing in New York, Florida, and Puerto Rico from 2011 to 2019. Principal Findings: Latinos in Florida had the lowest probability of having health care access across all four measures and all time periods compared with those in New York and Puerto Rico. While Latinos in Puerto Rico had greater overall health care access compared with Latinos in both states, health care access in Puerto Rico did not change over time. Among citizen Latinos in low-income households, New York had the greatest post-ACA probability of having any health insurance and any public health insurance, with a growing disparity with Puerto Rico (9.7% any [1.6 SE], 5.2% public [1.8 SE]). Conclusions: Limited Medicaid eligibility (non-expansion of Florida's Medicaid program) and capped Medicaid funds (Puerto Rico's Medicaid block grant) contributed to reduced health care access over time, particularly for citizen Latinos in low-income households.“If I was to post something, it would be too vulnerable:” University students and mental health disclosures on instagram
AbstractBudenz, A., Klassen, A., Purtle, J., Yom-Tov, E., Yudell, M., & Massey, P. (n.d.).Publication year
2022Journal title
Journal of American College HealthVolume
70Issue
2Page(s)
615-624AbstractObjective: Assess Instagram use for mental health disclosure in university students to assess the potential for Instagram use as mental health support-seeking. Participants: Twenty-one students using mental health services while attending a private, Mid-Atlantic university between 6/2017-12/2017. Methods: Collected qualitative interview and Instagram data and analyzed them in parallel. Instagram data supplemented interview themes and were coded and analyzed quantitatively to define features of participants’ Instagram use. Results: Participants displayed aversions to posting mental health disclosures on Instagram, citing public and self-stigma as barriers to disclosure. Despite this, participants reported instances in which their Instagram posts directly or indirectly reflected their lived experiences. Some also maintained second anonymous accounts for fuller disclosure. Conclusions: Given the benefits of mental health disclosures to well-being and the predilection for social media use in university students, student and university-led initiatives to promote social media environments conducive to disclosures could have widespread mental health benefits.Academic-Policy Partnerships in Evidence-Based Practice Implementation and Policy Maker Use of Child Mental Health Research
AbstractCervantes, P. E., Seag, D. E., Nelson, K. L., Purtle, J., Hoagwood, K. E., & Horwitz, S. M. C. (n.d.).Publication year
2021Journal title
Psychiatric ServicesVolume
72Issue
9Page(s)
1076-1079AbstractObjective: Strategies are needed to improve policy makers' evidence-informed decision making and the availability of evidence-based, state-supported services. This study examined whether academic-policy partnerships could promote these outcomes. Methods: Data from two national surveys of state mental health agency representatives were used to compare barriers to implementation of evidence-based practices (EBPs) and policy makers' use of child mental health research in states with strong academic-policy partnerships in workforce training or in program implementation/evaluation (IE) with barriers in states with no or limited partnerships in these areas. Results: Strong IE partnerships were associated with more confidence in research use and fewer issues with provider readiness and capacity but with more issues with EBP fidelity. Strong training partnerships were associated with fewer endorsements of lack of time as a barrier to research use. Conclusions: Academic-policy partnerships had some benefit for states' research use and EBP implementation. Because these partnerships may reduce barriers, further research should explore characteristics of effective collaborations.