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
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.Association between local public housing authority policies related to criminal justice system involvement and sexually transmitted infection rates
AbstractPurtle, J., Tekin, E., Gebrekristos, L. T., Niccolai, L., & Blankenship, K. M. (n.d.).Publication year
2021Journal title
Health and JusticeVolume
9Issue
1AbstractThe policies of U.S. local public housing authorities influence which populations have access to stable housing, an important resource for health. We assessed whether the restrictiveness of local public housing authority policies related to people with criminal justice histories—a population at high risk for HIV/STIs—were associated with HIV/STI rates at the local-level. An ecological analysis was conducted using data from 107 local public housing authority jurisdictions. The independent variable was a score that quantified the presence/absence of eight policies related to the ability of people with criminal justice histories to obtain and retain public housing. The dependent variables were county-level rates of HIV, gonorrhea, syphilis, and chlamydia. Ordinary least squares regression with state fixed effects was used. We find that the restrictiveness of housing authority policies towards people with criminal justice histories were significantly associated with higher HIV and gonorrhea rates, but not syphilis or chlamydia. For example, local housing authorities with a policy score more restrictive than the median score had an additional 6.05 cases of HIV per 100,000 population (32.9% increase relative to the mean rate) and 84.61 cases of newly diagnosed gonorrhea (41.3% increase). Local public housing authority policies related to people with criminal justice histories could affect HIV/STI risk at the population-level. These policies should be considered in studies and interventions at the intersection of housing, health, and justice involved populations.Changes in legislator vaccine-engagement on Twitter before and after the arrival of the COVID-19 pandemic
AbstractEngel-Rebitzer, E., Stokes, D. C., Buttenheim, A., Purtle, J., & Meisel, Z. F. (n.d.).Publication year
2021Journal title
Human Vaccines and ImmunotherapeuticsVolume
17Issue
9Page(s)
2868-2872AbstractWidespread SARS-CoV-2 vaccine uptake will be critical to resolution of the COVID-19 pandemic. Politicians have the potential to impact vaccine sentiment and uptake through vaccine-related communication with the public. We used tweets (n = 6,201), abstracted from Quorum, a public affairs software platform, to examine changes in the frequency of vaccine-related communication by legislators on the social media platform, Twitter. We found an increase in vaccine-related tweets by legislators following the arrival of SARS-CoV-2 in the United States. In the pre-COVID-19 era the majority of vaccine-related tweets were generated by Democrat and state senators. The increase in tweets following the arrival of COVID-19, however, was greater among Republican and federal legislators than Democrat or state legislators. This suggests that legislators who were previously less engaged in public discussion of vaccination, became engaged following the arrival of SARS-CoV-2, which may have implications for COVID-19 vaccine uptake among their followers.Determinants of using children’s mental health research in policymaking: variation by type of research use and phase of policy process
AbstractPurtle, J., Nelson, K. L., Horwitz, S. M. C., McKay, M. M., & Hoagwood, K. E. (n.d.).Publication year
2021Journal title
Implementation ScienceVolume
16Issue
1AbstractBackground: Research use in policymaking is multi-faceted and has been the focus of extensive study. However, virtually no quantitative studies have examined whether the determinants of research use vary according to the type of research use or phase of policy process. Understanding such variation is important for selecting the targets of implementation strategies that aim to increase the frequency of research use in policymaking. Methods: A web-based survey of US state agency officials involved with children’s mental health policymaking was conducted between December 2019 and February 2020 (n = 224, response rate = 33.7%, 49 states responding (98%), median respondents per state = 4). The dependent variables were composite scores of the frequency of using children’s mental health research in general, specific types of research use (i.e., conceptual, instrumental, tactical, imposed), and during different phases of the policy process (i.e., agenda setting, policy development, policy implementation). The independent variables were four composite scores of determinants of research use: agency leadership for research use, agency barriers to research use, research use skills, and dissemination barriers (e.g., lack of actionable messages/recommendations in research summaries, lack of interaction/collaboration with researchers). Separate multiple linear regression models estimated associations between determinant and frequency of research use scores. Results: Determinants of research use varied significantly by type of research use and phase of policy process. For example, agency leadership for research use was the only determinant significantly associated with imposed research use (β = 0.31, p < 0.001). Skills for research use were the only determinant associated with tactical research use (β = 0.17, p = 0.03) and were only associated with research use in the agenda-setting phase (β = 0.16, p = 0.04). Dissemination barriers were the most universal determinants of research use, as they were significantly and inversely associated with frequency of conceptual (β = −0.21, p = 0.01) and instrumental (β = −0.22, p = 0.01) research use and during all three phases of policy process. Conclusions: Decisions about the determinants to target with policy-focused implementation strategies—and the strategies that are selected to affect these targets—should reflect the specific types of research use that these strategies aim to influence.Disseminating evidence to policymakers
AbstractPurtle, J. (n.d.). In Networks, Knowledge Brokers, and the Public Policymaking Process: Accounting for audience heterogeneity (1–).Publication year
2021Page(s)
27-48AbstractDissemination strategies defined here as the targeted distribution of research evidence to policymakers can improve evidence-informed policymaking when activities are informed by theory, data, and when the right messenger delivers the right message to the right policymaker at the right time. This chapter presents evidence from surveys of state legislators, city mayors, and agency administrators in the United States to illustrate heterogeneity among policymakers in terms of the sources they turn to for evidence, the sources they perceive as reliable, and the attributes of evidence they perceive as most important. The chapter also reviews three broad types of dissemination strategies that can help account for audience heterogeneity and enhance the effectiveness of dissemination efforts: audience segmentation analysis, message tailoring, and framing.Does rental assistance improve mental health? Insights from a longitudinal cohort study
AbstractDenary, W., Fenelon, A., Schlesinger, P., Purtle, J., Blankenship, K. M., & Keene, D. E. (n.d.).Publication year
2021Journal title
Social Science and MedicineVolume
282AbstractAlmost half of renters in the United States are rent-burdened, meaning that they pay more than 30% of their income toward housing costs. Rental assistance through programs administered by the U.S. Department of Housing and Urban Development, alleviates these financial strains for around 5 million households. However, due to budgetary constraints, fewer than one in four eligible households actually receive this assistance and waitlists average two years nationally. Using longitudinal data from a cohort of 400 low-income adults living in New Haven, CT, this paper investigates how access to rental assistance affects mental health through two analytical methods that address selection into rental assistance. First, we performed a cross-sectional analysis to identify how psychological distress differs among those receiving and those on a waitlist for rental assistance. Second, we used a within-person fixed-effects analysis to compare changes in individuals following entry into rental assistance. We find that those receiving rental assistance report significantly less psychological distress than those on waiting lists and that transitions into rental assistance are associated with statistically non-significant decreases in psychological distress. Our findings suggest that expanding rental assistance may be one potential step toward improving the mental health of low-income individuals in the United States.Impact of the COVID-19 pandemic on child and adolescent mental health policy and practice implementation
AbstractPalinkas, L. A., De Leon, J., Salinas, E., Chu, S., Hunter, K., Marshall, T. M., Tadehara, E., Strnad, C. M., Purtle, J., Horwitz, S. M., McKay, M. M., & Hoagwood, K. E. (n.d.).Publication year
2021Journal title
International journal of environmental research and public healthVolume
18Issue
18AbstractBackground: The impact of the 2019 coronavirus pandemic on the mental health of millions worldwide has been well documented, but its impact on prevention and treatment of mental and behavioral health conditions is less clear. The COVID-19 pandemic also created numerous challenges and opportunities to implement health care policies and programs under conditions that are fundamentally different from what has been considered to be usual care. Methods: We conducted a qualitative study to determine the impact of the COVID-19 pandemic on implementation of evidence-based policy and practice by State Mental Health Authorities (SMHA) for prevention and treatment of mental health problems in children and adolescents. Semi-structured interviews were conducted with 29 SMHA representatives of 21 randomly selected states stratified by coronavirus positivity rate and rate of unmet services need. Data analysis with SMHA stakeholders used procedures embedded in the Rapid Assessment Procedure—Informed Community Ethnography methodology. Results: The need for services increased during the pandemic due primarily to family stress and separation from peers. States reporting an increase in demand had high coronavirus positivity and high unmet services need. The greatest impacts were reduced out-of-home services and increased use of telehealth. Barriers to telehealth services included limited access to internet and technology, family preference for face-to-face services, lack of privacy, difficulty using with young children and youth in need of substance use treatment, finding a Health Insurance Portability and Accountability Act (HIPAA)-compliant platform, training providers and clients, and reimbursement challenges. Policy changes to enable reimbursement, internet access, training, and provider licensing resulted in substantially fewer appointment cancellations or no-shows, greater family engagement, reduction in travel time, increased access for people living in remote locations, and increased provider communication and collaboration. States with high rates of coronavirus positivity and high rates of unmet need were most likely to continue use of telehealth post-pandemic. Despite these challenges, states reported successful implementation of policies designed to facilitate virtual services delivery with likely long-term changes in practice. Conclusions: Policy implementation during the pandemic provided important lessons for planning and preparedness for future public health emergencies. Successful policy implementation requires ongoing collaboration among policy makers and with providers.Linking Data on Constituent Health with Elected Officials’ Opinions: Associations Between Urban Health Disparities and Mayoral Officials’ Beliefs About Health Disparities in Their Cities
AbstractPurtle, J., Joshi, R., Lê-Scherban, F., Henson, R. M., & Diez Roux, A. V. (n.d.).Publication year
2021Journal title
Milbank QuarterlyVolume
99Issue
3Page(s)
794-827AbstractPolicy Points Mayoral officials’ opinions about the existence and fairness of health disparities in their city are positively associated with the magnitude of income-based life expectancy disparity in their city. Associations between mayoral officials’ opinions about health disparities in their city and the magnitude of life expectancy disparity in their city are not moderated by the social or fiscal ideology of mayoral officials or the ideology of their constituents. Highly visible and publicized information about mortality disparities, such as that related to COVID-19 disparities, has potential to elevate elected officials’ perceptions of the severity of health disparities and influence their opinions about the issue. Context: A substantive body of research has explored what factors influence elected officials’ opinions about health issues. However, no studies have assessed the potential influence of the health of an elected official's constituents. We assessed whether the magnitude of income-based life expectancy disparity within a city was associated with the opinions of that city's mayoral official (i.e., mayor or deputy mayor) about health disparities in their city. Methods: The independent variable was the magnitude of income-based life expectancy disparity in US cities. The magnitude was determined by linking 2010-2015 estimates of life expectancy and median household income for 8,434 census tracts in 224 cities. The dependent variables were mayoral officials’ opinions from a 2016 survey about the existence and fairness of health disparities in their city (n = 224, response rate 30.3%). Multivariable logistic regression was used to adjust for characteristics of mayoral officials (e.g., ideology) and city characteristics. Findings: In cities in the highest income-based life expectancy disparity quartile, 50.0% of mayoral officials “strongly agreed” that health disparities existed and 52.7% believed health disparities were “very unfair.” In comparison, among mayoral officials in cities in the lowest disparity quartile 33.9% “strongly agreed” that health disparities existed and 22.2% believed the disparities were “very unfair.” A 1-year-larger income-based life expectancy disparity in a city was associated with 25% higher odds that the city's mayoral official would “strongly agree” that health disparities existed (odds ratio [OR] = 1.25; P =.04) and twice the odds that the city's mayoral official would believe that such disparities were “very unfair” (OR = 2.24; P <.001). Conclusions: Mayoral officials’ opinions about health disparities in their jurisdictions are generally aligned with, and potentially influenced by, information about the magnitude of income-based life expectancy disparities among their constituents.Partisan differences in twitter language among US legislators during the COVID-19 pandemic: Cross-sectional study
AbstractGuntuku, S. C., Purtle, J., Meisel, Z. F., Merchant, R. M., & Agarwal, A. (n.d.).Publication year
2021Journal title
Journal of medical Internet researchVolume
23Issue
6AbstractBackground: As policy makers continue to shape the national and local responses to the COVID-19 pandemic, the information they choose to share and how they frame their content provide key insights into the public and health care systems. Objective: We examined the language used by the members of the US House and Senate during the first 10 months of the COVID-19 pandemic and measured content and sentiment based on the tweets that they shared. Methods: We used Quorum (Quorum Analytics Inc) to access more than 300,000 tweets posted by US legislators from January 1 to October 10, 2020. We used differential language analyses to compare the content and sentiment of tweets posted by legislators based on their party affiliation. Results: We found that health care–related themes in Democratic legislators’ tweets focused on racial disparities in care (odds ratio [OR] 2.24, 95% CI 2.22-2.27; P<.001), health care and insurance (OR 1.74, 95% CI 1.7-1.77; P<.001), COVID-19 testing (OR 1.15, 95% CI 1.12-1.19; P<.001), and public health guidelines (OR 1.25, 95% CI 1.22-1.29; P<.001). The dominant themes in the Republican legislators’ discourse included vaccine development (OR 1.51, 95% CI 1.47-1.55; P<.001) and hospital resources and equipment (OR 1.22, 95% CI 1.18-1.25). Nonhealth care–related topics associated with a Democratic affiliation included protections for essential workers (OR 1.55, 95% CI 1.52-1.59), the 2020 election and voting (OR 1.31, 95% CI 1.27-1.35), unemployment and housing (OR 1.27, 95% CI 1.24-1.31), crime and racism (OR 1.22, 95% CI 1.18-1.26), public town halls (OR 1.2, 95% CI 1.16-1.23), the Trump Administration (OR 1.22, 95% CI 1.19-1.26), immigration (OR 1.16, 95% CI 1.12-1.19), and the loss of life (OR 1.38, 95% CI 1.35-1.42). The themes associated with the Republican affiliation included China (OR 1.89, 95% CI 1.85-1.92), small business assistance (OR 1.27, 95% CI 1.23-1.3), congressional relief bills (OR 1.23, 95% CI 1.2-1.27), press briefings (OR 1.22, 95% CI 1.19-1.26), and economic recovery (OR 1.2, 95% CI 1.16-1.23). Conclusions: Divergent language use on social media corresponds to the partisan divide in the first several months of the course of the COVID-19 public health crisis.Perceived Persuasiveness of Evidence About Adverse Childhood Experiences: Results From a National Survey
AbstractPurtle, J., Nelson, K. L., Srivastav, A., & Gollust, S. E. (n.d.).Publication year
2021Journal title
Academic PediatricsVolume
21Issue
3Page(s)
529-533AbstractObjective: Advocates must make decisions about the types of evidence they emphasize when communicating to cultivate support for adverse childhood experience (ACE) prevention policies. This study sought to characterize public perceptions of the persuasiveness of 12 ACE evidence statements and assess differences by ideology in the strength of these evidence messages as rationales for ACE prevention policies. Methods: A web-based survey of a nationally representative sample of US adults was conducted using the KnowledgePanel (N = 503, completion rate = 60.5%). Respondents read ACE evidence statements and answered questions about the extent to which each was perceived as persuasive. Data were collected and analyzed in 2019. Results: The evidence statements perceived as most persuasive (scoring range 3–17) were those about ACEs as risk factors for mental health and substance use conditions (mean = 12.39) and suicide (mean = 12.14); ACEs generating financial costs for society (mean = 12.03); and the consequences of ACEs being preventable by a supportive adult (mean = 11.97). The evidence statements perceived as least persuasive were about ACEs generating health care costs for individuals (mean = 9.42) and ACEs as risk factors for physical health conditions (mean = 9.47). A larger proportion of liberals than conservatives rated every statement as providing a “strong reason” for ACE prevention policies. These differences were largest for evidence about ACEs generating financial costs for society (84.6% vs 42.8%, P <.0001) and socioeconomic disparities in ACEs (65.1% vs 32.9%, P <.0001). Conclusions: Many ACE evidence statements commonly used in policy advocacy differ from those perceived as most persuasive among a nationally representative sample of US adults.Posttraumatic stress, depression, and sleep among young survivors of violence
AbstractCorbin, T., Tabb, L. P., Waite, D., Purtle, J., Harris, E., Gardner, J., Gentile, N., Rowhani-Rahbar, A., & Rich, J. (n.d.).Publication year
2021Journal title
Journal of health care for the poor and underservedVolume
32Issue
3Page(s)
1339-1358AbstractSurvivors of violence often suffer psychological harm in addition to physical wounds. This study explored (1) the prevalence of Posttraumatic Stress Disorder (PTSD) symptoms, depression symptoms, and disordered sleep among young, violently injured, emergency department patients; and (2) how PTSD and depression symptoms are associated with sleep quality. Clinical scales for PTSD (PCL-5), depression (PHQ-8), and sleep (PROMIS®) were completed by 88 survivors of violent assault (gunshot, stabbing or assault) one month or less after presenting to an urban emergency department. High proportions of participants met criteria for prospective PTSD (59.1%), major depression (44.3%) or disordered sleep (34.1%), with 27.3% meeting criteria for all three conditions. Poorer sleep quality was correlated with higher levels of depression symptoms and PTSD symptoms. Survivors of violence experience symptoms that may further impair their sleep and behavioral health. Emergency providers should ask survivors about sleep/trauma symptoms and consider referral to trauma-informed behavioral health care.State Legislators’ Divergent Social Media Response to the Opioid Epidemic from 2014 to 2019: Longitudinal Topic Modeling Analysis
AbstractStokes, D. C., Purtle, J., Meisel, Z. F., & Agarwal, A. K. (n.d.).Publication year
2021Journal title
Journal of general internal medicineVolume
36Issue
11Page(s)
3373-3382AbstractBackground: The opioid epidemic is widely recognized as a legislative priority, but there is substantial variation in state adoption of evidence-based policy. State legislators’ use of social media to disseminate information and to indicate support for specific initiatives continues to grow and may reflect legislators’ openness to opioid-related policy change. Objective: We sought to identify changes in the national dialogue regarding the opioid epidemic among Democratic and Republican state legislators and to estimate changing partisanship around understanding and addressing the epidemic over time. Design: Longitudinal natural language processing analysis. Participants: A total of 4083 US state legislators in office between 2014 and 2019 with any opioid-related social media posts. Main Measures: Association between opioid-related post volume and state overdose mortality, as measured by Kendall’s rank correlation coefficient. Latent Dirichlet allocation analysis of all social media posts to identify key opioid-related topics. Longitudinal analysis of differences in the prevalence of key topics among Democrats and Republicans over time. Key Results: In total, 43,558 social media posts met inclusion criteria, with the vast majority to Twitter (n=28,564; 65.6%) or Facebook (n=14,283; 32.8%). Posts were more likely to mention fentanyl and less likely to mention heroin over time. The volume of opioid-related content was positively associated with state-level unintentional overdose mortality among both Democrats (tau=0.42, P<.001) and Republicans (tau=0.39, P<.001). Democrats’ social media content has increasingly spoken to holding pharmaceutical companies accountable, while Republicans’ social media content has increasingly spoken to curbing illicit drug trade. Overall, partisanship across topics increased from 2016 to 2019. Conclusion: The volume of opioid-related social media posts by US state legislators between 2014 and 2019 is associated with state-level overdose mortality, but the content across parties is significantly different. Democrats’ and Republicans’ social media posts may reflect growing partisanship regarding how best to address the overdose epidemic.The effect of caregiver key opinion leaders on increasing caregiver demand for evidence-based practices to treat youth anxiety: protocol for a randomized control trial
AbstractCrane, M. E., Atkins, M. S., Becker, S. J., Purtle, J., Olino, T. M., & Kendall, P. C. (n.d.).Publication year
2021Journal title
Implementation Science CommunicationsVolume
2Issue
1AbstractBackground: Research has identified cognitive behavioral therapy with exposures (CBT) as an effective treatment for youth anxiety. Despite implementation efforts, few anxious youth receive CBT. Direct-to-consumer marketing offers a different approach to address the unmet need for youth receiving effective treatments. Involving a local caregiver key opinion leader in direct-to-consumer initiatives may be an effective strategy to increase caregiver demand for CBT. Research indicates that key opinion leaders improve health promotion campaigns, but key opinion leaders have not been studied in the context of increasing caregiver demand for evidence-based treatments. Method: Project CHAT (Caregivers Hearing about Anxiety Treatments) will test the role of key opinion leader participation in conducting outreach presentations to increase caregiver desire to seek CBT for their youth’s anxiety. Caregiver attendees (N = 180) will be cluster randomized by school to receive one of two different approaches for presentations on CBT for youth anxiety. Both approaches will involve community outreach presentations providing information on recognizing youth anxiety, strategies caregivers can use to decrease youth anxiety, and how to seek CBT for youth anxiety. The researcher-only condition will be co-facilitated by two researchers. In the key opinion leader condition, a caregiver key opinion leader from each local community will be involved in tailoring the content of the presentation to the context of the community, co-facilitating the presentation with a researcher, and endorsing strategies in the presentation that they have found to be helpful. In line with the theory of planned behavior, caregiver attendees will complete measures assessing their knowledge of, attitudes towards, perceived subjective norms about, and intention to seek CBT pre- and post-presentation; they will indicate whether they sought CBT for their youth at 3-month follow-up. Results will be analyzed using a mixed method approach to assess the effectiveness of a key opinion leader to increase caregiver demand for CBT. Discussion: This study will be the first to examine the potential of key opinion leaders to increase caregiver demand for CBT. If proven effective, the use of key opinion leaders could serve as a scalable dissemination strategy to increase the reach of evidence-based treatments. Trial registration: This trial was registered on clinicaltrials.gov (NCT04929262) on June 18, 2021. At the time of trial registration, pre/post-presentation data had been collected from 17 participants; thus, it was retrospectively registered.The Intersection of Dissemination Research and Acupuncture: Applications for Chronic Low Back Pain
AbstractRoseen, E. J., Purtle, J., Zhang, W., Miller, D. W., Schwartz, A. W., Ramanadhan, S., & Sherman, K. J. (n.d.).Publication year
2021Journal title
Global Advances In Health and MedicineVolume
10AbstractBackground: Dissemination research is the study of distributing information and intervention materials to a specific clinical practice or public health audience. Acupuncture, a healthcare practice involving the stimulation of certain body points, often with thin needles, is considered an evidence-based treatment for low back pain (LBP), but is underutilized in the United States. Body: We will use the example of acupuncture for LBP to identify opportunities to leverage dissemination research to increase utilization of acupuncture. Deficits in the awareness or knowledge of acupuncture may limit its adoption by patients and other stakeholders. Thus, we summarize methods to gather data on stakeholder awareness and knowledge of acupuncture for LBP, i.e., audience research. Engaging multiple stakeholder audiences (e.g., health system leaders, primary care providers, patients), is needed to generate knowledge on promising dissemination strategies for each audience. Audience segmentation is important for identifying population subgroups for whom adoption of acupuncture may require a more intensive or tailored dissemination strategy. To illustrate potential audience ‘segments’, our research discussion focused on developing dissemination strategies by age (i.e., older adults – those age 65 years or older, and younger adults – those under age 65). This decision was prompted by Medicare’s recent policy covering acupuncture for chronic LBP. We leverage current knowledge of barriers and facilitators of acupuncture use to discuss how further tailoring of dissemination strategies might optimize adoption of acupuncture in both groups of adults. Experimental study designs could then be used to compare the effectiveness of such strategies to increase awareness, knowledge, or adoption of acupuncture. Conclusions: Conducting dissemination research may improve awareness and knowledge of acupuncture, and ultimately the adoption of acupuncture in biomedical settings. We anticipate that the concepts highlighted in this manuscript will also be helpful for those disseminating information about other complementary and integrative health approaches.