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
The Other US Border: Health Insurance Coverage Among Latino Immigrants In Puerto Rico
AbstractRivera-González, A. C., Stimpson, J. P., Roby, D. H., Canino, G., Purtle, J., Bellamy, S. L., & Ortega, A. N. (n.d.).Publication year
2021Journal title
Health AffairsVolume
40Issue
7Page(s)
1117-1125AbstractPuerto Rico is a US territory and a popular destination for Latino immigrants in the Caribbean. Even with few language and cultural barriers, however, many Latino immigrants in Puerto Rico are uninsured. Using data from the 2014–19 Puerto Rico Community Survey, we examined inequities in health insurance coverage for non–Puerto Rican Latinos ages 18–64 living in Puerto Rico according to citizenship status and Latino subgroup (Dominican, Cuban, Mexican, and other Latino). After controlling for potential confounders, we found that noncitizen Dominicans had a significantly lower probability of having any health insurance (57.2 percent) and having any private insurance (31.5 percent). Regardless of similarities in culture and language, Latino immigrants on the island, particularly Dominicans, experience major health insurance coverage inequities. Considering that Puerto Rico’s immigration system is regulated by US federal statute, both federal and local policy makers should acknowledge and focus on reducing these immigrant disparities in health insurance coverage.Who Is Talking About Adverse Childhood Experiences? Evidence From Twitter to Inform Health Promotion
AbstractSrivastav, A., Park, K., Koziarski, A., Strompolis, M., & Purtle, J. (n.d.).Publication year
2021Journal title
Health Education and BehaviorVolume
48Issue
5Page(s)
615-626AbstractBackground: Growing availability of research about addressing adverse childhood experiences (ACEs) has recently been embraced by the mainstream media and public. Social media, especially Twitter, provides a unique forum and platform for the public to access and share information about this topic. Objective: This study aims to better understand how the public is framing, sharing, and using research about ACEs on Twitter and to examine the information being commonly discussed about ACEs. Method: We obtained tweets on the topics of ACEs, childhood resilience, and childhood trauma between January 1, 2018, and December 31, 2019. This timeframe was determined based on key related events in the mainstream media. Crimson Hexagon, a social media analytics system using Boolean logic, was used to identify salient topics, influencers, and conduct a content analysis. Results: A total of 195,816 relevant tweets were obtained from our search. The weekly volume was approximately 1,864 tweets. Key topics included general use of the term ACEs (23%), trauma and ACEs (19%), long-term impact of ACEs (12%), preventing ACEs (11%), short-term effects of ACEs (8%), the 1997 ACE Study (5%), and students with ACEs (5%). The top two sentiments were fear and joy. Top conversation influencers included pediatricians, child health advocacy organizations, California’s state government, the Centers for Disease Control and Prevention, and National Public Radio. Conclusion: This analysis provides insight to the ways the public is conversing about ACEs and related topics. Results indicated that conversations focus on increasing awareness of ACEs by content experts and public health organizations. This presents an opportunity to leverage social media tools to increase public engagement and awareness.Aligning dissemination and implementation science with health policies to improve children’s mental health.
AbstractHoagwood, K. E., Purtle, J., Spandorfer, J., Peth-Pierce, R., & Horwitz, S. M. C. (n.d.).Publication year
2020Journal title
American PsychologistVolume
75Issue
8Page(s)
1130-1145AbstractThe prevalence of mental health problems among children (ages 0–21) in the United States remains unacceptably high and, post-COVID-19, is expected to increase dramatically. Decades of psychological knowledge about effective treatments should inform the delivery of better services. Dissemination and implementation (D&I) science has been heralded as a solution to the persistent problem of poor quality services and has, to some extent, improved our understanding of the contexts of delivery systems that implement effective practices. However, there are few studies demonstrating clear, population-level impacts of psychological interventions on children. Momentum is growing among communities, cities, states, and some federal agencies to build “health in all policies” to address broad familial, social, and economic factors known to affect children’s healthy development and mental health. These health policy initiatives offer a rare opportunity to repurpose D&I science, shifting it from a primary focus on evidence-based practice implementation, to a focus on policy development and implementation to support child and family health and well-being. This shift is critical as states develop policy responses to address the health and mental health impacts of the COVID-19 pandemic on already-vulnerable families. We provide a typology for building research on D&I and children’s mental health policy. (PsycInfo Database Record (c) 2020 APA, all rights reserved)<strong xmlns:lang="en">Public Significance Statement—The prevalence of mental health problems among children remains unacceptably high. Communities, cities, states, and some federal agencies are building “health in all policies” initiatives that address broad familial, social, and economic factors known to affect children’s healthy development. These initiatives offer a rare opportunity to repurpose D&I science and shift it from a primary focus on evidence-based practice implementation, to a focus on policy dissemination and implementation.Association of Vaccine-Preventable Disease Incidence with Proposed State Vaccine Exemption Legislation
Goldstein, N. D., Purtle, J., & Suder, J. S. (n.d.). In JAMA Pediatrics (1–).Publication year
2020Volume
174Issue
1Page(s)
88-89Dissemination of urban health research to maximize impact
Kolker, J., Slesinski, C., Carroll-Scott, A., & Purtle, J. (n.d.). In Urban Public Health (1–).Publication year
2020Page(s)
314-335Dissemination Strategies to Accelerate the Policy Impact of Children’s Mental Health Services Research
AbstractPurtle, J., Nelson, K. L., Bruns, E. J., & Hoagwood, K. E. (n.d.).Publication year
2020Journal title
Psychiatric ServicesVolume
71Issue
11Page(s)
1170-1178AbstractThe United States is in the midst of a children’s mental health crisis, with rates of depression, anxiety, and suicide increasing precipitously. Evidence produced by children’s mental health services research can help address this crisis by informing public policy decisions about service delivery, system design, and investments in the social determinants of mental health. Unfortunately, the policy impact of children’s mental health services research is limited because evidence often fails to reach policy makers, be responsive to their needs, resonate with their worldview, or reflect the contexts in which they make decisions. Dissemination strategies—defined as the development and targeted distribution of messages and materials about research evidence pertaining to a specific issue or intervention—can help address these challenges. Yet, limited integrated guidance exists to inform the design of such strategies. This article addresses this need by synthesizing the results of empirical studies to provide guidance about how to enhance the dissemination of children’s mental health services research to policy makers. The article provides four recommendations about the content of policy maker–focused dissemination materials, discusses how strategic framing and message tailoring can increase the chances that evidence is persuasive to policy makers, and highlights strategies to ensure that evidence reaches policy makers.Earmarked taxes as a policy strategy to increase funding for behavioral health services
AbstractPurtle, J., & Stadnick, N. A. (n.d.).Publication year
2020Journal title
Psychiatric ServicesVolume
71Issue
1Page(s)
100-104AbstractEarmarking taxes for behavioral health services is a policy strategy that many jurisdictions have implemented to increase funding for behavioral health systems. However, little has been written about these taxes, and limited guidance exists for policy makers who are pursing or implementing such taxes. This column summarizes approaches to designing earmarked behavioral health taxes, evidence of their impact, strategies to enhance implementation, and future directions for research. The column focuses on two jurisdictions: California, which imposes an additional 1% tax on all household income exceeding $1 million, and Washington State, which provides counties with the option of increasing sales tax by 0.1%.Factors associated with state legislators’ support for opioid use disorder parity laws
AbstractNelson, K. L., & Purtle, J. (n.d.).Publication year
2020Journal title
International Journal of Drug PolicyVolume
82AbstractBackground: In the United States, state behavioral health parity laws play a crucial role in ensuring equitable insurance coverage and access to substance use disorder treatment and services for people that need them. State legislators have the exclusive authority to adopt these laws. The purpose of this study was to identify legislator beliefs independently associated with “strong support” for opioid use disorder (OUD) parity. Methods: Data were from a 2017 cross-sectional, state-stratified, multi-modal survey of state legislators (N = 475). The dependent variable was “strong support” for OUD parity. Primary independent variables were beliefs about state parity laws. Bivariate analyses and mixed effects logistic regression were conducted. Results: Legislators who “strongly supported” OUD parity were significantly more likely than legislators who did not “strongly support” OUD parity to be female (64.1% vs. 46.5%, p<.001), Democrat (76.2% vs. 29.3%, p<.001), and have liberal, compared to conservative, ideology (85.6% vs. 27.1%, p<.001). After adjusting for legislator demographics and state-level covariates, beliefs such as agreeing that state parity laws do not increase health insurance premium costs (aOR=6.77, p<.01) and that substance use disorder treatments can be effective (aOR=5.00, p<.001) remained associated with “strong support” for OUD parity. These state legislators’ beliefs were more strongly associated with “strong support” for OUD parity than political party, ideology, and other demographic and state-level characteristics. Conclusions: Dissemination materials and communication strategies to cultivate support for OUD parity laws among state legislators should focus on the fiscal impacts of parity laws and the effectiveness of substance use disorder treatments.Mental illness and bipolar disorder on Twitter: implications for stigma and social support
AbstractBudenz, A., Klassen, A., Purtle, J., Yom Tov, E., Yudell, M., & Massey, P. (n.d.).Publication year
2020Journal title
Journal of Mental HealthVolume
29Issue
2Page(s)
191-199AbstractBackground: Mental illness (MI), and particularly, bipolar disorder (BD), are highly stigmatized. However, it is unknown if this stigma is also represented on social media. Aims: Characterize Twitter-based stigma and social support messaging (“tweets”) about mental health/illness (MH)/MI and BD and determine which tweets garnered retweets. Methods: We collected tweets about MH/MI and BD during a three-month period and analyzed tweets from dates with the most tweets (“spikes”), an indicator of topic interest. A sample was manually content analyzed, and the remainder were classified using machine learning (logistic regression) by topic, stigma, and social support messaging. We compared stigma and support toward MH/MI versus BD and used logistic regression to quantify tweet features associated with retweets, to assess tweet reach. Results: Of the 1,270,902 tweets analyzed, 94.7% discussed MH/MI and 5.3% discussed BD. Spikes coincided with a celebrity’s death and a MH awareness campaign. Although the sample contained more support than stigma messaging, BD tweets contained more stigma and less support than MH/MI tweets. However, stigma messaging was infrequently retweeted, and users often retweeted personal MH experiences. Conclusions: These findings demonstrate opportunities for social media advocacy to reduce stigma and increase displays of social support towards people living with BD.Public opinion about evidence-informed health policy development in U.S. Congress
AbstractPurtle, J. (n.d.).Publication year
2020Journal title
Translational Behavioral MedicineVolume
10Issue
6Page(s)
1549-1553AbstractPromoting evidence-informed health policymaking is a priority of the Society of Behavioral Medicine and other professional societies. However, politics often impede the translation of research into policy. Public opinion is an important feature of political context that influences policymakers' behaviors, but prior research has not examined public opinion about evidence-informed health policy development. This exploratory study sought to characterize public opinion about the influence that evidence should, and does, have on health policy development in U.S. Congress relative to other factors and examine differences by political party affiliation. A public opinion survey was conducted in 2018 using the SSRS Probability Panel (N = 532). Respondents separately rated the extent to which six factors (e.g., evidence, budget impact, industry interests) "should have"and "currently have"influence on U.S. congresspersons' health policy decisions. Evidence (59%) was the most frequently identified factor that should have "a lot of influence"on health policy development, but only 11% of respondents thought that evidence currently has "a lot of influence"(p <. 001). Opinions about evidence did not vary significantly by political party. The interests of insurance and pharmaceutical companies were identified as factors that should have the least influence on policy development, but were perceived as having the most influence (p <. 001). There is strong bipartisan public support for evidence to have much more influence on health policy development in U.S. Congress. Efforts that aim to improve evidence-informed health policymaking should consider harnessing the power of public opinion to change elected policymakers' behaviors.Public transit and depression among older adults: Using agent-based models to examine plausible impacts of a free bus policy
AbstractYang, Y., Langellier, B. A., Stankov, I., Purtle, J., Nelson, K. L., Reinhard, E., Van Lenthe, F. J., & Diez Roux, A. V. (n.d.).Publication year
2020Journal title
Journal of Epidemiology and Community HealthVolume
74Issue
11Page(s)
875-881AbstractBackground Daily transport is associated with mental health. A free bus policy (FBP) may be effective in promoting the use of public transit in older adults and be associated with reductions in depressive symptoms. Methods We developed an agent-based model and grounded it using empirical data from England to examine the impact of an FBP on public transit use and depression among older adults. We also used the model to explore whether the impact of the FBP bus use and depression is modified by the type of income segregation or by simultaneous efforts to improve attitudes towards the bus, to reduce waiting times or to increase the cost of driving via parking fees or fuel price. Results Our model suggests that improving attitudes towards the bus (eg, campaigns that promote bus use) could enhance the effect of the FBP, especially for those in proximity to public transit. Reducing wait times could also significantly magnify FPB impacts, especially in those who live in proximity to public transit. Contrary to expectation, neither fuel costs nor parking fees significantly enhanced the impact of the FBP. The impact of improving attitudes towards the bus and increasing bus frequency was more pronounced in the lower-income groups in an income segregation scenario in which destination and public transit are denser in the city centre. Conclusion Our results suggest that the beneficial mental health effects of an FBP for older adults can be magnified when combined with initiatives that reduce bus waiting times and increased spatial access to transit.Quantifying the Restrictiveness of Local Housing Authority Policies Toward People with Criminal Justice Histories: United States, 2009-2018
AbstractPurtle, J., Gebrekristos, L. T., Keene, D., Schlesinger, P., Niccolai, L., & Blankenship, K. M. (n.d.).Publication year
2020Journal title
American journal of public healthVolume
110Page(s)
S137-S144AbstractObjectives. To quantify variation in the restrictiveness of local public housing authority policies related to the admission and eviction of people with criminal justice histories. Methods. We conducted content analysis of housing authority policy documents for US cities with a population of 100 000 or more (n = 152). Factor analysis identified policy provisions to create a restrictiveness score (range = 0-8). We explored associations between restrictiveness scores and city-level measures of racial/ethnic diversity, racial/ethnic neighborhood segregation, ideology, and public housing scarcity. Results. Eight policy provisions, 6 relating to consideration of mitigating circumstances, explained 71.0% of the variance in housing authority policy provisions related to criminal justice histories. We observed small but significant positive associations between restrictiveness scores and racial/ethnic diversity (r = 0.22) and neighborhood segregation (r = 0.18). There was no correlation between restrictiveness scores of housing authorities within the same state (intraclass correlation = 0.0002). Conclusions. Housing authority policies vary substantially regarding the circumstances under which people with criminal justice histories can obtain and retain public housing. Exposure to constellations of policy provisions that might institutionalize health inequities and increase health risk among people with criminal justice histories can be quantified through a systematic process. (Am J Public Health. 2020;110:S137-S144. doi: 10.2105/AJPH.2019.305437).Quantitative measures of health policy implementation determinants and outcomes: A systematic review
AbstractAllen, P., Pilar, M., Walsh-Bailey, C., Hooley, C., Mazzucca, S., Lewis, C. C., Mettert, K. D., Dorsey, C. N., Purtle, J., Kepper, M. M., Baumann, A. A., & Brownson, R. C. (n.d.).Publication year
2020Journal title
Implementation ScienceVolume
15Issue
1AbstractBackground: Public policy has tremendous impacts on population health. While policy development has been extensively studied, policy implementation research is newer and relies largely on qualitative methods. Quantitative measures are needed to disentangle differential impacts of policy implementation determinants (i.e., barriers and facilitators) and outcomes to ensure intended benefits are realized. Implementation outcomes include acceptability, adoption, appropriateness, compliance/fidelity, feasibility, penetration, sustainability, and costs. This systematic review identified quantitative measures that are used to assess health policy implementation determinants and outcomes and evaluated the quality of these measures. Methods: Three frameworks guided the review: Implementation Outcomes Framework (Proctor et al.), Consolidated Framework for Implementation Research (Damschroder et al.), and Policy Implementation Determinants Framework (Bullock et al.). Six databases were searched: Medline, CINAHL Plus, PsycInfo, PAIS, ERIC, and Worldwide Political. Searches were limited to English language, peer-reviewed journal articles published January 1995 to April 2019. Search terms addressed four levels: health, public policy, implementation, and measurement. Empirical studies of public policies addressing physical or behavioral health with quantitative self-report or archival measures of policy implementation with at least two items assessing implementation outcomes or determinants were included. Consensus scoring of the Psychometric and Pragmatic Evidence Rating Scale assessed the quality of measures. Results: Database searches yielded 8417 non-duplicate studies, with 870 (10.3%) undergoing full-text screening, yielding 66 studies. From the included studies, 70 unique measures were identified to quantitatively assess implementation outcomes and/or determinants. Acceptability, feasibility, appropriateness, and compliance were the most commonly measured implementation outcomes. Common determinants in the identified measures were organizational culture, implementation climate, and readiness for implementation, each aspects of the internal setting. Pragmatic quality ranged from adequate to good, with most measures freely available, brief, and at high school reading level. Few psychometric properties were reported. Conclusions: Well-tested quantitative measures of implementation internal settings were under-utilized in policy studies. Further development and testing of external context measures are warranted. This review is intended to stimulate measure development and high-quality assessment of health policy implementation outcomes and determinants to help practitioners and researchers spread evidence-informed policies to improve population health.State and Local Government Expenditures and Infant Mortality in the United States
AbstractGoldstein, N. D., Palumbo, A. J., Bellamy, S. L., Purtle, J., & Locke, R. (n.d.).Publication year
2020Journal title
PediatricsVolume
146Issue
5AbstractBACKGROUND AND OBJECTIVES: Evidence suggests that government expenditures on non–health care services can reduce infant mortality, but it is unclear what types of spending have the greatest impact among groups at highest risk. Thus, we sought to quantify how US state government spending on various services impacted infant mortality rates (IMRs) over time and whether spending differentially reduced mortality in some subpopulations. METHODS: A longitudinal, repeated-measures study of US state-level infant mortality and state and local government spending for the years 2000–2016, the most recent data available. Expenditures included spending on education, social services, and environment and housing. Using generalized linear regression models, we assessed how changes in spending impacted infant mortality over time, overall and stratified by race and ethnicity and maternal age group. RESULTS: State and local governments spend, on average, $9 per person. A $0.30 per-person increase in environmental spending was associated with a decrease of 0.03 deaths per 1000 live births, and a $0.73 per-person increase in social services spending was associated with a decrease of 0.02 deaths per 1000 live births. Infants born to mothers aged,20 years had the single greatest benefit from an increase in expenditures compared with all other groups. Increased expenditures in public health, housing, parks and recreation, and solid waste management were associated with the greatest reduction in overall IMR. CONCLUSIONS: Investment in non–health care services was associated with lower IMRs among certain high-risk populations. Continued investments into improved social and environmental services hold promise for further reducing IMR disparities.State Mental Health Agency Officials’ Preferences for and Sources of Behavioral Health Research
AbstractPurtle, J., Lê-Scherban, F., Nelson, K. L., Shattuck, P. T., Proctor, E. K., & Brownson, R. C. (n.d.).Publication year
2020Journal title
Psychological ServicesVolume
17Page(s)
93-97AbstractState mental health agencies (SMHAs) are integral to public behavioral health service systems. As such, senior-level officials within SMHAs are important targets for advocacy and dissemination of behavioral health research findings. Evidence-informed decision making in SMHAs can potentially be enhanced by developing summaries of behavioral health research (e.g., policy briefs) that reflect SMHA officials’ information preferences, but knowledge about these preferences is lacking. An exploratory study was conducted with the aims of characterizing senior-level SMHA officials’ preferences for behavioral health research and describing where they turn for this research when making policy decisions. A cross-sectional, web-based survey of senior-level SMHA officials (1 per state) was conducted in March-May 2017 (n = 43, response rate = 84%). The features of behavioral health research that SMHA officials identified as “very important” most frequently were research being relevant to state residents (93.0%), providing data on cost-effectiveness (86.0%) and budget impact (81.4%), and being presented concisely (81.0%). The primary sources that SMHA officials turned to for behavioral research when making policy decisions were professional organizations (79.1%), SMHA agency staff (60.5%), and university researchers (55.8%). Compared with state legislators’ responses to the same survey questions, results suggest that senior-level SMHA officials and legislators have similar preferences for behavioral health research but turn to different sources for this research. Advocates and researchers who seek to promote evidence-informed decision making in SMHAs should consider developing policy briefs that are concise, provide state-level prevalence data about behavioral conditions, and contain economic evaluation data, and they should disseminate these materials to multiple sources.Systematic Review of Evaluations of Trauma-Informed Organizational Interventions That Include Staff Trainings
AbstractPurtle, J. (n.d.).Publication year
2020Journal title
Trauma, Violence, and AbuseVolume
21Issue
4Page(s)
725-740AbstractEnthusiasm for trauma-informed practice has increased dramatically. Organizational interventions that train staff about trauma-informed practice are frequently used to promote trauma-informed systems change, but evidence about these interventions’ effects has not been integrated. A systematic review was conducted of studies that evaluated the effects of organizational interventions that included a “trauma-informed” staff training component. A search was conducted in July 2017 and studies were identified in PubMed, PsycINFO, and the Published International Literature on Traumatic Stress database, limited to articles published in English after 2000. Six hundred and thirty-two articles were screened and 23 met inclusion criteria. Seventeen studies used a single group pretest/posttest design, five used a randomized controlled design, and one used a quasi-experimental design with a nonrandomized control group. The duration of trauma-informed trainings ranged from 1 hr to multiple days. Staff knowledge, attitudes, and behaviors related to trauma-informed practice improved significantly pre-/posttraining in 12 studies and 7 studies found that these improvements were retained at ≥1month follow-up. Eight studies assessed the effects of a trauma-informed organizational intervention on client outcomes, five of which found statistically significantly improvements. The strength of evidence about trauma-informed organization intervention effects is limited by an abundance of single group, pretest/posttest designs with short follow-up periods, unsophisticated analytic approaches, and inconsistent use of assessment instruments. In addition to addressing these methodological limitations, priorities for future research include understanding intervention effects on clients’ perceptions of care and the mechanisms through which changes in staff knowledge and attitudes about trauma-informed practice influence client outcomes.The heterogeneous effect of marijuana decriminalization policy on arrest rates in Philadelphia, Pennsylvania, 2009–2018
AbstractTran, N. K., Goldstein, N. D., Purtle, J., Massey, P. M., Lankenau, S. E., Suder, J. S., & Tabb, L. P. (n.d.).Publication year
2020Journal title
Drug and alcohol dependenceVolume
212AbstractBackground: Marijuana decriminalization holds potential to reduce health inequities. However, limited attention has focused on assessing the impact of decriminalization policies across different populations. This study aims to determine the differential effect of a marijuana decriminalization policy change in Philadelphia, PA on marijuana arrests by demographic characteristics. Methods: Using a comparative interrupted time series design, we assessed whether the onset of marijuana decriminalization in Philadelphia County was associated with reduction in arrests rates from 2009 to 2018 compared to Dauphin County. Stratified models were used to describe the differential impact of decriminalization across different demographic populations. Results: Compared to Dauphin, the mean arrest rate for all marijuana-related crimes in Philadelphia declined by 19.9 per 100,000 residents (34.9% reduction), 17.1 per 100,000 residents (43.1% reduction) for possession, and 2.8 per 100,000 resident (15.9% reduction) for sales/manufacturing. Arrest rates also differed by demographic characteristics post-decriminalization. Notably, African Americans had a greater absolute/relative reduction in possession-based arrests than Whites. However, relative reductions for sales/manufacturing-based arrests was nearly 3 times lower for African Americans. Males had greater absolute/relative reduction for possession-based arrests, but lower relative reduction for sales/manufacturing-based arrests compared to females. There were no substantial absolute differences by age; however, youths (vs. adults) experienced higher relative reduction in arrest rates. Conclusions: Findings suggest an absolute/relative reduction for possession-based arrests post-decriminalization; however, relative disparities in sales/manufacturing-based arrests, specifically for African Americans, increased. More consideration towards the heterogeneous effect of marijuana decriminalization are needed given the unintended harmful effects of arrest on already vulnerable populations.Toward the data-driven dissemination of findings from psychological science.
AbstractPurtle, J., Marzalik, J. S., Halfond, R. W., Bufka, L. F., Teachman, B. A., & Aarons, G. A. (n.d.).Publication year
2020Journal title
American PsychologistVolume
75Issue
8Page(s)
1052-1066AbstractThe public health impact of psychological science is maximized when it is disseminated clearly and compellingly to audiences who can act on it. Dissemination research can generate knowledge to help achieve this, but dissemination is understudied in the field of implementation science. As a consequence, the designs of dissemination strategies are typically driven by anecdote, not evidence, and are often ineffective. We address this issue by synthesizing key theory and findings from consumer psychology and detailing a novel research approach for “data-driven dissemination.” The approach has 3 parts: (a) formative audience research, which characterizes an audience’s awareness about, adoption of, and attitudes toward an intervention, as well as preferences for receiving information about it; (b) audience segmentation research, which identifies meaningful subgroups within an audience to inform the tailoring of dissemination strategies; and (c) dissemination effectiveness research, which determines the strategies that are most effective. This approach is then illustrated using the dissemination of the American Psychological Association’s (APA, 2017) Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults as a case study. Data are presented from a 2018–2019 survey of licensed APA-member psychologists who treat adults with PTSD (n = 407, response rate = 29.8%). We present survey findings on awareness about, attitudes toward, and adoption of the guideline and find significant differences across these domains between psychologists who do and do not regularly use clinical practice guidelines. We conclude by discussing future directions to advance dissemination research and practice. (PsycInfo Database Record (c) 2020 APA, all rights reserved)<strong xmlns:lang="en">Public Significance Statement—Dissemination is understudied in the field of implementation science and there is little guidance about how dissemination research should be conducted. As a consequence, the designs of dissemination strategies are typically driven by anecdote, not evidence. We address this issue by detailing a 3-part research approach for “data-driven dissemination.”What Predicts a Mayoral Official’s Opinion about the Role of Stress in Health Disparities?
AbstractCuevas, A. G., Levine, S., & Purtle, J. (n.d.).Publication year
2020Journal title
Journal of Racial and Ethnic Health DisparitiesVolume
7Issue
1Page(s)
109-116AbstractHigh stress is a public health issue in the United States (US), that disproportionately affects socially-marginalized group members, including racial and ethnic minorities and those of low socioeconomic status. While city governments have the potential to reduce stress exposure and health disparities through municipal policies, very little is known about factors that are associated with mayor officials’ beliefs about stress as a determinant of disparities. This information is important because it can inform the design of interventions to educate city policymakers about evidence related to stress and health disparities. Using data from a 2016 survey of 230 mayor officials (101 mayors, 129 senior staff), multivariable logistic regression was used to determine the extent to which respondents’ individual characteristics (e.g., ideology, highest level of education) and the characteristics of their city’s population (e.g., percentage of residents non-white) were associated with their identification of stress as a factor that has a “very strong effect” on health disparities. Forty-four percent of respondents identified stress as having a very strong effect on health disparities. In the fully adjusted model, every percentage point increase in the proportion of a respondent’s city population that was non-White increased the odds of identifying stress as having a very strong effect on health disparities by 2% [adjusted odds ratio (aOR) = 1.02; 95% CI = 1.00,1.04]. Interventions are needed to increase city policymakers’ knowledge about the role of stress in the production of health disparities, which could, in turn, help cultivate political will for city policies that reduce disparities.Big City Health Officials' Conceptualizations of Health Equity
AbstractHenson, R. M., Mcginty, M., Juliano, C., & Purtle, J. (n.d.).Publication year
2019Journal title
Journal of Public Health Management and PracticeVolume
25Issue
4Page(s)
332-341AbstractContext: Senior health officials of local health departments are uniquely positioned to provide transformational leadership on health disparities and inequities. Objective: This study aimed to understand how senior health officials in large US cities define health equity and its relationship with disparities and characterize these senior health officials' perceptions of using health equity and disparity language in local public health practice. Design: In 2016, we used a general inductive qualitative design and conducted 23 semistructured interviews with leaders of large local health departments. Thematic content analysis was conducted using NVivo 11. Participants: A purposive sample of senior health officials from Big Cities Health Coalition cities. Results: Health equity was conceptualized fairly consistently among senior health officials in big cities. Core elements of these conceptualizations include social and economic conditions, the input and redistribution of resources, equity in practice, values of justice and fairness, and equity as an outcome to be achieved. Senior health officials saw health disparity and health inequity as distinct but related concepts. Relationships between concepts included disparities data to identify and prioritize inequities, inequities creating health disparities, health equity to eliminate disparities, and disparities becoming inequities when their root causes are unjust. Some respondents critiqued health equity terminology for representing a superficial change, being inaccessible, and being politically loaded. Conclusions: Understanding how senior health officials conceptualize health equity and disparities can focus policy priorities, resources, and the scope of work undertaken by local health departments. Having a common language for health equity allows for policy and resource advocacy to promote the health of marginalized populations.Complex Systems Approaches to Understand Drivers of Mental Health and Inform Mental Health Policy: A Systematic Review
AbstractLangellier, B. A., Yang, Y., Purtle, J., Nelson, K. L., Stankov, I., & Diez Roux, A. V. (n.d.).Publication year
2019Journal title
Administration and Policy in Mental Health and Mental Health Services ResearchVolume
46Issue
2Page(s)
128-144AbstractWe conducted a systematic review of studies employing complex systems approaches (i.e., agent based and system dynamics models) to understand drivers of mental health and inform mental health policy. We extracted key data (e.g., purpose, design, data) for each study and provide a narrative synthesis of insights generated across studies. The studies investigated drivers and policy intervention strategies across a diversity of mental health outcomes. Based on these studies and the extant literature, we propose a typology of mental health research and policy areas that may benefit from complex systems approaches.Depression and alcohol misuse among older adults: exploring mechanisms and policy impacts using agent-based modelling
AbstractStankov, I., Yang, Y., Langellier, B. A., Purtle, J., Nelson, K. L., & Diez Roux, A. V. (n.d.).Publication year
2019Journal title
Social psychiatry and psychiatric epidemiologyVolume
54Issue
10Page(s)
1243-1253AbstractPurpose: To: (1) explore how multi-level factors impact the longitudinal prevalence of depression and alcohol misuse among urban older adults (≥ 65 years), and (2) simulate the impact of alcohol taxation policies and targeted interventions that increase social connectedness among excessive drinkers, socially isolated and depressed older adults; both alone and in combination. Methods: An agent-based model was developed to explore the temporal co-evolution of depression and alcohol misuse prevalence among older adults nested in a spatial network. The model was based on Los Angeles and calibrated longitudinally using data from the Multi-Ethnic Study of Atherosclerosis. Results: Interventions with a social component targeting depressed and socially isolated older adults appeared more effective in curbing depression prevalence than those focused on excessive drinkers. Targeting had similar impacts on alcohol misuse, though the effects were marginal compared to those on depression. Alcohol taxation alone had little impact on either depression or alcohol misuse trajectories. Conclusions: Interventions that improve social connectedness may reduce the prevalence of depression among older adults. Targeting considerations could play an important role in determining the success of such efforts.Examining the possible impact of daily transport on depression among older adults using an agent-based model
AbstractYang, Y., Langellier, B. A., Stankov, I., Purtle, J., Nelson, K. L., & Diez Roux, A. V. (n.d.).Publication year
2019Journal title
Aging and Mental HealthVolume
23Issue
6Page(s)
743-751AbstractObjectives: Daily transport may impact depression risk among older adults through several pathways including facilitating the ability to meet basic needs, enabling and promoting contact with other people and nature, and promoting physical activity (e.g. through active transportation such as walking or walking to public transit). Both daily transport and depression are influenced by the neighborhood environment. To provide insights into how transport interventions may affect depression in older adults, we developed a pilot agent-based model to explore the contribution of daily transport and neighborhood environment to older adults’ depression in urban areas. Method: The model includes about 18,500 older adults (i.e. agents) between the ages of 65 and 85 years old, living in a hypothetical city. The city has a grid space with a number of neighborhoods and locations. Key dynamic processes in the model include aging, daily transport use and feedbacks, and the development of depression. Key parameters were derived from US data sources. The model was validated using empirical studies. Results: An intervention that combines a decrease in bus fares, shorter bus waiting times, and more bus lines and stations is most effective at reducing depression. Lower income groups are likely to be more sensitive to the public transit-oriented intervention. Conclusion: Preliminary results suggest that promoting public transit use may be a promising strategy to increase daily transport and decrease depression. Our results may have implications for transportation policies and interventions to prevent depression in older adults.Modeling HPV vaccination scale-up among urban young men who have sex with men in the context of HIV
AbstractGoldstein, N. D., LeVasseur, M. T., Tran, N. K., Purtle, J., Welles, S. L., & Eppes, S. C. (n.d.).Publication year
2019Journal title
VaccineVolume
37Issue
29Page(s)
3883-3891AbstractIntroduction: Young men who have sex with men (YMSM) are at high risk to contract human papillomavirus (HPV). While an effective vaccination exists, its use among YMSM is markedly lower compared to non-MSM and women. This study compares scaling up HPV vaccination in conjunction with other prevention strategies. Methods: An agent-based model of urban YMSM (≤26 years of age) reflective of the demography of Philadelphia, PA, simulated for up to ten years of follow-up to examine anal and oral transmission of the HPV genotypes covered in the nonavalent (9v) vaccine: 6, 11, 16, 18, 31, 33, 45, 52, 58. Starting HPV prevalences ranged from a high of 18% (type 6) to a low of 6% (type 31); overall 65% of individuals carried any HPV genotype. Simulated levels of vaccination were ranged from 0% to 13% (present-day level), 25%, 50%, 80% (Healthy People 2020 target), and 100% in conjunction with condom use and HIV seroadaptive practices. The primary outcome was the relative reduction in HPV infection. Results: Compared to present-day vaccination levels (13%), scaling-up vaccination led to expected declines in 10-year post-simulation HPV prevalence. Anal HPV (any 9v types) declined by 9%, 27%, 46%, and 58% at vaccination levels of 25%, 50%, 80%, and 100%, respectively. Similarly, oral HPV (any 9v types) declined by 11%, 33%, 57%, and 71% across the same levels of vaccine uptake. Comparing the prevention strategies, condoms blocked the greatest number of anal transmissions when vaccination was at or below present-day levels. For oral transmission, vaccination was superior to condom use at all levels of coverage. Conclusions: Public health HPV preventions strategies should continue to emphasize the complementary roles of condoms and vaccination, especially for preventing oral infection. Improving vaccination coverage will ultimately have the greatest impact on reducing HPV infection among YMSM.Perceptions of patient-provider communication and receipt of mental health treatment among older adults with depressive symptoms
AbstractNelson, K. L., & Purtle, J. (n.d.).Publication year
2019Journal title
Aging and Mental HealthVolume
23Issue
4Page(s)
485-490AbstractObjectives: This study aimed to: (1) determine if and how perceptions towards healthcare providers differ between older adults with and without clinically signifcant depressive symptoms (CSDS), and (2) assess whether perceptions towards providers are associated with receipt of mental health treatment among older adults with CSDS. Methods: Data from the 2013 and 2014 Medical Expenditure Panel Survey were used to examine CSDS prevalence, receipt of mental health treatment, and perceptions of provider communication among community-dwelling adults ≥ age 65 (N = 6,936) using four of the ‘How Well Doctors Communicate’ composite items from the Consumer Assessment of Healthcare Providers and Systems(CAHPS). Multivariate logistic regression was used. Results: CSDS are associated with greater odds of having ‘poor’ perceptions of provider communication on all four CAHPS communication measures. Perceptions of provider communication are similar among older adults with CSDS who received and did not receive mental health treatment, except on an item measuring a provider's ability to explain information in ways patients understand. Conclusion: Older adults with CSDS have more negative perceptions of the quality of their communication with healthcare providers than their peers. Healthcare systems should consider how to accommodate these patients’ unique needs and communication preferences to ensure receipt of quality care.