Virginia W Chang
Virginia W Chang
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Associate Professor of Social and Behavioral Sciences
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Professional overview
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Virginia W. Chang, MD, PhD is Associate Professor of Global Public Health at NYU School of Global Public Health, Associate Professor of Population Health at NYU School of Medicine, and Affiliated Associate Professor in the Department of Sociology at NYU. Dr. Chang is a graduate of the Inteflex Program at the University of Michigan, where she received her BS and MD degrees. She then completed a residency in internal medicine, fellowship training with the Robert Wood Johnson Foundation Clinical Scholars Program, and a PhD in sociology, all at the University of Chicago. Prior to joining NYU, Dr. Chang was in the Division of General Internal Medicine at the Perelman School of Medicine at the University of Pennsylvania and a staff physician at the Philadelphia Veterans Administration Medical Center.
As a physician and sociologist, Dr. Chang integrates perspectives from medicine, epidemiology, sociology, and demography in her research. Much of her work has focused on obesity and health disparities, engaging topics such as the influence of socially structured context (e.g., racial segregation, income inequality, neighborhood social/physical disorder) on obesity; the relationship of obesity to mortality and disability; the influence of weight status on the quality of medical care; socioeconomic disparities in health and mortality; and the inter-relationships between health, medical technologies, and stratification.
Her research program has been funded by the NICHD, NHLBI, and NIA of the National Institutes of Health, the Veterans Health Administration, the Robert Wood Johnson Foundation, the Measy Foundation, the American Diabetes Association, and the Russell Sage Foundation. She is the recipient of numerous awards, including the Society of General Internal Medicine Award for Outstanding Junior Investigator of the Year and the Marjorie A. Bowman Award from the University of Pennsylvania School of Medicine for achievement in the health evaluation sciences. Dr. Chang is also a Diplomate of the American Board of Internal Medicine.
Dr. Chang’s publications span a variety of disciplines, including journals such as JAMA, Annals of Internal Medicine, JAMA Internal Medicine, Health Affairs, American Journal of Public Health, American Journal of Epidemiology, Journal of Health & Social Behavior, Social Science & Medicine, Demography, and Social Forces. She was recently an Associate Editor of the Journal of Health & Social Behavior.
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Education
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BS, Biomedical Sciences and Philosophy, University of Michigan, Ann Arbor, MIMD, Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, MIMA, Sociology, University of Chicago, Chicago, ILPhD, Sociology, University of Chicago, Chicago, IL-Fellow, Robert Wood Johnson Clinical Scholars Program, University of Chicago, Chicago, ILResident, Department of Medicine, University of Chicago, Chicago, ILIntern, Department of Medicine, University of Chicago, Chicago, IL-Diplomate, American Board of Internal MedicineLicensed Medical Physician, Commonwealth of Pennsylvania
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Honors and awards
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Majorie A. Bowman Research Award, University of Pennsylvania School of Medicine (2010)Outstanding Junior Investigator of the Year, Society of General Internal Medicine (2008)Robert Austrian Faculty Award for Health Evaluation Reserach, Department of Medicine, University of Pennsylvania School of Medicine (2008)Physician Faculty Scholars Award, Robert Wood Johnson Foundation (2007)Finalist, Hamolsky Junior Facutly Award, Society of General Internal Medicine (2004)Finalist, Richard Saller Prize for Best Dissertation in the Division of the Social Sciences, University of Chicago (2003)Graduate University Fellowship, University of Chicago (2001)Eli G. Rochelson Memorial Award for Excellence in Pulmonary and Critical Care Medicine, University of Michigan Medical School (1994)Biomedical Research Program Scholarship, University of Michigan Medical School (1991)James B. Angell Scholar, University of Michigan (1988)William J. Branstrom Freshman Prize, University of Michigan (1986)
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Areas of research and study
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Global HealthHealth DisparitiesInternal MedicineObesityPopulation HealthSocial Behaviors
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Publications
Publications
Update on the health disparities literature
AbstractLong, J. A., Chang, V. W., Ibrahim, S. A., & Asch, D. A. (n.d.).Publication year
2004Journal title
Annals of internal medicineVolume
141Issue
10Page(s)
805-812AbstractUnderrepresented minorities in the United States are likely to have worse health and receive less health care than the racial and ethnic majority. This Update focuses on studies that document disparities, explain disparities, and test strategies to reduce disparities.Self-perception of weight appropriateness in the United States
AbstractChang, V. W., & Christakis, N. A. (n.d.).Publication year
2003Journal title
American journal of preventive medicineVolume
24Issue
4Page(s)
332-339AbstractBackground: The self-perception of weight appropriateness is an important component of eating and weight-loss behaviors. Self-perceived weight status, however, is not fully explained by objective weight status. Objective: To examine the influence of sociodemographic factors on Americans' perceptions of their weight appropriateness, controlling for objective weight status. Design: In the Third National Health and Nutrition Examination Survey, respondents were asked, "Do you consider yourself now to be overweight, underweight, or about the right weight?" Responses to this question were compared with how respondents (n=15,593) would be classified by medical standards given their body mass index (BMI). A proportional odds logistic regression model was used to assess the predictive effects of various sociodemographic factors on weight self-perception. Results: Overall, 27.5% of women and 29.8% of men misclassified their own weight status by medical standards. Of particular note, 38.3% of normal weight women thought they were "overweight," while 32.8% of overweight men thought they were "about the right weight" or "underweight." Multivariate regression analysis revealed that, controlling for BMI, numerous factors - including gender, age, marital status, race, income, and education - were independently associated with the self-evaluation of weight status. Conclusions: The self-perceived appropriateness of weight status varies in highly predictable ways among population-level subgroups, likely reflecting differences in the normative evaluation of bodily weight standards. Such evaluations may assist in the explanation of discrepancies between clinical recommendations based on weight status and actual weight control behaviors, discrepancies that are socially patterned along some of the same subgroupings.Medical modelling of obesity: A transition from action to experience in a 20 th century American medical textbook
AbstractChang, V. W., & Christakis, N. A. (n.d.).Publication year
2002Journal title
Sociology of Health and IllnessVolume
24Issue
2Page(s)
151-177AbstractObesity is now the focus of considerable attention in the medical profession, and many have noted that obesity has been progressively medicalised. The subjection of phenomena to medical explanation, however, has been associated with both the potential to relieve and also to exacerbate the attribution of individual responsibility. In order to understand the ways in which a particular phenomenon, obesity, can be variously conceptualised at different time-points within a medical framework, we conducted a content analysis of a series of medical textbook entries. Using the widely-consulted Cecil Textbook of Medicine, we reviewed entries on obesity from 1927 to 2000 and found that throughout this period the text consistently maintains that obesity results from a simple excess of caloric intake over expenditure. Despite the unwavering nature of this basic model, an evolving set of causal factors is superimposed. Early models invoke aberrant individual activities, such as habitual overeating, while later editions drop these factors in favour of genetic and, paradoxically, environmental effects. Obesity shifts in ontological status, as it is transformed from being the product of something that individuals do to something that they experience. Concurrent with these changes, we find a change in the social appraisal of obesity. In each edition there is a narrative regarding the cost/benefit relationship between obese persons and society, as well as a construction of accountability for obesity as an outcome. Obese individuals are progressively held less responsible for their condition in successive editions of the text. Initially cast as societal parasites, they are later transformed into societal victims. Using these texts and obesity as a case-example, we demonstrate that medical conceptualisation of a presumably cohesive object of knowledge can undergo transformation quite independently of definitive experimental evidence, with a persistent dialectic between etiological configuration and formulations of social culpability and remediation. We situate our findings with respect to ongoing debates concerning the nature and implications of medicalisation. This case effectively highlights a more general epidemiological tension between an individual level of focus on risk behaviours and a population level of focus that contexualises behaviours within a social and material framework.Racial and ethnic differences in place of death: United States, 1993
AbstractIwashyna, T. J., & Chang, V. W. (n.d.).Publication year
2002Journal title
Journal of the American Geriatrics SocietyVolume
50Issue
6Page(s)
1113-1117AbstractOBJECTIVES: To examine racial and ethnic differences in place of death, adjusting for likely confounders. DESIGN: A retrospective cohort analyzed using multinomial logistic regression. SETTING: United States in 1993. PARTICIPANTS: A nationally representative sample of 22,658 deaths in 1993 from the National Mortality Followback Survey. MEASUREMENTS: Place of death as determined on the death certificate, with controls for age, sex, income, education, and cause of death. The outcomes of interest were death in a hospital during an inpatient stay, death in a nursing home, death in a private residence, or death in some other place. RESULTS: After adjustment, 43% of whites die after an inpatient hospital stay, as do 50% of blacks and 56% of Mexican Americans. Twenty percent of whites, 22% of Mexican Americans, and 14% of blacks die in nursing homes. Twenty-two percent of whites, 18% of blacks, and 9% of Mexicans die in a private residence. CONCLUSIONS: There are substantial differences between whites, blacks, and Mexican Americans in place of death that cannot be explained by differences in age, sex, income, education, and causes of death between the groups.The lack of effect of market structure on hospice use
AbstractIwashyna, T. J., Chang, V. W., Zhang, J. X., & Christakis, N. A. (n.d.).Publication year
2002Journal title
Health Services ResearchVolume
37Issue
6Page(s)
1531-1551AbstractObjective. To describe the relative importance of health care market structure and county-level demographics in determining rates of hospice use. Data Sources. Medicare claims data for a cohort of elderly patients newly diagnosed with lung cancer, colon cancer, stroke, or heart attack in 1993, followed for up to five years, and linked to Census and Area Resource File data. Study Design. Variation between markets in rates of hospice use by patients with serious illness was examined after taking into account differences in individual-level data using hierarchical linear models. The relative explanatory power of market-level structure and local demographic variables was compared. Data Collection Methods. The cohort was defined within the Medicare hospital claims data using validated algorithms to detect incident cases of disease with a three-year lookback. Use of hospice was determined by linkage at an individual level to the Standard Analytic Files for Hospice through 1997. Individual-level data was linked to the Area Resource File using county identifiers present in the Medicare claims. Principal Findings. There is substantial variation in hospice use across markets. This variation is not explained by differences in the major components of health care infrastructure: the availability of hospital, nursing home, or skilled nursing facilities, nor by the availability of HMOs, doctors, or generalists. Conclusions. Intercounty heterogeneity in hospice use is substantial, and may not be related to the set-up of the medical care system. The important local factors may be local preferences, differences in the particular mix of services provided by local hospices, or differences in community leadership on end of life-issues; many of these differences may be amenable to educational efforts.Extent and determinants of discrepancy between self-evaluations of weight status and clinical standards
AbstractChang, V. W., & Christakis, N. A. (n.d.).Publication year
2001Journal title
Journal of general internal medicineVolume
16Issue
8Page(s)
538-543AbstractOBJECTIVES: To examine the extent and type of discordance between personal and medical classifications of weight status, and to examine the influence of sociodemographic factors on the misclassification of weight status. DESIGN/SETTING: The 1991 Health Promotion and Disease Prevention Supplement of the National Health Interview Survey, a nationally representative, cross-sectional survey of the U.S. population. PARTICIPANTS: Adults 18 years and older (N = 41,676). MEASUREMENTS AND MAIN RESULTS: Respondents' self-evaluations of weight status were compared to classification of their body mass index (BMI) by medical standards. Twenty-nine percent of respondents incorrectly classified their weight status relative to medical standards, and the nature of this error was variable. While 27.4% of overweight persons judged their weight to be "just about right," of those who did judge themselves to be overweight, 23.9% were in fact normal or underweight according to their BMI. Overall, 16.6% of persons underassessed their weight category, and 12.4% overassessed their weight category. Multivariate analysis revealed that sex, age, race, income, education, and occupation influenced the misclassification of weight status. CONCLUSIONS: A substantial proportion of Americans deviate from medical standards in their self-evaluations of weight appropriateness, and this lack of correspondence may reflect the normative judgments of various population subgroups. Clinical and public health programs that employ a uniform strategy or approach to the population may not be efficacious.Substance P innervation of the lumbar spine facet joint
Beaman, D. N., Graziano, G. P., Glover, R. A., Wojtys, E. M., & Chang, V. W. (n.d.).Publication year
1993Journal title
SpineVolume
18Issue
8Page(s)
1044-1049Substance P innervation of the lumbar spine facet joint
Beaman, D. N., Graziano, G. P., Glover, R. A., Wojtys, E. M., & Chang, V. W. (n.d.).Publication year
1992Journal title
Orthopaedic TransactionsVolume
16Issue
2Page(s)
430-431