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 at the New York University School of Global Public Health and also 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, suicide prevention, and novel financing models for mental health services—such as earmarked taxes and fees.
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 a NIMH-funded project focused on financing policies related to the 988 Suicide & Crisis Lifeline (R01MH131649), a NIDA-funded study (through the CHERISH Center, P30DA040500) that is analyzing social media data to identify audience segments of state legislators who conceptualize substance use issues in different ways and experimentally testing different ways of communicating evidence these legislators, and co-leading a NCI-funded study focused on cancer policy implementation strategies (R21ACA293319). He is also a co-investigator on projects focused on mental health and health care system resilience following disasters is Puerto Rico (R01MD016426) and Hawaiʻi (R61MD019939).
He has published over 170 peer-reviewed journal articles, is an Associate Editor at Implementation Science, Co-Chairs the Policy Advisory Board at Psychiatric Services, is on the Scientific Advisory Committee of the American Foundation for Suicide Prevention, and is Core Faculty of the NIMH-funded Implementation Research Institute.
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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
A Case Study of the Philadelphia Sugar-Sweetened Beverage Tax Policymaking Process : Implications for Policy Development and Advocacy
AbstractPurtle, J., Langellier, B., & Lê-Scherban, F. (n.d.).Publication year
2018Journal title
Journal of Public Health Management and PracticeVolume
24Issue
1Page(s)
4-8AbstractContext: Policymakers are increasingly proposing sugar-sweetened beverage (SSB) taxes as an evidence-based strategy to reduce chronic disease risk; and local health departments (LHDs) are well-positioned to play a role in SSB policy development and advocacy. However, most SSB tax proposals fail to become law and limited empiric guidance exists to inform advocacy efforts. In June 2016, Philadelphia, Pennsylvania, passed an SSB tax. Objective: To identify features of the Philadelphia SSB tax policymaking process that contributed to the proposal's passage. Design: Qualitative case study. Semistructured interviews were conducted with key informants closely involved with the policymaking process. Interviews were audio-recorded and transcribed. Local news media about the SSB tax proposal were analyzed to triangulate interview findings. Analysis was conducted in NVivo 10 using inductive qualitative content analysis. Setting: Philadelphia, Pennsylvania, during the SSB tax policymaking in process. Participants: Nine key informants (2 city councilpersons, 4 city agency officials, 1 community-based advocate, 1 news reporter, and 1 researcher). Results: The Philadelphia SSB tax proposal was introduced with the explicit goal of financing universal prekindergarten and deliberately not framed as a health intervention. This framing shifted contentious debates about government involvement in individual behavior toward discussions about how to finance universal prekindergarten, a goal for which broad support existed. The LHD played an important role in communicating research evidence about potential health benefits of the SSB tax proposal at the end of the policymaking process. Conclusions: During local SSB tax policy development processes, LHD officials and other advocates should encourage policymakers to design SSB tax policies so that revenue is directed toward community investments for which broad public support exists. When communicating with policymakers and the public, LHDs should consider emphasizing how SSB tax revenue will be used in addition to presenting evidence about the potential health benefits of the SSB tax at the local level.A Content Analysis of Hospitals’ Community Health Needs Assessments in the Most Violent U.S. Cities
AbstractFischer, K. R., Schwimmer, H., Purtle, J., Roman, D., Cosgrove, S., Current, J. J., & Greene, M. B. (n.d.).Publication year
2018Journal title
Journal of Community HealthVolume
43Issue
2Page(s)
259-262AbstractThe emergence of evidence-supported interventions allows hospitals the opportunity to reduce future reinjury among patients who are violently injured. However, hospital knowledge of these interventions and their perceived role in violence prevention is unknown. The Patient Protection and Affordable Care Act created new legal requirements for non-profit hospitals to conduct community health needs assessments (CHNA) every three years to maintain not-for-profit status. In turn, this allows an empiric evaluation of hospital recognition and response to community violence. To do so, this study performed a content analysis of hospital CHNAs from the 20 U.S. cities with the highest violent crime rates. A total of 77 CHNAs were examined for specific violence-related keywords as well as whether violence prevention was listed as a priority community need. Overall, 74% of CHNAs mentioned violence-related terms and only 32% designated violence prevention as a priority need. When discussed, 88% of CHNAs referenced community violence, 42% intimate partner or sexual violence, and 22% child abuse. This study suggests that hospitals may lack awareness of violence as an actionable, preventable public health issue. Further, evidence-based program models are available to hospitals that can reduce the recurrence of assaultive injuries.A landscape assessment of the activities and capacities of evidence-to-policy intermediaries (EPI) in behavioral health
AbstractAlmquist, L., Walker, S. C., & Purtle, J. (n.d.).Publication year
2023Journal title
Implementation science communicationsVolume
4Issue
1AbstractBackground: A significant gap exists between the production of research evidence and its use in behavioral health policymaking. Organizations providing consulting and support activities for improving policy represent a promising source for strengthening the infrastructure to address this gap. Understanding the characteristics and activities of these evidence-to-policy intermediary (EPI) organizations can inform the development of capacity-building activities, leading to strengthened evidence-to-policy infrastructure and more widespread evidence-based policymaking. Methods: Online surveys were sent to 51 organizations from English-speaking countries involved in evidence-to-policy activities in behavioral health. The survey was grounded in a rapid evidence review of the academic literature regarding strategies used to influence research use in policymaking. The review identified 17 strategies, which were classified into four activity categories. We administered the surveys via Qualtrics and calculated the descriptive statistics, scales, and internal consistency statistics using R. Results: A total of 31 individuals completed the surveys from 27 organizations (53% response rate) in four English-speaking countries. EPIs were evenly split between university (49%) and non-university (51%) settings. Nearly all EPIs conducted direct program support (mean = 4.19/5 [sd = 1.25]) and knowledge-building (4.03 [1.17]) activities. However, engagement with traditionally marginalized and non-traditional partners (2.84 [1.39]) and development of evidence reviews using formal critical appraisal methods (2.81 [1.70]) were uncommon. EPIs tend to be specialized, focusing on a group of highly related strategies rather than incorporating multiple evidence-to-policy strategies in their portfolios. Inter-item consistency was moderate to high, with scale α’s ranging from 0.67 to 0.85. Ratings of respondents’ willingness to pay for training in one of three evidence dissemination strategies revealed high interest in program and policy design. Conclusions: Our results suggest that evidence-to-policy strategies are frequently used by existing EPIs; however, organizations tend to specialize rather than engage in a breadth of strategies. Furthermore, few organizations reported consistently engaging with non-traditional or community partners. Focusing on building capacity for a network of new and existing EPIs could be a promising strategy for growing the infrastructure needed for evidence-informed behavioral health policymaking.A Mixed-Methods Exploration of the Implementation of Policies That Earmarked Taxes for Behavioral Health
AbstractStadnick, N. A., Geremia, C., Mauri, A. I., Swanson, K., Wynecoop, M. R., & Purtle, J. (n.d.).Publication year
2024Journal title
Milbank QuarterlyVolume
102Issue
4Page(s)
913-943AbstractPolicy Points Earmarked tax policies for behavioral health are perceived as having positive impacts related to increasing flexible funding, suggesting benefits to expand this financing approach. Implementation challenges related to these earmarked taxes included tax base volatility that impedes long-term service delivery planning and inequities in the distribution of tax revenue. Recommendations for designing or revising earmarked tax policies include developing clear guidelines and support systems to manage the administrative aspects of earmarked tax programs, cocreating reporting and oversight structures with system and service delivery agents, and selecting revenue streams that are relatively stable across years. Context: Over 200 cities and counties in the United States have implemented policies earmarking tax revenue for behavioral health services. This mixed-methods study was conducted with the aim of characterizing perceptions of the impacts of these earmarked tax policies, strengths and weaknesses of tax policy designs, and factors that influence decision making about how tax revenue is allocated for services. Methods: Study data came from surveys completed by 274 officials involved in behavioral health earmarked tax policy implementation and 37 interviews with officials in a sample of jurisdictions with these taxes—California (n = 16), Washington (n = 12), Colorado (n = 6), and Iowa (n = 3). Interviews primarily explored perceptions of the advantages and drawbacks of the earmarked tax, perceptions of tax policy design, and factors influencing decisions about revenue allocation. Findings: A total of 83% of respondents strongly agreed that it was better to have the tax than not, 73.2% strongly agreed that the tax increased flexibility to address complex behavioral health needs, and 65.1% strongly agreed that the tax increased the number of people served by evidence-based practices. Only 43.3%, however, strongly agreed that it was easy to satisfy tax-reporting requirements. Interviews revealed that the taxes enabled funding for services and implementation supports, such as training in the delivery of evidence-based practices, and supplemented mainstream funding sources (e.g., Medicaid). However, some interviewees also reported challenges related to volatility of funding, inequities in the distribution of tax revenue, and, in some cases, administratively burdensome tax reporting. Decisions about tax revenue allocation were influenced by goals such as reducing behavioral health care inequities, being responsive to community needs, addressing constraints of mainstream funding sources, and, to a lesser degree, supporting services considered to be evidence based. Conclusions: Earmarked taxes are a promising financing strategy to improve access to, and quality of, behavioral health services by supplementing mainstream state and federal financing.A policy implementation study of earmarked taxes for mental health services : study protocol
AbstractPurtle, J., Stadnick, N. A., Wynecoop, M. R., Bruns, E. J., Crane, M. E., & Aarons, G. (n.d.).Publication year
2023Journal title
Implementation science communicationsVolume
4Issue
1AbstractBackground: Insufficient funding is frequently identified as a critical barrier to the implementation and sustainment of evidence-based practices (EBPs). Thus, increasing access to funding is recognized as an implementation strategy. Policies that create earmarked taxes—defined as taxes for which revenue can only be spent on specific activities—are an increasingly common mental health financing strategy that could improve the reach of EBPs. This project’s specific aims are to (1) identify all jurisdictions in the USA that have implemented earmarked taxes for mental health and catalogue information about tax design; (2) characterize experiences implementing earmarked taxes among local (e.g., county, city) mental health agency leaders and other government and community organization officials and assess their perceptions of the acceptability and feasibility of different types of policy implementation strategies; and (3) develop a framework to guide effect earmarked tax designs, inform the selection of implementation strategies, and disseminate the framework to policy audiences. Methods: The project uses the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to inform data collection about the determinants and processes of tax implementation and Leeman’s typology of implementation strategies to examine the acceptability and feasibility strategies which could support earmarked tax policy implementation. A legal mapping will be conducted to achieve aim 1. To achieve aim 2, a survey will be conducted of 300 local mental health agency leaders and other government and community organization officials involved with the implementation of earmarked taxes for mental health. The survey will be followed by approximately 50 interviews with these officials. To achieve aim 3, quantitative and qualitative data will be integrated through a systematic framework development and dissemination process. Discussion: This exploratory policy implementation process study will build the evidence base for outer-context implementation determinants and strategies by focusing on policies that earmarked taxes for mental health services.A regional analysis of healthcare utilization trends during consecutive disasters in puerto rico using private claims data
AbstractStimpson, J. P., Mercado, D. L., Rivera-González, A. C., Purtle, J., & Ortega, A. N. (n.d.).Publication year
2025Journal title
Scientific reportsVolume
15Issue
1AbstractPuerto Rico has endured multiple natural disasters in recent years, including Hurricanes Irma and Maria (2017), earthquakes (2019), and the COVID-19 pandemic (2020), which placed significant strain on its healthcare system. This study examined trends in health care utilization for injuries, infectious diseases, and mental health services across Puerto Rico’s health regions from 2016 to 2022. Using private claims data from four major insurers, we analyzed trends in health care utilization rates per 1,000 beneficiaries across seven health regions. Infectious disease claims rose significantly following each disaster, with the sharpest increases observed post-2020, particularly in the Caguas region. Mental health and substance use claims exhibited a consistent upward trend across all health regions, with Caguas and Ponce reporting the largest increases. Injury claims declined in 2020 but rebounded in most regions by 2021, with Caguas consistently reporting the highest rates. These findings highlight the substantial and varied impacts of consecutive disasters on health care utilization in Puerto Rico, particularly for infectious diseases and mental health services. Notable regional disparities, such as higher utilization rates in Caguas, underscore the need for interventions to strengthen health system resilience and ensure equitable healthcare access in preparation for future disasters.A review of policy dissemination and implementation research funded by the National Institutes of Health, 2007-2014
AbstractPurtle, J., Peters, R., & Brownson, R. C. (n.d.).Publication year
2016Journal title
Implementation ScienceVolume
11Issue
1AbstractBackground: Policy has a tremendous potential to improve population health when informed by research evidence. Such evidence, however, typically plays a suboptimal role in policymaking processes. The field of policy dissemination and implementation research (policy D&I) exists to address this challenge. The purpose of this study was to: (1) determine the extent to which policy D&I was funded by the National Institutes of Health (NIH), (2) identify trends in NIH-funded policy D&I, and (3) describe characteristics of NIH-funded policy D&I projects. Methods: The NIH Research Portfolio Online Reporting Tool was used to identify all projects funded through D&I-focused funding announcements. We screened for policy D&I projects by searching project title, abstract, and term fields for mentions of "policy," "policies," "law," "legal," "legislation," "ordinance," "statute," "regulation," "regulatory," "code," or "rule." A project was classified as policy D&I if it explicitly proposed to conduct research about the content of a policy, the process through which it was developed, or outcomes it produced. A coding guide was iteratively developed, and all projects were independently coded by two researchers. ClinicalTrials.gov and PubMed were used to obtain additional project information and validate coding decisions. Descriptive statistics-stratified by funding mechanism, Institute, and project characteristics-were produced. Results: Between 2007 and 2014, 146 projects were funded through the D&I funding announcements, 12 (8.2 %) of which were policy D&I. Policy D&I funding totaled $16,177,250, equivalent to 10.5 % of all funding through the D&I funding announcements. The proportion of funding for policy D&I projects ranged from 14.6 % in 2007 to 8.0 % in 2012. Policy D&I projects were primarily focused on policy outcomes (66.7 %), implementation (41.7 %), state-level policies (41.7 %), and policies within the USA (83.3 %). Tobacco (33.3 %) and cancer (25.0 %) control were the primary topics of focus. Many projects combined survey (58.3 %) and interview (33.3 %) methods with analysis of archival data sources. Conclusions: NIH has made an initial investment in policy D&I research, but the level of support has varied between Institutes. Policy D&I researchers have utilized a variety of designs, methods, and data sources to investigate the development processes, content, and outcomes of public and private policies.A Tale of Two Taxes : Implementation of Earmarked Taxes for Behavioral Health Services in California and Washington State
AbstractPurtle, J., Stadnick, N. A., Wynecoop, M. R., Walker, S. C., Bruns, E. J., & Aarons, G. A. (n.d.).Publication year
2024Journal title
Psychiatric ServicesVolume
75Issue
5Page(s)
410-418AbstractObjective: The authors sought to characterize perceptions of the impacts, attributes, and support for taxes earmarked for behavioral health services and to compare perceptions of the taxes among professionals in California and Washington, two states differing in earmarked tax designs. Methods: Surveys were completed by 155 public agency and community organization professionals involved in tax implementation in California (N=87) and Washington State (N=68) during 2022–2023 (29% response rate). Respondents indicated their perceptions of the taxes’ impacts, attributes, and support. Responses were summed as aggregate scores and were also analyzed as individual items. Bivariate analyses were used to compare responses of professionals in California versus Washington State. Results: Earmarked taxes were generally regarded positively. Of the respondents, >80% strongly agreed that the taxes increased funding for services and were helpful, and only 10% strongly agreed that the taxes decreased behavioral health funding from other sources. Substantially more respondents in California than in Washington State strongly agreed that taxes’ reporting requirements were complicated (45% vs. 5%, pAcademic-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. (n.d.).Publication year
2021Journal title
Hospital and Community PsychiatryVolume
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.Acceptability and feasibility of policy implementation strategies for taxes earmarked for behavioral health services
AbstractPurtle, J., Stadnick, N. A., Wynecoop, M. R., Walker, S. C., Bruns, E. J., & Aarons, G. A. (n.d.).Publication year
2024Journal title
Frontiers in Health ServicesVolume
4AbstractBackground: This study's aims are to: (1) Compare the acceptability and feasibility of five types of implementation strategies that could be deployed to increase the reach of evidence-based practices (EBPs) with revenue from policies that earmark taxes for behavioral health services, and (2) Illustrate how definitions of implementation strategies and measures of acceptability and feasibility can be used in policy-focused implementation science research. Methods: Web-based surveys of public agency and community organization professionals involved with earmarked tax policy implementation were completed in 2022–2023 (N = 211, response rate = 24.9%). Respondents rated the acceptability and feasibility of five types of implementation strategies (dissemination, implementation process, integration, capacity-building, and scale-up). Aggregate acceptability and feasibility scores were calculated for each type of strategy (scoring range 4–20). Analyses of variance compared scores across strategies and between organizational actor types. Findings: For acceptability, capacity-building strategies had the highest rating (M = 16.3, SD = 3.0), significantly higher than each of the four other strategies, p ≤. 004), and scale-up strategies had the lowest rating (M = 15.6). For feasibility, dissemination strategies had the highest rating (M = 15.3, significantly higher than three of the other strategies, p ≤.002) and scale-up strategies had the lowest rating (M = 14.4). Conclusions: Capacity-building and dissemination strategies may be well-received and readily deployed by policy implementers to support EBPs implementation with revenue from taxes earmarked for behavioral health services. Adapting definitions of implementation strategies for policy-focused topics, and applying established measures of acceptability and feasibility to these strategies, demonstrates utility as an approach to advance research on policy-focused implementation strategies.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. (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)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. (PsycInfo Database Record (c) 2020 APA, all rights reserved)Amplifying consumers as partners in dissemination and implementation science and practice
AbstractCrane, M. E., Purtle, J., & Becker, S. J. (n.d.).Publication year
2023Journal title
Implementation Research and PracticeVolume
4AbstractBackground: This Viewpoint argues for consumers (people with lived experience and their families) to be amplified as key partners in dissemination and implementation science and practice. Method: We contend that consumer opinion and consumer demand can be harnessed to influence practitioners and policymakers. Results: Amplifying consumers’ voices can improve the fit of evidence-based interventions to the intended end user. We offer recommendations of frameworks to engage consumers in the dissemination and implementation of health interventions. We discuss the primary types of evidence consumers may rely upon, including testimonials and lived experience. Conclusions: Our intention is for this Viewpoint to continue the momentum in dissemination and implementation science and practice of engaging consumers in our work.An audience research study to disseminate evidence about comprehensive state mental health parity legislation to US State policymakers : Protocol
AbstractPurtle, J., Lê-Scherban, F., Shattuck, P., Proctor, E. K., & Brownson, R. C. (n.d.).Publication year
2017Journal title
Implementation ScienceVolume
12Issue
1AbstractBackground: A large proportion of the US population has limited access to mental health treatments because insurance providers limit the utilization of mental health services in ways that are more restrictive than for physical health services. Comprehensive state mental health parity legislation (C-SMHPL) is an evidence-based policy intervention that enhances mental health insurance coverage and improves access to care. Implementation of C-SMHPL, however, is limited. State policymakers have the exclusive authority to implement C-SMHPL, but sparse guidance exists to inform the design of strategies to disseminate evidence about C-SMHPL, and more broadly, evidence-based treatments and mental illness, to this audience. The aims of this exploratory audience research study are to (1) characterize US State policymakers' knowledge and attitudes about C-SMHPL and identify individual- and state-level attributes associated with support for C-SMHPL; and (2) integrate quantitative and qualitative data to develop a conceptual framework to disseminate evidence about C-SMHPL, evidence-based treatments, and mental illness to US State policymakers. Methods: The study uses a multi-level (policymaker, state), mixed method (QUAN→qual) approach and is guided by Kingdon's Multiple Streams Framework, adapted to incorporate constructs from Aarons' Model of Evidence-Based Implementation in Public Sectors. A multi-modal survey (telephone, post-mail, e-mail) of 600 US State policymakers (500 legislative, 100 administrative) will be conducted and responses will be linked to state-level variables. The survey will span domains such as support for C-SMHPL, knowledge and attitudes about C-SMHPL and evidence-based treatments, mental illness stigma, and research dissemination preferences. State-level variables will measure factors associated with C-SMHPL implementation, such as economic climate and political environment. Multi-level regression will determine the relative strength of individual- and state-level variables on policymaker support for C-SMHPL. Informed by survey results, semi-structured interviews will be conducted with approximately 50 US State policymakers to elaborate upon quantitative findings. Then, using a systematic process, quantitative and qualitative data will be integrated and a US State policymaker-focused C-SMHPL dissemination framework will be developed. Discussion: Study results will provide the foundation for hypothesis-driven, experimental studies testing the effects of different dissemination strategies on state policymakers' support for, and implementation of, evidence-based mental health policy interventions.An Examination of Factors Affecting State Legislators’ Support for Parity Laws for Different Mental Illnesses
AbstractPilar, M., Purtle, J., Powell, B. J., Mazzucca, S., Eyler, A. A., & Brownson, R. C. (n.d.).Publication year
2022Journal title
Community mental health journalAbstractMental health parity legislation can improve mental health outcomes. U.S. state legislators determine whether state parity laws are adopted, making it critical to assess factors affecting policy support. This study examines the prevalence and demographic correlates of legislators’ support for state parity laws for four mental illnesses— major depression disorder, post-traumatic stress disorder (PTSD), schizophrenia, and anorexia/bulimia. Using a 2017 cross-sectional survey of 475 U.S. legislators, we conducted bivariate analyses and multivariate logistic regression. Support for parity was highest for schizophrenia (57%), PTSD (55%), and major depression (53%) and lowest for anorexia/bulimia (40%). Support for parity was generally higher among females, more liberal legislators, legislators in the Northeast region of the country, and those who had previously sought treatment for mental illness. These findings highlight the importance of better disseminating evidence about anorexia/bulimia and can inform dissemination efforts about mental health parity laws to state legislators.Assessing the spatial heterogeneity in overall health across the United States using spatial regression methods : The contribution of health factors and county-level demographics
AbstractTabb, L. P., McClure, L. A., Quick, H., Purtle, J., & Diez Roux, A. V. (n.d.).Publication year
2018Journal title
Health and PlaceVolume
51Page(s)
68-77Abstract~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.Association of Vaccine-Preventable Disease Incidence with Proposed State Vaccine Exemption Legislation
AbstractGoldstein, N. D., Purtle, J., & Suder, J. S. (n.d.).Publication year
2020Journal title
JAMA PediatricsVolume
174Issue
1Page(s)
88-89Abstract~Audience segmentation to disseminate behavioral health evidence to legislators : An empirical clustering analysis
AbstractPurtle, J., Lê-Scherban, F., Wang, X., Shattuck, P. T., Proctor, E. K., & Brownson, R. C. (n.d.).Publication year
2018Journal title
Implementation ScienceVolume
13Issue
1AbstractBackground: Elected officials (e.g., legislators) are an important but understudied population in dissemination research. Audience segmentation is essential in developing dissemination strategies that are tailored for legislators with different characteristics, but sophisticated audience segmentation analyses have not been conducted with this population. An empirical clustering audience segmentation study was conducted to (1) identify behavioral health (i.e., mental health and substance abuse) audience segments among US state legislators, (2) identify legislator characteristics that are predictive of segment membership, and (3) determine whether segment membership is predictive of support for state behavioral health parity laws. Methods: Latent class analysis (LCA) was used. Data were from a multi-modal (post-mail, e-mail, telephone) survey of state legislators fielded in 2017 (N=475). Nine variables were included in the LCA (e.g., perceptions of behavioral health treatment effectiveness, mental illness stigma). Binary logistic regression tested associations between legislator characteristics (e.g., political party, gender, ideology) and segment membership. Multi-level logistic regression assessed the predictive validity of segment membership on support for parity laws. A name was developed for each segment that captured its most salient features. Results: Three audience segments were identified. Budget-oriented skeptics with stigma (47% of legislators) had the least faith in behavioral health treatment effectiveness, had the most mental illness stigma, and were most influenced by budget impact. This segment was predominantly male, Republican, and ideologically conservative. Action-oriented supporters (24%) were most likely to have introduced a behavioral health bill, most likely to identify behavioral health issues as policy priorities, and most influenced by research evidence. This was the most politically and ideologically diverse segment. Passive supporters (29%) had the greatest faith in treatment effectiveness and the least stigma, but were also least likely to have introduced a behavioral health bill. Segment membership was a stronger predictor of support for parity laws than almost all other legislator characteristics. Conclusions: State legislators are a heterogeneous audience when it comes to behavioral health. There is a need to develop and test behavioral health evidence dissemination strategies that are tailored for legislators in different audience segments. Empirical clustering approaches to audience segmentation are a potentially valuable tool for dissemination science.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."Calculating the toll of trauma" in the headlines : Portrayals of posttraumatic stress disorder in the New York Times (1980-2015)
AbstractPurtle, J., Lynn, K., & Malik, M. (n.d.).Publication year
2016Journal title
American Journal of OrthopsychiatryVolume
86Issue
6Page(s)
632-638AbstractPublic awareness about traumatic stress is needed to address trauma as a public health issue. News media influence public awareness, but little is known about how traumatic-related disorders are portrayed in the news. A content analysis was conducted of all articles that mentioned posttraumatic stress disorder (PTSD) in The New York Times between 1980-2015. There were 871 articles analyzed. The number of PTSD articles published annually increased dramatically, from 2 in 1980 to 70 in 2014. Overall, 50.6% of articles were focused on military populations. Combat was identified as the trauma exposure in 38.0% of articles, while sexual assault was identified in 8.7%. Negative themes such as crimes perpetrated by people with possible PTSD (18.0%) and substance abuse (11.5%) were prominent, substance abuse being more prevalent in articles focused on military populations (16.4% vs. 6.3%, p =Causal Loop Diagrams of Food Systems, Diet, and Obesity : A Scoping Review of Methods, Contextual Factors, and Outcomes
AbstractStankov, I., Useche, A., Lekkas, P., Henson, R. M., Headen, I., Purtle, J., & Langellier, B. A. (n.d.).Publication year
2025Journal title
Obesity ReviewsAbstractThis scoping review characterizes the literature on qualitative systems methodologies that guide interest-holders in developing causal loop diagrams focused on food systems, diet, and obesity. Peer-reviewed research using interest-holder–driven causal loop diagrams to examine food environments, access, purchasing, diet, obesity, and related interventions/policies was included. A comprehensive search of six databases (ProQuest Central, Scopus, Web of Science, Ovid MEDLINE, Embase, and Emcare) yielded 40 eligible studies from a pool of 1370 unique records. We synthesize study characteristics, the intended uses of causal loop diagrams, methodological approaches, evaluation processes, and key findings. While all studies identified individual and behavioral drivers of obesity, studies based in the Global South more frequently featured structural factors such as racism, discrimination, crime, and incarceration. Papers focused on engaging minoritized populations similarly emphasized structural-level themes such as urban agriculture, gentrification, community investment, and capacity building. Our findings highlight the potential of causal loop diagrams to capture the interconnectedness and complexity of food systems, diet, and obesity, along with gaps in the geographical coverage of study efforts, as well as the representation of key populations in current conceptualizations of food systems. This review offers methodological insights for researchers and practitioners seeking to apply causal loop diagrams to understand and address complex public health issues related to food systems, diet, and obesity within their local contexts.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.Changes in Specialty Crisis Services Offered Before and After the Launch of the 988 Suicide and Crisis Lifeline
AbstractCantor, J., Schuler, M. S., Kerber, R., Purtle, J., & McBain, R. K. (n.d.).Publication year
2025Journal title
JAMA PsychiatryAbstractImportance: The launch of the 988 Suicide and Crisis Lifeline (988) in July 2022 aimed to enhance access to crisis mental health services by replacing the National Suicide Prevention Lifeline with a more memorable number and expanding the Lifeline scope beyond suicide. However, 988's success relies on the availability of community crisis services. Objective: To examine whether the launch of 988 was associated with the availability of crisis services. Design, Setting, and Participants: This cohort study characterized trends in crisis services offered by US mental health treatment facilities (MHTFs) from November 1, 2021, through June 30, 2023. Longitudinal data were from the Mental Health and Addiction Treatment Tracking Repository, which contains daily instances from the Substance Abuse and Mental Health Services Administration's Behavioral Health Treatment Locator. The analysis includes licensed MHTFs that completed the National Substance Use and Mental Health Services Survey. Proportions of facilities offering 4 specific crisis services were calculated nationally and at the state level. Mixed-effects logistic regression was used to assess changes in availability of each crisis service after the launch of 988, controlling for MHTF characteristics. Exposure: Launch of 988 in July 2022. Main Outcomes and Measures: Outcomes were the availability of mobile crisis response services, psychiatric emergency walk-in services, suicide prevention services, or peer support services. Results: Across 15623 MHTFs (184769 observations; 79268 before and 105501 after the 988 launch), the largest changes were observed for availability of peer support services, which increased from 39% (n = 31170) before to 42% (n = 44630) after the 988 launch (PComparing organization-focused and state-focused financing strategies on provider-level reach of a youth substance use treatment model : a mixed-method study
AbstractDopp, A. R., Hunter, S. B., Godley, M. D., González, I., Bongard, M., Han, B., Cantor, J., Hindmarch, G., Lindquist, K., Wright, B., Schlang, D., Passetti, L. L., Wright, K. L., Kilmer, B., Aarons, G. A., & Purtle, J. (n.d.).Publication year
2023Journal title
Implementation ScienceVolume
18Issue
1AbstractBackground: Financial barriers in substance use disorder service systems have limited the widespread adoption—i.e., provider-level reach—of evidence-based practices (EBPs) for youth substance use disorders. Reach is essential to maximizing the population-level impact of EBPs. One promising, but rarely studied, type of implementation strategy for overcoming barriers to EBP reach is financing strategies, which direct financial resources in various ways to support implementation. We evaluated financing strategies for the Adolescent Community Reinforcement Approach (A-CRA) EBP by comparing two US federal grant mechanisms, organization-focused and state-focused grants, on organization-level A-CRA reach outcomes. Method: A-CRA implementation took place through organization-focused and state-focused grantee cohorts from 2006 to 2021. We used a quasi-experimental, mixed-method design to compare reach between treatment organizations funded by organization-focused versus state-focused grants (164 organizations, 35 states). Using administrative training records, we calculated reach as the per-organization proportion of trained individuals who received certification in A-CRA clinical delivery and/or supervision by the end of grant funding. We tested differences in certification rate by grant type using multivariable linear regression models that controlled for key covariates (e.g., time), and tested threats to internal validity from our quasi-experimental design through a series of sensitivity analyses. We also drew on interviews and surveys collected from the treatment organizations and (when relevant) interviews with state administrators to identify factors that influenced reach. Results: The overall certification rates were 27 percentage points lower in state-focused versus organization-focused grants (p =.01). Sensitivity analyses suggested these findings were not explained by confounding temporal trends nor by organizational or state characteristics. We did not identify significant quantitative moderators of reach outcomes, but qualitative findings suggested certain facilitating factors were more influential for organization-focused grants (e.g., strategic planning) and certain barrier factors were more impactful for state-focused grants (e.g., states finding it difficult to execute grant activities). Discussion: As the first published comparison of EBP reach outcomes between financing strategies, our findings can help guide state and federal policy related to financing strategies for implementing EBPs that reduce youth substance use. Future work should explore contextual conditions under which different financing strategies can support the widespread implementation of EBPs for substance use disorder treatment.Comparing two federal financing strategies on penetration and sustainment of the adolescent community reinforcement approach for substance use disorders : protocol for a mixed-method study
AbstractDopp, A. R., Hunter, S. B., Godley, M. D., Pham, C., Han, B., Smart, R., Cantor, J., Kilmer, B., Hindmarch, G., González, I., Passetti, L. L., Wright, K. L., Aarons, G. A., & Purtle, J. (n.d.).Publication year
2022Journal title
Implementation science communicationsVolume
3Issue
1AbstractBackground: Sustained, widespread availability of evidence-based practices (EBPs) is essential to address the public health and societal impacts of adolescent substance use disorders (SUD). There remains a particularly significant need to identify effective financing strategies, which secure and direct financial resources to support the costs associated with EBP implementation and sustainment. This protocol describes a new project comparing two types of U.S. federal grant mechanisms (i.e., a type of financing strategy), which supported the implementation of the Adolescent Community Reinforcement Approach (A-CRA) EBP for SUD, through either organization-focused or state-focused granting of funds. The Exploration-Preparation-Implementation-Sustainment (EPIS) framework will guide our study aims, hypotheses, and selection of measures. Method: We will employ a longitudinal, mixed-method (i.e., web surveys, semi-structured interviews, document review, focus groups, administrative data), quasi-experimental design to compare the grant types’ outcomes and examine theoretically informed mediators and moderators. Aim 1 will examine the proportion of eligible clinicians certified in A-CRA with adequate fidelity levels (i.e., penetration outcomes) at the end of grant funding. Aim 2 will examine the sustainment of A-CRA up to 5 years post-funding, using a 10-element composite measure of treatment delivery and supervision activities. We will integrate the new data collected from state-focused grant recipients (~85 organizations in 19 states) with previously collected data from organization-focused grant recipients (Hunter et al., Implement Sci 9:104, 2014) (82 organizations in 26 states) for analysis. We will also use sensitivity analyses to characterize the effects of observed and unobserved secular trends in our quasi-experimental design. Finally, aim 3 will use comparative case study methods (integrating diverse quantitative and qualitative measures) to identify and disseminate policy implications about the roles of state- and organization-focused federal grants in efforts to promote adolescent SUD EBP implementation and sustainment. Discussion: The proposed research will have direct, practical implications for behavioral health administrators, policymakers, implementation experts, and the public. It will offer new knowledge that can directly inform financing strategies to support large-scale, sustained EBP delivery in behavioral health—while advancing implementation science through the use of novel methods to study financing strategies and sustainment.