EP26 The "Doing It NYC" App with Dr. Marybec Griffin

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I AM GPH EP26 The "Doing It NYC" App with Dr. Marybec Griffin

EP26 The "Doing It NYC" App with Dr. Marybec Griffin

Deborah Onakomaiya: Hey, guys and welcome to another episode of I AM GPH. I'm your host, Deborah Onakomaiya. On today's episode, we have Marybec Griffin, who's one of the first doctor graduates of the College of Global Public Health. Prior to beginning her doctoral studies, Marybec worked with the New York City Department of Health and Mental Hygiene to design Ryan White funded programs for people living with HIV/AIDS and conduct a citywide assessment of available sexual and reproductive health services for adolescents. Her research is on the subject of LGBTQ health care access, specifically decisions around coordinating primary and sexual health care services for these populations. Let's go to our conversation with her. Thank you so much, Marybec, for coming on our show today.

Marybec Griffin: Thank you for having me.

Deborah Onakomaiya: Awesome. You're one of the first PhD graduates from GPH. How does it feel to be done?

Marybec Griffin: I think it's just now starting to dawn on me that I'm finished. I defended my dissertation in February. I've been in this kind of not finished, but sort of finished place for a while, but after the graduation ceremony last week, it's starting to feel real. More than anything, I just feel like I have a lot of free time, which is nice. I can sleep without feeling guilty about sleeping, which is also a really good feeling. It feels great to be finished officially with school for forever, pending a law degree. Not going to do. It's weird to just not be a student anymore. It's been something that's been part of my identity for so long through so many degrees and then an NYU student for six years, four for my PhD and two for my MPH.

Deborah Onakomaiya: Wow.

Marybec Griffin: Yeah. It's like a shift of identity. It's also something interesting to kind of wrap my head around.

Deborah Onakomaiya: Wow.

Marybec Griffin: Yeah.

Deborah Onakomaiya: Congratulations.

Marybec Griffin: Thank you.

Deborah Onakomaiya: Wow. What was the PhD journey like for you? Was it different from what you expected coming into the program?

Marybec Griffin: The thing about doing a PhD is it's sort of like what you're familiar with, but it's also then not what you're familiar with. It looks like something you know. It looks like a good friend and you're like, oh yeah, I know this friend, but then it's a little bit different. Classes are a bit different. They're much smaller, where sometimes in your MPH you can maybe scoot through without doing all of the readings and you're in a class that has maybe six people. If you don't do the readings, it's really, really painfully obvious. Everything's just like at a different intensity level and there's a lot more expectation that if you don't understand, you're going to kind of figure it out on your own. That's like your first two years of coursework and then when you get through that and you pass your comp exams. The thing that I wasn't really expecting, but I actually really enjoyed was that it's all on you. Writing is all on your timeframe. If you want to take two years and do it like I did, you can do that. If your research is really different and you're doing like ethnographic stuff where you're doing interviews in the field, I can take a lot longer. It's like it's a solitary journey, but you're not by yourself. Then the other thing that I wasn't anticipating was having my mentors read things. It's like a lot of times I'd be like, I'm going to do X and Y and Z within the next couple of weeks, and then they would take longer to read my papers and get back to me. There's a lot of kind of stuff that's out of your hands completely. I just wasn't expecting that. It's not bad or good. I just wasn't expecting.

Deborah Onakomaiya: Wow, that's very exciting. For students who might be interested in a PhD, especially in public health, is there anything they should know going into the program?

Marybec Griffin: Absolutely. Not just specifically public health, but a PhD program in general. This is different than a DrPH, but PhD programs, because they tend to be funded, fully funded, meaning you get a stipend and health insurance and tuition remission, it's not just about how smart you are. You might have great transcripts and great grades in your master's, your undergrad, and you also might have fantastic GRE scores, but it's really like a bunch of different stars have to align perfectly. You have to have the grades, but then you also have to find a mentor or somebody that's working in your area that thinks about whatever it is. Mine was HIV. Has to think about like HIV prevention in kind of a similar way. It helps if there's a preexisting relationship there, or you've at least emailed the person who you think you might want to work with to be your mentors so they kind of know who you are. Then that person has to want to work with you and then there has to be funding for you. When I applied, I had a good mentor match in Perry Halkitis. He knew me, I knew him, so we knew that we could work together. I had the grades and scores to get in, but there was a big question about whether or not his NIH funding was going to come through and that was the funding that I was going to be on. If it hadn't come through, it would be like I'm smart enough, someone wants to work with me, I want to work with them, but there isn't the money to fund me. I would've had to wait a year and then reapply and then hope that all of the previous two stars had aligned again. I have friends that have taken... They had to apply three years in a row just because the funding wasn't there. It's like it's in a lot of ways... I don't want to say the word rejection, but like if a PhD doesn't happen the first time out of the gate in some ways, the rejection, I'm going to use that and I don't really like that word, is impersonal because it's about funding. Then in other ways it can be very personal if the mentor doesn't want to work with you. For people who are thinking about doing a PhD, those are the questions to ask. Is the PhD program funded? Does the mentor I want to work with have funding for me or coming up in the next few years? Then really do your homework and your research and reach out to people that you think you might want to work with because establishing that relationship and seeing if you like that person is key. I finished in four years because Perry Halkitis and I work really well together and he was really passionate about getting me in and then getting me out really quickly. If we didn't have that kind of relationship, I could have been here for six years, seven years, eight years, right? There are times that people and their mentor don't match and they don't finish or their priorities shift. It's a lot of like relationship building. I guess going back to the previous question, I also wasn't really expecting that.

Deborah Onakomaiya: Wow. I mean, even myself, I do want to pursue a PhD because I just finished my MPH. What advice would you have? You know for someone like me, fresh MPH student?

Marybec Griffin: Really, really take your time and think about what question it is that you have that you want to answer. Because if you don't like your topic, you're going to be thinking about this exclusively for a minimum of four years. If you don't love that topic, you're going to hate your day to day life. You're going to hate waking up and you're going to hate having to research or read about whatever your topic is. For me in the days where I would get frustrated or I was waiting for people to get back to me, or I just didn't want to write or read anything, I'm really passionate about health care access for people, specifically LGBTQ populations around sexual health. Because I was so interested and so passionate in it, it helped carry me through the days where it's like, I just don't want to do this anymore, or I just don't want to do this today. Then the other thing is, this is advice that somebody had given me and at the time I was like, oh, that's really like snotty and classist, but it isn't. Think about if the work that you want to do if you really, really need a PhD. Not everybody does. It doesn't mean you're not smart enough or bright enough where you couldn't do it, but ask if it's worth delaying a career to do a PhD, right? If you don't want to be involved in research or you don't want to be an academia or if the organizations that you want to work for don't really require PhDs or they're not something that you see people in higher level positions having, it might be that you don't need one. Yeah, because it's a degree that like again you sacrifice relationships and friendships. You have to tell your friends like, "I can't hang out," or you have to tell your partner, "No, I can't go on this like vacation with you because I have to write." You pay for it with lack of sleep. What is that where you type too much? Carpal tunnel. Things like that. It's a degree you have to really, really want to do and really, really need to do.

Deborah Onakomaiya: Wow. I think that's really golden advice.

Marybec Griffin: Thank you.

Deborah Onakomaiya: Shifting gears a little, doing your PhD, you were the lead creative and content designer of a new app. Can you tell us a little bit about that app?

Marybec Griffin: Sure. The app is called Doing It NYC. It's not a name I picked out, but the Department of Health rejected all hundred other names that I had brainstormed. But for better or worse, that's what it is. It replaces an app I had worked on previously called The Teens In New York City app. What it does is it helps connect people to sexual and reproductive health services here in the city. With the previous app, it was obviously only adolescent focused and it was very like heteronormative and it was very much for like pregnancy prevention for people who are in heterosexual relationships. I was like, okay, that's good, but we're missing out on the opportunity to serve a lot of people here in New York City. The new app is for people regardless of reproductive age, so anywhere from 12 to, I don't know, up in the people that are having babies up until their fifties, right? It provides information for people who are LGBTQ identified, who are having like oral, anal, vaginal sex, includes alternative sexual activities like oral, anal sex, things like that. Just providing more comprehensive information so that when you are looking through the app, whatever it is, whatever kind of sexual behaviors you're engaging in, really trying to normalize that and be like, hey, you know, if that's what you're into, cool. Here's a way that you can be safe or here's questions you should be asking your doctor about this. Then it also provides birth control, STI and HIV prevention information across the gender identity and sexual orientation spectrum. Things like for people who are trans identified that you can use rubber gloves and cut off the forefinger, ring finger, middle finger and pinky finger and just use the thumb as a condom if you have a smaller size penis or whatever term you might be using for that bit of genitalia. Really trying to be really inclusive and making sure that we're meeting all of the needs of people that are having sex here in New York or not having sex and also including information like fertility treatments and things like that for trans identified folks or for people who are cisgender and just a little bit older and maybe want to get pregnant, information on breastfeeding, breastfeeding and contraception, registering for insurance. If you need it, the app probably has it. I don't want to say definitely has it, but we've probably at least thought about it.

Deborah Onakomaiya: How did you get involved with this specifically? How did it all start? What's the story?

Marybec Griffin: The story is that when I graduated from NYU with my MPH, I decided I wanted to move into kind of mobile technology and things like that. I've been working in the Bureau of HIV before and I decided that I really wanted to give it a try working in reproductive healthcare. It was primarily at the time only cisgender women focused. I really saw the opportunity to take an existing product once I finished Teens In New York City app and launching that and really make it just more comprehensive. It was just like this idea that like we can queer up reproductive health. It doesn't have to be heteronormative. It doesn't have to be cisgender and really just trying to make sure that we're presenting information in a comprehensive way. My entire life's goal is to get people to talk to their doctors and to one another about sex in a real way, like in an honest way, in a way that's completely free of judgment. So often I think when we see information for LGBTQ identified folks, it's presented as separate from sexual health care that cisgender heterosexual people get like in middle school, elementary school, high school. I think just providing the information side by side helps normalize the conversation, helps people feel more comfortable. I mean like, oh, these things that I'm interested in are normal and I should be talking about them and it's totally okay. Then even if you were to operate just within a cisgender heterosexual couple, we often find that doctors aren't asking the right questions of their patients. If you walk in and you're a woman, cisgender woman, and you're married, they're like, "Oh, well she only has one partner," and they're not asking if you have more than one partner, or they're assuming that you're only concerned about pregnancy prevention because you're only having vaginal sex, but maybe you're having oral sex and maybe you're having anal sex. There are different tests that you should be doing for STI in different locations. You can get gonorrhea of the throat and gonorrhea and your anus. It's one of those things. The type of behavior you're engaging in changes the way you're screened and people just don't know it. Providing all this information in one place, if you have a question, we hopefully have an answer for you. If you're living in New York City, it provides information on the health insurance exchanges on enrolling in Medicaid. This thing called The Family Planning Benefit Program, which people don't know about, which is a Medicaid carve out here in New York State that works on presumptive eligibility. All that it means to say is that they assume that you're eligible for the program and then they'll go back and retroactively check. But you can walk in, say I need any kind of family planning services and they'll provide them to you for free. It's paid for under Medicaid funding. If you don't qualify, it's okay. The doctor still gets paid for that initial visit and then it's just flagged in your chart for the next time you go in that that program isn't available for you. It's just something that people don't know about. It's a way to get free or low cost services. Another part of the app is we also have a clinic locator for providers that have met our best practices that we've developed. It also includes information about cost, so if it's like free or low cost. Low cost meaning less than $15 for a copay. Really trying to get to that equity of access to not just where are services available, but if you have income restrictions and by income restrictions I mean anything like you can't afford regular copays or you don't want your doctor to know, ways that you can get free and confidential services or confidential and low cost services as well.

Deborah Onakomaiya: How about for people that don't have insurance as well? How can that app help?

Marybec Griffin: Yeah. We have these designations and they're Gold Star Clinics and those are clinics that offer services regardless of immigration status, regardless of your ability to pay, which means you can walk in, you can have no documentation, you can be an undocumented individual living in the United States and you can just say, "You know what? I need an HIV test. You know what? I need a pregnancy test. I want to get on the pill or have an IUD inserted." You can walk in and they will provide services completely for free. They won't check your immigration status. They won't ask you for ID, and they won't ask you for any kind of insurance. Again, really making sure that if you just walked in off the street you could get services.

Deborah Onakomaiya: Wow. Is this like in the Apple Store? Is this available for download? Our audience is probably like taking notes right now.

Marybec Griffin: They're like, “I want to download it right now." Yes. Right now it is only available for iPhone devices. We are working on launching the Android device, but this has been a project that is four years in development, which is an incredibly long time. We just wanted to make sure that we were able to get the Apple version out first or any version. We just started with Apple because I don't know much about technology, but my developer told me that it's much easier to develop apps for iPhones and then translate them into Android devices.

Deborah Onakomaiya: Sorry, Android users.

Marybec Griffin: It's coming. I promise. I just don't know when, but hopefully in the next three to six months. Yeah, but you can download it. It's in the iTunes Store. We're going to be officially launching it on June 13th hopefully with a bunch of kickoff events, but tell everybody that you know.

Deborah Onakomaiya: Is this like free? Is this through the NYC Health Department?

Marybec Griffin: It's sponsored by the NYC Health Department. It's a completely free app. The Health Department never charges for any of their apps or any of their information because we are public servants, so we are here to serve the public. Yeah. It's available for download. Completely free. If you search Doing It NYC, it should pop up. The little app icon is different shades of blue that fade from like a dark blue into like a teal. Yeah.

Deborah Onakomaiya: Doing It NYC.

Marybec Griffin: Yup.

Deborah Onakomaiya: Download it today.

Marybec Griffin: I promise it's not a hookup app even though that's what the name sounds like. People are like, "Wait, are you going to help me find people to do it with?" I was like, no, we're just going to help you do it.

Deborah Onakomaiya: Safely.

Marybec Griffin: Safely or safer.

Deborah Onakomaiya: Yeah. In the process of developing this app and all that, were there any NYU resources you found helpful in terms of tools or people or schools?

Marybec Griffin: The app is developed in partnership with Planned Parenthood of NYC. They had come up with an app and actually the method finder feature that I haven't talked about yet, which is to help people find birth control, which birth control method might be right for them. Planned Parenthood of NYC had this algorithm that they had developed and they had wanted to do something and they had wanted to build an app. They lost all of their funding. We're reaching out to them. We're talking preliminarily with them and what they were doing about and they're like, "You can just have our algorithm." It turns out that the algorithm was developed by an NYU professor here in the School of Social Work, Jim Jaccard. He helped tweak the algorithm a little bit, kind of gave us all of the information on decision making science and why they designed it this way. If you use the method finder, it asks you a bunch of different questions, like how old you are, if you're a smoker, how you feel about having something inserted in your body, how you feel about hormones, how you feel about touching your own vagina, things like that. Real questions that people have and they may or may not feel comfortable depending on who they are or their cultural background, to help really hone down the types of methods that are recommended to you to the ones that are the most appropriate. Then it'll also ask you what you know about certain methods to kind of tease out any preexisting notions that you may or may not have and then how your family or a romantic partner might feel about you using specific methods. Then once you've gone through all of that, it then recommends three different methods that might be right for you. You can go and talk to your doctor about it. Dr. Jaccard was saying it's based on decision making science and like how your family feels about certain methods that bring inherent biases, how your partners feel about certain methods also bring inherent biases. It's really trying to tease those things out. You're making recommendations that the user is more likely to be willing to adopt and to be happy with. Then also it acts as a clinician extender. That way if I go in and I was to see you and you are my doctor, I want you to be like, so I want to get on a contraceptive method, and you'd be like, okay, well, a lot of my patients like the pill. It's more designed for me to go in and say, I really want to get on a contraceptive method. I took this little quiz from the Department of Health and they recommended that the IUD might be good for me. The depo shot might be good for me and condoms might be good for me. What can you tell me about those methods? What are the side effects? It was really just kind of priming the patient to take ownership and have agency over their own health care and to ask the right questions and again, just get people thinking about the types of conversations they should be having with their doctor. Then the other NYU resource, which I found really, really helpful, was all of the interns that I have had. I've mentioned that this app took four years to develop and I've had so many NYU students working with me over the course of this, at least three or four. There was Mariah. There was Rachel McMillan. There was Rebecca Eleven. There was Eve Woll. Yeah, there's at least four NYU students who did their capstone or culminating experience or whatever it's called now. Now I can't remember. When I was here, it was a capstone. With us at the Department of Health, like working on helping us get these clinics assessed, get the app launched, helping with the design, helping doing user testing. Many NYU students have also tested the app for us and given us feedback on the look and the feel and the type of information contained in it. Yeah, all of our students have been Guinea pigs and then also helping lead the way with some of the development work.

Deborah Onakomaiya: Wow. Go NYU. That's really amazing.

Marybec Griffin: It takes a village.

Deborah Onakomaiya: I think after this interview, I'm just going to go download it.

Marybec Griffin: Oh, please do.

Deborah Onakomaiya: All right, so now that we're winding down a little bit, what's next for you? You've gotten your MPH. You have your PhD. What's next, Dr. Marybec?

Marybec Griffin: It's still weird hearing people call me doctor, but thank you very much. I am actually currently about to accept I think a position to be a tenure track faculty member at a school in New Jersey. I'm not going to say anymore because I don't want to jinx it and it's not official. I've also had a couple of interviews at the Health Department to do some really cool work with school-based health centers and reproductive health in school-based health centers, which could be really cool. I've interviewed for a few academic positions all over the country and turned a couple down, but I think this thing coming up in New Jersey is going to be the thing that I take next and then continuing my research. I really want to start asking patients like what types of conversations and questions they wish their doctors were asking them and really try to maybe get some more grant funding to continue that research, or also maybe looking at the difference in health care systems between the United States, which has a weird and fragmented system, and then a place that offers more universal coverage like in Europe and see if that affects the way people access services. If you're not worried about having a pre-existing condition as a diagnosis and a possible reason to deny you insurance coverage in the future, are you more likely to go? Are you more likely to be honest with your doctor? Things like that. Also, I really, really love teaching. I think I'm going to be still here in the fall doing some adjunct work at the undergrad classes. Yeah, I love it. I love it. I love it. I love it. I love public health and I love inspiring the leaders of tomorrow because one day they're going to be my boss.

Deborah Onakomaiya: All right, Professor Marybec. Just to touch on this a little, why you're so passionate about the work you do? Where does this motivation come from?

Marybec Griffin: I think it's because my parents never restricted TV for us as a kid. Well, I'm not very old, but I'm 37, so I'm getting up there. I was a child of the '80s and I watched the HIV epidemic unfold in the news. Like I said, my parents never restricted our access to the news. I remember being like eight or nine in 1989 when all of this is happening and watching people dying on the news every day just because they were gay men, right? The beginning of the epidemic was primarily concentrated among gay men and just watching people being denied access to things because of homophobia and sexism and heterosexism and things like that. Then also at the sameish time there was the Anita Hill trial, right? Very much these ideas of racism and sexism and what it means to be a woman and things like that. These ideas of denying people services based on their identities was something that just stuck with me and that we don't have equity for all people in our society. It's one of those things that's just always stuck with me to fight for social justice, racial equity, gender equity, sexual orientation equity, things like that. Then I don't know why specifically sexual health. I think it's one of those things like... Well, I guess I had a hard time talking to my mom about it. I never really talked to my dad about it. I remember my sister and I would be like, "Mom, we want to get on birth control." She'll be like, "No, no, no, that's not for you. You don't need that." It was like, well, but if we're asking, we're curious and that's not the type of conversation that we should be having? Really just wanting to like create a safe space for people and get real information out there because my mom provided like the very basic kind of information to us, I would get like really crazy off the wall advice from my friends like well, you know, you could only get pregnant if you have sex with the same person two times in a row within a 24 hour period, which is of course completely false. But at like 10 or 11, you're like, oh yeah, okay, friend that's also 10 or 11. That sounds accurate. Just really want to get information out there and get people talking about it. Then with the current political climate and like the global gag rule and this proposed domestic gag rule and changes in abortion coverage, like the six week ban in Iowa that just passed like two weeks ago, there's this real denial of basic healthcare for women, for LGBTQ identified individuals. It's like real and we have to fight to protect what we have. I think that we just kind of take for granted that we have the Roe v. Wade decision in 1973 and like we're just going to be fine and it's always going to be legal and we're always going to have access to this, but we're not. It's one of those things like to have health care services, you have to be willing to fight for it, right? We live in a democracy, which means that we have to participate. People just often don't think that policies that are made in Washington actually affect their daily lives and they really, really do.

Deborah Onakomaiya: Final question, Dr. Marybec, I'm going to call you that for the rest of the show, what are your ultimate public health goals?

Marybec Griffin: To create a more equitable society for people regardless of gender identity, sexual orientation, things like that, and again, just to get people to be talking to their doctors about the type of sex they're having, the sexual behaviors that they're engaging in, the number of partners they have, and just getting people to feel comfortable and realizing that if you're going to a doctor who doesn't want to hear that you have multiple partners of different gender identities, you don't have to go to that doctor. You can find a doctor that's going to meet your needs, right? Just changing the conversation and making people feel comfortable and that what they're doing and the behaviors that they're engaging in are normal. There are people out there that will help them be safe and will listen to them because there's nothing more important than your health. Nothing. Health is I think the fundamental human right and we have to get people talking about it.

Deborah Onakomaiya: Health is a human right.

Marybec Griffin: It is, yeah. The number one thing that you need for development in society and development of yourself and it's just so, so critical and it's not a given in America and it should be.

Deborah Onakomaiya: Thank you so much, Marybec, for coming on our show.

Marybec Griffin: Thank you for having me.