Michael P Anastario

CUNY Graduate Center, New York City, New York, United States

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Publications (25)51.87 Total impact

  • Elizabeth Rink, Michael P Anastario, Kris FourStar
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    ABSTRACT: This study investigated commitment, sexual risk taking behavior and condom use among heterosexual men. The sample was 120 American Indian men ages 18-24 on the Fort Peck Reservation. Measures included sexual risk taking behaviors, attitude towards the relationship, discordance in perception of attitudes toward the relationship, and condom use. Inconsistent condom users comprised 57 % of the sample. Men with more than one sexual partner as well as men who reported inconsistent condom use reported less favorable attitudes toward their relationship. Discordant attitudes were observed in men who reported that their partner was more committed to the relationship then they were. This influenced having multiple sex partners. Inconsistent condom use decreased as respondents perceived an increasing level of partner's attachment to the relationship in comparison to themselves. Further examination of intimate partner relationship characteristics and how these dynamics influence sexual and reproductive health among American Indians is needed.
    Journal of immigrant and minority health / Center for Minority Public Health. 06/2014;
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    ABSTRACT: Worldwide, military personnel have been recognized as a population at elevated risk for sexually transmitted infections (STIs) and HIV; however, it is not well understood how the military occupation itself is implicated in the production of sexual risk behavior. Using qualitative and quantitative data collected from the Belize Defense Force (BDF), we employed a grounded theoretical framework and the Bourdieusian concept of the field and habitus to clarify how the military occupation is implicated in structuring aspects of sexual risk behaviors among personnel. We focus results on in-depth qualitative interviews conducted with 15 male-identified BDF personnel. We identify and describe how two field elements, namely operational tempo and ongoing exposure to occupational hazards, are occupationally specific field elements implicated in the production of sexual risk behavior through the mediating matrix of the military class habitus. Our findings demonstrate a conceptual clarity regarding the institutional field and habitus through which military personnel make sense of and act on the risk of bodily harm with regard to their own sexual behaviors. We conclude by outlining our theoretical concept so that it can be directly applied in public health efforts in order to leverage military occupational field elements for the purpose of HIV and STI prevention.
    Culture Medicine and Psychiatry 10/2013; · 1.29 Impact Factor
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    ABSTRACT: This study compares rates of completion of client intake forms (CIFs) collected via three interview modes: audio computer-assisted self-interview (ACASI), face-to-face interview (FFI), and self-administered paper-based interview (SAPI). A total of 303 clients served through the Avon Breast Health Outreach Program (BHOP) were sampled from three U.S. sites. Clients were randomly assigned to complete a standard CIF via one of the three interview modes. Logistic regression analyses demonstrated that clients were significantly more likely to complete the entire CIF via ACASI than either FFI or SAPI. The greatest observed differences were between ACASI and SAPI; clients were almost six times more likely to complete the CIF via ACASI as opposed to SAPI (AOR = 5.8, p < .001). We recommend that where feasible, ACASI be utilized as an effective means of collecting client-level data in healthcare settings. Adoption of ACASI in health centers may translate into higher completion rates of intake forms by clients, as well as reduced burden on clinic staff to enter data and review intake forms for completion.
    Journal for Healthcare Quality 08/2013;
  • M Anastario, H Chun, E Soto, S Montano
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    ABSTRACT: Modalities of questionnaire administration may affect data quality, particularly when conducting Biological and Behavioral Surveillance Surveys (BBSS) of uniformed personnel. We aimed to examine differences in administration, reporting and data quality across several common modalities of administration for BBSS endeavors. Prior to a large-scale BBSS endeavor with the uniformed services of Peru, we pilot tested three modes of questionnaire administration among personnel engaged in internal combat: face-to-face interview (FFI), self-administered paper-based interview (SAPI), and audio computer-assisted self-interview (ACASI). Individuals who took the survey using ACASI were less likely to have missing data on measures of sexual risk and alcohol abuse and were more likely to report sexual risk behaviours and symptoms of alcohol abuse; however, more individuals took the survey using SAPI given inadequate time to devote to sitting through an entire FFI or ACASI. Sexually transmitted infections did not vary significantly across modes of questionnaire administration. While more logistically complicated for BBSS efforts in resource-constrained settings, we recommend the use of ACASI in collecting BBSS data from uniformed personnel if conditions are permissible.
    International Journal of STD & AIDS 07/2013; 24(7):573-7. · 1.00 Impact Factor
  • Michael P Anastario, Kris Fourstar, Elizabeth Rink
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    ABSTRACT: Native Americans in the United States are not typically regarded as a most at-risk population for HIV or other sexually transmitted infections (STIs), despite emerging evidence which suggests otherwise. As a result, Native Americans lack access to key prevention services and programs. In planning prevention programs for this unique population, however, it is important to take into account the cultural factors that may be implicated in health risk behaviors. Historical Loss is a type of historical trauma that has been reported in Native Americans, and which may be related to health behaviors. We examined whether Historical Loss was associated with sexual risk behaviors in a sample of 120 American Indian men living in Fort Peck Reservation in northeastern Montana who completed questions regarding Historical Loss and sexual risk behaviors. Symptoms of Historical Loss that reflected Anxiety/Depression and Anger/Avoidance were associated with an increased likelihood of individuals' having sex with multiple concurrent partners. Health interventions that aim to address HIV/STI prevention should take symptoms of Historical Loss into account, as Historical Loss could be a potential factor that will mitigate HIV, STI, and pregnancy prevention efforts in this population.
    Journal of Community Health 04/2013; · 1.28 Impact Factor
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    ABSTRACT: Abstract For HIV-positive individuals living in socially vulnerable circumstances, the complexities of accessing and navigating healthcare system can be overwhelming. Peer-driven interventions (PDIs) are increasingly being recognized as effective ways of addressing barriers to HIV care in the USA. The present study is a qualitative investigation of barriers, challenges, and facilitators to implementation of a peer integration program at three health centers in the USA. Findings reveal that health center staff and HIV-positive patients support the integration of HIV-positive peers on multidisciplinary healthcare teams. However, challenges related to peer-clinician communication and the risk of emotional burnout for peers may hinder program efficacy and sustainability. Practical implications and suggestions for improving the peer integration program in light of these findings are also discussed.
    AIDS Care 01/2013; · 1.60 Impact Factor
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    ABSTRACT: Worldwide, military personnel have been recognized as a population at elevated risk for sexually transmitted infections and HIV. However, few evidence based behavioral interventions for the prevention of HIV and STIs have been rigorously evaluated in military personnel. We adapted the Popular Opinion Leaders (POL) intervention and piloted the adapted program with the Barbados Defence Force at one military base in Barbados. Popular Opinion Leaders were selected and trained to focus conversations on condom use. Behavioral questionnaires were administered using audio computer-assisted self interview at baseline (n = 256) and 6-month follow-up (n = 303). Mid-point focus groups were conducted with a sample of 15 POLs at a 3 month mid-point assessment. Quantitative data showed moderate increases in condom use at 6-months, and significant uptake of condom use during oral-genital contact in female personnel. A subgroup analysis suggests that this change was partially mediated by post-intervention changes in injunctive norms surrounding condom use in women. Focus groups revealed that POLs were heavily focusing on condom demonstrations, condom provision within social networks, speaking with coworkers about pleasure associated with condom use, and that the most common venues for conversations included those where alcohol was consumed. During the intervention, POLs dispersed from the intervention site as a result of normal personnel movement across bases, resulting in our having to use a pre and post intervention design across the population. It is likely that larger effect sizes would be observed in efforts that account for the natural dispersion of personnel across bases.
    Journal of Community Health 07/2012; · 1.28 Impact Factor
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    ABSTRACT: Condom use during last sexual contact is a survey measure that may be used to inform monitoring and evaluation indicators of recent condom use in populations at risk for HIV infection and other sexually transmitted infections, such as the uniformed services. The authors tested for differences in condom use measures that were fielded within separate Biological and Behavioral Surveillance Surveys conducted in the armed forces of two separate nations: the Dominican Republic and Belize. Both surveys included measures of condom use during last sexual contact with specified partners and both surveys included the Risk Behavior Assessment (RBA), which measures specific sexual acts and condom use frequency during a specified time period. In both samples, more than 40% of respondents who reported condom use during last sexual contact with a regular partner also reported engaging in unprotected sex when screened with the RBA. Furthermore, more than 60% of respondents who reported condom use during last sexual encounter with a commercial sex worker also reported engaging in unprotected sex when screened with the RBA. The results carry implications for monitoring and evaluation indicators of large-scale HIV prevention programs. The authors recommend that, when feasible, more in-depth instruments such as the RBA be considered to measure recent condom use in populations of uniformed services personnel.
    American journal of men's health 11/2011; 6(2):132-5. · 1.15 Impact Factor
  • Helen Chun, Maria I Tavarez, Grace E Dann, Michael P Anastario
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    ABSTRACT: To determine whether self-reported sexual behavior and mental health varied by interviewer gender in a population of male military personnel. Eight male and six female data collectors verbally administered structured interviews to 474 male Dominican military personnel stationed at border crossing zones in the Dominican Republic. Measurements included sexual behaviors and mental health. Respondents were less likely to report oral and vaginal sex to male interviewers, and were more likely to report sexual coercion and alcohol abuse to male interviewers. Respondents were more likely to report depression and post-traumatic stress disorder to female interviewers. Interviewer gender influenced the prevalence of sexual behaviors and mental health, which carries implications for future research in military personnel.
    International Journal of Public Health 04/2011; 56(2):225-9. · 1.99 Impact Factor
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    ABSTRACT: This study is the first Biological and Behavioral Surveillance Survey to be conducted among personnel in the Belize Defense Force. The purpose of the study was to understand the prevalence of HIV infection and risk behaviours, and to identify key correlates of sexual risk behaviours. A representative sample of personnel underwent serological testing and an Audio Computer-Assisted Self Interview. Of those sampled, 351 completed a blood test and 334 completed a behavioural interview. The prevalence of HIV was 1.14%. Twelve percent had ever reported being diagnosed with a sexually transmitted infection (STI) or screened positive for HIV infection. The odds of ever having an STI/HIV were higher among those who had less education, those who had sex with a commercial sex worker (CSW), those who ever engaged in receptive anal sex and those with post-traumatic stress disorder (PTSD). Alcohol abuse and PTSD were prevalent and associated with HIV risk behaviours. These results are being used to inform current prevention efforts.
    International Journal of STD & AIDS 02/2011; 22(2):73-9. · 1.00 Impact Factor
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    ABSTRACT: To examine how the timing of hypoxic exposure results in specific childhood outcomes and whether there is a differential effect by sex. A sample of 10,879 prospectively followed pregnancies was drawn from the Boston and Providence sites (New England, NE) of the National Collaborative Perinatal Project. Based on placental pathology, we developed and validated a measure of probable chronic placental hypoxia (CHP) and contrasted the effects of acute perinatal hypoxia on age 7 emotional, behavioral, and cognitive outcomes. Perinatal hypoxia had a significant impact on multiple behavioral and cognitive outcomes in boys and girls by age 7, in contrast to probable CHP which had a differential effect on girls and boys such that there was decreased verbal IQ and increased inhibition in females alone. Findings underscore the importance of considering the timing of obstetric complications and offspring sex in investigations of the impact of fetal and perinatal hypoxia on offspring's outcomes throughout the life course.
    Social Psychiatry 02/2011; 47(3):455-64. · 2.05 Impact Factor
  • Michael P Anastario, Maria Isabel Tavarez, Helen Chun
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    ABSTRACT: To estimate the prevalence of sexual risk behaviors among military personnel stationed along major border-crossing zones between the Dominican Republic and Haiti. From November 2008 to January 2009, behavioral surveys were administered to 498 active duty military personnel stationed along the three largest border-crossing zones on the western border of the Dominican Republic. Participants were selected using systematic random sampling and asked about their sexual behavior over the past 12 months, alcohol use, and mental health. Forty-one percent reported having casual sex during the past 12 months, 37% of men had a history of having sex with a commercial sex worker (19% during the past 12 months), and 7% of men reported a history of having sex with a transmigrating Haitian (6% during the past 12 months). Among sexually non-monogamous respondents (51%), inconsistent condom use exceeded 60% for those engaging in anal, vaginal, or oral sex. Fifteen percent reported using sexual coercion during the past 12 months. Sexual risk behaviors were prevalent among military personnel stationed along border-crossing zones between the Dominican Republic and Haiti. Prevention programs targeted at military personnel in this region should incorporate sexual coercion and mental health as key elements of their HIV prevention programs.
    Revista Panamericana de Salud P├║blica 11/2010; 28(5):361-7. · 0.85 Impact Factor
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    ABSTRACT: To assess the needs of clients in a home-based care (HBC) program aimed at improving the quality of lives of people living with HIV in Region 4 of Guyana (Demerara-Mahaica region) following their involvement with the HBC program, volunteers, and nurse providers. A cross-sectional analysis of a needs assessment conducted through a verbally administered questionnaire. We collected a cross-sectional sample of 84 HBC clients living with HIV from Region 4 in Guyana. Respondents were administered a questionnaire that asked questions regarding the demographics; services received; quality of service delivery; and mental health and substance abuse. The services most commonly received by respondents included nutritional assessment and counseling, HIV prevention education, emotional support, hygiene education, support for antiretroviral adherence, and support for HIV disclosure. Respondents reported further need of referrals to income-generation opportunities, food and nutritional supplement support, and support for children. Forty-two percent of the respondents screened positive for probable depression, and 37% of respondents screened positive for being at risk for a drinking problem. While a substantial portion of needs were addressed by the HBC program, outstanding needs included linking people living with HIV to income-generation opportunities, food support, mental health, and services for children. We suggest that mental health and substance use services be factored into HIV programming and that referral systems be strengthened to ensure access to support services for people living with HIV.
    Public Health Nursing 11/2010; 27(6):482-91. · 0.78 Impact Factor
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    ABSTRACT: To assess the effect of survey distribution protocol (mail versus handout) on data quality and measurement of patient care experiences. Multisite randomized trial of survey distribution protocols. Analytic sample included 2,477 patients of 15 clinicians at three practice sites in New York State. Mail and handout distribution modes were alternated weekly at each site for 6 weeks. Handout protocols yielded an incomplete distribution rate (74 percent) and lower overall response rates (40 percent versus 58 percent) compared with mail. Handout distribution rates decreased over time and resulted in more favorable survey scores compared with mailed surveys. There were significant mode-physician interaction effects, indicating that data cannot simply be pooled and adjusted for mode. In-office survey distribution has the potential to bias measurement and comparison of physicians and sites on patient care experiences. Incomplete distribution rates observed in-office, together with between-office differences in distribution rates and declining rates over time suggest staff may be burdened by the process and selective in their choice of patients. Further testing with a larger physician and site sample is important to definitively establish the potential role for in-office distribution in obtaining reliable, valid assessment of patient care experiences.
    Health Services Research 10/2010; 45(5 Pt 1):1345-59. · 2.29 Impact Factor
  • Maria I Tavarez, Helen Chun, Michael P Anastario
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    ABSTRACT: A survey was conducted of sexually active male military personnel stationed along major border-crossing zones between the Dominican Republic (DR) and Haiti, taking an applied scientific approach, to better inform prevention programming with military personnel in the region. A subsample of 470 sexually active male military personnel was drawn from a stratified systematic sample of military personnel stationed along the three largest border-crossing zones on the western border of the Dominican Republic. Using a verbally administered questionnaire, an examination of how foci of current HIV prevention programming with military personnel correlated with key sexual risk behavioral outcomes was conducted. Mental health factors such as probable alcohol abuse and posttraumatic stress disorder showed consistent associations with sexual risk behaviors. Participants showed a relatively high level of HIV/AIDS-related knowledge, a moderate level of negative attitudes toward condoms, and a moderate level of stigma toward people living with HIV/AIDS. Psychosocial factors, which are typically preventive in nature, were not associated with decreased sexual risk behaviors. Gaps were identified in HIV prevention programming that need to be addressed in this population of sexually active male military personnel. Although knowledge, attitudes, and psychosocial factors are important foci of HIV prevention programming, they were not associated with sexual risk behaviors, particularly after controlling for mental health factors. The authors suggest that prevalent psychiatric disorders in military personnel, such as posttraumatic stress disorder, should be factored in to the development of HIV prevention programs for military personnel.
    American journal of men's health 04/2010; 5(1):65-77. · 1.15 Impact Factor
  • Michael Anastario, Nadine Shehab, Lynn Lawry
    Disaster Medicine and Public Health Preparedness 10/2009; 3(3):138-9. · 1.14 Impact Factor
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    Michael Anastario, Nadine Shehab, Lynn Lawry
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    ABSTRACT: Although different types of gender-based violence (GBV) have been documented in disaster-affected populations, no studies have documented a quantitative increase in rates of GBV among populations living in protracted displacement after a disaster. We aimed to assess the change in rates of GBV after Hurricane Katrina among internally displaced people (IDPs) living in travel trailer parks in Mississippi. The study design included successive cross-sectional randomized surveys, conducted in 2006 and 2007, among IDPs in Mississippi using a structured questionnaire. We sampled 50 travel trailer parks in 9 counties in Mississippi in 2006, and 69 parks in 20 counties in 2007. A total of 420 female respondents comprised the final sample. We measured respondent demographics, forms of GBV including sexual and physical violence further subtyped by perpetrator, suicidal ideation, suicide attempt, and Patient Health Questionnaire-9-assessed depression. Respondents had a mean age of 42.7 years. The crude rate of new cases of GBV among women increased from 4.6/100,000 per day to 16.3/100,000 per day in 2006, and remained elevated at 10.1/100,000 per day in 2007. The increase was primarily driven by the increase in intimate partner violence. GBV experience was significantly associated with increased risk for poor mental health outcomes. Overall, the rate of GBV, particularly intimate partner violence, increased within the year following Hurricane Katrina and did not return to baseline during the protracted phase of displacement. Disaster planning efforts should incorporate plans to decrease the incidence of GBV following a disaster, and to ensure adequate services to people with postdisaster GBV experience.
    Disaster Medicine and Public Health Preparedness 04/2009; 3(1):18-26. · 1.14 Impact Factor
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    Michael P Anastario, Ryan Larrance, Lynn Lawry
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    ABSTRACT: Assessment of gender-based violence (GBV) among internally displaced persons (IDPs) is at best difficult. In complex humanitarian disasters, GBV inquiry can sometimes be dangerous and may lead to underestimation of the true prevalence. We developed a method of identifying women who have greater odds of having been exposed to postdisaster GBV (PDGBV) using mental health indicators. We systematically random sampled IDPs living in travel trailer parks in Louisiana and Mississippi and interviewed respondents using a health needs assessment survey during an 8-week period in April and May 2006. Women (n = 194) were screened for GBV and symptoms of depression. Women were on average 43.3 years old (range 18-85). Of the nine symptoms assessed with the Patient Health Questionnaire-9 (PHQ-9), four were associated with PDGBV. Among women with sleep dysregulation, the odds of PDGBV were 2.5 times higher in comparison with women without sleep dysregulation (95% CI 1.2-5.1). Appetite dysregulation increased the odds by 3.8 (95% CI 1.4-10.3), low self-esteem increased the odds by 2.3 (95% CI 1.2-4.6), and suicidal ideation increased the odds by 2.7 (95% CI 1.1-6.7). The internal consistency reliability of this symptom cluster was higher among women with PDGBV. Women screening positive on all four symptoms were 2.7 times more likely to have experienced PDGBV (95% CI 1.03-7.1). Several but not all symptoms of depression indicated exposure to PDGBV. Sleeping dysregulation, appetite dysregulation, low self-esteem, and suicidal ideation should be considered secondary indicators useful for identifying the prevalence of PDGBV exposure among female IDPs. This model may be useful for identifying women with exposure to PDGBV in settings where direct questioning may not be safe and reliable.
    Journal of Women's Health 11/2008; 17(9):1437-44. · 1.90 Impact Factor
  • Nadine Shehab, Michael P. Anastario, Lynn A. Lawry
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    ABSTRACT: Previous reports have shown a substantially high burden of chronic diseases, including mental illness, among persons displaced by the 2005 U.S. Gulf Coast hurricane season who are residing in various temporary housing situations. As of November 2007, approximately 50,000 households were still residing in Federal Emergency Management Agency (FEMA)-supported travel trailer park communities in the Gulf Coast region. The impact of protracted displacement on the health status and health care needs of these internally displaced persons (IDPs) has not been evaluated. We conducted a population-based assessment of chronic disease, mental health status, and health care access of travel trailer residents in Mississippi to identify barriers to and gaps in the provision of health care services for this displaced population. Using a structured questionnaire, information was gathered from 610 respondents pertaining to demographics, displacement, self-reported health status, the extent and types of health care services that have been needed and accessed during displacement, as well as depression, suicidal ideation, suicide attempts and completions, reproductive and child health, and mortality. Our findings indicate a worsening of chronic disease and mental illness, and barriers to health care access since arrival to the trailer parks. In order to meet the health care needs of persons displaced by disaster, developing and implementing guidelines for ensuring the availability of primary and mental health care should be made the priority.
    136st APHA Annual Meeting and Exposition 2008; 10/2008
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    ABSTRACT: Physicians are increasingly asked to improve the delivery of clinical services and patient experiences of care. We evaluated the association between clinical performance and patient experiences in a statewide sample of physician practice sites and a sample of physicians within a large physician group. We separately identified 373 practice sites and 119 individual primary care physicians in Massachusetts. Using Health Plan Employer Data and Information Set data, we produced two composites addressing processes of care (prevention, disease management) and one composite addressing outcomes. Using Ambulatory Care Experiences Survey data, we produced seven composite measures summarizing the quality of clinical interactions and organizational features of care. For each sample (practice site and individual physician), we calculated adjusted Spearman correlation coefficients to assess the relationship between the composites summarizing patient experiences of care and those summarizing clinical performance. Among 42 possible correlations (21 correlations involving practice sites and 21 involving individual physicians), the majority were positive in site level (71%) and physician level (67%) analyses. For the 28 possible correlations involving patient experiences and clinical process composites, 8 (29%) were significant and positive, and only 2 (7%) were significant and negative. The magnitude of the significant positive correlations ranged from 0.13 to 0.19 at the site level and from 0.28 to 0.51 at the physician level. There were no significant correlations between patient experiences and the clinical outcome composite. The modest correlations suggest that clinical quality and patient experience are distinct, but related domains that may require separate measurement and improvement initiatives.
    Journal of General Internal Medicine 09/2008; 23(11):1784-90. · 3.28 Impact Factor

Publication Stats

246 Citations
51.87 Total Impact Points

Institutions

  • 2012–2013
    • CUNY Graduate Center
      New York City, New York, United States
  • 2008–2009
    • Uniformed Services University of the Health Sciences
      • • Department of Military & Emergency Medicine
      • • F. Edward Hebert School of Medicine
      Bethesda, MD, United States
    • Johns Hopkins Bloomberg School of Public Health
      Baltimore, Maryland, United States