Sarah C Shelton

Washington University in St. Louis, San Luis, Missouri, United States

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Publications (8)20.06 Total impact

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    ABSTRACT: Abstract Purpose. To assess the key components of smoke-free campaigns that may have influenced voting outcomes in three communities. Design. Community case studies with content analysis of tobacco-related newspaper articles. Setting. Three semiurban Missouri communities. Subjects. One hundred eighty-one articles referencing tobacco published during the campaigns and five key informant interviews. Measures. Articles were coded for type, community referenced, tobacco control position, source of quotations, use of evidence, and frame. Semistructured interviews with key informants collected additional information. Analysis. Descriptive statistics were utilized to examine media coverage in each community. Key themes and events for each campaign were identified from qualitative interviews. Results. The only community that failed to pass its initiative had the highest proportion of letters to the editor (81.1%), anti-tobacco control articles (34.2%), use of a rights frame (28.8%), no evidence used (36.9%), no neighboring communities with policies, strong Tea Party presence, and no support from the chamber of commerce. Across all communities, more articles incorporating health frames were pro-tobacco control (70.7%) and more articles with a rights frame were anti-tobacco control (62.0%), compared to other positions. Conclusion. Several factors can influence the policy process. Tobacco control policy advocates facing strong opposition should consider the many factors (demographics, proximity to other adopting localities, politics) driving the debate and use media as an avenue to influence the discussion, connect with the public and policymakers, and mobilize proponents.
    American journal of health promotion: AJHP 03/2013; · 2.37 Impact Factor
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    ABSTRACT: In public health, interpersonal influence has been identified as an important factor in the spread of health information, and in understanding and changing health behaviors. However, little is known about influence in public health leadership. Influence is important in leadership settings, where public health professionals contribute to national policy and practice agendas. Drawing on social theory and recent advances in statistical network modeling, we examined influence in a network of tobacco control leaders at the United States Department of Health and Human Services (DHHS).
    Journal of public health research. 02/2012; 1(1):67-74.
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    ABSTRACT: African Americans, Hispanics, service and blue-collar workers, and residents of rural areas are among those facing higher rates of workplace secondhand smoke exposure in states without smokefree workplace laws. Consequently, these groups also experience more negative health effects resulting from secondhand smoke exposure. The objective of this study was to examine disparities in workplace secondhand smoke exposure in a state without a comprehensive statewide smokefree workplace law and to use this information in considering a statewide law. We developed a logistic multilevel model by using data from a 2007-2008 county-level study to account for individual and county-level differences in workplace secondhand smoke exposure. We included sex, age, race, annual income, education level, smoking status, and rural or urban residence as predictors of workplace secondhand smoke exposure. Factors significantly associated with increased exposure to workplace secondhand smoke were male sex, lower education levels, lower income, living in a small rural or isolated area, and current smoking. For example, although the overall rate of workplace exposure in Missouri is 11.5%, our model predicts that among young white men with low incomes and limited education living in small rural areas, 40% of nonsmokers and 56% of smokers may be exposed to secondhand smoke at work. Significant disparities exist in workplace secondhand smoke exposure across Missouri. A statewide smokefree workplace law would protect all citizens from workplace secondhand smoke exposure.
    Preventing chronic disease 11/2011; 8(6):A135. · 1.82 Impact Factor
  • Tobacco control 02/2011; 20(5):388-90. · 3.85 Impact Factor
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    ABSTRACT: An ongoing challenge with complex public health initiatives is the ability to link efforts to health outcomes. As part of our evaluation of the Missouri Foundation for Health's multi-site, multi-program Tobacco Prevention and Cessation Initiative (TPCI), we created the Strength of Community Health Programming Index (SCHPI). The Index, comprised of three constructs (depth, breadth and quality), serves as a tool to monitor the intensity of TPCI programming at the county level and to link these efforts to each county's observed tobacco-related outcomes. The Index also serves as an important planning tool. By summarizing programming within communities one can identify gaps or over-saturation in activities and be more strategic with program funding. The process used to create SCHPI can be adapted to other community health interventions and a range of geographic boundaries. In this session, we will describe the process taken to create and validate SCHPI, how the index is currently used, and recommendations for use in other areas of public health.
    138st APHA Annual Meeting and Exposition 2010; 11/2010
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    ABSTRACT: We studied 5 members of the National Network Consortium on Tobacco Control in Priority Populations. These networks, which consist of governmental and nongovernmental organizations, targeted lesbian, gay, bisexual, and transgender persons; Asian Americans, Native Hawaiians, and Pacific Islanders; American Indians and Alaska Natives; African Americans; and persons with low socioeconomic status, respectively. We used statistical network analysis modeling to examine collaboration among these national networks in 2007. Network size and composition varied, but all 5 networks had extensive interorganizational collaboration. Location and work area were significant predictors of collaboration among network members in all 5 networks. Organizations were more likely to collaborate with their network's lead agency; collaborations with other agencies were more likely if they were geographically close. Collaboration was perceived to be important for achieving the goals of the national network. The similarity of collaboration patterns across the 5 networks suggests common underlying partnership formation processes. Statistical network modeling promises to be a useful tool for understanding how public health systems such as networks and coalitions can be used to improve the nation's health.
    American Journal of Public Health 07/2010; 100(7):1290-7. · 3.93 Impact Factor
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    ABSTRACT: Tobacco control policies gained ground nationwide in 2006, with voters in nine states approving legislation to strengthen clean indoor air policies and increase tobacco excise taxes. Despite having the second lowest cigarette tax rate in the nation, Missouri was unsuccessful in passing its 2006 ballot initiative to raise the tax. An important way to encourage health-related policy change such as increasing tobacco taxes is through media coverage of tobacco issues. We examined how tobacco issues were presented in Missouri's print media leading up to the 2006 election. This study analysed 1263 articles with tobacco content published in 187 Missouri newspapers in the year before the election. Articles were coded for general and tobacco-related characteristics including article type (news story, editorial, letter to the editor), tobacco control position (pro, neutral, anti) and article theme (economic, health, political). Most articles were news stories (73.6%) and pro-tobacco control (63.8%). The proportion of anti-tobacco control articles increased significantly (chi(2)=104.9, p<0.001) the month before the election, driven by an increase in economically themed articles. Economic articles were published more often in counties with less voter support for the tax (F=5.68, p<0.01). Finally, tobacco control position varied significantly across article types (chi(2)=148.3, p<0.01), with letters to the editor being anti-tobacco control most often. The media have a critical role in promoting public health goals and presenting health issues which influences formation of health policies. Tobacco control advocates must consider public opinion, opposition pressure, timing and themes in tobacco-related media coverage when promoting policy change.
    Tobacco control 12/2009; 19(1):37-43. · 3.85 Impact Factor
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    ABSTRACT: Public health initiatives often focus on the discovery of risk factors associated with disease and death. Although this is an important step in protecting public health, recently the field has recognized that it is critical to move along the continuum from discovery of risk factors to delivery of interventions, and to improve the quality and speed of translating scientific discoveries into practice. To understand how public health problems move from discovery to delivery, citation network analysis was used to examine 1877 articles on secondhand smoke (SHS) published between 1965 and 2005. Data were collected and analyzed in 2006-2007. Citation patterns showed discovery and delivery to be distinct areas of SHS research. There was little cross-citation between discovery and delivery research, including only nine citation connections between the main paths. A discovery article was 83.5% less likely to cite a delivery article than to cite another discovery article (OR=0.165 [95% CI=0.139, 0.197]), and a delivery article was 64.3% less likely (OR=0.357 [95% CI=0.330, 0.386]) to cite a discovery article than to cite another delivery article. Research summaries, such as Surgeon General reports, were cited frequently and appear to bridge the discovery-delivery gap. There was a lack of cross-citation between discovery and delivery, even though they share the goal of understanding and reducing the impact of SHS. Reliance on research summaries, although they provide an important bridge between discovery and delivery, may slow the development of a field.
    American journal of preventive medicine 05/2009; 36(6):538-48. · 4.24 Impact Factor