Patricia O'Campo

University of Toronto, Toronto, Ontario, Canada

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Publications (176)420.8 Total impact

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    ABSTRACT: Background: Criminal justice system (CJS) involvement plays a central role for recovery of homeless adults with mental illness. Aims: To examine the rates of self-reported contacts with the CJS among homeless adults with mental illness; identify the characteristics of participants who have had contacts with the CJS; report the dimensional structure of CJS involvement; identify typologies of justice-involved participants. Method: Self-report data on CJS involvement of 2,221 adults participating in a Canadian Housing First trial were analyzed using multiple correspondence and cluster analysis. Results: The dimensional structure of CJS involvement highlights the central roles of law enforcement personnel, as well as the burden of administration of justice offences on short-term justice trajectories. Seven CJS involvement profiles emerged; substance use and impulse control distinguished the clusters, whereas demographic and contextual variables did not. Conclusions: The large number of profiles indicates the need for a diverse and flexible range of interventions that could be integrated within or in addition to current support of housing services, including integrated substance use and mental health interventions, risk management strategies and trauma-oriented services
    The British Journal of Psychiatry 11/2014; · 6.61 Impact Factor
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    ABSTRACT: Background This study aims to explore the conceptualization of intimate partner violence (IPV) among men and women from diverse subpopulations in Toronto, ON, Canada. Relatively few research efforts have been made to examine differences in conceptualizations of IPV across populations of different race and ethnic backgrounds.Methods Using concept mapping methodology, we sampled 67 women and men identified concepts and groups of concepts (domains) that reflected their understandings of the behaviours and attitudes that comprised IPV. We also determined the relative importance of each concept and domain as a contributor to IPV.Results‘External and Cultural Influences’, ‘Victim Response to Abuse’ and ‘Social and Emotional Manipulation’ were a few domains that participants rated as moderately or highly important contributors to IPV. These conceptual domains are often left out of commonly used IPV measures.Conclusions Our findings have important implications for the conceptualization of IPV and for future IPV measurement and measurement tool development.
    Health expectations: an international journal of public participation in health care and health policy 11/2014; · 1.80 Impact Factor
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    ABSTRACT: The housing first (HF) model for individuals experiencing homelessness and mental illness differs by design from traditional models that require consumers to achieve "housing readiness" by meeting program or treatment prerequisites in transitional housing settings prior to permanent housing placement. Given a growing body of evidence for its favorable outcomes and cost effectiveness, HF is increasingly seen as an alternative to and argument against these traditional programs. As such, it is important that the elements and implementation challenges of the HF model be clearly understood and articulated. This qualitative study explored a largely unexamined aspect of the HF model-the need for and meaning of temporary residential settings (interim housing), a place to stay while waiting to secure permanent housing-using interviews and focus groups with service providers and consumers who experienced interim housing during implementation of HF in a large urban center. Although interim housing may not be necessary for all programs implementing the model, our study revealed numerous reasons and demands for safe, flexible interim housing options, and illustrated how they influence the effectiveness of consumer recovery, continuous service engagement, and housing stability. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    American Journal of Orthopsychiatry 07/2014; 84(4):431-7. · 1.60 Impact Factor
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    ABSTRACT: Participant retention is an important challenge in longitudinal research on homeless people. High attrition can threaten validity, and may represent lost opportunities to deliver interventions. In this article, we report on attrition in the At Home/Chez Soi study, a multi-site randomized controlled trial of a housing intervention for homeless people with mental illness.
    Social Psychiatry and Psychiatric Epidemiology 06/2014; · 2.86 Impact Factor
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    ABSTRACT: To address macro-social and economic determinants of health and equity, there has been growing use of intersectoral action by governments around the world. Health in All Policies (HiAP) initiatives are a special case where governments use cross-sectoral structures and relationships to systematically address health in policymaking by targeting broad health determinants rather than health services alone. Although many examples of HiAP have emerged in recent decades, the reasons for their successful implementation-and for implementation failures-have not been systematically studied. Consequently, rigorous evidence based on systematic research of the social mechanisms that have regularly enabled or hindered implementation in different jurisdictions is sparse. We describe a novel methodology for explanatory case studies that use a scientific realist perspective to study the implementation of HiAP. Our methodology begins with the formulation of a conceptual framework to describe contexts, social mechanisms and outcomes of relevance to the sustainable implementation of HiAP. We then describe the process of systematically explaining phenomena of interest using evidence from literature and key informant interviews, and looking for patterns and themes. Finally, we present a comparative example of how Health Impact Assessment tools have been utilized in Sweden and Quebec to illustrate how this methodology uses evidence to first describe successful practices for implementation of HiAP and then refine the initial framework. The methodology that we describe helps researchers to identify and triangulate rich evidence describing social mechanisms and salient contextual factors that characterize successful practices in implementing HiAP in specific jurisdictions. This methodology can be applied to study the implementation of HiAP and other forms of intersectoral action to reduce health inequities involving multiple geographic levels of government in diverse settings.
    Health Policy and Planning 05/2014; · 2.65 Impact Factor
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    ABSTRACT: This study explores factors contributing to delays and relocations during the implementation of the Housing First model in Toronto, Ontario. While interruptions in housing tenure are expected en route to recovery and housing stability, consumer and service provider views on finding and keeping housing remain largely unknown. In-person interviews and focus groups were conducted with 48 study participants, including 23 case managers or housing workers and 25 consumers. The following three factors contributed to housing delays and transfers: (1) the effectiveness of communication and collaboration among consumers and service providers, (2) consumer-driven preferences and ambivalence, and (3) provider prioritization of consumer choice over immediate housing access. Two strategies-targeted communications and consumer engagement in housing searches-supported the housing process. Several factors affect the timing and stability of housing. Communication between and among providers and consumers, and a shared understanding of consumer choice, can further support choice and recovery.
    The Journal of Behavioral Health Services & Research 05/2014; · 0.78 Impact Factor
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    ABSTRACT: History of abuse has been associated with greater HIV risk among women. This study examined client-perpetrated abuse among female sex workers (FSWs) in two Mexico-U.S. border cities where HIV prevalence is rising. Among 924 FSWs, prevalence of client-perpetrated abuse was 31%. In multivariate logistic regression models, intimate partner violence (IPV), psychological distress, and having drug-using clients were associated with experiencing client-perpetrated abuse. FSWs along the Mexico-U.S. border report frequently experiencing abuse from both clients and intimate partners, which may have serious mental health consequences. Our findings suggest the need for screening and gender-based violence prevention services for Mexican FSWs.
    Violence Against Women 03/2014; · 1.33 Impact Factor
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    ABSTRACT: Population-based health information on urban Aboriginal populations in Canada is limited due to challenges with the identification of Aboriginal persons in existing health data sets. The main objective of the Our Health Counts (OHC) project was to work in partnership with Aboriginal stakeholders to generate a culturally relevant, representative baseline health data set for three urban Aboriginal communities in Ontario, Canada.
    BMJ Open 01/2014; 4(7):e004978. · 1.58 Impact Factor
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    ABSTRACT: To evaluate the experience of select cities in the Americas using the Urban Health Equity Assessment and Response Tool (Urban HEART) launched by the World Health Organization in 2010 and to determine its utility in supporting government efforts to improve health equity using the social determinants of health (SDH) approach The Urban HEART experience was evaluated in four cities from 2010-2013: Guarulhos (Brazil), Toronto (Canada), and Bogotá and Medellín (Colombia). Reports were submitted by Urban HEART teams in each city and supplemented by first-hand accounts of key informants. The analysis considered each city's networks and the resources it used to implement Urban HEART; the process by which each city identified equity gaps and prioritized interventions; and finally, the facilitators and barriers encountered, along with next steps In three cities, local governments spearheaded the process, while in the fourth (Toronto), academia initiated and led the process. All cities used Urban HEART as a platform to engage multiple stakeholders. Urban HEART's Matrix and Monitor were used to identify equity gaps within cities. While Bogotá and Medellín prioritized among existing interventions, Guarulhos adopted new interventions focused on deprived districts. Actions were taken on intermediate determinants, e.g., health systems access, and structural SDH, e.g., unemployment and human rights Urban HEART provides local governments with a simple and systematic method for assessing and responding to health inequity. Through the SDH approach, the tool has provided a platform for intersectoral action and community involvement. While some areas of guidance could be strengthened, Urban HEART is a useful tool for directing local action on health inequities, and should be scaled up within the Region of the Americas, building upon current experience.
    Revista Panamericana de Salud Pública 12/2013; 34(6):407-15. · 0.85 Impact Factor
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    ABSTRACT: Gender inequalities in health have been widely described, but few studies have examined the upstream sources of these inequalities in health. The objectives of this review are 1) to identify empirical papers that assessed the effect of gender equality policies on gender inequalities in health or on women's health by using between-country (or administrative units within a country) comparisons and 2) to provide an example of published evidence on the effects of a specific policy (parental leave) on women's health. We conducted a literature search covering the period from 1970 to 2012, using several bibliographical databases. We assessed 1,238 abstracts and selected 19 papers that considered gender equality policies, compared several countries or different states in 1 country, and analyzed at least 1 health outcome among women or compared between genders. To illustrate specific policy effects, we also selected articles that assessed associations between parental leave and women's health. Our review partially supports the hypothesis that Nordic social democratic welfare regimes and dual-earner family models best promote women's health. Meanwhile, enforcement of reproductive policies, mainly studied across US states, is associated with better mental health outcomes, although less with other outcomes. Longer paid maternity leave was also generally associated with better mental health and longer duration of breastfeeding.
    Epidemiologic Reviews 09/2013; · 9.27 Impact Factor
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    ABSTRACT: Objective: Although participatory methods have become increasingly popular, people with lived experience of mental illness and homelessness have been historically excluded from service planning and research. To better plan for meaningful inclusion of consumers, this study examines lessons learned from the People with Lived Experience Caucus in the Toronto Site of the At Home/Chez Soi Research Demonstration Project on Homelessness and Mental Health. Method: The inclusion of the People with Lived Experience Caucus was evaluated using qualitative methods and multiple data sources, including review of 42 documents, 11 individual interviews, and three focus groups. Caucus members were included in the study team. Transcripts were analyzed using grounded theory methodology. Results: Findings revealed a complex story of Caucus engagement: Facing time constraints and given little direction, the Caucus developed through a tumultuous process related to both internal and external barriers to meaningful inclusion. Despite the challenges, the Caucus contributed meaningfully to various aspects of the research demonstration project. Conclusions and Implications for Practice: It is possible to successfully integrate psychiatric consumers with experience of homelessness in many aspects of research and service planning. Suggestions for future initiatives hoping to engage consumers include: early involvement, purposeful selection of members, clear communication of roles and responsibilities, a consumer coordinating group, and space for critical dialog throughout the process. Lessons learned can inform the inclusion of consumers in similar endeavors in other jurisdictions. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Psychiatric Rehabilitation Journal 09/2013; 36(3):180-6. · 0.75 Impact Factor
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    ABSTRACT: Health in All Policies (HiAP) is becoming increasingly popular as a governmental strategy to improve population health by coordinating action across health and non-health sectors. A variety of intersectoral initiatives may be used in HiAP that frame health determinants as the bridge between policies and health outcomes. The purpose of this glossary is to present concepts and terms useful in understanding the implementation of HiAP as a cross-sectoral policy. The concepts presented here were applied and elaborated over the course of case studies of HiAP in multiple jurisdictions, which used key informant interviews and the systematic review of literature to study the implementation of specific HiAP initiatives.
    Journal of epidemiology and community health 08/2013; · 3.04 Impact Factor
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    ABSTRACT: Objectives. Polygamy is a complex phenomenon and a product of power relations, with deep cultural, social, economic, and political roots. Despite being banned in many countries, the practice persists and has been associated with women's marginalization and mental health sequelae. In this study, we sought to improve understanding of this ongoing, complex phenomenon by examining the contribution of socioeconomic position (SEP) and social support to the excess of depressive symptoms (DS) and poor self-rated health (SRH) among women in polygamous marriages compared to women in monogamous marriages. Measuring the contribution of these factors could facilitate policies and interventions aimed at protecting women's mental health. Design. The study was conducted among a sample of Arab Bedouin women living in a marginalized community in southern Israel (N=464, age 18-50). The women were personally interviewed in 2008-2009. We then used logistic regression models to calculate the contribution of SEP (as defined by the women's education, family SEP, and household characteristics) and social support to excess of depressive symptoms and poor SRH among participants in polygamous versus monogamous marriages. Results. About 23% of the participants were in polygamous marriages. These women reported almost twice the odds of depressive symptoms (OR=1.91, 95%CI=1.22, 2.99) and poorer SRH (OR=1.73, 95%CI=1.10, 2.72) than those in monogamous marriages. Women's education changed these associations slightly, but family SEP and household characteristics resulted in virtually no further change. Social support reduced the odds for poor SRH and DS by about 23% and 28%, respectively. Conclusion. Polygamy is associated with higher risk for poor mental health of women regardless of their SEP and education. Social support seems to have some protective effect.
    Ethnicity and Health 05/2013; · 1.20 Impact Factor
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    ABSTRACT: To quantify the association between intimate partner violence (IPV) and incident HIV infection in women in the Rakai Community Cohort Study between 2000 and 2009. Data were from the Rakai Community Cohort Study annual surveys between 2000 and 2009. Longitudinal data analysis was used to estimate the adjusted incidence rate ratio (IRR) of incident HIV associated with IPV in sexually active women aged 15-49 years, using a multivariable Poisson regression model with random effects. The population attributable fraction was calculated. Putative mediators were assessed using Baron and Kenny's criteria and the Sobel-Goodman test. Women who had ever experienced IPV had an adjusted IRR of incident HIV infection of 1.55 (95% CI 1.25-1.94, P = 0.000), compared with women who had never experienced IPV. Risk of HIV infection tended to be greater for longer duration of IPV exposure and for women exposed to more severe and more frequent IPV. The adjusted population attributable fraction of incident HIV attributable to IPV was 22.2% (95% CI 12.5-30.4). There was no evidence that either condom use or number of sex partners in the past year mediated the relationship between IPV and HIV. IPV is associated with incident HIV infection in a population-based cohort in Uganda, although the adjusted population attributable fraction is modest. The prevention of IPV should be a public health priority, and could contribute to HIV prevention.
    AIDS (London, England) 05/2013; 27(8):1331-8. · 4.91 Impact Factor
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    ABSTRACT: The objective of this study was to assess the association between oral health and individual-level characteristics as well as both socioeconomic position (SEP) and service provision characteristics at the neighborhood level. Multilevel logistic analysis was undertaken of data from the Neighbourhood Effects on Health and Well-being Study in Toronto comprising 2,412 participants living in 47 neighborhoods and 87 census tracts. Three oral health outcomes were investigated: last dental visit, self-rated oral health, and self-rated oral pain. Results indicated that SEP was significantly associated with no dental visits in the last year, poor self-rated oral health, and experiencing oral pain after adjusting for age, gender, and immigrant status. Lack of dental insurance was associated with no visits to the dentist in the last year and poor self-rated oral health; however, no association was observed with oral pain. In adjusted regression models, few neighborhood level variables were significantly associated with dental visits and self-rated oral health and no neighborhood variables were associated with oral pain. Based on these results, SEP appears to be important in evaluating oral health outcomes. While insignificant in this study, neighborhood factors are important when considering the impact of service provision on oral health.
    Journal of Urban Health 04/2013; · 1.89 Impact Factor
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    ABSTRACT: Objectives. With a focus on socioeconomic position, we examined the association between maternal education and nonsupine infant sleep position, and examined patterns of effect modification with additional sociodemographic, maternal, infant, and health services predictors. Methods. Data were from the Maternity Experiences Survey, a national population-based sample of 76 178 new Canadian mothers (unweighted n = 6421) aged 15 years or older interviewed in 2006-2007. Using logistic regression, we developed multivariate models for 3 maternal education strata. Results. Level of maternal education was significantly and inversely related to nonsupine infant sleep position. Stratified analyses revealed different predictive factors for nonsupine infant sleep position across strata of maternal education. Postpartum home visits were not associated with use of this sleep position among new mothers with less than high school completion. Adequacy of postpartum information regarding sudden infant death syndrome was not associated with nonsupine infant sleep position in any of the educational strata. Conclusions. These findings suggest a need to revisit Back to Sleep health promotion strategies and to ensure that these interventions are tailored to match the information needs of all families, including mothers with lower levels of formal education. (Am J Public Health. Published online ahead of print April 18, 2013: e1-e9. doi:10.2105/AJPH.2012.301061).
    American Journal of Public Health 04/2013; · 3.93 Impact Factor
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    ABSTRACT: Child abuse and neglect, considered criminal acts under the Criminal Code of Canada, play an important role in substance use, violence, and other criminal behaviour in adulthood. We adopted the life course perspective to identify modifiable contextual influences and co-occurring individual, social, and familial determinants associated with adult criminality. Using in-depth interview data, a sub-sample of 13 women who had recently experienced intimate partner violence, recounted their experiences of childhood abuse, their own substance use or criminality, as well as implications of these factors on their children's life trajectories. For the purposes of this paper criminality was defined as child abuse and neglect, domestic violence, illegal substance use and underage alcohol use. Our objective was to explore, in our data: (1) patterns and trajectories of criminality from childhood to adulthood among women who were victims of violence, and (2) cumulative effects of early life exposures on experiences of criminality; with the aim of describing the life course perspective as a useful framework to understand criminality along the life trajectory. The analysis was not designed to demonstrate causal connections between early childhood and adulthood experiences of criminality. Rather we generated qualitative and quantitative hypotheses to guide future research in the field. Implications for research and interventions are discussed.
    International Journal of Environmental Research and Public Health 01/2013; 10(11):5470-89. · 2.00 Impact Factor
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    ABSTRACT: To examine the contribution of socio-economic position (SEP) in explaining the excess of any abuse and intimate partner violence (IPV) among Aboriginal versus non-Aboriginal women in Canada. This comparison has not been studied before. We conducted logistic regression analysis, using nationwide data from a weighted sample of 57,318 Canadian-born mothers of singletons who participated in the Canadian Maternity Experiences Survey 2006-7. The unadjusted odds of any abuse and IPV were almost four times higher among Aboriginal compared to non-Aboriginal mothers; OR 3.91 (95% CI 3.12-4.89) and OR 3.78 (2.87-4.97), respectively. Adjustment for SEP reduced the unadjusted OR of any abuse and IPV by almost 40%. However, even with this adjustment, the odds of any abuse and IPV for Aboriginal mothers remained twice that of non-Aboriginal mothers; OR 2.34 (1.82-2.99) and OR 2.19 (1.60-3.00), respectively. SEP is a predominant contributor to the excess of abuse against Aboriginal vs. non-Aboriginal women in Canada. Reducing violence against Aboriginal women can be achieved mostly by improving their SEP, and simultaneously be informed by social processes and services that can mitigate abuse. The fact that SEP did not fully explain the excess of abuse among the Aboriginal women might lend support to "colonization or postcolonial theories," and related contextual factors such as differences in community social resources (e.g., social capital) and services. The effect of these factors on the excess of abuse warrants future research.
    Canadian journal of public health = Revue canadienne de santé publique. 01/2013; 104(4):e278-83.
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    ABSTRACT: At Home/Chez Soi, a large, $110-million, randomized trial evaluating the effectiveness of Housing First services for 2,235 individuals who are homeless and experiencing mental illness, was implemented in five Canadian cities, beginning in fall 2009. This paper describes initial implementation of the Housing First model, focusing on specific strategies, including centrally coordinated training/technical assistance and local site coordinators as change agents in each city. Implementation of this complex intervention varied across sites but was remarkably consistent regarding the essential ingredients of the program model. A strategy that balanced a strong centrally coordinated approach to technical assistance with customization and adaptation on the local level was essential for achieving a high fidelity implementation.
    American Journal of Psychiatric Rehabilitation 01/2013; 16(4).
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    ABSTRACT: The traditional explanatory models used in epidemiology are "disease specific", identifying risk factors for specific health conditions. Yet social exposures lead to a generalized, cumulative health impact which may not be specific to one illness. Disease-specific models may therefore misestimate social factors' effects on health. Using data from the Canadian Community Health Survey and Canada 2001 Census we construct and compare "disease-specific" and "generalized health impact" (GHI) models to gauge the negative health effects of one social exposure: socioeconomic position (SEP). We use logistic and multinomial multilevel modeling with neighbourhood-level material deprivation, individual-level education and household income to compare and contrast the two approaches. In disease-specific models, the social determinants under study were each associated with the health conditions of interest. However, larger effect sizes were apparent when outcomes were modeled as compound health problems (0, 1, 2, or 3+ conditions) using the GHI approach. To more accurately estimate social exposures' impacts on population health, researchers should consider a GHI framework.
    International Journal of Environmental Research and Public Health 01/2013; 10(4):1186-201. · 2.00 Impact Factor

Publication Stats

5k Citations
420.80 Total Impact Points


  • 2006–2014
    • University of Toronto
      • • Bloomberg Faculty of Nursing
      • • Saint Michael's Hospital
      Toronto, Ontario, Canada
  • 2013
    • Ben-Gurion University of the Negev
      • Faculty of Health Sciences
      Beersheba, Southern District, Israel
  • 2005–2013
    • St. Michael's Hospital
      Toronto, Ontario, Canada
    • University of Texas Health Science Center at Tyler
      Tyler, Texas, United States
  • 2012
    • McMaster University
      • Department of Health, Aging, and Society
      Hamilton, Ontario, Canada
  • 2011
    • University of Manitoba
      • Faculty of Nursing
      Winnipeg, Manitoba, Canada
  • 2008–2011
    • University of Pittsburgh
      • • Department of Behavioral and Community Health Sciences
      • • Department of Family Medicine
      Pittsburgh, Pennsylvania, United States
    • New York Academy of Medicine
      New York City, New York, United States
    • University of North Texas at Dallas
      Dallas, Texas, United States
    • Duke University
      Durham, North Carolina, United States
  • 2010
    • University of Iowa
      • Department of Epidemiology
      Iowa City, IA, United States
    • Adelphi University
      Garden City, New York, United States
    • Brown University
      • Center for Gerontology and Health Care Research
      Providence, RI, United States
  • 2009–2010
    • University of California, San Diego
      • Department of Medicine
      San Diego, CA, United States
  • 2006–2008
    • University of North Carolina at Chapel Hill
      • • Department of Maternal and Child Health
      • • Department of Health Behavior and Health Education
      • • Department of Environmental Sciences and Engineering
      Chapel Hill, NC, United States
  • 1992–2008
    • Johns Hopkins Bloomberg School of Public Health
      • • Department of Population, Family and Reproductive Health
      • • Department of Health, Behavior and Society
      • • Department of Health Policy and Management
      Baltimore, Maryland, United States
  • 2007
    • University of Virginia
      • School of Nursing
      Charlottesville, VA, United States
  • 1996–2005
    • Johns Hopkins University
      • School of Nursing
      Baltimore, MD, United States
    • National Institute of Mental Health (NIMH)
      Maryland, United States
  • 2004
    • University of Maryland, Baltimore
      • School of Nursing
      Baltimore, MD, United States
  • 2003
    • George Washington University
      • Department of Prevention and Community Health
      Washington, Washington, D.C., United States