Katherine P Theall

• PhD
• Tulane University

In the current study, we examine associations between exposure to violence and antiretroviral medication adherence in persons with HIV (PWH) in a southern city in the United States. We include investigation of a variety of violence exposures including childhood sexual abuse, physical abuse, witnessing family violence, lifetime violence exposures an...

Background Gun violence disproportionately affects metropolitan areas of the United States (US). There is limited information regarding the influence of social determinants of health, such as food insecurity (FI) on firearm homicide mortality (FHM) in major metropolitan cities in the US. We sought to examine the relationship between FI and FHM. Ma...

Changing built environment conditions to impact health mindsets and health equity may be a promising target for public health interventions. The present study was a cluster randomized controlled trial to test the impact of remediating vacant and abandoned properties on factors related to health mindset—including well-being, health interconnectednes...

Objective: The effects of named weather storms on the rates of penetrating trauma is poorly understood with only case reports of single events currently guiding public health policy. This study examines whether tropical storms and hurricanes contribute to trauma services and volume. Methods: This was a cross-sectional review of tropical storms/h...

This study investigated the impact of transgenerational racial stress on youths’ adrenal-and-gonadal hormone levels and co-regulation in response to acute stress. Black youths (N=120) residing in a U.S. metropolitan area completed the Trier Social Stress Test (TSST). Youths’ cortisol, dehydroepiandrosterone, and testosterone coupling levels were ex...

We assessed the relationship between differences in indicators of social capital before and during the COVID-19 pandemic, and their association with self-reported measures of psychological distress. The data was analyzed from an existing cluster randomized control trial (the Healthy Neighborhoods Project ) with 244 participants from New Orleans, Lo...

Racism in all its manifestations is violence. This study examines the effect of discrimination-based racial violence in neighborhoods and schools on adolescent psychological and behavioral outcomes, while also testing the moderating influence of civic engagement. Researchers used a cross-sectional survey design to measure neighborhood and school-ba...

A shift in focus towards healthy reproductive outcomes may reveal opportunities for novel interventions and strategies to promote optimal health. Using variables from the National Center for Health Statistics restricted use natality files, we calculated Empirical Bayes smoothed (EBS) rates of optimal birth for the all live births—both overall and b...

Pregnancy-associated homicide remains an understudied yet critical issue. Using restricted use mortality files provided by the National Center for Health Statistics and the National Violent Death Reporting System, annual state-level pregnancy-associated homicide ratios were estimated as the count of deaths divided by the number of live births. The...

Statement of Purpose Rates of family violence, including intimate partner violence (IPV) and child maltreatment, play a significant role in the increasing trends in violence in the U.S. and globally and contribute to substantial health and economic costs on our society. Factors that explain the concentration of family violence in particular neighbo...

Background A shift in focus towards healthy reproductive outcomes may reveal opportunities for novel interventions and strategies to promote optimal health. Methods Using variables from the National Center for Health Statistics Period Linked Birth/Infant Death File, we calculated Empirical Bayes smoothed (EBS) rates of optimal birth for the total...

The purpose of this study was to characterize the social networks of female sex workers (FSWs) living with HIV in the Dominican Republic (DR) and to examine the association between daily drug use and network risk profile. The study employed a micro-longitudinal observational design using a 7-day mobile health (mHealth) daily diary to collect daily...

The purpose of this study was to explore the daily activity spaces of female sex workers living with HIV in the Dominican Republic and assess the relationship between activity path and location-based risk exposure measures and daily drug use. The study employed a micro-longitudinal observational study design using an innovative 7-day travel diary t...

Background Maternal mortality is an issue of growing concern in the United States, where the incidence of death during pregnancy and postpartum seems to be increasing. The purpose of this analysis was to explore whether residing in a maternity care desert (defined as a county with no hospital offering obstetric care and no OB/GYN or certified nurse...

Allostatic load is an indicator of multisystem physiologic dysregulation that may arise from prolonged or accumulated exposure to stress, including adverse childhood experiences (ACEs) and chronic stressors persisting into adulthood. People living with HIV (PLWH) may be particularly vulnerable given their high burdens of adversity across the life c...

Statement of Purpose Place-based interventions affect social and physical environmental conditions in neighborhoods and are policy-relevant opportunities for violence prevention that can also promote population health equity. This presentation discusses study design challenges and novel data integration methods relevant to such interventions. Meth...

As people living with HIV (PLWH) live longer, morbidity and mortality related to chronic illness specifically, cardiovascular disease (CVD) has increased. HIV disease has been associated with hypertension (HTN) and dyslipidemia, which are risk factors for developing CVD. The objective of this study was to determine whether heavy alcohol use among P...

Background: A growing body of evidence is beginning to highlight how mass incarceration shapes inequalities in population health. Non-Hispanic blacks are disproportionately affected by incarceration and criminal law enforcement, an enduring legacy of a racially-biased criminal justice system with broad health implications for black families and co...

Despite greater mental health co-morbidities and heavier alcohol use among PLWH, few studies have examined the role of the neighborhood alcohol environment on either alcohol consumption or mental health. Utilizing cross-sectional data from a cohort study in a southern U.S. metropolitan area, we examine the association between neighborhood alcohol e...

Aims: To characterize latent typologies of alcohol use among persons living with human immunodeficiency virus (HIV) (PLWH) and test their relationship with physical and mental health status. Methods: Baseline data from 365 adult in-care PLWH enrolled in the New Orleans Alcohol Use in HIV study were analyzed. Indicators of current and former heav...

Violence is a leading cause of death and disability in the United States and abroad, with far-reaching consequences for individuals and communities. Interventions that address environmental and social contexts have the potential for greater populationwide effects, yet research has been slow to identify and rigorously evaluate these types of interve...

Housing is an important social determinant of physical and mental health. Transgender and gender non-conforming individuals (T/GNCI) face a unique constellation of discrimination and compromised social services, putting them at risk for housing insecurity, homelessness, and its associated public health concerns. This study explores housing insecuri...

Evidence suggests that HIV-related stigma is a contributing factor to mental health and substance use problems among people living with HIV (PLWH). Limited research, however, has examined the differential effects that multiple stigma constructs, specifically, anticipated, enacted, and internalized stigma may have on mental health and alcohol use di...

Objective: Adverse childhood experiences (ACEs) are associated with mental and physical health risks that, through biological and psychosocial pathways, likely span generations. Within an individual, telomere length (TL), an established marker of cellular stress and aging, is associated with both ACE exposure and psychopathology, providing the bas...

Objective To test alterations in placental cellular aging as one pathway by which maternal early adversity influences physiologic development in her offspring. Methods Maternal report of her adverse childhood experiences (ACE) was obtained prenatally along with measures of prenatal stress and demographic information. Placentas (N = 67) were collec...

In this ecological study, we examined the associations between state-level income inequality and pregnancy-related mortality among non-Hispanic (NH) black and NH white populations across the US. We estimated total population and race-specific 5-year pregnancy-related mortality ratios in each state based on national death and live birth records from...

Background: Small island Caribbean countries such as Jamaica are now facing an epidemic of obesity and decreased physical activity (PA) levels. Public parks have been shown to be important resources for PA that also provide psychological and social benefits associated with increased PA. There are no studies that document PA in parks in the Caribbe...

Background: Unintended pregnancies, occurring in nearly 1 out of every 2 (45%) pregnancies in the United States, are associated with adverse health and social outcomes for the infant and the mother. The risk of unintended pregnancies is significantly reduced when women use long-acting reversible contraceptives, namely intrauterine devices and impl...

Background Alcohol use disorders (AUDs) are highly prevalent in people living with HIV (PLWH) and are associated with increased HIV risk behaviors, suboptimal treatment adherence, potential interaction with medication pharmacodynamics, and greater risk for disease progression. Preclinical studies show that chronic binge alcohol administration accel...

Exposure to violence and obesity continues to be growing epidemics, particularly among children. Our objective was to increase our understanding of the association between neighborhood violence exposure and children's weight and how biologic stress may mediate this relation. A matched, community-recruited cross-sectional study of 90 children, ages...

The purpose of this article is to introduce the Family Resilience Inventory (FRI) and present findings on initial efforts to validate this measure. The FRI is designed to assess family resilience in one's current family and in one's family of origin, enabling the assessment of family protective factors across these generations. The development of t...

Social norms regarding corporal punishment (CP) may be the most important population-level risk factor for child physical abuse in the U.S. Little is known about the perceived social contexts, such as perceived norms and collective efficacy, that are linked with CP. In particular, there is a paucity of research exploring the direct and/or moderatin...

The use of corporal punishment (CP) is a strong risk factor for many poor outcomes for children including child maltreatment. The use of CP occurs within social contexts which are important to understand. Although it is known that perceived social norms regarding CP are related to its use, the specific role that a mother's primary support person pl...

Background: Neighborhood safety has been linked to physical activity and obesity among adolescents, but few studies have used objective measures of crime or examined associations by gender. The goal of this study was to investigate if exposure to objectively measured neighborhood crime was associated with physical activity and overweight/obesity a...

Objective: To examine whether neighbourhood characteristics are associated with cumulative biological risk (CBR) and sex differences in CBR in a nationally representative sample in Jamaica, a small island developing country with increasing prevalence of non-communicable diseases (NCDs). Design: Cross-sectional study SETTING: A population-based c...

Acute reactivity of the stress hormone cortisol is reflective of early adversity and stress exposure, with some studies finding that the impact of adversity on the stress response differs by race. The objectives of the current study were to characterize cortisol reactivity to two dyadically based stress paradigms across the first year of life, to e...

Objectives: In 2005, Hurricane Katrina caused damage in New Orleans, Louisiana, and much of the land in low-resource neighborhoods became vacant and blighted. In 2014, New Orleans launched a program, Fight the Blight, which remediated properties in 6 neighborhoods. Our objective was to examine changes in crime rates near lots that were remediated...

Corporal punishment (CP) continues to be a common form of discipline in the U.S despite indications of its long-term harm to children, including strong risk for child physical abuse. Parents that are exposed to CP or physical abuse in childhood are at heightened risk for using CP with their own children. In examining parenting practices relevant to...

Intimate partner violence (IPV) is a persistent public health problem in the United States, with an estimated one in three women experiencing rape, physical violence, and/or stalking by an intimate partner within her lifetime. Non-Hispanic Black women disproportionately experience IPV, but there has been limited success in implementing culturally a...

Objective: To summarize the ways in which researchers have quantified measures of structural racism for the purposes of empirical, quantitative investigation of its associations with physical and mental health outcomes. Methods: Systematic review of literature published January 1, 2007-December 31, 2017. We searched PubMed and EMBASE databases for...

Background: Enhanced understanding of spatial social polarization as a determinant of infant mortality is critical to efforts aimed at advancing health equity. Our objective was to identify associations between spatial social polarization and risk of infant death. Methods: We conducted a cross-sectional analysis of all birth records issued to no...

Purpose: Gender Minority (GM) individuals experience healthcare access barriers, including financial concerns and discrimination, which influence their health seeking behaviors. This study explores the alternative navigation strategies used by GM individuals to cope with these barriers and access care, both biomedical and complementary and alternat...

Objective: To examine the impact of polymorphic variation in the solute carrier family 5 member 7 (SLC5A7) gene on autonomic nervous system (ANS) reactivity indexed by respiratory sinus arrhythmia (RSA) and heart rate (HR) in infants during a dyadic stressor, as well as maternal report of infant self-regulation. Given evidence of race differences...

Our understanding of how community-level context impacts care of persons living with HIV (PLWH), including antiretroviral therapy (ART) adherence and retention in care, is limited. The objective of this study was to characterize the activity spaces of PLWH from an urban area in Southeastern U.S., where the epidemic is among the nation's highest, an...

Purpose: This study examines the associations between discrimination experiences (types and locations) and care postponement among trans-feminine individuals in the United States. Methods: This secondary, cross-sectional study utilized a subset of the data from the National Transgender Discrimination Survey (n = 2248), specifically for trans-fem...

Gender-minority health disparity research is limited by binary gender measurement practices. This study seeks to broaden current discourse on gender identity measurement in the USA, including measurement adoption challenges and mitigation strategies, thereby allowing for better data collection to understand and address health disparities for people...

Objective: Geographic variation in obesity, Diabetes mellitus (DM) and hypertension (HTN) prevalence at the parish level was examined using the Jamaica Health and Lifestyle Survey 2008 (JHLS II). Methods: Total and gender-specific parish age-adjusted prevalence estimates of obesity, DM and HTN were obtained and ranked. Binary logistic regression mo...

The objectives of this study were to: (1) describe the quantity and quality of social support networks of Latino immigrants living in a new receiving environment, and (2) determine the role such networks play in their HIV/STI risk behaviors, including substance use. Double incentivized convenience sampling was used to collect egocentric social supp...

This study investigated the multigenerational impact of mothers’ own exposure to physical maltreatment on internalizing symptoms in her child after accounting for her parenting practices, depression, and the child’s own exposure to stressful life events. Children (n = 101, ages 5–16), predominantly African American, were recruited into this cross s...

This Special Issue of IJERPH focuses on maternal and child health (MCH), with research that highlights the role of environmental influences on MCH across a range of settings.[...]

Objective: Respiratory sinus arrhythmia (RSA) is a parasympathetic-mediated biomarker of self-regulation linked to lifespan mental and physical health outcomes. Intergenerational impacts of mothers' exposure to prenatal stress have been demonstrated, but evidence for biological embedding of maternal preconception stress, including adverse childhoo...

In the US, the non-Hispanic Black infant mortality rate exceeds the rate among non-Hispanic Whites by more than two-fold. To explore factors underlying this persistent disparity, we employed a mixed methods approach with concurrent quantitative and qualitative data collection and analysis. Eighteen women participated in interviews about their exper...

Despite the growth in empirical research on neighborhood environmental characteristics and their influence on children’s diets, physical activity, and obesity, much remains to be learned, as few have examined the relationship between neighborhood food availability on dietary behavior in children, specifically. This analysis utilized data from a com...

Objectives: To determine the association between neighborhood domestic violence and small-for-gestational-age (SGA) birth and to examine if there is a differential impact of neighborhood domestic violence on SGA births by race in a high crime community. Methods: This analysis includes all birth records issued in New Orleans, Louisiana from 2011...

This study examines the implications of a history of personal violence on health and health behaviors. A secondary analysis of cross-sectional data involving adults (n = 214) from a semirural area in southern Louisiana between October 2008 and December 2010 was conducted to ascertain the association between a personal history of violence victimizat...

We examined associations between state-level measures of structural racism and infant mortality among black and white populations across the US. Overall and race-specific infant mortality rates in each state were calculated from national linked birth and infant death records from 2010 to 2013. Structural racism in each state was characterized by ra...

Respiratory sinus arrhythmia (RSA), a marker of parasympathetic activity, has been shown to moderate the relation between adversity and child behavioral outcomes; however, this work has been conducted in primarily Caucasian samples and limited in focus to family-level adversity. The current analysis extends the previous literature to examine the co...

Childhood violence exposure is a prevalent public health problem. Understanding the lasting impact of violence requires an enhanced appreciation for the complex effects of violence across behavioral, physiologic, and molecular outcomes. This subject matched, cross-sectional study of 80 children explored the impact of violence exposure across behavi...

An increase in the marketing and use of herbal galactagogues among breastfeeding mothers in the US has raised the issue of how best to provide support and information on the use of these products, particularly in light of limited availability of certified lactation counselors and continued suboptimal rates of breastfeeding globally. Currently, no c...

Introduction: Systematic social observation (SSO) methods traditionally measure neighborhoods at street level and have been performed reliably using virtual applications to increase feasibility. Research indicates that collection at even higher spatial resolution may better elucidate the health impact of neighborhood factors, but whether virtual ap...

Background: Reproductive rights-the ability to decide whether and when to have children-shape women's socioeconomic and health trajectories across the life course. The objective of this study was to examine reproductive rights in association preterm birth (PTB; <37 weeks) and low birth weight (LBW; <2,500g) across states in the United States. Met...

Background: The U.S. Federal Reasonable Break Time for Nursing Mothers Law to support breastfeeding employees was passed in 2010, as part of the Affordable Care Act. However, few data are available assessing employers' awareness of the law or its implementation. Objectives: The study aims were to 1) describe New Orleans employers' awareness of t...

Background Exclusive breastfeeding for infants up to 6 months is widely recommended, yet breastfeeding rates are relatively low in the US. The most common reason women stop breastfeeding early is a perceived insufficiency of milk. Galactagogues are herbal and pharmaceutical products that can help increase milk supply; however, data on their efficac...

Importance: Exposure to violence continues to be a growing epidemic, particularly among children. An enhanced understanding of the biological effect of exposure to violence is critical. Objective: To examine the association between neighborhood violence and cellular and biological stress in children. Design, setting, and participants: A matche...

Background: Health disparities begin early in life and persist across the life course. Despite current efforts, black women exhibit greater risk for pregnancy complications and negative perinatal outcomes compared with white women. The placenta, which is a complex multi-tissue organ, serves as the primary transducer of bidirectional information be...

Table of contents A1. Infant feeding and poverty: a public health perspective in a global context Lisa H. Amir A2. Mothers’ experiences with galactagogues for lactation: an exploratory cross sectional study Alessandra Bazzano, Shelley Thibeau, Katherine P. Theall A3. The motherhood journey and breastfeeding: from self-efficacy to resilience and soc...

Background: In contrast with other developed countries, the United States lacks national paid maternity/family and sick leave policies, negatively impacting the health and economic security of both female and male workers and their children. Employer paid family and sick leave policies cover only about half of workers, and those lacking paid leave...

Anxiety in pregnancy has been associated with adverse birth outcomes. Relatively few studies have investigated how acculturation affects mental health in pregnancy among Latinas. The goal of this study was to determine if acculturation was associated with anxiety over the course of pregnancy in a sample of predominantly Puerto Rican women. Women we...

Introduction Latinas in the United States on average have poorer birth outcomes than Whites, yet considerable heterogeneity exists within Latinas. Puerto Ricans have some of the highest rates of adverse outcomes and are understudied. The goal of this study was to determine if acculturation was associated with adverse birth outcomes in a predominant...

The objective of this study was to examine the association between externalizing behaviors and indirect violence exposure, assessed both within the household and at the community level, as well as the interaction effect of indirect and direct violence exposure. A sample of parents of children ages 4–15 who have not been referred or enrolled in chil...

Background: Postpartum depression is associated with negative physical and mental health outcomes for both the mother and infant. This study examines the relationship between a mother and/or her partner's pregnancy intentions and reported post-partum depressive symptoms (PPDs). Methods: Using Louisiana pregnancy risk assessment monitoring system...

The current investigation examined the association between the aging-related biomarkers dehydroepiandrosterone (DHEA) and telomere length (TL) in community-recruited African-American youth. The examination of DHEA included stress reactive, basal and diurnal sampling, in order to elucidate the underlying physiological process that may overlap with T...

Objectives: We examined the relationship between cumulative experiences of racial discrimination and HIV-related risk taking, and whether these relationships are mediated through alcohol use among African Americans in semi-rural southeast Louisiana. Methods: Participants (N = 214) reported on experiences of discrimination, HIV sexual risk-taking...

Background: Therapeutic approaches to addressing insufficient lactation are available but remain poorly understood. Current trends in maternal health, such as increasing rates of obesity, delayed age at childbearing, and high rates of cesarean section, may be associated with physiological challenges for lactation that cannot be managed by counseli...

Background: Latinas have high overall breastfeeding initiation rates, yet Puerto Ricans have among the lowest exclusive breastfeeding rates. This study sought to determine if acculturation was associated with intent to breastfeed in a predominantly Puerto Rican population. Methods: A cohort of Latina women were enrolled in Proyecto Buena Salud,...

Background Socioeconomic status at national, sub-national, household, and individual levels explains a significant portion of variation in infant mortality. Women's education is among the major determinants of infant mortality. The mechanism through which a woman's own educational status, over her husband's as well as household characteristics, inf...

In May 2012, the Association of Maternal and Child Health (MCH) Programs initiated a project to develop indicators for use at a state or community level to assess, monitor, and evaluate the application of life course principles to public health. Using a developmental framework established by a national expert panel, teams of program leaders, epidem...

We examine the impact of an adapted community popular opinion leader (C-POL) intervention targeting alcohol-using social networks in Southeast Louisiana. A pre-post C-POL was conducted between October 2009 and April 2013, targeting alcohol users. A total of 65 popular opinion leaders were recruited, trained, and deployed into their social networks...

To explore the effect of an innovative, integrative program in female sexual reproductive health (SRH) and soccer (or fútbol, in Haitian Creole) in rural Haiti by measuring the rate of births among program participants 15-19 years old and their nonparticipant peers. A retrospective cohort study using 2006-2009 data from the computerized data-tracki...

To examine the impact of neighborhood disorder, perceived neighborhood safety, and availability of recreational facilities on prevalence of physical activity (PA), obesity, and diabetes mellitus (DM). Multilevel analyses were conducted among 2,848 respondents from the 2007-08 Jamaica Health and Lifestyle Survey. Neighborhood effects were based on a...

Background: To enhance the understanding of biological mechanisms connecting early adversity and negative health, we examine the association between community and family violence and telomere length in youth. These specific exposures were selected due to their established links with negative health consequences across the life-course. Methods: Ch...

Background: Louisiana has one of the lowest percentages of women breastfeeding at 6 months. Support from a mother’s employer, along with time and space to pump at work, is essential in addressing the issue of breastfeeding duration. Louisiana is the first state to pass legislation that addresses provisions for lactating mothers who work in the scho...

Objective To investigate reasons for geographic variation of obesity in Jamaica Study Design and Setting Using the Jamaica Health and Lifestyle Survey 2008 (JHLS II) parish-specific age-adjusted prevalence estimates of obesity were obtained. Sex-specific odds ratios for obesity by parish were determined using the parish with the lowest obesity...

We examine the association between personal history of violence and perceived discrimination and assertive communication with sexual partners among adult men and women interviewed as part of a baseline intervention study in a semi-rural area in southern Louisiana. Both personal history of violence and experiences of discrimination have been linked...