Michael R Kramer

Michael R Kramer
Emory University | EU · Department of Epidemiology

PhD

About

195
Publications
19,672
Reads
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5,262
Citations
Additional affiliations
January 2011 - August 2017
Emory University
Position
  • Professor
November 2009 - present
Emory University
Position
  • Research Assistant

Publications

Publications (195)
Article
Background: Bicycling is an important form of physical activity in populations. Research assessing the effect of infrastructure on bicycling with high-resolution smartphone data is emerging in several places, but it remains limited in low-bicycling U.S. settings, including the Southeastern U.S. The Atlanta area has been expanding its bicycle infra...
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Highly public anti-Black violence may increase preterm birth in the general population of pregnant women via stress-mediated paths, particularly Black women exposed in early gestation. To examine spillover from racial violence in the US, we included a total of 49 high publicity incidents of the following types: police lethal force toward Black pers...
Article
Purpose : To examine the hypothesis that longer distance from home-to-hospital is associated with worse outcomes among hospitalizations for community-acquired sepsis. Methods : A secondary analysis of data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) prospective cohort of 30,239 white and black US adults ≥ 45 years ol...
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Objective: To characterize county-level differences in pregnancy-related mortality as a function of sociospatial indicators. Methods: We conducted a cross-sectional multilevel analysis of all pregnancy-related deaths and all live births with available ZIP code or county data in the Pregnancy Mortality Surveillance System during 2011-2016 for non...
Article
Purpose Passively generated cell-phone location (“mobility”) data originally intended for commercial use has become frequently used in epidemiologic research, notably during the COVID-19 pandemic to study the impact of physical-distancing recommendations on aggregate population behavior (e.g., average daily mobility). Given the opaque nature of how...
Article
Policy Points Policies that increase county income levels, particularly for middle-income households, may reduce low birth weight rates and shrink disparities between Black and White infants. Given the role of aggregate maternal characteristics in predicting low birth weight rates, policies that increase human capital investments (e.g., funding for...
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Background Underserved subgroups are less likely to have optimal health prior to pregnancy. We describe preconception health indicators (behavior, pregnancy intention, and obesity) among pregnant Latina women with and without chronic stress in metro Atlanta. Design We surveyed 110 pregnant Latina women enrolled in prenatal care at three clinics in...
Article
Depression is a common comorbidity among Black women with systemic lupus erythematosus (SLE), an understudied autoimmune disease characterized by major racial and gender inequities. Research is needed that examines how area-level factors influence risk of depression in this population. Latent profile analysis revealed four neighborhood typologies a...
Article
Studies documenting self-reported experiences of discrimination over the life-course have been limited. Such information could be important for informing longitudinal epidemiologic studies of discrimination and health. We described trends in self-reports of racial, socioeconomic status, and gender discrimination over time measured using the Experie...
Article
Introduction: Limited existing research suggests that immigration climate and enforcement practices represent a social determinant of health for immigrants, their families, and communities. However, national research on the impact of specific policies is limited. The goal of this article is to estimate the effect of county-level participation in a...
Article
Highly public anti-Black violence in the United States may cause widely experienced distress for Black Americans. This study identifies 49 publicized incidents of racial violence and quantifies national interest based on Google searches; incidents include police killings of Black individuals, decisions not to indict or convict the officer involved,...
Article
Objectives Limited evidence suggests racial/ethnic disparities in postpartum visit attendance; however, little is known about patterns in postpartum visit content. We sought to determine whether receipt of screening and counseling varies by race/ethnicity and whether cardiovascular disease (CVD) risk (preconception or pregnancy related) predicts po...
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Introduction In the context of a shifting health care landscape, better understanding of the factors that motivate women to seek services from specialized family planning clinics like Planned Parenthood (PP) can provide insights about potential changes in the role of specialized family planning clinics. Methods We surveyed 725 women seeking servic...
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Stress across the life course is highly prevalent, particularly among immigrant and racial/ethnic minority women who face adversities associated with structural and interpersonal racism. Understanding how women perceive and describe stress and resilience can provide cultural context to inform interventions to improve health among pregnant women fac...
Article
Inconclusive evidence for how food environments affect health may result from an emphasis on residential neighborhood-based measures of exposure. We used an activity space approach to examine whether 1) measures of food access and 2) associations with diet and BMI differ between residential and activity space food environments among low-income Afri...
Article
Transient exposures are difficult to measure in epidemiologic studies, especially when both the status of being at risk for an outcome and the exposure change over time and space, as when measuring built-environment risk on transportation injury. Contemporary ‘big data’ generated by mobile sensors can improve measurement of transient exposures. Unf...
Article
Background: Little is known about the role that transplant centers may play in perpetuating racial disparities after liver transplantation, which are unexplained by patient-level factors. We examined variation in between- and within-center disparities among 34,114 Black and white liver transplant recipients in the United States from 2010 to 2017 u...
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Objectives: Respiratory failure with mechanical ventilation is a limited labor-intensive resource that is associated with high mortality. Understanding the longitudinal national epidemiology is essential for the organization of healthcare resources. Design: Serial cross-sectional study. Setting: The 2002-2017 Healthcare Utilization Project's N...
Article
Most Indian adolescents, particularly girls and private school students, do not engage in sufficient physical activity (PA). Current understanding of these sociodemographic differences is limited by a focus on exercise, which may not fully capture PA in developing countries. We examined how gender and school type are associated with multiple PA dom...
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Purpose HIV pre-exposure prophylaxis (PrEP) is highly efficacious, and yet most individuals indicated for it are not currently using it. To provide guidance for health policymakers, researchers, and community advocates, we developed county-level PrEP use estimates and assessed locality and policy associations. Methods Using data from a national ag...
Article
Introduction: The food environment has received considerable attention as a potential correlate of diet-related CV health. Features of the food environment are assumed to influence the places where people shop, which in turn affect the types of foods purchased and ultimately consumed. However, this assumption remains largely untested due to limited...
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Background: There is limited information on potentially modifiable risk factors for stillbirth, such as gestational weight gain (GWG). Our purpose was to explore the association between GWG and stillbirth using the GWG z-score. Methods: We analyzed 479 stillbirths and 1601 live births from the Stillbirth Collaborative Research Network case-contr...
Article
Increasing population levels of cycling has the potential to improve public health by increasing physical activity. As cyclists have begun using smartphone apps to record trips, researchers have used data generated from these apps to monitor cycling levels and evaluate cycling-related interventions. The goal of this research is to assess the extent...
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Using a case–control study of patients receiving antiretroviral treatment (ART) in 2010–2012 at McCord Hospital in Durban, South Africa, we sought to understand how residential locations impact patients’ risk of virologic failure (VF). Using generalized estimating equations to fit logistic regression models, we estimated the associations of VF with...
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This study explored the extent to which county- and individual-level factors were associated with awareness, willingness to use, and use of pre-exposure prophylaxis (PrEP) among US men who have sex with men (MSM). We conducted multilevel analyses using a sample of 8338 MSM residing in 1257 US counties drawn from the 2014–2015 American Men’s Interne...
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Objectives A skilled workforce is essential to advancing maternal and child health (MCH) in a rapidly changing public health system. Little is known about the MCH workforce’s existing capacity to maximize opportunities afforded by ongoing change. We assessed MCH workforce capacity in three areas: Systems Integration, Evidence-Based Decision-Making,...
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Objectives Preterm birth (PTB) is a leading cause of infant morbidity and mortality. One goal of Healthy People 2020 is to understand the role of preconception lifecourse exposures in relation to pregnancy outcomes, including PTB. The objective of this study was to examine the relationship between maternal exposure to multiple forms of childhood ab...
Article
Purpose: We examined the association between interpregnancy intervals (IPIs) and stillbirth (defined as fetal death ≥20 weeks), as both short and long IPIs have been associated with adverse perinatal outcomes. Prior pregnancy loss is also a known risk factor for stillbirth, and women who suffer a prior loss often have shorter IPIs. For these reaso...
Article
Introduction: The increasing global burden of CVD mortality is primarily attributable to the rising number of deaths in developing countries; India alone accounted for 15% of global CVD deaths in 2016. Little is known about patterns and predictors of physical activity (PA), a key modifiable risk factor for CVD, among Indian adolescents. Existing re...
Article
Study objective: Quantitative data suggest that adolescent users of long-acting reversible contraception (LARC), compared with short-acting methods (pill, patch, ring, depot medroxyprogesterone acetate [DMPA]), might be less likely to use condoms. We qualitatively describe and explain adolescent contraceptive users' motivations for condom use, inc...
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Background Using a cross-sectional design, we assessed the relationship between the time schools provide for physical activity and the proportion of students achieving a healthy aerobic capacity or body mass index. Methods In 2013–2014, physical education and grade-level teachers from 905 of 1,244 Georgia elementary schools provided survey data ab...
Data
Joint distribution of physical education frequency and duration for Georgia fifth-grade students (2013–2014). (DOCX)
Data
Histogram of physical education (PE) time (minutes per week) across Georgia elementary schools to demonstrate the creation of the continuous PE time variable. (DOCX)
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A holistic view of racial and gender disparities that simultaneously compares multiple groups can suggest associated underlying contextual factors. Therefore, to more comprehensively understand temporal changes in combined racial and gender disparities, we examine variations in the orders of county-level race-gender specific heart disease death rat...
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Background There is scarce longitudinal data on the risk factors and mediators of racial disparities in sepsis among community-dwelling US adults. Methods A longitudinal study of adult participants in the 1999–2005 National Health Interview Survey with data linked to the 1999–2011 National Death Index. We utilized National Vital Statistics System’...
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Living in neighborhoods characterized by poverty may act as a chronic stressor that results in physiological dysregulation of the sympathetic nervous system. No previous study has assessed neighborhood poverty with hemodynamic, neuroendocrine, and immune reactivity to stress. We used data from 632 patients with coronary artery disease. Patients’ re...
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One hypothesized explanation for the recent slowing of declines in heart disease death rates is the generational shift in the timing and accumulation of risk factors. However, directly testing this hypothesis requires historical age-group-specific risk factor data that do not exist. Using national death records, we compared spatiotemporal patterns...
Article
Objective: The Healthy Weight Counseling Maintenance of Certification (MOC) program integrates pediatrician training and clinic changes to promote use of evidence-based, diet and physical activity (PA) health messages and counseling strategies. This interrupted time series study assessed the impact of this MOC program on provision of weight-relate...
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Neighborhood social and physical factors shape sexual network characteristics in HIV-seronegative adults in the U.S. This multilevel analysis evaluated whether these relationships also exist in a predominantly HIV-seropositive cohort of women. This cross-sectional multilevel analysis included data from 734 women enrolled in the Women’s Interagency...
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Objectives: To explore international differences in the classification of births at extremely low gestation and the subsequent impact on the calculation of survival rates. Methods: We used national data on births at 22 to 25 weeks' gestation from the United States (2014; n = 11 144), Canada (2009-2014; n = 5668), the United Kingdom (2014-2015; n...
Article
Being born preterm and being raised in poverty are each linked with adverse cognitive outcomes. Using data from 5,250 singletons born in the US in 2001 and enrolled in the Early Childhood Longitudinal Study-Birth Cohort, we examined whether household socioeconomic status (SES) modified the association between preterm birth (PTB) and children's scor...
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Despite substantial declines since the 1960's, heart disease remains the leading cause of death in the United States (US) and geographic disparities in heart disease mortality have grown. State-level socioeconomic factors might be important contributors to geographic differences in heart disease mortality. This study examined the association betwee...
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Problem/condition: Heart disease is the leading cause of death in the United States. In 2015, heart disease accounted for approximately 630,000 deaths, representing one in four deaths in the United States. Although heart disease death rates decreased 68% for the total population from 1968 to 2015, marked disparities in decreases exist by race and...
Article
Background: Lung cancer–related death rates in the United States have declined steadily since 1990 in men but not until the mid-2000s in women, with the gap in mortality narrowing during the most recent time period. We examined variation in the declining trend among women by county, where many tobacco control policies are implemented. Methods: We o...
Article
Introduction: Community food environments (FE) are an important correlate of diet- and weight-related CV health. Conventional approaches to measuring the FE focus on residential neighborhoods, and do not assess the full extent of food sources regularly encountered and used. Further, little attention has been given to how individual diet-related exp...
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Childhood maltreatment is common and has been increasingly studied in relation to perinatal outcomes. While retrospective self-report is convenient to use in studies assessing the impact of maltreatment on perinatal outcomes, it may be vulnerable to bias. We assessed bias in reporting of maltreatment with respect to women's experiences of adverse p...
Article
Delay discounting is a measure of impulsivity that has been found to be associated with numerous health-related outcomes. To the extent that delay discounting is associated with sexual risk-taking, it might serve as a marker for HIV risk or as the basis for novel HIV prevention interventions. The goal of the current study was to examine the associa...
Article
Purpose: Long-acting reversible contraceptive (LARC) methods do not require annual clinic visits for continuation, potentially impacting receipt of recommended sexually transmitted infection (STI)/human immunodeficiency virus (HIV) services for young women. We assess service receipt among new and continuing LARC users versus moderately and less ef...
Article
Case reports and pathology series suggest associations of female genital schistosomiasis (Schistosoma haematobium) with infertility and ectopic pregnancy. Differential geographic distribution of infertility is not explained by analyses of known risk factors. In this cross-sectional multilevel semi-ecologic study, interpolated prevalence maps for S....
Article
Objective To investigate the potential dietary impact of the opening of new retailers of healthy foods. Design Systematic review of the peer-reviewed research literature. Setting References published before November 2015 were retrieved from MEDLINE, EMBASE and Web of Science databases using keyword searches. Subjects The outcome of the review wa...
Article
Background: Preterm birth and childhood poverty each adversely impact children's cognitive development and academic outcomes. In this study, we investigated whether the relationships between preterm and early term birth and children's cognitive scores at 3, 5, and 7 years old were modified by childhood poverty. Methods: This study was conducted...
Article
Background Delay discounting has been found to be associated with numerous health-related outcomes, including risky sexual behaviour. To date, it is unclear whether delay discounting measured in different domains is associated within individuals. The goal of this study was to assess the concordance of monetary and sexual delay discounting in men wh...
Article
Objective: To evaluate whether elective induction of labor between 39 through 41 weeks of gestation, as compared with expectant management, is associated with reduced cesarean delivery and other adverse outcomes among obese women and their offspring. Methods: We conducted a retrospective cohort study using the 2007-2011 California Linked Patient...
Article
Objective: To examine the effect of pregnancy history on the risk of stillbirth. Methods: In a population-based cross-sectional study, data were reviewed from all women aged at least 20 years with singleton pregnancies in Finland between 2000 and 2010. The primary outcome-stillbirth-was defined as fetal death after 22 gestational weeks or death...
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Social class gradients in children’s health and development are ubiquitous across time and geography. The authors develop a conceptual framework relating three actions of class—material allocation, salient group identity, and inter-group conflict—to the reproduction of class-based disparities in child health. A core proposition is that the actions...
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Studies on adult racial/ethnic minority populations show that the increased concentration of racial/ethnic minorities in a neighbourhood—a so-called ethnic density effect—is associated with improved health of racial/ethnic minority residents when adjusting for area deprivation. However, this literature has focused mainly on adult populations, indiv...
Article
Purpose: Recent national trends show decelerating declines in heart disease mortality, especially among younger adults. National trends may mask variation by geography and age. We examined recent county-level trends in heart disease mortality by age group. Methods: Using a Bayesian statistical model and National Vital Statistics Systems data, we...
Article
Background: Few studies have investigated international variations in the gestational age (GA) distribution of births. While preterm births (22-36 weeks GA) and early term births (37-38 weeks) are at greater risk of adverse health outcomes compared to full term births (39-40 weeks), it is not known if countries with high preterm birth rates also h...
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Background Access to transportation is vital to reducing the travel time to emergency obstetric and neonatal care (EmONC) for managing complications and preventing adverse maternal and neonatal outcomes. This study examines the distribution of travel times to EmONC in Kigoma Region, Tanzania, using various transportation schemes, to estimate the pr...
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It is unclear whether cancer and its treatments increase the risk of adverse pregnancy outcomes. Our aim was to examine whether cancer survivors have higher risks of poor outcomes in pregnancies conceived after diagnosis than women without cancer, and whether these risks differ by cancer type and race. Diagnoses from cancer registries were linked t...
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Introduction: Previous studies have found associations between respiratory morbidity and high temperatures; however, few studies have explored associations in potentially sensitive sub-populations. Methods: We evaluated individual and area-level factors as modifiers of the association between warm-season (May-Sept.) temperature and pediatric res...
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Background: This study aims to characterize the role of county-specific legacy of slavery in patterning temporal (i.e., 1968–2014), and geographic (i.e., Southern counties) declines in heart disease mortality. In this context, the U.S. has witnessed dramatic declines in heart disease mortality since the 1960s, which have benefitted place and race g...
Conference Paper
Introduction Long-acting reversible contraceptive (LARC) users may be less likely to receive recommended STI prevention services because these methods do not require routine clinic visits for continuation. We compared receipt of services between young women using LARC and other contraceptive methods or no method. Methods Data were from the 2011–20...